Sample records for high-output intestinal fistulas

  1. Systematic review: pharmacotherapy for high-output enterostomies or enteral fistulas

    NARCIS (Netherlands)

    de Vries, F. E. E.; Reeskamp, L. F.; van Ruler, O.; van Arum, I.; Kuin, W.; Dijksta, G.; Haveman, J. W.; Boermeester, M. A.; Serlie, M. J.


    High-output enterocutaneous fistula or enterostomies can cause intestinal failure. There is a wide variety of options in medical management of patients with high output. To systematically review the literature on available pharmacotherapy to reduce output and to propose an algorithm for standard of

  2. Systematic review : pharmacotherapy for high-output enterostomies or enteral fistulas

    NARCIS (Netherlands)

    de Vries, F. E. E.; Reeskamp, L. F.; van Ruler, O.; van Arum, I.; Kuin, W.; Dijksta, G.; Haveman, J. W.; Boermeester, M. A.; Serlie, M. J.

    Background: High-output enterocutaneous fistula or enterostomies can cause intestinal failure. There is a wide variety of options in medical management of patients with high output. Aim: To systematically review the literature on available pharmacotherapy to reduce output and to propose an algorithm

  3. Fístula de alto gasto High output fistula

    Directory of Open Access Journals (Sweden)

    Ricardo Almeida Varela


    Full Text Available Se presenta a un paciente de 37 años de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones torácicas y abdominales, con síntomas y signos sugestivos de fracturas costales múltiples, con hemotórax derecho y hemoperitoneo, corroborado imaginológicamente y en la punción abdominal. Se realiza pleurostomía mínima intermedia y laparotomía exploratoria. Se le encuentran lesiones hepáticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, además, deserosamientos en las asas delgadas intestinales y colon. Se realiza hepatorrafia y empaquetamiento hepático. Posteriormente van apareciendo complicaciones, por lo que tiene que ser reintervenido en más de 60 ocasiones. Entre ellas, la aparición de una fístula de alto gasto, que lo llevó a la desnutrición y a la permanencia con el abdomen expuesto durante 7 meses hasta el egreso. Se revisa la literatura correspondiente a estas entidades.A 37 years-old multi-traumatized male patient went to our emergency service. He had many injures in the thorax and the abdomen, together with symptoms and signs suggestive of multiple costal fractures, with right hemothorax and hemoperitoneum, all of which was confirmed by imaging techniques and by abdominal puncture. Minimal intermediate pleurostomy and exploratory laparoscopy were performed. We found hepatic lesions in the 6th, 5th, 8th and 4th segments, over 3 cm deep; additionally, the loss of serosa from the intestinal ansae and from the colon. Hepatorrhaphy and hepatic packing were also performed. Later on, more complications appeared, so he had to be re-operated more than 60 times. The occurrence of a high output fistula led him to malnutrition and his abdomen remained exposed for 7 months until he was finally discharged from hospital. This paper also presented a literature review on this topic.

  4. High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

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    Uygar Teomete


    Full Text Available Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.

  5. Fistuloclysis Improves Liver Function and Nutritional Status in Patients with High-Output Upper Enteric Fistula

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    Yin Wu


    Full Text Available Background. We aimed to determine the efficacy of fistuloclysis in patients with high-output upper enteric fistula (EF. Methods. Patients were assigned into the fistuloclysis group (n=35, receiving fistuloclysis plus total enteral nutrition (TEN and the control group (n=60, receiving TEN. Laboratory variables were measured during the four-week treatment. Results. At baseline, variables were similar between the two groups. Delta value was defined as the changes from baseline to day 28. Compared with the control group, the fistuloclysis group showed greater improvements in liver function (Delta total bilirubin (TB: 20.3±9.7 in the fistuloclysis group versus 15.6±6.3 in the control group, P=0.040; Delta direct bilirubin (DB: 12.5±3.4 versus 10.0±3.6, P=0.011; Delta alkaline phosphatase (ALP: 98.4±33.5 versus 57.6±20.9, P<0.001; nutritional status (Delta total protein: 21.8±8.7 versus 10.7±2.1, P<0.001; Delta albumin: 11.3±2.5 versus 4.2±1.3, P<0.001. In the fistuloclysis subgroups, biliary fistula patients had the maximum number of variables with the greatest improvements. Conclusions. Fistuloclysis improved hepatic and nutritional parameters in patients with high-output upper EF, particularly in biliary fistula patients.

  6. Traumatic rectourethral fistula repair: A potential application of porcine small intestinal submucosa

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    Shanmugasundaram Rajaian


    Full Text Available Rectourethral fistula is an uncommon but devastating condition. Traumatic rectourethral fistula is still uncommon and repair of traumatic rectourethral fistula involves a complex procedure. Most of the urologists would prefer to repair the fistula through perineal route especially when urethral reconstruction is also required. The repaired ends of the fistula are separated with various interposition flaps and grafts in order to prevent recurrence. Gracilis interposition muscle flap is commonly used. We describe the first case of traumatic rectourethral fistula repair in a 45-year-old man using interposition of a porcine small intestinal submucosal (Biodesign™ (Surgisis ® graft.

  7. Effect of intestinal pressure on fistula closure during vacuum assisted treatment: a computational approach. (United States)

    Cattoni, Diego I; Ravazzola, Constanza; Tüngler, Victoria; Wainstein, Daniel E; Chara, Osvaldo


    Enterocutaneous fistulae, pathological communications between the intestinal lumen and the abdominal skin, can arise as serious complication of gastrointestinal surgery. A current non-surgical treatment for this pathology involves topical application of sub-atmospheric pressure, also known as vacuum assisted closure (VAC). While this technique appears to be promising, surgeons report a number of cases in which its application fails to achieve fistula closure. Here, we evaluate the fistula's physical properties during the vacuum assisted closure process in a computational approach exploring the relevance of intraluminal intestinal pressure. A mathematical model formulated by differential equations based on tissue elasticity properties and principles of fluid mechanics was created and forcing functions were integrated to mimic intestinal pressure dynamics. A software to solve equations and to fit the model to experimentally obtained data was developed. This enabled simulations of vacuum assisted fistula closure under different intestinal pressure. The simulation output indicates conditions, in which fistula closure can or cannot be expected suggesting favoured or impeded healing, respectively. When modifications of intestinal pressure, as observed in fistula accompanying pathologies, are integrated, the outcome of fistula closure changes considerably. Rise of intestinal pressure is associated with delay of fistula closure and temporary fistula radius augmentation, while reduction of intestinal pressure during sub-atmospheric pressure treatment contributes to a faster and direct fistula closure. From the model predictions, we conclude that administration of intestinal pressure decreasing compounds (e.g. butylscopolamine, glucagon) may improve VAC treatment, while intestinal pressure increasing drugs should be avoided. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Managing high-output stomas: module 3 of 3. (United States)

    Slater, Rebecca; Gabe, Simon

    Enterocutaneous fistulae (ECF) and high-output stomas are challenging to manage, owing to the large volume of loss that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. Treatment is complex and based on various situations, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the length of residual intestine contributing as the cause of a high output stoma with the nutritional status of the patient, clinicians have to decide whether parenteral nutrition (PN) or enteral nutrition (EN) should be established. As previously discussed in module 1 and 2 (Gabe, 2013; Gabe and Slater, 2013) the theme of nutritional management and appliance/accessory selection to manage patients with ECF and high output stomas was outlined. The aim of providing an understanding of the nutritional needs and the practicalities of maintaining appliance adherence, and in turn, a reduction in the breakdown of the peri-stomal skin was described. Module 3 aims to provide understanding for the reader that may encounter patients undergoing surgery for the management of their ECF or high-output stoma. Lastly it was felt necessary to discuss the subject of intestinal transplantation. This complex surgical option is not available to all patients with intestinal failure and only undertaken at a couple of recognised centres. The process of referring patients that are deemed suitable for intestinal transplantation will be addressed and what the surgery entails with long-term outcomes and the quality of life for the patient.

  9. 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)


    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.)

  10. [Nutrition therapy in enterocutaneous fistula; from physiology to individualized treatment]. (United States)

    Rodríguez Cano, Ameyalli Mariana


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

  11. Fístula de alto gasto High output fistula


    Ricardo Almeida Varela; Oscar Suárez Echeverría; Oscar Pérez Gutiérrez; Eugenio Selman Houssein; Claudio Cordovés Sánchez; Yossuan García Ruiz


    Se presenta a un paciente de 37 años de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones torácicas y abdominales, con síntomas y signos sugestivos de fracturas costales múltiples, con hemotórax derecho y hemoperitoneo, corroborado imaginológicamente y en la punción abdominal. Se realiza pleurostomía mínima intermedia y laparotomía exploratoria. Se le encuentran lesiones hepáticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, además, deserosamie...

  12. Vitello-intestinal duct fistula--a rare presentation of a patent vitello-intestinal duct: a case report. (United States)

    Ali, Akhtar; Jawale, Atul R; Cama, Jitoko


    Patent Vitello-intestinal Duct (VID) results as of failed obliteration of the fetal omphalocele coelom (herniated loops of intestine in the umbilical cord) during the development of the midgut. We report a case of an infant who presented at 11 months of the age with history of persistent umbilical discharge since birth. The VID was confirmed with a fistulogram using gastrograffin contrast studies and a wedge resection with primary anastomosis. The infant was discharged 5 days post-op without any post-operative complications. This case report highlight a rare cause of umbilical discharge and the surgical intervention required.

  13. Outcome of 132 consecutive reconstructive operations for intestinal fistula--staged operation without primary anastomosis improved outcome in retrospective analysis

    DEFF Research Database (Denmark)

    Runström, B; Hallböök, O; Nyström, P O


    rate was lower after an operation with stoma without anastomosis (6 of 43, 14%) than after an operation with anastomosis (30 of 89, 34%) p = 0.0213. Of the 36 instances with unhealed fistula, 13 (36%) could be ascribed to inadvertent bowel lesions at the reconstructive operation. In addition...

  14. Rectovaginal Fistula (United States)

    ... 2015. Browning A, et al. Characteristics, management, and outcomes of repair of rectovaginal fistula among 1100 consecutive cases of genital tract fistula in Ethiopia. International Journal of Gynecology & Obstetrics. Accessed Aug. 23, 2015. Schwartz DA, et al. ...

  15. High Output Piezo/Triboelectric Hybrid Generator (United States)

    Jung, Woo-Suk; Kang, Min-Gyu; Moon, Hi Gyu; Baek, Seung-Hyub; Yoon, Seok-Jin; Wang, Zhong-Lin; Kim, Sang-Woo; Kang, Chong-Yun


    Recently, piezoelectric and triboelectric energy harvesting devices have been developed to convert mechanical energy into electrical energy. Especially, it is well known that triboelectric nanogenerators have a simple structure and a high output voltage. However, whereas nanostructures improve the output of triboelectric generators, its fabrication process is still complicated and unfavorable in term of the large scale and long-time durability of the device. Here, we demonstrate a hybrid generator which does not use nanostructure but generates much higher output power by a small mechanical force and integrates piezoelectric generator into triboelectric generator, derived from the simultaneous use of piezoelectric and triboelectric mechanisms in one press-and-release cycle. This hybrid generator combines high piezoelectric output current and triboelectric output voltage, which produces peak output voltage of ~370 V, current density of ~12 μ, and average power density of ~4.44 The output power successfully lit up 600 LED bulbs by the application of a 0.2 N mechanical force and it charged a 10 μF capacitor to 10 V in 25 s. Beyond energy harvesting, this work will provide new opportunities for developing a small, built-in power source in self-powered electronics such as mobile electronics.

  16. Enterocutaneous Fistula : Aetiology and Management Outcome in a ...

    African Journals Online (AJOL)

    Background: Enterocutaneous fistula is a major surgical challenge worldwide. It has a potential for serious morbidity and mortality, especially the high output type. Objective: To review the cases of Enterocutaneous fistula that presented to Federal Medical Center, Owerri, over a 6 year period with the aim of determining the ...

  17. Vesicovaginal Fistula

    African Journals Online (AJOL)


    countries of the world due to their excellent obstetric care.21,31-33. Many of the obstetric fistula patients from the northern Nigeria are teenagers. It is noteworthy that early marriage and pregnancy had been known to contribute to development of vesicovaginal fistula since the time of. Avicenna in 950AD5. The youngest age.

  18. High output stomas: ensuring safe discharge from hospital to home. (United States)

    Smith, Lisa

    High-output stomas are a challenge for the patient and all health professionals involved. This article discusses safe discharge home for this patient group, encouraging collaborative working practices between acute care trust and the community services. The authors also discuss the management of a high-output stoma and preparation and education of the patient before discharge home.

  19. Arteriovenous Fistula (United States)

    ... catheterization. An arteriovenous fistula may develop as a complication of a procedure called cardiac catheterization. During cardiac catheterization, a long, thin tube called a catheter is inserted in an artery or vein in ...

  20. Rectovaginal Fistula (United States)

    ... Vaginal discharge Rectovaginal fistula Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

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

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    Ping-Fu Yang


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

  2. Operative treatment of radiation-induced fistulae

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    Balslev, I.; Harling, H.


    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.

  3. Orchestrating the management of patients with high-output stomas. (United States)

    McDonald, Alison

    Working in isolation, managing high-output stomas can be stressful and difficult, with patient outcomes varying significantly. For the stoma care clinical nurse specialist, managing the choice of stoma appliance is only a small part of the care provided. To standardise and improve outcomes for patients with high-output stomas, team working is required. After contacting other stoma care services and using guidance from the High Impact Actions for Stoma Care document ( Coloplast, 2010 ), it was evident that the team should put together an algorithm/flow chart to guide both specialists and ward nursing staff in the evidence-based and standardised management of patients with high-output stomas. This article presents the flowchart that was produced and uses case studies to demonstrate improvements.

  4. [A rare cause of heart failure: aortocaval fistula associated with herniated lumbar disc surgery]. (United States)

    Çelebi, Aksüyek Savaş; Tosya, Alper; Uymaz, Barış; Ömürlü, Kenan; Aybek, Tayfun


    Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

  5. Possibilities and constraints for grazing in high output dairy systems

    NARCIS (Netherlands)

    Hennessy, D.; Delaby, L.; Pol, van den A.; Shalloo, L.


    In temperate and oceanic regions, grazed grass is the lowest cost feed available for milk production. In other regions, grazed grass is less important but can contribute to the diet of livestock. Within high output systems the interaction between the animal and sward is challenging for a host of

  6. Anal Abscess/Fistula (United States)

    ... and Fistula Expanded Information | ASCRS WHAT IS AN ANAL ABSCESS OR FISTULA? An anal abscess is an ... fistula tract and identifying internal openings. TREATMENT OF ANAL ABSCESS The treatment of an abscess is surgical ...

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

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    Francis A Uba


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

  8. An unusual case of hematemesis: Spontaneous reno-duodenal fistula

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    Vincenzo De Francesco


    Full Text Available Different diseases may cause gastrointestinal bleeding. A fistula infrequently manifest with severe intestinal bleeding, when excluding those directly involving vascular structures. We described a case of upper digestive bleeding by a spontaneous renal-duodenal fistula in the patient with kidney cancer. Bleeding was successfully stopped by transarterial embolization.

  9. Splenic arteriovenous fistula treated with percutaneous transarterial embolization

    DEFF Research Database (Denmark)

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


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

  10. High Output LED-Based Profile Lighting Fixture

    DEFF Research Database (Denmark)

    Török, Lajos; Beczkowski, Szymon; Munk-Nielsen, Stig


    Recent developments in power light emitting diode (LED) industry have made LEDs suitable for being efficiently used in high intensity lighting fixtures instead of the commonly used high intensity discharge (HID) lamps. A high output LEDbased profile-light fixture is presented in this paper....... The system consists of a power supply with power factor correction (PFC), a LED-driver and an optical system designed for an overall high efficiency. An interleaved boost converter was chosen as PFC converter. A soft switching phase-shifted full-bridge converter with current doubler provides isolation from...... the grid and delivers the required voltage to the LEDdriver which is a dual interleaved buck converter. Twelve highpower CBT-90 LEDs have been connected in a 4xRGBconfiguration to deliver high output of saturated colors without the need for subtractive color filters. More than 6000 lm of fixture light...

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

    LENUS (Irish Health Repository)

    O'Brien, Gavin C


    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. Coronary artery fistulas

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    V. M. Subbotin


    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  13. High-output heart failure in a newborn. (United States)

    Mascarenhas, Maria Inês; Moniz, Marta; Ferreira, Sofia; Goulão, Augusto; Barroso, Rosalina


    High-output cardiac failure is rare in newborns. Emergent diagnosis and management of this pathology is crucial. We report the case of a child, currently 12-months old; obstetric background is non-contributory. Clinic observation on D1 was normal except for the presence of a systolic cardiac murmur; cardiological evaluation revealed mild ventricular dysfunction of the right ventricle. On the third day of life, she developed cardiac failure with gallop rhythm, hepatomegaly and a murmur in the anterior fontanel; an echocardiogram confirmed clinic aggravation with biventricular dysfunction and right cavities and superior vena cava dilatation. The cranial MRI confirmed the presence of a pial arteriovenous malformation (AVM) involving the anterior and middle cerebral arteries with an associated fronto-parietal ischaemic lesion. The infant underwent embolisations of AVM with successful flow reduction and cardiac failure improvement. The multidisciplinary follow-up showed no cardiac dysfunction or permanent lesions but confirmed a severe psycho-motor delay and left hemiparesia.

  14. Ureteroarterial Fistula

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    D. H. Kim


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

  15. Stable gastric pentadecapeptide BPC 157 heals rectovaginal fistula in rats. (United States)

    Baric, Marko; Sever, Anita Zenko; Vuletic, Lovorka Batelja; Rasic, Zarko; Sever, Marko; Drmic, Domagoj; Pavelic-Turudic, Tatjana; Sucic, Mario; Vrcic, Hrvoje; Seiwerth, Sven; Sikiric, Predrag


    Rectovaginal fistula is a devastating condition providing more than 99% of patients for surgical treatment. We hypothesized that rectovaginal fistula may be healed by therapy with stable gastric pentadecapeptide BPC 157, in consistence with its initial clinical application and effect on external fistulas. BPC 157 (10μg/kg or 10ng/kg) was given perorally, in drinking water (0.16μg/ml or 0.16ng/ml, 12ml/rat/day) till sacrifice, or alternatively, intraperitoneally, first application at 30min after surgery, last at 24h before sacrifice. Controls simultaneously received an equivolume of saline (5.0ml/kg ip) or water only (12ml/rat/day). The assessment (i.e., rectal and vaginal defect, fistula leakage, defecation through the fistula, adhesions and intestinal obstruction as healing processes) was at day 1, 3, 5, 7, 10, 14 and 21. Regularly, rectovaginal fistulas exhibited poor healing, with both of the defects persisting, continuous fistula leakage, defecation through the fistula, advanced adhesion formation and intestinal obstruction. By contrast, BPC 157 given perorally or intraperitoneally, in μg- and ng-regimens rapidly improved the whole presentation, with both rectal and vaginal defects simultaneously ameliorated and eventually healed. The maximal instilled volume was continuously raised till the values of healthy rats were achieved, there were no signs of defecation through the fistula. A counteraction of advanced adhesion formation and intestinal obstruction was achieved. Microscopic improvement was along with macroscopic findings. BPC 157 effects appear to be suited to induce a full healing of rectovaginal fistulas in rats. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent

    Directory of Open Access Journals (Sweden)

    Portela Antenor


    Full Text Available We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.

  17. Stable gastric pentadecapeptide BPC 157 heals rat colovesical fistula. (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


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

  18. Surgical aspects and biological considerations of arteriovenous fistula placement. (United States)

    Achneck, Hardean E; Sileshi, Bantayehu; Li, Madison; Partington, Erin J; Peterson, David A; Lawson, Jeffrey H


    Since the Fistula First Initiative was formulated in 2003, providers and payers have increasingly emphasized the need to create more arteriovenous fistulae. To maximize the chances of successful fistula maturation, a thorough understanding of the biology and surgical aspects of fistula placement are essential. A functional endothelium in the target vessels is the prerequisite for the adaptive remodeling of the vessel wall, which has to take place after fistula formation. Mechanoreceptors of the endothelium sense the increase in shear stress and, through a variety of activated signaling cascades, induce the necessary changes and vasodilation of the respective vessels. The successful fistula placement starts with a thorough preoperative evaluation, which focuses on protecting the target vessels and avoiding intravenous catheters and devices. Intraoperatively, the risk of endothelial dysfunction and hyperplasia is further minimized through an atraumatic dissection with minimal manipulation of the vein and artery. The surgical technique should also focus on decreasing the vessel compliance mismatch and avoiding an inflammatory response secondary to hematoma formation. Postoperatively, the fistula must be diligently monitored for the complications of thrombosis, postoperative steal syndrome, neuropathy, aneurysm formation, infection, and high-output cardiac failure. Early recognition of a problem is the key to saving an otherwise doomed fistula. An armamentarium of percutaneous techniques is available to the access surgeon to treat the most common causes of failed access formation. However, in some cases a surgical revision of the access site through patch angioplasty, a jump graft, and graft interposition is necessary to create a fistula which can be successfully used for hemodialysis.

  19. [Spontaneous bilio-digestive fistula of lithiasic origin]. (United States)

    Marzocca, G; Botta, G; Lorenzini, L


    Personal experience about 11 cases of spontaneous biliary enteric fistula caused by lithiasic disease operated in the General Surgical Clinic of the University of Siena from 1969 to 1988, is reported. The epidemiology, pathogenesis, symptomatology, indications for operation and various operating techniques performed are discussed. In the gallstone intestinal obstruction, the authors prefer to resolve immediately the obstruction, deferring to a later moment the specific operation for the treatment of the biliary enteric fistula and the lithiasic disease.

  20. Surgical aspects of intestinal tuberculosis in children: Our experience

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    Bilal Mirza


    Full Text Available Background: Tuberculosis (TB is a major health problem in resource-constrained countries. Intestinal TB is especially notorious as a number of cases have to be dealt surgically, which too have morbidity and mortality. This study was conducted to identify various presentations of intestinal TB necessitating surgical intervention, their management, complications, and outcome in our hospital. Materials and Methods: This was a retrospective study carried out at the Department of Paediatric Surgery, The Children′s Hospital and The Institute of Child Health Lahore, Pakistan, from December 2007 to January 2010. The information about the demography, clinical presentations, investigations, management performed, complications encountered, and outcome of patients with intestinal TB were reviewed. Results: There were a total of 18 patients with intestinal TB who were managed surgically during this period. Five were male and 13 female patients (M : F 1 : 2.6. Mean age of presentation was 8.3 years. Clinical presentations were acute peritonitis in 7 patients, pneumoperitoneum in 5 patients, complete intestinal obstruction in 4 patients, pain in right iliac fossa in 2 patients, and irreducible inguinal hernia in 1 patient. Four patients had concurrent pulmonary TB. Surgical interventions included primary repair of perforation in one, repair of perforation with diversion ileostomy in 8, and merely peritoneal drainage (haemodynamically unstable patients in 3 patients. The post-operative complications were high output ileostomy in 3, faecal fistula in 1, wound dehiscence in 3, wound infection 5, and prolonged ileus in 1 patient. In three patients stoma was reversed during the same admission. There was one expiry in our study. Conclusion: Acute peritonitis, intestinal obstruction and intestinal perforation are the main clinical presentations requiring surgical interventions. Optimal surgical strategy should be adopted to avoid such pitfalls in the management.


    Directory of Open Access Journals (Sweden)



    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.

  2. Repair of a recurrent rectovaginal fistula with a biological graft. (United States)

    Berger, Kate; Faro, Jonathan; Faro, Sebastian


    This case involves a patient with the congenital absence of the lower third of the vagina. While undergoing surgical restoration of the vagina, she sustained a laceration, which ultimately led to the development of a rectovaginal fistula. After two unsuccessful attempts at repair, the recommendation was for a diverting colostomy with another attempted repair, and she presented to our clinic to discuss other possible surgical options. The patient underwent repair of the fistula using a porcine-derived small intestinal submucosal extracellular matrix graft, which resulted in the repair of the rectovaginal fistula without recurrence at 18 months' follow-up.

  3. [A double aorto-enteric fistula secondary to an aortic pseudoaneurysm. Its anatomical correction]. (United States)

    de Frutos Rincón, J L; Canales Reina, J; Gianpaolo, B; Iglesias Martínez, E; Viñas Salas, J; Casals Garrido, R; Reñé Espinet, J; Pérez Ruiz, L


    A very rare case of double fistula aorto-enteric jejunal and ileal, draining to an aortic pseudoaneurysm, is presented. There were not evidence of sepsis, and by this reason pseudoaneurysm and prosthesis were removed, a new prosthesis was inserted by reconstruction "in situ", and intestinal fistulas were closed. The short- and large-term postoperatory was satisfactory. A review about possible mechanisms implicated in a fistula, diagnosis and therapeutic alternatives was made.

  4. Surgical correction of an arteriovenous fistula in a ring-tailed lemur (Lemur catta). (United States)

    Boedeker, Nancy C; Guzzetta, Philip; Rosenthal, Steven L; Padilla, Luis R; Murray, Suzan; Newman, Kurt


    A 10-y-old ovariohysterectomized ring-tailed lemur (Lemur catta) was presented for exacerbation of respiratory signs. The lemur had a history of multiple examinations for various problems, including traumatic lacerations and recurrent perivulvar dermatitis. Examination revealed abnormal lung sounds and a femoral arteriovenous fistula with a palpable thrill and auscultable bruit in the right inguinal area. A diagnosis of congestive heart failure was made on the basis of exam findings, radiography, abdominal ultrasonography, and echocardiography. The lemur was maintained on furosemide until surgical ligation of the fistula was performed. Postoperative examination confirmed successful closure of the fistula and resolution of the signs of heart failure. Arteriovenous fistulas are abnormal connections between an artery and a vein that bypass the capillary bed. Large arteriovenous fistulas may result in decreased peripheral resistance and an increase in cardiac output with consequent cardiomegaly and high output heart failure. This lemur's high-flow arteriovenous fistula with secondary heart failure may have been iatrogenically induced during blood collection by prior femoral venipuncture. To our knowledge, this report is the first description of an arteriovenous fistula in a prosimian. Successful surgical correction of suspected iatrogenic femoral arteriovenous fistulas in a cynomolgus monkey (Macaca fascicularis) and a rhesus macaque (Macaca mulatta) have been reported previously. Arteriovenous fistula formation should be considered as a rare potential complication of venipuncture and as a treatable cause of congestive heart failure in lemurs.

  5. Classification Types Of Postoperative Enterocutaneous Fistula As A ...

    African Journals Online (AJOL)

    The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine ... Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally.

  6. Crohn's disease presenting as a recurrent perianal fistula: A case ...

    African Journals Online (AJOL)

    Crohn's disease (CD) is a multifactorial polygenic disease characterized by chronic inflammation of the gastrointestinal tract (GIT), often complicated by the development of intestinal strictures and/or formation of fistulas. Several diagnostic criteria have been proposed, usually relying on clinical, endoscopic, radiological or ...

  7. Pancreaticopleural fistula : CT demonstration

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


    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.

  8. Multiple myeloma presenting with high-output heart failure and improving with anti-angiogenesis therapy: two case reports and a review of the literature

    Directory of Open Access Journals (Sweden)

    Robin Jason


    output had normalized to 4.7 liters/minute. Conclusion Multiple myeloma can cause high-output failure. The mechanism is likely extensive bony involvement causing innumerable intramedullary arteriovenous fistulas. Diuretic therapy is not effective in treating this condition. Lenalidomide and thalidomide, both of which inhibit angiogenesis, seem to be viable treatment options. Based on the rapid and effective results seen in these two patients, a potential novel mechanism of 'pharmacologic fistula ligation' with these agents may be the most effective way to treat this presentation.

  9. Repair of a high-flow iliac arteriovenous fistula using a thoracic endograft. (United States)

    Cronin, Brett; Kane, Justin; Lee, William; Shriki, Jabi; Weaver, Fred A


    Open surgical repair of iliac arteriovenous fistulas is associated with significant morbidity and mortality, making endovascular repair an attractive alternative. This report describes a 39-year-old man who was admitted with two-pillow orthopnea, edema, and fatigue. He had sustained a gunshot wound to the pelvis 13 years previously. Six years after the gunshot wound, he was diagnosed with cardiomegaly and high-output congestive heart failure. A magnetic resonance angiography documented a large pelvic arteriovenous fistula. A diagnostic contrast angiogram confirmed a high-flow fistula between the left distal main internal iliac artery and left common iliac vein. A Gore TAG thoracic endoprosthesis (W. L. Gore and Assoc, Flagstaff, Ariz) was used to repair this large, high-flow internal iliac artery-common iliac vein arteriovenous fistula.

  10. High Efficiency, High Output Plastic Melt Waste Compactor (HEHO-PMWC) Project (United States)

    National Aeronautics and Space Administration — The innovative High Efficiency, High Output Plastic Melt Waste Compactor (HEHO-PMWC) is a trash dewatering and volume reduction system that uses heat melt compaction...

  11. Congenital parotid fistula

    Directory of Open Access Journals (Sweden)

    Shiggaon Natasha


    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.

  12. Congenital parotid fistula. (United States)

    Natasha, Shiggaon


    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.

  13. Treatment of acquired arteriovenous fistula with severe hemodynamic effects: therapeutic challenge

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    Bruna Ferreira Pilan


    Full Text Available A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.

  14. Vacuum-assisted closure therapy in patients with large postoperative wounds complicated by multiple fistulas

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    Tomasz Banasiewicz


    Full Text Available Vacuum-assisted closure (VAC therapy is a widely acknowledged method for chronic and traumatic wound healing.The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperativewounds pose significant therapeutic problems, especially when there are several fistula openings in thewound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patientsin a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closuretherapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healingprocess of other fistulas and the wound. A considerable improvement in general condition and wound healing wasnoted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7weeks a significant improvement in wound healing was observed in all patients. Once the general condition of allpatients was considered satisfactory (2-6 months, they underwent surgery aimed at restoration of the digestive tractcontinuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in thewound area and other sites should aim mainly at the improvement of patients’ general condition, limitation of thenumber of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, whichcan be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored.

  15. Reliability of Oronasal Fistula Classification. (United States)

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


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

  16. Laparoscopic treatment of genitourinary fistulae. (United States)

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


    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


    African Journals Online (AJOL)

    CONGENiTAL URETHROPERINEAL FISTULA l8 A'DISTINCT TYPE OF URETHRAL DUPLlCATION. gram revealed a normal dorsal urethra and failed to opacity the fistulous tract, but the fis- tula was demonstrated by injection of contrast through the perineal orifice (tistulogram). Cystourethroscopy revealed a normal dor~.

  18. Fistula in ano

    DEFF Research Database (Denmark)

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


    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....

  19. Robotic rectovaginal fistula repair. (United States)

    Puntambekar, Shailesh; Rayate, Neeraj; Agarwal, Geetanjali; Joshi, Sourabh; Rajmanickam, Sarvana


    Minimally invasive surgery for diseases in the pelvic region is gaining popularity due to advances in technology and increased benefit to the patient. As indications for such surgeries increase, the known boundaries for minimal access are being extended by a few teams. We report a patient who underwent robotic-assisted transabdominal repair of a high rectovaginal fistula which developed following a vaginal hysterectomy. Vaginography revealed a communication between the vaginal vault and the upper rectum. After evaluation of the colon and the vagina, the patient was planned for a robotic-assisted rectovaginal fistula repair. The three-arm daVinci(®) surgical robot was used. A total of five ports were used to complete the entire procedure, which included adhesiolysis, re-creation of the vaginal vault, repair of the fistula and omental interposition. This is the first robotic-assisted rectovaginal fistula repair reported to date. Besides the advantages of minimally invasive surgery for the patient, the surgeon benefits from the ease of suturing deep in the pelvis afforded by the articulated robotic arms.


    Directory of Open Access Journals (Sweden)

    M. A. Mohammadzade


    Full Text Available "nSecondary aortoenteric fistula (SAF is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. We present a case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. On Immediate exploratory laparatomy, proximal part of abdominal Aorta was clamped. Duodonorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed. Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty in order to protect the patch graft and to separate it from duodenorhaphy. Patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life threatening event.

  1. Ileorectal fistula due to a rectal cancer-A case report. (United States)

    Takahashi, Minoru; Fukuda, Takahiro


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

  2. [Experimental study on interdigestive migrating contractions with intestinal transection and injection of Ringer solution into intestine]. (United States)

    Koya, T


    The occurrence and mechanism of IMC are still not completely elucidated. Base on the conjecture of that the region of intestine and its ingredients may be concerning with the conduction mechanism of IMC, following experiment was performed by author. Small intestine was cut into two parts. Anal side was closed as blind end, and the end of oral side was sutured to colon or anal part of intestine by end to side anastomosis. Gastric fistula and intestinal fistula of the blind ending intestine were also made, and six pieces of force transducers were sutured to the serosa of the intestine in order to observe the movement of intestine. Under non-anesthesia and non-restricted condition for whole day long, Ringer solution was injected into gastric or intestinal fistula by 50 ml one shot or continuous dripped infusion of 250 ml per hour. The result is: In upper part of intestine, the appearance of IMC in oral and anal side of intestine is continuously observed. However, in lower part of intestine, the IMC of oral and anal part of intestine appeared completely independent without any continuity. And, as one shot of 50 ml of Ringer solution was injected, the conduction of IMC was suppressed but still observable, while continuously infused of 250 ml/hr, the IMC was completely disappeared.

  3. Proton Pump Inhibitors in the Management of Tachypnoea following Panproctocolectomy: A Case of High Output Ileostomy

    Directory of Open Access Journals (Sweden)

    Neville Azzopardi


    Full Text Available High output ileostomies are important complications of stoma formation following bowel surgery. Adequate management of such stomas might prevent severe morbidity and mortality when this potentially fatal complication develops. In this case report, we describe a female patient with a recent ileostomy formation following panproctocolectomy for ulcerative colitis who presented with progressively increasing shortness of breath. The patient was found to have a hypochloraemic metabolic acidosis on arterial blood gases. She rapidly improved with adequate sodium and fluid replacement and with the use of a course of proton pump inhibitors. This case highlights the importance of recognising high output ileostomies early and important management issues in their regard.

  4. High-Output Heart Failure from a Hepatic Hemangioma With Exertion-Induced Hypoxia. (United States)

    Smith, Aaron A H; Nelson, Matthew


    Patients with hepatic hemangiomas have been known to have high-output heart failure as a result of left-to-right arteriovenous shunting. We report a patient with a hepatic hemangioma that presented with high-output heart failure with hypoxia on exertion. After embolization of the hemangioma, the patient's hypoxia resolved and ejection fraction improved. In the absence of cardiopulmonary pathophysiology, we presume that our patient's hemangioma was causing a right-to-left shunt as opposed to an expected left-to-right shunt. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Treatment of non-IBD anal fistula

    DEFF Research Database (Denmark)

    Lundby, Lilli; Hagen, Kikke; Christensen, Peter


    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...

  6. Surgical procedures for digestive fistulae caused by radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Satoshi; Honda, Ichiro; Watanabe, Kazuo; Nagata, Matsuo; Yamamoto, Hiroshi; Soda, Hiroaki; Tasaki, Kentaro [Chiba Cancer Center Hospital (Japan)


    We evaluated the effectiveness of surgery to treat ileal fistulations associated with radiation exposure. An ileal fistula developed in eight patients, 13-102 months after 60 Gy of irradiation to the pelvic cavity, given as initial treatment or supportive therapy following resection of the primary tumor. The underlying diseases were cervical cancer in seven women and bladder cancer in one man. Two patients had an ileorectal fistula, two had an ileosigmoidal fistula, three had an ileovesical fistula, and one had an ileourethral fistula. We performed a partial enterectomy in one patient, a simple bypass operation without exclusion in one, and bypass operations with exclusion in the other six. Intestinal expansion in the exclusion site occurred in one patient, but there were no other complications related directly to surgery, such as sutural insufficiency. The patient who underwent a simple bypass operation died of emaciation 2 months after the surgery, but all of the other patients were discharged capable of oral ingestion. Our findings showed that surgery was beneficial for alleviating the various conditions related to digestive fistulation following radiation therapy. (author)

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

    Directory of Open Access Journals (Sweden)

    Williams Nigel


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

  8. Persistent very high output lymphatic drainage after radical nephrectomy successfully treated with surgical management. (United States)

    Ciftci, Seyfettin; Ozbudak, Ersan; Yilmaz, Hasan; Ustuner, Murat; Ozkan, Levend; Culha, Mustafa Melih


    Persistent lymphatic drainage is uncommon after most of the surgical operations. It is related with mechanical, nutritional and immunological problems as well as electrolyte imbalance and protein deficiency. It is most commonly seen in retroperitoneal surgeries including abdominal aortic surgery and retroperitoneal lymph node dissection. Conservative management is the first treatment choice and resolves the problem in most cases. However persistent high output drainage may not be resolved with conservative approach and surgical or invasive treatment may become necessary. Additionally, surgical management of persistent lymphatic drainage has not been sufficiently discussed in the literature. In this study, we present a case of persistent very high output lymphatic drainage after right radical nephrectomy which failed with conservative approach and was successfully treated with surgical management.

