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Ielpo B, Vellalta G, Jaume-Boettcher SM, d'Addetta MV, Sanchez-Velazquez P, Burdio F. Transduodenal robotic ampullectomy: tips and tricks and strategies for postoperative duodenal fistula management (with video). Updates Surg 2024:10.1007/s13304-024-01808-4. [PMID: 38507177 DOI: 10.1007/s13304-024-01808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Transduodenal Ampullectomy (TA) is a procedure for resecting low-malignancy ampullary tumors, with postoperative fistula as a notable complication. This study aims to clarify the indications for TA, outline the surgical robotic technique, and emphasize the importance of comprehensive complication management alongside the surgical approach. This multimedia article provides a detailed exposition of the robotic TA surgical technique, including the most important steps involved in exposing and reimplanting biliary and pancreatic ducts. The procedure encompasses the mobilization of the hepatic flexure of the colon, an extensive Kocher maneuver for duodenal mobilization, and ampulla exposure through a duodenal incision. Employing retraction loop sutures enhances surgical field visibility. Reconstruction involves securing pancreatic and biliary ducts to the duodenal mucosa, each tutored with a silicon catheter, and suturing for ampullectomy completion. The total operative time was 380 min. Final histopathology disclosed high-grade dysplasia with an isolated focus of adenocarcinoma (pT1), accompanied by clear resection margins. A postoperative duodenal fistula occurred, managed successfully through conservative treatment, utilizing subcutaneous drainage. Despite accurate robotic TA execution, complications may arise. This study underscores the importance of a comprehensive approach, incorporating meticulous surgical technique and effective complication management, to optimize patient outcomes.
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Affiliation(s)
- Benedetto Ielpo
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain.
| | - Gemma Vellalta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Sofia-Maria Jaume-Boettcher
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Maria Vittoria d'Addetta
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Patricia Sanchez-Velazquez
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
| | - Fernando Burdio
- HPB Unit, Pompeu Fabra University, Parc Salut Mar University Hospital, Passeig Maritim, 25, 08003, Barcelona, Spain
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Li L, Zhao Q, Ma S, Xue B. Rare causes of retroperitoneal abscess: A case report. Asian J Surg 2024; 47:691-692. [PMID: 37806884 DOI: 10.1016/j.asjsur.2023.09.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Liang Li
- Department of Gastrointestinal Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, 255036, China
| | - Qiang Zhao
- Department of Gastrointestinal Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, 255036, China
| | - Shanshan Ma
- Department of Geriatrics, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, 255036, China
| | - Bing Xue
- Department of Geriatrics, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, 255036, China.
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Abstract
INTRODUCTION A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates. METHODS A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed. RESULTS Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%). CONCLUSIONS Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.
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Affiliation(s)
- Ari Leppäniemi
- Abdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
- Meilahti Tower Hospital, Haartmaninkatu 4, 00029, Helsinki, Finland.
| | - Matti Tolonen
- Abdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Panu Mentula
- Abdominal Center, Division of Emergency Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Oh SY, Kim YI, Yoon YS, Cho MS, Park MY, Ryoo SB, Lee JL, Kim CW, Park IJ, Lim SB, Yu CS. Optimal surgical management of duodenal fistula in Crohn's disease: a Korean multicenter cohort study. Int J Colorectal Dis 2023; 38:106. [PMID: 37074597 DOI: 10.1007/s00384-023-04387-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Duodenal fistula in Crohn's disease (CDF) is a rare condition with an unclear optimal surgical management approach. We reviewed a Korean multicenter cohort of CDF surgery cases and assessed their perioperative outcomes to evaluate the effectiveness of the surgical interventions. METHODS The medical records of patients who underwent CD surgery between January 2006 and December 2021 from three tertiary medical centers were retrospectively reviewed. Only CDF cases were included in this study. The demographic and preoperative characteristics, perioperative details, and postoperative outcomes were analyzed. RESULTS Among the initial population of 2149 patients who underwent surgery for CD, 23 cases (1.1%) had a CDF operation. Fourteen of these patients (60.9%) had a history of previous abdominal surgery, and 7 had duodenal fistula at the previous anastomosis site. All duodenal fistulas were excised and primarily repaired via a resection of the originating adjacent bowel. Additional procedures such as gastrojejunostomy, pyloric exclusion, or T-tube insertion were performed in 8 patients (34.8%). Eleven patients (47.8%) experienced postoperative complications including for anastomosis leakages. Fistula recurrence was noted in 3 patients (13%) of which one patient required a re-operation. Biologics administration was associated with fewer adverse events by multivariable analysis (P = 0.026, odds ratio = 0.081). CONCLUSION Optimal perioperative conditioning of patients receiving a primary repair of a fistula and resection of the original diseased bowel can successfully cure CDF. Along with primary repair of the duodenum, other complementary additional procedures should be considered for better postoperative outcomes.
