Background: Low serum albumin concentration is a predictor of failure of source control for intra-abdominal infection. However, data on dynamics of albumin synthesis in these patients and to what extent these changes contribute to hypoalbuminemia are relatively scarce. We investigated in a group of patients with gastrointestinal fistula the dynamic response of liver albumin synthesis to intra-abdominal abscess and how these related to hypoalbuminemia and circulating endocrine hormone profiles. Methods: Eight gastrointestinal fistula patients scheduled to undergo percutaneous abscess sump drainage were enrolled prospectively to measure albumin synthesis rates at different stages of the inflammatory response (immediately after diagnosis and 7 d following sump drainage when clinical signs of intra-abdominal sepsis had been eradicated). Eight age-, sex-, and body mass index-matched intestinal fistula patients were studied as control patients. Consecutive arterial blood samples were drawn during a primed-constant infusion (priming dose: 4 micromol$kg -1 , infusion rate: 6 micromol$kg

Background: A retained intra-abdominal surgical sponge is always followed by foreign body granuloma and serious complications such as perforation, intra-abdominal abscess, intestinal obstruction, and intestinal fistula. Hemostatic materials have become increasingly popular and are used to control intra-abdominal hemorrhage, remaining in the abdominal cavity after surgery. Usually there are no symptoms in patients who have retained hemostatic materials because these materials are bioabsorbable and cause no harm. However, if the body fails to absorb the hemostatic materials completely, the retained materials will cause the same problems as the gossypiboma does. Case Presentation: We report a 37-year-old male who underwent emergency surgery because of closed abdominal trauma, rectum rupture, and intra-abdominal hemorrhage after an automobile accident. Partial rectectomy with sigmoid stoma was performed, however, the hemostatic materials used during the emergency surgery became calcified and caused damage to the intestine, leading to severe post-operative complications including intra-abdominal abscess, intestinal obstruction, and intestinal fistula. The patient was then transferred to our hospital and cured after the removal of the foreign bodies, resection of the terminal ileum fistula with anastomosis, and colostomy closure. Conclusions: Surgeons need to be cautious when leaving hemostatic materials in the abdominal cavity even if they are bioabsorbable.

Background: Malnutrition and sepsis remain the leading causes of death in gastrointestinal fistulas. Establishment of appropriate access of enteral nutrition is still challenging for patients with multiple fistulas. Case Presentation: We presented in this case a patient with multiple post-operative fistulas and anastomotic leakages. Because of the lack of intestinal integrity for enteral feeding, we performed a step-by-step assessment and monitoring to achieve maximum benefit. Conclusion: The establishment of nutritional feeding access to patients with multiple fistulas requires accurate assessment of sequencing of each fistula limb, percutaneous endoscopic enterostomy, and multiple times fistuloclysis to restore intestinal integrity. Conventional Treatment Conventional treatment including provision of fluid/electrolyte balance to replete fluid and electrolytes, adequate drainage, use of somatostatin, bowel rest via total parenteral