1
|
Schwanstecher A, Arnold J. Gastrocutaneous fistula for decompression in chronic ileus caused by peritoneal carcinomatosis. Gastrointest Endosc 2024; 99:458-459. [PMID: 37748547 DOI: 10.1016/j.gie.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/12/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Annekatrin Schwanstecher
- Department of Gastroenterology, Diakonieklinikum Rotenburg, Rotenburg, Wümme, Lower Saxony, Germany
| | - Joachim Arnold
- Department of Gastroenterology, Diakonieklinikum Rotenburg, Rotenburg, Wümme, Lower Saxony, Germany
| |
Collapse
|
2
|
Elmahdi A, Eisa M, Martindale R, Omer E. Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies. Curr Gastroenterol Rep 2024; 26:53-56. [PMID: 38194110 DOI: 10.1007/s11894-023-00912-6] [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: 12/27/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review available literature on management of persistent ostomy following PEG tube removal. We will discuss the incidence of persistent gastrocutaneous fistula (GCF) following PEG tube removal, risk factors for their development, and management strategies that have been proposed and their efficacy. RECENT FINDINGS The use of over the scope clips (OTSC) have evolved recently in the management of gastrointestinal bleeding, perforation, and fistula closures. OTSC has become more readily available and proven to be effective and safe. Suturing devices have shown promising results. Persistent gastrocutaneous fistula following PEG removal is a rare yet serious complication that can lead to continuous skin irritation and leakage of gastric contents and acid. There are several postulated risk factors but the most important of these is duration of placement. Management can include medical therapy which has recently been shown to be somewhat effective, endoscopic therapy and surgery as a last resort. Overall, the data on GCFs is limited and further study with larger sample size is needed.
Collapse
Affiliation(s)
- Alsiddig Elmahdi
- Virginia Commonwealth University Health Systems, Richmond, VA, USA
| | - Mohamed Eisa
- Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert Martindale
- Department of Surgery, Oregon Health Sciences University, Portland, OR, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, 530 S Jackson St ACB bldg 3rd floor, 40202, Louisville, KY, USA.
| |
Collapse
|
3
|
Fujinaga Y, Mitoro A, Yoshiji H. Endoscopic hand suturing for nonhealing gastrocutaneous fistula after gastrostomy tube removal. Dig Endosc 2024; 36:230-231. [PMID: 37914675 DOI: 10.1111/den.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
Watch a video of this article.
Collapse
Affiliation(s)
- Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Division of Endoscopy, Nara Medical University, Nara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| |
Collapse
|
4
|
Chopra A, Al Yafi M, Luckoski J, Das C, Sferra J, Stanek S. Management of Massive Upper Gastrointestinal Hemorrhage Secondary to Gastrosplenic Fistula. Am Surg 2023; 89:6224-6226. [PMID: 35861294 DOI: 10.1177/00031348221117045] [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] [Indexed: 11/15/2022]
Abstract
Gastrosplenic fistula (GSF) is seen secondary to the development of a fistulous track between the stomach and spleen and/or splenic vessels. It is most commonly seen in patients with diffuse B-cell lymphoma, who usually present with symptoms of abdominal pain and weight loss. GSF has also been seen in patients with gastric adenocarcinoma, Hodgkin's lymphoma, peptic ulcer disease, splenic abscesses, and post gastric sleeve resection. Less than 25% of the patients with GSF may present with upper gastrointestinal bleed (UGIB). This presentation of GSF is common with benign causes including peptic ulcer disease. UGIB secondary to GSF, while rare, requires prompt identification and intervention, to avoid catastrophic outcomes. We discuss the case of a 64-year-old female with GSF, who presented with sentinel bleed followed by hemorrhagic shock, secondary to a B-cell lymphoma, who was managed with a partial gastrectomy, splenectomy, and distal pancreatectomy, with favorable outcomes.
Collapse
Affiliation(s)
- Asmita Chopra
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| | - Motaz Al Yafi
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| | - John Luckoski
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| | - Chandan Das
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| | - Joseph Sferra
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| | - Stephen Stanek
- Department of General Surgery, University of Toledo, Toledo, OH, USA
- Department of Surgery, Promedica Toledo Hospital and Health Systems, Toledo Hospital, Toledo, OH, USA
| |
Collapse
|
5
|
Field X, Pullman J, French R. Surgical Management of Gastrocolic Fistula Formation Due to Simultaneous Gastric and Colonic Erosion of Laparoscopic Adjustable Gastric Band: a Case Report. Obes Surg 2023; 33:4165-4167. [PMID: 37889367 DOI: 10.1007/s11695-023-06845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Xavier Field
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand.
| | - Jack Pullman
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Rowan French
- Department of General Surgery, Waikato Hospital, Te Whatu Ora Waikato, Hamilton, New Zealand
| |
Collapse
|
6
|
Parkash O, Sohail Z, Khalid N. Endoscopic stent placement for the management of gastro-pleural and gastro-cutaneous fistula post laparoscopic sleeve gastrectomy: a case report. J Med Case Rep 2023; 17:461. [PMID: 37926809 PMCID: PMC10626742 DOI: 10.1186/s13256-023-04200-9] [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] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Gastro-pleural and gastro-cutaneous fistulae formation are rare yet life-threatening complications post-bariatric surgery. To our knowledge so far only limited cases of gastro-pleural and gastro-cutaneous fistulae post gastric sleeve surgery have been reported in the literature with their corresponding management. Therefore, we are reporting a case of placement of an endoscopic stent in the management of gastro-cutaneous fistula post laparoscopic sleeve gastrectomy. CASE PRESENTATION A 42 years old Pakistani, female morbidly obese patient, underwent laparoscopic sleeve gastrectomy. Within a week after the procedure, the patient presented with dyspnea. Workup showed a gastric leak for which percutaneous drain placement was done. Later, gastro-pleural and gastro-cutaneous fistulae were formed for which endoscopic fistula closure was done using a metallic stent. CONCLUSION Endoscopic stent placement is an emerging field and it is considered safe and effective for the management of complications related to bariatric surgery.
Collapse
Affiliation(s)
- Om Parkash
- The Aga Khan University Hospital, Karachi, Pakistan
| | | | | |
Collapse
|
7
|
Bawa JH, Sulutaura L, Patel NM, Sufi PA, Parmar C. Closure of Gastrocutaneous Fistula Following Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3658-3668. [PMID: 37804467 DOI: 10.1007/s11695-023-06861-3] [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] [Received: 07/02/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
Gastrocutaneous fistula (GCF) is a devastating complication that can arise after bariatric and metabolic surgery (BMS). This systematic review examines the success rate of closure techniques of GCF. A systematic search was conducted across MEDLINE, Embase and Cochrane databases to identify studies which reported on closure techniques of GCF after BMS in adults. Thirty-three studies (n = 108 patients) were included. Seventeen different techniques were used to close GCF across all studies. The most popular were stents (n = 17), tissue sealants (n = 12) and over-the-scope clips (n = 11). Twenty-one studies used multiple techniques to attempt closure, including endoscopic vacuum therapy and revisional surgery. This systematic review demonstrates current practice focusing on endoscopic methods such as stents and over-the-scope clips, with relative success in closing GCF.
