RESUMEN
A patient with a fistula between the aortic graft and the third portion of the duodenum was admitted in our institution and submitted to surgery that involved extra anatomical axillobifemoral bypass, prosthesis removal and bowel resection with a gastrojejunal Roux anastomosis. A prosthetic fistula after aortic surgery is a rare but potentially fatal complication. Erosion, infection and pseudoaneurysm are mechanisms in the pathogenesis of aortoenteric fistula. Because of the high mortality and morbidity, associated with secondary aortoenteric fistula, surgical treatment is always recommended. A combination of endoscopy and CT or MRI may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion. An aortoenteric fistula should always be suspected in all patients who have undergone aortic graft surgery and present with gastrointestinal haemorrhage. The authors discuss the modern management of this challenging complication of aortic surgery.
Asunto(s)
Enfermedades de la Aorta/etiología , Implantación de Prótesis Vascular/efectos adversos , Enfermedades Duodenales/etiología , Fístula Intestinal/etiología , Fístula Vascular/etiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Anciano , Aorta Abdominal/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Enfermedades Duodenales/diagnóstico por imagen , Enfermedades Duodenales/cirugía , Arteria Femoral/cirugía , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugíaRESUMEN
A case is described of severe Nocardia farcinica infection which mimicked a pulmonary neoplasm with pneumonia, superior vena cava syndrome, pericarditis, and hypertrophic osteoarthropathy. Treatment with trimethoprim-sulphamethoxazole and surgery resulted in complete recovery.
Asunto(s)
Nocardiosis/complicaciones , Neumonía Bacteriana/microbiología , Síndrome de la Vena Cava Superior/microbiología , Adulto , Diagnóstico Diferencial , Humanos , Pulmón/diagnóstico por imagen , Masculino , Nocardiosis/diagnóstico por imagen , Osteoartropatía Hipertrófica Primaria/diagnóstico por imagen , Osteoartropatía Hipertrófica Primaria/microbiología , Pericarditis/diagnóstico por imagen , Pericarditis/microbiología , Neumonía Bacteriana/diagnóstico por imagen , Radiografía , Síndrome de la Vena Cava Superior/diagnóstico por imagenRESUMEN
Primary mediastinal tumours (PMT) are rare, they include many different histological types, but lymphomas, thymomas and neurological tumours make up most of these tumours. Their symptomatology is often poor and they are in many cases discovered by routine thoracic radiography. Diagnosis mainly relies on medical imagery and on biopsy by mediastinoscopy or by CT-Scan controlled needle puncture. The treatment depends on the histological type (radiotherapy, chemotherapy, surgery). Median sternotomy is preferred to tackle anterior and middle mediastinum PMT, since it offers a large operative field and is more comfortable for the patient than classic thoracotomy, which will be reserved to tackle posterior mediastinum PMT.
Asunto(s)
Ganglioneuroma/diagnóstico por imagen , Linfoma de Células B/diagnóstico por imagen , Neoplasias del Mediastino/diagnóstico por imagen , Timoma/diagnóstico por imagen , Terapia Combinada , Diagnóstico Diferencial , Femenino , Ganglioneuroma/cirugía , Humanos , Linfoma de Células B/terapia , Masculino , Neoplasias del Mediastino/terapia , Persona de Mediana Edad , Timoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The presence of hepatic portal vein gas is the consequence of invasion by anaerobic bacteria originating from an intestinal tract lesion. Although this phenomenon is rare, it may result from several common intestinal pathologies. The prognosis, despite intensive treatment, is often very poor. The authors report a case associated with bowel necrosis resulting from intestinal band.