Influence Factors and Progress in Diagnosis and Treatment of Acute Pancreatitis Complicated With Gastro - intestinal Fistula / 胃肠病学

Gastrointestinal fistula (GIF) is one of the serious complications in the middle to late stage of acute pancreatitis (AP). The co-existence of AP and GIF can significantly prolong the course of the disease and increase the risks of infection and bleeding. Understanding the relevant mechanisms and influencing factors of GIF and taking effective measures to prevent its occurrence is crucial. The diagnosis of AP with GIF is relatively difficult. Therefore, it is essential to understand the related influencing factors and diagnostic methods of AP complicated with GIF, and to implement individualized comprehensive treatment measures, which is the key to improve the prognosis of the patient to the greatest extent. This article reviewed the influence factors and progress in diagnosis and treatment of AP complicated with GIF.

Colo-umbilical enterocutaneous fistula as a rare complication of diverticulitis of the sigmoid colon / Fístula enterocutánea sigmoidea umbilical como una rara complicación de una diverticulitis del colon sigmoide

Abstract The care of patients with enterocutaneous fistula constitutes a significant challenge owing to the alterations it usually brings about. For successful treatment, it is necessary to manage fluids and electrolytes adequately, provide practical nutritional support, and control sepsis until its eradication; thus, many fistulae close spontaneously. We present the case of a 36-year-old male patient with a four-month history of fecal-like umbilical secretion. When performing the fistulogram, we confirmed a fistulous tract of 9 cm, which ended at the level of the sigmoid colon, a rare location. In cases where the enterocutaneous fistula does not close, and surgical treatment is indicated, it is imperative to maximize perioperative care, decrease surgical time, choose the correct surgical technique, and prepare the patient for surgery to avoid complications with a fatal outcome.

Resumen La atención de los pacientes con fístula enterocutánea constituye un gran reto, por las alteraciones con las que suelen acompañarse. Para lograr un tratamiento exitoso es necesario realizar un adecuado manejo de los líquidos y electrolitos, brindar un apoyo nutricional eficaz y controlar la sepsis hasta lograr su erradicación; de esta manera, muchas fístulas cierran espontáneamente. Se expone el caso de un paciente de 36 años de edad, con un cuadro de secreción umbilical de aspecto fecaloideo de 4 meses de evolución. Al realizar la fistulografía se constató un trayecto fistuloso de 9 cm, el cual terminaba a nivel del colon sigmoide, localización poco frecuente. En los casos en que la fístula enterocutánea no cierre y tenga indicación de tratamiento quirúrgico, es necesario extremar los cuidados perioperatorios, minimizar el tiempo quirúrgico, elegir la técnica quirúrgica correcta y preparar al paciente para la cirugía, de modo que se eviten complicaciones que pueden tener un desenlace fatal.

Clinical characteristics and prognosisof 273 Crohn'spatientswih gastrointestinal fistulas / 中国实用外科杂志

OBJECTIVE:To analyze the clinical characteristics and prognosis of Crohn's patients with gastrointestinal fistulas.METHODS:The data of 273 patients with gastrointestinal fistulas who were registered in GI Fistula Center, Department of Surgery, Jinling Hospital from January 2001 to June 2015 were retrospectively reviewed and the clinical features,characteristics of gastrointestinal fistulas, medication plan and outcome of the patients were analyzed.RESULTS:The ratio of male to female was 2.5:1.The mean onset age was 29(22,40)years. The mean diagnosis age was 31(25,42)years. The averageage between onset to diagnosis was22(8,31)months. The most common initial symptoms were abdominal pain(78.0%), diarrhea(28.9%) and fever(26.0%). The most common lesion locations were terminal ileum(56.8%). The most common behavior of disease were penetrating(54.9%), followed by stricturing(42.1%), inflammatory(2.9%) and perianal disease(19.0%). 442 patients developed GI, including intestinal cutaneous fistulas(73.9%) and intestinal fistulas(26.1%).The most type of intestinal cutaneousfistulas were ileocecal anastomotic fistula.The most type of intestinal fistulas were entero-vesical fistulas. Enteral nutrition(91.9%) and parenteralnutrition(72.9%) combined with sulfasalazine(57.9%) and tripterygium glycosides(48.0%) were the most commonly used drugs. A total of 227(83.1%)patientsreceived antibiotics due to infectious complications. Β-lactam(77.6%) and nitroimidazoles(56.0%) were the most common antibi-otics. All the patients had received 625 cases of operations. The cumulative operative rates of 1 year, 3 years and 5 years after diagnosis were 34.4%, 59.0%and 63.0%. 9(3.3%)patients died during the research.The cumulative survival rates were 98.5%, 97.8%,and 96.7% at 1 year, 3 years and 10 years after diagnosis.CONCLUSION:Compared with the literature of western and other Asian countries, there are some differences in sex ratio, lesion locations, operative rates and mortality ratesamong Crohn's disease patients with GI fistula. Further followup and in-depth study are needed.

