scholarly journals Current concepts in the management of enterocutaneous fistula

2018 ◽  
Vol 5 (6) ◽  
pp. 1981
Author(s):  
Amabra Dodiyi-Manuel ◽  
Promise N. Wichendu
Keyword(s):  
Multidisciplinary Approach ◽  
Wound Care ◽  
Enterocutaneous Fistula ◽  
Operative Management ◽  
Morbidity And Mortality ◽  
Fistula Tract ◽  
Successful Management ◽  
Management Options ◽  
Type Iv ◽  
Considerable Morbidity

Enterocutaneous fistula is an abnormal connection between the intra-abdominal gastrointestinal tract and skin. It causes considerable morbidity and mortality. The goals of management are restoration of gastrointestinal continuity and allowance of enteral nutrition with minimal morbidity and mortality. A multidisciplinary approach is essential in the successful management and this has led to closure rates ranging from 5-20% following conservative management and 75-85% with operative treatment. This article seeks to review the current concepts in the management of enterocutaneous fistula. A systematic search of literature on enterocutaneous fistula was conducted. Relevant materials were selected and selected references from relevant books, journal articles and abstracts using Medline, Google scholar and Pubmed databases were critically reviewed. Enterocutaneous fistulas can be classified by the anatomy, aetiology or physiology. Anatomically, enterocutaneous fistula has been classified based on the organ of origin and this is useful in the consideration of management options: type l (abdominal oesophageal and gastroduodenal fistula), type ll (small bowel fistula), type lll (large bowel fistula) and type IV (enteroatmospheric, regardless of origin. The anatomy also depends on the presence or absence of associated abscess cavity and the length and characteristics of the fistula tract. Aetiologically, the majority of enterocutaneous fistulas are iatrogenic (75-85%) while between 15 and 25% occur spontaneously. The physiological classification is based on the volume of its output. High output fistulas drain more than 500mls in 24 hours, moderate output between 200 and 500mls in 24 hours and low output less than 200mls in 24 hours. Successful management requires a multidisciplinary approach and would consist of initial resuscitaion with fluids and electrolytes, control of sepsis, good and adequate nutrition, wound care and skin protection and definitive management. The treatment of enterocutaneous fistula is multidisciplinary and remains a challenge despite the recent improvement in supportive care. Once enterocutaneous fistula occurs, adequate stabilization of the patient and non-operative management should be commenced. If surgery is required, careful planning, meticulous dissection, restoration of bowel continuity and reconstruction of abdominal wall are critical.

scholarly journals Management of Intestinal Failure: The High-Output Enterostomy and Enterocutaneous Fistula

2017 ◽  
Vol 30 (03) ◽  
pp. 215-222 ◽  
Author(s):  
Franklin Adaba ◽  
Carolynne Vaizey ◽  
Janindra Warusavitarne
Keyword(s):  
Multidisciplinary Approach ◽  
Enterocutaneous Fistula ◽  
Intestinal Failure ◽  
Successful Management ◽  
Fluid Losses ◽  
High Output

AbstractThis article provides an overview of the pathophysiology, causes, investigations, and management of high-output enterostomy and enterocutaneous fistula. High-output stoma and enterocutaneous fistula can result in intestinal failure and this is often fatal if not managed properly. The management involves reducing fluid losses, providing nutrients with fluids, and treating the underlying cause and sepsis. A multidisciplinary approach is required for successful management of patients with high-output enterostomy and enterocutaneous fistula.

Incidence of poisoning deaths in Finland in 1971–2005

2008 ◽  
Vol 27 (7) ◽  
pp. 567-573 ◽  
Author(s):  
JE Kivistö ◽  
VM Mattila ◽  
J Parkkari ◽  
P Kannus
Keyword(s):  
Children And Adolescents ◽  
Incidence Rate ◽  
Cause Of Death ◽  
Secular Trend ◽  
Incidence Rates ◽  
Morbidity And Mortality ◽  
Death Rates ◽  
Alcohol Poisoning ◽  
Poisoning Deaths ◽  
Considerable Morbidity