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Affiliation(s)
- Soo Young Oh
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Min Soo Cho
- Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Young Park
- Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Bum Ryoo
- Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Zheng B, Li C, Wang S. Duodenal fistula caused by abdominal drainage tube: A rare postoperative complication. Asian J Surg 2023:S1015-9584(23)00278-6. [PMID: 36898919 DOI: 10.1016/j.asjsur.2023.02.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
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Tian W, Zhao R, Luo S, Xu X, Zhao G, Yao Z. Effect of postoperative utilization of somatostatin on clinical outcome after definitive surgery for duodenal fistula. Eur J Med Res 2023; 28:63. [PMID: 36732816 PMCID: PMC9896769 DOI: 10.1186/s40001-023-00988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the effect of postoperative utilization of somatostatin after definitive surgery for duodenal fistula (DF) in preventing a recurrence. METHODS Patients with definitive surgery for DF between January 2010 and December 2021 were categorized based on the utilization of somatostatin or not after the surgery. Patients in the Somatostatin group were matched to those in the Non-somatostatin group using propensity scores matching (PSM), so as to evaluate the effect of postoperative use of somatostatin by comparing the two groups. RESULTS A total of 154 patients were divided into the in the Somatostatin group (84) and the Non-somatostatin group (70). Forty-three patients (27.9%) exhibited a recurrent fistula, with which the postoperative use of somatostatin was not associated (19 [22.6%] in the Somatostatin group and 24 (34.3%) in the Non-somatostatin group; unadjusted OR 0.56; 95% CI 0.28-1.14; P = 0.11). However, the postoperative usage of somatostatin served as a protective factor for developing into high-output recurrent fistula (eight (13.3%) in the Somatostatin group and 15 (25%) in the Non-somatostatin group; adjusted OR 0.39; 95% CI 0.15-0.93; P = 0.04). After PSM, the recurrent fistula occurred in 29.2% subjects (35/120). The postoperative usage of somatostatin was not associated with recurrent fistula (13 in PSM Somatostatin group vs. 22 in PSM Non-somatostatin group; unadjusted OR 0.48; 95% CI 0.21-1.07; P = 0.07), while its postoperative usage decreased the incidence of recurrent high-output fistula (5/60 in the PSM Somatostatin group, compared with 13/60 in the PSM Non-somatostatin group; adjusted OR 0.30; 95% CI 0.09-0.95). CONCLUSION Postoperative use of somatostatin could effectively reduce the incidence of recurrent high-output fistula, without association with overall incidence of postoperative recurrent fistula.
