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At least 631 records · Page 35Linked to original sources
PubMed1997

Preliminary report on the use of oral tacrolimus (FK506) in the treatment of complicated proximal small bowel and fistulizing Crohn's disease.

BACKGROUND: Tacrolimus (FK506) has a mechanism of action similar to cyclosporine. Unlike standard oral cyclosporine, tacrolimus is well absorbed orally, even from diseased small bowel mucosa. OBJECTIVE: To report the use of oral tacrolimus in three patients with complicated proximal small bowel or fistulizing Crohn's disease as a "bridge" to methotrexate or 6-mercaptopurine. CASE REPORTS: Oral tacrolimus was started at doses of 0.15-0.29 mg/kg/day and adjusted to a whole blood tacrolimus concentration range of 10-20 ng/ml. Case 1: Gastroenterostomy for gastroduodenal Crohn's disease complicated by recurrent gastrointestinal hemorrhage from persistent duodenal ulceration. Case 2: Diffuse jejunoileal Crohn's disease, seven prior stricturoplasties, and a postoperative small intestinal fistula causing an abdominal abscess. Case 3: Perianal and pouch-vaginal fistulae after colectomy and ileal pouch-anal anastomosis in a patient with Crohn's disease. All three patients had good oral absorption of tacrolimus, rapid clinical improvement of their Crohn's disease, and began long-term remission maintenance treatment with either methotrexate (n = 2) or 6-mercaptopurine (n = 1). Dose dependent side effects resulting from tacrolimus therapy occurred in all three patients (nephrotoxicity, hyperkalemia, diarrhea, nausea, flushing, headache, tremor, paresthesias, and insomnia). CONCLUSIONS: Oral tacrolimus (0.15-0.29 mg/kg/day) is well absorbed in patients with Crohn's disease with proximal small bowel involvement or fistulae and appears to be of clinical benefit as a rapidly acting "bridge" to long-term therapy with methotrexate or 6-mercaptopurine.

Administration, Oral↗
PubMed2001

Intestinal transit in dogs is accelerated by volume distension during fat-induced jejunal brake.

Intestinal transit is accelerated by volume distension and slowed by nutrient load. We hypothesized that the accelerating effect of volume distension might overcome the slowing effect of nutrient. To test this hypothesis, we compared intestinal transit in five dogs equipped with duodenal and mid-intestinal fistulas. The proximal half of the small intestine was perfused with 60 mM oleate, while the distal half of the small intestine was either perfused with buffer (with distension) or left unperfused (without distension). We found that intestinal transit was slowed by oleate (with marker recovery reduced from 85.8 +/- 5.3 to 39.4 +/- 7.5%) (P < 0.01) and that volume distension accelerated intestinal transit so that marker recovery increased from 39.4 +/- 7.5 without distension to 60.8 +/- 6.3% with distension (P < 0.05). We concluded that intestinal transit is accelerated by volume distension during fat-induced jejunal brake.

Animals↗
PubMed1987

[Zinc deficiency in artificial nutrition].

A 35-year-old patient was parenterally fed for a total of 170 days because of a twice reoperated gastric ulcer followed by a gastric-antrum small intestinal fistula. This lead to a complete acute zinc deficiency syndrome with pronounced acrodermatitis enteropathica-like skin changes in the face and the genital region, paronychia, flat blistering on the hands and feet, loss of hair, fingernail ridging (Beau's) and serious physical changes. A dramatic improvement and healing of all these skin changes, the antrum and small intestinal fistula as well as physical disorders occurred after intravenous and subsequent oral intake of zinc.

Adult↗
PubMed1998

[Abdominal pain in patients undergoing radical cystectomy for bladder cancer].

