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1.
Rev. colomb. cir ; 37(1): 90-95, 20211217. fig, tab
Article in Spanish | LILACS | ID: biblio-1355314

ABSTRACT

Introducción. La fístula enteroatmosférica es una patología compleja que puede ser el resultado de múltiples intervenciones quirúrgicas de la cavidad abdominal. Describimos una nueva técnica para el control de la contaminación en pacientes con fístulas enteroatmosféricas en abdomen abierto Björck 4.Métodos. Se realizó un análisis retrospectivo de cuatro pacientes con fístulas enteroatmosféricas desarrolladas como complicación de procedimientos quirúrgicos abdominales. Se trataron integralmente por un grupo multidisciplinario de Cuidados Intensivos, Cirugía general, Soporte nutricional y Cuidado de heridas y ostomías. Se utilizó una novedosa técnica quirúrgica basada en el principio de capilaridad para mantener limpios los tejidos periostomales. Resultados. Con esta técnica se logró el control de la contaminación abdominal en todos los pacientes y una evo-lución clínica satisfactoria. Posteriormente se programaron para cierre quirúrgico definitivo con éxito. Conclusiones. El manejo de la fístula enteroatmosférica representa un reto para el cirujano y el grupo multidisciplinario que trata al paciente. Esta nueva técnica utilizada en pacientes con fístula enteroatmosférica con abdomen abierto Björck 4 se basa en el principio de capilaridad, y es eficaz en el control de la contaminación, infección y de la sepsis asociada.


Introduction. Enterocutaneous fistula is a complex pathology that can be the result of multiple surgical interventions of the abdominal cavity. We describe a new technique for the control of contamination in patients with enterocutaneous fistulas in the open abdomen Björck 4. Methods. A retrospective analysis of four patients with enterocutaneous fistulas developed as a complication of abdominal surgical procedures was performed. They were treated by a multidisciplinary team of Intensive Care, General Surgery, Nutritional support and Wound and ostomy care. A novel surgical technique based on the capillarity principle was used to keep the periostomies tissues clean. Results. With this technique, control of abdominal contamination was achieved in all patients and a satisfactory clinical evolution. Later they were scheduled for definitive surgical closure with total success. Conclusions. The management of an enterocutaneous fistula represents a challenge for the surgeon and the multidisciplinary group that treats these patients. This new technique used in patients with an enterocutaneous fistula with open abdomen Björck 4 is based on the principle of capillarity action, and is effective in controlling contamination, infection, and associated sepsis.


Subject(s)
Humans , Intestinal Fistula , Sepsis , Peritonitis , General Surgery , Capillaries
2.
Rev. Méd. Paraná ; 79(1): 82-84, 2021.
Article in Portuguese | LILACS | ID: biblio-1282483

ABSTRACT

O íleo biliar representa de 1 a 4% das causas de obstrução mecânica do trato gastrointestinal, causado por um cálculo de origem biliar quando atinge a luz intestinal através de uma fístula bilioentérica. O seu tratamento normalmente é cirúrgico através da enterolitotomia, com ou sem realização de colecistectomia e correção da fístula bilioentérica no mesmo tempo cirúrgico. Relata-se o caso de um paciente de 78 anos com obstrução intestinal ao nível do íleo terminal. Devido ao risco cirúrgico elevado optou-se pela realização de colonoscopia de urgência, que extraiu um cálculo de 2,1cm, impactado na válvula ileocecal. O paciente evoluiu bem após o procedimento, sendo optado pelo tratamento conservador da vesícula biliar e fístula durante o internamento. Conclui-se que pacientes de alto risco se beneficiam com procedimentos menos invasivos, como os endoscópicos, que além de diagnósticos podem ser terapêuticos


The gallstone ileus represents 1 to 4% of the causes of mechanical obstruction from gastrointestinal tract, caused by a gallstone when it reaches the intestinal lumen through a bilioenteric fistula. The treatment is usually the enterolithotomy, with or without cholecystectomy and correction of the bilioenteric fistula at the same surgical time. We report a case of a patient, 78 years old, with intestinal obstruction at the level of the ileocecal valve. The examination showed abdominal distension and pain, with no signs of peritonitis. Due to the surgical risk, a emergency colonoscopy was performed, which removed a 2.1 cm gallstone impacted into the ileocecal valve. The patient evolved well after the procedure and it was chosen the conservative approach to the gallbladder and fistula during the same hospital stay. We conclude that the high-risk patients could benefit from less invasive treatments, such as endoscopy, which can be diagnoses and therapeutic


