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[PMID]:29489659
[Au] Autor:Yao Z; Tian W; Xu X; Huang Q; Zhao Y
[Ad] Endereço:Department of General Surgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China.
[Ti] Título:An innovative method for placing a double-lumen irrigation-suction tube in the management of abdominal infection: A case report.
[So] Source:Medicine (Baltimore);97(9):e0048, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Currently, the use of double-lumen irrigation-suction tube for drainage has become increasingly more common. However, the insertion process is complex, and the position of the double cannula placed in this manner is not accurate. We developed a method for placing the drainage tube and use it in the treatment of an abdominal infection. PATIENT CONCERNS: A 51-year-old man with an abdominal infection due to colonic anastomotic fistula was admitted. Routine laboratory tests revealed an elevated white blood cell count (17 × 10/L) and C-reactive protein level (78 mg/L). Computed tomography (CT) revealed that the peritoneal cavity was filled with fluid. DIAGNOSES: The patient was diagnosed with colonic anastomosis fistula by gastrointestinal radiography. Abdominal infection was diagnosed based on CT scan, inflammatory markers, and patient signs and symptoms. INTERVENTIONS: Two punctures were performed. After skin expansion, the source of infection was drained with a suction catheter (diameter = 1.0 cm) under continuous negative pressure of 150 to 200 millibars, along with continuous saline irrigation at 300 mL/h. OUTCOMES: Pus in the abdomen drained completely. The abdominal infection was controlled. There were no adverse events. LESSONS: Abdominal infection in fistulas is a fatal disease. The main therapeutic target is full drainage at an early stage. Precise positioning of the tube, continuous negative pressure irrigation and drainage are key points in the treatment.
[Mh] Termos MeSH primário: Abscesso Abdominal/terapia
Sucção/métodos
[Mh] Termos MeSH secundário: Abscesso Abdominal/etiologia
Doenças do Colo/complicações
Seres Humanos
Fístula Intestinal/complicações
Masculino
Meia-Idade
Sucção/instrumentação
Irrigação Terapêutica/instrumentação
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000010048


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[PMID]:29428021
[Au] Autor:Martinez JL; Luque-de-León E; Souza-Gallardo LM; Jiménez-López M; Ferat-Osorio E
[Ti] Título:Results after Definitive Surgical Treatment in Patients with Enteroatmospheric Fistula.
[So] Source:Am Surg;84(1):28-35, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:As enteroatmospheric fistulas (EAF) lack healthy overlying tissue, spontaneous healing is very unlikely. Our aim was to identify risk factors for recurrence and mortality after definitive surgical treatment for EAF. Sixty-two consecutive patients with a diagnosis of EAF were submitted to definitive surgical repair (fistula resection and primary anastomosis) during a 6-year period. Several patient, disease, and operative variables were assessed as risk factors associated to our endpoints: recurrence and mortality. All patients were followed-up until hospital discharge or death. Univariate and multivariate analysis were performed. There were 24 females and 38 males with a median age of 53 years (interquartile ranges 43-63). EAF recurred in 23 patients. Univariate analysis identified several risk factors for recurrence which included performing more than one anastomosis (20 vs 52%, P = 0.013), failure of achieving total abdominal closure (16 vs 47%, P = 0.025), intraoperative hemorrhage >400 cc (28 vs 65%, P = 0.007), presence of multiple fistulas (25 vs 61%, P = 0.008), and preoperative C-reactive protein >0.5 mg/dL (54 vs 82%, P = 0.029). The latter two remained significant after multivariate analysis. Final EAF closure was attained in 47 patients (76%) and 8 more (13%) had a low-output (<50 mL/day) enterocutaneous fistula. Timing of surgery was not related to fistula recurrence. Eight patients died (13%), and fistula recurrence was the only risk factor found related to mortality both through univariate (26 vs 5%, P = 0.043) and after multivariate analysis. EAF management represents a rather challenging problem. Timing for surgical treatment is controversial and is based mostly on patient status and surgeon's criteria. Recurrence is associated to EAF characteristics and an inflammatory state; it was also the only factor associated to mortality.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Fístula Intestinal/diagnóstico
Fístula Intestinal/cirurgia
[Mh] Termos MeSH secundário: Adulto
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/mortalidade
Feminino
Seguimentos
Seres Humanos
Fístula Intestinal/etiologia
Fístula Intestinal/terapia
Masculino
Meia-Idade
Estudos Prospectivos
Recidiva
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29248124
[Au] Autor:Spanos K; Kouvelos G; Karathanos C; Matsagkas M; Giannoukas AD
[Ad] Endereço:Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Mezourlo, 41334 Larissa, Greece.
