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Sample records for acquired tracheoesophageal fistula

  1. Acquired tracheoesophageal fistula in infancy and childhood.

    PubMed

    Szold, A; Udassin, R; Seror, D; Mogle, P; Godfrey, S

    1991-06-01

    Acquired tracheoesophageal fistula (TEF) is a rare entity in the pediatric age group. We report two pediatric patients with acquired TEF caused by shells of pistachio nuts. In both patients the primary operation did not resolve the problem and a second intervention for recurrent fistula was needed. The special nature of acquired TEF, particularly the one described herein, requires delayed surgical intervention and meticulous separation of the respiratory and alimentary tracts by an intercostal muscle flap. PMID:1941455

  2. Tracheoesophageal fistula.

    PubMed

    Slater, Bethany J; Rothenberg, Steven S

    2016-06-01

    Tracheoesophageal fistula (TEF) is a relatively rare congenital anomaly. Surgical intervention is required to establish esophageal continuity and prevent aspiration and overdistension of the stomach. Since the first successful report of thoracoscopic TEF repair in 2000, the minimally invasive approach has become increasingly utilized. The main advantages of the thoracoscopic technique include avoidance of a thoracotomy, improved cosmesis, and superior visualization of the anatomy and fistula afforded by the laparoscope׳s magnification. PMID:27301604

  3. Tracheoesophageal fistula repair - slideshow

    MedlinePlus

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

  4. Esophageal Atresia and Tracheoesophageal Fistula

    MedlinePlus

    ... Return to Web version Esophageal Atresia and Tracheoesophageal Fistula Overview What is esophageal atresia? In babies who ... gets into the stomach. What is a tracheoesophageal fistula? A fistula (say “fist-you-lah”) is a ...

  5. Split latissimus dorsi muscle flap repair of acquired, nonmalignant, intrathoracic tracheoesophageal and bronchoesophageal fistulas.

    PubMed

    Hammoudeh, Ziyad S; Gursel, Eti; Baciewicz, Frank A

    2015-06-01

    The development of a fistula between the tracheobronchial tree and oesophagus due to nonmalignant causes is uncommon. Division of the fistula with muscle flap interposition eliminates contact between the tracheobronchial segment and the oesophagus, theoretically decreasing the chance of recurrence as well as providing a robust blood supply to aid in healing. The split latissimus dorsi muscle flap is a well-suited flap for such repairs because of the ability to simultaneously cover two separate apertures (tracheobronchial and oesophageal). The authors describe the split latissimus dorsi muscle flap with step-by-step technique for repair of intrathoracic aerodigestive fistulas. PMID:25697381

  6. Scintigraphic demonstration of tracheo-esophageal fistula

    SciTech Connect

    Dunn, E.K.; Man, A.C.; Lin, K.J.; Kaufman, H.D.; Solomon, N.A.

    1983-12-01

    A tracheo-esophageal fistula, developed following radiotherapy for an esophageal carcinoma, was vividly demonstrated by radionuclide imaging. The abnormality was later confirmed by a barium esophagram and endoscopic examinations. The scintigraphic procedure, making use of a Tc-99m sulfur colloid swallow, appears to be a simple alternative method use of a Tc-99m sulfur colloid swallow, appears to be a simple alternative method that may be clinically useful for the diagnosis of such a condition.

  7. The treatment strategy for tracheoesophageal fistula

    PubMed Central

    Wu, Xuemei; Zeng, Junli

    2015-01-01

    With the development of endoscopic techniques, the treatment of tracheoesophageal fistula (TEF) has made marked progress. As surgical intervention is often not an advisable option due to advanced malignancy and poor performance status of the patients, bronchoscopic intervention provides a good choice to palliate symptoms and reconstruct the airway and esophagus. In this review, we focus on the application of interventional therapy of TEF, especially the application of airway stenting, and highlight some representative cases referred to our department for treatment. PMID:26807286

  8. Tracheoesophageal fistula length decreases over time.

    PubMed

    Jiang, Nancy; Kearney, Ann; Damrose, Edward J

    2016-07-01

    The objectives of this study were to demonstrate that the length of the tracheoesophageal voice prosthesis changes over time and to determine whether the prosthesis length over time increased, decreased, or showed no predictable change in size. A retrospective chart review was performed at a tertiary care referral center. Patients who underwent either primary or secondary tracheoesophageal puncture between January 2006 and August 2014 were evaluated. Patients were excluded if the tracheoesophageal prosthesis size was not consistently recorded or if they required re-puncturing for an extruded prosthesis. Data analyzed included patient demographics and the length of the tracheoesophageal voice prosthesis at each change. A total of 37 patients were identified. The mean age was 64 years. Seventy-six percent were male. 24 % underwent primary tracheoesophageal puncture and 76 % underwent secondary tracheoesophageal puncture. The length of the prosthesis decreased over time (median Kendall correlation coefficient = -0.60; mean = -0.44) and this correlation between length and time was significant (p = 0.00085). Therefore, in conclusion, tracheoesophageal prosthesis length is not constant over time. The tracheoesophageal wall thins, necessitating placement of shorter prostheses over time. Patients with a tracheoesophageal voice prosthesis will require long-term follow-up and repeat sizing of their prosthesis. Successful tracheoesophageal voicing will require periodic reevaluation of these devices, and insurers must, therefore, understand that long-term professional care will be required to manage these patients and their prostheses. PMID:26951219

  9. FOREIGN BODY INDUCED TRACHEOESOPHAGEAL FISTULA IN A PEDIATRIC PATIENT WITH A MISDIAGNOSIS: CASE REPORT AND REVIEW OF LITERATURE.

    PubMed

    Tadesse, Amezene; Befekadu, Meheret; Getachew, Hanna; Bezabih, Abebe; Derbew, Milliard

    2015-10-01

    Acquired tracheoesophageal fistulae can be diagnosed clinically by features such as cough elicited by swallowing but symptoms can be mild. Here, we report a case of a foreign body induced trachea-esophageal fistula in a 2 year and 6 months old male child with a chronic cough who had long been misdiagnosed and mismanaged. PMID:27182587

  10. Tracheoesophageal fistula following disc battery ingestion and foreign body impaction

    PubMed Central

    Khaleghnejad Tabari, Ahmad; Mirshemirani, Alireza; Rouzrokh, Mohsen; Seyyedi, Javad; Khaleghnejad Tabari, Nasibeh; Razavi, Sajad; Talebian, Mahshid

    2011-01-01

    Background: Ingestion of foreign bodies may result in the formation of a tracheoesophageal fistula (TEF), which causes severe morbidity in children. We describe four cases of TEF, who underwent emergent surgery for repair. Case presentation: In this report, we present about four patients aged between 9 months to 2.5 years, who referred due to disc battery ingestion. There were two boys and two girls. The common symptoms were cough, cyanosis, and dysphagia, choking and vomiting. The diagnosis was performed through an x-ray, barium swallow and CT Scan. All batteries were impacted in the esophagus, two in upper, one in the middle, and one in lower esophagus position. All disc batteries were removed endoscopically, but had tracheoesophageal fistula (TEF). All the patients underwent TEF repaired surgically. There was no morbidity in four patients, but one patient developed moderate esophageal stenosis, which was repaired by staged dilatation. There was no mortality in our cases. Conclusion: Long-term impaction of foreign bodies may result in tracheoesophageal fistula. This complication may be seen earlier with alkaline disc batteries. Removal of these foreign bodies should be followed carefully for the diagnosis and treatment of these fistulas. PMID:24551442

  11. Tracheoesophageal fistula - a complication of prolonged tracheal intubation

    PubMed Central

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results. PMID:25713612

  12. Tracheoesophageal fistula--a complication of prolonged tracheal intubation.

    PubMed

    Paraschiv, M

    2014-01-01

    Tracheoesophageal fistula most commonly occurs as a complication of prolonged tracheal intubation. The incidence decreased after the use of low pressure and high volume endotracheal cuffs, but the intensive care units continue to provide such cases. The abnormal tracheoesophageal communication causes pulmonary contamination (with severe suppuration) and impossibility to feed the patient. The prognosis is reserved, because most patients are debilitated and ventilator dependent, with severe neurological and cardiovascular diseases. The therapeutic options are elected based on respiratory, neurological and nutritional status. The aim of conservative treatment is to stop the contamination (drainage gastrostomy, feeding jejunostomy) and to treat the pulmonary infection and biological deficits. Endoscopic therapies can be tried in cases with surgical contraindication. Operation is addressed to selected cases and consists in the dissolution of the fistula, esophageal suture with or without segmental tracheal resection associated. Esophageal diversion is rarely required. The correct indication and timing of surgery, proper surgical technique and postoperative care are prerequisites for adequate results. PMID:25713612

  13. Successful Treatment of a Recurrent Wide Tracheoesophageal Fistula With a Bioabsorbable Patch.

    PubMed

    Battistella, Lucia; Marulli, Giuseppe; Comacchio, Giovanni Maria; Mammana, Marco; Di Gregorio, Guido; Rea, Federico

    2016-05-01

    Acquired nonmalignant tracheoesophageal fistula (TEF) is a rare condition that requires proper treatment. We present the case of a 55-year-old woman with a 4.5-cm recurrent TEF, which had developed after an attempted surgical repair. After closure of the esophageal defect in two layers, a tracheoplasty technique was used to repair the tracheal membranous wall with a synthetic bioabsorbable patch (Gore Bio-A tissue reinforcement) covered with an intercostal muscle flap. The use of Gore Bio-A tissue reinforcement is an innovative and effective method to close a wide tracheal defect while achieving a scaffold for epithelial colonization. PMID:27106472

  14. Endoscopic Occlusion of Tracheoesophageal Fistula in Ventilated Patients Using an Amplatzer Septal Occluder.

    PubMed

    Cohen-Atsmoni, Smadar; Tamir, Akiva; Avni, Yona; Priel, Israel E; Roth, Yehudah

    2015-06-01

    Acquired tracheoesophageal fistula (TEF) is a challenging, life threatening condition. It most commonly appears in critically ill patients requiring prolonged mechanical ventilation, who cannot withstand open neck or chest surgery. An endoscopic technique could be better tolerated by these patients. We present our experience using a cardiac Amplatzer ASD septal occluder for an endoscopic TEF repair in ventilation-dependent patients. Two high risk patients underwent the procedure under general anesthesia and close respiratory monitoring. In one patient the device was inserted through the trachea and in the other through the esophagus. In both cases fistula closure was achieved for different periods of time allowing the patients a temporary relief of symptoms. The procedure was well tolerated by the patients, and no significant adverse effect documented. The technique was successful as a temporary solution for unstable patients with TEFs and should be considered as a treatment modality for similar patients. PMID:26075179

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

    PubMed Central

    Dalouee, Marziyeh Nouri; Masuom, Seyed Hossein Fattahi; Rahnama, Ali; Rajai, Zahra

    2016-01-01

    Tracheoinnominate artery fistula (TIF) is a serious complication of tracheostomy. If untreated, it could be life-threatening. The emergency approach to the condition that includes prompt diagnosis, rapid control of bleeding with a clear airway, and operation with or without interruption of the innominate artery are the most important factors influencing patient outcome. Tracheoesophageal fistula (TEF) is another complication of tracheostomy. In association with compromised quality of life, this condition is really hard to be treated. We report a case of combined TIF and TEF in a 27-year-old man with quadriplegia who suffered a car accident but was successfully managed with interruption and ligature of the innominate artery repair of trachea. PMID:27051118

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

    PubMed

    Dalouee, Marziyeh Nouri; Masuom, Seyed Hossein Fattahi; Rahnama, Ali; Rajai, Zahra

    2016-01-01

    Tracheoinnominate artery fistula (TIF) is a serious complication of tracheostomy. If untreated, it could be life-threatening. The emergency approach to the condition that includes prompt diagnosis, rapid control of bleeding with a clear airway, and operation with or without interruption of the innominate artery are the most important factors influencing patient outcome. Tracheoesophageal fistula (TEF) is another complication of tracheostomy. In association with compromised quality of life, this condition is really hard to be treated. We report a case of combined TIF and TEF in a 27-year-old man with quadriplegia who suffered a car accident but was successfully managed with interruption and ligature of the innominate artery repair of trachea. PMID:27051118

  17. Esophageal Microperforation due to Calcified Mediastinal Lymph Node Leading to Tracheoesophageal Fistula.

    PubMed

    Dwivedi, Sankalp; Schrickel, E Brooke; Siddiqui, Fayez; O'Brien, John; Kruer, James

    2016-01-01

    A 42-year-old male presented with worsening gastroesophageal reflux disease symptoms and cough. The clinical symptoms during the early course of illness were striking for aspiration pneumonia. He was given a prescription of proton pump inhibitors and antibiotics. Rapid decline in the clinical condition with worsening respiratory status was noted. Worsening symptoms of fever, cough, and chest pain prompted further diagnostic work-up suggesting esophageal microperforation. Esophagogram was found to be suggestive of tracheoesophageal fistula. The tracheoesophageal fistula was due to subcarinal lymph node of nontuberculous origin. PMID:27366334

  18. Esophageal Microperforation due to Calcified Mediastinal Lymph Node Leading to Tracheoesophageal Fistula

    PubMed Central

    Schrickel, E. Brooke; Siddiqui, Fayez; O'Brien, John; Kruer, James

    2016-01-01

    A 42-year-old male presented with worsening gastroesophageal reflux disease symptoms and cough. The clinical symptoms during the early course of illness were striking for aspiration pneumonia. He was given a prescription of proton pump inhibitors and antibiotics. Rapid decline in the clinical condition with worsening respiratory status was noted. Worsening symptoms of fever, cough, and chest pain prompted further diagnostic work-up suggesting esophageal microperforation. Esophagogram was found to be suggestive of tracheoesophageal fistula. The tracheoesophageal fistula was due to subcarinal lymph node of nontuberculous origin. PMID:27366334

  19. Gastrointestinal visualization during xenon-133 ventilation study in a patient with tracheoesophageal fistula

    SciTech Connect

    Takehara, Y.; Takahashi, M.; Isoda, H.; Niwa, H.; Mizuno, T.; Kaneko, M.

    1989-02-01

    A 37-yr-old female with H-type tracheoesophageal fistula demonstrated visualization of the gastrointestinal tract during a ventilation study using 133Xe gas. Gastrointestinal visualization by /sup 133/Xe on a ventilation study may prove to be a useful screening procedure for this condition in appropriate patients.

  20. Sealing of tracheoesophageal fistula using a Y stent through fiberoptic bronchoscope during general anesthesia under laryngeal mask airway

    PubMed Central

    Ye, Ling; Yang, Pingliang; Zuo, Yunxia

    2014-01-01

    A 64-yr-old man was admitted because of repeated pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula (15 mm) in the right posterior trachea 1 cm beyond the carina. Coated nickel-titanium shape memory alloy Y shaped stent was planned to seal this fistula under general anesthesia. We took advantage of laryngeal mask airway to insert the fiberoptic bronchoscope to guide the stent placement. Our method of sealing a large tracheoesophageal fistula with LMA under total intravenous anesthesia was successful. PMID:25664132

  1. Redo esophageal surgery: the diagnosis and management of recurrent tracheoesophageal fistula.

    PubMed

    Coran, Arnold G

    2013-10-01

    This article presents a 30-year review of 38 recurrent tracheoesophageal fistulas. The initial 26 cases were presented in 2009 at the annual meeting of the British Association of Pediatric Surgeons and the European Association of Pediatric Surgeons Joint Conference and published in the Journal of Pediatric Surgery (Bruchet al. J Pediatr Surg 45:337-340, 2010). In the initial cohort of 26 patients, 18 had a leak after their primary operation and 22 had respiratory symptoms leading to the discovery of the recurrent fistula. The diagnosis was made by a contrast study in 24. The repairs entailed replacing a catheter through the fistula, separating the trachea and esophagus completely using sharp dissection and placing vascularized tissue, either pleura or pericardium between the suture lines. Postoperative complications included seven anastomotic leaks, four strictures and three recurrent fistulas. Long-term follow-up (median of 84 months) showed that 21 took all of their nutrition by mouth, three were tube fed and two required a combination of both. Of the 23 patients with growth chart data, 16 fell into the first quartile of the growth chart, whereas none fell between the 75th and 100th percentile. In conclusion, this initial series of 26 patients along with the updated additional series of 12 patients is the largest series thus far reported in the literature. All 38 patients represent the characteristics of recurrent tracheoesophageal fistulas, including techniques to make the diagnosis and to provide a secure closure of the fistula, and the long-term outcomes of these patients. PMID:23975022

  2. Tracheoesophageal fistula in adults due to corrosive ingestion: challenges in management.

    PubMed

    Gupta, Vikas; Kurdia, Kailash C; Sharma, Anil; Mishra, Anand K; Yadav, Thakur D; Kochhar, Rakesh

    2015-03-01

    Esophagorespiratory fistula in adults as a result of corrosive ingestion is a rare occurrence and is a difficult problem to manage. Three young (15-19 years) patients (2F, 1M) out of 115 (incidence 2.6%) of corrosive ingestion who had tracheoesophageal fistula (TEF) were reviewed retrospectively. After initial management, enteral route of nutrition was established. Based on the extent of concomitant esophageal stricture, the fistulae were classified as: type I (short) and type II (long segment). Fistula was repaired through thoracotomy and formation of a neomembranous trachea. Esophageal stricture could be managed either short-segment resection (type I) or resection and replacement (type II). The etiology was aluminum phosphide in two and caustic soda in one. All the patients were operated beyond 9 weeks of ingestion. Tracheal defect was 5, 9 and 30 mm. Fistula could be repaired by neomembranous trachea in all the patients and defect reinforced with pleural flap in two and intercostal muscle flap in one patient. Two patients required colon interposition, while one could be managed with short-segment resection. All the patients are well at follow-up. TEF due to corrosive ingestion is a rare entity in adults. Formation of a neomembranous trachea is feasible in all patients. Management of esophageal stricture depends upon the pattern of involvement of the esophagus. PMID:25894506

  3. Management of patients with combined tracheoesophageal fistula, esophageal atresia, and duodenal atresia

    PubMed Central

    Nabzdyk, Christoph S.; Chiu, Bill; Jackson, Carl-Christian; Chwals, Walter J.

    2014-01-01

    INTRODUCTION Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge. PRESENTATION OF CASE Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms. DISCUSSION While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3–7 days under controlled circumstances. CONCLUSION A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes. PMID:25460495

  4. Button battery induced traumatic tracheoesophageal fistula: Case report and review of literature

    PubMed Central

    Abdulkareem, Insaf; Sabir, Omayma M.; Elamin, Abdelaziz

    2011-01-01

    Although accidental ingestions by children of various household chemicals and medicines are well described and the treatment is supported by protocols and hotlines, the ingestion of button batteries is less publicized, and the dangers are less understood by both parents and health care providers. We describe the case of a three-year-old girl, who presented to hospital with respiratory distress, cough, and fever; three weeks after the ingestion of a button battery. Endoscopic examination revealed impacted 20 mm disc battery, which was removed, and a tracheoesophageal fistula (TOF) in the upper third of the oesophagus associated with severe oesophagitis, and oesophageal ulcers. There was also evidence of oesophageal fungal infection, and severe hyperemic pan-gastritis and duodenitis. Parents were counseled and conservative management advised, but they opted for surgical repair of the TOF. The operation was done and the child survived, but she ended up with a tracheal stricture and recurrent chest infections. In conclusion, oesophageal button battery impaction places the patient at high risk for tracheoesophageal fistula. The key to successful therapy is prompt diagnosis and removal, which saves life and decreases morbidity. Because of the complications associated with this condition, patients should be managed at an institution with skilled personnel and facilities for advanced life support.

  5. Management of a congenital tracheoesophageal fistula in a young Spanish water dog

    PubMed Central

    2014-01-01

    Background Tracheoesophageal fistula (TEF) in dogs is a rare disease with only few reports in the literature. This report aims to contribute to the current literature on suitable diagnostic methods for TEF and to provide follow-up information after successful surgical treatment. Case presentation A seven-month-old intact female Spanish Water Dog was presented for further investigation of recurrent respiratory symptom. Bronchoscopy revealed a small hole-like defect in the tracheal wall at the bifurcation. The finding of the contrast material swallow study under fluoroscopy was indicative of a TEF. To further evaluate the connection between the trachea and esophagus, a computed tomography scan was performed. The TEF was surgically approached by thoracotomy through the right lateral sixth intercostal space. The fistula was identified, double ligated and divided. Histopathology confirmed the process to originate from the esophagus and to be patent. The dog was re-examined two weeks and ten months after surgery, with no evidence of recurring clinical signs. Conclusions Contrast material swallow study using fluoroscopy was the most reliable diagnostic method. Bronchoscopy may allow the fistula to be visualized, but due to a small fistular opening it can lead to a false negative result. Surgical correction by ligation and dividing of the fistula suggests a good prognosis for early diagnosed and operated TEF. PMID:24423070

  6. Scimitar Syndrome and H-type Tracheo-esophageal Fistula in a Newborn Infant.

    PubMed

    Lastinger, Allison; El Yaman, Malek; Gustafson, Robert; Yossuck, Panitan

    2016-06-01

    Scimitar syndrome is a rare congenital anomaly characterized by partial anomalous pulmonary venous drainage of the right lung to the inferior vena cava (IVC) creating a tubular opacity paralleling the right cardiac border on chest radiography which resembles a curved Turkish sword or scimitar. Associated pulmonary and vascular anomalies have been reported in cases of Scimitar syndrome, most commonly hypoplasia of right lung, dextroposition of the heart, hypoplasia of the right pulmonary artery, and aberrant arterial supply from the descending aorta to the affected lobe of the right lung. To the best of our knowledge, this is the first case of Scimitar syndrome with an H-type tracheoesophageal fistula that has ever been reported. PMID:24269859

  7. Absent upper blind Pouch in a case of tracheo-esophageal fistula.

    PubMed

    Harjai, Man Mohan; Badal, Sachendra; Khanna, Sangeeta; Singh, Ajit Kumar

    2015-01-01

    A common upper airway and digestive tract is a rare congenital anomaly that is usually fatal and its exact incidence is not known. It is a diagnostic challenge as it requires high index of suspicion. It should be considered in a neonate with respiratory distress in a non-vigorous baby requiring endotracheal intubation, which is difficult even in expert hand. We present a newborn with suspected tracheo-esophageal fistula that was diagnosed intraoperatively to have absent upper blind pouch of the esophagus and on autopsy found to have laryngeal atresia with absent vocal cords and a common aerodigestive tract continuing distally with trachea. The neonate was ventilated with endotracheal tube (ETT) placement which in retrospect we came to know that it was in the esophagus. The neonate also had associated multiple congenital anomalies of VACTERL association. The importance of teamwork between neonatologist, pediatric surgeon, anesthesiologist, and radiologist is highlighted for diagnosis and management of such rare cases. PMID:25552830

  8. Unilateral pulmonary agenesis associated with oesophageal atresia and tracheoesophageal fistula: A case report with prenatal diagnosis

    PubMed Central

    Miyano, Go; Morita, Keiichi; Kaneshiro, Masakatsu; Miyake, Hiromu; Koyama, Mariko; Nouso, Hiroshi; Yamoto, Masaya; Nakano, Reiji; Tanaka, Yasuhiko; Nishiguchi, Tomizo; Kawamura, Takakazu; Fukumoto, Koji; Urushihara, Naoto

    2015-01-01

    We describe herein a case of unilateral pulmonary agenesis (PA) with oesophageal atresia (EA)/tracheoesophageal fistula (TEF) that was diagnosed prenatally and repaired by esophagoesophagostomy with stable postoperative course. The patient was born at 34 weeks gestation, after ultrasonography at 22 weeks gestation showed possible right-sided diaphragmatic eventration or PA and EA was subsequently suspected due to hydramnios. The initial X-ray showed mediastinal shift to the right, and coil up sign of the nasogastric tube, without intracardiac anomaly. Immediately after the diagnosis of EA/TEF and unilateral PA on day 0, the patient was intubated in the operating room, and a gastrostomy tube was placed. After pulmonary status stabilized, at 4 days old, EA/TEF was repaired through a thoracotomy in the right 4th intercostal space. The right main bronchus was noted to continue into the distal oesophagus; this fistula was ligated and divided, and a single-layer esophagoesophagostomy was performed under mild tension with one vertebral gap. The neonate was maintained on mechanical ventilation and gradually weaned to extubation at 7 days old. The postoperative course was uneventful, with the exception of prolonged jaundice that emerged at 3 months old. Laparoscopic cholangiography at that time excluded biliary atresia, and jaundice resolved spontaneously. The patient has not shown any respiratory symptoms or feeding difficulties as of the 12-month follow-up. PMID:25659560

  9. Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: Basics of technique and its nuances

    PubMed Central

    Kanojia, Ravi Prakash; Bhardwaj, Neerja; Dwivedi, Deepak; Kumar, Raj; Joshi, Saajan; Samujh, Ram; Rao, K. L. N.

    2016-01-01

    Aim: To review the technique of thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (TREAT) and results reported in literature and with authors’ experience. Patients and Methods: The technique of TREAT was reviewed in detail with evaluation in patients treated at authors’ institution. The patients were selected based on selection criteria and were followed postoperatively. The results available in literature were also reviewed. Results: A total of 29 patients (8 females) were operated by TREAT. Mean age was 2.8 days (range 2-6 days). Mean weight was 2.6 kg (range 1.8-3.2 kg). There was a leak in four patients, and two patients had to be diverted. They are now awaiting definitive repair. Twenty-one patients have completed a mean follow-up of 1.5 years and are doing well except for two patients who had a stricture and underwent serial esophageal dilatations. The results from current literature are provided in tabulated form. Conclusions: TREAT is now a well-established procedure and currently is the preferred approach wherever feasible. The avoidance of thoracotomy is a major advantage to the newborn and is proven to benefit the recovery in the postoperative patient. The technique demonstrated, and the tweaks reported make the procedure easy and is helpful to beginners. The outcome is very much comparable to the open repair as proven by various series. Various parameters like leak rate, anastomotic stricture are the same. The outcome is comparable if you TREAT these babies well. PMID:27365905

  10. Thoracoscopic Esophageal Atresia with Tracheoesophageal Fistula Repair: The First Iranian Group Report, Passing the Learning Curve

    PubMed Central

    Hiradfar, Mehran; Gharavifard, Mohammad; Shojaeian, Reza; Joodi, Marjan; Nazarzadeh, Reza; Sabzevari, Alireza; Yal, Nazila; Eslami, Reza; Mohammadipour, Ahmad; Azadmand, Ali

    2016-01-01

    Background: Thoracoscopic treatment of esophageal atresia and tracheoesophageal fistula (EA+TEF) is accepted as a superior technique at least in cosmetic point of view but it is considered as an advance endoscopic procedure that needs a learning curve to be performed perfectly. This is the first report of Iranian group pediatric surgeons in thoracoscopic approach to EA. Methods and Materials: Since 2010, twenty four cases with EA+TEF underwent thoracoscopic approach in Sarvar Children Hospital (Mashhad -Iran). During the first 6 months, thoracoscopic approach to 6 cases of EA+TEF was converted to open procedure because of technical and instrumental problems. The first case of successful thoracoscopic EA repair was accomplished in 2010 and since then, 10 cases of EA+ TEF among 18 patients were treated successfully with thoracoscopic approach Results: Overall conversion rate was 58.3% but conversion rate after the primary learning curve period, was 35.7%. The main conversion causes include difficulties in esophageal anastomosis, limited exposure and deteriorating the patient's condition. Anastomotic leak and stenosis were observed in 20% and 40% respectively. Overall mortality rate was 4.2%. Conclusion: Thoracoscopic repair of esophageal atresia seems feasible and safe with considerable superiorities to the conventional method although acceptable results needs a prolonged learning curve and advanced endoscopic surgical skill. Clear judgment about the best surgical intervention for EA according to all cosmetic and functional outcomes needs further studies. PMID:27471677

  11. Review of oesophageal atresia and tracheoesophageal fistula in hospital sultanah bahiyah, alor star. Malaysia from january 2000 to december 2009.

    PubMed

    Narasimman, S; Nallusamy, M; Hassan, S

    2013-01-01

    Oesophageal atresia (EA) and tracheoesophageal fistula (TEF) is one of the congenital anomaly occurring in the newborns with the incidence of 1 in 2500 births seen worldwide. A retrospective review of newborns admitted to Hospital Sultanah Bahiyah (HSB) from 1st January 2000 to 31st December 2009 was done. The objective was to look at the influence of birth weight, time of surgical intervention, presence of other congenital anomaly and presence of preoperative pneumonia to the immediate outcome (mortality) of the surgery. There were 47 patients with oesophageal atresia, out of which 26 (55%) were males and 21 (45%) females. The distribution of patients by race were 34 Malays (72%), 9 Chinese (19%) and 4 Indians (9%). The birth weight of the babies range from 0.8 kg to 4.0 kg and there was a significant association with the outcome of the surgery (p< 0.05). Most of the babies (20) were operated within 24 hours of presentation but there was no significant association to the outcome. 23 (49%) of them were born with congenital malformation and there was a significant association with the outcome of the surgery (p<0.05). Based on the chest roentgenogram, 20 (43%) of them had pneumonia with significant association with the outcome (p<0.05). The mortality rate is 23% and the causes of death were pneumonia (36%), renal failure (18%), cardiac malformation (18%) and multiple congenital malformations (28%). The outcome of EA and TEF is determined mainly by birth weight, congenital malformations and presence of preoperative pneumonia in HSB. PMID:23466767

  12. Determinants of gap length in esophageal atresia with tracheoesophageal fistula and the impact of gap length on outcome

    PubMed Central

    Rassiwala, Muffazzal; Choudhury, Subhasis Roy; Yadav, Partap Singh; Jhanwar, Praveen; Agarwal, Raghu Prakash; Chadha, Rajiv; Debnath, Pinaki Ranjan

    2016-01-01

    Aim: This study was aimed at identifying factors which may affect the gap length in cases of esophageal atresia with tracheoesophageal fistula (EA-TEF) and whether gap length plays any role in determining the outcome. Materials and Methods: All consecutive cases of EA-TEF were included and different patient parameters were recorded. Plain radiographs with a nasogastric tube in the upper esophagus were taken. Patients were grouped into T1-T2; T2-T3; T3-T4; and T4 depending on the thoracic vertebral level of the arrest of the tube. During surgery, the gap length between the pouches was measured using a Vernier caliper and the patients were grouped into A, B, and C (gap length >2.1 cm; >1-≤2 cm and ≤1 cm). The operative gap groups were compared with the radiography groups and the other recorded parameters. Results: Total numbers of cases were 69. Birth weight was found to be significantly lower in Group A (mean = 2.14 kg) as compared to Group B (mean = 2.38 kg) and Group C patients (mean = 2.49 kg) (P = 0.016). The radiographic groups compared favorably with the intraoperative gap length groups (P < 0.001). The need for postoperative ventilation (70.83% in Group A vs. 36.84% in Group C, P = 0.032) and mortality (62.5%, 26.9% and 15.8% in Group A, B, and C, respectively, P = 0.003) co-related significantly with the gap length. Conclusion: Birth weight had a direct reciprocal relationship with the gap length. Radiographic assessment correlated with intraoperative gap length. Higher gap length was associated with increased need for postoperative ventilation and poor outcome. PMID:27365907

  13. Tracheomegaly and tracheosephagial fistula following mechanical ventilation: A case report and review of the literature

    PubMed Central

    Kucuk, Canan; Arda, Kemal; Ata, Naim; Turkkani, Mustafa Hamidullah; Yildiz, Özgür Ömer

    2016-01-01

    Postintubation Tracheoesophageal fistula (TEF) is a rare complication. Acquired TEF most commonly occurred following prolonged mechanical ventilation with an endotracheal or tracheostomy tube, cuff-related tracheal injury, post-intubation injury. We present a case of both tracheomegaly and tracheosephagial fistula following mechanical ventilation for 15 days, in the light of the literature. PMID:27222792

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

    PubMed

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

    2009-03-01

    A captive adult male grizzly bear (Ursus arctos horribilis) was evaluated due to multifocal wounds of the skin and subcutaneous tissues sustained as a result of trauma from another grizzly bear. On presentation, one lesion that was located in the perineal region seemed to be a deep puncture with purple tissue protruding from it. This perineal wound did not heal in the same manner or rate as did the other wounds. Twenty-five days after initial detection, substantial active hemorrhage from the lesion occurred and necessitated anesthesia for examination of the bear. The entire lesion was surgically excised, which later proved curative. An acquired arteriovenous fistula was diagnosed via histopathology. Arteriovenous fistulas can develop after traumatic injury and should be considered as a potential complication in bears with nonhealing wounds. PMID:19368261

  15. The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair.

    PubMed

    Takayasu, Hajime; Masumoto, Kouji; Ishikawa, Miki; Sasaki, Takato; Ono, Kentaro

    2016-12-01

    Recurrent tracheoesophageal fistula (TEF) is still difficult to diagnose and repair. In almost all cases, recurrence appears relatively soon after the primary surgery. We herein describe a case of recurrent TEF that appeared 10 years after the primary repair. At 2 years of age, the patient suffered from mental retardation due to encephalitis and developed a hiatus hernia with gastro-esophageal reflux. He underwent the repair of a hiatus hernia and fundoplication at 3 years of age. However, the hiatus hernia recurred 6 months after the operation. The patient suffered from recurrent pneumonia for 6 years after the appearance of the recurrent hiatus hernia. At 9 years of age, he was hospitalized frequently due to recurrent severe pneumonia. After admission at 9 years of age, an endoscopic study under general anesthesia was performed and revealed subglottic stenosis and a dilated esophagus with a recurrent hiatus hernia. Tracheotomy or laryngotracheal separation was first planned in order to improve his upper airway and facilitate the safer repair of the recurrent hiatus hernia. After laryngotracheal separation, the patient still suffered from severe pneumonia. In addition, a small volume of nutritional supplement was aspirated from the tracheostomy. Thus, recurrent TEF was suspected. Tests using dye under both esophagoscopy and bronchoscopy confirmed recurrent TEF. The fistula recurred in the cervical area because of the elevation of the esophagus due to the recurrent hiatus hernia. The fistula was surgically closed, with a sternothyroid muscle flap to prevent re-recurrence. At 4 months after this operation, the recurrent hiatus hernia was repaired. Thereafter, the patient's respiratory symptoms showed a dramatic improvement. The patient is now doing well and free from further recurrences of TEF and hiatus hernia at 2 years after the final operation. PMID:27589983

  16. Successful esophageal bypass surgery in a patient with a large tracheoesophageal fistula following endotracheal stenting and chemoradiotherapy for advanced esophageal cancer: case report.

    PubMed

    Miyata, Tatsunori; Watanabe, Masayuki; Nagai, Yohei; Iwatsuki, Masaaki; Iwagami, Shiro; Baba, Yoshifumi; Furushou, Chiyo; Ikuta, Yoshihiro; Yamamoto, Tatsuro; Baba, Hideo

    2013-03-01

    A 63-year-old man with esophageal achalasia for more than 20 years complained of respiratory distress. He was admitted as an emergency to the referral hospital three months previously. Computed tomography revealed tracheobronchial stenosis due to advanced esophageal cancer with tracheal invasion. He underwent tracheobronchial stenting and chemoradiotherapy. A large tracheoesophageal fistula (TEF) developed after irradiation (18 Gy) and chemotherapy, and he was unable to eat. Thereafter, he was referred to our hospital, where we performed esophageal bypass surgery using a gastric conduit. A percutaneous cardiopulmonary support system was prepared due to the risk of airway obstruction during anesthesia. A small-diameter tracheal tube inserted into the stent achieved ordinary respiratory management. No anesthesia-related problems were encountered. Oral intake commenced on postoperative day 9. He was discharged on postoperative day 23 and was able to take in sustenance orally right up to the last moment of his life. Esophageal bypass under general anesthesia can be performed in patients with large TEF with sufficient preparation for anesthetic management. PMID:23482402

  17. Fistulas

    MedlinePlus

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

  18. Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap

    PubMed Central

    Jaiswal, Dushyant; Yadav, Prabha; Shankhdhar, Vinay Kant; Gujjalanavar, Rajendra Suresh; Puranik, Prashant

    2015-01-01

    Introduction: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula. Materials and Methods: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. Results: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. Conclusion: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula. PMID:26933281

  19. Feasibility of a bilateral regional sternocleidomastoid muscular flap in the closure of a persistent acquired tracheopharyngeal fistula.

    PubMed

    Goh, Liang Chye; Santhi, Kalimuthu; Arvin, Balachandran; Mohd Razif, Mohamad Yunus

    2016-01-01

    An acquired persistent tracheopharyngeal fistula secondary to an infected tracheopharyngeal voice prosthesis is a common cause of recurrent aspiration pneumonia in a postlaryngectomy patient. We report a case of a successfully treated tracheopharyngeal fistula whereby both the sternocleidomastoid muscles were used as muscular flaps to close the defect and its outcome. PMID:27566213

  20. Aspiration of tracheoesophageal prosthesis in a laryngectomized patient

    PubMed Central

    2012-01-01

    Background The voice prosthesis inserted into a tracheoesophageal fistula has become the most widely used device for voice rehabilitation in patients with total laryngectomy. Case presentation We describe a case of tracheoesophageal prosthesis’ (TEP) aspiration in a laryngectomized patient, with permanent tracheal stoma, that appeared during standard cleaning procedure, despite a programme of training for the safe management of patients with voice prosthesis. Conclusions The definitive diagnosis and treatment were performed by flexible bronchoscopy, that may be considered the procedure of choice in these cases, also on the basis of the literature. PMID:22958961

  1. The Dural AV-Fistula (DAVF), the Most Frequent Acquired Vascular Malformation of the Central Nervous System (CNS).

    PubMed

    Wanke, I; Rüfenacht, D A

    2015-10-01

    Acquired arteriovenous malformations, such as is the case with dural arteriovenous fistulae (DAVF), are the consequence of a pathological new arterial ingrowth into venous spaces that reaches directly the venous lumen, without interposition of a capillary network, thereby creating an AV-shunt.The following concise text will provide elements in regards to diagnosis, indication for treatment discussion and choice of endovascular treatment (EVT) method. PMID:26308245

  2. Tracheoesophageal fistula and esophageal atresia repair

    MedlinePlus

    ... the chest wall) to drain fluids from the space between the outside of the lung and the inside of the chest cavity. Intravenous (IV) fluids, including nutrition Oxygen Pain medicines as needed If both the TEF and EA ...

  3. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation

    PubMed Central

    O’Sullivan, Katie E.; Bolster, Ferdia; Lawler, Leo P.; Hurley, John

    2014-01-01

    Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation. PMID:24057860

  4. Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

    PubMed Central

    Said, Salah A M; Mariani, Massimo A

    2016-01-01

    AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas (ACF) secondary to iatrogenic or infectious disorders. METHODS From a PubMed search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case - an adult male who presented with ACF between commissures of the right and non-coronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV - is added, the world literature is briefly reviewed. RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital (47%) or acquired (53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea (21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23 (60%), single method in 14 (37%) (echocardiography in 12 and catheterization in 2), and at autopsy in 2 (3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12 (30%) with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24 (63%). CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative. PMID:27621777

  5. Percutaneous Closure of an Iatrogenic Aorta to Right Ventricle Fistula Acquired Following Intracardiac Repair

    PubMed Central

    Rajasekhar, Durgaprasad; Vanajakshamma, Velam; Ranganayakulu, Kummaraganti Paramathma

    2016-01-01

    Iatrogenic aortocardiac fistulae have been described rarely following intracardiac repair. This 28 year-old-male presented to our facility with dyspnea going on 20 days after closure of ventricular septal defect (VSD) and resection of subaortic membrane. A communication was noticed between the aorta and the right ventricle (RV) upon transthoracic echocardiography. Cardiac catheterisation revealed a significant shunt and an aortogram revealed a 6 mm communication between aorta and right ventricle. Percutaneous closure of this defect was attempted under local anaesthesia through right femoral access. An alpha arteriovenous loop was formed despite repeated attempts, hence a retrograde approach for device delivery was considered. An 8 mm Amplatzer muscular VSD occluder device was deployed across the defect achieving a complete closure through an 8F delivery sheath. To the best of our knowledge this is the first report of an iatrogenic aorta to RV fistula occurring in a patient following an intracardiac repair which has been successfully treated percutaneously. PMID:27274181

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

    PubMed

    Shakoor, Muhammad Tariq; Islam, Ashequl M; Ayub, Samia

    2015-01-01

    Transcatheter aortic valve replacement (TAVR) techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD) formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient. PMID:25883809

  7. Esophageal aerodynamics in an idealized experimental model of tracheoesophageal speech

    NASA Astrophysics Data System (ADS)

    Erath, Byron D.; Hemsing, Frank S.

    2016-03-01

    Flow behavior is investigated in the esophageal tract in an idealized experimental model of tracheoesophageal speech. The tracheoesophageal prosthesis is idealized as a first-order approximation using a straight, constant diameter tube. The flow is scaled according to Reynolds, Strouhal, and Euler numbers to ensure dynamic similarity. Flow pulsatility is produced by a driven orifice that approximates the kinematics of the pharyngoesophageal segment during tracheoesophageal speech. Particle image velocimetry data are acquired in three orthogonal planes as the flow exits the model prosthesis and enters the esophageal tract. Contrary to prior investigations performed in steady flow with the prosthesis oriented in-line with the flow direction, the fluid dynamics are shown to be highly unsteady, suggesting that the esophageal pressure field will be similarly complex. A large vortex ring is formed at the inception of each phonatory cycle, followed by the formation of a persistent jet. This vortex ring appears to remain throughout the entire cycle due to the continued production of vorticity resulting from entrainment between the prosthesis jet and the curved esophageal walls. Mean flow in the axial direction of the esophagus produces significant stretching of the vortex throughout the phonatory cycle. The stagnation point created by the jet impinging on the esophageal wall varies throughout the cycle due to fluctuations in the jet trajectory, which most likely arises due to flow separation within the model prosthesis. Applications to tracheoesophageal speech, including shortcomings of the model and proposed future plans, are discussed.

  8. Gastrointestinal fistula

    MedlinePlus

    Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal ... cause diarrhea , malabsorption of nutrients, and dehydration . Entero-enteral fistulas may have no symptoms. Enterocutaneous fistulas cause ...

  9. Phonation Offset in Tracheoesophageal Speech

    ERIC Educational Resources Information Center

    Searl, Jeff; Ousley, Teri

    2004-01-01

    Tracheoesophageal (TE) speakers often have difficulty producing the voiced-voiceless distinction. Phonation offset (POff) as a TE speaker transitions from a vowel to a stop consonant may be altered, possibly contributing to listener misperceptions. The purposes of this study were to: (1) compare the duration of POff in TE versus laryngeal…

  10. A rare case of adult acquired tracheo-oesophageal fistula with sub-glottic stenosis for corrective surgery- an anesthetic challenge.

    PubMed

    Joshi, Smita; Kulkarni, Anitha; Holkunde, Roopa S

    2014-11-01

    Acquired trachea-esophageal fistula (TEF) is a rare condition in adults and causative factors include malignancy, trauma and various iatrogenic causes. The important causative factor of TEF in our case was percutaneous tracheostomy. The normal protective laryngeal reflexes are lost in TEF due to the patent tract from the airway to the upper gastrointestinal tract. The TEF poses a challenge for the surgeon and the anaesthesiologist, as the fistula lies in close proximity to oesophagus, trachea, upper mediastinal contents and large blood vessel. Here we present a rare case of anesthetic management of a 26 year old male patient with complaints of regurgitation of part of swallowed food particles through an in-situ tracheostomy tube since two years. PMID:25584239

  11. Genetics Home Reference: esophageal atresia/tracheoesophageal fistula

    MedlinePlus

    ... cases of isolated EA/TEF , no specific genetic changes or environmental factors have been conclusively determined to be the cause. Non-isolated or syndromic forms of EA/TEF can be caused by changes in single genes or in chromosomes, or they ...

