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World Journal of Surgical Oncology Aug 2023Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage...
BACKGROUND
Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients.
METHODS
This is retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage catheter, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated.
RESULTS
Sixty-four patients were included in the study. Insertion of the transnasal abscess drainage catheter, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients, while 35 patients received transnasal abscess drainage, 13 received percutaneous abscess drainage, and 16 received transnasal drainage plus percutaneous abscess drainage. Immediately after placement of the tube, the mean volume of drainage was 180 mL (range, 10-850 mL); the amount steadily decreased from then on. The clinical success rate was 84.3% (54/64). Median time to fistula healing was 58 days (range, 7-357 days).
CONCLUSIONS
Transnasal insertion of transnasal abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.
Topics: Humans; Abscess; Anastomosis, Surgical; Fistula; Gastrectomy; Anastomotic Leak; Retrospective Studies; Drainage
PubMed: 37528403
DOI: 10.1186/s12957-023-03105-7 -
Cureus Jun 2023Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we...
Penetrating peptic ulcers often lead to severe complications. The development of uretero-enteric fistulas is rare and can be challenging to diagnose and treat. Here, we present the case of a 41-year-old patient who previously underwent gastrojejunostomy for superior mesenteric artery syndrome and developed a peptic jejunal ulcer, leading to a uretero-jejunal fistula and finally causing acute pyelonephritis. The patient was managed with a multidisciplinary approach including medical therapy and endoscopic and radiologic interventions.
PubMed: 37492813
DOI: 10.7759/cureus.40824 -
Case Reports in Surgery 2023Bouveret syndrome is a gastric outlet obstruction, and biliary ileus is an obstruction of the small bowel, and both are caused by a gallstone that escaped the...
Bouveret syndrome is a gastric outlet obstruction, and biliary ileus is an obstruction of the small bowel, and both are caused by a gallstone that escaped the gallbladder through a bilio-enteric fistula. The concurrent occurrence of obstruction at both sites is encountered very rarely, and only two such cases associated with Bouveret syndrome were reported before. We now present a case involving a 78-year-old female with simultaneous obstruction at both the duodenum and jejunum. The literature is reviewed to evaluate the incidence of such a situation and to discuss the management of the case.
PubMed: 37483865
DOI: 10.1155/2023/9664165 -
Endoscopy Dec 2023
Topics: Humans; Endoscopy, Gastrointestinal; Esophageal Fistula
PubMed: 37433318
DOI: 10.1055/a-2107-2540 -
Gastrointestinal Endoscopy Jan 2024
Topics: Humans; Gallstones; Lithotripsy, Laser; Intestinal Obstruction; Ileus; Balloon Enteroscopy; Lithotripsy
PubMed: 37423536
DOI: 10.1016/j.gie.2023.07.010 -
Cureus May 2023Superior mesenteric artery (SMA) syndrome is also known as Wilkie's syndrome. Sometimes it is the cause of obstruction in the duodenum. In SMA syndrome, the acute...
Superior mesenteric artery (SMA) syndrome is also known as Wilkie's syndrome. Sometimes it is the cause of obstruction in the duodenum. In SMA syndrome, the acute angulation of the SMA against the abdominal aorta can prevent duodenal contents from draining into the jejunum (upper small intestine); hence inadequate intake of nutrition leads to weight loss and malnutrition. This is primarily attributed to the loss of intervening pad of mesenteric fat tissue due to various debilitating conditions. Abnormal connections between the intra-abdominal gastrointestinal tracts and skin over the abdomen are known as enterocutaneous fistulas (ECF). In this case report, a 37-year-old woman with a history of chronic dull pain in the upper abdominal region over the last seven months, who also complained of bloating, infrequent vomiting, nausea, and upper abdominal fullness for the same amount of time, was seen in the emergency room. Her symptoms had deteriorated by the time she approached the hospital. Additionally, she reports having had a foul-smelling, purulent discharge for the past five years right below the umbilicus. Upon close investigation, it was determined to be feces, and it was later discovered to be a low-output enterocutaneous fistula. She describes having an exploratory laparotomy and adhesiolysis for an intra-abdominal abscess and an acute intestinal obstruction caused by adhesions. This case emphasizes the provocation given a diagnosis of SMA syndrome with enterocutaneous fistula and demands increased awareness of this entity. This will ameliorate early identification to reduce immaterial tests and irrelevant treatments.
PubMed: 37398828
DOI: 10.7759/cureus.39696 -
World Journal of Clinical Cases Jun 2023Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula....
