Sequential changes of body composition in patients with enterocutaneous fistula during the 10 days after admission.
AIM: To investigate the sequential changes of body composition in the metabolic response that occurred in a group of patients with enterocutaneous fistula after admission to the hospital. METHODS: Sixty-one patients with enterocutaneous fistula admitted to our hospital had measurements of body composition by multiple-frequency bioelectrical impedance analysis after admission and 5, 10 days later. Sequential measurements of plasma constitutive proteins were also made. RESULTS: The body weight, fat-free mass, body mass index, and body cell mass were initially well below the normal range, especially the body mass index and body cell mass. And all the data gradually moved up over the 10-day study period, only a highly significant difference was found in body cell mass. Once the patients received nutrition supplement, ECW began to return to normal range slowly as well as ICW and TBW began to rise up, and ECW/TBW significantly declined to near normal level by day 10 in either male or female patients. There was a reprioritization of plasma constitutive protein synthesis that was obligatory and independent of changes in FFM. CONCLUSION: Serial measurements can quantify the disturbance of body composition in enterocutaneous fistula patients. The early nutritional intervention rapidly ameliorates the abnormal distribution of body water while the state-of-the-art surgical management prevents the further deterioration in cellular composition. (+info)
Treatment of early duodenal fistula after orthotopic liver transplantation: a case report.
Gastrointestinal fistula as a serious complication could lead to imbalance of nutrition or death. Duodenal fistula after orthotopic liver transplantation is rare and its treatment is complicated. On April 28, 200, we performed orthotopic liver transplantation for a patient at our hospital. Eight days after operation duodenal fistula developed, but cured after 13-day treatment. (+info)
Diaphragmatic defect with peritoneopericardial communication.
An 81-year-old man had a congenital defect of the central tendon of the diaphragm, including a peritoneopericardial communication with herniation of the omentum to the pericardial sac in front of the heart. In addition, he had a critically stenosed congenital bicuspid aortic valve and severe coronary artery disease. The patient underwent reduction of the herniated omentum into the abdominal cavity, coronary artery bypass grafting, aortic valve replacement, and closure of the peritoneopericardial communication with a synthetic patch. Three years later, the patient was doing well, with a normally functioning pericardial valve in the aortic position and no sign of omentum around the heart. (+info)
Complications of stent placement for benign stricture of gastrointestinal tract.
AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment. METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients. RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively. For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesia was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurred in 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients. CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain, reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures according to the specific conditions. (+info)
Intestinal perforation in Crohn's disease. Factors predictive of surgical resection.
New medical therapeutic options challenge the usual surgical management of Crohn's disease patients with intestinal perforation. OBJECTIVES: To determine factors predictive of surgery for perforation in Crohn's disease and define a group of patients that may benefit from non-surgical treatment. METHODS: One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn's disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. RESULTS: One hundred and fifty-one patients (93%) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 +/- 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 +/- 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. CONCLUSION: A significant proportion of patients with intestinal perforation complicating Crohn's disease, particularly those with a fistula, might benefit from non-surgical treatment. (+info)
Intraductal papillary mucinous carcinoma with atypical manifestations: report of two cases.
Intraductal papillary mucinous neoplasms (IPMNs) are a well-characterized group of mucin-producing cystic neoplasms of the clear malignant potential type. We report here two cases of intraductal papillary mucinous carcinoma (IPMC) with atypical manifestations. In one case, we discussed a pseudomyxoma peritonei caused by a ruptured IPMC. In the other case we discussed the fistulization of IPMC into the stomach and duodenum. These two cases suggest that IPMN can either spontaneously rupture causing mucinous materials to spill into the free abdominal cavity or directly invade adjacent organs resulting in fistula development. (+info)
Two cases of refractory post-bulbar duodenal ulcer.
Two young man patients with refractory post-bulbar duodenal ulcer (post-bulbar ulcer) were encountered. They had a single punched-out ulcer in the absence of an underlying disease. Patient 1 was Helicobacter pylori (Hp)-positive, and did not respond to Hp eradication therapy. The ulcer scarred after the long-term administration of a proton pump inhibitor (PPI), but recurred after a reduction in the dose. Patient 2 was Hp-negative. His ulcer did not scar even after long-term PPI administration, but it formed a fistula into the gallbladder, and the fistula was surgically closed. In both patients, laboratory and imaging studies excluded Zollinger-Ellison syndrome, but suggested a hyperacidic tendency. Unlike duodenal bulb ulcer (bulbar ulcer), the post-bulbar ulcer in Patient 1 did not heal with Hp eradication therapy, suggesting that post-bulbar ulcer differs etiologically from bulbar ulcer. We speculate that the possible causes of the refractoriness to treatment in both patients were ulcer penetration, callosity formation, and insufficient inhibition of gastric acid secretion due to the impaired passage of PPI into the deep portion of the duodenum as a result of luminal narrowing. (+info)
Outcome after endovascular stent graft repair of aortoenteric fistula: A systematic review.