Chronic fistula to rabbit cecum microbiome study

The purpose of this work is to approve a device for studying the microbiome of the gastrointestinal tract of mammals. The study of the quantitative and qualitative composition of the digestive tract microbiota is one of the promising directions in metagenomics. Knowledge obtained about the organization of microbiocenosis genome, the determination of species composition and study of metabolic relationships between its representatives not only expand the understanding of its role in the process of evolution, speciation and breeding but also provide a scientifically substantiated basis for targeting changes in the microbiome to form a phenotype (optimization of feed bioconversion, increasing overall resistance, etc.). Scientific novelty. For the first time, the main characteristics of cellulolytic bacteria isolated from the chyme of the rabbit cecum were isolated, cultured and described through a chronic fistula. Methods. In order to carry out research aimed to study mammalian microbiome and its correction, the need arises to develop methods of obtaining microbiome samples from experimental animals. To obtain access to the chyme of the cecum in 7 rabbits for up to 3 months the chronic fistulas developed in Scientific Research Institute of Fur-Bearing Animal Breeding and Rabbit Breeding n. a. V. A. Afanas’ev were installed. No negative manifestations were observed in the animals after installation of the fistulas, no changes in appetite were detected, and complete healing of the skin wound was determined on the 9th day. Diagnostic laparotomies performed 3 months after fistula placement revealed no pathological processes in any of the studied animals. Results. Characteristics of cellulolytic bacteria of the rabbit cecum Butirivibrio fibrisolvens and Ruminococcus flavefaciens were studied. Data on their enzymatic effects on dietary components, fermentation products, digestion and formation of organic substances and chemical compounds are presented.

Minimally Invasive Two-Staged Surgery in the Treatment of Large Cystic Lesions of the Jaw

Background: Cystic lesions of the jaw are commonly found in clinical practice. Large, expansive cysts raise challenges for the clinician from both diagnostic and surgical perspectives. The aim of our work is to present a combined, two-staged surgical approach in histologically confirmed non-aggressive cystic lesions of the jaw. Methods and Results: We report the case of an extensive mandibular cyst, associating a high risk of bone fracture, that is treated in the initial stage by cystic decompression through marsupialization with concomitant histological diagnostic confirmation, followed in the second stage by radical excision and mandibular reconstruction with titanium mesh, with the purpose of prevention for oro-cystic chronic fistula formation. Conclusions: Large odontogenic mandibular cysts imply a meticulously conducted assessment and treatment. Marsupialization should be taken into consideration for the treatment of large cystic lesions, followed by secondary enucleation, with minimal risks for the patient. The soft tissue healing process can be optimized with the use of titanium meshes, as an alternative for other reconstructive techniques, in the management of large cystic lesions.

Understanding New Ideas in Cryptoglandular Fistula-in-Ano

Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.

Multi-layer endoscopic suturing: a novel method of gastric fistula closure

Background and study aims Current endoscopic methods of treating gastric fistulas are either too complex or have high rates of recurrence. We aimed to provide a novel endoscopic method for robust fistula closure. Patients and methods This was a single-center, retrospective study of five patients who underwent multi-layer endoscopic suturing for closing of a chronic fistula (> 4 weeks). Devitalization of the fistula tract was achieved with argon plasma coagulation, followed by endoscopic suturing of the fistula. Then, endoscopic suturing of the gastric wall surrounding the fistula was performed, creating an overlay of healthy gastric mucosa around the fistula. Results Technical success (fistula closure on the day of the procedure) was achieved in all five patients, with no complications. After a median follow up of 5 months (range 2–23 months), there was a 100 % clinical success rate (no fistula recurrence). Conclusions Our single-operator method of multi-layer endoscopic suturing provides a robust fistula closure with minimal to no risk of recurrence. In light of limitations of current fistula closure methods, further investigations are warranted to better define long-term outcomes with it compared to alternative methods.

Laparoscopic Diagnosis and Treatment of Gossypiboma Postconventional Ovariohysterectomy in a Bitch

