fistula formation
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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
You Jia ◽  
Li Shuang ◽  
Wang Jun ◽  
Li Gang ◽  
Chen Hai-tao

Abstract Background Urogenital small foreign bodies (FBs) have rarely been reported in children, and their management is still challenging. This study aimed to describe the characteristics and treatment of spherical FBs no larger than 0.6 cm in the children’s genitourinary tracts.  Methods The clinical data of spherical FBs removed in our hospital from June 2013 to June 2020 were recorded and retrospectively analyzed, including demographics, location, symptoms, imaging examinations and treatment methods. Results A total of 10 patients were enrolled: 6 girls and 4 boys. Their ages ranged from 5.1 to 16.8 years old, with a mean age of 9.2 years. The course of the disease ranged from 3 h to 1 year, and symptoms recurred in some cases. Their imaging characteristics were reviewed and analyzed, 6 patients underwent color Doppler ultrasonography, 1 patient was suspected to have an FB in the vagina, 7 patients underwent an X-ray examination, and FBs were revealed in 6 patients. All FBs were removed under endoscopic minimally invasive surgery. Six vaginal FBs were successfully retrieved via vaginoscopy, and in the other four cases, removal by transurethral cystoscopy failed because of mutual attraction, which was eliminated by laparoscopy under pneumovesicum. Postoperative recovery was uneventful; in a follow-up of 3 months to 2 years, there was no perforation or fistula formation, and there were no urethral strictures in boys. Conclusion Small spherical FBs are clinically rare; they are sometimes difficult to detect by imaging examinations and can be easily overlooked. Minimally invasive endoscopy remains the first-line approach for the diagnosis and removal of genitourinary spherical FBs.


2022 ◽  
Vol 2022 ◽  
pp. 1-4
Author(s):  
Yousef S. Abuzneid ◽  
Hussam I. A. Alzeerelhouseini ◽  
Abdelrahman Rabee ◽  
Wafa Aqel ◽  
Rawan F. Ayyad ◽  
...  

Introduction. Foreign body ingestion is a common pediatric complain, and most can be passed spontaneously; however, magnetic object ingestion is rather rare, and they can cause severe complications when multiple magnets are ingested, as they lead to entrapment of bowel walls between them, causing ischemia, pressure necrosis, perforation, and fistula formation. Case Presentation. Herein, we present a case of a 16-month-old female patient presented to our department complaining of continuous vomiting for two days along with fever and irritability. X-ray revealed dilated bowel loops with a radioopaque foreign body in the right lower quadrant. After discussing with the parents, exploratory laparotomy was done, showing two bowel perforations at the site of the magnets. Affected bowel was resected with anastomosis. The patient was discharged after 3 days with an uneventful recovery. Discussion. The diagnosis and management of magnet ingestion differ from those of small foreign bodies, which are usually managed conservatively by watchful waiting. Usually, the diagnosis is done due to complications such as peritonitis and death. On the other hand, management depends on the number, size, magnetic field, and shape of the magnet, and whether it has passed the pylorus or not. Conclusion. It is important to establish the diagnosis of this condition as early as possible to prevent complications. Despite the efforts that were made to try to prevent and minimize the risk of magnet ingestion, more investigations are required to reach a common and united strategy for management of such conditions.


2022 ◽  
pp. 547-549
Author(s):  
Mohd Monis ◽  
Md Khalaf Saba ◽  
Syed M Danish Qaseem ◽  
Nadeem Arshad

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.


Author(s):  
S. Shanmuga Jayanthan ◽  
Rajagopal Ganesh

AbstractGarré's sclerosing osteomyelitis is a form of chronic osteomyelitis that commonly affects children and young adults. Here, we report one such case of Garré's sclerosing osteomyelitis in a 20-year-old female who presented with facial asymmetry and inability to open mouth. On clinical examination, it was bony hard swelling with trismus. History of infected second molar tooth extraction was present. Computed tomography scan showed thickening and sclerosis of the ramus and condylar process of mandible, on right side, with proliferative periostitis. Magnetic resonance imaging showed soft tissue edema and inflammation, in the form of enlargement of right masseter and pterygoid muscles with intramuscular fluid collection. On the basis of history, clinical signs, and imaging features, diagnosis of Garré's osteomyelitis with fascial space infection was made. To our knowledge, very few cases of Garré's osteomyelitis present with superimposed fascial space infection, as it is otherwise a nonsuppurative condition. Fistula formation is a very rare incidence as it is seen in our case.


Author(s):  
Tarang Preet Kaur ◽  
Sangeeta Bhasin ◽  
Asmita M. Rathore

Abstract Background Spontaneous vaginoperitoneal fistula formation in a case of carcinoma ovary is a very rare occurrence and has never been reported. Case presentation A 55-year-old postmenopausal lady presented with complaints of abdominal distention and mass coming out of the vagina for the last 10 days. On examination, she had tense ascites, uterovaginal prolapse and hard, fixed mass felt anteriorly on per-rectal examination. Biochemical investigations and radiological imaging suggested advanced stage ovarian neoplasm. She was planned for neoadjuvant chemotherapy. During the second cycle of chemotherapy, she developed spontaneous vaginoperitoneal fistula which was confirmed on exploratory laparotomy where interval debulking surgery was performed in collaboration with gastro-surgeons on a semi-emergency basis. The postoperative course was uneventful. Conclusion Spontaneous vaginoperitoneal fistula is a rare complication and should be kept in mind while managing advanced ovarian neoplasm.


