11/177. A case of aortoduodenal fistula occurring after surgery and radiation for pancreatic cancer.The patient was a 58-year-old woman given curative treatment (pancreatectomy (body and tail) intraoperative irradiation (25 Gy)) on the basis of a diagnosis of pancreatic carcinoma. Having a favorable postoperative course, she was discharged 24 days after surgery. A week after discharge, she was readmitted for a hemorrhagic gastric ulcer. She was later discharged again on conservative treatment, and followed up at the outpatient clinic, but nine months postoperatively, was readmitted complaining of loss of appetite and abdominal pain. Subsequent tests revealed stricture of the horizontal portion of the duodenum with distension oral to the stricture. Around the celiac artery, the paraaortic lymph nodes were swollen, and a diagnosis of stricture due to recurrent pancreatic carcinoma was made. On the day before bypass surgery was scheduled, the patient vomited blood, so the operation was postponed, conservative treatment such as blood transfusion was administered, and emergency angiography was performed simultaneously. The findings were an aortic pseudoaneurym 1 cm in diameter immediately below the origin of the superior mesenteric artery and between the left and right renal arteries, and a hemorrhage, caused by an aortoduodenal fistula, issuing from the horizontal portion of the duodenum. hemostasis via a laparotomy was judged difficult, and so an indwelling stent-graft in the aorta was tried to stanch the blood, but without success. Another stent then had to be inserted within the first, thus stopping the flow, but the blood supply to the celiac artery, the superior mesenteric arteries and the renal arteries was impaired, and the patient died about six hours later. Postmortem examination revealed aortoduodenal fistula without recurrence of the carcinoma. The duodenal wall around the fistulous tract showed delayed radiation changes with deep ulceration. The intraoperative radiation may have played an important part in the formation of the fistula.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
12/177. The endoscopic diagnosis of an aortoduodenal fistula.An aortoduodenal fistula is a serious complication of aortic reconstructive surgery. This artile describes a case in which the diagnosis of an aortoduodenal fistula was made by upper gastrointestinal endoscopy. The endoscopic finding of a vascular prosthesis within the duodenum allowed immediate surgical intervention and control of the gastrointestinal hemorrhage.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
13/177. Stent-graft treatment for bleeding from a presumed aortoenteric fistula.PURPOSE: To describe a technique for the endovascular treatment of aortoenteric fistula. methods AND RESULTS: A 67-year-old man who had undergone aortobi-iliac grafting for aneurysmal disease 8 years previously presented with life-threatening upper gastrointestinal hemorrhage. endoscopy after resuscitation did not identify the source of the bleeding. Computed tomographic (CT) scanning and angiography revealed pseudoaneurysm formation at the upper anastomosis 1 cm below the renal arteries. Measurements were taken for endovascular repair. Uncomplicated emergency aortic endografting for exclusion of the pseudoaneurysm was performed using a 28-mm x 3.75-cm AneuRx device. gastrointestinal hemorrhage ceased. CT scanning at 6 months confirmed the absence of a pseudoaneurysm, and the patient remains symptom free at 18 months. CONCLUSIONS: Endovascular treatment of aortoenteric fistula may represent a technique for treating gastrointestinal hemorrhage and for lessening the morbidity and mortality of open repair.- - - - - - - - - - ranking = 0.23379710289829keywords = upper (Clic here for more details about this article) |
14/177. Endovascular repair of a presumed aortoenteric fistula: late failure due to recurrent infection.PURPOSE: To describe a case of presumed aortoduodenal fistula that was treated by endovascular implantation of a stent-graft. methods AND RESULTS: A 76-year-old man was transferred from another hospital where he had been treated for upper gastrointestinal hemorrhage over a 2-month period. Ten years previously, he had undergone aortobifemoral bypass, the right limb of which recently thrombosed. At the time of transfer, computed tomographic scanning showed a large false aneurysm between the aorta and the duodenum. endoscopy disclosed mucosal erosions in the fourth portion of the duodenum. Following implantation of 2 overlapping stent-grafts, the bleeding ceased and the false aneurysm disappeared. At no time did the patient have a fever. The patient initially did well, but 8 months after treatment, he presented with fever and chills. Recurrent infection had caused erosion of the aorta so that a large portion of the stent-graft was visible from the duodenum. The infected graft and stent-grafts were removed in a two-part operation, from which the patient recovered satisfactorily. CONCLUSIONS: Endovascular stent-grafts may have a role to play in the management of aortoduodenal fistula, if only as a temporary measure to control bleeding.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
