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Sample records for aortoenteric fistula related

  1. Aortoenteric Fistula

    Directory of Open Access Journals (Sweden)

    Shou-Jiang Tang

    2014-04-01

    Conclusions: Diagnosis of aortoenteric fistula requires a high index of suspicion and careful history-taking. Endoscopic findings include adherent clots or bleeding at the fistula opening and/or eroded vascular graft or stent into the bowel.

  2. [Secondary aortoenteric fistula, multidisciplinary surgical management].

    Science.gov (United States)

    Cunha E Sá, Diogo; De Andrade, J Rebelo; Roquete, Paulo; Pestana, Cristina; Cabral, Gonçalo; Tiago, José; Dinis da Gama, A

    2011-01-01

    The authors report the clinical case of a 77-year old man, who underwent the surgical treatment of an abdominal aortic aneurism 11 years before, admitted in the hospital emergency department complaining of abdominal pain and melena. Clinical and laboratorial findings, together with CT-scan and endoscopy data, lead to the diagnosis of secondary aortoenteric fistula. This is a rare clinical entity, coursing with high morbimortality levels of and is still one of the most controversial issues in vascular surgery. The successful surgical treatment of this patient is described and the solution of choice is discussed, as well as other alternative approaches. PMID:23610769

  3. Critical gastrointestinal bleed due to secondary aortoenteric fistula.

    Science.gov (United States)

    Malik, Mohammad U; Ucbilek, Enver; Sherwal, Amanpreet S

    2015-01-01

    Secondary aortoenteric fistula (SAEF) is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A). The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF. PMID:26653698

  4. Critical gastrointestinal bleed due to secondary aortoenteric fistula

    Directory of Open Access Journals (Sweden)

    Mohammad U. Malik

    2015-12-01

    Full Text Available Secondary aortoenteric fistula (SAEF is a rare yet lethal cause of gastrointestinal bleeding and occurs as a complication of an abdominal aortic aneurysm repair. Clinical presentation may vary from herald bleeding to overt sepsis and requires high index of suspicion and clinical judgment to establish diagnosis. Initial diagnostic tests may include computerized tomography scan and esophagogastroduodenoscopy. Each test has variable sensitivity and specificity. Maintaining the hemodynamic status, control of bleeding, removal of the infected graft, and infection control may improve clinical outcomes. This review entails the updated literature on diagnosis and management of SAEF. A literature search was conducted for articles published in English, on PubMed and Scopus using the following search terms: secondary, aortoenteric, aorto-enteric, aortoduodenal, aorto-duodenal, aortoesophageal, and aorto-esophageal. A combination of MeSH terms and Boolean operators were used to device search strategy. In addition, a bibliography of clinically relevant articles was searched to find additional articles (Appendix A. The aim of this review is to provide a comprehensive update on the diagnosis, management, and prognosis of SAEF.

  5. Is EVAR the treatment of choice for aortoenteric fistula?

    DEFF Research Database (Denmark)

    Lönn, Lars; Dias, Nuño; Veith Schroeder, T;

    2010-01-01

    with endovascular repair have been attempted. Endovascular repair is often successful in the short-term achieving favorable immediate outcome. In the presence of systemic infection, however, EVAR alone as an ultimate solution is often followed by repeat infection and bleeding. A staged combination of EVAR treatment...... for acute bleeding and aggressive infection treatment with systemic and local antibiotics, surgical abscess revision and fistula tract closure might be an option in fragile patients. For patients fit for open repair, EVAR can be used as a bridging procedure to definitive repair particularly in the setting...

  6. An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess

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    Aytaç Gülcü

    2016-07-01

    Full Text Available Mycotic aortic aneurysms account for 1–3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm.

  7. [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].

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    Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent

    2013-01-01

    Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163

  8. Aortoduodenal fistula following aortic reconstruction of a pseudoaneurysm caused by stab wound 12 years ago

    Institute of Scientific and Technical Information of China (English)

    Jian-cang ZHOU; Qiu-ping XU; Lai-gen SHEN; Kong-han PAN; Yi-ping MOU

    2009-01-01

    Gastrointestinal bleeding due to aortoenteric fistula is extremely rare. Aortoenteric fistula is difficult to be diagnosed timely and entails a significant morbidity and mortality. Herein, we present an uncommon case of gastrointestinal bleeding caused by aortoduodenal fistula, which was a complication of a successful aortic reconstruction 4 months ago for an aortic pseudoaneurysm resulted from a stab wound 12 years ago. An urgent laparotomy confirmed an aortoduodenal fistula and repaired the defects in aorta and duodenum, but a prolonged shock led to the patient's death. In summary, early diagnosis and surgical intervention for aortoenteric fistula are vital for survival.

  9. Fistula

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    ... oxygen in the lungs) The navel and gut Inflammatory bowel disease, such as ulcerative colitis or Crohn disease, can lead to fistulas between one loop of intestine and another. Injury can cause fistulas to form ...

  10. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  11. Catheter-related infection in gastrointestinal fistula patients

    Institute of Scientific and Technical Information of China (English)

    Ge-Fei Wang; Jian-An Ren; Jun Jiang; Cao-Gan Fan; Xin-Bo Wang; Jie-Shou Li

    2004-01-01

    AIM: To study the incidence, bacterial spectrum and drug sensitivity of catheter-related infection (CRI) in gastrointestinal fistula patients.METHODS: A total of 216 patients with gastrointestinal fistulae during January 1998 to April 2001 were studied retrospectively. Two hundred and sixteen catheters of the 358 central venous catheters used in 216 gastrointestinal fistula patients were sent for microbiology analysis.RESULTS: Ninety-five bacteria were cultivated in 88catheters (24.6%). There were 54 Gram-negative bacteria (56.8%), 35 Gram-positive bacteria (36.8%), and 6 fungi (6.4%). During the treatment of CRI, 20 patients changed to use antibiotics or antifungal, and all patients were cured.The mean time of catheters used was 16.9±13.0 d.CONCLUSION: CRI is still the common complication during total parenteral nutrition (TPN) treatment in patients with gastrointestinal fistulae, and Gram-negative bacteria are the main pathogens, and bacterial translocation is considered the common reason for CRI.

  12. Enigma of primary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

    Miklosh Bala; Jacob Sosna; Liat Appelbaum; Eran Israeli; Avraham I Rivkind

    2009-01-01

    A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.

  13. Secondary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

    Girolamo Geraci; Franco Pisello; Francesco Li Volsi; Tiziana Facella; Lina Platia; Giuseppe Modica; Carmelo Sciumè

    2008-01-01

    Aorto-duodenal fistulae (ADF) are the most frequent aorto-enteric fistulae (80%), presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication (0.3%-2%) of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.

  14. Secondary Iliac-Enteric Fistula to the Sigmoid Colon Complicated with Entero-Grafto-Cutaneous Fistula

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    Gábor Bognár

    2008-04-01

    Full Text Available We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method.

  15. Treatment of a biliary-venous fistula following percutaneous biopsy in a pediatric living related liver transplant patient

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    Weintraub, Joshua L.; Mobley, David [Mount Sinai Medical Center, Department of Radiology, Division of Vascular and Interventional Radiology, One Gustave L. Levy Place, Box 1234, New York, NY (United States); Hawari, Ashraf; English, Benjamin [New York Medical College, Department of Radiology, Valhalla, NY (United States)

    2006-06-15

    Liver biopsy is a common study performed after hepatic transplantation. Most centers routinely perform a biopsy 1 week after surgery to evaluate for the possibility of acute rejection. Subsequent biopsies are based on clinical symptoms and routine hepatic function laboratory testing. We report the clinical presentation and treatment of a biliary-venous fistula resulting in sepsis and bilhemia (elevated serum bilirubin levels caused by a biliary-venous fistula) in a 21/2-year-old patient 4 months after partial left lateral segment living related liver transplantation. This case is unusual in that the fistula is the reversal of the more common venous-biliary fistula. The fistula developed after a percutaneous liver biopsy was performed. (orig.)

  16. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter;

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be ...

  17. Successful Multistaged Surgical Management of Secondary Aortoesophageal Fistula With Graft Infection.

    Science.gov (United States)

    Afifi, Rana O; Mushtaq, Harith H; Sandhu, Harleen K; Khalil, Kamal; Safi, Hazim J; Estrera, Anthony L

    2016-06-01

    Secondary aortoenteric fistula is a rare and dreaded complication of aortic graft replacement. This case demonstrates successful management of a patient with thoracic aortic graft infection resulting in aortoesophageal fistula and the feasibility of combined endovascular approach as a temporary measure to stabilize the patient in extremis, followed by a definitive surgical repair. The patient had a remote history of descending aortic repair and an emergent thoracic endovascular aortic repair for upper gastrointestinal bleeding 2 months ago. We performed a three-staged operation involving extraanatomic bypass, total infected aortic graft excision, and primary closure of the esophageal perforation with muscle flap coverage, from which he eventually recovered.

  18. STUDY OF ENTEROCUTANEOUS FISTULA

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    Arti

    2015-03-01

    Full Text Available BACKGROUND: A fistula is defined as abnormal communication between two epithelial surfaces . 1 Enterocutaneous fistula is defined as abnormal communication between hollow organ and skin. They are classified as congenital or acquired. We have excluded congenital and internal fistulas. We have also excluded esophageal, urinary, p ancreatic and biliary fistulas as their management is complex and differs significantly from enterocutaneous fistulas. AIM: 1. Study of aetiology, pathophysiology and management of enterocutaneous fistula. To evaluate previously laid principles of management of enterocutaneous fistula. 2. To assess the feasibility of early intervention safety and outcome as the conservative long term treatment appears to be cost prohibitive. 3. To study morbidity and mortality related to enterocutaneous fistula. MATERIAL AND METHODS: In all, 50 cases of enterocutaneous fistula were studied during a period from June 2012 to N ovember 2014 at a Government tertiary care C entre. Both, patients referred from other centres with post - operative fistulas and fistulas developed in this institute after surgeries or spontaneously were included in the study after fulfilling the inclusion and exclusion criteria. RESULT S : The maximum numbers of cases were between 39 - 48 years of age group. Spontaneous closure was achieved in 72.7% and surgical closure in 76.7% of the patients Vacuum assisted closure was achieved in 66.66% of the patients in whom VAC was used. Of the patients in whom octreotide was used closure was achieved in 66.66% of the patients. The association between serum albumin levels and fistula healing and between fistula output and mortality were statistically significant. Overall mortality in this study was 26% with 44.44% among referred cases and 15.625% among institutional cases.

  19. Massive hemobilia due to hepatic arteriobiliary fistula during endoscopic retrograde cholangiopancretography: An extremely rare guidewir-related complication

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    Nam, Jeong Gu; Seo, Young Woo; Hwang, Jae Cheol; Weon, Young Cheol; Kang, Byeong Seong; Bang, Sung Jo; Bang, Min Seo [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2015-05-15

    Although endoscopic retrograde cholangiopancreatography (ERCP) is an effective modality for diagnosis and treatment of biliary and pancreatic diseases, the risk for procedure-related complications is high. Hemorrhage is one of major complications of ERCP. Most ERCP-associated bleeding is primarily a complication related to sphincterotomy rather than diagnostic ERCP. We are reporting a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP, which was successfully treated with transarterial embolization of the hepatic artery.

  20. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands

    NARCIS (Netherlands)

    J.E. Baars; E.J. Kuipers; G. Dijkstra; D.W. Hommes; D.J. de Jong; P.C.F. Stokkers; B. Oldenburg; M. Pierik; P.J. Wahab; A.A. van Bodegraven; C.J. van der Woude

    2011-01-01

    Objective. Malignant transformation of fistulas has been observed, particularly in perianal fistulas in Crohn's disease (CD) patients. The prevalence of adenocarcinoma in enterocutaneous fistulas and non-CD-related fistulas, however, is unknown. We investigated adenocarcinoma originating from perian

  1. Malignant transformation of perianal and enterocutaneous fistulas is rare : results of 17 years of follow-up from The Netherlands

    NARCIS (Netherlands)

    Baars, Judith E.; Kuipers, Ernst J.; Dijkstra, Gerard; Hommes, Daniel W.; de Jong, Dirk J.; Stokkers, Pieter C. F.; Oldenburg, Bas; Pierik, Marieke; Wahab, Peter J.; van Bodegraven, Adriaan A.; van der Woude, Christien J.

    2011-01-01

    Objective. Malignant transformation of fistulas has been observed, particularly in perianal fistulas in Crohn's disease (CD) patients. The prevalence of adenocarcinoma in enterocutaneous fistulas and non-CD-related fistulas, however, is unknown. We investigated adenocarcinoma originating from perian

  2. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands

    NARCIS (Netherlands)

    Baars, J.E.; Kuipers, E.J.; Dijkstra, G.; Hommes, D.W.; Jong, D.J. de; Stokkers, P.C.; Oldenburg, B.; Pierik, M.; Wahab, P.J.; Bodegraven, A.A. van; Woude, C.J. van der

    2011-01-01

    OBJECTIVE: Malignant transformation of fistulas has been observed, particularly in perianal fistulas in Crohn's disease (CD) patients. The prevalence of adenocarcinoma in enterocutaneous fistulas and non-CD-related fistulas, however, is unknown. We investigated adenocarcinoma originating from perian

  3. Cardiocutaneous fistula

    OpenAIRE

    Danias, P; Lehman, T; Kartis, T; Missri, J.

    1999-01-01

    Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic ev...

  4. Modern management of anal fistula.

    Science.gov (United States)

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

    Ideal surgical treatment for anal fistula should aim to eradicate sepsis and promote healing of the tract, whilst preserving the sphincters and the mechanism of continence. For the simple and most distal fistulae, conventional surgical options such as laying open of the fistula tract seem to be relatively safe and therefore, well accepted in clinical practise. However, for the more complex fistulae where a significant proportion of the anal sphincter is involved, great concern remains about damaging the sphincter and subsequent poor functional outcome, which is quite inevitable following conventional surgical treatment. For this reason, over the last two decades, many sphincter-preserving procedures for the treatment of anal fistula have been introduced with the common goal of minimising the injury to the anal sphincters and preserving optimal function. Among them, the ligation of intersphincteric fistula tract procedure appears to be safe and effective and may be routinely considered for complex anal fistula. Another technique, the anal fistula plug, derived from porcine small intestinal submucosa, is safe but modestly effective in long-term follow-up, with success rates varying from 24%-88%. The failure rate may be due to its extrusion from the fistula tract. To obviate that, a new designed plug (GORE BioA®) was introduced, but long term data regarding its efficacy are scant. Fibrin glue showed poor and variable healing rate (14%-74%). FiLaC and video-assisted anal fistula treatment procedures, respectively using laser and electrode energy, are expensive and yet to be thoroughly assessed in clinical practise. Recently, a therapy using autologous adipose-derived stem cells has been described. Their properties of regenerating tissues and suppressing inflammatory response must be better investigated on anal fistulae, and studies remain in progress. The aim of this present article is to review the pertinent literature, describing the advantages and limitations of

  5. Sudden unexpected death as a result of primary aortoduodenal fistula identified with postmortem computed tomography.

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    Williams, Andrew S; Little, D'Arcy L; Herath, Jayantha

    2015-12-01

    Aortoenteric fistula (AEF) is an uncommon source of upper gastrointestinal (GI) tract hemorrhage, commonly occurring in persons with previous aortic surgery. Non-surgery related AEFs (primary AEFs) may occur in association with atherosclerotic lesions, infections, malignancies, or, rarely, result from penetrating/eroding foreign bodies. Given its rarity, primary AEF is not commonly considered in the pathologist's preliminary list of differential diagnoses at the commencement of an autopsy; however, the use of postmortem cross-sectional imaging may allow for the identification of primary AEF as a reasonable differential diagnoses prior to conventional autopsy. The current case outlines the forensic presentation, postmortem computed tomography (PMCT) features, and autopsy findings of a recent case of primary AEF resulting in lethal gastrointestinal hemorrhage. In such cases, PMCT features supporting primary AEF as the underlying cause of death include an atherosclerotic aneurysm abutting a segment of the GI tract with no definite soft tissue plane of separation, luminal GI contents of similar radiographic density to the aortic contents, lack of previous aortic surgery, and lack of a competing explanation for GI hemorrhage or a competing cause of death. Deaths from massive enteric hemorrhage without a medical history to suggest an underlying cause for the hemorrhage would fall under medicolegal jurisdiction and may, by examination of scene and circumstances alone, initially seem suspicious. This case demonstrates how PMCT could be used by a team of expert forensic radiologists and forensic pathologists to rapidly feedback vital information on the cause and manner of death to the criminal justice system. PMID:26464132

  6. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Harle, Robin A

    2013-01-01

    The association of cerebral dural arteriovenous fistula (DAVF) and ipsilateral flow related aneurysm has infrequently been reported. We describe a male patient who presented with an acute haemorrhagic stroke and was found to have a large right fronto-parietal intra-parenchymal haemorrhage from the ruptured Borden type II DAVF in addition to a large venous aneurysm and a flow related intraosseous aneurysm of the contralateral middle meningeal artery (MMA) all clearly delineated by CT and DSA. He underwent emergency stereotactic evacuation of the intraparenchymal haemorrhage and successful surgical treatment of all the vascular lesions at the same time with residual neurological deficit. To our knowledge, this is the first such reported case. We discuss the challenging surgical treatment, emphasising the role of CT/DSA in management, and provide a literature review.

  7. Idiopathic fistula-in-ano

    Institute of Scientific and Technical Information of China (English)

    Sherief Shawki; Steven D Wexner

    2011-01-01

    Fistula-in-ano is the most common form of perineal sep- sis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abs-cess, or more insiduously in a chronic manner. Mana-gement includes control of infection, assessment of the fistulous track in relation to the anal sphincter muscle, and finally, definitive treatment of the fistula. Fistulo-tomy was the most commonly used mode of manage-ment, but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps, fibrin glue, collagen fistula plug, ligation of the intersphincteric fistula track, and stem cells. Many descriptive and comparative studies have evaluated these different techniques with variable outcomes. The lack of consistent results, level I eviden-ce, or long-term follow-up, as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm. This article will review the most commonly available modalities and techniques for managing idio-pathic fistula-in-ano.

  8. Sonographic Diagnosis of Arterioportal Fistula

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    Canan Alkim

    2010-01-01

    Full Text Available Aim. We aimed to identify and describe characteristic and diagnostic ultrasonographic features of arterioportal fistula cases. Patients. In this case series we describe 3 patients with arterioportal fistula. By depending on shared sonographic features of these patients we describe a “sonographic pattern” for the sonographic diagnosis of arterioportal fistula. Conclusion. In summary; both of the artery and vein related with fistula were wider than normal and seen as adjacent anechoic circles, there was an aneurismatic dilation on vein which has turbulent flow within it, the communication between the artery and aneurism can be seen sonographically, both of the vessels have arterial flow, filling of the vein was retrograde and other branches of the artery and vein unrelated with aneurism were all normal in dimension.

  9. Fistula-in-ano. A manometric study.

    Science.gov (United States)

    Belliveau, P; Thomson, J P; Parks, A G

    1983-03-01

    The functional outcome of fistula surgery can be quantitated by anal manometry. A closed, water-filled microballoon (0.5 X 1.0 cm) system was used to measure resting anal pressure and maximal squeeze pressure in 47 patients with anal fistulas at St. Mark's Hospital. After treatment of intersphincteric fistulas, there was a significant reduction in resting pressure in the distal 2 cm. In treated transphincteric fistulas and suprasphincteric fistulas, anal pressure was reduced in the distal 3 cm. A significant lower pressure was measured in patients having the external sphincter divided, compared with those having the muscle preserved. Disturbance of continence was related to abnormally low resting pressure in six patients. This study supports attempts at sphincter preservation in fistula surgery. PMID:6825520

  10. Emphysematous prostatic abscess with rectoprostatic fistula

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    Po-Cheng Chen

    2014-12-01

    Full Text Available Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.

  11. A primary aorto-duodenal fistula associated with an inflammatory abdominal aortic aneurysm: a case report.

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    Honjo,Osami

    2005-08-01

    Full Text Available

    Primary aorto-enteric fistula (PAEFis a serious complication of abdominal aortic aneurysm(AAA. We report a patient with PAEF associated with inflammatory AAA who underwent emergent surgery. A 52-year-old male presented with recurrent hematemesis. A computer tomography scan showed a sealed rupture of the AAA adjacent to the duodenum. At surgery, a coin-sized PAEF was noted. The aorta was replaced with a Dacron graft in situ . Histological examination revealed the characteristics of an inflammatory AAA. The postoperative course was uneventful, and there has been no evidence of infection during a follow-up period of 3 years. We discuss the etiologic and surgical considerations regarding this unusual entity.

  12. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in an arm with arteriovenous (A-V) fistula for hemodialysis.

    Science.gov (United States)

    Chou, Ya-Hui; Li, Shu-Hua; Liao, Su-Fen; Tang, Hao-Wei

    2013-08-01

    Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape.

  13. Case report: Manual lymphatic drainage and kinesio taping in the secondary malignant breast cancer-related lymphedema in an arm with arteriovenous (A-V) fistula for hemodialysis.

    Science.gov (United States)

    Chou, Ya-Hui; Li, Shu-Hua; Liao, Su-Fen; Tang, Hao-Wei

    2013-08-01

    Lymphedema is a dreaded complication of breast cancer treatment. The standard care for lymphedema is complex decongestive physiotherapy, which includes manual lymphatic drainage (MLD), short stretch bandaging, exercise, and skin care. The Kinesio Taping could help to improve lymphatic uptake. We reported a patient with unilateral secondary malignant breast cancer-related lymphedema and arteriovenous (A-V) fistula for hemodialysis happened in the same arm, and used kinesio taping, MLD, and exercise to treat this patient because no pressure could be applied to the A-V fistula. The 12-session therapy created an excellent effect. We do not think the kinesio taping could replace short stretch bandaging, but it could be another choice for contraindicating pressure therapy patients, and we should pay attention to wounds induced by kinesio tape. PMID:22879520

  14. Ureteroarterial Fistula

    Directory of Open Access Journals (Sweden)

    D. H. Kim

    2009-01-01

    Full Text Available Ureteral-iliac artery fistula (UIAF is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.

  15. MRI in perianal fistulae

    International Nuclear Information System (INIS)

    MRI has become the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the sphincter muscles orthogonally, with good contrast resolution. In this article we give an outline of the classification of perianal fistulae and present a pictorial assay of sphincter anatomy and the MRI findings in perianal fistulae. This study is based on a retrospective analysis of 43 patients with a clinical diagnosis of perianal fistula. MRI revealed a total of 44 fistulae in 35 patients; eight patients had only perianal sinuses

  16. MRI in perianal fistulae

    Directory of Open Access Journals (Sweden)

    Khera Pushpinder

    2010-01-01

    Full Text Available MRI has become the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the sphincter muscles orthogonally, with good contrast resolution. In this article we give an outline of the classification of perianal fistulae and present a pictorial assay of sphincter anatomy and the MRI findings in perianal fistulae. This study is based on a retrospective analysis of 43 patients with a clinical diagnosis of perianal fistula. MRI revealed a total of 44 fistulae in 35 patients; eight patients had only perianal sinuses.

  17. [Surgery of anal fistulas].

    Science.gov (United States)

    Ricchi, E; Carriero, A; Spallanzani, A; Fundarò, S; Heydari, A; Piccoli, M; Gelmini, R

    1997-06-01

    The authors report a study on 120 patients with anal fistula (111 males and 9 females). The average age was 44.3 years (median 44, SD +/- 14.807). 64.1% of patients had an intersphincteric fistula, 23.3% hanal transphincteric fistula, 1.6% a suprasphincteric fistula, 7.5% a horseshoe fistula and the 3.3% an extrasphincteric fistula. We treated 14 patients (11.66%) with direct surgical treatment. The other 106 had various types of treatment depending on the localisation and the involvement of the anorectal sphincter. We had 11 cases (9.1%) of complications, such as recurrence in 5 patients (4.1%) transitory incontinence in 2 cases (1.6%) and finally postoperative bleeding in 3 patients (2.5%). PMID:9324655

  18. Histological characteristics of arterialized medullary vein in spinal dural arteriovenous fistulas related with clinical findings: Report of five cases

    Directory of Open Access Journals (Sweden)

    Takami Toshihiro

    2006-01-01

    Full Text Available The histological features of arterialized medullary vein (MV in spinal dural arteriovenous fistulas (SDAVF were studied in five consecutive patients who presented with progressive congestive myelopathy. Retrograde venous filling on preoperative angiography was recognized as being severe in 3 cases and moderate in 2 cases. Direct intradural interruption of the arterialized MV was performed in all patients. The arterialized MV was sampled and examined histologically to determine the percentage of the hyperplasia of venous wall (hypertrophic ratio. Histological examination of arterialized MV showed that hypertrophic alteration of venous wall structure was due to hyperplasia of elastic fibers, ranging from 41 to 82%. Patients with angiographically severe venous hypertension tended to have a higher hypertrophic ratio than patients with moderate venous hypertension. Our observations support the clinical concept that long-standing arterial stress in the spinal venous circulation causes histological alterations of spinal vascular structure associated with the progression of venous hypertension. We suggested that possibly the histological parameter can be used for predicting neurological recovery after occlusion of the fistulas.

  19. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis

    Science.gov (United States)

    Jiang, Wei; Tong, Zhihui; Yang, Dongliang; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

    2016-01-01

    Abstract Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN). Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with and without GI fistula regarding the baseline characteristics and outcomes. Over 4 years, a total of 928 AP patients were admitted into our center, of whom 119 patients with IPN were diagnosed with GI fistula and they developed 160 GI fistulas in total. Colonic fistula found in 72 patients was the most common form of GI fistula followed with duodenal fistula. All duodenal fistulas were managed by nonsurgical management. Ileostomy or colostomy was performed for 44 (61.1%) of 72 colonic fistulas. Twenty-one (29.2%) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation. Mortality of patients with GI fistula did not differ significantly from those without GI fistula (28.6% vs 21.9%, P = 0.22). However, a significantly higher mortality (34.7%) was observed in those with colonic fistula. GI fistula is a common finding in patients of AP with IPN. Most of these fistulas can be successfully managed with different procedures depending on their sites of origin. Colonic fistula is related with higher mortality than those without GI fistula. PMID:27057908

  20. Fistula gastrocólica Gastrocolic fistula

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

    1999-08-01

    Full Text Available A case of gastrocolic fistula(GCF in a patient with duodenal stenosis who had previously undergone gastroenteric anastomosis is reported. The patient went through hemigastrectomy, partial colectomy and segmental enterectomy with bloc resection. Reconstruction was carried out through Billroth II gastrojejunostomy, jejunojejunostomy and end-to-end anastomosis of the colon. The patient had good post-operative evolution and was discharged from hospital seven days after surgery. GCF should be suspected in patients presenting weight loss, diarrhea and fecal vomiting, mainly with history of peptic ulcer surgery, gastric or colonic malignancy and use of steroidal and nonsteroidal antiinflamatory drugs. Barium enema is the choice test for diagnosis, however, the benign or malignant nature of the lesion should always be evaluated through high digestive endoscopy. Clinical treatment with oral H2-antagonists and discontinuing ulcerogenic medications might be indicated in some cases; surgical treatment is indicated in cases of malignant disease and might be indicated in cases of peptic disease as it treats GCF and also the baseline disease. Some advise upwards colostomy at first. The most used technique is bloc resection, including the fistulous tract, hemigastrectomy and partial colectomy. Gastrectomy, fistulous tract excision and colon suturing may be performed in some cases. The mortality rate is related to metabolic disorders and the recurrence with the use of antiinflammatory drugs.

  1. Spontaneous aortocaval fistula.

    Directory of Open Access Journals (Sweden)

    Rajmohan B

    2002-07-01

    Full Text Available Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature.

  2. Dialysis fistula or graft: the role for randomized clinical trials.

    Science.gov (United States)

    Allon, Michael; Lok, Charmaine E

    2010-12-01

    The Fistula First Initiative has strongly encouraged nephrologists, vascular access surgeons, and dialysis units in the United States to make valiant efforts to increase fistula use in the hemodialysis population. Unfortunately, the rigid "fistula first" recommendations are not based on solid, current, evidence-based data and may be harmful to some hemodialysis patients by subjecting them to prolonged catheter dependence with its attendant risks of bacteremia and central vein stenosis. Once they are successfully cannulated for dialysis, fistulas last longer than grafts and require fewer interventions to maintain long-term patency for dialysis. However, fistulas have a much higher primary failure rate than grafts, require more interventions to achieve maturation, and entail longer catheter dependence, thereby leading to more catheter-related complications. Given the tradeoffs between fistulas and grafts, there is equipoise about their relative merits in patients with moderate to high risk of fistula nonmaturation. The time is right for definitive, large, multicenter randomized clinical trials to compare fistulas and grafts in various subsets of chronic kidney disease patients. Until the results of such clinical trials are known, the optimal vascular access for a given patients should be determined by the nephrologist and access surgeon by taking into account (1) whether dialysis has been initiated, (2) the patient's life expectancy, (3) whether the patient has had a previous failed vascular access, and (4) the likelihood of fistula nonmaturation. Careful clinical judgment should optimize vascular access outcomes and minimize prolonged catheter dependence among hemodialysis patients. PMID:21030576

  3. Management of Enterocutaneous Fistulas

    OpenAIRE

    Kaushal, Manish; Carlson, Gordon L.

    2004-01-01

    Despite advances in antimicrobial chemotherapy, nutritional support, and perioperative critical care, the development of an enterocutaneous fistula continues to represent a major therapeutic challenge, with appreciable morbidity and mortality. Specific problems that must be addressed for the successful management of patients with enterocutaneous fistulas are the control of sepsis, maintenance of adequate fluid and electrolyte balance, provision of adequate and complication-free nutritional su...

  4. Fistula Vesiko Vaginalis

    Directory of Open Access Journals (Sweden)

    Luki Ertandri

    2016-08-01

    Full Text Available Abstrak          Latar belakang : fistula vesiko vaginalis merupakan bagian dari fistula vesiko urogenital merupakansuatu keadaan ditandai fistel antara kandung kemih dengan vagina yang menyebabkan rembesan urin keluar melalui vagina.           Kasus : wanita P3A0H3, 44 tahun, datang dengan keluhan terasa rembesan buang air kecil dari kemaluan sejak 3 bulan yang lalu. Keluhan muncul 7 hari setelah menajalani operasi histerektomi 3 bulan yang lalu. Histerektomi dilakukan atas indikasi mioma uteri dilakukan di Rumah Sakit Swasta. Tanda vital dalam batas normal. Pada pemeriksaan inspekulo tampak cairan urin menumpuk di fornix posterior. Dilakukan prosedur tes methylene blue didapatkan hasil positif di puncak vagina anterior 1 fistel dengan ukuran 1-1,5 cm. Pada pasien dilakukan fistulorraphy vesikovagina dengan teknik repair latzko dalam spinal anasthesi.           Pembahasan : Kasus fistula vesiko vaginalis biasa muncul di negara berkembang. Diantara faktor predisposisi adalah disebabkan operasi histerektomi, selain itu trauma persalinan dan komplikasi operasi daerah pelvik. Pemeriksaan Fisik dan pemeriksaan tambahan secara konvensional atau minimal invasif seperti sistoskopi, sistografi menggunakan zat kontras bisa membantu menegakan diagnosa, menentukan lokasi, ukuran dan jumlah fistel. Pembedahan adalah terapi andalan untuk fistula urogenital melalui transvagina atau trans abdomen. Pendekatan terapi tergantung ilmu, pengalaman dan kolaborasi dengan ahli lain bila dibutuhkan.Kata kunci: fistula vesiko vaginalis, histerektomi, latzkoAbstractBackground : Vesica vagina fistula is a part of urogenital fistula wich condition that present fistula between bladder and vagina and make urine mold through vagina.Case Report: Woman P3A0H3, 44 years old, admitted with complaining mold of urine from vagina since three months ago after seven days having surgery procedure. Complaint appeared seven days after histerctomi procedure. The

  5. Congenital parotid fistula

    Directory of Open Access Journals (Sweden)

    Shiggaon Natasha

    2014-01-01

    Full Text Available Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen′s duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient.

  6. Congenital parotid fistula.

    Science.gov (United States)

    Natasha, Shiggaon

    2014-01-01

    Parotid fistula is a cause of great distress and embarrassment to the patient. Parotid fistula is most commonly a post-traumatic situation. Congenital parotid salivary fistulas are unusual entities that can arise from accessory parotid glands or even more infrequently, from normal parotid glands through an aberrant Stensen's duct. The treatment of fistulous tract is usually surgical and can be successfully excised after making a skin incision along the skin tension line around the fistula opening. This report describes a case of right accessory parotid gland fistula of a 4-year-old boy with discharge of pus from right cheek. Computed tomography (CT) fistulography and CT sialography demonstrated fistulous tract arising from accessory parotid gland. Both CT fistulography and CT sialography are very helpful in the diagnosis and surgical planning. In this case, superficial parotidectomy is the treatment of choice. A detailed history, clinical and functional examination, proper salivary gland investigations facilitates in correct diagnosis followed by immediate surgical intervention helps us to restore physical, psychological health of the child patient. PMID:25231049

  7. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.;

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding...

  8. Clinical Experiences of Bronchopleural Fistula-related Fatal Hemoptysis after 
the Resection of Lung Cancer: A Report of 7 Cases

    Directory of Open Access Journals (Sweden)

    Zhenming ZHANG

    2012-01-01

    Full Text Available Background and objective Massive hemoptysis was a rare but severe postoperative complication of lung cancer. The aim of the present study is to investigate the mechanisms, risk factors, early symptoms, prevention, and treatment options for fatal hemoptysis. Methods From April 2007 to May 2011, 1,737 patients with lung cancer were surgically treated in the West China Hospital of Sichuan University. Twenty patients died during the perioperative period, seven of whom died of massive hemoptysis. These seven cases were analyzed, and their clinical data, as well as related literatures, were reviewed. Results Massive hemoptysis is the second cause of death after lung cancer surgery. Six patients died directly of massive hemoptysis. One patient underwent secondary surgery because of massive hemoptysis, but eventually died because of lung infection and respiratory failure. Early symptoms of hemorrhage were observed in four cases, and the overall incidence rate of massive hemoptysis was 0.4% (7/1,737. Conclusion Bronchovascular fistula (BVF caused by bronchopleural fistula (BPF is the mechanism for massive hemoptysis. Diabetes is a high risk factor. Early diagnosis and surgical treatment of BPF or BVF can prevent the occurrence of death as a result of massive hemoptysis.

  9. Risk factors and clinical courses of chemoradiation-related arterio-esophageal fistula in esophageal cancer patients with clinical invasion of the aorta

    International Nuclear Information System (INIS)

    Although concurrent chemoradiotherapy (CRT) is a standard treatment for esophageal cancer invading adjacent structures (T4-EC), arterio-esophageal fistula (AEF) occurs occasionally as a critical adverse event of T4-EC with CRT. The frequency, clinical course, and risk factors of AEF related to CRT are not well known. We retrospectively analyzed 48 patients with T4-EC invasion of the aorta who were treated with 5-fluorouracil, cisplatin, and concurrent radiotherapy at our institution between September 2002 and April 2009. Treatment-related AEF was defined as AEF without obvious tumor progression. We evaluated the frequency, clinical courses, and risk factors of AEF. The median survival time was 10.6 months with a median follow-up time of 33.3 months. The 2-year survival rate was 25%. Treatment-related AEF was observed in 7 patients (14.6%) and 4 of them died of massive bleeding due to aortic AEF. In the other 3 patients with non-aortic AEF, hemorrhage could be arrested by transcatheter arterial embolization (TAE). In the univariate analysis of risk factors for AEF, lower serum cholesterol level was a risk factor for AEF (odds ratio (OR) 14.7; 95% confidence interval (CI) 1.58-137; P=0.008). Although CRT has a curative potential even for patients with T4-EC invading the aorta, we should be aware of the relatively high incidence of treatment-related AEF. TAE may be successful in rescuing a non-aortic AEF patient. Low serum cholesterol level may be a risk factor for AEF, but further investigation is needed. (author)

  10. Surgical Management of Enterocutaneous Fistula

    International Nuclear Information System (INIS)

    Enterocutaneous (EC) fistula is an abnormal connection between the gastrointestinal (GI) tract and skin. The majority of EC fistulas result from surgery. About one third of fistulas close spontaneously with medical treatment and radiologic interventions. Surgical treatment should be reserved for use after sufficient time has passed from the previous laparotomy to allow lysis of the fibrous adhesion using full nutritional and medical treatment and until a complete understanding of the anatomy of the fistula has been achieved. The successful management of GI fistula requires a multi-disciplinary team approach including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker and surgeons. With this coordinated approach, EC fistula can be controlled with acceptable morbidity and mortality.

  11. Tubercular fistula-in-ano

    International Nuclear Information System (INIS)

    To determine the frequency of tuberculosis in recurrent fistula-in-ano. The study included 100 cases of recurrent fistula-in-ano not responding to conventional surgery. Patients with other co-morbidities such as diabetes mellitus, bleeding disorders or with the evidence of pulmonary, abdominal or intestinal tuberculosis were excluded from this study. Fistulogram was performed in all patients. All the patients were subjected to fistulectomy followed by histopathology of the resected specimen. Thereafter, confirmation of the disease, anti-tuberculous treatment was immediately started and response to treatment was observed after 6 months. Out of the 100 studied patients, 11 cases had biopsy proven tuberculosis in the fistula. All the patients were male. The fistulae were low type, single and usually located posteriorly (n=9) with everted margins. Ten were located within 3 cm of anus. Fistulogram revealed single internal opening. Comparative statistics of tuberculous fistula-in-ano with fistulas due to specific inflammation revealed no major differences. The diagnosed patients of tubercular fistulae-in-ano were observed for at least 6 months after starting anti-tuberculous treatment. They all responded well to anti-tubercular treatment and the fistulae healed without any complication such as recurrence or anal stenosis within 6 months. Tuberculosis should be suspected in case of recurrent fistulae-in-ano, so as to avoid unusual delay in the treatment and miseries to the patient. Appropriate anti-tuberculous therapy leads to healing within 6 months. (author)

  12. Association of Genetic Polymorphisms of Renin–Angiotensin–Aldosterone System-Related Genes with Arterio-Venous Fistula Malfunction in Hemodialysis Patients

    OpenAIRE

    Chen, Yu-Wei; Wu, Yu-Te; Lin, Jhin-Shyaun; Yang, Wu-Chang; Hsu, Yung-Ho; Lee, Kuo-Hua; Ou, Shou-Ming; Chen, Yung-Tai; Shih, Chia-Jen; Lee, Pui-Ching; Chan, Chia-Hao; Chung, Ming-Yi; Lin, Chih-Ching

    2016-01-01

    Hemodialysis (HD) is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF) is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a m...

  13. Surgery for Crohn's anal fistulas.

    Science.gov (United States)

    Sugita, A; Koganei, K; Harada, H; Yamazaki, Y; Fukushima, T; Shimada, H

    1995-11-01

    The aim of this study was to analyze the features of Crohn's anal fistulas and to evaluate the efficacy of seton treatment. In 119 patients with Crohn's disease, the incidence of anal fistula was 56% (67/119), with no significant difference in the incidence among patients with ileitis, colitis, and ileocolitis. "Intractable" anal fistulas were found in 17% of patients with ileitis, compared to 64% of those with colitis (P = 0.051) and 68% of those with ileocolitis (P = 0.014). Seton treatment, i.e., non-cutting, long-term seton drainage, was performed for 21 patients (5 with intersphincteric, and 16 with transsphincteric fistulas). In the 16-month follow up, 9 patients required redrainage for recurrent fistulous abscess, mainly because of progressive colorectal disease. Finally, a good result was obtained in 17 of the 21 patients (81%) and no recurrent fistulous abscess developed in the 8 patients in whom all setons were removed. Anal continence was preserved in all the patients. These results indicate that anal fistulas with Crohn's ileitis were cured more easily than those with colitis or ileocolitis, and that seton treatment was effective for intersphincteric fistula with multiple fistula openings and for transphincteric fistulas in patients exhibiting remission of intestinal Crohn's disease. PMID:8563879

  14. Renopleural fistula after percutaneous nephrolithotomy.

    Science.gov (United States)

    Palou Redorta, J; Banús Gassol, J M; Prera Vilaseca, A; Ramón Dalmau, M; Morote Robles, J; Ahmad Wahad, A

    1988-01-01

    We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter. PMID:3388633

  15. Congenital bronchoesophageal fistula in adults

    Institute of Scientific and Technical Information of China (English)

    Bao-Shi Zhang; Nai-Kang Zhou; Chang-Hai Yu

    2011-01-01

    AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fistulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively. The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

  16. Urethrorectal fistula in a horse.

    OpenAIRE

    Cruz, A. M.; Barber, S M; Kaestner, S B; Townsend, H G

    1999-01-01

    Anomalies of the urethra are uncommon. Urethrorectal fistula in horses has only been reported in foals and only in conjunction with other congenital anomalies. This report describes the diagnosis, surgical management, and possible etiologies of a unique case of urethrorectal fistula in a mature gelding.

  17. Analysis the related factors of pharyngeal fistula following laryngeal cancer surgey and its prevention nursing%喉癌术后并发咽瘘的相关因素分析及预防护理

    Institute of Scientific and Technical Information of China (English)

    孙红霞

    2012-01-01

    Objeclice: To analyze the related factors of pharyngeal fistula Mowing laryngeal cancer surgey and summary the prevention nursing measures. Methods: The clinical data of 18 patients with pharyngeal fistula following laiyngeal cancer were analyzed, and put forward the relevant prevention measures. Results: The factors which were the low probability include the age less than 60 years old, the disease in the stage of T2 or T3 good nutrition, the operation time less than 5.5 hours, and partial laryngectomy. The factors which could increased the occur rate include neck dissection,cough, infection and malnutrition after operation. Oral irrigator could reduce the occur of pharyngeal fistula. There was no obvious correlation between centric negative pressure aspirator and pharyngeal fistula. The main prevention measures include familiar with patient condition, nutritional supportal before and after operation,do well the family's health education, oral care and tracheotomy care. Conclusion: Pharyngeal fistula following laryngeal cancer surgey was related with many factors, do well nursing before and after operation actively could reduce the occur of pharyngeal fistula.%目的:分析喉癌术后并发咽瘘的相关因素,总结预防喉癌术后并发咽瘘的护理措施.方法:回顾性分析2005年1月~2010年12月118例喉癌术后并发咽瘘患者的临床资料,对护理措施进行总结,提出相应的预防护理方法.结果:年龄小于60岁,病变在T2或T3期,营养状况良好,手术时间小于5.5h及喉部分切除的喉癌患者并发咽瘘的几率少;颈部淋巴结清扫,术后出现咳嗽、感染、营养低下时并发咽瘘的几率增加.口腔冲洗能降低咽瘘的发生,中心负压吸引与咽瘘的发生无明显相关性.主要的预防护理有:熟悉病情,术前术后加强营养支持,做好家属的健康教育,做好口腔护理,防止感染,加强创面的引流,做好气管切开的护理,防止呛咳.结论:喉癌术后并发

  18. MRI in evaluation of perianal fistulae:

    OpenAIRE

    Sofic, Amela; Beslic, Serif; Sehovic, Nedzad; Caluk, Jasmin; Sofic, Damir

    2010-01-01

    Background Fistula is considered to be any abnormal passage which connects two epithelial surfaces. Parks’ fistulae classification demonstrates the biggest practical significance and divides fistulae into: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. Etiology of perianal fistulae is most commonly linked with the inflammation of anal glands in Crohn’s disease, tuberculosis, pelvic infections, pelvic malignant tumours, and with the radiotherapy. Diagnostic method o...

  19. Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae.

    Science.gov (United States)

    Coentrao, Luis

    2013-01-01

    Functional vascular access is a prerequisite for adequate haemodialysis treatment in patients with end-stage renal disease. Autogenous arteriovenous fistulae are considered superior to synthetic grafts and central venous catheters; however, fistulae are not without problems. Fistulae thrombosis has become a clinical challenge in nephrology practice, with relevant clinical implications for dialysis patients. Several studies have reported on the feasibility and relatively high-clinical success rate of the endovascular approach to thrombosed fistulae in recent years. However, as repeated interventions are usually required to achieve long-term access survival, maintenance of a previously thrombosed fistulae could be a highly expensive policy. The goals of this article are to provide the reader an insight into the multiple endovascular approaches for thrombosed arteriovenous fistulae, bearing in mind its clinical effectiveness and financial implications. PMID:23897178

  20. Transvenous embolization of indirect carotid-cavernous fistula via upper ophthalmic/facial vein - Case report and literature review

    International Nuclear Information System (INIS)

    Indirect carotid-cavernous fistula or dural arterio-venous fistula of cavernous sinus is relatively rare pathologic finding. Different classifications of carotid-cavernous fistulae are proposed. Now days more and more they are treated by endovascular approach. A case of authors' practice of transvenous embolization of carotid-cavernous fistula via upper ophthalmic vein in 52 year old female is presented with review of the literature. A week later ocular symptoms of the patient regressed. Control angiography at the third month follow up does not visualize fistula. The transvenous approach in management of carotid cavernous fistulae is safe and effective in cases direct arterial approach is absent or technically impossible. Key words: Indirect Carotid-Cavernous Fistula. Embolization. Transvenous Approach

  1. Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria.

    Science.gov (United States)

    Phillips, Beth S; Ononokpono, Dorothy N; Udofia, Nsikanabasi W

    2016-09-01

    Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women. PMID:26958903

  2. Operative considerations for rectovaginal fistulas

    Institute of Scientific and Technical Information of China (English)

    Kevin; R; Kniery; Eric; K; Johnson; Scott; R; Steele

    2015-01-01

    To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas(RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas.

  3. Pancreaticopleural Fistula: Revisited

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2012-01-01

    Full Text Available Pancreaticopleural fistula is a rare complication of acute and chronic pancreatitis. This usually presents with chest symptoms due to pleural effusion, pleural pseudocyst, or mediastinal pseudocyst. Diagnosis requires a high index of clinical suspicion in patients who develop alcohol-induced pancreatitis and present with pleural effusion which is recurrent or persistent. Analysis of pleural fluid for raised amylase will confirm the diagnosis and investigations like CT. Endoscopic retrograde cholangiopancreaticography (ECRP or magnetic resonance cholangiopancreaticography (MRCP may establish the fistulous communication between the pancreas and pleural cavity. The optimal treatment strategy has traditionally been medical management with exocrine suppression with octreotide and ERCP stenting of the fistulous pancreatic duct. Operative therapy considered in the event patient fails to respond to conservative management. There is, however, a lack of clarity regarding the management, and the literature is reviewed here to assess the present view on its pathogenesis, investigations, and management.

  4. Imaging of Anal Fistulas: Comparison of Computed Tomographic Fistulography and Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Changhu [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Lu, Yongchao [Traditional Chinese Medicine Department, Provincial Hospital Affiliated to Shandong University, Jinan 250021 (China); Zhao, Bin [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Du, Yinglin [Shandong Provincial Center for Disease Control and Prevention, Public Health Institute, Jinan 250014 (China); Wang, Cuiyan [Shandong Medical Imaging Research Institute, Shandong University, Jinan 250021 (China); Jiang, Wanli [Department of Radiology, Taishan Medical University, Taian 271000 (China)

    2014-07-01

    The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.

  5. Optimizing management of pancreaticopleural fistulas

    Institute of Scientific and Technical Information of China (English)

    Marek Wronski; Maciej Slodkowski; Wlodzimierz Cebulski; Daniel Moronczyk; Ireneusz W Krasnodebski

    2011-01-01

    AIM: To evaluate the management of pancreaticopleu ral fistulas involving early endoscopic instrumentation of the pancreatic duct.METHODS: Eight patients with a spontaneous pancre aticopleural fistula underwent endoscopic retrograde cholangiopancreatography (ERCP) with an intention to stent the site of a ductal disruption as the primary treatment. Imaging features and management were evaluated retrospectively and compared with outcome.RESULTS: In one case, the stent bridged the site of a ductal disruption. The fistula in this patient closed within 3 wk. The main pancreatic duct in this case appeared normal, except for a leak located in the body of the pancreas. In another patient, the papilla of Vater could not be found and cannulation of the pancreatic duct failed. This patient underwent surgical treatment. In the remaining 6 cases, it was impossible to insert a stent into the main pancreatic duct properly so as to cover the site of leakage or traverse a stenosis situated down stream to the fistula. The placement of the stent failedbecause intraductal stones (n = 2) and ductal strictures (n = 2) precluded its passage or the stent was too short to reach the fistula located in the distal part of the pan creas (n = 2). In 3 out of these 6 patients, the pancre aticopleural fistula closed on further medical treatment. In these cases, the main pancreatic duct was normal or only mildly dilated, and there was a leakage at the body/tail of the pancreas. In one of these 3 patients, additional percutaneous drainage of the peripancreatic fluid collections allowed better control of the leakage and facilitated resolution of the fistula. The remaining 3 patients had a tight stenosis of the main pancreatic duct resistible to dilatation and the stent could not be inserted across the stenosis. Subsequent conservative treatment proved unsuccessful in these patients. After a failed therapeutic ERCP, 3 patients in our series devel oped super infection of the pleural or peripancreatic

  6. Nonsurgical Management of Pancreaticopleural Fistula

    Directory of Open Access Journals (Sweden)

    Ferran N

    2005-03-01

    Full Text Available CONTEXT: Pancreaticopleural fistula is seen in acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. Surgery leads to healing in 80-90% of cases but carries a mortality of up to 10%. AIM: Our aim was to assess the management of pancreaticopleural fistula on a specialist pancreatic Unit. METHODS: Patients presenting with pancreaticopleural fistulae were identified from acute and chronic pancreatitis databases. Management and outcome were compared with previous studies identified in MEDLINE and EMBASE. RESULTS: Four patients presented with dyspnoea from large unilateral pleural effusions. Three had a history of alcohol abuse and one of asymptomatic gallstones. All were treated with chest drainage, octreotide and endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent. Two had a pancreatic stent in situ for 5 and 8.5 months respectively. In the third sphincterotomy was performed; in the fourth the pancreatic duct could not be cannulated. The fistula healed in all cases, with no recurrence after 12-30 months, and no deaths. There are 14 reports including 16 cases treated with endoscopic retrograde cholangiopancreatography plus/minus pancreatic stent in the literature, with no recurrence after follow up ranging 4-30 months and no deaths in these 16 cases. CONCLUSIONS: A high index of suspicion is necessary to be aware of its presence. These data suggest that endoscopic management is preferable alternative to surgery for pancreaticopleural fistula.

