Cases reported "Gastric Fistula"

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1/44. Gastric tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap.

    A gastric tube-to-airway fistula is a very rare complication after esophageal reconstruction. A patient with a gastric tube-to-tracheal fistula that developed more than 9 years after surgery for cancer of the cervical esophagus was treated with transposition of a pedicled latissimus dorsi myocutaneous flap. Careful perioperative respiratory management helped save the patient's life.
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2/44. Gastropleural fistula as complication of postpneumonectomy empyema.

    A 54-year-old woman underwent a left pneumonectomy for monolateral congenital pulmonary cysts, complicated by a pleural empyema without bronchial fistula, in the late postoperative period. The pleural empyema was evacuated and managed by means of a small thoracic drainage. Three months after discharge the patient noticed the presence of ingesta in the pleural washing fluid. Diagnostic and operative procedures in this rare case of non malignant, non traumatic gastropleural fistula are described.
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keywords = operative
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3/44. Two cases of benign tracheo-gastric fistula following esophagectomy for cancer.

    Two successfully managed cases of esophageal replacement for cancer complicated by neoesophagotracheal fistula are described. In both cases radical esophagectomy with a gastric pull-up was performed. In the postoperative period different complications necessitated prolonged ventilatory support and tracheostomy. In both cases a tracheo-gastric fistula developed probably because of the ischaemic effort of the tracheostomy tube and the nasogastric tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In the first case resection of four strictured tracheal rings and tracheal anastomosis had to be performed. In the second case the fistula was recognized earlier and stricture did not develop. The defect on the membranous trachea was patched with autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the trachea and the pulled up stomach in both cases to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.
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keywords = operative
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4/44. Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication.

    Laparoscopic fundoplication has become the standard operation for gastroesophageal reflux disease. In our service, a laparoscopic fundoplication is performed as a 2-cm floppy 360 degrees wrap with division of the short gastric vessels and the fundoplication is sutured using a prolene 2/0 mattress suture (Ethicon, USA) and buttressed laterally with two teflon pledgets (PTFE 1.85 mm; low porosity, Bard, USA). We report a patient with post-operative dysphagia due to an esophagogastric fistula caused by erosion of a teflon pledget. This is the first such case in 734 laparoscopic fundoplications performed between January 1991 and December 1998. reoperation was required, resulting in a prolonged convalescence. A review of current literature has not revealed any similar cases. Causes for this rare complication are postulated.
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keywords = operative
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5/44. A rare complication of surgical management for esophageal tumor: a non neoplastic belated fistula between stomach and main right bronchus.

    The fistula between stomach and bronchus after surgery for cancer of the esophagus is a rare occurrence. We describe a gastric non neoplastic ulceration that arose late after six years from an esophagectomy, with an end-side cervical esophagogastrostomy, for a spino-cellular carcinoma. After the partial failure of surgical technique, of the endoscopic treatment and for the bad general conditions of patient we decided to treat the fistula by transluminal drainage. This technique involved a progressive resolution of the fistula, becoming, nowadays, in our division, the preferred treatment for these kinds of postoperative complications.
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ranking = 1
keywords = operative
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6/44. Gastric necrosis and perforation as a complication of splenectomy. Case report and related references.

    necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.
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ranking = 2
keywords = operative
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7/44. Iatrogenic gastric fistula due to inappropriate placement of intercostal drainage tube in a case of traumatic diaphragmatic hernia.

    A 26-year-old, 30 weeks primigravida presented with a gastric fistula through a left intercostal drain, which was inserted for drainage of suspected haemopneumothorax following minor trauma. It was confirmed to be a diaphragmatic hernia, with stomach and omentum as its contents. On exploratory laparotomy, disconnection of the tube and fistulous tract, with reduction of herniated contents and primary suturing of stomach was carried out. Diaphragmatic reconstruction with polypropylene mesh was also carried out. Post-operative recovery was uneventful with full lung expansion by 3rd postoperative day. Patient was asymptomatic at follow-up 6 months.
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ranking = 2
keywords = operative
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8/44. 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.
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ranking = 2
keywords = operative
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9/44. Pyloric atresia associated with multiple intestinal atresias and pylorocholedochal fistula.

    Although congenital pyloric atresia commonly occurs in isolation, it has rarely been reported in association with other alimentary tract atresias. This is a report of a newborn with congenital pyloric atresia associated with duodenal atresia, jejunal atresia, apple-peel ileal atresia, and pylorocholedochal fistula. Preoperative diagnosis was duodenal atresia because of bilious vomiting, and erect radiogram showed double bubble sign. The presented case is the first report of such an association.
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ranking = 1
keywords = operative
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10/44. 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.
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ranking = 8
keywords = operative
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