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Affiliation(s)
- Weiliang Tian
- grid.440259.e0000 0001 0115 7868Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu China
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Shikun Luo
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Xi Xu
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Guoping Zhao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Hushan Road No.169, Nanjing, Jiangsu China
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Freund MR, Perets M, Horesh N, Yellinek S, Halfteck G, Reissman P, Rosenthal RJ, Wexner SD. Prevalence, diagnosis, and surgical management of complex ileocolic- duodenal fistulas in Crohn's disease. Tech Coloproctol 2022; 26:637-643. [PMID: 35451660 DOI: 10.1007/s10151-022-02616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of the present study was to review the prevalence and surgical management of patients with Crohn's disease (CD) complicated by ileocolic-duodenal fistulas (ICDF). METHODS We performed a retrospective chart review of CD patients who underwent surgical takedown and repair of ICDF during January 2011-December 2021 at two inflammatory bowel disease referral centers. RESULTS We identified 17 patients with ICDF (1.3%) out of 1283 CD patients who underwent abdominal surgery. Median age was 42 (20-71) years, 13 patients were male (76%) and median body mass index was 22.7 (18.4-30.3) kg/m2. Four patients (24%) were diagnosed preoperatively and only 2 (12%) were operated on for ICDF-related symptoms. The most common procedure was ileocolic resection (13 patients, 76%) including 4 repeat ileocolic resections (24%). The duodenal defect was primarily repaired in all patients with no re-fistulization or duodenal stenosis, regardless of the repair technique. A laparoscopic approach was attempted in the majority of patients (14 patients, 82%); however, only 5 (30%) were laparoscopically completed. The overall postoperative complication rate was 65% including major complications in 3 patients (18%) and 2 patients (12%) who required surgical re-intervention for abdominal wall dehiscence and postoperative bleeding. Preoperative nutritional optimization was performed in 9 patients (53%) due to malnutrition. These patients had significantly less intra-operative blood loss (485 vs 183 ml, p = 0.05), and a significantly reduced length of stay (18 vs 8 days, p = 0.05). CONCLUSION ICDF is a rare manifestation of CD which may go unrecognized despite the implementation of a comprehensive preoperative evaluation. Although laparoscopic management of ICDF may be technically feasible, it is associated with a high conversion rate. Preoperative nutritional optimization may be beneficial in improving surgical outcomes in this select group of patients.
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Affiliation(s)
- M R Freund
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.,Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - M Perets
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Horesh
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - S Yellinek
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Halfteck
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - P Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - R J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - S D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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8
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Banter LR, Maatman TK, McGuire SP, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, Zyromski NJ. Duodenal complications in necrotizing pancreatitis: Challenges of an overlooked complication. Am J Surg 2020; 221:589-593. [PMID: 33218676 DOI: 10.1016/j.amjsurg.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Duodenal complications of necrotizing pancreatitis (NP) are challenging and understudied. We sought to characterize the demographics and clinical course of NP patients with duodenal complications. METHODS Single institution retrospective review of 687 NP patients treated from 2005 to 2018. RESULTS Duodenal complications developed in 40 (6%) patients including fistula in 11 (2%) and stricture in 29 (4%) patients. Patients with duodenal complications had increased computed tomography severity index (CTSI), degree of glandular necrosis, organ failure, infected necrosis, and disease duration. Mortality from NP was increased in patients with duodenal fistula (36%) compared to patients with duodenal stricture (7%) and patients without duodenal complications (9%). Surgical management of duodenal complications was required in 9/11 (82%) patients with fistula and 17/29 (59%) patients with stricture. CONCLUSIONS Duodenal complications occurred in 6% of necrotizing pancreatitis patients. Sixty five percent of patients with duodenal complications required surgical correction. Duodenal fistula was associated with increased mortality.
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Affiliation(s)
- Lucas R Banter
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean P McGuire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Trang K Nguyen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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9
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Po Chu Patricia Y, Ka Fai Kevin W, Fong Yee L, Kiu Jing F, Kylie S, Siu Kee L. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study. Am J Surg 2020; 220:976-981. [PMID: 32171473 DOI: 10.1016/j.amjsurg.2020.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Duodenal stump leakage is a challenging condition causing significant morbidity and mortality. The aim of this study is to identify the risk factors associated with duodenal leak and advocate modification to prevent the incident. METHODS A retrospective cohort study was performed to include patients who had gastrectomy with excluded duodenum in a single surgical centre in the period of Jan 2003-March 2017. Analysis of associated factors was performed. Patients with duodenal leak were further analyzed and the treatment strategy was reviewed. RESULTS During the study period, 678 patients had gastrectomy with excluded duodenum. 502 patients had elective gastrectomy and 176 patients had emergency gastrectomy. 52 patients had subsequent duodenal stump leakage (7.7%). The existence of duodenal ulcer, intra-operative contamination, lower pre-operative haemoglobin and duodenostomy were the independent associated factors for duodenal leak. CONCLUSION This is the largest cohort in studying associated factors regarding duodenal leak in both emergency and elective gastrectomy. The independent associated factors were identified. We advocate a conservative approach for duodenal leak with adequate drainage, nutrition and antibiotics.
