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Interventional management of gastrointestinal fistulas.

Kwon SH, Oh JH, Kim HJ, Park SJ, Park HC - Korean J Radiol (2008 Nov-Dec)

Bottom Line: Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality.GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin.In addition, new interventional management techniques continue to emerge.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Kyung Hee University Medical Center, Seoul, Korea.

ABSTRACT
Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.

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High-output fistula after Billroth I operation due to stomach cancer.A. Abdomen CT image shows abnormal loculated fluid collection with scanty air-bubbles (arrows) adjacent to gastroduodenal anastomotic site.B. Fistulogram after insertion of drainage tube shows fistula tract (arrow) from intra-abdominal abscess pocket to remnant of stomach via anastomosis site and stenosis at anastomosis site.C. Upper GI series obtained immediately after placement of covered Nitinol stent at gastroduodenal anastomosis site shows fully expanded stent with good passage of contrast media without visible fistula tract.D. Follow-up upper GI series taken three months after stent placement shows properly located stent with excellent patency.
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Figure 3: High-output fistula after Billroth I operation due to stomach cancer.A. Abdomen CT image shows abnormal loculated fluid collection with scanty air-bubbles (arrows) adjacent to gastroduodenal anastomotic site.B. Fistulogram after insertion of drainage tube shows fistula tract (arrow) from intra-abdominal abscess pocket to remnant of stomach via anastomosis site and stenosis at anastomosis site.C. Upper GI series obtained immediately after placement of covered Nitinol stent at gastroduodenal anastomosis site shows fully expanded stent with good passage of contrast media without visible fistula tract.D. Follow-up upper GI series taken three months after stent placement shows properly located stent with excellent patency.

Mentions: Classification of fistulas by output volume can be divided into high output and low output fistulas. High output fistulas (Fig. 3) drain between 300 and 4,000 ml per day, and usually arise from a lesion located between the inferior third of the esophagus and the ligament of Treitz. Low-output fistulas (Fig. 4) that drain less than 100 ml per day generally arise from the ileum or colon, except in the case of intestinal malabsorption (4). Recently, the output of pancreatic and intestinal fistulas has been characterized as either high or low output according to the volume of discharge over a 24-hour period (1, 2). Etiologic classification is determined with respect to the underlying disease.


Interventional management of gastrointestinal fistulas.

Kwon SH, Oh JH, Kim HJ, Park SJ, Park HC - Korean J Radiol (2008 Nov-Dec)

High-output fistula after Billroth I operation due to stomach cancer.A. Abdomen CT image shows abnormal loculated fluid collection with scanty air-bubbles (arrows) adjacent to gastroduodenal anastomotic site.B. Fistulogram after insertion of drainage tube shows fistula tract (arrow) from intra-abdominal abscess pocket to remnant of stomach via anastomosis site and stenosis at anastomosis site.C. Upper GI series obtained immediately after placement of covered Nitinol stent at gastroduodenal anastomosis site shows fully expanded stent with good passage of contrast media without visible fistula tract.D. Follow-up upper GI series taken three months after stent placement shows properly located stent with excellent patency.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627247&req=5

Figure 3: High-output fistula after Billroth I operation due to stomach cancer.A. Abdomen CT image shows abnormal loculated fluid collection with scanty air-bubbles (arrows) adjacent to gastroduodenal anastomotic site.B. Fistulogram after insertion of drainage tube shows fistula tract (arrow) from intra-abdominal abscess pocket to remnant of stomach via anastomosis site and stenosis at anastomosis site.C. Upper GI series obtained immediately after placement of covered Nitinol stent at gastroduodenal anastomosis site shows fully expanded stent with good passage of contrast media without visible fistula tract.D. Follow-up upper GI series taken three months after stent placement shows properly located stent with excellent patency.
Mentions: Classification of fistulas by output volume can be divided into high output and low output fistulas. High output fistulas (Fig. 3) drain between 300 and 4,000 ml per day, and usually arise from a lesion located between the inferior third of the esophagus and the ligament of Treitz. Low-output fistulas (Fig. 4) that drain less than 100 ml per day generally arise from the ileum or colon, except in the case of intestinal malabsorption (4). Recently, the output of pancreatic and intestinal fistulas has been characterized as either high or low output according to the volume of discharge over a 24-hour period (1, 2). Etiologic classification is determined with respect to the underlying disease.

Bottom Line: Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality.GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin.In addition, new interventional management techniques continue to emerge.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Kyung Hee University Medical Center, Seoul, Korea.

ABSTRACT
Gastrointestinal (GI) fistulas are frequently very serious complications that are associated with high morbidity and mortality. GI fistulas can cause a wide array of pathophysiological effects by allowing abnormal diversion of the GI contents, including digestive fluid, water, electrolytes, and nutrients, from either one intestine to another or from the intestine to the skin. As an alternative to surgery, recent technical advances in interventional radiology and percutaneous techniques have been shown as advantageous to lower the morbidity and mortality rate, and allow for superior accessibility to the fistulous tracts via the use of fistulography. In addition, new interventional management techniques continue to emerge. We describe the clinical and imaging features of GI fistulas and outline the interventional management of GI fistulas.

Show MeSH
Related in: MedlinePlus