  9. Acquired tracheo-oesophageal fistula.

    Directory of Open Access Journals (Sweden)

    Shah C


    Full Text Available Acquired tracheo-oesophageal fistula is rare. The most common causes are tuberculosis and malignancy. Here we report a patient who had come with dysphagia and aspiration pneumonia with paratracheal lymphnodes on X-ray chest and was diagnosed to have a tracheo-bronchial fistula on barium studies. Transtumoral intubation by pull-through method was carried out.

  10. 915 MHz microwave ablation with high output power in in vivo porcine spleens

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    Gao Yongyan, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Department of Special Diagnosis, The General Hospital of Chinese People' s Armed Police Forces, 69 Yongding Rd., Beijing 100039 (China); Wang Yang, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Duan Yaqi, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Li Chunling, E-mail: [Department of Special Diagnosis, The General Hospital of Chinese People' s Armed Police Forces, 69 Yongding Rd., Beijing 100039 (China); Sun Yuanyuan, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Zhang Dakun, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Lu Tong, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China); Liang Ping, E-mail: [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing 100853 (China)


    Objective: The purpose of this study was to evaluate the efficacy of 915 MHz microwave (MW) ablation with high output power in in vivo porcine spleens. Materials and methods: MW ablations were performed in 9 porcine spleens with an internally cooled 915 MHz antenna. Thermocouples were placed at 5, 10, 15, 20 mm away from the antenna to measure temperatures in real-time during MW emission. The energy was applied for 10 min at high output power of 60 W, 70 W or 80 W. Gross specimens were sectioned and measured to determine ablation size. Representative areas were examined by light microscopy and electron microscopy. Coagulation sizes and temperatures were compared among the three power groups. Results: Hematoxylin-eosin staining showed irreversible necrosis in the splenic coagulation area after MW ablation. As the power was increased, long-axis diameter enlarged significantly (p < .05). Short-axis diameter also tended to increase, but there were no statistical difference (p > .05). The coagulation size of long-axis and short-axis diameter with 80 W in vivo spleen ablation was 6.43 {+-} 0.52 and 4.95 {+-} 0.30 cm, respectively. With the increase of output power, maximum temperatures at 5, 10, 15, 20 mm from the antenna were increased accordingly (p < .05). The maximum temperature with 80 W at 5 and 20 mm from the antenna reached 146.17 {+-} 6.65 and 72.38 {+-} 4.23 {sup o}C respectively. Conclusion: With internally cooled antenna and high output power, 915 MHz MW ablation in the spleen could produce irreversible tissue necrosis of clinical significance. MW ablation may be used as a promising minimally invasive method for the treatment of splenic diseases.

  11. Mesenchymal Stem Cells to Treat Crohn's Disease with Fistula. (United States)

    Zhang, Xiao-Mei; Zhang, Yu-Jing; Wang, Wei; Wei, Yu-Quan; Deng, Hong-Xin


    Crohn's disease, which mainly affects the gastrointestinal tract, is a refractory inflammatory disease that has clinical manifestations of abdominal pain, fever, bowel obstruction, and diarrhea with blood or mucus. Together, these symptoms can severely impair a patient's quality of life. Besides the common complication of intestinal obstruction, fistulas, particularly anorectal fistulas, are common in Crohn's disease patients. Since radical surgical cures can be difficult to achieve and relapse is common, Crohn's disease patients often seek other effective treatments in addition to surgery. Stem-cell therapies have recently been proposed as a method to address the challenges and prospective medical needs of Crohn's disease patients in general and those with fistulas. Several studies suggest that mesenchymal stem cells (MSCs) could improve Crohn's disease and Crohn's fistula. Moreover, studies concerning MSC transplantation or local rejection of stem cells derived from bone marrow or adipose tissue-derived stem cells have assessed stem cell-based treatments for refractory Crohn's disease. Many patients in these studies are now in remission. A number of clinical trials for refractory Crohn's disease have also evaluated transplantation of autologous or allogenic MSCs and showed that MSCs can be safely administered to Crohn's disease patients, with some achieving positive clinical responses.

  12. Protocol for the detection and nutritional management of high-output stomas. (United States)

    Arenas Villafranca, Jose J; López-Rodríguez, Cristobal; Abilés, Jimena; Rivera, Robin; Gándara Adán, Norberto; Utrilla Navarro, Pilar


    An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management. This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100% effectiveness. 50% of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33% of the late HOS patients. The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.

  13. Sonographic Diagnosis of Arterioportal Fistula

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    Canan Alkim


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

  14. Vacuum-assisted closure therapy in patients with large postoperative wounds complicated by multiple fistulas (United States)

    Borejsza-Wysocki, Maciej; Meissner, Wiktor; Malinger, Stanisław; Szmeja, Jacek; Kościński, Tomasz; Ratajczak, Andrzej; Drews, Michał


    Vacuum-assisted closure (VAC) therapy is a widely acknowledged method for chronic and traumatic wound healing. The feasibility of VAC therapy used for the treatment of intestinal fistulas is still a subject of debate. Complex postoperative wounds pose significant therapeutic problems, especially when there are several fistula openings in the wound area and other sites, usually at the site of previous drains. This paper describes the treatment of three patients in a critical condition, with complex postoperative wounds complicated by multiple fistulas. Vacuum-assisted closure therapy was based on effective drainage of the biggest fistula opening and ensuring conditions promoting the healing process of other fistulas and the wound. A considerable improvement in general condition and wound healing was noted within 2-4 weeks and both the number of fistulas and the volume of excreted contents decreased. After 5-7 weeks a significant improvement in wound healing was observed in all patients. Once the general condition of all patients was considered satisfactory (2-6 months), they underwent surgery aimed at restoration of the digestive tract continuity.In our opinion, VAC therapy used for the treatment of postoperative wounds with multiple fistulas in the wound area and other sites should aim mainly at the improvement of patients’ general condition, limitation of the number of fistulas as well as accelerated wound healing. This may lead to formation of one stoma-type fistula, which can be dressed and cared for by patients until the continuity of the digestive tract has been surgically restored. PMID:23255975

  15. Ureteroarterial fistula: a case report

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


    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.

  16. Embolization for Thoracic Duct Collateral Leakage in High-Output Chylothorax After Thoracic Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kariya, Shuji, E-mail:; Nakatani, Miyuki, E-mail:; Yoshida, Rie, E-mail:; Ueno, Yutaka, E-mail:; Komemushi, Atsushi, E-mail:; Tanigawa, Noboru, E-mail: [Kansai Medical University, Department of Radiology (Japan)


    PurposeThis study was designed to investigate thoracic duct collateral leakage and the supply route of lymphatic fluid by lymphangiography and transcatheter thoracic ductography and to evaluate the results of embolization for thoracic duct collateral leakage performed to cut off this supply route.MethodsData were retrospectively collected from five patients who underwent embolization for thoracic duct collateral leakage in persistent high-output chylothorax after thoracic surgery. Extravasation of lipiodol at the ruptured thoracic duct collaterals was confirmed in all patients on lymphangiography. Transcatheter thoracic ductography was used to identify extravasation of iodinated contrast agent and to identify communication between the thoracic duct and leakage site. Thoracic duct embolization (TDE) was performed using the percutaneous transabdominal approach to cut off the supply route using N-butyl cyanoacrylate (NBCA) mixed with lipiodol (1:5–1:20).ResultsClinical success (drainage volume ≤10 mL/kg/day within 7 days after TDE) was achieved in all patients. The collateral routes developed as consequence of surgical thoracic duct ligation. In three patients, NBCA-Lipiodol reached the leakage site through direct communication between the thoracic duct and the ruptured lymphatic duct. In the other two patients, direct communication and extravasation was not detected on thoracic ductography, and NBCA-Lipiodol did not reach the leakage site. However, NBCA-Lipiodol did reach the cisterna chyli, lumbar trunks, and some collateral routes via the cisterna chyli or lumbar lymphatics. As a result, leakage was stopped.ConclusionsTDE was effective for the management of leakage of the collaterals in high-output chylothorax after thoracic surgery.

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


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


    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.

  18. Perforated appendicitis presenting as appendicoumbilical fistula. (United States)

    Killelea, Brigid K; Arkovitz, Marc S


    Perforated appendicitis is one of the most common diagnoses treated by pediatric surgeons. Although rare, a perforated appendix can present with a cutaneous fistula. Here we present the second reported case of perforated appendicitis presenting as an appendicoumbilical fistula.

  19. Management of the immature autogenous arteriovenous fistula. (United States)

    Saad, Theodore F


    A high-quality autogenous arteriovenous fistula provides the optimal access for hemodialysis. Following initial surgical construction of a fistula, the maturation process is driven by hemodynamic, cellular, and humoral factors that must result in increased blood flow, vessel dilation, and thickening of the vessel wall before the fistula can be successfully used for dialysis needle access. Different demands are placed on each fistula depending on the individual patient's hemodialysis requirements, which must be clearly understood to properly assess and treat the immature fistula. When spontaneous maturation fails to achieve a functional fistula, additional surgical or minimally invasive interventional procedures may be necessary to enhance the maturation process. Various techniques have been reported to achieve successful fistula maturation. The purpose of this article is to review the concepts of fistula maturation and the interventions that may be performed in cases where there is failure to mature spontaneously.

  20. Traumatic urethrocutaneous fistula: Case report andliterature review ...

    African Journals Online (AJOL)

    % of all trauma cases.Severe penile trauma may be complicated by urethrocutaneous fistula. A 22 year old male patient presentedwith urethrocutaneous fistula following severe crush injury of his penis from the rollers of a baking machine.

  1. Squamous Cell Carcinoma Originating from a Crohn’s Enterocutaneous Fistula

    Directory of Open Access Journals (Sweden)

    Bogdan Protyniak


    Full Text Available Purpose. Squamous cell carcinoma (SCC developing within fistulae and chronic wounds in patients with Crohn’s disease is a rare phenomenon with few reported studies in the literature. Clinical suspicion for SCC in Crohn’s disease patients with chronic painful fistulae is low, leading to delayed diagnosis and treatment. We present a patient with long-standing Crohn’s disease complicated by malignant degeneration of an enterocutaneous fistula tract. Methods. Workup with MRI, CT, and fistulogram revealed a 7 × 3 cm fistulous connection between a loop of small intestine and the patient’s perineum. Biopsies of the fistula tract confirmed the diagnosis of SCC. Results. The patient underwent an abdominoperineal resection with positive margins and is currently awaiting radiation therapy. Conclusions. This is the second case reported within the English literature of SCC arising from an enterocutaneous fistula in the setting of Crohn’s disease. Based on the findings in this case report and others presented in the literature, a high degree of suspicion of malignancy should be present in patients with chronic painful, poor-healing fistulae, especially in the absence of infection.

  2. A case of colouterine fistula managed laparoscopically. (United States)

    Dadhwal, Vatsla; Ghosh, Bhaswati; Jindal, Vijay Laxmi; Vaid, Arvind; Agarwal, Sandeep; Mittal, Suneeta


    Fistulas between the uterus and bowel are rarely reported. We report successful laparoscopic management of a colouterine fistula caused by a foreign body in the uterus. Fistulas between the gastrointestinal tract and the female genital tract are usually found between the vagina and rectum as a result of complications of childbirth or iatrogenic trauma. Communication between the uterus and bowel is rarely reported. We report successful laparoscopic management of an unusual case of colouterine fistula caused by a foreign body in the uterus.

  3. Gastrojejunocolic fistula after gastrojejunostomy: a case series


    Wu Jin-Ming; Wang Ming-Yang; Lee Po-Huang; Lin Ming-Tsan


    Abstract Introduction Gastrojejunocolic (GJC) fistulae represent a significant post-surgical cause of morbidity and mortality. GJC fistulae represent rare post-surgical complications, and most are associated with gastric surgery. In the past, this complication has been under-recognized because a fistula may form years after surgery. Case presentation We describe two cases of gastrojejunocolic fistula in men aged 67 and 60 who both initially presented with watery diarrhea and weight loss. Uppe...


    Aydinova, P R; Aliyev, E A


    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.

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

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


    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.)

  6. Gastrocolic Fistula: A Shortcut through the Gut

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    Nauzer Forbes


    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.

  7. [Ectopic intestinal varices in cirrhotic patients; an infrequent cause of severe intestinal bleeding]. (United States)

    Mateş, I N; Dinu, Daniela; Popescu, Luminiţa; Iosif, Cristina


    We report on a cirrhotic patient, with history of colecistectomy, admitted for acute digestive bleeding. Esogastric causes were excluded by endoscopy; due to continuous hemorrhage, the patient was operated in the next 20 hours. The cause was established during the operation; solitary omfalo-enteric varices, with active vascular fistula. Preoperative etiology of acute intestinal bleeding may be difficult to establish, sometimes even during the surgical intervention. We comment upon rare causes of acute intestinal bleeding, mainly ectopic varices determined by portal hypertension.

  8. Fistulas secondary to gynecological and obstetrical operations

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    Jakovljević Branislava N.


    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.

  9. Rectal atresia with rectolabial fistula


    Sharma S.; Upadhyaya V; Pandey A; Gangopadhyay A


    Rectal atresia is a rare condition in which the anus and sphincter muscles are normally developed, with usually no fistulous communication with the urinary tract. We describe an unusual case of membranous rectal atresia with recto-labial fistula. It was treated by blind perforation of rectal membrane with lay opening of fistlous tract.

  10. Gastropulmonary Fistula after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Maya Doumit


    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.

  11. Percutaneous Treatment of a Jejunovaginal Fistula Using a Combination of the Amplatzer Vascular Plug II and N-Butyl-2-Cyanoacrylate: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Kyung; Kwak, Hyo Sung; Han, Young Min [Dept. of Radiology, Chonbuk National University School of Medicine and Hospital, Chonju (Korea, Republic of); Kim, Young Kon [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    Treatment for an enterovaginal fistula should consider the location of an intestinal fistula. Most rectovaginal fistulas develop in the lower third of the vagina and can be treated surgically. Jejunovaginal fistulas can spontaneously close during conservative management. We report the first use of the Amplatzer vascular plug II (AVP II; AGA Medical Corp, Golden Valley, MN, USA) and the use of an N-butyl-2-cyanoacrylate (NBCA; Histoacryl, Braun, Melsungen, Germany)- iodized oil (Lipiodol Ultra-Fluid, Guerbet, Aulnay-sous-Bois, France) mixture for treatment of a patient with a jejunovaginal fistula which failed to close after conservative management. The patient did not have any vaginal discharge one day later after deployment of the AVP II.

  12. Mucinous Adenocarcinoma Arising in Chronic Perianal Fistula: Good Results with Neoadjuvant Chemoradiotherapy Followed by Surgery

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    Marisa D. Santos


    Full Text Available Chronic perianal fistulas are a common clinical condition. However, their evolution to adenocarcinoma is rare. We report the case of a 48-year-old man with perianal chronic fistulas, who developed two perianal ulcerated lesions near the external orifices of the fistulas, which extended proximally as a pararectal tumor. No intestinal lesion was seen at endoscopic examination. Histopathological biopsy indicated mucinous adenocarcinoma. Staging was performed by pelvic magnetic resonance imaging (MRI and thoracoabdominal CT scan. The patient underwent a laparoscopic colostomy followed by neoadjuvant chemoradiotherapy and then laparoscopic abdominoperineal resection followed by adjuvant therapy. We have seen a favorable outcome with no recurrence at 3 years of follow-up.

  13. New technique for the management of vesicorectal fistulas

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    Leifer, G.; Jacobs, W.H.


    We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.

  14. Laparoscopic Treatment of Vesicovaginal Fistula

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    Marcos Tobias-Machado


    Full Text Available Introduction Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.Objectives Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure; Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.Results Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7. Mean operative time was 2,5 (1,8-3,2 hours. Mean blood loss was 150 (100-200mL. Complication rate was 10% (one case of urinary infection treated conservatively. Mean hospital stay was 1,2 (1-2 days. Mean return to normal and activities was 20 (15-30 days. For nine patients mean sexual intercourse time was 3 (1-6 months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy. Mean follow-up was 36 (12-60 months.Conclusions Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.

  15. Management of Postpneumonectomy Bronchopleural Fistulae

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    Kemal Karapinar


    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. [Internal biliary fistula of lithiasic origin]. (United States)

    Oancea, T; Cojocea, V; Timaru, I; Bumbac, A; Andrei, V


    The authors present 17 cases of patients with internal biliary fistulae of lithiasic origin. Nine of these were of the cholecystoduodenal type, 2 of the cholecysto-gastric type, 2 had developed between the cholecyst and the colon, and 4 were of the bilio-biliary type, between the cholecyst and the choledochus. These cases represented 1.1% of the 1,500 interventions carried out on the extra-hepatic biliary pathways over a period of 10 years, between 1971 and 1980, and 13% of the total number of interventions performed for biliary lithiasis. The advanced age of the patients, the background disease and the complications that accompanied it, as well as the associated deficiencies have given rise to diagnostic and therapeutic difficulties. A correct diagnosis before surgery was made in only two of the patients. The postoperative evolution was good in 13 of the cases (representing 76% of the total), and this confirmed the correct surgical attitude which aimed at restoration of the physiological conditions and a normal digestive and biliary transit. In cases with biliary ileus the first therapeutic measure was to secure intestinal transit.

  17. Chemotherapy-induced enterocutaneous fistula after perineal hernia repair using a biological mesh: a case report

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    Eriksen MH


    Full Text Available MH Eriksen, O Bulut Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark Abstract: This is the first reported case of an enterocutaneous fistula as a late complication to reconstruction of the pelvic floor with a Permacol™ mesh after a perineal hernia. A 70-year-old man had a reconstruction of the pelvic floor with a biological mesh because of a perineal hernia after laparoscopic abdominoperineal resection. Nine months after the perineal hernia operation, the patient had multiple metastases in both lungs and liver. The patient underwent chemotherapy, including bevacizumab, irinotecan, calcium folinate, and fluorouracil. Six weeks into chemotherapy, the patient developed signs of sepsis and complained of pain from the right buttock. Ultrasound examination revealed an abscess, which was drained, guided by ultrasound. A computed tomography scan showed a subcutaneous abscess cavity located in the right buttock with communication to the small bowel. Operative findings confirmed a perineal fistula from the distal ileum to perineum. A resection of the small bowel with primary anastomosis was performed. The postoperative course was complicated by fluid and electrolyte disturbances, but the patient was stabilized and finally discharged to a hospice for terminal care after 28 days of hospital stay. It seems that hernia repairs with biological meshes have lower erosion and infection rates compared with synthetic meshes, and so far, evidence suggests that biological grafts are safe and effective in the treatment of pelvic floor reconstruction. There have been no reports of enteric fistulas after pelvic reconstruction with biological meshes. However, the development of intestinal fistulas after chemotherapy with bevacizumab has been described in the literature. Our case report supports this association between bevacizumab and fistula formation among rectal cancer patients, as symptoms of a

  18. Intestinal Cancer (United States)

    ... connects your stomach to your large intestine. Intestinal cancer is rare, but eating a high-fat diet ... increase your risk. Possible signs of small intestine cancer include Abdominal pain Weight loss for no reason ...

  19. Management of Complex Perineal Fistula Disease (United States)

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


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

  20. Minimally invasive management of urological fistulas. (United States)

    Núñez Bragayrac, Luciano A; Azhar, Raed A; Sotelo, Rene


    Urological fistulas are an underestimated problem worldwide and have devastating consequences for patients. Many urological fistulas result from surgical complications and/or inadequate perinatal obstetric healthcare. Surgical correction is the standard treatment. This article reviews minimally invasive surgical approaches to manage urological fistulas with a particular emphasis on the robotic techniques of fistula correction. In recent years, many surgeons have explored a minimally invasive approach for the management of urological fistulas. Several studies have demonstrated the feasibility of laparoscopic surgery and the reproducibility of reconstructive surgery techniques. Introduction of the robotic platform has provided significant advantages given the improved dexterity and exceptional vision that it confers. Fistulas are a concern worldwide. Laparoscopic surgery correction has been developed through the efforts of several authors, and difficulties such as the increased learning curve have been overcome with innovations, including the robotic platform. Although minimally invasive surgery offers numerous advantages, the most successful approach remains the one with the surgeon is most familiar.

  1. Spontaneous esophageal-pleural fistula

    Directory of Open Access Journals (Sweden)

    Sameer Vyas


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

  2. Fistula gastrocólica


    Henriques, Alexandre Cruz; Pezzolo, Sergio; Henriques, Simone A. Chiconelli


    A case of gastrocolic fistula(GCF) in a patient with duodenal stenosis who had previously undergone gastroenteric anastomosis is reported. The patient went through hemigastrectomy, partial colectomy and segmental enterectomy with bloc resection. Reconstruction was carried out through Billroth II gastrojejunostomy, jejunojejunostomy and end-to-end anastomosis of the colon. The patient had good post-operative evolution and was discharged from hospital seven days after surgery. GCF should be sus...

  3. Emphysematous prostatic abscess with rectoprostatic fistula

    Directory of Open Access Journals (Sweden)

    Po-Cheng Chen


    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.

  4. Report of a complete second branchial fistula.

    LENUS (Irish Health Repository)

    Khan, Mohammad Habibullah


    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.

  5. Choledochoduodenal fistula of ulcer etiology

    Directory of Open Access Journals (Sweden)

    Čolović Radoje


    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. .

  6. Martius procedure revisited for urethrovaginal fistula

    Directory of Open Access Journals (Sweden)

    N P Rangnekar


    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.

  7. The Patency Rate of Arteriovenous Fistulas

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal


    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.

  8. A Simple MPPT Algorithm for Novel PV Power Generation System by High Output Voltage DC-DC Boost Converter

    DEFF Research Database (Denmark)

    Sanjeevikumar, Padmanaban; Grandi, Gabriele; Wheeler, Patrick


    substantially improves the high output-voltage by a simple MPPT closed loop proportional-integral (P-I) controller, and requires only two sensor for feedback needs. The complete numerical model of the converter circuit along with PV MPPT algorithm is developed in numerical simulation (Matlab/Simulink) software......This paper presents the novel topology of Photo Voltaic (PV) power generation system with simple Maximum Power Point Tracking (MPPT) algorithm in voltage operating mode. Power circuit consists of high output voltage DC-DC boost converter which maximizes the output of PV panel. Usually traditional...... DC-DC boost converters are used for such application, but they are not the most suitable solution due to output limitation, lower efficiency and require more sensors with complex control algorithm. Further on, the effects of parasitic elements are suppressed, as well as the power transfer efficiency...

  9. Combined Vesicovaginal and Rectovaginal Fistulas Associated with ...

    African Journals Online (AJOL)

    the history is obtained after discovery of the fistula2. Fewer than ten case reports in the ... the bladder into the vagina and the rectum. Cystoscopy under anesthesia revealed a vesicovaginal fistula above the trigone, 3 cm in diameter, and the presence of a hard, blue, calcified mass. Pelvic examination under anesthesia.

  10. Diagnosis and Treatment of Transsphincteric Perianal Fistulas

    NARCIS (Netherlands)

    D.D.E. Zimmerman (David)


    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. An unusual presentation of congenital bronchoesophageal fistula ...

    African Journals Online (AJOL)

    An unusual presentation of congenital bronchoesophageal fistula. OM Atalabi, AG Falade, OM Obajimi, OO Akinyinka, SB Lagundoye, PO Ibinaiye. Abstract. We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features ...

  12. Assessment and management of urethrocutaneous fistula ...

    African Journals Online (AJOL)

    at time of fistula repair, type of original hypospadias procedure, and number of previous fistula repairs. An algorithm was suggested by some researchers for the management of different types of UCF [8]. Successful repair of these UCF depends on several basic principles, which are the avoidance of procedures on inflamed ...

  13. Erratum: Complications of Arteriovenous Fistula with ...

    African Journals Online (AJOL)


    Sep 14, 2017 ... Erratum: Complications of Arteriovenous Fistula with. Polytetraflouroethylen Grafts in Hemodialysis Patients. In the article titled “Complications of arteriovenous fistula with polytetraflouroethylen grafts in hemodialysis patients” published in pages 120-123, issue 1, vol. 18 of Nigerian Journal of Clinical ...

  14. Chronic leg swelling and palpitation as a late complication of post-traumatic arteriovenous fistula: A case report

    Directory of Open Access Journals (Sweden)

    Mehmet Kalender


    Full Text Available Introduction: Chronic post-traumatic arteriovenous fistula (AVF is a late complication of vascular injury and can be presented with symptoms of congestive heart failure, venous hypertension and distal ischaemia. We present an unusual case of chronic leg swelling in adult caused by post-traumatic AVF. Case presentation: A 52 year old white-male patient complained of palpitation, pain and swollen right leg. Arterial pulses distally from the groin were present. His medical history revealed him to have sustained gunshot injury of the left thigh 5 years before. Angiography showed a large AVF between superficial femoral artery and femoral vein. The patient underwent surgical repair of AVF with ligation of AVF between superficial femoral artery under spinal anaesthesia. Completion angiography confirmed AVF exclusion. Leg swelling healed within a month. Conclusion: Post-traumatic fistula should be obliterated as soon as possible. Untreated fistula results in complications including renin-mediated hypertension and high-output heart failure, venous and/or arterial insufficiency. Keywords: Cardiovascular disease, Trauma, Arteriovenous fistula, Lower extremity

  15. Case report: Primary aortosigmoid fistula

    DEFF Research Database (Denmark)

    Khalaf, Chirin; Houlind, Kim Christian


    : Aortoenteric fistulas are more common secondary to previous vascular surgery of aorta, however, PAEF’s involve the sigmoid in only 2 %. Fistulization can be due to diverticulitis and can be difficult to diagnose. CONCLUSION: Retroperitoneal bleeding from the left iliac artery is more common due to a ruptured...... aneurism. This case, however, demonstrates a special PAEF formation as a very rare complication of diverticulitis. The pathophysiology of the PAEF is very unique along with the anatomic localization in the sigmoid colon and left external iliac artery....

  16. Tuberculosis presenting as bronchoesophageal fistula

    Directory of Open Access Journals (Sweden)

    Santhosh Narayanan


    Full Text Available We report a case of bronchoesophageal fistula associated with tuberculosis. A 25 year old woman presented to us with 3 month history of cough worsening with deglutition. Radiological examination revealed mediastinal lymphadenopathy and bronchoscopy with esophagoscopy confirmed the presence of fistulous communication with features of endobronchial tuberculosis. Histological examination of bronchial biopsy specimen showed non necrotic granuloma with the PCR positive for Mycobacterium tuberculosis in her bronchial secretions. She was begun on antituberculous treatment and became asymptomatic after 2 months. Bronchoscopy done during follow up after 4 months showed normal bronchial lumen with disappearance of fistulous tract. Imaging showed resolution of lung lesions.

  17. Aortoesophageal fistula in a child

    Directory of Open Access Journals (Sweden)

    Shasanka Shekhar Panda


    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.

  18. Anal fistulas : New perspectives on treatment and pathogenesis

    NARCIS (Netherlands)

    R.S. van Onkelen (Robbert)


    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

  19. Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in ...

    African Journals Online (AJOL)

    Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair ...

  20. Enterovesical Fistulae: Aetiology, Imaging, and Management

    Directory of Open Access Journals (Sweden)

    Tomasz Golabek


    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.

  1. Vesicovaginal fistula: a review of nigerian experience. (United States)

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


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

  2. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    Directory of Open Access Journals (Sweden)

    C. Tran


    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.

  3. Our first experience in treatment of ano rectal fistula with SURGISIS AFP Anal Fistula Plug. (United States)

    Hadzhiev, B


    The aim of this study is to present the early results and to discuss the new method of treatment of ano-rectal fistula with SURGISIS AFP ANAL FISTULA PLUG. Three patients with ano-rectal fistula have been treated in the Department of General Surgery with Coloproctology, using Surgisist AFP anal fistula Plug. Two were with transsphincter and one with extrasphincter ano-rectal fistula. This method of SURGISIS AFP ANAL FISTULA PLUG treatment is presented in details. All patients are with closed fistulas after period of 4, 8 and 12 weeks of follow up. The author emphasized, that with the presented way of treatment the period of hospitalization is shorter, postoperative pain and period of healing are reduced. There are a lot of advantages using this method, compared with the traditional surgical methods. The presented material is insignificant, but it helps to initiate a new noninvasive method of treatment of ano-rectal fistula. Surgisist AFP anal fistula Plug method is a safe and successful. It preserves the anal anatomy and function. The data results, which are presented should be reproduced in a wider future study.

  4. A high output voltage flexible piezoelectric nanogenerator using porous lead-free KNbO3 nanofibers (United States)

    Ganeshkumar, Rajasekaran; Cheah, Chin Wei; Xu, Ruize; Kim, Sang-Gook; Zhao, Rong


    Self-powered nanodevices for applications such as sensor networks and IoTs are among the emerging technologies in electronics. Piezoelectric nanogenerators (P-NGs) that harvest energy from mechanical stimuli are highly valuable in the development of self-sufficient nanosystems. Despite progress in the development of P-NGs, the use of porous perovskite ferroelectric nanofibers was barely considered or discussed. In this letter, a flexible high output nanogenerator is fabricated using a nanocomposite comprising porous potassium niobate (KNbO3) nanofibers and polydimethylsiloxane. When a compressive force was applied to as-fabricated P-NG, a peak-to-peak output voltage of ˜16 V and a maximum closed circuit current of 230 nA were obtained, which are high enough to realize self-powered nanodevices. In addition, due to their porosity and non-toxic nature, KNbO3 nanofibers may be used as an alternative to the dominant lead-based piezoelectric devices. Besides the high output performance of the device, multifunctional capability, flexible design, and cost-effective construction of the as-fabricated P-NG can be crucial to large-scale deployment of autonomous devices.

  5. High-output-power, single-wavelength silicon hybrid laser using precise flip-chip bonding technology. (United States)

    Tanaka, Shinsuke; Jeong, Seok-Hwan; Sekiguchi, Shigeaki; Kurahashi, Teruo; Tanaka, Yu; Morito, Ken


    An Si/III-V hybrid laser oscillating at a single wavelength was developed for use in a large-scale Si optical I/O chip. The laser had an InP-based reflective semiconductor optical amplifier (SOA) chip integrated with an Si wavelength-selection-mirror chip in a flip-chip configuration. A low coupling loss of 1.55 dB at the Si-SOA interface was accomplished by both mode-field-matching between Si-SOA waveguides and accurately controlling the bonding position. The fabricated Si hybrid laser exhibited a very low threshold current of 9.4 mA, a high output power of 15.0 mW, and a high wall-plug efficiency of 7.6% at 20 °C. Moreover, the device maintained a high output power of >10 mW up to 60°C due to the high thermal conductance between the SOA chip and Si substrate. The short cavity length of the flip-chip bonded laser expanded the longitudinal mode spacing. This resulted in temperature-stable single longitudinal mode lasing and a low RIN level of <-130 dB/Hz.

  6. Major intestinal complications of radiotherapy. Management and nutrition

    Energy Technology Data Exchange (ETDEWEB)

    Deitel, M.; To, T.B.


    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome.

  7. Tracheoesophageal fistula associated with paracoccidioidomicosis

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira


    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.

  8. Malignant duodenocolic fistula. A case report. (United States)

    Giusto, F; Arzillo, G; Lodo, N; Falchero, F; Gramegna, A


    Malignant duodenocolic fistula is a rare condition in which radical surgical treatment is seldom possible. A personal case treated by pancreaticoduodenectomy is presented with a review of the literature.

  9. Enterocutaneous Fistula: Proven Strategies and Updates (United States)

    Gribovskaja-Rupp, Irena; Melton, Genevieve B.


    Management of enterocutaneous fistula represents one of the most protracted and difficult problems in colorectal surgery with substantial morbidity and mortality rates. This article summarizes the current classification systems and successful management protocols, provides an in-depth review of fluid resuscitation, sepsis control, nutrition management, medication management of output quantity, wound care, nonoperative intervention measures, operative timeline, and considerations, and discusses special considerations such as inflammatory bowel disease and enteroatmospheric fistula. PMID:27247538

  10. Management of lymph fistulas in thyroid surgery. (United States)

    Lorenz, Kerstin; Abuazab, Mohammed; Sekulla, Carsten; Nguyen-Thanh, Phuong; Brauckhoff, Michael; Dralle, Henning


    Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. Conservative and surgical management strategies for high- and low-output lymph fistulas are inconsistent. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are lacking. A retrospective single-center chart review of consecutively quality-control-documented thyroid surgeries from January 1998 to December 2009 was performed to identify reported postoperative lymph fistulas. Documentation of surgical procedures, drainage, medical, and nutritional management was analyzed to identify risk factors for occurrence and criteria for management of evident lymph fistulas. There were 29 patients identified with postoperative clinical evidence of lymph fistulas following thyroid surgery; incidence was 0.5%. Indication to surgery comprised benign nodular goiter, recurrent nodular goiter, and thyroid carcinoma or local and lymphonodal carcinoma recurrences. There were 12 (41%) primary and 17 (59%) redo surgeries performed. Surgical procedures performed included thyroidectomy, completion thyroidectomy, and primary and redo central and lateral systematic microdissection of lymphatic compartments. All patients were initially submitted to fasting diet and medical treatment, successfully in 19 (66%), whereas ten (34%) patients underwent surgical intervention for fistula closure after failure of conservative treatment. Complications were one wound infection and fistula recurrence in five (26%) patients in the conservative group and two (20%) in the surgical group. Hospital stay was exceedingly prolonged in both groups with a median of 21 and 11 versus 6 days in patients with regular postoperative course following thyroid surgery. Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with

  11. 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


    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.

  12. Radiology in cutaneous sinuses and fistulae

    Energy Technology Data Exchange (ETDEWEB)

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


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

  13. Quality of life with anal fistula. (United States)

    Owen, H A; Buchanan, G N; Schizas, A; Cohen, R; Williams, A B


    Anal fistula affects people of working age. Symptoms include abscess, pain, discharge of pus and blood. Treatment of this benign disease can affect faecal continence, which may, in turn, impair quality of life (QOL). We assessed the QOL of patients with cryptoglandular anal fistula. Newly referred patients with anal fistula completed the St Mark's Incontinence Score, which ranges from 0 (perfect continence) to 24 (totally incontinent), and Short form 36 (SF-36) questionnaire at two institutions with an interest in anal fistula. The data were examined to identify factors affecting QOL. Data were available for 146 patients (47 women), with a median age of 44 years (range 18-82 years) and a median continence score of 0 (range 0-23). Versus population norms, patients had an overall reduction in QOL. While those with recurrent disease had no difference on continence scores, QOL was worse on two of eight SF-36 domains (pfistula patients, 19.4% of patients experienced urgency versus 36.3% of those with recurrent fistulas. Patients with anal fistula had a reduced QOL, which was worse in those with recurrent disease, secondary extensions and urgency. Loose seton had no impact on QOL.

  14. Late caliceal fistula after kidney transplantation. (United States)

    Król, Robert; Ziaja, Jacek; Kolonko, Aureliusz; Chudek, Jerzy; Wiecek, Andrzej; Cierpka, Lech


    Caliceal fistula is a rare urological complication that can occur usually shortly after kidney transplantation (KTx). The occlusion of the renal accessory artery with subsequent necrosis of the kidney pole is the most common cause of the fistula development. We report a case of a 57-year-old man with reconstruction of two accessory renal arteries by anastomosis to the side of the main artery during graft placement complicated by late caliceal fistula, managed surgically. Directly after KTx good kidney graft function (serum creatinine concentration 151 micromol/L) was observed. The patient noticed protuberance and pain in the kidney graft area 5 months later. Diagnostic imaging revealed moderate urostasis and liquid collection in the region of the lower graft pole. Administration of a contrast medium through the inserted drain visualized a fistula of a lower renal calyx and ureteric stenosis. Percutaneous drainage was applied with subsequent stop of diuresis through the urethral catheter. During the surgery, the resection of a lower kidney graft pole necrosis was performed, with the closure of caliceal fistula. Simultaneously double pigtail ureteric stent was inserted. After the next two months the pigtail catheter was removed, and neither urostasis in the kidney graft nor liquid collection in the perigraft area were observed. The exceptionality of the case is the late caliceal fistula occurrence. We may only speculate, why it happened 5 months after KTx. The thrombosis of stenosed accessory artery is the most probable cause.

