SURGICAL TREATMENT OF IATROGENIC COMPLEX RECURRENT EXTRASPHINCTER ANORECTAL FISTULA: A CLINICAL CASE

Background: Anorectal fistula is a benign disease with an average prevalence of 1.69/10,000 population. The disease significantly reduces the life quality and has a tendency to relapse. Repeated surgical treatment can lead to anal sphincter impairment. Paraproctitis is the main anorectal fistulas cause. However, there are also iatrogenic traumatic fistulas that occur after various anorectal surgical interventions.Clinical case: A 44-year old female patient applied to the MSU University clinic in March 2020 with perineal wound with permanent purulent discharge. During examination perianal soft tissue defect was determined, the external fistula opening (40x25x25cm) was visualized at the wound bottom, the internal fistula opening (2x3mm) was visualized at 12h of the clock dial. The perianal area is deformed due to scarring. In 2016 the patient underwent surgical «rectocele elimination, posterior colporaphy, levatoroplasty, plastic surgery of the anterior rectal wall». Obstructive defecation syndrome developed during postoperative period, and repeated surgical treatment was performed – anterior anosfincterolevatoroplasty, Milligan-Morgan hemorrhoidectomy.On the 9th day, there was a «perianal soft tissue rupture» with bleeding and «local anterior rectal wall damage in the suprasphincter zone». Then «the rectal defect suturing» was performed. The perineal wound was left open. The patient was reoperated in 3 months due to a rectovaginal fistula with no effect. A fistulectomy was performed at the Moscow State University Medical Center with the removal of the anal canal defect by mucosal-submucosal flap. The surgical wound heals by secondary tension.Conclusion: The current studies describe a small number of cases of anorectal fistulas secondary to anorectal surgery. At the same time, there is no data on the further surgical management of such patients. It is important to present the iatrogenic anorectal fistulas cases, not only to analyze the fistula cause, but also to describe the surgical treatment method and its efficacy.

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Radiogenic Vaginal Angiosarcoma: a Clinical Case

Creative Surgery and Oncology ◽

10.24060/2076-3093-2020-10-2-143-148 ◽

2020 ◽

Vol 10 (2) ◽

pp. 143-148

Author(s):

K. V. Menshikov ◽

A. V. Pushkarev ◽

A. V. Sultanbaev ◽

V. A. Pushkarev ◽

I. A. Sharifgaliev

Keyword(s):

Radiation Therapy ◽

Soft Tissue ◽

Clinical Case ◽

Rectal Wall ◽

Soft Tissue Sarcomas ◽

Vaginal Wall ◽

Reproductive Age ◽

Anterior Rectal Wall ◽

Mesenchymal Neoplasms ◽

Secondary Tumour

Background. Vaginal sarcomas are rare malignant mesenchymal neoplasms. Incidence rate of vulvar and vaginal sarcomas ranges from 1 to 3%. Vaginal sarcomas are usually represented by leiomyosarcomas in reproductive-age women. More seldom are soft tissue fibrosarcomas, angiosarcomas, malignant fi brous histiocytomas and alveolar soft tissue sarcomas. Tumours induced by prior radiation therapy deserve special concern. In oncogynaecology, radiation therapy is commonly applied in cervical and endometrial cancer therapy. According to some evidence, average development time of a secondary tumour after completion of radiation therapy is 10.8 years. The relative risk of vaginal cancer increases by a factor of 300 after radiation therapy.Materials and methods. The reported clinical case represents a rare vaginal tumour, angiosarcoma, developed 26 years after radiation therapy for gynaecological cancer.Results and discussion. A 78 years-old patient underwent combined tumourectomy of the posterior vaginal wall with resection of the anterior rectal wall and application of preventive transversostoma. No postoperative complications were observed.Conclusion. Surgical treatment is a method of choice with patients of such kind and allows local containment of the disease.

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No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03747-2 ◽

2021 ◽

Author(s):

F. Wichlas ◽

V. Hofmann ◽

M. Moursy ◽

G. Strada ◽

C. Deininger

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Sierra Leone ◽

Low Income ◽

Soft Tissue Defect ◽

Low Income Countries ◽

Pelvic Surgery ◽

Closed Fractures ◽

Trauma Triage ◽

Tissue Defects

Abstract Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

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A CLINICAL CASE OF REMOVING A RESIDUAL FOREIGN BODY FROM THE LEFT SUPRACLAVICULAR REGION

Inter Collegas ◽

10.35339/ic.4.3.120-122 ◽

2017 ◽

Vol 4 (3) ◽

pp. 120-122

Author(s):

V.V. Boyko ◽

V.V. Makarov ◽

A.L. Sochnieva ◽

V.V. Kritsak

Keyword(s):

