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Sample records for complex perianal fistula

  1. Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach

    PubMed Central

    Sciaudone, Guido; Di Stazio, Crescenzo; Limongelli, Paolo; Guadagni, Ilaria; Pellino, Gianluca; Riegler, Gabriele; Coscione, Paolo; Selvaggi, Francesco

    2010-01-01

    Background The aim of this study was to compare the outcomes of the management of perianal fistulas in Crohn disease between infliximab, surgery or a combination of surgery and infliximab. Methods We prospectively subdivided 35 consecutive patients with Crohn disease with complex perianal fistulas into 3 groups: 11 patients received infliximab (5 mg/kg intravenously at 0, 2 and 6 wk; group A), 10 underwent surgery (group B) and 14 received a combination of surgery and postoperative infliximab (group C). We evaluated the rate and time of healing of perianal fistulas, the rate of recurrences and time to relapse at a median follow-up of 18.8 (standard deviation [SD] 10.8, range 8–38) months. Results The time to healing of fistulas was significantly shorter among patients who received surgery and infliximab than among those who received surgery alone (p < 0.05) and was close to statistically shorter among those who received both treatments than among those who received infliximab alone (p = 0.06). Patients who received surgery and infliximab had a significantly longer mean time to relapse (p < 0.05) than those who received infliximab (mean 2.6 [SD 0.7] mo) or surgery alone (mean 3.6 [SD 0.5] mo). Conclusion We found better outcomes among patients who received a combination of surgery and infliximab therapy. These patients experienced a short time to healing of fistulas and significantly longer mean time to relapse of complex fistulas. PMID:20858373

  2. MRI of Perianal Fistulas: Bridging the radiologic-surgical divide

    PubMed Central

    Gage, Kenneth L.; Deshmukh, Swati; Macura, Katarzyna J.; Kamel, Ihab R.; Zaheer, Atif

    2013-01-01

    Perianal fistula is a clinical entity with multiple surgical treatment options. Recently, magnetic resonance imaging (MRI) has emerged as an important imaging modality in the management of perianal fistulas. It provides accurate description of the fistula within the anal canal in relation to the sphincter complex and other pelvic floor structures as well as the associated complications such as abscess. By understanding the surgical viewpoint, the appearance of perianal fistulas, associated complications, and post-treatment findings of commonly used surgical interventions can more accurately be interpreted to aid clinicians. The objective of the article is to review MRI indications and findings, radiological versus surgical classification schemes, and surgical treatment options for perianal fistulas. PMID:23242265

  3. MRI in evaluation of perianal fistulae

    PubMed Central

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

    2010-01-01

    Background Fistula is considered to be any abnormal passage which connects two epithelial surfaces. Parks’ fistulae classification demonstrates the biggest practical significance and divides fistulae into: intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. Etiology of perianal fistulae is most commonly linked with the inflammation of anal glands in Crohn’s disease, tuberculosis, pelvic infections, pelvic malignant tumours, and with the radiotherapy. Diagnostic method options are: RTG fistulography, CT fistulography and magnetic resonance imaging (MRI) of pelvic organs. Patients and methods We have included 24 patients with perirectal fistulae in the prospective study. X-rays fistulography, CT fistulography, and then MRI of the pelvic cavity have been performed on all patients. Accuracy of each procedure in regards to the patients and the etiologic cause have been statistically determined. Results 29.16% of transphincteric fistulae have been found, followed by 25% of intersphincteric, 25% of recto-vaginal, 12.5% of extrasphincteric, and 8.33% of suprasphincteric. Abscess collections have been found in 16.6% patients. The most frequent etiologic cause of perianal fistulae was Crohn’s disease in 37.5%, where the accuracy of classification of MRI was 100%, CT was 11% and X-rays 0%. Ulcerous colitis was the second cause, with 20.9% where the accuracy of MRI was 100%, while CT was 80% and X-rays was 0%. All other etiologic causes of fistulae were found in 41.6% patients. Conclusions MRI is a reliable diagnostic modality in the classification of perirectal fistulae and can be an excellent diagnostic guide for successful surgical interventions with the aim to reduce the number of recurrences. Its advantage is that fistulae and abscess are visible without the need to apply any contrast medium. PMID:22933919

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

    PubMed

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

    2012-01-01

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

  5. Our Experience with MR Imaging of Perianal Fistulas

    PubMed Central

    Baskan, Ozdil; Koplay, Mustafa; Sivri, Mesut; Erol, Cengiz

    2014-01-01

    Summary Magnetic resonance imaging (MRI) depicts infectious foci in the perianal region better than any other imaging modality. MRI allows definition of the fistula, associated abscess formation and its secondary extensions. Accurate information is necessary for surgical treatment and to obtain a decrease in the incidence of recurrence and complications. Radiologists should be familiar with anatomical and pathological findings of perianal fistulas and classify them using the MRI – based grading system. The purpose of this article was to provide an overview for evaluation of perianal fistulas, examples of various fistula types and their classification. PMID:25550766

  6. Imperforate anus and perianal fistula in Ancient Greek medical writings.

    PubMed

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

    2012-01-01

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

  7. Treatment of peri-anal fistula in Crohn's disease

    PubMed Central

    Sica, Giuseppe S; Di Carlo, Sara; Tema, Giorgia; Montagnese, Fabrizio; Del Vecchio Blanco, Giovanna; Fiaschetti, Valeria; Maggi, Giulia; Biancone, Livia

    2014-01-01

    Anal fistulas are a common manifestation of Crohn’s disease (CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently employed. However, at the moment, none of these techniques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medical therapy and those causing disabling symptoms. Utmost attention should be paid to correcting the balance between eradication of the fistula and the preservation of fecal continence. PMID:25309057

  8. The Gastroenterologist's Role in Management of Perianal Fistula.

    PubMed

    Dalal, Robin L; Schwartz, David A

    2016-10-01

    Perianal fistula occurs frequently in the Crohn disease population. Therapy for fistulas has changed through the years from primarily surgical management to multidisciplinary management among gastroenterologists, radiologists, and surgeons. Gastroenterologists play a role in assisting with diagnosis through endoscopic ultrasound and assessment of luminal disease activity, providing medical therapy including biologic therapy and antibiotics, and coordinating the multidisciplinary care with surgical and radiologic colleagues. PMID:27633597

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

    PubMed

    Simkovic, D; Pospísil, I

    1994-03-01

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

  10. 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

  11. Management of perianal fistulas in Crohn’s disease: An up-to-date review

    PubMed Central

    Marzo, Manuela; Felice, Carla; Pugliese, Daniela; Andrisani, Gianluca; Mocci, Giammarco; Armuzzi, Alessandro; Guidi, Luisa

    2015-01-01

    Perianal disease is one of the most disabling manifestations of Crohn’s disease. A multidisciplinary approach of gastroenterologist, colorectal surgeon and radiologist is necessary for its management. A correct diagnosis, based on endoscopy, magnetic resonance imaging, endoanal ultrasound and examination under anesthesia, is crucial for perianal fistula treatment. Available medical and surgical therapies are discussed in this review, including new local treatment modalities that are under investigation. PMID:25663759

  12. Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

    PubMed Central

    Singh, Navdeep; Thukral, CL; Singh, Kunwar Pal; Bhalla, Varun

    2014-01-01

    Aims: The purpose of the study was to evaluate the role of Magnetic Resonance Imaging in detection and characterization of perianal fistulae and correlating it with surgical findings. Methods: Fifty consecutive patients with suspected perianal fistulae having one or more external openings were prospectively selected for MRI evaluation. Previously operated or patients with recurrent perianal disease were excluded from the study. MRI findings were recorded according to “St. James’s University Hospital MR Imaging Classification of Perianal Fistulae” and correlated with surgical observations. Finally, comparison between T2-weighted fat saturated and postcontrast T1-weighted fat saturated sequences was done. Results: Amongst the total of 50 patients, per-operative findings confirmed perianal fistulae in 45 patients. The sensitivity and specificity of MRI in correctly detecting and grading the primary tract was found to be 95.56% and 80% respectively; for abscess, it was 87.50% and 95.24% respectively. High sensitivity was also discerned in identification of secondary tract (93.75%), correct localization of internal opening (95.83%) and for correctly detecting the horse-shoeing (87.50%). Our assumption of null hypothesis was accepted on comparing results of T2-weighted fat saturated sequences and postcontrast T1-weighted fat saturated sequences. Conclusion: Magnetic Resonance Imaging (MRI) was highly accurate in assessment of surgically important parameters (primary tract and its grading, internal opening, secondary tract, abscess, horseshoeing) of perianal fistulae. Comparison of results of imaging findings on T2-weighted and postcontrast T1-weighted fat saturated sequences were statistically similar, so contrast study can be omitted, particularly while evaluating primary / previously unoperated perianal fistulae. PMID:25121040

  13. Three-dimensional endoanal ultrasound for diagnosis of perianal fistulas: Reliable and objective technique

    PubMed Central

    Garcés-Albir, Marina; García-Botello, Stephanie Anne; Espi, Alejandro; Pla-Martí, Vicente; Martin-Arevalo, Jose; Moro-Valdezate, David; Ortega, Joaquin

    2016-01-01

    AIM: To evaluate accuracy of three-dimensional endoanal ultrasound (3D-EAUS) as compared to 2D-EAUS and physical examination (PE) in diagnosis of perianal fistulas and correlate with intraoperative findings. METHODS: A prospective observational consecutive study was performed with patients included over a two years period. All patients were studied and operated on by the Colorectal Unit surgeons. The inclusion criteria were patients over 18, diagnosed with a criptoglandular perianal fistula. The PE, 2D-EAUS and 3D-EAUS was performed preoperatively by the same colorectal surgeon at the outpatient clinic prior to surgery and the fistula anatomy was defined and they were classified in intersphincteric, high or low transsphincteric, suprasphincteric and extrasphincteric. Special attention was paid to the presence of a secondary tract, the location of the internal opening (IO) and the site of external opening. The results of these different examinations were compared to the intraoperative findings. Data regarding location of the IO, primary tract, secondary tract, and the presence of abscesses or cavities was analysed. RESULTS: Seventy patients with a mean age of 47 years (range 21-77), 51 male were included. Low transsphincteric fistulas were the most frequent type found (33, 47.1%) followed by high transsphincteric (24, 34.3%) and intersphincteric fistulas (13, 18.6%). There are no significant differences between the number of IO diagnosed by the different techniques employed and surgery (P > 0.05) and, there is a good concordance between intraoperative findings and the 2D-EAUS (k = 0.67) and 3D-EAUS (k = 0.75) for the diagnosis of the primary tract. The ROC curves for the diagnosis of transsphincteric fistulas show that both ultrasound techniques are adequate for the diagnosis of low transsphincteric fistulas, 3D-EAUS is superior for the diagnosis of high transsphincteric fistulas and PE is weak for the diagnosis of both types. CONCLUSION: 3D-EAUS shows a higher

  14. Obesity and Outcome of Crohn’s Associated Perianal Fistula Surgery: A Case-Control Study

    PubMed Central

    Manne, Ashish; Khan, Ali S.; Malik, Talha A.

    2015-01-01

    Background Evidence suggests that obesity (body mass index (BMI) > 30 kg/m2) adversely affects several outcomes in Crohn’s disease (CD). CD-associated perianal fistula (CDPF) represents a debilitating phenotype with a clinical course that may be affected by obesity. We hypothesized that obese CD patients would be more likely to have poor outcomes following CDPF surgery. Methods We designed a case-control study of CD patients who underwent surgery for CDPF between 2000 and 2013 with documented pre-operative BMI and post-operative outcome. Cases and controls were defined based on the outcome of CDPF surgery. Poor outcomes were designated as cases. Results Of the 317 patients diagnosed with CDPF, 73 patients underwent 120 surgeries for CDPF. Eighty-nine (74%) of the surgeries comprised fistulotomy with or without Seton placement, whereas 31 (26%) were mucosal flap procedures. Twenty-five (21%) cases and 95 (79%) controls were identified. Unadjusted odds ratio (OR) for the association between obesity and outcome demonstrated a trend towards a poor surgical outcome among obese patients that did not reach statistical significance (OR: 1.86; 95% confidence interval (CI): 0.58 - 5.98; P = 0.295). Multivariable logistic regression analysis demonstrated an even stronger trend towards a poor outcome among obese CD patients, albeit without reaching statistical significance (OR: 2.83; 95% CI: 0.64 - 12.49; P = 0.169). Conclusion In patients undergoing Seton placement, fistulotomy or mucosal flap procedure for CDPF, there is a trend towards poor outcomes in the obese; however, as this trend did not reach statistical significance, this association should be examined further.

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

    PubMed Central

    Verma, Shashi; Gangkak, Goto; Yadav, Sher Singh; Tomar, Vinay

    2015-01-01

    Megalourethra with Y-type duplication is an extremely rare anomaly. We report here one such case, diagnosed with retrograde urethrogram, which was done from both penile meatus and perianal opening simultaneously. Patient was successfully treated by laser optical internal urethrotomy (OIU), excision of duplicated urethra, and reduction urethroplasty in a single stage. PMID:26146583

  16. First-in-Human Case Study: Pregnancy in Women With Crohn’s Perianal Fistula Treated With Adipose-Derived Stem Cells: A Safety Study

    PubMed Central

    García-Arranz, Mariano; Guadalajara, Hector; de la Quintana, Paloma; Herreros, Maria Dolores; García-Olmo, Damián

    2015-01-01

    The aim of this study was to determine whether treatment with adipose-derived stem cells (ASCs) had any influence on fertility, course of pregnancy, newborn weight, or physical condition of newborns. We performed a retrospective study of patients with a desire to become pregnant after having received intralesional injection of autologous ASCs for the treatment of perianal or rectovaginal fistula associated with Crohn’s disease. We collected data on the resulting pregnancies, deliveries, and newborns of these patients. ASCs were expanded in vitro and characterized according to the international guidelines for cell surface markers (clusters of differentiation) and differentiated to adipocytes, chondrocytes, and osteocytes prior to implantation (except first implant in 2002). We analyzed five young women with Crohn’s disease treated with ASCs: one for rectovaginal and perianal fistula, two for rectovaginal fistula only, and two for perianal fistula only. All patients received 2 doses of 20 million and 40 million cells at an interval of 3–4 months. Another patient received 2 doses of 6.6 million and 20 million ASCs with 9 months between each dose. Fertility and pregnancy outcomes were not affected by cell therapy treatment. No signs of treatment-related malformations were observed in the neonates by their respective pediatricians. In the patients studied, cell therapy with ASCs did not affect the course of pregnancy or newborn development. Significance Local treatment with mesenchymal stem cells derived from adipose tissue seems not to affect the ability to conceive, the course of pregnancy, pregnancy outcomes, or newborns’ health in female patients. This is the first publication about pregnancy outcome in women with perianal fistula and Crohn’s disease treated with stem cell therapy, and could be of interest for doctors working in cell therapy. This is a very important question for patients, and there was no answer for them until now. PMID:25925838

  17. Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR).

    PubMed

    Amato, A; Bottini, C; De Nardi, P; Giamundo, P; Lauretta, A; Realis Luc, A; Tegon, G; Nicholls, R J

    2015-10-01

    Perianal sepsis is a common condition ranging from acute abscess to chronic fistula formation. In most cases, the source is considered to be a non-specific cryptoglandular infection starting from the intersphincteric space. The key to successful treatment is the eradication of the primary track. As surgery may lead to a disturbance of continence, several sphincter-preserving techniques have been developed. This consensus statement examines the pertinent literature and provides evidence-based recommendations to improve individualized management of patients.

  18. [Our experience with the treatment of high perianal fistulas with the mucosal flap advancement technique].

    PubMed

    Marino, Giuseppe; Greco, Ettore; Gasparrini, Marcello; Romanzi, Aldo; Ottaviani, Maurizio; Nasi, Stefano; Pasquini, Giorgio

    2004-01-01

    The authors present their experience with the treatment of high transphincteric anal fistulas with the mucosal flap advancement technique. This technique, though by no means easy to perform, allows fistulas to be treated in a single surgical session in comparison to the technique in which setone is used or to the less well known transposition techniques, given the same long-term results in terms of continence and recurrence rate. After a brief overview of the problem, from the points of view of both aetiopathogenesis and classification, the principal surgical treatment techniques are described, presenting the results and complications observed in the authors' own case series. PMID:15038659

  19. Efficacy of magnetic resonance imaging in the diagnosis of perianal hidradenitis suppurativa, complicated by anal fistulae: A report of two cases and review of the literature

    PubMed Central

    Takiyama, Hirotoshi; Kazama, Shinsuke; Tanoue, Yusuke; Yasuda, Koji; Otani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Miyagawa, Takuya; Yamada, Daisuke; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Watanabe, Toshiaki

    2015-01-01

    Background Perianal hidradenitis suppurativa (PHS) is a chronic recurrent inflammatory disease of the apocrine glands present in the skin and soft tissue adjacent to the anus. It is often misdiagnosed or treatment is delayed, resulting in the formation of an abscess or, in the worst case, leading to sepsis. It is difficult to treat perianal lesions merged with fistulae completely due to its high recurrence rate. Therefore, we should diagnose it correctly and treat it with appropriate methods. Presentation of case We report two cases of PHS with anal fistulae that were examined preoperatively using magnetic resonance imaging (MRI) and treated safely by surgery without any recurrence. Discussion The anal sphincter area cannot be visualized and evaluated directly by fistulography. Also CT has only limited resolution, making it difficult to distinguish between soft tissues and inflammatory streaks. Endosonography is not suitable for the examination of supra-sphincteric or extra-sphincteric extensions, as it is limited by insufficient penetration of the ultrasonic beams. MRI can demonstrate the entire course of the fistulae owing to its high contrast resolution. Conclusion Our findings support the idea that PHS with complicated anal fistulae can be diagnosed accurately using MRI and treated safely and completely with surgery. PMID:26339787

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

    PubMed Central

    van Koperen, Paul J; Bemelman, Willem A; Bossuyt, Patrick MM; Gerhards, Michael F; Eijsbouts, Quirijn AJ; van Tets, Willem F; Janssen, Lucas WM; Dijkstra, F Robert; van Dalsen, Annette D; Slors, J Frederik M

    2008-01-01

    Background Low transsphincteric fistulas less than 1/3 of the sphincter complex are easy to treat by fistulotomy with a high success rate. High transsphincteric fistulas remain a surgical challenge. Various surgical procedures are available, but recurrence rates of these techniques are disappointingly high. The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons. In the literature a recurrence rate between 0 and 63% is reported for the mucosal flap advancement. Recently Armstrong and colleagues reported on a new biologic anal fistula plug, a bioabsorbable xenograft made of lyophilized porcine intestinal submucosa. Their prospective series of 15 patients with high perianal fistula treated with the anal fistula plug showed promising results. The anal fistula plug trial is designed to compare the anal fistula plug with the mucosal flap advancement in the treatment of high perianal fistula in terms of success rate, continence, postoperative pain, and quality of life. Methods/design The PLUG trial is a randomized controlled multicenter trial. Sixty patients with high perianal fistulas of cryptoglandular origin will be randomized to either the fistula plug or the mucosal advancement flap. Study parameters will be anorectal fistula closure-rate, continence, post-operative pain, and quality of life. Patients will be followed-up at two weeks, four weeks, and 16 weeks. At the final follow-up closure rate is determined by clinical examination by a surgeon blinded for the intervention. Discussion Before broadly implementing the anal fistula plug results of randomized trials using the plug should be awaited. This randomized controlled trial comparing the anal fistula plug and the mucosal advancement flap should provide evidence regarding the effectiveness of the anal fistula plug in the treatment of high perianal fistulas. Trial registration ISRCTN: 97376902 PMID:18573198

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

    PubMed Central

    2014-01-01

    Background. Perianal Crohn's disease (CD) can be challenging. Despite the high incidence of fistulizing CD, literature lacks clear guidelines. Several medical, surgical, and combined treatment modalities have been proposed, but evidences are scarce. Methods. We searched the literature to assess the facets of perianal CD, with particular focus on complex fistulae. Disease epidemiology, classification, diagnosis, activity scoring systems, and medical-surgical treatments were assessed. Results. Perianal fistulizing CD is common, frequently associated with upper gastrointestinal and colorectal CD. Complex fistulas often require repeated treatments. Continence is a major concern when dealing with repeated procedures. A prudent pathway is to resolve active sepsis and to limit damages, delaying a definitive treatment to the time when acute phase has been controlled. The improved diagnostic techniques allow better preoperative planning and are useful in monitoring the response to treatment. Besides newer devices, cell-based treatments are promising tools which have recently enriched the treatment portfolio. However, the need for proctectomy is still disturbingly high in CD patients with complex perianal fistulae. Conclusions. Perianal CD can impair quality of life and lead to need for proctectomy. A staged approach is reasonable. Treatment success can be improved by multimodal treatment and collaborative management by experienced gastroenterologists and surgeons. PMID:25431776

  2. [Surgical treatment for perianal Crohn's disease].

    PubMed

    Futami, Kitaro; Higashi, Daijiro; Hirano, Yukiko; Ikeda, Yuichi; Mikami, Koji; Hirano, Kimikazu; Miyake, Toru; Takahashi, Hiroyuki; Maekawa, Takafumi

    2015-03-01

    Perianal lesions are a frequent complication of Crohn's disease (CD) and include fistula, abscess, anal ulcer, skin tag, anal stricture, and carcinoma. Perianal fistula is the most commonly observed condition and exhibits multiple incidence and intractable characteristics. The starting point for the management of perianal fistula is an accurate diagnosis, which requires careful exploration during an EUA. The condition is treated with medications such as antibiotics, immunosuppressants, or anti-tumor necrosis factor agents. However, it is difficult to maintain long-term remission. Surgical therapy is selected according to the type of fistula and can include conventional fistulotomy, seton drainage, diverting stoma, and anorectal amputation. After fistulotomy, recurrence is frequent and there is an increased risk of incontinence. Seton drainage is the preferred treatment to improve symptoms and preserve anal function. Stoma is useful to relieve symptoms but difficult to indicate for young patients. The optimum treatment for perianal fistula associated with CD remains controversial. Currently, the goal of therapy for these patients has shifted from complete fistula closure to reducing drainage from the fistula to improve their quality of life. Ongoing careful management is important to control anal symptoms and maintain long-term anal function in the treatment of patients with CD, while monitoring them to detect possible progression to anorectal carcinoma.

  3. Imaging of perianal fistulizing Crohn's disease.

    PubMed

    Chidi, Vivian N; Schwartz, David A

    2015-06-01

    Perianal fistula is a complication of Crohn's disease that carries a high morbidity. It is a channel that develops between the lower rectum, anal canal and perianal or perineal skin. The development of perianal fistulas typically connotes a more aggressive disease phenotype and may warrant escalation of treatment to prevent poor outcomes over time. Based on fistula anatomy, debris can form inside these tracts and cause occlusion, which subsequently leads to abscess formation, fever and malaise. The clinical presentation is often with complaints of pain, continuous rectal drainage of fecal matter as well as malodorous discharge. Considering that the presence of fistulas often indicates refractory and aggressive disease, early identification of its presence is important. Some patients may not have the classic symptoms of fistulizing disease at presentation and others may have significant scarring and/or pain from previous fistulizing episodes, which can make an accurate assessment on physical exam alone problematic. As a result, utilizing diagnostic imaging is the best means of identifying the early signs of perianal fistulas or abscess formation in these patients. Several imaging modalities exist which can be used for diagnosis and management. Endoscopic ultrasound and pelvic MRI are considered the most useful in establishing the diagnosis. However, a combination of multiple imaging modalities and/or examination under anesthesia is probably the most ideal. Incomplete characterization of the fistula tract(s) extent or the presence of abscess carries a high morbidity and far-reaching personal expense for the patient - promoting worsening of the disease. PMID:25816833

  4. Fistula

    MedlinePlus

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

  5. Fistulizing Crohn's Disease Presenting After Surgery on a Perianal Lesion.

    PubMed

    Singer, Andrew A M; Gadepalli, Samir K; Eder, Sally J; Adler, Jeremy

    2016-03-01

    Perianal skin lesions, such as skin tags, can be an early presenting sign of Crohn's disease. Surgical intervention on these lesions may increase the risk of fistula development and lead to worse outcomes. This case series examined 8 patients who underwent surgical intervention on what appeared to be benign perianal skin lesions, only to reveal fistulas leading to the diagnosis of Crohn's disease. This patient population comprised 20% of all pediatric patients with Crohn's disease who had perianal fistula present at diagnosis. The initial type of perianal lesion varied from case to case and included skin tags, hemorrhoids, and perianal abscesses. All of the patients had other presenting features that, in retrospect, may have been attributed to Crohn's disease. None presented solely with a perianal lesion. Four patients had weight loss or growth failure. Most of the remainder had abnormal laboratory test results. These findings should raise the awareness of primary care providers that perianal lesions can be the first presenting sign of possible Crohn's disease in otherwise healthy appearing children. Such children should undergo a thorough evaluation for Crohn's disease before surgical intervention on perianal lesions because surgical procedures may be associated with worse outcomes.

  6. A rare case of congenital complex pulmonary AV fistula

    PubMed Central

    Pradhan, Akshyaya; Khare, Rashi; Sethi, Rishi

    2014-01-01

    A 15-year-old boy presented with central cyanosis with clubbing and dyspnoea on exertion. Cardiovascular examination did not reveal any abnormality. ECG was normal. Chest X-ray showed a normal sized heart with rounded opacities of variable size in the left upper lung field. Two-dimensional echocardiographic examination was normal. CT angiography showed a large complex lesion composed of serpiginous tubular structures involving the left upper and lingular lobe, suggestive of racemose tangle of blood vessels. A diagnosis of large complex arteriovenous (AV) fistula involving the left upper and lingular lobe was performed. This case reports a rare case of complex pulmonary AV fistula. PMID:25326563

  7. Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality.

    PubMed

    Wright, Emily K; Novak, Kerri L; Lu, Cathy; Panaccione, Remo; Ghosh, Subrata; Wilson, Stephanie R

    2015-01-01

    Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of luminal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility.

  8. Transperineal ultrasonography in perianal Crohn disease: A valuable imaging modality

    PubMed Central

    Wright, Emily K; Novak, Kerri L; Lu, Cathy; Panaccione, Remo; Ghosh, Subrata; Wilson, Stephanie R

    2015-01-01

    Aims of treatment for Crohn disease have moved beyond the resolution of clinical symptoms to objective end points including endoscopic and radiological normality. Regular re-evaluation of disease status to safely, readily and reliably detect the presence of inflammation and complications is paramount. Improvements in sonographic technology over recent years have facilitated a growing enthusiasm among radiologists and gastroenterologists in the use of ultrasound for the assessment of inflammatory bowel disease. Transabdominal intestinal ultrasound is accurate, affordable and safe for the assessment of lumi-nal inflammation and complications in Crohn disease, and can be performed with or without the use of intravenous contrast enhancement. Perianal fistulizing disease is a common, complex and often treatment-refractory complication of Crohn disease, which requires regular radiological monitoring. Endoanal ultrasound is invasive, uncomfortable and yields limited assessment of the perineal region. Although magnetic resonance imaging of the pelvis is established, timely access may be a problem. Transperineal ultrasound has been described in small studies, and is an accurate, painless and cost-effective method for documenting perianal fluid collections, fistulas and sinus tracts. In the present article, the authors review the literature regarding perineal ultrasound for the assessment of perianal Crohn disease and use case examples to illustrate its clinical utility. PMID:25996615

  9. Isolated perianal tuberculosis.

    PubMed

    Akgun, E; Tekin, F; Ersin, S; Osmanoglu, H

    2005-03-01

    Perianal tuberculosis, without the presence of any previous or active pulmonary infection, is extremely rare. A case of isolated perianal tuberculosis without gastrointestinal or pulmonary spread will be discussed here with an evaluation of the clinical features. PMID:15813425

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

    PubMed Central

    A ba-bai-ke-re, Ma-Mu-Ti-Jiang; Wen, Hao; Huang, Hong-Guo; Chu, Hui; Lu, Ming; Chang, Zhong-Sheng; Ai, Er-Ha-Ti; Fan, Kai

    2010-01-01

    AIM: To compare the efficacy and safety of acellular dermal matrix (ADM) bioprosthetic material and endorectal advancement flap (ERAF) in treatment of complex anorectal fistula. METHODS: Ninety consecutive patients with complex anorectal fistulae admitted to Anorectal Surgical Department of First Affiliated Hospital, Xinjiang Medical University from March 2008 to July 2009, were enrolled in this study. Complex anorectal fistula was diagnosed following its clinical, radiographic, or endoscopic diagnostic criteria. Under spinal anesthesia, patients underwent identification and irrigation of the fistula tracts using hydrogen peroxide. ADM was securely sutured at the secondary opening to the primary opening using absorbable suture. Outcomes of ADM and ERAF closure were compared in terms of success rate, fecal incontinence rate, anorectal deformity rate, postoperative pain time, closure time and life quality score. Success was defined as closure of all external openings, absence of drainage without further intervention, and absence of abscess formation. Follow-up examination was performed 2 d, 2, 4, 6, 12 wk, and 5 mo after surgery, respectively. RESULTS: No patient was lost to follow-up. The overall success rate was 82.22% (37/45) 5.7 mo after surgery. ADM dislodgement occured in 5 patients (11.11%), abscess formation was found in 1 patient, and fistula recurred in 2 patients. Of the 13 patients with recurrent fistula using ERAF, 5 (11.11%) received surgical drainage because of abscess formation. The success rate, postoperative pain time and closure time of ADM were significantly higher than those of ERAF (P < 0.05). However, no difference was observed in fecal incontinence rate and anorectal deformity rate after treatment with ADM and ERAF. CONCLUSION: Closure of fistula tract opening with ADM is an effective procedure for complex anorectal fistula. ADM should be considered a first line treatment for patients with complex anorectal fistula. PMID:20614483

  11. Perianal Basal Cell Carcinoma

    PubMed Central

    Bulur, Isil; Boyuk, Emine; Saracoglu, Zeynep Nurhan; Arik, Deniz

    2015-01-01

    Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer. Exposure to ultraviolet light is an important risk factor for BCC development and the disorder therefore develops commonly on body areas that are more exposed to sunlight, such as the face and neck. It is uncommon in the closed area of the body and quite rare in the perianal and genital regions. Herein, we report a 34-year-old patient with perianal BCC who had no additional risk factors. PMID:25848349

  12. [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

  13. PERFACT procedure: A new concept to treat highly complex anal fistula

    PubMed Central

    Garg, Pankaj; Garg, Mahak

    2015-01-01

    AIM: To check the efficacy of the PERFACT procedure in highly complex fistula-in-ano. METHODS: The PERFACT procedure (proximal superficial cauterization, emptying regularly fistula tracts and curettage of tracts) entails two steps: superficial cauterization of mucosa at and around the internal opening and keeping all the tracts clean. The principle is to permanently close the internal opening by granulation tissue. This is achieved by superficial electrocauterization at and around the internal opening and subsequently allowing the wound to heal by secondary intention. Along with this, all the tracts are curetted and it is ensured that they remain empty and clean in the postoperative period until they heal completely. The latter step also facilitates the closure of the internal opening by preventing collected fluid in the tracts from entering the internal opening and thus not letting it close. Objective incontinence scoring was done preoperatively and 3 mo after the operation. RESULTS: Fifty-one patients with complex fistula-in-ano were prospectively enrolled. The median follow-up was 9 mo (5-14 mo). The mean age was 42.7 ± 11.3 years. Male:female ratio was 43:8. Fistula was recurrent in 76.5% (39/51), horseshoe in 50.1% (26/51), had multiple tracts in 52.9% (27/51), had an associated abscess in 41.2% (21/51), was anterior in 33.3% (17/51), the internal opening was not found in 15.7% (8/51) and 9.8% (5/51) of fistulas had a supralevator extension. Seven patients were excluded (5 lost to follow up, 2 with tuberculosis leading to/associated with fistula-in-ano). The success rate was 79.5% (35/44) and the recurrence rate was 20.5% (9/44). Out of these recurrences, three underwent reoperation (2 PERFACT procedure, 1 fistulotomy) and all three were successful. Thus, the overall success rate was 86.4%. The only complication was a non-healing tract in 9.1% (4/44) of patients. There was no significant change in objective incontinence scores three months after the operation

  14. Tube-flap for management of complex recto-urinary fistula with York Mason technique: a case report.

    PubMed

    Limkuansuwan, P

    2001-05-01

    Recto-urinary fistula results as a complication following trauma to the perinium and pelvis. These fistulas are difficult to treat and have a high recurrence rate due to the difficult surgical approach in repairing them. Both the transabdominal or transperineal approaches used in repairing these fistulas are difficult and provide only limited exposure to the fistula being repaired. In the case report, we present a patient with complex recto-urinary fistula due to trauma to the pelvis 20 years previously. In this patient we used the transphincteric York Mason approach to directly approach the fistula, followed by construction of a tube flap connecting the bladder and the urethra. The technique is simple, easy and the outcome has been excellent after 4 years of follow-up. PMID:11560228

  15. Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa

    PubMed Central

    Tokunaga, Yukihiko; Sasaki, Hirokazu

    2015-01-01

    A variety of techniques have been described to treat complex anal fistulas. When complex anal fistulas are associated with hidradenitis suppurativa, the treatment has to be appropriately tailored for the severity and distribution of the disease so as to remove the external fistula tract to prevent recurrence while ensuring fecal continence. Between 2007 and 2011, a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions. The discharge had started about 12 to 18 months prior, and had increased progressively resulting in complex anal fistulas and hidradenitis suppurativa in the buttocks. They underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa. They were discharged from the hospital in 4 to 5 days, while the seton dropped spontaneously about 6 to 8 months after surgery. They have been well without any morbidities or recurrence. The present paper demonstrates that cases of complex anal fistulas associated with hidradenitis suppurativa can be successfully treated with a modified seton procedure and coring out of hidradenitis suppurativa. PMID:26414817

  16. Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa.

    PubMed

    Tokunaga, Yukihiko; Sasaki, Hirokazu

    2015-06-01

    A variety of techniques have been described to treat complex anal fistulas. When complex anal fistulas are associated with hidradenitis suppurativa, the treatment has to be appropriately tailored for the severity and distribution of the disease so as to remove the external fistula tract to prevent recurrence while ensuring fecal continence. Between 2007 and 2011, a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions. The discharge had started about 12 to 18 months prior, and had increased progressively resulting in complex anal fistulas and hidradenitis suppurativa in the buttocks. They underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa. They were discharged from the hospital in 4 to 5 days, while the seton dropped spontaneously about 6 to 8 months after surgery. They have been well without any morbidities or recurrence. The present paper demonstrates that cases of complex anal fistulas associated with hidradenitis suppurativa can be successfully treated with a modified seton procedure and coring out of hidradenitis suppurativa.

  17. Perianal Crohn disease.

    PubMed

    Asma, Sioud Dhrif; Soumaya, Youssef; Kahena, Jaber; Raouf, Dhaoui Mohamed; Nejib, Doss

    2006-12-10

    Crohn disease is a chronic inflammatory disease characterized by sharply demarcated segments of gastrointestinal involvement from mouth to anus. Its perineal manifestations are among the most devastating and mutilating complications. They occur at any time and may precede the intestinal manifestations. Their most common presentations are perineal ulceration, fistula, and abscess. Proliferative and polypoid morphology of the cutaneous lesions mimicking warts and condyloma are rarely described. We report a 25-year-old woman with a 4-month history of confluent plaques of the perineal region with vegetant surfaces, suspected to be genital warts. The lesions progressed to fistulas, inducing deep ulcerations surrounded by pseudocondylomatous tumors. About 2 months prior to presentation she began to suffer from gastrointestinal symptoms and noted weight loss. Physical examination, endoscopic examination, and pathological interpretation led to the diagnosis of Crohn disease with perineal involvement being the initial presenting sign. Significant improvement was induced with prednisone (45 mg daily) and azathioprine. Our observation is notable for the pseudocondylomatous appearance and the dramatic response to medical treatment despite severe involvement.

