Case Of Perforation Research Articles

Risk factors for rectal perforation during presacral cyst removal: a comparison between transabdominal, perineal, and combined surgical approaches.

This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts. This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software. The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge. The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.

Marginal ulcer causing anastomotic perforation and delayed penetration following one anastomosis gastric bypass

We report the rare clinical case of perforation and delayed penetration of an ulcer at the gastro-jejunal anastomosis following 14 months after laparoscopic one anastomosis gastric bypass in a young female patient. No significant ulcer predictors at baseline: a chronic ulcer formed within the first six months after one anastomosis gastric bypass against the background of continued proton pump inhibitor therapy, regardless of smoking, helicobacter infection or use of non-steroidal anti-inflammatory drugs. Initially the patient underwent the laparotomy with perforation suturing and Roux-jejunojejunostomy formation to exclude the bile reflux into the gastric pouch. The result of the first surgery (non-healing ulcer with the development of delayed penetration six months later) is agree with the recent literature about the possible overstatement of the role of biliary reflux in ulcer formation after one anastomosis gastric bypass. The follow-up surgery was performed by the laparoscopic approach in condition of pronounced adhesion process in abdominal cavity and included adhesiolysis, resection of the gastric pouch with the anastomosis and reconstructive Roux-Y-gastric bypass. Clinical and endoscopic evaluation of the result of the reconstructive surgery 10 months after indicates the patient's recovery.

A Case of Severe Post-Biopsy Bleeding and Perforation in Gastric Amyloidosis.

We herein describe a case of severe post-biopsy bleeding and perforation in gastric amyloidosis. A 70-year-old man who had been on dialysis underwent esophagogastroduodenoscopy and biopsy was performed. Post-biopsy bleeding occurred, and three times of coagulation hemostasis and once clip hemostasis were performed. After the hemostasis, he eventually had a gastric perforation and omental patch surgery was performed, however, he passed away after the surgery. From the pathological finding of biopsy specimen, he was diagnosed with gastric amyloidosis caused by dialysis-related amyloidosis. In patients of amyloidosis, the risk of bleeding and perforation is elevated due to vascular and tissue fragility. Therefore, when performing hemostasis in patients with gastrointestinal amyloidosis, clip hemostasis which minimizes tissue damage is considered preferable to coagulation hemostasis.

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations

Two Cases of Colonic Perforation Following Upper Gastrointestinal Barium Examinations

Prophylactic surgical drain placement with irrigation reduces abscess formation in patients with severe, uncontained, perforated appendicitis.

20-25% of perforated appendicitis cases are complicated by abscess formation. This study assesses whether prophylactic closed-suction surgical drain (SD) placement after irrigation can decrease postoperative abscess formation in patients with extensively contaminated, perforated appendicitis.Affiliations: Journal instruction requires country for affiliations; however, these are missing in all affiliations. Please verify if the provided country names are correct and amend if necessary.They're correct METHODS: A multicenter retrospective review was performed on pediatric patients with uncontained perforated appendicitis from January 1, 2020 to August 1, 2023. Limited irrigation was performed. All SDs were oriented towards the pelvis. Data were analyzed in four groups: (G1) SD and irrigation, (G2) only SD, (G3) only irrigation, (G4) neither SD nor irrigation. One hundred and fifteen patients (44 in G1, 3 in G2, 21 in G3, 47 in G4) were included. The abscess rate was 5.1% (G1), 33.3% (G2), 33.3% (G3), and 37.0% (G4) (p = 0.001). No interventional radiology (IR) drains were placed in G1 and G2. SD duration was 4.1 ± 2.1days in G1 and 2.7 ± 0.6days in G2. IR drain duration was 14 ± 10.7days in G3 and 8.3 ± 3.9days in G4 (p < 0.001). There were no significant differences in total length of stay and antibiotic duration. Irrigation with prophylactic SD placement may prevent postoperative abscesses in patients with severe, uncontained, perforated appendicitis, but prospective data are needed.