[Ti] Título:Current status of endovascular treatment of aortoenteric fistula.
[So] Source:Semin Vasc Surg;30(2-3):80-84, 2017 Jun - Sep.
[Is] ISSN:1558-4518
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastrointestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF. When endovascular treatment is applied where appropriate, early outcomes seem to be superior compared to open surgery. This benefit may be lost during long-term follow-up, implying that a staged approach with early conversion to in situ grafting may realize the best patient survival and morbidity. Lifelong administration of antibiotics is associated with a reduction in re-infection. An endovascular approach used as a bridging procedure in unstable patients is recommended, followed by definitive open therapy, if feasible, in patients with good life expectancy.
[Mh] Termos MeSH primário: Doenças da Aorta/cirurgia
Implante de Prótese Vascular
Remoção de Dispositivo
Procedimentos Endovasculares
Fístula Intestinal/cirurgia
Fístula Vascular/cirurgia
[Mh] Termos MeSH secundário: Doenças da Aorta/diagnóstico por imagem
Doenças da Aorta/etiologia
Doenças da Aorta/mortalidade
Aortografia/métodos
Prótese Vascular
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/instrumentação
Implante de Prótese Vascular/mortalidade
Angiografia por Tomografia Computadorizada
Remoção de Dispositivo/efeitos adversos
Remoção de Dispositivo/mortalidade
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/instrumentação
Procedimentos Endovasculares/mortalidade
Seres Humanos
Fístula Intestinal/diagnóstico por imagem
Fístula Intestinal/etiologia
Fístula Intestinal/mortalidade
Complicações Pós-Operatórias/etiologia
Desenho de Prótese
Fatores de Risco
Stents
Fatores de Tempo
Resultado do Tratamento
Fístula Vascular/diagnóstico por imagem
Fístula Vascular/etiologia
Fístula Vascular/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171218
[St] Status:MEDLINE


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[PMID]:29245311
[Au] Autor:Cui B; Zhou L; Khan S; Cui J; Liu W
[Ad] Endereço:aDepartment of Digestive DiseasesbDepartment of Imaging, General Hospital, Tianjin Medical University, Tianjin, China.
[Ti] Título:Role of enteral nutrition in pancreaticocolonic fistulas secondary to severe acute pancreatitis: A case report.
[So] Source:Medicine (Baltimore);96(49):e9054, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Pancreaticocolonic fistula (PCF) is an exceedingly rare complication of severe acute pancreatitis (SAP) and has primarily been treated surgically, but a few reported cases are successfully treated with nonsurgical methods. PATIENT CONCERNS: A 32-year-old male presented to our hospital with chief complaints of sharp and persistent left upper quadrant abdominal pain radiating to the back. DIAGNOSES: Computed tomography showed a pancreatic pseudocyst replacing a majority of the pancreatic parenchyma and PCF that formed between the pancreas and the colon. However, the final diagnosis of PCF was confirmed by drainage tube radiograph, which revealed extravasation of contrast from the tail of the pancreas into the colon. INTERVENTIONS: A therapeutic strategy of enteral nutrition (EN) was applied. OUTCOMES: The patient responded well to the treatment. No complication and recurrence were reported during 2-year follow-up. LESSONS: This case highlights the role of EN in the treatment of PCF secondary to SAP. To the best of our knowledge, this is the first case of PCF that treated successfully with EN, rather than surgical or endoscopic intervention.
