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Transvaginal approach for pelvic abscess drainage. A. 9×5 cm sized abscess cavity (arrows) formation in pelvic cavity following hysterectomy. Fistula tract between sigmoid colon and abscess is observed. B. 8.5 Fr drainage catheter insertion was performed by fluoroscopic guided transvaginal approaches.
Source publication
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 fro...
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Objective:
The aim of this study was to determine the results of ultrasound-guided percutaneous nephrostomy tube placement performed solely by urologists. We present our relevant one decade experience in a tertiary care hospital.
Material and methods:
We evaluated technical success and complication rates of ultrasound-guided percutaneous nephros...
Citations
... In addition, the contrast's diagnostic use is constrained by the presence of abscesses or other abnormalities, such as edema and debris, that prevent the contrast from reaching the intestine lumen [21]. The use of another radiological modality is essential as well because US has been demonstrated to have a number of drawbacks, including the necessity of a skilled operator, the difficulty of seeing the duodenum and jejunum, and obesity [24]. ...
There is one reported case of a pancreatoduodenal fistula that was managed using combined coil embolization and fibrin glue after the failure of other methods. Herein, we document this case to highlight the value of coil embolization and fibrin glue as surgical alternatives for fistula treatment. We present a case of a 39-year-old female patient who has a known case of Crohn's disease (CD) and presented with an enterocutaneous fistula (ECF) after her most recent surgery. With the failure of conservative approaches and as she refused any surgical interventions, fibrin glue injection and coiling were used. As a conclusion, embolization may work well as a surgical management alternative due to its simplicity.
... Gastrojejunocolic fistula (GJF) is a very serious complication that is associated with high morbidity and mortality [1]. ...
Gastrojejunocolic fistula (GJF) is a very rare complication of peptic ulcer surgery. Patients with this condition often present with diarrhea, fecal vomiting as well as weight loss. Here, we report a case of 62-year-old male with a GJF complicating upper gastrointestinal surgery.
... 37,43 Other than mortality, anastomotic leakage can result in decreased digestion and quality of life. [44][45][46][47][48][49][50][51][52] After a gastrectomy, the median time to diagnosis of leakage was about 7 days. [45][46][47] Endoscopy, CT imaging, or fluoroscopy using contrast agents are all used to identify anastomotic leaking. ...
... For a pelvic abscess, a transgluteal, transvaginal, or transrectal approach can be performed. 49,50 For enteral feeding and decompression, nasogastric tube insertion under fluoroscopic guidance is helpful. If a long period is required until tube removal, percutaneous transesophageal gastrotubing (access to the stomach via percutaneous access to the cervical esophagus) can be an alternative option to nasogastric tube (Fig. 2). ...
... [75][76][77] The decision to remove the catheter is made when the daily drainage is < 10 mL, the symptoms have improved, there is minimal or no residual cavity, and nonpurulent drainage. 50 ...
... Las fístulas pueden ser difíciles de diagnosticar y demandan frecuentemente reintervenciones quirúrgicas; de este modo aumenta la morbimortalidad y los costos de la hospitalización; por tanto, los principios fundamentales del tratamiento son la identificación del sitio del defecto, el drenaje y la prevención de colecciones adicionales, ya sea mediante la desviación del flujo del contenido luminal o el cierre del defecto (4,5) . Aunque el manejo quirúrgico tradicional o el conservador con reposo intestinal, los antibióticos intravenosos y el soporte nutricional son los pilares del tratamiento, no siempre son efectivos (6)(7)(8) . El manejo endoscópico ha demostrado ser una alternativa eficaz y menos invasiva que la cirugía primaria, y los stents metálicos autoexpandibles total o parcialmente cubiertos son una alternativa mínimamente invasiva en el manejo de las fugas y fístulas gastrointestinales, cuyo objetivo es prevenir la fuga del contenido gastrointestinal por el trayecto fistuloso y, de este modo, permitir la cicatrización del defecto, lo que favorece que el paciente retome la nutrición por vía oral y mejore sus condiciones nutricionales, para que de esta manera se permita el cierre del defecto y, a futuro, mejore la calidad de vida (9,10) . ...
Objetivos:
mostrar la eficacia y seguridad de los stents metálicos autoexpandibles para el manejo endoscópico de las fístulas esofágicas.
Materiales y métodos:
se evalúo una serie de casos de manera retrospectiva entre el 2007 y el 2017, en los que se manejaron a 11 pacientes con un stent metálico autoexpandible para el manejo de fístula esofágica, en quienes se realizó el diagnóstico por clínica, endoscopia digestiva alta o estudios radiológicos en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D. C., Colombia.
Resultados:
el principal síntoma inicial fue la disnea en 27,3 % de los casos, seguido por tos en un 18,2 %. El hallazgo más frecuentemente encontrado durante el seguimiento fue el derrame pleural en el 36,4 %, se realizó el diagnóstico de fístula en el 45,5 % con esofagograma y el tipo de lesión más reportada fue la fuga en la anastomosis esofagoentérica, con un 45,5 %, seguida de la esofagopleural, con un 36,4 %; y estos pacientes fueron manejados con un stent metálico autoexpandible. En el 100 % hubo éxito técnico y la resolución del defecto se evidenció en el 72,7 % de los casos. La única complicación reportada fue el desplazamiento del stent en el 27,3 %, y en un paciente se requirió el cambio del stent en 3 oportunidades. El promedio de estancia hospitalaria fue de 41,5 días.
Conclusiones:
el manejo endoscópico de las fístulas esofagogástricas con stents metálicos autoexpandibles es efectivo y seguro, con una baja tasa de complicaciones.
... Therefore, these complex patients require a cross-disciplinary treatment with effective but less invasive alternatives. Sometimes, solutions used in other pathologies or specialties may prove useful, such as interventional radiology, which is able to obstruct newly formed tracts (3,4) , or laser diode, which is used in fistulas at other locations (5) . ...