Poisonings cause considerable morbidity and mortality worldwide. However, only few countries have published nationwide statistics on poisoning deaths. Based on the Official Cause-of-Death Statistics of Finland, we investigated the incidence and secular trend of poisoning deaths in Finland in 1971–2005. Alcohol poisoning deaths and other poisoning deaths were analyzed separately. During the 35-year study period, other poisoning deaths (non-alcohol) increased from 2.6/100,000 in men and 1.4/100,000 in women in 1971 to 6.8/100,000 and 3.2/100,000 in 2005, respectively. Alcohol poisoning death rates also increased from 9.6/100,000 in men and 0.7/100,000 in women in 1971 to 16.8/100,000 and 4.2/100,000 in 2005, respectively. In the early 1970s, the incidence rates of alcohol deaths were about 10 times higher in men compared with women, whereas in the last few years of observation, men's incidence rate was only about four times higher. Our study showed that alcohol and other poisoning deaths increased in Finland between 1971 and 2005. Men’s risk was markedly higher than women’s risk, but in the later years, women’s risk was increasing. Poisoning death rates among children and adolescents were low throughout the period.

INCIDENCE OF ABDOMINAL TUBERCULOSIS IN PATIENTS PRESENTING WITH PAIN ABDOMEN

2021 ◽  
pp. 13-15
Author(s):  
Pankaj Prasad Verma ◽  
Manjar Ali ◽  
Sanjay Singh ◽  
Vinay Pratap
Keyword(s):  
Health Care Services ◽  
Abdominal Tuberculosis ◽  
Morbidity And Mortality ◽  
Medical Sciences ◽  
Major Health Problem ◽  
Major Health ◽  
Care Services ◽  
Abdominal Symptoms ◽  
Pain Abdomen ◽  
Considerable Morbidity

Tuberculosis is a major health problem worldwide and in India continues to be responsible for considerable morbidity and mortality despite tremendous effort made in diagnosis, prophylaxis and therapy. The disease may involve any system of body but abdomen is one of the commonest site of involvement after lungs. This study is carrying to nd out Incidence of Abdominal Tuberculosis in patients of pain abdomen presenting as acute/chronic cases. The present study was carried out in the Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi, from April 2018 to September 2019. The total number of cases selected disease remains early detection. A continual awareness on the part of the clinician of the possibility of abdominal Tuberculosis in many patients with obscure abdominal symptoms should avoid errors and aid in the detection of a condition, which if treated early, not only produces remarkable remission and relief on the part of for this study was 1800. According to the presentation, the patients were clinically divided into 2 broad groups: those who were admitted as acute emergencies and those who came with a chronic presentation. From these two groups 100 cases were fall in our inclusion criteria. Of these 100 patients, most were in their third or fourth decades of life, and females were approx two times more commonly affected as their male counterparts, maintaining an approximate ratio of 1.86:1. Thus we had a 5.55 % incidence of abdominal Tuberculosis in this series. The development of cheap and efcient procedures for early diagnosis remains one of the practical problems to battle this disease, because the only way to decrease morbidity and mortality of this the patients but also takes unnecessary burden off the health care services.

Pica as a Cause of Death in Three Mentally Handicapped Men

1988 ◽  
Vol 152 (6) ◽  
pp. 842-845 ◽  
Author(s):  
I. J. McLoughlin
Keyword(s):  
Cause Of Death ◽  
Morbidity And Mortality ◽  
Mentally Handicapped ◽  
Mental Handicap ◽  
Considerable Morbidity ◽  
Age Of Death

In Prudhoe Hospital, a large mental-handicap hospital of 1000 residents, it was found that of the 94 deaths that occurred between 1982 and 1986, three were closely associated with the habit of pica. These deaths occurred in severely and profoundly handicapped males, whose average age was 32, compared with an average age of death of 58 for the combined groups of severely and profoundly mentally handicapped patients (22 cases), and an average age of death of 60 for all degrees of handicap (94 cases). It seems likely that the habit of pica constitutes a cause of considerable morbidity and mortality in certain institutionalised patients.

scholarly journals Successful management of a triplet heterotropic caesarean scar pregnancy in spontaneous conception

