Surgical Treatment of Perianal Fistulizing Crohn’s Disease: From Lay-Open to Cell-Based Therapy—An Overview

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Gianluca Pellino

2014-01-01

Full Text Available Background. Perianal Crohn’s disease (CD can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons.

Evaluation of the inflammatory response induced by different materials in the treatment of perianal fistulas: experimental study in rats

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Mariana Ocampos Galvão

2016-01-01

Full Text Available The medical literature has no study evaluating the effectiveness of different materials used as setons in the treatment of perianal fistulas; therefore, there is no evidence of availability of a more effective material than others for this purpose. Objective: To evaluate the inflammatory response induced by different materials used as seton in perianal fistulas in rats. Method: Thirty Wistar rats, which were initially submitted for the construction of a perianal fistula by passing transfixing steel wire into the anal canal, were used. The rats were kept for 30 days; after this period, and with confirmation of the formation of the perianal fistula, the setons were introduced (10 rats – cotton thread #0; 10 rats – rubber; and 10 rats – silastic; after 30 days the animals were euthanized, and then the area of the fistula repaired by the seton was resected, and the material retrieved was submitted to histological analysis. The results were analyzed statistically. Results: The mean degree of inflammatory process observed by histological analysis after 30 days was 2.3 for the cotton group; 1 for the rubber group; and 1.2 for the silastic group. Conclusion: A greater inflammatory response was observed in the group treated with a cotton seton. In the remaining groups, a lower inflammatory response, with equal intensity for rubber and silastic-treated rats, was noted. Resumo: Não foram encontrados na literatura médica estudos que avaliassem a eficácia dos diferentes materiais utilizados como sedenho no tratamento de fístulas perianais, portanto, não havendo evidências de que haja um material mais eficaz do que outro para esta finalidade. Objetivo: avaliar a resposta inflamatória induzida por diferentes materiais utilizados como sedenhos em fístulas perianais em ratos. Método: foram utilizados 30 ratos Wistar, os quais foram inicialmente submetidos à criação de fístula perianal pela passagem de fio de aço transfixante no canal anal

Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report

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Suelene Suassuna Silvestre de Alencar

2014-07-01

Full Text Available Introduction: Anal carcinoma is a rare variant of epithelial tumors of the anal canal. When associated with chronic and active anal fistulas, usually this is an aggressive cancer that has difficult diagnosis and poor prognosis. Anal fistulas are a common manifestation of Crohn's disease (CD. This study aims to report a case of mucinous adenocarcinoma originating from recurrent perianal fistula in patients with CD. Case report: A man of 43 years, with melanoderma, complaining of perianal tumors, anal pain and mucopurulent secretion, the patient was diagnosed with fistulae. Colonoscopy revealed a chronic inflammatory process associated with villous polypoid lesion in the colonic and rectal mucosa. In a new episode, where it was diagnosed, chronic colitis of rectum and sigmoid was being prescribed sulfasalazine with improvement. There were relapses and the patient underwent repeated fistulectomias. After investigation, CD was diagnosed. Computed tomography (CT of abdomen and pelvis showed multiple perineal and gluteal collections, and the patient underwent abdominoperineal resection of the rectum. Anatomopathological exam showed invasive mucinous adenocarcinoma. A new CT showed residual growth of the lesion. The patient was referred to the oncology referral service, where chemotherapy and radiotherapy were planned. The patient developed unfavorably, and his death occurred two months after treatment. Resumo: Introdução: Carcinoma anal é uma rara variante de tumores epiteliais do canal anal. Quando associado a fístulas anais crônicas e ativas, geralmente é um câncer agressivo que possui difícil diagnóstico e mau prognóstico. Fístulas anais são uma manifestação comum da doença de Crohn (DC. Este estudo tem como objetivo relatar um caso de adenocarcinoma mucinoso originado de fístula perianal recidivante em paciente com DC. Relato de caso: Homem de 43 anos, com melanoderma e queixas de tumorações na região perianal, dor anal e secre

MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

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Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Radiology, Boston, MA (United States); Goldner, Dana; Israel, Esther J. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Pediatrics, Boston, MA (United States); Bradley, William F. [Analog Devices, Lyric Labs, Cambridge, MA (United States)

2014-01-15

Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease. (orig.)

MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

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Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S.; Goldner, Dana; Israel, Esther J.; Bradley, William F.

2014-01-01

Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease. (orig.)

Management of complex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT).

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Schulze, B; Ho, Y-H

2015-02-01

Ligation of intersphincteric fistula tract (LIFT) is a relatively new technique in the treatment of complex anorectal fistulas. As it spares the anal sphincter, rates of post-operative incontinence may be lower when compared to conventional treatment. To date, there have not been enough reports of long-term fistula recurrence rates. We performed a long-term follow-up study of 75 patients who underwent LIFT following seton drainage and partial fistulotomy. Only patients with complex cryptogenic anorectal fistulas were included. After seton insertion and partial fistulotomy, the tract was reviewed at 4 months for the absence of anorectal sepsis. Patients then underwent LIFT in a day surgery setting. Operative time, complications, recurrences and incontinence were evaluated. Between May 2008 and June 2013, 75 patients [51 men, mean age 49.5 years, standard error of the mean (SEM) 1.4 years] were treated with a LIFT protocol. The mean operating time for LIFT was 13.2 min (SEM 1.5 min). Complications included minor bleeding, superficial wound dehiscence and perianal pain. At a mean follow-up of 14.6 months (SEM 1.7 months), there were nine (12 %) recurrences, diagnosed at a mean 9.2 months (SEM 2.7 months). They were treated with seton insertion followed by LIFT with biomesh or anorectal advancement flap, and there were no subsequent recurrences. Review of preoperative and post-operative continence scores revealed only one (1.3 %) patient with minor incontinence following LIFT. Recurrences were significantly related to fistulas with multiple tracts (p < 0.001). Our results suggest that the protocol of seton insertion and partial fistulotomy followed by LIFT is associated with a low recurrence rate comparing well with published results from studies involving other techniques and protocols for treating anal fistula.

Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.

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de Groof, E Joline

2015-08-20

Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

Assessing the activity of perianal Crohn's disease: comparison of clinical indices and computer-assisted anal ultrasound.

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Losco, Alessandra; Viganò, Chiara; Conte, Dario; Cesana, Bruno Mario; Basilisco, Guido

2009-05-01

Assessing perianal disease activity is important for the treatment and prognosis of Crohn's disease (CD) patients, but the diagnostic accuracy of the activity indices has not yet been established. The aim of this study was to determine the accuracy and agreement of the Fistula Drainage Assessment (FDA), Perianal Disease Activity Index (PDAI), and computer-assisted anal ultrasound imaging (AUS). Sixty-two consecutive patients with CD and perianal fistulae underwent clinical, FDA, PDAI, and AUS evaluation. Perianal disease was considered active in the presence of visible fistula drainage and/or signs of local inflammation (induration and pain at digital compression) upon clinical examination. The AUS images were analyzed by calculating the mean gray-scale tone of the lesion. The PDAI and gray-scale tone values discriminating active and inactive perianal disease were defined using receiver operating characteristics statistics. Perianal disease was active in 46 patients. The accuracy of the FDA was 87% (confidence interval [CI]: 76%-94%). A PDAI of >4 and a mean gray-scale tone value of 117 maximized sensitivity and specificity; their diagnostic accuracy was, respectively, 87% (CI: 76%-94%) and 81% (CI: 69%-90%). The agreement of the 3 evaluations was fair to moderate. The addition of AUS to the PDAI or FDA increased their diagnostic accuracy to respectively 95% and 98%. The diagnostic accuracy of the FDA, PDAI, and computer-assisted AUS imaging was good in assessing perianal disease activity in patients with CD. The agreement between the techniques was fair to moderate. Overall accuracy can be increased by combining the FDA or PDAI with AUS.

Multi Detector Computed Tomography Fistulography In Patients of Fistula-in-Ano: An Imaging Collage.

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Bhatt, Shuchi; Jain, Bhupendra Kumar; Singh, Vikas Kumar

2017-01-01

Fistula-in-ano, or perianal fistula, is a challenging clinical condition for both diagnosis and treatment. Imaging modalities such as fistulography, anal endosonography, perineal sonography, magnetic resonance imaging (MRI), and computed tomography (CT) are available for its evaluation. MRI is considered as the modality of choice for an accurate delineation of the tract in relation to the sphincter complex and for the detection of associated complications. However, its availability and affordability is always an issue. Moreover, the requirement to obtain multiple sequences to depict the fistula in detail is cumbersome and confusing for the clinicians to interpret. The inability to show the fistula in relation to normal anatomical structures in a single image is also a limitation. Multi detector computed tomography fistulography ( MDCTF ) is an underutilized technique for defining perianal fistulas. Acquisition of iso-volumetric data sets with instillation of contrast into the fistula delineates the tract and its components. Post-processing with thin sections allows for a generation of good quality images for presentation in various planes (multi-planar reconstructions) and formats (volume rendered technique, maximum intensity projection). MDCTF demonstrates the type of fistula, its extent, whether it is simple or complex, and shows the site of internal opening and associated complications; all in easy to understand images that can be used by the surgeons. Its capability to represent the entire pathology in relation to normal anatomical structures in few images is a definite advantage. MDCTF can be utilized when MRI is contraindicated or not feasible. This pictorial review shares our initial experience with MDCT fistulography in evaluating fistula-in-ano, demonstrates various components of fistulas, and discusses the types of fistulas according to the standard Parks classification.

Management of fistula-in-ano: An introduction

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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.

Post-traumatic recto-spinal fistula

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Lantsberg, L.; Greenberg, G.; Laufer, L.; Hertzanu, Y.

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.)

Post-traumatic recto-spinal fistula

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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.)

Fistula-in-Ano complicated by Fournier′s gangrene our experience in North-Eastern region of Nigeria

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Abubakar A Bakari

2013-01-01

Full Text Available Background: Fistula-in-ano when complicated by Fournier′s gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases. Methods of Study: Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up. Results: A total of 10 men with a mean age of 50.5 years (35-60 were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70% of these patients presented with Fournier′s gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40% of these patients had inadequate drainage of their perianal abscess and 2 (20% had incision and drainage. Another 4 (40% had spontaneously rupture of the perianal abscess. 6 (60% of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50% and fistulotomy in 3 (30% patients. Another 30% had fistulotomy and continuing sitz bath. Conclusion: Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier′s gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier′s gangrene.

Chronic arthritis of the hip joint: an unusual complication of an inadequately treated fistula-in-ano

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Raghunath, Rajat; Varghese, Gigi; Simon, Betty

2014-01-01

We report a case of chronic arthritis of the right hip joint in an otherwise healthy young male athlete as a complication of inadequately treated anal fistula. A young male athlete presented with symptoms of right hip pain and difficulty in walking and intermittent fever for 2 months. He had a history of perianal abscess drainage. On examination he was found to have a tender right hip joint with severe restriction of movements. He was also found to have a partially drained right ischiorectal abscess. X-ray and MRI of the hip joint revealed chronic arthritis of the right hip joint, which was communicating with a complex fistula-in-ano. He underwent a diversion sigmoid colostomy and right ischiorectal abscess drainage along with appropriate antibiotics with a plan for definitive hip joint procedure later. He was lost to follow-up and succumbed to severe perianal sepsis within a few months. PMID:25414226

[Surgical treatment of anal fistula].

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Zeng, Xiandong; Zhang, Yong

2014-12-01

Anal fistula is a common disease. It is also quite difficult to be solved without recurrence or damage to the anal sphincter. Several techniques have been described for the management of anal fistula, but there is no final conclusion of their application in the treatment. This article summarizes the history of anal fistula management, the current techniques available, and describes new technologies. Internet online searches were performed from the CNKI and Wanfang databases to identify articles about anal fistula management including seton, fistulotomy, fistulectomy, LIFT operation, biomaterial treatment and new technology application. Every fistula surgery technique has its own place, so it is reasonable to give comprehensive individualized treatment to different patients, which may lead to reduced recurrence and avoidance of damage to the anal sphincter. New technologies provide promising alternatives to traditional methods of management. Surgeons still need to focus on the invention and improvement of the minimally invasive techniques. Besides, a new therapeutic idea is worth to explore that the focus of surgical treatment should be transferred to prevention of the formation of anal fistula after perianal abscess.

Rectal duplication cyst presenting as perianal sepsis: report of two cases and review of the literature.

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Flint, Richard; Strang, Jane; Bissett, Ian; Clark, Matthew; Neill, Mischel; Parry, Bryan

2004-12-01

Recurrent perianal sepsis is a difficult problem to manage in colorectal surgical practice. One cause is rectal duplication cyst, a rare congenital lesion that is easily overlooked. Many cases have associated congenital defects, especially musculoskeletal anomalies, and may provide a clue to the underlying condition. Early diagnosis is important because these cysts do not resolve spontaneously and may undergo malignant change. We present two cases of middle-aged females who presented with perianal sepsis secondary to rectal duplication cyst. The first case had numerous surgical procedures for a perianal fistula during a ten-year period. She had associated sacral anomalies consistent with Currarino syndrome. The second case presented with a perineal mass after a bout of perianal inflammation. Both cases had the entire cyst surgically excised. There were no complications postoperatively and no recurrence at follow-up. Histopathology revealed no malignancy in the cyst. Rectal duplication cyst is a rare cause of recurrent perianal sepsis that should be considered in difficult cases, especially in those with associated musculoskeletal anomalies. Complete surgical excision is the preferred treatment to prevent recurrence and the risk of malignant degeneration.

CT colonography combined with fistulography - a case of periannal fistula of a 6 months old child

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Sirakov, N.; Velkova, K.; Sirakov, V.; Tashev, P.

2007-01-01

We present a 6 months old child with perianal fistula with repeated secretion from it. The child was examined by double contrast barium enema and transrectal ultrasonography that gave suggestions of perianal fistula with no communication to the rectum and suspicion of a anal duplication of the rectum. The child was examined by CT colonography combined with fistulography. The exam was carried out on a axial CT Somatom Emotion by Siemens. The purpose of our report is to present the results of the combination of CT colonography and fistulography, applied to a 6-month-old child, as well as to present the specific protocol that we used for this examination. (authors)

Complex anal fistulas: plug or flap?

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Muhlmann, Mark D; Hayes, Julian L; Merrie, Arend E H; Parry, Bryan R; Bissett, Ian P

2011-10-01

Rectal mucosal advancement flaps (RMAF) and fistula plugs (FP) are techniques used to manage complex anal fistulas. The purpose of this study was to review and compare the results of these methods of repair. A retrospective review of all complex anal fistulas treated by either a RMAF or a FP at Auckland City Hospital from 2004 to 2008. Comparisons were made in terms of successful healing rates, time to failure and the use of magnetic resonance imaging. Overall, 70 operations were performed on 55 patients (55.7% male). The mean age was 44.9 years. Twenty-one patients (30%) had had at least one previous unsuccessful repair. Indications for repair included 57 high cryptoglandular anal (81%), 4 Crohn's anal (6%), 7 rectovaginal (10%), 1 rectourethral (1%) and 1 pouch-vaginal fistula (1%). All patients were followed up with a mean of 4.5 months. Forty-eight RMAFs (69% of total) were performed with 16 successful repairs (33%). Twenty-two FPs (31% of total) were performed with 7 successful repairs (32%, P = 0.9). In failed repairs, there was no difference in terms of mean time to failure (RMAF 4.8 months versus FP 4.1 months, P = 0.62). Magnetic resonance imaging was performed in 21 patients (37%) before the repair. The success rate in these patients was 20%. The results of treatment of complex anal fistulas are disappointing. The choice of operation of either a RMAF or a FP did not alter the poor healing rates of about one third of patients in each group.

Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks

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Sapalidis Konstantinos

2010-02-01

Full Text Available Abstract Background Individuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease. We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas. Case presentation A sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed. Conclusion The best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.

Assessment of fistulectomy combined with sphincteroplasty in the treatment of complicated anal fistula

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Fakhrolsadat Anaraki

2017-07-01

Full Text Available Introduction: The ideal method of treating the complex anal fistula is to eradicate the sepsis and preserve the anal sphincter; since there is no definite consensus on the surgical method of treating it. Recent studies show that fistulectomy and immediate sphincteroplasy are a safe and appropriate way to treat the fistula-in-ano. The aim of this study was to evaluate the long term outcomes of fistulectmy and sphincteroplasty in the treatment of complex perianal fistula. Methods: In this prospective study, we have analyzed the data of 80 patients who underwent fistulectomy and sphincteroplasty from May 2013 to May 2016. Preoperative information included physical examination, preoperative fecal incontinence evaluation and taking a complete history about underlying diseases and past related surgeries were collected. Results: Of all 80 patients with complex fistula, 57.5% (46 patients were male. 70-Patients were presented with high transsphincteric fistula (87.5% and anterior fistula was diagnosed in 10 of them (12.5%. 9 patients (11.3% suffered from hypertension and 43 patients (53.75% had recurrent fistula after previous surgeries. During the follow-up period, the overall success rate was 98.8% (98.8% and fistulectomy and sphincteroplasty failed in only one patient (failure rate: 1.3%. preoperative and post-operative scoring showed mild fecal incontinence in 8 patients (10%. We have found no significant relation between the age, gender, hypertension, previous surgery and post-operative recurrence. Conclusion: Fistulectomy and sphincteroplasty is a safe surgical procedure in the treatment of anterior anal fistula in females and high transsphincteric fistulas. Resumo: Introdução: o método ideal para tratar a fístula anal complexa consiste em erradicar a sepse e preservar o esfíncter anal, uma vez que não existe consenso definitivo com relação ao método cirúrgico para tratamento desse problema. Estudos recentes demonstram que a

[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.

Perianal Dermatitis.

Science.gov (United States)

Agulló-Pérez, Alfredo-Daniel; Hervella-Garcés, Marcos; Oscoz-Jaime, Saioa; Azcona-Rodríguez, Maialen; Larrea-García, Mónica; Yanguas-Bayona, Juan-Ignacio

Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

Perianal hidradenoma papilliferum

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Eduardo Rosetti Filho

2018-01-01

Full Text Available Hidradenoma papilliferum is a benign cystic tumor originated in apocrine sweat glands of the anogenital region. It is common in vulvar topography and rare in the perianal region. A well-documented case of a patient with slow-growing perianal nodulation without pain or other symptoms is reported. The histological study shows a hidradenoma papilliferum. The article reviews the topic and discusses the importance of the differential diagnosis of proctological conditions. A biopsy is mandatory in anal lesions of unusual presentation. Resumo: O hidradenoma papilífero é um tumor cístico benigno originado nas glândulas sudoríparas apócrinas da região anogenital, sendo comum em topografia vulvar e raro na região perianal. Relata-se um caso bem documentado de paciente com nodulação perianal de crescimento lento, sem dor ou outros sintomas, cujo estudo histológico revelou se tratar de hidradenoma papilífero. O artigo revisa o tema e discute a importância do diagnóstico diferencial das afecções proctológicas, sendo a biópsia obrigatória em lesões anais de apresentação não-usual. Keywords: Acrospiroma, Hidradenoma papilliferum, Anal canal, Perianal, Palavras-chave: Acrospiroma, Hidradenoma papilífero, Canal anal, Perianal

CLINICAL STUDY OF FISTULA IN ANO

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Sushma Ramteke

2017-02-01

and seton tightening was done in two patients (4%, these were of high fistula type. Complete healing period range from 2 weeks to 8 weeks. Maximum patients (72% got healed in 3-6 weeks. The postoperative complication was very minimal. Recurrence of fistula was observed in two cases. Secondary infection in one case and postoperative bleeding in two cases. CONCLUSION The disease is common in the middle-aged group of 31-50 years with male predominance. Low socioeconomic status is one of the risk factor may be due to illiteracy and poor hygiene. Previously, burst abscess or inadequately drained perianal abscess is the main aetiological factor found. Low type and posterior type of perianal fistula is common with discharging sinus as a commonest mode of presentation. Fistulectomy is the commonest suitable procedure for low type of fistula with less postoperative complication.

Treatment of Complex Fistula-in-Ano With a Nitinol Proctology Clip

DEFF Research Database (Denmark)

Nordholm-Carstensen, Andreas; Krarup, Peter-Martin; Hagen, Kikke

2017-01-01

BACKGROUND: The treatment of complex anocutaneous fistulas remains a major therapeutic challenge balancing the risk of incontinence against the chance of permanent closure. OBJECTIVE: The purpose of this study was to investigate the efficacy of a nitinol proctology clip for closure of complex ano...... with those of other noninvasive, sphincter-sparing techniques for high-complex anocutaneous fistulas, with no risk of incontinence. Predictive parameters for fistula healing using this technique remain uncertain. See Video Abstract at http://links.lww.com/DCR/A347....

Management of rare, low anal anterior fistula exception to Goodsall′s rule with Kṣārasūtra

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Pradeep S Shindhe

2014-01-01

Full Text Available Anal fistula (bhagandara is a chronic inflammatory condition, a tubular structure opening in the ano-rectal canal at one end and surface of perineum/peri-anal skin on the other end. Typically, fistula has two openings, one internal and other external associated with chronic on/off pus discharge on/off pain, pruritis and sometimes passing of stool from external opening. This affects predominantly male patients due to various etiologies viz., repeated peri-anal infections, Crohn′s disease, HIV infection, etc., Complex and atypical variety is encountered in very few patients, which require special treatment for cure. The condition poses difficulty for a surgeon in treating due to issues like patient hesitation, trouble in preparing kṣārasūtra, natural and routine infection with urine, stool etc., and dearth of surgical experts and technique. We would like to report a complex and atypical, single case of anterior, low anal fistula with tract reaching to median raphe of scrotum, which was managed successfully by limited application of kṣārasūtra.

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

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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.

The NOD2 Single Nucleotide Polymorphism rs72796353 (IVS4+10 A>C) Is a Predictor for Perianal Fistulas in Patients with Crohn's Disease in the Absence of Other NOD2 Mutations.

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Schnitzler, Fabian; Friedrich, Matthias; Wolf, Christiane; Stallhofer, Johannes; Angelberger, Marianne; Diegelmann, Julia; Olszak, Torsten; Tillack, Cornelia; Beigel, Florian; Göke, Burkhard; Glas, Jürgen; Lohse, Peter; Brand, Stephan

2015-01-01

A previous study suggested an association of the single nucleotide polymorphism (SNP) rs72796353 (IVS4+10 A>C) in the NOD2 gene with susceptibility to Crohn's disease (CD). However, this finding has not been confirmed. Given that NOD2 variants still represent the most important predictors for CD susceptibility and phenotype, we evaluated the association of rs72796353 with inflammatory bowel disease (IBD) susceptibility and the IBD phenotype. Genomic DNA from 2256 Caucasians, including 1073 CD patients, 464 patients with ulcerative colitis (UC), and 719 healthy controls, was genotyped for the NOD2 SNP rs72796353 and the three main CD-associated NOD2 mutations rs2066844, rs2066845, and rs2066847. Subsequently, IBD association and genotype-phenotype analyses were conducted. In contrast to the strong associations of the NOD2 SNPs rs2066844 (p=3.51 x 10(-3)), rs2066845 (p=1.54 x 10(-2)), and rs2066847 (p=1.61 x 10(-20)) with CD susceptibility, no significant association of rs72796353 with CD or UC susceptibility was found. However, in CD patients without the three main CD-associated NOD2 mutations, rs72796353 was significantly associated with the development of perianal fistulas (p=2.78 x 10(-7), OR 5.27, [95% CI 2.75-10.12] vs. NOD2 wild-type carriers). Currently, this study represents the largest genotype-phenotype analysis of the impact of the NOD2 variant rs72796353 on the disease phenotype in IBD. Our data demonstrate that in CD patients the IVS4+10 A>C variant is strongly associated with the development of perianal fistulas. This association is particularly pronounced in patients who are not carriers of the three main CD-associated NOD2 mutations, suggesting rs72796353 as additional genetic marker for the CD disease behaviour.

Complex branchial fistula: a variant arch anomaly.

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De Caluwé, D; Hayes, R; McDermott, M; Corbally, M T

2001-07-01

A 5-year-old boy presented with an infected left-sided branchial fistula. Despite antibiotic treatment and repeated excision of the fistula, purulent discharge from the wound persisted. Three-dimensional computed tomography (3D CT) reconstruction greatly facilitated the diagnosis and management of this case by showing the course of the fistulous tract. The complexity of the tract suggests that this represents a variant arch anomaly because it contains features of first, second, third, and fourth arch remnants. Copyright 2001 by W.B. Saunders Company.

Megalourethra with Y-Type Duplication of Urethra Presented as Perianal Fistula: A Rare Case Report

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Shashi Verma

2015-01-01

Full Text Available Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU, excision of duplicated urethra, and reduction urethroplasty in a single stage.

The operative management of children with complex perianal Crohn's disease.

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Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

2016-12-01

Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

Perianal atypical leiomyoma: A case report.

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Sun, Pingliang; Ou, Hailing; Huang, Shen; Wei, Longxiang; Zhang, Sen; Liu, Jiali; Geng, Shuguang; Yang, Kun

2017-12-01

Reports on perianal atypical leiomyoma, a perianal tumor, are rare. We confirmed a perianal atypical leiomyoma by its clinical presentation, magnetic resonance imaging findings, and immunohistochemistry. A 28-year-old female with a perianal mass found more than 4 years ago. The 5cm_4cm_4cm sized mass was located on the left side of the anus and vagina; The magnetic resonance imaging (MRI) scan revealed: A 4.1cm × 5.2cm × 4.9cm sized round mass was observed on the left side of the circumference. Perianal atypical leiomyoma. anal peripheral mass resection was performed under lumbar anesthesia. The postoperative course was uneventful, healing, the patient was discharged. Perianal atypical leiomyomas are benign tumors, but with the clinically atypical leiomyoma, it is sometimes difficult to distinguish between potential malignant smooth muscle tumors,and there may be malignant changes. Surgery should ensure complete resection, and to avoid postoperative recurrence, there should be a regular follow-up.

Ligation of the intersphincteric fistula tract (LIFT): a minimally invasive procedure for complex anal fistula: two-year results of a prospective multicentric study.

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Sileri, Pierpaolo; Giarratano, Gabriella; Franceschilli, Luana; Limura, Elsa; Perrone, Federico; Stazi, Alessandro; Toscana, Claudio; Gaspari, Achille Lucio

2014-10-01

The surgical management of anal fistulas is still a matter of discussion and no clear recommendations exist. The present study analyses the results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas, in particular healing, fecal continence, and recurrence. Between October 2010 and February 2012, a total of 26 consecutive patients underwent LIFT. All patients had a primary complex anal fistula and preoperatively all underwent clinical examination, proctoscopy, transanal ultrasonography/magnetic resonance imaging, and were treated with the LIFT procedure. For the purpose of this study, fistulas were classified as complex if any of the following conditions were present: tract crossing more than 30% of the external sphincter, anterior fistula in a woman, recurrent fistula, or preexisting incontinence. Patient's postoperative complications, healing time, recurrence rate, and postoperative continence were recorded during follow-up. The minimum follow-up was 16 months. Five patients required delayed LIFT after previous seton. There were no surgical complications. Primary healing was achieved in 19 patients (73%). Seven patients (27%) had recurrence presenting between 4 and 8 weeks postoperatively and required further surgical treatment. Two of them (29%) had previous insertion of a seton. No patients reported any incontinence postoperatively and we did not observe postoperative continence worsening. In our experience, LIFT appears easy to perform, is safe with no surgical complication, has no risk of incontinence, and has a low recurrence rate. These results suggest that LIFT as a minimally invasive technique should be routinely considered for patients affected by complex anal fistula. © The Author(s) 2013.

Fistulizing Crohn's disease: Diagnosis and management.

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Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

2013-06-01

Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

Extramammary Perianal Paget’s Disease

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M.N. Al Hallak

2009-11-01

Full Text Available Perianal Paget’s disease is a rare malignancy. It is rarely isolated and often associated with an underlying adenocarcinoma. It usually presents with anal itchiness and discomfort and can be misdiagnosed as hemorrhoids. Once the diagnosis of perianal Paget’s disease is granted, extensive work-up to find an underlying primary malignancy is crucial. Surgery is the standard modality of treatment of extramammary Paget’s disease (EMPD with recurrence rates of 44–60%. Other different treatment modalities including radiotherapy, laser therapy, topical and systemic chemotherapy and the new emerging, promising photodynamic therapy are in the field of study. A 76-year-old man was referred to our hospital with a one-year history of anal itchiness and intermittent rectal bleeding. Skin shave and punch biopsies from the perianal area were reported back as perianal Paget’s disease with no underlying adenocarcinoma. The immunohistochemical stains were positive for cytokeratin 7 but also positive for cytokeratin 20 and CEA which indicated the essentiality of extensive investigations to find a primary malignancy. Skin exam showed no primary source. The investigations were unable to find the primary malignancy. Given the results of immunohistochemical stains we recommended local perianal Paget’s disease resection. The intraoperative frozen section showed adenocarcinoma around the anal sphincter. Ten days later the patient underwent an abdominoperineal resection and the final pathology report showed extensive adenocarcinoma in three quadrants of the perianal area with focal involvement of the rectal mucosa. We recommended an adjuvant chemotherapy with FOLFOX following surgery given the bulkiness of the disease. We conclude that once perianal Paget’s disease is diagnosed, an extensive work-up should be done to find the underlying primary malignancy. Immunohistochemical stains are helpful in raising the suspicion of underlying primary malignancy

Outcome of peri-anal surgeries without use of prophylactic antibiotics, in terms of post operative wound infection

International Nuclear Information System (INIS)

Asif, M.; Mirza, A.A.; Saeed, A.

2017-01-01

To determine the outcome of perianal surgeries without use of antibiotics in terms of post operative infection. Study Design: Descriptive study. Place and Duration of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, from Jan 2014 to Jun 2015. Material and Methods: All patients, both male and female admitted for hemorrhoidectomy, fistulectomy and lateral internal sphincterotomy for Anal Fissure with minimum 02 months follow-up were included in the study through non probability consecutive sampling technique. The selected patients were not administered any antibiotics pre or postoperatively. All these patients were followed up for any post-operative surgical site infection up to 02 months. Patients were advised only to take pyodine sitz bath regularly. Results: One hundred and eighty two patients were selected for the study. Patients mean age was 48.0 +- 11.4 years. 68.68% were male and 31.3% were female patients. In our study most frequent clinical presentation was hemorrhoids (37.9.0%), followed by anal fissure (33.5%). Least frequent clinical presentation was of anal fistula (28.57%). None of the patients developed surgical site infection post operatively. Conclusions: In our study we found that there was no additional beneficial role of prophylactic antibiotics in perianal surgeries Perianal surgeries can safely be performed without the use pre or post-operative antibiotics there by significantly reducing health care expenses. (author)

New Surgical Approach for treatment of complex vesicovaginal fistula. Vesical autoplasty

International Nuclear Information System (INIS)

Gil-Vernet Vila, J. M.

2009-01-01

Although currently complex vesico-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.

Perianal nodular hidradenocarcinoma. Case report.

Science.gov (United States)

Sierra Montenegro, Ernesto; Sierra Luzuriaga, Gastón; Leone Stay, Gaetano; Salazar Menéndez, Vilma; Quiñonez Auria, Carlos

2010-01-01

Eccrine glands (sweat glands) appear in all sites of the skin and are more abundant in hands and feet. Nodular hidradenocarcinoma (NH) is a rare malignant and aggressive tumor of the eccrine glands. The objective of this study is to report a case of perianal hidradenocarcinoma. We present the case of a 75-year-old female with diabetes, hypertension, and hypothyroidism. Physical examination revealed a small perianal tumor that was palpated near the anal canal. Biopsy was done. Pathology report revealed perianal hidradenoma. Rectosigmoidoscopy was normal. Computed tomography showed 1-cm adenopathies in inguinal and right iliac regions. Extensive resection of the tumor was done. Definitive pathology report was malignant eccrine acrospiroma. The patient underwent adjuvant chemotherapy in the Oncology Service and died 1 month later. In patients with a first symptom of metastases in the inguinal region, suspicion must be directed to the anal canal.

Local application of adipose-derived mesenchymal stem cells supports the healing of fistula: prospective randomised study on rat model of fistulising Crohn's disease

Czech Academy of Sciences Publication Activity Database

Ryska, Ondřej; Šerclová, Z.; Měšťák, O.; Matoušková, E.; Veselý, P.; Mrázová, I.

2017-01-01

Roč. 52, č. 5 (2017), s. 543-550 ISSN 0036-5521 R&D Projects: GA MZd(CZ) NV16-31806A Institutional support: RVO:67985904 Keywords : mesenchymal stem cell * perianal fistula * bioluminescence Subject RIV: FE - Other Internal Medicine Disciplines OBOR OECD: Gastroenterology and hepatology Impact factor: 2.526, year: 2016

Case of anal fistula with Fournier's gangrene in an obese type 2 diabetes mellitus patient.

Science.gov (United States)

Yoshino, Hiroshi; Kawakami, Kyoko; Yoshino, Gen; Sawada, Katsuhiro

2016-03-01

A 64-year-old man was admitted to Shin-suma General Hospital, Kobe, Japan, complaining of a 3-day history of scrotal swelling and high fever. He had type 2 diabetes mellitus. On examination, his body temperature had risen to 38.5 °C. Examination of the scrotum showed abnormal enlargement. Laboratory data were as follows: white cell count 35,400/μL and glycated hemoglobin 9.6%. Anal fistula was found in an endorectal ultrasound. Computed tomography scan showed a relatively high density of subcutaneous tissue and elevated air density. Thus, he was diagnosed with Fournier's gangrene. On the fourth hospital day, the patient underwent debridement of gangrenous tissue. Seton surgery was carried out for anal fistula on the 34th hospital day. He responded to the treatment very well. He was discharged on the 33rd postoperative day. Once Fournier's gangrene has been diagnosed, considering the association of anal fistula and perianal abscess is important.

New Surgical Approach for treatment of complex vesicovaginal fistula. Vesical autoplasty; Avances en la cirugia de la fistula vesicovaginal compleja. Autoplastia vesical

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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.

Carcinoma basocelular perianal: relato de caso e revisão da literatura Perianal basal cell carcinoma: case report and literature review

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Daniel C. Damin

2007-09-01

Full Text Available O Carcinoma basocelular (CBC é a mais freqüente das neoplasias epiteliais, localizando-se preferencialmente em áreas expostas ao sol. A ocorrência deste tumor na região perianal é extremamente rara. Neste artigo, relatamos um caso de CBC perianal. Apresentamos também uma revisão da literatura médica sobre o tema, salientando as características clínicas e histopatológicas, bem como o tratamento preconizado para esse tipo de tumor.Basal Cell Carcinoma (BCC is the most common skin cancer. It is preferentially found in sun-exposed areas and it is extremely rare at perianal region. In this article, we report a case of perianal BCC. In addition, we present a review of the medical literature on this subject, outlining clinical and histologic characteristics of this type of tumor as well as the choices of treatment.

Obesity is a negative predictor of success after surgery for complex anal fistula

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Schwandner O

2011-05-01

Full Text Available Abstract Background It was the aim of this study to compare the outcome of surgery for complex anal fistulas in obese and non-obese patients. Methods All patients with complex anorectal fistulas who underwent fistulectomy and/or rectal advancement flap repair were prospectively recorded. Surgery was performed in a standardized technique. Body mass index (BMI [kg/m2] was used as objective measure to indicate morbid obesity. Patients with a BMI greater than 30 were defined as obese, and patients with a BMI below 30 were defined as non-obese. The parameters analyzed related to BMI included success or failure, and reoperation rate due to recurrent abscess. Success was defined as closure of both internal and external openings, absence of drainage without further intervention, and absence of abscess formation. Results Within two years, 220 patients underwent advancement flap repair and met the inclusion criteria. 55% of patients were females, mean age was 39 (range 18-76 years, and the majority of fistulas were located at the posterior site. 69% of patients (152/220 were non-obese (BMI 30. After a median follow-up of 6 months, primary healing rate ("success" for the whole collective was 82% (180/220. Success was significantly different between non-obese and obese patients: In non-obese patients, recurrence rate was significantly lower than in obese patients (14% vs. 28%; p Conclusion Obese patients are at higher risk for failure after surgery for complex anal fistula.

Granular cell tumor on perianal region: a case report.

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Kesici Ugur

2013-07-01

Full Text Available Granular cell tumor (GCT was first described by Abrikossoff in 1926. GCT is a rarely seen soft tissue tumor and is generally benign. While the tumor can be seen in all parts of the body it is generally located on the head and neck region, and especially on the tongue. GCT is rarely seen in the anal-perianal region. In accordance with literature this case was reported because it was thought to be the 27th anal-perianal located GCT case. In this case report, approximately 0,5-1 cm pedunculated polypoid lesion was determined in the perianal region during the physical examination of a 23 year old female patient who applied with palpable mass complaint in the perianal region. Lesion in the patient was totally excited with healthy skin-subcutaneous tissue under local anesthesia. A benign granular cell tumor was detected in the histopathological examination. Positive staining was monitored immunohistochemically with S-100 and neuron specific enolase (NSE. GCT is a rarely seen tumor in the anal-perianal region and its malign transformation rate is very low. Even lesions seen in the perianal region have clinically a benign appearance, a histopathological examination should be conducted and also GCT should be kept in mind during diagnosis. Malign-benign separation of these lesions is difficult so histopathological examination should be conducted with great care. Large local excision in the treatment provides curative treatment. But for those presenting malign transformation further examination must be performed for metastasis. After the treatment local recurrence and metastasis should be considered carefully. Prognosis of metastatic disease is very bad.

A combined technique using a muscular flap and endobronchial stent to repair complex broncho-oesophageal fistulae supported by ECMO.

Science.gov (United States)

Baste, Jean-Marc; Haddad, Laura; Philouze, Guillaume

2018-02-01

Certain broncho-oesophageal fistulae require surgical repair. Herein, we describe an innovative surgical technique combining intercostal flap and endobronchial stenting. Two patients, each with a with complex broncho-oesophageal fistula 2 years after radio-chemotherapy, were hospitalised for severe respiratory infection and extension of the fistula despite previous endoscopic treatment. The first patient presented with respiratory distress (ARDS). She had emergency surgery under extra corporeal membrane oxygenation: oesophagectomy and reconstruction of the left bronchus by a vascularised intercostal flap. Stenting was performed on day 10, due to persistence of the fistula. At 3 months the bronchus was healed, but the patient died of cerebral bleeding. For the second patient, repair was proposed before severe ARDS with the same surgical and ventilatory strategy and a stent was preventively inserted after surgery. After 3 months, the stent was removed and the left bronchus was healed. Complex post-radiotherapy broncho-oesophageal fistulae should be treated surgically before respiratory complications arise, by combining reconstruction with a vascularised flap and transient stenting.

Leiomioma perianal. Reporte de un caso

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Yorlenis C Uzcátegui R

2014-09-01

Full Text Available Los leiomiomas perianales son tumoraciones derivadas de células mesenquimales distribuidas por todo el cuerpo. Histológicamente se han clasificado en tres subtipos: vascular, no vascular y epiteloide. El subtipo vascular puede ser sólido, cavernoso o venoso. Los leiomiomas son raros en adultos, con incidencia de 0,1 %, generalmente se presentan entre la cuarta a sexta década de la vida con predominio en mujeres en caso de ser benignos. La forma de presentación más frecuente es un nódulo palpable, próximo al ano e indoloro. El diagnóstico se realiza según criterios histológicos e inmunohistoquímicos, además son útiles la ecografía endoanal y RMN. La exéresis es la primera opción terapéutica. Se presenta caso de paciente femenino de 41 años de edad, quien consulta por presentar nódulo palpable perianal derecho, con dolor a la palpación, de ocho meses de evolución, con valores normales de marcadores tumorales, el ultrasonido revela a nivel perianal derecho imagen sólida, hipocrómica (con tejido lineal fibroso, mide 4.82x 6.7x 6.87cm, la RMN muestra lesión ocupante de espacio en la misma ubicación, Doppler Color sin vascularización. Se efectuó exéresis de leiomioma en fosa isquiorectal derecha de 4x6 cm. El estudio anatomopatológico reportó leiomioma perianal subtipo epitelial. En el presente estudio se reporta un caso muy poco frecuente de leiomioma perianal doloroso, exponiendo las características clínicas e histológicas del mismo

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

Paracoccidioidomicosis perianal asociada a lepra lepromatosa: Presentación de un caso clínico Perianal paracoccidioidomycosis associated with lepromatous leprosy: A clinical case report

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M A Reyes

2008-06-01

Full Text Available Se presenta el caso de un paciente alcoholista con una ulceración perianal y manifestaciones cutáneas de enfermedad de Hansen. La biopsia de la lesión perianal y otros estudios arribaron al diagnóstico de una forma diseminada de paracoccidioidomicosis, así como también las biopsias cutáneas y los estudios baciloscópicos fueron diagnósticos de lepra lepromatosa. La respuesta a la terapéutica fue satisfactoria con desaparición de las lesiones cutáneas. La disminución de la respuesta inmunológica celular genera un terreno propicio para la infección de estos gérmenes y al compartir área endémica la asociación entre ambas patologías puede ocurrir.Lepra and Paracoccidioidomycosis are endemic diseases in Argentina. We report a case of a patient with an unusual perianal ulceration and cutaneous manifestations of Hansen's disease. The biopsy of perianal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, as well as skin biopsy and baciloscopic finding diagnostic of Lepromatous Leprosy. The main portal of entry of paracoccidioides is the lung. Hematogenous dissemination of the fungus may occur at this time, with the establishment of metastatic foci in any organ. Anal and perianal lesions are present only in 1.3 to 2.4% of the patients. The pathogenesis of anal lesions remains unclear, it may be secondary from a systemic or a local disease. The patient response to the therapeutic was notable, with disappearance of lesions up to the third month of started itraconazole orally 400 mg/day leading just atrophy scars in perianal areas. The treatment of Hansen's disease was made according to OMS guidelines for multibacillary disease.

Lesion mimicking perianal abscess in an immunocompromised patient: Report of a case

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Aranzazu Calero-Lillo

2014-01-01

CONCLUSION: Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account.

