1/57. Development of a colocutaneous fistula in a patient with a large surface area burn.A 61 year old female sustained a large surface area burn, complicated by inhalation injury. One month before the incident, she had undergone a left hemicolectomy with colorectal anastomosis for diverticular disease. Due to the severity of her burns, multiple surgical debridement and skin grafting procedures were required, including a large fascial debridement of her flank and back. Her hospital course was complicated by recurrent episodes of pulmonary and systemic infection, as well as pre-existing malnutrition. Prior to her discharge to a rehabilitation center, stool began to drain from her left posterior flank. This complication represented a colonic fistula arising from the recent colon anastomosis. The fistula was managed nonoperatively and gradually closed. To our knowledge, this is the first report of a colocutaneous fistula spontaneously draining from the abdomen via the retroperitoneum in a burn victim, not related to direct thermal injury to the peritoneal cavity.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
2/57. Biliary-enteric fistulas: report of five cases and review of the literature.Internal biliary fistulas (IBF) are seen rarely. Because the symptoms and signs of IBF are not specific and the diagnosis is not suspected, these patients are commonly investigated with plain abdominal films (PAF), ultrasonography (US), upper gastrointestinal series (UGIS), barium enema (BE), and computed tomography (CT), but not always with endoscopic retrograde cholangiopancreatography (ERCP). The purposes of this article are (a) to attract attention of radiologists to presumptive findings of IBF, so as not to misdiagnose this unsuspected and rare disease, and (b) review of the literature while presenting radiologic features of our cases. Five cases of IBFs in which extrahepatic biliary tree communicating with duodenum (four cases) and colon (one case) are reported. Diagnostic work-up of cases were done by PAF, US, UGIS, BE, and CT. Aerobilia, which cannot be explained using other means, ectopic gallstone and small bowel dilatation, nonvisualization of the gallbladder despite no history of cholecystectomy, and thick-walled shrunken gallbladder adherent to neighboring organs were suggestive findings of IBF in our study. knowledge of imaging findings suggestive of IBF and a high index of suspicion increase the diagnostic rate of IBFs.- - - - - - - - - - ranking = 0.015594606102186keywords = index (Clic here for more details about this article) |
3/57. The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases.OBJECTIVE: To review the imaging appearances, management and outcome of a large number of children with intussusception owing to pathologic lead points (PLP) in an attempt to define the role of various imaging modalities in this clinical setting. MATERIALS AND methods: review of the records and imaging studies of 43 children with intussusception due to PLP diagnosed between 1986 and 1999. RESULTS: The commonest PLP found were meckel diverticulum, polyps, Henoch-Schonlein purpura and cystic fibrosis. PLP were depicted on sonography in 23 (66%) of 35 patients, on computed tomography in 5 (71%) of 7, on air enema in 3 (11%) of 28, and on barium enema in 6 (40%) of 15. air enema successfully reduced 60% of the intussusceptions. Nine children had recurrent intussusceptions. CONCLUSION: Sonography depicted two-thirds of PLP and provided a specific diagnosis in nearly one-third of our series. Our review does not provide sufficient data on how to continue the investigation of those patients in whom sonography does not depict a PLP but in whom there is a high index of suspicion for its presence. It remains a diagnostic challenge as to how to search for PLP in these patients, and other imaging modalities have to be requested according to each particular case.- - - - - - - - - - ranking = 0.015594606102186keywords = index (Clic here for more details about this article) |
4/57. Diaphragmatic hernia after Ivor-Lewis esophagectomy manifested as lower gastrointestinal bleeding.Diaphragmatic hernia after esophageal resection is a recognized but rare complication. Parahiatal hernias may result from manipulation and extension of the crura during surgery. This can lead to a wide array of symptoms depending on the extent and organ that is herniated. A high index of suspicion is required because there is no one symptom that is specific for herniation. This report represents the first case of a patient presenting with lower gastrointestinal bleed from a parahiatal hernia after esophageal resection.- - - - - - - - - - ranking = 0.015594606102186keywords = index (Clic here for more details about this article) |
5/57. Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia.Parastomal hernia, particularly when recurrent, presents a troublesome problem to the surgeon. Since the late 1970s, prosthetic-mesh repairs have been used increasingly, though, as yet, there is no consensus on the best technique of repair. We report a case of failure of a polypropylene-mesh repair of a recurrent parastomal hernia, complicated by erosion of the mesh edge into the colon proximal to the stoma. This entailed further resection of the colon, excision of the mesh and relocation of the colostomy. The case highlights the potential for serious morbidity from this form of repair and the need for careful assessment of symptoms before contemplating a surgical approach to any type of parastomal hernia.- - - - - - - - - - ranking = 0.01904811828944keywords = assessment (Clic here for more details about this article) |