2019 ◽  
Vol 8 (9) ◽  
pp. 3808
Author(s):  
Nilofar Imamhusen Yelurkar ◽  
Dharam Jatin Shah ◽  
Meena Naresh Satia ◽  
Vijaya Rajesh Badhwar
Keyword(s):  
Previous Cesarean Section ◽  
Successful Management ◽  
Lower Segment ◽  
Triplet Pregnancy ◽  
Management Options ◽  
Surgical Interventions ◽  
Uncommon Presentation ◽  
Laparoscopic Excision ◽  
Medical Line ◽  
Previous Cesarean

A cesarean scar ectopic pregnancy -CSEP is a fairly uncommon presentation wherein the conceptus is implanted at the exact scar site of the previous cesarean section deep in the myometrium. Given the relatively rare incidence of CSEP establishing a diagnosis of CSEP can be challenging current standards of therapy have been derived from data obtained from a limited number of patient’s management options for CSEP range from medical line of treatment to surgical interventions such as sonography guided injections to laparoscopic excision or laparotomy or combination of these modalities. Herein we report a rare case of triplet pregnancy with one gestation sac implanted at the site of lower segment scar diagnosed on transvaginal ultrasonography along with MRI who was managed successfully with systemic methotrexate.

Gastrointestinal fistula with thigh extension and intractable pain

2019 ◽  
pp. bmjspcare-2018-001748
Author(s):  
Ewa Deskur-Śmielecka ◽  
Mateusz Sopata ◽  
Michal Chojnicki ◽  
Maciej Sopata
Keyword(s):  
Quality Of Life ◽  
Wound Care ◽  
Rare Complication ◽  
Enterocutaneous Fistula ◽  
Symptom Relief ◽  
Advanced Rectal Cancer ◽  
Intractable Pain ◽  
Gastrointestinal Fistula ◽  
Selective Therapy

Spontaneous enterocutaneous fistulae are a rare complication in patients with cancer, especially following irradiation, chemotherapy or cytoreductive operations. They are associated with worse prognosis, higher costs of treatment and impaired quality of life. Proper recognition of the problem and fast implementation of selective therapy including water electrolyte resuscitation, infection control, nutritional support, control of output volume, proper wound care and, ultimately, surgical treatment in selected patients may result in better symptom relief and improved quality of life of patients. We describe a case of a patient with advanced rectal cancer and acute pain in the lateral aspect of thigh caused by the presumptive presence of an enterocutaneous fistula, in whom therapy with antibiotics and surgical incision enabled rapid pain relief and comfort of dying.

Post thoracic surgery

2007 ◽  
pp. 103-106
Keyword(s):  
Clinical Practice ◽  
Thoracic Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Morbidity And Mortality ◽  
Surgical Patient ◽  
Current Clinical Practice ◽  
Operative Morbidity ◽  
Careful Assessment

Post thoracic surgery 104 Successful post-operative management of the thoracic surgical patient requires careful assessment. Potential complications should be recognized and managed early, as this will reduce post-operative morbidity and mortality. • In current clinical practice 30 day postoperative mortality following elective lobectomy is approximately 2–3% and minor morbidity is 40–50%....

Ultrasound Devices to Treat Chronic Wounds: The Current Level of Evidence

2020 ◽  
Vol 19 (4) ◽  
pp. 341-349
Author(s):  
Georgios Kotronis ◽  
Prashanth R. J. Vas
Keyword(s):  
Health Care ◽  
Best Practice ◽  
Chronic Wounds ◽  
Wound Care ◽  
Low Frequency ◽  
Current Level ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Considerable Morbidity ◽  
Significant Health

Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular debridement is a key component of wound care with a proven ability to accelerate healing. In this regard, a significant innovation in wound care has been the development of ultrasound debridement technology. The purpose of this review is to evaluate the current evidence behind the technology with an emphasis on noncontact low-frequency (NCLF) ultrasound. A number of studies, especially those evaluating NCLF technology, have demonstrated the potential of ultrasound debridement to effectively remove devitalized tissue, control bioburden, alleviate pain, and expedite healing. However, most of the studies are underpowered, involve heterogeneous ulcer types, and demonstrate significant methodological limitations making comparison between studies difficult; there is a paucity of data on cost-effectiveness. Future clinical trials on ultrasound debridement technology must address the design issues prevalent in current studies, and report on clinically relevant endpoints before adoption into best-practice algorithms can be recommended.

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