1/40. Interventional radiology in percutaneous management of bile duct obstruction: biliary drainage through a spontaneous common hepatic duct-duodenal fistula.bile duct injuries are a serious complication of biliary surgery. We report a case of benign obstruction of the common hepatic duct associated with common hepatic duct-duodenal spontaneous fistula following complex surgical intervention. We managed percutaneously the fistula with balloon dilatation and long-term stenting, as the fistula allowed biliary flow in the duodenum. We avoided reintervention preserving biliary flow, with good clinical results after a follow-up of a 3 years. We emphasize the role of a clinically focused approach to percutaneous management of complications following biliary surgery.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/40. Laparoscopic management of enterocutaneous fistula.Enterocutaneous fistulas develop in settings of prior abdominal surgery, inflammatory bowel disease, diverticulitis, radiation or malignancy. Traditional surgical management requires laparotomy with bowel resection and anastomosis and is associated with a high incidence of wound infection. Recent advances in instrumentation and accumulation of experience has allowed minimally invasive surgery to become an alternative and often preferred approach to handling complex surgical problems. We present a case of successful laparoscopic management of an enterocutaneous fistula that developed in the setting of prior colectomy and laparoscopic inguinal hernia repair with prosthetic mesh. laparotomy and its attending complications were avoided facilitating recovery and return to work.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
3/40. Complex enterocutaneous fistula: closure with rectus abdominis muscle flap.Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously in less than 30% of cases. mortality rates in patients with complex enterocutaneous fistulas may reach 60% to 80%. When traditional conservative surgeries of fistulous tract excision, bowel mobilization, and resection with primary end-to-end anastomosis fail, a more aggressive approach is required. The rectus abdominis muscle flap has been extensively studied and used in a wide variety of abdominal, vaginal, and perineal repairs. We report successful closure of complex enterocutaneous fistulas with a rectus abdominis muscle flap in a complicated case.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
4/40. Management of a high-output postoperative enterocutaneous fistula with a vacuum sealing method and continuous enteral nutrition.A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatment may become long-lasting, wearisome, and its outcome often is disappointing. Here, we describe the use of a novel device to treat a 67-year-old patient with a postoperative, high-output enterocutaneous fistula. A semipermeable barrier was created over the fistula by vacuum packing a synthetic, hydrophobic polymer covered with a self-adherent surgical sheet. To set up the system, we constructed a vacuum chamber equipped with precision instruments that supplied subatmospheric pressures between 350 and 450 mm Hg. The intestinal content was, thus, kept inside the lumen, restoring bowel transit and physiology. The fistula output was immediately reduced from a median of 800 ml/day (range, 400-1,600 ml/day), to a median of 10 ml/day (range, 0-250 ml/day), which was readily collected by the apparatus. Oral feeding was reinitiated while both parenteral nutrition and octreotide were withdrawn. No septic complications occurred, and the perifistular skin stayed protected from irritating intestinal effluents. Both the fistula orifice and the wound defect fully healed after 50 days of treatment. We believe this method may serve as a useful tool to treat selected cases of high-output enterocutaneous fistulas without the need for octreotide or parenteral nutrition.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/40. 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 = complex (Clic here for more details about this article) |
6/40. Duodenal tuberculosis with a choledocho-duodenal fistula.A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.- - - - - - - - - - ranking = 0.2267836763368keywords = neoplasm (Clic here for more details about this article) |
7/40. 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 = complex (Clic here for more details about this article) |
8/40. The use of wound drainage bags for complex wounds.The routine use of drainage devices for wound management is relatively uncommon because of the extensive range of dressings available. However, there is an almost equally large range of wound drainage devices with different designs and properties from which to choose. Large, complex wounds with a fistula draining small bowel content are difficult to manage. This article focuses on wound drainage bags and explores the case of a patient with a large abdominal wound with a fistula at the lower end whose effluent was contained by Wound Manager (manufactured by Craig Medical, obtained from ConvaTec).- - - - - - - - - - ranking = 5keywords = complex (Clic here for more details about this article) |
9/40. The wound that nearly got away: a case presentation.Chronic cavity wounds are not commonly seen in pediatrics, and little literature is available on their management. A pediatric patient with juvenile dermatomyositis (JDMS) who had a chronic cavity surgical wound with an enterocutaneous fistula presented a nursing challenge. The patient had complex medical and surgical problems that greatly influenced her ability to heal. nursing management of the wounds had to be innovative and flexible to adapt to these challenges. Factors affecting the patient's wound healing included JDMS; decreased mobility; persistently low serum magnesium, zinc and albumin; malnutrition; infection; and prolonged glucocorticosteroid therapy. nursing management of her complex wounds included the following strategies: absorption of excessive exudate, wound support, debridement, wound irrigation, wound bagging, healing by secondary intention, and control of hypergranulation.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
10/40. Symptomatic ileocolic fistula as a complication of endoscopic laser therapy. A case report.Since 1973, laser photo therapy is used in the treatment of gastrointestinal neoplasms as well as in various forms of intestinal hemorrhage. Complications including hemorrhage, stenosis and perforation are well documented but ileocolic fistulas after laser therapy for a villous adenoma have been rarely reported. We report the case of a patient with diarrhea related to an ileocecal fistula. This fistula appeared 1 year after laser therapy for a villous tumor of the cecum.- - - - - - - - - - ranking = 0.2267836763368keywords = neoplasm (Clic here for more details about this article) |
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