Subject(s)
Humans , Digestive System Fistula , Biliary Fistula , Intestinal Fistula , Gallbladder , Intestinal Obstruction , Ileum
3.
ABCD arq. bras. cir. dig ; 34(2): e1605, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345006

ABSTRACT

ABSTRACT Background: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. Aim: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. Method: A systematic literature search was conducted in May 2020 with the headings "fistuloclysis", "chyme reinfusion" and "succus entericus reinfusion", in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. Conclusion: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.


RESUMO Racional: As fístulas enterocutâneas representam uma conexão entre o trato gastrointestinal e os tecidos adjacentes. Dentre elas, há uma subdivisão - as fístulas enteroatmosféricas, em que a origem é o trato gastrointestinal em conexão com o meio externo por meio de uma ferida aberta no abdômen. Devido ao alto débito nas fístulas enterocutâneas, a perda de fluidos, eletrólitos, minerais e proteínas levam a complicações como sepse, desnutrição e desequilíbrios eletrolíticos. A nutrição parenteral tem seus riscos secundários, e a fistuloclise, que consiste na infusão de nutrição enteral e também do quimo pela fístula distal, representa uma alternativa no manejo desses pacientes até a abordagem cirúrgica definitiva. Objetivo: Avaliar as evidências atuais sobre a técnica de fistuloclise, sua aplicabilidade, vantagens e desvantagens para pacientes com fístulas de alto débito. Método: Foi realizada uma busca sistemática da literatura em maio de 2020 com os títulos "fistuloclysis", "chyme reinfusion" e "succus entericus reinfusion", nas bases de dados PubMed, Medline e SciELO. Resultados: Foram selecionados 29 artigos para o desenvolvimento desta síntese narrativa, no período de 2003 a 2020, incluindo revisões e relatos de caso. Conclusão: A fistuloclise é um método seguro que otimiza as condições clínicas, nutricionais e imunológicas dos pacientes com fístulas enteroatmosféricas, aumentando as chances de sucesso do procedimento de reconstrução. Nos casos em que o reparo definitivo não é possível, aumentam as chances de reduzir ou mesmo interromper o uso da nutrição pela via parental, representando uma modalidade promissora para o manejo dos casos mais desafiadores.


Subject(s)
Humans , Intestinal Fistula/therapy , Sepsis/therapy , Nutritional Status , Enteral Nutrition , Parenteral Nutrition
5.
Rev. cir. (Impr.) ; 72(1): 59-63, feb. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1092891

ABSTRACT

Resumen Introducción Las fístulas aorto-entéricas (FAE) son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Caso clínico Reportamos el caso de una mujer de 66 años intervenida por un aneurisma sacular aórtico abdominal (AAA) yuxtarrenal, con rotura contenida, fistulizado al duodeno. Presentó una hemorragia digestiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio. La paciente fue sometida a reparación quirúrgica urgente con instalación de una prótesis aórtica bifemoral y resección duodenal. En el postoperatorio inmediato presentó una trombosis parcial de las ramas de la prótesis aórtica e isquemia de extremidades, siendo reintervenida exitosamente. Discusión La FAE es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación de la fístula. Es preferible la resección duodenal ante la simple duodenorrafia.


Introduction Aorto-enteric fistulae (AEF) are a rare cause of gastrointestinal bleeding. The prognosis tends to be ominous, depending greatly in a high level of clinical suspicion and prompt diagnosis. Clinical case We report a case of a 66-year-old female with a saccular juxta-renal abdominal aortic aneurysm (AAA), with a contained rupture. The patient was urgently submitted to surgical repair using an bifemoral aortic prosthesis. A duodenal partial resection was performed. During the immediate postoperative time she presented partial thrombosis of prosthesis and ischemia of lower extremities so she was reoperated successfully. Discussion AEF is a potentially fatal cause of gastrointestinal bleeding. Diagnosis is still troublesome due to its vague presentation and it should always be considered when facing gastrointestinal haemorrhage with no apparent cause. There are several surgical approaches that should be pondered case to case without delaying the repair of the defect.


