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Sample records for fistulas clinically mimicking

  1. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae

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    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)

    2016-01-01

    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  2. Crohn's disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis

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    Zafer Teke; Faruk Onder Aytekin; Ali Ozgur Atalay; Nese Calli Demirkan

    2008-01-01

    We report a 31-year-old woman with Crohn's disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowell endometriosis, due to the patient's perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn's disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn's ileitis. Histopathology of the resected specimen revealed Crohn's disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn's diease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child- bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn's disease should be included in the differential diagnosis.

  3. Endometriosis mimicking the perianal fistula tract: Case report

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    Gül Türkcü

    2014-09-01

    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  4. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

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    Monteiro, Bárbara Vanessa de Brito; Grempel, Rafael Grotta; Gomes, Daliana Queiroga de Castro; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa

    2013-01-01

    Introduction Adenoid cystic carcinoma (ACC) is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site. PMID:25992095

  5. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

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    Monteiro, Bárbara Vanessa de Brito

    2014-01-01

    Full Text Available Introduction Adenoid cystic carcinoma (ACC is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site.

  6. Cholecystocolonic fistula mimicking acute cholecystitis diagnosed unequivocally by computed tomography.

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    Chick, Jeffrey Forris Beecham; Chauhan, Nikunj Rashmikant; Paulson, Vera Ashley; Adduci, Alexander J

    2013-12-01

    Cholecystocolonic fistula is an uncommon potential complication of cholecystitis found intraoperatively in 0.06-0.14 % of patients undergoing cholecystectomy and 0.1-0.5 % of autopsy series. Although cholecystocolonic fistula is the second most common cholecystoenteric fistula, second only to cholecystoduodenal fistula, it is diagnosed preoperatively in only 7.9 % of patients. Failure to preoperatively diagnose cholecystocolonic fistula places surgeons in precarious positions, as they may be forced to convert a seemingly routine cholecystectomy to a more sophisticated procedure coupled with adhesiolysis, colonic suturing, or colonic resection. We report a young patient who presented to the emergency department with complaints indicative of acute cholecystitis; however, preoperative ultrasound was suggestive of a cholecystoenteric fistula. Computed tomography and pathology were pathognomonic with clear visualization of the cholecystocolonic fistulous tract.

  7. 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.

  8. Ovarian Heterotopic Pregnancy Clinically Mimicking Endometrioma

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    Nilüfer ONAK KANDEMİR

    2010-01-01

    Full Text Available Heterotopic pregnancy is a very uncommon entity with a difficult preoperative diagnosis. In the present study, we presented an ovarian heterotopic pregnancy case, clinically mimicking endometrioma developed in a 33-year-old female following an in vitro fertilization procedure. The importance of clinical, histopathological, and immunohistochemical examinations in the diagnosis of heterotopic pregnancy are emphasized.

  9. CLINICAL STUDY OF FISTULA IN ANO

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    Sushma Ramteke

    2017-02-01

    Full Text Available BACKGROUND Fistula in ano is one of the common problem faced in today’s world. Fistula in ano is track lined by granulation tissue that connect deeply in the anal canal or rectum and superficially on the skin around the anus. It usually results from cryptoglandular infection causing abscess, which burst spontaneously or was drained inadequately. The study is conducted to find most common aetiological factor and to evaluate various surgical technique and their outcome. The aim of the study is to- 1. Study the incidence of various aetiologies of fistula in ano. 2. Study the clinical presentation of fistula in ano. 3. Evaluate different modalities of surgical approach and their outcome. MATERIALS AND METHODS This prospective study was conducted at Late Lakhiram Agrawal Memorial Government Medical College, Raigarh, during the study period of July 2015 to July 2016. All the 50 cases were included in this study who were above 15 year of age diagnosed with fistula in ano on the basis of clinical examination who underwent surgical procedure. RESULTS In present study of 50 cases, 60% of cases were in the age group of 31-50 years. Male:female ratio was 9:1. 80% of cases belong to low socioeconomic status. The most common mode of presentation was discharging sinus in 96% of cases. 70% of patient had past history of burst abscess or surgical drainage of abscess. 90% of cases have single external opening. 80% of cases had posterior external opening. Most of the fistula are of low anal type, which was 92% and rest of the patient had an internal opening situated above the anorectal ring. The most common surgical approach done was fistulectomy. Only fistulectomy was done in 80% of patients. Fistulectomy with sphincterectomy was done in two patients. These two patients had associated anal fissure. Fistulectomy with seton placement was done in two patients of high level of fistula type. Fistulotomy was done in four patients (8%, these were of low fistula type

  10. Fistulas

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    A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between ... two arteries. Some people are born with a fistula. Other common causes of fistulas include Complications from ...

  11. Entero-enteric fistula from the stump of an end-to-side ileocolic anastomosis mimicking cancer recurrence.

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    Elsafty, N; Clancy, C; Bajwa, R; Memeh, K; Joyce, M R

    2015-09-15

    Enteric fistulae are a complex and technically frustrating complication of any bowel surgery. The constellation of associated non-specific symptoms often leads to extensive investigation and, in this case, suspicion of disease recurrence. A 71-year-old gentleman with a history of previous colorectal cancer presented with chronic diarrhoea, weight loss and left lower quadrant pain. Elective exploratory laparoscopy was performed to investigate possible disease recurrence due to elevated carcinoembryonic antigen levels and a positron emission tomography positive area within the mesentery. A jejunal-ileal fistula was found at laparotomy where the blind ileal stump of the end-to-side ileocolic anastomosis had fistulated into the jejunum. Resection of the affected jejunum was performed with end-to-end jejuno-jejunal re-anastomosis and stapling of the ileal stump. Specimen histology was negative for recurrence. Intestinal fistulae represent a diagnostic challenge. This is the first case report describing an enteric fistula mimicking cancer recurrence.

  12. Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

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    Fadzillah Mohd-Tahir

    2013-01-01

    Full Text Available Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

  13. [Clinical observation of the ligation of intersphincteric fistula tract in the treatment of simple anal fistula].

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    Tian, Ying; Zhang, Zhongtao; An, Shaoxiong; Jia, Shan; Liu, Liancheng; Yu, Hongshun

    2015-12-01

    To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of simple anal fistula, including transphincteric anal fistula and insphincteric anal fistula. Clinical data of 52 patients with anal fistula receiving surgery treatment in Beijing Anorectal Hospital from January to October 2014 were analyzed retrospectively. Adoption of surgical procedure was based on rectal endoluminal ultrasound and patients' decision. Patients were divided into LIFT group and seton group. The two groups were compared in terms of operation time, blood loss, postoperative pain score, incidence of urinary retention, wound healing time, cure rate, recurrence, and the anal incontinence score. There were 52 patients in the entire cohort including 28 cases of transphincteric anal fistula (14 cases of LIFT and seton placement groups) and 24 cases of intersphincteric anal fistula (12 case of LIFT and seton placement). The operation time was shorter in seton placement group in patients with two simple anal fistula [(23.9±5.0) min vs. (46.3±7.7) min, Panal incontinence scores [(1.1±0.4) vs. (4.9±1.1)] were better than that of anal fistula seton (all P0.05]. The cure rate of intersphincteric anal fistula was 83.3%(10/12) in LIFT group, and 100%(12/12) in the seton group. The cure rate of transphincteric anal fistula was 78.6% (11/14) in LIFT and 92.9%(13/14) in anal fistula seton group. There was no statistically significant difference (P>0.05). In the treatment of transphincteric fistula tract and intersphincteric fistula tract, LIFT procedures should be considered.

  14. Clinical and Histologic Mimickers of Celiac Disease.

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    Kamboj, Amrit K; Oxentenko, Amy S

    2017-08-17

    Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and malabsorption. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. It is important to recognize and diagnose celiac disease, as strict adherence to a gluten-free diet can lead to resolution of clinical and histologic manifestations of the disease. However, many other entities can present with clinical and/or histologic features of celiac disease. In this review article, we highlight key clinical and histologic mimickers of celiac disease. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Many mimickers of celiac disease have clues to the underlying diagnosis, and many have a targeted therapy. It is necessary to provide patients with a correct diagnosis rather than subject them to a lifetime of an unnecessary gluten-free diet.

  15. Clinical evaluation of genito-urinary fistula

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    Companywala Rashida

    1978-01-01

    Full Text Available Clinical evaluation of 50 cases of genito-urinary fistula from January 1969 to March 1917 is presented. In 84% of the cases the aetiological factor was obstetric injury while in 12% it followed hysterectomy. Sixty per cent of the patients had come within one year of the development of symptoms. Eighty per cent of the cases were operated upon by vaginal route while 14% were operated upon by abdominal route and 6% by pereineo-abdominal route. The operative management is discussed. The success rate was 72%. The literature on this subject is reviewed.

  16. [Clinical analysis of labyrinthine fistula caused by choleseatoma otitis media].

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    Wang, Fangyuan; Wu, Nan; Hou, Zhaohui; Liu, Jun; Shen, Weidong; Han, Weiju; Yang, Shiming

    2015-05-01

    To investigate the clinical features of labyrinthine fistula and obtain the diagnosis, treatment and prognosis of different types of fistula. A retrospective analysis of 42 cases (43 ears) with labyrinthine fistula in our hospital from January 2007 to November 2014 was conducted. Data of preoperative clinical manifestation, auditory function, CT image, operative findings, treatment and postoperative recovery were collected and statistically analysed. Thirty-nine cases (40 ears) of the 42 cases (43 ears) which were diagnosed as labyrinthine fistula according to operative findings occurred in the lateral semicircular canal, 1 case occurred in the posterior semicircular canal, 1 case occurred in the superior semicircular canal, and 1 case occurred both in lateral and posterior semicircular canal. Before operation, 24 ears (55.8% ) experienced vertigo and 14 ears (32.6%) showed impaired bone conduction hearing threshold. According to Dornhoffer classification standard, 22 cases (23 ears) were diagnosed as type I fistula, 9 cases as type II fistula and 11 cases as type III fistula. There was no statistical difference among the 3 groups on type of hearing loss, vertigo, CT, facial nerve canal damage before operation and bone conduction hearing threshold, vertigo after operation. An accurate diagnosis of labyrinthine fistula relies on the operative findings rather than preoperative clinical manifestation, auditory function or CT The surgical intervention should be individualized. There is no significant difference on postoperative recovery among different types of labyrinthine fistula.

  17. CLINICAL STUDY OF FISTULA IN ANO

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    Raj

    2015-10-01

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

  18. Fistula

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

  19. Colovesical fistula secondary to sigmoid diverticulitis mimicking bladder tumor on ultrasonography: A case report

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    Kang, Yun Jung; Yi, Bum Ha; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    2002-12-15

    Colovesical fistula is not an infrequent urologic complication of diverticulitis. However, the frequency of diverticuli at sigmoid colon is low in Korea, and there have been few radiologic reports of colovesical fistula caused by diverticulitis. We report a case of colovesical fistula secondary to sigmoid diverticulitis that mimics bladder tumor on ultrasonography. Additional diagnostic modalities including CT and MRI were performed, and pathologic confirmation was done by surgery.

  20. Unusual MRI findings of dural arteriovenous fistula: Isolated perfusion lesions mimicking TIA

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    Kim Yong-Won

    2012-08-01

    Full Text Available Abstract Background The diagnosis of transient ischemic attack (TIA based on clinical history and objective findings, even including multiparametric MRI, can be misleading. We report two patients who presented with TIA-like deficits with isolated perfusion lesions in corresponding areas but were finally diagnosed as transient neurological symptoms associated with dural arteriovenous fistula (dAVF. Case presentation Two patients presented with transient focal neurological symptoms lasting less than one hour. An isolated perfusion deficit with no diffusion change in the clinically relevant area was shown on brain MRI, indicating transient ischemia as the most plausible cause of neurological symptoms. However, cerebral angiography let to diagnosis of dAVF in both cases. Intracerebral hemorrhage occurred after the initial diagnosis of TIA in one patient, and the small area of perfusion abnormality accompanied by the enlarged cortical vein in the other case helped to identify the dAVF through the further investigation. The pattern of perfusion-weighted imaging in both cases revealed increase of mean transit time and relative cerebral blood volume denoting the venous congestion in a clinically corresponding area. Conclusion Reported cases are uncommon clinical presentation of a dAVF, which can be misdiagnosed as TIA on clinical grounds. In rare cases, the isolated perfusion deficits could be attributable to venous congestion, despite the similar pattern of clinical presentation, such as with TIA.

  1. 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.

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

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    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.

  3. Vaginal Fistula

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    Vaginal fistula Overview By Mayo Clinic Staff A vaginal fistula is an abnormal opening that connects your vagina to ... or urine to pass through your vagina. Vaginal fistulas can develop as a result of an injury, ...

  4. Pulmonary tumour microembolism clinically mimicking alveolitis

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    Lo, A W I; Tse, G M K; Chu, W C W; Chan, A B W

    2003-01-01

    A 56 year old man with previously unsuspected recurrence of squamous cell carcinoma of the oesophagus presented with dyspnoea. Bronchoscopy and computed tomography suggested bronchopneumonic changes with an infectious cause. He suffered a rapidly deteriorating course and died despite active treatment, including antibiotics and mechanical ventilation. Necropsy revealed a florid pulmonary tumour microembolism mimicking alveolitis. No bronchopneumonia was seen. The emboli arose from loosely attached tumour vegetations in the tricuspid valve. In a patient with known malignancy, tumour microembolism should be considered as an uncommon cause of rapid respiratory failure, refractory to antibiotic treatment. PMID:14600135

  5. Multidrug-Resistant Tuberculous Mediastinal Lymphadenitis, with an Esophagomediastinal Fistula, Mimicking an Esophageal Submucosal Tumor.

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    Kim, Dongwuk; Kim, Juwon; Lee, Daegeun; Chang, Ha Sung; Joh, Hyunsung; Koh, Won-Jung; Lee, Jun Haeng

    2016-11-01

    Mediastinal tuberculous lymphadenitis rarely mimics esophageal submucosal tumor, particularly in the case of multidrug-resistant tuberculosis (MDR-TB). Herein, we report the case of a 61-year-old woman who visited a local hospital complaining of odynophagia. An initial esophagogastroduodenoscopy revealed an esophageal submucosal tumor, and subsequent chest computed tomography showed subcarinal lymphadenopathy with an esophagomediastinal fistula. The patient was then referred to Samsung Medical Center, and a second esophagogastroduodenoscopy showed deep central ulceration, as well as a suspicious fistula in the esophageal submucosal tumor-like lesion. A biopsy examination of the ulcerative lesion confirmed focal inflammation only. Next, an endobronchial, ultrasound-guided lymph node biopsy was performed, and TB was confirmed. The patient initially began a course of isoniazid, rifampicin, ethambutol, and pyrazinamide. However, after a drug sensitivity test, she was diagnosed with MDR-TB, and second-line anti-TB medications were prescribed. She recovered well subsequently.

  6. Bilateral Carotid and Vertebral Rete Mirabile Presenting with a Prominent Anterior Spinal Artery Mimicking a Spinal Dural AV Fistula at MRI

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    Lee, Seung Young; Cha, Sang Hoon [Chungbuk National University College of Medicine, Iksan (Korea, Republic of)

    2011-11-15

    Bilateral carotid and vertebral rete mirabile (CVRM) is a very rare condition. We report a new case of CVRM initially detected by magnetic resonance imaging (MRI) of the cervical spine. MRI demonstrated tortuous vascular signal voids limited to the anterior cerebrospinal fluid space mimicking spinal dural arteriovenous fistula. A diagnosis of CVRM was confirmed on the basis of angiographic findings of rete formation associated with bilateral aplasia of the cavernous internal carotid and vertebral arteries without abnormal arteriovenous connection.

  7. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

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    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  8. [Evolution aspect of anatomy clinical lesions of urogenital fistula (UGF) in Cocody Teaching Hospital urological unity from 1990 to 2011].

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    Konan, P G; Dekou, A H; Gowé, E E; Vodi, C C; Fofana, A; Kramo, N; Diomandé, F A; Nigue, L; Ouegnin, G A; Manzan, K

    2015-06-01

    The aim of this study is to compare anatomy pathological lesions seeing in urogenital fistula in Cocody Teaching Hospital between two decades, 1990 to 2000 and 2000 to 2010. This survey is retrospective and carries on 20 years (January 1990 to December 2011) 190 urogenital fistulas (140 cases between 1990 and 1999; 50 from 2000 to 2011) hospitalized in our unity. Anatomy clinical characteristics of these fistulas were determined by clinical or paraclinical examination. Between 1990 and 1999, fistulas were classified in 20 bladder-uterine fistulas (14.29%), 16 uretro-vaginal fistulas (11.43%) and 104 bladder-vaginal fistulas (74.29%) of whom 80 isolated UGFs and 24 UGFs associated with recto-vaginal fistula. These 104 UGFs were located at: bladder neck 22 cases (21.15%), bladder trigonal 46 cases (44.23%), urethra 14 cases (13.46%). Twenty-two bladder sphincter were destroyed and represented 21.15% of fistula's bladder-vaginal fistula and 15.71% of all UGFs. The average fistula diameter was 3 cm [extremes: 1 and 12 cm]. In 22 cases (15.71%), fistula diameter was more than 10 cm. It was bladder neck and sphincter destruction. Hundred and twenty-six fistulas were isolated (90%). Only 10% (14 cases) were associated. Fistulas were primitive in 85.71% of cases (120/140), recurrent in 7 cases (7.86%) and multi-recurrent (>3 reinterventions) in 9 cases (6.43%). From 2001 to 2011, no bladder-uterine fistulas were seen, but: 6 (13.95%) isolated uretero-vaginal fistulas and 6 (13.95%) uretero-vaginal fistulas associated with bladder-vaginal fistula, 31 (62%) bladder-vaginal fistulas of whom 20 (64.52%) bladder trigonal fistulas, 6 (19.34%) retro-trigonal fistulas and 2 (6.45%) urethral fistulas. Only three (9,68%) recto-vaginal fistulas were associated. The average fistula diameter was 2 cm. The fistulas were isolated in 40 cases (80%) and associated (VVF+uretero vaginal F) in 10 cases (20%). Thirty-five cases (70%) were primitive and 10 cases (20%) recurrent of whom 5 (10

  9. Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

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    Schmidt, C. Max; Choi, Jennifer; Powell, Emilie S.; Yiannoutsos, Constantin T.; Zyromski, Nicholas J.; Nakeeb, Attila; Pitt, Henry A.; Wiebke, Eric A.; Madura, James A.; Lillemoe, Keith D.

    2009-01-01

    Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF) and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD). We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%). Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98%) closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality. PMID:19461951

  10. Pancreatic Fistula Following Pancreaticoduodenectomy: Clinical Predictors and Patient Outcomes

    Directory of Open Access Journals (Sweden)

    C. Max Schmidt

    2009-01-01

    Full Text Available Pancreatic fistula continues to be a common complication following PD. This study seeks to identify clinical factors which may predict pancreatic fistula (PF and evaluate the effect of PF on outcomes following pancreaticoduodenectomy (PD. We performed a retrospective analysis of a clinical database at an academic tertiary care hospital with a high volume of pancreatic surgery. Five hundred ten consecutive patients underwent PD, and PF occurred in 46 patients (9%. Perioperative mortality of patients with PF was 0%. Forty-five of 46 PF (98% closed without reoperation with a mean time to closure of 34 days. Patients who developed PF showed a higher incidence of wound infection, intra-abdominal abscess, need for reoperation, and hospital length of stay. Multivariate analysis demonstrated an invaginated pancreatic anastomosis and closed suction intraperitoneal drainage were associated with PF whereas a diagnosis of chronic pancreatitis and endoscopic stenting conferred protection. Development of PF following PD in this series was predicted by gender, preoperative stenting, pancreatic anastomotic technique, and pancreas pathology. Outcomes in patients with PF are remarkable for a higher rate of septic complications, longer hospital stays, but in this study, no increased mortality.

  11. Hydrothorax with alveolar-pleural fistula mimicking re-expansion pulmonary edema during liver transplantation: a case report

    Science.gov (United States)

    2015-01-01

    We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation, which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotracheal tube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosed with an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmatic incision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusion towards the ipsilateral lung during the remaining operation period. Surgeon repaired the defect on the exposed lung surface via diaphragmatic opening. Anesthesiologists should consider an alveolar-pleural fistula as a possible differential diagnosis with re-expansion pulmonary edema when transudate emanating from the endotracheal tube is obtained in patients with massive hydrothorax. PMID:25844139

  12. [Clinical characteristics and risk factors for recurrence of anal fistula patients].

    Science.gov (United States)

    Li, Jiaqin; Yang, Wei; Huang, Zhijian; Mei, Zubing; Yang, Dacheng; Wu, Haiyan; Wang, Qingming

    2016-12-25

    To investigate the epidemiology, internal opening location, and risk factors associated with recurrence of anal fistula. Clinical data of 1783 hospitalized patients admitted for anal fistula treatment to Shanghai Shuguang Hospital from January 2013 to September 2015 were retrospectively analyzed. Fistula passing through anorectal ring or locating above was defined as high anal fistula (n=125). Internal opening location was defined as follows: posterior (5 to 7 o'clock), front(11 to 1 o'clock), left (2 to 4 o'clock) and right (8 to 10 o'clock). Among 1783 cases, 1526 were male with a median age of 36 years, 257 were female with a median age of 35 years, and the ratio of male to female was 5.9 vs 1.0. In high anal fistula cases, this ratio of male to female was 7.3 vs 1.0. Posterior internal opening accounted for 51.4%(884/1720), while this percentage was 66.4%(83/125) in high anal fistula cases, which was significantly higher than 50.2%(801/1595) in low anal fistula cases(P=0.002). Postoperative recurrence rate was 2.6%(45/1720) and the rates in high anal fistula and low anal fistula were 13.6%(17/125) and 1.8%(28/1595) respectively, with significant difference(P=0.000). Multivariate logistic regression analysis showed that fistula height(OR=5.475, 95%CI:2.230 to 13.445, P=0.000), treatment history(OR=2.671, 95% CI:1.315 to 5.424, P=0.007), seton placement history (OR=4.707, 95%CI:1.675 to 13.232, P=0.003) and concomitant colitis(OR=10.300, 95%CI:1.187 to 89.412, P=0.034) were independent risk factors for anal fistula recurrence. Seton placement history was an independent risk factor for high anal fistula recurrence (OR=6.476, 95%CI:1.116 to 37.589, P=0.037). Anal fistula occurs in young and middle-aged male patient. Internal opening locates in posterior more commonly, especially in high anal fistula patients. Postoperative recurrence rate of high anal fistula is quite high. Patient with both high anal fistula and seton placement history has significantly high rate

  13. Dural arteriovenous fistula at the foramen magnum: Report of a case and clinical-anatomical review.

    Science.gov (United States)

    Llácer, José L; Suay, Guillermo; Piquer, José; Vazquez, Victor

    2016-01-01

    Arterial supply and venous drainage at the foramen magnum is variable. Two main forms of clinical presentation, intracranial and spinal, can be differentiated when a dural arteriovenous fistula (DAVF) is found at this level. We describe a case of a 68-year-old patient with a progressive paraparesis, diagnosed of dural arteriovenous fistula located at the posterior lip of foramen magnum. We review, in this setting, the vascular radiological anatomy of those fistulas and its important correlation with neurologic clinical symptoms. Copyright © 2016 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

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

    Institute of Scientific and Technical Information of China (English)

    黎介寿; 任建安; 朱维铭; 尹路; 韩建明

    2003-01-01

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

  15. [Malignant duodenal fistulae of colonic origin (clinical case)].

    Science.gov (United States)

    Spay, G; Champetier, J; Manganas, D

    1996-01-01

    Duodenocolonic fistulas created by invasive cancer of the colon are rarely reported in the literature and their frequency is probably underestimated. We report 4 cases together with the problems encountered and therapeutic approaches used.

  16. [Coronary artery fistulas, a current problem: Clinical and therapeutic considerations].

    Science.gov (United States)

    Tiritilli, A; Iaria, P; Viard, P; Sayah, S; Benali, T; Detienne, J-P; Martis, S; Tchatchum, F; Aouate, P

    2016-02-01

    The coronary fistula is a link between one or more of the coronary arteries and cardiac cavity or great vessel. The exact occurrence is unknown. The majority of these fistulas are congenital in origin. However, they may occasionally be detected after cardiac surgery. For a long time, fistulas are asymptomatic, especially if they are small; the frequency of the symptoms and especially the complications rise with age. The potential complications are: cardiac failure, endocarditis, endarteritis, atrial fibrillation, ventricular arrhythmias, rupture, and thrombosis. The main differential diagnosis is patent arterial duct, while other congenital arteriovenous shunts need to be excluded. Even though echocardiography Doppler can help to differentiate shunts, the coronary angiography remains the main diagnostic tool for the description of the anatomy. For a long time, the surgery was the only therapeutic means, up till now, percutaneous occlusion is the first line therapy of coronary fistulas and that the different devices can be tailored to meet different anatomic and functional characteristics.

  17. Clinical evaluation of an expert system for arteriovenous fistula assessment.

    Science.gov (United States)

    Chanliau, Jacques; Charasse, Christophe; Rose, Cédric; Béné, Bernard

    2014-11-01

    The monitoring of ionic dialysance in hemodialysis allows early detection of arterio-venous fistula stenosis. One limitation to the practical use of ionic dialysance is that the analysis is very time consuming on a majority of normal cases.The purpose of the study is to evaluate the utility of an expert system reproducing a human analysis and allowing continuous monitoring of the ionic dialysance by helping the physician to focus his or her expertise on the abnormal cases.The method is based on a Bayesian model that analyzes the blood flow rate, the ionic dialysance, and the venous and arterial pressures measured on the extra corporeal circuit.The clinical evaluation was performed on 90 dialysis patients at the hospital dialysis center of Saint Brieux in France with a history of at least four consecutive months of validated recording. The retrospective automated analysis was evaluated in comparison to vascular access problems identified from invasive investigation or treatment. The sensitivity of the automated analysis is 92% with a specificity of 75%.As a conclusion we suggest that this expert system could be used in a continuous vascular access monitoring procedure consisting in a weekly review of the patient population at the dialysis center. The patients with the highest risk score need a further investigation of their historical data and their medical history in order to decide whether or not to perform an invasive intervention.

  18. Comparison of Endoanal Ultrasound with Clinical Diagnosis in Anal Fistula Assessment.

    Science.gov (United States)

    Sirikurnpiboon, Siripong; Phadhana-anake, Oradee; Awapittaya, Burin

    2016-02-01

    Anal fistula anatomy and its relationship with anal sphincters are important factors influencing the results of surgical management. Pre-operative definitions of fistulous track(s) and the internal opening play a primary role in minimizing damage to the sphincters and recurrence of the fistula. To evaluate the relative accuracy of digital examination and endoanal ultrasound for pre-operative assessment of anal fistula by comparing operative findings. A retrospective review was conducted of all patients with anal fistula admitted to the surgical unit between May 2008 and May 2012. Physical examination and hydrogen peroxide-enhanced endoanal ultrasound (utilising a 10 MHz endoprobe, HITACHI: EUB-7500), were performed in 142 consecutive patients. Results were matched with surgical features to establish their accuracy in preoperative anal fistula assessment. A total of 142 patients (107 men, 35 women), 28 of whom had had previous surgery, were included in the study. Their mean age was 40 (range 18-71) years and their mean BMI was 26.37 (range 17.30-36.11) kg/m². The majority of the fistulas were transphincteric (90.4%) and the rest were intersphincteric (9.6%). The accuracy rates of clinical examination and endoanal ultrasound were 55.63 and 95.07 percent (p anal fistula

  19. Dural arteriovenous fistulas of the cavernous sinus - clinical case and treatment

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2014-06-01

    Full Text Available The purpose of our article is to present the results of our treatment of dural arteriovenous fistula of the cavernous sinus by glue embolization of the external carotid artery feeders. By this case presentation we try to clarify the clinical course, with the dural carotid cavernous fistula (CCF, characterizing a pallet of symptoms, paying special attention to radiological finding and endovascular treatment.

  20. Post-mastectomy chylous fistula: anatomical and clinical implications.

    Science.gov (United States)

    Purkayastha, Joydeep; Hazarika, Sidhartha; Deo, S V S; Kar, Madhabananda; Shukla, N K

    2004-07-01

    A chylous fistula after a modified radical mastectomy is a rare occurrence; however, major anatomical variations in the termination of the thoracic duct may occur, rendering it susceptible to injury. High output chylous fistulae are difficult to manage and have local, metabolic, and immunologic complications with a mortality rate varying from 12.5-50%. Herein such a case of postmastectomy chylous fistula and its management are discussed. A 56-year-old postmenopausal woman with invasive duct carcinoma of the left breast underwent modified radical mastectomy with complete axillary clearance (Level I, II, III nodes). The operative procedure was uneventful. On the commencement of a normal diet, however, the patient started exuding milky fluid from the axillary drain and analysis of the fluid revealed biochemical features compatible with chyle. After 2 weeks of failed conservative management, the axilla was re-explored. A continuous flow of clear fluid was observed originating from a single major lymphatic trunk inferior to the axillary vein in the region of the former Level II nodes. The leak was controlled by the application of multiple mass ligatures using 2-0 silk suture. A part of the pectoralis major muscle was rotated and sutured over the area of the leak as additional reinforcement. Suturing a muscle flap over the leak has been described previously and functions theoretically by causing fibrosis. The chylous fistula in the present case was managed successfully with mass ligatures and muscle flap reinforcement.

  1. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V

    2012-01-01

    for systematic bias. In the clinical study, two interventional radiologists conducted a total of 250 measurements in 14 patients with arteriovenous fistulas to determine clinical precision and enable testing for bias between measurers.Results: Accuracy was excellent for both catheters with a high level...

  2. Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy.

    Science.gov (United States)

    Cecatto, Suzana Boltes; Monteiro-Soares, Matilde; Henriques, Teresa; Monteiro, Eurico; Moura, Carla Isabel Ferreira Pinto

    2015-01-01

    Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  3. Randomized clinical trial comparing collagen plug and advancement flap for trans-sphincteric anal fistula.

    Science.gov (United States)

    Bondi, J; Avdagic, J; Karlbom, U; Hallböök, O; Kalman, D; Šaltytė Benth, J; Naimy, N; Øresland, T

    2017-08-01

    The role of a collagen plug for treating anal fistula is not well established. A randomized prospective multicentre non-inferiority study of surgical treatment of trans-sphincteric cryptogenic fistulas was undertaken, comparing the anal fistula plug with the mucosal advancement flap with regard to fistula recurrence rate and functional outcome. Patients with an anal fistula were evaluated for eligibility in three centres, and randomized to either mucosal advancement flap surgery or collagen plug, with clinical follow-up at 3 and 12 months. The primary outcome was the fistula recurrence rate. Anal pain (visual analogue scale), anal incontinence (St Mark's score) and quality of life (Short Form 36 questionnaire) were also reported. Ninety-four patients were included; 48 were allocated to the plug procedure and 46 to advancement flap surgery. The median follow-up was 12 (range 9-24) months. The recurrence rate at 12 months was 66 per cent (27 of 41 patients) in the plug group and 38 per cent (15 of 40) in the flap group (P = 0·006). Anal pain was reduced after operation in both groups. Anal incontinence did not change in the follow-up period. Patients reported an increased quality of life after 3 months. There were no differences between the groups with regard to pain, incontinence or quality of life. There was a considerably higher recurrence rate after the anal fistula plug procedure than following advancement flap repair. Registration number: NCT01021774 (http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  4. Arteriovenous Fistula

    Science.gov (United States)

    ... home. Accessed Feb. 23, 2015. Vascular access for hemodialysis. National Kidney and Urologic Diseases Information Clearinghouse. http:// ... www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/basics/definition/CON-20034876 . Mayo Clinic Footer Legal Conditions and ...

  5. ARTERIO-VENOUS FISTULA IN THE TEMPORAL REGIONS – A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    Irina Dobrin

    2011-12-01

    Full Text Available The arterio-venous fistulae in the temporal regions, to be first described by Bartholin around 1730, were considered as tardy post-traumatic lesions correlated with the impact of tough objects in the above-mentioned area. The superficial temporal arterio-venous axis is usually interested at the level of the pterional region, while establishment of some communication between the artery and the vein generates an arterio-venous fistula with a systolodiastolic murmur and the tendency for progressive growth. The study discusses a clinical case and its surgical solution.

  6. [Arterial steal via an arteriovenous fistula for hemodialysis. A clinical case and review of the literature].

    Science.gov (United States)

    Juliá Montoya, J; Lozano Vilardell, P; Corominas Roura, C; Blanes Mompó, I; Flores López, D; Manuel-Rimbau Muñoz, E; García de la Torre, A

    1993-01-01

    We related a case of arterial atrappment in the left upper limb by an arteriovenous humerus-cephalic hyperfunctioning fistula. Surgical procedure consisted on the insertion of a PTFE's banding around the arterialized vein obtaining satisfactory clinic and functional results. We review in the literature, the frequency the pathogeny and the therapeutics possibilities.

  7. [A multicenter randomized controlled clinical trial of Ligation of the Intersphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug in the treatment of chronic anal fistula].

    Science.gov (United States)

    Zheng, Yi; Wang, Zhenjun; Yang, Xinqing; Cui, Jinjie; Chen, Chaowen; Zhang, Xuebin; Wang, Xiaoqiang; Zhang, Xiling; Che, Xiangming; Chen, Jincai; Cui, Feibo; Song, Weiliang; Chen, Yuzhuo

    2015-11-10

    To evaluate the effectiveness and safety of Ligation of the Intersphincteric Fistula Tract Plus Bioprosthetic Anal Fistula Plug (LIFT-plug) in the treatment of chronic anal fistula. A total of 239 patients (199 males, 40 females) with chronic anal fistula were recruited from 5 hospitals between March 2011 and April 2013. These patients were randomly assigned to the experimental group (n=119) treated with LIFT-plug or the control group (n=120) treated with LIFT. The follow-up period was 180 days. The collected data included healing rate, the median healing time, the recurrence rate, the Visual Analogue Scale (VAS), the incontinence rate, and the safety indicators associated with the anal fistula plug. The healing rate of the experimental group was better than the control group (96.5% vs 83.7%, Panal fistula plug in the experimental group. LIFT-plug is simple, less invasive, and with shorter healing time and more satisfactory healing rate in treating chronic anal fistula compared with LIFT.

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-11-15

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

  10. Clinical evaluation of a two-incision fistula technique for the treatment of oral ranulas.

    Science.gov (United States)

    Wang, Shaoyi; Zhang, Zhiyuan; Yang, Chi

    2016-01-01

    Oral ranulas are caused by extravasation of mucus from the sublingual glands, and the preferred treatment varies. We have developed a two-incision fistula operation for their treatment, and in this clinical study we have evaluated the efficacy and safety of this approach. Twelve patients with oral ranulas confirmed by fine needle aspiration cytology were enrolled and gave their consent to be treated by our new technique. The clinical outcomes and complications were evaluated during a period that ranged from 8-24 months. Nine ranulas became smaller and gradually disappeared, and there were no complications or injury to Wharton's duct. Three ranulas recurred, but disappeared after a second operation. The two-incision fistula operation can be effective and safe as an initial treatment for oral ranulas, and the method may become the preferred management for retention cysts.

  11. Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea

    Science.gov (United States)

    Delamou, Alexandre; Diallo, Moustapha; Beavogui, Abdoul Habib; Delvaux, Thérèse; Millimono, Sita; Kourouma, Mamady; Beattie, Karen; Barone, Mark; Barry, Thierno Hamidou; Khogali, Mohamed; Edginton, Mary; Hinderaker, Sven Gudmund; Ruminjo, Joseph; Zhang, Wei-Hong; De Brouwere, Vincent

    2015-01-01

    Objectives Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. Results The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Conclusion Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula. Objectifs La fistule génitale féminine reste un problème de santé publique dans les pays en développement. De janvier 2007 à septembre 2013, le projet Fistula Care, géré par Engender Health en partenariat avec le Ministère de la Santé et soutenu par l’USAID, a intégré les services de réparation de fistules dans les maternités des hôpitaux généraux en Guin

  12. Cervical Paraganglioma Mimicking Thyroid Nodule: A Rare Clinical Case

    Directory of Open Access Journals (Sweden)

    Berna İmge Aydoğan

    2016-01-01

    Full Text Available Objective. Paraganglioma is a rare neuroendocrine tumor. When it is located in the neck, it is commonly misdiagnosed as other thyroid neoplasms. Case Report. We report a case of cervical paraganglioma in a 55-year-old female. Patient was admitted to our clinic with goiter and neck pain. Thyroid ultrasonography revealed a 20 mm solitary, heterogeneous nodule located in the upper pole of left thyroid lobe. Fine needle aspiration cytology was nondiagnostic. She underwent left lobectomy and histopathology showed paraganglioma. Discussion. Cervical paragangliomas should be considered in the differential diagnosis of thyroid nodules.

  13. Lupus mimickers.

    Science.gov (United States)

    Calixto, Omar-Javier; Franco, Juan-Sebastian; Anaya, Juan-Manuel

    2014-08-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.

  14. Boric acid ingestion clinically mimicking toxic epidermal necrolysis.

    Science.gov (United States)

    Webb, David V; Stowman, Anne M; Patterson, James W

    2013-11-01

    The ingestion of large amounts of boric acid, a component of household insecticides, is a rare occurrence, characterized by a diffuse desquamative skin eruption, neutropenia, thrombocytopenia, delirium, acute renal failure and prolonged ileus. A 56-year-old male with a history of multiple previous suicide attempts was witnessed ingesting household roach killer and 4 days later presented to the hospital with lethargy, stiffness and a diffuse erythematous and desquamative eruption with bullous formation. He subsequently developed erythema of both palms as well as alopecia totalis. Histopathology from a right arm shave biopsy revealed a mostly intact epidermis with subtle vacuolar alteration of the basal layer, scattered intraepidermal apoptotic keratinocytes, parakeratosis with alternating layers of orthokeratosis and considerable superficial exfoliation; accompanying dermal changes included vasodilatation and mild perivascular inflammation. This report describes the cutaneous and systemic complications in a rare case of boric acid ingestion. There is little published material on the symptoms and histopathology following boric acid ingestion, but knowledge of this entity is important, both to differentiate it from other causes of desquamative skin rashes and to allow the initiation of appropriate clinical care. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Gastrointestinal fistula

    Science.gov (United States)

    Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... Most gastrointestinal fistulas occur after surgery. Other causes include: Blockage in the intestine Infection Crohn disease Radiation to the abdomen (most ...

  16. MRI in perianal fistulae

    Directory of Open Access Journals (Sweden)

    Khera Pushpinder

    2010-01-01

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

  17. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter

    2015-01-01

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

  18. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  19. Treatment of non-IBD anal fistula

    National Research Council Canada - National Science Library

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter; Buntzen, Steen; Thorlacius-Ussing, Ole; Andersen, Jens; Krupa, Marek; Qvist, Niels

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening...

  20. High cervical spinal subdural hemorrhage as a harbinger of craniocervical arteriovenous fistula: an unusual clinical presentation.

    Science.gov (United States)

    Kasliwal, Manish K; Moftakhar, Roham; O'Toole, John E; Lopes, Demetrius K

    2015-05-01

    Craniocervical dural arteriovenous fistula (dAVF) is rare as compared with the typical thoracolumbar dAVFs of the spine and usually presents with hemorrhagic manifestation, predominantly intracranial subarachnoid hemorrhage. We describe the first case of craniocervical dAVF with initial presentation as neck pain and spinal subdural hemorrhage. Case report. We present the case of a 59-year-old woman who presented with sudden onset of neck pain at an outside institution emergency department (ED) and was discharged after negative cervical spine radiographs. Magnetic resonance imaging of the cervical spine performed because of persistent pain demonstrated presence of high cervical spinal subdural hematoma and she was managed conservatively. She subsequently presented to our ED a week later with headache and was found to have an intraventricular hemorrhage on computed tomography scan of the head, which on subsequent workup with an angiography revealed the presence of a craniocervical dAVF. Surgical obliteration of the fistula was performed with use of intraoperative angiography as an adjunct to confirm complete fistula obliteration. She had an excellent clinical outcome with no deficits at her last follow-up at 9 months. Even though hemorrhagic presentation is fairly common in craniocervical dAVFs, there is no report of a craniocervical dAVF presenting with spinal subdural hemorrhage. The present case further highlights the propensity of these vascular lesions to bleed and emphasizes the clinical importance of including these lesions in the differential diagnosis of hemorrhage in the vicinity of foramen magnum region, whether subarachnoid or subdural in location. Physicians treating spinal pathologies should be aware of this entity and clinical presentation, as an angiography needs to be considered in these cases to direct appropriate referral and treatment. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Fistulotomy and sphincter reconstruction in the treatment of complex fistula-in-ano: long-term clinical and manometric results.

    Science.gov (United States)

    Arroyo, Antonio; Pérez-Legaz, Juan; Moya, Pedro; Armañanzas, Laura; Lacueva, Javier; Pérez-Vicente, Francisco; Candela, Fernando; Calpena, Rafael

    2012-05-01

    To evaluate the long-term clinical and manometric results of fistulotomy and sphincter reconstruction for the treatment of complex fistula-in-ano. Complex fistula-in-ano is difficult to treat due to the occurrence of postoperative anal incontinence and the high rate of recurrence. Seventy patients who were diagnosed with complex fistula-in-ano and underwent fistulotomy and sphincter reconstruction between October 2000 and October 2006 were analyzed in the present study. Preoperative assessment included physical examination, anorectal manometry, and anal endosonography. Appointments were scheduled every 6 months during the first and second year of treatment and every 2 years thereafter. Recurrence and incontinence were evaluated during each visit. Continence was assessed according to the Wexner continence grading scale. Anal manometry was performed 3 and 12 months after treatment and every 2 years thereafter. Anal endosonography was conducted 6 months after treatment. Fistulas were classified as medium-high trans-sphincteric in 64 patients (91.42%) and were recurrent in 22 patients (32%). Before surgery, 22 patients (32%) reported fecal incontinence, which improved after surgery in 15 cases (70%), from 6.75 to 1.88 (P Fistulotomy with sphincter reconstruction is an effective technique for the treatment of complex fistula-in-ano. Continence and anal manometry results were improved in incontinent patients and were not jeopardized in continent ones. Fistulotomy with sphincter reconstruction is an especially suitable technique for incontinent patients with recurrent fistulas.

  2. Evaluation of Diagnostic Values of Clinical Assessment in Determining the Maturation of Arteriovenous Fistulas for Satisfactory Hemodialysis.

    Science.gov (United States)

    Salimi, Fereshteh; Shahabi, Shahab; Talebzadeh, Hamid; Keshavarzian, Amir; Pourfakharan, Mohammad; Safaei, Mansour

    2017-01-01

    Fistulas are the preferred permanent hemodialysis vascular access, but a significant obstacle to increasing their prevalence is the fistula's high "failure to mature" (FTM) rate. This study aimed to identify postoperative clinical characteristics that are predictive of fistula FTM. This descriptive cross-sectional study was performed on 80 end-stage renal disease patients who referred to Al Zahra Hospital, Isfahan, for brachiocephalic fistula placement. After 4 weeks, the clinical criteria (trill, firmness, vein length, and venous engorgement) examined and the fistulas situation divided to favorable or unfavorable by each criterion, and the results comprised with dialysis possibility. Data were analyzed with SPSS version 21. Diagnostic index for CLINICAL examination was calculated. Among the 80 cases, 25 (31.2%) female and 55 (68.8%) male were studied with the mean age of 51.9 (standard deviation = 17) year ranged between 18 and 86 years old. Sixty-two (77.5%) cases had successful hemodialysis. All four clinical assessments were significantly more acceptable in patients with successful dialysis (P < 0.001). According to the results of our study, the accuracy of all physical assessments was above 70% and except vein length other criteria had a sensitivity and negative predictive value of 100%. In this study, firmness of vein has highest specificity and positive predictive value (83.9% and 64.3%, respectively). Results of our study showed that high sensitivity and relatively low specificity of the clinical criterion. It means that unfavorable results of each clinical criterion predict unfavorable dialysis. Clinical evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory.

  3. Clinical characteristics of patients with labyrinthine fistulae caused by middle ear cholesteatoma

    Institute of Scientific and Technical Information of China (English)

    YANG Juan-mei; CHI Fang-lu; HAN Zhao; HUANG Yi-bo; LI Yi-ke

    2013-01-01

    Background Labyrinthine fistula (LF) is a very common clinical complication mainly caused by middle ear cholesteatoma.Whether the presence of different degree LF caused by middle ear cholesteatoma aggravates neurosensory hearing loss (NSHL) and what is the degree of the hearing loss caused by LF were still under controversial.This study aimed to investigate whether the LF degree is correlative with the age distribution,disease duration and hearing loss degree for cholesteatomatous patients.Methods The files of 143 patients with middle ear cholesteatoma were selected and reviewed in a retrospective study.Seventy-eight patients with LF were divided into three types according to the degree of destruction of labyrinth.Sixty-five patients without LF were randomly chosen for control.Then,we compared the clinical characteristics of patients with or without labyrinthine fistulae caused by middle ear cholesteatoma.Results According to the study,cholesteatomatous patients with LF were older and suffered longer disease duration than those without LF.Hearing loss is severe with high frequencies both in patients with and without LF.Moreover,inner ear impairment is correlative with the degree of destruction in labyrinth,and more severe destruction in labyrinth follow the more severe symptoms correlative with inner ear impairment.Conclusion Surgical intervention should be performed as eady as possible for these cholesteatomatous patients.

  4. Management of colovesical fistula.

    Science.gov (United States)

    Rao, P N; Knox, R; Barnard, R J; Schofield, P F

    1987-05-01

    The clinical presentation and management of 24 patients treated for colovesical fistula were reviewed. It is concluded that an aggressive investigative approach in the management of patients with suspected colovesical fistula is rewarding. Cystoscopy and barium enema appear to be the most useful investigative tools. Once found the fistulae should be managed surgically. Radical excision of the sigmoid colon with primary anastomosis is the treatment of choice and is accompanied by no mortality and a very low complication rate.

  5. Vesicovaginal Fistula

    African Journals Online (AJOL)

    user1

    labour is consistently the most common cause (65.9%–96.5%) in all the series. .... causes; vesicovaginal fistula prevention; and vesicovaginal fistula ..... promotion of institutional deliveries. .... Risk factors for obstetric fistula in north-eastern ...

  6. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

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

    2015-01-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...... be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor...

  7. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter

    2015-01-01

    be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor......The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should...

  8. Effect of Fish Oil Supplementation and Aspirin Use on Arteriovenous Fistula Failure in Patients Requiring Hemodialysis: A Randomized Clinical Trial.

    Science.gov (United States)

    Irish, Ashley B; Viecelli, Andrea K; Hawley, Carmel M; Hooi, Lai-Seong; Pascoe, Elaine M; Paul-Brent, Peta-Anne; Badve, Sunil V; Mori, Trevor A; Cass, Alan; Kerr, Peter G; Voss, David; Ong, Loke-Meng; Polkinghorne, Kevan R

    2017-02-01

    Vascular access dysfunction is a leading cause of morbidity and mortality in patients requiring hemodialysis. Arteriovenous fistulae are preferred over synthetic grafts and central venous catheters due to superior long-term outcomes and lower health care costs, but increasing their use is limited by early thrombosis and maturation failure. ω-3 Polyunsaturated fatty acids (fish oils) have pleiotropic effects on vascular biology and inflammation and aspirin impairs platelet aggregation, which may reduce access failure. To determine whether fish oil supplementation (primary objective) or aspirin use (secondary objective) is effective in reducing arteriovenous fistula failure. The Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) study was a randomized, double-blind, controlled clinical trial that recruited participants with stage 4 or 5 chronic kidney disease from 2008 to 2014 at 35 dialysis centers in Australia, Malaysia, New Zealand, and the United Kingdom. Participants were observed for 12 months after arteriovenous fistula creation. Participants were randomly allocated to receive fish oil (4 g/d) or matching placebo. A subset (n = 406) was also randomized to receive aspirin (100 mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks. The primary outcome was fistula failure, a composite of fistula thrombosis and/or abandonment and/or cannulation failure, at 12 months. Secondary outcomes included the individual components of the primary outcome. Of 1415 eligible participants, 567 were randomized (359 [63%] male, 298 [53%] white, 264 [47%] with diabetes; mean [SD] age, 54.8 [14.3] y). The same proportion of fistula failures occurred in the fish oil and placebo arms (128 of 270 [47%] vs 125 of 266 [47%]; relative risk [RR] adjusted for aspirin use, 1.03; 95% CI, 0.86-1.23; P = .78). Fish oil did not reduce fistula thrombosis (60 [22%] vs 61 [23%]; RR, 0.98; 95% CI, 0

  9. Evaluation of Incidence and Clinical Features of Antibody-Associated Autoimmune Encephalitis Mimicking Dementia

    Directory of Open Access Journals (Sweden)

    Arzu Çoban

    2014-01-01

    Full Text Available Background. Anti-neuronal autoimmunity may cause cognitive impairment that meets the criteria for dementia. Objective. Our aim was to detect the incidence and clinical features of autoimmune encephalitis imitating clinical findings of primary dementia disorders and to delineate the validity of anti-neuronal antibody screening in dementia patients. Methods. Fifty consecutive patients fulfilling the clinical criteria for primary dementia, 130 control patients, and 50 healthy controls were included. Their sera were investigated for several ion channel and glutamic acid decarboxylase (GAD antibodies by a cell-based assay, radioimmunoassay, and ELISA, as required. Results. Sixteen patients satisfying dementia criteria had atypical findings or findings suggestive of autoimmune encephalitis. N-methyl-D-aspartate receptor (NMDAR antibody was detected in a patient with dementia, Parkinsonism, and REM sleep behavior disorder (RBD fulfilling the criteria for dementia with Lewy bodies (DLB. One control patient with bipolar disease displayed low anti-GAD antibody levels. Conclusions. Our study showed for the first time the presence of parkinsonism and RBD in an anti-NMDAR encephalitis patient mimicking DLB. Although autoimmune encephalitis patients may occasionally present with cognitive decline, most dementia patients do not exhibit anti-neuronal antibodies, suggesting that routine analysis of these antibodies in dementia is not mandatory, even though they display atypical features.

  10. A multidisciplinary clinical treatment of locally advanced rectal cancer complicated with rectovesical fistula: a case report

    Directory of Open Access Journals (Sweden)

    Zhan Tiancheng

    2012-10-01

    Full Text Available Abstract Introduction Rectal cancer with rectovesical fistula is a rare and difficult to treat entity. Here, we describe a case of rectal cancer with rectovesical fistula successfully managed by multimodality treatment. To the best of our knowledge, this is the first such case report in the literature. Case presentation A 51-year-old Chinese man was diagnosed as having rectal cancer accompanied by rectovesical fistula. He underwent treatment with neoadjuvant radiochemotherapy combined with total pelvic excision and adjuvant chemotherapy, as recommended by a multimodality treatment team. Post-operative pathology confirmed the achievement of pathological complete response. Conclusions This case suggests that a proactive multidisciplinary treatment is needed to achieve complete cure of locally advanced rectal cancer even in the presence of rectovesical fistula.

  11. Aortoenteric Fistula

    Directory of Open Access Journals (Sweden)

    Shou-Jiang Tang

    2014-04-01

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

  12. Pediatric intracranial dural arteriovenous fistulas: age-related differences in clinical features, angioarchitecture, and treatment outcomes.

    Science.gov (United States)

    Hetts, Steven W; Moftakhar, Parham; Maluste, Neil; Fullerton, Heather J; Cooke, Daniel L; Amans, Matthew R; Dowd, Christopher F; Higashida, Randall T; Halbach, Van V

    2016-11-01

    OBJECTIVE Intracranial dural arteriovenous fistulas (DAVFs) are rare in children. This study sought to better characterize DAVF presentation, angioarchitecture, and treatment outcomes. METHODS Children with intracranial DAVFs between 1986 and 2013 were retrospectively identified from the neurointerventional database at the authors' institution. Demographics, clinical presentation, lesion angioarchitecture, treatment approaches, angiographic outcomes, and clinical outcomes were assessed. RESULTS DAVFs constituted 5.7% (22/423) of pediatric intracranial arteriovenous shunting lesions. Twelve boys and 10 girls presented between 1 day and 18 years of age; boys presented at a median of 1.3 years and girls presented at a median of 4.9 years. Four of 8 patients ≤ 1 year of age presented with congestive heart failure compared with 0/14 patients > 1 year of age (p = 0.01). Five of 8 patients ≤ 1 year old presented with respiratory distress compared with 0/14 patients > 1 year old (p = 0.0021). Ten of 14 patients > 1 year old presented with focal neurological deficits compared with 0/8 patients ≤ 1 year old (p = 0.0017). At initial angiography, 16 patients harbored a single intracranial DAVF and 6 patients had 2-6 DAVFs. Eight patients (38%) experienced DAVF obliteration by the end of treatment. Good clinical outcome (modified Rankin Scale score 0-2) was documented in 77% of patients > 1 year old at presentation compared with 57% of patients ≤ 1 year old at presentation. Six patients (27%) died. CONCLUSIONS Young children with DAVFs presented predominantly with cardiopulmonary symptoms, while older children presented with focal neurological deficits. Compared with other pediatric vascular shunts, DAVFs had lower rates of angiographic obliteration and poorer clinical outcomes.

