RESUMEN
Since the last decade, iatrogenic injuries of ureter are increasingly common. We describe a case of 36-year-old young female, who underwent emergency cesarean section, presented to us after 3 weeks, with clear vaginal discharge. After evaluated with clinical examination and radiological investigations, she was found to have left uretero-uterine fistula and was successfully treated with robotic-assisted left uretero-uterine fistula repair by Lich-Gregoir technique.
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Cesárea , Procedimientos Quirúrgicos Robotizados , Enfermedades Ureterales , Fístula Urinaria , Enfermedades Uterinas , Humanos , Femenino , Adulto , Cesárea/efectos adversos , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , Embarazo , Enfermedades Uterinas/cirugía , Enfermedades Uterinas/etiología , Fístula/etiología , Fístula/cirugíaAsunto(s)
Fibrilación Atrial , Ablación por Catéter , Embolia Aérea , Fístula Esofágica , Oxigenoterapia Hiperbárica , Embolia Intracraneal , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Embolia Aérea/etiología , Embolia Aérea/terapia , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Fístula Esofágica/etiología , Oxigenoterapia Hiperbárica/métodos , Embolia Intracraneal/etiología , Masculino , Atrios Cardíacos/diagnóstico por imagen , Fístula/etiología , Persona de Mediana EdadRESUMEN
BACKGROUND: Managing infectious complications after kidney transplantation (KT) remains a major challenge. Infections are the leading non-cardiovascular cause of death among kidney transplant recipients (KTr). The urinary tract is particularly vulnerable to infections in this group, leading to high levels of morbidity and mortality, as well as significant economic costs. CASE PRESENTATION: This case report presents the first documented instance of extensive thigh pyomyositis resulting from cystic fistulae in an 84-year-old KTr. The patient was referred to our hospital with acute onset fever, pain in the inner thighs and pyuria. A CT scan revealed bilateral pyomyositis of the thighs, characterized by multiple abscesses in the adductor muscles and hydroaerobic levels. Additionally, cystic fistulae complicated by pubic symphysis osteitis were identified. CONCLUSION: In KTr, lower limb pyomyositis resulting from a urinary tract infection is an extremely rare and significantly worsens the overall prognosis for these patients.
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Trasplante de Riñón , Piomiositis , Muslo , Humanos , Piomiositis/microbiología , Trasplante de Riñón/efectos adversos , Muslo/patología , Masculino , Anciano de 80 o más Años , Bacterias Anaerobias/aislamiento & purificación , Infecciones Urinarias/microbiología , Infecciones Urinarias/complicaciones , Receptores de Trasplantes , Tomografía Computarizada por Rayos X , Infecciones Bacterianas/microbiología , Fístula/etiologíaRESUMEN
OBJECTIVE: To identify distinct clinical or imaging subtypes of spontaneous intracranial hypotension (SIH) due to spinal cerebrospinal fluid (CSF) venous fistula (CVF). BACKGROUND: Spontaneous intracranial hypotension is classically understood to present clinically with an orthostatic headache and stereotyped brain magnetic resonance imaging (MRI) findings; however, most prior literature examining clinical and brain MRI features of SIH has focused on all types of spinal CSF leaks concurrently. This study aimed to evaluate whether data support the possibility of internally consistent subtypes based on brain imaging features and clinical symptoms analogous to those seen in primary headache syndromes. METHODS: This retrospective cross-sectional single-institution study included 48 consecutive patients meeting the International Classification of Headache Disorders, 3rd edition criteria for SIH due to CVF. Clinical symptoms, pre-treatment brain MRI, and symptom duration were analyzed. Clinical and MRI data were analyzed to identify patterns and associations between symptoms and imaging findings. RESULTS: A total of 20 males and 28 females were evaluated, with a mean (standard deviation) age of 61 (10) years. In all, 44/48 (92%) patients experienced headaches, though 18/48 (40%) did not endorse relief when flat, including six of the 48 (13%) with worsening symptoms when flat. In all, 19/48 (40%) patients reported at least one migraine symptom, and six of the 48 (13%) presented with at least one migraine symptom and had no relief when flat. Clinical symptoms clustered primarily into a "classic" presentation