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Annals of the Royal College of Surgeons... Nov 1982
Topics: Duodenal Ulcer; Duodenum; Humans; Methods
PubMed: 7137836
DOI: No ID Found -
Vascular Health and Risk Management 2022Secondary aortoenteric fistula is a rare, highly morbid and often difficult to diagnose, cause of gastrointestinal bleeding. It is associated with prior aortic surgery...
BACKGROUND
Secondary aortoenteric fistula is a rare, highly morbid and often difficult to diagnose, cause of gastrointestinal bleeding. It is associated with prior aortic surgery or placement of a synthetic aortic graft. Our case features staged hybrid endovascular stent-grafting, graft excision, aortoplasty using a bovine pericardial patch, extra-anatomical bypass and complex bowel repair.
CASE REPORT
An 82-year-old man presented with gastrointestinal bleeding and Streptococcus Anginosus bacteraemia, with previous aorto-bi-iliac bypass surgery for left common iliac occlusive disease 15 years ago. Computed tomography angiography (CTA), gastroscopy, colonoscopy, capsule endoscopy and enteroscopy identified no bleeding source. Repeat CTA showed gas locules and stranding around the graft and the third part of the duodenum, concerning for fistulous communication. On the next day, a Zenith TX2 thoracic 28x80mm stent-graft was deployed into the infrarenal aorta. On laparotomy, a fistula was present between the Dacron graft and fourth part of the duodenum. The Dacron graft was excised, followed by aortic patching with bovine pericardium. A right-to-left femoral-femoral crossover graft was constructed. CT at one-month post-laparotomy showed no signs of perigraft endoleak and interval resolution of gas locules. He was transferred to a rehabilitation facility on the 34th post-operative day with a multidisciplinary follow-up arranged.
DISCUSSION
Aortoduodenal fistula is a challenging entity to diagnose and should be suspected in patients with GI bleeding and prior aortic surgery. Endovascular repair alone is a less invasive option but with higher re-infection and late failure rates. Liberal use of appropriate imaging modalities, a judicious repair strategy, long-term follow-up and multidisciplinary approach are critical for its management.
Topics: Aged, 80 and over; Animals; Aorta, Abdominal; Aortic Diseases; Cattle; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Polyethylene Terephthalates
PubMed: 35510033
DOI: 10.2147/VHRM.S363417 -
BMC Surgery Sep 2023The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially...
BACKGROUND
The procedure of total duodenum-preserving pancreatic head resection (DPPHRt) has been reported frequently, but rare in minimally invasive procedure, especially robotic-assisted operation. Here we share our experience and analyze the clinical outcomes of minimally invasive DPPHRt in the treatment of benign lesions or low-grade malignant tumors of the pancreatic head in this study.
MATERIALS AND METHODS
From October 2016 to January 2022, three patients received robot-assisted DPPHRt(RA-DPPHRt), and seventeen patients received laparoscopic DPPHRt(LDPPHRt). Data were retrospectively collected in terms of demographic characteristics (age, gender, body mass index, and pathological diagnosis), intraoperative variables (operative time, estimated blood loss), and post-operative variables (post-operative hospital stay, and complications).
RESULTS
All 20 patients received minimally invasive total duodenum-preserving pancreatic head resection successfully without conversion, including 8 males and 12 females. Pathological diagnosis suggested 1 case of serous cystadenoma (SCA), 4 cases of intraductal papillary mucinous neoplasm (IPMN) ,5 cases of mucinous cystic neoplasm (MCN), 4 cases of pancreatic neuroendocrine neoplasm (PNET), 2 cases of chronic pancreatitis (CP),4 case of solid pseudopapillary tumor (SPT). The average operation time was (285.35 ± 95.13 min), ranging from 95 to 420 min. The average estimate blood loss was (196.50 ± 174.45ml) ,ranging from 10 to 600ml.The average post-operative hospital stay was(20.90 ± 14.44days),ranging from 8 to 54 days. Postoperative complications occurred in 10 patients (50%). A total of 5 patients (20%) suffered grade B or C pancreatic fistula. Two patients (10%) suffered from biliary fistula. Two patients (10%) suffered from delayed gastric emptying. One patient (5%) suffered from abdominal bleeding. The 90-day mortality was 0. No patient was observed tumor recurrence and new-onset diabetes but one developed diarrhea.