  13. Colovesicular Fistula

    OpenAIRE

    2012-01-01

    A fistula is an atypical connection between two epithelial surfaces, in the case of an enterovesical fistula between the urinary and gastrointestinal systems. These may be the result of a number of causes including: 1. Congenital abnormalities 2. Inflammatory diseases of the bowel (such as diverticulitis and Crohn’s Disease) 3. Cancer 4. Infection 5. Trauma 6. Iatrogenic (such as a post-operative complication) [3] A colovesical fistula (colovesicular fistula), an abnor...

  14. Spontaneous carotid cavernous sinus fistulas: Correlation between clinical findings and venous drainage; Fistole carotido-cavernose spontanee: Correlazione tra quadri clinici e drenaggio venoso

    Energy Technology Data Exchange (ETDEWEB)

    Calzolari, Ferdinando [Arcispedale S. Anna, Ferrara (Italy). Servizio di Neuroradilogia; Ravalli, Luca [Ferrara, Univ. (Italy). Clinica Oculistica

    1997-04-01

    They reviewed retrospectively 6 cases of spontaneous carotid cavernous fistulas to discuss the differences in clinical findings depending on venous patterns. Orbit US was performed in all patients but one and all patients were examined with CT and intraarterial digital subtraction angiography (DSA). CT was performed to demonstrate possible lesions of the orbit apex or skull base and showed dilation of the superior ophthalmic vein in 4 patients, bilateral in only one case. Moreover, CT detected enlargement of the cavernous sinuses in 4 cases (3 unilateral, one bilateral). Dynamic CT, performed in 2 patients, showed early opacification of both cavernous sinuses. DSA was carried out on the basis of clinical data and US and CT findings. It diagnosed carotid cavernous fistulas in all cases. The fistulas were bilateral in 3 subjects. In all the patients with exophthalmos, conjunctival chemosis and dilated episcleral veins, the superior ophthalmic vein was the main venous drainage from the cavernous sinus. Only 4 of these patients had abduction nerve palsy: bruit was present in 2 cases only. The ocular signs were contralateral to the fistula in one patient. In the patient presenting III, IV and VI nerve palsy, the venous drainage was direct from the cavernous sinus to pericarotid plexus, plexus and inferior petrosal sinus; in this case there were no ocular signs. The clinical findings of spontaneous cavernous fistulas are caused by the arterial supply and by the venous drainage of the fistula: for the early diagnosis and treatment is important to know that some patients do not exhibit the classic triad of symptoms, characterized by pulsating bruit and conjunctival chemosis. Their experience has confirmed that spontaneous carotid cavernous fistulas may be characterized by atypical clinical findings, such as ocular signs contralateral to the fistula side or palsies of cranial nerves only.

  15. Laparoscopic treatment of genitourinary fistulae.

    Science.gov (United States)

    Garza Cortés, Roberto; Clavijo, Rafael; Sotelo, Rene

    2012-09-01

    We present the laparoscopic management of genitourinary fistulae, mainly five types of fistulae, vesicovaginal, ureterovaginal, vesicouterine, rectourethral and rectovesical fistula. Vesicovaginal fistula (VVF) is mostly secondary to urogynecologic procedures in developed countries, abdominal hysterectomy being the main cause of this condition; they represent 84.9% of the genitourinary fistulae (1).Management has been described for this type of fistula, where low success rate (7-12%) has been reported. Ureterovaginal fistulas may occur following pelvic surgery, particularly gynecological procedures, or as a result of vaginal foreign bodies or stone fragments after shock wave lithotripsy, patients typically present with global and persistent urine leakage through the vagina, this causes patient discomfort, distress, and typically protection is used to stay dry, the initial management is often conservative but typically fails. Vesicouterine fistula is a rare condition that only occurs in 1 to 4% of genitourinary fistulas, the primary cause is low segment cesareansection, and clinically presents in three different forms, which will be described. Treatment of this type of fistulae has been conservative,with hormone therapy and surgery, depending on the presenting symptoms. Recto-urinary (rectovesical and rectourethral) fistulae (RUF) are uncommon and can be difficult to manage clinically. Although they may develop in patients with inflammatory bowel disease and perirectal abscesses, rectourethral fistula frequently result as an iatrogenic complication of extirpative or ablative prostate procedures. Rectovesical fistula usually develops following radical prostatectomy, and occurs along the vesicourethral anastomotic line or along the suture line of a posterior "racquet-handle" closure of the bladder. Conservative management consisting of urinary diversion, broad-spectrum antibiotics and parenteral nutrition is often initially attempted but these measures often fail

  16. Hydrocephalus in a patient with an unruptured pial arteriovenous fistula: hydrodynamic considerations, endovascular treatment, and clinical course.

    Science.gov (United States)

    Morales-Gómez, Jesús A; Garza-Oyervides, Vicente V; Arenas-Ruiz, José A; Mercado-Flores, Mariana; Elizondo-Riojas, C Guillermo; Boop, Frederick A; de León, Ángel Martínez-Ponce

    2017-03-01

    Intracranial pial arteriovenous fistulas, also known as nongalenic fistulas, are rare vascular malformations affecting predominantly the pediatric population. Hydrocephalus is an unusual presentation in which the exact pathophysiology is not fully understood. The aim of treatment in these cases is occlusion of the fistula prior to considering ventricular shunting. Here, the authors describe the hydrodynamic considerations of the paravascular pathway and the resolution of hydrocephalus with endovascular treatment of the fistula.

  17. 透析用上肢自体动静脉内瘘的临床研究%Clinical observation on upper extremity autogenous arteriovenous fistulas for hemodialysis

    Institute of Scientific and Technical Information of China (English)

    郝清斌; 刘丽红; 刘建元; 张海河; 魏玉峰

    2012-01-01

    Objective: To investigate the advantages and disadvantages of three types of autogenous arteriovenous (AV) fistulas for hemodialysis, so as to provide guidance for their clinical application and maintenance. Methods: Sixty-three patients undergoing autogenous AV fistula procedures were divided into snuff-box AV fistula group (20 cases), wrist AV fistula group (25 cases) and elbow AV fistula group (18 cases) according to the type of AV fistula. The incidences of postoperative thrombosis, pseudoaneurysm formation and high-output heart failure, and the average anastomosis diameter and blood flow volume through AV fistula of the three groups were analyzed and compared. Results: In the entire group, postoperative thrombosis developed in 7 patients and their dialysis treatments were continued after removal of the embolus. Of these patients, 5 cases in wrist AV fistula group progressed to fistula failure within one year after operation, and then were switched to perform a contralateral forearm AV or elbow AV. One case each in wrist AV fistula group and elbow AV fistula group developed high-output heart failure which was alleviated by narrowing the anastomotic diameter. Color ultrasound examination one year after operation showed that the AV fistula blood flow of each group was more than 300 mL/min. Comparison among the three groups showed that the incidence of postoperative thrombosis in wrist AV fistula group (5/25) was higher than that in snuff-box AV fistula group (1/20) and elbow AV fistula group (1/18), and the incidence of pseudoaneurysm formation in elbow AV fistula group (7/18) was higher than that in snuff-box AV fistula group (2/20) and wrist AV fistula group (3/25) (all P0.05); the anastomosis diameter and AV blood flow volume in elbow AV fistula group were both higher than those in snuff-box AV fistula group and wrist AV fistula group (all P<0.05).Conclusion: Snuff-box AV fistula should be the first choice for patients with satisfactory vascular access, while

  18. Meta-analysis of randomized clinical trials comparing fistulectomy versus fistulotomy for low anal fistula.

    Science.gov (United States)

    Xu, Yansong; Liang, Siyuang; Tang, Weizhong

    2016-01-01

    We evaluated the efficacy of fistulectomy compared to fistulotomy, and which procedure was the best procedure for patients with low anal fistula. The literature search included PubMed, EMBASE, Cochrane library, Google original studies and a manual search of reference on the topic of fistulectomy compared to fistulotomy for anal fistula that had a deadline for publication by June 2016. Randomized controlled trials studies were included in the review. The outcome variables were analyzed which including operative time, healing time, postoperative complications, recurrence and incontinence. Six randomized controlled trials (fistulectomy = 280, fistulotomy = 285) were considered suitable for the meta-analysis, with a total of 565 patients. The result of meta-analysis indicated no statistically significant difference in operative time [OR 4.74, 95 % CI -2.74, 12.23, p = 0.21] and healing time [OR -3.32, 95 % CI -19.86, 13.23, p = 0.69] between the fistulectomy and fistulotomy procedures. Three main postoperative complications were included, and the combined result indicated no statistically significant difference in overall complications [OR 1.39, 95 % CI 0.51, 3.78, p = 0.52] and subgroup complication. At the end of follow up, two kinds of surgical methods have the same low recurrence rate and faecal incontinence. The result revealed that there was no significant difference in rate of fistula recurrence between the fistulectomy and the fistulotomy [OR 1.39, 95 % CI 0.70, 2.73, p = 0.34]. The meta-analysis indicates that there is no conclusive evidence if fistulectomy or fistulotomy procedure is better in the treatment of low anal fistula.

  19. Clinical and economic consequences of pancreatic fistula after elective pancreatic resection

    Institute of Scientific and Technical Information of China (English)

    Filip Čečka; Bohumil Jon

    2013-01-01

    BACKGROUND: Postoperative  pancreatic  fistula  is  the  main cause  of  morbidity  after  pancreatic  resection.  This  study aimed  to  quantify  the  clinical  and  economic  consequences of  pancreatic  fistula  in  a  medium-volume  pancreatic  surgery center. METHODS: Hospital records from patients who had undergone elective pancreatic resection in our department were identified. Pancreatic  fistula  was  defined  according  to  the  International Study Group on Pancreatic Fistula (ISGPF). The consequences of pancreatic fistula were determined by treatment cost, hospital stay, and out-patient follow-up until the pancreatic fistula was completely healed. All costs of the treatment are calculated in Euros.  The  cost  increase  index  was  calculated  for  pancreatic fistula of grades A, B, and C as multiples of the total cost for the no fistula group. RESULTS: In  54  months,  102  patients  underwent  elective pancreatic  resections.  Forty  patients  (39.2%)  developed pancreatic  fistula,  and  54  patients  (52.9%)  had  one  or  more complications.  The  median  length  of  hospital  stay  for  the no fistula, grades A, B, and C fistula groups was 12.5, 14, 20, and  59  days,  respectively.  The  hospital  stay  of  patients  with fistula of grades B and C was significantly longer than that of patients  with  no  fistula  (P CONCLUSIONS: The  grading  recommended  by  the  ISGPF is useful for comparing the clinical severity of fistula and for analyzing the clinical and economic consequences of pancreatic fistula.  Pancreatic

  20. Initial clinical experience with a new pulsed dye laser device in angioplasty of limb ischemia and shunt fistula obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Zwaan, M.; Weiss, H.D.; Kagel, H.; Gmelin, E.; Rinast, E. (Medical University of Luebeck (Germany). Department of Radiology); Goethlin, J.H. (Sahlgrenska Sjukhuset, Goeteborg (Sweden)); Kummer, D. (Medical University of Luebeck (Germany). Department of Angiology and Geriatry); Scheu, M. (Medical Laser Center Luebeck (Germany))

    Selective plaque ablation with laser radiation at 405-530 nm in vitro has been reported. The possibilities are investigated of a new pulsed dye laser device for in vivo recanalization of arteries in ischemic lower limbs and stenoses/occlusions of arterio-venous hemo-dialysis shunt fistulae. A specially designed 9F or 7F multifiber catheter was used for treatment of 10 patients with lower limb artery obliterations and 11 patients with malfunctioning hemodialysis access fistulae (HAF). The recanalization technical success was 5/5 in the iliac arteries (IA), 4/5 in the superficial femoral arteries (SFA), and 11/11 in the HAF. Early re-occlusions occurred in one SFA and IA, respectively, caused by very bad run-off. There was one clinically insignificant SFA perforation. Additional balloon angioplasty was considered necessary in 10/16 lesions. Mean ankle-arm index increased from 0.68 to 0.97. With two exceptions all HAF patients were re-integrated in the dialysis program. Pulsed dye laser angioplasty promises to be an effective and fast method for plaque ablation debulking. The first clinical experience confirms previous in vitro results. In particular laser recanalization may become the method of choice for treatment of rigid HAF obstructions and it seems to be superior to vascular surgery or balloon angioplasty alone. (author). 15 refs.; 2 figs.

  1. Congenital bronchoesophageal fistula in adults

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  2. Treatment of non-IBD anal fistula.

    Science.gov (United States)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter; Buntzen, Steen; Thorlacius-Ussing, Ole; Andersen, Jens; Krupa, Marek; Qvist, Niels

    2015-05-01

    The course of the fistula tract in relation to the anal sphincter is identified by clinical examination under general anaesthesia using a fistula probe and injection of fluid into the external fistula opening. In the event of a complex fistula or in the case of fistula recurrence, this should be supplemented with an endoluminal ultrasound scan and/or an MRI scan. St. Mark's fistula chart should be used for the description. Simple fistulas are amenable to fistulotomy, whereas treatment of complex fistulas requires special expertise and management of all available treatment modalities to tailor the right operation to the individual patient. The given levels of evidence and grades of recommendations are according to the Oxford Centre for Evidence-based Medicine (www.cemb.net).

  3. Primary central nervous system vasculitis and its mimicking diseases - clinical features, outcome, comorbidities and diagnostic results - A case control study.

    Science.gov (United States)

    Becker, J; Horn, P A; Keyvani, K; Metz, I; Wegner, C; Brück, W; Heinemann, F M; Schwitalla, J C; Berlit, P; Kraemer, M

    2017-05-01

    To compare clinical features and outcome, imaging characteristics, biopsy results and laboratory findings in a cohort of 69 patients with suspected or diagnosed primary central nervous system vasculitis (PCNSV) in adults; to identify risk factors and predictive features for PCNSV. We performed a case-control-study including 69 patients referred with suspected PCNSV from whom 25 were confirmed by predetermined diagnostic criteria based on biopsy (72%) or angiography (28%). Forty-four patients turned out to have 15 distinct other diagnoses. Clinical and diagnostic data were compared between PCNSV and Non-PCNSV cohorts. Clinical presentation was not able to discriminate between PCNSV and its differential diagnoses. However, a worse clinical outcome was associated with PCNSV (p=0.005). Biopsy (p=0.004), contrast enhancement (p=0.000) or tumour-like mass lesion (p=0.008) in magnetic resonance imaging (MRI), intrathecal IgG increase (p=0.020), normal Duplex findings of cerebral arteries (p=0.022) and conventional angiography (p 0.010) were able to distinguish between the two cohorts. In a cohort of 69 patients with suspected PCNSV, a large number (64%) was misdiagnosed and partly received treatment, since mimicking diseases are very difficult to discriminate. Clinical presentation at manifestation does not help to differentiate PCNSV from its mimicking diseases. MRI and cerebrospinal fluid analysis are unlikely to be normal in PCNSV, though unspecific if pathological. Cerebral angiography and biopsy must complement other diagnostics when establishing the diagnosis in order to avoid misdiagnosis and mistreatment. German clinical trials register: http://drks-neu.uniklinik-freiburg.de/drks_web/, Unique identifier: DRKS00005347. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Modern management of anal fistula.

    Science.gov (United States)

    Limura, Elsa; Giordano, Pasquale

    2015-01-07

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

  5. Cardiac sarcoidosis mimicking hypertrophic cardiomyopathy: clinical utility of radionuclide imaging for differential diagnosis.

    Science.gov (United States)

    Yazaki, Y; Isobe, M; Hayasaka, M; Tanaka, M; Fujii, T; Sekiguchi, M

    1998-06-01

    A 62-year-old woman with skin sarcoidosis was admitted to our hospital to ascertain whether she had cardiac involvement. Although she displayed no cardiac signs or symptoms, the electrocardiogram showed first-degree atrioventricular block, right bundle branch block with left anterior fascicular block, and giant negative T waves in the V3 lead. Echocardiography revealed marked hypertrophy localized in the basal portion of the interventricular septum (IVS) without systolic dysfunction, mimicking hypertrophic cardiomyopathy (HCM). Exercise thallium-201 myocardial imaging revealed redistribution in the anteroseptal region. Both gallium-67 (67Ga) and technetium-99m pyrophosphate (99mTc-PYP) scintigraphy revealed abnormal uptake in the myocardium. These findings disappeared after 2 months of steroid treatment. Reports of cardiac sarcoidosis mimicking HCM are rare. However, hypertrophy in the basal portion of the IVS is an important sign of early cardiac involvement in sarcoidosis. 67Ga and 99mTc-PYP scintigraphy were useful and necessary to differentiate this type of cardiac sarcoidosis from HCM.

  6. One-step endovascular treatment of bilateral traumatic carotid-cavernous fistulae with atypical clinical course.

    Science.gov (United States)

    Chiriac, Alexandru; Iliescu, Bogdan F; Dobrin, Nicolae; Poeata, Ion

    2014-01-01

    Traumatic carotid-cavernous fistula (TCCF) is a rare neurovascular pathologic entity. The bilateral form occurs even rarer and given the potential risk for both optic tracts presents an urgent indication for quick and effective treatment. We present a patient with a bilateral Barrow type A TCCF with a fulminant development of symptoms, who was successfully treated with bilateral detachable balloons in a single session endovascular procedure. The patient experienced complete relief of symptoms, however the complete neurological deficit in the left optic nerve was persistent.

  7. Tracheoesophageal fistula.

    Science.gov (United States)

    Slater, Bethany J; Rothenberg, Steven S

    2016-06-01

    Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Optimizing Arteriovenous Fistula Maturation

    OpenAIRE

    2009-01-01

    Autogenous arteriovenous fistulas are the preferred vascular access in patients undergoing hemodialysis. Increasing fistula prevalence depends on increasing fistula placement, improving the maturation of fistula that fail to mature and enhancing the long-term patency of mature fistula. Percutaneous methods for optimizing arteriovenous fistula maturation will be reviewed.

  9. Congenital parotid fistula

    Directory of Open Access Journals (Sweden)

    Shiggaon Natasha

    2014-01-01

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

  10. Pancreaticopleural fistula: a review.

    Science.gov (United States)

    Aswani, Yashant; Hira, Priya

    2015-01-31

    Pancreaticopleural fistula is a rare complication of chronic pancreatitis consequent to posterior disruption of the pancreatic duct. The fistulous track ascends into the pleural cavity and gives rise to large volumes of pleural fluid. Pancreaticopleural fistula thus poses a diagnostic problem since the source of pleural fluid is extrathoracic. To further complicate the matter, abdominal pain is seldom the presenting or significant feature. The pleural effusion is typically rapidly accumulating, recurrent and exudative in nature. Pleural fluid amylase in the correct clinical setting virtually clinches the diagnosis. Magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography and computed tomography may delineate the fistula and thus aid in diagnosis. Endoscopic retrograde cholangiopancreatography has emerged both as a diagnostic as well as therapeutic modality in select patients of pancreaticopleural fistula while magnetic resonance cholangiopancreatography is the radiological investigation of choice. Besides delineating the ductal anatomy, magnetic resonance cholangiopancreatography can help stratify patients for appropriate management. A near normal or mildly dilated pancreatic duct responds well to chest drainage with octreotide while endoscopic stent placement benefits patients with duct disruption located in head or body of pancreas. Failure of medical or endoscopic therapy calls in for surgical intervention. Besides, a primary surgical management may be tried in patients with complete ductal obstruction, ductal disruption in tail or ductal obstruction proximal to fistula site.

  11. Comparison of Ultrasound Attenuation and Backscatter Estimates in Layered Tissue-Mimicking Phantoms among Three Clinical Scanners

    Science.gov (United States)

    Nam, Kibo; Rosado-Mendez, Ivan M.; Wirtzfeld, Lauren A.; Ghoshal, Goutam; Pawlicki, Alexander D.; Madsen, Ernest L.; Lavarello, Roberto J.; Oelze, Michael L.; Zagzebski, James A.; O’Brien, William D.; Hall, Timothy J.

    2013-01-01

    Backscatter and attenuation coefficient estimates are needed in many quantitative ultrasound strategies. In clinical applications, these parameters may not be easily obtained because of variations in scattering by tissues overlying a region of interest (ROI). The goal of this study is to assess the accuracy of backscatter and attenuation estimates for regions distal to nonuniform layers of tissue-mimicking materials. In addition, this work compares results of these estimates for “layered” phantoms scanned using different clinical ultrasound machines. Two tissue-mimicking phantoms were constructed, each exhibiting depth-dependent variations in attenuation or backscatter. The phantoms were scanned with three ultrasound imaging systems, acquiring radio frequency echo data for offline analysis. The attenuation coefficient and the backscatter coefficient (BSC) for sections of the phantoms were estimated using the reference phantom method. Properties of each layer were also measured with laboratory techniques on test samples manufactured during the construction of the phantom. Estimates of the attenuation coefficient versus frequency slope, α0, using backscatter data from the different systems agreed to within 0.24 dB/cm-MHz. Bias in the α0 estimates varied with the location of the ROI. BSC estimates for phantom sections whose locations ranged from 0 to 7 cm from the transducer agreed among the different systems and with theoretical predictions, with a mean bias error of 1.01 dB over the used bandwidths. This study demonstrates that attenuation and BSCs can be accurately estimated in layered inhomogeneous media using pulse-echo data from clinical imaging systems. PMID:23160474

  12. The effect of cassia fistula emulsion on pediatric functional constipation in comparison with mineral oil: a randomized, clinical trial

    Directory of Open Access Journals (Sweden)

    Mozaffarpur Seyyed Ali

    2012-12-01

    Full Text Available Abstract Background The prevalence of Pediatric Functional Constipation (FC has been reported between 0.7% to 29.6%. This study was conducted to compare the laxative effect of cassia fistula emulsion (CFE with mineral oil (MO on FC. Cassia fistula is named in Traditional Iranian Medicine (TIM as “Folus”. Materials and methods A randomized clinical trial was carried on 81 children (age range: 4–13 years with FC, according to Rome III criteria in Amirkola Children’s Hospital, Babol, Iran. They received CFE or MO randomly for three weeks. CFE was produced according to the order of TIM references. Children were counted as improved when they exited from Rome III criteria of FC. Frequency of defecation, fecal incontinence, retentive posturing, severity of pain, consistency of stool and anal leakage of oily material were compared between the two groups and with baselines. An intent-to-treat analysis was used. Safety of drugs was assessed with the evaluation of clinical adverse effects. Results 41 children were assigned randomly to receive CFE and 40 children received MO. After three weeks of medication, 84% of children in CFE group and 50% in MO group (p = 0.002 exited from the criteria of FC, so called improved. All measurable criteria improved in both groups. The frequency of defecation in CFE group improved from 1.7 per week (before the study to 10.6 per week (at the third week while this parameter differed in MO group from 2 to 6.1 (p Conclusions CFE was most effective than MO in the 3-week treatment of children with FC.

  13. MYOMA OF THE ROUND LIGAMENT MIMICKING THE CLINICAL APPEARANCE OF THE INGUINAL HERNIA – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Aleš Pišek

    2004-12-01

    Full Text Available Background. Myomas are the most frequent gynecological tumors. They first occur during puberty; however, they are most frequent among aged between 35 and 50. In this age group their incidence is 15–20%. They are rare after menopause. The majority of myomas arise in the uterus, but they may arise from other extrauterine sites such as the fallopian tubes, ovaries, round ligament, ligamentum latum, sacrouterine ligament, vagina and even the urethra. Most authors agree that there are numerous causes for the occurrence of myomas; however, they have not yet been clearly proven. They however agree that the myomas appear most frequently in the reproductive age, when the ovarian hormone levels are high and they diminish after menopause. They equally agree that the risk factors for the clinically significant myomas are nulliparity, obesity, a positive family history of myomas and African racial origin.Patients and methods. A 43-year-old patient was referred to our institution for operative treatment by her personal gynaecologist who clinically and sonografically verified a solid tumor situated to the right side of the uterus. The size of the tumor was that of a newborn’s head. The patient, however, had been observing a reponible inguinal hernia the size of a female fist for a period of four years. A solid tumor (22×6×7 cm arising from the right round ligament, was remowed during surgery. Half of its size was situated in the inguinal canal thus mimicking the clinical appearance of the inguinal hernia. After the tumor was removed the inner door of the inguinal canal closed by itself, no surgical repair was necessary. On histological examination the tumor was classified as a leiomyoma.Conclusions. Although the leiomyoma of the round ligament is the most frequent tumor of that region it is a rare gynecological tumor. The described case is especially interesting due to the unusual position of the tumor. It was situated partly intraabdominally and partly

  14. Experimental porcine model of complex fistula-in-ano

    Science.gov (United States)

    A Ba-Bai-Ke-Re, Ma-Mu-Ti-Jiang; Chen, Hui; Liu, Xue; Wang, Yun-Hai

    2017-01-01

    AIM To establish and evaluate an experimental porcine model of fistula-in-ano. METHODS Twelve healthy pigs were randomly divided into two groups. Under general anesthesia, the experimental group underwent rubber band ligation surgery, and the control group underwent an artificial damage technique. Clinical magnetic resonance imaging (MRI) and histopathological evaluation were performed on the 38th d and 48th d after surgery in both groups, respectively. RESULTS There were no significant differences between the experimental group and the control group in general characteristics such as body weight, gender, and the number of fistula (P > 0.05). In the experimental group, 15 fistulas were confirmed clinically, 13 complex fistulas were confirmed by MRI, and 11 complex fistulas were confirmed by histopathology. The success rate in the porcine complex fistula model establishment was 83.33%. Among the 18 fistulas in the control group, 5 fistulas were confirmed clinically, 4 complex fistulas were confirmed by MRI, and 3 fistulas were confirmed by histopathology. The success rate in the porcine fistula model establishment was 27.78%. Thus, the success rate of the rubber band ligation group was significantly higher than the control group (P fistula-in-ano models. Large animal models of complex anal fistulas can be used for the diagnosis and treatment of anal fistulas. PMID:28348488

  15. The Effect of Cassia Fistula Emulsion on Pediatric Functional Constipation in Comparison with Mineral Oil: a Randomized, Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mohammad Kamalinejad

    2012-12-01

    Full Text Available Background: The prevalence of Pediatric Functional Constipation (FC has been reported between 0.7% to 29.6%.This study was conducted to compare the laxative effect of cassia fistula emulsion (CFE with mineral oil (MO on FC. Cassia fistula is named in Traditional Iranian Medicine (TIM as “Folus”.Materials and methods: A randomized clinical trial was carried on 81 children (age range: 4–13 years with FC,according to Rome III criteria in Amirkola Children’s Hospital, Babol, Iran. They received CFE or MO randomly for three weeks. CFE was produced according to the order of TIM references. Children were counted as improvedwhen they exited from Rome III criteria of FC. Frequency of defecation, fecal incontinence, retentive posturing,severity of pain, consistency of stool and anal leakage of oily material were compared between the two groups and with baselines. An intent-to-treat analysis was used. Safety of drugs was assessed with the evaluation of clinical adverse effects.Results: 41 children were assigned randomly to receive CFE and 40 children received MO. After three weeks of medication, 84% of children in CFE group and 50% in MO group (p = 0.002 exited from the criteria of FC, so called improved. All measurable criteria improved in both groups. The frequency of defecation in CFE group improvedfrom 1.7 per week (before the study to 10.6 per week (at the third week while this parameter differed in MO group from 2 to 6.1 (p < 0.001. The severity of pain during defecation and consistency of stool improved significantly better in CFE group than MO group (p < 0.05, but there were not any significant differences betweenthe two groups in fecal incontinence and retentive posturing. Anal leakage of oily material occurred as an important complication in MO group while the children in CFE group did not complaint it. Drug’s compliances were not significantly different in the two groups. CFE and MO did not cause clinically significant side effects

  16. Perilymph Fistula

    Science.gov (United States)

    ... to the head or in some cases a "whiplash" injury. Other common causes include ear trauma, objects perforating the eardrum, or “ear block” on descent of an airplane or SCUBA diving. Fistulas may also develop after rapid increases in intracranial pressure, such as may ...

  17. An imported case of severe falciparum malaria with prolonged hemolytic anemia clinically mimicking a coinfection with babesiosis.

    Science.gov (United States)

    Na, Young Ju; Chai, Jong-Yil; Jung, Bong-Kwang; Lee, Hyun Jung; Song, Ji Young; Je, Ji Hye; Seo, Ji Hye; Park, Sung Hun; Choi, Ji Seon; Kim, Min Ja

    2014-12-01

    While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.

  18. Efficacy analysis of lacrimal fistula excision combined double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula

    National Research Council Canada - National Science Library

    Hui-Ya Fan; Zhong Xu; Xiao-Kai Chen

    2015-01-01

    AIM: To observe the clinical effects of thelacrimal fistula excision combined with double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula.METHODS: Totally 25 cases(25 eyes...

  19. Fistula Tunnel Method to Suture a Period of Treatment, the Clinical Effect of the Treatment of Anal Fistula%瘘管隧道法切除一期缝合术治疗肛瘘的临床疗效

    Institute of Scientific and Technical Information of China (English)

    杨本军

    2016-01-01

    目的:探讨利用瘘管隧道法切除一期缝合术进行肛瘘治疗的临床疗效。方法方便选取2013年1月—2014年1月期间入住该院治疗肛瘘的120例患者,按治疗方法不同将其随机分为A、B、C 3组各40例,A组采用瘘管隧道切除一期缝合术,B组采用肛瘘切除缝合术,C组采用肛瘘切除术,对比3个组患者创面愈合时间、术后伤疤情况、感染情况以及肛门的括约肌功能恢复等。结果 A、B两组患者手术后伤口的愈合时间分别为(4±11)d和(5±12)d,相比于C组的愈合时间(9±18)d要更短,疤痕也较小,P<0.05;在手术后伤口出现感染情况以及复发情况的比较上,A组1例,B组15例,C组5例,B组又比A、C两组更高,P<0.05;肛门的变形数量方面A组2例,B组3例,C组18例,A、B两组明显比C组少,P<0.05;另外,A、B两组患者都没有出现因为肛门括约肌损伤而导致大小便时常的病例。结论治疗肛瘘疾病采用瘘管隧道法切除一期缝合术,有效减少了患者伤口创面痊愈的时间,且手术后的疤痕比较小,手术复发率低,最大限度的保护了患者肛门括约肌的功能,提高治疗肛瘘的疗效,值得在临床上广泛推广和应用。%Objective To study the fistula tunnel method is used to suture the first phase of treatment for anal fistula of clinical efficacy. Methods Convenient selection between January 2013 to January 2014 during the period of stay in the hos-pital for the treatment of anal fistula, 120 patients in treatment methods, based on the random divided into A, B, C three groups (40 cases, group A with fistula tunnel suture issue, group B with anal fistula resection decompression, group C with anal fistula resection, compare the three groups of patients with wound healing time, postoperative scar size, postoperative wound infection situation and anal deformation of anal sphincter function, and the postoperative recurrence 2 years of fol-low-up, and statistical analysis

  20. Anal Abscess/Fistula

    Science.gov (United States)

    ... to determine if antibiotics are indicated. TREATMENT OF ANAL FISTULA Currently, there is no medical treatment available for ... surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter ...

  1. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  2. Treatment of Crohn's-Related Rectovaginal Fistula With Allogeneic Expanded-Adipose Derived Stem Cells: A Phase I-IIa Clinical Trial.

    Science.gov (United States)

    García-Arranz, Mariano; Herreros, Maria Dolores; González-Gómez, Carolina; de la Quintana, Paloma; Guadalajara, Héctor; Georgiev-Hristov, Tihomir; Trébol, Jacobo; Garcia-Olmo, Damián

    2016-11-01

    : The aim of this clinical trial was to determine the safety and feasibility of expanded allogeneic adipose-derived stem cells to treat Crohn's-related rectovaginal fistula (CRRVF). We designed a phase I-II clinical trial (https://ClinicalTrials.gov, NCT00999115) to treat 10 patients with CRRVF. Patients receiving biological therapy during follow-up were excluded. Curettage was performed, and a vaginal or rectal flap was added if the surgeon considered it necessary. The therapeutic protocol included intralesional injection of 20 million stem cells in the vaginal walls (submucosal area) and fistula tract. Healing was evaluated 12 weeks later. If the fistula had not healed, a second dose of 40 million stem cells was administered. Patient follow-up was 52 weeks from last cell injection. Healing was defined as re-epithelialization of both vaginal and rectal sides and absence of vaginal drainage. Cytokines and immunological blood tests were monitored. Serious adverse events or rejection issues were not observed. Five patients were excluded because biologic drugs were required to treat a Crohn's disease flare-up during follow-up. Cytokine profiles and immunotoxicity assays showed no statistically significant alterations. Sixty percent of the nonexcluded patients achieved a complete healing. Expanded allogeneic adipose-derived stem-cell injection is a safe and feasible therapy for treating CRRVF, and the healing success rate seems promising (60%). The results of this trial encourage further exploration into this therapy. This may be the first publication in which allogeneic stem cells to treat rectovaginal fistula in Crohn´s disease seem to be a feasible and safe treatment. Additional studies are necessary to confirm the efficacy profile of the allogeneic stem cells strategy in a controlled design. ©AlphaMed Press.

  3. Enterovesical fistulae: aetiology, imaging, and management.

    Science.gov (United States)

    Golabek, Tomasz; Szymanska, Anna; Szopinski, Tomasz; Bukowczan, Jakub; Furmanek, Mariusz; Powroznik, Jan; Chlosta, Piotr

    2013-01-01

    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.

  4. Coring-out fistulectomy with a newly designed 'fistulectome' for complicated perianal fistulae: a retrospective clinical analysis.

    Science.gov (United States)

    Tasci, I; Erturk, S; Alver, O

    2013-07-01

    Conventional surgery for complex anal fistula (AF) is associated with continence disturbance and recurrence. In the hope of reducing these we developed a new mechanical device, the 'fistulectome', to excise the entire fistula tract. Between March 2001 and April 2011, 136 patients underwent surgery for a complex AF using the fistulectome. All fistulae were cryptoglandular in origin. Five patients were lost to follow up and were excluded from the analysis. Of the 131 fistulae, 76 were trans-sphincteric, 14 were suprasphincteric and 16 were extrasphincteric. Seven had a horseshoe extension and 18 were unclassified. Of the 131, 108 had recurred after conventional fistulotomy performed at another centre and 23 were primary. The mean duration of follow up was 34.6 months, the mean hospital stay was 5 days and the healing time was 14 days. Recurrence, flatus incontinence and soiling occurred in 17 (12.9%), four (3.5%) and two (1.52%) patients. The results of this series suggest that coring-out of a fistula using a fistulectome may be a valid treatment for complicated anal fistula. © 2013 The Authors Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  5. Vesicocervical fistula following vesicovaginal fistula repair report

    Directory of Open Access Journals (Sweden)

    Hamudur Rahman

    2016-07-01

    Full Text Available Vesicocervical fistula following vesicovaginal fistula repair is a very rare condition. It is a complication following repeated lower uterine cesarean section. We report a case of an young married woman who was admitted in the depart­ment of urology, Banghabandhu Sheikh Mujib Medical University Hospital with vesico-cervical fistula following vesico­vaginal fistula repair. Reposition of cervix into vaginal vault and repair of urinary bladder was done. There was no such report of vesicocervical fistula following vesicovaginal fistula repair from Bangladesh.

  6. German S3-Guideline: Rectovaginal fistula

    Science.gov (United States)

    Ommer, Andreas; Herold, Alexander; Berg, Eugen; Fürst, Alois; Schiedeck, Thomas; Sailer, Marco

    2012-01-01

    Background: Rectovaginal fistulas are rare, and the majority is of traumatic origin. The most common causes are obstetric trauma, local infection, and rectal surgery. This guideline does not cover rectovaginal fistulas that are caused by chronic inflammatory bowel disease. Methods: A systematic review of the literature was undertaken. Results: Rectovaginal fistula is diagnosed on the basis of the patient history and the clinical examination. Other pathologies should be ruled out by endoscopy, endosonography or tomography. The assessment of sphincter function is valuable for surgical planning (potential simultaneous sphincter reconstruction). Persistent rectovaginal fistulas generally require surgical treatment. Various surgical procedures have been described. The most common procedure involves a transrectal approach with endorectal suture. The transperineal approach is primarily used in case of simultaneous sphincter reconstruction. In recurrent fistulas. Closure can be achieved by the interposition of autologous tissue (Martius flap, gracilis muscle) or biologically degradable materials. In higher fistulas, abdominal approaches are used as well. Stoma creation is more frequently required in rectovaginal fistulas than in anal fistulas. The decision regarding stoma creation should be primarily based on the extent of the local defect and the resulting burden on the patient. Conclusion: In this clinical S3-Guideline, instructions for diagnosis and treatment of rectovaginal fistulas are described for the first time in Germany. Given the low evidence level, this guideline is to be considered of descriptive character only. Recommendations for diagnostics and treatment are primarily based the clinical experience of the guideline group and cannot be fully supported by the literature. PMID:23255878

  7. First Clinical Investigations of New Ultrasound Techniques in Three Patient Groups: Patients with Liver Tumors, Arteriovenous Fistulas, and Arteriosclerotic Femoral Arteries

    DEFF Research Database (Denmark)

    Hansen, Peter Møller

    ultrasound images of very high quality with high frame rate. Synthetic aperture is unfortunately very demanding computationally, and is therefore used only in experimental scanners. SASB reduces the data volume by a factor of 64, thereby making it possible to implement the technology on a commercial...... ultrasound scanner, to perform wireless data transfer and in the future to develop e.g. a wireless ultrasonic transducer. Nineteen patients with either primary liver cancer or liver metastases from colon cancer were ultrasound scanned the day before planned liver resection. Patients were scanned...... of the significant data reduction, is suitable for clinical use. In Study II, 20 patients with arteriovenous fistulas for hemodialysis were ultrasound scanned directly on the most superficial and accessible part of the fistula. The vector ultrasound technique Vector Flow Imaging (VFI) was used. VFI can...

  8. Hantavirus infection mimicking leptospirosis: how long are we going to rely on clinical suspicion?

    Science.gov (United States)

    Dahanayaka, Niroshana Jathum; Agampodi, Suneth Buddhika; Bandaranayaka, Anoma Kumari; Priyankara, Sumudu; Vinetz, Joshep M

    2014-08-13

    Hantavirus infections and leptospirosis can have similar clinical and epidemiological features. We present here a case study of a young farmer with fever during the post-flood leptospirosis outbreak in Anuradhapura, Sri Lanka, in 2011. He presented with a classical clinical picture of leptospirosis and was managed and notified as a case of leptospirosis. Retrospective analysis of a stored serum sample confirmed acute hantavirus infection. Diagnosis of newly identified or emerging infectious diseases such as hantavirus infection is challenging due to the lack of diagnostic facilities in developing countries. This case highlights the need for improving diagnostic facilities, educating medical staff, and conducting population-based prospective studies on hantavirus infections in Sri Lanka.

  9. A rare case of primary parasitic leiomyoma mimicking as ovarian mass: a clinical dilemma

    Directory of Open Access Journals (Sweden)

    Meenal Sarmalkar

    2016-02-01

    Full Text Available Uterine leiomyomas are the most common benign pelvic tumors in women of reproductive age group. Parasitic or wandering leiomyomas are known for their rarity, atypical clinical presentation and unusual location, posing challenge in making radiological and clinical diagnosis. More recently, rise in incidence of secondary parasitic leiomyomas has been reported as a complication of laparoscopic myomectomy and morcellations. We report an interesting case of primary parasitic leiomyoma which initially seemed to be a case of ovarian tumor. A 38 year old woman presented with chief complaints of pain in lower abdomen since 4 months with abdominal swelling since 2 months with CT abdomen suggestive of 8.7x5.2 cm exophytic right ovarian neoplasm with differential diagnosis of broad ligament fibroid in pouch of douglas. She had no previous history of abdominal or laparoscopic myomectomy and no family history of genital tract and breast malignancy. On clinical examination, no mass could be palpated per abdominally but a firm mass of 8 x6 cm size was felt through posterior fornix. Intraoperatively, a solid mass with lobulated surface was noted in pouch of Douglas attached through a thin vascular pedicle to sigmoid colon. Differential diagnosis considering location of tumor and pathological examination included possibility of gastrointestinal stromal tumor or extra-gastrointestinal stromal tumor or wandering leiomyoma. However, on histopathological slide examination (using immunohistochemistry, GIST was ruled out and diagnosis of parasitic fibroid was confirmed. Therefore, while dealing with pelvic tumors with atypical clinical presentation, possibility of these rare tumors have to be kept in mind for appropriate management. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 545-548

  10. A clinical risk model for the evaluation of bronchopleural fistula in non-small cell lung cancer after pneumonectomy.

    Science.gov (United States)

    Hu, Xue-fei; Duan, Liang; Jiang, Ge-ning; Wang, Hao; Liu, Hong-cheng; Chen, Chang

    2013-08-01

    There are no reliable risk factors to predict bronchopleural fistula (BPF) formation in patients undergoing pneumonectomy for non-small cell lung cancer (NSCLC). This study aims to create a validated clinical model based on the risk factors for BPF after pneumonectomy. The model to estimate the risk of BPF may help select patients for intervention therapy to reduce the rate of BPF after pneumonectomy. This retrospective analysis included 684 patients with NSCLC who underwent pneumonectomy at our institution from 1995 to 2012. The rates of BPF were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the independent risk factors for the BPF and based on which a clinical model for the prediction of the incidence of BPF was formed. The incidence of BPF was 4.4% (30 of 684 patients). Three factors were independently associated with BPF after pneumonectomy for NSCLC: neoadjuvant therapy (hazard ratio, 2.479), diabetes mellitus (hazard ratio, 1.061), and age 70 years or older (hazard ratio, 1.175). A scoring system for BPF was developed by assigning 2 points for a major risk factor (neoadjuvant therapy) and 1 point for each minor risk factor (diabetes mellitus and age ≥ 70 years). The 684 patients were divided into a low-risk group (score, 0 to 1), moderate-risk group (score, 2), and high-risk group (score, ≥ 3), with respective incidences of early BPF after pneumonectomy of 2.4%, 18.2%, and 58.3% This model, based on readily available clinical characteristics, can estimate the risk of BPF after pneumonectomy in the NSCLC patients, independent of early BPF and late BPF classifications. This model could be used to select patients for intervention therapy (parenteral alimentation, control of blood glucose level, oxygen therapy, and strengthening the antibiotic treatment) if validated in independent data sets. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Clinical Observation of Simple Anal Fistula Treated by Thread Dragging Through Fistula%隧道式拖线术治疗单纯性肛瘘疗效观察

    Institute of Scientific and Technical Information of China (English)

    徐晓波

    2016-01-01

    Objective To observe the effect of simple anal fistula treated by thread dragging through fistula. Methods 106 cases of patients with perianal abscess at our hospital from October 2012 to October 2015 were selected as the object of study. The patients were randomly divided into two groups, each group had 53 cases. The control group was treated by ligation therapy, and the treatment group was treated by thread dragging through fistula, the clinical effect, cure period and treatment charge of two groups were compared and analyzed. Results The total treatment effective rate of the treatment group was significantly higher than the control group (94.34%>73.58%), there was statistical significance (P<0.05). The cure period of the treatment group was significantly shorter than the control group, the treatment charge was significantly less than the control group, there was statistical significance (P<0.05). Conclusion That has better clinical effect of the simple anal fistula treated by thread dragging through fistula, and able to effective expedite the treatment process, reduce the treatment charge, thus to alleviate the financial burden of patients, that is worth for promotion.%目的:观察隧道式拖线术治疗单纯性肛瘘的临床疗效。方法选择2012年10月~2015年10月我院收治的106例单纯性肛瘘患者作为研究对象,将其随机分为两组,各53例。对照组行挂线疗法治疗,观察组行隧道式拖线术治疗。对两组患者临床疗效、治愈时间及治疗费用展开对比分析。结果观察组临床治疗总有效率明显高于对照组(94.34%>73.58%),差异显著(P <0.05);观察组治愈时间明显短于对照组,治疗费用明显低于对照组,差异显著(P <0.05)。结论隧道式拖线术治疗单纯性肛瘘较挂线疗法临床疗效更为显著,且能够有效加速治疗进程,减少治疗费用,从而减轻患者经济负担,值得临床推广。

  12. 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.

  13. Anaplastic large cell lymphoma ALK-negative clinically mimicking alcoholic hepatitis – a review

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos

    2013-10-01

    Full Text Available Anaplastic large cell lymphoma (ALCL, described less than 30 years ago by Karl Lennert and Herald Stein in Kiel, West Germany, is a T-cell or null non-Hodgkin lymphoma, with distinctive morphology (hallmark cells, prominent sinus and/or perivascular growth pattern, characteristic immunophenotype (CD30+, cytotoxic granules protein+, CD3–/+ and specific genetic features as translocations involving the receptor tyrosine kinase called anaplastic lymphoma kinase (ALK on 2p23 and variable partners genes, which results in the expression of ALK fusion protein. The absence of ALK expression is also observed and is associated with poorer prognosis that seen with ALK expression. ALK-negative ALCL is more frequent in adults, with both nodal and extra nodal clinical presentation and includes several differential diagnoses with other CD30+ lymphomas. Liver involvement by ALCL is rare and is generally seen as mass formation; the diffuse pattern of infiltration is even more unusual. The authors present a case of a 72-year-old man who presented clinical symptoms of acute hepatic failure. The patient had a long history of alcohol abuse and the diagnosis of alcoholic hepatitis was highly considered, although the serum lactic dehydrogenase (LDH value was highly elevated. The clinical course was fulminant leading to death on the fourth day of hospitalization. Autopsy demonstrated diffuse neoplastic hepatic infiltration as well as splenic, pulmonary, bone marrow, and minor abdominal lymph nodes involvement by the tumor. Based on morphological, immunophenotypical, and immunohistochemical features, a diagnosis of ALK- negative ALCL was concluded. When there is marked elevation of LDH the possibility of lymphoma, ALCL and other types, should be the principal diagnosis to be considered.

  14. Foreign body granuloma mimicking recurrent intracranial tumor: a very rare clinical entity.

    Directory of Open Access Journals (Sweden)

    Askin Esen Hasturk

    2013-11-01

    Full Text Available Gelatin sponge, oxidized cellulose and microfibrillar collagen are used to achieve hemostasis during neurosurgical procedures. Hemostatic agents may produce clinically symptomatic, radiologically apparent mass lesions. The differential diagnosis should include the foreign body along with recurrent tumor. We present a case of intracranial hemostatic agents found in a 56-year-old male patient seven years after undergoing a craniotomy for a left posterior parietal convexity meningioma. Preoperative magnetic resonance imaging (MRI suggested the presence of a recurrent tumor. We emphasize that although it is rare, a granuloma due to a foreign body reaction can result in a false image of tumor recurrence.

  15. Clinical outcome of Fitz-Hugh-Curtis syndrome mimicking acute biliary disease

    Institute of Scientific and Technical Information of China (English)

    Seong Yong Woo; Jin Il Kim; Dae Young Cheung; Se Hyun Cho; Soo-Heon Park; Joon-Yeol Han; Jae Kwang Kim

    2008-01-01

    AIM: To analyze the clinical characteristics of patients diagnosed with Fitz-Hugh-Curtis syndrome.METHODS: The clinical courses of patients that visited St. Mary's Hospital with abdominal pain from January 2005 to December 2006 and were diagnosed with Fitz-Hugh-Curtis syndrome were examined.RESULTS: Fitz-Hugh-Curtis syndrome was identified in 22 female patients of childbearing age; their mean age was 31.0 + 8.1 years. Fourteen of these cases presented with pain in the upper right abdomen alone or together with pain in the lower abdomen,and six patients presented with pain only in the lower abdomen. The first impression at the time of visit was acute cholecystitis or cholangitis in 10 patients and acute appendicitis or pelvic inflammatory disease in eight patients. Twenty-one patients were diagnosed by abdominal computer tomograghy (CT), and the results of abdominal sonography were normal for 10 of these patients. Ch/amydia trichomatis was isolated from 18 patients. Two patients underwent laparoscopic adhesiotomy and 20 patients were completely cured by antibiotic treatment.CONCLUSION: For women of childbearing age with acute pain in the upper right abdomen alone or together with pain in the lower abdomen, Fitz-HughCurtis syndrome should be considered during differential diagnosis. Moreover, in cases suspected to be Fitz-HughCurtis syndrome, abdominal c-r, rather than abdominal sonography, assists in the diagnosis.

  16. Clinic applicative value of MRI in the diagnosis of complex anal fistula%MRI诊断复杂性肛瘘的临床应用价值

    Institute of Scientific and Technical Information of China (English)

    王军大; 李映

    2014-01-01

    Objective To evaluate the clinical value of MRI examination in the diagnosis and guidance of operation complexity a-nal fistula.Methods Preoperative MRI findings of 32 patients with complex anal fistula confirmed by operation were analyzed ret-rospectively,and compared with the operation results.Results The pre-operation MRI results of 32 patients with complex anal fis-tula revealed that there were 43 fistulas,10 anus week abscesses,58 orificium fistulas,comparing the MRI diagnosis with operation results,coincidence rate of fistula,anus week abscesses,orificium fistula was 100.0%,100.0%,89.3%,respectively.MRI manifes-tations of fistula were that T1 WI manifestations of fistula was or low signal,T2 WI and T2 WI fat suppression sequence manifesta-tions of fistula was high signal,fistula presented a tubular shape obviously as T1 WI enhancement scanning,internal opening repre-sented as intensive dot,complicated embranchment,two type signal of fistula appeared at the same time.MRI manifestations of ab-scesses were that circular,ellipse,irregular form and horseshoe-shape,T1 WI manifestations of abscesses was low signal,there was gas in abscess cavity of some patients;intestinal tube surrounding of some patients were involved by abscess cavity,and up through the edge of bladder to the perineum.Conclusion MRI examination could accurately display the number of complex anal fistula,fis-tula walking and branch,the position of internal opening,correlativity between fistula and surrounding muscles,status of abscess, which could provide guidance for anorectal surgery.%目的:评价 MRI检查在复杂性肛瘘术前诊断及指导手术方面的临床应用价值。方法回顾性分析32例经手术证实为复杂性肛瘘患者的术前 MRI表现,并与手术结果进行对比研究。结果32例复杂性肛瘘患者术前 MRI显示有瘘管43条、肛周脓肿10个、瘘口58个,MRI诊断与手术结果对照,符合率分别为瘘管100.0%、脓肿100.0

  17. [Clinical study on the relationship between pancreatic fistula and the degree of pancreatic fibrosis after pancreatic and duodenal resection].