An Unusual Presentation of Lung Cancer Metastasis: Perianal Abscess

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Murat Kilic

2014-06-01

Full Text Available Lung cancer is one of the most commonly diagnosed cancers in both men and women. Although the most frequent sites of distant metastasis of lung cancers are the pleura, liver, adrenal glands, skeletal system and brain, perianal region has been rarely reported as a metastasis site. A male patient was admitted to our emergency room with a long standing perianal abscess. During abscess drainage, a mass was noticed at the base of the abscess pouch, and thus a biopsy was taken. Pathologically, it was reported as a metastasis of squamous cell carcinoma, therefore some radiological  investigations and endoscopic procedures were performed to determine the primary focus of cancer. A pulmonary mass was revealed in PET/CT, and was considered as primary tumor. Both primary and metastatic perianal tumors can be rarely presented as an abscess formation. In this situation, a biopsy should be performed from the lesion to avoid misdiagnosis.

An Unusual Presentation of Lung Cancer Metastasis: Perianal Abscess

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Murat Kilic

2014-01-01

Lung cancer is one of the most commonly diagnosed cancers in both men and women. Although the most frequent sites of distant metastasis of lung cancers are the pleura, liver, adrenal glands, skeletal system and brain, perianal region has been rarely reported as a metastasis site. A male patient was admitted to our emergency room with a long standing perianal abscess. During abscess drainage, a mass was noticed at the base of the abscess pouch, and thus a biopsy was taken. Pathologically, it w...

Sensitivity of perianal tape impressions to diagnose pinworm (Syphacia spp.) infections in rats (Rattus norvegicus) and mice (Mus musculus).

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Hill, William Allen; Randolph, Mildred M; Mandrell, Timothy D

2009-07-01

We determined the sensitivity of perianal tape impressions to detect Syphacia spp. in rats and mice. We evaluated 300 rat and 200 mouse perianal impressions over 9 wk. Pinworm-positive perianal tape impressions from animals with worm burdens at necropsy were considered as true positives. Conversely, pinworm-negative perianal tape impressions from animals with worm burdens were considered false negatives. The sensitivity of perianal tape impressions for detecting Syphacia muris infections in rats was 100%, and for detecting Syphacia obvelata in mice was 85.5%. Intermittent shedding of Syphacia obvelata ova is the most probable explanation for the decreased sensitivity rate we observed in mice. We urge caution in use of perianal tape impressions alone for Syphacia spp. screening in sentinel mice and rats.

Lemierre’s syndrome following perianal abscess: A case report

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Qusai Aljarrah

Full Text Available Introduction: Lemierre’s syndrome (LS is a rare and life-threatening condition characterized by suppurative thrombophlebitis of the internal jugular vein (IJV, and a history of head and neck (H&N sepsis. LS is usually caused by Fusobacterium necrophorum, which is part of the normal flora in the oro-pharynx, and the digestive and urogenital tracts. We here report the first case of LS following perianal sepsis. Presentation of case: A 60-year-old man with a painful left neck swelling, dysphagia and worsening sepsis was referred from a peripheral unit where he had an incision and drainage of a perianal abscess a week earlier. Urgent Doppler ultrasound and computed tomographic scans demonstrated suppurative thrombophlebitis of the left IJV, and the patient was subsequently commenced on intravenous Piperacillin/Tazobactam and heparin. The symptoms gradually improved, and the patient was eventually discharged on the 10th day. Discussion: Vigilant examination of the H&N region searching for a primary source is paramount, but LS following infections in the gastrointestinal or uro-genital tracts has also been described. A high index of suspicion is required for diagnosis, especially in patients with unresolving pharyngitis with a unilateral neck swelling, and septicaemia. Early resuscitation and treatment with broad-spectrum parenteral antimicrobials are important for favourable outcome. Conclusion: LS is well known to specialists in the H&N region, but other disciplines like general surgery, urology, or obstetrics and gynaecology might also rarely encounter the disease. We present a case of LS complicating a perianal abscess that was successfully treated with good outcome. Keywords: Lemierre’s syndrome, Thrombophlebitis, Internal jugular vein, Perianal abscess, Sepsis

Advancement Flap for Treatment of Complex Cryptoglandular Anal Fistula: Prediction of Therapy Success or Failure Using Anamnestic and Clinical Parameters.

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Boenicke, Lars; Karsten, Eduard; Zirngibl, Hubert; Ambe, Peter

2017-09-01

Multiple new procedures for treatment of complex anal fistula have been described in the past decades, but an ideal single technique has yet not been identified. Factors that predict the outcome are required to identify the best procedure for each individual patient. The aim of this study was to find those predictors for advancement flap at midterm follow-up. From 2012 to 2015 in a tertiary university clinic, all patients who underwent advancement flap for treatment of complex cryptoglandular fistula were prospectively enrolled. Pre- and postoperatively standardized anamnestic and clinical examinations were performed. Predictive factors for therapy failure were identified using univariate and multivariate analysis. Out of 65 patients, 61 (93%) completed all examinations and were included in the study. Therapy failure after a mean follow-up period of 25 months occurred in total n = 11 patients (18%). There was no significant disturbance of continence among the entire study cohort as shown by the incontinence score (preop 0.34 ± 0.91 pts., postop 0.37 ± 0.97 pts.; p = 0.59). Univariate analysis for risk factors for therapy failure revealed age (p = 0.004), history of surgical abscess drainage (p = 0.04), BMI (p = 0.002), suprasphincteric fistula (p = 0.019) and horseshoe abscess (p = 0.036) as independent parameters for therapy failure. During multivariate analysis, only history of surgical abscess drainage (OR = 8.09, p = 0.048, 95% CI 0.98-64.96), suprasphincteric fistula (OR = 6.83, p = 0.032, 95% CI 1.17-6.83) and BMI (OR = 1.23, p = 0.017, 95% CI 1.03-1.46) were independent parameters for therapy failure. Advancement flap for treatment of complex fistula is effective and has low risk of disturbed continence. BMI, suprasphincteric fistula and history of surgical abscess drainage are predictors for therapy failure.

Perianal injectable bulking agents as treatment for faecal incontinence in adults. (Update)

DEFF Research Database (Denmark)

Maeda, Yasuko; Laurberg, Søren; Norton, Christine

2013-01-01

BACKGROUND: Faecal incontinence is a complex and distressing condition with significant medical and social implications. Injection of perianal bulking agents has been used to treat the symptoms of passive faecal incontinence. However, various agents have been used without a standardised technique...... evaluation of outcomes and thus it is difficult to gauge whether the improvement in incontinence scores matched practical symptom improvements that mattered to the patients. AUTHORS' CONCLUSIONS: One large randomised controlled trial has shown that this form of treatment using dextranomer in stabilised...

The "Fistula VAC," a technique for management of enterocutaneous fistulae arising within the open abdomen: report of 5 cases.

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Goverman, Jeremy; Yelon, Jay A; Platz, John Joseph; Singson, Rufino C; Turcinovic, Michael

2006-02-01

Management of intestinal fistulae in open abdominal wounds remains a significant clinical challenge for those caring for patients surviving damage control abdominal operations. Breaking the cycle of tissue inflammation, infection, and sepsis, resulting from leakage of enteric contents, should be a major goal in the approach to these complex patients. We describe a technique utilizing vacuum assisted closure (VAC) which achieves control of enteric flow from fistulae in open abdominal wounds. The fistula-VAC is fashioned from standard sponge supplies, negative pressure pumps, and ostomy appliances. The fistula-VAC was changed every three days prior to split thickness skin grafting, and every five days following grafting. Five patients underwent application of the fistula-VAC. All patients had complete diversion of enteric contents. This enteric diversion allowed for successful skin grafting in all patients. Application of the fistula-VAC should be considered a useful option in treating patients with intestinal fistulae in open abdominal wounds.

[Perianal and rectal ulcers due to abuse of paracetamol-codeine suppositories].

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Wagner, G; Sand, C; Sachse, M M

2015-03-01

A 61-year-old woman presented with a progressive perianal ulcer which had developed 4 months ago. Upon further examination, another ulcer of the rectum was detected. Anorectal malignancies, viral infections or primary inflammatory bowel disease were not found. It could be demonstrated that the ulcers were induced by paracetamol and codeine suppositories. After discontinuation of these suppositories, the perianal ulcers healed almost completely within 3 weeks. The pathogenesis of paracetamol-induced ulcers is unknown. However, dose-dependent vasoconstriction is a possible explanation.

Perianal pain as a presentation of lumbosacral neurofibroma: a case report.

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Moghaddasi, Mehdi; Aghaii, Mahboubeh; Mamarabadi, Mansoureh

2014-12-01

Rectal and perianal pain is a common problem. Most people have experienced it at least once in their lifetime. It usually manifests as mild discomfort, but sometimes the pain can be so severe that it is incapacitating. A 59-year-old woman admitted with a 2-year history of paroxysmal perianal pain underwent a full work-up including proctoscopy, sigmoidoscopy, full colonoscopy, and barium enema that were unremarkable. Lumbosacral magnetic resonance imaging with and without gadolinium showed an intradural-extramedullary lesion at the level of L5. The pathologic diagnosis was a neurofibroma. She underwent surgery, and after a few weeks she felt well and medication was no longer needed for her paroxysmal pain. Although one should consider the usual causes of colorectal pain such as hemorrhoids, anal fissure, proctalgia fugax, and chronic perianal pain syndrome, we should keep in mind that some referral pain may mimic local pathologies and should be evaluated properly.

Enterocutaneous fistula: a novel video-assisted approach.

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Rios, Hugo Palma; Goulart, André; Rolanda, Carla; Leão, Pedro

2017-09-01

Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique to treat complex anal fistulas described by Meinero in 2006. An enterocutaneous fistula is an abnormal communication between the bowel and the skin. Most cases are secondary to surgical complications, and managing this condition is a true challenge for surgeons. Postoperative fistulas account for 75-85% of all enterocutaneous fistulas. The aim of paper was to devise a minimally invasive technique to treat enterocutaneous fistulas. We used the same principles of VAAFT applied to other conditions, combining endoluminal vision of the tract with colonoscopy to identify the internal opening. We present a case of a 78-year-old woman who was subjected to a total colectomy for cecum and sigmoid synchronous adenocarcinoma. The postoperative course was complicated with an enterocutaneous fistula, treated with conservative measures, which recurred during follow-up. We performed video-assisted fistula treatment using a fistuloscope combined with a colonoscope. Once we identified the fistula tract, we performed cleansing and destruction of the tract, applied synthetic cyanoacrylate and sealed the internal opening with clips through an endoluminal approach. The patient was discharged 5 days later without complications. Two months later the wound was completely healed without evidence of recurrence. This procedure represents an alternative treatment for enterocutaneous fistula using a minimally invasive technique, especially in selected patients not able to undergo major surgery.

Differential gene expression in patients with anal fistula reveals high levels of prolactin recepetor

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Song Yi-Huan

2017-01-01

Full Text Available Background/Aim. There are limited data examining variations in the local expression of inflammatory mediators in anal fistulas where it is anticipated that an improved understanding of the inflammatory milieu might lead to the potential therapeutic option of instillation therapy in complicated cases. The aim of the present study was to examine prolactin receptors (PRLR as inflammatory markers and to correlate their expression with both the complexity of anal fistulas and the likelihood of fistula recurrence. Methods. Microarray was used to screen the differentially expressed gene profile of anal fistula using anal mucosa samples with hemorrhoids with ageand sex-matched patients as controls and then a prospective analysis of 65 patients was conducted with anal fistulas. PRLR immunohistochemistry was performed to define expression in simple, complex and recurrent anal fistula cases. The quantitative image comparison was performed combining staining intensity with cellular distribution in order to create high and low score PRLR immunohistochemical groupings. Results. A differential expression profile of 190 genes was found. PRLR expression was 2.91 times lower in anal fistula compared with control. Sixty-five patients were assessed (35 simple, 30 complex cases. Simple fistulas showed significantly higher PRLR expression than complex cases with recurrent fistulae showing overall lower PRLR expression than de novo cases (p = 0.001. These findings were reflected in measurable integrated optical density for complex and recurrent cases (complex cases, 8.31 ± 4.91 x 104 vs simple cases, 12.30 ± 6.91 x 104; p < 0.01; recurrent cases, 7.21 ± 3.51 x 104 vs primarily healing cases, 8.31 ± 4.91 x 104; p < 0.05. In univariate regression analysis, low PRLR expression correlated with fistula complexity; a significant independent effect maintained in multivariate analysis odds ratio [(OR low to high PRLR expression = 9.52; p = 0.001]. Conclusion. PRLR

Normal anatomy of the anal wall and perianal spaces: An EUS, MRI and cadaveric correlative study

International Nuclear Information System (INIS)

Chung, Soo Young; Ryu, Sie Tae; Park, Ki Soon; Lee, Yul; Bae, Sang Hoon; Kang, Heung Sik

1994-01-01

To understand the normal endosonographic anatomy of the perianal spaces, and to evaluate the diagnostic efficacy and limitation of endorectal sonography(EUS), correlative study with MRI, cadaveric sectional image and cadaveric MRI were performed. EUS images of the normal 6 perianal spaces (pelvirectal, ischiorectal, intersphincteric, subcutaneous, central, submucous space) which were bounded by internal and external anal sphincters, rectal wall and levator ani muscle were correlated with MRI in 10 normal persons, cadaveric sectional images and cadaveric MRI in 2 cadavers. Pelvirectal space located superior to levator ani muscle could be demonstrable only on anterior wall scan but could not be visualized on lateral or posterior wall scan on EUS. Five perianal spaces located inferior to levator ani muscle were well seen on anterior, lateral, and posterior wall EUS. MRI was superior to EUS in the evaluation of pelvirectal and ischiorectal spaces but equal or inferior to EUS in the evaluation of intersphincteric, subcutaneous, central and submucous spaces. EUS was valuable in the evaluation of perianal spaces inferior to levator ani muscle but was limited in the evaluation of perianal spaces superior to levator ani muscle

Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.

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Vuille-dit-Bille, Raphael N; Berger, Christoph; Meuli, Martin; Grotzer, Michael A

2016-01-01

Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation. We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain. All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care. These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.

Anoperineal disease in Hidradenitis suppurativa: MR imaging distinction from perianal Crohn's disease

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Monnier, Louise; Amara, Nedjoua; Hoeffel, Christine [Hopital Maison Blanche, Department of Radiology, Reims (France); Dohan, Anthony [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Zagdanski, Anne-Marie [Saint Louis Hospital, Department of Radiology, Paris (France); Drame, Moustapha [Hopital Robert Debre, Department of Statistics, Reims (France); Soyer, Philippe [Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France)

2017-10-15

To determine whether Hidradenitis suppurativa (HS)-related anoperineal disease can be distinguished from Crohn's disease (CD) using MRI. Pelvic MRI of 23 HS and 46 CD patients with anoperineal disease between 2007 and 2014 were independently analysed by two radiologists. For diagnosis of HS, sensitivity, specificity and positive likelihood ratios (LRs) of inflammatory features and of their anatomical distribution were calculated and compared to those of CD. In HS, fistulae were less present (P =.033) and less frequently involved the sphincters (P =.001) than in CD. Granulomas were more frequent (P =.0005). For anterior/inguinal and posterior localizations, sensitivity, specificity and LR for diagnosis of HS were 70% (49.1, 84.4), 87% (74.3, 93.9), 5.3 (2.41, 11.79) and 57% (36.8, 74.4), 93% (82.5, 97.8), 8.67 (2.74, 27.41), respectively. Combination of signs including posterior involvement, absence of rectal wall thickening and bilaterality of features yielded specificity of 100% (95% CI: 92.3-100) for HS. Although MRI presentations of anoperineal disease may overlap between CD and HS, specific diagnosis of HS is possible with a combination of three features: absence of features' predominance in perianal area, absence of rectal wall thickening and bilaterality of features. (orig.)

[External pancreatic fistulas management].

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Stepan, E V; Ermolov, A S; Rogal', M L; Teterin, Yu S

The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.

Malignant sigmoidoduodenal fistula.

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Shapey, I M; Mahmood, K; Solkar, M H

2014-01-01

Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas. A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema. Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies. Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Management of acute perianal sepsis in neutropenic patients with hematological malignancy.

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Baker, B; Al-Salman, M; Daoud, F

2014-04-01

In neutropenic patients with acute perianal sepsis in the setting of hematological malignancy, the classical clinical features of abscess formation are lacking. Additionally, the role of surgical intervention is not well established. In this review, we discuss the challenges and controversy regarding diagnosis and optimal management when clear surgical guidelines are absent. In the literature, there is great diversity in the surgical approach to these patients, which leads to a high percentage of diagnostic errors, risks of complications, and unnecessary interventions. We review the literature and assess whether surgical intervention produces better outcomes than a non-surgical approach. Studies published on perianal sepsis in neutropenic cancer patients were identified by searching PubMed using the following key words: "perianal sepsis/abscesses, anorectal sepsis/abscess, neutropenia, hematological malignancy, cancer". No randomized or prospective studies on the management of acute perianal sepsis in hematological malignancies were found. The largest retrospective study and most comprehensive clinical data demonstrated that 42% of patients were treated successfully without surgical intervention and without morbidity or mortality related to treatment chosen. Small retrospective studies advocated surgical intervention, while the majority of successes were in a non-operative treatment. It is difficult to formulate a conclusion given the small retrospective series on management of neutropenic patients with hematological malignancies. While there is no evidence mandating a routine surgical approach in this category of patients, non-surgical management including careful follow-up to determine whether the patient's condition is deteriorating or treatment has failed is an acceptable approach in selected patients without pathognomonic features of abscess. Comprehensive and well-designed prospective studies are needed to firmly establish the guidelines of treatment

Hemodynamic Simulations in Dialysis Access Fistulae

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McGah, Patrick; Leotta, Daniel; Beach, Kirk; Riley, James; Aliseda, Alberto

2010-11-01

Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with End-Stage Renal Disease. It has long been hypothesized that the hemodynamic and mechanical forces (such as wall shear stress, wall stretch, or flow- induced wall vibrations) constitute the primary external influence on the remodeling process. Given that nearly 50% of fistulae fail after one year, understanding fistulae hemodynamics is an important step toward improving patency in the clinic. We perform numerical simulations of the flow in patient-specific models of AV fistulae reconstructed from 3D ultrasound scans with physiologically-realistic boundary conditions also obtained from Doppler ultrasound. Comparison of the flow features in different geometries and configurations e.g. end-to-side vs. side-to-side, with the in vivo longitudinal outcomes will allow us to hypothesize which flow conditions are conducive to fistulae success or failure. The flow inertia and pulsatility in the simulations (mean Re 700, max Re 2000, Wo 4) give rise to complex secondary flows and coherent vortices, further complicating the spatio- temporal variability of the wall pressure and shear stresses. Even in mature fistulae, the anastomotic regions are subjected to non-physiological shear stresses (>10.12pcPa) which may potentially lead to complications.

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.

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Polistina, Francesco A; Costantin, Giorgio; Settin, Alessandro; Lumachi, Franco; Ambrosino, Giovanni

2010-10-23

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.

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

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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.

Use of Intercostal Flap for Conservative Surgical Management of Complex Lower Esophageal Fistula.

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du Pouget, L; Tuech, J J; Baste, J M

2015-01-01

Lower esophageal fistula is a rare complication after upper digestive tract surgery, but it is associated with high morbi-mortality. There is no consensus on therapeutic care, however when reoperation is necessary, a pedicled inter-costal flap from the thoracotomy can be easily harvested to patch a large defect or buttress a direct suture, saving -digestive reconstruction. This technique should be mastered by thoracic and general surgeons. We present here two cases of lower esophagus fistulas cured thanks to this intercostal flap, in which we avoided fistula recurrence with maintenance of digestive continuity. Copyright© Acta Chirurgica Belgica.

Development of perianal ulcer as a result of acute fulminant amoebic colitis.

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Torigoe, Takayuki; Nakayama, Yoshifumi; Yamaguchi, Koji

2012-09-14

We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS). The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital. On admission, we observed a giant ulcer in the perianal region. At first, cytomegalovirus colitis was suspected by blood investigations. Ganciclovir therapy was initiated; however, the patient developed necrosis of the skin around the anus during therapy. We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion. Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae, indicating a final diagnosis of acute fulminant amoebic colitis. The patient's postoperative course was favorable, and proctectomy of the residual rectum was performed 11 mo later. Amoebic colitis is one of the most severe complications affecting patients with AIDS. Particularly, acute fulminant amoebic colitis may result in a poor prognosis; therefore, staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

Urethrovaginal fistula closure.

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Clifton, Marisa M; Goldman, Howard B

2017-01-01

In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.

Vesicovaginal Fistula

African Journals Online (AJOL)

user1

incidence of vesicovaginal fistula among populations. Globally, over two million women are estimated to be living with vesicovaginal fistula and majority are in. Sub-Saharan Africa and South Asia.6 The reported incidence rates of vesicovaginal fistula in West Africa range between 1– 4 per 1,000 deliveries.7–9 An annual.

Diagnosis and treatment of fistulising Crohn's disease

DEFF Research Database (Denmark)

Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius

2011-01-01

. Definitive surgical closure of perianal fistulas using an advancement flap may be attempted, but this procedure is associated with a high risk of relapse. Colostomy and proctectomy are the ultimate surgical treatment options for fistulas. Intestinal resection is almost always needed for the closure...

Clinical role of a modified seton technique for the treatment of trans-sphincteric and supra-sphincteric anal fistulas.

Science.gov (United States)

Tokunaga, Yukihiko; Sasaki, Hirokazu; Saito, Tohru

2013-03-01

We have devised a modified seton technique that resects the external fistula tract while preserving the anal sphincter muscle. This study assessed the technique when used for the management of complex anal fistulas. Between January 2006 and December 2007, 239 patients (208 males and 31 females, median age: 41 years) underwent surgery for complex anal fistulas using the technique. Of the 239 patients, 198 patients had trans-sphincteric fistula and 41 patients had supra-sphincteric fistula. The durations of the surgeries were 17 min (47, 13) [median (range, interquartile range)] for trans-sphincteric fistulas and 38 (44, 16) for supra-sphincteric fistulas. The durations of the surgeries were significantly (P trans-sphincteric fistula. The hospital stays were 4 (13, 2) days and 5 (14, 3) days, respectively, for trans- and supra-sphincteric fistulas. The durations of seton placement until the spontaneous dropping of the seton were 42 (121, 48) and 141 (171, 55) days respectively. The recurrence rate was 0 % in patients with trans-sphincteric fistulas and 4.9 % (2 of 41) in patients with supra-sphincteric fistulas (P < 0.01). Serious incontinence was not observed. The technique provided favorable results for the treatment of complex anal fistulas and could be safely applied while preserving the sphincter function and conserving fecal continence.

Clinical and echocardiographic features of aorto-atrial fistulas

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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.

A CLINICAL STUDY ON PERI ANAL TUBERCULOSIS IN S.V.R.R.G.G. HOSPITAL TIRUPATI

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Sobha Rani

2015-09-01

Full Text Available Tuberculosis around the anus is a rare form of extra pulmonary tuberculosis It is necessary to recognize it due to a specific treatment. (1 Perianal tuberculosis is an uncommon condition; it may not be easily distinguishable from the other inflammatory anal diseases. Undiagnosed cases are associated with high recurrence rates. Perianal tuberculosis can have varied presentation, frequently mimicking other common as well as rare diseases. Ano pe rianal tuberculosis may be associated with abdominal tuberculosis either as an extension of the original lesion or due to its spread via the lymphatics. AIMS & OBJECTIVES OF STUDY : To study the prevalence of ano - perianal tuberculosis in patients attending surgery OPD, SVRR Government General Hospital, Tirupati. To prevent recurrence and morbidity due to peri anal tuberculosis by early detection and intervention with anti tuberculous drugs . MATERIALS AND METHODS : STUDY DESIGN : Prospective study . STUDY SETTING : The present study was conducted at Department of General Surgery, SVRR Government General Hospital, and Tirupati. After getting institutional approval, written and informed consent was taken from each patient. PERIOD OF STUDY : 12 months . SAMPLE SI ZE : 142 patients who attended Surgery OP and were admitted in General Surgery ward, SVRR Government General Hospital, Tirupati with anal and perianal lesions like anal fistulae, perianal suppurations, growths, ulcers during the study period. INCLUSION CRIT ERIA : Age more than 15 years , Both men and women are included , Both sputum positive and negative for AFB , Both HIV positive and negative patients , All Anal and perianal (more than 3cm and within 3cm of anal verge lesions are included , Willingness of the p atient to participate in the study . EXCLUSION CRITERIA : Age less than 15 years , Patients who are not willing to participate in the study . CONCLUSION : Tuberculosis was responsible for 11% cases in recurrent fistula - in - ano

Aortoenteric Fistula

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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.

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

Recurrent Perianal Sinus in Young Girl Due To Pre‑sacral ...

African Journals Online (AJOL)

A young girl presented in our outpatient department with pus discharging from perianal sinus for the past 2 years. In addition, she was also having continuous dull pain in the lower abdomen along with constipation. Two years back, she was operated for this problem with misdiagnosis as fistula‑in‑ano. After 1 year period of ...

Vaginal Fistula

Science.gov (United States)

Vaginal fistula Overview A vaginal fistula is an abnormal opening that connects your vagina to another organ, such as your bladder, colon or rectum. Your ... describe the condition as a hole in your vagina that allows stool or urine to pass through ...

Temporary Fecal Diversion in the Management of Colorectal and Perianal Crohn’s Disease

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Rudolf Mennigen

2015-01-01

Full Text Available Aim. To evaluate the results of temporary fecal diversion in colorectal and perianal Crohn’s disease. Method. We retrospectively identified 29 consecutive patients (14 females, 15 males; median age: 30.0 years, range: 18–76 undergoing temporary fecal diversion for colorectal (n=14, ileal (n=4, and/or perianal Crohn’s disease (n=22. Follow-up was in median 33.0 (3–103 months. Response to fecal diversion, rate of stoma reversal, and relapse rate after stoma reversal were recorded. Results. The response to temporary fecal diversion was complete remission in 4/29 (13.8%, partial remission in 12/29 (41.4%, no change in 7/29 (24.1%, and progress in 6/29 (20.7%. Stoma reversal was performed in 19 out of 25 patients (76% available for follow-up. Of these, the majority (15/19, 78.9% needed further surgical therapies for a relapse of the same pathology previously leading to temporary fecal diversion, including colorectal resections (10/19, 52.6% and creation of a definitive stoma (7/19, 36.8%. At the end of follow-up, only 4/25 patients (16% had a stable course without the need for further definitive surgery. Conclusion. Temporary fecal diversion can induce remission in otherwise refractory colorectal or perianal Crohn’s disease, but the chance of enduring remission after stoma reversal is low.

Reliability of Oronasal Fistula Classification.

Science.gov (United States)

Sitzman, Thomas J; Allori, Alexander C; Matic, Damir B; Beals, Stephen P; Fisher, David M; Samson, Thomas D; Marcus, Jeffrey R; Tse, Raymond W

2018-01-01

Objective Oronasal fistula is an important complication of cleft palate repair that is frequently used to evaluate surgical quality, yet reliability of fistula classification has never been examined. The objective of this study was to determine the reliability of oronasal fistula classification both within individual surgeons and between multiple surgeons. Design Using intraoral photographs of children with repaired cleft palate, surgeons rated the location of palatal fistulae using the Pittsburgh Fistula Classification System. Intrarater and interrater reliability scores were calculated for each region of the palate. Participants Eight cleft surgeons rated photographs obtained from 29 children. Results Within individual surgeons reliability for each region of the Pittsburgh classification ranged from moderate to almost perfect (κ = .60-.96). By contrast, reliability between surgeons was lower, ranging from fair to substantial (κ = .23-.70). Between-surgeon reliability was lowest for the junction of the soft and hard palates (κ = .23). Within-surgeon and between-surgeon reliability were almost perfect for the more general classification of fistula in the secondary palate (κ = .95 and κ = .83, respectively). Conclusions This is the first reliability study of fistula classification. We show that the Pittsburgh Fistula Classification System is reliable when used by an individual surgeon, but less reliable when used among multiple surgeons. Comparisons of fistula occurrence among surgeons may be subject to less bias if they use the more general classification of "presence or absence of fistula of the secondary palate" rather than the Pittsburgh Fistula Classification System.

A Rare Case of Anal and Perianal Chemical Burn in a Child due to Potassium Permanganate Crystals.

Science.gov (United States)

Dash, Suvashis; Bhojani, Jatin; Sharma, Sharadendu

2018-02-09

Many chemicals used as medical treatments can cause chemical burns as an untoward side effect. One of such chemicals is potassium permanganate. It is a caustic chemical used as a disinfectant. The most common sites of burn by potassium permanganate are exposed sites like the face and hands. Chemical burns in the perianal and anal region are rare in clinical practice and even sparser in the pediatric age group. In this article, we report a case of perianal and anal chemical burn in an 18-month-old, male child, caused by potassium permanganate crystal applied wrongly for the treatment of pinworm infestation. As a chemical burn in this region can have serious complications, it is necessary to be vigilant when using such chemicals in these cases. Early and timely management in such cases leads to good outcomes. This is the first of such cases of chemical burn caused by potassium permanganate in the anal and perianal region.

Surgical Management of Enterocutaneous Fistula

International Nuclear Information System (INIS)

Lee, Suk Hwan

2012-01-01

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.

Vesicovaginal fistula in Uganda.

Science.gov (United States)

McCurdie, Fiona Katherine; Moffatt, Joanne; Jones, Kevin

2018-03-09

Kitovu Hospital in Masaka, Uganda, is a leading obstetric fistula repair centre in the country with the highest rates of fistula in the world. In this retrospective case review, the regional incidence and causative factors were studied in patients with vesicovaginal fistula (VVF) who were admitted at Kitovu Hospital. Fistula history included severity (ICIQ score), causes and outcomes of VVF were measured. Women suffered with symptoms of VVF for an average of 4.97 years with an average ICIQ severity score of 7.21. Patients travelled an average distance of 153 km and the majority travelled by public transport. Rates of prolonged labour were high. 69% of fistula-causing delivery resulted in stillbirth and 12% resulted in early neonatal death. Following surgery, 94% of patients were dry on discharge. Impact statement What is already known on this subject? Vesicovaginal fistula (VVF) is a severe, life-changing injury. Although largely eradicated from the Western world thanks to modern obstetric practice, VVF is still highly prevalent in developing countries where factors such as young childbearing age and poor access to emergency obstetric care increase the incidence (Wall et al. 2005 ). At the current rate of fistula repair, it is estimated that it would take 400 years to treat those already suffering with fistula, providing that no new cases emerged (Browning and Patel 2004 ). What do the results of this study add? The Ugandan women in this study reiterate tales of foetal loss, social isolation and epic journeys in search of fistula repair, as previously described in the literature. The study offers some hope for prompt help-seeking during labour and after fistulas are developed. It demonstrates the success of fistula repairs at Kitovu Hospital but highlights the paucity of service provision across Uganda. What are the implications of these findings for clinical practice and/or further research? Further epidemiological research is required to quantify the true

Carcinoma basocelular de la región perianal: reporte de un caso y revisión de la literatura

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L.A. Espino-Urbina

2013-01-01

Full Text Available La literatura reporta una incidencia anual de 5,900 casos de carcinoma anal en países desarrollados. Estos involucran a 3 zonas anatómicas distintas: carcinoma del canal anal; carcinoma perianal (antes denominado carcinoma del margen anal, ubicado a una distancia menor a 5 cm de este y carcinoma de la piel perianal (a más de 5 cm de distancia del margen anal. El carcinoma basocelular de la región perianal es una neoplasia poco común (0.27% de todos los carcinomas basocelulares diagnosticados cuyo tratamiento en la inmensa mayoría de las veces es la resección con márgenes libres de enfermedad; debe de diferenciarse de la variante basaloide epidermoide del carcinoma debido a su buen pronóstico y casi nulo potencial de diseminación.

The second branchial cleft fistula.

Science.gov (United States)

Maddalozzo, John; Rastatter, Jeffrey C; Dreyfuss, Heath F; Jaffar, Reema; Bhushan, Bharat

2012-07-01

To review the surgical anatomy and histopathology of second branchial cleft fistulae. Retrospective study of patients treated for second branchial cleft fistulae at a tertiary care pediatric hospital. The senior author noted anatomic and histologic features of second branchial cleft fistulae, not previously described. Tertiary care children's hospital. Retrospective examination of 28 patients was conducted who were operated upon for second branchial cleft fistula. Data collected included age at surgery, initial presentation, imaging characteristics prior to surgery, laterality of the fistula tract, pathology results and follow-up data. Twenty-eight patients met the criteria for inclusion. Three patients (11%) had bilateral fistulae. 11 (39%) were male and 17 (61%) were female. 23 (74.2%) tracts were lined with ciliated columnar epithelium, 3 (9.7%) had cuboidal epithelium, and 5 (16.7%) had squamous epithelium. Nineteen (61.3%) tracts contained salivary tissue. Of the unilateral fistula tracts, 25 (100%) were on the right side. Of the 3 patients with bilateral lesions, 2 (66%) had associated branchio-oto-renal syndrome (BORS). Second branchial cleft fistulae are rare. They are usually right-sided. If bilateral fistulae are present, one should consider an underlying genetic disorder. The histology of the fistulae mostly demonstrates ciliated columnar epithelium with the majority of specimens showing salivary tissue. There is a clear association with the internal jugular vein (IJV). Dissection should continue until superior to the hyoid bone, ensuring near complete surgical dissection and less risk of recurrence. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.

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Balik, Emre; Eren, Tunc; Bulut, Türker; Büyükuncu, Yilmaz; Bugra, Dursun; Yamaner, Sümer

2009-03-01

Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic

Three-dimensional virtual reconstruction as a tool for preoperative planning in the management of complex anorectal fistulas

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Edilson Carvalho Sousa Júnior

2018-01-01

Full Text Available The making of three-dimensional virtual models is a promising technology in preoperative planning, but that is not used in the treatment of anorectal fistulas. The objective of this work is to describe the development and initial experience of the construction of a virtual three-dimensional model of the pelvic anatomy of a patient, allowing the exact identification of the relationships between the fistulous tracts of complex anorectal fistulas and the other pelvic structures. An MRI was performed on this patient, and the images were exported to the Vitrea fX Workstation® software. A radiologist did the analysis and segmentation of the images that were then sent to a three-dimensional image processor (Meshlab v. 1.3.3 – ISTI – CNR Research Center, Pisa University, Italy. The final 3D color image was analyzed by the surgeon and used to guide the catheterization of the fistulous pathways, the internal orifice and to assist in the identification of adjacent structures. The final three-dimensional model presented a high correlation with the intraoperative findings and facilitated the surgical planning. Resumo: A criação de modelos virtuais tridimensionais é uma tecnologia promissora no planejamento pré-operatorio, entretanto não é utilizada no tratamento de fistulas anais. O objetivo desse trabalho é descrever o desenvolvimento e a experiência inicial da construção de um modelo virtual tridimensional da anatomia pélvica de um paciente, que permite a identificação exata das relações entre os tratos fistulosos de fistulas anais complexas e as demais estruturas pélvicas. O paciente realizou uma ressonância magnética e as imagens foram exportadas para o programa Vitrea fX software Workstation®. Um radiologista realizou a analise e segmentação das imagens que, em seguida, foram enviadas para um processador de imagens tridimensionais (Meshlab v. 1.3.3 – ISTI – CNR research center, Pisa University, Italy®. A imagem 3D colorida

Effect of phenotype on health care costs in Crohn's disease: A European study using the Montreal classification.

Science.gov (United States)

Odes, Selwyn; Vardi, Hillel; Friger, Michael; Wolters, Frank; Hoie, Ole; Moum, Bjørn; Bernklev, Tomm; Yona, Hagit; Russel, Maurice; Munkholm, Pia; Langholz, Ebbe; Riis, Lene; Politi, Patrizia; Bondini, Paolo; Tsianos, Epameinondas; Katsanos, Kostas; Clofent, Juan; Vermeire, Severine; Freitas, João; Mouzas, Iannis; Limonard, Charles; O'Morain, Colm; Monteiro, Estela; Fornaciari, Giovanni; Vatn, Morten; Stockbrugger, Reinhold

2007-12-01

Crohn's disease (CD) is a chronic inflammation of the gastrointestinal tract associated with life-long high health care costs. We aimed to determine the effect of disease phenotype on cost. Clinical and economic data of a community-based CD cohort with 10-year follow-up were analyzed retrospectively in relation to Montreal classification phenotypes. In 418 patients, mean total costs of health care for the behavior phenotypes were: nonstricturing-nonpenetrating 1690, stricturing 2081, penetrating 3133 and penetrating-with-perianal-fistula 3356 €/patient-phenotype-year (P<0.001), and mean costs of surgical hospitalization 215, 751, 1293 and 1275 €/patient-phenotype-year respectively (P<0.001). Penetrating-with-perianal-fistula patients incurred significantly greater expenses than penetrating patients for total care, diagnosis and drugs, but not surgical hospitalization. Total costs were similar in the location phenotypes: ileum 1893, colon 1748, ileo-colonic 2010 and upper gastrointestinal tract 1758 €/patient-phenotype-year, but surgical hospitalization costs differed significantly, 558, 209, 492 and 542 €/patient-phenotype-year respectively (P<0.001). By multivariate analysis, the behavior phenotype significantly impacted total, medical and surgical hospitalization costs, whereas the location phenotype affected only surgical costs. Younger age at diagnosis predicted greater surgical expenses. Behavior is the dominant phenotype driving health care cost. Use of the Montreal classification permits detection of cost differences caused by perianal fistula.

Operative treatment of radiation-induced fistulae

International Nuclear Information System (INIS)

Balslev, I.; Harling, H.

1987-01-01

Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05< p<0.10). Following establishment of defunctioning colostomy on account of rectovaginal fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. (author)

Operative treatment of radiation-induced fistulae

Energy Technology Data Exchange (ETDEWEB)

Balslev, I.; Harling, H.

1987-01-01

Out of 136 patients with radiation-induced intestinal complications, 45 had fistulae. Twenty-eight patients had rectovaginal fistulae while the remainder had a total of 13 different types of fistulae. Thirty-seven patients were treated operatively and eight were treated conservatively. Thirty-three patients were submitted to operation for rectal fistulae. Of these, 28 were treated by defunctioning colostomy, three were treated by Hartmann's method and resection and primary anastomosis was carried out in two patients. In the course of the period of observation, 35% of the patients developed new radiation damage. The frequency in the basic material without fistulae was 21% (0.05fistulae in 25 patients, eight patients developed new fistulae, Significantly more patients with fistulae died of recurrence as compared with patients with other lesions (p<0.01). Defunctioning colostomy in the treatment of rectal fistula is a reasonable form of treatment in elderly patients and in case of recurrence. Younger patients should be assessed in a special department in view of the possibility of a sphincter-preserving procedure following resection of the rectum and restorative anastomosis. 11 refs.

Management of anal fistula by ligation of the intersphincteric fistula tract

DEFF Research Database (Denmark)

Zirak-Schmidt, Samira; Perdawood, Sharaf

2014-01-01

INTRODUCTION: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treatment of anal fistulas described in 2007 by Rojanasakul et al. Several studies have since then assessed the procedure with varied results. This review assesses the relevant literature o...

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.)

Congenital broncho-oesophageal fistula

African Journals Online (AJOL)

1983-04-09

Apr 9, 1983 ... Rigid bronchoscopy performed under general anaesthesia .... Blackburn WR, Armour)' RA. Congenital esophago-pulmonary fistulas without esophageal atresia: an analysis of 260 fistulas in infants, children and adults.

Bilateral V-Y flap for a perianal basal cell carcinoma: A case report

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José P. Rivera-Chavarría

2016-01-01

Conclusion: Treatment modalities include early wide local excision to clear margins, ensuring further local recurrence and distant metastasis. The use of local V-Y advancement fasciocutaneous flaps may be another valid option for the reconstruction of perianal skin defects, with less morbidity than other flaps described in the literature.

Martius procedure revisited for urethrovaginal fistula

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N P Rangnekar

2000-01-01

Full Text Available Background: Urethrovaginal fistula is a dreadful com-plication of obstetric trauma due to prolonged labour or obstetric intervention commonly seen in developing coun-tries. Due to prolonged ischaemic changes, the fistula is resistant to healing. The strategic location of the fistula leads to postoperative impairment of continence mecha-nism. Anatomical repair was previously the commonest mode of surgical management, but was associated with a miserable cumulative cure rate ranging from 16-60%. Hence we tried to study the efficacy of Martius procedure in the management of urethrovaginal fistula. Material and Methods: We studied the outcome of 12 urethrovaginal fistulae, all caused by obstetric trauma, treated surgically with Martius procedure in 8 and with anatomical repair in 4, retrospectively. 9 patients had re-current fistulae while I patient had multiple fistulae. Pa-tients were followed up for the period ranging from 6 months to 4′/2 years for fistula healing, continence and postoperative complications like dvspareunia. Results: Cumulative cure rate ofMartius procedure was 87.5% with no postoperative stress incontinence, while fistula healing rate of anatomical repair was only 25% (I patient out of 4 which was also complicated by Intrin-sic Sphincter Deficiency (ISD. In case of recurrent fistu-lae the success rate of anatomical repair was 0% compared to 83.33% with Martius procedure. Conclusions: Martius procedure has shown much bet-ter overall cure rate compared to anatomical repair be-cause - a it provides better reinforcement to urethral suture line, b it provides better blood supply and lymph drainage to the ischaemic fistulous area, c provides sur-face for epithelialization and, d helps to maintain conti-nence. Hence we recommend Martius procedure as a surgical modality for the treatment of urethrovaginal fis-tula.

Spontaneous intrapartum vesicouterine fistula.

Science.gov (United States)

Kaaki, Bilal; Gyves, Michael; Goldman, Howard

2006-02-01

Vesicouterine fistulae as an obstetrical complication have been reported only in women with a history of cesarean. We present a patient with no such history who developed a vesicouterine fistula after vaginal delivery. A 43-year-old gravida 5 at term with no history of cesarean presented in the latent phase of labor. Gross hematuria was noted intrapartum, and a foley catheter was placed. A cystogram showed an extraperitoneal bladder perforation. The patient had urinary incontinence despite Foley catheter drainage. The diagnosis of vesicouterine fistula was made by cystoscopy and fistulogram. The patient had a successful repair at 3 months. This is a rare case of a vesicouterine fistula developing during a pregnancy with no previous cesarean. Accurate diagnosis is essential because surgical repair has an excellent outcome.

Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls

NARCIS (Netherlands)

J. Stoker (Jacob); E. Rociu (Elena); A.W. Zwamborn; W.R. Schouten (Ruud); J.S. Lameris

1999-01-01

textabstractAnorectal diseases (e.g., fecal incontinence, perianal and anovaginal fistulas, anorectal tumors) require imaging for proper case management. Endoluminal magnetic resonance (MR) imaging has become an important part of diagnostic work-up in such cases.

The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: our first experience

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Chiriac A.

2016-06-01

Full Text Available Complex cavernous sinus fistulae (CCF are still a technical challenge to neurovascular team. The most commonly performed treatment consists in endovascular embolization of the lesion through an arterial or venous approach. Not always these conventional routes are feasible, requiring alternative routes. We report a case of a 44-year-old woman with a complex indirect (Barrow D carotid cavernous sinus fistula treated by two interventional sessions that imposing a retrograde direct transvenous approach via the superior ophthalmic vein.

The Management of Delayed Post-Pneumonectomy Broncho-Pleural Fistula and Esophago-Pleural Fistula

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Dongsub Noh

2016-04-01

Full Text Available Broncho-pleural fistula (BPF and esophago-pleural fistula (EPF after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy.

Alternative treatment of symptomatic pancreatic fistula.

Science.gov (United States)

Wiltberger, Georg; Schmelzle, Moritz; Tautenhahn, Hans-Michael; Krenzien, Felix; Atanasov, Georgi; Hau, Hans-Michael; Moche, Michael; Jonas, Sven

2015-06-01

The management of symptomatic pancreatic fistula after pancreaticoduodenectomy is complex and associated with increased morbidity and mortality. We here report continuous irrigation and drainage of the pancreatic remnant to be a feasible and safe alternative to total pancreatectomy. Between 2005 and 2011, patients were analyzed, in which pancreaticojejunal anastomosis was disconnected because of grade C fistula, and catheters for continuous irrigation and drainage were placed close to the pancreatic remnant. Clinical data were monitored and quality of life was evaluated. A total of 13 of 202 patients undergoing pancreaticoduodenectomy required reoperation due to symptomatic pancreatic fistula. Ninety-day mortality of these patients was 15.3%. Median length of stay on the intensive care unit and total length of stay was 18 d (range 3-45) and 46 d (range 33-96), respectively. Patients with early reoperation (<10 d) had significantly decreased length of stay on the intensive care unit and operation time (P < 0.05). Global health status after a median time of 22 mo (range 6-66) was nearly identical, when compared with that of a healthy control group. Mean follow-up was 44.4 mo (±27.2). Four patients (36.6 %) died during the follow-up period; two patients from tumor recurrence, one patient from pneumonia, and one patient for unknown reasons. Treatment of pancreatic fistula by continuous irrigation and drainage of the preserved pancreatic remnant is a simple and feasible alternative to total pancreatectomy. This technique maintains a sufficient endocrine function and is associated with low mortality and reasonable quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.

Traumatic subarachnoid-pleural fistula

International Nuclear Information System (INIS)

Brown, W.H.; Stothert, J.C. Jr.

1985-01-01

Traumatic subarachnoid-pleural fistulas are rare. The authors found nine cases reported since 1959. Seven have been secondary to trauma and two following thoracotomy. One patient's death is thought to be directly related to the fistula. The diagnosis should be suspected in patients with a pleural effusion and associated vertebral trauma. The diagnosis can usually be confirmed with contrast or radioisotopic myelography. Successful closure of the fistula will usually occur spontaneously with closed tube drainage and antibiotics; occasionally, thoracotomy is necessary to close the rent in the dura

Sigmoid exclusion: a new technique in the management of radiation-induced fistula

International Nuclear Information System (INIS)

Aitken, R.J.; Elliot, M.S.

1985-01-01

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)

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.

Rectourethral fistula following LDR brachytherapy.

Science.gov (United States)

Borchers, Holger; Pinkawa, Michael; Donner, Andreas; Wolter, Timm P; Pallua, Norbert; Eble, Michael J; Jakse, Gerhard

2009-01-01

Modern LDR brachytherapy has drastically reduced rectal toxicity and decreased the occurrence of rectourethral fistulas to <0.5% of patients. Therefore, symptoms of late-onset sequelae are often ignored initially. These fistulas cause severe patient morbidity and require interdisciplinary treatment. We report on the occurrence and management of a rectourethral fistula which occurred 4 years after (125)I seed implantation. Copyright 2009 S. Karger AG, Basel.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix

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Omri Emodi, DMD

2018-03-01

Full Text Available Summary:. Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%. We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix.

Science.gov (United States)

Emodi, Omri; Ginini, Jiriys George; van Aalst, John A; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-03-01

Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

Directory of Open Access Journals (Sweden)

Ioannis Papaconstantinou

2011-01-01

Full Text Available A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

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.

Imaging features of colovesical fistulae on MRI.

Science.gov (United States)

Tang, Y Z; Booth, T C; Swallow, D; Shahabuddin, K; Thomas, M; Hanbury, D; Chang, S; King, C

2012-10-01

MRI is routinely used in the investigation of colovesical fistulae at our institute. Several papers have alluded to its usefulness in achieving the diagnosis; however, there is a paucity of literature on its imaging findings. Our objective was to quantify the MRI characteristics of these fistulae. We selected all cases over a 4-year period with a final clinical diagnosis of colovesical fistula which had been investigated with MRI. The MRI scans were reviewed in a consensus fashion by two consultant uroradiologists. Their MRI features were quantified. There were 40 cases of colovesical fistulae. On MRI, the fistula morphology consistently fell into three patterns. The most common pattern (71%) demonstrated an intervening abscess between the bowel wall and bladder wall. The second pattern (15%) had a visible track between the affected bowel and bladder. The third pattern (13%) was a complete loss of fat plane between the affected bladder and bowel wall. MRI correctly determined the underlying aetiology in 63% of cases. MRI is a useful imaging modality in the diagnosis of colovesical fistulae. The fistulae appear to have three characteristic morphological patterns that may aid future diagnoses of colovesical fistulae. To the authors' knowledge, this is the first publication of the MRI findings in colovesical fistulae.

Endoluminal MR imaging of the rectum and anus: technique, applications, and pitfalls

NARCIS (Netherlands)

Stoker, J.; Rociu, E.; Zwamborn, A. W.; Schouten, W. R.; Laméris, J. S.

1999-01-01

Anorectal diseases (e.g., fecal incontinence, perianal and anovaginal fistulas, anorectal tumors) require imaging for proper case management. Endoluminal magnetic resonance (MR) imaging has become an important part of diagnostic work-up in such cases. Optimal endoluminal MR imaging requires careful

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.

Cholesteatoma labyrinthine fistula: prevalence and impact.

Science.gov (United States)

Rosito, Letícia P Schmidt; Canali, Inesângela; Teixeira, Adriane; Silva, Mauricio Noschang; Selaimen, Fábio; Costa, Sady Selaimen da

2018-03-09

Labyrinthine fistula is one of the most common complications associated with cholesteatoma. It represents an erosive loss of the endochondral bone overlying the labyrinth. Reasons for cholesteatoma-induced labyrinthine fistula are still poorly understood. Evaluate patients with cholesteatoma, in order to identify possible risk factors or clinical findings associated with labyrinthine fistula. Secondary objectives were to determine the prevalence of labyrinthine fistula in the study cohort, to analyze the role of computed tomography and to describe the hearing results after surgery. This retrospective cohort study included patients with an acquired middle ear cholesteatoma in at least one ear with no prior surgery, who underwent audiometry and tomographic examination of the ears or surgery at our institution. Hearing results after surgery were analyzed according to the labyrinthine fistula classification and the employed technique. We analyzed a total of 333 patients, of which 9 (2.7%) had labyrinthine fistula in the lateral semicircular canal. In 8 patients, the fistula was first identified on image studies and confirmed at surgery. In patients with posterior epitympanic and two-route cholesteatomas, the prevalence was 5.0%; and in cases with remaining cholesteatoma growth patterns, the prevalence was 0.6% (p=0.16). In addition, the prevalence ratio for labyrinthine fistula between patients with and without vertigo was 2.1. Of patients without sensorineural hearing loss before surgery, 80.0% remained with the same bone conduction thresholds, whereas 20.0% progressed to profound hearing loss. Of patients with sensorineural hearing loss before surgery, 33.33% remained with the same hearing impairment, whereas 33.33% showed improvement of the bone conduction thresholds' Pure Tone Average. Labyrinthine fistula must be ruled out prior to ear surgery, particularly in cases of posterior epitympanic or two-route cholesteatoma. Computed tomography is a good diagnostic

[Scrotal fistulas revealing mucinous adenocarcinoma of the scrotum: about a case].

Science.gov (United States)

El Alaoui, Abdelilah; El Boté, Hicham; Ziouani, Oussama; Dembele, Oussman; El Sayegh, Hachem; Iken, Ali; Benslimane, Lounis; Nouini, Yassine

2017-01-01

Scrotales fistulas are rare and often represent secondary lesions of tuberculosis. Mucinous adenocarcinomas are tumors containing at least 50% of extracellular mucus. They occur most commonly in the rectosigmoid; scrotal location is rare. We report the case of a 54-year old patient, with no particular past medical history, with secondary mucinous adenocarcinoma of the scrotum revealed by scrotal fistulas. The patient had suffered from recurrent scrotal fistulas for two years, with no other associated signs. Clinical examination showed multiple scrotal fistulas with discharge of thick pus. Rectal examination was normal. Urological examinations (IVU, UCRM, cystoscopy, …) were normal, the assessment of infectious diseases as well as the detection of BK virus in urine and sputum were negative. Biopsy of sample of scrotal tissue was in favor of moderately differentiated mucinous adenocarcinoma. Immunohistochemical examination was in favor of primary colorectal cancer. Patient's evolution was marked by the occurrence of complex anal fistulas, which appeared on MRI as active, supplying several pelvic peritoneal collections resulting in fleshy buds. There is no consensus on the therapeutic approach due to the rarity of this cancer. Surgical resection is the treatment of choice for this disease. Preoperative chemotherapy and radiation therapy are recommended for this type of cancer, but their role is not well established. The patient underwent primary neoadjuvant chemotherapy and radiation therapy, before abdominoperineal excision.

Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb.

Science.gov (United States)

Tirakotai, W; Benes, L; Kappus, C; Sure, U; Farhoud, A; Bien, S; Bertalanffy, H

2007-01-01

Dural arteriovenous fistulas located in the vicinity of the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. The authors comprehensively analyze multiple features in a series of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Four patients who underwent surgery via the transcondylar approach to treat dural arteriovenous fistulas around the jugular foramen were retrospectively reviewed. Previously, endovascular treatment was attempted in all patients. The success of the surgical treatment was examined with postoperative angiography. Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three patients, and significant flow reduction in one individual. All patients had a good postoperative outcome, and only one experienced mild hypoglossal nerve palsy. Despite extensive bone drilling, an occipitocervical fusion was necessary in only one patient with bilateral lesions. The use of an individually tailored transcondylar approach to treat dural arteriovenous fistulas at the region of the jugular foramen is most effective. This approach allows for complete obliteration of the connecting arterial feeders, and removal of bony structures containing pathological vessels.

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.

Physiologic assessment of coronary artery fistula

International Nuclear Information System (INIS)

Gupta, N.C.; Beauvais, J.

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

MR evaluation of CSF fistulae

International Nuclear Information System (INIS)

Gupta, V.; Goyal, M.; Mishra, N.; Gaikwad, S.; Sharma, A.

1997-01-01

Purpose: To evaluate the role of MR imaging in the localisation of cerebrospinal fluid (CSF) fistulae. Material and Methods: A total of 36 consecutive unselected patients with either clincally proven CSF leakage (n=26) or suspected CSF fistula (n=10) were prospectively evaluated by MR. All MR examinations included fast spin-echo T2-weighted images in the 3 orthogonal planes. Thin-section CT was performed following equivocal or negative MR examination. MR and CT findings were correlated with surgical results in 33 patients. Results: CSF fistula was visualised as a dural-bone defect with hyperintense fluid signal continuous with that in the basal cisterns on T2-weighted images. MR was positive in 26 cases, in 24 of which the fistula was confirmed surgically. In 2 patients the CSF leakage was directly demonstrated on MR. MR sensitivity of 80% compared favourably with the reported 46-81% of CT cisternography (CTC). No significant difference in MR sensitivity in detecting CSF fistula was found between active and inactive leaks. (orig.)

Vesicovaginal Fistula Repair During Pregnancy

African Journals Online (AJOL)

Vesicovaginal Fistula Repair During Pregnancy: A Case Report ... Abstract. We report a repair of Vesicovaginal fistula during pregnancy that was aimed at preventing another spontaneous ... practices that encourage teenage marriage and girl.

Perianal Ulcer and Diabetes Insipidus: A Rare Presentation of Langerhans Cell Histiocytosis in an Adult Male

Directory of Open Access Journals (Sweden)

Ng Chong Beng

2017-07-01

Full Text Available Langerhans cell histiocytosis (LCH, previously known as Histiocystosis X, is a rare idiopathic disease caused by a build-up of langerhan cells in the body. LCH has a heterogenous form of clinical presentation and presents with varying degree of severity. The severity often depends on the disease burden. LCH can manifest as a unifocal disease, multifocal-unisystem or multifocal-multisystem disease with the latter being more fatal than the rest. Risk organ involvement confers a grim prognosis. Perianal lesions are extremely rare skin manifestation of LCH with only few cases reported in the past. Vinca-alkaloids and steroid therapy have been shown to be effective in a large percentage of those presenting with LCH. This case report highlights the diagnosis and management of LCH presenting as a painful perianal ulcer in the background of newly diagnosed diabetes insipidus.

Anal sphincter responses after perianal electrical stimulation

DEFF Research Database (Denmark)

Pedersen, Ejnar; Klemar, B; Schrøder, H D

1982-01-01

By perianal electrical stimulation and EMG recording from the external anal sphincter three responses were found with latencies of 2-8, 13-18 and 30-60 ms, respectively. The two first responses were recorded in most cases. They were characterised by constant latency and uniform pattern, were...... not fatigued by repeated stimulation, were most dependent on placement of stimulating and recording electrodes, and always had a higher threshold than the third response. The third response was constantly present in normal subjects. It had the longest EMG response and the latency decreased with increasing...... stimulation to a minimum of 30-60 ms. This response represented the clinical observable spinal reflex, "the classical anal reflex". The latencies of the two first responses were so short that they probably do not represent spinal reflexes. This was further supported by the effect of epidural anaesthesia which...

Enterocutaneous fistula: A review of 82 cases

African Journals Online (AJOL)

2012-06-15

Jun 15, 2012 ... the fistulas occurred after abdominal operations; many by general practitioners. After treatment for ... Address for correspondence: Dr. Gabriel E. ... sex of the patients, origin of the fistula, volume of the fistula output, type of ...

Relying on Visiting Foreign Doctors for Fistula Repair: The Profile of Women Attending Fistula Repair Surgery in Somalia.

Science.gov (United States)

Gele, Abdi A; Salad, Abdulwahab M; Jimale, Liban H; Kour, Prabhjot; Austveg, Berit; Kumar, Bernadette

2017-01-01

Obstetric fistula is treatable by surgery, although access is usually limited, particularly in the context of conflict. This study examines the profile of women attending fistula repair surgery in three hospitals in Somalia. A cross-sectional study was conducted in Somalia from August to September 2016. Structured questionnaires were administered to 81 women who registered for fistula repair surgery in the Garowe, Daynile, and Kismayo General Hospitals in Somalia. Findings revealed that 70.4% of the study participants reported obstetric labor as the cause of their fistula, and 29.6% reported iatrogenic causes. Regarding the waiting time for the repair surgery, 45% waited for the surgery for over one year, while the rest received the surgery within a year. The study suggests that training for fistula surgery has to be provided for healthcare professionals in Somalia, fistula centers should be established, and access to these facilities has to be guaranteed for all patients who need these services.

Diagnosis and management of fistulizing Crohn's disease

DEFF Research Database (Denmark)

Nielsen, Ole Haagen; Rogler, Gerhard; Hahnloser, Dieter

2009-01-01

, are mostly asymptomatic and do not require intervention. By contrast, perianal fistulas can be painful and abscesses may develop that require surgical drainage with or without seton placement, transient ileostomy, or in severe cases, proctectomy. This Review describes the epidemiology and pathology...

Spontaneous cholecystocutaneous fistula in a dog.

Science.gov (United States)

Marquardt, Shelly A; Rochat, Mark C; Johnson-Neitman, Jennifer L

2012-01-01

The purpose of this case report was to describe the surgical correction of a cholecystocutaneous fistula in a dog. A 6 yr old Vizsla presented with a 2 mo history of a chronic draining wound on the right ventral thorax. Diagnostics revealed numerous fistulous tracts opening at a single site on the right ventrolateral chest wall, extending caudodorsally through the chest wall and diaphragm to the region of the right medial liver lobe. Exploratory laparotomy revealed the apex of the gallbladder adhered to the diaphragm with a tract of fibrous tissue extending along the diaphragm laterally to the right thoracic wall. Cholecystectomy was performed. The fistulous tract was incised to expose the lumen of the fistula, and the fistula was omentalized. Twenty-eight months after surgery, the dog had had no recurrence of the fistulous tract. Exploratory laparotomy allowed excellent visualization of the intra-abdominal path of the fistula and facilitated the ease of resection of the source. Cholecystectomy resulted in rapid and complete resolution of the fistula without the need for excision of the fistula. Although rare, gallbladder disease should be a differential for chronic fistulous tracts.

Clinical value of endoluminal ultrasonography in the diagnosis of rectovaginal fistula

International Nuclear Information System (INIS)

Yin, Hao-Qiang; Wang, Chen; Peng, Xin; Xu, Fang; Ren, Ya-Juan; Chao, Yong-Qing; Lu, Jin-Gen; Wang, Song; Xiao, Hu-Sheng

2016-01-01

Rectovaginal fistula (RVF) refers to a pathological passage between the rectum and vagina, which is a public health challenge. This study was aimed to explore the clinical value of endoluminal biplane ultrasonography in the diagnosis of rectovaginal fistula (RVF). Thirty inpatients and outpatients with suspected RVF from January 2006 to June 2013 were included in the study, among whom 28 underwent surgical repair. All 28 patients underwent preoperative endoluminal ultrasonography, and the obtained diagnostic results were compared with the corresponding surgical results. All of the internal openings located at the anal canal and rectum of the 28 patients and confirmed during surgery were revealed by preoperative endosonography, which showed a positive predictive value of 100 %. Regarding the 30 internal openings located in the vagina during surgery, the positive predictive value of preoperative endosonography was 93 %. The six cases of simple fistulas confirmed during surgery were revealed by endosonography; for the 22 cases of complex fistula confirmed during surgery, the positive predictive value of endosonography was 90 %. Surgery confirmed 14 cases of anal fistula and 14 cases of RVF, whereas preoperative endoluminal ultrasonography suggested 16 cases of anal fistula and 12 cases of RVF, resulting in positive predictive values of 92.3 and 93 %, respectively. The use of endoluminal biplane ultrasonography in the diagnosis of RVF can accurately determine the internal openings in the rectum or vagina and can relatively accurately identify concomitant branches and abscesses located in the rectovaginal septum. Thus, it is a good imaging tool for examining internal and external anal sphincter injuries and provides useful information for preoperative preparation and postoperative evaluation

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)

Gastrobronchial fistula after toothbrush ingestion.

Science.gov (United States)

Karcher, Jan Christoph; von Buch, Christoph; Waag, Karl-Ludwig; Reinshagen, Konrad

2006-10-01

Gastrobronchial fistulous communications are uncommon complications of disease processes with only 36 previously reported cases. Described as complication of a number of conditions, such as previous gastroesophageal surgery, subphrenic abscess, and gastric ulcers (Jha P, Deiraniya A, Keeling-Robert C, et al. Gastrobronchial fistula--a recent series. Interact Cardiovasc Thorac Sur 2003;2:6-8), we report a case of fistulization caused by ingestion of a foreign body. A patient with mental retardation, admitted for the treatment of osteomyelitis, presented during hospitalization symptoms of high fever, vomiting, and respiratory distress. Endoscopy showed the presence of a gastrobronchial fistula, which developed after ingestion of a toothbrush. The toothbrush was extracted endoscopically, and the fistula was subsequently closed by surgery. The patient recovered completely. We report the first case of a gastrobronchial fistula as a complication of foreign body ingestion.

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.)

Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

International Nuclear Information System (INIS)

Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H.

2001-01-01

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.)

Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and ...

African Journals Online (AJOL)

after gut resection and anastomosis and explored those related to spontaneous closure of the fistulas. Objective. To determine the factors associated with the occurrence and spontane- ous closure of enterocutaneous fistulas. Design. A retrospective, hospital-based study of patients who developed enterocutaneous fistulas ...

Milk Fistula: Diagnosis, Prevention, and Treatment.

Science.gov (United States)

Larson, Kelsey E; Valente, Stephanie A

2016-01-01

Milk fistula is an uncommon condition which occurs when there is an abnormal connection that forms between the skin surface and the duct in the breast of a lactating woman, resulting in spontaneous and often constant drainage of milk from this path of least resistance. A milk fistula is usually a complication that results from a needle biopsy or surgical intervention in a lactating patient. Here, the authors present an unusual case of a spontaneous milk fistula which developed from an abscess in the breast of a lactating woman. The patient initially presented to the office with a large open wound on her breast, formed from skin breakdown, within which milk was pooling. She was treated with local wound care and cessation of breastfeeding, with appropriate healing of the wound and closure of the fistula with 6 weeks. Diagnosis, prevention, and treatment of milk fistula were reviewed. © 2015 Wiley Periodicals, Inc.

Analysis and description of disease-specific quality of life in patients with anal fistula.

Science.gov (United States)

Ferrer-Márquez, Manuel; Espínola-Cortés, Natalia; Reina-Duarte, Ángel; Granero-Molina, José; Fernández-Sola, Cayetano; Hernández-Padilla, José Manuel

2018-04-01

In patients diagnosed with anal fistula, knowing the quality of life specifically related to the disease can help coloproctology specialists to choose the most appropriate therapeutic strategy for each case. The aim of our study is to analyzse and describe the factors related to the specific quality of life in a consecutive series of patients diagnosed with anal fistula. Observational, cross-sectional study carried out from March 2015 to February 2017. All patients were assessed in the colorectal surgery unit of a hospital in southeast of Spain. After performing an initial anamnesis and a physical examination, patients diagnosed with anal fistula completed the Quality of Life in Ppatients with Anal Fistula Questionnaire (QoLAF-Q). This questionnaire specifically measures quality of life in people with anal fistula and its score range is the following: zero impact = 14 points, limited impact = 15 to 28 points, moderate impact = 29 to 42 points, high impact = 43 to 56 points, and very high impact = 57 to 70 points. A total of 80 patients were included. The median score obtained in the questionnaire for the sample studied was 34.00 (range=14-68). Statistically significant differences between patients with "primary anal fistula" (n=65) and "recurrent anal fistula" (n=15) were observed (mean rank=42.96 vs. mean rank=29.83, p=0.048). Furthermore, an inverse proportion (P=.016) between "time with clinical symptoms" and "impact on quality of life" was found (5 years: mean rank = 19.00). There were no statistically significant differences (P=.149) between quality of life amongst patients diagnosed with complex (mean rank = 36.13) and simple fistulae (mean rank = 43.59). Anal fistulae exert moderate-high impact on patients' quality of life. "Shorter time experiencing clinical symptoms" and the "presence of primary fistula" are factors that can be associated with worse quality of life. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Vesicovaginal fistula: a review of nigerian experience.

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Ijaiya, M A; Rahman, A G; Aboyeji, A P; Olatinwo, A W; Esuga, S A; Ogah, O K; Raji, H O; Adebara, I O; Akintobi, A O; Adeniran, A S; Adewole, A A

2010-01-01

Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. To review the causes, complications, and outcome of Vesicovaginal fistula in Nigeria. Studies on Vesicovaginal fistula were searched on the internet. Information was obtained on PubMed(medline), WHO website, Bioline International, African Journal of Line, Google scholar, Yahoo, Medscape and e Medicine. Many Nigerian women are living with Vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria that southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the Vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance and were poverty, illiteracy, ignorance, restriction of women's movement, non-permission from husband and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%-91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.

Early Diagnosis and Hematopoietic Stem Cell Transplantation for IL10R Deficiency Leading to Very Early-Onset Inflammatory Bowel Disease Are Essential in Familial Cases

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Neslihan Edeer Karaca

2016-01-01

Full Text Available Alterations of immune homeostasis in the gut may result in development of inflammatory bowel disease. A five-month-old girl was referred for recurrent respiratory and genitourinary tract infections, sepsis in neonatal period, chronic diarrhea, perianal abscess, rectovaginal fistula, and hyperemic skin lesions. She was born to second-degree consanguineous, healthy parents. Her elder siblings were lost at 4 months of age due to sepsis and 1 year of age due to inflammatory bowel disease, respectively. Absolute neutrophil and lymphocyte counts, immunoglobulin levels, and lymphocyte subsets were normal ruling out severe congenital neutropenia and classic severe combined immunodeficiencies. Quantitative determination of oxidative burst was normal, excluding chronic granulomatous disease. Colonoscopy revealed granulation, ulceration, and pseudopolyps, compatible with colitis. Very early-onset colitis and perianal disease leading to fistula formation suggested probability of inherited deficiencies of IL-10 or IL-10 receptor. A mutation at position c.G477A in exon of the IL10RB gene, resulting in a stop codon at position p.W159X, was identified. The patient underwent myeloablative hematopoietic stem cell transplantation from full matched father at 11 months of age. Perianal lesions, chronic diarrhea, and recurrent infections resolved after transplantation. IL-10/IL-10R deficiencies must be considered in patients with early-onset enterocolitis.

Behavior of pharyngocutaneous fistula

International Nuclear Information System (INIS)

Reynaldo Gonzalez, Maria de los Angeles; Trinchet Soler, Rafael; Perez Fernandez, Julia; Alvarez Borges, Francisco Emilio

2010-01-01

INTRODUCTION. The pharyngocutaneous fistula is clinically detected by appearance of saliva together with deglutition. It is more frequent in postoperative period of total laryngectomies and may to appear in a spontaneous way by dehiscence of pharyngeal suture provoked by deglutition movements of patient or to go with a infection or necrosis. METHODS. A descriptive and bilateral study was conducted on the behavior of pharyngocutaneous fistulas in Cervicofacial Oncology Surgery Service of ''Vladimir Ilich Lenin'' University Hospital in Holguin province. Study sample included all patients operated on by total laryngectomy from 2003 to 2008. There was a total 158 patients and all underwent a manual closure of hypofarynx. RESULTS. Fistulas were present in the 5,6% of cases. The 77,7% of patients had underwent radiotherapy before surgery and the 66,4% of them underwent tracheostomies at surgical operation. In all patients operated on by pharyngotome there was postsurgical sepsis and feeding was started at 10 and 12 days in the 88,4% of cases. CONCLUSIONS. The wide predominance of male patients is directly related to usual toxic habits in this sex. Presurgical tracheostomy is accepted by surgeons as a risk factor for development of fistula, but in present paper wasn't significant. Onset of oral feeding in patients presenting with layngectomies must to fluctuate between 10 and 14 days, never before, but there isn't a hypopharynx healing allowing the foods passage. Also, so it is possible to avoid the appearance of complications like the pharyngocutaneous fistulas. (author)

Causes and management of postoperative enterocutaneous fistulas

International Nuclear Information System (INIS)

Memon, A.S.; Siddiqui, F.G

2004-01-01

Objective: To identify the causes of postoperative enterocutaneous fistulas and to evaluate the results of conservative and operative treatment including the effectiveness of octreotide in the management of these fistulas. Subjects and Methods: Forty patients with postoperative fistula were studied. Demographic variables, causes and management outcome was observed and recorded. Results: There were 25 males and 15 females with 50% of the patients being in age group of 21-30 years. Emergency surgery for typhoid perforation(45%) and intestinal tuberculosis (30%) were the commonest causes. Ileum and jejunum were the commonest sites of fistulation found in 85% cases. Twenty-one patients were started on conservative treatment with spontaneous closure occurring in 15 (71.4%) patients. Nineteen patients were operated within three days of admission due to generalized peritonitis (73.7%) and local intra-abdominal collections (26.3%). Wound infection was the commonest complication in the operative group. The mortality rate in this series was 7.5%. All the deaths occurred following surgery. Conclusion: Postoperative enterocutaneous fistula has a high morbidity and a significant mortality. Sepsis in the peritoneal cavity is the major cause of mortality. Conservative treatment has a good outcome for these fistulas. The use of octreotide is highly recommended as it definitely converts high output fistulas to low output fistulas. (author)

Modified prosthesis for the treatment of malignant esophagotracheal fistula

International Nuclear Information System (INIS)

Buess, G.; Schellong, H.; Kometz, B.; Gruessner, R.J.; Junginger, T.

1988-01-01

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

Sexual violence-related fistulas in the Democratic Republic of Congo.

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Onsrud, Mathias; Sjøveian, Solbjørg; Luhiriri, Roger; Mukwege, Dennis

2008-12-01

To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women.

Collaural Fistula: A Case Report

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Kalyan Pal

2016-12-01

Full Text Available Introduction Collaural fistula or cervico-aural fistula is rare and accounts for less than 8% of branchial cleft anomalies. Their rarity and diverse presentations have frequently led to misdiagnosis and inappropriate treatment. Case Report We report one such case of a 7 year old girl who presented to us with two discharging cutaneous openings on the left side; one in the floor of the left external auditory canal and another in the upper neck and lower face (infra-auricular region. Discussion Surgical exploration and excision is the definitive treatment of a collaural fistula. A sinus/ fistula opening into the external auditory canal, should be removed with skin and cartilage. If more than 30% of the circumference of the external auditory canal is denuded, split thickness skin grafting and stenting are recommended. The potential post-operative complications are facial nerve paralysis and recurrence of the lesion. Fistulogram is a useful diagnostic tool.

Benign Duodenocolic Fistula: a Case Report.

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Soheili, Marzieh; Honarmand, Shirin; Soleimani, Heshmatollah; Elyasi, Anvar

2015-08-01

Benign duodenocolic fistula (DCF), known as a fistula between the duodenum and colon with or without cecum of nonmalignant origin, is an unusual complication of different gastrointestinal diseases. The present paper records a case in which the patient presented with chronic diarrhea, abdominal pain, weight loss as well as having a history of gastric ulcer. Most frequently the condition presents with signs of malabsorption such as weight loss and diarrhea, but other symptoms include nausea, vomiting (sometimes with fecal), and abdominal pain. Gastrointestinal inflammatory conditions are the usual causes. The most common 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 the fistula provides quick relief.

Total antioxidative capacity and zinc concentration in dogs suffering from perianal tumours

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Brodzki Adam

2015-09-01

Full Text Available The aim of the study was to determine total antioxidative capacity (TAC and zinc concentration in serum of dogs suffering from perianal tumours just before the start of the antihormonal treatment (AHT and one and six months later. The study was performed on 45 dogs divided into two groups: control group suffering from non-malignant tumours (N = 24 and a group with malignant neoplastic changes (N = 21. Serum TAC and zinc concentrations were measured using photometric and atomic absorption spectrophotometric methods. Six months after the start of the AHT, TAC was significantly lower by 10.6% in dogs with malignant tumours when compared to controls (P = 0.03. In the non-malignant group, serum zinc concentration was higher before the treatment than in the malignant group, while the opposite results were observed six months later (P < 0.001. In the non-malignant group, gradually decreasing values of serum zinc concentration at each stage of the investigation were observed, while the opposite results were obtained in the malignant group (P < 0.05. The obtained results indicate that malignant neoplastic process is associated with significantly reduced TAC. Determination of serum zinc concentration in dogs with non-malignant and malignant perianal tumours may have practical diagnostic and prognostic values and may serve towards increasing the effectiveness of AHT monitoring.

Urinary tract infection among fistula patients admitted at Hamlin fistula hospital, Addis Ababa, Ethiopia.

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Dereje, Matifan; Woldeamanuel, Yimtubezinesh; Asrat, Daneil; Ayenachew, Fekade

2017-02-16

Urinary Tract Infection (UTI) causes a serious health problem and affects millions of people worldwide. Patients with obstetric fistula usually suffer from incontinence of urine and stool, which can predispose them to frequent infections of the urinary tract. Therefore the aim of this study was to determine the etiologic agents, drug resistance pattern of the isolates and associated risk factor for urinary tract infection among fistula patients in Addis Ababa fistula hospital, Ethiopia. Across sectional study was conducted from February to May 2015 at Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Socio-demographic characteristics and other UTI related risk factors were collected from study participants using structured questionnaires. The mid-stream urine was collected and cultured on Cysteine lactose electrolyte deficient agar and blood agar. Antimicrobial susceptibility was done by using disc diffusion method and interpreted according to Clinical and Laboratory Standards Institute (CLSI). Data was entered and analyzed by using SPSS version 20. Out of 210 fistula patients investigated 169(80.5%) of the patient were younger than 25 years. Significant bacteriuria was observed in 122/210(58.1%) and 68(55.7%) of the isolates were from symptomatic cases. E.coli 65(53.7%) were the most common bacterial pathogen isolated followed by Proteus spp. 31(25.4%). Statistical Significant difference was observed with history of previous UTI (P = 0.031) and history of catheterization (P = 0.001). Gram negative bacteria isolates showed high level of resistance (>50%) to gentamicin and ciprofloxacin, while all gram positive bacteria isolated were showed low level of resistance (20-40%) to most of antibiotic tested. The overall prevalence of urinary tract infection among fistula patient is 58.1%. This study showed that the predominant pathogen of UTI were E.coli followed by Proteus spp. It also showed that amoxicillin-clavulanic acid was a drug of choice for urinary tract

Maturation of arteriovenous fistula: Analysis of key factors

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Muhammad A. Siddiqui

2017-12-01

Full Text Available The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.

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.

Key to successful vesico vaginal fistula repair, an experience of urogenital fistula surgeries and outcome at gynaecological surgical camp 2005

International Nuclear Information System (INIS)

Jatoi, N.; Jatoi, N.M.; Sirichand, P.

2008-01-01

Vesico-vaginal fistula is not life threatening medical problem, but the woman face demoralization, social boycott and even divorce and separation. The aetiology of the condition has been changed over the years and in developed countries obstetrical fistula are rare and they are usually result of gynaecological surgeries or radiotherapy. Urogenital fistula surgery doesn't require special or advance technology but needs experienced urogynaecologist with trained team and post operative care which can restore health, hope and sense of dignity to women. This prospective study was carried out to analyze the success rate in patients attending the referral hospital and sent from free gynaecological surgery camps held at interior of Sindh, and included preoperative evaluation for route of surgery, operative techniques and postoperative care. Total 70 patients were admitted from the patients attending the camp. Out of these, 29 patients had uro-genital fistula. Surgical repair of the fistula was done through vaginal route on 27 patients while 2 required abdominal approach. Out of 29 surgical repairs performed, 27 proved successful. Difficult and complicated fistulae need experienced surgeon. Establishment of separate fistula surgery unit along with appropriate care and expertise accounts for the desired results. (author)

Formation of a vesicovaginal fistula in a pig model

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Lindberg J

2015-08-01

Full Text Available Jennifer Lindberg,1 Emilie Rickardsson,1 Margrethe Andersen,2 Lars Lund1,2 1Clinical Institute, University of Southern Denmark, Odense, 2Department of Urology, Odense University Hospital, Odense C, Denmark Objective: To establish an animal model of a vesicovaginal fistula that can later be used in the development of new treatment modalities.Materials and methods: Six female pigs of Landrace/Yorkshire breed were used. Vesicotomy was performed through open surgery. An standardized incision between 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-scopy was performed to examine the fistula in vivo. Thereafter, the pigs were euthanized with intravenous pentobarbital.Results: Two out of four (50% pigs developed persistent fistulas. No per- or postoperative complications occurred.Conclusion: This study indicates that this pig model of vesicovaginal fistula can be an effective and cheap way to create a fistula between the bladder and vagina. Keywords: vesicovaginal fistula, urinary fistula, animal model

A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

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Takaaki Fujii

2007-10-01

Full Text Available Colocutaneous fistula caused by diverticulitis is relatively rare, and a delayed recrudescent case of colocutaneous fistula is very uncommon. We herein report a rare case of a Japanese 56-year-old male with delayed recrudescent sigmoidocutaneous fistula due to diverticulitis. A colocutaneous fistula was formed after a drainage operation against a perforation of the sigmoid colon diverticulum. After 5 years from treatment, he was admitted to our hospital because of lower abdominal pain. We diagnosed the recrudescent sigmoidocutaneous fistula by abdominal computed tomography and gastrografin enema, and managed the patient with total parenteral nutrition and antibiotics. As the fistula formation did not improve, a low anterior resection with fistulectomy was performed. The postoperative course was uneventful and the patient was discharged. It has been reported that, in fistulas of the skin caused by diverticular disease, complete closure of the fistula by conservative therapy may not be possible. This case also implies the possibility of a recurrence of the fistula even if the conservative treatment was effective. In cases of colocutaneous fistulas due to diverticulitis, radical surgery is considered necessary because of possibility of recurrence of the fistula.

Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

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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.)

Nontyphi Salmonella Empyema with Bronchopleural Fistula in a Patient with Human Immunodeficiency Virus

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Douglas Bretzing

2018-01-01

Full Text Available Patients with human immunodeficiency virus (HIV have an increased risk of inoculation with nontyphoid Salmonella compared to the general population. While nontyphoid Salmonella commonly manifests as gastroenteritis, Salmonella bacteremia can be seen in patients with HIV. We present a case of disseminated Salmonellosis in a patient with HIV complicated by bronchopleural fistula and secondary empyema. Case Presentation. A 40-year-old African American male with HIV noncompliant with HAART therapy presented with complaints of generalized weakness, weight loss, cough, night sweats, and nonbloody, watery diarrhea of four weeks’ duration. A computed tomography (CT scan demonstrated a bilobed large, thick-walled cavitary lesion in the right upper lobe communicating with the pleural space to form a bronchopleural fistula. Thoracentesis yielded growth of nontyphi Salmonella species consistent with empyema; he was treated with intravenous Ceftriaxone and underwent placement of chest tube for drainage of empyema with instillation of alteplase/dornase twice daily for three days. Repeat CT chest showed a hydropneumothorax. The patient subsequently underwent video-assisted thoracoscopy with decortication. The patient continued to improve and follow-up CT chest demonstrated improved loculated right pneumothorax with resolution of the right bronchopleural fistula and resolution of the cavitary lesions. Discussion. We describe one of the few cases of development of bronchopulmonary fistula and the formation of empyema in the setting of disseminated Salmonella. Empyema complicated by bronchopulmonary fistula likely led to failure of intrapleural fibrinolytic therapy and the patient ultimately required decortication in addition to antibiotics. While Salmonella bacteremia can be seen in immunocompromised patients, extraintestinal manifestations of Salmonella infection such as empyema and bronchopleural fistulas are uncommon. Bronchopleural fistulas most commonly

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...

Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management.

Science.gov (United States)

Yamamoto, T; Keighley, M R

2000-08-01

Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.

Genito-urinary fistula: a major morbidity in developing countries

International Nuclear Information System (INIS)

Sachdev, P.S.; Hassan, N.; Abbasi, R.M.; Das, C.M.

2009-01-01

Uro-genital fistulas, majority of which are vesico-vaginal fistulas (VVF), are a great challenge for women in developing countries. It is commonly caused by prolong obstructed labour and is one of the worst complications of child birth and poor obstetric care. The objective of this descriptive study was to review the cases of genitourinary fistulae so as to understand the magnitude of the problem and its aetiology and to share our experience of surgical repair with other specialists in this field. The study was conducted at Gynaecological Unit-II, Liaquat University Hospital Hyderabad, Pakistan from June 1996 to December 2007. The case records of all patients admitted and managed during study period were reviewed. The information regarding characteristics, risk factors and surgical management was collected. The data was analysed by SPSS and mean, range, standard deviation and percentage were calculated. During the study period, 278 patients with genitourinary fistulae were admitted and managed. The mean age of patients with urinary fistulae was 31.5+-7.5 years, parity was 4.2+-2.8, and duration of labour was 38.4+-6.5 hours. The duration of fistulae ranged from 1 day to 25 years. Obstructed labour 246 (88.4%) was the most common cause of urinary fistulae, followed by gynaecological surgeries mainly hysterectomies 26 (9.35%). The most common type of urinary fistula was vesico-vaginal fistula (VVF) 250 (89.9%). A total of 268 underwent surgery. Almost all 261 (97.3%) urinary fistulae were repaired transvaginally except patients with ureterovaginal and vesico-uterine fistulae. The most common surgical procedure used was layered closure. Martius graft was used in 3 (1.1%) patients, who required creation of new urethra. The success rate following first, second and third attempt was 85%, 91% and 96% respectively. Urogenital fistulae are rarity in developed world, but are frequently encountered problem in developing countries like Pakistan, often resulting from prolonged

The development of a magnetic resonance imaging index for fistulising Crohn's disease

NARCIS (Netherlands)

Samaan, M. A.; Puylaert, C. A. J.; Levesque, B. G.; Zou, G. Y.; Stitt, L.; Taylor, S. A.; Shackelton, L. M.; Vandervoort, M. K.; Khanna, R.; Santillan, C.; Rimola, J.; Hindryckx, P.; Nio, C. Y.; Sandborn, W. J.; D'Haens, G.; Feagan, B. G.; Jairath, V.; Stoker, J.

2017-01-01

Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a

Orbicularis oris musculomucosal flap for anterior palatal fistula

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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.

Tentorial artery embolization in tentorial dural arteriovenous fistulas

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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.)

Tentorial artery embolization in tentorial dural arteriovenous fistulas

International Nuclear Information System (INIS)

Rooij, Willem Jan van; Sluzewski, Menno; Beute, Guus N.

2006-01-01

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.)

