Porto-cholecysto-duodenal fistula as an infrequent cause of upper gastrointestinal hemorrhage

A case of porto-cholecysto-duodenal fistula which caused a severe upper gastrointestinal haemorrhage is presented. The difficulties involved in diagnosis and surgical treatment are discussed.     

Case report: Aortoduodenal fistula presenting as iron-deficiency anaemia

Aortoenteric fistulae are a rare cause of gastrointestinal bleeding. If undiagnosed, mortality is high. The outcome of aortoenteric fistula has improved significantly due to better diagnostic modalities, advances in anaesthesia and surgical techniques including endovascular aortic repair. Early diagnosis requires a high index of clinical suspicion. An aortoenteric fistula should be suspected in every patient with a history of surgical or endovascular repair of aortic disease who presents with gastrointestinal bleeding. Most patients present with massive gastrointestinal bleeding. Presentation with iron-deficiency anaemia on routine blood analysis, as in our case report, is extremely unusual.     

Aorto-duodenal fistula: endoscopic diagnosis

We report the case of a patient with hemorrhage due to secondary Aortoenteric Fistula (AEF), diagnosed by emergency oral endoscopy. We stress the importance of early diagnosis in these patients by virtue of a so-called "warning hemorrhage", which usually occurs hours or weeks before the appearance of a massive hemorrhage which is soon fatal. The importance of emergency endoscopy in the early diagnosis of these cases is emphasized.     

Aortocolic fistula,a lethal cause of lower gastrointestinal bleeding

Summary Aortocolic fistula occurs with spontaneous upture of aortic and iliac aneurysms into the sigmoid colon, or due to involvement of the aneurysmal wall by acute diverticulitis. In the eight cases reviewed, this complication proved uniformly lethal, although sufficient clinical findings were present for diagnosis, and adequate time was available for a planned therapeutic approach. Lower gastrointestinal bleeding in the patient who has an aortic aneurysm and left-lower-quadrant inflammation suggests the presence of an aortocolic fistula. Angiography should be performed during a bleeding episode to confirm the diagnosis. Surgical correction consists of an axillofemoral by pass graft, excision of the aortic aneurysm, and a Hartmann procedure.     

上消化道隧道内镜术后消化道瘘的评估与处理

为探讨上消化道隧道内镜术后消化道瘘的评估和处理方法,回顾性分析2012年1月—2022年10月于复旦大学附属中山医院内镜中心诊疗的15例上消化道隧道内镜术后发生消化道瘘患者的临床资料。患者经综合治疗后消化道瘘均成功愈合。3例患者采用了金属夹夹闭瘘口并留置胃管;10例患者采用了胃管联合小肠营养管置入术,其中7例胃管直接置入瘘腔中引流;2例患者接受了食管覆膜支架联合小肠营养管置入术。5例患者接受过创面组织胶喷洒;2例患者在瘘口缩小后,接受了热活检钳或氩离子凝固术灼烧瘘口,行尼龙绳+金属夹荷包缝合。由此可见,隧道内镜术后消化道瘘是复杂的术后并发症,需要早期发现、仔细评估和综合处理。     

Drugs as a cause of gastrointestinal disease

Gastrointestinal disorders are amongst the most commonly reported adverse reactions to drugs. The drugs most frequently implicated in damage to the gastrointestinal mucosa are antibiotics, aspirin, non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs), corticosteroids and potassium salts. The evidence is most conveniently summarized by the site of the damage.     

Primary aortoenteric fistula: a rare cause of gastrointestinal bleeding in young adults

Aortoenteric fistula is defined as a communication between the native aorta and any portion of the gastrointestinal tract. Depending on previous aortic grafting it can be classified as primary, without previous grafting, or secondary. Primary aortoenteric fistula is less frequent and usually arises from an abdominal aortic aneurysm. Clinical presentation is usually gastrointestinal bleeding. The main diagnostic procedures are gastroscopy and computed tomography. We report the case of a 46-year-old man who presented to the emergency room with gastrointestinal bleeding and an abdominal pulsatile mass. Although complementary tests and clinical signs suggested a diagnosis of primary aortoenteric fistula, the communication was not observed on gastroscopy and was confirmed by exploratory laparotomy. Despite aggressive surgical treatment, the prognosis of this entity is poor.     

Aortoenteric fistula: an unusual cause of gastrointestinal hemorrhage

The formation of an aortoenteric fistula is an infrequent cause of intestinal bleeding which carries out a bad prognosis. The causes may be diverse and the clinical picture is, occasionally, very unspecific with a high index of suspicion being fundamental in the management of this type of patients. Four cases of aortoenteric fistula which the authors believe to be clearly demonstrative are presented. One of these cases may currently be considered as very rare in Spain due to the etiology of the same. The authors emphasize the importance of exhaustive exploration by oral endoscopy which is able to diagnosis the localization of the bleeding in 80% of the cases. However they also underline the need for laparotomy, particularly in carriers of aortic vascular grafts which are currently the most important risk group, since confirmation of diagnosis by imaging methods may be delayed.     

