External Duodenal Fistula Research Articles

Prevalence of and Risk Factors for Abdominal Bleeding in Patients with External Duodenal Fistula.

BackgroundAbdominal bleeding is a severe complication of duodenal fistula, but few studies have focused on this problem. The purpose of the present study was to investigate the prevalence of and risk factors for intra-abdominal bleeding in patients with external duodenal fistula.Material/MethodsFrom January 2014 to December 2016, medical records of 97 patients with external duodenal fistula were retrospectively reviewed and analyzed. The prevalence and risk factors for intra-abdominal bleeding were evaluated.ResultsThe prevalence of abdominal bleeding in patients with external duodenal fistula was 31.9% (95%CI: 22.5–41.4%). A total of 31 patients had intra-abdominal bleeding. Results revealed that acute kidney failure (OR: 8.462, 95% CI: 1.921–37.28, p=0.005) and retroperitoneal infection (OR: 5.373, 95% CI: 1.504–19.197, p=0.010) were associated with abdominal bleeding.ConclusionsThe prevalence of abdominal bleeding in patients with external duodenal fistula was 31.9%, and acute kidney failure and retroperitoneal infection were found to be risk factors for intra-abdominal bleeding.

Spectrum of Presentation and Management of External Duodenal Fistula Following Surgery- A Hospital Based Study

Spectrum of Presentation and Management of External Duodenal Fistula Following Surgery- A Hospital Based Study

Antegrade endobiliary interventions in undilated bile ducts

To show advisability of antegrade transhepatic approach to bile ducts for benign and malignant biliary diseases if endoscopic technique is impossible or ineffective. 38 patients underwent external biliary drainage followed by endobiliary interventions for the period 2009-2016. In all patients treatment was effective and included following manipulations: antegrade balloon dilatation of stricture of biliodigestive anastomosis, papillodilatation, antegrade dislocation of calculuses from common bile duct to duodenum. There were 2 cases of complications after antegrade interventions. 1 woman died from severe pancreatic necrosis. Percutaneous transhepatic cholangiostomy on undilated bile ducts is effective for temporary biliary drainage in closure of external duodenal or biliary fistula, treatment of intra-abdominal bilema. The method is indicated in elective endobiliary interventions for choledocholithiasis management, elimination of stricture of biliodigestive anastomosis of major duodenal papilla if endoscopic or conventional approaches are impossible or ineffective.

Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.

Rectus abdominis muscle flap for high-output duodenal fistula: novel technique.

Duodenal fistula after closure of peptic ulcer perforation, though rare, is difficult to manage and carries a high mortality. The high mortality is associated with the poor nutritional status of the patient, high output from the fistula, and late development of peritonitis and septicemia. The various techniques described in the literature for the closure of the postsurgical external duodenal fistulas range from conservative management with total parenteral nutrition (TPN), serosal patch repair, and Roux-en- Y procedures to radical surgery like Billroth II gastrectomy. Total parenteral nutrition achieves spontaneous closure in 70% to 80% of cases, but it is very expensive and requires prolonged hospitalization. In addition, some surgical procedures have yielded poor results in our setting, so we sought a new modality of treatment. We describe a novel technique for repair of postsurgical external fistula of the duodenum with a rectus abdominis muscle flap. The rectus abdominis muscle is detached from its superior attachment and mobilized from the rectus sheath. The flap, based on the deep inferior epigastric artery, is raised and sutured to the duodenal fistula with thick silk sutures. We treated six patients with post-surgical duodenal fistulas with this technique between 1995 and 2002. The leak was completely sealed in all patients. One patient died of septicemia. We recommend this technique for the management of postsurgical external duodenal fistula as an alternative to other surgical techniques.

Successful management of external duodenal fistula in a specialized unit

High-output external duodenal fistula remains a challenging condition to treat. Despite advances in metabolic and nutritional care, mortality rates remain high. Retrospective casenote review of patients managed on a specialised unit. Thirteen of 388 admissions (3.4%, 11 males, median age 51 years) had an external duodenal fistula. Management was by eradication of abdominal and systemic sepsis and maintenance of nutritional status by the administration of total parenteral nutrition. The majority of fistulas followed surgery for peptic ulcer disease. Eight of 13 fistulas closed spontaneously, and of those requiring operative closure, surgery was successful in 4 of 5 cases. There were 2 mortalities. High-output external duodenal fistula may be successfully managed in a specialised unit.