  15. Management of anal fistula by ligation of the intersphincteric fistula tract

    DEFF Research Database (Denmark)

    Zirak-Schmidt, Samira; Perdawood, Sharaf


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

  16. Dynamics of Albumin Synthetic Response to Intra-Abdominal Abscess in Patients with Gastrointestinal Fistula (United States)

    Zhou, Bo; Han, Gang; Chen, Yu; A, Jiye; Gu, Guosheng; Chen, Jun; Wang, Gefei; Li, Jieshou


    Abstract Background: Low serum albumin concentration is a predictor of failure of source control for intra-abdominal infection. However, data on dynamics of albumin synthesis in these patients and to what extent these changes contribute to hypoalbuminemia are relatively scarce. We investigated in a group of patients with gastrointestinal fistula the dynamic response of liver albumin synthesis to intra-abdominal abscess and how these related to hypoalbuminemia and circulating endocrine hormone profiles. Methods: Eight gastrointestinal fistula patients scheduled to undergo percutaneous abscess sump drainage were enrolled prospectively to measure albumin synthesis rates at different stages of the inflammatory response (immediately after diagnosis and 7 d following sump drainage when clinical signs of intra-abdominal sepsis had been eradicated). Eight age-, sex-, and body mass index–matched intestinal fistula patients were studied as control patients. Consecutive arterial blood samples were drawn during a primed-constant infusion (priming dose: 4 micromol·kg−1, infusion rate: 6 micromol·kg−1·min−1) to determine the incorporation rate of L-[ring-2H5]-phenylalanine directly into plasma albumin using gas chromatography/mass spectrometry analysis. Results: Patients suffering from intra-abdominal infection had reduced plasma albumin and total plasma protein concentrations, compared with control patients. Albumin fractional synthesis rates in patients with intra-abdominal abscess were decreased, compared with those in the control group. When the source of infection was removed, albumin synthesis rates returned to control values, whereas albumin concentrations did not differ significantly from the corresponding concentrations in control subjects and patients with intra-abdominal abscess. Conclusion: Despite nutritional intervention, albumin synthesis rate is decreased in intestinal fistula patients with intra-abdominal abscess; albumin synthesis returns to

  17. Intestinal Phospholipase, a Novel Enzyme (United States)

    Mansbach, Charles M.; Pieroni, Gerard; Verger, Robert


    We evaluated phospholipase activity in the intestine of rats and other species. Phospholipase activity was assayed by a surface barostat technique or an egg yolk titration system. Mucosal activity was found only by the surface barostat technique with phosphatidylglycerol as substrate; it was not found with phosphatidylcholine as substrate in assays by either technique. In gut luminal fluid activity was found when both phosphatidylcholine and phosphatidylglycerol were used as substrate in assays by the surface barostat technique, and phosphatidylcholine as substrate yielded activity in egg yolk titration. In rats in which pancreatic juice had been diverted, mucosal and gut luminal phospholipase activity was greater than in controls, thus demonstrating that enzyme activity was not due to pancreatic phospholipase. Bacterial origin of phospholipase activity was excluded in that phospholipase activity was found in germ-free rats; gastric and salivary gland origins were excluded in that continued phospholipase activity was found in rats with gastric fistula. The physiological importance of the enzyme was established by the finding that rats with pancreatic fistula absorbed 111 μmol of phosphatidylcholine and that controls absorbed 119 μmol of a 135-μmol load. Activity was found to be three times greater in the distal than in the proximal intestine; in cryptal cells it was 10 times greater than in villus tip cells. 65% of the activity in the gut lumen was tightly bound to particulate matter. We propose that intestinal phospholipase may be important in gut bacterial control, in the digestion of vegetable matter (phosphatidylglycerol is a major phospholipid in both plants and bacteria), and in the digestion of phospholipids in the gut lumen. PMID:7056853

  18. Scalp congenital hemangioma with associated high-output cardiac failure in a premature infant: Case report and review of literature. (United States)

    Shah, Sumedh S; Snelling, Brian M; Sur, Samir; Ramnath, Alexandra R; Bandstra, Emmalee S; Yavagal, Dileep R


    Introduction Scalp congenital hemangiomas (CHs) are rare vascular malformations among infants; they can be associated with an array of complications, including cardiac and cosmetic issues. Here, we report the endovascular treatment of a premature infant with a suspected large right parietal scalp hemangioma and associated high-output cardiac failure. Case description A two-day-old female premature infant (29 weeks gestational age; 1330 g birth weight) was referred by the neonatologists to our department for consultation and potential treatment of a large right parietal CH causing abrupt hypotension and high-output cardiac failure. Doppler ultrasound imaging at bedside revealed areas of arterial-venous shunting from the scalp and the presence of a superior sagittal sinus waveform, consistent with intracranial venous drainage. To alleviate cardiac dysfunction secondary to this lesion, trans-arterial embolization via n-butyl cyanoacrylate (nBCA) glue and deployment of detachable coils was performed via umbilical artery to occlude the right superficial temporal and occipital artery branches supplying the CH. Following treatment, the infant continued to require ventilator management, vasopressor support, and correction of coagulopathy, but by post-operative day two, her condition improved remarkably and the mass size began decreasing. The patient was discharged after a relatively uncomplicated subsequent 2½-month course in the neonatal intensive care unit. Conclusion Endovascular therapy proved effective and safe in treating cardiac failure associated with scalp CH, despite potential complications associated with neuro-interventional surgery in premature infants. Appropriate consideration in this patient population should be given to factors including blood loss, contrast use, radiation exposure, operative time, and possible intra-/post-operative complications.

  19. Intestinal Surgery. (United States)

    Desrochers, André; Anderson, David E


    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Congenital rectovestibular fistula associated with rectal atresia: A rare occurrence


    Rizwan Ahmad Khan; Rajendra Singh Chana


    We report a rare variety of anorectal malformation, rectal atresia associated with rectovestibular fistula. The case was successfully treated by posterior sagittal repair. The fistula was mobilized and the continuity of the rectum was established by circumferential anastomosis.

  1. Urethrovaginal Fistula in a 5-Year-Old Girl (United States)

    Coulibaly, Noël; Sangaré, Ibrahima Séga


    Urethral fistulas are rare in girls. They occur most of the time during trauma. The case presented here is an iatrogenic fistula. The treatment was simple and consisted of a simple dissection and suture of urethra and vagina. PMID:25954566

  2. Imaging diagnosis of dural and direct cavernous carotid fistulae* (United States)

    dos Santos, Daniela; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante


    Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. PMID:25741093

  3. Imaging diagnosis of dural and direct cavernous carotid fistulae. (United States)

    Dos Santos, Daniela; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco E; Colli, Benedicto Oscar; Abud, Daniel Giansante


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

  4. Imaging diagnosis of dural and direct cavernous carotid fistulae

    Energy Technology Data Exchange (ETDEWEB)

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


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


    Directory of Open Access Journals (Sweden)

    Barbara Cvenkel


    Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

  6. Fistula gastrocólica

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

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

  7. Endoscopic Management of Gastrointestinal Leaks and Fistulae. (United States)

    Willingham, Field F; Buscaglia, Jonathan M


    Gastrointestinal leaks and fistulae can be serious acute complications or chronic morbid conditions resulting from inflammatory, malignant, or postsurgical states. Endoscopic closure of gastrointestinal leaks and fistulae represents major progress in the treatment of patients with these complex presentations. The main goal of endoscopic therapy is the interruption of the flow of luminal contents across a gastrointestinal defect. In consideration of the proper endoscopic approach to luminal closure, several basic principles must be considered. Undrained cavities and fluid collections must often first be drained percutaneously, and the percutaneous drain provides an important measure of safety for subsequent endoscopic luminal manipulations. The size and exact location of the leak/fistula, as well as the viability of the surrounding tissue, must be defined. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition, radiology, and surgery. Currently, gastrointestinal leaks and fistulae may be managed endoscopically by using 1 or more of the following modalities: stent placement, clip closure (including through-the-scope clips and over-the-scope devices), endoscopic suturing, and the injection of tissue sealants. In this article, we discuss these modalities and review the published outcomes data regarding each approach as well as practical considerations for successful closure of luminal defects. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  8. Lacrimal Gland Fistula following Severe Head Trauma

    Directory of Open Access Journals (Sweden)

    Cemil Demir


    Full Text Available We aim to present a unique case with discharging lacrimal gland fistula secondary to severe head trauma by an animal. A 9-year-old girl presented with serous fluid discharge from a cutaneous fistula in the left orbital region. The patient had history of surgery for traumatic frontal bone fracture and skin laceration in the superior orbital rim three weeks earlier. She underwent a complete ophthalmological examination and there was no anterior segment or fundus pathology. The orifice of the fistula was detected in mediolateral part of the left superior orbital rim and fluid secretion was increasing with irritation of the left eye. Neurosurgical complications were excluded and radiological assessment was nonremarkable. The patient’s legal representatives were informed and lacrimal gland fistulectomy was planned. However, the fistula was self-closed one week after initial ophthalmological examination, and the patient had no symptoms. In conclusion, traumatic injuries of superior orbital region should be carefully evaluated and wounds should be well closed to prevent consecutive lacrimal gland fistula.

  9. Intraventricular hemorrhage after dural fistula embolization

    Directory of Open Access Journals (Sweden)

    Joana Chaves Gonçalves Rodrigues de Carvalho

    Full Text Available Abstract Background and objectives: Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases. Case report: A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae. Conclusion: Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.

  10. A simple procedure for management of urethrocutaneous fistulas ...

    African Journals Online (AJOL)

    Objectives: The treatment of urethral fistulas is quite challenging. We try to evaluate the results of a simple procedure in post-hypospadias urethral fistula repair. Materials and Methods: In the period from 2003 to 2007, 35 patients with 35 fistulas, with an average age 3.5 years [range: 2-8], were classified into coronal 12, ...

  11. An Experience in Arterio-Venous Fistula creation for Chronic ...

    African Journals Online (AJOL)

    Obtaining a vascular access for haemodialysis is very vital in the long-term management of patients with end-age renal disease. This is achieved via an autogenous (primary) arteriovenous fistula or a grafted fistula in situations where autogenous fistulas may not function. Complications such as thrombosis and infection are ...

  12. Histological identification of epithelium in perianal fistulae: a prospective study

    NARCIS (Netherlands)

    van Koperen, P. J.; ten Kate, F. J. W.; Bemelman, W. A.; Slors, J. F. M.


    A procedure often performed following fistulotomy and advancement flap is curettage of the fistula tract after fistulotomy or after closing the internal opening. Epithelialization of the fistula tract might prevent closure of the fistula tract. The aim of this study was to assess the incidence and

  13. Paediatric Acquired Recto –Vestibular Fistula: Experience In Accra ...

    African Journals Online (AJOL)

    The association of acquired recto-vaginal fistula (RVF) with the human immunodeficiency virus is increasingly being recognized and reported in the literature Congenital recto - vestibular fistulae associated with imperforate anus is not uncommon, but it is rare to see children with acquired recto - vestibular fistula. From 1997 ...

  14. A simple procedure for management of urethrocutaneous fistulas ...

    African Journals Online (AJOL)

    Midline relaxing incision was used for large fistulas and then covered with a vascularised flap dartos-based flap [flip flap] in 19 and tunica vaginalis in 16. If a patient had more than one small fistula adjacent to each other, they were joined into a large single fistula and then repaired. Results: We have successfully repaired all ...

  15. The management of a coronary cameral fistula: lessons learnt

    African Journals Online (AJOL)


    Sep 21, 2011 ... Surgery for closure of the fistulae was planned months later when the patient was symptom-free. Preoperatively, on admission to the cardiothoracic ward, his blood pressure was. 138/89 mmHg ... Keywords: coronary arteriovenous fistula, coronary cameral fistula, cardiac disease, coronary artery anomaly.

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

    African Journals Online (AJOL)

    Enterocutaneous fistulas cause significant morbidity and mortality and can challenge even the most experienced surgeon (1). In the developed countries, most fistulas are due to Crohn's disease (2) but may also arise to postoperatively (3). Historically, when enterocutaneous fistulas developed, less than half closed ...

  17. 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. (United States)

    Zawadzki, Antoni; Johnson, Louis Banka; Bohe, Måns; Johansson, Claes; Ekelund, Mats; Nielsen, Ole Haagen


    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. An open, single-arm, prospective study with active treatment for 8 weeks and an optional follow-up until week 24 ( identifier NCT01462747) among patients with chronic, uncomplicated perianal fistulas scheduled for surgery was conducted. Of 28 patients included, 10 patients (35.7%) showed complete fistula healing (closed, no discharge on palpation) after 8 weeks; seven of these patients, corresponding to 25% of the enrolled patients, remained in remission for up to 31 weeks. At week 8, there was a statistically significant reduction in the discharge visual analog scale (p = 0.04), a significant improvement in the patient-perceived quality of life for the category of embarrassment (p = 0.002), and a trend toward improvement in the other assessment categories. The treatment was well tolerated, and patient acceptance was high. The results support the efficacy and safety of locally administered activated carbon for the treatment of patients with chronic uncomplicated perianal fistulas not receiving any other medication for fistula problems.

  18. Eyelid liquoric fistula secondary to orbital meningocele

    Directory of Open Access Journals (Sweden)

    Renato Antunes Schiave Germano


    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.

  19. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    Directory of Open Access Journals (Sweden)

    Sala Abdalla


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

  20. Eguchipsammia fistula Microsatellite Development and Population Analysis

    KAUST Repository

    Mughal, Mehreen


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


    Directory of Open Access Journals (Sweden)

    Sushma Ramteke


    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

  2. Transmission of laser pulses with high output beam quality using step-index fibers having large cladding (United States)

    Yalin, Azer P; Joshi, Sachin


    An apparatus and method for transmission of laser pulses with high output beam quality using large core step-index silica optical fibers having thick cladding, are described. The thick cladding suppresses diffusion of modal power to higher order modes at the core-cladding interface, thereby enabling higher beam quality, M.sup.2, than are observed for large core, thin cladding optical fibers. For a given NA and core size, the thicker the cladding, the better the output beam quality. Mode coupling coefficients, D, has been found to scale approximately as the inverse square of the cladding dimension and the inverse square root of the wavelength. Output from a 2 m long silica optical fiber having a 100 .mu.m core and a 660 .mu.m cladding was found to be close to single mode, with an M.sup.2=1.6. Another thick cladding fiber (400 .mu.m core and 720 .mu.m clad) was used to transmit 1064 nm pulses of nanosecond duration with high beam quality to form gas sparks at the focused output (focused intensity of >100 GW/cm.sup.2), wherein the energy in the core was 20 mJ delivered for 50 ns pulses) without damaging the silica fiber.

  3. Laparoscopic repair for vesicouterine fistulae

    Directory of Open Access Journals (Sweden)

    Rafael A. Maioli


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

  4. Tracheoesophageal fistula after blunt chest trauma. (United States)

    Reed, W J; Doyle, S E; Aprahamian, C


    Tracheoesophageal fistula is a very rare but potentially life-threatening complication of blunt chest trauma. Prior reviews have revealed that the victims were all young men involved in deceleration or crush injuries. Of those involved in motor vehicle accidents, most were thrown against the steering wheel. Herein, we review the world literature on this injury and include our own report of 1 of the few cases of traumatic tracheoesophageal fistula involving a female victim. In this case, the victim was an unrestrained driver thrown against an air bag.

  5. Vector Volume Flow in Arteriovenous Fistulas

    DEFF Research Database (Denmark)

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


    The majority of patients with end stage renal disease are in hemodialysis, and therefore dependent on a well functioning vascular access. The arteriovenous fistula is the recommended access and in order to maintain and keep the fistula patent, regular monitoring of the function is necessary....... The Ultrasound Dilution Technique is the reference method for volume flow measurement, but it only works in conjunction with the dialysis machine, and use is therefore restricted to dialysis sessions. Volume flow measurement with conventional Doppler ultrasound provides a non invasive, highly accessible solution...

  6. Intrahepatic arterioportal fistulae: role of transcatheter embolization. (United States)

    Tarazov, P G


    Management of 26 arterioportal fistulae (APFs) is reported. Among 13 hepatoma-induced fistulae (group A), conservative treatment was ineffective in 8 patients, and arterial embolization alleviated portal hypertension in the other 5. Of 10 iatrogenic APFs (group B), the 3 largest were successfully embolized, the remaining lesions resolved spontaneously. Three spontaneous nonmalignant APFs (group C) were embolized. Excellent results were obtained in 2 patients, and the other died of severe postembolization hepatic failure. Because long-standing APFs may cause severe portal hypertension with consequent variceal bleeding they should be treated. Arterial embolization is indicated in most patients.

  7. [Ruptured aortoiliac aneurysm with AV-fistula]. (United States)

    Kinkel, B; Ertecoglou, E; Pauleit, D


    A 65-year-old man presented an acute swelling of the left leg as the main sign. A pulsatile bruit could be auscultated over the abdomen. Doppler ultrasound suggested an aortic aneurysm with fistula. Dynamic bolus-triggered computed tomography demonstrated an aortoiliac aneurysm with a fistula into the confluence of the common iliac veins. An aorto-iliac graft was inserted surgically and and the patient recovered well. In patients with an acute swelling of a lower limb an aorto-iliac aneurysm, though a rare cause, should be considered.

  8. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. (United States)

    Demartini, Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha, Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis


    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

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

    Directory of Open Access Journals (Sweden)

    Gábor Bognár


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

  10. The brachio-brachial arteriovenous fistula: mid-term results. (United States)

    Dorobantu, Lucian Florin; Iliescu, Vlad Anton; Stiru, Ovidiu; Bubenek, Serban; Novelli, Eugenio


    To evaluate the mid-term results of the brachio-brachial arteriovenous fistula in patients without adequate superficial venous circulation in the upper limb. Retrospective analysis included 49 patients, in whom a brachio-brachial fistula had been created in an end-to-side configuration. After the maturation period (1 month), the brachial vein was transposed into the subcutaneous tissue. Follow-up study was performed in patients with functional brachio-brachial fistula after the superficialization. Forty-nine patients underwent 49 brachio-brachial fistula constructions. All fistulas were functional. One month after surgery, 40 (81.6%) of these patients had a functional fistula, but in only 39 (79.6%) cases was the fistula suitable for hemodialysis (HD) following transposition to subcutaneous tissue. During the 1-month maturation period, the fistula became occluded in nine patients, and in one case the vein was permeable, so the fistula was functional, but too small to permit HD. Seventeen patients developed temporary edema of the forearm during the first month, in three cases the edema was extended to the entire arm, but no other complications were associated with the procedure. Follow-up lasted 18.0 +/- 11.1 (3-37) months, during which 7/39 patients presented with fistula occlusion. Three patients died and another three were out of the study for various reasons. The brachio-brachial fistula is a good alternative to prosthetic grafts in patients without superficial venous circulation in the upper limb.

  11. A Delayed Recrudescent Case of Sigmoidocutaneous Fistula due to Diverticulitis

    Directory of Open Access Journals (Sweden)

    Takaaki Fujii


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

  12. Intestinal Ischemia (United States)

    ... weight loss Intestinal ischemia Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  13. The gut microbiome in intestinal fibrosis: environmental protector or provocateur? (United States)

    Rieder, Florian


    In individuals with inflammatory bowel diseases, intestinal fibrosis is a serious clinical complication with no specific therapies. Patients develop bowel fistulae and strictures that usually require surgery and often reoccur. The main driver of gut fibrogenesis is believed to be chronic inflammation, which leads to mesenchymal cell recruitment and activation. Recent findings suggest that the environment--in particular, the microbiome--plays a critical role in this process.

  14. A utility piezoelectric energy harvester with low frequency and high-output voltage: Theoretical model, experimental verification and energy storage

    Directory of Open Access Journals (Sweden)

    Guangyi Zhang


    Full Text Available In this paper, a utility piezoelectric energy harvester with low frequency and high-output voltage is presented. Firstly, the harvester’s three theoretical models are presented, namely the static model, the quasi static model and the dynamic vibration model. By analyzing the influence of the mass ratio of the mass block to the beam on output characteristics of the harvester, we compare the quasi static model and the dynamic vibration model and then define their applicable ranges. Secondly, simulation and experiments are done to verify the models, using the harvester with PZT-5H piezoelectric material, which are proved to be consistent with each other. The experimental results show that the output open-circuit voltage and the output power can reach up to 86.36V and 27.5mW respectively. The experiments are conducted when this harvester system is excited by the first modal frequency (58.90Hz with the acceleration 10m/s2. In this low frequency vibration case, it is easy to capture the energy in the daily environment. In addition, LTC 3588-1 chip (Linear Technology Corporation is used as the medium energy circuit to transfer charges from the PZT-5H electrode to the 0.22F 5V super capacitor and ML621 rechargeable button battery. For this super-capacitor, it takes about 100min for the capacitor voltage to rise from 0V to 3.6V. For this button battery, it takes about 200min to increase the battery voltage from 2.5V to 3.48V.

  15. Responses of mRNA expression of PepT1 in small intestine to ...

    African Journals Online (AJOL)



    May 4, 2009 ... To study the effect of circulation small peptides concentration on mRNA expression in small intestine, graded amount of soybean small peptides (SSP) were infused into lactating goats through duodenal fistulas. Peptide-bound amino acid (PBAA) concentration in arterial plasma and the mRNA expression.

  16. Responses of mRNA expression of PepT1 in small intestine to ...

    African Journals Online (AJOL)

    To study the effect of circulation small peptides concentration on mRNA expression in small intestine, graded amount of soybean small peptides (SSP) were infused into lactating goats through duodenal fistulas. Peptide-bound amino acid (PBAA) concentration in arterial plasma and the mRNA expression of PepT1 was ...

  17. Obstetric urogenital fistula: The Ilorin experience, Nigeria

    African Journals Online (AJOL)


    Dec 31, 1998 ... tula managed over a ten-year period (lst January, 1989 to. 31st December, 1998) at the University of Ilorin Teaching. Hospital is reported. The incidence of obstetric urogenital fistula is 1.1 per 1000 births. The condition is associated with illiteracy and poorly supervised delivery. The peak incidence is in 15 ...

  18. Assessment and management of urethrocutaneous fistula ...

    African Journals Online (AJOL)

    Background/Purpose To highlight and assess the different factors related to the development of urethrocutaneous fistulae (UCFs) after hypospadias repair, and the outcome of their repair using two different techniques. Patients and methods In the period June 2009 to October 2010, all patients presenting to the Pediatric ...

  19. Urethrocutaneous fistula complicating circumcision in children

    African Journals Online (AJOL)


    May 22, 2013 ... Thus, the patients might be uncooperative intraoperatively resulting in hasty clamping of urethral wall alongside the frenular vessels while securing hemostasis or in some cases inadvertent scalpel injury to the urethral wall. The consequent fistula is synonymous with this method as reported in some studies.

  20. Current Evidence Supporting Obstetric Fistula Prevention Strategies ...

    African Journals Online (AJOL)

    Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and ...

  1. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

    Directory of Open Access Journals (Sweden)

    Nilüfer Çetiner


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

  2. Management of fistulae in the abdominal region. (United States)

    Hocevar, Barbara J; Erwin-Toth, Paula; Landis-Erdman, Judy; Wu, James S; Navage, Ann; Duell, Ellen; Dunbar, Shirley; Barnard, Anne; Skinner, Catherine; Anderson, Diana; Shires, George Thomas; Hietala, Lea; Griffin, Sandra; Owens, Cindy; Lynch, Cheryl; Snyder, Susan


    We evaluated a new fistula and wound management system; ostomy and wound care nurses were queried about willingness to use the product in future patients, product wear time and pouch leakage, perifistular skin condition, access for wound care, pouching time, patient mobility and comfort, odor management, pouch flexibility, adhesiveness, and erosion. A health economic assessment was also done. Twenty-two patients (5 males and 17 females) with an abdominal fistula participated in the study. Participants tested 75 pouches, representing an average of 3.4 pouches per subject. The investigator at each site who performed the pouch changes completed a questionnaire at baseline, during the test, and after testing the pouches. Participants also completed a set of questions after each test pouch was removed. In 21 of 22 cases, the nurses would consider using the new system on future patients. After each pouch removal, patients were asked whether they were able to move around while wearing the test pouch and they answered yes 95% of the time. The new system was found to have significantly longer wear time than traditional systems (P = .003), but the average time spent on changing the pouches was not significantly different (P = .07). Access for fistula and wound care was rated as excellent in the new pouching system, and comfort was rated as very good. The results of the study suggest that all of the key requests received from nurses for an improved system for fistula and wound management were met by the new system.

  3. [Therapeutical options in lithiasic biliary fistula]. (United States)

    Ungureanu, D; Brătucu, E; Daha, C


    Chronic lythiasic cholecystitis is a disease distinguished by the pathologic changes because of the chronic inflammation of the biliary extrahepatic tree. Sometimes these morphological changes are associated with internal biliary fistulas arising spontaneously in patients with advanced calculus cholecystitis. The vast majority of fistulas result from the adherence of the inflamed gallbladder or common bile duct to an adjacent viscus and erosion of the gallstones into the adherent organ. The authors analyze an amount of 43 patients with bilio-biliary and bilio-digestive lythiasic fistulas, caused by the long evolution of chronic lythiasic atrophic cholecystitis, for 126 cases which were operated in the Surgery Department of the Caritas Clinic Hospital along 20 years. In these 126 cases the surgical strategy was determinated by the method of dealing with the pericolecystitis sclerotic blocks, by the identification methods of the biliary elements and by the approach of the main billiary way and digestive loops injuries occurred after suppressing the fistulae. The surgical solutions adapted for each separate case and the advantages of the axial drainage of prostheting the surgical reconstructions of the main biliary way as well as the results obtained along this project, are in fact the aims of this presentation.

  4. Combined Vesicovaginal and Rectovaginal Fistulas Associated with ...

    African Journals Online (AJOL)

    but rarely lead to the formation of a fistula. Such complications are frequently associated with the insertion of aerosol caps into the vagina, but also other objects including small cups, metal boxes and plastic bottle caps have been reported3,4. Due to the association with sexual gratification, these patients are ashamed, so.

  5. A systematic literature review on the use of vacuum assisted closure for enterocutaneous fistula. (United States)

    Misky, A; Hotouras, A; Ribas, Y; Ramar, S; Bhan, C


    Enterocutaneous fistula (ECF) is considered to be one of the most challenging complications a general surgeon can encounter. The current mainstay of treatment is surgical closure, associated with significant morbidity and mortality. Vacuum assisted closure (VAC) has been successfully used for closure of persistent abdominal wounds for a number of years. This study aims to investigate whether current literature supports the use of VAC for ECF. A PubMed search of the search terms 'enterocutaneous fistula' and 'vacuum assisted closure/therapy' was performed in December 2014. Results were restricted to articles involving human subjects with an available abstract and full text written between 1950 and 2014. The end-points analysed included rate of fistula closure, duration of follow-up, and morbidity and mortality where available. Ten studies (all level IV) including 151 patients were examined. In all except one, surgery was the underlying aetiology with median number of fistulae per patient of one. The median rate of closure with VAC was 64.6% (7.7-100%) with healing occurring within 58 (12-90) days. Follow-up was only mentioned in three of the 10 studies, in which the patients were followed for 3, 20 and 28.5 months. No complications were reported in all but one of the studies, in which abdominal wall disruption and intestinal obstruction were identified in a minority of patients. The included studies suggest that VAC therapy may be considered a safe treatment for ECF. The current evidence is generally of low level and characterized by heterogeneity. Definitive recommendations based on this information cannot therefore be made. Further studies are necessary to establish any proven benefit over standard surgical or conservative therapy. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  6. The immediate management of fresh obstetric fistulas. (United States)

    Waaldijk, Kees


    It has been a general rule to wait with the repair of an obstetric fistula for a minimum period of 3 months allowing the patient to become an outcast. In a prospective way an immediate management was studied and antibiotics were not used, all according to basic surgical principles. A total of 1716 patients with a fistula duration of 3 to 75 days after delivery were treated immediately on presentation by catheter and/or early closure. Instead of antibiotics, a high oral fluid regimen was instituted. The fistulas were classified according to anatomic and physiologic location in types I, IIAa, IIAb, IIBa, and IIBb, and according to size in small, medium, large, and extensive. The operation became progressively more complicated from type I through type IIBb and from small through extensive. At first attempt 1633 fistulas (95.2%) were closed and another 57 could be closed at further attempt(s), accounting for a final closure in 1690 patients (98.5%); 264 patients (15.4%) were healed by catheter only. Of these 1690 patients with a closed fistula, 1575 (93.2%) were continent and 115 (6.8%) were incontinent. The results as to closure and to continence became progressively worse from type I through type IIBb and from small through extensive. Postoperative wound infection was not noted; postoperative mortality was encountered in 6 patients (0.4%). This immediate management proves highly effective in terms of closure and continence and will prevent the patient from becoming an outcast with progressive downgrading medically, socially, and mentally.

  7. [Endovascular management of cavernous sinus dural fistulas]. (United States)

    Zenteno, Marco; Santos Franco, Jorge; Moscote-Salazar, Luis Rafael; Lee, Angel


    Describe the outcomes of patients diagnosed with indirect carotid-cavernous fistula treated by endovascular methods. A retrospective case series. Twelve patients with dural cavernous sinus fistula with important ophthalmologic involvement admitted and treated at the National Institute of Neurology and Neurosurgery between February 1990 and January 2005. Patients were managed by endovascular embolization for all fistulas. Angiographic controls to 24 hours and at 6 and 12 months were performed. 67 % were female and 33 % male. The mean age was 44 years. 67 % were spontaneous and 33% of traumatic origin. All patients had eye involvement with proptosis (92%) and involvement of the oculomotor nerve (67%). Headache and pulsatile tinnitus were not frequent ophthalmologic data. All were diagnosed by cerebral angiography, 33 % were type C, type D 67 %, and none of the type B classification Barrow. In 17 % of cases the distal arterial robbery showed severe. Predominance of anterior and superior venous drainage in 83 % and 42 % of cases occurred respectively. The surgical approach was arterial in 84% of cases, while in 17 % venous through the superior ophthalmic vein. Cyanoacrylate embolization material was used in 58 % of the cases, as it was associated with the use of removable ball with polyvinyl alcohol particles in 16 % in of venous approach cases. 17% detachable coils were utilized. There were no complications. After angiographic controls at 24 hours 100% occlusion was seen in patients treated with cyanoacrylate (58%) (p = 0.03). The remaining 42% were prescribed maneuver of manual compression. At 12-months angiography all patients had 100% occlusion of the carotid-cavernous fistula. CONCLSUIONS: This is the world's second largest series with indirect carotid-cavernous fistulas treated after trauma. 100 % of cases were cured with the use of a transarterial-controlled approach and N-butyl-cyanoacrylate after long-term observation.

  8. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae. (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Pongpech, Sirintara


    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. 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. 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. 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.

  9. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. (United States)

    Wang, Chen; Diao, Mei; Li, Long; Liu, Shuli; Chen, Zheng; Li, Xu; Cheng, Wei


    Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

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


    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.)

  11. Laparoscopic resection of chronic sigmoid diverticulitis with fistula. (United States)

    Abbass, Mohammad A; Tsay, Anna T; Abbas, Maher A


    A growing number of operations for sigmoid diverticulitis are being done laparoscopically. There is a paucity of data on the outcome of laparoscopy for sigmoid diverticulitis complicated by colonic fistula. The aim of this study was to compare the results of laparoscopic resection of sigmoid diverticulitis with and without colonic fistula. A retrospective review was conducted of all patients who underwent laparoscopic resection of sigmoid diverticulitis complicated by fistula at a single tertiary care institution over a 7-year period. Comparison was made with a group of patients who underwent resection for diverticulitis without fistula during the same study period. Forty-two patients were analyzed (group 1: diverticular fistula, group 2: no fistula). The median age was similar (49 vs. 50 years, P = .68). A chronic abscess was present in 24% of patients in group 1 and 10% in group 2 (P = .40). Fistula types were colovesical (71%), colovaginal (19%), and colocutaneous (10%). Operation types were sigmoidectomy (57% vs. 81%) and anterior resection (43% vs. 19%) in groups 1 and 2, respectively (P = .18). Ureteral catheters were used more frequently in group 1 (67% vs. 33% [P = .06]). No difference was noted in operative time, blood loss, conversion rate, length of stay, overall complications, wound infection rate, readmission rate, reoperation rate, and mortality. All patients healed without fistula recurrence. Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula.

  12. Surgical management of complex obstetric fistula in Eritrea. (United States)

    Husain, Amreen; Johnson, Khaliah; Glowacki, Carol A; Osias, Joelle; Wheeless, Clifford R; Asrat, Kibreab; Ghebrekidan, Abrehet; Polan, Mary Lake


    To evaluate the incidence of and demographic characteristics associated with obstetric fistula in Eritrea. To determine the outcomes of surgical repair of complex fistula in Eritrea by a visiting surgical team. A surgical team comprising expert gynecologic surgeons traveled to Eritrea in September 2004. We evaluated 50 patients with genitourinary fistula and performed surgical repairs of these fistulas on 37 women via both vaginal and abdominal approaches. Demographic and basic medical data were obtained at the time of evaluation, and follow-up questionnaires were completed at 4 weeks postoperative. The majority of the women had fistulas related to obstructed labor at their first pregnancy unattended by any healthcare professional. The average duration of labor was 3 days, and more than half had resulted in stillbirths. The rate of successful repair in women with primary vesicovaginal fistulas (VVF) was 63%, and that in women with recurrent vesicovaginal fistulas was 61%. Two women required urinary diversion procedures because of the severity of the damage to the genital tract. Urethral reconstruction in women with urethrovaginal fistulas (UVFs) was successfully accomplished in 77% of patients. The rate of successful repair of rectovaginal fistulas (RVFs) was 87%. We have demonstrated that a team of specialized surgeons can successfully accomplish surgical procedures and repairs of very complex urinary tract fistulas in a very short mission to a resource-poor nation.

  13. Digestive system fistula: a problem still relevant today. (United States)

    Głuszek, Stanisław; Korczak, Maria; Kot, Marta; Matykiewicz, Jarosław; Kozieł, Dorota


    Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries. THE AIM OF THE STUDY was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment. MATERIAL AND METHODS. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed. RESULTS. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma). CONCLUSIONS. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.

  14. Pro-inflammatory cytokines in cryptoglandular anal fistulas. (United States)

    van Onkelen, R S; Gosselink, M P; van Meurs, M; Melief, M J; Schouten, W R; Laman, J D


    Sphincter-preserving procedures for the treatment of transsphincteric fistulas fail in at least one out of every three patients. It has been suggested that failure is due to ongoing disease in the remaining fistula tract. Cytokines play an important role in inflammation. At present, biologicals targeting cytokines are available. Therefore, detection and identification of cytokines in anal fistulas might have implications for future treatment modalities. The objective of the present study was to assess local production of a selected panel of cytokines in anal fistulas, including pro-inflammatory interleukin (IL)-1β and tumor necrosis factor α (TNF-α). Fistula tract tissue was obtained from 27 patients with a transsphincteric fistula of cryptoglandular origin who underwent flap repair, ligation of the intersphincteric fistula tract or a combination of both procedures. Patients with a rectovaginal fistula or a fistula due to Crohn's disease were excluded. Frozen tissue samples were sectioned and stained using advanced immuno-enzyme staining methods for detection of selected cytokines, IL-1β, IL-8, IL-10, IL-12p40, IL-17A, IL-18, IL-36 and TNF-α. The presence and frequencies of cytokine-producing cells in samples were quantitated. The key finding was abundant expression of IL-1β in 93 % of the anal fistulas. Frequencies of IL-1β-producing cells were highest (>50 positive stained cells) in 7 % of the anal fistulas. Also, cytokines IL-8, IL-12p40 and TNF-α were present in respectively 70, 33 and 30 % of the anal fistulas. IL-1β is expressed in the large majority of cryptoglandular anal fistulas, as well as several other pro-inflammatory cytokines.