[Mh] Termos MeSH primário: Doenças do Colo/terapia
Nutrição Enteral/métodos
Fístula Intestinal/terapia
Fístula Pancreática/terapia
Pancreatite/complicações
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Doenças do Colo/etiologia
Seres Humanos
Fístula Intestinal/etiologia
Masculino
Fístula Pancreática/etiologia
Pseudocisto Pancreático/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009054


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[PMID]:29049214
[Au] Autor:Zhou Y; Chen P; Qiao T; Chen YF; Zong L
[Ad] Endereço:aDepartment of General Surgery, Suzhou Municipal Hospital (North Campus), Suzhou bDepartment of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University (the Northern Jiangsu People's Hospital), Yangzhou cMedical Research Center, Clinical Medical College of Yangzhou University (the Northern Jiangsu People's Hospital), Yangzhou, Jiangsu Province, China.
[Ti] Título:Complete transmural migration of a retained surgical sponge: an atypical case in image mimicking intussusception: A case report.
[So] Source:Medicine (Baltimore);96(42):e8246, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Intraluminal migration of a retained surgical sponge causing intestinal obstruction and fistula is extremely rare occurrence. PATIENT CONCERNS: A case of a 35-year-old male, who complaining a diffuse abdominal pain beginning three days earlier. He also complained of occasional vomiting, nonspecific abdominal pain, and an unintentional 15 kg weight loss during the past 2 years. However, there were no clear findings in previous laboratory work. He had received an open appendectomy approximately 4 years earlier. DIAGNOSES: Retained surgical sponge. INTERVENTIONS: A contrast-enhanced CT of the abdomen showed a clear invagination of the small intestine. However, intraoperatively, we could not find an intestinal segment with intussusception. After the adhesive intestine was detached, a jejunal-ileal cross-linked fistula was found. More surprisingly, a retained surgical sponge was found inside the ileal fistula when the cross-linked fistula was detached. OUTCOMES: The patient was discharged 7 days after surgery. LESSONS: This is the first report showing an atypical image of a complete transmural migration of a retained surgical sponge mimicking intussusception.
[Mh] Termos MeSH primário: Apendicectomia/efeitos adversos
Corpos Estranhos/diagnóstico por imagem
Migração de Corpo Estranho/diagnóstico por imagem
Doenças do Íleo/diagnóstico por imagem
Fístula Intestinal/diagnóstico por imagem
[Mh] Termos MeSH secundário: Dor Abdominal/diagnóstico por imagem
Dor Abdominal/etiologia
Adulto
Diagnóstico Diferencial
Corpos Estranhos/etiologia
Migração de Corpo Estranho/etiologia
Seres Humanos
Doenças do Íleo/complicações
Íleo/cirurgia
Fístula Intestinal/complicações
Obstrução Intestinal/diagnóstico por imagem
Obstrução Intestinal/etiologia
Intussuscepção/diagnóstico
Masculino
Tomografia Computadorizada por Raios X/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008246


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[PMID]:28904712
[Au] Autor:Mazine K; Barsotti P; Elbouhaddouti H; Taleb KA
[Ad] Endereço:Service de Chirurgie Viscérale A (C3), CHU Hassan II Fès, Maroc.
[Ti] Título:[Colonic gallstone ileus: a rare cause of colonic obstruction].
[Ti] Título:Iléus biliaire colique: une cause rare d'occlusion colique..
[So] Source:Pan Afr Med J;27:187, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Bile ileus with migration of the gallstone into the colon through cholecystocolonic fistula is rare. The diagnosis is difficult and often late. We here report the case of a 89-year old patient with a history of sigmoid diverticular disease presenting with colonic obstruction associated with bile ileus caused by migration of a large gallstone through cholecystocolonic fistula. Abdominal CT scan allowed the diagnosis. The patient underwent surgical extraction of the gallstone with sigmoidotomy followed by sigmoidostomy with subsequent recovery of the digestive continuity. The cholecystocolonic fistula wasn't identified.
