Left Iliac Research Articles

Femoral to abdomen tunneling at the bedside for medium/long term venous access.

Femoral to abdomen tunneling of small-bore central venous catheters is a bedside technique for patients with contraindications to a thoracic approach, or as an alternative to a lower extremity catheter exit site. A femoral to abdomen tunneling technique was implemented for patients receiving medium and long-term intravenous treatments with contraindications to the thoracic venous approach or as an alternative to a lower extremity catheter exit site. All venous access devices were inserted with ultrasound guidance under local anesthesia, and catheter tip placement assessed by post procedural radiography. In this case series, from January 2020 to January 2023, a total of eight FTA-tunneled venous access devices were inserted. There were seven ambulatory patients and one bedbound patient. The median length of the subcutaneous tunnel was 20 cm, ranging from 15 to 27 cm. The median length of the intravenous catheter to the terminal tip was 31 cm, ranging from 23 to 40 cm. Tip location was confirmed by post-procedural abdominal radiograph. The catheter tip locations were interpreted to be at the level of T8-T9 (2), T12 (1), L4 (2), L2 (2), L1(1).No insertion or post insertion related complication was reported. Six patients completed the scheduled intravenous treatment. One patient was unable to be tracked due to transfer to an outside facility. One catheter initially demonstrated to be coiled over the left common iliac vessel was repositioned using a high flow flush technique. There was one reported catheter dislodgment by the nurse providing care and maintenance. The overall implant days were 961, with a median dwell time of 125 days ranging from 20 to 399 days. Femoral to abdomen tunneling provides an alternative exit site useful in select patients with complex intravenous access. The data of this small retrospective review suggests this a safe and minimally invasive bedside procedure.

Anteriorization of the Left Common Iliac Vein: A Novel Approach to Treating Young Patients with May-Thurner Syndrome

Anteriorization of the Left Common Iliac Vein: A Novel Approach to Treating Young Patients with May-Thurner Syndrome

Brucella anthropi infection in a 5-week-old infant

Congenital brucellosis in infants is well described but occurs rarely and very few cases have been reported till now. Acquired brucellosis in young infants has rarely been reported. A 5-week-old infant weighing 3340 gm, presented to the emergency with complaints of fever, abdominal distension, lethargy, and decreased feeding for five days. A clinical diagnosis of septicemia was made. Laboratory parameters were suggestive of septicemia. There was a history of ingestion of unpasteurized buffalo’s milk. Empirical antibiotics started after withdrawing the blood culture. Blood culture came positive for Brucella anthropi. Ultrasonography of the abdomen showed a small abscess in the left iliac fossa measuring 44×38 mm. The antibiotics were changed to piperacillin-tazobactam and amikacin as per the blood culture and sensitivity report. Supportive care was given, and the baby gradually improved. The child was discharged on oral rifampicin and trimethoprim-sulfamethoxazole for 4 weeks and is being followed up and is doing well. Young infants may acquire Brucella infection from breastmilk or ingesting unpasteurized animal milk. Prompt diagnosis and treatment is the key to management. Exclusive breastfeeding is the best way to prevent not only animal milk-acquired Brucella but most other types of infection.

Image-based assessment of aortoiliac aneurysm anatomical characteristics in patients from the global iliac branch study

ObjectiveEndovascular repair is the preferred treatment for aortoiliac aneurysm, with preservation of at least one internal iliac artery recommended. This study aimed to assess pre-endovascular repair anatomical characteristics of aortoiliac aneurysm in patients from the Global Iliac Branch Study (GIBS, NCT05607277) to enhance selection criteria for iliac branch devices (IBD) and improve long-term outcomes.MethodsPre-treatment CT scans of 297 GIBS patients undergoing endovascular aneurysm repair were analyzed. Measurements included total iliac artery length, common iliac artery length, tortuosity index, common iliac artery splay angle, internal iliac artery stenosis, calcification score, and diameters in the device's landing zone. Statistical tests assessed differences in anatomical measurements and IBD-mediated internal iliac artery preservation.ResultsLeft total iliac artery length was shorter than right (6.7 mm, P = .0019); right common iliac artery less tortuous (P = .0145). Males exhibited greater tortuosity in the left total iliac artery (P = .0475) and larger diameter in left internal iliac artery's landing zone (P = .0453). Preservation was more common on right (158 unilateral, 34 bilateral) than left (105 unilateral, 34 bilateral). There were 192 right-sided and 139 left-sided IBDs, with 318 IBDs in males and 13 in females.ConclusionThis study provides comprehensive pre-treatment iliac anatomy analysis in patients undergoing endovascular repair with IBDs, highlighting differences between sides and sexes. These findings could refine patient selection for IBD placement, potentially enhancing outcomes in aortoiliac aneurysm treatment. However, the limited number of females in the study underscores the need for further research to generalize findings across genders.