  15. The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy. (United States)

    Vauthey, J N; Tomczak, R J; Helmberger, T; Gertsch, P; Forsmark, C; Caridi, J; Reed, A; Langham, M R; Lauwers, G Y; Goffette, P; Lerut, J


    Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. The aim of this study was to determine the etiology, anatomical location, and main symptom at presentation of APFs, and analyze the various modes of treatment. The etiology, clinical presentation, radiographs, and treatment of 12 patients with APFs are reported in detail, and another 76 cases published since 1980 are reviewed. APFs result from trauma (n = 25, 28%), iatrogenic procedures (n = 14, 16%), congenital vascular malformations (n = 13, 15%), tumor (n = 13, 15%), aneurysm (n = 12, 14%), and other causes (n = 11, 12%). The origin of APFs is the hepatic artery in the majority of patients (n = 56, 65%). The main symptoms at presentation are lower or upper gastrointestinal bleeding (n = 29, 33%), ascites (n = 23, 26%), heart failure (n = 4.5%), or diarrhea (n = 4.5%). Radiological intervention provides definitive treatment in 42% (n = 33) of patients, whereas the remainder are treated by surgery alone (n = 27, 31%) or a combination of radiological intervention and surgery (n = 8, 9%). APFs result in a protean syndrome variously combining portal hypertension and other hemodynamic imbalances (heart failure, intestinal ischemia). Single or multiple interventional radiological procedures using arterial and/or venous approaches allow definitive treatment of most APFs. With increasing technological advances, it is anticipated that surgery will only be indicated in rare instances after failure of radiological intervention(s).

  16. High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis. (United States)

    Mintziras, Ioannis; Miligkos, Michael; Bartsch, Detlef Klaus


    The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation. The hospital OPS-database (time period 2005-2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients' characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation. Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24-90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3-88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

  17. Espiroquetosis intestinal


    Vera Sempere, Francisco José


    El término “espiroquetosis intestinal” fue introducido por Harland y Lee en 1967 -en una breve comunicación publicada en el British Medical Journal- para describir una infección intestinal que morfológicamente se manifiesta en la biopsia de colon/recto por la presencia de una banda de microorganismos, adheridos a la superficie del epitelio de la mucosa intestinal y que fueron identificados al microscopio electrónico como espiroquetas. La definición por lo tanto de este pr...

  18. Primarily Proximal Jejunal Stone Causing Enterolith Ileus in a Patient without Evidence of Cholecystoenteric Fistula or Jejunal Diverticulosis

    Directory of Open Access Journals (Sweden)

    Houssam Khodor Abtar


    Full Text Available Stone formation within the intestinal lumen is called enterolith. This stone can encroach into the lumen causing obstruction and surgical emergency. Jejunal obstruction by an enterolith is a very rare entity and often missed preoperatively. To our knowledge, most cases of jejunal obstruction, secondary to stone, were associated with biliary disease (cholecystoenteric fistula, bezoar, jejunal diverticulosis, or foreign body. Hereby we present a rare case report of small bowel obstruction in an elderly man who was diagnosed lately to have primary proximal jejunal obstruction by an enterolith without evidence of a cholecystoenteric fistula or jejunal diverticulosis. This patient underwent laparotomy, enterotomy with stone extraction, and subsequent primary repair of the bowel.

  19. Asymptomatic Cholecystocolonic Fistula: A Diagnostic and Therapeutic Dilemma

    Directory of Open Access Journals (Sweden)

    Nicola Antonacci


    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.

  20. Tentorial artery embolization in tentorial dural arteriovenous fistulas

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


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

  1. Closure of oroantral fistula with rotational palatal flap technique

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja


    Full Text Available Oroantral fistula is one of the common complications following dentoalveolar surgeries in the maxilla. Closure of oroantral fistula should be done as early as possible to eliminate the risk of infection of the antrum. Palatal flap is one of the commonly used methods in the closure of oroantral fistula. A case is reported of a male patient who had two oroantral communication after having his two dental implants removed. Buccal flap was used to close the defects, but one of them remained open and resulted in oroantral fistula. Second correction was performed to close the defect using buccal fat pad, but the fistula still persisted. Finally, palatal rotational flap was used to close up the fistula. The result was good, as the defect was successfully closed and the donor site healed uneventfully.

  2. Small intestinal absorption during endotoxemia in swine. (United States)

    Kanno, S; Emil, S; Kosi, M; Monforte-Munoz, H; Atkinson, J


    We studied the effects of systemic endotoxemia on small intestinal absorption in an in vivo animal model. Seven adolescent Yorkshire swine underwent creation of 25 cm distal ileal Thiry-Vella fistulae. After 1 week recovery, the fistulae were perfused with a solution of glucose and electrolytes labeled with 14C-PEG, and net absorption of water, Na+, Cl-, and glucose was calculated. Animals were studied under three different conditions: (1) Basal fasting state, (2) immediately after intravenous injection of E. coli lipopolysaccharide (LPS; 250 micrograms/kg), and (3) 24 hours after LPS. Water, Na+, and Cl- absorption was significantly reduced 2 hours after LPS, but recovered to baseline values by the third hour after LPS. Twenty-four hours after LPS water, Na+, and Cl- absorption was significantly decreased below baseline values. Glucose absorption after LPS paralleled that of water and electrolytes, except that the transient early recovery was not observed. Histological studies of the ileum after LPS showed marked epithelial inflammation at 6 hours, villous atrophy at 24 hours, and signs of recovery at 7 days. Intestinal absorption of water, electrolytes, and glucose is adversely affected in the immediate and early periods after an endotoxemic episode, but the histological epithelial injury secondary to endotoxemia is reversible.

  3. Comparative Analysis of the Antioxidant Activity of Cassia fistula Extracts


    Irshad, Md.; Zafaryab, Md.; Singh, Man; Rizvi, M. Moshahid A.


    Antioxidant potential of various extracts of Cassia fistula was determined by the DPPH, FRAP, Fe3+ reducing power, and hydrogen peroxide scavenging assay. Methanolic extracts of Cassia fistula showed the highest amount of phenolic and flavonoid content and reducing capacity, whereas hexane extracts exhibited the lowest level of reducing capacity. The order of antioxidant activity in Cassia fistula extracts displayed from higher to lower level as methanolic extracts of pulp, methanolic extract...

  4. Role of diaphragm in pancreaticopleural fistula. (United States)

    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic "stomata" does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization.

  5. Role of diaphragm in pancreaticopleural fistula (United States)

    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic “stomata” does not contribute to the formation of such a pleural effusion, as it is inaccurately mentioned in that report. A strictly conservative approach is recommended in that article as the management of choice. Although this may be an option in selected frail patients, there has been enough accumulative evidence that a pancreaticopleural fistula may be best managed by early endoscopy in order to avoid complications causing prolonged hospitalization. PMID:21990959

  6. Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis

    Directory of Open Access Journals (Sweden)

    Jose R. De Souza


    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.

  7. [Clinical study of 18 vesicointestinal fistulas]. (United States)

    Yoshida, Takahiro; Harada, Yasunori; Uemura, Motohide; Kanno, Nobuhumi; Nishimura, Kensaku; Miyoshi, Susumu; Nezu, Riichiro


    We studied 18 cases of vesicointestinal fistula surgically treated between January 2001 and July 2005. The underlying'cause was an inflammatory disease in 12 cases, a carcinoma in 5 and injury (post-radiation therapy) in 1 case. The fistula was visualized by cystography in 2 cases and enterography in 4. Surgical procedures were cystectomy with enterectomy in 2 cases, partial cystectomy with enterectomy in 3, bladder wall overlay-suture with enterectomy in 6 and enterectomy alone in 4. In 3 cases, colostomy without enterectomy was performed for palliative surgery. In all cases the postoperative course was good and surgical treatment was effective. Surgical procedures varied in each case depending on the etiology and the patient's condition.

  8. Coronary fistula resembling patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Sgarbieri Ricardo Nilsson


    Full Text Available A 14-year-old girl, presenting with heart failure and a continuous murmur, similar to that of a patent arterial duct, was investigated using echocardiogram and cardiac catheterization revealing a left to right shunt throught a coronary artery fistulae between the first septal branch and the right ventricular outflow tract. The patient was submitted to surgery, occluding the anomalous branch by the suturing of its orifice in the right ventricular outflow tract, under cardiopulmonary bypass. After the operation, cardiac catheterization revealed complete occlusion of the fistula without any residual shunt or compromise to the coronary circulation. In seven years of follow-up the patient is completely free of symptoms.

  9. Role of diaphragm in pancreaticopleural fistula


    Ninos, Anestis P; Pierrakakis, Stephanos K


    A pancreatic pleural effusion may result from a pancreatopleural fistula. We herein discuss two interesting issues in a similar case report of a pleural effusion caused after splenectomy, which was recently published in the World Journal of Gastroenterology. Pancreatic exudate passes directly through a natural hiatus in the diaphragm or by direct penetration through the dome of the diaphragm from a neighboring subdiaphragmatic collection. The diaphragmatic lymphatic “stomata” does not contrib...

  10. Medical image of the week: tracheoesophageal fistula

    Directory of Open Access Journals (Sweden)

    Wong C


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

  11. [Nonsurgical treatment of coronary pulmonary arteriovenous fistula]. (United States)

    Cano, M N; Kambara, A; Maldonado, G; Mattos, L A; Tanajura, L F; Fontes, V F; Pinto, I M; Feres, F; Sousa, A G; Sousa, J E


    Fifty eight year old man, with dyspnea, fatigue and progressive angina underwent cinecoronarography, which showed an arterio-venous coronary-pulmonary fistula originating from the circumflex artery to the pulmonary circulation. We decided to occlude it percutaneously, using a detachable balloon technic. The occlusion was accomplished successfully. Clinical evolution was excellent and the follow-up cinecoronarography 6 months later showed the maintainance of the initial results.

  12. Traumatic fistula:the case for reparations

    Directory of Open Access Journals (Sweden)

    Arletty Pinel


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

  13. Isolated arterioportal fistula presenting with variceal hemorrhage


    Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi


    We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. T...

  14. Arterioportal Fistulas in Liver Transplant Recipients


    Saad, Wael E. A.


    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically s...

  15. An unusual presentation of congenital bronchoesophageal fistula. (United States)

    Atalabi, O M; Falade, A G; Obajimi, O M; Akinyinka, O O; Lagundoye, S B; Ibinaiye, P O


    We present the case of a 5-week-old neonate with multiple congenital abnormalities including a broncho-oesophageal fistula, which showed radiological features suggestive of congenital diaphragmatic hernia. Emergency limited barium swallow done was initially reported as a case of diaphragmatic hernia. Autopsy revealed pus within the right lung, and a fistulous connection between the oesophagus and an intralobar sequestrated lung. No diaphragmatic hernia or intra-abdominal organ abnormality were seen, and an occipital meningomyelocoele was also confirmed.

  16. Urethrocutaneous fistulae after hypospadias repair: When do they occur? (United States)

    Liao, Adelene Y; Smith, Grahame Hh


    The aim is to determine the incidence and timing of urethrocutaneous fistula diagnosis after hypospadias surgery. A retrospective review of all patients who had both initial hypospadias surgery and subsequent fistula repair from 1995 to 2012. A comparison was made between patients who had an initial onlay island flap procedure and those who had a tubularised incised plate repair. Patient age at initial surgery ranged from 6 months to 16 years of age. The median time to fistula presentation was 8.5 months with a range of less than 1 month to 13.9 years post-hypospadias surgery. The median time to fistula repair was 17 months. The overall fistula rate was 8%. There was no significant difference between the rates of fistulae for onlay island flap (9%) versus tubularised incised plate procedure (7%). Urethrocutaneous fistulae can present many years after the original hypospadias repair. The majority are diagnosed within the first year after surgery. Rates of fistulae are probably underreported due to short follow-up, but more importantly, due to patients transferring to other surgeons for fistula repair. © 2016 The Author Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  17. An algorithm for the physical examination of early fistula failure. (United States)

    Beathard, Gerald A


    Evaluation of a newly created fistula 4-6 weeks after surgery should be considered mandatory. If the fistula is going to become adequate for dialysis, it will be apparent at this time. This evaluation can be accomplished by physical examination. However, it must be performed by someone who is knowledgeable. Using a systematic approach facilitates the evaluation and ensures that a problem is not overlooked. Once it is determined that the fistula is dysfunctional, the case should be immediately referred for management to an interventionalist who is experienced in dealing with early fistula failure. The majority of these cases can be salvaged.

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

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Djurhuus, Christian Born; Morre-Pedersen, Erik


    Doppler spectra obtained 10 cm downstream of the fistula. All measurements were carried out with open and clamped fistula. RESULTS: At 30% diameter reducing stenosis opening of the fistula induced a 12% systolic pressure drop across the stenosis but had no adverse effect on the Doppler waveform parameters......PURPOSE: The purpose of this study was to assess the impact of arteriovenous fistulas combined with varying degrees of stenosis on distal bypass hemodynamics and Doppler spectral parameters. METHODS: In an in vitro flow model bypass stenoses causing 30%, 55%, and 70% diameter reduction were induced...

  19. Volume Flow in Arteriovenous Fistulas Using Vector Velocity Ultrasound

    DEFF Research Database (Denmark)

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes


    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev......, Denmark) with a linear transducer, 20 arteriovenous fistulas were scanned directly on the most superficial part of the fistula just before dialysis. Vector Flow Imaging volume flow was estimated with two different approaches, using the maximum and the average flow velocities detected in the fistula. Flow...

  20. Detachable balloon embolization of an aneurysmal gastroduodenal arterioportal fistula

    Energy Technology Data Exchange (ETDEWEB)

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


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

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

    Directory of Open Access Journals (Sweden)

    Pushappreet Kaur


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

  2. Surgical treatment of labyrinthine fistula in cholesteatoma surgery. (United States)

    Quaranta, Nicola; Liuzzi, Cristina; Zizzi, Stefania; Dicorato, Anna; Quaranta, Antonio


    Evaluate the treatment of labyrinthine fistula in a large series of middle ear cholesteatomas. Case series in a tertiary referral center. Between January 2001 and December 2007, 361 ears affected by mastoid and middle ear cholesteatoma were operated at our institution. The incidence of labyrinthine fistula, preoperative and postoperative hearing function, preoperative symptoms, type of surgery, and intraoperative findings were all analyzed. The incidence of labyrinthine fistula was 12.7 percent. During surgery the matrix over the fistula was removed in all but one case. A labyrinthine fistula occurred in larger cholesteatomas as demonstrated by the higher number of cases with more than two sites involved (P < 0.001), facial nerve exposed (P < 0.001), and stapes superstructure eroded (P = 0.010). Postoperative change of bone conduction threshold and postoperative dead ears were not significantly different between fistula and nonfistula cases. The preservation of the bone conduction threshold is a common finding in small fistulas and can be obtained also in "large" fistulas when appropriate surgical technique is used. In fistulas involving the promontory the matrix should be left in situ when the endosteum is involved.

  3. Coronary artery to left ventricle fistula

    Directory of Open Access Journals (Sweden)

    Kumar Vivek


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

  4. Do the Surgical Outcomes of Rectovaginal Fistula Repairs Differ for Obstetric and Nonobstetric Fistulas? A Retrospective Cohort Study. (United States)

    Karp, Natalie E; Kobernik, Emily K; Berger, Mitchell B; Low, Chelsea M; Fenner, Dee E


    Rectovaginal fistulas can occur from both obstetric and nonobstetric (eg, inflammatory bowel disease, iatrogenic, or traumatic) etiologies. Current data on factors contributing to rectovaginal repair success or failure are limited, making adequate patient counseling difficult. Our objective was to compare outcomes of transperineal rectovaginal fistula repair performed in a single referral center on women with obstetric and nonobstetric causes. We performed a retrospective cohort study of women who had a transperineal rectovaginal fistula repair performed by a urogynecologist at the University of Michigan from 2005 to 2015. Data were obtained by chart review and included demographics, medical comorbidities, fistula etiology, history of a prior fistula repair, failure of current repair, time to failure, and operative details. Repair failure was defined as fistula symptoms with presence of recurrent fistula on exam or imaging in the postoperative follow-up period. Comparisons between the obstetric and nonobstetric cohorts were performed using χ, Fisher exact, and Wilcoxon rank sum tests. Relative risks were calculated to identify predictors of failure. Eighty-eight women were included-53 obstetric and 35 nonobstetric fistulas. The overall fistula repair failure rate was 22.7% (n = 20). Median follow-up was 157.0 days (range, 47.5-402.0). Of all the factors, only nonobstetric etiology was significantly associated with an increased risk of repair failure (relative risk, 3.53 [range, 1.50-8.32]; P = 0.004. Nonobstetric rectovaginal fistulas have a nearly 4-fold increased risk of repair failure compared with obstetric fistulas. Our results will help surgeons adequately counsel patients on potential outcomes of surgical repair of obstetric versus nonobstetric rectovaginal fistulas.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    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.

  6. Retroperitoneal and extrapelvic spread of suppurative process during intestinal perforation (clinical roentgenologic data)

    Energy Technology Data Exchange (ETDEWEB)

    Shniger, N.U.; Krivosheina, I.L. (Ministerstvo Putej Soobshcheniya SSSR, Moscow)

    Clinical and radiologic examinations of 17 patients with rectal and colonic perforation with further spread of suppurative process in the retroperitoneal space and beyond the pelvis has been carried out. Surgical and pathological comparisons show that the fistulas go along the fascial-muscular sheaths and vessels. Large intestinal fistulas are divided by their character into simple complete and incomplete and complex complete and incomplete. Use of irrigoscopy is advisable along with fistulography for proper diagnosis. In such cases radiologic examination plays a decisive role in the diagnosis revision, development of the therapeutic approach, and the confirmation of the process intensity.

  7. Sphincter-Sparing Anal Fistula Repair: Are We Getting Better? (United States)

    Sugrue, Jeremy; Mantilla, Nathalie; Abcarian, Ariane; Kochar, Kunal; Marecik, Slawomir; Chaudhry, Vivek; Mellgren, Anders; Nordenstam, Johan


    Sphincter-sparing repairs are commonly used to treat anal fistulas with significant muscle involvement. The current study evaluates the trends and efficacy of sphincter-sparing repairs and determines risk factors for fistula recurrence. A retrospective review was performed at 3 university-affiliated teaching hospitals. All 462 patients with cryptoglandular anal fistulas who underwent 573 sphincter-sparing repairs between 2005 and 2015 were included. Patients with Crohn's disease were excluded. The primary outcome was the rate of fistula healing defined as cessation of drainage with closure of the external opening. Risk factors for nonhealing were also analyzed. Five hundred three sphincter-sparing repairs were analyzed, whereas 70 were lost to follow-up. Two hundred twenty sphincter-sparing repairs (44%) resulted in healing, 283 (56%) resulted in nonhealing with a median follow-up of 9 (range, 1-125) months. The median time to fistula recurrence was 3 (range, 0-75) months with 79% and 91% of recurrences noted within 6 and 12 months. Patients treated with a dermal advancement flap, rectal advancement flap, or ligation of the intersphincteric tract procedure were less likely to have a recurrence than patients treated with a fistula plug or fibrin glue (p fistula plugs and fibrin glue (p fistula characteristics. This study was limited by its retrospective design. Healing rates following sphincter-sparing repairs of cryptoglandular anal fistulas are modest, but have improved over time with the use of better surgical techniques. In this study, ligation of the intersphincteric fistula tract and flaps were superior to fistula plugs and fibrin glue; the former procedures are therefore favored. See Video Abstract at

  8. pharmcopieal standards for the fruits of cassia fistula and cassia ...

    African Journals Online (AJOL)

    The pods of Cassia fistula L. and C. podocarpa Guill. et Perr. known for their laxative properties were examined macro- and microscopially. The pods can be distinguished in powder form by the presence of uniseriate trichomes in the C. podocarpa, which are absent in C. fistula. Chemical evaluation showed that both pods ...

  9. Congenital rectovestibular fistula associated with rectal atresia: A rare occurrence

    Directory of Open Access Journals (Sweden)

    Rizwan Ahmad Khan


    Full Text Available We report a rare variety of anorectal malformation, rectal atresia associated with rectovestibular fistula. The case was successfully treated by posterior sagittal repair. The fistula was mobilized and the continuity of the rectum was established by circumferential anastomosis.

  10. Management of Small Urethrocutaneous Fistula by Tight Ligation ...

    African Journals Online (AJOL)

    Background/Purpose: Urethrocutaneous fistula (UCF) is the most common reported complication of hypospadias repair. The success of the operative technique is usually measured by its effectiveness in reduction of the incidence of UCF. Materials & Methods: In a prospective study, 11 patients with 12 small caliber fistulae ...

  11. Treatment of pharyngocutaneous fistula acquired from incisions and ...

    African Journals Online (AJOL)

    Treatment of pharyngocutaneous fistula acquired from incisions and drainage of deep neck space abscess in a patient with occult third branchial anomaly. ... We did surgical exploration to excise and close the fistula but only succeeded at the second attempt. Conclusion: We conclude that branchial apparatus anomaly ...

  12. Enterocutaneous fistula: a Tanzanian experience in a tertiary care ...

    African Journals Online (AJOL)

    ... outcome and prognostic factors for fistula closure and mortality in our local setting. Methods: A prospective study of patients with enterocutaneous fistulae was conducted at Bugando Medical Centre between December 2007 and November 2009. After informed written consent for the study and HIV testing, all patients who ...

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

    African Journals Online (AJOL)

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

  14. Aetiology, management and outcome of entero-cutaneous fistula in ...

    African Journals Online (AJOL)

    Aetiology, management and outcome of entero-cutaneous fistula in Maiduguri, Nigeria. UE Eni, BM Gali. Abstract. Background: Enterocutaneous fistula (ECF) remains an important surgical problem with significant morbidity and mortality. This study aims to review the aetiology and management outcome in a depressed ...

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

    African Journals Online (AJOL)

    Background: Information was collected on 1500 obstetric fistula patients attending Bugando Medical Centre (BMC) in Mwanza, Tanzania. Objectives: To identify high risk populations of fistula patients treated from 1998-2006. Design: A prospective description study of 1294 patients treated for urine and faecal incontinence ...

  16. Enterocutaneous fistula: A review of 82 cases | Njeze | Nigerian ...

    African Journals Online (AJOL)

    Objective: Enterocutaneous fistula is an unpleasant and troublesome complication of abdominal operations. The objective was to review the outcome of treatment of patients treated for enterocutaneous fistula. Materials and Methods: This is a retrospective study of 82 teenage and adult patients, who suffered from ...

  17. Tuberculous anal fistulas – prevalence and clinical features in an ...

    African Journals Online (AJOL)

    Introduction. The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas. Patients and methods. This was a prospective study of all patients who underwent surgery for ...

  18. [One case of postoperative facial paralysis after first branchial fistula]. (United States)

    Wang, Xia; Xu, Yaosheng


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

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

    LENUS (Irish Health Repository)

    Hodnett, Pa


    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.

  20. [Giant cervical angioma caused by "malignant" arteriovenous fistulae]. (United States)

    Palou, J; Mir y Mir, L


    A case of angioma by malignant AV fistula (described by F. Martorell in 1970) is reported. Such kind of fistulas have usually a lethal course. The case reported underwent a surgical correction, and after a following of 10 years, no major complications have been reported.

  1. An orbital fistula complicating anaerobic frontal sinusitis and osteomyelitis

    NARCIS (Netherlands)

    H.J. Simonsz (Huib); H.J.F. Peeters; G.M. Bleeker


    textabstractA patient is described with an orbital fistula complicating frontal sinusitis and osteomyelitis of the frontal bone. The fistula was excised, but a fortnight later an acute exacerbation occurred. From the discharging pus a Staphylococcus aureus was cultured and from mucosa obtained

  2. Vesicovaginal Fistula: A Review of Nigerian Experience | Ijaiya ...

    African Journals Online (AJOL)

    OBJECTIVE: To review the causes, complications, and outcome of vesicovaginal fistula in Nigeria. METHODS: Studies on vesicovaginal fistula were searched on the internet. Information was obtained on Pubmed (medline), WHO website, Bioline Innternational, African Journal on Line, Google scholar, Yahoo, Medscape ...

  3. Congenital anterior penile isolated urethrocutaneous fistula: A case ...

    African Journals Online (AJOL)

    Urethrocutaneous fistula is a common complication after hypospadias repair. If congenital, it is usually associated with other genitourinary and gastrointestinal anomalies. Isolated congenital urethral fistula is a very rare anomaly. We present a 4-year old circumcised boy with this unusual anomaly. Etiology, embryology, and ...

  4. Treatment of ureterovaginal fistula using a Memokath stent

    DEFF Research Database (Denmark)

    Mohammad, Wael; Fode, Mikkel Mejlgaard; Azawi, Nessn Htum


    Ureterovaginal fistula (UVF) is a challenging problem for patients and doctors, especially in patients who have been treated by radiation for malignancy. UVF may occur in conjunction with surgeries involving the uterus. A success rate of 70-100% has been reported for fistula repair with the best...

  5. Vesicovaginal fistula: Do the patients know the cause?

    African Journals Online (AJOL)

    Int Urogynecol J Pelvic Floor Dysfunct. 1998;9:189-94. 2. Kelly J. Vesicovaginal fistula: The burden of maternal ill health. Safe Mother 1999;27:5-7. 3. Danso KA, Martey JO, Wall LL, Elkins TE. The epidemiology of genitourinary fistulae in Kumasi, Ghana, 1977-1992. Int Urogyecol J Pelvic Floor Dysfunct 1996;7:117-20. 4.

  6. Experience with enterocutaneous fistula management in a district ...

    African Journals Online (AJOL)

    Our objective was to review the practice of the nutritional management and outcome of ECF in a resource limited setting in Nigeria. Methods: A retrospective ... Thirty-nine (68.42%) fistulae closed spontaneously on conservative management while 12 (21.05%) fistulae healed following restorative surgery. Mortality rate was ...

  7. Group Psychological Therapy in Obstetric Fistula Care: A ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Group psychotherapy in Obstetric fistula care. African Journal of Reproductive Health March 2014; 18(1): 156. ORIGINAL RESEARCH ARTICLE. Group Psychological Therapy in Obstetric Fistula Care: A. Complementary Recipe for the Accompanying Mental Ill Health. Morbidities? Oladosu A Ojengbede. 1. , Yvonne Baba. 2.

  8. Analysis of 137 obstetric fistula cases seen at three fistula centres in ...

    African Journals Online (AJOL)

    Conclusion: This study shows that child marriage, low education, unskilled birth attendance and low contraceptive uptake are common among the obstetric fistula patients in north west Nigeria. Public advocacy and formulation of laws and policies to protect girls from early marriage, girl child education to secondary school ...

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

    Directory of Open Access Journals (Sweden)

    Masato Shino


    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.

  10. Robotic-assisted laparoscopic repair of a vesicouterine fistula. (United States)

    Chang-Jackson, Shao-Chun R; Acholonu, Uchenna C; Nezhat, Farr R


    As cesarean sections become a more common mode of delivery, they have become the most likely cause of vesicouterine fistula formation. The associated pathology with repeat cesarean deliveries may make repair of these fistulas difficult. Computer-enhanced telesurgery, also known as robotic-assisted surgery, offers a 3-dimensional view of the operative field and allows for intricate movements necessary for complex suturing and dissection. These qualities are advantageous in vesicouterine fistula repair. A healthy 34-year-old woman who underwent 4 cesarean deliveries presented with a persistent vesicouterine fistula. Conservative management with bladder decompression and amenorrhea-inducing agents failed. Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process.

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

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair


    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...

  12. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management

    Directory of Open Access Journals (Sweden)

    F. Aguilar-Espinosa


    ón clínica, diagnóstico por imagen, manejo quirúrgico, complicaciones posoperatorias y su seguimiento. Material y métodos: Análisis retrospectivo de pacientes intervenidos mediante colecistectomía en nuestra institución por colelitiasis, colecistitis o colangitis, en un periodo de 3 años, en busca de fístula bilioentérica. Resultados: Se identificaron 4 pacientes, 2 hombres y 2 mujeres con fístula colecistoduodenal, con una edad promedio de 81.5 años; 2 pacientes presentaron colangitis aguda y 2 obstrucción intestinal por íleo biliar. Todos los pacientes fueron tratados quirúrgicamente. Se analiza el manejo diagnóstico y terapéutico de cada paciente. Conclusiones: La incidencia de fístula colecistoduodenal fue similar a la reportada en la literatura médica: es una complicación poco común de litiasis vesicular y su diagnóstico es difícil por la sintomatología poco específica. Se debe tener en cuenta en pacientes adultos mayores, en los que se encuentra vesícula biliar escleroatrófica y múltiples adherencias. Keywords: Cholecystoduodenal fistula, Gallstone ileus, Cholangitis, Palabras clave: Fístula colecistoduodenal, Íleo biliar, Colangitis

  13. Intestinal Complications of IBD (United States)

    ... anus which may be superficial or deep. Unlike fistulas, fissures are only in the area of the anus. They can cause mild-to-severe rectal pain and bleeding, particularly during bowel movements. Anal ...

  14. Methylene Blue for Bronchopleural Fistula Localization. (United States)

    Sakata, Kenneth K; Nasim, Faria; Schiavo, Dante N; Nelson, Darlene R; Kern, Ryan M; Mullon, John J


    A bronchopleural fistula (BPF) is a communication between the pleural space and the bronchial tree. BPFs are challenging to diagnose and are associated with a high morbidity and mortality. Sequential balloon occlusion is commonly used for localization of a BPF. We describe our experience with 4 cases of successful localization of the BPF by instillation of methylene blue into the pleural space through a pigtail catheter, with simultaneous bronchoscopic visualization of dye in the tracheobronchial tree. Two patients were treated with endobronchial valves and 3 had a surgical thoracic muscle flap placed.

  15. Clinical evaluation of genito-urinary fistula

    Directory of Open Access Journals (Sweden)

    Companywala Rashida


    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. Multimodal endovascular treatment for traumatic carotidcavernous fistula

    Directory of Open Access Journals (Sweden)

    ZENG Tao


    Full Text Available 【Abstract】Objective: To present our experience in treating traumatic carotid-cavernous fistula (TCCF by multimodal endovascular treatment. Methods: The management of 28 patients with TCCF between January 2004 and October 2012 in our hospital was retrospectively analyzed. According to imaging charateristics, 24 cases were categorized into Type I, 3 Type II and 1 Type III. Totally 30 endovascular treatments were performed: Type I TCCFs were obliterated via transvenous approach (7/25, or transarterial approach (18/25 including 6 by detachable balloon occlusion, 6 by microcoil embolization, 3 by Hyperglide balloon-assisted coil embo- lization and 3 by a combination of detachable balloon and coil embolization. Two patients were treated with closure of internal carotid artery (ICA. Type II TCCFs were treated with transvenous embolotherapy (2/3 or carotid artery com- pression therapy (1/3. The Type III patient underwent de- tachable balloon embolization. Results: Immediate postoperative angiography showed recovery in 26 cases. One recurrent TCCF was found 2 weeks after detachable balloon embolization, and then re- Chin J Traumatol 2013;16(6:334-338 obliterated by transarterial coils. Reexamination found bal- loon deflation and fistula recanalization in 1 patient one month after combination of detachable balloons and coil embolization, which was cured by a second treatment via transvenous approach. The immediate angiography revealed residual blood flow in 4 patients. Among them, 2 patients with delayed symptoms at follow-up needed a second treatment, 1 patient recovered after carotid artery compres- sion therapy, and the remaining patient’s symptoms disap- peared on digital subtraction angiography at five-month follow-up. CT angiography revealed anterior communicat- ing artery aneurysm in the patient who was treated with closure of ICA 4 years later. Conclusion: According to results of images, characteristics of the fistula and type of drainage

  17. An arteriovenous fistula following chalazion excision

    Directory of Open Access Journals (Sweden)

    Dias-Amborcar Yuri


    Full Text Available An arteriovenous fistula secondary to a chalazion is a rare occurrence. It may follow spontaneous necrosis or surgical trauma. Digital subtraction angiography and identification of the arterial feeders combined with direct puncture of the nidus and embolization is recommended, as surgical excision becomes much easier and results in a complete excision of the lesion. Conchal cartilage graft is a useful lining material for reconstruction of the tarsal plate due to its natural curvature. It restores lid integrity and ensures a stable and functional eyelid.

  18. Isolated arterioportal fistula presenting with variceal hemorrhage. (United States)

    Nookala, Anupama; Saberi, Behnam; Ter-Oganesyan, Ramon; Kanel, Gary; Duong, Phillip; Saito, Takeshi


    We report a case of life-threatening hematemesis due to portal hypertension caused by an isolated arterioportal fistula (APF). Intrahepatic APFs are extremely rare and are a cause of presinusoidal portal hypertension. Etiologies for APFs are comprised of precipitating trauma, malignancy, and hereditary hemorrhagic telangiectasia, but these were not the case in our patient. Idiopathic APFs are usually due to congenital vascular abnormalities and thus usually present in the pediatric setting. This is one of the first cases of adult-onset isolated APF who presented with portal hypertension and was successfully managed through endoscopic hemostasis and subsequent interventional radiological embolization.

  19. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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


    . All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed...

  20. Intestinal myiasis

    Directory of Open Access Journals (Sweden)

    U S Udgaonkar


    Full Text Available Purpose: Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces. This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man. They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe. The condition is not uncommon and is often misdiagnosed as pinworm infestation. Correct diagnosis by the clinical microbiologist is important to avoid unnecessary treatment. Materials and Methods: We had 7 cases of intestinal myiasis. In 2 cases the larvae were reared to adult fly in modified meat and sand medium (developed by Udgaonkar. This medium is simple and can be easily prepared in the laboratory. Results: Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans. Conclusions: S. haemorrhoidalis was the commonest maggot involved. A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics. The reason for long duration of illness and recurrence of infestation is baffling. The nearest to cure was colonic wash. We feel prevention is of utmost importance, which is to avoid eating food articles with easy access to flies.

  1. Spinal Dural Arteriovenous Fistula: A Review. (United States)

    Maimon, Shimon; Luckman, Yehudit; Strauss, Ido


    Spinal dural arteriovenous fistula (SDAVF) is a rare disease, the etiology of which is not entirely clear. It is the most common vascular malformation of the spinal cord, comprising 60-80 % of the cases. The clinical presentation and imaging findings may be nonspecific and misleading, often mistaking it for other entities like demyelinating or degenerative diseases of the spine.This chapter describes the imaging findings, clinical signs, and symptoms of this disease and also the available treatment options according to the current literature.Angiography is still considered the gold standard for diagnosis; however, MRI/MRA is increasingly used as a screening tool. Modern endovascular techniques are becoming increasingly more effective in treating SDAVF offering a less invasive treatment option; however, they still lag behind surgical success rates which approach 100 %. The outcome of both treatment options is similar if complete obliteration of the fistula is obtained and depends mainly on the severity of neurological dysfunction before treatment.Heightened awareness by radiologists and clinicians to this rare entity is essential to make a timely diagnosis of this treatable disease. A multidisciplinary treatment approach is required in order to make appropriate treatment decisions.

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

    Directory of Open Access Journals (Sweden)

    Huang Qilin


    Full Text Available 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.

  3. Diagnosis of gastrogastric fistula on computed tomography: a quantitative approach. (United States)

    Gao, Guangzu; Nezami, Nariman; Mathur, Mahan; Balcacer, Patricia; Israel, Gary; Spektor, Michael


    To determine if the attenuation of contrast material in the excluded stomach compared with the gastric pouch is helpful in diagnosing gastrogastric (GG) fistula. In a retrospective study, 13 CT scans in 12 patients (age 43.2 ± 9.2, 10 females) who had undergone Roux-en-Y gastric bypass and who had oral contrast in both the gastric pouch and excluded stomach were qualitatively and quantitatively evaluated for GG fistula by two radiologists, using upper GI series (UGI) as the gold standard. Quantitative analysis was performed by computing the relative attenuation (RA) ratio (HU in excluded stomach/HU in gastric pouch). Statistical analysis was performed to determine if the RA ratio values correlated with the UGI findings of GG fistula. 46.2% (6/13) of UGI studies demonstrated a GG fistula. Statistical analysis demonstrated a significant difference in RA ratio (P ratio of 0.8 that maximized sensitivity (100%), at the expense of specificity (78.6%), for diagnosing GG fistula. In contrast, the initial qualitative evaluation for GG fistula yielded a lower sensitivity (45.8%) and a higher specificity (89.2%). After taking RA ratios into account, radiologists' final conclusions achieved higher sensitivity (58.3%) and specificity (100%). The relative attenuation ratio of oral contrast in the excluded stomach versus the gastric pouch can be a reliable tool in differentiating GG fistula from oral contrast reflux up the biliopancreatic limb on CT.

