Traditional treatments of gastrointestinal fistula include early drainage, maintaining nutrition and then resection of fistula at the proper time,which usually take three to four months or even longer. Rapid treatments of gastrointestinal fistula mean promoting rapid spontaneous closure of tract fistula and early primary resection of fistula within two weeks after fistula occurrence. Early diagnosis is the premise of early management, and fistulography and abdominal CT scan are important early diagnostic methods. Most of fistula could close spontaneously in the maintaining stage. To promote the rapid closure, however, special measures including sufficient drainage, somatostatin and total parenteral nutrition in the early stage should be implemented to avoid intra-abdominal collection of intestinal fluid and infection, control further leakage of intestinal fluid and improve nutritional status. In the late stage,when leakage of intestinal fluid could be controlled, recombine human growth hormone (rhGH) and enteral nutrition should be administered in place of somatostatin and total parenteral nutrition respectively. The fistula can reach rapid spontaneous closure in both stages. Fibrin glue and rhGH used at the same time can improve the curative rate and shorten the treatment time even more. In the 1960s and 1970s, early primary resection of the fistula and re-anastomosis often resulted in anastomosis failure. The reasons for this included poor nutritional status, uncontrolled secretion of intestinal fluid, severe intra-abdominal infection and multiorgan dysfunction syndrome. Such stage management policy has been proposed, developed and persisted since late 1960s. Nowadays, the advance of medical science provided the possibility to change or improve the current policy. Our research proved that early resection of the primary fistula and re-anastomosis of the small bowel could be performed successfully in some selected patients whose general conditions are good and intestinal adhesion were not severe within ten to fourteen days after fistula occurrence. More studies are still needed to define the indications and contradictions for early resection of the primary gastrointestinal fistula, and prove the feasibility and rationality of rapid treatments of gastrointestinal fistula.
Early Diagnosis ; Humans ; Intestinal Fistula ; diagnosis ; therapy ; Parenteral Nutrition, Total

Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.
Drainage ; Gastric Fistula/diagnosis/radiography/*therapy ; Humans ; Intestinal Fistula/diagnosis/radiography/*therapy ; Punctures ; *Radiography, Interventional

Open abdomen therapy is an effective treatment to deal with severe abdominal infections, abdominal hypertension and other critical abdominal diseases. However, this therapy is difficult to implement and has many uncertainties in the timing, manners, and follow-up treatment, which leads to the fact that open abdomen therapy is not very accessible and standardized in medical systems of China. This consensus aims to provide guiding principles for indications and implementation of open abdomen, classification methods of open abdomen wounds, technologies for abdominal closure, and management of enteroatmospheric fistula, so as to improve the accessibility and success rate of open abdomen in China.
Humans ; Abdomen/surgery* ; Consensus ; Intestinal Fistula/therapy* ; Negative-Pressure Wound Therapy ; Open Abdomen Techniques

In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.
Adult ; Crohn Disease/*complications/drug therapy/pathology ; Humans ; Intestinal Fistula/complications ; Male ; Optic Neuritis/*complications/diagnosis

PURPOSE: The conventional treatment for postlaparotomy wound dehiscence usually involves surgical revision. Recently, vacuum-assisted closure has been successfully used in postlaparotomy wound dehiscence. The aim of the present study was to compare the clinical outcome of 207 patients undergoing vacuum-assisted closure therapy or conventional treatment for postlaparotomy wound dehiscence. METHODS: Two hundred and seven consecutive patients underwent treatment for postlaparotomy wound dehiscence: vacuum-assisted closure therapy (January 2007 through August 2012, n = 25) or conventional treatment (January 2001 through August 2012, n = 182). RESULTS: The failure rate to first-line treatment with vacuum-assisted closure and conventional treatment were 0% and 14.3%, respectively (P = 0.002). There was no statistically significant difference in the enterocutaneous fistulas and hospital stay after vacuum-assisted closure therapy or conventional treatment respectively. CONCLUSION: Our findings support that vacuum-assisted closure therapy is a safe and reliable option in postlaparotomy wound dehiscence with very low failure rate in surgical revision compared with conventional treatment.
Humans ; Intestinal Fistula ; Length of Stay ; Negative-Pressure Wound Therapy ; Reoperation ; Wounds and Injuries*