A case study of abdominal wall and limb necrotizing fasciitis: an extremely rare post -operative complication.

Infectious affections are the most frequent post-operative complications, the rate have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis. There is no well-codified treatment. A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. Two months after surgery, the patient presented with fever. Abdominal CT scan revealed a recto-vaginal fistula. The patient underwent a surgical evacuation of the collection and a bypass colostomy. Post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs and medial left leg's thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required and a ligature of the left external iliac vessels. Then she received palliative treatment.she died one month after surgery because of multivisceral failure due to sepsis. Necrotizing fasciitis is extremely rare and serious condition, the diagnosis is clinical and radiological, CT scan is helpful for the. There are predisposing factors such as diabetes, neoadjuvant radiotherapy or chemotherapy. The prognosis can be improved with rapid management and appropriate medical and surgical excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.

Disseminated Cryptococcus neoformans infection involving multiple bones and lung in an immunocompetent patient: a case report

BackgroundCryptococcal osteomyelitis is a rare and potentially serious condition, typically encountered in individuals with compromised immune systems. This case underscores the unusual occurrence of disseminated Cryptococcosis in an immunocompetent person, involving multiple bones and lungs, with Cryptococcus neoformans identified as the causative agent.Case presentationAn Indonesian man, previously in good health, presented with a chief complaint of successive multiple bone pain lasting for more one month, without any prior history of trauma. Additionally, he reported a recent onset of fever. On physical examination, tenderness was observed in the left lateral chest wall and right iliac crest. Laboratory findings indicated mildly elevated inflammatory markers. A computed tomography (CT) scan of the chest revealed an ovoid solid nodule in the right lower lung and multifocal osteolytic lesions in the sternum, ribs, and humeral head. A magnetic resonance imaging (MRI) study of the sacrum showed multiple lesions in the bilateral iliac bone and the lower L4 vertebral body. Confirmation of Cryptococcal osteomyelitis involved a fine-needle biopsy and culture, identifying Cryptococcus neoformans in the aspirate. The patient responded positively to targeted antifungal treatments, leading to a gradual improvement in his condition.ConclusionsThis case emphasizes the need to consider Cryptococcus neoformans osteomyelitis in immunocompetent patients with bone pain. A definitive diagnosis involves a fine-needle biopsy for pathology and culture, and prompt initiation of appropriate antifungal treatment has proven effective in preventing mortality.

Retrospective case-control study on radiation dose for uterine artery embolization procedures.

Uterine artery embolization is performed in pre-menopausal women. Understanding the contribution of radiation dose at each stage of the procedure is important for potential dose reduction. The aim was to retrospectively analyse radiation dose on a per-procedural-stage basis, comparing digital subtraction angiography (DSA) and conventional roadmap (CRM). Group A consisted of 50 patients where DSA was used for road mapping at all stages: (I) Aortogram, (II) Left internal iliac artery (IIA) DSA, (III) Left uterine artery (UA) DSA, (IV) Right IIA DSA and (V) Right UA DSA. Group B included 50 patients, where CRM was used for road mapping at stages (II) and (IV). For Group A, mean total dose-area product (DAP) was 39.7 Gy·cm2; mean DAP for each stage were (I) Aortogram = 3.4 Gy·cm2, (II) Left IIA DSA = 5.9 Gy·cm2, (III) Left UA DSA = 3.2 Gy·cm2, (IV) Right IIA DSA = 5.5 Gy·cm2 and (V) Right UA DSA = 3.0 Gy·cm2. For Group B, mean total DAP was 33.6 Gy·cm2, mean DAP for each stage were (I) Aortogram = 3.3 Gy·cm2, (II) Left IIA CRM = 1.5 Gy·cm2, (III) Left UA DSA = 3.3 Gy·cm2, (IV) Right IIA CRM = 1.5 Gy·cm2 and (V) Right UA DSA = 3.3 Gy·cm2. Fluoroscopy time was 10 and 9.4 min for Groups A and B, respectively. The highest road-mapping radiation dose contribution was from bilateral IIA DSA. The use of CRM, intermittent fluoroscopy and elimination of the aortogram is recommended to further reduce procedural radiation dose.

Unusual origins of cardiac insufficiency: a case of iliac arteriovenous fistula post-spinal disc surgery

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions.

