[Case of an internal bilio-small intestinal fistula and obturational intestinal obstruction caused by a biliary calculus].
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[Gastric fistula instead of large intestine fistula].
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[Vesico-intestinal fistulae].
Vesico-intestinal fistulae were observed in 14 patients within a period of 10 years (vesico-colonic: ten; vesico-rectal: two; vesico-ileal and vesico-rectal-ileal: one each). The causes were diverticulitis in five, carcinoma of the sigmoid in two, radiation damage after prostatic or cervical carcinoma in two, and Crohn's disease, abscess of Douglas's pouch after perforated appendicitis, ileal carcinoma, sarcoma of the pelvis, and ovarian carcinoma, one each. Pneumaturia, faecaluria and dysuria were the most frequent symptoms, treatment-resistant cystitis was present in three. Cystoscopy, intravenous pyelogram, retrograde cystogram, barium meal, barium swallow with follow-through, and rectosigmoidoscopy proved to be the best methods of diagnosis. Four patients had multiple operations, three one operation, with a cure in all. In the neoplastic fistulae the underlying carcinoma could not be radically operated on: colostomy or colostomy with palliative resection was performed. In four of these the fistulae then closed, once it remained open. One woman with a vesicorectal fistula due to ovarian carcinoma died of tumor cachexia 16 days after a colostomy had been made.
Abscess↗
[Management of postoperative intestinal fistulas with elemental diet (author's transl)].
From 1973-1976 sixteen patients with clinically manifest post-operative fistulas (7 small intestinal and 9 colonic) were studied. These patients received an elemental diet (ED) as their only nutritional support for 9-44 days. On ED spontaneous closure was observed in 4 out of 7 small intestinal fistulas and in 7 out of 9 colonic fistulas. Hemoglobin and serum albumin increased significantly on ED and nitrogen balance performed on 7 patients was in equilibrium or positive. Advantages of ED over intravenous nutrition in the treatment of intestinal fistulas are discussed.
Adult↗
[External intestinal fistulae and their treatment].
The results of treatment of 188 patients with different external fistulas of the intestine are reported. A detailed analysis of 23 observations of small intestine fistulas is given, including 16 cases with enterostomies complicated with phlegmon of the abdominal wall, emaciation and hemorrhage from acute intestinal ulcers. An early surgical treatment of such fistulas is recommended.
Adult↗
[External intestinal fistulae].
The authors describe external intestinal fistulae found within 11 years at 5000 urgent operations on abdominal organs in 56 patients. 20 of them showed fistulae of appendicular origin, 15 developed fistulae following various traumas of abdominal organs, 1--after intestinal ileus, in 3 cases fistulae were due to incarceration of hernia, in 17 cases external fistulae were applied in intestinal neoplasms. Small gut fistulae were noted in 15, colon fistulae--in 41 patients. The total of 19 patients died, most of them had malignant intestinal neoplasms.
Appendectomy↗
[Treatment of external intestinal fistulae].
The authors observed 105 cases of external intestinal fistula of various localization and found that the destruction of the intestinal wall under the conditions of suppurative peritonitis, together with the tampons and drainage tubes inserted into the abdominal cavity and left there for a long period of time, constitute the main causes of the occurrnce of intestinal fistula. Surgical treatment of a lip-shaped fistula (63 cases) of the small intestine and colon, mainly by the intraabdominal method, was carried out. Tubular fistula was closed conservatively in 22 cases. The intestinal motor activity was studied in 20 cases and potassium iodide resorption was investigated in the experiments on 20 animals. Some practically important recommendations are given.
Animals↗
[The treatment of unformed intestinal fistulae].
Experience in the treatment of 33 patients with unformed intestinal fistulas is discussed. The choice of the method for surgical management was determined by the localization of the fistulas, the possibility of their occlusion, and the severity of the patient's condition. Complex therapy included selective administration of antibacterial agents and extracorporeal detoxification by means of biohemosorption. Rational surgical tactics and complex treatment including extracorporeal detoxification in patients with unformed external intestinal fistulas made it possible to reduce the mortality rate from 33.4% to 21.2% (7 patients died).
Anastomosis, Surgical↗
[Urological aspect of vesico-intestinal fistulas. Apropos of 14 cases].
This series of 14 cases of vesico-intestinal fistulae, together with a review of the literature, led to a certain number of remarks: From an aetiological standpoint, in addition to classical concepts with the predominance of diverticulosis of the colon accounting for 46% of cases, followed by carcinoma of the colon (14%) and Crohn's disease, we feel it to be of interest to stress the possible urinary origin of vesico intestinal fistulae (4 of our cases, and 4.5% of the total number collectedin the literature). From a diagnostic standpoint, we would emphasise that these fistulae present almost solely with urinary symptoms and signs and stress the clinical importance of what is now known, since J. Cibert, as "pre-fistulous cystitis" preceding the development of pathognomic signs--faecaluria and pneumatria. Radiological opacification of the colon and rectum is essential in patients with a syndrome of chronic urinary infection unexplained by a urological cause. From a therapeutic standpoint, the surgical treatment of vesico-intestinal fistulae is associated with a high operative mortality (2 deaths amongst our 14 patients) and which, independently of the aetiological factor (predominance of carcinomas) is explained above all by the septic nature of the lesions.
Adult↗
[Differential therapy of vesico-intestinal fistulas].
40 patients with vesico-intestinal fistulas (50% inflammatory, 30% traumatic, 20% neoplastic) were treated within 10 years. Closure was achieved in 97% of 31 patients operated on with curative intention. The remaining 9 patients had palliative surgery, i.e. colostomy or cystostomy. The decision single- or multiple-stage procedure depends upon the etiology, localization and extent of the fistula.
