1/235. Mucin-producing biliary papillomatosis associated with gastrobiliary fistula. We report a case of mucin-producing biliary papillomatosis in a 78-year-old woman. Abdominal ultrasound (US) and computed tomography (CT) showed wall thickening and dilatation of the intrahepatic bile duct (IHBD), as well as a nodular lesion, 1.2 cm in diameter, in the left branch of the IHBD. Gastric endoscopy revealed excretion of bile-containing mucin on the anterior wall of the body of the stomach. Endoscopic ultrasonography (EUS) showed gastrobiliary fistula and discharge of mucin into the stomach. Needle biopsy of the biliary tumor revealed papillary proliferation, but no malignant cells were recognized histologically. Therefore this patient was diagnosed as having mucin-producing biliary papillomatosis forming gastrobiliary fistula. She did not present with obstructive jaundice, probably because of the fistula. She is alive, without obstructive jaundice, 16 months after the diagnosis without having had surgery. This is, to our knowledge, the first reported case of biliary papillomatosis forming gastrobiliary fistula and with the patient free of obstructive jaundice. ( info) |
2/235. Gastric tuberculosis: unusual presentations in two patients. We report two cases of gastric tuberculosis (TB) in Nigerians. The first case concerns an elderly man initially thought to have abdominal malignancy but was subsequently found to have extensive and complicated gastric TB coexisting with chronic peptic ulcer disease. The second case involved the extremely rare condition of gastro-bronchial fistula in a young woman. In contrast to previously reported cases, it was of tuberculous origin and pulmonary symptoms were minimal. Both cases were radiologically evident. ( info) |
3/235. Successful surgical treatment of aortogastric fistula after an esophagectomy and subsequent endovascular graft placement: report of a case. An aortogastric fistula is a rare but fatal complication after an esophagectomy and intrathoracic esophagogastric anastomosis. A 54-year-old man underwent an esophageal resection due to carcinoma in his lower esophagus. The alimentary tract continuity was restored by intrathoracic esophagogastric anastomosis. Forty-six days later, he suffered a massive hematemesis due to an aortogastric fistula which had formed at the esophagogastric suture line. The fistula was surgically obliterated twice, but each operation was followed by pseudoaneurysm formation. The patient was finally successfully treated with an endovascular stent graft placement. This is the first report of a patient surviving after developing this complication. ( info) |
4/235. Gastrojejunal fistula after insertion of percutaneous endoscopic gastrostomy. The authors report the case of a 12-year-old boy with cystic fibrosis, in whom a percutaneous endoscopic gastrostomy device migrated into the jejunum, forming a gastrojejunal fistula. ( info) |
5/235. Gastric tube-to-tracheal fistula closed with a latissimus dorsi myocutaneous flap. A gastric tube-to-airway fistula is a very rare complication after esophageal reconstruction. A patient with a gastric tube-to-tracheal fistula that developed more than 9 years after surgery for cancer of the cervical esophagus was treated with transposition of a pedicled latissimus dorsi myocutaneous flap. Careful perioperative respiratory management helped save the patient's life. ( info) |
6/235. Complete recovery after spontaneous drainage of pancreatic abscess into the stomach. Pancreatic abscess is a dreaded complication of acute pancreatitis, with a high death rate even with aggressive surgical treatment. We report two cases in which recovery followed spontaneous drainage into the stomach. A 75-year-old woman with biliary pancreatitis and a 63-year-old man with ethanol-induced pancreatitis both developed pancreatic abscess, diagnosed by computed tomography scans and ultrasound. The spontaneous gastric fistula was heralded by a large emesis of purulent and necrotic material in one case and copious nasogastric tube secretions of a similar material in the other. Defervescence was immediate, and both patients went on to complete recovery without any further interventions. Contrast studies showed the fistulae. It is concluded that in the event that a pancreatic pseudocyst spontaneously drains into the stomach a 'wait and see' policy should be adopted, and a favorable outcome can be expected. ( info) |
7/235. Gastrocolic fistula due to adenocarcinoma of the colon: simulation of primary gastric leiomyosarcoma on CT. This article describes the CT findings in two patients with adenocarcinoma of the colon and gastrocolic fistula which simulated the classic appearance of gastric leiomyosarcoma on CT. The role of CT in the diagnosis of gastrocolic fistula is also discussed. ( info) |
8/235. Double pylorus: a complication of chronic gastric ulcer? A case of double pylorus with a chronic ulcer in one of the two channels is described. The patient, a middle-aged man with active rheumatoid arthritis, required partial gastrectomy to allow continued treatment of the arthritis with anti-inflammatory drugs. Detailed histological examination of the surgical specimen revealed features consistent with intramural penetration of an ulcer across the pyloric ring, resulting in a gastro-duodenal fistula. The findings provide further support for the hypothesis that the double pylorus is an acquired lesion, which occurs as an uncommon complication of chronic peptic ulcer. ( info) |
9/235. Gastric perforation presenting as bilateral scrotal pneumatoceles. Although processus vaginalis is patent in the majority of newborn infants, the expression of an intraabdominal pathology such as gastrointestinal perforation or bleeding in the scrotum is very rare. In a large percentage of neonates with the gastrointestinal perforation, pneumoperitoneum is absent. In any case, it may not be detected in early radiographs. We report a newborn baby who presented with bilateral scrotal pneumatoceles as a first sign of pneumoperitoneum due to gastric perforation. Plain x-ray of the abdomen was normal except for pneumoscrotum, but contrast study revealed gastric perforation. ( info) |
10/235. Ascending cholangitis as a cause of pyogenic liver abscesses complicated by a gastric submucosal abscess and fistula. Ruptures of nonamebic (pyogenic) liver abscesses into the thorax and peritoneum are very uncommon; but, hepatoduodenal and hepatocolonic fistulas are ever more rare. We report a case where ascending cholangitis was associated with pyogenic liver abscess formation and a gastric fistula. drainage into the stomach was demonstrated by gastroduodenal endoscopy for gastric bleeding. After fistula formation, we could successfully treat the inflammation caused by infection of citrobacter freundii and candida albicans with intravenous infusion of both antibiotic and antifungal agents. ( info) |