consisting of relief when flat, occipital head pain, comorbid neck pain, a pressure/throbbing headache quality, and an "atypical" presentation that was characterized by having several differences: less relief when flat (nine of 22 (41%) vs. 20/23 (87.0%), p = 0.002; odds ratio [OR] 0.110, 95% confidence interval [CI] 0.016-0.53), more frontal head pain (14/22 (64%) vs. one of 23 (4%), p < 0.001; OR 35.0, 95% CI 4.2-1681.0), less neck pain (two of 21 (4.5%) vs. nine of 13 (69.6%), p < 0.001; OR 0.023, 95% CI 0.0005-0.196), and more stabbing/sharp headache quality (nine of 22 (41%) vs. two of 23 (9%), p = 0.017; OR 7.0, 95% CI 1.18-75.9). Brain MRI findings clustered into three groups: those presenting with most imaging findings of SIH concurrently, those with brain sag but less pachymeningeal/venous engorgement, and those with pachymeningeal/venous engorgement but less brain sag. CONCLUSION: This study highlights the clinical and imaging diversity among patients with SIH due to CVF, challenging the reliance on classic orthostatic headache alone for diagnosis. The findings suggest the existence of distinct SIH subtypes based on clinical and imaging presentations, underscoring the need for comprehensive evaluation in patients with suspected CVF. Future research should further elucidate the relationship between clinical symptoms and imaging findings, aiming to refine diagnostic criteria and enhance understanding of SIH's pathophysiology.
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Hipotensión Intracraneal , Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Hipotensión Intracraneal/diagnóstico por imagen , Hipotensión Intracraneal/complicaciones , Estudios Transversales , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Pérdida de Líquido Cefalorraquídeo/diagnóstico por imagen , Pérdida de Líquido Cefalorraquídeo/complicaciones , Fístula/diagnóstico por imagen , Fístula/complicaciones , Cefalea/etiología , Cefalea/diagnóstico por imagen , AdultoRESUMEN
Objective: To summarize the HRCT and MRI appearances of stapical footplate fistula related to inner ear malformation (SFF-Re-IEM). Methods: The HRCT and MRI materials of 48 cases (53 ears) SFF-Re-IEM were retrospectively analyzed. Among them, 25 SFF-Re-IEM ears were confirmed by surgery. Their CT and MRI findings including associated IEM type, internal auditory canal (IAC) malformation, tympanic fluid, its density and signal features, and accompanied labyrinthitis were recorded. Results: Among 48 cases (53 ears) with SFF-Re-IEM, 17 ears with incomplete partition type â , accounting for 32.1%, 13 ears with common cavity for 24.5%, 13 ears with cochlear aplasia for 24.5%, 7 ears with cochlear dysplasia â ¡ for 13.2%, and 3 ears with Mondini for 5.7%,were found respectively. 94.3% of them were associated with a defect or dysplasia in the found of the IAC. They were divided into 4 types according to the intact of the stapical footplate and accompanied CSF otorrhea: 22 ears were diagnosed as the stapical footplate leaking, of them, 2 ears might come from the stapical footplate bony defect, 6 ears were from the stapical footplate hernia. 1 ear belonged to the peristapical footplate leaking. 30 ears with the isolated the stapical footplate hernia were another found. The bony defect in 2 ears with the stapical footplate bony defect were not presented on CT and MRI.The focal bony defect of the affected stapical footplate of 36 ears with the stapical footplate hernia were demonstrated, which presented the hemispherical protruding into the tympana, the soft-tissue density on CT, and CSF-like signal on the MR heaved-T2WI images. Among 22 ears with the stapical footplate leaking, their imaging appearances varied from the different amount of the leaking CSF. Besides the focal bony defects of the affected stapical footplates, there were much more CSF-like density or signal in the ipsilateral tympanic cavity in 17 affected ears connecting with the vestibule through the defect area. In the CSF leaking ears with less CSF leaking in 5 ears, the CSF-like cysts like SFH were shown on the stapical footplate defect area, but their outer edges were irregular, and the CSF-like signal scattering in the tympanic cavity did not connect with the protruding cysts at the stapical area. Conclusion: The variable appearances of the SFF-Re-IEM ears based on the different subtypes are its characteristic HRCT and MRI appearances. This is helpful for the SFF-Re-IEM diagnosing to grasp its imaging features.