[Mh] Termos MeSH primário: Cálculos Biliares/diagnóstico por imagem
Íleus/diagnóstico por imagem
Obstrução Intestinal/diagnóstico por imagem
Doenças do Colo Sigmoide/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Cálculos Biliares/complicações
Cálculos Biliares/cirurgia
Seres Humanos
Íleus/complicações
Fístula Intestinal/diagnóstico por imagem
Obstrução Intestinal/etiologia
Obstrução Intestinal/cirurgia
Doenças do Colo Sigmoide/etiologia
Doenças do Colo Sigmoide/cirurgia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.187.12238


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[PMID]:28637559
[Au] Autor:López-Cano M; Quiles MT; Pereira JA; Armengol-Carrasco M; Arbós Vía MA
[Ti] Título:Complex Abdominal Wall Hernia Repair in Contaminated Surgical Fields: Factors Affecting the Choice of Prosthesis.
[So] Source:Am Surg;83(6):583-590, 2017 Jun 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To compare patients with complex abdominal wall hernias undergoing surgical repair using synthetic nonabsorbable or biologic meshes in contaminated fields. Retrospective review of 62 patients with complex abdominal wall hernia with surgical repair in an elective setting and in the context of a clean-contaminated or contaminated fields (January 2009-April 2015). Two groups according to the prosthesis (synthetic nonabsorbable, n = 48 or biologic, n = 14). Mean follow-up was 24.6 (15.8) months. Clean-contaminated wounds were significantly more frequent in the synthetic group. Contaminated wounds were significantly more frequent in the biologic group. Enterocutaneous fistula, recurrent hernia, and removal of chronic infected mesh were significantly more frequently in the biologic group. Differences in postoperative complications and surgical site infections were not found. Recurrence was higher in the biologic group (35.7% vs 8.3%, P = 0.03). In the elective repair of complex hernia, the level of contamination, a recurrent hernia, an enterocutaneous fistula or removal of chronic infected mesh were the factors affecting the choice of prosthesis. In the clean-contaminated setting, the use of a synthetic nonabsorbable mesh versus a biologic mesh did not increase the rate of postoperative infections. Recurrences are significantly higher with biologic meshes.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Eletivos/efeitos adversos
Hérnia Ventral/cirurgia
Fístula Intestinal/etiologia
Telas Cirúrgicas/efeitos adversos
[Mh] Termos MeSH secundário: Parede Abdominal/cirurgia
Idoso
Índice de Massa Corporal
Feminino
Seguimentos
Seres Humanos
Fístula Intestinal/cirurgia
Tempo de Internação
Masculino
Meia-Idade
Recidiva
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE


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[PMID]:28534335
[Au] Autor:Yang J; Gong J; Li Y; Gu L; Zhu W; Li J
[Ti] Título:[Consistency analysis between preoperative CT enterography and intraoperative findings in patients undergoing surgery for Crohn's disease].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(5):555-559, 2017 May 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To evaluate the diagnostic value of preoperative CT enterography (CTE) on obstruction, fistula and abscess formation compared to intraoperative findings in patients undergoing surgery for Crohn's disease(CD), aiming to provide reference to clinical practice. METHODS: Preoperative CTE data of 176 CD patients confirmed by clinic, endoscopy, imaging, operation and pathology at the Department of General Surgery in Nanjing Jinling Hospital from January 2013 to December 2015 were enrolled in retrospective cohort study. All the patients underwent enhanced full abdominal CT scan using SIMENS SOMATOM Definition Flash 64 row dual-source CT machine. CTE scans were performed from the dome of diaphragm to the symphysis pubis. The CT images in arterial and venous phase were reconstructed with 1.0 mm thin layer, and then processed in MMWP 4.0 workstation including multi-planar recombination, surface recombination and maximum density projection. The sensitivity, specificity, positive and negative predictive value, false negative rate and