1/11. Endovascular repair of aortojejunal fistula.A 64-year-old male with vascular occlusive disease involving multiple vessels is presented with a history of aortobifemoral bypass grafting and bilateral femoral false aneurysm surgery. More recently, he had cystectomy for bladder carcinoma and repeated urinary stents and sepsis. Gastrointestinal bleeding developed due to the aortic graft anastomotic false aneurysm eroding into the distal jejunum. Endograft placement stabilized the critical situation and served as a bridge to a safer, more elective resection of the previous graft, the false aneurysm, and the endograft with closure of the jejunum.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. A case of fistula of the right common iliac aneurysm to the appendix.We report a very rare case of spontaneous ilioappendicial fistula with right common iliac aneurysm. After the aneurysm was opened, afferent and efferent vessels were closed following extraanatomical femorofemoral bypass, and the appendectomy was performed. The wall of the aneurysm showed the atherosclerotic change and histologic study of the appendix confirmed the diagnosis of acute appendicitis. Enhanced computed tomography was useful for the diagnosis and the extraanatomical bypass was deemed the most effective operative strategy. The pathogenesis of the fistula was surmised to be related to the appendicitis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Acute acalculous cholecystitis associated with cholecystoduodenal fistula and duodenal bleeding. A case report.Although acute acalculous cholecystitis (AAC) accounts for less than 10% of acute cholecystitis in the adult population, gangrene and perforation are much more frequent compared to the usual cases of acute cholecystitis (calculus cholecystitis). However, spontaneous biliary-enteric fistula is well recognized in AAC, 90% of which are cholecystoduodenal fistula (CDF) though it is an uncommon disorder. The majority of the CDF are caused by cholelithiasis. As patients are usually associated with complicated clinical illness, the diagnosis is often difficult to make and required surgery is often delayed. We have studied a rare complication of acute acalculous cholecystitis which was presented as intermittent upper gastrointestinal bleeding. Ulceration of the superficial branch of the cystic artery has been observed due to acalculous cholecystitis associated with a cholecystoduodenal fistula. We have performed a transfixing ligation of the bleeding vessel, cholecystectomy and simple closure of the CDF. We have finally made a diagnosis of early gallbladder cancer through a frozen section. There was no serious complication after the operation and the patient has achieved an uneventful recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Endovascular techniques in the management of acute arterioenteric fistulas.PURPOSE: To report the use of endovascular techniques to emergently treat hemorrhagic complications of rare arterioenteric fistulas. case reports: Two patients, a 71-year-old man and a 61-year-old woman, presented with acute bleeding arising from primary arterioenteric fistulas. In the first patient, a fistula between the iliac artery and the small intestine complicated laparoscopic treatment of acute appendicitis. In the second patient, irradiation of a metastatic cervical carcinoma led to a fistula between the right iliac artery and the terminal ileum. In both patients, the hemorrhage was controlled with implantation of a Jostent Peripheral Stent-Graft. The man is alive at 3 years with a patent endograft, but the woman died 1 month after treatment from complications of tumor progression. CONCLUSIONS: Endovascular application of covered stents provides an alternative treatment, avoiding extensive surgery. In cases of neoplastic erosion of a large vessel, endovascular stenting can offer a palliative solution.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. Massive lower gastrointestinal bleeding after rejection of pancreatic transplants.BACKGROUND: This article highlights two cases of massive lower gastrointestinal bleeding in patients on dialysis after rejection of kidney-pancreas transplants. Patient 1 was a 34-year-old female with 27 years of type I diabetes, who had a kidney-pancreas transplant in 1996, which was complicated by rejection of the kidney and pancreas in 2000 and 2002, respectively. Later in 2002, she presented in shock after experiencing cramping abdominal pain and passage of large bloody stools. Patient 2 was a 38-year-old male with 26 years of type I diabetes, who had a pancreas-kidney transplant in 1998, which was complicated by rejection of the kidney and pancreas in early 2003. He presented in late 2003 with a single episode of coffee-ground emesis and two episodes of brisk hematochezia. INVESTIGATION: Arterial angiography. diagnosis: Pseudoaneurysm and small-bowel fistula from the arterial supply to the transplanted pancreas. MANAGEMENT: Angiographic embolization of the aneurysmal vessel and fistula achieved hemostasis. Patient 1 did not have her transplanted organ surgically removed and suffered a recurrent massive lower gastrointestinal bleed that proved fatal. In Patient 2, subsequent surgery and removal of the rejected pancreas was performed and the patient continues to do well.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/11. Post-traumatic pseudoaneurysm of the left hepatic artery initially appearing as upper gastrointestinal hemorrhage secondary to hepatic artery-duodenal fistula. A case study.Post-traumatic hepatic artery pseudoaneurysm initially appearing as upper gastrointestinal hemorrhage secondary to rupture in the duodenum is rare. diagnosis was made on selective arteriogram and the patient was managed successfully by ligating the feeding vessel to the aneurysm.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Massive bleeding due to arterial-enteric fistula from an ingested toothpick.A 62-year-old man developed massive lower gastrointestinal tract bleeding. Upper endoscopy and superior mesenteric arteriography initially failed to disclose a cause of bleeding. On rebleeding, intra-arterial vasopressin infusion during repeated arteriography caused reflux of dye into the iliac vessels to allow visualization of an arterial-enteric fistula. Exploratory laparotomy subsequently revealed perforation of the small bowel and common iliac artery by a toothpick which had been swallowed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/11. renal artery graft-to-duodenum fistula: unusual presentation of a recurrent flank abscess.Perhaps the most devastating complication of a prosthetic vascular graft is the formation of an aortoenteric fistula. Most reports have dealt with fistulas between the aortic graft and the duodenum, although any revascularized vessel with prosthetic material can be the site of an enteric fistula. We report an unusual case in which a renal artery previously revascularized with a silk prosthetic graft developed a fistula to the duodenum 16 years later. Whether the prosthetic graft is in the aortic position or to a visceral vessel, when a fistula develops the only acceptable treatment is complete removal of the graft and revascularization with autogenous tissues, if necessary.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
9/11. Massive rectal bleeding from colonic fistula in pancreatitis.Two cases of massive hematochezia from pancreatitis-associated colonic fistulae occurred. diagnosis was made by arteriography; prompt surgical intervention ensued and both patients recovered. This rare complication of pancreatitis should be considered in every patient with rectal bleeding and a history consistent with pancreatitis, especially when an abdominal mass is present. Contrast enema examinations may help to make the diagnosis, but visceral arteriography is preferred because it defines the source of bleeding and guides the operative plan. The minimal surgical treatment consists of ligating bleeding vessels, debriding necrotic tissue, widely draining the peripancreatic space, and creating a totally diverting colostomy. All involved organs should be resected when technically feasible, since this eliminates abnormal tissue and minimizes the chances that hemorrhage will occur.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Indications for exploring the retroperitoneal space.The retroperitoneal space is an area that deserves consideration in patients with serious bleeding problems. This area should be explored in all patients with a history of previous reconstructive vascular surgery of the abdominal aorta and iliac vessels and who subsequently present with gastrointestinal hemorrhage. It should also be considered for exploration in patients presenting with serious bleeding problems when the bleeding site cannot be identified and the area in which blood is accumulating cannot be detected. We present three cases in which early adequate exploration of the retroperitoneal space would have been beneficial to the patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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