OBJECTIVE: To analyze the incidence and causes of emergency admission for abdominal pain in patients submitted to radical cystectomy for bladder cancer. METHODS: A retrospective study was conducted on 176 patients who had undergone radical cystectomy for bladder cancer. The preoperative treatment, urinary diversion procedure, postoperative tumor stage, complications and adjuvant treatment required were analyzed. The patients had a follow-up of 43.7-58.3 months (mean 51). RESULTS: 18 patients required admission for abdominal pain; 7 for complete bowel obstruction, 5 for partial obstruction of the intestine and 6 for intestinal fistula (4 to the neobladder, 1 to the urethra, and 1 to the vagina). In 6 patients abdominal pain was caused by recurrence of a pelvic tumor. Seven patients required emergency surgery and 5 elective surgery. CONCLUSIONS: 10.5% of the patients who had undergone radical cystectomy for bladder cancer had at least one episode of abdominal pain requiring admission to hospital. During the first 6 months postoperatively, partial obstruction of the intestine was the most common cause of abdominal pain, and thereafter, complete bowel obstruction and intestinal fistula to the neobladder. Abdominal pain was caused by recurrence of a pelvic tumor in 33% of the patients and by a benign condition in the remaining patients. We found no risk factors related with the preoperative treatment, tumor, urinary diversion procedure or early complications that may predispose to episodes of abdominal pain.

Abdominal Pain↗
PubMed1997

Causes and management of intestinal obstruction in a Saudi Arabian hospital.

A retrospective review of 84 cases of intestinal obstruction admitted to the National Guard Hospital over a period of 10 years was carried out. The main causes of obstruction were: post-operative adhesions, 38 patients (45%); hernia, 17 (20%); pseudo-obstruction, eight (9.5%); intussusception, six (7%); malignant obstruction, four (4.8%); inflammatory obstruction, three (3.6%); volvulus, three (3.6%); and others, five (6%). Large bowel obstruction occurred in only 16 patients (19%). Surgical intervention was necessary in 61 patients (73%) while 23 patients (27%) responded to conservative treatment. Post-operative complications occurred in 14 patients (17%). The main complications were: wound infection, chest infection, prolonged ileus and intestinal fistulae. The mortality rate was 3.5%. The pattern of small bowel obstruction in Saudi Arabia is similar to that in the West, while large bowel obstruction is rather uncommon.

Adult↗
PubMed1994

[Typhoid perforations: experiences in a surgical setting in Cameroon. Apropos of 49 cases].

Over a period of 3 years, 49 typhoid perforations of the small intestine were treated at Yaoundé Central Hospital. These 34 men and 15 women with a mean age of 29.6 years presented sthenic peritonitis in 20 cases and more difficult to diagnose asthenic peritonitis in 29 cases. The perforation was always located at the end of the ileum and was single in 40 cases, double in 6 cases and triple in 3 cases. Surgical management in association with intensive care and multiple agent antimicrobial therapy consisted in sleeve resection in 29 cases, resections with an exteriorized anastomosis in 15 cases, and ileocolonic intubation in 5 cases. The postoperative complications were suppuration of the wall (n = 4), intestinal fistula (n = 3), evisceration, and residual abscess. There were 9 deaths (18.4%) including 4 after sleeve resection and 5 after resection with an exteriorized anastomosis. On the basis of this experience, the authors describe the diagnostic difficulties posed by typhoid perforations, discuss surgical techniques proposed in the literature, and emphasize the value of sleeve resection.

Adult↗
PubMed2005

A novel surgical technique to localize small enteropouch fistula.

BACKGROUND: One of the rare complications of ileal neobladder after radical cystectomy is pouch-to-intestine fistula. There isn't a classic method to intraoperative diagnosis of small fistula. CASE PRESENTATION: An entero-pouch fistula was occurred in a patient after radical cystectomy with ileal orthotopic pouch. Because of failed conservative management, the patient was candidate for surgery. The hidden small fistula in the small intestine was diagnosed by high intraluminal hydrostatic pressure (by intraluminal saline injection). CONCLUSION: Intraoperative diagnosis the intestinal opening of a small fistula is very important. At the time of surgery if the fistula tract becomes open (during releasing the adhesions), it may leak in the peritoneum in postoperative period. Intraluminal high pressure is a useful method for intraoperative small hidden intestine opening.

