Primary aortoenteric fistula following disseminated bacillus Calmette-Guérin infection: a case report

The aim of this paper is to illustrate a rare case of primary aortoenteric fistula in the presence of disseminated infection and review the critical decision-making process. A clinical case was reviewed for its initial presentation, planning of treatment strategy and outcome. A secondary literature search for discussion on current accepted recommendations for primary aortoenteric fistula was then completed. Aortoenteric fistulas are rare pathologies with highly morbid potential. Their diagnosis requires a high index of suspicion and prompt intervention is critical to patient survival. In conclusion, aortoenteric fistula most commonly arises from large atherosclerotic aneurysms but can be caused by systemic infection. In the case of the latter, extra-anatomic repair appears to be the treatment of choice.

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Primary aortoenteric fistula related to septic aortitis

Sao Paulo Medical Journal ◽

10.1590/s1516-31802001000400008 ◽

2001 ◽

Vol 119 (4) ◽

pp. 150-153 ◽

Cited By ~ 16

Author(s):

Fábio Lambertini Tozzi ◽

Erasmo Simão da Silva ◽

Fernando Campos ◽

Henrique Oscar de Azevedo Fagundes Neto ◽

Marcos Lucon ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Arrest ◽

Abdominal Aortic Aneurysm ◽

Clinical Case ◽

Bowel Wall ◽

Aortoenteric Fistula ◽

Axillofemoral Bypass ◽

Aortic Pseudoaneurysm ◽

Abdominal Aortic ◽

Aortoenteric Fistulas

CONTEXT: Primary aortoenteric fistulas usually result from erosion of the bowel wall due to an associated abdominal aortic aneurysm. A few patients have been described with other etiologies such as pseudoaneurysm originating from septic aortitis caused by Salmonella. OBJECTIVE: To present a rare clinical case of pseudoaneurysm caused by septic aortitis that evolved into an aortoenteric fistula. CASE REPORT: A 65-year-old woman was admitted with Salmonella bacteremia that evolved to septic aortitis. An aortic pseudoaneurysm secondary to the aortitis had eroded the transition between duodenum and jejunum, and an aortoenteric fistula was formed. In the operating room, the affected aorta and intestinal area were excised and an intestine-to-intestine anastomosis was performed. The aorta was sutured and an axillofemoral bypass was carried out. In the intensive care unit, the patient had a cardiac arrest that evolved to death.

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Intravesical bacillus calmette-guerin treatment improves patient survival in conservatively treated TIG3 bladder tumours

European Urology Supplements ◽

10.1016/s1569-9056(02)80470-5 ◽

2002 ◽

Vol 1 (1) ◽

pp. 121

Author(s):

Alejandro Rodriguez ◽

Jean Jacques Patard ◽

Emmanuelle Leray ◽

Bernard Lobel ◽

François Guille

Keyword(s):

Patient Survival ◽

Bacillus Calmette Guerin ◽

Bladder Tumours

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Cholecystitis in Patients Undergoing Liver Transplantation: A Five-Year Analysis of Incidence, Causes, and Impact

The American Surgeon ◽

10.1177/0003134820964210 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1254-1259

Author(s):

Danielle S. Graham ◽

Takahiro Ito ◽

Michelle Lu ◽

Joseph Dinorcia ◽

Vatche G. Agopian ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Patient Population ◽

Patient Survival ◽

Kaplan Meier ◽

High Acuity ◽

Transplant Candidates ◽

Pathology Reports ◽

End Stage ◽

High Index Of Suspicion

There is a paucity of data on cholecystitis in liver transplant candidates (LTC), including the incidence of the cholecystitis and the associated outcomes in this patient population. As such, this study examines the incidence of and factors associated with cholecystitis in the high-acuity LTC population, as well as the association between cholecystitis and graft and patient survival. Liver transplant candidates undergoing orthotopic liver transplantation (OLT) at a large transplant center from January 1, 2012 to December 31, 2016 were included in the initial analysis. Surgical pathology reports were examined for the presence of cholecystitis. Univariate analyses were performed to determine the association between patient factors and cholecystitis. Kaplan-Meier analyses and multivariate Cox proportional hazard models were performed to examine the association between cholecystitis and graft and patient survival. Of the 405 patients in the final study population, 267 (65.9%) had no cholecystitis, 21 (5.2%) had acute cholecystitis, and 117 (28.9%) had chronic cholecystitis. The presence of cholecystitis was associated with preoperative WBC, sepsis within 10 days prior to transplant, location prior to transplant, and total length of stay. While this study revealed no association between cholecystitis and graft or patient survival, it also suggests that cholecystitis is under-recognized in high-model end-stage liver disease (MELD) OLT candidates. Therefore, a high index of suspicion for cholecystitis may be helpful in caring for this vulnerable patient population; however, further studies must be performed to determine the optimal management of cholecystitis in these patients.

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Intravesical Bacillus Calmette-Guerin Treatment Improves Patient Survival in T1G3 Bladder Tumours

European Urology ◽

10.1016/s0302-2838(02)00173-2 ◽

2002 ◽

Vol 41 (6) ◽

pp. 635-642 ◽

Cited By ~ 38

Author(s):

Jean-Jacques Patard ◽

Alejandro Rodriguez ◽

Emmanuelle Leray ◽

Nathalie Rioux-Leclercq ◽

François Guillé ◽

...