Subject(s)
Humans , Female , Aged , Aortic Diseases/complications , Intestinal Fistula/surgery , Intestinal Fistula/complications , Duodenal Diseases/complications , Gastrointestinal Hemorrhage/surgery , Intestinal Fistula/diagnosis , Treatment Outcome , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Blood Vessel Prosthesis Implantation/methods , Perioperative Period , Gastrointestinal Hemorrhage/diagnosis
6.
MedUNAB ; 23(2): 288-293, 22-07-2020.
Article in Spanish | LILACS | ID: biblio-1118340

ABSTRACT

Introducción. La patología umbilical es un tema frecuente en el ámbito pediátrico, la presentación clínica de una fístula umbilical hace pensar en dos patologías mencionadas en la literatura de manera independiente; la primera es la persistencia del conducto onfalomesentérico y la segunda es la persistencia del remanente del uraco producto del fracaso en el cierre de las estructuras embrionarias. Su presencia en adultos es infrecuente y no existen datos estadísticos acerca de su presentación conjunta en población pediátrica o adulta, solo algunos pocos reportes de caso. El diagnóstico se basa principalmente en la sospecha clínica, depende en gran manera del examen físico al evidenciar secreción a través del ombligo al realizar esfuerzos o maniobras de Valsalva. Objetivo. Mostrar un caso infrecuente de la presentación simultánea del conducto de uraco y onfalomesentérico en un paciente adulto. Reporte de caso. Paciente femenina de 24 años de edad con antecedentes de infecciones urinarias y celulitis periumbilicales a repetición. Se sospecha un conducto persistente onfalomesentérico por lo que es sometida a un procedimiento quirúrgico en el que se encontró incidentalmente la persistencia simultánea del conducto onfalomesentérico y persistencia del uraco. Discusión. La persistencia del conducto onfalomesentérico o la persistencia del uraco de forma individual es poco frecuente en adultos, y es aún más raro la persistencia simultánea de ambos conductos; la presencia simultánea de ambos conductos es reportada principalmente en menores de dos años. Conclusiones. La persistencia de estos conductos es rara en adultos y representa un reto diagnóstico para el clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.


Introduction. Umbilical pathology is a common topic in the pediatric sphere. The clinical presentation of an umbilical fistula leads to the consideration of two pathologies independently reported in literature. The first is a persistent vitelline duct and the second is a persistent urachal remnant as a result of the embryonic structures' failure to close. They are uncommon in adults and there are no statistical data about their presentation together in the pediatric or adult population, only very few case reports. The diagnosis is mainly based on clinical suspicion. It largely depends on a physical examination noting secretion through the navel when straining or performing Valsalva maneuvers. Objective. Show an uncommon case of the simultaneous presentation of the urachus and vitelline ducts in an adult patient. Case report. Female patient aged 24 years with a background of repeated urinary tract infections and periumbilical cellulitis. A persistent vitelline duct is suspected. Therefore, the patient is subject to a surgical procedure in which the simultaneous persistence of the vitelline duct and the urachus was found incidentally. Discussion. The persistence of the vitelline duct or the persistence of the urachus individually is uncommon in adults, and the simultaneous persistence of both ducts is even rarer. The simultaneous presence of both ducts is reported mainly in infants aged under two years. Conclusions. The persistence of these ducts is rare in adults and poses a diagnostic challenge for clinicians. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.


Introdução. A patologia umbilical é um tópico frequente no cenário pediátrico; a apresentação clínica de uma fístula umbilical faz pensar em duas patologias mencionadas na literatura de forma independente; a primeira é a persistência do ducto onfalomesentérico e a segunda é a persistência do úraco como resultado da falha no fechamento das estruturas embrionárias. É pouco frequente sua presença em adultos e não há dados estatísticos sobre sua apresentação conjunta em população pediátrica nem adulta, apenas alguns poucos relatos de caso. O diagnóstico baseia-se principalmente na suspeita clínica, dependendo em grande parte do exame físico ao evidenciar uma secreção pelo umbigo quando realizar esforço ou manobra de Valsalva. Objetivo. Mostrar um caso infrequente de apresentação simultânea do úraco e ducto onfalomesentérico em um paciente adulto. Relato de caso. Paciente do sexo feminino, 24 anos, com histórico de infecções urinárias e celulite periumbilical recorrentes. Suspeita-se de um ducto onfalomesentérico persistente, portanto ela é submetida a um procedimento cirúrgico no qual encontrou-se a persistência do ducto onfalomesentérico e a persistência de úraco simultaneamente. Discussão. A persistência do ducto onfalomesentérico e a persistência de úraco individualmente é rara em adultos, e a persistência simultânea de ambos os ductos é ainda mais rara; esta presença simultânea é relatada principalmente em crianças menores de dois anos de idade. Conclusão. A persistência desses ductos é rara em adultos e representa um desafio diagnóstico para o profissional de saúde clínico. Cómo citar: Escudero-Sepúlveda AF, Cala-Duran JC, Belén Jurado MB, Pinasco-Gómez R, Tomasone SE, Roccuzzo C, Domínguez-Alvarado GA. Persistencia simultánea del conducto uraco y onfalomesentérico en un paciente adulto, reporte de caso. MedUNAB. 2020;23(2): 288-293. doi: 10.29375/01237047.3826.