  12. [Preliminary results in the use of polydimethylsiloxane textured elastomers (Bioplastique) in the treatment of leakage around tracheoesophageal voice prosthesis].

    PubMed

    Bertino, G; Benazzo, M; Occhini, A; Aresi, G; Mira, E

    2002-10-01

    Leakage around the prosthesis is one of the worst problems afflicting patients fitted with tracheoesophageal (TE) voice prosthesis. Removing the prosthesis for a few days can reduce the size of the fistula, or the leakage may be eliminated simply by replacing the prosthesis. In cases that are refractory to such treatment, the perifistular injection of different types of autologous, heterologous or alloplastic substances has been proposed. A new kind of silicone, previously available abroad, has recently appeared on the Italian market as well; constituted by polydimethylsiloxane textured elastomers (Bioplastique) for soft tissue implants, it appears to guarantee excellent standards of long-term safety and stability. Three patients fitted with Provox2 tracheoesophageal voice protheses who had been experiencing leakage for about 4 months underwent Bioplastique implant procedures. The correction of the fistula size was easy to accomplish and well tolerated by the patients. There was no sign of inflammation, formation of granulomas or other pathological modifications, and the size of the fistula, together with its fluid-tightness, remained stable in time. From our point of view, the Bioplastique implant appears to provide valid and effective treatment of gaping TE fistulas. PMID:12510340

  13. Quality of "Glottal" Stops in Tracheoesophageal Speakers

    ERIC Educational Resources Information Center

    van Rossum, M. A.; van As-Brooks, C. J.; Hilgers, F. J. M.; Roozen, M.

    2009-01-01

    Glottal stops are conveyed by an abrupt constriction at the level of the glottis. Tracheoesophageal (TE) speakers are known to have poor control over the new voice source (neoglottis), and this might influence the production of "glottal" stops. This study investigated how TE speakers realized "glottal" stops in abutting words that end and begin…

  14. The application of a new cyanoacrylate glue in pediatric surgery for fistula closure.

    PubMed

    Hosseini, Seyed Mohammad Vahid; Bahador, Ali; Foroutan, Hamid Reza; Sabet, Babak; Geramizadeh, Bita; Zarenezhad, Mohammad

    2011-03-01

    Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January-December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas. PMID:23365480

  15. The Application of a New Cyanoacrylate Glue in Pediatric Surgery for Fistula Closure

    PubMed Central

    Hosseini, Seyed Mohammad Vahid; Bahador, Ali; Foroutan, Hamid Reza; Sabet, Babak; Geramizadeh, Bita; Zarenezhad, Mohammad

    2011-01-01

    Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January–December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas. PMID:23365480

  16. Clinical and etiological heterogeneity in patients with tracheo-esophageal malformations and associated anomalies.

    PubMed

    Brosens, Erwin; Ploeg, Mirjam; van Bever, Yolande; Koopmans, Anna E; IJsselstijn, Hanneke; Rottier, Robbert J; Wijnen, Rene; Tibboel, Dick; de Klein, Annelies

    2014-08-01

    Esophageal Atresia (EA) is a severe developmental defect of the foregut that presents with or without a Tracheo-Esophageal Fistula (TEF). The prevalence of EA/TEF over time and around the world has been relatively stable. EA/TEF is manifested in a broad spectrum of anomalies: in some patients it manifests as an isolated atresia or fistula, but in over half it affects several organ systems. While the associated malformations are often those of the VACTERL spectrum (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal and Limb), many patients are affected by other malformations, such as microcephaly, micrognathia, pyloric stenosis, duodenal atresia, a single umbilical artery, and anomalies of the genitourinary, respiratory and gastrointestinal systems. Though EA/TEF is a genetically heterogeneous condition, recurrent genes and loci are sometimes affected. Tracheo-Esophageal (TE) defects are in fact a variable feature in several known single gene disorders and in patients with specific recurrent Copy Number Variations and structural chromosomal aberrations. At present, a causal genetic aberration can be identified in 11-12% of patients. In most, EA/TEF is a sporadic finding; the familial recurrence rate is low (1%). As this suggests that epigenetic and environmental factors also contribute to the disease, non-syndromic EA/TEF is generally believed to be a multifactorial condition. Several population-based studies and case reports describe a wide range of associated risks, including age, diabetes, drug use, herbicides, smoking and fetal alcohol exposure. The phenotypical and genetic heterogeneity seen in EA/TEF patients indicates not one underlying cause, but several. Unraveling the complex multifactorial and heterogeneous etiology of EA/TEF and associated features will require large cohorts of patients. Combined statistical analysis of component findings, genome sequencing, and genome wide association studies will elucidate new causal genetic defects and

  17. Diagnosis and Surgical Management of Uroenteric Fistula.

    PubMed

    Gill, Harcharan S

    2016-06-01

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

  18. Nephrocutaneous fistula.

    PubMed Central

    Charles, J. C.

    1990-01-01

    The author presents a case of spontaneous nephrocutaneous fistula associated with a complete staghorn calculus in a nonfunctioning kidney. A renal scan, an intravenous pyelogram, and a right retrograde pyelogram confirmed the need for a nephrectomy. The procedure and results are described here. Images Figure 1 Figure 2 Figure 3 PMID:2395179

  19. Post-traumatic recto-spinal fistula.

    PubMed

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

    2000-01-01

    Acquired recto-spinal fistula has been described elsewhere as a rare complication of colorectal malignancy and Crohn's enterocolitis. We treated a young man who developed a recto-spinal fistula as a result of a high fall injury. The patient presented with meningeal signs, sepsis and perianal laceration. Computerized axial tomography revealed air in the supersellar cistern. Gastrografin enema showed that contrast material was leaking from the rectum into the spinal canal. Surgical management included a diverting sigmoid colostomy, sacral bone curettage and wide presacral drainage. To the best of our knowledge, rectospinal fistula of traumatic origin has not been previously reported in the English literature. PMID:10663732

  20. A new approach for the management of esophageal atresia without tracheo-esophageal fistula

    PubMed Central

    Bedi, Nandini K.; Grewal, Alka G.; Rathore, Shubhra; George, Uttam

    2016-01-01

    Long gap esophageal atresia (OA) is a challenging condition. While discussing the various methods of management available to us, we report the use of magnetic resonance imaging in a case of pure OA to judge the gap between two ends of the esophagus. PMID:27365910

  1. A new approach for the management of esophageal atresia without tracheo-esophageal fistula.

    PubMed

    Bedi, Nandini K; Grewal, Alka G; Rathore, Shubhra; George, Uttam

    2016-01-01

    Long gap esophageal atresia (OA) is a challenging condition. While discussing the various methods of management available to us, we report the use of magnetic resonance imaging in a case of pure OA to judge the gap between two ends of the esophagus. PMID:27365910

  2. Ileocolic Arteriovenous Fistula with Superior Mesenteric Vein Aneurism: Endovascular Treatment

    SciTech Connect

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

    2004-09-15

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

  3. Arteriovenous fistula simulating a solid tumor of the kidney.

    PubMed

    Vorreuther, R; Gross-Fengels, W; Mathers, M J

    1991-01-01

    In this report we describe a 57-year-old male hemophiliac with an acquired renal arteriovenous (AV) fistula presenting as a renal mass. Even after intravenous pyelography, ultrasound and computed tomography, a carcinoma seemed possible. Causes, symptoms and therapy of renal AV fistulas are shown and pitfalls in the usual diagnostic approach are discussed. PMID:1792712

  4. Pulmonary arteriovenous fistula

    MedlinePlus

    Pulmonary arteriovenous fistula is an abnormal connection between an artery and vein in the lungs. As a result, blood passes ... Pulmonary arteriovenous fistulas are usually the result of abnormal development of the blood vessels of the lung. Most occur in ...

  5. Coronary artery fistula

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/007315.htm Coronary artery fistula To use the sharing features on this page, please enable JavaScript. Coronary artery fistula is an abnormal connection between one of ...

  6. Pulmonary arteriovenous fistula

    MedlinePlus

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

  7. Physiology and prospects of bimanual tracheoesophageal brass instrument play.

    PubMed

    Hilgers, F J M; Dirven, R; Jacobi, I; van den Brekel, M W M

    2015-06-01

    This study investigated whether trachea pressures during brass instrument play of laryngectomised patients are within the range of those measured during tracheoesophageal voicing, and whether application of an automatic speaking valve can 'free' both hands to play a brass instrument. Objective assessment of voicing and music playing parameters was carried out in 2 laryngectomised patients with a low-pressure indwelling voice-prosthesis able to play brass instruments (tenor horn and slide trombone): sound pressure levels in dB, maximum phonation time in seconds and trachea pressures in mmHg; videofluoroscopy, stroboscopy and digital high speed endoscopy to assess neoglottis vibration and opening. The dynamic range of the voice in the patients was 29 and 20 dB, and maximum phonation time was 22 and 19 sec, respectively; intratracheal pressures during voicing varied from 7 mmHg for the softest /a/ to 49 mmHg for the loudest /a/. For brass instrument play, the intratracheal pressures varied from 14 mmHg for the softest tone to 48 mmHg for the loudest tone. Imaging confirmed earlier findings that the neoglottis is closing and vibrating during voicing and remains 'open' without vibrations during music play, indicating good neoglottis control and innervation. From these objective measurements, we can conclude that trachea pressures during brass instrument play are within physiological ranges for tracheoesophageal voicing with a low-pressure indwelling voice-prosthesis. Furthermore, it was shown that application of a stable baseplate for retaining an automatic speaking valve and an additional customisable 'neck brace' makes bimanual play possible again. PMID:26246666

  8. Thoracoscopic repair of esophageal atresia with a distal fistula – lessons from the first 10 operations

    PubMed Central

    Zaborowska, Kamila; Rogowski, Błażej; Kalińska, Anita; Nosek, Marzena; Golonka, Anna; Lesiuk, Witold; Obel, Marcin

    2015-01-01

    Introduction Thoracoscopic esophageal atresia (EA) repair was first performed in 1999, but still the technique is treated as one of the most complex pediatric surgical procedures. Aim The study presents a single-center experience and learning curve of thoracoscopic repair of esophageal atresia and tracheo-esophageal (distal) fistula. Material and methods From 2012 to 2014, 10 consecutive patients with esophageal atresia and tracheo-esophageal fistula were treated thoracoscopically in our center. There were 8 girls and 2 boys. Mean gestational age was 36.5 weeks and mean weight was 2230 g. Four children had associated anomalies. The surgery was performed after stabilization of the patient between the first and fourth day after birth. Five patients required intubation before surgery for respiratory distress. Bronchoscopy was not performed before the operation. Results In 8 patients, the endoscopic approach was successfully used thoracoscopically, while in 2 patients conversion to an open thoracotomy was necessary. In all patients except 1, the anastomosis was patent, with no evidence of leak. One patient demonstrated a leak, which did not resolve spontaneously, necessitating surgical repair. In long-term follow-up, 1 patient required esophageal dilatation of the anastomosis. All patients are on full oral feeding. Conclusions The endoscopic approach is the method of choice for the treatment of esophageal atresia in our center because of excellent visualization and precise atraumatic preparation even in neonates below a weight of 2000 g. PMID:25960794

  9. Aerodynamic characteristics associated with oesophageal and tracheoesophageal speech of Cantonese.

    PubMed

    Ng, Manwa L

    2011-04-01

    The present study investigated the aerodynamic differences between standard oesophageal (SE) and tracheoesophageal (TE) speech. Airflow and air pressure values below the pharyngoesophageal segment were obtained from 10 SE and 12 TE superior speakers of Cantonese. Airflow data were directly measured from sustained vowels, and sub-pharyngoesophageal segment pressure was estimated from /ip(h)ip(h)i/ syllables produced by the alaryngeal speakers. Results indicated that SE speech was associated with a lower rate of airflow and a higher pressure below the pharyngoesophageal segment than TE speech. SE and TE speakers exhibited an average airflow and sub-pharyngoesophageal segment pressure values of 70.50 mL/s and 134.15 mL/s, and 25.13 cm H(2)O and 22.61 cm H(2)O, respectively. Using the airflow and sub-pharyngoesophageal segment pressure, neoglottal resistance values were derived. The estimated neoglottal resistance was greater in SE speakers than in TE speakers. It is speculated that such difference in neoglottal resistance may be related to the use of different air reservoir mechanisms between SE and TE speakers. Such information will help speech-language pathologists design better speech therapy regimes for SE and TE speakers by understanding more about the difference between SE and TE phonation. PMID:21480810

  10. Repair of tracheo-oesophageal fistula.

    PubMed

    Muniappan, Ashok; Mathisen, Douglas J

    2016-01-01

    Acquired non-malignant tracheo-oesophageal fistula (TOF) most commonly develops after prolonged intubation or tracheostomy. It may also develop after trauma, oesophagectomy, laryngectomy and other disparate conditions. TOF leads to respiratory compromise secondary to chronic aspiration and pulmonary sepsis. Difficulty with oral intake usually leads to nutritional compromise. After diagnosis, the goals are to eliminate or reduce ongoing pulmonary contamination and to restore proper nutrition. Operative repair of benign TOF is generally performed through a cervical approach. The majority of patients require tracheal resection and reconstruction to address concomitant tracheal or laryngotracheal stenosis. Muscle flap interposition between tracheal and oesophageal repairs reduces the risk of fistula recurrence. Operative repair of the fistula is associated with generally good outcomes with a minimal risk of mortality. PMID:26933202

  11. Spontaneous aortocaval fistula.

    PubMed

    Rajmohan, B

    2002-01-01

    Spontaneous aortocaval fistula is rare, occurring only in 4% of all ruptured abdominal aortic aneurysms. The physical signs can be missed but the presence of low back pain, palpable abdominal aortic aneurysm, machinery abdominal murmur and high-output cardiac failure unresponsive to medical treatment should raise the suspicion. Pre-operative diagnosis is crucial, as adequate preparation has to be made for the massive bleeding expected at operation. Successful treatment depends on management of perioperative haemodynamics, control of bleeding from the fistula and prevention of deep vein thrombosis and pulmonary embolism. Surgical repair of an aortocaval fistula is now standardised--repair of the fistula from within the aneurysm (endoaneurysmorraphy) followed by prosthetic graft replacement of the aneurysm. A case report of a 77-year-old woman, initially suspected to have unstable angina but subsequently diagnosed to have an aortocaval fistula and surgically treated successfully, is presented along with a review of literature. PMID:12432197

  12. Improving arteriovenous fistula cannulation skills.

    PubMed

    Ball, Lynda K

    2005-01-01

    Cannulation of arteriovenous fistulae is technically more challenging than cannulation of arteriovenous grafts. With the advent of the National Vascular Improvement Initiative, Fistula First, the United States has seen an increase in the number of arteriovenous fistulae. The problem we now face is how to refocus and reeducate nurses to the intricacies of arteriovenous fistula cannulation. Through evidenced-based practice and current best-demonstrated practices, this article will provide the tools needed to improve arteriovenous fistulae cannulation skills. PMID:16425809

  13. Acoustic Analysis of the Voiced-Voiceless Distinction in Dutch Tracheoesophageal Speech

    ERIC Educational Resources Information Center

    Jongmans, Petra; Wempe, Ton G.; van Tinteren, Harm; Hilgers, Frans J. M.; Pols, Louis C. W.; van As-Brooks, Corina J.

    2010-01-01

    Purpose: Confusions between voiced and voiceless plosives and voiced and voiceless fricatives are common in Dutch tracheoesophageal (TE) speech. This study investigates (a) which acoustic measures are found to convey a correct voicing contrast in TE speech and (b) whether different measures are found in TE speech than in normal laryngeal (NL)…

  14. Voice Onset Time Characteristics of Esophageal, Tracheoesophageal, and Laryngeal Speech of Cantonese

    ERIC Educational Resources Information Center

    Ng, Manwa L.; Wong, Juliana

    2009-01-01

    Purpose: To investigate the ability of standard esophageal (SE) and tracheoesophageal (TE) speakers of Cantonese to differentiate between aspirated and unaspirated stops produced at 3 places of articulation were investigated. Method: Six Cantonese stops, /p, t, k, p[superscript h], t[superscript h], k[superscript h]/, followed by the vowel /a/…

  15. Fundamental Frequency and Gender Identification in Standard Esophageal and Tracheoesophageal Speakers

    ERIC Educational Resources Information Center

    Bellandese, Mary H.

    2009-01-01

    The purpose of this study was to determine if there was a relationship between fundamental frequency (Fo) and gender identification in standard esophageal (ES) or tracheoesophageal (TE) speakers. Twenty-three male and 20 female ES and TE speakers participated in this study. Recordings of these speakers reading the Rainbow Passage were played to 48…

  16. AB193. Rectourethral fistula

    PubMed Central

    Jiang, Hai

    2016-01-01

    Objective To investigate the treatment of rectourethral fistula. Methods Eleven cases of male patients with rectourethral fistula were treated in our department from 2011 to 2015. Age 16–66 years old. Causes: three cases of patients with congenital closed anus, four cases of traumatic pelvic fracture with urethral distraction and rectum injury, four cases after radical prostatectomy. The size of the fistula was 0.5–1.5 cm. In addition to the leakage of urine in the large fistula, urine mixed with stool samples. Three patients with congenital closed anal postoperative patients with posterior or anterior median sagittal approach for resection of the fistula, hierarchical closed urethral and rectal wall defect, at least three layer (between the urethral and rectal suture layer), indwelling catheter for 3–4 weeks, no cystostomy. Sigmoid colostomy underwent prior to the surgery. Of which six cases were repaired by perineal approach, one case by abdominal perineal approach, one case by abdominal repair. According to size of fistula and the surrounding scar decide whether or not to adopt tissue interposition, this group of five cases with gracilis muscle flap, one case with bulbocavernosus muscle flap interposed between the rectum and urethra; one case repaired by sigmoid colon pull-through procedure. Post-operation indwelling catheterization for 3–4 weeks with cystostomy. Results A total of 10 patients were successful, and no leakage of urine was found after removal of the catheter. One patient improved, occasionally a small amount of drops of urine voiding from anus. Reoperation was successful after 6 months. Recovered enteric continuity 3–6 months post-operation. Conclusions The median sagittal approach provide good exposure for the repair of congenital rectourethral fistula; perineal approach is a good choice for patients caused by trauma or surgery; complete resection of scar around the fistula, tension-free anastomosis, tissue interposition and sigmoid

  17. Congenital parotid fistula.

    PubMed

    Natasha, Shiggaon

    2014-01-01

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

  18. Labyrinthine fistulae: a retrospective analysis.

    PubMed

    Vanclooster, C; Debruyne, F; Vantrappen, G; Desloovere, C; Feenstra, L

    1997-01-01

    A retrospective analysis has been conducted of 57 labyrinthine fistulae found in 375 cholesteatoma cases, primarily treated by removal of the matrix of the cholesteatoma and covering the fistula with a mixture of bone paste and fibrin glue. CT-scan with slices of 1 mm demonstrated the fistula in almost 90% of the cases. Eighteen percent of the ears were pre-operatively totally deaf. Large fistulae are riskier than smaller ones for post-operative perceptive losses, but even in very large and multiple fistulae the hearing may be preserved in most cases. PMID:9241379

  19. Rectourethral Fistula Management.

    PubMed

    Ramírez-Martín, Daniel; Jara-Rascón, José; Renedo-Villar, Teresa; Hernández-Fernández, Carlos; Lledó-García, Enrique

    2016-03-01

    Rectourethral fistula (RUF) is a rare condition that occurs, in most cases, as a consequence of prostate cancer treatments. Clinical suspicion and proper assessment prior to surgery are essential to adapt and successfully carry out an appropriate treatment plan. There are no randomized trials to guide clinical practice, and therefore, scientific evidence in this respect is limited. Expert recommendations seem to agree on the transperineal approach with flap interposition as the surgical treatment of choice in cases of complex fistulas, especially in those that have undergone prior radiation. Undoubtedly, the key to the successful treatment of the disease is the multidisciplinary and standardized management by physicians with experience in the field. PMID:26874534

  20. Rectovaginal fistula in Crohn's disease.

    PubMed

    Cohen, J L; Stricker, J W; Schoetz, D J; Coller, J A; Veidenheimer, M C

    1989-10-01

    Rectovaginal fistulas in the setting of Crohn's disease present a difficult management dilemma. Some patients with this problem require proctocolectomy, yet other patients with minimal symptoms never require an operation for treatment of the rectovaginal fistula. For a small percentage of patients, local surgical repair of the fistula may be warranted. Since 1980, this study has attempted local repair in seven patients with symptomatic rectovaginal fistulas from Crohn's disease. Five patients underwent staged repair of the fistula. Closure of the colostomy was eventually possible in three of these patients. Two of the three patients have had no evidence of recurrence at followup in excess of two years. The third patient required an ileostomy for intestinal disease and had no recurrence of the fistula. Two patients underwent primary repair of the rectovaginal fistula without fecal diversion; in one of these patients, the fistula recurred ten days after operation, necessitating a diverting ileostomy. The other patient remains cured 26 months after repair. The results of this review indicate that in the setting of quiescent rectal disease, an attempt to repair the fistula can be expected to have a reasonable chance of success. The presence of a rectovaginal fistula in a patient with Crohn's disease does not mandate removal of the rectum. PMID:2791765

  1. Embolization of Brain Aneurysms and Fistulas

    MedlinePlus

    ... Professions Site Index A-Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms ... Aneurysms and Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous ...

  2. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  3. Deterioration of the Provox silicone tracheoesophageal voice prosthesis: microbial aspects and structural changes.

    PubMed

    van Weissenbruch, R; Albers, F W; Bouckaert, S; Nelis, H J; Criel, G; Remon, J P; Sulter, A M

    1997-05-01

    Device life of tracheoesophageal voice prostheses is limited due to deterioration of the polymers. A group of 55 postlaryngectomy patients fitted with a Provox voice prosthesis have been studied prospectively during 6 months. Thirty-seven prostheses were replaced due to a dysfunctional valve mechanism. Although colonization with Candida species was highly associated with destruction of the silicone material, other upper respiratory tract commensals, e.g. Staphylococcus aureus, were also demonstrated. Electron microscopy of the contaminated devices showed colonization and disruption of the silicone material by penetrating yeast hyphae. During the study a remarkable increase of intratracheal phonatory pressures was assessed with progressive colonization of the prostheses. PMID:9199534

  4. Modern management of anal fistula

    PubMed Central

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

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

  5. Modern management of anal fistula.

    PubMed

    Limura, Elsa; Giordano, Pasquale

    2015-01-01

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

  6. Congenital Median Upper Lip Fistula

    PubMed Central

    al Aithan, Bandar

    2012-01-01

    Congenital median upper lip fistula (MULF) is an extremely rare condition resulting from abnormal fusion of embryologic structures. We present a new case of congenital medial upper lip fistula located in the midline of the philtrum of a 6 year old girl. PMID:22953305

  7. Treatment of an Iatrogenic Left Internal Mammary Artery to Pulmonary Artery Fistula with a Bovine Pericardium Covered Stent

    SciTech Connect

    Heper, Gulumser Barcin, Cem; Iyisoy, Atila; Tore, Hasan F.

    2006-10-15

    We report a case with an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary bypass surgery treated with a bovine pericardium covered stent. We also reviewed similar cases reported previously.

  8. Laparoscopic management of cholecystocolic fistula

    PubMed Central

    CONDE, Lauro Massaud; TAVARES, Pedro Monnerat; QUINTES, Jorge Luiz Delduque; CHERMONT, Ronny Queiroz; PEREZ, Mario Castro Alvarez

    2014-01-01

    Introduction Cholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy. Aim To describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments. Technique After dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery. Conclusion Laparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy. PMID:25626940

  9. Contemporary review: Impact of primary neopharyngoplasty on acoustic characteristics of alaryngeal tracheoesophageal voice.

    PubMed

    Albirmawy, Osama A; Elsheikh, Mohamed N; Silver, Carl E; Rinaldo, Alessandra; Ferlito, Alfio

    2012-02-01

    The physiology of the vibratory mechanism in alaryngeal tracheoesophageal speech depends on several factors. The structure and resulting function of the neoglottis (or neopharynx) varies from patient to patient depending on the individual details of the surgical procedure performed, as well as the patient's anatomy. In general, the vibratory segment is a blending of the pharyngeal constrictor muscles, cricopharyngeus, and upper circular fibers of the esophagus. Limited ability to visualize dynamically these three-dimensional structures during rapid events of voice and speech production impedes complete understanding of the vibratory function of the neopharynx. Acoustic studies have elucidated some general characteristics of the pharyngoesophagus and neoglottic vibratory mechanism in the laryngectomized population. A critical degree of tonicity is necessary for apposition of mucosal surfaces in the production of tracheoesophageal voice. Deficiencies in the vibratory segment can usually be managed with various surgical procedures (neopharyngoplasty), resulting in reduced intraesophageal pressure and corresponding increase in fluent, intelligible, effortless speech. The acoustic measures, when correlated with neopharyngoplasty variables, produce many significant associations. Some of them are paramount and deserve further attention. PMID:22258890

  10. Bronchobiliary fistula: a case report

    PubMed Central

    Fischer, James D.

    1998-01-01

    Fewer than 20 cases of bronchobiliary fistula have been reported in the literature. In this report a newborn female infant was referred for investigation of gastroesophageal reflux. Upper gastrointestinal endoscopy and 24-hour pH monitoring revealed severe reflux. A fundoplication was carried out. In the immediate postoperative period bile was noticed coming from the endotracheal tube. Bronchoscopy revealed an abnormal opening just to the left of the carina. Fistulography and HIDA scanning confirmed the presence of a bronchobiliary fistula. A right thoracotomy was used to divide the fistula. The child made an uncomplicated recovery. Pathological examination of the excised specimen demonstrated tissue most consistent with an esophageal origin. PMID:9854540

  11. Operative considerations for rectovaginal fistulas

    PubMed Central

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

    2015-01-01

    To describe the etiology, anatomy and pathophysiology of rectovaginal fistulas (RVFs); and to describe a systematic surgical approach to help achieve optimal outcomes. A current review of the literature was performed to identify the most up-to-date techniques and outcomes for repair of RVFs. RVFs present a difficult problem that is frustrating for patients and surgeons alike. Multiple trips to the operating room are generally needed to resolve the fistula, and the recurrence rate approaches 40% when considering all of the surgical options. At present, surgical options range from collagen plugs and endorectal advancement flaps to sphincter repairs or resection with colo-anal reconstruction. There are general principles that will allow the best chance for resolution of the fistula with the least morbidity to the patient. These principles include: resolving the sepsis, identifying the anatomy, starting with least invasive surgical options, and interposing healthy tissue for complex or recurrent fistulas. PMID:26328032

  12. [Clinical study of enterovesical fistulas].

    PubMed

    Atsuta, Takeshi; Magaribuchi, Toshihiro; Takao, Noriyasu; Shirahase, Toshiaki; Taki, Yoji; Takeuchi, Hideo

    2014-08-01

    We conducted a retrospective review of 16 patients who were diagnosed with enterovesical fistula in our hospital between January 2000 and July 2013. The patient's median age was 74 years old and 4 were female. Most of the chief complaints were pneumaturia and fecaluria. There was a vesicosigmoidal fistula in 12 patients, an ileovesical fistula in 2, and a rectovesical fistula in 2. The main underlying cause was diverticulitis in 9 patients and a sigmoid colon carcinoma in 3. Diagnoses were made based on the findings of cystoscopy, barium enema, abdominal computed tomography and so on. Treatment varied in each case depending on the etiology and the patient's condition. The procedure was mostly open surgery, but laparoscopic sigmoidectomy was performed preserving the bladder in the two most recent cases. PMID:25179986

  13. Imaging of acquired coronary diseases: From children to adults.

    PubMed

    Dehaene, A; Jacquier, A; Falque, C; Gorincour, G; Gaubert, J Y

    2016-05-01

    Acquired coronary diseases include aneurysms, fistulae, dissections, and stenosis. Aneurysms may occur secondarily to Kawasaki disease, a childhood vasculitis, the prognosis of which depends on the coronary involvement, or they may be degenerative, infectious, inflammatory, or traumatic in origin. Fistulae develop between the coronary arterial system and a pulmonary or bronchial artery, or cardiac cavity. Dissections may occur spontaneously or may be post-traumatic. These coronary abnormalities may be found incidentally or may present as complications, infarction or rupture. The goals of this article are to understand acquired childhood and adult coronary diseases and their usual means of presentation, the ways of investigating them, and the principles of their treatment. PMID:27130480

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

    PubMed Central

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

    2016-01-01

    Perianal fistula formation is a rare complication in children after rectal biopsy. Perianal fistula may become difficult to treat; therefore a lot of surgical options are present. One of these options is video assisted anal fistula treatment (VAAFT). We present a 6-year-old female who developed perianal fistula following rectal biopsy for which VAAFT was done successfully. PMID:26816676

  15. Congenital urethrocutaneous fistula in an adolescent male

    PubMed Central

    Kale, Satish M.; Mody, Nikunj B.; Patil, Surendra B.; Sadawarte, Pranam

    2015-01-01

    A urethrocutaneous fistula is a common complication after hypospadias repair, but congenital fistula is a rare anomaly. We present a 16-year-old boy with this unusual anomaly. Its etiology, embryology, and management are discussed in brief. PMID:26424989

  16. [Advances on endoscopic treatment of intestinal fistulas].

    PubMed

    Wu, X W; Ren, J A; Li, J S

    2016-03-01

    Intestinal fistulas are severe complications after abdominal surgical procedures. The endoscopic therapy makes it possible to close fistulas without surgical interventions. When patients achieved stabilization and had no signs of systemic sepsis or inflammation, these therapies could be conducted, which included endoscopic vacuum therapy, fibrin glue sealing, stents, fistula plug, suture, and Over The Scope Clip (OTSC). Various techniques may be combined. Endoscopy vacuum therapy could be applied to control systemic inflammation and prevent continuing septic contamination by active drainage. Endoscopic stent is placed over fistulas and gastrointestinal continuity is recovered. The glue sealing is applied for enterocutaneous fistulas, and endoscopy suture has the best results seen in fistulas <1 cm in diameter. Insertion of the fistula plug is used to facilitate fistula healing. The OTSC is effective to treat leaks with large defects. Endoscopic treatment could avoid reoperation and could be regarded as the first-line treatment for specific patients. PMID:26932894

  17. Frequent Hemodialysis Fistula Infectious Complications

    PubMed Central

    Lok, Charmaine E.; Sontrop, Jessica M.; Faratro, Rose; Chan, Christopher T.; Zimmerman, Deborah Lynn

    2014-01-01

    Background Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation. Methods Data were prospectively collected from 631 patients dialyzed with a fistula from 2001 to 2010 (Toronto and Ottawa, Canada). We compared the person-time incidence rate of bacteremia and local fistula infections using the exact binomial test. Results Forty-six (7.3%) patients received SDH (≥5 sessions/week, 2-4 h/session), 128 (20.3%) NHD (≥4 sessions/week, ≥5 h/session) and 457 (72%) CIHD (3 sessions/week, ≤4 h/session). Fifty percent of SDH and 72% of NHD patients used the buttonhole technique. There were 39 buttonhole-related bacteremias (rate: 0.196/1,000 fistula days) and at least 2 local buttonhole site infections. Staphylococcus aureus accounted for 85% of the bacteremias. There were 5 (13%) infection-related hospitalizations and 3 (10%) serious metastatic infections, including fistula loss. In comparison, there was 1 possible fistula-related infection in CIHD during follow-up (rate: 0.002/1,000 fistula days). Conclusions The rate of buttonhole-related infections was high among patients on frequent hemodialysis and more than 50 times greater than that among patients on CIHD with the stepladder technique. Most bacteremias were due to S. aureus – with serious consequences. The risks and benefits of buttonhole cannulation require individual consideration with careful monitoring, prophylaxis and management. PMID:25473405

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

    PubMed

    Aydinova, P R; Aliyev, E A

    2015-05-01

    Results of surgical treatment of 21 patients, suffering high transsphincteric and extrasphincteric rectal fistulas, were studied. In patients of Group I the fistula passage was closed, using fistula plug obturator; and in patients of Group II--by the same, but preprocessed by fibrin adhesive. The fistula aperture germeticity, prophylaxis of rude cicatrices development in operative wound zone, promotion of better fixation of bioplastic material were guaranteed, using fistula plug obturator with preprocessing, using fibrin adhesive. PMID:26419026

  19. Gastrocolic Fistula: A Shortcut through the Gut

    PubMed Central

    Forbes, Nauzer; Al-Dabbagh, Raed; Lovrics, Peter; Morgan, David

    2016-01-01

    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.

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

    PubMed

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

    2007-11-01

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

  1. Embolotherapy of an Arterioportal Fistula

    SciTech Connect

    Chen, Qi Tack, Carl; Morcos, Morcos; Ruggiero, Mary Ann; Schlossberg, Peter; Fogel, Joshua; Weng Lijun; Farkas, Jeffrey

    2007-09-15

    We present a complex case of a splanchnic arterioportal vein fistula in a patient who presented with weight loss, abdominal pain, diarrhea, and pancreatitis. We report successful use of the Guglielmi Detachable Coil (GDC) and N-butyl cyanoacrylate glue for the therapeutic embolization of the fistula between the superior mesenteric artery, the common hepatic artery, and the portal vein. On the day following the procedure, the patient reported total remission of the abdominal pain and diarrhea. These results were maintained at 3 months follow-up.

  2. Acquired hyperpigmentations*

    PubMed Central

    Cestari, Tania Ferreira; Dantas, Lia Pinheiro; Boza, Juliana Catucci

    2014-01-01

    Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all dermatological consultations in our country. They can be congenital, with different patterns of inheritance, or acquired in consequence of skin problems, systemic diseases or secondary to environmental factors. The vast majority of them are linked to alterations on the pigment melanin, induced by different mechanisms. This review will focus on the major acquired hyperpigmentations associated with increased melanin, reviewing their mechanisms of action and possible preventive measures. Particularly prominent aspects of diagnosis and therapy will be emphasized, with focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation, dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis nigricans, cutaneous amyloidosis and reticulated confluent dermatitis PMID:24626644

  3. New technique for the management of vesicorectal fistulas

    SciTech Connect

    Leifer, G.; Jacobs, W.H.

    1988-08-01

    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.

  4. In vitro leakage susceptibility of tracheoesophageal shunt prostheses in the absence and presence of a biofilm.

    PubMed

    Oosterhof, Janine J H; van der Mei, Henny C; Busscher, Henk J; Free, Rolien H; Kaper, Hans J; van Weissenbruch, Ranny; Albers, Frans W J

    2005-04-01

    Although leakage through a tracheoesophageal shunt prosthesis is the main cause of prosthesis failure in a laryngectomy patient, this has never been the subject of in vitro evaluation. The aim of this study was to compare three commercially available voice prostheses by comparison of their in vitro leakage patterns, in absence or presence of a biofilm. To compare in vitro leakage patterns, a model comprised of an artificial throat equipped with a single prosthesis coupled to a water reservoir was developed. By varying the height of the water reservoir, different pressures on the voice prosthesis can be obtained. Both in absence and presence of a biofilm, the Blom Singer voice prosthesis demonstrated the lowest leakage, followed by Groningen Low Resistance. The Provox2 showed significantly the most leakage, however, in presence of a biofilm the leakage of the Provox2 significantly decreased. Regular airflow during biofilm formation significantly increased leakage through the Provox2. Out of 746 clinical replacements, Provox2 showed 76% and Groningen Low Resistance 57% replacements due to leakage. The model used in this study showed significant differences in leakage of the three types of voice prostheses used. Leakage occurred more readily through Provox2 than through Groningen Low Resistance and Blom Singer prostheses, which is in line with clinical observations and enforces the model. PMID:15660395

  5. Enlarged Tracheoesophageal Puncture after Total Laryngectomy: A Systematic Review and Meta-Analysis

    PubMed Central

    Hutcheson, Katherine A.; Lewin, Jan S.; Sturgis, Erich M.; Kapadia, Asha; Risser, Jan

    2014-01-01

    Background Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure. Methods A systematic review was conducted (1978–2008). A summary risk estimate was calculated using a random-effects meta-analysis model. Results Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP- site injections were the most commonly reported conservative treatments. Prosthetic diameter (p =.076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported. Conclusion The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management. PMID:20848420

  6. Management of Complex Perineal Fistula Disease.

    PubMed

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

    2016-06-01

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

  7. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    PubMed

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded. PMID:23404794

  8. German S3-Guideline: Rectovaginal fistula

    PubMed Central

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

    2012-01-01

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

  9. New Techniques for Treating an Anal Fistula

    PubMed Central

    2012-01-01

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

  10. Voice quality and surgical detail in post-laryngectomy tracheoesophageal speakers.

    PubMed

    Jacobi, I; Timmermans, A J; Hilgers, F J M; van den Brekel, M W M

    2016-09-01

    The objective of this study is to assess surgical parameters correlating with voice quality after total laryngectomy (TL) by relating voice and speech outcomes of TL speakers to surgical details. Seventy-six tracheoesophageal patients' voice recordings of running speech and sustained vowel were assessed in terms of voice characteristics. Measurements were related to data retrieved from surgical reports and patient records. In standard TL (sTL), harmonics-to-noise ratio was more favorable after primary TL + postoperative RT than after salvage TL. Pause/breathing time increased when RT preceded TL, after extensive base of tongue resection, and after neck dissections. Fundamental frequency (f0) measures were better after neurectomy. Females showed higher minimum f0 and higher second formants. While voice quality differed widely after sTL, gastric pull-ups and non-circumferential pharyngeal reconstructions using (myo-)cutaneous flaps scored worst in voice and speech measures and the two tubed free flaps best. Formant/resonance measures in/a/indicated differences in pharyngeal lumen properties and cranio-caudal place of the neoglottic bar between pharyngeal reconstructions, and indicate that narrower pharynges and/or more superiorly located neoglottic bars bring with them favorable voice quality. Ranges in functional outcome after TL in the present data, and the effects of treatment and surgical variables such as radiotherapy, neurectomy, neck dissection, and differences between partial or circumferential reconstructions on different aspects of voice and speech underline the importance of these variables for voice quality. Using running speech, next to sustained/a/, renders more reliable results. More balanced data, and better detail in surgical reporting will improve our knowledge on voice quality after TL. PMID:26395116

  11. Outcomes and Adverse Events of Enlarged Tracheoesophageal Puncture after Total Laryngectomy

    PubMed Central

    Hutcheson, Katherine A.; Lewin, Jan S.; Sturgis, Erich M.; Risser, Jan

    2014-01-01

    Objective Enlargement of the tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The primary objective was to summarize control of leakage around the VP after conservative management of enlarged TEP. Study Design Retrospective cohort study. Methods This 5-year cohort included 194 patients who underwent total laryngectomy (± pharyngectomy) and TEP at the University of Texas MD Anderson Cancer Center. Control of leakage around the VP was analyzed at last follow-up after enlarged TEP. Adverse events were compared in patients with and without enlarged TEP. Results The incidence of enlarged TEP was 18.6% (36/194, 95% CI: 13.0%-24.1%). Conservative methods commonly attempted in lieu of complete TEP closure included placement of an enlarged-flange VP (34/36, 94%), temporary VP removal (14/36, 39%), and TEP-site injection (8/36, 22%). At last follow-up, conservative methods controlled leakage around the VP in 81% (29/36) of patients. Only 2 patients required complete TEP closure due to persistent leakage after enlarged TEP. Unresolved leakage was more common in patients with recurrent cancer after laryngectomy (p=0.081) and irregular TEP contour (p=0.003). Relative to controls without TEP enlargement, patients with enlarged TEP had 3-fold higher risk of pneumonia (RR: 3.4, 95% CI: 1.9-6.2) and aspiration of the prosthesis (RR: 3.3, 95% CI: 0.8-14.1). Conclusions Although the rate of enlarged TEP is relatively low, the complication significantly elevates risk of pneumonia. Prosthetic leakage related to TEP enlargement can often be managed conservatively to avoid complete closure of the TEP. Level of evidence: 2b PMID:21647906

  12. Perilymph Fistula: Rare but Real

    PubMed Central

    Gleeson, Susan E.; Williams, D. Malcolm

    1989-01-01

    Although perilymph fistula is a rare diagnosis, it is important that family physicians be aware of the signs and symptoms that suggest its presence. When a patient develops sudden loss of hearing and/or vestibular dysfunction after experiencing trauma to the head or ears, after barotrauma, or after performing a vigorous Valsalva manoeuvre, he should be referred promptly to an otolaryngologist for assessment and proper management of the condition. ImagesFigure 1 PMID:21249027

  13. Bilorrhea secondary to bronchobiliary fistula.

    PubMed

    Olivencia-Yurvati, A H; Rollins, Christine

    2014-01-01

    Bronchobiliary fistula (BBF) is a rare condition which occurs most commonly as a complication of hydatid cyst liver disease. The following report describes a patient who presented with biliptysis 6 months following decortication of an empyema that had occurred following partial hepatectomy of a colon cancer metastasis. This is the only case to our knowledge that describes the presentation of a BBF in this context. The patient was diagnosed with BBF and successfully underwent open thoracotomy for fistulectomy and repair. PMID:25058780

  14. Voice restoration following total laryngectomy by tracheoesophageal prosthesis: Effect on patients' quality of life and voice handicap in Jordan

    PubMed Central

    Attieh, Abdelrahim Y; Searl, Jeff; Shahaltough, Nada H; Wreikat, Mahmoud M; Lundy, Donna S

    2008-01-01

    Background Little has been reported about the impact of tracheoesophageal (TE) speech on individuals in the Middle East where the procedure has been gaining in popularity. After total laryngectomy, individuals in Europe and North America have rated their quality of life as being lower than non-laryngectomized individuals. The purpose of this study was to evaluate changes in quality of life and degree of voice handicap reported by laryngectomized speakers from Jordan before and after establishment of TE speech. Methods Twelve male Jordanian laryngectomees completed the University of Michigan Head & Neck Quality of Life instrument and the Voice Handicap Index pre- and post-TE puncture. Results All subjects showed significant improvements in their quality of life following successful prosthetic voice restoration. In addition, voice handicap scores were significantly reduced from pre- to post-TE puncture. Conclusion Tracheoesophageal speech significantly improved the quality of life and limited the voice handicap imposed by total laryngectomy. This method of voice restoration has been used for a number of years in other countries and now appears to be a viable alternative within Jordan. PMID:18373867

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

    PubMed Central

    Teomete, Uygar; Gugol, Rubee Anne; Neville, Holly; Dandin, Ozgur; Young, Ming-Lon

    2016-01-01

    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. PMID:26885434

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

    PubMed

    Teomete, Uygar; Gugol, Rubee Anne; Neville, Holly; Dandin, Ozgur; Young, Ming-Lon

    2016-01-01

    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. PMID:26885434

  17. [Endovascular treatment for dural arteriovenous fistula].