  4. The psychosocial impact of vesico-vaginal fistula in Niger. (United States)

    Alio, Amina P; Merrell, Laura; Roxburgh, Kimberlee; Clayton, Heather B; Marty, Phillip J; Bomboka, Linda; Traoré, Salamatou; Salihu, Hamisu M


    To explore the psycho-social impact of vesico-vaginal fistula (VVF) on women in Niger. We conducted a qualitative study on 21 women in convalescence at the DIMOL Reproductive Health Center in Niamey, Niger, in 2008 and 2009. The women had undergone 1-3 fistula repair operations and all had stillborn infants. Women reported many psychological consequences of VVF including depression, feelings of shame, and loneliness. Others reported feeling devalued as a woman and wanting to end their lives. Social consequences of fistula reported by these women included rejection from society, isolation, rejection from husband and/or divorce. Almost half of the women reported of having lost their social network and support as a result of the fistula. Women with VVF were deemed unworthy, and their illness was often attributed to some fault of their own. Our findings support the notion that socio-economic factors, though they certainly contribute to obstetric fistula, are not the primary reason for fistula, particularly in Niger. Fistula is a direct result of lack of access to skilled birth attendants and emergency obstetric care.

  5. Vesicocutaneous fistula formation during treatment with sunitinib malate: Case report

    Directory of Open Access Journals (Sweden)

    Sakashita Hiroyuki


    Full Text Available Abstract Background The oral multi-kinase inhibitor sunitinib malate improves the survival of patients with gastrointestinal stromal tumors (GIST after the disease progresses or intolerance to imatinib mesylate develops. Urinary fistulae arising during treatment with sunitinib for GIST have not been described. Case presentation We describe a 62-year-old female patient diagnosed with unresectable GIST that involved the abdominal wall, urinary bladder wall, bowel, mesentery and peritoneum in the pelvic cavity. Intestinocutaneous fistulae developed on a surgical lesion after orally administered imatinib was supplemented by an arterial infusion of 5-flurouracil. Sunitinib was started after the patient developed resistance to imatinib. On day 4 of the fourth course of sunitinib, a widely dilated cutaneous fistula discharged large amounts of fluid accompanied by severe abdominal pain. Urinary communication was indicated based on the results of an intravenous injection of indigo carmine. Computed tomography findings suggested a small opening on the anterior urinary bladder wall and fistulous communication between the bladder and abdominal walls bridged by a subcutaneous cavity. The fistula closed and the amount of discharge decreased when sunitinib was discontinued. Therefore, sunitinib might have been associated with the development of the vesicocutaneous fistula in our patient. Conclusion This is the first description of a vesicocutaneous fistula forming while under sunitinib treatment. Clinicians should be aware of the possible complication of vesicocutaneous fistula formation during treatment with molecular targeting agents in patients with extravesical invasion and peritoneal dissemination of GIST.

  6. The lived experience of Malawian women with obstetric fistula. (United States)

    Yeakey, Marissa Pine; Chipeta, Effie; Taulo, Frank; Tsui, Amy O


    Data on women who experience obstetric fistula paints an often tragic picture. The majority of previous research has focused on facility-based data from women receiving surgical treatment. The goal of this qualitative study was to gain an understanding of the lived experience of obstetric fistula in Malawi. Forty-five women living with fistula were interviewed in their homes to learn how the condition affected them and their families on a daily basis. Findings indicate that the experiences of Malawian women with fistula were more varied than anticipated. Concerning relationships with husbands and family, we found high rates of divorce and stigma, yet these outcomes were far from universal or inevitable. Many women, in addition to their families, discussed high levels of support from those individuals closest to them. Nonetheless, many women experienced the fistula as a direct assault on their ability to fulfil social expectations of them as women, wives and mothers. Women identified fertility and continued childbearing as central concerns. The data suggest that we cannot discount the experiences of women living with fistula from continued participation in marriage, community and childbearing. Programmes for outreach and services should consider a broadened range of outcomes of women living with fistula.

  7. Gurya cutting and female genital fistulas in Niger: ten cases. (United States)

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


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

  8. Fistuloclysis: An Interprofessional Approach to Nourishing the Fistula Patient. (United States)

    Willcutts, Kate; Mercer, David; Ziegler, Jane


    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.

  9. [Enterovesical fistula caused by a prosthesis made of synthetic material]. (United States)

    Pros, I; Puyol, M; Franco, A; Alcaraz, A; Llovera, J M; Gutierrez, R; Carretero, P


    Enterovesical fistulas affect mainly male patients, due to the interposition of the uterus in women. They can be caused by neoplastic, inflammatory or traumatic processes. A case of ilovesical fistula due to migration of a silastic plate used to repair an epigastric infissional hernia is presented. This case has two distinctive features: first, the cause is extraurological, causing a fistula between both systems due to an inflammatory process. Secondly, we report the long distance travelled by the synthetic mesh, causing a peculiar clinical picture five years after its implantation.

  10. Clinical spectrum of spontaneous carotid-cavernous fistula

    Directory of Open Access Journals (Sweden)

    Das Jayanta


    Full Text Available A carotid-cavernous fistula (CCF is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF is divided into two categories, direct and indirect. Direct fistulas usually account for 70 to 90% of all CCF. Spontaneous, low-flow fistulas are usually associated with atherosclerosis, hypertension and collagen vascular disease or may develop in females during peripartum period. The elderly age group, especially women are at increased risk. We report three cases of spontaneous CCF presenting with ocular manifestations and hypertension, without any collagen vascular disease. One case was a direct variety and the other two were of indirect variety.

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

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair


    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......-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...

  12. First Branchial Arch Fistula: A Rarity and a Surgical Challenge. (United States)

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


    Although 2(nd) Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1(st) arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

  13. [Arteriovenous fistula in patients with a complicated postphlebitic syndrome]. (United States)

    Quiñones Castro, M; Fernández de la Vara Sánchez, L; Perera González, F; Alvarez Sánchez, J A


    An investigation, which goal is to evidencing AV fistulas in patients with a complicated postthrombotic syndrome, as well as to determinate the efficacy of noninvasive methods used for the study of AV fistulas in such patients, is presented. So, patients with a complicated postphlebitic syndrome interned into the Instituto de Angiología were studied. Twenty-five patients were included in the study, 9 of these patients (36%) had arteriovenous fistulas, arteriographically evidenced. Haemodynamic study do not support the evidence of such communications.

  14. Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings. (United States)

    Erdim, Ibrahim; Sirin, Ali Ahmet; Baykal, Bahadir; Oghan, Fatih; Guvey, Ali; Kayhan, Fatma Tulin

    Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29±6 months follow up. Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula

  15. Clinical and economic consequences of pancreatic fistula after elective pancreatic resection. (United States)

    Čečka, Filip; Jon, Bohumil; Šubrt, Zdeněk; Ferko, Alexander


    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. 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. 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 (P8239, and 30 820 Euros in the no fistula, grades A, B, and C fistula groups, respectively. 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 fistula prolongs the hospital stay and increases the cost of treatment in proportion to the severity of the fistula.

  16. Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. (United States)

    Delamou, Alexandre; Delvaux, Therese; El Ayadi, Alison M; Tripathi, Vandana; Camara, Bienvenu S; Beavogui, Abdoul H; Romanzi, Lauri; Cole, Bethany; Bouedouno, Patrice; Diallo, Moustapha; Barry, Thierno H; Camara, Mandian; Diallo, Kindy; Leveque, Alain; Zhang, Wei-Hong; De Brouwere, Vincent


    Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6-36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5-89·3) and an incidence proportion of 18·4% (14·8-22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0-36·2), and corresponding to 10·3% (5·2-19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8-35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Recurrence of

  17. [Colonic gallstone ileus: A rare cause of intestinal obstruction]. (United States)

    Marenco-de la Cuadra, Beatriz; López-Ruiz, José Antonio; Tallón-Aguilar, Luis; López-Pérez, José; Oliva-Mompeán, Fernando

    A gallstone colonic ileus is a very rare condition. The case is reported of an 87 year-old patient who came to the Emergency Department due to an intestinal obstruction of several days onset, which was caused by a gallstone affected sigmoid colon. Colonic gallstone ileus is a rare disease that usually occurs in older patients due to the passage of large gallstone directly from the gallbladder to colon, through a cholecystocolonic fistula. It has a high morbidity and mortality. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Iliac arteriovenous fistulas after lumbar spinal surgery. (United States)

    Ocal, Osman; Peynircioglu, Bora; Eldem, Gonca; Akpinar, Erhan; Onur, Mehmet Ruhi; Kabakci, Giray


    Iatrogenic arteriovenous fistula (AVF) is an unusual and potentially fatal complication of lumbar spinal surgery. The presentation of these injuries is usually late, with symptoms such as leg swelling or cardiac failure. It is crucial to suspect AVF in the patient which presents to emergency with lumbar spinal surgery history. The diagnosis is often based on imaging studies such as computed tomography (CT) or magnetic resonance (MR) angiography. Surgery was the first choice of treatment, but with recent advances in stent technology endovascular approach has become widely popular. We present two cases of AVF secondary to lumbar spinal surgery, one of them presenting with overt heart failure and the other one with leg swelling.

  19. Inoperable aggressive mesenteric fibromatosis with ureteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Khanna, Paritosh C. [Radiology Department, Nanavati Hospital, Mumbai (India)]. E-mail:; Lath, Chinar [Radiology Department, Nanavati Hospital, Mumbai (India); Gadewar, Swapna B. [Radiology Department, Nanavati Hospital, Mumbai (India); Agrawal, Dilpesh [Internal Medicine Department, Wockhardt Hospital, Mumbai (India)


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

  20. Arterioportal fistulas in liver transplant recipients. (United States)

    Saad, Wael E A


    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280-300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.

  1. Presentation and perioperative management of arterioportal fistulas. (United States)

    Strodel, W E; Eckhauser, F E; Lemmer, J H; Whitehouse, W M; Williams, D M


    Arterioportal fistulas (APFs) are usually traumatic in origin and may result in portal hypertension and its complications. Over six years, six patients (aged 20 to 59 years) presented with APFs. Two APFs developed after percutaneous liver biopsy, but only one was complicated (hemobilia). Neither patient was treated operatively. Four APFs occurred two days to three years after gunshot wounds. Three patients presented with gastrointestinal tract hemorrhage. All patients had abdominal bruits. Two patients underwent primary repair. One patient underwent APF resection and replacement of the superior mesenteric artery with autogenous vein. Another patient underwent APF and bowel resection. Three patients survived. One patient died of liver failure. The development of an abdominal bruit in a patient with penetrating abdominal trauma suggests APF and should prompt angiography. Elective repair is recommended before complications of portal hypertension develop.

  2. Acquired lacrimal sac fistula mimicking basal cell carcinoma. (United States)

    Litwin, A S; Timlin, H; Sagili, S; Wright, M; Malhotra, R


    Lacrimal sac fistulae can arise after an episode of dacryocystitis, usually forming below the medial canthus. Preceding symptoms of a watery eye with mucous discharge and a history or signs of inflammation are typical. To highlight the features of lacrimal sac fistulae and encourage readers to consider this in the differential diagnosis of apparently ulcerative medial canthal skin lesions. We describe three patients with inferior-medial canthal ulcerative skin lesions, all referred to ophthalmic plastic surgeons either by dermatologists or plastic surgeons, presumed clinically to have basal cell carcinoma (BCC). All three were in fact due to acquired lacrimal sac fistulae, and syringing of the nasolacrimal system confirmed the presence of a fistula. These cases illustrate the importance of questioning patients about their previous ocular symptoms when dealing with less familiar periocular lesions. © 2013 The Authors. BJD © 2013 British Association of Dermatologists.

  3. Imperforate anus and perianal fistula in Ancient Greek medical writings. (United States)

    Tsoucalas, Gregory; Gentimi, Fotini; Kousoulis, Antonis A; Karamanou, Marianna; Androutsos, George


    Anorectal malformations remain a challenging topic in pediatric surgery, known since antiquity. In our paper we expose the main descriptions and therapeutic approaches of imperforate anus and perianal fistula through the works of the ancient Greek and Byzantine physicians.

  4. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management

    National Research Council Canada - National Science Library

    Feld, R; Wechsler, RJ; Bonn, J


    ...: Our purpose was to report the use of percutaneous catheter drainage as a therapeutic option in the management of three patients with biliary-pleural fistulas without biliary obstructions. CONCLUSION...

  5. Vesico-vaginal Fistula Surgery in Uganda. Brian Hancock, Mhairi ...

    African Journals Online (AJOL)



    Dec 2, 2004 ... first attempt but a further 10% may have unacceptable stress incontinence. Conclusion: We ... fistula camps can make a significant contribution to teaching and cure of patients. ... outcome from prolonged labour, which every.

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

    African Journals Online (AJOL)

    AJRH Managing Editor

    , especially in the developing context. This study brings together the ...... Current Opinion in. Obstetrics and Gynecology, (18). 26. Shefren, J. (2009). The tragedy of obstetric fistula and strategies for prevention. American Journal of. Obstetrics ...

  7. Clinical and echocardiographic features of aorto-atrial fistulas

    Directory of Open Access Journals (Sweden)

    Ananthasubramaniam Karthik


    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.

  8. Salpingocutaneous fistula in an adolescent resulting from septic ...

    African Journals Online (AJOL)

    ... challenge for the adolescent because of the various reproductive and social consequences. ... The issue of unsafe abortion within the context of the unmet sexual and reproductive ... Keywords: Fistula, adolescent, unsafe abortion, abscess

  9. Endovascular treatment of carotid cavernous sinus fistula: A systematic review (United States)

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman


    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  10. Intracranial dural arteriovenous fistula with spinal medullary venous drainage

    Energy Technology Data Exchange (ETDEWEB)

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


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

  11. Epidemiology and outcome of patients with postoperative abdominal fistula. (United States)

    Wercka, Janaina; Cagol, Patricia Paola; Melo, André Luiz Parizi; Locks, Giovani de Figueiredo; Franzon, Orli; Kruel, Nicolau Fernandes


    to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit. abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality. apresentar o perfil epidemiológico, incidência e desfecho em pacientes que evoluíram com fístula abdominal pós-operatória. trata-se de um estudo prospectivo transversal observacional que avaliou pacientes submetidos à cirurgia abdominal. Foram estudados o perfil epidemiológico, a incidência das fístulas pós-operatórias e suas características, desfecho desta complicaçãoe fatores preditivos de mortalidade. a amostra constou de 1148 pacientes. A incidência de fístula foi 5,5%. Houve predominância de fístulas biliares (26%), seguidas de fístulas colônicas (22%) e gástricas (15%). O tempo médio para o surgimento da fístula foi 6,3 dias. Para o fechamento, a média foi 25,6 dias. A taxa de mortalidade dos pacientes com fístula foi 25,4%. Os fatores preditivos de mortalidade nos casos que desenvolveram fístula foram idade maior do que 60 anos, presença de

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

    DEFF Research Database (Denmark)

    Nielsen, Tina G; Djurhuus, Christian Born; Morre-Pedersen, Erik


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

  13. Biliary-pleural fistulas without biliary obstruction: percutaneous catheter management. (United States)

    Feld, R; Wechsler, R J; Bonn, J


    Our purpose was to report the use of percutaneous catheter drainage as a therapeutic option in the management of three patients with biliary-pleural fistulas without biliary obstructions. In the proper clinical setting, the CT findings of liver dome laceration or abscess, diaphragm disruption, and pleural effusion should suggest biliary-pleural fistula. Percutaneous catheter management can be curative or serve a temporizing function before surgery.

  14. Successful Use of Modified Suprapubic Catheter to Rescue Prostatorectal Fistula

    Directory of Open Access Journals (Sweden)

    Yi-Chun Chiu


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

  15. Benign duodenocolic fistula. A case presenting with acidosis

    DEFF Research Database (Denmark)

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


    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....

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


    Monteiro Furtado, Angelina; Elisângela Teixeira Lima, Francisca


    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...

  17. Radiological evaluation of anal fistulae: a prospective study of fistulograms. (United States)

    Ani, A N; Lagundoye, S B


    A review of 33 fistulograms in a four-year study is presented. Four types of communicating tracts have emerged: single (58%), branched (18%), fistulous abscess (15%) and compound (9%). This classification has formed the basis of selection of operative treatment in all the cases. Diminished lumbo-sacral angle was also found in most of the anal fistula cases and this establishes a possible association between the pathology of anal fistula and the low back syndrome.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  19. Enterocutaneous Fistulas in the Setting of Trauma and Critical Illness (United States)


    aortic aneurysm leads to increased intraperitoneal and retroperitoneal volume, visceral edema, abdominal wall edema, and may lead to ACS. The term...patients that had developed oliguria and abdominal distention after abdominal aortic aneurysm repair.30 The advent of endovascular techni- ques for...fistula complicating electric burns a case report. J Pediatr Surg 2003;38(8):1232 1233 13. Prasad JK, Thomson PD, East MK. Faecal fistula as the

  20. [Intestinal microbiota]. (United States)

    Perez, Horacio Joaquín; Menezes, Maria Elisabeth; d'Acâmpora, Armando José


    There is accumulative evidence on the multiple functions of the intestinal microflora in relation to the homeostasis of the host. At first considered as a simple mutualism, today this relationship proves to be essential to the health and to pathologic processes, particularly metabolic (eg, obesity) and gastrointestinal (eg, inflammatory bowel disease and functional disorders). The first studies were conducted on the microbiota from fecal material cultured anaerobically. With the advent of molecular biology, it has become possible to determine qualitative and quantitatively the dominant, subdominant and transients species. In recent years, there were advances in the understanding of the relationship betwen the microbiota and the host, as well as among the microorganisms in their respective niches. These advances result from translational integration of microbiology with specialities such as molecular biology, cell phisiology, immunology and ecology. There are few studies on the spatial distribution of the microflora in the gut. Unravelling the topography of the microflora in mammals is a way to validate new animal models for the study of microflora.

  1. Treatment of traumatic carotid cavernous fistulas using detachable balloons

    Energy Technology Data Exchange (ETDEWEB)

    Han, Moon Hee; Han, Joon Koo; Chang, Kee Hyun [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Since the introduction of the concept of detachable balloon technique to occlude arteriovenous fistulas, this technique has become the treatment of choice in the management of traumatic carotid cavernous fistulas (CCF). We tried the occlusion of fistula using detachable balloons in 30 consecutive cases of traumatic CCF and the result of our experience is reported. Transarterial approach with manually-tied latex balloons is tried in all cases and the fistulas were successfully occlude in 28 cases of all. In 20 cases, internal carotid artery was preserved and the arterial lumen was occluded along with fistula opening in 9 cases. In rest of 2 cases, surgical ligation was done because of procedure-related thromboembolism and incomplete occlusion of fistula. We experienced hemiparesis as a major complication in 3 cases. In one of them, the symptom developed during occlusion tolerance test, one just after insertion of guiding catheter into the internal carotid artery, and in one case 2 days after the occlusion of internal carotid artery. In one case, the procedure was performed by the direct puncture of carotid artery because of the ligation of common carotid artery by previous surgery. It is suggested that the systemic heparinization during the procedure is indispensable and starting the procedure with No 9 balloon is considered reasonable.

  2. Congenital nasolacrimal duct fistula in Brown Swiss cattle. (United States)

    Braun, Ueli; Jacober, Simon; Drögemüller, Cord


    An increased incidence of nasolacrimal duct fistula in the offspring of dam J and three of her sons (bulls A, B and C) prompted a study to investigate the prevalence and clinical manifestation of this anomaly. The dam J, bull B, 255 direct offspring of bulls A, B, and C and eight other direct and indirect offspring of cow J were examined. The periocular region of each animal was examined for unilateral or bilateral nasolacrimal duct fistula and the location, appearance and size of the lesions. Of 265 cattle examined, 54 had unilateral (n = 24) or bilateral fistula (n = 30). The prevalence of affected offspring differed significantly among the three bulls. The fistulae were located medial to the medial canthus of the eye and were 1 to 10 mm (median, 1 mm) in height and 1 to 12 mm (median, 2 mm) in length. The shape of the opening was circular in 58, oval in 23 and slit-like in three. One other animal had a large opening with an atypical shape and another had an abnormal medial canthus with several fistulous openings. Seventy openings were pigmented and 52 were hairless. The fistulae were clinically significant in 12 animals. The findings suggest a hereditary cause of nasolacrimal duct fistula in Brown Swiss cattle.

  3. Elevated Shear Stress in Arteriovenous Fistulae: Is There Mechanical Homeostasis? (United States)

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


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

  4. Sexual activity among Nigerian women following successful obstetric fistula repair. (United States)

    Anzaku, Stephen A; Lengmang, Sunday J; Mikah, Samaila; Shephard, Steven N; Edem, Bassey E


    To evaluate post-operative sexual activity among women who have undergone obstetric fistula repair. The present descriptive cross-sectional study recruited married women who had undergone successful obstetric fistula repair who were attending reunion activities at Bingham University Teaching Hospital, Jos, Nigeria, between March 13 and March 15, 2014. Participants were interviewed regarding penetrative vaginal intercourse after surgery, and any changes in sexual desire, arousal, orgasm, sexual satisfaction, and the presence of coital pain compared with before they experienced obstetric fistula. There were 102 patients who participated in interviews; 23 (22.5%) reported not being able to engage in penetrative vaginal intercourse and 12 (52%) of these patients ascribed this to a "tight" or "narrow" vagina. Compared with the pre-fistula period, 63 (61.7%) patients reported reduced sexual desire, 57 (55.9%) reported lack of or inadequate lubrication during intercourse, 12 (11.8%) reported anorgasmia, and 60 (58.8%) reported reduced attainment of orgasm. Dyspareunia was reported by 48 (47.1%) patients; 43 (90%) experienced superficial or deep dyspareunia, and 5 (10%) experienced both. A lack of and lower sexual satisfaction were reported by 20 (19.6%) and 40 (39.2%) patients, respectively. Following obstetric fistula repair, many women experienced difficulty engaging in penetrative vaginal intercourse and reported sexual dysfunction. Management of sexual dysfunction should be part of fistula rehabilitation programs. © 2016 International Federation of Gynecology and Obstetrics.

  5. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    M. Crespi


    Full Text Available Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  6. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era. (United States)

    Crespi, M; Montecamozzo, G; Foschi, D


    Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  7. Primary aortoduodenal fistula after radiotherapy. Report of a case

    Energy Technology Data Exchange (ETDEWEB)

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


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

  8. A rare case of congenital bronchoesophageal fistula in an adult. (United States)

    Taira, Naohiro; Kawasaki, Hidenori; Atsumi, Eriko; Furugen, Tomonori; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Baba, Motoo; Kawabata, Tsutomu


    When congenital bronchoesophageal fistulas exist without atresia of the esophagus, the diagnosis can be delayed, although symptoms may occur early following fistula development. Therefore, while they are usually found in infants, they can be extremely rarely found in adults. We herein report a rare case of bronchoesophageal fistula without atresia in an adult. An 69-year-old male presented to the outpatient clinic with a decades-long history of cough with expectoration immediately after taking food, especially liquids. Computed tomograph, esophagoscopy, and esophagography revealed the fistulous communication between the mid-esophagus and right lower lobe bronchus, with consolidation in the right lower lobe. We performed right lower lobectomy with the closure and excision of the fistula. The histopathology of the fistula revealed the mucosa to be lined by stratified squamous epithelium. There was no evidence of inflammation, granuloma, or carcinoma. In conclusion, despite the benign nature of this malformation, if left untreated, it can cause long-term debilitating respiratory symptoms associated with the fistula. Therefore, the diagnosis should be considered in the evaluation of recurrent lung infection. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Surgical management of aneurysms of arteriovenous fistulae in hemodialysis patients: A case series

    Directory of Open Access Journals (Sweden)

    Christopher SP Valentine


    Full Text Available Christopher SP Valentine, Olugbenga AworantiDepartment of Surgery, Cornwall Regional Hospital, Montego Bay, JamaicaBackground: One of the complications of arteriovenous (AV fistulae used for hemodialysis is aneurysm formation and subsequent risk for rupture. Surgery is one of the modalities utilised to treat this condition.Methods: A retrospective review of medical records was done to identify patients managed surgically at our institution over a four-year period. The surgical procedures varied from aneurysmectomy alone, to partial aneurysmectomy with preservation of the fistula, to aneurysmectomy and creation of a new fistula.Results: Seven patients who had undergone AV fistula aneurysm were identified. The usual presentation was of a pulsatile, expansile mass at the site of the AV fistula scar associated with pain. Two patients presented with bleeding. Patients in whom preservation of the fistula was attempted had poor patency of the fistula postoperatively. All patients in whom aneurysmectomy with creation of a new fistula was done had a functional fistula postoperatively.Discussion: Others have described surgical techniques for fistula preservation, but these have necessitated a significant delay until use of the fistula. Arterial blood flow in a new fistula increases gradually for up to 10 days, then tapers off. Therefore, it should be possible to begin use of the fistula at this time.Conclusions: AV fistula aneurysms may be treated by aneurysmectomy and creation of a new fistula. This may also reduce the waiting time before the fistula can be used for dialysis.Keywords: arteriovenous fistula, aneurysm, hemodialysis aneurysm, pseudoaneurysm

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

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    Marko Malovrh


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

  11. Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies (United States)

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


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

  12. Robotic repair of vesicovaginal fistula - initial experience

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    Ankush Jairath


    Full Text Available ABSTRACT Objective The most common acquired fistula of the urinary tract is Vesicovaginal fistulae (VVF (1 posing social stigmata for the patient as well as a surgical challenge for the urologist. Here we present our initial experience with Robotic assisted laparoscopic repair of VVF, its safety and efficacy. Materials and Methods Seven out of eight fistulas were post hysterectomy; five had undergone abdominal while two had laparoscopic hysterectomy while one was due to prolonged labour. Two had associated ureteric injury. All underwent robotic assisted laparoscopic trans abdominal extravesical approach. Three 8 mm ports for robotic arms, one 12 mm port for camera and another 12 mm for assistant were used in a fan shaped manner. All had preoperative ureteric catheter placed. Bladder was closed in two layers and vagina in one layer. Omental flap placed in all cases except two where it was not possible. Drain and per urethral catheter placed in all cases. Double J stents were placed in two cases requiring ureteric implantation additionally. Results The mean age of presentation was 39.25 years (26-47 range with mean BMI being 26.25 kg/m2 (21-32 range. Mean duration between insult and repair was 9.37 months (3-24 months. Only in single case there was history of previous repair attempt. On cystoscopy four had supratrigonal VVF and four were trigonal with mean size of 13.37 mm (7-20 mm. Mean operative time was 117.5 minutes (90-150. There were no intraoperative/postoperative complications or need for open conversion. Mean haemoglobin drop was 1.4 gm/dL (0.3-2 gm. Drain was removed once 24-48 hours output is negligible. One patient had post-operative urinary leak at 2 weeks which ceased with continuation of catheterisation for another 2 weeks. Catheter was removed after voiding cystourethrogram showed no leak at 2-3 weeks postoperatively. Mean duration of drain was 3.75 days (3-5 and per urethral catheterisation (which was removed after voiding

  13. Surgical management of chronic fistula after sleeve gastrectomy. (United States)

    Nedelcu, A Marius; Skalli, Mehdi; Deneve, Eric; Fabre, Jean Michel; Nocca, David


    There is no clear definition of the chronic leak after sleeve gastrectomy. There are several endoscopic approaches, including endoprothese, endoscopic clips, endoscopic sealing glue, or balloon dilation. In case of failure of the endoscopic treatment, a definitive surgical approach can be attempted. The objective was to evaluate the surgical treatment of chronic leak after sleeve gastrectomy. From November 2010 through March 2012, 8 patients with chronic gastric fistula after laparoscopic sleeve gastrectomy had definitive surgical repair. The initial intervention, the diagnosis and management of the fistula, and the endoscopic approach were carefully reviewed. Five patients had their original laparoscopic sleeve gastrectomies performed at another hospital, while 3 had laparoscopic sleeve gastrectomy at our institution. The mean period of time from the diagnosis of the fistula to definitive surgical treatment was 14.4 months (range 5-44 months). Seven patients initially had surgical drainage by laparoscopy (5) and by laparotomy (2), with concomitant feeding jejunostomy in 6 patients. The endoscopic treatment consisted of endoprothese in 4 patients, endoscopic sealing glue in 2 patients, and sequential approach with glue and prosthesis in 2 other patients. One patient was treated exclusively by endoscopic approach with no surgical drainage. The surgical procedures performed for chronic fistula were gastrojejunal lateral anastomosis (4), Roux-en-Y gastric bypass (2), and gastrectomy with esojejunal anastomosis (2). Four patients presented with postoperative fistula, with a mean healing time of 32 days (range 22-63 days). No mortality was recorded. In chronic forms of fistulas with no improvements by endoscopic approach, the surgical treatment can be a solution. It remains a difficult procedure with a high percentage of leakage, but this type of fistula is more easily tolerated by the patient and heals faster. Crown Copyright © 2013. Published by Elsevier Inc. All

  14. Pentadecapeptide BPC 157 and the esophagocutaneous fistula healing therapy. (United States)

    Cesarec, Vedran; Becejac, Tomislav; Misic, Marija; Djakovic, Zeljko; Olujic, Danijela; Drmic, Domagoj; Brcic, Luka; Rokotov, Dinko Stancic; Seiwerth, Sven; Sikiric, Predrag


    Esophagocutaneous fistulas are a failure of the NO-system, due to NO-synthase blockage by the NOS-blocker L-NAME consequently counteracted by l-arginine and gastric pentadecapeptide BPC 157 (l-arginine BPC 157), precipitating a therapeutic benefit. Previously, there was an established BPC 157-NO-system interaction. BPC 157 GEPPPGKPADDAGLV, MW 1419 (LD1 not achieved), is a safe and stable anti-ulcer peptide, successful in inflammatory bowel disease trials, counteracting esophagitis, sphincter failure, gastrointestinal and skin ulcers, gastrocutaneous or colocutaneous fistulas. We treated rats with established cervical esophagocutaneous fistulas throughout four days (both open skin and esophageal defects, with significant leakage) with BPC 157 (parenterally and perorally) and L-NAME (blocking NO genesis) and l-arginine (NO-substrate) alone or in combination. RT-PCR investigated eNOS, iNOS, COX-2 mRNA levels in the fistulas. We evidenced a closely inter-related process of unhealed skin, esophageal defects, unhealed fistulas (up regulated eNOS, iNOS and COX2 mRNA levels), usually lethal, particularly NO-system related and therapy dependent. Generally, the course of fistula healing was accelerated either to a greater extent (with BPC 157 (in particular, less eNOS gene expression) completely counteracting L-NAME effects, in L-NAME+BPC 157 and L-NAME+l-arginine+BPC 157 groups), or to a lesser extent (with l-arginine). Conversely, the process was aggravated, rapidly and prominently (with L-NAME). In particular, BPC 157 was effective either given per-orally/intraperitoneally, in μg- and ng-regimens. Shortly, defects started to heal, with less fistula leakage and no mortality at day 4. Failure of pyloric and lower esophageal sphincter pressure was restored, with practically no esophagitis. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Direct and indirect costs for anal fistula in Sweden. (United States)

    Lundqvist, Adam; Ahlberg, Ida; Hjalte, Frida; Ekelund, Mats


    Anal fistula is an abnormal tract with an external and internal opening that cause leakage, discomfort, and occasionally pain. Surgery is standard treatment, but recurrence and anal incontinence is common. The objective of the study was to analyze resource use, costs and sick leave for newly diagnosed patients with anal fistula in Sweden. The study was based on register data from linkages between Swedish population-based registers including patients treated for anal fistula in Västra Götaland County, Sweden. Health care resource use, costs and sick leave were estimated. The sample included 362 patients of which 27% had no surgery, 37% had one surgery and 36% had multiple surgeries. Patients with multiple surgeries underwent over four surgeries on average. Approximately 67% of the contacts occurred during the first year after diagnosis. Estimated mean sick leave was 10.4 full-time equivalent days per patient. Total discounted costs were €5,561 per patient where approximately 80% were direct costs. To our knowledge this is the first study of resource use, costs and sick leave related to anal fistulas. The study indicates that anal fistula is a condition that is costly for society and that the burden of anal fistula in terms of health care resources and sick leave is especially high for patients experiencing multiple surgeries. Anal fistula is a condition that is costly for society and there is an unmet need for the group of patients with multiple surgeries to find appropriate treatment interventions. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Neurofibromatosis with vertebral artery A-V fistula and cervical meningocele -a case report-

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    Kim, Yong Joo; Suh, Kyung Jin; Kim, Tae Heon; Kang, Duk Sik; Park, Yeun Mook; Park, June Sik [College of Medicine, Kyungpook National University, Daegu (Korea, Republic of)


    Arteriovenous fistula is a rare abnormality in patient with neurofibromatosis. A review of English-language literature revealed only 3 reported cases. We report a case of neurofibromatosis with vertebral artery A-V fistula and cervical meningocele.

  17. Giant coronary cameral fistula with coarctation of aorta in a neonate

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    Neeraj Awasthy


    Full Text Available A coronary cameral fistula (CCF involves a sizable communication between a coronary artery and a cardiac chamber. We present a case of giant coronary cameral fistula associated with coarctation of aorta in a 13 days old neonate.


    Directory of Open Access Journals (Sweden)

    Kishore Babu


    Full Text Available Objective to determine the effectiveness of seton tie as treatment modality in a high anal fistula in contrary to diversion colostomy which also can be used for treating a high anal fistula.

  19. A case of gastrocolic fistula secondary to adenocarcinoma of the colon

    Directory of Open Access Journals (Sweden)

    BiaoHuan Zhou


    Conclusion: It is rare for gastrocolic fistula case to be caused by colon adenocarcinoma, and has been rarely reported inside China. The best therapy of gastrocolic fistula remains radical en-bloc surgery.

  20. Intestinal microbiome landscaping

    NARCIS (Netherlands)

    Shetty, Sudarshan A.; Hugenholtz, Floor; Lahti, Leo; Smidt, Hauke; Vos, de Willem M.


    High individuality, large complexity and limited understanding of the mechanisms underlying human intestinal microbiome function remain the major challenges for designing beneficial modulation strategies. Exemplified by the analysis of intestinal bacteria in a thousand Western adults, we discuss

  1. Vasoactive intestinal peptide test (United States)

    ... Vasoactive intestinal peptide test To use the sharing features on this page, please enable JavaScript. Vasoactive intestinal peptide (VIP) is a test that measures the amount ...

  2. Intestinal ischemia and infarction (United States)

    ... ency/article/001151.htm Small intestinal ischemia and infarction To use the sharing features on this page, please enable JavaScript. Intestinal ischemia and infarction occurs when there is a narrowing or blockage ...

  3. Preserving arteriovenous fistula outcomes during surgical training. (United States)

    McGrogan, Damian G; Maxwell, Alexander P; Inston, Nicholas G; Krishnan, Hari; Field, Mel


    Arteriovenous fistulae (AVFs) are the preferred option for vascular access, as they are associated with lower mortality in hemodialysis patients than in those patients with arteriovenous grafts (AVGs) or central venous catheters (CVCs). We sought to assess whether vascular access outcomes for surgical trainees are comparable to fully trained surgeons. A prospectively collected database of patients was created and information recorded regarding patient demographics, past medical history, preoperative investigations, grade of operating surgeon, type of AVF formed, primary AVF function, cumulative AVF survival and functional patency. One hundred and sixty-two patients were identified as having had vascular access procedures during the 6 month study period and 143 were included in the final analysis. Secondary AVF patency was established in 123 (86%) of these AVFs and 89 (62.2%) were used for dialysis. There was no significant difference in survival of AVFs according to training status of surgeon (log rank x2 0.506 p=0.477) or type of AVF (log rank x2 0.341 p=0.559). Patency rates of successful AVFs at 1 and 2 years were 60.9% and 47.9%, respectively. We have demonstrated in this prospective study that there are no significant differences in outcomes of primary AVFs formed by fully trained surgeons versus surgical trainees. Creation of a primary AVF represents an excellent training platform for intermediate stage surgeons across general and vascular surgical specialties.

  4. Medical image of the week: bronchopleural fistula

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    Desai H


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

  5. Role of magnetic resonance imaging in pre-operative assessment of ano-rectal fistula


    Mohamed, Rania E.; Dina M. Abo-Sheisha


    Aim of the work: To evaluate the role of magnetic resonance imaging (MRI) in preoperative assessment of ano-rectal fistula and tracing its full extent and relationship. Materials and methods: Twenty-four patients with ano-rectal fistula were enrolled in this study. They were examined with different MRI sequences for evaluation of the fistulas and their extent. Fistulas were classified according to St. James’s University Hospital MRI based classification system (which correlates the Parks s...

