DOCSLIB.ORG

Temporary Retrograde Occlusion of High-Flow Tracheo-Esophageal Fistula Colin D

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Temporary Retrograde Occlusion of High-Flow Tracheo-Esophageal Fistula Colin D Temporary Retrograde Occlusion of High-Flow Tracheo-Esophageal Fistula Colin D. Gause, MD, Ian Glenn, MD, Michael Liu, MD, Federico G. Seifarth, MD This report describes a temporary retrograde occlusion technique for control abstract of a high-flow tracheo-esophageal fistula in a critically ill, premature infant born at 29 weeks’ gestational age, with a diagnosis of type C (Gross) esophageal atresia and tetralogy of Fallot (TOF). This procedure is a useful bridging maneuver before definitive surgical correction for extremely low birth weight, unstable neonates with tracheo-esophageal fistula who are suffering from associated malformations. Esophageal atresia (EA) with tracheo- a guide in which those with stable esophageal fistula (TEF) represents cardiac and respiratory status a spectrum of foregut abnormalities underwent early repair, whereas characterized by incomplete unstable patients underwent delayed esophageal organogenesis with or repair. Spitz et al10 later proposed without associated abnormal a new classification system, designated communication between the trachea I to III, based on birth weight and the and esophagus, with an incidence of presence of major cardiac disease. Department of Pediatric Surgery, Cleveland Clinic Children’s ∼1 in 3500 births worldwide. Patients Okamoto et al11 refined the Spitz Hospital, Cleveland, Ohio fi fi have additional congenital classi cation into a modi ed class Dr Gause performed patient chart review, drafted abnormalities in ∼50% to 70% of system, designated I to IV, with the initial manuscript, and revised the manuscript; cases. These abnormalities are emphasis on cardiac anomalies, Dr Glenn performed chart review and reviewed and predominantly cardiovascular because they represent the revised the manuscript; Dr Liu reviewed and revised (20%–39%),1 although genitourinary predominant predictor of survival. the manuscript; Dr Seifarth performed the surgical – procedures included herein, managed the patient, (14% 24%), gastrointestinal Neonates with a large TEF are at risk conceptualized the article, and reviewed and revised – (14% 23%), musculoskeletal for shunting excessive amounts of air the manuscript; and all authors approved the final – (17% 56%), and central nervous into the gastrointestinal tract, and manuscript as submitted. system (7%) abnormalities are also positive-pressure mechanical www.pediatrics.org/cgi/doi/10.1542/peds.2015-1234 common.1–5 Cardiovascular anomalies ventilation exacerbates this DOI: 10.1542/peds.2015-1234 contribute to the majority of morbidity phenomenon, contributing to Accepted for publication Jun 2, 2015 and mortality, cited as the cause of subsequent hypoventilation. Extremely death in 78% of cases.6 Address correspondence to Federico G. Seifarth, MD, premature neonates or patients with Department of Pediatric Surgery, Cleveland Clinic Anatomic classification is most severe associated anomalies are often Main Campus, Mail Code A120, 9500 Euclid Avenue, commonly described according to the too unstable to undergo early TEF Cleveland, OH 44195. E-mail: [email protected] Gross system, which classifies the repair. Therefore, operative PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, disease into 6 categories designated intervention to occlude the TEF before 1098-4275). 7 AtoF, the most common of which is definitive repair may be necessary to Copyright © 2015 by the American Academy of type C: proximal EA with distal TEF allow adequate ventilation and Pediatrics (84% of cases). The Waterson prevention of gastrointestinal FINANCIAL DISCLOSURE: The authors have indicated classification stratifies these infants complications. Gastrostomy represents they have no financial relationships relevant to this into survival categories A through C, a potential option, but this method article to disclose. based on birth weight and associated allows air to preferentially flow FUNDING: No external funding. 8 fi fi anomalies. This classi cation system through the stula and exit via POTENTIAL CONFLICT OF INTEREST: The authors have was refined by Randolph et al.9 The gastrostomy at the expense of indicated they have no potential conflicts of interest authors used physiologic status as pulmonary ventilation.12 This to disclose. Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 136, number 4, October 2015 CASE REPORT occurrence is particularly intervention. On day 4 she was taken problematic in neonates with poor to the operating room, where she lung compliance. Bronchoscopic underwent a 2.5-cm transverse mini- placement of a Fogarty balloon to laparotomy, Stamm gastrostomy, and occlude the fistula,13,14 endotracheal placement of a 10-Fr Mallinckrodt (ET) tube placement distal to the catheter. At the gastrostomy site, a fistula,12 esophageal banding,15 6-Fr Fogarty catheter was advanced Nissen fundoplication,16 and gastric under fluoroscopic guidance into the division17 are additional options to TEF (Figs 1 and 2). The balloon was prevent diversion of airflow, with cautiously inflated with 1 mL water- bronchoscopic occlusion used most soluble radiopaque contrast until FIGURE 2 commonly. ventilator control indicated Radiographic confirmation of occlusive balloon placement. This case report describes the resolution of the air leak (Figs 3 and 4). management of an unstable, The Fogarty catheter was secured premature, 810-g infant with a type C to the abdominal wall. The TEF and TOF (Waterson C, Spitz Mallinckrodt was then temporarily thoracotomy and suture ligation of fi group III, Okamoto class IV), in which placed to water seal to detect an air the stula. The distal esophagus was the high-flow fistula was managed leak, of which there was none. tacked to the chest wall under mild fi with creation of a gastrostomy and Despite signi cant improvement of tension and the proximal esophageal fluoroscopically guided placement of ventilator management, the patient pouch remained intubated with a retrograde esophageal fistula was deemed too unstable to undergo a Replogle catheter. On day 145, she occlusion balloon catheter, followed repair at that time. underwent complete repair of TOF, by staged repair of the TEF after Over the course of her hospitalization, closure of her patent foramen ovale, stabilization of the patient’s status. the Fogarty balloon was deflated and ligation of her patent ductus every other day for ∼30 minutes to arteriosus. Repair of TEF was prevent accumulation and aspiration deferred for 6 weeks in accordance with the recommendations of our CASE REPORT of esophageal secretions. Gastric tube feeds were begun. On day 25, she was cardiac surgery colleagues. On day fi The patient is a premature female taken to the operating room for 197, the patient underwent de nitive ’ singleton, born at 29 weeks ligation of the TEF. The fistula was reconstruction of the esophagus via gestational age, with an temporarily occluded with a 6-Fr thoracoscopic esophago- ultrasonographic prenatal diagnosis Fogarty catheter via the trachea, and esophagostomy. She tolerated the of TOF. Before the second minute of the patient underwent uncomplicated procedure well, and there were no life, the patient was intubated, and complications. inhaled surfactant was administered The patient was extubated on for respiratory distress of postoperative day 5. Iohexol upper prematurity. Attempts to insert gastrointestinal series on a Replogle orogastric tube failed, postoperative day 7 revealed a patent because the tube could not be anastomosis with contrast flow into . advanced 8 cm. Subsequent the stomach, with no evidence of abdominal radiograph revealed extravasation or anastomotic leak diffuse gastric, small and large bowel (Fig 5). She was started on breast fi gaseous distention, con rming the milk by mouth on postoperative day diagnosis of type C TEF. The Replogle 15, with supplemental gastrostomy tube was positioned in the distal feeds. She recovered well from her esophageal pouch and kept to low operations and continued to gain continuous suction. Contrast weight appropriately. The patient was radiography was not performed. discharged from the hospital into the fi Echocardiography con rmed TOF. care of her parents on day 221 of The patient remained stable for the life, smiling and active. She was last first 3 days of life. However, despite seen in clinic at 14 months of age delicate ventilator management, she (8 months after repair). At that developed increasing abdominal time, she was tolerating tube distention and needed progressive FIGURE 1 feeding at goal and taking puffed ventilator support, prompting urgent Retrograde TEF balloon occlusion via gastrostomy. baby food and yogurt by mouth, with Downloaded from www.aappublications.org/news by guest on September 27, 2021 e1052 GAUSE et al subsequent feeding or an overly loose wrap resulting in persistent air leak. ET tube placement distal to the fistula12 maybepossibleonlyinaproximal fistula, because efforts to completely pass the fistula may result in ET obstruction at the carina or incidental mainstem bronchus intubation. Retrograde occlusion is temporary and does not alter gastric anatomy, thus not necessitating a reversal procedure17 or surgical band removal.15 It is important FIGURE 5 to note that although a gastrotomy is Postoperative esophagram confirming esopha- created to introduce the retrograde geal patency and integrity of repair. occlusion catheter, the same site is used for placement of an enteral feeding division. Kadowaki et al19 similarly tube, which may be removed without reported retrograde insertion of an additional
Load more

Recommended publications
  • Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement
    CLINICAL REPORT Diagnosis and Treatment of Perianal Crohn Disease: NASPGHAN Clinical Report and Consensus Statement ÃEdwin F. de Zoeten, zBrad A. Pasternak, §Peter Mattei, ÃRobert E. Kramer, and yHoward A. Kader ABSTRACT disease. The first description connecting regional enteritis with Inflammatory bowel disease is a chronic inflammatory disorder of the perianal disease was by Bissell et al in 1934 (2), and since that time gastrointestinal tract that includes both Crohn disease (CD) and ulcerative perianal disease has become a recognized entity and an important colitis. Abdominal pain, rectal bleeding, diarrhea, and weight loss consideration in the diagnosis and treatment of CD. Perianal characterize both CD and ulcerative colitis. The incidence of IBD in the Crohn disease (PCD) is defined as inflammation at or near the United States is 70 to 150 cases per 100,000 individuals and, as with other anus, including tags, fissures, fistulae, abscesses, or stenosis. autoimmune diseases, is on the rise. CD can affect any part of the The symptoms of PCD include pain, itching, bleeding, purulent gastrointestinal tract from the mouth to the anus and frequently will include discharge, and incontinence of stool. perianal disease. The first description connecting regional enteritis with perianal disease was by Bissell et al in 1934, and since that time perianal INCIDENCE AND NATURAL HISTORY disease has become a recognized entity and an important consideration in the Limited pediatric data describe the incidence and prevalence diagnosis and treatment of CD. Perianal Crohn disease (PCD) is defined as of PCD. The incidence of PCD in the pediatric age group has been inflammation at or near the anus, including tags, fissures, fistulae, abscesses, estimated to be between 13.6% and 62% (3).
    [Show full text]
  • Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent
    Abe et al. J Clin Gastroenterol Treat 2016, 2:038 Volume 2 | Issue 4 Journal of ISSN: 2469-584X Clinical Gastroenterology and Treatment Clinical Image: Open Access Esophago-Pulmonary Fistula Caused by Lung Cancer Treated with a Covered Self-Expandable Metallic Stent Takashi Abe1, Takayuki Nagai1 and Kazunari Murakami2 1Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Japan 2Department of Gastroenterology, Oita University, Japan *Corresponding author: Takashi Abe M.D., Ph.D., Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Tsurumi 4333, Beppu City, Oita 874-8585, Japan, Tel: +81-977-23-7111 Fax: +81-977-23-7884, E-mail: [email protected] Keywords Esophagus, Pulmonary parenchyma, Fistula, lung cancer, Self- expandable metallic stent A 71-year-old man was diagnosed with squamous cell lung cancer in the right lower lobe. He was treated with chemotherapy (first line: TS-1/CDDP; second line: carboplatin/nab-paclitaxel) and radiation therapy (41.4 Gy), but his disease continued to progress. The patient complained of relatively sudden-onset chest pain and high-grade fever. Computed tomography (CT) showed a small volume of air in the lung cancer of the right lower lobe, so the patient was suspected of fistula between the esophagus and the lung parenchyma. Upper gastrointestinal endoscopy revealed an esophageal fistula (Figure 1), which esophagography using water- soluble contrast medium showed overlying the right lower lobe Figure 2: Esophagography findings. Contrast medium is shown overlying the right lower lobe (arrow). (Figure 2). The distance from the incisor teeth to this fistula was 28 cm endoscopically. CT, which was done after esophagography, showed fistulous communication between the esophagus and Figure 1: Endoscopy showing esophageal fistula (arrow).
    [Show full text]
  • Colo-Gastric Fistula As an Uncommon Complication of Crohn's Disease
    Colo-gastric Fistula as an Uncommon Complication of Crohn’s Disease Molly Stone, MD September 28, 2019 Background - Crohn’s Disease (CD): a transmural inflammatory process which often gives rise to sinus tracts and eventually fistulization into adjacent serosa. - Fistulizing disease is a common complication of CD - Risk increases with longer disease duration - Prevalence of 15% in childhood; up to 50% at 20 yrs from dx - Fistulas most commonly form in perianal region - Intra-abdominal fistula develop in approximately 30% of patients. Common Sites of Fistulas Torres. The Lancet. 2017. Gastrocolic Fistula - First described in 1775, first case related to Crohn’s Disease reported in 1948 - Most commonly seen with peptic ulcer disease, cases also noted in gastric and colon cancers in addition to Crohn’s. - Classic Triad: diarrhea, weight loss, feculent emesis - Only present in 30% of cases - Presence of feculent emesis helps to distinguish gastrocolic from more distal entero-enteric fistulas Epidemiology - Rare complication noted in only 0.6% of CD pt - Youngest reported case in a 13 yo pt who had CD for 3 yrs, however most pts range 25-60 with disease duration >10 yrs - M=F - Predisposing factors: Ileal disease and prior ileocolic anastomoses Pathogenesis - Most form from mid- to distal transverse colon to the greater curvature of the stomach - Initiate from active area of colitis - Multiple cases with evidence of proximal disease on resection implying gastric to colic or bidirectional formation Greenstein, Diseases of Colon and Rectum. 1989.
