Baki Hekimoglu, Mehmet Ercument Dogen, Umit Yasar Ayaz

Alt ve U st Gastrointestinal Fistu llerin Go sterilmesinde Kontrastlı Fluoroskopik Çalışmalar

Üst ve alt gastrointestinal (GI) fistüllerin saptanmasında, yerlerinin belirlenmesinde ve uzanımlarının görülmesinde konvansiyonel fluoroskopik kontrastlı çalışmaların yararlılığını araştırmayı amaçladık. Çalışmamıza, klinik olarak çeşitli tiplerde GI fistülleri olduğu düşünülen, yaşları 1 ay ile 75 yaş arasında değişen 24 hasta dahil edildi. Fistülleri göstermek için suda çözünür iyotlu kontrast ajanlar her olgu için en uygun şekilde oral, perkütan veya rektal yoldan verildi. Olgular etiyolojik olarak sınıflandırıldı. Fistüllerin, orokutanöz/tiroglossal (n=1), trakeoözofageal (n=4), özofagoplevral (n = 4), gastrokolik (n=1), duodenorenal (n=2), duodenokütanöz (n=1) , enterokutanöz (n = 2), enterovezikal (n=1), kolokütanöz (n = 1), kolovezikal (n=1), rektovezikal (n=1), rektovajinal (n=1), anorektokütanöz (n= 4) olduğu ve uzanımları etkin olarak gösterilebildi. İatrojenik etyolojiler (cerrahi, radyoterapi vb.), 24 hastanın 11'inde (%45.8) GI fistüllerin başlıca nedeni olarak tespit edildi. Kontrast madde geçişini gerçek zamanlı olarak görebilmemiz, seçtimiz bölgeye yönelik çalışabilmemiz, farklı projeksiyonlarda yüksek uzaysal çözünürlükte görüntüler elde edebilmemiz nedeniyle, değişik türlerde GI fistüllerin ilk görüntülemesinde konvansiyonel fluoroskopik kontrastlı çalışmaların tercih edilen radyolojik yöntem olmaya devam ettiği sonucuna vardık.

The Utility of Fluoroscopic Contrast Studies in Demonstration of Upper and Lower Gastrointestinal Fistulas

Our aim was to investigate the utility of conventional fluoroscopic contrast studies in detecting, localizing the upper andlower gastrointestinal (GI) fistulas and seeing their extensions. Our study included 24 patients between 1 month to 75 years of ageswho were clinically suspected to have various types of GI fistulas. We administered water soluble iodinated contrast agents orally,percutaneously and rectally in an appropriate way in each case to demonstrate the fistulas. The cases were etiologically classified.We were able to demonstrate orocutaneous/thyroglossal (n=1), tracheoesophageal (n=4), esophagopleural (n=4), gastrocolic (n=1),duodenorenal (n=2), duodenocutaneous (n=1), enterocutaneous (n=2), enterovesical (n=1), colocutaneous (n=1), colovesical (n=1),rectovesical (n=1), rectovaginal (n=1), anorectocutaneous (n=4) fistulas and their extensions effectively. Iatrogenic etiologies(surgery, radiotherapy etc.) were found to be the leading cause of GI fistulas by 11 patients out of 24 ( 45.8%). Since we are able tosee contrast material flow real-time, make selective studies and get highest spatial resolution images in different projections, weconclude that conventional fluoroscopic contrast studies remain to be the radiologic method of choice particularly for the initialimaging of various types of GI fistulas.

PDF

___

Halasz NA. Changing patterns in the management of small bowel fistulas. Am J Surg. 1978; 136: 61-65.
Tio TL, Mulder CJ, Wijers OB, Sars PR, Tytgat GN. Endosonography of peri-anal and peri-colorectal fistula and/or abscess in Crohn's disease. Gastrointest Endosc. 1990; 36: 331-6.
Edmunds LH Jr, Williams GM, Welch CE. External fistulas arising from the gastro-intestinal tract. Ann Surg. 1960; 152: 445-71.
Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002; 224: 9-23.
Maconi G, Sampietro GM, Parente F, et al. Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn's disease: a prospective comparative study. Am J Gastroenterol. 2003; 98: 1545-55.
Frick MP, Feinberg SB, Stenlund RR, Gedgaudas E. Evaluation of abdominal fistulas with computed body tomography. Comput Radiol. 1982 ;6: 17-25.
Khera PS, Badawi HA, Afifi AH. MRI in perianal fistulae. Indian J Radiol Ima-ging. 2010;20:53-57.
Arslan M, Adıbelli Z, Cengiz F, Söker G. The Role of Magnetic Resonance Imaging in Determining of Perianal Fistulas. J Harran Unv Med F. 2017; 14: 25-30.
Senem Ş, Acar M. Perianal Fistüllerde MR Görüntüleme. Trd Sem. 2015; 3: 127-137.
Segar RJ, Bacon HE, Gennaro AR. Surgical management of enterocutaneous fistulas of the small intestine and colon. Dis Colon Rectum. 1968;11:69- 73.
Alexander ES, Weinberg S, Clark RA, Belkin RD. Fistulas and sinus tracts: radiographic evaluation, management, and outcome. Gastrointest Radiol. 1982; 7: 135-140.
Osborn C, Fischer JE. How I do it: gastrointestinal cutaneous fistulas. J Gastrointest Surg. 2009;13:2068-2073.
Fontaine P, Truy E, Kauffmann I, Disant F, Morgan A. Congenital cysts and fistulae of the face and the neck. Pediatrie. 1992;47:617-22.
Anbari MM, Levine MS, Cohen RB, Rubesin SE, Laufer I, Rosato EF. Delayed leaks and fistulas after esophagogastrectomy: radiologic evaluation. Am J Roentgenol. 1993;160:1217-20.
Donner CS. Pathophysiology and therapy of chronic radiation-induced injury to the colon. Dig Dis. 1998;16:253-61.
Ayaz UY, Dilli A, Tüzün ÖM, Hekimoğlu B. Gastric varices mimicking polypoid tumoural mass. Journal of Ankara University Faculty of Medicine. 2010; 63: 93-97.
Levenback C, Gerhenson DM, McGehee R, Eifel PJ, Morris M, Burke TW. Enterovesical fistula following radiotherapy for gynecologic cancer. Gynecol Oncol. 1994;52:296-300.
Karaca AS. 994 cases of Ferguson hemorrhoidectomy: 10-years experience of a single surgeon. J Clin Anal Med. 2017;8:307-10.
Rose D, Yarborough M, Canizaro PC, Lowry SF. One hundred and fourteen fistulas of the gastrointestinal tract treated with total parenteral nutrition. Surg Gynecol Obstet. 1986;163:345-50.
Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009; 251: 751- 61.