accuracy of preoperative CTE on obstruction, fistula and abscess were compared with intraoperative findings. RESULTS: Among 176 patients, 122 were males and 54 were females with median age of 29 (18 to 65) years, median disease duration of 48 (1 to 240) months, median time interval from CT scan to operation of 16(1 to 30) days, and median body mass index of 17.8 (10.8 to 34.7) kg/m . Twenty-six cases (14.8%) had nutritional risk (NRS2002≥3); 23 cases (13.1%) had lesions limited to ileum; 19 cases (10.8%) had lesions limited to colon; 126 cases (71.6%) had simultaneous lesions of ileum and colon, and 8 cases (4.5%) had lesion in upper gastrointestinal tract. A total of 199 lesions of small intestine were identified by preoperative CTE, including 131 of obstruction (65.8%), 42 of fistula (21.1%), and 26 of abscess (13.1%), while 235 lesions were confirmed by operation, including 133 of obstruction (56.6%), 74 of fistula (31.5%), 28 of abscess (11.9%). The modification of planned surgical procedure due to unexpected intraoperative findings were found in 29(16.5%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of preoperative CTE were 86.4%, 78.8%, 86.9% and 76.0% for obstruction; 83.8%, 79.1%, 67.5% and 90.4% for fistula; and 96.2%, 98.0%, 90.1% and 99.3 for abscess, respectively. CONCLUSION: Preoperative CTE can effectively evaluate the lesions of intestinal obstruction, fistula and abscess in CD patients, with the highest accuracy of abscess, and has quite good consistency with intraoperative findings, which may be used as the first choice of imaging diagnosis of CD.
[Mh] Termos MeSH primário: Abscesso/diagnóstico por imagem
Colo/diagnóstico por imagem
Doença de Crohn/diagnóstico por imagem
Doença de Crohn/cirurgia
Íleo/diagnóstico por imagem
Fístula Intestinal/diagnóstico por imagem
Obstrução Intestinal/diagnóstico por imagem
Intestino Delgado/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Colo/cirurgia
Feminino
Seres Humanos
Íleo/cirurgia
Intestino Delgado/cirurgia
Masculino
Meia-Idade
Radiografia Abdominal/métodos
Radiografia Abdominal/estatística & dados numéricos
Estudos Retrospectivos
Sensibilidade e Especificidade
Tomografia Computadorizada por Raios X/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28534329
[Au] Autor:Ren H; Wang G; Gu G; Hu Q; Li G; Hong Z; Wu X; Ren J
[Ti] Título:[Predictive value of procalcitonin in postoperative intra-abdominal infections after definitive operation of intestinal fistulae].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(5):524-529, 2017 May 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To investigate the predictive value of procalcitonin(PCT) in postoperative intra-abdominal infections (IAI) after definitive operation of intestinal fistulae(IF). METHODS: With the exclusion of emergence operation, preoperative clinical infection, preoperative renal or hepatic dysfunction, and age less than 18 years, a total of 356 consecutive patients who underwent elective digestive tract reconstruction of intestinal fistulae from February 2012 to December 2015 at Intestinal Fistula Center of Jinling Hospital were prospectively enrolled in the study. All the patients were divided into IAI group (26 cases, 21 of anastomosis leakage and 5 of peritoneal abscess) and non-IAI group (330 cases) based on the existence of postoperative IAI. The non-IAI group was then divided into two subgroups of other infection (93 cases) and non-infection(237 cases) according to the presence of other infections. Plasma PCT level, serum CRP concentration and WBC count were assessed preoperatively and on postoperative days (PODs) 1, 3, 5, 7 by immunofluorescence, turbidimetry and automatic blood analyzer, respectively. The predictive value of each marker for IAI was calculated by receiver operating characteristic (ROC) curve. RESULTS: There was no significant difference in general clinical data between IAI and non-IAI group (all P>0.05). The proportions of multi-IF (53.8%, 14/26) and colectomy (61.5%, 16/26) in IAI group were higher than those of non-IAI group [20.0% (66/330), χ =15.847, P=0.000 and 31.2%(103/330), χ =9.961, P=0.002]. Differences of