  6. Vacuum-assisted Closure of a Vesicocutaneous Fistula in a Pediatric Patient After Bladder Cystoplasty. (United States)

    Elizondo, Rodolfo A; Au, Jason K; Gargollo, Patricio C; Tu, Duong T


    A vesicocutaneous fistula is an abnormal communication from the bladder to the skin (Pritts et al, 2001). Recently, wound vacuum-assisted closure (VAC) has been used to facilitate fistula closure. There are no reports of using VAC to help fistula closure in the pediatric population. We present a case of an adolescent patient who develops a vesicocutaneous fistula after bladder augment cystoplasty and was treated with VAC only. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report. (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fukata, Tadafumi; Yagi, Toshiya; Fujiwara, Yoshiyuki; Yano, Masahiko


    Vacuum-assisted closure (VAC) is useful for treating complex wounds because it promotes granulation. In the present report, a successful case of VAC used for an open abdominal wound with enterocutaneous fistulae after multiple intestinal perforations during chemotherapy is described. A 73-year-old man was admitted to our hospital with severe abdominal pain. He underwent surgical resection for ascending colon cancer 4 years ago and was administered chemotherapy with bevacizumab for recurrence. Physical examination and computed tomography revealed perforation of the intestine, and an emergency operation was performed. Following this procedure, other intestinal perforations occurred, resulting in an open abdominal wound at postoperative day (POD) 10. To isolate enteric contents and promote granulation, VAC was applied to the abdominal wound with enterocutaneous fistulae. Oral intake started at POD 21 and the wound size became smaller. Further, an ostomy bag was directly attached to the most oral perforation site. The patient recovered from life-threatening events without severe infection and was transferred to another hospital close to his home at POD 180. Gastrointestinal perforation is known to be one of the fatal adverse events of bevacizumab. In this case four gastrointestinal perforations were observed. Isolation of enteric contents is important to heal the wound and VAC is an effective therapy for the management of open abdominal wounds even with enterocutaneous fistulae. Innovative VAC use for the management of open abdominal wounds can improve the nutritional status and overall wound healing of the patient. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Intestinal lymphangiectasia in adults


    Freeman, Hugh James; Nimmo, Michael


    Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has bec...

  9. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

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


    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.

  10. [Management of postoperative pancreatic fistula resistant to octreotide therapy]. (United States)

    Dobosz, M; Dymecki, D; Babicki, A; Hać, S; Gruca, Z; Wajda, Z


    Pancreatic fistula is a rare postoperative complication, usually occurring after pancreatic surgery. Majority of them heal spontaneously, some patients require somatostatin/octreotide treatment. The authors have presented 11 patients with postoperative pancreatic fistula, in whom octreotide therapy in dose of 0.1 mg t.i.d./10 days has been ineffective. The causes of pancreatic fistula have been as follows: necrosectomy of the infected pancreatic necrosis--5 patients, distal pancreatic resection--2 patients, insulinoma enucleation--2 patients, gastrectomy with partial pancreatectomy--2 patients. In 9 patients endoscopic stenting of the main pancreatic duct has been performed. In remained 2 patients after Roux-en-Y gastrectomy the endoscopic access to Vater papilla has been impossible and the patients have received one intramuscular injection of long acting somatostatin analogue. In 8 of 9 patients with pancreatic stenting and in two patients after gastrectomy the fistula has been closed within the period of 6-17 days. In one patient after the necrosectomy the prosthesis implacement has been ineffective. This patient has been successfully treated with two additional injections of long acting somatostatin analogue (one injection/14 days). Authors have concluded that endoscopic pancreatic stenting has been an effective method of treatment of the postoperative pancreatic fistula, resistant to octreotide therapy. In some cases, additional administration of long acting somatostatin analogue has been necessary.

  11. Chronic kidney disease aggravates arteriovenous fistula damage in rats. (United States)

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


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

  12. Transitional Flow in an Arteriovenous Fistula: Effect of Wall Distensibility (United States)

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


    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.

  13. Fistula-associated anal adenocarcinoma: good results with aggressive therapy. (United States)

    Gaertner, Wolfgang B; Hagerman, Gonzalo F; Finne, Charles O; Alavi, Karim; Jessurun, Jose; Rothenberger, David A; Madoff, Robert D


    To evaluate the clinical features, pathology, treatment, and outcome of patients with fistula-associated anal adenocarcinoma. We identified 14 patients with histologically proven fistula-associated anal adenocarcinoma. We reviewed their medical records and pathology specimens to characterize their presentation, treatment, and clinical outcome. Nine patients presented with a persistent fistula, 3 with a perianal mass, 1 with pain and drainage, and 1 with a recurrent perianal abscess. The average age at time of diagnosis was 59 (range, 37-76) years. Eleven patients had preexisting chronic anal fistulas. Ten had Crohn's disease, and 1 had previously received pelvic radiation therapy. The diagnosis of cancer was suspected during physical examination in 6 of the 14 patients (43 percent). Twelve patients had extensive local disease at presentation. Primary abdominoperineal resection was performed in 11 patients, 7 following neoadjuvant chemoradiation. Six patients received postoperative chemotherapy, and 2 received postoperative radiation. Four patients died with metastatic disease. The remaining 10 patients are alive without evidence of disease at a mean follow-up of 64.3 (range, 14-149) months. The diagnosis of fistula-associated anal adenocarcinoma is often unsuspected. Most patients can be cured with aggressive surgical and adjuvant chemoradiotherapy.

  14. Fistulotomy versus fistulectomy as a treatment for low anal fistula in ...

    African Journals Online (AJOL)

    fistula-in-ano in children. Br J Surg 2003; 90:220–221. 7 Piazza DJ, Radhakrishnan J. Perianal abscess and fistula-in-ano in children. Dis Colon Rectum 1990; 33:1014–1016. 8 Longo WE, Touloukian RJ, Seashore JN. Fistula in ano in infants and children: implications and management. Pediatrics 1991; 87 (I):. 737–739.

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

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


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

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

    DEFF Research Database (Denmark)

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


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

  17. Obstetric Fistula “Disease” and Ensuing Care: Patients' Views in ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    We explored obstetric fistula patients' real-life experience of care in modern Health System. Our aim was to analyze how these women's views impacted their care uptake and coping. We conducted 67 in-depth interviews with 35 fistula patients or former patients in 5 fistula repair centers within referral hospitals in Mali and ...

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

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    Raut V


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

  19. Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

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    Sirakov Stanimir S.


    Full Text Available We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF, with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery.

  20. Aphallia with urethrorectal fistula, bladder and urethral calculi

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    M Movarrekh


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

  1. MR angiography of hemodialysis access fistula. Evaluation before PTA procedure

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, Atsuko; Yoshimura, Hirohide; Hosokawa, Chisa; Yoshida, Toshiko [Yodogawa Christian Hospital, Osaka (Japan)


    We evaluated the feasibility of MR angiography for hemodialysis fistula. Eleven patients with suspected stenosis or occlusion of an autogenous hemodialysis fistula in the forearm underwent MRA. MRA was obtained using both the 3D-PC method and 3D gadolinium contrast-enhanced (CE) method with a knee coil. The two methods were compared with DSA in seven patients. CE-MRA clearly demonstrated the entire dialysis fistula. However, signals of the stenotic area are effaced in PC-MRA. The diameter of the vessels evaluated in the CE-MRA was well correlated with angiography. CE-MRA demonstrated smaller collateral vessels more clearly than PC-MRA. CE-MRA provided useful information before the PTA procedure. (author)

  2. Management of pharynx fistula after upper digestive tract instrumentation

    Directory of Open Access Journals (Sweden)

    Bogdan Popescu


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

  3. Negotiating living with an arteriovenous fistula for hemodialysis. (United States)

    Richard, Cleo J; Engebretson, Joan


    The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses.

  4. Endovascular Modalities for the Treatment of Cavernous Sinus Arteriovenous Fistulas: A Single-Center Experience. (United States)

    Hassan, Tamer; Rashad, Sherif; Aziz, Waseem; Sultan, Ahmed; Ibrahim, Tamer


    Cavernous sinus (CS) fistulas are classified into traumatic and spontaneous. Traumatic carotid-cavernous fistulas (CCFs) are usually direct internal carotid artery (ICA) high-flow fistulas; whereas spontaneous CCFs are usually dural, low-flow fistulas and generally possess less severe symptoms than direct carotid-cavernous fistulas. This study involved 34 patients who were classified into 2 groups: Group A included 26 patients with direct carotid-cavernous fistula; and Group B included 8 patients with indirect dural cavernous fistula. All patients had ocular manifestations. One patient had subarachnoid hemorrhage. Coils were used alone in 19 cases of direct fistula and in 1 case of dural fistulas. Coils and Onyx (Covidien, Mansfield, MA, USA) were used in 7 cases of direct fistula and in 2 cases of dural fistulas. Onyx alone was used to treat 5 cases with dural fistulas but none of the cases with direct fistulas. Covered stents and coils were used in 2 cases of direct fistulas. All patients in both groups showed full recovery of their clinical signs and symptoms. Only 1 procedure-related complication was observed (3%) in which a patient had an embolic event and trigeminal dysesthesia as a result of Onyx reflux through external carotid artery-ICA anastomosis. Coils are superior solid embolic agents used for the treatment of direct high-flow fistulas, while Onyx is more valuable in dural low-flow CCF. Onyx shortens the procedure time and decreases procedure cost. Onyx injection inside the CS proper through the transarterial or transvenous route may be safer than Onyx injected inside dural arteries supplying the CS. However, more cases are needed to determine this. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. Thrombophilia and arteriovenous fistula survival in ESRD. (United States)

    Salmela, Birgitta; Hartman, Jari; Peltonen, Seija; Albäck, Anders; Lassila, Riitta


    The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities. This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and d-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models. Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF. Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.

  6. Endometriosis mimicking the perianal fistula tract: Case report

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    Gül Türkcü


    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

  7. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

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


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

  8. Biomaterials in the Treatment of Anal Fistula: Hope or Hype? (United States)

    Scoglio, Daniele; Walker, Avery S.; Fichera, Alessandro


    Anal fistula (AF) presents a chronic problem for patients and colorectal surgeons alike. Surgical treatment may result in impairment of continence and long-term risk of recurrence. Treatment options for AFs vary according to their location and complexity. The ideal approach should result in low recurrence rates and minimal impact on continence. New technical approaches involving biologically derived products such as biological mesh, fibrin glue, fistula plug, and stem cells have been applied in the treatment of AF to improve outcomes and decrease recurrence rates and the risk of fecal incontinence. In this review, we will highlight the current evidence and describe our personal experience with these novel approaches. PMID:25435826

  9. Congenital anterior urethrocutaneous fistula: Report of two rare cases

    Directory of Open Access Journals (Sweden)

    Jayalaxmi Shripati Aihole


    Full Text Available Isolated congenital anterior urethrocutaneous fistiula (CAUF is a rare anomaly. CAUF can be defined as a fistula of the penile urethra associated with a normal foreskin, in which urethral meatus and prepuce are intact. Additionally, it may be associated with other anomalies such as congenital hernias and anorectal malformations. Treatment of CAUF is individualized according to site of fistula, associated anomalies and condition of the distal urethra. We are reporting our experience of two cases that had abnormal openings on the ventral aspect of distal penis with normal foreskin without hypospadias and chordee.

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

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    Tomas Mujo


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

  11. Traumatic esophageopleural fistula due to fish bone injury

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Verma


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

  12. [Massive pneumocephalus and cerebrospinal fluid fistula after thoracotomy]. (United States)

    Olarra, J; Longarela, A


    We report the case of a 70-year-old man (ASA physical status 2) who developed massive pneumocephalus caused by a fistula between the subarachnoid and pleural spaces following a left pneumonectomy. After an uneventful immediate postoperative period, the patient was readmitted to the recovery care unit with dyspnea, intense headache, confusion, and diminished level of consciousness. Computed tomography confirmed a cerebrospinal fluid fistula secondary to the opening of the intradural space during tumor resection. Treatment was conservative, consisting of rest in a slightly Trendelenburg position, antibiotic prophylaxis to prevent meningitis, and a water seal on the thoracic drainage tube.

  13. Endoscopic Management of Recurrent Tracheoesophageal Fistula with Fibringlue and Electrocautery


    Ospina, Juan Camilo; Hospital Universitario San Ignacio; Wuesthoff, Carolina; Pontificia Universidad Javeriana-Hospital Universitario San Ignacio


    Recurrent Tracheoesophageal Fistulas (RTEF) remains a therapeutic challenge, cause of the high rates of morbidity and mortality associated with open surgical closure and their frequent recurrence. Endoscopic techniques provide an alternative approach with the potential for improved surgical outcomes. We present a case of successful repair of recurrent tracheoesophageal fistula using bronchoscopy and esophagoscopy, as well as a combined technique with electrocautery and fibrin glue. We believe...

  14. Doppler findings in a rare coronary artery fistula. (United States)

    Jung, Christian; Jorns, Carl; Huhta, James


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

  15. [The effectiveness of the valve bronchial occlusion in case of bronchopleural fistulas]. (United States)

    Gasanov, A M; Pinchuk, T P; Danielian, Sh N; Tarabrin, E A


    The experience of endobronchial valve «Medlung" installation in 24 patients with bronchopleural fistula was summarized in the article. In 18 (75%) patients the cause of bronchopleural fistula was purulent - destructive processes in the lungs, including the associated trauma in 4 (22.2%) patients, pneumonia in 14 (77.8%) patients. In 3 (12.5%) cases the cause of the bronchopleural fistula was the lung tumors of different localization and in 3 (12.5%) cases - idiopathic pulmonary fibrosis. Reasonable use of endobronchial valve in patients with bronchopleural fistula provides a persistent separation of the fistula and lets to avoid extensive, traumatic operations.

  16. Role of HIDA scanning in the assessment of external biliary fistulae

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    McPherson, G.A.; Collier, N.A.; Lavender, J.P.; Blumgart, L.H.


    Three patients with postoperative external biliary fistula are described. In each, radionuclide /sup 99m/Tc HIDA was used to define the anatomy of the fistula. The extent of the fistula and the presence of distal obstruction to bile flow could also be determined. This information was used to predict the likelihood of spontaneous fistula closure. HIDA scanning is a useful noninvasive alternative to other investigations, such as fistulography and cholangiography, which do not always provide useful information. The results of HIDA scanning can aid the clinical decision on the need for surgical intervention to correct an external biliary fistula.

  17. [A case of intractable fistula after low anterior resection repaired by transsacral direct suture]. (United States)

    Yamada, Takanobu; Kodato, Takashi; Shirai, Junya; Kamiya, Mariko; Sujishi, Ken; Kumazu, Yuta; Sugano, Nobuhiro; Hatori, Shinsuke; Osaragi, Tomohiko; Yoneyama, Katsuya; Kasahara, Akio; Rino, Yasushi; Masuda, Munetaka; Yamamoto, Yuji


    We report a case of an intractable fistula repaired by transsacral direct suture. A 65-year-old man underwent low anterior resection for rectal cancer. He subsequently underwent ileostomy due to anastomosis leakage. The fistula of the anastomosis persisted 3 months after surgery. He underwent surgery to repair the fistula using a transsacral approach. After removing the coccyx, the fistula in the postrectal space was exposed directly. The presence of the fistula was confirmed by an air leak test and was closed by direct suture. After 33 days, the patient underwent ileostomy closure.

  18. Aortocaval Fistula in Rat: A Unique Model of Volume-Overload Congestive Heart Failure and Cardiac Hypertrophy

    Directory of Open Access Journals (Sweden)

    Zaid Abassi


    Full Text Available Despite continuous progress in our understanding of the pathogenesis of congestive heart failure (CHF and its management, mortality remains high. Therefore, development of reliable experimental models of CHF and cardiac hypertrophy is essential to better understand disease progression and allow new therapy developement. The aortocaval fistula (ACF model, first described in dogs almost a century ago, has been adopted in rodents by several groups including ours. Although considered to be a model of high-output heart failure, its long-term renal and cardiac manifestations are similar to those seen in patients with low-output CHF. These include Na+-retention, cardiac hypertrophy and increased activity of both vasoconstrictor/antinatriureticneurohormonal systems and compensatory vasodilating/natriuretic systems. Previous data from our group and others suggest that progression of cardiorenal pathophysiology in this model is largely determined by balance between opposing hormonal forces, as reflected in states of CHF decompensation that are characterized by overactivation of vasoconstrictive/Na+-retaining systems. Thus, ACF serves as a simple, cheap, and reproducible platform to investigate the pathogenesis of CHF and to examine efficacy of new therapeutic approaches. Hereby, we will focus on the neurohormonal, renal, and cardiac manifestations of the ACF model in rats, with special emphasis on our own experience.

  19. Pancreatic fistula after central pancreatectomy: case series and review of the literature. (United States)

    Zhou, Yan-Ming; Zhang, Xiao-Feng; Wu, Lu-Peng; Su, Xu; Li, Bin; Shi, Le-Hua


    Postoperative pancreatic fistula is one of the most common complications after pancreatectomy. This study aimed to assess the occurrence and severity of pancreatic fistula after central pancreatectomy. The medical records of 13 patients who had undergone central pancreatectomy were retrospectively studied, together with a literature review of studies including at least five cases of central pancreatectomy. Pancreatic fistula was defined and graded according to the recommendations of the International Study Group on Pancreatic Fistula (ISGPF). No death was observed in the 13 patients. Pancreatic fistula developed in 7 patients and was successfully treated non-operatively. None of these patients required re-operation. A total of 40 studies involving 867 patients who underwent central pancreatectomy were reviewed. The overall pancreatic fistula rate of the patients was 33.4% (0-100%). Of 279 patients, 250 (89.6%) had grade A or B fistulae of ISGPF and were treated non-operatively, and the remaining 29 (10.4%) had grade C fistulae of ISGPF. In 194 patients, 15 (7.7%) were re-operated upon. Only one patient with grade C fistula of ISGPF died from multiple organ failure after re-operation. Despite the relatively high occurrence, most pancreatic fistulae after central pancreatectomy are recognized a grade A or B fistula of ISGPF, which can be treated conservatively or by mini-invasive approaches.

  20. Arteriovenous fistula in the rat tail: a new model of hemodialysis access dysfunction. (United States)

    Lin, Tao; Horsfield, Catherine; Robson, Michael G


    Problems with vascular access are an important cause of morbidity and mortality in hemodialysis patients. We established a rodent model of arteriovenous fistula by anastomosing the end of a lateral vein to the side of the ventral artery of the rat tail. All operations were technically successful and in all animals the fistula was patent with a dilated fistula vein clearly visible after 28 days. Neointimal hyperplasia was found in 4 out of 5 fistulae with varied pathology from immature to more mature lesions seen both proximal and distal to the anastomosis. There was no particular pattern to the presence of or type of lesion found at any particular site of the fistulae. This fistula promises to be useful in analyzing pathologic processes that occur in native arteriovenous fistulae since the vein is accessible to functional studies and to test new subcutaneous or intravascular treatments.

  1. Arteriovenous Fistulae for Haemodialysis: A Systematic Review and Meta-analysis of Efficacy and Safety Outcomes. (United States)

    Bylsma, L C; Gage, S M; Reichert, H; Dahl, S L M; Lawson, J H


    Arteriovenous fistulae are the currently recommended gold standard vascular access modality for haemodialysis because of their prolonged patency, improved durability, and low risk of infection for those that mature. However, notable disadvantages are observed in terms of protracted maturation time, associated high rates of catheter use, and substantial abandonment rates. The aim of this study was to quantitatively summarize the outcomes of fistula patency, infection, maturation, and abandonment published in the scientific literature. This was a systematic review and meta-analyses of studies evaluating fistula outcomes. Literature searches were conducted in multiple databases to identify observational and interventional studies of mean fistula patency rates at 1 year, infection risk, maturation time, and abandonment. Digitisation software was used to simulate individual patient level data from Kaplan-Meier survival plots. Over 8000 studies were reviewed, and from these, 318 studies were included comprising 62,712 accesses. For fistulas the primary unassisted, primary assisted, and secondary patency rates at one year were 64%, 73% and 79% respectively, however not all fistulas reported as patent could be confirmed as being clinically useful for dialysis (i.e. functional patency). For fistulas that were reported as mature, mean time to maturation was 3.5 months, however only 26% of created fistulas were reported as mature at 6 months and 21% of fistulas were abandoned without use. Overall risk of infection in fistula patients was 4.1% and the overall rate per 100 access days was 0.018. Reported fistula patency rates may overstate their potential clinical utility when time to maturation, maturation rate, abandonment and infection are considered. Protracted maturation times, abandonment and infection all have a significant impact on evaluating the clinical utility of fistula creation. A rigorous and consistent set of outcomes definitions for hemodialysis access are

  2. Endoscopic treatment of congenital H-Type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue. (United States)

    Tzifa, K T; Maxwell, E L; Chait, P; James, A L; Forte, V; Ein, S H; Friedburg, J


    Congenital H-Type tracheoesophageal fistulae (H-Type TEF) and recurrent fistulae after primary repair of esophageal atresia represent a difficult problem in diagnosis and management. The treatment traditionally involved an open technique via a cervical or thoracic route, approaches with high morbidity and mortality rates of up to 50%. Endoscopic closure of fistulae has been reported with various techniques such as tissue adhesives, electrocautery, sclerosants and laser. However, the published case series contain a small number of patients with usually short-term follow-up. The aim of this paper is to present the experience of a decade at Toronto's Hospital for Sick Children, using diathermy and histoacryl tissue adhesive and discuss the indications and limitations of this technique. Since 1995, 192 patients have been managed in this institution with tracheoesophageal fistulae of which 10 patients have been treated endoscopically. The fistulae were both of H-Type and recurrent tracheoesophageal fistulae following surgery for esophageal atresia and fistula division. One fistula occurred following trauma. The procedure was undertaken under general anesthesia in the image guided therapy suite under fluoroscopic control. Flexible ball electrocautery and injection of histoacryl glue were used either on their own or in combination. Fistula closure was achieved in 9 out of 10 fistulae. Four patients had a second endoscopic procedure. No major respiratory or other complications were encountered in association with the procedure. Follow-up has been between 3 months and 9 years. We conclude, endoscopic treatment of tracheoesophageal fistulae with electrocautery and histoacryl glue has been a safe and successful technique of managing H-Type and recurrent tracheoesophageal fistulae. In this paper, we discuss the indications and the surgical steps of the procedure. We highlight that diathermy should be carefully controlled and applied preferably in the small non

  3. Tratamento colonoscópico de fístula colo-cutânea com plugue de colágeno Colonoscopic treatment of colocutaneous fistula with collagen plug

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    Júlio Cezar Uili Coelho


    Full Text Available INTRODUÇÃO: Fístulas digestivas permanecem como complicações mais frequentes após operações abdominais. Quando ocorrem, o tempo de internação, custo e a morbimortalidade pós-operatória aumentam. Apesar das várias opções de tratamento, um número significativo de pacientes requerem procedimentos cirúrgicos complexos para fechá-las. O desenvolvimento da endoscopia intervencionista proporcionou nova opção de tratamento para fístulas gastro-intestinais. RELATO DO CASO: Paciente com fístula colocutânea foi tratada com sucesso com um plugue de colágeno. A injeção percutânea de azul de metileno identificou o orifício interno da fístula no cólon transverso. Aplicação de clips anteriormente realizada não foi bem sucedida. A fístula fechou em poucos dias após a introdução de plugue de colágeno através de um procedimento combinado percutâneo-colonoscopico. CONCLUSÃO: O uso de tampões de colágeno por procedimento percutâneo e endoscópico combinado tem a vantagem de permitir a redução do tempo de tratamento da fístula intestinal e pode evitar intervenções cirúrgicas mais complexas.BACKGROUND: Digestive fistulas remain as frequent complications after abdominal operations. When they occur, hospitalization time, cost, morbidity and post-operative mortality increase significantly. Despite various treatment options, a significant number of patients require complex surgical procedures to close them. The development of interventional endoscopy has provided new treatment option for gastro-intestinal fistulas. CASE REPORT: Patient with colocutaneous fistula was successfully treated with a collagen plug. Percutaneous injection of methylene-blue identified the internal orifice of the fistula in the transverse colon. Previous clips application was unsuccessful. The fistula closed in few days after collagen plug introduction through a combined percutaneous-colonoscopic procedure. CONCLUSION: The use of plugs of collagen

  4. [Severe hypophosphataemia after starting parenteral nutrition in a patient with an intestinal fistula]. (United States)

    Temprano, J L; Bretón, I; Zugasti, A; Cuerda, C; Camblor, M; Pérez-Díaz, M D; García, P


    Hypophosphataemia is a complication that may appear in undernourished patients who are given nutrition by either enteral or parenteral means. It is associated with several clinical manifestations, including cardiological, neurological and haematological conditions of note, and may potentially be even life-threatening. It is therefore mandatory to ensure prevention and follow-up in those patients at risk of suffering this condition, taking into account the considerable morbidity and mortality associated with it.

  5. Surgical results in cases of intestinal radiation injury

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    Deguchi, Hisatsugu; Ozawa, Tetsuro; Wada, Toshihiro; Tsugu, Yukio (Toho Univ., Tokyo (Japan). School of Medicine)


    Surgical procedures were performed on 25 patients suffering from late-phase intestinal tract disorders induced by irradiation. The primary diseases of these cases were almost exclusively gynecological in nature, such as cancer of the uterine cervix. Symptoms observed in these cases were overwhelming ileus followed by melena, fistulation and free perforation, as well as combination thereof. The most common portion involved was the recto-sigmoidal colon, followed by the ileo-cecum and ileum. As for the relationship of symptoms to the disordered portion, ileus was seen mainly in cases of disorders at the ileocecal portion; melena was observed exclusively in cases of disorders at the rectosigmoidal colon; fistulation was manifested mainly as recto-vaginal fistula or ileo-sigmoidal fistula; free perforation was observed at both the ileum and sigmoidal colon. Colostomy was the most frequent surgical method applied. Only 3 cases were able to undergo enterectomy. Other cases were subjected to enteroanastomosis or enterostomy. In most cases it was nearly in possible to excise the disordered portions. As for the effect of surgical procedures on symptoms, cases of melena or fistulation were all subjected to colostomy; the majority of these cases showed improvement in symptoms. Moreover, a high improvement ratio was obtained in cases of ileus which were subjected to enterectomy and enteroanastomosis. Cases of free perforation showed high improvement ratio irrespective of the surgical procedure given. As for postoperative complications, one case of free perforation at the ileum showed anastomotic leakage after partial resection. For cases suffering from late-phase intestinal tract disorders induced by irradiation, immediate resection of the disordered intestinal tract and anastomosis are ideal. However, conservative operations must be considered, based on the focal condition. (author).

  6. Obstetric vesico-vaginal fistulae seen in the Northern Democratic ...

    African Journals Online (AJOL)

    and involuntary leakage of urine through the vagina6. An obstetric vesico-vaginal fistula results from trauma ... During both missions, patients who presented com- plaining of uncontrolled leakage of urine were recruit- ... We calculated frequency and percent age of each cat- egorical socio-demographic variable (education ...

  7. The Spectrum of Hand Dysfunction After Hemodialysis Fistula Placement


    Rehfuss, Jonathan P.; Berceli, Scott A.; Sarah M. Barbey; He, Yong; Kubilis, Paul S.; Beck, Adam W.; Huber, Thomas S.; Salvatore T Scali


    Contemporary dogma has classically attributed hand dysfunction following hemodialysis arteriovenous fistula (AVF) placement to regional ischemia. We hypothesize that hemodynamic perturbations alone do not entirely explain the postoperative changes in hand function and, furthermore, that various elements of hand function are differentially affected following surgery. Methods: Bilateral wrist and digital pressures and upper extremity nerve conduction tests were recorded preoperatively and at...

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

    NARCIS (Netherlands)

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


    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

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

    Directory of Open Access Journals (Sweden)

    Cebrián, Rosario


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

  10. [Tactic of surgical treatment of complex rectal fistula]. (United States)

    Grubnik, V V; Degtiarenko, S P


    The experience of the examination and treatment of 646 patients for different forms of complex rectal fistula (CRF) summarized. A working classification of the CRF with regard to their complication was developed and implemented. A differentiated approach has allowed greater use sphincter-preserving methods to improve functional outcome, quality of life, reduce the duration of the disability period and frequency of patients disability.

  11. Histoacryl injection in the management of fourth branchial fistula

    African Journals Online (AJOL)

    J Laryngol Otol 1995; 109:999–1000. 6 Chaudhary N, Gupta A, Motwani G, Kumar S. Fistula of the fourth branchial pouch. Am J Otolaryngol Head Neck Med Surg 2003; 24:250–252. 7 Franciosi JP, Sell LL, Conley SF, Bolender DL. Pyriform sinus malformations: a cadaveric representation. J Pediatr Surg 2002; 37:533–538.

  12. Vesicovaginal fistula following an induced abortion with a huge ...

    African Journals Online (AJOL)

    A case of a 26 year old P +1 woman who developed vesico-vaginal fistula (VVF) following an induced 1 abortion is presented. She presented with five year history of continous leakage of urine following a voluntary termination of pregnancy at about 11 weeks of gestation using metallic instruments in a chemist shop by a ...

  13. Effect of Ethanolic Leaf Extract of Senna Fistula on some ...

    African Journals Online (AJOL)

    This study was designed to investigate the effect of chronic administration of ethanolic leave extract of Senna fistula on haematological values, oxidative stress and dyslipidemia in experimental diabetic rats. Twenty-four albino rats weighing 120-150 g were divided into 4 experimental groups of six rats each; control, diabetic ...

  14. Large Vesico‑Vaginal Fistula Caused by a Foreign Body

    African Journals Online (AJOL)

    Vesico‑vaginal fistula is commonly caused by obstructed labor, gynecological surgery, occasionally due to malignancy and rarely foreign body; in most cases being ring pessaries.[1] Cases of a foreign body in the vagina have been reported mostly in developed countries.[1‑4] Foreign body within the vagina can result in ...

  15. Enterovaginal or Vesicovaginal Fistula Control Using a Silicone Cup. (United States)

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


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

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

    Directory of Open Access Journals (Sweden)

    Andres Asser


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

  17. Management of a vesicovaginal fistula using holmium laser ablation. (United States)

    Singh, Ruchira; Schmitt, Jennifer J; Knoedler, John J; Occhino, John A


    The objective was to demonstrate a surgical technique for the management of a small vesicovaginal fistula (VVF) involving a combination of cystoscopic holmium laser ablation and vaginal repair. A 55-year-old morbidly obese female presented with complaints of menometrorrhagia and complex adnexal mass. She underwent an attempted robotic hysterectomy, which was converted to open hysterectomy, omentectomy, and lymphadenectomy owing to an intraoperative diagnosis of endometrioid carcinoma of the endometrium and dense pelvic adhesions. Postoperatively, the patient developed intermittent urinary leakage associated with position change. On evaluation, a speculum examination did not reveal any fistulous tract or leakage of fluid in the vagina. A tampon test was positive, but no evidence of a fistula was noted on a CT urogram. Cystourethroscopy was performed and identified a small VVF. The patient subsequently underwent repair of her VVF using a combination of cystoscopic holmium laser ablation and transvaginal excision of the suspected fistula opening. About 2 weeks after the surgery, a tampon test was negative and cystourethroscopy revealed healing bladder mucosa. The patient remains fistula-free at 12 months post-operatively. Holmium laser ablation combined with partial vaginal excision may be considered as a management option for a small VVF.

  18. Management of Complex Urogenital Fistulae in the Female | Al ...

    African Journals Online (AJOL)

    The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. Results: The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Conclusion: Through urological evaluation of complex urinary ...

  19. genito-urinary fistula patients at bugando medical centre

    African Journals Online (AJOL)


    Jul 7, 2010 ... Kegel exercises before discharge. We are also beginning to see more “fresh” fistula-that which has happened in the past 1-3 months. We are now attempting repair on these women at an earlier time. DISCUSSION. The most prominent feature of these patients is their low level of education (98% have low or ...

  20. Acquired Salpingo-Enteric Fistula – A Case Report | Ogbeide ...

    African Journals Online (AJOL)

    Hysterosalpingogram a common radiological examination is routinely used in the investigation of infertility and sub-fertility in women. The close proximity of the uterus to adjacent pelvic structures results in various types of pelvic fistulas after pelvic disease, pelvic radiation therapy, trauma or pelvic surgery. The case of a 34 ...

  1. Living with vesico-vaginal fistula: experiences of women awaiting ...

    African Journals Online (AJOL)

    Vesico-vaginal fistula (VVF) is one of maternal health problems confronting public health workers in Nigeria today. Information on how women suffering from this condition cope is important in that it can inform the design and delivery of programmes and interventions to address the challenges that face victims of VVF.

  2. Bladder perforation and development of a vesico - vaginal fistula ...

    African Journals Online (AJOL)

    Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible ...

  3. Classification Types Of Postoperative Enterocutaneous Fistula As A ...

    African Journals Online (AJOL)

    Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. ... Compared with the other classifications considered in the study classification into high and low output highly correlated with the outcome of treatment logistic regression p < 0.006 ...

  4. Post-laparotomy haemoptysis due to broncho-abdominal fistula ...

    African Journals Online (AJOL)

    as a right-sided lung abscess.6 Broncho-abdominal fistula (BAF) is similarly rare with a search yielding two reports .... conservative treatment without needing surgery.7. The use of sampling tracers such as Xenon-133 ... fundus was thought to be a result of the damage inflicted by the swab abscess complex in the left upper ...

  5. Effect of Ethanolic Leaf Extract of Senna Fistula on some ...

    African Journals Online (AJOL)


    leave extract of Senna fistula on haematological values, oxidative stress and dyslipidemia in experimental diabetic rats. Twenty-four albino rats ... might improve the diabetic induced disturbances of some haematological parameters, reduces the plasma lipid imbalances .... Malaysia, alloxan monohydrate and all other.

  6. Oesophageal bleeding from aorto- oesophageal fistula due to aortic ...

    African Journals Online (AJOL)


    Jan 22, 1983 ... ing gives warning of fistula formation. S Air Med J 1983: 63: 124-127. Exsanguinating oesophageal haemorrhage due to an established .... tive review has persuaded us that a more alert and vigorous approach in our cases might well have achieved some success. We are indebted to the Department of ...

  7. Outcomes after ulnar-basilic arteriovenous fistula formation. (United States)

    Liu, Wing; Lagaac, Regin; Pettigrew, Gavin J; Callaghan, Christopher J


    The ulnar-basilic arteriovenous fistula (UBAVF) is rarely used owing to perceived problems with poor patency and prolonged maturation times. We report outcomes after UBAVF formation. Patients who had a forearm UBAVF formed between October 1, 2002 and September 31, 2010 were identified from a prospectively maintained database. Fifty-two UBAVFs were formed in 48 patients. The majority were male (77.1%), with a median (range) age of 69.5 (18-86) years. Primary and secondary patencies at 1, 3, and 5 years were 43%, 13%, 13%, and 54%, 18%, and 13%, respectively. Primary patencies were higher in those with previously functioning radiocephalic arteriovenous fistulas on the same arm (P = 0.03). Thirty-six percent of UBAVFs became functional, with a median (range) time to maturation of 100 (32-471) days. Nine UBAVFs (17.3%) required revision surgery. Complications were rare (7.7%), with only one case of steal syndrome. Although UBAVF patency and functionality rates are low, we believe that these are acceptable, given the low risk of complications and preservation of precious upper-arm venous capital. Maturation can be prolonged, but when the forearm cephalic vein is unusable, UBAVFs can provide an alternative to upper-arm fistulas, and should be utilized more widely, especially in those with previously functioning ipsilateral radiocephalic arteriovenous fistulas. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Robotic versus laparoscopic resection for sigmoid diverticulitis with fistula. (United States)

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


    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.

  9. Variation in flowering phenology of Cassia fistula Linn. population in ...

    African Journals Online (AJOL)

    Flowering phenology in the population of Cassia fistula Linn. at Ota, Ogun State, Nigeria was investigated for three years to determine if there was variation in the phenology and the patterns were compared with some environmental factors to determine if there was any correlation. The number of plants flowering each ...

  10. A Case Report of Cholecystocolonic Fistula in a Cadaveric Setting

    Directory of Open Access Journals (Sweden)

    E Esfandiari


    Full Text Available ABSTRACT: Introduction & Objective: About 12% of complications of cholecystitis are reported to be the fistula between the gall bladder and the gastrointestinal tract. In this article, a case of inflammatory adhesion between the gall bladder and the transverse colon is reported. Due to the importance of this phenomenon, the literature has been reviewed in order to highlight anatomical relation between these two viscera. Case: A case of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon was observed during routine dissection of abdominal cavity of a male middle age cadaver. The adhesional fold contained multiple fistulae between the fundus of gall bladder and the adjacent part of transverse colon. Through the round openings of these fistulae, the green bile material appeared to have been passed from the gall bladder to the colon. Conclusion: In cases of untreated chronic cholecystitis, this kind of inflammatory adhesion between the gall bladder and the adjacent part of transverse colon and subsequent fistulae used to be a usual complication. Because of low level of hygiene and medical services, the frequency of these complications, was not uncommon in the past, but their occurrence has decreased in recent decades. Meanwhile, due to the possibility of occurrence, the emphasis on anatomical relation of these two viscera, and drafting an integrated discussion of anatomy, developmental and clinical aspects of heptorenal pouch is mandatory in the educational areas.

