BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue nec...BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.展开更多
s To explore successful models of management of enterocutaneous fistulas and u nresolved problems requiring further study Method Analysis of therapeutic results of 1168 cases treated in one center from January 19...s To explore successful models of management of enterocutaneous fistulas and u nresolved problems requiring further study Method Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000 Results In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non operative treatment The mortality rate was 5 5%, mos t of which occurred due to sepsis Of 659 cases receiving definitive operations for enteric fistula, 98% recovered Recovery, mortality and operational succes s rates (94 2%, 4 4%, 99 7%) of cases treated between January 1985 and Decemb er 2000 were significantly better than those (90 4%, 8 2%, 95 5%) of cases tr eated earlier (January 1971 December 1984) ( P <0 05) Conclusions The results from this study were better overall than those reported in previous literatures The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs a re the key reasons for improvement of managing enteric fistulas However, incre asing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operatio ns for enteric fistula at early stages are still problematic and require further study展开更多
文摘BACKGROUND Cholecystoenteric fistula(CEF)involves the formation of a spontaneous ano-malous tract between the gallbladder and the adjacent gastrointestinal tract.Chronic gallbladder inflammation can lead to tissue necrosis,perforation,and fistulogenesis.The most prevalent cause of CEF is chronic cholelithiasis,which rarely results from malignancy.Because the symptoms and laboratory findings associated with CEF are nonspecific,the condition is often misdiagnosed,pre-senting a challenge to the surgeon when detected intraoperatively.Therefore,a preoperative diagnosis of CEF is crucial.We present the case of a 57-year-old male with advanced gallbladder cancer(GBC)who arrived at the emergency room with persistent vomiting,abdominal pain,and diarrhea.An abdominopelvic computed tomography scan revealed a contracted gallbladder with bubbles in the fundus connected to the second por-tion of the duodenum and transverse colon.We suspected that GBC had invaded the adjacent gastrointestinal tract through a cholecystoduodenal fistula(CDF)or a cholecystocolonic fistula(CCF).He underwent multiple examinations,including esophagogastroduodenoscopy,an upper gastrointestinal series,colo-noscopy,and magnetic resonance cholangiopancreatography;the results of these tests con-firmed a diagnosis of synchronous CDF and CCF.The patient underwent a Roux-en-Y gastrojejunostomy and loop ileostomy to address the severe adhesions that were previously observed to cover the second portion of the duodenum and hepatic flexure of the colon.His symptoms improved with supportive treatment while hospitalized.He initiated oral targeted therapy with lenvatinib for further anticancer treatment.CONCLUSION The combination of imaging and surgery can enhance preoperative diagnosis and alleviate symptoms in patients with GBC complicated by CEF.
文摘s To explore successful models of management of enterocutaneous fistulas and u nresolved problems requiring further study Method Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000 Results In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non operative treatment The mortality rate was 5 5%, mos t of which occurred due to sepsis Of 659 cases receiving definitive operations for enteric fistula, 98% recovered Recovery, mortality and operational succes s rates (94 2%, 4 4%, 99 7%) of cases treated between January 1985 and Decemb er 2000 were significantly better than those (90 4%, 8 2%, 95 5%) of cases tr eated earlier (January 1971 December 1984) ( P <0 05) Conclusions The results from this study were better overall than those reported in previous literatures The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs a re the key reasons for improvement of managing enteric fistulas However, incre asing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operatio ns for enteric fistula at early stages are still problematic and require further study