  18. [Perianal and rectal impalement injuries].

    PubMed

    Joos, A K; Herold, A; Palma, P; Post, S

    2006-09-01

    Perianal impalement injuries with or without involvement of the anorectum are rare. Apart from a high variety of injury patterns, there is a multiplicity of diagnostic and therapeutic options. Causes of perianal impalement injury are gunshot, accidents, and medical treatment. The diagnostic work-up includes digital rectal examination followed by rectoscopy and flexible endoscopy under anaesthesia. We propose a new classification for primary extraperitoneal perianal impalement injuries in four stages in which the extension of sphincter and/or rectum injury is of crucial importance. Therapeutic aspects such as wound treatment, enterostomy, drains, and antibiotic treatment are discussed. The proposed classification encompasses recommendations for stage-adapted management and prognosis of these rare injuries. PMID:16896899

  19. Long-term outcome of infliximab combined with surgery for perianal fistulizing Crohn's disease

    PubMed Central

    Yang, Bo-Lin; Chen, Yu-Gen; Gu, Yun-Fei; Chen, Hong-Jin; Sun, Gui-Dong; Zhu, Ping; Shao, Wan-Jin

    2015-01-01

    AIM: To evaluate the efficacy and long-term outcome of infliximab combined with surgery to treat perianal fistulizing Crohn’s disease (CD). METHODS: The work was performed as a prospective study. All patients received infliximab combined with surgery to treat perianal fistulizing CD, which was followed by an immunosuppressive agent as maintenance therapy. RESULTS: A total of 28 patients with perianal fistulizing CD were included. At week 30, 89.3% (25/28) of the patients were clinically cured with an average healing time of 31.4 d. The CD activity index decreased to 70.07 ± 77.54 from 205.47 ± 111.13 (P < 0.01) after infliximab treatment. The perianal CD activity index was decreased to 0.93 ± 2.08 from 8.54 ± 4.89 (P < 0.01). C-reactive protein, erythrocyte sedimentation rate, platelets, and neutrophils all decreased significantly compared with the pretreatment levels (P < 0.01). Magnetic resonance imaging results for 16 patients after therapy showed that one patient had a persistent presacral-rectal fistula and another still had a cavity without clinical symptoms at follow-up. After a median follow-up of 26.4 mo (range: 14-41 mo), 96.4% (27/28) of the patients had a clinical cure. CONCLUSION: Infliximab combined with surgery is effective and safe in the treatment of perianal fistulizing CD, and this treatment was associated with better long-term outcomes. PMID:25741157

  20. Therapeutic management of complex anal fistulas by installing a nitinol closure clip: study protocol of a multicentric randomised controlled trial—FISCLOSE

    PubMed Central

    Dubois, Anne; Carrier, Guillaume; Pereira, Bruno; Gillet, Brigitte; Faucheron, Jean-Luc; Pezet, Denis; Balayssac, David

    2015-01-01

    Introduction Complex anal fistulas are responsible for pain, faecal incontinence and impaired quality of life. The rectal mucosa advancement flap (RMAF) procedure to cover the internal opening of the fistula remains a strategy of choice. However, a new procedure for closing anal fistulas is now available with the use of a nitinol closure clip (OTSC Proctology, OVESCO), which should ensure a better healing rate. This procedure is currently becoming more widespread, though without robust scientific validation, and it is therefore essential to carry out a prospective evaluation in order to determine the efficacy and safety of this new medical device for complex anal fistulas. Methods and analysis The FISCLOSE trial is aimed at evaluating the efficacy and safety of a nitinol closure clip compared to the RMAF procedure for the management of complex anal fistulas. This trial is a prospective, randomised, controlled, single-blind, bicentre and interventional study. Patients (n=46 per group) will be randomly assigned for management with either a closure clip or RMAF. The main objectives are to improve the healing rate of the anal fistula, lessen the postoperative pain and faecal incontinency, enhance the quality of life, and lower the number of reinterventions and therapeutic management costs. The primary outcome is the proportion of patients with a healed fistula at 3 months. The secondary outcomes are anal fistula healing (6 and 12 months), proctological pain (visual analogue scale), the faecal incontinence score (Jorge and Wexner questionnaire), digestive disorders and quality of life (Gastrointestinal Quality of Life Index and Euroqol EQ5D-3 L) up to 1 year. Ethics and dissemination The study was approved by an independent medical ethics committee 1 (IRB00008526, CPP Sud-Est 6, Clermont-Ferrand, France) and registered by the competent French authority (ANSM, Saint Denis, France). The results will be disseminated in a peer-reviewed journal and presented at

  1. Update on anal fistulae: Surgical perspectives for the gastroenterologist

    PubMed Central

    Tabry, Helena; Farrands, Paul A

    2011-01-01

    Anal fistulae are common and debilitating; they are characterized by severe pain and discharge. They arise following infection near the anal canal, or as a primary event from an abscess in the abdomen, fistulating into the vagina or perianal skin. The term ‘cryptoglandular’ is given to abscesses arising from the anal glands. For many years, the treatment of choice was to lay open the fistula; however, this risks causing incontinence with potentially devastating consequences. Alternative surgical treatments include setons, fibrin glue, collagen plugs and flaps to cover the internal fistula opening. These have achieved varying degrees of success, as will be discussed. The present review also discusses anal fistulae in light of much recently published literature. Currently, anal fistulae remain challenging and require specialist expertise; however, new treatment options are on the horizon. PMID:22175058

  2. Case report: late perianal mucinous adenocarcinoma after Crohn's disease proctectomy: an oncological rarity

    PubMed Central

    Keese, Michael; Back, Walter; Dinter, Dietmar; Gladisch, Rainer; Joos, Andreas; Palma, Pablo

    2005-01-01

    Background As in ulcerative colitis, there is an increased incidence of colorectal carcinoma in Crohn's disease. While carcinoma formation originating from ano-rectal fistulas is generally considered as a rare event there are different publications reporting on mucinous adenocarcinoma formation in association with a neovagina and rectovaginal fistulas. To the best of our knowledge this is the first description of a perianal mucinous adenocarcinoma arising in a patient after Crohn's disease proctocolectomy. Case presentation We report the case of a 50-year old female with a mucinous adenocarcinoma forming in the perineum eleven years after proctocolectomy for Crohn's disease. The patient was readmitted with perineal pain, leucocytosis and a perineal mass highly suspicious of abscess formation in the MRI-Scan. Histological examination revealed a mucinous adenocarcinoma. Exenteration including vagina, uterus and ovaries together with the coccygeal-bone was performed. Conclusion Mucinous adenocarcinoma formation is a rare complication of Crohn's disease and so far unreported after proctocolectomy. PMID:15987512

  3. The suction pouch for management of simple or complex enterocutaneous fistulae.

    PubMed

    Franklin, Christoph

    2010-01-01

    Containing effluent from an enterocutaneous fistula (ECF) requires expertise, critical thinking skills, and creativity. Using a combination of products readily available to WOC nurses practicing in the United States, I have designed a suction pouch that reliably contains fistula output. A standard ostomy pouch can be converted into a suction pouch by adding a large, single-lumen catheter into the pouch, sealing it, and connecting the assembly to low continuous suction. The resulting pouch can be used by itself to drain effluent from an ECF or it can be used in combination with wound dressings, or a negative pressure wound therapy system. Application of a suction pouch extends the integrity of the appliance and diverts succus away from the wound bed or the newly applied skin graft with increased reliability. This article describes the technique used to create a suction pouch, followed by 4 brief case descriptions that demonstrate feasibility of its use for the management of ECFs.

  4. Multimodal treatment strategies for complex pediatric cerebral arteriovenous fistulas: contemporary case series at Barrow Neurological Institute.

    PubMed

    Zaidi, Hasan A; Kalani, M Yashar S; Spetzler, Robert F; McDougall, Cameron G; Albuquerque, Felipe C

    2015-06-01

    OBJECT Pediatric cerebral arteriovenous fistulas (AVFs) are rare but potentially lethal vascular lesions. Management strategies for these lesions have undergone considerable evolution in the last decade with the advent of new endovascular, surgical, and radiosurgical technologies. This study sought to review current treatment strategies and long-term clinical outcomes at a high-volume cerebrovascular institute. METHODS A retrospective chart review was performed on patients with a diagnosis of cerebral AVF from 1999 to 2012. Patients with carotid-cavernous fistulas, vein of Galen malformations, and age > 18 years were excluded from final analysis. Medical history, surgical and nonsurgical treatment, and clinical outcomes were documented. Pre- and postoperative angiograms were analyzed to assess for obliteration of the fistula. RESULTS Seventeen patients with pial AVFs (29.4%), dural AVFs (64.7%), or mixed pial/dural AVFs (5.9%) were identified. The majority of lesions were paramedian (70.6%) and supratentorial (76.5%). The study population had a mean age of 6.4 years, with a slight male predominance (52.9%), and the most common presenting symptoms were seizures (23.5%), headaches (17.6%), congestive heart failure (11.7%), and enlarging head circumference (11.7%). Among patients who underwent intervention (n = 16), 56.3% were treated with endovascular therapy alone, 6.3% were treated with open surgery alone, and 37.5% required a multimodal approach. Overall, 93.8% of the treated patients received endovascular treatment, 43.8% received open surgery, and 12.5% received radiosurgery. Endovascular embolysates included Onyx (n = 5), N-butyl cyanoacrylate (NBCA; n = 4), or coil embolization (n = 7) with or without balloon assistance (n = 2). Complete angiographic obliteration was achieved in 87.5% at the last follow-up evaluation (mean follow-up 3.1 years). One infant with incomplete AVF obliteration died of congestive heart failure, and 1 patient with complete

  5. 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

  6. [Conservative anal fistula treatment with collagenic plug and human fibrin sealant. Preliminary results].

    PubMed

    Gubitosi, A; Moccia, G; Malinconico, F A; Docimo, G; Ruggiero, R; Iside, G; Avenia, N; Docimo, L; Foroni, F; Gilio, F; Sparavigna, L; Agresti, M

    2009-01-01

    The authors, on the basis of a long clinical experience with human fibrin glue in general surgery, compared two different extracellular matrix (collagen), Surgisis and TissueDura, with human fibrin glue, applied during the operation, and sometimes in postoperative, to obtain the healing of perianal fistulas. The collagenic extracellular matrix provides, according to the rationale suggested, an optimal three-dimensional structure for the fibroblastic implant and neoangiogenesis, hence for the fistula "fibrotizzation" and closure. The encouraging results for transphincteric fistulas and a simple and easy technique push to researchers on samples statistically significant. PMID:19272233

  7. 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

  8. A case of langerhans cell histiocytosis with anal fistula.

    PubMed

    Akbayram, Sinan; Akgun, Cihangir; Ozen, Suleyman; Kaya, Avni; Tuncer, Oguz; Yuca, Sevil Ari; Caksen, Huseyin; Oner, Ahmet Faik

    2009-01-01

    Langerhans cell histiocytosis (LCH) is an uncommon clinically heterogeneous disorder characterized by the proliferation and accumulation of Langerhans cells with local infiltration of tissues and organ destruction. LCH takes many clinical forms, affecting different systems and different sites in the same system with variable outcomes. Bone, skin, lymph node, pituitary, liver, lung, bone marrow and spleen involvement can be seen in patients with LCH. Involvement of the perianal site is rare. In this article, a 16-month-old boy with multiple organ involvement including skin, liver, lung, and bone is presented. Aside from these systemic involvements, he also had a simple anal fistula. According to our best knowledge, this case of LCH with anal fistula is only the second to be reported in childhood. We would like to emphasize that LCH may be associated with anal fistula; therefore, we suggest that patients with LCH should be examined for this condition. PMID:20505285

  9. Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

    PubMed Central

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

    2016-01-01

    Objective To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. Materials and Methods We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. Results The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410–100690/µL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. Conclusion In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion. PMID:26957917

  10. Photodynamic therapy (PDT) for perianal bowenoid papulosis

    NASA Astrophysics Data System (ADS)

    Gahlen, Johannes; Stern, Josef; Graschew, Georgi; Kaus, Michael R.; Tilgen, W.

    1995-03-01

    HPV associated bowenoid papulosis of the anogenital region are classified as carcinoma in situ. The treatment can be difficult and recurrence rates are high. Extended surgical resections may have complications such as anal sphincter insufficiency. PDT does have some advantages and less side effects in the treatment of these tumors. We treated one female patient with an extended perianal bowenoid papulosis. Previous surgical resection led to local recurrence and partial sphincter insufficiency. Twenty-four hours before local laser light radiation (Ar-Dye laser, 630 nm wavelength), a systemic photosensitizer was applied (Photofrin II, 1.5 mg/kg BW). Four courses of PDT were performed within one year. We observed a total tumor necrosis in every radiation area. The previous sphincter insufficiency improved during the sessions. Side effects were rare. Pain in the radiation was stopped within 2 - 3 days under pain medication. PDT can induce a total local tumor necrosis in perianal bowenoid papulosis. Concerning local expansion, PDT can be a curable treatment.

  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. Arteriovenous fistulas of the brain and the spinal cord.

    PubMed

    Tomlinson, F H; Rüfenacht, D A; Sundt, T M; Nichols, D A; Fode, N C

    1993-07-01

    Arteriovenous (AV) fistulas of cerebral and spinal arteries are characterized angiographically by an immediate AV transition without a capillary bed or "nidus" as occurs in AV malformations (AVM's). The clinical presentation, morphology, radiology, and treatment of 12 patients with cerebral AV fistulas and of 12 patients with spinal AV fistulas are reviewed. In the patients with cerebral lesions, headache and seizure disorders were the most common presentations followed by subarachnoid hemorrhage, cardiac failure, progressive neurological dysfunction, and incidental detection on prenatal ultrasound study. In patients with spinal AV fistulas, weakness and sensory disturbance in the lower extremities were the most frequent clinical presentations followed by back pain, disturbances of micturition, and grand mal seizure. The etiology of the symptom complex produced by AV fistulas in each of these locations differed, with venous hypertension being important in spinal cord lesions. Of the patients with cerebral lesions, nine had a single AV fistula, one had two fistulas, and two had multiple fistulas. An AVM was observed in five patients with fistulas (two large, three small). Nine patients exhibited extramedullary AV fistulas of the spine, of whom eight had a single fistula and one had three fistulas; three patients had intramedullary spinal AV fistulas. An arterial aneurysm was found in association with two fistulas, one cerebral and one spinal. Venous ectasias or varices, frequently exhibiting mural calcification, were observed to be prominent in all AV fistulas involving cerebral arteries and in two involving spinal arteries. The location and size of the venous complexes reflected the diameter of the fistula. In addition to conventional imaging techniques (cerebral angiography, computerized tomography, and magnetic resonance (MR) imaging), MR angiography was a helpful adjunct in the evaluation of fistulas. Treatment strategies employed for AV fistulas in both

  13. [Postoperative digestive fistulas. Etiopathogenic considerations].

    PubMed

    Munteanu, Iulia; Stefan, S; Sirbu-Boeti, Mirela; Popescu, R; Burcoveanu, Ioana; Topală, Roxana; Burcoveanu, C

    2009-01-01

    The digestive fistula is one of the most serious complications that might appear following different types of resectional digestive surgery. This condition still carries a considerable morbidity and mortality rate and therefore all surgical and ICU staff pay a great deal of attention and intensify their care to avoid the fatalities. The postoperative digestive fistulas, through their physiopathological and clinical complexity induce the disturbance of the biological equilibrium with vital consequences. The trend of the last decades is the increasing of digestive fistulas incidence with a variable mortality rate after different authors. A therapeutic algorithm is needed. The mortality rate due to digestive fistulas, two decades ago was, around 60%; at the present there is a decrease of the mortality rate, which is around 10%. The explanation is the introduction of the new methods of treatment such as lactic acid lavage aspiration for alkaline fistulas or total parenteral nutrition, continuous enteral nutrition and antiexocrine chemotherapy. A fistula is a communication between two epithelial or endothelial surfaces, lined by granulation tissue. It can be a life-threatening condition. PMID:21495307

  14. Combined surgical and endovascular treatment of complex high-flow conus medullaris arteriovenous fistula associated with Parkes Weber syndrome: case report.

    PubMed

    Bagherpour, Arya N; Rodriguez, Gustavo J; Moorthy, Chetan; Trier, Todd T; Maud, Alberto

    2016-08-01

    Parkes Weber syndrome (PWS) is a congenital overgrowth disorder characterized by unilateral limb and axial hypertrophy, capillary malformations of the skin, and high-flow arteriovenous fistulas (AVFs). Spinal AVFs in the setting of PWS are challenging vascular lesions that often contain multiple arteriovenous (AV) shunts. The present case report highlights an adolescent girl with PWS who presented with a ruptured complex high-flow conus medullaris AVF. She was successfully treated with endovascular embolization and microsurgery. At the 2-year follow-up, the patient remained free of neurological symptoms and had no recurrence of the vascular malformation.

  15. EFFECTIVENESS OF THE LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) IN THE TREATMENT OF ANAL FISTULA: INITIAL RESULTS

    PubMed Central

    TOMIYOSHI, Sergio Danilo Tanahara; SANTOS, Carlos Henrique Marques DOS

    2014-01-01

    Background The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. Aim To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. Methods The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. Results Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. Conclusion The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence. PMID:25004286

  16. 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.

  17. Granular cell tumor on perianal region: a case report.

    PubMed

    Ugur, Kesici; Emine, Mataraci; Sevgi, Kesici; Sezgin, Zeren

    2013-01-01

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

  18. Coronary artery fistula

    MedlinePlus

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel ( ...

  19. A link between perianal strep and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).

    PubMed

    Toufexis, Megan; Deoleo, Caroline; Elia, Josephine; Murphy, Tanya K

    2014-04-01

    Perianal streptococcal dermatitis is an infection caused by group A streptococcus (GAS). Children with a pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) phenotype may have tics or obsessive compulsive symptoms secondary to a systemic immune activation by GAS infecting perianal areas. In this retrospective case series, the authors describe three children with symptoms consistent with PANDAS and a confirmed perianal streptococcal dermatitis as the likely infectious trigger. Concomitant perianal dermatitis and new-onset obsessive-compulsive symptoms and/or tics are strong indications for perianal culture and rapid antigen detection test in young children. PMID:24763762

  20. A link between perianal strep and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).

    PubMed

    Toufexis, Megan; Deoleo, Caroline; Elia, Josephine; Murphy, Tanya K

    2014-04-01

    Perianal streptococcal dermatitis is an infection caused by group A streptococcus (GAS). Children with a pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) phenotype may have tics or obsessive compulsive symptoms secondary to a systemic immune activation by GAS infecting perianal areas. In this retrospective case series, the authors describe three children with symptoms consistent with PANDAS and a confirmed perianal streptococcal dermatitis as the likely infectious trigger. Concomitant perianal dermatitis and new-onset obsessive-compulsive symptoms and/or tics are strong indications for perianal culture and rapid antigen detection test in young children.

  1. Continent vesicovaginal fistula

    PubMed Central

    de Toledo, Luís Gustavo Morato; Santos, Victor Espinheira; Maron, Paulo Eduardo Gourlat; Vedovato, Bruno César; Fucs, Moacyr; Perez, Marjo Deninson Cardenuto

    2013-01-01

    ABSTRACT Vesicovaginal fistula is an abnormal communication between the bladder and vagina and represents the most frequent type of fistula in the urinary tract. The most common cause in Brazil is iatrogenic fistula, secondary to histerectomia. Classically these women present continuous urinary leakage from the vagina and absence of micturition, with strong negative impact on their quality of life. We present a case of totally continent vesicovaginal fistula, with a follow-up of 11 years with no complications. PMID:23579756

  2. [Idiopathic renal arteriovenous fistula].

    PubMed

    Bennani, S; Ait Bolbarod, A; el Mrini, M; Kadiri, R; Benjelloun, S

    1996-06-01

    The authors report a case of idiopathic renal arteriovenous fistula. The diagnosis was established angiographically in a 24 year old man presenting gross hematuria. Embolization of the fistula was performed. Efficiency of this treatment was appreciated clinically and by duplex renal ultrasonography. The characteristics of renal arteriovenous fistulas are reviewed. PMID:8763700

  3. Colocutaneous fistula management in a dehisced wound: a case study.

    PubMed

    Reed, Terri; Economon, Diana; Wiersema-Bryant, Laurel

    2006-04-01

    A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions.

  4. Tumors and Tumorlike Conditions of the Anal Canal and Perianal Region: MR Imaging Findings.

    PubMed

    Surabhi, Venkateswar R; Menias, Christine O; Amer, Ahmed M; Elshikh, Mohamed; Katabathina, Venkata S; Hara, Amy K; Baughman, William C; Kielar, Ania; Elsayes, Khaled M; Siegel, Cary L

    2016-01-01

    Tumors and tumorlike conditions of the anus and perianal region originate from the anal canal and anal margin or result from direct extension of tumors from adjacent organs. The anatomy of the anal canal is complex, and its different histologic characteristics can lead to diverse pathologic conditions. The anal canal extends from the anorectal junction to the anal verge. The World Health Organization classification of anal canal tumors includes (a) anal intraepithelial neoplasia, the precursor of squamous cell carcinoma (SCC), and (b) invasive tumors. Invasive tumors are further classified on the basis of cell type as epithelial tumors (SCC, adenocarcinoma, mucinous adenocarcinoma, small cell carcinoma, and undifferentiated carcinoma), nonepithelial tumors, carcinoid tumors, melanoma, and secondary tumors (direct spread from rectal, cervical, or prostate carcinoma). The anal margin, or perianal skin, lies outside the anal verge and encompasses a radius of 5 cm from the anal verge. Tumors in the anal margin are classified according to the World Health Organization classification of skin tumors. Anal margin tumors include SCC, anal intraepithelial neoplasia, also known as Bowen disease, adenocarcinoma and its precursor Paget disease, basal cell carcinoma, and verrucous carcinoma (Buschke-Löwenstein tumor), which is a rare variant of SCC. Imaging plays an important role in the evaluation, staging, and follow-up of patients with anal and perianal tumors. However, because of the overlap in imaging features among these diverse entities, a definitive diagnosis is best established at histopathologic examination. Nevertheless, familiarity with the pathogenesis, imaging features, and treatment of these tumors can aid radiologic diagnosis and guide appropriate patient treatment. (©)RSNA, 2016. PMID:27618320

  5. 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

  6. [Surgery of anal fistulas].

    PubMed

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

    1997-06-01

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

  7. Lipoprotein lipase deficiency presenting with neonatal perianal abscesses.

    PubMed

    Akesson, Lauren S; Burnett, John R; Mehta, Divyesh K; Martin, Andrew C

    2016-01-01

    Lipoprotein lipase (LPL), a member of the triglyceride lipase gene family, is synthesised by parenchymal cells of the heart, skeletal muscle and adipose tissues before being transported to luminal surfaces of vascular endothelial cells to exert its main physiological function to hydrolyse plasma lipoproteins. LPL deficiency is a rare autosomal recessive disorder, resulting in severe hypertriglyceridaemia from birth. The effect of marked hypertriglyceridaemia on the immune function in children has not been described. We present a case of a neonate with LPL deficiency and grossly elevated plasma triglyceride levels, presenting with recurrent and recalcitrant perianal abscesses suggestive of underlying immunodeficiency. With reduced levels of plasma triglycerides, the recurrent perianal infections resolved. This case report reviews evidence for potential deleterious effects of hypertriglyceridaemia on immune function, however, underlying mechanisms are poorly understood. Whether hypertriglyceridaemia contributes to immune dysfunction in this context is unknown. If there is a pathophysiological link, this may have implications for hypertriglyceridaemia management. PMID:26825936

  8. [Complex control of the source of infection in sepsis : Extracorporeal membrane oxygenation (ECMO) as a bridging concept for tracheal fistula repair in sepsis-associated ARDS].

    PubMed

    Weiterer, S; Schmidt, K; Deininger, M; Ulrich, A; Tochtermann, U; Eberhardt, R; Hofer, S; Weigand, M A; Brenner, T

    2016-09-01

    Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully. PMID:27596367

  9. Neoplastic transformation in longstanding fistula-in-ano.

    PubMed Central

    Welch, G. H.; Finlay, I. G.

    1987-01-01

    A case in which an infiltrating mucinous carcinoma developed within a suprasphincteric fistula-in-ano is presented. The diagnosis was suspected on biopsy and confirmed by repeat biopsy. The clinical and histological features of this case establish with certainty that the carcinoma arose within the fistula and was not a secondary manifestation of the tumour. It is suggested that this rare complication of chronic fistula-in-ano may be prevented by prompt expert management of complex primary fistula. Images Figure 1 PMID:2829151

  10. Sciatica: An Extremely Rare Complication of the Perianal Abscess

    PubMed Central

    Gujrathi, Rahul; Gupta, Kanchan; Ravi, Chetan; Pai, Bhujang

    2016-01-01

    Summary Background Sciatica has been classically described as pain in the back and hip with radiation in the leg along the distribution of the sciatic nerve, secondary to compression or irritation of the sciatic nerve. Spinal abnormality being the most common etiology, is one of the most common indications for MRI of the lumbosacral spine. Here we describe imaging findings secondary to a supralevator perianal abscess causing irritation of the sciatic nerve, which was diagnosed on MRI of the lumbosacral spine. Case Report A 47-year-old male patient presented to the emergency department with severe acute pain in the right hip and right leg which was aggravated by limb movement. Clinically, a possibility of sciatica was suggested and MRI of the lumbosacral spine was ordered. The MRI did not reveal any abnormality in the lumbosacral spine; however, on STIR coronal images, a right perianal abscess with air pockets was seen. The perianal abscess was extending above the levator ani muscle with and was seen tracking along the sciatic nerve, explaining pain along the distribution of the sciatic nerve. The abscess was surgically drained, followed by an antibiotic course. The patient was symptomatically better post-surgery. Post-operative scan done 3 days later revealed significant resolution of the infra- and supralevator perianal abscess. The patient was discharged from hospital on post-operative day 3 on oral antibiotics for 7 days. On 15th post-operative day, the patient was clinically completely asymptomatic with good healing of the perianal surgical wound. Conclusions Extra-spinal causes are rare and most often overlooked in patients with sciatica. While assessing patients with sciatica, extra-spinal causes for the radiation of pain along the distribution of the sciatic nerve should always be looked for if abnormalities in the MRI of the lumbar spine are not found. Inclusion of STIR sequences in the imaging of the lumbosacral spine, more often than not, helps to

  11. 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.

  12. Endoscopic Management of Gastrointestinal Leaks and Fistulae.

    PubMed

    Willingham, Field F; Buscaglia, Jonathan M

    2015-10-01

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

  13. [An ectopic ureter which drained into the perianal area].

    PubMed

    Delgado Chanis, G

    1992-05-01

    The author reviews the clinical record of a 6-year-old boy, who had urinary incontinence with wetting of his underwear in the posterior part. IVP, Cystoscopy, Cystogram, Left Retrograde Pyelogram and Surgery showed a double distal ureter on the left side. The normal ureter drained in the bladder in the orthotopic ureteral orifice. The medial dilated ectopic ureter, in the form of an H, was connected to the normal ureter and drained in the perianal area. The incontinence stopped after the resection of the ectopic ureter. PMID:1620895

  14. Aorto-digestive fistulae.

    PubMed

    Benhamou, G; Duron, J J

    1982-01-01

    On the basis of a case of aorto-duodenal fistula due to fissuration of a tuberculous sub-renal aneurysm, the authors review the difficult question of primary and secondary aorto-digestive fistulae. Primary fistulae are due to the rupture of an artheromatous or infectious aneurysm. The latter possibility must always be borne in mind. Aneurysms secondary to an aortic suture are more common in practice. There is also often a troublesome infectious element, requiring axillobifemoral bypass prior to treatment of the aneurism itself. PMID:6897648

  15. Infantile Perianal Pyramidal Protrusion with Coexisting Perineal and Perianal Hemangiomas: A Fortuitous Association or Incomplete PELVIS Syndrome?

    PubMed Central

    Verma, Shyam B; Wollina, Uwe

    2014-01-01

    Two cases of infantile perianal pyramidal protrusions (IPPP), one pyramidal in shape and one leaf shaped, are being described by us. Both were notable for coexisting hemangiomas in the close vicinity. To the best of our knowledge we are reporting these two variants of IPPP with the associated neighboring hemangiomas for the first time in Indian dermatologic literature. We suggest that this presentation may be a part of one of the syndromes that comprise anorectal malformations with hemangiomas like PELVIS syndrome and others mentioned in the table. PMID:24470664

  16. Perianal injuries resulting from sexual abuse: a longitudinal study.

    PubMed

    McCann, J; Voris, J

    1993-02-01

    Four children who incurred perianal injuries as a result of a sexual assault were followed on a longitudinal basis to document the anatomical changes that ensued. The subjects, whose ages ranged from 4 to 8 years, were followed from 1 week to 14 months. They were examined in both supine and prone knee-chest positions and a 35-mm camera mounted on a colposcope was used to record their injuries. At the time of the initial examination, there were a variety of findings including erythema of the tissues, edema of the skin folds, localized venous engorgement, dilation of the external anal sphincter, and lacerations of different depths. Superficial lacerations reepithelized within 1 to 11 days. The second-degree wounds in two of the children were healed by the 1- and 5-week return visits, leaving narrow bands of scar tissue. In the two subjects who were followed the longest, signs of both a second-degree laceration and a surgically repaired third-degree injury had virtually disappeared by 12 to 14 months after the assaults. The wounds in one subject, infected with a herpes simplex type 2 virus, remained erythematous for a longer period of time than did similar injuries in the other children. A skin tag created by the avulsion of the tissues in one subject persisted, although it became less obvious as it retracted into the redundant folds of the perianal tissues over time. PMID:8424016

  17. Perianal and vulvar Crohn's disease presenting as suspected abuse.

    PubMed

    Porzionato, Andrea; Alaggio, Rita; Aprile, Anna

    2005-12-01

    Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.

  18. Urethral steinstrasse with urethrocutaneous fistula.

    PubMed

    Kumar, Santosh; Sharma, Sumit; Ganesamoni, Raguram; Singh, Shrawan K

    2012-02-01

    A middle-age man presented with acute urinary retention and a history of passage of urine and stones through a fistula at the root of the penis of 7 years' duration. Computed tomography of the soft tissue penis revealed multiple calculi in the urethra. After an initial suprapubic cystostomy, he underwent Johanson's Stage I urethroplasty with excision of the fistulous tract and retrieval of the urethral stones. Intraoperatively, dense stricture of the distal penile urethra was found, with complete obliteration in places. A urethral stricture, if not promptly managed, can lead to devastating complications necessitating complex surgical management.

  19. Occult Blood and Perianal Exam: Value Added in Pediatric Inflammatory Bowel Disease Screening

    PubMed Central

    Moran, Christopher J.; Kaplan, Jess L.

    2016-01-01

    OBJECTIVE Pediatric inflammatory bowel disease (IBD) often presents insidiously and standard blood tests are normal in 20% of patients. We hypothesize that fecal occult blood testing (FOBT) and the perianal examination in addition to blood tests provide important information during the screening process for IBD. The goal of this study was to measure the diagnostic value of adding FOBT and perianal examination to standard screening labs in evaluating children and adolescents for IBD. METHODS The medical records of consecutive patients undergoing ileocolonoscopy for IBD were reviewed. Laboratory test results, FOBT, and perianal examination prior to the decision to perform the ileocolonoscopy were recorded. Standard limits of laboratory tests were used. Multivariate logistic regression was performed on a discovery cohort and applied to an independent validation cohort. RESULTS The discovery cohort included 335 patients (85 IBD and 250 non-IBD). 61.2% had FOBT and perianal examination performed prior to the decision to perform the ileocolonoscopy. 119 patients had complete blood testing, FOBT, and perianal exam available for full analysis. The sensitivity of the lab testing was 80.5% for IBD and the sensitivity of FOBT with perianal examination was 65.9%. However, the combined sensitivity of lab testing and FOBT with perianal examination was 97.6%. The most predictive model included CRP, platelets and FOBT with perianal examination and was superior to the lab value-only model (p<0.001) which was validated in a separate cohort. CONCLUSIONS Perianal examination and FOBT improves sensitivity in screening children for IBD. PMID:25651490

  20. Diffuse large B cell lymphoma presenting as a peri-anal abscess.

    PubMed

    Jayasekera, Hasanga; Gorissen, Kym; Francis, Leo; Chow, Carina

    2014-01-01

    A non-healing peri-anal abscess can be difficult to manage and is often attributed to chronic disease. This case documents a male in his seventh decade who presented with multiple peri-anal collections. The abscess cavity had caused necrosis of the internal sphincter muscles resulting in faecal incontinence. Biopsies were conclusive for diffuse large B-cell lymphoma. A de-functioning colostomy was performed and the patient was initiated on CHOP-R chemotherapy. Anal lymphoma masquerading as a peri-anal abscess is rare. A high degree of suspicion must be maintained for an anal abscess which does not resolve with conservative management. PMID:24898408

  1. Association between plaque-type psoriasis and perianal streptococcal cellulitis and review of the literature.

    PubMed

    Rasi, Abbas; Pour-Heidari, Nargess

    2009-11-01

    Perianal streptococcal dermatitis is an uncommon superficial cutaneous infection of the perianal area almost exclusively described in children. Perianal streptococcal dermatitis is caused by group A beta-hemolytic streptococci and occurs mainly in children between six months and ten years of age. Prior therapy with topical antifungal agents, topical corticosteroids, and oral preparations for pinworms either fails to improve or worsens patient's symptoms. Early antibiotic therapy causes a dramatic and rapid improvement of symptoms. Treatment protocol consists of amoxicillin 40 mg/kg/day, divided into three doses, and/or topical application of mupirocin 2% ointment three times per day for ten days. We describe a four-year-old boy with perianal streptococcal dermatitis who was brought to our clinic with plaque type psoriasis.

  2. Association between plaque-type psoriasis and perianal streptococcal cellulitis and review of the literature.

    PubMed

    Rasi, Abbas; Pour-Heidari, Nargess

    2009-11-01

    Perianal streptococcal dermatitis is an uncommon superficial cutaneous infection of the perianal area almost exclusively described in children. Perianal streptococcal dermatitis is caused by group A beta-hemolytic streptococci and occurs mainly in children between six months and ten years of age. Prior therapy with topical antifungal agents, topical corticosteroids, and oral preparations for pinworms either fails to improve or worsens patient's symptoms. Early antibiotic therapy causes a dramatic and rapid improvement of symptoms. Treatment protocol consists of amoxicillin 40 mg/kg/day, divided into three doses, and/or topical application of mupirocin 2% ointment three times per day for ten days. We describe a four-year-old boy with perianal streptococcal dermatitis who was brought to our clinic with plaque type psoriasis. PMID:19877754

  3. 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.