  7. Gastrocolic Fistula: A Shortcut through the Gut

    Directory of Open Access Journals (Sweden)

    Nauzer Forbes

    2016-01-01

    Full Text Available Gastrocolic fistulas are observed in association with several conditions. Traditionally, peptic ulcer disease was commonly implicated in the formation of gastrocolic fistulas; however, this is now a rare etiology. Here, we present a case of gastrocolic fistula secondary to peptic ulcer disease alone, in addition to reviewing the literature and providing options for diagnosis and treatment.

  8. A simple novel technique for enteroatmospheric fistulae: silicone fistula plug.

    Science.gov (United States)

    Ozer, M Tahir; Sinan, Hüseyin; Zeybek, Nazif; Peker, Yusuf

    2014-06-01

    Enteroatmospheric fistulae (EAFs), a rare condition that develops in patients treated with an open abdomen, present serious problems for the surgeon. There are no fixed algorithms for treatment of EAF, and treatment options are determined based on the experience of the surgeon and status of the patient. We developed a 'suspended silicone fistula plug' for treating a patient who developed an EAF after undergoing multiple operations in a short period of time. Used in conjunction with negative pressure wound therapy, application of this novel therapy resulted in EAF closure and patient discharge.

  9. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)

    2001-05-01

    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  10. Endovascular exclusion of aortoesophageal fistula after coarctation extraanatomical bypass.

    Science.gov (United States)

    Myers, Patrick O; Gemayel, Gino; Mugnai, Damiano; Murith, Nicolas; Kalangos, Afksendiyos

    2014-07-01

    Extraanatomical bypass has been advocated as the primary technique in adolescents or adults presenting with aortic coarctation. This approach carries significant morbidity, and graft-related complications may be more important in the young patient population. A 52-year-old man who had previously undergone extraanatomical bypass of aortic coarctation was diagnosed with a distal anastomotic pseudoaneurysm and aortoesophageal fistula. This was managed by proximal bypass plugging with an occluder, endovascular exclusion with a stent-graft in the thoracic descending aorta covering the pseudoaneurysm, and coarctation balloon dilation. Aortoesophageal fistula is a late complication observed after extraanatomical bypass for coarctation. This case illustrates this rare complication.

  11. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Sakala, Michelle D. [Wayne State University School of Medicine, Detroit, MI (United States); Dillman, Jonathan R.; Ladino-Torres, Maria F. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States)

    2011-05-15

    Crohn disease, a form of chronic inflammatory bowel disease is characterized by discontinuous inflammatory lesions of the gastrointestinal tract, has a variety of behavioral patterns, including penetrating or fistulous disease. While magnetic resonance enterography (MRE) excellently depicts inflamed bowel segments, it can also be used to assess for a variety of Crohn-disease-related extraintestinal complications, including fistulae. We present the MRE findings of a complex ileocolovesicular fistula in a 14-year-old boy with Crohn disease, where the fistulous tract to the urinary bladder was best delineated on precontrast T1-W imaging because of the presence of fecal material. (orig.)

  12. Usefulness of magnetic resonance in the evaluation of perianal fistulas; Utilidad de la resonancia magnetica en la valoracion de las fistulas perianales

    Energy Technology Data Exchange (ETDEWEB)

    Campo, M.; Isusi, M.; Oleaga, L.; Grande, D. [Hospital de Basurto. Bilbao (Spain); Fernandez, G.; Tardaguila, F. [Clinica POVISA. Vigo (Spain)

    2003-07-01

    Our aim was to confirm the usefulness of magnetic resonance in the evaluation of perianal fistulas, and in conjunction with a thought anatomical review of affected areas. This would allow for the building of a proper surgical plan, which would necessarily differ according to the fistula's complexity. We studied 75 patients with perianal fistulas and performed 81 MR studies by means of axial, sagittal and coronal T1 and T2 sequences. Fistula type, degree, etiology and correlation to surgical findings were all studied. Fifty-five patients underwent surgical treatment, and 26 underwent a more conservative treatment with MR follow-up. Ninety-nine fistulas were observed and classified according to norms set down by St. James University Hospital. Of the 55 cases submitted to surgery, 46 showed concordance between the surgical report and MR, whose sensitivity was 84%. In 9 patients, there was no correlation. In the study of perianal fistulas, it is important to establish both the fistulous tract and relationship to the sphincter complex. MR permits an identification of the sprinter complex and a more precise anatomical localization of the fistulous trajectory. It is also capable of differentiating between fibrosis and abscess. Therefore, MR is an appropriate technique for the study of perianal fistulas and related surgical planning. (Author) 6 refs.

  13. Idiopathic esophagopleural fistula in the newborn

    Energy Technology Data Exchange (ETDEWEB)

    Iannaccone, G.; Cozzi, F.; Roggini, M.; Capocaccia, P.

    1982-07-01

    Idiopathic rupture of the esophagus in the neonate is a rare event, probably related to the same mechanism of ischemic necrosis responsible for other 'spontaneous' g.i. tract perforations in the newborn. The laceration is usually located on the right aspect of the distal esophagus and is complicated by esophagopleural fistula and hydropneumothorax. Plain chest film and esophagography are diagnostic. The condition is an emergency one and usually carries a bad prognosis without prompt surgical repair. A typical case is reported in a baby who survived without early surgery; a residual tiny blind pouch and a small hiatal hernia required surgery at 1 year of age.

  14. Diagnosis and Surgical Management of Uroenteric Fistula.

    Science.gov (United States)

    Gill, Harcharan S

    2016-06-01

    Uroenteric fistulae can occur between any part of the urinary tract and the small and large bowel. Classification is generally based on the organ of origin in the urinary tract and the termination of the fistula in the segment of the gastrointestinal tract. Surgery is often necessary. Congenital fistulae are rare, with most being acquired. Uroenteric fistulae most frequently occur in a setting of inflammatory bowel disease. Imaging often helps in the diagnosis. Management of urinary fistulae includes adequate nutrition, diversion of the urinary tract, diversion of the gastrointestinal tract, treatment of underling inflammatory process or malignancy, and surgery. PMID:27261796

  15. MRI of congenital urethroperineal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Ghadimi-Mahani, Maryam; Dillman, Jonathan R.; Pai, Deepa; DiPietro, Michael [C. S. Mott Children' s Hospital, Department of Radiology, Section of Pediatric Radiology, University of Michigan Health System, Ann Arbor, MI (United States); Park, John [C. S. Mott Children' s Hospital, Department of Pediatric Urology, University of Michigan Health System, Ann Arbor, MI (United States)

    2010-12-15

    We present the MRI features of a congenital urethroperineal fistula diagnosed in a 12-year-old boy being evaluated after a single urinary tract infection. This diagnosis was initially suggested by voiding cystourethrogram and confirmed by MRI. Imaging revealed an abnormal fluid-filled tract arising from the posterior urethra and tracking to the perineal skin surface that increased in size during micturition. Surgical resection and histopathological evaluation of the abnormal tract confirmed the diagnosis of congenital urethroperineal fistula. MRI played important roles in confirming the diagnosis and assisting surgical planning. (orig.)

  16. Endoscopic Airway Evaluation in Congenital Tracheoesophageal Fistula

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    Bracci Paolo

    2014-06-01

    Full Text Available Introduction. The communication between the trachea and esophagus is called tracheoesophageal fistula (TEF. It can occurs as a congenital malformation (0.025-0.05% (in particular related to the esophageal atresia or can occurs as an acquired pathology. Endoscopic evaluation is the gold standard for the diagnosis of TEF and must be performed, in presence of symptoms such as choking, coughing, and cianosis at feeding. Materials and methods. The authors present 145 endoscopic airway evaluations, performed in 142 children for the suspected presence of TEF and for a diagnostic classification of esophageal atresia. The endoscopic airway procedure was performed with the rigid endoscopy technique, in general anesthesia and spontaneous ventilation, with topical anesthesia. Results. The use of the rigid endoscopy allows us to assure an open airway and assists operative management: in the presence of TEF the endoscopic procedure was infact diagnostic, and operative at surgery. The tracheobronchoscopic airway evaluation was able to identify the presence, the level and number of TEF in all patients, in order to classify the cases and plan the therapeutic strategy. Endoscopy showed the fovea of TEF in different positions, in the upper, medium and lower part of the trachea, in rare cases a double fistula or in some cases did not detect the presence of fistula. Discussion and Conclusions. The fovea located in the upper part of the trachea was always of small size, and difficult to diagnose, while the fovea located in the lower or medium part of the trachea was always of large size, and simple to identify. The identification of the precise anatomic position of the TEF guides the surgical planning but also permits to achieve the optimal ventilation and strategies to reduce potential complications during anesthesia.

  17. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit

    2009-01-01

    Full Text Available The Roux-en-Y gastric bypass is one of the most common operations for morbid obesity. Although rare, gastropulmonary fistulas are an important complication of this procedure. There is only one recently reported case of this complication. The present report describes the serious nature of this complication in a patient after an uneventful laparoscopic gastric bypass surgery.

  18. Vesicouterine fistula and blind vagina

    International Nuclear Information System (INIS)

    A case of vesicouterine fistula with blind vagina following cesarean section for obstructed labor is presented. It was surgically treated by fistulectomy, cervicoplasty and maintenance of bladder and cervical potency by catheterization. Intrauterine synechiae formation was prevented by copper T insertion and oral contraceptive pills. The patient is making uneventful a symptomatic progress planning to conceive. (author)

  19. Pharyngocutaneous fistula after total laryngectomy: A single-institution experience, 2001–2012☆,☆☆

    Science.gov (United States)

    Benson, Eleni M.; Hirata, Richard M.; Thompson, Carol B.; Ha, Patrick K.; Fakhry, Carole; Saunders, John R.; Califano, Joseph A.; Arnaoutakis, Demetri; Levine, Marshall; Tang, Mei; Neuner, Geoffrey; Messing, Barbara P.; Blanco, Ray G.F.

    2015-01-01

    Purpose The purpose of this study was to determine the incidence of and risk factors for pharyngocutaneous fistula in patients undergoing total laryngectomy at a single institution. Materials and methods The records of 59 patients undergoing primary or salvage total laryngectomy at our institution from 2001 to 2012 were retrospectively reviewed. Data collected included patient, tumor and treatment characteristics, and surgical technique. Risk factors were analyzed for association with pharyngocutaneous fistula formation. Results Twenty patients (34%) developed fistulas. Preoperative tracheostomy (OR 4.1; 95% CI 1.3–13 [p = 0.02]) and low postoperative hemoglobin (OR 9.1; 95% CI 1.1–78 [p = 0.04]) were associated with fistula development. Regarding surgical technique, primary sutured closure of the total laryngectomy defect had the lowest fistula rate (11%). In comparison, primary stapled closure and pectoralis onlay flap over primary closure had nonsignificantly increased fistula rates (43%, OR 6.0; 95% CI 1.0–37.3 [p = 0.06] and 25%, OR 2.7; 95% CI 0.4–23.9 [p = 0.38], respectively). Pectoralis flap incorporated into the suture line had a significantly increased fistula rate (50%, OR 7.1; 95% CI 1.4–46 [p = 0.02]). After stratification for salvage status, patient comorbidities were associated with fistula in non-salvage cases whereas disease-related characteristics were associated with fistula in salvage cases. Fistula development was associated with increased length of hospital stay (p < 0.001) and increased time before oral diet initiation (p < 0.001). Conclusions Pharyngocutaneous fistula is a common complication of total laryngectomy. Preoperative tracheostomy, postoperative hemoglobin, and surgical technique are important in determining the risk of fistula. PMID:25245411

  20. Management of Postpneumonectomy Bronchopleural Fistulae

    Directory of Open Access Journals (Sweden)

    Kemal Karapinar

    2016-04-01

    Full Text Available Aim: Postpneumonectomy bronchopleural fistula (PPBPF is a hard-to-treat complication that may develop after pneumonectomy. It follows a persistent course. Although there is no commonly adopted method, closure of the fistula with flaps is the general principle. The use of the omental flap may provide higher success rates in the treatment. Material and Method: PPBPF developed in 12 out of 162 pneumonectomies performed at the department of thoracic surgery between 2011 and 2014. The demographic characteristics, fistula management strategies, morbidity, and mortalities were retrospectively studied by analysis of operative reports and a digital database. Results: The rate of PPBPF was 7.4%. The bronchopleural fistulae could be closed by various treatments in 10 patients; omentopexy constituted the basis of treatment in 8 of them. In the other patients with successful results, resuturing with staplers and vacuum assisted closure were performed during the early period. One of the patients who failed treatment died due to ARDS; therefore, it was not possible to apply all the treatment alternatives. In the other patient, despite the use of all treatment alternatives (eloesser flap, tracheal stent, omentopexy, thoracomyoplasty, vacuum assisted closure, the treatment failed. Discussion: PPBPF is one of the most significant causes of morbidity and mortality in thoracic surgery units. Because its treatment may be long, a good plan and its execution by experienced units are necessary. The omental flap is increasingly popular due to good perfusion. We believe that omentopexy and j type tracheal stent performed by experienced teams will provide successful results in fistula treatment.

  1. Association of Genetic Polymorphisms of Renin–Angiotensin–Aldosterone System-Related Genes with Arterio-Venous Fistula Malfunction in Hemodialysis Patients

    Science.gov (United States)

    Chen, Yu-Wei; Wu, Yu-Te; Lin, Jhin-Shyaun; Yang, Wu-Chang; Hsu, Yung-Ho; Lee, Kuo-Hua; Ou, Shou-Ming; Chen, Yung-Tai; Shih, Chia-Jen; Lee, Pui-Ching; Chan, Chia-Hao; Chung, Ming-Yi; Lin, Chih-Ching

    2016-01-01

    Hemodialysis (HD) is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF) is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a multicenter, cross-sectional study to evaluate the association between genetic polymorphisms of renin-angiotensin-aldosterone system and AVF malfunction. Totally, 577 patients were enrolled. Their mean age was 60 years old and 53% were male. HD patients with AVF malfunction had longer duration of HD (92.5 ± 68.1 vs. 61.2 ± 51.9 months, p < 0.001), lower prevalence of hypertension (44.8% vs. 55.3%, p = 0.025), right-sided (31.8% vs. 18.4%, p = 0.002) and upper arm AVF (26.6% vs. 9.7%, p < 0.001), and higher mean dynamic venous pressure (DVP) (147.8 ± 28.3 vs. 139.8 ± 30.0, p = 0.021). In subgroup analysis of different genders, location of AVF and DVP remained significant clinical risk factors of AVF malfunction in univariate and multivariate binary logistic regression in female HD patients. Among male HD patients, univariate binary logistic regression analysis revealed that right-side AVF and upper arm location are two important clinical risk factors. In addition, two single nucleotide polymorphisms (SNPs), rs275653 (Odds ratio 1.90, p = 0.038) and rs1492099 (Odds ratio 2.29, p = 0.017) of angiotensin II receptor 1 (AGTR1), were associated with increased risk of AVF malfunction. After adjustment for age and other clinical factors, minor allele-containing genotype polymorphisms (AA and CA) of rs1492099 still remained to be a significant risk factor of AVF malfunction (Odds ratio 3.63, p = 0.005). In conclusion, we demonstrated that rs1492099, a SNP of AGTR1 gene, could be a

  2. Association of Genetic Polymorphisms of Renin–Angiotensin–Aldosterone System-Related Genes with Arterio-Venous Fistula Malfunction in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Yu-Wei Chen

    2016-05-01

    Full Text Available Hemodialysis (HD is the most commonly-used renal replacement therapy for patients with end-stage renal disease worldwide. Arterio-venous fistula (AVF is the vascular access of choice for HD patients with lowest risk of infection and thrombosis. In addition to environmental factors, genetic factors may also contribute to malfunction of AVF. Previous studies have demonstrated the effect of genotype polymorphisms of angiotensin converting enzyme on vascular access malfunction. We conducted a multicenter, cross-sectional study to evaluate the association between genetic polymorphisms of renin-angiotensin-aldosterone system and AVF malfunction. Totally, 577 patients were enrolled. Their mean age was 60 years old and 53% were male. HD patients with AVF malfunction had longer duration of HD (92.5 ± 68.1 vs. 61.2 ± 51.9 months, p < 0.001, lower prevalence of hypertension (44.8% vs. 55.3%, p = 0.025, right-sided (31.8% vs. 18.4%, p = 0.002 and upper arm AVF (26.6% vs. 9.7%, p < 0.001, and higher mean dynamic venous pressure (DVP (147.8 ± 28.3 vs. 139.8 ± 30.0, p = 0.021. In subgroup analysis of different genders, location of AVF and DVP remained significant clinical risk factors of AVF malfunction in univariate and multivariate binary logistic regression in female HD patients. Among male HD patients, univariate binary logistic regression analysis revealed that right-side AVF and upper arm location are two important clinical risk factors. In addition, two single nucleotide polymorphisms (SNPs, rs275653 (Odds ratio 1.90, p = 0.038 and rs1492099 (Odds ratio 2.29, p = 0.017 of angiotensin II receptor 1 (AGTR1, were associated with increased risk of AVF malfunction. After adjustment for age and other clinical factors, minor allele-containing genotype polymorphisms (AA and CA of rs1492099 still remained to be a significant risk factor of AVF malfunction (Odds ratio 3.63, p = 0.005. In conclusion, we demonstrated that rs1492099, a SNP of AGTR1 gene, could

  3. A prospective study of pharyngocutaneous fistulas following total laryngectomy

    Directory of Open Access Journals (Sweden)

    Qureshi S

    2005-01-01

    Full Text Available Pharyngocutaneous (PC fistula is a common complication following laryngectomy. It leads to increased morbidity, delay in adjuvant treatment, prolonged hospitalization and an increase in treatment costs. Although a number of factors that result in PC fistula have been described, there is still no agreement on the most significant factors. We undertook a prospective study to critically analyze PC fistula and its association with various tumors, patient and treatment related factors. This was a prospective study that included 143 patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx and pyriform sinus. Use of pectoralis major myocutaneous flap to reconstruct the neopharynx, primary disease in pyriform and extensive soft tissue infiltration were significantly associated with PC fistula. Prior treatment (radiotherapy and chemotherapy, type of closure (T closure, Y closure and vertical closure, Layers of closure (full thickness interrupted, submucosal interrupted, submucosal continuous type of suture material (silk, vicryl , age, sex, stage, preoperative tracheostomy, cut margin status, pre/postoperative hemoglobin and experience of surgeons did not relate significantly.

  4. Management of Complex Perineal Fistula Disease.

    Science.gov (United States)

    Akiba, Ricardo Tadayoshi; Rodrigues, Fabio Gontijo; da Silva, Giovanna

    2016-06-01

    Management of complex perineal fistulas such as high perianal, rectovaginal, pouch-vaginal, rectourethral, or pouch-urethral fistulas requires a systematic approach. The first step is to control any sepsis with drainage of abscess and/or seton placement. Patients with large, recurrent, irradiated fistulas benefit from stoma diversion. In patients with Crohn's disease, it is essential to induce remission prior to any repair. There are different approaches to repair complex fistulas, from local repairs to transperineal and transabdominal approaches. Simpler fistulas are amenable to local repair. More complex fistulas, such as those secondary to irradiation, require interposition of healthy, well-vascularized tissue. The most common flap used for this treatment is the gracilis muscle with good outcomes reported. Once healing is confirmed by imaging and endoscopy, the stoma is reversed. PMID:27247533

  5. Lacrimal gland fistula after upper eyelid blepharoplasty

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli

    2011-01-01

    Full Text Available To report the first case of lacrimal gland fistula after upper eyelid blepharoplasty for blepharochalasis. Standard upper blepharoplasty and the hooding excision were performed in a female with blepharochalasis. The patient developed a fistulous tract with tearing from the incision few days after hooding excision. Fistula excision and lacrimal gland repositioning were performed. There were no complications after the repositioning procedure (6 months follow up. Prolapsed lacrimal gland and fistula formation can occur after upper blepharoplasty hooding excision.

  6. Spontaneous enterocutaneous fistula due to femoral hernia

    OpenAIRE

    Kumar, Awanish; Pahwa, Harvinder Singh; Pandey, Anand; Kumar, Suresh

    2012-01-01

    Spontaneous enterocutaneous fistula is a rare entity. We encountered a case of spontaneous enterocutaneous fistula in the groin region due to femoral hernia. A 60-year-old man presented with spontaneous enterocutaneous fistula in the left groin region without signs of peritonitis. He was kept on conservative treatment, but on third postadmission day, he developed a swelling in his right groin, which became firm and irreducible with signs of intestinal obstruction. On exploratory laparotomy, b...

  7. ANTIMICROBIAL ACTIVITY OF CASSIA FISTULA LINN. LEGUMES

    OpenAIRE

    Chauhan Neelam; Bairwa Ranjan; Sharma Komal; Chauhan Nootan

    2011-01-01

    Cassia fistula Linn. (Leguminoseae), commonly known as the Golden Shower, Indian Laburnum. Cassia fistula trees as leguminous plants are popularly grown in Thailand. It is native to India, the Amazon and Sri Lanka and diffused in various countries including Mexico, China, Mauritius, South Africa, East Africa, and West Indies. The antibacterial activities of the petroleum ether, chloroform, ethyle acetate, methanolic and 50% (v/v) hydro alcoholic successive extracts of Cassia fistula (L) fruit...

  8. El agua en Segobriga (Saelices, Hispania Citerior: Las fistulae plumbeae

    Directory of Open Access Journals (Sweden)

    Cebrián, Rosario

    2014-12-01

    Full Text Available In the present article the lead pipes found in the archaeological site of Segobriga and in its surroundings are presented. Some of these fistulae are related to the siphon aqueduct that brought drinking water from Fuente la Mar in Saelices, while others correspond to the internal water supply in the city. Both epigraphic references containing the abbreviated name of the municipality, r(es p(ublica S(egobrigensis vel Segobrigensium, identified on a fistula and in a lead cover, show the public property of the Segobriga hydraulic network.En este artículo presentamos las tuberías de plomo halladas en el yacimiento arqueológico de Segobriga y su entorno. Algunas de estas fistulae están relacionadas con el sifón del acueducto que condujo el agua potable desde la Fuente de la Mar en Saelices, mientras que otras corresponden a la red de distribución del agua en el interior de la ciudad. Las dos menciones epigráficas con el nombre abreviado del municipio, r(es p(ublica S(egobrigensis vel Segobrigensium, documentadas en una fistula y en la tapa de un registro ponen de manifiesto la propiedad pública del sistema hidráulico de Segobriga.

  9. Report of a complete second branchial fistula.

    LENUS (Irish Health Repository)

    Khan, Mohammad Habibullah

    2010-08-01

    We report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa. Cysts, fistulas, and sinuses of the second branchial cleft are the most common developmental anomalies arising from the branchial apparatus. In our case, a 43-year-old man presented with a several-year history of a discharging sinus from the right side of his neck, consistent with a branchial fistula. He underwent various investigations and finally was treated with a one-stage complete surgical excision of the fistula tract. We describe the general clinical presentation, investigations, and surgical outcome of this case.

  10. Malignant colo-duodenal fistula; case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Williams Nigel

    2006-12-01

    Full Text Available Abstract Background Colo-duodenal fistula is a rare complication of malignant and inflammatory bowel disease. Cases with malignant colo-duodenal fistulae can present with symptoms from the primary, from the fistula or from metastatic disease. The fistula often results in diarrhoea and vomiting with dramatic weight loss. Upper abdominal pain is usually present as is general malaise both from the presence of the disease and from the metabolic sequelae it causes. The diarrhoea relates to colonic bacterial contamination of the upper intestines rather than to a pure mechanical effect. Vomiting may be faeculant or truly faecal and eructation foul smelling but in the case reports this 'classic' symptomatology was often absent despite a fistula being present and patent enough to allow barium through it. Occasionally patients will present with a gastro-intestinal bleed. Case presentation We present an unusual case of colorectal carcinoma, where a 65 year old male patient presented with diarrhoea and vomiting secondary to a malignant colo-duodenal fistula near the hepatic flexure. Adenocarcinoma was confirmed on histology from a biopsy obtained during the patient's oesophageogastroduodenoscopy, and the fistula was demonstrated in his barium enema. Staging computed tomography showed a locally advanced carcinoma of the proximal transverse colon, with a fistula to the duodenum and regional lymphadenopathy. The patient was also found to have subcutaneous metastasis. Following discussions at the multidisciplinary meeting, this patient was referred for palliation, and died within 4 months after discharge from hospital. Conclusion We present the case, discuss the management and review the literature. Colo-duodenal fistulae from colonic primaries are rare but early diagnosis may allow curative surgery. This case emphasises the importance of accurate staging and repeated clinical examination.

  11. Tracheoesophageal Fistula; A Case Report

    OpenAIRE

    ÖZDEN, Okan; Gün, İsmet

    2012-01-01

    A tracheoesophageal fistula is an abnormal con- nection between the esophagus and the trachea and is a rarely seen pathology. The absence of the fetal stomach or visualization of the fetal stom- ach smaller than normal by ultrasound in early gestation, and detection of polyhydramnios in third trimester are the most valuable signs in ul- trasonographic examination. In addition to this, depending on the type of the anomaly, blind pouch sign of the esophagus can be detected at the medi- astinum ...

  12. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

    Full Text Available Introduction Choledochoduodenal fistulas are very rare and in most cases are caused by a long-lasting and poorly treated chronic duodenal ulcer. They may be asymptomatic or followed by symptoms of ulcer disease, by attacks of cholangitis or bleeding or vomiting in cases of ductoduodenal stenosis. The diagnosis is simple and safe, however treatment is still controversial. If surgery is the choice of treatment, local findings should be taken into consideration. As a rule, intervention involving closure of fistula is not recommended. Case Outline The authors present a 60-year-old woman with a long history of ulcer disease who developed attacks of cholangitis over the last three years. Ultrasonography and CT showed masive pneumobilia due to a choledochoduodenal fistula. . As there was no duodenal stenosis or bleeding, at operation the common bile duct was transected and end-to-side choledochojejunostomy was performed using a Roux-en Y jejunal limb. From the common bile duct, multiple foreign bodies of herbal origin causing biliary obstruction and cholangitis were removed. After uneventful recovery the patient stayed symptom free for four years now. Conclusion The performed operation was a simple and good surgical solution which resulted in complication-free and rapid recovery with a long-term good outcome. .

  13. Risk factors for obstetric fistulae in north-eastern Nigeria.

    Science.gov (United States)

    Melah, G S; Massa, A A; Yahaya, U R; Bukar, M; Kizaya, D D; El-Nafaty, A U

    2007-11-01

    This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally

  14. Prospective study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas

    OpenAIRE

    Rahbour, Goher; Hart, Ailsa L.; Al-Hassi, Hafid O.; Ullah, Mohammad R; Gabe, Simon M; Knight, Stella C.; Warusavitarne, Janindra; Vaizey, Carolynne J

    2011-01-01

    Background Enterocutaneous fistulas (ECF) are debilitating and usually result following complex abdominal surgery. While there is an association with inflammatory bowel disease (IBD), a large number of fistulas occur after surgery not related to IBD. The consequences of ECF include short bowel syndrome and the need for long term parenteral nutrition. ECF can heal spontaneously and in the case of IBD can be cured by medical therapy in some instances. Those that do not resolve spontaneously hav...

  15. Congenital hepatoportal arteriovenous fistula associated with intrahepatic portal vein aneurysm and portohepatic venous shunt: case report

    International Nuclear Information System (INIS)

    A congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm is a rare type of arteriovenous malformation. Only 14 pediatric cases have been reported to the best of the authors' knowledge. An intrahepatic shunt between the portal and systemic veins is also relatively rare. We report a case of a congenital hepatoportal arteriovenous fistula associated with an intrahepatic portal vein aneurysm and a portohepatic venous shunt in a neonate who presented with tachypnea and melena

  16. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  17. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal

    2004-01-01

    Full Text Available The purpose of this investigation is to determine the patency of thearteriovenous (A-V fistulas, created in patients with chronic renal failure, inthe early and late periods according to sex.The A-V fistulas created for hemodialisis were investigated retrospectively.Of 238 patients, there were 130 male.269 operations were made to 238 patients. Of these, 198 (73.6 % wereradiochephalic, 56 (20.8 % were brachiochephalic, 8 (3 % were brachiobasilicA-V fistulas. In 3 (1.1 % patients loop graft between brachial artery and vein,in 1 (0.37 % patient graft between radial artery and brachial vein, in 1 patientgraft between brachial artery and basilic vein, in 1 patient graft betweensuperficial femoral artery and saphenous vein were placed. Of 198radiochephalic A-V fistulas 24 (12.1 % in early period and 3 (1.5 % in lateperiod became inactive. Of 56 brachiochephalic A-V fistulas 4 (7.1 % and of 8brachiobasilic A-V fistulas 2 (25 % became unsuccessful in early period. 1 of 6A-V fistulas with prosthetic graft failed in late period because of thrombosis. Inradial level patency rate of A-V fistulas in females were lower than in males(82.3 %-89.8 %.The patency rate of A-V fistulas in radial and brachial levels were similar,but in radial level rate of successful of A-V fistulas decreased in femalesaccording to males. Use of graft in A-V fistula didn’t give superiority to A-Vfistulas without graft.

  18. Transvaginal repair of recurrent rectovaginal fistula with laparoscopic-assisted rectovaginal mobilization.

    Science.gov (United States)

    Pelosi, M A; Pelosi, M A

    1997-12-01

    This study examines the use of laparoscopic upper rectovaginal mobilization to facilitate the transvaginal repair of recurrent rectovaginal fistulas. A 39-year-old female presented with fecal and gas incontinence consequent to an obstetrically related rectovaginal fistula with five unsuccessful transvaginal repairs over a 5-year period. Her condition was successfully treated by a transphincteric approach that combined an extensive laparoscopic dissection of the rectovaginal space from above with transvaginal dissection of the rectovaginal space from below to create complete mobilization between the two organs and to permit an excellent, tension-free closure of the rectal defect. Successful fistula closure and restoration of anal continence were achieved. The patient remains cured 18 months postsurgery. Laparoscopic mobilization of the upper rectovaginal septum followed by transvaginal division of the lower septum permits a more extensive mobilization and release of tension for fistula repair than that typically noted by the vaginal route alone. PMID:9449089

  19. Pancreatic Fistula after Pancreatectomy: Definitions, Risk Factors, Preventive Measures, and Management—Review

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2012-01-01

    Full Text Available Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the “Achilles heel” of pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to pancreatic fistula. The morbidity rate after pancreaticoduodenectomy remains high in the range of 30% to 65%, although the mortality has significantly dropped to below 5%. Most of these complications are related to pancreatic fistula, with serious complications of intra-abdominal abscess, postoperative bleeding, and multiorgan failure. Several pharmacological and technical interventions have been suggested to decrease the pancreatic fistula rate, but the results have been controversial. This paper considers definition and classification of pancreatic fistula, risk factors, and preventive approach and offers management strategy when they do occur.

  20. Minimal Invasive Coronary Artery Fistula Ligation

    OpenAIRE

    Mitropoulos, Fotios A.; Kanakis, Meletios A.; Chatzis, Andrew; Contrafouris, Constantinos; Sofianidou, Ioanna A.; Lioulias, Achilleas G.

    2014-01-01

    A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

  1. Vector Volume Flow in Arteriovenous Fistulas

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Heerwagen, Søren; Pedersen, Mads Møller;

    2013-01-01

    , but is very challenging due to the angle dependency of the Doppler technique and the anatomy of the fistula. The angle independent vector ultrasound technique Transverse Oscillation provides a new and more intuitive way to measure volume flow in an arteriovenous fistula. In this paper the Transverse...

  2. Gastro-peritoneo-cutaneous fistula following splenectomy

    OpenAIRE

    BAYRAKÇI, Berna; ORUÇ, Nevin; TEKİN, Fatih; Elmas, Nevra; ÖZÜTEMİZ, A. Ömer

    2009-01-01

    Splenectomy operation is usually indicated for treatment of hematological disorders or splenic trauma. Splenectomy complications including gastric injury and peritoneal abscess formation were rarely reported. Forty seven years old male patient diagnosed with immune thrombocytopenic purpura and had splenectomy operation. Abdominal pain and cutaneous fistula was developed after the operation. Further investigations revealed gastric fistula opening endoscopically and presence of intraabdominal a...

  3. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  4. Causes and consequences of obstetric fistula in Ethiopia: A literature review

    Directory of Open Access Journals (Sweden)

    Daniel Nigusse Tollosa, Mengistu Asnake Kibret

    2013-04-01

    Full Text Available ABSTRACTObstetric fistula (OF is one of the major potential complications of childbirth mostly young women in developing countries including Ethiopia. Though few scientific studies have been conducted related to its causes and consequences, it is challenging to find a comprehensive figure about obstetric fistula in Ethiopia. Therefore, this paper sought that to review the causes and consequences of obstetric fistula in Ethiopia. A number of relevant obstetrics and gynaecology websites and journals were reviewed. Google, Pubmed, and Hinari searching engines were used to find out relevant references. Year of publication, location, language and its type of publication were the inclusion criteria used for reviewing literatures. It is observed that obstetric fistula has been a major burdened mainly for women in the rural Ethiopian and its causes and consequences are very deep and diverse. The great majority of obstetric fistula causes in Ethiopia is due to Obstetric labour. Distance to the health care facility, transportation access, economic factors (poverty, poor knowledge related to the problem, poor health seeking behaviour of the affected women and age at first marriage are the other triggering factors. Stigma and discrimination of obstetric fistula patients by their husbands and families, economic dependency and psychological disorder are often mentioned as consequences for OF patients in Ethiopia.

  5. Aortoesophageal fistula in a child

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda

    2013-01-01

    Full Text Available Aortoesophageal fistulae (AEF are rare and are associated with very high mortality. Foreign body ingestions remain the commonest cause of AEF seen in children. However in a clinical setting of tuberculosis and massive upper GI bleed, an AEF secondary to tuberculosis should be kept in mind. An early strong clinical suspicion with good quality imaging and endoscopic evaluation and timely aggressive surgical intervention helps offer the best possible management for this life threatening disorder. Our case is a 10-year-old boy who presented to the pediatric emergency with massive bouts of haemetemesis and was investigated and managed by multidisciplinary team effort in the emergency setting.

  6. Radiologic recognition of bronchopleural fistula.

    Science.gov (United States)

    Friedman, P J; Hellekant, C A

    1977-08-01

    Examination of more than 30 cases of bronchopleural fistula (BPF), of diverse causes, including 6 following resectional surgery, revealed a distinctive configuration of air/fluid collections in the pleural space. Maler in 1940 independently observed that loculated BPF pockets conform in shape to the adjacent chest wall. With the most common posterior costophrenic angle location, there is a wide air-fluid level in the frontal view, but on lateral films the anteroposterior diameter is narrow. In contrast, abscess cavities tend to be spherical and farther from the ribs. Use of these plain film criteria permits earlier and more confident diagnosis.

  7. A tiny dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    ZHANG Peng 张 鹏; ZHU Fengshui 朱风水; LING Feng 凌 锋; Christophe COGNARD

    2003-01-01

    @@ Pulsatile tinnitus is commonly encountered in approximately 10% of a given population.1 Since causes of the disease vary, selecting appropriate protocols of imaging strategies is quite challenging.2 Vascular anormalies or diseases including anormalies of the carotid arteries and jugular veins, intracranial arteriovenous malformation and dural arteriovenous fistula (DAVF) are major causative factors of the disease. Before imaging studies, history inquiry and physical examination are important for detect the possible causes of pulsatile tinnitus. Different imaging examinations are depended on histories and clinical signs of different patients.

  8. Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

    OpenAIRE

    Sharma, Arindam; Kurtz, Michael P.; Jairam R. Eswara

    2014-01-01

    Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We s...

  9. Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report

    Directory of Open Access Journals (Sweden)

    Adibnejad Soheil

    2006-01-01

    Full Text Available Abstract Background The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding. Case presentation We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar. Conclusion Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.

  10. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Directory of Open Access Journals (Sweden)

    Tomasz Golabek

    2013-01-01

    Full Text Available Background and Study Objectives. Enterovesical fistula (EVF is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: “enterovesical fistula,” “colovesical fistula” (CVF, “pelvic fistula”, and “urinary fistula”. Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.

  11. Post-operative duodenal fistula: percutaneous treatment and review

    Directory of Open Access Journals (Sweden)

    D.Huerta

    2015-04-01

    Full Text Available Duodenal fistula is a complex condition, relatively frequent presentation, being in most cases of postoperative origin. Among the latter, 6% to 11% are secondary to surgical treatment of perforated duodenal ulcer, and more unusual, as a complication of cholecystectomy. Two cases treated percutaneous at the Polyclinic Bank city of Buenos Aires are presented. The first, a female patient with a duodenal fistula as a postoperative complication of a perforated duodenal ulcer and the second one patient male with the same pathology but as a complication of cholecystectomy. Percutaneous treatment of this disease has been reported sporadically without having proven its usefulness. Once diagnosed the same Fistulography and obliteration were performed percutaneously achieving complete remission of the disease.

  12. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HUANG Cheng-guang; QI Xiang-qian; CHEN Huai-rui; L(U) Li-quan; WU Xiao-jun; BAI Ru-lin; LU Yi-cheng

    2011-01-01

    Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

  13. Hodgkin Lymphoma Untreated for Six Years Presenting with Tracheoesophageal Fistula

    Directory of Open Access Journals (Sweden)

    Jason R. Westin

    2012-01-01

    Full Text Available Hodgkin lymphoma is a highly curable cancer with modern therapy, with five-year survival rates in excess of 80%. However, the natural history of the untreated disease is largely unknown. We present the case of a patient with Hodgkin lymphoma who went untreated for over 5 years due to patient choice. Eventually, the patient developed hypoxemia, significant weight loss, and a tracheoesophageal fistula. After a placement of a gastrostomy tube and tracheal stent, treatment with standard chemotherapy was initiated. The patient achieved an excellent response, the fistula closed without further intervention, and there is no evidence of relapse six years later. Even in a patient with significant Hodgkin-lymphoma-related sequelae, standard therapy can result in excellent long-term outcomes.

  14. Post-traumatic recto-spinal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Lantsberg, L.; Greenberg, G. [Department of Surgery A, Soroka University Medical Center, Beer-Sheva (Israel); Laufer, L.; Hertzanu, Y. [Department of Diagnostic Radiology, Soroka University Medical Center, Beer-Sheva (Israel)

    2000-01-01

    Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. (orig.)

  15. The changing face of obstetric fistula surgery in Ethiopia

    Science.gov (United States)

    Wright, Jeremy; Ayenachew, Fekade; Ballard, Karen D

    2016-01-01

    Objective To examine the incidence and type of obstetric fistula presenting to Hamlin Fistula Ethiopia over a 4-year period. Study design This is a 4-year retrospective survey of obstetric fistula treated at three Hamlin Fistula Hospitals in Ethiopia, where approximately half of all women in the country are treated. The operation logbook was reviewed to identify all new cases of obstetric fistula presenting from 2011 to 2015. New cases of urinary fistula were classified by fistula type (high or low), age, and parity of the woman. Results In total, 2,593 new cases of urinary fistulae were identified in the study period. The number of new cases fell by 20% per year over the 4 years (P<0.001). A total of 1,845 cases (71.1%) were low (ischemic) fistulae, and 804 cases (43.6%) of these had an extreme form of low circumferential fistula. A total of 638 (24.6%) women had a high bladder fistula, which predominantly occurs following surgery, specifically cesarean section or emergency hysterectomy, and 110 (4.2%) women had a ureteric fistula. The incidence of high fistulae increased over the study period from 26.9% to 36.2% (P<0.001). A greater proportion of multiparous women had a high bladder fistula (70.3%) compared with primigravid women (29.7%) (P<0.001). Conversely, a greater proportion of primiparous women experienced a low circumferential fistulae (68.6%) compared with multiparous women (31.4%) (P<0.001). Conclusion There appears to be a decline in the number of Ethiopian women being treated for new obstetric urinary fistulae. However, the type of fistula being presented for treatment is changing, with a rise in high fistulae that very likely occurred following cesarean section and a decline in the classic low fistulae that arise following obstructed childbirth. PMID:27445505

  16. Tracheoesophageal fistula associated with paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Paracoccidioidomycosis is a systemic fungal disease caused byParacoccidioides brasiliensis, agent geographically distributed to certainareas of Central and South America. The infection by P. brasiliensis hasbeen reported from north Mexico to south Argentina. Paracoccidioidomycosispresents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequentlymisdiagnosed as malignancy or tuberculosis. The authors present a caseof a 57 year-old man admitted to the hospital due to a chronic consumptivesyndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid andpyrazinamide 1 year ago without resolution of the simptoms. During the clinicalinvestigation, pulmonary paracoccidioidomycosis with tracheoesophagealfistula was diagnosed. The systemic infection was treated with deoxicolate Bamphotericin followed by sulfametoxazole and trimetoprin due to acute renalfunction impairment. The fistula was endoscopically treated; inittialy with theprotection of left main bronchus with a tracheal prosthesis followed by theesophageal fistula’s ostium clipping.

  17. Pharyngocutaneous fistula after anterior cervical spine surgery

    OpenAIRE

    Sansur, Charles A.; Early, Stephen; Reibel, James; Arlet, Vincent

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closu...

  18. Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ragozzino, A.; Rosa, R. De; Galdiero, R.; Maio, A.; Manes, G. [Aorn Cardarelli Napoli (Italy). Dept. di Gastroenterologia

    2005-08-01

    Bronchobiliary fistula (BBF) is a rare disorder consisting of a passageway between the biliary ducts and the bronchial tree. Many conditions may give rise to this development. Management of these fistulas is often difficult and can be associated with high morbidity and mortality rates. We present a case of BBF developing after hemihepatectomy in a 74-year-old man treated with endoscopic biliary drainage and illustrate MRCP findings.

  19. Radiology in cutaneous sinuses and fistulae

    International Nuclear Information System (INIS)

    In patients with cutaneous openings, sinograph and fistulography an usually performed. Fistulae in the head/neck region and perineum are seldom life-threatening while enterocutaneous fistulae involving the small bowel can be a serious threat due to loss of fluid. Radiology contributes to the preoperative examination of these patients. Fistulography outlines communications to the gastrointestinal tract, pleura, joints and other underlying crucial structures. Involved bowel segments are further demonstrated with barium examination. (orig.)

  20. Radiology in cutaneous sinuses and fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Sundgren-Borgstroem, P.; Ekberg, O.; Lasson, A.

    1988-12-01

    In patients with cutaneous openings, sinograph and fistulography an usually performed. Fistulae in the head/neck region and perineum are seldom life-threatening while enterocutaneous fistulae involving the small bowel can be a serious threat due to loss of fluid. Radiology contributes to the preoperative examination of these patients. Fistulography outlines communications to the gastrointestinal tract, pleura, joints and other underlying crucial structures. Involved bowel segments are further demonstrated with barium examination.

  1. MRI IN THE EVALUATION OF PERIANAL FISTULAS

    Directory of Open Access Journals (Sweden)

    Gururaj

    2015-05-01

    Full Text Available Perianal fistulae though uncommon , can be quite distressing to the patient. Correct surgical management requires accurate pre - operative assessment and grading of this condition. MRI is now considered the modality of choice in the pre - operative assessment of perianal fistulae. We did a retrospective analysis of patients who underwent MR imaging for perianal fistulae in our institution , and compared it with the surg ical findings. The purpose of the study was to evaluate the accuracy of MRI in the pre - operative grading of perianal fistulae. A total of 32 patients were included in this study. Of these , 12(37% had type 1 intersphincteric , 8(25% had type 2 intersphincteric , 6(18% had type 3 transsphincteric , 4(12% had type 4 transphincteric , and 2(6% showed supra - levator extension. MRI was able to correctly grade the fistulous tract in 30 of these 32 patients , giving an accuracy of 94%. MRI was found to b e extremely useful in the pre - operative assessment of perianal fistulae. It helps in correctly classifying the fistulae and to detect hidden or deep seated tracts or abscesses which would have been otherwise missed. Thus , it is useful in selecting the most appropriate surgical procedure , thereby reducing the chances of recurrence and to avoid complications such as fecal incontinence from occurring.

  2. Modified prosthesis for the treatment of malignant esophagotracheal fistula

    International Nuclear Information System (INIS)

    Esophagotracheal fistula is usually a sequela of irradiation or laser treatment of advanced carcinoma of the esophagus or the tracheobronchial tree. Resection of the tumor in these cases is not possible, and palliative bypass surgery is highly risky. The peroral placement of a prosthesis is less invasive, but conventional prostheses often fail to occlude the fistula. The authors regularly use an endoscopic multiple-diameter bougie for dilation. After dilation, a specially designed prosthesis is pushed through the tumor stenosis to block the fistula. This procedure can be done without general anesthesia. The funnels of conventional prostheses cannot cover the fistula when there is either a wide, proximal esophagus above the fistula or a high fistula. To cope with this particular situation, a special fistula funnel was developed. It perfectly occludes the fistulas in all patients. Of 21 patients, 19 were discharged without further aspiration

  3. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    2014-07-15

    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

  4. The pattern of non-obstetric fistula: A Cameroonian experience

    Directory of Open Access Journals (Sweden)

    Pierre-Marie Tebeu

    2014-09-01

    Conclusion: UGF fistula is the main type of NOGF in Cameroonian context, with hysterectomy being the leading cause. Proper knowledge on NOGF will enable better strategies to fight against genital fistula.

  5. Traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery treated by transarterial coil embolization--case report.

    Science.gov (United States)

    Kobayashi, Nozomu; Miyachi, Shigeru; Oi, Sachie; Yamamoto, Naohito

    2011-01-01

    A 30-year-old woman presented with traumatic carotid-cavernous fistula associated with persistent primitive trigeminal artery (PPTA) manifesting as right conjunctival chemosis, exophthalmos, and diplopia. The lesion was treated successfully by trans-arterial coil embolization using the double catheter method with balloon assist. Injury to the PPTA is relatively rare and the PPTA should be sacrificed together with the fistula during the repair. PMID:21273742

  6. 维持性血液透析患者动静脉内瘘穿刺疼痛的相关因素分析%Analysis of the correlated factors of puncture-related pain in patients with the arteriovenous fistula undergoing maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    刘佳; Shan Liu; 严谨; 王露芳

    2015-01-01

    Objective To investigate the current situation of puncture-related pain in patients with the arteriovenous fistula undergoing maintenance hemodialysis and its correlated factors. Methods A total of 180 hemodialysis patients with the arteriovenous fistula undergoing maintenance hemodialysis were investigated with demographic data questionnaire, visual analogue scale and pain self-efficacy questionnaire. Results The effective questionnaires rate was 93.89%(169/180). The median score of puncture-related pain was 5 scores, the score of pain self-efficacy was (31.42±14.59) scores;multivariate analysis demonstrated that the puncture-related pain was positively correlated with the patient gender, using time of arteriovenous fistula and pain self-efficacy ( β=0.152,-0.017,-0.409, P<0.05), OR (95%CI)were 2.069 (1.206-3.148), 0.803(0.710-0.984), 1.004(0.886-1.431). There was negative correlation between the puncture-related pain score and pain self-efficacy in these patients, r=-0.647, P<0.01. Conclusions Puncture-related pain is common sense in patients with the arteriovenous fistula undergoing maintenance hemodialysis, some factors including the patient gender, using time of arteriovenous fistula and pain self-efficacy influence this feeling.%目的:调查分析维持性血液透析患者动静脉内瘘穿刺疼痛的现状及相关影响因素。方法使用疼痛视觉模拟法评分、疼痛自我效能量表及患者一般情况调查表对180例使用动静脉内瘘进行维持性血液透析治疗的患者进行调查。结果回收有效问卷169份,有效回收率93.89%(169/180)。动静脉内瘘穿刺患者穿刺疼痛强度中位数评分为5分,疼痛自我效能得分为(31.42±14.59)分;逐步多元回归分析显示,穿刺疼痛主要与患者性别、内瘘使用时间及疼痛自我效能有关(β=0.152、-0.017、-0.409,P<0.05),OR值(95%CI)分别为2.069(1.206~3.148)、0.803(0.710~0.984)、1.004(0.886~1.431

  7. Superior ophthalmic vein approach for endovascular treatment of dural cavernous sinus fistulas

    International Nuclear Information System (INIS)

    Objective: To investigate the method for surgical exposure the superior ophthalmic vein with embolization of the cavernous sinus dural arteriovenous fistula and evaluate its efficacy and safety. Methods: Surgical exposure of the superior ophthalmic vein was performed by eyelid incision and followed by catheterization and embolization with micro-coils for 16 patients with cavernous sinus dural arteriovenous fistulas. Results: Clinical cure was achieved in all patients and complete angiographic obliteration of fistula was documented in 15 patients (94%). Residual fistula was left in 1 patients with compact occlusion via pterygoid drainage but disappeared one month later by manual compression of the carotid artery. Headache and vomiting were the most common symptoms after the embolization, other 2 patients had mild diplopia and relieved within two months. No permanent procedure-related morbidity and recurrence occurred during clinical follow up for 5 months to 6 years. Conclusion: Surgical exposure of the superior ophthalmic vein for embolization of cavernous sinus dural arteriovenous fistula is a safe and efficient method. (authors)

  8. Changes in aetiological determinants of urinary fistula

    Institute of Scientific and Technical Information of China (English)

    Prosper E. Gharoro; Chukwunwendu A. Okonkwo

    2009-01-01

    Objective: Objective: To investigate the localization and aetiological factors associated with urinary fistulae at the University Teaching Hospital in Benin-City, Nigeria. Methods: Records on 96 patients treated by the authors at the gynaecological ward of the University of Benin Teaching Hospital, Benin-City, Nigeria between January 1997 and December 2006 were analyzed. Information extracted and analyzed included data on socio-biological, demographic, and obstetric event of the antecedent pregnancy. Results: The average age of patients with vesico-vaginal fistula(VVF) was 34 years with a mean parity of 3. The various mean values for patients' height, weight and body mass index (BMI) were 1.58m, 58.29kg and 24.13 respectively. The majority (92.7%) of fistulas are obstetric in origin. While 5.21% were due to total abdominal hysterectomy and 2.08% due to post irradiation for advanced gynecological malignancy. 53(55.21%) patients had obstetric operative interventions (Forceps or vacuum extraction, and or caesarean section). Caesarean section contributed 23.96% to the total figure. Juxta-cervical fistula was the most frequent, next mid vagina and followed by vesico-uterine (32. 98%, 24.4% and 19.15% respectively).Conclusion: Obstetric surgical intervention by care providers is a major cause of VVF formation with particular reference to Caesarean section. Vesico-uterine fistulas are on the increase.