    PubMed

    Miyachi, Shigeru

    2008-08-01

    Intracranial dural arteriovenous fistulas (DAVFs) are acquired abnormal epidural arteriovenous shunts, particularly at the sinus wall. Most of the DAVFs are associated with progressive sinus occlusion. They are located in the cavernous sinus, lateral (transverse-sigmoid) sinus, superior-sagittal sinus, anterior condylar confluence, tentorial sinus, craniocervical junction, and anterior skull base (ethmoidal sinus). The treatment strategy differs based on the etiology and drainage pattern of DAVFs. The most effective treatment for DAVFs at the sinus wall is transvenous embolization (TVE) with coils. The target coil packing is effective if the sinus point is identified. Certain cases that are difficult to approach transvenously are treated with transarterial embolization (TAE) by using liquid materials like such glue. In particular cases with sinus occlusive lesion sinus reconstruction with sinoplasty is effective. The cases with failed or impossible endovascular approach should be treated with surgical interruption of shunts or by radiosurgery. The most frequent complication of TAE is brain and nerve ischemia due to the overembolization or migration, and that in TVE is the bleeding due to obstruction of the drainage route and nerve compression due to overpacking of coils. PMID:18717194

  18. Duodenocaval fistula: case report and literature review

    SciTech Connect

    Rheudasil, J.M.; Chuang, V.P.; Amerson, J.R.

    1988-03-01

    Duodenocaval fistulae are rare but may well be the source of gastrointestinal hemorrhage with associated sepsis in patients undergoing surgery and subsequently receiving radiation to the right upper abdomen. Management of these fistulae may be challenging. Diagnosis usually requires a high index of suspicion, particularly in post irradiated patients.

  19. Idiopathic Aortic Root to Right Atrial Fistula.

    PubMed

    Campisi, Salvatore; Cluzel, Armand; Vola, Marco; Fuzellier, Jean Francois

    2016-06-01

    An aorta to right atrium fistula is rare. We report a case of idiopathic aortic root to right atrial fistula with right heart failure and review the literature. doi: 10.1111/jocs.12751 (J Card Surg 2016;31:373-375). PMID:27109166

  20. Computed tomography demonstration of cholecystogastric fistula.

    PubMed

    Chou, Chung Kuao

    2016-06-01

    Cholecystogastric fistula is a rare complication of chronic cholecystitis or long-standing cholelithiasis. It results from the gradual erosion of the approximated, chronically inflamed wall of the gall bladder and stomach with fistulous tract formation. The present case describes the direct visualization of a cholecystogastric fistula by computed tomography in a patient without prior biliary system complaints. PMID:27257453

  1. Arterio-Ureteric Fistula Following Iliac Angioplasty

    SciTech Connect

    Aarvold, Alexander; Wales, Lucy Papadakos, Nikolaos; Munneke, Graham; Loftus, Ian; Thompson, Matt

    2008-07-15

    Arterio-ureteric fistulae are rare but can be associated with significant morbidity and mortality. We describe a novel case in which an arterio-ureteric fistula occurred as a complication following external iliac artery angioplasty and stenting, in a patient who had undergone previous pelvic surgery, radiotherapy, ureteric stenting, and urinary diversion surgery. Prompt recognition enabled successful endovascular management using a covered stent.

  2. [AORTOENTERIC FISTULA, A POOR PROGNOSIS FINDING].

    PubMed

    Benoit, A; Thai, M; Medart, L; Desiron, Q; Fraipont, V

    2016-05-01

    We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of radiological imaging in parallel with the clinical course. We take this opportunity to write a brief literature review mainly focused on the description and diagnostic modalities of aortoenteric fistulas. PMID:27337841

  3. END-TO-END VERSUS END-TO-SIDE ANASTOMOSIS IN THE TREATMENT OF ESOPHAGEAL ATRESIA OR TRACHEO-ESOPHAGEAL FISTULA

    PubMed Central

    ASKARPOUR, Shahnam; OSTADIAN, Nasrollah; PEYVASTEH, Mehran; ALAVI, Mostafa; JAVAHERIZADEH, Hazhir

    2016-01-01

    Background : Dehiscence of esophageal anastomosis is frequent and there are still controversies which type of anastomosis is preferred to diminish its incidence Aim : To compare end-to-end anastomosis versus end-to-side anastomosis in terms of anastomotic leakage, esophageal stricture and gastroesophageal reflux symptom. Methods : This study was carried out for two year starting from 2012. End-to-side and end-to-side anastomosis were compared in terms of anastomotic leakage, esophageal stricture, gastroesophageal reflux symptom, length of surgery and pack cell infusion. Results : Respectively to end-to-end and end-to-side anastomosis, duration of surgery was 127.63±13.393 minutes and 130.29±10.727 minutes (p=0.353); esophageal stricture was noted in two (5.9%) and eight (21.1%) cases (p=0.09); gastroesophageal reflux disease was detected in six (15.8%) and three (8.8%) cases (p=0.485); anastomotic leakage was found in five (13.2%) and one (2.9%) cases (p=0.203); duration of neonatal intensive care unit admission was significantly shorter in end-to-end (11.05±2.438 day) compared to end-to-side anastomosis (13.88±2.306 day) (p<0.0001). Conclusion : There were no significant differences between end-to-end and end-to-side anastomosis except for length of neonatal intensive care unit admission which was significantly shorter in end-to-end anastomosis group. PMID:27120740

  4. MRI of perianal fistulae: a pictorial kaleidoscope.

    PubMed

    Kumar, N; Agarwal, Y; Chawla, A Singh; Jain, R; Thukral, B Bhushan

    2015-12-01

    Perianal fistulae are an abnormal communication between the anorectum and the perianal skin. A seemingly benign condition, it can be a cause of considerable distress to the patient if it is not mapped out adequately before embarking upon surgical correction. The persistence of residual disease complicates and up-stages the grade of the remnant fistula with increased risk of anal incontinence following surgery secondary to damage to the anal sphincter complex. Magnetic resonance imaging (MRI) can play a critical role in mapping the fistulae tract in relation to the anal sphincter complex and hence, act as a reliable guide for the surgeon to chart the optimised management of perianal fistulae. This review illustrates the role of MRI in the imaging evaluation of perianal fistulae, to facilitate a well-planned surgical course. PMID:26455651

  5. Physiologic assessment of coronary artery fistula

    SciTech Connect

    Gupta, N.C.; Beauvais, J. )

    1991-01-01

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

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

    PubMed Central

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

    2016-01-01

    Introduction Recurrent and complex high fistulas remain a surgical challenge. This paper reports our experience with the anal fistula plug in patients with complex fistulas. Methods Data were collected prospectively and analyzed from consecutive patients undergoing insertion of a fistula plug from January 2011 through April 2014 at Hazrat-e-Rasoul Hospital in Tehran. We ensured that sepsis had been eradicated in all patients prior to placement of the plug. During surgery, a conical shaped collagen plug was pulled through the fistula tract. Results Twelve patients were included in this case study. All patients had previously undergone failed surgical therapy to cure their fistula and had previously-placed Setons. There were eight males and four females with an average age of 44 who were treated for complex fistulas. At a median time of follow-up of 22.7 months, 10 of the 12 patients had healed (83.3%). One patient developed an abscess that was noted on the sixth postoperative day, and there was one recurrence during follow-up. Conclusions Fistula plugs are effective for the long-term closure of complex anal fistulas. Success of treatment with the fistula plug depends on the eradication of sepsis prior to plug placement. PMID:27280009

  7. Tracheoinnominate artery fistula following tracheostomy.

    PubMed

    Keçeligil, H T; Erk, M K; Kolbakir, F; Yildirim, A; Yilman, M; Unal, R

    1995-10-01

    Tracheoinnominate artery fistula is a relatively rare but highly lethal complication occurring in patients with long-standing tracheostomies. Early evaluation of this problem and prompt aggressive therapy are necessary. When massive haemorrhage begins, immediate arterial compression, control of the airway and subsequent treatment of the injured artery may be lifesaving. Immediate surgical exploration through a median sternotomy is necessary to control the proximal and distal innominate artery. After the damaged artery has been excised, vascular reconstruction can be performed to preserve the connection between the proximal and distal ends of the innominate artery. A pedicled pericardial patch was successfully used for the tracheal reconstruction. PMID:8574535

  8. Introducing the operation method for curing anal fistula by laser

    NASA Astrophysics Data System (ADS)

    Ji, Bingzhi

    1993-03-01

    The key to the treatment of anal fistula lies in scavenging the infected anal gland thoroughly, which is the source of anal fistula infection. The fistula tract at the internal orifice of the anal fistula is cut 1 cm using laser with the infectious source completely degenerated and the wound gassified and scanned. The residual distal fistula softens and disappears upon the action of organic fibrinolysin.

  9. Robotic repair of vesicovaginal fistula - initial experience

    PubMed Central

    Jairath, Ankush; Sudharsan, S.B; Mishra, Shashikant; Ganpule, Arvind; Sabnis, Ravindra; Desai, Mahesh

    2016-01-01

    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 cystourethrography

  10. Saphenofemoral arteriovenous fistula as hemodialysis access

    PubMed Central

    2010-01-01

    Background An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. Methods SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. Results Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. Conclusion SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate. PMID:20955561

  11. Endotherapy of leaks and fistula

    PubMed Central

    Goenka, Mahesh Kumar; Goenka, Usha

    2015-01-01

    Perforations, leaks and fistula involving gastrointestinal (GI) tract are increasing encountered in clinical practice. There is a changing paradigm for their management with surgical approach being replaced by conservative approach including endoscopic therapy. Clips (through the scope and over the scope) and covered stent are front runners for endotherapy for GI leaks and fistula. Over the scope clips introduced recently, can treat larger defects compared to through the scope clips. Covered stents are suited for larger defects and those associated with luminal narrowing. However cervical esophagus, gastro-esophageal junction, stomach and right colonic lesions may be better for clip therapy rather than stenting. Recent developments in this field include use of endovac therapy which consists of a sponge with suction device, biodegradable stent, use of fibrin glue and some endo-suturing device. Conservative therapy with no surgical or endoscopic intervention, may be suitable for a small subset of patients. An algorithm based on location, size of defect, associated stricture, infection and available expertise needs to be developed to reduce the mortality and morbidity of this difficult clinical problem. PMID:26140097

  12. TRACHEOSTOMAPLASTY: A SURGICAL METHOD FOR IMPROVING RETENTION OF AN INTRALUMINAL STOMA BUTTON FOR HANDS-FREE TRACHEOESOPHAGEAL SPEECH

    PubMed Central

    Moreno, Mauricio A.; Lewin, Jan S.; Hutcheson, Katherine A.; Bishop Leone, Julie K.; Barringer, Denise A.

    2014-01-01

    Background We describe a minimally invasive surgical technique, tracheostomaplasty, to overcome anatomical deformities of the stoma that preclude successful retention of a stoma button for hands free tracheoesophageal (TE) speech. Methods We conducted a retrospective analysis of 21 patients who underwent tracheostomaplasty after laryngectomy to accommodate an intraluminal valve attachment for hands-free TE speech. Results Sixteen men and 5 women (median age, 65 years; median follow-up, 27.7 months) underwent tracheostomaplasty; 6 patients developed a mild cellulitis that required therapy and 5 patients required a minor revision surgery. At last follow-up, 15 (71%) patients successfully achieved hands-free TE speech using an intraluminal stoma button. Three patients only retained the intraluminal device to facilitate digital occlusion. Tracheostomaplasty failed in 3 patients because of granulation tissue formation or stomal stenosis. Conclusions Tracheostomaplasty is a successful technique to improve intraluminal retention of a stoma button for hands-free TE speech in laryngectomy patients. PMID:20848405

  13. Biofilms on tracheoesophageal voice prostheses: a confocal laser scanning microscopy demonstration of mixed bacterial and yeast biofilms.

    PubMed

    Kania, Romain E; Lamers, Gerda E M; van de Laar, Nicole; Dijkhuizen, Marloes; Lagendijk, Ellen; Huy, Patrice Tran Ba; Herman, Philippe; Hiemstra, Pieter; Grote, Jan J; Frijns, Johan; Bloemberg, Guido V

    2010-07-01

    The aim of this study was to demonstrate the presence of yeast and bacterial biofilms on the surface of tracheoesophageal voice prostheses (TVPs) by a double-staining technique with confocal laser scanning microscopy (CLSM). Biofilms of 12 removed TVPs were visualized by scanning electron microscopy, then stained with ConA-FITC and propidium iodide for CLSM. Microbial identification was by partial 16S rRNA gene analysis and ITS-2 sequence analysis. Microbial biofilms on the TVPs consisted of bacteria and filamentous cells. Bacterial cells were attached to the filamentous and unicellular yeast cells, thus forming a network. Sequence analyses of six voice prostheses identified the presence of a variety of bacterial and yeast species. In vivo studies showed that Klebsiella oxytoca and Micrococcus luteus efficiently attached to Candida albicans. CLSM with double fluorescence staining can be used to demonstrate biofilm formations composed of a mixture of yeast and bacterial cells on the surface of TVPs. PMID:20473799

  14. The changing face of obstetric fistula surgery in Ethiopia

    PubMed Central

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

    2016-01-01

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

  15. [Vesicovaginal fistula in Africa. 230 cases].

    PubMed

    Falandry, L

    1992-02-15

    The author reports 230 cases of vesico-vaginal fistula taken from a series of 271 obstetrical fistulae treated by the same operator. The fistula was obstetrical in most cases (93 percent), occurring in young women and primiparas. Associated lesions (urethro-vaginal, recto-vaginal and perineal) were observed in 23.4 percent of the patients. Also studied were 7 pure urethro-vaginal fistulae and 2 urethro-vesical fistulae. Surgical treatment, usually (85.6 percent) through the lower route, consisted of closing the orifice of the fistula by simple separate sutures performed on the bladder and the vagina (Chassar Moir) in 95 cases. A filler tissue, a muscular and fatty pedicle flap (Martius technique), was used in 55 cases. Complementary techniques were considered indispensable in 49 cases. Eighteen patients underwent palliative surgery. Among 230 fistula patients whose postoperative follow-up ranged from 6 months to 1 year, 180 (80 percent) were considered cured (no incontinence and recovery of mictional function), and 17 were considered partially cured (sphincteral leakage during efforts); there were 29 failures. Far from being eradicated in Africa, vesico-vaginal fistulae continue to be one of the major public health problems, with an average annual prevalence of 2 percent. This critical situation is due to different social, economic, traditional and cultural factors which stay firmly inalterable. There is a need for a fistula management strategy based on a classification of the lesions encountered to increase the chances of success. The author describes the main prognostic and therapeutic groups: simple fistulae where success was obtained as a rule (group I, 33 percent of the cases in this series); difficult fistulae (group II, 43 percent), with the dual problem of attaining watertightness and healing, where the support of a well-vascularized filler tissue has proved necessary (Martius); complex fistulae (group III, 23.9 percent), where the associated lesions call

  16. A Minimally Invasive Approach for Postoperative Pancreatic Fistula

    SciTech Connect

    Yamazaki, Shintaro Kuramoto, Kenmei; Itoh, Yutaka; Watanabe, Yoshika; Ueda, Toshisada

    2003-11-15

    Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.

  17. CT in the diagnosis of enterovesical fistulae

    SciTech Connect

    Goldman, S.M.; Fishman, E.K.; Gatewood, O.M.B.; Jones, B.; Siegelman, S.S.

    1985-06-01

    Enterovesical fistulae are difficult to demonstrate by conventional radiographic methods. Computed tomography (CT), a sensitive, noninvasive method of documenting the presence of such fistulae, is unique in its ability to outline the extravesical component of the primary disease process. Twenty enterovesical fistulae identified by CT were caused by diverticulitis (nine), carcinoma of the rectosigmoid (two), Crohn disease (three), gynecologic tumors (two), bladder cancer (one), cecal carcinoma (one), prostatic neoplasia (one), and appendiceal abscess (one). The CT findings included intravesical air (90%), passage of orally or rectally administered contrast medium into the bladder (20%), focal bladder-wall thickening (90%), thickening of adjacent bowel wall (85%), and an extraluminal mass that often contained air (75%). CT proved to be an important new method in the diagnosis of enterovesical fistulae.

  18. Benign Duodenocolic Fistula: a Case Report.

    PubMed

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

    2015-08-01

    Benign duodenocolic fistula (DCF), known as a fistula between the duodenum and colon with or without cecum of nonmalignant origin, is an unusual complication of different gastrointestinal diseases. The present paper records a case in which the patient presented with chronic diarrhea, abdominal pain, weight loss as well as having a history of gastric ulcer. Most frequently the condition presents with signs of malabsorption such as weight loss and diarrhea, but other symptoms include nausea, vomiting (sometimes with fecal), and abdominal pain. Gastrointestinal inflammatory conditions are the usual causes. The most common ones are perforated duodenal ulcer and Crohn's disease. Barium enemas are usually diagnostic. Treatment consists of excising the fistula and repairing the duodenal and colonic defects. Closure of the fistula provides quick relief. PMID:26545997

  19. Enterocutaneous Fistula: Proven Strategies and Updates.

    PubMed

    Gribovskaja-Rupp, Irena; Melton, Genevieve B

    2016-06-01

    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

  20. Clinical Characteristics of Odontogenic Cutaneous Fistulas

    PubMed Central

    Lee, Eun-Young; Kang, Ji-Yeon; Kim, Kyung-Won; Choi, Ki Hwa; Yoon, Tae Young

    2016-01-01

    Background Odontogenic cutaneous fistula appears as dimpling or a nodule with purulent discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. However, clinical symptoms of facial skin fistula without dental problems can lead to misdiagnosis. Objective The purpose of this study was to investigate the clinical characteristics of patients with odontogenic cutaneous fistulas. Methods This retrospective observational study was performed at Chungbuk National University Hospital by analyzing patients who visited from April 1994 to September 2014. Following clinical and radiographic examinations, the paths and origins of sinus fistulas were determined. Investigated factors were gender, age, morphology, location, originating tooth, time to evolution, recurrence, and treatment method. Results Thirty-three patients (22 males, 11 females; average age 49.2 years) were examined during the investigation period. Thirty-four fistulas were diagnosed as odontogenic cutaneous fistulas. The most common morphology was dimpling (n=14, 41.2%). The various locations observed were related to the originating tooth. The most common site was the mandibular body related to mandibular molars. The referral clinical diagnosis was of odontogenic origin in 6 cases (18.2%). The majority of patients had experienced recurrence after treatment in previous clinics that had failed to diagnose odontogenic cutaneous fistula. Surgical fistulectomy and/or tooth treatment were performed in all cases. All patients were followed-up for 1 year. None showed signs of recurrence. Conclusion Extraoral and dental examinations are required to make a diagnosis of odontogenic cutaneous fistula. Thus, cooperation between dermatologists and dentists is essential. PMID:27489421

  1. Three Distinct Urethral Fistulae 35 Years After Pelvic Radiation

    PubMed Central

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

    2014-01-01

    Introduction: While the development of fistulae is a well-known complication of radiotherapy, such fistulae can often be challenging to manage. Case Presentation: We describe the case of a 37 year old male who developed in succession a urethrocutaneous fistula to the thigh, a rectourethral fistula and a peritoneo-urethral fistula 35 years after radiotherapy for pediatric pelvic rhabdomyosarcoma. These complications were managed successfully after multiple surgical procedures. Discussion: We subsequently discuss the different approaches currently employed for the management of radiation induced urinary fistulas and describe the rationale behind our approach towards their surgical management. PMID:24783170

  2. Hemodynamic Simulations in Dialysis Access Fistulae

    NASA Astrophysics Data System (ADS)

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

    2010-11-01

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

  3. Anorectal conditions: anal fissure and anorectal fistula.

    PubMed

    Fox, Audralan; Tietze, Pamela H; Ramakrishnan, Kalyanakrishnan

    2014-04-01

    Anal fissures are linear splits in the anal mucosa. Acute fissures typically resolve within a few weeks; chronic fissures persist longer than 8 to 12 weeks. Most fissures are posterior and midline and are related to constipation or anal trauma. Painful defecation and rectal bleeding are common symptoms. The diagnosis typically is clinical. High-fiber diet, stool softeners, and medicated ointments relieve symptoms and speed healing of acute fissures but offer limited benefit in chronic fissures. Lateral internal sphincterotomy is the surgical management of choice for chronic and refractory acute fissures. Anorectal fistula is an abnormal tract connecting the anorectal mucosa to the exterior skin. Fistulas typically develop after rupture or drainage of a perianal abscess. Fistulas are classified as simple or complex; low or high; and intersphincteric, transsphincteric, suprasphincteric, or extrasphincteric. Inspection of the perianal area identifies the skin opening, and anoscopy visualizes internal openings. The goal of management is to obliterate the tract and openings with negligible sphincter disruption to minimize incontinence. Fistulotomy is effective for simple fistulas; patients with complex fistulas may require fistulectomy. Other procedures that are used include injection of fibrin glue or insertion of a bioprosthetic plug into the fistula opening. PMID:24742084

  4. Congenital lacrimal fistula: A major review.

    PubMed

    Chaung, Jia Quan; Sundar, Gangadhara; Ali, Mohammad Javed

    2016-08-01

    The purpose of this article is to review and summarize the etiopathogenesis, symptomatology, systemic associations, management, complications and clinical outcomes of congenital lacrimal fistulae. The authors performed an electronic database (PubMed, MEDLINE, EMBASE and Cochrane Library) search of all articles published in English on congenital lacrimal fistulae. Congenital subsets of patients from series of mixed lacrimal fistulae were included in the review. These articles were reviewed along with their relevant cross-references. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. The prevalence of congenital lacrimal fistulae is reported to be around 1 in 2000 live births. They are frequently unilateral, although familial cases tend to be bilateral. Lacrimal and systemic anomalies have been associated with lacrimal fistulae. Exact etiopathogenesis is unknown but mostly believed to be an accessory out budding from the lacrimal drainage system during embryogenesis. Treatment is indicated when significant epiphora or discharge is present and is mostly achieved by various fistulectomy techniques with or without a dacryocystorhinostomy. Congenital lacrimal fistulae are a distinct clinical entity with unique features. Surgical management can be challenging and successful outcomes are usually achieved with widely accepted protocols. PMID:27191932

  5. Modified prosthesis for the treatment of malignant esophagotracheal fistula

    SciTech Connect

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

    1988-04-15

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

  6. Scintimaging of bronchopleural fistula. A simple method of diagnosis

    SciTech Connect

    Lowe, R.E.; Siddiqui, A.R.

    1984-01-01

    A bronchopleural fistula in a patient with empyema was demonstrated by xenon-133 ventilation lung scanning. Because of its ease and simplicity, the ventilation study should be one of the first diagnostic tests performed when bronchopleural fistula is suspected.

  7. Urethrovaginal Fistula in a 5-Year-Old Girl

    PubMed Central

    Coulibaly, Noël; Sangaré, Ibrahima Séga

    2015-01-01

    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

  8. Bilateral pulmonary arteriovenous fistulae treated with balloon embolization.

    PubMed Central

    Kumar, S.; Ruttley, M. J.; Fisher, D. J.

    1986-01-01

    A patient with bilateral pulmonary arteriovenous fistulae is described who was treated successfully by embolization of the two fistulae with detachable balloons introduced percutaneously through the femoral vein. Images Figure 1 Figure 2 Figure 3 PMID:3714608

  9. Chronic utero-rectal fistula with menochezia and amenorrhea.

    PubMed

    Pinto, P; Sharma, L; Kini, P

    1990-09-01

    Utero-intestinal fistulas are commonly acute in nature and usually follow malignancies of the intestines. Here we report a chronic uterorectal fistula with uncommon symptom of cyclical rectal bleeding (menochezia) and amenorrhea. PMID:1974538

  10. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    SciTech Connect

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

    2008-05-15

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

  11. Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement

    SciTech Connect

    Lorenz, Jonathan M.; Zangan, Steven M. Leef, Jeffrey A.; Ha, Thuong G. Van

    2010-04-15

    Stent-graft exclusion of an ischemic, hilar portobiliary fistula after liver transplantation has not been reported. Isolated reports have described peripheral or nonischemic fistulas, and alternative treatment options have ranged from balloon tamponade to surgical repair. We present a unique case of a hilar portobiliary fistula successfully treated to resolution by unilateral placement of a stent-graft.

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

    PubMed

    Noh, Dongsub; Park, Chang-Kwon

    2016-04-01

    Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy. PMID:27066439

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

    PubMed Central

    Noh, Dongsub; Park, Chang-Kwon

    2016-01-01

    Broncho-pleural fistula (BPF) and esophago-pleural fistula (EPF) after pulmonary resection are challenging to manage. BPF is controlled by irrigation and sterilization, but such therapy is not sufficient to promote closure of EPF, which usually requires surgical management. However, it is generally difficult to select an appropriate surgical method for closure of BPF and EPF. Here, we report a case of concomitant BPF and EPF after left completion pneumonectomy, in which both fistulas were closed through a right thoracotomy. PMID:27066439

  14. Congenital urethrovaginal fistula with transverse vaginal septum.

    PubMed

    Amer, Mohamed Ibrahim; Ahmed, Mortada El-Sayed; Ali, Ali Hagag

    2016-08-01

    Congenital urethrovaginal fistula is an extremely rare genitourinary anomaly. Literature search identified only five reported cases, all of which were associated with urogenital abnormalities. Transverse vaginal septum is another rare condition, resulting from abnormalities in the vertical fusion between the vaginal components of the Mullerian ducts and the urogenital sinus; and associated fistulous connection of the vagina with the urethra is even rarer. Herein we describe the case of a 35-year-old woman who presented with dyspareunia, and a 1-year history of infertility, who was found to have a urethrovaginal fistula with low transverse vaginal septum. The patient was successfully treated with excision of the septum and closure of the urethrovaginal fistula. PMID:27170419

  15. Pancreatic Pseudocyst Pleural Fistula in Gallstone Pancreatitis

    PubMed Central

    Abdalla, Sala; Nikolopoulos, Ioannis; Kerwat, Rajab

    2016-01-01

    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. PMID:27274876

  16. Magnetic Resonance Imaging for Perianal Fistula.

    PubMed

    Tolan, Damian J M

    2016-08-01

    Perianal fistulas and other inflammatory diseases of the anus and perianal soft tissues are a cause of substantial morbidity, and are a major part of the practice of any colorectal surgeon. Magnetic resonance imaging (MRI) has a key role in the assessment of patients for the extent of fistulizing Crohn disease, complications related to fistulas, and to assist in confirming the diagnosis or proposing an alternative. Technique is critical and in particular, the selection of sequences for diagnosis and characterization of abnormalities with the main choices being between standard anatomical sequences (T1 or T2), assessing for edema (FS T2 or STIR), assessing abnormal contrast enhancement (FS T1), and assessing for abnormal diffusion or a combination of these. Guidance on MRI sequence selection, classification of fistulas, the current guidance on the role of MRI in assessing patients, and advice on how to provide useful structured reports, as well as how to detect complications of perianal sepsis are included. PMID:27342895

  17. [A vertebral arteriovenous fistula diagnosed by auscultation].

    PubMed

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

    2015-01-01

    Cervical artery fistulas are rare arteriovenous malformations. The etiology of the vertebral arteriovenous fistulas (AVF) can be traumatic or spontaneous. They tend to be asymptomatic or palpation or continuous vibration in the cervical region. An arteriography is necessary for a definitive diagnosis. The treatment is complete embolization of the fistula. We present the case of a two year-old male, where the mother described it «like a washing machine in his head». On palpation during the physical examination, there was a continuous vibration, and a continuous murmur in left cervical region. A vascular malformation in vertebral region was clinically suspected, and confirmed with angio-MRI and arteriography. AVF are rare in childhood. They should be suspected in the presence of noises, palpation or continuous vibration in the cervical region. Early diagnosis can prevent severe complications in asymptomatic children. PMID:24598790

  18. Vascular access for hemodialysis: arteriovenous fistula.

    PubMed

    Malovrh, Marko

    2005-06-01

    The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus. PMID:15966992

  19. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation

    PubMed Central

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

    2015-01-01

    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. PMID:26955353

  20. Endovascular therapy for tracheoinnominate artery fistula: a temporizing measure.

    PubMed

    Wall, L Philipp; Gasparis, Antonios; Criado, Enrique

    2005-01-01

    Tracheoinnominate artery fistula remains an uncommon, highly fatal complication of tracheostomy and peritracheal pathology. Endovascular placement of a covered stent can provide control of the fistula. Depending on the conditions of the trachea and peritracheal tissues, the fistula may heal or the stent may become infected and/or further erode into the trachea. We report on a case of a patient with a tracheoinnominate artery fistula related to peritracheal tumor invasion, radiation therapy, and tracheostomy. The fistula was initially excluded with a covered stent, but a few weeks later hemoptysis recurred secondary to deep tracheal erosion by the covered stent. PMID:15714376

  1. Rectovaginal fistula: a new approach by stapled transanal rectal resection.

    PubMed

    Li Destri, Giovanni; Scilletta, Beniamino; Tomaselli, Tiziana Grazia; Zarbo, Giuseppe

    2008-03-01

    Many surgical procedures have been developed to repair rectovaginal fistulas even if no "procedure of choice" is reported. The authors report a case of relatively uncommon, complex, medium-high post-obstetric rectovaginal fistula without sphincteral lesions and treated with a novel tailored technique. Our innovative surgical management consisted of preparing the neck of the fistula inside the vagina and folding it into the rectum so as to enclose the fistula within two semicontinuous sutures (stapled transanal rectal resection); no fecal diversion was performed. Postoperative follow-up at 9 months showed no recurrence of the fistula. PMID:17899300

  2. Recurrent Colonization of Successively Implanted Tracheoesophageal Vocal Prostheses by a Member of the Fusarium solani Species Complex

    PubMed Central

    Honraet, K.; De Vos, M. M.; Summerbell, R. C.; van Kempen, I.; De Saeger, S.; Vermeersch, H.; Van Peteghem, C.; Nelis, H. J.

    2005-01-01

    Tracheoesophageal vocal prostheses (TVP) in laryngectomized patients commonly deteriorate due to overgrowth by yeasts, particularly Candida species. We describe the first case of colonization of such devices by a member of the Fusarium solani species complex in a patient with a history of glottal carcinoma. Three isolates, from three prostheses, were found morphologically consistent with the traditional picture of F. solani. Ribosomal sequence analysis showed that the isolates belonged to a distinct, as yet apparently unnamed phylogenetic species within the F. solani species complex. This species, one of two distinct genetic types (genotype 2) traditionally considered part of the plant-pathogenic subtaxon Fusarium solani f. sp. radicicola, has not previously been identified as an agent of human or animal disease, although it is closely related to a known etiologic agent of mycetoma, an Acremonium-like species recently renamed Fusarium falciforme. Sequence and multisatellite M13 polymorphism analysis revealed no distinctions among the case isolates. Production of cyclosporine was detected for all three case isolates. PMID:15695678

  3. Endovascular Management of Posttraumatic Arteriovenous Fistulae

    SciTech Connect

    Koshy, Chiramel George Keshava, Shyamkumar Nigudala; Surendrababu, Narayanam R. S.; Moses, Vinu; Stephen, Edwin; Agarwal, Sunil

    2009-09-15

    Surgery is considered to be the treatment of choice for vascular injuries caused by trauma. However, endovascular techniques are emerging as an alternative means of treatment. In this article, we describe three patients with posttraumatic arteriovenous fistulae in different body regions that were managed using endovascular techniques. Each case had its unique set of associated problems requiring innovative methods and a multidisciplinary approach. While the short-term results are encouraging, long-term follow-up of posttraumatic arteriovenous fistulae that have been treated with endovascular techniques is still required.

  4. Choleduodenal fistula with gastric outlet obstruction.

    PubMed

    Dong, Matthew; Guerron, Alfredo Daniel; Morris-Stiff, Gareth; Chalikonda, Sricharan

    2016-01-01

    Bouveret's syndrome, cholecystoduodenal fistula with gastric outlet obstruction secondary to an impacted gallstone, is a rare but serious complication of cholelithiasis. We report the case of a 69-year-old woman who presented with epigastric pain and vomiting in whom cross-sectional imaging revealed a duodenal mass with cholecystoduodenal fistula and pneumobilia. Endoscopic evaluation identified a large gallstone obstructing the pyloric channel. She underwent laparotomy and stone extraction with pyloroplasty, had an unremarkable recovery. She was asymptomatic at 15 months follow-up. PMID:27053537

  5. Laparoscopic repair for vesicouterine fistulae

    PubMed Central

    Maioli, Rafael A.; Macedo, André R. S.; Garcia, André R. L.; de Almeida, Silvio H. M.; Rodrigues, Marco Aurélio Freitas

    2015-01-01

    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. Discussion: Laparoscopy has

  6. Hospital-acquired pneumonia

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/000146.htm Hospital-acquired pneumonia To use the sharing features on this page, please enable JavaScript. Hospital-acquired pneumonia is an infection of the lungs ...

  7. Formation of a vesicovaginal fistula in a pig model

    PubMed Central

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

    2015-01-01

    Objective To establish an animal model of a vesicovaginal fistula that can later be used in the development of new treatment modalities. Materials and methods Six female pigs of Landrace/Yorkshire breed were used. Vesicotomy was performed through open surgery. An standardized incision between the bladder and the vagina was made, and the mucosa between them was sutured together with absorbable sutures. A durometer ureteral stent was introduced into the fistula, secured with sutures to the bladder wall, allowing for the formation of a persistent fistula tract. Six weeks postoperatively cystoscopy was performed to examine the fistula in vivo. Thereafter, the pigs were euthanized with intravenous pentobarbital. Results Two out of four (50%) pigs developed persistent fistulas. No per- or postoperative complications occurred. Conclusion This study indicates that this pig model of vesicovaginal fistula can be an effective and cheap way to create a fistula between the bladder and vagina. PMID:26317081

  8. Management of labyrinthine fistulas in cholesteatoma.

    PubMed

    Vanden Abeele, D; Offeciers, F E

    1993-01-01

    Surgical management of labyrinthine fistulas caused by cholesteatoma remains controversial. In 213 patients with middle ear surgery for cholesteatoma, 18 patients (18 ears-8.5%) presented a labyrinthine fistula. These cases are reviewed in the present paper. Symptoms, audiometry, pre-operative imaging, surgical procedure and results are discussed. In all cases total removal of the pathology was pursued with preservation of cochlear function. A two-stage closed technique was used. During the first stage reconstruction with tympano-ossicular allografts, according to the technique of J. Marquet, was performed. A second look followed one year later. Three ears were deaf pre-operatively. Improvement of bone conduction was observed in more than 50% and hearing preservation in all other cases but one. In one ear total deafness occurred from extensive intralabyrinthine invasion by cholesteatoma, demanding a labyrinthectomy. The hearing was preserved in four cases in which an amputation of a large part of the membranous labyrinth could be observed. Since neither pre-operative clinical examination nor imaging can be relied on to reveal a fistula, the surgeon needs to be prepared for unexpected fistulas. PMID:8213141

  9. Coronary Artery Fistula: Two Rare Cases.

    PubMed

    Wehbe, Mahmoud Sleiman; Vondran, Maximilian; Sauer, Matthias; Mohr, Friedrich-Wilhelm; Schroeter, Thomas

    2015-11-01

    Coronary artery fistula (CAF) is an incidental finding in up to 0.2% of cardiac catheterization studies and is a rare pathologic condition affecting up to 1% of the general population. We report two cases of CAF diagnosed by coronary angiography and managed by surgical ligation, with excellent postoperative outcome. Anatomic location, clinical presentation, investigation, and treatment of CAF are discussed. PMID:26522575

  10. A Balance Test for Chronic Perilymph Fistula

    PubMed Central

    Hornibrook, Jeremy

    2012-01-01

    Perilymph fistula is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semicircular canal from cholesteotoma and the superior canal dehiscence syndrome. First recognized as a complication of stapedectomy, it then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause. Descriptions of “spontanenous” perilymph fistulas with no trauma history followed. It is likely that most perilymph fistula patients have a congential potential weakness of the otic capsule at the round or oval window. The vestibular symptoms have been assumed to be due to endolymphatic hydrops, but there is poor evidence. Their unilateral disequilibrium, nausea, and subtle cognitive problems suggest they are due to otolith disfunction and that these patients have a specific balance abnormality, unlike subjects with unilateral vestibular hypofuction. In this series of twenty patients with a confirmed fistula a logical simplification of Singleton's “eyes-closed turning” test predicted a PLF in twelve with a trauma history. In four no cause was found. In three a prior traumatic event was later recalled, but one patient had concealed it. PMID:23028388

  11. Endovascular Treatment of an Aortobronchial Fistula

    SciTech Connect

    Numan, Fueruezan Arbatli, Harun; Yagan, Naci; Demirsoy, Ergun; Soenmez, Binguer

    2004-01-15

    A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.

  12. CT demonstration of an aortoesophageal fistula.

    PubMed

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

    1987-01-01

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

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

    PubMed Central

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

    2015-01-01

    Background: Magnetic resonance imaging (MRI) is highly accurate for the depiction of both the primary tract of fistula and abscesses, in patients with perianal disease. In addition, MRI can be used to evaluate the activity of fistulas, which is a significant factor for determining the therapeutic strategy. Objectives: This study aimed to determine the usefulness of diffusion-weighted (DW) MRI for assessing activity and visibility of perianal fistula. Patients and Methods: Fifty-three patients with 56 perianal fistulas were included in the current retrospective study. The T2-weighted imaging (T2WI) and DWMRI were performed and apparent diffusion coefficient (ADC) values of fistulas were measured. Fistulas were classified into two groups: only perianal fistulas and fistulas accompanied by abscess. Fistulas were also classified into two groups, based on clinical findings: positive inflammatory activity (PIA) and negative inflammatory activity (NIA). Results: Mean ADC value (mm2/s) of PIA group was significantly lower than that of NIA group, regarding lesions in patients with abscess-associated fistulas (1.371 × 10-3 ± 0.168 × 10-3 vs. 1.586 × 10-3 ± 0.136 × 10-3; P = 0.036). No statistically significant difference was found in mean ADC values between PIA and NIA groups, in patients with only perianal fistulas (P = 0.507). Perianal fistula visibility was greater with combined evaluation of T2WI and DWMRI than with T2WI, for two reviewers (P = 0.046 and P = 0.014). Conclusion: The DWMRI is a useful technique for evaluating activity of fistulas with abscess. Perianal fistula visibility is greater with combined T2WI and DWMRI than T2WI alone. PMID:26715982

  14. Laparoscopic Resection of Chronic Sigmoid Diverticulitis with Fistula

    PubMed Central

    Abbass, Mohammad A.; Tsay, Anna T.

    2013-01-01

    Background and Objectives: 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. Methods: 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. Results: 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. Conclusions: Patients with sigmoid diverticulitis with fistula can be successfully treated with laparoscopic excision, with similar outcomes for patients without fistula. PMID:24398208

  15. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis.

    PubMed

    Zamani, Payman; Kaufman, James; Kinlay, Scott

    2009-11-01

    Arteriovenous fistulae in the arm are commonly used for hemodialysis in end-stage renal disease. Although physiological steal with reverse flow in the artery distal to the fistula is common, hand ischemia or infarction are rare. The ischemic steal syndrome (hand or forearm ischemia) is usually a result of arterial disease proximal or distal to the fistula and/or poor collateral supply to the hand. The diagnosis is primarily clinical; however, markedly reduced digital pressures and pulse volume recordings support the diagnosis. Management requires imaging for focal stenoses or disease in arteries proximal and distal to the fistula from the aorta to the hand. We present a case caused by subclavian artery occlusion that was initially missed due to focusing investigation only on the fistula. We describe the percutaneous treatments and surgical revisions that attempt to restore flow to the hand without compromising the fistula. PMID:19808723

  16. Embolization of a giant arterioportal fistula requiring multiple Amplatzer vascular plugs.

    PubMed

    Ward, Thomas J; Marin, Michael L; Lookstein, Robert A

    2015-12-01

    Arterioportal fistulas (APFs) are rare vascular communications between the mesenteric arterial tree and the portal vein. The causes and presentations of this entity are varied. APFs related to tumor, infection, and trauma have been described. Patients may be asymptomatic or present with hemobilia, portal hypertension, or mesenteric steal syndrome. Small APFs require no intervention, with treatment indicated for large or symptomatic APFs. The treatment has shifted from surgical ligation or hepatic resection to an endovascular-first approach. We describe an endovascular treatment option for the management of an acquired extrahepatic (type 2) APF and present a review of the literature. PMID:24840744

  17. Superior mesenteric arteriovenous fistula embolisation complicated by bowel ischaemia

    PubMed Central

    Hussein, Maher; Issa, Ghada; Muhsen, Shirin; Haydar, Ali

    2013-01-01

    Superior mesenteric arteriovenous fistulas are rare, especially when iatrogenic in origin. Management of these fistulas can be surgical or endovascular. Endovascular embolisation is the preferred modality with a low rate of complications. Among the reported complications, bowel ischaemia is considered an unlikely occurrence. We report a case of a complex iatrogenic arterioportal fistula that was managed by endovascular embolisation and controlled through both its inflow and outflow, and was later complicated by bowel ischaemia. PMID:23682091

  18. Rectovesical Fistula Related to Transurethral Resection of a Bladder Lesion

    PubMed Central

    Topaktaş, Ramazan; Tepeler, Abdulkadir; Kurt, Omer; Erdem, Mehmet Remzi; Armağan, Abdullah; Önol, Şinasi Yavuz

    2011-01-01

    A rectovesical fistula (RVF) is an uncommon complication of urooncologic surgery. Although several RVFs have been reported, our case is the first reported RVF in the literature that iatrogenically occurred after transurethral resection of the bladder. A single-stage primary repair with omental flap interposition without a colostomy was successfully performed because of the persistence of the fistula during followup. After 6 months of followup, no fistula or bladder mass was detected. PMID:21969833

  19. [Obstetric vesicovaginal fistula: reporting two cases in France].

    PubMed

    Labarrère, A; Gueye, A; Ouaki, F; Pires, C; Pierre, F; Fritel, X

    2011-05-01

    Obstetric vesicovaginal fistula is nowadays rare in developed countries. We are reporting two cases of patients with obstetric vesicovaginal fistula that occurred after operative vaginal deliveries performed in a French hospital. Early postpartum symptoms were vaginal urine leakage and infectious syndrome. The fistula has been cured by vaginal surgery one case and combined (laparotomy and vagina surgery) in the other case. Patients were totally healed a few months following the surgery. PMID:21514873

  20. Oophorovesicular-colonic fistula: a rare complication of Crohn's disease.

    PubMed

    Goldberg, S D; Gray, R R; Cadesky, K I; Mackenzie, R L

    1988-11-01

    Salpingitis and vesicular fistulas are rare complications of Crohn's disease. In this report the authors describe a case of oophorovesicular-colonic fistula secondary to Crohn's disease. The patient presented with bleeding from the bladder during menstruation, fecaluria and pneumaturia. A single-stage left salpingo-oophorectomy, sigmoid resection and repair of the fistula were carried out, with complete resolution of symptoms and preservation of fertility potential. PMID:3179852

  1. Acquired reactive perforating collagenosis.

    PubMed

    Basak, P Y; Turkmen, C

    2001-01-01

    Acquired perforating disorder has been recognized as an uncommon distinct dermatosis in which altered collagen is eliminated through the epidermis. Several disorders accompanied by itching and scratching were reported to be associated with reactive perforating collagenosis. A 67-year-old white woman diagnosed as acquired reactive perforating collagenosis with poorly controlled diabetes mellitus and congestive cardiac failure is presented. PMID:11525959

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

    PubMed

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

    2015-10-01

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

  3. [Congenital broncho-biliary fistula: a case report].

