Cases reported "Intestinal Fistula"

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1/12. 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.
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2/12. 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.
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3/12. Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula.

    OBJECTIVE: The objective of our study was to illustrate a case of endoscopically placed biliary stent breakage. methods: A72-year-old woman with a prolonged history of cholangitis following laparoscopic cholecistectomy was referred to our institution 8 years ago. dilatation of the intra- and extrahepatic biliary tree and a benign stricture at the cystic confluence were observed at US and endoscopic retrograde cholangiopancreatography (ERCP). A 12-F gauge plastic endoprosthesis was placed. In the absence of any symptoms, breakage of the stent was revealed 18 months later at plain radiology. Eight years later an enterocutaneous fistula occurred originating from a jejunal loop containing the indwelled distal part of the stent. Surgery was undertaken and the distal part of the stent removed with the perforated jejunal loop. The proximal part was successively endoscopically removed. CONCLUSIONS: Disruption of a biliary endoprosthesis is observed in patients in whom the stent is kept in situ for a long period or consequent to exchange. The removal and exchange is mandatory when the stent disruption is followed by cholangitis. In the current case, because of the absence of any symptoms the removal of the stent was not attempted. Immediate endoscopic removal of the prosthetic fragments seems to be the treatment of choice for replacement of a new stent.
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4/12. Staged and complete laparoscopic management of cholelithiasis in a patient with gallstone ileus and bile duct calculi.

    BACKGROUND: Gallstone ileus is an uncommon cause of small bowel obstruction, and its incidence peaks in elderly women. Although enterolithotomy has been accomplished laparoscopically, often using a laparoscopically assisted approach, controversy persists as to the indication, timing, and surgical approach to a cholecystectomy with closure of the cholecystoduodenal fistula. methods: We present the case of a 63-year-old woman with symptomatic cholecystolithiasis who presented with acute gallstone ileus and underwent an emergency laparoscopic enterolithotomy. Hypotonic duodenography during the follow-up period demonstrated a cholecystoduodenal fistula and previously unsuspected stones in the bile duct. The patient underwent an elective laparoscopic cholecystectomy with repair of the fistula, a concomitant bile duct exploration, choledocholithotomy, and primary bile duct closure. RESULTS: The patient enjoyed an uneventful recovery, and was discharged home on postoperative day 5 after her initial emergency surgery. Her recovery after the subsequent elective surgery was more expeditious, with a discharge from hospital on postoperative day 2 and a return to office employment 2 weeks later. CONCLUSION: In the good-risk patient, staged laparoscopic management of gallstone ileus and the associated cholecystoduodenal fistula is feasible and appears to be safe. In such patients, imaging of the biliary tree is essential to detect silent choledocholithiasis, which also may be managed concomitantly and safely by the laparoscopic approach.
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5/12. Colobronchial fistula: a late complication of childhood radiotherapy.

    We present the case of a colobronchial fistula in a 41-year-old man who underwent radiotherapy for nephroblastoma as an infant. He attended for barium enema, which demonstrated a fistula between colon and bronchial tree. Following right hemicolectomy and pathological examination of the resected bowel, no active disease process was identified to explain the development of this rare fistula. radiotherapy was deemed the most probable aetiology. We are unaware of this having been previously described.
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6/12. Pneumobilia: benign or life-threatening.

    Pneumobilia, or air within the biliary tree of the liver, suggests an abnormal communication between the biliary tract and the intestines, or infection by gas-forming bacteria. Pneumobilia usually can be distinguished from air in the portal venous system by its appearance on computed tomography (CT) scan. The most common conditions associated with pneumobilia include: 1) a biliary-enteric surgical anastamosis, 2) an incompetent sphincter of oddi, or 3) a spontaneous biliary-enteric fistula. Three cases of pneumobilia associated with its most common causes are presented and further differential diagnostic possibilities as well as the implications of this finding on patient management are discussed.
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7/12. Cholecystocolic fistula: an unusual presentation and diagnosis by endoscopic retrograde cholangiopancreatography.

    This report describes a patient with a cholecystocolic fistula whose presentation was unusual because it lacked the signs and symptoms that suggest biliary disease (abdominal pain, food intolerance, and belching) and because the fistula was not visualized on barium enema but was apparent on endoscopic retrograde cholangiopancreatography after incidental pneumobilia discovered on ultrasound directed our attention to the biliary tree. A previous Billroth II with vagotomy may have predisposed to the development of the fistula.
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8/12. Choledochoduodenal fistula: a rare complication of duodenal ulcer. Case report.

    In a 29-year-old man with pyloric obstruction, plain abdominal radiography showed gas in the biliary tree. gastroscopy revealed severe duodenal stenosis with a large posterior ulcer, and barium from a test meal passed into the common bile duct. Ten days after truncal vagotomy and gastrojejunostomy, signs of ascending cholangitis appeared. Following antibiotic treatment and cholecystectomy the patient recovered.
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9/12. Enterobronchial fistula.

    An unusual case of a fistula originating from the jejunum and crossing the diaphragm to involve the pleura and bronchial tree is presented. The presence of the fistula was first suggested on a computed tomographic examination of the chest. An upper gastrointestinal series verified the origin of the fistula.
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10/12. Percutaneous transhepatic sphincterotomy in the management of biliary tract disease.

    This report describes a novel modification of existing transhepatic techniques and illustrates successful relief of mechanical obstructive jaundice in 2 patients in whom surgical or endoscopic intervention was contraindicated or impossible. In each, percutaneous transhepatic cholangiogram (PTC) was performed in the usual manner. A standard endoscopic papillotome was then advanced across the stricture into the duodenum. Sphincterotomy was performed at the 11 to 1 o'clock position using blended current for 3-4 seconds. Repeat cholangiography showed successful decompression of the biliary tree in both patients. No morbidity or mortality was directly attributable to percutaneous transhepatic sphincterotomy in these patients. This technique offers a safe and therapeutic alternative to biliary tract obstruction, and should be considered in selected patients who are not candidates for surgery or endoscopy.
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