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PubMed2004

The use of synthetic vascular prosthesis in the surgical treatment of secondary aorto-duodenal fistulas.

In this paper the methods with synthetic vascular prosthesis used in surgical treatment of the secondary aorto-intestinal fistula are presented. 10 cases of 22 patients treated in the years 1993-2003 for secondary aorto-intestinal fistulas as a complication of vascular prosthesis infection are analysed. In all patients the abdominal CT, scintigraphy with technetium 99m labeled leucocytes and endoscopy were performed. The patients underwent the operation of infected dacron prosthesis' replacement with silver/collagen coated prosthesis or extraanatomic bypass (subclavian to femoral). To close the intestinal fistula the duodenectomy with gastroenterostomy was performed or the duodenum was sutured and protected with the use of pedicled omentum. In 4 patients extraanatomic subclavian-femoral of polytetrafluoroethylene (PTFE) bypass was used. In these cases the intestinal surgery was composed of the partial duodenectomy with fistula excision and duodenal stumps formation followed by antecolic gastrojejunostomy with the Braun's enteroanastomosis and pyloroplasty. In this group 2 patients (50%) died in the follow up period. There were two extraanatomic bypass thromboses in the 30 days follow up and one amputation (25%). The infected vascular prosthesis was replaced with silver/collagen coated prosthesis in the 6 patients. In these cases duodenal fistula was closed with two layers of stitches and additionally protected with pedicled fragment of the greater omentum, which was sewn on the duodenum. In this group 1 patients (16.7%) died in the follow up period. In one case (16.7%) in 9 months after operation reinfection od silver prosthesis was observed. There were no significative differences (p = 0.45) in terms of early mortality between both group of patients. The treatment of the fistula is a difficult and hazardous surgical procedure, results of which are unpredictable.

Adult↗
PubMed1984

Extraperitoneal versus transperitoneal drainage of the intra-abdominal abscess.

Controversy as to whether the intra-abdominal abscess should be drained extraperitoneally or through formal laparotomy still rages. Arguments for a transperitoneal approach include no need to identify specific locus preoperatively and uniform drainage of all abscesses, especially any otherwise unrecognized pus collection. Proponents for the extraperitoneal route stress failure to contaminate previously uninvolved peritoneal spaces and more reliable avoidance of injury to intestine, predisposing to subsequent intestinal fistula. To resolve this impasse, a prospective study of each method was based upon a schedule of previously randomized treatment options. After 32 months of study, 60 patients had been enrolled without obvious differences between treatment groups with respect to demographic features, preoperative definition and locus of infection, precipitating cause of sepsis, associated diseases, responsible bacteria and antibiotic therapy. With the transperitoneal approach, five patients had hollow viscus injury, while seven eventually had an intestinal fistula develop, causing major problems in four. Despite no obvious intestinal injury with the extraperitoneal route, two transient intestinal fistulas did occur. Seven patients drained transperitoneally had additional abscesses discovered, yet another operation was required to drain at least one complicating abscess in seven of this same group. With the extraperitoneal route, only two patients needed reoperation to drain another abscess. Although there were more deaths and complications in the group drained transperitoneally, morbidity (47 per cent) and mortality (7 per cent) were not significantly different statistically. Such data refute the professed superiority of a transperitoneal approach to intra-abdominal abscess drainage, both from need to reoperative for second abscess as well as incidence of latter intestinal fistula. Best results were noted with abscess identification through computerized tomography followed by extraperitoneal drainage.

Abdomen↗
PubMed2003

Use of porcine small intestinal submucosa in Ehlers-Danlos syndrome Type IV.

Ehlers-Danlos syndrome (EDS) Type IV results in inadequate production of type III collagen and can lead to devastating vascular, gastrointestinal, and uterine complications. A case is presented of spontaneous colonic perforation in a patient with EDS Type IV complicated by multiple intestinal fistulas managed with porcine small intestinal submucosa. Early success with this technique would suggest additional applications in a variety of complicated gastrointestinal problems.

Adult↗
PubMed2006

The "Fistula VAC," a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases.

BACKGROUND: Management of intestinal fistulae in open abdominal wounds remains a significant clinical challenge for those caring for patients surviving damage control abdominal operations. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from leakage of enteric contents, should be a major goal in the approach to these complex patients. We describe a technique utilizing vacuum assisted closure (VAC) which achieves control of enteric flow from fistulae in open abdominal wounds. METHODS: The fistula-VAC is fashioned from standard sponge supplies, negative pressure pumps, and ostomy appliances. The fistula-VAC was changed every three days prior to split thickness skin grafting, and every five days following grafting. RESULTS: Five patients underwent application of the fistula-VAC. All patients had complete diversion of enteric contents. This enteric diversion allowed for successful skin grafting in all patients. CONCLUSION: Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.

Colostomy↗
PubMed1992

[Traumatic external gastrointestinal fistula: report of 77 cases].

Seventy-seven patients developed gastroenteric fistula as a complication of abdominal trauma, including small bowl fistula (25), duodenal fistula (17), colonic fistula (16), pancreatic fistula (3), gastric fistula (2), and multiple fistula (14). These patients accounted for 15.9% (77/483) of all patients with intestinal fistula treated in the same period in our department. An average of 8.8 days had elapsed before the final diagnosis of GI fistula was made, during which 73 patients had 1-8 kinds of complications, 48 received 1-5 operations, and 67 were given nutritional support for 6 to 254 days. Thirty patients were cured operatively and 33 (52.4%) spontaneously. The mortality was 18.2%. The etiology, principles of prevention, and management of traumatic intestinal fistula were discussed with emphasis on effective nutritional support and intraabdominal drainage.

Abdominal Injuries↗