  9. Effects of arteriovenous fistulas on cardiac oxygen supply and demand

    NARCIS (Netherlands)

    Bos, W.J.W.; Zietse, R.; Wesseling, K.H.; Westerhof, N.

    1999-01-01

    Background. Arteriovenous (AV) fistulas used for hemodialysis access may affect cardiac load by increasing the preload while decreasing the afterload. In dogs, AV fistulas have also been shown to affect coronary perfusion negatively. We investigated the net effect of AV fistulas on cardiac oxygen su

  10. Formation of a vesicovaginal fistula in a pig model

    DEFF Research Database (Denmark)

    Lindberg, Jennifer; Rickardsson, Emilie; Andersen, Margrethe;

    2015-01-01

    the bladder and the vagina was made, and the mucosa between them was sutured together with absorbable sutures. A durometer ureteral stent was introduced into the fistula, secured with sutures to the bladder wall, allowing for the formation of a persistent fistula tract. Six weeks postoperatively cysto...... be an effective and cheap way to create a fistula between the bladder and vagina....

  11. Transarterial detachable coil embolization combined with ipsilateral intermittent carotid oppression for traumatic carotid-cavernous fistula with small fistula

    Institute of Scientific and Technical Information of China (English)

    Qing Huang; Hongbing Zhang; Gang Wang; Jun Yang; Yanlong Hu; Jianxin Liu

    2015-01-01

    One case of traumatic carotid-cavernous fistula (TCCF) with small fistula treated by transarterial detachable coil embolization was reported.The intermittent ipsilateral carotid compression was used to identify the final blocking of the residual fistula.The follow-up digital subtraction angiography showed that the TCCF was cured finally, From this case, we conclude that this method may be an effective way to treat TCCF with small fistula.

  12. Vesicovaginal Fistula-A-5 Year Review

    Directory of Open Access Journals (Sweden)

    Vineet Kaur

    2002-01-01

    Full Text Available A rctrospective analysis of 25 patients who underwent surgery for vesicovaginal fistula is herebyreported. The mean age ofpatients was 38.48 ± 10.72 years. Gynaecological surgery was the leadingfactor in etiology in 60% cases followed by obstetrical trauma in 32% and road traffic accident in8%. The primary presenting complaint was leaking of urine per vagina and the mean duration ofsymptoms was 41.81 months ± 9.90. Fistulas due to gynaecological surgical trauma were seen onthe vault. while anterior vaginal wall was involved in obstetrical trauma. 84% of patients had singlefistula, in remaining 16% two to three fistulas were demonstrated. In 20 patients. transvaginal repairwas done, remaining 5 patients underwent repair via abdominal route. Success rate of 80% wasreported in Ollr series.

  13. Successful tubes treatment of esophageal fistula

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Aim: To discuss the merits of "tubes treatment" for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful "three tubes treatment" (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. Results:The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Conclusion: Tubes treatment is an effective basic way for EF. It may be an alternative treatment option.

  14. Eyelid liquoric fistula secondary to orbital meningocele

    Directory of Open Access Journals (Sweden)

    Renato Antunes Schiave Germano

    2015-02-01

    Full Text Available Liquoric fistula (LF is defined as the communication of the subarachnoid space with the external environment, which main complication is the development of infection in the central nervous system. We reported the case of a patient with non-traumatic eyelid liquoric fistula secondary to orbital meningocele (congenital lesion, which main clinical manifestation was unilateral eyelid edema. Her symptoms and clinical signs appeared in adulthood, which is uncommon. The patient received surgical treatment, with complete resolution of the eyelid swelling. In conclusion, eyelid cerebrospinal fluid (CSF fistula is a rare condition but with great potential deleterious to the patient. It should be considered in the differential diagnosis of unilateral eyelid edema, and surgical treatment is almost always mandatory.

  15. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Sala Abdalla

    2016-01-01

    Full Text Available Extra-abdominal complications of pancreatitis such as pancreaticopleural fistulae are rare. A pancreaticopleural fistula occurs when inflammation of the pancreas and pancreatic ductal disruption lead to leakage of secretions through a fistulous tract into the thorax. The underlying aetiology in the majority of cases is alcohol-induced chronic pancreatitis. The diagnosis is often delayed given that the majority of patients present with pulmonary symptoms and frequently have large, persistent pleural effusions. The diagnosis is confirmed through imaging and the detection of significantly elevated amylase levels in the pleural exudate. Treatment options include somatostatin analogues, thoracocentesis, endoscopic retrograde cholangiopancreatography (ERCP with pancreatic duct stenting, and surgery. The authors present a case of pancreatic pseudocyst pleural fistula in a woman with gallstone pancreatitis presenting with recurrent pneumonias and bilateral pleural effusions.

  16. Eguchipsammia fistula Microsatellite Development and Population Analysis

    KAUST Repository

    Mughal, Mehreen

    2012-12-01

    Deep water corals are an understudied yet biologically important and fragile ecosystem under threat from recent increasing temperatures and high carbon dioxide emissions. Using 454 sequencing, we develop 14 new microsatellite markers for the deep water coral Eguchipsammia fistula, collected from the Red Sea but found in deep water coral ecosystems globally. We tested these microsatellite primers on 26 samples of this coral collected from a single population. Results show that these corals are highly clonal within this population stemming from a high level of asexual reproduction. Mitochondrial studies back up microsatellite findings of high levels of genetic similarity. CO1, ND1 and ATP6 mitochondrial sequences of E. fistula and 11 other coral species were used to build phylogenetic trees which grouped E. fistula with shallow water coral Porites rather than deep sea L. Petusa.

  17. Benign Duodenocolic Fistula: a Case Report

    Directory of Open Access Journals (Sweden)

    Marzieh Soheili

    2015-10-01

    Full Text Available Benign duodenocolic fistula (DCF, known as a fistula between the duodenum and colon with orwithout cecum of nonmalignant origin, is an unusual complication of different gastrointestinal diseases. Thepresent paper records a case in which the patient presented with chronic diarrhea, abdominal pain, weight lossas well as having a history of gastric ulcer. Most frequently the condition presents with signs ofmalabsorption such as weight loss and diarrhea, but other symptoms include nausea, vomiting (sometimeswith fecal, and abdominal pain. Gastrointestinal inflammatory conditions are the usual causes. The mostcommon ones are perforated duodenal ulcer and Crohn’s disease. Barium enemas are usually diagnostic.Treatment consists of excising the fistula and repairing the duodenal and colonic defects. Closure of thefistula provides quick relief.

  18. Spontaneous Hepaticoduodenal and Choledochoduodenal Fistula Mimicking Duodenal Ulcer Perforation, a Very Rare Complication of Transarterial Chemoembolization

    Directory of Open Access Journals (Sweden)

    Varayu Prachayakul

    2015-03-01

    Full Text Available Spontaneous bilo-enteric fistula is a rare complication following surgery or some therapeutic interventions such as transarterial chemoembolization (TACE. The present case was a young man, a known case of chronic hepatitis B with multiple recurrent hepatocellular carcinoma, who presented with clinical sepsis and jaundice. Computed tomography showed dilated proximal left intrahepatic ducts which suspected anastomotic stricture. He underwent endoscopic retrograde cholangiopancreatography, but the endoscopic view showed a deep ulcer covered by yellowish debris tissue. After re-evaluation it was found to be hepaticoduodenostomy and choledochoduodenostomy tracts. In the present case the fistula was suspected to be related to a previous TACE procedure.

  19. Assessing fistula and obstetrical surgical capacity in South Kivu, DRC

    Directory of Open Access Journals (Sweden)

    Stephen C. Morris

    2013-07-01

    Full Text Available The Democratic Republic of Congo has suffered from decades of conflict and poverty. The Eastern DRC, in particular, continues to be a region dominated by instability, resulting in a fragmented health system. Governments and agencies interested in working towards improving health in the region are often challenged by an absence of knowledge of health metrics, limited capacity for health care delivery and overwhelming needs. The Harvard Humanitarian Initiative and Engender Health needs assessment, outlined in this report, demonstrates an effort to better understand the current state of surgical capacity in the region with an emphasis on needs and opportunities related to fistula repair.

  20. Aortocaval Fistula in a Behcet's Disease Patient

    Directory of Open Access Journals (Sweden)

    Yusuf Ata

    2009-01-01

    Full Text Available Behcet's disease (BD is a chronic, recurrent, systemic disease that is characterized by oral and genital ulcers and oculocutaneous inflammatory lesions. Cardiovascular involvement especially large artery involvement is a serious and vital complication of BD. Pseudoaneurysms in the major arteries may be the cause of sudden death in BD. In our case a pulsatile abdominal mass was determined to be an aortic pseudoaneurysm associated with BD and an aortocaval fistula. Here we report this case and a short review of literature because this is the first reported aortocaval fistula in a BD patient in English literature.

  1. CAROTID CAVERNOUS FISTULA: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Satish Prasad

    2015-01-01

    Full Text Available Carotico - cavernous fistula represent abnormal communication between the carotid circulation and the cavernous sinus. They can be classified as direct or indirect which are separate conditions with different aetiologies. Direct Carotico - cavernous fistulas ( CCFs are often secondary to trauma, and as such the demographics reflect the distribution of head trauma, most commonly seen in the young male patients. Presentation is acute and symptoms develop rapidly. In contrast, indirect CCFs have a predilection for the postmenopausal female patient a nd the onset of symptoms is often insiduous. Other conditions that predispose to increased risk include . Ehlers - Danlos syndrome . Fibromuscular dysplasia .

  2. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli

    2015-10-01

    Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery

  3. One-stage laparoscopic-assisted resection of gastrojejunocolic fistula after gastrojejunostomy for duodenal ulcer: a case report

    Directory of Open Access Journals (Sweden)

    Takemura Masashi

    2011-11-01

    Full Text Available Abstract Introduction Gastrojejunocolic fistula is a rare condition after gastrojejunostomy. It was thought to be a late complication related to stomal ulcers as a result of inadequate gastrectomy or incomplete vagotomy. We report a case of gastrojejunocolic fistula after gastrojejunostomy for peptic ulcer treated with one-stage laparoscopic resection. Case presentation A 41-year-old Japanese man complained of diarrhea for 10 months, as well as severe weight loss and weakness. After admission, we immediately started intravenous hyperalimentation. On performing colonoscopy and barium swallow, gastrojejunocolic fistula was observed close to the gastrojejunostomy site leading to the transverse colon. After our patient's nutritional status had improved, one-stage surgical intervention was performed laparoscopically. After the operation, our patient recovered uneventfully and his body weight increased by 5 kg within three months. Conclusions Modern management of gastrojejunocolic fistula is a one-stage resection because of the possibility of early recovery from malnutrition using parenteral nutritional methods. Today, laparoscopic one-stage en bloc resection may be feasible for patients with gastrojejunocolic fistula due to the development of laparoscopic instruments and procedures. We describe the first case of gastrojejunocolic fistula treated laparoscopically by one-stage resection and review the literature.

  4. Study on the factors related to the postoperative pharyngeal fistula in patients with laryngeal cancer%喉癌患者术后发生咽瘘的相关因素研究

    Institute of Scientific and Technical Information of China (English)

    颜少观

    2015-01-01

    目的:探讨减少喉癌患者术后咽漏发生率及临床护理要点.方法:收治喉癌行手术治疗患者68例,将胃管留置时间分为10 d及20 d.留置20 d为试验组,留置10 d为对照组,将两组患者发生咽瘘的情况进行比较,同时术前加强心理护理和术前准备,术后密切观察生命体征和颈部切口引流等护理,加强气管切开的护理,重视患者的心理护理、吞咽训练、发育指导.结果,试验组、对照组咽瘘发生率的差异有统计学意义(P<0.05).结论:留置胃管时间20 d对于喉癌术后预防咽瘘的发生有较好效果.%Objective:To investigate the key points to reduce the incidence of postoperative pharyngeal leakage in patients with laryngeal cancer,and the clinical nursing on those patients.Methods:68 patients with laryngeal carcinoma were selected,they were divided into two groups according to the length of gastric tuber,with 20 days as the experimental group,and 10 days as the control group,then compared pharyngeal fistula of patients in two groups,and strengthen preoperative psychological care and preoperative preparation,observed the vital signs and neck incision drainage closely after surgery,strengthen the care of patients,pay attention to the patient's psychological care,swallowing training,and giving developmental guidance.Results:The difference in the incidence of pharyngeal fistula was statistically significant between the experimental group and the control group(P<0.05).Conclusion:Indwelling gastric tube for 20 days has good effect on preventing pharyngeal fistula in patients with laryngeal cancer after operation.

  5. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner

    2014-01-01

    Full Text Available Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy.

  6. Scimitar syndrome with pulmonary arteriovenous fistulas.

    Science.gov (United States)

    Le Rochais, J P; Icard, P; Davani, S; Abouz, D; Evrard, C

    1999-10-01

    Right abnormal pulmonary venous return into the inferior vena cava associated with abnormal fissure, dextrocardia, and systemic arterial supply of a variable degree, are the characteristics of the scimitar syndrome. We report on a patient in whom this rare syndrome was associated with pulmonary arteriovenous fistulas within the involved lung.

  7. Congenital H-type anovestibuler fistula

    Institute of Scientific and Technical Information of China (English)

    Mesut Yazlcl; Barlas Etensel; Harun Gürsoy; Sezen Ozklsaclk

    2003-01-01

    The congenital H-type fistula between the anorectum and genital tract besides a normal anus is a rare entity in the spectrum of anorectal anomalies. We described a girl with an anovestibuler H-type fistula and left vulvar abscess. A 40-day-old girl presented symptoms after her parents noted the presence of stool at the vestibulum. On the physical examination, anus was in normal location and size, and had normal sphincter tone. A vestibuler opening was seen in the midline just below of the hymen. A fistulous communication was found between the vestibuler opening and the anus, just above the dentate line. There was a vulvar abscess which had a left lateral vulvar drainage opening 15 mm left lateral to the perineum. After the management of local inflammation and abscess, the patient was operated for primary repair of the fistula. A protective colostomy wasn′t performed prior the operation. A profuse diarrhea started after 5 hours of postoperation. After the diarrhea, a recurrent fistula was occurred on the second postoperative day. A divided sigmoid colostomy was performed. 2 months later, and anterior sagital anorectoplasty was reconstructed and colostomy was closed 1 month later. Various surgical techniques with or without protective colostomy have been described for double termination repair. But there is no consensus regarding surgical management of double termination.

  8. CT demonstration of an aortoesophageal fistula.

    Science.gov (United States)

    Longo, J M; Lopez-Rasines, G; Ortega, E; Pagola, M A

    1987-01-01

    A case of aortoesophageal fistula (AEF) is reported in a patient with esophageal bleeding resulting from ingestion of a foreign body. CT showed a saccular aneurysm in close proximity to the esophageal lumen at the level of the bleeding site. AEF has not previously been described on CT. PMID:3107831

  9. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  10. Arteriovenous fistula: An evidence based practice in nursing care

    Directory of Open Access Journals (Sweden)

    Evangelia Prevyzi

    2013-01-01

    Full Text Available The arteriovenous fistula (AVF is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting longevity and reducing complications, based on scientific data and international guidelines. Material-Method: The methodology followed in this review relied on literatures reviews and investigative studies, which were carried out during the period 2000-2012 and international (Medline, PubMed, Cinahl and Greek databases (Iatrotek on the care and management of fistula in people undergoing chronic haemodialysis. Key-words were used: Arteriovenous fistula, cannulation techniques fistula, guidelines, vascular access, role of nurse. Results: The arteriovenous fistula (AVF is the life line for patients undergoing haemodialysis. For this reason, the appropriate care of fistula and its maintenance in a good condition plays an important role for patient΄s life. Conclusions: Nephrology nurse has a major role in the proper management of the fistula and the education of the patient. Additionally, there is a need for cooperation between all the members of the multidisciplinary team, which includes dialysis nurse, nefrologist, access surgeon, and radiologist, for the broader assessment of fistula and the prevention and timely treatment of any complications.

  11. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, O.; Doerfler, A.; Forsting, M.; Hartmann, M.; Kummer, R. von; Tronnier, V.; Sartor, K. [Dept. of Neuroradiology, University of Heidelberg Medical School (Germany)

    1999-12-01

    We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels - three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses - by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. (orig.)

  12. Percutaneous closure of a coronary fistula with single Amplatzer Vascular Plug II in a five-month-old female: The youngest case report.

    Science.gov (United States)

    Gulgun, Mustafa; Slack, Michael

    2016-02-01

    Coronary artery fistula (CAF) is a rare clinical abnormality characterized by a connection between one or more coronary arteries and an adjacent cardiac chamber or vascular structure. Although CAF complications are more common in older children over time, there is still no consensus in terms of treatment indications in children with asymptomatic fistula. We describe an asymptomatic infant diagnosed with a severely dilated right coronary artery and a coronary-cameral fistula treated successfully by transcatheter device closure. The Amplatzer Vascular Plug II appears to be safe, effective and relatively easy to use for CAF closure in infants. PMID:26852309

  13. Incidence of Pancreatic Fistula after Distal Pancreatectomy and Efficacy of Endoscopic Therapy for Its Management: Results from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Savio C. Reddymasu

    2013-08-01

    Full Text Available Pancreatic fistula is a known complication of distal pancreatectomy. Endotherapy with pancreatic duct stent placement and pancreatic sphincterotomy has been shown to be effective in its management; however, experience of endotherapy in the management of this complication has not been extensively reported from the United States. Preoperative endoscopic retrograde cholangiopancreatography (ERCP with pancreatic stent placement has also been proposed to prevent this complication after distal pancreatectomy. In our cohort of 59 patients who underwent distal pancreatectomy, 13 (22% developed a pancreatic fistula in the immediate postoperative period, of whom 8 (14% patients (5 female, mean age 52 years were referred for an ERCP because of ongoing symptoms related to the pancreatic fistula. The pancreatic fistula resolved in all patients after a median duration of 62 days from the index ERCP. The median number of ERCPs required to document resolution of the pancreatic fistula was 2. Although a sizeable percentage of patients develop a pancreatic fistula after distal pancreatectomy, only a small percentage of patients require ERCP for management of this complication. Given the high success rate of endotherapy in resolving pancreatic fistula and the fact that the majority of patients who undergo distal pancreatectomy never require an ERCP, performing ERCP for prophylactic pancreatic duct stent prior to distal pancreatectomy might not be necessary.

  14. Gastro-bronchial fistula after laparoscopic nissen fundoplication.

    Science.gov (United States)

    Faraj, Walid; Khalifeh, Mohamad; Soweid, Asaad; Habli, Nader; Selmo, Francesca; Priest, Oliver; Jamali, Faek R

    2007-10-01

    Gastro-bronchial fistula (GBF) is an unusual complication of Nissen fundoplication, particularly when performed via a transabdominal approach. The mechanism of such fistula is thought to be related to a previously untreated ulcer in the mucosa of the wall of the gastric wrap or to a subclinical injury to the gastric wall during the process of division of the short gastric vessels and gastric mobilization. This process is greatly aided by herniation of the wrap into the chest in the postoperative period, placing the stomach in intimate contact with the bronchial tree. The diagnosis of GBF is often difficult to establish and requires a high index of suspicion. Most investigative studies tend to be unrevealing. Historically, an upper gastrointestinal series was the recommended study of choice in the literature. Newer reports, however, highlight the value and importance of upper endoscopy as a diagnostic tool in this condition. The majority of GBF were reported in the era of transthoracic Nissen fundoplication. The incidence of this complication seems to have markedly decreased after the widespread adoption of the transabdominal approach to the treatment of GERD. We are reporting the second case in the literature of a GBF developing after a laparoscopic Nissen fundoplication in a 28-year-old male patient. This case report should serve to increase awareness of this uncommon complication that should be considered in the differential diagnosis of patients with recurrent pneumonia or refractory hemoptysis after major upper gastrointestinal surgical procedures.

  15. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  16. Asymptomatic Cholecystocolonic Fistula: A Diagnostic and Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Nicola Antonacci

    2013-01-01

    Full Text Available Cholecystocolonic fistulas (CCF are rare complications of gallstones with a variable clinical presentation. Despite modern diagnostic tools, cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is the cholecystoduodenal (70%, followed by the cholecystocolic (10–20%, and the least common is the cholecystogastric fistula. Herein, we report a case of female patient with multiple episodes of acute recurrent cholangitis due to common bile duct and gallbladder stones in which preoperative imaging studies were negative for cholecystocolonic fistula that was incidentally discovered and treated during surgery and was appropriately treated. A review of the literature is reported too.

  17. Genitourinary Fistula - An Experience from Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Kallol K. Roy, Neena Malhotra, Sunesh Kumar, Amlesh Seth*, Bonilla Nayar

    2006-07-01

    Full Text Available Genito urinary fistula remains a frustrating condition for patients in the developing world. Weretrospectively analysed twenty three women who underwent fistula repair over the last 5 years in oneunit at Department of Obstetric and Gynaecology, All India Institute of Medical Sciences. Twenty-sevenfistulae were repaired in 23 women of which 78.2% were vesecovaginal fistula. Majority of these fistula(73.9% were obstetric in origin, as a result of neglected, mismanaged labour. Surgical repair was themainstay with 100% success for those undergoing primary repair and an overall success rate of 83.3% forvesico vaginal fistula. Though principles of fistula repair were adhered to by the operating surgeon, eachpatient was unique. Surgeons trained in such repair can individually vary approach and technique to suiteach patient giving high success rate.

  18. Temporary mushroom like covered stent placement with transnasal esophageal fistula abscess drainage for gastroesophageal anastomotic fistula

    International Nuclear Information System (INIS)

    Objective: To investigate the therapeutic effects on gastroesophageal anastomotic fistula with temporary placing covered stent of mushroom shape and transnasal drainage of gastroesophageal anastomotic abscess. Methods: For 8 patients with gastroesophageal anastomotic fistula, under fluoroscopic guidance, the drainage tube was put into the abscess cavity through nasal cavity and esophageal fistula, then stent was implanted within the esophagus. The abscess cavity was aspirated and esophagogram was taken in suitable time. Retaining the drainage tube about one month and then the stent was withdrawn after one week of the taken out of the former. Results: The drainage of abscess and stent placement was successful. The drainage tube was pulled out during 14-21 days after placement. The stent should be removed within one month. All fistulas were closed up and the abscesses disappeared. Conclusions: It is a safe, efficient, complicationless, non-invasive method to treat gastroesophageal anastomotic fistula with temporary placing covered stent with mushroom shape and drainage of abscess through nasal cavity and esophagus. Temporary mushroom-like covered stent placement with transnasal gastroesophageal anastomotic abscess drainage is a safe efficient, complication-less non-invasive method used interventionally. (authors)

  19. Fistulotomy and marsupialisation for simple fistula-in-ano.

    Science.gov (United States)

    Yang, C Y

    1992-06-01

    Nineteen consecutive cases of simple fistula-in-ano treated with fistulotomy and marsupialisation were retrospectively reviewed. Fourteen cases were simple intersphincteric and the remaining 5 cases were uncomplicated transphincteric fistulae. The cases were followed up for between 3 to 10 months (mean 6.9 months). There were no reports of bowel incontinence or recurrence of fistula. The advantages of this 'tissue conserving' procedure are discussed in the paper. PMID:1631585

  20. Oronasal Fistula and Complete Edentulism: What to Do?

    OpenAIRE

    Pushappreet Kaur; Jaspinder Kaur

    2014-01-01

    Oronasal fistula is an internal fistula which represents an abnormal epitheliazed tract between oral and nasal cavity, thus impairing associated functions of deglutition and speech by nasal regurgitation of fluid and nasal speech respectively, besides risk of nasal infection resulting from food lodgement. This paper provides a brief yet definitive insight on the etiology, diagnosis and surgical closure of oronasal fistula along with a case report and discussion on prosthodontic rehabilitation...

  1. Arteriovenous fistula: An evidence based practice in nursing care

    OpenAIRE

    Evangelia Prevyzi

    2013-01-01

    The arteriovenous fistula (AVF) is the most frequent form of vascular access for patients undergoing haemodialysis because it ensures good quality of dialysis and reduce haemodialysis mortality. For this reason, the nephrology nurse plays an important role in the appropriate care of fistula with a view to promoting the longevity and prevention of complications. Purpose: The purpose of this review was to investigate the role of Nephrology nurse in the appropriate care of fistula, promoting lon...

  2. Chylous Fistula following Axillary Lymphadenectomy: Benefit of Octreotide Treatment

    Directory of Open Access Journals (Sweden)

    Elena González-Sánchez-Migallón

    2016-01-01

    Full Text Available Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide.

  3. Pharyngocutaneous fistula onset after total laryngectomy: scintigraphic analysis

    OpenAIRE

    Galli, J; VALENZA V; Parrilla, C; Galla, S; Marchese, MR; P. Castaldi; ALMADORI, G.; Paludetti, G

    2009-01-01

    Pharyngocutaneous fistula is the most common non-fatal complication following total laryngectomy. To start oral feeding and exclude the presence of a pharyngocutaneous fistula, a subjective test and instrumental assessments using videofluoroscopy, have been described. The aim of this study was to evaluate the effectiveness of oral-pharyngo-oesophageal scintigraphy as an objective and non-invasive tool to establish presence, site and dimensions of the fistula. Observations were performed on 3 ...

  4. Three-dimensional ultrasound imaging for diagnosis of urethrovaginal fistula.

    Science.gov (United States)

    Quiroz, Lieschen H; Shobeiri, S Abbas; Nihira, Mikio A

    2010-08-01

    We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient presented with persistent urinary incontinence, after having three mid-urethral sling procedures performed within the past year. The diagnosis of a urethrovaginal fistula was made by endovaginal 3-D endovaginal ultrasound and confirmed intraoperatively. We have described a novel technique that may benefit patients with urethrovaginal fistulas that are difficult to visualize.

  5. Early Recognition of H-Type Tracheoesophageal Fistula

    Directory of Open Access Journals (Sweden)

    Muhammad Riazulhaq

    2012-02-01

    Full Text Available Tracheoesophageal fistula (TEF without associated esophageal atresia (EA is a rare congenital anomaly. Diagnosis in neonatal period is usually not made and most of the patients are treated as cases of pneumonia. A case of H-type of tracheoesophageal fistula, diagnosed within 24 hours of delivery based upon choking and cyanosis on first trial of feed, is being reported. Diagnosis was confirmed with contrast esophagram. Through cervical approach fistula was repaired and baby had uneventful post operative outcome.

  6. Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

    Institute of Scientific and Technical Information of China (English)

    LI Yong-dong; HAN Xin-wei; WU Gang; LI Ming-hua

    2007-01-01

    Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula (BSF). Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types (A and B) of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7(87.5%) of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple,safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. (J Intervent Radiol, 2007, 16: 253-257)[ Key words ] Fistula, pulmonary; Bronchialpleural fistula; Stents and prostheses; Computed tomography

  7. Treatment of tracheopharyngeal and tracheo-oesophageal fistulas following laryngectomy and fistula classification based on individual silicone casts.

    Science.gov (United States)

    Herzog, Michael; Lorenz, Kai J; Glien, Alexander; Greiner, Ingo; Plontke, Stefan; Plößl, Sebastian

    2015-10-01

    Persistent tracheopharyngeal (TPF) and tracheo-oesophageal (TEF) fistulas after laryngectomy create a therapeutic challenge. The current classification of TPFs and TEFs is based on clinical experience without detailed anatomical information. In this study, casts of TPFs/TEFs were obtained from 16 patients; these were the first steps in manufacturing customised prostheses. Fistulas were classified according to the shape and dimension of the tracheopharyngeal and tracheo-oesophageal silicone casts and prostheses as well as on epithetic requirements. Four different types of fistulas were classified: Type A, a fistula with a straight axis between the neopharynx and oesophagus; Type B, a fistula with a stenosis of the neopharynx but a straight axis; Type C, the axis between the neopharynx and oesophagus is flexed anteriorly; and Type D, neighbouring structures are absent creating a large defect. This classification system might improve the manufacturing processes of customised prostheses in individual cases with challenging tracheopharyngeal and tracheo-oesophageal fistulas. PMID:25178413

  8. Heuber Maneuver in Evaluation of Direct Carotid-Cavernous Fistula

    Science.gov (United States)

    Rajagopal, Rengarajan; Mehta, Neeraj; Saran, Sonal; Khera, Pushpinder S.

    2016-01-01

    Summary Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Elevated venous pressure produces congestion in the orbit with resultant transudation of fluid and increased intraocular pressure, thereby leading to secondary glaucoma which may result in visual loss. Immediate treatment is hence, warranted in these cases. The planning of endovascular management is dependent on many parameters, the most important of which are the size and location of the fistula. Since these are high-flow fistulas, assessment requires certain manoeuvers. Heuber manoeuver is one of the manoeuvers used to demonstrate the size of the fistula.

  9. Oronasal Fistula and Complete Edentulism: What to Do?

    Directory of Open Access Journals (Sweden)

    Pushappreet Kaur

    2014-12-01

    Full Text Available Oronasal fistula is an internal fistula which represents an abnormal epitheliazed tract between oral and nasal cavity, thus impairing associated functions of deglutition and speech by nasal regurgitation of fluid and nasal speech respectively, besides risk of nasal infection resulting from food lodgement. This paper provides a brief yet definitive insight on the etiology, diagnosis and surgical closure of oronasal fistula along with a case report and discussion on prosthodontic rehabilitation of a 65 year old female with an iatrogenic oronasal fistula developed as a result of maxillary molar extraction using a complete metal based denture.

  10. Orbicularis oris musculomucosal flap for anterior palatal fistula

    Directory of Open Access Journals (Sweden)

    Tiwari V

    2006-01-01

    Full Text Available Anterior palatal fistulae or residual anterior clefts are a frequent problem following palatoplasty. Various techniques have been used to repair such fistulae, each having its own advantages and disadvantages. We have successfully used orbicularis oris musculomucosal flap to close anterior fistula and residual clefts in 25 patients. This study shows the superiority of this flap over other techniques because of its reliable blood supply, easy elevation and transfer to fistula site and finally because it is a single-stage procedure.

  11. Current Diagnosis and Management of Pelvic Fistulae in Women.

    Science.gov (United States)

    Rogers, Rebecca G; Jeppson, Peter C

    2016-09-01

    Pelvic fistulae are an abnormal communication among the genitourinary tract, the gastrointestinal tract, and the vagina or perineum. Genital tract fistulae have been described in the medical literature for the past several thousand years. Advancements in both the diagnosis and treatment of vaginal fistulae have been obtained over the past century as surgical interventions have become safer and surgical techniques have improved. The most common cause of fistulae worldwide is obstructed labor. In developed countries, fistulae most commonly occur after benign gynecologic surgery, but obstructed labor, malignancy, radiation exposure, and inflammatory bowel disease can also cause fistulae. Fistulae significantly affect quality of life. Diagnostic studies and radiologic imaging can help aid the diagnosis, but a thorough physical examination is the most important component in the evaluation and diagnosis of a fistula. Temporizing treatments are available to help ease patient suffering until surgical management can be performed. Surgical repairs can be performed using an abdominal, vaginal, or transanal approach. Although technically challenging, surgical repair is usually successful, but closure of the fistula tract does not guarantee continence of urine or feces, because there is often underlying damage to the bowel and bladder. PMID:27500321

  12. Management of fistula-in-ano: An introduction

    Institute of Scientific and Technical Information of China (English)

    AM El-Tawil

    2011-01-01

    Peri-anal fistulae are a worldwide health problem that can affect any person anywhere. Surgical management of these fistulae is not free from risks. Recurrence and fecal incontinence are the most common complica-tions after surgery. The cumulative personal surgical experience in managing cases with anal fistulae is sig-nificantly considered as necessary for obtaining better results with minimal adverse effects after surgery. The purpose for conducting this survey is to facilitate better outcome after surgical interventions in idiopathic anal fistulae' cases.

  13. Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Defreyne, Luc; De Schrijver, Ignace; Vanlangenhove, Peter; Kunnen, Marc [Department of Radiology and Medical Imaging, Ghent University Hospital (Belgium)

    2002-01-01

    Extrahepatic arteriovenous fistulas involving the gastroduodenal artery and the portal venous system are rare and almost always a late complication of gastric surgery. Secondary portal hypertension and mesenteric ischemia may provoke abdominal pain, upper and lower gastrointestinal hemorrhage, diarrhea, and weight loss. Until recently, surgical excision has been the therapy of choice with excellent results. The authors report a case of gastroduodenal arterioportal fistula with a rare large interpositioned aneurysm in a cardiopulmonary-compromised patient who was considered a non-surgical candidate. The gastroduodenal arterioportal fistula was occluded endovascularly by means of a detachable balloon. A survey of the literature of this rare type of arterioportal fistula is included. (orig.)

  14. Countermeasure against postoperative fistulas of head and neck cancer

    International Nuclear Information System (INIS)

    It is very difficult to treat postoperative fistulas of head and neck cancer by irradiation and other preoperative therapy. We reviewed 179 patients with oral cancer, mesopharyngeal and hypopharyngeal cancer underwent reconstruction between 1994 and 2003. Our analysis reveals that the incidence of fistula is 18.4% and exposure dose is predisposing factor for fistula formation. We observed many fistulas in posterior of oral floor and pedicle flap more than free flap. There are 14 patients of surgical repair, we detected pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) in them. (author)

  15. An unusual case of pancreatic fistula.

    Science.gov (United States)

    Johnston, M J; Prew, C L; Fraser, I

    2013-03-21

    We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be an external pancreatic fistula with discharge of amylase-rich fluid from the Lanz incision. A trial of conservative management failed despite multiple percutaneous drainage procedures and treatment with broad-spectrum antibiotics. After a second opinion was sought, it was decided to fit a roux loop anastomosis between the head of the pancreas and the duodenum to divert the fistulous fluid. This procedure was a success and the patient remains well 2 years later.

  16. Dural fistulas of the cavernous sinus

    Energy Technology Data Exchange (ETDEWEB)

    Guibert-Tranier, F.; Piton, J.; Caille, J.M.; Lemoine, J.J.

    1984-11-01

    Five cases of dural fistulas of the cavernous sinus are reported. The clinical aspect of this lesion is often misleading in the absence of subjective or objective bruits. The diagnosis is made at angiography which should systematically include the internal and external carotid arteries bilaterally. The goal of this study was to elucidate the great variability of the venous drainage and to correlate it with the clinical symptoms and course. The main problem is to know when and how these fistulas should be treated. Vascular ligatures should not be performed. Therapeutic angiography is the treatment of choice, but should be limited to the following indications: poorly tolerated bruits, severe ophthalmic damage (elevated ocular tension, diminished visual acuity, or oculomotor paralysis), angiographically demonstrated massive arteriovenous shunting, and a high degree of cortical venous reflux. Whatever the indication, the course after embolisation is rarely predictable and in particular the risk of extensive venous thrombosis or recurrence is great.

  17. Dural fistulas of the cavernous sinus

    International Nuclear Information System (INIS)

    Five cases of dural fistulas of the cavernous sinus are reported. The clinical aspect of this lesion is often misleading in the absence of subjective or objective bruits. The diagnosis is made at angiography which should systematically include the internal and external carotid arteries bilaterally. The goal of this study was to elucidate the great variability of the venous drainage and to correlate it with the clinical symptoms and course. The main problem is to know when and how these fistulas should be treated. Vascular ligatures should not be performed. Therapeutic angiography is the treatment of choice, but should be limited to the following indications: poorly tolerated bruits, severe ophthalmic damage (elevated ocular tension, diminished visual acuity, or oculomotor paralysis), angiographically demonstrated massive arteriovenous shunting, and a high degree of cortical venous reflux. Whatever the indication, the course after embolisation is rarely predictable and in particular the risk of extensive venous thrombosis or recurrence is great. (orig.)

  18. An unusual case of pancreatic fistula.

    Science.gov (United States)

    Johnston, M J; Prew, C L; Fraser, I

    2013-01-01

    We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be an external pancreatic fistula with discharge of amylase-rich fluid from the Lanz incision. A trial of conservative management failed despite multiple percutaneous drainage procedures and treatment with broad-spectrum antibiotics. After a second opinion was sought, it was decided to fit a roux loop anastomosis between the head of the pancreas and the duodenum to divert the fistulous fluid. This procedure was a success and the patient remains well 2 years later. PMID:24964425

  19. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  20. A Retrospective, Observational Study of Enteral Nutrition in Patients with Enteroatmospheric Fistulas.

    Science.gov (United States)

    Reinisch, Alexander; Liese, Juliane; Woeste, Guido; Bechstein, Wolf; Habbe, Nils

    2016-07-01

    Enteroatmospheric fistulas (EAFs) represent a challenging problem in patients with an open abdomen (OA). A retrospective, descriptive study was conducted to evaluate the effects of enteral alimentation on wound status and management and nutrition. All patients with an EAF in an OA treated between October 2012 and December 2014 at a university hospital in Germany were included without criteria for exclusions. Demographic and morbidity-related data collected included age, gender, surgeries, OA grading, body mass index (BMI), serum albumin, and serum creatinin. Underlying diseases and time between the index operation and the formation of the OA and EAFs were analyzed in relation to the initiation of enteral nutrition (EN), which can aggravate and contaminate the OA due to intestinal secretions necessary for digestion. The OA was described in size and area of the fascia defect and classified according to the Björck Scale. The number and location of the fistulas and the duration of negative pressure wound therapy (NPWT) were documented. Outcome parameters included fistula volume, wound management (eg, dressing change frequency, need for wound revision), feeding tolerance, systemic impact of nutrition, nutrition status at discharge, and mortality. Data were analyzed using primary descriptive statistics. The Mann-Whitney test was used to evaluate changes in fistula volume and BMI; categorical data were compared using Fisher's exact test. A P value less than 0.05 was considered significant. Ten (10) patients (8 women, median age of participants 55.4 [range 44-71] years) were treated during the study time period. Seven (7) patients had the first fistula orifice in the upper jejunum (UJF); 8 had more than 1 fistula. EN was initiated with high caloric liquid nutrition and gradually increased to a 25 kcal/kg/day liquid or solid nutrition. All patients were provided NPWT at 75 mm Hg to 100 mm Hg. EN was not followed by a significant increase of median daily fistula volume

  1. Successful laparoscopic management for cholecystoenteric fistula

    Institute of Scientific and Technical Information of China (English)

    Wen-Ke Wang; Chun-Nan Yeh; Yi-Yin Jan

    2006-01-01

    AIM: Since 1987, laparoscopic cholecystectomy (LC)has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula (CF) is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy.METHODS: During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial Hospital-Taipei were retrospectively reviewed.RESULTS: The study comprised two male and two female patients with ages ranging from 36 to 74 years (median: 53.5 years). All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography.One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d (median, 8 d).CONCLUSION: CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.

  2. Pancreaticoureteral Fistula Following Penetrating Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Joshua H Wolf

    2007-09-01

    Full Text Available Context The main pancreatic duct can form a fistulous communication with another epithelium in the setting of prolonged inflammation, operative manipulation, or direct trauma. We present a rare complication of a pancreaticoureteral fistula following a trauma nephrectomy. Case report A 17-year-old male who sustained a gunshot wound to the back arrived to our Emergency Room hyopotensive, tachycardic, and with free intraperitoneal fluid on focused assessment sonography for trauma (FAST exam. He was taken to the operating room for an exploratory laporatomy where a left nephrectomy was performed to control active bleeding from the left renal hilum. Significant bleeding was also encountered at the portal venous confluence. After packing and damage control laparotomy, the periportal/pancreatic bleeding was controlled during a second procedure 6 hours later. After one month in the Intensive Care Unit with an open abdomen, a computed tomography (CT scan revealed a fluid collection in the splenic fossa which was drained by catheter. Persistent drainage revealed a high amylase concentration (greater than 50,000 U/L. A fistulogram revealed interruption of the main pancreatic duct, and a fluid collection by the tail of the pancreas that was in communication with the left ureter. The patient’s urine amylase was also elevated. The patient was treated nonoperatively given the healing open abdomen and controlled fistula. He had an otherwise uncomplicated recovery. Conclusions This is the second report of a pancreaticoureteral fistula in the literature. Treatment of this communication should be similar to that of other pancreatic fistulae.

  3. An unusual case of pancreatic fistula

    OpenAIRE

    Johnston, M. J.; Prew, C.L.; Fraser, I

    2013-01-01

    We report an unusual case of a pancreatic fistula communicating with an appendicectomy wound. This occurred following an episode of acute haemorrhagic pancreatitis. The patient was initially admitted with signs and symptoms indicating appendicitis and went to theatre for an open appendicectomy. However, this did not resolve his symptoms and a laparotomy was performed the next day revealing haemorrhagic pancreatitis. He endured a stormy post-operative course, the cause of which was found to be...

  4. Traumatic fistula:the case for reparations

    Directory of Open Access Journals (Sweden)

    Arletty Pinel

    2007-01-01

    Full Text Available As a conflict strategy, women are often sexually assaulted using sticks, guns, branches of trees and bottles. Women’s genitals are deliberately destroyed, some permanently. Traumatic fistula often results. As with victims of torture and other grave human rights abuses, there exists an obligation to restore the women to health as far as possible and to provide reparation for their violations.

  5. Medical image of the week: tracheoesophageal fistula

    Directory of Open Access Journals (Sweden)

    Wong C

    2013-06-01

    Full Text Available A 51 year old woman with a history of tracheal and bronchial stents for airway impingment from small cell carcinoma was intubated for respiratory failure. After prolonged intubation, she underwent tracheostomy to transition into hospice. The tracheal stent was removed during the procedure due to its location. A tracheoesophageal fistula was demonstrated by visualization of her feeding tube on bronchoscopy performed the next day. The patient underwent palliative ablation of the tracheal tumor and died several days later in hospice.

  6. Pancreatic pseudocyst-portal vein fistula: Serial imaging and clinical follow-up from pseudocyst to fistula

    Energy Technology Data Exchange (ETDEWEB)

    Jee, Keun Nahn [Dept. of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2015-03-15

    Pancreatic pseudocyst-portal vein fistula is an extremely rare complication of pancreatitis. Only 18 such cases have been previously reported in the medical literature. However, a serial process from pancreatic pseudocyst to fistula formation has not been described. The serial clinical and radiological findings in a 52-year-old chronic alcoholic male patient with fistula between pancreatic pseudocyst and main portal vein are presented.

  7. Elbow arteriovenous fistulas for chronic haemodialysis.

    Science.gov (United States)

    Elcheroth, J; de Pauw, L; Kinnaert, P

    1994-07-01

    Arteriovenous fistulas (AVFs) were created at the elbow, rather than using prosthetic grafts, when forearm vessels were inadequate. A total of 272 such fistulas were constructed: 49 between the brachial artery and a forearm vein, 91 between the brachial artery and the elbow perforating vein, 52 between the brachial artery and the cephalic vein and 80 between the brachial artery and the basilic vein. In each case the vein was sutured end to side to the artery. The immediate failure rate was 11.8 per cent. The 1- and 4-year cumulative patency rates were 68.7 and 51.2 per cent for brachial artery-forearm vein AVFs, 80.3 and 68.0 per cent for those between the brachial artery and the elbow perforator, 74.1 and 61.3 per cent for brachial artery-cephalic vein fistulas, and 76.7 and 49.2 per cent for those between the brachial artery and the basilic vein. The elbow AVF is a reliable means of establishing vascular access for haemodialysis. PMID:7922091

  8. Clinical usefulness of doppler ultrasonography before percutaneous transluminal angioplasty immature native arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Eun [Dept. of Radiology, Inje University Seoul Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of); Cho, Young Kwon; Sim, Jae Chan; Lee, So Young; Sung, Su Ah; Hwang, Young Hwan [Eulji General Hospital, College of Medicine, Eulji University, Seoul (Korea, Republic of)

    2013-11-15

    To report the clinical efficacy of preprocedural doppler ultrasound examination for the treatment of immature arteriovenous fistula by means of percutaneous transluminal angioplasty (PTA) and the efficacy of PTA about its treatment. From November 2008 to May 2013, 28 patients who were diagnosed with immature arteriovenous fistula using doppler ultrasound examination and obtained successful maturation of it after PTA were included in this study. A retrospective comparative analysis was performed according to the findings between doppler ultrasound examination and fistulography during the procedure. The success rate of PTA and patency of fistula were evaluated in each patient Doppler ultrasound examination revealed stenosis in twenty three patients and thrombotic total occlusion in five patients. Stenosis was located in the proximal cephalic vein 2 cm from the anastomosis in 67.8% (19/28). In the five cases of thrombotic total occlusion, the lesions were long lesions from the anastomosis to the entire proximal cephalic vein at the elbow joint level. Fistulography revealed 5 patients with thrombotic total occlusion and 24 stenosis sites in 23 patients, respectively. The location and characteristics of all lesions were consistent on doppler ultrasound examination. Only four cases were observed as non-thrombotic total occlusion on fistulography, which had more than 90% stenosis on doppler ultrasound examination. The initial success rate of PTA for immature arteriovenous fistula was 96.4% (27/28). In three patients, clinical success was obtained after four times of additional PTA. Six additional PTAs were performed during follow-up, no complications related to the procedures were found. The primary patency rate was 92.9% at 3 months, 60.7% at 6 months and 39.3% at 12 months. The estimated mean survival of arteriovenous fistula was 347.9 days and the estimated median survival was 232 days. Also, the 12 months primary patency rates between the stenosis group and occlusion

  9. Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump.METHODS: Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis,operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined.RESULTS: Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology,use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma.The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear.CONCLUSION: The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

  10. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

    Madsen, M.A.; Frevert, S.; Madsen, P.L.;

    2008-01-01

    Splenic arteriovenous fistula is a rare complication following splenectomy. We report a case of a large splenic arteriovenous fistula 23 years after splenectomy in a 50-year old male with abdominal pain, gastro-intestinal bleeding, ascites, diarrhoea, dyspnoea, portal hypertension and heart failure...

  11. [One case of postoperative facial paralysis after first branchial fistula].

    Science.gov (United States)

    Wang, Xia; Xu, Yaosheng

    2015-12-01

    Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.

  12. Tracheo-oesophageal fistula diagnosed with multidetector computed tomography.

    LENUS (Irish Health Repository)

    Hodnett, Pa

    2009-04-01

    This case highlights important issues in investigation of patients with suspected tracheo-oesophageal fistula including the value of multidetector computed tomography, the importance of thorough imaging evaluation when high clinical suspicion of tracheo-oesophageal fistula exists and the value of close interaction between radiologists and intensive care physicians in the investigation of these patients.

  13. Chemoradiotherapy for a patient with a giant esophageal fistula

    Institute of Scientific and Technical Information of China (English)

    Takuma Nomiya; Kazuhide Teruyama; Hitoshi Wada; Kenji Nemoto

    2007-01-01

    We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy.However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died,her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula.The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.

  14. Esophagotracheal fistula caused by gastroesophageal reflux 9 years after esophagectomy

    Institute of Scientific and Technical Information of China (English)

    Kiyotomi Maruyama; Satoru Motoyama; Manabu Okuyama; Yusuke Sato; Kaori Hayashi; Yoshihiro Minamiya; Jun-ichi Ogawa

    2007-01-01

    Fistula between digestive tract and airway is one of the complications after esophagectomy with lymph node dissection. A case of esophagotracheal fistula secondary to esophagitis 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. It was successfully treated with transposition of a pedided pectoralis major muscle flap.

  15. [Nutrition therapy in enterocutaneous fistula; from physiology to individualized treatment].

    Science.gov (United States)

    Rodríguez Cano, Ameyalli Mariana

    2014-01-01

    Enterocutaneous fistula is the most common of all intestinal fistulas. Is a condition that requires prolonged hospital stay due to complications such as electrolyte imbalance, malnutrition, metabolic disorders and sepsis. Nutritional support is an essential part of the management; it favors intestinal and immune function, promotes wound healing and decreases catabolism. Despite the recognition of the importance of nutrition support, there is no strong evidence on its comprehensive management, which can be limiting when establishing specific strategies. The metabolic imbalance that a fistula causes is unknown. For low-output fistulas, energy needs should be based on resting energy expenditure, and provide 1.0 to 1.5 g/kg/d of protein, while in high-output fistulas energy requirement may increase up to 1.5 times, and provide 1.5 to 2.5 g/kg of protein. It is suggested to provide twice the requirement of vitamins and trace elements, and between 5 and 10 times that of Vitamin C and Zinc, especially for high-output fistulas. A complete nutritional assessment, including type and location of the fistula, are factors to consider when selecting nutrition support, whether is enteral or parenteral nutrition. The enteral route should be preferred whenever possible, and combined with parenteral nutrition when the requirements cannot be met. Nutritional treatment strategies in fistulas may include the use of immunomodulators and even stress management.

  16. Repair of large palatal fistula using tongue flap

    Directory of Open Access Journals (Sweden)

    Fejjal Nawfal

    2014-01-01

    Full Text Available Large palatal fistulas are a challenging problem in cleft surgery. Many techniques are used to close the defect. The tongue flap is an easy and reproductible procedure for managing this complication. The authors report a case of a large palatal fistula closure with anteriorly based tongue flap.

  17. [Resolution of a neck chylous fistula with oral diet treatment].

    Science.gov (United States)

    Cánovas, B; Morlán, M A; Familiar, C; Sastre, J; Marco, A; López, J

    2005-01-01

    Chylous fistula after neck dissection is a well-described complication. This pHatology can lead to serious respiratory and nutritional complications. Therapeutical options for chylous fistula remains controversial. On last reviews, there are an agreement on the conservative management. Within of this management, low long-chain triglycerides fat diet is an essential part.