Abdomen ; surgery ; Cutaneous Fistula ; etiology ; therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Intestinal Fistula ; etiology ; therapy ; Male ; Postoperative Complications ; etiology ; therapy ; Retrospective Studies

OBJECTIVETo summarize the experience in nutritional support for the management of duodenocutaneous fistula.

METHODSData of 32 patients with duodenocutaneous fistula in Zhejiang provincial people's hospital from January 1999 to December 2009 were analyzed retrospectively.

RESULTSThe mean duration of nutritional support was 35.6 days (range, 8-82 days). Eight received total parenteral nutrition, 2 total enteral nutrition, and 22 parenteral nutrition combined with enteral nutrition respectively. Succus entericus reinfusion with enteral nutrition was used in 11 cases, glutamine-enriched nutritional support in 28 cases, somatostatin in 12 cases. In these patients, the healing rate was 75.0% after conservative treatment. In the 8 patients who underwent surgery, 6 were cured and 2 died (due to severe abdominal infection and multiple organ failure). A total of 30 patients had the fistulas cured and discharged.

CONCLUSIONSParenteral nutrition combined with enteral nutrition, succus entericus reinfusion combined with enteral nutrition, glutamine-enriched nutritional support and somatostatin are important factors for the healing of duodenocutaneous fistulas.

Adult ; Aged ; Duodenal Diseases ; therapy ; Female ; Humans ; Intestinal Fistula ; therapy ; Male ; Middle Aged ; Nutritional Support ; Retrospective Studies

OBJECTIVETo investigate the effects of enteral nutrition on intestinal intraepithelial lymphocytes and the barrier of mucus in patients with stomal type enteric fistulas.

METHODSTen patients with stomal type enteric fistulas after long-term fasting were observed. They received enteral nutrition of 146 kJ.kg(-1).d(-1) non-protein calorie and 0.25 g.kg(-1).d(-1) nitrogen per day. Intestinal mucosa were taken by endoscope through stoma of fistula before, 5 and 10 days after enteral nutrition support. Hematoxylin-eosin stain and immunohistochemical stain were performed to count the cell counts of intestinal intraepithelial lymphocytes (iIELs) and mucin-2 (MUC2) positive cells, specific stain (Alcian Blue) was performed to test the thickness of mucus.

RESULTSFive days after enteral nutrition, MUC2 positive cells and the thickness of mucus were significantly higher than that before enteral nutrition support (P<0.05). Ten days after enteral nutrition, iIEL cell and CD8 counts were also significantly higher than that before enteral nutrition support (P<0.05), MUC2 positive cells and the thickness of mucus showed a significant increase (P<0.01).

CONCLUSIONEnteral nutrition is effective in protecting the gut mucosal and improving the immune function of the intestinal intraepithelial in patients with stomal type fistula.

Adolescent ; Adult ; Aged ; Cell Count ; Enteral Nutrition ; Female ; Humans ; Intestinal Fistula ; physiopathology ; therapy ; Intestinal Mucosa ; immunology ; physiopathology ; Intestine, Small ; Lymphocytes ; metabolism ; Male ; Middle Aged ; Mucus ; immunology ; Young Adult

OBJECTIVETo investigate the etiology and management of tertiary peritonitis in the patients with intestinal fistula.

METHODSOne hundred and fifty-three cases of intestinal fistula complicated with tertiary peritonitis were reviewed. The microbiological characteristics, treatment Methods and outcomes were analyzed.