Unveiling Gastroduodenal Fistula: A Comprehensive Exploration

Gastroduodenal fistula (GDF) is a rare pathology, often associated with peptic ulcers and typically diagnosed electively. This article presents an unprecedented case of GDF perforation in a 79-year-old male, deviating from the asymptomatic norm. The unique feature lies in the acute abdominal presentation, challenging conventional understanding. The intricate surgical exploration revealed a novel fistulous tract extending from the prepyloric region to the fourth part of the duodenum. This atypical manifestation underscores the need for deeper research into GDF's diverse presentations, contributing to enhanced diagnostic and treatment strategies for this rare medical phenomenon.

Renal Collecting System Calcified Hematoma Following Parenchymal Perforation by Ureteral Stent in Kidney Transplantation: A Case Report

Introduction: Renal parenchymal perforation by ureteral stent placement is a rare but serious complication. There is also a paucity of data regarding collecting system hematomas and potential calcification in renal allografts. Case presentation: We report a unique case of a 51-year-old male who underwent unrelated living-donor kidney transplantation with stent incorporation during ureteroneocystostomy. Post-operatively he was found to have renal parenchymal perforation by the ureteral stent resulting in a pelvicalyceal hematoma with subsequent calcification and obstruction. At the time of guidewire introduction for percutaneous nephrolithotomy one year later, a nephrostogram and passage of a hydrophilic guidewire resulted in improved contrast drainage into the bladder, so the invasive surgery was no longer needed. Discussion: There are few reported cases of renal parenchymal perforation by a ureteral stent, none of which resulted in a collecting system hematoma. The calcification of urinary tract hematomas is also rare and attributed to metabolic abnormalities, prolonged stagnation of blood, and infection. Conclusions: We suspect the nephrostogram and guidewire introduction created enough antegrade pressure and mechanical disruption to force the calcified hematoma into the bladder.

EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital

Abstract Background Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital. Method This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25. Results Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134). Conclusion Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.

EGS SO20 - Management &amp; outcomes from oesophageal perforations at a tertiary centre

Abstract Background Oesophageal perforations, whilst rare, are a challenging surgical emergency. Traditionally associated with high morbidity and mortality, outcomes have progressively improved over the past 25 years, likely due to advances in medical care and specialised management in high volume tertiary centres. This study examines the management strategies and outcomes from oesophageal perforations at our tertiary unit. Method A retrospective cohort analysis was conducted on consecutive emergency cases of thoracic and junctional oesophageal perforations from January 2019 to June 2024. Data on patient demographics, baseline characteristics, management strategies and clinical outcomes were extracted from the patient’s electronic records. Kaplan-Meier survival curves were generated using the management approach and the extent of perforation as the predictive variables. Results 51 patients (mean age 47 years, 66% male) were treated for oesophageal perforations. The predominant aetiology was spontaneous (80%, n=41). Contained perforations were identified in 57% (n=29) of patients based on imaging, endoscopic, or operative findings. Conservative management was applied in 57% (n=29) of cases. Among those requiring intervention, 11 (58%) underwent surgery, while the remainder underwent endoscopical via vacuum therapy (32%, n=6) or stenting (11%, n=2). The mean in-hospital stay was 11 days (IQR 7-29). The 30-day mortality rate was 18% (n=9). Survival analysis revealed improved survival probabilities with contained perforations and non-surgical management strategies (p=0.023 and 0.001 respectively). Conclusion Our results demonstrate that the outcomes from oesophageal perforations continue to improve, reflecting ongoing advancements in therapeutic management. Furthermore, whilst surgery was once the mainstay, there appears to be a safe, increasing shift towards more conservative and endoscopic management.

Dupilumab-Associated Bilateral Conjunctival Papillomas and Corneal Perforation.