    PubMed

    Pérez, Cinthia G; Reusmann, Aixa

    2016-10-01

    Congenital tracheo-or-bronchobiliary fistula or congenital he-patopulmonary fistula is a rare malformation with high morbidity and mortality if the diagnosis is not made early. The tracheo-or-bronchobiliary fistula is a communication between the respiratory (trachea or bronchus) and biliary tract. To date, only 35 cases have been published worldwide. We report a case of a neonate with right pneumonia and bilious fluid in the endotracheal tube. Diagnosis was made using bronchoscopy with fluoroscopy. Videothoracoscopy was used to remove the bronchobiliary fistula. Subsequently, a left he-patectomy with Roux-en-Y biliary-digestive anastomosis was performed as bile ductus hypoplasia was present. PMID:27606661

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

    PubMed

    Rogers, Rebecca G; Jeppson, Peter C

    2016-09-01

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

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

    PubMed

    Allon, Michael; Lok, Charmaine E

    2010-12-01

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

  6. Iliac arterial-enteric fistulas occurring after pelvic irradiation

    SciTech Connect

    Vetto, J.T.; Culp, S.C.; Smythe, T.B.; Chang, A.E.; Sindelar, W.F.; Sugarbaker, P.H.; Heit, H.A.; Giordano, J.M.; Kozloff, L.

    1987-05-01

    Fistulas from the iliac artery to the bowel constitute a condition that is often lethal. Excluding fistulas related to vascular grafts, a review of previously reported cases shows that they are most often due to atherosclerotic iliac aneurysms. Three unusual cases of this condition that occurred after high-dose pelvic irradiation for treatment of cancer are presented; in no case was recurrent tumor evident. These cases suggest that high-dose pelvic irradiation can predispose to the formation of iliac arterial-enteric fistulas, particularly if sepsis or inflammation develops. The definitive surgical management of these fistulas entails bowel resection, arterial ligation, and extra-anatomic bypass.

  7. Laparoscopic repair of iatrogenic vesicovaginal and rectovaginal fistula

    PubMed Central

    Chu, Lei; Wang, Jian-Jun; Li, Li; Tong, Xiao-Wen; Fan, Bo-Zhen; Guo, Yi; Li, Huai-Fang

    2015-01-01

    Objective: To investigate the clinical efficacy of laparoscopic repair of iatrogenic vesicovaginal fistulas (VVF) and rectovaginal fistulas. Methods: Seventeen female patients with iatrogenic fistulas (11 cases of VVF and 6 cases of high rectovaginal fistulas) were included. All patients were hospitalized and underwent laparoscopic fistula repair in our hospital between 2008 and 2012. The mean age of the patients was 44.8 ± 9.1 years. The fistulas and scar tissue were completely excised by laparoscopy, orifices were tension-free closed using absorbable sutures, omental flaps were interposed between the vagina and the bladder or rectum, and drainage was kept after repair. Results: Laparoscopic repair of fistulas was successful in all 17 patients. No complication was found during or after repair. No reoperation was needed after the repair. The operative time was 80.2 ± 30.0 minutes (range 50-140 minutes). The blood loss was 229.4 ± 101.6 ml (range 100-400 ml). The double J catheters were placed in 7 patients and removed 1-2 months after repair. Eight VVF patients underwent cystoscopy 3 months after laparoscopic repair and there were no abnormal findings. The follow-up time was 17.1 ± 6.5 months (range 8-29 months). Conclusion: Laparoscopic repair of VVF and rectovaginal fistulas is a safe and an effective minimally invasive procedure for treatment of iatrogenic fistula. PMID:25932174

  8. Rare dural arteriovenous fistula of the lesser sphenoid wing sinus.

    PubMed

    Khadavi, Nicole M; Mancini, Ronald; Nakra, Tanuj; Tsirbas, Angelo C; Douglas, Raymond S; Goldberg, Robert A; Duckwiler, Gary R

    2009-01-01

    A fistula of the lesser sphenoid wing sinus is a rare dural arteriovenous fistula resulting from a connection between the middle meningeal artery and recipient vein in the sinus of the lesser sphenoid wing. In this report, MRI/magnetic resonance angiography of a 54-year-old man who presented with sudden-onset glaucoma and proptosis revealed a fistula in this anatomic location. Drainage patterns here may account for the absence of serious complications and optimistic prognosis following embolization. Care in diagnosis is required to avoid superfluous procedures, because classic signs of the more common carotid-cavernous fistula are absent. PMID:19966661

  9. c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

    PubMed Central

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

    2014-01-01

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

  10. Management of trachea--innominate artery fistula.

    PubMed

    Ramesh, M; Gazzaniga, A B

    1978-01-01

    The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor. PMID:339003

  11. An unusual case of pancreatic fistula.

    PubMed

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

    2013-01-01

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

  12. An unusual case of pancreatic fistula

    PubMed Central

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

    2013-01-01

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

  13. Tubular Colonic Duplication Presenting as Rectovestibular Fistula

    PubMed Central

    Bendre, Pradnya; D'souza, Flavia; Ramchandra, Mukunda; Nage, Amol; Palse, Nitin

    2015-01-01

    Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in about 15% of all gastrointestinal duplications. Double termination of tubular colonic duplication in the perineum is even more uncommon. We present a case of a Y-shaped tubular colonic duplication which presented with a rectovestibular fistula and a normal anus. Radiological evaluation and initial exploration for sigmoidostomy revealed duplicated colons with a common vascular supply. Endorectal mucosal resection of theduplicated distal segment till the colostomy site with division of the septum of the proximal segment and colostomy closure proved curative without compromise of the continence mechanism. Tubular colonic duplication should always be ruled out when a diagnosis of perineal canal is considered in cases of vestibular fistula alongwith a normal anus. PMID:26473141

  14. Tubular Colonic Duplication Presenting as Rectovestibular Fistula.

    PubMed

    Karkera, Parag J; Bendre, Pradnya; D'souza, Flavia; Ramchandra, Mukunda; Nage, Amol; Palse, Nitin

    2015-09-01

    Complete colonic duplication is a very rare congenital anomaly that may have different presentations according to its location and size. Complete colonic duplication can occur in about 15% of all gastrointestinal duplications. Double termination of tubular colonic duplication in the perineum is even more uncommon. We present a case of a Y-shaped tubular colonic duplication which presented with a rectovestibular fistula and a normal anus. Radiological evaluation and initial exploration for sigmoidostomy revealed duplicated colons with a common vascular supply. Endorectal mucosal resection of theduplicated distal segment till the colostomy site with division of the septum of the proximal segment and colostomy closure proved curative without compromise of the continence mechanism. Tubular colonic duplication should always be ruled out when a diagnosis of perineal canal is considered in cases of vestibular fistula alongwith a normal anus. PMID:26473141

  15. The evolution of viscous flow structures in the esophagus during tracheoesophageal speech

    NASA Astrophysics Data System (ADS)

    Erath, Byron; Hemsing, Frank

    2015-11-01

    A laryngectomy is an invasive surgical procedure whereby the entire larynx is removed, usually as a result of cancer. Removal of the larynx renders conventional voiced speech impossible, with the most common remediation following surgery being tracheoeosphageal (TE) speech. TE speech is produced by inserting a one-way valve to connect the posterior wall of the trachea with the anterior wall of the esophagus. As air is forced up from the lungs it passes through the prosthesis and into the esophagus. The resulting esophageal pressure field incites self-sustained oscillations of the pharyngoesophageal segment (PES), which ultimately produces sound. Unfortunately, the physics of TE speech are not well understood, with up to 50% of individuals unable to produce intelligible sound. This failure can be related to a lack of understanding regarding the esophageal flow field, where all previous scientific investigations have assumed the flow is one-dimensional and steady. An experimental TE speech flow facility was constructed and particle image velocimetry measurements were acquired at the exit of the model prosthesis (entrance of the esophagus). The flow is observed to be highly unsteady, and the formation and propagation of vortical flow structures through the esophageal tract are identified. Observations regarding the influence of the flow dynamics on the esophageal pressure field and its relation to the successful production of TE speech are discussed.

  16. Radiologic evaluation of postoperative gastropericardial fistula

    PubMed Central

    Chen, Jeffrey S.; Hal, Hassan M.; Tappouni, Rafel F.R.

    2015-01-01

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

  17. Transperineal approach to complex rectourinary fistulae

    PubMed Central

    Tran, Henry; Flannigan, Ryan; Rapoport, Daniel

    2015-01-01

    Introduction: We sought to present our experience and outcomes in patients with complex rectourethral fistulae (RUF) treated using the transperineal approach with gracilis muscle flap interposition. Complex RUF was defined as having prior radiation, failed repair attempts, and large size (>2 cm). Methods: A retrospective review identified 10 patients presenting with complex RUF between July 2009 and November 2013. Three were excluded due to large fistula defects managed with urinary diversion. Seven patients met inclusion criteria and underwent reconstruction. Results: Six of 7 patients had prostate cancer, and one patient had colon cancer treated with low anterior resection with adjuvant radiation. The primary modality of prostate cancer therapy was brachytherapy (n=3), external beam radiotherapy (n=2) and radical retropubic prostatectomy (RRP) (n=1). Three patients had salvage cancer therapy, including RRP (n=1), cystoprostatectomy with ileal conduit (n=1), and cryotherapy (n=1). One patient developed RUF post-primary RRP without radiation. Mean fistula size was 2.8cm (2–4 cm). No fistulas recurred at mean follow-up 11.4 months (6–20 months). Three patients have had colostomy reversal, one is pending reversal and three have permanent colostomies. Five patients have stress urinary incontinence, with two managed with one to four pads per day, one managed with a condom catheter, and two waiting for artificial urinary sphincter (AUS). One patient developed a perineal wound infection and one developed a pulmonary embolus treated medically. Conclusion: Complex RUF defects are effectively treated with transperineal repair using gracilis muscle interposition. The procedure has low morbidity and high success. Concomitant stress incontinence and bladder outlet contracture are prevalent in this population and may require ongoing management. PMID:26788240

  18. An unusual presentation of congenital bronchoesophageal fistula.

    PubMed

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

    2004-01-01

    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. PMID:15171538

  19. Treatment of a recurrent parotid fistula and sialocele by controlled internal fistula: a case report.

    PubMed

    Khatun, S; Asaduzzaman, M; Huq, M Z; Sajedeen, M; Rahman, K M; Khatun, M H

    2015-04-01

    A 17 years old male patient presented with continuous flow of clear watery discharge from his right cheek for 14 years following trauma. He had previous history of two surgical interventions but result was not satisfactory. The diagnosis was parotid fistula & sialocele based on clinical examination & investigation. To repair this fistula we entered the sialocele cavity where saliva was accumulated between the superficial fascia & parotid fascia, then one end of feeding tube (5Fr) was placed at the bottom of the cavity and another end was fixed intra-orally to create a controlled fistula. After four weeks the feeding tube removed and a channel was made through which the salivary flow comes out, up to one year follow up resulting a satisfactory outcome. PMID:26007275

  20. Acquired Cystic Kidney Disease

    MedlinePlus

    ... a kidney transplant or blood-filtering treatments called dialysis. The cysts are more likely to develop in people who are on kidney dialysis. The chance of developing acquired cystic kidney disease ...

  1. Hospital-acquired pneumonia

    MedlinePlus

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  2. Rectovaginal Fistula as a Result of Coital Injury.

    PubMed

    Hussain, Khalid; Ibrahim, Taseer; Khan, Misbah; Masood, Jovaria

    2016-01-01

    Rectovaginal fistula following sexual intercourse is rarely reported. It is a social stigma; and without adequate treatment and social support, the patient may end-up in isolation. A thorough knowledge of the problem and management is essential for successful outcome. We report a case of low rectovaginal fistula in a newly married female managed trans-vaginally with prior defunctioning colostomy. PMID:26787035

  3. Xanthogranulomatous pyelonephritis with nephrocutaneous fistula due to Providencia rettgeri infection.

    PubMed

    Lee, Gilho; Hong, Jeong Hee

    2011-07-01

    We describe what is to our knowledge the first case of xanthogranulomatous pyelonephritis combined with nephrocutaneous fistula caused by Providencia rettgeri. Surgical extirpation including nephrectomy and fistulectomy was successfully performed. The strain was identified by 16S rRNA gene sequencing in both renal tissue and pus culture from the fistula. PMID:21459904

  4. Giant left main coronary artery to right atrium fistula

    PubMed Central

    Gualis, Javier; Castaño, Mario; Gómez-Plana, Jesús; Mencía, Pilar; Martín, Carlos; Martínez, Jose M; Alonso, David; De Miguel, Antonio; De Diego, Alejandro

    2010-01-01

    Aneurysmal arterial origin of coronary fistulae is an extremely rare combination. We report a case of a giant left main coronary artery to right atrium fistula in a 48-year-old male. We describe the clinical course and management options.

  5. Postresection bronchopleural fistula: detection by regional ventilation-perfusion studies

    SciTech Connect

    Dixon, C.; Ali, M.K.; Atallah, M.R.; Ewer, M.S.

    1983-04-01

    In three patients, bronchopleural fistula developed after right pneumonectomy for bronchogenic carcinoma. In each instance, radiologic and clinical evidence was inconclusive. Xenon 133 regional ventilation-perfusion studies confirmed the diagnosis of a bronchopleural fistula in both the immediate and late postoperative periods.

  6. Coil Embolization of Arterioportal Fistula That Developed After Partial Gastrectomy

    SciTech Connect

    Ishigami, Kousei; Yoshimitsu, Kengo; Honda, Hiroshi; Kuroiwa, Toshiro; Irie, Hiroyuki; Aibe, Hitoshi; Tajima, Tsuyoshi; Hashizume, Makoto; Masuda, Kouji

    1999-07-15

    A 51-year-old man suffered from bleeding esophageal varices. He had undergone partial gastrectomy for gastric cancer 1 year before. An extrahepatic arterioportal fistula and resultant portal hypertension were found. We successfully performed transarterial embolization of the fistula using stainless steel coils. Portal hypertension improved dramatically. RID='''' ID='''' Correspondence to: K. Ishigami, M.D.

  7. Spontaneous carotid cavernous fistula in Ehlers Danlos syndrome.

    PubMed Central

    Fox, R; Pope, F M; Narcisi, P; Nicholls, A C; Kendall, B E; Hourihan, M D; Compston, D A

    1988-01-01

    A patient is described with Ehlers Danlos syndrome presenting with spontaneous carotid cavernous fistula, in whom there was biochemical evidence for defective type III collagen synthesis. Despite the risks associated with arterial manipulation, the fistula was successfully closed by interventional neuroradiology and the patient has since remained well. This outcome is in contrast with the results in previous reports. Images PMID:3204406

  8. Nonclosure of rectourethral fistula during posterior sagittal anorectoplasty: Our experience

    PubMed Central

    Jadhav, Sudhakar; Raut, Amit; Mandke, Jui; Patil, Santosh; Vora, Ravindra; Kittur, Dinesh

    2013-01-01

    Aim: To study the effect of nonclosure of rectourethral (RU) fistula and to do a comparative analysis of the complications with and without nonclosure of RU fistula during posterior sagittal anorectoplasty (PSARP) in anorectal malformation cases (ARM). Materials and Methods: A total of 68 cases of ARM were included in the study group, of which 34 cases were those in whom RU fistula was not closed (group A) during PSARP. Another 34 successive cases were included in study group B in whom the RU fistula was closed as is conventionally done by using interrupted sutures. Results: Comparatively, group A had none or minimum urological complications as compared to Group B. Conclusion: RU fistula closure is not mandatory during PSARP and nonclosure avoids urological complications. It especially avoids urethral complications, which are 100% preventable. PMID:23599574

  9. Esophageal fistula associated with intracavitary irradiation for esophageal carcinoma

    SciTech Connect

    Hishikawa, Y.; Tanaka, S.; Miura, T.

    1986-05-01

    Fifty-three patients with esophageal carcinoma were treated with high-dose-rate intracavitary irradiation following external irradiation. Ten patients developed esophageal fistula. Perforations were found in the bronchus (four), major vessels (four), pericardium (one), and mediastinum (one). The frequency of fistula occurrence in these patients was not remarkably different from that in 30 other patients treated only with greater than or equal to 50 Gy external irradiation. From the time of the development of esophageal fistula, intracavitary irradiation did not seem to accelerate the development of fistula. The fistulas in our ten patients proved to be associated with tumor, deep ulcer (created before intracavitary irradiation), chemotherapy, infection, and trauma rather than the direct effect of intracavitary irradiation.

  10. Robotic-Assisted Laparoscopic Repair of a Vesicouterine Fistula

    PubMed Central

    Chang-Jackson, Shao-Chun R.; Acholonu, Uchenna C.

    2011-01-01

    Background: 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. Case: 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. Results: Robotic-assisted laparoscopic repair was successfully performed with the patient maintaining continence after surgery. Conclusion: Robotic-assisted laparoscopic repair of vesicouterine fistulas offers a minimally invasive approach to treatment of a complex disease process. PMID:21985720

  11. Arteriovenous fistula of the internal maxillary artery in a child: case report.

    PubMed

    Cluzel, P; Pierot, L; Jason, M; Rose, M; Kieffer, E; Chiras, J

    1992-01-01

    Direct arteriovenous fistulae supplied by the external carotid artery are unusual. Rarely, congenital fistulae have been described involving the head and neck. We describe the first case of congenital internal maxillary arteriovenous fistula in a child. Balloon embolization is currently considered the method of choice for treatment of direct arteriovenous fistula. PMID:1407539

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

    PubMed

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

    2016-08-01

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

  13. The surgical repair of benign tracheo-oesophageal/pharyngeal fistula in patients on mechanical ventilation for severe neurological injuries†.

    PubMed

    Daddi, Niccolò; Tassi, Valentina; Belloni, Gian Piero; Mattioli, Sandro

    2016-04-01

    Acquired benign tracheo-oesophageal or pharyngeal fistulas (TO/PF) in neurological patients who cannot be weaned from mechanical ventilation represent a highly demanding clinical problem. We report on 3 patients on intermittent or continuous mechanical ventilation who successfully underwent tracheal resection and direct repair of the digestive fistula. Postoperative mechanical ventilation was provided through a modified silicone Safe-T-Tube, with which the cranial branch can be occluded with an internal inflatable balloon, inserted through tracheostomy performed at or below the level of the cricoid-tracheal suture line. Since the T prosthesis does not have an external cuff in the distal branch, a trans-tracheal open ventilation (TOV) technique was adopted. All patients, after a period that ranged from 21 h to 38 days from surgery, were restored to spontaneous breath; tracheal and oesophageal sutures healed normally. PMID:26306514

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

    PubMed Central

    Poncyljusz, Wojciech; Pauli, Wojciech

    2012-01-01

    Summary Background: Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors present a patient with liver cirrhosis, in whom percutaneous APF closure facilitated liver transplantation. Case Report: We describe a case of a 50-year-old patient with liver cirrhosis and APF, probably formed as a result of liver biopsy. Due to the presence of a high-flow fistula, which elevated portal hypertension, patient did not qualify for the liver transplantation. Patient was transferred to the interventional radiology department, where the fistula’s vascular supply was endovascularly closed using the Amplatzer occluder. This subsequently enabled the execution of transplantation. Conclusions: Percutaneous closure of APF should be considered a relatively simple and fast-acting tool to facilitate or even enable liver transplant surgery. Currently, there are more and more products available such as e.g. Amplatzer occluder to simplify the procedure and shorten the duration of exposure to ionizing radiation. PMID:23269937

  15. Community-acquired pneumonia.

    PubMed

    Falguera, M; Ramírez, M F

    2015-11-01

    This article not only reviews the essential aspects of community-acquired pneumonia for daily clinical practice, but also highlights the controversial issues and provides the newest available information. Community-acquired pneumonia is considered in a broad sense, without excluding certain variants that, in recent years, a number of authors have managed to delineate, such as healthcare-associated pneumonia. The latter form is nothing more than the same disease that affects more frail patients, with a greater number of risk factors, both sharing an overall common approach. PMID:26186969

  16. Spontaneous closure of a dural arteriovenous fistula

    PubMed Central

    Al-Afif, Shadi; Nakamura, Makoto; Götz, Friedrich; Krauss, Joachim K

    2014-01-01

    Spontaneous closure of a dural arteriovenous fistula (dAVF) is a rare condition and only a few cases have been reported since its first description in 1976. We report delayed and progressive spontaneous closure of a dAVF after massive intracerebral hemorrhage documented by angiographic studies before and after bleeding. To our knowledge, this is the first report to document gradual closure of a dAVF by serial angiographic studies. The mechanism of spontaneous closure of dAVFs has not been fully elucidated. We suggest different factors for consideration from previously published data and show how each of these factors can influence the others. PMID:25053666

  17. Acquired Brain Injury Program.

    ERIC Educational Resources Information Center

    Schwartz, Stacey Hunter

    This paper reviews the Acquired Brain Injury (ABI) Program at Coastline Community College (California). The ABI Program is a two-year, for-credit educational curriculum designed to provide structured cognitive retraining for adults who have sustained an ABI due to traumatic (such as motor vehicle accident or fall) or non-traumatic(such as…

  18. Acquired von Willebrand disease.

    PubMed

    Petrini, P

    1999-05-01

    Acquired von Willebrand disease (AvWD) is a syndrome that has clinical and laboratory features similar to hereditary vWD. In contrast to the latter it occurs in patients without a family history of previous bleeding tendency. PMID:23401904

  19. Endovascular Treatment in Spinal Perimedullary Arteriovenous Fistula

    PubMed Central

    Phadke, Rajendra V; Bhattacharyya, Avik; Handique, Akash; Jain, Krishan; Kumar, Alok; Singh, Vivek; Baruah, Deb; Kumar, Tushant; Patwari, Sriram; Mohan, B.Madan

    2014-01-01

    Summary This study includes 20 patients with 21 spinal perimedullary fistulae. There were nine Type IVa (42.8%) lesions, ten Type IVb (47.6%) and two Type IVc (9.5%) lesions. The dominant arterial supply was from the anterior spinal artery (47.6%), posterior spinal artery (19%) and directly from the radiculomedullary artery (28.5%). Sixteen lesions in 15 patients were treated by endovascular route using n-butyl-2-cyanoacrylate. Endovascular treatment was not feasible in five patients. Of the ten patients with microfistulae, catheterization failed/was not attempted in 40%, complete obliteration of the lesion was seen in 60% but clinical improvement was seen in 40% of patients. Catheterization was feasible in all ten patients with macrofistulae (nine type IVb and two type IVc lesions). Complete obliteration of the lesions was seen in 60% and residue in 30%. Clinical improvement was seen in 80% and clinical deterioration in 10%. In conclusion, endovascular glue embolization is safe and efficacious in type IVb and IVc spinal perimedullary fistulae and should be considered the first option of treatment. It is also feasible in many of the type IVa lesions. PMID:24976100

  20. Cutaneous Bronchobiliary Fistula Treated with Tissucol Sealant

    SciTech Connect

    Prieto-Nieto, M. I. Perez-Robledo, J. P.; Alvarez-Luque, A. Suz, J. I. Acitores Torres, J. Novo

    2011-02-15

    Bronchobiliary fistula is a rare and is an uncommon but severe complication of hydatid disease of the liver. Treatment has traditionally been surgical resection, but embolization and stent placement have been described. The invasive method seems to be a key component of patient treatment. We describe a case of a 58-year-old woman who, 25 years before, had undergone surgery for a hydatid cyst. A total cystectomy without previous puncture or parasite extraction was carried out. The lower aspect of the cyst was found to be completely perforated over the biliary duct. During the postoperative course, the patient had subphrenic right-sided pleural effusion and biliary fistula that subsided with medical treatment. Afterward, the patient came to the outpatient area of our hospital complaining of leakage of purulent exudate through the cutaneous opening, pain located on the right hypochondrium radiating to the right hemithorax, malaise, fever, chronic cough, and occasional vomiting of bile. Fistulography revealed an anfractuous cavity communicating with a residual cystic cavity on the right hepatic lobe. We observed communication with the intrahepatic canaliculi. Computed tomographic scan revealed a fistulous tract on the anterior liver border through the abdominal wall. There were no posttreatment complications. The patient is asymptomatic.

  1. Spinal Dural Arteriovenous Fistula: A Review.

    PubMed

    Maimon, Shimon; Luckman, Yehudit; Strauss, Ido

    2016-01-01

    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. PMID:26508408

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

    PubMed

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

    2016-06-01

    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. PMID:26875638

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

    PubMed Central

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

    2016-01-01

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

  4. Preserving bone conduction in patients with labyrinthine fistula.

    PubMed

    Gocea, Anamaria; Martinez-Vidal, Brigida; Panuschka, Charlotte; Epprecht, Pilar; Caballero, Miguel; Bernal-Sprekelsen, Manuel

    2012-04-01

    The management of labyrinthine fistula is a controversial issue. Hearing preservation represents a major challenge. Retrospective study of 31 patients with labyrinthine fistula confirmed intra-operatively during cholesteatoma surgery. In all cases, total matrix removal was performed, and the fistula covered with bone dust, periostium and/or cartilage. Twenty-five patients received a high intra-operative dosage (500 mg) of intravenously applied steroids at least 15 min before handling the fistula. Outcome measurements included comparison of the pre-operative and post-operative bone conduction to assess inner ear function. The results were, the fistula was located in the lateral semicircular canal (LSC) in 22 patients (71.8%) and in the oval window in eight. One patient had a double localization in the superior and lateral semicircular canals. Out of the LSC fistulas, five patients (16.12%) had a fistula type I, 8 had type IIa (25.8%), four (12.9%) type IIb, and six patients type III (19.35%). Three out of eight patients with fistula located in the oval window had a total absence of the footplate, other four presented a partial anterior resorption at the level of the fissula antefenestram and the remaining one had a fractured platina. Pre-operatively, the bone conduction displayed a mean threshold of 35 dB. Twenty-two (85%) out of 26 patients treated intra-operatively with steroids showed preservation or improvement of bone conduction. Patients with fistulas of the oval window, type I, IIa and III fistulas in the LSC treated with cortisone presented good sensorineural hearing outcome (preservation or significant improvement of inner ear function in the majority of cases-91%); the auditory results for group IIb were inconclusive. Five patients did not receive steroids, four of them developed partial sensorineural hearing loss and one went deaf. To conclude, cholesteatoma surgery with a single-staged matrix removal on perilymphatic fistulas, after intra

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

    PubMed Central

    Rajkumar, J.S.; Anirudh, J.R.; Akbar, S.; Joshi, Niraj

    2016-01-01

    Although 2nd Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1st 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.

  6. [Vesico-uterine fistula, a rare complication of cesarean section].

    PubMed

    Medina Ramos, N; Cerezuela Requena, J F; Martín Martínez, A; García Hernández, J A; Chesa Ponce, N

    2003-03-01

    We present the case of a vesicouterine fistula secondary to a caesarean section indicated due to the disproportion the pelvis and the head of the baby. This kind of fistula is due fundamentally to obstetric causes, especially to caesarean sections in developed countries and to prolonged labour in developing countries. The commonest clinical presentation is urinary incontinence in the form of continuous or intermittent urinary leaks. Surgical treatment is generally the therapy of choice, although, in the case of small fistulas, conservative treatment is feasible. The best form of prevention is correct indication of caesarean section and careful surgical technique. PMID:12812125

  7. Orbital fistula. Causes and treatment of 20 cases.

    PubMed

    Wang, W J; Li, C X; Sebag, J; Ni, C

    1983-11-01

    A retrospective analysis of 20 cases of orbital fistula in Shanghai showed the causes to be trauma with foreign-body retention, osteomyelitis, mucocele, and dermoid cyst. Half the patients were children younger than 10 years old. Cicatricial ectropion, ptosis, and extraocular motility disturbance constituted the common clinical findings. Treatment according to the various causes included surgical removal of the foreign body, oral administration of antibiotics combined with local irrigation, radical extraction of all the epithelium lining the fistula, and excision of the fistula. PMID:6639428

  8. Parks' coloanal sleeve anastomosis for treatment of postirradiation rectovaginal fistula

    SciTech Connect

    Nowacki, M.P.; Szawlowski, A.W.; Borkowski, A.

    1986-12-01

    Postirradiation rectovaginal fistula is a complex problem in colorectal surgery. The modified Parks procedure curettage of rectal mucosa heavily damaged by radiation is introduced. Fifteen cases of coloanal sleeve anastomosis for the repair of rectovaginal postirradiation fistula are described. All patients previously were irradiated heavily because of carcinoma of the uterine cervix. Three patients had simultaneous repair of vesicovaginal fistula. One postoperative death was observed. Of the surviving patients, functional results have been good in 11. In the seven patients with difficult stripping of the rectal mucosa, surgical curettage was performed. The latter procedure is suggested as the method of choice in relevant cases.

  9. Closure of esophagotracheal fistula after esophagectomy for esophageal cancer.

    PubMed

    Arimoto, Junji; Hatada, Atsutoshi; Kawago, Mitsumasa; Nishimura, Osamu; Maebeya, Shinji; Okamura, Yoshitaka

    2015-11-01

    Fistula between the trachea and esophagogastric anastomosis after esophagectomy is rare. We successfully treated a 75-year-old woman with such a lesion by single-stage repair. The patient had undergone radical esophagectomy 20 years ago, and repeatedly developed aspiration pneumonia for recent 5 years. Radiological and endoscopic examinations demonstrated the fistula between the trachea at the level of sternal notch and esophagogastric anastomosis. The fistula was separated and the defects on both sides were closed. A sternocleidomastoid muscle flap was inserted between the two structures. The postoperative course was uneventful. PMID:26189183

  10. Renographic Demonstration of Desmoid Tumor-Ureteral Fistula.

    PubMed

    Kim, David U; McQuinn, Garland; Lin, Eugene; Lee, Marie

    2016-01-01

    A 20-year-old woman with Gardner syndrome and intra-abdominal desmoid tumors presented with increasing abdominal pain. CT demonstrated a new area of central hypodensity in a presumed desmoid tumor, compressing the left ureter. Findings were suspicious for abscess or fistula to the ureter. Subsequent 99mTc-MAG3 renogram demonstrated persistent extraureteral radiotracer activity in the region of the tumor, confirming a desmoid tumor-ureteral fistula. Desmoid tumors are benign but locally aggressive fibrous neoplasms that can be sporadic or associated with familial adenomatous polyposis syndromes, specifically Gardner syndrome. Fistula formation to the ureter has been reported infrequently. PMID:26284772

  11. The problem of post-partum fistulas in developing countries.

    PubMed

    Steiner, A K

    1996-12-30

    Postpartum fistulas are frequent in the tropical environment. They are mostly found in very young women who live in remote areas. Without treatment women with fistulas will be condemned to the disconsolate life of social outcasts. Good operative treatment is crucial. The different operative methods are discussed. The operation through vaginal approach can be performed in any hospital. It does not need special surgical skill. More important than surgery is prevention of postpartum fistulas through a well-organised primary health care program which reaches out into the villages and which includes adequate prenatal controls and competent midwifery. PMID:9028407

  12. Traumatic arteriovenous fistula of the scalp. Case report.

    PubMed

    Badejo, L; Rockwood, P

    1987-05-01

    A case of an arteriovenous fistula resulting from an air-rifle pellet injury to the scalp is reported. Traumatic arteriovenous fistulas of the scalp are rare lesions. A suggested pathogenesis is a disruption of the arterial wall and its vasa vasorum with endothelial proliferation to adjacent veins. Classically, these fistulas are described as single channels, but more commonly they consist of multiple connections. Angiography is necessary to delineate the full extent of the lesions unless they are extremely small. Careful complete excision is the definitive management, as recurrences are common. PMID:3572503

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

    PubMed Central

    Rahmani, Arshad H.

    2015-01-01

    Cassia fistula Linn is known as Golden shower has therapeutics importance in health care since ancient times. Research findings over the last two decade have confirmed the therapeutics consequence of C. fistula in the health management via modulation of biological activities due to the rich source of antioxidant. Several findings based on the animal model have confirmed the pharmacologically safety and efficacy and have opened a new window for human health management. This review reveals additional information about C. fistula in the health management via in vivo and in vitro study which will be beneficial toward diseases control. PMID:26130932

  14. Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning.

    PubMed

    Atsumi, Naotaka; Matsubara, Muneaki; Kimura, Naritaka; Terada, Masatsugu

    2015-10-01

    This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future. PMID:24057599

  15. Acquired von Willebrand disease.

    PubMed

    Kumar, Shaji; Pruthi, Rajiv K; Nichols, William L

    2002-02-01

    Acquired von Willebrand disease (AvWD) is a relatively rare acquired bleeding disorder that usually occurs in elderly patients, in whom its recognition may be delayed. Patients usually present predominantly with mucocutaneous bleeding, with no previous history of bleeding abnormalities and no clinically meaningful family history. Various underlying diseases have been associated with AvWD, most commonly hematoproliferative disorders, including monoclonal gammopathies, lymphoproliferative disorders, and myeloproliferative disorders. The pathogenesis of AvWD remains incompletely understood but includes autoantibodies directed against the von Willebrand factor (vWF), leading to a more rapid clearance from the circulation or interference with its function, adsorption of vWF by tumor cells, and nonimmunologic mechanisms of destruction. Laboratory evaluation usually reveals a pattern of prolonged bleeding time and decreased levels of vWF antigen, ristocetin cofactor activity, and factor VIII coagulant activity consistent with a diagnosis of vWD. Acquired vWD is distinguished from the congenital form by age at presentation, absence of a personal and family history of bleeding disorders, and, often, presence of a hematoproliferative or autoimmune disorder. The severity of the bleeding varies considerably among patients. Therapeutic options include desmopressin and certain factor VIII concentrates that also contain vWF. Successful treatment of the associated illness can reverse the clinical and laboratory manifestations. Intravenous immunoglobulins have also shown some efficacy in the management of AvWD, especially cases associated with monoclonal gammopathies. Awareness of AvWD is essential for diagnosis and appropriate management. PMID:11838652

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

    PubMed Central

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

    2012-01-01

    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 extracts of seed, hexane extracts of pulp, and hexane extracts of seed. The antioxidant potential of Cassia fistula extracts significantly correlated (P < 0.02) with the phenolic content of the methanolic extracts. Ascorbic acid taken as control showed highest antioxidant power in the present study. PMID:25374682

  17. Selective Embolization of Large Symptomatic Iatrogenic Renal Transplant Arteriovenous Fistula

    SciTech Connect

    Barley, Fay L.; Kessel, David Nicholson, Tony; Robertson, Iain

    2006-12-15

    We report on the successful treatment of hypertension by occlusion of a large iatrogenic renal transplant arteriovenous fistula using detachable embolization coils with concomitant flow reduction by occlusion balloon in two patients.

  18. Gastropericardial fistula as a delayed complication of a Nissen fundoplication

    PubMed Central

    Kakarala, Kokila; Edriss, Hawa

    2015-01-01

    A 41-year-old man presented to the emergency department with substernal chest pain and was found to have ST elevations in the inferior leads on his electrocardiogram. An emergent cardiac catheterization did not identify significant coronary narrowing. Computed tomography of the thorax demonstrated a pneumopericardium and a hiatal hernia. The patient had a complicated past surgical history, including a Nissen fundoplication and three additional surgeries for postoperative complications. An esophagram later revealed an ulcer and possible fistula, and the patient underwent gastropericardial fistula resection after the fistula failed to close with fibrin sealant application. Enteropericardial fistulas occur infrequently but have high morbidity and mortality rates. This possibility is much more likely in patients with prior gastroesophageal surgery, including laparoscopic Nissen fundoplication. PMID:26424947

  19. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    PubMed Central

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

    2013-01-01

    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

  20. Ascending aortopulmonary fistula 40 years after previous cardiac surgery.

    PubMed

    Maki, Alexandra C; Williams, Matthew L

    2011-03-01

    We present a case of a 64-year-old female presenting with hemoptysis and an ultimate diagnosis of ascending aortopulmonary fistula 40 years after an atrial septal defect repair. A literature review of this rare complication of ascending aortic cannulation includes the pathogenesis and etiology of this rare diagnosis. Aortobronchopulmonary fistula is a rare diagnosis with grave consequences if not treated urgently. We present a case of such diagnosis that was treated with a good outcome. PMID:21299625

  1. A Very Rare Complication of Acute Appendicitis: Appendicovesical Fistula

    PubMed Central

    Alis, Deniz; Samanci, Cesur; Namdar, Yesim; Ustabasioglu, Fethi Emre; Yamac, Elif; Tutar, Onur; Ucpinar, Burak; Onal, Bulent

    2016-01-01

    Appendicovesical fistula (AVF) is an uncommon type of enterovesical fistula and a very rare complication of acute appendicitis. Herein, we report a case of 39-year-old male patient who presented with persistent urinary tract infection, recurrent abdominal pain, and pneumaturia. Imaging techniques including ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) were performed to identify the abnormality. However, definitive diagnosis of AVF was made by cystoscopy. PMID:27239365

  2. Multidisciplinary management of multiple spinal dural arteriovenous fistulae

    PubMed Central

    Ge, Liang; Feng, Rui; Zhang, Xiaolong; Sun, Bing; Gu, Shixin; Xu, Qiwu; Lu, Gang; Huang, Lei

    2013-01-01

    Multiple SDAVFs are quite rare. We present two cases with double synchronous shunts and both were treated during one-stage interventional or surgical procedure. Unique images of the multiple SDAVFs as a PMAVF-like fistula were obtained. These interesting findings suggest the presence of multiple fistulas must be considered in patients being evaluated for SDAVF. A multidisciplinary approach to the management of multiple SDAVFs should depend on the anatomic location and angioarchitecture. PMID:24179577

  3. Bronchoscopic location of bronchopleural fistula with xenon-133

    SciTech Connect

    Lillington, G.A.; Stevens, R.P.; DeNardo, G.L.

    1982-04-01

    Successful application of the technique of transbronchoscopic endobronchial occlusion of a persistent bronchopleural fistula requires an accurate determination of the segmental location of the air leak. This was achieved by injections of small boluses of Xe-133 into a number of segmental bronchi through a fiber-optic bronchoscope. Following the instillation of Xe-133 into the segmental bronchus leading to the fistula, there was a marked increase in radioactivity in the intercostal drainage tube.

  4. Surgical management of hepatic arterioportal fistula in a neonate.

    PubMed

    Ramachandran, Priya; Shanmugam, N P; Vij, M; Rela, M

    2014-05-01

    Congenital arterioportal fistulae in the liver are rare malformations which can lead to portal hypertension. We report a hepatic arterioportal fistula in a neonate who presented with intestinal hypoperfusion. Computerised tomography angiography showed a fistulous communication between the left hepatic artery and portal vein with hypoperfusion of small and large bowel. A formal left hepatectomy was done followed by clinical improvement and reduction in portal venous pressures. The case and the literature pertaining to it are discussed. PMID:24448912

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

    PubMed

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

    2016-06-01

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

  6. Extensive arterial aneurysm formation proximal to ligated arteriovenous fistula.

    PubMed Central

    Graham, J M; McCollum, C H; Crawford, E S; DeBakey, M E

    1980-01-01

    As a result of abnormal flow patterns and hyperdynamic flow in arteries proximal to an arteriovenous fistula a particular susceptibility to atherosclerotic changes and aneurysmal deterioration develops. In the following report two patients are presented in which chronic arteriovenous fistulas existed for 15 and 33 years prior to correction. Each patient developed extensive and progressive aneurysmal dilation of the proximal arterial tree and subsequently required surgical resection and graft replacement. Images Fig. 1. Fig. 2. Fig. 3. PMID:6444798

  7. Closure of a nonhealing gastrocutaneous fistula using an endoscopic clip.

    PubMed

    Siddiqui, Ali A; Kowalski, Thomas; Cohen, Sidney

    2007-01-01

    Gastrocutaneous fistula after gastrostomy tube removal may persist for a prolonged period. We present a case of a 58-year-old woman with a GCF that had persisted for 5 months following the removal of an endoscopically-placed gastrostomy tube (PEG). Conservative therapy with anti-acid medications and administering motility agents was unsuccessful. For the closure of the GCF, the endoscopic metal clips were used to close the fistula. PMID:17269533

  8. Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy.

    PubMed

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

    2016-01-01

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

  9. Arterioureteral fistula: an unusual clinical case.

    PubMed

    Coelho, Hugo; Freire, Maria José; Azinhais, Paulo; Temido, Paulo

    2016-01-01

    Arterioureteral fistulas (AUFs) are abnormal communications between a major artery and the mid to distal ureter. It is a rare but potentially life-threatening condition that is seldom recognised. We present a case of a 66-year-old man who was admitted to the surgical ward owing to infection of an aortic bifemoral bypass graft. During admission, the patient developed persistent haematuria with considerable loss of haemoglobin. He was submitted to urgent surgical exploration of the graft. An ascending pyelography performed at the beginning of the surgery clearly shows a communication between the left ureter and the vascular graft. Open surgical exploration was undertaken, the fistulised section of the ureter resected and an end-to-end ureteroplasty was performed. The vascular graft was removed and the patient later submitted to left supracondylar amputation. Urinary drainage remained intact. PMID:26969358

  10. Multiple Intracranial Arteriovenous Fistulas in Cowden Syndrome.

    PubMed

    Prats-Sánchez, Luis A; Hervás-García, Jose V; Becerra, Juan L; Lozano, Manuel; Castaño, Carlos; Munuera, Josep; Escudero, Domingo; García-Esperón, Carlos

    2016-06-01

    Cowden syndrome is a rare autosomal dominant disease. It is characterized by multiple noncancerous tumorlike growths called hamartomas, which typically are found in the skin, oral mucosa, thyroid, breast, and gastrointestinal tract. It carries with it a potential risk of malignant transformation, especially of the breast and thyroid. In 80% of the cases, the human tumor suppressor gene, phosphatase and tensin homolog (PTEN), is mutated in the germ line. We report a patient with Cowden syndrome who presented with generalized seizure and left anterior temporal hemorrhage and a nontraumatic subarachnoid hemorrhage due to multiple intracranial arteriovenous fistulas (AVFs). We discuss previous reports about vascular malformations in patients with Cowden syndrome and PTEN mutations. Importantly, we hypothesize that the production of multiple AVFs in our patient was associated with PTEN mutation. PMID:27105569

  11. Pericardioesophageal Fistula Following Left Atrial Ablation Procedure

    PubMed Central

    Bailey, Christopher W.; Tallaksen, Robert J.

    2014-01-01

    We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation. PMID:25426222

  12. Pericardioesophageal fistula following left atrial ablation procedure.

    PubMed

    Bailey, Christopher W; Tallaksen, Robert J

    2014-10-01

    We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation. PMID:25426222

  13. Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy

    PubMed Central

    Kaler, Kamaljot S.; Cwikla, Daniel

    2016-01-01

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

  14. [Acquired von Willebrand syndrome].

    PubMed

    Franchini, Massimo

    2006-01-01

    Acquired von Willebrand syndrome (aVWS) is a rare, but probably underestimated, bleeding disorder that mimics the congenital form of von Willebrand disease (VWD) in terms of laboratory findings and clinical presentation. However, unlike congenital VWD, it arises in individuals with no personal or family history of bleeding. AVWS occurs in association with a variety of underlying disorders, including lymphoproliferative disorders, myeloproliferative disorders and cardiovascular diseases. The main pathogenic, clinical, laboratory and therapeutic aspects of this syndrome are concisely reported in this review. PMID:16913181

  15. [Decision on the operative approach and volume of interventions in patients with tubular intestine fistulas].

