, Gyoung Tae Noh A 25-year-old female visited the clinic with abdominal pain and poor oral intake. She was diagnosed with Crohn’s disease and had a history of using infliximab for 4 years. She had no previous operative history. Magnetic resonance enterography demonstrated the progression of a penetrating complication that involved the distal ileum and complex entero-enteric fistula between the terminal ileum and sigmoid colon. Surgery was conducted using the da Vinci SP surgical system. In the operative field, severe adhesion was observed between the terminal ileum, adjacent ileum, cecum, and the sigmoid colon. After adhesiolysis of the small bowel and right colon was performed, the fistula tract between the sigmoid colon and terminal ileum was identified and resected. Then, simultaneous ileocecectomy and anterior resection was performed. The operation was completed without any intraoperative complications and patient’s recovery was uneventful. She was discharged postoperatively, after 8 days.
, Ka Hyun Lee, Ji-Won Han, Su Jin Cho The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. We report a case of a neonate with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with meconium sprouting from the umbilical stump. Segmental resection of the ileum and end to end anastomosis were conducted. The patient was discharged on the 8th postoperative day without any complications, and no abnormalities were observed at the outpatient clinic follow-up up to 5 months after surgery. Here we describe the case and a review of the literature.
Citations
, Ki-Nam Shim, Won Young Cho, Chan Young Kim, Hyeon-Ju Kang, Mi Yeon Kim, So Young Ahn, Yoon Pyo Lee, Hyoung Won Cho, Sung Ae Jung, Joo-Ho Lee Laparoscopic sleeve gastrectomy can reduce morbidity and mortality in patients with morbid obesity, but it can cause complications such as a gastrointestinal leak. A 30-year-old morbidly obese female who had type 2 diabetes mellitus and hypertension with estimated body mass index of 40.2 kg/m2 was admitted. Laparoscopic sleeve gastrectomy was performed. On postoperative day 19, a leak was suspicious on physical examination and radiologic findings. Conservative management was performed, but the patient was hemodynamically unstable and imminently septic. After laparoscopic drainage procedure, esophagogastroduodenoscopy was performed and revealed the fistula opening at staple line just below gastroesophageal junction. Fibrin tissue adhesive was injected around the fistula and the esophageal covered stent was inserted to cover the leak. At 14th days after stent insertion, the barium study confirmed no more leak. In this case, we experienced that the esophageal stent insertion with fibrin tissue adhesive injection may reduce recovery time of the fistula developed after laparoscopic sleeve gastrectomy.
, Jae Jin Han There have been many parameters that determined the results of radiocephalic ffisutla. However, few reliable intraoperative parameters have been suggested until now. The purpose of this study was to find the correlation between intra-operative blood flow and early patency of radiocephalic fistula.
Between March 1998 and October 1999, 45 radiocephalic arteriovenous fistulas were constructed in 38 patients. Intra-operative blood flow measurements were made 10 minutes after complection of the vascular anastomoses with 3-4mm handheld flow probes. Patients were followed until failure of fistula or 3months after first hemodialysis with these fistulas. Intraoperative blood flow as well as age, sex, presence of diabetes, size of cephalic vein, thrill on the fistula and flow of radial artery were correlated with early patency.
The mean intraoperative blood flow was 195.9±16.7 mL/min ranged from 50 to 500 mL/min, and it was the only significant parameter that determined early patency of radiocephalic fistula. Fistulas with flow less than 150 ml/min(10 of 18) revealed higher failure rate than those of flow more than 150 ml/min(1 of 27), which was statistically significant(p<0.01). All of the patients with flow less than 70 ml/min(5 of 5) failed in maintaining patency within a month. However, the other variables were not correlated with early patency.
In conclusion intra-operative blood flow measurements can be performed with ease and intraoperative blood flow in radiocephalic fistula is well correlated with early patency of the fistula. And we rocommend that radio-cephalic fistula of flow less than 150mL/min should be observed carefully and that of flow less than 70mL/min must be abandoned intraoperatively.
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