We report a unique case of significant human papillomavirus-associated conjunctival papillomas and severe corneal ulceration leading to corneal perforation in a patient treated with dupilumab for atopic dermatitis. This study is a case report and literature review of severe corneal side effects related to dupilumab. A 27-year-old man with severe atopic dermatitis and no ocular history was administered dupilumab 300 mg via subcutaneous injections every 2 weeks with an excellent response. Following the onset of treatment, the patient developed conjunctivitis, conjunctival papillomas, and dry eyes, which were initially treated with lubricating eye drops. Fourteen months after commencing dupilumab, he had a rapid onset of painful visual loss in the OD accompanied by severe bilateral conjunctival injection and was found to have a central corneal ulcer and diffuse papillomas on the palpebral and bulbar conjunctiva. Despite management with intravenous methylprednisolone and topical dexamethasone, the patient's corneal ulcer progressed to a corneal melt, resulting in perforation 2 months after diagnosis, which necessitated a corneal graft. We present the third reported case of dupilumab-associated corneal perforation and the first case to our knowledge of dupilumab-associated conjunctival papillomas. As dupilumab usage increases, awareness of these potential complications among prescribers is essential.

Esophageal perforation in premature newborns

BACKGROUND: Esophageal perforation is a rare entity in newborns. This condition is most common in premature babies with very low and extremely low birth weight. The major cause of such pathology is considered to be iatrogenic trauma of either pharynx or esophagus, their soft tissues being delicate and tender enough to produce delamination and perforation of their wall. As a rule, this occurs as a complication of either a difficult tracheal intubation soon after birth or during some troubles with oro- or nasogastric tube insertion. AIM: To analyze our experience of revealing and treatment of esophageal perforation in preterm babies, and to demonstrate conservative approach as a possible as well as reasonable option in such cases. METHODS: A retrospective study of neonatal esophageal perforation cases was performed, including newborns without any congenital esophageal malformations or previous surgical procedures. During 2017–2022 9 newborns with esophageal perforation were treated at neonatal intensive care unit and neonatal departments of Childrens’ City Multidisciplinary Clinical Specialized Center of High Medical Technologies of Saint Petersburg. All of them were premature, 2 having very low, and 7 having extremely low birth weight. The incidence of that condition appeared to be 1:1320 live births. RESULTS: 8 patients were treated conservatively. This included adjustment of artificial lung ventilation, pain control, antibiotics, cancellation of gastric enteral feeding and administration of total parenteral nutrition. Babies with hydrothorax, pneumothorax or ascites underwent thoraco- or laparocentesis. 2 patients died, both being born at 23th week of gestation. In both cases death occurred from polyorganic insufficiency. The mortality rate appeared to be 22%. CONCLUSION: In most cases the esophageal perforation in premature babies can be treated conservatively, the efficacy of such treatment being largely dependent on early diagnosis of this complication. An important key-point in it is a radiologic control of gastric tube location.

Application of nasal pedicle mucosal flap based on nasal blood supply in reconstruction of nasal skull base defects

Objective: To evaluate the clinical efficacy of nasal pedicle tissue flap based on nasal blood supply in the reconstruction of nasal skull base defects. Methods: A retrospective analysis was conducted on 138 clinical cases of skull base tumors and cerebrospinal fluid rhinorrhea treated at the Department of Otolaryngology, Head and Neck Surgery at Xiangya Hospital of Central South University from March 2017 to March 2023. A total of 79 males and 59 females were enrolled, aged from 8 to 82 years, with a median age of 51 years, including 108 patients (78.3%) with skull base tumors and 30 patients (21.7%) with cerebrospinal fluid rhinorrhea (and/or meningoencephalocele). During the surgery, 88 cases (63.8%) were repaired with nasal septal mucosal flaps pedicled with the posterior nasal septal artery, 14 cases (10.1%) with mucosal flaps pedicled with the anterior ethmoidal artery on the lateral wall of the nasal cavity, 6 cases (4.3%) with mucosal flaps pedicled with the posterior lateral nasal artery on the lateral wall and nasal floor, 12 cases (8.7%) with mucosal flaps pedicled with the anterior ethmoidal artery and posterior ethmoidal artery, and 18 cases (13.0%) with nasal septal mucosal extension flaps pedicled with the sphenopalatine artery or internal maxillary artery. Patients were followed up for 12 to 72 months postoperatively. Endoscopic examination or skull base enhanced MRI was performed to assess the growth and tumor recurrence in the skull base repair area. The t-test was used for statistical analysis. Results: Among 138 patients, primary repair was successful in 133 patients (96.4%), while 5 patients (3.6%) experienced postoperative cerebrospinal fluid rhinorrhea. These 5 patients all underwent nasal septal mucosal flap repair with the posterior nasal septal artery as the pedicle. Complications included 1 case of mucosal flap necrosis, 1 case of mucosal flap central perforation, and 3 cases of mucosal flap survival peripheral leakage, of which were all successfully treated with a second repair. Conclusion: The use of nasal pedicle mucosal flap based on nasal blood supply is a reliable, safe, and effective technique for repairing skull base defects.

