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Results for “Intestinal Fistula”

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PubMed1983

[Total parenteral nutrition in patients with enterocutaneous intestinal fistulas].

This is a retrospective analysis out of 49 patients suffering from enterocutaneous fistulae. 25 patients received total parenteral nutrition. The enteral feeding of 17 patients was completed by parenteral nutrition: 7 patients were fed perorally. 13 fistulae (27%) healed up by conservative treatment, 10 underwent surgery and 8 patients had persistent fistulae. The total mortality rate came up to 41%. Total parenteral nutrition can be the only treatment or is an effective adjunct to supplement the surgical management of enterocutaneous fistulae.

Adolescent↗
PubMed2000

[External intestinal fistulae following gynecological operations and their treatment].

The authors share their experiences with treatment of 38 patients with external intestinal fistulas after operations on internal genitals. The patients were divided into three groups: patients with pyo-inflammatory diseases, patients with benign tumors and patients with malignant neoplasms. It is noted that preoperative diagnosis of involvement of the intestine in the process is rather difficult, instrumental methods of examination in patients with pyo-inflammatory diseases are poorly informative. In patients with malignant diseases of the uterus and uterine appendages the sigmoid colon should be examined in order to exclude the penetration of the tumor. Adhesive processes resulting from previous operations are considered to be a predisposing factor. Relaparotomies must be performed with the obligatory participation of the surgeon. Operation on the intestine should be performed before the intervention on the internal genitals. The unloading colostomy must be made in suturing the defect of the colon. The use of the method described allowed to save the life of 36 patients (lethality was 5.3%).

Adnexal Diseases↗
PubMedDate not supplied

Aorto-intestinal fistula after reconstructive arterial surgery.

In a group of 184 patients with synthetic, arterial bifurcation grafts, we have performed 16 operations for distal anastomotic pseudo-aneurysms and 11 for proximal anastomotic pseudoaneurysms. Four of the latter were encountered in three patients and took the form of aorto-intestinal fistulae. Excision of the arterial prosthesis, suture of the intestinal orifice and insertion of a new extra-anatomic bypass seems to be the treatment of choice. However, excision of an aortobifemoral prosthesis and replacement in situ with a new prosthesis or even suture of the aortic fistula with a patch represent acceptable treatment in certain particular situations.

Aged↗
PubMedDate not supplied

Gastro-intestinal fistulas: the role of nutritional support.

Over the decades the advent of advanced surgical techniques, antibiotics, management of acid-base and electrolyte disorders, monitoring and support of cardiorespiratory function, have greatly implemented the treatment of patients with gastro-intestinal fistulas, resulting in most series in a mortality of approximately 20%. The apparent clinical benefit of sophisticated parenteral nutrition has not further reduced mortality because in the seventies patients in most series were older, sicker, had more advanced cancer, underwent bigger operations and were more at risk in almost every respect. In recent series mortality is almost exclusively determined by uncontrolled sepsis. It is therefore imperative to control intra-abdominal infection because ongoing sepsis ultimately nullifies the effect of other therapeutic modalities. When infection is controlled however nutritional support may serve several purposes. It may relieve malnourishment. It may decrease gastro-intestinal, biliary and pancreatic secretion allowing fistula output to diminish and sometimes fistulae to heal spontaneously. It may allow a potential future operative field to quiet down. With adequate nutritional support fistulae may heal spontaneously (lateral, no distal obstructions, no adjacent abscesses, good quality bowel). Others may be surgically treated with the patient in good nutritional state and with a favourable local situation. Crohn's fistulae heal spontaneously in a large percentage (80%) but have to be operated after closure because the cause of the fistulae is almost invariably an irreversibly stenosed fibrotic bowel segment so that fistulae may recur after resumption of oral feeding. In unfavourable fistulae (total disruption, adjacent abscesses, bad quality bowel) infection is often difficult to control.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