CONCLUSION
RA-DPPHRt or LDPPHRt provided a minimally invasive approach with good organ-preservation for patients with benign and low-grade malignant pancreatic head tumor. It is only recommended to be performed in high-volume pancreatic centers by experienced pancreatic surgeons.
Topics: Female; Male; Humans; Retrospective Studies; Neoplasm Recurrence, Local; Pancreatectomy; Pancreas; Pancreatic Neoplasms; Duodenum
PubMed: 37735367
DOI: 10.1186/s12893-023-02170-9 -
Journal of Medical Case Reports Jul 2020A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the... (Review)
Review
INTRODUCTION
A retroperitoneal abscess caused by duodenal perforation is a relatively rare disease clinically. We report the case of a patient with a local high-density shadow at the head of the retroperitoneal pancreas.
CASE PRESENTATION
A 28-year-old Chinese man presented with fever and abdominal pain after overeating and heavy drinking. On physical examination, he had mild tenderness in his upper abdomen. Laboratory examination results showed a white blood cell count of 24.06 10/L and a neutrophil absolute value of 18.81 10/L, and a computed tomography scan showed an irregular soft tissue mass with uneven enhancement of the cystic wall in the retroperitoneal space. Gastroscopy showed that there was a fistula in the anterior wall of the duodenal bulb. Endoscopic anastomosis clip system (over-the-scope clip) of the duodenal fistula was performed successfully. After the operation, nasal feeding was provided with a nutrition tube, and empiric anti-infection, acid-inhibiting, and stomach-protecting treatments were administered. Our patient's body temperature gradually returned to normal, and his abdominal pain decreased.
CONCLUSIONS
A retroperitoneal abscess caused by duodenal perforation can be diagnosed by clinical symptoms and abdominal computed tomography imaging. The choice of treatment should be based on accurate and timely clinical and imaging data.
Topics: Abdomen; Abdominal Abscess; Abscess; Adult; Duodenal Diseases; Duodenum; Humans; Male
PubMed: 32678002
DOI: 10.1186/s13256-020-02393-x -
Asian Journal of Surgery Sep 2022
Topics: Duodenal Diseases; Duodenum; Endoscopy; Humans; Intestinal Fistula; Negative-Pressure Wound Therapy
PubMed: 35599128
DOI: 10.1016/j.asjsur.2022.05.034 -
Revista Espanola de Enfermedades... May 2024Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric...
Gallstone ileus is a rare complication of cholelithiasis, characterized by mechanical bowel obstruction due to a biliary calculus originating from a bilioenteric fistula. The Rigler triad, consisting of aerobilia, ectopic gallstone, and intestinal obstruction, is rarely observed in its complete form. We present the case of a 92-year-old male with a history of acute lithiasic cholecystitis who presented to the Emergency department with acute epigastric pain. Initial evaluation revealed gallbladder dilatation, gallstones, and gallbladder wall thickening suggestive of acute cholecystitis. During hospitalization, the patient experienced an episode of hematemesis, leading to the diagnosis of a cholecystoduodenal fistula and a large blood clot in the duodenal bulb. Further imaging showed an ectopic gallstone causing small bowel obstruction. The patient underwent urgent surgery for stone extraction, followed by endoscopic intervention for the bleeding vessel identified at a subsequent gastroscopy. Unfortunately, the patient had a poor postoperative course and passed away seven days later. This case report highlights the exceptional occurrence of both the Rigler triad and upper gastrointestinal bleeding in a patient with gallstone ileus. Surgical intervention is crucial for the initial resolution of intestinal obstruction, followed by cholecystectomy and repair of the bilioenteric fistula. Awareness of these rare presentations is important for timely diagnosis and appropriate management of this uncommon complication of cholelithiasis.
Topics: Humans; Male; Gastrointestinal Hemorrhage; Aged, 80 and over; Gallstones; Ileus; Intestinal Obstruction; Fatal Outcome; Intestinal Fistula; Biliary Fistula
PubMed: 37314135
DOI: 10.17235/reed.2023.9731/2023 -
Journal of Ultrasound Jun 2022We describe a case of a cholecystoduodenal fistula (CDF) diagnosed using oral contrast-enhanced ultrasound (CEUS). CDF is a rare type of biliary-enteric fistulation in...
