Exclusion Of Fistula Research Articles

Unusual presentation of congenital chloride diarrhea mimicking colovesical fistula: a case report and literature review

Background: Congenital chloride diarrhea (CCD) is a rare autosomal recessive condition characterized by lifelong watery diarrhea. CCD is challenging to diagnose because of its severe clinical presentations and differentials. Therefore, it is crucial to be diagnosed early and receive appropriate management as it causes early death if left untreated or due to complications. Case Report: A Saudi newborn baby boy was passing a large amount of urine through the anal canal and was otherwise healthy. He was referred to our center with a high suspicion of a colovesical fistula. Diagnosed with CCD by the exclusion of fistula after confirmation with contrast study. Conclusion: This case highlights an unusual presentation of CCD mimicking a colovesical fistula. To the best of our knowledge, no similar case has been reported in the literature, and we believe this is the first Saudi case of CCD mimicking a colovesical fistula. It underscored the diagnostic challenges of this rare disorder and emphasized the importance of early recognition and accurate diagnosis to prevent such complications.

Unusual presentation of congenital chloride diarrhea mimicking colovesical fistula: a case report and literature review

Background: Congenital chloride diarrhea (CCD) is a rare autosomal recessive condition characterized by lifelong watery diarrhea. CCD is challenging to diagnose because of its severe clinical presentations and differentials. Therefore, it is crucial to be diagnosed early and receive appropriate management as it causes early death if left untreated or due to complications. Case Report: A Saudi newborn baby boy was passing a large amount of urine through the anal canal and was otherwise healthy. He was referred to our center with a high suspicion of a colovesical fistula. Diagnosed with CCD by the exclusion of fistula after confirmation with contrast study. Conclusion: This case highlights an unusual presentation of CCD mimicking a colovesical fistula. To the best of our knowledge, no similar case has been reported in the literature, and we believe this is the first Saudi case of CCD mimicking a colovesical fistula. It underscored the diagnostic challenges of this rare disorder and emphasized the importance of early recognition and accurate diagnosis to prevent such complications.

Two-Stage Treatment of Enterocutaneous Fistulas

Aim: to determine the most efficient treatment of enterocutaneous fistulas.Materials and methods. Eighty-eight patients with intestinal fistulas underwent a two-stage treatment, including: the first stage — multicomponent therapy, the second stage — reconstructive surgery. Enterocutaneous fistulas were diagnosed in 61 patients, enteroatmospheric fistulas — in 26 patients, and combined fistula (enterocutaneous and enteroatmospheric) — in 1 patient.Results. All 88 patients underwent reconstructive surgery after the multicomponent therapy. Resection of the intestine with a fistula with the formation of an entero-entero anastomosis was performed in 72 (81.8 %) patients; marginal resection of the intestine with a fistula, followed by suturing of the defect — in 7 (8.0 %); resection of the intestine with fistulas in combination with excision and suturing of the fistula — in 5 (5.7 %); an operation aimed at disabling the fistula from the passage of intestinal contents — in 3 (3.4 %); resection of the intestine with a fistula in combination with fistula exclusion — in 1 (1.1 %) patient. Postoperative complications in the group of patients with enteroatmospheric fistulas occurred in 13 cases, in the group with enterocutaneous fistulas — in 25 patients. Three (3.4 %) patients with enterocutaneous fistulas died from complications unrelated to the underlying disease and surgical interventions.Conclusion. Two-stage treatment including multicomponent therapy (nutritional support, infection generalization control, local wound treatment) and reconstructive surgery allowed to reduce mortality rates to 3.4 %, which proves the effectiveness of this method.

Novel Treatment of Direct Carotid Cavernous Fistula with XCalibur Aneurysm Occlusion Device – A Case Report

To report a case of post-traumatic direct carotid-cavernous fistula (CCF) treated with Merlin’s XCalibur as a standalone treatment. XCalibur is a balloon mounted flow diverter covered with polymer biostable membrane. A single device was deployed across the rent which resulted in the complete exclusion of fistula. This is the second case of its kind to be reported for the treatment of post-traumatic direct CCF with an XCalibur device. The device proved to be effective and safe and did not require any additional coiling, thus this paper has immense value and benefit for the medical community at large as it displays a new technique being successfully used.

Abdominal drain amylase on the first day after pancreatectomy: a predictive factor for pancreatic fistula.

To analyze abdominal drain on the first postoperative day and evaluate its predictive nature for the diagnosis of Pancreatic Fistula exclusion, seeking to establish a cutoff point from which lower values demonstrate safety in excluding the possibility of this complication. From August 2017 to June 2020, data from 48 patients undergoing pancreatic resection were collected and analyzed from a prospective cohort. The patients were divided into two groups, one group consisting of patients who did not develop PF (Group A), and the other composed of patients who developed PF (Group B). The receiver operation characteristic curve was constructed, and cutoff points were evaluated by calculating sensitivity and specificity. Group A brought 30 patients together (62.5%) and Group B brought 18 patients together (37.5%). The 444 U/L value was the most satisfactory cutoff point for the receiver operation characteristic curve (CI 0.690-0.941), with a sensitivity of 94.4% and a specificity of 60%, thus being able to select 18 of 30 patients who did not succumb to PF. Abdominal drain on the first postoperative day can be used as a predictive factor in the diagnosis of PF exclusion (CI 0.690-0.941), with the value of 444 U/L being the best performance cutoff point.

