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At least 595 records · Page 33Linked to original sources
PubMed1991

Prevention of anastomosis leakage: an artificial connective tissue.

Anastomosis leakage still causes considerable morbidity and mortality after digestive tract surgery. We report here our experience of the use of reconstituted connective tissue created from elastin, fibronectin and collagen in preventing anastomosis leakage and closing intestinal fistulas. In animal studies (56 rats), this connective tissue was used as a patch applied with fibrin sealant to the edges of a 1 cm diameter colonic defect. In a clinical evaluation, eight patients had an intestinal fistula closed by a simple sewn suture reinforced by a sealed patch and seven patients had a high risk anastomosis reinforced by a sealed patch, in most cases as an alternative to staged surgery. In animal studies, complete reconstitution of the three colonic layers was obtained without retraction and without inflammatory reaction within 40 days, while the patch was slowly resorbed. In clinical trials all 15 defects and anastomoses healed without complication. Three patients died from other causes and, at autopsy, the patch was found to have remained in place covering the suture line. If these results are confirmed by a prospective clinical trial, such biomaterial offers the possibility of reducing the occurrence of anastomosis leakage, especially in high risk circumstances.

Adult↗
PubMedDate not supplied

[Intestinal-urinary fistula in children].

The authors report their 15-year experience with diagnosis and treatment of 63 boys at the age of 6 months to 15 years having various intestino-urinary bypasses. Clinical manifestations of the latter are polymorphic. The examination of the patients included ultrasonic, histomorphological, x-ray contrast and other investigations. An original classification of the fistulas are proposed. Congenital, acquired, primary, recurrent fistulas are distinguished. Location, topographoanatomic form and diameter are also considered. Surgical policy is discussed in respect of the above factors.

Adolescent↗
PubMed2003

Colonic fistula complicating electric burns--a case report.

Intestinal fistula is an uncommon complication of electric burns. The authors report the case of an 11-year-old child who sustained accidental burns from a high-voltage electric current and was admitted to their hospital with full-thickness burns of both the upper limbs and deep burns of the anterior abdominal wall. Staged surgery was required, and the authors were involved in the management of the burn of the anterior abdominal wall. Laparotomy was done because omentum was found prolapsing out of the abdominal wound. Three scattered areas of subserosal burn of the small bowel were noticed, which required no intervention. The rest of the viscera all were normal. During the course of his stay, he had a fecal fistula on the 19th postburn day, which was found to be from the transverse colon. Conservative management of the fistula with total parenteral nutrition for 23 days resulted in complete healing.

Abdominal Injuries↗
PubMed1995

[Intestinal urinary fistulas of renal and pelvis origin].

As the authors point out the uncommon occurrence of these fistulas between the calicopyelic cavities with the colon, the duodenum and still more unusually with the stomach and the jejunum, they report the etiological and clinical features found in the published cases. Usually the only solution is a nephrectomy.

Humans↗
PubMedDate not supplied

[Studer's type ileal neobladder. Study of complications and continence].

Analysis of early and late post-surgical complications in 44 cases of Studer's type bladder replacement due to carcinoma of the bladder performed over a 6-year period. Follow-up ranges between 6 months and 6 years. 4 patients died during the post-operative (9.09%): 1 myocardial infarction, 1 pulmonary embolism and 2 intestinal fistula. 28 patients (63.64%) had post-operative complications: 4 GI fistula (9.09%) 5 ileus (11.36%), 2 GI bleeding (4.54%), 1 ureteral fistula (2.27%), 1 ureteral stenosis, 6 urethro-intestinal fistula (13.36%), 1 tubular necrosis, 1 ruptured ureteral catheter, 5 wound infections (11.36%), 12 urine infections (27.27%), 6 sepsis (13.63%), 1 lymphocele, 1 evisceration and 2 eventrations. Repeat surgery was required in 6 cases. Within 6 months from discharge, 7 of 40 patients (17.5%) had some complication: 3 acute pyelonephritis, 4 episodes of acidosis-dehydration and 1 ureter stenosis. After 6 months, 7 of 38 patients (18.4%) had complications: 1 acidosis, 3 vesical lithiasis, 2 ureteral stenosis and 1 urethro-intestinal, plus 2 cases of chronic urinary retention. Daytime continence was 97.2% and nighttime continence 30%; after 6 months evolution, no further changes were seen.

Adult↗
PubMed1975

Extroversion of cerebral hemispheres in a full term human foetus.

Extroversion of the cerebral hemispheres and a posterior intestinal fistula are described in a male foetus with single umbilical artery and craniorhachischisis. The paper has distinction of describing for the first time the cerebral extroversion in a full term human foetus. At this stage of development, the everted cerebral hemispheres, after having proliferated exuberantly to a considerable size present a disorganised appearance which would vary in every case of this type. However, the lateral ventricles are still visible, structures comparable to thalami and choroid plexus can be made out and the vascular masses with large blood clots seen in anencephaly are minimal. That the posterior intestinal fistula represents persistence of an accessory neurenteric canal is discussed. The neural and neurenteric defects in the specimen described here are possibly due to abnormal arterial pattern in the caudal half of the body, imposed by single umbilical artery.

Abnormalities, Multiple↗
PubMed1997

[An autopsy case of severe tuberculosis associated with anal fistula and intestinal perforation].