Association of haemato-biochemical indices and blood composite ratios with microfilaridermia in Onchocerciasis patients

BackgroundOnchocerciasis causes chronic systemic inflammation. Several studies have used markers such as haemato-biochemical indices to predict the occurrence of systemic inflammation. This study assessed the variability and predictability of haemato-biochemical indices and blood composite ratios (BCRs) in microfilariae positive (MF+) and microfilariae negative (MF-) subgroups of onchocercomata participants.MethodsOne hundred and five (105) MF + and 34 MF- participants were retrospectively recruited into the study. Screening for the presence of O. volvulus microfilariae was done from skin snips taken from the left and right iliac crests of participants using established and approved protocols. Haematological and biochemical indices were measured using standard laboratory automated analyzers. Blood composite ratios (BCRs) were calculated as ratios of the absolute parameters involved.ResultsA significantly increased total WBC, absolute eosinophil, eosinophil percent and absolute basophil were observed in the MF + participants compared to MF- participants. Reduced gamma-glutamyl transferase (GGT) with increased estimated glomerular filtration rate (eGFR) was significantly associated with MF + participants compared to MF- participants. BCRs were significantly higher for eosinophil-to-neutrophil ratio (ENR), eosinophil-to-monocyte ratio (EMR), eosinophil-to-basophil ratio (EBR) and eosinophil-to-lymphocyte ratio (ELR) in MF + participants compared to MF- participants. After multivariate adjustment, onchocercomata participants with increased eosinophil counts (aOR = 13.86, 95% CI [2.07–92.90], p = 0.007), ENR x10 (aOR = 1.42, 95% CI [1.05–1.93], p = 0.025), EMR (aOR = 2.64, 95% CI [1.25–5.60], p = 0.011), EBR (aOR = 1.07, 95% CI [1.01–1.10], p = 0.020) and ELR x10 (aOR = 1.69, 95% CI [1.14–2.51], p = 0.009) were more likely to have microfilaridermia.ConclusionsElevated eosinophil counts with higher ENR, EMR, EBR and ELR levels are significantly associated with microfilaridermia in onchocercomata participants. Combining BCRs with eosinophil count significantly led to an improvement in the conventional model for predicting microfilaridermia.

In vivo evaluation of safety and performance of a tapered nitinol venous stent with inclined proximal end in an ovine iliac venous model

A tapered stent with inclined proximal end is designed for fitting the iliac anatomically. The aim of the present study was to evaluate the safety and performance of the new stent in ovine left iliac veins. The experiment was performed in 30 adult sheep, and one nitinol-based VENA-BT® iliac venous stent (KYD stent) was implanted into each animal’s left common iliac vein. Follow-up in all sheep consisted of angiographic, macroscopic, and microscopic examinations at Day 0 (< 24 h), Day 30, Day 90, Day 180 and Day 360 post-stenting (six animals per each time-point). 30 healthy ~ 50 kg sheep were included in this study and randomly divided into five groups according to the follow-up timepoint. All stents were implanted successfully into the left ovine common iliac vein. No significant migration occurred at follow-up. There is no statistically significant difference between the groups (p > 0.05), indicating no serious lumen loss occurred during the follow-up period. Common iliac venous pressure was further measured and the results further indicated the lumen patency at follow-up. Histological examinations indicated that no vessel injury and wall rupture, stent damage, and luminal thrombus occurred. There was moderate inflammatory cell infiltration around the stent in Day-0 and Day-30 groups with the average inflammation score of 2.278 and 2.167, respectively. The inflammatory reaction was significantly reduced in Day-90, Day-180 and Day-360 groups and the average inflammation scores were 0.9444 (p < 0.001, Day-90 vs Day-0), 1.167 (p < 0.001, Day-180 vs Day-0) and 0.667 (p < 0.001, Day-90 vs Day-0), respectively. The microscopic examinations found that the stents were well covered by endothelial cells in all follow-up time points. The results suggested that the KYD stent is feasible and safe in animal model. Future clinical studies may be required to further evaluate its safety and efficacy.

