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Asian Journal of Surgery Jun 2022
Topics: Duodenal Diseases; Gastrectomy; Humans; Intestinal Fistula; Laparoscopy; Stomach Neoplasms
PubMed: 35221179
DOI: 10.1016/j.asjsur.2022.02.019 -
Internal Medicine (Tokyo, Japan) 2013We herein describe the case of a 51-year-old man with a duodenocolic fistula (DCF) caused by a stomal ulcer. The patient complained of watery diarrhea, dysgeusia and... (Review)
Review
We herein describe the case of a 51-year-old man with a duodenocolic fistula (DCF) caused by a stomal ulcer. The patient complained of watery diarrhea, dysgeusia and malnutrition. His medical history included distal gastrectomy with Billroth I reconstruction for duodenal ulcer perforation. A combination study using endoscopy and contrast imaging confirmed the presence of DCF. Laparotomic fistulectomy was performed, which resulted in the patient's recovery from diarrhea and malnutrition. The histological findings suggested that the fistula had originated from a stomal ulcer. In patients with chronic watery diarrhea of obscure origin following gastrectomy, DCF is a possible cause of the diarrhea.
Topics: Colonic Diseases; Duodenal Diseases; Gastrectomy; Humans; Intestinal Fistula; Male; Middle Aged; Peptic Ulcer
PubMed: 23857089
DOI: 10.2169/internalmedicine.52.0496 -
Langenbeck's Archives of Surgery Nov 2022Laparoscopic duodenum-preserving pancreatic head resection (L-DPPHR) is technically demanding with extreme difficulty in biliary preservation. Only a few reports of...
Laparoscopic duodenum-preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity.
PURPOSE
Laparoscopic duodenum-preserving pancreatic head resection (L-DPPHR) is technically demanding with extreme difficulty in biliary preservation. Only a few reports of L-DPPHR are available with alarming bile leakage, and none of them revealed the long-term metabolic outcomes. For the first time, our study explored the different dosage and timing of indocyanine green (ICG) for guiding L-DPPHR and described the long-term metabolic results.
METHODS
Between October 2015 and January 2021, different dosage and timing of ICG were administrated preoperatively and evaluated intra-operatively using Image J software to calculate the relative fluorescence intensity ratio of signal-to-noise contrast between bile duct and pancreas. Short-term complications and long-term metabolic disorder were collected in a prospectively maintained database and analyzed retrospectively.
RESULTS
Twenty-five patients were enrolled without conversion to laparotomy or pancreaticoduodenectomy. Administrating a dosage of 0.5 mg/kg 24 h before the operation had the highest relative fluorescence intensity ratio of 19.3, and it proved to guide the biliary tract the best. Fifty-six percent of patients suffered from postoperative complications with 48% experiencing pancreatic fistula and 4% having bile leakage. No one suffered from the duodenal necrosis, and there was no mortality. When compared with the non-ICG group, the ICG group had a comparable diameter of tumor and similar safety distance from lesions to common bile duct; however, it decreased the incidence of bile leakage from 10% to none. The median length of hospital stay was 16 days. After a median follow-up of 26.6 months, no one had tumor recurrence or refractory cholangitis. No postoperative new onset of diabetes mellitus (pNODM) was observed, while pancreatic exocrine insufficiency (pPEI) and non-alcoholic fatty liver disease (NAFLD) were seen in 4% of patients 12 months after the L-DPPHR.
CONCLUSION
L-DPPHR is feasible and safe in selected patients, and real-time ICG imaging with proper dosage and timing may greatly facilitate the identification and the prevention of biliary injury. And it seemed to be oncological equivalent to PD with preservation of metabolic function without refractory cholangitis.
Topics: Humans; Indocyanine Green; Retrospective Studies; Duodenum; Pancreatectomy; Pancreaticoduodenectomy; Common Bile Duct; Laparoscopy; Morbidity; Cholangitis; Pancreatic Neoplasms
PubMed: 35854048
DOI: 10.1007/s00423-022-02570-0 -
Sao Paulo Medical Journal = Revista... Jul 2001Primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. A few patients have been described with other... (Review)
Review
CONTEXT
Primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. A few patients have been described with other etiologies such as pseudoaneurysm originating from septic aortitis caused by Salmonella.
OBJECTIVE
To present a rare clinical case of pseudoaneurysm caused by septic aortitis that evolved into an aortoenteric fistula.
CASE REPORT
A 65-year-old woman was admitted with Salmonella bacteremia that evolved to septic aortitis. An aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. In the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. The aorta was sutured and an axillofemoral bypass was carried out. In the intensive care unit, the patient had a cardiac arrest that evolved to death.
Topics: Aged; Aneurysm, False; Aorta; Aortic Diseases; Aortitis; Female; Humans; Intestinal Fistula; Radiography; Sepsis; Vascular Fistula
PubMed: 11500790
DOI: 10.1590/s1516-31802001000400008 -
California Medicine Dec 1952Gastroduodenostomy after gastric resection is a procedure which can be readily performed if the short gastric vessels are first divided. It makes for a more...
Gastroduodenostomy after gastric resection is a procedure which can be readily performed if the short gastric vessels are first divided. It makes for a more physiological restoration of the gastrointestinal tract than is accomplished with gastrojejunostomy and permits proper admixture of the food with the bile and pancreatic enzymes. It avoids several potential dangers such as leakage from the duodenal stump, the possibility of a gastrocolic fistula, and malfunction of the anastomosis due to distortion of a jejunal loop. Apparently the "dumping syndrome" does not occur after gastroduodenostomy as it sometimes does after gastrojejunostomy.