Surgical Treatment ◽

Foreign Body ◽

Soft Tissue ◽

Clinical Case ◽

Foreign Bodies ◽

Soft Tissues ◽

Life Quality ◽

The Other ◽

Practical Case ◽

The One

Boyko V.V., Makarov V.V., Sochnieva A.L., Kritsak V.V.Residual foreign bodies in soft tissues are one of the main causes of chronical infection lesions and decrease in life quality. Surgical treatment is the most common way to relieve the patient from a foreign body. Often there is a question whether to remove a foreign body? On the one hand, all foreign bodies that are in the human body must be removed. On the other hand, in the absence of symptoms, the risk of surgery performed for the purpose of removal exceeds the risk associated with finding the foreign body. We would like to describe a practical case of removing a foreign body (Kirschner`s wires) from the left supraclavicular region. The young patient lived with a fragment of Kirschner's wire left after the osteosynthesis of the fractured clavicle for 5 years. Surgery to remove the residual foreign body was successful. On the 7th postoperative day the patient was discharged from the hospital under the supervision of surgeons at the place of residence.Key words: foreign body in soft tissue, Kirschner`s wire, surgical treatment. КЛІНІЧНИЙ ВИПАДОК ВИДАЛЕННЯ ЗАЛИШКОВ СТОРОННЬОГО ТІЛА З ЛІВОЇ НАДКЛЮЧИЧНОЇ ОБЛАСТІБойко В.В., Макаров В.В., Сочнева А.Л., Крицак В.В.Залишкові чужорідні тіла м'яких тканин залишаються однією з основних причин виникнення вогнища хронічної інфекції та зниження рівня якості життя. Хірургічне лікування основний спосіб позбавити хворого від наявності чужорідного агента. Часто виникає питання чи видаляти чужорідне тіло. З одного боку, усі сторонні тіла, що знаходяться в тілі людини, підлягають видаленню, з іншого боку при відсутності симптомів ризик операції, проводимої з метою видалення, перевищує ризик, пов'язаний з перебуванням чужорідного тіла. Ми хотіли б поділитися випадком видалення залишкового стороннього тіла (спиці Кіршнера) лівої надключичної ділянки із власної практики. Молода пацієнтка прожила з уламком спиці Кіршнера, залишеної після металлоостеосинтезу поламаної ключиці протягом 5 років. Операція з видалення залишкового стороннього тіла пройшла успішно. На 7 післяопераційну добу пацієнтка була виписана зі стаціонару під спостереження хірурги за місцем проживання.Ключові слова: чужорідне тіло м'яких тканин, спиця Кіршнера, хірургічне лікування. кЛИНИЧЕСКИЙ СЛУЧАЙ УДАЛЕНИЯ ОСТАТКОВ ИНОРОДНОГО ТЕЛА ИЗ ЛЕВОЙ ПОДКЛЮЧИЧНОЙ ОБЛАСТИ Бойко В.В., Макаров В.В., Сочнева А.Л., Крицак В.В.Остаточные инородные тела мягких тканей остаются одной из основных причин возникновения очага хронической инфекции и снижения уровня качества жизни. Хирургическое лечение основной способ избавить больного от наличия чужеродного агента. Часто возникает вопрос удалять ли инородное тело? С одной стороны, все инородные тела, находящиеся в теле человека, подлежат удалению, с другой стороны при отсутствии симптомов риск операции, производимой с целью удаления, превышает риск, связанный с нахождением инородного тела. Мы хотели бы поделится случаем удаления остаточного инородного тела (спицы Киршнера) левой надключичной области из собственной практики. Молодая пациентка прожила с обломком спицы Киршнера, оставленной после металлоостеосинтеза поломанной ключицы в течении 5 лет. Операция по удалению остаточного инородного тела прошла успешно. На 7 послеоперационные сутки пациентка была выписана из стационара под наблюдение хирурги по месту жительства.Ключевые слова: инородное тело мягких тканей, спица Киршнера, оперативное лечение.

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Early Maxillary Orthopedics in a Child with an Oblique Facial Cleft

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0147_emoiac_2.3.co_2 ◽

1997 ◽

Vol 34 (2) ◽

pp. 147-150 ◽

Cited By ~ 1

Author(s):

Angelika Stellzig ◽

Efthimia K. Basdra ◽

Jochen Mühling ◽

Gerda Komposch

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Soft Tissue Defect ◽

Alveolar Cleft ◽

Facial Cleft ◽

Tissue Defect ◽

Plastic Reconstruction ◽

Facial Clefts ◽

Newborn Child

Objective Oblique facial clefts are extremely rare. In view of their variabilty, surgical treatment cannot be standardized. To date, early maxillary orthopedics in the treatment of oblique facial clefts have not been reported. The case described here presents a newborn child with a Tessier 3 cleft. Because of the enormous width of the alveolar cleft, a narrowing of the segments was regarded as prerequisite for definitive lip closure. To bring the segments together, an actively working plate with a forward pull was designed. Conclusion After a period of 4 weeks, proper alignment and proximity of the segments were achieved, so that definitive lip closure and plastic reconstruction of the remaining soft tissue defect could be easier performed.