Tumoral Calcinosis (TC) of iliac Crest in a 70 year-Old Female: A Case Report

A seventy-year-old lady had a hard tumor mass in left sacroiliac region. She was operated. Biopsy was taken from the left iliac crest and histopathological examination was done. Tumor measured 3×2×2 cms approximately. It was chalky-white ball-like. Its surface was lobulated. Microscopically, it showed small and large areas of necrosis and calcification. Areas of mild-to-moderate lymphocytic infiltration were seen. Fibrosis and hyalinization were seen. Bony trabeculae and osteoid formation were also seen. The patient was finally diagnosed as a case of primary tumoral calcinosis of sacroiliac region. Keywords: Soft tissue calcification necrosis osteoid formation chronic inflammation

Double secondary aorto-enteric fistula: a case report

Introduction: Endoprothesis infections (EIs) are rare postoperative complications of endovascular procedures, with incidence ranging from 0.2% to 0.7%. Secondary aorto- enteric fistulas presents a mortality rate of approximately 60%, featuring more prevalence the association with the duodenum (70%) and displays a rare association when endovascular procedures are performed. Case report: This study reports the case of a 72-year-old male patient who developed a duodenal aorto-enteric fistula associated with a fistula in the sigmoid colon and left common iliac artery after undergoing by stent implantation for aortic aneurysm repair. Successful treatment and surgical correction was performed. Conclusion: Aorto-enteric fistulas after endovascular approach correspond to a rare complication with high mortality, being extremely important the early diagnosis and effective therapeutic approach.

Safety and quality of cystectomy and pelvic lymph node dissection after neoadjuvant durvalumab and cisplatin/gemcitabine.

To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle-invasive bladder cancer (MIBC) after neoadjuvant chemo-immunotherapy. The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open-label single-arm phase II trial including 61 cisplatin-fit patients with clinical stage (c)T2-T4a cN0-1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien-Dindo Classification. Data were analysed descriptively. A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo-immunotherapy. The median (interquartile range) number of lymph nodes removed was 29 (23-38). No intraoperative complications were registered. Grade ≥III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively. This study supports the surgical safety of RC and PLND following neoadjuvant chemo-immunotherapy in patients with MIBC. The extent and completeness of protocol-defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template.

Prolonged abdominal pregnancy incidentally discovered during cesarean section: a case report

BackgroundAbdominal pregnancy is a rare medical condition that is still missed in developing countries due to inadequate medical facilities. The clinical indicators manifest in various forms and are nonspecific, making it challenging to diagnose and often leading to delayed detection. However, obstetric ultrasound serves as an essential tool in early detection. Our objective was to share our experience dealing with this condition and emphasise the importance of early ultrasound diagnosis through efficient pregnancy monitoring in our regions.Case presentation35-year-old Black African woman who had ten months of amenorrhea sought consultation due to an absence of active foetal movements. Her pregnancy was of 39 weeks with fetal demise which was confirmed following clinical examination and ultrasound. She underwent cesarean section in view of transverse position of fetus. During cesarean section, the fetus was found within the abdominal cavity with the placenta attached over the left iliac fossa including surface of left ovary. The uterus and right adnexa were within normal limits. A 2600 g macerated fetus with placenta and membranes were extracted without any complications. The maternal outcome was successful.ConclusionsAbdominal pregnancy remained an inadequately diagnosed condition in developing countries. It is imperative to increase awareness among pregnant women regarding high-quality prenatal care, including early obstetric ultrasound, from conception. Meanwhile, healthcare professionals should receive continuous training and the technical platform modernised. To ensure accurate diagnosis, the location of the gestational sac must be identified for every pregnant woman during their initial ultrasound appointment.

Protocolo diagnóstico del dolor en fosa ilíaca izquierda

Abdominal pain located in the left iliac fossa (LIF) is one of the most frequent reasons for consultation in clinical practice. Its etiology is highly varied, as it includes diseases of gastrointestinal, gynecological, urological, and abdominal wall origin. The most frequent cause of pain in the LIF is acute diverticulitis. A detailed case history and a good physical examination are of enormous value in the diagnosis of this disease and, together with laboratory tests, allow for guiding the diagnosis. However, on occasion, they may need to be supplemented with imaging tests. Computed tomography is the imaging technique of choice for the diagnosis of non-gynecologic causes and ultrasound should be requested as the first line of diagnostic test in gynecologic disease. A plain x-ray has poor cost-effectiveness in this clinical scenario and its use must be limited to select circumstances, such as identification of foreign bodies ingested.

Biomechanical characteristics of arteries during pelvic fracture reduction and dynamic simulation analysis

During robot-assisted reduction of pelvic fracture, blood vessels are susceptible to tensile and shear forces, making them prone to injury. Considering the impact of pelvic reduction on the risk of arterial injury, the biomechanical characteristics of arteries during the pelvic fracture reduction process are studied, and a refined coupled composite model of the damaged pelvic structure is established. Dynamic simulations of pelvic fracture reduction are conducted based on the planned reduction path. The simulation results show that during the reduction process, when the affected side is rotated, the stress and strain of the artery are maximum, particularly at the locations of the iliac common artery, internal iliac artery, and the superior gluteal artery arch endure significant stress and strain. After reduction, the maximum stress is observed in the right superior gluteal artery, and the maximum strain occurs at the intersection of the right iliac common artery. The stretch ratio of both the left and right iliac common arteries is considerable. Therefore, it can be concluded that the superior gluteal artery and the internal iliac artery are prone to injury, particularly the segment from the origin of the superior gluteal artery to its passage around the greater sciatic notch. After reduction, substantial traction on the iliac common artery, which makes it more susceptible to deformation, carries a risk of arterial rupture and aneurysm formation. This study provides a reference for planning the safe reduction path of pelvic fracture surgery and improving safety.

