Choledochoduodenal fistula: a rare complication of acute peptic ulcer bleeding

2021 ◽  
Vol 14 (11) ◽  
pp. e246532
Author(s):  
Shruti Sreekumar ◽  
Mathew Vithayathil ◽  
Pritika Gaur ◽  
Shwan Karim
Keyword(s):  
Alcohol Intake ◽  
Rare Complication ◽  
Pancreatic Head ◽  
Mucosal Healing ◽  
Ulcer Bleeding ◽  
Deep Ulceration ◽  
History Of ◽  
Choledochoduodenal Fistula ◽  
Fistula Treatment

A 75-year-old man presented with a 3-week history of melaena and right upper quadrant pain. This was on a background of significant alcohol intake and a complex medical history. He was haemodynamically unstable with investigations indicating a new iron-deficiency anaemia. After resuscitation, urgent intervention was required under general anaesthesia. This involved a triple phase abdominal CT, followed by emergency oesophagogastroduodenoscopy. This revealed deep ulceration with extension to the pancreatic head and common bile duct. There was also evidence of pneumobilia on CT, secondary to a choledochoduodenal fistula. Treatment encompassed an invasive and medical approach. Following treatment, the patient was stable, with follow-up endoscopy exhibiting good duodenal mucosal healing.

Radiation-associated versus sporadic osteosarcoma: A single-institution experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11018-11018
Author(s):  
Brittany Siontis ◽  
Emily Roberts ◽  
Lili Zhao ◽  
Jonathan B. McHugh ◽  
Dawn Owen ◽  
...  
Keyword(s):  
Rare Complication ◽  
Progression Free Survival ◽  
Primary Malignancy ◽  
Free Survival ◽  
Significant Difference ◽  
Detectable Difference ◽  
History Of ◽  
Median Cumulative Dose ◽  
Worse Prognosis

11018 Background: Osteosarcoma (osarc) can be a rare complication from radiation (rt) therapy. Radiation-associated osarc (RAO) is reported to have a worse prognosis than non rt-associated osarc with limited objective data comparing the two. We conducted a retrospective study comparing demographics, therapy and outcomes of sporadic osarc (SO) to RAO. This study was confined to adults. Methods: We identified patients (pts) > age 18 years (yr) with osarc treated at our institution between 1990 and 2016 using an institutional database. We categorized tumors as SO or RAO based on history of prior rt within field of osarc. We extracted data on demographics, treatment, and primary malignancy characteristics. Results: We identified 159 pts with osarc, 28 were RAO tumors. Results are in Table 1. Median follow-up was 2.8 yr (0.1-19.6 yr). For RAO, median time from rt to diagnosis was 11.5 yr (1.5-28 yr) with a median cumulative dose of 60 Gy (44-75.8 Gy). Median progression free survival (PFS) and overall survival (OS) were not significantly different in pts presenting with metastatic osarc; PFS 10.3 mo vs 4.8 mo (p=0.45) and OS 15.6 mo vs 6.1 mo (p=0.96) in SO vs RAO pts, respectively. For pts with localized osarc, median relapse-free survival (RFS) and OS were significantly different, not reached vs 12.2 mo (p<0.001) and not reached vs 27.6 mo (p=0.001) in SO vs RAO, respectively. Conclusions: In our series, there was a significant difference in age, size and location of RAO vs non rt-associated osarc. Overall, all osarc pts with metastatic disease at diagnosis fared poorly. Pts presenting with localized RAO had worse outcomes than patients with localized SO. This was not associated with a detectable difference in therapy rendered or treatment effect in resection specimens. [Table: see text]

scholarly journals Post-stroke psychosis: how long should we treat?

2017 ◽  
Vol 39 (2) ◽  
pp. 144-146 ◽  
Author(s):  
Maria do Céu Ferreira ◽  
Célia Machado ◽  
Beatriz Santos ◽  
Álvaro Machado
Keyword(s):  
Low Dose ◽  
Rare Complication ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Post Stroke ◽  
History Of ◽  
One Year

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Sarcomas Arising in Paget Disease of Bone: A Clinicopathologic Analysis of 70 Cases

2007 ◽  
Vol 131 (6) ◽  
pp. 942-946 ◽  
Author(s):  
Andrea T. Deyrup ◽  
Anthony G. Montag ◽  
Carrie Y. Inwards ◽  
Zhiheng Xu ◽  
Ronald G. Swee ◽  
...  
Keyword(s):  
Rare Complication ◽  
Clinical History ◽  
Axial Skeleton ◽  
Clinical Findings ◽  
Paget Disease Of Bone ◽  
Paget Disease ◽  
Significant Difference ◽  
History Of ◽  
Age Range