  4. 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

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

    PubMed Central

    Calero-Lillo, Aranzazu; Caubet, Enric

    2014-01-01

    INTRODUCTION Ischiorrectal tumoral masses mimicking perianal abscess and abscess from uncommon microbiological origins have previously been reported. PRESENTATION OF CASE Unusual perianal abscess arising from an hematoma in an elderly woman with myelodysplastic syndrome: the patient presented on the emergency with gluteal pain and fever after intramuscular injection of analgesic drug. Physical examination revealed subcutaneous thickening on gluteus and perianal region, without skin changes. Magnetic resonance reported an heterogeneous mass sized 5 cm × 12 cm × 20 cm from gluteus maximus to ischioanal fat under levator ani muscle, through sciatic notch. Debridement of an staphylococceal infected hematoma through a single left lateral gluteus incision, and primary closure was performed. Proctologic examination was normal, so any perianal incision was done. The site infection progressed, so the patient required new surgery with wet cure. The patient contracted nosocomial pneumonia and died due to sepsis. DISCUSSION Hematological diseases can yield infectious and bleeding disorders. Intramuscular injections often cause haematomas that can lead to pyomyositis. Pyomyositis requires early debridement and continue cure. CONCLUSION Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account. PMID:25460429

  6. Coronary fistulas: a case series.

    PubMed

    Nada, Fennich; Fedoua, Elouali; Ghita, Saghi; Nadia, Bouzammour; Leila, Haddour; Jamila, Zarzur; Mohamed, Cherti

    2014-01-01

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

  7. Laparoscopic treatment of genitourinary fistulae.

    PubMed

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

    2012-09-01

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

  8. Chyle fistula management.

    PubMed

    Lucente, F E; Diktaban, T; Lawson, W; Biller, H F

    1981-01-01

    Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. In view of the morbidity produced by chyle leak discovered postoperatively and the lack of success of its management by aggressive surgical techniques, we have employed a different protocol for the past six years. It is based on careful intraoperative inspection of the neck for possibly chyle fistula, minimal but specific surgical handling of the damaged duct, and a postoperative nutritional program designed to reduce chyle formation and facilitate spontaneous closure. The nutritional element involves the use of medium chain triglycerides (MCT) that are easily ingested, rapidly absorbed, and readily metabolized directly into the portal venous system, bypassing the thoracic duct lymphatic system. During a four-year period, 1976 to 1980, 574 radical neck dissections were performed with only six chyle fistulas being detected postoperatively. All have been successfully treated by the protocol with no patients requiring reexploration. There have been no deaths owing to chyle fistula and no complications or side effects from the use of medium chain triglycerides.

  9. 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 ...

  10. Recent microbiological shifts in perianal bacterial dermatitis: Staphylococcus aureus predominance.

    PubMed

    Heath, Candrice; Desai, Nina; Silverberg, Nanette B

    2009-01-01

    Traditionally, bacterial infections of the anal skin have been found to be caused by Streptococcus. The aim of this study was to determine the breakdown of bacterial isolates and the current presentation of bacterial diseases involving the perineum. From the chart review of children who had bacterial cultures of the anus from 2005 to 2008 in a pediatric dermatology practice population in New York City, 26 pediatric patients (ages 5 months to 12 yrs) who had the indications of anal erythema or recurrent buttocks dermatitis were identified. Bacterial cultures of 17 patients grew pathogens, that of 14 (82% of identifiably infected patients) grew Staphylococcus aureus, in 11 as a solo pathogen (6 MSSA and 5 MRSA in 2 family clusters). Streptococcus was identified in three patients, two on culture and one on latex agglutination test; and two patients were identified as having both group A beta hemolytic Streptococcus and Staphylococcus aureus (2 MSSA and 1 MRSA). In patients with S. aureus perianally, concurrent small papules and pustules of the buttocks or extension of the erythema to adjacent buttock skin was the primary clinical feature distinguishing this condition from isolated streptococcal disease. Whereas Streptococcal infections of the anus and buttocks occur commonly, Staphylococcus aureus has become the leading cause of anal bacterial infection in the setting of skin involvement; therefore, antibacterial therapy for anal and buttock bacterial infections should be tailored accordingly. PMID:20199443

  11. 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

  12. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area.

    PubMed

    Jia-Zi, Shi; Xiao, Zhai; Jun-Hui, Li; Chun-Yu, Xue; Hong-da, Bi

    2016-08-01

    Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing.Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at -150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up.All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements.NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus. PMID:27583890

  13. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area

    PubMed Central

    Jia-zi, Shi; Xiao, Zhai; Jun-hui, Li; Chun-yu, Xue; Hong-da, Bi

    2016-01-01

    Abstract Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing. Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at −150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up. All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements. NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus. PMID:27583890

  14. Negative pressure wound therapy combined with skin grafting improves surgical wound healing in the perianal area.

    PubMed

    Jia-Zi, Shi; Xiao, Zhai; Jun-Hui, Li; Chun-Yu, Xue; Hong-da, Bi

    2016-08-01

    Management of large tissue defects resulting from local wide resection of perianal is a clinical challenge for surgeons. The aim of the present study was to investigate the efficacy of negative pressure wound therapy (NPWT) following skin grafting on perianal surgical wound healing.Included in this study were 12 patients with perianal tumors who received skin grafting after perianal tumor resection between December 2012 and December 2014. A self-designed negative pressure drainage device was then applied to maintain a standard negative pressure at -150 mm Hg and removed on day 8 postoperation. The outcome was recorded immediately after NPWT and at 6-month follow-up.All skin grafts survived without infection, hematoma, and necrosis in all 12 patients. No tumor recurrence was detected during 6-month follow-up. Natural folds were observed around the anus. All patients showed normal bowel movements.NPWT following skin grafting was effective for perianal surgical wound healing and infection prevention, thus benefiting anatomical and functional recovery of the anus.

  15. Cow's Milk Allergy Is a Major Contributor in Recurrent Perianal Dermatitis of Infants.

    PubMed

    El-Hodhod, Mostafa Abdel-Aziz; Hamdy, Ahmad Mohamed; El-Deeb, Marwa Talaat; Elmaraghy, Mohamed O

    2012-01-01

    Background. Recurrent perianal inflammation has great etiologic diversity. A possible cause is cow's milk allergy (CMA). The aim was to assess the magnitude of this cause. Subjects and Methods. This follow up clinical study was carried out on 63 infants with perianal dermatitis of more than 3 weeks with history of recurrence. Definitive diagnosis was made for each infant through medical history taking, clinical examination and investigations including stool analysis and culture, stool pH and reducing substances, perianal swab for different cultures and staining for Candida albicans. Complete blood count and quantitative determination of cow's milk-specific serum IgE concentration were done for all patients. CMA was confirmed through an open withdrawal-rechallenge procedure. Serum immunoglobulins and CD markers as well as gastrointestinal endoscopies were done for some patients. Results. Causes of perianal dermatitis included CMA (47.6%), bacterial dermatitis (17.46%), moniliasis (15.87%), enterobiasis (9.52%) and lactose intolerance (9.5%). Predictors of CMA included presence of bloody and/or mucoid stool, other atopic manifestations, anal fissures, or recurrent vomiting. Conclusion. We can conclude that cow's milk allergy is a common cause of recurrent perianal dermatitis. Mucoid or bloody stool, anal fissures or ulcers, vomiting and atopic manifestations can predict this etiology. PMID:22988522

  16. Extramammary Paget disease of the perianal region: the potential role of imiquimod in achieving disease control

    PubMed Central

    Knight, Stephen R.; Proby, Charlotte; Ziyaie, Dorin; Carey, Frank; Koch, Sacha

    2016-01-01

    Extramammary Paget disease (EMPD) is a rare perineal neoplasia associated with a high rate of local recurrence. Surgical excision is the standard treatment; however, this has high rates of post-operative morbidity in combination with potentially mutilating results. Previous literature has demonstrated good response with imiquimod 5% cream in patients with vulval EMPD, yet its effectiveness in primary perianal disease is unknown. We describe the case of a 40-year-old woman presenting with EMPD of the perianal region, providing detailed histological and pictoral evidence of its response to topical imiquimod 5% cream over a 16-week period, which initially resulted in remission prior to metastatic lymph node recurrence. This case demonstrates the potential for topical imiquimod cream to avoid major surgery and its associated complications in patients presenting with EMPD of the perianal region. We discuss the current evidence for treating this rare condition with medical therapy, how this case adds to current literature and possible future directions. PMID:27511910

  17. Giant perianal condyloma acuminatum: Reconstruction with bilateral gluteal fasciocutaneous V-Y advancement flap

    PubMed Central

    Gürbulak, Esin Kabul; Akgün, İsmail Ethem; Ömeroğlu, Sinan; Öz, Ayhan

    2015-01-01

    Condyloma acuminatum caused by human papilloma virus is the most common sexually transmitted infection in the anogenital region. On the other hand, giant condyloma acuminatum that is also known as Buschke-Lowenstein tumor is a rare disease. Its primary treatment is surgical excision. The purpose of this report is to present a case that reached immense dimensions in the perianal region, and to emphasize the importance of wide surgical excision. A 17-year-old woman presented with a giant mass in the perianal region for 2 years, which progressively increased in size. Local examination revealed a large vegetative lesion in the perianal area. Wide surgical excision of the involved skin and lesion was undertaken. The wound was reconstructed by bilateral gluteal fasciocutaneous V-Y advancement flap. Response to various treatments is often poor, with a high recurrence rate. In conclusion, surgical treatment with wide excision and plastic reconstruction is an effective therapy for giant anal condylomas. PMID:26504423

  18. Surgery for Crohn's anal fistulas.

    PubMed

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

    1995-11-01

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

  19. Renopleural fistula after percutaneous nephrolithotomy.

    PubMed

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

    1988-01-01

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

  20. 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

  1. Perianal streptococcal dermatitis associated with guttate psoriasis and/or balanoposthitis: a study of five cases.

    PubMed

    Patrizi, A; Costa, A M; Fiorillo, L; Neri, I

    1994-06-01

    Perianal streptococcal dermatitis (PSD) is a recently described cutaneous entity caused by group A beta-hemolytic streptococci. It is characterized by perianal erythema, sometimes associated with functional disturbances. We describe four children (2 boys, 2 girls) who had acute guttate psoriasis and also PSD. One of these patients also had balanoposthitis. A fifth patient experienced an association of PSD and balanoposthitis without psoriasis. To our knowledge, the association between guttate psoriasis and PSD has only been reported in five children, and the one with balanitis has not been previously reported.

  2. Three-dimensional spiral computed tomographic cysto-urethrography for post-traumatic complex posterior urethral strictures associated with urethral-rectal fistula.

    PubMed

    Sa, Ying Long; Xu, Yue Min; Feng, Chao; Ye, Xu Xiao; Song, Lu Jie

    2013-01-01

    To evaluate the value of three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) in diagnosing posterior urethral strictures associated with urethrorectal fistulas (URF). Between June 2008 and March 2012, 38 patients with posterior urethral strictures associated with URFs were examined by CTCUG, retrograde urethrography (RUG) and cysto-urethrography (CUG). Urethral reconstruction was undertaken and URFs were surgically repaired in all patients. The length of the urethral defect, location and size of URFs were recorded. Data from radiological examinations were compared with surgical findings. No statistically significant difference was found in the length of stricture measured using CTCUG (4.31 ± 2.28 cm) or conventional urethrography (4.02 ± 3.12 cm; p > 0.05), However, the accuracy in determining the location of the stricture was higher with CTCUG (93.12%) than with conventional urethrography (70.59%; p < 0.05). CTCUG identified URFs in all 38 patients (100%), whereas URFs were only observed in 27 patients (71%) using conventional urethrography. In conclusion, CTCUG was more accurate, safer and provided more details of URFs and urethral defects than conventional urethrography in patients with posterior urethral strictures associated with URFs.

  3. Perianal pyoderma gangrenosum after excision and fulguration of anal condyloma acuminatum

    PubMed Central

    Agnew, Jennifer L.; Strombom, Paul D.; Fong, Carmen F.; Kelly, Timothy J.; Martz, Joseph E.

    2015-01-01

    Introduction Pyoderma gangrenosum (PG) is a rare, inflammatory skin pathology frequently associated with systemic inflammatory disease. While rare after surgery, recognition of this disease in the post-surgical setting is important as it can mimic wound infection. Presentation of case We herein present a dramatic presentation of perianal PG four days after routine excision and fulguration of anal condyloma acuminatum. The affected area did not improve with broad spectrum antibiotics or surgical debridement. A diagnosis of PG was made from clinical suspicion and pathology findings, and further confirmed with rapid improvement after starting steroids. Diagnosis of this disease in the postoperative period requires high suspicion when the characteristic ulcerative or bullae lesions are seen diffusely and show minimal improvement with antibiotic treatment or debridement. Discussion Our case highlights the importance of recognizing this disease in the post-operative period, to allow for early initiation of appropriate treatment and prevent unnecessary surgical debridement of a highly sensitive area. There have been 32 case reports of PG in the colorectal literature, mostly following stoma creation. There is one case report of idiopathic perianal pyoderma gangrenosum with no known prior trauma. To our knowledge there are no previously reported cases of perianal PG after routine elective anorectal surgery. Conclusion This is the first reported case of perianal pyoderma gangrenosum in the post-surgical setting. Increased awareness of pyoderma gangrenosum in the surgical literature will aid in prompt diagnosis and proper medical management of this uncommon postoperative morbidity. PMID:26547888

  4. Non-traumatic causes of perianal hemorrhage and excoriation in the young.

    PubMed

    Byard, Roger W; Donald, Terence G; Rutty, Guy N

    2008-01-01

    The discovery at autopsy or at a death scene of fresh perianal hemorrhage and/or cutaneous excoriation in a young child is always of concern as this raises the possibility of inflicted injury. Three cases are reported where perianal bleeding and excoriation that were initially considered due to possible sexual assault were subsequently found to be of a non-suspicious nature. Case 1: A previously well 18-month-old boy was accidentally hanged. Fresh perianal hemorrhage that had raised the possibility of sexual assault was subsequently shown to be due to perineal streptococcal dermatitis. Case 2: A 2-year-old girl vomited and then stopped breathing. Fresh blood at the anus, that was also thought to be patulous, raised suspicions of sexual assault. At autopsy, however, bleeding around the normally configured anus was due to a midgut volvulus associated with intestinal malrotation. Case 3: A 21-month-old girl was found dead in her cot. Sexual abuse was suspected when lacerations were allegedly found around her anus. These were, however, due to skin lesions from her previously diagnosed ectodermal dysplasia clefting syndrome. Death was due to upper airway obstruction from acute and chronic inflammation. There was no evidence of anogenital trauma or sexual assault in any of the cases. Although inflicted traumatic causes of perianal hemorrhage and excoriation must be judiciously sought in the young, the current cases demonstrate that organic etiologies must also be considered. Perianal infections, congenital malformations of the mesentery and intestines, and inherited disorders of the skin may all produce findings that may initially suggest that sexual assault has occurred. Careful examination with appropriate photography and/or microbiological testing are required. PMID:19291454

  5. 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

  6. Endocaval suture of aortocaval fistula.

    PubMed

    Illuminati, G; Calió, F G; Bertagni, A; Caratozzolo, M; Vietri, F

    1997-05-01

    A case of aortocaval fistula complicating a ruptured infrarenal aortic aneurysm is reported. As the length of the defect and the thickness of the aortic wall made repair from within the aorta unsafe, the defect was repaired from within the vena cava. The details of the technique are reported. It can be a useful alternative to inferior vena cava ligation, when standard repair of aortocaval fistulae from within the aorta is risky or difficult to attempt.

  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. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2014-03-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  9. Onyx embolization of anterior condylar confluence dural arteriovenous fistula.

    PubMed

    Takemoto, Koichiro; Tateshima, Satoshi; Rastogi, Sachin; Gonzalez, Nestor; Jahan, Reza; Duckwiler, Gary; Vinuela, Fernando

    2013-01-01

    The anterior condylar confluence (ACC) is a small complex venous structure located medial to the jugular vein and adjacent to the hypoglossal canal. To our knowledge, this is the first report of transvenous Onyx embolization for ACC dural arteriovenous fistula (DAVF). Three patients with ACC DAVF were treated using the Onyx liquid embolic agent with or without detachable coils. Complete angiographic obliteration of the fistulas was achieved in all cases without permanent lower cranial neuropathy. This report suggests that the controlled penetration of Onyx is advantageous in order to obliterate ACC DAVFs with a small amount of embolic material.

  10. Perianal findings in prepubertal children selected for nonabuse: a descriptive study.

    PubMed

    McCann, J; Voris, J; Simon, M; Wells, R

    1989-01-01

    The results of the perianal portion of a project designed to collect normative data of the anogenital anatomy from a representative sample of prepubertal children is presented. A total of 318 children were examined by three physicians from a child sexual abuse evaluation program. After screening for the onset of puberty and the possibility of undetected abuse, 267 subjects remained. The sample included 161 girls and 106 boys ranging in age from 2 months to 11 years. The perianal findings that were encountered with the greatest frequency included erythema (41%), increased pigmentation (30%), and venous engorgement (52%) after two minutes in the knee-chest position. Wedge-shaped smooth areas in the midline, with or without depressions, were found both anterior and posterior to the anus in 26% of the children. Anal skin tags/folds were discovered anterior to the anus in 11%. In 49% of the children there was some dilatation of the anus which opened and closed intermittently in 62%. Flattening of the anal verge and rugae occurred during dilatation by the midpoint of the examination in 44% and 34%, respectively. Perianal findings that were found infrequently in all subgroups included skin tags/folds (0%) and scars (1%) outside the midline, anal dilatation greater than 20 mm without the presence of stool in the rectal ampulla (1.2%), irregularity of the anal orifice after complete dilatation (3%), and prominence of the anal verge (3%). No abrasions, hematomas, fissures, or hemorrhoids were encountered. Less commonly detected findings within specific subgroups included perianal erythema in girls (32%) as compared to boys (57%), pigmentation in the lighter skinned white children (22%) when compared to black (53%) and Hispanic (58%) children, and venous congestion at the beginning of the examination (7%) when compared to the same findings after four minutes in the knee-chest position (73%). There were no perianal skin tags/folds found in the boys. The relatively high

  11. [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

  12. The antimicrobial peptide pardaxin exerts potent anti-tumor activity against canine perianal gland adenoma

    PubMed Central

    Pan, Chieh-Yu; Lin, Chao-Nan; Chiou, Ming-Tang; Yu, Chao Yuan; Chen, Jyh-Yih; Chien, Chi-Hsien

    2015-01-01

    Pardaxin is an antimicrobial peptide of 33 amino acids, originally isolated from marine fish. We previously demonstrated that pardaxin has anti-tumor activity against murine fibrosarcoma, both in vitro and in vivo. In this study, we examined the anti-tumor activity, toxicity profile, and maximally-tolerated dose of pardaxin treatment in dogs with different types of refractory tumor. Local injection of pardaxin resulted in a significant reduction of perianal gland adenoma growth between 28 and 38 days post-treatment. Surgical resection of canine histiocytomas revealed large areas of ulceration, suggesting that pardaxin acts like a lytic peptide. Pardaxin treatment was not associated with significant variations in blood biochemical parameters or secretion of immune-related proteins. Our findings indicate that pardaxin has strong therapeutic potential for treating perianal gland adenomas in dogs. These data justify the veterinary application of pardaxin, and also provide invaluable information for veterinary medicine and future human clinical trials. PMID:25544775

  13. [Congenital H-type tracheoesophageal fistula].

    PubMed

    Raos, M; Koncul, I; Javorović, B

    1996-01-01

    A 12-year-old girl with H-type tracheoesophageal fistula is presented. The fistula was proven by bronchoscopic, oesophageoscopic and radiographic (with contrast medium) studies. As a sucking child the girl was operated, but there is no medical documentation (the girl is a displaced person). The question remains whether it is a primary or recurrent fistula.

  14. Recurrent Perianal Sinus in Young Girl Due To Pre-sacral Epidermoid Cyst.

    PubMed

    Jain, V; Misra, S; Tiwari, S; Rahul, K; Jain, H

    2013-07-01

    Pre-sacral epidermoid cysts are rare development cysts resulting from dysembryogenesis mostly diagnosed in middle aged women. We report a case of pre-sacral epidermoid cyst presenting with recurrent perianal sinus in young girl. Generally pre-sacral epidermoid cysts are seen in adult age group but it is rare presentation in young age group. We report a rare case of presacral epidermoid cyst occurring in a young female.

  15. Perianal neuroendocrine tumor with suspected lymph node metastasis causing colonic compression and subsequent megacolon

    PubMed Central

    Joudrey, Scott D.; Robinson, Duane A.; Blair, Robert; McLaughlin, Leslie D.; Gaschen, Lorrie

    2015-01-01

    An 8-year-old spayed female domestic shorthair cat was presented with a 4- to 5-month history of a progressively growing mass above her anus and an inability to defecate for 3 to 4 wk. External perianal and internal regional masses were subsequently identified and diagnosed as tumors of neuroendocrine origin through surgical excision and histopathologic evaluation. The cat was treated with 2 courses of chemotherapy and radiation therapy. PMID:25750442

  16. 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

  17. Ligation of intersphincteric fistula tract: what is the evidence in a review?

    PubMed

    Vergara-Fernandez, Omar; Espino-Urbina, Luis Alberto

    2013-10-28

    Broadly, complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing, prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from 10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure (LIFT procedure) as a treatment option in these types of fistula. A search was conducted in Medline, PUBMED, EMBASE and ISI Web of Knowledge, and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates, mean healing time and patient satisfaction with this surgical technique. Eighteen studies were included in this review. The total number of patients included was 592 (65% male). The median age reported was 42.8 years. The most common type of fistula included was transsphincteric (73.3% of cases). The mean healing rate reported was 74.6%. The risk factors for failure discovered were obesity, smoking, multiple previous surgeries and the length of the fistula tract. The mean healing time was 5.5 wk, and the mean follow-up period was 42.3 wk. The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes (Bio-LIFT, LIFT-Plug, LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.

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

    PubMed

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

    1983-03-01

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

  19. Perianal melanoma with a BRAF gene mutation in a young Portuguese Roma native.

    PubMed

    Tan, Jennifer

    2016-01-01

    A case of a young man diagnosed with perianal nodular melanoma with a gene mutation, accompanied by regional and pulmonary metastases on initial presentation, and later on with hepatic and bone involvement, is presented. The patient underwent wide local excision but was unresponsive to dacarbazine. Targeted therapy with vemurafenib had shown clinical improvement for a 5-month duration until he showed signs of disease progression. Just after the shift of adjuvant therapy to ipilimumab, he was diagnosed with multiple cerebral metastases that eventually led to his demise 6 months after initiation of vemurafenib, having had a 12-month survival period from the time of initial melanoma diagnosis. PMID:26880821

  20. Infantile perianal pyramidal protrusion: a case report with dermoscopy and ultrasound findings

    PubMed Central

    Lamberti, Arianna; Filippou, Georgios; Adinolfi, Antonella; Fimiani, Michele; Rubegni, Pietro

    2015-01-01

    Infantile perianal pyramidal protrusion, it is a rare benign cutaneous condition described in relatively recent times. It is considered to be under-reported in the pediatric literature because it is often mistaken for other conditions. The unawareness of this lesion may be responsible for an excessive concern both in physician and in parents, which leads to overly aggressive and unnecessary treatments. Thus its recognition has many implications regarding proper management and treatment. We report a typical presentation of IPPP in which the diagnosis was based on the use of non-invasive diagnostic tools and in particular of dermoscopy and ultrasonography. PMID:26114069

  1. Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool?

    PubMed Central

    Pietersma, Carsten S; Schreuder, Henk W R; Kooistra, Anko; Schraffordt Koops, Steven E

    2014-01-01

    Vesicovaginal fistulas are a rare complication of hysterectomy. When conservative therapy fails, vaginal or abdominal repair is necessary. A robotic-assisted laparoscopic approach can be a useful tool to repair complex fistulas. A 50-year-old woman with a vesicovaginal fistula located at the top of the vagina, was treated with robotic-assisted laparoscopic repair. The fistula tissue was removed from the vaginal wall and bladder, and epiploic of the sigmoid was interposed in between. The total operation time was 104 min. The hospital stay was 3 days; no complications occurred. Cystography 6 weeks and 6 months postoperative confirmed a successful repair. A review of current literature is presented regarding the application of robotic assistance during this procedure. The presented case shows that robotic-assisted laparoscopic repair of a vesicovaginal fistula seems to be a feasible technique with promising results. PMID:24916979

  2. [Evaluation of surgical treatment of anal fistula].

    PubMed

    Fall, B; Mbengue, M; Diouf, M L; Ndiaye, A; Diarra, O; Ba, M

    2001-01-01

    Second reason for consultations in proctology in our department after hemorroïds-linked illnesses, fistulas in ano constitute a chronic disease which causes therapeutic difficulties linked mainly to the futur functionning of the sphincter, especially in its most complex types. In our group of 43 patients in whom surgical exploration with stylet was the key of the diagnosis, the anorectoscopy and even less chirurgical examination were not often contributive, the fear of post-operative incontinence forced us to prefer ligation-section with rubber every time that the sphincter was involved. With our results, the majority of patients (41/43) healed in normal periods with a sufficient functionning of the anus. This result confirmed our attitude towards the sphincter: that is to save if possible.

  3. Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study

    PubMed Central

    2016-01-01

    Objectives To evaluate the effectiveness of regenerative tissue matrix (Alloderm) as an oral layer for difficult anterior palatal fistula closure. Materials and Methods The authors have tested the feasibility of a novel surgical technique of adding a regenerative tissue matrix (Alloderm) as an oral layer for closure of recalcitrant large anterior palatal fistulae and report the outcome of the first 12 patients in this pilot study. Patients with recurrent large fistula who otherwise would require either a local pedicled flap, free flap, or an obturator were treated with this technique and followed up for at least 6 months to monitor the progress of healing. Results Of the 12 patients, 8 patients (66.7%) had complete closure of the fistula, and 2 patients (16.7%) showed reduction in size of the fistula to the extent that symptoms were eliminated, for an overall success rate of 83.3% (10/12 patients). Premature graft loss and recurrence of the fistula were noted in 2 patients (16.7%). Conclusion Alloderm provided an adequate barrier allowing healing to occur unimpeded and allowed closure of the palatal fistula. In our experience, this new technique using regenerative tissue matrix as an adjunct to the oral layer in large anterior palatal fistula has an advantage compared to other more invasive complex procedures and has been shown to provide satisfactory results. PMID:27162747

  4. Obstetric fistula: what about gender power?

    PubMed

    Roush, Karen; Kurth, Ann; Hutchinson, M Katherine; Van Devanter, Nancy

    2012-01-01

    Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

  5. Enterocutaneous Fistula: Different Surgical Intervention Techniques for Closure along with Comparative Evaluation of Aluminum Paint, Karaya Gum (Hollister) and Gum Acacia for Peristomal Skin Care

    PubMed Central

    Namrata; Ahmad, Shabi

    2015-01-01

    Introduction Gastrointestinal fistulas are serious complications and are associated with high morbidity and mortality rates. In majority of the patients, fistulas are treatable. However, the treatment is very complex and often multiple therapies are required. These highly beneficial treatment options which could shorten fistula closure time also result in considerable hospital cost savings. Aim This study was planned to study aetiology, clinical presentation, morbidity and mortality of enterocutaneous fistula and to evaluate the different surgical intervention techniques for closure of enterocutaneous fistula along with a comparative evaluation of different techniques for management of peristomal skin with special emphasis on aluminum paint, Karaya gum (Hollister) and Gum Acacia. Materials and Methods This prospective observational study was conducted in the Department of Surgery, M.L.N. Medical College, Allahabad and its associated hospital (S.R.N. Hospital, Allahabad) for a period of five years. Results Majority of enterocutaneous fistula were of small bowel and medium output fistulas (500-1000 ml/24hours). Most of the patients were treated with conservative treatment as compared to surgical intervention. Large bowel fistula has maximum spontaneous closure rate compare to small bowel and duodenum. Number of orifice whether single or multiple does not appear to play statistically significant role in spontaneous closure of fistula. Serum Albumin is a significantly important predictor of spontaneous fistula closure and mortality. Surgical management appeared to be the treatment of choice in distal bowel fistula. The application of karaya gum (Hollister kit), Gum Acacia and Aluminum Paint gave similar outcome. Conclusion Postoperative fistulas are the most common aetiology of enterocutaneous fistula and various factors do play role in management. Peristomal skin care done with Karaya Gum, Gum Acacia and Aluminum Paint has almost equal efficiency in management of skin

  6. Sialic acids and antimicrobial substances in the apocrine glands of porcine perianal skin.

    PubMed

    Nara, Takayuki; Yasui, Tadashi; Fujimori, Osamu; Meyer, Wilfried; Tsukise, Azuma

    2012-10-01

    The porcine perianal skin shows prominent apocrine glands with large saccular dilatations, whereby the functional significance of the glandular secretions is rather unexplained. Our study focuses on the demonstration of sialoglycoconjugates and antimicrobial substances in these glands, using glycoconjugate histochemical and immunohistochemical methods. The result obtained emphasized the general presence of sialic acids, linked to α2-6Gal/GalNAc and α2-3Gaβl1-4GlcNAc, in the secretory cells. The secretory epithelium and luminal secretions also contained a spectrum of antimicrobial substances, such as lysozyme, IgA, lactoferrin, and the peptide group of β-defensins. Realizing that sialic acids possess diverging functional properties through various saccharide residues, and that antimicrobial substances serve as a non-specific defense against microorganisms, these secretory products may function as protective agents in order to preserve the integrity of the perianal region. This view includes that the amounts of bacteria on the skin surface are controlled and maintained at the certain level.

  7. Perianal Tuberculosis: A Case Report and a Review of the Literature

    PubMed Central

    Ibn Majdoub Hassani, K.; Ait Laalim, S.; Toughrai, I.; Mazaz, K.

    2012-01-01

    Extra pulmonary tuberculosis accounts for less than 15% of all cases of tuberculosis whereas the Intestinal one constitutes less than 1% of the extrapulmonary forms of the disease. The lesions of abdominal organs are more common while they rarely occur in the anoperineal area for the spread of the disease to the anus is extremely rare. We report a case of a 37-year-old male patient with large bilateral infected perianal tubercular ulcerations as well as pulmonary and peritoneal tuberculosis. The treatment was both surgical and medical and the therapy lasted for seven months. After six months from the beginning of the treatment, the lesion had totally disappeared and there is still no recurrence after one year of followup. Tuberculosis should generally be taken into consideration in the differential diagnosis of the ulcerative lesions of the anal and perianal regions for these lesions do occur in the said areas despite their rarity. The treatment is usually both surgical and medical so as to get excellent results. PMID:23346433

  8. 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

  9. Nonsurgical faecal diversion in the management of severe perianal sepsis: a retrospective evaluation of the flexible faecal management system

    PubMed Central

    Goh, Minghui; Chew, Min-Hoe; Au-Yong, Phui-Sze; Ong, Choo-Eng; Tang, Choong-Leong

    2014-01-01

    INTRODUCTION Severe perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis. METHODS We retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed. RESULTS None of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%). CONCLUSION The use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation. PMID:25630316

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

    PubMed Central

    DUTRA, Robson Azevedo; BOSCOLLO, Adriana Cartafina Perez

    2016-01-01

    ABSTRACT Background: The anorectal anomalies consist in a complex group of birth defects. Laparoscopic-assisted anorectoplasty improved visualization of the rectal fistula and the ability to place the pull-through segment within the elevator muscle complex with minimal dissection. There is no consensus on how the fistula should be managed. Aim: To evaluate the laparoscopic-assisted anorectoplasty and the treatment of the rectal urinary fistula by a bipolar sealing device. Method: It was performed according to the original description by Georgeson1. Was used 10 mm infraumbilical access portal for 30º optics. The pneumoperitoneum was established with pressure 8-10 cm H2O. Two additional trocars of 5 mm were placed on the right and left of the umbilicus. The dissection started on peritoneal reflection using Ligasure(r). With the reduction in the diameter of the distal rectum was identified the fistula to the urinary tract. The location of the new anus was defined by the location of the external anal sphincter muscle complex, using electro muscle stimulator externally. Finally, it was made an anastomosis between the rectum and the new location of the anus. A Foley urethral probe was left for seven days. Results: Seven males were operated, six with rectoprostatic and one with rectovesical fistula. The follow-up period ranged from one to four years. The last two patients operated underwent bipolar sealing of the fistula between the rectum and urethra without sutures or surgical ligation. No evidence of urethral leaks was identified. Conclusion: There are benefits of the laparoscopic-assisted anorectoplasty for the treatment of anorectal anomaly. The use of a bipolar energy source that seals the rectal urinary fistula has provided a significant decrease in the operating time and made the procedure be more elegant. PMID:27759786

  11. 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.

  12. Bronchopleural fistula in a neonate.

    PubMed

    Shen-Schwarz, S; Dosi, P C; Schwarz, K O; Brown, E G; Strauss, L

    1986-01-01

    Bronchopleural fistula (BPF) produced by endotracheal suction catheter is a known cause of persistent pneumothorax in preterm infants in intensive care nurseries. This report describes the pulmonary pathology of a neonate who had sustained this injury. The observation suggests that the abnormal airflow results in severe damage of the involved lobe and an unusually mild bronchopulmonary dysplasia in the rest of the lung. This is in agreement with the fact that BPF acts as the path of least resistance for the oxygen-rich air from the ventilator.

  13. [Neck chylous fistula: conservative treatment].

    PubMed

    López Otero, Maria J; Fernández López, Maria T; Outeiriño Blanco, E; Álvarez Vázquez, P; Pinal Osorio, I; Iglesias Diz, D

    2010-01-01

    Injury to the thoracic duct, leading to chyle leak, occurs in 1-2,5% of patients who undergo neck dissection. Associated complications include malnutrition, immune compromise, fistula formation and carotid blowout. No definitive treatment algorithm can be deduced from the current literature, but on last reviews, there is an agreement on the conservative management. Medical management is based on that decreasing chyle flow will allow for spontaneous closure of the chyle leak. Conservative treatment includes: closed vacuum drainage, bed-rest, nutrition modification and synthetic somatostatin analog. Nutrition modification involves a low-fat diet supplemented with medium-chain triglycerides (MCT), enteral nutrition with high percentage of MCT or parenteral nutrition.

  14. Radiologic recognition of bronchopleural fistula.

    PubMed

    Friedman, P J; Hellekant, C A

    1977-08-01

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

  15. Surgery for fistula-in-ano in a specialist colorectal unit: a critical appraisal

    PubMed Central

    2011-01-01

    Background Several techniques have been described for the management of fistula-in-ano, but all carry their own risks of recurrence and incontinence. We conducted a prospective study to assess type of presentation, treatment strategy and outcome over a 5-year period. Methods Between 1st January 2005 and 31st March 2011 247 patients presenting with anal fistulas were treated at the University Hospital Tor Vergata and were included in the present prospective study. Mean age was 47 years (range 16-76 years); minimum follow-up period was 6 months (mean 40, range 6-74 months). Patients were treated using 4 operative approaches: fistulotomy, fistulectomy, seton placement and rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, healing rate, postoperative complications, reinterventions and recurrence. Results Etiologies of fistulas were cryptoglandular (n = 218), Crohn's disease (n = 26) and Ulcerative Colitis (n = 3). Fistulae were classified as simple -intersphincteric 57 (23%), low transphincteric 28 (11%) and complex -high transphicteric 122 (49%), suprasphincteric 2 (0.8%), extrasphinteric 2 (0.8%), recto-vaginal 7 (2.8%) Crohn 26 (10%) and UC 3 (1.2%). The most common surgical procedure was the placement of seton (62%), usually applied in case of complex fistulae and Crohn's patients. Eighty-five patients (34%) underwent fistulotomy, mainly for intersphincteric and mid/low transphincteric tracts. Crohn's patients were submitted to placement of one or more loose setons. The main treatment successfully eradicated the primary fistula tract in 151/247 patients (61%). Three cases of major incontinence (1.3%) were detected during the follow-up period; Furthermore, three patients complained minor incontinence that was successfully treated by biofeedback and permacol injection into the internal anal sphincter. Conclusions This prospective audit demonstrates an high proportion of complex anal fistulae treated by seton

  16. 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

  17. Lepromatous leprosy and perianal tuberculosis: a case report and literature review

    PubMed Central

    2014-01-01

    Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic. PMID:25180030

  18. Severe perianal shingles during azathioprine and budesonide treatment for Crohn's disease-preventable with zoster vaccine?

