Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

Intestinal fistula, as a serious complication after abdominal surgery, not only leads to a series of pathophysiological changes such as fluid loss, malnutrition and organ dysfunction, but also causes the severe abdominal infection, which often threatens the life of patients. How to make the diagnosis and give the treatment of intestinal fistula is the key to save the lives of high-risk patients. In our hospital, during the past course of diagnosis and treatment for intestinal fistula complicated with severe abdominal infection, based on the combination of literatures at home and abroad with our clinical experiences for many years, an effective three-stage prevention and treatment strategy was formed gradually, which included early diagnosis, effective treatment of infection source, open drainage of abdominal infection and early enteral nutrition support. This strategy subverts the traditional concept of surgery alone, and becomes an effective means to save patients with severe abdominal infection.
Clinical Protocols ; standards ; Digestive System Surgical Procedures ; adverse effects ; Drainage ; methods ; Early Diagnosis ; Enteral Nutrition ; methods ; Humans ; Intestinal Fistula ; complications ; diagnosis ; prevention & control ; therapy ; Intraabdominal Infections ; etiology ; therapy ; Nutritional Support ; methods ; Treatment Outcome

Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.
Aged ; Anti-Bacterial Agents/therapeutic use ; Breath Tests ; Colonic Pseudo-Obstruction/*diagnosis/etiology ; Colonoscopy ; Humans ; Intestinal Fistula/*diagnosis/drug therapy/microbiology ; Male ; Methane/chemistry/metabolism ; Tomography, X-Ray Computed

Aortic Aneurysm, Abdominal ; surgery ; Endovascular Procedures ; adverse effects ; Humans ; Intestinal Fistula ; diagnosis ; etiology ; Male ; Middle Aged

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.
Adult ; Crohn Disease/complications/*diagnosis ; Endoscopy, Digestive System/instrumentation/methods ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Preoperative Care ; Tomography, X-Ray Computed

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 ; Colon, Sigmoid/*pathology ; Diverticulitis/complications/*surgery ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Male ; Sigmoidoscopy ; Tomography, X-Ray Computed

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Although surgical resection still remains the treatment of choice for HCC, radiofrequency ablation (RFA) has emerged as reliable alternatives to resection. It is less invasive and can be repeated after short intervals for sequential ablation in case of multiple lesions. The most common complication of RFA is liver abscess, and bile duct injury such as bile duct stricture has been reported. This is a case report of a rare complication of abscesso-colonic fistula after RFA for HCC. The case was treated by percutaneous abscess drainage and antibiotics and occlusion of abscesso-colonic fistula with n-butyl-2-cyanoacrylate embolization.
Aged ; Anti-Bacterial Agents/therapeutic use ; Carcinoma, Hepatocellular/diagnosis/*surgery ; Catheter Ablation/*adverse effects ; Colonic Diseases/etiology/*therapy ; Drainage ; Embolization, Therapeutic ; Enbucrilate/*therapeutic use ; Humans ; Intestinal Fistula/etiology/*therapy ; Liver Abscess/etiology/ultrasonography ; Liver Neoplasms/diagnosis/*surgery ; Male ; Pseudomonas aeruginosa/isolation & purification ; Tomography, X-Ray Computed

Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed.
Colonic Diseases/complications/*diagnosis ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Iliac Artery/*radiography ; Intestinal Fistula/complications/*diagnosis ; Middle Aged ; Stents ; Tomography, X-Ray Computed ; Vascular Fistula/complications/*diagnosis

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

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