058. A Rare Case: Anterior Wall Rectum Perforation Due to Intrauterine Device Migration

Background: Intrauterine devices (IUDs) are widely used for contraception due to their long-acting, safe, and effective nature in preventing pregnancy. However, common side effects and complications, such as vaginal bleeding, expulsion, displacement, translocation, and perforation necessitate attention, with translocation and perforation being rare but potentially severe, warranting prompt removal according to WHO recommendations. This study aims to document and analyze a rare case of rectal perforation resulting from the migration of an IUD. Case: A report was made from 31-year-old pregnant woman with a history of two cesarean sections presented with 10-day abdominal pain and an IUD inserted 42 days post-surgery, which MRI revealed had translocated into the left anterolateral rectal wall, prompting retroscopy for extraction. Uterine perforation and IUD migration into adjacent organs can result in various complications, including uterine, bladder, and intestinal perforation, with initial symptoms potentially being asymptomatic, emphasizing the need for routine check-ups. Retrieval of migrated IUDs can be achieved through methods such as endoscopy, laparoscopy, or laparotomy, as illustrated in a case involving a patient with abdominal pain and imaging evidence of IUD translocation to the rectum's anterior wall, managed through less invasive rectoscopy. Conclusion: Translocated IUDs may exhibit varying symptoms or none at all, necessitating removal regardless of type or location, with management guided by radiological and endoscopic findings alongside understanding abdominal organ anatomy

The impact of a multidisciplinary team approach on the management of patients diagnosed with complex colorectal polyps.

Large nonpedunculated colorectal polyps (LNPCPs) have a greater than average risk of malignancy, incomplete resection/recurrence and complications associated with treatment. Appropriate management of these lesions is crucial to prevent cancer and reduce harm. The British Society of Gastroenterologists (BSG) and the Association of Coloproctologists of Great Britain and Ireland (ACPGBI) published guidelines for the management of LNPCPs in 2015. The aim of this work was to evaluate the case mix and outcomes from a single centre's multidisciplinary approach to managing such lesions against the key performance indicators (KPIs) set within these national guidelines. Cohort study from a single centre over a 2-year period, January 2020 to December 2022. After exclusions, a total of 229 cases were discussed. Most complex polyps were treated endoscopically, with conservative management recommended in 22 cases where patients had significant comorbidities and were unlikely to benefit from therapy. The overall surgical intervention rate (including transanal endoscopic microsurgery/per anal excision) was 14%. Of the cases treated endoscopically, there was residual polyp detected in 3.9% at 12-months' follow-up. Complications were rare. There was a single case of perforation following endoscopic submucosal dissection and no significant postprocedure bleeds. There were no perforations following endoscopic mucosal resection, although postpolypectomy bleeding requiring admission occurred in 4%. Sixty-eight per cent of patients were treated within 56 days of multidisciplinary team (MDT) discussion, despite the timeframe being within a period of huge disruption due to the global COVID pandemic. KPI standards published by the BSG were therefore met. MDT management of complex polyps (LNPCPs) is effective and meets the standards set by national guidance. Patient outcomes following treatment for complex polypectomy are improved when the most appropriate procedure is performed by the most appropriate operator. Discussion at a complex polyp MDT can facilitate this approach.

