Presence Of Fistula Research Articles

Atypical Presentation of Direct Carotid Cavernous Fistula

An atypical case of carotid cavernous fistula (CCF) is presented which was challenging to diagnose even with investigations. A 50-year old female, presented with complaints of increasing chemosis, diplopia and proptosis of her right eye following a fall from stairs. Her IOP was 32 mm Hg in right and 18 in left eye. Absence of other classic clinical signs like bruit/thrill of carotid cavernous fistula led to difficulty in diagnosing. There was absence of radiological evidence like enlargement of superior ophthalmic vein on MRI, MRV and MRA. We started symptomatic treatment for increased IOP and exposure keratopathy. Right sided CCF diagnosis was confirmed on CT angiogram and Digital Subtraction Angiography. Coil embolization was done which resulted in symptomatic and clinical relief. Carotid cavernous fistula with absence of typical signs is sometimes challenging to diagnose and treat. Importance of Digital Subtraction Study and CT Angiogram is highlighted.

A case of aortocaval fistula presenting with circulatory failure

A case of aortocaval fistula presenting with circulatory failure

AB133. SOH22ABS008. A rare case of haemoptysis: a case presentation of aorto-bronchial fistula and review of the literature

Background: Aorto-bronchial fistulas (ABF) is a rare presentation of haemoptysis. They are associated with several pathologies of the descending aorta. Rapid diagnosis and management as essential, as patients can present with a high mortality rate otherwise.

Dural arteriovenous fistula presenting as thalamic dementia: a case description with rare imaging findings.

Dural arteriovenous fistula presenting as thalamic dementia: a case description with rare imaging findings.

Cephalic arch stenosis in autologous hemodialysis fistula; to stent or not to stent? Long-term follow up

BackgroundA retrospective study of 44 patients with autologous arteriovenous fistula (AVF) presenting with cephalic arch stenosis was carried out. The aim is to assess the effectiveness of angioplasty and stenting in cephalic arch stenosis in autologous AVF in hemodialysis patients and also to assess the outcome of metal stents at this distinctive anatomical site. All patients were subjected to Doppler examination, where the stenotic lesion and the AVF flow volume were assessed prior to intervention. The follow-up period reached up to 57 months in some patients. All patients were under surveillance and were assessed for patency and flow volume. The primary and secondary stenosis-free rates were calculated. Re-intervention during the follow-up period was recorded.ResultsThe technical success rate was 100%. Twenty-six patients had balloon angioplasty. Eighteen patients had primary and/or secondary stents inserted. The primary patency rate at 6 and 12 months for the balloon angioplasty group was 80% and 60% and for the stent group was 86% and 71%, respectively. The mean primary patency rate in balloon angioplasty patients was 12.9 months, while in the primary stented patients was 19.9 months. Twenty-six patients had secondary intervention. The average secondary patency rate for patients with balloon angioplasty was 25.5 months, while it was 33.6 months in the stented patients.ConclusionCephalic arch angioplasty and stenting is an effective intervention increasing the longevity of the AVF that is crucial for hemodialysis patients. The use of metal stents whether bare metal stents or covered stents is safe and adds significant increase in patency rates.

Risk of Early Versus Later Rebleeding From Dural Arteriovenous Fistulas With Cortical Venous Drainage.

