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PubMed1983

Gastrointestinal disease: nutritional implications.

The management of patients with gastrointestinal disease must include attention to nutritional status. It has been documented that morbidity and mortality previously considered common in these patients can be reduced significantly. Perhaps the largest contribution that advances in nutritional support have made is the reduction in the frequency of surgical intervention. Remission of inflammatory bowel disease, closure of fistulas, intestinal adaptation, and prevention of malnutrition in complicated pancreatitis with the use of nutritional therapies help to avoid the complications of operative procedures.

Crohn Disease↗
PubMedDate not supplied

[Reno-colic fistula].

Nephro-intestinal fistulas involve the GI tract and the kidney or pyelocalyceal system. The main causes may be urologic or digestive, the site diverse. Reno-colic fistulas, although rare, are more frequently observed. We describe a case of left reno-colic fistula secondary to lithiasic pyonephrosis that presented as sepsis. Diagnosis was confirmed by retrograde pyelography. Treatment was by surgery (left nephrectomy, closure of the fistula, and colonorhaphy).

Colonic Diseases↗
PubMed1995

Colonic duplication: an unusual cause of enterovesical fistula.

Intestinal duplications are rare, occurring in 1 in 4000 births. Even rarer are tubular hindgut duplications, with less than 75 cases reported in the literature to date. We report an uncommon case of an enterovesical fistula caused by a duplication of the sigmoid colon. This is the first reported case of a tubular colonic duplication presenting as a colovesical fistula in an adult. We discuss the presentation and shortcomings in the diagnosis and treatment of enterovesical fistulas and colonic duplications.

Adult↗
PubMed2002

A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities.

Open management of the peritoneal cavity is an efficacious technique for controlling fulminant intraabdominal sepsis. A significant proportion of these patients develop intestinal fistulae for which there are few good treatment options. We propose a novel technique for preventing and potentially treating intestinal fistulas that involves patching intestinal deserosalizations and fistulas with acellular dermal matrix (Alloderm) and fibrin glue. We report our experience with this technique in 2 patients who developed small bowel deserosalizations, neither of whom went on to develop fistulas. We additionally describe 1 patient who developed an intestinal fistula for whom we were able to affect closure with this technique. We propose that our method is a useful temporizing measure to prevent fistulae formation. Furthermore, we believe this technique may be a useful option for treating intestinal fistulae arising in patients managed with open abdominal wounds.

Collagen↗
PubMed1979

[Spontaneous intestinal biliodigestive fistula and its treatment (author's transl)].

The current clinical and therapeutic status of spontaneous intestinal biliodigestive fistulae in 14 of the author's own cases is presented. Two groups are distinguished: those "short-circuit" connections to the gastro-intestinal tract due to biliary disease--the biliodigestive fistula in the narrower sense as well as enterobiliary fistulae caused by gastro-intestinal disease. Differences in etiology, clinical presentation, therapy and operative lethality make it seem advisable to form two categories, A and B, and to compare the one with the others.

Aged↗
PubMed2004

Release of peptide YY by fat in the proximal but not distal gut depends on an atropine-sensitive cholinergic pathway.

Peptide YY (PYY) is released when PYY cells in short term culture are exposed to fat suggesting that this peptide may be released by fat in the distal gut without neural stimulation. PYY is also released by fat in the proximal 1/2 of small intestine. To test the hypothesis that the release of PYY by fat in the proximal but not distal intestine may depend on an atropine-sensitive, cholinergic pathway, PYY levels were compared in four dogs equipped with duodenal and mid-intestinal fistulas when 60 mM oleate was perfused into either the proximal (between fistulas) or distal (beyond mid-intestinal fistula) 1/2 of gut at 2 ml/min for 120 min with intravenous administration of saline or atropine. We found that, when fat was confined to the proximal 1/2 of the intestine, PYY release was reduced following intravenous atropine when compared with saline (p<0.01). However, when fat was confined to the distal 1/2 of the intestine, PYY release was not affected by the intravenous atropine. We conclude that PYY release by fat in the proximal but not distal intestine depends on an atropine-sensitive, cholinergic pathway.