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Oído Interno , Fístula , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Estudios Retrospectivos , Oído Interno/diagnóstico por imagen , Oído Interno/anomalías , Niño , Adolescente , Adulto , Fístula/diagnóstico por imagen , Fístula/etiología , Preescolar , Lactante , Adulto Joven , Persona de Mediana Edad , Estribo/anomalías , Estribo/diagnóstico por imagen , Cóclea/diagnóstico por imagen , Cóclea/anomalíasRESUMEN
A labyrinthine fistula is a severe complication of middle ear cholesteatoma that can cause profound sensorineural hearing loss and vertigo. However, there is no consensus regarding the transition to postoperative hearing. Although hearing deteriorates gradually with a delay in some cases of labyrinthine fistula, insufficient consideration has been given to this point. We examined perioperative changes in cases of middle ear cholesteatoma with labyrinthine fistulas. We retrospectively reviewed the medical records of 578 patients with middle ear cholesteatoma who underwent tympanoplasty at our hospital between 2016 and 2021. Patients with labyrinthine fistulas were selected; their perioperative bone-conduction hearing was assessed. Fistula depth was determined following the classification reported by Dornhoffer et al. The hearing was compared preoperatively, early postoperatively (3-6 months), and 1 year postoperatively. Forty-eight patients (8.3%) had labyrinthine fistulas. Regarding depth, 21 cases were type I, 14 were type IIa, 3 were type IIb, and 10 were type III. Preoperative bone-conduction hearing was significantly poor in invasion type IIb or deeper cases. Cases with type IIb or deeper fistulas, multiple fistulas, or vertigo deteriorated postoperatively. Type III cases or those with multiple fistulas deteriorated further from the early postoperative period to 1 year postoperatively. Concerning frequency, 500 and 2000 Hz showed a delayed deterioration. This is a valuable report of delayed hearing loss after surgery in patients with a labyrinthine fistula. This change is associated with the labyrinthine fistula's depth and multiple fistulas-this is important during preoperative counseling of patients undergoing surgery.
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Colesteatoma del Oído Medio , Fístula , Enfermedades del Laberinto , Complicaciones Posoperatorias , Timpanoplastia , Humanos , Estudios Retrospectivos , Masculino , Femenino , Fístula/etiología , Fístula/cirugía , Persona de Mediana Edad , Adulto , Colesteatoma del Oído Medio/cirugía , Colesteatoma del Oído Medio/complicaciones , Enfermedades del Laberinto/cirugía , Enfermedades del Laberinto/etiología , Enfermedades del Laberinto/diagnóstico , Complicaciones Posoperatorias/etiología , Timpanoplastia/métodos , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Sensorineural/cirugía , Anciano , Adulto Joven , Conducción Ósea/fisiología , Vértigo/etiología , Adolescente , Audición/fisiologíaAsunto(s)
Colgajos Quirúrgicos , Humanos , Masculino , Femenino , Resultado del Tratamiento , Fístula Cutánea/cirugía , Fístula Cutánea/congénito , Enfermedades del Oído/cirugía , Enfermedades del Oído/congénito , Pabellón Auricular/cirugía , Pabellón Auricular/anomalías , Fístula/cirugía , Fístula/congénitoRESUMEN
A Fístula Coronário Cavitaria (FCC) é a comunicação entre uma artéria coronária e uma veia ou câmara cardíaca. A incidência é cerca de 0,002% na população geral e até 0,25% dos pacientes submetidos a cineangiocoronariografia. As fístulas para ventrículo esquerdo são muito mais raras, com incidência de cerca de 3%. CASO: Paciente masculino, 75 anos, hipertenso e tabagista, com relato de dispneia aos moderados esforços e pressão arterial (PA) divergente (200/70mmHg). O Médico da unidade básica de saúde solicitou cintilografia miocárdica que evidenciou hipoperfusão persistente na parede ínfero lateral do ventrículo esquerdo e função ventricular global preservada. O eletrocardiograma não evidenciou área eletricamente inativa (contrastando com a cintilografia). Ao ecocardiograma observou-se artérias coronárias com ectasia (troncos principais com 9 e 7mm de diâmetro), múltiplas imagens sugestivas de fluxo diastólico direcionado da parede para dentro do ventrículo esquerdo. O VE tinha discreta dilatação, com fração de ejeção no limite inferior da normalidade e strain global longitudinal reduzido. Sem evidência de insuficiência aórtica ou de outras causas de roubo de fluxo. A