An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and ...An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip(OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the "J" pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the "J" pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgeryrelated complications.展开更多
Gastrointestinal stromal tumor(GIST)is a rare mesenchymal tumor of the gastrointestinal tract that has been associated with the formation of fistulas to adjacent organs in few case reports.However,GIST with enterohepa...Gastrointestinal stromal tumor(GIST)is a rare mesenchymal tumor of the gastrointestinal tract that has been associated with the formation of fistulas to adjacent organs in few case reports.However,GIST with enterohepatic fistula has not been reported.Here we report the case of an enterohepatic fistula that occurred after embolization of a liver mass originating in the distal ileum.An 87-year-old woman was hospitalized for melena.On initial conventional endoscopy,a bleeding focus in the gastrointestinal tract was not found.Because of massive hematochezia,enteroscopy was performed through the anus.A protruding,ulcerative mass was found in the distal ileum that was suspected to be the source of the bleeding;a biopsy sample was taken.Electrocoagulation was not successful in controlling the bleeding;therefore,embolization was performed.After embolization,the patient developed a high fever and severe abdominal tenderness with rebound tenderness.Follow-up abdominopelvic computed tomography revealed an enterohepatic fistula between the liver and distal ileum.The fistula was treated surgically by segmental resection of the distal ileum and unlooping of the liver mass.展开更多
Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—on...Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.展开更多
Background: Ileal perforation is a very critical condition. Objectives: The purpose of the present study was to see the post-operative mortality after ileal perforation. Methodology: This prospective cohort study was ...Background: Ileal perforation is a very critical condition. Objectives: The purpose of the present study was to see the post-operative mortality after ileal perforation. Methodology: This prospective cohort study was conducted in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2000 to December 2002 for period of 2 years and 3 months. All the patients presented with ileal perforation at any age with both sexes were included in this study. Patients were selected consecutively and the patients who showed ileal perforation at laparotomy were included in this study. Preoperative diagnosis was based on detailed history, complete physical examinations supported by plain x-ray abdomen in erect posture including both domes of diaphragm. After immediate resuscitation surgical treatment was undertaken as soon as possible following admission in all cases. The patients were followed up and the mortality profiles were recorded after surgical intervention. Result: Out of 53 patients having postoperative complications 38 patients were survived and 15 patients were expired. So total survivors were 85% and non-survivors 15%. In this study most of the mortality (12%) was attributed to septicemia and mode of death was multiple organ failure. Respiratory complications caused 2% mortality one patient died of ARDS and another elderly patient with preexisting bronchial asthma developed respiratory failure and was unresponsive to treatment. One death was related to faecal fistula followed by severe fluid, electrolyte and acid-base imbalance with peritonitis and gross sepsis. Conclusion: In conclusion, the mortality is significantly high due to septicemia, ARDS and faecal fistula.展开更多
文摘An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip(OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the "J" pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the "J" pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgeryrelated complications.
文摘Gastrointestinal stromal tumor(GIST)is a rare mesenchymal tumor of the gastrointestinal tract that has been associated with the formation of fistulas to adjacent organs in few case reports.However,GIST with enterohepatic fistula has not been reported.Here we report the case of an enterohepatic fistula that occurred after embolization of a liver mass originating in the distal ileum.An 87-year-old woman was hospitalized for melena.On initial conventional endoscopy,a bleeding focus in the gastrointestinal tract was not found.Because of massive hematochezia,enteroscopy was performed through the anus.A protruding,ulcerative mass was found in the distal ileum that was suspected to be the source of the bleeding;a biopsy sample was taken.Electrocoagulation was not successful in controlling the bleeding;therefore,embolization was performed.After embolization,the patient developed a high fever and severe abdominal tenderness with rebound tenderness.Follow-up abdominopelvic computed tomography revealed an enterohepatic fistula between the liver and distal ileum.The fistula was treated surgically by segmental resection of the distal ileum and unlooping of the liver mass.
文摘Purpose: To review potential risk factors for the development of ileal conduit fistulae. Methods: Two patients were identified who had a remote history of an ileal conduit and who formed a fistula from the conduit—one to the small bowel and one to the skin. Their presentation, management and outcomes are described. Results: Both patients had parastomal hernias as the likely cause of their fistula formation. Discussion: Parastomal herniation may contribute to fistula formation due to a strangulated ischemic pressure necrosis of the adjacent ileal conduit and/or bowel.
文摘Background: Ileal perforation is a very critical condition. Objectives: The purpose of the present study was to see the post-operative mortality after ileal perforation. Methodology: This prospective cohort study was conducted in the Department of Surgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from September 2000 to December 2002 for period of 2 years and 3 months. All the patients presented with ileal perforation at any age with both sexes were included in this study. Patients were selected consecutively and the patients who showed ileal perforation at laparotomy were included in this study. Preoperative diagnosis was based on detailed history, complete physical examinations supported by plain x-ray abdomen in erect posture including both domes of diaphragm. After immediate resuscitation surgical treatment was undertaken as soon as possible following admission in all cases. The patients were followed up and the mortality profiles were recorded after surgical intervention. Result: Out of 53 patients having postoperative complications 38 patients were survived and 15 patients were expired. So total survivors were 85% and non-survivors 15%. In this study most of the mortality (12%) was attributed to septicemia and mode of death was multiple organ failure. Respiratory complications caused 2% mortality one patient died of ARDS and another elderly patient with preexisting bronchial asthma developed respiratory failure and was unresponsive to treatment. One death was related to faecal fistula followed by severe fluid, electrolyte and acid-base imbalance with peritonitis and gross sepsis. Conclusion: In conclusion, the mortality is significantly high due to septicemia, ARDS and faecal fistula.
