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Enterocutaneous fistulas

R L Lassiter, E L Simmerman, J Sol Oh, C J Mentzer, N E Burkart, S B Holsten
OBJECTIVE: Necrotising soft tissue infection is a rare surgical emergency, which requires immediate and aggressive surgical debridement. Following control of the infection, patients are often left with large defects, with wound reconstruction and closure creating significant challenges. Here we describe a case of extensive thoracoabdominal necrotising soft tissue infection and provide a discussion on the standard of care and treatment based on a current literature review. METHOD: A 53-year-old female presented with bilious and feculent discharge from her surgical incision two weeks after a total abdominal hysterectomy...
October 2016: Journal of Wound Care
Alfin Okullo, Mehan Siriwardhane, Tony C Y Pang, Jane-Louise Sinclair, Vincent W T Lam, Arthur James Richardson, Henry Pleass, Emma Johnston
INTRODUCTION: Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. METHODS: A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done...
September 26, 2016: Surgical Innovation
Myriam Mesbahi, Michal Shteinberg, Michael Wilschanski, Aurelie Hatton, Thao Nguyen-Khoa, Hannah Friedman, Michael Cohen, Virginie Escabasse, Muriel Le Bourgeois, Vicenzina Lucidi, Isabelle Sermet-Gaudelus, Laurence Bassinet, Galit Livnat
Ivacaftor, a CFTR potentiator, has been found to improve CFTR function and clinical outcomes in patients with cystic fibrosis (CF) gating mutations. We investigated the effects of ivacaftor on CFTR functional measurement in CF patients carrying gating mutations other than p.Gly551Asp. Two siblings aged 13 and 12 carrying the p.Ser549Asn mutation, two sisters (45 and 43years old) compound heterozygotes for p.Asp1152His and p.Gly1244Glu, a 37year old man homozygous for the p.Gly1244Glu mutation, and a 7year old girl with p...
September 19, 2016: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
Jon S Thompson
No abstract text is available yet for this article.
August 25, 2016: American Journal of Surgery
Sarah J Valle, Nayef Alzahrani, Saleh Alzahrani, Thamer Bin Traiki, Winston Liauw, David L Morris
BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal carcinomatosis (PC) from multiple origins, however is associated with increased complications compared to conventional gastrointestinal surgery. The aetiology of enterocutaneous fistulas (ECF) in most cases is a result of various contributing factors and therefore remains a major clinical problem, occurring in 4-34% of patients post-CRS. The aim of this study was to analyze the incidence and outcome of ECF following CRS/HIPEC...
September 2016: Surgical Oncology
C D Brandi, S Roche, S Bertone, M E Fratantoni
PURPOSE: To determine the incidence of enterocutaneous fistulas (ECFs) developed after elective incisional hernia (IH) repair using intraperitoneal uncoated polypropylene (PPE) mesh. METHODS: This is a retrospective descriptive study of a prospective cohort of patients undergoing elective IH repair using intraperitoneal uncoated PPE mesh at the Department of General Surgery of a high complexity University Hospital. RESULTS: Between January 1992 and December 2013, 695 IH repairs were performed using intraperitoneal uncoated PPE mesh...
August 13, 2016: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Ujjwal Gorsi, Pankaj Gupta, Naveen Kalra, Mandeep Kang, Rajinder Singh, Rajesh Gupta, Vikas Gupta, Niranjan Khandelwal
OBJECTIVE: To evaluate the role of multidetector computed tomography (CT) and CT angiography (CTA) in post cholecystectomy complications. METHODS: A retrospective analysis of data from December 2012 to August 2014 was performed. Eight hundred sixty consecutive patients with history of cholecystectomy (laparoscopic or open) were evaluated. After exclusion of 645 patients with normal imaging, analysis for post cholecystectomy complications was performed in 215 patients...