6/57. diagnosis and current management of gastrojejunocolic fistula.Gastrojejunocolic fistula is a late complication of gastroenterostomy and is associated with inadequate gastric resection and incomplete vagotomy. In the past, attempted primary repair had high mortality and staged operations were normally performed. We present two cases of gastrojejunocolic fistula and discuss the modern management of this condition. In both cases, improved nutritional support allowed successful one-stage surgical repair to be performed.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
7/57. Gastrojejunocolic fistula after gastrectomy with Billroth II reconstruction: report of a case.We herein report the case of a 65-year old man with gastrojejunocolic fistula. The patient was admitted to our hospital because of edema of the lower limbs, diarrhea, and weight loss. His history included a distal gastric resection and Billroth II reconstruction for a duodenal ulcer 20 years previously. The laboratory data on admission revealed hypoproteinemia and hypoalbuminemia. An upper gastrointestinal X-ray series revealed a fistula between the transverse colon and upper jejunum. After improving his state of malnutrition, a partial resection of the remnant stomach, transverse colon, and jejunum, which were involved in the fistula, was performed. The postoperative course was uneventful and the patient was discharged on the 26th postoperative day. Gastrojejunocolic fistula is one of the severe complications of a stomal ulcer after a gastric resection with Billroth II reconstruction, which is considered to be induced by an inadequate resection of the stomach. As a result of the recent development of improved agents for the treatment of peptic ulcers, the occurrence of gastrojejunocolic fistula has decreased remarkably. However, gastrojejunocolic fistula should be recognized as one of the late severe complications observed after a gastrectomy with Billroth II reconstruction, since this disease may occur even 20 years after the first operation for peptic ulcer.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
8/57. Gastrojejunocolic fistula following surgery for peptic ulcer complications: two case reports.Two patients were admitted in the surgical unit--I of Mymensingh Medical College Hospital on January 2001 and March 2001 with the complaints of epigastric pain and discomfort, feculent eructation and fecal vomiting, diarrhoea with lienteric stools, weight loss and weakness. Both of them had previous history ulcer complications. The diagnoses of gastrojejunocolic fistula were made on the basis of history, barium enema examination and upper gastrointestinal endoscopy. Early resuscitation with correction of nutritional deficiencies, fluid and electrolyte imbalance was attempted along with blood transfusion, antibiotics and other supportive measures. But the first patient was too ill to cope up with the treatment and developed cardio-respiratory symptoms. A single stage procedure comprising of partial gastrectomy along with resection of the fistula and restoration of bowel continuity (by jejunojejunostomy, colocolostomy and closure of duodenal stump) was adopted in both patients. Early postoperative recovery was good in both but the first patient expired on 8th postoperative day from acute myocardial infarction, while the second one developed anastomotic leakage and wound infection, which were managed conservatively. On follow up the second patient was found in sound health till to date after his discharge from the hospital.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
9/57. Incarcerated diaphragmatic hernia: report of an unusual case.Traumatic diaphragmatic hernias, although quite common are frequently overlooked as a cause of intestinal obstruction. The hernia may produce significant symptoms acutely or manifest itself many years following the initial injury. A high index of suspicion is necessary to diagnose intestinal obstruction due to incarcerated diaphragmatic hernia. The operation should be performed through the transabdominal approach when hernia occurs acutely, and the transthoracic approach is recommended when herniorrhaphy is performed long after the time of injury. A case of incarcerated traumatic diaphragmatic hernia that occurred 19 years following a gunshot wound of the chest is reported. The intestinal obstruction was initially thought to be due to cancer of the splenic flexure of the colon.- - - - - - - - - - ranking = 0.015594606102186keywords = index (Clic here for more details about this article) |
10/57. Anorectal malformation with malrotation of gut.Infants with anorectal anomaly have a high risk of having other congenital anomalies, but associated gastrointestinal tract anomalies are quite rare. Malrotation of gut is rarely associated with anorectal anomaly. We report two such cases of anorectal malformation with malrotation of gut. The high index of suspicion, diagnostic difficulty and surgical management with avoidance of appendicectomy in these neonates is discussed.- - - - - - - - - - ranking = 0.015594606102186keywords = index (Clic here for more details about this article) |
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