Rectovesicovaginal fistula following rectovaginal fistula caused by radiation therapy for uterine cancer. A case report

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Hara, Tsuneo; Shiba, Masahiro; Matsuoka, Yasuhiro; Kakimoto, Ken-ichi; Oda, Masayoshi; Koide, Takuo [Osaka Koseinenkin Hospital (Japan)

1997-07-01

A case of rectovesicovaginal fistula caused by pelvic radiation for uterine cancer is presented. A 62-year-old woman visited our department complaining of macroscopic hematuria, mictional pain and pollakisuria. She had a history of total hysterectomy and radiation therapy for cervical cancer 26 years earlier. Melena was noted in March 1994 and an escape of stool from the vagina followed nine months later. She consulted a surgeon about it, however no active treatment was performed before coming under our care. Computed tomography demonstrated that the posterior bladder wall was extremely thin and the possibility of the formation of vesical perforation was strongly suggested. We constructed transverse-colostomy, however, a rectovesicovaginal fistula developed seven months later. Therefore, in order to regain a dry life, an ileal conduit was constructed and her quality of life began to improve. It is probable that the rectovesicovaginal fistula could have been prevented if colostomy had been carried out soon after the appearance of melena or soon after the formation of the rectovaginal fistula. (author)

Rectovesicovaginal fistula following rectovaginal fistula caused by radiation therapy for uterine cancer. A case report

International Nuclear Information System (INIS)

Hara, Tsuneo; Shiba, Masahiro; Matsuoka, Yasuhiro; Kakimoto, Ken-ichi; Oda, Masayoshi; Koide, Takuo

1997-01-01

A case of rectovesicovaginal fistula caused by pelvic radiation for uterine cancer is presented. A 62-year-old woman visited our department complaining of macroscopic hematuria, mictional pain and pollakisuria. She had a history of total hysterectomy and radiation therapy for cervical cancer 26 years earlier. Melena was noted in March 1994 and an escape of stool from the vagina followed nine months later. She consulted a surgeon about it, however no active treatment was performed before coming under our care. Computed tomography demonstrated that the posterior bladder wall was extremely thin and the possibility of the formation of vesical perforation was strongly suggested. We constructed transverse-colostomy, however, a rectovesicovaginal fistula developed seven months later. Therefore, in order to regain a dry life, an ileal conduit was constructed and her quality of life began to improve. It is probable that the rectovesicovaginal fistula could have been prevented if colostomy had been carried out soon after the appearance of melena or soon after the formation of the rectovaginal fistula. (author)

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

International Nuclear Information System (INIS)

Kuśmierska, Małgorzata; Gać, Paweł; Nahorecki, Artur; Szuba, Andrzej; JaŸwiec, Przemysław

2013-01-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

Energy Technology Data Exchange (ETDEWEB)

Kuśmierska, Małgorzata; Gać, Paweł [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland); Nahorecki, Artur [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Szuba, Andrzej [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Medical University, Wrocław (Poland); JaŸwiec, Przemysław [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland)

2013-07-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus.

Esophagojejunal Anastomosis Fistula, Distal Esophageal Stenosis, and Metalic Stent Migration after Total Gastrectomy

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Nadim Al Hajjar

2015-01-01

Full Text Available Esophagojejunal anastomosis fistula is the main complication after a total gastrectomy. To avoid a complex procedure on friable inflamed perianastomotic tissues, a coated self-expandable stent is mounted at the site of the anastomotic leak. A complication of stenting procedure is that it might lead to distal esophageal stenosis. However, another frequently encountered complication of stenting is stent migration, which is treated nonsurgically. When the migrated stent creates life threatening complications, surgical removal is indicated. We present a case of a 67-year-old male patient who was treated at our facility for a gastric adenocarcinoma which developed, postoperatively, an esophagojejunostomy fistula, a distal esophageal stenosis, and a metallic coated self-expandable stent migration. To our knowledge, this is the first reported case of an esophagojejunostomy fistula combined with a distal esophageal stenosis as well as with a metallic coated self-expandable stent migration.

Post pneumonectomy empyema with bronchopleural fistula

International Nuclear Information System (INIS)

Hirata, Seiyu; Yamamoto, Kensuke.

1991-01-01

A 48-year-old woman underwent a right pneumonectomy for advanced mycobacterial disease (M. avium Complex), which followed the postoperative radiotherapy against a malignant schwannoma of the right lower chest wall treated seven years ago. On the 13th postoperative day, re-suture of the bronchial stump was performed urgently because of early bronchopleural fistula development. On the heels of that, reclosure of the bronchial fistula with coverage of the stump by parietal pleural flap was performed on the forty-first post operative day. On the 110th day, however, open drainage with thoracoplasty was performed because development of insidious aspergillous empyema was detected. Since then, local instillation of amphotellisin B, with an oral administration of antifungus drug was started. After succeeding to control the mycotic infection, reclosure of the bronchofistula, covered with pedicled intercostal muscle flap were performed on the 280th postoperative day and extraperiostal air-plombage for reducing empyema cavity. Postoperative course was uneventful and the patient was discharged one year later. With respect to pathogenetic relationship between radiation pneumonitis and feasibility of infection to atypical mycobacteria, preoperative radiotherapy and concurrence of postoperative bronchofistula, and some problems on management of empyema bronchofistula were briefly discussed. (author)

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

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Skartsis, Nikolaos; Martinez, Laisel; Duque, Juan Camilo; Tabbara, Marwan; Velazquez, Omaida C.; Asif, Arif; Andreopoulos, Fotios; Salman, Loay H.

2014-01-01

Stenosis of arteriovenous (A-V) fistulae secondary to neointimal hyperplasia (NIH) compromises dialysis delivery, which worsens patients' quality of life and increases medical costs associated with the maintenance of vascular accesses. In the present study, we evaluated the role of the receptor tyrosine kinase c-Kit in A-V fistula neointima formation. Initially, c-Kit was found in the neointima and adventitia of human brachiobasilic fistulae, whereas it was barely detectable in control veins harvested at the time of access creation. Using the rat A-V fistula model to study venous vascular remodeling, we analyzed the spatial and temporal pattern of c-Kit expression in the fistula wall. Interestingly, c-Kit immunoreactivity increased with time after anastomosis, which concurred with the accumulation of cells in the venous intima. In addition, c-Kit expression in A-V fistulae was positively altered by chronic kidney failure conditions. Both blockade of c-Kit with imatinib mesylate (Gleevec) and inhibition of stem cell factor production with a specific short hairpin RNA prevented NIH in the outflow vein of experimental fistulae. In agreement with these data, impaired c-Kit activity compromised the development of NIH in A-V fistulae created in c-KitW/Wv mutant mice. These results suggest that targeting of the c-Kit signaling pathway may be an effective approach to prevent postoperative NIH in A-V fistulae. PMID:25186298

Sealing of Airway Fistulas for Metallic Covered Z-type Stents

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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.

[Hepatobronchial Fistula and Lung Abscess after Transarterial Chemoembolization].

Science.gov (United States)

Lee, Kwanjoo; Song, Jeong Eun; Jeong, Hyang Sook; Kim, Do Young

2017-05-25

Transarterial chemoembolization (TACE) is a common treatment modality to locally manage hepatocellular carcinoma. Liver abscess and bile duct injury are common complications of TACE. However, hepatobronchial fistula is a rare complication. Herein, we report a case of lung abscess due to hepatobronchial fistula after TACE. A 67-year-old man, who had underwent TACE 6 months ago, presented cough and bile-colored sputum. He was diagnosed with lung abscess and hepatobronchial fistula. We performed endoscopic retrograde cholangiopancreatography; however, there was no improvement in his symptoms. Thereafter, partial hepatectomy and repair of fistula were successively conducted.

Neuroradiological diagnosis and interventional therapy of carotid cavernous fistulas

International Nuclear Information System (INIS)

Struffert, T.; Engelhorn, T.; Doelken, M.; Doerfler, A.; Holbach, L.

2008-01-01

Carotid cavernous fistulas are pathologic connections between the internal and/or external carotid artery and the cavernous sinus. According to Barrow one can distinguish between direct (high flow) and indirect (low flow) fistulas, whereby direct fistulas are often traumatic while indirect fistulas more frequently occur spontaneously in postmenopausal women. Diagnosis can easily be established using MRI and angiography, which allow exact visualization of the anatomy of fistulas to plan the interventional neurological therapy that in recent years has replaced surgical therapy. This article provides an overview on imaging findings, diagnosis using MRI and angiography as well as interventional treatment strategies. (orig.) [de

[Diagnostic and therapeutic concepts for vesicovaginal and ureterovaginal fistulas].

Science.gov (United States)

Lang, Isabelle Joy; Fisch, Margit; Kluth, Luis Alex

2018-02-01

 Vesico- and ureterovaginal fistulas are defined as abnormal connections between the urinary tract, on the one side, and the female genital system, on the other. Despite being highly prevalent as an acquired pathology of the urogenital system, there has as yet been no standardized protocol in place for diagnosing and treating these fistulas. This review analyses the current literature concerning vesico- and ureterovaginal fistulas in order to profile common diagnostic and therapeutic concepts.  Literature research was carried out using the data bases of Medline and PubMed. A general internet research was added as well as the subsequent analysis of textbooks. Subsequently 40 scientific publications, four textbooks and one internet source were consulted.  In the diagnostic process of not only vesicovaginal, but also ureterovaginal fistulas a timely vaginal examination followed by a cystoscopy and further imaging by retrograde vaginal methylene blue instillation should be carried out. In order to further the differential diagnosis of ureterovaginal fistulas in particular, additional imaging techniques may be required. However, the therapies of both fistulas manifest essential differences. Ureterovaginal fistulas are closed in a two-stage procedure. At first, a percutaneous nephrostomy is placed to decompress the renal collecting system and further drain the urine, followed by a second intervention, which closes the fistula. The management of vesicovaginal fistulas includes both conservative and surgical concepts, the latter of which may in turn be divided into a transabdominal and/or a transvaginal approach. Essentially, transabdominal fistula surgery should, at first, include the identification of the orifices of both ureters to subsequently splint them as indicated. This should be followed by the excision of the fistula. In the case of large fistulas a flap reconstruction of the area may be considered after the mobilisation of the surrounding tissue. Despite

Vesicovaginal fistula repair through vaginal approach

International Nuclear Information System (INIS)

Ashraf, S.; Rahim, J.

2014-01-01

Objectives: To evaluate the outcome of trans-vaginal repair of vesico-vaginal fistula through vaginal approach. Study Design: Prospective study. Material and Methods: This study was carried out in Department of Urology, Shaikh Zayed Postgraduate Medical Institute and National institute of Kidney Diseases, Lahore for the period extending from April 2009 to April 2014. Total 17 patients were included in the study. History, physical examination and findings on investigations were reviewed. In all patients cystoscopy and vaginal examination was performed to see fistula site and ureteral orfices. Then trans-vaginal repair was done in all cases. Results: VVF repair was performed on 17 patients aging 25 to 45 years (mean 35.83 ± 7.37 years). The symptoms preceded for a period of 3 months to 8 years. The cause was gynecological hysterectomy 8 (47.05%), obstetric C-section 7 (41.17%) and obstructed labor 2(11.76%). In three of our patients VVF was previously repaired trans-abdominally. On cystoscopy no patients had more than one fistula. In two (11.76%) patients fistula was supratrigonal. The average size of fistula was 2.05 em, detail of fistula site and size is given in table. One patient had leakage on second postop day that was managed with change of Foleys catheter. Successful repair was achieved in all patients and no patient required second attempt. No ureteric injury and other complications were observed. Conclusion: Trans-vaginal repair of VVF avoid laparotomy and bladder bisection. It has reduced hospital stay and morbidity. (author)

Radiation arteriopathy in the transgenic arteriovenous fistula model.

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Lawton, Michael T; Arnold, Christine M; Kim, Yung J; Bogarin, Ernesto A; Stewart, Campbell L; Wulfstat, Amanda A; Derugin, Nikita; Deen, Dennis; Young, William L

2008-05-01

The transgenic arteriovenous fistula model, surgically constructed with transgenic mouse aorta interposed in common carotid artery-to-external jugular vein fistulae in nude rats, has a 4-month experimental window because patency and transgenic phenotype are lost over time. We adapted this model to investigate occlusive arteriopathy in brain arteriovenous malformations after radiosurgery by radiating grafted aorta before insertion in the fistula. We hypothesized that high-dose radiation would reproduce the arteriopathy observed clinically within the experimental time window and that deletions of endoglin (ENG) and endothelial nitric oxide synthase (eNOS) genes would modify the radiation response. Radiation arteriopathy in the common carotid arteries of 171 wild-type mice was examined with doses of 25, 80, 120, or 200 Gy (Experiment 1). Radiation arteriopathy in 68 wild-type arteriovenous fistulae was examined histologically and morphometrically with preoperative radiation doses of 0, 25, or 200 Gy (Experiment 2). Radiation arteriopathy in 51 transgenic arteriovenous fistulae (36 ENG and 15 eNOS knock-out fistulae) was examined using preoperative radiation doses of 0, 25, or 200 Gy (Experiment 3). High-dose radiation (200 Gy) of mouse common carotid arteries induced only mild arteriopathy (mean score, 0.66) without intimal hyperplasia and with high mortality (68%). Radiation arteriopathy in wild-type arteriovenous fistulae was severe (mean score, 3.5 at 200 Gy), with intimal hyperplasia and medial disruption at 3 months, decreasing luminal areas with increasing dose, and no mortality. Arteriopathy was robust in transgenic arteriovenous fistulae with ENG +/- and with eNOS +/-, with thick intimal hyperplasia in the former and distinct smooth muscle cell proliferation in the latter. The transgenic arteriovenous fistula model can be adapted to rapidly reproduce radiation arteriopathy observed in resected brain arteriovenous malformations after radiosurgery. High

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

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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.

Evaluation of urogenital fistulas by magnetic resonance urography

International Nuclear Information System (INIS)

Mamere, Augusto Elias; Coelho, Rafael Darahem Souza; Cecin, Alexandre Oliveira; Feltrin, Leonir Terezinha; Lucchesi, Fabiano Rubiao; Seabra, Daniel

2008-01-01

Objective: Vesicovaginal and ureterovaginal fistulas are unusual complications secondary to pelvic surgery or pelvic diseases. The therapeutic success in these cases depends on an appropriate preoperative evaluation for diagnosis and visualization of the fistulous tract. The present study is aimed at demonstrating the potential of magnetic resonance urography for the diagnosis of vesicovaginal and ureterovaginal fistulas as well as for defining the fistulous tracts. Materials And Methods: Seven female patients clinically diagnosed with vesicovaginal or ureterovaginal fistulas had their medical records, radiological and magnetic resonance images retrospectively reviewed. Magnetic resonance urography included 3D-HASTE sequences with fat saturation. Results: Six patients presented vesicovaginal fistulas and, in one patient, a right-sided ureterovaginal fistula was diagnosed. Magnetic resonance urography allowed the demonstration of the fistulous tract in six (85.7%) of the seven patients evaluated in the present study, without the need of bladder catheterization or contrast injection. Conclusion: This study demonstrates both the potential and applicability of magnetic resonance urography in the evaluation of these types of fistulas. (author)

Non-matured arteriovenous fistulae for haemodialysis: diagnosis, endovascular and surgical treatment

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Marko Malovrh

2010-04-01

Full Text Available Non-maturation is a feature of autologous vascular access. The autologous arteriovenous fistula needs time to mature and for the vein to enlarge to a size where it can be needled for dialysis. A fistula that fails early is one that either never develops adequately to support dialysis or fails within the first three months of its use. Two variables are required for fistula maturation. Firstly, the fistula should have adequate blood flow to support dialysis and secondly, it should have enough size to allow for successful repetitive cannulation. Three main reasons for maturation failure are: arterial and venous problems and the presence of accessory veins. Early diagnostics and intervention for fistula maturation minimizes catheter use and its associated complications. The identification of immature fistulae is relatively simple. Physical examination has been highlighted to be a valuable tool in assessing fistula. Any fistula that fails to mature adequately and demonstrates abnormal physical findings should be studied aggressively. Ultrasonography can successfully identify candidates who fail to meet the recently developed criteria for immature fistulae. In recent years, digital subtraction angiography and contrast-enhanced magnetic resonance angiography has been introduced for assessment of dysfunctional haemodialysis conduits, including immature fistulae. A great majority of non-matured fistulae can be successfully salvaged using percutaneous techniques. In addition to endovascular techniques, surgical intervention can also be an option. This paper reviews the process of fistula maturation and presents information regarding how to obtain a mature fistula.

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...

Management of Pharyngocutaneous Fistula With Negative-Pressure Wound Therapy.

Science.gov (United States)

Teixeira, Sérgio; Costa, Joana; Bartosch, Isabel; Correia, Bernardo; Silva, Álvaro

2017-06-01

Pharyngocutaneous fistula is a common complication of laryngopharyngeal surgery and is associated with increased morbidity and mortality. Beyond the classical management, negative-pressure wound therapy (NPWT) can be an alternative and effective treatment. Two patients with pT3N0M0 squamous cell carcinoma of pyriform sinus were subjected to total laryngectomy and pharyngoesophageal reconstruction of a circular (patient 1) and an anterior wall defect (patient 2) with radial forearm free flap and pectoralis major muscle flap, respectively. Both developed a pharyngocutaneous fistula and NPWT was used.A significant decrease of the fistula aperture and exudate was observed after 22 and 21 days of NPWT in patients 1 and 2, respectively. After that standard wound care was instituted and closure of the fistulae was accomplished in 5 and 7 days, respectively. Negative-pressure wound therapy can be an effective treatment for pharyngocutaneous fistula closure, either in the setting of fistulae that persist besides multiple surgical revisions using muscle flaps or as a first-line therapy when fistulae develops.

Treatment of radiation-induced vesicovaginal fistulae

International Nuclear Information System (INIS)

Parm Ulhoei, B.; rosgaard, A.; Harling, H.

1994-01-01

The records of 23 patients with vesicovaginal fistulae (VVF) probably caused by irradiation treatment for cancer of the uterine cervix were analyzed. The median latency between irradiation and fistula formation was 17 years. Ten patients had histologically verified cancer recurrence besides a VVF. In addition, nine patients had a rectovaginal- and one an ileovaginal fistula. Twelve patients were treated primarily with ureteroileocutaneostomy a.m. Bricker. Six had bladder drainage, and four of these had ureteroileocutaneostomy performed at a later stage. Four patients initially underwent percutaneous nephrostomy. One patients had a unilateral ureteroileocutaneostomy performed. Eight patients are alive today (median observation time 2.5 years), and all of these had had ureteroileocutaneostomy performed. Three of these patients (39%) were completely relieved of symptoms while the rest occasionally experienced pain, vaginal discharge and bladder empyema. We conclude that ureteroilocutaneostomy a.m. Bricker is a satisfactory procedure for vesicovaginal fistulae because the socially incapacitating symptoms disappear or are considerably diminished. (au) (9 refs.)

Ureteroarterial fistula: a case report

International Nuclear Information System (INIS)

Kim, Young Sun; Kim, Ji Chang

2007-01-01

Ureteroarterial fistula is an extremely rare complication, but is associated with a high mortality rate. Previous pelvic surgery, long standing ureteral catheter insertion, radiation therapy, vascular surgery and vascular pathology contribute the development of this uncommon entity. Herein, a case of ureteroarterial fistula in a 69-year-old female patient, who presented with a massive hematuria, proven in a second attempt at angiography, is reported

Nephrobronchial fistula complicating neglected nephrolithiasis and xanthogranulomatous pyelonephritis

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Indu B Dubey

2011-01-01

Full Text Available Nephrobronchial fistula is a rare complication seen in association with renal infections, trauma or stone disease. Xanthogranulomatous pyelonephritis (XGP is an infectious disease with a potential for fistulization to lung, skin, colon and other organs. We present a case of nephrolithiasis complicated by obstruction leading to pyonephrosis and nephrobronchial fistula, treated successfully by nephrectomy and excision of fistulous tracts. Nephrobronchial fistula, although a rare complication of longstanding renal stone, should be considered when a patient presents with perirenal suppurative process. This clinical case illustrates the natural history of nephro-bronchial fistula and the relevance of early treatment of nephrolithiasis.

[Multiple coronary arteriovenous fistulae. Hazard or predetermination?].

Science.gov (United States)

Rangel, Alberto; Muñoz-Castellanos, Luis; Solorio, Sergio

2003-01-01

The authors present the clinical cases of three adult patients (49, 53 and 61 year-old), with rheumatic cardiac valvulopathy, and bilateral coronary arteriovenous fistulae draining in the main pulmonary artery. Based on documental investigation, the authors speculate about the predeterminate origin of coronary arteriovenous fistulae. At first glance, it seems obvious that congenital cardiopathies occur at random, i.e., embryonic development deviate or stops due to unknown reasons, originating the persistence of lacunar blood spaces prior to the development of coronary arteries cords. There are two factors involved in the genesis of congenital malformations: a genomic preexisting factor and the presence of an environmental precipitating factor, i.e., isolated pulmonary valve atresia or left ventricular hypoplastic syndrome, with mitral and aortic valve stenosis, can predispose development of coronary arteriovenous fistulae. Recently, the question has been raised whether there is a relation of coronary arteries fistulae with: ethnic groups, hereditary gigantism, autoimmune diseases, such as polymyositis, hereditary hemorrhagic telangiectasia, and apical hypertrophic myocardiopathy. Coronary arteriovenous fistulae, as well as some congenital cardiopathies, could be due to chromosome alterations or might be related to hereditary diseases, such as hemorrhagic telangiectasia, induced by a disturbed genetic program. Although, there is no concrete evidence that a genetic factor is related to the development of coronary arteriovenous fistulae, there are signs that suggest that such a possibility could be investigated.

Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

Science.gov (United States)

Safroneeva, E; Vavricka, S R; Fournier, N; Pittet, V; Peyrin-Biroulet, L; Straumann, A; Rogler, G; Schoepfer, A M

2015-10-01

The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown. To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006). Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication. © 2015 John Wiley & Sons Ltd.

Cholecystic fistula with atypical symptoms

DEFF Research Database (Denmark)

Bang, U.C.; Hasbak, P.; From, G.

2008-01-01

We report a patient with spontaneous cholecystocolonis fistula secondary to cholelithiasis. A 93 year-old woman was admitted because of weight loss, diarrhoea and upper abdominal pain. Ultrasound examination revealed air in the biliary tract and cholescientigraphy revealed a fistula between the g...... the gallbladder and right colon. Using endoscopic retrograde cholangiopancreatography a calculus was extracted from the bile duct and the symptoms disappeared Udgivelsesdato: 2008/1/14...

Pulmonary arteriovenous fistulas

International Nuclear Information System (INIS)

Medeiros Sobrinho, J.H. de; Kambara, A.M.

1987-01-01

Six cases of pulmonary arteriovenous fistulas, isolated, without hemorrhagic hereditary telangiectasia (Rendu-Osler-Weber Symdrome) are reported emphasizing the radiographic, tomographic and angiographic examinations, (M.A.C.) [pt

Combined endovascular and surgical treatment in vertebral arteriovenous fistula

International Nuclear Information System (INIS)

Nakstad, P.H.; Haakonsen, M.; Magnaes, B.; Hetland, S.

1997-01-01

A 7-year-old girl with a right-sided congenital arteriovenous fistula in the neck was admitted with signs of cardial incompensation. Her fistula was fed from the right vertebral artery in antegrade as well as retrograde directions. A steal from the intracranial arteries was established. In addition, smaller feeding arteries from the neck were found. She was operated on with ligation of the right vertebral artery proximal to the fistula but the attempted ligation of the artery cranially to the fistula was unsuccessful. She was therefore embolized by the formation of a plug of platinum fiber coils in the upper right vertebral artery. Catheterization was performed from the left vertebral artery via the basilar artery. Persisting minor feeders to the fistula from cervical arteries were embolized in a second session. Finally, surgical extirpation of the fistula was performed together with the operative ligation of a crossover feeding artery from the left vertebral artery. Her heart size, heart rate and blood pressure were successively normalized. (orig.)

The complete branchial fistula: A case report.

Science.gov (United States)

Shekhar, C; Kumar, R; Kumar, R; Mishra, S K; Roy, M; Bhavana, K

2005-10-01

The incomplete branchial fistula is not an uncommon congenital anomaly of branchial apparatus but a complete one is rare. Here we report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa.

The complete branchial fistula: A case report

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Shekhar, C.; Kumar, R.; Kumar, R.; Mishra, S. K.; Roy, M.; Bhavana, K.

2005-01-01

The incomplete branchial fistula is not an uncommon congenital anomaly of branchial apparatus but a complete one is rare. Here we report a case of complete congenital branchial fistula with an internal opening near the tonsillar fossa.

Congenital cutaneous fistula at the sternoclavicular joint - Not a dermoid fistula but the remnant of the fourth branchial (pharyngeal) cleft ?

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Ohno, Michinobu; Kanamori, Yutaka; Tomonaga, Kotaro; Yamashita, Tatsuya; Migita, Misato; Takezoe, Toshiko; Watanabe, Toshihiko; Fuchimoto, Yasushi; Matsuoka, Kentaro

2015-12-01

A fourth branchial pouch remnant is well known as a pyriform sinus fistula. However, there has been no report of a fistula composed of the complete remnant of the fourth branchial apparatus. We experienced patients with a congenital lower neck cutaneous fistula which was thought to be the skin-side remnant of the fourth branchial cleft. Seven children were referred to our hospital from 2009 to 2015 for the treatment of a cutaneous fistula situated near the sternoclavicular joint. All of them were surgically resected and their pathological characteristics were examined. Clinical charts were retrospectively reviewed. In six cases, the left side was affected. All cutaneous fistulas had a small skin orifice near the sternoclavicular joint and they were situated at the anterior edge of the sternocleidomastoid muscle. Abscess formation was seen in four cases. Surgical resection was performed at the age of 6 months to 9 years. These fistulas ran deep into the subcutaneous tissue and had a blind end. Pathological examination showed that the epithelial layer was mainly composed of a stratified squamous epithelium. In two cases the epithelium was composed of ciliated columnar epithelium. Recurrence has not been observed in any of the cases. The seven cases had a common clinical feature and were a definite clinical entity. Judging from the characteristics of our cases and the previous literature, we concluded that this lower neck cutaneous fistula was most likely a congenital skin-side remnant of the fourth branchial cleft. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A case of lymphogranuloma venereum of 20 years' duration. Isolation of Chlamydia trachomatis from perianal lesions.

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Dan, M; Rotmensch, H H; Eylan, E; Rubinstein, A; Ginsberg, R; Liron, M

1980-01-01

Chlamydia trachomatis was isolated from perianal lesions in a patient in whom lymphogranuloma venereum had been diagnosed 20 years previously. Treatment with tetracycline resulted in a pronounced improvement. Although C trachomatis is known to persist for a long time in the host, isolation of the micro-organism from infected tissues after such a prolonged period has not previously been reported. Images PMID:7427708

Endovascular Management of Acute Bleeding Arterioenteric Fistulas

International Nuclear Information System (INIS)

Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

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 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

Gastrointestinal fistula

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... to look in the stomach or small bowel Barium enema to look in the colon CT scan of the abdomen to look for fistulas between loops of the intestines or areas of infection Fistulogram, in which contrast dye is injected into the opening of the ...

Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula.

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Grgic, Tihomir; Grgic, Dora; Drmic, Domagoj; Sever, Anita Zenko; Petrovic, Igor; Sucic, Mario; Kokot, Antonio; Klicek, Robert; Sever, Marko; Seiwerth, Sven; Sikiric, Predrag

2016-06-05

To establish the effects of BPC 157 on the healing of rat colovesical fistulas, Wistar Albino male rats were randomly assigned to different groups. BPC 157, a stable gastric pentadecapeptide, has been used in clinical applications-specifically, in ulcerative colitis-and was successful in treating both external and internal fistulas. BPC 157 was provided daily, perorally, in drinking water (10µg/kg, 12ml/rat/day) until sacrifice or, alternatively, 10µg/kg or 10ng/kg intraperitoneally, with the first application at 30min after surgery and the last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). Assessment (i.e., colon and vesical defects, fistula leaking, fecaluria and defecation through the fistula, adhesions and intestinal obstruction as healing processes) took place on days 7, 14 and 28. Control colovesical fistulas regularly exhibited poor healing, with both of the defects persisting; continuous fistula leakage; fecaluria and defecation through the fistula; advanced adhesion formation; and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally and in µg- and ng-regimens rapidly improved the whole presentation, with both colon and vesical defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised until it reached the values of healthy rats, there were no signs of fecaluria and no defecation through the fistula, there was counteraction of advanced adhesion formation or there was an intestinal obstruction. In conclusion, BPC 157 effects appear to be suited to inducing full healing of colocutaneous fistulas in rats. Copyright © 2016 Elsevier B.V. All rights reserved.

Coronary Arteriovenous Fistula Causing Hydrops Fetalis

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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.

Factors associated with early failure of arteriovenous fistulae for haemodialysis access.

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Wong, V; Ward, R; Taylor, J; Selvakumar, S; How, T V; Bakran, A

1996-08-01

The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. Post-operative follow-up was performed at various intervals to monitor the development of the fistulae. Radial artery and cephalic vein diameter less than 1.6 mm was associated with early fistula failure. The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery.

Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate

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Justin R. Bryant, DO, MBA

2017-10-01

Full Text Available Summary:. An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.

Countermeasure against postoperative fistulas of head and neck cancer

International Nuclear Information System (INIS)

Hori, Yasutaka; Nishikawa, Kunio; Utida, Hiroshi; Fujisawa, Takurou; Eguchi, Motoharu

2004-01-01

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)

Transoral robotic surgery-assisted excision of a congenital cervical salivary duct fistula presenting as a branchial cleft fistula.

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Rassekh, Christopher H; Kazahaya, Ken; Livolsi, Virginia A; Loevner, Laurie A; Cowan, Andy T; Weinstein, Gregory S

2016-02-01

Congenital cervical salivary duct fistulae are rare entities and can mimic branchial cleft fistulae. Ectopic salivary tissue associated with these pharyngocervical tracts may have malignant potential. We present a case report of a novel surgical approach and review of the literature. A 27-year-old man presented with complaint of drainage from the right side of his neck since early childhood. A tract was found from the posterior tonsillar pillar into the neck and ectopic salivary tissue was found along the tract. A congenital hearing loss was also present. Transoral robotic (TORS)-assisted surgery was used in the management of this patient and allowed excellent visualization of the pharyngeal component of the lesion and a minimally invasive approach. The patient did well with no recurrence. TORS was helpful for management of a congenital salivary fistula and may be helpful for branchial cleft fistulae. These lesions may be associated with the branchio-oto-renal (BOR) syndrome. © 2015 Wiley Periodicals, Inc.

Perpheral bronchopleural fistula: CT evaluation in 22 patients

International Nuclear Information System (INIS)

Lee, Ye Ri; Kim, Min Young; Choi, Seong Hee; Kim, Eung Jo; Lee, Jin Joo; Kim, Oak

1999-01-01

To determine the usefulness of CT for the evaluation of peripheral bronchopleural fistulas. CT scans of 22 patients with persistent air leak, as seen on serial chest PA, and a clinical history, were retrospectively evaluated. We determined the visibility of direct communication between the lung and pleural space, and the frequency and location of this, and if direct communications were not visualized the probable cause. A bronchopleural fistula(n=13) or its probable cause(n=6) was visualized in 19 patients(86%). Direct communications between the lung and pleural space were seen in 13 patients(59%) ; there were six cases of tuberculous empyema, three of tuberculosis, two of necrotizing empyema, one of trauma, and one of postobstructive pneumonitis. In six patients, bronchiectatic change in peripheral lung adjacent to the pleural cavity was noted, and although this was seen as a probable cause of bronchopleural fistula, direct communication was invisible. Bronchopleural fistula or its probable cause was multiple in 18 of 19 patients, involving the upper and lower lobe in eight, the upper in nine, and the lower in two. CT is useful for evaluating the presence of bronchopleural fistula, and its frequency and location, and in patients in whom the fistula is not directly visualized, the cause of this

Appendicoumbilical Fistula: A Rare Reason for Neonatal Umbilical Mass

OpenAIRE

Cevik, M.; Boleken, M. E.; Kadıoglu, E.

2011-01-01

The normal umbilicus is a simple structure, but the intrauterine development of the umbilicus is highly complex. Neonatal umbilical mass anomalies usually represent failure of obliteration of the vitelline duct or the allantois which results in persistence of remnants, which can lead to a wide variety of disorders. In this paper, we present a case of an appendicoumbilical fistula in a neonate along with the differential diagnosis and management options. Embryologic explanation of the etiology...

Laparoscopic repair of vesicovaginal fistula

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Miłosz Wilczyński

2011-06-01

Full Text Available A vesicovaginal fistula is one of the complications that a gynaecologist is bound to face after oncological operations, especially in postmenopausal women. Over the years there have been introduced many techniques of surgical treatment of this entity, including transabdominal and transvaginal approaches.We present a case of a 46-year-old patient who suffered from urinary leakage via the vagina due to the presence of a vesicovaginal fistula that developed after radical abdominal hysterectomy and subsequent radiotherapy. The decision was made to repair it laparoscopically due to retracted, fibrous and scarred tissue in the vaginal apex that precluded a transvaginal approach. A small cystotomy followed by an excision of fistula borders was performed. After six-month follow-up no recurrence of the disease has been noted.We conclude that laparoscopy is an interesting alternative to traditional approaches that provides comparable results.

The association of carotid cavernous fistula with Graves′ ophthalmopathy

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Ozlem Celik

2013-01-01

Full Text Available Graves′ ophthalmopathy (GO is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature.

The association of carotid cavernous fistula with Graves’ ophthalmopathy

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Celik, Ozlem; Buyuktas, Deram; Islak, Civan; Sarici, A Murat; Gundogdu, A Sadi

2013-01-01

Graves’ ophthalmopathy (GO) is one of the frequent manifestations of the disorder which is an inflammatory process due to fibroblast infiltration, fibroblast proliferation and accumulation of glycosaminoglycans. Eye irritation, dryness, excessive tearing, visual blurring, diplopia, pain, visual loss, retroorbital discomfort are the symptoms and they can mimic carotid cavernous fistulas. Carotid cavernous fistulas are abnormal communications between the carotid arterial system and the cavernous sinus. The clinical manifestations of GO can mimic the signs of carotid cavernous fistulas. Carotid cavernous fistulas should be considered in the differential diagnosis of the GO patients especially who are not responding to the standard treatment and when there is a unilateral or asymmetric eye involvement. Here we report the second case report with concurrent occurrence of GO and carotid cavernous fistula in the literature. PMID:23571267

Gastrojejunocolic fistula after gastrojejunostomy: a case series

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Wu Jin-Ming

2008-06-01

Full Text Available Abstract Introduction Gastrojejunocolic (GJC fistulae represent a significant post-surgical cause of morbidity and mortality. GJC fistulae represent rare post-surgical complications, and most are associated with gastric surgery. In the past, this complication has been under-recognized because a fistula may form years after surgery. Case presentation We describe two cases of gastrojejunocolic fistula in men aged 67 and 60 who both initially presented with watery diarrhea and weight loss. Upper GI studies with small bowel follow-through or barium contrast enema studies allowed a conclusive diagnosis to be made. Both patients underwent one-stage en bloc resection, and their postoperative course was uneventful. Conclusion With surgery, this condition is entirely correctable. Pre-operative nutritional status should be evaluated in patients undergoing corrective surgery, and total parenteral nutrition plays a major role in the provision of bowel rest to allow recovery in malnourished patients.

MR findings in traumatic cerebrospinal fluid fistulae

International Nuclear Information System (INIS)

Fortuny, M.E.; Molina Ferrer, L.; Ferreyra, M.; D'Agustini, M.

2000-01-01

Purpose: CSF fistulae represent the 4%-8% of complications after a serious encephalocranial trauma in the infant population. The experience in 3 patients using MRI with Spin-Eco T2 and Cine-GRE sequences is presented. Material and method: Three male patients 6, 11 and 13 years old were studied, who presented encephalocranial trauma and the common complication was Diplococcus Pneumoniae meningitis. They were studied in a 0.5 T equipment with FSE T2 multiplanar sequences with 3 mm slice thickness and Cine-GRE also 3 mm in four phases of 16 images each. Results: Multiple fistulas were found in the temporomastoidic region in two patients. In one case MRI showed only one fistula though the cribiform plate of the ethmoid bone. Conclusions: MRI is a highly reliable method for CSF fistula detection in patients with encephalocranial trauma. FSE-T2-weighted images and Cine-GRE are sensitive sequences. (author)

Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.

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Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

2013-07-01

Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. Copyright © 2013 Wiley Periodicals, Inc.

Pancreatico-pleural Fistula: Case Series

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Manoj Munirathinam

2018-01-01

Full Text Available Pancreatico-pleural fistula is a rare but serious complication of acute and chronic pancreatitis. The pleural effusion caused by pancreatico-pleural fistula is usually massive and recurrent. It is predominately left-sided but right-sided and bilateral effusion does occur. We report four cases of pancreatico-pleural fistula admitted to our hospital. Their clinical presentation and management aspects are discussed. Two patients were managed by pancreatic endotherapy and two patients were managed conservatively. All four patients improved symptomatically and were discharged and are on regular follow-up. Most of these patients would be evaluated for their breathlessness and pleural effusion delaying the diagnosis of pancreatic pathology and management. Hence, earlier recognition and prompt treatment would help the patients to recover from their illnesses. Pancreatic pleural fistula diagnosis requires a high index of suspicion in patients presenting with chest symptoms or pleural effusion. Extremely high pleural fluid amylase levels are usual but not universally present. A chest X-ray, pleural fluid analysis, and abdominal imaging (magnetic resonance cholangiopancreatography/magnetic resonance imaging abdomen more useful than contrast-enhanced computed tomography abdomen would clinch the diagnosis. Endoscopic retrograde cholangiopancreatography with stent or sphincterotomy should be considered when pancreatic duct (PD reveals a stricture or when medical management fails in patients with dilated or irregular PD. Surgical intervention may be indicated in patients with complete disruption of PD or multiple strictures.

Time-to-recovery from obstetric fistula and associated factors: The ...

African Journals Online (AJOL)

EPHA USER33

potential risk factors associated with time to recovery of patients from obstetric fistula. Methods: An ... urinary tract or between the vagina and the rectum by compression of ..... duration of incontinence, width of fistula, length of fistula, status of ...

The two sides of the coin: Similarities and differences in the pathomechanisms of fistulas and stricture formations in irritable bowel disease.

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Scharl, Michael; Bruckner, Ramona S; Rogler, Gerhard

2016-08-01

Fistulas and fibrosis or strictures represent frequent complications in irritable bowel disease (IBD) patients. To date, treatment options for fistulas are limited and surgery is often required. Similarly, no preventive treatment for fibrosis and stricture formation has been established. Frequently, stricture formation and fibrosis precede fistula formation, indicating that both processes may be connected or interrelated. Knowledge about the pathology of both processes is limited. A crucial role for the epithelial-to-mesenchymal transition (EMT) in fistula development has been demonstrated. Of note, EMT also plays a major role in the pathogenesis of fibrosis in many organs, and most likely also plays that role in the intestine. In addition, aberrant matrix remodeling, as well as soluble factors such as tumor necrosis factor (TNF), interleukin 13 (IL-13) and tumor growth factor beta (TGFβ) were involved, both in the onset of the fistula and fibrosis formation. Both fistulas and fibrosis may occur due to deregulated wound healing mechanisms from chronic and severe intestinal inflammation; however, further research is required to obtain a better understanding of the complex pathophysiology of fistula and intestinal fibrosis formation, to allow the development of new and more effective preventive treatment options for those important disease complications.

Pulmonary Arteriovenous Fistula: Clinical and Histologic Spectrum of Four Cases

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Soomin Ahn

2016-09-01

Full Text Available Pulmonary arteriovenous fistula (PAVF is abnormally dilated vessels that provide a right-to-left shunt between pulmonary artery and pulmonary vein and is clinically divided into simple and complex type. Here, we report four cases of surgically resected sporadic PAVFs presenting various clinical and histologic spectrums. Cases 1 (a 57-old-female and 2 (a 54-old-female presented as incidentally identified single aneurysmal fistulas and the lesions were surgically removed without complication. On the other hand, case 3 (an 11-old-male showed diffuse dilated vascular sacs involving both lungs and caused severe hemodynamic and pulmonary dysfunction. Embolization and surgical resection of the main lesion failed to relieve the symptoms. Case 4 (a 36-old-male had a localized multiloculated cyst clinically mimicking congenital cystic adenomatoid malformation. Microscopically, the lesion consisted of dilated thick vessels, consistent with the diagnosis of fistulous arteriovenous malformation/hemangioma.

[Social integration of women operated for obstetric urogenital fistula].

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Diarra, A; Tembely, A; Berthe, H J G; Diakité, M L; Traoré, B; Ouattara, K

2013-10-01

To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula. Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database. Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts. The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Benign Duodenocolic Fistula: a Case Report

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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.

A successful treatment of traumatic bronchobiliary fistula

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LIAO Guan-qun

2012-04-01

Full Text Available 【Abstract】Bronchobiliary fistula (BBF is a rare condition in which there is a nonnatural communication be-tween the biliary tract and the bronchial trees. It is usually aroused by the complications of hepatic hydatidosis, he-patic amebic, biliary obstruction, trauma, neoplasm and he-patic abscess formation. In this paper, we described a pa-tient suffering from BBF that is secondary to trauma or surgery. Especially, BBF was detected in the left lung. Finally, we managed this case successfully without an open surgery. Key words: Bronchial fistula; Biliary fistula; Cholangiopancreatography, endoscopic retrograde; Endoscopy, gastrointestinal

Intermediate-term patency of upper arm arteriovenous fistulae for hemodialysis access in children.

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Haricharan, Ramanath N; Aprahamian, Charles J; Morgan, Traci L; Harmon, Carroll M; Barnhart, Douglas C

2008-01-01

The goal of this study was to estimate the 2-year cumulative thrombosis-free survival of basilic vein transposition (BVT) and brachiocephalic fistulae in children. All children who underwent BVT or brachiocephalic fistula construction at a tertiary care children's hospital from June 2001 to July 2006 were reviewed. Kaplan-Meier analysis, log-rank test, and proportional hazards regression were done. Sixteen children (7 girls) with inadequate forearm veins underwent creation of 18 fistulae (12 BVT, 6 brachiocephalic). Median age was 14 (9-19) years. Mean (+/-SE) operative times for BVT and brachiocephalic fistulae were 3.4 (+/- 0.6) hours and 1.9 (+/-0.4) hours, respectively. The overall 2-year cumulative survival rate was 74% (BVT, 66%; brachiocephalic fistula, 83%). Four fistulae failed (1 brachiocephalic, 3 BVT) and 14 fistulae were censored (5, patent fistula; 4, renal transplantation; 2, unrelated death; 1, elective conversion to peritoneal dialysis; 1, surgical ligation of fistula; 1, lost to follow-up). Of 18 fistulae, 6 underwent additional interventions (4, percutaneous angioplasty; 2, surgical thrombectomy). There were no significant differences in survival times based on fistula type, prior transplant status, age, or operative time. Brachiocephalic and BVT fistulae create reliable hemodialysis access for children who have inadequate forearm veins to allow construction of more distal fistulae.