    Science.gov (United States)

    Yang, M W; Deng, Y; Huang, T; Zhang, L D

    2017-05-01

    Objective: To explore the risk factors of pancreatic fistula after pancreatoduodenectomy and its relationship with pancreatic fibrosis. Methods: Retrospective analysis was made including 408 patients who underwent pancreaticoduodenectomy from January 2013 to December 2015 in Department of Hepatobiliary Surgery of the First Affiliated Hospital of Third Military Medical University. There were 274 males and females, aging from 14 to 82 years with an average age of 54.6 years. Postoperative pathological diagnosis: 285 cases with pancreatic ductal adenocarcinoma, 81 cases with gastrointestinal tumors, 13 cases with neuroendocrine tumors, 16 cases with inflammatory changes, 8 cases with pancreatic papillary tumors, 4 cases with serous cystadenoma, 1 case with retroperitoneal liposarcoma.Univariate analysis using pearson's χ(2) test, multivariate analysis using binary Logistic regression analysis, correlation analysis using Spearman rank correlation analysis and the predictive value of pancreatic fibrosis in pancreatic fistula after pancreaticoduodenectomy was assessed using the area under the receiver operating characteristic(ROC) curve. Results: There were 123 cases (30.1%) with postoperative pancreatic fistula among 408 patients. Univariate analysis showed that body mass index(BMI)(P=0.005), preoperative gamma-glutamyltranspeptidase content(P=0.046), pancreatic duct diameter(P=0.001), CT value of pancreatic tissue(P=0.049), operation time(P=0.037), pancreatic stiffness (intraoperative judgment)(P=0.001) and percentage of pancreatic fibrosis(P=0.034) were the prognostic factors of pancreatic fistula. Multivariate analysis showed that BMI≥25 kg/m(2), pancreatic duct diameter ≤3 mm, pancreatic tissue CT value fistula occurrence of high-risk factor(Pfistula's CT value and percentage of pancreatic fibrosis were significantly lower than non-pancreatic fistula group, the difference was statistically significant(Pfistulae(Pfistula severity was negatively correlated with

  18. LIFT术在肛瘘治疗中的应用%Clinical Application of LIFT Procedure in Treatment of Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    陈敏; 张涛; 龚旭晨

    2012-01-01

    目的 探讨结扎括约肌间瘘管术(LIFT)对肛瘘的临床疗效.方法 对50例肛瘘管患者行LIFT术,并结合术中所见以及术后随访对LIFT术的疗效进行评价.结果 经LIFT术治疗的肛瘘患者,随访3~6个月,仅3例出现复发,术后未发生肛门失禁.结论 LIFT术操作简便,疗效显著,不损伤括约肌功能,是治疗肛瘘的有效方法.%Objective To investigate the clinical effect of LIFT procedure in treatment of anal fistula. Methods LIFT procedure was done to 50 patients with anal fistula. The finding in operation and follow-up was used to estimate the effect of LIFT procedure. Results Only 3 of the 50 patients have been found recrudescence after follow-up of 3 to 6 months. There were no anal incontinence in all the patients after the operation. Conclusion LIFT procedure as a simplified technique has notable curative effect,which does no harm to the sphincter muscle,thas is an effective treatment for anal fistula.

  19. 40 Cases of Recurrent Anal Fistula of Clinical Diagnosis and Treatment Experience%40例复发性肛瘘临床诊疗体会

    Institute of Scientific and Technical Information of China (English)

    李国栋; 袁正; 笪霞

    2014-01-01

    目的探讨复发性肛瘘的诊疗对策。方法对40例复发性肛瘘患者分析病因及个体化治疗。结果34例一次手术痊愈;3例炎症性肠病患者,一期控制肠道炎症,肛周局部引流,二期手术痊愈;2例肺外结核患者行手术及抗结核治疗后痊愈;1例骶前囊肿外院不当手术后合并形成高位肛瘘患者,治疗后无效,行高位挂线引流保守治疗。结论复发性肛瘘病因复杂,临床完善的术前检查,合理的个性化治疗是保证诊治成功的关键。%Objective To study the recurrent anal fistula and treatment countermeasures. Methods 40 cases of patients with recurrent anal fistula analyze the etiology and individual treatment. Results 34 cases by surgery; 3 cases of inflammatory bowel disease, a phase control intestinal inflammation and crissum local drainage, phase i by surgery; 2 cases of extrapulmonary tuberculosis patients after surgery and anti-tuberculosis treatment cured; 1 case of sacral cyst outer court before joined to form a high anal fistula patients after the operation, improper treatment is invalid, hanging line drainage line high conservative treatment. Conclusion The recurrent cause complex anal fistula, clinical perfect preoperative examination, reasonable individualized treatment is the key to successful treatment.

  20. Three-dimensional Anorectal Ultrasound Scanning Combining with Fistula Imaging Localization Diagnosis of Anal Fistula of Clinical Research%三维肛肠超声扫描结合瘘管造影定位诊断肛瘘临床研究

    Institute of Scientific and Technical Information of China (English)

    李瑞

    2016-01-01

    目的:探讨三维肛肠超声扫描结合瘘管造影定位诊断肛瘘的临床研究情况。方法整群选取该院2015年4月—2016年4月收治的118例经手术确诊肛瘘的患者作为研究对象,分为观察组和对照组。给予对照组实施三维肛肠超声扫描的方法诊断肛瘘,观察组在对照组的基础上实施瘘管造影定位的方法诊断肛瘘。结果观察组检测出单纯性肛瘘的例数为38例,占比64.41%,检测出复杂性肛瘘的例数为21例,占比35.59%;对照组检测出单纯性肛瘘的例数为50例,占比84.74%,检测出复杂性肛瘘的例数为9例,占比15.25%,两组在诊断肛瘘分型上的对比差异有统计学意义(P﹤0.0.5)。结论三维肛肠超声扫描结合瘘管造影定位的方式在肛瘘诊断中的应用,能够有效诊断出肛瘘的类型,对于患者肛瘘疾病的治疗具有重要的借鉴价值。%Objective To investigate the three-dimensional anorectal ultrasound scanning combined with the clinical re-search of fistula imaging localization diagnosis of anal fistula. Methods Group selection in our hospital from April 2015 to April 2016 118 cases were confirmed by surgery of anal fistula patients as the research object, for the observation group and control group. Give control to implement the three dimensional anorectal ultrasound scan method in the diagnosis of anal fistula, observation group in the control group on the basis of implementing fistula angiography positioning method in the di-agnosis of anal fistula. Results The observation group detected simple anal fistula cases for 38 cases, accounted for 64.41%, detect the complexity anal fistula cases for the 21 cases, accounted for 35.59%; Control group detected cases of simple anal fistula of 50 cases, accounted for 84.74%, detect the complexity anal fistula cases for 9 cases, accounted for 15.25%, two groups in the diagnosis of anal fistula classification comparison on difference was

  1. Clinical Application of High-field MRI in Diagnosis of Anal Fistula%高场磁共振在肛瘘诊断中的临床应用

    Institute of Scientific and Technical Information of China (English)

    余留森; 刘艳玲; 余海霞; 吴淮昌; 贾小强

    2012-01-01

    目的 探讨1.5T高场磁共振成像(MRI)在肛瘘诊断中的应用价值.方法 31例临床诊断为肛瘘的患者,术前应用磁共振体部相控阵线圈进行轴位、矢状位、冠状位的多种序列检查.结果 MRI成像均符合临床诊断,其中经括约肌肛瘘9例,括约肌间肛瘘16例,括约肌外肛瘘1例,括约肌上肛瘘5例;单纯性肛瘘11例,复杂性肛瘘20例;能够正确显示内口位置27例.结论 应用高场MRI能准确定位肛瘘的内口、瘘管的走向及其与肛管直肠括约肌之间的关系,具有重要的临床实用和推广价值.%Objective To explore the application value of 1 .5T magnetie resonance imaging in diagnosis of anal fistula. Methods 31 cases oi anal fistula were examined by MRI in phased array roil using multiple sequences such as axial, sagittal and coronal sections. Results The imaging of MRI all accorded with the clinical diagnosis,including 9 cases of anal fistula, through sphincter, 16 cases of inter sphincter anal fistula, 1 case oi outter sphincter anal fistula, and 5 cases of above sphincter anal fistula; there were 1 1 cases diagnosed as simple anal fistula,20 cases as complex anal fistula. 27 cases could be located the internal opening by MRI. Conclusion High-field MRI can locate the internal opening of anal fistula,form oi anal fistula,and the relation of anal fistula with sphincter, which has important clinical utility and promotional value.

  2. Clinical and angioarchitectural factors influencing the endovascular approach to galenic dural arteriovenous fistulas in adults: case series and review of the literature.

    Science.gov (United States)

    Cohen, José E; Gomori, John Moshe; Rajz, Gustavo; Paldor, Iddo; Moscovici, Samuel; Itshayek, Eyal

    2017-05-01

    Galenic dural arteriovenous fistulas (DAVF) are rare; however, they are the most frequent type of DAVF to manifest aggressive clinical behavior and usually represent a diagnostic and therapeutic challenge for clinicians. We retrospectively reviewed clinical and imaging data of patients managed with neuroendovascular techniques for the treatment of galenic DAVFs from 2000 to 2016. We searched the 2000-2016 English-language literature for papers discussing neuroendovascular management of galenic DAVFs, with or without companion surgical procedures. Five patients were treated for galenic DAVFs during the study period (four males; mean age, 61 years). Three presented with progressive neurological deterioration due to venous congestion, two with acute intracranial hemorrhage. Three were treated by staged transarterial embolization procedures (three procedures in two, four procedures in one); two underwent a single transvenous embolization procedure. Four out of five fistulas were completely occluded. All patients improved clinically; the patient whose fistula was partially occluded remains angiographically stable at 2-year follow-up. Six reports describing 17 patients are reviewed. Embolization was performed via transvenous approach in 1/17 and transarterial approach in 16/17 with additional open surgery in 9/16. The trend toward the use of transarterial approaches is based primarily on advances on embolization techniques that allow better and more controllable penetration of the embolizing agents with improved clinical and angiographic results, as well as the technical complexity of the transvenous approach. Although transarterial embolization is the preferred endovascular route for the management of most galenic DAVFs, selected cases can be successfully treated by transvenous approach.

  3. Secondary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

  4. Gore Bio-A® Fistula Plug: a new sphincter-sparing procedure for complex anal fistula.

    Science.gov (United States)

    Ratto, C; Litta, F; Parello, A; Donisi, L; Zaccone, G; De Simone, V

    2012-05-01

    The surgical treatment of a complex anal fistula remains controversial, although 'sphincter-saving' operations are desirable. The Gore Bio-A® Fistula Plug is a new bioprosthetic plug that has been proposed for the treatment of complex anal fistula. This study reports preliminary data following implantation of this plug. Eleven patients with a complex anal fistula underwent insertion of Gore Bio-A® Fistula Plugs. The disc diameter and number of tubes in the plug were adapted to the fistula to allow accommodation of the disc into a submucosal pocket, and the excess tubes were trimmed. During the follow-up period, patients underwent clinical and physical examinations and three-dimensional endoanal ultrasound. Fistulas were high anterior transphincteric in five patients and high posterior transphincteric in six patients. All patients had a loose seton placement before plug insertion. Two, three and four tubes were inserted into the fistula plug in seven, three and one patient, respectively. The median follow-up period was 5 months. No patient reported any faecal incontinence. There was no case of early plug dislodgement. Treatment success was noted for eight (72.7%) of 11 patients at the last follow-up appointment. Implanting a Gore Bio-A® Fistula Plug is a simple, minimally invasive, safe and potentially effective procedure to treat complex anal fistula. Patient selection is fundamental for success. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  5. Catheter-based flow measurements in hemodialysis fistulas - Bench testing and clinical performance

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Lönn, Lars; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to perform bench and clinical testing of a catheter-based intravascular system capable of measuring blood flow in hemodialysis vascular accesses during endovascular procedures. Methods: We tested the Transonic ReoCath Flow Catheter System which uses...... of agreement between results from the ReoCath Flow Catheter System and the reference flowmeter. Clinical precision, expressed as the mean coefficient of variation, was 5.9% and 4.7% for the antegrade and retrograde catheters, respectively. Flow measurements were significantly affected by the distance between...... a stenosis and the tip of a retrograde catheter with the effect being proportional to the degree of stenosis. There was no systematic bias between measurers. Conclusions: The Reocath Flow Catheter System was found to be accurate and precise. Reliable results require careful attention to catheter placement...

  6. Clinical analysis of the second operational resection in 52 cases of congenit preauricular fistula%52例先天性耳前瘘管二次手术治疗体会

    Institute of Scientific and Technical Information of China (English)

    王慧敏; 叶放蕾; 王俊杰; 陈文明

    2014-01-01

    目的:探讨先天性耳前瘘管切除术后复发的原因及再次手术的临床效果。方法:回顾性分析52例先天性耳前瘘管术后再发患者的临床资料,分析引起术后复发的原因,并对二次手术的临床效果进行统计。结果:52例患者中,27例术中可见耳轮脚前方瘘管组织残留,16例可见瘘管组织与耳轮脚软骨粘连,3例沿耳轮脚向上瘘管残余,6例残余瘘管组织伸向外耳道前下壁。50例Ⅰ期痊愈(96.15%)。结论:先天性耳前瘘管切除术后复发的原因主要为瘘管分支走形复杂导致瘘管组织残余、软骨附着等。再次手术彻底切除瘘管组织是治疗先天性耳前瘘管术后复发的有效途径。%Objective:To investigate the causes of postoperative recurrence of congenital preauricu-lar fistula and the clinical effects of the second operational resection .Methods:the clinical data of 52 cases congenital preauricular fistula with postoperative recurrence were retrospectively analyzed . The causes of postoperative recurrence and the clinical effects of the second operational resection were investigated .Results:There are 23 cases with residual fistula organization in front of the crus of helix, 16 cases with residual fistula organization adhered with anthelix cartilage , 3 cases with re-sidual fistula organization above the crus of helix , 6 cases with residual fistula organization toward the anterior-inferior wall of external auditory canal .There were 50 cases with healing by first inten-tion(96.15%).Conclusion:The main causes of postoperative recurrence of congenital preauricu-lar fistula are the complex fistula fistula branch leading to organization residual , cartilage attach-ment and so on.The second operational resection is an effective method for recrudescent congenital preauricular fistula .

  7. A Newly Designed Anal Fistula Plug: Clinicopathological Study in an Experimental Iatrogenic Fistula Model

    Science.gov (United States)

    Aikawa, Masayasu; Miyazawa, Mitsuo; Okada, Katsuya; Akimoto, Naoe; Koyama, Isamu; Yamaguchi, Shigeki; Ikada, Yoshito

    2013-01-01

    We report on a clinicopathologic study in an animal model of treatment with a new bioabsorbable polymer plug (BAPP). Over a 2-week period, 6 porcine models, which each had 4 anal fistulae, were created using Blake drains. The pigs were divided into 2 groups: the BAPP-treatment group (n = 12 fistulae) and the control group (n = 12 fistulae). Two weeks later, the pigs were humanely killed, and the perianal sites were excised and examined with gross and pathologic studies. Each fistula in the BAPP group was completely cured. In the pathologic study, the treatment sites had little disarray, few defects in the muscular layer, and small numbers of inflammatory cells. The control group had a significantly greater number of inflammatory cells and microabscesses than the BAPP group. The newly developed BAPP reduced the infection and induced good healing in anal fistulae. The BAPP may be a useful new device for the clinical treatment of anal fistulae. PMID:23701146

  8. Clinical Research on the Treatment of Anal Fistula by the Technique of Closing Internal Opening and Filling Anal Fistula by Biological Patch%生物补片内口封闭瘘道填塞术治疗肛瘘临床观察

    Institute of Scientific and Technical Information of China (English)

    史瑞霞; 王业皇; 吴金萍

    2012-01-01

    Objective:To study the clinical curative effects on the treatment of anal fistula by the technique of closing internal opening and filling anal fistula by biological patch. Methods:The technique of closing internal opening and filling anal fistula by biological patch was used to treat anal fistula. Results: During 13 cases of this group,biological patch and tissue dissolved each other well in the course of disease,part patches were gradually degraded and absorbed and external opening were gradually cured. Al present, 13 cases had been discharged from hospital, among which, 10 cases were cured and in the condition of low - position anal fistula. 1 case achieved excellent effect and was in the condition of low - position and complex anal fistula and 1 case was effective and in the condition of high - position and complex anal fistula. 1 case was ineffective and also in the condition of high - position and complex anal fistula. Conclusion: The technique of closing internal opening and filling anal fistula by biological patch has great superiority in alleviating pain in patients, narrowing areas of wounds,and reducing postoperative defect of anal canal.%目的:探讨生物补片内口封闭瘘道填塞术治疗肛瘘的临床疗效.方法:应用生物补片内口封闭瘘道填塞术治疗肛瘘.结果:本组13例患者均在病程中可见补片与组织相溶良好,部分补片逐渐降解吸收,外口逐渐愈合.经手术出院13例,其中痊愈10例,为低位肛瘘;显效1例,为低位复杂性肛瘘;有效1例,为高位复杂性肛瘘;无效1例,亦为高位复杂性肛瘘.结论:生物补片内口封闭瘘道填塞术在减轻患者疼痛,缩小创面,减少术后肛管缺损等方面具有显著优势.

  9. 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.

  10. [Acquired coronary-cameral fistula complicated by a ventricular pseudoaneurysm].

    Science.gov (United States)

    Hammami, R; Bosmans, J; Voormolen, M; Vermeulen, T; Salgado, R; Vrints, C

    2013-12-01

    Coronary-cameral fistulas are usually congenital, rarely acquired; the complication of this anomaly with ventricular pseudoaneurysm is exceptional. We report a new case of acquired coronary-cameral fistula, occurred in a patient who had received a bypass graft and who had suffered from angina 1 year after the surgery. On computed tomography coronary angiography, the fistula seems to communicate the first diagonal to a left ventricle pseudoaneurysm. Embolization of the fistula and filling of the pseudoaneurysm by neurocoil were successfully performed. The clinical and angiographic control after 3 months showed symptoms improvement and absence of recanalization of the fistula.

  11. Enigma of primary aortoduodenal fistula

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  12. The Anal Fistula Plug versus the mucosal advancement flap for the treatment of Anorectal Fistula (PLUG trial

    Directory of Open Access Journals (Sweden)

    Janssen Lucas WM

    2008-06-01

    Full Text Available Abstract Background Low transsphincteric fistulas less than 1/3 of the sphincter complex are easy to treat by fistulotomy with a high success rate. High transsphincteric fistulas remain a surgical challenge. Various surgical procedures are available, but recurrence rates of these techniques are disappointingly high. The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons. In the literature a recurrence rate between 0 and 63% is reported for the mucosal flap advancement. Recently Armstrong and colleagues reported on a new biologic anal fistula plug, a bioabsorbable xenograft made of lyophilized porcine intestinal submucosa. Their prospective series of 15 patients with high perianal fistula treated with the anal fistula plug showed promising results. The anal fistula plug trial is designed to compare the anal fistula plug with the mucosal flap advancement in the treatment of high perianal fistula in terms of success rate, continence, postoperative pain, and quality of life. Methods/design The PLUG trial is a randomized controlled multicenter trial. Sixty patients with high perianal fistulas of cryptoglandular origin will be randomized to either the fistula plug or the mucosal advancement flap. Study parameters will be anorectal fistula closure-rate, continence, post-operative pain, and quality of life. Patients will be followed-up at two weeks, four weeks, and 16 weeks. At the final follow-up closure rate is determined by clinical examination by a surgeon blinded for the intervention. Discussion Before broadly implementing the anal fistula plug results of randomized trials using the plug should be awaited. This randomized controlled trial comparing the anal fistula plug and the mucosal advancement flap should provide evidence regarding the effectiveness of the anal fistula plug in the treatment of high perianal fistulas. Trial registration ISRCTN

  13. Dural metastases from disseminated prostate cancer clinically mimicking a benign reactive condition of the dura: case report and review of the literature.

    Science.gov (United States)

    Gunia, S; Ecke, T; Wohlfarth, B; Koch, S; Erbersdobler, A

    2011-01-01

    Dural spread from prostate cancer (PC) is exceedingly uncommon. We report on a 62-year-old man suffering from disseminated PC with osseous metastases who presented with a parietal skull metastasis along with a circumscribed nodular thickening of the adjacent dura. Magnetic resonance imaging findings suggested a benign reactive condition of the dura which, however, histologically turned out to be a dural metastasis. Therefore, the present case report stresses the notion that very rarely, disseminated PC might present with clinically unsuspected dural metastases radiologically mimicking a benign condition.

  14. Video-assisted anal fistula treatment: a new concept of treating anal fistulas.

    Science.gov (United States)

    Meinero, Piercarlo; Mori, Lorenzo; Gasloli, Giorgio

    2014-03-01

    The surgical treatment of complex anal fistulas is very challenging because of the incidence of incontinence and recurrence after traditional approaches. Video-assisted anal fistula treatment is a novel endoscopic sphincter-saving technique. The aim of this article is to evaluate the results of treating complex anal fistulas from the inside and to focus on the rationale and the advantages of this innovative approach. This is a retrospective observational study. The study was conducted at a tertiary care public hospital in Italy. From February 2006 to February 2012, video-assisted anal fistula treatment was performed on 203 patients (124 men and 79 women; median age, 42 years; range, 21-77 years) who had complex anal fistulas. One hundred forty-nine had undergone previous anal fistula surgery. Video-assisted anal fistula treatment has 2 phases: diagnostic and operative. The fistuloscope is introduced through the external opening to identify the main tract, possible secondary tracts or abscess cavities, and the internal opening. With the use of an electrode, the fistula and its branches are destroyed under direct vision and cleaned. The internal opening is closed by a stapler or a flap. Half a milliliter of synthetic cyanoacrylate is used for suture reinforcement. Successful healing of the fistula was assessed with clinical evaluation. Continence was evaluated by using patient self-reports of the presence/absence of postdefecation soiling. Follow-up was at 2, 4, 6, 12, and 24 months. The 6-month cumulative probability of freedom from fistula estimated according to a Kaplan-Meier analysis is 70% (95%CI, 64%-76%). No major complications occurred. No patients reported a reduction in their postoperative continence score. The limitations of this study included potential single-institution bias, lack of anorectal manometry, and potential selection bias. Video-assisted anal fistula treatment is effective and safe for the treatment of fistula-in-ano.

  15. Pulmonary arteriovenous fistula

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001090.htm Pulmonary arteriovenous fistula To use the sharing features on this page, please enable JavaScript. Pulmonary arteriovenous fistula is an abnormal connection between an artery and ...

  16. Tracheoesophageal fistula repair - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100103.htm Tracheoesophageal fistula repair - series—Normal anatomy To use the sharing ... Editorial team. Related MedlinePlus Health Topics Esophagus Disorders Fistulas Tracheal Disorders A.D.A.M., Inc. is ...

  17. Congenital tracheobiliary fistula.

    NARCIS (Netherlands)

    Croes, F.; Nieuwaal, N.H. van; Heijst, A.F.J. van; Enk, G.J. van

    2010-01-01

    Congenital tracheobiliary fistula is a rare malformation that can present with a variety of respiratory symptoms. We present a case of a newborn patient with a tracheobiliary fistula and severe respiratory insufficiency needing extracorporal membrane oxygenation to recover.

  18. Ureteroarterial Fistula

    Directory of Open Access Journals (Sweden)

    D. H. Kim

    2009-01-01

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

  19. 切开缩创缝合治疗肛瘘的临床分析%Cut clinical analysis of suture in the treatment of anal fistula

    Institute of Scientific and Technical Information of China (English)

    张配远

    2014-01-01

    将60例肛瘘患者均采用切开缩创缝合治疗,60例均一次性痊愈。治愈率100%,46例患者术后无明显疼痛,5例术后疼痛,3例术后尿潴留。60例患者均无发生肛门失禁、肛管直肠狭窄或肛门畸形等。随访无复发。结果表明,切开缩创缝合法治疗肛瘘疗效显著,值得在临床上推广应用。%60 cases of anal fistula patients were treated with open debridement for the treatment of 60 cases of shrinkage, are one-time cure. The cure rate was 100%, 46 cases of patients with no significant postoperative pain, pain in 53 cases of uroschesis after operation. 60 patients had no occurrence of anal incontinence, anorectal stenosis or anal deformity. There was no recurrence. The results show that the shrinkage, open a suture in the treatment of anal fistula significant curative effect, and worth of clinical application.

  20. Risk factors for pancreatic fistula after pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    WANG Xiaolong

    2017-01-01

    Full Text Available ObjectiveTo investigate the risk factors for pancreatic fistula after pancreaticoduodenectomy (PD, and to provide a reference for the prevention and treatment of pancreatic fistula after PD in clinical treatment. MethodsA retrospective analysis was performed for the clinical data of 75 patients who underwent PD in Huadong Hospital, Fudan University from January 2014 to December 2015. The influencing factors for pancreatic fistula were analyzed, and the incidence rate of pancreatic fistula was compared between patients undergoing laparoscopic or open PD. The chi-square test or Fisher′s exact test was used for univariate analysis, and the logistic regression model was used for multivariate analysis. ResultsOf all patients, 21 (28% had pancreatic fistula, among whom 7 had grade A pancreatic fistula, 11 had grade B pancreatic fistula, and 3 had grade C pancreatic fistula. The univariate analysis showed that age, presence or absence of pancreatic duct dilatation, and amylase level in drainage fluid on day 1 after surgery were influencing factors for pancreatic fistula after surgery (χ2=6.868, 12.990, and 4.383, P=0.009, P<0.001, and P=0.004. The multivariate analysis showed that age ≥65 years (95%CI: 2.551-187.550, P=0.005 and absence of pancreatic duct dilatation (95%CI: 5.210-487.321, P=0.001 were risk factors for pancreatic fistula after surgery. An amylase level of ≥5000 IU/L in drainage fluid on day 1 after surgery had a certain predictive value for the development of pancreatic fistula after surgery. There was no significant difference in the incidence rate of pancreatic fistula between patients undergoing laparoscopic or open PD (18.8% vs 30.5%, P>0.05. Conclusion As for patients with an age of ≥65 years, absence of pancreatic duct dilatation, and an amylase level of ≥5000 IU/L in drainage fluid on day 1 after surgery, treatment should be given as soon as possible to avoid the development of pancreatic fistula.

  1. Anal fistula: Intraoperative difficulties and unexpected findings

    Institute of Scientific and Technical Information of China (English)

    Ahmed A Abou-Zeid

    2011-01-01

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. De-spite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical ex-amination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the oper-ation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected find-ings that can be encountered during anal fistula sur-gery and how to overcome them.

  2. Anal fistula: intraoperative difficulties and unexpected findings.

    Science.gov (United States)

    Abou-Zeid, Ahmed A

    2011-07-28

    Anal fistula surgery is a commonly performed procedure. The diverse anatomy of anal fistulae and their proximity to anal sphincters make accurate preoperative diagnosis essential to avoid recurrence and fecal incontinence. Despite the fact that proper preoperative diagnosis can be reached in the majority of patients by simple clinical examination, endoanal ultrasound or magnetic resonance imaging, on many occasions, unexpected findings can be encountered during surgery that can make the operation difficult and correct decision-making crucial. In this article we discuss the difficulties and unexpected findings that can be encountered during anal fistula surgery and how to overcome them.

  3. 肛门括约肌间瘘管结扎术治疗复杂性肛瘘效果观察%Fistula Ligation of Anal Sphincter in the Treatment of Complicated Anal Fistula:An Observation of Its Clinical Effect

    Institute of Scientific and Technical Information of China (English)

    赵剑军

    2015-01-01

    Objective:to explore the anal intersphincteric fistula ligation in the treatment of complex anal Fistula: a clinical effect.Methods: retrospective analysis of July 2011 ~2012 year in July at my hospital for treatment of 80 cases of anal fistula patients, divided into two groups according to the treatment and observation of 40 cases, fistula ligation in the treatment of the anal sphincter, and 40 patients in the control group, treated using conventional methods.Comparison of clinical efficacy.Result:to observe the clinical curative effect was significantly better than the control group, there was a statistically significant differ-ence (P<0.05) .Observation of adverse reaction incidence was significantly lower than the control group (P<0.05) , the differ-ence was statistically significant.Conclusion: when clinical treatment of complex anal fistula, fistula ligation for treatment of the anal sphincter, access to satisfactory clinical efficacy and postoperative pain is light, fast recovery, so you can consider further popularized in clinical practice.%目的:探讨肛门括约肌间瘘管结扎术治疗复杂性肛瘘的临床疗效。方法:回顾性分析2011年7月至2012年7月在我院接受治疗的复杂性肛瘘患者80例,根据治疗方法分为两组,观察组40例,采用肛门括约肌间瘘管结扎术治疗,对照组40例,采用常规方法治疗。比较两组的临床疗效。结果:观察组临床疗效明显优于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率明显低于对照组(P<0.05),差异有统计学意义。结论:临床治疗复杂性肛瘘时,采用肛门括约肌间瘘管结扎术进行治疗,能够获得满意的临床疗效,且术后疼痛感比较轻,患者恢复快,因此可以考虑在临床上进一步推广应用。

  4. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes.

    Science.gov (United States)

    Hetts, S W; Tsai, T; Cooke, D L; Amans, M R; Settecase, F; Moftakhar, P; Dowd, C F; Higashida, R T; Lawton, M T; Halbach, V V

    2015-10-01

    A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas. We performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital. Of 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments. Few patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively. © 2015 by American Journal of Neuroradiology.

  5. 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.

  6. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Science.gov (United States)

    Golabek, Tomasz; Szymanska, Anna; Szopinski, Tomasz; Bukowczan, Jakub; Furmanek, Mariusz; Powroznik, Jan; Chlosta, Piotr

    2013-01-01

    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. PMID:24348538

  7. Perianal Fistula With and Without Abscess: Assessment of Fistula Activity Using Diffusion-Weighted Magnetic Resonance Imaging.

    Science.gov (United States)

    Bakan, Selim; Olgun, Deniz Cebi; Kandemirli, Sedat Giray; Tutar, Onur; Samanci, Cesur; Dikici, Suleyman; Simsek, Osman; Rafiee, Babak; Adaletli, Ibrahim; Mihmanli, Ismail

    2015-10-01

    Magnetic resonance imaging (MRI) is highly accurate for the depiction of both the primary tract of fistula and abscesses, in patients with perianal disease. In addition, MRI can be used to evaluate the activity of fistulas, which is a significant factor for determining the therapeutic strategy. This study aimed to determine the usefulness of diffusion-weighted (DW) MRI for assessing activity and visibility of perianal fistula. Fifty-three patients with 56 perianal fistulas were included in the current retrospective study. The T2-weighted imaging (T2WI) and DWMRI were performed and apparent diffusion coefficient (ADC) values of fistulas were measured. Fistulas were classified into two groups: only perianal fistulas and fistulas accompanied by abscess. Fistulas were also classified into two groups, based on clinical findings: positive inflammatory activity (PIA) and negative inflammatory activity (NIA). Mean ADC value (mm(2)/s) of PIA group was significantly lower than that of NIA group, regarding lesions in patients with abscess-associated fistulas (1.371 × 10(-3) ± 0.168 × 10(-3) vs. 1.586 × 10(-3) ± 0.136 × 10(-3); P = 0.036). No statistically significant difference was found in mean ADC values between PIA and NIA groups, in patients with only perianal fistulas (P = 0.507). Perianal fistula visibility was greater with combined evaluation of T2WI and DWMRI than with T2WI, for two reviewers (P = 0.046 and P = 0.014). The DWMRI is a useful technique for evaluating activity of fistulas with abscess. Perianal fistula visibility is greater with combined T2WI and DWMRI than T2WI alone.

  8. Clinical Effect and Safety Evaluation of Thread-dragging Through Fistula in Treatment of Simple anal Fistula%隧道式拖线术治疗单纯性肛瘘的临床疗效及安全性评价

    Institute of Scientific and Technical Information of China (English)

    王国军

    2014-01-01

    Objective To explore the clinical effect and safety evaluation of thread -dragging through fistula in treatment of simple anal fistula .Methods 72 patients with simple anal fistula were randomly divided into thread -dragging through fistula treatment group(observation group)and the incision line treatment group(control group),36 cases in each group,compared the clinical effect of cases in two groups.Results The cured time of cases in observation group was(21.2 ±6.8)d,less than that in control group(29.6 ±10.1)d,there was significant difference between two groups(P0.05).All patients had no complications.Conclusion Taking thread -dragging through fistula in treatment of simple anal fistula has good clinical effect and high safety,worthy of further clinical application.%目的:探讨隧道式拖线术治疗单纯性肛瘘的临床疗效及安全性。方法将72例单纯性肛瘘患者随机分为隧道式拖线术治疗组(观察组)和切开挂线治疗组(对照组),每组各36例,比较两组患者的临床疗效。结果观察组患者治愈时间为(21.2±6.8)d,少于对照组患者的(29.6±10.1)d,组间差异有统计学意义(P<0.05)。观察组患者治疗总有效率为94.4%,对照组患者治疗总有效率97.2%,组间差异无统计学意义(P>0.05)。两组患者术后均未出现并发症。结论隧道式拖线术治疗单纯性肛瘘临床疗效确切,安全性高,值得临床进一步推广使用。

  9. STUDY OF ENTEROCUTANEOUS FISTULA

    Directory of Open Access Journals (Sweden)

    Arti

    2015-03-01

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

  10. Aortocaval fistula complicating abdominal aortic aneurysm: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Bong Gak; Kim, Hyun; Kang, Si Won [College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of); Kim, Man Deuk [College of Medicine, Pochon CHA Univ., Pochon (Korea, Republic of)

    2002-01-01

    Aortocaval fistula is rare complication arising from an abdominal aortic aneurysm. A typical feature observed during the arterial phase of contrast-enhanced CT scanning in such patients is simultaneous enhancement of the dilated inferior vena cava and aorta. Awareness of the specific radiologic features of aortocaval fistula may facilitate diagnosis when the condition is unsuspected clinically. We report a case of aortocaval fistula secondary to abdominal aortic aneurysm, and review the previous literature.

  11. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-12-01

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

  12. Pancreaticopleural Fistula: Revisited

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2012-01-01

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

  13. Combined partial fistulectomy and electro-cauterization of the intersphincteric tract as a sphincter-sparing treatment of complex anal fistula: clinical and functional outcome.

    Science.gov (United States)

    Shafik, A A; El Sibai, O; Shafik, I A

    2014-11-01

    The aim of this study was to report a simple, effective and safe procedure, associated with minimal risk of incontinence and recurrence, for treating complex anal fistulas. This was a prospective study of 53 consecutive patients with complex anal fistulas. The technique used included excision of the distal part of the fistula tract down to the external anal sphincter and electro-cauterization of the intersphincteric part of the tract with simple closure of the internal opening. Data collected included patient characteristics, fistula type determined by magnetic resonance imaging, pre- and postoperative continence status evaluated using the Wexner incontinence score (0-10), previous operations, hospital stay, healing time, recurrence rate and complications. The patients had a mean age of 41.37 ± 7.82 years; the most frequent fistula type was the high transsphincteric fistula; the mean follow-up period was 19 months with a success rate of 92.5 %; the mean wound healing time was 3.6 weeks; the incontinence scores were the same as before the procedure. The recurrence rate was 7.5 %. Partial fistulectomy combined with electrocauterization of the intersphincteric fistula tract is a simple, and effective procedure for the treatment of complex anal fistulas.

  14. 99例肛瘘切除I期缝合术治疗低位单纯性肛瘘的临床疗效%Clinical Effi cacy of 99 Patients with Low Anal Fistula Treated by Simple Suture of Stage I Anal Fistula Removal

    Institute of Scientific and Technical Information of China (English)

    李津; 叶文峰; 朱沛劲

    2012-01-01

    Objective:Excision of anal fistula closure in the treatment of stage I anal fistula simple low clinical efficacy. Methods:Retrospective analysis of our hospital in January 2009 ~ May 2010 were treated 99 cases of the use of simple low anal fistula anal fistula excision and suture in the treatment of stage I patients with information, summarize the patient's recovery, postoperative complications. Results:99 patients in Grade healing in 72 cases, accounting for 72.73%; B healed in 20 cases, accounting for 20.20%; C healed in 7 cases, accounting for 7.07%. All patients had no incontinence, anal sphincter dysfunction, and anal stenosis happen. Conclusion:Resection with fistula closure in the treatment of stage I of simple low anal fistula can achieve good results, mostly in patients with grade healing, postoperative complications, less worthy of clinical use.%目的:探讨肛瘘切除I期缝合术治疗低位单纯性肛瘘的临床疗效.方法:回顾性分析我院2009年1月~2010年5月收治的99例低位单纯性肛瘘并采用肛瘘切除I期缝合术治疗的患者资料,总结患者的痊愈情况,术后并发症情况.结果:99例患者中,甲级愈合72例,占72.73%;乙级愈合20例,占20.20%;丙级愈合7例,占7.07%.所有患者均无大小便失禁、肛门括约肌功能障碍和肛门狭窄等情况发生.结论:采用肛瘘切除I期缝合术治疗低位单纯性肛瘘能取得较好的效果,患者多为甲级愈合,术后并发症较少,值得在临床推广使用.

  15. Asymptomatic cholecystocolonic fistula: a diagnostic and therapeutic dilemma.

    Science.gov (United States)

    Antonacci, Nicola; Taffurelli, Giovanni; Casadei, Riccardo; Ricci, Claudio; Monari, Francesco; Minni, Francesco

    2013-01-01

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

  16. [Fistulas of the lower urinary tract in children].

    Science.gov (United States)

    Tonegatti, Luca; Scarpa, Maria-Grazia; Goruppi, Ilaria; Olenik, Damiana; Rigamonti, Waifro

    2015-01-01

    A lower urinary tract fistula consist in an abnormal connection between bladder, urethra and adjacent abdominal organs or skin. There are several types of urinary fistulas in paediatric age and they may be congenital or acquired. Etiology may be due to embriological defects, infectious processes, malignant tumours, pelvic irradiation as well as complications following surgical procedures, especially postsurgical repair of hypospadia or epispadia. Clinical presentation depends on the type of fistula and diagnosis is based on signs, symptoms and radiological or endoscopic examinations. We performed PubMed research using terms such as lower urinary fistulae, urology and paediatrics and we consulted medical texts. We reviewed selected articles and used the relevant ones to perform our study concentrating on classification, diagnosis and treatment of different types of fistulas. Paediatric lower urinary fistulas are an uncommon pathology, but the knowledge of their etiology and classification is important to recognise them and lead the physician to an appropriate treatment, which is surgical in most cases.

  17. Asymptomatic Cholecystocolonic Fistula: A Diagnostic and Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Nicola Antonacci

    2013-01-01

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

  18. Clinical curative effect analysis of different operation methods in the treatment of complex anal fistula%不同手术方法治疗复杂性肛瘘的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    吴根良

    2015-01-01

    目的:探讨不同手术方式在复杂性肛瘘治疗中的临床疗效及优点。方法:2002年4月-2014年1月收治复杂性肛瘘患者255例,其中行切缝内口引流术64例,切开挂线术68例,瘘管旷置术58例,瘘管摘除缝合术65例。对255例复杂性肛瘘进行术后随访。结果:255例患者随访时间7个月~3年,平均(11.8±4.8)个月。切缝内口引流术复发6例(9.4%),平均愈合时间(19.4±5.6)d;切开挂线术复发2例(2.9%),平均愈合时间(20.1±5.3)d;瘘管旷置术复发7例(12.1%),平均愈合时间(28.8±7.2)d;瘘管摘除缝合术复发9例(13.8%),平均愈合时间(24.7±6.9)d。结论:高位的复杂性肛瘘常采用瘘管旷置术和切开挂线术,低位的复杂性肛瘘常采用瘘管摘除缝合术和切缝内口引流术。%Objective:To explore the clinical curative effect and advantages of different operation methods in the treatment of complex anal fistula.Methods:255 patients with complex anal fistula were selected from April 2002 to January 2014.64 cases were given cutting seam endostoma drainage,68 cases were incision hang line operation,58 cases were fistula putting-aside operation, 65 cases were fistula removed suture operation.255 cases of complex anal fistula were followed up postoperatively.Results:255 patients were followed up for 7 months to 3 years,the average was (11.8 ± 4.8)months.6 cases(9.4%) were recurrence in cutting seam endostoma drainage,the mean healing time was (19.4 ± 5.6)days.2 cases(2.9%) were recurrence in incision hang line operation,the mean healing time was (20.1±5.3)days.7 cases(12.1%) were recurrence in fistula putting-aside operation,the mean healing time was (28.8±7.2)days.9 cases(13.8%) were recurrence in fistula removed suture operation,the mean healing time was (24.7 ± 6.9)days.Conclusion:The elevatus complex anal fistula often adopts fistula putting-aside operation and incision hang line operation,the low-order complex anal

  19. [Traumatic arteriovenous pial fistula masquerading as a carotid-cavernous fistula: an uncommon disorder with an unusual presentation].

    Science.gov (United States)

    Santos-Franco, Jorge Arturo; Lee, Angel; Nava-Salgado, Giovanna; Zenteno, Marco; Gómez-Villegas, Thamar; Dávila-Romero, Julio César

    2012-01-01

    Traumatic intracranial pial arteriovenous fistulae are infrequent lesions. Their cardinal signs have been related to mass effect and hemorrhage, but their clinical manifestations due to venous retrograde flow into ophthalmic veins has never been described. This phenomenon is usually seen in dural arteriovenous fistula draining to the cavernous sinus or carotid-cavernous sinus fistula.A traumatic intracranial pial arteriovenous fistula arising from the supraclinoid internal carotid artery in a young patient was revealed by aggressive behavior and ophthalmologic manifestations. The endovascular management included the use of coils, stent, and ethylene-vinyl alcohol with transient balloon occlusion of the parent vessel.

  20. Clinical Significance of Magnetic Resonance Imaging before Complex Anal Fistula Surgery%术前磁共振检查在复杂性肛瘘手术中的临床意义

    Institute of Scientific and Technical Information of China (English)

    孙平良; 陈文福; 李晶; 黄艳; 蒙建兴

    2011-01-01

    目的 探讨术前磁共振(MRI)检查对复杂性肛瘘手术的临床意义.方法 将80例复杂性肛瘘患者分为低位观察组、低位对照组、高位观察组、高位对照组四组,每组20例.低位观察组和高位观察组术前进行MRI检查,记录内口位置、数目,并与术中情况进行比较;低位对照组和高位对照组术前单依靠临床经验诊断,不进行MRI检查.对四组的术后手术次数、再次手术率、愈合时间、半年后复发率进行比较.结果 低位观察组与低位对照组比较,在术中发现内口数量、手术次数、再次手术率、愈合时间及复发情况方面,两组差异均无统计学意义(P>0.05).而高位观察组与高位对照组比较,在术中发现内口数量、手术次数、愈合时间方面,两组差异有统计学意义(P<0.05).高位对照组的再次手术率高于高位观察组,无统计学差异(P>0.05);高位观察组的MRI内口部位准确率高于低位观察组,无统计学意义(P>0.05).结论 术前MRI检查能提高高位复杂性肛瘘的临床疗效,应成为高位复杂性肛瘘的术前常规检查项目.%Objective To explore the clinical significance of magnetic resonance imaging( MRI )before complex anal fistula surgery. Methods 80 cases of complex anal fistula were divided into a low - level fistula observation group, a low -level fistula control group, a high -level fistula observation group and a high -level control group ,20 cases in each one. Before the surgery, MRI was performed in low -level fistula observation group and high - level fistula observation group. The location and number of internal opening were recorded and compared with those discovered in the surgery. In low - level control group and high - level control group, the diagnosis relied only on the clinical experience before the surgery,without MRI performed. The comparison was conducted after the surgery among four groups in terms of the surgical frequency, re - surgical

  1. Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Naoko; Naito, Isao; Takatama, Shin; Shimizu, Tatsuya; Iwai, Tomoyuki [Geriatrics Research Institute and Hospital, Department of Neurosurgery, Maebashi (Japan); Shimaguchi, Hidetoshi [Gunma University Graduate School of Medicine, Department of Neurosurgery, Maebashi (Japan)

    2009-01-15

    Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) rarely cause venous infarction (VI) and/or intracranial hemorrhage (ICH) despite the presence of cortical venous drainage (CVD). The present study investigated the characteristics of CS DAVFs manifesting as VI/ICH. Fifty-four patients treated for CS DAVFs were retrospectively studied. Six patients presented with VI/ICH. Two of the three patients presenting with ICH had CVD only to the superficial sylvian vein (SSV) or the deep sylvian vein (DSV). Three patients presenting with VI had multiple drainages, and angiography of these patients showed a varix on the SSV, drainage into the DSV with agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the distal petrosal vein. CS DAVF with CVD only carries higher risk of VI/ICH than multiple drainages. Many CS DAVFs presenting with VI, especially those with drainage into the petrosal vein, have multiple drainages in the early stage. Thrombosis of the inferior and superior petrosal sinuses and superior orbital vein gradually increases pressure of the CVD, and then, VI may occur. In contrast, CS DAVFs with CVD only from the beginning, common in the patients with drainage into the SSVs and DSVs, are likely to cause ICH. Angiographic risk factors causing VI/ICH are CVD only, varix formation, agenesis of the second and third segment of basal vein of Rosenthal, and thrombosis of the superior orbital vein, lateral half of the superior petrosal sinus, and distal CVD. (orig.)

  2. 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.

  3. Anal abscess and fistula.

    Science.gov (United States)

    Sneider, Erica B; Maykel, Justin A

    2013-12-01

    Benign anorectal diseases, such as anal abscesses and fistula, are commonly seen by primary care physicians, gastroenterologists, emergency physicians, general surgeons, and colorectal surgeons. It is important to have a thorough understanding of the complexity of these 2 disease processes so as to provide appropriate and timely treatment. We review the pathophysiology, presentation, diagnosis, and treatment options for both anal abscesses and fistulas.

  4. Vesicouterine fistula: MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, J.M.; Lomas, D.J. [Dept. of Radiology, Addenbrooke' s Hospital and University of Cambridge, Cambridge (United Kingdom); Lee, G.; Doble, A. [Dept. of Urology, Addenbrooke' s Hospital and University of Cambridge (United Kingdom); Sharma, S.D. [Dept. of Urology, Peterborough NHS Trust Hospital (United Kingdom)

    1999-07-01

    A case of vesicouterine fistula in a young woman following caesarean section is presented. The diagnosis was established successfully using heavily T2-weighted MRI which clearly demonstrated fluid within the fistula, obviating the need for conventional radiographic contrast examination. (orig.)

  5. Carotid cavernous fistula: Ophthalmological implications

    Directory of Open Access Journals (Sweden)

    Chaudhry Imtiaz

    2009-01-01

    Full Text Available Carotid cavernous fistula (CCF is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery or both. These fistulas may be divided into spontaneous or traumatic in relation to cause and direct or dural in relation to angiographic findings. The dural fistulas usually have low rates of arterial blood flow and may be difficult to diagnose without angiography. Patients with CCF may initially present to an ophthalmologist with decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. Patients with CCF may have predisposing causes, which need to be elicited. Radiological features may be helpful in confirming the diagnosis and determining possible intervention. Patients with any associated visual impairment or ocular conditions, such as glaucoma, need to be identified and treated. Based on patient′s signs and symptoms, timely intervention is mandatory to prevent morbidity or mortality. The conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. Ophthalmologist may be the first physician to encounter a patient with clinical manifestations of CCF, and this review article should help in understanding the clinical features of CCF, current diagnostic approach, usefulness of the available imaging modalities, possible modes of treatment and expected outcome.

  6. 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.

  7. Spontaneous aortocaval fistula.

    Directory of Open Access Journals (Sweden)

    Rajmohan B

    2002-07-01

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

  8. Clinical observation of the ligation of intersphincteric fistula tract in the treatment of simple anal fistula%括约肌间瘘管结扎术在单纯肛瘘治疗中的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    田颖; 张忠涛; 安少雄; 贾山; 刘连成; 于洪顺

    2015-01-01

    Objective To investigate the clinical efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of simple anal fistula, including transphincteric anal fistula and insphincteric anal fistula. Methods Clinical data of 52 patients with anal fistula receiving surgery treatment in Beijing Anorectal Hospital from January to October 2014 were analyzed retrospectively. Adoption of surgical procedure was based on rectal endoluminal ultrasound and patients′ decision. Patients were divided into LIFT group and seton group. The two groups were compared in terms of operation time, blood loss, postoperative pain score, incidence of urinary retention, wound healing time, cure rate, recurrence, and the anal incontinence score. Results There were 52 patients in the entire cohort including 28 cases of transphincteric anal fistula (14 cases of LIFT and seton placement groups) and 24 cases of intersphincteric anal fistula (12 case of LIFT and seton placement). The operation time was shorter in seton placement group in patients with two simple anal fistula [ ( 23 . 9 ± 5.0) min vs. (46.3±7.7) min, P0.05]. The cure rate of intersphincteric anal fistula was 83.3%(10/12) in LIFT group, and 100%(12/12) in the seton group. The cure rate of transphincteric anal fistula was 78.6% (11/14) in LIFT and 92.9%(13/14) in anal fistula seton group. There was no statistically significant difference (P>0.05). Conclusion In the treatment of transphincteric fistula tract and intersphincteric fistula tract, LIFT procedures should be considered.%目的 探讨括约肌间瘘管结扎术(LIFT)在单纯肛瘘(包括经括约肌肛瘘和括约肌间肛瘘)治疗中的临床疗效.方法 对北京市肛肠医院肛肠外科2014年1-10月期间治疗的52例肛瘘患者临床资料进行回顾性分析. 根据直肠腔内超声诊断结果、患者自愿选择手术方式的原则,分组进行LIFT和肛瘘切开挂线术配对研究,比较两种术式的手术时间、出血量、术后

  9. Efficacy of LIFT for recurrent anal fistula.

    Science.gov (United States)

    Lehmann, J-P; Graf, W

    2013-05-01

    Ligation of the intersphincteric fistula tract (LIFT) is a novel sphincter-preserving technique for anal fistula. This pilot study was designed to evaluate the results in patients with a recurrent fistula. Seventeen patients [nine men; median age 49 (range, 30-76) years] with a recurrent trans-sphincteric fistula were treated with a LIFT procedure between June 2008 and February 2011. All were followed prospectively for a median of 16 (range, 5-27) weeks with clinical examination. Fifteen followed for 13.5 (range, 8-26) months by clinical examination also had three-dimensional (3D) anal ultrasound. The duration of the procedure was 35 (range, 18-70) min. One patient developed a small local haematoma and one had a subcutaneous infection, but otherwise there was no morbidity. At follow up, 11 (65%) patients had a successful closure, two (12%) had a remaining sinus and four (23%) had a persistent fistula. The incidence of persistent or recurrent fistulae at 13.5 months was six (40%) of 15 patients. No de novo faecal incontinence was reported. LIFT is a safe procedure for patients with recurrent anal fistula, with healing at short-term and medium-term follow-up comparable with or superior to that of other sphincter-preserving techniques. Larger studies with a longer follow up are needed to define the ultimate role of LIFT in patients with recurrence. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  10. The Experience of Clinical Treatment and Care for Patients with Intestinal Fistula Operation with Taking 20 Examples%20例肠瘘术后患者的临床护理分析体会

    Institute of Scientific and Technical Information of China (English)

    高丽杰

    2014-01-01

    目的:探讨20例肠瘘患者术后的临床观察护理效果。方法通过对20例肠瘘患者术前术后的临床护理进行分析。结果在医务人员精心护理下20例患者均有好转,临床护理效果显著。结论对肠瘘患者做好术前术后的护理,能够促进患者早日康复,对患者恢复身体健康尤为重要。%Objective Making a discussion on the clinical examination on treatment and nursing care for 20 patients with intestinal fistula operation. MethodsAnalyzing clinical pre-surgica and post-surgical treatment data selected from 20 cases of patients with fistula.Results because of the considerate treatment and care, al of the 20 patients have turned into a better state; the clinic treatment and care have showed its satisfactory effect. Conclusion Providing a considerate treatment for the patients with intestinal fistula operation is quite conducive for their rehab.

  11. Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings

    Directory of Open Access Journals (Sweden)

    Puneet S Kochar

    2016-01-01

    Full Text Available We describe the clinical, laboratory, and imaging data of three patients who are proven cases of blastomycosis with cranial involvement. In this review, we discuss the imaging features of cranial blastomycosis with relevant clinical case examples including computed tomography (CT, magnetic resonance imaging (MRI, and advanced MR imaging techniques like magnetic resonance spectroscopy (MRS and MR perfusion. Literature is reviewed for modern-day diagnosis and treatment of this fatal intracranial infection, if not diagnosed promptly and managed effectively.

  12. Aortoesophageal fistula in a child

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda

    2013-01-01

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

  13. 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.