Introduction. Gossypiboma is a rare surgical complication in small animals. The authors reported the laparoscopic diagnosis and treatment of an abdominal gossypiboma and chronic draining fistula postopen ovariohysterectomy (OVH) unresponsive to medical treatment in a bitch. Case Presentation. The patient had undergone OVH and exploratory laparotomy in other veterinary practice 3 years previously. The animal, presenting a chronic fistula, was then referred to UFSM Veterinary Hospital. Ultrasonographic examination revealed a structure compatible with a granuloma. For the laparoscopic procedure, a 3-port (two at 11 mm; one at 6 mm) access was used. Adhesiolysis and mass removal were performed by blunt dissection and bipolar electrocoagulation. The fistula was treated by mobilising the omentum through it. There were no intra- or postoperative complications. The chronic wound showed first intention healing. The mass was composed of fibrous tissues surrounding one surgical gauze. Discussion and Conclusion. The removal of a retained surgical gauze in the abdomen by laparoscopy has already been described in medicine. However, a laparoscopic approach for treating a fistulous draining tract due to a gossypiboma has not been previously reported in dogs. Laparoscopic exploration of the fistula allowed the use of a pedicled omental flap through infected sites to control chronic infection. Laparoscopic surgery can be used to identify and treat abdominal gossypiboma in dogs, including those with chronic abdominal sinus.

A Case Report of Skip Lesions in Perianal Mucinous Adenocarcinoma

Perianal Mucinous Adenocarcinoma (PMA) is a rare gastrointestinal malignancy, known to occur in patients with a long-standing history of recurrent perirectal abscesses or a chronic fistula. In this case report, we present a unique presentation of perianal mucinous adenocarcinoma, which began as a rectal abscess and progressed to a case of perianal mucinous adenocarcinoma, with a skip lesion present all the way up in the mid-rectal region. To the best of our knowledge, this is the first case in which PMA presented with skip lesions as opposed to a continuous lesion, and presented without a long standing history of fistulas and recurrent abscesses, but instead just a 4-day history of perianal burning, itching and tingling. The use of CT imaging, MRI’s and PET scans as diagnostic modalities for PMA are further elucidated in the report, along with a discussion of NCCN guidelines on using radiation therapy followed by an APR with inguinal node dissection for the management and treatment of PMA. Sharing this unique and atypical presentation of PMA with multimodality speciality groups and tumor boards helps in the development of various diagnostic and therapeutic approaches for PMA, as well as enhances our understanding of this rare malignant entity.

Management of Chronic Fistula Using the Cardiac Septal Defect Occluder

Therapeutic endoscopy plays a critical role in the management of gastrointestinal (GI) fistulas. Innovative endoscopic approaches have revolutionized the treatment of GI fistulas; however, current endoscopic treatment modalities require multiple sessions and are associated with highly variable success rates and safety profi les. Due to these currently limitations, the off -label use of cardiac septal defect occluders (CSDOs) has emerged as a promising device to treatment GI fi stulas, with early studies suggesting it to be a technically feasible, effective, and safe treatment. Therefore, we believe CSDO devices may be a preferred option for the management of refractory GI fistulas.

Percutaneous embolization for a subacute gastric fistula following laparoscopic sleeve gastrectomy: a case report and literature review

Background The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles’ heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. Case presentation A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. Conclusions PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention.

5 CREATION OF A CHRONIC PERIANAL CROHN’S FISTULA IN SWINE

Introduction Perianal Crohn’s disease (PCD) is associated with worse outcomes including poor quality of life and higher medical costs. PCD is notoriously difficult to treat despite advancements in biologic therapies for luminal disease. In order to test innovative therapies for PCD, an animal model that closely mimics human perianal disease is warranted. Previous efforts were successful in creating perianal fistulas in swine, however, these closed after removal of the seton. A chronic model that maintains the fistula open and replicates the inflammatory component found in clinic is necessary. Methods Under general anesthesia, 4 female pigs underwent creation of surgical perianal fistulas using basic surgical technique with scalpel and hemostat. Size 24 French silicone foley catheter setons were placed to maintain patency of the fistula tract. Each pig had 3 fistulas created – 1 rectovaginal and 2 perianal. The setons were left in place for 4 weeks. After removal of the setons, Trinitrobenzenesulfonic acid (TNBS) was administered into the fistula tract twice a week to create local inflammation. After 2 weeks of TNBS, an MRI was obtained to assess the fistula tracts and the pigs were sacrificed to review histopathology. Results MRI showed successful creation of chronic fistula tracts, and maintenance of these tracts 2 weeks after removal of setons. We noted a transsphincteric fistula with supralevator component as well as an associated abscess 3.3 x 1.0 cm containing fluid and gas (Fig 1). Gross specimen revealed patent fistula tracts. Histopathology found significant chronic active inflammation on standard H&E staining (Fig 2). Conclusions A chronic perianal fistula model in pigs was successfully created using large bore rubber setons and TNBS stimulation that strongly resembles that seen in humans. Further studies are needed to standardize the conditions required to have a reproducible model with well-defined levels of inflammation, fistula patency, and other parameters.