scholarly journals EP.FRI.616 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neill Allen ◽  
Rachael McBride ◽  
William Wallace ◽  
Richard Lyndsay
Keyword(s):  
Peritoneal Cavity ◽  
Guide Wire ◽  
Enterocutaneous Fistula ◽  
Significant Risk ◽  
Gain Control ◽  
Small Bowel Resection ◽  
Abdominal Sepsis ◽  
Fistula Formation ◽  
Jejunostomy Tube ◽  
Novel Technique

Abstract Introduction Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation. We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61 year old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.  Method Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.  Conclusion This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time. This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.

scholarly journals 30 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Allen ◽  
R McBride ◽  
R Lindsay ◽  
W Wallace
Keyword(s):  
Peritoneal Cavity ◽  
Guide Wire ◽  
Enterocutaneous Fistula ◽  
Significant Risk ◽  
Gain Control ◽  
Small Bowel Resection ◽  
Abdominal Sepsis ◽  
Fistula Formation ◽  
Jejunostomy Tube ◽  
Novel Technique

Abstract Introduction Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation. We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61-year-old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia. Method Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity. Conclusions This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control, and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time. This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.

scholarly journals Novel Approach for Enterocutaneous Fistula Treatment with the Use of Viable Cryopreserved Placental Membrane

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Frederick Nichols ◽  
Aaron Overly
Keyword(s):  
Standard Treatment ◽  
Surgical Complication ◽  
Enterocutaneous Fistula ◽  
Small Bowel Resection ◽  
Jejunostomy Tube ◽  
Novel Approach ◽  
Venous Catheterization ◽  
Fistula Treatment ◽  
Prolonged Hospital

Enterocutaneous fistulas (ECF) are a difficult and costly surgical complication to manage. The standard treatment of nil per os (NPO) and total paraenteral nutrition (TPN) is not well tolerated by patients. TPN is also known for complications associated with long term central venous catheterization and for high cost of prolonged hospital stay. We present two low output ECF cases successfully treated with viable cryopreserved placental membrane (vCPM) placed into the fistula tracts. One patient is a 59-year-old male with a low output ECF from a jejunostomy tube site four weeks after the surgery. The second patient is an 87-year-old male with a low output ECF following a small bowel resection secondary to a strangulated inguinal hernia. He was evaluated on day 41 after surgery. NPO and TPN for several weeks did not resolute the ECF. The fistulae were closed postoperatively in both patients with zero output on the same day after one vCPM application. On day 3 postoperatively both patients were started on clear liquid diets and subsequently advanced to regular diets. The ECF have remained resolved for over 2 months. The use of vCPM is a novel promising approach for treatment of ECF.

Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report

2016 ◽  
Vol 25 (2) ◽  
pp. 249-252 ◽  
Author(s):  
Gabriel Constantinescu ◽  
Vasile Şandru ◽  
Mădălina Ilie ◽  
Cristian Nedelcu ◽  
Radu Tincu ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Guide Wire ◽  
Subsequent Development ◽  
Covered Stent ◽  
Metallic Stents ◽  
Fistula Formation ◽  
Life Threatening ◽  
Endoscopic Placement ◽  
Surgical Gastrostomy ◽  
Methods Of Treatment

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035” guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible. Abbreviations: ERCP: endoscopic retrograde cholangio-pancreatography; GI: gastrointestinal; SEMS: self-expandable metallic stents.