preoperative PCT, CRP and WBC levels among IAI, other infection and non-infection groups were not significant. These three markers all increased obviously and immediately after surgery. PCT and WBC values reached the peak point on POD 1, whereas CRP on POD 3. In IAI group, mean PCT values were (5.4±4.2) µg/L, (2.9±1.9) µg/L and (1.6±1.8) µg/L on POD 1, POD 3 and POD 5, respectively, which were higher than those of other infection group [(4.2±8.7) µg/L, (1.9±3.8) µg/L and (0.6±0.8) µg/L] and non-infection group [(2.7±5.8) µg/L, (1.1±1.7) µg/L and (0.5±0.7) µg/L, all P<0.05]. Mean CRP values in IAI group were 99.4 mg/L and 183.9 mg/L respectively on POD 1 and POD 3,and mean WBC values of IAI group on POD 1, POD 3 and POD 5 were 16.0×10 /L, 10.8×10 /L and 8.7×10 /L, respectively, which were all significantly higher than those in the other 2 groups (all P<0.05). No significant differences were obtained between other infection group and non-infection group in all these three markers (all P>0.05). ROC curve demonstrated that PCT had the biggest area under the curve (AUC) of 0.86 and 0.84 on POD 3 and POD 5, with the cut-off value of 0.98 µg/L and 0.83 µg/L, 92.0% sensitivity and 74.0% specificity, 91.0% sensitivity and 73.0% specificity, respectively. The highest AUC was 0.72 on POD 3 for CRP and 0.71 on POD 3 for WBC, with 80.0% sensitivity and 54.0% specificity, 56.0% sensitivity and 73.0% specificity, respectively. CONCLUSION: The value of procalcitonin above 0.98 µg/L on POD 3 and 0.83 µg/L on POD 5 can predict the occurrence of IAI after definitive operations of intestinal fistulae.
[Mh] Termos MeSH primário: Calcitonina/sangue
Colectomia/efeitos adversos
Colectomia/estatística & dados numéricos
Fístula Intestinal/complicações
Fístula Intestinal/cirurgia
[Mh] Termos MeSH secundário: Abscesso Abdominal/etiologia
Fístula Anastomótica/etiologia
Área Sob a Curva
Biomarcadores/sangue
Procedimentos Cirúrgicos Eletivos/efeitos adversos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos
Feminino
Seres Humanos
Infecções Intra-Abdominais/etiologia
Masculino
Complicações Pós-Operatórias/epidemiologia
Valor Preditivo dos Testes
Curva ROC
Estudos Retrospectivos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 9007-12-9 (Calcitonin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28472817
[Au] Autor:Reider KE
[Ad] Endereço:Kersten E. Reider, RN, BSN, CWOCN, WOC Nurse, Reading Health System, West Reading, Pennsylvania.
[Ti] Título:Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing: A Case Study.
[So] Source:J Wound Ostomy Continence Nurs;44(3):293-298, 2017 May/Jun.
[Is] ISSN:1528-3976
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. METHODS: Several approaches were used to manage output from the fistula during her hospital course. She was initially discharged to a skilled nursing facility where a fistula management pouch was used for several months to encompass the wound and contain effluent, but this method ultimately proved ineffective. The fistula was then isolated using a collapsible enteroatmospheric fistula isolation device and an ostomy appliance to contain effluent. CONCLUSION: The application of the collapsible enteroatmospheric fistula isolation and effluent containment devices in conjunction with negative-pressure wound therapy produced positive patient outcomes; it improved patient satisfaction with fistula management, promoted wound healing, and diminished cost.
[Mh] Termos MeSH primário: Fístula Intestinal/terapia
Tratamento de Ferimentos com Pressão Negativa/métodos
Complicações Pós-Operatórias/enfermagem
Cicatrização
[Mh] Termos MeSH secundário: Técnicas de Fechamento de Ferimentos Abdominais/enfermagem
Técnicas de Fechamento de Ferimentos Abdominais/normas
Feminino
Enfermagem Domiciliar/métodos
Enfermagem Domiciliar/normas
Seres Humanos
Laparotomia/efeitos adversos
Meia-Idade
Tratamento de Ferimentos com Pressão Negativa/normas
Obesidade Mórbida/complicações
Obesidade Mórbida/enfermagem
Estomia/instrumentação
Nutrição Parenteral Total/enfermagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000329



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