cineangiocoronariografia mostrou coronárias com ectasia, isentas de processo ateromatoso, com imagem sugestiva de FCC tanto da coronária esquerda quanto direita. CONCLUSÃO: A maioria dos casos de FCC é assintomática e diagnosticada incidentalmente. No caso do nosso paciente, a presença de PA divergente direcionou o exame para patologias com roubo de fluxo. Excluímos as mais frequentes e obvias, e o achado de fluxo diastólico da parede para o VE ajudou no diagnóstico de FCC, confirmado por coronariografia. Devido baixa casuística relatada, o diagnóstico desses pacientes é ainda um desafio para a prática clínica do ecocardiografista. Também é um desafio terapêutico, dessa forma, mais estudos precisam ser realizados para que esta condição seja cada vez mais suspeitada, diagnosticada e tratada.
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Humanos , Masculino , Anciano , FístulaRESUMEN
A 35-year-old female presented with a chief complaint of exudates from the outer corner of the left eye for more than half a year after cosmetic lateral canthoplasty. A fistula was seen in the skin of the left eye 5 mm from the lateral canthus, with clear fluid inside it. Left eyelid fistula was diagnosed and surgically removed. The histopathological examination confirmed that the tissue connected with the fistula was lacrimal gland tissue. No recurrence was found during the 2-month follow-up.
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Párpados , Humanos , Femenino , Adulto , Párpados/cirugía , Enfermedades de los Párpados/etiología , Enfermedades de los Párpados/cirugía , Aparato Lagrimal/cirugía , Blefaroplastia/efectos adversos , Blefaroplastia/métodos , Fístula/etiología , Fístula/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.
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Absceso , Cuerpos Extraños , Escroto , Uretra , Humanos , Masculino , Anciano , Absceso/cirugía , Absceso/diagnóstico por imagen , Escroto/cirugía , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/complicaciones , Uretra/cirugía , Uretra/lesiones , Fístula Urinaria/cirugía , Fístula Urinaria/diagnóstico por imagen , Enfermedades Uretrales/cirugía , Enfermedades de los Genitales Masculinos/cirugía , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Factores de Tiempo , Fístula/cirugía , Fístula/etiologíaRESUMEN
A G4P4 woman in her 30s with a type II vesicouterine fistula, as defined by the Jozwik classification system, presented with symptoms of menouria, vaginal menses and urinary incontinence 8 years after caesarean delivery, the time of probable origination of the fistula tract. Transvaginal ultrasound identified a fistula tract communicating between the bladder and uterus, a rare finding that many years remote from caesarean delivery. Traditional surgical technique includes laparoscopic, abdominal and endoscopic methods of repair, sometimes using a transvesical approach. Transvesical repair can be associated with subsequent inpatient hospital stays and prolonged catheterisation. Our technique proposes a transvaginal surgical approach as an outpatient procedure with decreased operating time (40 min), postoperative pain and catheterisation requirement. It is the authors' belief that a transvaginal approach is less invasive and allows for better preservation of the uterus for future pregnancies and vaginal deliveries, as desired by the patient.
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Fístula de la Vejiga Urinaria , Enfermedades Uterinas , Humanos , Femenino , Adulto , Fístula de la Vejiga Urinaria/cirugía , Fístula de la Vejiga Urinaria/etiología , Enfermedades Uterinas/cirugía , Cesárea/efectos adversos , Cesárea/métodos , Fístula/cirugía , Fístula/diagnóstico por imagen , Vagina/cirugía , Resultado del TratamientoRESUMEN
Gastropericardial fistula is a rare, extremely serious and life-threatening condition. Its most common aetiology is secondary to iatrogenic injury following gastric surgery. Clinical manifestations may be non-specific with precordial pain, simulating an acute coronary syndrome, and may be accompanied by electrocardiogram abnormalities. Diagnosis is made by thoracoabdominal computed tomography (CT) with oral and intravenous contrast. Treatment is surgical and consists of repair of the anomalous communication. We present the case of an 81-year-old male patient with gastropericardial fistula who underwent surgery, with the aim of reviewing the diagnosis and the appropriate therapeutic strategy.