Subject(s)
Urachus , Umbilicus , Vitelline Duct , Urinary Bladder Fistula , Intestinal Fistula , Cutaneous Fistula
7.
Rev. colomb. gastroenterol ; 34(4): 445-449, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1092975

ABSTRACT

Resumen El síndrome de Bouveret (SB) es una patología poco frecuente, la cual se caracteriza por la presencia de obstrucción gástrica o duodenal secundaria a un cálculo enclavado en la luz duodenal, el cual migra a través de una fístula colecistoduodenal. Su incidencia es de alrededor 1% al 3% de todos los casos de íleo biliar. Los principales síntomas consisten en vómito, dolor abdominal, hematemesis, pérdida de peso y anorexia. En el 91% de los casos se requiere manejo quirúrgico. En este artículo se presenta un caso de un paciente de 50 años, con cuadro clínico de 2 meses de evolución de dolor abdominal en epigastrio y mesogastrio, distensión abdominal y múltiples episodios de emesis. Al examen físico con clínica de obstrucción intestinal se realizó tomografía abdominal, donde se evidenció obstrucción intestinal por imagen intraluminal en primera porción duodenal asociada con tríada de Rigler, con diagnóstico de síndrome de Bouveret.


Abstract Bouveret syndrome is a rare pathology which is characterized by gastric or duodenal obstruction secondary to a gallstone embedded in the lumen after migrating through a cholecystoduodenal fistula. Its incidence is approximately 1% to 3% of all cases of biliary ileus. The main symptoms consist of vomiting, abdominal pain, hematemesis, weight loss and anorexia. Surgery is required in 91% of cases. This article presents the case of a 50-year-old patient who had suffered from abdominal pain in the epigastrium and mesogastrium, abdominal distension and multiple episodes of emesis for two months. Physical examination indicated obstruction of the intestine. An abdominal CT scan showed that the obstruction was in the first duodenal portion and that Rigler's triad was present. It was diagnosed as Bouveret Syndrome.


Subject(s)
Humans , Female , Middle Aged , Syndrome , Duodenal Obstruction , Intestinal Obstruction , Vomiting , Weight Loss , Anorexia , Abdominal Pain , Intestinal Fistula , Fistula
8.
Rev. cir. (Impr.) ; 71(5): 442-445, oct. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058298

ABSTRACT

Resumen Introducción: Las fístulas secundarias a una enfermedad diverticular complicada son una indicación formal de cirugía electiva en el 4 a 23% de los casos. Caso Clínico: Se presenta el caso de una mujer de 52 años con antecedentes de una histerectomía subtotal por miomatosis uterina que consulta por cuadro de dolor abdominal en hipogastrio acompañado de fiebre de 4 días de evolución. La tomografía computada (TC) de abdomen y pelvis describe una diverticulitis complicada con absceso peridiverticular. Tratada con antibióticos con buena respuesta clínica consulta a los 3 meses en nuestro servicio por pérdida de material fecal por vagina. Nueva TC confirma la presencia de una colección perisigmoidea y engrosamiento de la pared vesical. La colonoscopía informa una estenosis franqueable a nivel de sigmoides y se constata salida de gases por vagina. La corrección quirúrgica electiva incluyó una sigmoidectomía abierta con traquelectomía en block, cierre de la cúpula vaginal y anastomosis colorrectal mecánica, con buena evolución posoperatoria, sin recidiva a los 12 meses de seguimiento. La fístula sigmoido-cervical es una complicación rarísima de la enfermedad diverticular complicada que puede ocurrir en pacientes sometidas a una histerectomía subtotal previa. Aunque el diagnóstico de la fístula es clínico, la colonoscopía y la TC permiten descartar otras etiologías. La resección radical del segmento afectado es el tratamiento estándar en pacientes aptos.