    [Show full text]
  • Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-In-Ano, and Rectovaginal Fistula Jon D
    PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Jon D. Vogel, M.D. • Eric K. Johnson, M.D. • Arden M. Morris, M.D. • Ian M. Paquette, M.D. Theodore J. Saclarides, M.D. • Daniel L. Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Sur- and submucosal locations.7–11 Anorectal abscess occurs geons is dedicated to ensuring high-quality pa- more often in males than females, and may occur at any Ttient care by advancing the science, prevention, age, with peak incidence among 20 to 40 year olds.4,8–12 and management of disorders and diseases of the co- In general, the abscess is treated with prompt incision lon, rectum, and anus. The Clinical Practice Guide- and drainage.4,6,10,13 lines Committee is charged with leading international Fistula-in-ano is a tract that connects the perine- efforts in defining quality care for conditions related al skin to the anal canal. In patients with an anorec- to the colon, rectum, and anus by developing clinical tal abscess, 30% to 70% present with a concomitant practice guidelines based on the best available evidence. fistula-in-ano, and, in those who do not, one-third will These guidelines are inclusive, not prescriptive, and are be diagnosed with a fistula in the months to years after intended for the use of all practitioners, health care abscess drainage.2,5,8–10,13–16 Although a perianal abscess workers, and patients who desire information about the is defined by the anatomic space in which it forms, a management of the conditions addressed by the topics fistula-in-ano is classified in terms of its relationship to covered in these guidelines.
    [Show full text]
  • Incidental Cholecystojejunal Fistula: a Rare Complication of Gall Stone Disease
    MedCrave Online Journal of Surgery Case Report Open Access Incidental cholecystojejunal fistula: a rare complication of gall stone disease Abstract Volume 8 Issue 4 - 2020 Cholecystoenteric fistula is a rare complication of gallstone disease and difficult to diagnose Vipul K Srivastava,1 Shilpi Roy,1 Ramniwas preoperatively. Among Cholecystoenteric fistula, cholecystojejunal fistulae are even rarer Meena,2 Rahul Khanna2 and only a few case reports have been published on it. Here we report a case of a 60-year 1Resident, Department of General Surgery, Institute of Medical male patient with cholecystojejunal fistula diagnosed intraoperatively while performing Sciences, India laparoscopic cholecystectomy. Fundus of the gall bladder was found to be communicating 2Professor, Department of General Surgery, Institute of Medical with proximal jejunum. We conclude that in elderly patients if the ultrasonography shows Sciences, India features of contracted gall bladder in presence of large gall stones one should consider an option of getting a computed tomography scan done preoperatively. Correspondence: Dr. Ramniwas Meena, Professor Department of General Surgery, Institute of Medical Sciences Banaras Hindu University, Varanasi–221005, UP, India, Keywords: cholecystoenteric, cholecystojejunal, fistula, gall-stones, cholecystitis Tel +919935141697, Email Received: October 25, 2020 | Published: December 17, 2020 Introduction Cholecystoenteric fistula (CEF) was first described by Courvoisier in 1890. They are a rare complication of gallstone disease and are formed due to ongoing inflammation.1 They are bilioenteric type of Internal Biliary fistula which is rare to find. Preoperative diagnosis of CEF is difficult to make with pneumobilia being the most common radiological finding.2 So here we report a rare case of cholecystojejunal fistula.