Collapse
Affiliation(s)
- Jasmine H Bawa
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Liene Sulutaura
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Nikhil M Patel
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Pratik A Sufi
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK
| | - Chetan Parmar
- Department of Upper GI and Bariatric Surgery, Whittington Health NHS Trust, Magdala Ave, London, N19 5NF, UK.
- Barts Health NHS Trust, London, EC1A 7BE, UK.
- Apollo Hospitals Research and Education Foundation, Delhi, 50096, India.
- University College London, Gower St, London, WC1E 6BT, UK.
| |
Collapse
|
8
|
Shahabi S, Oshidari B, Zefreh H, Eghbali F, Pakaneh MA, Sheikhbahaei E. Resection of Gastric Fistula and Conversion to RYGB for Gastro Pleural Fistula After Laparoscopic Sleeve Gastrectomy-a Video Report. Obes Surg 2023; 33:2951-2953. [PMID: 37410262 DOI: 10.1007/s11695-023-06723-y] [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: 04/14/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Shahab Shahabi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahador Oshidari
- General Surgery Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Zefreh
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Foolad Eghbali
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Ali Pakaneh
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
9
|
Morgan AD, Griffin AM, Iwuchukwu CO. Gastrojejunal Fistula Following Gastrostomy Tube. Am Surg 2023; 89:3971-3972. [PMID: 37969090 DOI: 10.1177/00031348231157890] [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] [Indexed: 11/17/2023]
Abstract
Gastrostomy tubes are often placed in patients with poor voluntary intake, oropharyngeal dysphagia, or chronic illness to provide definitive nutritional access. Despite the widespread use of gastrostomy tubes, some patients can experience complications associated with this procedure including gastrocolic-cutaneous fistula and dislodgement of gastrostomy tube. This case discusses an instance of gastrojejunal fistula formation over one year after gastrostomy tube placement likely due to tube dislodgement. Imaging showed gastrostomy tube traversing the posterior wall of the stomach and creating a fistula into the jejunum, with the balloon inflated within the jejunum. Gastrostomy tube was removed and replaced, with gastrostomy tube study showing no extravasation of contrast. Patient is now doing well-tolerating tube feeds at goal.
Collapse
Affiliation(s)
- Alexandra D Morgan
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ashlee M Griffin
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Chinenye O Iwuchukwu
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
10
|
Negm S, Mousa B, Shafiq A, Abozaid M, Allah EA, Attia A, AbdelKader T, Farag A. Endoscopic management of refractory leak and gastro-cutaneous fistula after laparoscopic sleeve gastrectomy: a randomized controlled trial. Surg Endosc 2023; 37:2173-2181. [PMID: 36326931 PMCID: PMC10017559 DOI: 10.1007/s00464-022-09748-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gastro-cutaneous fistula is a rare complication after laparoscopic sleeve gastrectomy (LSG) with incidence of occurrence 1-2%. Most of gastro-cutaneous fistulae do not respond to conservative management and need intervention either surgically or endoscopically. METHODS This prospective randomized clinical study included referred patients who had LSG performed at our department or other centers, and complicated with post-LSG leak or gastro-cutaneous fistula between December/2019 and March/2021. Included patients were ASA Physical status I-II. Primary and secondary outcomes were recurrence of the fistula and mortality in each group after the intervention during the 18 months follow-up period, respectively. RESULTS Thirty patients were randomized into two groups: Surgery Group (SG, n = 15) and Endoscopy Group (EG, n = 15). Mean age of patients was 42.3 ± 8.7 and 42.6 ± 8.3 years-old in SG and EG, respectively. Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4-7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively. Incidence of recurrent leak during 1st week was significantly higher in SG than EG (p < 0.001). No mortality reported in EG, while 2 patients died in SG (p = 0.48). CONCLUSION Endoscopic intervention may offer a successful modality in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients.
Collapse
Affiliation(s)
- Said Negm
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Bassam Mousa
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Shafiq
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Abozaid
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ehab Abd Allah
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Adel Attia
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Taha AbdelKader
- grid.415762.3Shepeen alkom teaching hospital, Ministry of health, Monufia, Egypt
| | - Ahmed Farag
- grid.31451.320000 0001 2158 2757Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
11
|
Piszker A, McManus N, Foreman M. Rare atypical presentation of a polymicrobial gastropericardial fistula. BMJ Case Rep 2022; 15:15/9/e250093. [PMID: 36123006 PMCID: PMC9486181 DOI: 10.1136/bcr-2022-250093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial Appendage Closure device placement 1 year prior to arrival and gastric bypass surgery 20 years prior to arrival. The patient presented to the emergency department with weakness, diarrhoea and left knee pain. He was admitted for cellulitis of the left lower extremity, prosthetic septic arthritis of the left knee and group G streptococcus bacteraemia. His hospital course was complicated by acute chest pain and dyspnoea. Imaging revealed pneumopericardium. Oesophagogastroduodenoscopy visualisation confirmed the diagnosis of gastropericardial fistula. The patient could not be transferred to a tertiary centre for definitive management because of the effect of the COVID-19 pandemic on tertiary hospital volumes. After pericardial drainage and administration of antimicrobials without improvement, the patient was discharged to hospice care at his request and died 1 day after discharge.
Collapse
Affiliation(s)
- Alexander Piszker
- Graduate Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
- Emergency Medicine, Mercy Health Partners, Muskegon, Michigan, USA
| | - Nicholas McManus
- Emergency Medicine, Mercy Health Partners, Muskegon, Michigan, USA
- Core Faculty, West Michigan Emergency Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA
| | - Mark Foreman
- Internal Medicine, Mercy Health Partners, Muskegon, Michigan, USA
- Associate Program Director, Internal Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA
| |
Collapse
|
12
|
Fang H, Yao T, Chen Y, Lu Y, Xiong K, Su Y, Zhang Y, Wang Y, Zhang L. An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:6439-6445. [PMID: 35102432 DOI: 10.1007/s00464-021-08992-z] [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] [Received: 08/26/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication. PATIENTS AND METHODS The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded. RESULTS Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 ± 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 ± 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 ± 55.8 days and 21.4 ± 10.0 days after eliminating the data of first case. The average fistula size was 12 ± 10 mm, the average endoscopic procedure duration was 40 ± 16 min, and the average number of endoscopic procedures required was 1.6 ± 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred. CONCLUSIONS EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.
Collapse
Affiliation(s)
- Haiming Fang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tingting Yao
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yating Chen
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yan Lu
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kangwei Xiong
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuan Su
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yujue Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yong Wang
- Department of General and Bariatric Surgery, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Lijiu Zhang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China.
| |
Collapse
|
13
|
López-Fernández J, García-Plaza G, García-Quesada SM, Fernández IA, Hernández-Hernández JR. Conservative management of gastro-pleural fistula after POSE (primary obesity surgery endoluminal) procedure. Cir Esp 2022; 100:380-382. [PMID: 35483588 DOI: 10.1016/j.cireng.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/01/2021] [Indexed: 06/14/2023]
Affiliation(s)
- José López-Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
| | - Gabriel García-Plaza
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Sara María García-Quesada
- Servicio de Radiodiagnóstico, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Ismael Antón Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Juan Ramón Hernández-Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
14
|
Chinelli J, Hernández G, Rodríguez G. Gastro-gastric Fistula: Late Complication After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:2490-2491. [PMID: 35562554 DOI: 10.1007/s11695-022-06104-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Gastro-gastric fistula is a rare complication after divided Roux-en-Y gastric by-pass. VIDEO CONTENT 52-year-old male with a BMI over 49 who underwent divided Roux-en-Y gastric by-pass presented with weight regain 2 years later and a type 2 gastro-gastric fistula. Laparoscopic revision, excision of the fistula with re-do of gastrojejunal anastomosis and remnant gastrectomy, was performed CONCLUSION: Laparoscopic resolution is a technical challenge in this case due to the local inflammatory environment.