A novel technique for large lateral enterocutaneous fistula management after intestinal transplantation

2021 ◽  
Author(s):  
Agustina R Oliva ◽  
Paula Violo Gonzalez ◽  
Luciana Lerendegui ◽  
Rodrigo Sanchez Clariá ◽  
Juan Moldes ◽  
...  
Keyword(s):  
Enterocutaneous Fistula ◽  
Intestinal Transplantation ◽  
Novel Technique

scholarly journals The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

2009 ◽  
Vol 91 (3) ◽  
pp. 255-258 ◽  
Author(s):  
J Skipworth ◽  
D Raptis ◽  
D Brennand ◽  
C Imber ◽  
A Shankar
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Rare Complication ◽  
Enterocutaneous Fistula ◽  
Fistula Formation ◽  
Visceral Artery ◽  
Haemodynamic Instability ◽  
Successful Recovery ◽  
Necrotising Pancreatitis ◽  
Tomographic Angiography

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.

scholarly journals IP185. Novel Technique for Lower Extremity Reverse Saphenous Vein Bypass—Use of Fistula Formation During Great Saphenous Vein Harvest

2019 ◽  
Vol 69 (6) ◽  
pp. e160-e161
Author(s):  
Michael S. Segal ◽  
Bishoy Emmanuel ◽  
Mohammad Gilani ◽  
Mohan Badhey ◽  
Mahalingham Sivakumar
Keyword(s):  
Lower Extremity ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Fistula Formation ◽  
Novel Technique ◽  
Saphenous Vein Bypass ◽  
Vein Bypass

scholarly journals CXCL5-mediated recruitment of neutrophils into the peritoneal cavity ofGdf15-deficient mice protects against abdominal sepsis

2020 ◽  
Vol 117 (22) ◽  
pp. 12281-12287 ◽  
Author(s):  
Isa Santos ◽  
Henrique G. Colaço ◽  
Ana Neves-Costa ◽  
Elsa Seixas ◽  
Tiago R. Velho ◽  
...  
Keyword(s):  
Septic Shock ◽  
Organ Dysfunction ◽  
Peritoneal Cavity ◽  
Host Response ◽  
Abdominal Sepsis ◽  
Neutrophil Recruitment ◽  
Life Threatening ◽  
Pathogen Control ◽  
Circulating Levels ◽  
Deficient Mice

Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated host response to an infection. Here we report that the circulating levels of growth and differentiation factor-15 (GDF15) are strongly increased in septic shock patients and correlate with mortality. In mice, we find that peptidoglycan is a potent ligand that signals through the TLR2-Myd88 axis for the secretion of GDF15, and thatGdf15-deficient mice are protected against abdominal sepsis due to increased chemokine CXC ligand 5 (CXCL5)-mediated recruitment of neutrophils into the peritoneum, leading to better local bacterial control. Our results identify GDF15 as a potential target to improve sepsis treatment. Its inhibition should increase neutrophil recruitment to the site of infection and consequently lead to better pathogen control and clearance.

Proinflammatory role of neutrophil extracellular traps in abdominal sepsis

2014 ◽  
Vol 307 (7) ◽  
pp. L586-L596 ◽  
Author(s):  
Lingtao Luo ◽  
Su Zhang ◽  
Yongzhi Wang ◽  
Milladur Rahman ◽  
Ingvar Syk ◽  
...  
Keyword(s):  
Lung Injury ◽  
Peritoneal Cavity ◽  
Tissue Injury ◽  
Cecal Ligation ◽  
Neutrophil Extracellular Traps ◽  
Abdominal Sepsis ◽  
Extracellular Dna ◽  
Extracellular Traps ◽  
Proinflammatory Role

