i've been reading a lot of CT enteroclysis and the detail is incredible. especially in crohn's.
the SBFTs have only been good for looking at the TI.
and i prefer to inject a enterocutaneous fistula directly from the skin and track it from there to see approximately where it is (and you can confirm that on a CT if you can take them from the fluoro suite fast enough).
CT enteroclysis is clearly the shiznat. We've just started doing them over the last year and a half. There's a learning curve we're going through, but it's totally worth it.
Fistulagrams are plus/minus in my practice. I'm sometimes more interested in how much bowel lies upstream and where it sits. That gets factored into surgical decision making. If I'm trying to figure out whether or not there's a component of distal relative/partial obstruction, then I don't care how the contrast gets there so injection is fine. For enormous high output fistulae (measured in liters per day) I *REALLY* need to evaluate the amount and position of the proximal bowel. I'd be skeptical that you could inflate the proximal bowel in those situations.
We've had 3 really complex cases with rediculous fistulas over the past year. One of them was actually out wandering the streets and was at a local fast food place when he was spotted by off duty EMS. They saw him pour a strawberry shake into his mouth and it immediately came out of his shirt. They walked up to him and offered to bring him to the county hospital... unfortunately for me, he agreed. He'd AMA'd from another hospital recently after they were unable to treat him completely for complications of surgery that occurred in Mexico.
CT enteroclysis is clearly the shiznat. We've just started doing them over the last year and a half. There's a learning curve we're going through, but it's totally worth it.
Fistulagrams are plus/minus in my practice. I'm sometimes more interested in how much bowel lies upstream and where it sits. That gets factored into surgical decision making. If I'm trying to figure out whether or not there's a component of distal relative/partial obstruction, then I don't care how the contrast gets there so injection is fine. For enormous high output fistulae (measured in liters per day) I *REALLY* need to evaluate the amount and position of the proximal bowel. I'd be skeptical that you could inflate the proximal bowel in those situations.
We've had 3 really complex cases with rediculous fistulas over the past year. One of them was actually out wandering the streets and was at a local fast food place when he was spotted by off duty EMS. They saw him pour a strawberry shake into his mouth and it immediately came out of his shirt. They walked up to him and offered to bring him to the county hospital... unfortunately for me, he agreed. He'd AMA'd from another hospital recently after they were unable to treat him completely for complications of surgery that occurred in Mexico.
Jeez, and I thought I have problems! My god, is he doing allright?
Jeez, and I thought I have problems! My god, is he doing allright?
Well... he's crazy. I can't suture that.
He's also drug addicted and kind of a butthead. I'll try just a bit to work with that, but in the end, after a long hospitalization, my ability to maintain a relationship with drug seekers begins to fatigue.
He was discharged with a continuous alimentary tract, but an open abdominal wound that was still healing.
If he played his cards wrong... which I suspect that he did... he's leaking again.
Location: native California gal, now expat in Germany
Posts: 1,993
Re: Ask the Bellydoc
Quote:
Katfish previously said:
VBAC if necessary, like I go into labor or something - but no meds???? WHY in the he11 would ANYONE do that when they are readily available???? FREAK!
Just teasing, kind of....I love epidurals.....last Wednesday in the hospital again with contractions, a couple were so fierce I wanted the darn epi.....
Women have been having children for thousands of years without the aid of meds, why have we become so wimpy in the last 50 or so? That said, after nearly 12 hours of labor, at 4 am I caved when they told me there was only one epi left, and the next batch wouldn't arrive for hours, and other women were contemplating getting it. I said hook that sucker up, NOW!
I still feel like a wimp.
So what's the hap's around here? I haven't visited for what seems like weeks.
Women have been having children for thousands of years without the aid of meds, why have we become so wimpy in the last 50 or so? That said, after nearly 12 hours of labor, at 4 am I caved when they told me there was only one epi left, and the next batch wouldn't arrive for hours, and other women were contemplating getting it. I said hook that sucker up, NOW!
I still feel like a wimp.
So what's the hap's around here? I haven't visited for what seems like weeks.
One relevant difference between then and now is that both mother and child are generally expected to survive the experience... just a thought...
This process continues to kill randomly throughout the undeveloped portions of the world. It's not just the pain meds, it's the complete medical supervision throughout pregnancy and labor that makes a difference. Obstetricians stave off disaster every single day. Thanks to the expectation of survival, we can now concentrate on things like comfort.
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THE BLACK SHEEP SHEPARD... shall you follow?
We're easily amused.................
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One relevant difference between then and now is that both mother and child are generally expected to survive the experience... just a thought...
This process continues to kill randomly throughout the undeveloped portions of the world. It's not just the pain meds, it's the complete medical supervision throughout pregnancy and labor that makes a difference. Obstetricians stave off disaster every single day. Thanks to the expectation of survival, we can now concentrate on things like comfort.
is he doing allright?
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