Abstract Context.—Sarcomatous transformation is a rare complication of Paget disease of bone. Prognosis in patients with other types of sarcomas arising in bone has improved in the last several decades because of therapeutic advances. However, because of the rarity of Paget sarcoma, outcome studies in these patients are limited. Objective.—To determine whether prognosis for Paget sarcoma has improved. Design.—Seventy cases of sarcomas arising in the setting of Paget disease were collected, and the histologic and clinical findings were reviewed. Clinical follow-up was obtained in 67 cases. Results.—Sarcoma arising in Paget disease tended to arise in older men (46 men, 24 women; age range, 31–88 years; mean age, 66 years) and predominated in the axial skeleton (n = 37), especially in the pelvis. Thirty-three patients had a clinical history of Paget disease ranging in duration from 16 months to 30 years (mean, 15 years). No significant difference in incidence between monostotic (n = 33) and polyostotic (n = 36) disease was noted. Most tumors were osteosarcomas (88%). All tumors were high grade. Follow-up information was obtained in 67 of 70 cases (range of follow-up, 1–252 months). Survival ranged from 1 month to 20 years, with a 5-year survival rate of 10%. Conclusions.—Prognosis remains poor in patients with Paget sarcoma. There is no significant correlation between the number of bones involved with Paget disease or the duration of disease and development of Paget sarcoma. Poor prognosis in Paget sarcoma is unrelated to site or stage at presentation.

scholarly journals Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

2021 ◽  
Vol 10 (8) ◽  
pp. e10810817005
Author(s):  
Gustavo Vargas Borgongino Monteiro ◽  
Marcela Chagas Lima Mussi ◽  
Mateus Jorge Nardelli ◽  
Bruno Campos Santos ◽  
Cláudia Alves Couto
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Ductal Carcinoma ◽  
Rare Complication ◽  
Nodular Regenerative Hyperplasia ◽  
Trastuzumab Emtansine ◽  
Her2 Breast Cancer ◽  
History Of ◽  
The Right

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.

scholarly journals Endovascular coil embolization and stenting for the treatment of iatrogenic right internal mammary artery injury: A case report

2018 ◽  
Vol 46 (3) ◽  
pp. 1271-1276
Author(s):  
Zhen Jiang ◽  
JinXiu Yang ◽  
XingXiang Wang
Keyword(s):  
Internal Mammary Artery ◽  
Rare Complication ◽  
Arterial Embolization ◽  
Graft Patency ◽  
Covered Stent ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Internal Mammary ◽  
History Of ◽  
Internal Mammary Artery Injury

A 54-year-old Chinese woman presented with a 10-year history of repeated paroxysmal palpitations. She was diagnosed with paroxysmal supraventricular tachycardia by 12-lead electrocardiogram and was advised to undergo catheter-based radiofrequency ablation. During the procedure, a rare complication occurred that was diagnosed as a right internal mammary artery penetrating injury. After appropriate emergency treatment with arterial embolization and membrane-covered stent implantation, the patient was out of immediate danger of haemorrhaging. Follow-up computed tomography angiography of the subclavian artery at 3 months after she was discharged from hospital revealed stent-graft patency with no evidence of in-stent thrombosis or stent stenosis. No problems were observed at the 6-month follow-up visit.

Diagnosis and Management of Choledochoduodenal Fistula

2011 ◽  
Vol 77 (3) ◽  
pp. 348-350 ◽  
Author(s):  
Kai-Can Zong ◽  
Hai-Bo You ◽  
Jian-Ping Gong ◽  
Bing Tu
Keyword(s):  
Laparoscopic Surgery ◽  
Past History ◽  
Imaging Techniques ◽  
Operative Therapy ◽  
Primary Treatment ◽  
Biliary Disease ◽  
History Of ◽  
Choledochoduodenal Fistula ◽  
Upper Abdominal

Recent advances in hepatobiliary imaging techniques have led to the increased detection of choledochoduodenal fistula. However, the diagnosis and treatment of choledochoduodenal fistula is still a challenge. In this study, we summarize how patients were diagnosed and treated for choledochoduodenal fistula at our institution. Sixty-six patients with choledochoduodenal fistula were diagnosed and treated in our department from January 2000 to June 2009. Sixty-one patients were treated operatively, whereas five patients were treated with medicine. Patients with choledochoduodenal fistula were confirmed by endoscopic retrograde cholangiography. Of the 61 patients needing surgical intervention, clinical outcomes were excellent in 57 patients, and five patients underwent successful laparoscopic surgery for repairing the choledochoduodenal fistula. Follow-up of these patients for 6 months to 10 years showed they did not suffer from further cholangitis. A patients’ past history of biliary disease, upper abdominal pain, fever, and jaundice may lead to choledochoduodenal fistula. Operative therapy, including laparoscopic surgery, was the primary treatment for most patients, regardless of the preoperative diagnosis.

scholarly journals Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess From Ten Years of Experience at a Tertiary Care Center

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Bryan Walker ◽  
Eric Heidel ◽  
Mahmoud Shorman
Keyword(s):  
Staphylococcus Aureus ◽  
Rare Complication ◽  
Care Center ◽  
Tertiary Care ◽  
Care Hospital ◽  
Risk Patients ◽  
History Of ◽  
A Site ◽  
Lost To Follow Up