Bile acid inhibits tetragastrin-stimulated gastric secretion after Roux-en-Y biliary diversion in dogs

The present study was carried out to investigate the effect of several bile acids on tetragastrin-stimulated gastric secretion in dogs in which diversion of the biliary system was performed. Cholecystojejunostomy of the Roux-en-Y type was performed, along with the creation of a Heidenhain pouch (HP) and an external duodenal fistula. Gastric juice was collected from the HP and a mixture of bile acids and corn oil was administered through the duodenal fistula. Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) exerted an inhibitory effect on gastric hypersecretion. Conjugated UDCA and several bile acids with different hydroxyl groups were also examined, and these bile acids also showed evidence of an inhibitory effect on the secretion of gastric juice, although there were no significant differences between them. Thus, it appears that all bile acids inhibit tetragastrin-stimulated gastric hypersecretion. This finding suggests that peptic ulcer disease can be prevented by the administration of bile acids to patients who undergo biliary diversion and are at a high risk for this postoperative complication.

External duodenal fistula. Causes, complications, and treatment.

We reviewed records of 18 patients with external duodenal fistula. Fourteen patients developed duodenal fistulas following an operation, two following abdominal trauma, and two as a complication of other diseases. Copious drainage of intestinal juice from the abdomen was the most common presenting sign. Contrast fistulography, upper gastrointestinal tract roentgenography, and T-tube cholangiography were useful diagnostic studies. Nine patients were treated nonoperatively; nine patients required at least one operation. Complications occurred frequently; of special interest were three patients who developed postoperative acute cholecystitis. Six patients died (33% mortality). Factors associated with mortality were advanced age (greater than 65 years), uncontrolled infection and multiple organ failure, high-output fistula, malnutrition, delay in diagnosis (more than three days), and multiple reoperations to treat the fistula or complications. External duodenal fistula continues to be a life-threatening problem whether it is postoperative, posttraumatic, or secondary to a disease process.

Duodenal fistula: With special reference to choledochoduodenal fistula complicating duodenal ulcer

The subject of duodenal fistula has been reviewed. During a fifteen-year period at Charity Hospital and Touro Infirmary, New Orleans, Louisiana, forty-three duodenal fistulas were recorded with a 37.2 per cent mortality. Four deaths occurred in twenty-one internal fistulas and twelve deaths in twenty-two external fistulas. There was a 66.6 per cent mortality in the end type of external fistula. The average onset of the end type of fistula was eight days after surgery. This type occurred more frequently in men. There was a 40 per cent mortality in the lateral type of external fistula. The average onset of the lateral type was five days after surgery. No sex preponderance was noted in this type. Interruption of intestinal continuity produced by external duodenal fistula leads to loss of contents and destruction of the abdominal wall. Adequate replacement of fluids and electrolytes and constant removal of drainage from the fistula by suction are important considerations in the care of these patients. Internal duodenal fistulas often communicate with the gallbladder. Rarer is the choledochoduodenal fistula which usually arises from duodenal ulcer which perforates onto the common duct. Most duodenocolic fistulas are due to carcinoma. Slightly less frequent in causation is duodenal ulcer. The demonstration of duodenocolic fistula is best accomplished by barium enema. The treatment of malignant duodenocolic fistula is radical resection in one or two stages, and duodenocolic fistula due to benign ulcer, subtotal gastrectomy and closure of colonic opening. Regurgitation of duodenal contents into the common duct is ordinarily prevented by the oblique course of the common duct through the pancreas and duodenal wall, the valve-like folds in the ampulla of Vater and the sphincter of Oddi. The presence of air in the biliary tract is of great value in diagnosis of patients who are seen for the first time during the phase of intestinal obstruction since gallstone ileus usually has its beginning with a duodenobiliary communication. The possibility of developing an abnormal communication between the biliary tract and duodenum due to biliary tract disease is a strong argument for removal of the gallbladder in all cases of cholelithiasis. Once the fistula is present, it must be attacked, the opening in the bowel closed, gallbladder removed and the common duct explored. Five case reports of choledochoduodenal fistula complicating duodenal ulcer are presented. There is a twofold problem in the management of this condition: to rid the patient of his fistula and to cure him of his ulcer. The preferred method of handling the fistula would appear to be reimplantation of the common duct into the duodenum or jejunum, and subtotal gastrectomy combined with vagotomy.

The Use of Blood in the Treatment of Duodenal Fistula

EXTERNAL duodenal fistula constitutes a problem of great importance: and if not corrected usually terminates fatally.1 Fortunately, it is a rare complication. Up to 1923 only 61 cases had been reported.2 In a more recent communication by Bartlett and Lowell,3 however, 128 authentic cases were presented in what was believed to be a complete review of the literature from 1865 to 1937. It is apparent that within the last two decades the prevalence of this disease has increased, perhaps owing to the greater number of operative procedures carried out in the right upper quadrant of the abdomen. The mortality is still extremely high. Most authors consistently report an approximate mortality of 50 per cent irrespective of the procedures used, whether medical or surgical.4 Management along conservative measures, however, has considerably reduced the mortality.5 According to Kittelson,6 65 cases treated conservatively had

A note on external duodenal fistula: With a record of some unpublished cases

A note on external duodenal fistula: With a record of some unpublished cases