Duodenocolic fistula caused by a peptic stomal ulcer following distal gastrectomy

Benign duodenocolic fistula: A case report and review of the literature

Duodenocolic fistula is a rare upper gastrointestinal fistula that can be benign or malignant. However, benign duodenocolic fistulas are particularly rare. Duodenocolic fistulas are often a complication of advanced colon cancer. The most common cause of benign fistulas is perforation of the duodenal ulcer. We report a case of a benign duodenocolic fistula in a patient who presented with abdominal pain, diarrhea, and weight loss. Gastroscopy and an upper gastrointestinal study confirmed the presence of the fistula. Surgery was performed, and the pathological examination demonstrated that the fistula originated from a duodenal ulcer.

Ileo-ileal fistula with severe malnutrition caused by strangulated ileus surgery while preserving ischemic ileum: A case report

INTRODUCTION

Entero-enteric fistulas are rare complications that occur in patients with inflammatory bowel disease and other intestinal diseases. In this report, we present an ileo-ileal fistula accompanied by severe malnutrition caused by strangulated ileus surgery while preserving the ischemic ileum in a very elderly patient.

CASE PRESENTATION

A 90-year-old woman underwent emergency surgery without bowel resection for strangulated ileus in another hospital. Minor abdominal pain and slight fever persisted after surgery. She lost weight, losing approximately 10 kg within half a year. She gradually became difficult to move due to dyspnea upon exertion and generalized edema and visited at our hospital. Pleural effusions, ascites and severe malnutrition were observed. An elastic hard mass with mild tenderness was palpated in her abdomen. Computed tomography showed a loop-like ileum and ileo-ileal fistula with adjacent fat stranding. We performed a partial small bowel resection. The resected specimen demonstrated an ileo-ileal fistula and circumferential ulceration in the loop-like adhesion. After the operation, the nutrition status was resolved immediately without any medications.

DISCUSSION

In cases of strangulated ileus, there are no deterministic criteria for evaluating intestinal blood flow. This is the first report of ileo-ileal fistula onset after surgery for strangulated ileus without intestinal resection. Furthermore, this fistula caused severe malnutrition duo to chronic inflammation, ulcer formation, and the blind-loop syndrome.

CONCLUSIONS

When preserving the intestinal tract in the operation of strangulated ileus, the occurrence of entero-enteric fistulas should be considered. Since malnutrition in the elderly is a serious problem, it should be treated promptly.

Efficacy of pantoprazole and omeprazole in treatment of peptic ulcer bleeding

AIM

To evaluate the efficacy of pantoprazole and omeprazole in the treatment of peptic ulcer bleeding.

METHODS

Eighty hospitalized patients with peptic ulcer bleeding treated at Department of Gastroenterology, Qianjiang Central Hospital from March 2016 to December 2016 were included and divided into either an omeprazole group (n = 40) or a pantoprazole group (n = 40) according to the drug used. The curative effect, bleeding, hematemesis and melena were compared between the two groups.

RESULTS

There was no significant difference in the total effective rate between the pantoprazole group and omeprazole group [95% (38/40) vs 95% (38/40), P > 0.05]. The amount of bleeding (153.2 mL + 15.6 mL on day 1 and 12.1 mL + 2.5 mL on day 3) was significantly lower, and the time to hemostasis (1.3 d + 0.4 d) was significantly shorter in the pantoprazole group than in the omeprazole group (P < 0.05). The average duration of hematemesis (0.2 + 0.1) and the average number of episodes of melena (0.9 + 0.2) in the pantoprazole group were significantly lower than those of the omeprazole group (P < 0.05). The average intragastric pH value within 24 h was 6.7 ± 0.2 in the pantoprazole group, which was significantly higher than that in the omeprazole group. The mean duration of intragastric pH > 4.0 (18.1 min ± 2.5 min) min and > 6.0 (31.5 min ± 1.2 min) in the pantoprazole group was significantly shorter than that of the omeprazole group (P < 0.05).

CONCLUSION

The clinical curative effect of omeprazole and pantoprazole in the treatment of peptic ulcer bleeding is comparable, but pantoprazole is superior in controlling hemorrhage, shortening the bleeding time, and alleviating melena symptoms.