Introduction: Diverticular disease is complicated by fistulas in 4% to 23% of patients. Case Report: A woman 52 years-old previously operated on with parcial histerectomy was successfully treated with antibiotics due to diverticulitis complicated with an abscess. Three months later the patient presented with vaginal discharge of faeces. Computed tomography showed wall thickening of sigmoid colon and vesical wall. Colonoscopy exclude cancer and confirmed the exit of gas through vagina. En-bloc resection of the sigmoid colon with traquelectomy with primary anastomosis was performed. The postoperative course was good without recurrence after 12 months of follow up. Sigmoido-cervical fistula is a very rare benign fistula due to diverticular disease. Diagnosis is basically clinic, but tomography and colonoscopy are important to exclude other causes of fistulas. Radical surgery with primary anastomosis is the standard treatment.


Subject(s)
Humans , Female , Middle Aged , Sigmoid Diseases/surgery , Sigmoid Diseases/diagnosis , Uterine Cervical Diseases/etiology , Intestinal Fistula/etiology , Diverticular Diseases/complications , Diverticular Diseases/diagnosis , Tomography, X-Ray Computed , Abdominal Pain/etiology , Treatment Outcome , Diverticular Diseases/drug therapy , Hysterectomy/adverse effects , Anti-Bacterial Agents/therapeutic use
9.
Rev. cir. (Impr.) ; 71(4): 318-322, ago. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058278

ABSTRACT

INTRODUCCIÓN: La enfermedad diverticular de colon sigmoides representa la principal causa de fistulización del colon a órganos vecinos. OBJETIVO: Describir variables clínicas y terapia quirúrgica de esta entidad. MATERIALES Y MÉTODO: Revisión retrospectiva de los casos de fístulas colónicas de origen diverticular (FCD) operados en forma electiva en un centro terciario. RESULTADOS: En un periodo de 30 años se realizó cirugía resectiva por una FCD en 49 pacientes. Los órganos más afectados fueron la vejiga en 33 casos (68%) y la vagina en 6 (12%). La cirugía efectuada fue la sigmoidectomía en 48 casos (5 con una ileostomía de protección) y una operación de Hartmann. La vía de abordaje fue laparoscópica en 4 pacientes y la morbilidad global de la serie fue 20%, sin mortalidad. Con un seguimiento promedio de 87 meses (extremos 16-178) no hubo casos de recidiva de la fístula. CONCLUSIONES: La FCD representa el 26% de los casos intervenidos por una enfermedad diverticular de colon sigmoides, lo que probablemente refleja un diagnóstico tardío. La fístula colovesical (FCV) es la fístula más común por esta causa y en la mitad de los casos tienen una presentación silenciosa. Las fístulas colovaginales ocurren en mujeres histerectomizadas. La cirugía resectiva del colon en pacientes con riesgo normal es la cirugía estándar con buenos resultados a corto y largo plazo. La cirugía laparoscópica es factible y segura especialmente en los casos de FCV.


BACKGROUND: Fistula formation is a well-known complication of diverticular disease (FCD). AIM: Determine the clinical presentation and surgical management of this kind of fistulas. MATERIALS AND METHODS: Retrospective revision of all consecutive scheduled cases operated on in a terciary public centre in a thirty-years period. RESULTS: Forty-nine patients with a segmental resection of sigmoid colon were analized. Colovesical fistulas were the most common type (n = 33), followed by colovaginal (n = 6). Resection with anastomosis was performed in 48 cases and Hartmann type operation in one. Laparoscopic procedure was made in 4 cases without conversion. Complication rate was 20% and two patients were reoperated on, without mortality in this series. Follow up showed no case of recurrence. CONCLUSIONS: FDC represent 26% of cases operated on in our series. Colovesical fistula is the most common type, followed by colovaginal fistula in histerectomized women. Resection and primary anastomosis should be the treatment of choice in average risk patients with acceptable morbidity and good long-term results. Laparoscopic approach is safe, specifically in patients with colovesical fistulas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Intestinal Fistula/surgery , Colonic Diseases/surgery , Colon, Sigmoid/surgery , Retrospective Studies , Follow-Up Studies , Intestinal Fistula/complications , Treatment Outcome , Colonic Diseases/etiology , Diverticular Diseases/complications
10.
Article in English | WPRIM | ID: wpr-719681

ABSTRACT

Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.