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Fístula , Fístula Gástrica , Cardiopatías , Pericardio , Humanos , Masculino , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Anciano de 80 o más Años , Fístula/diagnóstico por imagen , Fístula/etiología , Pericardio/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: We evaluated vessel counts in the pharyngeal mucosal margins of patients who underwent salvage laryngectomy to establish whether mucosal vascularity might predict fistula risk. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary Medical Center. METHODS: Patients who underwent salvage total laryngectomy at our institution between 1999 and 2015 were identified. Pharyngeal mucosal margins from laryngectomy specimens were evaluated histologically for each patient, and vessel counts were performed on 5 ×10 images. The primary outcome measure was fistula within 30 days of surgery and mean vessel counts were assessed as the principle explanatory variable. RESULTS: Seventy patients were included and 40% developed a postoperative fistula. There was a large difference in the mean vessel count in patients who did develop fistula (48.6 vessels/×10 field) compared to those who did not (34.7 vessels/×10 field). A receiver operative characteristic curve found that a cutoff value of 33.9 vessels/×10 field provided a sensitivity of 75% and specificity of 62% to predict the likelihood of fistula occurrence (area under the curve = 0.71, 95% confidence interval [CI]: 0.59-0.83). In a binary logistic regression, patients with vessel counts greater than 33.9 had a 5-fold increased risk of developing fistula (95% CI: 1.8-16.45). Histologically, vessels in the pharyngeal mucosa of patients who developed fistulas were more disorganized. CONCLUSION: After salvage laryngectomy, patients with higher mean mucosal margin vessel counts are at increased risk of fistula. The mechanism is unknown, but the disorganization of the vasculature may contribute to poor wound healing. Vessel counting may allow for fistula risk stratification and guide postoperative care.
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Fístula Cutánea , Neoplasias Laríngeas , Laringectomía , Enfermedades Faríngeas , Complicaciones Posoperatorias , Terapia Recuperativa , Humanos , Laringectomía/efectos adversos , Laringectomía/métodos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Fístula Cutánea/etiología , Neoplasias Laríngeas/cirugía , Neoplasias Laríngeas/patología , Enfermedades Faríngeas/etiología , Enfermedades Faríngeas/patología , Anciano , Márgenes de Escisión , Faringe , Membrana Mucosa/patología , Valor Predictivo de las Pruebas , Fístula/etiologíaRESUMEN
Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.
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Fístula Bronquial , Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Masculino , Carcinoma Hepatocelular/complicaciones , Persona de Mediana Edad , Neoplasias Hepáticas/complicaciones , Fístula Bronquial/etiología , Fístula/etiología , Fístula/complicaciones , Cardiopatías/etiología , Cardiopatías/complicacionesRESUMEN
We report a patient with fever and cough for 2 months who was finally given a diagnosis of alveolar-pleural fistula due to aspergillus empyema. We successfully closed the alveolar-pleural fistula with a ventricular septal defect occluder through bronchoscopy. Endoscopic closure of an alveolar-pleural fistula with ventricular septal defect occluder is worth being explored.
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Aspergilosis , Humanos , Masculino , Aspergilosis/complicaciones , Aspergilosis/diagnóstico , Aspergilosis/microbiología , Broncoscopía , Resultado del Tratamiento , Aspergillus/aislamiento & purificación , Empiema Pleural/microbiología , Empiema Pleural/cirugía , Enfermedades Pleurales/cirugía , Enfermedades Pleurales/microbiología , Dispositivo Oclusor Septal , Fístula/microbiología , Fístula/cirugíaRESUMEN
BACKGROUND: Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. METHODS: This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. RESULTS: Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61-1.33). CONCLUSIONS: Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.