  14. 经肛周三维超声对肛瘘诊断价值的研究%Clinical value of trans-anal three dimensional ultrasound in diagnosis of anal fistula

    Institute of Scientific and Technical Information of China (English)

    余俊丽; 杨川; 王晓学; 郑小迪; 艳玲; 刘广健; 曹飞; 覃斯

    2015-01-01

    目的:探讨经肛周三维超声检查在肛瘘诊断中的应用价值。方法术前对39例肛瘘患者分别行经肛周高频联合经直肠双平面超声和经肛周三维超声检查,以手术结果为金标准,分析并比较2种检查方法对肛瘘的诊断价值。结果经肛周高频联合经直肠双平面二维超声检查均能充分显示39例患者的病灶,进行有效评估;经肛周三维超声因受扫查深度和观察范围不足影响而未能对2例(2/9)高位肛瘘及5例(27.8%)复杂性肛瘘患者进行有效评估。经肛周三维超声检查对内口、瘘管、合并脓肿的探查情况及分型比经肛周高频联合经直肠双平面超声检查的符合率稍低,分别为82.1% vs.87.2%、82.1% vs.92.3%、64.1% vs.76.9%及82.1% vs.92.3%,但比较差异均无统计学意义(P 均>0.05)。2种方法对低位和高位肛瘘以及单纯性和复杂性肛瘘在内口、瘘管、合并脓肿及分型方面的诊断符合率比较差异均无统计学意义(P 均>0.05)。经肛周三维超声检查可以形象地显示肛瘘整体观,可以得到二维图像难以得到的 C 平面。三维表面成像及断层超声成像模式多层面显像可以连续追踪观察瘘管的走行。结论经肛周三维超声检查能直观地评估肛瘘情况,尤其适用于低位及单纯性肛瘘,但因受扫查深度和范围等的影响使其对部分高位和复杂性肛瘘的评估受限。肛周三维超声检查可作为经肛周高频联合经直肠双平面超声的备用检查方式。%Objective To evaluate the clinical value of trans-anal three-dimensional ultrasound in di-agnosis of anal fistula.Methods Thirty nine patients diagnosed with anal fistula received trans-anal high-fre-quency linear probe combined with transrectal biplane ultrasound and trans-anal three-dimensional ultrasound before surgery.Surgical outcomes were considered as gold

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

    Directory of Open Access Journals (Sweden)

    Zhenming ZHANG

    2012-01-01

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

  16. Endovascular management of intracranial pial arterio-venous fistulas.

    Science.gov (United States)

    Limaye, U S; Siddhartha, W; Shrivastav, M; Anand, S; Ghatge, S

    2004-03-01

    From 1996-2002 we treated 5 consecutive cases of pial fistula. There were 3 patients with a single hole-single channel pial fistula and two patients had a complex pial fistula. Three patients presented with intracerebral hematoma and had a focal neurological deficit. One patient presented with history of seizures and 1 patient had headache. The results of the treatment were analyzed both clinically and angiographically. The follow-up period ranged from 6 months to 6 years. All fistulas were treated with concentrated glue. The glue cast included the distal part of the feeding artery, A-V connection and the proximal part of the vein. Post-embolisation angiography showed complete occlusion of two single-hole fistulas and one complex pial A-V fistula and near total occlusion of one single-hole and one complex pial A-V fistula. Four patients had excellent clinical outcome. One patient with single-hole fistula had a hemorrhagic venous infarct resulting in transient hemiparesis.

  17. Clinical Implications of the 2016 International Study Group on Pancreatic Surgery Definition and Grading of Postoperative Pancreatic Fistula on 775 Consecutive Pancreatic Resections.

    Science.gov (United States)

    Pulvirenti, Alessandra; Marchegiani, Giovanni; Pea, Antonio; Allegrini, Valentina; Esposito, Alessandro; Casetti, Luca; Landoni, Luca; Malleo, Giuseppe; Salvia, Roberto; Bassi, Claudio

    2017-07-03

    The aim of the present study was to evaluate the clinical implications of the 2016 International Study Group for Pancreatic Surgery (ISGPS) definition and classification of postoperative pancreatic fistula (POPF) using a single high-volume institutional cohort of patients undergone pancreatic surgery. The ISGPS definition and grading system of POPF has been recently updated. Although the rationale for the changes was supported by previous studies, the effect of the new definition and classification scheme on surgical series has not been established. A total of 775 patients undergone pancreatic surgery in our institute from 2013 to 2015 were reviewed. The parameters modified in the ISGPS classification were analyzed according to postoperative outcomes. Finally the classification was validated by external clinical and economical outcomes. Applying the 2016 scheme, 17.5% of patients changed classification group compared to the 2015 system. Grade B increased from 11.5% to 22.1%, whereas grade C decreased from 15.2% to 4.6%. Biochemical leak occurred in 7% of patients, and it did not differ from the non-POPF condition in terms of surgical outcomes. Non-POPF group, grades B and C POPF differed significantly in terms of intensive care unit staying (P < 0.001), length of stay (P < 0.001), readmission rate (P < 0.001), and hospital costs (P < 0.001). The present study has confirmed the pertinence of the changes introduced in the 2016 ISGPS POPF definition and grading. This updated classification is effective in identifying three conditions that differ in terms of clinical and economic outcomes. These results suggested the reliability of the new definition and scheme in classifying POPF-related outcomes.

  18. Clinical Treatment and Nursing Care for Diabetic Patients with Anal Fistula%糖尿病患者合并肛瘘的临床治疗及其护理

    Institute of Scientific and Technical Information of China (English)

    潘景英; 李楠; 张建英

    2015-01-01

    目的:探讨糖尿病患者合并肛瘘的临床治疗及其护理。方法选取我院2013年11月和2014年11月收治的60例肛瘘患者为研究对象,回顾手术治疗方法和护理方法。结果对60糖尿病患者合并肛瘘患者的治疗疗效进行分析,发现痊愈患者有45(75.0%)例,有效患者11(18.3%)例,无效患者4(6.7%)例。总有效率为93.3%结论手术治疗治疗糖尿病合并肛瘘效果较好,同时合理的临床护理有助于手术治疗和术后恢复。%Objective To investigate the clinical treatment and nursing for diabetic patients with anal fistula.Methods 60 patients with anal fistula admitted in our hospital between November 2013 and November 2014 were selected as the subjects. And the methods of surgery and nursing for the patients were reviewed.Results The result of the treatment effect of 60 diabetic patients with anal fistula showed that 45 cases(75.0%) were cured, the treatment was effective in 11 cases(18.3%), and that was invalid in 4 cases(6.7%), the overall response rate was 93.3%.Conclusion For diabetes complicated by anal fistula, surgical treatment has good effect, and proper clinical nursing is conducive to the surgical treatment and postoperative recovery.

  19. 前臂自体动静脉内瘘建立血液透析通路的临床分析%A clinical analysis of dynamic forearm autogenous hemodialysis pathway of arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    王伟; 秦东强

    2014-01-01

    Objective To investigate the end-stage renal failure patients with forearm operation mode, establish the fistula intravenous operation experience and application value. Methods in our department from 2007 to 2013 implementation of internal arteriovenous fistula in 106 cases of clinical data, wherein thesnuffbox arteriovenous fistula group (82 cases), wrist fistula group (24 cases), postoperative anastomotic acute occlusion detection Forgarty thrombectomy in5cases,anastomotic stenosis and thrombosis embolectomy operation again balloon dilatation of recanalization in 4 cases. Reasons for success rate and complications of operation mode, operation points. Results 106 patients with autologous arteriovenous fistula, 98(92.5%) cases were successful, failed in 8(7.5%) cases, 1 cases of re occlusion thrombectomy, 42 cases of limb edema patients. No high output heart failure and stealsyndrome. Color Doppler ultrasound examination of fistula blood flow more than 300ml/min after March. Conclusion snuffbox arteriovenous fistula is the preferred way to access for hemodialysis, the same wrist fistula can successfully recommended hemodialysis access, to treat the postoperative complication, can avoid the fistulae.%目的:探讨终末期肾功能衰竭患者前臂自体动静脉内瘘建立的手术方式、手术经验及应用价值。方法总结我科2007年1月-2013年3月施行自体动静脉内瘘术106例患者的临床资料,其中鼻咽窝内瘘组(82例),腕部内瘘组(24例);术后吻合口急性闭塞探查Fogarty取栓5例,吻合口狭窄并血栓形成再次手术取栓加球囊扩张再通4例。分析手术方式的选择、操作要点、成功率及并发症原因。结果106例自体动静脉内瘘术,成功98例(92.5%),失败8例(7.5%),取栓后再次闭塞1例,患肢不同程度水肿42例。无高输出量心力衰竭及窃血综合征发生。3个月后彩色多普勒超声检查内瘘血流量大于300 mL/min。结论鼻

  20. Pancreaticopleural fistula : CT demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, Jin Kyeung [Chuncheon Medical Center, ChunChon (Korea, Republic of)

    1997-03-01

    In patients with chronic pancreatitis, the pancreaticopleural fistula is known to cause recurrent exudative or hemorrhagic pleural effusions. These are often large in volume and require treatment, unlike the effusions in acute pancreatitis. Diagnosis can be made either by the finding of elevated pleural fluid amylase level or, using imaging studies, by the direct demonstration of the fistulous tract. We report two cases of pancreaticopleural fistula demonstrated by computed tomography.

  1. The clinical value of transthoracic echocardiography and Multi-slice spiral CT for evaluation of fistula diameter in patients with coronary artery fistula%经胸超声心动图及多层螺旋CT对诊断冠状动脉瘘患者的临床价值

    Institute of Scientific and Technical Information of China (English)

    李晓明; 牛宝荣; 吴山; 杨娅; 张纯

    2015-01-01

    目的:以血管造影为“金标准”,评价经胸超声心动图( transthoracic echocardiography,TTE)和多层螺旋CT( multi-slice spiral CT,MSCT)筛查冠状动脉瘘及估算瘘口直径的能力,并分析其各自的影响因素。方法回顾性分析北京安贞医院接受封堵术治疗并经血管造影确诊为冠状动脉瘘的患者,所有患者均于术前1个月内接受TTE及MSCT辅助检查。结果以血管造影结果为金标准,MSCT及TTE对冠状动脉瘘患者的明确诊断准确度为96.7%及90.0%。针对瘘口直径的测定,血管造影对瘘口直径的平均测定值为(8.70±3.50)mm,MSCT及TTE的平均估算值分别为(8.86±3.71)mm及(7.50±5.90)mm,经配对t检验,P值均>0.05。但MSCT估测值较TTE的估算值与血管造影结果的相关性更好( r值分别为0.913及0.778,P值均10.5mm时,TTE高估瘘口直径;MSCT估测结果则与血管造影间的吻合性良好。结论 TTE和MSCT对冠状动脉瘘患者的筛查准确度均较高。但是,对于瘘口直径的判断,MSCT的稳定性较TTE更佳,其术前应用可以进一步提高诊断的准确性。%Objective Angiography as a reference to evaluate the clinical value of transthoracic echocardiography ( TTE) and multi – slice apiral CT ( MSCT) for evaluation of fistula diameters in patients with coronary artery fis-tula( CAF) ,and to investigate their influencing factors. Method Thirty consecutive patients who had coronary artery fistula were revealed by angiography through the interventional operation in Anzhen Hospital. Result Accuracy of MSCT and TTE for diagnosis of CAF are 96. 7% and 90. 0% ,with angiography as reference. For CAF patients, di-ameter of fistula determined by MSCT ,TTE and Angiography were (8. 86 ± 3. 71) mm,(7. 50 ± 5. 90) mm and (8. 70 ± 3. 50)mm (all P>0. 05). But, fistula diameter revealed by MSCT was better related with angiography re-sult than that revealed by TTE (r=0. 913 and 0. 778,P<0. 001). And through Bland-Altman analyze

  2. [Preliminary efficacy of video-assisted anal fistula treatment for complex anal fistula].

    Science.gov (United States)

    Liu, Hailong; Xiao, Yihua; Zhang, Yong; Pan, Zhihui; Peng, Jian; Tang, Wenxian; Li, Ajian; Zhou, Lulu; Yin, Lu; Lin, Moubin

    2015-12-01

    To evaluate the preliminary efficacy of video-assisted anal fistula treatment (VAAFT) for complex anal fistula. Clinical data of 11 consecutive patients with complex anal fistula undergoing VAAFT in our department from May to July 2015 were reviewed. VAAFT was performed to manage the fistula under endoscope without cutting or resection. VAAFT was successfully performed in all the 11 patients. The internal ostium was closed using mattress suture in 10 cases, and Endo-GIA stapler in 1 case. The mean operative time was (42.0±12.4) min, mean hospital stay was (4.1±1.5) d. Complication included bleeding and perianal infection in 1 case respectively. After 1 to 3.2 months follow-up, success rate was 72.7%(8/11), and no fecal incontinence was observed. Video-assisted anal fistula treatment is an effective, safe and minimally invasive surgical procedure for complex anal fistula with preservation of anal sphincter function.

  3. Z-plasty for uterus-to-abdominal-wall fistula

    Institute of Scientific and Technical Information of China (English)

    Lou Xiaoli; Zhang Mingli; Cui Ying; Song Jianxing

    2009-01-01

    Objective: Uterus-to-abdominal-wall fistula is a very rare complication after uterine-incision delivery over the last decades. It can even lead to death. Mainly, the fistula occurs when big tension and critical infection exist within the incision of uterus and abdominal wall. Methods: The authors described the clinical presentation, pathology of uterus-to-abdominal-wall fistula, and reported their experience in 6 cases who underwent Z-plasty operation for this rare complication from January 1998 to January 2008. Results: All flaps survived completely and all the wounds in abdominal walls healed very well. The six cases were followed up for 1 to 5 years, and no fistula recurrence occurred. Conclusion: Z-plasty technique is a very simple and efficient approach to repair uterus to abdominal fistula after uterine-incision delivery.

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

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

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

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

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Masato Shino

    2014-01-01

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

  7. The association of carotid cavernous fistula with Graves′ ophthalmopathy

    Directory of Open Access Journals (Sweden)

    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.

  8. A clinical and neurobiological case of IgM NMDA receptor antibody associated encephalitis mimicking bipolar disorder.

    Science.gov (United States)

    Choe, Chi-Un; Karamatskos, Evangelos; Schattling, Benjamin; Leypoldt, Frank; Liuzzi, Gianpiero; Gerloff, Christian; Friese, Manuel A; Mulert, Christoph

    2013-07-30

    Autoimmune encephalitis associated with IgG antibodies to the N-methyl-d-aspartic acid receptor subunit NR1 (NMDAR) presents with neurological symptoms, such as seizures, and especially psychiatric symptoms, such as hallucinations, psychosis, agitation and anxiety. To date, however, the pathological relevance of IgM NMDAR antibodies remains elusive. Here, we describe clinical, neuroradiological and neurobiological findings of a 28-year-old male presenting with IgM NMDAR antibodies coincident with autoimmune encephalitis characterized by symptoms of bipolar disorder. After repeated steroid treatment, cognitive and psychiatric abnormalities improved and no NMDAR antibody was detectable. Using primary neuronal cultures, we demonstrate that patient's serum containing IgM NMDAR antibodies reduced the detection of NMDAR on neuronal cells and decreased cell survival. Although NMDAR encephalitis with IgG antibodies is increasingly recognized and diagnosed, atypical presentations with NMDAR antibodies with immunoglobulin subclasses other than IgG pose a diagnostic and therapeutic challenge. Further clinical and neurobiological studies are needed to study the pathophysiological relevance of IgM NMDAR antibodies.

  9. A simple skin flap plasty to repair tracheocutaneous fistula after tracheotomy

    Institute of Scientific and Technical Information of China (English)

    Qilin Huang; Haipeng Liu; Shengqing Lü

    2015-01-01

    The tracheocutaneous fistula after tracheostomy is a complex clinical problem.An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature.We used a turnover skin flap to cover the fistula.All the procedures were completed at bedside under local anesthesia.The fistula was successfully closed and well healed without complications within 7-9 days.It has been proven that this operation is simple,effective,and safe.

  10. The Clinical Treatment Analysis of 30 Cases of Anal Fistula Surgery%30例手术治疗肛瘘的临床分析

    Institute of Scientific and Technical Information of China (English)

    颜培刚

    2015-01-01

    Objective the surgical treatment effect on anal fistula is to be investigated. Methods Analyze the surgical treatment data selected from 30 patients with anal fistula who are treated in hospital from March 2012 to March 2014. Results All patients with anal fistula are cured and discharged from hospital after surgical treatment;the hospitalization time is from 14 to 40 days and it is 26 days on average;there is no relapse and anal dysfunction. Conclusion Surgical treatment is the only way to cure anal fistula;it is required to cut or excise all fistula branches to cure it.%目的:探讨肛瘘手术治疗方法疗效。方法对2012年3月~2014年3月收治的肛瘘患者30例手术方法资料进行分析。结果肛瘘患者手术治疗均手术成功痊愈出院,住院时间14~40 d,平均26 d,无复发及肛门功能障碍。结论手术是唯一能治愈的手段,手术时应对瘘管的所有分支均要予以切开或切除,根治肛瘘。

  11. Vascular access for hemodialysis: arteriovenous fistula.

    Science.gov (United States)

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus.

  12. A tiny dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

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

    2003-01-01

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

  13. Appearance of a colovesical fistula at cystoscopy

    OpenAIRE

    2015-01-01

    Key Clinical Message Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

  14. Argyrophilic grain disease mimicking temporal Pick's disease: a clinical, radiological, and pathological study of an autopsy case with a clinical course of 15 years.

    Science.gov (United States)

    Tsuchiya, K; Mitani, K; Arai, T; Yamada, S; Komiya, T; Esaki, Y; Haga, C; Yamanouchi, H; Ikeda, K

    2001-08-01

    This report concerns an autopsy case of argyrophilic grain disease (AGD) mimicking temporal Pick's disease. The patient was a Japanese woman without hereditary burden who was 89 years old at the time of death. She developed memory impairment and began wandering at the age of 74, followed by prominent character changes about 6 years after disease onset. A neurological examination 5 months before her death revealed poor rapport, unconcern, severe dementia, and double incontinence, without aphasia or muscle rigidity. Serial neuroradiological examination revealed progressive enlargement of the bilateral inferior horns of the lateral ventricle, reflecting progressive atrophy of the medial temporal lobes. Macroscopically, neuropathological examination showed circumscribed atrophy of the bilateral amygdalae, hippocampi, parahippocampal gyri, and lateral occipitotemporal gyri. Histologically, there was neuronal loss in the areas mentioned above, the caudate nucleus, putamen, thalamus, substantia nigra, and locus ceruleus, with ballooned neurons in the cerebral cortex and amygdala. Numerous argyrophilic grains with coiled bodies were present not only in the limbic system, but also in the affected cerebrum. Rare neurofibrillary changes were present in the limbic areas, consistent with Braak stage II, with no senile plaques. Based on these findings and a review of the literature, we note that AGD is clinicopathologically similar not only to mesolimbocortical dementia, but also to atypical senile dementia of Alzheimer type. This report may contribute to the elucidation of the clinicopathological hallmarks of AGD.

  15. Lymphomatoid granulomatosis mimicking interstitial lung disease.

    Science.gov (United States)

    Braham, Emna; Ayadi-Kaddour, Aïda; Smati, Belhassen; Ben Mrad, Sonia; Besbes, Mohammed; El Mezni, Faouzi

    2008-11-01

    Lymphoid granulomatosis is a rare form of pulmonary angiitis. This case report presents a patient with lymphoid granulomatosis in whom the clinical presentation, radiological features and the partial response to corticosteroid therapy mimicked interstitial lung disease. Lymphoid granulomatosis was only diagnosed at post-mortem examination. The range of reported clinical presentations, diagnostic approaches and outcomes are described.

  16. Clinical Study of External Application of Qiyu Oil(芪榆油) Gauze for Promoting Post-operational Healing in Patients with Anal Fistula

    Institute of Scientific and Technical Information of China (English)

    李绍堂; 曹波; 邓文玲; 李志

    2009-01-01

    Objective:To observe the effects of the external application of Qiyu oil(芪榆油)gauze(QYOG) for promoting post-operational healing in patients with anal fistula and to explore its mechanism of action so as to provide a beneficial scientific basis for its wide use.Methods:Sixty patients with anal fistula scheduled to receive simple low anal fistulectomy were equally assigned,according to the sequence of hospitalization, to the tested group and the control group,and their wounds were classified according to l...

  17. Clinical nursing of cervical anastomotic fistula in patients with esophageal carcinoma%食管癌颈部吻合口瘘的临床护理

    Institute of Scientific and Technical Information of China (English)

    阴爱华; 郁殿琴; 杨晓娟

    2012-01-01

    Objective To promote the healing of cervical anastomotic fistula,alleviate the suffering of patients and shorten the duration of hospitalization. Methods Among 75 patients who received esophageal carcinoma surgery,8 had cervical anastomotic fistula. They received early interventions such as strengthening of psychological nursing,the fistula nursing and nutritional support. Results All of the 8 patients with cervical anastomotic fistula healed well. Conclusion Cervical anastomosis fistula is the common complication of esophageal carcinoma surgery. Early detection of anastomotic fistula by nursing staff is essential to the healing of cervical anastomotic fistula. The psychological nursing,nutritional support and care are important to the recovery of cervical anastomotic fistula,which can also relieve suffering,improve life quality,and shorten the duration of hospitalization.%目的 为使食管癌颈部吻合口瘘早期愈合,减轻患者的痛苦,缩短患者住院时间.方法 对行食管癌根治术的75例中发生颈部吻合口瘘的8例患者,进行及早干预、加强心理护理、瘘口护理、营养支持等.结果 本组8例患者颈部吻合口瘘均愈合良好.结论 食管癌术后颈部吻合瘘,是常见的并发症.护理人员及早发现吻合口瘘的发生,是促进吻合口瘘早期愈合的前提.加强患者心理护理、营养支持、颈部瘘口护理等是吻合口瘘愈合的重要保证,并可以减轻痛苦,提高生活质量,缩短患者住院时间.

  18. Benign duodenocolic fistula. A case presenting with acidosis

    DEFF Research Database (Denmark)

    Benn, Marianne; Nielsen, F T; Antonsen, H K

    1997-01-01

    A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed.......A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed....

  19. The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Alireza Kazemeini

    2014-01-01

    Full Text Available Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1. Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS at 0 (transfer to ward, 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P<0.001. Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P<0.05. Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5% combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.

  20. Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

    Directory of Open Access Journals (Sweden)

    Fernandes MA

    2014-02-01

    analysis included the formation of foreign body granuloma in the gastroenteroanastomosis and enteroanastomosis in 88.9% of the swine that underwent manual suture and in none of the swine that underwent stapling. There was also a significant statistical difference among swine from Group A, and those from groups B, C and D regarding the degree of inflammation, being more intense in those swine that underwent manual suture. Conclusion: This study shows that both types of suture promoted proper healing of gastroenteroanastomosis and enteroanastomosis, although there was a higher degree of inflammation and an increased occurrence of foreign body granuloma in swine subjected to manual suture, although there have been similarities in safety, efficiency, and effectiveness between the models of linear mechanical staplers tested during the performance of these anastomoses on swine. Keywords: linear mechanical stapler, stapler, manual suture, surgery, gastroenteroanastomosis, enteroanastomosis, swine, randomized clinical trial

  1. Study on Clinical Therapeutic Effect on Anal Fistula Patients With Ligation of the Intersphincteric Fistula Technique (LIFT)%肛瘘患者采用结扎括约肌间瘘管术(LIFT)的临床治疗效果研究

    Institute of Scientific and Technical Information of China (English)

    耿润昌

    2015-01-01

    Objective Study on clinical therapeutic effect on Anal ifstula patients with ligation of the intersphincteric fistula technique. Methods Selected 58 patients with anal fistula were divided into two groups, compared the indicators of two groups of patients. Results The observation group with operation, hospitalization and healing time was shorter than the control group, P<0.05, had difference statistically signiifcance. Comparied the function recovery from the anus, the observation group resume was better than the control group P<0.05, had difference statistically significance. Conclusion Ligation sphincter fistula between the curative effect can shorten the operation time and hospital stay effectively, it is beneift to recovery anal morphology and function.%目的:研究肛瘘患者采用结扎括约肌间瘘管术(LIFT)的临床治疗效果。方法选择58例肛瘘患者分为两组,对比两组患者的各项指标。结果从手术时间和住院时间、愈合时间等方面对比,观察组短于对照组, P<0.05,差异具有统计学意义。从肛门功能恢复情况对比,观察组恢复优于对照组,P<0.05,差异具有统计学意义。结论结扎括约肌间瘘管术疗效理想,可以有效缩短手术时间和住院时间,利于肛门形态和功能的恢复。

  2. Impact of pharyngeal closure technique on fistula after salvage laryngectomy.

    Science.gov (United States)

    Patel, Urjeet A; Moore, Brian A; Wax, Mark; Rosenthal, Eben; Sweeny, Larissa; Militsakh, Oleg N; Califano, Joseph A; Lin, Alice C; Hasney, Christian P; Butcher, R Brent; Flohr, Jamie; Arnaoutakis, Demetri; Huddle, Matthew; Richmon, Jeremy D

    2013-11-01

    No consensus exists as to the best technique, or techniques, to optimize wound healing, decrease pharyngocutaneous fistula formation, and shorten both hospital length of stay and time to initiation of oral intake after salvage laryngectomy. We sought to combine the recent experience of multiple high-volume institutions, with different reconstructive preferences, in the management of pharyngeal closure technique for post-radiation therapy salvage total laryngectomy in an effort to bring clarity to this clinical challenge. To determine if the use of vascularized flaps in either an onlay or interposed fashion reduces the incidence or duration of pharyngocutaneous fistula after salvage laryngectomy compared with simple primary closure of the pharynx. Multi-institutional retrospective review of all patients undergoing total laryngectomy after having received definitive radiation therapy with or without chemotherapy between January 2005 and January 2012, conducted at 7 academic medical centers. Academic, tertiary referral centers. The study population comprised 359 patients from 8 institutions. All patients had a history of laryngeal irradiation and underwent laryngectomy between 2005 and 2012. They were grouped as primary closure, pectoralis myofascial onlay flap, or interposed free tissue. All patients had a minimum of 4 months follow-up. Fistula incidence, severity, and predictors of fistula. Of the 359 patients, fistula occurred in 94 (27%). For patients with fistula, hospital stay increased from 8.9 to 12.1 days (P fistula with primary closure was 34%. For the interposed free flap group, the fistula rate was lower at 25% (P = .07). Incidence of fistula was the lowest for the pectoralis onlay group at 15% (P = .02). Multivariate analysis confirmed a significantly lower fistula rate with either flap technique. For patients who developed fistula, mean duration of fistula was significantly prolonged with primary closure (14.0 weeks) compared with pectoralis flap (9

  3. Fistula Vesiko Vaginalis

    Directory of Open Access Journals (Sweden)

    Luki Ertandri

    2016-08-01

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

  4. [Tuberculous prostato-rectal fistula].

    Science.gov (United States)

    Rabii, Redouane; Fekak, Hamid; el Manni, Ahmed; Joual, Abdenbi; Benjelloun, Saad; el Mrini, Mohammed

    2002-09-01

    In a 60-year-old man admitted for right epididymo-orchitis with scrotal fistula and urine leak via the rectum, the diagnosis of tuberculosis was based on histological examination of a tissue sample of the scrotal fistula. The fistula was successfully treated with tuberculostatic drugs and cystostomy.

  5. Management of Complex Anal Fistulas

    Science.gov (United States)

    Bubbers, Emily J.; Cologne, Kyle G.

    2016-01-01

    Complex anal fistulas require careful evaluation. Prior to any attempts at definitive repair, the anatomy must be well defined and the sepsis resolved. Several muscle-sparing approaches to anal fistula are appropriate, and are often catered to the patient based on their presentation and previous repairs. Emerging technologies show promise for fistula repair, but lack long-term data. PMID:26929751

  6. Fistulas complicating diverticulitis.

    Science.gov (United States)

    Vasilevsky, C A; Belliveau, P; Trudel, J L; Stein, B L; Gordon, P H

    1998-01-01

    This study was undertaken to assess the appropriate management of patients with diverticulitis complicated by fistula formation. A retrospective chart review was conducted on patients with symptoms of a fistula who presented between 1975 to 1995. There were 42 patients (32 women, 76%; 10 men, 24%) who ranged in age from 46 to 89 years (mean 69.8 +/- 9.8). Six patients had multiple fistulas. The types of fistulas included colovesical (48%), colovaginal (44%), colocutaneous (4%), colotubal (2%), and coloenteric (2%). Operative procedures consisted of resection and primary anastomosis in 38 patients and a Hartmann's operation in one. Three patients were managed conservatively with antibiotics (two due to poor performance status, the third due to resolution of symptoms). There were no operative deaths. The postoperative course was uncomplicated in 69%, while 12 patients (31%) experienced 19 complications (40%). These consisted of urinary tract infection (9.5%), atelectasis (7.1%), prolonged ileus (4.8%), arrhythmias (4.8%) and renal failure, myocardial infarction, pseudomembranous colitis, peroneal nerve palsy, unexplained fever, pulmonary edema (2.4% each). There were no anastomotic leaks and no deaths. Hospital stay ranged from 6 to 31 days (mean 12.3 +/- 7.6). Fistulas due to diverticulitis were safely managed by resection and primary anastomosis without mortality and with acceptable morbidity in this series. Patients deemed to be poor operative risks can be managed with a course of nonoperative treatment.

  7. Clinical study of the treatment tunnel thread in treating patients with simple anal fistula%用隧道式拖线术治疗单纯性肛瘘的效果探析

    Institute of Scientific and Technical Information of China (English)

    林茂; 雷燕; 谢守勇

    2015-01-01

    Objective To investigate clinical effect of the treatment tunnel thread in treating patients with simple anal fistula.Methods 136 cases with high and low simple anal fistula were slected in our hospital during Jan 2013 to Dec 2014, 64 case with high simple anal fistula were randomly divided into observation group and control group, 32 cases in each group; 72 case with simple low anal fistula were randomly divided into observation group and control group, with 36 cases in each group. The control group was treated by traditional incision (thread) operation , the observation group was treated by the treatment tunnel thread surgery. To compare the healing time and cure rate of the two groups. Results The difference of cure rates of simple low or high in patients with anal fistula between observation group and control group was not significant (P>0.05); the healing time of high and low anal fistula patients in observation group was significantly less than control group (P<0.05). Conclusion Tunnel thread technique can effectively reduce the simple anorectal fistula healing time, worthy of clinical application.%目的:探讨用隧道式拖线术治疗单纯性肛瘘的临床效果。方法:对2013年1月~2014年12月期间我院收治的136例单纯性肛瘘患者的临床资料进行回顾性研究。我们将这136例患者随机分为观察组和对照组,每组各有68例患者。我院使用隧道式拖线术对观察组患者进行治疗,使用传统的切开挂线术对对照组患者进行治疗。治疗结束后,比较两组患者治疗的效果和病情痊愈的用时。结果:两组患者治疗的总有效率均为100%,二者相比差异无显著性(P>0.05)。观察组患者病情痊愈的用时明显短于对照组患者,二者相比差异具有显著性(P<0.05)。结论:用隧道式拖线术治疗单纯性肛瘘不仅效果确切,而且能有效地缩短患者康复的时间。因此,进行隧道式拖线术可作为临床

  8. Enterocutaneous fistulas and Crohn's disease: Clinical characteristics and response to treatment Fístulas enterocutáneas en la enfermedad de Crohn: características clínicas y respuesta al tratamiento

    Directory of Open Access Journals (Sweden)

    Silvia Gómez-Senent

    2013-01-01

    Full Text Available Introduction: the low prevalence of enterocutaneous fistulas (ECF in patients with Crohn's disease (CD justifies the scarcity of studies that analyze the effect of medical treatment and the need for surgery in these patients. The objective of this study was to evaluate the clinical characteristics of patients with CD who have ECF and the response to different treatments. Materials and methods: patients with CD who presented ECF fistula between 1970 and 2009 in three tertiary centers in Spain were analyzed retrospectively for their clinical characteristics, response to treatment as well as the correlation between the response to biological therapies for ECF and perianal disease. The inflammatory activity of the disease was measured using the Harvey-Bradshaw index. The definitions of partial or complete response were based on the treating physician's judgment. Results: twenty six patients were included (18 women; in more than half of cases (67%, anti-TNF treatment improved fistula drainage. Postoperative fistulas responded better to anti-TNF treatment than did spontaneous fistulas (80 versus 57%. One hundred percent and 60% of spontaneous and postoperative fistulas closed after surgery, respectively. Conclusions: although the majority of patients required surgery as the ultimate treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients who were treated. Therefore, this may be a treatment strategy prior to surgery in a select group of patients.Introducción: la baja prevalencia de las fístulas enterocutáneas (FEC en los pacientes con enfermedad de Crohn (EC justifica la escasez de estudios que analicen el efecto del tratamiento médico y la necesidad de cirugía en estos pacientes. El objetivo del presente estudio ha sido evaluar las características clínicas de los pacientes con EC que presentan FEC y la repuesta a los distintos tratamientos. Material y métodos: se analizaron retrospectivamente los pacientes con

  9. Clinical value of high-frequency color Doppler ultrasound in diagnosing perianal abscess and anal fistula%高频彩色多普勒超声在肛周脓肿、肛瘘的应用价值

    Institute of Scientific and Technical Information of China (English)

    董愉

    2012-01-01

    目的 探讨高频彩色多普勒超声诊断肛周脓肿与肛瘘的临床应用价值.方法 使用高频彩色多普勒超声对90例肛周脓肿或肛瘘患者进行检查,并将检查结果与手术结果对照.结果 肛周脓肿与肛瘘的声像图与周围正常组织有明显的区别,对肛周脓肿的诊断特异度、阳性预测均是100%,灵敏度为94.3%;对肛瘘的诊断特异度与阳性预测值分别为95.1%、95.5%,灵敏度为85.7%.结论 高频彩色多普勒超声检查对肛周脓肿的位置、大小、数目、范围及肛瘘瘘管的走行、数目具有很高的诊断价值,且方便、直接、无痛苦、诊断准确、易被患者接受.%Objective To study the clinical value of high-frequency coloc Doppler ultrasound in diagnosing perianal abscess and a-nal fistula. Methods Ninety cases of perianal abscess or anal fistula were inspected by high-frequency color Doppler ultrasound. The inspection results were compared with surgical findings. Results There were significantly differences in the sonogram between the tissue with perianal abscess or anal fistula and surrounding normal tissues. The diagnostic specificity of perianal abscess and the positive predictive value were 100% , the sensitivity was 94. 3% ; the diagnostic specificity of anal fistula the positive predictive value were 95.1% and 95.5% , the sensitivity was 85.7%. Conclusion High-frequency color Doppler ultrasound can ascertain the location, size, number and extent of perianal abscess and clearly estimate the trend and number of anal fistula, and it is simple, direct, painless, with high diagnostic accuracy, easily be accepted by patients.

  10. [Cryptoglandular anal fistulas].

    Science.gov (United States)

    de Parades, Vincent; Zeitoun, Jean-David; Bauer, Pierre; Atienza, Patrick

    2008-10-31

    Cryptoglandular anal fistulae are the most frequently occurring form of perianal sepsis. Characteristically they have an endoanal primary opening, a fistula track and an abscess and/or an external purulent opening. Antibiotic therapy is not of use in initial management except in special cases. Treatment of an abscess, if present, is required urgently and when possible, consists of its incision under local anaesthesia. Treating the fistula track occurs afterwards and aims to dry up the purulent discharge and avoid recurrence of the abscess by means of surgical fistulotomy. These techniques are very effective in terms of eradication of the problem but there is sometimes a risk of anal incontinence. This explains the increasing interest in sphincter preserving techniques using the advancement of a covering flap of rectal mucosa and the injection of fibrin glue.

  11. Clinical Application of Double Cannula to Treat Intestinal Fistula%双套管引流治疗肠外瘘--附15例报告

    Institute of Scientific and Technical Information of China (English)

    杨士民; 张楠; 陈鄢津; 徐斌; 杨强

    2015-01-01

    目的:研究肠外瘘的病因、治疗方法、手术时机及其疗效。方法:将30例肠外瘘患者分为对照组和治疗组各15例,对照组给予传统方法治疗,治疗组同时放置“黎氏双套管”、持续冲洗负压引流、纤维蛋白胶封堵瘘管等综合治疗,对两组肠外瘘自愈时间、非手术肠外瘘愈合率、治愈率及死亡率进行比较。结果:肠外瘘治愈率治疗组(93.3%)优于对照组(60%),非手术肠外瘘愈合率治疗组(73.3%)优于对照组(33.3%),非手术治愈时间治疗组(24.1±4.5)d早于对照组(47.8±5.8)d,P<0.05。结论:肠外瘘采用“黎氏双套管”加纤维蛋白胶封堵瘘管的综合治疗方案,对于非手术治疗不成功者可择期行确定性手术治疗。%Objective To study the cause of disease, treatment, operative opportunity and therapeutic effect of the intestinal fistula. Methods Thirty patients with intestinal fistula were divided into two groups, control group(n=15) and treatment group (n=15) were given routine treatment. The treatment group were additionally giv⁃en‘Lishi double cannulae’continue negative pressure drainage and fibrin glue block fistula. The self-healing time of intestinal fistula, healing rate of intestinal fistula with no-operation, cure rate and mortality of intestinal fistula were studied with the two groups. Results The healing rate with no-operation and cure rate of intesti⁃nal fistula of treatment group was obviously larger than those of control group,but the self-healing time of intesti⁃nal fistula of treatment group was obviously less than that of control group, characterized with statistical differ⁃ence(P<0.05). Conclusion The comprehensive therapeutic schedule of‘Lishi double cannula ’continue negative pressure drainage and fibrin glue block fistula is important to treat intestinal fistula. After the conserva⁃tive treatment is unsuccessful, a definitive operation is

  12. Delayed internal pancreatic fistula with pancreatic pleural effusion postsplenectomy

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

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

  13. Coronary Fistulas: A Case Series

    Directory of Open Access Journals (Sweden)

    Nada Fennich

    2014-01-01

    Full Text Available Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  14. Clinical Study of Heterogeneous Acellular Dermal Matrix for Repairing Hard Palatal Fistula%异种脱细胞真皮基质整复硬腭部腭瘘的临床研究

    Institute of Scientific and Technical Information of China (English)

    张波; 李健

    2013-01-01

    [Objective]To explore the clinical efficacy of heterogeneous acellular dermal matrix( Heal-All Oral Biofilm) for repairing hard palatal fistula. [Methods]Thirty-eight patients with hard palate fistula were randomly divided into treatment group and control group. Palatal fistulas of patients in treatment group( n = 18) was repaired with heterogeneous acellular dermal matrix. Palatal fistulas of patients in control group( n = 20) was repaired with traditional method. The recurrence in the closed fistula and the incidence of buccal gingi-val sulcus becoming shallow in patients of two groups were observed 1~3 months after the operation. [Results]The recurrence rate of closed fistula in treatment group was 11. 1 % (2/18) 1 ~ 3 months after the operation, which was markedly lower than that in control group(25. 0%, 5/20) , and there was significant differ-ence( P <0. 05). The incidence of buccal gingival sulcus becoming shallow in treatment group was 5. 5% (1/ 18), which was markedly higher than that in control group(90% , 18/20), and there was significant difference ( P <0. 01). [Conclusion]The efficacy of heterogeneous acellular dermal matrix(Oral Biofilm) for repairing hard palatal fistula is satisfactory, and has simple operation, little damage of surrounding tissue and no incidence of buccal gingival sulcus becoming shallow after the operation.%[目的]探讨异种脱细胞真皮基质(下称口腔修复膜)修补硬腭部腭瘘的临床疗效.[方法]38例硬腭部腭瘘的患者随机分为治疗组和对照组,治疗组18例患者采用口腔修复膜修补硬腭部腭瘘,对照组20例患者采用传统方法修复硬腭部腭瘘,观察两组患者术后1~3个月手术部位是否再次穿孔及龈颊沟是否变浅.[结果]治疗组在术后1~3个月再次穿孔的发生率为11.1%(2/18)显著低于对照组25.0%(5/20),其差异有统计学意义(P<0.05);治疗组龈颊沟变浅发生率为5.5%(1/18)显著低于对照组发生率为90%(18

  15. FISTULOTOMY VERSUS FISTULECTOMY FOR TREATMENT OF FISTULA-IN-ANO

    Directory of Open Access Journals (Sweden)

    Ravi Kumar

    2016-06-01

    Full Text Available Fistula-in-ano is notorious for its frequent exacerbations, recurrences and its chronic condition. The anorectal abscess is an acute inflammatory process that often is the initial manifestation of the underlying anal fistula and is the chronic condition following inadequate drainage of the abscess. Around 90% of the cases occur due to infected anal glands. Incision and drainage of the abscess cavity will result in complete resolution of the infection in 50% of the patients, whereas in the rest an anal fistula will develop. Most patients with an overt fistula have an antecedent history of abscess that drained spontaneously or for which surgical drainage had been performed. There are different surgeries mentioned in literature. The ultimate goal of fistula surgery is to eradicate it without disturbing or minimally disturbing the anal sphincter mechanism. MATERIALS AND METHODS A total number of 300 patients diagnosed with low fistula-in-ano were included in this clinical study. These 300 patients presented to the general surgery OPD and were admitted under the Department of General Surgery in Vydehi Institute of Medical Sciences and Research Centre during the period of April 2012 to Jan 2016. The patients were not randomized for any imaging modality or surgical procedures. Detailed history including the past history of anorectal abscess and of previous fistula surgery was taken. The mode of presentation, other comorbid conditions like diabetes, the findings on clinical examination (Digital examination and proctoscopy were recorded in the case sheet for individual patients. Complete blood count, random blood sugar, HIV, HBsAg, sono-fistulogram were done. The discharge from the external opening was sent for culture and sensitivity studies. High anal fistulas and tuberculous fistulas were excluded from the study. RESULTS 150 patients were treated with fistulotomy and 150 patients were treated with fistulectomy. More number of males had fistula

  16. The clinical effect of evidence-based nursing on patients with anal fistula after surgery.%肛瘘手术患者术后循证护理的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    张国花

    2011-01-01

    Objective : To explore the clinical effect of EBN on patients with anal fistula after surgery. Methods :72 cases of patients with anal fistula after surgery were randomly divided into experimental group and control group. The routine care was used for control group, and EBN was used for experimental group. Results: The complication rate and pain release in experimental group was significantly better than that in control group( P < 0. 05 ). Conclusion :EBN used for the recovery of patients with anal fistula after surgery , is meaningful for prompting recovery of patients and enhancing nursing equality of nurses, so it is a nursing type in clinical work that deserved promotion and application.%目的:探讨循证护理应用于肛瘘患者术后恢复的临床效果.方法:将72例肛瘘术后患者随机分为实验组和对照组,对照组给予常规护理,实验组给予循证护理.结果:实验组并发症发生率和疼痛改善均优于对照组(P<0.05).结论:循证护理应用于肛瘘术后患者的康复护理,对于促进患者术后康复和护理人员改善护理质量是很有意义的,值得在临床上应用和推广.

  17. Percutaneous treatment of subarachnoid-pleural fistula with Onyx.

    Science.gov (United States)

    Knafo, Steven; Parker, Fabrice; Herbrecht, Anne; Court, Charles; Saliou, Guillaume

    2013-04-01

    Subarachnoid-pleural fistula is a well-described complication after anterior surgery for thoracic disc herniation, but is difficult to treat by means of traditional chest and lumbar drains due to interference by positive ventilation pressures that may keep the fistula open and prevent proper closure. Current treatment strategies include surgical repair, which is technically challenging, and noninvasive positive pressure ventilation, which can take several weeks to be effective. In this report, the authors describe a novel treatment for subarachnoid-pleural fistula using percutaneous obliteration with Onyx. Surgery for removal of a T7-8 disc herniation associated with ossification of the posterior longitudinal ligament was performed in a 56-year-old woman via an anterior transthoracic transpleural approach. Ten days after surgery, she presented with diplopia due to a subarachnoid-pleural fistula that was confirmed by CT myelography. Percutaneous injection of Onyx was performed under local anesthesia. Postprocedure CT showed complete obliteration of the fistula with no adverse events. A CT scan obtained 1 month later showed complete resolution of the pleural effusion. Neurological examination at 3 months postsurgery was normal. Clinical and radiological follow-up at 1 year showed complete recovery and no sign of fistula recurrence. Percutaneous treatment for subarachnoid-pleural fistula is an easy, safe, and effective strategy and can therefore be proposed as a first-line option for this challenging complication.

  18. Rhabdoid Tumor Mimicking Hemangioma

    NARCIS (Netherlands)

    Assen, Yvette J.; Madern, Gerard C.; de Laat, Peter C. J.; den Hollander, Jan C.; Oranje, Arnold P.

    2011-01-01

    We report a young boy with a malignant tumor, which remained unrecognized for 8 months because it was assumed to be a hemangioma. The presentation of a rhabdoid tumor mimicking hemangioma is very rare. It was reported only on two earlier occasions. Rhabdoid tumors are one of the most aggressive type

  19. Rhabdoid Tumor Mimicking Hemangioma

    NARCIS (Netherlands)

    Assen, Yvette J.; Madern, Gerard C.; de Laat, Peter C. J.; den Hollander, Jan C.; Oranje, Arnold P.

    2011-01-01

    We report a young boy with a malignant tumor, which remained unrecognized for 8 months because it was assumed to be a hemangioma. The presentation of a rhabdoid tumor mimicking hemangioma is very rare. It was reported only on two earlier occasions. Rhabdoid tumors are one of the most aggressive

  20. Video-Assisted Anal Fistula Treatment (VAAFT) for Complex Anal Fistula: A Preliminary Evaluation in China.

    Science.gov (United States)

    Jiang, Hui-Hong; Liu, Hai-Long; Li, Zhen; Xiao, Yi-Hua; Li, A-Jian; Chang, Yi; Zhang, Yong; Lv, Liang; Lin, Mou-Bin

    2017-04-30

    BACKGROUND Although many attempts have been made to advance the treatment of complex anal fistula, it continues to be a difficult surgical problem. This study aimed to describe the novel technique of video-assisted anal fistula treatment (VAAFT) and our preliminary experiences using VAAFT with patients with complex anal fistula. MATERIAL AND METHODS From May 2015 to May 2016, 52 patients with complex anal fistula were treated with VAAFT at Yangpu Hospital of Tongji University School of Medicine, and the clinical data of these patients were reviewed. RESULTS VAAFT was performed successfully in all 52 patients. The median operation time was 55 minutes. Internal openings were identified in all cases. 50 cases were closed with sutures, and 2 were closed with staplers. Complications included perianal sepsis in 3 cases and bleeding in another 3 cases. Complete healing without recurrence was achieved in 44 patients (84.6%) after 9 months of follow-up. No fecal incontinence was observed. Furthermore, a significant improvement in Gastrointestinal Quality of Life Index (GIQLI) score was observed from preoperative baseline (mean, 85.5) to 3-month follow-up (mean, 105.4; panal fistula with preservation of anal sphincter function.

  1. Colovesical fistula: unexpected complication 7 years after augmentation ileocystoplasty.

    Science.gov (United States)

    Abdelhalim, Ahmed; Hafez, Ashraf T

    2013-11-01

    Augmentation enterocystoplasty has been extensively used to attain high-capacity low-pressure urinary reservoirs in patients with neuropathic bladder, exstrophy-epispadias complex, valve bladder syndrome, and contracted bladder. Enterovesical fistula might occur as an early complication after enterocystoplasty. We report the case of a 16-year-old boy, who presented with chronic watery diarrhea 7 years after augmentation ileocystoplasty. A colovesical fistula was diagnosed. We discuss the clinical presentation, management plan, and operative findings.

  2. Care of arteriovenous fistula by patients with chronic renal failure.

    OpenAIRE

    Monteiro Furtado, Angelina; Elisângela Teixeira Lima, Francisca

    2008-01-01

    This descriptive study aimed at identifying care of arteriovenous fistula (AVF) performed patients under hemodialysis. Twenty one hemodialysis patients were randomly selected in a clinic in Fortaleza, Ceara, Brazil:11 female and 11 male patients, age between 30 and 50 yearold, and most were single, retired, and had low education level. Semi-structured interview was applied. The following procedures were mentioned: cleaning the fistula arm, thrill palpation, avoiding lifting weight with AVF...

  3. Fistula in ano

    DEFF Research Database (Denmark)

    Madsen, S M; Myschetzky, P S; Heldmann, U;

    1999-01-01

    Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal fist...... fistulae and patients with no active fistulation we performed a retrospective study....

  4. Fistula in ano

    DEFF Research Database (Denmark)

    Madsen, S M; Myschetzky, P S; Heldmann, U

    1999-01-01

    Patients suspected of having perianal suppurative disease often undergo a combination of several potentially painful, invasive procedures to establish or rule out the diagnosis. To evaluate the accuracy of low-field magnetic resonance imaging (MRI) in distinguishing patients with active anal...... fistulae and patients with no active fistulation we performed a retrospective study....

  5. An adult intussusception mimicking early appendicitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Chun Tseng; Cheng-Ting Hsiao; Yu-Cheng Hung

    2012-01-01

    Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

  6. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    Science.gov (United States)

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

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

    Directory of Open Access Journals (Sweden)

    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.

  8. 切开挂线对口引流术治疗110例复杂性肛瘘临床观察%Clinical observation of incision line counterparts drainage in treatment of complex anal fistula 110 cases

    Institute of Scientific and Technical Information of China (English)

    茆海兵

    2011-01-01

    目的 观察切开挂线对口引流术治疗复杂性肛瘘的临床疗效.方法 回顾性分析切开挂线对口引流治疗高位复杂性肛瘘110例患者的临床资料.结果本组一次手术治愈102例,二次治愈8例,治愈率100%.疗程15 ~75d,平均30d.术后对110例随访6个月至1年半,无复发、肛门失禁、疤痕畸形、移位、继发感染等后遗症.结论 切开挂线加对口引流术治疗高位复杂性肛瘘,整个术式体现了损伤肛门括约肌少,不影响肛门功能,伤口愈合快,彻底治愈肛瘘的原则,值得临床推广应用.%Objective To observe the incision line counterparts drainage in the treatment of complex anal fistula. Methods A retrospective analysis of their counterparts in drainage incision line treatment of high anal fistula complex clinical data of 110 patients. Results A surgical cure in 102 cases, eight cases of secondary cured, the cure rate was 100%. Course of 15 to 75 days, an average of 30 days. Of 110 patients were followed up after 6 months to 1 year and a half, without recurrence, incontinence , scar deformity, displacement, secondary infection and other complications. Conclusions Canadian counterparts incision drainage line treatment of high complex anal fistula, the surgical damage to the anal sphincter shows a small, does not affect anal function, wound healing, the principle of complete cure of anal fistula, is worthy of clinical application.

  9. Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula.

    Science.gov (United States)

    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.

  10. Fistuloclysis: An Interprofessional Approach to Nourishing the Fistula Patient.

    Science.gov (United States)

    Willcutts, Kate; Mercer, David; Ziegler, Jane

    2015-01-01

    Enteric fistulas can be classified as enterocutaneous and/or enteroatmospheric. Both are devastating complications of bowel disease, abdominal surgery, and/or open abdomen. Enteric fistulas are associated with a mortality rate varying from 1% to 33%; the main cause of death is sepsis. Coordinated and skillful efforts of an interprofessional team are required in customizing successful treatment regimens appropriate to each patient's unique clinical scenario. A 65-year-old white woman experienced an enteroatmospheric fistula patient after ventral hernia repair. Care of this patient was based on the complementary relationship between professionals from 2 disciplines: the wound and ostomy continence nurse (WOC nurse) and the nutrition support registered dietitian/nutritionist. Working together, they developed a comprehensive wound, ostomy, and nutritional plan. Initially, the patient received parenteral nutrition exclusively. After the fistula tract was clearly defined, a feeding tube was placed into the distal limb of the fistula, and she received nourishment via a fistuloclysis (ie, enteral feedings administered via the fistula). A special wound management system was created to contain fistula output while allowing feeding through the distal limb of the fistula. Enterocutaneous and enteroatmospheric fistulas originating from the small bowel present a management challenge to the entire healthcare team. WOC nurses are often called upon to meet the challenge of maintaining skin health while promoting dignity and function. Nutrition support via registered dietitian/nutritionists play a critical role in managing the nutrition regimen for these patients. In this case, the use of fistuloclysis met the patient's nutritional needs while avoiding the risks associated with parenteral nutrition.