Subject(s)
Abdominal Pain , Abdominal Wall , Abscess , Adolescent , Azathioprine , Constriction, Pathologic , Crohn Disease , Dysuria , Fistula , Humans , Ileum , Inflammatory Bowel Diseases , Intestinal Fistula , Male , Urachus
11.
Intestinal Research ; : 171-176, 2019.
Article in English | WPRIM | ID: wpr-764142

ABSTRACT

The role and efficacy of exclusive enteral nutrition (EEN) in the treatment of luminal Crohn's disease (CD) has been well established over the last 2 decades. Consequently, in many centers nutritional therapy is now considered first line therapy in the induction of remission of active CD. However, the use of nutritional therapy in complicated CD has yet to be fully determined. This article aimed to review case reports and clinical trials published in the last decade that have considered and evaluated nutritional therapy in the setting of complicated CD in children and adults. Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios. Further assessments, involving large numbers of patients managed with consistent approaches, are required to further substantiate these roles.


Subject(s)
Adult , Child , Crohn Disease , Enteral Nutrition , Humans , Intestinal Fistula , Intestinal Obstruction , Phenobarbital , Remission Induction
12.
African Journal of Reproductive Health ; 23(1): 150-153, 2019. ilus
Article in English | AIM, AIM | ID: biblio-1258534

ABSTRACT

Enterocutaneous fistula is an abnormal communication between the intestine and the skin, while enterovesical fistula is an abnormal communication between the intestine and the bladder. Both are not usual complications of ovarian cystectomy. We present a patient with enterovesical fistula coexisting with enterocutaneous fistula following ovarian cystectomy. She is a 24-year-old lady with background immunosupression who presented to the National Obstetric Fistula Centre, Abakaliki South-East Nigeria with a history fecaluria, pneumaturia and passage of feculent fluid through the skin following ovarian cystectomy. Fistulogram was in keeping with rectovesical fistula. She was repaired in a single stage and made an uneventful recovery. Enterovesical fistula and enterocutaneus fistula are uncommon but possible complications of ovarian cystectomy


Subject(s)
Cystectomy , Intestinal Fistula , Intestinal Fistula/complications , Nigeria , Patients
13.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1283458

ABSTRACT

La persistencia del conducto onfalomesentérico permeable es una de las formas de presentación menos frecuente, dentro de la patología, de los restos embrionarios derivados de este conducto. Se presenta el caso de un lactante de 30 días de vida a quien se le hace un diagnóstico de conducto onfalomesentérico permeable y se realiza cirugía resectiva, con una buena evolución postoperatoria inmediata y con alta a domicilio a los 8 días. Se revisan los datos de embriología así como de patología, la presentación clínica, los diagnósticos diferenciales y las opciones terapéuticas.


The persistence of permeable omphalosenteric duct is one of the less frequent forms of presentation, within the pathology, of the embryonic remnants derived from this duct. We present the case of a 30-day-old infant who is diagnosed with permeable omphalomesenteric duct, and resective surgery is performed, with a good postoperative evolution and with home discharge at 8 days. The embryology data as well as the pathology, the clinical presentation, the differential diagnoses and the therapeutic options are reviewed.


A persistência do ducto onfalossentérico permeável é uma das formas menos freqüentes de apresentação, dentro da patologia, dos remanescentes embrionários derivados desse ducto. Apresentamos o caso de um lactente de 30 dias que é diagnosticado comducto oncomumentérico permeável, sendo realizada cirurgia ressectiva, com boa evolução pós-operatória e com descarga domiciliar aos 8 dias. Os dados da embriologia, bem como a patologia, a apresentação clínica, os diagnósticos diferenciais e as opções terapêuticas são revisados.