Sigmoid-vaginal fistula during bevacizumab treatment diagnosed by fistulography.

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Hayashi, C; Takada, S; Kasuga, A; Shinya, K; Watanabe, M; Kano, H; Takayama, T

2016-12-01

There have been several reports describing rectovaginal fistula development after bevacizumab treatment, and these fistulas were diagnosed by CT scan or colonoscopy. We report a case of sigmoid-vaginal fistula diagnosed by fistulography. The case is a 53-year-old woman who was treated for chronic myelogenous leukaemia and gynaecological cancers 8 years previously. At 52 years of age, she was diagnosed with colon cancer and had a partial colectomy performed. One year after surgery, colon cancer recurred, and she was treated with anticancer agents, including bevacizumab. During chemotherapy, she complained of a foul smelling discharge from the vagina. Fistulography revealed a sigmoid-vaginal fistula. This is the first report of vaginal fistulography performed on a patient who was treated with bevacizumab. Fistulography may be useful for detecting sigmoid-vaginal fistula. © 2016 John Wiley & Sons Ltd.

Traumatic Intrarenal Arteriovenous Fistula Treated by Conservative ...

African Journals Online (AJOL)

1974-06-01

Jun 1, 1974 ... with these vascular lesions.' Varela' in 1928 reported the first case of intrarenal arteriovenous fistula. Arteriovenous fistula of the kidney is an ... and penetrating abdominal trauma, this lesion will be encountered with increasing frequency. Selective renal artery catheterisation aids materially in making the.

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

International Nuclear Information System (INIS)

Zhi Aihua; Dai Ruping; Jiang Shiliang; Lu Bin

2012-01-01

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)

Sonographic diagnosis of vesicouterine fistula.

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Park, O-R; Kim, T-S; Kim, H-J

2003-07-01

Vesicouterine fistula is one of the least common types of urogenital fistula, accounting for only 1-4% of all cases. We report a case of vesicouterine fistula after vacuum delivery in a woman with a history of a previous Cesarean section. The 29-year-old woman was hospitalized due to continuous serosanguinous vaginal leakage and hematuria. Transvaginal sonography demonstrated the presence of a fistulous tract between the uterus and the bladder. Cystoscopy demonstrated a small opening in the posterior bladder wall and a cystogram revealed a fistulous tract between the posterior portion of the bladder and the uterine cavity. Since the patient could not tolerate her symptoms, we decided to close the fistulous tract surgically. The fistulous tract was excised and the bladder and uterus were closed primarily. The bladder was drained with a Foley catheter for 12 days and subsequent follow-up of the patient has demonstrated urinary continence. Copyright 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn's Disease Patients: Results from the CONNECT Study.

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Chang Mo Moon

Full Text Available Diagnostic delay frequently occurs in Crohn's disease (CD patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn's Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years (p = 0.014, concomitant upper gastrointestinal (UGI disease (p = 0.012 and penetrating disease behavior at diagnosis (p = 0.001 were positively associated with long diagnostic delay (≥18 months. During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07-1.93; p = 0.017, internal fistulas (HR, 1.62; 95% CI, 1.12-2.33; p = 0.011, and perianal fistulas (HR, 1.38; 95% CI, 1.06-1.80; p = 0.016. However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.

Clinical evaluation of patients with pyriform sinus fistula

International Nuclear Information System (INIS)

Sato, Katsuro; Takahashi, Sugata; Tomita, Masahiko; Watanabe, Jun; Matsuyama, Hiroshi

2007-01-01

Thirteen patients with pyriform sinus fistula treated surgically at our department were clinically evaluated. Twelve (92%) fistulae occurred in the left pyriform sinus, and one (8%) in the right. There were a mean of 4 infectious episodes before the final diagnosis. The median age at the first infection was 5 years, and the median age at surgery was 13 years, although there were 2 elderly patients (over 60 years old) in this series. Association with pharyngeal foreign body was suspected in the case with onset at 81 years of age. There was a history of previous surgery for cervical disease in 54% of the patients. The final diagnosis was based on delineation of the fistula by hypopharyngography, although coronal section of CT and MRI were also useful for understanding the morphopathology. The surgical procedure consisted of identification and staining of the fistula under direct hypopharyngoscopy, followed by identification and extirpation of the fistula until the distal end via a cervical approach. There was no recurrence of infections, although resection of the thyroid gland and identification of the recurrent laryngeal nerve were not always performed. The most important surgical principle is considered to be complete disconnection of the lesion from the hypopharynx, and complete identification and extirpation of the fistula by the procedure used at our department is considered to be a useful surgical strategy. (author)

Analysis of related risk factors for pancreatic fistula after pancreaticoduodenectomy

Directory of Open Access Journals (Sweden)

Qi-Song Yu

2016-08-01

Full Text Available Objective: To explore the related risk factors for pancreatic fistula after pancreaticoduodenectomy to provide a theoretical evidence for effectively preventing the occurrence of pancreatic fistula. Methods: A total of 100 patients who were admitted in our hospital from January, 2012 to January, 2015 and had performed pancreaticoduodenectomy were included in the study. The related risk factors for developing pancreatic fistula were collected for single factor and Logistic multi-factor analysis. Results: Among the included patients, 16 had pancreatic fistula, and the total occurrence rate was 16% (16/100. The single-factor analysis showed that the upper abdominal operation history, preoperative bilirubin, pancreatic texture, pancreatic duct diameter, intraoperative amount of bleeding, postoperative hemoglobin, and application of somatostatin after operation were the risk factors for developing pancreatic fistula (P<0.05. The multi-factor analysis showed that the upper abdominal operation history, the soft pancreatic texture, small pancreatic duct diameter, and low postoperative hemoglobin were the dependent risk factors for developing pancreatic fistula (OR=4.162, 6.104, 5.613, 4.034, P<0.05. Conclusions: The occurrence of pancreatic fistula after pancreaticoduodenectomy is closely associated with the upper abdominal operation history, the soft pancreatic texture, small pancreatic duct diameter, and low postoperative hemoglobin; therefore, effective measures should be taken to reduce the occurrence of pancreatic fistula according to the patients’ own conditions.

Percutaneous drainage of abscesses associated with biliary fistulae

International Nuclear Information System (INIS)

Berger, H.; Winter, T.; Pratschke, E.; Sauerbruch, T.; Klinikum Grosshadern, Muenchen; Klinikum Grosshadern, Muenchen

1989-01-01

33 abdominal abscesses associated with fistulae in 31 patients were treated by percutaneous drainage. 19 of these patients had had surgery immediately preceding the drainage. In 64% the percutaneous drainage led to a diagnosis of an internal fistula. Additional therapeutic measures, because of the fistula, were necessary in 45% (operation, biliary drainage, repositioning of catheter). The average duration of drainage was 29 days. 77% of those abscesses which could be drained were treated successfully. Mortality in the entire series was 19%. (orig.) [de

Gurya cutting and female genital fistulas in Niger: ten cases.

Science.gov (United States)

Ouedraogo, Itengre; McConley, Regina; Payne, Christopher; Heller, Alison; Wall, L Lewis

2018-03-01

The objective was to determine the contribution of female genital cutting to genital fistula formation in Niger from the case records of a specialist fistula hospital. A retrospective review was undertaken of the records of 360 patients seen at the Danja Fistula Center, Danja, Niger, between March 2014 and September 2016. Pertinent clinical and socio-demographic data were abstracted from the cases identified. A total of 10 fistulas resulting from gurya cutting was obtained: 9 cases of urethral loss and 1 rectovaginal fistula. In none of the cases was genital cutting performed for obstructed labor or as part of ritual coming-of-age ceremonies, but all cutting procedures were considered "therapeutic" within the local cultural context as treatment for dyspareunia, lack of interest in or unwillingness to engage in sexual intercourse, or female behavior that was deemed to be culturally inappropriate by the male spouse, parents, or in-laws. Clinical cure (fistula closed and the patient continent) was obtained in all 10 cases, although 3 women required more than one operation. Gurya cutting is an uncommon, but preventable, cause of genital fistulas in Niger. The socio-cultural context which gives rise to gurya cutting is explored in some detail.

Frequency of oronasal fistulae in complete cleft palate repair

International Nuclear Information System (INIS)

Aslam, M.

2015-01-01

To determine the frequency of oro-nasal fistula in patients undergoing complete cleft palate repair by two flappalatoplasty. Study Design: Case series. Place and Duration of Study: Department of Plastic Surgery, Services Hospital, Lahore, from January to December 2013. Methodology: Patients admitted to the study place for repair of cleft palate after informed consent obtained were included. Cleft palate was repaired by two-flap palatoplasty, using Bardach technique. Patients were discharged on the second postoperative day and followed-up at third week postoperatively. During follow-up visits, fistulae formation and their sites were recorded on pre-designed proforma. Results: Among the total 90 patients, 40 patients (44.4%) were male and 50 patients (55.6%) were female. The mean age was 6.4 +- 5.7 years ranging from 9 months to 20 years. At third week follow-up, 5 patients (5.6%) had fistulae formation. Four patients (80%) had anterior fistulae and one patient (20%) had posterior fistula. Conclusion: With two-flap palatoplasty Bardach procedure for repair of cleft palate, the complication of fistula formation was uncommon at 5.6%, provided the repair was tension free and multi-layered. (author)

Genito-Urinary Fistula Patients at Bugando Medical Centre ...

African Journals Online (AJOL)

Genito-Urinary Fistula Patients at Bugando Medical Centre. ... Interventions: A total of 1294 patients underwent surgical treatment of incontinence. ... study shows that low education and poverty were the key factors in the development of fistula.

Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula

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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.)

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

Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters...

Open liver trauma causing hepatico caval fistula successfully treated by embolization

Directory of Open Access Journals (Sweden)

Zeineb Mzoughi

2017-02-01

Full Text Available Introduction: Traumatic arteriovenous fistula results from a breach of vascular integrity between a vein and an adjacent artery. Hepato caval fistula is a rare entity. Open surgical approaches have increasingly given way to radiological embolization techniques in the treatment of these arteriovenous fistulae, especially in intrahepatic locations. Case report: We report the case of a patient diagnosed with a fistula, from the right branch of the liver artery to the right hepatic vein, developed following an open liver trauma. Successful embolization through the transarterial route was achieved with simple outcomes. Conclusion: The interventional radiology for endovascular management has revolutionized the treatment of hepatic liver traumas. The conservative treatment is henceforth the common approach even if hepatic artery or hepatic veins are involved in case of arteriovenous fistula. Keywords: Fistula, Trauma, Arteriovenous, Embolization

MRI of congenital urethroperineal fistula

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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.)

MRI of congenital urethroperineal fistula

International Nuclear Information System (INIS)

Ghadimi-Mahani, Maryam; Dillman, Jonathan R.; Pai, Deepa; DiPietro, Michael; Park, John

2010-01-01

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.)

A case of vesicouterine fistula after cesarean section with delivery through the bladder

DEFF Research Database (Denmark)

Schroeder, T; Kristensen, J K

1983-01-01

We report a case of a vesicouterine fistula subsequent to delivery at cesarean section through the bladder. A first attempt to close the fistula failed but a second operation adhering to the general principles of fistula repair was successful.......We report a case of a vesicouterine fistula subsequent to delivery at cesarean section through the bladder. A first attempt to close the fistula failed but a second operation adhering to the general principles of fistula repair was successful....

Nigeria task force alerts public to fistula hazards.

Science.gov (United States)

1994-01-01

Nigeria's National Task Force on Vesico-vaginal Fistula has published a booklet to draw public attention to the problem of fistulae. The 20-page booklet explains how fistulae happen and what can be done to prevent them. It makes clear that early marriage and early pregnancy are major causes of fistulae that lead to the social rejection of many young women. The booklet tells the story of two girls in a series of color pictures with accompanying text in Hausa and English. One girl is given in marriage to an older man at the age of nine, becomes pregnant before she is fully grown, suffers obstructed labor, is denied obstetric care and is left with a vesico-vaginal fistula. With urine leaking from her bladder through her vagina, she smells constantly of urine and is thrown out of the house by her husband. Her parents also reject her and she is reduced to begging until one day she hears of a hospital where fistulae can be repaired. After the repair she is warned that if she has any more babies they must be delivered in a hospital. The other girl is not given away in marriage but goes to school, graduates from university and marries a man of her choice. She becomes pregnant only when her body is fully developed, attends the antenatal clinic, has an easy labor and safe delivery. full text

Anal metastasis originating from colorectal cancer: Report of two cases

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Kim, Jae Min; Lim, Joon Seok; Choi, Jin Young; Park, Mi Suk; Kim, Myeong Jin [Dept. of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chung, Taek; Kim, Ho Guen [Dept. of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

Anal metastasis from colorectal cancer rarely occurs, but it severely impairs the patient's quality of life, often requiring wide resection including the anal sphincter with permanent colostomy. This lesion can be misdiagnosed as a perianal fistula or an abscess, and it can be overlooked at the time of surgery because it is not included in the routine surgical extent of low anterior resection. We report two rare cases of anal metastasis from colorectal cancer. In both cases, perianal nodules with an internal solid portion were detected on preoperative rectal magnetic resonance imaging and additional local excisions of the anal lesions were performed during the process of treatment. Anal metastasis was pathologically confirmed by histology and immunohistochemical staining.

Eph-B4 regulates adaptive venous remodeling to improve arteriovenous fistula patency

OpenAIRE

Protack, Clinton D.; Foster, Trenton R.; Hashimoto, Takuya; Yamamoto, Kota; Lee, Monica Y.; Kraehling, Jan R.; Bai, Hualong; Hu, Haidi; Isaji, Toshihiko; Santana, Jeans M.; Wang, Mo; Sessa, William C.; Dardik, Alan

2017-01-01

Low rates of arteriovenous fistula (AVF) maturation prevent optimal fistula use for hemodialysis; however, the mechanism of venous remodeling in the fistula environment is not well understood. We hypothesized that the embryonic venous determinant Eph-B4 mediates AVF maturation. In human AVF and a mouse aortocaval fistula model, Eph-B4 protein expression increased in the fistula vein; expression of the arterial determinant Ephrin-B2 also increased. Stimulation of Eph-B-mediated signaling with ...

Colour Doppler ultrasound assessment of well-functioning mature arteriovenous fistulas for haemodialysis access

International Nuclear Information System (INIS)

Pietura, Radoslaw; Janczarek, Marzena; Zaluska, Wojciech; Szymanska, Anna; Janicka, Lucyna; Skublewska-Bednarek, Anna; Szczerbo-Trojanowska, Malgorzata

2005-01-01

Background: A well-functioning mature arteriovenous fistula is essential for the maintenance of haemodialysis in patients with chronic renal failure. The Brescia-Cimino arteriovenous fistula has the best survival characteristics and low rate of complications. The most common reason of fistula failure is thrombosis caused by stenosis. Colour Doppler ultrasonography has proven to be effective in the assessment of anatomical vascular features. The majority of studies were done in patients with clinically presumed arteriovenous fistula complications. However, only limited data are available about the well-functioning mature arteriovenous fistulas. The purpose of the present study was to evaluate completely asymptomatic, mature arteriovenous fistulas with colour Doppler ultrasound. Materials and methods: From July 2001 to April 2003, we examined 139 patients with the end-stage renal disease. They were in the range of 19-79 years of age (mean, 46.7 years). The study included only the patients who met the following criteria: (1) no difficulties with haemodialysis (as reported by nurses); (2) normal venous diastolic blood pressure (<150 mmHg) at monthly evaluation; (3) normal urea clearance x time/urea volume of distribution; (4) blood cells count, plasma electrolytes, and liver function at monthly evaluation. The mean fistula age was 26 months (S.D. = 21.9). The mean time of dialysis therapy was 49 months. Thirty-eight percent patients had primary fistulas, 23%-secondary, 11%-third and 11%-fourth, 4%-fifth, 5%-sixth, and 8% patients had more than sixth. Results: There was no correlation between: (1) patient's age and fistula age; (2) patient's age and number of fistulas in one patient; (3) fistula age and number of fistulas in one patient; (4) localization of fistula and fistula age. There was a strong correlation between dialysis therapy period and number of fistulas in one patient. The mean flow volume was 1204.1 ml/min (S.D. = 554). It was significantly higher in the

Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

Science.gov (United States)

Gu, Guo-Li; Wang, Lin; Wei, Xue-Ming; Li, Ming; Zhang, Jie

2014-06-28

Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management.

A Case of Pyriform Sinus Fistula Infection with Double Tracts

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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.

Primary aortoduodenal fistula after radiotherapy. Report of a case

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Oshima, Takeshi; Inoue, Hitoshi; Oshima, Akira; Minami, Tomohito; Matsumine, Takao [Tokyo Metropolitan Fuchu Hospital (Japan)

1999-10-01

Aortoduodenal fistula is a rare and life-threatening cause of gastrointestinal hemorrhage. The patient was a 44-year-old woman who repeated intermittent hematemesis and melena after hysterectomy, para-aortic lymph node dissection, and subsequent radiotherapy. Angiography revealed no bleeding point. Upper gastrointestinal endoscopy showed an ulcer at the third portion of the duodenum. Emergency laparotomy revealed an aortoduodenal fistula which was inferred to be caused by radiotherapy because no recurrence of malignancy was detected. After the fistula was closed, the patient repeated hematemesis and anal bleeding. She died of acute hemorrhagic shock, in spite of three operations including axillo-femoral bypass. We propose that radiation might have played a role in the pathogenesis of the aortoduodenal fistula in our case. The new case of primary aortoduodenal fistula following radiotherapy is added to four cases previously reported in the literature. Six cases in which the lesion of the duodenum could be demonstrated by endoscopy, have been reported in Japan. Aortoduodenal fistula should be considered as a probable diagnosis in patients presenting massive gastrointestinal hemorrhage after radiotherapy. Rapid surgical treatments are needed, and operative procedures to be considered include resection of the aorta with aortic stump closure and axillo-femoral bypass. (author)

Management of Gastropleural Fistula after Revisional Bariatric Surgery: A Hybrid Laparoendoscopic Approach.

Science.gov (United States)

Ghanem, Omar M; Abu Dayyeh, Barham K; Kellogg, Todd A

2017-10-01

Gastropleural fistula (GPF) is a serious complication after bariatric surgery. Multiple treatment modalities including pharmacologic, endoscopic, and revisional surgery have been proposed. We present a case of a GPF managed successfully with a laparoendoscopic approach utilizing a fistula plug. A 43-year-old male patient presented with a GPF after a revisional bariatric surgery. A laparoendoscopic approach including lysis of adhesions, identification of the fistula, plugging the fistula with a BioGore A® fistula plug, placement an enteric stent, placement of a feeding tube, and surgical drainage was performed. The multimedia video illustrates the technique used. Postoperatively, upper gastrointestinal (UGI) imaging showed no evidence of leak. The enteric stent was removed after 2 months after verifying complete healing of the fistula. A laparoendoscopic approach to GPF repair with the use of fistula plug is effective, safe, and feasible.

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...

A designated centre for people with disabilities operated by Daughters of Charity Disability Support Services Ltd., Dublin 15

LENUS (Irish Health Repository)

de Groof, E Joline

2015-08-20

Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

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.

Diagnosis and management of pancreaticopleural fistula.

Science.gov (United States)

Tay, Clifton Ming; Chang, Stephen Kin Yong

2013-04-01

Pancreaticopleural fistula is a rare diagnosis requiring a high index of clinical suspicion due to the predominant manifestation of thoracic symptoms. The current literature suggests that confirmation of elevated pleural fluid amylase is the most important diagnostic test. Magnetic resonance cholangiopancreatography is the recommended imaging modality to visualise the fistula, as it is superior to both computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) in delineating the tract within the pancreatic region. It is also less invasive than ERCP. While a trial of medical regimen has traditionally been the first-line treatment, failure would result in higher rates of complications. Hence, it is suggested that management strategies be planned based on pancreatic ductal imaging, with patients having poor chances of spontaneous closure undergoing either endoscopic or surgical intervention. We also briefly describe a case of pancreaticopleural fistula in a patient who was treated using a modified Puestow procedure after failed endoscopic treatment.

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.

[Observing effect of treatment of the second branchial fistula with endoscopic resection].

Science.gov (United States)

Jiang, Jiping; Wang, Shuyun; Tong, Kang

2014-03-01

To explore synergic effect of treatment of the second branchial fistula with endoscopic resection. All patients of the second branchial fistula were scanned in neck with CT (computed tomography), we injected ioversol-320 from the entrance of the second branchial fistula in front of sternocleidomastiod into the second branchial fistula, then scanned the neck with CT (computed tomography), and rebuilding the picture of the second branchial fistula, to prepare for the operation. 9 patients of the second branchial fistula were operated under general anesthesia with endoscopic resection. All of 9 patients were cured. no one recurred after follow-up of 6 months. It is minimally invasive and complete to resect the second branchial with endoscopic resection, the operation is simply and easy to promote.

Angiographic patterns of carotid-cavernous fistulas

International Nuclear Information System (INIS)

Georgieva, G.; Jekova, M.; Genov, P.; Hadjidekov, V.

2006-01-01

Full text: The aim of the study is to present our experience in angiographic evaluation of carotid-cavernous fistulas. 8 patients with carotid-cavernous fistula (6 men and 2 women, range of age from 15 to 62) are included in the study out of all undergone cerebral angiography for a four year period (1996 - 2000). All patients underwent CT brain examination, two out of 8 - MRI. Visualization of ipsi- and contra lateral cavernous sinus and ophthalmic vein dilatation are assessed. In all cases the communication between the internal carotid artery and the cavernous sinus has been assessed as direct. Near simultaneous visualization of the home internal carotid artery, the dilated ipsilateral cavernous sinus and dilated superior ophthalmic vein is found in 2 patients, simultaneous visualization of both cavernous sinuses - in two. In 1 patient the early visualization of the cavernous sinus through the fistula enabled visualization of ipsilateral main internal carotid artery from the contra lateral circulation through the communicating arteries.In 1 excessive contralateral cavernous sinus and contralateral superior ophthalmic vein dilatation is detected. In other 1 excessive flow to dilated ipsilateral cavernous sinus lead insufficient circulation in distal vessels. Digital subtraction Angiography remains the most suitable imaging method in carotid-cavernous fistula assessment regarding type of communication and level of following vessels morphology changes

Successful conservative treatment of enterocutaneous fistula with cyanoacrylate surgical sealant: case report.

Science.gov (United States)

Musa, N; Aquilino, F; Panzera, P; Martines, G

2017-01-01

Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy. A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant. The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula. This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.

A case of ileo-cutaneou fistula due to radiation enteritis

Energy Technology Data Exchange (ETDEWEB)

Oyama, Tsukasa; Oguchi, Yoshiro; Nakaba, Hiroyuki [Kure National Hospital, Hiroshima (Japan); and others

1992-07-01

Radiation enteritis can cause late complications including stenosis, perforation, fistulization, and bleeding, which sometimes necessitate surgical treatment, but a complication of ileocutaneous fistula is rarely reported. In this paper, an excellent result of an operation for ileocutaneous fistula due to radiation enteritis is described. A 68-year-old woman had undergone extended total histerectomy and radiation therapy on uterine cervical cancer. After the operation and the radiation therapy, frequent abdominal pain bothered her and then the intestinal fistula ensued resulted in the fistulization. The fistula was located between two stenotic lesions of the intestine caused by radiation enteritis. Resection of ileum including the two stenotic lesion and the fistula and end-to-end anastomosis relieved the symptoms and the treatment course has been satisfactory. The two stenotic lesions were resected because it was suggested that the two stenotic lesions directly led the fistulization. She is now followed asymptomatically. (author).

Reprinted article "Factors associated with early failure of arteriovenous fistulae for haemodialysis access".

Science.gov (United States)

Wong, V; Ward, R; Taylor, J; Selvakumar, S; How, T V; Bakran, A

2011-09-01

The radiocephalic arteriovenous fistula remains the method of choice for haemodialysis access. In order to assess their suitability for fistula formation, the radial arteries and cephalic veins were examined preoperatively by ultrasound colour flow scanner in conjunction with a pulse-generated run-off system. Intraoperative blood flow was measured after construction of the fistulae. Post-operative follow-up was performed at various intervals to monitor the development of the fistulae. Radial artery and cephalic vein diameter less than 1.6 mm was associated with early fistula failure. The intraoperative fistula blood flow did not correlate with the outcome of the operation probably due to vessel spasm from manipulation. However, blood flow velocities measured non-invasively 1 day after the operation were significantly lower in fistulae that failed early compared with those that were adequate for haemodialysis. Most of the increase in fistula diameter and blood flow occur within the first 2 weeks of surgery. Copyright © 2011. Published by Elsevier Ltd.

Laparoscopic conservative treatment of colo-vesical fistula: a new surgical approach

Directory of Open Access Journals (Sweden)

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.

Current practices in treatment of female genital fistula: a cross sectional study

Directory of Open Access Journals (Sweden)

Ruminjo Joseph

2010-11-01

Full Text Available Abstract Background Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Methods Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. Results The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence, while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence. These findings are based on a small sample and do not allow for recommending

Current practices in treatment of female genital fistula: a cross sectional study.

Science.gov (United States)

Arrowsmith, Steven D; Ruminjo, Joseph; Landry, Evelyn G

2010-11-10

Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for

Gastrosplenic fistula in Hodgkin's lymphoma treated successfully by laparoscopic surgery and chemotherapy

International Nuclear Information System (INIS)

Al-Asghar, Hamad I.; Khan, Mohammad Q.; Ghamdi, Abdullah M.; Bamehirz, Fahad Y.; Maghfoor, I.

2007-01-01

A gastrosplenic fistula is a rare complication of a gastric or splenic lesion. We report a case of Hodgkin's lymphoma (nodular sclerosis) involving the spleen that was complicated by spontaneous gastrosplenic fistula. The fistula was closed laparoscopically and the patient underwent partial gastrectomy and gastric wall repair followed by successful chemotherapy. This is also the first reported case in published literature where the closure of gastrosplenic fistula and partial gastrectomy was carried out laparoscopically. We recommend that extensive open surgical procedures including total gastroectomy, splenectomy and pancreatectomy may be avoided in the management of gastrosplenic fistula and the patient could be managed by less radical, simple laparoscopic fistulectomy, with partial gastric resection. If the fistula is caused by a malignant process, the surgical repair should be followed by definitive treatment with chemotherapy and radiotherapy. (author)

Coronary artery to left ventricle fistula

Directory of Open Access Journals (Sweden)

Kumar Vivek

2005-11-01

Full Text Available Abstract Background Coronary cameral fistulas are an uncommon entity, the etiology of which may be congenital or traumatic. They involve abnormal termination of a coronary artery, usually the right coronary, into a cardiac chamber, usually the right ventricle. Case Presentation We describe a case of female patient with severe aortic stenosis and interventricular septal hypertrophy that underwent bioprosthetic aortic valve replacement with concomitant septal myectomy. On subsequent follow-up an abnormal flow traversing the septum into the left ventricle was identified and Doppler interrogation demonstrated a continuous flow, with a predominantly diastolic component, consistent with coronary arterial flow. Conclusion The literature on coronary cameral fistulas is reviewed and the etiology of the diagnostic findings discussed. In our patient, a coronary artery to left ventricle fistula was the most likely explanation secondary to trauma to the septal perforator artery during myectomy. Since the patient was asymptomatic at the time of diagnosis no intervention was recommended and has done well on follow-up.

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.

Vesico Vaginal Fistula Following Sexual Assault: Case Report ...

African Journals Online (AJOL)

She had indwelling urethral catheter for 21 days with urinary antiseptic and the fistula healed. This approach is a treatment option in young girls with traumatic VVF particularly where limited tissue access will make surgical repair difficult. Key Words: Vesico-Vaginal Fistula, Sexual Assault. [ Trop J Obstet Gynaecol, 2004 ...

Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol

OpenAIRE

Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

2015-01-01

Background Obstetric fistula is a debilitating birth injury that affects an estimated 2?3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65?95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal ...

Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

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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.

Bronchobiliary Fistula Localized by Cholescintigraphy with Single-Photon Emission Computed Tomography

International Nuclear Information System (INIS)

Artunduaga, Maddy; Patel, Niraj R.; Wendt, Julie A.; Guy, Elizabeth S.; Nachiappan, Arun C.

2015-01-01

Biliptysis is an important clinical feature to recognize as it is associated with bronchobiliary fistula, a rare entity. Bronchobiliary fistulas have been diagnosed with planar cholescintigraphy. However, cholescintigraphy with single-photon emission computed tomography (SPECT) can better spatially localize a bronchobiliary fistula as compared to planar cholescintigraphy alone, and is useful for preoperative planning if surgical treatment is required. Here, we present the case of a 23-year-old male who developed a bronchobiliary fistula in the setting of posttraumatic and postsurgical infection, which was diagnosed and localized by cholescintigraphy with SPECT

Successful Treatment of Bronchoesophageal Fistula With Esophageal and Bronchial Stenting

Directory of Open Access Journals (Sweden)

Cheng-Yi Wang

2011-04-01

Full Text Available Bronchoesophageal fistula is reported in 5-10% of patients with esophageal cancer. In most of these cases, the insertion of a single stent, either a tracheobronchial or an esophageal stent, is sufficient to seal off the fistula. In this case we describe a 67-year-old man with esophageal cancer and complications of bronchoesophageal fistula, which resulted in repeated pneumonia and acute respiratory failure. Initially, two expandable metallic membranous esophageal stents were placed to cover the fistula. However, the esophageal stent failed to stop the air leak and dislodged into the stomach. Thereafter, a bronchial stent was placed at the right intermediate bronchus and successfully stopped the air leak. The patient was then weaned from the ventilator 1 week after the insertion of a bronchial stent. In conclusion, stenting in both the esophagus and airways should be considered when both are severely invaded by malignancy, when the airway is compressed, or when the fistula is insufficiently sealed by an esophageal stent.

Congenital bronchobiliary fistula diagnosis by cholescintigraphy

International Nuclear Information System (INIS)

Aguilar, C.; Cano, R.; Camasca, A.; Del Pino, T.; Gonzales, J.; Rivera, J.; Untiveros, A.

2005-01-01

A case of a six-year-old female patient diagnosed with congenital bronchobiliary fistula is presented. Only 20 cases have been reported in the literature of this disease in this institution. The patient showed sings and symptoms of a respiratory illness from birth that complicated progressively. She was submitted to multiple imaging like chest x-rays, CT, ultrasound and Tc-99m HIDA cholescintigraphy. This procedure confirmed the presence of a bronchobiliary fistula that was corrected by surgery, with subsequent improvement of clinical symptoms. (authors)

First Branchial Arch Fistula: A Rarity and a Surgical Challenge.

Science.gov (United States)

Rajkumar, J S; Ganesh, Deepa; Anirudh, J R; Akbar, S; Joshi, Niraj

2016-06-01

Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

Management of pediatric second branchial fistulae: is tonsillectomy necessary?

Science.gov (United States)

Cheng, Jeffrey; Elden, Lisa

2012-11-01

To describe the surgical management of second branchial fistulae that extend to the pharynx, specifically to determine whether tonsillectomy, along with surgical excision of the tract affects the rate of recurrence. Retrospective chart review of pediatric patients (agebranchial anomalies at a tertiary-care children's hospital between January 1, 2006 and September 1, 2011. Sinus tracts that extended to the pharynx were considered to be fistulae. Seventy-four patients were identified who underwent surgical excision of 85 total second branchial anomalies - 20 cysts (23.5%), 29 sinuses (34.1%), and 36 fistulae (42.4%). The 36 fistulae were removed from 32 patients, 23 males and 9 females, with an average age of 43.3 months. There were 16 right, 11 left, and 5 bilateral lesions. In 14 (43.8%) of the fistulae cases, a tonsillectomy was performed. There was only one recurrence (2.8%), which occurred 41 months postoperatively. No statistically significant difference for recurrence (p=1.0) was found between the group of patients that underwent tonsillectomy and those that did not. Pediatric branchial anomalies can present as a cyst, sinus, or fistula. They are developmental failures in the involution of the branchial apparatus during the embryologic period. Management of second branchial anomalies is with surgical excision of the tract and ligation of the terminal attachment to the pharynx. Our results suggest that the recurrence rates are not affected by whether or not an ipsilateral tonsillectomy is performed. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.

Science.gov (United States)

Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

2015-12-18

Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

Obstetric fistulae repair in a Nigerian Tertiary Health Institution ...

African Journals Online (AJOL)

This was a hospital based retrospective study of one hundred and fifty-five ... fistula and also describe factors that may influence the outcome of successful repair. ... and presence of rectovaginal fistula and duration of urinary incontinence prior ...

Appendicoumbilical Fistula: A Rare Reason for Neonatal Umbilical Mass

Directory of Open Access Journals (Sweden)

M. Cevik

2011-01-01

Full Text Available The normal umbilicus is a simple structure, but the intrauterine development of the umbilicus is highly complex. Neonatal umbilical mass anomalies usually represent failure of obliteration of the vitelline duct or the allantois which results in persistence of remnants, which can lead to a wide variety of disorders. In this paper, we present a case of an appendicoumbilical fistula in a neonate along with the differential diagnosis and management options. Embryologic explanation of the etiology was discussed with the possible association with different forms of malpositioning and rotation of the gut.

Appendicoumbilical fistula: a rare reason for neonatal umbilical mass.

Science.gov (United States)

Cevik, M; Boleken, M E; Kadıoglu, E

2011-01-01

The normal umbilicus is a simple structure, but the intrauterine development of the umbilicus is highly complex. Neonatal umbilical mass anomalies usually represent failure of obliteration of the vitelline duct or the allantois which results in persistence of remnants, which can lead to a wide variety of disorders. In this paper, we present a case of an appendicoumbilical fistula in a neonate along with the differential diagnosis and management options. Embryologic explanation of the etiology was discussed with the possible association with different forms of malpositioning and rotation of the gut.

TEMS: an alternative method for the repair of benign recto-vaginal fistulae.

Science.gov (United States)

Darwood, R J; Borley, N R

2008-07-01

The repair of high recto-vaginal fistula can be challenging since access may be limited via the endo-anal approach yet the alternative trans-abdominal route carries significant morbidity. We report the use of TEMS to repair a recto-vaginal fistula following anterior resection and pelvic radiotherapy. The patient was placed prone and a 25 cm rectoscope was inserted. A proximally based mucosal advancement flap was raised to repair the fistula. The patient was discharged 2 days later and a contrast study confirmed closure of the fistula. COMPARISON WITH OTHER TECHNIQUES: TEMS allows excellent visualisation of a rectovaginal fistula compared to standard endo-anal or trans-vaginal techniques. The morbidity is lower than the trans-abdominal route. TEMS is a useful technique for the repair of benign recto-vaginal fistula and has distinct advantages over conventional techniques.

Determinants of obstetric fistula in Ethiopia. Asrat Atsedeweyn ...

African Journals Online (AJOL)

2017-09-03

Sep 3, 2017 ... factors for obstetrics fistula include early age at pregnan- cy, short stature, illiteracy, poverty, not attending antenatal care, and rural place of residence or living far away from a health facility14. Tesfaye17 used the Cox proportional hazard analysis to evaluate time to recovery of obstetric fistula at Yirgalem.

Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

International Nuclear Information System (INIS)

Ragozzino, A.; Rosa, R. De; Galdiero, R.; Maio, A.; Manes, G.

2005-01-01

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

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.

Characterization of the upper pouch tracheo-oesophageal fistula in oesophageal atresia.

Science.gov (United States)

Summerour, Virginia; Stevens, Paul S; Lander, Anthony D; Singh, Michael; Soccorso, Giampiero; Arul, G Suren

2017-02-01

A small proportion of infants with oesophageal atresia (OA) are thought to have a proximal tracheoesophageal fistula (TOF). Failure to recognize these can hamper mobilization of the upper pouch and lead to life-threatening episodes of aspiration once oral feeding starts. We reviewed our experience of upper pouch fistulae to identify characteristic features of proximal TOF. A retrospective review of TOF/OA patient notes and bronchoscopy photographs and videos, identified from our database from 01/01/2006 to 12/31/2015, was performed. Eight (6.1%) infants were identified (M:F 5:3) from a total population of 131 newly diagnosed TOF/OA infants during the period. Their median gestational age was 33 (range 28-39) weeks, and median birth weight was 1647g (range 1100-3400g). Five were initially diagnosed with pure OA and 3 with a distal TOF. All patients underwent rigid bronchoscopy at the initial surgery but only one proximal fistula was identified. The 7 missed proximal fistulae were subsequently found either during on-table oesophagograms for gap assessment (n=2), at the time of thoracotomy when mobilizing the upper pouch (n=3), or during subsequent bronchoscopy for symptoms post OA repair (n=2). Two patients needed a further operation to divide the fistula. Review of the bronchoscopy videos identified four characteristic differences between upper and lower pouch fistulae. Proximal fistulae are found just distal to the vocal cords, are very small, often no more than a pit, do not open and close with ventilation, and are best identified by insufflation of the esophagus. Upper pouch fistulae are relatively easy to miss because of different characteristics compared with H-type or distal fistulae that have not previously been mentioned in the literature. level IV. Copyright © 2016. Published by Elsevier Inc.

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.

Post-traumatic arteriovenous fistula of the hepatic pedicle.

Science.gov (United States)

Ibn Majdoub Hassani, K; Mohsine, R; Belkouchi, A; Bensaid, Y

2010-10-01

Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion. Copyright © 2010. Published by Elsevier Masson SAS.

Adenocarcinoma within a rectal duplication cyst: case report and literature review.

Science.gov (United States)

Michael, D; Cohen, C R; Northover, J M

1999-05-01

Intestinal duplications are uncommon but recognised developmental anomalies. Duplications of the rectum are the most uncommon of these anomalies. They may present with perianal fistulae, bleeding, a pelvic mass or symptoms produced by a mass, or, rarely, malignant change. We present a case of an adenocarcinoma within a rectal duplication cyst which was initially thought to be inoperable but was treated by radical surgery.

A case of hypopharyngeal fistula suspected of late complication due to irradiation

International Nuclear Information System (INIS)

Fuchigami, Teruhiko; Karaho, Takehiro; Hyodo, Yoshihiro; Tanabe, Tetsuya; Kitahara, Satoshi

2003-01-01

We report a case of hypopharyngeal fistula which was suspected of being a late complication due to radiotherapy. The patient was 54-year-old female who had undergone total thyroidectomy for thyroid carcinoma in 1967, receiving a total of 75 Gy postoperative irradiation. In 2001 she came to our hospital complaining of neck pain and difficulty in swallowing. On pharyngoesophagogram we found a hypopharyngeal fistula. The fistula was located under the posterior wall of the hypopharynx between C4 and C7. It was undetectable with flexible fiberscope but was detected with rigid endoscope under the general anesthesia. We suspected it was a late complication of the irradiation. We performed endoscopic laser surgery (KTP), resected the tissue between the upper and lower openings of the fistula, and vertically exposed the fistula in the hypopharyngeal space. Her dysphagia improved. We discuss the mechanism of fistula formation in this case. (author)

A case of hypopharyngeal fistula suspected of late complication due to irradiation

Energy Technology Data Exchange (ETDEWEB)

Fuchigami, Teruhiko; Karaho, Takehiro; Hyodo, Yoshihiro; Tanabe, Tetsuya; Kitahara, Satoshi [National Defense Medical Coll., Tokorozawa, Saitama (Japan)

2003-05-01

We report a case of hypopharyngeal fistula which was suspected of being a late complication due to radiotherapy. The patient was 54-year-old female who had undergone total thyroidectomy for thyroid carcinoma in 1967, receiving a total of 75 Gy postoperative irradiation. In 2001 she came to our hospital complaining of neck pain and difficulty in swallowing. On pharyngoesophagogram we found a hypopharyngeal fistula. The fistula was located under the posterior wall of the hypopharynx between C4 and C7. It was undetectable with flexible fiberscope but was detected with rigid endoscope under the general anesthesia. We suspected it was a late complication of the irradiation. We performed endoscopic laser surgery (KTP), resected the tissue between the upper and lower openings of the fistula, and vertically exposed the fistula in the hypopharyngeal space. Her dysphagia improved. We discuss the mechanism of fistula formation in this case. (author)

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.

Pyloro-duodenal hernia with formation of enterocutaneous fistula in ...

African Journals Online (AJOL)

A body wall hernia entrapping abomasum and concurrent duodenal fistula in a buffalo calf aged about 8 months, secondary to a dog bite was successfully treated by closure of fistulous orifice and ventro lateral herniorrhaphy. Keywords: Abomaso-epiplocele, Buffalo calf, Duodenal fistula, Herniorrhaphy.

MR cisternography: a new method for the diagnosis of CSF fistulae

International Nuclear Information System (INIS)

Eberhardt, K.E.W.; Tomandl, B.F.; Huk, W.J.; Hollenbach, H.P.; Deimling, M.

1997-01-01

The aim of this study was to compare a new MRI method for detecting the existence of cerebrospinal fluid (CSF) fistulae, i. e. MR cisternography, with CT cisternography. In a prospective study, 30 patients with post-traumatic CSF fistulae were examined. The MR examinations were performed with a 1.0-T whole-body MR system, using two T2 * -weighted sequences, a 3D PSIF (time-inversed fast imaging with steady-state precession, FISP) and a 3D constructive interference steady-state (CISS) sequence. The results of MRI and CT cisternography were compared with the surgical findings. The sensitivity in detecting CSF fistulae with MR cisternography (PSIF: 89.9 %; CISS: 93.6 %) was higher than with CT cisternography (72.3 %). The sensitivity of CT cisternography at detecting CSF fistulae in patients with a size of dural lesion less than 2 mm or in patients with multiple dural lesions is significantly lower compared with the MR method. Although the localization of CSF fistulae always proved possible with MR cisternography, this could only be accomplished wih CT in 70 % of cases. The MR cisternography technique is a new examination method with a higher sensitivity for the detection of CSF fistulae than CT cisternography. The CISS technique is superior compared with PSIF and should be used in patients with high-flow CSF fistulas. (orig.)

