ABSTRACT
We present an unique case report of pneumatosis intestinalis after fistuloclysis.
Subject(s)
Intestinal Fistula/complications , Intestinal Fistula/diagnostic imaging , Nutritional Support/methods , Pneumatosis Cystoides Intestinalis/complications , Pneumatosis Cystoides Intestinalis/diagnostic imaging , Aged , Humans , Intestinal Fistula/surgery , Intestines/diagnostic imaging , Intestines/surgery , Male , Pneumatosis Cystoides Intestinalis/surgery , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Short-term studies have shown that patients with type III intestinal failure often develop gallstones and have recommended prophylactic cholecystectomy. In this retrospective cohort study, we aimed to define the incidence and clinical consequences of cholelithiasis over an extended time period, in order to refine the role of prophylactic cholecystectomy in type III intestinal failure. METHODS: Data were retrospectively collected from a prospectively maintained audit. Patients with intestinal failure for 5 years or more were included. Kaplan-Meier analysis was used to estimate cumulative incidence over time. Predictors of cholelithiasis were evaluated by Cox regression. RESULTS: Between 1 January 1983 and 1 December 2008, 81 patients were commenced on parenteral support lasting 5 years or more. Of 63 patients with no pre-existing gallstones on imaging, 17 (27%) developed gallstones during a median observation period of 133 months. On Kaplan-Meier analysis, the incidence at 10 years was 21%; at 20 years, 38%; and at 30 years, 47%. Thirteen of the 17 had symptoms and ten required surgical and/or endoscopic intervention. Increased weekly calorific content (P 0.003) and the provision of parenteral lipids (P 0.003) were predictors of cholelithiasis on univariable Cox regression. CONCLUSION: Many patients with long-term intestinal failure develop gallstones over time, with a 20-year incidence of 38%. The majority of those have symptoms or complications and require intervention. Therefore, prophylactic en-passant cholecystectomy is justified when gallstones are present in type III intestinal failure, supporting routine pre-operative imaging of the gallbladder prior to abdominal surgery.
Subject(s)
Cholecystectomy , Gallstones/complications , Gallstones/epidemiology , Intestinal Diseases/complications , Adolescent , Adult , Aged , Chronic Disease , Female , Gallstones/surgery , Humans , Incidence , Intestinal Diseases/surgery , Kaplan-Meier Estimate , Longitudinal Studies , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , Risk Factors , Time Factors , Young AdultABSTRACT
Anterior cervical spine plating is a standard procedure for fixing unstable vertebral fractures. Following surgery, oesophageal perforation has an incidence of 0.25% and this is usually hours following surgery, due to over prominent screws or friction between the oesophagus and the plate. Instrumentation failure of these plates months or years following surgery is very rare but potentially life-threatening. We report a case of microcytic anaemia which was investigated by oesophagogastroduodenoscopy, and subsequently found that a screw from the anterior plate had lifted off and perforated the oesophagus. This is very rare, but emphasises an important lesson. Anyone presenting with gastrointestinal bleeding or infectious signs, with a history of cervical spine plating should be investigated immediately for instrumentation failure as it brings a high mortality.