Subject(s)
Humans , Infant, Newborn , Vitelline Duct/surgery , Vitelline Duct/pathology , Diverticulitis , Meckel Diverticulum/surgery , Meckel Diverticulum/diagnosis , Vitelline Duct/abnormalities , Intestinal Fistula/surgery
14.
Metro cienc ; 26(1): 21-26, jun. 2018.
Article in Spanish | LILACS | ID: biblio-981562

ABSTRACT

La fístula aortoentérica (FAE) es la solución de continuidad entre la arteria aorta y una porción del sistema digestivo; su incidencia va del 0.04 al 0.07% y su mortalidad alcanza hasta 79%, lo que la convierte en un verdadero reto a la hora de establecer su manejo por la efectividad con la cual se debe efectuar su manejo. Existen diversas manifestaciones de la enfermedad que pueden distraer su diagnóstico, sin embargo es común el dolor abdominal y el sangrado digestivo acompañado o no de signos de inestabilidad hemodinámica. Actualmente, no existe un consenso para el manejo de las FAE; sin embargo, los pilares fundamentales son: control de la infección, reparación vascular y reconstrucción entérica; para esto es indispensable un equipo multidisciplinario de gran experiencia. Se presenta el caso de una paciente de 76 años con varias comorbilidades, portadora de bypass aorto-bi-femoral por enfermedad aterosclerótica de la aorta. Acudió por dolor abdominal, sangrado digestivo alto e inestabilidad hemodinámica. Luego de la valoración inicial fue diagnosticada de FAE y sepsis. Tomando en cuenta las recomendaciones mundiales, se realizó un procedimiento en 2 tiempos que incluían: a) reparo vascular: bypass extra-anatómico, exéresis de prótesis y cierre del muñón aórtico y, b) reparo entérico (por la magnitud anatómica de la lesión intestinal y luego de haber descartado la factibilidad de una rafia o derivación intestinal): como último recurso un procedimiento de Whipple


Aortoenteric fistulas are defined as a communication between the aorta and a portion of the digestive system. This pathology has a 0.04-0.07% incidence with a mortality rate of up to 79% making it's management a true challenge. Clinical manifestations vary thus common symptoms include abdominal pain and digestive bleeding and may or may not include signs of hemodynamic instability. Until now there is no consensus regarding the management of FAE hence the pillars of treatment include: infection control, vascular reparation and enteric reconstruction. A multidisciplinary team is imperative. We are presenting the case of a 76-year-old female with various comorbidities and a history of an aortic bifemoral bypass reconstruction due to aortic sclerosis disease; that presented with abdominal pain, upper digestive bleeding and hemodynamic instability. She was diagnosed with a FAE and sepsis. Taking into consideration international recommendations she was treated with a single procedure in two times. For the vascular correction: an extra-anatomical bypass; removal of previous prosthetic aortic implant and closure of the aortic stump. Due to the magnitude of the intestinal damage simple closure and intestinal derivation were discarded as options for enteric repair and a Whipple procedure was used as a last resource.


Subject(s)
Humans , Female , Aged , Aortic Diseases , Gastric Bypass , Digestive System Fistula , Intestinal Fistula , Abdominal Pain , Sepsis , Gastrointestinal Hemorrhage
15.
Int. braz. j. urol ; 44(2): 280-287, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-892978

ABSTRACT

ABSTRACT Objectives This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD.


Subject(s)
Humans , Male , Female , Adult , Aged , Pyelonephritis/surgery , Tuberculosis, Renal/surgery , Pyonephrosis/surgery , Hand-Assisted Laparoscopy/adverse effects , Kidney Diseases/surgery , Nephrectomy/methods , Nephritis/surgery , Pyelonephritis, Xanthogranulomatous/surgery , Reproducibility of Results , Blood Loss, Surgical , Intestinal Fistula/surgery , Colonic Diseases/surgery , Operative Time , Fistula/surgery , Length of Stay , Middle Aged , Nephrectomy/adverse effects
16.
Article in English | WPRIM | ID: wpr-717802

ABSTRACT

Foreign body ingestions pose a significant health risk in children. Neodymium magnets are high-powered, rare-earth magnets that is a serious issue in the pediatric population due to their strong magnetic force and high rate of complications. When multiple magnets are ingested, there is potential for morbidity and mortality, including gastrointestinal fistula formation, obstruction, bleeding, perforation, and death. Many cases require surgical intervention for removal of the magnets and management of subsequent complications. However, we report a case of multiple magnet ingestion in a 19-month-old child complicated by gastroduodenal fistula that was successfully treated by endoscopic removal and supportive care avoiding the need for surgical intervention. At two-week follow-up, the child was asymptomatic and upper gastrointestinal series obtained six months later demonstrated resolution of the fistula.