    PubMed

    Vorob'ev, S A; Levchik, E Iu

    2009-01-01

    Results of operative treatment of 93 patients with tubular small and large intestine fistulas were analyzed depending on the operative access and volume of interventions. In the postoperative period incompetence of the intestinal anastomosis and recurrent intestine fistulas are found more often in the group of patients with not removed causes of maintenance of the fistula persistence. These complications are rarer in patients operated from the bordering access with liquidation of the cause of long existence of the fistula. The liquidation of the persistence causes and operative access some distance away from the external opening of the fistula resulted in the absence of incompetence of the intestinal anastomosis and recurrent fistulas. PMID:19947425

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

    PubMed

    Unosawa, Satoshi; Kimura, Haruka; Niino, Tetsuya

    2013-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2011-11-01

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

  18. Carotid Cavernous Fistula Associated with Persistent Trigeminal Artery

    PubMed Central

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

    1998-01-01

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

  19. A code of ethics for the fistula surgeon.

    PubMed

    Wall, L Lewis; Wilkinson, Jeffrey; Arrowsmith, Steven D; Ojengbede, Oladosu; Mabeya, Hillary

    2008-04-01

    Vesicovaginal fistulas from obstructed labor no longer exist in wealthy industrialized countries. In the impoverished countries of sub-Saharan Africa and south Asia obstetric fistulas continue to be a prevalent clinical problem. As many as 3.5 million women may suffer from this condition and few centers exist that can provide them with competent and compassionate surgical repair of their injuries. As this situation has become more widely known in the industrialized world, increasing numbers of surgeons have begun traveling to poor countries to perform fistula operations. To date, these efforts have been carried out largely by well-intentioned individuals, acting alone. An international community of fistula surgeons who share common goals and values is still in the process of being created. To help facilitate the development of a common ethos and to improve the quality of care afforded to women suffering from obstetric fistulas, we propose a Code of Ethics for fistula surgeons that embraces the fundamental principles of beneficence, non-maleficence, respect for personal autonomy, and a dedication to the pursuit of justice. PMID:18068168

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

    PubMed Central

    Crespi, M.; Montecamozzo, G.; Foschi, D.

    2016-01-01

    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. PMID:26819608

  1. Current management of anal fistulas in Crohn's disease

    PubMed Central

    Eder, Piotr; Banasiewicz, Tomasz; Matysiak, Konrad; Łykowska-Szuber, Liliana

    2015-01-01

    Anal fistulas occurring in Crohn's disease (CD) comprise a risk factor of severe course of inflammation. They are frequently intractable due to various factors such as penetration of the anal canal or rectal wall, impaired wound healing, and immunosuppression, among others. Anal fistulas typical to CD develop from fissures or ulcers of the anal canal or rectum. Accurate identification of the type of fistula, such as low and simple or high and complex, is crucial for prognosis as well as for the choice of treatment. If fistulotomy remains the gold standard in the surgical treatment of the former, it is contraindicated in high and complex fistulas due to possible risk of damage to the anal sphincter with subsequent faecal incontinence. Therefore, the latter require a conservative and palliative approach, such as an incision and drainage of abscesses accompanying fistulas or prolonged non-cutting seton placement. Currently, conservative, sphincter-preserving, and definitive procedures such as mucosal advancement or dermal island flaps, the use of plugs or glue, video assisted anal fistula treatment, ligation of the intersphincteric track, and vacuum assisted closure are gaining a great deal of interest. Attempting to close the internal opening without injuring the sphincter is a major advantage of those methods. However, both the palliative and the definitive procedures require adjuvant therapy with medical measures. PMID:26557938

  2. AIDS: acquired immunodeficiency syndrome *

    PubMed Central

    Gilmore, N.J.; Beaulieu, R.; Steben, M.; Laverdière, M.

    1992-01-01

    Acquired immunodeficiency syndrome, or AIDS, is a new illness that occurs in previously healthy individuals. It is characterized by immunodeficiency, opportunistic infections and unusual malignant diseases. Life-threatening single or multiple infections with viruses, mycobacteria, fungi or protozoa are common. A rare neoplasm, Kaposi's sarcoma, has developed in approximately one third of patients with AIDS. More than 800 cases of AIDS have been reported in North America, over 24 of them in Canada. The majority of patients are male homosexuals, although AIDS has also developed in abusers of intravenously administered drugs, Haitian immigrants, individuals with hemophilia, recipients of blood transfusions, prostitutes, and infants, spouses and partners of patients with AIDS. The cause of AIDS is unknown, but the features are consistent with an infectious process. Early diagnosis can be difficult owing to the nonspecific symptoms and signs of the infections and malignant diseases. Therefore, vigilance by physicians is of the utmost importance. PMID:1544049

  3. Community-acquired pneumonia.

    PubMed

    Polverino, E; Torres Marti, A

    2011-02-01

    Despite the remarkable advances in antibiotic therapies, diagnostic tools, prevention campaigns and intensive care, community-acquired pneumonia (CAP) is still among the primary causes of death worldwide, and there have been no significant changes in mortality in the last decades. The clinical and economic burden of CAP makes it a major public health problem, particularly for children and the elderly. This issue provides a clinical overview of CAP, focusing on epidemiology, economic burden, diagnosis, risk stratification, treatment, clinical management, and prevention. Particular attention is given to some aspects related to the clinical management of CAP, such as the microbial etiology and the available tools to achieve it, the usefulness of new and old biomarkers, and antimicrobial and other non-antibiotic adjunctive therapies. Possible scenarios in which pneumonia does not respond to treatment are also analyzed to improve clinical outcomes of CAP. PMID:21242952

  4. Acquired Porphyria Cutanea Tarda

    PubMed Central

    Koval, Andrew; Danby, C. W. E.; Petermann, H.

    1965-01-01

    Currently, the porphyrias are classified in four main groups: congenital porphyria, acute intermittent porphyria, porphyria cutanea tarda hereditaria, and porphyria cutanea tarda symptomatica. The acquired form of porphyria (porphyria cutanea tarda symptomatica) occurs in older males and is nearly always associated with chronic alcoholism and hepatic cirrhosis. The main clinical changes are dermatological, with excessive skin fragility and photosensitivity resulting in erosions and bullae. Biochemically, high levels of uroporphyrin are found in the urine and stools. Treatment to date has been symptomatic and usually unsuccessful. A case of porphyria cutanea tarda symptomatica is presented showing dramatic improvement of both the skin lesions and porphyrin levels in urine and blood following repeated phlebotomy. Possible mechanisms of action of phlebotomy on porphyria cutanea tarda symptomatica are discussed. ImagesFig. 1Fig. 2 PMID:14341652

  5. [ICU acquired neuromyopathy].

    PubMed

    Gueret, G; Guillouet, M; Vermeersch, V; Guillard, E; Talarmin, H; Nguyen, B-V; Rannou, F; Giroux-Metges, M-A; Pennec, J-P; Ozier, Y

    2013-09-01

    ICU acquired neuromyopathy (IANM) is the most frequent neurological pathology observed in ICU. Nerve and muscle defects are merged with neuromuscular junction abnormalities. Its physiopathology is complex. The aim is probably the redistribution of nutriments and metabolism towards defense against sepsis. The main risk factors are sepsis, its severity and its duration of evolution. IANM is usually diagnosed in view of difficulties in weaning from mechanical ventilation, but electrophysiology may allow an earlier diagnosis. There is no curative therapy, but early treatment of sepsis, glycemic control as well as early physiotherapy may decrease its incidence. The outcomes of IANM are an increase in morbi-mortality and possibly long-lasting neuromuscular abnormalities as far as tetraplegia. PMID:23958176

  6. Case of bronchoesophageal fistula with gastric perforation due to multidrug-resistant tuberculosis

    PubMed Central

    Park, Chan Sung; Seo, Kwang won; Park, Chang Ryul; Nah, Yang Won; Suh, Jae Hee

    2014-01-01

    Gastric perforation and tuberculous bronchoesophageal fistula (TBEF) are very rare complications of extrapulmonary tuberculosis (TB). We present a case of pulmonary TB with TBEF and gastric perforation caused by a multidrug-resistant tuberculosis strain in a non-acquired immune deficiency syndrome male patient. The patient underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy and feeding jejunostomy during intravenous treatment with anti-TB medication, and esophageal reconstruction with colonic interposition and jejunocolostomy were performed successfully after a full course of anti-TB medication. Though recent therapies for TBEF have favored medication, patients with severe stenosis or perforation require surgery and medication with anti-TB drugs based upon adequate culture and drug susceptibility testing. PMID:25548611

  7. Infective endocarditis related to a coronary artery fistula with an unusual localization and ectatic coronary arteries.

    PubMed

    Gerede, Demet Menekse; Acibuca, Aynur; Uzun, Caglar; Goksuluk, Huseyin; Ongun, Aydan; Kilickap, Mustafa; Erol, Cetin

    2015-04-01

    Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31-year-old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery. PMID:25362867

  8. Pentadecapeptide BPC 157 and the esophagocutaneous fistula healing therapy.

    PubMed

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

    2013-02-15

    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 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. PMID:23220707

  9. Concurrent Chemoradiotherapy for Esophageal Cancer With Malignant Fistula

    SciTech Connect

    Koike, Ryuta; Nishimura, Yasumasa Nakamatsu, Kiyoshi; Kanamori, Shuichi; Shibata, Toru

    2008-04-01

    Background: We reviewed clinical results of chemoradiotherapy (CRT) in the treatment of patients with advanced esophageal cancer with fistulae that developed before or during CRT. Methods and Materials: The study group included 16 patients with fistulous esophageal cancer treated by means of CRT between 1999 and 2006. Nine patients had fistulae before CRT, whereas 7 developed fistulae during CRT. The group included 12 men and four women with a median age of 55 years (range, 37-77 years). There were 9 patients with Stage III disease and 7 with Stage IV disease. All tumors were squamous cell carcinomas. Two courses of concurrent chemotherapy were combined with radiation therapy; 60 Gy/30 fractions/7 weeks (1-week split). For 15 patients, low-dose protracted chemotherapy with 5-fluorouracil (250-300 mg/m{sup 2} x 14 days) and cisplatin (7 mg/m{sup 2} x 10 days) was administered, whereas full-dose cisplatin and 5-fluorouracil were administered to the remaining patient. Results: The planned dose of 60 Gy was delivered to 11 patients (69%), whereas radiation therapy was terminated early in 5 patients (40-58 Gy) because of acute toxicities, including two treatment-related deaths. Disappearance of fistulae was noted during or after CRT in 7 patients (44%). All three esophagomediastinal fistulae were closed, but only four of 13 esophagorespiratory fistulae were closed by CRT. For patients with Stage III, 1- and 2-year survival rates were 33% and 22%, respectively. Median survival time was 8.5 months. Conclusion: Despite significant toxicity, concurrent CRT appears effective at closing esophageal malignant fistulae.

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

    PubMed

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

    2009-10-01

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

  11. Spontaneous Colo-Umbilical Fistula Complicating Diverticulitis of the Sigmoid Colon

    PubMed Central

    Kouklakis, Georgios; Courcoutsakis, Nikos; Oikonomou, Panagoula; Karayiannakis, Anastasios J.

    2013-01-01

    Colocutaneous fistula caused by diverticulitis is relatively uncommon with colo-umbilical fistulas being even rarer. We herein report a rare case of a spontaneous colo-umbilical fistula due to diverticulitis of the sigmoid colon. The fistula developed from a diverticulum of the sigmoid colon that discharged through the umbilicus after two episodes of acute diverticulitis. The condition was successfully treated by resectional surgery. PMID:23841011

  12. Spontaneous extrusion of staghorn renal calculus with nephrocutaneous fistula in a child.

    PubMed

    Purkait, Bimalesh; Sinha, Rahul Janak; Bansal, Ankur; Singh, Vishwajeet

    2016-01-01

    Renal stone disease may present as nephrocutaneous fistula. Spontaneous extrusion of renal stone with nephrocutaneous fistula is rare. Most of the cases have been reported in adults. We present a case of nephrocutaneous fistula with spontaneous extrusion of staghorn renal calculus in a paediatric patient. PMID:27068729

  13. Is the Simple Closure Technique Effective in the Treatment of Genital Fistulas?

    PubMed Central

    Unlubilgin, Eylem; İlhan, Tolgay Tuyan; Sivaslioglu, Ahmet Akin; Dolen, Ismail

    2013-01-01

    Aim. Genitourinary fistulas are bothersome clinical entities not only for the patient but also for the treating surgeon as well. A lot of surgical procedures have been proposed; however, most of the fistulas can be easily treated with plain surgical techniques, such as the simple surgical closure of the fistula tract. Material and Method. The study was carried out in the urogynecology department of Ankara Etlik Zübeyde Hanım Maternity Training and Research Hospital. The study included 12 cases with vesicovaginal fistulas and 15 cases with rectovaginal fistulas. Twenty-six patients underwent simple surgical closure technique. The age, the referral time to the hospital, the longest diameter of the fistula opening, the hospitalization time, the follow-up period and identifiable risk factors of the patients were evaluated. Results. Caeserean section was detected as primary risk factor for vesicovaginal fistulas and prolonged labor was detected as the most important risk factor for rectovaginal fistulas. In our study, we found that the simple closure technique cured 91% of vesicovaginal fistulas and 93% of rectovaginal fistulas. Conclusion. The simple closure technique has very high cure rates for both vesicovaginal and rectovaginal fistulas when the longest diameter of the fistula openings is ≤5 mm. PMID:23476795

  14. Acute Traumatic Renal Artery to Inferior Vena Cava Fistula Treated with a Covered Stent

    SciTech Connect

    Tam, J.; Kossman, T.; Lyon, S.

    2006-12-15

    A 34-year-old man presented within hours of suffering a penetrating stab wound and was diagnosed with a right renal artery to inferior vena cava fistula. Initial attempts at excluding the fistula with a balloon were unsuccessful. He was subsequently treated with a covered stent inserted into the right renal artery which successfully excluded the fistula.

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

    PubMed Central

    Lee, Sang Don; Kim, Tae Nam; Ha, Hong Koo

    2011-01-01

    Causes of previously reported reno-colic fistulas included primary renal and colonic pathologic states involving infectious, malignant or other inflammatory processes. However, reno-colic fistula after renal injury is extremely uncommon. We report an unusual delayed presentation of reno-colic fistula that occurred at 4 months later after blunt abdominal trauma. PMID:21423539

  16. Radial Artery Approach to Salvage Nonmaturing Radiocephalic Arteriovenous Fistulas

    SciTech Connect

    Hsieh, Mu-Yang; Lin, Lin; Tsai, Kuei-Chin; Wu, Chih-Cheng

    2013-08-01

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

  17. Imperforate Anus with Fistula Exiting at the Penile Skin.

    PubMed

    Sfoungaris, Dimitrios; Mouravas, Vassilios; Lambropoulos, Vassilios; Kepertis, Chrysostomos; Spyridakis, Ioannis

    2016-03-01

    We present the case of a male neonate with imperforate anus and a fistula exiting on the penile skin. Anorectal malformations in boys often present themselves with an entero-perineal or entero-urinary tract fistula, the type of which is a key feature for the classification and the treatment plan. A fistula exiting in front of the scrotum, such as described in our case, is very rare and is not incorporated in the current classification and treatment algorithms. Scarce reports on misjudgment concerning the position of the blind rectal pouch in similar cases, led us to perform a colostomy instead of a one-stage correction. A posterior sagittal anorectoplasty was performed eight months later and the rectal pouch was found inside the levator sling, justifying the cautious approach. The colostomy was closed three months later and after six months the distal part of the fistula was excised. We believe that in cases with a rare fistula presentation, the position of the rectal pouch is not predictable and the surgeon should proceed with caution. PMID:27134930

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

    NASA Astrophysics Data System (ADS)

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

    2012-11-01

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

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

    PubMed Central

    Maddah, Ghodratollah; Fattahi, Asieh Sadat; Rahnama, Ali; Jamshidi, Shirin Taraz

    2016-01-01

    A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation — she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months’ postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management. PMID:26989289

  20. Surgical treatment of labyrinthine fistula in patients with cholesteatoma.

    PubMed

    Ueda, Y; Kurita, T; Matsuda, Y; Ito, S; Nakashima, T

    2009-01-01

    Labyrinthine fistula is one of the most common complications of chronic otitis media associated with cholesteatoma. The optimal management of labyrinthine fistula, however, remains controversial. Between 1995 and 2005, labyrinthine fistulae were detected in 31 (6 per cent) patients in our institution. The canal wall down technique was used in 27 (87 per cent) patients. The cholesteatoma matrix was completely removed in the first stage in all patients. Bone dust and/or temporalis fascia was inserted to seal the fistula in 29 (94 per cent) patients. A post-operative hearing test was undertaken in 27 patients; seven (26 per cent) patients showed improved hearing, 17 (63 per cent) showed no change and three (11 per cent) showed a deterioration. The study findings indicate that there are various treatment strategies available for cholesteatoma, and that the treatment choice should be based on such criteria as auditory and vestibular function, the surgeon's ability and experience, and the location and size of the fistula. PMID:19460207

  1. Foramen magnum dural arteriovenous fistula presenting with epilepsy.

    PubMed

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

    2015-12-01

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

  2. Imperforate Anus with Fistula Exiting at the Penile Skin

    PubMed Central

    Mouravas, Vassilios; Lambropoulos, Vassilios; Kepertis, Chrysostomos; Spyridakis, Ioannis

    2016-01-01

    We present the case of a male neonate with imperforate anus and a fistula exiting on the penile skin. Anorectal malformations in boys often present themselves with an entero-perineal or entero-urinary tract fistula, the type of which is a key feature for the classification and the treatment plan. A fistula exiting in front of the scrotum, such as described in our case, is very rare and is not incorporated in the current classification and treatment algorithms. Scarce reports on misjudgment concerning the position of the blind rectal pouch in similar cases, led us to perform a colostomy instead of a one-stage correction. A posterior sagittal anorectoplasty was performed eight months later and the rectal pouch was found inside the levator sling, justifying the cautious approach. The colostomy was closed three months later and after six months the distal part of the fistula was excised. We believe that in cases with a rare fistula presentation, the position of the rectal pouch is not predictable and the surgeon should proceed with caution. PMID:27134930

  3. Coronary-cameral fistulas: indications and methods for closure.

    PubMed

    Carminati, Mario; Giugno, Luca; Chessa, Massimo; Butera, Gianfranco; Piazza, Luciane; Bussadori, Claudio

    2016-05-17

    Coronary-cameral fistulas (CCF) are anomalous connections between one or more coronary arteries and a cardiac chamber, most commonly the right ventricle or right atrium. The major indications for closure are: significant left to right shunt, myocardial ischaemia, prevention of endoarteritis or rupture. Nowadays, the first option for treatment is transcatheter closure. According to the morphology of the fistulas the most appropriate occluder device should be selected: coils (e.g., Gianturco coils, controlled-release coils, PFM coils), vascular plugs or a patent ductus arteriosus (PDA) device or muscular ventricular septal defect (VSD) device. The way to deploy the occluders could be direct arterial or venous through an arteriovenous loop, according to the anatomy of the fistulas assessed by multiple angiograms in different projections. A test occlusion of the fistula with balloon catheter and simultaneous coronary angiogram is recommended for choosing the proper device type and size and the best position for deployment to achieve complete occlusion of the fistula without compromising the flow in coronary side branches. PMID:27174108

  4. Impact of surgeon factor on radiocephalic fistula patency rates

    PubMed Central

    Arer, Ilker Murat; Yabanoglu, Hakan

    2015-01-01

    Introduction Hemodialysis with arteriovenous fistula (AVF) has been widely accepted treatment modality for patients with chronic renal failure (CRF). Radiocephalic fistulas are considered to be the most desirable for the initial vascular access. The aim of this study is to investigate the surgeon factor on radiocephalic fistula patency rates. Methods A total of 186 patients with diagnosis of CRF underwent Radiocephalic fistula for hemodialysis access were included. Patients were divided into 2 groups according to operating surgeon. Patients were evaluated according to demographic characteristics, secondary patency rates, second AVF creation and complications. Results Mean age was 57.7 ± 14.8 years. The most common etiology of CRF was idiopathic (66.6%). 40 (75.5%) patients in group 1 and 122 (91.7%) patients in group 2 were pre-dialysis patients (p < 0.05). Overall secondary patency rate was 77.4%. Patients in group 1 and group 2 have secondary patency rates of 83% and 75.2%, respectively (p = 0.458). Second AVF creation was done in 2 (3.8%) patients in group 1 and 23 (17.3%) patients in group 2 (p < 0.05). Postoperative complication rate was 9.6%. Conclusion Operating surgeon is not a major factor of secondary patency in radiocephalic arteriovenous fistulas. PMID:26900457

  5. Glaucoma Management in Carotid Cavernous Fistula.

    PubMed

    Calafiore, Silvia; Perdicchi, Andrea; Scuderi, Gianluca; Contestabile, Maria Teresa; Abdolrahimzadeh, Solmaz; Recupero, Santi Maria

    2016-01-01

    Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment. PMID:27462258

  6. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma.

    PubMed

    Alturkistani, Husain; Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  7. Glaucoma Management in Carotid Cavernous Fistula

    PubMed Central

    Calafiore, Silvia; Perdicchi, Andrea; Scuderi, Gianluca; Contestabile, Maria Teresa; Abdolrahimzadeh, Solmaz; Recupero, Santi Maria

    2016-01-01

    Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment. PMID:27462258

  8. Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma

    PubMed Central

    Almarzooqi, Mohamed-Karji; Oliva, Vincent; Gilbert, Patrick

    2016-01-01

    This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma. PMID:27403360

  9. Treatment of Traumatic Carotid-Cavernous Fistula

    PubMed Central

    Wu, Z.; Zhang, Y.; Wang, C.; YANG, X.; Li, Y.

    2000-01-01

    Summary From 1986 to the end of 1998, 482 cases of traumatic carotid-cavernous fistula (TCCF) were treated by means of intravascular embolisation technique. The experience is overviewed in this article. Many kinds of detachable balloon catheters (including Chinese made detachable balloon catheters), coils and cyano aery late were used as embolic materials. Transcervical, transfemoral, anterior communicating artery, posterior communicating artery approach, or transvenous approach were selected according to conditions. A combination of different approaches or materials was used for complex TCCF. We found that the special sign, named “bileakage sign”, indicated multileakage of TCCF and was not mentioned before. All 482 cases of TCCF were embolised successfully, of which 405 cases maintained the patency of internal carotid artery (ICA). No death related to the treatment occurred in our group and the symptoms or signs in 462 cases were relieved after embolisation. Emergency embolisation was needed in some conditions such as serious epistaxis, delayed or repeatedly subdural haematoma and rapid visual impairment. Endovascular treatment of TCCF is a safe and efficient method. The time of operation, approach, and materials for embolisation must be carefully selected in order to obtain the best result. PMID:20667206

  10. Perilymph Fistula: Fifty Years of Controversy

    PubMed Central

    Hornibrook, Jeremy

    2012-01-01

    Perilymph fistula (PLF) is defined as a leak of perilymph at the oval or round window. It excludes other conditions with “fistula” tests due to a dehiscent semi circular canal from cholesteatoma and the superior canal dehiscence syndrome. It was first recognized in the early days of stapedectomy as causing disequilibrium and balance problems before sealing of the stapedectomy with natural tissue became routine. It then became apparent that head trauma and barotraumatic trauma from flying or diving could be a cause of PLF. Descriptions of “spontaneous” PLF with no trauma history followed. A large literature on PLF from all causes accumulated. It became an almost emotional issue in Otolaryngology with “believers” and “nonbelievers.” The main criticisms are a lack of reliable symptoms and diagnostic tests and operative traps in reliably distinguishing a perilymph leak from local anaesthetic. There are extensive reviews on the whole topic, invariably conveying the authors' own experiences and their confirmed views on various aspects. However, a close examination reveals a disparity of definitions and assumptions on symptoms, particularly, vestibular. This is an intentionally provocative paper with suggestions on where some progress might be made. PMID:23724269

  11. Middle meningeal arteriovenous fistulas: A rare and potentially high-risk dural arteriovenous fistula

    PubMed Central

    Almefty, Rami O.; Kalani, M. Yashar S.; Ducruet, Andrew F.; Crowley, R. Webster; McDougall, Cameron G.; Albuquerque, Felipe C.

    2016-01-01

    Background: Middle meningeal arteriovenous fistulas (MMAVFs) are rare lesions with a poorly established natural history. We report our experience with patients with MMAVFs who presented with intracranial hemorrhage. Methods: We reviewed our prospectively maintained endovascular database for patients with MMAVFs, who were treated by embolization during a 15-year period. Hospital and outpatient medical records and imaging studies were reviewed. Results: Nine patients with MMAVFs, who presented with intracranial hemorrhage, underwent embolization (mean age 60.3 years, range 21–76; four male and five female). Four patients presented after trauma and five after spontaneous hemorrhage. All nine patients were angiographically cured after embolization of the fistula with liquid embolic agents (n = 8) or coils (n = 1). There were no procedure-related complications. Conclusion: MMAVFs represent a rarely reported class of vascular lesions. They are typically associated with trauma, but also develop spontaneously, and may be associated with intracranial hemorrhage, which warrants classification of these lesions as high risk. Endovascular treatment is safe and effective and should be considered for these patients, particularly for those who have lesions with intracranial venous drainage. PMID:27127711

  12. Acute Acquired Concomitant Esotropia

    PubMed Central

    Chen, Jingchang; Deng, Daming; Sun, Yuan; Shen, Tao; Cao, Guobin; Yan, Jianhua; Chen, Qiwen; Ye, Xuelian

    2015-01-01

    Abstract Acute acquired concomitant esotropia (AACE) is a rare, distinct subtype of esotropia. The purpose of this retrospective study was to describe the clinical characteristics and discuss the classification and etiology of AACE. Charts from 47 patients with AACE referred to our institute between October 2010 and November 2014 were reviewed. All participants underwent a complete medical history, ophthalmologic and orthoptic examinations, and brain and orbital imaging. Mean age at onset was 26.6 ± 12.2 years. Of the 18 cases with deviations ≤ 20 PD, 16 presented with diplopia at distance and fusion at near vision at the onset of deviation; differences between distance and near deviations were < 8 PD; all cases except one were treated with prism and diplopia resolved. Of the 29 cases with deviations > 20 PD, 5 were mild hypermetropic with age at onset between 5 and 19 years, 16 were myopic, and 8 were emmetropic with age at onset > 12 years; 24 were surgically treated and 5 cases remained under observation; all 24 cases achieved normal retinal correspondence or fusion or stereopsis on postoperative day 1 in synoptophore; in 23 cases diplopia or visual confusion resolved postoperatively. Of the 47 cases, brain and orbital imaging in 2 cases revealed a tumor in the cerebellopontine angle and 1 case involved spinocerebellar ataxia as revealed by genetic testing. AACE in this study was characterized by a sudden onset of concomitant nonaccommodative esotropia with diplopia or visual confusion at 5 years of age or older and the potential for normal binocular vision. We suggest that AACE can be divided into 2 subgroups consisting of patients with relatively small versus large angle deviations. Coexisting or underlying neurological diseases were infrequent in AACE. PMID:26705210

  13. 16 CFR 801.2 - Acquiring and acquired persons.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... confer control of X and therefore will file as an acquiring person. Because A held the plant prior to the... within two persons, “A” and “B.” Under this section, if V is to acquire corporation X, both “A” and “B... person. Examples: 1. Assume that person “Q” will acquire voting securities of corporation X held by...

  14. 16 CFR 801.2 - Acquiring and acquired persons.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... confer control of X and therefore will file as an acquiring person. Because A held the plant prior to the... within two persons, “A” and “B.” Under this section, if V is to acquire corporation X, both “A” and “B... person. Examples: 1. Assume that person “Q” will acquire voting securities of corporation X held by...

  15. The closure of postpalatoplasty fistula with local turn-down flap

    PubMed Central

    Erdenetsogt, J.; Ayanga, G. N.; Tserendulam, D.; Bayasgalan, R.

    2015-01-01

    Introduction: The three common complications after cleft palate repair are velopharyngeal incompetence, delayed maxillary growth, and fistula formation. Fistula formation rates are reported 0–76% in the literature. Wider palatal defects are more challenging to avoid excess tension, and recent reports suggest defects >15 mm have a significantly higher risk of fistula formation. By localization, the fistulas are divided into seven groups with Pittsburgh fistula classification system (PFCS). The timing of treatment of fistula can vary considerably, and a recurrence rate after surgical correction ranges 10–37%. Materials and Methods: Three patients with fistula in the hard palate (PFCS-4) in size 7–12 mm, between 2010 and 2012, who underwent fistula repair with local turn-down flap. In two cases, surgery was the first fistula repair and was the second repair in one case. The incisions in the frontal and bilateral edges were made around the fistula, in the distal side of fistula incision was made 3–5 mm longer than fistula size in the oral mucosa, and separate oral and nasal mucosa was rendered by organizing flap. This flap was turn-down and closed nasal side of fistula. The oral side of fistula was closed with the two-flap procedure by Bardach technique. Results: The postoperative wound was covered initially in all cases. Conclusion: We believe this two layer method for correction big palatal fistula is simpler than tongue, and buccal flap and patients need only intervention in this case. In addition, this method involves more effective usage of mucosal tissues bilaterally for closure on the oral side of the defect. PMID:26981487

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

    PubMed Central

    Valente, Michael A; Hull, Tracy L

    2014-01-01

    Rectovaginal fistula is a disastrous complication of Crohn’s disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women’s quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula. PMID:25400993

  17. Negotiating living with an arteriovenous fistula for hemodialysis.

    PubMed

    Richard, Cleo J; Engebretson, Joan

    2010-01-01

    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. PMID:20830944

  18. Asymptomatic spinal arteriovenous fistula presenting only as continuous murmur.

    PubMed

    Asada, Dai; Itoi, Toshiyuki; Hamaoka, Kenji

    2015-12-01

    Spinal arteriovenous fistula is extremely rare in children. Weakness and sensory disturbance in the lower extremities are the specific clinical presentations. Children, however, commonly have no subjective symptoms; in rare cases, a continuous murmur is the only physical finding. An 18-month-old boy was referred for evaluation of a continuous murmur audible at the back. He had no motor or sensory disorder; only a Levine 3/6 continuous murmur audible at the back was found. Echocardiography showed a structurally normal heart but indicated ascending continuous blood flow behind the aortic arch and dilatation of the innominate vein. We suspected spinal arteriovenous fistula, and it was visualized on computed tomography angiography. Spinal arteriovenous fistula was detected using only auscultation and echocardiography. Suspicion of this anomaly on careful auscultation and simple examination, and confirmation on detailed examination, even in the absence of motor or sensory disturbance, is important. PMID:26711922

  19. Successful treatment of a bronchopleural fistula after en masse lobectomy

    PubMed Central

    Ibe, Takashi; Kawatani, Natsuko; Ohsawa, Fumi; Yoshikawa, Ryohei

    2016-01-01

    A 72-year-old man underwent en masse lobectomy of the lower left lobe because of continued hemoptysis. We chose en masse lobectomy as a last resort because the patient had cardiopulmonary problems including chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and continued hemoptysis. The patient developed a bronchopleural fistula 2 weeks later, so the Clagett window procedure was performed. After gauze exchange and cleaning of the pleural space, the Clagett window was closed using a latissimus dorsi muscle flap. He was discharged about 3 months after the initial operation. One of the most critical complications after en masse lobectomy is a bronchopleural fistula because the bronchial stump and vessel are too close to each other. The space between the bronchus and vessel can fill with tissue, such as pulmonary parenchyma or lymph nodes, which cover the fistula. PMID:27621901

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

    PubMed

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

    1984-04-01

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

  1. Endovascular Management of Superior Mesenteric Artery Pseudoaneurysm and Fistula

    SciTech Connect

    Narayanan, Govindarajan; Barbery, Katuska; Lamus, Daniel; Nanavati, Kunal

    2008-11-15

    The uncommon presentation of an arterioportal fistula (APF) involving the superior mesenteric artery (SMA) associated with a pseudoaneurysm represents a therapeutic challenge. We present the case of a 24-year-old female admitted to the hospital after multiple gunshot wounds to the abdomen; the patient underwent multiple surgeries and, in the process, developed a SMA pseudoaneurysm and fistula. The vascular interventional radiology team was consulted for treatment of the pseudoaneurysm and fistula. A covered stent was inserted percutaneously to exclude the APF and the pseudoaneurysm in a single procedure. The patient returned to our service after 21 months for a follow-up CT scan, which demonstrated the stent and the distal vasculature to be patent.

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

    PubMed

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

    2016-05-01

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

  3. Successful treatment of a bronchopleural fistula after en masse lobectomy.

    PubMed

    Kamiyoshihara, Mitsuhiro; Ibe, Takashi; Kawatani, Natsuko; Ohsawa, Fumi; Yoshikawa, Ryohei

    2016-08-01

    A 72-year-old man underwent en masse lobectomy of the lower left lobe because of continued hemoptysis. We chose en masse lobectomy as a last resort because the patient had cardiopulmonary problems including chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and continued hemoptysis. The patient developed a bronchopleural fistula 2 weeks later, so the Clagett window procedure was performed. After gauze exchange and cleaning of the pleural space, the Clagett window was closed using a latissimus dorsi muscle flap. He was discharged about 3 months after the initial operation. One of the most critical complications after en masse lobectomy is a bronchopleural fistula because the bronchial stump and vessel are too close to each other. The space between the bronchus and vessel can fill with tissue, such as pulmonary parenchyma or lymph nodes, which cover the fistula. PMID:27621901

  4. Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

    PubMed Central

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

    2016-01-01

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

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

    SciTech Connect

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

    1984-01-01

    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.

  6. Embolization of a High-Output Postnephrectomy Aortocaval Fistula with Gianturco Coils and Cyanoacrylate

    SciTech Connect

    Cekirge, Saruhan; Oguzkurt, Levent; Saatci, Isil; Boyvat, Fatih; Balkanci, Ferhun

    1996-11-15

    The authors describe the endovascular treatment of a high-output, large-caliber, postnephrectomy aortocaval fistula using a mixture of cyanoacrylate and lipiodol combined with Gianturco coil embolization. Thirty-nine coils were used to decrease the flow through the fistula so that a fast-polymerizing glue mixture could be injected into the fistula. During rapid polymerization, the N-butyl-2-cyanoacrylate (NBCA) mixture was trapped within the coils, providing an easily controllable glue cast in the fistula, thereby preventing inadvertent embolization into the lungs. This approach can be of considerable benefit for the endovascular treatment of central high-output fistulas.

  7. Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

    PubMed Central

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

    2014-01-01

    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

  8. Endovascular Repair of a Secondary Aorto-Appendiceal Fistula

    SciTech Connect

    Tse, Donald M. L.; Thompson, Andrew R. A.; Perkins, Jeremy; Bratby, Mark J.; Anthony, Susan; Uberoi, Raman

    2011-10-15

    Aortoenteric fistula (AEF) is an uncommon but serious complication occurring after aortic surgery and may occur at any site in the gastrointestinal tract, with the duodenum being the most common. Conventional surgical repair of secondary AEF has high mortality, whereas endovascular repair has emerged as an alternative treatment despite concerns about persistent or recurrent infection. We report the case of a 91-year old man who was admitted with rectal bleeding from an aorto-appendiceal fistula 9 years after open abdominal aortic aneurysm repair. This rare site for AEF was diagnosed on computed tomography, and we present the first case of endovascular treatment of this uncommon complication.

  9. Dutch survey of congenital coronary artery fistulas in adults

    PubMed Central

    Said, S.A.M.; van der Werf, T.

    2006-01-01

    Aims This Dutch survey focused on the clinical presentation, noninvasive and invasive diagnostic methods, and treatment modalities of adult patients with congenital coronary artery fistulas (CAFs). Methods Between 1996 and 2003, the initiative was taken to start a registry on congenital CAFs in adults. In total 71 patients from a diagnostic coronary angiographic population of 30,829 at 28 hospitals were collected from previously developed case report forms. Patient demographic data, clinical presentation, noninvasive and invasive techniques and treatment options were retrospectively collected and analysed. Results Out of 71 patients with angiographically proven CAFs, 51 (72%) had 63 congenital solitary fistulas and 20 (28%) had 31 congenital coronary-ventricular multiple microfistulas. Patients with pseudofistulas were excluded from the registry. Coronary angiograms were independently re-analysed for morphology and specific fistula details. The majority (72%) of the fistulas were unilateral, 24% were bilateral and only 4% were multilateral. The morphological characteristics of these 94 fistulas were as follows: the origin was multiple in 47% and single in 53%; the termination was multiple in 52% and single in 48%; and the pathway of the fistulous vessels was tortuous/multiple in 66%, tortuous/single in 28%, straight/multiple in 3% and straight/single in 3%. Percutaneous transluminal embolisation (PTE) was performed in two (3%) patients; surgical ligation was undertaken in 13 (18%) patients. The overwhelming majority of the patients (56; 79%) were treated with conservative medical management. The total mortality was 6% (4/71) at a mean follow-up period of approximately five years. Cardiac mortality accounted for 4% (3/71); in all three patients, death could possibly be attributed to the presence of the fistula. Conclusion Registry of congenital coronary artery fistulas in adults in the Netherlands is feasible. In spite of restrictions imposed by the Dutch Privacy

  10. Endovascular treatment of tracheoinnominate artery fistula: a case report.

    PubMed

    Palchik, Eugene; Bakken, Andrew M; Saad, Nael; Saad, Wael E; Davies, Mark G

    2007-01-01

    Tracheoinnominate fistula is a rare but lethal condition that requires emergent surgical intervention to prevent ensuing exsanguinating hemorrhage. In clinical situations where the risk of open surgery is prohibitively high, endovascular repair may provide a life-saving alternative to control hemorrhage and serve as a temporizing or definitive solution based on a given clinical scenario. The authors report successful endovascular repair of the bleeding tracheoinnominate fistula with a stent in a liver transplant patient with high comorbidities and review the current literature. PMID:17595395

  11. Endovascular repair of tracheo-innominate artery fistula.

    PubMed

    Wang, Po-Kai; Yen, Pao-Sheng; Shyr, Ming-Hwang; Chen, Tsung-Ying; Chen, Albert; Liu, Hsu-Tang

    2009-03-01

    Innominate arterial wall rupture with pseudoaneurysm formation was found during angiography in a 39-year-old woman 2 days after she had undergone percutaneous dilatational tracheostomy. Endovascular stent surgery and balloon angioplasty were performed but these procedures failed to control the massive bleeding resulting from an endoleak. We report the clinical presentations and describe the treatment of a tracheo-innominate artery fistula in our patient. We also reviewed the algorithms of management and the rescue options for treating a tracheo-innominate artery fistula. PMID:19318299

  12. Angiographic and Interventional Management for a Esophagopericardial Fistula

    SciTech Connect

    Wu, Keng You, Qiong He, Song-Jian; Mo, Hai-Liang

    2013-06-19

    We reported a case of a 78-year-old patient with esophagopericardial fistula who was referred for angiographic and interventional management. Emergent implantation of the esophageal stent could not lengthen or even save the patient’s life. One week later, the patient died of multiple organ failure, which was probably from formation of granulation tissue and stent migration. Therefore, if the inflammatory to the esophagopericardial fistula had been better controlled initially, and the implantation of the esophageal stent delayed, our patient would have survived.

  13. Facial palsy following embolization of a dural arteriovenous fistula.

    PubMed

    Ozluoglu, Levent N; Koycu, A; Jafarov, S; Hizal, E; Boyvat, F

    2016-09-01

    Intracranial arteriovenous malformations are infrequent. Advances in endovascular treatment techniques have promoted the use of endovascular embolization in management of intracranial arteriovenous malformations. Transvenous or transarterial embolization procedures are effective options in the treatment of the arteriovenous fistulas. However, complications such as cranial nerve palsies may occur. Here, we present a case of right-sided lower motor neuron facial paralysis due to embolization of an intracranial dural arteriovenous fistula that have presented with clinical findings on the left eye. Facial functions of the patient improved from total weakness to House-Brackmann grade II, following facial nerve decompression surgery. PMID:26329900

  14. Colo-articular fistula following a Girdlestone resection arthroplasty

    PubMed Central

    El-Daly, Ibraheim; Natarajan, Brenavan; Rajakulendran, Karthig; Symons, Sean

    2014-01-01

    Colo-articular fistulas are rare complications that are usually associated with inflammatory, infective or malignant bowel disease. We report the case of a 44-year-old male who was found to have a colo-articular fistula intra-operatively during the washout of a septic hip joint. The patient had no pre-existing bowel disease, but was an intravenous drug user, who had previously undergone a Girdlestone procedure for osteomyelitis of the proximal femur. The patient was managed through a multi-disciplinary team approach with subsequent debridement and formation of a transverse loop colostomy to control the faeculent fistulous discharge. PMID:24876512

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

    PubMed Central

    Priddy, Erin; Harris, John J.; Poulos, Eric

    2016-01-01

    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. PMID:27293944

  16. [Labial recurrent swelling revealing median congenital upper-lip fistula].

    PubMed

    Rohart, J; Nicot, R; Myon, L; Elbaz, J; Raoul, G; Ferri, J

    2015-11-01

    Midline upper-lip fistulas are an extremely rare variant of congenital facial malformations. Less than 30 cases have been reported in the literature since 1970. We report the case of a 2 and a half-year-old girl presenting with a median congenital blind fistula of the upper lip, without any relation with the oral cavity. A recurrent swelling of the upper lip was the main symptom. Complete surgical excision of the cyst or of the fistulous tract must be obtained to avoid recurrence. PMID:26138739

  17. Tracheoinnominate fistula: a rare acute complication of penetrating neck injury.

    PubMed

    Kulyapina, Alena; Díaz, Dolores Pérez; Rodríguez, Teresa Sanchez; Fuentes, Fernando Turegano

    2015-05-01

    Penetrating injuries in the base of the neck are considered to be the most dangerous due to the potential combination of vascular and intrathoracic lesions. We describe an extremely rare case of combined injury of the trachea and innominate artery, which resulted in formation of a traumatic acute tracheoinnominate fistula. Previously, these fistulas have been described as an iatrogenic complication of tracheostomy, presenting with massive peristomal bleed or hemoptysis. This case demonstrates that a combination of lesions to vital anatomical structures in the neck can change their clinical presentation, making them extremely difficult to diagnose. PMID:24948779

  18. Gastroesophageal variceal bleeding caused by hepatoportal arteriovenous fistula.

    PubMed

    Tzeng, J J; Lai, K H; Wen, S C; Lo, G H; Hsueh, C W; Chang, T H

    2000-08-01

    Hepatoportal arteriovenous fistulas are usually traumatic in origin and may result in portal hypertension and serious complications. We report a 34-year-old female with a history of abdominal trauma, who developed symptoms of tarry stools and hematemesis 5 years later. Esophageal and gastric varices with bleeding were diagnosed by upper gastrointestinal endoscopy. Abdominal ultrasonography and computerized tomography favored noncirrhotic portal hypertension. An extrahepatic hepatoportal arteriovenous fistula was demonstrated by angiography. The patient underwent surgery to correct the condition. The liver had a smooth surface and both the common hepatic and gastroduodenal arteries were ligated during surgery. The postoperative course was uneventful. The varices later disappeared. PMID:10969452

  19. Coblation-assisted closure of persistent tracheocutaneous fistulae.

    PubMed

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

    2016-06-01

    Persistent tracheocutaneous fistulae (PTCFs) are sequelae of long-term tracheostomy tube use, and while many procedures exist to correct this issue, several are invasive and incur risk to the patient. This case study discusses a minimally invasive approach to closure of small PFTFs with a coblator device that may reduce the risks associated with other closure procedures. We demonstrated successful tracheocutaneous fistulae closure after coblation in all 4 patients that the operation was performed. We believe this technique can be considered for patients under select circumstances and can be part of a surgeon's armamentarium for the treatment of small PTCFs. PMID:27240508

  20. Giant Supratrigonal Vesicocervicovaginal Fistula – A Case Report

    PubMed Central

    Bose, Chinmoy K; Basu, Amit; Kanjilal, Subir; Basu, Srabani

    2005-01-01

    Vesicovaginal fistula (VVF) is prevalent in the developing world, with recent estimates suggesting that 2 million women live with fistula, mainly in sub-Saharan Africa and South Asia. VVF is associated with urogenital infections and ammonia dermatitis, and the psychosocial ramifications may be devastating, as women may be socially isolated from their families and community. VVF also remains a challenging condition for the gynecologic surgeon. We present a case of a giant supratrigonal VVF repaired using an abdominal (suprapubic) transperitoneal transvesical approach. PMID:16614696

  1. Benign duodenocolic fistula as a complication of peptic ulcer disease

    PubMed Central

    Kamani, Fereshteh; Abrishami, Alireza

    2014-01-01

    A 44-year-old man with upper abdominal pain, diarrhea and 25 kg weight loss since 3 months ago was admitted. He had a history of dyspepsia and peptic ulcer disease 4 months before admission. Gastroduodenal endoscopy and upper gastrointestinal series with barium study were done. Biopsies and CT-scan ruled out malignancies. Endoscopy and radiology studies revealed a duodenocolic fistula. He underwent right hemicolectomy, fistula en bloc excision, and distal gastrectomy surgery with gastrojejunostomy and ileocolic anastomosis. Radiologic modalities are necessary before surgery. Surgery is the only curative treatment in benign cases and reconstruction method is dependent on patient's situation. PMID:25436101

  2. Cavernous Sinus Dural Fistula Treated by Transvenous Facial Vein Approach

    PubMed Central

    Prochazka, V.; Cizek, V.; Kacirova, R.

