Risk Factorsand Outcomefor Abdominal Bleedingin Patientswith Duodenal Fistula

Background and Objection:Abdominal bleeding with duodenal fistula is a fatal complication.There are few studies on it.Currently,the studies of abdominal bleeding are mainly focused on trauma and postoperative bleeding.Abdominal bleeding with duodenal fistula is particularity.The cause of bleeding is intestinal fluid erosion,the location of bleeding is anatomically disordered,and there is always capillary hemorrhage.Due to the dispersion of duodenal fistula,some cases lack evidence-based evidence.There are few studies on intraperitoneal hemorrhage caused by duodenal fistula.There is a lack of investigation for risk factors for duodenal fistula bleeding,the analysis of prognosis and the related study of secondary duodenal hemorrhage.Duodenal fistula cases in most parts of the country are treated at our center.It is convenient and feasible for the study of the risk factors of duodenal fistula,the analysis of prognosis and the study of the hemostasis mode of duodenal fistula with abdominal bleeding.The purposes of this study were as follows:1.to investigate the risk factors of bleeding with duodenal fistula.2.to investigate the hemostatic effect and prognosis between different hemostasis methods.3.to investigate the prognosis of patients with intraperitoneal hemorrhage.Methods and materials1.Part one:The clinical data of patients with duodenal fistula from January 2011 to December 2015 in the Nanjing Jinling Hospital,Southern Medical University,were reviewed and collected.The patients were divided into hemorrhage group and non-bleeding group according to whether the abdominal hemorrhage occurred during the treatment.The risk factors of abdominal hemorrhage with duodenal fistula were screened.2.Part two:According to the methods of hemostasis,the bleeding group can be divided into arterial embolism group and laparotomy group(the method of hemostasis was decided by the experienced surgeon based on the objective condition of bleeding).The success rates of 2 hemostasis were analyzed.In order to assess the effect of embolic hemostasis and surgical hemostasis on the prognosis of patients,embolic hemostasis patients were included in Group A.Patients with successful hemostasis in operation group were included in Group B.According to the difference of prognosis in two groups,the prognosis of two groups of A and B was evaluated.3.Part three:Statistical analysis of the prognosis of duodenal fistula bleeding group and non-bleeding group was performed.To evaluate the prognosis of patients with duodenal fistula due to abdominal bleeding.Results:1.Part one:a total of 177 patients were included in the study.There were 72 patients in the bleeding group and 105 in the non-bleeding group.acute kidney injury(OR:8.164,95%CI:1.648-40.435,P = 0.010),and retroperitoneal infection(OR:5.195,95%CI:1.524-17.709,P = 0.008)were associated with abdominal bleeding in patients with duodenal fistula.2.Part two:72 patients in the bleeding group.Of the 72patients,there were 42 in the embolism group,including 28 cases with successful embolization(66.67%).There were 30 patients in the laparotomy group,18 cases(60%)were successfully hemostasis,and there was no significant difference between the two groups in the success rate of hemostasis(p=0.623).There were 28 patients in group A and 18 patients in group B.There was no significant difference in prognosis between the two groups.However,the decrease rate of leukocyte and C reactive protein in group B was faster than that of the patients receiving arterial embolization for 3 weeks.P<0.05).3.Part three:The incidence of hepatic(p=0.002)and kidney(p<0.001)injury in bleeding group was significantly higher than that in non-bleeding group,while the spontaneous closure rate in bleeding group was significantly lower than that in non-bleeding group(p<0.001).ConclusionAcute renal injury and retroperitoneal infection were 2 risk factors for abdominal bleeding due to duodenal fistula.The prognosis of duodenal fistula complicated with abdominal bleeding was poor.The effect of laparotomy hemostasis on infection control was better,but the prognoses of patients with the 2different intervention methods were not statistically significant.