    [Show full text]
  • Discharge Instructions After Fistulotomy
    FAIRFAX COLON & RECTAL SURGERY, P.C. DONALD B. COLVIN, M.D., F.A.S.C.R.S. PAUL E. SAVOCA, M.D., F.A.S.C.R.S. LYNDA S. DOUGHERTY, M.D., F.A.S.C.R.S. DANIEL P. OTCHY, M.D., F.A.S.C.R.S. LAWRENCE E. STERN, M.D., F.A.S.C.R.S. KIMBERLY A. MATZIE, M.D., F.A.C.S. COLORECTAL/ANORECTAL SURGERY, COLONOSCOPY, ANORECTAL PHYSIOLOGY (703) 280-2841 DISCHARGE INSTRUCTIONS AFTER FISTULOTOMY An anal fistula is an abnormal channel or tunnel-like chronic infection that starts inside the anus and ends outside on the skin around the anus. Its development is usually the result of a previous anal infection or abscess. About 50% of people with an anal abscess end up with a fistula. Most fistulas are short and superficial and are best treated by simply opening the entire tunnel and leaving it open to heal in gradually. Occasionally a patient can have a complex fistula with multiple tracts or the tunnel may traverse a considerable amount of the sphincter muscle. For this reason the surgical treatment has to be individualized for each particular patient depending on the location and anatomy of the fistula. Frequently, the surgeon cannot guarantee exactly what will need to be done until the examination that is done under anesthesia at the time of the surgery. It is important to realize that the operative procedure can change depending on what is found at the time of the surgery. At times a fistula will require more than one surgery to cure.
    [Show full text]
  • What Is Enterocutaneous Fistula?
    Patient Education What Is Enterocutaneous Fistula? An enterocutaneous fistula is an opening from the intestines to the top of the skin that leaks fluids or stool. This liquid usually comes from your stomach or intestines. How do I know if I have Enterocutaneous Fistula? Symptoms of an enterocutaneous fistula include: • Intestinal fluid or stool leaking through and onto the skin (seen as drainage coming from the stomach). • The stomach becomes unable to absorb nutrients (malabsorption). • Dehydration (not drinking enough water). What causes Enterocutaneous Fistula? • Problems from abdominal surgery • Trauma resulting from penetrating wounds (such as stabbings or gunshot) • Inflammatory disorders (Crohn’s disease) • Side effect of radiation to the abdomen or pelvis (can occur years after treatment) How can I fix it? Treatment for an enterocutaneous fistula depends on the size, location, patient’s history, cause of fistula, and problems related to the fistula. At times an enterocutaneous fistula closes on its own after a few weeks to months. If problems happen and/or the fistula does not heal on its own after a couple of months surgery will be needed. If the enterocutaneous fistula is draining a large amount of gastrointestinal (stomach and intestinal) fluid, the fistula is managed as a stoma (an opening in the belly for getting rid of wastes). The use of an ostomy device may also be used. Sometimes patients may need nutritional support with TPN (intravenous source of nutrition). How can I learn more? You can also find information through the American Society of Colon & Rectal Surgeons (ASCRS) at http://www.fascrs.org/patients/conditions/ Do you have any questions or comments for your doctor? _________________________________ ____ ____________________________________ PTED#0000118 Division of Colon & Rectal Surgery.
    [Show full text]
  • Fistula-Related Cancer in Crohn's Disease: a Systematic Review
    cancers Systematic Review Fistula-Related Cancer in Crohn’s Disease: A Systematic Review Andromachi Kotsafti 1,* , Melania Scarpa 1 , Imerio Angriman 2 , Ignazio Castagliuolo 3 and Antonino Caruso 4 1 Laboratory of Advanced Translational Research, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; [email protected] 2 First Surgical Clinic Section, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, 35128 Padua, Italy; [email protected] 3 Department of Molecular Medicine DMM, University of Padua, 35121 Padua, Italy; [email protected] 4 Gastroenterology Unit, ULSS2 Marca Trevigiana, Montebelluna Hospital, 31044 Montebelluna, Italy; [email protected] * Correspondence: [email protected] Simple Summary: Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease. The relationship between perianal fistula in CD (Chron’s disease) and SCC (squa- mous cell carcinoma) development is not clear but chronic inflammation of ano-rectal mucosa, delayed wound healing and cell turnover may play important roles. The aim of this systematic review was to determine the clinical characteristics of patients with squamous cell carcinoma arising from perianal fistula in CD, the surgery and oncological treatment, the role of HPV infection, im- munosuppression and the survival of these patients. Fistula-related carcinoma in CD can be very difficult to diagnose. An early diagnosis has the potential to improve the outcome of disease. Abstract: Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous Citation: Kotsafti, A.; Scarpa, M.; cell carcinoma (SCC).