    2004-01-01

    Summary We report on the endovascular treatment of the spontaneous indirect dural carotid cavernous sinus type D fistula in a 60-year-old woman, in whom ipsilateral facial, angular and superior ophthalmic veins catheterization was performed to get access to the fistula site for embolization treatment. Approach via the facial vein is helpful after inferior petrosal sinus treatment failure. Although this technique requires caution in the angular vein region it allows a safe and effective treatment of these lesions. 3D rotational digital angiography can obtain more information of the angioarchitecture of the cavernous plexus and venous outflow for the catheter navigation. PMID:20587267

  3. Management of Traumatic Sinus of Valsalva-Right Ventricular Fistulae

    PubMed Central

    Murphy, J. Peter; Weiland, Anne P.; Adams, Phillip R.; Walker, William E.

    1986-01-01

    Residual intracardiac defects following penetrating injuries to the heart require thorough invasive evaluation and strong consideration for operative repair based upon the degree of hemodynamic compromise. Traumatic aortico-right ventricular fistulae result in high flow left-to-right shunts, and are associated with early onset of congestive failure. Operative repair requires utilization of total cardiopulmonary bypass, ventriculotomy and aortotomy to allow for thorough inspection of the ventricular septum, aortic valve cusps, and coronary ostia. Obliteration of both ends of the fistula (septal and sinus of Valsalva repair) minimizes the risk of recurrence. Images PMID:15227364

  4. Can primary failure of arteriovenous fistulas be anticipated?

    PubMed

    Gibyeli Genek, Dilek; Tuncer Altay, Canan; Unek, Tarkan; Sifil, Aykut; Seçil, Mustafa; Camsari, Taner

    2015-04-01

    Primary failure, early thrombosis, and inadequate maturation are the main complications encountered in arteriovenous fistulas. Doppler ultrasonographic assessment of flow-mediated dilatation (FMD) is currently used for the early diagnosis of atherosclerosis. Clinical experience in the use of FMD for preoperative assessment of vasculature is rather limited; therefore, we sought to elucidate the relationship between preoperative FMD and primary failure of the fistula. Thirty-three patients with end-stage renal disease who were admitted to our hospital between January and July 2005 were included in our study. Medical histories were established and the internal diameter, wall thickness, peak systolic flow rate, and resistive index (RI) were measured in the cephalic vein and radial and brachial arteries. Flow-mediated dilatation and nitrate-mediated dilatation (NMD) of the brachial artery were assessed. Fistulas were evaluated 48 hours and 30 days postoperatively. Brachial arterial internal diameter was lower in all fistulas that developed primary failure in 48 hours (0.4 ± 0.07 cm vs. 0.35 ± 0.07 cm, P = 0.016). The radial artery RI was found to be significantly elevated in fistulas with both early (48-hour) and late-term (30-day) failure (0.9 ± 0.08 vs. 0.68 ± 0.3, P = 0.01, and 0.86 ± 0.8 vs. 0.67 ± 0.3, P = 0.038, respectively). The brachial artery peak systolic flow rate was significantly reduced in patients in the radiocephalic fistula group that developed early and late-term failure (42.9 ± 12 cm/sec vs. 68.4 ± 10 cm/sec, P = 0.01, and 44.1 ± 13 cm/sec vs. 57.7 ± 16 cm/sec, P = 0.038, respectively). Our study, constrained by a smaller, older patient group, was unable to show a statistically significant correlation between FMD, NMD, and fistula success. Any single parameter may not be sufficient to assess vascular health preoperatively. A multifactorial approach incorporating

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

    PubMed Central

    Kramer, Scott; Tzimas, Demetrios; Saitta, Patrick

    2016-01-01

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

  6. Over-the-scope clip closure of gastrocutaneous fistula.

    PubMed

    Rodrigues-Pinto, Eduardo; Pereira, Pedro; Vilas-Boas, Filipe; Macedo, Guilherme

    2016-09-01

    A 35-year-old female patient, with Batten's disease, submitted to a surgical gastrostomy in 2005, and had it replaced in 2007, 2011 and 2014 with one with a filled balloon as its internal retention mechanism. In 2015, she presented to the emergency room due to stomal enlargement, leakage and chemical dermatitis and cellulitis. A 12 mm over-the-scope clip was placed, after anchoring the fistula edges with the twin grasper and suction of the defect into the applicator cap. Endoscopic resolution of the fistula was achieved. PMID:27615017

  7. Results of endoscopic and surgical fistula treatment in oesophagointestinal anastomosis after gastrectomy

    PubMed Central

    Ciostek, Piotr; Petryka, Robert; Słowik, Jakub; Jarosz, Mirosław

    2015-01-01

    Introduction Intestinal fistulas occur in 4–8% of cases of upper gastrointestinal tract surgery. Until now, surgery has been the standard of treating fistulas in oesophagointestinal anastomosis. The use of stents and haemoclips still causes much controversy, but more and more publications present good results with this type of treatment. Aim To present results of endoscopic and surgical treatment of fistulas in oesophagointestinal anastomosis after gastrectomy. Material and methods A fistula in the oesophagointestinal anastomosis was observed in 23 (4.8%) patients within an 18-year period. The indications for endoscopic treatment were small fistulas (< 50 ml/day), and large (> 50 ml/day) fistulas in subjects with no symptoms of peritonitis or abscess were treated with implantation a of covered stent. Surgical treatment was performed with a large fistula leading to peritonitis and complicated gangrene of margins and/or the presence of abscess. Results Four subjects were treated endoscopically with the use of haemoclips, resulting in 50% technical and clinical success. We implanted stents in 12 patients. Technical success was achieved in all the patients, yet permanent closure of the fistula was reported for 8 (66%) subjects. The percentage of patients operated on for fistula was 33%. We recorded 4 deaths in this group. Conclusions The use of haemoclips in treatment of small fistulas, and self-expandable, covered stents in treatment of medium and large fistulas, is an effective method that shortens the hospitalisation period and accelerates introduction of oral nutrition while reducing the number of fatal complications. PMID:26865886

  8. Treatment of urethrorectal fistulas caused by radical prostatectomy – two surgical techniques

    PubMed Central

    Krajka, Kazimierz; Fudalewski, Tomasz; Matuszewski, Marcin

    2014-01-01

    Introduction The repair of complex urethrorectal fistulas, which can be the result of treating prostate cancer with radical prostatectomy, is a big problem in urology and its final result is not always satisfactory. There are no universally accepted methods for repairing such fistulas. In our work we present a retrospective analysis of patients treated for urethrorectal fistulas after previous radical prostatectomy. The methods used were the initial excision and suture of the fistula, or a gracilis muscle flap interposition. Material and methods In the years 2000–2012, four patients were treated because of urethrorectal fistulas after radical prostatectomy. In two patients, open radical prostatectomy had been performed. Two other patients had been operated laparoscopically. Two patients had a primary fistula repair. They were operated using anterior perineal access. Two others were treated with the use of a gracilis muscle flap. Results During the follow up, there was no recurrence of fistulas. Medium follow up for the first two patients was 120 and 156 months, and follow up of two other patients was 16 and 23 months. Until now, there were no final postoperative complications. Conclusions Repair of the fistulas requires an individual approach to each case. Excision and suturing of the fistula gives a very good final result, especially when the primary reconstruction is performed. Repair of urethrorectal fistula using a gracilis muscle flap appears to be an excellent option in cases of complex recurrent fistulas. It is also associated with low morbidity in patients and a high success rate. PMID:24982792

  9. 16 CFR 801.2 - Acquiring and acquired persons.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... acquired person is the pre-acquisition ultimate parent entity of the entity. (ii) The value of an... directors of B. A is deemed to be acquiring all of the assets of B as a result. (g) Transfers of patent... transfer of patent rights covered by this paragraph constitutes an asset acquisition; and (3) Patent...

  10. Children Acquire Emotion Categories Gradually

    ERIC Educational Resources Information Center

    Widen, Sherri C.; Russell, James A.

    2008-01-01

    Some accounts imply that basic-level emotion categories are acquired early and quickly, whereas others imply that they are acquired later and more gradually. Our study examined this question for fear, happiness, sadness, and anger in the context of children's categorization of emotional facial expressions. Children (N=168, 2-5 years) first labeled…

  11. Dental implant complications - extra-oral cutaneous fistula.

    PubMed

    Mahmood, R; Puthussery, F J; Flood, T; Shekhar, K

    2013-07-01

    Dental implants have shown great success in recent years. However, in certain circumstances they can suffer from complications. It usually results from a combination of infection and host inflammatory responses or a lack thereof. This report documents an extra-oral cutaneous fistula associated with an osseointegrated dentoalveolar implant. PMID:23887526

  12. Suprasternal approach for impending tracheo-innominate artery fistula.

    PubMed

    Fujimoto, Yoshifumi; Hirose, Keiichi; Ota, Noritaka; Murata, Masaya; Ide, Yujiro; Tosaka, Yuko; Tachi, Maiko; Sakamoto, Kisaburo

    2010-09-01

    We report preventive innominate artery division or ligation through a suprasternal approach for impending tracheo-innominate artery fistula (TIF) with recurrent airway oozing in patients with severe neuromuscular disease. Our approach is less invasive and a favorable procedure as preventive surgery for impending TIF. PMID:20859729

  13. Closure of Bronchopleural Fistula with Angio-Seal

    SciTech Connect

    Pianta, Marcus; Vargas, Patricio; Niedmann, Juan; Lyon, Stuart

    2011-02-15

    Bronchopleural fistula is rare and occurs most often after trauma or surgery. Conservative management and support comprise the initial treatment, but if unsuccessful, surgical closure is usually required. We describe for what is to our knowledge the first successful use of an Angio-Seal vascular closure device in a patient who was not a candidate for surgery.

  14. Bilateral Cutaneous Fistula After the Placement of Zygomatic Implants.

    PubMed

    Garcia Garcia, Blas; Ruiz Masera, Juan Jose; Insert Last Name, Insert First Name Insert Middle Name; Zafra Camacho, Francisco Manuel

    2016-01-01

    Zygomatic implants are used to restore function in patients with highly edentulous atrophic maxillae, in which it is not possible to place conventional implants. The aim of this paper is to present a case of bilateral cutaneous fistula after placement of zygomatic implants and the treatment performed to resolve the condition, as well as to establish a hypothesis regarding the etiology of these lesions. Presented is a 59-year-old woman with an atrophic edentulous maxilla who received four zygomatic implants. At 8 months and 31 months after implant placement on the right and left sides, respectively, the patient developed inflammatory lesions in the lateral aspect of both orbits that evolved toward developing a fistula within weeks. The patient underwent surgery in both cases. Complications of zygomatic implants are relatively common but rarely involve the loss or removal of implants. In this case, the patient retained her implants, and several months after resection of both fistulae, the patient is asymptomatic without recurrence of the lesions. The probable cause of the occurrence of the fistula could be an accumulation of sinus mucosa remnants, periosteum, and bone particles at the malar level as a result of poor irrigation at the time of implant placement. PMID:26478973

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

    ERIC Educational Resources Information Center

    Backous, Douglas D.; Niparko, John K.

    1997-01-01

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

  16. Volume flow in arteriovenous fistulas using vector velocity ultrasound.

    PubMed

    Hansen, Peter Møller; Olesen, Jacob Bjerring; Pihl, Michael Johannes; Lange, Theis; Heerwagen, Søren; Pedersen, Mads Møller; Rix, Marianne; Lönn, Lars; Jensen, Jørgen Arendt; Nielsen, Michael Bachmann

    2014-11-01

    Volume flow in arteriovenous fistulas for hemodialysis was measured using the angle-independent ultrasound technique Vector Flow Imaging and compared with flow measurements using the ultrasound dilution technique during dialysis. Using an UltraView 800 ultrasound scanner (BK Medical, Herlev, 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 was estimated to be 242 mL/min and 404 mL/min lower than the ultrasound dilution technique estimate, depending on the approach. The standard deviations of the two Vector Flow Imaging approaches were 175.9 mL/min and 164.8 mL/min compared with a standard deviation of 136.9 mL/min using the ultrasound dilution technique. The study supports that Vector Flow Imaging is applicable for volume flow measurements. PMID:25282482

  17. Interventional Radiology in Hemodialysis Fistulae and Grafts: A Multidisciplinary Approach

    SciTech Connect

    Turmel-Rodrigues, Luc; Pengloan, Josette; Bourquelot, Pierre

    2002-01-15

    Purpose: To review the place of interventional radiology in arteriovenous access for hemodialysis. Methods: Prophylactic dilation of stenoses greater than 50% associated with clinical abnormalities such as flow-rate reduction is warranted to prolong access patency. Stents are placed only in selected cases with clearly insufficient results of dilation but they must never overlap major side veins and obviate future access creation. Thrombosed fistulae and grafts can be declotted by purely mechanical methods or in combination with a lytic drug. Results: The success rates are over 90% for dilation, with frequent resort to stents in central veins. Long-term results in the largest series are better in forearm native fistulae compared with grafts (best 1-year primary patency: 51% versus 40%). The success rates for declotting are better in grafts compared with forearm fistulae but early rethrombosis is frequent in grafts so that primary patency rates can be better for native fistulae from the first month's follow-up (best 1-year primary patency: 49% versus 26%). Conclusion: Radiology achieves results comparable with surgery, with minimal invasiveness and better venous preservation. However, wide variations in the results suggest that the degree of commitment of physicians might be as important as the type of technique used.

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

    PubMed

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

    2015-04-01

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

  19. Cholecystocutaneous fistula containing multiple gallstones in a dog

    PubMed Central

    Fabbi, Martina; Volta, Antonella; Quintavalla, Fausto; Zubin, Elena; Manfredi, Sabrina; Martini, Filippo M.; Mantovani, Luciana; Tribaudino, Mario; Gnudi, Giacomo

    2014-01-01

    A 7-year-old dog was presented with a history of an open lesion on the right thoracic wall, discharging honey-like fluid and small stones. Ultrasonography and computed tomographic fistulography identified a cholecystocutaneous fistula; cholecystectomy was curative. Veterinarians should consider this disease in patients with long-term discharging lesions on the right thoracic or abdominal wall. PMID:25477544

  20. Aorto-conduit fistula developing four years after esophagectomy.

    PubMed

    Strong, S; Higgs, S; Streets, C; Titcomb, D; Barham, P; Blazeby, J; Hollowood, A

    2012-01-01

    A 71 year old lady was treated for a squamous cell carcinoma of the oesophagus with neo-adjuvant chemotherapy followed by a two phase Ivor-Lewis oesophagectomy with two field lymphadenectomy. She presented four years later with life threatening bleeding from a fistula between the thoracic aorta and the gastric conduit, which was treated successfully with a thoracic aortic stent. PMID:24960784

  1. System identification of perilymphatic fistula in an animal model

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

  2. Is modern management of fistula-in-ano acceptable?

    PubMed

    Oldfield, Frances; Gilbert, Timothy; Skaife, Paul

    2016-07-01

    Fistula-in-ano has been managed by a number of techniques and there remains no consensus on the most appropriate management for all patients. The mainstay of any treatment balances the need to control sepsis vs the risk of potential incontinence post-intervention. Management should focus on the primary source of sepsis. PMID:27388377

  3. Stent-Graft Repair of Peroneal Arteriovenous Fistula

    SciTech Connect

    Piffaretti, Gabriele Tozzi, Matteo; Lomazzi, Chiara; Rivolta, Nicola; Lagana, Domenico; Carrafiello, Gianpaolo; Caronno, Roberto; Castelli, Patrizio

    2007-02-15

    Arteriovenous fistulas (AVFs) are infrequently seen in the civilian health-care system; traditionally, these lesions have been treated with ligation, or direct surgical repair with concomitant revascularization. We describe a rare case of a peroneal AVF treated with a stent-graft.

  4. Incidental demonstration of pericardial fistula during hepatobiliary scintigraphy

    SciTech Connect

    Marlatt, S.W.; Caride, V.J.; Prokop, E.K. )

    1991-03-01

    Biliary vomiting developed 16 mo after resection of adenocarcinoma of the esophagus in a patient with a complex postoperative course. A biliary scan revealed an outline of the pericardium, suggesting a fistula. The potential role of radionuclide imaging in this rare and potentially fatal complication is discussed.

  5. Hemodynamics in the Cephalic Arch of a Brachiocephalic Fistula

    PubMed Central

    Boghosian, M.; Cassel, K.; Hammes, M.; Funaki, B.; Kim, S.; Qian, X.; Wang, X.; Dhar, P.; Hines, J.

    2014-01-01

    The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year. PMID:24695337

  6. Pudendal thigh flap for repair of rectovaginal fistula.

    PubMed

    Sathappan, S; Rica, M A I

    2006-08-01

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

  7. Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas

    PubMed Central

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Lv, Ming; Zhang, Jingbo; Wu, Zhongxue

    2008-01-01

    Summary The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fu-siform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons
2/15. Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection. Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities. PMID:20557743

  8. Hemodynamics in the cephalic arch of a brachiocephalic fistula.

    PubMed

    Boghosian, M; Cassel, K; Hammes, M; Funaki, B; Kim, S; Qian, X; Wang, X; Dhar, P; Hines, J

    2014-07-01

    The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year. PMID:24695337

  9. Persistent oronasal fistula after primary management of facial gunshot injuries.

    PubMed

    Majid, Omer W

    2008-01-01

    We present our experience of treating 42 young men with facial gunshot injuries, 9 of whom had associated palatal injuries. We attempted definitive treatment at the primary operation, but five patients with palatal injuries presented with oronasal fistula postoperatively and required secondary intervention. Three patients underwent surgical closure using palatal transposition flap, in all of whom it was successful. PMID:17196310

  10. An unusual presentation of right coronary artery fistula.

    PubMed Central

    Rein, A J; Yatsiv, I; Simcha, A

    1988-01-01

    A four year old girl with infective endocarditis had unexplained facial swelling. Cross sectional echocardiography showed that a large right coronary artery fistula to the right atrium was obstructing the distal superior vena cava. The diagnosis was confirmed by cardiac catheterisation and at operation. The child was symptom free one year after operation. Images Fig 1 Fig 2 PMID:3382575

  11. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis: A 4-Year Single-Center Experience.

    PubMed

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

    2016-04-01

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

  12. Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula.

    PubMed

    Lee, Jookyung; Lim, Young-Min; Suh, Dae Chul; Rhim, Seung Chul; Kim, Sang Joon; Kim, Kwang-Kuk

    2016-04-01

    Spinal dural arteriovenous fistula (SDAVF) is a relatively common acquired vascular malformation of the spinal cord. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. Diagnosis of a SDAVF is often delayed, and some patients receive unnecessary treatment and treatment delays, often resulting in a poor outcome. The aim of this study was to characterize the clinical presentation, typical imaging findings, and long-term outcome of SDAVF. Forty patients (13 women, 27 men; mean age 58.18 ± standard deviation 14.75 years) who were treated at our hospital from June 1992 to March 2014 were retrospectively reviewed. We investigated the baseline characteristics, clinical presentation, imaging findings, treatment modalities, and outcome of the patients. The most common clinical presentation was a sensory symptom (80%), followed by motor weakness (70%), and sphincter dysfunction (62.5%). Roughly one-third (32.5%) of patients had a stepwise progression of fluctuating weakness and sensory symptoms, but the most common presentation was chronic progressive myelopathic symptoms (47.5%). Thirty-four patients (85%) had T2 signal change on the spinal cord MRI, indicative of cord edema. Thirty-eight patients had typical perimedullary vessel flow voids on T2-weighted MRI. Twenty-eight patients were treated with endovascular embolization, five patients underwent surgery, and four patients underwent both. Clinical outcome was determined by severity of initial deficit (p=0.008), extent of cord edema (p=0.010), treatment failure (p=0.004), and a residual fistula (p=0.017). SDAVF causes a treatable myelopathy, so early diagnosis and intervention is essential. PMID:26765752

  13. Management of Vesicovaginal Fistulae: A Multicenter Analysis From the Fellows’ Pelvic Research Network

    PubMed Central

    Oakley, Susan H.; Brown, Heidi W.; Greer, Joy A.; Richardson, Monica L.; Adelowo, Amos; Yurteri-Kaplan, Ladin; Lindo, Fiona M.; Greene, Kristie A.; Fok, Cynthia S.; Book, Nicole M.; Saiz, Cristina M.; Plowright, Leon N.; Harvie, Heidi S.; Pauls, Rachel N.

    2016-01-01

    Objectives Vesicovaginal fistulae (VVF) are the most commonly acquired fistulae of the urinary tract, but we lack a standardized algorithm for their management. The purpose of this multicenter study was to describe practice patterns and treatment outcomes of VVF in the United States. Methods This institutional review board–approved multicenter review included 12 academic centers. Cases were identified using International Classification of Diseases codes for VVF from July 2006 through June 2011. Data collected included demographics, VVF type (simple or complex), location and size, management, and postoperative outcomes. χ2, Fisher exact, and Student t tests, and odds ratios were used to compare VVF management strategies and treatment outcomes. Results Two hundred twenty-six subjects were included. The mean age was 50 (14) years; mean body mass index was 29 (8) kg/m2. Most were postmenopausal (53.0%), nonsmokers (59.5%), and white (71.4%). Benign gynecologic surgery was the cause for most VVF (76.2%). Most of VVF identified were simple (77.0%). Sixty (26.5%) VVF were initially managed conservatively with catheter drainage, of which 11.7% (7/60) resolved. Of the 166 VVF initially managed surgically, 77.5% resolved. In all, 219 subjects underwent surgical treatment and 83.1% of these were cured. Conclusions Most of VVF in this series was managed initially with surgery, with a 77.5% success rate. Of those treated conservatively, only 11.7% resolved. Surgery should be considered as the preferred approach to treat primary VVF. PMID:24368481

  14. Fluidodynamic evaluation of arteriovenous fistulae for hemodialysis.

    PubMed

    Liepsch, D; Pallotti, G; Colì, L; Donati, G; Losinno, F; Freyrie, A; Stefoni, S

    2003-01-01

    Arteriovenous fistulae (AVF) are commonly used in dialysis treatment of uremic patients. However, many AVF create problems and have to be re-examined. Problems arise in the cannulation site and must be treated with antibiotics, and stenosis, both in the arterial and in the venous side of the AVF. In the worst case, the AVF must be replaced for treatment to continue. However, this can only be repeated once before the AVF site is no longer viable. This increases the discomfort, the morbidity and the mortality of the dialysis patient. Several kinds of AVF were studied to determine whether flow disturbances give rise to these complications. Many studies have already demonstrated the importance of hemodynamic factors in vascular disease pathogenesis. These factors include: the pulsatility of flow, the elasticity of the vessel, the non-Newtonian blood, flow behavior and, very importantly for AVF, the vessel geometry. In model studies, intimal changes have been observed in bends and bifurcations, regions of vessel construction and vessel stenosis. In these regions, blood flow changes abruptly and this contributes to arterial disease. We prepared several one-to-one, true-to-scale elastic silicon rubber models of different AVF. The AVF models were based on angiographic studies of chronic dialysis patients and on AVF from the arms of cadavers. The models had a similar compliance to that of the human blood vessel. Flow was visualized using photoelasticity apparatus and a birefringent blood-like fluid. This method is suitable to analyze the spatial configuration of flow profiles, to differentiate laminar flow from disturbed flow, and to visualize flow separation, vortex formation and secondary flow. It was found that AVF create disturbances that are not found under normal physiological flow conditions. The X-formed AVF was very unsatisfactory, creating significant flow disturbances. The AVF had high velocity fluctuations. These could lead, for example, to aneurysm formation. A

  15. Laparoscopic repair of urogenital fistulae: A single centre experience

    PubMed Central

    Sharma, Sumit; Rizvi, Syed Jamal; Bethur, Santhosh Shivanandaiah; Bansal, Jyoti; Qadri, Syed Javid Farooq; Modi, Pranjal

    2014-01-01

    CONTEXT: Sparse literature exists on laparoscopic repair of urogenital fistulae (UGF). AIMS: The purpose of the following study is to report our experience of laparoscopic UGF repair with emphasis on important steps for a successful laparoscopic repair. SETTINGS AND DESIGN: Data of patients who underwent laparoscopic repair of UGF from 2003 to 2012 was retrospectively reviewed. MATERIALS AND METHODS: Data was reviewed as to the aetiology, prior failed attempts, size, number and location of fistula, mean operative time, blood loss, post-operative storage/voiding symptoms and episodes of urinary tract infections (UTI). RESULTS: Laparoscopic repair of 22 supratrigonal vesicovaginal fistulae (VVF) (five recurrent) and 31 ureterovaginal fistulae (UVF) was performed. VVF followed transabdominal hysterectomy (14), lower segment caesarean section (LSCS) (7) and oophrectomy (1). UVF followed laparoscopy assisted vaginal hysterectomy (18), transvaginal hysterectomy (2) and transabdominal hysterectomy (10) and LSCS (1). Mean VVF size was 14 mm. Mean operative time and blood loss for VVF and UVF were 140 min, 75 ml and 130 min, 60 ml respectively. In 20 VVF repairs tissue was interposed between non-overlapping suture lines. Vesico-psoas hitch was done in 29 patients of urterovaginal fistulae. All patients were continent following surgery. There were no urinary complaints in VVF patients and no UTI in UVF patients over a median follow-up of 3.2 years and 2.8 years respectively. CONCLUSION: Laparoscopic repair of UGF gives easy, quick access to the pelvic cavity. Interposition of tissue during VVF repair and vesico-psoas hitch during UVF repair form important steps to ensure successful repair. PMID:25336817

  16. Ophthalmologic outcome of direct and indirect carotid cavernous fistulas.

    PubMed

    Grumann, Astor Junior; Boivin-Faure, Laeticia; Chapot, René; Adenis, Jean Paul; Robert, Pierre Yves

    2012-04-01

    Carotid cavernous fistulas (CCFs) can be classified as direct and indirect, depending on their flow rates and their etiology. Both forms can cause the same characteristic ophthalmological symptoms and signs. We analyzed these ocular characteristics and determined the prognostics factors associated with treatment outcome. Forty-seven patients with an angiographically confirmed diagnosis of CCF, a preoperative ophthalmic evaluation and at least one ophthalmic sign or symptom at the initial presentation were retrospectively evaluated. The patients were followed-up ophthalmically until the end of treatment, and the complications and the remaining ophthalmological signs and symptoms were then recorded. The patients' ages ranged from 13 to 89 years, with an average of 55.78 (±20.73) years, and a predominance of 28 female (57.8 %) patients. The patients with a direct CCF had a lower average age (p = 0.02). The most common symptoms were blurred vision in 17 (36.2 %) and proptosis in 37 (78.7 %) patients. Elevated intraocular pressure (IOP) was more prevalent in patients with an indirect CCF (p = 0.02). Thrill was more prevalent in patients with direct CCF (p = 0.01). The presence of an initial decrease of visual acuity at the first ophthalmic evaluation was significantly associated with the persistence of ocular symptoms after fistula treatment (odds ratio 3.33). In conclusion our study shows a slight difference in ophthalmic symptoms among patients with different types of fistula. Elevated IOP was significantly associated with indirect fistulas, whereas thrill was significantly associated with direct fistulas. The presence of an initial decrease of visual acuity was significantly associated with a worse ophthalmic prognosis. PMID:22447030

  17. Acquired double pylorus: Clinical and endoscopic characteristics and four-year follow-up observations.

    PubMed

    Lei, Jing-Jing; Zhou, Li; Liu, Qi; Xu, Chun-Fang

    2016-02-14

    Double pylorus (DP), or duplication of the pylorus, is an uncommon condition that can be either congenital or acquired. Acquired DP (ADP) occurs when a peptic ulcer erodes and creates a fistula between the duodenal bulb and the distal stomach. The clinical features and endoscopic characteristics of four patients with ADP were reviewed and compared with previously reported cases. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb, and in all cases, a peptic ulcer was located in or immediately adjacent to the accessory channel. In one of the patients, the bridge between the double-channel pylorus disappeared, resulting in a single large opening and duodenal kissing ulcer after two years and three months. Finally, nonsteroidal anti-inflammatory drugs, Helicobacter pylori and other risk factors associated with ADP are assessed. PMID:26877621

  18. Endoscopic vacuum-assisted closure with sponge for esophagotracheal fistula after esophagectomy.

    PubMed

    Lee, Hyun Jik; Lee, Hyuk

    2015-04-01

    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. PMID:25799256

  19. Hemodialysis vascular access options after failed Brescia-Cimino arteriovenous fistula

    PubMed Central

    Srivastava, Aneesh; Sharma, Sandeep

    2011-01-01

    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. PMID:21814303

  20. Traumatic right coronary artery-right ventricular fistula with retained intramyocardial bullet.

    PubMed

    Alter, B R; Whelling, J R; Martin, H A; Murgo, J P; Treasure, R L; McGranahan, G M

    1977-11-01

    A case of traumatic right coronary artery-right ventricular fistula secondary to a gunshot wound is presented. In addition, the bullet was retained within the interventricular septum. The diagnostic approach, surgical findings and operative procedure of this and other reported cases are discussed. Several key points are emphasized. First, extended follow-up is necessary after trauma to the heart since fistulas may develop years after the initial injury. Second, surgery is generally indicated for fistulas although some data are presented suggesting that small to moderate fistulas may be treated medically. Third, if surgery is undertaken, very careful operative technique must be utilized to locate and close the fistula. Surgical treatment of choice may be coronary arterial ligation with a distal bypass graft if necessary. Postoperative evaluation is mandatory because fistulas may recur. Indications for removal of a foreign body within the myocardium are also discussed. PMID:920619

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

    PubMed

    Coentrao, Luis

    2013-01-01

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

  2. Laparoscopic surgery for sigmoidocutaneous fistula due to diverticulitis: A case report.

    PubMed

    Hidaka, Eiji; Nakahara, Kenta; Maeda, Chiyo; Takehara, Yusuke; Ishida, Fumio; Kudo, Shin-ei

    2015-08-01

    Sigmoidocutaneous fistulas due to sigmoid colon diverticulitis are very rare. Here we report a case in which laparoscopic sigmoidectomy was used to successfully treat a sigmoidocutaneous fistula due to diverticulitis. A 41-year-old man was admitted to our hospital because of redness and swelling of the left inguinal skin. Enhanced abdominal CT revealed a subcutaneous abscess in the left lower abdomen. Percutaneous drainage was performed, and fistulography revealed a fistula between the sigmoid colon and left inguinal skin. Therefore, a sigmoidocutaneous fistula was diagnosed, and laparoscopic sigmoidectomy and fistulectomy were performed. The sigmoid colon had several diverticula, and a pathological examination revealed that the sigmoidocutaneous fistula was due to diverticulitis. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. In cases of sigmoidocutaneous fistula, laparoscopic treatment can be safely performed. PMID:26303733

  3. Iatrogenic Arteriovenous Fistula in a Renal Allograft: The Result of a TAD Guidewire Injury

    SciTech Connect

    Lee-Elliott, Catherine; Khaw, Kok-Tee; Belli, Anna-Maria; Patel, Uday

    2000-07-15

    A case is presented of an iatrogenic arteriovenous fistula developing in a renal allograft following guidewire manipulation during transplant renal artery angioplasty. Hyperdynamic flow through the fistula was causing a shunt of blood away from the renal cortex as demonstrated on sonography and scintigraphy. Selective embolization was performed, correcting the maldistribution of flow to the peripheral renal cortex. The diagnosis and difficulty in management of asymptomatic renal arteriovenous fistulae is also discussed.

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

    SciTech Connect

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

    1996-04-15

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

  5. Traumatic Left Anterior Descending Coronary Artery-Right Ventricle Fistula: A Case Report

    PubMed Central

    Sheikhi, Mohammad Ali; Asgari, Mehdi; Firouzabadi, Mehdi Dehghani; Zeraati, Mohammad Reza; Rezaee, Alireza

    2011-01-01

    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. PMID:23074613

  6. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis

    PubMed Central

    2013-01-01

    Background Obstetric fistula is a severe condition which has devastating consequences for a woman’s life. The estimation of the burden of fistula at the population level has been impaired by the rarity of diagnosis and the lack of rigorous studies. This study was conducted to determine the prevalence and incidence of fistula in low and middle income countries. Methods Six databases were searched, involving two separate searches: one on fistula specifically and one on broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women. Results Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95% CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95% CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95% CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95% CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women. Conclusions Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula. PMID:24373152

  7. Combined radiologic and endoscopic treatment (using the "rendezvous technique") of a biliary fistula following left hepatectomy.

    PubMed

    Gracient, Aurélien; Rebibo, Lionel; Delcenserie, Richard; Yzet, Thierry; Regimbeau, Jean-Marc

    2016-08-14

    Despite the ongoing decrease in the frequency of complications after hepatectomy, biliary fistulas still occur and are associated with high morbidity and mortality rates. Here, we report on an unusual technique for managing biliary fistula following left hepatectomy in a patient in whom the right posterior segmental duct joined the left hepatic duct. The biliary fistula was treated with a combined radiologic and endoscopic procedure based on the "rendezvous technique". The clinical outcome was good, and reoperation was not required. PMID:27570431

  8. Fistulae After Successful Free Tissue Transfer to Head and Neck: Its Prevention and Treatment.

    PubMed

    Al Deek, Nidal Farhan; Wei, Fu-Chan; Tsao, Chung-Kan

    2016-10-01

    Fistulas, either between oral cavity and external face or between oral and nasal cavity, are major complications after microsurgical head and neck reconstruction. Any flaw in surgical planning, design, and execution may lead to this untoward outcome. Once fistula develops, it may interface with oncologic treatment, endanger the reconstruction, and increase overall patient suffering. This article analyzes individual factors involved in development of fistulas in spite of successful transfer of a free flap and proposes treatment guideline. PMID:27601397

  9. Intrabronchial valves for treatment of alveolar-pleural fistula in a patient with Pneumocystis jirovecii pneumonia.

    PubMed

    Vicencio, Alfin G; Tozzi, Meghan; Thompson, Cecilia; Satchell, Margaret; Delbello, David; Ting, Andrew; Harkin, Timothy J

    2014-10-01

    Alveolo-pleural fistula is a common complication of severe pulmonary infection. Some patients require long-term placement of chest tubes until spontaneous closure of the fistula takes place, whereas others require surgical intervention. We report a case of a patient with alveolo-pleural fistula secondary to Pneumocystis jirovecii pneumonia who was successfully treated with the use of intrabronchial unidirectional valves inserted using flexible bronchoscopy. PMID:25321456

  10. Superior mesenteric artery-duodenal fistula secondary to a gunshot wound.

    PubMed

    Fielding, Cory M; Frandah, Wesam; Krohmer, Steven; Flomenhoft, Deborah

    2016-01-01

    Arterioenteric fistulas are a rare cause of massive gastrointestinal hemorrhage. We present a patient who developed a fistula between a middle colic artery pseudoaneurysm, a proximal branch of the superior mesenteric artery (SMA), and the third part of the duodenum 2 weeks after a self-inflicted gunshot wound to the abdomen. The patient's presentation, evaluation, treatment, and prognosis are discussed. All prior published cases of SMA-duodenal fistulas are reviewed. PMID:26722161

  11. Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment

    PubMed Central

    Günday, Murat

    2011-01-01

    Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis. PMID:22140315

  12. Over-the-scope clip to close a gastrocutaneous fistula after esophagectomy

    PubMed Central

    Shen, Shan-Shan; Zhang, Xiao-Qi; Li, Zhen-Lei; Zou, Xiao-Ping; Ling, Ting-Sheng

    2015-01-01

    Over-the-scope clip (OTSC) system is becoming a new reliable technique which is available for the endoscopic closure of fistulas, bleeding, perforations and so on. We describe the case of a patient with a non-healing gastrocutaneous fistula after esophagectomy for esophageal squamous cell carcinoma which was successfully closed using an OTSC system. This is the first report of the use of OTSC to treat a non-healing gastrocutaneous fistula successfully after esophagectomy. We believe our experience will give such patients an ideal way to cure the fistula without suffering too much and also explore new application of OTSC. PMID:26715825

  13. A case with tracheo-innominate artery fistula. Successful management of endovascular embolization of innominate artery.

    PubMed

    Takasaki, Kenji; Enatsu, Kaori; Nakayama, Masahiko; Uchida, Takatoshi; Takahashi, Haruo

    2005-06-01

    Tracheo-innominate artery fistula (TIF) is known as a fatal complication after tracheostomy. We report a 9-year-old girl with early hypoxic encephalopathy who had a tracheo-innominate artery fistula with exsanguinating hemorrhage from her tracheostoma 10 months after tracheostomy. After temporary control of bleeding, embolization of the innominate artery was performed. The patient has remained well 1 year after the procedure. We reviewed the aetiology, diagnosis and management of the tracheo-innominate fistula, and findings suggest that endovascular embolization of the innominate artery may be an appropriate treatment for patients with tracheo-innominate artery fistula. PMID:15917179

  14. Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

    PubMed Central

    Lee, Christina W.; Pitt, Henry A.; Riall, Taylor S.; Ronnekleiv-Kelly, Sean S.; Israel, Jacqueline S.; Leverson, Glen E.; Parmar, Abhishek D.; Kilbane, E. Molly; Hall, Bruce L.

    2016-01-01

    Introduction Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out. Methods Patients undergoing pancreatic resection from November 1, 2011 to December 31, 2012 were selected from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project data-base. Pancreatic fistula was defined as drainage of amylase-rich fluid with drain continuation >7 days, percutaneous drainage, or reoperation for a pancreatic fluid collection. Univariate and multi-variable regression models were utilized to identify factors predictive of pancreatic fistula. Results DFA1 was recorded in 536 of 2,805 patients who underwent pancreatic resection, including pancreaticoduodenectomy (n=380), distal pancreatectomy (n=140), and enucleation (n=16). Pancreatic fistula occurred in 92/536 (17.2 %) patients. DFA1, increased body mass index, small pancreatic duct size, and soft texture were associated with fistula (p<0.05). A DFA1 cutoff value of <90 U/L demonstrated the highest negative predictive value of 98.2 %. Receiver operating characteristic (ROC) curve confirmed the predictive relationship of DFA1 and pancreatic fistula. Conclusion Low DFA1 predicts the absence of a pancreatic fistula. In patients with DFA1<90 U/L, early drain removal is advisable. PMID:25112411

  15. Congenital anterior urethrocutaneous fistula at the penoscrotal junction with proximal penile megalourethra: A case report

    PubMed Central

    Cheng, Shih-Yao; Chen, Shyh-Jye; Lai, Hong-Shiee

    2016-01-01

    Congenital anterior urethrocutaneous fistula and megalourethra are both rare anomalies. These anomalies are commonly associated with other anorectal or genitourinary anomalies and evaluated with voiding cystourethrography. We examined a 34-month-old boy who presented with a fistula at the penoscrotal junction. A voiding cystourethrogram showed a jet of urine coming through the fistula and proximal saccular dilatation of the penile urethra. We present the imaging findings of the first case of an association between a congenital anterior urethrocutaneous fistula at the penoscrotal junction and a proximal penile megalourethra. We also discuss the etiology, management, and differential diagnosis of this entity, and review the literature. PMID:27200160

  16. Surgical Correction of an Arteriovenous Fistula in a Ring-Tailed Lemur (Lemur catta)

    PubMed Central

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

    2014-01-01

    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. PMID:24672831

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

    PubMed

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

    2002-07-01

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

  18. Coronary artery fistula connecting the left main coronary artery with the superior vena cava

    PubMed Central

    Nikolaidou, C; Gourassas, J

    2015-01-01

    Background Coronary artery fistulas are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. Description of case We report a case of a large coronary artery fistula connecting the left main coronary artery with the superior vena cava in a 70-year-old patient undergoing diagnostic coronary angiography for a non-ST-segment elevation myocardial infarction. The patient rejected closure of the fistula and remains asymptomatic on follow-up. Conclusion Angiographic recognition of coronary artery fistulas is important for the appropriate diagnosis and management of patients. Hippokratia 2015; 19 (2):186-188.

  19. Application of YAG laser technique in the treatment of anal fistula

    NASA Astrophysics Data System (ADS)

    Liu, Jian-xun; Zhang, Xinrong

    1993-03-01

    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.

  20. Are Covered Stents Really Effective at Closing Esophagotracheal Fistulas? Results of an Animal Study

    SciTech Connect

    Wagner, Hans-Joachim; Stinner, Benno; Barth, Peter; Klose, Klaus-Jochen

    2000-07-15

    Purpose: To determine whether covered self-expanding metal stents successfully exclude experimentally created esophagotracheal fistulas.Methods: Esophagotracheal fistulas were surgically created in the upper third of the esophagus in 12 minipigs and immediately sealed by implantation of a covered self-expanding metal stent (20 mm expanded diameter) in the esophagus. Before the animals were killed, after 3, 7, 14, 28, 30, and 36 days, the position of the stent and the sealing of the fistula were monitored fluoroscopically. The esophagus, trachea, and both lungs were examined histologically.Results: Creation of an esophagotracheal fistula was successful in all cases. All fistulas were widely patent at autopsy. The technical success rate for stent deployment and initial sealing of the fistula was 100%. During follow-up, five stents migrated distally, but none into the stomach. Therefore, the fistula was no longer excluded in five animals. In seven animals the stent sealed the fistula until the death of the animal. Tracheal narrowing necessitated additional tracheal stenting in three animals. Two minipigs died due to aspiration of food. Histologic examination showed signs of aspiration in all animals with stents in place for longer than 2 weeks.Conclusion: This experimental animal study revealed worse results for sealing of esophagotracheal fistulas with covered self-expanding metal stents than have been reported for the clinical use of these devices.

