1/44. Acquired ileal atresia and spontaneous reconstitution of intestinal continuity in a premature infant with necrotizing enterocolitis.An 849-g (26-week gestation) premature infant had pneumoperitoneum on the 20th day of life after having normal stools and accepting partial enteric alimentation. Percutaneous penrose drainage had to be performed on 2 consecutive days at 2 different sites (right lower quadrant, left lower quadrant), at which time she stabilized. Eleven days later, she started to pass stool, and oral feeding was begun (1 to 2 mL every 4 hours). Enteral intake could not be advanced because of repeated bouts of abdominal distension, despite having regular bowel motions. Gastrointestinal contrast radiographic investigation suggested a stricture of the ileum. At laparotomy (at age 2 months) ileal atresia with a "V"-shaped defect in the mesentery was found. Surprisingly, intestinal continuity was established via an ileoileal fistula. After resection and anastomosis, she recovered fully. Mesenteric and enteric vascular ischemia (necrotizing enterocolitis) produced acquired ileal atresia-a rare occurrence. More rare is the reestablishment of intestinal continuity by fistulization.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/44. Stent-graft treatment for bleeding from a presumed aortoenteric fistula.PURPOSE: To describe a technique for the endovascular treatment of aortoenteric fistula. methods AND RESULTS: A 67-year-old man who had undergone aortobi-iliac grafting for aneurysmal disease 8 years previously presented with life-threatening upper gastrointestinal hemorrhage. endoscopy after resuscitation did not identify the source of the bleeding. Computed tomographic (CT) scanning and angiography revealed pseudoaneurysm formation at the upper anastomosis 1 cm below the renal arteries. Measurements were taken for endovascular repair. Uncomplicated emergency aortic endografting for exclusion of the pseudoaneurysm was performed using a 28-mm x 3.75-cm AneuRx device. gastrointestinal hemorrhage ceased. CT scanning at 6 months confirmed the absence of a pseudoaneurysm, and the patient remains symptom free at 18 months. CONCLUSIONS: Endovascular treatment of aortoenteric fistula may represent a technique for treating gastrointestinal hemorrhage and for lessening the morbidity and mortality of open repair.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/44. Primary aortosigmoid fistula treated by descending thoracic aortofemoral bypass.Primary aortoenteric fistula is a rare disease with a fatal outcome unless it is diagnosed accurately and treated surgically. We present an elderly patient with primary aortosigmoid fistula confirmed by endoscopy. Descending thoracic aortofemoral bypass was performed and the aortoiliac aneurysm and sigmoid colon were then resected in continuity. The patient maintains a good quality of life 6 years after the operation with good graft patency and no sign of graft infection.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/44. Upper gastrointestinal hemorrhage secondary to erosion of a biliary Wallstent in a woman with pancreatic cancer.A 77-year-old patient with unresectable pancreatic adenocarcinoma sustained a life-threatening, upper gastrointestinal hemorrhage 1 month after placement of a biliary Wallstent. Radiographic and endoscopic studies revealed a choledocho-arterio-enteric fistula caused by erosion of the stent through the posterior duodenal wall. The patient was treated successfully with arterial embolization. This represents an unusual case of arterial bleeding with choledocho-arterio-enteric fistulization into the duodenum subsequent to biliary stent erosion.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/44. Secondary aortoduodenal fistula. Rare endoscopic finding in the course of digestive hemorrhage.Secondary aortoduodenal fistula is a rare and life-threatening long-term complication of abdominal aortic surgery. Pathogenesis is often not clear; both mechanical trauma and septic procedures are involved as principal factors. The interval between first intervention and development of the fistula can vary from months to years. The presentation is often subtle with a herald bleeding followed by a period of grace, followed or not by an exsanguinating hemorrhage. The right diagnosis of aortoduodenal fistula hemorrhage can be difficult. We emphasize the need to have an early and correct diagnosis in one with differential diagnosis of patients with gastrointestinal bleeding after previous abdominal aortic replacement surgery. The esophagogastroduodenoscopy (until the Treitz) is the main diagnostic procedure, able to demonstrate the fistula and rule out other possible causes of bleeding.