1/31. Double pylorus: a complication of chronic gastric ulcer?A case of double pylorus with a chronic ulcer in one of the two channels is described. The patient, a middle-aged man with active rheumatoid arthritis, required partial gastrectomy to allow continued treatment of the arthritis with anti-inflammatory drugs. Detailed histological examination of the surgical specimen revealed features consistent with intramural penetration of an ulcer across the pyloric ring, resulting in a gastro-duodenal fistula. The findings provide further support for the hypothesis that the double pylorus is an acquired lesion, which occurs as an uncommon complication of chronic peptic ulcer.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/31. Cholecystogastric fistula presenting with haematemesis: diagnosed by endoscopic retrograde cholangiography.The case is reported of a 72-year-old woman suffering from morbid obesity, who presented with haematemesis while on anti-coagulant therapy. The source of the bleeding proved to be the gastric exit of a cholecystogastric fistula. Subsequent cholangitis was successfully treated by endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) while simultaneously the extent of the fistula was established. cholecystectomy and closure of the fistula was contraindicated because of her morbid obesity. She remained well for 6 months but then presented with a gallstone ileus while another stone was found to be escaping from the gastric fistula. Her morbid obesity resulted in surgical procrastination, which eventually proved fatal. This patient experienced both of the most common types of complication in cholecysto-enteral fistulation, cholangitis and gallstone ileus. Although cholecysto-enteral fistulas (CEF) are probably less common than several decades ago, they are now most likely to be diagnosed during ERC. Gastroenterologists therefore need to be aware of their potential to contribute to the diagnosis and treatment of this surgical condition.- - - - - - - - - - ranking = 87.754164850723keywords = closure (Clic here for more details about this article) |
3/31. Broncho-gastric fistula complicating transthoracic esophagectomy.Tracheo-esophageal and broncho-esophageal fistulas are recognized complications in advanced esophageal cancers. The common complications seen after transthoracic esophagectomy include pulmonary complications, anastomotic leaks, gastric stasis, and anastomotic strictures. A broncho-gastric fistula is a very rare complication of transthoracic esophagectomy and has been reported anecdotally in the literature. We report a patient who underwent a transthoracic esophagectomy and developed a broncho-gastric fistula caused by a staple from the stomach tube suture line eroding into the right bronchus. diagnosis was made by fiberoptic bronchoscopy. The patient was successfully treated with re-exploratory thoracotomy and closure of the fistula.- - - - - - - - - - ranking = 87.754164850723keywords = closure (Clic here for more details about this article) |
4/31. Gastrobronchial fistula repair followed by esophageal leak--rescue by transesophageal drainage of the pleural cavity.A gastrobronchial fistula (GBF) associated with bilateral aspiration pneumonia was diagnosed six years after an esophagectomy with gastric pull-up. After failed surgical repair, an uncontained esophagopleural leak developed. Fistula closure was attempted by implanting a Wilson-Cook endoprosthesis, which quickly became dislodged. Transesophageal drainage was positioned endoscopically through the suture-line defect and led to closure of the leak after 10 days.- - - - - - - - - - ranking = 175.50832970145keywords = closure (Clic here for more details about this article) |
5/31. Successful management and outcome of a postoperative aortogastric fistula in a patient with recurrent gastric cancer: report of a case.The case of a 57-year-old patient is described, who presented with regional gastric cancer recurrence 1 year after a gastrectomy for a T3N1M0 (Stage IIIA) adenocarcinoma of the stomach. He underwent a radical resection with intraoperative radiation to the regional field. Two months postoperatively, massive upper gastrointestinal bleeding occurred. Operative management included a left thoracotomy, aortic cross-clamping, laparotomy, and suture repair of a fistula from the root of the celiac trunk to the gastric remnant, with a completion gastrectomy. The patient survived and underwent a delayed reconstruction and closure. Subsequently, several repeat bleeding episodes took place, from sources including the celiac, common hepatic, and proper hepatic arteries. Multiple angiographic coil embolization and surgical procedures became necessary, ultimately requiring an esophagostomy and cecostomy for intestinal diversion. A rectus abdominis flap coverage of the exposed large arteries was performed. Although two more bleeding episodes took place, the patient was ultimately managed successfully. He is currently free of disease 3 years after reexploration, able to take oral nutrition, with intermittent jejunostomy feeding supplements. The discussion highlights aspects relevant to this case: the importance of a complete regional resection during a gastric cancer resection, the management strategy for an acute catastrophic intra-abdominal bleeding, and possible mechanisms that could contribute to such bleeding, including intraoperative radiation and postoperative infection.- - - - - - - - - - ranking = 87.754164850723keywords = closure (Clic here for more details about this article) |
