1.Staged Surgery for Chronic Primary Aortoduodenal Fistula in a Septic Patient.
Yong Pil CHO ; Gil Hyun KANG ; Myoung Sik HAN ; Hyuk Jai JANG ; Yong Ho KIM ; Je ho RYU ; Chang Kyun PARK ; Sung Gyu LEE
Journal of Korean Medical Science 2004;19(2):302-304
Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.
Aged
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Aortic Aneurysm, Abdominal/complications/*pathology/*surgery
;
Chronic Disease
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Digestive System Surgical Procedures
;
Duodenum/pathology
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Human
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Intestinal Fistula/complications/*pathology/*surgery
;
Male
;
Sepsis/*complications
;
Tomography, X-Ray Computed
2.Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy.
Yong Wook JUNG ; Jung Hyun YOO ; Jung Soo LEE ; Byung Ik JANG ; Kyeong Ok KIM ; Sang Hun JUNG
The Korean Journal of Gastroenterology 2011;58(5):284-287
Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.
Aged
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Colon, Sigmoid/*pathology
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Diverticulitis/complications/*surgery
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Humans
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Intestinal Fistula/*diagnosis/etiology/surgery
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Male
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Sigmoidoscopy
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Tomography, X-Ray Computed
4.Ovarian-colonic fistula caused by endometriotic cyst of ovary: report of a case.
Tian-Cheng WANG ; Bin WANG ; Juan WANG ; Xia YUAN
Chinese Journal of Pathology 2009;38(10):650-650
Adnexa Uteri
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surgery
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Colectomy
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methods
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Colonic Diseases
;
etiology
;
pathology
;
surgery
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Colostomy
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Endometriosis
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complications
;
pathology
;
surgery
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Female
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Fistula
;
etiology
;
pathology
;
surgery
;
Follow-Up Studies
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Humans
;
Intestinal Fistula
;
etiology
;
pathology
;
surgery
;
Middle Aged
;
Ovarian Cysts
;
complications
;
pathology
;
surgery
;
Ovarian Diseases
;
etiology
;
pathology
;
surgery
;
Ovariectomy
5.Cytomegalovirus Infection-related Spontaneous Intestinal Perforation and Aorto-enteric Fistula after Abdominal Aortic Aneurysmal Repair.
Su Young AHN ; Sun Young LEE ; Bum Sung KIM ; Kyoung Hoon RHEE ; Jeong Hwan KIM ; In Kyung SUNG ; Hyung Seok PARK ; Choon Jo JIN
The Korean Journal of Gastroenterology 2010;55(1):62-67
Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Aged
;
Aged, 80 and over
;
Aorta, Abdominal/*surgery
;
Aortic Aneurysm, Abdominal/complications/*surgery
;
Aortic Diseases/*diagnosis/surgery/virology
;
Cytomegalovirus Infections/*complications/diagnosis/pathology
;
Endoscopy, Gastrointestinal
;
Gastrointestinal Hemorrhage/etiology
;
Humans
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Intestinal Fistula/*diagnosis/surgery/virology
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Intestinal Perforation/*diagnosis/virology
;
Male
;
Vascular Fistula/*diagnosis/surgery/virology
6.Cytomegalovirus Infection-related Spontaneous Intestinal Perforation and Aorto-enteric Fistula after Abdominal Aortic Aneurysmal Repair.
Su Young AHN ; Sun Young LEE ; Bum Sung KIM ; Kyoung Hoon RHEE ; Jeong Hwan KIM ; In Kyung SUNG ; Hyung Seok PARK ; Choon Jo JIN
The Korean Journal of Gastroenterology 2010;55(1):62-67
Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Aged
;
Aged, 80 and over
;
Aorta, Abdominal/*surgery
;
Aortic Aneurysm, Abdominal/complications/*surgery
;
Aortic Diseases/*diagnosis/surgery/virology
;
Cytomegalovirus Infections/*complications/diagnosis/pathology
;
Endoscopy, Gastrointestinal
;
Gastrointestinal Hemorrhage/etiology
;
Humans
;
Intestinal Fistula/*diagnosis/surgery/virology
;
Intestinal Perforation/*diagnosis/virology
;
Male
;
Vascular Fistula/*diagnosis/surgery/virology
7.Prevention and treatment of anastomotic leakage and intestinal ischemia after esophageal replacement with colon.
Jun XIA ; Yi PENG ; Jie HUANG ; Bang-Chang CHENG ; Zhi-Wei WANG
Chinese Journal of Gastrointestinal Surgery 2009;12(1):17-19
OBJECTIVETo explore the effective management to prevent anastomotic leakage and intestinal ischemia after esophageal replacement with colon(ERC).