Diagnostic Techniques, Surgical↗
PubMed2006

Laparoscopic-assisted pancreatic necrosectomy: A new surgical option for treatment of severe necrotizing pancreatitis.

HYPOTHESIS: Open surgery for pancreatic debridement is often associated with major morbidity such as wound complications, fascial dehiscence, and intestinal fistulae. Hand-assisted laparoscopic surgery (HALS) is useful for complex abdominal procedures since the benefits of traditional laparoscopic surgery are retained. Published experience with HALS for pancreatic debridement is limited to anecdotal case reports. SETTING: University-affiliated private and public hospitals. PATIENTS: Twenty-three patients with necrotizing pancreatitis were evaluated and 19 patients underwent pancreatic debridement from 2001 to 2006. A GelPort (Applied Medical, Rancho Santa Margarita, Calif) was used to provide laparoscopic hand access. In the majority of the patients, an infracolic approach was used to access the pancreatic necrosis. RESULTS: Nineteen patients underwent laparoscopic evacuation of pancreatic necrosis, and in 18 patients, the procedure was completed. The mean age was 54 years; the mean +/- SEM body mass index, calculated as weight in kilograms divided by height in meters squared, was 32.0 +/- 2.6; the mean American Society of Anesthesiologists score was 3.4; and 7 of 19 patients had past history organ failure. The mean +/- SEM operating time was 153 +/- 10 minutes and mean +/- SEM blood loss was 352.6 +/- 103 mL. Four patients required reoperations, 2 using HALS and 2 open. There were no postoperative complications related to the HAL procedure itself, such as major wound infections, intestinal fistulae, or postoperative hemorrhage. Postoperative computed tomographic scans confirmed adequacy of debridement. The mean +/- SEM length of hospital stay after surgery was 16.3 +/- 3.8 days. CONCLUSIONS: This is the largest reported study of laparoscopic debridement for pancreatic necrosis. The procedure is feasible and associated with a low morbidity and mortality. Pancreatic debridement with HALS may provide a new option for the surgical treatment of selected patients with severe necrotizing pancreatitis.

Adult↗
PubMed1985

[Aorto-intestinal and paraprosthetic fistulas. A rare differential diagnosis of gastrointestinal hemorrhage].

Secondary aorto-intestinal or paraprosthetic fistulas had developed in seven patients after implantation of an angioprosthesis. In six cases, the fistula was located in the duodenum, in each case after a bifurcation bypass had been established, whereas in one case the fistula occurred in the area of the caecum (unilateral aortofemoral bypass as preliminary operation). Gastrointestinal bleeding was the initial sign in five patients, preceding in each case the final massive haemorrhage as a typical premonitory haemorrhage by several days. A secondary aorto-intestinal fistula must be assumed if there is a constellation of acute gastrointestinal bleeding, sepsis or fever and previous aorto-iliacal bypass operation, unless it is possible to confirm some other source of haemorrhage by endoscopy. The present-day standard therapy consists in occluding the intestinal fistula opening, removal of the entire prosthetic material and, if necessary, establishment of an extra-anatomic axillofemoral bypass.

Abscess↗
PubMed1980

Complications of ureteroileal conduit with radical cystectomy: review of 336 cases.

Review of complications of the ileal conduit in patients undergoing radical cystectomy for bladder cancer showed a statistically significant increase in renal calculi, ureteral obstruction, acute and chronic pyelonephritis and deterioration of renal function by 60 months postoperatively. Ureteroileal fistulas occurred in 3.3 per cent, stomal stenosis in 5.1 per cent, intestinal fistulas in 5.4 per cent, severe intestinal obstruction in 6 per cent and abdominal wound infection or dehiscence in 20.2 per cent of the cases. The over-all operative mortality was 13.7 per cent, with 8 per cent of the deaths attributed to complications from the ileal conduit. Comparison of colonic conduits to ileal conduits as a means of urinary diversion with radical cystectomy for bladder cancer demonstrated no convincing evidence of its superiority.

Adult↗