The primary study of fistulae isolation for difficult-cured traumatic carotid cavernous by two accesses

International Nuclear Information System (INIS)

Wang Ziliang; Li Tianxiao; Zhai Shuiting; Cao Huicun; Xu Jiangyu; Bai Weixing; Liu Jian

2007-01-01

Objective: To investigate the feasibility and security of the isolation of fistulae for difficult-cured traumatic carotid cavernous by the anterio or inferior communicating artery. Methods: Five patients with difficult-cured TCCF including four males and one female. They were cathetered by both femoral arteries. Balloon-catheter directly attached to the near of fistulae and microcatheter conversely attached to the far of fistulae. Detachable balloons and micro coils were used to isolated the fistulae. Results: Five patients were cured with fistulae isolation and angiography did not show remnants fistulae in time. Clinical signs and symptoms got better and better. During follows-up no one recurred. Conclusions: The isolation of fistulae is a feasible and secure therapy for the difficult-cured traumatic direct carotid cavernous fistulae. (authors)

Obstetric Fistula: A Narrative Review of the Literature on Preventive ...

African Journals Online (AJOL)

AJRH Managing Editor

, especially ... fistula, Prevention, Intervention, Sub-Saharan Africa, Maternal health ... related mental health issues, with these women .... there are misconceptions as to the ‗normal' length ..... component of obstetric fistula prevention programs.

CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography.

Science.gov (United States)

Kranz, Peter G; Amrhein, Timothy J; Gray, Linda

2017-12-01

The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM). Visibility of the CSF venous fistula on CTM and a modified conventional myelography technique we refer to as dynamic myelography was also compared. Twenty-two cases of CSF venous fistula were identified. The fistulas were located between T4 and L1. Ninety percent occurred without a concurrent epidural CSF leak. In most cases (82%), the CSF venous fistula originated from a nerve root sleeve diverticulum. On CTM, the abnormal veins associated with the CSF venous fistula were seen in a paravertebral location in 45% of cases, centrally within the epidural venous plexus in 32%, and lateral to the spine in 23%. Differences in attenuation between the fistula veins and the control veins was highly statistically significant (p CSF venous fistulas are an important cause of SIH that can be detected on both CTM and dynamic myelograph y and may occur without an epidural CSF leak. Familiarity with the imaging characteristics of these lesions is critical to providing appropriate treatment to patients with SIH.

Obstetric vesico-vaginal fistula is preventable by timely recognition ...

African Journals Online (AJOL)

Prevention of obstetric fistula should include universal access to maternity care, recognition and timely correction of abnormal progress of labour and punctilious attention to bladder care to avoid post-partum urinary retention. Key words: Obstetric fistula, Risk factors, Pathophysiology, Post-partum urinary retention ...

Gastrointestinal Fistula: Audit of management in a remote hospital ...

African Journals Online (AJOL)

Background: The management of gastrointestinal fistula continues to present considerable challenge to the surgeon in general and gastrointestinal surgeon in particular. Objectives: To audit the management and report the outcome of the gastrointestinal fistula in a remote hospital. Setup: Eldamazeen Hospital is a regional ...

Evolution of Computed Tomography Findings in Secondary Aortoenteric Fistula

International Nuclear Information System (INIS)

Bas, Ahmet; Simsek, Osman; Kandemirli, Sedat Giray; Rafiee, Babak; Gulsen, Fatih; Numan, Furuzan

2015-01-01

Aortoenteric fistula is a rare but significant clinical entity associated with high morbidity and mortality if remain untreated. Clinical presentation and imaging findings may be subtle and prompt diagnosis can be difficult. Herein, we present a patient who initially presented with abdominal pain and computed tomography showed an aortic aneurysm compressing duodenum without any air bubbles. One month later, the patient presented with gastrointestinal bleeding and computed tomography revealed air bubbles within aneurysm. With a diagnosis of aortoenteric fistula, endovascular aneurysm repair was carried out. This case uniquely presented the computed tomography findings in progression of an aneurysm to an aortoenteric fistula

Elevated Shear Stress in Arteriovenous Fistulae: Is There Mechanical Homeostasis?

Science.gov (United States)

McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto

2011-11-01

Arteriovenous fistulae are created surgically to provide access for dialysis in patients with renal failure. The current hypothesis is that the rapid remodeling occurring after the fistula creation is in part a process to restore the mechanical stresses to some preferred level (i.e. mechanical homeostasis). Given that nearly 50% of fistulae require an intervention after one year, understanding the altered hemodynamic stress is important in improving clinical outcomes. We perform numerical simulations of four patient-specific models of functioning fistulae reconstructed from 3D Doppler ultrasound scans. Our results show that the vessels are subjected to `normal' shear stresses away from the anastomosis; about 1 Pa in the veins and about 2.5 Pa in the arteries. However, simulations show that part of the anastomoses are consistently subjected to very high shear stress (>10Pa) over the cardiac cycle. These elevated values shear stresses are caused by the transitional flows at the anastomoses including flow separation and quasiperiodic vortex shedding. This suggests that the remodeling process lowers shear stress in the fistula but that it is limited as evidenced by the elevated shear at the anastomoses. This constant insult on the arterialized venous wall may explain the process of late fistula failure in which the dialysis access become occluded after years of use. Supported by an R21 Grant from NIDDK (DK081823).

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease.

Science.gov (United States)

Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-07-28

To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn's disease (CD). Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 +/- 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 +/- 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients.

Combined tracheoinnominate artery fistula and tracheoesophageal fistula: A very rare complication of indwelling tracheostomy tube

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Marziyeh Nouri Dalouee

2016-01-01

Full Text Available Tracheoinnominate artery fistula (TIF is a serious complication of tracheostomy. If untreated, it could be life-threatening. The emergency approach to the condition that includes prompt diagnosis, rapid control of bleeding with a clear airway, and operation with or without interruption of the innominate artery are the most important factors influencing patient outcome. Tracheoesophageal fistula (TEF is another complication of tracheostomy. In association with compromised quality of life, this condition is really hard to be treated. We report a case of combined TIF and TEF in a 27-year-old man with quadriplegia who suffered a car accident but was successfully managed with interruption and ligature of the innominate artery repair of trachea.

A rare complication of Meckel's diverticulum: A fistula between Meckel's diverticulum and the appendix

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Ping-Fu Yang

2012-10-01

Full Text Available Meckel diverticulum is the most common congenital anomaly of the small intestine, occurring in about 2%–4% of the population. Meckel diverticulum results from incomplete closure of the omphalomesenteric duct. The presentation of symptomatic Meckel diverticulum includes gastrointestinal hemorrhage, intestinal obstruction, volvulus, intussusception, diverticulitis, and neoplasms. The development of fistula is an extremely rare complication. Previous literature has even shown an enterocolonic fistula, a vesicodiverticular fistula, ileorectal fistula, and fistula-in-ano. To the best of our knowledge, we present the first case of the fistula complicated between Meckel diverticulum and the appendix in a review of the English literature.

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...

gastrocolic fistula as a complication of benign gastric ulcer

African Journals Online (AJOL)

Colonoscopy was used in 4 patients and diagnosed fistula in 2. One patient who presented with haematemesis had the fistula diagnosed at surgery. All group A patients underwent partial gastrectomy with a Billroth I gastroduodenotomy and segmental colonic resection with primary anastomosis. There was no recurrence.

Aorto-right atrial fistula after Bentall repair.

Science.gov (United States)

Howard, Charles E; Velasco, Carlos E; Roullard, Christina P; Rafael, Aldo

2017-07-01

We describe a man with the Marfan syndrome and a prior ascending aortic aneurysm resection who presented with knee pain and concern of endocarditis. Transesophageal echocardiogram showed no vegetations, and computed tomography angiogram of the heart showed a possible pseudoaneurysm. Cardiac catheterization and aortogram revealed the diagnosis of an aorto-right atrial fistula, which was then operatively repaired. This case highlights the role that cardiac catheterization with aortogram can play in the detection of aorto-atrial fistula.

An unusual case of spontaneous esophagopleural fistula

OpenAIRE

Manoranjan Dash; Thitta Mohanty; Jyoti Patnaik; Narayan Mishra; Saswat Subhankar; Priyadarsini Parida

2017-01-01

Esophago-pleural fistula (EPF) is an uncommon condition, despite of an anatomical proximity of these structures. Causes of EPF include pneumonectomy for suppurative or tubercular disease of lung and carcinoma lung, malignancy of esophagus. Benign EPF is rare and may be due to trauma or infection. The most common infectious cause is tuberculosis. Spontaneous development of fistula between esophagus and pleura is rarely described in literature. We, hereby present a spontaneous case of such a ra...

Esophagorespiratory fistula: treatment with self-expanding covered stent

International Nuclear Information System (INIS)

Zang Jian; Dou Yongchong; Wang Zheng; Kong Jian

2002-01-01

Objective: To evaluate self-expanding covered stent in the management of esophagorespiratory fistula. Methods: A self-expanding esophageal covered stent was implanted under fluoroscopic guidance in 13 patients with esophagorespiratory fistula. In this series patients aged 31-73 years (60.2 years in average). All patients had a pre-procedure fast of 6-41 days (17.3 days in average), in which 12 patients had pulmonary infection. Results: All fistulas were excluded and swallowing function was restored. No stend-related complication was observed. Pulmonary infection was managed in 10 patients out of 13. The mean survived time was 33.3 wks (1-178 wks) in follow-up. Conclusion: Covered self-expanding stent implantation is a safe and effective treatment of ERF

Obstetric fistula: a narrative review of the literature on preventive ...

African Journals Online (AJOL)

Obstetric fistula: a narrative review of the literature on preventive ... Eniya K. Lufumpa, Sarah Steele ... The literature also highlights the need for increased governmental support, as a means of preventing the development of fistulas.

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

International Nuclear Information System (INIS)

Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

2003-01-01

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

A case report of congenital coronary artery fistula to the left ventricle

International Nuclear Information System (INIS)

Lee, Byung Hee; Yu, Shi Joon; Moon, Eon Soo; Kim, Sam Hyun; Choi, Young Hi

1987-01-01

Congenital coronary artery fistula is a rare malformation with an incidence of 0.4% of congenital heart disease. Among the various subtypes, fistula to the left ventricle is extremely rare with 6 reported cases till 1983. We present a case of coronary artery fistula between the right coronary artery and the left ventricle. The dilated right coronary artery formed a mass like bulging the right lower heart border in the plain chest PA, we think this is first case with a coronary artery fistula to the left ventricle, reported in Korea

Bronchopleural cutaneous fistula due to Eikenella corrodens.

Science.gov (United States)

Wong, Kin-Sun; Huang, Yhu-Chering

2005-01-01

The aim of this paper is to review the subject and to report on and discuss a case of bronchopleural cutaneous fistula due to Eikenella corrodens. A 16-year-old girl was brought to our hospital with fever and blood-tinged sputum 2 weeks prior to her admission. She suffered from neurologic sequelae of herpetic encephalitis and had been bed-ridden since 5 years of age. A longitudinal paraspinal soft mass had been noted in the previous week by her mother. She had been given oral feeding despite frequent choking for the past few years. On palpation, the mass can be squeezed to follow the least resistance of subcutaneous space longitudinally extending to the lower thoracic region. Chest computed tomography scan revealed right lower lobe necrotizing pneumonitis and a pleuro-cutaneous fistula leading to the subcutaneous air locules. A protracted course of antibiotics was prescribed and subcutaneous air trapping decreased in size over 8 weeks. Eikenella corrodens has increasingly been implicated as a potential causative pathogen in pleuropulmonary infections. Pleuro-cutaneous fistula and abscess formation complicating empyema and necrotizing pneumonitis due to E. corrodens infection have not been reported. A bulging thoracic subcutaneous lesion waxes and wanes with respiration suggest the possibility of a pleruo-cutaneous fistula. Treatment of Eikenella empyema using antibiotics without surgical decortication requires a prolonged course of antibiotic therapy.

Appendico-cutaneous fistula following hysterectomy: first case report

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Antonio Sérgio Brenner

2017-04-01

Full Text Available Appendico-cutaneous fistulas not related to acute appendicitis or cancer are rare and show spontaneous resolution after conservative treatment, mainly when they show low output, absence of obstruction or sepsis and in patients with good nutritional status. We found no report in the literature on appendico-cutaneous fistula after hysterectomy. The evolution of this case shows that this type of fistula can have low, but persistent debt, requiring definitive surgery. Resumo: Fístulas apendico-cutâneas não relacionadas à apendicite aguda ou neoplasias são raras e de resolução espontânea após tratamento conservador, sobretudo quando se apresentam com baixo débito, ausência de obstrução ou sepse e em pacientes em bom estado nutricional. Não encontramos relato na literatura de fístula apendico-cutânea após histerectomia. A evolução desse caso demonstra que a esse tipo de fístula pode apresentar débito baixo, mas persistente, demandando cirurgia definitiva. Keywords: Fistula, Colorectal surgery, Appendix, Palavras-chave: Fístula, Cirurgia colorretal, Apêndice

Time-to-recovery from obstetric fistula and associated factors: The ...

African Journals Online (AJOL)

EPHA USER33

potential risk factors associated with time to recovery of patients from obstetric fistula. Methods: An ... maternal health service and emergency obstetric care are contributing ..... process that causes the fistula may also lead to further destruction ...

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

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......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....... Closure of a fistula with blood flow around or below 100 mL/min did not increase distal outflow, whereas closure of fistulae with higher blood flow resulted in unpredictable changes in distal outflow. Only fistulae with a blood flow above approximately 100 mL/min may be of hemodynamic significance....

Endoscopic transpapillary stenting for pancreatic fistulas after necrosectomy with necrotizing pancreatitis.

Science.gov (United States)

Karjula, Heikki; Saarela, Arto; Vaarala, Anne; Niemelä, Jarmo; Mäkelä, Jyrki

2015-01-01

Data concerning the incidence and treatment of pancreatic fistula after necrosectomy in severe acute necrotizing pancreatitis (SAP) are scarce. Our aim was to assess the incidence of pancreatic fistula, and the feasibility and results of endoscopic transpapillary stenting (ETS) in patients with SAP after necrosectomy. From January 2009 to December 2012 twenty-nine consecutive patients with SAP and necrosectomy in Oulu University Hospital were enrolled into this study. Five patients died before ETS because of the rapid progress of the disease and were, therefore, excluded. ERP was performed for the remaining 24 patients demonstrating fistula in 22/24 patients (92 %). ETS was successful in 23 patients and the fistula closed in all of them after a median of 82 (2-210) days with acceptable morbidity and no procedure-related mortality. All patients after necrosectomy for SAP seem to have internal or external pancreatic fistula. EST aimed at internal drainage of the necrosectomy cavity is a feasible and effective therapy in these patients.

An Interesting Fistula Tract Presenting with Recurrent Gluteal Abscess: Instructive Case

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Gulsum Iclal Bayhan

2015-01-01

Full Text Available A fistula extending from the gluteus to penis is an extremely rare entity. In this paper, we have highlighted novel variant of congenital penile to gluteal fistula complicated with gluteal and penoscrotal abscess in a previously healthy boy. A fistulous tract extending from the gluteus to penis has been shown by fistulogram. Bleomycin has been used in fistula tract with successful results in our patient.

False traumatic aneurysms and arteriovenous fistulas: retrospective analysis.

Science.gov (United States)

Davidovic, Lazar B; Banzić, Igor; Rich, Norman; Dragaš, Marko; Cvetkovic, Slobodan D; Dimic, Andrija

2011-06-01

The purpose of this study was to analyze the incidence, clinical presentation, diagnosis, and treatment of false traumatic aneurysms and arteriovenous fistulas as well as the outcomes of the patients. A retrospective, 16-year survey has been conducted regarding the cases of patients who underwent surgery for false traumatic aneurysms (FTA) of arteries and traumatic arteriovenous fistulas (TAVF). Patients with iatrogenic AV fistulas and iatrogenic false aneurysms were excluded from the study. There were 36 patients with TAVF and 47 with FTA. In all, 73 (87.95%) were male, and 10 (12.05%) were female, with an average age of 36.93 years (13-82 years). In 25 (29.76%) cases TAVF and FTA appeared combat-related, and 59 (70.24%) were in noncombatants. The average of all intervals between the injury and surgery was 919. 8 days (1 day to 41 years) for FTA and 396.6 days (1 day to 9 years) for TAVF. Most of the patients in both groups were surgically treated during the first 30 days after injury. One patient died on the fourth postoperative day. There were two early complications. The early patency rate was 83.34%, and limb salvage was 100%. There were no recurrent AV fistulas that required additional operations. Because of their history of severe complications, FTA and TAV fistulas require prompt treatment. The treatment is simpler if there is only a short interval between the injury and the operation. Surgical endovascular repair is mostly indicated.

Thyrocervical artery - jugular fistula following internal jugular venous catheterization

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P P Zachariah

2014-01-01

Full Text Available Arteriovenous fistula (AVF is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far.

An unusual case of spontaneous esophagopleural fistula.

Science.gov (United States)

Dash, Manoranjan; Mohanty, Thitta; Patnaik, Jyoti; Mishra, Narayan; Subhankar, Saswat; Parida, Priyadarsini

2017-01-01

Esophago-pleural fistula (EPF) is an uncommon condition, despite of an anatomical proximity of these structures. Causes of EPF include pneumonectomy for suppurative or tubercular disease of lung and carcinoma lung, malignancy of esophagus. Benign EPF is rare and may be due to trauma or infection. The most common infectious cause is tuberculosis. Spontaneous development of fistula between esophagus and pleura is rarely described in literature. We, hereby present a spontaneous case of such a rare entity in a middle-aged male.

Treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube

International Nuclear Information System (INIS)

Han Xinwei; Wu Gang; Li Yongdong; Ma Nan; Wang Yanli; Gao Xuemei

2005-01-01

Objective: To investigate the value of treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube. Methods: Ten patients with mediastinoesophageal fistula were treated by 5F catheter inserting into the abscess cavities through nasal esophageal fistula, with stent placement in the esophagus. The abscess cavities were washed and angiograghied through drainage tube and the sites of the drainage tube were adjusted in time until withdrawal of the tube. Results: The drainage tubes were pulled out within 10-25 days with disappearance of the abscess cavities and normal diet intake without difficulty. Conclusions: Treating mediastinoesophageal fistula with covered stent through nasal esophagus drainage tube is safe, microinvasive economic and acceptable, worth to be recommended. (authors)

Physical examination of the hemodialysis arteriovenous fistula to detect early dysfunction.

Science.gov (United States)

Abreo, Kenneth; Amin, Bakhtiar M; Abreo, Adrian P

2018-04-01

The maintenance of vascular access patency for end-stage renal disease patients on hemodialysis is necessary for survival. Many nephrologists, nurse practitioners, and nurses have limited experience with the physical examination of the arteriovenous fistula. In this review, we define key terms used in the assessment of an arteriovenous fistula. We discuss the arteriovenous fistula physical exam, including details of inspection, palpation, and auscultation. Using these concepts, we review the abnormal findings that can assist practitioners in determining the location of a stenosis. We review the existing literature that validates physical exam findings with gold standard tests such as ultrasound and angiography. Finally, we review data supporting the value of training physicians and nurses in arteriovenous fistula physical examination.

[A vertebral arteriovenous fistula diagnosed by auscultation].

Science.gov (United States)

Iglesias Escalera, G; Diaz-Delgado Peñas, R; Carrasco Marina, M Ll; Maraña Perez, A; Ialeggio, D

2015-01-01

Cervical artery fistulas are rare arteriovenous malformations. The etiology of the vertebral arteriovenous fistulas (AVF) can be traumatic or spontaneous. They tend to be asymptomatic or palpation or continuous vibration in the cervical region. An arteriography is necessary for a definitive diagnosis. The treatment is complete embolization of the fistula. We present the case of a two year-old male, where the mother described it «like a washing machine in his head». On palpation during the physical examination, there was a continuous vibration, and a continuous murmur in left cervical region. A vascular malformation in vertebral region was clinically suspected, and confirmed with angio-MRI and arteriography. AVF are rare in childhood. They should be suspected in the presence of noises, palpation or continuous vibration in the cervical region. Early diagnosis can prevent severe complications in asymptomatic children. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Systemic-pulmonary arteriovenous fistula of traumatic origin: A case report

International Nuclear Information System (INIS)

Hirsch, M.; Maroko, I.; Gueron, M.; Goleman, L.

1983-01-01

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. (orig.)

COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

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Masoud Poormoghaddas

2010-11-01

Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

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

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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.

Spontaneous bronchoesophageal fistula in an adult – A possible delayed sequela of pulmonary tuberculosis

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Surendra Patel

2015-01-01

Full Text Available Spontaneous bronchoesophageal fistula in the adult is a rare clinical entity. Most bronchoesophageal fistulae are due to malignancy, prolonged endotracheal intubation or trauma. Granulomatous infections like tuberculosis, HIV and mediastinitis are rare causes of acquired bronchoesophageal fistula. We report a case of a 50 year old man, treated for pulmonary tuberculosis 15 years ago, who developed a spontaneous bronchoesophageal fistula between the mid-esophagus and right main stem bronchus, having no history of malignancy or trauma. Surgical closure of the fistula was done and post operative recovery was uneventful. In this case, the bronchoesophageal fistula probably developed as a delayed sequela of pulmonary tuberculosis as the patient had no active signs of pulmonary tuberculosis clinically or histopathologically.

An unusual case of spontaneous esophagopleural fistula

Directory of Open Access Journals (Sweden)

Manoranjan Dash

2017-01-01

Full Text Available Esophago-pleural fistula (EPF is an uncommon condition, despite of an anatomical proximity of these structures. Causes of EPF include pneumonectomy for suppurative or tubercular disease of lung and carcinoma lung, malignancy of esophagus. Benign EPF is rare and may be due to trauma or infection. The most common infectious cause is tuberculosis. Spontaneous development of fistula between esophagus and pleura is rarely described in literature. We, hereby present a spontaneous case of such a rare entity in a middle-aged male.

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.

A simple novel technique [PUIT] for closure of urethrocutaneous fistula after hypospadias repair: Preliminary results

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Awad M

2005-01-01

Full Text Available Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied, the closure of the fistula is a challenging problem. We present a simple surgical procedure, posterior urethral incision technique [PUIT] to close the fistula in our department. Between February 2001 and December 2004 we prospectively evaluated 32 patients, 26 patients with initial hypospadias fistulas and 6 with recurrent fistulas who underwent closure of urethrocutaneous fistula after hypospadias repair. The mean age of patients was 5 years, the operation consisted of trimming the fistula edge after mobilization of the skin all-around then a midline posterior urethral incision was done 2 mm above and 2 mm below the fistula opening then re-approximation of the urethral edges using 6/0 vicryl sutures with loop magnification. The timing of fistula repair was between 6 and 13 months after it was formed, all of these were effectively closed except three cases with stricture and fistula. Of these, two were completely relieved after repeated urethral dilatation, three times a week for 2 weeks. The third failed case will need another sitting after 6 months. The posterior midline urethral incision gives a good opportunity for repair without tension with a good cosmetic outcome. This may be done under local anesthesia in adults. The procedure is considered simple rapid and easy to be done for variable fistulas types whatever of its site and the age.

Spontaneous lateral sphenoid cerebrospinal fluid fistula: MRI diagnosis

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Matthew Goodier

2012-02-01

Full Text Available Spontaneous or primary cerebrospinal fluid (CSF fistula is a rare cause of CSF rhinorrhoea. Magnetic resonance imaging with high resolution highly T2-weighted images is valuable in preoperative localisation and characterisation of the defect particularly if a transnasal endoscopic approach is planned. This report describes the radiological evaluation and surgical management of a 53 year old male who presented with a spontaneous lateral sphenoid CSF fistula.

System identification of perilymphatic fistula in an animal model

Science.gov (United States)

Wall, C. 3rd; Casselbrant, M. L.

1992-01-01

An acute animal model has been developed in the chinchilla for the study of perilymphatic fistulas. Micropunctures were made in three sites to simulate bony, round window, and oval window fistulas. The eye movements in response to pressure applied to the external auditory canal were recorded after micropuncture induction and in preoperative controls. The main pressure stimulus was a pseudorandom binary sequence (PRBS) that rapidly changed between plus and minus 200 mm of water. The PRBS stimulus, with its wide frequency bandwidth, produced responses clearly above the preoperative baseline in 78 percent of the runs. The response was better between 0.5 and 3.3 Hz than it was below 0.5 Hz. The direction of horizontal eye movement was toward the side of the fistula with positive pressure applied in 92 percent of the runs. Vertical eye movements were also observed. The ratio of vertical eye displacement to horizontal eye displacement depended upon the site of the micropuncture induction. Thus, such a ratio measurement may be clinically useful in the noninvasive localization of perilymphatic fistulas in humans.

Rendu-Osler-Weber syndrome presenting with pulmonary arteriovenous fistula

International Nuclear Information System (INIS)

Halefoglu, A.M.

2005-01-01

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu-Osler-Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5-15% of Rendu-Osler-Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49-year-old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X-ray revealed a 5-cm mass in the left lower lobe and after magnetic resonance examination, together with 3-D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu-Osler-Weber syndrome presenting with a pulmonary arteriovenous fistula. Copyright (2005) Blackwell Science Pty Ltd

Endoscopic use of cyanoacrylate glue in the treatment of urethral fistula

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Andre Ramos Sorgi Macedo

2013-07-01

Full Text Available Purpose The aim of this video is to demonstrate an endoscopic and minimally invasive repair of an urethrocutaneous fistula with cyanoacrylate glue. Materials and Methods: A 56 year-old-man with post-infectious urethral stricture and recurrent perineal abscess formation due to urethral fistulas. Results The operative time was 60 minutes, no major complications were observed perioperatively and postoperatively. At a follow-up time of 6 months the patient had no evidence of recurrent fistula and abscess formation. CONCLUSIONS The endoscopic use of cyanoacrylate glue represents a safe and minimally invasive approach that might be offered as a first line option for the treatment of urinary fistulas in selected patients, especially those with narrow and long tracts.

Percutaneous treatment of a bronchobiliary fistula caused by cholelithiasis: case report

International Nuclear Information System (INIS)

Kim, Jae Soo; You, Jin Jong

2004-01-01

Bronchobiliary fistulae are rare disorders, with inflammatory diseases of the liver, trauma, previous surgery and biliary obstruction being frequent causative factors. Endoscopic or transhepatic biliary drainage has been used successfully to avoid surgical treatment. We describe a case of a bronchobiliary fistula a 78-year-old man with biliary obstruction caused by impacted calculi. Without surgical or endoscopic intervention, fistulae were treated by percutaneous transhepatic biliary drainage and removal of calculi, in conjunction with balloon sphincteroplasty

Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

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Harwood, Lori E.; Wilson, Barbara M.; Oudshoorn, Abe

2016-01-01

Background Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation. Method This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis. Results Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes. Conclusions Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use. PMID:26985384

Expanded polytetrafluoroethylene graft fistula for chronic hemodialysis.

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Tellis, V A; Kohlberg, W I; Bhat, D J; Driscoll, B; Veith, F J

1979-01-01

In a retrospective study of 66 PTFE arteriovenous fistulae and 71 BCH arteriovenous fistulae for dialysis access, PTFE had a higher patency rate than BCH at 12 months (62.4 versus 32.5%). PTFE was easier to work with and easier to handle in the face of infection. The lateral upper arm approach to placement of the PTFE graft is desirable in patients who have had multiple previous access procedures because this area is usually free from scarring, is distant from neurovascular structures, and provides a greater length of graft for needle punctures.

CT morphology of splenic vessels in splenoportal fistula

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Mansfeld, L; Poehls, C; Boitz, F

1986-12-01

CT examination of a 53-year-old patient with endocarditis and clinical signs of hepatosplenomegaly revealed an atypical vascular morphology in the hilum of the spleen, for which no diagnosis could be established. Angiography indicated the presence of a symptom-free splenoportal fistula, the histological study of which suggested its congenital genesis. The paper describes the morphology, as ascertained by CT, of the splenic vessels characterised by changed haemodynamics due to a hilar splenoportal fistula.

First branchial arch fistula: diagnostic dilemma and improvised surgical management.

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Prabhu, Vinod; Ingrams, Duncan

2011-01-01

First branchial cleft anomalies are uncommon, and only sporadic case reports are published in the literature. They account for 1% to 8% of all the branchial abnormalities. The often variable presentation and tract siting of first arch fistulae have led to misdiagnosis. The misdiagnosis results in inappropriate/ineffective treatment and recurrence of the sinus tract. We present a 19-year-old woman who presented to the ENT outpatient department with episodic discharge from a long-standing fistula anterior to the left sternomastoid muscle. This was associated with repeated episodes of ipsilateral tonsillitis. In relation to the history and because of the position of the fistula, a diagnosis of second branchial arch fistula was made. An attempt at excision was unfortunately followed by early recurrence of discharge. At review following the procedure, a defect of the left tympanic membrane in the form of a fibrous band was noted, and a revised diagnosis of first branchial arch sinus was made. Wide surgical excision of the tract with partial parotidectomy was performed. An uneventful postoperative course followed, with no recurrence of symptoms after 24 months of review. We discuss the case, the diagnostic pathway, and the wide local excision technique used for removal of branchial fistulae. Copyright © 2011 Elsevier Inc. All rights reserved.

Transitional Flow in an Arteriovenous Fistula: Effect of Wall Distensibility

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McGah, Patrick; Leotta, Daniel; Beach, Kirk; Aliseda, Alberto

2012-11-01

Arteriovenous fistulae are created surgically to provide adequate access for dialysis in patients with end-stage renal disease. Transitional flow and the subsequent pressure and shear stress fluctuations are thought to be causative in the fistula failure. Since 50% of fistulae require surgical intervention before year one, understanding the altered hemodynamic stresses is an important step toward improving clinical outcomes. We perform numerical simulations of a patient-specific model of a functioning fistula reconstructed from 3D ultrasound scans. Rigid wall simulations and fluid-structure interaction simulations using an in-house finite element solver for the wall deformations were performed and compared. In both the rigid and distensible wall cases, transitional flow is computed in fistula as evidenced by aperiodic high frequency velocity and pressure fluctuations. The spectrum of the fluctuations is much more narrow-banded in the distensible case, however, suggesting a partial stabilizing effect by the vessel elasticity. As a result, the distensible wall simulations predict shear stresses that are systematically 10-30% lower than the rigid cases. We propose a possible mechanism for stabilization involving the phase lag in the fluid work needed to deform the vessel wall. Support from an NIDDK R21 - DK08-1823.

Dural arteriovenous fistula presenting with exophthalmos and seizures.

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Feyissa, Anteneh M; Ponce, Lucido L; Patterson, Joel T; Von Ritschl, Rudiger H; Smith, Robert G

2014-03-15

Concomitant seizures and exophthalmos in the context of a temporal dural arteriovenous fistula (dAVF) has not been described before. Here, we report a 55-year-old-male who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures. Cerebral angiography demonstrated Cognard Type IIa left cerebral dAVF fed by branches from the left occipital artery and an accessory meningeal artery, with drainage to the superior ophthalmic vein. Following surgical obliteration of dAVF feeding vessels, our patient had dramatic improvement in visual acuity, proptosis and chemosis along with cessation of clinical seizures. Published by Elsevier B.V.

Management of Severe Pancreatic Fistula After Pancreatoduodenectomy.

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Smits, F Jasmijn; van Santvoort, Hjalmar C; Besselink, Marc G; Batenburg, Marilot C T; Slooff, Robbert A E; Boerma, Djamila; Busch, Olivier R; Coene, Peter P L O; van Dam, Ronald M; van Dijk, David P J; van Eijck, Casper H J; Festen, Sebastiaan; van der Harst, Erwin; de Hingh, Ignace H J T; de Jong, Koert P; Tol, Johanna A M G; Borel Rinkes, Inne H M; Molenaar, I Quintus

2017-06-01

Postoperative pancreatic fistula is a potentially life-threatening complication after pancreatoduodenectomy. Evidence for best management is lacking. To evaluate the clinical outcome of patients undergoing catheter drainage compared with relaparotomy as primary treatment for pancreatic fistula after pancreatoduodenectomy. A multicenter, retrospective, propensity-matched cohort study was conducted in 9 centers of the Dutch Pancreatic Cancer Group from January 1, 2005, to September 30, 2013. From a cohort of 2196 consecutive patients who underwent pancreatoduodenectomy, 309 patients with severe pancreatic fistula were included. Propensity score matching (based on sex, age, comorbidity, disease severity, and previous reinterventions) was used to minimize selection bias. Data analysis was performed from January to July 2016. First intervention for pancreatic fistula: catheter drainage or relaparotomy. Primary end point was in-hospital mortality; secondary end points included new-onset organ failure. Of the 309 patients included in the analysis, 209 (67.6%) were men, and mean (SD) age was 64.6 (10.1) years. Overall in-hospital mortality was 17.8% (55 patients): 227 patients (73.5%) underwent primary catheter drainage and 82 patients (26.5%) underwent primary relaparotomy. Primary catheter drainage was successful (ie, survival without relaparotomy) in 175 patients (77.1%). With propensity score matching, 64 patients undergoing primary relaparotomy were matched to 64 patients undergoing primary catheter drainage. Mortality was lower after catheter drainage (14.1% vs 35.9%; P = .007; risk ratio, 0.39; 95% CI, 0.20-0.76). The rate of new-onset single-organ failure (4.7% vs 20.3%; P = .007; risk ratio, 0.15; 95% CI, 0.03-0.60) and new-onset multiple-organ failure (15.6% vs 39.1%; P = .008; risk ratio, 0.40; 95% CI, 0.20-0.77) were also lower after primary catheter drainage. In this propensity-matched cohort, catheter drainage as first intervention for severe

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.

A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea.

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Delamou, Alexandre; Delvaux, Therese; Beavogui, Abdoul Habib; Levêque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent

2016-10-10

Obstetric fistula is a serious medical condition which affects women in low income countries. Despite the progress of research on fistula, there is little data on long term follow-up after surgical repair. The objective of this study is to analyse the factors associated with the recurrence of fistula and the outcomes of pregnancy following fistula repair in Guinea. A descriptive longitudinal study design will be used. The study will include women who underwent fistula repair between 2012 and 2015 at 3 fistula repair sites supported by the Fistula Care Project in Guinea (Kissidougou Prefectoral Hospital, Labé Regional Hospital and Jean Paul II Hospital of Conakry). Participants giving an informed consent after a home visit by the Fistula Counsellors will be interviewed for enrolment at least 3 months after hospital discharge The study enrolment period is January 1, 2012 - June 30, 2015. Participants will be followed-up until June 30, 2016 for a maximum follow up period of 48 months. The sample size is estimated at 364 women. The cumulative incidence rates of fistula recurrence and pregnancy post-repair will be calculated using Kaplan-Meier methods and the risk factor analyses will be performed using adjusted Cox regression. The outcomes of pregnancy will be analysed using proportions, the Pearson's Chi Square (χ2) and a logistic regression with associations reported as risk ratios with 95 % confidence intervals. All analyses will be done using STATA version 13 (STATA Corporation, College Station, TX, USA) with a level of significance set at P < 0.05. This study will contribute to improving the prevention and management of obstetric fistula within the community and support advocacy efforts for the social reintegration of fistula patients into their communities. It will also guide policy makers and strategic planning for fistula programs. ClinicalTrials.gov Identifier: NCT02686957 . Registered 12 February 2016 (Retrospectively registered).

Targeted transgastric drainage of isolated pancreatic duct segments to cure persistent pancreaticocutaneous fistulas from pancreatitis.

Science.gov (United States)

Boas, F Edward; Kadivar, Fatemeh; Kelly, Peter D; Drebin, Jeffrey A; Vollmer, Charles M; Shlansky-Goldberg, Richard D

2015-02-01

Chronic pancreaticocutaneous fistulas can be difficult to treat. This article presents a snare-target technique for draining a nondilated pancreatic duct into the stomach, diverting pancreatic fluid away from the pancreaticocutaneous fistula to allow it to heal. Internal or internal/external transgastric pancreatic duct or fistula drains were placed in six patients. After an average of 4 months of drainage, all six patients experienced resolution of the cutaneous fistula. Two patients developed a pseudocyst but no recurrent fistula after drain removal, and the other four patients had no pseudocyst or fistula after an average 27-month follow-up (range, 6-74 mo). Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Urethro-vaso-cutaneous fistula in a 5-year-old child

International Nuclear Information System (INIS)

Arat, A.; Midia, M.; Oeztuerk, H.; Uenal, B.; Aydingoez, Ue.; Uensal, M.

1997-01-01

A 5-year-old boy with a 4-year history of urethro-vaso-cutaneous fistula is presented. This is the youngest patient reported to have an acquired urethro-vaso-cutaneous fistula. Fistulography is a convenient method for the demonstration of such entities. (orig.). With 1 fig

Selective occlusion of a carotid sinus cavernous fistula after transsphenoidal hypophysectomy

International Nuclear Information System (INIS)

Lins, E.; Dietrich, U.; Wappenschmidt, J.

1987-01-01

A case of carotid cavernous sinus fistula following transsphenoidal hypophysectomy is reported. A selective occlusion of the fistula with patency of the carotid artery was achieved by means of a detachable balloon catheter. (orig.) [de

An unusual case of adult-onset multi-systemic Langerhans cell histiocytosis with perianal and incident thyroid involvement

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Ozen Oz Gul

2017-02-01

Full Text Available Langerhans cell histiocytosis (LCH is a rare sporadic disease characterized by histiocytic neoplastic infiltration of various organ systems and a wide spectrum of clinical manifestations, ranging from benign and self-limiting to lethal. Herein, we report a rare case of adult-onset multi-systemic LCH in a 36-year-old male patient with an initial perianal presentation and incidental finding of subsequent thyroid gland involvement in the follow-up period. The patient with a history of perianal LCH treated with surgical excision and local radiotherapy was referred to our Endocrinology Department upon detection of hypermetabolic nodular lesions in the left lateral lobe of thyroid gland on positron emission tomography–computed tomography (PET/CT scan in the nineth month of follow-up. Current evaluation revealed euthyroid status, a hypoechoic solid lesion of 13 × 9 mm in size with irregular borders in the left thyroid lobe on thyroid USG and cytologic assessment of thyroid nodule. The patient was diagnosed with suspected, oncocytic lesion, Hashimoto thyroiditis or LCH. The patient underwent total thyroidectomy and pathological assessment confirmed the diagnosis of Langerhans cell histiocytosis. Assessments in the sixth month of postoperative follow-up revealed euthyroid status with no thyroid tissue remnants or pathological lymph node on thyroid USG. In view of the multifocal lesions indicating multi-system disease, a systemic chemotherapy protocol with combination of prednisone (PRED and vinblastine (VBL has been planned by the hematology department.

Management of pharynx fistula after upper digestive tract instrumentation

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Bogdan Popescu

2017-05-01

Full Text Available Pharynx fistula is a pathological state that can pose serious problems for both physician and patient and can lead up to the death of the patient in complicated cases. The authors describe a series of guidelines for the management of the pharynx fistula regarding the complications of the instrumentation of the upper digestive tract. Most of the cases that are addressed to our clinic can be treated with a conservative approach and a nutrition therapy plan tailored to each case. In selected cases surgery is the method of choice for therapy. The management of the pharynx fistula can be well managed in a multidisciplinary approach using resources from the E.N.T. and H.N.S. department and more important from the ICU department.

An aortoduodenal fistula as a complication of immunoglobulin G4-related disease

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Sarac, Momir; Marjanovic, Ivan; Bezmarevic, Mihailo; Zoranovic, Uros; Petrovic, Stanko; Mihajlovic, Miodrag

2012-01-01

Most primary aortoduodenal fistulas occur in the presence of an aortic aneurysm, which can be part of immunoglobulin G4 (IgG4)-related sclerosing disease. We present a case who underwent endovascular grafting of an aortoduodenal fistula associated with a high serum IgG4 level. A 56-year-old male underwent urgent endovascular reconstruction of an aortoduodenal fistula. The patient received antibiotics and other supportive therapy, and the postoperative course was uneventful, however, elevated levels of serum IgG, IgG4 and C-reactive protein were noted, which normalized after the introduction of steroid therapy. Control computed tomography angiography showed no endoleaks. The primary aortoduodenal fistula may have been associated with IgG4-related sclerosing disease as a possible complication of IgG4-related inflammatory aortic aneurysm. Endovascular grafting of a primary aortoduodenal fistula is an effective and minimally invasive alternative to standard surgical repair. PMID:23155348

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

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Jose R. De Souza

2003-06-01

Full Text Available INTRODUCTION: Nephrobronchial fistula is a rare complication of xanthogranulomatous pyelonephritis, a disease that can fistulize to lungs, skin, colon and other organs. CASE REPORT: A 37-year old patient presented a chronic history of lumbar pain and thoracic symptoms such as cough, dyspnea and oral elimination of pus. Patient went to several services and was submitted to 2 thorax surgeries before definitive treatment (nephrectomy was indicated. After nephrectomy, the patient presented an immediate improvement with weight gain (8 kg / 1 month and all his symptoms disappeared. CONCLUSION: This clinical case illustrates the natural history of nephrobronchial fistula, the importance of clinical history for diagnosis and the relevance of early treatment of renal lithiasis.

CT morphology of splenic vessels in splenoportal fistula

International Nuclear Information System (INIS)

Mansfeld, L.; Poehls, C.; Boitz, F.

1986-01-01

CT examination of a 53-year-old patient with endocarditis and clinical signs of hepatosplenomegaly revealed an atypical vascular morphology in the hilum of the spleen, for which no diagnosis could be established. Angiography indicated the presence of a symptom-free splenoportal fistula, the histological study of which suggested its congenital genesis. The paper describes the morphology, as ascertained by CT, of the splenic vessels characterised by changed haemodynamics due to a hilar splenoportal fistula. (orig.) [de

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula.

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Zheng, Xiangyi; Lin, Yiwei; Chen, Bin; Zhou, Xianyong; Zhou, Xiaofeng; Shen, Yuehong; Xie, Liping

2013-12-01

Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation.

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

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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.

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

International Nuclear Information System (INIS)

Lee, Ju Young; Jang, Kyung Mi; Yoon, Hoi Soo; Kim, Min Jeong; Lee, Kwan Seop; Lee, Yul; Bae, Sang Hoon

2007-01-01

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

Enterovaginal or Vesicovaginal Fistula Control Using a Silicone Cup.