  18. All's Well That Ends Well: Shakespeare's treatment of anal fistula.

    Science.gov (United States)

    Cosman, B C

    1998-07-01

    Textual and contextual evidence suggests that the French king's fistula, a central plot device in Shakespeare's play All's Well That Ends Well, is a fistula-in-ano. Anal fistula was known to the lay public in Shakespeare's time. In addition, Shakespeare may have known of the anal fistula treatise of John Arderne, an ancestor on Shakespeare's mother's side. Shakespeare's use of anal fistula differs from all previous versions of the story, which first appeared in Boccaccio's Decameron and from its possible historical antecedent, the fistula of Charles V of France. This difference makes sense given the conventions of Elizabethan comedy, which included anal humor. It is also understandable when one looks at what wounds in different locations mean in European legend. In this light, it is not surprising that subsequent expurgations treat Boccaccio's and Shakespeare's fistulas differently, censoring only Shakespeare's. This reading has implications for the staging of All's Well That Ends Well, and for our view of the place of anal fistulas in cultural history.

  19. A Case of Pyriform Sinus Fistula Infection with Double Tracts

    Directory of Open Access Journals (Sweden)

    Masato Shino

    2014-01-01

    Full Text Available Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid.

  20. USAID program for the prevention and treatment of vaginal fistula.

    Science.gov (United States)

    MacDonald, P; Stanton, M E

    2007-11-01

    The cornerstone of the US Agency for International Development (USAID) fistula program is to support and strengthen local capacity for fistula repair. The USAID program includes support to upgrade facilities, enhance local surgical repair capability, allocate equipment and supplies to operating rooms, implement quality improvement systems, and cover the women's transportation costs to and from the treatment facilities. The program also offers training in clinical and counseling skills; transferring skills South-to-South; and monitoring and evaluating the program's effectiveness. As new fistula cases continually increase the backlog of untreated cases, its efforts are also directed toward the prevention of fistula and the reintegration of treated women into their communities. Furthermore, the program challenges the culture of sexual violence against women that leads to traumatic gynecologic fistulas. PMID:17869253

  1. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair;

    2011-01-01

    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  2. Lateral semicircular canal fistula in cholesteatoma: diagnosis and management.

    Science.gov (United States)

    Meyer, Anais; Bouchetemblé, Pierre; Costentin, Bertrand; Dehesdin, Danièle; Lerosey, Yannick; Marie, Jean-Paul

    2016-08-01

    The objective of this retrospective study was to present the authors' experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent tympanoplasty for cholesteatoma, in a University Hospital between 1993 and 2013 were reviewed, to select only those with labyrinthine fistulas. 42 patients (6%) had cholesteatoma complicated by fistula of the lateral semicircular canal (LSCC). The following data points were collected: symptoms, pre- and postoperative clinical signs, surgeon, CT scan diagnosis, fistula type, surgical technique, preoperative vestibular function and audiometric outcomes. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. However, preoperative high-resolution computed tomography predicted fistula in 88 %. Using the Dornhoffer and Milewski classification, 16 cases (38 %) were identified as stage 1, 22 (52 %) as stage II, and 4 (10 %) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In eight patients (19 %), the canal was drilled with a diamond burr before sealing with autologous tissue. After surgery, hearing was preserved or improved in 76 % of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula and the hearing outcome. In conclusion, a complete and nontraumatic removal of the matrix cholesteatoma over the fistula in a one-staged procedure and its sealing with bone dust and fascia temporalis, with sometimes exclusion of the LSCC, is a safe and effective procedure to treat labyrinthine fistula. PMID:26351038

  3. Treatment of fistula-in-ano with fistula plug – A Review under special consideration of the technique

    Directory of Open Access Journals (Sweden)

    Ferdinand eKöckerling

    2015-10-01

    Full Text Available IntroducationIn a recent Cochrane review the authors concluded that there is an urgent need for well-powered, well-conducted randomized controlled trials comparing various modes of treatment of fistula-in-ano. Ten randomized controlled trials were available for analyses: There were no significant differences in recurrence rates or incontinuence rates in any of the studied comparisons. The following article reviews all studies available for treatment of fistula-in-ano with a fistula plug.Material and MethodsPubMed, Medline, Embase and the Cochrane medical database were searched up to December 2014. 47 articles were relevant for this review.ResultsHealing rates of 50 – 60 % can be expected for treatment of complex anal fistula with a fistula plug, with a plug-extrusion rate of 10 – 20 %. Such results can be achieved not only with plugs made of porcine intestinal submucosa, but also those made of other biological mesh materials, such as acellular dermal matrix. Important technical steps in the performance of a complex anal fistula plug repair need to be followed.SummaryTreatment of a complex fistula-in-ano with a fistula plug is an option with a success rate of 50 – 60 % with low complication rate. Further improvements in technique and better studies

  4. Successful treatment of an iatrogenic hepatic arteriobiliary fistula with an endobiliary covered stent graft: A case report

    International Nuclear Information System (INIS)

    Hepatic arteriobiliary fistula is a rare cause of hemobilia following percutaneous transhepatic biliary drainage for treatment of hilar cholangiocarcinoma. Hemobilia related to arterial injury is resistant to conservative treatment. Therefore, transarterial embolization after confirmation of bleeding vessels on an angiogram is generally considered as the first line of treatment to stop arterial bleeding. However, in high risk situations such as a hepatic infarction by arterial embolization, the endobiliary approach with a covered stent can be considered as an alternative treatment method. The authors report a case of iatrogenic arteriobiliary fistula in a patient with hilar cholangiocarcinoma which was successfully controlled by an endobiliary covered stent graft

  5. Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein

    International Nuclear Information System (INIS)

    In a patient with progressive ophthalmological problems, including uncontrolled intraocular pressure related to a cavernous sinus dural arteriovenous fistula, urgent intervention may be necessary to prevent permanent visual loss. We report a case in which inadequate transarterial embolisation and lack of access for transvenous catheterisation, including a direct approach through the superior ophthalmic vein, preceded percutaneous puncture of the superior ophthalmic vein deep within the orbit, permitting venous occlusion without complications. This case demonstrates that deep orbital puncture of the vein is feasible for occlusion of a cavernous sinus dural arteriovenous fistula. (orig.)

  6. CLINICAL STUDY OF FISTULA IN ANO

    Directory of Open Access Journals (Sweden)

    Raj

    2015-10-01

    Full Text Available Fistula in Ano is a benign treatable lesion of the rectum and the anal canal. Cryptoglandular infection accounts for about 90% of these cases. Majority of the infections are Acute and a minority contributed by chronic low grade infection hence pointing to varying etiologies. The pathogenesis has been attributed to the bursting open of an acute or inadequately treated Anorectal abscess into the peri anal skin. Diagnosis of the condition can be made easily with a good source of light, a proctoscope and a meticulous digital examination. Establishing a cure in this condition is difficult owing to two reasons. Firstly, the site of the infection makes the patient reluctant to subject themselves to examination. Secondly, a significant percent of these diseases persist or recur when appropriate surgery is not done or when the post op care is inadequate. Mostly it affects the young and the middle age group thus affecting productive man hours and quality of life. MATERIALS AND METHODS: All cases of clinically diagnosed Fistulae-in-ano above the age of 12 years, admitted in various surgical units in K.R. Hospital (attached to Government Medical College, Mysore during the study period December 1, 2008 to May 31, 2010. REUSLTS: Age Incidence, Sex Incidence, Socio Economic Status, Modes of Presentation, No. of External Openings, Situation of External Openings, Level of Fistulae, Type of surgical treatment, Associated with Fissure in Ano, Postoperative complication and Results were studied. CONCLUSION: Commonest age of presentation in our series is 30-40 years – 40%. Males are more commonly affected. Ratio Male: Female::3:1, Disease is more commonly seen in people with lower socio economic status group. 80% High socio economic class 20%. Discharging sinus is the commonest mode of presentation 72% and pain 72% and 84% pass history of perianal abscess was the presenting symptoms.

  7. Pulmonary arterio-venous micro fistulae - Diagnostic

    International Nuclear Information System (INIS)

    Four patients with pulmonary arterio-venous micro-fistulae - of which two were male (50%) - the ages varying from 10 to 43 (X sup(∼) = 22,7), were studied at the Cardiology Centre of the 6th Ward of Santa Casa da Misericordia Hospital in Rio de Janeiro. They were all basically suffering from Manson's Schistosomiasis, the hepato-splenic form in 3 cases (75%) and the Rendu Osler Weber disease with juvenile cirrhosis in 1 case (25%). All four of them had portal hypertension. The individual cases were clinically evaluate with X-rays, scintillographic and hemodynamic tests. (author)

  8. Radiologic evaluation of postoperative gastropericardial fistula

    Directory of Open Access Journals (Sweden)

    Jeffrey S. Chen

    2014-01-01

    Full Text Available Laparoscopic Nissen fundoplication is the current standard surgical option for complicated GERD and symptomatic hiatal hernia. Though comparable in safety, short-term efficacy, and patient satisfaction when compared with open operation, laparoscopic Nissen fundoplication has demonstrated shorter hospital stays and recuperative times. Commonly reported complications include gastric or esophageal injury, splenic injury, pneumothorax, bleeding, pneumonia, fever, wound infections, and dysphagia. We present an unusual case of gastropericardial fistula that developed as a late complication of laparoscopic Nissen fundoplication performed 4 years earlier.

  9. Congenital, solitary, large, intrahepatic arterioportal fistula in a child: management and review of the literature

    International Nuclear Information System (INIS)

    Congenital intrahepatic arterioportal fistula (APF) is a rare condition. In most cases, the symptoms and complications develop during infancy. We report here the incidental finding of a large and solitary congenital APF in a 13-year-old boy, with subsequent related clinical complications. At angiography, an APF connecting the left hepatic artery and the left branch of the portal vein (PV) was demonstrated with reversed flow in the left and main PV. The fistula was successfully occluded, in a single embolisation session, using an Amplatzer occlusion device. This was associated with immediate restoration of normal hepatopetal flow in the PV and followed by resolution of the clinical signs of portal hypertension. This patient is the oldest child with congenital intrahepatic APF to be reported. We emphasise the interest of using a large device (Amplatzer) to occlude a solitary large APF in a single session and, more importantly, to avoid other possible complications related to embolisation. (orig.)

  10. EFFECT OF HEPARIN ON THE PATENCY OF ARTERIOVENOUS FISTULA

    Directory of Open Access Journals (Sweden)

    H Ravari

    2008-11-01

    Full Text Available "nPatients with end stage renal disease need a good vascular access for hemodialysis. Arteriovenous fistula is the method of choice for vascular access in these patients. However, failure of arteriovenous fistula due to thrombosis is a major problem. The aim of this study was to evaluate the effect of the heparin on the patency of the arteriovenous fistula. This prospective interventional case control study was performed from November 2003 through May 2005 in vascular surgery ward in Imam Reza Hospital. All the patients who underwent a surgery in order to perform an arteriovenous fistula in cubital or snuff box areas for the dialysis means were enrolled. They were randomly divided into two groups. The case group (n = 96 received intraoperative heparin whereas the controls (n = 102 did not. Early observation of arteriovenous fistula (immediately after surgery showed patency in 89% of heparin group and in 87% of the control group. The patency rate 2 weeks after the surgery was 85% in heparin group versus 74% in the control group, resulting in a statistically significant difference (P value = 0.046. According to higher patency rate of arteriovenous fistula in 2 weeks following surgery in case group, we recommend intraoperative use of heparin in arteriovenous fistula operations.

  11. Management of enterocutaneous fistulas: 30-year clinical experience

    Institute of Scientific and Technical Information of China (English)

    黎介寿; 任建安; 朱维铭; 尹路; 韩建明

    2003-01-01

    Objectives To explore successful models of management of enterocutaneous fistulas and u nresolved problems requiring further study. Method Analysis of therapeutic results of 1168 cases treated in one center from January 1971 to December 2000. Results In this group of patients, the recovery rate was 93% and 37% of fistulas healed spontaneously after non-operative treatment. The mortality rate was 5.5%, mos t of which occurred due to sepsis. Of 659 cases receiving definitive operations for enteric fistula, 98% recovered. Recovery, mortality and operational succes s rates (94.2%, 4.4%, 99.7%) of cases treated between January 1985 and Decemb er 2000 were significantly better than those (90.4%, 8.2%, 95.5%) of cases treated earlier (January 1971-December 1984) (P<0.05). Conclusions The results from this study were better overall than those reported in previous literatures. The change in therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are the key reasons for improvement of managing enteric fistulas. However, incre asing spontaneous closure of fistula, improving the therapeutic rate of specific enteric fistula (IBD or radiation enteritis) and performing definitive operations for enteric fistula at early stages are still problematic and require further study.

  12. Enteroatmospheric fistula: from soup to nuts.

    Science.gov (United States)

    Majercik, Sarah; Kinikini, Merin; White, Thomas

    2012-08-01

    Enteroatmospheric fistula (EAF), a special subset of enterocutaneous fistula (ECF), is defined as a communication between the gastrointestinal (GI) tract and the atmosphere. It is one of the most devastating complications of "damage control" laparotomy (DCL) and results in significant morbidity and mortality. The published incidence of EAF ranges from 5%-19% of patients who have undergone DCL and survived long enough to develop complications. Their etiology is complex and ranges from persistent abdominal infection, anastomotic leakage, adhesions of the bowel to itself or fascia, and repeated bowel manipulation during return trips to the operating room or dressing changes. Prevention is clearly the best treatment strategy but may be difficult to achieve. Once an EAF occurs, immediate management consists of treatment of sepsis if present; nutrition, fluid, and electrolyte support in the form of parenteral nutrition (PN); and wound/effluent control and protection of surrounding tissues and exposed bowel. It should be noted that EAF almost never close spontaneously, and definitive repair usually requires major surgical intervention and abdominal wall reconstruction 6 to 12 months after the original insult. Enteral feeding should be attempted once the anatomy of the EAF is defined and reliable enteral access is obtained. Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone. Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF.

  13. Tracheoesophageal fistula in utero: 22 cases

    International Nuclear Information System (INIS)

    A retrospective review of 22 infants born with tracheoesophageal fistula (TEF) detected on in utero US was performed. In addition, ten cases reported in the literature were reviewed. TEF or esophageal atresia should be considered when there is polydramnios and the stomach is not fluid filled; these findings were seen in 32% of the cases. Amniotic fluid flows freely through some TEFs, resulting in a normal amount of amniotic fluid and a fluid-filled stomach (6 of 22 cases), while in other cases the fluid does not traverse the fistula easily and polyhydramnios results. Polyhdramnios was present in 62% of the cases we reviewed and was the most common sonographic finding. The earliest age at which polyhdramnios was diagnosed was 24 weeks. Associated abnormalities are seen in 50%-70% of cases of TEF and are a major contributing factor to morbidity and mortality. Sonography will continue to miss many cases of TEF; however, when TEF is suspected from fetal US (i.e., polyhdramnios and no fluid-filled stomach, or polyhdramnios with no etiology identified), an improved outcome is expected

  14. Interventional therapy for priapism caused by arteriovenous fistula of penis: the nursing experience in two patients

    International Nuclear Information System (INIS)

    Objective: To discuss the perioperative nursing measures for interventional treatment of priapism caused by arteriovenous fistula of penis in order to reduce the operation-related complications and to promote rehabilitation. Methods: A series of nursing steps were carried out in 2 patients who suffered from priapism caused by arteriovenous fistula of penis and received interventional therapy. The nursing measures included preoperative psychological nursing,routine preoperative examinations, promotion of friendly relations between nurse and patient, preparation for the operation method, the preparation of skin, postoperative nursing of patient's position, observation of penis erection and vital signs, postoperative psychological nursing, and the health guidance at the time of discharge. Results: After the interventional therapy two patients were successfully cured at the time of discharge. No complications related to the operation occurred. Three months after the operation the erect function of the penis remained normal. Conclusion: The interventional therapy is a safe and reliable technique for priapism caused by arteriovenous fistula of penis. The proper and effective perioperative and postoperative nursing measures can surely improve the successful rate of interventional treatment as well as prevent the occurrence of complications. (authors)

  15. Transcatheter embolization of hepatic arteriovenous fistulas in Rendu-Osler-Weber disease: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Stockx, L.; Raat, H.; Caerts, B.; Wilms, G.; Marchal, G. [Department of Radiology, Catholic University of Leuven (Belgium); Cutsem, E. van [Department of Internal Medicine, Catholic University of Leuven (Belgium)

    1999-09-01

    A patient with hereditary hemorrhagic telangiectasia and diffuse intrahepatic arteriovenous fistulas developed secondary high-output ventricular failure and pulmonary hypertension. A serial staged hepatic arterial coil embolization was performed with long-term resultant haemodynamic and clinical improvement. The methods of this procedure and related complications are discussed. (orig.) With 2 figs., 2 tabs., 13 refs.

  16. Efficacy of preoperative US vascular mapping for arteriovenous fistula in patients with hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Min Sun; Hwang, Ji Young; Kang, Byung Chul; Baek, Seung Yon [College of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2007-07-15

    The purpose of this study is to assess the efficacy of preoperative US vascular mapping to predict postoperative patency of the arteriovenous fistula for hemodialysis. Sixty-six patients who underwent hemodialysis for end-stage renal failure (M:F = 34:32, mean age, 58.8 years) were observed prospectively from January 2001 to April 2003. The patients were divided into two groups: the vascular mapping group and the control group. A comparative analysis of the re-operation rate between the two groups was determined by use of the chi-square rest, efficacy of preoperative US vascular mapping according to the type of surgery. A comparative analysis of the secondary patency after percutaneous transluminal angioplasty was determined by the use of Fischer exact test, and a comparative analysis of the diminution of patency during the follow-up periods was determined by the use of the Logrank test. In the mapping group, the diameters of intraoperatively selected vessels were investigated and compared with the recommended diameter on preoperative US vascular mapping determined statistically by the use of Fisher's exact test. The preoperative US vascular mapping group had relatively lower re-operation rates (11.8%) than the control group (28.1%) ({rho} = 0.09). The preventive role of US vascular mapping in more effective in decreasing the re-operation rate for a native arteriovenous fistula (7.4%) than for a synthetic arteriovenous graft (25.9%) ({rho} = 0.06). For patients than had an interventional procedure, the failure rate to obtain a secondary patency was smaller than in the mapping group (33.3%), compared with the control group (46.3%) ({rho} = 0.37). Patients in the mapping group had a higher patency than the control group patients for a native arteriovenous fistula (92.0%) and a synthetic arteriovenous graft (71.4%) at one year following surgery ({rho} = 0.10, {rho} = 0.79). The arteriovenous fistulas in the mapping group had a higher patency for both a native

  17. A large congenital and solitary intrahepatic arterioportal fistula in an old woman

    Institute of Scientific and Technical Information of China (English)

    Zhen-Ya Lu; Jian-Yang Ao; Tian-An Jiang; Zhi-Yi Peng; Zhan-Kun Wang

    2009-01-01

    Arterioportal fistula (APF) is a rare cause of portal hypertension and may lead to death. APF can be congenital, post-traumatic, iatrogenic (transhepatic intervention or biopsy) or related to ruptured hepatic artery aneurysms. Congenital APF is a rare condition even in children. In this case report, we describe a 73-year-old woman diagnosed as APF by ultrasonography, computed tomography, and hepatic artery selective arteriography. The fistula was embolized twice but failed, and she still suffered from alimentary tract hemorrhage. Then, selective arteriography of the hepatic artery was performed again and venae coronaria ventriculi and short gastric vein were embolized. During the 2-year follow-up, the patient remained asymptomatic. We therefore argue that embolization of venae coronaria ventriculi and short gastric vein may be an effective treatment modality for intrahepatic APF with severe upper gastrointestinal bleeding.

  18. Case report: misdiagnosis of tailgut cyst presenting as recurrent perianal fistula with pelvic abscess.

    Science.gov (United States)

    Johnson, Kevin N; Young-Fadok, Tonia M; Carpentieri, David; Acosta, Juan M; Notrica, David M

    2013-02-01

    Tailgut cysts are uncommon lesions that usually occur within the presacral space. The relative rarity and nonspecific complaints associated with these lesions often lead to misdiagnosis or unnecessary procedures before the correct diagnosis is made. We describe a case of a 16-year-old female who presented with pelvic pain. She had previously undergone several procedures at an outside institution for recurrent perianal fistula and perirectal abscess. Subsequent evaluation under anesthesia revealed a presacral cystic mass with a well-developed tract within the anorectal ring in the posterior midline. This mass was surgically removed using a combined transanal and posterior sagittal excision technique and was found to be a tailgut cyst upon pathologic evaluation. Tailgut cysts and other presacral masses should be included in the differential for patients with recurrent abscess in the presacral space or fistula within the anal canal. A variety of surgical approaches are available depending on the anatomy of the lesion. PMID:23414899

  19. Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Tariq Shakoor

    2015-01-01

    Full Text Available Transcatheter aortic valve replacement (TAVR techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.

  20. 全喉切除术后咽瘘相关因素分析%Study of pharyngo-cutaneous fistula fistula after total laryngectomy

    Institute of Scientific and Technical Information of China (English)

    高琳; 黎万荣; 付文广

    2011-01-01

    目的 分析全喉切除术后咽瘘发生的相关因素.方法 回顾分析我院2001年1月~2010年1月住院期间行全喉切除术后患者的临床资料,应用SPSS13.0进行统计学分析.结果 165例患者中26例发生术后咽瘘(15.76%),其发生与肿瘤的临床分期分型、术前放疗、手术时间、颈部淋巴结清扫、是否合并糖尿病以及营养不良、鼻饲时间、术后感染有关(P<0.01).结论 喉癌的早期诊断、治疗对于预防术后咽瘘的发生有重要作用,重视咽瘘发生的相关因素,制定合理的治疗措施,有助于预防咽瘘的发生.%Objective To explore the factors which lead to pharyngo-cutaneous fistula after total laryngectomy. Methods 165 hospitalized patients who underwent surgical treatment from Jan 2000 to Jan 2010 were restrospectively studied, applicate SPSS13. 0 for statistical analysis . Results The rate of post-laryngectomy pharyngo-cutaneous fistula is 15. 76% , it appears reduced tendency. With single-factor analysis , the factors effect on the rate of post-laryngectomy pharyngo-cutaneous fistula include clinical tumor stage , tumor types, preoperative radiotherapy, operation time , cleaning up cervical lymph node, whether with diabetes mellitus and malnutrition, nasal feeding time, and post-operative infection( P < 0. 01) . Conclusion Early diagnosis and prompt treatment are crucial to prenvent this complication; pay more attention on the related factors about the pharyngo-cutaneous fistula, formulate rational treatment measures, may help prevent pharyngo-cutaneous fistula.

  1. Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    The occurrence of pancreatic pleural effusion,secondary to an internal pancreatic fistula,is a rare clinical syndrome and diagnosis is often missed.The key to the diagnosis is a dramatically elevated pleural fluid amylase.This pancreatic pleural effusion is also called a pancreatic pleural fistula.It is characterized by profuse pleural fluid and has a tendency to recur.Here we report a case of delayed internal pancreatic fistula with pancreatic pleural effusion emerging after splenectomy.From the treatment ...

  2. Management of chronic parotid fistula with sodium tetradecyl sulfate.

    Science.gov (United States)

    Singh, Virendra; Kumar, Pradeep; Agrawal, Aviral

    2013-01-01

    A parotid fistula is a rare, extremely unpleasant disease. It may be due to chronic pathologies of the facial soft tissues, trauma (tangential injury to face), infection or congenital. Various treatment modalities including surgical and conservative management are present to treat this disease. Conservative management plays a vital role in patients who are systemically compromised and unfit for surgery. In the present case report an alternative conservative technique of parotid fistula management has been described in a 28-year-old girl who was severe anemic with parotid fistula since last 25 yrs.

  3. Cassia fistula Linn: Potential candidate in the health management

    Directory of Open Access Journals (Sweden)

    Arshad H Rahmani

    2015-01-01

    Full Text Available Cassia fistula Linn is known as Golden shower has therapeutics importance in health care since ancient times. Research findings over the last two decade have confirmed the therapeutics consequence of C. fistula in the health management via modulation of biological activities due to the rich source of antioxidant. Several findings based on the animal model have confirmed the pharmacologically safety and efficacy and have opened a new window for human health management. This review reveals additional information about C. fistula in the health management via in vivo and in vitro study which will be beneficial toward diseases control.

  4. Congenital tracheoesophageal fistula successfully diagnosed by CT esophagography

    Institute of Scientific and Technical Information of China (English)

    Koichi Nagata; Yoshito Kamio; Tamaki Ichikawa; Mitsutaka Kadokura; Akihiko Kitami; Shungo Endo; Haruhiro Inoue; Shin-Ei Kudo

    2006-01-01

    Tracheoesophageal fistula (TEF) or bronchoesophageal fistula may be congenital, inflammatory, neoplastic,or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy.But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.

  5. Enterovesical fistula caused by a bladder squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    Chun-Hsiang Ou Yang; Keng-Hao Liu; Tse-Ching Chen; Phei-Lang Chang; Ta-Sen Yeh

    2009-01-01

    Enterovesical fistulas are not uncommon in patients with inflammatory or malignant colonic disease, however,fistulas secondary to primary bladder carcinomas are extremely rare. We herein reported a patient presenting with intractable urinary tract infection due to enterovesical fistula formation caused by a squamous cell carcinoma of the urinary bladder. This patient underwent en bloc resection of the bladder dome and involved ileum, and recovered uneventfully without urinary complaint. To the best of our knowledge, this is the first case reported in the literature.

  6. Enterovesical Fistula Secondary to Squamous Cell Carcinoma of the Bladder.

    Science.gov (United States)

    Sellers, William; Fiorelli, Robert

    2015-11-01

    Enterovesical fistulas are a well-known complication of inflammatory and malignant bowel disease. Bladder carcinoma, however, is an extremely rare etiology. We describe a case of squamous cell carcinoma of the bladder with an enterovesical fistula. This rare phenomenon has never been previously reported in western literature. We review the diagnosis, work up and treatment of enterovesical fistulas. Unfortunately, the prognosis for these highly invasive tumors is very poor and the treatment is often palliative. The high morbidity and mortality makes management of these patients exceptionally challenging.

  7. Enteric fistulous communication with an aortobifemoral graft permitting for Eggerthella lenta colonization

    Directory of Open Access Journals (Sweden)

    Waqas Jehangir

    2015-01-01

    Full Text Available The presence of an aortoenteric fistula following aortobifemoral graft repair of an abdominal aortic aneurysm is associated with a high probability of infection leading to clinically significant bacteremia. We report a case of an aortoenteric fistula that developed two years after initial aortic grafting resulting in colonization with the anaerobe, Eggerthella lenta. This dangerous bacterium is difficult to culture, associated with high mortality and the patient may have mild symptoms on presentation.

  8. Obstetric fistula in Assam, India: a neglected cause of maternal morbidities and mortality

    Directory of Open Access Journals (Sweden)

    Suresh Jungari

    2015-02-01

    Full Text Available Each year between 50,000 to 100,000 women worldwide are affected by obstetric fistula, a hole in the birth canal. Obstetric fistula is one of the major cause for maternal morbidities and mortality and it has been successfully eradicated in developed nations. Women who experience obstetric fistula suffer constant incontinence, shame, and social segregation. Obstetric fistula is prevalent in African and Asian countries, including India. In India, data has been collected in a large scale survey of district level household survey regarding obstetric fistula and its causes. In this study, efforts are endeavoured to understand the prevalence and causes of obstetric fistula in Assam state, India, where prevalence of obstetric fistula is very high (4.5%. Chi-square test was applied to determine the affecting factors of obstetric fistula. Results showing the socioeconomic status, education, place of residence and age group are important determinants in variation of fistula prevalence among women.

  9. Tracheoesophageal fistula as the presenting manifestation of Hodgkin's lymphoma.

    OpenAIRE

    Alba, D.; Lobato, S. D.; Alvarez-Sala, R.; Villasante, C.; Echevarría, C.

    1994-01-01

    We present a patient with tracheoesophageal fistula as the initial manifestation of Hodgkin's disease with oesophageal involvement. To our knowledge, this has not been previously reported. The diagnosis of Hodgkin's lymphoma was made at autopsy.

  10. Intracranial dural arteriovenous fistula with spinal medullary venous drainage

    Energy Technology Data Exchange (ETDEWEB)

    Wiesmann, M.; Padovan, C.S.; Pfister, H.W.; Yousry, T.A. [Muenchen Univ. (Germany). Abt. fuer Neuroradiologie

    2000-10-01

    We report on a 46-year-old patient in whom an intracranial dural arteriovenous (AV) fistula, supplied by a branch of the ascending pharyngeal artery, drained into spinal veins and produced rapidly progressive symptoms of myelopathy and brainstem dysfunction including respiratory insufficiency. Magnetic resonance imaging studies demonstrated brainstem oedema and dilated veins of the brainstem and spinal cord. Endovascular embolization of the fistula led to good neurological recovery, although the patient had been paraplegic for 24 h prior to embolization. This case demonstrates the MRI characteristics of an intracranial dural AV fistula with spinal drainage and illustrates the importance of early diagnosis and treatment. Even paraplegia may be reversible, if angiography is performed and the fistula treated before ischaemic and gliotic changes become irreversible. (orig.)

  11. Large vesico-vaginal fistula caused by a foreign body.

    Science.gov (United States)

    Massinde, An; Kihunrwa, A

    2013-07-01

    Foreign body is a rare cause of vesico-vaginal fistula most often reported in developed countries. In developing countries obstructed labor is the commonest cause of fistula. A nulliparous 19-year-old female presented with a 3-week history of a foreign body in the vagina causing urinary incontinence and offensive vaginal discharge. Her guardian allegedly inserted the foreign body after she refused a pre-arranged marriage. A plastic container was removed from the vagina under general anesthesia. A large vesico-vaginal fistula was discovered, which was successfully surgically repaired. We recommend urgent removal of the foreign body, preferably under general anesthesia. However, if the history or physical examination reveals prolonged exposure, repair of the fistula should be delayed to allow for adequate debridement in order to prevent any life-threatening complications.

  12. Role of fistulography in evaluating pancreatic fistula after pancreaticoduodenectomy.

    NARCIS (Netherlands)

    Faccioli, N.; Foti, G.; Molinari, E.; Hermans, J.J.; Comai, A.; Talamini, G.; Bassi, C.; Pozzi-Mucelli, R.

    2012-01-01

    OBJECTIVE: To evaluate the usefulness of fistulography as a diagnostic and management tool for clinically suspected pancreatic fistulas (PF) after pancreaticoduodenectomy (PD). METHODS: 84 consecutive fistulographies were performed for clinical suspicion of PF and retrospectively analysed. We radiol

  13. Role of fistulography in evaluating pancreatic fistula after pancreaticoduodenectomy

    NARCIS (Netherlands)

    N. Faccioli (Niccolo); G. Foti (G.); F. Molinari (Francesca); J.J. Hermans (John); A. Comai (A.); G. Talamini (G.); C. Bassi (Claudio); R. Pozzi Mucelli (Roberto Silvio)

    2012-01-01

    textabstractObjective: To evaluate the usefulness of fistulography as a diagnostic and management tool for clinically suspected pancreatic fistulas (PF) after pancreaticoduodenectomy (PD). Methods: 84 consecutive fistulographies were performed for clinical suspicion of PF and retrospectively analyse

  14. Clinical and echocardiographic features of aorto-atrial fistulas

    Directory of Open Access Journals (Sweden)

    Ananthasubramaniam Karthik

    2005-01-01

    Full Text Available Abstract Aorto-atrial fistulas (AAF are rare but important pathophysiologic conditions of the aorta and have varied presentations such as acute pulmonary edema, chronic heart failure and incidental detection of the fistula. A variety of mechanisms such as aortic dissection, endocarditis with pseudoaneurysm formation, post surgical scenarios or trauma may precipitate the fistula formation. With increasing survival of patients, particularly following complex aortic reconstructive surgeries and redo valve surgeries, recognition of this complication, its clinical features and echocardiographic diagnosis is important. Since physical exam in this condition may be misleading, echocardiography serves as the cornerstone for diagnosis. The case below illustrates aorto-left atrial fistula formation following redo aortic valve surgery with slowly progressive symptoms of heart failure. A brief review of the existing literature of this entity is presented including emphasis on echocardiographic diagnosis and treatment.

  15. Congenital lacrimal sac fistula: intraoperative visualization by polyvinyl siloxane cast.

    Science.gov (United States)

    Bhatnagar, Aparna; Eckstein, Lauren A; Douglas, Raymond S; Goldberg, Robert A

    2008-01-01

    We report the intraoperative use of polyvinyl siloxane impression material to demonstrate the anatomy of the lacrimal sac, canaliculi, and lacrimal duct in a case of congenital lacrimal sac fistula. A 1-week-old boy was examined for tearing since birth. Examination revealed a left congenital lacrimal sac fistula. After a failed surgery to close the fistula with silicone intubation at 6 months of age, the patient underwent endonasal dacryocystorhinostomy performed at 14 months of age, aided by intraoperative injection of polyvinyl siloxane (trade name Reprosil) to mark and protect the nasolacrimal sac and facilitate endonasal visualization. A polyvinyl siloxane cast demonstrated the anatomy of the accessory canaliculus causing nasolacrimal duct obstruction. Postoperatively, the epiphora resolved and the fistula remained closed. The polyvinyl siloxane cast provides a 3-dimensional "ex vivo " model of the lacrimal sac, upper duct, and canalicular anatomy, and can be used in dacryocystorhinostomy surgery to identify and protect the lacrimal sac.

  16. Recurrent perimedullary arteriovenous fistula at thoracic level

    Institute of Scientific and Technical Information of China (English)

    HAI Jian; CHEN Zuo-quan; DENG Dong-feng; PAN Qing-gang; LING Feng

    2006-01-01

    @@ Perimedullary arteriovenous fistula (PMAVF, type Ⅳ spinal cord arteriovenous malformation,SCAVM) is a direct arteriovenous shunt without abnormal vascular connection between the feeding artery and draining vein. Most patients with PMAVF present with a progressive myelopathy caused by venous hypertension, resulting in disabling deficits and incurable complete transverse myelopathy.1'2The lesion is usually located on the surface of the spinal cord or under the pia mater at the level of the conus medullaris or cauda equina, thoracic PMAVF is rarely encountered. Most PMAVFs are fed by the anterior spinal artery (ASA), posterior spinal artery (PSA), or both.1-5 Multiple arterial feeders from the ASA can make the treatment of the disease difficult.6From August 2004 to February 2005, we treated a patient with a recurrent PMAVF (type Ⅳb) at the thoracic level with multiple blood supply.

  17. Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy.

    Science.gov (United States)

    Kaler, Kamaljot S; Cwikla, Daniel; Clayman, Ralph V

    2016-01-01

    Pleural effusions due to pleural injury following supracostal percutaneous nephrolithotomy (PCNL) occur in upwards of 15% of patients; however, these effusions are invariably diagnosed immediately postoperative or during the hospital stay. Herein, we report our initial experience with a delayed nephropleural fistula. A 52-year-old female underwent an uneventful supracostal right PCNL staghorn stone procedure and was discharged on postoperative day 1. She presented to the emergency department 8 days after her original procedure and one day after ureteral stent removal in the office, with right pleural effusion, concomitant contralateral renal colic secondary to migration of a left pelvic stone into her left proximal ureter, and acute renal failure/oliguria. She was treated with right chest tube drainage, bilateral nephrostomy tube placement, and subsequent left holmium laser ureterolithotripsy. PMID:27579431

  18. Inoperable aggressive mesenteric fibromatosis with ureteric fistula

    International Nuclear Information System (INIS)

    The purpose of our report is to illustrate an aggressive case of mesenteric fibromatosis in a 17-year-old girl with a ureteric fistula and to review imaging and pathological features, natural history and treatment options of this disease. Our patient underwent computed tomography that revealed a widespread intra-abdominal mass. The necrotic centre of this mass had a fistulous communication with the right ureter. Fibromatoses represent a spectrum of uncommon benign conditions characterised by proliferating fibrous tissue. The deep intra-abdominal form of mesenteric fibromatosis (MF), one of the rare subtypes of the 'fibromatoses' or 'desmoid tumours', grows rapidly and may become extensive. Surgery provides good results in limited disease and non-surgical modalities in cases of unresectable and residual disease

  19. Vector velocity volume flow estimation: Sources of error and corrections applied for arteriovenous fistulas.

    Science.gov (United States)

    Jensen, Jonas; Olesen, Jacob Bjerring; Stuart, Matthias Bo; Hansen, Peter Møller; Nielsen, Michael Bachmann; Jensen, Jørgen Arendt

    2016-08-01

    A method for vector velocity volume flow estimation is presented, along with an investigation of its sources of error and correction of actual volume flow measurements. Volume flow errors are quantified theoretically by numerical modeling, through flow phantom measurements, and studied in vivo. This paper investigates errors from estimating volumetric flow using a commercial ultrasound scanner and the common assumptions made in the literature. The theoretical model shows, e.g. that volume flow is underestimated by 15%, when the scan plane is off-axis with the vessel center by 28% of the vessel radius. The error sources were also studied in vivo under realistic clinical conditions, and the theoretical results were applied for correcting the volume flow errors. Twenty dialysis patients with arteriovenous fistulas were scanned to obtain vector flow maps of fistulas. When fitting an ellipsis to cross-sectional scans of the fistulas, the major axis was on average 10.2mm, which is 8.6% larger than the minor axis. The ultrasound beam was on average 1.5mm from the vessel center, corresponding to 28% of the semi-major axis in an average fistula. Estimating volume flow with an elliptical, rather than circular, vessel area and correcting the ultrasound beam for being off-axis, gave a significant (p=0.008) reduction in error from 31.2% to 24.3%. The error is relative to the Ultrasound Dilution Technique, which is considered the gold standard for volume flow estimation for dialysis patients. The study shows the importance of correcting for volume flow errors, which are often made in clinical practice.

  20. Management of postoperative enterocutaneous fistulae in children: A decade experience in a single centre

    Directory of Open Access Journals (Sweden)

    Francis A Uba

    2012-01-01

    Full Text Available Background: Enterocutaneous fistula (ECF in children poses a lot of management challenges due to sepsis, malnutrition, fluid and electrolyte deficits, which are frequent complications. Knowledge of prognostic factors of postoperative ECF is essential for therapeutic decision-making processes. This study examined the variables that relate to the outcomes of management of ECF in children. Patients and Methods: Consecutive children who were managed for postoperative ECF in our unit between 2000 and 2009 were evaluated. Data were analysed for clinical features, management and its outcome. Results: A total of 54 patients were managed for ECF. Majority of the fistulas were due to operation for infective causes, with typhoid intestinal perforation ranking the highest. Overall, spontaneous closure without operative intervention occurred in 29 (53.7% patients. Twenty-one (38.9% patients required restorative operations to close their fistulas, which was successful only in 12 (22.2% patients. There was a strong correlation between high-output fistulas (jejunal location and surgical closure (P<0.001. Hypoalbuminaemia and jejunal location profoundly resulted in non-spontaneous closure of ECF (P<0.001 and were associated with high morbidity (P<0.001. Thirteen (24.1% patients died due to hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia. Conclusions: Majority of the ECF in children closed spontaneously following high-protein and high-carbohydrate nutrition. Hypoalbuminaemia and jejunal location were important prognostic variables resulting in non-spontaneous closure, while hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia were associated with high mortality in children with ECF.

  1. A Newly Designed Enterocutaneous Esophageal Fistula Model in the Pig.

    Science.gov (United States)

    Rahmi, Gabriel; Perretta, Silvana; Pidial, Laetitia; Vanbiervliet, Geoffroy; Halvax, Peter; Legner, Andras; Lindner, Veronique; Barthet, Marc; Dallemagne, Bernard; Cellier, Christophe; Clément, Olivier

    2016-06-01

    Background Fistulas after esophagectomy are a significant cause of morbidity and mortality. Several endoscopic treatments have been attempted, with varying success. An experimental model that could validate new approaches such as cellular therapies is highly desirable. The aim of this study was to create a chronic esophageal enterocutaneous fistula model in order to study future experimental treatment options. Methods Eight pigs (six 35-kg young German and two 50-kg adult Yucatan pigs) were used. Through a left and right cervicotomy, under endoscopic view, 1 (group A, n = 6) or 2 (group B, n = 7) plastic catheters were introduced into the esophagus 30 cm from the dental arches bilaterally and left in place for 1 month. Radiologic and endoscopic fistula tract evaluations were performed at postoperative day (POD; 30) and at sacrifice (POD 45). Results Three fistulas were excluded from the study because of early (POD 5) dislodgment of the catheter, with complete fistula closure. At catheter removal (POD 30), the external orifice was larger in group B (5.2 ± 1.1 mm vs 2.6 ± 0.4 mm) with more severe inflammation (72% vs 33%). At POD 45, the external orifice was closed in all fistulas in group A and in 1/7 in group B. At necropsy, the fistula tract was still present in all animals. Yucatan pigs showed more complex tracts, with a high level of necrosis and substantial fibrotic infiltration. Conclusions In this article, we show a reproducible, safe, and effective technique to create an esophagocutaneous fistula model in a large experimental animal. PMID:26989046

  2. Coronary arterovenous fistula: to treat or not to treat?

    OpenAIRE

    Jiritano, Federica; Prestipino, Filippo; Mastroroberto, Pasquale; Chello, Massimo

    2015-01-01

    We reported the case of a 68-year old male with chest pain. The coronary angiography showed the disease of the left anterior descending coronary artery and, incidentally, an arteriovenous coronary fistula between this coronary branch and the pulmonary artery. The patient underwent off-pump coronary bypass through a left mini thoracotomy. In the present case, after a series of detailed exams, we decided not to close the fistula for several reasons, but mainly because of the singular localizati...

  3. Pathophysiology of fistula formation in Crohn’s disease

    Institute of Scientific and Technical Information of China (English)

    Michael; Scharl; Gerhard; Rogler

    2014-01-01

    Fistulae represent an important complication in patient suffering from Crohn’s disease(CD). Cumulative incidence of fistula formation in CD patients is 17%-50% and about one third of patients suffer from recurring fistulae formation. Medical treatment options often fail and also surgery frequently is not successful. Available data indicate that CD-associated fistulae originate from an epithelial defect that may be caused by ongoing inflammation. Having undergone epithelial to mesenchymal transition(EMT), intestinal epithelial cells(IEC) penetrate into deeper layers of the mucosa and the gut wall causing localized tissue damage formation of a tube like structure and finally a connection to other organs or the body surface. EMT of IEC may be initially aimed toimprove wound repair mechanisms since "conventional" wound healing mechanisms, such as migration of fibroblasts, are impaired in CD patients. EMT also enhances activation of matrix remodelling enzymes such as matrix metalloproteinase(MMP)-3 and MMP-9 causing further tissue damage and inflammation. Finally, soluble mediators like TNF and interleukin-13 further induce their own expression in an autocrine manner and enhance expression of molecules associated with cell invasiveness aggravating the process. Additionally, pathogen-associated molecular patterns also seem to play a role for induction of EMT and fistula development. Though current knowledge suggests a number of therapeutic options, new and more effective therapeutic approaches are urgently needed for patients suffering from CD-associated fistulae. A better understanding of the pathophysiology of fistula formation, however, is a prerequisite for the development of more efficacious medical anti-fistula treatments.

  4. Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.

    Science.gov (United States)

    Rustagi, Tarun; McCarty, Thomas R; Aslanian, Harry R

    2015-01-01

    Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.

  5. Nutritional Management in Enterocutaneous Fistula. What is the evidence?

    OpenAIRE

    Badrasawi, Manal; Shahar, Suzana; Sagap, Ismail

    2015-01-01

    The management of Enterocutaneous fistula (ECF) is challenging. It remains associated with morbidity and mortality, despite advancements in medical and surgical therapies. Early nutritional support using parenteral, enteral or fystuloclysis routs is essential to reverse catabolism and replace nutrients, fluid and electrolyte losses. This study aims to review the current literature on the management of ECF. Fistulae classifications have an impact on the calories and protein requirements. Early...

  6. Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure

    OpenAIRE

    Kucuk, Nurten; Sari, Murat; Midi, Ahmet; Yumusakhuylu, Ali Cemal; Findik, Ozan; Binnetoglu, Adem

    2015-01-01

    Objectives In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase i...

  7. H type tracheoesophageal fistula detected by radionuclide salivagram

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Yun; Kim, Kyung Mo; Kim, Jae Seung [Univ. of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-09-15

    Congenital H type tracheoesophageal fistula is a rare anomaly in infants and the early diagnosis of this disorder is still a challenge to pediatricians due to scarcity, non specific symptoms and lack of a single diagnostic examination. We report the case of a 3 month old baby with choking and recurrent aspiration which finally turned out to be a tracheoesophageal fistula without esophageal atresia (H type)by radionuclide salivagram.

  8. Doppler findings in a rare Coronary Artery Fistula

    OpenAIRE

    Jorns Carl; Jung Christian; Huhta James

    2007-01-01

    Abstract One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery to the left ventricular (LV) apex. Associated cardiac abnormalities were found: a ventricula...

  9. Thoracic fistulas of the pancreas and their complications in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Fritsch, R.; Schirg, E.; Buerger, D.

    1981-08-01

    The article reports on two thoracic fistulas of the pancreas in infants. Anamnesis revealed that recurring abdominal pain had occured in those children for years; at the time of their admission to hospital there was considerable dyspnoea with thoracic pain depending on the respiration. Fistulas of the pancreas with thoracic connection were identified as the cause. The article goes into the details of genesis, differential diagnosis and course of the disease.

  10. Carotid Cavernous Fistula Subsequent to Nasal Septoplasty; A Case Report

    Directory of Open Access Journals (Sweden)

    H Moin

    2005-03-01

    Full Text Available Carotid cavernous fistula (CCF is a rare and lethal condition; it can be spontaneous, traumatic or iatrogenic. This report Presents a case of CCF subsequent to nasal septoplasty who was a 24 years old lady with proptosis and severe decreased visual acuity. After cerebral angiography, trapping and embolization of fistula was performed with good recovery. Like our case, review of articles shows that the patients are signs and symptoms free after embolization.

  11. Arteriovenous fistulas aggravate the hemodynamic effect of vein bypass stenoses

    DEFF Research Database (Denmark)

    Nielsen, T G; Djurhuus, C; Pedersen, Erik Morre;

    1996-01-01

    PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...... hemodynamic conditions of a more severe stenosis. Assessment of the hemodynamic impact of fistulas must be undertaken in the evaluation of in situ vein bypass stenoses....

  12. SPONTANEOUS DUODENO-BILIARY FISTULA CAUSED BY DUODENAL PEPTIC ULCER

    Directory of Open Access Journals (Sweden)

    N. Danila

    2005-07-01

    Full Text Available Spontaneous duodeno-biliary fistula represents a rare complication of chronic duodenal peptic ulcer. The authors present two cases with this pathology and also the particularities of surgical approach. Spontaneous duodeno-biliary fistula caused by chronic peptic ulcer is often a surprising diagnostic in the era of H2 blockers. The difficulties and the complexity of the diagnosis associated with the particularities of surgical technique represent the key of this rare disease.

  13. Atrio-esophageal fistula after AF ablation: Pathophysiology,Prevention & Treatment

    Directory of Open Access Journals (Sweden)

    Carlo Pappone; Gabriele Vicedomini; Vincenzo Santinelli

    2013-10-01

    Full Text Available Atrioesophageal fistula is a very rare but often fatal late complication of atrial fibrillation ablation procedures resulting from thermal injury to the esophagus and surrounding structures. Causes of death include cerebral air embolism, massive gastrointestinal bleeding, and septic shock. Because of its unusual rate of occurrence, there has not been an uniform approach to either the diagnosis or corrective therapy. This low incidence poses a challenge in strictly determining effective preventive measures during and immediately following posterior wall left atrial ablation. Currently, strategies proposed to prevent esophageal injury include reduced power titration while ablating the posterior left atrial wall, limiting RF delivery time, avoiding overlapping ablation lines as well as monitoring intraluminal esophageal temperature, using conscious sedation rather than general anesthesia for better pain perception, monitoring intraprocedural esophageal position in relation to the posterior left atrium and extensive patient education regarding signs and symptoms of esophageal injury. Early diagnosis is essential to enable therapeutic preventive strategies to minimize the excessive morbidity and mortality associated with this condition. Unfortunately, despite application of such preventive measures, cases of atrial-esophageal fistula have still been reported. If esophageal injury with fistula formation is clinically suspected, a prompt diagnosis and an immediate aggressive intervention including stenting and/or surgical intervention is required for the patient’survival.

  14. Postoperative peritonitis without an underlying digestive fistula after complete cytoreductive surgery plus HIPEC

    Directory of Open Access Journals (Sweden)

    Charles Honoré

    2013-01-01

    Full Text Available Background/Aim: Peritoneal carcinomatosis (PC is a pernicious event associated with a dismal prognosis. Complete cytoreductive surgery (CCRS combined with hyperthermic intraperitoneal chemotherapy (HIPEC is able to yield an important survival benefit but at the price of a risky procedure inducing potentially severe complications. Postoperative peritonitis after abdominal surgery occurs mostly when the digestive lumen and the peritoneum communicate but in rare situation, no underlying digestive fistula can be found. The aim of this study was to report this situation after CCRS plus HIPEC, which has not been described yet and for which the treatment is not yet well defined. Patients and Methods: Between 1994 and 2012, 607 patients underwent CCRS plus HIPEC in our tertiary care center and were retrospectively analyzed. Results: Among 52 patients (9% reoperated for postoperative peritonitis, no digestive fistula was found in seven (1%. All had a malignant peritoneal pseudomyxoma with an extensive disease (median Peritoneal Cancer Index: 27. The median interval between surgery and reoperation was 8 days [range: 3-25]. Postoperative mortality was 14%. Five different bacteriological species were identified in intraoperative samples, most frequently Escherichia coli (71%. The infection was monobacterial in 71%, with multidrug resistant germs in 78%. Conclusions: Postoperative peritonitis without underlying fistula after CCRS plus HIPEC is a rare entity probably related to bacterial translocation, which occurs in patients with extensive peritoneal disease requiring aggressive surgeries. The principles of treatment do not differ from that of other types of postoperative peritonitis.