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Affiliation(s)
| | | | - Lam Fong Yee
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Fung Kiu Jing
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Szeto Kylie
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Leung Siu Kee
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
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10
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Shen B, Yu H, Guo F, Duan L, Cen D, Cai XJ. [Severe acute pancreatitis with iatrogenic duodenal fistula: cause and minimal invasive treatment]. Zhonghua Yi Xue Za Zhi 2019; 99:1418-1420. [PMID: 31137131 DOI: 10.3760/cma.j.issn.0376-2491.2019.18.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the causes and treatment of severe acute pancreatitis (SAP) with iatrogenic duodenal fistula. Methods: The clinical data of the SAP patients with duodenal fistula treated in the Severe Acute Pancreatitis Center of Sir Run Run Shaw Hospital from May 2015 to May 2018 was analyzed retrospectively. Results: A total of 11 patients were enrolled, among which 5 cases of duodenal fistula were caused by iatrogenic injury, including 2 cases of puncture injury, 2 cases of nutritional tube injury and 1 case of drainage tube injury. For patients with poor infection control after conservative treatment, laparoscopic assisted debridement through the right retroperitoneal approach was performed. Treatment of two patients failed for liver failure and the remaining patients were cured. Conclusions: Iatrogenic injury is one of the causes of duodenal fistula in patients with severe pancreatitis. Laparoscopic assisted debridement through the right retroperitoneal approach is an effective treatment for duodenal fistula.
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Affiliation(s)
- B Shen
- Department of Surgery, Sir Run Run Shaw Hospital, Affiliated School of Medicine, Zhejiang University, Hangzhou 310016, China
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11
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Wang YN, Li XQ, Guo F, Yang AM, Qian JM, Li JN, Xue HD, Zhou WX, Ma ZQ. [The 465th case: intestinal obstruction, gastrointestinal hemorrhage and duodenal fistula]. Zhonghua Nei Ke Za Zhi 2018; 57:614-616. [PMID: 30060340 DOI: 10.3760/cma.j.issn.0578-1426.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn's disease. The patient was treated with thalidomide and recovered well during follow-up.
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Affiliation(s)
| | - X Q Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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12
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Abstract
Reports of duodenal loss of substance after laparoscopic cholecystectomy are rare. We report successful management of a large duodenal defect that occurred after cholecystectomy by endoscopic insertion of a duodenal stent and double pigtail catheters.
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13
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Gong J, Wei Y, Gu L, Li Y, Guo Z, Sun J, Ding C, Zhu W, Li N, Li J. Outcome of Surgery for Colo duodenal Fistula in Crohn's Disease. J Gastrointest Surg 2016; 20:976-84. [PMID: 26718702 DOI: 10.1007/s11605-015-3065-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was conducted to report the short- and long-term outcomes of surgery for coloduodenal fistula in Crohn's disease and explore the effect of preoperative optimization on surgical outcome. METHODS This is a retrospective review of 34 patients with coloduodenal fistula complicating Crohn's disease between Jan 2008 and May 2015. Demographic information, preoperative management, and intraoperative and postoperative outcome data were collected. RESULTS Primary duodenal repair was carried out in 33 patients (13 with duodenal defect >3 cm), and bypass surgery was performed in one patient with duodenal stenosis. Patients undergoing preoperative optimization (n = 25) had decreased postoperative major (24.0 vs. 87.5 %, P = 0.005) and intra-abdominal septic (20.0 vs. 75.0 %, P = 0.008) complications compared to patients with emergent/semi-emergent surgery (n = 8). No duodenal stenosis occurred on a median follow-up of 22.5 months. Patients with duodenum-ileocolic anastomosis fistula had longer postoperative stay (14.0 vs. 10.0 days, P = 0.032) and increased possibility of refistulization of the duodenum on follow-up (30.0 vs. 0 %, P = 0.031) compared with those with spontaneous duodenum-colonic fistula. CONCLUSION Primary duodenal repair can be safely performed in coloduodenal fistula in Crohn's disease provided there was no duodenal stenosis, even for large duodenal defects. Preoperative optimization is associated with reduced postoperative complications. Patients with duodenum-ileocolic anastomosis fistula are more likely to have duodenum fistula recurrence compared to those with spontaneous duodenum-colonic fistula.