Clinical study on endoscopic closure of gastrointestinal fistula using the over-the-scope-clip system / 医学研究生学报

Objective Gastrointestinal fistula is a serious complication after operation. It is reported that the over-the-scope-clip(OTSC) can close intestinal full-thickness wall and treat gastrointestinal fistula effectively. This study was to investigate the efficacy of OTSC in the treatment of gastrointestinal fistula.Methods We analyzed the clinical data of 28 postoperative patients with gastrointestinal fistula who underwent endoscopic closure using OTSC in Endoscopy Center of Research Institute of General Surgery in our hospital from October 2014 to October 2017, and recorded the course of disease, the site of gastrointestinal fistula, the diameter of fistula and the efficacy of OTSC. Patients with successful closure were followed up for half a year after hospital discharge to observe the recurrence of fistula.Results Endoscopic closure with OTSC was successful in all the 28 patients without complications like bleeding and falling off. In the sinus tract or digestive tract radiography at 1-2 weeks after OTSC closure, 23 patients were successful in endoscopic closure(82.14%). In the six months′ follow-up of 23 patients with successful treatment, 4 patients were lost to follow-up and 19 patients were successful without recurrence of fistula.Conclusion The endoscopic closure of gastrointestinal fistula using OTSC is safe and effective, avoiding reoperation and reducing trauma.

Application of over-the-scope clip system in treatment of gastrointestinal endoscopy / 局解手术学杂志

Objective To assess the efficacy and safety of over-the-scope clip(OTSC) system in treatment of the perforation ,fistula and bleeding of the digestive tract .Methods The data of 33 patients who were treated with OTSC in our department were analyzed retrospective-ly,and the technical success rate ,clinical success rate and complications were statistically analyzed .Among the 33 patients,there were 14 pa-tients with upper gastrointestinal bleeding , 8 patients with postoperative fistula , and 11 patients with endoscopic full-thickness resection (EFTR) of gastric or duodenal bulb.Results The technical success rate and clinical success rate of 33 cases were 96.97% and 93.94%respectively,and there was no complication in all patients .Among them,the clinical success rate of the upper gastrointestinal bleeding was 92.85%,the anastomotic fistula was 75.00%,and the EFTR was 100%.Conclusion As a new type of clinical endoscopic suture system , OTSC is safe and effective in gastrointestinal bleeding ,perforation and fistula .

Desarrollo e implementación de un nuevo diseño de stent de nitinol para el manejo de estenosis y fístulas benignas del tracto digestivo / Development and Implementation of a New Nitinol Stent Design for Managing Benign Stenoses and Fistulas of the Digestive Tract

Antecedentes: las estenosis benignas, la ruptura del tracto digestivo y las fístulas digestivas son condiciones que ponen en riesgo la vida y que por lo general son tratadas quirúrgicamente. Ahora, ha surgido la colocación de stents metálicos parcial o totalmente cubiertos como una opción de manejo con mínima invasión. Se pretende determinar la efectividad clínica de un nuevo diseño de stent de nitinol totalmente cubierto para el tratamiento de las perforaciones digestivas y las fístulas anastomóticas, con especial énfasis en la evaluación de la hiperplasia reactiva. Métodos: en el período 2012-2013 se colocó un stent de nitinol autoexpandible totalmente cubierto en 15 pacientes con perforaciones benignas de esófago, fístulas anastomóticas, estenosis después de cirugía gastrointestinal alta o baja. Se utilizó un stent de mayor diámetro en su centro (20 mm) y en su porción proximal (28 mm). Se recolectaron datos demográficos, tipo de lesión, ubicación del stent y remoción, éxito clínico y complicaciones. Resultados: a un total de 15 pacientes se les puso 15 nuevos stents por fístulas anastomóticas (n = 8), estenosis esofágica (n = 2), estenosis en anastomosis colorrectal (n = 2), estenosis de anastomosis gastroyeyunal (n = 1), ruptura iatrogénica de esófago (n = 1), y estenosis pilórica (n = 1). La remoción endoscópica del stent fue exitosa en todos los pacientes, y una fue particularmente difícil por hiperplasia reactiva. El éxito clínico se logró en 9 pacientes (73%), con una media de permanencia del stent de 10 semanas (rango 7 a 12 semanas). En total, ocurrieron 7 complicaciones en 15 pacientes (47%): hiperplasia reactiva (n = 1), migración (n = 3), dolor severo (n = 2), ulceración esofágica (n = 1), y solo 1 paciente requirió cirugía después del fallo del stent. Ningún paciente falleció como consecuencia de la colocación del mismo. Conclusiones: un stent totalmente cubierto, con nuevo diseño, dejado por 10 semanas, puede ser una alternativa ...