We describe a case of a cholecystoduodenal fistula (CDF) diagnosed using oral contrast-enhanced ultrasound (CEUS). CDF is a rare type of biliary-enteric fistulation in which an abnormal communication forms between the gallbladder and duodenum. CDF are usually found in older patients, in the context of chronic cholecystitis, and can be associated with serious consequences. Given the non-specific presentation and limitations of the various imaging modalities, CDF are notoriously difficult to diagnose. CEUS is a recognised technique predominantly deployed for imaging following intravenous administration. Experience of CEUS has expanded into endocavitary use, including in the biliary and gastrointestinal systems. We describe a case of a CDF identified on intracavitary CEUS. This case report demonstrates oral ingestion of a diluted ultrasound contrast agent is a novel and safe mode of administration with stability of the contrast agent and the ability to define fistulation.
Topics: Aged; Contrast Media; Gallbladder; Humans; Intestinal Fistula; Ultrasonography
PubMed: 33159665
DOI: 10.1007/s40477-020-00535-x -
California Medicine Feb 1958The literature on the subject and the records of 40 cases of proven gallstone obstruction in the small intestine observed at the Los Angeles County General Hospital over...
The literature on the subject and the records of 40 cases of proven gallstone obstruction in the small intestine observed at the Los Angeles County General Hospital over a 27-year period were reviewed. The incidence of this type of obstruction is about 1.5 per cent of all cases of mechanical intestinal obstruction; and it occurs more often in women than in men-the ratio was 3.7 to 1 in the Los Angeles County General Hospital series. In general, the majority of patients are in the seventh decade of life, although in the present series the age average was well over 70 years. Gallstones large enough to cause intestinal obstruction almost invariably reach the intestinal tract through a fistula between the gallbladder and the duodenum. The symptoms of gallstone obstruction are principally those of mechanical obstruction of the small bowel. The usual site of obstruction is the distal ileum. When gallstones are the cause of obstruction, the symptoms may be intermittent. Surgical operation is the treatment of choice. Exploration should include a complete examination of the intestinal tract to make certain multiple stones are not overlooked, and the right upper quadrant should be palpated for the presence of an acutely inflamed gallbladder or more calculi.
Topics: Cholelithiasis; Duodenum; Female; Gallstones; Humans; Ileum; Incidence; Intestinal Obstruction; Male
PubMed: 13500219
DOI: No ID Found -
Cirugia Espanola Oct 2008
Topics: Aged, 80 and over; Cholecystectomy; Duodenum; Gallstones; Gastric Outlet Obstruction; Humans; Intestinal Fistula; Laparotomy; Male; Radiography, Abdominal; Syndrome; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 18928774
DOI: 10.1016/s0009-739x(08)72624-1 -
The Journal of International Medical... Nov 2019Gastric teratoma primarily occurs within 3 months following birth, and is a rare pattern of gastric lesion in adult patients. The present study reports the case of a... (Review)
Review
Gastric teratoma primarily occurs within 3 months following birth, and is a rare pattern of gastric lesion in adult patients. The present study reports the case of a 60-year-old male patient who was diagnosed with a tumour in the lesser curvature within the gastric cardia area, which grew outside the cavity, invaded into the duodenal bulb and formed a gastroduodenal fistula. Briefly, initial gastroscopy upon hospital admission revealed mucosa bulging into the gastric cavity, gastric ulcer and duodenal bulb mucosal congestion with oedema. Subsequent computed tomography scans showed lesser curvature-occupying hamartoma in the gastric cardia area, and upper gastrointestinal angiography confirmed gastric stromal tumour complicated with cardia duodenal fistula. Total gastrectomy followed by Roux-en-y oesophagojejunostomy was performed, and pathology analysis of the tissue specimen confirmed mature gastric teratoma. The formation of a gastroduodenal bulb fistula with the tumour as a bridge is a rare phenomenon. A notable finding of the present case study was that the final diagnosis of gastric teratoma mainly depended on pathological examination.
Topics: Adult; Angiography; Gastric Fistula; Humans; Male; Middle Aged; Neoplasm Invasiveness; Stomach Neoplasms; Teratoma; Tomography, X-Ray Computed
PubMed: 31558072
DOI: 10.1177/0300060519869722