  15. Parallel wire balloon angioplasty for undilatable venous stenosis in hemodialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom; You, Jin Jong; Cho, Jae Min [Gyeongsang National University Hospital, Jinju (Korea, Republic of)] (and others)

    2007-05-15

    The purpose of this study was to assess the value of the parallel wire balloon angioplasty technique for treating dysfunctional hemdialysis fistula with rigid stenosis, and this type of lesion was resistant to conventional angioplasty. Between March 2002 and August 2003, we included 6 patients (mean age: 59, males: 2, females: 4) who were treated via parallel the wire balloon angioplasty technique and their hemodialysis fistula has stenoses that were resistant to conventional angioplasty. We performed conventional angioplasty in all patients, but we failed to achieve sufficient dilatation. In the cases of highly resistant stenosis, an additional 0.016 inch wire was inserted into the 7 F vascular sheath. During angioplasty, a 0.016 inch guide wire was inserted between the balloon and the stenosis and then it was pushed to and fro until the balloon indentation disappeared. After the procedure, we performed angiography to identify the residual stenosis and the procedure-related complications. The undilatable stenoses in 5 patients were successfully resolved without complications via the parallel wire angioplasty technique. In one patient, indentation of balloon was not resolved, but the residual stenosis was both minimal and hemodynamically insignificant. The parallel wire angioplasty technique seems to be a feasible and cost-effective method for treating a dysfunctional hemodialysis fistula with undilatable and rigid stenosis.

  16. Palliative Endoscopic Therapy for Cancer Patients with Esophageal Fistula

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ji-chang; ZHANG Li-jian; WU Qi; ZHANG Jun; ZHOU Zong-hui; WU Yang; XU Zhao-li

    2008-01-01

    Objective:To find an effective treatment for advanced cancer patients with esophageal fistula. Methods:From 1998 to 2006, we studied 42 patients with advanced esophageal cancer and 5 lung cancer patients with carcinomatous esophageal fistula(3 females,44 males,aged 29-92 years). Ten patients with both esophageal cancer stricture and fistula were first dilated under endoscope,then a memory stent with a membrane was placed in the esophageal lumen. Others were treated only with a memory stent with a membrane,three of them with a large fistula(diameter>1.5 cm)were treated with bio-protein glue after placement of an esophageal metal stent.Results:The fistulas were covered by a stent and the patients could eat and drink immediately.Their quality of life was improved and their survival was prolonged, 44 out of 47 patients survived for>3 mo. Conclusion:Placement of esophageal stent with membrane or in combination with bio-protein glue through endoscope is an effective method for treating the bronchoesophageal fistula.

  17. Carotid Cavernous Fistula Associated with Persistent Trigeminal Artery

    Science.gov (United States)

    Hurst, Robert W.; Howard, Robert S.; Zager, Eric

    1998-01-01

    Carotid-cavernous fistula (CCF) associated with persistent trigeminal artery (PTA) is a rare but important clinical entity. We present a case treated by microcoil embolization with preservation of internal carotid, PTA, and hasilar artery flow following embolization. A 62-year-old female developed pulsatile tinnitus followed by left eye proptosis and diplopia. Examination revealed a cranial nerve VI palsy and an objective bruit over the left orbit. Angiographic evaluation revealed a carotid cavernous fistula originating from a persistent trigeminal artery. Placement of a detachable balloon across the fistula site while preserving the PTA proved impossible, and the fistula was treated with microcoils following placement of a microcatheter across the fistula into the cavernous sinus. Complete closure of the fistula was followed by resolution of the patient's symptoms. Preservation of all major vessels including the PTA was accomplished through the use of coil embolization. Careful evaluation of the angiogram is necessary to identify PTA associated with a CCF. Previous reports have described treatment of CCF with PTA by surgical or balloon ocolusion, some involving sacrifice of the PTA. Examination of the relevant embryology and anatomy reveals, however, that occlusion of the PTA must be approached with caution due to potential supply to the posterior circulation. ImagesFigure 1 PMID:17171071

  18. Surgical repair of ruptured abdominal aortic aneurysm with non-bleeding aortocaval fistula.

    Science.gov (United States)

    Unosawa, Satoshi; Kimura, Haruka; Niino, Tetsuya

    2013-01-01

    We present a case of an aortocaval fistula (ACF) without bleeding because a clot was covering the fistula. A 60-year-old man was diagnosed as having a ruptured abdominal aortic aneurysm (AAA) and an aortocaval fistula, by enhanced computed tomography (CT). After the aneurysm had been opened, the fistula was detected, but there was no bleeding because it was covered with clot. After graft repair, bleeding from the fistula occurred when the clot was removed by suction. Direct closure of the fistula was achieved after bleeding was controlled by digital compression. PMID:23825505

  19. Pharyngocutaneous fistula onset after total laryngectomy: scintigraphic analysis.

    Science.gov (United States)

    Galli, J; Valenza, V; Parrilla, C; Galla, S; Marchese, M R; Castaldi, P; Almadori, G; Paludetti, G

    2009-10-01

    Pharyngocutaneous fistula is the most common non-fatal complication following total laryngectomy. To start oral feeding and exclude the presence of a pharyngocutaneous fistula, a subjective test and instrumental assessments using videofluoroscopy, have been described. The aim of this study was to evaluate the effectiveness of oral-pharyngo-oesophageal scintigraphy as an objective and non-invasive tool to establish presence, site and dimensions of the fistula. Observations were performed on 3 male patients, mean age 65 years, who underwent total laryngectomy and mono or bilateral neck dissection after failure of radiotherapy in 2 cases and of conservative laryngeal surgery in the third case, complicated by post-operative pharyngocutaneous fistula. Oral-pharyngo-oesophageal scintigraphy dynamic study with sequential images were obtained during the swallowing phases. In case 1, the test showed a wide pharyngocutaneous fistula the internal orifice of which was at the level of the base of the tongue: on the scintigraphic images, the radiomarked water bolus, from the fistulous orifice, descended along the stoma walls and only a small part reached the oesophagus. In the other two patients, the pharyngocutaneous fistula was small and the internal fistulous orifice was detected in the lower part of T-suture line. In conclusion, scintigraphy offered the possibility to precisely identify presence of pharyngocutaneous fistula and location of its internal orifice and to monitor its spontaneous closure. Therefore, important information could be obtained regarding the suture line status and the possibility of deciding whether to remove the nasogastric tube or to leave it in place. Finally, these data showed that oral-pharyngo-oesophageal scintigraphy could be performed in the early post-operative period to optimize starting safe oral feeding. PMID:20162023

  20. Trans-Fistula Anorectoplasty (TFARP: Our Experience in the Management of Anorectovestibular Fistula in Neonates

    Directory of Open Access Journals (Sweden)

    Ashrarur Rahman Mitul

    2012-07-01

    Full Text Available Aim: The purpose of the study was to observe the outcome of trans-fistula anorectoplasty (TFARP in treating female neonates with anorectovestibular fistula (ARVF. Methods: A prospective study was carried out on female neonates with vestibular fistula, admitted into the surgical department of a tertiary level children hospital during the period from January 2009 to June 2011. TFARP without a covering colostomy was performed for definitive correction in the neonatal period in all. Data regarding demographics, clinical presentation, associated anomalies, preoperative findings, preoperative preparations, operative technique, difficulties faced during surgery, duration of surgery, postoperative course including complications, hospital stay, bowel habits and continence was prospectively compiled and analyzed. Anorectal function was measured by the modified Wingspread scoring as, “excellent”, “good”, “fair” and “poor”. Results: Thirty-nine neonates with vestibular fistula underwent single stage TFARP. Mean operation time was 81 minutes and mean hospital stay was 6 days. Three (7.7% patients suffered vaginal tear during separation from the rectal wall. Two patients (5.1% developed wound infection at neoanal site that resulted in anal stenosis. Eight (20.51% children in the series are more than 3 years of age and are continent; all have attained “excellent” fecal continence score. None had constipation or soiling. Other 31 (79.5% children less than 3 years of age have satisfactory anocutaneous reflex and anal grip on per rectal digital examination, though occasional soiling was observed in 4 patients. Conclusion: Primary repair of ARVF in female neonates by TFARP without dividing the perineum is a feasible procedure with good cosmetic appearance and good anal continence. Separation of the rectum from the posterior wall of vagina is the most delicate step of the operation, takes place under direct vision. It is very important to keep

  1. Recurrent ischemia resulting from left internal mammary artery-to-pulmonary artery fistula.

    Science.gov (United States)

    Madu, E C; Hanumanthu, S K; Kim, C; Prudoff, A

    2001-03-01

    This report describes a case series of recurrent ischemia after coronary artery bypass grafting resulting from left internal mammary artery-to-pulmonary artery fistula. An angiographic demonstration of this fistula is presented.

  2. Congenital tracheoesophagel fistula with no esophageal atresia (H-type) in adult (a case report)

    Energy Technology Data Exchange (ETDEWEB)

    Byun, W. M.; Jung, K. H.; Cho, K. H.; Kim, S. Y.; Hwang, M. S.; Chang, J. C.; Chung, M. K.; Lee, C. J. [Yeungnam University College of Medicine, Gyengsan (Korea, Republic of)

    1986-08-15

    Congenital tracheoesophageal fistula with no esophageal atresia is considered a rate type anomaly, especially in adult age. We report a case of isolated tracheoesophageal fistula with no esophageal atresia with review of literature.

  3. Hemiparesis in carotid cavernous fistulas (CCFs):a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    王慧晓; 白如林; 黄承光; 卢亦成; 张光霁

    2004-01-01

    @@ Carotid-cavernous fistulas (CCFs) are abnormal arteriovenous anastamoses between the carotid artery and the cavernous sinus. These fistulas may be classified by cause (spontaneous or traumatic), flow velocity (high or low ), or pathogenesis (direct or indirect).

  4. Usefulness of CT virtual endoscopy in imaging a large esophagorespiratory fistula

    Energy Technology Data Exchange (ETDEWEB)

    Sonomura, Tetsuo; Kishi, Kazushi; Ishii, Seigo; Kawai, Nobuyuki; Masuda, Mitsunori; Terada, Masaki; Nakamine, Hirokazu; Sato, Morio

    2000-04-01

    A 73-year-old woman with a large esophagorespiratory fistula underwent bronchoscopy and computed tomographic (CT) virtual endoscopy before stenting. Noninvasive CT virtual endoscopy showed the large fistula, and the CT findings agreed with the bronchoscopic findings.

  5. [Treatment of carotid-cavernous fistula using a detachable balloon catheter--a case report and review].

    Science.gov (United States)

    Chono, Y; Abe, H; Sasaki, H; Abe, S; Takei, H; Koiwa, M; Saito, H

    1983-01-01

    A case of post-traumatic carotid cavernous fistula, successfully treated by a detachable balloon catheter, is reported. A 55-year-old housewife was admitted to the author's department on 25th August, 1980. Three months prior to admission, she complained of right tinnitus following a traffic accident and then developed right chemosis and exophthalmus. A selective right internal carotid angiography revealed rapid filling of the carotid cavernous fistula. Under general anesthesia, the patient was treated by the maneuver after Debrun. Since it appeared necessary to employ the second balloon, the first one was released gently being inflated only with the contrast medium. During the procedure, the neck of the balloon was incidentally snapped upward and, then, the fistula was eventually occluded preserving the carotid flow as was verified by a control angiography. The bruit was abolished immediately after the procedure and all ocular symptoms disappeared during the following a few weeks. A skull film showed a deflation of the balloon at 4 weeks postoperatively, but clinical and angiographic follow-up examinations at 9 months thereafter revealed no signs or symptoms of recurrence. This Debrun's procedure is being widely accepted for a carotid cavernous fistula as a relatively simpler, safer, and more effective one comparing with the conventional methods. Our experiment on dogs, however, indicated that rupture of the balloon is not always avoidable even with a smaller volume than its maximum capacity and some resistance was felt during introduction of the co-axial catheter. Thus, it appeared mandatory to improve and quality control the balloon and the catheter. In the case presented here, a follow-up angiography showed no recurrence of the fistula except for an asymptomatic pseud-aneurysmal pouch, even though the balloon was inflated only with the contrast medium and was deflated within 4 weeks. These findings suggest possibility of successful, and long-lasting outcome

  6. Obstetric fistula in Assam, India: a neglected cause of maternal morbidities and mortality

    OpenAIRE

    Suresh Jungari; Bal Govind Chauhan

    2015-01-01

    Each year between 50,000 to 100,000 women worldwide are affected by obstetric fistula, a hole in the birth canal. Obstetric fistula is one of the major cause for maternal morbidities and mortality and it has been successfully eradicated in developed nations. Women who experience obstetric fistula suffer constant incontinence, shame, and social segregation. Obstetric fistula is prevalent in African and Asian countries, including India. In India, data has been collected in a large scale survey ...

  7. Inferior Turbinate Flap for Nasal-side Closure of Palatal Fistula in Cleft Patients: Technical Note

    OpenAIRE

    Amin Rahpeyma; Saeedeh Khajehahmadi

    2015-01-01

    Summary: Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this pu...

  8. Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

    Science.gov (United States)

    Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

    2002-01-01

    Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

  9. CONGENITAL VESICOUTERINE FISTULA ALONG WITH DISTAL VAGINAL AGENESIS, SOLITARY KIDNEY AND TONGUE TIE: A RARITY

    OpenAIRE

    Khalid; Amit; Rana Pratap; Ahsan; Takallum

    2015-01-01

    : Congenital vesicouterine fistula in association with vaginal agenesis and solitary renal agenesis has been rarely reported. We present a case of 19 year old female suffering from cyclical menouria for last years. Physical examination revealed absence of vagina. IVP revealed left renal agenesis and CT scan revealed left renal agenesis with vesicouterine fistula. Cystoscopy showed vesicouterine fistula located above trigone near midline. Vesicouterine fistula was repaired along wi...

  10. A penile torsion with a fistula due to previous hypospadias surgery: A case report

    OpenAIRE

    Mustafa Rasid Toksoz; Ramazan Kocaaslan; Furkan Erol Karabekmez

    2014-01-01

    We presented a case of penile torsion due to previous hypospadias surgery. A patient applied to our clinic for treatment of hypospadias fistula and accompanying penile torsion. Patient’s urethral fistula was repaired first and penile torsion was corrected in the second stage due to multiple fistula tracts. Proximal based flip flap technique was used for closure of the fistula and simple degloving with release of fibrous tissue and pedicle of the previous preputial island flap was used for cor...

  11. 'As a man I felt small': a qualitative study of Ugandan men's experiences of living with a wife suffering from obstetric fistula.

    Science.gov (United States)

    Barageine, Justus Kafunjo; Faxelid, Elisabeth; Byamugisha, Josaphat K; Rubenson, Birgitta

    2016-01-01

    The effects of obstetric fistula surpass the individual woman and affect husbands, relatives, peers and the community at large. Few studies have documented the experiences of men who live with wives suffering from fistula. In this study, our objective was to understand how fistula affects these men's lives. We conducted 16 in-depth interviews with men in central and western Uganda. We used thematic narrative analysis and discuss our findings based on Connell's theory of hegemonic masculinity. Findings show that the men's experiences conflicted with Ugandan norms of hegemonic masculinity. However, men had to find other ways of explaining their identity, such as portraying themselves as small men but still be responsible, caring husbands and fathers. The few individuals who married a second wife remained married to the wife with the fistula. These men viewed marriage as a lifetime promise before God and a responsibility that should not end because of a fistula. Poverty, love, care for children and social norms in a patriarchal society compelled the men to persevere in their relationship amidst many challenges. PMID:26466639

  12. High-resolution MRI for Primary anal fistulas

    International Nuclear Information System (INIS)

    Objective: To evaluate the accuracy and clinical value of preoperative high-resolution magnetic resonance (MR) imaging with a phased-army coil for the detection of anal fistulas. Methods: A total of 20 patients with surgically proved anal fistulas underwent preoperative MR imaging with phased-array coil at 1.5 T MR unit. The imaging protocol included high-resolution T2-weighted turbo spin echo sequence acquisition at axial, sagittal and coronal planes and axial T2-weighted sequence with fat suppression. Results: Twenty patients were found to have 27 fistulas, 24 internal openings, 28 external openings, and 10 perianal abcesses. The sensitivity and specificity for detecting primary fistula tracks, abscesses and internal openings were 92.6% (25/27) and 92.3% (12/13), 100.0% (10/10) and 96.3% (26/27), 91.7% (22/24) and 85.7% (12/14), respectively. Conclusion: High-resolution Mil imaging is a very accurate preoperative technique for evaluating the classification of fistula-in-ano, the course of primary tracks and the presence of abscesses, thus providing important information for proper surgical treatment. (authors)

  13. Another view of "humanitarian ventures" and "fistula tourism".

    Science.gov (United States)

    Morgan, Mark A

    2007-06-01

    There are many ethical issues involved in medical missions to developing countries. The Current Opinion/Update "Humanitarian ventures or 'fistula tourism?': the ethical perils of pelvic surgery in the developing world" raised many concerns about surgical trips to treat obstetric fistula. Despite a lack of experience with obstetric fistula, western surgeons may still bring surgical and public health techniques that may be of value to health systems in developing countries. Emphasis should be placed on program development and assessment first. This should include not only surgical training but also help with counseling, prevention and reintegration. Participation in clinical trials should be up to the health care personnel in the country being helped, and aide should not depend on such participation. Success will likely be determined by a national effort and integration into existing health systems, not isolated "fistula champions." The appalling situation of obstetric fistula in the twenty-first century should be a wake-up call to obstetricians/gynecologists and urologists. The dictum "first do no harm" must not evolve into "first do nothing." PMID:17252312

  14. Risk factors for leukopenia in patients with gastrointestinal fistula

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zheng; REN Jian-an; LIU Hai-yan; GU Guo-sheng; LI Jie-shou

    2010-01-01

    Background White blood cell count is an important index to the outcome of patients. In hospital, leukopenia is accompanied by high mortality, morbidity and treatment costs. However, in infectious diseases, the reasons responsible for leucopenia was not well elucidated. We investigated patients with gastrointestinal fistula to find risk factors for leukopenia.Methods A prospective case control investigation was carried out in the Gastrointestinal Fistula Center, General Surgical Institute of Jinling Hospital. Cases included gastrointestinal fistula patients with leukopenia (n=98) and controls composed of gastrointestinal fistula patients with normal white blood cell count (n=78). The two groups were compared for risk factors of leucopenia by statistical analysis.Results Factors associated with an increased risk for leukopenia included bacterial infection (25.5%) and hypoalbuminaemia (61.2%). Multivariable Logistic regression analysis identified bacterial infection (80%), urinary catheter (70%) and central vein catheter (60%) as the independent determinants for mortality in cases.Conclusions In patients with gastrointestinal fistula, two independent factors for leukopenia and three significant predictors of mortality were elucidated. We suggest that clinicians give patients more supportive management and apply prevention strategies to treat and prevent leukopenia.

  15. Chronic kidney disease aggravates arteriovenous fistula damage in rats.

    Science.gov (United States)

    Langer, Stephan; Kokozidou, Maria; Heiss, Christian; Kranz, Jennifer; Kessler, Tina; Paulus, Niklas; Krüger, Thilo; Jacobs, Michael J; Lente, Christina; Koeppel, Thomas A

    2010-12-01

    Neointimal hyperplasia (NIH) and impaired dilatation are important contributors to arteriovenous fistula (AVF) failure. It is unclear whether chronic kidney disease (CKD) itself causes adverse remodeling in arterialized veins. Here we determined if CKD specifically triggers adverse effects on vascular remodeling and assessed whether these changes affect the function of AVFs. For this purpose, we used rats on a normal diet or on an adenine-rich diet to induce CKD and created a fistula between the right femoral artery and vein. Fistula maturation was followed noninvasively by high-resolution ultrasound (US), and groups of rats were killed on 42 and 84 days after surgery for histological and immunohistochemical analyses of the AVFs and contralateral femoral vessels. In vivo US and ex vivo morphometric analyses confirmed a significant increase in NIH in the AVFs of both groups with CKD compared to those receiving a normal diet. Furthermore, we found using histological evaluation of the fistula veins in the rats with CKD that the media shrank and their calcification increased significantly. Afferent artery dilatation was significantly impaired in CKD and the downstream fistula vein had delayed dilation after surgery. These changes were accompanied by significantly increased peak systolic velocity at the site of the anastomosis, implying stenosis. Thus, CKD triggers adverse effects on vascular remodeling in AVFs, all of which contribute to anatomical and/or functional stenosis.

  16. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Hsieh, Mu-Yang; Lin, Lin; Tsai, Kuei-Chin; Wu, Chih-Cheng, E-mail: chihchengwumd@gmail.com [National Taiwan University Hospital, Department of Cardiology (China)

    2013-08-01

    PurposeTo evaluate the usefulness of an approach through the radial artery distal to the arteriovenous anastomosis for salvaging nonmaturing radiocephalic arteriovenous fistulas.MethodsProcedures that fulfilled the following criteria were retrospectively reviewed: (1) autogenous radiocephalic fistulas, (2) fistulas less than 3 months old, (3) distal radial artery approach for salvage. From 2005 to 2011, a total of 51 patients fulfilling the above criteria were enrolled. Outcome variables were obtained from angiographic, clinical and hemodialysis records, including the success, complication, and primary and secondary patency rates.ResultsThe overall anatomical and clinical success rates for the distal radial artery approach were 96 and 94 %, respectively. The average procedure time was 36 {+-} 19 min. Six patients (12 %) experienced minor complications as a result of extravasations. No arterial complication or puncture site complication was noted. The postinterventional 6-month primary patency rate was 51 %, and the 6-month secondary patency rate was 90 %. When the patients were divided into a stenosed group (20 patients) and an occluded group (31 patients), there were no differences in the success rate, complication rate, or primary and secondary patency rates.ConclusionAn approach through the radial artery distal to the arteriovenous anastomosis is an effective and safe alternative for the salvage of nonmaturing radiocephalic arteriovenous fistulas, even for occluded fistulas.

  17. Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P. [Neuroradiology Department, Garcia de Orta Hospital (Portugal); Willinsky, R.; TerBrugge, K. [Toronto Western Hospital, ON (Canada). Div. of Neuroradiology

    2001-10-01

    Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors. (orig.)

  18. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group of...

  19. Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Sang Don Lee

    2011-01-01

    Full Text Available Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.

  20. Delayed Presentation of Renocolic Fistula at 4 Months after Blunt Abdominal Trauma

    OpenAIRE

    Sang Don Lee; Tae Nam Kim; Hong Koo Ha

    2011-01-01

    Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma.

  1. Successful resection of enterovesical fistula in a patient with sigmoid colonic malignancy

    Institute of Scientific and Technical Information of China (English)

    江军; 朱方强; 姜庆; 王洛夫; 叶锦; 张连阳

    2003-01-01

    @@ Enterovesical fistula is a rare complication of a variety of inflammatory and neoplastic diseases. Early diagnosis of enterovesical fistula is difficult and its management is complicated. In this paper, we describe an unusual case of enterovesical fistula secondary to sigmoid colonic malignancy.

  2. BUCCAL ADVANCEMENT FLAP DAN ANTROSTOMI: UNTUK TERAPI ORO ANTRAL FISTULA (Laporan Kasus)

    OpenAIRE

    Rizal Rivandi

    2015-01-01

    Buccal advancement flap is one of the many ways of treating oro antral fistula. This technique is frequently used by dentists because it is easier to do and has several advantages compared to other techniques. This paper reports a case of oro antral fistula caused by complication of a tooth extraction, with discussions about definition, ethics and other therapies of oro antral fistula.

  3. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...

  4. Medical image of the week: bronchopleural fistula

    Directory of Open Access Journals (Sweden)

    Desai H

    2016-09-01

    Full Text Available No abstract available. Article truncated at 150 words. A 58-year-old man with past medical history significant for chronic smoking and seizures was referred to the emergency room after a chest x-ray done by his primary care physician for evaluation of cough showed a hydropneumothorax. His symptoms included dry cough for past 2 months without fever, chills or other associated symptoms. He did not have any thoracic procedures performed and had no past history of recurrent infections. He was hemodynamically stable. Physical examination was only significant with decreased breath sounds on the right side of the chest. Thoracic CT with contrast was performed which showed complete collapse of the right lower lobe, near complete collapse of right middle lobe as well as an air-fluid level. There was a suspicion of a direct communication between bronchi and pleural space at the posterior lateral margin of the collapsed right lower lobe (Figure 1. The presence of bronchopleural fistula (BPF was confirmed ...

  5. Aphallia with urethrorectal fistula, bladder and urethral calculi

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    M Movarrekh

    2006-04-01

    Full Text Available Introduction: Aphallia is a very rare urogenital anomaly with incidence rate of 1 in 30,000,000. It usually coexists with other anomalies such as cardiovascular anomalies which are incompatible with normal life, and therefore infants are delivered stillbirth or live for a very short period of time. Methods: We present an 18 months old boy with aphallia associated with congenital urethrorectal fistula, bladder and urethral stones. All stones were removed endourologically, recto-urethral fistula was repaired and perincal urethrostomy was performed. Results: The stones were composed of calcium phosphate colonized by klebiella pneumonia and proteus mirabilis. Urethrorectal fistula repairment was confirmed by cystography. Patient was discharged without a urinary catheter. Conclusion: In developed countries, management of such patients is to raise them as females. However, we must consider socio-cultural conditions, parents preference and patients tendency in management of aphallia.

  6. [Personal experience in the treatment of perianal fistulas].

    Science.gov (United States)

    Simkovic, D; Pospísil, I

    1994-03-01

    The authors describe the therapeutic results assembled with perianal fistulae in 130 patients. The best and most reliable method for treatment of the above mentioned lesions is discision or excision of the fistula followed by the so-called "open method" of healing. Since 1988 by this method 74 patients were treated where only two relapses were recorded. Postoperative treatment is simple, dietetic provisions are not necessary. Regular digital control of the wound hastens granulation. After rapid epithelization the wound heals by an almost linear scar. As in particular intersphincteric and low transphincteric fistulae calt for careful sphincterotomy of an appropriate extent it is essential that these operations should be performed by a surgeon adequately experienced in proctosurgery. PMID:8184366

  7. Successful therapy of brachiocephalic arteriogastric fistula after esophagectomy.

    Science.gov (United States)

    Nagai, Yohei; Watanabe, Masayuki; Ikeda, Osamu; Nakasone, Yutaka; Sakaguchi, Hisashi; Kunitomo, Ryuji; Yamashita, Yasuyuki; Baba, Hideo

    2011-10-01

    We report the case of an 86-year-old man, who had undergone subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route 7 years ago, who was referred for treatment of a brachiocephalic arteriogastric fistula. An emergency stent-graft placement was performed to prevent massive bleeding from the fistula. After 2 weeks, a follow-up esophagogastroscopy revealed that the gastric tube ulcer had been penetrated, and the stent graft was exposed. Therefore, surgical treatment was indicated. After a carotid-carotid arterial bypass graft was made, the brachiocephalic artery was resected with the stent graft and the gastric wall. The defect between the cervical esophagus and the remnant gastric tube was replaced by a free jejunal graft. The patient tolerated these procedures well and was transferred to the referral hospital 3 months after surgery. Therefore, both an early diagnosis and the administration of multidisciplinary treatment are essential to save patients presenting with an arterioenteric fistula.

  8. [Endovascular repair of iliocaval arteriovenous fistula complicating lumbar disc surgery].

    Science.gov (United States)

    Ben Jemaa, H; Maalej, A; Lazzez, K; Jemal, H; Karray, S; Ben Mahfoudh, K

    2016-05-01

    Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful. PMID:26920402

  9. Vesical fistulae--an experience from a developing country.

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    Raut V

    1993-01-01

    Full Text Available This study analyses patients with vesical fistulae presenting at a teaching, referral hospital over the last ten years. There were 62 cases of vesical fistulae of which 60 were obstetric in origin (44 home and 16 hospital deliveries and 2 were following gynaecological surgery. Of the hospital deliveries which culminated in fistula formation, 8 were vaginal and 7 forceps deliveries. In one patient, lower segment caesarean section was carried out. After a thorough urological work-up, patients were subjected to standard technique of layered closure (61 by vaginal approach and one by abdominal. Repair was successful in 53 (87.09% patients. Of the 9 failures, 4 were repeat repairs.

  10. Detection of occult colovesical fistula by the Bourne test.

    Science.gov (United States)

    Amendola, M A; Agha, F P; Dent, T L; Amendola, B E; Shirazi, K K

    1984-04-01

    The value of different diagnostic tests in the detection of colovesical fistulas was studied in 28 surgically proven cases seen during the last 10 years at the University of Michigan, Ann Arbor. Etiologies were diverticulitis (19), Crohn disease (three), postradiation therapy (four), previous trauma (one), and bladder carcinoma (one). The fistulas were demonstrated by barium enema in 10 of 20 patients and by cystography in eight of 26. Cystoscopy was diagnostic in 11 of 25 patients and sigmoidoscopy in four of 24. Methylene blue test was positive in five of six patients, and in one patient given a charcoal enema the material appeared in the urine. The Bourne test, consisting of radiography of the centrifuged urine samples obtained immediately after a nondiagnostic barium enema, was positive in nine of 10 patients. In seven of these 10 patients, the Bourne test was the only positive evidence of an otherwise occult colovesical fistula later proven at surgery. PMID:6608228

  11. Contemporary surgical management of rectovaginal fistula in Crohn's disease.

    Science.gov (United States)

    Valente, Michael A; Hull, Tracy L

    2014-11-15

    Rectovaginal fistula is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.

  12. Fistulains A and B, New Bischromones from the Bark of Cassia fistula, and Their Activities.

    Science.gov (United States)

    Zhou, Min; Zhou, Kun; Gao, Xue-Mei; Jiang, Zhi-Yong; Lv, Jun-Jiang; Liu, Zhi-Hua; Yang, Guang-Yu; Miao, Ming-Ming; Che, Chun-Tao; Hu, Qiu-Fen

    2015-06-01

    Fistulains A and B (1 and 2), two novel bischromones with unique coupling patterns, alone with their biosynthetic related compound 3, were isolated from the bark of Cassia fistula. Fistulain A represents a new type of dimeric chromone alkaloid biogenetically derived from a chromone and a tricyclic alkaloid through an unusual C-14-N linkage. Fistulain B has a new carbon skeleton with a C-14-C-5' linkage formed between two different chromone units. Fistulain A displayed anti-TMV activity, and both 1 and 2 showed weak cytotoxicities.

  13. Pancreaticoportal Fistula and Disseminated Fat Necrosis After Revision of a Transjugular Intrahepatic Portosystemic Shunt

    Energy Technology Data Exchange (ETDEWEB)

    Klein, Seth J., E-mail: kleins@mir.wustl.edu; Saad, Nael [Washington University School of Medicine, Interventional Radiology Section, Mallinckrodt Institute of Radiology (United States); Korenblat, Kevin [Washington University School of Medicine, Division of Gastroenterology, Department of Internal Medicine (United States); Darcy, Michael D. [Washington University School of Medicine, Interventional Radiology Section, Mallinckrodt Institute of Radiology (United States)

    2013-04-15

    A 59-year old man with alcohol related cirrhosis and portal hypertension was referred for transjugular intrahepatic portosystemic shunt (TIPS) to treat his refractory ascites. Ten years later, two sequential TIPS revisions were performed for shunt stenosis and recurrent ascites. After these revisions, he returned with increased serum pancreatic enzyme levels and disseminated superficial fat necrosis; an iatrogenic pancreaticoportal vein fistula caused by disruption of the pancreatic duct was suspected. The bare area of the TIPS was subsequently lined with a covered stent-graft, and serum enzyme levels returned to baseline. In the interval follow-up period, the patient has clinically improved.

  14. Treatment of traumatic trigeminal-cavernous fistula by coil embolization and compression of carotid artery

    Directory of Open Access Journals (Sweden)

    Yang Xinjian

    2007-01-01

    Full Text Available We report a case of a traumatic cavernous fistula supplied by a persistent primitive trigeminal artery. The process of treatment was unique in this case. Fistula was subcompletely occluded by coiling from primitive trigeminal artery. Residual fistula was helped to form thrombosis by compression of the carotid artery with hand in the procedure. Long-term follow-up was satisfactory. Traumatic cavernous fistula supplied by a persistent primitive trigeminal artery could be treated by embolization and temporal compression of the parent artery might be useful for residual minimal fistula.

  15. Spontaneous biliopneumothorax (thoracobilia) following gastropleural fistula due to stomach perforation by nasogastric tube.

    Science.gov (United States)

    Bini, Alessandro; Grazia, Manuele; Petrella, Francesco; Stella, Franco; Bazzocchi, Ruggero

    2004-07-01

    Gastropleural fistula may occur after pulmonary resection, perforated paraesophageal hernia, perforated malignant gastric ulcer at the fundus, or gastric bypass surgery for morbid obesity. We describe a case of gastropleural fistula after stomach perforation by a nasogastric tube in a patient who underwent Billroth II gastric resection for adenocarcinoma. Left biliopneumothorax occurred and was treated by thoracic drainage with -20 cm H2O aspiration. As gastropleural fistula persisted, laparotomy was repeated and gastric and diaphragmatic perforations were sutured. Gastropleural fistula is rare and, to our knowledge, this is the first reported case of gastropleural fistula and biliopneumothorax caused by gastric and diaphragmatic perforation by a nasogastric tube.

  16. A bill of rights for patients with obstetric fistula.

    Science.gov (United States)

    Wall, L Lewis

    2014-12-01

    According to the seven categories of vulnerability proposed by Kipnis (cognitive, juridical, deferential, medical, allocational, social, and infrastructural), and the four generally accepted principles of biomedical ethics (respect, beneficence, non-maleficence, and fairness), women with obstetric fistulas are an exceptionally vulnerable population. Therefore, they merit special consideration in both clinical care and research settings. Adoption of a formal bill of rights for patients with fistula similar to the one proposed in the present report should be encouraged at all facilities where these women are treated. Acknowledgment of their rights would help to improve their care and end the abuses they are exposed to in institutional settings. PMID:25194211

  17. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair;

    2011-01-01

    and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies...... from six controls were also included. Total functional MMP activity was measured by a high-pressure liquid chromatography (HPLC)-based, fluorogenic MMP-substrate cleavage assay, and the specific activity of MMP-2, -3 and -9 by the MMP Biotrak Activity Assay. The MMP inhibitors comprised ethylene...

  18. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula

    Directory of Open Access Journals (Sweden)

    Tomas Mujo

    2016-01-01

    Full Text Available Active extravasation via an arterioureteral fistula (AUF is a rare and life-threatening emergency that requires efficient algorithms to save a patient’s life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.

  19. Coblation-assisted closure of persistent tracheocutaneous fistulae.

    Science.gov (United States)

    Walner, David L; Mularczyk, Chris; Kakodkar, Kedar

    2016-06-01

    Persistent tracheocutaneous fistulae (PTCFs) are sequelae of long-term tracheostomy tube use, and while many procedures exist to correct this issue, several are invasive and incur risk to the patient. This case study discusses a minimally invasive approach to closure of small PFTFs with a coblator device that may reduce the risks associated with other closure procedures. We demonstrated successful tracheocutaneous fistulae closure after coblation in all 4 patients that the operation was performed. We believe this technique can be considered for patients under select circumstances and can be part of a surgeon's armamentarium for the treatment of small PTCFs.

  20. Pneumobilia Resulting From Choledochoduodenal Fistula Secondary to Metastatic Colon Adenocarcinoma

    Science.gov (United States)

    Kramer, Scott; Tzimas, Demetrios; Saitta, Patrick

    2016-01-01

    Pneumobilia, or air within the biliary tree, is a poor prognostic indicator in a patient without prior biliary sphincterotomy. Differential diagnosis includes infection with gas-forming organisms, choledochoenteric fistula in the setting of gallstones or penetrating ulcer disease, malignant invasion from a primary liver or biliary tract tumor, or metastatic disease. Treatment depends on etiology and patient factors, but often requires surgical intervention. We report a patient with gastrointestinal bleeding in whom pneumobilia was incidentally noted on abdominal plain film. Computed tomography and endoscopy revealed the biliary-enteric fistula to be caused by metastatic colon adenocarcinoma invading the biliary tree. PMID:26958563

  1. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis

    Directory of Open Access Journals (Sweden)

    Sabzi, Feridoun

    2015-11-01

    Full Text Available The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE. She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25 day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected.

  2. A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis.

    Science.gov (United States)

    Sabzi, Feridoun; Heidari, Aghighe; Faraji, Reza

    2015-01-01

    The concomitant presence of abnormal connection from three aortic valsalva sinuses to cardiac chambers is a rare complication of native aortic Brucella endocarditis. This case report presents a 37-year-old Iranian female patient who had native aortic valve Brucella endocarditis complicated by periannular abscess formation and subsequent perforation to multi-cardiac chambers associated with congestive heart failure and left bundle branch block. Multiple aorto-cavitary fistulas to right atrium, main pulmonary artery, and formation of a pocket over left atrial roof were detected by transthoracic echocardiogram (TTE). She had received a full course of antibiotics therapy in a local hospital and was referred to our center for further surgery. TTE not only detected multiple aorto-cavitary fistulas but also revealed large vegetation in aortic and mitral valve leaflets and also small vegetation in the entrance of fistula to right atrium. However, the tricuspid valve was not involved in infective endocarditis. She underwent open cardiac surgery with double valve replacement with biologic valves and reconstruction of left sinus of valsalva fistula to supra left atrial pocket by pericardial patch repair. The two other fistulas to main pulmonary artery and right atrium were closed via related chambers. The post-operative course was complicated by renal failure and prolonged dependency to ventilator that was managed accordingly with peritoneal dialysis and tracheostomy. The patient was discharged on the 25(th) day after admission in relatively good condition. The TTE follow-up one year after discharge revealed mild paravalvular leakage in aortic valve position, but the function of mitral valve was normal and no residual fistulas were detected. PMID:26605134

  3. The York-Mason technique for recto-urethral fistulas Correção de fistula reto-uretral pela técnica de York-Mason

    OpenAIRE

    Alexandre Crippa; Marcos F. Dall' Oglio; Luciano J. Nesrallah; Endric Hasegawa; Alberto Azoubel Antunes; Miguel Srougi

    2007-01-01

    OBJECTIVE: Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. There is no consensus in the literature regarding the treatment of these fistulas. We present here our experiences treating recto-urethral fistulas. MATERIAL AND METHODS: We analyzed 8 cases of rectourethral fistula treated at our institution in the last seven years. Seven of the patients underwent repair of the fistula using the modified York-Mason procedure. RESULTS:...

  4. A cost-effectiveness analysis of fistula treatment in the abdominal region using a new integrated fistula and wound management system

    DEFF Research Database (Denmark)

    Keiding, Hans; Skovgaard, Rasmus

    2008-01-01

    OBJECTIVE: To evaluate wear time and costs of a new fistula and wound management system (FWMS) compared to standard fistula treatments. METHODS: Data were collected from 22 patients with an abdominal fistula recruited from 5 sites in the United States. This economic evaluation was based on a cost......, the sensitivity analysis showed that 77% of patients achieved a cost reduction when changing to the FWMS. CONCLUSION: The FWMS was less costly than traditional methods for managing abdominal fistula, probably due to longer wear time and less time spent on each pouching session....

  5. Unusual Development of Iatrogenic Complex, Mixed Biliary and Duodenal Fistulas Complicating Roux-en-Y Antrectomy for Stenotic Peptic Disease of the Supraampullary Duodenum Requiring Whipple Procedure: An Uncommon Clinical Dilemma

    Directory of Open Access Journals (Sweden)

    Francesco A. Polistina

    2010-10-01

    Full Text Available Complex fistulas of the duodenum and biliary tree are severe complications of gastric surgery. The association of duodenal and major biliary fistulas occurs rarely and is a major challenge for treatment. They may occur during virtually any kind of operation, but they are more frequent in cases complicated by the presence of difficult duodenal ulcers or cancer, with a mortality rate of up to 35%. Options for treatment are many and range from simple drainage to extended resections and difficult reconstructions. Conservative treatment is the choice for well-drained fistulas, but some cases require reoperation. Very little is known about reoperation techniques and technical selection of the right patients. We present the case of a complex iatrogenic duodenal and biliary fistula. A 42-year-old Caucasian man with a diagnosis of postoperative peritonitis had been operated on 3 days earlier; an antrectomy with a Roux-en-Y reconstruction for stenotic peptic disease was performed. Conservative treatment was attempted with mixed results. Two more operations were required to achieve a definitive resolution of the fistula and related local complications. The decision was made to perform a pancreatoduodenectomy with subsequent reconstruction on a double jejunal loop. The patient did well and was discharged on postoperative day 17. In our experience pancreaticoduodenectomy may be an effective treatment of refractory and complex iatrogenic fistulas involving both the duodenum and the biliary tree.

  6. Sudden Sensorineural Hearing Loss: The Question of Perilymph Fistula.

    Science.gov (United States)

    Backous, Douglas D.; Niparko, John K.

    1997-01-01

    Perilymph fistula (PLF) is an abnormal communication between the fluid-containing spaces of the inner ear and the air-containing spaces of the temporal bone that can cause hearing loss, tinnitus, aural fullness, vertigo, and postural instability. Diagnosis of PLF and management of those with presumed PLF are discussed. (Contains extensive…

  7. Esophageal Atresia and Tracheoesophageal Fistula with Unilateral Pulmonary Agenesis - Hypoplasia

    Directory of Open Access Journals (Sweden)

    Katragadda Laxmi Narsimha Rao

    2013-04-01

    Full Text Available Association of unilateral severe pulmonary hypoplasia or agenesis and esophageal atresia (EA with or without tracheoesophageal fistula (TEF is an exceedingly rare and highly lethal combination. We report a case of full term male baby who had EA with TEF and right lung hypoplasia, managed at our centre. He is alive and doing well at 10 years of age.

  8. Acute gastric volvulus in operated cases of tracheoesophageal fistula

    Directory of Open Access Journals (Sweden)

    Joshi Milind

    2010-01-01

    Full Text Available A report of two neonates of esophageal atresia with tracheoesophageal fistula who had acute gastric volvulus in the postoperative period and required gastropexy after correction of the volvulus. Such postoperative complication has not been reported in the literature so far.

  9. MR imaging evaluation of perianal fistulas: spectrum of imaging features.

    Science.gov (United States)

    de Miguel Criado, Jaime; del Salto, Laura García; Rivas, Patricia Fraga; del Hoyo, Luis Felipe Aguilera; Velasco, Leticia Gutiérrez; de las Vacas, M Isabel Díez Pérez; Marco Sanz, Ana G; Paradela, Marcos Manzano; Moreno, Eduardo Fraile

    2012-01-01

    Perianal fistulization is an inflammatory condition that affects the region around the anal canal, causing significant morbidity and often requiring repeated surgical treatments due to its high tendency to recur. To adopt the best surgical strategy and avoid recurrences, it is necessary to obtain precise radiologic information about the location of the fistulous track and the affected pelvic structures. Until recently, imaging techniques played a limited role in evaluation of perianal fistulas. However, magnetic resonance (MR) imaging now provides more precise information on the anatomy of the anal canal, the anal sphincter complex, and the relationships of the fistula to the pelvic floor structures and the plane of the levator ani muscle. MR imaging allows precise definition of the fistulous track and identification of secondary fistulas or abscesses. It provides accurate information for appropriate surgical treatment, decreasing the incidence of recurrence and allowing side effects such as fecal incontinence to be avoided. Radiologists should be familiar with the anatomic and pathologic findings of perianal fistulas and classify them using the St James's University Hospital MR imaging-based grading system.

  10. Condylomata acuminata within perianal fistulae tracts: report of two cases.

    Science.gov (United States)

    Panidis, Stavros; Paramythiotis, Daniel; Papadopoulos, Vasileios N; Michalopoulos, Antonios

    2015-04-01

    The commonest sights of appearance of condylomata acuminata are in the genital and anal regions. Herein we present two cases of condylomata within perianal fistulae tracts, resulting in recurrence in one case and a malignant-like tumour in the second. To our knowledge, these are the first cases reported in the literature. PMID:24872374

  11. Carotid cavernous fistula after elective carotid endarterectomy: Case report

    Directory of Open Access Journals (Sweden)

    Andres Asser

    2014-12-01

    This is a case to illustrate a rare complication of carotid artery surgery. The patient had atherosclerotic vessel damage of ICA visible on earlier CT scans. This combined with abrupt increase of transmural pressure due to the revascularization procedure could possibly lead to arterial wall rupture and fistula formation.

  12. Pudendal thigh flap for repair of rectovaginal fistula.

    Science.gov (United States)

    Sathappan, S; Rica, M A I

    2006-08-01

    The pudendal thigh flap or the Singapore flap is a versatile flap that can be used in the repair of recto-vaginal fistulae. Apart from the potential problem of hair growth, this neurovascular flap proves to be surprisingly simple in technique, robust and has a high potential for normal or near-normal function. PMID:17240589

  13. Retained drains causing a bronchoperitoneal fistula: a case report

    Directory of Open Access Journals (Sweden)

    Kieninger Alicia A

    2011-05-01

    Full Text Available Abstract Introduction Bronchoperitoneal fistulas are extremely rare. We present a case where retained surgical drains from a previous surgery resulted in erosion and fistula formation. This condition required an extensive surgical procedure and advanced ventilator techniques. Case presentation A 24-year-old African-American man presented to our Emergency Department with a one-week history of fever, dyspnea, cough, and abdominal pain. A computed tomography scan of his chest and abdomen revealed bilateral lower lobe pneumonia and two retained Jackson-Pratt drains in the right upper quadrant. He was taken to the operating room for drain removal, a right hemicolectomy, debridement of a duodenal injury, a Roux-en-y duodenojejunostomy, and an end ileostomy. He subsequently became increasing hypoxemic in the intensive care unit and a bronchoperitoneal fistula was diagnosed. He required high-frequency oscillatory ventilation followed by lung isolation, and was successfully resuscitated using these techniques. Conclusion To the best of our knowledge, this is the first known case report of a bronchoperitoneal fistula caused by retained surgical drains. This is also the first known report that details successful management of this condition with advanced ventilatory techniques. This case highlights the importance of follow-up for trauma patients since retained surgical drains have the potential to cause life-threatening complications. When faced with this condition, clinicians should be aware of advanced ventilatory methods that can be employed in the intensive care unit. In this case, these techniques proved to be life-saving.

  14. Spontaneous gastrojejunal fistula is a complication of gastric ulcer

    Institute of Scientific and Technical Information of China (English)

    (D)or(d)e M (C)ulafi(c); Olivera D Mateji(c); Vladimir S (D)uki(c); Miodrag D Vuk(c)evi(c); Mirko D Kerkez

    2007-01-01

    Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula.Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also,gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration.Postoperative course was uneventful. Per oral intake started on the 4th postoperative day, and the patient was discharged on the 8th postoperative day. In summary,this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.

  15. Spontaneous gastrojejunal fistula is a complication of gastric ulcer.

    Science.gov (United States)

    Culafić, Dorde-M; Matejić, Olivera-D; Dukić, Vladimir-S; Vukcević, Miodrag-D; Kerkez, Mirko-D

    2007-01-21

    Spontaneous gastrojejunal fistula formation is an extremely rare complication of gastric ulcer disease. We report a 77-year old woman who presented with diffuse abdominal pain, weight loss, malaise, nausea, and occasional dark stools. Laboratory tests showed extreme hyposideremic anemia with inflammatory syndrome. In addition, biochemical parameters of malnourishment were presented. Upper endoscopy revealed the patent esophagus along the full length without any pathological changes. Large and deep ulceration with perforation in the small intestine was detected in the posterior gastric wall. The small intestine loop was reached by endoscope through spontaneously developed gastrojejunal fistula. Polytopic biopsies of described ulcerative change were carried out. Histopathologically reepithelialized ulcerous zone was seen in the gastric mucosa. Also, gastrojejunal fistula was visualized after wide opening of hepatogastric and gastrocolic ligament. Jejunal loop 25 cm from ligament of Treitz was attached to mesocolon and posterior gastric wall because of ulcer penetration. Postoperative course was uneventful. Per oral intake started on the 4(th) postoperative day, and the patient was discharged on the 8(th) postoperative day. In summary, this case indicates that persistent symptoms of peptic ulcer disease associated with nutritional disturbances may be caused by gastrojejunal fistula.

  16. Transanal approach in repairing acquired rectovestibular fistula in females

    Institute of Scientific and Technical Information of China (English)

    Ya-Jun Chen; Ting-Chong Zhang; Jin-Zhe Zhang

    2004-01-01

    AIM: To summarize the operative experience of the transanal approach in acquired rectovestibular fistula repair.METHODS: Ninety-six cases of acquired rectovestibular fistula in young females were analyzed retrospectively. The etiology and operative procedure were discussed. Operative essential points were, the patient was laid in prone frog position, with the knees and hips flexed at 90°; the perineum was elevated; and the anal opening was exposed. Four stay sutures were applied to the margin of the fistular orifice in the anal opening at points 3, 6, 9 and 12 o'clock.A circular incision of mucosa surrounding the stay sutures was made. The fistula was dissected from its anal opening to its vestibular opening. The wound of vestibule was sutured,and the rectoanal wound was then sutured transversely.RESULTS: All the 96 patients recovered uneventfully from operation with a successful rate of 93.75%.CONCLUSION: The transanal approach in the treatment of the acquired rectovestibular fistula is a simple and feasible technique.

  17. Giant aneurysm in a left coronary artery fistula

    DEFF Research Database (Denmark)

    Frestad, Daria; Helqvist, Steffen; Helvind, Morten;

    2013-01-01

    Congenital coronary artery fistula complicated with giant coronary artery aneurysm is a very rare condition. In this case report, we present a 65-year-old woman, referred to us with a continuous heart murmur, occasional atypical chest pain and few episodes of fainting. A giant aneurysm and a coro...

  18. Duodenocolic fistula: case report and review of the literature.

    Directory of Open Access Journals (Sweden)

    Xenos E

    1999-07-01

    Full Text Available Duodenocolic fistula is a rare complication of malignant and inflammatory bowel disease. It presents as diarrhoea and faeculent vomiting. The diagnosis is established with upper and lower gastrointestinal tract contrast studies. A case is reported and the optimal operative procedure is discussed.