Excessive neutrophil activation is a major component in septic lung injury. Neutrophil-derived DNA may form extracellular traps in response to bacterial invasions. The aim of the present study was to investigate the potential role of neutrophil extracellular traps (NETs) in septic lung injury. Male C57BL/6 mice were treated with recombinant human (rh)DNAse (5 mg/kg) after cecal ligation and puncture (CLP). Extracellular DNA was stained by Sytox green, and NET formation was quantified by confocal microscopy and cell-free DNA in plasma, peritoneal cavity, and lung. Blood, peritoneal fluid, and lung tissue were harvested for analysis of neutrophil infiltration, NET levels, tissue injury, as well as CXC chemokine and cytokine formation. We observed that CLP caused increased formation of NETs in plasma, peritoneal cavity, and lung. Administration of rhDNAse not only eliminated NET formation in plasma, peritoneal cavity, and bronchoalveolar space but also reduced lung edema and tissue damage 24 h after CLP induction. Moreover, treatment with rhDNAse decreased CLP-induced formation of CXC chemokines, IL-6, and high-mobility group box 1 (HMGB1) in plasma, as well as CXC chemokines and IL-6 in the lung. In vitro, we found that neutrophil-derived NETs had the capacity to stimulate secretion of CXCL2, TNF-α, and HMGB1 from alveolar macrophages. Taken together, our findings show that NETs regulate pulmonary infiltration of neutrophils and tissue injury via formation of proinflammatory compounds in abdominal sepsis. Thus we conclude that NETs exert a proinflammatory role in septic lung injury.

scholarly journals Enterocutaneous fistula secondary to mesh erosion of bowel: a late complication of polypropylene mesh use in ventral hernia repair

2019 ◽  
Vol 6 (11) ◽  
pp. 4163
Author(s):  
Kartik Saxena ◽  
Rijul Saini
Keyword(s):  
Hernia Repair ◽  
Polypropylene Mesh ◽  
Case Reports ◽  
Enterocutaneous Fistula ◽  
Standard Procedure ◽  
Late Complication ◽  
Incisional Hernia Repair ◽  
Mesh Erosion ◽  
Fistula Formation ◽  
Review Of Literature

Use of mesh for reinforcing hernia defects has become standard procedure but it is associated with a few serious complications like bowel erosion and fistula formation. We present a case of a 62 yrs lady with enterocutaneous fistula due to mesh erosion of small bowel, 10 yrs after open incisional hernia repair using polypropylene mesh who had to undergo laparotomy and resection of eroded bowel. A brief review of literature revealed that very few case reports of such fistulas following open incional hernioplasty have been reported and that current research on improving the properties of mesh may reduce such complications in future. 

scholarly journals Mesh Migration into the Neobladder and Ileum with Complicated Fistula Formation following Incisional Hernia Repair

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Masatsugu Kuroiwa ◽  
Masato Kitazawa ◽  
Yusuke Miyagawa ◽  
Futoshi Muranaka ◽  
Shigeo Tokumaru ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hernia Repair ◽  
Abdominal Wall ◽  
Rare Case ◽  
Intestinal Tract ◽  
Incisional Hernia Repair ◽  
Small Bowel Resection ◽  
Fistula Formation ◽  
Mesh Migration ◽  
Incisional Surgical Site Infection

Background. Tension-free repair using mesh has become the standard treatment for abdominal wall incisional hernias. However, its postoperative complications reportedly include mesh infection, adhesions, and fistula formation in other organs. Here, we report an extremely rare case of mesh migration into the neobladder and ileum with entero-neobladder and neobladder-cutaneous fistulas. Case Presentation. An 80-year-old male who had undergone radical cystectomy 5 years ago and abdominal wall incisional hernia repair 3 years ago presented with fever and abdominal pain. Computed tomography (CT) scan revealed mesh migration into the neobladder and ileum. He was treated conservatively with antibiotics for a month but did not show improvement; hence, he was transferred to our hospital. He was diagnosed with mesh migration into the neobladder and ileum with complicated fistula formation. He underwent mesh removal, partial neobladder resection, and partial small bowel resection. He developed superficial incisional surgical site infection, which improved with drainage and antibiotics, and he was discharged 40 days after the surgery. Conclusions. We reported a rare case of mesh migration into the neobladder and ileum with fistula formation. Successful conservative treatment cannot be expected for this condition because mesh migration into the intestinal tract causes infection and fistula formation. Hernia repair requires careful placement of the mesh such that it does not come into contact with the intestinal tract. Early surgical intervention is important if migration into the intestinal tract is observed.

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