Clinical Study Of Intestinal Fistula Complicated With Wernicke Encephalopathy

Background:Clinically,the incidence of Wernicke encephalopathy(WE)is relatively low,and the incidence of intestinal fistula complicated with Wernicke encephalopathy is even less than that of Wernicke encephalopathy.On the one hand,it is related to the lack of early specific clinical manifestations.On the other hand,the occurrence and development of intestinal fistula complicated with Wernicke encephalopathy involve many complex pathophysiological mechanisms,and its diagnosis and treatment also involve many disciplines such as general surgery,neurology and nutrition.At present,there is a lack of effective diagnostic indicators for intestinal fistula complicated with Wernicke encephalopathy,which makes clinical diagnosis difficult and easy to be missed or misdiagnosed.Therefore,it is of great significance for us to understand the occurrence and development of this disease and the clinical manifestations of patients with intestinal fistula complicated with Wernicke encephalopathy.Studies have shown that gender,the amount of fistula fluid,the use of vitamin B1(VB1)are closely related to the occurrence and development of the disease.Therefore,a better understanding of the clinical manifestations of intestinal fistula complicated with Wernicke encephalopathy and its related risk factors is of great significance to improve our clinical diagnosis thinking and reduce the missed diagnosis or misdiagnosis of the disease.Aims:The correlation between the gender,the amount of fistula fluid and the clinical manifestations(memory disorder,blurred vision,weakness of lower limbs,ataxia,triad)of patients with intestinal fistula and Wernicke encephalopathy was analyzed,and the amount of fistula fluid,theoccurrence of Wernicke encephalopathy triad and the good conversion of vitamin B1 after one week's treatment were further observed.To explore the influence of gender and the amount of fistula fluid on the clinical manifestations of intestinal fistula complicated with Wernicke encephalopathy,as well as the amount of fistula fluid and the influence of the occurrence of Wernicke encephalopathy triad on the effect of vitamin B1 treatment,which can improve the diagnosis of intestinal fistula complicated with Wernicke encephalopathy to a certain extent,strive to achieve early detection,early diagnosis and treatment,and help patients improve survival situation.Methods:1.To collect the detailed data of patients with intestinal fistula complicated with Wernicke encephalopathy in general surgery department of The First Affiliated Hospital of Henan University hospital from January 2012 to January 2019,and make a systematic and comprehensive retrospective analysis.According to the gender of the patients,the amount of fistula fluid(low output: less than 200 ml in 24 h fistula,less than 200 ml in non-low output: more than 200 ml in 24 h fistula)and the presence of Wernicke encephalopathy triad,the gender,the amount of fistula fluid and the effect of clinical manifestations(memory disorder,blurred vision,lower extremity weakness,ataxia,triad)were divided into three groups Line analysis.At the same time,the amount of fistula fluid and the occurrence of triad were correlated with the improvement after one week of vitamin B1 treatment.SPSS statistics 24.0software was used for statistical analysis,and Fisher's accurate test method,namely four grid accurate probability method,was used for analysis.(P < 0.05),the difference was statistically significant.2.The participants of this study should follow the following requirements: one:The inclusion criteria of enterofistula are:(1)abdominal pain,fever and abdominal distention,and some peritonitis;(2)outflow or discharge of intestinal contents or gases from the ostium or incision area;(3)imaging examination such as gastrointestinal radiography or CT suggests the existence of fistula.two : The inclusion criteria of Wernicke encephalopathy were as follows: the diagnostic screening criteria of Wernicke encephalopathy(WE)published by the European Federation of Neurological Societies(EFNS)in December 2010 was used[1],that is to say,if two of the following four conditions are met,we diagnosis can be doubted to be established and included in the study:(1)There are long-term nutritional disorders or heavy drinkinghistory;(2)eye symptoms(blurred vision);(3)cerebellar symptoms(ataxia);(4)mental and consciousness changes or mild memory dysfunction;three:The clinical history was intestinal fistula complicated with Wernicke encephalopathy.Results:18 cases of intestinal fistula complicated with Wernicke encephalopathy were collected.The average age of 11 / 7(11 male and 7 female)patients were 62.73 ± 11.13 and 59.29 ±10.86 years old.The statistical results showed that there was no significant difference in gender and clinical manifestations(memory disorder,blurred vision,weakness of lower limbs,ataxia,triad)(P > 0.05)? Among the indicators of fistula fluid volume,5 were low output fistula and 13 were non low output fistula.The statistical results showed that there was a statistical difference between the amount of fistula fluid and the clinical manifestations(blurred vision)(P<0.05),but there was no significant difference between the amount of fistula fluid and the improvement after one week of vitamin B1 treatment(P > 0.05)?Our further study found that the number of patients with Wernicke encephalopathy triad was 6,while the number of patients without Wernicke encephalopathy triad was 12.The statistical results showed that there was no statistical difference between the improvement of Wernicke encephalopathy triad and vitamin B1 after one week of treatment(P > 0.05).Conclusion:There was no significant correlation between the gender of patients and the clinical manifestations(memory disorder,blurred vision,weakness of lower limbs,ataxia,triad).At the same time,there was no significant correlation between the amount of intestinal fistula fluid,whether there was triad of Wernicke encephalopathy and the improvement of vitamin B1 after one week's treatment.However,there is a significant correlation between the amount of fistula fluid and the clinical manifestations(blurred vision).This suggests that the loss of intestinal fistula fluid may be one of the causes of blurred vision in patients with intestinal fistula complicated with Wernicke encephalopathy in the development of Wernicke encephalopathy.