Abstract Objective Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). Method This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. Results Twenty-one patients were included. The average age was 46 years. Fourteen (67%) patients presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections (52%), history of genitourinary disease or instrumentation (48%), IDU (38%), and diabetes mellitus (38%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. Conclusions S. aureus PA continues to be a rare complication of S.aureus infections. In most published reports, MRSA is the culprit. In high risk patients with persistent bacteremia, physicians need to consider the prostate as a site of infection.

scholarly journals A Case of Psychosis in Disulfiram Treatment for Alcoholism

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Raquel Calvão de Melo ◽  
Rui Lopes ◽  
José Carlos Alves
Keyword(s):  
Psychiatric Illness ◽  
Past History ◽  
Rare Complication ◽  
Chronic Alcoholism ◽  
Physical Symptoms ◽  
Psychotic Symptoms ◽  
Alcohol Dependency ◽  
Mesolimbic System ◽  
History Of

Background. Disulfiram, a drug used in the treatment of alcohol dependence, is an inhibitor of dopamine-β-hydroxylase causing an increase in the concentration of dopamine in the mesolimbic system. In addition to the physical symptoms associated with concomitant use of alcohol, disulfiram may lead to adverse events, when used alone, including psychosis.Aims. To report a case of a rare complication when using disulfiram for alcoholism treatment in a patient in alcoholic abstinence.Case Report. We describe the case of a 42-year-old male patient, who developed psychotic symptoms 3 weeks after initiating treatment with disulfiram for alcohol dependency. The patient had a history of chronic alcoholism for 12 years and was under disulfiram treatment (250 mg/day) for 1 month, with no other past history of psychiatric illness. The symptoms worsened after he initiated alcohol consumption, while taking disulfiram. The patient was hospitalized and disulfiram was suspended. After 4 days he was asymptomatic and at 6-week follow-up remained asymptomatic.Conclusion. Treatment with disulfiram can lead to the appearance of psychosis in patients with increased vulnerability. In clinical practice, psychosis in the context of alcoholism with disulfiram therapy is often neglected and should be taken into account.

scholarly journals Appearance of cerebellar cyst following microvascular decompression to treat hemifacial spasm: a report of two cases and literature review

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052093211
Author(s):  
Yu Cui ◽  
Zhong-Xi Yang ◽  
Chun-Mei Wang ◽  
Zhan-Peng Zhu
Keyword(s):  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Rare Complication ◽  
Intracerebral Haematoma ◽  
Appropriate Treatment ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Safe Approach

Microvascular decompression (MVD) is an effective and safe approach for treating hemifacial spasm (HFS). Postoperative complications may include facial nerve palsy, hearing loss, intracerebral haematoma, and brainstem infarction. The occurrence of intracranial cyst following MVD is extremely rare, with few cases documented in the literature. Herein, the cases of two patients with HFS who developed ipsilateral cerebellar cyst following MVD are reported. The first patient was a 50-year-old male presenting with a 6-year history of HFS on the right side of his face. MVD was performed, and 12 days postoperatively he developed dizziness and nausea. Magnetic resonance imaging (MRI) showed a cyst in the ipsilateral cerebellum. Antibiotic treatment provided no benefit, and the cyst was drained. The second patient was a 44-year-old female presenting with a 4-year history of HFS on the right side of her face. MVD was performed, and 18 days following surgery, she developed dizziness and nausea. MRI showed an ipsilateral cerebellar cyst. Conservative treatment was applied and the cyst shrunk. At the 2-month follow-up appointment, symptoms were completely resolved in both patients. Cerebellar cyst is a rare complication following MVD. Timely diagnosis and appropriate treatment should be emphasized, and surgical treatment may be unnecessary.

scholarly journals Vascular injury in tubular lumbar microdiscectomy, case report and literature review

2019 ◽  
Vol 7 ◽  
pp. 2050313X1985169 ◽  
Author(s):  
Ghazwan Abdulla Hasan ◽  
Hayder Qatran Raheem ◽  
Akeel Yuser ◽  
Luay M Al-Naser ◽  
Reda Ali Sheta
Keyword(s):  
Vascular Injury ◽  
Primary Repair ◽  
Rare Complication ◽  
Synthetic Graft ◽  
Vascular Surgeon ◽  
Burning Pain ◽  
Lumbar Disk Disease ◽  
History Of ◽  
Hip Flexion

Vascular injury in lumbar disk disease is a common complication reviewed in the literature. In our study, we reviewed the rare complication of vascular injury that occurs during lumbar microscopic tubular discectomy. The patient is a 46-year-old male, diabetic, hypertensive and a smoker who presented with a history of backache and right-sided radiculopathy to S1 dermatome for 6 weeks. Conservative measures failed, and we planned and performed microscopic tubular discectomy at the level of L5-S1. Immediately postoperatively, the patient developed acute, sharp, burning pain in the left leg, partially relieved on hip flexion, with diminished distal pulsation of dorsalis pedis, popliteal and femoral. Urgent consultation with a vascular surgeon included a computed tomography angiography which confirmed a vascular injury of the left iliac artery and vein near the bifurcation. The plan involved urgent retroperitoneal exploration of the left iliac vessels, and primary repair with synthetic graft was done with distal embolectomy to regain distal pulsation postoperatively. Further follow-up revealed that the repair was successful.

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