Case of colon perforation due to segmental absence of intestinal musculature accompanied by cancer treated with colonic resection and anastomosis

BackgroundSegmental absence of intestinal musculature (SAIM) is a partial defect of intestinal muscularis propria without diverticulum. Many reports indicate that the increase in intestinal pressure caused by enemas or endoscopic examinations leads to bowel perforation, but there are few reports involving malignant tumors. Moreover, few reports have had good outcomes after performing one-stage intestinal anastomosis.Case presentationA 60-year-old male came to the office with right-side abdominal pain, and was diagnosed with acute generalized peritonitis caused by ascending colon perforation. Emergency laparotomy was performed, and oval and smooth perforation at the ascending colon was observed, which caused ascites with feces. In addition, there was a tumor on the distal side. The terminal ileum was not dilated, so the cause of the perforation was more likely the SAIM-related thin intestinal wall rather than increased internal intestinal pressure due to obstruction of the tumor. Therefore, a right hemicolectomy with functional end-to-end anastomosis (FEEA) between the ascending colon and ileum was performed, rather than creating a stoma. On pathological examination, the resected bowel segments had a partial defect of intestinal muscularis propria around the perforation, leading to the diagnosis of SAIM. The patient had a favorable postoperative course without anastomotic issues and was discharged safely.ConclusionsThis case implies that initial intestinal anastomosis can be performed without creating a stoma when SAIM is suspected from the shape of the perforation and proximal intestine. This case report suggests surgeons should keep SAIM in mind during operations for colon perforations.

Arthroscopic Findings in an Unusual Case of Disc Perforation After a Whiplash Mechanism

Arthroscopic Findings in an Unusual Case of Disc Perforation After a Whiplash Mechanism

The efficacy of an intracoronary cocktail administration in preventing no-reflow during excimer laser coronary angioplasty in patients with in-stent restenosis: A pilot study. (ELCA- cocktail study)

BackgroundThe no-reflow phenomenon is a significant complication during excimer laser coronary angioplasty (ELCA) procedures, which can lead to adverse outcomes. This study explores the efficacy of intracoronary administration of a cocktail solution comprising nitroglycerin, heparin, and verapamil on preventing no-reflow during ELCA in patients with in-stent restenosis (ISR). MethodsThis study included patients undergoing ELCA with contrast infusion for ISR. Based on whether receiving the intracoronary cocktail solution during ELCA, participants were divided into two groups: the cocktail (+) group and the cocktail (−) group. The primary endpoint was the incidence of no-reflow, which was defined as the cessation of blood flow into the distal coronary artery in the absence of a clear angiographic explanation for impairment of flow. ResultsA total of 54 lesions in 51 patients were included. The mean age of the study population was 61.8 ± 9.7 years, with 84.3 % male. Baseline clinical characteristics were well-balanced. The incidence of no-reflow was significantly lower in the cocktail (+) group compared to the cocktail (−) group (0 % vs. 17.9 %, P = 0.024). No cases of hypotension, major bleeding or coronary perforation in either group. Major adverse cardiac events (MACE) within 6-month were no significant difference between the groups (4.0 % vs. 3.8 %, P = 0.977). ConclusionsThe pilot study suggests that intracoronary administration of a cocktail comprising heparin, nitroglycerin, and verapamil may reduce the incidence of no-reflow during ELCA in patients with ISR. However, given the limited sample size and the non-randomized design, these findings should be considered hypothesis-generating. Future validation needs to be confirmed through multicenter studies with larger sample sizes.