    PubMed

    Elliott, Timothy Ross; Miller, Charles; Macrae, Finlay A

    2016-01-01

    Patients with inflammatory bowel disease (IBD), particularly those on immunosuppressive medications, suffer a high incidence of, and worse clinical outcomes relating to, herpes zoster (HZ) reactivation. We report on the presentation and management of a patient with Crohn's disease who developed severe perianal HZ after starting azathioprine and oral budesonide treatment. The zoster vaccine may prevent such zoster reactivation in patients with IBD. The zoster vaccine is effective in decreasing the risk of HZ in older adults but its role in younger adults and those with IBD has not been tested prospectively. A review of the potential risks and benefits of this live vaccine in patients with IBD and an approach to further determining its role in this patient population is discussed. PMID:27440857

  19. 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

  20. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst

    PubMed Central

    Tran, C.; Even, M.; Carbonnel, M.; Preaux, F.; Isnard, F.; Rault, A.; Rouanne, M.; Ayoubi, J. M.

    2014-01-01

    We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula. PMID:25152819

  1. Vesicoovarian fistula on an endometriosis abscessed cyst.

    PubMed

    Tran, C; Even, M; Carbonnel, M; Preaux, F; Isnard, F; Rault, A; Rouanne, M; Ayoubi, J M

    2014-01-01

    We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula. PMID:25152819

  2. Obstetric Fistula: Living With Incontinence and Shame

    PubMed Central

    Semere, Luwam; Nour, Nawal M

    2008-01-01

    Over 2 million women worldwide have an obstetric fistula, with the majority of cases occurring in resource-poor countries. Afflicted women tend to be young, primiparous, impoverished, and have little or no access to medical care. Incontinent of urine and/or stool, these women become ostracized and shunned by their community. Most obstetric fistulas are surgically correctible, although surgical outcomes have been poorly studied. Programs that improve nutrition, delay the age of marriage, improve family planning, and increase access to maternal and obstetric care are necessary to prevent obstetric fistula. PMID:19173024

  3. Choledochoduodenal fistula: an unusual case of pneumobilia

    PubMed Central

    Fedidat, Raphael; Safadi, Wajdi; Waksman, Igor; Hadary, Amram

    2014-01-01

    Pneumobilia is the finding of air in the biliary tree. Most cases are iatrogenic in origin, especially after sphincterotomy and after hepaticojejunostomy or choledochojejunostomy. In patients without such history, the presence of pneumobilia needs further investigation. Most patients are likely to have an enterobiliary fistula. Although patients may be asymptomatic, possible complications include gallstone ileus, Bouveret syndrome or recurrent episodes of cholangitis. We present a case of a 38-year-old man presenting with obstructive jaundice and pneumobilia in whom choledochoduodenal fistula was diagnosed at endoscopic retrograde cholangiography. A description of different types of choledochoduodenal fistulas and management recommendations are also provided. PMID:25312898

  4. 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

  5. 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.

  6. Parotid sialocele and fistula after mandibular osteotomy.

    PubMed

    Dierks, E J; Granite, E L

    1977-04-01

    Two cases are presented that show the progression to sialocele or salivary fistula, or both, after a modified Risdon approach is used for mandibular subcondylar osteotomy. Use of antisialogogues and conservative management is recommended.

  7. Gastrobronchial fistula following laparoscopic sleeve gastrectomy

    PubMed Central

    Abraham, Albin; Virdi, Ravi Paul Singh; Rajan, Dhyan; Singh, Jaspreet; Mustacchia, Paul; Iqbal, Javed; Rizvon, Kaleem

    2012-01-01

    Acquired fistulas between the tracheobronchial tree and the gastrointestinal tract are rare but serious complications of laparoscopic sleeve gastrectomies with significant morbidity and mortality. With the rising popularity and widespread acceptance of bariatric surgery techniques, the occurrence of gastrobronchial fistulas is being increasingly recognised. We present the case of a 26-year-old woman who underwent laparoscopic sleeve gastrectomy for morbid obesity and presented later with a history of chronic productive cough. Upper gastrointestinal series showed the presence of a communicating fistula between the stomach and the lung, with extravasation of contrast into the lung. The aim of this paper is to highlight the importance of considering the diagnosis of a gastrobronchial fistula in cases of persistent respiratory infections in the postoperative period following bariatric surgery and to review its incidence, clinical manifestations and treatment. PMID:22977059

  8. 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.

  9. Pancreaticocolonic fistula: a complication of pancreatitis.

    PubMed Central

    Alsumait, A. R.; Jabbari, M.; Goresky, C. A.

    1978-01-01

    In three cases of pancreaticocolonic fistula presenting before the stage of exsanguinating hemorrhage of severe sepsis the problem was diagnosed on the basis of the clinical history, visualization of the terminal part of the fistula by roentgenography after a barium enema had been given and, in two cases, demonstration of the communication with the pancreatic ductal system by endoscopic retrograde pancreatography. The lesions were repaired surgically. Pancreaticocolonic fistula should be suspected in a patient with upper abdominal pain who has a history of abdominal pain and excessive alcohol consumption and in whom diarrhea and fever, hematochezia or a disappearing abdominal mass develops. Characteristically barium will collect in the terminal part of the fistula and thus permit a tentative diagnosis; the diagnosis can then be confirmed by endoscopic retrograde pancreatography. With this approach surgical treatment can be carried out earlier and the often fatal course of the disorder can be averted. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 PMID:709471

  10. Necrotising fasciitis secondary to a colocutaneous fistula.

    PubMed

    Husnoo, N; Patil, S; Jackson, A; Khan, M

    2016-09-01

    Colocutaneous fistulae secondary to diverticular disease are rare, especially spontaneous fistulae. We report a case of a 74-year-old lady, with no previous history of diverticular disease, presenting with necrotising fasciitis of the anterior abdominal wall in the left iliac fossa, without any other symptoms. Urgent surgery was performed. An initial diagnostic laparoscopy demonstrated a perforated sigmoid diverticulum forming a fistula to the anterior abdominal wall. Following soft tissue debridement, a sigmoid colectomy was performed through a midline laparotomy. Gastrointestinal pathology should be considered as a potential cause of abdominal wall necrotising fasciitis. Our approach of using laparoscopic visualisation to assess for intra-abdominal sources in this context (in the absence of preoperative imaging when imaging could delay treatment) has not been described before. To our knowledge, only two cases of abdominal wall necrotising fasciitis secondary to diverticular disease with a colocutaneous fistula have been reported in the English literature. PMID:27241606

  11. Revisiting an ancient treatment for transphincteric fistula-in-ano ‘There is nothing new under the sun’ Ecclesiastes 1v9

    PubMed Central

    Sturgeon, G; Hargest, R

    2015-01-01

    Objective The history of treatments for fistula-in-ano can be traced back to ancient times. Current treatment of transphincteric fistulae is controversial, with many options available. We reviewed the history of treatment using cutting setons and present our series of transphincteric fistulae in the light of the series in the literature. Design Literature review and case series. Setting Hospital based coloproctology service Participants 140 consecutive patients presenting with fistula-in-ano were included. Main Outcome Measures The literature pertaining to treatment of transphincteric fistula was reviewed, along with the outcome of various treatment methods for this condition. Data were collected for 140 consecutive patients presenting with fistula- in-ano were assessed for fistula healing, recurrence and complications. Results A total of 140 consecutive patients with fistula-in-ano were identified, of which 111 were cryptoglandular (79.3%). Eighty-one of these 111 were transphincteric (73.0%). At a median follow-up of 35 months (range, 2–83 months), 70 transphincteric fistulae had healed (86.4%), 10 were still undergoing treatment (12.3%) and one patient was lost to follow-up prior to treatment (1.2%). Two patients in this group required a stoma (2.5%), six patients developed recurrence (7.4%); three ‘true’ recurrences (3.7%). One (1.2%) developed a chronic fissure. There were no reported cases of incontinence. Conclusions The management of transphincteric fistula-in-ano is complex and controversial, for which no clear surgical procedure has gained acceptance as the gold standard. This study demonstrates that transphincteric fistulae can be successfully treated using cutting setons. A high healing rate (86.4%), low recurrence rate (7.4%) and a low complication rate (3.7%) are shown, which compares favourably with published rates over a long follow-up. PMID:26152674

  12. 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

  13. Pancreatic-pleural fistula in chronic pancreatitis.

    PubMed

    Elkaoui, Hakim; Atoini, Fouad; Bouchentouf, Sidi Mohamed; El Omari, Fatima; Mahi, Mohamed; Ait Ali, Abdelmounaim; Bounaim, Ahmed; Sair, Khalid; Zentar, Aziz

    2012-03-01

    Pancreatic-pleural fistula is a rare condition and few data related to its diagnosis and treatment are available. A fistulous connection linking the pancreas with the pleura via the diaphragm or mediastinum through the retroperitoneal area is formed. We report on a case with pancreatic-pleural fistula at its early stages in an alcoholic male patient aged 45 years with known chronic pancreatitis. The operation by Roux-en-Y jejuno-pseudocystostomy was followed by chest tube drainage. PMID:22560825

  14. Management of pancreatic ductal leaks and fistulae.

    PubMed

    Larsen, Michael; Kozarek, Richard

    2014-01-01

    Pancreatic duct leaks can occur as a result of both acute and chronic pancreatitis or in the setting of pancreatic trauma. Manifestations of leaks include pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome, and internal and external pancreatic fistulas. Patient presentations are highly variable and range from asymptomatic pancreatic cysts to patients with severe abdominal pain and sepsis from infected fluid collections. The diagnosis can often be made by high-quality cross-sectional imaging or during endoscopic retrograde cholangiopancreatography (ERCP). Because of their complexity, pancreatic leak patients are best managed by a multidisciplinary team comprised of therapeutic endoscopists, interventional radiologists, and surgeons in the field of pancreatic interventions. Minor leaks will often resolve with conservative management while severe leaks will frequently require interventions. Endoscopic treatments for pancreatic duct leaks have replaced surgical interventions in many situations. Interventional radiologists also have the ability to offer therapeutic interventions for many leak patients. The mainstay of endotherapy for pancreatic leaks is transpapillary pancreatic duct stenting with a stent that bridges the leak if possible, but varies based on the manifestation and clinical presentation. Fluid collections that result from leaks, such as pseudocysts, can often be treated by endoscopic transluminal drainage with or without endoscopic ultrasound or by percutaneous drainage. Endoscopic interventions have been shown to be effective and have an acceptable complication rate.

  15. Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria

    PubMed Central

    Copelan, Alexander; Chehab, Monzer; Cash, Charles; Korman, Howard; Dixit, Purushottam

    2014-01-01

    Ureteroarterial fistula is a rare, potentially life-threatening cause of hematuria characterized by an abnormal channel between a ureter and artery. The rarity of this condition, complexity of predisposing risk factors and intermittence of symptoms may delay or obscure its diagnosis. With a high index of suspicion and careful angiographic evaluation, embarking on this condition is not only possible but sets the stage for curative intervention. We report a case of a ureteroarterial fistula presenting with intermittent hematuria, successfully diagnosed at angiography and managed with endovascular stent graft placement. PMID:25426238

  16. 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

  17. Transcatheter coil embolization of a traumatic intrahepatic arterioportal fistula.

    PubMed

    Bapuraj, J R; Kalra, N; Rao, K L; Suri, S; Khandelwal, N

    2001-07-01

    Traumatic arterioportal fistulas are rare lesions in the pediatric age group. This case highlights the safe and effective management of intrahepatic arterioportal fistulas by transcatheter coil embolization. PMID:11519293

  18. Pharyngocutaneous fistula after anterior cervical spine surgery

    PubMed Central

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

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19 year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16 months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap. PMID:19330360

  19. 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.

  20. Iatrogenic inguinal chyle fistula: a rare case report.

    PubMed

    Zubaidah, N H; Jasmi, A Y; Hanafiah, H; Shaker, A H; Asri, C M; Emad, A R; Das, S

    2012-01-01

    Chyle fistula may be common in the neck and thorax region but it is a rare entity in the inguinal region. The rarity of the incidence of chyle fistula and the tremendous response to conservative management are the important aspects to be remembered. We hereby report a case of iatrogenic inguinal chyle fistula complicating a femoral vein cannulation.

  1. 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

  2. Spontaneous closure of congenital coronary artery fistulas

    PubMed Central

    Schleich, J; Rey, C; Gewillig, M; Bozio, A

    2001-01-01

    Six cases of full spontaneous closure of congenital coronary artery fistulas, and one case of near closure, as seen by colour Doppler echocardiography, are presented. It is worth reconsidering the classical view that nearly all cases of spontaneous closure are eligible for surgical or percutaneous correction to prevent the development of significant and potentially fatal complications. As the natural course of coronary artery fistulas is still poorly defined, asymptomatic patients, especially those under 7 years old with small shunts, should be periodically followed up by echocardiography rather than be subjected to operative closure, even by catheterisation.


Keywords: congenital heart disease; coronary artery disease; coronary artery fistula; spontaneous closure PMID:11250983

  3. Surgical treatment of congenital coronary artery fistula.

    PubMed Central

    John, S; Perianayagam, W J; Muralidharan, S; Nandakumar, V; Mansfield, R; Krishnaswamy, S; Sukumar, I P; Cherian, G

    1981-01-01

    Six patients with congenital coronary artery fistula underwent successful corrective surgery. Precise diagnosis was established either by retrograde aortography or more recently by selective arteriography. The left coronary artery was involved in four and the right in two cases. The fistula communicated with the right ventricle in three and the right atrium in three subjects. The operative approach is dictated by the site of entry of the vessel into the cardiac chamber. The use of cardiopulmonary bypass for intracardiac repair allows accurate closure of the fistula thereby reducing the chances of recurrence. A follow-up of one to seven years showed that all patients are asymptomatic and leading normal lives. Images PMID:7314003

  4. Primary uretero-iliac fistula: the unusual source of haematuria.

    PubMed

    Khong, Tak Loon; Winstanley, Virginia; Lee, George; Christmas, Tim; Ramsay, Jonathan

    2007-01-01

    Uretero-iliac fistula is a rare cause of frank haematuria. The aetiology of such fistula is commonly iatrogenic. We present a unique case of a primary aorto-iliac fistula in the absence of an aneurysm or arteriovenous malformation. The diagnosis was demonstrated by ureteroscopy and real-time retrograde ureterogram. Multiple arterial embolisation of the fistula had failed, and the patient underwent a successful ureterolysis and ligation of fistula. We demonstrate the diagnostic difficulties and treatment dilemma of such rare cause of haematuria.

  5. 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.

  6. 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

  7. Diagnostic and prognostic value of cellular proliferation assessment with Ki-67 protein in dogs suffering from benign and malignant perianal tumors.

    PubMed

    Brodzki, Adam; Łopuszyński, Wojciech; Brodzki, Piotr; Tatara, Marcin R

    2014-01-01

    In the perianal region of carnivores, skin consists of modified sebaceous glands called perianal glands. Tumors originating from perianal glands are the third most frequent type of neoplasm in male dogs after neoplastic diseases of testes and skin. Ki-67 is a nuclear non-histone protein considered a proliferation marker in normal and neoplastic proliferating cells. Previous investigations revealed that Ki-67 expression may be used as a prognostic factor for breast cancer in humans. Thus, the aim of this study was to estimate the diagnostic and prognostic value of Ki-67 evaluation in dogs suffering from benign and malignant perianal tumors. The highest value of the Ki-67 index was obtained in the carcinoma group (18.50% ± 2.68), significantly higher compared to the values obtained in the control tissue (7.63% ± 2.12) and adenoma (7.33% ± 1.06; all P < 0.05). Statistically significant differences in the Ki-67 index were not found between the epithelioma group (11.95% ± 1.96) and all other groups (P < 0.05). This investigation on dogs with perianal gland tumors has shown significantly increased expression of Ki-67 antigen in carcinoma cells, while the expression of this protein was similar in the case of control tissues, adenoma and epithelioma. Thus, it may be postulated that Ki-67 evaluation in perianal gland tumors in dogs may serve as a useful marker possessing high diagnostic and prognostic value and enabling differentiation of malignant and benign tumors. PMID:25412511

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

    PubMed Central

    Bruckner, Ramona S; Rogler, Gerhard

    2016-01-01

    Fistulas and fibrosis or strictures represent frequent complications in irritable bowel disease (IBD) patients. To date, treatment options for fistulas are limited and surgery is often required. Similarly, no preventive treatment for fibrosis and stricture formation has been established. Frequently, stricture formation and fibrosis precede fistula formation, indicating that both processes may be connected or interrelated. Knowledge about the pathology of both processes is limited. A crucial role for the epithelial-to-mesenchymal transition (EMT) in fistula development has been demonstrated. Of note, EMT also plays a major role in the pathogenesis of fibrosis in many organs, and most likely also plays that role in the intestine. In addition, aberrant matrix remodeling, as well as soluble factors such as tumor necrosis factor (TNF), interleukin 13 (IL-13) and tumor growth factor beta (TGFβ) were involved, both in the onset of the fistula and fibrosis formation. Both fistulas and fibrosis may occur due to deregulated wound healing mechanisms from chronic and severe intestinal inflammation; however, further research is required to obtain a better understanding of the complex pathophysiology of fistula and intestinal fibrosis formation, to allow the development of new and more effective preventive treatment options for those important disease complications. PMID:27536360

  9. Scimitar syndrome with pulmonary arteriovenous fistulas.

    PubMed

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

    1999-10-01

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

  10. 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

  11. Surgical management of congenital coronary artery fistulas.

    PubMed Central

    Lowe, J E; Oldham, H N; Sabiston, D C

    1981-01-01

    Congenital fistulas are the most common of the coronary arterial malformations and with the widespread use of selective coronary arteriography are being recognized with increasing frequency. Twenty-eight patients with congenital coronary fistulas have been evaluated at the Duke University Medical Center between 1960 and 1981. An additional 258 patients have previously been reported in the literature, making a total of 286 available for review. The right coronary artery is most commonly involved, and the fistulous communication is most often to the right ventricle, right atrium or pulmonary artery. Slightly more than half of the patients with coronary fistulas are symptomatic at the time the diagnosis is made. Surgical correction is strongly recommended to prevent the development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and pulmonary hypertension, as well as coronary aneurysm formation, with subsequent rupture or embolization. There were no operative or late deaths in the patients who underwent operations. Moreover, there have been no recurrent fistulas during a mean follow-up period of ten years. The risks of operative correction appear to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients. Images Fig. 2a. Fig. 2b. Fig. 3. PMID:7283502

  12. Dural cavernous sinus fistula: an unusual presentation.

    PubMed Central

    Procope, J. A.; Kidwell, E. D.; Copeland, R. A.; Perry, A. F.

    1994-01-01

    This article describes a 22-year-old man who presented to the Howard University Hospital emergency room with acute onset of swelling, proptosis, and decreased vision in the right eye preceded by 24 hours of nausea and vomiting. The patient's visual acuity was count fingers in the involved eye with marked proptosis and limitation of ocular motility. There was no history given of any ocular or head trauma. A computed tomography scan of the orbits showed diffuse symmetric enlargement of the extraocular muscles of the right eye, felt to be consistent with an orbital inflammatory pseudotumor. The patient was treated with intravenous steroids initially, then placed on oral prednisone. After minimal improvement on the steroids, a selective external carotid angiogram showed a moderate-sized dural cavernous sinus fistula. The patient underwent selective embolization of the fistula with rapid resolution of periorbital edema and proptosis. Visual acuity was stabilized at 20/200 in the right eye. The differential diagnosis and pathogenesis of carotid cavernous sinus fistulas and the likely pathogenesis of the fistula in this case are discussed. Images Figure 1 Figure 2 Figure 3 PMID:8046763

  13. 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.

  14. Transposition of brachiobasilic arteriovenous fistulae: improving the cosmetic effect without compromising patency.

    PubMed

    van Dellen, David; Junejo, Muneer; Khambalia, Hussein; Campbell, Babatunde

    2016-01-01

    Introduction Subjects who undergo haemodialysis are living longer, which necessitates increasingly complex procedures for formation of arteriovenous fistulas. Basilic veins provide valuable additional venous 'real estate' but surgical transposition of vessels is required, which required a cosmetically disfiguring incision. A minimally invasive transposition method provides an excellent aesthetic alternative without compromised outcomes. Methods A retrospective review was made of minimally invasive brachiobasilic fistula transpositions (using two short incisions of <4 cm) between February 2005 and July 2011. Primary endpoints were one-year patency as well as the perioperative and late complications of the procedure. Results Thirty-one patients underwent 32 transposition procedures (eight pre-dialysis cases; 24 haemodialysis patients). All patients were treated with a minimally invasive method. Thirty-one procedures resulted in primary patency, with the single failure refashioned successfully. The only indication for a more invasive approach was intraoperative complications (two haematomas). All other complications presented late and were amenable to intervention (one aneurysm, one peri-anastomotic stricture). Conclusion Formation of arteriovenous fistulae using minimally invasive methods is a novel approach that ensures fistula patency with improved aesthetic outcomes and without significant morbidity. PMID:26688395

  15. [Multi-technical management of biliary fistula].

    PubMed

    Vargas, F; Barrios, R; Palao, R; Garnica, E

    1991-01-01

    Biliary fistula is an occasional complication of cholecystectomy and are usually associated to retained biliary stones, surgical trauma of the biliary ducts and local infection. They were mainly treated by surgical methods up to the acquisition of the new endoscopic and percutaneous techniques used together with parenteral and enteral nutrition and new antibiotics. A total of seven patients with diagnosis of biliary fistula were seen between 1984 and 1990 at the "Unidad de Gastroenterología y Cirugía Digestiva" of the Clínica Sanatrix en Caracas. Average age was 50 with ranged between 31 and 76, 4 were male and 3 female. The fistulas were in 1 due to necrotizing pancreatitis, in 3 to lost of the ligation of the cystic duct, 2 were due to accidental injury of the common duct and the last case was a partial dehiscence of a choledoco-jejunostomy after the resection of a common duct cyst. Four of the cases were choledoco-cutaneous fistula, one hepatocutaneous, two hepatoduodenal. All the seven patients had subhepatic collections, one had a retroperitoneal collection, two had subdiaphragmatic collections and one had multiple hepatic abscesses. The abdominal collections were treated by percutaneous drainage using mainly the Ring-McLean and Van Sonnenberg tubes. The fistula was occluded with biliary prosthesis in four cases, using either endoscopic, percutaneous or mixed technique to place the stent. Patency of the stents ranged between 2 weeks and 24 months. Control time was from 2 to 40 months.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Patterns of Failure for Rhabdomyosarcoma of the Perineal and Perianal Region

    SciTech Connect

    Casey, Dana L.; Wexler, Leonard H.; LaQuaglia, Michael P.; Meyers, Paul A.; Wolden, Suzanne L.

    2014-05-01

    Purpose: To analyze prognostic factors and patterns of failure for rhabdomyosarcoma of the perineal and perianal region (PRMS), with an emphasis on radiation therapy for locoregional control. Methods and Materials: Detailed records of all 14 patients treated for PRMS at Memorial Sloan-Kettering Cancer Center between 1998 and 2012 were reviewed. The Kaplan-Meier method was used to assess the event-free survival (EFS) and overall survival (OS), and a competing-risks analysis was used to assess the cumulative incidence of local, regional, and distant failures. Results: Median age was 15.8 years (range, 1.1-31.9 years). High-risk features were identified: 9 of 14 patients (64%) had group 3 disease and 3 of 14 (21%) had group 4; 11 of 14 tumors (78%) were alveolar; 12 of 14 tumors (86%) were ≥5 cm; and 9 of 14 patients (64%) had involved lymph nodes (N1). Of those aged ≥10 years at diagnosis, 9 of 10 (90%) had alveolar histology, all had tumors ≥5 cm, and 8 of 10 (80%) presented with N1 disease. The rates of local, regional, and distant failure at 5 years were 17%, 31%, and 52%, respectively. Although 3 of the 4 patients with regional failure received nodal irradiation, only one of the nodal failures occurred in the radiation therapy field. The 5-year EFS was 33%, and OS was 39%. Age ≥10 years was associated with poor outcomes: EFS was 13% in patients aged ≥10 years, compared with 75% in those aged <10 years (P=.04); the OS was 13% in patients aged ≥10 years, compared with 100% in those aged <10 years (P=.04). Conclusions: Patients with PRMS, especially those aged ≥10 years, present with poor prognostic features and continue to have poor outcomes. Given the high incidence of regional node recurrence, we recommend prophylactic ilioinguinal lymph node irradiation for all patients aged ≥10 years. For children aged <10 years, nodal evaluation is essential to determine the role for lymph node irradiation.

  17. A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis

    PubMed Central

    2014-01-01

    Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the patient’s prosthesis mismatch and effective orifice area. PMID:25022608

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

    PubMed

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

    2015-01-01

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

  19. Long head of biceps femoris flap in anal fistula treatment: anatomical study and case report.

    PubMed

    Terryn, F X; Leonard, D; Chateau, F

    2015-01-01

    In case of complex anal fistulae, the treatment can include muscular flaps. The gracilis transposition flap is the gold-standard in perineal reconstructive surgery, with wide use during the past decades. However, in some cases, this flap is too short to reach difficult locations such as the posterior perineum. The long head of the biceps femoris, which has already been studied in the electrically stimulated neosphincter formation, could be more appropriate in such clinical situations. Furthermore, its potential advantages, amongst which an excellent functional outcome, would be to allow persistent prone position, during both treatment and reconstruction, as well as a more favorable intramuscular vascularisation. We report the case of a 39-year-old man with a complex recurrent transphincteric posterior anal fistula with an external orifice in the right buttock and complicated with a severe cellulitis, treated with an endo-anal flap combined with a long head of biceps femoris pediculised flap. PMID:26021955

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

    PubMed Central

    González-Sánchez-Migallón, Elena; Aguilar-Jiménez, José; García-Marín, José Andrés; Aguayo-Albasini, José Luis

    2016-01-01

    Chyle leak following axillary lymph node clearance is a rare yet important complication. The treatment of postoperative chyle fistula still remains unclear. Conservative management is the first line of treatment. It includes axillary drains on continuous suction, pressure dressings, bed rest, and nutritional modifications. The use of somatostatin analogue is well documented as a treatment for chylous fistulas after neck surgery. We present a case of chylous fistula after axillary surgery resolved with the use of octreotide. PMID:26925285

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

    PubMed

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

    2010-08-01

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

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

    PubMed

    Yang, C Y

    1992-06-01

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

  3. A unique type of dural arteriovenous fistula at confluence of sinuses treated with endovascular embolization: a case report.

    PubMed

    Gupta, Rahul; Miyachi, Shigeru; Matsubara, Noriaki; Izumi, Takashi; Naito, Takehiro; Haraguchi, Kenichi; Wakabayashi, Toshihiko

    2013-02-01

    Dural arteriovenous fistula (DAVF) is classically defined as abnormal arteriovenous connections located within the dural leaflets. Though the exact etiology is still not clear, they are generally accepted as acquired lesions. However, some DAVFs formed as the congenital disorders are called dural arteriovenous malformations and these lesions with a marked cortical venous reflux are considered to be aggressive and warrant an early intervention. The authors describe a case of 35-year-old man presented with unique type of DAVF. The fistula was located adjacent to the confluence of venous sinuses with multiple feeders. The feeders drained into a large venous pouch just anterior to the confluence which had a bilateral venous drainage. This was associated with multiple cerebellar venous ectasia along the draining cortical vein. It was managed by staged endovascular procedures and complete cure could be achieved. The pathogenesis and technique of embolization of this complex fistula/malformation are also discussed.

  4. [Esophageal stenosis and esophagotracheal fistula with concomitant gastric ulcer in "caustic soda" ingestion].

    PubMed

    Sabău, D; Drăghicescu, M; Dobre, M; Popescu, O; Popa, I; Giurgea, A

    1996-01-01

    The article deals with a special case through it's gravity and lesional complexity. A forty years old ill person with esophagus stenosis and postcaustic esophagotracheal fistula, having both a gastric ulcer on the date of surgery is operated in three stages: 1. Vagotomy, pyloroplasty and gastrotomy. 2. Esophagectomy with Kirschner-Nakayama gastric grafting. Posterior tracheorraphy with esophageal muscular patch. 3. Anastomotic cervical stenosis--plastic replacement (grafting) with a fat-less skin.

  5. 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

  6. 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

  7. [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

  8. [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.

  9. 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

  10. One hundred and nineteen patients with gastrointestinal fistulas.

    PubMed

    Soeters, P B; Fischer, J E; Franklin, C

    1977-01-01

    One hundred and nineteen patients with gastrointestinal fistulas were treated in the Massachusetts General Hospital, Boston, in the period from January 1960 to January 1970. None of these patients was hyperalimented. The mortality in this seris amounted to 15%; 78.2% of the patients had their fistulas closed. These results are correlated with primary disease, etiology, fistula output, fistula location, type of treatment, malnutrition, electrolyte disturbances and sepsis. In the discussion it is concluded that treatment based on sound surgical principles acquired in the past decades, with the support of modern techniques of intensive patient care, should considerably diminish mortality and improve closure rate.

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

    PubMed Central

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

    2016-01-01

    Summary Carotid-cavernous fistulas are abnormal communications between the carotid system and the cavernous sinus. Elevated venous pressure produces congestion in the orbit with resultant transudation of fluid and increased intraocular pressure, thereby leading to secondary glaucoma which may result in visual loss. Immediate treatment is hence, warranted in these cases. The planning of endovascular management is dependent on many parameters, the most important of which are the size and location of the fistula. Since these are high-flow fistulas, assessment requires certain manoeuvers. Heuber manoeuver is one of the manoeuvers used to demonstrate the size of the fistula. PMID:27781074

  12. 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

  13. Enterocolic fistula: A rare presentation of cytomegalovirus infection.

    PubMed

    Gill, Richdeep S; Taylor, Geoffrey; Penner, Robert M; Logsetty, Sarvesh

    2012-01-01

    In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.

  14. An unusual case of pancreatic fistula.

    PubMed

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

    2013-03-21

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

  15. Tracheoesophageal fistula induced by invasive pulmonary aspergillosis

    PubMed Central

    Yu, Yuetian; Zhu, Cheng; Qian, Xiaozhe

    2016-01-01

    Invasive pulmonary aspergillosis (IPA) is commonly seen in immunocompromised patients, and tracheoesophageal fistula (TEF) induced by IPA is rare and seldom reported. Management of these critically ill patients is challenging and often requires a multidisciplinary approach. The authors reported an adult suffering from aplastic anemia who developed TEF caused by IPA. The diagnosis was confirmed following bronchoscopy and histopathological examination. Antifungal and bronchoscopic intervention provided a cure without any recurrence as yet.

  16. 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

  17. Socio-demographic profile and obstetric experience of fistula patients managed at the Addis Ababa Fistula Hospital.

    PubMed

    Muleta, Mulu

    2004-01-01

    Obstetric experience, clinical and socio-economic characteristics, and reasons for preference of place of delivery of 639 fistula patients admitted to the Addis Ababa Fistula Hospital between May 1999 and February 2000 are described About 94% of fistula patients were married and 83.6% had been through with the delivery caused the fistula before the age of 20. The mean ages at the first marriage and at the causative delivery were 14.7 (sd=2.6) and 17.8 (sd=3.2) years respectively. Mean height of fistula patients studied was 149 cms (sd=8). About 64% were primiparous, 44% (279) delivered at home, and labor lasted for 3.8 days on average. Majority of fistula patients mentioned distance as a main problem for the delays. Lack of money, poor knowledge and delay in referral were the other frequently mentioned reasons for the delays. About 62%(399) of fistula patients owned nothing valuable. Of 279 patients delivered at home 186 were those who owned nothing. Out of 180-fistula patients mentioned distance as the major problem, 103 (57%) stayed at home for delivery. About 54% of fistula patients were already divorced on arrival to the hospital and this figure varied among women with different parity and among those owning different property. Teenage and short stature are observed features of fistula patients. The study also showed the huge problems faced by fistula patients in accessing emergency obstetric care services. Analytic study is recommended to compare the magnitude of these problems among other mothers with different obstetric outcome. Meanwhile, community education about problems following teenage pregnancy, sign and symptoms of obstructed labor and the advantage of institutional delivery might reduce the occurrence rate of obstetric fistula. Community organized fund and maternity waiting areas for young and short expecting mothers are among other recommendations to be considered. PMID:15884272

  18. Perilymph fistulas in children: experience of the Otologic Medical Group.

    PubMed

    House, J W; Rizer, F M

    1989-11-01

    We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2610242

  19. A solitary fibrous tumor in the perianal region with a 13-year follow-up: report of a case.

    PubMed

    Yoshida, R; Takada, H; Iwamoto, S; Uedono, Y; Kawanishi, H; Yoshioka, K; Nakane, Y; Hioki, K; Sakaida, N; Okamura, A

    1999-01-01

    A case of a solitary fibrous tumor (SFT) of the perianal region in a 62-year-old man is reported herein. The patient had undergone an abdominoperineal excision of the rectum for an anorectal tumor 13 years previously, and had been referred to our hospital for a perineal mass. Computerized tomography and angiography revealed a markedly hypervascular tumor measuring 11 x 8 cm in size in the pelvic cavity. After preoperative radiotherapy (total 58 Gy) and the embolization of the feeding arteries, he underwent an en bloc excision of the tumor. Microscopically, the tumor was composed of spindle shaped cells with a "patternless" arrangement in a collagenous background. There was immunohistochemical evidence that these cells were strongly positive for CD34, thus suggesting the tumor to be SFT. The previously resected anorectal tumor showed similar histological and immunohistochemical findings. The patient's recovery was uneventful.

  20. Peri-anal implantation of bioengineered human internal anal sphincter constructs intrinsically innervated with human neural progenitor cells

    PubMed Central

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

    2014-01-01

    Background The internal anal sphincter (IAS) is a major contributing factor to anal canal pressure and is required for maintenance of rectoanal continence. IAS damage or weakening results in fecal incontinence. We have demonstrated that bioengineered intrinsically innervated human IAS tissue replacements possess key aspects of IAS physiology, like generation of spontaneous basal tone and contraction/relaxation in response to neurotransmitters. The objective of this study is to demonstrate the feasibility of implantation of bioengineered IAS constructs in the peri-anal region of athymic rodents. Methods Human IAS tissue constructs were bioengineered from isolated human IAS circular smooth muscle cells and human enteric neuronal progenitor cells. Upon maturation of the bioengineered constructs in culture, they were implanted surgically into the perianal region of athymic rats. Growth factor was delivered to the implanted constructs through a microosmotic pump. Implanted constructs were retrieved from the animals 4 weeks post-implantation. Results Animals tolerated the implantation well, and there were no early postoperative complications. Normal stooling was observed during the implantation period. Upon harvest, implanted constructs were adherent to the perirectal rat tissue, and appeared healthy and pink. Immunohistochemical analysis revealed neovascularization. Implanted smooth muscle cells maintained contractile phenotype. Bioengineered constructs responded to neuronally evoked relaxation in response to electrical field stimulation and vasoactive intestinal peptide, indicating the preservation of neuronal networks. Conclusions Our results indicate that bioengineered innervated IAS constructs can be used to augment IAS function in an animal model. This is a regenerative medicine based therapy for fecal incontinence that would directly address the dysfunction of the IAS muscle. PMID:24582493

  1. Single Operation to Repair Multifocal Cerebrospinal Fluid Fistulae Following Gunshot Wound: A Case Report

    PubMed Central

    White-Dzuro, Gabrielle A.; Entezami, Pouya; Wanna, George; Russell, Paul; Chambless, Lola B.