METHODSClinical data of 572 cases received ERC from March 1966 to March 2006 were analyzed retrospectively.
RESULTSMost of patients received ERC were diagnosed as esophageal cancer and esophageal stenosis(92.5%). 55.6% of cases underwent esophageal reconstruction and 44.4% of cases underwent esophageal bypass. During ERC procedure, the colon interposition graft length should be 3-4 cm longer than expectation; good blood supply was maintained; the lifted passage was unobstructed, and the physiological peristalsis direction was kept. The incidence of anastomotic leakage was analyzed among different periods, which were 14.2%, 13.5%, and 5.6% during 1966-1975, 1976-1995 and 1996-2006 respectively(P<0.05). No intestinal ischemia was observed in all the patients.
CONCLUSIONSWhen performing ERC, the main preventional managements of anastomotic leakage and intestinal ischemia are fully blood supply maintenance and intercepting enough length of the colon graft. Ensuring unobstructed passage is good for survival of the colon graft. Correct physiological peristalsis direction of colon interposition is beneficial to the healing of the anastomosis.
Adolescent ; Adult ; Aged ; Anastomosis, Surgical ; adverse effects ; Child ; Child, Preschool ; Colon ; transplantation ; Esophagus ; surgery ; Female ; Fistula ; etiology ; prevention & control ; Humans ; Intestinal Diseases ; etiology ; prevention & control ; Ischemia ; etiology ; prevention & control ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Surgical Stomas ; pathology ; Young Adult
8.Treatment of complications after laparoscopic intersphincteric resection for low rectal cancer.
Bin ZHANG ; Ke ZHAO ; Quanlong LIU ; Shuhui YIN ; Yujuan ZHAO ; Guangzuan ZHUO ; Yingying FENG ; Jun ZHU ; Jianhua DING
Chinese Journal of Gastrointestinal Surgery 2017;20(4):432-438
OBJECTIVETo summarize the perioperative and postoperative complications follow laparoscopic intersphincteric resection (LapISR) in the treatment of low rectal cancer and their management.
METHODSAn observational study was conducted in 73 consecutive patients who underwent LapISR for low rectal cancer between June 2011 and February 2016 in our hospital. The clinicopathological parameters, perioperative and postoperative complications, and clinical outcomes were collected from a prospectively maintained database. Perioperative and postoperative complications were defined as any complication occurring within or more than 3 months after the primary operation, respectively.
RESULTSForty-nine(67.1%) cases were male and 24(32.9%) were female with a median age of 61(25 to 79) years. The median distance from distal tumor margin to anal verge was 4.0(1.0 to 5.5) cm. The median operative time was 195 (120 to 360) min, median intra operative blood loss was 100 (20 to 300) ml, median number of harvested lymph nodes was 14(3 to 31) per case. All the patients underwent preventive terminal ileum loop stoma. No conversion or hospital mortality was presented. The R0 resection rate was 98.6% with totally negative distal resection margin. A total of 34 complication episodes were recorded in 21(28.8%) patients during perioperative period, and among which 20.6%(7/34) was grade III(-IIII( according to Dindo system. Anastomosis-associated morbidity (16.4%,12/73) was the most common after LapISR, including mucosa ischemia in 9 cases(12.3%), stricture in 7 cases (9.6%, 4 cases secondary to mucosa necrosis receiving anal dilation), grade A fistula in 3 cases (4.1%) receiving conservative treatment and necrosis in 1 case (1.4%) receiving permanent stoma. After a median follow up of 21(3 to 60) months, postoperative complications were recorded in 12 patients (16.4%) with 16 episodes, including anastomotic stenosis (8.2%), rectum segmental stricture (5.5%), ileus (2.7%), partial anastomotic dehiscence (1.4%), anastomotic fistula (1.4%), rectovaginal fistula (1.4%) and mucosal prolapse (1.4%). These patients received corresponding treatments, such as endoscopic transanal resection, anal dilation, enema, purgative, permanent stoma, etc. according to the lesions. Six patients (8.2%) required re-operation intervention due to postoperative complications.
CONCLUSIONAnastomosis-associated morbidity is the most common after LapISR in the treatment of low rectal cancer in perioperative and postoperative periods, which must be strictly managed with suitable methods.
Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; adverse effects ; Blood Loss, Surgical ; statistics & numerical data ; Colectomy ; adverse effects ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; adverse effects ; Intestinal Mucosa ; pathology ; Ischemia ; etiology ; Laparoscopy ; adverse effects ; Lymph Node Excision ; statistics & numerical data ; Male ; Margins of Excision ; Middle Aged ; Necrosis ; etiology ; Operative Time ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; complications ; surgery ; Rectovaginal Fistula ; etiology ; therapy ; Surgical Stomas ; Treatment Outcome