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Intestinal Fistula

Intestinal Fistula and Abscess


Presentation

  • The doctor will also ask about the person's symptoms, including when they presented and whether anything relieves or worsens them. If the doctor suspects a gastrointestinal fistula, they will order medical tests to confirm the diagnosis.[medicalnewstoday.com]
  • The presenting signs and symptoms of fistulae associated with ovarian tumours vary. Rare cases present with giant cystic air-filled masses 8, 9 ; others, with bowel obstruction necessitating emergency surgical intervention 10.[current-oncology.com]
  • OBJECTIVE: To present a case of ureterocolonic fistula secondary to acute sigmoid diverticulitis in a nonfunctioning ureter due to a previous nephrectomy.[ncbi.nlm.nih.gov]
  • In general, at least 48 inches of bowel either proximal or distal to the fistula must be present in order to utilize this route.[ncbi.nlm.nih.gov]
  • Control of Sepsis Sepsis is the most common presenting symptom of enterocutaneous fistulas, and the majority of deaths are related to uncontrolled sepsis. 1 Computed tomography (CT) scan can define abscesses and may guide percutaneous drainage.[ncbi.nlm.nih.gov]
Physician
  • Drainage of these abscesses should be carried out only after injection of water-soluble contrast into the abscess by the physician. These studies can yield anatomic information that is otherwise unobtainable.[ncbi.nlm.nih.gov]
  • J Coll Physicians Surg Pak. 2004; 14 :237–240. [ PubMed ] [ Google Scholar ] 38. Leandros E, Antonakis P T, Albanopoulos K, Dervenis C, Konstadoulakis M M.[ncbi.nlm.nih.gov]
Fishing
  • Penetration of the intestinal wall from a foreign body (eg, an ingested metallic object or a fish bone) can lead to enteroenteric fistula formation because of erosion into adjacent bowel loops. Fistulas do not commonly form this way.[emedicine.medscape.com]
Drooling
  • Oral glycopyrrolate alleviates drooling in a patient with tongue cancer. J Pain Symptom Manage. 1999; 18 (04):300–302. [ PubMed ] [ Google Scholar ] 27. Tscheng D Z. Sialorrhea - therapeutic drug options.[ncbi.nlm.nih.gov]
Ulcer
  • Inflammation gradually progresses to microabscess formation and internal perforation in the ulcerated areas. The ulcerated areas penetrate through the bowel wall into the adjacent involved structure, leading to fistula formation.[emedicine.medscape.com]
  • Other possible causes of gastrointestinal fistulae include: a history of radiation to the abdomen infection, such as diverticulitis inflammatory bowel diseases, including Crohn's disease an ulcer in the gut physical injury to the abdomen cancer Symptoms[medicalnewstoday.com]
Excoriation
  • Enteric fluid rapidly leads to skin excoriation and breakdown.[ncbi.nlm.nih.gov]
  • The success of surgical therapy may be improved if excoriation or superinfection of the skin surrounding the fistula tract can be prevented. After initial stabilization and resuscitation, adequate attention must be directed to nutritional support.[ncbi.nlm.nih.gov]
Blurred Vision
  • Side effects may include behavioral irritability, urinary retention, constipation, excessive dryness of the mouth, headache, drowsiness, blurred vision, facial flashing, vomiting, and inability to sweat in hot environments.[ncbi.nlm.nih.gov]
Headache
  • Side effects may include behavioral irritability, urinary retention, constipation, excessive dryness of the mouth, headache, drowsiness, blurred vision, facial flashing, vomiting, and inability to sweat in hot environments.[ncbi.nlm.nih.gov]

Workup

Ischemic Changes
  • Radiation injury and malignancy Long-term radiation injury to the intestine leads to ischemic changes in the intestinal wall. Erosions and dense adhesions between bowel loops develop, which can result in enteroenteric fistula formation.[emedicine.medscape.com]

Treatment

  • It is emphasized that these less commonly used approaches should be regarded as complimentary tools in the arsenal of those treatments whose role is already established in the treatment of enterocutaneous fistulas.[ncbi.nlm.nih.gov]
  • Treatment Treatment for a gastrointestinal fistula depends on its severity and location. Fistulae that are small and not infected will often close on their own.[medicalnewstoday.com]
  • The etiology of small intestinal fistulas is important for determining the subsequent treatment. The common mechanisms of intestinal fistula formation are outlined below.[emedicine.medscape.com]
  • Serous ovarian carcinoma is highly responsive to chemotherapy, with a response rate as high as 80% to first-line treatment 16.[current-oncology.com]
  • […] radiation, malignancy, infection Two categories [ edit ] Low-output fistula: 500 mL/day High-output fistula: 500 mL/day Three categories [ edit ] Low-output fistula: 200 mL/day Moderate-output fistula: 200–500 mL/day High-output fistula: 500 mL/day [3] Treatment[en.wikipedia.org]

Etiology

  • The etiology of small intestinal fistulas is important for determining the subsequent treatment. The common mechanisms of intestinal fistula formation are outlined below.[emedicine.medscape.com]
  • Fistulas may be classified based on anatomic, physiologic, or etiologic criteria ( table I ).[ncbi.nlm.nih.gov]
  • Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002; 224 (01):9–23. [ PubMed ] [ Google Scholar ] 57. August D A, Serrano D, Poplin E.[ncbi.nlm.nih.gov]

Pathophysiology

  • Thus, in essence, the pathophysiology underlying the development of metabolic acidosis from a duodenal fistula is the same as that of a pancreatic fistula- it is basically the same secretions being lost. Not so for the jejunum.[derangedphysiology.com]

Prevention

  • The presence of food in the gut triggers the additional secretion of gastric juices, preventing a person with a fistula from getting enough nutrients. A lack of nutrition will make it difficult for a person's body to heal.[medicalnewstoday.com]
  • Malnutrition is easier to prevent than correct. Once established, malnutrition may be difficult to correct, especially with concomitant sepsis, but malnutrition and sepsis remain principal causes of death in patients with fistulas.[ncbi.nlm.nih.gov]
  • Somatostatin and octreotide in the prevention of postoperative pancreatic complications and the treatment of enterocutaneous pancreatic fistulas: a systematic review of randomized controlled trials.[ncbi.nlm.nih.gov]

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