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

    PubMed

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

    2016-09-01

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

  2. Survival in a 2-year-old boy with hemorrhage secondary to an aortoesophageal fistula.

    PubMed

    Coates, Laura J; McNally, Janet; Caputo, Massimo; Cusick, Eleri

    2011-12-01

    Aortoesophageal fistula (AOF) in children with no history of cardiac disease or trauma is extremely rare, and survival is even rarer. We present a case of a 2-year-old boy who presented with massive hematemesis secondary to a primary aortoesophageal fistula and was found at endoscopy to have a submucosal hematoma. He then suffered a cardiac arrest with further catastrophic bleeding only controlled by a Sengstaken-Blakemore tube. Subsequent cardiopulmonary bypass was instituted and allowed direct repair of the fistula. He was discharged home 4 weeks later. The etiology of the fistula remains unknown. PMID:22152890

  3. Safety of brachial arteriogram using a 3-French dilator to evaluate nonmaturing arteriovenous fistulae.

    PubMed

    Vachharajani, Tushar J; Asif, Arif

    2014-01-01

    Nonmaturing arteriovenous fistula remains a hurdle in improving the fistula rate in the hemodialysis population. Timely referral can assist in salvaging fistula with endovascular interventions. Pathology at the inflow segment is frequently encountered as a primary reason for maturation failure. Conventional retrograde angiography can result in poor delineation of the inflow segment and may not be an ideal method for evaluating nonmaturing fistulae. Moreover, the risk of vascular rupture and overzealous diagnosis of accessory veins often result in additional unnecessary therapeutic interventions. Alternatively, a direct brachial arteriogram can provide complete anatomic delineation to perform appropriate endovascular interventions. PMID:24118439

  4. Hepatic Arterioportal Fistula: A Curable Cause of Portal Hypertension in Infancy

    PubMed Central

    Billing, J. S.

    1997-01-01

    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. PMID:9298386

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

    PubMed

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

    2014-02-01

    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. PMID:24672831

  6. Successful Palliation of a Malignant Cologastric Fistula with a Covered Self-Expanding Metal Stent

    PubMed Central

    Breitenbauch, Mathilde Therese Winther; Tøttrup, Anders

    2015-01-01

    When patients present with malignant cologastric fistulas, the tumor stage is often advanced and management is only palliative. We report the case of a 75-year-old man with a symptomatic cologastric fistula arising from an advanced tumor in the transverse colon, previously stented owing to malignant obstruction. An 8-cm-long covered self-expanding metal stent (COMVI enteral colonic stent; Taewoong Medical) was placed inside the primary stent, which sealed the fistula and completely alleviated the symptoms. Considering the successful outcome, we propose that insertion of a covered stent be considered in the palliative management of patients with malignant cologastric fistulas. PMID:26668809

  7. Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

    PubMed Central

    Wilson, Sarah M.; Sikkema, Kathleen J.; Watt, Melissa H.; Masenga, Gileard G.

    2016-01-01

    Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions. PMID:25670025

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

    PubMed

    Özdemir-van Brunschot, Denise M D; de Sévaux, Ruud G L; van Hamersvelt, Henk W; Warlé, Michiel C

    2016-09-01

    Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min) led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion. PMID:27313989

  9. Congenital cerebrospinal fluid fistula through the inner ear and meningitis.

    PubMed

    Phelps, P D; Proops, D; Sellars, S; Evans, J; Michaels, L

    1993-06-01

    Congenital deformities of the labyrinth of the inner ear can be associated with a fistulous communication between the intracranial subarachnoid space and the middle ear cavity. We describe seven such cases, six confirmed by high resolution CT and one by postmortem histological section. The seven patients all presented with meningitis although a cerebrospinal fluid fistula was demonstrated at subsequent surgery or postmortem. The lesions were bilateral in three patients, unilateral in three and probably bilateral in the postmortem case although only one temporal bone was obtained. In every case there was a dilated sac instead of the normal two and a half turn cochlea on the affected side and this was confirmed at surgery. The demonstration of the basal cochlear turn is of paramount importance in any deaf child presenting with meningitis. A true Mondini deformity with a normal basal turn and some hearing is not at risk of developing a fistula. PMID:8345296

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

    PubMed

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

    2014-01-01

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

  11. Operative technique for tracheo-innominate artery fistula repair.

    PubMed

    Furukawa, Kojiro; Kamohara, Keiji; Itoh, Manabu; Morokuma, Hiroyuki; Morita, Shigeki

    2014-04-01

    Tracheo-innominate artery fistula is fatal unless treated surgically. We describe our surgical approach and results in seven patients. The average patient age was 15.7 years; all patients had prior severe neurological deficits. Three of seven patients were in hemorrhagic shock; control of preoperative bleeding was achieved with tracheostomy tube cuff overinflation. The innominate artery and the trachea were exposed through a collar incision and partial upper sternotomy. The innominate artery was divided at the aortic arch and at the bifurcation, with one exception. Cerebral blood flow was monitored by the blood pressure difference in the bilateral upper extremities and by near-infrared spectroscopy. The tracheal fistula was left adherent to the innominate artery in all but one patient. All patients were discharged without new neurologic deficits or severe morbidity. Overall survival was 84% at 37 months, without any vascular, tracheal, or neurological events. PMID:24239114

  12. Endovascular treatment of posterior condylar canal dural arteriovenous fistula.

    PubMed

    Maus, Volker; Söderman, Michael; Rodesch, Georges; Kabbasch, Christoph; Mpotsaris, Anastasios

    2016-01-01

    Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even dementia. Diagnosis and endovascular treatment require a profound knowledge of the vascular anatomy of the craniocervical junction and comprehensive neurovascular imaging. We describe the clinical presentation, angiographic imaging and endovascular treatment of a PCC DAVF in a female patient with pulse-synchronous bruit as the presenting symptom. The fistula drained almost exclusively into the sigmoid sinus and internal jugular vein. There was no intracranial reflux. The PCC DAVF was treated with transvenous coil occlusion of the fistulous pouch in the condylar canal. Symptoms resolved immediately after intervention and the patient recovered quickly without any neurological deficits. MR angiography confirmed occlusion of the DAVF. The dural sinus was patent with normal blood flow. PMID:27247204

  13. Spinal dural AV fistula: an unusual cause of chest pain

    PubMed Central

    Bioh, Gabriel; Bogle, Richard

    2014-01-01

    A 22 -year-old man presented with 6 months of sudden onset, incapacitating, left-sided chest pain occurring 1–2 times a week. The severity of the pain caused loss of consciousness several times leading to multiple fractures. Investigation with echocardiogram, exercise tolerance test, Holter monitor, chest X-ray and V/Q scan revealed no abnormality as did EEG and 48 h video telemetry. MRI of the thoracic and lumbar spine showed a spinal dural arteriovenous fistula (SDAVF) at the level of T6, confirmed on angiogram. The patient underwent division of the left T6 AV fistula. Following the operation, the patient has been completely pain free. Our patient, presenting in his early 20s does not fit the usual age demographic for SDAVF. A second atypical feature is his presentation with chest pain alone and no neurological symptoms. This case represents a rare presentation of SDAVF. PMID:24532234

  14. Laparotomized Direct Puncture for Embolization of a Retroperitoneal Arteriovenous Fistula

    SciTech Connect

    Inagawa, Shoichi; Unno, Naoki; Yamashita, Shuhei; Tanaka, Hiroki; Sakahara, Harumi

    2010-02-15

    A 28-year-old woman was referred to our institution with hope for another child after having an abortion several months previously to avoid a potential risk of catastrophic hemorrhage from a retroperitoneal arteriovenous fistula (AVF) with enlarged and twisted draining veins in the pelvis. Multiple branches coming from the right lumbar arteries and the right iliac arteries fed fistulae converging on an enlarged venous pouch anterior to the psoas major muscle in the right retroperitoneal space. It seemed impossible to achieve complete occlusion of the lesion in a single session by either transarterial or transvenous approach. A laparotomy and direct puncture of the enlarged draining vein immediately downstream of the venous pouch was performed and embolization was done with n-butyl cyanoacrylate and the aid of coils. Complete occlusion of the retroperitoneal AVF was achieved and confirmed in control angiography 5 months later.

  15. Vesicocutaneous fistula following adjuvant radiotherapy for prostate cancer

    PubMed Central

    Hennessey, Derek Barry; Bolton, Eva; Thomas, Arun Z; Lynch, Thomas H

    2013-01-01

    Vesicocutaneous fistulas (VCF) are a rare complication of radical radiotherapy to the pelvis. Timely diagnosis and management are often difficult and complex. We report the unusual case of a 64-year-old gentleman who presented to the emergency department with worsening sepsis and profuse discharge from a cutaneous opening in the left groin. This presentation was 6 weeks following the completion of external beam radiotherapy for apical margin-positive prostate cancer (pT3a). A diagnosis of a VCF was confirmed after CT scanning of the abdomen and pelvis with contrast. Urinary diversion was achieved by a temporary urethral catheter insertion. Full resolution of this gentleman's symptoms was accomplished. In this article, we present a non-invasive approach to the management of VCF. This case raises intricate management issues in the atypical development of an early urinary tract fistula postradiotherapy. PMID:23625668

  16. Lethal Hemorrhage Caused by Aortoenteric Fistula Following Endovascular Stent Implantation

    SciTech Connect

    Kahlke, Volker; Brossmann, Joachim; Klomp, Hans-Juergen

    2002-06-15

    A 55-year-old women developed an aortointestinal fistula between the bifurcation of the aorta and the distal ileum following implantation of multiple endovascular stents into both common iliac arteries for treatment of aortoiliac occlusive disease. Ten months before the acute onset of the gastrointestinal hemorrhage two balloon-expandable steel stents had been implanted into both common iliac arteries. Due to restenosis and recurrent intermittent claudication, three balloon-expandable covered stents were implanted 4 months later on reintervention. The patient presented with abdominal pain and melena, and fell into hemorrhagic shock with signs of upper gastrointestinal bleeding. After transfer to our hospital, she again developed hemorrhagic shock with massive upper and lower gastrointestinal bleeding and died during emergency laparotomy. The development of aortoenteric fistulas following endovascular surgery/stent implantation is very rare and has to be considered in cases of acute gastrointestinal hemorrhage.

  17. Endobronchial Watanabe Spigot in the treatment of bronchobiliary fistula.

    PubMed

    Özdemir, Cengiz; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altay, Sezin; Karasulu, Ahmet Levent; Dalar, Levent

    2016-01-01

    Bronchobiliary fistula (BBF) is a rare condition in which an abnormal communication exists between the bile ducts and the bronchial tree. Malignancy is the most common etiology of BBF, although many others are possible. A 74-year-old male patient with an inoperable Klatskin tumor presented with a complaint of yellow-green sputum and cough; the patient underwent fiber-optic bronchoscopy based on a preliminary diagnosis of bronchobiliary fistula. Using fiber-optic rigid bronchoscopy, the laterobasal segment of the lower right lung lobe was occluded using three pieces of 5-mm Endobronchial Watanabe Spigot. Bile drainage subsequently ceased. A bronchoscopic approach provides an alternative option for BBF treatment, particularly in patients who choose not to undergo surgery, or for whom surgery is not an option due to their underlying general condition. PMID:27374219

  18. Treatment of ureterovaginal fistula using a Memokath stent.

    PubMed

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

    2014-01-01

    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 results in non-radiated patients. Meanwhile, conservative treatment using ureteral stents in selected patients has resulted in reported success rates of 71%. We present the case of a 24-year-old woman with UVF due to surgery and radiotherapy for cervix cancer. The patient has been successfully treated with the insertion of a Memokath 051 stent (PNN Medical A/S, Denmark), which is a thermoexpandable, nickel-titanium alloy stent. The patient has been totally continent during a follow-up period of 3 years. The Memokath stent has been changed twice within this period due to dysfunction. PMID:25527688

  19. Ureteroarterial Fistulas After Robotic and Open Radical Cystectomy

    PubMed Central

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

    2016-01-01

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

  20. Robot-Assisted Laparoscopic Repair of Spontaneous Appendicovesical Fistula

    PubMed Central

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

    2016-01-01

    Abstract Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option. PMID:27579435

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

    PubMed

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

    2016-06-01

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

  2. Brainstem Hemorrhage Caused by Direct Carotid-Cavernous Fistula

    PubMed Central

    Chan, Fook-How; Shen, Chao-Yu; Liu, Jung-Tung; Li, Cho-Shun

    2014-01-01

    Summary A 34-year-old woman presented with a history of persisting headache for years, and a newly developed dizziness, left facial palsy and right hemiparesis two days prior to this admission. Initial computed tomographic angiography of the head demonstrated an area of increased density in the left middle and posterior fossae. Multiple aneurysmally dilated venous ectasias with contrast enhancement at the left pre-pontine cistern causing a massive mass effect to the brainstem were also noted, suggesting a huge vascular abnormality. Digital subtraction angiography revealed an abnormal vascular lesion surrounding the brainstem, which indicated a left direct carotid-cavernous fistula with posterior drainage. As her consciousness deteriorated the next day, a follow-up computed tomography scan was done which revealed a pontine hemorrhage. Subsequently, endovascular closure of the fistula with sacrifice of the left ICA was performed, which successfully eliminated the imaging abnormalities. PMID:25207913

  3. Surgical Management of Recurrent Tracheocarotid Fistula following Endovascular Stent Placement

    PubMed Central

    Steitz, Jeffrey T.; Cappello, Zachary J.; Katrib, Ziad; Tennant, Paul A.

    2015-01-01

    We report the case of a 25-year-old woman who developed a tracheocarotid fistula secondary to an infected endovascular stent placed in the right carotid artery after the patient experienced hemorrhage on her first tracheostomy change. The patient originally had the tracheostomy placed at an outside hospital in September 2014, due to prolonged intubation after a motor vehicle accident. The patient presented to the otolaryngology service with an acute tracheal hemorrhage. This necessitated a neck exploration, median sternotomy, right carotid stent removal with subclavian to carotid bypass, and sternocleidomastoid flap reconstruction. This paper addresses the epidemiology and anatomy of a tracheocarotid fistula and discusses methods to treat such a complication. PMID:26693370

  4. Global efforts for effective training in fistula surgery.

    PubMed

    Elneil, Sohier

    2015-10-01

    Obstetric fistulas continue to be a problem in low- and middle-income nations, affecting women of childbearing age during pregnancy and labor and resulting in debilitating urinary and/or fecal incontinence. Historically, this predicament also affected women in high-income nations until the middle of the last century. This is not a "new world" crisis therefore, but simply one of economic and health development. In the last two decades, new global initiatives have been instituted to improve training and education in preventative and curative fistula treatment by developing a unified and competency-based learning tool by surgeons in the field in partnership with FIGO and its global partners. This modern approach to the management of a devastating condition can only serve to achieve the WHO objective of health security for women throughout their life span. PMID:26433511

  5. Ureteroarterial Fistulas After Robotic and Open Radical Cystectomy.

    PubMed

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

    2016-01-01

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

  6. Supporting patients with enterocutaneous fistula: from hospital to home.

    PubMed

    Slater, Rebecca C

    2011-02-01

    The aim of this article is to discuss the care of patients with enterocutaneous fistula (ECF) requiring long-term support in the community. The discussion of what ECF are and aspects of nutrition will support the knowledge required to care for this group of patients effectively in their homes. This article focuses on the management of ECF appliances and gives a basic guide of skin care and how to reduce the prevalence of appliance leaks. PMID:21378670

  7. Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

    PubMed Central

    Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

    2016-01-01

    Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

  8. Management of postirradiation recurrent enterocutaneous fistula by muscle flaps

    SciTech Connect

    Lui, R.C.; Friedman, R.; Fleischer, A.

    1989-07-01

    Occasionally surgeons have to operate on patients who have had previous abdominal or pelvic operations and irradiations for malignancies. Bowel resection with primary anastomosis under these circumstances is fraught with major complications such as anastomotic breakdown with intra-abdominal sepsis or recurrent enterocutaneous fistula, which are refractory to conventional management. New techniques for using vascularized muscle flaps from a distant nonirradiated field to achieve safe repair of the bowel defects in three such instances are presented.

  9. Congenital Palatal Fistula Associated with Submucous Cleft Palate

    PubMed Central

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

    2016-01-01

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

  10. Cholecystitis of a duplicated gallbladder complicated by a cholecystoenteric fistula.

    PubMed

    Huang, Brady K; Chess, Mitchell A

    2009-04-01

    Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder. PMID:19205686

  11. Pelvic arteriography in obstetrics and gynecology: arteriovenous fistulas

    SciTech Connect

    Schneider, G.T.

    1984-12-01

    Pelvic arteriography has become an increasingly useful diagnostic and therapeutic tool in the past decade along with angiography of other areas of the body. A brief historical review of its development in obstetrics and gynecology since 1950 is presented, including placental localization and study of pelvic arterial adequacy. Modern practical uses include (1) diagnosis and therapy of pelvic arteriovenous fistulas, and (2) arterial embolization for intractable recurrent pelvic hemorrhage associated either with malignancy or with trauma or uncontrollable surgical bleeding.

  12. Tracheo-oesophageal fistula in a patient with chronic sarcoidosis.

    PubMed

    Darr, A; Mohamed, S; Eaton, D; Kalkat, M S

    2015-10-01

    Sarcoidosis is a common multisystem granulomatous condition of unknown aetiology, predominantly involving the respiratory system. Tracheal stenosis has been described but we believe that we present the first case of a tracheo-oesophageal fistula secondary to chronic sarcoidosis. A 57-year-old woman with sarcoidosis, a known tracheal stricture and a Polyflex(®) stent in situ presented with stridor. Bronchoscopy confirmed in-stent stenosis, by exuberant granulation tissue. The stent was removed and the granulation tissue was resected accordingly. Postoperatively, the patient was noticed to have an incessant cough and video fluoroscopy raised the suspicion of a tracheo-oesophageal fistula. A repeat bronchoscopy demonstrated marked granulation tissue, accompanied by a fistulous connection with the oesophagus at the mid-lower [middle of the lower] third of the trachea. Three Polyflex(®) stents were sited across the entire length of the trachea. Sarcoidosis presents with varying clinical manifestations and disease progression. Tracheal involvement appears to be a rare phenomenon and usually results in stenosis. To date, there has been little or no documented literature describing the formation of a tracheo-oesophageal fistula resulting from sarcoidosis. Early reports documented the presence of sarcoidosis induced weakening in the tracheal wall, a process termed tracheal dystonia. Weaknesses are more apparent in the membranous aspect of the trachea. Despite the rare nature of such pathology, this case report highlights the need to consider the presence of a tracheo-oesophageal fistula in sarcoidosis patients presenting with repeat aspiration in the absence of an alternate pathology. PMID:26274763

  13. Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy

    PubMed Central

    Whelan, Lucy; Mullarkey, Emma; Woo, Henry H.

    2015-01-01

    This case report documents a rare complication of prostate resection following a Greenlight laser procedure. The 75-year-old gentleman involved underwent photoselective vaporisation of the prostate (PVP) for clinically benign prostatic obstruction. Subsequent to PVP, the patient experienced recurrent macroscopic haematuria and pubic pain. Investigations confirmed the presence of a prostate-symphyseal fistula, a rare complication of PVP. We believe this to be the first reported case of successful treatment with robotic assisted radical prostatectomy. PMID:26576316

  14. The Antibacterial Activity of Cassia fistula Organic Extracts

    PubMed Central

    Seyyednejad, Seyyed Mansour; Motamedi, Hossein; Vafei, Mouzhan; Bakhtiari, Ameneh

    2014-01-01

    Background: Cassia fistula, is a flowering plant and a member of Fabaceae family. Its leaves are compound of 4 - 8 pairs of opposite leaflets. There are many Cassia species around the world which are used in herbal medicine. Objectives: This study was designed to examine in vitro anti-bacterial activity of methanolic and ethanolic extracts of C. fistula native to Khuzestan, Iran. Materials and Methods: The microbial inhibitory effect of methanolic and ethanolic extracts of C. fistula was tested on 3 Gram positive: Bacillus cereus, Staphylococcus aureus and S. epidermidis and 5 Gram negative: Salmonella Typhi, Kelebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis bacterial species using disc diffusion method at various concentrations. The minimum inhibitory and bactericidal concentrations (MIC and MBC) were measured by the tube dilution assay. Results: The extract of C. fistula was effective against B. cereus, S. aureus, S. epidermidis, E. coli and K. pneumoniae. The most susceptible microorganisms to ethanolic and methanolic extracts were E. coli and K. pneumoniae, respectively. Also B. cereus and S. aureus showed the least sensitivity to ethanolic and methanolic extracts, respectively. The MIC (minimum inhibitory concentration) and MBC (minimum bactericidal concentration) of ethanolic extracts against S. aureus, E. coli, S. epidermidis and K. pneumoniae were also determined. Conclusions: With respect to the obtained results and regarding to the daily increase of the resistant microbial strains to the commercial antibiotics, it can be concluded that these extracts can be proper candidates of antibacterial substance against pathogenic bacterial species especially S. aureus, E. coli, K. pneumoniae and S. epidermidis. PMID:25147664

  15. Emergency Endovascular 'Bridge' Treatment for Iliac-Enteric Fistula

    SciTech Connect

    Franchin, Marco; Tozzi, Matteo; Piffaretti, Gabriele; Carrafiello, Gianpaolo; Castelli, Patrizio

    2011-10-15

    Aortic aneurysm has been reported to be the dominant cause of primary iliac-enteric fistula (IEF) in >70% of cases [1]; other less common causes of primary IEF include peptic ulcer, primary aortitis, pancreatic pseudocyst, or neoplastic erosion into an adjacent artery [2, 3]. We describe an unusual case of IEF managed with a staged approach using an endovascular stent-graft as a 'bridge' in the emergency setting to optimize the next elective definitive excision of the lesion.

  16. Pancreaticoureteral Fistula: A Rare Complication of Chronic Pancreatitis

    PubMed Central

    Patel, Hiren G.; Cavanagh, Yana; Shaikh, Sohail N.

    2016-01-01

    Context: Chronic pancreatitis is an inflammatory condition that may result in progressive parenchymal damage and fibrosis which can ultimately lead to destruction of pancreatic tissue. Fistulas to the pleura, peritoneum, pericardium, and peripancreatic organs may form as a complications of pancreatitis. This case report describes an exceedingly rare complication, pancreaticoureteral fistula (PUF). Only two additional cases of PUF have been reported. However, they evolved following traumatic injury to the ureter or pancreatic duct. No published reports describe PUF as a complication of pancreatitis. Case Report: A 69-year-old Hispanic female with a past medical history of cholecystectomy, pancreatic pseudocyst, and recurrent episodes of pancreatitis presented with severe, sharp, and constant abdominal pain. Upon imaging, a fistulous tract was visualized between the left renal pelvis (at the level of an upper pole calyx) and the pancreatic duct and a ureteral stent was placed to facilitate fistula closure. Following the procedure, the patient attained symptomatic relief and oral intake was resumed. A left retrograde pyelogram was repeated 2 months after the initial stent placement and demonstrating no evidence of a persistent fistulous tract. Conclusion: Due to PUF's unclear etiology and possible variance of presentation, it is important for physicians to keep this rare complication of pancreatitis in mind, especially, when evaluating a patient with recurrent pancreatitis, urinary symptoms and abnormal imaging within the urinary collecting system and pancreas. PMID:27114974

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

    PubMed Central

    Reid, Raymond; Rattray, Vaughn; Williams, Ruth; Denny, Marcel

    2016-01-01

    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. PMID:27034834

  18. [Genitourinary fistulae at the National Institute of Perinatology].

    PubMed

    Villagrán-Cervantes, R; Rodríguez-Colorado, S; Delgado-Urdapilleta, J; Kunhardt-R, J

    1996-07-01

    Evaluation of the characteristics of urogenital fistula with a retrospective study at the clinic of Urology Ginecologica in the Instituto Nacional de Perinatologia between March 1992 to June 1995, information of the location, etiopathogenesis of the disease, urinary tract infection and surgical treatment were obtained form de patients records in the clinic. The etiophatogenesis of the disease was surgical gynecological procedures in 51.1%, and obstetric cause 48.5%; the location were 14 (66.6%) vesicovaginal, 5 (23.5% 0 ureterovaginal and 2 (urethrovaginal). The abdominal approach were in 8 patients and vaginal route in 9, no surgical treatment were 2. Successfully repair fistula were in 80.9%. Urinary tract infections before treatment agreed on the obstetric etiology was 47.6%, and for surgical gynecological procedures 52.2%. There is an increase in the incident of obstetric vesicovaginal fistula, we believe it depends on the patients that we have in de Instituto Nacional de Perinatologia, most of them are obstetric patients. PMID:8756196

  19. Chronic expanding hematoma with bronchopleural fistula and empyema space.

    PubMed

    Tsubochi, Hiroyoshi; Sato, Nobuyuki; Imai, Tadashi

    2009-06-01

    Chronic expanding hematoma of the thorax is not typically accompanied by a bronchopleural fistula or purulent lesion. We report an extremely rare case of chronic expanding hematoma with a bronchopleural fistula and empyema space in a 66-year-old man with a history of tuberculous pleurisy admitted because of fever and bloody sputa. Computed tomography and a magnetic resonance imaging revealed a huge mass and an air space in the right thorax. A fiber-optic bronchoscope examination showed hemorrhagic effusion from the apical bronchus of the right lower lobe. First, open-window thoracostomy was undertaken to control the septic state and to prevent aspiration of infected pleural fluid. At operation, air leakage was found at the most superior portion in the rear of the thoracic empyema space; this was thought to be from the bronchopleural fistula. Enterococcus casseliflavus was detected in cultures for bacteria of the effusion from the empyema space. After an improvement of his general condition, a radical operation, including the complete extirpation of the hematoma and intrathoracic muscle transposition using the latissimus dorsi muscle, was successfully performed. PMID:19597392

  20. Rectovaginal fistula with anal atresia in 5 dogs

    PubMed Central

    Rahal, Sheila C.; Vicente, Cristiane S.; Mortari, Ana C.; Mamprim, Maria J.; Caporalli, Evelyn H.G.

    2007-01-01

    Five dogs with rectovaginal fistula and atresia ani that had been treated by surgical correction of the malformations were studied retrospectively. Ages at presentation varied from 1 to 3 months and weight from 350 g to 7.5 kg. The histories included voiding of feces through the vulva, with or without tenesmus, usually observed after weaning. Atresia ani, presence of feces in the vaginal canal, abdominal distention, and discomfort on abdominal palpation were observed during clinical examination. Also, 3 dogs had partial tail agenesis. In all dogs, the rectovaginal fistula was isolated and transected, the vulvar and rectal defects were closed separately, and the atresia ani was repaired. Normal defecation was restored, but 1 dog had fecal incontinence that subsequently resolved. One dog died 2.5 months postoperatively, and follow-up was done on the others for periods ranging from 1.6 year to 7.7 years. Surgical correction in dogs with rectovaginal fistula and atresia ani may result in a favorable outcome, if it is done early. PMID:17824325

  1. Bacteriological analysis of necrotic pulp and fistulae in primary teeth

    PubMed Central

    FABRIS, Antônio Scalco; NAKANO, Viviane; AVILA-CAMPOS, Mario Júlio

    2014-01-01

    Objectives Primary teeth work as guides for the eruption of permanent dentition, contribute for the development of the jaws, chewing process, preparing food for digestion, and nutrient assimilation. Treatment of pulp necrosis in primary teeth is complex due to anatomical and physiological characteristics and high number of bacterial species present in endodontic infections. The bacterial presence alone or in association in necrotic pulp and fistula samples from primary teeth of boys and girls was evaluated. Material and Methods Necrotic pulp (103) and fistula (7) samples from deciduous teeth with deep caries of 110 children were evaluated. Bacterial morphotypes and species from all clinical samples were determined. Results A predominance of gram-positive cocci (81.8%) and gram-negative coccobacilli (49.1%) was observed. In 88 out of 103 pulp samples, a high prevalence of Enterococcus spp. (50%), Porphyromonas gingivalis (49%), Fusobacterium nucleatum (25%) and Prevotella nigrescens (11.4%) was observed. Porphyromonas gingivalis was detected in three out of seven fistula samples, Enterococcus spp. in two out of seven samples, and F. nucleatum, P. nigrescens and D. pneumosintes in one out of seven samples. Conclusions Our results show that Enterococcus spp. and P. gingivalis were prevalent in necrotic pulp from deciduous teeth in boys from 2 to 5 years old, and that care of the oral cavity of children up to five years of age is important. PMID:24676582

  2. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

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

    PubMed

    Goldson Barnaby, Andrea; Reid, Raymond; Rattray, Vaughn; Williams, Ruth; Denny, Marcel

    2016-01-01

    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. PMID:27034834

  4. The management of genitourinary fistula in the third millennium

    PubMed Central

    Ghoniem, Gamal M.; Warda, Hussein A.

    2014-01-01

    Background A vesicovaginal fistula (VVF) is an abnormal fistulous tract between the bladder and vagina, causing continuous loss of urine via the vagina. VVF is a relatively uncommon condition, but there is a drastically higher prevalence in the developing world. Furthermore, iatrogenic postoperative VVF is most common in developed countries, compared to mainly obstetric trauma in developing countries. In this review we focus on the development of current management techniques for VVF. Methods Medline was searched to identify articles related to urogenital fistulae, including VVF. Based on these reports we focus on the aetiology, clinical presentation, diagnosis and management of VVF. This in-depth review includes the optimal surgical timing, different surgical approaches (including minimally invasive techniques such as laparoscopic and robotic surgery), recommendations for postoperative care, surgical complications, and the need for further research in the use of robotic surgery to treat this condition. Results In all, 60 articles were identified and included in this review; eight were related to the aetiology, 12 to diagnosis, and 40 to the management of VVF. A thorough evaluation of VVF is imperative for planning the repair. Although the surgeonís experience typically influences the surgical approach, special situations will dictate the best approach. Conclusion The treatment of genitourinary fistulae with robotic assistance continues to develop, but further research is necessary to fully understand the use of this technology. PMID:26019933

  5. Religious coping among women with obstetric fistula in Tanzania

    PubMed Central

    Watt, Melissa H.; Wilson, Sarah M.; Joseph, Mercykutty; Masenga, Gileard; MacFarlane, Jessica C.; Oneko, Olola; Sikkema, Kathleen J.

    2014-01-01

    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 (p<.001), 76% reported at least one form of 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 counseling and general psychosocial support for this population. PMID:24735435

  6. Endoscopic management of gastrointestinal perforations, leaks and fistulas

    PubMed Central

    Rogalski, Pawel; Daniluk, Jaroslaw; Baniukiewicz, Andrzej; Wroblewski, Eugeniusz; Dabrowski, Andrzej

    2015-01-01

    Gastrointestinal perforations, leaks and fistulas may be serious and life-threatening. The increasing number of endoscopic procedures with a high risk of perforation and the increasing incidence of leakage associated with bariatric operations call for a minimally invasive treatment for these complications. The therapeutic approach can vary greatly depending on the size, location, and timing of gastrointestinal wall defect recognition. Some asymptomatic patients can be treated conservatively, while patients with septic symptoms or cardio-pulmonary insufficiency may require intensive care and urgent surgical treatment. However, most gastrointestinal wall defects can be satisfactorily treated by endoscopy. Although the initial endoscopic closure rates of chronic fistulas is very high, the long-term results of these treatments remain a clinical problem. The efficacy of endoscopic therapy depends on several factors and the best mode of treatment will depend on a precise localization of the site, the extent of the leak and the endoscopic appearance of the lesion. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarized the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of the gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience. PMID:26457014

  7. Gene expression changes in venous segment of overflow arteriovenous fistula.

    PubMed

    Hashimoto, Yasuhiro; Okamoto, Akiko; Saitoh, Hisao; Hatakeyama, Shingo; Yoneyama, Takahiro; Koie, Takuya; Ohyama, Chikara

    2013-01-01

    Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV) fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44 K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas. PMID:23710358

  8. Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

    PubMed Central

    2013-01-01

    Background In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000–2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges. Methods Descriptive study using routine programme data. Results Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31–51 days). The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model. Conclusion In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed. PMID:23965150

  9. Acquired Equivalence Changes Stimulus Representations

    ERIC Educational Resources Information Center

    Meeter, M.; Shohamy, D.; Myers, C. E.

    2009-01-01

    Acquired equivalence is a paradigm in which generalization is increased between two superficially dissimilar stimuli (or antecedents) that have previously been associated with similar outcomes (or consequents). Several possible mechanisms have been proposed, including changes in stimulus representations, either in the form of added associations or…

  10. Transitional Flow in the Venous Side of Patient-Specific Arteriovenous Fistulae for Hemodialysis.

    PubMed

    Bozzetto, Michela; Ene-Iordache, Bogdan; Remuzzi, Andrea

    2016-08-01

    Arteriovenous fistula (AVF) is the first choice for providing vascular access for hemodialysis patients, but maintaining its patency is challenging. AVF failure is primarily due to development of neointimal hyperplasia (NH) and subsequent stenosis. Using idealized models of AVF we previously suggested that reciprocating hemodynamic wall shear is implicated in vessel stenosis. The aim of the present study was to investigate local hemodynamics in patient-specific side-to-end AVF. We reconstructed realistic geometrical models of four AVFs from magnetic resonance images acquired in a previous clinical study. High-resolution computational fluid dynamics simulations using patient-specific blood rheology and flow boundary conditions were performed. We then characterized the flow field and categorized disturbed flow areas by means of established hemodynamic wall parameters. In all AVF, either in upper or lower arm location, we consistently observed transitional laminar to turbulent-like flow developing in the juxta-anastomotic vein and damping towards the venous outflow, but not in the proximal artery. High-frequency fluctuations of the velocity vectors in these areas result in eddies that induce similar oscillations of wall shear stress vector. This condition may importantly impair the physiological response of endothelial cells to blood flow and be responsible for NH formation in newly created AVF. PMID:26698581

  11. Left ventricular fistula as a cause of intractable angina pectoris. Successful surgical repair.

    PubMed

    Housman, L B; Morse, J; Litchford, B; Stein, R; Mazur, J; Starr, A

    1978-07-28

    Two patients had intractable angina pectoris due to left-coronary-artery to left-ventricle fistulas. Surgical repair resulted in complete relief of symptoms. Postoperative cardiac catheterization showed obliteration of the fistulas, with preservation of ventricular function. Operative therapy is indicated in this disorder. PMID:660873

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

    PubMed Central

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

    2001-01-01

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

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

    PubMed

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

    2013-01-01

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

  14. Incidentally diagnosed post-cesarean vesicouterine fistula (Youssef’s syndrome)

    PubMed Central

    Keskin, Mehmet Zeynel; Budak, Salih; Can, Ertan; İlbey, Yusuf Özlem

    2015-01-01

    Vesicouterine fistula (VUF) is a very rare occurrence and is estimated to occur in only 1–4% of all genitourinary fistulas; 90% of cases are Youssef syndrome, which is accompanied by amenorrhea and cyclic hematuria (menouria). In this article, a renal transplant donor who was incidentally diagnosed with Youssef syndrome 20 years after a second cesarean delivery. PMID:26834907

  15. Vertebral Arteriovenous Fistula Presenting as Cervical Myelopathy: A Rapid Recovery with Balloon Embolization

    SciTech Connect

    Modi, Manish; Bapuraj, J. Rajiv; Lal, Anupam; Prabhakar, S.; Khandelwal, N.

    2010-12-15

    A 24-year-old male presented with progressive cervical myelopathy of 2 months' duration. Magnetic resonance imaging of the cervical spine and angiography revealed a large arteriovenous fistula arising from the left vertebral artery. The present case highlights the clinical features and dramatic recovery following endovascular balloon occlusion of a giant cervical arteriovenous fistula.

  16. Successful endoscopic ablation of a pyriform sinus fistula in a child: case report and literature review.

    PubMed

    Abbas, Paulette I; Roehm, Corrie E; Friedman, Ellen M; Athanassaki, Ioanna; Kim, Eugene S; Brandt, Mary L; Wesson, David E; Lopez, Monica E

    2016-06-01

    Recurrent thyroid infections are rare in children. When present, patients should be evaluated for anatomic anomalies such as pyriform sinus fistulae. We describe a 12-year-old girl with history of recurrent thyroid abscesses secondary to a pyriform sinus fistula and managed with concurrent endoscopic ablation and incision and drainage. PMID:26820515

  17. Extensive balanitis xerotica obliterans of urethrocutaneous fistula presenting as mass in scrotum.

    PubMed

    Kumar, Santosh; Nagappa, Bhubnesh; Ganesamoniv, Raguram

    2010-08-01

    A rare case of extensive lichen sclerosis (balanitis xerotica obliterans) involving the anterior urethra, urethrocutaneous fistula, and scrotum is described in a middle-aged man who presented with a history of obstructive voiding symptoms. He was managed by excision of mass along with the fistulae and staged buccal mucosal urethroplasty. PMID:19913886

  18. Cholecystoduodenal fistula: A complication of inserted self-expandable metallic bilitary stents

    SciTech Connect

    Nishida, Hirotoshi; Inoue, Hiroki; Ueno, Kazuto; Nagata, Yukitaka; Kato, Takeshi; Miyazono, Nobuaki; Nakajo, Masayuki

    1998-05-15

    We encountered a case of hepatic hilar cholangiocarcinoma resulting in cholecystoduodenal fistula after insertion of self-expandable metallic biliary stents (EMBSs). To our knowledge, there has been no report of cholecystoduodenal fistula after insertion of EMBSs. This case suggests that immediate gallbladder decompression may be necessary if acute cholecystitis occurs after insertion of EMBSs.

  19. Transcatheter Embolization of a Renal Arteriovenous Fistula Complicated by an Aneurysm of the Feeding Renal Artery

    SciTech Connect

    Kensella, Denise; Kakani, Nirmal Pocock, Richard; Thompson, John; Cowan, Andrew; Watkinson, A.

    2008-03-15

    Renal arteriovenous fistula (AVF) is rare. Renal AVF complicated by aneurysm of the feeding artery presents a technical challenge for endovascular treatment. We report a case managed by covered stenting of the renal artery aneurysm, coil embolization of the fistula, and bare stenting of the aorta.

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

    SciTech Connect

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

    1983-04-01

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

  1. Pseudo-obstruction of the biliary tract associated with a traumatic biliary fistula

    SciTech Connect

    Kidder, R.E.; Doherty, P.W.

    1984-05-01

    Documentation of a biliary fistula as a complication of hepatic trauma may be made simply and noninvasively using radionuclide (technetium) cholescintigraphy. This report describes the utility of this approach in the evaluation of the pathophysiology underlying apparent biliary obstruction in a patient with a large traumatic biliary fistula.

  2. Cholecystoduodenal Fistula: A Complication of Inserted Self-Expandable Metallic Biliary Stents

    SciTech Connect

    Nishida, Hirotoshi; Inoue, Hiroki; Ueno, Kazuto; Nagata, Yukitaka; Kato, Takeshi; Miyazono, Nobuaki; Nakajo, Masayuki

    1998-05-15

    We encountered a case of hepatic hilar cholangiocarcinoma resulting in cholecystoduodenal fistula after insertion of self-expandable metallic biliary stents (EMBSs). To our knowledge, there has been no report of cholecystoduodenal fistula after insertion of EMBSs. This case suggests that immediate gallbladder decompression may be necessary if acute cholecystitis occurs after insertion of EMBSs.

  3. Successful Management of Atrio-Esophageal Fistula after Cardiac Radiofrequency Catheter Ablation

    PubMed Central

    Shim, Hun Bo; Kim, Chilsung; Kim, Hong-Kwan

    2013-01-01

    An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation. PMID:23614102

  4. Secondary Aortoesophageal Fistula Associated With Aneurysmal Graft Infection by Coxiella burnetii.

    PubMed

    Okwara, Chinemerem John; Petrasek, Jan; Gibson, Maeghan; Burstein, Ezra

    2016-04-01

    Aortoesophageal fistula is a rare and serious condition that carries a high mortality rate. We present a case of overt gastrointestinal bleeding from an aortoesophageal fistula in a patient with chronic infection of an endovascular prosthesis with Coxiella burnetii. PMID:27144194

  5. Secondary Aortoesophageal Fistula Associated With Aneurysmal Graft Infection by Coxiella burnetii

    PubMed Central

    Petrasek, Jan; Gibson, Maeghan; Burstein, Ezra

    2016-01-01

    Aortoesophageal fistula is a rare and serious condition that carries a high mortality rate. We present a case of overt gastrointestinal bleeding from an aortoesophageal fistula in a patient with chronic infection of an endovascular prosthesis with Coxiella burnetii. PMID:27144194

  6. Mechanical Thrombectomy of Occluded Hemodialysis Native Fistulas and Grafts Using a Hydrodynamic Thrombectomy Catheter: Preliminary Experience

    SciTech Connect

    Sahni, Vikram Kaniyur, Sunil; Malhotra, Anmol; Fan, Stanley; Blakeney, Charles; Fotheringham, Tim; Sobeh, Mohammed; Matson, Matthew

    2005-12-15

    The purpose of this study was to evaluate the efficacy and safety of a new hydrodynamic percutaneous thrombectomy catheter in the treatment of thrombosed hemodialysis fistulas and grafts. Twenty-two patients (median age: 47 years; range: 31-79 years) underwent mechanical thrombectomy for thrombosed hemodialysis fistulas or polytetrafluoroethylene (PTFE) grafts. In all cases, an Oasis hydrodynamic catheter was used. Five patients had native fistulas and 17 had PTFE grafts. Six patients required repeat procedures. All patients with native fistulas and 15 of the 17 with PTFE grafts also underwent angioplasty of the venous limb following the thrombectomy. Major outcome measures included technical success, clinical success, primary and secondary patency, and complication rates. Twenty-eight procedures were performed in total. The technical success rate was 100% and 90% and clinical success was 86% and 76% for native fistulas and grafts, respectively. The primary patency at 6 months was 50% and 59% for fistulas and grafts, respectively, and the secondary patency at 6 months was 75% and 70% for fistulas and grafts, respectively. Two patients died of unrelated causes during the follow-up period. The Oasis catheter is an effective mechanical device for the percutaneous treatment of thrombosed hemodialysis access. Our initial success rate showed that the technique is safe in the treatment of both native fistulas and grafts.

  7. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas.