RESULTSThere were 114 males and 39 females with a mean age of (42+/- 19) years. The main causes of intestinal fistula included gastrointestinal surgery (40.5%), trauma (31.4%) and severe pancreatitis (14.4%), etc. The most common cultured bacteria of 157 specimens from 79 patients with tertiary peritonitis were Escherichia coli (24.2%), Pseudomonas aeruginosa (12.1%), Staphylococcus aureus (10.8%), Enterobacter cloacae (10.2%), Klebsiella pneumoniae (8.3%). Debridement of the necrotic tissues, drainage of the abscess, continuous rinsing plus negative pressure drainage and antibiotics treatment were performed in 52 cases. Nineteen patients only changed from simple tube drainage to continuous rinsing plus negative pressure drainage. Twenty- eight patients changed to continuous rinsing plus negative pressure drainage and received antibiotics as well. Thirty- six patients received antibiotics and ecoimmune nutrition, while 18 patients only received ecoimmun nutrition.

CONCLUSIONSIntestinal fistula complicated with tertiary peritonitis was mainly caused by residual infectious focus and inappropriate drainage. The rational treatments include reoperation for debridement of the necrotic and infectious tissues, changing drainage to continuous rinsing plus negative pressure drainage, appropriate usage of antibiotics, and ecoimmune nutrition.

Abdominal Cavity ; microbiology ; Adult ; Bacterial Infections ; complications ; therapy ; Drainage ; methods ; Female ; Humans ; Intestinal Fistula ; complications ; microbiology ; therapy ; Male ; Middle Aged ; Peritonitis ; complications ; therapy ; Treatment Outcome ; Young Adult

PURPOSE: Preoperative chemoradiation therapy for rectal cancer seems to improve local control, anal sphincter preservation, resectability, and possibly survival in patients. However, there are several adverse effects, too. The aim of this study is to analyze the disadvantages of preoperative chemoradiation for rectal cancer. METHODS: We retrospectively reviewed 139 patients who were treated by using preoperative chemoradiation for an adenocarcinoma of the rectum between January 1995 and December 2004. All patients had fixed or locally advanced lesions, as determined by digital rectal examination. No distant metastasis was proven before preoperative chemoradiation. All of the patiedts received the full scheduled dose of radiation (range, 5,000~5,400 rad). Concurrent intravenous chemotherapy with 5-fluorouracil (425 mg/m2/day) and leucovorin (45 mg/day) was administered continuously on days 1~5 and 29~33. The mean interval between chemoradiation and surgery was 4~6 weeks. After preoperative chemoradiation, 117 patients underwent an operation. We reviewed the side effects of preoperative chemoradiation, postoperative complications, and distant metastases detected during the preoperative period after preoperative chemoradiation and during the operation. RESULTS: The side effects of preoperative chemoradiation were diarrhea (23%), radiation dermatitis (2.2%), fistula (0.7%), sepsis (0.7%), and rectal bleeding (0.7%). Two patients died from sepsis and rectal bleeding. The postoperative complications were bowel obstruction in 9 cases (7.7%), wound seroma in 8 cases (6.8%), wound infection in 5 cases (4.3%), anastomotic leakage in 5 cases (7.1%), rectovaginal fistula in 2 cases (2.8%), an enterocutaneous fistula in 2 cases (1.7%), and a vesicocutaneous fistula in 1 case (0.8%). Distant metastases were detected in 14 patients (10.1%) after preoperative chemoradiation. CONCLUSIONS: Although preoperative chemoradiation can be performed safely, careful management for the side effects of preoperative chemoradiation and for postoperative complications is necessary. We need a more sensitive study method for detecting distant metastasis of rectal cancer, especially during scheduled preoperative chemoradiation.
Adenocarcinoma ; Anal Canal ; Anastomotic Leak ; Dermatitis ; Diarrhea ; Digital Rectal Examination ; Drug Therapy ; Fistula ; Fluorouracil ; Hemorrhage ; Humans ; Intestinal Fistula ; Leucovorin ; Neoplasm Metastasis ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms* ; Rectovaginal Fistula ; Rectum ; Retrospective Studies ; Sepsis ; Seroma ; Wound Infection ; Wounds and Injuries