Keyword(s):

Patient Survival ◽

Bacillus Calmette Guerin ◽

Bladder Tumours

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Systemic infection following intravesical therapy with BCG

BMJ Case Reports ◽

10.1136/bcr-2021-243641 ◽

2021 ◽

Vol 14 (11) ◽

pp. e243641

Author(s):

Ana Andrade Oliveira ◽

Joana Morais ◽

Jorge Ribeiro ◽

Paulo Ferreira Gouveia

Keyword(s):

Bladder Cancer ◽

Systemic Infection ◽

Severe Case ◽

Invasive Bladder Cancer ◽

Intravesical Therapy ◽

Muscle Invasive Bladder Cancer ◽

Laboratory Confirmation ◽

Life Threatening ◽

Muscle Invasive ◽

High Index Of Suspicion

Immunotherapy with BCG is an effective and widely used treatment for non-muscle-invasive bladder cancer. BCG sepsis is a rare but life-threatening and frequently not a straightforward complication of this treatment; in cases with a high index of suspicion, anti-bacillary treatment should not wait for laboratory confirmation and be instituted immediately. We report a severe case of BCG sepsis, in which timely diagnosis and initiation of antituberculosis agents enabled a full recovery.

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A Case of Pott’s Disease with Epidural Abscess and Probable Cerebral Tuberculoma following Bacillus Calmette-Guérin Therapy for Superficial Bladder Cancer

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2010/572410 ◽

2010 ◽

Vol 21 (1) ◽

pp. e75-e78 ◽

Cited By ~ 10

Author(s):

Colin B Josephson ◽

Saleh Al-Azri ◽

Daniel J Smyth ◽

David Haase ◽

B Lynn Johnston

Keyword(s):

Interferon Alpha ◽

Epidural Abscess ◽

Transitional Cell ◽

Vertebral Osteomyelitis ◽

Systemic Infection ◽

Late Presentation ◽

Bacillus Calmette Guerin ◽

Interferon Alpha 2B ◽

Intravesical Bcg ◽

Cerebral Tuberculoma

Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is an accepted treatment for transitional cell carcinoma of the bladder. Carcinoma in situ of the bladder progresses to invasive muscular disease in approximately 54% of untreated patients, mandating early initiation of therapy once the diagnosis is confirmed. Should BCG treatment fail, an additional course of BCG combined with interferon-alpha, both administered intravesically, is a promising second-line immunotherapy. In greater than 95% of patients, BCG is tolerated without significant morbidity or mortality. However, both early (within three months of the original treatment) and late presentations of systemic infection resulting from intravesical BCG treatment have been described. The present study describes the course of a 75-year-old man with a late presentation of BCG vertebral osteomyelitis, discitis, epidural abscess, bilateral psoas abscesses and probable cerebral tuberculoma, following treatment regimens of intravesical BCG followed by intravesical BCG plus interferon-alpha 2b.

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Oesophageal tuberculosis with concomitant candidiasis: a rare cause of dysphagia

BMJ Case Reports ◽

10.1136/bcr-2019-231435 ◽

2019 ◽

Vol 12 (11) ◽

pp. e231435

Author(s):

Nolitha Makapi Tisetso Morare ◽

David Morris Rose ◽

Olivia Appels

Keyword(s):

Developing Countries ◽

High Risk ◽

Global Health ◽

Antiretroviral Treatment ◽

Systemic Infection ◽

Risk Groups ◽

Newly Diagnosed ◽

Health Crisis ◽

The World ◽

High Index Of Suspicion

We present a case of a 23-year-old woman with dysphagia. She was reportedly newly diagnosed with HIV and had been initiated on antiretroviral treatment and tuberculosis (TB) prophylaxis. Oesophagogastroduodenoscopy revealed an irregular, ulcerative oesophageal lesion. Subsequent histopathology revealed Mycobacterium tuberculosis as well as Candida albicans. A CT scan demonstrated widespread disease with miliary TB. She was subsequently initiated on antituberculous and antifungal medications. TB is one of the most common and deadly infectious diseases in the world, with the highest rates seen in the developing countries. It commonly occurs as an opportunistic infection of HIV. Despite its potential for systemic infection, infection of the oesophagus is incredibly rare, more so as a co-infection with candida. This case highlights the need to have a high index of suspicion in high risk groups, as early treatment is crucial in addressing this global health crisis.

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AAC Decision-Making and Mobile Technology: Points to Ponder

Perspectives on Augmentative and Alternative Communication ◽

10.1044/aac23.2.104 ◽

2014 ◽

Vol 23 (2) ◽

pp. 104-111 ◽

Cited By ~ 6

Author(s):

Mary Ann Abbott ◽

Debby McBride

Keyword(s):

Decision Making ◽

Mobile Technology ◽

Communication System ◽

Augmentative And Alternative Communication ◽

Evaluation Process ◽

Decision Making Process ◽

Alternative Communication ◽

Ipod Touch ◽

Feature Match

The purpose of this article is to outline a decision-making process and highlight which portions of the augmentative and alternative communication (AAC) evaluation process deserve special attention when deciding which features are required for a communication system in order to provide optimal benefit for the user. The clinician then will be able to use a feature-match approach as part of the decision-making process to determine whether mobile technology or a dedicated device is the best choice for communication. The term mobile technology will be used to describe off-the-shelf, commercially available, tablet-style devices like an iPhone®, iPod Touch®, iPad®, and Android® or Windows® tablet.

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