  11. The Clinical Therapeutic Effects of Different Surgical Methods on High Complex Anal Fistula%不同手术方式治疗高位复杂肛瘘的疗效观察

    Institute of Scientific and Technical Information of China (English)

    方晓东

    2011-01-01

    Objective:To explore the clinical therapeutic effects of different surgical methods on high complex anal fistula. Methods:40 cases of high complex anal fistula selected from June 2008 to June 2010 were randomly divided into control group and observation group,20 patients in each group. Control group received tying therapy on main fistula with external anal fistulate laid aside,then the observation group was performed by cutting and tying therapy on main fistula with the branch suitable drainage treatment.The clinical efficacy,healing time,recurrence and complications were observed in two groups.Results:The cure rate of the observation group(95.00%) was significantly higher than that of the control group (80.00%) P<0.05;The healing time of the control group(32.78 ± 7.94)d was significantly more than that of the observation group (18.46±3.57)d,P<0.05;Cases of recurrence in the control group (3 cases) were more than that in the observation group(0 case),P<0.05;There was no significant difference between the two groups in complications,such as anal deformation(0 case),skin defects(0 case),anal stenosis(0 case),P>0.05.Conclusion:Cutting and tying therapy on main fistula with the branch suitable drainage treatment was a more effective surgical method for high complex anal fistula with fewer complications.%目的:探讨不同手术方式治疗高位复杂肛瘘的临床效果.方法:选择2008 年6月~2010 年6月40 例高位复杂肛瘘患者,随机分为对照组和观察组,每组20 例,对照组采用肛门外瘘旷置加肛管内主管挂线法治疗,观察组应用主管切开挂线支管对口引流治疗.观察两组患者的临床疗效、治愈时间、复发情况以及并发症情况.结果:观察组一次手术治愈率95.00%,明显高于对照组的80.00%,P<0.05; 对照组的治愈时间为(32.78±7.94)d,显著多于观察组的(18.46±3.57)d,P<0.05; 术后随访半年,观察组无1例复发,对照组有3例复发,二者相比有统计学差异,P<0

  12. The clinical effect of maintence of arteriovenous fistula by Songling Xuemaikang%松龄血脉康对动静脉内瘘功能保持的价值

    Institute of Scientific and Technical Information of China (English)

    师丙帅; 刘建林; 王晓磊

    2011-01-01

    Objective To valuate the clinical effect of maintence of arteriovenous fistula by Songling Xuemaikang capsule.Methods 40 cases were obtained from patients with chronic renal failure had received arterio-venous fistula operation,24 cases were observed with the combination treatment and 16 cases were served as control group,Hemorheology and difference value of vein diameter before and after treatment,blood flow of native arteivenous fistula and primary using time were observed.Results The improvement degree of high shear rate and low shear rate were significantly as compared with that in the control group (P =0.000,P =0.001 ),while the blood flow after fistula maturation and ifference value of vein diameter were better than that in the control group( P =0.0356),primary using time between two groups were no significant differences ( P =0.056).Conclusion Songlinxuemaikang capsule was an effective drug for prevention high blood caogulation state,increasing blood flow of native arteivenous fistula,and enlargment vein diameter after arterio-venous fistula operation,which had certain value in clinical application.%目的 探讨松龄血脉康胶囊对动静脉内瘘功能保持的价值.方法 选择肾功能不全行动静脉内瘘手术患者40例予分组观察:联合治疗组24例和对照组16例在治疗前后血液流变学,内瘘成熟后的血流量,静脉内径差值及初次使用时间的变化.结果 联合治疗组治疗前后全血黏度下的高切变率改善程度比较(P=0.000)和低切变率改善程度比较(P=0.001),均差异有统计学意义;两组内瘘血流量比较(P=0.0356)以及两组治疗前后静脉内径差值比较(P<0.05),均差异有统计学意义;初次使用时间的变化比较,差异无统计学意义(P=0.056).结论 松龄血脉康胶囊是改变动静脉内瘘术后血液高凝状态;增加内瘘的血流量;有效扩大静脉内径的有效药物.具有一定的临床应用价值.

  13. Anorectal Infection: Abscess–Fistula

    Science.gov (United States)

    Abcarian, Herand

    2011-01-01

    Anorectal abscess and fistula are among the most common diseases encountered in adults. Abscess and fistula should be considered the acute and chronic phase of the same anorectal infection. Abscesses are thought to begin as an infection in the anal glands spreading into adjacent spaces and resulting in fistulas in ~40% of cases. The treatment of an anorectal abscess is early, adequate, dependent drainage. The treatment of a fistula, although surgical in all cases, is more complex due to the possibility of fecal incontinence as a result of sphincterotomy. Primary fistulotomy and cutting setons have the same incidence of fecal incontinence depending on the complexity of the fistula. So even though the aim of a surgical procedure is to cure a fistula, conservative management short of major sphincterotomy is warranted to preserve fecal incontinence. However, trading radical surgery for conservative (nonsphincter cutting) procedures such as a draining seton, fibrin sealant, anal fistula plug, endorectal advancement flap, dermal island flap, anoplasty, and LIFT (ligation of intersphincteric fistula tract) procedure all result in more recurrence/persistence requiring repeated operations in many cases. A surgeon dealing with fistulas on a regular basis must tailor various operations to the needs of the patient depending on the complexity of the fistula encountered. PMID:22379401

  14. 脱细胞异体真皮基质填塞治疗肛瘘的临床体会%Clinical study on anal fistula treatment with acellular extracellular matrix

    Institute of Scientific and Technical Information of China (English)

    安少雄; 黄斌

    2012-01-01

    Objective To observe the effects of the efficacy of acellular extracellular matrix (AEM) treatment for anal fistula. Methods Twelve patients with anal fistula were treated with AEM. The clinical effects were observed. Results Nine cases were cured, but 3 failed and 1 case relapsed after 6 months. The heal rate of anal fistula was 75%. Conclusions This method has advantages of mild traumas and less pain, rapid recovery rapidly, and the most important is that this treatment could protect anal function and appearance. However, the long-term effect needs further study.%目的 探讨脱细胞异体真皮基质填塞治疗肛瘘的临床疗效.方法 采用脱细胞异体真皮基质填塞治疗12例肛瘘患者,观察其临床效果.结果 本组患者瘘管愈合时间7~18 d,平均(13.0±3.3)d.12例患者中治愈9例,治愈率为75%,失败3例,随访6个月复发1例,复发率为8.3%.本组无肛门失禁、肛门畸形发生.结论 脱细胞异体真皮基质填塞治疗肛瘘具有创伤小、疼痛轻、恢复快、不损害肛门功能和外形的优点,但远期效果需进一步观察.

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

    Institute of Scientific and Technical Information of China (English)

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

    2010-01-01

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

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

    OpenAIRE

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

    2016-01-01

    A colopleural fistula is a rare condition reported to be caused by Crohn’s disease, a malignant tumor of the gastrointestinal tract, and other clinical conditions. Some studies have noted that a sub-diaphragmatic abscess, usually organized following abdominal surgery, may play some role in the formation of this type of fistula. Therefore, a colopleural fistula is a complication very rarely encountered by thoracic surgeons after lung resection. We experienced an extremely rare case of colopleu...

  17. Vesicocervical fistula: rare complication secondary to intrauterine device (Lippes loop) erosion.

    Science.gov (United States)

    Magudapathi, Chandrakala; Manickam, Ramalingam; Thangavelu, Kavitha

    2015-06-01

    We report a case of vesicocervical fistula following intrauterine device (Lippes loop) erosion following insertion 45 years ago. Vesicocervical fistula was suspected clinically. Ultrasound and magnetic resonance imaging confirmed the presence of a foreign body. Biopsy and magnetic resonance imaging were performed to rule out malignancies of the urogenital tract. The fistula was managed by laparotomy, hysterectomy, and bladder flap closure. We report this case because of its rarity.

  18. Embolization of Brain Aneurysms and Fistulas

    Science.gov (United States)

    ... Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms and arteriovenous malformations (AVM) ... Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous malformations (AVM)/ ...

  19. Amyand's hernia masquerading inguinal abscess complicated with appendico-cutaeneous fistula in an infant with Hirschsprung's disease

    Directory of Open Access Journals (Sweden)

    Ruzaimie Noor

    2017-06-01

    Full Text Available A normal or diseased vermiform appendix located inside the inguinal hernia is called Amyand's hernia (AH. The incidence of appendicitis in Amyand's hernia is rare. The appendicitis per se is uncommon disease in infancy. We reported an extremely rare case of undiagnosed right Amyand's hernia mimicking inguinal abscess complicated with appendico-cutaneous fistula in total colonic Hirschsprung's Disease.

  20. 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.

  1. 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.

  2. Necrobiosis lipoidica mimicking cellulitis

    Directory of Open Access Journals (Sweden)

    Joshi A

    1997-01-01

    Full Text Available A 57-year-old obese patient presented with a 5 month history of tender, indurated, erythematous plaques with superficial ulceration on the right shin. The lesions closely mimicked cellulitis but were unresponsive to antibiotics. Though the patient was not a known diabetic, on investigations she was found to be a diabetic. Histology confirmed the diagnosis of necrobiosis lipoidica. This acutely inflammed presentation of necrobiosis lipoidica is extremely rare.

  3. Evolutionary History of Multiple Dural Fistula

    Directory of Open Access Journals (Sweden)

    Braulio Martinez-Burbano MD

    2016-12-01

    Full Text Available Intracranial dural arteriovenous fistulas (DAVFs are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient.

  4. Evolutionary History of Multiple Dural Fistula

    Science.gov (United States)

    Martinez-Burbano, Braulio; Correa Diaz, Edgar Patricio; Jácome Sánchez, Carolina

    2016-01-01

    Intracranial dural arteriovenous fistulas (DAVFs) are abnormal communications between arteries and veins or dural venous sinuses, which sit between the sheets of the dura. They represent 10% to 15% of intracranial vascular malformations. Clinical manifestations and prognosis depend on the pattern of venous drainage and location. The clinical presentation of DAVF may be mistaken for vascular or nonvascular brain pathologies. For that reason, within the differential diagnosis come a wide range of conditions, such as secondary headaches, encephalopathies, dementias including those with rapid progression, neurodegenerative diseases, inflammatory processes, or tumors typically at the orbital level or in the cavernous sinus. Diagnosis requires a high degree of suspicion because of the multiplicity of symptoms and presentations, making this pathology an entity that provides a major challenge for clinicians, yet early and multidisciplinary treatment of high-grade fistulas improve the possibility of avoiding poor or unfavorable outcomes for the patient. PMID:28203571

  5. 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.

  6. [Laparoscopic operation for colovesical fistula].

    Science.gov (United States)

    Tvedskov, Tove H Filtenborg; Ovesen, Henrik; Seiersen, Michael

    2008-01-14

    Since 2005 the surgical department of Roskilde County Hospital has treated selected patients with colovesical fistulas laparoscopically. We describe two patients with symptoms of pneumaturia and urinary tract infections. CT scanning, cystoscopy and sigmoideoscopy showed colovesical fistula and laparoscopic operation was performed. The operating times were 280 and 285 minutes and the length of their hospital stays was four and three days without complications. We suggest that laparoscopic operation for colovesical fistula can be a good alternative to open operation on selected patients.

  7. Controversies in Fistula in Ano

    OpenAIRE

    2012-01-01

    Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major...

  8. Clinical Observation on TCM Hip Bath for 60 Patients after the Surgery of Anal Fistula%中药坐浴治疗肛瘘术后60例

    Institute of Scientific and Technical Information of China (English)

    杨惠; 李建明; 张翻翻

    2013-01-01

    目的:观察常规使用头孢唑啉钠、创面清洁换药联合通络活血,清热解毒之中药坐浴治疗肛瘘术后患者的临床疗效。方法:将120例肛瘘术后患者随机分为观察组、对照组各60例,2组术后立即给予头孢唑啉钠,术后第2天行创面清洁换药。观察组在对照组治疗的基础上于患者排便后给予中药坐浴,15 min/次。2组均以治疗7天为1个疗程,治疗2个疗程后评价疗效并观察2组疼痛、水肿、创面渗出物消失时间,创面愈合时间。结果:总有效率观察组为93.33%,对照组为76.67%,2组相比差异有统计学意义(P<0.05)。疼痛、水肿、创面渗出物消失时间,创面愈合时间观察组均短于对照组,2组相比差异有统计学意义(P<0.05)。结论:在常规使用头孢唑啉钠、创面清洁换药等常规治疗的基础上给予通络活血,清热解毒之中药坐浴,有助于提高肛瘘术后临床疗效,缩短疼痛、水肿、创面渗出物消失时间及创面愈合时间。%Objective:To observe cefazolin sodium, wound cleaning, changing the dressing and hip bath with herbs of freeing collaterals, activating blood, heat clearing and detoxifying in treating the patients after the surgery of anal fistula. Method: All 120 patients were randomized into the observation group and the control group. Both groups took cefazolin sodium after the surgery immediately, received wound cleaning and dressing changing at the 2nd day after the surgery. The patients in the observation group were given with hip bath after defection, 15min each time. Seven days were one course of treatment , clinical effects were assessed after two courses of treatment, disappearing time of wound exudates, the pain and edema, healing time of wound in both groups were observed. Result: Total effective rate of the observation group was 93.33%, higher than 76.67% of the control group, the difference between both groups had statistical

  9. Tracheoesophageal fistula associated with paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

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

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

    Science.gov (United States)

    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

  11. 长期肠内营养患者造瘘管置换术临床应用进展%Gastric fistula tube replacement in long-term enteral nutrition patients’ clinical application

    Institute of Scientific and Technical Information of China (English)

    李思静; 庾艳军; 卢杰夫

    2015-01-01

    For swallowing dysfunction or dysphagia patients but with normal gastrointestinal function, we can indwell a gastric fistula, reconstruction of gastrointestinal nutrition pathway, make it get better nutrition and drug suppot. However, gastrostomy tube fistula is not permanent, for patients with long-term enteral nutrition,the tube is the need to change regularly. This article will be introducing several aspects of the peg replacement technology research from its development, clinical applications,complications, prevention, and prospects.%对于无法正常吞咽,而具有正常的消化功能的患者,通常医生进行肠内营养,使患者更好的得到营养及药物支持。然而造瘘管并不是永久性的,对于行造瘘术进行肠内营养的患者,多种原因使造瘘管需要进行更换。文章将从造瘘管置换术方法、适应症、并发症及其预防、前景与展望等几方面阐述长期肠内营养患者行造瘘管置换术的现状及最新研究进展。

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

    Directory of Open Access Journals (Sweden)

    Prakash Kumar

    2015-06-01

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

  13. Gout: radiographic findings mimicking infection

    Energy Technology Data Exchange (ETDEWEB)

    Rousseau, I.; Raymond-Tremblay, D. [Dept. of Diagnostic Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Cardinal, E. [Dept. of Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Beauregard, C.G. [Dept. of Diagnostic Radiology, Hopital du Sacre-Coeur de Montreal,Que. (Canada); Braunstein, E.M. [Dept. of Radiology, Indiana University Hospital (United States); Saint-Pierre, A. [Rheumatology Unit, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada)

    2001-10-01

    Objective: To describe radiographic features of gout that may mimic infection. Design and patients: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. Conclusion: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. (orig.)

  14. 动静脉内瘘吻合术式的临床观察%Clinical Observation on Anastomosis of Arteriovenous Fistula

    Institute of Scientific and Technical Information of China (English)

    吴云; 叶中景; 魏伟强; 曾纳新

    2011-01-01

    [Objective] To compare the different methods of arteriovenous fistula(AVF) surgery and concerned operative skills, and to evaluate the postoperative patency rate of AVF. [Methods] The clinical data of 296 cases undergoing forearm AVF surgery were analyzed retrospectively. Among them, 279 cases underwent autogenous AVF surgery, and 11 cases underwent autogenous vein graft, and 6 cases underwent vascular prosthesis implantation. End-to-side (ETS) or side-to-side (STS) anastomosis was performed for 216 cases,while end-to-end(ETE) anastomosis was performed for 74 cases. [Results] The postoperative patency rate of ETS or STS and ETE anastomosis was 97.6% and 97.2%, respectively, and there was no significant difference( P >0.05). The patency rate of ETS or STS anastomosis 3 months after operation was 94.4% which was obviously higher than that of ETE anastomosis(87.8 %), and there was significant difference(p<0. 05).The patency rate of AVF with vascular prosthesis implantation after operation and 3 months after operation was 100%. [Conclusion] ETS or STS anastomosis is the preferred method for forearm AVF operation. AVF with autogenous vein graft or vascular prosthesis implantation can be as the preferred operative methods for patients without appropriate autogenous vessel for anastomosis.%[目的]比较不同动静脉内瘘成形手术(AVF术)方法及手术相关技巧,评估术后瘘管通畅率.[方法]回顾性分析290例前臂AVF术患者的临床资料,其中自体AVF术279例,自体静脉移植AVF术及人工血管植入AVF术11例.采取端-侧或侧-侧吻合术216例;端-端吻合术74例.[结果]采取端-侧或侧-侧吻合术术后通畅率(97.6%)与端-端吻合术术后通畅率(97.2%),相比差异无显著性(P>0.05),术后3个月通畅率(94.4%)明显高于端-端吻合术(87.8%),且差异有显著性(P<0.05);人工血管植入AVF术后及术后3月通畅率达100%.[结论]前臂AVF术采取端-侧或侧-侧吻合术是首选方法,对无

  15. 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.

  16. Conservative treatment of post-lobectomy bronchopleural fistula

    Science.gov (United States)

    Naranjo Gómez, Jose Manuel; Carbajo Carbajo, Miguel; Valdivia Concha, Daniel; Campo-Cañaveral de la Cruz, Jose Luis

    2012-01-01

    Post-lobectomy bronchopleural fistula is a rare complication of lung resection surgery, and proper management is essential for its successful resolution. Most published papers deal with endoscopic and surgical treatment. We report our experience with conservative management. Data were collected by reviewing the clinical charts of patients diagnosed with post-lobectomy bronchopleural fistula at the University Hospitals Marqués de Valdecilla, Santander, and Puerta de Hierro, Majadahonda-Madrid, Spain, from June 2003 to December 2010. Bronchopleural fistula was diagnosed by means of endoscopic visualization. Treatment included the insertion of a thoracostomy drainage tube in the pleural cavity. In patients under mechanical ventilation, independent pulmonary ventilation was also applied. Seven cases of post-lobectomy bronchopleural fistula were collected. Three of them occurred within the first week, another three within the first month and the remaining case after 10 months. The fistula size ranged between 6 mm and complete suture dehiscence. Two patients died due to causes unrelated to the treatment. The period of time elapsed for the resolution of this complication varied between 5 and 36 days. We conclude that conservative treatment of post-lobectomy bronchopleural fistula is a safe and simple option that must be taken into account in the management of this problem. PMID:22508893

  17. [Analysis of predisposing factors for pancreatic fistula after pancreaticoduodenectomy].

    Science.gov (United States)

    Chen, You-yi; Sun, Bei; Jiang, Hong-chi

    2013-08-01

    To analyze the predisposing factors for pancreatic fistula after pancreaticoduodenectomy. The clinical data of 323 patients undergoing pancreaticoduodenectomy from January 2007 to March 2012 were analyzed retrospectively. There were 185 male and 138 female patients, aging from 27 to 82 years. All the patients were devided into pancreatic fistula group (n = 52) and non-pancreatic fistula group (n = 271). Twenty variables, such as age, sex, primary disease, alcohol abuse, cholangitis, bilirubin, albumin, hemoglobin, operating time, blood loss, transfusion, texture of the remnant pancreas, diameter of wirsung, drainages of pancreatic duct, specialized group which potentially affect the incidence, were analyzed by t test for continuous variables and χ(2) test for discrete variables. The variables with significance (P fistula rate was 16.1% (52/323), 7 patients died for pancreatic fistula PF. In univariate analysis, primary disease, preoperative high bilirubin level, intraoperative blood loss and transfusion, texture of the remnant pancreas, diameter of wirsung, drainages of pancreatic duct, specialized group had significant difference between two groups (χ(2) = 4.072 to 9.008, P analysis revealed that primary disease (OR = 2.091, P = 0.001), texture of the remnant pancreas (OR = 7.715, P = 0.040), diameter of wirsung (OR = 5.405, P = 0.006), pancreatic duct stent (OR = 4.313, P = 0.001) and specialized group (OR = 6.404, P = 0.006) were independent risk factors in pancreatic fistula. Primary disease, texture of the remnant pancreas, diameter of wirsung, pancreatic duct stent and specialized group are independent risk factors in pancreatic fistula. With the purpose of decreasing pancreatic fistula rate after PD, it is necessary to operate meticulously and precisely, place external pancreatic duct stent and establish pancreatic center or specialized group.

  18. Novel biological strategies in the management of anal fistula.

    Science.gov (United States)

    Lewis, R; Lunniss, P J; Hammond, T M

    2012-12-01

    The mostly widely studied biomaterials for the sphincter sparing treatment of anal fistulas are fibrin glue and the anal fistula plug (AFP). However their overall mean clinical success is only 50-60%. As the understanding of the pathology of anal fistula, wound healing and the host response to materials has improved, so new biological sphincter-sparing strategies have been developed. The aim of this review is to assess the safety and efficacy of these novel techniques. PubMed, the Cochrane database and EMBASE were independently searched. All studies that investigated the potential of a biomaterial (defined as any synthetic or biologically derived substance in contact with host tissue) to augment the healing of anal fistula without sphincter division were included. Studies solely describing the role of fibrin glue or an AFP were excluded. Data extraction included type of material, fistula aetiology, treatment of the primary tract, fistula healing, incontinence, duration of follow-up and any specific complications. Systematic quality assessment of the included articles was performed. Twenty-three articles were finally selected for review. These included a variety of biological and synthetic systems that were employed to deliver selected components of the extracellular matrix, growth factors, cytokines, stem cells or drugs to the fistula tract. To date no study matches fistulotomy with regard to long-term fistula eradication rate. This is probably due to implant extrusion, inadequate track preparation or an unsuitable material. Future techniques need to address all these issues to ensure success. Success should be validated by MRI or long-term follow-up. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  19. Role of Montgomery salivary stent placement during pharyngolaryngectomy, to prevent pharyngocutaneous fistula in high-risk patients.

    Science.gov (United States)

    Bondi, S; Giordano, L; Limardo, P; Bussi, M

    2013-01-01

    To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent. Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy). Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx. Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p fistula development.

  20. Colovesical fistula presenting as Listeria monocytogenes bacteraemia.

    Science.gov (United States)

    Hobbs, Mark

    2015-03-31

    We present a case of colovesical fistula presenting with a clinical syndrome of urosepsis subsequently demonstrated to be due to Listeria monocytogenes bacteraemia. The patient had a history of previous rectal cancer with a low anterior resection and a covering ileostomy that had been reversed 6 months prior to this presentation. L. monocytogenes was also isolated among mixed enteric organisms on urine culture. There were no symptoms or signs of acute gastrointestinal listeriosis or meningoencephalitis. This unusual scenario prompted concern regarding the possibility of communication between bowel and bladder, which was subsequently confirmed with CT and a contrast enema. The patient recovered well with intravenous amoxicillin and to date has declined surgical management of his colovesical fistula. This case illustrates the importance of considering bowel pathology when enteric organisms such as Listeria are isolated from unusual sites.

  1. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  2. Novel perineal approach for repair of a urethrorectal fistula in a bulldog.

    Science.gov (United States)

    Ralphs, S Christopher; Kramek, Betty A

    2003-10-01

    A urethrorectal fistula was diagnosed in a 10-week-old, intact male bulldog, presented with a history of urine dribbling from his anus. The fistula was ligated using a novel perineal approach, resulting in resolution of clinical signs. The described procedure is simpler and less invasive than previously described repairs.

  3. Efficacy analysis of lacrimal fistula excision combined double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula

    Directory of Open Access Journals (Sweden)

    Hui-Ya Fan

    2015-01-01

    Full Text Available AIM: To observe the clinical effects of thelacrimal fistula excision combined with double silicone intubation in the treatment of chronic dacryocystitis with lacrimal fistula.METHODS: Totally 25 cases(25 eyesof chronic dacryocystitis with lacrimal fistula were allocated into two groups: the double silicone intubation group of 13 cases(13 eyesreceived lacrimal fistula excision combined with double silicone intubation, and the routine group of 12 cases(12 eyesreceived routine dacryocystorhinotomy, we analyzed the curative effect. RESULTS: The double silicone intubation group had a cure rate of 92.3%(12 eyes, a effective rate of 100%, compared with the routine group had a cure rate of 91.7%(11 eyes, a effective rate of 100%, there were no statistically significant difference between the two groups(P>0.05.CONCLUSION:Lacrimal fistula excision combined with double silicone intubation has a same effect with routine dacryocystorhinotomy in the treatment of chronic dacryocystitis with lacrimal fistula, but less invasive, no scar, less pain, and meet the patients' esthetic needs.

  4. Anal fistula plug: a prospective evaluation of success, continence and quality of life in the treatment of complex fistulae.

    Science.gov (United States)

    Adamina, M; Ross, T; Guenin, M O; Warschkow, R; Rodger, C; Cohen, Z; Burnstein, M

    2014-07-01

    Curing complex anal fistula without compromising continence can be extremely challenging. This study investigated the healing rate, continence and quality of life of patients after treatment of complex anal fistula of cryptoglandular origin with a bioprosthetic plug. Consecutive patients were prospectively followed in four referral centres. Following seton conditioning, a bioprosthetic plug was inserted into the fistula and sutured to the anal sphincter. Clinical evaluation was performed at 10 days, 6 weeks and 6 months after surgery, and was completed by telephone interviews. Anal continence and quality of life were evaluated using the Fecal Incontinence Score Index and the Short Form-36 Health Survey, version 2 (SF-36 v2) questionnaire. Forty-six patients presenting with a complex anal fistula and a median of three previous fistula surgeries were included. The 6-month recurrence rate was 30.7% (95% CI: 15.9-42.8%), increasing to 48.0% (95% CI: 30.6-61.1%) after 2 years. Follow up was continued for a median of 68.1 months, and 26 (56.5%) recurrences were identified. Anal continence improved from a median of 19 points to 12 points at 6 months of follow up (P = 0.008). Quality of life markedly improved in all scales. The physical summary score increased from 47.2 to 56.2 (P fistula plug demonstrated a healing rate close to 50% in complex cryptoglandular fistula. Also, it markedly improved anal continence and quality of life. These data support the use of a bioprosthetic plug as first-line therapy for complex fistula instead of more aggressive and potentially debilitating surgical options. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  5. [Perianal fistula and anal fissure].

    Science.gov (United States)

    Heitland, W

    2012-12-01

    CRYPTOGLANDULAR ANAL FISTULA: Perianal abscesses are caused by cryptoglandular infections. Not every abscess will end in a fistula. The formation of a fistula is determined by the anatomy of the anal sphincter and perianal fistulas will not heal on their own. The therapy of a fistula is oriented between a more aggressive approach (operation) and a conservative treatment with fibrin glue or a plug. Definitive healing and the development of incontinence are the most important key points. ANAL FISSURES: Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation.

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

    Science.gov (United States)

    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).

  7. [The anal fistula disease and abscess].

    Science.gov (United States)

    Strittmatter, Bernhard

    2004-01-01

    There are two forms of anal fistulas arising from its pathogenesis: the acute stage is the abscess, whereas the chronic stage is the fistula in ano. The classification of the fistula in ano is named after Parks. Pathogenesis and classification are explained. For complete cure, every abscess needs precise examination to be able to show the course and shape of the fistula. The surgical procedure depends on the fistula tract. Most fistulas can be operated by means of a fistulotomy or fistulectomy. Recovery depends on locating the total fistula tract.

  8. [Morgagni hernia mimicking intrathoracic lipomatous tumor].

    Science.gov (United States)

    Pinto, Carlos Silva; Bernardo, João; Eugénio, Luís; Antunes, Manuel J

    2013-01-01

    Morgagni hernia is the rarest type of diaphragmatic hernia, accounting for 2% of all cases. It consists in the thoracic protrusion of fat and/or abdominal viscera through a congenital defect in a retro or parasternal position. The clinical importance of this pathological entity is associated with the fact that it can be asymptomatic, mimicking other diseases, such as a large intrathoracic lipoma, as it happened in the case presented here. Incorrect diagnosis can cause catastrophic complications during surgery.

  9. New Techniques for Treating an Anal Fistula

    OpenAIRE

    Song, Kee Ho

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is exp...

  10. [Abscess, fistula and occlusion of colonic diverticulosis].

    Science.gov (United States)

    Bouillot, J L

    1995-04-15

    Diverticular disease is generally benign but may be serious in case of septic complications. The most common complication of acute diverticulitis is development of an abscess which can be located around the colon or in the pelvis. The diagnosis can be clinically suspected in case of non-response to medical management of severe acute diverticulitis. Confirmation is obtained by conventional radiographic examinations and computerized tomography. This condition can be safely treated by percutaneous catheter drainage associated to antibiotics followed by an elective delayed single-stage operation without colostomy. Fistula occurs in 20% of the patients who undergo surgery for diverticular disease. Colovesical fistula is the most common type of spontaneous internal fistula. Routine evaluation may raise the suspicion of complication. Surgical management requires colonic resection and primary anastomosis. Complete obstruction secondary to diverticular disease is uncommon and generally resolves with conservative management. However, some degree of ileus is frequent secondary to inflammatory changes of diverticulitis but should imperatively be differentiated from ileus observed in case of generalized peritonitis.

  11. 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.

  12. 食管癌、贲门癌术后胸胃瘘20例临床分析%A Clinical Analysis of 20 Cases of Thoracic Gastric Fistulas after Esophagectomy and Cardia Resection/

    Institute of Scientific and Technical Information of China (English)

    丁国文; 陈锁成; 孙斌; 董长青; 唐巍峰; 施益军; 邵爱中; 孙扬永; 顾海勇

    2012-01-01

      目的:探讨食管癌、贲门癌术后胸胃瘘的治疗方法。方法:对笔者所在医院20例胸胃瘘患者的治疗进行回顾性分析。早期胃瘘及后期瘘口较大的12例胃瘘进行再次手术,手术方式包括行胃瘘修补术7例,结肠代食管术2例,坏死胃壁及吻合口切除重新吻合2例,1例行扩清术;中晚期胃瘘瘘口较小的8例患者采用保守治疗,包括2例胸腔引流,6例经瘘口内引流。结果:20例患者中有17例治愈出院,3例死亡,死亡率15%。结论:食管癌贲门癌术后胃瘘的治疗方式,根据胃瘘发生的时间、范围而定,术后早期胃瘘及晚期胃瘘较大的病例选用手术治疗,术后晚期胃瘘瘘口小的病例适合保守治疗。%  Objective:To investigate the treatment of thoracic gastric fistulas after esophagectomy and cardia resection.Methods:Twenty cases with thoracic gastric fistulas after esophagectomy and cardia resection were enrolled in this study.12 cases with early gastric fistula and lager fistula were re-operated. Including gastric fistula repair (7 cases),colon replace esophagus (2 cases),re-anastomosis (2 cases) and dissection surgery (1 cases).8 cases with small fistulas in advanced gastric fistula were treated by conservative treatment.Including thoracic drainage (2 cases) and fistula drainage (6 cases).Results:Seventeen cases were cured,3 patients died,the mortality rate is 15%.Conclusion:The treatment of thoracic gastric fistulas after esophagectomy and cardia resection were depend on the time and size of fistulas.Early fistula and large fistula of advanced gastric fistula select operation.large fistula of advanced gastric fistula prefer conservative treatment.

  13. Idiopathic fistula-in-ano

    Institute of Scientific and Technical Information of China (English)

    Sherief Shawki; Steven D Wexner

    2011-01-01

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

  14. Internal fistulas in diverticular disease.

    Science.gov (United States)

    Woods, R J; Lavery, I C; Fazio, V W; Jagelman, D G; Weakley, F L

    1988-08-01

    Internal fistulas in diverticular disease are uncommon and have a reputation of being difficult to treat. Eighty four patients treated from 1960 to April 1986, representing 20.4 percent (84 of 412) of the surgically treated diverticular disease patients, were reviewed. Eight patients had multiple fistulas. Sixty-five percent (60 to 92) of fistulas were colovesical, 25 percent (23 of 92) colovaginal, 6.5 percent (6 of 92) coloenteric, and 3 percent (3 of 92) colouterine fistulas. There were 66 percent (35 of 53) males and 34 percent (18 of 53) females with colovesical fistulas only. Hysterectomies had been performed in 50 percent (12 of 24) and 83 percent (19 of 23) of females with colovesical and colovaginal fistulas, respectively. Operative management included: resection anastomosis, resection with anastomosis and diversion, Hartmann procedure, and three-stage procedure. In the latter half of the series there was a significant decrease in staging procedures with no significant statistical difference in complications. There were three deaths (3.5 percent) in the series. Other complications included: wound infection, 21 percent (18 of 84), enterocutaneous fistula, 1 percent (4 of 84), and anastomotic dehiscence, 5 percent (4 of 84). Primary anastomosis can be performed with acceptable morbidity and mortality and today is the procedure of choice, leaving staging procedures to selected patients.

  15. Idiopathic fistula-in-ano

    Science.gov (United States)

    Shawki, Sherief; Wexner, Steven D

    2011-01-01

    Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal opening, a track, and an external opening. The external opening might acutely appear following infection and/or an abscess, or more insiduously in a chronic manner. Management includes control of infection, assessment of the fistulous track in relation to the anal sphincter muscle, and finally, definitive treatment of the fistula. Fistulotomy was the most commonly used mode of management, but concerns about post-fistulotomy incontinence prompted the use of sphincter preserving techniques such as advancement flaps, fibrin glue, collagen fistula plug, ligation of the intersphincteric fistula track, and stem cells. Many descriptive and comparative studies have evaluated these different techniques with variable outcomes. The lack of consistent results, level I evidence, or long-term follow-up, as well as the heterogeneity of fistula pathology has prevented a definitive treatment algorithm. This article will review the most commonly available modalities and techniques for managing idiopathic fistula-in-ano. PMID:21876614

  16. Cryptoglandular anal fistula.

    Science.gov (United States)

    de Parades, V; Zeitoun, J-D; Atienza, P

    2010-08-01

    Fistula arising from the glands of the anal crypts is the most common form of anoperineal sepsis. It is characterized by a primary internal orifice in the anal canal, a fistulous tract, and an abscess and/or secondary perineal orifice with purulent discharge. Antibiotics are not curative. The treatment of an abscess is urgent and consists, whenever possible, of incision and drainage under local anesthesia. Definitive treatment of the fistulous tract can await a second stage. The primary aim is to control infection without sacrificing anal continence. Fistulotomy is the basis for all treatments but the specific technique depends on the height of the fistula in relation to the sphincteric mechanism. Overall results of fistulotomy are excellent but there is some risk of anal incontinence. This explains the growing interest in sphincter sparing techniques such as the mucosal advancement flap, the injection of fibrin glue, and the plug procedure. However, results of these procedures are not yet good enough and leave much room for improvement.

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

    Science.gov (United States)

    2013-01-01

    Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus 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. Results 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. Conclusion 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. PMID:24321441

  18. Foramen magnum dural arteriovenous fistula presenting with epilepsy

    Science.gov (United States)

    Manisor, Monica; Aloraini, Ziad; Chibarro, Salvatore; Proust, Francois; Quenardelle, Véronique; Wolff, Valérie; Beaujeux, Rémy

    2015-01-01

    Intracranial dural arteriovenous fistulas (dAVFs) with perimedullary drainage represent a rare subtype of intracranial dAVF. Patients usually experience slowly progressive ascending myelopathy and/or lower brainstem signs. We present a case of foramen magnum dural arteriovenous fistula with an atypical clinical presentation. The patient initially presented with a generalised tonic-clonic seizure and no signs of myelopathy, followed one month later by rapidly progressive tetraplegia and respiratory insufficiency. The venous drainage of the fistula was directed both to the left temporal lobe and to the perimedullary veins (type III + V), causing venous congestion and oedema in these areas and explaining this unusual combination of symptoms. Rotational angiography and overlays with magnetic resonance imaging volumes were helpful in delineating the complex anatomy of the fistula. After endovascular embolisation, there was complete remission of venous congestion on imaging and significant clinical improvement. To our knowledge, this is the first report of a craniocervical junction fistula presenting with epilepsy. PMID:26472637

  19. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-08-01

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

  20. Pancreaticojejunostomy after pancreaticoduodenectomy: Suture material and incidence of post-operative pancreatic fistula.

    Science.gov (United States)

    Andrianello, Stefano; Pea, Antonio; Pulvirenti, Alessandra; Allegrini, Valentina; Marchegiani, Giovanni; Malleo, Giuseppe; Butturini, Giovanni; Salvia, Roberto; Bassi, Claudio

    2016-01-01

    Pancreatic fistula represents the most important complication in terms of clinical management and costs after pancreaticoduodenectomy. A lot of studies have investigated several techniques in order to reduce pancreatic fistula, but data on the effect of sutures material on pancreatic fistula are not available. The analysis investigated the role of suture material in influencing pancreatic fistula rate and severity. Results from 130 consecutive pancreaticoduodenectomy with pancreaticojejunostomy performed between March 2013 and September 2014 were prospectively collected and analyzed. In 65 cases pancreaticojejunostomy was performed with absorbable sutures, in the other 65 cases using non-absorbable sutures (polyester, silk and polybutester). Pancreaticojejunostomy with non-absorbable sutures had the same incidence of pancreatic fistula, but less severe and with less episodes of post-operative bleeding if compared with absorbable sutures. A sub-analysis was carried out comparing polydioxanone with polyester: the latter was associated with a lower pancreatic fistula rate (11.9% vs. 31.7%; p = 0,01) and less severe pancreatic anastomosis dehiscence (grade C - 0% vs. 30%; p = 0.05). Univariate and multivariate analysis confirmed that hard pancreatic texture, pancreatic ductal adenocarcinoma at final histology and the use of polyester for pancreaticojejunostomy were associated with a lower pancreatic fistula rate (p fistula with less severe clinical impact. Copyright © 2015 IAP and EPC. Published by Elsevier India Pvt Ltd. All rights reserved.

  1. Management of Severe Pancreatic Fistula After Pancreatoduodenectomy.

    Science.gov (United States)

    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

  2. Mimickers of breast malignancy on breast sonography.

    Science.gov (United States)

    Cho, So Hyun; Park, Sung Hee

    2013-11-01

    The aim of this article is to review benign breast lesions that can mimic carcinoma on sonography. Cases of benign lesions mimicking carcinoma on sonography were collected among lesions that were initially assessed as suspicious on sonography according to the American College of Radiology Breast Imaging Reporting and Data System category. Sonographically guided core needle biopsy was performed, and the pathologic types were confirmed to be benign. Cases of benign lesions mimicking carcinoma on sonography were shown to include fat necrosis, diabetic mastopathy, fibrocystic changes, sclerosing adenosis, ruptured inflammatory cysts, inflammatory abscesses, granulomatous mastitis, fibroadenomas, fibroadenomatous mastopathy, and apocrine metaplasia. Benign breast lesions may present with malignant features on imaging. A clear understanding of the range of appearances of benign breast lesions that mimic malignancy is important in radiologic-pathologic correlation to ensure that benign results are accepted when concordant with imaging and clinical features but, when discordant, there is no delay in further evaluation up to and including excisional biopsy.

  3. Colovesical fistula presenting with epididymitis.

    Science.gov (United States)

    Arneill, Matthew; Hennessey, Derek Barry; McKay, Damian

    2013-04-23

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Subsequent CT imaging revealed air in the bladder and a colovesical fistula. The patient went on to have Hartmann's procedure with repair of the bladder defect. This case highlights that: (1) Colovesical fistulae may rarely present with epididymitis. (2) Colovesical fistulae are the most common cause of pneumaturia.

  4. Operative considerations for rectovaginal fistulas

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  5. Colovesical fistula presenting with epididymitis

    Science.gov (United States)

    Arneill, Matthew; Hennessey, Derek Barry; McKay, Damian

    2013-01-01

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Subsequent CT imaging revealed air in the bladder and a colovesical fistula. The patient went on to have Hartmann's procedure with repair of the bladder defect. This case highlights that: (1) Colovesical fistulae may rarely present with epididymitis. (2) Colovesical fistulae are the most common cause of pneumaturia. PMID:23616326

  6. Anal fistula. Past and present

    National Research Council Canada - National Science Library

    Zubaidi, Ahmad M

    2014-01-01

    Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess...

  7. The Rate of Oronasal Fistula Following Primary Cleft Palate Surgery: A Meta-Analysis.

    Science.gov (United States)

    Bykowski, Michael R; Naran, Sanjay; Winger, Daniel G; Losee, Joseph E

    2015-07-01

    Despite decades of craniofacial surgeons repairing cleft palates, there is no consensus for the rate of fistula formation following surgery. The authors present a meta-analysis of studies that reported on primary cleft palate to determine the rate of oronasal fistula and to identify risk factors for their development. A literature search for the period between 2000 and 2012 was performed. Articles were queried and strict inclusion and exclusion criteria were applied to focus on primary cleft palate repair. A meta-analysis of these data was conducted. The meta-analysis included 11 studies, comprising 2505 children. The rate of oronasal fistula development was 4.9% (95% confidence interval, 3.8% to 6.1%). When analyzing a larger cohort, there was a significant relationship between Veau classification and the occurrence of a fistula (P fistulae most prevalent in patients with a Veau IV cleft. The most common location for a fistula was at the soft palate-hard palate junction. One study used decellularized dermis in cleft repair with a fistula rate of 3.2%. Using 11 studies comprising 2505 children, we find the rate of reported fistula occurrence to be 4.9%. Furthermore, patients with a Veau IV cleft are significantly more likely to develop an oronasal fistula. When fistulae do occur, they do so most often at the soft palate-hard palate junction. A deeper understanding of fistula formation will help cleft palate surgeons improve their outcomes in the operating room and will allow them to effectively communicate expectations with patients' families in the clinic.

  8. Endovascular treatment of dural fistulas with the venous outflow of laterocavernous sinus

    Energy Technology Data Exchange (ETDEWEB)

    Lv Xianli; Jiang Chuhan; Li Youxiang; Lv Ming [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing, 100050 (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Chongwen, Beijing, 100050 (China)

    2010-08-15

    Objective: To report our findings concerning the laterocavernous sinus (LCS) drainage of dural fistulas, focusing our attention on the important implications in treatment of the LCS, which is one of the principal drainage pathways of the superficial middle cerebral vein (SMCV). Methods: Consecutive 32 patients with dural fistulas treated endovascularly between 2005 and 2008 were reviewed. Seven patients had angiographic features such as dural fistulas draining with SMCV via LCS. Clinical records for these 7 patients were focused to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Results: Over 3 years, 7 patients had 7 dural fistulas drained with SMCV via LCS were treated. Six-vessel angiography confirmed the presence of the dural fistulas. All fistulas were Cognard Type III featured by leptomeningeal veins drainage. One fistula involving the lesser sphenoid wing and 6 fistulas involving CS were supplied by external carotid artery branches with or without dural branches of the internal carotid artery. LCS was identified as a contiguous to SMCV drainage in these cases. One patient was treated with transvenous coil embolization alone, two with transvenous a combination of Onyx and coil embolization, and 4 with transarterial embolization. An angiographic obliteration and clinical cure was achieved in all patients. Complication was local hair loss due to X-ray radiation in one patient. Conclusion: It is very important to diagnose the presence of LCS in dural fistulas during the diagnostic angiography. It is believed that the knowledge of LCS might be relevant for the understanding and treatment of dural fistulas involving the LCS.

  9. [Clinical investigation of detecting the bronchi responsible for pulmonary air leakage by injecting methylene blue saline in 27 cases with intractable pneumothorax and bronchial fistula].

    Science.gov (United States)

    Jin, Pule; Ge, Hui; Peng, Luanshun; Wang, Guojun; Hu, Wenxia; Song, Shan

    2014-11-01

    To establish a new method for detecting the bronchus responsible for pulmonary air leakage by injecting methylene blue saline and to evaluate its efficacy and safety in cases with intractable pneumothorax and bronchial fistula. From January 2006 to October 2013, a total of 19 cases of intractable spontaneous pneumothorax and 8 cases of bronchial fistula were recruited in the study at the Fourth Hospital affiliated to Hebei Medical University. Of all the cases, 15 were diagnosed as having tension pneumothorax and 12 as having communicating pneumothorax. All the cases failed to respond to continuous pleural suction for more than 5 days and consented to the proposed treatment. Before procedure, chest suction was established to allow sustained airflow through the drainage tube while the patients breathed normally. Under direct vision through fiberoptic bronchoscope, injection catheter was inserted into the bronchoscopy channel, and methylene blue saline was slowly injected into the potentially leaking segmental or sub-segmental bronchi. When a steady decline or disappearance in the amount of methylene blue saline in the airways was observed, or methylthionine-tainted saline was detected within the chest drainage tube, the bronchus responsible for air leakage was indicated. Before blocking the target bronchus, the negative pressure level of pleural suction should be reduced or stopped, and then porcine fibrin glue or a-cyanoacrylate was used for sealing the bronchi associated with air leakage. When the air was absent from the drainage tube, and lung recruitment was indicated in the chest X-ray for 5 days, and bronchial blockade of air leakage was proved successful. The bronchi responsible for air leakage were successfully located in all 27 cases, among them segmental bronchi were located in 16, subsegmental bronchi in 10, and small subsegmental bronchus in only one. Multiple adjacent segmental involvement occurred in 3, and multiple adjacent subsegmental involvement in

  10. Ureteroarterial fistula: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Sun; Kim, Ji Chang [Daejeon St Mary' s Hospital, Daejeon (Korea, Republic of)

    2007-01-15

    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.

  11. Esophagogastric fistula complicating Nissen fundoplication

    OpenAIRE

    Marcel Tafen; Nader Tehrani; Afshin A. Anoushiravani; Avinash Bhakta; Timothy G. Canty; Christine Whyte

    2016-01-01

    Esophagogastric fistula or double-lumen esophagus is a rare condition. There have been fewer than 15 reported cases in adults and only one reported case in the pediatric population. Esophagogastric fistulas typically develop in patients with preexisting gastrointestinal reflux, esophagogastric surgery, esophageal ulcers, or carcinoma. Our case involves a 5-year old girl presenting with odynophagia and nocturnal cough who had a prior Nissen fundoplication. She was found to have an esophagogast...

  12. 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...

  13. Spontaneous nephrocutaneous fistula

    Directory of Open Access Journals (Sweden)

    Alberto A. Antunes

    2004-08-01

    Full Text Available Spontaneous renal fistula to the skin is rare. The majority of cases develop in patients with antecedents of previous renal surgery, renal trauma, renal tumors, and chronic urinary tract infection with abscess formation. We report the case of a 62-year old woman, who complained of urine leakage through the skin in the lumbar region for 2 years. She underwent a fistulography that revealed drainage of contrast agent to the collecting system and images suggesting renal lithiasis on this side. The patient underwent simple nephrectomy on this side and evolved without intercurrences in the post-operative period. Currently, the occurrence of spontaneous renal and perirenal abscesses is extremely rare, except in patients with diabetes, neoplasias and immunodepression in general.

  14. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  15. [Surgical treatment of anal fistula].

    Science.gov (United States)

    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.

  16. Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case

    Directory of Open Access Journals (Sweden)

    Ghodratollah Maddah

    2016-03-01

    Full Text Available A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.

  17. [Oral cancer surgery and oral cutaneous fistulas: risk factors].

    Science.gov (United States)

    Ramos, Gyl Henrique A; Crivelaro, André Luiz Soares; de Oliveira, Benedito Valdecir; Pedruzzi, Paola Andrea G; de Freitas, Rosyane Rena

    2010-04-01

    To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

  18. Transitional Flow in an Arteriovenous Fistula: Effect of Wall Distensibility

    Science.gov (United States)

    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.

  19. Brucellosis in spondyloarthritis mimicking an exacerbation.

    Science.gov (United States)

    Garip, Y; Eser, F; Erten, S; Yilmaz, O; Yildirim, P

    2014-01-01

    Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

  20. Tumoral calcinosis mimicking recurrent osteosarcoma

    National Research Council Canada - National Science Library

    Petscavage, Jonelle M; Richardson, Michael L

    2009-01-01

    We report a case of a tumoral calcinosis mimicking the appearance of recurrent osteosarcoma of the left femur and tibia in a 29-year-old woman with a history of osteosarcoma and chronic renal failure...

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Management of acquired bronchobiliary fistula: A systematic literature review of 68 cases published in 30 years

    Institute of Scientific and Technical Information of China (English)

    Guan-Qun Liao; Hao Wang; Guang-Yong Zhu; Kai-Bin Zhu; Fu-Xin Lv; Sheng Tai

    2011-01-01

    AIM: To outline the appropriate diagnostic methods and therapeutic options for acquired bronchobiliary fistula (BBF).METHODS: Literature searches were performed in Medline, EMBASE, PHMC and LWW (January 1980-August 2010) using the following keywords: biliobronchial fistula, bronchobiliary fistula, broncho-biliary fistula, biliary-bronchial fistula, tracheobiliary fistula, hepatobronchial fistula, bronchopleural fistula, and biliptysis. Further articles were identified through cross-referencing. RESULTS: Sixty-eight cases were collected and reviewed. BBF secondary to tumors (32.3%, 22/68), including primary tumors (19.1%, 13/68) and hepatic metastases (13.2%, 9/68), shared the largest proportion of all cases. Biliptysis was found in all patients, and other symptoms were respiratory symptoms, such as irritating cough, fever (36/68) and jaundice (20/68). Half of the patients were treated by less-invasive methods such as endoscopic retrograde biliary drainage. Invasive approaches like surgery were used less frequently (41.7%, 28/67). The outcome was good at the end of the follow-up period in 28 cases (range, 2 wk to 72 mo), and the recovery rate was 87.7% (57/65).CONCLUSION: The clinical diagnosis of BBF can be established by sputum analysis. Careful assessment of this condition is needed before therapeutic procedure. Invasive approaches should be considered only when non-invasive methods failed.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Aortoenteric fistula formation is a devastating condition regardless of whether it is primary or secondary (i.e. after previous aneurysm repair) in nature. Patients present with signs and symptoms of gastrointestinal bleeding with or without signs of systemic infection and are often in a very poor...... clinical condition. Conventional treatment consists of extensive open surgery (extra-anatomical bypass or aortic ligation), closure of fistula tract and complete removal of any prosthetic material. This treatment is associated with high morbidity and mortality and therefore more minimally invasive options...... for acute bleeding and aggressive infection treatment with systemic and local antibiotics, surgical abscess revision and fistula tract closure might be an option in fragile patients. For patients fit for open repair, EVAR can be used as a bridging procedure to definitive repair particularly in the setting...

  4. Factors predictive of failure of Brescia-Cimino arteriovenous fistulas

    NARCIS (Netherlands)

    Zeebregts, C; van den Dungen, J; Franssen, C; Verhoeven, E; van Schilfgaarde, R

    2002-01-01

    Objective: To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure. Design: Retrospective clinical study. Setting: University hospital, The Netherlands. Subjects: 150 consecutive patients (mean age 56 years. range 17-80) who had 153 p

  5. Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula

    OpenAIRE

    Naeem Liaqat; Asif Iqbal; Sajid Hameed Dar; Faheem Liaqat

    2016-01-01

    Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT). We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

  6. Video Assisted Anal Fistula Treatment in a Child with Perianal Fistula

    Directory of Open Access Journals (Sweden)

    Naeem Liaqat

    2016-01-01

    Full Text Available Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT. We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully.

  7. Assessment and management of urethrocutaneous fistula ...

    African Journals Online (AJOL)

    Assessment and management of urethrocutaneous fistula developing ... at the Cairo University Pediatric Hospital with fistulae after .... to control cases with severe postoperative pain. All ... pressure, respiratory rate, and temperature), regular.

  8. Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

    Science.gov (United States)

    Leng, Qiang; Jin, Hei-Ying

    2012-01-01

    AIM: To investigate the efficacy of the anal fistula plug (AFP) compared to the mucosa advancement flap (MAF), considered the best procedure for patients with a complex anal fistula. METHODS: The literature search included PubMed, EMBASE, Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011. Randomized controlled trials, controlled clinical trials and prospective cohort studies were included in the review. After information collection, a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity. The quality of postoperative life was also included with the clinical results. RESULTS: Six studies involving 408 patients (AFP = 167, MAF = 241) were included in the meta-analysis. The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference (RD) = -0.12, 95%CI: -0.39 - 0.14; RD = 0.13; 95%CI: -0.18 - 0.43, respectively]. However, for the AFP, the risk of postoperative impaired continence was lower (RD = -0.08, 95%CI: -0.15 - -0.02) as was the incidence of other complications (RD = -0.06, 95%CI: -0.11 - -0.00). The postoperative quality of life, for patients treated using the AFP was superior to that of the MAF patients. Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced. CONCLUSION: The AFP is an effective procedure for patients with a complex anal fistula; it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life. Additional evidence is needed to confirm these findings. PMID:23494149

  9. Experimental model of anal fistula in rats

    OpenAIRE

    Arakaki, Mariana Sousa; Santos,Carlos Henrique Marques dos; Falcão, Gustavo Ribeiro; Cassino,Pedro Carvalho; Nakamura, Ricardo Kenithi; Gomes,Nathália Favero; Santos,Ricardo Gasparin Coutinho dos

    2013-01-01

    INTRODUCTION: the management of anal fistula remains debatable. The lack of a standard treatment free of complications stimulates the development of new options. OBJECTIVE: to develop an experimental model of anal fistula in rats. METHODS: to surgically create an anal fistula in 10 rats with Seton introduced through the anal sphincter musculature. The animals were euthanized for histological fistula tract assessment. RESULTS: all ten specimens histologically assessed had a lumen and surroundi...