    2016-01-01

    Introduction Traumatic cerebrospinal fluid (CSF) fistulae can be a challenging neurosurgical disease, often requiring complicated surgical intervention. Case Presentation A 54-year-old man presented with a gunshot wound to the head with complex injury to the skull base and significant CSF leakage from multiple sites. A single surgery was performed using a combined Neurosurgery, Neurotology, and Rhinology team, which was successful in repairing the multiple skull base defects and preventing further CSF leak. Discussion Trauma to the skull base is a common inciting factor for the development of CSF fistulae. Endoscopic approaches are often preferred for repairing these defects, but craniotomy remains a viable option that may be required in more complex cases. A combined approach has not been described previously, but was successful for this severe multifocal defect. Conclusion A multidisciplinary approach allowed for a combined intervention that addressed both the anterior and middle fossae fistulae simultaneously. This limited the potential infectious complications of continued CSF leak and allowed for early rehabilitation. PMID:27330926

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

    PubMed

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

    2005-01-01

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

  3. [Salivary stone in parotid gland with a cutaneous fistula].

    PubMed

    Abadi, Peymaneh; Larsen, Stine Rosenkilde; Godballe, Christian

    2013-01-01

    Parotid fistulas are very rare and arise from various causes such as trauma, operative complications, infection, malignancy and stone. They may also be congenital. A rare case of cutaneous salivary fistula is presented. A 59-year-old man had a recurrent inflammatory parotid disease which disappeared after the expulsion of the calculus. PMID:23305643

  4. Pulmonary arteriovenous fistula ruptured to pleural cavity in pregnancy.

    PubMed

    Freixinet, J; Sanchez-Palacios, M; Guerrero, D; Rodriguez de Castro, F; Gonzalez, D; Lopez, L; Guerra, M

    1995-01-01

    Congenital pulmonary arteriovenous fistula is frequently associated with hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). With the increased blood flow in pregnancy such fistulas enlarge, occasionally giving rise to haemothorax, which generally has a poor prognosis. A familial case is presented in which massive haemothorax required emergency thoracotomy in the 27th week of pregnancy.

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

    PubMed

    Cosman, B C

    1998-07-01

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

  6. Treatment of a malignant enterocutaneous fistula with octreotide acetate.

    PubMed

    Ayache, S; Wadleigh, R G

    1999-01-01

    An enterocutaneous malignant fistula developed in a patient who had a retroperitoneal angiosarcoma. He was treated with octreotide acetate subcutaneously. Drainage decreased and ceased after 2 weeks of therapy. The closure of this malignant fistula suggests that palliative therapy with octreotide acetate merits further study in view of the grave prognosis of this complication.

  7. 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.

  8. Double congenital fistulae with aneurysm diagnosed by combining imaging modalities.

    PubMed

    Tachibana, Motomi; Mukouhara, Naoki; Hirami, Ryouichi; Fujio, Hideki; Yumoto, Akihisa; Watanuki, Yutaka; Hayashi, Aiko; Suminoe, Isao; Koudani, Hiroshi

    2013-01-01

    Congenital coronary pulmonary artery fistula (CAF) is rare, and systemic-to-pulmonary artery fistula (SPAF) is even more so. Furthermore, congenital coronary pulmonary fistula associated with congenital SPAF is extremely rare. As far as we know, CAF and SPAF connected with an aneurysm have not been described very often. We described an 83-year-old woman with an aneurysm originating from a CAF connected to an aortopulmonary artery fistula. Chest radiography revealed a shadow at the left edge of the heart line. Multi-detector-row computed tomography (MDCT) with contrast enhancement and coronary cine angiography revealed that the shadow was an aneurysm connected to a tortuous fistula at the left anterior descending coronary artery. The aneurysm was formed by congenital coronary pulmonary and aortopulmonary artery fistulae. Echocardiography revealed predominantly systolic blood flow in the fistula from the left anterior descending coronary artery (LAD). Although neither MDCT, echocardiography nor coronary angiography alone could provide a comprehensive image of the anomaly, including the hemodynamics in the fistulae and their relationship with surrounding organs and tissues, their combination could provided important facts the led to a deeper understanding of this very uncommon occurrence. PMID:24145730

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

    PubMed

    Wang, Xia; Xu, Yaosheng

    2015-12-01

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

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

    PubMed

    Rodríguez Cano, Ameyalli Mariana

    2014-01-01

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

  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. [Secondary aortoenteric fistula, multidisciplinary surgical management].

    PubMed

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

    2011-01-01

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

  14. [A case of spontaneous pyeloduodenal fistula].

    PubMed

    Hamamoto, Y; Noguchi, A; Minoshima, K; Taniguchi, M; Takeuchi, T; Sakai, S

    1999-05-01

    A 61-year-old woman visited our hospital complaining of right flank pain and fever. The radiograph demonstrated multiple renal calculi. Radio renography showed no uptake in the right kidney. Therefore, we diagnosed her with pyonephrosis, and recommended open nephrectomy. However, she selected the conservative treatment with extra corporeal shockwave lithotripsy (ESWL). In spite of disappearance of multiple calculi, pyuria continued for 3 months after ESWL. Retrograde pyelography showed a fistula from the right pelvis into the duodenum. The patient was successfully treated by nephrectomy and duodeno-fistelectomy.

  15. Colocutaneous Fistula after Open Inguinal Hernia Repair

    PubMed Central

    Kallis, Panayiotis; Koronakis, Nikolaos; Hadjicostas, Panayiotis

    2016-01-01

    The plug-and-patch technique is frequently used for the open repair of inguinal hernias; however, serious complications may arise on rare occasions. We present the case of a 69-year-old patient who presented with a colocutaneous fistula with the sigmoid colon 9 years after the repair of a left sliding inguinal hernia with the plug-and-patch technique. The patient underwent sigmoidectomy and excision of the fistulous track. He was discharged on postoperative day 5 and had an uneventful recovery. Although such complications are reported rarely, the surgeon must be aware of them when deciding upon the method of hernia repair. PMID:27738544

  16. Hydatid cyst fistula into the aorta.

    PubMed

    Viver, E; Bianchi, L; Callejas, J M; Martorell, A

    1989-01-01

    A case is presented of fistula formation between a primary hydatid cyst and the abdominal aorta which we believe is the first in the world literature. The patient underwent surgery with a diagnosis of aneurysm of the coeliac trunk. During the operation the presence was discovered of a hydatid cyst opening into the aorta. It was dealt with by partial resection and closing of the communication. Three months later the patient was readmitted with a new bleeding episode which resulted in a fatal outcome.

  17. Complete Genome Sequence of Noninvasive Streptococcus pyogenes M/emm28 Strain STAB10015, Isolated from a Child with Perianal Dermatitis in French Brittany.

    PubMed

    de Andrade Barboza, Suzane; Meygret, Alexandra; Vincent, Pascal; Moullec, Séverine; Soriano, Nicolas; Lagente, Vincent; Minet, Jacques; Kayal, Samer; Faili, Ahmad

    2015-07-16

    We report here the complete genome sequence of a noninvasive strain of Streptococcus pyogenes M/emm28, isolated from perianal dermatitis in a child. The genome is composed of 1,950,454 bp, with a G+C content of 38.2%, and it has 1,925 identified coding sequences and harbors two intact prophages and a new integrating conjugative element (ICE).

  18. Incomplete restoration of homeostatic shear stress within arteriovenous fistulae.

    PubMed

    McGah, Patrick M; Leotta, Daniel F; Beach, Kirk W; Eugene Zierler, R; Aliseda, Alberto

    2013-01-01

    Arteriovenous fistulae are surgically created to provide adequate access for dialysis patients suffering from end-stage renal disease. It has long been hypothesized that the rapid blood vessel remodeling occurring after fistula creation is, in part, a process to restore the mechanical stresses to some preferred level, i.e., mechanical homeostasis. We present computational hemodynamic simulations in four patient-specific models of mature arteriovenous fistulae reconstructed from 3D ultrasound scans. Our results suggest that these mature fistulae have remodeled to return to ''normal'' shear stresses away from the anastomoses: about 1.0 Pa in the outflow veins and about 2.5 Pa in the inflow arteries. Large parts of the anastomoses were found to be under very high shear stresses >15 Pa, over most of the cardiac cycle. These results suggest that the remodeling process works toward restoring mechanical homeostasis in the fistulae, but that the process is limited or incomplete, even in mature fistulae, as evidenced by the elevated shear at or near the anastomoses. Based on the long term clinical viability of these dialysis accesses, we hypothesize that the elevated nonhomeostatic shear stresses in some portions of the vessels were not detrimental to fistula patency. PMID:23363216

  19. Transcatheter coil embolization of multiple bilateral congenital coronary artery fistulae.

    PubMed

    Iglesias, Juan F; Thai, Hoa Tran; Kabir, Tito; Roguelov, Christan; Eeckhout, Eric

    2010-03-01

    Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but remain a relatively uncommon clinical problem. Moreover, multiple fistulae originating from both the left and the right coronary arteries and draining into the left ventricular chamber are a rare condition. Due to the low prevalence of these anomalies, the appropriate management of patients with symptomatic coronary artery fistulae is controversial. Transcatheter closure approaches have emerged as a less invasive strategy and are nowadays considered a valuable alternative to surgical correction with similar effectiveness, morbidity and mortality. The percutaneous management, however, is mainly limited by the individual anatomic features of the fistula and an appropriate patient's selection is considered as a key determining factor to achieve complete occlusion. Thus, success rates of transcatheter closure techniques reported in the literature are extremely variable and highly dependent upon the nature of the follow up, which, at present, is not standardized. The optimal management of symptomatic patients with multiple coronary artery fistulae still remains a challenging problem and has been traditionally considered as an indication for cardiac surgery. We report here the case of a patient with double bilateral congenital coronary artery fistulae arising from both the left and right coronary arteries and draining individually into the left ventricular chamber. This patient underwent successful transcatheter anterograde closure of both fistulae using a microcoil embolization technique.

  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. Venous Drainage Patterns in Carotid Cavernous Fistulas

    PubMed Central

    Aralasmak, Ayse; Karaali, Kamil; Senol, Utku; Ozdemir, Huseyin; Alkan, Alpay

    2014-01-01

    Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach. PMID:24967298

  2. Prospective evaluation of a new device for the treatment of anal fistulas

    PubMed Central

    Ratto, Carlo; Litta, Francesco; Donisi, Lorenza; Parello, Angelo

    2016-01-01

    AIM: To evaluate the safety of the implantation of a new device for the treatment of anal fistulas. The short-term clinical efficacy was also assessed. METHODS: This study took place at a tertiary care university hospital. Patients with a complex anal fistula of cryptoglandular origin were enrolled in the study and were treated with insertion of the new device. All patients were evaluated by clinical and physical examination, including an endoanal ultrasound at the baseline, and then at the 2 wk and 1, 2, 3 and 6-mo follow-up visits. RESULTS: Morbidity, continence status, and success rate were the main outcome measures. Ten patients underwent the placement of the new device. The fistulas were transphincteric in eight patients and extrasphincteric in the remaining two. The median duration of the surgical procedure was 34.5 (range, 27-42) min. Neither intra- nor postoperative complications occurred, and all patients were discharged the day after the procedure. At the 6-mo follow-up evaluation, the final success rate was 70%. Three failures were registered: a device expulsion (on the 10th postoperative day), the persistence of inflammatory tissue around the fistula tract (at the 2-mo follow up), and the persistence of serum discharge (at the 6-mo follow up). No patient experienced any change incontinence, as assessed by the Cleveland Clinic Fecal Incontinence score. CONCLUSION: The technical procedure is simple and has low risk of perioperative morbidity. The pre- and post-operative continence status did not change in any of the patients. The initial results at the 6-mo follow up seem to be promising. However, a longer follow-up period and a larger sample size are needed to confirm these preliminary results. PMID:27570429

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

    SciTech Connect

    Schmelter, Christopher Raab, Udo; Lazarus, Friedrich; Ruppert, Volker; Vorwerk, Dierk

    2015-08-15

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

  4. 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

  5. The effect of preemptive perianal ropivacaine and ropivacaine with dexmedetomidine on pain after hemorrhoidectomy: a prospective, randomized, double-blind, placebo-controlled study.

    PubMed

    Kim, Beom Gyu; Kang, Hyun

    2014-02-01

    The objective of this study was to assess the efficacy of perianal infiltration of ropivacaine and dexmedetomidine added to ropivacainein in the relief of pain after hemorrhoidectomy. Patients in group C(placebo control group, n = 21) received perianal injections of normal saline and those in group RO(ropivacaine injection group, n = 21) received ropivacaine, those in group RD(ropivacaine with dexmedetomidine injection group, n = 19) were administered ropivacaine with dexmedetomidine, prior to the initiation of the operation. Reductions of the VAS score, the frequency with which the PCA button was pushed, and fentanyl consumption were assessed in groups RO and RD as compared to that of group C, and in group RD as compared to that of group RO(p < 0.05). We concluded that the use of perianal ropivacaine injection prior to surgical incision reduced both postoperative pain and fentanyl consumption following hemorrhoidectomy, and the addition of dexmedetomidine to ropivacaine may have an additive effect in postoperative analgesic care.

  6. 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

  7. 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

  8. 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. PMID:27504352

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

    PubMed

    Sellers, William; Fiorelli, Robert

    2015-11-01

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

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

    PubMed

    Singh, Virendra; Kumar, Pradeep; Agrawal, Aviral

    2013-01-01

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

  11. Team approach for closure of oroantral and oronasal fistulae.

    PubMed

    Kraut, R A; Smith, R V

    2000-03-01

    Oroantral and oronasal fistulas present with a broad range of causation, size, duration, and extent of infection involving the nose and paranasal sinuses. Accurate diagnosis of the extent of the disease with appropriate radiographic evaluation will guide the surgeon to select an approach that addresses all of the infected sites. When significant sinus disease is found, an endoscopic approach to restoring drainage in all of the involved sinuses can promote predictably successful closure of oroantral and oronasal fistulas. The multispecialty team approach to this disease, with the concomitant management of the sinusitis and fistula closure, is a significant advance in the successful management of this chronic condition.

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

    PubMed

    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

  13. 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

  14. Prospective Evaluation of Acute Toxicity and Quality of Life After IMRT and Concurrent Chemotherapy for Anal Canal and Perianal Cancer

    SciTech Connect

    Han, Kathy; Cummings, Bernard J.; Lindsay, Patricia; Skliarenko, Julia; Craig, Tim; Le, Lisa W.; Brierley, James; Wong, Rebecca; Dinniwell, Robert; Bayley, Andrew J.; Dawson, Laura A.; Ringash, Jolie; Krzyzanowska, Monika K.; Moore, Malcolm J.; Chen, Eric X.; Easson, Alexandra M.; Kassam, Zahra; Cho, Charles; Kim, John

    2014-11-01

    Purpose: A prospective cohort study was conducted to evaluate toxicity, quality of life (QOL), and clinical outcomes in patients treated with intensity modulated radiation therapy (IMRT) and concurrent chemotherapy for anal and perianal cancer. Methods and Materials: From June 2008 to November 2010, patients with anal or perianal cancer treated with IMRT were eligible. Radiation dose was 27 Gy in 15 fractions to 36 Gy in 20 fractions for elective targets and 45 Gy in 25 fractions to 63 Gy in 35 fractions for gross targets using standardized, institutional guidelines, with no planned treatment breaks. The chemotherapy regimen was 5-fluorouracil and mitomycin C. Toxicity was graded with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. QOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Correlations between dosimetric parameters and both physician-graded toxicities and patient-reported outcomes were evaluated by polyserial correlation. Results: Fifty-eight patients were enrolled. The median follow-up time was 34 months; the median age was 56 years; 52% of patients were female; and 19% were human immunodeficiency virus—positive. Stage I, II, III, and IV disease was found in 9%, 57%, 26%, and 9% of patients, respectively. Twenty-six patients (45%) required a treatment break because of acute toxicity, mainly dermatitis (23/26). Acute grade 3 + toxicities included skin 46%, hematologic 38%, gastrointestinal 9%, and genitourinary 0. The 2-year overall survival (OS), disease-free survival (DFS), colostomy-free survival (CFS), and cumulative locoregional failure (LRF) rates were 90%, 77%, 84%, and 16%, respectively. The global QOL/health status, skin, defecation, and pain scores were significantly worse at the end of treatment than at baseline, but they returned to baseline 3 months after treatment. Social functioning and appetite scores were

  15. Successful Treatment of Secondary Aortoenteric Fistula with a Special Graft

    PubMed Central

    Çiçek, Ömer Faruk; Çiçek, Mustafa Cüneyt; Kadiroğulları, Ersin; Uzun, Alper; Ulaş, Mahmut

    2016-01-01

    Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection. PMID:26880931

  16. 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.

  17. Necrotizing fasciitis secondary to enterocutaneous fistula: three case reports.

    PubMed

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

    2014-06-28

    Necrotizing fasciitis (NF) is an uncommon, rapidly progressive, and potentially fatal infection of the superficial fascia and subcutaneous tissue. NF caused by an enterocutaneous fistula has special clinical characters compared with other types of NF. NF caused by enterocutaneous fistula may have more rapid progress and more severe consequences because of multiple germs infection and corrosion by digestive juices. We treated three cases of NF caused by postoperative enterocutaneous fistula since Jan 2007. We followed empirically the principle of eliminating anaerobic conditions of infection, bypassing or draining digestive juice from the fistula and changing dressings with moist exposed burn therapy impregnated with zinc/silver acetate. These three cases were eventually cured by debridement, antibiotics and wound management. PMID:24976737

  18. Successful Treatment of Secondary Aortoenteric Fistula with a Special Graft.

    PubMed

    Çiçek, Ömer Faruk; Çiçek, Mustafa Cüneyt; Kadiroğulları, Ersin; Uzun, Alper; Ulaş, Mahmut

    2016-01-01

    Aortoenteric fistula is an uncommon but life-threatening cause of gastrointestinal blood loss. We report a case of a 70-year-old man who presented to the emergency department with an episode of melena and infection in the left inguinal region. Diagnosis of secondary aortoenteric fistula was made between the left limb of the aortobifemoral graft and the descending colon. We performed excision of the infected graft and in situ silver acetate coating of prosthetic vascular graft replacement (aortoleft femoral) on the patient. This study reports a rare type of secondary aortoenteric fistula to the left colon, and it describes an unusual and successful surgical treatment. Antimicrobial coating of prosthetic vascular grafts may be a good alternative in the presence of graft infection associated with aortoenteric fistula because in situ grafts may carry an increased risk of reinfection. PMID:26880931

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

    PubMed

    Massinde, An; Kihunrwa, A

    2013-07-01

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

  20. Large Vesico-Vaginal Fistula Caused by a Foreign Body

    PubMed Central

    Massinde, AN; Kihunrwa, A

    2013-01-01

    Foreign body is a rare cause of vesico-vaginal fistula most often reported in developed countries. In developing countries obstructed labor is the commonest cause of fistula. A nulliparous 19-year-old female presented with a 3-week history of a foreign body in the vagina causing urinary incontinence and offensive vaginal discharge. Her guardian allegedly inserted the foreign body after she refused a pre-arranged marriage. A plastic container was removed from the vagina under general anesthesia. A large vesico-vaginal fistula was discovered, which was successfully surgically repaired. We recommend urgent removal of the foreign body, preferably under general anesthesia. However, if the history or physical examination reveals prolonged exposure, repair of the fistula should be delayed to allow for adequate debridement in order to prevent any life-threatening complications. PMID:24116334

  1. Anchor Coil Technique for Arteriovenous Fistula Embolization

    PubMed Central

    Kanemaru, Kazuya; Ezura, Masayuki; Nishiyama, Yoshihisa; Yagi, Takashi; Yoshioka, Hideyuki; Fukumoto, Yuichiro; Horikoshi, Toru; Kinouch, Hiroyuki

    2014-01-01

    Summary We describe a case of arteriovenous fistula (AVF) successfully treated by coil embolization with an anchor coil inserted in the varix to facilitate dense packing at the shunting site. AVF of the left anterior choroidal artery (AChoA) draining into the ipsilateral basal vein of Rosenthal was incidentally found in a newborn female. A single detachable coil was inserted as an anchor into the varix adjacent to the shunt, and the microcatheter was pulled back to the shunting point. Three more detachable coils were delivered at the shunting point without migration under the support of the anchor coil, and the AVF was successfully obliterated with preservation of AChoA blood flow. The anchor coil technique can reduce the risk of coil migration and the number of coils required. PMID:24976089

  2. 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

  3. 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

  4. 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

  5. Use of previously divided latissimus dorsi muscle for bronchopleural fistula.

    PubMed

    Kaplan, Tevfik; Kaya, Basar; Kazbek, Baturay Kansu; Kocer, Bulent; Han, Serdar; Yormuk, Erdem

    2015-06-01

    Management of postpneumonectomy bronchopleural fistula remains a major challenge for thoracic surgeons. Successful closure of a postpneumonectomy bronchopleural fistula was performed in a 60-year-old man, using a flap made by a combination of serratus anterior and latissimus dorsi muscle which had been divided during the pneumonectomy operation. The flap was prepared on the presence of a dependable collateral serratus anterior branch to the lateral thoracic artery, which provides retrograde flow to the latissimus dorsi muscle.

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

    PubMed

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

    2015-01-01

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

  7. [Spontaneous bilio-digestive fistula of lithiasic origin].

    PubMed

    Marzocca, G; Botta, G; Lorenzini, L

    1990-02-01

    Personal experience about 11 cases of spontaneous biliary enteric fistula caused by lithiasic disease operated in the General Surgical Clinic of the University of Siena from 1969 to 1988, is reported. The epidemiology, pathogenesis, symptomatology, indications for operation and various operating techniques performed are discussed. In the gallstone intestinal obstruction, the authors prefer to resolve immediately the obstruction, deferring to a later moment the specific operation for the treatment of the biliary enteric fistula and the lithiasic disease. PMID:2192306

  8. 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).

  9. Fistulas of the genitourinary tract: a radiologic review.

    PubMed

    Yu, Nam C; Raman, Steven S; Patel, Monica; Barbaric, Zoran

    2004-01-01

    Fistulas of the genitourinary tract have diverse anatomic locations, causes, and clinical features. They can involve the upper urinary tract (kidney, ureter), the lower urinary tract (bladder, urethra), or the female reproductive tract (vagina, uterus). Causes include infection, inflammatory disease, neoplasms, congenital conditions, trauma, and iatrogenic injury. Diagnosis of genitourinary tract fistulas usually requires radiologic studies performed with fluoroscopic or cross-sectional modalities. Fistulography is the most direct means of visualizing a fistula and should be considered when feasible (eg, cutaneous fistulas). Intravenous urography and pyelography or ureterography are mainstays of investigation of the upper tract. Likewise, voiding cystourethrography and urethrography are central to study of the lower tract. Cross-sectional techniques, in particular computed tomography, are increasingly useful for diagnosis and are considered the primary test in some cases. Radiologists should be familiar with the radiologic features of genitourinary tract fistulas for accurate diagnosis and treatment planning. Management approaches depend on the type of fistula, the degree of morbidity, and the overall functional status of the patient and vary from conservative observation to aggressive surgical repair. PMID:15371612

  10. A two-layer closure of sino-orbital fistula.

    PubMed

    Tse, D T; Bumsted, R M

    1989-11-01

    A two-layer closure of sino-orbital fistulae using tension-free local flaps is described. For small fistulae, the opening is first closed with a mucosal turnover flap; this is combined on the orbital surface with a local rotational advancement flap of the orbital skin. For larger fistulae where a mucosal turnover flap cannot be fashioned, a two-stage, delayed, composite mucocutaneous rotational flap is used. The advantages of these techniques are: (1) a mucous membrane to provide nasal or sinus lining, insulating the raw ventral surface of the skin flap; (2) each flap has an independent blood supply; (3) local flaps are used, avoiding the use of a pedicle flap from forehead; (4) excellent cosmesis since tissues outside the orbital rim are not disturbed; and (5) does not require refitting of exenteration prosthesis since the integrity of the orbital rim is maintained. The authors have used these techniques in six patients with chronic sino-orbital fistulae of the exenterated socket. In one patient, a wound dehiscence occurred and a small fistula measuring 3 to 4 mm in diameter persisted. The fistulae of the remaining five patients were successfully closed.

  11. Congenital nasolacrimal duct fistula in Brown Swiss cattle

    PubMed Central

    2014-01-01

    Background An increased incidence of nasolacrimal duct fistula in the offspring of dam J and three of her sons (bulls A, B and C) prompted a study to investigate the prevalence and clinical manifestation of this anomaly. The dam J, bull B, 255 direct offspring of bulls A, B, and C and eight other direct and indirect offspring of cow J were examined. The periocular region of each animal was examined for unilateral or bilateral nasolacrimal duct fistula and the location, appearance and size of the lesions. Results Of 265 cattle examined, 54 had unilateral (n = 24) or bilateral fistula (n = 30). The prevalence of affected offspring differed significantly among the three bulls. The fistulae were located medial to the medial canthus of the eye and were 1 to 10 mm (median, 1 mm) in height and 1 to 12 mm (median, 2 mm) in length. The shape of the opening was circular in 58, oval in 23 and slit-like in three. One other animal had a large opening with an atypical shape and another had an abnormal medial canthus with several fistulous openings. Seventy openings were pigmented and 52 were hairless. The fistulae were clinically significant in 12 animals. Conclusions The findings suggest a hereditary cause of nasolacrimal duct fistula in Brown Swiss cattle. PMID:24548799

  12. 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

  13. Repair of a vesico-vaginal fistula with amniotic membrane – Step 1 of the IDEAL recommendations of surgical innovation

    PubMed Central

    Gerullis, Holger; Ecke, Thorsten; Varga, Gabriella; Boros, Mihaly; Pintelon, Isabel; Timmermans, Jean-Pierre; Winter, Alexander; Bagner, Jens-Willem; Otto, Thomas

    2015-01-01

    Introduction Complex vesico-vaginal fistula (VVF) has a high recurrence rate and so the repair with graft tissues seems to be favorable. Amniotic membrane (AM) plays an increasing role as a scaffold for the repair of defect tissue due to its unique biological properties with regard to promoting wound healing. Material and methods An innovative surgical procedure for AM-assisted repair of a complex vesico-vaginal fistula as the Idea Stage following the IDEAL recommendations is presented. The development of amnion preparation and the involved surgical steps are described. Results We are able to report a successful repair of VVF by abdominal approach with an amniotic membrane graft. Good functional results, no adverse events and no graft rejection have been detected. Conclusions Favorable results confirm the technical simplicity, safety and efficacy of this procedure. Following the IDEAL recommendations, consecutive animal experiments and a cohort study are in progress. PMID:26855802

  14. [Spontaneous right primary iliac arteriovenous fistula and an unrecognized aorto-caval fistula located above an aneurysm].

    PubMed

    Van de Berg, L; Jambor, G Y; Delhez, J M

    1979-01-01

    A patient admitted for treatment of an aorto-iliac aneurism presented himself with swelling of the lower extremities and a low grade bruit over the abdomen continuous throughout systole and diastole. Aortography demonstrated the presence of a suspected ilio-caval fistula. Surgical treatment consisted of closure of the fistula and vascular replacement with an appropriate aorto-bifemoral prosthesis. Large statistics report an incidence of aortocaval fistula up to 4% in association with rupturing aortic aneurisms. The grave clinical signs and aortography confirm the diagnosis. Some of those may obstruct themselves spontaneously only to reopen at the time of operation as in the case reported. The greatest peroperatory problems with closure of those fistulae are pulmonary emboli by air and aneurismal contents. In our first case a temporary caval clip was placed as a part in the management of the lesion. PMID:525160

  15. Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies

    PubMed Central

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

    2014-01-01

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

  16. 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

  17. Congenital and acquired perilymph fistula: review of the literature.

    PubMed

    Roman, S; Bourliere-Najean, B; Triglia, J M

    1998-08-01

    Perilymph fistula is caused by an abnormal communication between the perilymph space and the middle ear. The etiology is either congenital or acquired. The congenital fistula can be associated or not with clinical symptoms or radiologically detectable abnormalities of the temporal bone. In patients presenting congenital fistula without symptoms or radiologically detectable abnormalities, little malformations of the middle ear may be detected during surgery. The acquired fistula can be caused by iatrogenic trauma, physical injury or erosion. As far as therapy is concerned, surgical treatment can be performed and the perilymph fistula thus represents one of the few causes of sensorineural hearing loss that can be treated surgically. However, the main challenge is the identification of those patients that need to undergo an exploratory tympanotomy, since there are no clinical-audiologic symptoms or radiographic indicators that can be considered pathognomonic of perilymph fistula. The aim of this review of the literature is to define the guidelines for preoperative diagnosis to indicate exploratory tympanotomy both in children and in adults. On the basis of our results, exploratory tympanotomy should be performed in patients with vertigo and/or progressive, sudden or fluctuating hearing loss in association with one or more than one of the following elements: a history of cranial trauma, radiographically detectable abnormalities of the inner ear, congenital malformations of the head, recurring meningitis, positive fistula test. The surgical treatment consists in placing a graft of temporalis fascia or tragal perichondrium and it usually results in a significant improvement of vestibular symptoms and sometimes of the hearing function as well.

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

    PubMed

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

    2001-03-01

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

  19. The aetiology, histopathology, and ultrastructural features of perianal erythema (red anus syndrome) in the European eel (Anguilla anguilla).

    PubMed

    Tamam, Omar A S

    2014-01-01

    The European eel (Anguilla anguilla) is a critically endangered species. Red anus syndrome (RAS) is known to be associated with parasitic infections of the eel, particularly with Anguillicola crassus, but the full range of causative pathogenic organisms has not been systematically investigated. Here we examined the infective organisms and histopathological and ultrastructural features of seventy eels with RAS. In total, nine different pathogens were detected in association with RAS: Pseudomonas aeruginosa were present in twelve specimens (17%), the metacercaria of Euclinostromum heterostomum in three cases (4%), Gastrostome (Bucephalidae family) in seven cases (10%), A. crassus in forty-five cases (64%), Bothriocephalus in seventeen cases (24%), and Proteocephalus in twenty-three cases (32%). Yeast, amoeba, and myxobolus-like pathogens were seen in the anal skin in all cases when examined in combination with electron microscopy. Histopathologically, the lesions appeared as anoproctitis of varying severity from mild anusitis to severe haemorrhagic anoproctitis, with severe perianal oedema, haemorrhage, and proctoptosis. Gut inflammation ranged from mild catarrhal enteritis to severe haemorrhagic enteritis with mucosal sloughing. RAS is associated with a range of parasitic infections, not only A. crassus, some of which we describe here for the first time. Since RAS is not associated with direct invasion by parasites, it is likely that RAS is a secondary phenomenon caused by superadded infection on a background of generalised immunosuppression, or indirect local toxic effects. RAS may be used as a non-invasive indicator of underlying parasitic infection, but further investigations are required to establish the causative organisms for effective fishery management.

  20. The Aetiology, Histopathology, and Ultrastructural Features of Perianal Erythema (Red Anus Syndrome) in the European Eel (Anguilla anguilla)

    PubMed Central

    Tamam, Omar A. S.

    2014-01-01

    The European eel (Anguilla anguilla) is a critically endangered species. Red anus syndrome (RAS) is known to be associated with parasitic infections of the eel, particularly with Anguillicola crassus, but the full range of causative pathogenic organisms has not been systematically investigated. Here we examined the infective organisms and histopathological and ultrastructural features of seventy eels with RAS. In total, nine different pathogens were detected in association with RAS: Pseudomonas aeruginosa were present in twelve specimens (17%), the metacercaria of Euclinostromum heterostomum in three cases (4%), Gastrostome (Bucephalidae family) in seven cases (10%), A. crassus in forty-five cases (64%), Bothriocephalus in seventeen cases (24%), and Proteocephalus in twenty-three cases (32%). Yeast, amoeba, and myxobolus-like pathogens were seen in the anal skin in all cases when examined in combination with electron microscopy. Histopathologically, the lesions appeared as anoproctitis of varying severity from mild anusitis to severe haemorrhagic anoproctitis, with severe perianal oedema, haemorrhage, and proctoptosis. Gut inflammation ranged from mild catarrhal enteritis to severe haemorrhagic enteritis with mucosal sloughing. RAS is associated with a range of parasitic infections, not only A. crassus, some of which we describe here for the first time. Since RAS is not associated with direct invasion by parasites, it is likely that RAS is a secondary phenomenon caused by superadded infection on a background of generalised immunosuppression, or indirect local toxic effects. RAS may be used as a non-invasive indicator of underlying parasitic infection, but further investigations are required to establish the causative organisms for effective fishery management. PMID:24608418

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

    PubMed

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

    2002-01-01

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

  2. 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.

  3. [Colo-uterine fistula, a complication of sigma diverticulitis].

    PubMed

    Nistri, R; Basili, G; Vitali, A; Carrieri, P; Nardi, S

    1998-10-01

    The colo-uterine fistula is a rare complication of diverticular disease of the colon; the literature review has shown only few well studied cases. The fistula, among the complications of the sigma diverticulitis, is 20% of the observed cases; generally, the bladder is the most involved organ, but also the skin or gut can be interested. If we consider the aetiology of the colo=uterine fistula of the observed case, the presence of the sigma locked stenosis with an endocolic pressure increase, associated with a peridiverticulitis condition, seems to have a relevant rule. The clinical symptomatology is represented by vague abdominal pain localized in particular in the left iliac cavity and by emission of blood, purulent material and stools from the vagina. The diagnosis of colo-uterine fistula is not easily reached: barium enema, Fallopian tube endoscopy and colon endoscopy not always allow to visualize in a right manner the fistula and only the oral administration of non-absorbable substances to be searched in the vaginal tampon, clear each doubt. Regarding the therapy to be carried out, we think that, colic resection en bloc with the uterus is the treatment of choice, while, in emergency, the Hartman operation is the most suitable to avoid the beginning of septic complications.

  4. Need for a global obstetric fistula training strategy.

    PubMed

    Rushwan, Hamid; Khaddaj, Sinan; Knight, Louise; Scott, Rachel

    2012-10-01

    Obstetric fistula is a complication of childbirth that often follows obstructed labor and is almost exclusive to low-resource countries. The original Global Burden of Disease Study (GBD 1990 Study) reported an incidence of 8.68 per 100000 and a prevalence of 51.35 per 100,000 for women aged 15-44 years in low-resource regions. The most cited global prevalence estimate is 2 million women. Although the global burden of obstetric fistula remains unclear, the number of women suffering from the condition is increasing, while surgical treatment remains limited. There are few experienced fistula surgeons and past surgical training approaches have been inconsistent. The Global Competency-Based Fistula Surgery Training Manual developed by FIGO and partners contains a set curriculum and, to ensure its implementation, a global strategy and training program have been developed. This paper describes key elements of the training program and its implementation. The anticipated impact of the training program is a reduction in global morbidity caused by obstetric fistula.

  5. 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.

  6. [Acquierd entero-cutaneous fistulas--diagnostic and therapeutic approach].

    PubMed

    Draganov, K; Dimitrova, V; Ionkov, A; Rusenov, D; Tosheva, E; Dimitrov, K; Tonev, S

    2005-01-01

    The acquired entero-cutaneous fistulas are a current problem in the field of abdominal surgery. Most of them are postoperative--after an intestinal resection and/or anastomosis. Crohn's disease and coplicated colonic diverticulosis rank second as causal factors. The risk factors for the development of an entero-cutaneous fistula and for the poor prognosis at the same time are the next: (1) Most of the patients suffer of severe main and co-exhisting diseases; (2) The presence of previous laparotomies, radion and chemotherapy, significant disturbances in the base-acid and water-electrolyte balance; (3) The fistula itself worsens these disturbances and may doom to fail the substitutional and nutritional therapy. The diagnostics of a fistula, including its location is comparatively easy. The surgical treatment plays an important role in the therapeutic scheme, especially in cases of high-output fistulas of the small intestin. At the same time the adequate total parenteral nutrition and correction of the base-acid and water-electrolyte disbalance is also very important. Recently there are some new diagnostic methods and alternatives of the basic surgical procedures, some of them quite contraversial.