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Acute Cardiac Tamponade Secondary to Cardiac Vascular-Type Pleomorphic Leiomyosarcoma: Case Report

Case Reports in Oncology ◽

10.1159/000520358 ◽

2021 ◽

pp. 1860-1867

Author(s):

Ricardo Fernández-Ferreira ◽

Pamela Denisse Soberanis-piña ◽

Emilio Conde-Flores ◽

Andrés Mauricio Arroyave-Ramírez ◽

Ileana Mackinney-Novelo ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Soft Tissue ◽

Pulmonary Artery ◽

Cardiac Tamponade ◽

Clinical Case ◽

Soft Tissue Sarcomas ◽

Initial Manifestation ◽

Vascular Type ◽

Great Vessels

Soft tissue sarcomas represent <1% of all neoplasms. Leiomyosarcomas comprise only 5–7% of cases, and only 2% of these are vascular. Vascular leiomyosarcomas are extremely rare and represent only 0.001% of all neoplasms, the venous type being up to 5 times more frequent. Arterial leiomyosarcomas most frequently affect the great vessels, being fatal in most cases. In the reported cases of arterial leiomyosarcomas, the most frequently affected site is the pulmonary artery. We present the clinical case of 2 patients (a 42-year-old woman and a 36-year-old man) with a diagnosis of arterial pleomorphic leiomyosarcoma that conditioned cardiac tamponade as the initial manifestation. As it is an exceptionally rare neoplasm and with few cases reported in the literature, it is important to identify and describe this pathology which, due to the impossibility of offering surgical treatment, represents a therapeutic challenge.

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Ileo-perineal fistula: Rare late complication after rectal amputation – clinical case

Romanian Medical Journal ◽

10.37897/rmj.2021.1.17 ◽

2021 ◽

Vol 68 (1) ◽

pp. 102-105

Author(s):

Andrei Iulian Toader ◽

◽

Călin Pavel Cobelsch ◽

Aurel Mironescu ◽

Alfred Redalf Alain Gheorghiu ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Case ◽

Fistulous Tract ◽

Late Complication ◽

Perineal Wound ◽

Rectal Neoplasm ◽

Perineal Fistula ◽

Ileal Loop ◽

Case Presentation ◽

Technical Advances

Abdominal-perineal rectal amputation retains a well-defined place in the surgical treatment of rectal cancer, despite technical advances. The authors present the case of a 67-year-old patient who developed an entero-perineal fistula involving the last ileal loop, two years after an abdominal-perineal rectal amputation for a radiotreated rectal neoplasm. For surgical treatment of the fistula, right ileo-hemicolectomy with ileo-transverse anastomosis were performed. The fistulous tract is treated by soft field typhoon meshing in the same manner of treating the perineal wound after rectal amputation. The evolution is favorable, with the closure of the perineal wound, 6 weeks after surgery. The peculiarity of the case consists in the way of surgical solution. This case presentation is important due to the rarity of the ileo-perineal fistula after amputation of the rectum, as well as due to the particular way of surgical resolution.

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A combined two wavelenght laser treatment of prosthesis-related fibrous hyperplasia - Report of a clinical case

Journal of Surgery Peridontology and Implant Research ◽

10.35252/jspir.2019.1.001.1.03 ◽

2019 ◽

Vol 1 (1) ◽

pp. 18-21

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Soft Tissue ◽

Clinical Case ◽

Er:Yag Laser ◽

Soft Tissue Lesion ◽

Nd:Yag Lasers ◽

Tissue Healing ◽

Chronic Trauma ◽

Oral Soft Tissue

Purposes: Prosthesis-related Fibrous Hyperplasia, also many times referred as epulis fissuratum, is one of the most common benign oral soft tissue lesion, that appears due to chronic trauma, usually caused by a poorly adapted prosthesis. It is more common in the anterior region of the maxilla, being an exophytic lesion, which affects mainly elderly and female patients. Our aim is to present the usefulness of Er:YAG and Nd:YAG lasers in the surgical treatment of an Prosthesis-related Fibrous Hyperplasia (PRFH). Case report: The present paper reports a clinical case of two PRFH located in the maxillary vestibulum mucosa and in the palate in a 56-year-old female, caused by a poorly adapted prosthesis. For excision of the lesions in the vestibule and palate we used Er:YAG Laser (2940nm) and ND:YAG (1064nm), respectively. In the postoperative period, the patient did not report any discommodity, and presented a good tissue healing. Histological examination revealed the presence of Fibrous Hyperplasia. Conclusions: Elimination of PRFH is the treatment of choice with the confection of a new prosthesis. The two lesions were correctly eliminated, with the use of an Er:YAG and Nd:YAG lasers, with excellent recover and without recurrence.

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