Collapse
Affiliation(s)
- Javier Chinelli
- Corporación Médica de Canelones (COMECA), 1472, Mercedes St, Montevideo, PC 11200, Uruguay.
| | - Graciela Hernández
- Corporación Médica de Canelones (COMECA), 1472, Mercedes St, Montevideo, PC 11200, Uruguay
| | - Gustavo Rodríguez
- Corporación Médica de Canelones (COMECA), 1472, Mercedes St, Montevideo, PC 11200, Uruguay
| |
Collapse
|
15
|
Symeonidis S, Giankoulof C, Christidis P, Anestiadou E, Loutzidou L, Bitsianis S, Ioannidis O, Tsalis K, Angelopoulos S, Petsatodis E. Microwave ablation of a solitary colorectal liver metastasis complicated by stomach perforation and gastrocutaneous fistula - a case report. Klin Onkol 2022; 35:323-327. [PMID: 35989090 DOI: 10.48095/ccko2022323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Organ perforation secondary to thermal ablation is a rare but severe complication that can occur in certain patients, in whom tissue dissection and preservation cannot be adequately achieved. CASE DESCRIPTION A 69-year-old man presented with a gastrocutaneous fistula 20 days after a microwave ablation of liver metastases from colorectal cancer. Besides skin rash, local tenderness, and gastric content discharge from a wound where the probe had been placed, no other signs or symptoms were present. The patient was treated surgically, and a wedge-shaped gastric resection was performed. His postoperative course was uneventful. After 8 months, the patient underwent the same procedure for local progression of the same lesion, using a pulsed MW antenna and a dedicated hydrodissection needle, without complications. CONCLUSIONS A gastrocutaneous fistula is a rare complication of microwave ablation. However, adequate hydrodissection can minimize the risk for the development of these complications. Proper treatment of these complications does not preclude repeated usage of microwave ablation in the future.
Collapse
|
16
|
D'Amata G, Del Papa M, Palmieri I, Manzi F, Musmeci L, Florio G, Buonocore V, Demoro M, Antonellis F. Cholecystogastric fistula. A case report and literature review. Ann Ital Chir 2021; 10:S2239253X21036483. [PMID: 34982734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cholecystogastric fistulas is a rare complication of gallstone. Even if well described in the literature, this condition still poses a debate on diagnosis and surgical treatment. We present a case of a 35 year's old female which unexpectedly presented a cholecystogastric fistula during a laparoscopic cholecystectomy, treated successfully with fistula transection and repair and cholecystectomy through an open access. The open access remains the preferable option in this cases but laparoscopic techniques are being used worldwide with increasing success. The preoperative diagnosis remains difficult for the unspecific symptoms. KEY WORDS: Biliodigestive Fistula, Gallstone Ileus, Gastric Fistula, Biliary Fistula, Cholecystitis.
Collapse
|
17
|
Wang SY, Yuan WC, Wu EB. Airway management during left-sided gastrobronchial fistula repair after esophagectomy for esophageal carcinoma: A case report. Medicine (Baltimore) 2021; 100:e27133. [PMID: 34477161 PMCID: PMC8415952 DOI: 10.1097/md.0000000000027133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/31/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Gastrobronchial fistula (GBF) is a rare but life-threatening complication of esophagectomy with gastric conduit reconstruction, and airway management during fistula repair is challenging. Here, we describe airway management in a patient undergoing left-sided GBF repair using video-assisted thoracoscopic surgery. PATIENT CONCERNS A 63-year-old man diagnosed with esophageal carcinoma underwent esophagectomy with reconstruction by gastric pull-up and tabularization of the gastric conduit. Subsequently, about 8 weeks later, the patient presented with repeated pneumonia and a 1-week history of cough with significant sputum, dysphagia, and repeated fever. DIAGNOSIS GBF, a rare postoperative complication, was located on the left main bronchus at 2 cm below the carina and was diagnosed based on findings from gastroscopy, flexible bronchoscopy, and thoracic computed tomography scan with contrast. INTERVENTIONS We performed left-sided one-lung ventilation (OLV) under total intravenous anesthesia instead of inhalational anesthetics. The left-sided OLV, with positive end-expiratory pressure (PEEP) and nasogastric tube decompression, generated positive pressure across the fistula. It prevented backflow into the left main bronchus. Total intravenous anesthesia preserved hypoxic pulmonary vasoconstriction and prevented adverse effects associated with inhalational anesthetics. A right-sided, double-lumen endotracheal tube was inserted after anesthesia induction, and surgical repair was performed through a right-sided video-assisted thoracoscopic surgery. OUTCOMES Intraoperative hemodynamics remained relatively stable, except for brief tachycardia at 113 beats/min. Arterial blood gas analysis revealed pH 7.17 and PaO2 89.1 mmHg upon 100% oxygenation, along with hypercapnia (PaCO2 77.1 mmHg), indicating respiratory acidosis. During OLV, pulse oximetry remained higher than 92%. The defect in the left main bronchus was successfully sutured after dissecting the fistula between the left main bronchus and the gastric conduit, and subsequently, OLV resulted in ideal ventilation. LESSONS A left-sided GBF could lead to leakage from the OLV during surgery. Possible aspiration or alveolar hypoventilation due to this leakage is a major concern during airway management before surgical repair of the main bronchus.
Collapse
|
18
|
Donatelli G, Spota A, Cereatti F, Granieri S, Dagher I, Chiche R, Catheline JM, Pourcher G, Rebibo L, Calabrese D, Msika S, Dammaro C, Tranchart H, Lainas P, Tuszynski T, Pacini F, Arienzo R, Chevallier JM, Trelles N, Lazzati A, Paolino L, Papini F, Torcivia A, Genser L, Arapis K, Soprani A, Randone B, Chosidow D, Bouillot JL, Marmuse JP, Dumont JL. Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients. Surg Obes Relat Dis 2021; 17:1432-1439. [PMID: 33931322 DOI: 10.1016/j.soard.2021.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopy plays a pivotal role in the management of adverse events (AE) following bariatric surgery. Leaks, fistulae, and post-operative collection after sleeve gastrectomy (SG) may occur in up to 10% of cases. OBJECTIVES To evaluate the efficacy and safety of endoscopic internal drainage (EID) for the management of leak, fistula, and collection following SG. SETTING Retrospective, observational, single center study on patients referred from several bariatric surgery departments to an endoscopic referral center. METHODS EID was used as first-line treatment for the management of leaks, fistulae, and collections. Leaks and fistulae were treated with double pigtail stent (DPS) deployment in order to guarantee internal drainage and second intention cavity obliteration. Collections were treated with endoscropic ultrasound (EUS)-guided deployment of DPS or lumen apposing metal stents. RESULTS A total of 617 patients (83.3% female; mean age, 43.1 yr) were enrolled in the study for leak (n = 300, 48.6%), fistula (n = 285, 46.2%), and collection (n = 32, 5.2%). Median follow-up was 19.5 months. Overall clinical success was 84.7% whereas 15.3% of cases required revisional surgery after EID failure. Clinical success according to type of AE was 89.5%, 78.5%, and 90% for leak, fistula, and collection, respectively. A total of 10 of 547 (1.8%) presented a recurrence during follow-up. A total of 28 (4.5%) AE related to the endoscopic treatment occurred. At univariate logistic regression predictors of failure were: fistula (OR 2.012), combined endoscopic approach (OR 2.319), need for emergency surgery (OR 1.755), and previous endoscopic treatment (OR 4.818). CONCLUSION Early EID for the management of leak, fistula, and post-operative collection after SG seems a safe and effective first-line approach with good long-term results.