Background: Benign stenoses, digestive tract ruptures and fistulas are conditions that endanger life and are often treated surgically. Recently, the placement of partially or fully covered metal stents has emerged as a minimally invasive treatment option. This article looks at a new design for stents to determine its clinical effectiveness. The new stent is a completely covered nitinol stent for treatment of gastrointestinal perforations and anastomotic leaks. This article places special emphasis on evaluating reactive hyperplasia. Methods: Fifteen had the new completely covered self-expanding nitinol stent placed for treatment of benign esophageal perforations, anastomotic leaks, and stenoses following upper or lower gastrointestinal surgery during 2012 and 2013. The stents are 20 mm in diameter in the middle and 28 mm in diameter at the proximal end. Information about patient demographics, type of lesion, lesion locations, stent removal, clinical success and complications was collected. Results: A total of 15 stents were placed in 15 patients to treat anastomotic leaks (n = 8), esophageal stenoses (n = 2), colorectal stenoses (n = 2), a gastrojejunostomy stenosis (n = 1), an esophageal iatrogenic rupture (n = 1), and a pyloric stenosis (n = 1). Endoscopic removal of the stent was successful in all patients. Although it was particularly difficult in one case because of reactive hyperplasia. Clinical success was achieved in nine patients (73%). Average duration of time between stent placement and removal was 10 weeks with a range of 7 to 12 weeks. In total, seven complications occurred in 15 patients (47%): reactive hyperplasia (n = 1), migration (n = 3) severe pain (n = 2) esophageal ulceration (n = 1) only one patient required surgery after stent failure. No patients died as the result of stenting. Conclusions: A redesigned completely covered stent kept in place for 10 weeks may be an alternative to surgery for treating gastrointestinal ...

Descripción epidemiológica y tratamiento de los pacientes con enfermedad de Crohn / Epidemiological description and treatment of Crohn's disease patients

Antecedentes: la enfermedad de Crohn es un proceso inflamatorio crónico granulomatoso que puede afectar todo el tracto digestivo. Se diagnostica cada vez más frecuentemente en nuestro medio, y es causa importante de morbimortalidad en los pacientes afectados. El presente estudio tiene como objetivo conocer la prevalencia de esta enfermedad, sus manifestaciones clínicas más frecuentes, los diversos tratamientos utilizados y la respuesta a estos. Métodos: se revisaron los expedientes clínicos de todos los pacientes con diagnóstico de enfermedad de Crohn evaluados durante 2009 en el Servicio de Gastroenterología de un centro de salud terciario, el Hospital "Dr. Rafael A. Calderón Guardia". Resultados: de un total de 28 pacientes con enfermedad de Crohn, solo tres casos fueron diagnosticados en la década 1990-2000, mientras que los restantes 25 casos fueron diagnosticados de 2001 a 2009. Un 60 por ciento de los casos diagnosticados corresponden a pacientes del sexo masculino. La población estudiada tiene una distribución de edades entre los 17 y 72 a¤os, con un promedio de edad de 39 años de edad. El 82 por ciento de los pacientes se encuentran con tratamiento de mantenimiento con base en derivados del ácido 5-aminosalicílico, mientras que un 62 por ciento también utiliza azatiprina, 6-mercaptopurina o metotrexate, un 51 por ciento reciben esteroides sistemáticos y solo siete pacientes recibieron inflimixab. Un 68 por ciento de los pacientes del presente estudio requirió manejo quirúrgico en algún momento de su evolución, y en un 96 por ciento de los pacientes se logró remisión de la enfermedad. Conclusión: la prevalencia de la enfermedad de Crohn parece encontrarse en aumento, y en los casos en los cuales hay fallo terapéutico al régimen farmacológico, puede ser necesario un abordaje quirúrgico...

Two Cases of Alimentary Tract Fistula Treated by Endoscopic Local Injection Therapy / 대한소화기내시경학회지

Gastrointestinal fistula is a disease of varying etiologies. It may occur spontaneously or as a result of an iatrogenic cause. Spontaneous fistula occurs as a result of an inflammatory process, malignancy or radiotherapy. The majority of fistula are caused by iatrogenic causes, most frequently as a complication of surgical intervention. Treatment of gastrointestinal fistulae usually consists of surgery and conservative management such as nutritional support and control of inflammation. Recently, it has been reported that gastrointestinal fistulae can be treated endoscopically using tissue adhesive agents such as Histoacryl and fibrin glue. We report two cases of gastrointestinal fistulae that were successfully treated by endoscopic local injection therapy with a review of literature.

Analysis of efficacy and sensitivity of monitoring index during enteral nutrition with Pepti-2000 Variant in patients with gastrointestinal flstulas / 肠外与肠内营养

Objectives:To observe the efficacy of enteral nutrition with short peptide elemental diet(Pepti 2000) in patients with gastrointestinal fistulas and evaluate the sensitivity of nutrition associated index in nutrition monitoring. Methods:Ten cases with gastrointestinal fistulas were administered total enteral nutrition(TEN).They received 146 kJ/(kg?d) of non protein calorie(NPC) and 0.25 g/(kg?d) of nitrogen per day. Body weight,serum albumin, transferrin(TFN), prealbumin(PA),fibronectin(FN),triglyceride and cholesterol were monitored on before and 7th and 28th after TEN. Results:Seven days after TEN,serum PA and FN levels rised significantly( P