BACKGROUND
Gallstone ileus is a rare complication of gallstone disease in which a stone enters the enteric lumen and causes mechanical obstruction usually by bilioenteric fistula. Gallstone ileus accounts for 25% of all bowel obstructions among the population > 65 years of age. Despite medical advances over the last decades, gallstone ileus is still associated with high rates of morbidity and mortality.
CASE SUMMARY
An 89-year-old man with a history of gallstones was admitted to the Gastroenterology Department of our hospital, complaining of vomiting and cessation of bowel movements and flatus. Abdominal computed tomography showed cholecystoduodenal fistula and upper jejunum obstruction due to gallstones, pneumatosis in the gallbladder, and pneumobilia indicating Rigler's triad. Considering the high risk of surgical management, we performed propulsive enteroscopy and laser lithotripsy twice to relieve the bowel occlusion. However, the intestinal obstruction was not relieved by the less invasive procedure. Then, the patient was transferred to the Department of Biliary-pancreatic Surgery. The patient underwent the one-stage procedure including laparoscopic duodenoplasty (fistula closure), cholecystectomy, enterolithotomy, and repair. After surgery, the patient presented with complications of acute renal failure, postoperative leak, acute diffuse peritonitis, septicopyemia, septic shock, and multiple organ failure, and finally died.
CONCLUSION
Early surgical intervention is the mainstay of treatment for gallstone ileus. For elderly patients with significant comorbidities, enterolithotomy alone is advised.
PubMed: 37388782
DOI: 10.12998/wjcc.v11.i17.4159 -
Annals of Surgical Oncology Sep 2023Central pancreatectomy (CP) has been established as the most common type of parenchyma-sparing pancreatectomy; however, CP is associated with higher morbidity and a...
BACKGROUND
Central pancreatectomy (CP) has been established as the most common type of parenchyma-sparing pancreatectomy; however, CP is associated with higher morbidity and a higher pancreatic fistula (PF) rate than distal pancreatectomy or pancreaticoduodenectomy. The jejunum patch technique (JPT) for distal pancreatectomy has recently been applied, which efficiently decreases the incidence of PF. We have adapted this technique to CP as well as distal pancreatectomy with celiac axis resection. Here, we retrospectively evaluated the usefulness of JPT for open CP cases, and report the experience of robot-assisted CP using the JPT.
METHODS
Among 37 consecutive cases who underwent CP at our institution between 2011 and 2022, clinical characteristics and postoperative short-term outcomes were compared between patients who underwent CP with and without the JPT. In robot-assisted CP using the JPT, after resection of the middle of the pancreas the transected jejunum was elevated through the retrocolic route in a Roux-en-Y fashion. The pancreatic stump was covered by the JPT using a modified Blumgart technique, following pancreaticojejunostomy for the distal side. RESULTS: Among the entire cohort, 19 patients underwent CP using the JPT. The clinically relevant PF rate of the JPT group was significantly lower (47.4%) than the no-JPT group (83.3%, p = 0.022), and the length of drainage and hospital stay were shorter in the JPT group (p= 0.010 and p = 0.017, respectively). The blood loss of robot-assisted CP using the JPT was 20 mL, and the JPT took only 15 min.
CONCLUSION
Robot-assisted CP using the JPT is an easy-to-use and promising procedure, based on experience and outcomes from open surgery.
Topics: Humans; Pancreatectomy; Jejunum; Robotics; Retrospective Studies; Pancreatic Neoplasms; Pancreatic Fistula; Postoperative Complications; Treatment Outcome
PubMed: 37314546
DOI: 10.1245/s10434-023-13734-7 -
Radiology Case Reports Aug 2023Rapunzel syndrome is a rare clinical entity in pediatric patients with a history of trichotillomania and trichophagia that has only been mentioned a few times in the...
Rapunzel syndrome is a rare clinical entity in pediatric patients with a history of trichotillomania and trichophagia that has only been mentioned a few times in the literature. It is characterized by abnormal gastric bezoar formation that sometimes extends to the duodenum, jejunum, or colon. Here, we present a case of a 16-year-old previously healthy female patient who had prolonged hospitalization due to complications related to a significant gastric bezoar that led to massive bleeding due to a superior mesenteric artery (SMA)-duodenal fistula successfully treated with stent graft placement. Undiagnosed trichobezoar can lead to rare and unexpected complications, such as SMA-duodenal fistula, with life-threatening hemorrhagic shock. Prompt activation of massive transfusion protocol and endovascular control of the hemorrhage was vital to successfully treating our patient.
PubMed: 37273725
DOI: 10.1016/j.radcr.2023.05.031