Collapse
Affiliation(s)
- Gianfranco Donatelli
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France.
| | - Andrea Spota
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Università degli studi di Milano, Scuola di Specializzazione in Chirurgia Generale, Milano, Italy
| | - Fabrizio Cereatti
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France; Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Viale Concordia 1, Cremona, Italy
| | | | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Renaud Chiche
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Jean-Marc Catheline
- Department of Digestive Surgery, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Guillaume Pourcher
- Department of Digestive Diseases, Obesity Center, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Lionel Rebibo
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Daniela Calabrese
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Simon Msika
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Carmelisa Dammaro
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - Thierry Tuszynski
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Filippo Pacini
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Roberto Arienzo
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Jean-Marc Chevallier
- Centre Obésité Paris Peupliers, Hôpital Privé des Peupliers, Ramsay Santé, Paris, France
| | - Nelson Trelles
- Service de Chirurgie Générale et Digestive, Centre Hospitalier Rene Dubos, Pontoise, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luca Paolino
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Federica Papini
- Service de Chirurgie Digestive, Group Hospitalier Nord-Essonne Site d'Orsay, Orsay, France
| | - Adriana Torcivia
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Laurent Genser
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Kostas Arapis
- Service de chirurgie digestive œsogastrique et bariatrique, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Antoine Soprani
- Service de Chirurgie digestive et de l'Obésité, Clinique Geoffry Saint Hilaire, Paris, France
| | - Bruto Randone
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Denis Chosidow
- Service de chirurgie digestive et obésité, Clinique Parc Monceau, Paris, France
| | - Jean-Luc Bouillot
- Service de chirurgie digestive et obésité, hôpital Paris Saint-Joseph, Paris, France
| | | | - Jean-Loup Dumont
- Unité d'Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| |
Collapse
|
19
|
Jiao D, Yao Y, Zhang Q, Wang L, Ren J, Han X. Effectiveness and safety of a newly designed partially covered tracheal metallic Y-shaped stent for the treatment of high cervical gastro-tracheal or tracheo-esophageal fistula: A retrospective observational study. Medicine (Baltimore) 2021; 100:e25132. [PMID: 33725993 PMCID: PMC7982221 DOI: 10.1097/md.0000000000025132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/13/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to evaluate the effectiveness and safety of a partially covered metallic tracheal Y-shaped stent for the treatment of high cervical gastro-tracheal fistula (GTF) and tracheo-esophageal fistula (TEF). From January 2017 to January 2019, 16 patients with high cervical GTF and TEF received partially covered metallic Y-shaped stent placement under fluoroscopic guidance. The technical and clinical success rates, incidence of major complications, and survival outcomes were analyzed. Eastern Cooperative Oncology Group (ECOG) score and quality of life (SF-36 questionnaire) were compared pre and post stent placement. Technical and clinical success rates were 100% and 81.3%, respectively. Major complications (severe tumor ingrowth, mucostasis, hyperplastic granulation tissue) occurred in 7/16 (43.8%) patients. ECOG score and 5 of the 8 domains of the SF-36 (physical function, role physical, general health, vitality, social function) were significantly improved at 1 month after treatment (P < .01). During the median follow-up period of 8.3 months, 9 patients were alive. Median overall survival was 10.3 months (95% CI, 8.0-12.6). The newly designed partially covered tracheal Y-shaped stent appears to be effective and safe for treatment of high cervical GTF and TEF.
Collapse
|
20
|
Dolan RD, Bazarbashi AN, Jirapinyo P, Thompson CC. Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2471-2476. [PMID: 33619691 DOI: 10.1007/s11695-021-05296-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard. METHODS Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF. RESULTS One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities. CONCLUSIONS Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
Collapse
Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
21
|
Kim D, Chowdhary S, Pullat R, Crowley N. Laparoscopic Takedown of a Recurrent Gastrojejunocolonic Fistula after a Gastric Bypass. Am Surg 2019; 85:e511-e512. [PMID: 31638557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
22
|
Vilallonga R, Bademci R, Roriz-Silva R, Sanchez-Cordero S, Curbelo Y, Almanza A. Conversion of AspireAssist System® to Sleeve Gastrectomy: Technical Video Description. Obes Surg 2019; 29:2715-2717. [PMID: 31183784 DOI: 10.1007/s11695-019-03993-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE The AspireAssist System® (Aspire Bariatrics, Inc. King of Prussia, PA) is a new endoscopic procedure used to treat obese patients. The aim of this dedicated video is to present a case that required revision surgery due to failure of the AspireAssist System®, and to show how the cannula was removed from the abdomen, and why sleeve gastrectomy (SG) was a good option for revisional surgery in that patient. We aim to discuss technical aspects. PATIENT AND METHODS A 43-year-old female patient who underwent a placement in 2016. Her initial BMI (body mass index) was 38 kg/m2, with a follow-up period of 26 months. A revisional surgery was performed including dissection of the previous gastric fistula and adhesiolysis from the previous AspireAssist System® placement. A complete dissection of the gastrostomy, including removal of all the system, was done. A decision was made, once the incisura angularis and the placement of a 40 Fch bougie showed that the transection could be performed. SG was done. Patients showed an uneventful postoperative course and 4 months follow-up with 45% EWL. CONCLUSION In case of having the device in place, the surgeon must be aware to remove intraoperatively or endoscopically, the device. Surgeons should consider endoscopic removal of the AspireAssist System® before conversion to another procedure (SG or GBP) at least 6 months of the removal. Removal of the AspireAssist System® should be performed endoscopically but direct conversion to another bariatric procedure can be considered, either to SG or GBP depending on the technical intraoperative aspects.
Collapse
Affiliation(s)
- Ramon Vilallonga
- QUIROBES, Integral Obesity Care, Centro Médico Teknon, C. Marquesa de Vilallonga, 12, 08017, Barcelona, Spain.
