paired Coagulation Status in the Crohn＇s Disease Patients Complicated with Intestinal Fistula

Background： Intestinal fistula is one of the common complications of Crohn＇s disease （CD） that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula. Methods： Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinting Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student＇s t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups. Results： Compared with CD patients without intestinal fistula, prothrombin time （PT） in patients with intestinal fistula was significantly longer （12.13 ± 1.27 s vs. 13.18± 1.51 s,P〈0.001 in overall cohort： 11.56± 1.21 svs. 12.61 ±0.73 s,P 0.001 in females： and 12.51± 1.17 s vs. 13.37± 1.66 s, P - 0.003 in males）. Platelet （PLT） count was much lower in intestinal fistula group than in nonintestinal fistula group （262.53 ± 94.36 × 109/L vs. 310.36 ± 131.91× 109/L, P = 0.009）. Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT （odds ratio [OR] 1.900, P 〈 0.001 ）, a reduced amount of PLT （OR = 0.996, P = 0.（124）, and an increased operation history （OR = 5.408, P 〈 0.001 ）. Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline （ 12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006）. Conclusions： Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.

Endoscopic treatment of primary aorto-enteric fistulas:A case report and review of literature

BACKGROUND Primary aorto-enteric fistula(PAEF)is a rare condition,traditionally treated in the acute,bleeding phase with open surgery or endovascular repair.However,these approaches have high morbidity and mortality,indicating a need for new methods.With advances in endoscopic techniques and equipment,haemoclipping of fistulas has now become feasible.Therefore,we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools.An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum.Afterward,a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm.Based on the clinical presentation and the combined endoscopic and radiographic findings,we argue that this is a case of a PAEF.CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF,serving as a bridge to final therapy.

Mesh erosion into the colon following repair of parastomal hernia: A case report

BACKGROUND In recent years,mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain.However,using mesh to repair parastomal hernias also carries potential dangers.One of these dangers is mesh erosion,a rare but serious complication following hernia surgery,particularly parastomal hernia surgery,and has attracted the attention of surgeons in recent years.CASE SUMMARY Herein,we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery.The patient,who underwent parastomal hernia repair surgery 3 years prior,presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus.Three months later,a portion of the mesh was excreted from the patient’s anus and was removed by a doctor.Imaging revealed that the patient’s colon had formed a t-branch tube structure,which was formed by the mesh erosion.The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.CONCLUSION Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.

When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement

Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice.They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes.As the incidence of complicated diverticular disease and colorectal malignancy increases,so too does the extent of fistulous connections between the gastrointestinal and urinary systems.These complex problems will be more common as a factor of an aging population with increased life expectancy.Diverticular disease is the most commonly encountered aetiology,accounting for up to 80%of cases,followed by colorectal malignancy in up to 20%.A high index of suspicion is required in order to make the diagnosis,with ever improving imaging techniques playing an important role in the diagnostic algorithm.Management strategies vary,with most surgeons now advocating for a single-stage approach to enterovesical fistulae,particularly in the elective setting.Concomitant bladder management techniques are also disputed.Traditionally,open techniques were the standard;however,increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management.Unfortunately,due to the relative rarity of these entities,no randomised studies have been performed to ascertain the most appropriate management strategy.Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer.With radiotherapy being a major contributing factor in the development of these complex fistulae,optimum surgical approach and exposure has changed accordingly to optimise their management.Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling,macerated tissues or associated co-morbidities.One may plan for definitive surgical intervention at a later stage.Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available.An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described.In low lying fistulae,a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts.According to recent literature,it offers a high success rate in complex cases.

A jejunopericardial fistula 14 years after surgery for gastric cancer

Afistula between pericardium and its adjacent structures is an extremely rare and usually fatal complication with the esophagus and stomach most frequently involved.In this report, we present the rare case of a patient who developed a jejunopericardial fistula after surgery for gastric cancer and intraperitoneal chemotherapy with placement of Port-A-Cath 14 years ago.