Small Bowel Volvulus on Incomplete Common Mesentery in Adults with Rare Late Presentation: Report of a Case

Small bowel volvulus complicating incomplete common mesentery corresponds to an arrest in the 180° rotation of the primitive intestinal loop. The root of the mesentery is very short and the entire small intestine is pedunculated on the superior mesenteric artery. This situation carries a very high risk of small bowel volvulus and entero-mesenteric infarction. Acute volvulus requires emergency surgery; imaging should not delay surgical management. The surgical procedure consists of untwisting the volvulus (anticlockwise) and assessing the viability of the intestine. The intestine is stored in the position of complete common mesentery: coetus in the left iliac fossa. We report the observation of a 24-year-old patient admitted for small bowel volvulus on incomplete common mesentery, operated on as an emergency with a favourable postoperative outcome.

Atypical May-Thurner Syndrome Caused by Large Lumbar Osteophyte

AbstractAn 82-year-old man presented to the emergency department with intermittent left lower extremity swelling for the last 4 to 5 months that limited his daily activities. The patient had a negative lower extremity venous duplex 3 months prior and had been treating symptoms with compression stockings but experienced no improvement. Venography showed venous outflow obstruction in his left common iliac vein and the etiology was confirmed to be a lumbar vertebral osteophyte compressing the vein. The patient underwent endovascular treatment with balloon venoplasty and stent placement over the lesion with return of adequate outflow. This report describes treatment of symptomatic left common iliac venous compression with endovascular therapy alone.

Acute Intestinal Obstruction Due to a Foreign Body Migrated into the Abdomen after a Clandestine Abortion Almost 20 Years Ago

Acute intestinal obstruction caused by a foreign body is no longer a rare phenomenon, especially if the latter is found in the digestive tract. However, the migration of an extradigestive foreign body as a cause of obstruction is extremely rare. We report the case of a 60-year-old female patient seen urgently on September 5, 2023 at 3:00 p.m. at the District Hospital of Commune IV of Bamako with the diagnosis of acute intestinal obstruction. Intraoperatively we noted grélo-uterine, grélo-sigmoid adhesions and bands tying the terminal ileum with significant intestinal dilatation upstream without signs of necrosis. Also a foreign body (tubing of a serum infuser) rigid curved of approximately 40 cm was located between the loop. The procedures performed were: adhesiolysis, sectioning of the flanges, extraction of the foreign body, toileting and installation of a Redon drain in the Douglas cul de sac. The in-depth postoperative questioning revealed a notion clandestine abortion in 2003 by a nurse in a country in the sub-region, leaving an infusion tube in place for a few hours. And she was supposed to go in the next day for a check-up, but she didn't show up. Our medical team reviewed the ASP image where we noted in addition to the central hydroaeric levels, an inverted U-shaped image of a foreign body (infuser tubing) going from the left hypochondrium to the left iliac fossa. confirming the diagnosis intraoperatively. The postoperative course was simple. The patient returned home on postoperative day 5.

Nursing care of a patient after a craniofacial area microsurgical transplant in a teenage boy

Abstract Aim. The aim of the study was to make selected nursing diagnoses for a patient after a microsurgical transplant in the facial area, with the aim of providing the patient with comprehensive care in the perioperative period. Material and methods. The study describes the case of a child after microsurgical transplantation of a flap taken from the left iliac plate to the right submandibular region. The individual case method was used. Clinical interview, observation, measurement and medical documentation data were analyzed. Results. Four selected nursing diagnoses were presented along with planned interventions: risk of complications at the site of microsurgical flap transplantation, risk of donor site infection, discomfort caused by intense oozing of secretions from the postoperative wound in the oral cavity and the boy’s depressed mood caused by low self-esteem resulting from the changed postoperative facial appearance and the failure of the first surgical procedure. Conclusions. Nursing interventions should be adapted to the patient’s dynamically changing recovery process. They should be based on systematic inspection of the recipient and donor sites for the occurrence of complications. Education of the patient and the caregiver is an important element of the therapeutic process. It was not possible to significantly improve the child’s mood.