Aorto-digestive fistula: a rare cause of gastrointestinal bleeding

<p>Aorto-digestive fistulas are a rare but extremely dangerous cause of massive gastrointestinal bleeding with a high risk of death. The aim of the review was to examine the modern principles of aorto-digestive fistula diagnosis and optimal treatment modalities.</p><p>Scientific publications and their reference lists were searched on PubMed database, Google Scholar and Russian Science Citation Index. Articles relevant to the topic, published over the past 25 years (1996-2021), were included and they were searched and categorised using the following key words: ‘gastrointestinal bleeding’, ‘aorto-digestive fistulas’, ‘diagnosis’ and ‘treatment’. Inclusion criteria were limited to gastrointestinal bleeding associated with aorto-digestive fistulas.</p><p>Patients with aortic aneurysms or those who have undergone prosthetics should have increased alertness regarding the formation of aorto-digestive fistulas. With a presence of gastrointestinal bleeding and exclusion of other sources based on multispiral computed tomography data with intravenous bolus contrast enhancement, this will allow for quick verification of the diagnosis and also enable timely medical measures to be taken. In an emergency situation, to achieve rapid hemostasis in unstable patients, endovascular aortic replacement is most justified. Open reconstruction of the aorta in situ with simultaneous elimination of the hollow organ defect and sanitation of fistula-associated foci of infection should be considered as a radical intervention for aorto-digestive fistulas.</p><p>Received 19 May 2021. Revised 7 July 2021. Accepted 9 July 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>

Clinical Features and Therapeutic Management of Postoperative Eso-Gastro-Duodenal Fistulas – A 6-Year Retrospective Study

The postoperative digestive fistula is the most feared complication of gastrointestinal surgeries. We performed a retrospective study over a period of 6 years, in which we included 28 patients who developed postoperative esophageal, gastric or duodenal fistulae in the General Surgery Department of “Bagdasar–Arseni” Emergency Hospital. We assessed the risk factors for this complication, its management and its results. Most patients were males and the mean age was 61.1 years. For 15 patients, the surgeries were required for benign lesions while the rest of 13 patients had malignant disease. Regarding the type of the fistula, 14 were duodenal stump fistulas, 13 were anastomotic leakages and one was a dehiscence of a sutured duodenal ulcer. Six cases required emergency relaparotomy for sepsis and peritonitis. Sixteen patients had a favourable outcome while death occurred in 12 cases. The mortality was higher for patients with sepsis and peritonitis as the first clinical manifestations of fistula and with the need for an emergency reoperation.

Simplified gastric bypass: 13 years of experience and 12,000 patients operated

BACKGROUND: Obesity is increasingly prevalent disease worldwide and bariatric surgery is the most effective treatment for the most severe cases. The Roux-en-Y gastric bypass is still the most used technique all over the world and the laparoscopic approach has been preferred by surgeons with different approaches, propositions and techniques in performing the procedure. AIM: To report the surgical aspects of the systematization and results of the simplified laparoscopic gastric bypass (Brazilian technique). METHODS: Were included all patients undergoing this procedure from January 2001 to July 2014; were described and analyzed aspects of this technique, the systematization and complications associated with the procedure. RESULTS: A total of 12,000 patients (72% women) were included, with a mean age of 43 years (14-76) and a mean BMI of 44.5 (35-90 kg/m2). Mean total operative time was 72 minutes (36-270) and the mean hospital stay was 36 hours. There were 303 cases of gastrojejunostomy stenosis (2.5%), 370 patients had gastrointestinal bleeding (3%) with only one lap revision due to a enteroanastomosis bleeding and six revisions related to intestinal obstruction caused by impacted clots in the jejunojenunostomy. Blood transfusion was needed in 32 patients (0.3%); Petersen hernia was diagnosed in 18 (0.15%) and digestive fistula in 54 (0.45%), which led to reoperation in 43 of them (67%). The overall mortality was 0.1% (fistula with sepsis=8, pulmonary thromboembolism=3; intestinal obstruction associated with sepsis=1). CONCLUSION: The simplified laparoscopic gastric bypass is a feasible and safe option with low complication rate and easy reproducibility for education and training in bariatric surgery.