  10. VAAFT: Video Assisted Anal Fistula Treatment; Bringing revolution in Fistula treatment

    OpenAIRE

    2015-01-01

    Objective: To share our findings that the new treatment modality Video Assisted Anal Fistula Treatment (VAAFT) is a better alternate to the conventional treatments of Fistula in Ano in our setup with minor changes in the initial method described by Meinero. Methods: Karl Storz Video equipment including Meinero Fistuloscope was used. Key steps are visualization of the fistula tract, correct localization of the internal fistula opening under direct vision and endoscopic treatment of the fistula...

  11. [APPLICATION OF FISTULA PLUG WITH THE FIBRIN ADHESIVE IN TREATMENT OF RECTAL FISTULAS].

    Science.gov (United States)

    Aydinova, P R; Aliyev, E A

    2015-05-01

    Results of surgical treatment of 21 patients, suffering high transsphincteric and extrasphincteric rectal fistulas, were studied. In patients of Group I the fistula passage was closed, using fistula plug obturator; and in patients of Group II--by the same, but preprocessed by fibrin adhesive. The fistula aperture germeticity, prophylaxis of rude cicatrices development in operative wound zone, promotion of better fixation of bioplastic material were guaranteed, using fistula plug obturator with preprocessing, using fibrin adhesive.

  12. Preventing obstetric fistulas in low-resource countries: insights from a Haddon matrix.

    Science.gov (United States)

    Wall, L Lewis

    2012-02-01

    An obstetric fistula is classically regarded as an "accident of childbirth" in which prolonged obstructed labor leads to destruction of the vesicovaginal/rectovaginal septum with consequent loss of urinary and/or fecal control. Obstetric fistula is highly stigmatizing and afflicted women often become social outcasts. Although obstetric fistula has been eliminated from advanced industrialized nations, it remains a major public health problem in the world's poorest countries. Several million cases of obstetric fistula are currently thought to exist in sub-Saharan Africa and south Asia. Although techniques for the surgical repair of such injuries are well known, it is less clear which strategies effectively prevent fistulas, largely because of the complex interactions among medical, social, economic, and environmental factors present in those countries where fistulas are prevalent. This article uses the Haddon matrix, a standard tool for injury analysis, to examine the factors influencing obstetric fistula formation in low-resource countries. Construction of a Haddon matrix provides a "wide angle" overview of this tragic clinical problem. The resulting analysis suggests that the most effective short-term strategies for obstetric fistula prevention will involve enhanced surveillance of labor, improved access to emergency obstetric services (particularly cesarean delivery), competent medical care for women both during and after obstructed labor, and the development of specialist fistula centers to treat injured women where fistula prevalence is high. The long-term strategies to eradicate obstetric fistula must include universal access to emergency obstetric care, improved access to family planning services, increased education for girls and women, community economic development, and enhanced gender equity. Successful eradication of the obstetric fistula will require the mobilization of sufficient political will at both the international and individual country levels to

  13. Optimizing management of pancreaticopleural fistulas

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  14. Gastrocolic Fistula: A Shortcut through the Gut

    Directory of Open Access Journals (Sweden)

    Nauzer Forbes

    2016-01-01

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

  15. Fistulectomy with primary sphincter reconstruction in the treatment of high transsphincteric anal fistulas.

    Science.gov (United States)

    Hirschburger, Markus; Schwandner, Thilo; Hecker, Andreas; Kierer, Walter; Weinel, Rolf; Padberg, Winfried

    2014-02-01

    The treatment of transsphincteric anal fistulas is a challenge between recurrence rate and incontinence. Many surgical and conservative procedures have been described in the treatment of anal fistulas. Fistulectomy and primary sphincter reconstruction (FPSR) has not gained great popularity in this field due to the risk of sphincter damage. The aim of this study is to evaluate FPSR in the treatment of transsphincteric fistulas. We retrospectively analyzed 50 patients with high transsphincteric fistulas of cryptoglandular origin that were treated with FPSR between 2005 and 2008. Preoperative assessment included physical and proctologic examination. Continence and pain scores were evaluated preoperatively and postoperatively. In our 50 patients, 22 patients (44 %) had a previous proctologic operation and 11 patients (22 %) presented with recurrent fistulas. The fistulas existed for an average of 8 months. The operation time was 28 ± 16 min. Mean follow-up was 22± months. The fistula healed in 44 patients (88 %) who developed no recurrence. In five patients (10 %), the fistula healed, but they developed a recurrence in the observation period. In one patient (2 %), the fistula did not heal. Three patients developed low-grade incontinence for flatus, and one patient with 2° incontinence improved. Preoperatively and postoperatively calculated continence and pain scores showed a slight but significant elevation in the Clinical Continence Score, the German Society of Coloproctology Score showed no significant difference, and preexisting pain was reduced significantly by surgery. FPSR is a safe surgical procedure for the treatment of high transsphincteric anal fistula. The primary healing rate is high with a low risk of recurrence or incontinence.

  16. German S3 guidelines: anal abscess and fistula (second revised version).

    Science.gov (United States)

    Ommer, Andreas; Herold, Alexander; Berg, Eugen; Fürst, Alois; Post, Stefan; Ruppert, Reinhard; Schiedeck, Thomas; Schwandner, Oliver; Strittmatter, Bernhard

    2017-03-01

    The incidence of anal abscess and fistula is relatively high, and the condition is most common in young men. This is a revised version of the German S3 guidelines first published in 2011. It is based on a systematic review of pertinent literature. Cryptoglandular abscesses and fistulas usually originate in the proctodeal glands of the intersphincteric space. Classification depends on their relation to the anal sphincter. Patient history and clinical examination are diagnostically sufficient in order to establish the indication for surgery. Further examinations (endosonography, MRI) should be considered in complex abscesses or fistulas. The goal of surgery for an abscess is thorough drainage of the focus of infection while preserving the sphincter muscles. The risk of abscess recurrence or secondary fistula formation is low overall. However, they may result from insufficient drainage. Primary fistulotomy should only be performed in case of superficial fistulas. Moreover, it should be done by experienced surgeons. In case of unclear findings or high fistulas, repair should take place in a second procedure. Anal fistulas can be treated only by surgical intervention with one of the following operations: laying open, seton drainage, plastic surgical reconstruction with suturing of the sphincter (flap, sphincter repair, LIFT), and occlusion with biomaterials. Only superficial fistulas should be laid open. The risk of postoperative incontinence is directly related to the thickness of the sphincter muscle that is divided. All high anal fistulas should be treated with a sphincter-saving procedure. The various plastic surgical reconstructive procedures all yield roughly the same results. Occlusion with biomaterial results in lower cure rate. In this revision of the German S3 guidelines, instructions for diagnosis and treatment of anal abscess and fistula are described based on a review of current literature.

  17. 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

    OpenAIRE

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

    2010-01-01

    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...

  18. 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.)

  19. Perianal fistulas in Crohn's disease: MRI diagnosis and surgical planning: MRI in fistulazing perianal Crohn's disease.

    Science.gov (United States)

    Szurowska, Edyta; Wypych, Joanna; Izycka-Swieszewska, Ewa

    2007-11-01

    Crohn's disease is a chronic, transmural inflammatory process of the gastrointestinal tract. It often affects the colon with the perianal area. The most common intestinal manifestations include external and/or internal fistulas and abscesses. Assessment of the activity of perianal fistulas in the course of Crohn's disease seems to be an important factor influencing therapeutic approach. Fistula's activity is evaluated by such methods as magnetic resonance imaging, anal ultrasound and examination under anaesthesia. Usefulness of imaging methods in the diagnosis of fistulas still remains to be defined.MRI is used to present a wide spectrum of perianal fistulazing Crohn's disease. Additionally, it is an important instrument revealing location, extent and severity of inflammation. It is also very helpful to detect clinically silent sepsis related to small, local inflammation. The most common method used in MR imaging to assess topography of a fistula's track, is Parks' classification.Clinical indications to MRI may include follow-up studies of a diagnosed disease, classification of fistulas' subtypes in the course of Crohn's disease, determination of the extent of fistulas' tracts and spread of an inflammatory process what can guide surgical procedures.

  20. [Etiology, diagnosis and treatment analysis of 37 cases with orbital fistula].

    Science.gov (United States)

    Lin, Ting-Ting; He, Yan-Jin; Zhu, Li-Min; Zhang, Hong; Wang, Dong; Song, Guo-Xiang

    2009-07-07

    To present some instruction in diagnosis and treatment of the orbital fistula by analyze the clinical manifestation. The clinical data for 37 cases with orbital fistula treated during 1980 to 2007 were analyzed retrospectively. Among 37 cases with orbital fistula, there are 21 cases caused by foreign bodies, including 17 cases by retained wooden bodies, 3 cases by iatrogenic foreign bodies and 1 case by firecrackers. There are 9 cases caused by orbital cysts, including 5 cases dermoid cysts, 3 cases epidermoid cysts and 1 case frontal mucopyocele. There are 6 cases orbital infection inflammation, including 5 cases osteomyelitis and 1 case orbital abscess. There is 1 case eosinophilic granuloma. Different etiologies have characteristic features. Medical history, fistula examinations and imaging examinations must be analyzed synthetically in order to make proper etiological diagnosis. Eradicate etiologies and resect fistula are most important. It is necessary to make an ancillary therapy, such as ENT treatment. The common etiologies of orbital fistula are retained foreign body, dermoid cysts and osteomyelitis. The pathogenesis include infective inflammation, congenital heteroplasia, operation and tumor. B-scan ultrasonography, CT, and MRI can be used for the localization and qualitation diagnosis. There are comprehensive approaches for diagnosis and management of this type of injury. In order to give an effective therapy, we must make an accurate diagnosis and analyze the features of fistula.

  1. Long-term outcome after surgery for Crohn's anal fistula.

    Science.gov (United States)

    Graf, W; Andersson, M; Åkerlund, J-E; Börjesson, L

    2016-01-01

    Treatment of Crohn's anal fistula remains challenging and little is known about factors associated with healing. The aim of this study was to assess the rate of healing after surgical treatment and analyse clinical variables related to healing. A total of 119 patients [63 women, mean age 36 (±13.7) years] with histopathologically verified Crohn's disease underwent a surgical procedure for anal fistula at four main referral centres in Sweden, January 1998 to December 2009. Baseline and treatment-related variables were recorded and analysed for correlation with fistula healing at a final follow-up after a mean of 7.2 (median 7.1, 1.0-17.5) years. Of the 119 patients 62 (52%) were healed at final follow-up. Fourteen healed after one procedure and the remaining 48 healed after a further median of 4.0 (2-20) procedures. Ten (8%) patients were subjected to a proctectomy. Final healing was more common in patients operated with a procedure aiming at eradicating the fistula (P = 0.0001), without proctitis (P = 0.02) and a shorter duration of Crohn's disease (P = 0.0019). Long-term healing of a Crohn's anal fistula can be expected in about half of the patients, usually after repeated surgical treatment. The probability for cure was higher when a curative operation was performed in a patient without proctitis and with a shorter duration of Crohn's disease. An attempt to close a Crohn's anal fistula is thus often worthwhile. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

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

    Directory of Open Access Journals (Sweden)

    Francesco A. Polistina

    2010-10-01

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

  3. 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

    Science.gov (United States)

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

    2010-01-01

    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. PMID:21103208

  4. Benzalkonium Chloride Intoxication Mimicking Herpes Zoster Encephalitis

    Directory of Open Access Journals (Sweden)

    Ekrem Güler

    2011-06-01

    Full Text Available Benzalkonium chloride (BAC is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is to draw attention to the fact that BAC application to the scalp for treating pediculosis capitis may resemble the herpes encephalitis clinical picture.

  5. Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2014-01-01

    Full Text Available Traumatic diaphragmatic hernia (TDH is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.

  6. Post-pancreatitis Fat Necrosis Mimicking Carcinomatosis.

    Science.gov (United States)

    Smith, Joshua P; Arnoletti, J Pablo; Varadarajulu, Shyam; Morgan, Desiree E

    2008-01-01

    Acute pancreatitis can result in retroperitoneal fat necrosis, typically occurring in the peripancreatic region, with extension into the transverse mesocolon, omentum and mesenteric root. When evaluated with contrast enhanced computed tomography (CECT), acute peripancreatic post necrotic collections typically become lower in attenuation over time, and often appear as homogeneous fluid collections. Saponification as a complication of fat necrosis in patients with acute pancreatitis is a well recognized clinical entity. While retroperitonal fat necrosis is commonly seen on CECT, saponification is not a prominent imaging feature. We present a case of acute pancreatitis complicated by extensive saponification of fat throughout the retroperitoneum and peritoneal lining, mimicking carcinomatosis.

  7. Clinical Effect of Vitapex on Refractory Periapical Periodontitis with Fistula%Vitapex 糊剂根管消毒治疗有瘘型难治性根尖周炎的临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    高晓琳; 张巧红; 刘璐; 王国友; 李效斐

    2012-01-01

      目的观察比较Vitapex糊剂和氢氧化钙糊剂用于有瘘型难治性根尖周炎根管消毒的疗效.方法将80颗有瘘型难治性慢性根尖周炎患牙,在常规根管预备成形后随机分为实验组和对照组,实验组(40颗患牙)采用Vitapex糊剂根管封药消毒,对照组(40颗患牙)采用氢氧化钙糊剂根管封药消毒,分别将Vitapex糊剂、氢氧化钙糊剂导入根管内暂封2周.对两组根管消毒效果进行临床观察和分析.结果实验组有效率(92.50%)与根充率(22.50%)与对照组(有效率为57.50%,根充率为8.00%)比较差异有显著性,且实验组在术后疼痛控制方面优于对照组.结论 Vitapex糊剂根管内封药能够减少有瘘型难治性根尖周炎根管封药消毒的次数,有利于瘘道的尽快愈合.%  Objective To investigate the clinical effect of Vitapex paste and calcium hydroxide paste on re-fractory periapical periodontitis with fistula .Methods A total of 80 tooth with apical periodontitis and fistula were ran-domly divided into Vitapex paste goup as the study goup and the calcium hydroxide paste group as the control group . Root canals were disinfected and dressed at interim for one week .The therapeutic effect between them was compared .Re-sults The effective ratio and root filling rate of the study group were 92.50%and 22.50%respectively.And the control group were 57.50%and 8.00%respectively.The effect of postoperative pain control of Vitapex paste group was superior to control group.The difference between two groups was statistically significant (P<0.05).Conclusion Vitapex paste has a better therapeutic effect on refractory periapical periodontitis and is worth popularizing .

  8. Laparoscopic repair of vesicovaginal fistula

    Directory of Open Access Journals (Sweden)

    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.

  9. Anal fistula. Past and present.

    Science.gov (United States)

    Zubaidi, Ahmad M

    2014-09-01

    Anal fistula is a common benign condition that typically describes a miscommunication between the anorectum and the perianal skin, which may present de novo, or develop after acute anorectal abscess. Athough anal fistulae are benign, the condition can still negatively influence a patient's quality of life by causing minor pain, social hygienic embarrassment, and in severe cases, frank sepsis. Despite its long history and prevalence, anal fistula management remains one of the most challenging and controversial topics in colorectal surgery today. The end goals of treatment include draining the local infection, eradicating the fistulous tract, and minimizing recurrence and incontinence rates. The goal of this review is to ensure surgeons and physicians are aware of the different imaging and treatment choices available, and to report expected outcomes of the various surgical modalities so they may select the most suitable treatment. 

  10. Clinical effect of minimally invasive thread-drawing operation via another approach on high horseshoe anal fistula%微创另路挂线术治疗高位蹄形肛瘘的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    杨静; 杨平

    2015-01-01

    Objective To observe the clinical effect of minimally invasive thread-drawing operation via another approach on high horseshoe anal fistula.Methods Seventy-six patients with high horseshoe anal fistula patients were divided into minimally invasive group and control group according to the random number table,with 38 cases in each group.The minimally invasive group received minimally invasive thread-drawing operation via another approach,while the control group received conventional arc-incision drainage.The intraoperative blood loss, operation duration and incision healing time as well as postoperative external anal sphincter electromyography,anal function,pain score,anal drainage score,ankyloproctia degree and anal incontinence score were compared between two group.Results The minimally invasive group gained higher contraction and resting amplitudes of external anal sphincter as well as less myoelectric interval of external anal sphincter after operation compared with control group(all P0.05).Conclusion Minimally invasive thread-drawing operation via another approach achieves favorable effects on high horseshoe anal fistula with less trauma,which might effectively protect the perianal tissues and promote the recovery of anal function.%目的:观察微创另路挂线术治疗高位蹄形肛瘘的临床效果。方法将高位蹄形肛瘘患者76例,按照随机数字表法分为微创组与对照组,每组38例,微创组行微创另路挂线术治疗,对照组行常规的弧形切开引流术。对比两组术中出血量、手术时间、切口愈合时间、术后肛门外括约肌肌电图、肛门功能、疼痛积分、肛门渗液积分、肛门狭窄程度积分、肛门失禁积分。结果微创组术后肛门外括约肌收缩波幅、静息波幅均高于对照组(P均<0.05),肛门外括约肌肌电时程低于对照组(P<0.05),术后6 d疼痛积分、肛门渗液积分少于对照组(P<0.05),两组术后肛门狭

  11. Ureteroiliac Artery Fistula in a Young Woman with Short Bowel Syndrome for Radiation Enteritis

    Directory of Open Access Journals (Sweden)

    Lidia Santarpia

    2010-01-01

    Full Text Available Ureteral-iliac artery fistula is a rare and potentially life-threatening complication, typically occurring after radiation therapy in already surgically treated cancer patients. This case report describes the diagnostic challenges and the successful management, with the positioning of an intra-arterial prosthesis, of a fistula between the internal iliac artery and the left ureter presenting as massive hematuria in a young woman with history of total colectomy and pelvic radiotherapy for rectal cancer and subsequent wide ileal resections and bilateral ureteral stent positioning for radiation enteritis. Ureteroiliac artery fistulas require a prompt diagnosis and intervention, to avoid life threatening clinical events.

  12. Leiomyosarcoma with coronary fistulae and ventricular septal perforation:A case study

    Institute of Scientific and Technical Information of China (English)

    Dang-Sheng HUANG; Yu-Mei WANG; Yu CHEN

    2014-01-01

    Coronary fistulae and ventricular septal perforation are very rare clinically, and even less caused by cardiac leiomyosarcoma. A case is reported that a 67-year-old female had cardiac leiomyosarcoma with progressive heart failure and coronary fistulae and ventricular septal perforation. This case was special since all ante-mortem examinations and cardiac surgery failed to detect the presence of any abnormal car-diac mass. Therefore, the malignant cardiac tumors could appear in an invasive form without mass and be one of the causes of the coronary fistulae and ventricular septal perforation.

  13. Fistulas secondary to gynecological and obstetrical operations

    Directory of Open Access Journals (Sweden)

    Jakovljević Branislava N.

    2003-01-01

    Full Text Available The authors present urogenital and rectogenital fistulas treated at the Department of Obstetrics and Gynecology in Novi Sad in the period from 1976 to 1999. The study comprised 28 cases of fistula out of which 17 were vesicovaginal, 3 ureterovaginal, 1 vesicorecto vaginal and 7 recto vaginal. During the investigated period there were 182 Wertheim operations, 3864 total abdominal hysterectomies, 1160 vaginal hysterectomies and 7111 cesarean sections. The vesicovaginal fistulas were most frequent with the incidence of 0.33%, whereas the tocogenic fistulas did not occur. Urogenital fistulas secondary to radical hysterectomy are extremely rare thanks to the administered measures of prevention during the surgical procedure.

  14. MRI of congenital urethroperineal fistula

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-12-15

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

  15. 单中心动静脉内瘘手术临床分析%A clinical analysis of arteriovenous fistula operations in a hemodialysis center

    Institute of Scientific and Technical Information of China (English)

    何达; 苏姗娜; 万胜; 潘建华; 熊飞

    2014-01-01

    Objective Toanalyzetheclinicaldatafromhemodialysispatientssubjecttoarterio-venous fistulas (AVF)operations in a single center,to retrospectively define the establishment and protectionofarteriovenousfistulas.Methods Thestudyenrolled490hemodialysispatientsafterfistu-laoperationsbetweenJanuary2012andMarch2014intheFirstHospitalofWuhan.Results Thepri-mary diseases of the 490 patients screened were mainly chronic nephritis (49.6%), diabetes (17.6%),hypertension (12.9%).37.4% of the patients completed the operation before the first di-alysis,and the vast majority of the patients had reached CKD 5 level.Seventy-seven (15.7%)patients had successful AVF construction with the conventional side,without affecting their daily life during the follow-up.The diameters of the artery and vein of patients in the first AVF were (2.25 ±0.47) mm and 2.08±0.49 mm respectively,significantly smaller than those of the patients undergoing re-peated AVF surgery [(3.10±0.92)mm and (3.65±1.58)mm respectively,P<0.05].The success rate of AVF initial construction or reconstruction was 98.5% (447/454).Furthermore,there was no significant difference in patency rate between diabetic and non-diabetic group.Elderly patients had de-creasedone-yearpatencyrateascomparedwiththeyoungpatients.Conclusions (1)Thestarttiming of fistula operation for uremic patients is usually late;(2)Conventional side operation has no signifi-cant influence on patient's daily lives;(3)No remarkable difference in operation success rate and pa-tency rate exists between diabetic and non-diabetic groups;(4)Long-term patency rate for elderly pa-tients? is usually on the lower side.%目的分析行动静脉内瘘手术的血液透析患者的临床资料,以期对动静脉内瘘的建立及保护提供理论依据。方法收集2012年1月1日至2014年3月31日在武汉市第一医院行动静脉内瘘手术的490例患者病例资料进行回顾性统计分析。结果手术患者原发病以慢性肾球肾炎243例(占49.6%)

  16. Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis.

    Science.gov (United States)

    Xu, Yansong; Tang, Weizhong

    2016-12-01

    The aim of this analysis was to compare the advantages of the anal fistula plug (AFP) with the mucosa advancement flap (MAF) for complex anal fistulas. Comparative studies of the efficacy of AFP and MAF were included. Two independent reviewers selected articles for inclusion. After information collection, a meta-analysis was performed using data on overall healing rates, complications, incontinences and recurrences. The quality of postoperative life and cost were also included with the clinical results. Ten studies included 778 patients who were divided into AFP and MAF groups in this meta-analysis. During the follow-up period, no significant difference in healing rates, complications and recurrences were found (P = 0.55, P = 0.78 and P = 0.23, respectively). The incontinence rate of AFP was lower than that of MAF (P = 0.04). The postoperative quality of life of AFP patients was superior to that of MAF patients. The AFP patients had less persistent pain of a shorter duration and shortened healing time and hospital stay. The treatment cost of AFP patient was lower than that of MAF. Compared to the MAF procedure, the AFP procedure has some advantages for complex anal fistulas, but more and large randomized clinical trials comparing the two procedures for fistula management need to be conducted. © 2016 Royal Australasian College of Surgeons.

  17. Successful closure of gastrocutaneous fistulas using the Surgisis(®) anal fistula plug.

    Science.gov (United States)

    Darrien, J H; Kasem, H

    2014-05-01

    Gastrocutaneous fistulas remain an uncommon complication of upper gastrointestinal surgery. Less common but equally problematic are gastrocutaneous fistulas secondary to non-healing gastrostomies. Both are associated with considerable morbidity and mortality. Surgical repair remains the gold standard of care. For those unfit for surgical intervention, results from conservative management can be disappointing. We describe a case series of seven patients with gastrocutaneous fistulas who were unfit for surgical intervention. These patients were managed successfully in a minimally invasive manner using the Surgisis(®) (Cook Surgical, Bloomington, IN, US) anal fistula plug. Between September 2008 and January 2009, seven patients with gastrocutaneous fistulas presented to Wishaw General Hospital. Four gastrocutaneous fistulas represented non-healing gastrostomies, two followed an anastomotic leak after an oesophagectomy and one following an anastomotic leak after a distal gastrectomy. All patients had poor nutritional reserve with no other identifiable reason for failure to heal. All were deemed unfit for surgical intervention. Five gastrocutaneous fistulas were closed successfully using the Surgisis(®) anal fistula plug positioned directly into the fistula tract under local anaesthesia and two gastrocutaneous fistulas were closed successfully using the Surgisis(®) anal fistula positioned endoscopically using a rendezvous technique. For the five patients with gastrocutaneous fistulas closed directly under local anaesthesia, oral alimentation was reinstated immediately. Fistula output ceased on day 12 with complete epithelialisation occurring at a median of day 26. For the two gastrocutaneous fistulas closed endoscopically using the rendezvous technique, oral alimentation was reinstated on day 5 with immediate cessation of fistula output. Follow-up upper gastrointestinal endoscopy confirmed re-epithelialisation at eight weeks. In none of the cases has there been

  18. Successful closure of gastrocutaneous fistulas using the Surgisis® anal fistula plug

    Science.gov (United States)

    Kasem, H

    2014-01-01

    Introduction Gastrocutaneous fistulas remain an uncommon complication of upper gastrointestinal surgery. Less common but equally problematic are gastrocutaneous fistulas secondary to non-healing gastrostomies. Both are associated with considerable morbidity and mortality. Surgical repair remains the gold standard of care. For those unfit for surgical intervention, results from conservative management can be disappointing. We describe a case series of seven patients with gastrocutaneous fistulas who were unfit for surgical intervention. These patients were managed successfully in a minimally invasive manner using the Surgisis® (Cook Surgical, Bloomington, IN, US) anal fistula plug. Methods Between September 2008 and January 2009, seven patients with gastrocutaneous fistulas presented to Wishaw General Hospital. Four gastrocutaneous fistulas represented non-healing gastrostomies, two followed an anastomotic leak after an oesophagectomy and one following an anastomotic leak after a distal gastrectomy. All patients had poor nutritional reserve with no other identifiable reason for failure to heal. All were deemed unfit for surgical intervention. Five gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula plug positioned directly into the fistula tract under local anaesthesia and two gastrocutaneous fistulas were closed successfully using the Surgisis® anal fistula positioned endoscopically using a rendezvous technique. Results For the five patients with gastrocutaneous fistulas closed directly under local anaesthesia, oral alimentation was reinstated immediately. Fistula output ceased on day 12 with complete epithelialisation occurring at a median of day 26. For the two gastrocutaneous fistulas closed endoscopically using the rendezvous technique, oral alimentation was reinstated on day 5 with immediate cessation of fistula output. Follow-up upper gastrointestinal endoscopy confirmed re-epithelialisation at eight weeks. In none of the

  19. Does regional compared to local anaesthesia influence outcome after arteriovenous fistula creation?

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    Macfarlane, Alan James Robert; Kearns, Rachel Joyce; Aitken, Emma; Kinsella, John; Clancy, Marc James

    2013-08-19

    An arteriovenous fistula is the optimal form of vascular access in patients with end-stage renal failure requiring haemodialysis. Unfortunately, approximately one-third of fistulae fail at an early stage. Different anaesthetic techniques can influence factors associated with fistula success, such as intraoperative blood flow and venous diameter. A regional anaesthetic brachial plexus block results in vasodilatation and improved short- and long-term fistula flow compared to the infiltration of local anaesthetic alone. This, however, has not yet been shown in a large trial to influence long-term fistula patency, the ultimate clinical measure of success.The aim of this study is to compare whether a regional anaesthetic block, compared to local anaesthetic infiltration, can improve long-term fistula patency. This study is an observer-blinded, randomised controlled trial. Patients scheduled to undergo creation of either brachial or radial arteriovenous fistulae will receive a study information sheet, and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either: (i) an ultrasound guided brachial plexus block using lignocaine with adrenaline and levobupivicaine, or (ii) local anaesthetic infiltration with lignocaine and levobupivicaine.A total of 126 patients will be recruited. The primary outcome is fistula primary patency at three months. Secondary outcomes include primary patency at 1 and 12 months, secondary patency and fistula flow at 1, 3 and 12 months, flow on first haemodialysis, procedural pain, patient satisfaction, change in cephalic vein diameter pre- and post-anaesthetic, change in radial or brachial artery flow pre- and post-anaesthetic, alteration of the surgical plan after anaesthesia as guided by vascular mapping with ultrasound, and fistula infection requiring antibiotics. No large randomised controlled trial has examined the influence of brachial plexus block compared with local anaesthetic

  20. Partial fistulectomy and fistular wall flap for the treatment of high perianal fistulas.

    Science.gov (United States)

    Lasheen, Ahmed E

    2004-01-01

    Controversy surrounds the management of fistula in ano especially the high type. This study assesses the clinical results of a partial fistulectomy with a closure of the internal opening using a fistular wall flap for the management of high perianal fistulas. This technique was performed in 50 patients with this condition, with the aid of a fistulectomy tube. The clinical outcome was assessed in terms of continence and recurrence for a period of 22 months after operation. The technique is easy to perform, results in less morbidity, and provided successful healing in 49 patients. A recurrent fistula occurred in one patient. No continence disturbance was noted during the follow-up period. This technique is thus considered to be an effective method for managing high perianal fistulas since it was found to demonstrate good results in terms of recurrence and continence.

  1. Using autologous platelet-rich plasma for the treatment of complex fistulas

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    Almudena Moreno-Serrano

    Full Text Available Objective: This study aims to demonstrate the effectiveness and safety of autologous fibrin gel rich in platelet growth factors for the treatment of complex perianal fistulas. Material and methods: Prospective epidemiological study. Patients with complex perianal fistula or perianal fistula mere alteration of continence are included. identification of both holes and the journey, curettage of it and instillation of Vivostat PRF® in the way it is done to observe excess material by OFE. The variables analyzed were: age, sex, use of prior Seton clinic prevalent type of fistula, postoperative complications, fistula closure and impaired quality of life using the SF-36 test (v2. Results: From January 2011 to May 2013 have involved 23 patients, 12 men and 11 women, with an average age of 49 years and a minimum follow-up of 12 months. Two dropped out. 17 patients had low transsphincteric fistulas, 2 and 2 high transsphincteric intersphincteric with impaired continence. The most common symptom is the discharge. Twelve patients had a loose seton (62%, of which nine cured. Of all the patients we have operated the success rate is 62%. No patient developed incontinence after treatment. Only two reported a worse quality of life after surgery. Conclusion: This study demonstrates that there is a clear benefit to the use of Vivostat PRF® as a treatment for complex perianal fistulas. It is a highly reproducible technique with acceptable results and does not produce impairment of continence.

  2. [The effect evaluation of suction drainage to prevent fistula after superficial parotidectomy].

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    Jiang, Jin; Jia, Mu-yun; Cai, Zhen; Yuan, Rong-tao; Wang, Ke; Zhang, Kui; Bu, Ling-xue

    2014-12-01

    To evaluate the clinical value of suction drainage to prevent fistula after parotidectomy, and seek the best opportunity to remove the drainage according to the draining output and duration. One hundred and ninety-four patients with parotid diseases after superficial parotidectomy were assigned into pressure dressing group and suction drainage group. Pressure dressing was used after suction drainage tube was removed in the pressure group, while suction drainage tube was fixed through the process in the suction group. Postoperative salivary fistula occurrence between the 2 groups was analyzed with Pearson chi-square test, and the contribution of the output and duration resulting in salivary fistula was analyzed by Fisher's exact test with SPSS 19.0 software package. The occurrence of salivary fistula in the pressure dressing group and suction group was 11.6% and 15.5%, respectively in the suction group. No significance difference was found between the 2 groups (P>0.05). In the suction drainage group, significant correlation of the draining duration and salivary fistula was not found (P>0.05). However, the draining output less than 20 mL resulted in lower salivary fistula rate compared with the draining output of 20-30 mL. According to our findings, suction drainage can be used as a substitute for pressure dressing after parotidectomy in preventing salivary fistula, and the best timing of drainage extubation is when the draining output is less than 20 mL within 24 hours.

  3. Contiguous spinal metastasis mimicking infectious spondylodiscitis

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    Lee, Chul Min; Lee, Seung Hun [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)

    2015-12-15

    Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis.

  4. Asymptomatic Urolithiasis Complicated by Nephrocutaneous Fistula

    Science.gov (United States)

    Hamard, Marion; Amzalag, Gaël; Becker, Christoph D; Poletti, Pierre-Alexandre

    2017-01-01

    Asymptomatic spontaneous nephrocutaneous fistula is a rare and severe complication of chronic urolithiasis. We report a case of 56-year-old woman with a nephrocutaneous fistula (NFC) which developed from a superinfected urinoma following calyceal rupture due to an obstructing calculus in the left ureter. The patient was clinically asymptomatic and came to the emergency department for a painless left flank fluctuating mass. This urinoma was superinfected, with a delayed development of renal abscesses and perirenal phlegmon found on contrast-enhanced uro-computed tomography (CT), responsible for left renal vein thrombophlebitis and left psoas abscess. Thereafter, a 99 mTc dimercaptosuccinic acid (DMSA) scintigraphy revealed a nonfunctional left kidney, leading to the decision of left nephrectomy. Chronic urolithiasis complications are rare and only few cases are reported in medical literature. A systematic medical approach helped selecting the best imaging modality to help diagnosis and treatment. Indeed, uro-CT scan and renal scintigraphy with 99 mTc-DMSA are the most sensitive imaging modalities to investigate morphological and functional urinary tract consequences of NFC, secondary to chronic urolithiasis. PMID:28299237

  5. URETHRORECTAL FISTULA - COMPLICATION OF TUBERCULOSIS OF PROSTATE

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    Pravin

    2016-02-01

    Full Text Available INTRODUCTION Urethrorectal fistula is an abnormal communication between the urethra and rectum. It can be congenital in children and acquired in adults. Congenital cases usually occur in association with anorectal malformations.1,2 In neonates, urine may be meconium stained. Concurrent imperforate anus requires postnatal surgery. In adults, they arise as complications of prostate surgery, infections including tuberculosis, neoplasm, radiation therapy, and urethral instrumentation. 1,3,4 Adults may present with recurrent urinary tract infections, urine per the rectum, faecaluria, hematuria, pneumaturia and infection of the seminal vesicles. We present a 50 years old male patient with past history of pulmonary tuberculosis presenting with chief complaints of difficult in passing urine, faecaluria, pneumaturia and leakage of urine from the rectum during micturition. Large irregular pooling/extravasation of contrast in retrograde urethrogram and large urethra-rectal fistula seen in computed tomography. We discuss clinical findings and the results of preoperative retrograde urethrogram and computed tomography findings along with review of this rare condition.

  6. Abducens Nerve Palsy and Ipsilateral Horner Syndrome in a Patient With Carotid-Cavernous Fistula.

    Science.gov (United States)

    Kal, Ali; Ercan, Zeynep E; Duman, Enes; Arpaci, Enver

    2015-10-01

    The combination of abducens nerve palsy and ipsilateral Horner syndrome was first described by Parkinson and considered as a localizing sign of posterior cavernous sinus lesions. The authors present a case with right abducens nerve palsy with ipsilateral Horner syndrome in a patient with carotid-cavernous fistula because of head trauma. The patient was referred to the ophthalmology clinic with diplopia complaint after suffering a head trauma during a motorcycle accident. Cerebral angiography showed low-flow carotid-cavernous fistula.

  7. A giant left main trunk and left circumflex artery-to-right ventricle fistula

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    Zhao-hui Peng

    2014-01-01

    Full Text Available Coronary artery fistula including the left trunk and left circumflex is uncommon. We present a 24-year-old male patient with a giant left main trunk and left circumflex artery to right ventricle fistula, which is diagnosed by transthoracic echocardiography and coronary computed tomography angiography. In this paper, the case report is to provide a better understanding of clinical characteristics for this disease.

  8. Gastropulmonary Fistula after Bariatric Surgery

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    Maya Doumit

    2009-01-01

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

  9. TUBERCULOUS SIALO-CUTANEOUS FISTULA

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    Bapi Lal

    2013-04-01

    Full Text Available ABSTRACT: Tuberculosis of the parotid gland is a rare clinica l entity. We present a case of parotid gland tuberculosis that presented with a sial o-cutaneous fistula. This case was successfully treated with antituberculous drugs onl y without any surgical excision.

  10. Analysis of three kinds of operation in the treatment of anal fistula clinical curative effect%三种手术治疗肛瘘临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    苏卫平

    2015-01-01

    Objective In order to compare the incision and thread drawing technique, anal fistula, incision and drainage of stripping ligation three kinds of operation treatment of anal fistula, treatment of anal fistula operation mode selection. Methods 60 patients with anal fistula were randomly divided into 3 groups, 20 cases in each group, the treatment group (group A) with anal fistula Seton therapy, control group 1 (group B) with anal fistula incision and drainage for the treatment, control group 2 (group C) by stripping ligation in the treatment of anal fistula, and to compare its efficacy. Results In the treatment group and two in control group in the cure rate, recurrence rate had significant difference (P<0.05). Conclusion The results show that, the incision line of the exact curative effect in the treatment of anal fistula, anal fistula is easy to operate;stripping ligation anal function less damage, high recurrence rate, development prospect.%目的:为了比较切开挂线术、切开引流术、肛瘘剥离结扎术三种手术治疗肛瘘效果,探讨治疗肛瘘手术方式的选择。方法:将60例低位肛瘘患者随机分为3组,每组20例,治疗组(A组)采用肛瘘切开挂线术治疗,对照1组(B组)采用肛瘘切开引流术治疗,对照2组(C组)采用肛瘘剥离结扎术治疗,并比较其疗效。结果:治疗组与两对照组在治愈率、复发率有显著性差异(P<0.05)。结论:结果表明,切开挂线术治疗肛瘘疗效确切,易于操作;肛瘘剥离结扎术肛门功能损伤较少,复发率较高,有发展的前景。

  11. [Impact of the 2016 new definition and classification system of pancreatic fistula on the evaluation of pancreatic fistula after pancreatic surgery].

    Science.gov (United States)

    Han, X L; Xu, J; Wu, W M; Dai, M H; Zhang, T P; Liao, Q; Chen, G; Guo, J C; Wang, W B; Cong, L; Zhao, Y P

    2017-07-01

    Objective: To discuss the impact of updated definition and classification system of pancreatic fistula published in 2016 on the postoperative classification of pancreatic fistula. Methods: Retrospective analysis was made on patients who underwent pancreatic surgery at ward 1 in Department of General Surgery, Peking Union Medical College Hospital from January 2015 to December 2016.A total of 408 patients were included in this retrospective study, male/female was 184/224, aged from 9 to 81 years with mean age of 51.6 years.One hundred and fifty-two cases were performed pancreaticoduodenectomy, 125 cases for distal pancreatectomy, 43 cases for spleen preservation distal pancreatectomy, 61 cases for partital pancreatectomy or enucleation, 8 cases for middle pancreatectomy, 6 cases for pancreaticojejunostomy and 13 cases for other procedures.Clinical data including postoperative drainage fluid volume, amylase concentration, duration of hospitalization and drainage were obtained, revaluated and re-analyzed, classified grounded on 2005 edition and 2016 edition, respectively.t-test was adopted for data analysis. Results: According to the previous standards, the incident rate of pancreatic fistula was 57.4%, and the incident rate of B-level plus C-level pancreatic fistula was 35.8%, which decreased to 13.7% based on 2016 edition.Nine patients who received percutaneous puncture or endoscopic drainage was regraded from C-level to B-level. The average duration of postoperative hospitalization of patients without pancreatic fistula was (12.5±6.0)days, demonstrating no significant difference compared to (14.1±7.7)days, duration of postoperative hospitalization of A-level(under 2005 edition of criteria) pancreatic fistula group(t=1.66, P=0.09) and (12.4±6.1)days, duration of postoperative hospitalization of biochemical leakage group(t=0.14, P=0.89). Nevertheless, there was statistical significant difference between the average postoperative duration of hospitalization(30.7±16

  12. Xanthogranulomatous cholecystitis mimicking gallbladder cancer.

    Science.gov (United States)

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma

    2014-05-08

    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

  13. 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.

  14. Robotic versus laparoscopic resection for sigmoid diverticulitis with fistula.

    Science.gov (United States)

    Elliott, Peter A; McLemore, Elisabeth C; Abbass, Mohammad A; Abbas, Maher A

    2015-06-01

    Robotic abdominal surgery is growing despite a paucity of clinical reports to evaluate its impact on patient outcomes. In this retrospective case series, we aim to analyze our early experience with robotic resection in 11 consecutive patients with chronic colonic diverticulitis complicated by fistula to bladder, vagina, or skin and to compare the results of the robotic approach to 20 patients undergoing laparoscopic resection for the same indication. Our main outcome measures include operative time, blood loss, conversion rate, transfusion rate, hospital length of stay, complications, readmission, and fistula healing rate. In our study, we found robotic resection for colonic diverticulitis with fistula was technically feasible and yielded 100% fistula healing rate. The operative time, complication and readmission rates were similar to laparoscopy. A higher conversion rate, diverting stoma need, and longer hospital length of stay were noted in the robotic group; however, these findings could have been attributed to a higher number of cases involving rectal excision in the robotic group. Larger studies are needed to further examine the impact of robotic surgery on the outcome of patients with complicated chronic sigmoid diverticulitis.

  15. Management of Postpneumonectomy Bronchopleural Fistulae

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    Kemal Karapinar

    2016-04-01

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

  16. 如意金黄散外敷与喜疗妥治疗动静脉内瘘血肿的疗效比较%Clinical efficacy of Ruyi golden powder external application and hirudoid for arteriovenous fistula hematoma

    Institute of Scientific and Technical Information of China (English)

    刘丽红; 刘玉红; 刘慧军

    2015-01-01

    目的:探讨如意金黄散外敷及喜疗妥涂抹治疗动静脉内瘘血肿的效果。方法将132例动静脉内瘘使用过程中发生皮下血肿的患者随机分为两组,其中对照组66例,发生血肿后常规按压,止血后冰袋冷敷血肿处,24 h后使用毛巾进行局部湿热敷,于热敷后在血肿局部涂抹喜疗妥软膏并轻轻按摩5~10 min,直至药膏全部经皮肤吸收,每日进行3~4次。研究组66例,血肿发生24 h后将如意金黄散用蜂蜜或清茶调匀成稀泥状外敷,每天更换2~3次。观察两组临床疗效。结果对血肿范围5~10 cm及>10 cm,研究组在血肿面积缩小等方面的疗效明显优于对照组,差异有统计学意义(P10 cm的皮下血肿消散、吸收的疗效显著,操作简便,值得推广。%Objective To compare the clinical efficacy between Ruyi golden powder with hiru doid for arteriovenous fis-tula hematoman. Methods A total of 132 cases with subcutaneous hematoma in arteriovenous fistula were divided into two groups randomly. 66 cases of control group was treated with conventional pressure, icepack being applied after hemostasis, local wet towels fomentation after 24 hours, then hirudoid cream topical smearing with massage for 5-10 minutes until creams being absorbed through the skin, with 3-4 times per day. 66 cases of study group were treated with Ruyi golden powder with tea or honey to mix thoroughly into the mud like for local application in 24h of hematoma formation, with 2-3 times per day. Clinical efficacy of two groups was compared. Results In range of 5-10 cm and range of >10 cm, hmatoma size reduction of study group was better than that in the control group (P10 cm subcutaneous hematoma dissipated,absorption is signifi-cant,and easy to operate,worthy of clinical promotion.

  17. Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

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    Hanni Gulwani

    2010-01-01

    Full Text Available Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome.

  18. Achromobacter xylosoxidans infection presenting as a pulmonary nodule mimicking cancer.

    Science.gov (United States)

    Claassen, Stephanie L; Reese, Jason M; Mysliwiec, Vincent; Mahlen, Steven D

    2011-07-01

    Achromobacter xylosoxidans is typically isolated from pulmonary sources, presenting as pneumonia in immunosuppressed individuals. We describe a novel clinical presentation of A. xylosoxidans infection presenting as multiple spiculated, pulmonary nodules mimicking cancer for which the patient underwent a wedge resection of the lung for diagnosis and staging of presumptive cancer.

  19. Interleukin-13 and transforming growth factor β synergise in the pathogenesis of human intestinal fistulae.

    Science.gov (United States)

    Scharl, Michael; Frei, Sandra; Pesch, Theresa; Kellermeier, Silvia; Arikkat, Joba; Frei, Pascal; Fried, Michael; Weber, Achim; Jehle, Ekkehard; Rühl, Anne; Rogler, Gerhard

    2013-01-01

    Epithelial to mesenchymal transition (EMT) seems to play an important role in the pathogenesis of fistulae, a common clinical complication of Crohn's disease (CD). TGFβ and interleukin-13 (IL-13) have been correlated with the onset of EMT-associated organ fibrosis and high levels of TGFβ have been shown in transitional cells (TCs) lining CD fistula tracts. This study investigated whether IL-13 could be involved in the pathogenesis of CD-associated fistulae. Protein or mRNA levels in HT29 intestinal epithelial cells (IECs) or colonic lamina propria fibroblasts (CLPFs) were studied by western blotting or real-time PCR. CLPFs were isolated from non-inflammatory disease controls or patients with CD with or without fistulae and IL-13 levels were analysed in surgically removed fistula specimens by immunohistochemistry. TGFβ induced IL-13 secretion in CLPFs from patients with fistulising CD. In fistula specimens high levels of IL-13 were detected in TCs covering fistula tracts. In HT29 IEC monolayers, IL-13 induced SLUG and β6-integrin mRNA, which are associated with cell invasion. HT29 spheroids completely disintegrated when treated with TGFβ for 7 days, whereas IL-13-treated spheroids did not show morphological changes. Here, TGFβ induced mRNA expression of SNAIL1 and IL-13, whereas IL-13 elevated SLUG and β6-integrin mRNA. An anti-IL-13 antibody was able to prevent IL-13-induced SLUG expression in HT29 IECs. TGFβ induces IL-13 expression and an EMT-like phenotype of IECs, while IL-13 promotes the expression of genes associated with cell invasion. These findings suggest that TGFβ and IL-13 play a synergistic role in the pathogenesis of fistulae and inhibition of IL-13 might represent a novel therapeutic approach for fistula treatment.

  20. 主管改道切开支管开窗引流术治疗高位复杂性肛瘘的临床研究%Clinical research on window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula

    Institute of Scientific and Technical Information of China (English)

    陈开平

    2015-01-01

    目的:探讨主管改道切开支管开窗引流术治疗高位复杂性肛瘘的临床价值。方法:将80例高位复杂肛瘘患者随机分为两组,治疗组给予主管改道切开支管开窗引流术治疗,对照组给予肛瘘切开挂线术治疗。结果:治疗组术后疼痛、创面愈合时间、肛门畸形均优于对照组(P<0.05)。结论:主管改道切开支管开窗引流术治疗高位复杂性肛瘘较切开挂线术效果好。%Objective:To investigate the clinical value of window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula.Methods:80 patients with high complex anal fistula were randomly divided into two groups.Patients in the treatment group were given window drainage operation of cut branch through supervisor diversion,while in the control group were treated with anal fistula incision and thread drawing therapy.Results:The pain degree,the healing time and the anal deformity after operation of the treatment group were better than those of the control group(P<0.05).Conclusion:Window drainage operation of cut branch through supervisor diversion in the treatment of high complex anal fistula is better than incision and thread operation.

  1. Transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery: report of four cases.

    Science.gov (United States)

    Luo, Guo-De; Cao, Yong-Kuan; Wang, Yong-Hua; Zhang, Guo-Hu; Wang, Pei-Hong; Gong, Jia-Qing

    2014-01-01

    To investigate the feasibility and superiority of transvaginal early fistula debridement and repair plus continuous vacuum aspiration via anal tube for rectovaginal fistula following rectal cancer surgery. The clinical data of four cases of rectovaginal fistula following rectal cancer surgery were retrospectively analyzed in our center. After adequate preoperative preparation, the patients underwent transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube under continuous epidural anesthesia. After surgery and before discharge, anti-infection and nutritional support was administered for 2 d, and fluid diet and anal tube vacuum aspiration continued for 7 d. All the four cases healed. Three of them healed after one operation, and the other patient had obvious shrinkage of the fistular orifice after the first operation and underwent the same operation for a second time before complete healing. The duration of postoperative follow-up was 2, 7, 8 and 9 months respectively. No recurrence or abnormal sex life was reported. Early transvaginal fistula debridement and repair plus continuous vacuum aspiration via anal tube are feasible for rectovaginal fistula following rectal cancer surgery. This operation has many advantages, such as minimal invasiveness, short durations of operation, short treatment cycles, and easy acceptance by the patient. In addition, it does not necessitate colostomy for feces shunt and a secondary colostomy and reduction.

  2. ENTEROCUTANEOUS FISTULAS, OUR EXPERIENCE IN MANAGEMENT

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    Anantha Ramani Pratha

    2016-06-01

    Full Text Available Enterocutaneous fistulas are a surgeon’s nightmare, more so if they occur after one’s own surgery. They are a challenge, testing the surgeon’s patience and expertise. Their management remains a team work. The success depends on the wellbeing of the patient during this great ordeal of management. In this article, we are reviewing and presenting the experience gained by us while managing 58 cases of enterocutaneous fistulas. We have studied the causes, the time of occurrence, the duration of conservative treatment, the methods of investigations and definitive treatment and ultimate outcome of our management of 58 cases of postoperative enterocutaneous fistulas, in a period of 5 years. Total 58 cases, postoperative enterocutaneous fistulas were the most common type (75%, 4 lost for followup. All fistulas were initially managed conservatively. Patients were maintained on total parenteral nutrition, evaluated for the cause and site of leak. High output fistulas were made as controlled fistula by diverting the loop to exterior following stabilisation, to minimise spillage and sepsis. Low output fistulas explored and definitive treatment carried out if there is persistent leak after 8 weeks. 8 ileal fistulas healed spontaneously (13.7%. 3 malignant rectal fistulas sent for radiotherapy. Initial damage control surgery was done in 15 cases (ileal+sigmoid+rectum (25.86%. Definitive surgery was done in 39 cases (67%. Out of 54 cases, 15 expired-(27.7%

  3. Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report

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    Yuminaga Yuigi

    2012-01-01

    Full Text Available Abstract Introduction Iliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula. Case presentation A 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula. Conclusion Our case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be

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

    Science.gov (United States)

    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.

  5. Mediastino-abdominal lipomatosis: deep accumulation of fat mimicking a respiratory disease and ascites. Clinical aspects and metabolic studies in vitro.

    Science.gov (United States)

    Enzi, G; Digito, M; Marin, R; Carraro, R; Baritussio, A; Manzato, E

    1984-01-01

    We report on clinical and metabolic studies of a newly delineated lipomatosis, characterised by an abnormal mediastinal and abdominal accumulation of fat, without obesity. The clinical features, which occurred in all the patients studied, are: Exertional dyspnoea due to a space-occupying mediastinal accumulation of fat, without evidence of cardiac or pulmonary disease. A pseudo-ascitic abdominal enlargement, due to intra- and retroperitoneal accumulation of fatty tissue. Insulin-independent diabetes mellitus. Type IV hyperlipidaemia and elevated levels of plasma uric acid were observed in four patients. Intra-abdominal lipomatous tissue, obtained during laparoscopy from four patients, demonstrated a reduced lipolytic response to beta-adrenergic stimulation. Thus, fat deposition in the abdominal and mediastinal areas could be causally related to defective lipid mobilization in lipomatocytes. Lipoprotein lipase activity in abdominal adipose tissue were normal in two patients (10.0 and 10.6 nmol/g/min) and markedly elevated in another two patients (37.3 and 49.9 nmol/g/min), as compared with controls (12.7 +/- 2.1 nmol/g/min). When expressed on per cell basis, LPL activity in lipomatous tissue was significantly higher than in control tissue (3.21 +/- 1.1 nmol/10(5) cell/min vs 0.92 +/- 0.16 nmol/10(5) cell/min). Lipoprotein fractionation did not demonstrate consistent modification of the serum lipoprotein pattern. HDL and HDL2 cholesterol values were reduced, even in patients with elevated LPL activity in adipose tissue.

  6. An investigation of the relationship between autonomy, childbirth practices, and obstetric fistula among women in rural Lilongwe District, Malawi.

    Science.gov (United States)

    Kaplan, Julika Ayla; Kandodo, Jonathan; Sclafani, Joseph; Raine, Susan; Blumenthal-Barby, Jennifer; Norris, Alison; Norris-Turner, Abigail; Chemey, Elly; Beckham, John Michael; Khan, Zara; Chunda, Reginald

    2017-06-19

    Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi

  7. Autologous adipose tissue-derived stem cells treatment demonstrated favorable and sustainable therapeutic effect for Crohn's fistula.

