1/12. Secondary aortoduodenal fistula.Secondary aortoenteric fistula (SAF) is now recognized as an uncommon but exceedingly important complication of abdominal aortic reconstruction. The complication often occurs months to years after the original surgery. The main clinical manifestation of the disease is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. The mortality is high if no prompt operation. We present a case of secondary aortoduodenal fistula (SADF) found 20 days after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. Even immediate exploratory laparotomy was performed, the patient died 48 hrs after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with SAF will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life-threatening event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Appendicovesical fistula in childhood: a rare complication of ruptured appendix.The diagnosis of appendicovesical fistula is difficult and usually delayed. This is most unfortunate, since surgery is uniformly successful. The case we report reemphasizes the diagnostic value of the rectal examination, intravenous pyelogram, and foiding cystogram in a child with subacute or chronic abdominal pain. Only an awareness of this condition on the part of the attending physician will lead to prompt diagnosis and definitive therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. Bouveret's syndrome: revisiting gallstone obstruction of the duodenum.Bouveret's syndrome is obstruction of the duodenum secondary to an impacted gallstone, usually without the presence of pneumobilia. With the steadily increasing life expectancy, greater numbers of these cases are being seen. gallstones enter the gastrointestinal tract following fistula formation between the gallbladder and an adjacent hollow viscus and may cause obstruction at any point along the intestinal tract. duodenal obstruction is the least common and represents only a very small percentage of cases. The presenting signs of nausea vomiting, abdominal cramping, and the absence of abdominal distension should alert the clinician to pathology in the proximal small bowel. The purpose of this report is to heighten the awareness of the primary care physicians, emergency room doctors, and surgeons to this diagnosis in elderly patients so that it can be included in the differential with the usual causes of gastric outlet obstruction--including ulcer disease; neoplasm; gastric volvulus; and other enteroliths, such as bezoars. early diagnosis is critical, as these cases require urgent surgical intervention. Early resuscitation, diagnosis, and treatment are essential for a successful outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/12. Clasp knife in the gut: a case report.BACKGROUND: A wide range of foreign bodies has been retrieved from the gut and reported. The presentation may be in the form of complications like intestinal obstruction, perforation and formation of abscesses etc but there is no case report of a half open clasp knife being retrieved from the ileum, the patient having thrived, in spite of its presence for a period of eight months. CASE PRESENTATION: A 30-year-old administrative clerk had undergone emergency abdominal surgery eight months previously under mysterious circumstances at a remote district hospital and had recovered completely. Later the blade of a knife was accidentally detected when an X ray of the abdomen was done during a routine follow-up visit to his family physician. Surgery revealed a clasp knife in the ileum, which was retrieved. The presence of an entero-enteric fistula short circuiting the loop was the secret of his earlier survival. CONCLUSIONS: To the best of our information this is the first case-report of a clasp knife in the gut and of the patient thriving in spite of its presence. We report here the dramatic sequence of events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Retroperitoneal perforation of the colon caused by colonic tuberculosis: report of a case.We present a 25-year-old, hiv-negative patient from kosovo, with no significant past medical history, who was admitted to a local hospital for nonspecific upper abdominal discomfort. He was transferred to us after a retroperitoneal mass with contact to the right colonic flexure had been found during workup. colonoscopy demonstrated an edemateous area with a central fistula in the right flexure, and histology showed caseous necrosis. Although neither bacteriology nor histology could detect any germs, gastrointestinal tuberculosis seemed to be very probable. laparotomy with a segmental resection of the colon was performed to remove the fistula-bearing segment, and histologic examination of the resected specimen confirmed the intraoperative suspect of a retroperitoneal colonic perforation. Again, all cultures from the specimen were negative for tuberculosis, but polymerase chain reaction of a regional lymph node revealed acid-fast bacilli of the mycobacterium tuberculosis/bovis species. Although the patient had no other sites of tuberculosis infection like pulmonary or urinary, he received adjuvant standard tuberculosis treatment for six months. At control examination one year after the operation, the patient was free of recurrence and in very good general condition. We report this extremely rare presentation of gastrointestinal tuberculosis to sensitize physicians to tuberculosis again, because incidence rates are increasing and this disease will certainly play a more important role in the future.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/12. Simultaneous gastropleural and gastrocolic fistulae in a quadriplegic male.A 56-year-old, quadriplegic man presented to a physician's office with a large, left pleural effusion. He subsequently was found to have a gastropleural and gastrocolic fistula. These two very rare complications of benign peptic ulcer disease are discussed with special reference to patients with profoundly altered sensation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/12. Retained surgical sponge after laparotomy. Unusual presentation.Erosion of a retained surgical sponge into the intestine is an unusual occurrence and may make its appearance months or years later. The demonstration of a distended bowel by the barium-impregnated mass with multiple polypoidal filling defects in a patient who has undergone previous laparotomy should lead the physician to suspect a retained surgical sponge. Surgical intervention is rewarding.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/12. Cholescintigraphic diagnosis of cholecystocolic fistula.The diagnosis of a cholecystocolic fistula has often presented a dilemma to the practicing physician. Routine imaging modalities to confirm this diagnosis have not proven extremely successful. The presence of a small fistulous tract from the gallbladder to the colon is often difficult to demonstrate radiographically. However, with the advent of the newer hepatobiliary radioisotopic scanning agents, the ability to visualize the intrahepatic and extrahepatic bile ducts as well as the presence of the intestinal activity of the radiotracers has improved considerably. The authors present a case of cholecystocolic fistula that was adequately demonstrated with a Tc-99m-PIPIDA hepatobiliary scan. This article is the first to report demonstration of this type of fistula with hepatobiliary scanning.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/12. Flexible video vaginoscopy and its use in enterovaginal fistulas.The demonstration of the pathway of enterovaginal fistulas has been challenging physicians since first described. This case demonstrates a new method for elucidating the tract pathway via flexible vaginoscopy, the use of catheters for endoscopic retrograde cholangiopancreatography, and plain films of the pelvis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/12. Spinal epidural abscess complicating an ileal J-pouch-anal anastomosis. Report of a case.A 42-year-old man developed recurrent epidural abscesses from an enteroepidural fistula arising from a J pouch. Lower-extremity neurologic deficit in patients with an ileal pouch-anal anastomosis should alert the physician to this rare complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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