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/44. Timing of surgery for enterovesical fistula in Crohn's disease: decision analysis using a time-dependent compartment model.OBJECTIVES: Previous decision analyses of inflam matory bowel diseases (IBD) have used decision trees and markov chains. Occasionally IBD patients present with medical problems that are difficult or even impossible to phrase in terms of such established decision tools. This article aims to introduce modeling by a time-dependent compartment mode and demonstrate its feasibility for decision analysis in IBD methods: A Crohn's disease patient presented with a pelvic abscess and an enterovesical fistula. Being hesitant to operate in an acutely inflamed area, the surgeon recommended that the patient continue antibiotic therapy until the abscess had re solved. The gastroenterologist argued that the patient had already been treated with antibiotics for a prolonged time period and expressed concern that the patient's overall diminished health status would deteriorate by further delay of surgery. The occurrence of fistula, abscess, urinary tract infection, antibiotic therapy, surgical operation, and health-related quality of life were modeled as separate compartments, with time-dependent relationships among them. The simulation was carried out on an Excel spreadsheet. RESULTS: In the model, the surgeon's predictions were associated with rapid resolution of the pelvic abscess under antibiotic therapy and improvement of the patient's health status. The gastroenterologist's predictions resulted in a smaller decline in abscess size and further deterioration of the patient's health while waiting for a definitive treatment. The disagreement between surgery and gastroenterology arose from predicting different time courses for the individual disease events, in essence, from assigning different time constants to the time-dependent influences of the disease model. CONCLUSIONS: The compartment model provides a simple and generally applicable method to assess time dependent-changes of a complex disease. The present analysis also serves to illustrate the usefulness of such models in simulating disease behavior.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/44. Primary aortoenteric fistula in the Emergency Department.A primary aortoenteric fistula is a rare, life-threatening cause of gastrointestinal bleeding. Primary aortoenteric fistula results most commonly from an abdominal aortic aneurysm, with the fistula forming most often between the aorta and the third portion of the duodenum. Often, the classic triad of abdominal pain, gastrointestinal bleeding, and pulsatile mass is absent. A heraldic bleed frequently precedes lethal exsanguination from a primary aortoenteric fistula. Patient survival is dependent on prompt diagnosis and emergent therapeutic laparotomy.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/44. Duodenocaval fistula: a life-threatening condition of various origins.We report on two cases of duodenocaval fistula. The first patient, a 73-year-old man, had sepsis and occult digestive bleeding. We diagnosed a fistula that resulted from a right nephrectomy and subsequent radiotherapy for a urothelial tumor 20 months earlier. The second patient, a 60-year-old woman, complained of right abdominal pain. A duodenocaval fistula that was caused by duodenal perforation by a migrating caval filter placed 10 years earlier was revealed by means of endoscopy. Both patients had a successful operation to treat the condition. An extensive review of the literature disclosed 35 other cases and identified two factors of good prognosis: duodenocaval fistulas caused by migrating caval filters and early surgery.- - - - - - - - - - ranking = 4keywords = life (Clic here for more details about this article) |
9/44. vacuum-assisted closure for cutaneous gastrointestinal fistula management.BACKGROUND: Cutaneous gastrointestinal (GI) fistulas are a challenging complication in the oncologic patient population. The fistulous effluent is difficult to manage and adversely alters quality of life. Nonsurgical management of enteric fistulas is successful in 30% of cases, requiring at least 4 to 6 weeks. Recently a new technology has been developed to expedite wound healing. The vacuum-Assisted Closure (VAC) method is a subatmospheric pressure technique that has been demonstrated in laboratory and clinical studies to significantly improve wound healing. Here we report its use in the successful medical management of a cutaneous GI fistula. CASE: A 63-year-old woman with advanced ovarian cancer developed an extensive complex cutaneous GI fistula in an open healing wound. She was treated with total parental nutrition and the VAC device, which resulted in complete closure of the fistula. CONCLUSION: We propose that the VAC device may be a useful adjunct for the medical management of cutaneous GI fistulas.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/44. Disseminated peritoneal adenomucinosis associated with a panperitonitis-like onset: report of a case.A 59-year-old man was admitted to our department due to a fever of unknown origin. Abdominal ultrasonography and computed tomography showed a large cystic mass in the lower abdomen and a massive amount of abdominal fluid. A laparotomy was performed under a diagnosis of panperitonitis. Diffuse pyogenic gelatinous ascites and a large cystic mass with a grayish wall, and a hard solid lesion in part were found. The microscopic findings of the hard solid lesion showed calcification, osteogenesis, and focal epithelial proliferation in a tiny area consisting of mucinous cells with no significant cytologic atypia. The remaining part of the cystic wall and small cystic lesions were hyalinized, fibrous, or necrotic tissue. Since a total resection of the masses was not possible, the patient received adjuvant chemotherapy with cisplatin followed by the administration of mitomycin C and 5-fluorouracil. An abdominal fistula with the excretion of pyogenic gelatinous fluid occurred, but the patient is still alive and doing well over 2 years postoperatively. The primary site of this tumor could unfortunately not be identified.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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