  7. Urethroscrotal Fistula: A Rare Cause of Scrotal Swelling

    PubMed Central

    Parlak, Selcuk; Okay, Aysun E.

    2016-01-01

    Summary Background Urethroscrotal fistula (USF) is an abnormal communication between the urethra and the scrotum. This rare abnormality may be iatrogenic or secondary to perforation of the urethra by a stone. After the passage of urine to the scrotum through the fistula, painless scrotal swelling develops, which disappears completely with manual compression, and voiding can be maintained in this way. Retrograde urethrography (RU) and voiding cystourethrography (VCU) are traditional diagnostic methods, but they have limitations, such as technical difficulties and inability to evaluate the surrounding tissues. Multidetector CT (MDCT), together with reformatted images, can provide valuable information about the surrounding tissues and associated pathologies. Case Report We present a case of a 36-year-old male patient who had painless scrotal swelling after cystolithotomy and urethral stone surgery. The patient indicated that the swelling disappeared after manual compression. A fistula between the bulbous urethra and the scrotum was discovered by MDCT. In our case, we believe that the fistula developed iatrogenically during stone excision or secondary to perforation of the urethra by a stone. Conclusions As a rare pathology, urethroscrotal fistula should be considered in men with a history of urethral stone surgery and symptoms, including painless scrotal swelling, which can be manually compressed after voiding.

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

    PubMed

    Morgan, Mark A

    2007-06-01

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

  9. Urethroscrotal Fistula: A Rare Cause of Scrotal Swelling

    PubMed Central

    Parlak, Selcuk; Okay, Aysun E.

    2016-01-01

    Summary Background Urethroscrotal fistula (USF) is an abnormal communication between the urethra and the scrotum. This rare abnormality may be iatrogenic or secondary to perforation of the urethra by a stone. After the passage of urine to the scrotum through the fistula, painless scrotal swelling develops, which disappears completely with manual compression, and voiding can be maintained in this way. Retrograde urethrography (RU) and voiding cystourethrography (VCU) are traditional diagnostic methods, but they have limitations, such as technical difficulties and inability to evaluate the surrounding tissues. Multidetector CT (MDCT), together with reformatted images, can provide valuable information about the surrounding tissues and associated pathologies. Case Report We present a case of a 36-year-old male patient who had painless scrotal swelling after cystolithotomy and urethral stone surgery. The patient indicated that the swelling disappeared after manual compression. A fistula between the bulbous urethra and the scrotum was discovered by MDCT. In our case, we believe that the fistula developed iatrogenically during stone excision or secondary to perforation of the urethra by a stone. Conclusions As a rare pathology, urethroscrotal fistula should be considered in men with a history of urethral stone surgery and symptoms, including painless scrotal swelling, which can be manually compressed after voiding. PMID:27668028

  10. 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

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

    PubMed

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

    2010-12-01

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

  12. [The treatment of external biliary fistulae by means of lavage and continuous aspiration].

    PubMed

    Katergiannakis, V; Manouras, A; Xepapadakis, G; Pierrakakis, S; Papadopoulou, A; Karkanias, G; Apostolidis, N

    1990-10-15

    In 99% of cases external biliary fistulas are caused by liver and biliary tract surgery. The paper describes a new continuous aspiration of the fistula. This method was used to treat 18 patients and full closure of the fistula was achieved in 15 out of 18 patients.

  13. Coronary artery to left atrium fistula requiring revascularisation: case report and literature review.

    PubMed Central

    Swank, M; Koepke, D E

    1982-01-01

    Only 12 cases of coronary artery to left atrium fistula have been reported, with successful correction in at least seven. We describe a unique case of repair of a left main coronary artery to left atrium fistula using revascularisation with general discussion of the embryology, pathophysiology, complications, and diagnosis of these fistulae, indications for operation, and guidelines for surgical management. Images PMID:7112475

  14. Successful operation on a coronary arteriovenous fistula in a 74 year old woman.

    PubMed Central

    Brack, M J; Hubner, P J; Firmin, R K

    1991-01-01

    Coronary arteriovenous fistulas are rare and are usually diagnosed in children or young adults. Most are believed to be congenital. A right coronary arteriovenous fistula was first diagnosed in a patient of 74. Despite her age the fistula was successfully operated on and her symptoms were relieved. Images PMID:1867943

  15. Laparoscopic treatment of colovesical fistulas: technique and review of the literature.

    PubMed

    Tsivian, Alexander; Kyzer, Shlomo; Shtricker, Avraham; Benjamin, Shalva; Sidi, Abraham Ami

    2006-05-01

    Colovesical fistula is an uncommon complication of diverticulitis. We present our technique of a laparoscopic approach for treatment of vesicosigmoid fistulas and review the available published literature. We believe that a laparoscopic approach is a feasible and advantageous alternative for the treatment of colovesical fistulas, with low morbidity and short hospital stay. PMID:16771754

  16. 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.

  17. 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

  18. 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

  19. 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

  20. Embryological Consideration of Dural Arteriovenous Fistulas.

    PubMed

    Tanaka, Michihiro

    2016-09-15

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falco-tentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  1. 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

  2. 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

  3. Embryological Consideration of Dural Arteriovenous Fistulas

    PubMed Central

    TANAKA, Michihiro

    2016-01-01

    The topographical distribution of dural arteriovenous fistulas (DAVFs) was analyzed based on the embryological anatomy of the dural membrane. Sixty-six consecutive cases of intracranial and spinal DAVFs were analyzed based on the angiography, and each shunt point was identified according to the embryological bony structures. The area of dural membranes was categorized into three different groups: a ventral group located on the endochondral bone (VE group), a dorsal group located on the membranous bone (DM group) and a falcotentorial group (FT group) located in the falx cerebri, tentorium cerebelli, falx cerebelli, and diaphragm sellae. The FT group was designated when the dural membrane was formed only with the dura propria (meningeal layer of the dura mater) and not from the endosteal dura. Cavernous sinus, sigmoid sinus, and anterior condylar confluence was categorized to VE group, which had a female predominance, more benign clinical presentations, and a lower rate of cortical and spinal venous reflux. Transverse sinus, confluence, and superior sagittal sinus belonged to the DM group. Olfactory groove, falx, tent of the cerebellum, and nerve sleeve of spinal cord were categorized to the FT group, which presented later in life and which had a male predominance, more aggressive clinical presentations, and significant cortical and spinal venous reflux. The DAVFs was associated with the layers of the dural membrane characterized by the two different embryological bony structures. The FT group was formed only with the dura propria as an independent risk factor for aggressive clinical course and hemorrhage of DAVFs. PMID:27250699

  4. 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

  5. Lingual Artery-Retromandibular Vein Fistula Four Years after an Uncomplicated Carotid Endarterectomy: Case Report and Review of Possible Etiologies and Treatment Options

    PubMed Central

    Manjila, Sunil; Kumar, Kunal; Kulhari, Ashish; Singh, Gagandeep; Jung, Richard S.; Tarr, Robert W.; Bambakidis, Nicholas C.

    2016-01-01

    The external carotid artery’s lingual branch to retromandibular venous fistula following a carotid endarterectomy has not been reported earlier in literature. We report a unique case of an 87-year-old man who had a right-sided carotid endarterectomy in 2009 and presented four years later with complaints of fullness and discomfort in the area of right parotid gland with associated pulsatile tinnitus. A computed tomography (CT) scan of the neck revealed a deep portion of the right parotid gland having abnormal aneurysmal dilatation of a vascular structure, which appeared to be an arteriovenous fistula between branches of right external carotid artery and the retromandibular vein. Conventional catheter angiogram showed a complex arteriovenous fistula seen with the right retromandibular vein receiving multiple small arterial feeders from the right external carotid artery via its lingual artery branch. Slight reflux was noted into the right pterygoid plexus, right maxillary, and right submental veins as well. Surgical treatment was deferred due to high risk of inadvertent facial nerve injury from extensive parotid dissection involved in the procedure. Transarterial embolization of five discrete arterial branches from the right external carotid artery supplying the fistula was performed using particles with resultant remarkable slowing of the venous drainage into the retromandibular vein. After the procedure, his tinnitus and ear fullness resolved completely. The presence of arteriovenous fistula after carotid endarterectomy is a rare yet serious complication and therefore should be diagnosed early and treated promptly. The article highlights the relevant literature on arteriovenous fistula formation in the setting of arterial patch, intraoperative shunting, and surgical-site infections. PMID:27403218

  6. Isolation, characterization, and evaluation of Cassia fistula Linn. seed and pulp polymer for pharmaceutical application

    PubMed Central

    Killedar, Suresh G; Nale, Ashwini B; more, Harinath N; Nadaf, Sameer J; Pawar, Anuja A; Tamboli, Umarfarukh S

    2014-01-01

    Introduction: Present work, is an effort toward exploring the potential of Cassia fistula Linn. seed gum as an extended release polymer and laxative. While, C. fistula pulp polymer has evaluated as suspending agent. Materials and Methods: For extended release application, total five batches (F1-F5) were prepared by varying the ratio of drug:polymer as 1:1, 1:2, 1:3, 1:4, and 1:5, respectively. The granules were prepared by wet granulation method and further evaluated for micromeritic properties such as angle of repose (θ), Carr's compressibility index (CCI), and Hausner's ratio. Further compacts were evaluated by hardness, thickness, swelling index, in-vitro dissolution, and so on. Laxative activity was evaluated by administration of seed polymer (100 mg/kg) alone or in combination with bisacodyl (2.5 mg/kg) in 1% Tween 80. Zinc oxide suspension was prepared by varying the concentration of C. fistula pulp polymer and compared with suspension made by use of tragacanth, sodium carboxymethyl cellulose and bentonite. Results: Result showed that granules were free flowing, while the compact extended the drug release up to 10 h (72.84 ± 0.98; batch F5) and followed Higuchi matrix release kinetics. This extended release might be due to the formation of polyelectrolyte complex because of gluco-mannose in seed gum. Result of in-vivo laxative activity showed that seed polymer reduced faeces weight after 24 h compared to control (P < 0.01). Conclusions: Pulp polymer showed good sedimentation volume, but alone fails to stabilize the suspension for a longer period, so it could be useful in combination with other suspending agents and can be useful as novel excipient. PMID:25426443

  7. 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.

  8. [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

  9. Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy

    SciTech Connect

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

    1999-01-15

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

  10. 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

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. Endovascular management of superior mesenteric artery pseudoaneurysm and fistula.

    PubMed

    Narayanan, Govindarajan; Mohin, Geetika; Barbery, Katuska; Lamus, Daniel; Nanavati, Kunal; Yrizarry, Jose M

    2008-01-01

    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.

  16. Successful therapy of brachiocephalic arteriogastric fistula after esophagectomy.

    PubMed

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

    2011-10-01

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

  17. A Nasogastric Tube Inserted into the Gastrocutaneous Fistula

    PubMed Central

    Kim, Yang Soo; Kim, Joon Sung; Yu, In Hee; Jeong, Ji Young; Jung, Sung Hee; Jo, Yil Ryun

    2011-01-01

    We reported a case in which a nasogastric tube was inserted into the gastrocutaneous fistula, diagnosed by abdominal computed tomography. A 78-year-old man with a history of recurrent cerebral hemorrhage had a percutaneous endoscopic gastrostomy tube due to dysphagia for 2 years. However, soft tissue infection at the gastrostomy site caused the removal of the tube. Immediately, antibiotic agents were infused. For appropriate hydration and medication, a nasogastric tube was inserted. However, there was no significant improvement of the soft tissue infection. Moreover, the amount of bloody exudate increased. Abdominal computed tomography revealed the nasogastric tube placed under the patient's skin via gastrocutaneous fistula. The nasogastric tube was removed, and an antibiotic agents were maintained. After 3 weeks, the signs of infection fully improved, and percutaneous endoscopic gastrostomy was performed again. This case shows necessities of an appropriate interval between removal of the gastrostomy tube and insertion of a nasogastric tube, and suspicion of existence of gastrocutaneous fistula. PMID:22506228

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

    PubMed

    Valente, Michael A; Hull, Tracy L

    2014-11-15

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

  19. Arterio venous fistula experience at a tertiary care hospital in Pakistan

    PubMed Central

    nawaz, Shah; Ali, Shahzad; Shahzad, Iqbal; Baloch, M.Umar

    2013-01-01

    Objective: To evaluate the two year patency rate of functioning arteriovenous fistula. Methodology: This prospective case series study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, from 1st January 2009 to 31st December, 2010. Patients were chosen for CBRC arteriovenous fistula at wrist and patients undergoing other types of vascular access or secondary fistula formation were excluded. Results:One hundred and eighty two patients underwent arteriovenous fistula formation. The mean ± SD age was 63 ± 13 years and there were 102 (56%) males and 80 (44%) females. 12.6% fistulae failed within first month without dialysis. The primary patency rate was 66.5% at three months and 57.7% at six months. Failing arteriovenous fistula was managed by new arteriovenous fistula in our series. 28.6% patients had redo arteriovenous fistula. This study demonstrated a poor outcome for fistulas in diabetic patients. Fifteen out of 23 (65.2%) who failed primarily were diabetics and out of these diabetics 13 (86.7%) failed in first three months. Infection and burst fistulae were found in nine (4.9%), pseudo aneurysm in 3.2%, fever 4.9%, peri-operative failure 0.55% and burst fistulae 3.2%. Conclusions: One-third of radiocephalic fistulas fail within two years. The outcome is worse for women and diabetic patients. This information may be useful in assessing and counseling patients with end-stage renal failure. Arteriovenous fistula is the better and ideal choice for haemodialysis. A Radiocephalic fistula in forearm seems to have better results as comparison to cubital fossa arteriovenous fistula. End to side anastomosis results are better than side to side anastomosis. PMID:24353531

  20. 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.

  1. A new technique of closing a gastroatmospheric fistula with a rectus abdominis muscle flap.

    PubMed

    Gupta, Rahul; Singh, Harjeet; Talukder, Shibojit; Verma, Ganga Ram

    2015-03-27

    Proximal enteroatmospheric fistulae are difficult to manage and carry high mortality from sepsis and electrolyte imbalances. Conservative management with total parenteral nutrition, exclusion of fistula, resection and anastomosis are conventional methods of treatment with low success rate. Providing muscle cover to manage an enteroatmospheric fistula is a noble concept. A postoperative high-output gastroatmospheric fistula (GAF) was repaired by superior epigastric artery-based rectus abdominis muscle flap (RAMF). Postoperative recovery was uneventful. This technique may be useful for closure of proximal enteroatmospheric fistulae that fail to heal through medical and conventional surgical management.

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

    PubMed

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

    2004-07-01

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

  3. A Rare Etiology of Heart Failure: Traumatic Arteriovenous Fistula Due to Stab Injury 17 Years Ago

    PubMed Central

    Hüseyin, Serhat; Yüksel, Volkan; Güçlü, Orkut; Yılmaztepe, Mustafa; Canbaz, Suat

    2015-01-01

    Background: Although traumatic fistula is frequently encountered, high-output heart failure due to fistula is a very rare condition. Despite an indefinitive history of trauma, arteriovenous (AV) fistula may develop insidiously, and therefore identification of a shunt is highly important for treatment. Case Report: Here we report a 46-year-old male patient with heart failure due to traumatic femoral arteriovenous fistula developed following a penetrating stab injury 17 years ago. Conclusion: Traumatic AV fistula is a curable cause of heart failure. Also, careful examination of the patient is as significant as radiological imaging methods. PMID:26185721

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

    PubMed

    Wall, L Lewis

    2014-12-01

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

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

    PubMed

    Wall, L Lewis

    2014-12-01

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

  6. 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.

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

    PubMed

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

    2014-07-01

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

  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. 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

  10. 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.

  11. Endoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas

    PubMed Central

    Haseeb, Abdul; Abu Dayyeh, Barham K.; Levy, Michael J.; Fujii, Larissa L.; Pearson, Randall K.; Chari, Suresh T.; Gleeson, Ferga C.; Peterson, Bret T.; Swaroop Vege, Santhi

    2016-01-01

    Pancreaticocutaneous fistulas (PCFs) may be refractory to medical therapy or endoscopic retrograde cholangopancreaticography. Four patients underwent endoscopic ultrasound-guided management of refractory PCFs, which were internalized by endoscopic ultrasound-guided transmural puncture of the pancreatic duct (n = 2), fistula tract (n = 1), or both (n = 1), with placement of transmural stents providing internal drainage to the stomach (n = 3) or duodenum (n = 1). Drainage from PCFs ceased in all patients, and all percutaneous drains were removed; internal stents were left in place indefinitely. Endoscopic ultrasound-guided interventions may successfully treat PCFs, allowing removal of percutaneous drains, and are an attractive alternative for patients who might otherwise require pancreatic resection.

  12. 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

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

    PubMed

    Mujo, Tomas; Priddy, Erin; Harris, John J; Poulos, Eric; Samman, Mahmoud

    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

  14. Concealed Left Ventricle to Right Atrium Fistula Complicating Infective Endocarditis.

    PubMed

    Onzuka, Tatsushi; Morishige, Shoji; Yamashita, Yoshiyuki; Ueno, Yasutaka

    2016-09-01

    We report a case of aortic prosthetic valve endocarditis presenting with subaortic stenosis without perivalvular leakage and vegetations in the left ventricular outflow and right atrium, the latter being attached to the atrioventricular septum. Intraoperatively, an abscess that had formed on the aortic annulus and perforated to the right atrium was unexpectedly found, the fistula being occluded by vegetations. Even when no left-to-right shunts are detected by imaging, vegetations adjacent to the atrioventricular septum may conceal a left ventricle-right atrium fistula, resulting in prosthetic valve endocarditis presenting clinically as subaortic stenosis without perivalvular leakage. PMID:27549556

  15. 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.

  16. 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

  17. Novel Mutation in PRKAR1A in Carney Complex.

    PubMed

    Park, Ko Un; Kim, Hyun-Sook; Lee, Seung Kwan; Jung, Woon-Won; Park, Yong-Koo

    2012-12-01

    A case of Carney complex in a Korean patient is presented. The patient had the characteristics of Carney complex including skin lesions, positive family history, and multiple myxomas including a superficial angiomyxoma in the perianal area. An extensive genetic analysis revealed a novel mutation in the protein kinase A type I-a regulatory subunit (PRKAR1A) gene, but not in the phosphodiesterase type 11A (PDE11A) gene. This is the first case wherein extensive genetic studies were performed in a patient with Carney complex in Korea. PMID:23323113

  18. Combined transarterial, transvenous, and direct puncture of the cavernous sinus to cure a traumatic carotid cavernous fistula.

    PubMed

    Lin, Chung-Jung; Luo, Chao-Bao; Chang, Feng-Chi; Teng, Michael Mu-Huo; Wang, Kao-Lun; Chu, Shu-Hsun

    2009-12-01

    Direct carotid cavernous fistulas (CCF) are generally well managed by simple endovascular treatment. We report an 8-year-old boy who required subsequent direct puncture of the cavernous sinus to completely obliterate the residual fistula after both transarterial and transvenous embolization had been performed. He presented with a mild right frontal headache, congestion of the right conjunctiva, blurred vision, and photophobia. Cerebral angiography demonstrated a right direct CCF. The patient underwent transarterial and transvenous embolization of the cavernous sinus (CS) with Gugliemi detached coils (GDCs), but a residual shunt persisted. Two days later, another session of embolization by direct puncture of the CS with GDCs was performed after failure to navigate through the superior ophthalmic vein which was partially occupied by previously deployed coils. Immediate control angiography showed complete obliteration of the fistula and the patient's symptoms rapidly resolved. This is the first report of a patient with a CCF who required three combined approaches - transarterial, transvenous, and direct puncture of the CS - to achieve complete closure of the complexed shunt.

  19. 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

  20. [Intraoperative fluid therapy in infants with congestive heart failure due to intracranial pial arteriovenous fistula].

    PubMed

    Arroyo-Fernández, F J; Calderón-Seoane, E; Rodríguez-Peña, F; Torres-Morera, L M

    2016-05-01

    Pial arteriovenous fistula is a rare intracranial congenital malformation (0.1-1: 100,000). It has a high blood flow between one or more pial arteries and drains into the venous circulation. It is usually diagnosed during the childhood by triggering an intracranial hypertension and/or congestive heart failure due to left-right systemic shunt. It is a rare malformation with a complex pathophysiology. The perioperative anaesthetic management is not well established. We present a 6-month-old infant diagnosed with pial arteriovenous fistula with hypertension and congestive heart failure due to left-right shunt. He required a craniotomy and clipping of vascular malformation. Anaesthetic considerations in patients with this condition are a great challenge. It must be performed by multidisciplinary teams with experience in paediatrics. The maintenance of blood volume during the intraoperative course is very important. Excessive fluid therapy can precipitate a congestive heart failure or intracranial hypertension, and a lower fluid therapy may cause a tissue hypoxia due to the bleeding.

  1. Aortocaval fistula: a rare cause of paradoxical pulmonary embolism.

    PubMed Central

    Bridger, J. E.

    1994-01-01

    An 83 year old woman died suddenly from a paradoxical pulmonary embolus which had originated in an abdominal aortic aneurysm and embolised via an aortocaval fistula. This lesion should be considered in the differential diagnosis of embolic disease. Images Figure 1 PMID:8170884

  2. 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.

  3. Gallbladder Papillomatosis and Cholecystocolonic Fistula: A Rare Combination

    PubMed Central

    Kuo, Jenn-Yuan; Jao, Yeun Tarl Fresner Ng

    2014-01-01

    Patient: Female, 81 Final Diagnosis: Gallbladder papillomatosis Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Biliary papillomatosis (BP) with sole involvement of the gall bladder or gall bladder papillomatosis (GBP) is very rare. Biliary-enteric fistula, particularly the cholecystocolonic fistula (CCF) type, is also very rare. The combination of both types of lesions in a single patient has never previously been reported in the English literature. Case Report: We report herein the case of an 81-year-old woman who was diagnosed with both disease entities, which occurred in a cause-and-effect relationship. She underwent resection of the gall bladder with closure of the fistula, and was discharged improved afterwards. Conclusions: GBP is a premalignant condition that warrants extensive resection. An absent Murphy’s sign or jaundice on physical examination should not rule out this disease or accompanying biliary tract infection because a biliary-enteric fistula may be present. Thorough review of the radiologic images should be performed, since subtle details could be easily missed or dismissed, thus affecting the postoperative course. A CCF should alert the physician that another disease entity is present. PMID:25351203

  4. 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

  5. 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.

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

    PubMed

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

    2007-01-21

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

  7. Cerebrospinal fluid fistula as a consequence of war head injury.

    PubMed

    Melada, Ante; Marcikić, Marcel; Mrak, Goran; Stimac, Dinko; Sćap, Miroslav

    2002-08-01

    Cerebrospinal fluid (CSF) fistula as a consequence of brain missile injury and following infectious complications has been recognized for years. Different methods of treatment have been advocated. Missiles used in war cause extensive destruction of the skull and brain as a result of their high kinetic energy. On its transfer through the skull, such high kinetic energy causes fractures called "discontinuous fractures," which are distant from the entry wound and not related to the fracture of the vault. The role of the timely diagnosis of CSF fistulas and their early repair in the management of these wounds is emphasized. Data on 312 patients with missile injuries of the brain inflicted during the war in Croatia were retrieved and analyzed, with special reference to the complications of CSF fistulas and infection. Forty-five patients developed CSF fistula, 15 (33%) of them at the wound site, 23 (51%) as CSF rhinorrhea, and seven (15%) as CSF otorrhea. Six patients developed infectious complications. The presented strategy and operative approach resulted in a low incidence of infectious complications in the study series.

  8. Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization.

    PubMed

    Kim, Hyun-Jung; Yang, Ji-Ho; Lee, Hong-Jae; Lee, Hyung-Jin

    2015-09-01

    Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment. PMID:26539273

  9. 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…

  10. [The management of arteriovenous fistula for dialysis patients].

    PubMed

    Lopez, Teodoro; Casino, Francesco

    2014-01-01

    A well-functioning vascular access is a basic requirement for a good dialysis treatment. Among the vascular accesses, the Artero-venous fistula (FAV) with native vessels is preferred for increasing survival rate, reducing risk of infection and with fewer complications. This review examines some aspects concerning the preparation and the surveillance of AVF.

  11. 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.

  12. 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

  13. 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

  14. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula.

    PubMed

    Dixon, Bradley S; Novak, Lisa; Fangman, Jerry

    2002-01-01

    Achieving Dialysis Outcomes Quality Initiative guidelines for native arteriovenous fistulae using the radiocephalic forearm fistula (lower-arm fistula [LAF]) is difficult. This study reports results using the upper-arm native arteriovenous fistula (UAF). From a prospective access database (1992 to 1998), this study was based on 204 patients (322 accesses). Average patient age was 56 +/- 1 years, 63% were men, and 47% had diabetes. A native fistula was the first access in 73% of patients (36%, LAFs; 37%, UAFs) and accounted for 48% of subsequent accesses (13%, LAFs; 35%, UAFs). Younger men were more likely to receive an LAF, but there was no demographic difference between patients receiving a UAF or arteriovenous graft (AVG). Both primary unassisted and cumulative access patencies were significantly better for UAFs than either LAFs or AVGs. For first accesses, cumulative access patency rates at 1, 3, and 5 years were 71%, 57%, and 57% for UAFs; 54%, 46%, and 36% for LAFs; and 54%, 28%, and 0% for AVGs (P < 0.01). Despite shorter access survival, AVGs required more total access procedures than either UAFs or LAFs (procedures per access: 2.5, 1.0, and 0.6 for AVGs, UAFs, and LAFs, respectively). When used, catheters were required for dialysis for a longer time for UAFs (median catheter days, 36, 53, and 56 for AVGs, LAFs, and UAFs, respectively; P < 0.05). Access flow rates were greater in UAFs (1,247 mL/min; n = 48; P < 0.01) than AVGs (851 mL/min; n = 30) or LAFs (938 mL/min; n = 31). There was no evidence that UAFs were banded or ligated for steal syndromes or heart failure more often than AVGs or LAFs. These results show that the UAF is a good alternative to an AVG for achieving Dialysis Outcomes Quality Initiative guidelines.

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

    PubMed

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

    2006-11-01

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

  16. Arteriovenous fistula of the groin in a drug abuser with endocarditis.

    PubMed

    Jonasson, Solveig Aalstad; Jøssang, Dag Eirik; Haaverstad, Rune; Wendelbo, Øystein; Pedersen, Gustav

    2016-01-01

    Intravenous drug abusers commonly develop endocarditis due to injection of particulate matter that can cause endothelial damage to the valves. The frequent need to access the venous system can result in vascular traumas with potential complications including arteriovenous (AV) fistulas. Here, we present the case of an intravenous drug abuser with endocarditis and an unusually large AV fistula in the groin. The patient was successfully operated for endocarditis. However, the AV fistula was at the time not acknowledged. The combination of ileofemoral vein thrombosis and a large AV fistula led to pulmonary septic embolism and life-threating, right-sided heart failure. Computed tomography scan did not reveal the AV fistula, but suspicion was raised. Ultrasound diagnosed and revealed the magnitude of the AV fistula, and the patient was treated with a minimally invasive percutaneous technique. PMID:26829963

  17. Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy

    PubMed Central

    Katsanos, Konstantinos H; Christodoulou, Dimitrios K; Kamina, Sevasti; Maria, Kosmidou; Lambri, Evangelia; Theodorou, Stavroula; Tsampoulas, Konstantinos; Vasiliki, Mitsi; Tsianos, Epameinondas V

    2010-01-01

    Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to anus. Complications of heterotopic gastric mucosa include dysphagia, upper gastrointestinal bleeding, upper esophageal ring stricture, adenocarcinoma and fistula formation. In this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus. A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial fistula. Microscopic examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic mucosa. We decided to do a non-surgical therapeutic endoscopic procedure. A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results. PMID:21160729

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

    PubMed

    Magudapathi, Chandrakala; Manickam, Ramalingam; Thangavelu, Kavitha

    2015-06-01

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

  19. 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

  20. 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.

  1. 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.

  2. 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

  3. 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

  4. 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

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

    PubMed Central

    Bayhan, Gulsum Iclal; Metin, Ozge; Ardicli, Burak; Karaman, Ayse; Tanir, Gonul

    2015-01-01

    A fistula extending from the gluteus to penis is an extremely rare entity. In this paper, we have highlighted novel variant of congenital penile to gluteal fistula complicated with gluteal and penoscrotal abscess in a previously healthy boy. A fistulous tract extending from the gluteus to penis has been shown by fistulogram. Bleomycin has been used in fistula tract with successful results in our patient. PMID:25945276

  6. Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

    PubMed Central

    2013-01-01

    Background Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. Description The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. Conclusions Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis. PMID:24266908

  7. 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.

  8. 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

  9. 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

  10. 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

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

    PubMed

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

    2015-07-01

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

  12. Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report.

    PubMed

    Ou, Chang-Hsien; Wang, Hao-Kuang; Yang, Tzu-Hsien; Liang, Cheng-Loong; Wong, Ho-Fai

    2015-08-01

    The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism.

  13. Disturbed shear stress reduces Klf2 expression in arterial-venous fistulae in vivo

    PubMed Central

    Yamamoto, Kota; Protack, Clinton D; Kuwahara, Go; Tsuneki, Masayuki; Hashimoto, Takuya; Hall, Michael R; Assi, Roland; Brownson, Kirstyn E; Foster, Trenton R; Bai, Hualong; Wang, Mo; Madri, Joseph A; Dardik, Alan

    2015-01-01

    Laminar shear stress (SS) induces an antiproliferative and anti-inflammatory endothelial phenotype and increases Klf2 expression. We altered the diameter of an arteriovenous fistula (AVF) in the mouse model to determine whether increased fistula diameter produces disturbed SS in vivo and if acutely increased disturbed SS results in decreased Klf2 expression. The mouse aortocaval fistula model was performed with 22, 25, or 28 gauge needles to puncture the aorta and the inferior vena cava. Duplex ultrasound was used to examine the AVF and its arterial inflow and venous outflow, and SS was calculated. Arterial samples were examined with western blot, immunohistochemistry, and immunofluorescence analysis for proteins and qPCR for RNA. Mice with larger diameter fistulae had diminished survival but increased AVF patency. Increased SS magnitudes and range of frequencies were directly proportional to the needle diameter in the arterial limb proximal to the fistula but not in the venous limb distal to the fistula, with 22-gauge needles producing the most disturbed SS in vivo. Klf2 mRNA and protein expression was diminished in the artery proximal to the fistula in proportion to increasing SS. Increased fistula diameter produces increased SS magnitude and frequency, consistent with disturbed SS in vivo. Disturbed SS is associated with decreased mRNA and protein expression of Klf2. Disturbed SS and reduced Klf2 expression near the fistula are potential therapeutic targets to improve AVF maturation. PMID:25780089

  14. Portal vein thrombosis secondary to embolization of superior mesenteric arteriovenous fistula.

    PubMed

    Zhao, Yuliang; Li, Zhengyan; Zhang, Ling; Wei, Bo; Zeng, Xiaoxi; Fu, Ping

    2014-02-01

    Superior mesenteric arteriovenous fistula is a rare vascular disorder. Endovascular embolization has been widely used to treat this disease. Patients receiving successful fistula embolization generally have good prognoses. We present a man with iatrogenic superior mesenteric arteriovenous fistula who received endovascular embolization. Portal thrombus was detected on postoperative day 2, and the patient eventually died of multiple organ failure on postoperative day 13 despite having received antithrombotic and antiplatelet therapy. We identified portal thrombosis as a serious complication of transcatheter superior mesenteric arteriovenous fistula embolization.

  15. [Intracranial dural arteriovenous fistula draining into spinal cord veins: case report].

    PubMed

    Seda, Lauro Franco; Pieruccetti, Marco Antonio; Freitas, José Maria Modenesi; Listik, Sérgio; Pereira, Clemente Augusto Brito

    2002-09-01

    We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.

  16. 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

  17. [Myocardial ischemia secondary to a bilateral coronary fistula with drainage into the pulmonary artery trunk].

    PubMed

    Castelo, V; González-Juanatey, J R; Amaro, A; Iglesias, C; Rubio, J; Gil, M

    1994-07-01

    A case of bilateral coronary artery fistula into main pulmonary artery which courses with crisis of angina and subepicardial ischaemic changes in anterolateral leads is presented. The interest of the case reported is based on the peculiar anatomy of the fistula; there is only an unique collector to the pulmonary artery for both fistula and they present a completely different way of emerging: an unique vessel from the right coronary artery and several vessels from the anterior descending coronary artery. Ligation of the fistula was performed successfully and postoperative course was uneventful.

  18. Spino-renal fistula due to gunshot injury.

    PubMed

    Alsharef, M M; Christopher, N; Fourie, T

    2011-07-01

    A 22-year-old female patient was treated for spino-renal fistula as a result of a high-velocity gunshot injury to her abdomen. The patient presented with meningeal signs, a headache and right monoparesis. A CT scan of her abdomen revealed a leak of contrast from the right kidney into the perirenal space and tracking further into the thecal sac. An MRI scan showed a stable fracture of L3 with slight compression of the thecal sac and features of cord contusion caused by the shockwave of the bullet. To the best of our knowledge a spino-renal fistula of traumatic origin has not previously been reported in the English language literature.

  19. 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

  20. 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

  1. Gastropleural fistula: an unusual sequel of blunt chest trauma.

    PubMed

    Muzaffar, Muhammad Sultan; Umair, Bilal; Asghar, Asif; Ali, Mujahid Zulfiqar; Hanif, Muhammad Shoaib; Kamal, Daud

    2009-07-01

    In the October 2005 Earthquake in mountainous Azad Kashmir and adjacent areas in Pakistan, a young female sustained crush injury chest and upper abdomen. She remained hospitalized with lower chest pain. All initial investigations were normal and she was discharged symptom-free on conservative management. Six months later, she developed acute left sided chest pain and dyspnoea. Provisional diagnosis of empyema was made on X-ray, and tube thoracostomy was done. Diagnostic VATS revealed gastropleural fistula secondary to necrosis of herniated stomach. Resection of necrosed stomach, repair of diaphragm and decortication and transthoracic repair with lower thoracoplasty two months later was performed but both were unsuccessful. After another 02 months, a Roux-en-Y gastrojejunostomy at fistula site was fashioned which proved curative.

  2. 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

  3. 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.

  4. 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

  5. Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach.

    PubMed

    Farid, Farah Naz; Azhar, Maimoona; Samnani, Sunil Sadruddin; Allana, Saleema; Naz, Angeela; Bohar, Farzana; Shamim; Syed, Shershah

    2013-11-01

    Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition. PMID:24169399

  6. 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

  7. Multiple spinal arteriovenous fistulas: A case-based review.

    PubMed

    Avecillas-Chasín, Josue M; Brin, Juan R; Lopez-Ibor, Luis; Gomez, Gustavo; Rodriguez-Boto, Gregorio

    2015-12-01

    The occurrence of multiple spinal dural arteriovenous fistulas (AVFs) is rare. The majority of cases reported are synchronous and the lesions are mainly found at different spinal levels. Metachronous AVFs have been defined as lesions that manifest in a temporal sequence after treatment of a first AVF. In this report, we present two distinct cases of multiple spinal AVFs. Also, we review the main features of the cases previously reported, with emphasis on the proposed theories for the origin of multiple AVFs. In patients with failure to improve after treatment of a spinal DAVF, a whole-spine angiographic examination is mandatory, not only to ascertain the complete closure of the treated fistula, but also to look for a possible second lesion at a different spinal level. PMID:26355909

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. Bronchopleural fistula in a newborn undergoing ECMO-transbronchial closure.