October 2015: Tropical Gastroenterology: Official Journal of the Digestive Diseases Foundation
George Melich, Ajit Pai, Banujan Balachandran, Slawomir J Marecik, Leela M Prasad, John J Park
INTRODUCTION: Large high-output enterocutaneous fistulas pose great difficulties, especially in the setting of recent surgery and compromised skin integrity. METHODS: This video demonstrates a new technique of endoscopic control of enterocutaneous fistula by using two covered overlapping stents. In brief, the two stents are each inserted endoscopically, one proximal, and the other distal to the fistula with 2 cm of each stent protruding cutaneously. Following this, the proximal stent is crimped and intussuscepted into the distal stent with an adequate overlap...
September 2016: Surgical Endoscopy
Margaret H Lauerman, Joseph Dubose, Kyle Cunningham, Brandon Bruns, Matthew Bradley, Jose Diaz, Thomas Scalea, Deborah Stein
BACKGROUND: In damage control laparotomy, operative principles include hemorrhage and contamination control. However, required components of initial damage control laparotomy are unknown, and nonemergency injury repair is sometimes delayed for resuscitation, angiography, or nonabdominal operations. The frequency and effects of delayed interventions are unknown. METHODS: A retrospective review of patients undergoing damage control laparotomy at a single, urban trauma center was performed...
August 4, 2016: Surgery
Xiaofei Song, Yucheng Song, Yuan Yuan, Peng Zhang, Xuedong Zhang
BACKGROUND: Enterocutaneous fistula (ECF) poses a supreme challenge for the surgeons associated with abdominal sepsis, fluid electrolyte imbalance and undernutrition. Individual prognostic stratification is pivotal in the clinical management. Presepsin is a novel biomarker showing diagnostic and prognostic value in sepsis. We aimed to evaluate the prognostic value of presepsin in ECF. METHODS: Consecutive patients with ECF were enrolled if diagnosed as abdominal sepsis from June 2014 to June 2015...
September 2016: International Journal of Surgery
A A Adejumo, N M Mshelia, Y M Saleh
BACKGROUND: Acute appendicitis is a common cause of acute abdomen and right iliac fossa pain in the study centre with attendant negative appendicectomies. AIM: To study the demographic pattern, aetiology, clinical presentation and management outcome of appendicitis. METHODS: This is a retrospective study carried out on patients, who had appendicectomies between January 2007 and December 2014. A total of two hundred and thirteen (213) cases were operated during the study period...
October 2015: Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria
Steven Kesten, John K Fraser
Adipose derived regenerative cells (ADRCs) are a heterogeneous population of cells including multipotent adipose derived stems cells, other progenitor cells, fibroblasts, T-regulatory cells, and macrophages. Preclinical data exist supporting benefits that are predominantly through angiogenesis, modulation of inflammation, and wound remodeling. Such effects are likely paracrine in nature. The application of autologous ADRCs has been investigated across multiple therapeutic areas. While there are numerous publications, there is a relative lack of double-blind, well-controlled, randomized clinical trials in the literature...
July 29, 2016: Surgical Technology International
Yit J Leang, Stephen W Bell, Peter Carne, Martin Chin, Chip Farmer, Steward Skinner, Roger Wale, Satish K Warrier
BACKGROUND: Enterocutaneous fistulas (ECFs) are complex and can result in significant morbidity and mortality. The study aimed to evaluate ECF outcomes in a single tertiary hospital. METHODS: A retrospective study of all patients treated with ECF between the period of January 2009 and June 2014 was conducted. Baseline demographic data assessed included the primary aetiology of the fistula, site of the fistula and output of the fistula. Outcomes measures assessed included re-fistulation rate, return to theatre, wound complications, fistula closure rate and death over the study period...
July 24, 2016: ANZ Journal of Surgery
Nathan W Kugler, Melanie Bobbs, Travis Webb, Thomas W Carver, David Milia, Jasmeet S Paul
BACKGROUND: The Modified Hernia Grading System (MHGS) was developed to risk stratify complex ventral hernia repairs (VHRs). MHGS grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection (SSI) rates are over 40% after single-stage VHR in contaminated fields. In an attempt to decrease the SSI rate in MHGS grade 3 patients, we developed a dual-stage VHR (DSVHR) approach. METHODS: We reviewed adult general surgery patients undergoing DSVHR between January 2010 and June 2014...