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.
| | - Refik Bademci
- Camlica Hospital, Istanbul Medipol University, 34767, Istanbul, Turkey
| | - Renato Roriz-Silva
- Department of Medicine, Division of General Surgery, Hospital de Base of Porto Velho, Federal University of Rondônia - Unir, Porto Velho, RO, Brazil
| | | | - Yuhamy Curbelo
- General Surgery Department, Hospital Universitari de Vic (Consorci Hospitalari de Vic), Vic, Spain
| | - Ariel Almanza
- QUIROBES, Integral Obesity Care, Centro Médico Teknon, C. Marquesa de Vilallonga, 12, 08017, Barcelona, Spain
| |
Collapse
|
23
|
Hirata H, Azuma K, Kasetani T, Morita T, Nishioka H. [Successful One-Stage Operation for Transverse Colon Cancer with Gastrocolic Fistula and Synchronous Rectal Cancer]. Gan To Kagaku Ryoho 2019; 46:598-600. [PMID: 30914626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 76-year-old man visited our hospital with complaints of appetite loss and diarrhea. Abdominal computed tomography (CT)showed a large transverse colon tumor at the splenic flexure and a gastrocolic fistula. Upper gastrointestinal series and gastroscopy demonstrated a type 2 tumor in the transverse colon and a gastrocolic fistula as the scope was inserted into the transverse colon. Colonoscopy showed a type 2 tumor of the rectum. Based on the diagnosis of advanced transverse colon cancer with gastrocolic fistula and synchronous rectal cancer, a one-stage curative operation was performed. Pathologically, both cancers were well-differentiated adenocarcinomas, but the transvers colon cancer was partially mucinous. Lymph node metastasis was absent. Gastrocolic fistula complicating colon cancer is rare, to our knowledge, with only 29 cases reported in Japan. A curative operation was performed in 73%of these cases, including ours, and lymph node metastasis was observed in only 22%. This suggests that colon cancer with a gastrocolic fistula might undergo less lymph node metastasis despite increased invasion depth, and that a curative operation for the colon cancer and gastrocolic fistula should be considered.
Collapse
|
24
|
Bi Y, Yu Z, Han X, Wu G. Combined Y-Shaped Covered Metallic Stents for Gastrobronchial Fistulas Involving the Right Intermediate Bronchus. Cardiovasc Intervent Radiol 2019; 42:927-930. [PMID: 30737543 DOI: 10.1007/s00270-019-02180-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 11/10/2018] [Accepted: 02/02/2019] [Indexed: 12/19/2022]
Abstract
Gastrobronchial fistula that involves the right intermediate bronchus is an extremely rare complication of esophagectomy. In this report, two patients with gastrobronchial fistulas around the secondary right carina were treated by combined Y-shaped covered metallic stents. Four covered stents were inserted successfully at the first attempt with no complications. The gastrobronchial fistula was fully sealed in each patient, and they were able to eat without coughing.
Collapse
Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Zepeng Yu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
| |
Collapse
|
25
|
Banday M, Patel G, Jain A, Singh M, Singh RS. Laparoscopic Management of Incidentally Detected Cholecystogastric Fistula - Report of Two Cases. J Coll Physicians Surg Pak 2018; 28:809-810. [PMID: 30266132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Mansoor Banday
- Department of Surgery, ESI PGIMSR and Model Hospital, Basaidarapur, New Delhi, India
| | - Gaurav Patel
- Department of Surgery, ESI PGIMSR and Model Hospital, Basaidarapur, New Delhi, India
| | - Atul Jain
- Department of Surgery, ESI PGIMSR and Model Hospital, Basaidarapur, New Delhi, India
| | - Malwinder Singh
- Department of Surgery, ESI PGIMSR and Model Hospital, Basaidarapur, New Delhi, India
| | - Rabi Shankar Singh
- Department of Surgery, ESI PGIMSR and Model Hospital, Basaidarapur, New Delhi, India
| |
Collapse
|
26
|
Affiliation(s)
- Simant Singh Thapa
- Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Jeffrey Scott
- Pulmonary and Critical Care Medicine, Saint Vincent Hospital, Worcester, MA, USA
| |
Collapse
|
27
|
Jirapinyo P, Thompson AC, Kröner PT, Chan WW, Thompson CC. Metabolic Effect of Foregut Exclusion Demonstrated by the Impact of Gastrogastric Fistula on Recurrence of Diabetes. J Am Coll Surg 2018; 226:259-266.e1. [PMID: 29274838 PMCID: PMC5826850 DOI: 10.1016/j.jamcollsurg.2017.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) resolves in >80% of patients after Roux-en-Y gastric bypass (RYGB). It has been hypothesized that foregut exclusion is mechanistically important to this observation. This study aimed to determine whether gastrogastric (GG) fistula, with a loss of foregut exclusion, is associated with T2DM relapse, and to assess whether closure of GG fistula is associated with T2DM resolution. STUDY DESIGN A matched cohort study of patients who experienced T2DM remission after RYGB. Cases (patients with GG fistula) were matched to controls (patients without GG fistula) based on age, BMI, weight regain, and duration from RYGB. Primary end point was T2DM relapse. Time-to-event analysis was performed to identify an association between GG fistula and time to T2DM resolution. RESULTS One hundred and twenty-six patients (42 cases and 84 controls) were included. Cases experienced a higher rate of T2DM relapse than controls (48% vs 13%; odds ratio 18; p < 0.0001). On multivariable analysis, GG fistula remained a significant predictor of T2DM relapse after controlling for sex and insulin use (odds ratio 6.3; p = 0.02). Of the 42 cases, 20 experienced T2DM relapse, with 1 spontaneous resolution. Of 19, thirteen underwent fistula revision and experienced a higher rate of T2DM resolution than the nonrevision group (69% vs 0%; odds ratio 27; p = 0.036). Time to T2DM resolution was shorter in the revision group compared with the nonrevision group (p = 0.006). CONCLUSIONS The RYGB patients with GG fistula have a higher rate of T2DM relapse, compared with those without GG fistula with similar BMI and weight regain. Successful fistula revision is associated with resolution of T2DM.
Collapse
Affiliation(s)
- Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Andrew C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul T Kröner
- Department of Medicine, Mount Sinai St. Luke's, Mount Sinai West Hospitals, New York, NY
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| |
Collapse
|
28
|
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) has been shown to significantly improve glucose control in patients with type 2 diabetes (T2DM). The formation of a gastrogastric fistula (GGF) allows nutrients to pass through the native route, rather than bypassing the duodenum in typical RYGB configuration. We sought to evaluate the effect of revisional bariatric surgery for known GGF on control of diabetes. METHODS A retrospective chart review of a single academic institution was performed to identify patients who had T2DM at the time of corrective surgery for a GGF. Baseline characteristics, and postoperative outcomes including changes in body mass index (BMI), glycated hemoglobin, fasting blood glucose (FBG), and diabetes medications were assessed. RESULTS Ten patients were identified with GGF who had T2DM at the time of corrective surgery. Patients had a male-to-female ratio of 2:3, a mean age of 59.2 ± 10 years, a mean baseline BMI of 38.1 ± 17.6 kg/m2, and a median duration of 9 years (interquartile range 6-14) from initial RYGB to revision. At a mean follow-up of 14.9 ± 8.5 months, a mean reduction in BMI of 4.9 ± 6 kg/m2 was associated with a significant mean reduction in FBG (167.1 ± 88.2 vs. 106.1 ± 20.4 mg/dL, p = 0.04) and number of diabetes medications (1.4 ± 0.8 vs. 0.7 ± 0.7, p = 0.04). CONCLUSION In patients with diabetes and GGF, a corrective surgery for closure of fistula and restoration of bypass anatomy results in improvement of glucose control and status of diabetes medications. This finding can highlight the potential metabolic significance of duodenal exclusion.