6/31. Primary aortogastric fistula after nissen fundoplication: a case report and review of pertinent literature.Aortogastric fistulas are a rare but usually fatal entity that presents as an acute gastrointestinal bleeding. The authors present the case of a 65-year-old man who had undergone a Nissen fundoplication and presented in the emergency room with syncope secondary to massive upper gastrointestinal tract bleed. Despite aggressive resuscitation and prompt operative intervention with repair of the gastric ulcer and closure of the aortic side of the fistula, he succumbed to the complications of hypovolemic shock. Overview of the pertinent literature with discussion of the most common causes of aortogastric fistulas as well as guidelines for intraoperative management are also presented.- - - - - - - - - - ranking = 87.754164850723keywords = closure (Clic here for more details about this article) |
7/31. Successful endoscopic closure of a benign gastrocolonic fistula using human fibrin sealant through gastroscopic approach: a case report and review of the literature.Gastrocolonic fistula is a well-recognized but rare complication of a variety of diseases, and surgical or endoscopic procedures. If not promptly treated it might result in death due to severe nutritional debility, fluid and electrolyte imbalances. The rarity of the condition leaves clinicians without a proven management option. Traditionally, operative treatment has been advocated. Spontaneous closure of a gastrocolonic fistula, with conservative management only, is infrequent. In the era of minimally invasive surgery the management approach warrants a review. We report a case where non-surgical treatment with local instillation of human fibrin glue was successfully undertaken, as demonstrated by contrast studies, to treat a benign gastrocolonic fistula, and might be a valid alternative to both surgical and medical treatment, although the patient's return to high risk behaviour resulted in a recurrence. Furthermore, in high operative risk patients or those with poor prognosis, this approach might prevent major morbidity, mortality or prolonged hospital stay.- - - - - - - - - - ranking = 438.77082425362keywords = closure (Clic here for more details about this article) |
8/31. Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant.BACKGROUND: Gastrocutaneous fistula is an uncommon and difficult to treat complication that occurs in 0.5% to 3.9% of patients who undergo gastric surgery. sepsis usually follows, and, when it is not managed effectively, the associated mortality rate can be as high as 85%. A fibrin sealant was used to endoscopically manage gastrocutaneous fistulas that developed in 3 morbidly obese patients after bariatric surgery. methods: Two of 14 (14.29%) patients who underwent vertical gastroplasty (MacLean procedure) developed a non-healing gastrocutaneous fistula. In addition, one of 24 (4.17%) patients who had a biliopancreatic diversion with preservation of pylorus developed a gastrocutaneous fistula. Endoscopic application of a fibrin sealant was performed under direct vision via a double-lumen catheter passed through a forward-viewing endoscope. OBSERVATIONS: Treatment was successful in all patients after one or more endoscopic sessions in which the fibrin sealant was applied; no evidence of fistula was found at follow-up endoscopy. CONCLUSIONS: Endoscopic closure of gastrocutaneous fistula with human fibrin tissue sealant is simple, safe, and effective, and, in some cases, can be life-saving. Endoscopic application of fibrin sealant should be considered a therapeutic option for treatment of gastrocutaneous fistula that develops after bariatric surgery.- - - - - - - - - - ranking = 87.754164850723keywords = closure (Clic here for more details about this article) |
9/31. Gastrocolic fistula secondary to nonsteroidal anti-inflammatory drugs abuse in a cirrhotic patient.Gastrocolic fistula is rarely described in the literature. It has been associated with a variety of diseases and recently with benign gastric ulcers related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs'). The present case represents the first report of gastrocolic fistula due to NSAIDs in a cirrhotic patient. This is in keeping with the established knowledge that cirrhotic patients constitute a high-risk group of patients when treated with NSAIDs'. review of the literature shows that this condition warrants a complete diagnostic work-up to exclude more ominous underlined diseases.- - - - - - - - - - ranking = 5keywords = drug (Clic here for more details about this article) |
10/31. A new technique of postoperative pancreatico gastric enterocutaneous fistula repair using de-tubularised afferent loop.Postoperative fistula involving upper gastrointestinal tract surgery is a rare but troublesome occurrence. reoperation on these patients is challenging and needs to be individualised. Various methods are described including primary closure, bypass procedures, serosal patch repair and Roux-en-Y repair. We present a new technique of repair using afferent loop that provided a vascularized bowel segment, which used in an anatomical fashion for closure of fistula.- - - - - - - - - - ranking = 175.50832970145keywords = closure (Clic here for more details about this article) |
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