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Affiliation(s)
- Jianfeng Gong
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Yao Wei
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Lili Gu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Yi Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Zhen Guo
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Jing Sun
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Chao Ding
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002.
| | - Ning Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
| | - Jieshou Li
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, East Zhongshan Road, 305, Nanjing, People's Republic of China, 210002
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Zidan A, Ibrahim H, Farrag M, Shehata M, Maghrabi M. Giant haemangioma of the liver with haemangiodudenal fistula: the first reported case in literature. Ann R Coll Surg Engl 2015; 97:e90-e92. [PMID: 26274759 PMCID: PMC5126247 DOI: 10.1308/rcsann.2015.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 08/29/2023] Open
Abstract
Giant liver haemangiomas are usually asymptomatic with normal liver function, which makes the course long and uneventful. The most commonly reported complications of giant haemangiomas are rupture with intraperitoneal haemorrhage that is either traumatic or non-traumatic, consumption coagulopathy, Budd-Chiari syndrome and congestive heart failure. We describe the first reported complications of a giant liver haemangioma as a fistula between the haemangioma and the gastrointestinal tract.
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Affiliation(s)
- A Zidan
- Rajhy Liver Hospital, Assiut University , Egypt
| | - H Ibrahim
- Rajhy Liver Hospital, Assiut University , Egypt
| | - M Farrag
- Rajhy Liver Hospital, Assiut University , Egypt
| | - M Shehata
- Rajhy Liver Hospital, Assiut University , Egypt
| | - M Maghrabi
- Rajhy Liver Hospital, Assiut University , Egypt
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Poincloux L, Goutorbe F, Rouquette O, Mulliez A, Goutte M, Bommelaer G, Abergel A. Biliary stenting is not a prerequisite to endoscopic placement of duodenal covered self-expandable metal stents. Surg Endosc 2015; 30:437-445. [PMID: 25894447 DOI: 10.1007/s00464-015-4216-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/06/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Duodenal covered self-expandable metal stent (cSEMS) can be used in malignant or benign gastroduodenal obstruction. The need for biliary stenting in patients with no concomitant biliary stricture, before duodenal cSEMS placement, remains unknown. The aim of this study was to determine whether cSEMS placement is responsible for biliary obstruction. METHODS This is a single-center, retrospective, case-controlled study, including 106 patients with symptomatic gastric outlet obstruction or duodenal fistula who received a covered nitinol duodenal stent by using through-the-scope/over-the-wire placement procedure. The main outcome measurement was the occurrence comparison of jaundice and bilirubin level, between patients with previous or concomitant biliary stenting (cSEMS + BS group), and patients with no biliary stent (cSEMS group) during an observational period of 90 days. RESULTS Hundred and six patients underwent cSEMS placement between June 2005 and March 2014: 53 in the cSEMS group (58% male, mean age 66.4 ± 13.3 years) and 53 in cSEMS + BS group (60% male, mean age 70.4 ± 11.6 years). The obstruction was due to cancer in 45% in cSEMS group and 87% in cSEMS + BS group. No case of jaundice was reported in the cSEMS group or in the cSEMS + BS group. In cSEMS group, the mean bilirubin level (μmol/L ± SD) was 8.0 ± 4 at baseline and 8.5 ± 4.6 at day 10, while in the cSEMS + BS group it was 91.4 ± 108 at baseline and 35.3 ± 39 at day 10 (p < 0.01). Patients from the two groups were matched on age, gender and bilirubin level at baseline. Evolution of bilirubinemia was +0.98 ± 2.76 µmol/L in experimental group and +0.39 ± 522 µmol/L in the control group (p = 0.34). No significant difference was observed between the two groups in term of technical success, clinical effectiveness, migration and other complications. CONCLUSIONS Previous biliary stenting is not required before endoscopic covered duodenal stent placement in patients with no associated biliary obstruction. Prospective studies are needed.