  11. uncomplicated midvaginal vesico-vaginal fistula repair in ibadan

    African Journals Online (AJOL)

    leadership for capacity building and training of specialists that are interested in acquiring the skills. The case records of women that presented with genitourinary ..... Postgrad Med. 1993 Jan-Mar;39(1):20-21. 20. Wall L.L., Wilkinson J., Arrowsmith S.D.,. Ojengbede O., and Mabeya H. A code of ethics for the fistula surgeon.

  12. Determinants of obstetric fistula in Ethiopia | Andargie | African ...

    African Journals Online (AJOL)

    Background: Obstetric fistula is a maternal morbidity creating devastating health problems for the women. Continuous and uncontrollable leaking of urine or faeces from vagina can lead to life changing stigmatization for women in third world countries. The underlying factors and consequences of this problem are not yet fully ...

  13. Vesico-vaginal fistula surgery in Uganda | Hancock | East and ...

    African Journals Online (AJOL)

    Background: Childbirth injuries are common in Uganda. This paper describes our experience with Vesico-vaginal Fistula repair and aftercare. Methods: Between 1999 and 2003, 341 consecutive patients underwent VVF repair complicating childbirth trauma. Another 29 VVF patients were seen but not operated because of ...

  14. Modified transanal repair of congenital H-type rectovestibular fistula ...

    African Journals Online (AJOL)

    Congenital H-type rectovestibular fistulas are rare in the spectrum of anorectal malformations. Repair is associated with recurrence rates of up to 30%, using perineal repair, vestibuloanal pull-through or anterior anorectoplasty. The rarity of the malformation has limited experience with the surgical approach; hence, the rate ...

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

    African Journals Online (AJOL)


    Sep 3, 2017 ... and Biostatistics,. University of Gondar, Ethiopia. Email: Introduction. Obstetric fistula is a child birth injury usually caused by unrelieved, prolonged obstructed labor. Obstructed labor can develop during the second stage of labor, when the fetus cannot fit through the birth canal because ...

  16. Bronchopleural fistula: the Damocles sword of all pneumonectomies. (United States)

    Pop, Daniel; Nadeemy, Ahmad S; Venissac, Nicolas; Mouroux, Jérôme


    The postpneumonectomy bronchopleural fistula (BPF) remains a difficult challenge for the thoracic surgeon. We report the case of a very late-onset (60 years) left BPF managed by video-assisted mediastinoscopy discussing the direct consequences of this complication in the postpneumonectomy period.

  17. Neonatal perforated Amyand's hernia presenting as an enterocutaneous scrotal fistula

    Directory of Open Access Journals (Sweden)

    Antonios Panagidis


    Full Text Available Perforation of the vermiform appendix in a septic neonate with an Amyand's hernia resulted in the formation of a scrotal enterocutaneous fistula. In conclusion from this exceptional complication, active parental awareness for any neonatal scrotal swelling is required, and an early operative policy for the neonatal inguinal hernia is significant.

  18. Chronic foot ulcer complicating a traumatic arteriovenous fistula ...

    African Journals Online (AJOL)

    Background: Chronic foot ulcers could be a complication of traumatic arteriovenous (A-V) fistulation. We report a rare case of chronic foot ulcer and deformity resulting from arteriovenous fistula of the anterior tibial artery. Method: The clinical presentation and the outcome of treatment in a patient treated at the University of ...

  19. Obstetric vesico-vaginal fistulae seen in the Northern Democratic ...

    African Journals Online (AJOL)

    Background: The Democratic Republic of Congo (DRC) is a developing country with poor obstetric indicators. Despite ongoing efforts to improve care, women continue to suffer multiple complications of child birth including vesico-vaginal fistulae (VVF). Objective: To describe socio-demographic and clinical characteristics of ...

  20. Formation of a vesicovaginal fistula in a pig model

    DEFF Research Database (Denmark)

    Lindberg, Jennifer; Rickardsson, Emilie; Andersen, Margrethe


    Objective: To establish an animal model of a vesicovaginal fistula that can later be used in the development of new treatment modalities. Materials and methods: Six female pigs of Landrace/Yorkshire breed were used. Vesicotomy was performed through open surgery. An standardized incision between t...

  1. Acquired tubercular bronchoesophageal fistula in a hemophiliac child

    Directory of Open Access Journals (Sweden)

    Jyoti Bothra


    Full Text Available Acquired bronchoesophageal fistula in children is usually a late diagnosis, due to the rarity of the condition. The diagnosis was further complicated by presence of multiple co-morbid conditions. We would like to emphasize the importance of tackling the co-morbid factors strategically along with the surgical aspects in this case report.

  2. Risk factors for postoperative pancreatic fistula in distal pancreatectomy. (United States)

    Soga, Koji; Ochiai, Toshiya; Sonoyama, Teruhisa; Inoue, Koji; Ikoma, Hisashi; Kikuchi, Shojiro; Ichikawa, Daisuke; Fujiwara, Hitoshi; Okamoto, Kazuma; Otsuji, Eigo


    The purpose of this study was to identify risk factors related to severe pancreatic fistula in patients who underwent distal pancreatectomy (DP). From 2000 to 2008, 63 patients underwent DP. We retrospectively identified the risk factors for Grade B or C postoperative pancreatic fistula (POPF) occurring after DP. POPF was classified according to the International Study Group on Pancreatic Fistula definition. Postoperative mortality and morbidity rate were 0% and 61%, respectively. POPF developed in 32 patients (51%); 21 of fistulas were classified as Grade A, nine as Grade B and two as Grade C. The incidence of severe POPF (Grade B or C) was significantly associated with two factors by univariate analyses: polyethylene glycolic acid (PGA) felt with fibrin sealant and blood loss during operation. To clarify the useful manner in DP, multivariate analysis was performed using 5 surgery-related factors. The use of polyethylene glycolic acid felt (PGA) with fibrin sealant and blood loss during operation were the significant factors for severe POPF (p=0.026 and 0.012, respectively). Using PGA felt with fibrin sealant for the pancreatic stump could reduce the risk of severe POPF.

  3. Arterioportal fistulas: introduction of a novel classification with therapeutic implications. (United States)

    Guzman, Eduardo A; McCahill, Laurence E; Rogers, Frederick B


    Arterioportal fistulas (APFs) are arteriovenous communications between the splanchnic arteries and the portal vein that represent an infrequent cause of presinusoidal portal hypertension. They can be acquired or congenital. Penetrating hepatic trauma, including liver biopsies, represent the most common etiology. They can be asymptomatic or manifest with portal hypertension. An abdominal bruit is a valuable physical finding. Persistence of an APF can cause hepatoportal sclerosis and possibly portal fibrosis. A detailed radiologic evaluation is mandatory. One must differentiate between small peripheral intrahepatic APFs (type 1) and large central APFs (type 2). The former usually resolve spontaneously, whereas the latter can cause portal hypertension and hepatic parenchymal changes. Type 1 APFs caused by needle injury can be followed by Doppler ultrasound. All other fistulas need treatment. Arterioportal fistulas are first treated by transcatheter embolization. Surgical approaches are reserved for complex cases. Congenital APFs (type 3) are diffuse and intrahepatic and can be difficult to manage. Overall, the prognosis is good. Herein, we propose a novel classification for arterioportal fistulas with therapeutic implications.

  4. [Post-partum vesicovaginal fistula: abdominal muscle strip treatment]. (United States)

    Perata, E; Severoni, S; Schietroma, M; Rossi, M; Perata, A; Natuzzi, G; Coiera, F; Carlei, F; Palmieri, R; Capperucci, G


    The Vesico-Vaginal Fistula (VVF) very often occur in tropical countries, but their treatment is usually not correct. A surgical treatment was carried put on 68 patients affected by VVF from March 1986 to December 19997 in the Nazareth Hospital (Nairobi). Their mean age was 22 years old; 27 patients (39.7%) underwent surgery for the first time, while for 41 patients (60.2%) the treatment was repeated. Fourteen patients (20.5%) had also Vesico-Rectum-Vaginal Fistula (VRV). The VVF was cured with a transvaginal treatment using a Martius strip for 32 cases. For 16 cases both vaginal and abdominal treatment was performed in the same time using an abdominal muscle strip, which was inserted in the space between the vagina and bladder. In VRV and VVF combined cases, the VVF was treated in the following way: first of all, during the same session, the VVF was cured by making a colostomy and then, after 2 months VRV was treated. The follow-up took about 7.2 months; 62 patients (91.1%) recovered, for 6 cases treated only with transvaginal operation, it has been necessary a second surgical procedure owing to relapsing, and for 2 of them an abdominal muscle strip was used. In conclusion, while the transvaginal repair is satisfactory treatment for little fistula never surgically treated before, on the other hand the transabdominal vaginal treatment is the best cure forge large or relapsing fistulas.

  5. Vesico vaginal fistula (VVF): a shift in epidemiology in northeastern ...

    African Journals Online (AJOL)

    Prolonged obstructed labour was the leading cause in 90% and most were in social class IV and V ( using standard occupational classification, OPCS.). Seventy five percent had successful repair, while about 50% were either divorced or neglected by their husbands. Conclusion: Vesico-vaginal fistula remains one ...

  6. Management of Hemorrhagic Pseudoaneurysmal Arteriovenous Fistula of the Sphenopalatine Artery

    Directory of Open Access Journals (Sweden)

    Ajeet Gordhan


    Full Text Available n-Butyl cyanoacrylate (n-BCA embolization of a hemorrhagic pseudoaneurysmal arteriovenous fistula of the sphenopalatine artery in a patient with paranasal sinus squamous cell carcinoma treated with regional surgery and radiation has, to our knowledge, not been previously reported.

  7. Group Psychological Therapy in Obstetric Fistula Care: A ...

    African Journals Online (AJOL)

    %) and mild (25.0 to 21.7%) and those without increased (43.3 to 73.3%). In conclusion, GPT is a useful adjunct to OF care as it improves their overall mental health status. (Afr J Reprod Health 2014; 18[1]: 156-160). Keywords: Obstetric fistula ...

  8. Management dilemma of cholecysto-colonic fistula: Case report

    Directory of Open Access Journals (Sweden)

    Waleed Gibreel


    Conclusion: Based on our experience with this particular case, we could safely conclude that an operation for cholecystocolonic fistula presence in the setting of biliary obstruction that failed decompressive attempts should be performed in an urgent fashion to avoid biliary sepsis development.

  9. Vesicovaginal fistula, bladder calculus, retained foreign body or all ...

    African Journals Online (AJOL)

    L. Paik

    Retained foreign bodies causing vesicovaginal fistula has been reported in the literature, specifically aerosol bottle caps [1–3]. Contraception and masturbation have been described as reasons for placing an aerosol cap within the vagina [1], but sexual abuse must also be considered as a possibility in these cases. It is also ...

  10. gastrocolic fistula as a complication of benign gastric ulcer

    African Journals Online (AJOL)

    Fourteen patients presenting at a surgical ward at King Edward VIII Hospital, Durban, with gastrocolic fistula as a complication of benign gastric ulcer between 1983 and 1994 were retrospectively reviewed. Patients were categorised clinically into two groups. Group A patients (N = 8) underwent surgery and group B patients.

  11. Echinococcal Cyst of the Pancreas with Cystopancreatic Duct Fistula ...

    African Journals Online (AJOL)

    Echinococcal Cyst of the Pancreas with Cystopancreatic. Duct Fistula Successfully Treated by Partial Cystectomy and. Cystogastrostomy. Ahmed Elaffand, Adarsh Vijay1, Samah Mohamed, Hassan Hani Al-Battah1, Ayda Youssef, Ahmed Farahat. INTRODUCTION. Hydatid disease (HD) is a rare endemic disease in.

  12. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula


    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk


    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization m...

  13. Combined oesophageal atresia with upper pouch fistula and ...

    African Journals Online (AJOL)

    Upper pouch tracheoesophageal fistula occurs is less than 1% of all oesophageal atresia variants. Meconium peritonitis is a rare neonatal condition with an incidence of 1:30 000 live births. In this case report, we describe the presentation, clinical findings and management of a patient diagnosed with an oesophageal ...

  14. Aortocaval fistula – rare complication of ruptured abdominal aortic ...

    African Journals Online (AJOL)

    Aortocaval fistula (ACF) formation is a rare condition occurring in 0.2 - 1.3% of patients with degenerative aortic aneurysms. 1 This paper describes the presentation and successful management of a patient with such an ACF. We wish to highlight the need to maintain a high index of suspicion for this condition in patients with ...

  15. A Case of Esophagopericardial Fistula as a Complication of Upper ...

    African Journals Online (AJOL)

    A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy (UGIE). A 38‑year‑old schizophrenic male patient with gastro-esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain.

  16. A Case of Esophagopericardial Fistula as a Complication of Upper ...

    African Journals Online (AJOL)

    A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy. (UGIE). A 38‑year‑old schizophrenic male patient with gastro‑esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain.

  17. Traumatic carotid-cavernous fistula presenting as massive epistaxis. (United States)

    Wyrick, Deidre; Smith, Samuel D; Dassinger, Melvin S


    Carotid-cavernous sinus fistulae (CCF) are a rare complication with the potential for great morbidity including intracranial hemorrhage, blindness, cranial nerve palsy and stroke. Traumatic CCF are the most common type of CCF. Here we discuss a patient who sustained blunt head trauma and had substantial epistaxis, requiring massive transfusion, intraoperatively due to unrecognized CCF. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Risk factors for obstetric fistulae in north-eastern Nigeria. (United States)

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


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

  19. Common intestinal parasites

    National Research Council Canada - National Science Library

    Kucik, Corry Jeb; Martin, Gary L; Sortor, Brett V


    Intestinal parasites cause significant morbidity and mortality. Diseases caused by Enterobius vermicularis, Giardia lamblia, Ancylostoma duodenale, Necator americanus, and Entamoeba histolytica occur in the United States. E...

  20. Intestinal parasites and pregnancy. (United States)

    D'Alauro, F; Lee, R V; Pao-In, K; Khairallah, M


    Intestinal parasites and pregnancy commonly coexist. Environmental, nutritional, and immunologic factors influence the clinical manifestations and determine the need for treatment of intestinal parasitism during pregnancy. No serious medical or obstetric problems attributable to intestinal parasites developed among 147 parasitized pregnant refugees living and delivering in a refugee camp in Southeast Thailand. These patients received adequate nutrition, careful prenatal monitoring, and no antiparasitic drug therapy. During pregnancy chemotherapy for intestinal parasites should not be used unless required for appropriate clinical and public health reasons.

  1. Intestinal parasites and tuberculosis

    Directory of Open Access Journals (Sweden)

    Anuar Alonso Cedeño-Burbano


    Conclusions: The available evidence was insufficient to affirm that intestinal parasites predispose to developing tuberculous. The studies carried out so far have found statistically insignificant results.

  2. Fistula-Associated Anorectal Cancer in the Setting of Crohn's Disease. (United States)

    Shwaartz, Chaya; Munger, Jordan A; Deliz, Juan R; Bornstein, Joseph E; Gorfine, Stephan R; Chessin, David B; Popowich, Daniel A; Bauer, Joel J


    Cancer arising from perianal fistulas in patients with Crohn's disease is rare. There are only a small series of articles that describe sporadic cases of perianal cancer in Crohn's disease fistulas. Therefore, there are no clear guidelines on how to appropriately screen patients at risk and choose proper management. The purpose of this study was to describe patients diagnosed with cancer in perianal fistulas in the setting of Crohn's disease. The study involved an institutional review board-approved retrospective review of medical charts of patients with perianal Crohn's disease. The data extracted from patient charts included demographic and clinical characteristics. Patients seen at the Mount Sinai Medical Center were included. We identified patients who were diagnosed with perianal cancer in biopsies of fistula tracts. We observed the number of patients with Crohn's disease who had fistulas, cancer in fistula tract, and time to diagnosis. The charts of 2382 patients with fistulizing perianal Crohn's disease were reviewed. Cancer in a fistula tract was diagnosed in 19 (0.79%) of these patients, 9 with squamous-cell carcinoma and 10 with adenocarcinoma. The majority of the 19 patients (68%) had symptoms typical of perianal fistula. The mean time from diagnosis of Crohn's disease to fistula diagnosis and from fistula diagnosis to cancer diagnosis was 19.4 and 6.0 years. In 5 patients (26%), cancer was not diagnosed in the first biopsy obtained from the fistula tract. This is a retrospective chart review of a rare outcome; the results may not be generalizable. Routine biopsies of long-standing fistula tracts in patients with Crohn's disease should be strongly considered and may yield an earlier diagnosis of cancer in the fistula tracts.

  3. Functional diagnostic parameters for arteriovenous fistula. (United States)

    Rajabi-Jagahrgh, Ehsan; Banerjee, Rupak K


    The inability to detect the arteriovenous fistula (AVF) dysfunction in a timely manner under the current surveillance programs, which are based on either diameter (d), flow rate (Q), or pressure (p) measurements, is one of the major challenges of dialysis treatment. Thus, our aim is to introduce new functional diagnostic parameters that can better predict AVF functionality status. Six AVFs were created between the femoral arteries and veins of three pigs, each pig having two AVFs on either limb. Flow fields and pressure drop (Δp) in AVFs were obtained via numerical analysis utilizing the CT scan and Doppler ultrasound data at 2D (D: days), 7D, and 28D postsurgery. The dataset included 16 (two pigs [four AVFs] for three time points, and one pig [two AVFs] for two time points) repeated measurements over time, and the statistical analysis was done using a mixed model. To evaluate the nature of pressure drop-flow relationships in AVFs, the Δp was correlated with the average velocity at proximal artery (v) and also the corresponding scaled velocity (v*) by the curvature ratio of anastomotic segment. Based on these relationships, two new functional diagnostic parameters, including the nonlinear pressure drop coefficient (Cp ; pressure drop divided by dynamic pressure at proximal artery) and the linear resistance index (R; pressure drop divided by velocity at proximal artery), were introduced. The diagnostic parameters that were calculated based on scaled velocity are represented as R* and Cp *. A marginal (P = 0.1) increase in d from 2D (5.4 ± 0.7 mm) to 7D (6.8 ± 0.7 mm), along with a significant increase in Q (2D: 967 ± 273 mL/min; 7D: 1943 ± 273 mL/min), was accompanied by an almost unchanged Δp over this time period (2D: 16.42 ± 4.6 mm Hg; 7D: 16.40 ± 4.6 mm Hg). However, the insignificant increase in d and Q from 7D to 28D (d = 7.8 ± 0.8 mm; Q = 2181 ± 378 mL/min) was accompanied by the elevation in Δp (24.6 ± 6.5 mm Hg). The functional diagnostic

  4. adhesive intestinal obstruction

    African Journals Online (AJOL)


    Jun 1, 2006 ... ABSTRACT. Background: Adhesions after abdominal and pelvic surgery are a major cause of intestinal obstruction in the western world and the pathology is steadily gaining prominence in our practice. Objective: To determine the magnitude of adhesive intestinal obstruction; to determine the types.

  5. Neuromodulation of intestinal inflammation

    NARCIS (Netherlands)

    Costes, L.M.M.


    Interactions between the central nervous system and the immune system have been shown to exert a crucial role in the tight regulation of the immune response in the intestine. In particular, the vagus nerve was recently unraveled as an important player in this neuromodulation of intestinal

  6. Congenital intestinal lymphangiectasia

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    Popović Dušan Đ.


    Full Text Available Background. Congenital intestinal lymphangiectasia is a disease which leads to protein losing enteropathy. Tortous, dilated lymphatic vessels in the intestinal wall and mesenterium are typical features of the disease. Clinical manifestations include malabsorption, diarrhea, steatorrhea, edema and effusions. Specific diet and medication are required for disease control. Case report. A 19-year old male patient was hospitalized due to diarrhea, abdominal swelling, weariness and fatigue. Physical examination revealed growth impairment, ascites, and lymphedema of the right hand and forearm. Laboratory assessment indicated iron deficiency anaemia, lymphopenia, malabsorption, inflammatory syndrome, and urinary infection. Enteroscopy and video capsule endoscopy demonstrated dilated lymphatic vessels in the small intestine. The diagnosis was confirmed by intestinal biopsy. The patient was put on high-protein diet containing medium-chain fatty acids, somatotropin and suportive therapy. Conclusion. Congenital intestinal lymphangiectasia is a rare disease, usually diagnosed in childhood. Early recognition of the disease and adequate treatment can prevent development of various complications.

  7. Lymphatic fistulas: obliteration by low-dose radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mayer, R.; Stranzl, H.; Prettenhofer, U.; Poschauko, J. [Dept. of Radiation Oncology, Medical Univ. of Graz (Austria); Sminia, P. [Dept. of Radiation Oncology, Section Radiobiology, VU Univ. Medical Center, Amsterdam (Netherlands); McBride, W.H. [Roy E. Coats Research Labs., Dept. of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States); Fruhwirth, J. [Dept. of Vascular Surgery, Dept. of Surgery, Medical Univ. of Graz (Austria)


    Background: lymphatic drainage from the surgical wound is an uncommon but challenging complication of surgical intervention. Protracted lymphorrhea contributes to morbidity, favors infections and results in a prolonged hospital stay. Treatment options include surgical ligation and, more conservatively, leg elevation, continuous local pressure, subatmospheric pressure dressings, and low-dose radiotherapy. This study examines the efficacy of low-dose radiotherapy. Patients and methods: 17 patients (19 fistulas) with lymphorrhea following vena saphena harvesting (n = 7), femoropopliteal bypass (n = 3), varicose vein surgery (n = 2), hip arthroplasty (n = 3; five fistulas), shunt surgery (n = 1), and piercing (n = 1) were referred for external radiotherapy. Depending on the depth of the fistula, orthovoltage (n = 12), electrons (4-11 MeV; n = 2) or photons (8 MV; n = 3) were used. Fractions between 0.3 Gy and 2 Gy were applied; the individual total dose depended on the success of the radiotherapy, i.e., the obliteration of the lymph fistula, and varied from 1 to 12 Gy. Results: In 13 out of 17 patients complete obliteration of the fistula was achieved. Interestingly, this was achieved in nine of the ten patients irradiated with total doses of {<=} 3 Gy and with fraction sizes ranging from 0.3 to 0.5 Gy. In one patient with hip arthroplasty, only two out of three fistulas disappeared after 12 Gy and in a further three cases no distinct benefit was observed after 2.4 Gy, 8 Gy, and 10.5 Gy, respectively. No treatment-related side effects occurred. Conclusion: radiotherapy represents an efficacious and economical treatment option in cases of persistent lymphorrhea and is able to reduce the risk of secondary infection, to decrease the duration of hospitalization, and to reduce overall costs for the individual patient. Daily scoring of treatment efficacy is recommended, because radiotherapy can be terminated as soon as lymphorrhea has stopped. Very low total doses with 0

  8. Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin

    NARCIS (Netherlands)

    van Koperen, Paul J.; Wind, Jan; Bemelman, Willem A.; Bakx, Roel; Reitsma, Johannes B.; Slors, J. Frederik M.


    PURPOSE: This study assessed long-term functional outcome and explored risk factors for fistula recurrence in patients surgically treated for cryptoglandular fistulas. METHODS: Three hundred ten consecutive patients were surgically treated for perianal fistulas. After exclusion of patients with

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  10. [Neobladder-rectal fistula as early postoperative complication of radical cystectomy and orthotopic neobaldder construction]. (United States)

    Yokota, Narushi; Ito, Fumio; Ishikawa, Tetsuo; Yamashita, Kaori; Nakazawa, Hayakazu


    We report a case of neobladder-rectal fistula that developed as an early postoperative complication of radical cystectomy and orthotopic neobladder construction procedures. A 75-year-old man underwent a radical cystectomy and orthotopic neobladder construction using Studer's method for locally invasive bladder cancer (cT2N0M0). The patient had severe watery diarrhea on postoperative day 20, and was diagnosed with a neobladder-rectal fistula based on cystography findings. We inserted a Foley catheter into the neobladder, and performed conservative treatment. Four months after development of the fistula, cystography revealed that it had spontaneously closed. A neobladder-rectal fistula is an extremely rare complication, with no other known reports. Herein, we present this case of neobladder-rectal fistula and discuss its formation, diagnosis and treatment, along with reference to previous reports of neobladder-vaginal fistulas.

  11. Hemodialysis vascular access options after failed Brescia-Cimino arteriovenous fistula

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    Aneesh Srivastava


    Full Text Available The survival of patients on long-term hemodialysis has improved. End-stage renal disease patients now need maintenance of their vascular access for much longer periods. Arteriovenous fistulae formed at the wrist are the first choice for this purpose, but, in many patients, these fistulae fail over time or are not feasible because of thrombosed veins. We searched the Pubmed database to evaluate the various options of vascular access in this group of patients based on the published literature. It is quite evident that, whenever possible, autogenous fistulae should be preferred over prosthetic grafts. Use of upper arm cephalic and basilic veins with transpositions wherever required can enhance autogenous fistula options to a large extent. Upper arm grafts should be used when no autogenous fistula is possible. Lower limb and body wall fistula sites are to be considered at the end, when all options in both upper limbs are exhausted.

  12. Endoscopic vacuum-assisted closure with sponge for esophagotracheal fistula after esophagectomy. (United States)

    Lee, Hyun Jik; Lee, Hyuk


    We experienced a case of endoscopic vacuum-assisted closure with sponge for esophagotracheal fistula diagnosed after esophagectomy due to squamous cell esophageal cancer. The patient, who had undergone a robotic-assisted thoracoscopic esophagectomy and esophageal reconstruction of the stomach, was referred for the management of esophagotracheal fistula. Diagnostic esophagogastroduodenoscopy and imaging studies were performed, and they indicated anastomotic leakage with esophagotracheal fistula. The patient was treated by the endoscopic placement of full-covered self-expanding metal stents, but the fistula persisted. Then, we applied a size-adjusted sponge endoscopically with continuous suction by a vacuum system in the fistula lesion. Complete closure was achieved without any procedure-related complications. After 40 days, symptomatic esophageal stricture was detected and treated successfully with endoscopic balloon dilation. Endoscopic vacuum-assisted closure with a sponge might be an adequate alternative treatment option for esophageal stenting for esophagotracheal fistula after esophagectomy.

  13. Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis. (United States)

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


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

  14. A New Method to Treat High Anal Fistula - Bidirectional Isobaric Drainage

    DEFF Research Database (Denmark)

    Zheng, Linghua; Wang, Yanmei; Zhao, Jingbo


    Background and aim: Traditionally, the principle of the treatment for anal fistula is "open fistula, fistulotomy ". Fistulotomy is the standard treatment for simple and low fistulas. However for the high fistula, the anorectal ring will be disconnected by fistulotomy. A better treatment should...... damage the anorectal ring less and protect the anal function more. The aim of the present study is to explore a new method-bidirectional isobaric drainage radical resection to treat simple high anal fistula. Materials and methods:One hundred and twenty patients with simple high anal fistula were randomly......-category verbal rating scale, VRS), and the score of anal function (Wexner Incontinence Score) were quantitatively evaluated. Results: Comparison of the efficacy between two groups indicated that the complete cure rate differed significantly between two groups (P

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

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    Stephen P. Juraschek


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

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

    DEFF Research Database (Denmark)

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


    Doppler examination identified 89% of those branches with sufficient flow to opacify the deep venous system on completion arteriogram. Half of the missed fistulas underwent spontaneous thrombosis, and in only one case did the arteriovenous fistula lead to hemodynamic symptoms demanding surgical closure......Intraoperative identification and later development of arteriovenous fistulas were investigated prospectively in 70 in situ saphenous vein bypass procedures. Surveillance was performed by completion arteriography and intra- and postoperative continuous wave Doppler examination. The intraoperative...... of the fistula. Pursuing a policy of selectively ligating fistulas that only fill the deep venous system on completion arteriography led to an additional nine arteriovenous fistulas. Developed over an average follow-up of six months, four patients presented symptoms of edema and swelling and were relieved upon...

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

    Directory of Open Access Journals (Sweden)

    Surendra Patel


    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.

  18. Antibiotics Suppress Activation of Intestinal Mucosal Mast Cells and Reduce Dietary Lipid Absorption in Sprague-Dawley Rats. (United States)

    Sato, Hirokazu; Zhang, Linda S; Martinez, Kristina; Chang, Eugene B; Yang, Qing; Wang, Fei; Howles, Philip N; Hokari, Ryota; Miura, Soichiro; Tso, Patrick


    The gut microbiota affects intestinal permeability and mucosal mast cells (MMCs) responses. Activation of MMCs has been associated with absorption of dietary fat. We investigated whether the gut microbiota contributes to the fat-induced activation of MMCs in rats, and how antibiotics might affect this process. Adult male Sprague-Dawley rats were given streptomycin and penicillin for 4 days (n = 6-8) to reduce the abundance of their gut flora, or normal drinking water (controls, n = 6-8). They underwent lymph fistula surgery and after an overnight recovery were given an intraduodenal bolus of intralipid. We collected intestinal tissues and lymph fluid and assessed activation of MMCs, intestinal permeability, and fat transport parameters. Compared with controls, intestinal lymph from rats given antibiotics had reduced levels of mucosal mast cell protease II (produced by MMCs) and decreased activity of diamine oxidase (produced by enterocytes) (P antibiotics had reduced intestinal permeability in response to dietary lipid compared with controls (P antibiotics also reduced lymphatic transport of triacylglycerol and phospholipid (P antibiotics and controls. These effects were not seen with an acute dose of antibiotics or 4 weeks after the antibiotic regimen ended. The intestinal microbiota appears to activate MMCs after the ingestion of fat in rats; this contributes to fat-induced intestinal permeability. We found that the gut microbiome promotes absorption of lipid, probably by intestinal production of apolipoproteins and secretion of chylomicrons. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

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


    Zhan Tiancheng; Wang Lin; Li Ming; Li Zhongwu; Cai Yong; Shen Lin; Gu Jin


    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 to...

  20. Graciloplasty for recurrent recto-neovaginal fistula in a male-to-female transsexual. (United States)

    Altomare, D F; Scalera, I; Bettocchi, C; Di Lena, M


    Rectovaginal fistula is usually a challenging condition for surgeons, but a fistula between the rectum and the neovagina in male-to-female transsexual is even more difficult to treat as it is a rare complication occurring in a patient with modified anatomy of the perineum, with heavy psychological implications for the patient. Here, we report a case of recurrent recto-neovaginal fistula in a male-to-female transsexual successfully treated by perineal graciloplasty.

  1. "Prediction of early failure of vascular-access arteriovenous fistula based on immediate postsurgical evaluation"


    Keshvari A; Jafarian A; Makarem J; Rabbani A; Mirsharifi SM


    Background: For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical exam...

  2. "Prediction of early failure of vascular-access arteriovenous fistula based on immediate postsurgical evaluation"

    Directory of Open Access Journals (Sweden)

    Keshvari A


    Full Text Available Background: For patients requiring chronic hemodialysis, the preferred site for vascular access is an autogenous arteriovenous fistula. Although a properly formed fistula is advantageous because it is less susceptible than other types of vascular accesses to infection and clot formation and can last longer than any other types of vascular access, AV fistula has a high rate of early failure that can increase immediate cost and complications. In this study, the prognostic value of physical examination of arteriovenous fistula by the surgeon at the end of the surgery was evaluated. Methods: In the general surgery ward of Imam Khomeini Hospital in 326 chronic renal failure patients, 354 arteriovenous fistula operations were accomplished by two surgeons from 1377 to 1381 (ca. 1998 to 2002. The performance of each fistula was divided into the following groups by the surgeon at the end of operation: 1 systolic and diastolic thrill, 2 systolic thrill 3 souffle 4 pulse 5 not functional. Clinical function of the fistula was evaluated by the same surgeon in the following days if no souffle or thrill, early failure was detected on initial inspection. Results: In the 354 cases of arteriovenous fistula, the total early failure rate was 12.7%. The lowest early-failure rate was 3.5% in the systolic and diastolic thrill group. The highest early-failure rate was in the not functional group (P<0.001. There was no correlation between early failure and age, sex, surgeon and location of fistula. Conclusion: Optimally, an arteriovenous fistula has a thrill with a soft compressible pulse. At the end of each operation, if the surgeon cannot detect a thrill at the fistula site, can find only pulse, or if the function is otherwise unsatisfactory, considering of a new arteriovenous fistula may be required, however it is better to postpone the surgery.

  3. Primary patency rate of native AV fistula: long term follow up


    GH, Kazemzadeh; MHS, Modaghegh; H, Ravari; M, Daliri; L, Hoseini; M, Nateghi


    The number of end stage of renal disease patients that need dialysis or renal transplantation increased in the world. Insertion and maintenance functional vascular access remain the challenging problem. Arteriovenous fistula is the common access for dialysis but complication and its failure is the main problem. The aim of this study is to evaluate patients with arteriovenous fistula during 4 years and describe the probable influenced factors on fistula patency. In this analytical descriptive ...

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

    Energy Technology Data Exchange (ETDEWEB)

    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)


    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.

  5. The efficacy of CT arteriography for spinal arteriovenous fistula surgery: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Hasegawa, M.; Fujisawa, H.; Kawamura, T.; Yamashita, J.; Matsui, O. [Depts. of Neurosurgery and Radiology, Kanazawa Univ. (Japan)


    We performed helical computed tomography with contrast injection into feeding arteries through a selectively introduced microcatheter to provide precise definition of the vascular and bony structure of the spine in patients with spinal arteriovenous fistula. This selective CT arteriography reliably showed structures including abnormal epi- and intradural feeding arteries, the fistula, perimedullary draining veins and surrounding vertebrae preoperatively with a minimal contrast medium load. This technique can facilitate safe, minimally invasive surgical obliteration of the fistula and a favorable outcome. (orig.)

  6. Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn's disease. (United States)

    Yarur, A J; Kanagala, V; Stein, D J; Czul, F; Quintero, M A; Agrawal, D; Patel, A; Best, K; Fox, C; Idstein, K; Abreu, M T


    Infliximab has been found to be efficacious in the treatment of fistulas in the setting of Crohn's disease, even though some patients do not benefit from therapy. To assess the correlation between perianal fistula healing and trough levels of infliximab. In this cross-sectional study, we identified patients with Crohn's disease who had perianal fistulas and were treated with infliximab for at least 24 weeks. We excluded patients who underwent a faecal diversion procedure or proctectomy. Predictive variables included demographics, disease phenotype, disease activity, infliximab levels, anti-infliximab antibodies. The primary outcome was fistula healing defined as the absence of drainage. The secondary outcome was complete fistula closure and mucosal healing. 117 patients were included. Patients with fistula healing had significantly higher median serum infliximab levels when compared to those with active fistulas [15.8 vs. 4.4 μg/mL, respectively (P infliximab levels. The AUC for the association between fistula healing and infliximab levels was 0.82 (P infliximab levels and fistula closure was 0.69 (P = 0.014). Patients with anti-infliximab antibodies had a lower chance of achieving fistula healing (OR: 0.04 [95%CI: 0.005-0.3], P infliximab levels and rates of fistula healing. Achieving infliximab levels ≥10.1 mcg/mL in patients with Crohn's disease and perianal fistulas may improve outcomes as part of a treat-to-target strategy. © 2017 John Wiley & Sons Ltd.

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  8. Traumatic Left Anterior Descending Coronary Artery-Right Ventricle Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sheikhi


    Full Text Available Traumatic coronary artery-cameral fistulas (TCAF are rare and may present secondary to penetrating injuries (80% or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

  9. Traumatic Left Anterior Descending Coronary Artery-Right Ventricle Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Alireza Rezaee


    Full Text Available Traumatic coronary artery-cameral fistulas (TCAF are rare and may present secondary to penetrating injuries (80%or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

  10. Tunneled Tunica Vaginalis Flap for Recurrent Urethrocutaneous Fistulae

    Directory of Open Access Journals (Sweden)

    Jonathan C. Routh


    Full Text Available The tubularized incised plate (TIP hypospadias repair is currently the most widely used urethroplasty technique. The most significant post-TIP complication is urethrocutaneous fistula (UCF development. Tunneled tunica vaginalis flap (TVF is a well-described technique for the repair of UCF. We retrospectively reviewed all patients undergoing repeat repair of UCF after TIP repair from 2001 to 2005. Twelve boys underwent TVF repair at our institution for recurrent UCF. Fistulae ranged from distal penile to penoscrotal in location. Median surgical time was 45 minutes and no postoperative complications occurred. After a median follow-up of 32 months (range 16–48 months, no patient has yet had a recurrence of UCF. In conclusion, TVF repair is a successful technique for the treatment of UCF after previous failed repair. TVF is technically simple to perform and should be considered for treating UCF following TIP urethroplasty, particularly in a repeat surgical setting.