  19. Successful closure of a bronchopleural fistula by intrapleural administration of fibrin sealant: A case report with review of Literature

    Directory of Open Access Journals (Sweden)

    Pranabh Shrestha

    2014-01-01

    Full Text Available Context: There are no established guidelines for the proper treatment of patients with bronchopleural fistulas (BPFs. Apart from attempts to close the fistula, emphasis of treatment and management is placed on preventive measures, early administration of antibiotics, drainage of the empyema and aggressive nutritional and rehabilitative support. Case Report: A 53-year-old male presented with nausea, vomiting, and dry cough with eventual respiratory failure. He was found to have an empyema of the left hemithorax which was managed with thoracostomy drainage and antibiotics. However, he had persistent air leak through the chest tube due to a BPF. Bronchoscopy failed to localize the involved segment. Application of fibrin glue through the chest tube succeeded in completely sealing the leak. Conclusion: To our knowledge, this is the first case report in which fibrin glue was successfully used intrapleurally to close a BPF related to an empyema.

  20. Computer assisted sound analysis of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Malindretos, Pavlos; Liaskos, Christos; Bamidis, Panagiotis; Chryssogonidis, Ioannis; Lasaridis, Anastasios; Nikolaidis, Pavlos

    2014-02-01

    The purpose of this study was to reveal the unique sound characteristics of the bruit produced by arteriovenous fistulae (AVF), using a computerized method. An electronic stethoscope (20 Hz to 20 000 Hz sensitivity) was used, connected to a portable laptop computer. Forty prevalent hemodialysis patients participated in the study. All measurements were made with patients resting in supine position, prior to the initiation of mid-week dialysis session. Standard color Doppler technique was used to estimate blood flow. Clinical examination revealed the surface where the perceived bruit was more intense, and the recording took place at a sample rate of 22 000 Hz in WAV lossless format. Fast Fourier Transform (FFT) mathematical algorithm, was used for the sound analysis. This algorithm is particularly useful in revealing the periodicity of sound data as well as in mapping its frequency behavior and its strength. Produced frequencies were divided into 40 frequency intervals, 250 Hz apart, so that the results would be easier to plot and comprehend. The mean age of the patients was 63.5 ± 14 years; the median time on dialysis was 39.6 months (mean 1 month, max. 200 months). The mean blood flow was 857.7 ± 448.3 ml/min. The mean sound frequency was approximately 5 500 Hz ± 4 000 Hz and the median, which is also expressing the major peak of sound data, was 750 Hz, varying from 250 Hz to 10 000 Hz. A possible limitation of the study is the relatively small number of participants. PMID:24619890

  1. Computer assisted sound analysis of arteriovenous fistula in hemodialysis patients.

    Science.gov (United States)

    Malindretos, Pavlos; Liaskos, Christos; Bamidis, Panagiotis; Chryssogonidis, Ioannis; Lasaridis, Anastasios; Nikolaidis, Pavlos

    2014-02-01

    The purpose of this study was to reveal the unique sound characteristics of the bruit produced by arteriovenous fistulae (AVF), using a computerized method. An electronic stethoscope (20 Hz to 20 000 Hz sensitivity) was used, connected to a portable laptop computer. Forty prevalent hemodialysis patients participated in the study. All measurements were made with patients resting in supine position, prior to the initiation of mid-week dialysis session. Standard color Doppler technique was used to estimate blood flow. Clinical examination revealed the surface where the perceived bruit was more intense, and the recording took place at a sample rate of 22 000 Hz in WAV lossless format. Fast Fourier Transform (FFT) mathematical algorithm, was used for the sound analysis. This algorithm is particularly useful in revealing the periodicity of sound data as well as in mapping its frequency behavior and its strength. Produced frequencies were divided into 40 frequency intervals, 250 Hz apart, so that the results would be easier to plot and comprehend. The mean age of the patients was 63.5 ± 14 years; the median time on dialysis was 39.6 months (mean 1 month, max. 200 months). The mean blood flow was 857.7 ± 448.3 ml/min. The mean sound frequency was approximately 5 500 Hz ± 4 000 Hz and the median, which is also expressing the major peak of sound data, was 750 Hz, varying from 250 Hz to 10 000 Hz. A possible limitation of the study is the relatively small number of participants.

  2. Postoperative pancreatic fistulas are not equivalent after proximal, distal, and central pancreatectomy.

    Science.gov (United States)

    Pratt, Wande; Maithel, Shishir K; Vanounou, Tsafrir; Callery, Mark P; Vollmer, Charles M

    2006-11-01

    It is uncertain whether postoperative pancreatic fistulas after distal and central pancreatectomies behave similarly to those after pancreaticoduodenectomy. To date, this concept has not been validated either clinically or economically. Overall, 256 consecutive pancreatic resections from October 2001 to February 2006 (184 pancreaticoduodenectomies, 66 distal pancreatectomies, and 6 central pancreatectomies) were evaluated according to the International Study Group of Pancreatic Fistula classification scheme. Pancreatic fistula was defined as any measurable drainage on or after postoperative day 3, with amylase content greater than three times the normal serum value. Outcomes were divided into four grades: (1) no fistula, (2) grade A: biochemical fistula without clinical sequelae, (3) grade B: fistula requiring any therapeutic intervention, or (4) grade C: fistula with severe clinical sequelae. Grades B and C are considered clinically relevant fistulas based on worsening morbidity, increased length of stay, frequent hospital readmission, and increased costs/resource utilization. Clinical and economic outcomes were compared-grade for grade-across the three resection types. Fistulas of any extent (Grades A-C) occurred in one third of all patients; two thirds had no fistula. Overall, there were 16 readmissions (6%), six reoperations (2%), and no deaths attributable to pancreatic fistula. Outcomes between no fistula and grade A patients were identical across resection types, though grade A fistula was more common in distal pancreatectomy. For each resection type, length of stay and costs progressively increased with grades B and C. However, the negative impact of these clinically relevant fistulas varied between resection types. Rates for intensive care unit admission and rehabilitation placement were higher among pancreaticoduodenectomy patients. Total parenteral nutrition and antibiotic use were similar, but percutaneous drainage was used more often for distal

  3. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Loffroy, R. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)], E-mail: loffroy.romaric@neuf.fr; Guiu, B.; Lambert, A. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Mousson, C.; Tanter, Y. [Department of Nephrology and Renal Transplantation (France); Martin, L. [Department of Pathology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Cercueil, J.-P.; Krause, D. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)

    2008-06-15

    Aim: To evaluate the outcomes after transcatheter embolization of percutaneous biopsy-related arteriovenous fistulas in renal allografts. Materials and methods: All post-biopsy renal-transplant vascular injuries referred for embolization between June 1999 and October 2006 were reviewed retrospectively. There were six male and six female patients with a mean age of 49.8 years (range 25-67 years); nine patients were symptomatic, three asymptomatic. Colour Doppler ultrasound (CDUS) and angiography showed one intra-renal arteriovenous fistula in 10 patients and two in two patients, combined with a pseudoaneurysm in six patients. Superselective embolization using a single catheter or coaxial microcatheter was performed with 0.035'' coils or 0.018''microcoils, respectively, in all 12 cases. 24-h creatinine clearance values before (the day of biopsy) and after (7-14 days; 3 months) the procedure were compared using the Wilcoxon signed-rank test. Physical examination and CDUS were performed after 1, 6, and 12 months, and yearly thereafter. Mean follow-up was 33.6 months. Results: Complete definitive occlusion of the fistula was achieved consistently with a single procedure. No procedure-related complications occurred. Renal infarction was minor in all patients (0-10% in nine and 10-20% in three). Symptoms resolved completely. Creatinine clearance values obtained before and after embolization were not statistically different (p = 0.168;.889 respectively). No late recurrences were reported. Conclusion: Transcatheter embolization with coaxial or single-catheter techniques was effective and safe for treating post-biopsy arteriovenous fistulas in renal transplants. The loss of renal parenchyma was minimal and no mid-term deterioration of allograft function was noted. The long-term survival of the renal allograft seemed to be not affected by embolization.

  4. Postoperative Pancreatic Fistula: A Surgeon’s Nightmare! An Insight with a Detailed Literature Review

    Directory of Open Access Journals (Sweden)

    Prasad Seetharam

    2015-03-01

    Full Text Available Context Postoperative fistula formation is an important complication following pancreatic resections. Objective A large volume of literature without uniform conclusions is available regarding various controversies about postoperative pancreatic fistulae. The term postoperative pancreatic fistula includes fistula resulting from any surgery involving pancreas, most commonly pancreaticoduodenectomy and distal pancreatectomy. In this review, we have tried to present a comprehensive account of postoperative pancreatic fistula with particular emphasis on important controversies clouding the subject. Methods We performed Medline literature search for relevant articles using the key words pancreas, pancreatic cancer, pancreatectomy, pancreatoduodenectomy, Whipple’s operation, postoperative, complications, fistula, management and treatment in various combinations with the Boolean operators AND, OR and NOT. Conclusions Postoperative pancreatic fistula is a troublesome complication of pancreaticoduodenectomy. Although the risk factors for postoperative pancreatic fistula have been extensively described, none of the methods recommended for preventing postoperative pancreatic fistula have been conclusively proved to be effective. While endoscopic treatment and percutaneous treatment form important aspects of treatment of postoperative pancreatic fistula, surgery may be required for select cases.

  5. Aorto-right atrial fistula after ascending aortic replacement or aortic value replacement

    International Nuclear Information System (INIS)

    Objective: To evaluate the CT features of aorto-right atrial fistula after aortic valve replacement (AVR) or ascending aortic replacement. Methods: Eighty-seven patients with aortic-right atrial fistula underwent CT after operation. The CT features were retrospectively analyzed. Fistula was measured according to maximum width of the shunt. Results: Aorto-right atrial fistula was detected in 87 patients after aortic valve replacement or ascending aortic replacement by CT scan. Among them, 25 patients were diagnosed as mild aorto-right atrial fistula, 47 patients as moderate, and 15 patients as severe. Thirty-seven patients underwent follow-up CT.Among them, 10 patients with mild to moderate aorto-right atrial fistula were considered to have complete regression, 8 patients with mild aorto-right atrial fistula considered to have incomplete regression, 14 patients with mild to moderate aorto-right atrial fistula considered to have stable condition, and 5 patients with moderate aorto-right atrial fistula considered to have progression at the 3-month follow-up. Conclusion: CT is a useful tool for defining aorto-right atrial fistula after AVR or ascending aortic replacement and for evaluating it in follow-up. (authors)

  6. Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

    Energy Technology Data Exchange (ETDEWEB)

    Shawyer, Andrew, E-mail: andrew.shawyer@bartsandthelondon.nhs.uk [The Royal London Hospital, Radiology Department (United Kingdom); Fotiadis, Nicos I., E-mail: fotiadis.nicholas@gmail.com [Royal Marsden Hospital, Radiology Department, The Royal Marsden NHS Foundation Trust (United Kingdom); Namagondlu, Girish, E-mail: girish.namagondlu@bartsandthelondon.nhs.uk [The Royal London Hospital, Renal Medicine Department (United Kingdom); Iyer, Arun, E-mail: arun.iyer@bartsandthelondon.nhs.uk [The Royal London Hospital, Radiology Department (United Kingdom); Blunden, Mark, E-mail: mark.blunden@bartsandthelondon.nhs.uk; Raftery, Martin, E-mail: martin.raftery@bartsandthelondon.nhs.uk; Yaqoob, Magdi, E-mail: magdi.yaqoob@bartsandthelondon.nhs.uk [The Royal London Hospital, Renal Medicine Department (United Kingdom)

    2013-02-15

    Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.

  7. Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula

    Directory of Open Access Journals (Sweden)

    Stephen P. Juraschek

    2011-01-01

    Full Text Available Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described, fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain, signs of heart failure, and a new left bundle branch block (LBBB. Cardiac catheterization revealed a small left anterior descending (LAD-to-pulmonary artery (PA fistula. Diuresis led to subjective improvement of the patient's symptoms and within several days the LBBB resolved. We hypothesize that the coronary fistula in this patient contributed to transient ischemia of the LAD territory through a coronary steal mechanism. We elected to observe rather than repair the fistula, as his symptoms and ECG changes resolved with treatment of his heart failure.

  8. Gastro-umbilical fistula as a rare complication of benign gastric ulcer perforation: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ju Young; Jang, Kyung Mi; Yoon, Hoi Soo; Kim, Min Jeong; Lee, Kwan Seop; Lee, Yul; Bae, Sang Hoon [College of Medicine, Hallym University, Anyang (Korea, Republic of)

    2007-11-15

    As fistula occurring between the stomach and other abdominal internal organs or to the surface of the body is usually encountered as a complication of stomach cancer or colon cancer, peptic ulcer disease, or other variable causes. The most common type of gastric fistula is a gastro-colic fistula that is mainly found as a complication of a gastric carcinoma or of a carcinoma of the transverse colon invading each other. Sometimes, a benign gastric ulcer perforation also can cause a gastro-colic fistula. However, as far as we know, a fistula occurring between the stomach and the umbilicus has not been reported. Here we present a case report of a gastro-umbilical fistula in a young woman that manifested as a umbilical discharge.

  9. FREE VASTUS LATERALIS MUSCLE FLAP FOR CLOSURE OF RECURRENT ORONASAL FISTULA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Prakash Kumar

    2015-06-01

    Full Text Available Recurrent oronasal fistulas after cleft palate repair present a difficult problem for the cleft surgeon. Repeated surgeries to close the fistula results in increased scar formation with associated soft tissue contracture and a resultant increase in fistula size. Although locally available flaps ha s been the standard procedure for closure of small fistulae, Large fistulas requires regional flaps like tongue flaps requiring multistage transfer, with resultant intra oral scarring, to avoid the problems associated with loco regional flaps and recent in crease in success rates of free tissue transfers make them a viable, one - stage means of closing these defects. In this case report we present our clinical experience with recurren t palatal fistula and highlight the effective use of the free vastuslateralis mus cle flap as a means of repair.

  10. The upper arm arterio-venous fistula--an alternative for vascular access in haemodialysis

    DEFF Research Database (Denmark)

    Gade, J; Aabech, J; Hansen, R I

    1995-01-01

    Forty-eight consecutive arteriovenous fistulae of the upper arm constructed in 44 patients between 1983 and 1987 were reviewed. The median observation time was 8.5 months (range 1 day-65 months). The overall patency rate for fistulae used for haemodialysis (early failures excluded) was 50% after...... one year and 38% after two years. However, only six (18.7%) of the used fistulae stopped because of thrombosis. The total number of thromboses was nine (19.6%). The main cause of discontinuance of fistulae was a high number of deaths (n = 22), presumably a result of a high median age of 62 years....... Early failure rate was seven of 46 (15.2%); in three cases (6.5%) this was caused by thrombosis. The results are compared to other alternatives for radiocephalic fistulae and the difficulties of comparisons are discussed. It is concluded that the upper arm arteriovenous fistula can serve as a second...

  11. Ileorectal fistula due to a rectal cancer—A case report

    OpenAIRE

    Takahashi, Minoru; Fukuda, Takahiro

    2010-01-01

    A 51-year-old man was seen at our hospital because of diarrhea. Barium enema and colonoscopy revealed a cancer in the lower rectum and fistula formation from the site to ileum. Resection of the rectal cancer and ileorectal fistula was performed. Histologically, the resected lesion was mucinous adenocarcinoma with contiguous invasion from the rectum to the ileum. The patient is alive with no sign of recurrence 120 months after operation. Fistula formation between the colon and other gastrointe...

  12. Intestinal prolapse through omphalomesenteric fistula, a rare cause of neonatal occlusion: A case report

    OpenAIRE

    Cheikh Diouf; Ndeye Aby Ndoye; Aimé Lakh Faye; Oumar Ndour; Gabriel Ngom

    2016-01-01

    Acute intestinal obstruction secondary to omphalomesenteric fistula is a very rare condition. Omphalomesenteric fistula is a consequence of a defect in involution of the vitelline duct between the fifth and ninth week of intrauterine development. We are reporting on a case of neonatal intestinal obstruction due to a prolapse of small bowel through an omphalomesenteric fistula. A newborn baby aged 15 days was admitted in emergency with acute intestinal obstruction lasting for two days. The phy...

  13. Bioassay-Directed Isolation of Active Compounds with Antiyeast Activity from a Cassia fistula Seed Extract

    OpenAIRE

    Subramanion L. Jothy; Sreenivasan Sasidharan; Lai Ngit Shin; Lachimanan Yoga Latha; Yee Ling Lau; Yeng Chen; Zuraini Zakaria

    2011-01-01

    Background and objective: Cassia fistula L belongs to the family Leguminosae, and it is one of the most popular herbal products in tropical countries. C. fistula seeds have been used as a herbal medicine and have pharmacological activity which includes anti-bacterial, anti-fungal, and antioxidant properties. The goal of this study was to identify compounds from C. fistula seeds which are responsible for anti-Candida albicans activity using bioassay-directed isolation. Results: The preliminary...

  14. Coronary artery fistula draining into pulmonary artery and optimal management: a review

    OpenAIRE

    Rippel, Radoslaw Adam; Kolvekar, Shyam

    2013-01-01

    Coronary artery fistula is a rare congenital malformation of high variability. The disease is illustrated with a description of a case example. The management of patients with coronary artery fistulas remains controversial. Both spontaneous regression and life threatening complications have been described. The fistula can be ligated or embolised; however, there are no long term outcome data regarding management. Intraoperative risk of myocardial infarction is less than 5% and death rate varie...

  15. Tunica vaginalis: An aid in hypospadias fistula repair: Our experience of 14 cases

    Directory of Open Access Journals (Sweden)

    Yogender Singh Kadian

    2011-01-01

    Full Text Available Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. The correction of such fistula is associated with a failure rate of 10 to 40%. The step in successful repair of a fistula is separation of the suture lines in the urethra and skin using well vascularized elastic tissue. We report our experience of using the tunica vaginalis flap as a layer between the neourethra and skin suture line in repair of recurrent urethrocutaneous fistula. Patients and Methods: We have used the tunica vaginalis flap for the repair of recurrent urethrocutaneous fistula in 14 children with a mean age of 6.5 years (range 3-14 years. All patients had undergone previous hypospadias repair and at least one previous attempt to close the fistula had failed. Surgery was initiated by injecting a povidone solution via urethral meatus to identify all fistulae. The fistulae were closed primarily and urethral suture line was covered with a flap of tunica vaginalis which was harvested either through a small scrotal incision and mobilized via a subcutaneous tunnel into the penile shaft (8/14 or by the same incision as for fistula closure (6/14. The testis was fixed to the scrotum. A urethral catheter was kept for urinary diversion for 10 days. Results: The repair was successful in all but one patient in whom there was leak from the fistula site. One patient in whom tunica vaginalis fascia was tunnelled into neourethra developed scrotal haematoma which needed drainage. Penile cosmesis was acceptable without any significant postoperative testicular complication in 13/14 patients. Conclusion: Repair of recurrent urethrocutaneous fistula with a tunica vaginalis flap is highly effective regardless of fistula location. This flap is easy to mobilize and provide effective coverage of urethral suture line. Putting a glove drain should be considered into scrotal wound if perfect haemostasis is doubtful.

  16. Temporary ileostomy for the preservation of colon fistula in patients with postoperative complications: case report

    OpenAIRE

    Solaine Chiminácio De Oliveira Patrício; Alcides José Branco Filho; Ana Carla Broetto Biazon

    2011-01-01

    Among the postoperative complications in the digestive system, the fistulae are the most common ones. The changes resulting from these fistulae are very important, once they can determine the patient's situation and the development of multiple organic failures. This paper reports the case of a patient who had relevant complications after having undergone temporary ileostomy to maintain the colon fistulized. About 90 to 95% of the digestive tract fistulae have spontaneous resolution. In so...

  17. Sealing of Airway Fistulas for Metallic Covered Z-type Stents

    Directory of Open Access Journals (Sweden)

    Hongwu WANG

    2011-08-01

    Full Text Available Background and objective Treating airway fistulas, including esophagorespiratory fistulas (ERFs, bronchopleural fistulas (BPFs, and tracheomediastinal fistulas (TMFs, is difficult. The aim of this study is to evaluate the safety and clinical efficacy of metallic covered Z-type stents (CZTS for the treatment of airway fistulas through bronchoscopy or fluroscopy. Methods Thirty-eight patients with fistulas between the esophagus, mediastina, and airways (32 ERFs, 5 BPFs, and 1 TMF were retrospectively reviewed after treatment with covered metallic esophageal and airway stents. The fistulas were caused by esophageal (n=26, bronchogenic (n=11, and thyroid (n=1 carcinomas. Results Forty-six fistulas were found in 38 patients. The fistula size ranged from 0.5 cm to 7.0 cm. Forty airway covered metal stents (24 Y-type, 8 L-type, and 8 I-type and 24 esophageal metal stents were placed. Complete responses to the sealing effects of fistulas were noted in 4.3% of all the fistulas, 60.9% showed complete clinical responses, 23.9% showed partial responses, and 10.9% showed no response. An effectivity rate of 89.1% was observed, and the median survival duration of all patients was 5 months. Conclusion The use of CZTS appears to be safe and feasible for the palliative treatment of ERFs, BPFs, and TMFs. Airway stent placement is recommended for patients with ERF. In the event that airway stents fail, esophageal stents should be given. Airway bifurcation stents were observed to be especially suitable for the sealing of fistulas near the trachea carina.

  18. Randomized controlled trial of minimally invasive surgery using acellular dermal matrix for complex anorectal fistula

    Institute of Scientific and Technical Information of China (English)

    Ma-Mu-Ti-Jiang; A; ba-bai-ke-re; Er-Ha-Ti; Ai

    2010-01-01

    AIM: To compare the efficacy and safety of acellular dermal matrix (ADM) bioprosthetic material and endorectal advancement flap (ERAF) in treatment of complex anorectal fistula. METHODS: Ninety consecutive patients with complex anorectal fistulae admitted to Anorectal Surgical Department of First Affi liated Hospital, Xinjiang Medical University from March 2008 to July 2009, were enrolled in this study. Complex anorectal fistula was diagnosed following its clinical, radiographic, or endoscopic diagnostic cr...

  19. Essential oil constituents and their biological activities from the leaves of Cassia fistula growing in Nepal

    OpenAIRE

    Prabodh Satyal; Dosoky, Noura S.; Ambika Poudel; William N. Setzer

    2013-01-01

    Cassia fistula L. (Fabaceae) fruit is used traditionally in Nepal as an antipyretic and to treat constipation, while the leaves are used to treat jaundice, piles, rheumatism, ulcers, insect bites, facial paralysis and skin eruptions. C. fistula leaves are important ingredients in Ayurvedic medicine. This study was undertaken to characterize the volatile constituents of C. fistula leaves and to evaluate their antimicrobial and cytotoxic properties. The essential oil from the leaves of Cassia f...

  20. Endovascular Management of Splenic Arteriovenous Fistula with Giant Venous Aneurysmal Dilatation

    OpenAIRE

    Hamed Ibrahim, Wael; M Bassurrah, Hana

    2012-01-01

    Although splenic artery aneurysm is the commonest visceral and third most common intra abdominal aneurysm after aorta and iliac artery, aneurysm of splenic artery along with aneurysm of splenic vein and arteriovenous fistula is a rare entity. Most of them are 10 cm have been reported. We report a case of 11 cm × 8 cm giant splenic vein aneurysm with splenic arteriovenous fistula as the 1st case of giant splenic venous aneurysm with arteriovenous fistula managed by endovascular treatment.

  1. BUCCAL ADVANCEMENT FLAP DAN ANTROSTOMI: UNTUK TERAPI ORO ANTRAL FISTULA (Laporan Kasus

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    Rizal Rivandi

    2015-08-01

    Full Text Available Buccal advancement flap is one of the many ways of treating oro antral fistula. This technique is frequently used by dentists because it is easier to do and has several advantages compared to other techniques. This paper reports a case of oro antral fistula caused by complication of a tooth extraction, with discussions about definition, ethics and other therapies of oro antral fistula.

  2. Arteriovenous Fistula Complicated by Popliteal Venous Access for Endovascular Thrombolytic Therapy of Deep Vein Thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Byun, Sung Su; Kim, Jeong Ho; Park, Chul Hi; Hwang, Hee Young; Kim, Hyung SiK [Gacheon University Gil Medical Center, Gacheon (Korea, Republic of); Jeon, Young Sun; Kim, Won Hong [Inha University College of Medicine, Incheon (Korea, Republic of)

    2008-10-15

    We report a case of an iatrogenic arteriovenous fistula complicated by catheter- directed thrombolytic therapy in a patient with acute deep vein thrombosis of a lower extremity. To the best of our knowledge, this is the first report of an arteriovenous fistula between the sural artery and popliteal vein in that situation. As the vessels have a close anatomical relationship, the arteriovenous fistula seems to be a potential complication after endovascular thrombolytic therapy of acute deep vein thrombosis.

  3. Spontaneous pneumobilia revealing choledocho-duodenal fistula: A rare complication of peptic ulcer disease

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    Massimo Tonolini

    2013-01-01

    Full Text Available Spontaneous pneumobilia without previous surgery or interventional procedures indicates an abnormal biliary-enteric communication, most usually a cholelithiasis-related gallbladder perforation. Conversely, choledocho-duodenal fistulisation (CDF from duodenal bulb ulcer is currently exceptional, reflecting the low prevalence of peptic disease. Combination of clinical data (occurrence in middle-aged males, ulcer history, absent jaundice and cholangitis and CT findings including pneumobilia, normal gallbladder, adhesion with fistulous track between posterior duodenum and pancreatic head allow diagnosis of CDF, and differentiation from usual gallstone-related biliary fistulas requiring surgery. Conversely, ulcer-related CDF are effectively treated medically, whereas surgery is reserved for poorly controlled symptoms or major complications.

  4. Application of Amplatzer vascular occluder in hepatic artery closure as a method of treatment of high-flow arterioportal fistula before liver transplantation

    International Nuclear Information System (INIS)

    Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors present a patient with liver cirrhosis, in whom percutaneous APF closure facilitated liver transplantation. We describe a case of a 50-year-old patient with liver cirrhosis and APF, probably formed as a result of liver biopsy. Due to the presence of a high-flow fistula, which elevated portal hypertension, patient did not qualify for the liver transplantation. Patient was transferred to the interventional radiology department, where the fistula’s vascular supply was endovascularly closed using the Amplatzer occluder. This subsequently enabled the execution of transplantation. Percutaneous closure of APF should be considered a relatively simple and fast-acting tool to facilitate or even enable liver transplant surgery. Currently, there are more and more products available such as e.g. Amplatzer occluder to simplify the procedure and shorten the duration of exposure to ionizing radiation

  5. [Sigmoidoperianal fistula associated with diverticulitis and Cul de Sac situation--diagnostics and therapy].

    Science.gov (United States)

    Weyand, G; Rinast, E; Englert, A; Houf, M

    2002-07-01

    We report on the case of a 64-year-old female patient who presented herself in our outpatient clinic because of a perianal fistula with recurrent abscesses. We describe the step diagnostics and the surgical treatment of the causal sigmoido-perianal fistula with diverticulitis and Cul de sac situation. Clinical examination, fistulography, colonoscopy and MRT were part of the precise representation and preparation for the high anterior rectosigmoidal resection with simultaneous rectopexy according to Sudeck which were performed without complications. The sigmoidoperianal fistula must be taken into account as a differential diagnosis of a recalcitrant high perianal fistula. PMID:12122593

  6. Fistula Formation between Right Upper Bronchus and Bronchus Intermedius Caused by Endobronchial Tuberculosis: A Case Report.

    Science.gov (United States)

    Kim, Mikyoung; Kang, Eun Seok; Park, Jin Yong; Kang, Hwa Rim; Kim, Jee Hyun; Chang, YouJin; Choi, Kang Hyeon; Lee, Ki Man; Kim, Yook; An, Jin Young

    2015-07-01

    Endobronchial tuberculosis is defined as a tuberculous infection of the tracheobronchial tree and has a prevalence of up to 50% in active pulmonary tuberculosis cases. The most common complication of endobronchial tuberculosis is bronchial stenosis; benign fistula formation by endobronchial tuberculosis is rare, especially inter-bronchial fistula formation. We reported a rare case of a 73-year-old woman with a fistula between the right upper bronchus and bronchus intermedius. A diagnosis of inter-bronchial fistula caused by endobronchial tuberculosis was based on the results of chest computed tomography scans, bronchoscopy, and microbiological and pathological tests. The patient was treated with anti-tuberculous medication, and her symptoms gradually improved.

  7. Inferior Turbinate Flap for Nasal-side Closure of Palatal Fistula in Cleft Patients: Technical Note

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    Amin Rahpeyma

    2014-12-01

    Full Text Available Summary: Residual palatal fistula after repair of palatal cleft is common. Repair of residual oronasal fistula is not always successful. Two-layer closure techniques that close these fistulas with soft tissue are a common practice. Turnover flaps are the most used flaps and often the sole method for nasal-side closure of fistula. Anteriorly based inferior turbinate flap can be used to provide soft tissue for nasal-side closure when turnover flaps will not provide sufficient tissue for this purpose. Under general anesthesia with nasotracheal intubation, inferior turbinate was released from posterior attachment. After removing the inferior conchal bone, mucoperiosteal flap was used for nasal-side closure of anterior palatal fistula in patients with cleft. Anteriorly based inferior turbinate flap was used for nasal-side closure of residual palatal fistula in 3 patients with cleft. Age of the patients was 14, 16, and 18, and recurrence of palatal fistula has not occurred. Anteriorly based inferior turbinate flap is an axial pattern flap with appropriate surface of the paddle and vicinity to the oral cavity roof. It can be used in large anterior, palatal fistula for reconstruction of nasal floor. Considering appropriate another flap for oral side coverage of such fistula is mandatory.

  8. The pattern of non-obstetric fistula:A Cameroonian experience

    Institute of Scientific and Technical Information of China (English)

    Pierre-Marie Tebeu; Eric Brice Touka; Yvette Mawamba; Calvin Tiyou; Joseph Nelson Fomulu; Charles Henry Rochat

    2014-01-01

    Objective:To investigate the pattern ofNon-obstetrical genital fistula(NOGF) inCameroonian context.Materials and methods:This was a cross-sectional analytic study, with two groups of patients, including those treated for non-obstetrical fistula as subject, and their obstetrical counterparts as the control.Data were retrieved from the obstetric fistula database of the Department ofObstetrics andGynecology in theUniversityTeachingHospital ofYaoundé Cameroon for patients operated fromJanuary,1,2009 toDecember31,2012.Results:NOGF represented19.78% of genital fistula.Uro-genital fistula(UGF) represented72.20% while non-obstetrical genito-digestive fistula(GDF) represented27.80% ofNOGF.The main cause ofUGF was hysterectomy(46.15%) while the main cause of genito-digestive fistula was vaginal infections (40.00%).Most patients had never been operated before their arrival in theYUTH(84.60% forUGF and60.00% forGDF).We had one failure at first surgical attempt.Conclusion:UGF fistula is the main type ofNOGF inCameroonian context, with hysterectomy being the leading cause.Proper knowledge onNOGF will enable better strategies to fight against genital fistula.

  9. CONGENITAL VESICOUTERINE FISTULA ALONG WITH DISTAL VAGINAL AGENESIS, SOLITARY KIDNEY AND TONGUE TIE: A RARITY

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    Khalid

    2015-11-01

    Full Text Available : Congenital vesicouterine fistula in association with vaginal agenesis and solitary renal agenesis has been rarely reported. We present a case of 19 year old female suffering from cyclical menouria for last years. Physical examination revealed absence of vagina. IVP revealed left renal agenesis and CT scan revealed left renal agenesis with vesicouterine fistula. Cystoscopy showed vesicouterine fistula located above trigone near midline. Vesicouterine fistula was repaired along with uterine preservation. Sigmoid colon neovagina was created. Patient is doing well and menstruating per vagina till last followup

  10. Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases

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    Denise M.D. Özdemir-van Brunschot

    2016-09-01

    Full Text Available Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion.

  11. A penile torsion with a fistula due to previous hypospadias surgery: A case report

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    Mustafa Rasid Toksoz

    2015-01-01

    Full Text Available We presented a case of penile torsion due to previous hypospadias surgery. A patient applied to our clinic for treatment of hypospadias fistula and accompanying penile torsion. Patient’s urethral fistula was repaired first and penile torsion was corrected in the second stage due to multiple fistula tracts. Proximal based flip flap technique was used for closure of the fistula and simple degloving with release of fibrous tissue and pedicle of the previous preputial island flap was used for correction of the penile torsion. Post hypospadias surgery torsion deformity as in our case may corrected with simple degloving and dissection at the level of the buck fascia.

  12. Peroneal arteriovenous fistula and pseudoaneurysm: an unusual presentation.

    Science.gov (United States)

    Ching, Kevin C; McCluskey, Kevin M; Srinivasan, Abhay

    2014-01-01

    Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome. PMID:25349770

  13. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  14. Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

    Science.gov (United States)

    Kibar, Yusuf; Yalcin, Serdar; Kopru, Burak; Topuz, Bahadir; Ebiloglu, Turgay

    2016-01-01

    Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option.

  15. Doppler findings in a rare Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Jorns Carl

    2007-03-01

    Full Text Available Abstract One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF. It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD artery to the left ventricular (LV apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm, a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life.

  16. Peroneal Arteriovenous Fistula and Pseudoaneurysm: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Kevin C. Ching

    2014-01-01

    Full Text Available Peroneal artery arteriovenous fistulas and pseudoaneurysms are extremely rare with the majority of reported cases due to penetrating, orthopedic, or iatrogenic trauma. Failure to diagnose this unusual vascular pathology may lead to massive hemorrhage or limb threatening ischemia. We report an interesting case of a 14-year-old male who presented with acute musculoskeletal pain of his lower extremity. Initial radiographs were negative. Further imaging workup revealed a peroneal arteriovenous fistula with a large pseudoaneurysm. After initial endovascular intervention was unsuccessful, the vessels were surgically ligated in the operating room. Pathology revealed papillary endothelial hyperplasia consistent with an aneurysm and later genetic testing was consistent with Ehlers-Danlos syndrome Type IV. This case illustrates an unusual cause of acute atraumatic musculoskeletal pain and uncommon presentation of Ehlers-Danlos syndrome.

  17. Ureteroarterial Fistulas After Robotic and Open Radical Cystectomy.

    Science.gov (United States)

    Palmerola, Ricardo; Westerman, Mary E; Fakhoury, Mathew; Boorjian, Stephen A; Richstone, Lee

    2016-01-01

    Ureteroarterial fistulas (UAFs) are defined as an abnormal communication between one of the major arteries and the ureter. Urologists most frequently encounter iatrogenic fistulas occurring in patients with a history of pelvic extirpative surgery, chronic ureteral catheterization, and history of pelvic radiation. We present two cases of UAFs in patients with no history of prior radiation, who underwent open radical cystectomy and robot-assisted radical cystectomy with intracorporeal ileal conduit. Both patients developed postoperative ureteroileal anastomotic leaks that were managed with indwelling ureteral catheters. Furthermore, both patients were having left-sided UAF after presenting with nonlife threatening gross hematuria, which became brisk and pulsatile during ureteral stent exchange. Endovascular stenting was performed in both patients with resolution of hemorrhage and full recovery. In one patient, nephrostomy tubes were placed and ureteral catheters were removed; the second patient was managed with continued ureteral catheterization without further episodes of hematuria. PMID:27579415

  18. The radiological management of the thrombosed arteriovenous dialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

    Bent, C.L., E-mail: clare_bent@yahoo.co.u [Royal Bournemouth and Christchurch Hospitals, Bournemouth (United Kingdom); Sahni, V.A. [Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States); Matson, M.B. [Barts and The London NHS Trust, London (United Kingdom)

    2011-01-15

    Patent vascular access is a prerequisite for adequate haemodialysis, and is a major determinant of quality of life and long-term survival of patients with end-stage renal disease. Autogenous haemodialysis fistulas (AVFs) have demonstrated superior clinical outcome when compared to synthetic grafts, but both types of access remain susceptible to venous stenoses, and consequent thrombotic occlusion. Recent publications have reported primary patency rates of up to 100% following percutaneous de-clotting of AVFs incorporating techniques such as pharmacological thrombolysis, mechanical thrombectomy, and thrombo-aspiration. Endovascular management also provides information regarding the underlying cause of access thrombosis, with option to treat. Consequently, there has been a paradigm shift in the management of fistula thrombosis, with interventional radiology assuming a lead role in initial salvage procedures. This article will attempt to provide the reader with an insight into the multiple radiological techniques that can be employed to salvage a thrombosed AVF based on current published literature.

  19. A case report of ileovesical fistula in radiation enteritis

    Energy Technology Data Exchange (ETDEWEB)

    Ishibashi, Keiichiro; Tsuchiya, Akira; Ito, Takaaki; Akiyama, Akito; Ohkubo, Yuhei; Oyama, Hironori; Sato, Shigenori; Kusama, Hiroshi [Tokyo Medical Coll., Ibaraki (Japan). Kasumigaura Hospital

    1996-09-01

    A 49-year-old female was admitted with chief complaint of fecaluria on March 4th 1993. A radiation therapy had been performed for uterocervical cancer 18 years ago. The small intestine and bladder was detected by DIP and cystogram simultaneously. It was diagnosed as an ileovesical fistula. A segmental resection of the ileum with partial cystectomy was performed on March 23rd. Histopathologically, the ileum showed a radiation enteritis. Eventually, we diagnosed that this ileovesical fistula was caused by radiation. After operation, an incompletion of suture occurred. So we made an ileostomy secondarily and performed hyperbaric oxygen therapy. The patient was getting well temporarily but died of gastric hemorrhage on May 1st. (author)

  20. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty.

    Science.gov (United States)

    Letter, Haley P; Limback, Joseph; Wasyliw, Christopher; Bancroft, Laura; Scherer, Kurt

    2016-06-01

    Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware. PMID:27257460

  1. Acquired arteriovenous fistula in a grizzly bear (Ursus arctos horribilis).

    Science.gov (United States)

    Tuttle, Allison D; MacLean, Robert A; Linder, Keith; Cullen, John M; Wolfe, Barbara A; Loomis, Michael

    2009-03-01

    A captive adult male grizzly bear (Ursus arctos horribilis) was evaluated due to multifocal wounds of the skin and subcutaneous tissues sustained as a result of trauma from another grizzly bear. On presentation, one lesion that was located in the perineal region seemed to be a deep puncture with purple tissue protruding from it. This perineal wound did not heal in the same manner or rate as did the other wounds. Twenty-five days after initial detection, substantial active hemorrhage from the lesion occurred and necessitated anesthesia for examination of the bear. The entire lesion was surgically excised, which later proved curative. An acquired arteriovenous fistula was diagnosed via histopathology. Arteriovenous fistulas can develop after traumatic injury and should be considered as a potential complication in bears with nonhealing wounds.

  2. TRAUMATIC GASTROPLEURAL FISTULA COMPLICATED BY EMPYEMA AND PNEUMOTHORAX

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    Vijay Kumar

    2015-02-01

    Full Text Available We herein report a case of traumatic gastropleural fistula complicated by empyema and pneumothorax which is a rare entity. A 22 year old male was admitted with alleged history of stab injury to left lower chest. Patient was f ound to have left sided pneumothorax, for which intercostal drainage tube was inserted and the patient stabilised. Chest radiograph taken three days after the chest tube insertion showed persistent hydropneumothorax for which the patient underwent a contra st enhanced computed tomography of thorax (CECT. CECT of thorax revealed herniation of fundus of stomach through a defect in the left dome of diaphragm into the left thoracic cavity with leakage of oral contrast into the left pleural cavity. Preoperative diagnosis of gastropleural fistula was made and the same was confirmed in the intraoperative findings. The patient underwent laparotomy with repair of the diaphragmatic defect and closure of the gastric perforation. The patient made an uneventful recovery

  3. Oroantral fistula from bisphosphonate induced osteonecrosis of the jaw

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    Henry Sharp

    2010-07-01

    Full Text Available Bisphosphonates like alendronic acid, disodium etidronate, and risedronate are effective for preventing postmenopausal and corticosteroid induced osteoporosis. They are also useful in the treatment of Paget’s disease, hypercalcaemia of malignancy and in bony metastases. However osteonecrosis of the jaw has been reported following intravenous bisphosphonate use and rarely in those taking them orally.Increasingly, oroantral fistulae have been shown to occur as sequelae of bisphosphonate-induced osteonecrosis of the jaw and this case report highlights a patient that presented to our ENT department and required sinus surgery in collaboration with maxillofacial surgeons.This case report aims to raise awareness among ENT surgeons to these patients on bisphosphonates that could present to them with sinus disease from oroantral fistulae. There is an on-going audit in the maxillofacial community on this emerging trend.

  4. Diagnosis and management of acute traumatic arteriovenous fistula

    OpenAIRE

    Nagpal, Kamal; Ahmed, Kamran; Cuschieri, RJ

    2008-01-01

    Acute arterial injuries are often complicated by the development of an arteriovenous fistula (AVF). In the acute setting, an AVF may present at the same time as the arterial injury. A case of traumatic AVF in the thigh that presented with normal neurovascular examination findings is reported. AVF was diagnosed by duplex scan and managed promptly. The authors suggest that duplex imaging together with arteriography, where appropriate, should be performed routinely when penetrating wounds are in...

  5. Contemporary surgical management of rectovaginal fistula in Crohn's disease

    OpenAIRE

    Valente, Michael A; Hull, Tracy L

    2014-01-01

    Rectovaginal fistula is a disastrous complication of Crohn’s disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women’s quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for a...

  6. Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results

    Energy Technology Data Exchange (ETDEWEB)

    Maeda, Kiyosumi [Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192 (Japan)]. E-mail: kiyosumi@belle.shiga-med.ac.jp; Furukawa, Akira [Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192 (Japan); Yamasaki, Michio [Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192 (Japan); Murata, Kiyoshi [Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu-city, Shiga 520-2192 (Japan)

    2005-06-01

    Objective: To evaluate the initial clinical success and long-term patency rates of percutaneous transluminal angioplasty (PTA) using a venous approach for dysfunctional Brescia-Cimino fistula and to identify factors that may affect initial success and long-term patency. Materials and methods: A total of 99 PTA procedures were performed in retrograde fassion for 60 mature Brescia-Cimino shunts with dysfunction caused by anastomotic or peripheral outflow vein stenosis or occlusion. The initial clinical success rates were compared between stenosis and occlusion using Fisher's exact test. The Kaplan-Meier method was used to calculate the primary and secondary cumulative patency rates, and the log-rank test was used for comparison. Relative risks of patency loss according to clinical characteristics were determined with multivariate Cox models. Results: The initial clinical success rate of all interventions was 92%, and the rates for stenosis and occlusion were 99 and 65%, respectively (P < 0.0001). The primary and secondary cumulative patency rates for fistulas (excluding initial failure) at 12 months were 53 and 84%, respectively. The relative risks were 5.2 (P 0.004) for longer lesions and 4.5 (P = 0.007) for younger fistulas. The primary cumulative patency rate of four patients with a younger fistula and a longer stenosis at 4 months was 0%. Conclusion: Favorable primary and secondary cumulative patency rates are obtained in most patients. Long lesion length and younger age of fistulas were the two factors that reduced the patency rate after PTA.

  7. Intraoperative physical diagnosis in the management of anal fistula.

    Science.gov (United States)

    Gonzalez-Ruiz, Claudia; Kaiser, Andreas M; Vukasin, Petar; Beart, Robert W; Ortega, Adrian E

    2006-01-01

    This report reviews a prospective database applying a systematic fistulomy technique in 101 patients requiring surgery for fistula in ano at LAC+USC Medical Center during a 15-month period. Data were collected for the reliability of primary crypt palpation, success of tract injection with peroxide/methylene blue, and the accuracy of Goodsall's rule. Time to healing, recurrence, and incontinence according to type of procedure were also recorded. Palpation of the primary crypt was possible in 93 per cent. Hydrogen peroxide/methylene blue injection successfully delineated the tract in 83 per cent. Goodsall's rule was correct in 81 per cent. Each fistula was categorized as intersphincteric (n = 72), transphincteric (n = 33), extrasphincteric (n = 1), or submucosal (n = 6). At a mean follow-up period of 44 weeks, 89.2 per cent of patients were cured. Reasons for recurrence included wound bridging (n = 6), misdiagnosis of the tract (n = 3), and two blind-ended fistulae (n = 2). Time to healing in weeks was (mean, range): simple fistulotomy (12, 3-21), seton (16, 4-28), Hanley procedure (28, 8-48). Patients with a marsupialized tract healed at an average of 6 weeks (range 4-8). Four (3.9%) patients reported postoperative incontinence (1 gas, 3 liquid, 0 solids). PMID:16494174

  8. Characterization of Jamaican Delonix regia and Cassia fistula Seed Extracts

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    Andrea Goldson Barnaby

    2016-01-01

    Full Text Available Delonix regia and Cassia fistula seed extracts were evaluated for their antioxidant activity, total phenolics, ash, zinc and fatty acid content. Fourier Transform Infrared Spectroscopy (FTIR was utilized to assess the chemical functionalities present within the seeds. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazyl (DPPH and Trolox equivalent antioxidant capacity (TEAC assays. Total phenolics were determined by the Folin-Ciocalteu assay. Lipid extracts were characterized by nuclear magnetic resonance spectroscopy and gas chromatography/mass spectrometry. Zinc concentration was determined by atomic absorption spectroscopy. Extracts from the seeds of C. fistula had a higher antioxidant activity, free radical scavenging activity, and phenolic content than D. regia. FTIR revealed that the seeds are a rich source of protein with small quantities of fat. C. fistula extracts contained a higher percentage of total fat than D. regia. Palmitic acid was identified as the predominant saturated fatty acid in both extracts. Oleic acid and linoleic acid were identified in smaller quantities. Seed extracts may be considered for use in food and nutraceutical applications.

  9. Gene Expression Changes in Venous Segment of Overflow Arteriovenous Fistula

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    Yasuhiro Hashimoto

    2013-01-01

    Full Text Available Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44 K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas.

  10. Spontaneous Cholecystocutaneous Fistula: A Rare Presentation of Gallstones

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    Leela Sayed

    2010-07-01

    Full Text Available Spontaneous cholecystocutaneous fistula, one of the rarest complications of acute cholecystitis, has been reported in fewer than 25 cases over the past 50 years. Not only is this case rare but interestingly the patient experienced no pain or symptoms consistent with gallbladder pathology leading up to her hospitalisation. Furthermore, laboratory studies, microbiology and computed tomography scanning did not establish a diagnosis until the fistula passed calculi.An 85-year-old lady with multiple co-morbidities presented to the Emergency Department with an erythematous soft and non-tender mass in her right flank. The mass had spontaneously ruptured and was discharging a serous-like material. Prior to further investigation a working diagnosis of an eroding/fungating caecal tumour was made. The lesion continued to discharge over a 3 month period which heralded the passage of 11 small, brown calculi thought to be gallstones. At this point spontaneous cholecystocutaneous fistula was diagnosed and was later confirmed by magnetic resonance imaging cholangiopancreatography.

  11. Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

    OpenAIRE

    Kasamba, Nassar; Kaye, Dan K; Mbalinda, Scovia N.

    2013-01-01

    Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus gr...

  12. Prospective study of immunological factors in non-inflammatory bowel disease enterocutaneous fistulas

    Directory of Open Access Journals (Sweden)

    Warusavitarne Janindra

    2011-05-01

    Full Text Available Abstract Background Enterocutaneous fistulas (ECF are debilitating and usually result following complex abdominal surgery. While there is an association with inflammatory bowel disease (IBD, a large number of fistulas occur after surgery not related to IBD. The consequences of ECF include short bowel syndrome and the need for long term parenteral nutrition. ECF can heal spontaneously and in the case of IBD can be cured by medical therapy in some instances. Those that do not resolve spontaneously have to be cured by surgery which is complex and associated with a high morbidity. It is not considered traditional treatment to use the same medical therapy as in IBD to cure ECF caused by other conditions. A small case series has reported three patients with persistent ECF not related to IBD to have healed following use of Infliximab which is the treatment commonly used for ECF caused by IBD. Infliximab acts by inhibiting the activity of the inflammatory cytokine TNF- alpha. It is not known if this cytokine is present in ECF tissue in the absence of IBD. The aim of this study is to demonstrate the presence of inflammatory markers in tissue surrounding non-IBD ECF and in particular to quantify the presence of the cytokine TNF- alpha. We hypothesise that TNF - alpha levels are raised in non-IBD ECF. Methods/Design Tissue and serum from ECF of IBD and non-IBD patients will be prospectively collected at St. Mark's Hospital Intestinal Failure Unit. The control group will consist of patients undergoing colonoscopy for bowel cancer screening, with normal findings. Biopsies of the terminal ileum will be obtained from this group during colonoscopy. The fistula tract and serum cytokine profiles of interleukins (IL-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, TNF- alpha, IFN-y, MCP-1, EGF and VEGF will be assessed. Discussion This study aims to assess the presence or absence of TNF- alpha expression in the ECF tissue in non-IBD origin. If our hypothesis is correct

  13. Infected interventricular Teflon patch: repair and closure of fistula with omentum.

    OpenAIRE

    Chatzis, A; Pepper, J.; Treasure, T.

    1992-01-01

    A pericardiocutaneous fistula five years after repair of a rupture of the ventricular septum was managed by removing all foreign material (Teflon). The resulting defect was repaired with part of the central tendon of the diaphragm and a pedicle of omentum was used to cover the heart. This radical approach was found necessary after other measures, including surgical excision of the fistula, had failed.

  14. Neuro-endovascular Embolic Agent for Treatment of a Renal Arteriovenous Fistula

    Directory of Open Access Journals (Sweden)

    Gurpreet Singh

    2016-01-01

    Full Text Available Renal arteriovenous fistula is a known complication following a renal biopsy, and may require catheter based embolization. Distal location of these fistulas in the renal parenchyma in many a case may necessitate non-traditional embolic materials. Liquid embolic agents that allow a controlled delivery may be suitable in this situation, as demonstrated in this case report.

  15. The effect of arteriovenous fistulas on in situ saphenous vein bypasses

    DEFF Research Database (Denmark)

    Rørdam, Peter; Jensen, Leif Panduro; Schroeder, T;

    1991-01-01

    Doppler examination identified 89% of those branches with sufficient flow to opacify the deep venous system on completion arteriogram. Half of the missed fistulas underwent spontaneous thrombosis, and in only one case did the arteriovenous fistula lead to hemodynamic symptoms demanding surgical closure...