Background:Cranial dural arteriovenous fistulas with cortical venous drainage are rare lesions that can present with hemorrhage. A high rate of rebleeding in the early period following hemorrhage has been reported, but published long-term rates are much lower. No study has examined how risk of rebleeding changes over time. Our objective was to quantify the relative incidence of rebleeding in the early and later periods following hemorrhage.Methods:Patients with dural arteriovenous fistula and cortical venous drainage presenting with hemorrhage were identified from the multinational CONDOR (Consortium for Dural Fistula Outcomes Research) database. Natural history follow-up was defined as time from hemorrhage to first treatment, rebleed, or last follow-up. Rebleeding in the first 2 weeks and first year were compared using incidence rate ratio and difference.Results:Of 1077 patients, 250 met the inclusion criteria and had 95 cumulative person-years natural history follow-up. The overall annualized rebleed rate was 7.3% (95% CI, 3.2–14.5). The incidence rate of rebleeding in the first 2 weeks was 0.0011 per person-day; an early rebleed risk of 1.6% in the first 14 days (95% CI, 0.3–5.1). For the remainder of the first year, the incidence rate was 0.00015 per person-day; a rebleed rate of 5.3% (CI, 1.7–12.4) over 1 year. The incidence rate ratio was 7.3 (95% CI, 1.4–37.7; P, 0.026).Conclusions:The risk of rebleeding of a dural arteriovenous fistula with cortical venous drainage presenting with hemorrhage is increased in the first 2 weeks justifying early treatment. However, the magnitude of this increase may be considerably lower than previously thought. Treatment within 5 days was associated with a low rate of rebleeding and appears an appropriate timeframe.

Tracheoesophageal fistula presenting with ventilator air leaks and recurrent pneumonia.

We describe a patient who received tracheostomy but complicated with tracheoesophageal fistula, where the nasogastric tube was visible from the fistula under bronchoscopy. Tracheostomy tube was then replaced with an endotracheal tube to bypass the fistula.

A rare presentation of enterocutaneous fistula

Enterocutaneous fistula is an abnormal communication between two epithelialized surfaces, one of which is a hollow viscous organ. It most commonly occurs as a surgical complication. Other causes are trauma, malignancy, inflammatory bowel disease, ischemia. The great majority of enterocutaneous fistula are iatrogenic (75-85%) and rest (15-25%) occur spontaneously. Enterocutaneous fistula is the one of the most challenging conditions managed by General surgeon. The mortality rates vary in different series for patients, with enterocutaneous fistula and remains 5% to 15%.Here we report a rare presentation of enterocutaneous fistula.

A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review

BackgroundIn 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation. AimTo raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon. MethodsPatient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed. OutcomesTo identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis. ResultsFour patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found. Clinical ImplicationsIf considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications. Strengths and LimitationsThe rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients. ConclusionDamage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery.Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med 2022;19:879–886.

Colosplenic fistula presentation in the context of undiagnosed colon cancer: Case report and review of literature.

Introduction and importanceEnteric fistulas commonly arise from inflammatory, infectious, or neoplastic processes. Colosplenic fistulas are rare with only several reported worldwide.Case presentationHerein, we present a case of colosplenic fistula in a 39-year-old gentleman with past history of rectal cancer previously in remission. He was admitted with severe abdominal pain and hemodynamic instability due to septic shock. The erect chest x-ray revealed pneumoperitoneum under the diaphragm.Clinical discussionLaparotomy was performed and ileum perforation was managed by resection and anastomosis. The post-op recovery was complicated by a febrile episode. To locate the source of infection a contrasted abdominal computed tomography was ordered, confirming the presence of a splenic abscess, suggestive of colosplenic fistula. We proceeded with laparotomy for drainage of the abscess, with splenectomy and splenic flexure resections. He was discharged 40 days post-op at a pre-morbid state.ConclusionDue to the high prevalence of colon cancer worldwide, novel complications such as the one reported here, are important to be reflected on. We hope this case can exemplify the significance of higher index of suspicion in at risk patient groups by the surgical teams and appropriate training on acute management of this rare complication.

Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition characterized by outpouchings from the esophageal lumen into the outer esophageal wall. It can lead to complications such as esophageal strictures presenting as dysphagia and esophagobronchial fistula (EBF) presenting as recurrent aspiration pneumonia. Only 1 other report of EIP with EBF has been reported in the literature. EIP itself is typically managed medically while a complication such as EBF, on the other hand, elicits far more invasive approaches in the form of open surgical intervention. We present the case of a 50 year-old male newly diagnosed with EIP complicated by EBF who was palliated with esophageal stenting. Upper endoscopy with esophageal stent placement offers a safe, feasible, and non-operative therapy for EIP and EBF.