Collapse
Affiliation(s)
- Katherine M Meister
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.
| |
Collapse
|
29
|
Kang DH, Huh J, Lee JH, Jeong YK, Cha HJ. Gastrosplenic fistula occurring in lymphoma patients: Systematic review with a new case of extranodal NK/T-cell lymphoma. World J Gastroenterol 2017; 23:6491-6499. [PMID: 29085199 PMCID: PMC5643275 DOI: 10.3748/wjg.v23.i35.6491] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/20/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To provide the overall spectrum of gastrosplenic fistula (GSF) occurring in lymphomas through a systematic review including a patient at our hospital.
METHODS A comprehensive literature search was performed in the MEDLINE database to identify studies of GSF occurring in lymphomas. A computerized search of our institutional database was also performed. In all cases, we analyzed the clinicopathologic/radiologic features, treatment and outcome of GSF occurring in lymphomas.
RESULTS A literature search identified 25 relevant studies with 26 patients. Our institutional data search added 1 patient. Systematic review of the total 27 cases revealed that GSF occurred mainly in diffuse, large B-cell lymphoma (n = 23), but also in diffuse, histiocytic lymphoma (n = 1), Hodgkin’s lymphoma (n = 2), and NK/T-cell lymphoma (n = 1, our patient). The common clinical presentations are constitutional symptoms (n = 20) and abdominal pain (n = 17), although acute gastrointestinal bleeding (n = 6) and infection symptoms due to splenic abscess (n = 3) are also noted. In all patients, computed tomography scanning was very helpful for diagnosing GSF and for evaluating the lymphoma extent. GSF could occur either post-chemotherapy (n = 10) or spontaneously (n = 17). Surgical resection has been the most common treatment. Once patients have recovered from the acute illness status after undergoing surgery, their long-term outcome has been favorable.
CONCLUSION This systematic review provides an overview of GSF occurring in lymphomas, and will be helpful in making physicians aware of this rare disease entity.
Collapse
MESH Headings
- Abdominal Abscess/diagnostic imaging
- Abdominal Abscess/epidemiology
- Abdominal Abscess/etiology
- Abdominal Abscess/surgery
- Abdominal Pain/diagnostic imaging
- Abdominal Pain/epidemiology
- Abdominal Pain/etiology
- Abdominal Pain/surgery
- Acute Disease/epidemiology
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Dialysis
- Gastric Fistula/diagnostic imaging
- Gastric Fistula/epidemiology
- Gastric Fistula/etiology
- Gastric Fistula/surgery
- Gastrointestinal Hemorrhage/diagnostic imaging
- Gastrointestinal Hemorrhage/epidemiology
- Gastrointestinal Hemorrhage/etiology
- Gastrointestinal Hemorrhage/surgery
- Hepatomegaly/diagnostic imaging
- Hepatomegaly/etiology
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma/complications
- Lymphoma/drug therapy
- Lymphoma, Extranodal NK-T-Cell/complications
- Lymphoma, Extranodal NK-T-Cell/diagnostic imaging
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, Extranodal NK-T-Cell/virology
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/therapy
- Positron-Emission Tomography
- RNA, Viral/isolation & purification
- Spleen/diagnostic imaging
- Spleen/pathology
- Spleen/surgery
- Spleen/virology
- Splenectomy
- Splenic Diseases/diagnostic imaging
- Splenic Diseases/epidemiology
- Splenic Diseases/etiology
- Splenic Diseases/surgery
- Splenomegaly/diagnostic imaging
- Splenomegaly/etiology
- Stem Cell Transplantation
- Stomach/diagnostic imaging
- Stomach/pathology
- Stomach/surgery
- Stomach/virology
- Tomography, X-Ray Computed
- Transplantation, Autologous
- Treatment Outcome
- Tumor Lysis Syndrome/etiology
Collapse
Affiliation(s)
- Dong Hyeok Kang
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Jimi Huh
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Jong Hwa Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Yoong Ki Jeong
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 682-714, South Korea
| |
Collapse
|
30
|
Riley JS, Bartlett EK, Dempsey DT. A left thoracoabdominal approach for transdiaphragmatic fistulas following bariatric surgery. Surg Obes Relat Dis 2017; 13:1455-1458. [PMID: 28552739 DOI: 10.1016/j.soard.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Affiliation(s)
- John S Riley
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
31
|
Sreter KB, Degoricija V, Trbušić M. Pneumopericardium and colo-pericardial fistula. QJM 2017; 110:237-238. [PMID: 28082381 DOI: 10.1093/qjmed/hcx015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- K B Sreter
- From the Department of Clinical Immunology, Pulmonology and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - V Degoricija
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Internal Medicine, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - M Trbušić
- University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Cardiology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| |
Collapse
|
32
|
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become during the last few years the most frequent procedure in bariatric surgery. However, complications related to the gastric staple line can be even more serious. The incidence of gastric fistula after LSG varies from 1 to 7%. Its management can be very challenging and long. In case of chronic fistula and failure of the previous treatment, total gastrectomy or Roux-en-Y fistulo-jejunostomy (RYFJ) might be considered. RYFJ has been described very rarely as a salvage procedure of gastric leaks after LSG. METHODS Between January 2015 and December 2015, we have performed a RYFJ in two patients, with chronic and persisting gastric fistulas, one after LSG and one after duodenal switch, respectively. In the two patients, the RYFJ procedure was attempted laparoscopically but in one case (patient after duodenal switch), conversion into laparotomy was necessary because of severe intra-abdominal inflammatory adhesions. In our video, we are presenting the case of this particular patient treated laparoscopically with a late and persisting leak 1 year after LSG. RESULTS In this multimedia high-definition video, we described the steps of our technique of laparoscopic RYFJ. There was neither mortality nor severe postoperative complications. The fistula control after a minimum of 6 months follow-up was 100% for both of patients. CONCLUSIONS RYFJ in our particular case was efficient. However, larger series and longer follow-up are needed to confirm the efficiency of the RYFJ as a salvage procedure.
Collapse
Affiliation(s)
- Theodoros Thomopoulos
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium.
| | - Maximilien Thoma
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| | - Benoit Navez
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium
| |
Collapse
|
33
|
Omori T, Tokushige K, Kinoshita F, Ito A, Taniai M, Taneichi M, Iizuka B, Itabashi M, Nagashima Y, Yamamoto M, Nakamura S, Hashimoto E. A case of gastrojejunocolic fistula with steatohepatitis. Clin J Gastroenterol 2016; 10:23-31. [PMID: 27995467 DOI: 10.1007/s12328-016-0703-2] [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] [Received: 08/12/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
A man in his 30s, who had undergone retrocolic Billroth II reconstruction for perforated duodenal ulcer, presented with watery diarrhea for 2 years and suspected fatty liver. He was referred to our hospital for management of chronic diarrhea, weight loss, hepatopathy and hypoalbuminemia. Initial upper and lower gastrointestinal endoscopies were negative. Since a small bowel lesion was suspected, peroral single-balloon enteroscopy was performed, which identified feces-like residue near the Billroth II anastomotic site and a connection to the colon separate from the afferent and efferent loops. Transanal single-balloon enteroscopy identified a fistula between the gastrojejunal anastomosis and transverse colon, with the scope reaching the stomach transanally. Barium enema confirmed flow of contrast medium from the transverse colon through the fistula to the anastomotic site, allowing the diagnosis of gastrojejunocolic fistula. Liver biopsy showed relatively severe steatohepatitis (Brunt's classification: stage 2-3, grade 3). Resection of the anastomotic site and partial transverse colectomy were performed to remove the fistula, followed by Roux-en-Y reconstruction. Postoperatively, watery diarrhea resolved and the stools became normal. Hepatopathy and hypoproteinemia improved. One year later, liver biopsy showed marked improvement of steatosis. This case demonstrated marked improvement of both diarrhea/nutritional status and steatohepatitis after treatment of gastrojejunocolic fistula, suggesting that the fistula caused non-alcoholic steatohepatitis.