Science.gov (United States)

Russell, Katie W; Robinson, Ryan E; Mone, Mary C; Scaife, Courtney L

2016-12-01

An enterovaginal or vesicovaginal fistula is a complication resulting in vaginal discharge of succus, urine, or stool that can lead to significant complications. For low-volume fistulae, tampons or pads may be used. With high-volume fistulae, frequent product change can be painful and unpredictable in terms of efficacy. The psychologic distress is profound. Surgery may not be an option, making symptom control the priority. We report the use of a reusable menstrual silicone vaginal cup placed to divert and contain drainage. The menstrual cup provided significant symptom relief. Drainage is immediately diverted from tissue, unlike with tampon or pad use, which involves longer contact periods with caustic fluids. A system was created by adapting the end of the cup by adding silastic tubing and an external leg bag to provide long-term drainage control. Improvement in quality of life is of primary importance when dealing with fistula drainage. This simple and inexpensive device should be considered in those cases in which the drainage can be diverted as a viable option, especially in those who are symptomatic and awaiting surgical repair or in those for whom surgery cannot be performed.

Broncho-pleural fistula with hydropneumothorax at CT: Diagnostic implications in mycobacterium avium complex lung disease with pleural involvement

International Nuclear Information System (INIS)

Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Park, Hye Yun; Koh, Won Jung; Kim, Jung Soo

2016-01-01

To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion

Broncho-pleural fistula with hydropneumothorax at CT: Diagnostic implications in mycobacterium avium complex lung disease with pleural involvement

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Yoon, Hyun Jung; Chung, Myung Jin; Lee, Kyung Soo; Park, Hye Yun; Koh, Won Jung [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jung Soo [Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of)

2016-04-15

To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Congenital coronary artery fistula in children: the interventional management and outcome

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Wei, Gao; Aiqing, Zhou; Zhiqing, Yu; Fen, Li; Yumin, Zhong; Yuqi, Zhang; Meirong, Huang; Kun, Sun [Department of Cardiology, Xinhua Hospital, Shanghai Children' s Medical Center Affiliated to School of Medicine, Shanghai Jiaotong Univ., Shanghai (China)

2006-11-15

Objective: To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas (CAFs). Methods: Retrospective analysis was performed on 19 patients mean age of (5.5 {+-} 4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization. Amplatzer PDA occluder or Amplatzer plug. One case had a residual fistula postoperatively associated with patent ductus arteriosus (PDA). Results: The abnormal parameters included mean fistula diameter (3.7 {+-} 1.6) mm (2.5-8.2 mm), pulmonary mean pressure (28.0 {+-} 5.0 mmHg (25.0-67.0 mmHg) and pulmonary to systemic shunt (Qp/Qs) 1.6 {+-} 0.8 (1.0-2.3). The sites of the fistulas were originated in right coronary artery 11, left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5. Various occlusion devices used to close these fistulas included one Gianturco coil in 10, 2-4 Gianturco coils in 3, Duct-Occlud in 3. Amplatzer duct occluder in 2 and Amplatzer plug in 1. the post-operative residul fistula with PDA was treated successfully with PDA occlusion. the immediate, one month and one year complete occlusion rates were 55.6%(10/18), 88.9%(16/18), 100%(18/18), respectively. The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps. Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt. Conclusion: Transcatheter closure of CAFs is a safe and effective alternative to surgical repair. (authors)

Congenital coronary artery fistula in children: the interventional management and outcome

International Nuclear Information System (INIS)

Gao Wei; Zhou Aiqing; Yu Zhiqing; Li Fen; Zhong Yumin; Zhang Yuqi; Huang Meirong; Sun Kun

2006-01-01

Objective: To assess the safety and efficacy of transcatheter closure of congenital coronary artery fistulas (CAFs). Methods: Retrospective analysis was performed on 19 patients mean age of (5.5 ± 4.1) years treated from February 1995 to December 2005 with transcatheter closure of CAFs using transcatheter spring coil embolization. Amplatzer PDA occluder or Amplatzer plug. One case had a residual fistula postoperatively associated with patent ductus arteriosus (PDA). Results: The abnormal parameters included mean fistula diameter (3.7 ± 1.6) mm (2.5-8.2 mm), pulmonary mean pressure (28.0 ± 5.0 mmHg (25.0-67.0 mmHg) and pulmonary to systemic shunt (Qp/Qs) 1.6 ± 0.8 (1.0-2.3). The sites of the fistulas were originated in right coronary artery 11, left anterior descending coronary artery or left circumflex coronary artery 8. Abnormal communication sites of these fistulas were to right ventricle in 14 and right atrium in 5. Various occlusion devices used to close these fistulas included one Gianturco coil in 10, 2-4 Gianturco coils in 3, Duct-Occlud in 3. Amplatzer duct occluder in 2 and Amplatzer plug in 1. the post-operative residul fistula with PDA was treated successfully with PDA occlusion. the immediate, one month and one year complete occlusion rates were 55.6%(10/18), 88.9%(16/18), 100%(18/18), respectively. The coil slipped into the left pulmonary artery in 1 case and correction was obtained by retrieving with forceps. Follow-up studies at 3 months to 4.3 years showed complete abolition of shunt in all patients with no evidence of recanalization leading to recurrences of shunt. Conclusion: Transcatheter closure of CAFs is a safe and effective alternative to surgical repair. (authors)

Endovascular Treatment of Autogenous Radiocephalic Fistulas with the 'Eighth Note' Deformity for Hemodialysis

International Nuclear Information System (INIS)

Weng Meijui; Chen, Matt Chiung-Yu; Chi Wenche; Liu Yichun; Chien Kofen; Liang Hueilung; Pan, Huay-Ben

2010-01-01

The purpose of this paper is to describe a unique 'eighth note' deformity of the autogenous radiocephalic fistula for hemodialysis and to retrospectively evaluate the efficacy and safety of its endovascular treatment. Over 3 years, a total of 808 patients and 558 autogenous radiocephalic fistulas were treated for vascular access dysfunction or thrombosis. These included 14 fistulas in 14 patients (9 men, 5 women; mean age, 58.2 ± 2.8 years; range 27-79 years) whose fistulograms before treatment resembled a musical note, the eighth note. Endovascular treatment sought to remodel the deformed vascular access to a classic radiocephalic fistula and increase the number of cannulation sites available for hemodialysis. The technical and clinical success rates were each 92.8% (13/14). Fistula remodeling was successful in 13 patients. The postintervention primary patency was 100% at 90 days, 91.7 ± 0.8% at 120 days, 78.6 ± 13.9% at 180 days, 62.9 ± 17.9% at 360 days, 31.4 ± 24.0% at 540 days, and 0% at 720 days. The postintervention secondary patency was 100% at 90 days, 100% at 120 days, 100% at 180 days, 85.7 ± 13.2% at 360 days, and 85.7 ± 13.2% at 720 days. No major complications were noted. Minor complications were found in 71.4% of patients, all of which resolved spontaneously. In conclusion, endovascular treatment of fistulas with the eighth note deformity can effectively increase the number of available cannulation sites, facilitate fistula maturation, and facilitate thromboaspiration after fistula thrombosis.

[Aortodigestive fistula and septic wound of the lower leg. A case report].

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Sommier, B; Casoli, V; Gachie, E; Weigert, R; Castède, J-C

2013-06-01

An aortodigestive fistula can be revealed by a peripheral septic wound when patient have aortic endovascular prosthesis. Our clinical case is about a 69-year-old patient with an abscess of the lateral aspect of his left lower limb. He has been treated few years ago for an aorto-abdominal anevrysm by an aortobifemoral prosthesis. In spite of a negative initial assessment for an aortodigestive fistula, anaerobic germs were found into the abscess. The initial treatment associated debridement, negative pressure therapy, dermal substitute and a split thickness skin graft for the loss of cutaneous substance. Months later, in front of an unexplained skin healing delay and fever, we realised new assessment bringing to light an aortodigestive fistula. Furthermore, the local bacterial samples from the wound and the hemocultures found both a lot of Escherichia Coli. The change of the aorto-bifemoral prosthesis and the cure of the aortodigestive fistula allowed the complete healing of the loss of cutaneous substance of the leg. The aortodigestive fistulas have a very high mortality. Because of their difficult diagnosis, their clinical suspicion has to start a complete medical assessment. Every septic wound when patients have vascular prosthesis is suggestive of an aortodigestive fistula. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn’s disease

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Lakatos, Peter Laszlo; Czegledi, Zsofia; Szamosi, Tamas; Banai, Janos; David, Gyula; Zsigmond, Ferenc; Pandur, Tunde; Erdelyi, Zsuzsanna; Gemela, Orsolya; Papp, Janos; Lakatos, Laszlo

2009-01-01

AIM: To assess the combined effect of disease phenotype, smoking and medical therapy [steroid, azathioprine (AZA), AZA/biological therapy] on the probability of disease behavior change in a Caucasian cohort of patients with Crohn’s disease (CD). METHODS: Three hundred and forty well-characterized, unrelated, consecutive CD patients were analyzed (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits. RESULTS: A change in disease behavior was observed in 30.8% of patients with an initially non-stricturing, non-penetrating disease behavior after a mean disease duration of 9.0 ± 7.2 years. In a logistic regression analysis corrected for disease duration, perianal disease, smoking, steroid use, early AZA or AZA/biological therapy use were independent predictors of disease behavior change. In a subsequent Kaplan-Meier survival analysis and a proportional Cox regression analysis, disease location (P = 0.001), presence of perianal disease (P < 0.001), prior steroid use (P = 0.006), early AZA (P = 0.005) or AZA/biological therapy (P = 0.002), or smoking (P = 0.032) were independent predictors of disease behavior change. CONCLUSION: Our data suggest that perianal disease, small bowel disease, smoking, prior steroid use, early AZA or AZA/biological therapy are all predictors of disease behavior change in CD patients. PMID:19630105

CD4+ LYMPHOCYTES IMPROVE VENOUS BLOOD FLOW IN EXPERIMENTAL ARTERIOVENOUS FISTULAE

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Duque, Juan C.; Martinez, Laisel; Mesa, Annia; Wei, Yuntao; Tabbara, Marwan; Salman, Loay H.; Vazquez-Padron, Roberto I.

2015-01-01

Background The role of immune cells in arteriovenous fistulae (AVF) maturation is poorly understood and has received, until quite recently, little attention. This study examines the role of T lymphocytes in AVF vascular remodeling. Methods Experimental fistulae were created in athymic rnu nude rats lacking mature T lymphocytes and euthymic control animals by anastomosing the left superior epigastric vein to the nearby femoral artery. Blood flow rates, wall morphology and histological changes were assessed in AVF 21 days after creation. The effect of CD4+ lymphocytes on AVF maturation in athymic animals was analyzed by adoptive transfer of cells after fistula creation. Results The absence of T lymphocytes compromised blood flow in experimental fistulae. Histopathological inspection of AVF from athymic rats revealed that T cell immunodeficiency negatively affected venous vascular remodeling, as evidenced by a reduced lumen, a thick muscular layer and a low number of inflammatory cells compared to control animals. Adoptive transfer of CD4+ lymphocytes from euthymic rats into athymic animals before and after fistula creation improved blood flow and reduced intima-media thickness. Conclusion These results point at the protective role of CD4+ lymphocytes in the remodeling of the AVF vascular wall. PMID:25999254

[Detection and analysis of the characteristic expression of microRNAs of anal fistula patients].

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Qiu, Jianming; Yu, Jiping; Yang, Guangen; Xu, Kan; Tao, Yong; Lin, Ali; Wang, Dong

2016-07-01

To detect and analyze the characteristic miRNAs profile of anal fistula and explore their possible target genes and potential clinical significance. The anal mucosa close to the hemorrhoids were collected from three patients undergoing fistulectomy and hemorrhoidectomy (fistula group) as well as three patients receiving only hemorroidectomy(hemorrhoids group), matching with fistula group in age, gender and body weight. miRNA microarray was used to compare the expression of 1 285 human miRNAs of the anal mucosa between two groups. Cluster analysis was adopted to analyze the accumulation of the differentially expressed miRNAs(Pcharacteristic miRNAs profile in anal fistula patients, which may play a role in the occurrence and development of anal fistula.

A case-control study of the risk factors for obstetric fistula in Tigray, Ethiopia.

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Lewis Wall, L; Belay, Shewaye; Haregot, Tesfahun; Dukes, Jonathan; Berhan, Eyoel; Abreha, Melaku

2017-12-01

We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.

Lymphogranuloma venereum presenting as a rectovaginal fistula.

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Lynch, C M; Felder, T L; Schwandt, R A; Shashy, R G

1999-01-01

Lymphogranuloma venereum (LGV) is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world's literature, there has not been a case reported in the last thirty years of a case of LGV presenting as a rectovaginal fistula. We present a case of an otherwise healthy American woman who presented with a rectovaginal fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage. PMID:10449269

Multifactorial dyspahgia complicated by esophago-bronchial fistula

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Sebastian Julie

2007-01-01

Full Text Available Dysphagia in an elderly patient necessitates urgent clinical evaluation to exclude the possibility of an underlying esophageal malignancy. Atherosclerotic aortic aneurysms are common in old age, but dysphagia aortica resulting from compression of the esophagus by an aortic aneurysm is a rare cause for dysphagia. Development of a malignant esophago-airway fistula can occur from a variety of tumors, the most common of which is esophageal cancer. A case of longstanding dysphagia resulting from dysphagia aortica later developing an esophageal malignancy complicated by esophago-bronchial fistula is outlined in this unique case report.

Spacer Facial Artery Musculomucosal Flap: Simultaneous Closure of Oronasal Fistulas and Palatal Lengthening.

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Lee, Jonathan Y; Alizadeh, Kaveh

2016-01-01

In this series, the authors describe a modification of the facial artery musculomucosal flap for oronasal fistula repair. The spacer facial artery musculomucosal flap technique is characterized by a pedicle inset into the retromolar trigone and palate, obviating a second operative stage. This was performed in 14 patients with a 5.2-cm mean fistula size. Average follow-up was 4.3 years, with one partial flap necrosis but no recurrent oronasal fistula. There was a mean decrease of 18 percent in the distance between the velum and the posterior pharyngeal wall. The spacer facial artery musculomucosal flap provides a single-stage reconstruction of oronasal fistula while lengthening the palate through a pushback mechanism. Although further study of velopharyngeal function is needed, the spacer facial artery musculomucosal flap may be beneficial for patients with a short velum and an oronasal fistula. Therapeutic, IV.

Congenital coronary artery fistula

International Nuclear Information System (INIS)

Oh, Yeon Hee; Kim, Hong; Zeon, Seoc Kil; Suh, Soo Jhi

1986-01-01

Congenital coronary artery fistula (CCAF) is communication of a coronary artery or its main branch with one of the atria or ventricles, the coronary sinus, the superior vena cava, or the pulmonary artery. In Korean peoples, only 4 cases of the CCAF were reported as rare as worldwide and authors want to report another case of CCAF, confirmed by operation. 10-year-old girl shows a fistula between sinus node artery of the right coronary artery and right atrium on root aortogram with left-to-right shunt and Qp/Qs=1.58, in which simple ligation of the sinus node artery from right coronary artery was performed. All of the 5 Korean CCAF (4 were previously reported and 1 of authors) were originated from right coronary artery, and of which 4 were opening into right ventricle and 1 of authors were into right atrium. Associated cardiac anomaly was noted in only 1 case as single coronary artery. Ages were from 9 months of age to 10 years old and no adult left case were found. 3 were female and 2 were male patients.

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

International Nuclear Information System (INIS)

Sirakov, S.; Penkov, M.; Sirakov, A.; Kamenov, B.; Todorov, Y.; Ninov, K.; Bachvarov, Ch.

2015-01-01

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

Carotid-cavernous fistula after functional endoscopic sinus surgery.

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Karaman, Emin; Isildak, Huseyin; Haciyev, Yusuf; Kaytaz, Asim; Enver, Ozgun

2009-03-01

Carotid-cavernous fistulas (CCFs) are anomalous communications between the carotid arterial system and the venous cavernous sinus. They can arise because of spontaneous or trauma causes. Most caroticocavernous fistulas are of spontaneous origin and unknown etiology. Spontaneous CCF may also be associated with cavernous sinus pathology such as arteriosclerotic changes of the arterial wall, fibromuscular dysplasia, or Ehler-Danlos syndrome. Traumatic CCFs may occur after either blunt or penetrating head trauma. Their clinical presentation is related to their size and to the type of venous drainage, which can lead to a variety of symptoms, such as visual loss, proptosis, bruit, chemosis, cranial nerve impairment, intracranial hemorrhage (rare), and so on. Treatment by endovascular transarterial embolization with electrolytically detachable coils is a very effective method for CCF with good outcomes. Carotid-cavernous fistulas have been rarely reported after craniofacial surgery and are uncommon pathologies in otolaryngology practice. In this study, we report a 40-year-old woman with CCF secondary to blunt trauma of functional endoscopic sinus surgery.

Tracheoesophageal Fistula due to a Damaged Tracheal Stent

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Masahiro Kimura

2014-01-01

Full Text Available We describe the management of a tracheoesophageal fistula due to a damaged tracheal stent, which was first inserted to treat tracheal stenosis. A 29-year-old woman with a history of treated epilepsy had a seizure and suffered from smoke inhalation during a fire. Breathing difficulties appeared and gradually worsened; consultation was obtained two years afterward. After undergoing a thorough examination, the patient was diagnosed with tracheal strangulation. A noncovered, metallic stent was inserted. When the patient was 37 years old, she was admitted to our hospital for the treatment of a tracheoesophageal fistula. We diagnosed it as a tracheoesophageal fistula due to the collapse of the damaged tracheal stent toward the esophageal side, and we decided to perform a mediastinal tracheostomy. Granulation may be formed in the circumference of a stent that has been present for a prolonged period, and removal of the stent may become difficult. This case suggests that insertion of a noncovered, metallic stent is contraindicated for a benign disease.

Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy

International Nuclear Information System (INIS)

AAssar, O. Sami; LaBerge, Jeanne M.; Gordon, Roy L.; Wilson, Mark W.; Mulvihill, Sean J.; Way, Lawrence W.; Kerlan, Robert K.

1999-01-01

Purpose: To evaluate the efficacy of percutaneous drainage of fluid collections following pancreaticoduodenectomy (Whipple's procedure). Methods: We performed a retrospective review of 19 patients referred to our service with fluid collections following pancreaticoduodenectomy. The presence of associated enteric or biliary fistulas, the route(s) of access for image-guided drainage, the incidence of positive bacterial cultures, and the duration and success of percutaneous management were recorded. Results: Fistulous communication to the jejunum in the region of the pancreatico-jejunal anastomosis was demonstrable in all 19 patients by gentle contrast injection into drainage tubes. Three patients had concurrent biliary fistulas. In 18 of 19 patients, fluid samples yielded positive bacterial cultures. Successful percutaneous evacuation of fluid was achieved in 17 of 19 patients (89%). The mean duration of drainage was 31 days. Conclusion: Percutaneous drainage of abscess following pancreaticoduodenectomy is effective in virtually all patients despite the coexistence of enteric and biliary fistulas

Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

International Nuclear Information System (INIS)

Takao, Hidemasa; Doi, Ippei; Makita, Kohzoh; Watanabe, Toshiaki

2005-01-01

Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted

cancerous esophagotracheal fistula: treatment of placement with covered self-expanding metallic stent

International Nuclear Information System (INIS)

Han Xinwei; Li Tianxiao; Wang Ruilin; Fan Qingxia

1997-01-01

Purpose: To treat the esophagotracheal fistula that was the main cause of death in patients with esophageal carcinoma, the placement of the stent was studied. Materials and methods: Under the fluoroscopic guidance, 28 stents (5 stents made in USA and 23 in China) were successfully implanted in all the 28 patients with esophagotracheal fistula. Results: The aphagia of the patients was greatly improved and a normal diet could be swallowed at once after the placement of the stents. The 27 cases of inhalation pneumonia that caused by the fistula was recovered. Conclusion: The result indicated that the treatment with the placement of the covered self-expanding stent is simple, safe, and effective for most patients with aphagia and pneumonia due to esophagotracheal fistula

Selective Embolization of Bilateral Arterial Cavernous Fistulas for Posttraumatic Penile Arterial Priapism

International Nuclear Information System (INIS)

Lazinger, Maxwell; Beckmann, Carl F.; Cossi, Alda; Roth, Robert A.

1996-01-01

A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot

Pediatric esophagopleural fistula

OpenAIRE

Cui, Yun; Ren, Yuqian; Shan, Yijun; Chen, Rongxin; Wang, Fei; Zhu, Yan; Zhang, Yucai

2017-01-01

Abstract Esophagopleural fistula (EPF) is rarely reported in children with a high misdiagnosis rate. This study aimed to reveal the clinical manifestations and managements of EPF in children. Two pediatric cases of EPF in our hospital were reported. A bibliographic search was performed on the PubMed, WANFANG, and CNKI databases for EPF-related reports published between January 1980 and May 2016. The pathogeny, clinical manifestations, diagnosis, treatments, and prognosis of EPF patients were ...

CORONARY ARTERY FISTULA: A CASE REPORT

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MZ Chowdhury

2007-01-01

Full Text Available The prevalence of congenital abnormalities of coronary artery is about 2% of general population. Of these abnormalities 5% were related to coronary artery fistulae (CAF. We report a case of 66 year old diabetic woman who presented with retrosternal chest pain. Her chest pain was associated with exercise and progressively deteriorated over the last 6 months. Electrocardiography showed right bundle branch block and Echo Color Doppler revealed hypo kinetic lateral wall. Coronary angiogram detected nothing abnormal except an aberrant tortuous branch of left circumflex. CT scan revealed a calcified sac medial to the descended thoracic aorta. A contrast enhancement was also done. All these imaging impressions were suggestive of coronary-to-pulmonary fistula. Ibrahim Med. Coll. J. 2007; 1(1: 32-33

Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

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Ali Kemal Gür

2013-12-01

Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

The missing foley catheter: an unusual finding in vesicouterine fistula.

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Shephard, Steven N; Lengmang, Sunday J

2013-12-18

A 28-year-old G1P1 presented complaining of urine leakage per vaginum following caesarean delivery, accompanied by amenorrhoea, cyclic haematuria and cyclic pelvic pain. Examination findings were suggestive of vesicouterine fistula and the patient was taken for exploratory laparotomy, during which the foley catheter could not be identified within the bladder. During separation of the bladder from the uterus, the catheter was found to be traversing the fistulous tract into the uterine cavity. Vesicouterine fistula is a fairly uncommon type of urogenital fistula that is frequently associated with caesarean section. Surgical treatment remains the mainstay and successfully cured this patient. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

Vesicovaginal fistula after sexual intercourse. A case report

International Nuclear Information System (INIS)

Takeda, Toshikazu; Nishiyama, Toru; Ohara, Rei; Hasegawa, Shintaro

2007-01-01

A 53-year old female visited our hospital with a complaint of continuous urinary incontinence after sexual intercourse. She had been diagnosed with carcinoma of uterine cervix stage I b2 and had undergone radical hysterectomy and radiation therapy (45 Gy). Cystoscopy revealed vesicovaginal fistula in the trigone which measured almost 3 cm. We repaired it by transabdominal and vaginal routes 5 days after the injury. She was discharged with a Foley catheter. Three months after the operation, cystography revealed improvement of vesicovaginal fistula. (author)

The poppy seed test for colovesical fistula: big bang, little bucks!

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Kwon, Eric O; Armenakas, Noel A; Scharf, Stephen C; Panagopoulos, Georgia; Fracchia, John A

2008-04-01

Diagnosis of a colovesical fistula is often challenging, and usually involves numerous invasive and expensive tests and procedures. The poppy seed test stands out as an exception to this rule. We evaluated the accuracy and cost-effectiveness of various established diagnostic tests used to evaluate a suspected colovesical fistula. We identified 20 prospectively entered patients with surgically confirmed colovesical fistulas between 2000 and 2006. Each patient was evaluated preoperatively with a (51)chromium nuclear study, computerized tomography of the abdomen and pelvis with oral and intravenous contrast medium, and the poppy seed test. Costs were calculated using institutional charges, 2006 Medicare limiting approved charges and the market price, respectively. The z test was used to compare the proportion of patients who tested positive for a fistula with each of these modalities. The chromium study was positive in 16 of 20 patients (80%) at a cost of $490.83 per study. Computerized tomography was positive in 14 of 20 patients (70%) at a cost of $652.92 per study. The poppy seed test was positive in 20 of 20 patients (100%) at a cost of $5.37 per study. The difference in the proportion of patients who tested positive for a fistula on computerized tomography and the poppy seed test was statistically significant (p = 0.03). There was no difference between the chromium group and the computerized tomography or poppy seed group (p = 0.72 and 0.12, respectively). The poppy seed test is an accurate, convenient and inexpensive diagnostic test. It is an ideal initial consideration for evaluating a suspected colovesical fistula.

A case of intractable gastrocutaneous fistula after gastric pull-up reconstruction of the pharynx and esophagus

International Nuclear Information System (INIS)

Wada, Tadahiko; Tanaka, Shinzo; Hiratsuka, Yasuyuki; Kumabe, Yohei; Yamahara, Kohei; Koyama, Taiji

2012-01-01

Pharyngocutaneous or esophagocutaneous fistula formation is not a rare complication after surgical treatment of head/neck cancer. In cases having developed such fistula, conservative treatment with local manipulation or surgical closure of the fistula using a local or pedicled flap is often possible. We recently encountered a case with an intractable gastrocutaneous fistula which occurred a long time after gastric pull-up reconstruction of the pharynx and esophagus. The patient was a 58-year-old female. As treatment for hypopharyngeal and thoracic esophageal cancers, the patient underwent total resections of the laryngopharynx and esophagus and gastric pull-up reconstruction of the esophagus. Postoperatively, 50 Gy radiation was applied to the neck. Although there was no recurrence of cancer, a salivary fistula above the tracheostomy occurred six years after surgery. Closure of the fistula with a local flap was attempted twice, but did not succeed. The fistula was then closed with a deltopectoral (DP) flap, but a fistula recurred five months later. Finally, by resecting the cervical segment of the pulled-up stomach, the esophagus was reconstructed successfully with a free jejunal graft. An intractable fistula should be replaced using tissue with rich blood flow, such as a free jejunal graft. (author)

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

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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.

[A case of anterior tibial arteriovenous fistula after closed fracture of the leg].

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Touzard, R C

1975-01-01

This case permits one to emphasize the great rareness of arteriovenous fistula after closed fractures of the shaft of the tibia. Fistulas in this anterior tibial position are remarkably latent, cause no symptoms below the fistula nor symptoms of heart failure. Treatment by several ligatures, permitted this patient to return to work 15 days after operation without any further treatment. The patient no longer has any symptoms.

Logistic regression analysis of the risk factors of anastomotic fistula after radical resection of esophageal‐cardiac cancer

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Huang, Jinxi; Wang, Chenghu; Yuan, Weiwei; Zhang, Zhandong; Chen, Beibei; Zhang, Xiefu

2017-01-01

Background This study was conducted to investigate the risk factors of anastomotic fistula after the radical resection of esophageal‐cardiac cancer. Methods Five hundred and forty‐four esophageal‐cardiac cancer patients who underwent surgery and had complete clinical data were included in the study. Fifty patients diagnosed with postoperative anastomotic fistula were considered the case group and the remaining 494 subjects who did not develop postoperative anastomotic fistula were considered the control. The potential risk factors for anastomotic fistula, such as age, gender, diabetes history, smoking history, were collected and compared between the groups. Statistically significant variables were substituted into logistic regression to further evaluate the independent risk factors for postoperative anastomotic fistulas in esophageal‐cardiac cancer. Results The incidence of anastomotic fistulas was 9.2% (50/544). Logistic regression analysis revealed that female gender (P < 0.05), laparoscopic surgery (P < 0.05), decreased postoperative albumin (P < 0.05), and postoperative renal dysfunction (P < 0.05) were independent risk factors for anastomotic fistulas in patients who received surgery for esophageal‐cardiac cancer. Of the 50 anastomotic fistulas, 16 cases were small fistulas, which were only discovered by conventional imaging examination and not presenting clinical symptoms. All of the anastomotic fistulas occurred within seven days after surgery. Five of the patients with anastomotic fistulas underwent a second surgery and three died. Conclusion Female patients with esophageal‐cardiac cancer treated with endoscopic surgery and suffering from postoperative hypoproteinemia and renal dysfunction were susceptible to postoperative anastomotic fistula. PMID:28940985

Out of the shadows and 6000 reasons to celebrate: An update from FIGO's fistula surgery training initiative.

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Slinger, Gillian; Trautvetter, Lilli; Browning, Andrew; Rane, Ajay

2018-06-01

Obstetric fistula is a devastating childbirth injury caused by unrelieved obstructed labor. Obstetric fistula leads to chronic incontinence and, in most cases, significant physical and emotional suffering. The condition continues to blight the lives of 1-2 million women in low-resource settings, with 50 000-100 000 new cases each year adding to the backlog. A trained, skilled fistula surgeon is essential to repair an obstetric fistula; however, owing to a global shortage of these surgeons, few women are able to receive life-restoring treatment. In 2011, to address the treatment gap, FIGO and partners released the Global Competency-Based Fistula Surgery Training Manual, the first standardized curriculum to train fistula surgeons. To increase the number of fistula surgeons, the FIGO Fistula Surgery Training Initiative was launched in 2012, and FIGO Fellows started to enter the program to train as fistula surgeons. Following a funding boost in 2014, the initiative has grown considerably. With 52 fellows involved and a new Expert Advisory Group in place, the program is achieving major milestones, with a record-breaking number of fistula repairs performed by FIGO Fellows in 2017, bringing the total number of repairs since the start of the project to more than 6000. © 2018 International Federation of Gynecology and Obstetrics.

Peri-anal surgery under saddle block anaesthesia comparing three different doses of hyperbaric 0.75% bupivacaine

International Nuclear Information System (INIS)

Ali, L.; Alam, W.; Abbas, M.A.; Ali, U.

2017-01-01

To compare three doses of hyperbaric 0.75% bupivacaine and measuring time for home readiness after day care perianal surgery under saddle block anaesthesia. Study Design: Non randomized controlled trial. Place and Duration of Study: The study was conducted at the department of Anaesthesia, CMH Rawalpindi from Jun 2014 to Apr 2015. Material and Methods: In this study 90 patients who presented for perianal day care surgery, were divided in three equal groups. Group A received 7.5 mg, group B 6.0 mg and group C 4.5 mg of hyperbaric 0.75% bupivacaine. Intrathecal injection was given in L4-5 space by 25 G spinal needle in sitting position. Lithotomy position was made after five minutes. After surgery patients were monitored in recovery room. After fulfilling ambulatory and discharge criteria patients were allowed to go home with attendants. Time of intrathecal injection, assessment of above criteria and time of discharge were noted and analyzed. Results: Male patients were 85.6% and females were 14.4%. Mean time of surgery was 48 +- 10.59 min. Mean time of discharge in minutes for group A was 235.86 +- 49.38, for group B 217.7 +- 42.49 and for group C 205.76 +- 32. Time of discharge was significantly different between group A and group C (p=0.02). While it was not significantly different between group A and group B (p=0.29) and between group B and group C (p=0.819). Conclusion: Lower dose of hyperbaric bupivacaine can reduce the time for home readiness compared to higher dose. Time of discharge is mainly dependent on time to micturate after saddle block anaesthesia. (author)

Perianal implantation of bioengineered human internal anal sphincter constructs intrinsically innervated with human neural progenitor cells.

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Raghavan, Shreya; Miyasaka, Eiichi A; Gilmont, Robert R; Somara, Sita; Teitelbaum, Daniel H; Bitar, Khalil N

2014-04-01

The internal anal sphincter (IAS) is a major contributing factor to pressure within the anal canal and is required for maintenance of rectoanal continence. IAS damage or weakening results in fecal incontinence. We have demonstrated that bioengineered, intrinsically innervated, human IAS tissue replacements possess key aspects of IAS physiology, such as the generation of spontaneous basal tone and contraction/relaxation in response to neurotransmitters. The objective of this study is to demonstrate the feasibility of implantation of bioengineered IAS constructs in the perianal region of athymic rats. Human IAS tissue constructs were bioengineered from isolated human IAS circular smooth muscle cells and human enteric neuronal progenitor cells. After maturation of the bioengineered constructs in culture, they were implanted operatively into the perianal region of athymic rats. Platelet-derived growth factor was delivered to the implanted constructs through a microosmotic pump. Implanted constructs were retrieved from the animals 4 weeks postimplantation. Animals tolerated the implantation well, and there were no early postoperative complications. Normal stooling was observed during the implantation period. At harvest, implanted constructs were adherent to the perirectal rat tissue and appeared healthy and pink. Immunohistochemical analysis revealed neovascularization. Implanted smooth muscle cells maintained contractile phenotype. Bioengineered constructs responded in vitro in a tissue chamber to neuronally evoked relaxation in response to electrical field stimulation and vasoactive intestinal peptide, indicating the preservation of neuronal networks. Our results indicate that bioengineered innervated IAS constructs can be used to augment IAS function in an animal model. This is a regenerative medicine based therapy for fecal incontinence that would directly address the dysfunction of the IAS muscle. Copyright © 2014 Mosby, Inc. All rights reserved.

Lymphogranuloma Venereum Presenting as a Rectovaginal Fistula

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C. M. Lynch

1999-01-01

Full Text Available Lymphogranuloma venereum (LGV is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world’s literature, there has not been a case reported in the last thirty years of a case ofLGV presenting as a rectovaginal fistula. We present a case of an otherwise healthy American woman who presented with a rectovaginal fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage. Infect. Dis. Obstet. Gynecol. 7:199–201, 1999.

Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases.

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Chi, Cuong Tran; Nguyen, Dang; Duc, Vo Tan; Chau, Huynh Hong; Son, Vo Tan

2014-01-01

We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies. Only type A CCF patients (Barrow's classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fiatula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization. A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced

LAPAROSCOPICALLY ASSISTED ANORECTOPLASTY AND THE USE OF THE BIPOLAR DEVICE TO SEAL THE RECTAL URINARY FISTULA.

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Dutra, Robson Azevedo; Boscollo, Adriana Cartafina Perez

2016-01-01

The anorectal anomalies consist in a complex group of birth defects. Laparoscopic-assisted anorectoplasty improved visualization of the rectal fistula and the ability to place the pull-through segment within the elevator muscle complex with minimal dissection. There is no consensus on how the fistula should be managed. To evaluate the laparoscopic-assisted anorectoplasty and the treatment of the rectal urinary fistula by a bipolar sealing device. It was performed according to the original description by Georgeson1. Was used 10 mm infraumbilical access portal for 30º optics. The pneumoperitoneum was established with pressure 8-10 cm H2O. Two additional trocars of 5 mm were placed on the right and left of the umbilicus. The dissection started on peritoneal reflection using Ligasure(r). With the reduction in the diameter of the distal rectum was identified the fistula to the urinary tract. The location of the new anus was defined by the location of the external anal sphincter muscle complex, using electro muscle stimulator externally. Finally, it was made an anastomosis between the rectum and the new location of the anus. A Foley urethral probe was left for seven days. Seven males were operated, six with rectoprostatic and one with rectovesical fistula. The follow-up period ranged from one to four years. The last two patients operated underwent bipolar sealing of the fistula between the rectum and urethra without sutures or surgical ligation. No evidence of urethral leaks was identified. There are benefits of the laparoscopic-assisted anorectoplasty for the treatment of anorectal anomaly. The use of a bipolar energy source that seals the rectal urinary fistula has provided a significant decrease in the operating time and made the procedure be more elegant. As anomalias anorretais consistem de um grupo complexo de defeitos congênitos. A anorretoplastia laparoscópica permite melhor visualização da fístula retourinária e propicia o posicionamento do reto abaixado

Spontaneous esophageal-pleural fistula

OpenAIRE

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-01-01

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

Spontaneous esophageal-pleural fistula.

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Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-10-01

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

Long-term survival from gastrocolic fistula secondary to adenocarcinoma of the transverse colon

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Murali Kothandaraman

2005-02-01

Full Text Available Abstract Background Gastrocolic fistula is a rare presentation of both benign and malignant diseases of the gastrointestinal tract. Malignant gastrocolic fistula is most commonly associated with adenocarcinoma of the transverse colon in the Western World. Despite radical approaches to treatment, long-term survival is rarely documented. Case presentation We report a case of a 24-year-old woman who presented with the classic triad of symptoms associated with gastrocolic fistula. Radical en-bloc surgery and adjuvant chemotherapy were performed. She is still alive ten years after treatment. Conclusions Gastrocolic fistula is an uncommon presentation of adenocarcinoma of the transverse colon. Radical en-bloc surgery with adjuvant chemotherapy may occasionally produce long-term survival.

Ileocolic Arteriovenous Fistula with Superior Mesenteric Vein Aneurism: Endovascular Treatment

International Nuclear Information System (INIS)

Gregorio, Miguel Angel de; Gimeno, Maria Jose; Medrano, Joaquin; Schoenholz, Caudio; Rodriguez, Juan; D'Agostino, Horacio

2004-01-01

We report a case of a venous aneurysm secondary to an acquired ileocolic arteriovenous fistula in a 64-year-old woman with recurrent abdominal pain and history of appendectomy. The aneurysm was diagnosed by ultrasound and computed tomography. Angiography showed an arteriovenous fistula between ileocolic branches of the superior mesenteric artery and vein. This vascular abnormality was successfully treated with coil embolization

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

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Alexandre Crippa

2007-01-01

Full Text Available 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: The causes of the fistula were radical retropubic prostatectomy in five patients, perineal debridement of Fournier's gangrene in one, transvesical prostatectomy in one and transurethral resection of the prostate in the other patient. The most common clinical manifestation was fecaluria, present in 87.5% of the cases. The mean time elapsed between diagnosis and correction of the fistula was 29.6 (7-63 months. One spontaneous closure occurred after five months of delayed catheterization. Urinary and retrograde urethrocystography indicated the site of the fistula in 71.4% of the cases. No patient presented recurrence of the fistula after its correction with the modified York-Mason procedure. CONCLUSION: The performance of routine colostomy and cystostomy is unnecessary. The technique described by York-Mason permits easy access, reduces surgical and hospitalization times and presents low complication and morbidity rates when surgically correcting recto-urethral fistulas.OBJETIVO: As fístulas reto-uretrais são de acesso difícil e por vezes complexo, sendo seu fechamento espontâneo raro. Com o diagnóstico precoce e aumento do número de intervenções, principalmente a cirurgia por adenocarcinoma da próstata localizado, sua incidência apesar de rara vem crescendo. Nós demonstramos a nossa experiência dos casos de fístulas reto-uretrais entre 2000 a 2006 com uma serie de oito pacientes, sendo que sete realizaram correção da fístula pela Técnica de

Effect of BioGlue on the incidence of pancreatic fistula following pancreas resection.

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Fisher, William E; Chai, Christy; Hodges, Sally E; Wu, Meng-Fen; Hilsenbeck, Susan G; Brunicardi, F Charles

2008-05-01

Despite numerous modifications of surgical technique, pancreatic fistula remains a serious problem and occurs in about 10% of patients following pancreas resection. BioGlue is a new sealant that creates a flexible mechanical seal within minutes independent of the body's clotting mechanism. Application of BioGlue sealant will reduce the incidence of pancreatic fistula following pancreas resection. A retrospective cohort study was performed with 64 patients undergoing pancreas resection. BioGlue sealant was applied to the pancreatic anastomosis (Whipple) or resection margin (distal pancreatectomy) in 32 cases. Factors that could affect the rate of postoperative pancreatic fistula were recorded. Pancreatic fistula was defined as greater than 50 ml of drain output with an amylase content greater than three times normal serum value after postoperative day 10. To improve the sensitivity of our study, we also examined pancreatic fistula with a strict definition of any drain output on or after postoperative day 3 with a high amylase content and graded the fistulas in terms of clinical severity. Grade A leaks were defined as subclinical. Grade B leaks required some response such as making the patient nil per os, parenteral nutrition, octreotide, antibiotics, or a prolonged hospital stay. Grade C leaks were defined as serious and life threatening. They were associated with hemorrhage, sepsis, resulted in deterioration of other organ systems, and mandated intensive care. Comparisons between the two groups were made using the chi-square test or Fisher's exact test for categorical variables and by the Wilcoxon rank-sum test for continuous variables. P values of 0.05 or less were deemed statistically significant. There were no differences between the patients who received BioGlue and the control cohort in terms of comorbid conditions, tumor location, texture of the pancreas, size of the pancreatic duct, or surgical technique. By the common definition, pancreatic fistula occurred

Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.

LENUS (Irish Health Repository)

Martin-Smith, James D

2009-01-01

BACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report

LENUS (Irish Health Repository)

Martin-Smith, James D

2009-12-24

Abstract Background The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. Case presentation A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula Conclusions This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

A Rare Complication of Composite Dual Mesh: Migration and Enterocutaneous Fistula Formation

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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.

[Resection of the recurrent third branchial fistula under gastroscope with assistance of yellow zebra guidewire].

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Feng, X; Huang, Z C; Tao, F; Ou, X L

2016-02-01

To investigate clinical aspects and a new operative method for resecting third branchial fistula. The clinical aspects of 4 patients with third branchial fistula were retrospectively analyzed. It is difficult to locate the inner orifice of fistula through neck path due to tiny diameter of inner orifice. The inner orifice could be found and closed effectively by inserting yellow zebra guidewire from sinus piriformis with gastroscope. The mucous membrane of sinus piriformis could not be damaged due to the soft pointed end of yellow zebra guidewire. 4 cases were treated successfully without pharyngeal fistula or recurrent laryngeal nerve injury. No recurrent infections were found in all cases with follows-up of 6-66 months. Ineffectiveness of radiography with meglumine diatrizoate or oral administration of methylene blue before operation indicates tiny fistula. In this case, resection of third branchial fistula with the assistance of gastroscope and yellow zebra guidewire under general anesthesia can be performed. This innovative method of diagnosis and treatment is worth of application clinically.

Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

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Albers Lisette

2011-01-01

Full Text Available Abstract Background Pregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and especially perianal Crohn's disease. Methods This is a retrospective cohort study which was performed in a tertiary level referral hospital in the Netherlands. From the IBD database, female patients aged 18-80 years in 2004 were selected. Data analysis took place in the years 2005 and 2006. Eventually, 114 women with at least one pregnancy after the diagnosis of Crohn's disease were eligible for the study. Differences between groups were analyzed using Wilcoxon Mann Whitney tests and Chi-square analysis with 2 × 2 or 2 × 3 contingency tables. Two-tailed values were used and p values Results 21/114 women (18% had active luminal disease prior to pregnancy, with significantly more pregnancy related complications compared to women with inactive luminal disease (Odds ratio 2.8; 95% CI 1.0 - 7.4. Caesarean section rate was relatively high (37/114, 32%, especially in patients with perianal disease prior to pregnancy compared to women without perianal disease (Odds ratio 4.6; 95% CI 1.8 - 11.4. Disease progression after childbirth was more frequent in patients with active luminal disease prior to pregnancy compared to inactive luminal disease (Odds ratio 9.7; 95% CI 2.1 - 44.3. Progression of perianal disease seems less frequent after vaginal delivery compared with caesarean section, in both women with prior perianal disease (18% vs. 31%, NS and without prior perianal disease (5% vs 14%, NS. There were no more fistula-related complications after childbirth in women with an episiotomy or second degree tear. Conclusion A relatively high rate of caesarean sections was observed in women with Crohn's disease, especially in women with perianal disease

"Hoping for a normal life again": reintegration after fistula repair in rural Tanzania.

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Teddy Mselle, Lilian; Evjen-Olsen, Bjørg; Marie Moland, Karen; Mvungi, Abu; Wankuru Kohi, Thecla

2012-10-01

To explore women's expectations, worries, and hopes related to returning to their family and community after fistula repair. We used a concurrent mixed methods design with a hospital survey and qualitative interviews. One hundred fifty-one women completed a questionnaire, eight were interviewed in hospital after fistula repair, and one woman was followed up at home for six months during the reintegration phase. Women were concerned about where they could live and about not being accepted by their husbands and in-laws. While 51% feared that their husbands would not accept them despite full recovery, 53% said their parents would accept them. In the qualitative study women wished to live with their parents, whereas almost one half (49.7%) of the women in the quantitative study, who had lived with fistula for a shorter time, wished to live with their husbands. All women hoped to have children in the future, although many women, especially those with no children, were worried about whether they could bear children in the future. Despite fears related to economic survival and social acceptance, women were optimistic about regaining a normal social life. Women's expectations of going home after fistula repair are linked to their history of living with obstetric fistula. For women who have lived with a fistula for many years, reintegration involves re-establishing an identity that is clean and respected. To facilitate this transition, fistula repair needs to be accompanied by psychological and social rehabilitation and assistance in returning to reproductive capabilities.

How I do it: surgical ligation of craniocervical junction dural AV fistulas.

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Sorenson, Thomas J; La Pira, Biagia; Hughes, Joshua; Lanzino, Giuseppe

2017-08-01

Dural arteriovenous fistulas (DAVFs) of the craniocervical junction are uncommon vascular lesions, which often require surgical treatment even in the endovascular era. Most commonly, the fistula is placed laterally, and surgical ligation is performed through a lateral suboccipital craniotomy. After dural opening, the area is inspected, and the arterialized vein is identified emerging from the dura, often adjacent to the entry point of the vertebral artery, and ligated. A far lateral craniotomy is the authors' preferred surgical approach for accessing and treating dural arteriovenous fistulas of the craniocervical junction that cannot be reached endovascularly.

Recurrent neck infection with branchial arch fistula in children.

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Madana, J; Yolmo, Deeke; Kalaiarasi, R; Gopalakrishnan, S; Saxena, S K; Krishnapriya, S

2011-09-01

Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side. A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases. The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence. Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All

Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

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Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

2015-08-15

PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

A "rendezvous technique" for treating a pancreatic fistula after distal pancreatectomy.

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Imai, Daisuke; Yamashita, Yo-ichi; Ikegami, Toru; Toshima, Takeo; Harimoto, Norifumi; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Ikeda, Tetsuo; Maehara, Yoshihiko

2015-01-01

Pancreatic fistulae are a major complication of distal pancreatectomy (DP). Some cases of severe pancreatic fistula require invasive procedures. There have been some reports concerning the effectiveness of pancreatic duct drainage through an endoscopic transpapillary approach for pancreatic fistulae. We herein present a case of a pancreatic fistula after DP that was successfully treated with percutaneous pancreatic duct drainage, which was performed using a combined percutaneous and endoscopic approach, named the "rendezvous technique". In our case, we performed distal pancreatectomy with celiac artery resection for a locally advanced pancreatic body cancer. On postoperative day (POD) 7, the drain amylase level increased up to 37,460 IU/l. Computed tomography (CT) revealed peripancreatic fluid collections. On POD 10, we placed a catheter in the main pancreatic duct using the rendezvous technique. CT on POD 14 revealed a decrease in the size of the peripancreatic fluid collection, and contrast imaging from the drains on POD 22 revealed almost complete disappearance of the fluid collection. We withdrew the pigtail catheter on POD 27 and the percutaneous pancreatic duct drain on POD 36. This patient was discharged from our hospital on POD 40. We herein report a new approach called the "rendezvous technique" for the management of pancreatic fistulae after DP that can be used instead of a stressful nasopancreatic tube.

Embolization of AV intra-hepatic fistulas

Energy Technology Data Exchange (ETDEWEB)

Mallarini, G; Saitta, S; Cariati, M; Nicorelli, M; de Caro, G

1982-05-01

The use of therapeutic embolization in a case of hepatic AV fistula with portal flow inversion and portal hypertension is described. Indications, technique and an illustrative case followed up for one year after the intervention are presented.

Congenital Palatal Fistula Associated with Submucous Cleft Palate

Science.gov (United States)

Eshete, Mekonen; Camison, Liliana; Abate, Fikre; Hailu, Taye; Demissie, Yohannes; Mohammed, Ibrahim; Butali, Azeez; Losken, H. Wolfgang

2016-01-01

Background: Although cleft lip and cleft palate are among the most common congenital malformations, the presence of an isolated congenital palatal fistula along with a submucous cleft is very rare. This appears as an oval-shaped, full-thickness fenestration in the palatal midline that does not fully extend anteriorly or posteriorly, accompanied by the findings of a submucous cleft. Because of the uncommon nature of this entity, there is controversy about its etiology, diagnosis, and management. Methods: Two cases of children with congenital palatal fistulae and a submucous cleft palate are presented who were treated in different settings by different surgeons. Cases are discussed along with a thorough review of the available literature. Results: Patient 1 presented at 4 years of age with “a hole in the palate” since birth and abnormal speech. His palatal fistula and submucous cleft were repaired with a modified von Langenbeck technique in Ethiopia. At a 2-year follow-up, the palate remained closed, but hypernasal speech persisted. Patient 2 was a 1-year-old presenting with failure to thrive and nasal regurgitation, who underwent a Furlow palatoplasty in the United States with good immediate results. She was unfortunately lost to follow-up. Conclusions: A congenital fenestration of the palate is rare. Reports reveal suboptimal speech at follow-up, despite various types of repair, especially when combined with a submucous cleft. Available literature suggests that repair should not focus on fistula closure only but instead on providing adequate palate length to provide good velopharyngeal function, as in any cleft palate repair. PMID:27014542

Rectal fistulas after prostate brachytherapy

International Nuclear Information System (INIS)

Tran, Audrey; Wallner, Kent; Merrick, Gregory; Seeberger, Jergen M.S.; Armstrong, Julius R.T.T.; Mueller, Amy; Cavanagh, William M.S.; Lin, Daniel; Butler, Wayne

2005-01-01

Purpose: To compare the rectal and prostatic radiation doses for a prospective series of 503 patients, 44 of whom developed persistent rectal bleeding, and 2 of whom developed rectal-prostatic fistulas. Methods and Materials: The 503 patients were randomized and treated by implantation with 125 I vs. 103 Pd alone (n = 290) or to 103 Pd with 20 Gy vs. 44 Gy supplemental external beam radiotherapy (n = 213) and treated at the Puget Sound Veterans Affairs Medical Center (n = 227), Schiffler Cancer Center (n 242) or University of Washington (n = 34). Patients were treated between September 1998 and October 2001 and had a minimum of 24 months of follow-up. The patient groups were treated concurrently. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological Association and Radiation Therapy Oncology Group criteria, at 1, 3, 6, 12, 18, and 24 months. Patients who reported Grade 1 or greater Radiation Therapy Oncology Group rectal morbidity were interviewed by telephone to clarify details regarding their rectal bleeding. Those who reported persistent bleeding, lasting for >1 month were included as having Grade 2 toxicity. Three of the patients with rectal bleeding required a colostomy, two of whom developed a fistula. No patient was lost to follow-up. The rectal doses were defined as the rectal volume in cubic centimeters that received >50%, 100%, 200%, or 300% of the prescription dose. The rectum was considered as a solid structure defined by the outer wall, without attempting to differentiate the inner wall or contents. Results: Persistent rectal bleeding occurred in 44 of the 502 patients, 32 of whom (73%) underwent confirmatory endoscopy. In univariate analysis, multiple parameters were associated with late rectal bleeding, including all rectal brachytherapy indexes. In multivariate analysis, however, only the rectal volume that received >100% of the dose was significantly predictive of bleeding. Rectal fistulas occurred

Spontaneous esophageal-pleural fistula

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Sameer Vyas

2011-01-01

Full Text Available Spontaneous esophageal-pleural fistula (EPF is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

The diagnostic concordance of endoanal ultrasonography and endoanal MRI in cases of anorectal fistula

International Nuclear Information System (INIS)

Kim, Wan Tae; Yoo, Weon Young; Moon, Hee Jung; Shin, Hyun Ja; Joo, Jae Sik

2000-01-01

To evaluate the preoperative diagnostic concordance of morphologic classification of anorectal fistula by endoanal ultrasonography (EUSG) and endoanal magnetic resonance imaging (EMRI). Between January 1998 and March 1999, 17 patients with anorectal fistula underwent endoanal ultrasonography and magnetic resonance imaging for preoperative assessment. The types of fistula and abscess formation were evaluated, and the findings compared with those obtained during surgery. The overall accordance of anorectal fistula was 76% (13 of 17 cases) on ultrasonography and 94% (16 of 17 cases) on magnetic resonance imaging. According to the findings of EUSG, the accordance of each type of anorectal fistula was as follows: transphineteric, 92% (11 of 12 cases); suprasphinteric, 33% (1 of 3); and extrasphincteric, 50% (1 of 2), while for EMRI, the respective figures were 100% (12 of 12 cases), 67% (2 of 3), and 100% (2 of 2). An analysis of reproducibility using kappa value showed that overall concordance between endoanal ultrasonography and surgery (κ=0.820) as well as between endoanal MRI and surgery (κ=0.866), was very close. For the evaluation of anorectal fistula, preoperative endoanal magnetic resonance imaging was more accurate and informative than endoanal ultrasonography

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

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

2013-12-10

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. A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.

Embolization of carotid-cavernous fistula using a silicone balloon and a tracker-catheter system

International Nuclear Information System (INIS)

Kim, Sun Yong; Cho, Kil Ho; Park, Bok Hwan

1992-01-01

With the recent introduction and development of the detachable balloon system, it has become the treatment of choice in the management of carotid cavernous fistulas(CCFs). But, since most delivery systems for embolization of CCF mainly depend on flow guidance for balloon delivery, in case of small fistula, pseudo aneurysm and arterialized venous collaterals, failure of balloon embolization can occur. To overcome these limitation, the authors designed and used a new versatile, steerable, and flow-guided detachable balloon system by using a Tracker catheter system with silicone or latex balloons. Using this maneuver, we could get successful fistula occlusion in 7 out of 8 patients (silicone balloon). But in one case, we had to occlude the internal carotid artery at the fistula site, proximal and distal cervical portions of the internal carotid artery. This balloon delivery system proved to provide high selectivity for fistula and relatively ease of handing

Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital.

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Mathur, Rajkumar; Joshi, Nitin; Aggarwal, Gaurav; Raikwar, Ramsharan; Shrivastava, Vaibhav; Mathur, Poonam; Raikwar, Poonam; Joshi, Rupali

2010-05-01

The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO) has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal) and lower segment caesarean section (LSCS) were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU). Cystoscopy along with examination under anaesthesia (EUA) were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF

Prevention of pharyngocutaneous fistulas by means of laser-weld techniques.

Science.gov (United States)

Shohet, J A; Reinisch, L; Ossoff, R H

1995-07-01

Although much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser-weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser-weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine-green dye-enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty-nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser welds ex vivo, but this finding was not clinically significant.

Diagnosis and treatment of traumatic carotid cavernous fistula combined with sphenoid sinus pseudoaneurysm

International Nuclear Information System (INIS)

Chen Huairui; Bai Rulin; Huang Chengguang; Hu Guohan; Luo Chun; Yuan Guoliang; Lu Yicheng

2008-01-01

Objective: To explore the diagnosis and treatment of traumatic carotid cavernous fistula combined with sphenoid sinus pseudoaneurysm. Methods: Interventional diagnosed and treated 6 eases of traumatid carotid cavernous fistula combined with sphenoid sinus pseudoaneurysm. Results: 5 patients presented with recurrent massive epistaxis and symptoms of CCF caused by pseudoaneurysms and fistulas were occluded with detachable balloons and internal carotid arteries were reserved in 2 cases; of which, 1 case also had indirect carotid cavernous fistula in contralateral side, embolizated by trans facial vein approach with microcoil. Complete symptoms resolution was achieved in all cases, without procedure related complications. During the follow-up period, all patients returned to their work. Conclusions: Falling from high speed motorcycle without helmet may be one of the main causes of this disease. The site of strike mostly localize at the frontal and lateral aspects of the orbit. MRI scan is very helpful for the diagnosis before receiving angiography. Detachable balloon occlusion for the pseudoaneurysm and fistula is safe and efficient for the treatment. (authors)

Traumatic esophageopleural fistula due to fish bone injury

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Ajay Kumar Verma

2015-01-01

Full Text Available Oesophageopleural fistula (EPF is an abnormal communication in between the oesophagous and pleural space such that the contents of oesophagous are drained into the pleural space surrounding the lungs. We describe a case of a middle-aged female who presented with right sided pyothorax secretions of which consisted of food particles. Chest computed tomography and barium swallow confirmed the diagnosis of oesophageopleural fistula, cause of which was found to be an accidental fish bone injury. Conservative management was done by chest tube drainage along with ryles tube feeding. Patient expired following severe sepsis.

Fanconi anaemia with bilateral diffuse pulmonary arterio venous fistulae: a case report

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Samarakoon Lasitha

2012-03-01

Full Text Available Abstract Background We report a patient with cytogenetically confirmed Fanconi anaemia with associated diffuse bilateral pulmonary arterio-venous fistulae. This is only the second reported case of diffuse pulmonary arterio-venous fistulae with Fanconi anaemia. Case Presentation A 16 year old Sri Lankan boy, with a cytogenetically confirmed Fanconi anaemia was admitted to University Medical Unit, National Hospital of Sri Lanka for further assessment and treatment. Both central and peripheral cyanosis plus clubbing were noted on examination. The peripheral saturation was persistently low on room air and did not improve with supplementary Oxygen. Contrast echocardiography failed to demonstrate an intra cardiac shunt but showed early crossover of contrast, suggesting the possibility of pulmonary arterio-venous fistulae. Computed tomography pulmonary angiogram was inconclusive. Subsequent right heart catheterisation revealed bilateral diffuse arterio-venous fistulae not amenable for device closure or surgical intervention. Conclusion To our knowledge, this is the second reported patient with diffuse pulmonary arterio-venous fistulae associated with Fanconi anaemia. We report this case to create awareness among clinicians regarding this elusive association. We recommend screening patients with Fanconi anaemia using contrast echocardiography at the time of assessment with transthoracic echocardiogram. Though universal screening may be impossible given the cost constraints, such screening should at least be performed in patients with clinical evidence of desaturation or when a therapeutic option such as haematopoietic stem cell transplantation is considered. Treatment of pulmonary arteriovenous fistulae would improve patient outcome as desaturation by shunting worsens the anaemic symptoms by reducing the oxygen carrying capacity of blood.

Acute suppurative thyroiditis secondary to piriform sinus fistula: a case report

International Nuclear Information System (INIS)

Diez, O.; Anorbe, E.; Aisa, P.; Saez De Ormijana, J.; Aguirre, X.; Paraiso, M.

1998-01-01

We present a typical case of acute suppurative thyroiditis (AST), associated with a piriform sinus fistula. We illustrate the case with an ultrasound picture of a hypoechogenic perithyroid mass and a CT scan using intravenous iodine contrast showing a perithyroid hypodense mass with peripheral enhancement, the mass also having intrathyroid involvement. When clinical and radiological findings suggest the presence of AST, it is necessary to rule out the presence of a piriform sinus fistula by means of a radiological study with barium contrast. Piriform sinus fistula is a rare abnormality derived from the branchial arch which is directly related to recurrent episodes of AST; surgical excision is hence, necessary to avoid such episodes

Transarterial embolization for hematuria caused by renal arteriovenous malformations or fistulae

International Nuclear Information System (INIS)

Meng Xiaoxi; Liu Shiyuan; Dong Weihua; Dong Sheng; Jia Ningyang; Xiao Xiangsheng

2008-01-01

Objective: To evaluate the efficacy and safety of transarterial embolization for hematuria caused by renal arteriovenous malformation or fistulae. Methods: Seven patients with gross hematuria caused by renal arterial abnormalities were retrospectively reviewed, of which three had congenital renal arteriovenous malformations and the other four had non-neoplastic acquired renal arteriovenous fistulae. All patients were confirmed by renal arterial angiography and undergone embolization with various embolic materials. Results: Embolization was successfully carried out in all cases. Gross hematuria disappeared one to seven days after the procedure. No severe complications were encountered. No recurrence occurred within 12 to 36 months of follow-up. Conclusions: Transarterial embolization is safe and effective for hematuria caused by renal arteriovenous malformations or fistulae. (authors)

Sphincter of Oddi botulinum toxin injection to prevent pancreatic fistula after distal pancreatectomy.

Science.gov (United States)

Hackert, Thilo; Klaiber, Ulla; Hinz, Ulf; Kehayova, Tzveta; Probst, Pascal; Knebel, Phillip; Diener, Markus K; Schneider, Lutz; Strobel, Oliver; Michalski, Christoph W; Ulrich, Alexis; Sauer, Peter; Büchler, Markus W

2017-05-01

Postoperative pancreatic fistula represents the most important complication after distal pancreatectomy. The aim of this study was to evaluate the use of a preoperative endoscopic injection of botulinum toxin into the sphincter of Oddi to prevent postoperative pancreatic fistula (German Clinical Trials Register number: DRKS00007885). This was an investigator-initiated, prospective clinical phase I/II trial with an exploratory study design. We included patients who underwent preoperative endoscopic sphincter botulinum toxin injection (100 units of Botox). End points were the feasibility, safety, and postoperative outcomes, including postoperative pancreatic fistula within 30 days after distal pancreatectomy. Botulinum toxin patients were compared with a control collective of patients undergoing distal pancreatectomy without botulinum toxin injection by case-control matching in a 1:1 ratio. Between February 2015 and February 2016, 29 patients were included. All patients underwent successful sphincter of Oddi botulinum toxin injection within a median of 6 (range 0-10) days before operation. One patient had an asymptomatic, self-limiting (48 hours) increase in serum amylase and lipase after injection. Distal pancreatectomy was performed in 24/29 patients; 5 patients were not resectable. Of the patients receiving botulinum toxin, 7 (29%) had increased amylase levels in drainage fluid on postoperative day 3 (the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula grade A) without symptoms or need for reintervention. Importantly, no clinically relevant fistulas (International Study Group of Pancreatic Surgery grades B/C) were observed in botulinum toxin patients compared to 33% postoperative pancreatic fistula grade B/C in case-control patients (P botulinum toxin injection is a novel and safe approach to decrease the incidence of clinically relevant postoperative pancreatic fistula after distal pancreatectomy. The results of

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.

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.

Duodenorenal Fistula as a Complication of Radiofrequency Ablation of Hepatic Metastasis of Renal Cell Carcinoma

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Arman Erkan

2017-06-01

Full Text Available Duodenorenal fistula is a rare condition. The right kidney and the second part of the duodenum are in close anatomic proximity. Although unusual, fistulae can occur between these two anatomic structures. We report a patient who presented with duodenorenal fistula after radiofrequency ablation for renal cell carcinoma and its hepatic metastasis.

Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review

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Chirag Choudhary

2013-01-01

Full Text Available To highlight a potentially fatal complication of broncho-vascular fistula arising from the self expanding metallic stent (SEMS placement. We retrospectively analyzed five patients with benign and malignant airway diseases, who developed tracheo/broncho-vascular fistulas following SEMS placement in our tertiary care setting. All patients received either Wallstent or Ultraflex® stent (Boston Scientific, Natick, MA between 1999 and 2007. All patients had received adjunct therapy such as balloon bronchoplasty, laser therapy or electrocautery. Most patients presented with massive hemoptysis. A total of 483 SEMS were placed during this period. SEMS placement can be complicated by Broncho-vascular fistula formation. True incidence and precise time interval between the insertion of stent and onset of this complication is unknown. Additional therapeutic modalities to maintain stent patency may enhance the risk of fistula formation. SEMS should only be used in a select sub-group of patients, after exhaustive evaluation of other treatment options. These cases provide evidence that broncho-vascular fistulas can develop at any time following SEMS placement, suggesting the need for a more cautious approach, especially while using them for a long term management. In benign airway disease, the stent should be removed as soon as healing has taken place.

Selective digital venous hypertension: A rare complication of hemodialysis arteriovenous fistula

Energy Technology Data Exchange (ETDEWEB)

Swayne, L.C.; Manstein, C.; Somers, R.; Cope, C.

1983-04-01

We report and document angiographically a case of selective venous hypertension, masquerading as an infection, which involved the three middle digits of the right hand in a patient with an access arteriovenous (AV) fistula. This complication arose following hemodialysis and was resolved after resection of the right radial artery at the site of AV fistula and re-anastomosis.

Comparison of pharyngocutaneous fistula closure with and without bacterial cellulose in a rat model.

Science.gov (United States)

Demir, Berat; Sarı, Murat; Binnetoglu, Adem; Yumusakhuylu, Ali Cemal; Filinte, Deniz; Tekin, İshak Özel; Bağlam, Tekin; Batman, Abdullah Çağlar

2018-04-01

The present study aimed to compare the effects of bacterial cellulose used for closure of pharyngocutaneous fistulae, a complication of total laryngectomy, with those of primary sutures in a rat model. Thirty female Sprague-Dawley underwent experimental pharyngoesophagotomy and were grouped depending on the material used for pharyngocutaneous fistula closure: group I, which received primary sutures alone, group II, which received bacterial cellulose alone; and group III, which received both. After 7 days, the rats were sacrificed. Pharyngocutaneous fistula development was assessed, the gross wound was inspected, and histological examination was conducted. Pharyngocutaneous fistulae developed in 12 rats (41%) in all: 6 from group I (21%), 4 from group II (14%) and 2 from group III (7%). Fibroblast density and inflammatory cell infiltration were significantly greater in group III than group I. We concluded that bacterial cellulose may be useful for pharyngocutaneous fistula closure. Copyright © 2017 Elsevier B.V. All rights reserved.

Neoplasia intra-epitelial grau III da vulva e da região perianal tratada com vulvectomia superficial: relato de caso High-grade vulvar and perianal intraepithelial neoplasia treated with skinning vulvectomy: a case report

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Walquíria Quida Salles Pereira Primo

2003-05-01

Full Text Available A neoplasia intra-epitelial vulvar grau III (NIV III se manifesta de modo visível, portanto, acessível à biópsia e, por conseguinte, ao diagnóstico histológico. Há duas formas precursoras do câncer vulvar: a NIV associada ao papiloma vírus humano (HPV e a NIV associada ao líquen simples crônico, hiperplasia de células escamosas e líquen escleroso, não tratados. Porém, pode existir sobreposição das duas formas. O termo papulose bowenóide, apesar de ser desencorajado, define uma das formas clínicas da NIV, que se apresenta como lesões pigmentadas, verruciformes, papulares e múltiplas. A NIV III está associada com HPV em mais de 80% dos casos e em 40% das vezes, nota-se envolvimento perianal. O seu tratamento é muito difícil e pode ocorrer recorrência em qualquer tempo e por muitos anos. Embora não exista tratamento padrão definido, os trabalhos apontam para a cirurgia, respeitando margem de segurança, como o mais adequado.High-grade vulvar intraepithelial neoplasia (VIN III is a visible lesion; therefore, it is accessible to biopsy and thus, to a histological diagnosis. There are two forms of vulvar cancer precursors: VIN caused by human papillomavirus (HPV and VIN associated with untreated lichen simplex chronicus, squamous cell hyperplasia, and lichen sclerosus. There may be overlap of the two forms. The term bowenoid papulosis, although discouraged, identifics a clinical form of VIN III. Such lesion appears as pigmented, wart-like growths or papules. VIN III is associated with HPV in more than 80% of the cases, and there is perianal involvement in 40% of the times. Vulvar intraepithelial neoplasia is difficult to cure and relapses can occur at any time for many years. Although there is no defined standard treatment, studies point to surgery, respecting a free margin, as the most adequate one.

A rare case of complete second arch branchial fistula in a 7-year-old child

OpenAIRE

Shankar, Venkateswara Gomathi; Babu, Thirunavukkarasu Arun; Swami, Hartimath Basavanand

2012-01-01

Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated.

A rare case of complete second arch branchial fistula in a 7-year-old child.

Science.gov (United States)

Shankar, Venkateswara Gomathi; Babu, Thirunavukkarasu Arun; Swami, Hartimath Basavanand

2012-07-01

Branchial fistulae are formed due to the abnormal persistence of the embryonic branchial clefts. Complete branchial fistula with internal and external opening is extremely rare. We report a rare case of complete second arch branchial fistulae in a 7-year-old boy, which was confirmed by a fistulogram. The tract was completely excised and the patient was successfully treated.

Treatment of esophagopleural fistulas using covered retrievable expandable metallic stents.

Science.gov (United States)

Kim, Tae-Hyung; Shin, Ji Hoon; Kim, Kyung Rae; Park, Jung-Hoon; Kim, Jin Hyoung; Song, Ho-Young

2014-04-01

To evaluate the clinical efficacy of placement of covered retrievable expandable metallic stents for esophagopleural fistulas (EPFs). During the period 1997-2013, nine patients with EPF were treated using covered retrievable expandable metallic stents. The underlying causes of EPF were esophageal carcinoma (n = 6), lung cancer (n = 2), and postoperative empyema for Boerhaave syndrome (n = 1). Technical success was achieved in eight patients (88.9%). In one patient, incomplete EPF closure was due to incomplete stent expansion. Clinical success, defined as complete EPF closure within 7 days, was achieved in five patients (55.6%). Overall fistula persistence (n = 1) or reopening (n = 4) occurred in five patients (55.6%) 0-15 days after stent placement. The causes of reopening were due to the gap between the stent and the esophagus (n = 3) or stent migration (n = 1). For fistula persistence or reopening, additional interventional management, such as gastrostomy, stent removal, or stent reinsertion, was performed. Stent migration occurred as a complication in one patient with EPF from a benign cause secondary to postoperative empyema. In the eight patients who died during the follow-up period, the mean and median survival times were 78.8 days and 46 days, respectively. Placement of a covered expandable metallic esophageal stent for the palliative treatment of EPF is technically feasible, although the rate of clinical success was poor secondary to fistula persistence or reopening. Fistula reopening was caused by the gap between the stent and the esophagus or by stent migration, and additional interventional treatment was useful to ensure enteral nutritional support. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

A Fast Placement Technique for Covered Tracheobronchial Stents in Patients with Complicated Esophagorespiratory Fistulas

International Nuclear Information System (INIS)

Kishi, Kazushi; Nakao, Taisei; Goto, Hironobu; Kimura, Masashi; Sonomura, Tetsuo; Yamanaka, Noboru; Nanjo, Kishio; Sato, Morio

2005-01-01

Purpose. To test an endotracheal placement procedure for malignant esophagorespiratory fistula when endoesophageal placement is inapplicable. Methods. We report on patients with malignant esophagorespiratory fistula to which endoesophageal approaches were complicated with a complete obstruction of the hypopharynx, a collapsible tracheobronchus, or a previously placed endoesophageal stents. Gore-Tex membrane-covered Z-stents were deployed in the trachea using a coaxial introducer system in three patients. A Dumon tube was deployed in the bronchus over the bronchofiberscope in one patient. Results. All fistula were completely sealed by the endotracheal or endobronchial stenting. Symptomatic and clinical improvements were immediate obtained. Conclusion. Endotracheal or endobronchial covered stent placement is thought to be an effective alternative method for sealing esophagorespiratory fistula

Positron emission tomography with 68Ga-EDTA in the diagnosis and localization of CSF fistulas

International Nuclear Information System (INIS)

Bergstrand, G.; Bergstroem, M.; Eriksson, L.; Edner, G.; Widen, L.

1982-01-01

Five patients with cerebrospinal fluid (CSF) rhinorrhea were investigated with computed tomography (CT) and positron emission tomography (PET) to localize the site of a CSF fistula. After intrathecal injection of 10 MBq of 68 Ga-EDTA, radioactivity was demonstrated in the basal cisterns. In three cases, the site of the fistula was visualized with PET. It is not always possible to demonstrate a CSF leakage with CT cisternography (CTC) using metrizamide, particularly in cases with minute fistulas or intermittent CSF rhinorrhea. With further experience and improved PET techniques, it may be possible to detect even very small fistulas

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...... 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......-9.83) compared with non-Crohn's fistulas, [0.32 ng/ml, range 0-2.66, (p MMP-9 activity [0.64 ng/ml, range 0-5.66 and 0.17 ng/ml, range 0-1.1, respectively (p MMP activity level by 42% and suppressed the specific MMP-3...

Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis.

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Goldberg, Leah; Elsamra, Sammy; Hutchinson-Colas, Juana; Segal, Saya

2016-01-01

A vesicouterine fistula is a rare form of urogenital fistula, yet there is increasing prevalence in the United States because of the rising rate of cesarean deliveries. Vesicouterine fistulas have various presentations including menouria, hematuria, or urinary incontinence. A 39-year-old multiparous woman presented with urine leakage after her third cesarean delivery. She had been treated for mixed urinary incontinence with overactive bladder medications and a midurethral sling with continued complaints of urine leakage. The patient noticed her symptoms of urine leakage improved during menses when she used a menstrual cup. After confirmation of vesicouterine fistula, the patient underwent robotic-assisted surgery and her symptoms of insensible urine leakage resolved. When evaluating women with urinary incontinence and a history of cesarean deliveries, use of menstrual cup may aid in the diagnosis of vesicouterine fistula. Robotic-assisted laparoscopic repair with tissue interposition flap is an efficacious minimally invasive method for treatment of vesicouterine fistula.

Successful Use of Modified Suprapubic Catheter to Rescue Prostatorectal Fistula

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Yi-Chun Chiu

2008-06-01

Full Text Available Prostatorectal fistula is a complication following radiotherapy. It remains a clinical challenge to treat because most patients experience a poor quality of life. This case report discusses a modified suprapubic catheter for use in a patient with a prostatorectal fistula that developed after radiotherapy for localized prostate cancer. It is an inexpensive, easily available, and more patient-tolerable catheter that improves quality of life. Herein, we describe the development of this catheter.

Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital

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Mathur Rajkumar

2010-01-01

Full Text Available Introduction: The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. Materials and Methods: 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal and lower segment caesarean section (LSCS were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU. Cystoscopy along with examination under anaesthesia (EUA were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Results: Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40

Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial

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Barone Mark A

2012-03-01

Full Text Available Abstract Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT comparing the new proposed short-term (7 day urethral catheterization to longer-term (14 day urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and

Pancreaticobiliary fistula evident after ESWL treatment of pancreatolithiasis.

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Arakura, Norikazu; Ozaki, Yayoi; Maruyama, Masafumi; Chou, Yoshimi; Kodama, Ryou; Takayama, Mari; Hamano, Hideaki; Tanaka, Eiji; Kawa, Shigeyuki

2009-01-01

Here we report a patient with a pancreaticobiliary fistula that was possibly associated with pancreatolithiasis. He was admitted due to mild pancreatitis. Pancreatolithiasis was revealed in the parenchyma of the head region and in the main pancreatic duct of the pancreas body with distal dilatation. Extracorporeal shock wave lithotripsy (ESWL) effectively eliminated the pancreatic stones; however, an apparent internal fistula from the middle portion of the common bile duct (CBD) to the main pancreatic duct was revealed where the parenchymal stones had been located. The patient was considered to be in the same condition as pancreato-biliary malunion without CBD dilatation, and was treated with laparoscopic cholecystectomy.

Acute suppurative thyroiditis secondary to piriform sinus fistula: a case report

International Nuclear Information System (INIS)

Diez, O.; Anorbe, E.; Aisa, P.; Saez De Ormijana, J.; Aguirre, X.; Paraiso, M.

1998-01-01

We present a typical case of acute suppurative thyroiditis (AST), associated with a piriform sinus fistula. We illustrate the case with an ultrasound picture of a hypoechogenic perithyroid mass and a CT scan using intravenous iodine contrast showing a perithyroid hypodense mass with peripheral enhancement, the mass also having intrathyroid involvement. When clinical and radiological findings suggest the presence of AST, it is necessary to rule out the presence of a piriform sinus fistula by means of a radiological study with barium contrast. Piriform sinus fistula is a rare abnormality derived from the branchial arch which is directly related to recurrent episodes of AST; surgical excision is hence, necessary to avoid such episodes. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

Acute suppurative thyroiditis secondary to piriform sinus fistula: a case report

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Diez, O.; Anorbe, E.; Aisa, P.; Saez De Ormijana, J.; Aguirre, X.; Paraiso, M. [Department of Radiology, Hospital Santiago Apostol, C/Olaguibel 29, E01004 Vitoria-Gasteiz (Spain)

1998-11-01

We present a typical case of acute suppurative thyroiditis (AST), associated with a piriform sinus fistula. We illustrate the case with an ultrasound picture of a hypoechogenic perithyroid mass and a CT scan using intravenous iodine contrast showing a perithyroid hypodense mass with peripheral enhancement, the mass also having intrathyroid involvement. When clinical and radiological findings suggest the presence of AST, it is necessary to rule out the presence of a piriform sinus fistula by means of a radiological study with barium contrast. Piriform sinus fistula is a rare abnormality derived from the branchial arch which is directly related to recurrent episodes of AST; surgical excision is hence, necessary to avoid such episodes. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

Enterovesical fistula and acute pyelonephritis in renal transplantation. Role of ultrasound

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Antonio De Pascalis

2014-12-01

Full Text Available The enterovesical fistula is a communication between the urinary tract and the colon and is a rare complication of various inflammatory and cancer diseases. The most frequent cause is represented by diverticulitis of the sigmoid colon and less frequently from Crohn's disease, tumors of the colon and bladder, trauma, radiation therapy and appendicitis. In this report we describe the occurrence of an enterovesical fistula in a patient with renal allograft from a cadaveric donor, which onsetted with signs of acute pyelonephritis and pneumaturia due to diverticulitis of the sigmoid colon, clinically silent. The ultrasound in the diagnosis of enterovesical fistula, yet with a minor role compared to computed tomography (CT, is fundamental being always the first level examination.

Delayed diagnosis of xanthogranulomatous pyelonephritis in a quadriplegic patient with uncontrolled cutaneous fistula

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Yang, Jae-Hyuk; Shin, Jin Yong; Roh, Si-Gyun; Chang, Suk-Choo; Lee, Nae-Ho

2018-01-01

Abstract Rationale: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula. Patient concerns: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. Diagnoses: Abdominal computed tomography revealed a renal obstructing stone and enlarged right kidney with a perinephric fluid collection that communicated with the cutaneous fistula. Interventions: The patient underwent a right nephrectomy at the department of urology. Outcomes: Two months after surgery, the patient was clinically well with no discharging fistula. Lessons: The XGP accompanied by complications requires an immediate evaluation and early diagnosis. In this case, the diagnosis was delayed because the state of quadriplegia rendered no symptoms of XGP. PMID:29480882

Congenital bronchobiliary fistula: MRI appearance

International Nuclear Information System (INIS)

Hourigan, Jon S.; Carr, Michael G.; Burton, Edward M.; Ledbetter, Joel C.

2004-01-01

Congenital bronchobiliary fistula (CBBF) is a rare anomaly. Twenty-three cases have been reported since the anomaly was first described in 1952. Most of these cases were diagnosed by bronchoscopy, cholangiography, or hepatobiliary nuclear imaging. Our case of a newborn with bilious emesis with CBBF was depicted by T1-weighted gradient-echo MRI sequences. (orig.)

Vesicouterine fistula and blind vagina

International Nuclear Information System (INIS)

Hafeez, M.; Hameed, S.; Asif, S.

2003-01-01

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)

The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group

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Lee, Jae Bum; Yoon, Seo-Gue; Park, Kyu Joo; Lee, Kang Young; Kim, Dae Dong; Yoon, Sang Nam

2015-01-01

Purpose Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD. Methods From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed. Results Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001). Conclusion Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures. PMID:26576395

Barriers to obstetric fistula treatment in low-income countries: a systematic review.

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Baker, Zoë; Bellows, Ben; Bach, Rachel; Warren, Charlotte

2017-08-01

To identify the barriers faced by women living with obstetric fistula in low-income countries that prevent them from seeking care, reaching medical centres and receiving appropriate care. Bibliographic databases, grey literature, journals, and network and organisation websites were searched in English and French from June to July 2014 and again from August to November 2016 using key search terms and specific inclusion and exclusion criteria for discussion of barriers to fistula treatment. Experts provided recommendations for additional sources. Of 5829 articles screened, 139 were included in the review. Nine groups of barriers to treatment were identified: psychosocial, cultural, awareness, social, financial, transportation, facility shortages, quality of care and political leadership. Interventions to address barriers primarily focused on awareness, facility shortages, transportation, financial and social barriers. At present, outcome data, though promising, are sparse and the success of interventions in providing long-term alleviation of barriers is unclear. Results from the review indicate that there are many barriers to fistula treatment, which operate at the individual, community and national levels. The successful treatment of obstetric fistula may thus require targeting several barriers, including depression, stigma and shame, lack of community-based referral mechanisms, financial cost of the procedure, transportation difficulties, gender power imbalances, the availability of facilities that offer fistula repair, community reintegration and the competing priorities of political leadership. © 2017 John Wiley & Sons Ltd.

Mycobacterium chelonae empyema with bronchopleural fistula in an immunocompetent patient

International Nuclear Information System (INIS)

Wali, Siraj

2009-01-01

Mycobacterium Calhoun is one of the rapidly growing mycobacteria that rarely cause lung disease. M chelonae more commonly causes skin and soft tissue infections primarily in immunosuppressed individuals. Thoracic empyema caused by rapidly growing mycobacteria and complicated with bronchopleural fistula is rarely reported, especially in immunocompetent patients. In this article we report the first immunocompetent Arabian patient presented with M chelonae- related empyema with bronchopleural fistula which mimics, clinically and radiologically, empyema caused by Mycobacterium tuberculosis. (author)

Multidetector computerized tomographic fistulography in the evaluation of congenital branchial cleft fistulae and sinuses.

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Sun, Zhipeng; Fu, Kaiyuan; Zhang, Zuyan; Zhao, Yanping; Ma, Xuchen

2012-05-01

The aim of this study was to primarily investigate the usefulness of computerized tomographic (CT) fistulography in the diagnosis and management of branchial cleft fistulae and sinuses. Fifteen patients with confirmed branchial fistulae or sinuses who had undergone CT fistulography were included. The diagnoses were confirmed by clinical, radiologic, or histopathologic examinations. The internal openings, distribution, and neighboring relationship of the lesions presented by CT fistulography were analyzed to evaluate the usefulness in comparison with x-ray fistulography. Nine patients were diagnosed with first branchial fistulae or sinuses, 2 with second branchial fistulae, and 4 with third or fourth branchial fistulae. The presence and location of the lesions could be seen on x-ray fistulography. The distribution of the lesions, internal openings, and neighboring relationship with parotid gland, carotid sheath, and submandibular gland could be clearly demonstrated on CT cross-sectional or volume-rendering images. CT fistulography could provide valuable information and benefit surgical planning by demonstrating the courses of branchial anomalies in detail. Copyright © 2012 Elsevier Inc. All rights reserved.

Endovascular management of acute bleeding arterioenteric fistulas

DEFF Research Database (Denmark)

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

2008-01-01

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....... 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...... 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. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

Phase-contrast MR angiography of intracranial dural arteriovenous fistulae

International Nuclear Information System (INIS)

Cellerini, M.; Mascalchi, M.; Mangiafico, S.; Ferrito, G.P.; Scardigli, V.; Pellicano, G.; Quilici, N.

1999-01-01

MRI and phase-contrast MR angiography (PC MRA) were obtained in 13 patients with angiographically confirmed intracranial dural arteriovenous fistulae (DAVF). Three- and two-dimensional PC MRA was obtained with low (6-20 cm/s) and high (>40 cm/s) velocity encoding along the three main body axes. MRI showed focal or diffuse signal abnormalities in the brain parenchyma in six patients, dilated cortical veins in seven, venous pouches in four with type IV DAVF and enlargement of the superior ophthalmic vein in three patients with DAVF of the cavernous sinus. However, it showed none of the fistula sites and did not allow reliable identification of feeding arteries. 3D PC MRA enabled identification of the fistula and enlarged feeding arteries in six cases each. Stenosis or occlusion of the dural sinuses was detected in six of eight cases on 3D PC MRA with low velocity encoding. In six patients with type II DAVF phase reconstruction of 2D PC MRA demonstrated flow reversal in the dural sinuses or superior ophthalmic vein. (orig.)

Robotic repair of vesicovaginal fistula - initial experience

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Ankush Jairath

2016-02-01

Full Text Available ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF (1 posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range with mean BMI being 26.25 kg/m2 (21-32 range. Mean duration between insult and repair was 9.37 months (3-24 months. Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm. Mean operative time was 117.5 minutes (90-150. There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm. Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5 and per urethral catheterisation (which was removed after voiding

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report☆

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Yetişir, Fahri; Salman, A. Ebru; Mamedov, Ruslan; Aksoy, Mustafa; Yalcin, Abdussamet; Kayaalp, Cüneyt

2014-01-01

INTRODUCTION To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS. PRESENTATION OF CASE Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up. DISCUSSION Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period. CONCLUSION Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula. PMID:24584042