Superior Mesenteric Arteriovenous Fistula

Arteriovenous fistulae between the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) are extremely rare; most are associated with abdominal trauma. A 47 year old woman who was diagnosed with extensive metastatic ovarian carcinoma presented with right sided low abdominal pain. She denied any history of abdominal surgery. Plain computed tomography (CT) showed bowel oedema. Intestinal vasculopathy was suspected. Contrast enhanced CT angiography revealed not only a hyperaemic bowel (white arrow), but also a fistula between the SMA (red arrow) and SMV (blue arrow; A and B). Endovascular fistula exclusion was recommended, but the patient declined further treatment.Image 1

Indocyanine Green Videoangiography “In Negative”

Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

Endovascular Aortic Occlusion for a Secondary Aorto-Enterocutaneous Fistula:44-Month Follow-up

To describe the durability of endovascular aortic occlusion as an alternative treatment of an aortoenteric fistula in a severely unstable patient. A 47-year-old patient with a history of numerous previous vascular reconstructions underwent surgical exclusion of a persistent aorto-enterocutaneous fistula originating from a former colostomy site in proximity with the occluded left leg of an aortobifemoral bypass. Nine weeks later, he presented in profound hypovolemic shock from bleeding via the cutaneous remnant of the fistula and gastrointestinal tract. Because of the severe shock, recent surgery, and lack of a suitable endograft for the small-caliber aorta (19 mm), endovascular exclusion of the fistula was undertaken by occluding the infrarenal aorta. Talent occluders were also placed in the right femoral bypass limb and the right common iliac artery. An extra-anatomical bypass was created to revascularize the lower extremities. The patient was discharged in good condition on day 20. The fistula spontaneously regressed after 12 months. Since the patient refused further surgery, 44-month follow-up is now available. There are no signs of reinfection or recurrent aortoenteric fistula. Endovascular occlusion of a small caliber aorta with extra-anatomical revascularization of the lower extremities may be considered a useful treatment alternative for an aortoenteric fistula in severely unstable or compromised patients, either as a bridge to open surgery or as a definitive treatment if signs of reinfection do not occur.

Giant bronchoesophageal fistula: A rare complication of bronchial artery embolization

Bronchoesophageal fistulas after bronchial artery embolization are rare. In the previous literature only 2 cases were recorded. Here we report treatment of a giant bronchoesophageal fistula on both the left and right bronchus. Our surgical treatment included fistula exclusion by esophageal diversion, and esophageal reconstruction was made by retrosternal stomach. The result was good, and the patient made a satisfactory recovery.

Fístulas carótido-cavernosas. Perspectivas de diagnóstico e terapêutica.

Even though in clinical practice carotid cavernous fistulas (CCF) are not a frequent pathology, it should be a diagnostic hypothesis in face of a suggestive clinical presentation. We intended to review the diagnosis and the therapeutics, comparing them with the actual perspectives. Files of 25 patients with the diagnostic hypothesis of CCF, confirmed by conventional angiography in the HSAC Neuroradiology Department, were reviewed. In this group of patients, (5 males and 20 females), the fistulous aetiology was spontaneous in 10 and traumatic in 15. Clinically the symptom most often presented was diplopia (23 cases) and the most frequent encountered sign was ophthalmoplegia (20 cases). Of the Neuroradiologic investigation, CT scan (done to all patients) have shown an prominent superior ophthalmic vein as the most frequent abnormality. Angiographic study was based on Lasjaunias et al protocol (Surgical Neuroangiography, Vol. 2, Springer-Verlag). Surgery was the therapeutic approach for the traumatic fistulas; only 2 of the spontaneous were treated by endovascular route. Three patients are still under observation. In all the others cases there was a fistula exclusion.

Tracheoesophageal Fistula from Carcinoma of the Esophagus

The records of the patients with tracheoesophageal fistula from carcinoma of the esophagus treated from 1970 to 1983 were reviewed to assess the length and quality of their survival. Twenty-four patients with malignant tracheoesophageal fistula were treated during this period. The site of the carcinoma was the middle third of the esophagus in 18 patients, the lower third in 5, and the upper third in 1. Three patients received only supportive treatment, and 1 had only radiation therapy. Nine patients underwent insertion of a Mousseau-Barbin or Celestin tube with or without gastrostomy, and 7 patients had gastrostomy alone. Four patients had exclusion of the tracheoesophageal fistula, 3 with esophagogastrostomy and 1 with colon interposition. The 3 patients who received only supportive treatment survived 5 days, 1 week, and 2 weeks. The 7 patients who had gastrostomy lived 3 days to 18 weeks (mean, 6 weeks). The 9 patients with a Mousseau-Barbin or Celestin tube lived 1 week to 6 months (mean, 8 weeks). The 4 patients who had exclusion of the tracheoesophageal fistula survived 5 weeks, 4 months, 7 months, and 26 months following operation. This study suggests that the treatment for patients with tracheoesophageal fistula from carcinoma of the esophagus should be individualized and that in selected patients, exclusion of the fistula with esophagogastrostomy improves the quality of life and prolongs survival.