Topics: Bile; Digestive System Surgical Procedures; Dumping Syndrome; Duodenum; Gastrectomy; Gastric Fistula; Gastroenterostomy; Humans; Stomach
PubMed: 13009501
DOI: No ID Found -
European Journal of Vascular and... Oct 2019
Topics: Aged; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Duodenal Diseases; Fatal Outcome; Female; Humans; Intestinal Fistula; Uterine Cervical Neoplasms; Vascular Fistula; Vena Cava, Inferior
PubMed: 31400923
DOI: 10.1016/j.ejvs.2019.07.002 -
Chirurgia (Bucharest, Romania : 1990) 2015We report the case of an elderly woman, 81 years old, who was admitted in our department for hematemesis, hematochezia and lower abdominal pain. The abdominal ultrasound...
We report the case of an elderly woman, 81 years old, who was admitted in our department for hematemesis, hematochezia and lower abdominal pain. The abdominal ultrasound and the CT scan diagnosed a primary aortoenteric fistula between an abdominal aortic aneurysm (AAA) and the second part of the duodenum, which is a very rare localization regarding this condition. Surgical pathology,diagnosis and management are discussed.
Topics: Abdominal Pain; Aged, 80 and over; Aortic Dissection; Aortic Aneurysm, Abdominal; Aortic Rupture; Duodenal Diseases; Fatal Outcome; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Intestinal Fistula; Vascular Fistula
PubMed: 25800321
DOI: No ID Found -
BMJ Case Reports Feb 2021We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an...
We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an 80-year-old retired farmer. This presentation is rarely reported in literature and only through case reports. Early diagnosis and definitive surgery were critical to a successful outcome. Serological diagnosis of Q fever was initiated on the patient's past exposure to animal reservoirs. Complicating the case was ongoing gastrointestinal bleeding postsurgery, with multiple endoscopies undertaken before a culprit remnant fistula was found. This case highlights the value in considering as an underlying cause in patients with known risk factors presenting with primary aortoduodenal fistulas. Though rare, it represents a readily treatable cause.
Topics: Aged, 80 and over; Anti-Bacterial Agents; Antimalarials; Aortic Aneurysm, Abdominal; Coxiella burnetii; Doxycycline; Duodenal Diseases; Gastrointestinal Hemorrhage; Humans; Hydroxychloroquine; Intestinal Fistula; Male; Q Fever; Tomography, X-Ray Computed; Vascular Fistula
PubMed: 33542018
DOI: 10.1136/bcr-2020-238373 -
BMJ Case Reports Dec 2020
Topics: Anal Canal; Bronchoscopy; Conservative Treatment; Contrast Media; Delayed Diagnosis; Duodenum; Enteral Nutrition; Esophagus; Female; Heart Defects, Congenital; Humans; Infant; Kidney; Limb Deformities, Congenital; Pneumonia, Aspiration; Radius; Ribs; Spine; Tomography, X-Ray Computed; Trachea; Tracheoesophageal Fistula; Tricuspid Atresia
PubMed: 33334771
DOI: 10.1136/bcr-2020-239327 -
Il Giornale Di Chirurgia 2014The biliodigestive fistula is not a rare affection in the context of acute pathology of the gastrointestinal tract. It often affects patients between 63 and 85 years old...
The biliodigestive fistula is not a rare affection in the context of acute pathology of the gastrointestinal tract. It often affects patients between 63 and 85 years old , particularly the female sex, and the most common cause is acute or chronic cholecystolithiasis. Open issues are the delayed in the pre-operative diagnosis, and controversies exist regarding the best surgical approach. The choice of treatment options is influenced by the age of the patients and their clinical conditions and also by the presence of comorbidities and of a delayed right diagnosis. In the 1 to 3% of cases, the biliodigestive fistula presents a gallstone ileus as complication, whose diagnosis is particularly difficult for the lack of specific signs and symptoms. The contrast-enhanced CT is considered the gold standard for a specific pre-operative diagnosis, as it directly shows the fistula. Surgical treatments include one-stage procedure or two-stage procedure. Many studies seem to favor a deferred definitive procedure. The Authors describe 4 cases: in 3 cases, women between 70 and 80 years old presenting an history of recurrent cholecystitis, in 2 cases, and in 1 case presenting a bowel obstruction; in 1 case a 50-years-old man, with no significant past medical history, presenting a bowel obstruction. The Authors have performed in the 2 cases of gallstone ileus an enterolithotomy with cholecysto-duodenal fistula repair and cholecystectomy, in one-stage, and this has been possible because of the good clinical conditions of the patients and their low operative risk. In the case of fistula without the complication of gallstone ileus, the treatment approach has been cholecysto-gastric fistula closure with a gastroplastic using separate stitches and cholecystectomy, in one-stage. We are in agreement with data in the literature regarding the delay into the diagnosis of biliodigestive fistula and with the importance to suspect it or gallstone ileus presence, although the clinical presentation is extremely non-specific. In our experience, cholangiopancreatography-CT and CECT have made easier the pre-operative diagnosis and so reducing the delay of the treatment.
Topics: Adolescent; Aged; Aged, 80 and over; Biliary Fistula; Female; Gallstones; Humans; Ileus; Intestinal Fistula; Male; Middle Aged
PubMed: 25419590
DOI: No ID Found