July 2016: Journal of Surgical Research
Juan Antonio Bellido Luque, Araceli Bellido Luque, Julio Gomez Menchero, Juan Manuel Suarez Grau, Joaquin García Moreno, Antonio Tejada Gomez, Juan Guadalajara Jurado
BACKGROUND: Laparoscopic ventral or incisional hernia repair requires intraperitoneal mesh placement. This is associated with an increase in adhesions, bowel obstruction and enterocutaneous fistula. Intraabdominal meshes are laparoscopically fixed using traumatic fixation methods that increase acute, chronic pain and adhesions to bowel loops. The aim was to check the safety and effectiveness of the laparoscopic approach in ventral or incisional hernia, using a self-adhesive mesh in the preperitoneal space without tacks or transfascial sutures, and to objectively assess its benefits and complications...
July 21, 2016: Surgical Endoscopy
Miguel Parra-Flores, Luis Manuel Souza-Gallardo, Gabriel Adrián García-Correa, Sócrates Centellas-Hinojosa
BACKGROUND: Central venous catheters are devices used for therapeutic, diagnostic, and monitoring purposes. Complications associated with central venous catheter use include those related to their insertion, rupture and displacement of the catheter, occlusion, thrombosis, and infection. Of these the latter is important due to the high morbidity and mortality it causes in the patients, and total parenteral nutrition increases the risk. The aim of this study is determine the incidence and risk factors associated with catheter-related infection in patients on parenteral nutrition...
July 12, 2016: Cirugia y Cirujanos
Jose L Martinez, Enrique Luque-de-León, Eduardo Ferat-Osorio, Alicia Estrada-Castellanos
BACKGROUND: Recurrence rates after surgical repair of enterocutaneous fistula (ECF) have not changed substantially. Serum C-reactive protein (s-CRP) has been used as an indicator of postoperative complications in abdominal surgery. ​ The aim of this study was to determine the predictive value of preoperative s-CRP for recurrence after definitive surgical repair of ECF. METHODS: Fifty consecutive patients with ECF persistence submitted electively to definitive surgical repair (ECF resection with primary anastomosis) were included...
June 16, 2016: American Journal of Surgery
J Spiliotis, E O Argiriou, E Vafias, V Manou, N Vaos, A Datsis, E Efstathiou
BACKGROUND: Peritoneal metastasis (PM) is currently treated with the complex procedure of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS + HIPEC). This procedure presents high morbidity and mortality rates, but they have only been examined in the immediate post-operative period. The aim of our study is to present, describe and analyze the post-operative events, secondary to a cytoreductive surgery and HIPEC procedure that occurs after the patients' discharge from the hospital...
April 2016: Acta Chirurgica Belgica
Ronan Thibault, Denis Picot
PURPOSE OF REVIEW: Patients with double temporary enterostomy or enterocutaneous fistula may suffer from intestinal failure. Parenteral nutrition is the gold standard treatment until surgical re-establishment of intestinal continuity, but serious complications may arise. Chyme reinfusion or enteroclysis are indicated. RECENT FINDINGS: Chyme reinfusion corrects the intestinal failure by restoring intestinal absorption, allowing parenteral nutrition weaning in 91% of patients...
June 29, 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Peter J Fagenholz, Ashraf Thabet, Peter R Mueller, David G Forcione
Enteric fistula is a serious complication of necrotizing pancreatitis. Endoscopic transluminal drainage and necrosectomy can significantly reduce the incidence of enterocutaneous fistula after pancreatic debridement. However, endoscopic necrosectomy may not be well-suited to debridement of necrosis that tracks laterally to the paracolic gutters, which is often more efficiently addressed by video-assisted retroperitoneal debridement (VARD). We report the combined use of endoscopic transgastric drainage and VARD for treatment of a 76 year old man with severe necrotizing acute pancreatitis complicated by infected, walled-off pancreatic necrosis...
September 2016: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
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