Adipose Tissue↗
PubMed2005

Effect of the combination of fibrin glue and growth hormone on incomplete intestinal anastomoses in a rat model of intra-abdominal sepsis.

BACKGROUND: The presence of established intra-abdominal sepsis has been considered a contraindication to primary anastomoses. Our hypothesis was that fibrin glue (FG), growth hormone (rhGH), and combination of them synergistically improve intestinal primary anastomotic healing in a rat model of intestinal fistulae with peritonitis. MATERIALS AND METHODS: Male Wistar rats, induced intestinal fistulae with peritonitis after 24 h, were performed an enterectomy and intestinal anastomoses. Group A, rats (n = 60) had a complete anastomoses (end-to-end single layer anastomoses using 12 inverted interrupted 6-0 sutures) without peritonitis, group B, rats (n = 60) had a complete anastomoses after 24 h of peritonitis, group C rats had an incomplete anastomoses (four inverted interrupted sutures), groups D, E, F rats (n = 60) received FG, rhGH, or both of them, respectively. rhGH was given daily for 5 days. Anastomoses indicated the anastomotic bursting pressure (ABP), tensile strength, and hydroxyproline content, were determined. RESULTS: On POD 1, ABP of group C and group D was significantly lower than that of other groups (P < 0.01); On POD 3, ABP could not be determined because of intestinal dehiscence in groups C and E, ABP was significantly higher in groups D and F than that of groups A and B (P < 0.01); the ABP increased after 5 days of operation in groups A, B, and F. At the same time, that of group D decreased (P < 0.01). On POD 5, the tensile strength was significantly higher in groups A, D, and F than that in groups C, and E. On POD 5, hydroxyproline content was higher in groups D and F compared to that in group C (P < 0.05). CONCLUSIONS: These data suggested that FG improve intestinal primary anastomotic healing within post-operative 5 days in a rat model of intestinal fistulae with peritonitis. RhGH alone fails to improve intestinal anastomotic healing, and the combination of FG and rhGH have no synergistic effect to improves intestinal anastomotic healing.

Anastomosis, Surgical↗
PubMed1997

[Orthotopic bladder replacement: II. Functional results and complications in patients with Studer-type ileal neobladder].

OBJECTIVE: Since 1988, 100 Studer ileal low pressure urinary reservoirs have been performed at our institution. The functional results and the complications observed in these patients are presented. METHODS: Patients submitted to radical cystectomy and lower urinary tract reconstruction with the Studer technique from 1988 to 1994 were retrospectively studied. All patients were males, their mean age was 60 years (37-75) and the mean follow-up was 18 months (6-72). The isoperistaltic ileal segment as antireflux mechanism was utilized in 97 cases and intussusception of the ileal segment to which the ureters were anastomosed in 3 cases. Reinsertion of the ureter was done using the Wallace technique in 90 cases and by direct fixation according to a personal technique (H.V.) in 10 cases. Anastomosis of the neobladder and the urethra was done with the end of the second suture of the orthotopic reservoir. The neurovascular bands were preserved in 21 patients less than 60 years old with tumor stage T2-T3a, according to the technique described by Walsh and Mostwin (1984). RESULTS: One patient died early postoperatively from sepsis. The early complications included urinoma (4%), urinary fistula (3%), intestinal fistula (2%), pulmonary complications (4%), pelvic hematoma (1%) and intestinal obstruction (3%). Only 4 of these patients required surgical resolution of the complication. The late complications included stricture of neobladder-urethra anastomosis (6%), lithiasis in neobladder (4%), ureteroileal stricture (8%), 5 renal units were lost, chronic urinary retention (5%), symptomatic metabolic acidosis (1%) and urinary infection (14%). Thirteen of these patients with late complications required surgery. At 6 months' minimum follow-up, 90% of the patients were continent during the day and 60% during the night. Overall, 36% of the patients recovered erection postoperatively; 76% of the patients with preserved neurovascular bands recovered erection. Forty-four percent of the patients claimed they had a satisfactory sexual activity postoperatively. CONCLUSION: The Studer neobladder permits voiding through the urethra, preservation of the upper urinary tract, the urinary infection rate is acceptable, the complication rate is low and it offers patients continence rates that allow them to have a good quality of life.