    PubMed

    Goldstein, Stuart L; Ikizler, T Alp; Zappitelli, Michael; Silverstein, Douglas M; Ayus, Juan C

    2009-11-01

    Although hemodialysis catheters predispose to infection which, in turn, causes inflammation, we studied whether they induce inflammation independent of infection. We compared the level of the inflammatory marker C-reactive protein (CRP) in maintenance hemodialysis patients, comparing those dialyzed using a non-infected catheter to those using arteriovenous fistulas. All incident patients had catheters and fistula placement at dialysis initiation. In 35 patients the fistulas matured, the catheters were removed and the patients were evaluated at 6 months (catheter-fistula). These results were compared to 15 patients in whom the fistula did not mature and catheter use persisted for 6 months (catheter-catheter). There was a significant 82% reduction in the CRP level in the catheter-fistula group but a 16% increase in the catheter-catheter group at 6 months. The changes in CRP did not differ by gender, diabetes status, or by race, and was not correlated with a change in phosphorus, age, or urea reduction ratio at 1 month following hemodialysis initiation. Decreased CRP was associated with increased hemoglobin and albumin. Patients with persistent fistula use from dialysis initiation through 6 months had consistently low CRP levels over that time period. Our study shows that catheters might contribute to increased inflammation independent of infection, and supports avoidance of catheters and a timely conversion to fistulas with catheter removal. PMID:19675528

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

    PubMed

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

    2016-12-01

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

  9. Left subclavian artery-esophageal fistula induced by a paper star: a case report.

    PubMed

    Lin, Chen-Sheng; Lin, Cheng-Wen

    2016-06-01

    A subclavian artery-esophageal fistula usually occurs on the right side of an aberrant subclavian artery. It also rarely appears in the site between a non-aberrant subclavian artery and the esophagus due to the ingestion of a foreign body. Upper gastrointestinal bleeding in the case of a subclavian artery-esophageal fistula is rare but often fatal. Here, we report on a 62-year-old male patient with a left subclavian arteryesophageal fistula complicated by hemorrhagic shock. He swallowed a foreign body at a birthday party. An upper gastrointestinal endoscopy indicated a paper star lodged at 20 cm from the incisors, inducing a kissing esophageal ulcer around the esophageal sphincter. One month later, he suffered an unusually strong episode of hematemesis. Subsequently, a computed tomography angiography was performed and demonstrated a left subclavian artery-esophageal fistula. Finally, the fistula induced by the ingestion of a paper star was successfully treated by endovascular stent grafting. PMID:27514535

  10. Surgical repair of large aortocaval fistula with limited shunt: Case report

    PubMed Central

    Doi, Toshio; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2014-01-01

    A 67-year-old man was admitted with severe back pain and bilateral lower limb swelling. Enhanced computed tomography showed an infrarenal abdominal aortic aneurysm (92 × 75 mm2) and a short aortocaval fistula (7 mm). Immediately afterward, circulatory collapse occurred, and the patient was rushed to the operating theater. A much larger aortocaval fistula (22 × 35 mm2) than that demonstrated by preoperative computed tomography was found and was repaired with a Dacron patch while using two balloon-tipped catheters to control bleeding. Then, the abdominal aortic aneurysm was replaced with a bifurcated graft. The patient’s postoperative course was uneventful. In this case, enhanced computed tomography detected the aortocaval fistula, but could not assess its size accurately. Successful surgical repair of an aortocaval fistula depends on early accurate delineation of the fistula and prompt control of bleeding. PMID:27489655

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

    PubMed

    Takahashi, Minoru; Fukuda, Takahiro

    2011-01-01

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

  12. Acquired causes of intestinal malabsorption.

    PubMed

    van der Heide, F

    2016-04-01

    This review focuses on the acquired causes, diagnosis, and treatment of intestinal malabsorption. Intestinal absorption is a complex process that depends on many variables, including the digestion of nutrients within the intestinal lumen, the absorptive surface of the small intestine, the membrane transport systems, and the epithelial absorptive enzymes. Acquired causes of malabsorption are classified by focussing on the three phases of digestion and absorption: 1) luminal/digestive phase, 2) mucosal/absorptive phase, and 3) transport phase. Most acquired diseases affect the luminal/digestive phase. These include short bowel syndrome, extensive small bowel inflammation, motility disorders, and deficiencies of digestive enzymes or bile salts. Diagnosis depends on symptoms, physical examination, and blood and stool tests. There is no gold standard for the diagnosis of malabsorption. Further testing should be based on the specific clinical context and the suspected underlying disease. Therapy is directed at nutritional support by enteral or parenteral feeding and screening for and supplementation of deficiencies in vitamins and minerals. Early enteral feeding is important for intestinal adaptation in short bowel syndrome. Medicinal treatment options for diarrhoea in malabsorption include loperamide, codeine, cholestyramine, or antibiotics. PMID:27086886

  13. [Intracranial Dural Arteriovenous Fistula Associated with Multiple Arterio-arterial Fistulas between the Systemic Arteries and the Pulmonary Artery:A Case Report].

    PubMed

    Miyamoto, Junichi; Niijima, Kyo

    2016-09-01

    An intracranial dural arteriovenous fistula(dAVF)was incidentally detected in a 39-year-old man during a medical checkup. Except for a mild episode of pneumonia at the age of 22 years, his medical history was unremarkable. He had no family history of hereditary hemorrhagic telangiectasia(HHT). The dAVF was treated radically via ligation of the fistula, without any complications. Postoperative angiography demonstrated that the dAVF had completely healed, but showed an aberrant, dilatated, and tortuous internal mammary artery. A contrast-enhanced computed tomography scan revealed multiple arterio-arterial fistulas between various systemic arteries and the pulmonary artery(an intercostal artery to the pulmonary artery fistula, an internal mammary artery to the pulmonary artery fistula, and an inferior phrenic artery to the pulmonary artery fistula). These thoracic lesions did not require additional treatment because they did not cause any symptoms, e.g., respiratory or cardiac failure. In most previous cases, such aberrant thoracic arterial fistulas were detected incidentally or based on the presence of minor clinical symptoms. However, in some cases, they caused severe respiratory or cardiac failure and were treated via the embolization of the responsible vessels. Therefore, the co-existence of thoracic arterial fistulas in patients with dAVF should be evaluated, even if the dAVF does not meet the criteria for HHT. Such thoracic lesions might cause a chest murmur that can be detected via a stethoscope or via a blunt costophrenic angle on chest radiography. PMID:27605480

  14. AngioJet Thrombectomy for Occluded Dialysis Fistulae: Outcome Data

    SciTech Connect

    Littler, Peter Cullen, Nicola; Gould, Derek; Bakran, Ali; Powell, Steven

    2009-03-15

    This study evaluates AngioJet thrombectomy of occluded autogenous dialysis fistulae and polytetrafluoroethylene (PTFE) grafts in a UK hemodialysis population. Comparison is made with published data of alternative percutaneous thrombectomy methods. All patients with occluded dialysis fistulae who sought care at the Royal Liverpool University Hospital between October 2006 and June 2008 were included in the study. All patients were treated with the AngioJet Rheolytic Thrombectomy Device (Possis, Minneapolis, MN). Demographics, time of occlusion, adjunctive therapies, complications, and follow-up data have been prospectively recorded. A total of 64 thrombectomy procedures were performed in 48 patients. Forty-four autogenous fistulas were treated in 34 patients (19 brachiocephalic, 8 radiocephalic, and 7 transposed brachiobasilic). Twenty PTFE grafts were treated in 14 patients (9 brachioaxillary, 3 brachiocephalic loop grafts, 1 brachiobasilic, and 1 femoro-femoral). The average length of occlusion was 24 cm. Average time to intervention was 4 days. Immediate primary patency was 91%. Primary patency at 1, 3, and 6 months, respectively, was 71%, 60%, and 37%. Secondary patency at 3, 6, and 12 months was 87%, 77%, and 62%, respectively. Angioplasty was carried out in all procedures. Patients required stent insertion in 34 of the 64 thrombectomies to treat angioplasty-resistant stenoses. Complications included a puncture-site hematoma, and three angioplasty-related vein ruptures in one patient, all treated with covered stent grafts. Two cases of distal brachial arterial embolization were successfully treated by thrombosuction. AngioJet thrombectomy in dialysis access occlusion is safe and effective, comparing favorably with other methods.

  15. Recurrent neck lesions secondary to pyriform sinus fistula.

    PubMed

    Zhang, Peijun; Tian, Xiufen

    2016-03-01

    Recurrent neck lesions associated with third or fourth branchial arch fistula are much less common than those of second arch and usually present with acute suppurative thyroiditis or neck abscess. Our aim is to describe clinical features, management and treatment outcomes of 64 cases of congenital pyriform sinus fistula (PSF). Medical record of these 64 patients (33 males, 31 females) treated at the First Affiliated Hospital of Zhengzhou University from 2011 to 2014 were reviewed. The patients comprised 33 males and 31 females, and their ages ranged from 18 months to 47 years (median 10 years, mean 12.7 years). Neck abscess and recurrent infection was the mode of presentation in 37 cases (57.8 %), 4 patients (6.3 %) presented with acute suppurative thyroiditis, neck mass was the mode of presentation in 17 cases (26.6 %), 2 patients (3.1 %) presented with neck mass with respiratory distress, and cutaneous discharging fistula was the mode of presentation in 1 cases (1.6 %). The remaining 3 patients (4.7 %) presented with cutaneous discharging fistula with neck infection. Investigations performed include barium swallow, CT scan, and ultrasound which were useful in delineating PSF tract preoperatively. Barium swallow was taken as the gold standard for diagnosis. Our patients were treated by fistulectomy with hemithyroidectomy, fistulectomy, fistulectomy with endoscopic electric cauterization, endoscopic electric cauterization or endoscopic coblation cauterization, respectively. Histopathologic examination of the surgical specimens revealed that they were lined with ciliated epithelium, stratified cuboid epithelium with chronic inflammatory cell infiltration and fibrosis. Voice hoarseness occurred after operation in seven patients, but disappeared 1 week later. PSF recurred in 6 patients, 4 of them were cured by a successful re-excision. One patient was cured by successful endoscopic electric cauterization. The other 1 has remained asymptomatic for 5 months. In our

  16. Tracheoinnominate fistula: surgical management of an iatrogenic disaster.

    PubMed

    Ridley, R W; Zwischenberger, J B

    2006-08-01

    Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF. PMID:16709270

  17. Aortoesophageal fistula after thoracic endovascular aortic repair and transthoracic embolization.

    PubMed

    Riesenman, Paul J; Farber, Mark A; Mauro, Matthew A; Selzman, Craig H; Feins, Richard H

    2007-10-01

    Endografts are more commonly being used to treat thoracic aortic aneurysms and other vascular lesions. Endoleaks are a potential complication of this treatment modality and can be associated with aneurysmal sac expansion and rupture. This case report presents a patient who developed a type IA endoleak after endograft repair of a descending thoracic aneurysm. The endoleak was successfully treated through computed tomographic-guided transthoracic embolization, although the patient experienced lower extremity paraparesis postprocedurally. The patient's endovascular repair was complicated by the development of an aortoesophageal fistula and endograft infection necessitating operative débridement and endograft explantation. PMID:17903656

  18. Tentorial dural arteriovenous fistula of the medial tentorial artery.

    PubMed

    Liu, Syrone; Lee, Dane C; Tanoura, Tad

    2016-09-01

    The medial tentorial artery arises from the meningohypophyseal trunk, a branch of the cavernous internal carotid artery, and it is poorly visualized on angiography in the absence of pathologically increased blood flow. We present the case of a 38-year-old man with intraventricular hemorrhage from a tentorial dural arteriovenous fistula (DAVF) singularly supplied by a robust medial tentorial artery. Tentorial DAVFs comprise a rare but high-risk subset of DAVFs. The diagnosis was suggested by computed tomography and magnetic resonance imaging findings and confirmed with digital subtraction angiography. PMID:27594958

  19. Venous ulcer: late complication of a traumatic arteriovenous fistula.

    PubMed

    Young, Calvin J; Dardik, Alan; Sumpio, Bauer; Indes, Jeff; Muhs, Bart; Ochoa Chaar, Cassius I

    2015-01-01

    Arteriovenous fistula (AVF) formation after penetrating trauma is a well-described phenomenon. However, diagnosis of traumatic AVF is frequently delayed as patients often do not have hard signs of vascular injury at the initial presentation. Late complications of traumatic AVF include arterial and venous dilatation, distal ischemia, venous congestion, and congestive heart failure. This case report describes a traumatic femoral AVF causing distal venous ulceration 3 years after the injury. The AVF was treated with open repair. In the operating room, the Nicoladoni-Branham sign was elicited. The ulcer healed at 1 month and has not recurred at 1-year follow-up. PMID:25725283

  20. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula

    PubMed Central

    2016-01-01

    Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis. PMID:27313922

  1. Pancreaticopericardial fistula: a rare complication of chronic pancreatitis.

    PubMed

    Nasa, Mukesh; Patil, Gaurav; Choudhary, Narendra Singh; Puri, Rajesh

    2016-01-01

    Pancreaticopericardial fistula (PPF) is an extremely rare clinical problem encountered in patients with chronic pancreatitis. The diagnosis should be suspected if a patient presents with pericardial effusion on a background of chronic pancreatitis. Significantly raised amylase in the pericardial fluid offers an important clue for the diagnosis. CT is the initial imaging modality to look for pancreatic and pericardial changes. The therapeutic options include medical, endoscopic or surgical interventions. Medical and endoscopic therapies are the preferred modes of treatment while surgery is reserved for those who fail these measures. PMID:27190118

  2. Long-term preservation of native arteriovenous dialysis fistulas.

    PubMed

    Mallios, Alexandros; Costanzo, Alessandro; Boura, Benoit; Combes, Myriam; Alomran, Faris; de Blic, Romain; Jennings, William C

    2014-04-01

    Preservation of native arteriovenous fistulas (AVFs) in the long term can be technically challenging. Various anatomic or functional problems can occur and multiple open and/or endovascular interventions may be required for extended preservation of native accesses. In this report, we review vascular access maintenance in a 72-year-old woman during a 5-year period. Multiple complications of her native radiocephalic AVF included recurrent occlusions, a central venous stent fracture and symptomatic venous outflow stenosis. We present this case to illustrate the various techniques and combination of approaches used in the long-term preservation of a native AVF. PMID:24360937

  3. Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

    SciTech Connect

    Sheth, Rahul A.; Feldman, Adam S.; Walker, T. Gregory

    2015-02-15

    Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

  4. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula

    PubMed Central

    Sung, Kyoung-Su; Song, Young-Jin

    2016-01-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system. PMID:27446527

  5. Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

    PubMed Central

    Dold, Stefan; Doberauer, Johannes P.; Mai, Peter

    2013-01-01

    Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation. PMID:24285953

  6. Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis

    PubMed Central

    Dember, Laura M.; Beck, Gerald J.; Allon, Michael; Delmez, James A.; Dixon, Bradley S.; Greenberg, Arthur; Himmelfarb, Jonathan; Vazquez, Miguel A.; Gassman, Jennifer J.; Greene, Tom; Radeva, Milena K.; Braden, Gregory L.; Ikizler, T. Alp; Rocco, Michael V.; Davidson, Ingemar J.; Kaufman, James S.; Meyers, Catherine M.; Kusek, John W.; Feldman, Harold I.

    2016-01-01

    Context The arteriovenous fistula is the preferred type of vascular access for hemodialysis because of lower thrombosis and infection rates and lower health care expenditures compared with synthetic grafts or central venous catheters. Early failure of fistulas due to thrombosis or inadequate maturation is a barrier to increasing the prevalence of fistulas among patients treated with hemodialysis. Small, inconclusive trials have suggested that antiplatelet agents may reduce thrombosis of new fistulas. Objective To determine whether clopidogrel reduces early failure of hemodialysis fistulas. Design, Setting, and Participants Randomized, double-blind, placebo-controlled trial conducted at 9 US centers composed of academic and community nephrology practices in 2003–2007. Eight hundred seventy-seven participants with end-stage renal disease or advanced chronic kidney disease were followed up until 150 to 180 days after fistula creation or 30 days after initiation of dialysis, whichever occurred later. Intervention Participants were randomly assigned to receive clopidogrel (300-mg loading dose followed by daily dose of 75 mg; n = 441) or placebo (n = 436) for 6 weeks starting within 1 day after fistula creation. Main Outcome Measures The primary outcome was fistula thrombosis, determined by physical examination at 6 weeks. The secondary outcome was failure of the fistula to become suitable for dialysis. Suitability was defined as use of the fistula at a dialysis machine blood pump rate of 300 mL/min or more during 8 of 12 dialysis sessions. Results Enrollment was stopped after 877 participants were randomized based on a stopping rule for intervention efficacy. Fistula thrombosis occurred in 53 (12.2%) participants assigned to clopidogrel compared with 84 (19.5%) participants assigned to placebo (relative risk, 0.63; 95% confidence interval, 0.46–0.97; P = .018). Failure to attain suitability for dialysis did not differ between the clopidogrel and placebo groups (61

  7. Brief Report: Concurrent cervical giant perimedullary arteriovenous fistula, aneurysm on a feeding artery of fistula and unilateral congenital carotid aplasia

    PubMed Central

    Kaloostian, Paul E; Chen, Han; Khan, Shah-Naz H; Taylor, Christopher

    2014-01-01

    Giant perimedullary arteriovenous fistulae (GPAVFs) are extremely rare, particularly cervical GPAVFs whose incidence has not been tabulated. The occurrence of aneurysm on an artery feeding a GPAVF has previously not been described. Internal carotid artery aplasia is also very rare (0.01%). The concurrence of these disorders has previously not been recorded. We report a case of a 5-year-old female with increasing headaches, who was found to have intraventricular hemorrhage and above anomalies. Coil embolization of GPAVF and the adjacent aneurysm was attempted. Treatment was complicated by stroke and death. Embryological and anatomical factors underlying these anomalies as well as, management options are discussed. PMID:24920990

  8. Perioperatively acquired disorders of coagulation

    PubMed Central

    Grottke, Oliver; Fries, Dietmar; Nascimento, Bartolomeu

    2015-01-01

    Purpose of review To provide an overview of acquired coagulopathies that can occur in various perioperative clinical settings. Also described are coagulation disturbances linked to antithrombotic medications and currently available strategies to reverse their antithrombotic effects in situations of severe hemorrhage. Recent findings Recent studies highlight the link between low fibrinogen and decreased fibrin polymerization in the development of acquired coagulopathy. Particularly, fibrin(ogen) deficits are observable after cardiopulmonary bypass in cardiac surgery, on arrival at the emergency room in trauma patients, and with ongoing bleeding after child birth. Regarding antithrombotic therapy, although new oral anticoagulants offer the possibility of efficacy and relative safety compared with vitamin K antagonists, reversal of their anticoagulant effect with nonspecific agents, including prothrombin complex concentrate, has provided conflicting results. Specific antidotes, currently being developed, are not yet licensed for clinical use, but initial results are promising. Summary Targeted hemostatic therapy aims to correct coagulopathies in specific clinical settings, and reduce the need for allogeneic transfusions, thus preventing massive transfusion and its deleterious outcomes. Although there are specific guidelines for reversing anticoagulation in patients treated with antiplatelet agents or warfarin, there is currently little evidence to advocate comprehensive recommendations to treat drug-induced coagulopathy associated with new oral anticoagulants. PMID:25734869

  9. Foodborne listeriosis acquired in hospitals.

    PubMed

    Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M

    2014-08-15

    Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods. PMID:24846635

  10. An ongoing dispute in the management of severe pancreatic fistula: Pancreatospleenectomy or not?

    PubMed Central

    Dellaportas, Dionysios; Tympa, Aliki; Nastos, Constantinos; Psychogiou, Vasiliki; Karakatsanis, Andreas; Polydorou, Andreas; Fragulidis, George; Vassiliou, Ioannis; Smyrniotis, Vassilios

    2010-01-01

    The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery. Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery. However, leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection. Various strategies have been employed in order to manage pancreatic fistula. Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment. A Medline search was performed, with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C. Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death. Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures, while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions. There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery. Completion pancreatectomy is reserved for patients not improving with conventional measures. PMID:21160901

  11. Cardiovascular magnetic resonance and computed tomography in the evaluation of aneurysmal coronary-cameral fistula

    PubMed Central

    Detorakis, Efstathios E; Foukarakis, Emmanouil; Karavolias, George; Dermitzakis, Alkiviades

    2015-01-01

    Coronary artery fistulas represent abnormal communications between a coronary artery and a major vessel like venae cavae, pulmonary arteries or veins, the coronary sinus, or a cardiac chamber. The latter is called coronary cameral fistula is a rare condition and is most of the times congenital but can be also post traumatic or post surgical, especially after cardiovascular interventional procedures. Most patients are asymptomatic and coronary-cameral fistulae are discovered incidentally during angiographic evaluation for coronary vascular disorders, while other patients have a clinical presentation ranging from angina pectoris to heart failure. In this article, we report a rare case of an aneurysmal right coronary cameral fistula draining into the left ventricle. Echocardiography usually represents the first diagnostic imaging approach, but often due to a poor acoustic window may not show the entire course of the fistula which is crucial for the final diagnosis. ECG-gated cardiovascular CT may play an important role in the evaluation of the origin, course, termination and morphology of the fistula, its relation to the adjacent anatomical structures as well as the morphology and contractility of the heart. Cardiac MRI instead plays an additional crucial role regarding not only the above mentioned factors but also in estimating the blood flow within the fistula, providing more detailed information about the cardiac function but also about myocardial wall viability. PMID:26629294

  12. Pancreaticopericardial Fistula: A Case Report and Literature Review

    PubMed Central

    Khan, Muhammad S.; Shahbaz, Najmi; Zia, Hassaan A.; Hamza, Muhammad; Iqbal, Henna; Awab, Ahmed

    2016-01-01

    Purpose. Pancreaticopericardial fistula (PPF) is an extremely rare complication of acute or chronic pancreatitis. This paper presents a rare case of PPF and provides systematic review of existing cases from 1970 to 2014. Methods. A PubMed search using key words was performed for all the cases of PPF from January 1970 to December 2014. Fourteen cases were included in the study. The cases were reviewed for demographic characteristics, diagnostic modalities, and treatment. Descriptive analysis of these variables was performed. Results. Median age was 43 years. 78% were known alcoholics and 73.3% had chronic pancreatitis. Dyspnea was present in 78%. Cardiac tamponade was present in 53%; 75% of patients had known chronic pancreatitis (RR = 0.74). Surgery was associated with best treatment outcomes and 50% of patients who underwent endoscopic treatment survived. Conclusion. PPF is a rare disease. This paper indicates that acute cardiac tamponade in patients with history of alcoholism and chronic pancreatitis could be a sign of an existing pancreaticopericardial fistula and early surgical intervention could be life-saving. PMID:27190657

  13. Intravenous Digital Subtraction Angiography (DSA) of Hemodialysis Access Fistulae

    PubMed Central

    Allen, Gregory J.; Burnett, Keith R.; Vaziri, Nosratola D.; Friedenberg, Richard M.

    1986-01-01

    Hemodialysis access fistulae or grafts are subject to a variety of complications, including thrombosis, stenoses, and aneurysm or pseudoaneurysm formation. The usual radiologic methods to evaluate these problems consist of retrograde venous angiography or standard femoral or brachial arteriography. Both are invasive, and may traumatize the artery or graft. Six patients with internal blood access were studied using digital subtraction angiography; five using a central venous injection and one with direct graft injection. Preliminary results indicate that intravenous digital subtraction angiography (IV-DSA) can depict the anatomy of access fistula with adequate spatial resolution. Pathologic entities (stenoses, aneurysms) can be demonstrated, as well as other findings of uncertain clinical significance (kinks and webs). In addition, hemodynamic data can be inferred from the near-physiologic sequence of vessel opacification. Methods are in development that will allow determination of absolute blood flow in pertinent vessels via IV-DSA. There were no complications in this small series, and all examinations were performed on outpatients utilizing standard technique. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:3537322

  14. Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster.

    PubMed

    Allam, Hesham; Callison, R Charles; Scodary, Daniel; Alawi, Aws; Hogan, Daniel W; Alshekhlee, Amer

    2014-12-28

    Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent. PMID:25550998

  15. Complex Vertebral Arteriovenous Fistula and Ruptured Aneurysm in Neurofibromatosis

    PubMed Central

    Roth, Tori C.; Manness, Wayne K; Hershey, Beverly L.; Yazdi, Joseph

    2000-01-01

    The objective and importance of this study was to describe the challenges encountered with treating a high-flow vertebral arteriovenous fistula (AVF) and ruptured aneurysm in a patient with life-threatening hemorrhage. A 36-year-old female with Neurofibromatosis type 1 (NF1) presented 2 weeks after uneventful cesarean section with a rapidly expanding pulsatile neck mass. Angiography demonstrated a complex left vertebral AVF and multiple associated vertebral artery aneurysms. Emergent endovascular coil embolization was performed using a retrograde and antegrade approach to occlude the fistulas and trap the ruptured aneurysm, successfully treating the acute hemorrhage. Subsequent definitive therapy was accomplished utilizing a combined neurointerventional and neurosurgical strategy of direct-puncture acrylic embolization and ligation of the vertebral artery. Recent advances in neurointerventional technology allow novel approaches in the primary and/or preoperative treatment of complex vascular lesions such as those seen in NF1. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5p40-b PMID:17171099

  16. Dural arteriovenous fistula discovered in patient presenting with recent head trauma

    PubMed Central

    Cooper, Chad J.; Said, Sarmad; Nunez, Angelica; Quansah, Raphael; Khalillullah, Sayeed; Hernandez, German T.

    2013-01-01

    Patient Male, 32 Final Diagnosis: Dural arterio-venous fistula Symptoms: Eye redness • post-trauma headache • tinnitus Medication: — Clinical Procedure: Fistula embolization Specialty: Neurology Objective: Mistake in diagnosis Background: A dural arteriovenous fistula (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. The pathogenesis of DAVF still remains unclear. Sinus thrombosis, head trauma, chronic central nervous system, hypercoagulable state, surgery, and hormonal influence are the pre-disposing factors that initiate this disease. The symptoms experienced by the patient will depend on the location of the fistula. Case Report: Thirty-two year old Hispanic male who presented one day after a rear ended motor vehicle collision (MVC) with a severe throbbing headache in the left parietal region, left eye redness but no retro-orbital pain and tinnitus in the left ear. He was initially misdiagnosed to have a carotid-cavernous fistula but upon cerebral angiogram was actually diagnosed with a dural arterio-venous fistula in the posterior fossa venous system followed by successful embolization of the fistula. Conclusions: A cerebral angiography is the gold standard for detection and characterization of a DAVF and will distinguish it from a CCF. Endovascular surgery involves a catheter-based technique for embolization of the lumen of arteries feeding the DAVF, or directly into the vein draining the DAVF. It is very important to recognize the typical findings of patients presenting with a DAVF then quickly proceeding with a cerebral angiogram to determine the exact location of the fistula and the appropriate treatment plan. By diagnosing and treating a DAVF as early as possible, the associated fatal complications can be averted. PMID:24194975

  17. [Malignant esophageal-respiratory fistula and esophageal stenosis treated with a Gianturco-Z-stent].

    PubMed

    Solt, J; Boros, S; Zoltán, I; Horváth, O P; Andics, L; Bajor, J

    1998-10-11

    Oesophago-respiratory fistula in most instances in a complication of advanced malignant tumours of the oesophagus or the lung. In our patient group eleven oesophago-respiratory and one gastro-respiratory fistulas were encountered. Three patients were operated upon. In one of them with achalasia, early oesophageal carcinoma was discovered in the background of the fistula. Two patients had fistulas without of oesophageal narrowing, therefore, stent implantation into the trachea and bronchus was performed. One of them was previously managed endoscopically with lyodura plug and fibrin glue, but only temporary occlusion of the fistula was obtained. In five patients, seven conventional oesophageal prosthesis (6 Cook, 1 Rüsch) were used to close the fistulas. In one of these patients, three oesophago-respiratory fistulas developed one after the other at the level of the prosthesis funnel. They were closed with three prostheses connected with short silicone tubes. In the last two patients, Gianturco-Z stent was employed. Its advantages over the plastic prostheses include small basic and lager final luminal diameter, lesser predilatation, easier implantation, lower complication and mortality rate. The silicone coated and double funnel stent with expansile force is effective in fistulas closure. On implantation, stent shortening in minimal, allowing precise placement of the stent even in proximal malignant oesophageal stenosis with oesophago-bronchial fistula. The high price of the stent is compensated for by the lower complication rate, shorter hospitalization and subsequent reduction is hospital expenses. Therefore these metal stents should be financed by the National Health Service, at least in specialized centers for managing patients with dysphagia. PMID:9805459

  18. Worsening angle closure glaucoma and choroidal detachments subsequent to closure of a carotid cavernous fistula

    PubMed Central

    2012-01-01

    Background Carotid cavernous fistulas are abnormal communications between the cavernous sinus and the external or internal carotid arteries. Although rare, closure of carotid cavernous fistulas can lead to immediate ocular complications. To our knowledge, our case represents the first report of worsening angle closure glaucoma and choroidal detachments over an extended period of two months subsequent to closure of a carotid cavernous fistula. Case presentation A 70-year-old female with a history of primary angle closure glaucoma presented with 4 mm of proptosis, resistance to retropulsion, tortuous corkscrew blood vessels and an orbital bruit of the right eye. Diagnostic cerebral angiogram showed a small indirect Barrow type D right carotid cavernous fistula. Transarterial embolization was planned but repeat cerebral angiography prior to the procedure demonstrated spontaneous partial closure of the carotid cavernous fistula and the procedure was aborted. One month later, our patient was noted to have worsening vision and choroidal detachments of the right eye. She declined further testing and was thus started on self-administered manual carotid jugular compressions. One month later, she developed progressive worsening of her choroidal detachments and angle closure. She eventually opted for surgical intervention but repeat cerebral angiography showed significant thrombosis of the carotid cavernous fistula and no intervention was warranted. Examination two months later showed complete resolution of the choroidal detachments and open angles of both eyes. Conclusions Our patient demonstrated worsening angle closure glaucoma and choroidal detachments after spontaneous closure of her carotid cavernous fistula had been noted. Ocular complications, including acute angle closure, have been reported to occur immediately after closure of carotid cavernous fistulas, but not over months as in our patient. It is imperative that individuals who have undergone apparent closure

  19. Late intracranial haemorrhage and subsequent carotid-cavernous sinus fistula after fracture of the facial bones.

    PubMed

    Chang, Chien-Ming; Cheng, Chi-Sheng

    2013-12-01

    Carotid-cavernous sinus fistula is an arteriovenous fistula between the internal carotid artery and the cavernous sinus, and is usually caused by a traumatic tear or a ruptured aneurysm of the cavernous segment of the internal carotid artery. We describe a rare case of delayed intracranial haemorrhage and carotid-cavernous sinus fistula that presented 3 weeks after fracture of the facial bones. The patient developed orbital apex syndrome including ptosis of upper eyelid, pulsatile exophthalmos, chemosis, loss of ocular motility, monocular blindness on the right, and numbness of the right infraorbital region. After transcatheter intra-arterial embolisation, the ptosis and chemosis improved. PMID:23958350

  20. Internal Pudendal Artery Perforator Island Flap for Management of Recurrent Benign Rectovaginal Fistula

    PubMed Central

    Malahias, Marco N.; Karandikar, Sharad; Hendrickse, Charles

    2016-01-01

    Summary: The management of recurrent rectovaginal fistula after obstetric injury and cryptoglandular sepsis is considered a major surgical challenge. The fistula poses a significant negative psychosocial and sexual morbidity. In addition, the poor quality of local tissues due to previous attempts at surgical repair adds to this challenge. There are few data regarding the management of persistent or recurrent fistula in the literature; however, several studies reported high failure rates after 2 or more procedures. We present 4 cases managed successfully in a multidisciplinary approach involving fistulectomy and immediate reconstruction with an internal pudendal artery perforator island flap. PMID:27622109

  1. Successful management of tracheo-innominate artery fistula with endovascular stent graft repair.

    PubMed

    Deguchi, J; Furuya, T; Tanaka, N; Nobori, M; Seki, Y; Nomura, Y; Umehara, I; Saito, H; Miyata, T

    2001-06-01

    Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. PMID:11389430

  2. Successful Anesthesia Management for 2-Stage Surgical Procedure of a Refractory Tracheogastric Tube Fistula After Esophagectomy.

    PubMed

    Ishibashi, Tomoko; Ishikawa, Seiji; Suzuki, Akiko; Miyawaki, Yutaka; Kawano, Tatsuyuki; Makita, Koshi

    2016-02-15

    Tracheogastric tube fistulas are rare but fatal complications after esophagectomy. Anesthetic management for a patient with this complication is challenging because air leakage and mechanical ventilation may cause aspiration. We present a case report of the anesthetic management of a patient having 2-stage surgical repair combined with endoscopic mucosal resection for a giant carinal tracheogastric tube fistula. The first stage was separation of the gastric tube above the fistula with spontaneous breathing under local anesthesia and sedation. The second stage was complete separation and reconstruction of the digestive tract under epidural and general anesthesia with spontaneous breathing and pressure support before insertion of a decompression tube. PMID:26862719

  3. Bilateral Persistent Trigeminal Arteries with Unilateral Trigeminal Artery to Cavernous Sinus Fistula

    PubMed Central

    Chen, David; Chen, Chi-Jen; Chen, Jiann-Jy; Tseng, Ying-Chi; Hsu, Hui-Ling; Ku, Jan-Wen

    2013-01-01

    Summary A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a spontaneous fistula connected from one PTA to the ipsilateral cavernous sinus. This paper reports such a rare circumstance. PMID:24070083

  4. Bilateral persistent trigeminal arteries with unilateral trigeminal artery to cavernous sinus fistula. A case report.

    PubMed

    Chen, David; Chen, Chi-Jen; Chen, Jiann-Jy; Tseng, Ying-Chi; Hsu, Hui-Ling; Ku, Jan-Wen

    2013-09-01

    A 59-year-old man who denied a history of trauma presented with left pulsatile tinnitus and left orbital swelling for six months. Digital subtraction angiography showed a left persistent trigeminal artery (PTA) with a trigeminal artery to cavernous sinus (trigeminal-cavernous sinus) fistula and a right PTA. Transarterial detachable coil embolization of the left trigeminal-cavernous sinus fistula was performed, and the symptoms subsided. There has been no report of bilateral PTAs with a spontaneous fistula connected from one PTA to the ipsilateral cavernous sinus. This paper reports such a rare circumstance. PMID:24070083

  5. Recurrent Myocardial Infarction in a Patient with an Arteriovenous Coronary Fistula and No Coronary Artery Disease.

    PubMed

    Marcaccini, Sandro; Templin, Christian; Manka, Robert; Stämpfli, Simon F

    2016-06-01

    Myocardial infarction in the absence of coronary artery disease is a rare finding. Mechanisms leading to infarction include paradoxical embolism, coronary dissection, coronary spasm, hypercoagulable states, vasculitis, or-in presence of a coronary fistula-a steal phenomenon. We report for the first time a case of a patient with an arteriovenous coronary fistula and no coronary artery disease, suffering from three incidents of myocardial infarction in three different coronary regions-of which only one was located in the area supplied by the coronary artery connected to the fistula. PMID:27231431

  6. Rectovaginal fistula after gastrointestinal tract continuity restoration using a stapler--case report.

    PubMed

    Welanyk, Joanna; Wysocki, Tomasz; Nowobilski, Wiesław; Dobosz, Marek

    2011-12-01

    The authors presented a case of rectovaginal fistula in a 40-year old female patient after gastrointestinal tract continuity restoration (Hartmann's operation) performed because of iatrogenic rectal damage. The most likely cause of rectovaginal fistula development was the erroneous introduction of the stapler into the vagina and sigmoidovaginostomy during an attempt to reconstruct the continuity of the gastrointestinal tract. In order to reconstruct the continuity of the gastrointestinal tract the patient was subject to anterior rectal resection, sigmoidorectostomy, and closure of the fistula inside the vaginal wall by its duplication. Additionally, a double protective ileostomy was performed, which was subject to closure after three months. PMID:22343206

  7. Coronary–Cameral Fistula Caused by Guidewire Trauma and Resolved by Coil Embolization

    PubMed Central

    Banerjee, Suvro

    2016-01-01

    A 57-year-old woman presented with effort angina. A coronary angiogram revealed critical 2-vessel disease, for which she subsequently underwent percutaneous coronary intervention. During angioplasty, a coronary guidewire—inadvertently passed into the right ventricle through the septal branches of the posterior descending coronary artery—caused a coronary artery-to-right ventricular fistula. This fistula was successfully closed percutaneously by coil embolization. To our knowledge, this is the first report of a case in which a coronary artery-to-right ventricular fistula caused by a guidewire was managed successfully by coil embolization. PMID:27547147

  8. Percutaneous Intravertebral Body Embolization of a Traumatic Spinal Epidural Arteriovenous Fistula with Secondary Perimedullary Venous Reflux

    PubMed Central

    Gjertsen, Ø.; Nakstad, P. HJ.; Pedersen, HK; Dahlberg, D.

    2010-01-01

    Summary Arteriovenous fistulas following vertebral fractures are probably very rare. We present a case with fistulous connection between arteries and veins within the fractured 12th thoracic vertebral body with retrograde venous drainage to perimedullary veins resulting in spinal venous hypertension and a cauda equina like symptomatology. Pre-treatment 3D CT enabled us to puncture the venous pouch within the vertebra and deposit glue in the vertebral fistula. The procedure led to a complete occlusion of the fistula and relief of pain and neurological symptoms. PMID:20377987

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

    PubMed

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

    2015-01-01

    Lower esophageal fistula is a rare complication after upper digestive tract surgery, but it is associated with high morbi-mortality. There is no consensus on therapeutic care, however when reoperation is necessary, a pedicled inter-costal flap from the thoracotomy can be easily harvested to patch a large defect or buttress a direct suture, saving -digestive reconstruction. This technique should be mastered by thoracic and general surgeons. We present here two cases of lower esophagus fistulas cured thanks to this intercostal flap, in which we avoided fistula recurrence with maintenance of digestive continuity. PMID:26324039

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

    PubMed

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

    2016-01-01

    Arterial supply and venous drainage at the foramen magnum is variable. Two main forms of clinical presentation, intracranial and spinal, can be differentiated when a dural arteriovenous fistula (DAVF) is found at this level. We describe a case of a 68-year-old patient with a progressive paraparesis, diagnosed of dural arteriovenous fistula located at the posterior lip of foramen magnum. We review, in this setting, the vascular radiological anatomy of those fistulas and its important correlation with neurologic clinical symptoms. PMID:26949168

  11. Posttraumatic arteriovenous fistula and subclavian vein thrombosis: treatment by percutaneous arterial embolization and vein angioplasty.

    PubMed

    Gobin, Y P; Soulez, G; Riadh, A; Houdart, E; Herbreteau, D; Merland, J J

    1993-09-01

    A 71-year-old woman had edema and venous dilatation of her upper right limb that caused painful functional disability following a shoulder injury. Arteriograms demonstrated an arteriovenous fistula between the subclavian artery and vein associated with thrombosis of the vein at the same level. The arteriovenous fistula was found to have multiple arteriovenous communications. Because of associated distal venous thrombosis, venous drainage was retrograde through the brachial vein. The inflow arteries of the fistula were embolized and then the subclavian vein thrombosis was recanalized, dilated, and an endoluminal stent inserted. Clinical signs completely resolved. PMID:8268095

  12. IMAGING DIAGNOSIS-URETHROVAGINAL FISTULA CAUSED BY A MIGRATING GRASS AWN IN THE VAGINA.

    PubMed

    Agut, Amalia; Carrillo, Juana D; Anson, Agustina; Belda, Eliseo; Soler, Marta

    2016-05-01

    A young intact female dog was presented with urinary incontinence. Abdominal ultrasound revealed the presence of hyperechoic linear structures within the cranial vagina suggestive of foreign material. A computed tomography (CT) retrograde vaginourethrogram demonstrated the presence of a fistulous tract between the urethra and vagina. A presumptive diagnosis of urethrovaginal fistula due to migration of foreign material was made. The grass awn was removed with vaginoscopic-guided retrieval. Fourteen days later, surgical repair of the fistula and an ovariohysterectomy were done. This case report emphasizes the usefulness of CT for diagnosis and precise anatomical localization of genitourinary tract fistulas. PMID:26592703

  13. Aortoiliac Aneurysm with Arteriocaval Fistula Treated by a Bifurcated Endovascular Stent-Graft

    SciTech Connect

    Beveridge, Carolyn J.; Pleass, Henry C.C.; Chamberlain, John; Wyatt, Michael G.; Rose, John D.G.

    1998-05-15

    A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported.

  14. Congenital Aorto-azygous Fistula Treated with Coil Embolization: Case Report and Review of the Literature

    SciTech Connect

    Romero, Francisco Diaz; Fernandez, Eudaldo M. Lopez-Tomassetti Albelo, Tomas Perez; Gonzalez, Helio Valles; Gonzalez, Ivan Arteaga

    2006-10-15

    Arteriovenous fistulas between the aorta and the azygous vein usually manifest as a continuous audible murmur mimicking a patent ductus arteriosus when observed at birth. Symptoms when present during childhood are related to dyspnea or cardiac insufficiency. Embolotherapy of congenital vascular malformations is possible. However when this less invasive treatment fails, surgical treatment is sometimes necessary. We describe the case of a 12-year-old child with a large thoracic arteriovenous fistula between the descending thoracic aorta and the azygous vein, which was closed successfully by coil embolization. Available data in the literature suggest that coil embolization of aorto-azygous fistulas is usually successful.

  15. Endovascular Treatment of a Coronary Artery Bypass Graft to Pulmonary Artery Fistula with Coil Embolization

    SciTech Connect

    Nielson, Jeffery L. Kang, Preet S.

    2006-04-15

    Fistula formation between a coronary artery bypass graft (CABG)and the pulmonary arterial circulation represents a rare cause of recurrent angina in patients following bypass grafting. Therapy has traditionally involved surgical ligation by open thoracotomy. We describe a case of left internal mammary artery-left upper lobe pulmonary artery fistula presenting as early recurrent angina following CABG. The fistula was embolized using platinum coils, resulting in symptomatic relief and improvement in myocardial perfusion on cardiac perfusion scintigraphy. Coil embolization should be considered a therapeutic option in patients with coronary-pulmonary steal syndrome.

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

    PubMed Central

    Rippel, Radoslaw Adam; Kolvekar, Shyam

    2013-01-01

    Coronary artery fistula is a rare congenital malformation of high variability. The disease is illustrated with a description of a case example. The management of patients with coronary artery fistulas remains controversial. Both spontaneous regression and life threatening complications have been described. The fistula can be ligated or embolised; however, there are no long term outcome data regarding management. Intraoperative risk of myocardial infarction is less than 5% and death rate varies between 0% and 6%. Due to a small number of cases being described in the literature and a lack of evidence on optimal management, further research is needed in order to determine the best treatment options. PMID:27326064

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

    PubMed Central

    Santos, Marisa D.; Nogueira, Carlos; Lopes, Carlos

    2014-01-01

    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. PMID:25506029

  18. Odontogenic maxillary sinusitis with oro-nasal fistula: a case report

    PubMed Central

    Carini, Fabrizio; Longoni, Salvatore; Amosso, Ernesto; Carini, Stefania; Garavello, Werner; Porcaro, Gianluca

    2014-01-01

    Summary Aim of the study The odontogenic sinusitis has an incidence between 38 and 40.6%. Increased risk of maxillary sinusitis has been reported with the presence of periapical abscesses, periodontal disease, dental trauma, tooth extraction and implant placement when the sinusal membrane is perforated. Materials and methods A patient with odontogenic maxillary sinusitis associated with oro-nasal fistula was treated. Results The follow-up at six months showed the complete resolution of maxillary sinusitis, palatal fistula got closed and pain symptoms disappeared. Conclusion This case report describes a rare complication of odontogenic maxillary sinusitis: the oro-nasal fistula. PMID:25678949

  19. Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

    PubMed Central

    Hammes, Mary

    2015-01-01

    The outcome of patients with end-stage renal disease on hemodialysis depends on a functioning vascular access. Although a variety of access options are available, the arteriovenous fistula remains the best vascular access. Unfortunately the success rate of mature fistula use remains poor. The creation of an arteriovenous fistula is followed by altered hemodynamic and biological changes that may result in neointimal hyperplasia and eventual venous stenosis. This review provides an overview of these changes and the needed research to provide a long lasting vascular access and hence improve outcomes for patients with end-stage renal disease. PMID:26495286

  20. Acquired immunodeficiency syndrome: neuroradiologic findings.

    PubMed

    Kelly, W M; Brant-Zawadzki, M

    1983-11-01

    Central nervous system complications depicted by CT in ten patients with acquired immunodeficiency syndrome are described. Three patients had multifocal intra-axial enhancing lesions representing atypical brain abscesses (two with toxoplasmosis, one with candidiasis). A fourth patient with multifocal "ring" lesions whose biopsy was interpreted as suggestive of toxoplasmosis responded poorly to treatment. Following his death three months later of Pneumocystis carinii pneumonia, autopsy revealed primary intracerebral immunoblastic lymphoma. One patient had Kaposi sarcoma involving the right frontal lobe (seen as an enhancing mass on the CT scan). CT findings in the remaining five patients revealed mild to moderate enlargement of cerebrospinal fluid spaces (including ventricles and basal cisternae) as a result of cryptococcal meningitis in three patients and "aseptic" meningitis in two. The two patients in whom early biopsy confirmed toxoplasmosis responded well to anti-infective therapy, resulting in dramatic clinical recoveries. PMID:6622693