A 55 year-old man was admitted to the department of the gastroenterology of the hospital because of severe weakness and appetite loss for the past one month. In the last two months, he has been suffering from recurrent fistula of the anus. He left his symptoms without therapy. A gastric ulcer was found out with gastric endoscopy. At the same time, chest X-ray film showed bilateral abnormal shadows, which were suspected of severe pulmonary tuberculosis by a chest physician. After the admission, the patient immediately developed respiratory failure. Both sputa and discharge from anal fistula were positive for acid fast bacillus. Despite of anti-tuberculosis therapy and mechanical ventilation, he died of respiratory failure. At the autopsy, severe pulmonary tuberculosis, tuberculous fistula of the anus, intestinal tuberculosis with perforation, miliary tuberculosis and peptic ulcer of the stomach were defined. We suspected that the extensive disease caused by hematogeneous spread and the late diagnosis of tuberculosis was owing to patient's delay.

Fatal Outcome↗
PubMedDate not supplied

[Renal-colonic-cutaneous fistula secondary to xanthogranulomatous pyelonephritis].

The appearance of intestinal fistulas secondary to kidney disease is a rare occurrence. Even rarer are complex fistulas involving several organs or systems [correction of apparati]. In this study, the authors report on a case of reno-colo-cutaneous fistula which set in as a complication of xanthogranulomatous pyelonephritis.

Colonic Diseases↗
PubMed1980

[Fistula between the bowel and urinary tract in Crohn's disease (author's transl)].

Six patients are presented with urological complications due to Crohn's disease. (Five vesico-intestinal fistulas and two ureteral strictures). Dysuria and recurrent infections preceded the fistula in every case. Pneumaturia was seen five times, fecal-uria four times. On the average, 35 months passed since the beginning of Crohn's disease until a vesico-intestinal fistual appeared. Diagnosis of vesico-intestinal fistula was established by anamnesis four times, by contrast enema twice, once by cystoscopy, once by cystography. Five patients were treated by partial resection of bowel and either partial resection of bladder or bladder suture. One fistula healed spontaneously by indwelling bladder catheter. Ureter strictures were treated by ureteral splints, 1 successfully for over 6 months, 1 still under treatment where nephrectomy probably will be necessary.

Adult↗
PubMed1994

Gastrointestinal hemorrhage caused by secondary aorto-duodenal fistula: report of 5 cases.

Aorto-intestinal fistula is a late complication of reconstructive vascular operation, which is difficult to indentify. After the cessation of a massive, life-threatening bleeding, the best result can be expected from extraanatomical, axillobifemoral bypass. The authors treated 5 patients for fistula, developed following an aorto-bifemoral bypass. Diagnosis could be made before operation only in two of the cases. Axillo-bifemoral bypass was performed in 3 patients following the treatment of the fistula and the removal of the graft; 2 of their patients recovered.

Aged↗
PubMed1996

General management of gastrointestinal fistulas. Recognition, stabilization, and correction of fluid and electrolyte imbalances.

Gastrointestinal fistulas are unfortunate complications of a number of disease states, such as inflammatory bowel disease and tumors, or may result from complications of surgical intervention. Fistulas may be associated with significant morbidity and mortality, much of which is a result of fluid losses and electrolyte imbalances. Thus, attention to these issues is a critical component of the management of patients with gastrointestinal fistulas. The management of gastrointestinal fistulas is divided into three phases: diagnosis/recognition, stabilization/investigation, and treatment. The major goal of the stabilization phase is the correction of fluid losses and electrolyte abnormalities. This phase must be carried out expeditiously to reduce the associated complications. Knowledge of the electrolyte content of various secretions of the gastrointestinal tract is essential to guide this phase of management. Early control of infectious foci, with drainage of abscesses if present, is of great importance. Esophageal fistulas most commonly result from instrumentation of the esophagus and are diagnosed by radiographic imaging studies. Nonoperative therapy is an option in select patients, but aggressive surgical intervention is often required. Dehydration is often associated with these injuries and must be corrected. Gastric and duodenal fistulas are most commonly iatrogenic and may be associated with significant fluid losses. Careful measurement of the fistula effluent is important. Nutritional support is begun following correction of fluid and electrolyte abnormalities. Pancreatic fistulas are often high volume fistulas and are associated with significant skin breakdown if they are cutaneous. The use of a somatostatin analogue may decrease the volume of the fistula to allow healing. Small intestinal fistulas often result from postoperative complications and require careful attention to electrolyte abnormalities. Spontaneous closure often obviates surgical intervention. Colonic fistulas are less often associated with complications than are other fistulas of the gastrointestinal tract. The stabilization phase in the management of patients with gastrointestinal fistulas is a critical time during which careful attention to fluid and electrolyte losses can result in reduced morbidity and mortality from these difficult management problems.

Duodenal Diseases↗
PubMed2001

[Uretero-colonic fistula in non-functioning ureter].

OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy. METHODS/RESULTS: A 68-year-old patient that had undergone nephrectomy due to xanthogranulomatous pyelonephritis two years earlier, consulted for long-standing non-specific abdominal pain. Radiological evaluation showed a pneumogram pattern in the ureteral stump associated to a pelvic mass. The patient underwent surgery for a suspected uretero-intestinal fistula. The intraoperative findings and anatomopathological study demonstrated a uretero-sigmoid fistula due to diverticular disease of colon. CONCLUSIONS: Uretero-intestinal fistulas present unimportant clinical features. Radiological assessment and a clinical suspicion are important to diagnosis.

Aged↗
PubMed2006

[Surgical management of chronic radiation enteritis].

OBJECTIVE: To explore the surgical methods and the clinical results of chronic radiation enteritis. METHODS: Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases. RESULTS: Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died. CONCLUSIONS: Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.

Adult↗