    PubMed

    Saleemi, M S; McLaren, C; Sharma, B K; Muthialu, N; Roebuck, D; Ng, C

    2013-08-01

    Refractory pneumothoraces with bronchopleural fistula (BPF) pose a significant challenge in managing critically sick and ventilated neonates. We report a case of the term female neonate being treated with extracorporeal membrane oxygenation (ECMO) support for meconium aspiration and presumed sepsis, with a significant air leak refractory to pleural drainage that was managed using endobronchial application of cyanoacrylate (enbucrilate) glue to seal the leak. PMID:23897313

  16. Liver failure posthepatectomy and biliary fistula: multidisciplinar treatment.

    PubMed

    Calleja Kempin, Javier; Colón Rodríguez, Arturo; Machado Liendo, Pedro; Acevedo, Agustín; Martín Gil, Jorge; Sánchez Rodríguez, Teresa; Zorrilla Matilla, Laura

    2016-05-01

    The main cause of morbimor-mortality after major liver surgery is the development of liver failure posthepatectomy(LFPH). Treatment must involve multiple options and will be aggressive from the beginning. We report a case of a patient with cholangiocarcinoma perihilar treated with surgery: right hepatectomy extended to sI + IVb with develop of LFPH and biliary fistula and being management successfully in a multidisciplinary way.

  17. 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.

  18. 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.

  19. Cholecystocolonic fistula: malabsorptive consequences of lost bile acids.

    PubMed

    Benage, D; O'Connor, K W

    1990-04-01

    A patient with the painless onset of a cholecystocolonic fistula associated with virtually complete common bile duct obstruction due to stones provided a unique opportunity to assess the consequences of prolonged bile acid depletion on the digestion and absorption of nutrients. Over 2 years, the patient insidiously developed steatorrhea, osteomalacia with an atraumatic pelvic fracture, and congestive heart failure complicated by polymorphic ventricular tachycardia (torsade de pointes) all of which could be attributed to malabsorption of fat and fat-soluble vitamins.

  20. 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

  1. Dural arteriovenous fistula involving the anterior condylar canal.

    PubMed

    Cyril, Chivot; Ofélia, Marabotto; Hervé, Deramond

    2013-07-01

    Dural arteriovenous fistula (DAVF) of the anterior condylar canal is a rare subgroup of posterior fossa DAVF. Successful treatment of this DAVF requires an accurate image diagnosis and the knowledge of the anatomy of the anterior condylar confluent. We present the imaging features of angiography and MR angiography of a 54-year-old man, who presented progressive right synchronous tinnitus due to a DAVF of the anterior condylar confluent, successfully treated by transvenous embolization. PMID:22607489

  2. 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

  3. Endoscopic therapies for leaks and fistulas after bariatric surgery.

    PubMed

    Bhayani, Neil H; Swanström, Lee L

    2014-02-01

    Bariatric surgery is the most effective treatment for the medical comorbidities associated with morbid obesity. Though uncommon, staple line or anastomotic leaks after bariatric surgery are highly morbid events and challenging to treat. In selected patients without severe sepsis or distant pollution, endoscopic transluminal peritoneal drainage may provide source control. For leaks within 3 days of surgery, endoscopic stenting does not appear to speed closure but does permit oral nutrition. In uncomplicated situations, the risk of migration and resulting complications of enteric stents appear to overshadow the benefits. Initial treatment failures and leaks presenting more than 48 hours after surgery respond to enteric diversion by endoscopic stenting. Occlusion of the leak by injection of fibrin glue also shows promise; however, these case series are limited to a small number of patients. Endoclips may work best to occlude leaks and close fistulas if the epithelium is debrided. As suturing technology improves, direct internal closure of fistulas may prove feasible. Therapeutic endoscopy offers several technologies that can assist in the closure of early leaks and that are essential to the treatment of late leaks and fistulas after bariatric surgery.

  4. 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

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

    PubMed

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

    2006-01-01

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

  6. A stitch in time: an unusual cause of enterovesical fistula

    PubMed Central

    O'Callaghan, John Matthew; Boyd, Jason Timothy; Singh, Anjana

    2014-01-01

    A 64-year-old woman with a history of a Stamey procedure for stress incontinence 20 years previously, underwent a diagnostic flexible cystoscopy to investigate recurrent urinary sepsis. Cystoscopic examination demonstrated a large vesicular calculus. When traction was applied to the calculus it was shown to be attached to a 10 cm length of non-absorbable suture material. The suture was attached to two further calculi, apparently originating from outside the bladder wall. All visible calculi and the suture were removed. In the following weeks the patient reported passage of air and faeculent material per-urethra. A repeat cystoscopy revealed an opening in the posterolateral bladder wall and CT confirmed the presence of an enterovesical fistula. Laparoscopy demonstrated a fistula between the terminal ileum and bladder wall. A further 10 cm length of non-absorbable suture material was removed from the terminal ileum and omentum. Laparoscopic repair of the fistula was performed successfully and the patient has remained symptom free following the procedure. PMID:25239995

  7. 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

  8. 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

  9. 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

  10. [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.

  11. 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

  12. [Antegrade flow in the aorta ascendens despite aortic atresia: 2 case reports with retrograde coronary perfusion through coronary fistulas and sinusoids].

    PubMed

    Jux, C; Kaulitz, R; von Wasielewski, R; Peuster, M; Fink, C; Paul, T; Hausdorf, G

    2000-06-01

    In aortic atresia, coronary perfusion normally occurs through retrograde blood flow in the ascending aorta. We report on two patients with antegrade flow in the ascending aorta despite aortic atresia. In one patient with hypoplastic left heart syndrome (aortic atresia, severe mitral stenosis), an intact interatrial septum/premature closure of the foramen ovale was found. While no other way of left atrial or ventricular decompression was found, echocardiography, angiography and the post-mortem examination showed left ventricular to coronary sinusoids as the sole pathway for systemic oxygenation. In a second patient with complex congenital heart disease, including aortic atresia, antegrade flow in the ascending aorta was through a left coronary fistula with shunt flow originating from the pulmonary trunk. This report describes systemic perfusion depending on retrograde coronary flow due to coronary-cameral (sinusoids) and coronary arterio-venous fistulas leading to the phenomenon of antegrade blood flow in the ascending aorta despite aortic atresia. PMID:10929434

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

    PubMed

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

    2013-08-01

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

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

    PubMed Central

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

    2016-01-01

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

  15. 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

  16. 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.

  17. Pseudoaneurysm with Arteriovenous Fistula after Arthroscopic Procedure: A Rare Complication of Arthroscopy.

    PubMed

    Jin, Moran; Lee, Yang-Haeng; Yoon, Young Chul; Han, Il-Yong; Park, Kyung-Taek; Wi, Jin Hong

    2015-08-01

    Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. Aortoesophageal Fistula in a Child With Undiagnosed Vascular Ring: Life-Threatening or Lethal?

    PubMed

    Clarke, Nicholas S; Murthy, Raghav; Hernandez, Jennifer; Megison, Steve; Guleserian, Kristine J

    2016-10-01

    Exsanguinating hematemesis secondary to an aortoesophageal fistula from an impacted foreign body occurred in a patient with a vascular ring. This report describes successful resuscitation and repair in a 6-year-old boy who was transferred from an outside hospital in extremis with an aortoesophageal fistula from a foreign body in the presence of a vascular ring. PMID:27645973

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

    PubMed

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

    2014-01-01

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

  4. Pseudoaneurysm with Arteriovenous Fistula after Arthroscopic Procedure: A Rare Complication of Arthroscopy

    PubMed Central

    Jin, Moran; Lee, Yang-Haeng; Yoon, Young Chul; Han, Il-Yong; Park, Kyung-Taek; Wi, Jin Hong

    2015-01-01

    Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously. PMID:26290846

  5. 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

  6. 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

  7. 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.

  8. 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.

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

    PubMed Central

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

    2014-01-01

    Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula. PMID:25187726

  10. Videothoracoscopic management of middle esophageal diverticulum with secondary bronchoesophageal fistula: report of a case.

    PubMed

    Braghetto, Italo; Cardemil, Gonzalo; Schwartz, Eitan; Valladares, Hector; Rencoret, Guillermo; Estay, Rene; Rodriguez-Navarro, Alberto J

    2008-01-01

    Middle esophageal diverticulum is rare, but can result in bronchoesophageal fistula. Previous reports have described open surgical techniques to treat esophageal diverticula, but few have evaluated the effectiveness of a videothoracoscopy approach. We report a case of middle esophageal diverticulum associated with bronchoesophageal fistula, managed successfully with videothoracoscopy. We also review the relevant literature.

  11. [Differential diagnosis of postoperative fistulas of the urinary tract (author's transl)].

    PubMed

    Zimmermann, A; Siewert, R; Stuhler, T

    1979-01-01

    A case is demonstrated in which an indwelling intravenous catheter was pushed by mistake via V. subclavia and the right heart into the V. cava inf. There the catheter perforated the wall of the V. cava. The continued infusion induced a cystic retroperitoneal tumor. The puncture of this tumor was followed by a fistula that was misinterpreted as a fistula of the urinary tract.

  12. Appendico-cutaneous fistula 20 years after groin hernia repair with a polypropylene plug

    PubMed Central

    Wijers, Olivier; Conijn, Anne; Wiese, Hans; Sjer, Mike

    2013-01-01

    The formation of an appendico-cutaneous fistula is rare. Few case reports have been published; most describe the formation of a fistula after appendicitis. Here we describe the case of a 79-year-old woman presenting with an appendico-cutaneous fistula after groin hernia repair. She was referred to our outpatient department with a painful mass in the right groin. An ultrasound showed a fluid containing mass. Incision and drainage was performed. After 9 weeks she was referred again with a persisting open wound. Fistulogram and CT scan showed a fistuleous tract involving the appendix. Wound culture showed Escherichia coli. Diagnostic laparoscopy showed an appendix stuck to the ventral wall of the abdomen without any sign of previous infection. After an appendectomy, pathological investigation revealed an appendix sana. After operation, the fistula persisted due to a polypropylene plug from the previous groin hernia correction. The (infected) plug was removed and the fistula healed. PMID:23921697

  13. Aorto-left renal vein fistula: an unusual complication of abdominal aortic aneurysm.

    PubMed Central

    Suzuki, M; Collins, G M; Bassinger, G T; Dilley, R B

    1976-01-01

    A patient with an abdominal aortic aneurysm with a preaortic left renal vein fistula is presented. Review of the 7 reported cases of aorto-left renal vein fistulae demonstrates many similarities in the clinical presentation with aorto-caval fisulae. However, in addition to the triad of pain, pulsatile abdominal mass and bruit, commonly found in aorto-caval fistulae, the presence of hematuria, proteinuria, and azotemia suggests a renal vein fistula. Radiographic studies often demonstrate a large non-functional left kidney. Operative management of the fistula may be performed by a variety of maneuvers. All 7 patients survived. When repair was undertaken without delay, function in the left kidney returned to normal within two months postoperatively. Images Fig. 1. Fig. 3. PMID:938115

  14. 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

  15. Pericardium plug in the repair of the corneoscleral fistula after Ahmed Glaucoma Valve explantation.

    PubMed

    Yoo, Chungkwon; Kwon, Sung Wook; Kim, Yong Yeon

    2008-12-01

    We report four cases in which a pericardium (Tutoplast) plug was used to repair a corneoscleral fistula after Ahmed Glaucoma Valve (AGV) explantation. In four cases in which the AGV tube had been exposed, AGV explantation was performed using a pericardium (Tutoplast) plug to seal the defect previously occupied by the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast), measured 1 mm in width, was plugged into the fistula and secured with two interrupted 10-0 nylon sutures. To control intraocular pressure, a new AGV was implanted elsewhere in case 1, phaco-trabeculectomy was performed concurrently in case 2, cyclophotocoagulation was performed postoperatively in case 3 and anti-glaucomatous medication was added in case 4. No complication related to the fistula developed at the latest follow-up (range: 12-26 months). The pericardium (Tutoplast) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants.

  16. A novel approach to the repair of urethrocutaneous fistulae arising after abdominoperineal anorectal resection

    PubMed Central

    Yassein, Alaya; Dason, Shawn; Davies, Timothy; Kelly, Stephen

    2015-01-01

    This case report describes a novel approach to the repair of perineal urethrocutaneous fistulae (UCF) after abdominoperineal resection (APR). A 62-year-old patient developed a UCF after an APR for rectal cancer complicated by perineal abscess formation. The patient presented with continuous urinary drainage from the fistula that persisted despite a number of conservative and surgical measures. The patient underwent successful repair of the urethrocutaneous fistula in prone position—an approach that has not previously been described in the literature. Repair was performed by the multi-disciplinary team of a reconstructive urologist, colorectal surgeon, and plastic surgeon. Post-operative retrograde urethrogram demonstrated the absence of a persistent fistula tract and the patient has been continent for 18 months. The prone approach for UCF repair allows for excellent access to the fistula tract for posterior urethroplasty in a patient that has had prior APR. PMID:26834897

  17. Aortovenous fistulas due to ruptured infrarenal aortic aneurysms: experience with six cases.

    PubMed

    Gourdin, F W; Salam, A A; Smith, R B; Perdue, G D

    1982-08-01

    A review of patients undergoing aortic aneurysmectomy between 1970 and 1979 at the Emory University Hospital and the Atlanta Veterans Administration Medical Center disclosed six patients with aortovenous fistulas. Four fistulas were aorta to vena cava; one, aorta to left renal vein; and one, aorta to left iliac vein. Four of the arteriovenous fistulas were identified preoperatively. In another patient the symptoms and signs were masked by concomitant retroperitoneal rupture of the aneurysm. The final patient was asymptomatic preoperatively, but had an occluded fistula discovered at operation when laminated thrombus was removed from the wall of the aneurysm. One patient died while being prepared for operation; five were operated upon and survived. Successful management of this problem is contingent upon preoperative recognition, careful manipulation of the aneurysm with endoaneurysmal closure of the fistula, and judicious perioperative fluid management. PMID:7112194

  18. [Esophageal-pulmonary fistula in a patient with squamous cell carcinoma of the esophagus].

    PubMed

    Leguen, Y; Stern, J B; Sauvanet, A; Mal, F; Reffas, T; Fournier, M; Mal, H

    2000-11-01

    Acquired eso-respiratory fistulae are usually consecutive to an eso-tracheal or an eso-bronchial fistula. Esophago-pulmonary fistulae have been rarely described. We report a case of esophago-pulmonary fistula in a patient with esophageal carcinoma. Our patient presented progressive necrotizing pneumonia. CT scan of the thorax demonstrated necrosis of the esophagal wall and communication between the esophagus and the lung parenchyma. Furthermore, the biochemical analysis of the lung abcess fluid revealed a high level of amylase. Outcome was poor despite drainage of the lung abcess and insertion of an esophageal stent. Based on this case, we reviewed the cases of esophago-pulmonary fistulae described in the literature.

  19. [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

  20. 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.

  1. Successful non-operative management of an iatrogenic recto-urethral fistula in a 13-year-old boy.

    PubMed

    Zilbert, Nathan R; Sand, Matthew; Draper, Lawrence; Ricci, John; Nadler, Evan P

    2009-04-01

    Here we present a case of successful non-operative management of an iatrogenic recto-urethral fistula in a 13-year-old boy. The fistula was created when urethroscopic repair of a urethral stricture was attempted. Due to the anatomy of the lesion and previous urinary diversion, it was deemed possible to spare this patient diverting colostomy or surgical repair of the fistula. The result was successful closure of the fistula, which was confirmed on retrograde urethrogram. While we do not support the routine use of non-operative management for recto-urethral fistulas we have demonstrated that there are circumstances where it can be safely applied.

  2. Multiple Enteroenteric Fistulas- Crohn’s Disease- A Case Report

    PubMed Central

    DHARAMSHI, Hasnain Abbas; MOHSIN ALI, Ali Abbas; RAZA, Tufail; SHAHID, Narmeen; SHERAZ, Faizan; SAJID, Tooba; LILANI, Zohair; REHMAN, Mustaqueem ur; NAFEES, Taha

    2015-01-01

    Crohn's disease is a type of chronic inflammatory bowel disease (IBD) of unknown etiology that may affect any part of the gastrointestinal tract from mouth to anus and shows extra-intestinal involvement. It characteristically shows skip lesions. This case report reported in 2014 describes a middle age Pakistani male known to have documented evidence of significant crohn's disease since past 18 years. He was diagnosed with multiple fistulas that are a rare entity of patients with crohn's disease, which is itself a rare disease in Asian countries. PMID:26744714

  3. 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

  4. Acquired Tracheo-oesophageal Fistula: A Challenging Complication of Tracheostomy.

    PubMed

    Sethi, Priyanka; Bhatia, Pradeep Kumar; Biyani, Ghansham; Paliwal, Bharat; Sharma, Vandana

    2015-10-01

    Acquired tracheo-oesophageal fistula (TEF) after tracheostomy is a life threatening complication and can occur in about 1% of cases of tracheostomy. Percutaneous tracheostomy was performed in intensive care unit on a 40 years male patient for long-term mechanical ventilation. Subsequently patient developed TEF as the complication of tracheostomy. He was initially managed with endoscopically inserted self expanding plastic stent but later on required surgery for definitive repair. The problems associated with acquired TEF and its management are discussed hereby. PMID:26522209

  5. Primary Aortoduodenal Fistula: First you Should Suspect it

    PubMed Central

    Beuran, Mircea; Negoi, Ionut; Negoi, Ruxandra Irina; Hostiuc, Sorin; Paun, Sorin

    2016-01-01

    A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition. The postoperative recovery was uneventful, with discharge after 12 days. PMID:27737411

  6. Physical examination: how to examine the arm with arteriovenous fistula.

    PubMed

    Sousa, Clemente Neves; Apóstolo, João Luís; Figueiredo, Maria Henriqueta; Martins, Maria Manuela; Dias, Vanessa Filipa

    2013-04-01

    Physical examination has demonstrated its effectiveness in identifying complications of arteriovenous fistula (AVF). It should be initiated at the stage prior to the construction of the AVF and continue in its accomplishment, maturation, and subsequent use in the treatment of hemodialysis. Nurses should incorporate the physical examination in their practices, in order to preserve the vascular net of patients and assist in the recognition of complications of AVF. It is intended to describe aspects of the physical examination that enable the identification of the AVF complications including: infection, accessory veins, venous stenosis, steal syndrome, high-output cardiac failure, and venous hypertension.

  7. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure

    PubMed Central

    Chan, Esther Ern-Hwei

    2016-01-01

    Hydrothorax secondary to a pancreaticopleural fistula (PPF) is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up. PMID:27747128

  8. Direct Superficial Temporal Vein Approach for Dural Carotid Cavernous Fistula

    PubMed Central

    Matsubara, S.; Kazekawa, K.; Aikawa, H.; Onizuka, M.; Tsutsumi, M.; Ikou, M.; Kodama, T.; Nii, K.; Nagata, S.; Tanaka, A.

    2007-01-01

    Summary We present an alternative endovascular approach to treat dural carotid cavernous fistulae (dural CCF) that drain only into the superior ophthalmic vein. Four cases of cavernous dural AVFs that could not be treated via the inferior petrosal vein were accessed via the direct superficial temporal vein approach through the superior ophthalmic vein. Successful embolization was documented radiographically and clinically in all patients. The trans-superficial temporal vein approach is safe and useful for inaccessible dural CCFs through the inferior petrosal sinus. PMID:20566079

  9. Endovascular Aortic Stenting in Patients with Chronic Traumatic Aortocaval Fistula

    PubMed Central

    2013-01-01

    This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated. PMID:24386026

  10. 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.

  11. 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

  12. Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula.

    PubMed

    Loudin, Michael; Clayburgh, Daniel R; Hakki, Morgan

    2016-01-01

    Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis. PMID:27313922

  13. Combined palatal flap and titanium mesh for oroantral fistula closure

    PubMed Central

    de Souza Lopes, Pedro Henrique; Sampaio, Diogo de Oliveira; de Souza Menezes, Bruno Luiz; do Nascimento, Daniel Ferreira; Torres, Belmino Carlos Amaral

    2015-01-01

    The oroantral fistula (OAF) is an epithelialized communication between the oral cavity and the maxillary sinus. In most of the cases, this communication occurs after molars and premolars extractions, but other factors may be cause of the communication, such as trauma. This article demonstrates an alternative surgical technique illustrated with a case report in which we perform the surgical treatment of OAF with palatal flap rotation combined with the use of titanium mesh in a victim of gunshot projectile wound in oral cavity. PMID:26389042

  14. Dural arteriovenous fistula coexisting with a lumbar lipomeningocele. Case report.

    PubMed

    Rajeev, Kariyattil; Panikar, Dilip

    2005-11-01

    The authors describe the case of a 44-year-old woman who presented with recent onset of progressive paraparesis and bladder involvement; she had an asymptomatic lumbosacral lipomatous swelling that was present since birth. Magnetic resonance imaging confirmed the diagnosis of a lipomeningocele. It also revealed intramedullary hyperintensity on T2-weighted images and serpiginous flow voids suggestive of a dural arteriovenous fistula (DAVF) at the same level; the lesion was confirmed by spinal angiography. Both lesions were surgically managed, and the patient subsequently experienced neurological improvement. The coexistence of a DAVF and a lipomeningocele at the same level is unusual and can lead to treatment failure if missed.

  15. Communicating Tubular Esophageal Duplication Combined with Bronchoesophageal Fistula

    PubMed Central

    Kim, Ju Hwan; Kwon, Chang-Il; Rho, Ji Young; Han, Sang Woo; Kim, Ji Su; Shin, Suk Pyo; Song, Ga Won; Hahm, Ki Baik

    2016-01-01

    Esophageal duplication (ED) is rarely diagnosed in adults and is usually asymptomatic. Especially, ED that is connected to the esophagus through a tubular communication and combined with bronchoesophageal fistula (BEF) is extremely rare and has never been reported in the English literature. This condition is very difficult to diagnose. Although some combinations of several modalities, such as upper gastrointestinal endoscopy, esophagography, computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, can be used for the diagnosis, the results might be inconclusive. Here, we report on a patient with communicating tubular ED that was incidentally diagnosed on the basis of endoscopy and esophagography during the postoperational evaluation of BEF. PMID:26855929

  16. Traumatic perilymphatic fistula with pneumolabyrinth: diagnosis and management.

    PubMed

    Prisman, Eitan; Ramsden, James D; Blaser, Susan; Papsin, Blake

    2011-04-01

    A perilymphatic fistula (PLF) is an abnormal communication between the inner and middle ear resulting in vestibular or cochlear symptoms. We review three pediatric traumatic temporal bone fractures with pneumolabyrinth, confirmed radiologically by the presence of air within the cochlea (pneumocochlea) or vestibule (pneumovestibule). Patients were treated conservatively with complete resolution of vestibulopathy. Hearing outcome was variable and worse in two patients with pneumocochlea. A pneumolabyrinth on radiologic imaging confirms a PLF and obviates the need for exploration to reach a diagnosis. We suggest exploration be reserved for patients with persisting cerebrospinal fluid leakage, progressive sensorineural hearing loss, or vestibular symptomatology.

  17. 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.

  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. Management of colovesical fistulae associated with pelvic malignancy.

    PubMed

    Holmes, S A; Christmas, T J; Kirby, R S; Hendry, W F

    1992-05-01

    Thirteen patients with malignant colovesical fistulae are presented. The underlying pathology was cancer of the colon (seven cases), bladder (four cases) and cervix (two cases). The series demonstrates that wide surgical excision may be needed to achieve tumour clearance and that this may necessitate pelvic exenteration. Three patients who underwent inadequate tumour excision developed recurrence in the bladder, two with a fatal outcome. Wide excision of the bladder may be performed without urinary diversion by subtotal cystectomy and a reconstructive procedure. Substitution cystoplasty was performed on two patients at the time of tumour excision. Urinary tract involvement by such tumours is often extensive and optimal results may be achieved with a multidisciplinary approach.

  20. Treatment of fecal incontinence - review of observational studies (OS) and randomized controlled trials (RCT) related to injection of bulking agent into peri-anal tissue

    PubMed Central

    2011-01-01

    Purpose Novel treatments are needed to augment medical therapy for fecal incontinence. Methods Medline and Google search (fecal incontinence and injection treatment), English publications. Results Twenty-two observational studies and 4 randomized controlled trials were identified. OS mostly with limited sample sizes reported promising results. Repeated injection was necessary in some patients. Effect on anal sphincter pressures was highly variable. Significant improvements in the length of anal high-pressure zone, asymmetry index and maximum tolerable rectal volume were suggested. Four randomized controlled trials (n=176) revealed: 1. Short-term benefits from injection of Bioplastique under ultrasound guidance compared with digital guidance; 2. Silicone biomaterial (PTQ) provided some advantages and was safer than carbon-coated beads (Durasphere); 3. PTQ did not demonstrate clinical benefit compared to control injection of saline; 4. There was significant improvement at 6 weeks post injection, but no difference between Bulkamid and Permacol. A 2010 Cochrane review, however, noted that these data were inconclusive due to limited number and methodological weaknesses. Conclusion Further studies are warranted to assess patient-centered outcomes (e.g. adequate relief) in addition to the attenuation of severity of incontinence symptoms in ambulatory patients. In nursing home residents, cost-effectiveness studies combining injection treatment and prompted voiding (to mitigate constraints of immobility and dementia) in preventing peri-anal skin complications deserves to be considered. PMID:22586538

  1. The over-the-scope clip system – a novel technique for gastrocutaneous fistula closure: The first North American experience

    PubMed Central

    Kothari, Truptesh H; Haber, Gregory; Sonpal, Niket; Karanth, Nithin

    2012-01-01

    BACKGROUND: The mainstay of therapy for gastrocutaneous (GC) fistulas has been surgical intervention. However, endoclips are currently used for management of perforations and fistulas but are limited by their ability to entrap and hold the tissue. OBJECTIVE: To report the first North American experience with a commercially available over-the-scope clip (OTSC) device, a novel and new tool for the endoscopic entrapment of tissue for the closure of fistula and perforations. METHODS: The present single-centre study was conducted at a tertiary referral academic gastroenterology unit and centre for advanced therapeutic endoscopy and involved patients referred for endoscopic treatment for the closure of a GC fistula. The OTSC device was mounted on the tip of the endoscope and passed into the stomach to the level of the fistula. The targeted site of the fistula was grasped with the tissue anchoring tripod and pulled into the cap with concomitant scope channel suction. Once the tissue was trapped in the cap, a ‘bear claw’ clip was deployed. RESULTS: The patients recovered with fistula closure. No complication or recurrence was noted. Fistula sizes >1 cm, however, were difficult to close with the OTSC system. The length of stay of the bear claw clip at the fistula site is unpredictable, which may lead to incomplete closure of the fistula. CONCLUSION: Closure of a GC fistula using a novel ‘bear claw’ clip system is feasible and safe. PMID:22506258

  2. Large Urethro-Vesico-Vaginal Fistula due to a Vaginal Foreign Body in a 22-Year-Old Woman: Case Report and Literature Review.

    PubMed

    D'Elia, Carolina; Curti, Pierpaolo; Cerruto, Maria Angela; Monaco, Carmelo; Artibani, Walter

    2015-01-01

    In the non-industrialized countries of Africa and Asia obstetric fistulas are more frequently caused by prolonged labour, whereas in countries with developed healthcare systems they are generally the result of complications of gynaecological surgery or, rarely, benign pathologies like inflammation or foreign bodies. A 22-year-old woman was brought to the gynaecology clinic because of foul-smelling vaginal discharge. On pelvic examination a ring-like foreign body was impacted between the anterior and posterior vaginal wall. MRI scan confirmed the presence of a cylindrical foreign body in the vagina and the patient revealed that she had 'involuntarily' inserted a plastic bubble bath cap into the vagina. At surgery removal of the cap was difficult and at the end of the manoeuver evidence of a huge urethro-vesico-vaginal fistula occurred. The patient was discharged with bilateral ureteral stents and suprapubic catheter. After 3 months we performed an end-to-end anastomotic urethroplasty to repair the urethral avulsion and restored the bladder/trigonal and vaginal/cervical defects with 3 layers of sutures; 3 months later the patient had no complaints. Complex genital fistulas represent an extremely debilitating morbidity. In our case, a vaginal approach was successful, but the choice between an abdominal or vaginal approach depends on the surgeon's experience and training. PMID:25138359

  3. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    PubMed Central

    Dennis, Alexis C; Wilson, Sarah M; Mosha, Mary V; Masenga, Gileard G; Sikkema, Kathleen J; Terroso, Korrine E; Watt, Melissa H

    2016-01-01

    Objective An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients.

  4. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania

    PubMed Central

    Dennis, Alexis C; Wilson, Sarah M; Mosha, Mary V; Masenga, Gileard G; Sikkema, Kathleen J; Terroso, Korrine E; Watt, Melissa H

    2016-01-01

    Objective An obstetric fistula is a childbirth injury resulting in uncontrollable leakage of urine and/or feces and can lead to physical and psychological challenges, including social isolation. Prior to and after fistula repair surgery, social support can help a woman to reintegrate into her community. The aim of this study was to preliminarily examine the experiences of social support among Tanzanian women presenting with obstetric fistula in the periods immediately preceding obstetric fistula repair surgery and following reintegration. Patients and methods The study used a mixed-methods design to analyze cross-sectional surveys (n=59) and in-depth interviews (n=20). Results Women reported widely varying levels of social support from family members and partners, with half of the sample reporting overall high levels of social support. For women experiencing lower levels of support, fistula often exacerbated existing problems in relationships, sometimes directly causing separation or divorce. Many women were assertive and resilient with regard to advocating for their fistula care and relationship needs. Conclusion Our data suggest that while some women endure negative social experiences following an obstetric fistula and require additional resources and services, many women report high levels of social support from family members and partners, which may be harnessed to improve the holistic care for patients. PMID:27660492

  5. The Role of Surgery and Hyperalimentation in Therapy of Gastrointestinal-Cutaneous Fistulae

    PubMed Central

    Aguirre, Alfonso; Fischer, Josef E.; Welch, Claude E.

    1974-01-01

    Thirty-eight patients with external gastrointestinal fistulas arising from different levels of the gastrointestinal tract, observed and treated at the Massachusetts General Hospital, from December 1970 to April 1973, are analyzed. Surgical complications were the causes of fistulization in 77% of the cases. The treatment program included parenteral nutrition through a subclavian line in all cases. The 38 patients were fed parenterally for a total of 2311 days. Spontaneous fistula closure occurred in only 11 of the 38 patients. Surgical procedures were necessary in 71.05% of the cases to control fistula complications or persistent fistula drainage. Operative success rate was 70.4%. Parenteral nutrition effects on metabolic parameters, fistula secretion, nutritional status, morbidity and mortality of fistulas are discussed. Parenteral nutrition hazards are also presented. Overall mortality in this series was 21%. Roles of parenteral nutrition and surgery in the total management of external gastrointestinal fistulas are suggested. ImagesFig. 1.Fig. 2.Fig. 3.Fig. 4.Fig. 5.Fig. 6.Fig. 7. PMID:4213479

  6. Gastro-bronchial fistula after laparoscopic nissen fundoplication.

    PubMed

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

    2007-10-01

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

  7. Rectourethral fistula: A rare complication of injection sclerotherapy.

    PubMed

    Tanwar, Raman; Singh, Santosh Kumar; Pawar, Devendra Singh

    2014-07-01

    In the modern era, the incidence of rectourethral fistula (RUF) has been on a rise due to an increasing number of surgeries being performed for prostatic carcinoma. Other causes of this condition still remain rare and their management differs from that of post prostatectomy RUF. We report a rare case of a young man who presented with leakage of urine per rectum 4 weeks after injection sclerotherapy for haemorrhoids. A Micturating Cystourethrogram/Retrograde Cystourethrogram revealed the presence of RUF arising at the level of prostrato-membranous urethra and the urine examination did not show any fecal contamination of urine. A fistula at the level or verumontanum along with stricture of the distal penile urethra was demonstrated on urethroscopy. The patient was successfully managed by dilatation of the stricture segment and urethral catheterization. RUF can rarely result from injection sclerotherapy and must be thoroughly evaluated. Cases which present early and have minimal contamination of urine by fecal contents can be conservatively managed with a simple Foleys catheterization for 4-6 weeks after ruling out any obstruction distal to the fistulous tract.

  8. Torcular dural arteriovenous fistula treated via stent placement and angioplasty in the affected straight and transverse sinuses: case report.

    PubMed

    Takada, Shigeki; Isaka, Fumiaki; Nakakuki, Takuya; Mitsuno, Yuto; Kaneko, Takaaki

    2015-05-01

    The successful obliteration of torcular dural arteriovenous fistula (DAVF) with a diffuse shunt in the affected sinus may require complex treatment strategies. Therapeutic goals include the preservation of normal venous drainage and complete obliteration of shunt flow. The authors report the case of a torcular DAVF. The treatment of this type of AVF may require a combined approach with transarterial and transvenous embolization, open surgery, or radiosurgery and is associated with many problems. Stent placement and angioplasty in the affected sinus result in compression of the fistulous dural wall of the sinus and decrease shunt flow. In cases in which there is a diffuse shunt in the affected sinus and no evident shunt point, such as in AVFs involving venous pouches and parasinuses, sealing the fistula orifice with self-expandable stents and angioplasty (balloon inflation) is considered the best treatment option to preserve normal cerebral venous sinus drainage and obliterate shunt flow. In such cases, the authors recommend using one or more self-expandable and closed-cell stents and using angioplasty to avoid endoleakage into the gap between the stent graft and the vessel wall.

  9. [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

  10. An unusual presentation of spinal dural arteriovenous fistula: A case report

    PubMed Central

    Saadat, Payam; Adabi, Marzie

    2016-01-01

    Background: Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence. Case Presentation: Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities Result: A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula. Conclusion: Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities. PMID:27757211

  11. Huge aneurysm and coronary-cameral fistula from right coronary branch: First case.

    PubMed

    Ahmad, Tanveer; Pasarad, Ashwini Kumar; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere

    2016-02-01

    Coronary-cameral fistulas are rare cardiovascular anomalies. A giant coronary artery aneurysm associated with a coronary-cameral fistula is a very rare condition, with an estimated prevalence of 0.02%. We report the case of middle-aged woman who presented with a huge extracardiac aneurysmal mass and a coronary-cameral fistula from a right coronary artery branch. It was successfully repaired by ligation and excision plus marsupialization of the aneurysm. We believe this is the first such a case reported in literature.

  12. Oronasal fistula in a 53-year-old hippopotamus (Hippopotamus amphibius).

    PubMed

    Wittschen, P; Ochs, A; Gruber, A D

    2007-11-01

    An oronasal fistula is described in a 53-year-old captive hippopotamus, the animal having shown a nasal discharge, consisting mainly of food particles, during and after feeding for at least 15 years. Necropsy of the emaciated animal revealed an oronasal fistula, measuring 4.5 x 3.5 cm, adjacent to the third left molar tooth, the first and second molars being missing. The fistula was thought to have been caused by an earlier necrotizing alveolitis and osteitis. There was no evidence of rhinitis or aspiration pneumonia. Unrelated findings consisted of a follicular thyroid adenoma and generalized muscle atrophy.

  13. Oronasal fistula in a 53-year-old hippopotamus (Hippopotamus amphibius).

    PubMed

    Wittschen, P; Ochs, A; Gruber, A D

    2007-11-01

    An oronasal fistula is described in a 53-year-old captive hippopotamus, the animal having shown a nasal discharge, consisting mainly of food particles, during and after feeding for at least 15 years. Necropsy of the emaciated animal revealed an oronasal fistula, measuring 4.5 x 3.5 cm, adjacent to the third left molar tooth, the first and second molars being missing. The fistula was thought to have been caused by an earlier necrotizing alveolitis and osteitis. There was no evidence of rhinitis or aspiration pneumonia. Unrelated findings consisted of a follicular thyroid adenoma and generalized muscle atrophy. PMID:17888937

  14. 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.