Subject(s)
Child , Eating , Endoscopy , Fistula , Follow-Up Studies , Foreign Bodies , Gastric Fistula , Hemorrhage , Humans , Infant , Intestinal Fistula , Mortality , Neodymium
17.
Article in English | WPRIM | ID: wpr-715679

ABSTRACT

In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.


Subject(s)
Abdomen , Abdominal Wound Closure Techniques , Aged , Anastomotic Leak , Extracorporeal Membrane Oxygenation , Fistula , Gastrectomy , Hemodiafiltration , Humans , Intestinal Fistula , Perforator Flap , Skin , Surgeons , Surgery, Plastic , Transplants , Ultrasonography , Ultrasonography, Doppler , Ventilators, Mechanical , Wounds and Injuries
18.
Article in Korean | WPRIM | ID: wpr-713776

ABSTRACT

A fistula between the renal pelvis and duodenum (pyeloduodenal fistula) is very rare. It can occur spontaneously or after trauma to one of these organs. A spontaneous pyeloduodenal fistula is usually caused by chronic inflammation, including reactions to foreign bodies, nephrolithiasis, benign and malignant neoplasms, as well as pyogenic infections. The main treatment to date has been surgery. We encountered one case of pyeloduodenal fistula found during an evaluation for abdominal discomfort in a 39-year-old female. Pyeloduodenal fistula was diagnosed by upper gastrointestinal endoscopy and abdominal computed tomography, and it was caused by direct invasion of nephrolithiasis. Surgical operation was recommended, but the patient refused. The patient has been free of symptoms for four years. Herein, we report an unusual case of pyeloduodenal fistula without surgical management and relevant literature review.


Subject(s)
Adult , Duodenum , Endoscopy, Gastrointestinal , Female , Fistula , Foreign Bodies , Humans , Inflammation , Intestinal Fistula , Kidney , Kidney Calculi , Kidney Pelvis , Nephrolithiasis
19.
Article in English | WPRIM | ID: wpr-738958

ABSTRACT

Pseudoaneurysms of the cystic artery and cholecystoduodenal fistula formation are rare complications of cholecystitis and either may result from an inflammatory process in the abdomen. A 68-year-old man admitted with acute cholecystitis subsequently developed massive upper gastrointestinal (GI) bleeding. Abdominal computed tomography showed acute calculous cholecystitis and hemobilia secondary to bleeding from the cystic artery. Angiography suggested a ruptured pseudoaneurysm of the cystic artery. Upper GI endoscopy showed a deep active ulcer with an opening that was suspected to be that of a fistula at the duodenal bulb. The patient was managed successfully with multimodality treatment that included embolization followed by elective laparoscopic cholecystectomy. Presently, there is no clear consensus regarding the clinical management of this disease. We have been able to confirm various clinical features, diagnoses, and treatments of this disease through a literature review. A multidisciplinary approach through interagency/interdepartmental collaboration is necessary for better management of this disease.


Subject(s)
Abdomen , Aged , Aneurysm, False , Angiography , Arteries , Cholecystectomy, Laparoscopic , Cholecystitis , Cholecystitis, Acute , Consensus , Cooperative Behavior , Diagnosis , Endoscopy , Fistula , Hemobilia , Hemorrhage , Humans , Intestinal Fistula , Ulcer
20.
Einstein (Säo Paulo) ; 16(1): eRC4070, 2018.
Article in English | LILACS | ID: biblio-891465

ABSTRACT

ABSTRACT The incidence of inflammatory bowel disease in the pediatric population has increased in the last years. The most common form of inflammatory bowel disease is Crohn's disease and, according to its form and age of presentation, it is possible to predict the evolution of the disease.


RESUMO A incidência de doença inflamatória intestinal aumentou na população pediátrica nos últimos anos. A forma mais comum de doença inflamatória intestinal é a doença de Crohn e, conforme sua forma e a idade de apresentação é possível prever a evolução da doença.


Subject(s)
Humans , Female , Child , Crohn Disease/surgery , Intestinal Fistula/surgery , Intestinal Obstruction/surgery , Severity of Illness Index , Crohn Disease/complications , Colonoscopy , Intestinal Fistula/complications , Intestinal Obstruction/complications
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