Togetherness Reminded by the Earthquake: Relationship Between Stress and Peptic Ulcer Perforation

Background: Severe stress is one of the leading causes of peptic ulcer perforations. Peptic ulcer perfora-tion is a clinical condition that can be fatal if not treated urgently. This study aimed to investigate the effects of social stress caused by the earthquakes in Kahramanmaraş on peptic ulcer perforation. Materials and Methods: A retrospective evaluation was conducted on 66 peptic ulcer perforation cases operated on in three major centers in Şanlıurfa, considering two large earthquakes that occurred on February 6, 2023, and by comparing the 6-month periods before and after the earthquakes. Patients were assessed in terms of age, gender, diagnostic method, perforation site, surgical technique, operation time, length of hospital stay, and mortality. Our study also evaluated laboratory parameters such as white blood cell (WBC) count, hemoglobin, urea, creatinine, and albumin levels. Results: In the 6 months prior to the earthquakes, 21 patients underwent surgery for peptic ulcer perfo-ration, whereas 45 patients were operated on for the same reason in the 6 months following the earthquakes; there were two deaths in each group. The number of patients operated on after the earthquakes was significantly higher than the number of patients operated on before the earthquakes. Furthermore, the two groups were also compared in terms of demographic data and laboratory findings; no significant differences between the two groups were observed regarding these parameters. Conclusions: Stress plays a remarkable role in the development of peptic ulcer perforation. In stressful situations that affect the general population, such as earthquakes, it is essential to assess stress tenden-cies and dyspeptic complaints in patients presenting to the hospital. Patients with positive findings should undergo endoscopy if necessary, followed by appropriate gastric treatment.

Endoscopic Cartilage Slice Reinforcement Technique for Anterior Perforation Repair with Anterior Canal Wall Protrusion.

Objective: To evaluate the outcomes and complications of the endoscopic cartilage slice reinforcement technique used on anterior margins for anterior perforation repair with anterior canal wall protrusion. Material and Methods: We conducted a prospective study on 38 cases of anterior perforation with anterior canal wall protrusion, treated using the endoscopic cartilage slice reinforcement technique from February 1, 2017 to August 29, 2023. The follow-up period was 6 months. Results: Of the 38 patients, medium perforations were present in 28.9%, large in 65.8%, and subtotal in 5.3%. The cause was mucosal chronic otitis media in 92.1%, traumatic perforation in 5.3%, and ventilation tube removal in 2.6%. The average operation time was 27.2 ± 4.6 minutes. The graft success rate was 94.7% (36/38) at 6 months postoperative. The average preoperative air-bone gap (ABG) was 19.8 ± 4.2 dB, and postoperative ABG was 8.6 ± 2.9 dB; this improvement was statistically significant (P < .001; paired-sample t-test). The ABG gain was 11.8 ± 5.1 dB, and the rate of successful surgery (postoperative ABG ≤ 20 dB) was 97.4% (37/38). No complications such as altered taste, vertigo, or tinnitus were reported, and no cases involved graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion. However, myringitis was observed in 4 (10.5%) patients. Conclusion: The endoscopic cartilage slice reinforcement technique for anterior margins is a simple and effective method for repairing anterior perforations with anterior canal wall protrusion, achieving a high graft success rate, improved hearing, and minimal complications.

Extracranial-intracranial bypass using a cephalic vein graft for iatrogenic internal carotid artery injury during functional endoscopic sinus surgery: illustrative case.

Injury to the internal carotid artery (ICA) during functional endoscopic sinus surgery is a rare but potentially fatal complication. Although treatment algorithms have been developed, guidelines for effectively managing iatrogenic ICA injury have not been established. A case of ICA perforation during functional endoscopic sinus surgery treated with cerebral bypass utilizing a cephalic vein graft is presented. A woman in her late 50s presented with a left cavernous ICA injury that had occurred during endoscopic nasal polypectomy at an outside hospital. Hemostasis was achieved with intranasal Foley catheter placement. Left common carotid artery angiography revealed a high-flow carotid-cavernous fistula. Cerebral revascularization was chosen as the optimal procedure. The initial intent was to use a radial artery graft, but the radial artery was found to be occluded intraoperatively. Postoperatively, the patient experienced decreased vision and left eye movement but was otherwise neurologically intact. Postoperative angiography showed complete resolution of the fistula. In cases involving ICA injury and carotid-cavernous fistula formation, microsurgical trapping with high-flow bypass is a favorable treatment option. The cephalic vein is a viable graft option when unexpected challenges arise with a radial artery graft. https://thejns.org/doi/10.3171/CASE24222.