    Science.gov (United States)

    Lee, Woo Yong; Park, Kyu Joo; Cho, Yong Beom; Yoon, Sang Nam; Song, Kee Ho; Kim, Do Sun; Jung, Sang Hun; Kim, Mihyung; Yoo, Hee-Won; Kim, Inok; Ha, Hunjoo; Yu, Chang Sik

    2013-11-01

    Fistula is a representative devastating complication in Crohn's patients due to refractory to conventional therapy and high recurrence. In our phase I clinical trial, adipose tissue-derived stem cells (ASCs) demonstrated their safety and therapeutic potential for healing fistulae associated with Crohn's disease. This study was carried out to evaluate the efficacy and safety of ASCs in patients with Crohn's fistulae. In this phase II study, forty-three patients were treated with ASCs. The amount of ASCs was proportioned to fistula size and fistula tract was filled with ASCs in combination with fibrin glue after intralesional injection of ASCs. Patients without complete closure of fistula at 8 weeks received a second injection of ASCs containing 1.5 times more cells than the first injection. Fistula healing at week 8 after final dose injection and its sustainability for 1-year were evaluated. Healing was defined as a complete closure of external opening without any sign of drainage and inflammation. A modified per-protocol analysis showed that complete fistula healing was observed in 27/33 patients (82%) by 8 weeks after ASC injection. Of 27 patients with fistula healing, 26 patients completed additional observation study for 1-year and 23 patients (88%) sustained complete closure. There were no adverse events related to ASC administration. ASC treatment for patients with Crohn's fistulae was well tolerated, with a favorable therapeutic outcome. Furthermore, complete closure was well sustained. These results strongly suggest that autologous ASC could be a novel treatment option for the Crohn's fistula with high-risk of recurrence. Copyright © 2013 AlphaMed Press.

  8. Malignant Catatonia Mimicking Pheochromocytoma

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    Sophia Wong

    2013-01-01

    Full Text Available Malignant catatonia is an unusual and highly fatal neuropsychiatric condition which can present with clinical and biochemical manifestations similar to those of pheochromocytoma. Differentiating between the two diseases is essential as management options greatly diverge. We describe a case of malignant catatonia in a 20-year-old male who presented with concurrent psychotic symptoms and autonomic instability, with markedly increased 24-hour urinary levels of norepinephrine at 1752 nmol/day (normal, 89–470 nmol/day, epinephrine at 1045 nmol/day (normal, <160 nmol/day, and dopamine at 7.9 μmol/day (normal, 0.4–3.3 μmol/day. The patient was treated with multiple sessions of electroconvulsive therapy, which led to complete clinical resolution. Repeat urine collections within weeks of this presenting event revealed normalization or near normalization of his catecholamine and metanephrine levels. Malignant catatonia should be considered in the differential diagnosis of the hypercatecholamine state, particularly in a patient who also exhibits concurrent catatonic features.

  9. Tentorium schwannoma mimicking meningioma: an unusual location.

    Science.gov (United States)

    Calişaneller, Tarkan; Ozen, Ozlem; Altinörs, Nur; Caner, Hakan

    2008-07-01

    A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.

  10. Urethral Fistula and Scrotal Abscess Associated with Colovesical Fistula Due to the Sigmoid Colon Cancer

    OpenAIRE

    2015-01-01

    We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the...

  11. VAAFT - Videoassisted anal fistula treatment: a new approach for anal fistula

    OpenAIRE

    Mendes,Carlos Ramon Silveira; FERREIRA, Luciano Santana de Miranda; Sapucaia,Ricardo Aguiar; LIMA, Meyline Andrade; Araujo, Sergio Eduardo Alonso

    2014-01-01

    INTRODUCTION: Anal fistula is an epithelised path between the rectum or anal canal and the perianal region. The use of laparoscopic surgery with a minimally invasive procedure has led to the development of video-assisted surgical treatment of anal fistula.OBJECTIVE: To describe the surgical technique VAAFT as a new approach to fistula.CONCLUSION: This is a safe and reproducible procedure. It enables the study of the entire fistula, obtaining the identification of accessory paths, cavitations ...

  12. Treating anal fistula with the anal fistula plug: case series report of 12 patients

    OpenAIRE

    Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi

    2016-01-01

    Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped col...

  13. Retrospective analysis of risk factors affecting pacreatic fistula formation after the closure of the pancreatic stump with sutures in distal pancreatectomy.

    Science.gov (United States)

    Unek, Tarkan; Egeli, Tufan; Ozbilgin, Mucahit; Arslan, Naciye Cigdem; Astarcioglu, Huseyin; Karademir, Sedat; Atasoy, Gulsen; Astarcioglu, Ibrahim

    2013-10-01

    Development of pancreatic fistula after distal pancreatectomy is still a major problem. Various methods have been defined to prevent the development of the fistula. In this study, the results of suture closure of pancreatic duct and closure of pancreatic stump with “U” sutures passing through each other and the risk factors affecting the development of fistula are studied. Fifty-one patients with prospectively collected data were included in the study. In all patients, pancreatic stump was closed with the same surgical technique. Risk factors that may affect fistula formation were studied between groups with and without fistula. Pancreatic fistula definition was made according to the International Study Group on Pancreatic Fistulas classification. Eight (15.7%) of the 51 patients had fistula. Clinically significant fistula ratio was 9.8% (according to ISGPF B and C). Additional organ resections were performed in 18 patients (35.3%). In multivariate analysis, the soft texture of pancreatic parenchyma (OR: 12.420, p = 0.048) and over 150 mL of blood loss (OR: 1.003, p = 0.043) were found as risk factors for the development of fistula. Closure of pancreatic stump after distal pancreatectomy with “U” shaped sutures passing through each other is a method that can be performed safely.

  14. Colovesical fistula causing an uncommon reason for failure of computed tomography colonography: a case report

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    Neroladaki Angeliki

    2012-07-01

    Full Text Available Abstract Introduction Computed tomography colonography, or virtual colonoscopy, is a good alternative to optical colonoscopy. However, suboptimal patient preparation or colon distension may reduce the diagnostic accuracy of this imaging technique. Case presentation We report the case of an 83-year-old Caucasian woman who presented with a five-month history of pneumaturia and fecaluria and an acute episode of macrohematuria, leading to a high clinical suspicion of a colovesical fistula. The fistula was confirmed by standard contrast-enhanced computed tomography. Optical colonoscopy was performed to exclude the presence of an underlying colonic neoplasm. Since optical colonoscopy was incomplete, computed tomography colonography was performed, but also failed due to inadequate colon distension. The insufflated air directly accumulated within the bladder via the large fistula. Conclusions Clinicians should consider colovesical fistula as a potential reason for computed tomography colonography failure.

  15. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management.

    Science.gov (United States)

    Fiaschetti, Valeria; Manenti, Guglielmo; Di Poce, Isabelle; Fornari, Maria; Ricci, Aurora; Finazzi Agrò, Enrico; Simonetti, Giovanni

    2012-01-01

    Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with "transrectal High-Intensity Focused Ultrasound (HIFU) treatment." We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan-with MPR, MIP, and VR reconstruction-before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-08-01

    Arteriovenous fistulas between the systemic circulation and the pulmonary artery are extremely rare. Continuous precordial murmur is the usual clinical sign while unilateral rib notching may be the only radiologic manifestation of this condition. Selective angiographic investigation is necessary to localize the site of such an arteriovenous (AV) fistula before surgery is performed. In a review of the literature of 15 published cases, the majority were of congenital origin, with four of these systemic-pulmonary AV fistulas of traumatic origin, of which one occurred after insertion of an intercostal catheter. We describe one case of traumatic origin 9 years after percutaneous thoracic drainage for spontaneous pneumothorax, in which transcatheter embolic occlusion of the feeding arteries of an AV fistula was attempted. The advantages and the disadvantages of the non-surgical and surgical therapeutic approaches are discussed.

  17. An atypical case of lacrimal sac fistula located on the temporal side of the lateral canthus.

    Science.gov (United States)

    Kim, Gyu-Nam; Huh, Hyun-Do; Park, Jong-Moon; Seo, Seong-Wook

    2012-12-01

    We report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus. A systemically healthy 1-year-old girl came to the outpatient clinic with a complaint of tearing on the temporal side of the right lateral canthus since birth. On examination, a small orifice was found in the skin on the temporal side of the lateral canthus. There was no evidence of inflammation or swelling within the opening. Surgeons carried out an operation under general anesthesia. They passed a probe through the lacrimal orifice and advanced it toward the lacrimal sac. Next, they introduced saline to the inferior punctum and found that it drained to the lateral fistula. The lower lid stretched as the dissected fistula was pulled. After the operation, the patient was free of the symptom. This paper is to report a case of congenital lacrimal sac fistula located on the temporal side of the lateral canthus.

  18. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  19. Short-term outcomes of the surgical management of acquired rectourethral fistulas: does technique matter?

    Directory of Open Access Journals (Sweden)

    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

  20. Use of a Balloon Rectal Catheter in Magnetic Resonance Imaging of Complex Anal Fistula to Improve Detection of Internal Openings.

    Science.gov (United States)

    Zhan, Songhua; Yang, Shuohui; Lin, Jiang; Zhu, Qiong; Lu, Fang; Tan, Wenli; Cheng, Ruixin; Gong, Zhigang; Yang, Wei

    2016-01-01

    The aim of this study was to investigate the utility of a balloon rectal channel catheter (BRCC) in complex anal fistula magnetic resonance imaging (MRI). A prospective study was done on 54 patients with clinical diagnosis of complex anal fistula. Eighteen patients had preoperative MRI before and after inserting BRCC. Another 18 underwent MRI with BRCC and the rest without. Fistulas, internal openings, extensions, and abscesses were identified on MRI and compared with surgical findings. Intraindividual and interindividual differences with and without BRCC were analyzed. In intragroup patients, the accuracy of MRI in detecting the number of fistulas, internal openings, extensions, and abscesses before and after using BRCC was 100%/100%, 67%/90%, 95%/95%, and 100%/100%, respectively, with a significant difference on internal openings (P anal fistula.

  1. What role do bacteria play in persisting fistula formation in idiopathic and Crohn's anal fistula?

    Science.gov (United States)

    Tozer, P J; Rayment, N; Hart, A L; Daulatzai, N; Murugananthan, A U; Whelan, K; Phillips, R K S

    2015-03-01

    The aetiology of Crohn's disease-related anal fistula remains obscure. Microbiological, genetic and immunological factors are thought to play a role but are not well understood. The microbiota within anal fistula tracts has never been examined using molecular techniques. The present study aimed to characterize the microbiota in the tracts of patients with Crohn's and idiopathic anal fistula. Samples from the fistula tract and rectum of patients with Crohn's and idiopathic anal fistula were analysed using fluorescent in situ hybridization, Gram staining and scanning electron microscopy were performed to identify and quantify the bacteria present. Fifty-one patients, including 20 with Crohn's anal fistula, 18 with idiopathic anal fistula and 13 with luminal Crohn's disease and no anal fistula, were recruited. Bacteria were not found in close association with the luminal surface of any of the anal fistula tracts. Anal fistula tracts generally do not harbour high levels of mucosa-associated microbiota. Crohn's anal fistulas do not seem to harbour specific bacteria. Alternative explanations for the persistence of anal fistula are needed. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  2. Long-term outcome of the anal fistula plug for anal fistula of cryptoglandular origin.

    Science.gov (United States)

    Tan, K-K; Kaur, G; Byrne, C M; Young, C J; Wright, C; Solomon, M J

    2013-12-01

    This study aimed to evaluate the long-term outcome of the anal fistula plug in the treatment of anal fistula of cryptoglandular origin. A review of all patients who had at least one anal fistula plug inserted from March 2007 to August 2008 was performed. Only anal fistulae of cryptoglandular origin were included. Success was defined as the closure of the external opening with no further purulent discharge or collection. Thirty anal fistula plugs were inserted in 26 patients [median age 40 (26-70) years]. Twenty-six of the fistulae were transsphincteric and three were suprasphincteric. One patient had a high intersphincteric fistula, which was the only fistula that did not have a seton inserted. The median duration between seton insertion and the plug procedure was 12 (4-28) weeks. The median length of the fistula tract was 3 (1-7.5) cm. After a median follow-up of 59 (13-97) weeks, 26 (86.7%) fistulae recurred. Of the 26 failures, the median time to failure was 8 (2-54) weeks. Subsequent surgical interventions were performed in 20 of the failures. The role of the fistula plug in the management of anal fistula of cryptoglandular origin remains debatable and warrants further evaluation. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  3. Treatment of an Immature Autogenous Arteriovenous Fistula with Percutaneous Transluminal Angioplasty

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    Kim, Hyoung Rae [Kangwon National University, Chuncheon (Korea, Republic of)

    2008-11-15

    The purpose of this study was to evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in facilitating maturation of autogenous arteriovenous fistulae. There were 12 immature autogenous arteriovenous fistulae. We performed 15 PTAs transvenously. Post-intervention anatomic and clinical successes were estimated, and the 6-month and 1-year primary and secondary patency rates were calculated using Kaplan-Meier analysis. All immature fistulae had underlying stenosis (n=20): arteriovenous anastomosis (n=1) and venous outflow (n=19): 1) within 5 cm from the anastomosis (n=10); 2) more than 5 cm but less than 10 cm from the anastomosis (n=5); 3) more than 10 cm from the anastomosis, including central veins (n=4). Six fistulae had two or more stenoses. Repeat intervention was necessary in two patients. The anatomical success rate was 94.3%, and the clinical success rate was 86.7%. The 6-month and 1-year primary patency rates were 72.7% and 54.5%, and the secondary patency rates were 100% and 81.8%, respectively. All immature hemodialysis fistulae have underlying stenosis, most of which are located near the arteriovenous anastomosis. Early interventional procedures are helpful in the salvage and maintenance of immature arteriovenous fistulae, with a high degree of success

  4. Lacrimal gland fistula after upper eyelid blepharoplasty

    Directory of Open Access Journals (Sweden)

    Mohsen Bahmani Kashkouli

    2011-01-01

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

  5. Successful tubes treatment of esophageal fistula

    OpenAIRE

    Zhou, Ning; Chen, Wei-Xing; Li, You-ming; Xiang, Zhun; Gao, Ping; Fang, Ying

    2007-01-01

    Aim: To discuss the merits of “tubes treatment” for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful “three tubes treatment” (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He...

  6. Enterovesical Fistulae: Aetiology, Imaging, and Management

    OpenAIRE

    2013-01-01

    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 revie...

  7. Bronchopleural fistula following laparoscopic liver resection.

    Science.gov (United States)

    Bhardwaj, Neil; Kundra, Amritpal; Garcea, Giuseppe

    2014-10-09

    A rare case is presented of a 58-year-old woman who developed a bronchopleural fistula following a laparoscopic liver resection for a colorectal metastasis. The bronchopleural fistula was finally diagnosed when after repeated admissions for chest infections, the patient coughed up surgical clips. We propose a management plan based on our experience and hope this case report will add to the scarce reports of postoperative bronchopleural fistula cases in the literature.

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

    Science.gov (United States)

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

    2017-07-01

    The treatment of complex anocutaneous fistulas remains a major therapeutic challenge balancing the risk of incontinence against the chance of permanent closure. The purpose of this study was to investigate the efficacy of a nitinol proctology clip for closure of complex anocutaneous fistulas. This is a single-center cohort study with retrospective analysis of all of the treated patients. Data were obtained from patient records and MRI reports, as well as follow-up telephone calls and clinical follow-up with endoanal ultrasonography. All of the patients were treated for high transsphincteric and suprasphincteric anocutaneous fistulas at the Digestive Disease Center, Bispebjerg Hospital, between May 2013 and February 2015. All of the patients were treated with the nitinol proctology clip. Primary outcome was fistula healing after proctology clip placement, as evaluated through clinical examination, endoanal ultrasonography, and MRI. The fistula healing rate 1 year after the clip procedure was 54.3% (19 of 35 included patients). At the end of follow-up, 17 (49%) of 35 patients had persistent closure of the fistula tracks. No impairment of continence function was observed. Treatment outcome was not found to be statistically associated with any clinicopathological characteristics. The study is limited by its retrospective and nonrandomized design. Selection bias may have occurred, because treatment options other than the clip were available during the study period. The small number of patients means that there is a nonnegligible risk of type II error in the conclusion, and the follow-up may be too short to have detected all of the failures. Healing rates were comparable 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.

  9. Multicystic Hepatocarcinoma Mimicking Liver Abscess

    Directory of Open Access Journals (Sweden)

    Evangelos Falidas

    2013-01-01

    Full Text Available The diagnosis of hepatocellular carcinoma (HCC became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.

  10. Current Diagnosis and Management of Gastrojejunocolic Fistula

    Directory of Open Access Journals (Sweden)

    Can Kece

    2010-05-01

    Full Text Available We herein report the case of a 51-year-old man with gastrojejunocolic fistula. It is one of the late severe complications of gastrectomy and gastrojejunostomy and is considered to be induced by a stomal ulcer due to inadequate resection of the stomach and incompleteness of vagotomy. The main clinical presentation of this condition is chronic abdominal pain, weight loss, diarrhea, gastrointestinal bleeding and fecal vomiting. The diagnostic workup should include barium enema, gastroscopy and sometimes colonoscopy and abdominal tomography for excluding and ruling out the possibility of malignant extraluminal disease. The historical approach of the treatment of this rare entity was 2–3-phased operations which included colostomy. However today, medical management has recently been recommended as the first-line therapy, with parenteral and enteral support treatments. The preferred surgical approach is single-stage gastrocolic resection and anastomosis and this has been favored to minimize mortality.

  11. 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.

  12. Colovesical fistulae in the sigmoid diverticulitis.

    Science.gov (United States)

    Cirocchi, R; La Mura, F; Farinella, E; Napolitano, V; Milani, D; Di Patrizi, M S; Trastulli, S; Covarelli, P; Sciannameo, F

    2009-01-01

    In most cases Colovesical fistulae are complications of diverticular disease and representing the most common kind of colodigestive fistula; less common are colovaginal, colocutaneous, coloenteric and colouterine fistula. In this article we review the literature concerning colovesical fistulae in colorectal surgery for sigmoid diverticulitis and report on two cases that required a surgical treatment, one elective and the other in emergency. In both cases we performed a sigmoid resection with a primary anastomosis and small vesical window-ectomy placing a Foley catheter for about 10 days.

  13. New techniques for treating an anal fistula.

    Science.gov (United States)

    Song, Kee Ho

    2012-02-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae.

  14. Emphysematous prostatic abscess with rectoprostatic fistula

    Directory of Open Access Journals (Sweden)

    Po-Cheng Chen

    2014-12-01

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

  15. Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis.

    Science.gov (United States)

    Simoneau, Eve; Chughtai, Talat; Razek, Tarek; Deckelbaum, Dan L

    2014-12-17

    Severe acute necrotising pancreatitis is associated with numerous local and systemic complications. Abdominal compartment syndrome requiring urgent decompressive laparotomy is a potential complication of this disease process and is associated with increased morbidity and mortality. We describe the case of a pancreaticoatmospheric fistula following decompressive laparotomy in a patient with severe acute necrotising pancreatitis. While this fistula was managed successfully using the current standard of care for pancreatic fistulas, the wound care for in this patient with drainage of the fistula through an open abdomen, is a significant challenge.

  16. New Techniques for Treating an Anal Fistula

    Science.gov (United States)

    2012-01-01

    Surgery for an anal fistula may result in recurrence or impairment of continence. The ideal treatment for an anal fistula should be associated with low recurrence rates, minimal incontinence and good quality of life. Because of the risk of a change in continence with conventional techniques, sphincter-preserving techniques for the management complex anal fistulae have been evaluated. First, the anal fistula plug is made of lyophilized porcine intestinal submucosa. The anal fistula plug is expected to provide a collagen scaffold to promote tissue in growth and fistula healing. Another addition to the sphincter-preserving options is the ligation of intersphincteric fistula tract procedure. This technique is based on the concept of secure closure of the internal opening and concomitant removal of infected cryptoglandular tissue in the intersphincteric plane. Recently, cell therapy for an anal fistula has been described. Adipose-derived stem cells have two biologic properties, namely, ability to suppress inflammation and differentiation potential. These properties are useful for the regeneration or the repair of damaged tissues. This article discusses the rationales for, the estimated efficacies of, and the limitations of new sphincter-preserving techniques for the treatment of anal fistulae. PMID:22413076

  17. Hypercalcaemia Mimicking STEMI on Electrocardiography

    Directory of Open Access Journals (Sweden)

    Joseph Donovan

    2010-01-01

    Full Text Available Acute coronary syndrome is a common cause of presentation to hospital. ST segment elevation on an electrocardiogram (ECG is likely to be cardiac in origin, but in low-risk patients other causes must be ruled out. We describe a case of a man with hypercalcaemia, no evidence of cardiac disease, and ECG changes mimicking acute myocardial infarction. These ECG changes resolved after treatment of the hypercalcaemia.

  18. Ten Cases of Colovesical Fistula due to Sigmoid Diverticulitis

    OpenAIRE

    2015-01-01

    Colovesical fistula (CVF) resulting from colon diverticulosis is a comparatively rare disease, and neither the diagnosis nor treatment has been established. Our experience with CVF due to sigmoid diverticulitis over a 9-year period was reviewed to clarify the clinical presentation and diagnostic confirmation. Ten patients with CVF were identified in this period, and chief complaints, laboratory findings, presenting symptoms, diagnostic investigations, and subsequent treatments were reviewed. ...

  19. Colovesical fistula presenting with epididymitis

    OpenAIRE

    2013-01-01

    This article reports a case of colovesical fistula presenting with epididymitis. A 75-year-old man with a recent conservatively managed localised diverticular perforation presented to hospital with acute pain and swelling of his left testicle and epididymis. On further questioning, the patient reported passing air in his urine. Urine cultures grew Enterococcus faecalis. Ultrasound scan confirmed a diagnosis of bacterial epididymitis and the patient was treated with intravenous antibiotics. Su...

  20. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje

    2010-01-01

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

  1. Addison's Disease Mimicking as Acute Pancreatitis: A Case Report.

    Science.gov (United States)

    Chaudhuri, Sayani; Rao, Karthik N; Patil, Navin; Ommurugan, Balaji; Varghese, George

    2017-04-01

    Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison's disease. Adrenal insufficiency (Addison's disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison's disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis.

  2. Osteolytic nasal polyp of the maxillary sinus mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Arvind Karikal

    2014-01-01

    Full Text Available We present an osteolytic nasal polyp of the maxillary sinus with clinical features and radiographic features mimicking that of a malignancy. Maxillary sinusitis being a common inflammatory condition progressed to cause destruction of the maxillary bone and spread into the facial soft tissue, which is quite a rare occurrence. We have discussed in detail the clinical, radiological, histopathology and management of this uncommon presentation of a common case.

  3. A Q fever case mimicking crimean-congo haemorrhagic fever

    Directory of Open Access Journals (Sweden)

    O Karabay

    2011-01-01

    Full Text Available Coxiella burnetii is the bacterium that causes Q fever. Human infection is mainly transmitted from cattle, goats and sheep. The disease is usually self-limited. Pneumonia and hepatitis are the most common clinical manifestations. In this study, we present a case of Q fever from the western part of Turkey mimicking Crimean-Congo haemorrhagic fever (CCHF in terms of clinical and laboratory findings.

  4. First Clinical Investigations of New Ultrasound Techniques in Three Patient Groups: Patients with Liver Tumors, Arteriovenous Fistulas, and Arteriosclerotic Femoral Arteries

    DEFF Research Database (Denmark)

    Hansen, Peter Møller

    arteriosclerotic lesion was raised, recordings of the flow were made. The recordings were subsequently analyzed, and for each recording blood flow velocity at the lesion was compared with the flow velocity in a healthy adjacent arterial segment. If the velocity at the lesion was higher than in the healthy segment...... of the new ultrasound techniques in selected groups of patients. For all three studies the results are promising, and hopefully the techniques will find their way into everyday clinical practice for the benefit of both patients and healthcare practitioners....

  5. Martius procedure revisited for urethrovaginal fistula

    Directory of Open Access Journals (Sweden)

    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.

  6. The Patency Rate of Arteriovenous Fistulas

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    Aşkın Ender Topal

    2004-01-01

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

  7. [Colovesical fistula as a complication of diverticular disease].

    Science.gov (United States)

    Shelygin, Iu A; Achkasov, S I; Moskalev, A I; Likhter, M S; Zarodniuk, I V; Skridlevskiĭ, S N; Trubacheva, Iu L

    2013-01-01

    The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 +/- 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 +/- 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

  8. Accessory veins in nonmaturing autogenous arteriovenous fistulae: analysis of anatomic features and impact on fistula maturation.

    Science.gov (United States)

    Engstrom, Bjorn I; Grimm, Lars J; Ronald, James; Smith, Tony P; Kim, Charles Y

    2015-01-01

    The appropriate management of nonmaturing arteriovenous (AV) fistulae continues to be a controversial issue. While coil embolization of accessory side-branch veins can be performed to encourage maturation of nonmaturing AV fistulae, the true efficacy and optimal patient population are not well understood. Fistulagrams performed on nonmaturing AV fistulae were retrospectively reviewed in 145 patients (86 males, median age 63 years) for the presence of accessory veins. Fistula and accessory vein measurements were obtained, as were rates of eventual fistula maturation after accessory vein coil embolization. Of 145 nonmaturing fistulae, 49 (34%) had a stenosis without any accessory veins, 76 (52%) had a stenosis and one or more accessory veins, and 20 (14%) had an accessory vein without concurrent stenosis. Eighteen AV fistulae had one or more accessory veins without coexisting stenosis. Nine fistulae had a caliber decrease immediately downstream from the accessory vein. Coil embolization of dominant accessory veins with a caliber decrease immediately downstream (n = 6) resulted in a 100% eventual fistula maturation rate versus 67% for fistulae without this configuration (n = 6, p = 0.15). Accessory vein size was not correlated with maturation rates (p = 0.51). The majority of nonmaturing fistulae with accessory veins had a coexisting stenosis. Higher maturation rates may result with selected anatomic parameters, although additional studies with more robust sample sizes are needed prior to definitive conclusions. © 2014 Wiley Periodicals, Inc.

  9. Association between parity and fistula location in women with obstetric fistula: a multivariate regression analysis.

    Science.gov (United States)

    Sih, A M; Kopp, D M; Tang, J H; Rosenberg, N E; Chipungu, E; Harfouche, M; Moyo, M; Mwale, M; Wilkinson, J P

    2016-04-01

    To compare primiparous and multiparous women who develop obstetric fistula (OF) and to assess predictors of fistula location. Cross-sectional study. Fistula Care Centre at Bwaila Hospital, Lilongwe, Malawi. Women with OF who presented between September 2011 and July 2014 with a complete obstetric history were eligible for the study. Women with OF were surveyed for their obstetric history. Women were classified as multiparous if prior vaginal or caesarean delivery was reported. The location of the fistula was determined at operation: OF involving the urethra, bladder neck, and midvagina were classified as low; OF involving the vaginal apex, cervix, uterus, and ureters were classified as high. Demographic information was compared between primiparous and multiparous women using chi-squared and Mann-Whitney U-tests. Multivariate logistic regression models were implemented to assess the relationship between variables of interest and fistula location. During the study period, 533 women presented for repair, of which 452 (84.8%) were included in the analysis. The majority (56.6%) were multiparous when the fistula formed. Multiparous women were more likely to have laboured fistula location (37.5 versus 11.2%, P fistula. Multiparity was common in our cohort, and these women were more likely to have a high fistula. Additional research is needed to understand the aetiology of high fistula including potential iatrogenic causes. Multiparity and caesarean delivery were associated with a high tract fistula in our Malawian cohort. © 2016 Royal College of Obstetricians and Gynaecologists.

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

    Directory of Open Access Journals (Sweden)

    Ashrarur Rahman Mitul

    2012-07-01

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

  11. Inherited cardiomyopathies mimicking arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Roberts, Jason D; Veinot, John P; Rutberg, Julie; Gollob, Michael H

    2010-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) represents an inherited cardiomyopathy that manifests clinically with malignant ventricular arrhythmias, sudden cardiac death, and less commonly heart failure. The condition is characterized by replacement of the myocardium, primarily of the right ventricle, with fibrofatty tissue. Extensive fibrofatty replacement of the myocardium has been previously thought to be pathognomonic of ARVC; however, this report details two other forms of inherited cardiomyopathy, namely hypertrophic cardiomyopathy (HCM) and the PRKAG2 cardiac syndrome, that were found to have significant fibrofatty myocardial replacement at pathologic examination. This report represents the first documentation of inherited cardiomyopathies mimicking ARVC and highlights the concept that other cardiac conditions can be associated with fibrofatty replacement of the myocardium. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Orbital Lymphoma Mimicking Lacrimal Gland Pleomorphic Adenoma

    Directory of Open Access Journals (Sweden)

    Diego Strianese

    2013-09-01

    Full Text Available Purpose: To describe the case of a patient affected by orbital lymphoma mimicking pleomorphic adenoma of the lacrimal gland. Methods: This was a retrospective case report. Results: We present the case of a patient with 15-year history of slowly progressive left proptosis and inferomedial bulbar dislocation who had the presumptive diagnosis of lacrimal gland pleomorphic adenoma based on clinical and radiological features. The patient underwent lateral orbitotomy and lacrimal gland excision. Postoperative histological features were consistent with low-grade B-cell non-Hodgkin lymphoma. Conclusion: The accepted clinico-radiological criteria used for the diagnosis of lacrimal gland fossa lesions might have a certain false-positive rate, even in recent years. The initial surgical approach with the appropriate choice between fine-needle aspiration biopsies, intraoperative biopsies and lacrimal gland excisions might be a challenge.

  13. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

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

    Directory of Open Access Journals (Sweden)

    Barone Mark A

    2012-03-01

    self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site. Discussion If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia. Trial registration ClinicalTrials.gov Identifier NCT01428830.

  15. Role of the pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage laryngectomy.

    Science.gov (United States)

    Sharma, S; Chaukar, D A; Laskar, S G; Kapre, N; Deshmukh, A; Pai, P; Chaturvedi, P; D'Cruz, A

    2016-09-01

    This study aimed to assess the utility of onlay pectoralis major myofascial flap in preventing pharyngocutaneous fistula following salvage total laryngectomy. A retrospective analysis was performed of 172 patients who underwent salvage laryngectomy for recurrent carcinoma of the larynx or hypopharynx between 1999 and 2014. One hundred and ten patients underwent primary closure and 62 patients had pectoralis major myofascial flap onlay. The overall pharyngocutaneous fistula rate was 43 per cent, and was similar in both groups (primary closure group, 43.6 per cent; onlay flap group, 41.9 per cent; p = 0.8). Fistulae in the onlay flap group healed faster: the median and mean fistula duration were 37 and 55 days, respectively, in the primary closure group and 20 and 25 days, respectively, in the onlay flap group (p = 0.008). Use of an onlay pectoralis major myofascial flap did not decrease the pharyngocutaneous fistula rate, although fistula duration was shortened. A well-designed randomised-controlled trial is needed to establish parameters for its routine use in clinical practice.

  16. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis.

    Science.gov (United States)

    Yang, Ji; Huang, Qiang; Wang, Chao

    2015-10-01

    This study to evaluate the utility of drain fluid amylase as a predictor of PF in patients undergoing pancreatic surgery based on the International Study Group of Pancreatic Fistula definitions of pancreatic fistula. A comprehensive search was carried out using Pubmed (Medline), Embase, Web of science and Cochrane database for clinical trials, which studied DFA as a diagnostic marker for pancreatic fistula after pancreatic surgery. Sensitivity, specificity and the diagnostic odds ratios with 95% confidence interval were calculated for each study. Summary receiver-operating curves were conducted and the area under the curve was evaluated. A total of 10 studies were included. The pooled sensitivity and specificity of drain fluid amylase Day 1 for the diagnosis of postoperative pancreatic fistula were 81% and 87%, respectively (area under the curve was 0.897, diagnostic odds ratios was 16.83 and 95%CI was 12.66-22.36), the pooled sensitivity and specificity of drain fluid amylase Day 3 for the diagnosis of postoperative pancreatic fistula were 56% and 79%, respectively (area under the curve was 0.668, diagnostic odds ratios was 3.26 and 95%CI was 1.83-5.82) CONCLUSIONS: The drain fluid amylase Day 1, instead of drain fluid amylase Day 3, may be a useful criterion for the early identification of postoperative pancreatic fistula, and a value of drain fluid amylase Day 1 over than 1300 U/L was a risk factor of pancreatic fistula. And the diagnostic accuracy and the proposed cut-off levels of drain fluid amylase Day 1 in predicting the postoperative pancreatic fistula will have to be validated by multicenter prospective studies. Copyright © 2015. Published by Elsevier Ltd.

  17. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    Directory of Open Access Journals (Sweden)

    Dennis AC

    2016-09-01

    Full Text Available Alexis C Dennis1 Sarah M Wilson1–3 Mary V Mosha4 Gileard G Masenga4 Kathleen J Sikkema1,5,6 Korrine E Terroso1 Melissa H Watt1 1Duke Global Health Institute, Duke University, 2Department of Veterans Affairs, Mid-Atlantic Mental Illness Research, Education and Clinical Center, 3Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Kilimanjaro Christian Medical Center, Moshi, Tanzania; 5Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; 6Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa Objective: An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration.Patients and methods: The study used a mixed-methods design to analyze cross-sectional surveys (n=59 and in-depth interviews (n=20.Results: Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs.Conclusion: Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic

  18. [Aortoenteric fistula secondary to aortobifemoral prosthesis infection].

    Science.gov (United States)

    Gabriel Botella, F; Labiós Gómez, M; Ibáñez Gadea, L; Fácila Rubio, L; Carbonell Cantí, C

    2002-05-01

    We present the case of a 76 year-old man, intervened of an obstruction bilateral iliac by means of placement of a prosthesis aortobifemoral that presented pain in the grave left iliac and fever in needles of 39 degrees C to the five years of the intervention. In the physical exploration it highlighted a painful abdomen in the grave left iliac with signs of peritoneal irritation. In the laboratory tests a leukocytosis was detected with neutrophilia and negative culture. The computed thomography (CT) show the presence of gas bubbles around the prosthesis, as well as a liquid collection with areas necrotics in their interior that affected to the psoas and iliac muscles. In the same exploration the aspirative puncture with drainage of the absces demonstrated in the cultivations carried out in aerobic means the presence of Enterococcus faecalis and Enterobacter cloacae. When presenting a high gastrointestinal hemorrhage abruptly, he was practiced and gastroduodenal endoscope in which a aortoduodenal fistula was evidenced with having bled active. When a bypass extra-anatomic, the sick person will practice it died when presenting a shock abrupt hipovolemic that he didn't respond to the pertinent treatment. We analyze the approaches current diagnoses of infection of the vascular prosthesis and their more serious complication, the aortoenteric fistula (AEF) that either appears in the 0.3-5.9% of the patients who undergo prosthetic reconstruction of the abdominal aorta, for occlusive or aneurismal disease. We highlight the importance of carrying out a precocious diagnosis of the infection of the portion retroperitoneal of the vascular graft that, often, it is manifested with subtle and not specific clinical signs, with the techniques at the moment available as: the CT, fine needle aspiration guided by her, and to diminish the rates of mortality, from the current of 43%, until the most optimistic estimated in 19%.

  19. Recent smoking is a risk factor for anal abscess and fistula.

    Science.gov (United States)

    Devaraj, Bikash; Khabassi, Soheil; Cosman, Bard C

    2011-06-01

    Smoking is a risk factor for inflammatory, fistulizing cutaneous diseases. It seems reasonable that smoking might be a risk factor for anal abscess/fistula. This study aimed to test the hypothesis that recent smoking is a risk factor for development of anal abscess/fistula. This is a case-control study. This study was conducted at a Department of Veterans Affairs general surgical clinic. Included in the study were 931 patients visiting the general surgical clinic over a 6-month period. A tobacco use questionnaire was administered. Patients with anal abscess/fistula history were compared with controls, who had all other general surgical conditions. To investigate the temporal relation between smoking and the clinical onset of anal abscess/fistula, we compared the group consisting of current smokers and former smokers who had recently quit, against the group consisting of nonsmokers and former smokers who had quit a longer time ago (ie, not recently). We excluded patients with IBD and HIV. Cases and controls were comparable in age (57 and 59 y) and sex (93% and 97% male). After exclusions, there were 74 anal abscess/fistula cases and 816 controls. Among the anal abscess/fistula cases, 36 patients had smoked within 1 year before the onset of anal abscess/fistula symptoms, and 38 had not smoked within the prior year; among controls, 249 had smoked within 1 year before seeking surgical treatment, and 567 had not (OR 2.15, 95% CI 1.34-3.48, 2-tail P = .0025). Using a 5-year cutoff for recent smoking, the association was less pronounced but still significant (OR 1.72, 95% CI 1.03-2.86, P = .0375), and the association was insignificant at 10 years (OR 1.34, 95% CI 0.78-2.21, P = .313). Limitations of the study included self-selection bias, recall bias, convenience sample, and noninvestigation of the dose-response relationship. Recent smoking is a risk factor for anal abscess/fistula development. As in other smoking-related diseases, the influence of smoking as a risk

  20. 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...

  1. Urethral diverticulo-rectal fistula in AIDS.

    Science.gov (United States)

    Lee, W H; Yang, W J; Rha, K H; Chang, K H; Kim, J M; Lee, M S

    2001-10-01

    A 41-year-old heterosexual African man was evaluated for persistent urethral discharge, pneumaturia and watery diarrhea. Radiographic and endoscopic procedures established the diagnosis of a rectourethral fistula. The differential diagnosis of an acquired rectourethral fistula and the significance of AIDS are discussed.

  2. Computed tomography demonstration of cholecystogastric fistula

    Directory of Open Access Journals (Sweden)

    Chung Kuao Chou, MD, MPH

    2016-06-01

    Full Text Available Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints.

  3. Diagnosis and Treatment of Transsphincteric Perianal Fistulas

    NARCIS (Netherlands)

    D.D.E. Zimmerman (David)

    2003-01-01

    textabstractFistula’ is the Latin word for a reed, pipe or flute. In medicine it implies a chronic granulating track connecting two epithelium lined surfaces. These surfaces may be cutaneous or mucosal. Perianal fistulas run from the anal canal to the perianal skin or perineum. Perianal fistulas are

  4. Identification of epithelialization in high transsphincteric fistulas

    NARCIS (Netherlands)

    L.E. Mitalas (Litza); R.S. van Onkelen (Robbert); K. Monkhorst (Kim); D.D.E. Zimmerman (David); M.P. Gosselink (Martijn Pieter); W.R. Schouten (Ruud)

    2012-01-01

    textabstractBackground At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure

  5. Diagnosis and treatment of inflammatory intestinovesical fistulas.

    Science.gov (United States)

    Szentgyörgyi, E; Kondás, J; Szöke, D; Balogh, A; Orbán, L

    1989-01-01

    The histories of 3 patients operated for inflammatory intestinovesical fistulas are reviewed. Two of them were treated for colovesical, one for ileovesical fistula. The questions concerning the development, diagnostics and surgical management are discussed in detail. The importance of cystoscopy in diagnosis is emphasized. In all three patients one-session operations were performed with good results.

  6. Venous manifestations of spinal arteriovenous fistulas

    NARCIS (Netherlands)

    Andersson, T; van Dijk, JMC; Willinsky, RA

    2003-01-01

    Impairment of the spinal cord venous outflow may create symptoms caused by venous hypertension and congestion. This has been referred to as venous congestive myelopathy. Spinal dural arteriovenous fistulas, as well as some of the epidural arteriovenous fistulas and perimedullary spinal cord arteriov

  7. Cholecystoduodenal fistula in a porcelain gallbladder

    Energy Technology Data Exchange (ETDEWEB)

    Delpierre, I.; Tack, D.; Delcour, C. [Department of Radiology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Moisse, R. [Department of Gastroenterology, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium); Boudaka, W. [Department of Surgery, CHU-Hopital Civil de Charleroi, 92 Boulevard Janson, 6000 Charleroi (Belgium)

    2002-09-01

    Calcification of the gallbladder wall (porcelain gallbladder) is rare. Its appearance is quite characteristic on plain films, ultrasonography and computed tomography. Sporadic cases of cholecystitis have been described in porcelain gallbladders. Enterobiliary fistula may complicate acute or chronic cholecystitis in non-calcified gallbladder. We report a unusual case of acute cholecystitis with cholecystoduodenal fistula in a porcelain gallbladder. (orig.)

  8. Spontaneous Resolution of Direct Carotid Cavernous Fistula

    NARCIS (Netherlands)

    Ishaq, Mazhar; Arain, Muhammad Aamir; Ahmed, Saadullah; Niazi, Muhammad Khizar; Khan, Muhammad Dawood; Iqbal, Zamir

    2010-01-01

    Proptosis due to carotid cavernous fistula is rare sequelae of head injury. We report a case of post-traumatic, direct high flow carotid cavernous fistula that resolved spontaneously 06 weeks after carotid angiography. It however, resulted in loss of vision due to delay in early treatment. In the ca

  9. Identification of epithelialization in high transsphincteric fistulas

    NARCIS (Netherlands)

    L.E. Mitalas (Litza); R.S. van Onkelen (Robbert); K. Monkhorst (Kim); D.D.E. Zimmerman (David); M.P. Gosselink (Martijn Pieter); W.R. Schouten (Ruud)

    2012-01-01

    textabstractBackground At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure

  10. Diagnosis and Treatment of Transsphincteric Perianal Fistulas

    NARCIS (Netherlands)

    D.D.E. Zimmerman (David)

    2003-01-01

    textabstractFistula’ is the Latin word for a reed, pipe or flute. In medicine it implies a chronic granulating track connecting two epithelium lined surfaces. These surfaces may be cutaneous or mucosal. Perianal fistulas run from the anal canal to the perianal skin or perineum. Perianal fistulas are

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Aortoenteric fistula formation is a devastating condition regardless of whether it is primary or secondary (i.e. after previous aneurysm repair) in nature. Patients present with signs and symptoms of gastrointestinal bleeding with or without signs of systemic infection and are often in a very poor...... clinical condition. Conventional treatment consists of extensive open surgery (extra-anatomical bypass or aortic ligation), closure of fistula tract and complete removal of any prosthetic material. This treatment is associated with high morbidity and mortality and therefore more minimally invasive options...... with endovascular repair have been attempted. Endovascular repair is often successful in the short-term achieving favorable immediate outcome. In the presence of systemic infection, however, EVAR alone as an ultimate solution is often followed by repeat infection and bleeding. A staged combination of EVAR treatment...

  12. The radiological management of the thrombosed arteriovenous dialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-01-15

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

  13. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

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

  14. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

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

    Science.gov (United States)

    Wall, L Lewis

    2014-12-01

    According to the seven categories of vulnerability proposed by Kipnis (cognitive, juridical, deferential, medical, allocational, social, and infrastructural), and the four generally accepted principles of biomedical ethics (respect, beneficence, non-maleficence, and fairness), women with obstetric fistulas are an exceptionally vulnerable population. Therefore, they merit special consideration in both clinical care and research settings. Adoption of a formal bill of rights for patients with fistula similar to the one proposed in the present report should be encouraged at all facilities where these women are treated. Acknowledgment of their rights would help to improve their care and end the abuses they are exposed to in institutional settings. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Selective Management for Gastrointestinal Hemorrhage caused by Choledochoduodenal Fistula

    Directory of Open Access Journals (Sweden)

    Pawan Chansaenroj

    2017-03-01

    Full Text Available Background: To report a patient of choledochoduodenal fistulae (CDF who presented with melena and review a specific treatment for CDF. Methods: This study was designed as a retrospective chart review using patient’s clinical data, imaging, endoscopic report, treatment review, and literature review for treatment options. Results: A 74-year-old female presented with diffuse, non-tender abdominal pain and associated melena for one week. Physical examination showed mildly icteric sclera and mild epigastric tenderness on deep palpation. Initial diagnoses included cholangitis with anemia and acute kidney injury. Computed tomography of the abdomen revealed dilated common bile duct (CBD with a likely 1 cm stone at the distal common bile duct. The patient was given intravenous antibiotic and proper fluid administration. An ERCP was performed noting a fistula from the bile duct to the 2nd part of the duodenum with stone impaction. Sphincterotomy was performed from papilla to fistula. Balloon extraction of 1 cm stone from the CBD was done. Conclusion: The clinical presentation of CDF is generally quite nonspecific. In this case report, we present a presentation of a patient with gastrointestinal hemorrhage as an example of the presentation of CDF associated with a CBD stone. This study also discussed recent data concerning proposed treatment of CDF.

  17. Treatment of a coronary artery to superior vena cava fistula resulting from early closure of a Possis Perma-Flow graft.

    Science.gov (United States)

    Graham, M M; Kells, C M; Sullivan, J; O'Neill, B J

    1999-06-01

    The Perma-Flow graft used in bypass surgery achieves more complete revascularization when paucity of native conduits exists. We report a coronary artery to superior vena cava fistula as a complication of this graft, leading to severe right heart failure. The fistula was successfully occluded percutaneously, improving the patient's clinical situation.

  18. 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.

  19. Decidualized Ovarian Mass Mimicking Malignancy

    Directory of Open Access Journals (Sweden)

    Lufee Wong

    2015-01-01

    Full Text Available Deciduosis classically occurs in the context of known endometriosis in the pelvis, most commonly in the ovaries, but also in the peritoneum. However, ovarian deciduosis outside the context of endometriosis is rare and makes diagnosis difficult, especially as the sonographic appearance suggests a malignant process. We report a case of decidualized ovarian mass in a patient without prior history of endometriosis that mimicked an ovarian malignancy. MRI may be a useful imaging modality to monitor these lesions and guide management. Consultation with a multidisciplinary team accustomed to such conditions will help to tailor the management to each individual.

  20. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)

    2015-01-01

    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging

  1. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)

    2015-01-01

    markdownabstractAbstract The objective of modern anal fistula treatment is healing of the fistula without diminished fecal continence. Sphincter saving techniques have been developed for anal fistulas, for which fistulotomy is not suitable. Treatment of these anal fistulas remains challenging and

  2. [Congenital preauricular fistula infection: a histopathology observation].

    Science.gov (United States)

    Hua, Na; Wei, Lai; Jiang, Tao; Guo, Ying; Wang, Meiyi; Wang, Zhiqiang

    2014-08-01

    To investigate the pathology characteristics of congenital preauricular fistula with infection, in order to reduce the recurrence rate after surgery and improve operative technique. Twenty-five patients diagnosed as congenital preauricular fistula with infection were analyzed. There were 14 patients in infection history group, 9 in infective stage group, and 2 in recurrence group respectively. The whole piece of fistula and scar tissue was completely excised during operation. The specimens were observed by naked eye and serial tissue sections were analyzed. (1) Macroscopically, in infection history group, initial morphology can be maintained near the fistula orifice, but the distal tissue was dark red scar tissue. In infective stage group, the distal tissue of the specimens was granulation tissue and cicatricial tissue. The granulation tissue was crisp and bright red. In recurrence group, multicystic lesions with severe edema was observed, with a classical dumb-bell appearence. (2) Microscopically, in infection history group and recurrence group, we can see that the distal fistula tissue was discontinuous and was separated by scar tissue. In infective stage group, we can find neo-angiogenesis and infiltration of plasma cells, lymphocytes, neutrophil between interrupted fistula tissues. (3) All patients were followed up for 6-12 month, without recurrence. The fistula tissue of congenital preauricular fistula with infection was divided by the scar tissue, and they did not communicate with each other. Complete delineation of fistula is hardly achieved by methylene blue staining. Radical excision of the fistula and scar tissue may help to avoid leaving viable squamous epithelial remnants and reduce the recurrence rate.

  3. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography.

    Science.gov (United States)

    Braithwaite, Kiery A; Alazraki, Adina L

    2014-08-01

    Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The "star sign" is a radiological finding of internal fistula that has previously been described in the gastroenterology literature in adult Crohn disease patients undergoing MR enteroclysis. The goal of this paper is to review the clinical and imaging features of penetrating disease in pediatric Crohn disease patients, highlighting the star sign as a useful diagnostic tool for diagnosing internal fistula in children by MR enterography. The recognition of penetrating complications by MR imaging can have important therapeutic and prognostic implications.

  4. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography

    Energy Technology Data Exchange (ETDEWEB)

    Braithwaite, Kiery A.; Alazraki, Adina L. [Emory University, Department of Radiology and Imaging Sciences, Children' s Healthcare of Atlanta, Atlanta, GA (United States)

    2014-08-15

    Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The ''star sign'' is a radiological finding of internal fistula that has previously been described in the gastroenterology literature in adult Crohn disease patients undergoing MR enteroclysis. The goal of this paper is to review the clinical and imaging features of penetrating disease in pediatric Crohn disease patients, highlighting the star sign as a useful diagnostic tool for diagnosing internal fistula in children by MR enterography. The recognition of penetrating complications by MR imaging can have important therapeutic and prognostic implications. (orig.)

  5. Recurrent pyriform sinus fistula successfully treated by endoscopic Glubran 2 sealing: A rare case and literature review

    Science.gov (United States)

    Di Nardo, Giovanni; Valentini, Valentino; Angeletti, Diletta; Frediani, Simone; Iannella, Giannicola; Cozzi, Denis; Roggini, Mario; Magliulo, Giuseppe

    2016-01-01

    Objectives: The authors present the case of a 3-year-old girl with a history of complicated surgery for removing a third branchial cleft fistula. Methods: An endoscopic approach using N-butyl-2-acrylate and metacrilosisolfolane glue (GLUBRAN 2) to seal the fistula was performed. Results: The clinical and radiological 6-year follow-up confirmed the absence of the fistulous orifice and the persistence of scar due to previous open-neck surgical procedures. Conclusion: endoscopic Glubran 2 sealing has been an effective treatment procedure for branchial fistula. PMID:27781098

  6. [Pay attention to the imaging diagnosis of complex anal fistula].

    Science.gov (United States)

    Zhou, Zhiyang

    2015-12-01

    The diagnosis and treatment of complex anal fistula has been a significant challenge. Unwise incision and excessive exploration will lead to the secondary branch, sinus and perforation. A simple fistula may become a surgical problem and result in disastrous consequences. Preoperative accurate diagnosis of anal fistula, including in the internal opening, primary track and location of the fistula, extensions and abscess, is important for anal fistula treatment. In the diagnosis of anal fistula, imaging examination, especially MRI plays a crucial role. Localization and demarcation of anal fistula and the relationship with sphincter are important. MRI has been an indispensable confirmatory imaging examination.

  7. Vacuum Assisted Closure (VAC) therapyTM as a swiss knife multi-tool for enteric fistula closure: tips and tricks: a pilot study.

    Science.gov (United States)

    Pepe, G; Magalini, S; Callari, C; Persiani, R; Lodoli, C; Gui, D

    2014-01-01

    Enterocutaneous fistulas (ECFs) are an uncommon surgical problem, but they are characterized by a difficult management. Vacuum-assisted closure (VAC) therapy is a method utilized for chronic and traumatic wound healing. At first, VAC therapy had been contraindicated in the treatment of intestinal fistulas, but as time went by, VAC therapy revealed itself to be a "Swiss knife multi-tool". This paper presents some clinical cases of enterocutaneous (ECF) and enteroatmospheric fistulas (EAF) treated with VAC therapy™. The history of 8 patients treated for complex fistulas was revised. Four of them presented with enterocutaneous and four with enteroatmospheric fistulas. All were treated with VAC therapy with variations elaborated to help in accelerated closure of intestinal wall lesions. Four out of four ECFs closed spontaneously. In the EAF group, in three cases the fistula turned slowly into an entero-cutaneous fistula, and in one out of four it closed spontaneously. The mean length of VAC therapy™ was 35.5 days and that of spontaneous closure was 36.4 days. The results of our study encourage the use of VAC therapy™ for the treatment of enterocutaneous fistulas. VAC therapy™ use has a double therapeutic value: (1) it promotes the healing of the skin and allows also the management of EAFs; (2) in selected cases, those in which it is possible to create a deep fistula tract ("well") it is possible to assist to a complete healing with closure of the ECFs.