Collapse
Affiliation(s)
- Teppei Omori
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Katsutoshi Tokushige
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Fukiko Kinoshita
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ayumi Ito
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makiko Taniai
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Mikiko Taneichi
- Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bunei Iizuka
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Michio Itabashi
- Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoji Nagashima
- Department of Surgical Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Institute of Gastroenterology Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinichi Nakamura
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Etsuko Hashimoto
- Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
34
|
Affiliation(s)
- Allison R Schulman
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Hiroyuki Aihara
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
35
|
Harfouch N, Fakhry T, Gonzalvo JP. Robotic-assisted revision of gastrojejunostomy for gastrogastric fistula takedown after gastric bypass: a video case report. Surg Obes Relat Dis 2016; 12:1899. [PMID: 27771311 DOI: 10.1016/j.soard.2016.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Nassier Harfouch
- Tampa General Hospital in conjunction with University of South Florida Health, Tampa, Florida
| | - Tannous Fakhry
- Tampa General Hospital in conjunction with University of South Florida Health, Tampa, Florida
| | - John Paul Gonzalvo
- Tampa General Hospital in conjunction with University of South Florida Health, Tampa, Florida.
| |
Collapse
|
36
|
Rodrigues-Pinto E, Pereira P, Vilas-Boas F, Macedo G. Over-the-scope clip closure of gastrocutaneous fistula. Rev Esp Enferm Dig 2016; 108:578. [PMID: 27615017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 35-year-old female patient, with Batten's disease, submitted to a surgical gastrostomy in 2005, and had it replaced in 2007, 2011 and 2014 with one with a filled balloon as its internal retention mechanism. In 2015, she presented to the emergency room due to stomal enlargement, leakage and chemical dermatitis and cellulitis. A 12 mm over-the-scope clip was placed, after anchoring the fistula edges with the twin grasper and suction of the defect into the applicator cap. Endoscopic resolution of the fistula was achieved.
Collapse
Affiliation(s)
| | - Pedro Pereira
- Gastroenterology, Centro Hospitalar São João, Portugal
| | | | | |
Collapse
|
37
|
Hu Q, Wang G, Ren J, Ren H, Li G, Wu X, Gu G, Li R, Guo K, Deng Y, Li Y, Hong Z, Wu L, Li J. Preoperative prognostic nutritional index predicts postoperative surgical site infections in gastrointestinal fistula patients undergoing bowel resections. Medicine (Baltimore) 2016; 95:e4084. [PMID: 27399098 PMCID: PMC5058827 DOI: 10.1097/md.0000000000004084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in postoperative septic complications of elective colorectal surgeries. However, the evaluation of PNI in contaminated surgeries for gastrointestinal (GI) fistula patients is lack of investigation. The purpose of this study was to explore the predictive value of PNI in surgical site infections (SSIs) for GI fistula patients undergoing bowel resections.A retrospective review of 290 GI patients who underwent intestinal resections between November 2012 and October 2015 was performed. Univariate and multivariate analyses were conducted to identify risk factors for SSIs, and receiver operating characteristic cure was used to quantify the effectiveness of PNI.SSIs were diagnosed in 99 (34.1%) patients, with incisional infection identified in 54 patients (18.6%), deep incisional infection in 13 (4.5%), and organ/space infection in 32 (11.0%). receiver operating characteristic curve analysis defined a PNI cut-off level of 45 corresponding to postoperative SSIs (area under the curve [AUC] = 0.72, 76% sensitivity, 55% specificity). Furthermore, a multivariate analysis indicated that the PNI < 45 [odd ratio (OR): 2.24, 95% confidence interval (CI): 1.09-4.61, P = 0.029] and leukocytosis (OR: 3.70, 95% CI: 1.02-13.42, P = 0.046) were independently associated with postoperative SSIs.Preoperative PNI is a simple and useful marker to predict SSIs in GI fistula patients after enterectomies. Measurement of PNI is therefore recommended in the routine assessment of patients with GI fistula receiving surgical treatment.
Collapse
Affiliation(s)
- Qiongyuan Hu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
- Correspondence: Jianan Ren, Department of Surgery, Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, China (e-mail: )
| | - Huajian Ren
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Guanwei Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Xiuwen Wu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Guosheng Gu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Ranran Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Kun Guo
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Youming Deng
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Yuan Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Zhiwu Hong
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Lei Wu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| |
Collapse
|
38
|
Abstract
Gastrogastric fistulas are an uncommon complication following laparoscopic Roux-Y gastric bypass surgery (LRYGB) and may be caused by staple-line dehiscence or leak. Described here is a novel technique to treat these fistulae via a laparoscopic transgastric approach and closure of the fistulous tract with an Endo Stitch™ device. The 33-year-old patient, post LRYGB in 2002, with documented gastrogastric fistula, had failed non-operative management. A transoral endoscope was passed into the cephalad portion of the gastrogastric fistula; a glidewire was passed from the gastric pouch into the gastric remnant. Laparoscopically, 2 gastrotomies were made and a “pneumogastrium” created with carbon dioxide. Under direct, transgastric visualization, the distal portion of the gastrogastric fistula was closed using an Endo Stitch™ device. This technique is safe and reproducible when performed by an experienced laparoscopic surgeon and could be modified for other scenarios requiring alternate access to the stomach.
Collapse
Affiliation(s)
- Kurt E Roberts
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | |
Collapse
|
39
|
Nayfe R, Ascha MS, Ismail M, Salvino R. Gastrocolic Fistula as a Presentation of Concomitant Gastric and Colon Cancer in a Patient with a History of Metastatic Pancreatic Adenocarcinoma. J Gastrointest Cancer 2016; 48:379-381. [PMID: 27251299 DOI: 10.1007/s12029-016-9841-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rabih Nayfe
- Department of Internal Medicine, Cleveland Clinic Akron General, 1st Akron General ave., Akron, OH, USA.