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Affiliation(s)
- L Poincloux
- Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France. .,ISIT (Image Sciences for Innovations Techniques), UMR Auvergne University/CNRS 6284, Clermont-Ferrand, France.
| | - F Goutorbe
- Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - O Rouquette
- Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - A Mulliez
- Biostatistics Unit, DRCI, Gabriel Montpied University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - M Goutte
- Clinical Research Unit, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - G Bommelaer
- Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France
| | - A Abergel
- Digestive Diseases Department, NHE University Hospital of Clermont-Ferrand, 63003, Clermont-Ferrand, France.,ISIT (Image Sciences for Innovations Techniques), UMR Auvergne University/CNRS 6284, Clermont-Ferrand, France
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Kamalakar G, Prasad VD, Devaratnam J, Ganeshan A. Pyloro-duodenal hernia with formation of enterocutaneous fistula in a buffalo calf following a dog attack. Open Vet J 2015; 5:127-9. [PMID: 26623378 PMCID: PMC4663805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/04/2015] [Indexed: 10/27/2022] Open
Abstract
A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy.
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Affiliation(s)
- G. Kamalakar
- Department of Veterinary Surgery and Radiology, College of Veterinary Science, Proddatur, Andhra Pradesh, India, 516360,Corresponding Author: Dr. Gurram Kamalakar. Department of Veterinary Surgery and Radiology, College of Veterinary Science, Proddatur, Andhra Pradesh, India, 516360. E-mail:
| | - V. Devi Prasad
- Department of Veterinary Surgery and Radiology, College of Veterinary Science, Proddatur, Andhra Pradesh, India, 516360
| | - J. Devaratnam
- Department of Veterinary Surgery and Radiology, College of Veterinary Science, Proddatur, Andhra Pradesh, India, 516360
| | - A. Ganeshan
- Department of Animal Reproduction and Gynaecology, College of Veterinary Science, Proddatur, Andhra Pradesh, India, 516360
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Okumura K, Suganuma T, Nakatani K, Okada S, Kubota T, Lefor AT. Duodenal fistula associated with a peri-appendiceal abscess: A case report. Int J Surg Case Rep 2013; 4:1104-6. [PMID: 24240079 DOI: 10.1016/j.ijscr.2013.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/17/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Retroperitoneal abscess is an unusual presentation of perforated appendicitis. A fistula between the duodenum and an abscess resulting from appendicitis has not been previously reported. PRESENTATION OF CASE A 53-year-old Japanese man with a past medical history of hypertension and iron deficiency anemia presented with a 10-day history of fever and right lower abdominal pain, and was diagnosed with a retroperitoneal abscess secondary to perforated appendicitis. He was then treated with piperacillin and tazobactam after undergoing ultrasound-guided drainage, after which his overall condition improved. Due to iron deficiency anemia, we performed further evaluation for gastrointestinal bleeding and esophagogastroduodenoscopy showed an elevated lesion with granulomatous tissue in the duodenum, without an associated ulcer. At 10 days after abscess drainage, duodenography with contrast showed continuity between the abscess cavity and the duodenum. At 74 days after drainage, we performed laparoscopic appendectomy. Pathological examination showed granulomatous tissue inside the appendix with an inflammatory background and fecaliths infiltrated by macrophages. DISCUSSION Perforated appendicitis has various presentations and many unusual fistulae have been reported, however, a fistula between a peri-appendiceal abscess and the duodenum has not yet been reported. A retroperitoneal abscess around the duodenum and appendix should be checked to differentiate it from Valentino's syndrome. CONCLUSION We present the rare complication of a duodenal fistula during the treatment of perforated appendicitis. The possibility of fistula formation should be considered in patients with complicated appendicitis.
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Abstract
Duodenal injuries are uncommon injuries but are associated with significant morbidity and mortality from a delayed diagnosis in the case of blunt trauma and associated major vascular injuries in penetrating trauma. A simplistic approach with primary repair or resection and anastomosis is ideal for the vast majority. Complex procedures such as pyloric exclusion with or without gastrojejunostomy may be indicated for delayed treatment or severe, high-grade combined pancreato-duodenal injuries. A high index of suspicion and a judicious treatment plan based on a careful consideration of all the available options are crucial for optimal outcome.
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Affiliation(s)
- Rao R Ivatury
- , 1200 East Broad Street, W15E Rihmond, VA, 23298, USA.
| | | | | | - Therese M Duane
- Division of Trauma, Critical Care and Emergency Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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