  11. Acquired arteriovenous fistula in a grizzly bear (Ursus arctos horribilis). (United States)

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


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

  12. Differential radiodiagnosis of draining pararectal cysts and rectal fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Mushnikova, V.N.; Savvateeva, N.Yu.; Arablinskij, V.M.

    Proceeding from an analysis of multimodality examination and treatment of patients with difficulties in differential diagnosis, it has been established that proctography and fistulography play the most important role in radiodiagnosis. The presence of a multichamber cavity with clear even contours at the level of the medium- or lower ampullar region of the rectum is characteristic of draining pararectal cysts. The fustulous passage is single and unramified. Usually there is no connection between the cavity and fistula with the rectum. In rectal fistulas as a result of chronic periproctites the cavity is single, of uneven shape with unclear irregular contours at the level of the anal canal or lower ampullar region of the rectum. The fustulous passage is ramified, frequently connected with the rectal lumen.

  13. Augmented-pressure colostogram in imperforate anus with fistula

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    Gross, G.W. (Jefferson Medical Coll., Philadelphia, PA (United States). Dept. of Radiology); Wolfson, P.J. (Jefferson Medical Coll., Philadelphia, PA (United States). Dept. of Surgery); Pena, A. (Schneider Children' s Hospital, Long Island Jewish Medical Center, New York, NY (United States). Dept. of Pediatric Surgery)


    Most newborns with imperforate anus, except for those with very low varieties, undergo a diverting colostomy performed in the postnatal period, with definitive surgical repair at a later age. Accurate demonstration of the anatomy of any associated fistula between the rectum and urogenital tract is essential for optimal surgical management. An augmented-pressure distal segment colostogram is recommended prior to definitive repair, both to confirm the level of rectal atresia and to define any associated fistulous communication. We report a case of high imperforate anus with rectourethral fistula in which the fistulous tract was not identified on the conventional contrast colostogram but was readily delineated when an augmented-pressure modification of the technique was utilized. The technical aspects of augmented-pressure colostography are presented. (orig.).

  14. Peroneal Arteriovenous Fistula and Pseudoaneurysm: An Unusual Presentation

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    Kevin C. Ching


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

  15. Pulmonary Arteriovenous Fistula: Clinical and Histologic Spectrum of Four Cases

    Directory of Open Access Journals (Sweden)

    Soomin Ahn


    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.

  16. Doppler findings in a rare Coronary Artery Fistula

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    Jorns Carl


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

  17. [Traumatic common carotid-internal jugular fistula: positive aspect]. (United States)

    Avrahami, R; Levinzon, M; Haddad, M; Zelikovsky, A


    A 42-year-old man presented with a penetrating neck injury from a pellet gun. Physical examination showed an open 1 cm wound on the right side of the neck, hematoma of the right sternocleidomastoid muscle, and carotid artery injury. He was hemodynamically stable and there was no neurological deficit. Arteriogram of the neck disclosed a pseudoaneurysm with an arteriovenous fistula between the common carotid artery and internal jugular vein. At surgery, the tears in the carotid artery and jugular vein were sutured and a vacuum drain was introduced. The postoperative course was uneventful, and the patient was discharged 5 days later. Instead of the expected results of a penetrating carotid artery injury, such as blood loss, airway obstruction or neurological deficit, the arteriovenous fistula caused by the pellet actually saved the patient's life. Blood flow from the artery via the pseudoaneurysm to the jugular vein kept the patient in stable condition.

  18. Use of Plastic Needles for Early Arteriovenous Fistula Cannulation. (United States)

    Letachowicz, Krzysztof; Kusztal, Mariusz; Gołębiowski, Tomasz; Letachowicz, Waldemar; Weyde, Wacław; Klinger, Marian


    The native arteriovenous fistula (AVF) needs maturation before it can be used. Needling done before time may result in haematoma formation, miscannulation or even access loss. This retrospective study included 20 patients with AVFs punctured with fluoroplastic dialysis catheters within 30 days after access creation and 19 historical controls. The time to first puncture was 2-29 days for the study group and 1-26 days for the control group. The incidences of haematoma were 16.7 and 48 per 1,000 dialysis sessions for plastic and metal needles, respectively. Estimated primary functional fistula survival at 3, 6 and 12 months were 95, 90 and 74% for the study group and 79, 67 and 60% for the control group (p = 0.106), respectively. Use of plastic needles enables safe AVF cannulation. If applied judiciously, it can minimize or even avoid catheter use.

  19. Spinal type IV arteriovenous malformations (perimedullary fistulas) in children. (United States)

    Sure, U; Wakat, J P; Gatscher, S; Becker, R; Bien, S; Bertalanffy, H


    Intradural perimedullary spinal arteriovenous fistula (AVF) is a synonym for type IV spinal arteriovenous malformation (AVM). It is an important clinical differential diagnosis in all patients with slowly progressive or acute spinal symptoms. Perimedullary AVFs are rare in the paediatric age group. We report the treatment regimen and the clinico-radiological findings for these malformations at our institution. Of four paediatric patients, three individuals with persistent fistulas after endovascular treatment were operated on. The malformations were obliterated completely in all patients without any morbidity. In three patients previously documented neurological symptoms resolved during follow-up. If slowly progressive or acute radicular or medullary symptoms arise in children, a spinal arteriovenous malformation should be ruled out by MRI. A combined endovascular and surgical treatment of paediatric spinal AVM type IV (perimedullary AVFs) carries a low risk of morbidity and is reasonably effective.

  20. Congenital arteriovenous fistula of the horseshoe kidney with multiple hemangiomas

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    Lazić Miodrag


    Full Text Available Introduction. Congenital renal arteriovenous fistulas (AVF are rare, especially if they are associated with other developmental renal anomalies. Case Outline. A 34-year-old female was hospitalized due to total painless hematuria and bladder tamponade. Excretory urography revealed a horseshoe kidney with normal morphology of pyelocaliceal system and ureters. Aortography and selective renovasography detected a cluster-like vascular formation with multiple arteriovenous fistulas (AVF. Due to a large AVF gauge and poor flow of the efferent vein to the inferior vena cava, a surgical procedure of two renal artery segmentary branches ligation and division was performed. During the operative procedure, the presence of multiple superficial renal hemangiomas was detected. Conclusion. Although selective arterial embolization represents the preferable treatment option, conventional surgery remains favorable alternative in selected cases with large and complex AVF.

  1. Oroantral fistula from bisphosphonate induced osteonecrosis of the jaw

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    Henry Sharp


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

  2. Nutritional Management in Enterocutaneous Fistula. What is the evidence? (United States)

    BADRASAWI, Manal; SHAHAR, Suzana; SAGAP, Ismail


    The management of Enterocutaneous fistula (ECF) is challenging. It remains associated with morbidity and mortality, despite advancements in medical and surgical therapies. Early nutritional support using parenteral, enteral or fystuloclysis routs is essential to reverse catabolism and replace nutrients, fluid and electrolyte losses. This study aims to review the current literature on the management of ECF. Fistulae classifications have an impact on the calories and protein requirements. Early nutritional support with parenteral, enteral nutrition or fistuloclysis played a significant role in the management outcome. Published literature on the nutritional management of ECF is mostly retrospective and lacks experimental design. Prospective studies do not investigate nutritional assessment or management experimentally. Individualising the nutritional management protocol was recommended due to the absence of management guidelines for ECF patients. PMID:26715903

  3. Thoracobiliary Fistula of Calcified Hydatid Cyst of the Liver

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    Ashraf Fackrju


    Full Text Available Thoracobiliary fistula is a rare complication of hydatid cystdisease of the liver especially in calcified form. Given the rarityand high mortality of such fistula, it is not surprising thatthere is no consensus about surgical treatment of this condition.In the present paper we report two cases of thoracobiliaryfistula of complicated calcified hydatid cyst of the liver. A 64-year-old man with cough and biliary sputum and a 66-year-oldman with cough and right biliary pleural effusion (pleurobiliaryfistula. The patients underwent left hepatectomy withcholecystectomy and T-tube choledochal drainage in one patientand successful decortication of the lung, and cystectomywith excision of calcified pericystectomy of the liver in anotherpatient. Pathologic examinations revealed calcified hydatidcysts of the liver. Because of poor prognosis of thoracobiliaryfistula, radical surgical intervention is recommended.

  4. A bill of rights for patients with obstetric fistula. (United States)

    Wall, L Lewis


    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.


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    Vijay Kumar


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

  6. The radiological management of the thrombosed arteriovenous dialysis fistula

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    Bent, C.L., E-mail: [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)


    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.

  7. Colovesical fistula secondary to hernia mesh migration: an unusual incident


    Ramanathan, Sabarinathan; Krishnamoorthy, Veeraraghavan; Ratnakar, Kini; Thangavel, Pugazhendhi; Sundarraj, Raju


    ABSTRACT We evaluated a 27-year old male with pneumaturia and fecaluria with a past history of right inguinal hernia repair. Though, cystoscopy and contrast enhanced computed tomography did not furnish any evidence to arrive at a diagnosis, interestingly, colonoscopy revealed a mesh in the sigmoid colon making apparent the diagnosis of colovesical fistula secondary to mesh migration. Later, surgical removal of the mesh from the sigmoid colon with rent closure of the fistulous opening was done...

  8. Sealing of small postlaryngectomy pharyngocutaneous fistulas with voice prosthesis. (United States)

    Karakullukcu, M Baris; Lohuis, Peter J; van den Brekel, Michiel W; Hilgers, Frans J M


    Pharyngocutaneous fistulas (PCFs) following total laryngectomy is a common complication. The standard therapy is conservative management, and if this is not successful, surgical closure. There is a group of patients with limited survival chance who have small PCFs. In these patients who are not candidates for surgery, sealing of the PCF with a voice prosthesis can significantly improve the functionality of these patients allowing them to swallow and phonate.

  9. Congenital Palatal Fistula Associated with Submucous Cleft Palate. (United States)

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


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

  10. Congenital Palatal Fistula Associated with Submucous Cleft Palate


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


    Background: Although cleft lip and cleft palate are among the most common congenital malformations, the presence of an isolated congenital palatal fistula along with a submucous cleft is very rare. This appears as an oval-shaped, full-thickness fenestration in the palatal midline that does not fully extend anteriorly or posteriorly, accompanied by the findings of a submucous cleft. Because of the uncommon nature of this entity, there is controversy about its etiology, diagnosis, and managemen...

  11. Gastropericardial Fistula as a Late Complication of Laparoscopic Gastric Banding

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    Adam A Rudd


    Full Text Available Laparoscopic adjustable gastric banding (LAGB is a bariatric procedure that is being performed with increasing frequency as an alternative management option for morbid obesity. Several common complications have been reported including gastric band slippage and associated pouch dilatation, intragastric erosion of the band, gastric wall perforation, and abscess formation. We present a case of gastropericardial fistula occurring nine years after an LAGB. There have been no previous documented cases of the complication after this procedure.

  12. [Vesico-uterine fistula. Report of 10 cases]. (United States)

    Tazi, K; el Fassi, J; Karmouni, T; Koutani, A; Ibn Attya, A I; Hachimi, M; Lakrissa, A


    To study the aetiopathogenics, diagnostic and therapeutic aspects of this pathology. The authors report a series of 10 vesico-uterine fistulas observed over à 10 years period. The mean age was 32 years(30-40). The fistulas were secondary to cesarian section in 6 cases and to abnormal delivery in 4 cases. The symptomatology was an urinary leakage from the vagina in 6 cases, an isolated cyclic hematuria in 3 cases and the association of the two signs in one case. The diagnostic was established on clinical examination in 8 cases. Intraveinous urography was performed in all the patients and visualised the uterine cavity in only 8 cases. In the 2 remaining cases a retrograd cystography was performed and demonstrated the opacification of the uterine cavity. The treatment was surgical in 9 cases. One patient who had a menuria has refused the operation. The diagnostic of the vesico-uterine fistulas is often based on clinic examination but often necessitate recourse to complementary examinations mostly in the menouria forms. The intraveinous urography does not establish the diagnostic in all the cases but is an indispensable complementary investigation because it permits searching for an associated ureteral injury. With a mean recoil of one year the results judged on the disappearance of the clinic signs was good in all the patients. The vesico-uterine fistulas are often secondary to cesarian section or abnormal delivery. Their treatment is surgical but is above all preventive by the improvement of the obstetric taking care and avoiding the vesical injuries in the course of the cesarian section.

  13. Acquired tracheoesophageal fistula status post laryngeal neoplasm resection


    Luber, Sarah; Alweis, Richard


    A tracheoesophageal fistula (TEF), albeit rare, can be a life-threatening condition that requires prompt identification and treatment. Pulmonary contamination and restriction of proper nutrition are common, unfortunate consequences of untreated TEFs and are often the causes of mortality in this population. In our patient, a history of laryngeal malignancy along with symptoms of chest pain and cough with ingestion of liquids, even without evidence of aspiration pneumonia, appropriately prompte...

  14. Gastrosplenic fistula due to splenic large B-cell lymphoma

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    Yin-Lu Ding


    Full Text Available A gastrosplenic fistula (GSF is an unusual complication arising from a variety of primary gastric or splenic malignant lesions and less commonly from benign diseases. Splenic large cell lymphoma may be a main cause of this distinctive complication. We report a case of 62-year-old male with spontaneous GSF due to pathologically proven splenic large cell lymphoma who was diagnosed by computed tomography and treated successfully by surgical management.

  15. Neurofibromatosis-associated massive right internal carotid artery aneurysm with a coexisting arteriovenous fistula

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    Marlin Wayne Causey, MD


    Full Text Available A 47-year-old woman presented with a right cervical mass that had been slowly enlarging for 6 years, causing pulsatile tinnitus and dizziness with compression. Computed tomography angiography demonstrated a partially thrombosed 8-cm right internal carotid artery aneurysm with a coexisting arteriovenous fistula. Conventional angiography demonstrated a vertebrojugular fistula (right vertebral artery to right internal jugular vein and retrograde flow in the right vertebral artery to the fistula. Successful repair was performed in a staged fashion: operative repair of the internal carotid artery aneurysm with interposition bypass, followed by endovascular embolization of the vertebrojugular fistula through a bilateral vertebral artery approach.

  16. Repairing Bronchoesophageal Tube Fistula Using A Contralateral Latissimus Dorsi Musculocutaneous Flap

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    Shuchi Azuma, MD


    Full Text Available Summary:. A postoperative aerodigestive fistula is one of the rare but critical complications after esophagectomy, and management is challenging. The essential keys to successful treatment of these fistula are thorough debridement and complete closure followed by separation of the respiratory and digestive tract. We present a case of a recurrent bronchoesophageal fistula between the left main bronchus and neo esophagus, which was successfully treated through a contralateral approach. The fistula was debrided and closed primarily through a right thoracotomy, and the interposition of a pedicled latissimus dorsi musculocutaneous flap from the right side was carried out. The patient was able to resume oral feeding at 16th postoperative day.

  17. Laparoscopic repair of a rectal fistula due to a benign ovarian dermoid cyst. (United States)

    Kim, Ji Hye; Chong, Gun Oh; Chun, Da Som; Park, Soo Yeun; Lee, Yoon Hee; Hong, Dae Gy


    Ovarian dermoid cysts are one of the most common benign neoplasms in women. Rectal fistula formation due to an ovarian dermoid cyst, particularly a benign dermoid cyst, is extremely rare. A 17-year-old girl with symptoms of lower abdominal pain, passage of sebaceous materials in the stool, and hematochezia was found to have an 11-cm dermoid cyst complicated with a rectal fistula formation. Laparoscopic repair of the rectal fistula was performed successfully with bilateral ovarian cystectomies. This case presents the rare formation of a fistula between a benign dermoid cyst and the rectum and its treatment using laparoscopic repair without laparotomy.

  18. A case of metastatic carcinoma of anal fistula caused by implantation from rectal cancer. (United States)

    Takahashi, Rina; Ichikawa, Ryosuke; Ito, Singo; Mizukoshi, Kosuke; Ishiyama, Shun; Sgimoto, Kiichi; Kojima, Yutaka; Goto, Michitoshi; Tomiki, Yuichi; Yao, Takashi; Sakamoto, Kazuhiro


    This case involved an 80-year-old man who was seen for melena. Further testing revealed a tubular adenocarcinoma 50 mm in size in the rectum. In addition, an anal fistula was noted behind the anus along with induration. A biopsy of tissue from the external (secondary) opening of the fistula also revealed adenocarcinoma. Nodules suspected of being metastases were noted in both lung fields. The patient was diagnosed with rectal cancer, a cancer arising from an anal fistula, and a metastatic pulmonary tumor, and neoadjuvant chemotherapy was begun. A laparoscopic abdominoperineal resection was performed 34 days after 6 cycles of mFOLFOX-6 therapy. Based on pathology, the rectal cancer was diagnosed as moderately differentiated adenocarcinoma, and this adenocarcinoma had lymph node metastasis (yp T3N2aM1b). There was no communication between the rectal lesion and the anal fistula, and a moderately differentiated tubular adenocarcinoma resembling the rectal lesion was noted in the anal fistula. Immunohistochemical staining indicated that both the rectal lesion and anal fistula were cytokeratin 7 (CK7) (-) and cytokeratin 20 (CK20) (+), and the patient's condition was diagnosed as implantation of rectal cancer in an anal fistula.In instances where an anal fistula develops in colon cancer, cancer implantation in that fistula must also be taken into account, and further testing should be performed prior to surgery.

  19. Atrial tachycardia treated by coil embolization of a giant coronary artery fistula. (United States)

    Alihanoglu, Yusuf Izzettin; Uludag, Burcu; Kilic, Ismail Dogu; Yildiz, Bekir Serhat; Kocyigit, Ali; Evrengul, Harun


    Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Intrathecal administration of gadopentetate dimeglumine for MR cisternography of nasoethmoidal CSF fistula. (United States)

    Arbeláez, Andrés; Medina, Elcy; Rodríguez, Margarita; Londoño, Ana C; Castillo, Mauricio


    Accurate diagnosis and localization of dural defects associated with CSF fistulas are difficult and often involve multiple imaging studies performed at the appropriate clinical moment. Our purpose was to assess the utility of intrathecal administration of gadopentetate dimeglumine for MR cisternography of patients with CSF fistula suspected clinically to arise from defects in the nasoethmoidal regions. MR cisternography was useful for evaluating patients with rhinorrhea and suspected CSF fistula. It depicted the fistula site in most patients. No adverse effects were found in any patient.

  1. Magnetization transfer ratio for the assessment of perianal fistula activity in Crohn's disease

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    Pinson, C.; Dolores, M.; Cruypeninck, Y.; Koning, E.; Dacher, J.N.; Savoye-Collet, C. [Rouen University Hospital-Charles Nicolle, Department of Radiology, Rouen cedex (France); Savoye, G. [Rouen University Hospital-Charles Nicolle, Department of Gastroenterology, Rouen cedex (France)


    Assessment of perianal fistulas is important to guide management of Crohn's disease (CD). Our objectives were to analyze the feasibility of magnetization transfer (MT) imaging to assess fistulas and to evaluate its contribution in assessing disease activity. During 15 months, all patients referred for perianal fistulas in CD underwent 3T-MRI including diffusion, T2/T1-weighted gadolinium-enhanced sequences and MT sequences (one with an off-resonance saturation pulse of 800 and one with 1200 Hz). We collected Van Assche score, fistula activity signs by analyzing T2, diffusion and contrast enhancement. We calculated MT ratio (MTR) with a ROI in the largest fistula. Twenty-nine patients (mean 34.9 years, range 17-53) were included. Van Assche score was 11.7, range 4-21. In 22 patients, the fistula presented with a bright T2 and diffusion signal with contrast enhancement, and was characterized as active. Mean MTR was respectively 47.2 (range 12-68) and 34.3 (range 11-57) at 800 and 1200 Hz. MTR at 800 Hz was significantly lower in non-active (34, range 12-55) than in active fistulas (51, range 24-68) (p < 0.02). MTR is feasible for the assessment of fistulas in CD and in the future could be used to help identify active and non-active fistulas. (orig.)

  2. The role of counseling for obstetric fistula patients: lessons learned from Eritrea. (United States)

    Johnson, Khaliah A; Turan, Janet M; Hailemariam, Letu; Mengsteab, Elsa; Jena, Dirk; Polan, Mary Lake


    The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea. To evaluate the impact of the counseling program, clients were interviewed both before pre-operative counseling and again after post-operative counseling. A questionnaire was used in the interviews to assess women's knowledge about fistula, self-esteem, and their behavioral intentions for health maintenance and social reintegration following surgical repair. In addition, two focus groups were conducted with a total of 19 clients assessing their experiences with the surgical care and counseling. Data from the questionnaires revealed significant improvements in women's knowledge about fistula, self-esteem, and behavioral intentions following counseling. Focus group data also supported increased knowledge and self-esteem. Evaluation of the short-term impact of an initial formal counseling program for fistula patients in sub-Saharan Africa affirmed the positive effects that such a program has for fistula patients, with increased knowledge about the causes of fistula, fistula prevention and enhanced self-esteem. Culturally appropriate counseling can be incorporated into services for surgical repair of obstetric fistula in low-resource settings and has the potential to improve the physical and mental well-being of women undergoing fistula repair. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  3. Permacol™ collagen paste injection for the treatment of complex anal fistula: 1-year follow-up. (United States)

    Fabiani, B; Menconi, C; Martellucci, J; Giani, I; Toniolo, G; Naldini, G


    Optimal surgical treatment for anal fistula should result in healing of the fistula track and preserve anal continence. The aim of this study was to evaluate Permacol™ collagen paste (Covidien plc, Gosport, Hampshire, UK) injection for the treatment of complex anal fistulas, reporting feasibility, safety, outcome and functional results. Between May 2013 and December 2014, 21 consecutive patients underwent Permacol paste injection for complex anal fistula at our institutions. All patients underwent fistulectomy and seton placement 6-8 weeks before Permacol™ paste injection. Follow-up duration was 12 months. Eighteen patients (85.7%) had a high transsphincteric anal fistula, and three female patients (14.3%) had an anterior transsphincteric fistula. Fistulas were recurrent in three patients (14.3%). Seven patients (33%) had a fistula with multiple tracts. After a follow-up of 12 months, ten patients were considered healed (overall success rate 47.6%). The mean preoperative FISI score was 0.33 ± 0.57 and 0.61 ± 1.02 after 12 months. Permacol™ paste injection was safe and effective in some patients with complex anal fistula without compromising continence.

  4. Hepatic Arterioportal Fistula: A Curable Cause of Portal Hypertension in Infancy

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    J. S. Billing


    Full Text Available Hepatic arterioportal fistulae are a rare cause of portal hypertension. The case is reported of a twoyear old girl with a congenital arterioportal fistula, who presented with splenomegaly and ascites. Colour doppler ultrasound showed a large shunt between the left hepatic artery and a branch of the left portal vein, producing a reversal of flow in the main portal vein. She was treated by a formal left hemihepatectomy, which has been successful in eliminating the fistula and its consequent portal hypertension in the long term. The literature regarding arterioportal fistulae and their treatment is reviewed.

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


    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.

  6. Application of YAG laser technique in the treatment of anal fistula (United States)

    Liu, Jian-xun; Zhang, Xinrong


    The method of treating anal fistula with YAG laser technique is described in this essay. One-hundred-twenty patients have been treated successfully with this method and no recurrence was found in our series. Anal fistula is a common disorder in the anus and rectum. The tunnel of fistula zigzags around the external or internal sphincters. If the drainage is poor, and the skin around the external opening grows rapidly, false healing may occur and cause recurrent abscess. In this case, a fistula can not be cured except by operation.

  7. Acquired Palatal Fistula in Patients with Submucous and Incomplete Cleft Palate before Surgery

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    Ie Hyon Park


    Full Text Available It is uncommon for a palatal fistula to be detected in individuals who have not undergone surgery, and only sporadic cases have been reported. It is even more difficult to find cases of acquired palatal fistula in patients with submucous or incomplete cleft palate. Herein, we present 2 rare cases of this phenomenon. Case 1 was a patient with submucous cleft palate who acquired a palatal fistula after suffering from oral candidiasis at the age of 5 months. Case 2 was a patient with incomplete cleft palate who spontaneously, without trauma or infection, presented with a palatal fistula at the age of 9 months.

  8. Acquired Palatal Fistula in Patients with Submucous and Incomplete Cleft Palate before Surgery. (United States)

    Park, Ie Hyon; Chung, Jee Hyeok; Choi, Tae Hyun; Han, Jihyeon; Kim, Suk Wha


    It is uncommon for a palatal fistula to be detected in individuals who have not undergone surgery, and only sporadic cases have been reported. It is even more difficult to find cases of acquired palatal fistula in patients with submucous or incomplete cleft palate. Herein, we present 2 rare cases of this phenomenon. Case 1 was a patient with submucous cleft palate who acquired a palatal fistula after suffering from oral candidiasis at the age of 5 months. Case 2 was a patient with incomplete cleft palate who spontaneously, without trauma or infection, presented with a palatal fistula at the age of 9 months.


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    Full Text Available Vesicovaginal fistula (VVF is a preventable calamity, which has been an age - long menace in developing countries. The etiology of VVF has shifted from obstructed labor to post - surgical complication due to good obstetric care at primary health centers. In the present study a total of 35 patients with vesico - vaginal fistulas were operated during the 5 years period of study. The most common etiology was post - surgical complication following hysterectomy and caesarian section in 71.42% of cases. Most of the fistulas were simple. The success rate after surgery was 91.4%.Recurrence was seen in 3 cases and is mostly due to complex fistulas

  10. Multiple coronary arteriovenous fistulae combined with ventricular septal defect: a case report

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    Jung, Kun Sik; Zeon, Seok Kil; Kim, Ki Sik [Keimyung University, School of Medicine, Daegu (Korea, Republic of); Oh, Yeon Hee [Pohang Hospital, Dongguk University, Pohang (Korea, Republic of)


    Congenital coronary arteriovenous fistulas are all of those anomalies and malformations that result in a direct communication of a coronary artery and/or any of its branches with a cardiac chamber or extra cardiac vessel resulting in a shunt of varying proportions. The majority of these fistulas form an A-V connection between a coronary artery and the right heart chambers, and rarely their is communication with the left heart chambers. In most reported cases, the abnormal fistula involves only one coronary artery which developed alone. This report describes a unique case in which multiple coronary fistulas associated with VSD were encountered.

  11. Religious coping among women with obstetric fistula in Tanzania. (United States)

    Watt, Melissa H; Wilson, Sarah M; Joseph, Mercykutty; Masenga, Gileard; MacFarlane, Jessica C; Oneko, Olola; Sikkema, Kathleen J


    Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study aimed to examine religious coping among women with obstetric fistulae. Fifty-four women receiving fistula repair at a Tanzanian hospital completed a structured survey. The Brief RCOPE assessed positive and negative religious coping strategies. Analyses included associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). Forty-five women also completed individual in-depth interviews where religion was discussed. Although participants utilised positive religious coping strategies more frequently than negative strategies (p negative religious coping. In univariate analysis, negative religious coping was associated with stigma, depression and low social support. In multivariate analysis, only depression remained significant, explaining 42% of the variance in coping. Qualitative data confirmed reliance upon religion to deal with fistula-related distress, and suggested that negative forms of religious coping may be an expression of depressive symptoms. Results suggest that negative religious coping could reflect cognitive distortions and negative emotionality, characteristic of depression. Religious leaders should be engaged to recognise signs of depression and provide appropriate pastoral/spiritual counselling and general psychosocial support for this population.

  12. Radiofrequency fistulotomy: a better alternative for treating low anal fistula

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    Pravin Jaiprakash Gupta

    Full Text Available CONTEXT: Wide varieties of approaches are employed in dealing with low anal fistula. However, the simple method of laying open the fistula tract (fistulotomy is still considered to be the favored one. MATERIALS AND METHODS: A modified approach to the procedure of fistulotomy is discussed. This study describes the procedure, which used a technique of radiofrequency surgery, and its outcome in 232 patients with low anal fistula. The patients were followed for a period of 15 months. RESULTS: The patients were discharged on the same day as the procedure. The mean period off work was four days. The average healing time recorded was 67 days. Four wound complications in the form of premature closure of the external wound were noted, which required trimming of the edges. Two of these wounds remained unhealed. The recurrence rate was 1.7%. CONCLUSION: In this era when the emphasis is on criteria like the minimization of hospital stay, reduction of postoperative pain, early resumption of work and low and comparable recurrence rates, there is a future for the procedure of radiofrequency fistulotomy.

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

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    Andrea Goldson Barnaby


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

  14. Selective Management for Gastrointestinal Hemorrhage caused by Choledochoduodenal Fistula

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    Pawan Chansaenroj


    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.

  15. [The colocutaneous fistula - a rare complication of percutaneous endoscopic gastrostomy]. (United States)

    Heuss, L T; Spalinger, R


    A 43-year-old woman with spastic tetraparesis, mental retardation and long-term tube feeding was admitted for a replacement of the PEG tube, 15 months after placement and regular use of her first feeding tube. New problems had occurred with local infection and a suspected leakage. The gastrostoma showed a local erythema and increased secretion of putrid fluids, furthermore a tendency to diarrhea had developed. Otherwise the abdomen was inconspicuous. All routinely achieved blood tests were normal. Gastroscopy revealed a mucosal scar with a small fistula instead of the expected tip of the PEG tube. A CT scan demonstrated displacement of the tip into the transverse colon. The displaced PEG tube was removed by colonoscopy. After laparoscopic occlusion of the colocutaneous fistula with a surgical stapler and clearing of further adhesions a new PEG was inserted endoscopically during the same operation with laparoscopic guidance through the pneumoperitoneum. The development of a colocutaneous fistula as a result of an unperceived perforation is a rare complication of a PEG placement. Despite of the notable mechanism that the tip of the tube erodes the gastric wall and penetrates into the adjacent colon, the clinic is often oligosymptomatic and can easily been missed. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Autologous intratympanic blood patch for presumed perilymphatic fistulas. (United States)

    Foster, P K


    To assess an alternative to bed rest and surgery for suspected perilymphatic fistulas using intratympanic blood injections. A review was conducted of patients' history, physical and audiometric data, before and after treatment by intratympanic blood injections performed from 2009 to 2015. Twelve ears were identified, with trauma associated with air travel, water sports or nose blowing. Ten of these cases had hearing loss, six had vestibular symptoms. Four cases had audiological and vestibular symptoms, two had vestibular symptoms only, and six had audiological symptoms only. Time-to-treat varied from 1 day to 30 days. Magnetic resonance imaging scans were obtained for five cases. Ten cases received steroids. Six out of seven cases showed improvement of hearing loss. Five cases showed positive fistula test results, four with documented resolution. Seven cases had full resolution of all symptoms, four had near-full resolution and one had no improvement. Intratympanic blood injections offer an effective alternative to conservative or surgical therapy. Advantages include sooner time-to-treat, lower financial costs and decreased psychosocial burdens. It allows a more flexible and liberal use of a potential definite treatment for perilymphatic fistula.

  17. Balloon-Assisted Fistula Sealing Procedure for Symptomatic Tarlov Cysts. (United States)

    Zheng, Xuesheng; Li, Shiting; Sheng, Hansong; Feng, Baohui; Zhang, Nu; Xie, Chaoran


    Tarlov cyst is an abnormal expansion of the spinal nerve sleeve, and it communicates with the subarachnoid cavity via a perineural fistula. This study presents our experience of a balloon-assisted fistula sealing procedure in treating Tarlov cyst. Twenty-two patients with symptomatic Tarlov cysts were surgically treated. An emulsion balloon was placed into the lumbar subarachnoid cistern through a trocar, so as to temporarily block cerebrospinal fluid flow, then the thecal sac was opened and the inlet of the fistula was sealed by suture of a muscular patch and reinforced by fibrin glue. Finally, the cyst wall was imbricated and the bony cavity was filled with pedicled muscle flaps. Comparing the preoperative and postoperative pain scores according to visual analog scale, 2 patients were slightly improved and 18 patients were substantially improved, including 3 completely pain-free cases. Only 2 patients were unchanged in pain, and both of them had multiple cysts. As a whole, the postoperative pain score was much better than the preoperative score (2.4 vs. 7.5; P Tarlov cyst, especially for the single cyst. It is a good complement to the cyst wall imbricating procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Evolution of chylous fistula management after neck dissection. (United States)

    Campisi, Corrado C; Boccardo, Francesco; Piazza, Cesare; Campisi, Corradino


    The present review is focused on the management of lymphatic, chylous, and thoracic duct lesions following head and neck surgery, with particular attention to these complications after neck dissection. Postoperative scenarios may include chylous fistula, chylothorax, chylomediastinum, chylopericardium, lymphocele, persistent lymphorrhea, and secondary lymphedema. There is a paucity of literature on the treatment of lymphatic, chylous, and thoracic duct injuries following head and neck surgery; however, this review suggests that the most appropriate treatment should include both conservative and surgical approaches. Nonsurgical options consist of low-fat diet with medium-chain triglycerides, total parenteral nutrition, careful monitoring of fluid and electrolytes, drainage of the leakage, somatostatin analogs such as octreotide, and negative-pressure wound therapy. On the other hand, surgical management includes therapeutic percutaneous lymphography-guided thoracic duct cannulation and embolization, thoracic duct ligation, excision and imbrication of leaking lymphatics, chylous fistula surgical/microsurgical repair, fistula closure by locoregional flaps, video-assisted thoracoscopic surgery, thoracotomy, pleurodesis and decortication, pericardial 'window', and pleura-venous/pleura-peritoneal shunts. In addition, single or, preferably, multiple lymphovenous anastomoses may be taken into account. The various possible clinical presentations of such challenging lymphatic, chylous, and thoracic duct injuries require an appropriate multidisciplinary approach by experienced teams. Primary prevention of these complications can be achieved through adequate surgical planning to minimize lesions, including structured and thorough patient assessment, and centralization of resources and teams.

  19. Religious coping among women with obstetric fistula in Tanzania (United States)

    Watt, Melissa H.; Wilson, Sarah M.; Joseph, Mercykutty; Masenga, Gileard; MacFarlane, Jessica C.; Oneko, Olola; Sikkema, Kathleen J.


    Religion is an important aspect of Tanzanian culture, and is often used to cope with adversity and distress. This study aimed to examine religious coping among women with obstetric fistulae. Fifty-four women receiving fistula repair at a Tanzanian hospital completed a structured survey. RCOPE assessed positive and negative religious coping strategies. Analyses included associations between negative religious coping and key variables (demographics, religiosity, depression, social support and stigma). Forty-five women also completed individual in-depth interviews where religion was discussed. Although participants utilised positive religious coping strategies more frequently than negative strategies (pcoping. In univariate analysis, negative religious coping was associated with stigma, depression and low social support. In multivariate analysis, only depression remained significant, explaining 42% of the variance in coping. Qualitative data confirmed reliance upon religion to deal with fistula-related distress, and suggested that negative forms of religious coping may be an expression of depressive symptoms. Results suggest that negative religious coping could reflect cognitive distortions and negative emotionality, characteristic of depression. Religious leaders should be engaged to recognise signs of depression and provide appropriate pastoral/spiritual counseling and general psychosocial support for this population. PMID:24735435

  20. Is early cannulation of an arteriovenous fistula associated with early failure of the fistula? (United States)

    Wilmink, Teun; Hollingworth, Lee; Stevenson, Tamasin; Powers, Sarah


    To study the effect of early cannulation of arteriovenous fistulas (AVF) on early AVF failure. Analysis of two databases of access operations and dialysis sessions from 1/12/2002 till 1/4/2015. Follow-up until 1/4/2016. Functional dialysis use defined as six consecutive cannulations of the AVF with two needles. Early cannulation defined as needling of the AVF within 30 days of creation. Early failure was defined as abandonment for new form of access within 90 days of first cannulation. Machine blood-flow rates (BFR) of each dialysis session for the first 2 months collected from the dialysis database. We analysed 1167 AVFs with functional dialysis use. Some 148 AVFs (11%) were needled within 30 days. Early needling was not associated with increased early failure rates (p = 0.43). Early failure rates were lower in AVFs with six consecutive successful cannulations from the start (p = 0.002). There was a trend of reduced early failure rates (test for trend: p = 0.018) in the latter years of the study period, but no trend in early cannulation rates (p = 0.19). Failure to achieve six successful cannulations from the start was an independent predictor of early AVF failure but early needling was not an independent predictor in multivariate analysis. Average starting BFRs were higher in AVF that were needled early. Early cannulation was not associated with early failure. Failure to achieve six successful cannulations from the start was an independent predictor of early failure. The trend in yearly variation of early failure rates suggests that evolving practices influenced early failure rates.