2022 ◽  
pp. 37-40
Author(s):  
Z. A-G. Radzhabova ◽  
M. A. Kotov ◽  
E. V. Levchenko

Objective. Analyze the frequency and prognostic factors of complications in patients with locally advanced cervical esophageal cancer after pharyngolaryngoesophagectomy with simultaneous reconstruction of the defect.Material and methods. The retrospective study included patients with a verified locally advanced cervical esophageal cancer who were treated at the N. N. Petrov National Research Institute of Oncology in the period from 2009 to 2018, who underwent surgical treatment followed by chemoradiotherapy. The end point of the study was the frequency of postoperative complications.Results. Forty-eight patients were included in the study. All patients underwent laryngopharyngoesophagectomy with simultaneous reconstruction of the digestive tract. Forty-one patients (85.4 %) underwent the reconstructive stage using a narrow gastric stalk, and a wide gastric stalk and a small intestine graft were used in 5 (10.4 %) and 2 (4.2 %) patients, respectively. The average duration of the operation was 390 (337.5–525.0) minutes, the volume of blood loss was 300 (200–500) ml, and the average time of hospitalization and the patient’s stay in the intensive care unit was 21.5 (16.00–36.00) and 3 (1.000–6.75) days, respectively. Complications within 30 days after surgical treatment were observed in 54.1 % of patients, while anastomosis failure, fistula formation and pneumonia were observed in 22.9 %, 12.5 % and 18.8 % of cases, respectively. Factors slightly increasing the likelihood of pneumonia in the early postoperative period were: duration of surgery [OR = 1.0 (95 % CI: 1.00–1.01), p = 0.0131] and intraoperative blood loss [OR = 1.0 (95 % CI: 1.00–1.01), p = 0.0017].Conclusion. The overall complication rate after pharyngolaryngoesophagectomy with simultaneous repair of the defect by bioengineered graft was 54.1 %. Intraoperative blood loss and duration of surgery were associated with an increased risk of complications.


2022 ◽  
Vol 5 (1) ◽  
pp. e000225
Author(s):  
M Reza Roshandel ◽  
Tannaz Aghaei Badr ◽  
Fahimeh Kazemi Rashed ◽  
Samantha Salomon ◽  
Seyyed Mohammad Ghahestani ◽  
...  

BackgroundTubularized incised plate urethroplasty is the most common hypospadias repair technique. However, there are unanswered questions and debates about the anatomical prognostic factors affecting the repair outcomes. This study tried to address some of the problems in the studies compromising the results of the current body of literature.MethodsA prospective cohort of 101 males aged 1–3 years undergoing primary distal to mid-shaft hypospadias repair were enrolled in the study. Complications including edema, erection, inadvertent removal of the urethral stent, surgical wound infection, bladder spasm, hematoma, and hemorrhage were evaluated. Studies in the current literature were reviewed to achieve a better perspective for future investigations.ResultsPersistent complications were found in 16 cases (15.8%) including fistula formation, the persistence of chordee, meatal stenosis, glans, and urethral dehiscence. The mean follow-up time was 6.6±3.4 months. In the single-variable analysis, the meatal location, the length and width of the urethral plate, and the reversible acute postoperative events were significantly associated with the complications. Furthermore, fistula formation was associated with acute surgical site infection (p<0.001). However, the multivariable regression study revealed the presurgical meatal location to be the only statistically significant factor (p=0.03). Notably, the glans diameter or glanular groove shape, urethral plate dimensions, or presence of mild chordee were not independently associated with the outcomes (p>0.05).ConclusionsOur study on the toddlers with hypospadias surgery revealed that the location of urethral meatal was the main predicting factor in the development of major complications. Furthermore, the fistula formation at the infected surgical site emphasizes the importance of postsurgical care.


2021 ◽  
pp. 972-977
Author(s):  
Bakht S. Cheema ◽  
Maged Ghali ◽  
Ron Schey ◽  
Ziad Awad ◽  
Bruno Ribeiro

The Food and Drug Administration (FDA) has recently released a safety communication recommending transition to duodenoscopes with innovative designs that facilitate or eliminate the need for reprocessing. Thus, there has been a significant amount of development into disposable duodenoscope components and single-use duodenoscopes, with variable tactile feedback. We describe a case of esophageal perforation after using a single-use disposable duodenoscope (EXALT Model D; Boston Scientific Corporation, Marlborough, MA, USA). To our knowledge, this is the first reported case of an esophageal perforation since FDA approval of this device in December 2019. ERCP was performed with the EXALT Model D single-use duodenoscope (Boston Scientific Corporation) by an experienced gastroenterologist. During the procedure, gentle force applied through the gastroesophageal junction caused a liner perforation in the distal esophagus. An esophageal stent was placed with satisfactory wound healing and no fistula formation. There have been a few reports in the last 2 years showing promising results using this device; however, the differences in the tactile feedback, navigation, and pushability of the device may make it prone to unintended consequences.


Author(s):  
Reem Ali AlShaikh ◽  
Dimah Saad Alnowaiser ◽  
Abdul Ali Peer Zada ◽  
Awatif AlMutairi ◽  
Hamzah AlGhamdi

Here we report on a challenging diagnosis of VIAHS in a patient who presented at a very early age with a perianal abscess with fistula formation, fever, aphthous ulcers, bicytopenia, and hematochezia. Marked phenotypic variability can occur, and screening for families should be initiated in those with ADA2 mutation.


2021 ◽  
Author(s):  
V. O. Nevmerzhytskyi

Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects. The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity. The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %). Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity.  


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