  16. Repair of vesicovaginal fistula caused by radiation therapy with labia maiora skin flap

    Directory of Open Access Journals (Sweden)

    Stanojević Dušan

    2010-01-01

    Full Text Available Introduction Vesicovaginal fistula can occur after delivery, gynaecologic or urologic surgery, irradiation therapy or as destruction caused by a tumour or trauma. The main problem after irradiation is decreased elasticity of the tissue around the fistula. We present our experience in the treatment of three patients with vesicovaginal fistula using a labia maiora skin flap. Case Outline From May 2007 to January 2008 three patients with vesicovaginal fistula were treated using labia maiora skin flap. The fistulae occurred after mean 19 months (11, 20 and 26 months following irradiation therapy applied to treat malignant disease. The mean age of the patients was 54 years (47, 53 and 62 years. The mean diameter of the fistulae was 3.5 cm (2, 4 and 4.5 cm. Using transvaginal approch, all devitalized and fibrous tissue was removed with the closure of the bladder wall. The labia maiora skin flap with good vascularization was transposed to close the defect and anastomozed to the vagina. The mean follow-up was 16 months (13, 17 and 18 months. Labia maiora skin flap size was mean 3.7 cm (2.6, 3.7 and 4.8 cm. We achieved satisfactory outcome in all patients. There were neither postoperative complications nor fistula recurrence. Conclusion Labia maiora skin flap presents a good alternative for surgical treatment of vesicovaginal fistula. The flap is more adequate for larger defects and for the repair of fibrously changed vaginal wall which is present after irradiation therapy. .

  17. Usefulness assessment of preoperative MRI fistulography in patients with perianal fistulas

    International Nuclear Information System (INIS)

    Accurate preoperative assessment of the perianal fistulous tract is the main purpose of the diagnostics and to a large extend determines surgery effectiveness. One of the useful diagnostic methods in perianal fistulas is magnetic resonance imaging. The authors presented experiences in the application of MRI fistulography for evaluation of cases of perianal fistulas difficult to diagnose and treat. Own examination method was described; MRI fistulography findings were analyzed and compared with intraoperative conditions in 14 patients (11 men and 3 women) diagnosed in the years 2005– 2009. Eight patients had recurrent fistulas and 6 had primary fistulas. Imaging was performed with a GE SIGNA LX HS scanner with a 1.5-Tesla field strength and a dedicated surface coil placed at the level of hip joints. Contrast agent was a gadolinium-based solution. Intraoperative findings were consistent with radiological descriptions of 13 MRI fistulographies. Only in one case, according to surgery findings, it was a transsphincteric fistula with an abscess in the ischioanal fossa, with an orifice in the posterior crypt; the radiologist described it as a transsphincteric, internal blind fistula. Due to its accuracy in the assessment of the perianal fistulous tracts in soft tissues, MRI fistulography becomes a useful and recommended diagnostic method in this pathology. It shows the location of the fistula regarding the system of anal sphincters, and identifies the internal orifice and branching of the fistula. It enables precise planning of surgical treatment. Authors suggest that this diagnostic method should be improved and applied more commonly

  18. Urethro-urethral fistula: A rare cause of post-TURP incontinence

    OpenAIRE

    Moorthy, H. Krishna; Biju S Pillai

    2014-01-01

    Prostatic abscess rarely follows acute prostatitis and can sometimes lead to a fistula by breaking into the prostatic urethra, peri-rectal tissues, the perineum, or the rectum. We report a case of a prostatic abscess tracking into the bulbar urethra after a transurethral resection of the prostate. This created a fistula, mimicking a urethral duplication and leading to urinary incontinence.

  19. Post-Traumatic Cavernous Fistula Fed by Persistent Trigeminal Artery: Treatment by GDC Embolisation

    Science.gov (United States)

    Deol, P.S.; Mishra, N.K.; Gupta, V.; Gaikwad, S.B.; Garg, A.; Singh, N.

    2001-01-01

    Summary A case of traumatic persistent primitive trigeminal artery (PPTA) cavernous sinus fistula treated with GDC embolisation is reported. Because of the small lumen of PPTA, posteriorly directed course and flow contribution from the posterior circulation, balloon embolisation via the carotid system was not considered appropriate. The fistula was successfully closed by GDC embolisation. PMID:20663331

  20. [Trigeminal-cavernous fistula. Report of a case and review of the literature].

    Science.gov (United States)

    Santos Franco, Jorge; Sánchez Olivera, Carlos; Saavedra Andrade, Rafael; Sandoval Balanzario, Miguel Antonio

    2013-01-01

    Persistent primitive trigeminal artery is a rare anatomical variant resulting from the absence of obliteration of the embryonic trigeminal artery. The shunt between the persistent primitive trigeminal artery and the cavernous sinus is called trigeminal-cavernous fistula. We report the case of a woman with a trigeminal-cavernous fistula secondary to head trauma who was treated by transarterial embolization. PMID:24108341

  1. Colopleural fistula caused by aspergillus: an extremely rare complication after lung resection-case report.

    Science.gov (United States)

    Hayashi, Akio; Susaki, Yoshiyuki; Ose, Naoko; Takeuchi, Yukiyasu; Maeda, Hajime

    2016-12-01

    A colopleural fistula is a rare condition reported to be caused by Crohn's disease, a malignant tumor of the gastrointestinal tract, and other clinical conditions. Some studies have noted that a sub-diaphragmatic abscess, usually organized following abdominal surgery, may play some role in the formation of this type of fistula. Therefore, a colopleural fistula is a complication very rarely encountered by thoracic surgeons after lung resection.We experienced an extremely rare case of colopleural fistula following a left lower lobectomy for lung aspergillosis. Here, we report a 71-year-old man with a surgical history of proximal gastrectomy for gastric cancer. He underwent left lower lobectomy of the lung for aspergillosis, and a colopleural fistula occurred on the second operative day as a complication. Aspergillus might be responsible for forming a fistula between the colon and lung via the diaphragm, and lung surgery manifested this rare condition. Although some reports suggest that surgical treatment is mandatory to cure this fistula, an immediate colostomy in our case reduced the internal pressure of the colon, thus enabling spontaneous closure of the fistula with appropriate drainage and antibiotics. The patient was discharged in a good condition. PMID:27108124

  2. Thoracic Duct Chylous Fistula Following Severe Electric Injury Combined with Sulfuric Acid Burns: A Case Report

    Science.gov (United States)

    Chang, Fei; Cheng, Dasheng; Qian, Mingyuan; Lu, Wei; Li, Huatao; Tang, Hongtai; Xia, Zhaofan

    2016-01-01

    Patient: Male, 32 Final Diagnosis: Thoracic duct chylous fistula Symptoms: Fistula Medication: — Clinical Procedure: A boneless muscle flap transplantatio Specialty: — Objective: Rare disease Background: As patients with thoracic duct injuries often suffer from severe local soft tissue defects, integrated surgical treatment is needed to achieve damage repair and wound closure. However, thoracic duct chylous fistula is rare in burn patients, although it typically involves severe soft tissue damage in the neck or chest. Case Report: A 32-year-old male patient fell after accidentally contacting an electric current (380 V) and knocked over a barrel of sulfuric acid. The sulfuric acid continuously poured onto his left neck and chest, causing combined electrical and sulfuric acid burn injuries to his anterior and posterior torso, and various parts of his limbs (25% of his total body surface area). During treatment, chylous fistula developed in the left clavicular region, which we diagnosed as thoracic duct chylous fistula. We used diet control, intravenous nutritional support, and continuous somatostatin to reduce the chylous fistula output, and hydrophilic silver ion-containing dressings for wound coverage. A boneless muscle flap was used to seal the left clavicular cavity, and, integrated, these led to resolution of the chylous fistula. Conclusions: Patients with severe electric or chemical burns in the neck or chest may be complicated with thoracic duct injuries. Although conservative treatment can control chylous fistula, wound cavity filling using a muscle flap is an effective approach for wound healing. PMID:27725628

  3. Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center.

    Science.gov (United States)

    Badrasawi, Manal Mh; Shahar, Suzana; Sagap, Ismail

    2014-01-01

    Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.

  4. Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis

    Directory of Open Access Journals (Sweden)

    Patino Carlos

    2003-01-01

    Full Text Available Allthough infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymphnodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.

  5. Ileorectal fistula due to a rectal cancer-A case report.

    Science.gov (United States)

    Takahashi, Minoru; Fukuda, Takahiro

    2011-01-01

    A 51-year-old man was seen at our hospital because of diarrhea. Barium enema and colonoscopy revealed a cancer in the lower rectum and fistula formation from the site to ileum. Resection of the rectal cancer and ileorectal fistula was performed. Histologically, the resected lesion was mucinous adenocarcinoma with contiguous invasion from the rectum to the ileum. The patient is alive with no sign of recurrence 120 months after operation. Fistula formation between the colon and other gastrointestinal tract organs is very rare, especially for rectal cancer. Fistula-forming colorectal cancers are rarely found to have metastatic lesions in the liver, peritoneum and lymph nodes despite their invasive behavior; accordingly, curative resection involving partial resection of the intestine with fistula is expected. PMID:22096678

  6. Hybrid management of a spontaneous ilio-iliac arteriovenous fistula: a case report

    LENUS (Irish Health Repository)

    O'Brien, Gavin C

    2011-08-22

    Abstract Introduction Spontaneous iliac arteriovenous fistulae are a rare clinical entity. Such localized fistulation is usually a result of penetrating traumatic or iatrogenic injury. Clinical presentation can vary greatly but commonly includes back pain, high-output congestive cardiac failure and the presence of an abdominal bruit. Diagnosis, therefore, is often incidental or delayed. Case presentation We report a case of a spontaneous ilio-iliac arteriovenous fistula in a 68-year-old Caucasian man detected following presentation with unilateral claudication and congestive cardiac failure. Following computed tomography evaluation, the fistula was successfully treated with a combined endovascular (aorto-uni-iliac device) and open (femoro-femoral crossover) approach. Conclusion Endovascular surgery has revolutionized the management of such fistulae and we report an interesting case of a high-output iliac arteriovenous fistulae successfully treated with a hybrid vascular approach.

  7. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

    Energy Technology Data Exchange (ETDEWEB)

    Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

    2008-08-15

    We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

  8. Tracheoesophageal fistula without esophageal atresia: are pull-back tube esophagograms needed for diagnosis?

    Energy Technology Data Exchange (ETDEWEB)

    Laffan, E.E.; Daneman, A.; Kerrigan, D.; Manson, D.E. [Univ. of Toronto (Canada). Dept. of Diagnostic Imaging; Ein, S.H. [Univ. of Toronto (Canada). Div. of General Surgery

    2006-11-15

    A pull-back tube esophagogram (PBTE) is widely accepted in the literature as the radiological investigation of choice for the diagnosis of tracheoesophageal fistula without esophageal atresia. However, PBTE is rarely performed in our institution, as we have been successful in confirming the presence of such fistulae with a contrast material swallow (CS). We hypothesized that PBTE is not the radiological investigation of choice for the diagnosis of the fistula in this condition. We sought to determine what proportion of patients with tracheoesophageal fistula without esophageal atresia can be diagnosed promptly by a CS and what the indications are for a PBTE. We retrospectively analyzed the clinical and radiological findings in patients with tracheoesophageal fistula without esophageal atresia to determine whether the fistula was diagnosed with a CS or PBTE. We identified 20 children (13 female and 7 male) with tracheoesophageal fistula without esophageal atresia. Their age at diagnosis ranged from 3 days to 168 months with a median of 9 days. The diagnosis was documented by CS in 12, PBTE in 7 and CT in 1. In three of the seven who had the fistula documented by PBTE, a previous CS had shown contrast material in the trachea, but no fistulous tract or aspiration was identified. We believe that CS should be the examination of choice in most patients suspected of having a tracheoesophageal fistula without esophageal atresia. A PBTE is indicated in patients who are intubated or are at significant risk of aspiration. Furthermore, a PBTE is also indicated in patients who are intubated or are at significant risk of aspiration. Furthermore, a PBTE is also indicated where contrast material is seen in the airway on CS and there is uncertainty whether this is due to aspiration or a fistula.

  9. 2 case of lymphatico-calyceal fistula causing chyluria

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seoung Oh; Hong, Seung Mo; Park, Jae Hyung; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1983-03-15

    After advent of lymphangiographic technique, the causes of chyluria can be evaluated by lymphangiography. The most common etiology known until today is parasitic origin, especially filariasis. In Korea, established organism of filariasis is Brugia malayi. And other nonparasitic etiologies such as retroperitoneal malignancy, chronic inflammatory diseases, trauma, pregnancy, aneurysm are very rate. The authors experienced two cases of lymphatico-calyceal fistulas causing chyluria demonstrated by lymphangiography. The etiology of these two cases were unknown exactly, but the clinical diagnosis were filariasis. These cases are reported with emphasis on the lymphangiographic findings of chyluria.

  10. Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

    LENUS (Irish Health Repository)

    Ogbonnaya, Ebere Sunny

    2011-01-01

    Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

  11. Effects of recombinant human growth hormone on enterocutaneous fistula patients

    Institute of Scientific and Technical Information of China (English)

    Guo-Sheng Gu; Jian-An Ren; Ning Li; Jie-Shou Li

    2008-01-01

    AIM: To explore the effects of recombinant human growth hormone (rhGH) on intestinal mucosal epithelial cell proliferation and nutritional status in patients with enterocutaneous fistula.METHODS: Eight patients with enterocutaneous fistulas recived recombinant human growth hormone(10 μg/d) for 7 d. Image analysis and immunohisto-chemical techniques were used to analyse the expression of proliferating cell nuclear antigen (PCNA) in intestinal mucosal epithelial cells in biopsy samples from the patients who had undergone an endoscopic biopsy through the fistula at day 0, 4 and 7. Body weights, nitrogen excretion, serum levels of total proteins, albumin, prealbumin, transferrin and fibronectin were measured at day 0, 4 and 7. RESULTS: Significant improvements occurred in the expression of PCNA in the intestinal mucosal epithelial cells at clay 4 and 7 compared to day 0 (24.93±3.41%, 30.46±5.24% vs 12.92±4.20%, P<0.01).These changes were accompanied by the significant improvement of villus height (500.54±53.79 μm,459.03±88.98 μm vs 210.94±49.16 μm, P<0.01),serum levels of total proteins (70.52±5.13 g/L, 74.89±5.16 g/L vs 63.51±2.47 g/L, P<0.01), albumin (39.44±1.18 g/L, 42.39±1.68 g/L vs 35.74±1.75 g/L, P<0.01) and fibronectin (236.3±16.5 mg/L,275.8±16.9 mg/L vs 172.5±21.4 mg/L, P<0.01) at day 4 and 7, and prealbumin (286.38±65.61 mg/L vs180.88±48.28 mg/L, P<0.05), transferrin (2.61±0.12 g/L vs 2.41±0.14 g/L, P<0.05) at day 7. Nitrogen excretion was significantly decreased at day 7 (3.40±1.65 g/d vs 7.25±3.92 g/d, P<0.05). No change was observed in the body weight.CONCLUSION: Recombinant human growth hormone could promote intestinal mucosal epithelial cell proliferation and protein synthesis in patients with enterocutaneous fistula.2008 The WIG Press. All rights reserved.

  12. Traumatic subclavian arteriovenous fistula in a young adult

    International Nuclear Information System (INIS)

    The case report of a 23 year-old patient who was admitted to the General Surgery Service of 'Saturnino Lora Torres' Provincial Teaching Clinical Surgical Hospital in Santiago de Cuba with the diagnosis of traumatic pneumothorax is described, as consequence of stab wounds in the right anterior and superior region of the thorax; but then, after 48 hours, a right subclavian arteriovenous fistula, which was proven by means of x ray was diagnosed. The postoperative clinical course was favorable and the patient was discharged after 11 days, completely asymptomatic. His working activities began 2 months later.(author)

  13. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

    Science.gov (United States)

    Sung, Kyoung-Su; Song, Young-Jin

    2016-01-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system. PMID:27446527

  14. Tracheoinnominate artery fistula as a complication of radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Reiter, D.; Piccone, B.R.; Littman, P.; Lisker, S.A.

    1979-03-01

    Tracheoinnominate artery fistulization is a well-known complication of tracheostomy and of tracheal resection. The first known occurrence of this problem in a patient in whom no transtracheal procedure had ever been performed is reported, and high-dose radiation therapy delivered three years before for a mediastinal malignancy is suggested as the cause. No evidence of tumor was found in or adjacent to the tracheovascular communication. The tracheoinnominate artery fistula must be considered a potential complication of radiation therapy as well as of surgery.

  15. Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Sheth, Rahul A. [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States); Feldman, Adam S. [Massachusetts General Hospital, Division of Urology, Department of Surgery (United States); Walker, T. Gregory, E-mail: tgwalker@partners.org [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States)

    2015-02-15

    Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

  16. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula

    Directory of Open Access Journals (Sweden)

    Michael Loudin

    2016-01-01

    Full Text Available Coccidioidomycosis (valley fever is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.

  17. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula.

    Science.gov (United States)

    Loudin, Michael; Clayburgh, Daniel R; Hakki, Morgan

    2016-01-01

    Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis. PMID:27313922

  18. Metastatic melanoma to the small bowel complicated by fistula formation

    Directory of Open Access Journals (Sweden)

    Nausheen Khan

    2011-12-01

    Full Text Available Malignant melanoma (MM is an unpredictable tumour that can metastasise to any organ, and is well known for its widespread dissemination. The incidence of metastases to the gastro-intestinal (GI tract is well documented; this, however, is a late manifestation of the disease with an overall poor prognosis. Most GI metastases are asymptomatic and are only discovered on postmortem, with the majority in the small bowel. The presenting symptoms are usually of obstruction or intussusception; GI bleeding is also common. Fistula formation with the small bowel is rare; ours is believed to be the second case documented.

  19. Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

    Directory of Open Access Journals (Sweden)

    Sven Richter

    2013-01-01

    Full Text Available Introduction. The open abdomen (OA is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients’ demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during ( or after NPWT (. Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation.

  20. Post-traumatic cerebrospinal fluid fistula: a case report; Fistula liquorica pos-traumatica - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Tamburus, Wander Miguel; Figueiredo Wanderley, Eliana Christina; Maciel, Damacio Ramon Kaimen; Narciso, Avelino Jose Soares; Sendenski, Mauricio Michalak [Universidade Estadual de Londrina, PR (Brazil). Centro de Ciencias da Saude

    1996-10-01

    Fronto-basal fracture occurs in around 5% of cranioencephalic trauma. the involved structures are: arachnoid, dura-mater, osseous base and the mucosa, and there us contact between the brain and the environment. Even with rupture of all these structures cerebrospinal fluid leakage may not occur; regardless of this, there may be infectious complications, such as bacterial meningitis or brain abscess. the authors report the case of a patient with head injury and four bacterial meningitis, the diagnosis of post-traumatic liquoric fistula being made only through magnetic resonance imaging. (author) 10 refs., 1 fig.

  1. PENUTUPAN FISTULA CELAH LANGITAN MEMAKAI PLAT PROTESA AKRILIK LEPASAN PADA ANAK (Laporan Kasus

    Directory of Open Access Journals (Sweden)

    Sjahril Noerdin

    2015-08-01

    Full Text Available Fistula cleft palate is an abnormal opening from the mouth to the nose (via the palate, where a part of the cleft palate did not heal properly after a surgical treatment. Fistula cleft palate in children is categorized as a psychic problem because of the abnormal appearance and problems to the mouth organ for eating, speech, and hearing. Providing optimal rehabilitation of closing the fistula cleft palate is not easy to achieve and requires a team-work of different experienced specialists. A child of three years with a fistula cleft palate came to the Dental Faculty's clnic with a poor gingival state, a high rate of caries on the deciduous teeth (destroyed and missing. The dental rehabilitation treatment would be to cover the fistula. The closing of the fistula with a removable acrylic protheses as obturator is to establish a normal arch-form, improved and redirected growth of the maxilla, so that the growth and development will be normally active with the feeding and speech development improved. The purpose of this case presentation was to overcome the difficulties in treating the teeth of children with fistula cleft palate.

  2. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    Science.gov (United States)

    Dennis, Alexis C; Wilson, Sarah M; Mosha, Mary V; Masenga, Gileard G; Sikkema, Kathleen J; Terroso, Korrine E; Watt, Melissa H

    2016-01-01

    Objective An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients. PMID:27660492

  3. Antiplasmodial activity of the ethnobotanical plant Cassia fistula.

    Science.gov (United States)

    Grace, Mary H; Lategan, Carmen; Graziose, Rocky; Smith, Peter J; Raskin, Ilya; Lila, Mary Ann

    2012-10-01

    In our ongoing investigation of new compounds with activity against malaria parasites, we tested the in vitro antiplasmodial activity of fractions and purified compounds from Cassia fistula L., a plant traditionally used by native populations of Tanzania, Zimbabwe, Mozambique and Brazil to treat malaria or symptoms associated with this disease. Crude extracts from leaves, bark and fruits were tested for their antiplasmodial activity against the chloroquine-sensitive strain of Plasmodium falciparum (D10), where leaf extracts showed the highest activity. The chloroform extract of the leaves was further bioassay-guided fractionated using a combination of centrifugal partition chromatography and flash column chromatography. Three main antiplasmodial principles, phytol (1) (IC50 18.9 +/- 0.60 microM), lutein (2) (IC50 12.5 +/- 0.35 microM), and di-lineolylgalactopyranosyl-glycerol (DLGG) (IC50 5.8 +/- 0.27 microM) (3), were isolated and identified using spectroscopic methods. When the three active principles were tested for their cytotoxicity using a Chinese Hamster Ovarian (CHO) cell line, compound 3 showed very weak toxicity (IC50 75.9 +/- 0.28 microM), while the other two compounds were nontoxic, even at the highest concentration tested. The study provides evidence to support the use of Cassia fistula as an antimalarial remedy and describes the antiplasmodial constituents from the leaves.

  4. Pancreaticopericardial Fistula: A Case Report and Literature Review

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    Muhammad S. Khan

    2016-01-01

    Full Text Available Purpose. Pancreaticopericardial fistula (PPF is an extremely rare complication of acute or chronic pancreatitis. This paper presents a rare case of PPF and provides systematic review of existing cases from 1970 to 2014. Methods. A PubMed search using key words was performed for all the cases of PPF from January 1970 to December 2014. Fourteen cases were included in the study. The cases were reviewed for demographic characteristics, diagnostic modalities, and treatment. Descriptive analysis of these variables was performed. Results. Median age was 43 years. 78% were known alcoholics and 73.3% had chronic pancreatitis. Dyspnea was present in 78%. Cardiac tamponade was present in 53%; 75% of patients had known chronic pancreatitis (RR = 0.74. Surgery was associated with best treatment outcomes and 50% of patients who underwent endoscopic treatment survived. Conclusion. PPF is a rare disease. This paper indicates that acute cardiac tamponade in patients with history of alcoholism and chronic pancreatitis could be a sign of an existing pancreaticopericardial fistula and early surgical intervention could be life-saving.

  5. Rectourethral fistula: A rare complication of injection sclerotherapy

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    Raman Tanwar

    2014-01-01

    Full Text Available In the modern era, the incidence of rectourethral fistula (RUF has been on a rise due to an increasing number of surgeries being performed for prostatic carcinoma. Other causes of this condition still remain rare and their management differs from that of post prostatectomy RUF. We report a rare case of a young man who presented with leakage of urine per rectum 4 weeks after injection sclerotherapy for haemorrhoids. A Micturating Cystourethrogram/Retrograde Cystourethrogram revealed the presence of RUF arising at the level of prostrato-membranous urethra and the urine examination did not show any fecal contamination of urine. A fistula at the level or verumontanum along with stricture of the distal penile urethra was demonstrated on urethroscopy. The patient was successfully managed by dilatation of the stricture segment and urethral catheterization. RUF can rarely result from injection sclerotherapy and must be thoroughly evaluated. Cases which present early and have minimal contamination of urine by fecal contents can be conservatively managed with a simple Foleys catheterization for 4-6 weeks after ruling out any obstruction distal to the fistulous tract.

  6. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

    Institute of Scientific and Technical Information of China (English)

    Hesham; Allam; R; Charles; Callison; Daniel; Scodary; Aws; Alawi; Daniel; W; Hogan; Amer; Alshekhlee

    2014-01-01

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.

  7. Embolization of intracranial dural arteriovenous fistulas with Onyx-18

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China); Wu Zhongxue [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantan Xili, Chongwen, Beijing 100050 (China)], E-mail: ttyyzjb@sina.com

    2010-03-15

    Background and purpose: The use of Onyx in the treatment of AVMs has been reported in the literature, but experience in the treatment of DAVF is lacking. We report the clinical outcome obtained in the treatment of dural arteriovenous fistulas (DAVFs) using a new liquid embolic agent, Onyx-18. Methods: The present series included 21 patients; 9 had DAVFs draining directly into the cortical veins, 6 had DAVFs draining directly into the dural sinus, 4 had DAVFs draining through the ophthalmic veins and 2 had DAVFs involving the dural sinus with leptomeningeal retrograde venous drainage Clinical data were extracted from hospital files and all patients were followed. Results: In 14 patients (70%) there was complete angiographic elimination of the shunts and resolution of the symptoms. The remaining 7(30%) patients was not cured with residual shunts. Adverse events occurred in 6(30%) of 21 patients with 1 DAVF located at the transverse sigmoid sinus, 2 at tentorium, and 3 at the cavernous sinus. Cranial deficits occurred in 3(15%) patients, brain infarction in 1(5%) patient and microcatheter gluing in 1(3.2%) patient. At final follow up, 20 patients were asymptomatic with 1 showed clinical improvement. Conclusion: Definitive cure may be attained effectively with Onyx in dural arteriovenous fistulas and adjunctive to surgery and radiotherapy. Location of the DAVFs affected the outcome of transarterial embolization.

  8. Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach

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    Cochetti Giovanni

    2013-09-01

    Full Text Available Introduction The standard treatment of colo-vesical fistula is the exeresis of fistula, suture of bladder wall, colic resection with or without temporary colostomy. Usually the approach is open because conversion rates and morbidity are lower than laparoscopy. The aim of video is to show the steps of a new mini-invasive approach of colo-vesical fistula without colic resection. Materials and Methods A 69 years old male underwent laparoscopic conservative treatment of colo-vesical fistula due to endoscopic polipectomy in sigmoid diverticulum. 12 mm trocar for the camera was placed at the umbilicus, two 10 mm trocars were placed along bisiliac line and 5 mm port was placed along left emiclavear line; Trendelenburg position was 20°. The fistulous loop was carefully isolated, clipped with Hem-o-lock® clips and removed. Since diverticular disease appeared slight and no inflammation signs were evident, colon resection was not performed. We sutured and sinked the sigmoid wall; after curettage of the fistula site, the bladder wall was sutured. Fat tissue was placed between sigmoid and bladder wall to reduce the risk of fistula recurrence. Results Operative time, estimated blood loss, catheterization time, time to flatus and hospital stay were respectively 210 minutes, 300 mL, 10 days, 48 h and 8 days. The histological examination showed colonic inflammatory and necrotic tissue. No complications or fistula recurrence occurred at 54 months follow-up. Conclusions The laparoscopic conservative treatment of colo-vesical fistula is a safe and feasible technique, in particular when the diverticular disease is limited and the fistula is not due to diverticulitis.

  9. The role of proper treatment of maxillary sinusitis in the healing of persistent oroantral fistula

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    David B. Kamadjaja

    2008-09-01

    Full Text Available Background: Oroantral communication (OAC is one of the possible complications after extraction of the upper teeth. If not identified and treated properly, a large OAC may develop into oroantral fistula (OAF which means that there is a permanent epithelium-lined communication between antrum and oral cavity. Such fistulas may cause ingress of microorganism from oral cavity into the antrum leading to maxillary sinusitis. Oroantral fistula usually persists if the infection in the maxillary antrum is not eliminated. Therefore, treatment of oroantral fistula should include management of maxillary sinusitis in which surgical closure of oroantral fistula should be done only when the sinusitis has been cured. Purpose: This case report emphasizes on the importance of proper management of maxillary sinusitis in the healing of oroantral fistula. Case: A case of an oroantral fistula following removal of upper left third molar is presented. As the maxillary sinusitis was not identified pre-operatively, two surgical procedures to close the fistula had ended up in dehiscence. Case management: The diagnosis of maxillary sinusitis was finally made and the sinusitis subsequently treated with combination of trans-alveolar sinus wash out, insertion of an acrylic splint, and two series of nasal and sinus physiotherapy procedures. The size of the defect decreased gradually during the treatment of the sinusitis and finally closed up without any further surgical intervention. Conclusion: This case report points out that it is important to detect intraoperatively an antral perforation after any surgery of the maxillary teeth and to close any oroantral communication as early as possible and that it is important to treat properly any pre-existing maxillary sinusitis before any surgical method is done to close the fistula.

  10. Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula

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    Thinda Sumeer

    2012-07-01

    Full Text Available Abstract Background Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the external or internal carotid arteries. Although rare, closure of carotid cavernous fistulas can lead to immediate ocular complications. To our knowledge, our case represents the first report of worsening angle closure glaucoma and choroidal detachments over an extended period of two months subsequent to closure of a carotid cavernous fistula. Case presentation A 70-year-old female with a history of primary angle closure glaucoma presented with 4 mm of proptosis, resistance to retropulsion, tortuous corkscrew blood vessels and an orbital bruit of the right eye. Diagnostic cerebral angiogram showed a small indirect Barrow type D right carotid cavernous fistula. Transarterial embolization was planned but repeat cerebral angiography prior to the procedure demonstrated spontaneous partial closure of the carotid cavernous fistula and the procedure was aborted. One month later, our patient was noted to have worsening vision and choroidal detachments of the right eye. She declined further testing and was thus started on self-administered manual carotid jugular compressions. One month later, she developed progressive worsening of her choroidal detachments and angle closure. She eventually opted for surgical intervention but repeat cerebral angiography showed significant thrombosis of the carotid cavernous fistula and no intervention was warranted. Examination two months later showed complete resolution of the choroidal detachments and open angles of both eyes. Conclusions Our patient demonstrated worsening angle closure glaucoma and choroidal detachments after spontaneous closure of her carotid cavernous fistula had been noted. Ocular complications, including acute angle closure, have been reported to occur immediately after closure of carotid cavernous fistulas, but not over months as in our patient. It is imperative that individuals who have

  11. Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

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    Badrasawi MMH

    2014-08-01

    Full Text Available Manal MH Badrasawi,1 Suzana Shahar,1 Ismail Sagap2 1Dietetics Program, School of Health Care Sciences, Faculty of Health Sciences, 2Department of Surgery, Faculty of Medicine, UKM Medical Center, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Abstract: Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical

  12. [Conservative anal fistula treatment with collagenic plug and human fibrin sealant. Preliminary results].

    Science.gov (United States)

    Gubitosi, A; Moccia, G; Malinconico, F A; Docimo, G; Ruggiero, R; Iside, G; Avenia, N; Docimo, L; Foroni, F; Gilio, F; Sparavigna, L; Agresti, M

    2009-01-01

    The authors, on the basis of a long clinical experience with human fibrin glue in general surgery, compared two different extracellular matrix (collagen), Surgisis and TissueDura, with human fibrin glue, applied during the operation, and sometimes in postoperative, to obtain the healing of perianal fistulas. The collagenic extracellular matrix provides, according to the rationale suggested, an optimal three-dimensional structure for the fibroblastic implant and neoangiogenesis, hence for the fistula "fibrotizzation" and closure. The encouraging results for transphincteric fistulas and a simple and easy technique push to researchers on samples statistically significant. PMID:19272233

  13. Rectovaginal Fistula after Low Anterior Resection for Rectal Cancer Using a Double Stapling Technique

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    Satoshi Yodonawa

    2010-07-01

    Full Text Available A 55-year-old female underwent low anterior resection for rectal cancer using a double stapling technique. She developed a rectovaginal fistula on the 9th postoperative day. She was discharged from hospital after undergoing transverse colostomy, and 5 months later she underwent transvaginal repair of the rectovaginal fistula. She subsequently had an uneventful recovery. The leading cause of this complication is involvement of the posterior wall of the vagina in the staple line when firing the circular stapler. Transvaginal repair with a diverting stoma for rectovaginal fistula is a safe, minimally invasive and effective method.

  14. Appendico-cutaneous fistula 20 years after groin hernia repair with a polypropylene plug

    OpenAIRE

    Wijers, Olivier; Conijn, Anne; Wiese, Hans; Sjer, Mike

    2013-01-01

    The formation of an appendico-cutaneous fistula is rare. Few case reports have been published; most describe the formation of a fistula after appendicitis. Here we describe the case of a 79-year-old woman presenting with an appendico-cutaneous fistula after groin hernia repair. She was referred to our outpatient department with a painful mass in the right groin. An ultrasound showed a fluid containing mass. Incision and drainage was performed. After 9 weeks she was referred again with a persi...

  15. [Enterocutaneous fistula formation in a dog as a result of colonic foreign body perforation].

    Science.gov (United States)

    Wunderlin, N; Biel, M; Peppler, C; Amort, K; Kramer, M

    2012-04-24

    A 5-year-old female Poodle was presented with a 3-month history of recurrent abscess and fistula formation on the right abdominal wall. Radiographic and ultrasonographic examinations demonstrated an enterocutaneous fistula formation secondary to foreign body perforation of the colon. Additionally, the diagnosis of a pyometra was made. Twenty-four hours after surgical therapy (ventral midline coeliotomy, foreign body removal, closure of the colon perforation, abdominal lavage and drainage, revision of the fistula) the patient was euthanized due to sepsis and incipient multiorgan dysfunction. PMID:22526816

  16. Short-term outcomes of the surgical management of acquired rectourethral fistulas: does technique matter?

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    Nfonsam VN

    2013-01-01

    Full Text Available Valentine N Nfonsam,1 James JL Mateka,2 Andrew D Prather,2 Jorge E Marcet21Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA; 2Department of Surgery, College of Medicine, University of South Florida, Tampa, FL, USABackground: Acquired rectourethral fistulas are uncommon and challenging to repair. Most arise as a complication of prostate cancer treatment. Several procedures have been described to repair rectourethral fistulas with varying outcomes. We review the etiology, management, and outcomes of patients with rectourethral fistulas at our institution.Materials and methods: A retrospective review of patients undergoing repair of rectourethral fistulas was undertaken. Data were collected on patient demographics, fistula etiology, operative procedure, fecal and urinary diversion, and clinical outcome. Patients with urinary and/or fecal diversion underwent radiographic evaluation to confirm closure of the fistula prior to reversal of the diversion.Results: Fistula repair was performed on 22 patients from 1999 to 2009. All the patients were male of an average age of 69 years (range: 39–82 years. All patients, except one, had prostate cancer. Fistula formation was associated with radiotherapy in 54.4% of patients, brachytherapy in 36.4% of patients, and with external beam radiation therapy in 18.2% of patients. Other causes included prostatectomy (seven patients, 31.8%, cryotherapy (two patients, 9.1%, and perianal abscess (one patient, 4.5%. Procedures performed for fistula repair included transanal repair (eleven patients, 50%, transperineal repair (five patients, 22.7%, transabdominal repair (three patients, 13.6%, and York–Mason repair (three patients, 13.6%. Fourteen patients (63.6% had urinary diversion. Fecal diversion was performed in 16 (72.7% patients. Five (22.7% patients had had previous attempts at fistula repair. Of the 22 patients treated, repair was successful in 20 patients (91%. The average

  17. Leiomyosarcoma with coronary fistulae and ventricular septal perforation:A case study

    Institute of Scientific and Technical Information of China (English)

    Dang-Sheng HUANG; Yu-Mei WANG; Yu CHEN

    2014-01-01

    Coronary fistulae and ventricular septal perforation are very rare clinically, and even less caused by cardiac leiomyosarcoma. A case is reported that a 67-year-old female had cardiac leiomyosarcoma with progressive heart failure and coronary fistulae and ventricular septal perforation. This case was special since all ante-mortem examinations and cardiac surgery failed to detect the presence of any abnormal car-diac mass. Therefore, the malignant cardiac tumors could appear in an invasive form without mass and be one of the causes of the coronary fistulae and ventricular septal perforation.

  18. Bilateral Persistent Trigeminal Arteries with Unilateral Trigeminal Artery to Cavernous Sinus Fistula

    Science.gov (United States)

    Chen, David; Chen, Chi-Jen; Chen, Jiann-Jy; Tseng, Ying-Chi; Hsu, Hui-Ling; Ku, Jan-Wen

    2013-01-01

    Summary A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a spontaneous fistula connected from one PTA to the ipsilateral cavernous sinus. This paper reports such a rare circumstance. PMID:24070083

  19. Bilateral persistent trigeminal arteries with unilateral trigeminal artery to cavernous sinus fistula. A case report.

    Science.gov (United States)

    Chen, David; Chen, Chi-Jen; Chen, Jiann-Jy; Tseng, Ying-Chi; Hsu, Hui-Ling; Ku, Jan-Wen

    2013-09-01

    A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a spontaneous fistula connected from one PTA to the ipsilateral cavernous sinus. This paper reports such a rare circumstance. PMID:24070083

  20. Ureteroiliac Artery Fistula in a Young Woman with Short Bowel Syndrome for Radiation Enteritis

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    Lidia Santarpia

    2010-01-01

    Full Text Available Ureteral-iliac artery fistula is a rare and potentially life-threatening complication, typically occurring after radiation therapy in already surgically treated cancer patients. This case report describes the diagnostic challenges and the successful management, with the positioning of an intra-arterial prosthesis, of a fistula between the internal iliac artery and the left ureter presenting as massive hematuria in a young woman with history of total colectomy and pelvic radiotherapy for rectal cancer and subsequent wide ileal resections and bilateral ureteral stent positioning for radiation enteritis. Ureteroiliac artery fistulas require a prompt diagnosis and intervention, to avoid life threatening clinical events.

  1. Hemodynamic effects of closure of residual arteriovenous fistulae during in situ graft procedures

    DEFF Research Database (Denmark)

    Laustsen, Jesper; Nielsen, Henriette Svarre; Pedersen, Erik Morre;

    2011-01-01

    The objective was to study the intraoperative hemodynamic effects of closure of residual arteriovenous fistulae during in situ saphenous vein graft procedures. Data on 60 residual arteriovenous fistulae in nine patients (five men) with a median age of 74 years (range 64-83 years) with critical...... lower limb ischemia were obtained. Direct measurements of proximal and distal blood pressures in the graft were taken and simultaneous determinations of volume blood flow proximally and distally in the graft with ultrasound transit time technique before and after closure of residual fistulae were made...

  2. Huge aneurysm and coronary-cameral fistula from right coronary branch: First case.

    Science.gov (United States)

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-02-01

    Coronary-cameral fistulas are rare cardiovascular anomalies. A giant coronary artery aneurysm associated with a coronary-cameral fistula is a very rare condition, with an estimated prevalence of 0.02%. We report the case of middle-aged woman who presented with a huge extracardiac aneurysmal mass and a coronary-cameral fistula from a right coronary artery branch. It was successfully repaired by ligation and excision plus marsupialization of the aneurysm. We believe this is the first such a case reported in literature.

  3. A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult

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    Rajamanickam Saravana

    2010-01-01

    Full Text Available A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult.

  4. Fístulas dentales en el perro: estudio epidemiológico Dental fistulae in the dog: epidemiological study

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    S.Z Hernández

    2007-12-01

    .21%, followed by the upper first molar (11.84%, upper canine teeth (1.97% and lower first molar (1.97%. In relation with the upper fourth premolar roots, the distal one was involved in 86 cases (67.18%, the mesiovestibular in 17 (13.28% and both of them in 25 (19.53%. It is very important to perform an adequate radiological diagnosis in order to determine the tooth (and root that originates the fistulae, and be able to perform the suitable treatment (exo or endodontic.

  5. Arteriovenous Fistula Development in the First 6 Weeks after Creation.

    Science.gov (United States)

    Robbin, Michelle L; Greene, Tom; Cheung, Alfred K; Allon, Michael; Berceli, Scott A; Kaufman, James S; Allen, Matthew; Imrey, Peter B; Radeva, Milena K; Shiu, Yan-Ting; Umphrey, Heidi R; Young, Carlton J; Group, For The Hemodialysis Fistula Maturation Study

    2016-05-01

    Purpose To assess the anatomic development of native arteriovenous fistula (AVF) during the first 6 weeks after creation by using ultrasonographic (US) measurements in a multicenter hemodialysis fistula maturation study. Materials and Methods Each institutional review board approved the prospective study protocol, and written informed consent was obtained. Six hundred and two participants (180 women and 422 men, 459 with upper-arm AVF and 143 with forearm AVF) from seven clinical centers underwent preoperative artery and vein US mapping. AVF draining vein diameter and blood flow rate were assessed postoperatively after 1 day, 2 weeks, and 6 weeks. Relationships among US measurements were summarized after using multiple imputation for missing measurements. Results In 55% of forearm AVFs (68 of 124) and 83% of upper-arm AVFs (341 of 411) in surviving patients without thrombosis or AVF intervention prior to 6 weeks, at least 50% of their 6-week blood flow rate measurement was achieved at 1 day. Among surviving patients without thrombosis or AVF intervention prior to week 2, 70% with upper-arm AVFs (302 of 433) and 77% with forearm AVFs (99 of 128) maintained at least 85% of their week 2 flow rate at week 6. Mean AVF diameters of at least 0.40 cm were seen in 85% (389 of 459), 91% (419 of 459), and 87% (401 of 459) of upper-arm AVFs and in 40% (58 of 143), 73% (104 of 143), and 77% (110 of 143) of forearm AVFs at 1 day, 2 weeks, and 6 weeks, respectively. One-day and 2-week AVF flow rates and diameters were used to predict 6-week levels, with 2-week prediction of 6-week measures more accurate than those of 1 day (flow rates, R(2) = 0.47 and 0.61, respectively; diameters, R(2) = 0.49 and 0.82, respectively). Conclusion AVF blood flow rate at 1 day is usually more than 50% of the 6-week blood flow rate. Two-week measurements are more predictive of 6-week diameter and blood flow than those of 1 day. US measurements at 2 weeks may be of value in the early identification of

  6. Gastric Duplication: A Rare Cause of Massive Lower Gastrointestinal Haemorrhage, Chest Wall Mass, and Enterocutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Emeka B. Kesieme

    2012-01-01

    Full Text Available Gastric duplications are uncommon developmental abnormality reported to present with different clinical scenarios. We present a 2-1/2-year-old Nigerian female who started having intermittent massive lower gastrointestinal haemorrhage at 5 months of age. She subsequently developed a lower chest wall mass and enterocutaneous fistula. She was found to have gastric duplication with fistulous communication with the descending colon, spleen, and lower chest wall. To the best of our knowledge, this is the first paper on gastric duplication resulting in intermittent massive lower gastrointestinal bleeding mainly from splenic capsular erosion and fistula and enterocutaneous fistula resulting from erosion of anterior abdominal wall. Gastric duplication is hence an important rare cause of intermittent massive lower gastrointestinal haemorrhage and spontaneous enterocutaneous fistula in the paediatric population.

  7. The nance obturator, a new fixed obturator for patients with cleft palate and fistula.

    Science.gov (United States)

    Borzabadi-Farahani, Ali; Groper, John N; Tanner, Aaron M; Urata, Mark M; Panossian, Andre; Yen, Stephen L-K

    2012-07-01

    In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.

  8. Conversion of percutaneous endoscopic gastrostomy to gastrojejunostomy under fluoroscopic guidance for treatment of gastrocutaneous fistula.

    Science.gov (United States)

    Kim, Joon-Sung; Baik, Jun Hyun; Lim, Seong Hoon; Hong, Bo Young; Jo, Leechan

    2015-02-01

    Persistent enterocutaneous fistula after the removal of a gastrostomy tube is an unusual complication of percutaneous endoscopic gastrostomy (PEG). The following case report describes an 81-year-old man diagnosed with stroke and dysphagia in May 2008. The patient had been using a PEG since 2008, and PEG site infection occurred in June 2013. The PEG tube was removed and a new PEG tube was inserted. Thereafter, formation of gastrocutaneous fistula around the previous infected PEG site was observed. The fistula was refractory to medical management, accompanied by long duration of fasting and peripheral alimentation. Therefore, gastrojejunostomy tube insertion via the previously inserted PEG tube was performed, under fluoroscopic guidance; this mode of management was successful. For patients who have a gastrocutaneous fistula, gastrojejunostomy tube insertion via the pre-existing PEG tube is a safe and effective alternative management for enteral feeding. PMID:25750883

  9. Hypertrophic Pyloric Stenosis Following Repair of Esophageal Atresia and Tracheo-Esophageal Fistula

    OpenAIRE

    Emmanuelle Seguier-Lipszyc; Baruch Klin

    2014-01-01

    Two cases of hypertrophic pyloric stenosis (HPS) developed after a few weeks of repair of an esophageal atresia and tracheo-esophageal fistula (EA&TEF). Both cases were dealt successfully with laparoscopic pyloromyotomy.

  10. Hypertrophic Pyloric Stenosis Following Repair of Esophageal Atresia and Tracheo-Esophageal Fistula

    Directory of Open Access Journals (Sweden)

    Emmanuelle Seguier-Lipszyc

    2014-07-01

    Full Text Available Two cases of hypertrophic pyloric stenosis (HPS developed after a few weeks of repair of an esophageal atresia and tracheo-esophageal fistula (EA&TEF. Both cases were dealt successfully with laparoscopic pyloromyotomy.

  11. Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Hirsch, M.; Maroko, I.; Gueron, M.; Goleman, L.

    1983-08-01

    Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the non-surgical and surgical therapeutic approaches are discussed.

  12. Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

    International Nuclear Information System (INIS)

    Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the non-surgical and surgical therapeutic approaches are discussed. (orig.)

  13. Nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients. Methods: After breaking thrombus through indwelling catheter, both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula. The necessary nursing measures were carried out to assist the whole therapeutic procedure. Results: All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion. The reopening rate of the obstructed fistula was 100%. Conclusion: Indwelling catheter thrombolysis with urokinase infusion is a simple, effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients. In order to obtain optimal results, necessary nursing measures must be carried out. (authors)

  14. Mussel adhesion-employed water-immiscible fluid bioadhesive for urinary fistula sealing.

    Science.gov (United States)

    Kim, Hyo Jeong; Hwang, Byeong Hee; Lim, Seonghye; Choi, Bong-Hyuk; Kang, Seok Ho; Cha, Hyung Joon

    2015-12-01

    Urinary fistulas, abnormal openings of a urinary tract organ, are serious complications and conventional management strategies are not satisfactory. For more effective and non-invasive fistula repair, fluid tissue adhesives or sealants have been suggested. However, conventional products do not provide a suitable solution due to safety problems and poor underwater adhesion under physiological conditions. Herein, we proposed a unique water-immiscible mussel protein-based bioadhesive (WIMBA) exhibiting strong underwater adhesion which was employed by two adhesion strategies of marine organisms; 3,4-dihydroxy-l-phenylalanine (DOPA)-mediated strong adhesion and water-immiscible coacervation. The developed biocompatible WIMBA successfully sealed ex vivo urinary fistulas and provided good durability and high compliance. Thus, WIMBA could be used as a promising sealant for urinary fistula management with further expansion to diverse internal body applications. PMID:26352517

  15. A Rare Complication of Composite Dual Mesh: Migration and Enterocutaneous Fistula Formation

    Directory of Open Access Journals (Sweden)

    Ozgur Bostanci

    2015-01-01

    Full Text Available Introduction. Mesh is commonly employed for abdominal hernia repair because it ensures a low recurrence rate. However, enterocutaneous fistula due to mesh migration can occur as a very rare, late complication, for which diagnosis is very difficult. Presentation of Case. Here we report the case of an enterocutaneous fistula due to late mesh migration in a mentally retarded, diabetic, 35-year-old male after umbilical hernia repair with composite dual mesh in 2010. Discussion. Mesh is a foreign substance, because of that some of the complications including hematoma, seroma, foreign body reaction, organ damage, infection, mesh rejection, and fistula formation may occur after implantation of the mesh. In the literature, most cases of mesh-associated enterocutaneous fistula due to migration involved polypropylene meshes. Conclusion. This case serves as a reminder of migration of composite dual meshes.