Massive gastrointestinal bleeding due to rectovaginal fistula: A rare case report

Rectovaginal fistula is usually observed due to obstetric traumas during giving birth, rectal or gynecologic malignities or after surgical therapy of malignant lesions or radiotherapy. Rectovaginal fistulas are not common in general surgery and gynecology clinics. However, these lesions are rarely seen during gastroenterology practice. In gastroenterology practice, we may face with rectovaginal fistula during Crohn’s disease’s course. These lesions deteriorate patients’ quality of life and increase morbidity and mortality. Endoscopy may be used to detect the localization of fistula and may help to choose correct treatment modality. Endoscopy sometimes may also be used to treat rectovaginal fistula via endoclips or stents. Typical complaints for rectovaginal fistulas are air, gas, or mucus discharge from vagina. Dyspareunia, perineal pain, or recurrent vaginal infections may also be seen. Rectal bleeding is not a common complaint for rectovaginal fistulas. Herein we report a rare case with rectovaginal fistula presenting with massive rectal bleeding after debulking surgery for ovarian carcinoma.

Odontogenic Cutaneous Fistula and Abscess of the Superficial Peri-Zygomatic Area

Purulent processes of the zygomatic and peri-zygomatic area are not common. Among etiologies are: otitis media, complication of zygomatic implantation, osteomyelitis, medication-related osteonecrosis of the jaw, drug-related osteonecrosis, and odontogenic infection. This article highlights the first literature reported case of clinical presentation of odontogenic abscess and cutaneous fistula of the superficial peri-zygomatic area from the upper third molar. The preoperative and follow-up photographs of a 76-year-old Caucasian male patient are demonstrated. The uniqueness of this case is that until now the upper third molars never been published as a source of abscesses of the peri-zygomatic area.

A Case of the Superior Sagittal Sinus Dural Arteriovenous Fistula Presenting with Papillary Edema and Visual Impairment

A Case of the Superior Sagittal Sinus Dural Arteriovenous Fistula Presenting with Papillary Edema and Visual Impairment

Spinal dural arteriovenous fistula presenting as acute onset paraplegia

Spinal dural arteriovenous fistula presenting as acute onset paraplegia

Tentorial Dural Arteriovenous Fistula Presenting with Myelopathy Successfully Treated by Transarterial Embolization with N-butyl-2-cyanoacrylate: A Case Report

Tentorial Dural Arteriovenous Fistula Presenting with Myelopathy Successfully Treated by Transarterial Embolization with N-butyl-2-cyanoacrylate: A Case Report

Dural arteriovenous fistula presenting as reversible dementia

DAVF is an abnormal connection between arteries and veins, where supply is mainly through branches arising from the external carotid artery. A 30 years old male had multiple episodes of seizures and progressive behavioral and cognitive decline, inattention and disorientation to time, place and person, along with ptosis and ophthalmoplegia in the right eye. DSA provided a definitive diagnosis of hypervascular Dural AV fistula at the right transverse sigmoid junction with significant cortical venous hypertension. Through femoral access, both underwent transarterial embolization through the Middle Meningeal branch of the right external carotid artery using onyx, resulting in complete occlusion of fistula and resolution of venous hypertension. Post embolisation, cognitive function assessment revealed increased attention span and improved orientation with time, place and person. Thus, DAVF can be one of the rare but reversible causes of dementia. Early diagnosis and treatment may help to dramatically improve patients’ clinical condition and minimize long-term disability.

Occipital dural fistula presenting with hydrocephalus: A case report

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Pancreatic fistula presenting with bloody ascites and acute peritonitis in a chronic pancreatitis patient: a case report

Pancreatic fistula presenting with bloody ascites and acute peritonitis in a chronic pancreatitis patient: a case report

A peculiar case of coronary artery to pulmonary artery fistula presenting as ST-elevation myocardial infarction

A peculiar case of coronary artery to pulmonary artery fistula presenting as ST-elevation myocardial infarction