| | - Mustafa S Ascha
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Mayada Ismail
- Department of Internal Medicine, Cleveland Clinic Akron General, 1st Akron General ave., Akron, OH, USA
| | - Richard Salvino
- Department of Internal Medicine, Cleveland Clinic Akron General, Northeast Ohio Medical University, Akron, OH, USA
| |
Collapse
|
40
|
Küttner-Magalhães R, Rodrigues Â, Ferreira D, Maia L, Barrias S, Pedroto I. Endoscopy-assisted suture of gastrocutaneous fistula. Gastrointest Endosc 2016; 83:653-4. [PMID: 26394386 DOI: 10.1016/j.gie.2015.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - Ângela Rodrigues
- Department of Gastroentrology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Daniela Ferreira
- Department of Gastroentrology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Luís Maia
- Department of Gastroentrology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Sílvia Barrias
- Department of Gastroentrology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| | - Isabel Pedroto
- Department of Gastroentrology, Santo António Hospital, Porto Hospital Center, Porto, Portugal
| |
Collapse
|
41
|
Suciu BA. A fatal complication of an incarcerated diaphragmatic hernia: pyo-pneumopericardium due to a gastro-pericardial fistula Case report and literature review. Ann Ital Chir 2016; 87:75-78. [PMID: 27026068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia. Usually, it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication. CASE REPORT We present the case of a 65 year old man who was admitted to our emergency service with clinical signs of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatic hernia was diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic and abdominal), discerning during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula due to an incarcerated diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardial fistula, evacuation of the pericardial abscess, performing the splenectomy (in order to have a better surgical access) and adequate treatment of the diaphragmatic hernia. Despite the medical efforts, the patient died on the 10th postoperative day due to septic complications. To our knowledge this is the first case reported in the literature of gastro-pericardial fistula complicated with pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing a double surgical approach (thoracic and abdominal) we can provide a proper resolution of the case, also based on the objective situation found during surgery, where the splenectomy can provide an easier approach to the diaphragmatic hernia. KEY WORDS Diaphragmatic hernia, Gastropericardial fistula, Pyo-pneumopericardium.
Collapse
|
42
|
Prasad VGM, Prasad M, Patil PM, Reddy UV, Asif SM, Murthy KVKSN, Prasad M, Govindasamy V, Shanker GK. Spontaneous magnetic gastrojejunal fistula caused by accidentally ingested lithium batteries. Gastrointest Endosc 2016; 83:252. [PMID: 26276503 DOI: 10.1016/j.gie.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/05/2015] [Indexed: 12/11/2022]
|
43
|
Shen SS, Zhang XQ, Li ZL, Zou XP, Ling TS. Over-the-scope clip to close a gastrocutaneous fistula after esophagectomy. World J Gastroenterol 2015; 21:13396-13399. [PMID: 26715825 PMCID: PMC4679774 DOI: 10.3748/wjg.v21.i47.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/15/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023] Open
Abstract
Over-the-scope clip (OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a non-healing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a non-healing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC.
Collapse
|
44
|
Janczak D, Pawłowski W, Ziomek A, Dorobisz T, Janczak D, Janus W, Chabowski M. Endoscopic esophageal self-expanding stent implantation WallFlex™ (Boston Scientific) in the management of a gastrocutaneous fistula, as a complication of sleeve bariatric gastrectomy. Pol Przegl Chir 2015; 87:320-3. [PMID: 26247505 DOI: 10.1515/pjs-2015-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Indexed: 11/15/2022]
Abstract
The study presented a case of a gastrocutaneous fistula, as a result of bariatric sleeve gastrectomy. The discussion considered the main pathogenesis, etiology, diagnostics and endoscopic treatment using the implantation of covered esophageal stents. Special attention was placed upon the multifactorial origin of this life-threatening clinical condition, typical for bariatric surgery.
Collapse
|
45
|
Karaahmet F, Akinci H, Hamamci M, Coban S, Yuksel I. Adjusting the patient positioning during endoscopy in diagnosis of gastrocolic fistula related to advanced stage gastric malignancy. J Gastrointest Cancer 2015; 46:195-6. [PMID: 25645585 DOI: 10.1007/s12029-015-9685-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Fatih Karaahmet
- Department of Gastroenterology, Dışkapı Yıldırım Beyazıt Educational and Research Hospital, 06080, Altındag, Ankara, Turkey,
| | | | | | | | | |
Collapse
|
46
|
Graif A, Conde K, DeMauro CA. Imaging of a gastrobronchial fistula after gastric bypass surgery and the contrast dilemma. Del Med J 2015; 87:113-116. [PMID: 26027409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Obesity and bariatric procedures have become more common in the United States over the past 20 years. Therefore, the incidence of previously rare complications is also on the rise. One of the more ominous complications is a gastric leak with subsequent creation of a fistulous tract. A very rare subset of this complication is when the fistulous tract connects the gastric pouch to the bronchial tree. Several contrast agents can be utilized for imaging of the upper gastrointestinal tract, some of which may cause significant adverse effects if not properly tailored to the specific pathology in question. We present a case of a gastrobronchial fistula developing several years after a laparoscopic Roux-en-Y gastric bypass and discuss the ideal choice of contrast material when imaging this specific pathology.
Collapse
|
47
|
Gupta R, Singh H, Talukder S, Verma GR. A new technique of closing a gastroatmospheric fistula with a rectus abdominis muscle flap. BMJ Case Rep 2015; 2015:bcr2015209309. [PMID: 25819831 PMCID: PMC4386304 DOI: 10.1136/bcr-2015-209309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/04/2022] Open
Abstract
Proximal enteroatmospheric fistulae are difficult to manage and carry high mortality from sepsis and electrolyte imbalances. Conservative management with total parenteral nutrition, exclusion of fistula, resection and anastomosis are conventional methods of treatment with low success rate. Providing muscle cover to manage an enteroatmospheric fistula is a noble concept. A postoperative high-output gastroatmospheric fistula (GAF) was repaired by superior epigastric artery-based rectus abdominis muscle flap (RAMF). Postoperative recovery was uneventful. This technique may be useful for closure of proximal enteroatmospheric fistulae that fail to heal through medical and conventional surgical management.
Collapse
Affiliation(s)
- Rahul Gupta
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shibojit Talukder
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ganga Ram Verma
- Surgical Gastroenterology Division, Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
48
|
Harriman S, Rodych N, Hayes P, Moser MAJ. The C-reactive protein: prealbumin ratio as a predictor of successful surgical closure of gastrointestinal fistulas. Am Surg 2015; 81:E73-E74. [PMID: 25642862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Suzanne Harriman
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | | |
Collapse
|
49
|
Horn C, Hallowell P. Esophagogastric fistula. Am Surg 2015; 81:E38-E39. [PMID: 25569062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Christopher Horn
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | |
Collapse
|
50
|
Frydman J, Grunner S, Kluger Y. IgG4-related disease manifesting as an acute gastric-pericardial fistula. World J Gastroenterol 2014; 20:16782-16785. [PMID: 25469052 PMCID: PMC4248227 DOI: 10.3748/wjg.v20.i44.16782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/10/2014] [Accepted: 07/25/2014] [Indexed: 02/06/2023] Open
Abstract
IgG4-related disease is a recently recognized entity linked initially to autoimmune pancreatitis and has been subsequently described in nearly every organ system. Men over the age of 50 represent the most affected demographic group and a comprehensive set of diagnostic criteria has been developed to aid treating clinicians. Though elevated levels of IgG4 in the serum are suggestive of the disease, definitive diagnosis is made on histopathology. Treatment is tailored to the clinical presentation with corticosteroid therapy known to have proven efficacy. Gastric manifestations of the IgG4-related disease primarily come in two varieties, notably chronic ulceration or pseudotumor formation. Autoimmune pancreatitis conveys increased risk for IgG4-related disease of the stomach, which is independent of Helicobacter pylori status. In this case report, we present an acute gastric-pericardial fistula secondary to IgG4-related disease that required urgent operative management. To our knowledge, this is the first report in the medical literature describing this complication of IgG4-related disease.
Collapse
|