    [Show full text]
  • Radiologic Diagnosis of Tracheoesophageal Fistula in Children
    11 Review Article Page 1 of 11 Radiologic diagnosis of tracheoesophageal fistula in children Ercan Ayaz, Mithat Haliloglu Division of Pediatric Radiology, Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey Contributions: (I) Conception and design: All authors; (II) Administrative support: E Ayaz; (III) Provision of study materials or patients: M Haliloglu; (IV) Collection and assembly of data: E Ayaz; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Mithat Haliloglu, MD. Professor of Radiology, Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey. Email: [email protected]. Abstract: Radiological imaging plays an essential role in the diagnostic algorithm of tracheoesophageal fistula (TEF) in the prenatal and postnatal period. Although the primary imaging modality is esophagogram with water-soluble contrast, there are various imaging techniques to make the diagnosis. As ultrasound and magnetic resonance imaging (MRI) are compatible during the prenatal period, computed tomography (CT) and plain radiographs may provide additional information to contrast studies in the postpartum period. Imaging is also crucial to identify other associated anomalies and to predict the outcome. Moreover, radiological examinations are often necessary in the postoperative period to define complications and recurrent TEF. The aim of this article is two folds; first to describe indications, imaging methods and findings of congenital, acquired, and recurrent TEF and accompanying conditions to confirm the diagnosis, and second, to discuss the yield of different imaging methods in line with the literature. While describing congenital TEF, concomitant anomalies, such as esophageal atresia (EA) and tracheal agenesis were depicted systematically according to the prevalent classifications.
    [Show full text]
  • TUMOUR and TREATMENT SIDE-EFFECTS
    TUMOUR and TREATMENT SIDE-EFFECTS TUMOUR TUMOUR TREATMENT EFFECTS RADIATION SITE EFFECTS CHEMOTHERAPY SURGERY THERAPY Head & Neck Difficulty Nausea Mucositis Impaired chewing & chewing or Vomiting Stomatitis swallowing swallowing Diarrhea Dysgeusia, Xerostomia Stomatitis hypogeusia Xerostomia, dysphagia Difficulty chewing secondary to dental decay or infection Viscous saliva Oropharyngeal ulceration Osteoradionecrosis Fistula Trismus Esophagus Dysphagia Nausea Dysphagia Decreased gastric secondary to Esophagitis motility esophageal Esophageal fibrosis or Decreased gastric obstruction stricture acid production Regurgitation Fistula Fistula of meals Nausea Esophageal stenosis Edema Regurgitation Steatorrhea Stomach Early satiety Nausea Nausea Fat malabsorption & Vomiting after Vomiting Vomiting diarrhea meals Stomatitis Decreased gastric Diarrhea motility "Dumping" syndrome Hypoglycemia Protein malabsorption Deficiences in iron, calcium, fat-soluble vitamins & vitamin B12 Esophagitis Pancreas & Malabsorption Nausea Nausea Diabetes mellitus biliary tree &/or diabetes Vomiting Vomiting Malabsorption of fat, secondary to Stomatitis protein, & fat-soluble pancreatic Diarrhea vitamins & insufficiency Minerals Dysgeusia Nausea Small Bowel Nausea Gastrointestinal Loss of bile salts, intestine obstruction Stomatitis ulceration calcium, magnesium, Malabsorption Diarrhea Villous hypoplasia zinc Malabsorption Metabloic acidosis secondary to Increased risk of decreased enzyme renal stones production Postoperative gastric Intestinal fistula hypersecretion
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Information and Advice Following Placement of Seton for Anal Fistula
    Oxford University Hospitals NHS Trust Information and advice following placement of seton for anal fistula page 2 What is a fistula? You can get an anal fistula as a result of an infection or a collection of pus (abscess) in or around your anus. It can also be caused by conditions which affect your bowel, such as Crohn’s disease. There are different types of fistula. Some develop as a single tunnel (tract) running from your rectum through to the skin near your anus. Others may be more complex and branch off into more than one opening. Sometimes they cross the muscles which control the opening and closing of your anus (sphincter muscles). This can cause problems with controlling your bowel movements and may cause you to be incontinent. Symptoms and signs of anal fistula can be there all the time or may disappear for a while before coming back. Symptoms of an anal fistula can include: • pus from your anal area • pain and discomfort in and around your anus • bleeding from in and around your anal area • irritation of the skin around your anus • an open hole or wound near to your anus • a collection of pus (an abscess). page 3 What is a seton? A seton is a thin silicone string (very similar to an elastic band) which is inserted into the fistula tract. This allows the fistula to drain and heal from the inside out. This procedure is normally carried out under general anaesthetic. This means you will be asleep throughout the operation. After the seton has been placed in the fistula tract, the wound will be covered with a light, padded dressing.
    [Show full text]