Introduction:
Enterocutaneous fistula treatment in patients undergoing multiple surgeries is complex and requires creative solutions. We present the case of an enterocutaneous fistula managed with laser diode and cyanoacrylates.
Clinical case:
15-year-old patient, diagnosed with ulcerative colitis at 12 years of age, undergoing full colectomy with urgent ileostomy as a result of a flare-up refractory to medical treatment. Five months later, an ileoanal pull-through with pouch was carried out, leaving a protection ileostomy in place. However, postoperative evolution was poor, with pelvic infection, so two further urgent open surgeries were required for lavage and hemostasis purposes. Six months later, anastomotic stricture was noted. It was healed following various pneumatic dilations under ultrasound vision and at-home dilations using Hegar dilators. One year following this, ileostomy was closed, but one month later, abdominal distension occurred. It was associated with a fistula in the abdominal midline, which could be endoscopically guided, with its origin being located at the ileoanal anastomosis. Laser diode sessions were applied for treatment purposes, with partial improvement, but still with gas emission. One year later, embolization was performed by placing platinum coils and lipiodol-diluted cyanoacrylates, and clinical signs disappeared. 17 months following this surgery, the patient has no symptoms, with full day and night fecal continence and 3 daily stools, and the fistula is completely closed.
Conclusion:
Combined treatment with laser diode and platinum coil and cyanoacrylate embolization proves effective in the management of enterocutaneous fistula, with low morbidity.
... Ultrasound abdomen and Upper gastrointestinal endoscopy are not diagnostic. CT Fistulogram is the investigation of choice in these circumstances [7,8]. ...
Introduction:
Peptic perforation repair is a common stomach surgery. This surgery has not been associated with delayed onset gastrocutaneous fistula formation. However such a complication has been reported following a variety of other stomach surgeries. We are reporting this case as it is a rare complication. Also its diagnosis and management is challenging.
Case summary:
We are presenting a case of peptic perforation repair where burst abdomen happened in the immediate post-operative period. The patient was put on conservative management. He responded well to it but his abdominal wound was not healing. After a wait of four months the wound was covered with a skin graft. The graft uptake was satisfactory but a discharging ulcer appeared on it. This condition persisted for one month. Finally a computed tomography Fistulogram (CT Fistulogram) was performed. It revealed an underlying complex gastric fistula. A repeat surgery was performed.
Conclusion:
A gastrocutaneous fistula diagnosed at sixth month following the peptic perforation repair and causing minimal discomfort to the patient is a rare presentation. The abdominal wound following the surgery was possibly not healing because of the underlying fistula.
... Barium does, however, have a greater sensitivity for demonstrating enteric fistulae. 32,33 In some cases, direct visualization of the mucosa is required with endoscopy. This can help to assess the pathology underlying strictures or inflammation, which may be difficult to fully distinguish on radiological imaging alone. ...
Intestinal failure (IF) is a condition characterized by the inability to maintain a state of adequate nutrition, or fluid and electrolyte balance due to an anatomical or a physiological disorder of the gastrointestinal system. IF can be an extremely debilitating condition, significantly affecting the quality of life of those affected. The surgical management of patients with acute and chronic IF requires a specialist team who has the expertise in terms of technical challenges and decision-making. A dedicated IF unit will have the expertise in patient selection for surgery, investigative workup and planning, operative risk assessment with relevant anesthetic expertise, and a multidisciplinary team with support such as nutritional expertise and interventional radiology. This article covers the details of IF management, including the classification of IF, etiology, prevention of IF, and initial management of IF, focusing on sepsis treatment and nutritional support. It also covers the surgical aspects of IF such as intestinal reconstruction, abdominal wall reconstruction, and intestinal transplantation.
... Further investigation can be done using an angiographic catheter and guidewire under fluoroscopy to delineate the fistula course and any pockets or cavities. 56 For rectovaginal fistulas that are suspected but not visualized on CTE or MRE, proctography with barium enemas or vaginography with instillation of contrast in the vagina aided by an occluding vaginal balloon can be performed, with vaginography demonstrating superior sensitivity for fistula detection. 57 Enterovesical or colovesical fistulas are best evaluated on CTE or MRE with a diagnostic accuracy close to 100%. ...
Crohn’s disease (CD) leads to the development of complications through progressive uncontrolled inflammation and the transmural involvement of the bowel wall. Most of the available literature on penetrating CD focuses on the perianal phenotype. The management of nonperianal penetrating complications poses its own set of challenges and can result in significant morbidity and an increased risk of mortality. Few controlled trials have been published evaluating this subgroup of patients for clinicians to use for guidance. Utilizing the available evidence, we review the epidemiology, presentation, and modalities used to diagnosis and assess intestinal fistulas, phlegmons, and abscesses. The literature regarding the medical, endoscopic, and surgical management options are reviewed providing physicians with a therapeutic framework to comprehensively treat these nonperianal penetrating complications. Through a multidisciplinary evidence-based approach to the complex sequela of CD outcomes can be improved and patient’s quality of life enhanced.
Close
... In this context, the field of interventional radiology has provided reliable, safe and effective solutions for the management of postoperative complications. Among them, image-guided percutaneous drainage is one of the most commonly used techniques for the management of abscesses [3], but these techniques often have limited effectiveness in the presence of associated fistulas. This report demonstrates how reoperation might be safely avoided with minimal access, percutaneous treatment of an intraabdominal fistula. ...
... The pre-tion between the gastrointestinal tract and the skin. sence of any of these components in EC fistula represents an indication to surgery (7). ...
Aim:
Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy.
Case report:
A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant.
Results:
The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula.
Conclusion:
This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.