Colostomy↗
[Gastrointestinal haemorrhage due to aorto-intestinal fistula. 3 cases (author's transl)].
Three types of aorto-intestinal fistula may be associated with gastrointestinal bleeding: primary fistulae from an aneurysm, secondary fistulae related to an aorto-prosthetic anastomosis and paraprosthetic fistulae by intraduodenal protrusion of a graft. The prevalence of secondary and paraprosthetic fistulae increases with more widespread vascular surgery. Only if the diagnosis is always borne in mind in a patient with an aneurysm or an aortic prosthesis makes it possible to recognise an aorto-intestinal fistula in time. Upper GI series and endoscopy are more useful in reaching a diagnosis than arteriography but signs must be sought in the third and fourth parts of the duodenum. The lesion may even be missed on surgical exploration, being concealed before separation of the aorta and duodenum. Infection and the underlying general medical condition are factors in the gravity of the operative prognosis. One of our three patients treated surgically was saved by the insertion of an extra-anatomic bypass. The prognosis in paraprosthetic fistulae, the possible precursor stage of a secondary aorto-digestive fistula, is more favourable.
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[Contribution of arteriography to diagnosis of secondary arterio-digestive fistulas. Intestinal haemorrhage due to ilio-ileal fistula, a complication in vascular reconstruction (author's transl)].
The authors describe a case of secondary ilio-ileal fistula revealed by an intestinal haemorrhage which occurred ten years after vascular reconstruction. They stress the importance of arteriography which shows up the pseudo-aneurysm causing the fistularisation and vascular contrast material escaping into the digestive lumen. A complete review of the literature on arterio-colonic fistulas, and more particularly, ileo-ileal fistulas, shows that they usually express themselves clinically in the form of digestive haemorrhages occurring generally after vascular graft and after a variable lapse of time. The association of digestive haemorrhage and a previous vascular reconstruction should suggest the diagnosis of arterio-digestive fistula and should lead to early angiography to enable coherent surgical strategy to be put into operation.
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[Use of ferromagnetic rheological suspensions in the treatment of non-formed intestinal fistulas].
Data on treatment of 42 patients with nonformed intestinal fistulas with the help of ferromagnetic rheological suspensions are presented. The authors have shown that their method tested under experimental conditions is close to universal since it does not require selection of the individual obturator. The use of the method is not possible in patients with one or multiple abscesses of the abdominal cavity, through which the formed fistula passes.
Adult↗
[The treatment of intestinal fistulae in children by applying a by-pass anastomosis using magnetic devices].
A new method is suggested for the exclusion of intestinal fistulas by the formation of by-pass anastomoses by means of a permanent magnet. The variants of the techniques of magnet by-pass anastomoses are discussed. The results of treatment of 46 children with external intestinal fistulas are shown. With the formation of a by-pass compression anastomosis the mortality rate among children with intestinal fistulas reduced from 31 to 13%.
Anastomosis, Surgical↗
[Primary aorto-intestinal fistula as a diagnostically difficult complication of ruptured abdominal aortic aneurysm].
Three cases are presented of a rare complication of abdominal aorta aneurysm, that is its rupture into the gastrointestinal tract. In two cases the aneurysm ruptured into the duodenum, and in one case into small intestine. The authors call attention to the variety of symptomatology and diagnostic difficulties with the primary aorto-intestinal fistula. This is true especially of cases in which the rupture is the first and not infrequently the only symptom of the aneurysm. The rupture of the abdominal aorta aneurysm into the gastrointestinal tract is still fraught with a very high mortality; out of three patients with primary aorto-intestinal fistula only one was saved.
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[State of the mucus membrane of the small intestine in upper intestinal fistulas].
In modeled experiments of 23 polyfistulous dogs with a reproduced high complete small-intestine fistula it was established that enteral compensation of water-electrolyte losses by means of a saline solution, isotonic and isoionic to the chyme, contributed to the maintenance of the water-salt balance for a prolonged period of time, kept up the animals' life and ensured the return to normalcy following the closure of the fistula. Preservation of the function of absorption by the small intestine was confirmed by the data of morphological investigations of 403 bioptic specimens of the mucosa from various parts of the small intestine repitedly taken in the course of the experiments. The data obtained testify to the absence of atrophy of villi and nakedness of their stroma, despite the intravital detachment of the epithelium into the lumen of the intestine, as well as to hyperproduction of the mucus, dilatation of the vessels of the circulatory and lymphatic systems, to retention of the mitotic activity.
Animals↗
[External postoperative intestinal fistulae in appendicitis].
The author presents an analysis of the data obtained in 8500 patients operated upon for acute appendicitis, in 62 of them the postoperative period was complicated by intestinal fistula. It was found that the main causes of occurrence of intestinal fistulas are as follows: late terms of hospitalization and operative treatment of patients with acute appendicitis, some damage to the bowel due to inadequate access in appendectomy. The author advocates an earlier operative treatment for acute appendicitis and the use of a wide approach (transverse) in appendectomy.
Acute Disease↗
Intestinal fistula complicating pancreatic abscess.
Intestinal fistulization following acute pancreatitis is a complication of abscess formation and may occur after initial surgical drainage. It should be suspected in anyone with protracted pancreatitis in whom an abdominal mass suddenly disappears or in whom gastrointestinal bleeding develops. Although transient improvement may occur, decompression will often be incomplete and will usually be followed by recurrent sepsis or severe life threatening hemorrhage. For this reason, spontaneous fistulization into the intestine does not eliminate the need for adequate surgical drainage. With fistulas into the colon, drainage should be combined with proximal diverting colostomy. Some duodenal fistulas may respond to abscess drainage and intravenously administered hyperalimentation, while others may require drainage plus conversion from a side to an end fistula.
Abscess↗