  15. Nonsurgical closure of esophago-respiratory fistulas: role for the somatostatin analogue octreotide acetate?

    PubMed

    Nylen, E S; Hall, J L; Krasnow, S H; Becker, K L; Wadleigh, R G

    1994-09-01

    Esophago-respiratory fistulas (ERF) do not close spontaneously and are uniformly fatal. A somatostatin analogue (octreotide acetate) was used in three consecutive patients to promote the closure of ERF. In 2 patients with esophageal cancer, treatment with octreotide acetate was associated with fistula closure in 30 and 46 days, respectively. In a third patient with virally-induced ERF, treatment was associated with improvement of the inflammation of the fistula before the patient's death from pulmonary aspiration after 40 days of treatment. These preliminary observations suggest that octreotide acetate treatment of ERF should receive further investigative scrutiny.

  16. Bronchoesophageal Fistula Stenting Using High-Frequency Jet Ventilation and Underwater Seal Gastrostomy Tube Drainage.

    PubMed

    Fokeerah, Nitish; Liu, Xinwei; Hao, Yonggang; Peng, Lihua

    2016-01-01

    Managing a patient scheduled for bronchoesophageal fistula repair is challenging for the anesthetist. If appropriate ventilation strategy is not employed, serious complications such as hypoxemia, gastric distension, and pulmonary aspiration can occur. We present the case of a 62-year-old man with a bronchoesophageal fistula in the left main stem bronchus requiring the insertion of a Y-shaped tracheobronchial stent through a rigid bronchoscope, under general anesthesia. We successfully managed this intervention and herein report this case to demonstrate the effectiveness of underwater seal gastrostomy tube drainage used in conjunction with high-frequency jet ventilation during bronchoesophageal fistula stenting. PMID:27672454

  17. Bronchoesophageal Fistula Stenting Using High-Frequency Jet Ventilation and Underwater Seal Gastrostomy Tube Drainage

    PubMed Central

    2016-01-01

    Managing a patient scheduled for bronchoesophageal fistula repair is challenging for the anesthetist. If appropriate ventilation strategy is not employed, serious complications such as hypoxemia, gastric distension, and pulmonary aspiration can occur. We present the case of a 62-year-old man with a bronchoesophageal fistula in the left main stem bronchus requiring the insertion of a Y-shaped tracheobronchial stent through a rigid bronchoscope, under general anesthesia. We successfully managed this intervention and herein report this case to demonstrate the effectiveness of underwater seal gastrostomy tube drainage used in conjunction with high-frequency jet ventilation during bronchoesophageal fistula stenting. PMID:27672454

  18. [Enterocutaneous fistula formation in a dog as a result of colonic foreign body perforation].

    PubMed

    Wunderlin, N; Biel, M; Peppler, C; Amort, K; Kramer, M

    2012-04-24

    A 5-year-old female Poodle was presented with a 3-month history of recurrent abscess and fistula formation on the right abdominal wall. Radiographic and ultrasonographic examinations demonstrated an enterocutaneous fistula formation secondary to foreign body perforation of the colon. Additionally, the diagnosis of a pyometra was made. Twenty-four hours after surgical therapy (ventral midline coeliotomy, foreign body removal, closure of the colon perforation, abdominal lavage and drainage, revision of the fistula) the patient was euthanized due to sepsis and incipient multiorgan dysfunction. PMID:22526816

  19. Bronchoesophageal Fistula Stenting Using High-Frequency Jet Ventilation and Underwater Seal Gastrostomy Tube Drainage

    PubMed Central

    2016-01-01

    Managing a patient scheduled for bronchoesophageal fistula repair is challenging for the anesthetist. If appropriate ventilation strategy is not employed, serious complications such as hypoxemia, gastric distension, and pulmonary aspiration can occur. We present the case of a 62-year-old man with a bronchoesophageal fistula in the left main stem bronchus requiring the insertion of a Y-shaped tracheobronchial stent through a rigid bronchoscope, under general anesthesia. We successfully managed this intervention and herein report this case to demonstrate the effectiveness of underwater seal gastrostomy tube drainage used in conjunction with high-frequency jet ventilation during bronchoesophageal fistula stenting.

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

    PubMed

    Diez, O; Añorbe, E; Aisa, P; Saez de Ormijana, J; Aguirre, X; Paraiso, M

    1998-11-01

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

  1. 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

  2. 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

  3. Safety and efficacy of topical Cidofovir to treat high-grade perianal and vulvar intraepithelial neoplasia in HIV-positive men and women

    PubMed Central

    STIER, Elizabeth A; GOLDSTONE, Stephen E.; EINSTEIN, Mark H.; JAY, Naomi; BERRY, J. Michael; WILKIN, Timothy; LEE, Jeannette Y.; DARRAGH, Teresa M.; DA COSTA, Maria; PANTHER, Lori; ABOULAFIA, David; PALEFSKY, Joel M.

    2013-01-01

    Objective To evaluate the safety and efficacy of topical cidofovir for treatment of high-grade squamous perianal and vulvar intraepithelial neoplasia (PAIN and VIN) lesions in HIV-positive individuals. Design Phase IIa prospective multicenter trial conducted at eight clinical sites through the AIDS Malignancy Consortium (AMC) Methods HIV-positive patients with biopsy-proven high-grade PAIN that was ≥ 3 cm2 were enrolled. PAIN biopsy specimens were assessed for HPV using PCR and type-specific HPV probing. Subjects applied 1% topical cidofovir to PAIN and VIN (if present) for 6 two-week cycles. Results were designated as complete response (CR), partial response (PR) (> 50% reduction in size), stable disease (SD), or progressive disease (PD). Results Twenty-four men and 9 women (8 with high-grade VIN as well) were enrolled. Mean age was 44 years, mean CD4+ count was 412 cells/μl. HPV DNA (most commonly HPV16) was detected in all pre-treatment study specimens. Twenty six (79%) subjects completed treatment per protocol—CR: 5 (15%); PR: 12 (36%), SD: 7 (21%); PD: 2 (6%) (1 with a superficially invasive cancer and 1 with new area of high-grade PAIN). Treatment was well tolerated with most common adverse events being mild to moderate affecting lesional skin: pain/burning/irritation (25 subjects) and ulceration (13 subjects). Conclusions Topical cidofovir had 51% efficacy in the short-term treatment of high-grade PAIN and VIN with acceptable toxicity in HIV-positive individuals. Randomized control studies with more prolonged treatment courses and longer follow-up to assess the durability of the response are needed. PMID:23032420

  4. Iatrogenic arteriovenous fistula of the superficial temporal artery after manual reduction of temporomandibular joint dislocation.

    PubMed

    Takeuchi, Satoru; Takasato, Yoshio

    2011-09-01

    A 33-year-old man fell from a height and was referred to our hospital. Physical examination showed a swelling in the left preauricular region without laceration. No thrill or bruit was detected at this time. A face x-ray and a computed tomographic scan showed a left temporomandibular joint (TMJ) dislocation, Le Fort I fractures, and a mandibular body fracture. Left TMJ dislocation was treated by manual reduction. Two days after admission, a swelling in the left preauricular region progressed, with thrill and bruit. Left external carotid artery angiograms showed an arteriovenous fistula with a dilated pouch near the left TMJ. The fistula was fed by the left superficial temporal artery and drained into the left superficial temporal vein. The fistula was successfully embolized using Tornado coils. This is the first case of an arteriovenous fistula of the superficial temporal artery after manual reduction of TMJ dislocation. PMID:21959481

  5. Mussel adhesion-employed water-immiscible fluid bioadhesive for urinary fistula sealing.

    PubMed

    Kim, Hyo Jeong; Hwang, Byeong Hee; Lim, Seonghye; Choi, Bong-Hyuk; Kang, Seok Ho; Cha, Hyung Joon

    2015-12-01

    Urinary fistulas, abnormal openings of a urinary tract organ, are serious complications and conventional management strategies are not satisfactory. For more effective and non-invasive fistula repair, fluid tissue adhesives or sealants have been suggested. However, conventional products do not provide a suitable solution due to safety problems and poor underwater adhesion under physiological conditions. Herein, we proposed a unique water-immiscible mussel protein-based bioadhesive (WIMBA) exhibiting strong underwater adhesion which was employed by two adhesion strategies of marine organisms; 3,4-dihydroxy-l-phenylalanine (DOPA)-mediated strong adhesion and water-immiscible coacervation. The developed biocompatible WIMBA successfully sealed ex vivo urinary fistulas and provided good durability and high compliance. Thus, WIMBA could be used as a promising sealant for urinary fistula management with further expansion to diverse internal body applications. PMID:26352517

  6. Multimodal endovascular treatment of a vertebrovertebral fistula presenting with subarachnoid hemorrhage and hydrocephalus.

    PubMed

    Walcott, Brian P; Berkhemer, Olvert A; Leslie-Mazwi, Thabele M; Chandra, Ronil V; Ogilvy, Christopher S; Yoo, Albert J

    2013-09-01

    Vertebrovertebral fistulae are rare vascular malformations that uncommonly can rupture to present clinically as intracranial subarachnoid hemorrhage. We report a 69-year-old man presenting following spontaneous apoplectic collapse. Initial workup revealed diffuse, intracranial subarachnoid hemorrhage, intraventricular hemorrhage and hydrocephalus. However, the etiology was not apparent on CT angiography of the head. Catheter-based angiography was performed, demonstrating a single-hole, high-flow vertebrovertebral fistula, arising from the V2 segment and decompressing into both cervical and skull base venous structures. Definitive treatment consisted of endovascular fistula obliteration with a combination of coil and liquid embolic material. The patient made a full neurological recovery. High cervical and skull base fistulae are rare causes of intracranial hemorrhage; endovascular treatment is effective at disconnection of the arteriovenous shunt.

  7. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting.

    PubMed

    Tao, Mary; Shlomovitz, Eran; Darling, Gail; Roche-Nagle, Graham

    2016-08-16

    Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula. PMID:27574612

  8. Posttraumatic carotid-cavernous fistula: Pathogenetic mechanisms, diagnostic management and proper treatment. A case report

    PubMed Central

    Marín-Fernández, Ana-Belén; Román-Ramos, María; Fernandez-Solis, José; Martínez-Lara, Ildefonso

    2016-01-01

    Carotid-cavernous fistulas are an uncommon diseases characterized by abnormal communications between arteries and veins located in the cavernous sinus. According with Barrow´s classification they could be divided in two groups: direct and indirect. The typical symptoms showed by theses pathologies are: pulsating exophthalmos and orbital blow. The present study describes a case of direct posttraumatic carotid-cavernous fistula in a 26 years old man. Furthermore, we present the images that we used to make the diagnosis. In this light, we decided to treat this case with endovascular approach after considering several therapeutic options. The aim of the present report is twofold. First, we examine the importance of the proper management of the direct posttraumatic carotid-cavernous fistula. Second, we describe this rare syndrome with the goal of proposing suitable treatments. Key words:Carotid cavernous fistulas, pulsating exophthalmos, orbital blow, endovascular approach, Barrow´s classification. PMID:27034767

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

    PubMed

    Pelosi, M A; Pelosi, M A

    1997-12-01

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

  10. Unusual fistulas and connections in the cardiovascular system: A pictorial review

    PubMed Central

    Ghandour, Abed; Rajiah, Prabhakar

    2014-01-01

    A fistula is an abnormal vascular connection leading to diversion of blood from a high resistance arterial circuit to low resistance venous circuit. Coronary artery fistulas are abnormal communications of the coronary artery with a chamber of the heart, or with any segment of systemic or pulmonary circulation, bypassing the myocardial capillaries. Other unusual fistulas include connection between aorta and the right atrium/superior vena cava, aorta and the inferior vena cava or between a coronary artery bypass graft and a cardiac vein. Abnormal connections also include origin of the coronary artery from the pulmonary artery. In this article, we review the imaging, particularly computed tomography and magnetic resonance imaging of unusual fistulas and connections involving the cardiovascular system, particularly the coronary arteries and the aorta. PMID:24876921

  11. Primary Aortoenteric Fistula: A Rare Case of a Massive Gastrointestinal Bleed

    PubMed Central

    Liu, Bo; Loya, Raul; Koury, Ibrahim

    2016-01-01

    Aortoenteric fistulas (AEFs) are deadly, abnormal connections between the aorta and gastrointestinal (GI) tract. While secondary aortoenteric fistulas (SAEFs) are more common and arise after aortic reconstruction, primary aortoenteric fistulas (PAEFs) are generally caused by abdominal aortic aneurysms (AAAs). PAEFs may present with self-limited GI bleeds called “herald bleeds,” and the fistula often goes undiagnosed until patients undergo laparotomy for a massive GI bleed. We describe a case of a PAEF in a 79-year-old man with known AAA. Due to variable clinical presentations and the rarity of the condition, many patients with PAEF die before an accurate diagnosis is made. In interpreting computed tomography (CT) scans of AEFs, the role of the radiologist is critical in the management of PAEF patients. PMID:27725922

  12. The formation of bronchocutaneous fistulae due to retained epicardial pacing wires: A literature review

    PubMed Central

    Patris, Vasileios; Argiriou, Michalis; Salem, Agni-Leila; Giakoumidakis, Konstantinos; Baikoussis, Nikolaos G.; Charitos, Christos

    2016-01-01

    Temporary epicardial pacing wires during open-heart surgery are routinely used both for diagnostic and treatment purposes. In complicated cases where patients are unstable or the wires are difficult to remove, the pacing wires are cut at the skin level and allowed to retract by themselves. This procedure rarely causes complications. However, there have been cases reporting that retained pacing wires are linked to the formation of sterno-bronchial fistulae, which may present a while after the date of operation and are usually infected. This review aims to study the cases presenting sterno-bronchial fistulae due to retained epicardial pacing wires and to highlight the important factors associated with these. It is important to note these complications, as fistulae may cause a variety of problems to the patient if undiagnosed and left untreated. With the aid of scans such as fistulography, fistulae can be identified and treated and will improve the patients’ health dramatically. PMID:27716700

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

    SciTech Connect

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

    2005-12-15

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

  14. An unusual presentation of xanthogranulomatous pyelonephritis: psoas abscess with reno-colic fistula

    PubMed Central

    Ghoz, Hassan M.; Williams, Martin; Perepletchikov, Aleksandr; James, Nicholas; Babeir, Abdulrahman A.

    2016-01-01

    Xanthogranulomatous pyelonephritis (XGP) is a rare histological subset of pyelonephritis characterized by being a chronic destructive granulomatous inflammation of the renal parenchyma. XGP is classified according to the extent of disease into two entities: within the renal cortex (focal or segmental XGP) or diffuse spread with pelvic communication (diffuse XGP). Although rare, XGP can have fatal complications including perinephric, psoas abscess, nephro-cutaneous fistula and reno-colic fistula. Only few studies have reported XGP complicated with psaos abcess and reno-colic fistula. Our aim is to add to the literature and share our experience with a case of extensive XGP eroding into the psoas muscle and ascending colon leading to severe sepsis that was successfully managed. We report a 56-year-old woman who was found to have XGP complicated by psoas abscess and reno-colic fistula managed by antibiotics, nephrostomy, and subsequent nephrectomy and partial colectomy. PMID:27471599

  15. An unusual presentation of xanthogranulomatous pyelonephritis: psoas abscess with reno-colic fistula.

    PubMed

    Ghoz, Hassan M; Williams, Martin; Perepletchikov, Aleksandr; James, Nicholas; Babeir, Abdulrahman A

    2016-07-01

    Xanthogranulomatous pyelonephritis (XGP) is a rare histological subset of pyelonephritis characterized by being a chronic destructive granulomatous inflammation of the renal parenchyma. XGP is classified according to the extent of disease into two entities: within the renal cortex (focal or segmental XGP) or diffuse spread with pelvic communication (diffuse XGP). Although rare, XGP can have fatal complications including perinephric, psoas abscess, nephro-cutaneous fistula and reno-colic fistula. Only few studies have reported XGP complicated with psaos abcess and reno-colic fistula. Our aim is to add to the literature and share our experience with a case of extensive XGP eroding into the psoas muscle and ascending colon leading to severe sepsis that was successfully managed. We report a 56-year-old woman who was found to have XGP complicated by psoas abscess and reno-colic fistula managed by antibiotics, nephrostomy, and subsequent nephrectomy and partial colectomy.

  16. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting

    PubMed Central

    Tao, Mary; Shlomovitz, Eran; Darling, Gail; Roche-Nagle, Graham

    2016-01-01

    Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula. PMID:27574612

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

    PubMed Central

    2013-01-01

    Background Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. Case presentation We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Conclusions Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation. PMID:24289138

  18. The nance obturator, a new fixed obturator for patients with cleft palate and fistula.

    PubMed

    Borzabadi-Farahani, Ali; Groper, John N; Tanner, Aaron M; Urata, Mark M; Panossian, Andre; Yen, Stephen L-K

    2012-07-01

    In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.

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

    PubMed Central

    Forshaw, Matthew J; Dastur, Jamasp K; Murali, Kothandaraman; Parker, Michael C

    2005-01-01

    Background Gastrocolic fistula is a rare presentation of both benign and malignant diseases of the gastrointestinal tract. Malignant gastrocolic fistula is most commonly associated with adenocarcinoma of the transverse colon in the Western World. Despite radical approaches to treatment, long-term survival is rarely documented. Case presentation We report a case of a 24-year-old woman who presented with the classic triad of symptoms associated with gastrocolic fistula. Radical en-bloc surgery and adjuvant chemotherapy were performed. She is still alive ten years after treatment. Conclusions Gastrocolic fistula is an uncommon presentation of adenocarcinoma of the transverse colon. Radical en-bloc surgery with adjuvant chemotherapy may occasionally produce long-term survival. PMID:15705194

  20. Women of the courtyard. A nurse's journey to treat obstetric fistulae in Niger.

    PubMed

    Ng'ang'a, Njoki

    2006-01-01

    Obstetric fistula is a devastating condition that results from prolonged or unassisted labor. It produces debilitating physical and emotional consequences caused by constant leaking of urine and/or feces. Because high-quality medical care is available throughout the developed world, unrepaired obstetric fistulae are virtually nonexistent in developed nations. However, the condition is rampant in many developing countries, including Niger, a nation in West Africa. This article explains what obstetric fistula is, why it is such a problem, and what nurses and other health care professionals can do to help improve the situation worldwide. It also tells the story of one nurse who went on a volunteer mission to treat obstetric fistulae in Niger, where she met a courtyard full of women she will never forget.

  1. Bronchopleural Fistula After Radiofrequency Ablation of Lung Tumours

    SciTech Connect

    Cannella, Mathieu; Cornelis, Francois; Descat, Edouard; Ferron, Stephane; Carteret, Thibault; Castagnede, Hugues; Palussiere, Jean

    2011-02-15

    The present article describes two cases of bronchopleural fistula (BPF) occurring after radiofrequency ablation of lung tumors. Both procedures were carried out using expandable multitined electrodes, with no coagulation of the needle track. After both ablations, ground-glass opacities encompassed the nodules and abutted the visceral pleura. The first patient had a delayed pneumothorax, and the second had a recurrent pneumothorax. Both cases of BPF were diagnosed on follow-up computed tomography chest scans (i.e., visibility of a distinct channel between the lung or a peripheral bronchus and the pleura) and were successfully treated with chest tubes alone. Our goal is to highlight the fact that BPF can occur without needle-track coagulation and to suggest that minimally invasive treatment is sufficient to cure BPFs of this specific origin.

  2. Orocutaneous Fistula or Traumatic Infectious Skin Lesion: A Diagnostic Dilemma

    PubMed Central

    Vermani, Mayank; Kalia, Vimal; Singh, Sumita; Garg, Sunny; Aggarwal, Shweta; Khurana, Richa; Kalra, Geeta

    2015-01-01

    Orocutaneous fistula (OCF) (of dental origin) is an uncommon but well-described condition in the literature. These are often misdiagnosed by physicians and dentists. Careful selection of investigating modality is important in case of diagnostically challenging cases. A 19-year-old female came with a complaint of a lesion on the chin reported with h/o trauma with the impact on chin presented as diagnostic dilemma because of unusual case history and clinical examination. Commonly used radiographic investigations like IOPA and orthopantomograph did not resolve the dilemma whereas advanced imaging modality like CT scan, 3D volume imaging, and contrast enhanced CT played an important role in the diagnosis of OCF and selecting the treatment plan. PMID:26618009

  3. Cutaneous Mycobacterium chelonae infection distal to the arteriovenous fistula

    PubMed Central

    Van Ende, Charlotte; Wilmes, Dunja; Lecouvet, Frédéric E.; Labriola, Laura; Cuvelier, René; Van Ingelgem, Grégory; Jadoul, Michel

    2016-01-01

    A few single cases of Mycobacterium chelonae skin infection have been reported in haemodialysis patients. We report three additional cases that share peculiar clinical characteristics, pointing to diagnostic clues. All three cases presented as erythematous nodules developing distally to a proximal arteriovenous fistula (AVF). This presentation was identical to that of two published cases. A survey of all Belgian haemodialysis units during the period 2007–11 yields an estimated incidence of ∼0.9/10 000 patient-years. Although the source of M. chelonae remains unclear, this specific clinical presentation should be added to the listing of potential complications of an AVF and should be recognized, as it is fully treatable if diagnosed by culture and tissue biopsy. PMID:27679721

  4. Iatrogenic spinopelvic cerebro-spinal fluid fistula. Case report.

    PubMed

    Maleci, A; Bianco, F; Onnis, G; Di Lorenzo, N

    1995-12-01

    Perineurial cysts usually affect the lumbosacral spinal nerve roots, but sometimes they can erode the sacrum and reach the retroperitoneal space. In such cases misdiagnosis can lead to an improper treatment and cause serious complications. A presacral mass was diagnosed in a young woman during routine ultrasound investigation, and an exploratory laparotomy was performed. A large, fluid-containing cyst was found and marsupialized into the pelvis. After operation the patient experienced headache, vomiting and VI cranial nerve palsy whenever she stood up. By radiculography a iatrogenic spinopelvic cerebro-spinal fluid fistula was diagnosed, which required further surgery to be repaired. The presence of a giant perineurial cyst in the pelvis in unusual but must be considered in the differential diagnosis of presacral masses; the exceptionally rare case reported in this paper is exemplar of the harmful complications that an incautious procedure can determine.

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

    PubMed Central

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

    2013-01-01

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

  6. Cutaneous Mycobacterium chelonae infection distal to the arteriovenous fistula

    PubMed Central

    Van Ende, Charlotte; Wilmes, Dunja; Lecouvet, Frédéric E.; Labriola, Laura; Cuvelier, René; Van Ingelgem, Grégory; Jadoul, Michel

    2016-01-01

    A few single cases of Mycobacterium chelonae skin infection have been reported in haemodialysis patients. We report three additional cases that share peculiar clinical characteristics, pointing to diagnostic clues. All three cases presented as erythematous nodules developing distally to a proximal arteriovenous fistula (AVF). This presentation was identical to that of two published cases. A survey of all Belgian haemodialysis units during the period 2007–11 yields an estimated incidence of ∼0.9/10 000 patient-years. Although the source of M. chelonae remains unclear, this specific clinical presentation should be added to the listing of potential complications of an AVF and should be recognized, as it is fully treatable if diagnosed by culture and tissue biopsy.

  7. [Digestive hemorrhage caused by aorto-duodenal fistula. Report of 5 cases].

    PubMed

    Rodríguez-San Román, J L; Abad, C; Cabrera, J; Rodríguez-San Román, M T; Mayor, J; Ortiz, E; Guerra, C

    1992-04-01

    The aortoduodeonal fistula is a rare condition and has high mortality. We report five retrospective cases of digestive hemorrhage due to an aortoduodenal fistula (4 secondary and 1 primary) between 1986 and 1990. Three of them died. Attention is called to the importance of clinical suspicion and the main diagnostic methods in early diagnosis such as oral endoscopy. We also enhance the importance of emergency surgery for survival.

  8. Spontaneous closure of posttraumatic high-flow carotid-cavernous fistula following cerebral angiography

    PubMed Central

    Meena, Ugan Singh; Gupta, Pankaj; Shrivastava, Trilochan; Purohit, Devendra

    2016-01-01

    Traumatic carotid-cavernous fistula (TCCF) is a direct communication between cavernous portion of the internal carotid artery (ICA) and cavernous sinus due to tear in ICA. Most of the cases are treated by endovascular embolization. Spontaneous resolution of high-flow TCCFs is extremely rare. We report a case of posttraumatic, direct, high-flow carotid cavernous fistula (Barrow type A) that resolved spontaneously after cerebral angiography. PMID:27057229

  9. [Use of human fibrin glue (Tissucol) in the treatment of recurrent fistulas].

    PubMed

    La Torre, F; Pascarella, G; Nicolai, A P; Pontone, P; Montori, A

    1995-05-01

    In this study, the treatment of either primitive or secondary abdominal relapsed fistulas with Human Fibrin Glue (Tissucol) is reported. Twelve patients with different types of fistulas were treated in day hospital with the above mentioned procedure. Apart from two patients, the good percentage of success obtained in a short period of time is stressed. Results show that such a technique may be favourably adopted, nevertheless a correct first surgical procedure is recommended.

  10. Endovascular Coil Embolization in a Postnephrostomy Renal Vein to Renal Pelvis Fistula

    SciTech Connect

    Anil, Gopinathan Taneja, Manish

    2011-02-15

    We report the case of a 74-year-old man with post-percutaneous-nephrostomy venous hemorrhage from an iatrogenic fistula between the renal pelvis and a large tributary of the renal vein. Conservative management failed to contain the hemorrhage. Hence the fistula was occluded by coil embolization through the renal vein. This endovascular approach enabled rapid and effective stoppage of the venous bleed.There was no recurrence of the bleed or any pertinent complication at 3-month follow-up.

  11. [Nonsurgical and surgical treatment of an urachal fistula in an alpaca cria. A case report].

    PubMed

    Kubus, K; Wöckel, A; Felton, C; Schwarzenberger, J; Sobiraj, A

    2015-01-01

    Urachal fistula is a neonatal condition. There are two reported forms: a congenital and an acquired form. We describe the case of a 6-hour-old female alpaca cria that was presented with a damp umbilicus and a meconium impaction. Conservative treatment of the urachal fistula with local and systemic medication was unsuccessful after 6 days; therefore, a resection of the umbilicus under general anaesthesia was performed. Reconvalescence was uneventful.

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

    SciTech Connect

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

    2010-02-15

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

  13. Occlusion of a hepatic artery to portal vein fistula with Bucrylate

    SciTech Connect

    Kerlan, R.K. Jr.; Hoddick, W.K.; Pogany, A.C.; Bank, W.O.; Sollenberger, R.D.

    1983-08-01

    A 49-year-old woman with cirrhosis and portal hypertension was evaluated for a portal-systemic shunt procedure following recurrent variceal hemorrhage. The preoperative visceral angiogram demonstrated a hepatic arterial to portal venous fistula, presumably a complication of a previous liver biopsy. The fistula was successfully closed using isobutyl-2-cyanoacrylate (Bucrylate) delivered through a flow-directed, calibrated-leak balloon microcatheter.

  14. Use of a Balloon and N-Butyl-2-Cyanoacrylate for Treatment of Arteriovenous Fistula

    SciTech Connect

    Doenmez, Halil Mavili, Ertugrul; Toker, Birguel; Oztuerk, M. Halil; Soylu, Serra O.; Hekimoglu, Baki

    2008-07-15

    We report a patient who developed a large arteriovenous fistula in right lower extremity after gunshot injury. Because other endovascular methods failed, the patient was successfully treated with concomitant use of detachable latex balloon and N-butyl-2-cyanoacrylate (NBCA). The combination of detachable balloon and NBCA can be effectively used for endovascular treatment of peripheral arteriovenous fistulas in selected cases when effective embolization could not be achieved with other embolizing agents or their various combinations.

  15. Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization

    PubMed Central

    Hung, C; Tseng, J; Lui, K; Wan, Y; Tsai, C; Shem, C; Wu, C

    1999-01-01

    We describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.


Keywords: splenic arteriovenous fistula; gastrointestinal bleeding; transcatheter arterial embolization PMID:10435172

  16. Nitric Oxide Resistance Reduces Arteriovenous Fistula Maturation in Chronic Kidney Disease in Rats

    PubMed Central

    Molin, Daniel G.; Wagenaar, Allard; Compeer, Mathijs G.; Tordoir, Jan H.; Schurink, Geert W.; De Mey, Jo G.; Post, Mark J.

    2016-01-01

    Background Autologous arteriovenous (AV) fistulas are the first choice for vascular access but have a high risk of non-maturation due to insufficient vessel adaptation, a process dependent on nitric oxide (NO)-signaling. Chronic kidney disease (CKD) is associated with oxidative stress that can disturb NO-signaling. Here, we evaluated the influence of CKD on AV fistula maturation and NO-signaling. Methods CKD was established in rats by a 5/6th nephrectomy and after 6 weeks, an AV fistula was created between the carotid artery and jugular vein, which was followed up at 3 weeks with ultrasound and flow assessments. Vessel wall histology was assessed afterwards and vasoreactivity of carotid arteries was studied in a wire myograph. The soluble guanylate cyclase (sGC) activator BAY 60–2770 was administered daily to CKD animals for 3 weeks to enhance fistula maturation. Results CKD animals showed lower flow rates, smaller fistula diameters and increased oxidative stress levels in the vessel wall. Endothelium-dependent relaxation was comparable but vasorelaxation after sodium nitroprusside was diminished in CKD vessels, indicating NO resistance of the NO-receptor sGC. This was confirmed by stimulation with BAY 60–2770 resulting in increased vasorelaxation in CKD vessels. Oral administration of BAY 60–2770 to CKD animals induced larger fistula diameters, however; flow was not significantly different from vehicle-treated CKD animals. Conclusions CKD induces oxidative stress resulting in NO resistance that can hamper AV fistula maturation. sGC activators like BAY 60–2770 could offer therapeutic potential to increase AV fistula maturation. PMID:26727368

  17. [A rare case of post-partum urethrovaginal fistula. Management of obstetric complications].

    PubMed

    Gołka, Karolina Agnieszka; Klasa-Mazurkiewicz, Dagmara; Milczek, Tomasz; Emerich, Janusz

    2008-01-01

    A rare case of a 22-year old patient with obstetric urethrovaginal fistula, resulting in urinary incontinence, has been reported in the following report The emphasis is put on a number of medical and social consequences related to the formation of the fistula. Authors have presented the diagnostic difficulties. The aim of the report is to draw attention to the probable complications following prolonged labour and the necessity of appropriate treatment.

  18. Transcatheter closure of coronary artery fistula using Guglielmi detachable coil

    PubMed Central

    Munawar, Muhammad; Siswanto, Bambang B.; Harimurti, Ganesha M.; Nguyen, Thach N.

    2012-01-01

    Background Coronary artery fistula (CAF) is a rare anomaly. Transcatheter CAF closure has been introduced using various materials, but only few data are available on the Guglielmi detachable coil (GDC). The advantage of using GDC for transcatheter CAF closure is more controllable, therefore much safer when compared to other coils. This report is about our experience in transcatheter closure of CAF using fibered GDC in our hospital. Methods & Results From 2002 to 2007, there were 10 patients with CAFs (age range: 28 to 56 year-old, 7 males) who underwent transcatheter CAF closure. There were a total of 19 CAFs which originated from right coronary (n = 5), left circumflex (n = 3), left anterior descending artery (n = 10) and left main trunk (n = 1). Median number of coil deployment for each fistula was 3 (range: 1 to 6). The pulmonary artery was the most common site of the distal communication of CAFs (n = 14), followed by right atrium (n = 3), left atrium (n = 1) and left ventricle (n = 1). Immediate coronary angiography after GDC deployment revealed no residual shunt in 12 (63.2%) CAFs, significant reduction of the flow in 5 (26.3%), while 2 (10.5%) could not be closed due to small size. Nine (90%) patients underwent a repeated angiography within 3 to 8 months. Among 12 CAFs that were occluded immediately post-deployment, there were 2 CAFs with insignificant residual flow. Among 6 CAFs with significantly decreased flow immediately post-deployment, 2 were occluded totally in the follow-up angiography. In total, 12 (70.5%) CAFs were occluded completely and 5 (29.5%) CAFs still had insignificant residual flow, which did not need any additional coil deployment. During a mean follow up of 4.3 ± 0.7 year, all patients remained symptom and complication free. Conclusions The fibered GDC is a safe and effective method for percutaneous closure of the CAFs. PMID:22783318

  19. Discharge with Pancreatic Fistula after Pancreaticoduodenectomy Independently Predicts Hospital Readmission.

    PubMed

    Mosquera, Catalina; Vohra, Nasreen A; Fitzgerald, Timothy L; Zervos, Emmanuel E

    2016-08-01

    Readmission rates after pancreaticoduodenectomy (PD) are among the highest of any surgical procedure. The purpose of this study was to identify those factors present at discharge that may predict readmission after PD. All patients undergoing PD between 2010 and 2015 at a very high (>35 PD/year) volume center were entered into a prospective database. Twenty factors present at discharge from index admission identified on univariate analysis were subjected to multivariate analysis to identify those independently predictive of 30-day hospital readmission. A total of 220 patients underwent PD during the study period, 88 per cent of which had cancer. Mean age was 64.4 ± 11.7 years with slight male preponderance (54.5%) and significant African American representation (33.2%). Surgical complications occurred in 67.3 per cent of patients the most common of which included infectious/leak (30%), gastrointestinal (29%), cardiorespiratory (13%), other (13%), minor complications (7%), multi system failure (5%), and new onset diabetes (3%). The 30-day readmission rate was 27.3 per cent and was due to infection (89%), failure to thrive (32%), nausea/vomiting (15%), or other (15%). On multivariate analysis, presence of pancreatic leak/fistula at discharge was the only significant predictor of readmission, present in 62.5 per cent of all readmitted patients (P = 0.001). Comorbidities, length of stay, insurance status, obesity, smoking, and discharge to a care venue other than home did not predict readmission. Patients manifesting pancreatic fistula after PD are at high risk for hospital readmission. Enhanced scrutiny regarding suitability for discharge should be exercised in these patients and measures taken to minimize readmission whenever possible. PMID:27657584

  20. [Aorto-enteric and paraprosthetic fistulas. Apropos of 5 cases].

    PubMed

    Glock, Y; Bouissou, E; Tasrini, J; Fourtanier, G; Fournier, D; Puel, P

    1984-05-01

    Five cases of aorto-enteric fistula (AEF) are reported. The first case was a primary AEF from rupture of the infrarenal section of the abdominal aorta treated successfully by an obliteration and graft. The second patient had a primary AEF from rupture of an abdominal aorta aneurysm, complicated after an obliteration and graft of the primary AEF, requiring excision of the graft and an extra-anatomical shunt (EAS): healing following parenteral hypernutrition. The third case, a patient with a primary AEF from rupture of an aortic adventitial cyst in the left colon, died from septic complications. The fourth case died with heart rhythm disorders on the 4th day after resection and EAS for an aortic fistula. The fifth patient had a secondary AEF with cataclysmic digestive hemorrhage: excision of the graft with digestive closure and aortofemoral bypass did not prevent a fatal outcome on the 20 th day. Digestive hemorrhage and septic signs may be combined or occur as isolated complications. The most valid complementary investigation is fibroscopy, bacteriological culture of arterial blood distal to the prosthesis having an orientation value. Ultrasound, computed tomography or Gallium scintigraphy imaging may detect a retroperitoneal abscess. Effective treatment of all aneurysms can prevent primary AEF and avoidance of infection and interpositioning of viable tissue between duodenum and anastomotic line reduce the risk of secondary AEF. Maximum chances of success require aggressive surgery: aortic ligature; excision of all septic material and duodenal closure or segmental digestive resection with discharge of proximal pocket. Lower limb ischemia is treated by insertion of an EAS.