15/177. Endovascular repair of an aortoenteric fistula in a high-risk patient.PURPOSE: To describe the endovascular repair of an aortoenteric fistula in a high-risk patient. methods AND RESULTS: A Vanguard tube stent-graft was deployed at the upper anastomotic suture line of a secondary aortoenteric fistula, successfully sealing the communication between the aorta and the third part of the duodenum without occlusion of the renal arteries. CONCLUSIONS: Endovascular stent-graft repair of aortoenteric fistulae is possible, but further evaluation of this technique will determine its role in the management of this complication.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
16/177. Infected pancreatic pseudocysts with colonic fistula formation successfully managed by endoscopic drainage alone: report of two cases.Fistulization of pancreatic pseudocysts into surrounding viscera is a well-known phenomenon and usually requires surgical management. We report two cases of pancreatic pseudocysts that developed spontaneous fistulas to the colon with resulting fever and abdominal pain. The patients were managed nonoperatively with a combination of endoscopic drainage and antibiotics, and their pseudocysts and fistulas resolved. The patients have remained symptom-free for a mean of 14 months of follow-up.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
17/177. Upper gastrointestinal hemorrhage secondary to erosion of a biliary Wallstent in a woman with pancreatic cancer.A 77-year-old patient with unresectable pancreatic adenocarcinoma sustained a life-threatening, upper gastrointestinal hemorrhage 1 month after placement of a biliary Wallstent. Radiographic and endoscopic studies revealed a choledocho-arterio-enteric fistula caused by erosion of the stent through the posterior duodenal wall. The patient was treated successfully with arterial embolization. This represents an unusual case of arterial bleeding with choledocho-arterio-enteric fistulization into the duodenum subsequent to biliary stent erosion.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
18/177. Ileovesical fistula. Failure of T.P.N. role of oral 14C PEG (polyethylene glycol) and charcoal in diagnosis.A patient with regional enteritis presenting with symptoms of fecaluria and pneumaturia is presented. Most of the established technics such as upper gastrointestinal series, cystography, cystoscopy and colonoscopy failed to demonstrate the fistula in this patient. 14C PEG as a nonabsorbable marker was given by mouth and a seven-fold increase in the counts at the fourth hour of urine collection confirmed the presence of an ileovesical fistula. This increase in counts was not seen when 14C PEG test was repeated after closure of this fistula surgically and was also not seen in a similar disease control patient and a healthy normal volunteer. Total parenteral nutrition with intralipids, Freamine II and glucose given in a peripheral vein for 45 days failed to close this fistula.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
19/177. Primary aortoenteric fistula in the Emergency Department.A primary aortoenteric fistula is a rare, life-threatening cause of gastrointestinal bleeding. Primary aortoenteric fistula results most commonly from an abdominal aortic aneurysm, with the fistula forming most often between the aorta and the third portion of the duodenum. Often, the classic triad of abdominal pain, gastrointestinal bleeding, and pulsatile mass is absent. A heraldic bleed frequently precedes lethal exsanguination from a primary aortoenteric fistula. Patient survival is dependent on prompt diagnosis and emergent therapeutic laparotomy.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
20/177. Duodenal tuberculosis with a choledocho-duodenal fistula.A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.- - - - - - - - - - ranking = 0.11689855144915keywords = upper (Clic here for more details about this article) |
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