Nematode as a Cause of Appendicular–Cutaneous Fistula

BackgroundCutaneous fistula may develop spontaneously as a complication of an perforating appendicitis. However, intestinal fistula caused by parasites is a rare report.Case presentationIn the operation, we found that expanded appendix was perforated from its distal part and was fistulized to the right lateral abdominal wall. The complications of postoperative was intestinal fistula. Colonoscopy was performed revealing some nematode around the appendiceal orifice. The development of fistula after bowel resection and anastomosis can be devastating. Immediate drainage and establishment of enteral nutrition can lead to spontaneous healing of fistula.ConclusionsTesting for nematode infection in a patient with suspected appendicitis is not routine, it still stands as a challenge in clinical practice. In view of this situation, killing parasites is necessary, otherwise it is difficult to cure.

Survival and swallowing function outcome impact factors analysis of surgery-oriented comprehensive treatment for hypopharyngeal cancer in a series of 122 patients

Objective Under current standards of treating highly aggressive hypopharyngeal cancer (HPC), oncological control and functional outcome are still unsatisfactory worldwide. This study explored the surgery-oriented comprehensive treatment approach based on 15 years of practice. Methods A retrospective cohort of HPC patients treated by the senior author at Chinese PLA General Hospital between Nov 2005 and Aug 2012 and Capital Medical University Beijing Friendship Hospital between May 2014 and Nov 2019 was studied. Oncological control, swallowing function, and quality of life (QoL) were assessed. Results In total, 122 patients were included in this study, with 11 (9.0%) cases in the early stage and 111 (91.0%) cases in the advanced stage. Five-year overall survival (OS) and disease-free survival (DFS) were 40.0% and 36.1%, respectively. The swallowing outcome was satisfactory in 90 (73.8%) patients. Tracheostomy-free survival was achieved in 55 (45.1%) patients. Multivariate cox regression analysis showed that the size of the surgical defect, local-regional recurrence, and distant metastasis were independent impact factors for OS and DFS ( P < .05). Multivariate analysis showed that the logistic regression coefficients (standard error) of pharyngo-cutaneous fistula and local-regional recurrence on swallowing function were 1.274 (.532) and 1.283 (.496), respectively ( P < .05). In addition, the logistic regression coefficients (standard error) of the clinical stage, local-regional recurrence, decannulation, and feeding tube on QoL were −7.803 (3.593), −7.699 (3.151), 13.853 (3.494), and −20.243 (3.696), respectively ( P < .05). Conclusions Surgery-oriented comprehensive treatment can give rise to good swallowing function without jeopardizing oncological control. The size of the surgical defect, local-regional recurrence, and distant metastasis were independent factors impacting OS and DFS. Pharyngo-cutaneous fistula and local-regional recurrence were independent factors impacting swallowing function. Clinical stage, local-regional recurrence, decannulation, and feeding tube were independent factors impacting QoL.

Curious Case of Spontaneous Colocutaneous Fistula

A colocutaneous fistula is an infrequent condition, which often occurs as a post- surgical complication, while a spontaneous colocutaneous fistula is an even rarer occurence, which may be seen in conditions like diverticulitis or Crohn’s disease. Cases of colocutaneous fistulas as a sequelae of endometriosis are very rare. Here, we present a case report of a 38 year old lady who presented developed a spontaneous colo-cutaneous fistula secondary to endometriosis involving the sigmoid colon.

Orocutaneous Fistula After Oral Cavity Resection and Reconstruction: Systematic Review and Meta-Analysis

Objective: Orocutaneous fistula (OCF) after reconstruction for oral cavity resection can lead to prolonged hospitalization and adjuvant treatment delay. Few studies have examined factors leading to OCF after oral cavity resection. Primary objective: evaluate overall incidence and factors associated with OCF after oral cavity reconstruction. Data Sources: Scopus 1960—database was searched for terms: “orocutaneous fistula,” “oro cutaneous fistula,” “oral cutaneous fistula,” “orocervical fistula,” “oral cavity salivary fistula.” Review Methods: English language studies with >5 patients undergoing reconstruction after oral cavity cancer resection were included. About 1057 records initially screened; 214 full texts assessed; 78 full-texts included. PRISMA guidelines were followed, and MINORS criteria used to assess risk of bias. Data were pooled using random-effects model. Primary outcome was OCF incidence. Meta-analysis to determine the effect of preoperative radiation on OCF conducted on 12 eligible studies. Pre-collection hypothesis was that prior radiation therapy is associated with increased OCF incidence. Post-collection analyses: free versus pedicled flaps; mandible-sparing versus segmental mandibulectomy. Results: Seventy-eight studies were included in meta-analysis of overall OCF incidence. Pooled effect size showed overall incidence of OCF to be 7.71% (95% CI, 6.28%-9.13%) among 5400 patients. Meta-analysis of preoperative radiation therapy on OCF showed a pooled odds ratio of 1.68 (95% CI, 0.93-3.06). OCF incidence was similar between patients undergoing free versus pedicled reconstruction, or segmental mandibulectomy versus mandible-sparing resection. Conclusion: Orocutaneous fistula after oral cavity resection has significant incidence and clinical impact. Risk of OCF persists despite advances in reconstructive options; there is a trend toward higher risk after prior radiation.