经皮内镜下胃造瘘空肠置管术在高位肠外瘘患者中的临床应用

目的探讨经皮内镜下胃造瘘空肠置管术治疗高位肠外瘘患者的方法、并发症及疗效。方法回顾性分析经皮内镜下胃造瘘空肠置管术治疗我院24例高位肠外瘘患者的手术操作时间、成功率、并发症、导管留置时间及肠瘘治愈率。结果所有患者均置管成功,成功率为100%,平均置管时间为(16.5±3.8)min,无置管相关并发症;置管后并发症发生率为12.5%(3/24):2例营养管堵塞,1例造瘘管周围感染,平均导管留置时间(83.7±46.2)d。18例患者肠瘘愈合,治愈率为75%(18/24),5例肠瘘未愈行外科手术治疗,1例因原发病死亡。结论经皮内镜下胃造瘘空肠置管术具有操作简单易行、安全,住院时间短,空肠营养管越过肠瘘给予肠内营养等优点,可用于高位肠外瘘患者的临床治疗。     

Angiodysplasia as a cause of upper gastrointestinal bleeding

Angiodysplasia of the stomach, the proximal part of the small intestine, or both was diagnosed in 30 patients by upper gastrointestinal (Gl) endoscopy over a 40-month period. This diagnosis represented 4% of 676 patients referred over the same time period for endoscopic examination of suspected upper Gl bleeding. Twenty-three patients (77%) had experienced at least one episode of overt bleeding (hematemesis or melena) prior to diagnosis. Multiple gastroduodenal angiodysplastic lesions were found in 19 (63%) of the patients, and additional colonic angiodysplasia was detected in six of 12 patients who also underwent colonoscopy. Renal insufficiency was significantly more prevalent in the patients with angiodysplasia than in a comparison group of similar age with upper Gl bleeding from other lesions (60% v 24%). We conclude that angiodysplasia, although uncommon, should be considered in the differential diagnosis of both occult and overt upper Gl bleeding. The lesion appears to be associated with renal insufficiency.     

Secondary aorto-enteral fistula as a cause of acute recurrent gastrointestinal bleeding, 20 years after living kidney donation

Aorto-enteral fistulas (AEF) are a rare but life-threatening cause of acute gastrointestinal bleeding. Clinically, they can appear through massive haematochezia and haematemesis or as intermittent occult intestinal bleeding. The diagnostic procedure using endoscopy is often difficult but can contribute to making the correct diagnosis. We report on a patient who developed a secondary aorto-enteral fistula twenty years after a living kidney donation. The vascular surgery in combination with a chronic inflammatory reaction had resulted in the formation of a fistula between the renal artery stump and the duodenum. The inflammatory response was maintained by continuous treatment with methotrexate because of rheumatoid arthritis. Despite several total enteroscopies and diagnostic laparotomies, the fistula was seen on several occasions but was overlooked and misinterpreted in the absence of bleeding at first. The suspected fistula was finally marked with two endoclips and confirmed subsequently by radiological imaging by means of an abdominal CT scan.     

Aorto-intestinal fistula following bypass operation--a rare cause of gastrointestinal hemorrhage

A rare case of aorto-enteric fistula is reported. The age of the patient was 56 years. The fistula is a complication of abdominal aortic surgery. The early diagnosis (duodenoscopy) decides on life of the patient.     

Imprint cytology in the endoscopic diagnosis of gastrointestinal malignancies

BACKGROUND/AIMS: To compare imprint cytology with histopathology regarding diagnostic accuracies and quickness in the diagnosis of gastrointestinal malignancies. METHODOLOGY: Multiple endoscopic biopsies were taken from 146 patients having various lesions without a prior histopathological diagnosis. Imprint smears were prepared, using all biopsied tissues, on 3-5 slides. Tissues were fixed in 10% formalin. Time from the materials were received at the pathology laboratory to when the results were available was recorded. Cytopathologists and histopathologists, blinded to each other's diagnosis, examined the imprint smears and tissues. RESULTS: Average time to get imprint cytology results was shorter than that of histopathology (55 minutes vs. 8 days). Fifty-eight patients had a final diagnosis of malignancy. Histopathology and imprint were positive in 56 and 54, respectively. Eighty-eight patients had benign histopathology, all of these had negative imprint results. False-negative and false-positive rates for imprint were 6.8%, 0% and for histopathology were 3.4%, 0%, respectively. CONCLUSIONS: Imprint cytology is an easy, reliable method that can be used as an adjunctive measure with histopathology. It gives the earliest information about the nature of the lesion with a minimum misdiagnosis risk. Imprint cytology lets the surgeon plan a therapeutic strategy approximately 1 week earlier.     

Sonographic diagnosis and endoscopic therapy of a biliopancreatic fistula complicating a pancreatic pseudocyst

This is the first report of a case of biliopancreatic fistula complicating a pancreatic pseudocyst diagnosed correctly by transabdominal ultrasound. The diagnosis was confirmed by magnetic resonance and endoscopic retrograde cholangiopancreatography. The fistula was treated successfully with biliary stenting. The clinical and imaging features of this exceptional complication are presented along with a brief review of the topic.     

重视少见胃肠道疾病的内镜诊断

内镜工作从上世纪８０年代中期开始至今，得到了迅速的发展，内镜检查已经成为日常诊断胃肠道疾病的主要手段，解决了很多临床问题，年复一年的工作使内镜诊断已越来越成熟，并且已经从单纯诊断进而通过内镜给予治疗，甚至替代了一些外科手术，减轻患者的痛苦和经济负担。因此内镜技术已成为临床工作的重要手段。但是，学无止镜，还有许多疾病存在内镜诊断的困难，需要从事消化内镜的医生们去探索，以达到精益求精。如本期发表的少见疾病的报道，望引起同道们注意。淀粉样变是由于淀粉样蛋白沉积于组织并致组织损害所引起的一种临床综合征，…