Adult↗
PubMedDate not supplied

Octreotide for treatment of postoperative alimentary tract fistulas.

Eighteen patients with postoperative fistulas of the gastrointestinal tract were treated with the somatostatin analog octreotide between November 1989 and November 1992. Fourteen patients had enterocutaneous fistulas: seven from the duodenum and seven from the ileum. Another three patients had pancreatic fistulas, and one patient had a biliary fistula. Within 24 hours of octreotide treatment, a mean reduction of 52% in the intestinal fistulas' output, 40% in the pancreatic fistulas, and 30% in the biliary fistula was noted. In the intestinal fistulas group the closure rate was 72% after a mean of 11 days. Early closure (mean 6 days) was achieved in all three pancreatic fistulas. In the patient with the biliary fistula a 30% reduction was observed twice following the administration of octreotide, and an increase occurred when it was withheld. The reduction rate of the secretions in high-output intestinal fistulas (> 500 ml/day) was higher than in the low-output fistulas (63 +/- 8% versus 39 +/- 4%, p < 0.05). Fistula output and the initial response to octreotide treatment had no value in predicting spontaneous healing. In conclusion, octreotide is a valuable tool for the conservative treatment of fistulas of the digestive tract. It is especially valuable for management of high-output enteric fistulas and pancreatic fistulas.

Anti-Bacterial Agents↗
PubMed2005

[A case of subphrenic abscess with ileal fistula caused by metastatic adenocarcinoma of unknown origin].

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.

Adenocarcinoma↗
PubMed1983

Staged reduction using a Silastic sac is the treatment of choice for large congenital abdominal wall defects.

Although the survival for infants with abdominal wall defects (AWD) has dramatically improved, agreement on the optimum surgical approach has not been reached. From October 1970 through March 1983, 31 neonates with gastroschisis and 14 neonates with omphalocele were treated. Reduction of the herniated viscera with primary fascial and skin closure was performed in 30% of the gastroschisis patients and 64% of the omphalocele patients. The remaining infants were managed by staged reduction of the herniated viscera using a Silastic sac. Overall, 27 of 45 patients (60%) were treated by staged reduction. Our procedure for staged reduction includes application of a Silastic sac as soon as the infant is stable. The herniated contents are reduced as rapidly as possible so that the prosthetic sacs can be removed within seven days. Abdominal wall stretching, "milking" of the intestinal contents into the stomach for decompression and a gastrostomy tube are avoided. The duration of hospitalization was not influenced by the method of abdominal wall closure in the gastroschisis infants. However, the hospitalization was approximately 10 days longer for those omphalocele patients managed by staged reduction. Complications which occurred in these patients include: respiratory distress (1); wound infection after removal of the Silastic sac (2); intestinal fistula (1); intestinal resection (3); intraabdominal sepsis (1); and incisional hernia (3). There was one death in the omphalocele group and three deaths in the gastroschisis group. Therefore, the overall survival for the 45 patients with AWD was 91%. Staged reduction of the herniated abdominal contents can be a safe, uncomplicated method of obtaining abdominal wall closure in neonates with AWD.

Abdominal Muscles↗
PubMed1977

Some experimental surgical techniques on the alimentary tract of young pigs.

The paper describes the surgical techniques used in the preparation of gastric, intestinal and caecal fistulae, intestinal re-entrant fistulae, gastric pouches and Thiry-Vella loops. A total of 189 pigs were used in the study ranging from 1 h to 16 weeks of age. All procedures were carried out under cyclopropane/oxygen anaesthesia.

Anesthesia, Inhalation↗