  8. Treating anal fistula with the anal fistula plug: case series report of 12 patients.

    Science.gov (United States)

    Saba, Reza Bagherzadeh; Tizmaghz, Adnan; Ajeka, Somar; Karami, Mehdi

    2016-04-01

    Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped collagen plug was pulled through the fistula tract. Twelve patients were included in this case study. All patients had previously undergone failed surgical therapy to cure their fistula and had previously-placed Setons. There were eight males and four females with an average age of 44 who were treated for complex fistulas. At a median time of follow-up of 22.7 months, 10 of the 12 patients had healed (83.3%). One patient developed an abscess that was noted on the sixth postoperative day, and there was one recurrence during follow-up. Fistula plugs are effective for the long-term closure of complex anal fistulas. Success of treatment with the fistula plug depends on the eradication of sepsis prior to plug placement.

  9. ProTaper联合根管加压冲洗治疗窦道型慢性根尖周炎的临床分析%Clinical analysis on ProTaper combined with root canal pressure washing technique for treatment of chronic apical periodontitis with fistula

    Institute of Scientific and Technical Information of China (English)

    周瑾; 阿依古丽·依沙克

    2014-01-01

    目的:对应用ProTaper与根管加压冲洗技术联合对患有窦道型慢性根尖周炎的患者实施治疗的临床效果进行研究。方法将我院收治的82例患有窦道型慢性根尖周炎的患者随机分为对照组和治疗组,平均每组41例。采用ProTaper与注射器冲管技术联合对对照组患者实施治疗;采用ProTaper与根管加压冲洗技术联合对治疗组患者实施治疗。结果治疗组患者窦道型慢性根尖周炎病情治疗效果明显优于对照组;治疗操作总时间和牙齿功能复常时间明显短于对照组。结论应用ProTaper与根管加压冲洗技术联合对患有窦道型慢性根尖周炎的患者实施治疗的临床效果非常明显。%Objective To study the clinical effects of ProTaper combined with root canal pressure washing technique for treatment of chronic apical periodontitis with fistula. Methods 82 patients with chronic apical periodontitis with fistula admitted and treated in our hospital were randomly assigned to the control group and the treatment group with 41 cases in each group. The control group was given ProTaper combined with syringe flushing pipe technique while the treatment group was given ProTaper combined with root canal pressure washing technique. Results The treatment group had better efficacy for treatment of chronic apical periodontitis with fistula than the control group. The treatment group had shorter operating time and faster recovery of tooth functions than the control group. Conclusion ProTaper combined with root canal pressure washing technique demonstrates excellent clinical effects for treatment of chronic apical periodontitis with fistula.

  10. Ozone Treatment for Chronic Anal Fistula: It Is Not Promising.

    Science.gov (United States)

    Ozturk, Alaattin; Atalay, Talha; Cipe, Gokhan; Luleci, Nurettin

    2017-08-01

    The aim of this study is to assess the effect of ozone gas in the treatment of anorectal fistulae. The tip of a 20 G intravenous cannula was inserted from the fistula orifice. Medical ozone was introduced into the fistula. A total of 10 sessions of ozone gas insufflation was performed on alternate days. Treatment was considered to be successful if fistula discharge ceased and the outer fistula orifice closed; however, if discharge was continued or outer fistula orifice was open, the treatment considered to be failed. A total of 12 adult patients were included in the study. The fistula was closed in three patients (25 %), in nine patients (75 %) without closure. In one patient who had fistula closure, the fistula recurred after 2 months. Patients did not express any discomfort during ozone insufflation. There were no side effects or complications due to ozone insufflation. The success rate of ozone insufflation in anorectal fistulae closure is low.

  11. Radiologic recognition of bronchopleural fistula.

    Science.gov (United States)

    Friedman, P J; Hellekant, C A

    1977-08-01

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

  12. Bronchoesophageal fistula secondary to mediastinal lymph node tuberculosis: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    廖理粤

    2014-01-01

    Objective To analyze the clinical features of 1 case of bronchoesophageal fistula(BEF)secondary to medias-tinal lymph node tuberculosis.Methods The clinical,auxiliary examinational and pathological data of 1 case with BEF were presented,and the literatures were reviewed.Results The patient was a 19 year old female,who was admitted to hospital because of

  13. The clinical effect of Maxillary sinus fistula neoplasty assisted with endoscopic%鼻内镜辅助下口腔上颌窦瘘修补术的临床疗效

    Institute of Scientific and Technical Information of China (English)

    顾晓莉

    2015-01-01

    目的:探讨口腔上颌窦瘘的修补方法。方法:对5例合并严重上颌窦炎的口腔上颌窦瘘患者,在鼻内镜辅助下采用口腔合瓣缝合加上颌窦内“三明治”法修补。结果:5例患者均一期愈合,随访3个月~1年,瘘口愈合良好,复查鼻窦CT上颌窦炎症消失。结论:鼻内镜辅助下口腔内合瓣缝合加上颌窦内“三明治”法修补术是治疗合并严重上颌窦炎口腔上颌窦瘘的有效方法。%Objective:To investigate the repair method of maxillary sinus fistula.Methods:5 patients with oral maxillary sinus fistula combined severe maxillary sinusitis were taken oral sympetalous suture plus maxillary sinus "sandwich" repair under endoscopic assisted.Results:All of those 5 patients were primary healing,and followed up for 3 months to 1 years,the fistula of patients healing well,and the inflammation of maxillary sinus disappeared when reviewed the sinus CT.Conclusion:Oral sympetalous suture plus maxillary sinus "sandwich" repair under endoscopic assisted is an effective treatment of patients with oral maxillary sinus fistula combined severe maxillary sinusitis.

  14. Evaluation of Clinical Decision-making in Artificial Arteriovenous Fistula Complications Applied with Color Doppler Ultrasound%彩色多普勒超声在人工动静脉内瘘并发症中的临床决策评价

    Institute of Scientific and Technical Information of China (English)

    薄华颖

    2012-01-01

    As a result of wide range application of hemodialysis,the survival time in patients with uremia was significantly longer. Establish and maintain good and long - term vascular access for chronic hemodialysis is prerequisite. Color Doppler ultrasound as a non-invasive checking method has important clinical value in mcnitoring the vascular access of artificial arteriovenous fistula. This text has evaluated the importance of clinical decision - making in artificial arteriovenous fistula complications applied with color Doppler ultrasound.%由于血液透析的广泛应用,尿毒症患者的生存时间显著延长. 建立并保持良好的血管通路是长期慢性血液透析的前提条件.彩色多普勒超声作为一种无创性检查方法,在人工动静脉内瘘血管通路的监测中发挥着重要的临床价值.本文评估彩色多普勒超声在人工动静脉内瘘并发症临床决策中的重要作用.

  15. Embryological Consideration of Dural Arteriovenous Fistulas

    Science.gov (United States)

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  16. Clinical observation analysis of treatment 334 patients' anal sinusitis by incision and drainage anal fistula%肛窦切开引流术治疗肛窦炎334例临床分析

    Institute of Scientific and Technical Information of China (English)

    徐征; 赵义群; 李文峰

    2012-01-01

    目的 探索肛窦炎的有效治疗方法及疗效.方法 回顾性总结我科2005~2008年634例肛窦炎治疗经过,治疗组334例,采用肛窦切开引流术;对照组300例采用保守治疗.结果 治疗后,治疗组总有效率100%;对照组总有效率80.3%.治疗组复发率明显少于对照组.结论 肛窦切开引流术可治疗肛窦炎,并有效避免了脓肿或肛瘘的发生.%Objective In order to probe into the effective therapy and curative effect. Methods Reviewed summary our hospital 634 patients, 334 anal sinusitis patients by using anal fistula curative effect and other 300 patients take conservation treatment. Results After treatment, patients in the treatment group have a 100% effective rate; an other group has a 80. 3% . Treatment group's recurrence rate is absolutely less than normal group. Conclusion Incision and drainage anal fistula can cure anal sinusitis and avoid abscess and anal fistula effective.

  17. Clinical Observation of Continuous Abdominal Double-cannula Lavage and Drainage for Anastomotic Stoma Fistula of Colorectal%腹腔双套管持续冲洗引流在结直肠吻合口瘘中的临床观察

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

      目的探讨腹腔双套管持续冲洗引流治疗结直肠吻合口瘘的效果,促进其临床推广应用。方法对29例结直肠手术后并发吻合口瘘的患者给予腹腔双套管生理盐水灌洗,低负压吸引引流治疗。结果29例患者给予腹腔双套管持续引流后15~25d(平均22.5d)后均痊愈出院,随访3个月以上,未见吻合口狭窄及肠梗阻等并发症。结论腹腔双套管持续冲洗引流简单易行,是治疗结直肠吻合口瘘的有效措施。%Objective To examine the outcomes of continuous irrigation and drainage by abdominal double-cannula in management of colorectal anastomotic stoma fistula for wider clinical application. Methods 29 cases of anastomotic stoma fistula of colorectal were treated by continuous abdominal double-cannula lavage and low negative pressure drainage. Results 29 patients discharged from the hospital,who were treated by continuous abdominal double-cannula lavage and drainage for15~25 days, on average of 22.5 days. No complications of anastomotic stoma constriction or intestinal obstruction were found during 3 month follow-up. Conclusion Continuous abdominal double-cannula lavage and drainage are easy to conduct, which are the effective way to treat the anastomotic stoma fistula of colorectal.

  18. 肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘疗效观察%Clinical effect of partes superficialis approach operation in the treatment of high complex anal fistula of posterior position

    Institute of Scientific and Technical Information of China (English)

    吴俊荣; 刘建峰; 金晶

    2013-01-01

    目的 探讨肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘的临床疗效.方法 对2010年-2012年收治的29例后位高位复杂性肛瘘患者经肛门外括约肌浅部入路行切开挂线术、切开挂线旷置术、切开旷置术.结果 29例患者28例治愈,治愈率96.6%.结论 肛门外括约肌浅部入路手术治疗后位高位复杂性肛瘘手术成功率高,不损害肛门功能及外形,对患者造成的痛苦轻.%Objective To explore the clinical effect of partes superficialis (external anal sphincter)approach operation in the treatment of high complex anal fistula of posterior position.Methods Twenty-nine patients with high complex anal fistula of posterior position From 2010 to 2012 were treated by partes superficialis incision thread-drawing,incision and thread-drawing indwelling,open indwelling.Results Twenty-eight patients were cured,and the curative rate was 96.6 %.Conclusion Success rate of partes superficialis approach operation in the treatment of high complex anal fistula of posterior position after operation is high,and it does not damage the anal function and shape,and causes less suffering.

  19. Introducing the operation method for curing anal fistula by laser

    Science.gov (United States)

    Ji, Bingzhi

    1993-03-01

    The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

  20. Giant intracranial aneurysm with fistula to the paranasal sinuses - a case report; Aneurisma gigante intracraniano com fistula para os seios paranasais - relato de um caso

    Energy Technology Data Exchange (ETDEWEB)

    Cabral, Luciano Gusmao; Monteiro, Soraya Silveira; Rossi, Luiz Antonio; Araujo, Marcelo Antonio Nobrega; Iagarachi, Celso Kendy; Oliveira, Luiz Antonio Nunes de [Hospital do Servidor Publico Estadual de Sao Paulo, SP (Brazil). Serv. de Radiologia

    1998-09-01

    The authors present a case of giant aneurysm of internal carotid artery with extensive bone erosion, which led to a fistula to the paranasal sinuses. The clinical aspects, radiological findings and differential diagnosis of giant intracranial aneurysms are discussed. (author) 9 refs., 5 figs.

  1. A case of colovesical fistula induced by sigmoid diverticulitis.

    Science.gov (United States)

    Yang, Hwa-Yeon; Sun, Woo-Young; Lee, Taek-Gu; Lee, Sang-Jeon

    2011-04-01

    Colonic diverticulosis has continuously increased, noticeably left-sided diseases, in Korea. A colovesical fistula is an uncommon complication of diverticulitis, and its most common cause is diverticular disease. Confirmation of its presence generally depends on clinical findings, such as pneumaturia and fecaluria. The primary aim of a diagnostic workup is not to observe the fistular tract itself but to find the etiology of the disease so that an appropriate therapy can be initiated. We present here the case of a 79-year-old man complaining of pneumaturia and fecaluria. On abdomen and pelvis CT, the patient was diagnosed as having a colovesical fistula due to sigmoid diverticulitis. After division of the adhesion between the sigmoid colon and the bladder, the defect of the bladder wall was repaired by simple closure. The colonic defect was treated with a segmental resection, including the rectosigmoid junction. The patient is doing well at 6 months after the operation and shows no evidence of recurrence of the fistula.

  2. Carotid-cavernous fistula after functional endoscopic sinus surgery.

    Science.gov (United States)

    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.

  3. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns;

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  4. An open prospective study evaluating efficacy and safety of a new medical device for rectal application of activated carbon in the treatment of chronic, uncomplicated perianal fistulas

    DEFF Research Database (Denmark)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns

    2017-01-01

    PURPOSE: It has been proposed that biological/chemical substances in the intestine might play a role in the occurrence and deterioration of perianal fistulas. Elimination of such unidentified factors from the lower gastrointestinal tract might offer a new strategy for the management of anal...... fistulas. The aim of this study was to evaluate the clinical effects on non-Crohn's disease perianal fistula healing, and the safety and tolerability of a new medical device that applies high-purity, high-activity granular activated carbon locally into the rectum twice daily of patients with perianal...... fistulas without any concomitant medication. METHODS: An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( ClinicalTrial.gov identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted...

  5. An Adolescent Patient with Scabies Mimicking Gottron Papules

    OpenAIRE

    Eiji Yoshinaga; Naoki Oiso; Shigeru Kawara; Akira Kawada

    2009-01-01

    Atypical features of scabies occur in infants and children and patients with prolonged use of corticosteroids or immunosuppression. We report a non-immunosuppressed 15-year-old female case of scabies showing scaly reddish papules over the proximal interphalangeal joints mimicking Gottron papules in classic dermatomyositis. Periungal erythema was also seen. Four months’ topical corticosteroids from previous clinics had been used. Dermoscopic findings were consistent with typical pictures of sc...

  6. Spitz Nevus on the Earlobe Mimicking Cutaneous Leishmaniasis

    Directory of Open Access Journals (Sweden)

    İbrahim Özmen

    2010-06-01

    Full Text Available Spitz nevus is a benign, usually acquired melanocytic tumor which is seen especially in children and adolescents. It usually appears as a pink or light-brown, smooth-surfaced, well-circumscribed and asymptomatic papulonodular lesion. A large group of dermatologic disorders should be considered in the differential diagnosis. Herein we present a case of Spitz nevus with a two month history of a nodular lesion on the earlobe which mimicks cutaneous leishmaniasis clinically.

  7. Acutely calcified hematoma mimicking a displaced medial epicondyle fracture

    Directory of Open Access Journals (Sweden)

    Majed Addie

    2009-01-01

    Full Text Available We present an interesting and unusual case of an acutely calcified pin-site infection hematoma mimicking a displaced cartilaginous medial epicondyle, in a child with a Gartland type III fracture. The treatment of such pathology could be confusing and may interfere with the correct clinical decision-making process. To our knowledge, this is the first presentation of such a case.

  8. Juvenile Myelomonocytic Leukemia in a Premature Neonate Mimicking Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    Ming-Luen Lee

    2016-04-01

    Full Text Available Juvenile myelomonocytic leukemia (JMML is a rare hematologic malignancy in children. Its presentations include anemia, thrombocytopenia, monocytosis, skin rash, marked hepatomegaly, and/or splenomegaly. Fever and respiratory involvement are common. Here, we report a case of a premature neonate with initial symptoms of respiratory distress. She gradually developed clinical manifestations of JMML that mimicked neonatal sepsis. Three weeks after birth, JMML was diagnosed. This is the first reported case of JMML presenting in a premature infant in Taiwan.

  9. A Case of Hidroacanthoma Simplex Mimicking Bowen s Disease

    Directory of Open Access Journals (Sweden)

    Pinar Ozuguz

    2013-10-01

    Full Text Available Hidroacanthoma simplex is a rare benign tumor that originates from eccrine sweet gland ducts. The lesions are characterized by slowly-growing, flat or slightly elevated, skin-colored, brown or erythematous, verrucous papules or plaques. Clinically, plaques may resemble seborrheic keratosis, basal cell carcinoma and Bowen%u2019s disease. Here, we present a case of atypically localized hidroacanthoma simplex mimicking Bowen%u2019s disease.

  10. A case of gallbladder mass: Malakoplakia (The tumor mimicker

    Directory of Open Access Journals (Sweden)

    Kanwaljeet Singh

    2017-01-01

    Full Text Available Diagnosis of malakoplakia presenting as gall bladder mass is a diagnostic dilemma faced by pathologists, radiologists, and surgeons. Malakoplakia is a rare inflammatory disorder and tumor mimicker usually occurring in the urinary tract, may occasionally be found in gall bladder. Here, we present a rare case, presenting as gall bladder mass in a known case of gallstone disease, clinically suspected as carcinoma and later turned out to be malakoplakia in gall bladder.

  11. Transvesicoscopic Repair of Vesicovaginal Fistula

    Directory of Open Access Journals (Sweden)

    R. B. Nerli

    2010-01-01

    Full Text Available Introduction. Vesicovaginal fistula has been a social and surgical problem for centuries. Many surgical techniques have been developed to correct this abnormality, including transabdominal, transvaginal, and endoscopic approaches. The best approach is probably the one with which the surgeon feels most experienced and comfortable. Laparoscopy has become increasingly popular in urology, reducing the invasiveness of treatment and shortening the period of convalescence. We report our results of transvesicoscopic approach for VVF repair. Materials and Methods. Patients with VVF were offered repair using the transvesicoscopic route. With the patient under general anaesthesia and in modified lithotomy position cystoscopy was performed with gas insufflation. Under cystoscopic guidance the bladder was fixed to anterior abdominal wall and ports inserted into the bladder. The fistula was repaired under endoscopic vision. Results. Four women, who had VVF following abdominal hysterectomy, underwent this procedure. The operating time ranged from 175 to 235 minutes. There was minimal bleeding. Post operative complications included ileus in one and fever in another. No recurrence of VVF was noted in any patient. Conclusions. Transvesicoscopic repair of VVF is feasible, safe, and results in lower morbidity and quicker recovery time.

  12. [Secondary aorto-enteric fistula].

    Science.gov (United States)

    Giordanengo, F; Boneschi, M; Miani, S; Erba, M; Beretta, L

    1998-01-01

    Aortic graft fistula is a rare and life-threatening complication after aortic reconstruction. The incidence ranges from 0.5 to 4%, and even if the diagnosis and treatment is appropriate, the results of surgery are poor: mortality rate ranges from 14 to 70%. The optimal method of treatment is still controversial; prosthetic removal and extra-anatomic bypass has been advocated as the standard method, but more recently, because the high mortality rate associated with this procedure, some have prompted to recommend in situ aortic graft replacement as a more successful treatment. Personal experience with incidence (0.7%) outcome and mortality (57%) in 7 patients treated over a period of 6 years (1990-1996) is reported. Results from this group are compared with another group (6 patients) previously treated (1975-1982) for the same pathology. Our results after 10 years, show the same incidence (0.7 vs 0.6%) and an elevated and unchanged mortality (57 vs 66%). Better results in the management of aorto-enteric fistulas could be achieved with the removal of infected infrarenal aortic prosthetic grafts and in situ homografts replacement.

  13. Acute abducens nerve palsy as a presenting feature in carotid-cavernous fistula in a 6-year-old girl [

    Directory of Open Access Journals (Sweden)

    Pawar, Neelam

    2013-04-01

    Full Text Available [english] Carotid-cavernous fistulas (CCF are abnormal communications between the internal carotid artery and the cavernous sinus. Traumatic carotid-cavernous fistulae are rare potential complications of craniofacial trauma. Typical findings of CCF are proptosis, chemosis, headache, oculomotor or abducens nerve palsy, trigeminal pain and pulsating bruit over the temporal skull and the bulb.CCF are reported very rarely in childhood. This report describes the clinical and radiological findings of a pediatric patient presented with CCF.

  14. Parotid fistula secondary to suppurative parotitis in a 13-year-old girl: a case report

    Directory of Open Access Journals (Sweden)

    Mudhol Ramesh S

    2010-08-01

    Full Text Available Abstract Introduction The most common cause of parotid fistula is trauma, followed by malignancy, operative complications (parotidectomy or rhytidectomy and infection. Acute suppurative parotitis can rarely produce parotid fistula. There are various treatment options available, however it is necessary to standardize the treatment according to the duration of history and the patient's general condition. Case report A 13-year-old Indo-Caucasian girl presented to us with a two-year history of clear watery discharge from a wound just above and behind the angle of her right jaw. A diagnosis of salivary (parotid fistula was made based on clinical examination and investigations. The parotid fistula was successfully managed. Conclusion Parotid fistula secondary to suppurative parotitis is rare and difficult to manage successfully. Meticulous dissection, complete excision of the fistulous tract with closure of the parotid fascia and layered closure of the incision followed by application of a post-operative pressure bandage, anticholinergic agents and antibiotics contribute significantly to the successful management of this difficult clinical condition.

  15. STUDY OF FACTORS INFLUENCING THE NONCLOSURE OF BRONCHOPLEURAL FISTULA IN PATIENTS WITH SPONTANEOUS PNEUMOTHORAX

    Directory of Open Access Journals (Sweden)

    Ejaj Ahmed

    2015-11-01

    Full Text Available A pneumothorax is an abnormal collection of air or gas in the pleural space. Pneumothoraces are essentially of two types, spontaneous and tramautic pneumothoraces, based on whether the lung is diseased or not. Spontaneous pneumothoraces are further of two types- primary and secondary spontaneous pneumothoraces. A subcategory of traumatic pneumothorax is iatrogenic pneumothorax. Hydro-pneumothorax, pyo-pneumothorax and hemo-pneumothorax result from collection of clear fluid, pus and blood respectively in the pleural cavity. A bronchopleural fistula is a communication between the pleural space and the lung. MATERIAL AND METHODS A prospective study of 54 cases of spontaneous pneumothorax with bronchopleural fistula, which were admitted in Department of Pulmonary Medicine, SVRRGGH, Tirupathi, over a period of 1 year from July 2014 to July 2015 was undertaken. Patients with pneumothorax were identified by clinical and radiological examination, where it was necessary for CT chest to be performed. Depending on the chest x ray and CT chest findings, the patients were subjected to tube thoracotomy. Patients who had persistent bronchopleural fistula after 15 days had to be referred to the CT surgeon for decortication or pleurectomy. For all those whose bronchopleural fistula closed by itself, the intercostal tube was removed at the earliest. After completion of the study, the findings and results were analysed and compared with those of the previous studies. RESULTS In the study period, out of 120 pneumothorax patients 54 patients with bronchopleural fistula were diagnosed. In 34 of the 54 patients, that is in 63% the bronchopleural fistula healed spontaneously in 2 weeks’ time. In 16 of the patients even after 15 days of intercostal tube drainage, the bronchopleural fistula did not heal and they had to be referred to the cardiothoracic surgeon for decortication/pleurectomy; 46 of the 54(85.2% were males and 8(14.8% were females; 45 patients (83% had TB

  16. Post-traumatic recto-spinal fistula

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-01-01

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

  17. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

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    C. Tran

    2014-01-01

    Full Text Available We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula.

  18. Diagnosis and management of colovesical fistulas.

    Science.gov (United States)

    Shatila, A H; Ackerman, N B

    1976-07-01

    Diagnosis and management may present difficult problems in patients with colovesical fistulas. Symptoms in the urinary tract are most common, and cystoscopy, and cystography are the most valuable diagnostic procedures. It may not always be possible to demonstrate the fistula by diagnostic tests, and a high index of suspicion should be maintained in patients with inflammatory or neoplastic disease of the rectosigmoid area or bladder with recurrent cystitis. Definitive treatment should include resection of the fistula and diseased segment of the intestine. Both one stage and multistage procedures have their place in the treatment of this condition. There are specific criteria for success for a one stage procedure.

  19. Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study.

    Science.gov (United States)

    Ratto, Carlo; Litta, Francesco; Parello, Angelo; Zaccone, Giuseppe; Donisi, Lorenza; De Simone, Veronica

    2013-02-01

    Fistulotomy plus primary sphincteroplasty for complex anal fistulas is regarded with scepticism, mainly because of the risk of postoperative incontinence. The aim of this study was to evaluate safety and effectiveness of this technique in medium-term follow up and to identify potential predictive factors of success and postoperative continence impairment. This was a prospective observational study conducted at a tertiary care university hospital in Italy. A total of 72 patients with complex anal fistula of cryptoglandular origin underwent fistulotomy and end-to-end primary sphincteroplasty; patients were followed up at 1 week, 1 and 3 months, 1 year, and were invited to participate in a recent follow-up session. Success regarding healing of the fistula was assessed with 3-dimensional endoanal ultrasound and clinical evaluation. Continence status was evaluated using the Cleveland Clinic fecal incontinence score and by patient report of post-defecation soiling. Of the 72 patients, 12 (16.7%) had recurrent fistulas and 29 patients (40.3%) had undergone seton drainage before definitive surgery. At a mean follow-up of 29.4 (SD, 23.7; range, 6-91 months, the success rate of treatment was 95.8% (69 patients). Fistula recurrence was observed in 3 patients at a mean of 17.3 (SD, 10.3; range, 6-26) months of follow-up. Cleveland Clinic fecal incontinence score did not change significantly (p = 0.16). Eight patients (11.6% of those with no baseline incontinence) reported de novo postdefecation soiling. None of the investigated factors was a significant predictor of success. Patients with recurrent fistula after previous fistula surgery had a 5-fold increased probability of having impaired continence (relative risk = 5.00, 95% CI, 1.45-17.27, p = 0.02). The study was limited by potential single-institution bias, lack of anorectal manometry, and lack of quality of life assessment. Fistulotomy with end-to-end primary sphincteroplasty can be considered to be an effective

  20. Efficacy of an anal fistula plug for fistulas-in-Ano in children.

    Science.gov (United States)

    Kouchi, Katsunori; Takenouchi, Ayao; Matsuoka, Aki; Yabe, Kiyoaki; Korai, Mashahiro; Nakata, Chikako

    2017-08-01

    In children, perianal abscesses have a good prognosis and often heal with age. However, some perianal abscesses are refractory to treatment and remain as fistulas-in-Ano. Treatment with a Surgisis Anal Fistula Plug® has been reported as a new method of treatment for fistulas. In adults, the plug has been reported to cause little pain and have a high cure rate, but there have been no reported cases of its use in children. This study was designed to analyze the efficacy of the plug for closure of refractory fistulas in children. Since the plug has not been approved as a medical device in Japan, application for its use was submitted to the ethics committee of our university, and approval was granted, marking the first use of the plug in Japan. We classified refractory fistulas as those treated for 6months or longer and remaining unhealed, even after 1year of age, despite continued conservative treatment. The plug was used in 11 refractory fistulas in 8 children. Eight of 11 fistulas (72.7%) were successfully treated. Three fistulas recurred, and fistulectomies were performed. No sequelae were observed after AFP treatment. The plug was effective even for closure of refractory fistulas without sequelae in children. Treatment Study, Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach

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    Rakesh Kapoor

    2007-01-01

    Full Text Available Purpose: We aim to present our experience for the repair of vesicovaginal fistula (VVF with special reference to surgical approach. Materials and Methods: From January 1999 to June 2005, 52 VVF patients with mean age of 32 years underwent operative treatment. Fistulas were divided into two groups, simple and complex, depending on site, size, etiology and associated anomalies. Simple VVFs were approached through the vaginal route and complex VVFs via the transabdominal route. Patients were evaluated at two to three weeks initially, three-monthly twice and later depending on symptoms. Results: Thirty-two (61.5% had simple fistulas and 20 (38.5% complex fistulas. The most common etiology was obstetric trauma in 31 (59.6% patients, while the second most common cause was post hysterectomy VVF. Thirty-two (61.5% patients were managed by transvaginal route, of which 17 had supratrigonal and 15 trigonal fistulas. Twenty (38.5% patients with complex fistulas were managed by abdominal route. The mean blood loss, postoperative pain and mean hospital stay were shorter in transvaginal repair. Eleven (21.2% patients required ancillary procedures for various other associated anomalies at the time of fistula repair. Three patients failed repair giving a success rate of 94.2%. At a mean follow-up of three years 48 women were sexually active, of these 10 (19.2% complained of mild to moderate dyspareunia. Conclusion: Most of the simple fistulas irrespective their locations are easily accessible transvaginally while in complex fistulas we recommend the transabdominal approach. Depending on the clinical context both the approaches achieved comparable success rates.

  2. Risk Factors for Esophageal Fistula Associated With Chemoradiotherapy for Locally Advanced Unresectable Esophageal Cancer: A Supplementary Analysis of JCOG0303.

    Science.gov (United States)

    Tsushima, Takahiro; Mizusawa, Junki; Sudo, Kazuki; Honma, Yoshitaka; Kato, Ken; Igaki, Hiroyasu; Tsubosa, Yasuhiro; Shinoda, Masayuki; Nakamura, Kenichi; Fukuda, Haruhiko; Kitagawa, Yuko

    2016-05-01

    Esophageal fistula is a critical adverse event in patients treated with chemoradiotherapy (CRT) for locally advanced esophageal cancer. However, risk factors associated with esophageal fistula formation in patients receiving CRT have not yet been elucidated.We retrospectively analyzed data obtained from 140 patients who were enrolled in a phase II/III trial comparing low-dose cisplatin with standard-dose cisplatin administered in combination with 5-flurouracil and concomitant radiotherapy. Inclusion criteria were performance status (PS) 0 to 2 and histologically proven thoracic esophageal cancer clinically diagnosed as T4 and/or unresectable lymph node metastasis for which definitive CRT was applicable. Risk factors for esophageal fistula were examined with univariate analysis using Fisher exact test and multivariate analysis using logistic regression models.Esophageal fistula was observed in 31 patients (22%). Of these, 6 patients developed fistula during CRT. Median time interval between the date of CRT initiation and that of fistula diagnosis was 100 days (inter quartile range, 45-171). Esophageal stenosis was the only significant risk factor for esophageal fistula formation both in univariate (P = 0.026) and in multivariate analyses (odds ratio, 2.59; 95% confidence interval, 1.13-5.92, P = 0.025). Other clinicopathological factors, namely treatment arm, age, sex, PS, primary tumor location, T stage, lymph node invasion to adjacent organs, blood cell count, albumin level, and body mass index, were not risk factors fistula formation.Esophageal stenosis was a significant risk factor for esophageal fistula formation in patients treated with CRT for unresectable locally advanced thoracic esophageal squamous cell carcinoma.

  3. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions

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    Schmidt, S.; Meuwly, J.Y.; Meuli, R.; Schnyder, P.; Denys, A. [Universitaire Vaudois - CHUV, Service de radiodiagnostic et radiologie interventionnelle, Centre Hospitalier, Lausanne (Switzerland); Chevallier, P. [Hopital Archet II, Imagerie Medicale, Nice (France); Bessoud, B. [Hopital Kremlin-Bicetre, Radiologie Generale, Kremlin-Bicetre (France); Felley, C. [University Hospital, CHUV, Service de Gastroenterologie, Lausanne (Switzerland)

    2007-11-15

    The diagnostic performance of magnetic resonance imaging (MRI) for detection of intestinal fistulas, other than perianal, in patients with known complicated inflammatory bowel conditions (CIBC) was investigated. Our study group consisted of 20 patients (12 women, mean age 43 years) with CIBC, including Crohn's disease (n=13), colonic diverticulitis (n=3), colitis after radiotherapy (n=3) and of postoperative origin (n=1). Eleven surgically proven enteral fistulas were known in ten (50%) of these patients, being of enterovesical (n=3), enterocolic (n=2), enteroenteral (n=2), rectovaginal (n=2), rectovaginovesical (n=1) and of entercutaneous (n=1) localisation. The other ten patients (50%), used as the control group, showed MR features of CIBC, although without any fistulous tract. Multiplanar T1- and T2-weighted sequences had been performed, including gadolinium-enhanced acquisition with fat saturation (1.5 T). MR findings were independently blindly and retrospectively reviewed by three radiologists for the presence and etiology of any fistula, as well as visualization and characterization of the fistulous tract. Results were compared with surgical findings (n=16) and clinical evolution (n=4). Interobserver agreement was calculated. Interobserver agreement kappa for fistula detection was 0.71. Overall sensitivity, specificity and accuracy for fistula detection were 78.6%, 75% and 77.2%, respectively. Sensitivity for fistula characterization was 80.6%, with visualization of the fistulous tract in all cases, whereby T1-weighted gadolinium-enhanced fat-saturated images were considered the most useful sequences. Gadolinium-enhanced MRI is a reliable and reproducible tool for detection of enteral fistulas secondary to inflammatory conditions. (orig.)

  4. CT vaginography: a new CT technique for imaging of upper and middle vaginal fistulas.

    Science.gov (United States)

    Botsikas, Diomidis; Pluchino, Nicola; Kalovidouri, Anastasia; Platon, Alexandra; Montet, Xavier; Dallenbach, Patrick; Poletti, Pierre-Alexandre

    2017-05-01

    Different types of vaginal fistulas is a relatively uncommon condition in the Western world but very frequent in developing countries. In the past, conventional vaginography was the radiological examination of choice for exploring this condition. CT and MRI are now both used for this purpose. Our objective was to test the feasibility and to explore the potential role of a new CT imaging technique implementing vaginal introitus obstruction and opacification of the vagina with iodine contrast agent, to show patency of a fistula. We describe the technical protocol of CT-vaginography as performed in Geneva University Hospitals, including vaginal catheterization with a Foley catheter and obstruction of the introitus by inflating the balloon of the catheter. We also report three cases of patients with suspected vaginal fistula who underwent CT-vaginography. The examinations were technically successful. In one patient, it revealed the presence of fistulous pathways from the vaginal fornix along the bilateral infected surgical prostheses. In a second patient, it showed a fistula between the vagina and the necrotic cavity of a recurrent cervical cancer. In a third patient, it proved the absence of a suspected vaginal fistula. CT-vaginography is a technically feasible CT protocol that provides anatomical and functional information on clinically suspected vaginal fistulas. Advances in knowledge: After the abandon of conventional vaginography in the era of transaxial imaging, the current modalities of imaging vaginal fistulas provide excellent anatomical detail but less functional information concerning the permeability of a vaginal fistulous pathway. We propose the use of CT-vaginography, a technical protocol that we describe in detail.

  5. Vesico-vaginal fistula post cold cup bladder biopsy: mini review

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    Abigail Mawhinney

    2010-09-01

    Full Text Available Abigail Mawhinney1,*, Ammar Hameed2,*, Ali Thwaini1, Colin Mulholland11Belfast City Hospital, Urology Department, Belfast, Northern Ireland, UK; 2Addenbrookes University Hospital, Urology Department, Cambridge, UK*These authors contributed equally to this paperIntroduction: We report a case of a vesico-vaginal fistula (VVF post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade.Methods and results: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment.Conclusion: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.Keywords: vesico-vaginal fistula, vaginal fistula, surgical repair of vaginal fistula, management of vaginal fistula

  6. 肠外瘘患者的护理%Enterocutaneous Fistula Patient Care

    Institute of Scientific and Technical Information of China (English)

    郭梅娟; 韩玲; 张茜

    2014-01-01

    目的:通过对肠外瘘患者的护理,提高肠外瘘患者的治愈率。方法通过心理护理、病情观察、持续引流管负压冲洗吸引的护理、营养支持、基础护理等方面进行护理。结果通过采取一系列的临床护理措施,患者病情得到改善,提高了治愈率。结论肠外瘘是腹部外科常见的一种严重并发症,在肠外瘘成功治疗之中,护理工作极其重要。作者认为肠外瘘护理有较强的专科护理特点,细致的护理计划及措施,成功的护理是肠外瘘治疗不可缺少的重要部分,对肠瘘患者的起积极作用。%Objective through observation and nursing of intestinal fistula patients, improve the cure rate of intestinal fistula patients. Methods: the psychological nursing, disease observation, continuous drainage tube care, nutritional support, basic nursing,negative pressure irrigation and suction for nursing. Results: through clinical nursing measures, patient's condition improved, improved the cure rate. Conclusion: intestinal fistula is a serious complication of abdominal surgery incommon, intestinal fistula successful y treated, nursing work extremely important. The author thinks enterocutaneous fistula care nursing features strong, nursing plan and measures detailed, successful nursing is an important part of intestinal fistula treatment of essential, to play an active role in intestinal fistula patients.

  7. Double spinal dural arteriovenous fistulas: case report and review of the literature

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    Krings, T. [Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Department of Neurosurgery, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Mull, M.; Thron, A. [Department of Neuroradiology, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany); Reinges, M.H.T. [Department of Neurosurgery, University Hospital of the University of Technology, Aachen, Pauwelsstrasse 30, 52057, Aachen (Germany)

    2004-03-01

    Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation. It mainly affects men after the fifth decade and is usually an acquired lesion with an unknown etiology. We report on a patient with the unusual finding of two separate SDAVFs at the level of L1 on the right and L2 on the left side. Initial selective spinal digital subtraction angiography (DSA) was terminated with demonstration of a SDAVF at the level of L1 but incomplete demonstration of all segmental arteries. Due to a recurrent deterioration of the patient's neurological status, and persistent pathological vessels seen on MRI, a second spinal DSA was performed 6 years later, demonstrating the second fistula at the level of L2 on the left side with a separate venous drainage pattern. A retrospective analysis of the angiographic films suggested that both fistulas had already been present 6 years previously. This conclusion is justified because of a transient and faint opacification of the left L2 fistula demonstrated on the films after injection of the right L2 segmental artery. We conclude that in the case of incomplete angiography and persistent clinical and MR findings not only reopening of the treated SDAVF has to be taken into account but also the existence of a second fistula. Since this is the first case of a double fistula in our series of 129 SDAVFs, and given the few reported cases of double SDAVFs, we do not think that completion of selective spinal DSA has to be postulated routinely after a fistula has been found. However, repeat angiography should be performed in patients who continue to deteriorate, fail to improve with persisting MRI pathologies, or demonstrate delayed deterioration after a period of improvement. (orig.)

  8. Endovascular and surgical treatment of spinal dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Andres, Robert H. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Barth, Alain [University of Berne (Switzerland). Department of Neurosurgery; Medical University of Graz, Department of Neurosurgery, Graz (Austria); University of Berne (Switzerland). Inselspital; Guzman, Raphael [University of Berne (Switzerland). Department of Neurosurgery; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA (United States); University of Berne (Switzerland). Inselspital; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard [University of Berne (Switzerland). Department of Diagnostic and Interventional Neuroradiology; University of Berne (Switzerland). Inselspital; Seiler, Rolf W.; Widmer, Hans R. [University of Berne (Switzerland). Department of Neurosurgery; University of Berne (Switzerland). Inselspital

    2008-10-15

    The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

  9. Colovesical Fistula After Renal Transplantation: Case Report.

    Science.gov (United States)

    Imafuku, A; Tanaka, K; Marui, Y; Sawa, N; Ubara, Y; Takaichi, K; Ishii, Y; Tomikawa, S

    2015-09-01

    Colovesical fistula is a relatively rare condition that is primarily related to diverticular disease. There are few reports of colovesical fistula after renal transplantation. We report of a 53-year-old man who was diagnosed with colovesical fistula after recurrent urinary tract infection, 5 months after undergoing cadaveric renal transplantation. Laparoscopic partial resection of the sigmoid colon with the use of the Hartmann procedure was performed. Six months after that surgery, there was no evidence of recurrent urinary tract infection and the patient's renal graft function was preserved. Physicians should keep colovesical fistula in mind as a cause of recurrent urinary tract infection in renal transplant recipients, especially in those with a history of diverticular disease.

  10. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

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    Dorota Overbeck-Zubrzycka

    2011-01-01

    Full Text Available Context Pancreaticobronchial fistula is a rare complication of severe pancreatitis. Various diagnostic methods have been described previously. Case report The presentation, diagnostic methods, management and 5-year follow-up of a 40-year-old woman with severe gallstone induced pancreatitis complicated by a pancreaticobronchial fistula were reviewed. Diagnosis was made on the endotracheal intubation when amylase rich-fluid was drained via the tube and confirmed by CT scanning. Successful management was achieved by an open pancreatic necrosectomy, during which air bubbles were seen emerging from the pancreatic collection which supported the diagnosis of the fistula. Five-year follow-up did not reveal any complications. Conclusions Pancreaticobronchial fistulas have the potential to cause severe respiratory complications and mortality. Awareness of this condition is important in the treatment of complicated cases of pancreatitis.

  11. Surgical Management of Fistula-in-ano Among Patients With Crohn's Disease: Analysis of Outcomes After Fistulotomy or Seton Placement-Single-Center Experience.

    Science.gov (United States)

    Papaconstantinou, I; Kontis, E; Koutoulidis, V; Mantzaris, G; Vassiliou, I

    2017-09-01

    Fistula-in-ano is a common problem among patients with Crohn's disease and carries significant morbidity. We aimed to study the outcomes of surgical treatment of fistula-in-ano after fistulotomy or seton placement in patients with perianal fistulizing Crohn's disease. A retrospective observational study of 59 patients diagnosed with Crohn's disease, who were treated surgically for fistula-in-ano between 2010 and 2014 in our department. The assessment of disease complexity included a detailed physical examination, magnetic resonance imaging of the rectum, and examination under anesthesia. Outcomes for analysis included wound healing rate and postoperative incontinence. High transsphincteric fistula was found in 44% of the patients, while mid or low transsphincteric fistulas were found in 51%. Three women (5%) had a rectovaginal fistula. All patients with high transsphincteric fistulas were treated with loose seton placement. Patients with mid- or low-level transsphincteric fistula were offered either fistulotomy or seton placement based on the clinical evaluation. The mean follow-up duration was 1.6 ± 1.1 years. In terms of recurrence, one patient treated with seton placement presented with recurrence 6 months after seton removal and one patient with fistulotomy failed to achieve wound healing. Minor incontinence was found in six patients treated with fistulotomy and in three patients treated with seton placement; however, this difference was not significant (chi-square = 1.723, df = 1, Monte-Carlo: p = 0.273). Fistulotomy could achieve good results in terms of wound healing and incontinence in strictly selected patients with Crohn's disease suffering from low-lying transsphincteric fistulae. For more high-lying or complicated fistulae, seton placement is more appropriate. For high transsphincteric fistulae, the only option is placement of loose seton.

  12. Prospective multicenter study of a synthetic bioabsorbable anal fistula plug to treat cryptoglandular transsphincteric anal fistulas.

    Science.gov (United States)

    Stamos, Michael J; Snyder, Michael; Robb, Bruce W; Ky, Alex; Singer, Marc; Stewart, David B; Sonoda, Toyooki; Abcarian, Herand

    2015-03-01

    Although interest in sphincter-sparing treatments for anal fistulas is increasing, few large prospective studies of these approaches have been conducted. The study assessed outcomes after implantation of a synthetic bioabsorbable anal fistula plug. A prospective, multicenter investigation was performed. The study was conducted at 11 colon and rectal centers. Ninety-three patients (71 men; mean age, 47 years) with complex cryptoglandular transsphincteric anal fistulas were enrolled. Exclusion criteria included Crohn's disease, an active infection, a multitract fistula, and an immunocompromised status. Draining setons were used at the surgeon's discretion. Patients had follow-up evaluations at 1, 3, 6, and 12 months postoperatively. The primary end point was healing of the fistula, defined as drainage cessation plus closure of the external opening, at 6 and 12 months. Secondary end points were fecal continence, duration of drainage from the fistula, pain, and adverse events during follow-up. Thirteen patients were lost to follow-up and 21 were withdrawn, primarily to undergo an alternative treatment. The fistula healing rates at 6 and 12 months were 41% (95% CI, 30%-52%; total n = 74) and 49% (95% CI, 38%-61%; total n = 73). Half the patients in whom a previous treatment failed had healing. By 6 months, the mean Wexner score had improved significantly (p = 0.0003). By 12 months, 93% of patients had no or minimal pain. Adverse events included 11 infections/abscesses, 2 new fistulas, and 8 total and 5 partial plug extrusions. The fistula healed in 3 patients with a partial extrusion. The study was nonrandomized and had relatively high rates of loss to follow-up. Implantation of a synthetic bioabsorbable fistula plug is a reasonably efficacious treatment for complex transsphincteric anal fistulas, especially given the simplicity and low morbidity of the procedure.

  13. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results.

    Science.gov (United States)

    Sirany, Anne-Marie E; Nygaard, Rachel M; Morken, Jeffrey J

    2015-06-01

    The ligation of the intersphincteric fistula tract procedure, a sphincter-preserving technique, aims to obtain complete, durable healing, while preserving fecal continence in the treatment of transsphincteric anal fistulas. This was a systematic review to evaluate the outcomes of the originally described (classic) ligation of the intersphincteric fistula tract procedure and the identified technical variations of the procedure. PubMed, Web of Science, and the archive of Diseases of the Colon & Rectum were searched with the terms "ligation of intersphincteric fistula" and "ligation of intersphincteric fistula tract." Original, English-language studies reporting the primary healing rate for each technical variation of the ligation of the intersphincteric fistula tract procedure were included. Studies were excluded when the technique used was unclear or when primary healing rate was reported in a pooled manner including outcomes from multiple technical variations of the ligation of the intersphincteric fistula tract procedure. Outcomes associated with all of the technical variations of the ligation of the intersphincteric fistula tract procedure were investigated. The main outcome measured was primary healing rate. Secondary outcome measures included time to healing, changes in continence, and risk factors for failure. In all, 26 studies met criteria for review, including 1 randomized controlled trial and 25 cohort/case series. Seven technical variations of the ligation of the intersphincteric fistula tract procedure were identified and classified according to the surgical technique. Primary healing rates ranged from 47% to 95%. The levels of evidence available in the published works are relatively low, as indicated by the Oxford Center for Evidence-Based Medicine evidence levels. The ligation of the intersphincteric fistula tract procedure is a promising treatment option for transsphincteric fistulas, with reasonable success rates and minimal impact on continence. The

  14. Initial experience of treating anal fistula with the Surgisis anal fistula plug.

    Science.gov (United States)

    Chan, S; McCullough, J; Schizas, A; Vasas, P; Engledow, A; Windsor, A; Williams, A; Cohen, C R

    2012-06-01

    Complex anal fistulas remain a challenge for the colorectal surgeon. The anal fistula plug has been developed as a simple treatment for fistula-in-ano. We present and evaluate our experience with the Surgisis anal fistula plug from two centres. Data were prospectively collected and analysed from consecutive patients undergoing insertion of a fistula plug between January 2007 and October 2009. Fistula plugs were inserted according to a standard protocol. Data collected included patient demographics, fistula characteristics and postoperative outcome. Forty-four patients underwent insertion of 62 plugs (27 males, mean age 45.6 years), 25 of whom had prior fistula surgery. Mean follow-up was 10.5 months Twenty-two patients (50%) had successful healing following the insertion of plug with an overall success rate of 23 out of 62 plugs inserted (35%). Nineteen out of 29 patients healed following first-time plug placement, whereas repeated plug placement was successful in 3 out of 15 patients (20%; p = 0.0097). There was a statistically significant difference in the healing rate between patients who had one or less operations prior to plug insertion (i.e. simple fistulas) compared with patients who needed multiple operations (18 out of 24 patients vs. 4 out of 20 patients; p = 0.0007). Success of treatment with the Surgisis anal fistula plug relies on the eradication of sepsis prior to plug placement. Plugs inserted into simple tracts have a higher success rate, and recurrent insertion of plugs following previous plug failure is less likely to be successful. We suggest the fistula plug should remain a first-line treatment for primary surgery and simple tracts.

  15. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano.

    Science.gov (United States)

    Han, J G; Yi, B Q; Wang, Z J; Zheng, Y; Cui, J J; Yu, X Q; Zhao, B C; Yang, X Q

    2013-05-01

    Ligation of the intersphincteric fistula tract and reinforcement with a bioprosthetic graft are two recently reported procedures that have shown promise in the treatment of anal fistula. This study was undertaken to validate combining ligation of the intersphincteric fistula tract plus bioprosthetic anal fistula plug and report our preliminary results and experience. Twenty-one patients with transsphincteric anal fistula were treated with ligation of the intersphincteric fistula tract plus concurrent bioprosthetic plug of the anal fistula. We evaluated healing time, fistula closure rate and postoperative anal function according to the Wexner continence score. No mortality or major complications were observed. Median operative time was 20 (range 15-40) min. After a median follow-up of 14 (range 12-15) months, the overall success rate was 95% (20/21), with a median healing time of 2 (range 2-3) weeks for external anal fistula opening and 4 (range 3-7) weeks for intersphincteric groove incision. Only 1 (5%) patient reported rare incontinence for gas postoperatively (Wexner score 1). Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug is an easy, safe, effective and useful alternative in the management of anal fistula. Further randomized controlled studies are necessary to better evaluate long-term results. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  16. 胃造口双管法治疗食管手术后吻合瘘的疗效观察%Clinical Observation of Gastrostomize with Double Vessel for Postoperative Fistula in the Anastomotic Stoma of Esophagogastrostomy

    Institute of Scientific and Technical Information of China (English)

    曹恒昌; 范昭; 王永剑; 乌达

    2009-01-01

    Objective To investigate the improvement in therapies of postoperative fistula in the anastomotic stoma of carcinoma of esophagus or gastric cardia.Methods 27cases of carcinoma of esophagus or gastric cardia,which were found postoperative fistula in the anastomotic stoma,received gastrostomize with double vessel by which gastrointestinal decompression and intestinal tract nutritional support were taken.Results 25 patients fully recovered to leave hospital.while 2 cases died of severe septic shock and multiple organ failure.Conclusion Therapies of gastrointestinal decompression and intestinal tract nutritional support by gastrostomize with double vessel could efficiently promote healing of fistula in the anastomotic stoma,degrade the death rate notably.%目的 探讨食管癌贲门癌术后吻合口瘘的治疗方法 的改进.方法 对食管癌贲门癌手术后出现吻合口瘘的27例患者,分别于确诊的当日或第一日行胃造口术,置入双管,行胃肠减压和肠道内营养支持治疗.结果 25例患者痊愈出院2例患者因重度感染性休克,多器官衰竭死亡.结论 经胃双管法的胃肠减压和肠内营养可有效地促进吻合口瘘的愈合,显著降低食管手术吻合口瘘的死亡率.

  17. Bronchobiliary Fistula Evaluated with Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-08-01

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

  18. Aortoenteric Fistula Assocaited with Acute Myocardial Infarcation

    OpenAIRE

    Fingerote, Robert J.; Alan BR Thomson

    1990-01-01

    A 64-year-old male with a prior abdominal aortic graft for lower limb ischemia presented with melena and myocardial infarction. Despite aggressive investigation, an aortoenteric fistula was not diagnosed until after massive gastrointestinal hemorrhage. The patient's myocardial infarction may have heen precipitated by hypotension induced by hemorrhage through the aortoenteric fistula. Patients with prior abdominal aortic graft surgery presenting with gastrointestinal bleeding, abdominal pain o...

  19. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    OpenAIRE

    2014-01-01

    We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection ...

  20. Psychological stress in patients with anal fistula.

    Science.gov (United States)

    Cioli, V M; Gagliardi, G; Pescatori, M

    2015-08-01

    Psychological stress is known to affect the immunologic system and the inflammatory response. The aim of this study was to assess the presence of psychological stress, anxiety, and depression in patients with anal fistula. Consecutive patients with anal fistula, hemorrhoids, and normal volunteers were studied prospectively. Stressful life events were recorded and subjects were asked to complete the state-trait anxiety inventory (STAI), a depression scale, and three different reactive graphic tests (RGT). Seventy-eight fistula patients, 73 patients with grade III-IV hemorrhoids, and 37 normal volunteers were enrolled. Of the fistula patients, 65 (83 %) reported one or more stressful events in the year prior to diagnosis, compared to 16 (22 %) of the hemorrhoid patients (P = 0.001). There were no significant differences in the percentage of subjects with abnormal trait anxiety (i.e., proneness for anxiety) and depression scores between fistula patients, hemorrhoid patients, and controls. Fistula patients had significantly higher (i.e., better) scores compared to hemorrhoid patients in two of three RGT and significantly lower (i.e., worse) scores in all three RGT compared to healthy volunteers. Of 37 patients followed up for a median of 28 months (range 19-41 months) after surgery, 8 (21.6 %) had persistent or recurrent sepsis. There was no significant difference in depression, STAI, and RGT scores between patients with sepsis and patients whose fistula healed. Our results suggest that an altered emotional state plays an important role in the pathogenesis of anal fistula and underline the importance of psychological screening in patients with anorectal disorders.