  16. An unusual presentation of xanthogranulomatous pyelonephritis: psoas abscess with reno-colic fistula.

    Science.gov (United States)

    Ghoz, Hassan M; Williams, Martin; Perepletchikov, Aleksandr; James, Nicholas; Babeir, Abdulrahman A

    2016-07-01

    Xanthogranulomatous pyelonephritis (XGP) is a rare histological subset of pyelonephritis characterized by being a chronic destructive granulomatous inflammation of the renal parenchyma. XGP is classified according to the extent of disease into two entities: within the renal cortex (focal or segmental XGP) or diffuse spread with pelvic communication (diffuse XGP). Although rare, XGP can have fatal complications including perinephric, psoas abscess, nephro-cutaneous fistula and reno-colic fistula. Only few studies have reported XGP complicated with psaos abcess and reno-colic fistula. Our aim is to add to the literature and share our experience with a case of extensive XGP eroding into the psoas muscle and ascending colon leading to severe sepsis that was successfully managed. We report a 56-year-old woman who was found to have XGP complicated by psoas abscess and reno-colic fistula managed by antibiotics, nephrostomy, and subsequent nephrectomy and partial colectomy. PMID:27471599

  17. One trial treatment for postoperative fistulas of irradiated malignant tumors in the head and neck

    International Nuclear Information System (INIS)

    It is very difficult to treat postoperative fistulas of irradiated malignant tumors in the head and neck. These fistulas generally require either surgical or conservative therapy, but the poor healing induced by irradiation means that a long time is required to obtain a complete cure. As one of the conservative therapies for these wounds, we first applied alcloxa powder which had been used as the treatment of either decubitis or ulcers, and we thus were able to obtain a complete cure in 8 patients without the need for any reconstructive surgery. The number of days required to obtain a complete cure of the fistulas ranged from 9 to 84 days, with an average of 39.8 days. These results indicated that this powder had an excellent efficacy on wound healing, and it should thus be used frequently on incurable postoperative fistulas after irradiation in head and neck malignancies. (author)

  18. Multimodality Imaging Diagnostic Approach of Systemic-to-Pulmonary Vein Fistulae.

    Science.gov (United States)

    El Ghannudi, Soraya; Germain, Philippe; Jeung, Mi-Young; Jahn, Christine; Hirschi, Sandrine; Roy, Catherine

    2016-03-01

    A 26-year-old man with a history of bilateral lung transplantation for pulmonary cystic fibrosis 6 months before was admitted in our institution for acute heart failure. Cardiac magnetic resonance imaging (CMR) showed an increased aortic output, as aortic flow assessed by velocity mapping was twofold the pulmonary flow, an occluded superior vena cava (SVC), and enlarged azygos vein. A systemic-to-pulmonary vein fistula (SAPVF) was suspected. The selective angiography showed numerous fistulae between intercostals, thyro-cervical, internal mammary arteries and pulmonary veins. The thoracic CT performed before the CMR, which was initially considered as normal, showed well these arteriovenous fistulae after 3D MIP reconstruction. This particular observation highlights the great value of multimodality imaging for the diagnosis of this rare pathology. The MR velocity mapping is a noninvasive imaging technique of great interest to guide the diagnosis of arteriovenous fistulae, and further indicating more invasive complementary imaging modalities like selective arterial angiography. PMID:26603830

  19. Diagnosis and management of trigemino-cavernous fistulas: case reports and review of the literature.

    Science.gov (United States)

    Miller, Timothy R; Jindal, Gaurav; Mohan, Suyash; Fortes, Manuel; Hurst, Robert; Pukenas, Bryan; Gandhi, Dheeraj

    2015-01-01

    Although usually asymptomatic, a persistent trigeminal artery (PTA) can rarely be associated with a direct fistula to the cavernous sinus (ie, trigemino-cavernous fistula). We present three patients with trigemino-cavernous fistulas; two were subsequently treated using modern endovascular techniques while the third initially declined therapy. We then review the literature of reported cases of this unusual entity. The aberrant anatomy associated with a PTA presents unique challenges to the management of these lesions, and must be well delineated prior to treatment. Finally, conservative management of trigemino-cavernous fistulas, either de novo or recurrent, may be considered if they demonstrate no evidence of cortical venous reflux and patient symptoms are tolerable. PMID:24394154

  20. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  1. Sigmoid exclusion: a new technique in the management of radiation-induced fistula

    International Nuclear Information System (INIS)

    Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas. (author)

  2. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh

    DEFF Research Database (Denmark)

    Eriksen, Mh; Bulut, O

    2014-01-01

    abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis....... It seems that hernia repairs with biological meshes have lower erosion and infection rates compared with synthetic meshes, and so far, evidence suggests that biological grafts are safe and effective in the treatment of pelvic floor reconstruction. There have been no reports of enteric fistulas after pelvic...... reconstruction with biological meshes. However, the development of intestinal fistulas after chemotherapy with bevacizumab has been described in the literature. Our case report supports this association between bevacizumab and fistula formation among rectal cancer patients, as symptoms of a fistula started only...

  3. Risk factors for obstetric fistula in Western Uganda: a case control study.

    Directory of Open Access Journals (Sweden)

    Justus Kafunjo Barageine

    Full Text Available INTRODUCTION: Two million women worldwide are living with genital fistula with an annual incidence of 50,000-100,000 women. Risk factors for obstetric fistula are context bound. Studies from other countries show variation in the risk factors for obstetric fistula. This study was conducted to identify risk factors for obstetric fistula in western Ugandan context. METHODS: A case control study comparing background factors of women with obstetric fistula (cases and women without fistula (controls was conducted in western Uganda. Data was collected using face-to-face interviews. Univariate, bivariate and multivariate analysis was conducted using Stata 12. RESULTS: Altogether, 420 respondents (140 cases and 280 controls participated in the study. Duration of labour was used to form the product terms when assessing for interaction and confounding since it was one the most significant factors at bivariate level with a narrow confidence interval and was hence considered the main predictor. After adjusting for interaction and confounding, significant risk factors associated with development of obstetric fistula in western Uganda were: Caesarean section (adjusted odds ratio [AOR] = 13.30, 95% CI = 6.74-26.39, respondent height of 150 cm or less (AOR = 2.63, 95% CI = 1.35-5.26, baby weight of 3.5 kg or more (AOR = 1.52, 95% CI = 1.15-1.99, prolonged labour (AOR = 1.06, 95% CI = 1.04-1.08. A quarter of the fistulas had resulted from iatrogenic complication during caesarean section. Compared to no education, post primary level of education was protective against obstetric fistula (AOR = 0.31, 95% CI = 0.13-0.72 and there was no difference between respondents without education and those with primary level education. CONCLUSIONS: Surgeons contribute to a big proportion (25% of fistula cases hence caesarean section being a risk factor in this region. Other risk factors include; prolonged labour, weight of the baby of 3.5 kg or more, respondent height of 150 cm

  4. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

    Science.gov (United States)

    Monteiro, Bárbara Vanessa de Brito; Grempel, Rafael Grotta; Gomes, Daliana Queiroga de Castro; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa

    2013-01-01

    Introduction Adenoid cystic carcinoma (ACC) is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site. PMID:25992095

  5. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Monteiro, Bárbara Vanessa de Brito

    2014-01-01

    Full Text Available Introduction Adenoid cystic carcinoma (ACC is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site.

  6. Congenital esophageal atresia with tracheo-esophageal fistula

    Energy Technology Data Exchange (ETDEWEB)

    Rhee, Chung Sik [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    1970-10-15

    Three cases of esophageal atresia with tracheo-esophageal fistula. 1). Case 1: A female infant birth Wt. 1.95 kg , Apgar Score 10, Skeletal anomalies, was delivered after a pregnancy compeicated by hydroamnious on Aug. 17, 1970. The family history was not contributory. 2) Case 2: A male infant birth Wt. 2.8 kg , Apgar Score 8, was forcep delivered after a pregnancy on Feb. 8, 1970. This infant is twin. The family history was not contributory. 3) Case 3: A female infant birth Wt. 2.22 kg , Apgar Score 10, was C-section after a pregnancy on May, 16. 1970. The family history was not contributory. All cases: After 24 hours 5% glucose solution was given and immediately vomited and some of it regurgitating through the nose and mouth with associated cyanosis and dyspnea. A catheter was inserted through the nose into the esophagus under diagnosis of the esophageal atresia.

  7. Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)

    1990-01-01

    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

  8. Spinal dural arteriovenous fistula: Imaging features and its mimics

    Energy Technology Data Exchange (ETDEWEB)

    Jeog, Ying; Ting, David Yen; Hsu, Hui Ling; Huang, Yen Lin; Chen, Chi Jen; Tseng, Ting Chi [Dept. of Radiology, aipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan (China)

    2015-10-15

    Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.

  9. Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

    Directory of Open Access Journals (Sweden)

    Parthasarathi Ramakrishnan

    2005-10-01

    Full Text Available Abstract Background Rectovaginal fistula (RVF is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature. Methods We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature. Results The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found. Conclusion Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.

  10. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes;

    2014-01-01

    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev...... was estimated to be 242 mL/min and 404 mL/min lower than the ultrasound dilution technique estimate, depending on the approach. The standard deviations of the two Vector Flow Imaging approaches were 175.9 mL/min and 164.8 mL/min compared with a standard deviation of 136.9 mL/min using the ultrasound dilution...... technique. The study supports that Vector Flow Imaging is applicable for volume flow measurements....

  11. Review Article: Medical, surgical and radiological management of perianal Crohn's fistulas

    OpenAIRE

    Tozer, Phil; Burling, David; Gupta, Arun; Phillips, Robin K.; Hart, Ailsa

    2010-01-01

    Abstract Background Crohn?s anal fistulas are common and cause considerable morbidity. Their management is often difficult; medical and surgical treatments rarely lead to true healing with frequent recurrence and complications. Aim In this review, we examine medical treatments previously and currently used, surgical techniques and the important role of optimal imaging. Methods We conducted a literature search in the Pub Med database using Crohn?s, Anal Fistula, ...

  12. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal

    OpenAIRE

    Sileri Pierpaolo; Cadeddu Federica; D'Ugo Stefano; Franceschilli Luana; Del Vecchio Blanco Giovanna; De Luca Elisabetta; Calabrese Emma; Capperucci Sara; Fiaschetti Valeria; Milito Giovanni; Gaspari Achille

    2011-01-01

    Abstract Background Several techniques have been described for the management of fistula-in-ano, but all carry their own risks of recurrence and incontinence. We conducted a prospective study to assess type of presentation, treatment strategy and outcome over a 5-year period. Methods Between 1st January 2005 and 31st March 2011 247 patients presenting with anal fistulas were treated at the University Hospital Tor Vergata and were included in the present prospective study. Mean age was 47 year...

  13. Transcatheter closure of large right pulmonary artery-to-left atrial fistula

    Directory of Open Access Journals (Sweden)

    Karunakar Vadlamudi

    2013-01-01

    Full Text Available We report the successful transcatheter closure of right pulmonary artery fistula to left atrium in a six-year-old boy, who had presented with cyanosis and shortness of breath. The two-dimensional echocardiogram with bubble contrast study demonstrated the communication between right pulmonary artery and left atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy. The fistula was closed successfully by a transcatheter trans-septal approach using an 18/20 duct occluder.

  14. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    Directory of Open Access Journals (Sweden)

    Dennis AC

    2016-09-01

    Full Text Available Alexis C Dennis1 Sarah M Wilson1–3 Mary V Mosha4 Gileard G Masenga4 Kathleen J Sikkema1,5,6 Korrine E Terroso1 Melissa H Watt1 1Duke Global Health Institute, Duke University, 2Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Kilimanjaro Christian Medical Center, Moshi, Tanzania; 5Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; 6Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa Objective: An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.Patients and methods: The study used a mixed-methods design to analyze cross-sectional surveys (n=59 and in-depth interviews (n=20.Results: Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.Conclusion: Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic

  15. Traumatic Persistent Trigeminal Artery - Cavernous Sinus Fistula Treated by Transcatheter Arterial Embolization: A Case Report

    OpenAIRE

    Asai, K.; Hasuo, K; Hara, T.; Miyagishima, T.; Terano, N.

    2010-01-01

    We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation.

  16. Nitric Oxide Resistance Reduces Arteriovenous Fistula Maturation in Chronic Kidney Disease in Rats.

    Directory of Open Access Journals (Sweden)

    Irma L Geenen

    Full Text Available Autologous arteriovenous (AV fistulas are the first choice for vascular access but have a high risk of non-maturation due to insufficient vessel adaptation, a process dependent on nitric oxide (NO-signaling. Chronic kidney disease (CKD is associated with oxidative stress that can disturb NO-signaling. Here, we evaluated the influence of CKD on AV fistula maturation and NO-signaling.CKD was established in rats by a 5/6th nephrectomy and after 6 weeks, an AV fistula was created between the carotid artery and jugular vein, which was followed up at 3 weeks with ultrasound and flow assessments. Vessel wall histology was assessed afterwards and vasoreactivity of carotid arteries was studied in a wire myograph. The soluble guanylate cyclase (sGC activator BAY 60-2770 was administered daily to CKD animals for 3 weeks to enhance fistula maturation.CKD animals showed lower flow rates, smaller fistula diameters and increased oxidative stress levels in the vessel wall. Endothelium-dependent relaxation was comparable but vasorelaxation after sodium nitroprusside was diminished in CKD vessels, indicating NO resistance of the NO-receptor sGC. This was confirmed by stimulation with BAY 60-2770 resulting in increased vasorelaxation in CKD vessels. Oral administration of BAY 60-2770 to CKD animals induced larger fistula diameters, however; flow was not significantly different from vehicle-treated CKD animals.CKD induces oxidative stress resulting in NO resistance that can hamper AV fistula maturation. sGC activators like BAY 60-2770 could offer therapeutic potential to increase AV fistula maturation.

  17. The Folded Buccal Musculomucosal Flap for Large Palatal Fistulae in Cleft Palate

    Directory of Open Access Journals (Sweden)

    Shinji Kobayashi, MD

    2014-02-01

    Conclusion: The f-BMMF is able to cover both sides without a raw surface and a mucosal graft even in cases of large fistula closure, although BMMF cannot usually cover both oral and nasal sides of a fistula. The advantages of this procedure are that it does not require second surgery to release the pedicle and that its distal island mucosa can be used to monitor engraftment. This proposed method seems to be an appealing alternative.

  18. A Novel Cassia fistula (L.)-Based Emulsion Elicits Skin Anti-Aging Benefits in Humans

    OpenAIRE

    Barkat Ali Khan; Naveed Akhtar; Abder Menaa; Farid Menaa

    2015-01-01

    Cassia fistula, a flowering plant in the family of Caesalpinaceae (Fabaceae), is used in traditional medicine for several indications. Nevertheless, too little is known about its effects on skin conditions and skin aging. Therefore, in this pioneering study, the extracts of oil-in-water macro-emulsions containing 5% C. fistula (L.) crude pods (i.e., phyto-active formulation) were optimally developed and compared to the placebo (i.e., emulsions without the crude extract) for assessment of the...

  19. Multiple coronary-cameral fistulas to the left ventricle arising from both coronary arteries

    OpenAIRE

    Pathak, Ranjan; Giri, Smith; Hwang, Inyong; Alsafwah, Shadwan

    2016-01-01

    Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and a cardiac chamber or major vessel, seen in about 0.8% of the cases undergoing coronary angiography. Most patients are asymptomatic and diagnosis is made incidentally during coronary angiography. We present an image case of CCF which was found incidentally during pre-liver transplantation work up.Keywords: coronary cameral fistula; coronary angiography; Management(Published: 6 July 2016)Citation: Journal of...

  20. Aorta-to-right atrium fistula, an unusual complication of endocarditis

    OpenAIRE

    Chen, Miao-yan; Zhong, Dan-dan; Ying, Zhi-qiang

    2009-01-01

    Infective endocarditis (IE) remains a serious disease. Aorta-to-right atrium fistula is a rare but very serious complication of IE and predicts a higher mortality. This report describes a 50-year-old man with endocarditis, vegetation, perforation of noncoronary sinus, and formation of two aorta-to-right atrium fistulas with native valves detected by transthoracic echocardiography. This disease is lethal despite developments in cardiac imaging and antibacterial therapy. Early diagnosis, aggres...

  1. A giant left main trunk and left circumflex artery-to-right ventricle fistula

    Directory of Open Access Journals (Sweden)

    Zhao-hui Peng

    2014-01-01

    Full Text Available Coronary artery fistula including the left trunk and left circumflex is uncommon. We present a 24-year-old male patient with a giant left main trunk and left circumflex artery to right ventricle fistula, which is diagnosed by transthoracic echocardiography and coronary computed tomography angiography. In this paper, the case report is to provide a better understanding of clinical characteristics for this disease.

  2. Intraductal papillary mucinous neoplasm of the bile duct with gastric and duodenal fistulas

    OpenAIRE

    Hong, Man Yong; Yu, Dong Wook; Hong, Seung Goun

    2014-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the bile duct is still rare and not yet understood despite of its increased incidence and similar clinicopathologic characteristics compared with IPMN of the pancreas. The fistula formation into other organs can occur in IPMN, especially the pancreatic type. To our knowledge, only two cases of IPMN of the bile duct with a choledochoduodenal fistula were reported and we have recently experienced a case of IPMN of the bile duct penetrating into ...

  3. The Prevalence of Labyrinthine Fistula in Chronic Otitis Media Surgery in Shiraz, Southern Iran

    OpenAIRE

    Faramarzi, A H; Heydari, S T; Rusta, M

    2011-01-01

    Background The incidence of fistulas found during the surgery for chronic otitis media with cholesteatoma has been reported in a wide range in different geographical areas. This study aims to find the prevalence of labyrinthine fistula in the south of Iran. Methods A prospective cross sectional study of 787 (504 ears belong to 462 patients) consecutive tympanoplasty with or without mastoidectomy for chronic otitis media was performed. Data on preoperative clinical and preoperative and postope...

  4. Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

    Institute of Scientific and Technical Information of China (English)

    Jorge; Avalos-González; Eliseo; Portilla-deBuen; Caridad; Aurea; Leal-Cortés; Abel; Orozco-Mosqueda; María; del; Carmen; Estrada-Aguilar; Gabriela; Abigail; Velázquez-Ramírez; Gabriela; Ambriz-González; Clotilde; Fuentes-Orozco; Aldo; Emmerson; Guzmán-Gurrola; Alejandro; González-Ojeda

    2010-01-01

    AIM: To assess whether the use of fibrin sealantshortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application d...

  5. Spontaneous occlusion of traumatic carotid-cavernous fistula - the effect of angiography

    Energy Technology Data Exchange (ETDEWEB)

    Stampfel, G.

    1984-08-01

    In two patients with a traumatic carotid-cavernous fistula, permanent occlusion of the lesion was observed following cerebral angiography and confirmed by further angiography. A delay is therefore recommended between performing angiography and carrying out further treatment, which may carry some risk. Possibly the use of ionic contrast media, which irritate the vessels, compression of the carotid artery, which reduces flow through the fistula, and general anaesthesia, which may drop the blood pressure, initiate thrombosis in the cavernous sinus. 3 figs.

  6. Endovascular embolization for the treatment of carotid cavernous fistula: recent progresses in research

    International Nuclear Information System (INIS)

    Carotid cavernous fistula is the abnormal arteriovenous communications, which can be located within the internal carotid cavernous segment itself, or between the cavernous and the internal carotid branches or external carotid meningeal branches. With the development of interventional neuroradiology, endovascular embolization has become the choice of treatment for the carotid cavernous fistula, as the technique is less invasive, simple and reliable. This paper aims to review the recent progresses in this respect in order to further improve its clinical diagnosis and treatment. (authors)

  7. Bilateral Persistent Trigeminal Arteries with Unilateral Trigeminal Artery to Cavernous Sinus Fistula: A Case Report

    OpenAIRE

    Chen, David; Chen, Chi-Jen; Chen, Jiann-Jy; Tseng, Ying-Chi; Hsu, Hui-Ling; Ku, Jan-Wen

    2013-01-01

    A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a sponta...

  8. Transcatheter closure of a congenital coronary artery to right ventricle fistula: a case report

    OpenAIRE

    Gribaa, Rym; Slim, Mehdi; Ouali, Sana; Neffati, Elies; Boughzela, Essia

    2014-01-01

    Introduction Congenital coronary artery fistula is a rare anomaly that may cause angina, atrial fibrillation, endocarditis, aneurysmal dilation and myocardial infarction. Both spontaneous regression and life-threatening complications have been described. Treatment can be conservative, surgical or more recently through transcatheter closure. Case presentation We report the case of a 27-year-old Tunisian man with a large coronary artery fistula from the left anterior descending artery to the ri...

  9. Detection of an occult transclival cerebrospinal fluid fistula by CT and MRI

    International Nuclear Information System (INIS)

    We describe an unusual occult transclival cerebrospinal fluid (CSF) fistula to the sphenoid sinus demonstrated by MRI. CT was performed because of a posterior cerebral infarct caused by cardiac arrhythmia. Axial sections showed fluid in the sphenoid sinus. High-resolution scans revealed a bony defect 3 mm in diameter of the posterior wall of the sphenoid sinus, and MRI showed a transclival CSF fistula. This occult lesion was confirmed by surgery and duraplasty was successfully performed via an endonasal approach. (orig.)

  10. Traumatic Persistent Trigeminal Artery - Cavernous Sinus Fistula Treated by Transcatheter Arterial Embolization

    Science.gov (United States)

    Asai, K.; Hasuo, K.; Hara, T.; Miyagishima, T.; Terano, N.

    2010-01-01

    Summary We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation. PMID:20377986

  11. Traumatic persistent trigeminal artery--cavernous sinus fistula treated by transcatheter arterial embolization. A case report.

    Science.gov (United States)

    Asai, K; Hasuo, K; Hara, T; Miyagishima, T; Terano, N

    2010-03-01

    We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation. PMID:20377986

  12. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    OpenAIRE

    Valeria Fiaschetti; Guglielmo Manenti; Isabelle Di Poce; Maria Fornari; Aurora Ricci; Enrico Finazzi Agrò; Giovanni Simonetti

    2012-01-01

    Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU) treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since...

  13. Pulmonary Hilar Lymph Node Metastasis of Breast Cancer Induced Bronchopleural Fistula and Superior Vena Cava Syndrome

    OpenAIRE

    Nishinari, Yutaka; Kashiwaba, Masahiro; UMEMURA, Akira; Komatsu, Hideaki; Sasaki, Akira; Wakabayashi, Go

    2014-01-01

    Patient: Female, 56 Final Diagnosis: Broncho-pleural fistula • empyema • supra-vena cava syndrome Symptoms: Dyspnea • fever • facial edema Medication: — Clinical Procedure: — Specialty: Oncology and Pulmonology Objective: Unusual clinical course Background: It is extremely rare for pulmonary hilar lymph node metastasis (PHLNM) of a cancer to be independently lethal. Here, we report an exceedingly rare case of cavitation in PHLNM from breast cancer triggering bronchopleural fistula and empyema...

  14. Detection of cerebroespinal fluid nasal fistulae by radionuclide cisternography

    Directory of Open Access Journals (Sweden)

    Betancourt-Piñeres Aiken Felípe

    2012-06-01

    Full Text Available Background: Cerebrospinal fluid rhinorrhea is the escape of fluid from the subarachnoidspace into the frontal, sphenoid or ethmoid sinus and the tympanic cavity. Ninetypercent (90% of cases are traumatic or surgical. Although up to two-thirds arespontaneously resolved, early diagnosis and proper management are important as itis a serious condition where bacterial meningitis is a major cause of morbidity andpotential mortality.Case report: A forty nine year old patient with CSF leak, identifiedby radio isotope cisternography, because of the negativity or failure of computedtomography (CT and magnetic resonance imaging (MRI.Conclusion: The importance of radio isotope cisternography to confirm nasal fistula ishighligthed, when it is not demonstrated by other diagnostic imaging modalitie.RESUMEN:Introducción: la rinorrea de líquido cefalorraquídeo es el escape de líquido desde elespacio subaracnoideo hacia el seno frontal, esfenoidal o etmoidal y también hacia elinterior de la caja timpánica. El 90% de los casos son de origen traumático o quirúrgico.A pesar de que hasta las dos terceras partes resuelven de manera espontanea, esimportante el diagnóstico precoz y el manejo adecuado ya que es una condición seria,donde la meningitis bacteriana es la mayor causa de la potencial morbilidad y mortalidad.Caso clínico: paciente de 49 años con fístula de líquido cefalorraquídeo, identificada porcisternografía radio isotópica, ante la negatividad de la tomografía axial computarizada(TAC y resonancia magnética nuclear (RMN.Conclusion: se resalta la importancia de la cisternografía radio isotópica, para confirmarla fistula nasal, cuando no es demostrado por los otras modalidades diagnósticas porimagen.

  15. Endotherapy for pancreatic fistulae: inside out or outside in?

    Science.gov (United States)

    Cohen, Seth A; Siegel, Jerome H

    2007-03-01

    How therapeutic endoscopy has changed! As participants and observers of the evolution of endotherapy, one has to marvel at the progress we have made in this field. We have withstood mild outrage of our description of precut sphincterotomy, to questions regarding the efficacy of balloon dilators for the bile and pancreatic duct sphincters, to outspoken objections at national meetings of our presentations describing the use of pancreatic stents for the treatment of various forms of pancreatitis, to the expectation of greater progress and advancement in the field. We routinely drain pseudocysts, stent disrupted pancreatic ducts, but, now, we commend the innovators from Erasme Hospital in Brussels for their newly described technique of completing an endoscopic rendezvous procedure performed through an external pancreatic fistula (EPF). In this new technique, an endoscopist, who is observing the progress of a percutaneous puncture through an EPF, positions an endoscope in the stomach or small bowel lumen while assisting another endoscopist (not a radiologist) who is advancing catheters and guide wires through the fistulous tract (a virtual cyst demonstrated by EUS) so that the assistant can guide the operator's puncture through the gut wall into the bowel lumen in order to deploy an internal stent to allow the normal flow or egress of pancreatic juices into the gut facilitating the closure of the fistula. Although the procedure is time-consuming and probably not cost-effective for the free enterprise reimbursement system in the United States, the results of this procedure, in a small number of patients over a long time period, were as effective as surgery. Our hats are off to those who continue to explore the outer limits of endotherapy, and we look forward to more exciting, unquestioned developments in the field. This is progress. PMID:17335446

  16. Discharge with Pancreatic Fistula after Pancreaticoduodenectomy Independently Predicts Hospital Readmission.

    Science.gov (United States)

    Mosquera, Catalina; Vohra, Nasreen A; Fitzgerald, Timothy L; Zervos, Emmanuel E

    2016-08-01

    Readmission rates after pancreaticoduodenectomy (PD) are among the highest of any surgical procedure. The purpose of this study was to identify those factors present at discharge that may predict readmission after PD. All patients undergoing PD between 2010 and 2015 at a very high (>35 PD/year) volume center were entered into a prospective database. Twenty factors present at discharge from index admission identified on univariate analysis were subjected to multivariate analysis to identify those independently predictive of 30-day hospital readmission. A total of 220 patients underwent PD during the study period, 88 per cent of which had cancer. Mean age was 64.4 ± 11.7 years with slight male preponderance (54.5%) and significant African American representation (33.2%). Surgical complications occurred in 67.3 per cent of patients the most common of which included infectious/leak (30%), gastrointestinal (29%), cardiorespiratory (13%), other (13%), minor complications (7%), multi system failure (5%), and new onset diabetes (3%). The 30-day readmission rate was 27.3 per cent and was due to infection (89%), failure to thrive (32%), nausea/vomiting (15%), or other (15%). On multivariate analysis, presence of pancreatic leak/fistula at discharge was the only significant predictor of readmission, present in 62.5 per cent of all readmitted patients (P = 0.001). Comorbidities, length of stay, insurance status, obesity, smoking, and discharge to a care venue other than home did not predict readmission. Patients manifesting pancreatic fistula after PD are at high risk for hospital readmission. Enhanced scrutiny regarding suitability for discharge should be exercised in these patients and measures taken to minimize readmission whenever possible. PMID:27657584

  17. New Surgical Approach for treatment of complex vesicovaginal fistula. Vesical autoplasty; Avances en la cirugia de la fistula vesicovaginal compleja. Autoplastia vesical

    Energy Technology Data Exchange (ETDEWEB)

    Gil-Vernet Vila, J. M.

    2009-07-01

    Although currently complex ve sico-vaginal fistulae are an uncommon finding, their solution still remains a problem since no effective surgical technique is yet available. We describe a new vesical autoplasty procedure for solving this entity. Once the fistulae has been thoroughly resected and its borders have been unfolded, a graft is obtained from the posterior-superior vesical wall, which is then slid down to the vesical neck thereby covering great extensions where tissue has been lost, even in the presence of low-capacity bladders. This new operation has led to a 100% cure rate of the 42 consecutive cases of vesico-vaginal fistulae operated on and that had undergone repeated surgery using other thecniques. (Author) 8 refs.

  18. Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

    Science.gov (United States)

    Kikuchi, Masahiro; Nishizaki, Yasuhiro; Tsuruya, Kota; Hamada, Ikuko; Higashi, Toru; Sakuma, Keiko; Shiozawa, Hirokazu; Aoki, Jun; Nagashima, Rena; Koizumi, Jun; Arase, Yoshitaka; Shiraishi, Koichi; Matsushima, Masashi; Mine, Tetsuya

    2014-02-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein. PMID:26183509

  19. Acute portal vein thrombosis due to chronic relapsing pancreatitis: a fistula between a pancreatic pseudocyst and the splenic vein.

    Science.gov (United States)

    Kikuchi, Masahiro; Nishizaki, Yasuhiro; Tsuruya, Kota; Hamada, Ikuko; Higashi, Toru; Sakuma, Keiko; Shiozawa, Hirokazu; Aoki, Jun; Nagashima, Rena; Koizumi, Jun; Arase, Yoshitaka; Shiraishi, Koichi; Matsushima, Masashi; Mine, Tetsuya

    2014-02-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but several other causes might play an important role in PVT pathogenesis. We present a case of alcoholic chronic pancreatitis complicated by acute extensive PVT. The patient was managed conservatively with danaparoid sodium at first, but the thrombosis gradually extended. We then tried radiological intervention using the direct transhepatic and transjugular intrahepatic postsystemic shunt approaches. Although we were able to successfully catheterize the percutaneous transhepatic portal vein (PTP), we could not achieve recanalization of the portal vein. Therefore, PTP catheterization and systemic intravenous infusion of urokinase and heparin was performed to prevent further progression of the thrombosis and cavernous transformation was finally achieved. Computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a pancreatic stone which had possibly induced dilatation of the tail duct and formation of a pancreatic pseudocyst and caused intractable pancreatitis. We performed endoscopic retrograde cholangiopancreatography and placed a stent in the pancreatic duct, which completely cured the pancreatitis. Retrospectively, the previous CT with curved multi-planar reconstruction was reviewed and a fistula was detected between the pancreatic pseudocyst and splenic vein. We concluded that the etiology of the PVT was not only inflammatory extension from pancreatitis but also a fistula between the pancreatic duct and the splenic vein.

  20. Protective effect of Cassia fistula fruit extract on bromobenzene-induced nephrotoxicity in mice.

    Science.gov (United States)

    Kalantari, Heibatullah; Jalali, Mohammadtaha; Jalali, Amir; Salimi, Abobakr; Alhalvachi, Foad; Varga, Balazs; Juhasz, Bela; Jakab, Anita; Kemeny-Beke, Adam; Gesztelyi, Rudolf; Tosaki, Arpad; Zsuga, Judit

    2011-10-01

    The efficacy of a crude hydro-alcoholic extract of Cassia fistula (golden shower tree) fruit to protect the kidney against bromobenzene-induced toxicity was studied. Negative control mice received normal saline; positive control mice were given 460 mg/kg of bromobenzene; Cassia fistula treated mice received 200, 400, 600 and 800 mg/kg of Cassia fistula fruit extract followed by 460 mg/kg bromobenzene (daily by oral gavage for 10 days). On the 11th day, the mice were sacrificed, blood samples were obtained to assess blood urea nitrogen (BUN) and creatinine levels, and kidneys were removed for histological examination. We found that bromobenzene induced significant nephrotoxicity reflected by an increase in levels of BUN and creatinine that was dose dependently prevented by the Cassia fistula fruit extract. The nephroprotective effect of the Cassia fistula fruit extract was confirmed by the histological examination of the kidneys. To the best of our knowledge, this is the first study to demonstrate the protective effect of Cassia fistula in nephrotoxicity.

  1. Treatment of an Immature Autogenous Arteriovenous Fistula with Percutaneous Transluminal Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyoung Rae [Kangwon National University, Chuncheon (Korea, Republic of)

    2008-11-15

    The purpose of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in facilitating maturation of autogenous arteriovenous fistulae. There were 12 immature autogenous arteriovenous fistulae. We performed 15 PTAs transvenously. Post-intervention anatomic and clinical successes were estimated, and the 6-month and 1-year primary and secondary patency rates were calculated using Kaplan-Meier analysis. All immature fistulae had underlying stenosis (n=20): arteriovenous anastomosis (n=1) and venous outflow (n=19): 1) within 5 cm from the anastomosis (n=10); 2) more than 5 cm but less than 10 cm from the anastomosis (n=5); 3) more than 10 cm from the anastomosis, including central veins (n=4). Six fistulae had two or more stenoses. Repeat intervention was necessary in two patients. The anatomical success rate was 94.3%, and the clinical success rate was 86.7%. The 6-month and 1-year primary patency rates were 72.7% and 54.5%, and the secondary patency rates were 100% and 81.8%, respectively. All immature hemodialysis fistulae have underlying stenosis, most of which are located near the arteriovenous anastomosis. Early interventional procedures are helpful in the salvage and maintenance of immature arteriovenous fistulae, with a high degree of success

  2. Tube-flap for management of complex recto-urinary fistula with York Mason technique: a case report.

    Science.gov (United States)

    Limkuansuwan, P

    2001-05-01

    Recto-urinary fistula results as a complication following trauma to the perinium and pelvis. These fistulas are difficult to treat and have a high recurrence rate due to the difficult surgical approach in repairing them. Both the transabdominal or transperineal approaches used in repairing these fistulas are difficult and provide only limited exposure to the fistula being repaired. In the case report, we present a patient with complex recto-urinary fistula due to trauma to the pelvis 20 years previously. In this patient we used the transphincteric York Mason approach to directly approach the fistula, followed by construction of a tube flap connecting the bladder and the urethra. The technique is simple, easy and the outcome has been excellent after 4 years of follow-up. PMID:11560228

  3. [Epithelium and anal glands in rectal pouches and fistula. Histologic studies of swine with congenital anal atresia].

    Science.gov (United States)

    Lambrecht, W; Kluth, D; Lierse, W

    1989-02-01

    The epithelial coating of the rectal pouch and fistula was studied morphologically in 33 newborn piglets with high and low forms of anal atresia and was found to be similar to the epithelial coating of the anal canal in normal piglets: the typical epithelium of the rectum changed its character into transitional epithelium at the region of the internal sphincter which surrounded the fistulae in all animals. In the caudal part of the fistula the transitional epithelium was followed by squamous epithelium. Only in male piglets with deformities and recto-urethral fistulae no squamous epithelium was found. In these cases transitional epithelium covered all parts of the fistula and the region of the internal sphincter. Anal glands were found in all animals, with or without anorectal malformations. They always invaded the internal sphincter. According to our morphological studies the fistula in anorectal malformations represents an ectopic anal canal.

  4. The archaeology of uncommon interventions: Articulating the rationale for transcatheter closure of congenital coronary artery fistulas in asymptomatic children.

    Science.gov (United States)

    McElhinney, Doff B

    2016-02-15

    Transcatheter closure of coronary artery fistulas can be executed successfully in infants and children with few serious procedural complications. Indications for and long-term outcomes of closure of coronary artery fistulas remain poorly defined. Registries may offer the best opportunity for advancing our knowledge about uncommon interventions such as coil or device closure of coronary artery fistulas, but to do so, they must include sufficient data and evaluate factors potentially associated with salutary or adverse outcome.

  5. Novel treatment of coronary artery fistulae concealing severe coronary artery lesion: using thrombus aspiration catheter as a delivery guide

    OpenAIRE

    Korkmaz, Levent; Acar, Zeydin; Dursun, İhsan; Akyüz, Ali Rıza; Korkmaz, Ayca Ata

    2014-01-01

    In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheter...

  6. Duodenal-bronchial fistula: an unusual cause of shortness of breath and a productive cough

    Directory of Open Access Journals (Sweden)

    Cynthia Wong, BMBS

    2016-09-01

    Full Text Available Duodenal-bronchial fistulas are very uncommon, even among the already rare subgroup of abdominal-bronchial fistulas. We describe a case of a woman with Crohn's disease who presented with shortness of breath and a productive cough who was found to have a duodeanl bronchial fistula on computed tomography scan. We demonstrate with this case how these rare cases can lead to chronic lung aspirations and require multidisciplinary involvement.

  7. Duodenal-bronchial fistula: an unusual cause of shortness of breath and a productive cough.

    Science.gov (United States)

    Wong, Cynthia; Khan, Kalim; Byass, Oliver

    2016-09-01

    Duodenal-bronchial fistulas are very uncommon, even among the already rare subgroup of abdominal-bronchial fistulas. We describe a case of a woman with Crohn's disease who presented with shortness of breath and a productive cough who was found to have a duodeanl bronchial fistula on computed tomography scan. We demonstrate with this case how these rare cases can lead to chronic lung aspirations and require multidisciplinary involvement. PMID:27594936

  8. A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia

    DEFF Research Database (Denmark)

    Nielsen, H S; Lindberg, L; Nygaard, U;

    2009-01-01

    from stress or urge incontinence and three (8%) had a persistent fistula. Surgery improved quality of life and facilitated social reintegration to a level comparable to that experienced before fistula development for both women who were dry and those with residual incontinence (P = 0.001). For women...... Ethiopia. Despite one-third still suffering stress or urge incontinence, the women reported improved quality of life and social reintegration after fistula closure....

  9. Novel treatment of coronary artery fistulae concealing severe coronary artery lesion: using thrombus aspiration catheter as a delivery guide.

    Science.gov (United States)

    Korkmaz, Levent; Acar, Zeydin; Dursun, Ihsan; Akyüz, Ali Rıza; Korkmaz, Ayca Ata

    2014-03-01

    In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulae with difficult anotomy. PMID:24748888

  10. Morphologic and functional assessment of hemodialysis arteriovenous fistula with duplex doppler sonography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, On Koo; Kim, Yong Soo; Rhim, Hyun Chul; Koh, Byung Hee; Kim, Bong Soo; Song, Soon Young; Park, Chan Hyun [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2001-03-15

    The pattern of morphologic and functional status of the hemodialysis AV fistula was studied using doppler ultrasound to define the useful parameter and its normal range for detecting the initial dysfunctional. Sixty patients of chronic renal failure with radial artery-cephalic vein fistula for hemodialysis (50 clinically normal and 10 clinically abnormal functioning AV fistula) were studied by duplex ultrasound. The examination followed the feeding artery to the draining vein and observed the morphology and waveform of the vessels. Peak systolic velocity (PSV), End diastolic velocity (EDV) and Systolic/Diastolic ratio (S/D ratio) were measured in the feeding artery. In the draining vein, peak velocity was measured and the presence of arterial pulsation was observed. Normal range of these measuring parameters and its significance and reliability for detecting dysfunction AV fistula were studied. In normally functioning fistula, waveforms of flow in the feeding artery were monophasic, with PSV 0.5-3.48 m/sec (average 1.75 {+-} 0.79 m/sec), EDV 0.2-1.47 m/sec (average 0.82 {+-} 0.41 m/sec) and S/D ratio 1.44-3.48 (average 2.34 {+-} 0.56). The draining vein showed components of arterial pulsations with peak velocity of 0.21-1.20 m/sec (average 0.54 {+-} 0.23 m/sec). Of the 10 clinically dysfunctional AV fistula, two cases had arteriosclerous vessel wall calcification and showed normal function on doppler sonography. Two cases of focal stenotic lesion of the draining vein showed significantly increased PSV which were more than 4.0 m/sec. Six cases of venous thrombosis showed a high resistance pattern of reversed diastolic flow with a measured S/D ratio of more than 4.0 and the absence of flow was noted within the draining S/D ratio was statically very reliable parameter (P=0.003) for defining normal and abnormal functioning AV fistula, however PSV and EDVV were unreliable (P=0.459). Duplex ultrasound is a useful diagnostic method for interpretating function of the

  11. STUDY OF FACTORS INFLUENCING THE NONCLOSURE OF BRONCHOPLEURAL FISTULA IN PATIENTS WITH SPONTANEOUS PNEUMOTHORAX

    Directory of Open Access Journals (Sweden)

    Ejaj Ahmed

    2015-11-01

    Full Text Available A pneumothorax is an abnormal collection of air or gas in the pleural space. Pneumothoraces are essentially of two types, spontaneous and tramautic pneumothoraces, based on whether the lung is diseased or not. Spontaneous pneumothoraces are further of two types- primary and secondary spontaneous pneumothoraces. A subcategory of traumatic pneumothorax is iatrogenic pneumothorax. Hydro-pneumothorax, pyo-pneumothorax and hemo-pneumothorax result from collection of clear fluid, pus and blood respectively in the pleural cavity. A bronchopleural fistula is a communication between the pleural space and the lung. MATERIAL AND METHODS A prospective study of 54 cases of spontaneous pneumothorax with bronchopleural fistula, which were admitted in Department of Pulmonary Medicine, SVRRGGH, Tirupathi, over a period of 1 year from July 2014 to July 2015 was undertaken. Patients with pneumothorax were identified by clinical and radiological examination, where it was necessary for CT chest to be performed. Depending on the chest x ray and CT chest findings, the patients were subjected to tube thoracotomy. Patients who had persistent bronchopleural fistula after 15 days had to be referred to the CT surgeon for decortication or pleurectomy. For all those whose bronchopleural fistula closed by itself, the intercostal tube was removed at the earliest. After completion of the study, the findings and results were analysed and compared with those of the previous studies. RESULTS In the study period, out of 120 pneumothorax patients 54 patients with bronchopleural fistula were diagnosed. In 34 of the 54 patients, that is in 63% the bronchopleural fistula healed spontaneously in 2 weeks’ time. In 16 of the patients even after 15 days of intercostal tube drainage, the bronchopleural fistula did not heal and they had to be referred to the cardiothoracic surgeon for decortication/pleurectomy; 46 of the 54(85.2% were males and 8(14.8% were females; 45 patients (83% had TB

  12. Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

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    Tajahuerce Marcos

    2011-08-01

    Full Text Available Abstract Background Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the BRAF gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature. Case Presentation Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the V600E (T1799A mutation was detected in exon 15 of the BRAF gene. Conclusion Since fistulae experience persistent inflammation, the fact that this melanoma harbours a BRAF mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of BRAF gene mutations.

  13. Vesico-vaginal fistula post cold cup bladder biopsy: mini review

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    Abigail Mawhinney

    2010-09-01

    Full Text Available Abigail Mawhinney1,*, Ammar Hameed2,*, Ali Thwaini1, Colin Mulholland11Belfast City Hospital, Urology Department, Belfast, Northern Ireland, UK; 2Addenbrookes University Hospital, Urology Department, Cambridge, UK*These authors contributed equally to this paperIntroduction: We report a case of a vesico-vaginal fistula (VVF post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.Methods and results: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.Conclusion: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.Keywords: vesico-vaginal fistula, vaginal fistula, surgical repair of vaginal fistula, management of vaginal fistula

  14. Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting.

    Science.gov (United States)

    Wilson, Sarah M; Sikkema, Kathleen J; Watt, Melissa H; Masenga, Gileard G; Mosha, Mary V

    2016-05-01

    Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies. PMID:27010550

  15. Dutch survey of congenital coronary artery fistulas in adults: coronary artery-left ventricular multiple micro-fistulas multi-center observational survey in the Netherlands.

    NARCIS (Netherlands)

    Said, S.A.M.; Werf, T. van der

    2006-01-01

    BACKGROUND: Congenital coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) in adults are rare anomalies. They may cause angina pectoris and myocardial infarction in association with normal coronary arteries. METHODS AND RESULTS: From the medical databases of a Dutch Survey of corona

  16. Spinal dural arteriovenous fistulas; Spinale durale arteriovenoese Fisteln

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    Thron, A. [Abt. Neuroradiologie, Universitaetsklinikum der RWTH Aachen (Germany)

    2001-11-01

    The spinal dural arteriovenous fistula (SDAVF) is an important cause of a slowly progressive sensorimotor transverse lesion in mostly elderly patients. The disease affects men in 80% of the cases. Per year and per 1 Million inhabitants only 5-10 new cases of the disease have to be expected. Although rare, the serious disease should not be missed. Diagnosis can be made by MRI and spinal angiography. The result of treatment depends on early diagnosis. The arteriovenous shunt is located within the dural layer of the spinal canal. It connects branches of a radiculomeningeal artery with the veins of the spinal cord. Spinal cord supplying vessels are not primarily involved. Arterialisation of the venous part of the spinal cord circulation results in a chronic congestive myelopathy, which can well be demonstrated by MR imaging. The role of selective spinal angiography is to detect and exactly localize the site of the avshunt, which is rather difficult in some cases. Therapeutic alternatives are effective embolization of the fistula with liquid agents or surgical dysconnection. (orig.) [German] Die spinale durale arteriovenoese Fistel (SDAVF) ist eine wichtige Ursache fuer eine sich langsam, aber progredient entwickelnde Querschnittslaehmung des meist aelteren Patienten. 80% der Betroffenen sind Maenner. Die Erkrankungshaeufigkeit ist mit 5-10 Neuerkrankungen/1 Mio. Einwohner/Jahr zwar selten. Die unbehandelt ernste Prognose sowie die Tatsache, dass diese Erkrankung diagnostizierbar ist und der Erfolg der Behandlung von einer moeglichst fruehzeitigen Diagnosestellung abhaengt, machen sie jedoch zu einer wichtigen Erkrankung. Die der Erkrankung zugrundeliegende arteriovenoese Gefaessfehlverbindung ist in der Dura mater des Rueckenmarks gelegen. Ihre Ursache ist ungeklaert, sie ist vermutlich erworben wie die ihr aehnlichen arteriovenoesen Fisteln in der harten Hirnhaut des Schaedels. Im Gegensatz zu den angeborenen arteriovenoesen Gefaessmissbildungen zwischen

  17. Transcatheter closure of coronary artery fistula using Guglielmi detachable coil

    Institute of Scientific and Technical Information of China (English)

    Muhammad Munawar; Bambang B. Siswanto; Ganesha M. Harimurti; Thach N. Nguyen

    2012-01-01

    Background Coronary artery fistula (CAF) is a rare anomaly.Transcatheter CAF closure has been introduced using various materials,but only few data are available on the Guglielmi detachable coil (GDC).The advantage of using GDC for transcatheter CAF closure is more controllable,therefore much safer when compared to other coils.This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital.Methods & Results From 2002 to 2007,there were 10 patients with CAFs (age range:28 to 56 year-old,7 males) who underwent transcatheter CAF closure.There were a total of 19 CAFs which originated from right coronary (n =5),left circumflex (n =3),left anterior descending artery (n =10) and left main trunk (n =1).Median number of coil deployment for each fistula was 3 (range:1 to 6).The pulmonary artery was the most common site of the distal communication of CAFs (n =14),followed by right atrium (n =3),left atrium (n =1) and left ventricle (n =1).Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs,significant reduction of the flow in 5 (26.3%),while 2 (10.5%) could not be closed due to small size.Nine (90%) patients underwent a repeated angiography within 3 to 8 months.Among 12 CAFs that were occluded immediately post-deployment,there were 2 CAFs with insignificant residual flow.Among 6 CAFs with significantly decreased flow immediately post-deployment,2 were occluded totally in the follow-up angiography.In total,12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow,which did not need any additional coil deployment.During a mean follow up of 4.3 ± 0.7 year,all patients remained symptom and complication free.Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs.

  18. 喉癌术后咽瘘的原因及预防护理对策%The causes and nursing countermeasures to prevent fistula complicated with postoperative laryngeal pharynx

    Institute of Scientific and Technical Information of China (English)

    林曼舒

    2014-01-01

    Objective To discuss the causes and nursing countermeasures to prevent pharyngeal fistula after surgery of laryngeal carcinoma. Method A retrospective analysis of our hospital 131 cases of laryngeal cancer resection patients, including 23 cases of pharyngeal fistula, analysis of its causes, and put forward the prevention and nursing measures. Results With or without preoperative radiotherapy and tracheotomy, stage of tumor, intraoperative period whether cervical lymphadenectomy, operation mode selection, whether the factors of infection, nutrition status and closely related to postoperative pharyngeal fistula. Conclusion There are many factors of postoperative laryngeal cancer patients with pharyngeal fistula, active preoperative, intraoperative, postoperative nursing can effectively reduce the incidence of pharyngeal fistula after total laryngectomy.%目的:探讨喉癌术后并发咽瘘的原因以及相关预防护理对策。方法回顾性分析131例行喉癌切除术患者的临床资料,其中23例并发咽瘘,分析相关原因,并提出相应预防护理措施。结果术前有无放疗及气管切开、肿瘤分期,术中同期有无行颈淋巴结清扫术、手术方式的选择,术后感染与否、营养支持状况等因素与并发咽瘘存在相关性(P<0.05)。结论喉癌术后并发咽瘘的原因因素较多,积极做好术前、术中以及术后预防护理能有效降低喉癌术后并发咽瘘的概率。

  19. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal

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    Sileri Pierpaolo

    2011-11-01

    Full Text Available Abstract Background Several techniques have been described for the management of fistula-in-ano, but all carry their own risks of recurrence and incontinence. We conducted a prospective study to assess type of presentation, treatment strategy and outcome over a 5-year period. Methods Between 1st January 2005 and 31st March 2011 247 patients presenting with anal fistulas were treated at the University Hospital Tor Vergata and were included in the present prospective study. Mean age was 47 years (range 16-76 years; minimum follow-up period was 6 months (mean 40, range 6-74 months. Patients were treated using 4 operative approaches: fistulotomy, fistulectomy, seton placement and rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, healing rate, postoperative complications, reinterventions and recurrence. Results Etiologies of fistulas were cryptoglandular (n = 218, Crohn's disease (n = 26 and Ulcerative Colitis (n = 3. Fistulae were classified as simple -intersphincteric 57 (23%, low transphincteric 28 (11% and complex -high transphicteric 122 (49%, suprasphincteric 2 (0.8%, extrasphinteric 2 (0.8%, recto-vaginal 7 (2.8% Crohn 26 (10% and UC 3 (1.2%. The most common surgical procedure was the placement of seton (62%, usually applied in case of complex fistulae and Crohn's patients. Eighty-five patients (34% underwent fistulotomy, mainly for intersphincteric and mid/low transphincteric tracts. Crohn's patients were submitted to placement of one or more loose setons. The main treatment successfully eradicated the primary fistula tract in 151/247 patients (61%. Three cases of major incontinence (1.3% were detected during the follow-up period; Furthermore, three patients complained minor incontinence that was successfully treated by biofeedback and permacol injection into the internal anal sphincter. Conclusions This prospective audit demonstrates an high proportion of complex anal fistulae treated by

  20. Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

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    Kim Yong-Won

    2012-08-01

    Full Text Available Abstract Background The diagnosis of transient ischemic attack (TIA based on clinical history and objective findings, even including multiparametric MRI, can be misleading. We report two patients who presented with TIA-like deficits with isolated perfusion lesions in corresponding areas but were finally diagnosed as transient neurological symptoms associated with dural arteriovenous fistula (dAVF. Case presentation Two patients presented with transient focal neurological symptoms lasting less than one hour. An isolated perfusion deficit with no diffusion change in the clinically relevant area was shown on brain MRI, indicating transient ischemia as the most plausible cause of neurological symptoms. However, cerebral angiography let to diagnosis of dAVF in both cases. Intracerebral hemorrhage occurred after the initial diagnosis of TIA in one patient, and the small area of perfusion abnormality accompanied by the enlarged cortical vein in the other case helped to identify the dAVF through the further investigation. The pattern of perfusion-weighted imaging in both cases revealed increase of mean transit time and relative cerebral blood volume denoting the venous congestion in a clinically corresponding area. Conclusion Reported cases are uncommon clinical presentation of a dAVF, which can be misdiagnosed as TIA on clinical grounds. In rare cases, the isolated perfusion deficits could be attributable to venous congestion, despite the similar pattern of clinical presentation, such as with TIA.