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.
Asunto(s)
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/cirugíaRESUMEN
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.
Asunto(s)
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 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.
Asunto(s)
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.
Asunto(s)
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.
Asunto(s)
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
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.
Asunto(s)
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/cirugíaAsunto(s)
Colesteatoma del Oído Medio , Fístula , Enfermedades del Laberinto , Canales Semicirculares , Humanos , Canales Semicirculares/patología , Canales Semicirculares/diagnóstico por imagen , Colesteatoma del Oído Medio/cirugía , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/patología , Fístula/cirugía , Enfermedades del Laberinto/patología , Enfermedades del Laberinto/diagnóstico por imagen , Enfermedades del Laberinto/etiología , Masculino , Femenino , Persona de Mediana EdadAsunto(s)
Fístula , Humanos , Fístula/cirugía , Masculino , Tomografía Computarizada por Rayos X , FemeninoRESUMEN
When searching over associations between congenital ear abnormalities, especially microtia and affiliated deformities like cleft lip or palate and congenital heart diseases, some clinical analysis and genetic theories are found. A 10-year-old boy sent to the plastic surgery hospital was puzzled by a congenital anterior auricular fistula with fluid trace for more than 9 years. The preoperative diagnoses were branchial cleft fistula and congenital left ear deformity with postoperation of TOF. By browsing over studies on genetic concerns and clinical performance, it may be attributed to a possible association between microtia, branchial cleft fistula, and tetralogy of Fallot, though whose fundamental mechanisms remain concerned.
Asunto(s)
Región Branquial , Microtia Congénita , Tetralogía de Fallot , Humanos , Masculino , Tetralogía de Fallot/cirugía , Región Branquial/anomalías , Región Branquial/cirugía , Niño , Microtia Congénita/cirugía , Fístula/cirugía , Fístula/congénito , Enfermedades Faríngeas , Anomalías CraneofacialesRESUMEN
BACKGROUND: A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention. CASE PRESENTATION: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4. CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient's condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.
Asunto(s)
Válvula Aórtica , Endocarditis Bacteriana , Válvula Mitral , Humanos , Masculino , Anciano , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/microbiología , Válvula Aórtica/cirugía , Válvula Mitral/cirugía , Ecocardiografía Transesofágica , Fístula/cirugíaRESUMEN
A 72-year-old male with a history of a triple-vessel coronary artery bypass graft years ago presented with a DeBakey type 2 aortic dissection and an aorto-left atrial fistula with patent bypass grafts (left internal mammary artery and saphenous vein grafts). He developed pulmonary oedema and required intubation. The right axillary artery was cannulated. After the ascending aorta and left internal mammary artery were clamped, the aorta was transected, leaving aortic tissue around two saphenous vein grafts as two separate patches. An entry tear was found adjacent to the proximal anastomosis of the saphenous vein graft to the posterior descending artery. A fistula, which was located between a false lumen in the non-coronary sinus and the dome of the left atrium, was primarily closed. Because the adventitia was thinned out in the non-coronary sinus due to aortic dissection, partial aortic root remodelling was performed with resuspension of the commissures. Hemiarch repair was performed under moderate hypothermia and unilateral antegrade cerebral perfusion. After systemic perfusion was resumed, the locations of the saphenous vein graft buttons were determined. The ascending graft was cross-clamped again; the saphenous vein graft to the obtuse marginal branch graft was reimplanted using the Carrel patch technique while a saphenous vein graft to the posterior descending artery required interposition of a 10-mm Dacron graft to accommodate the length.
Asunto(s)
Disección Aórtica , Puente de Arteria Coronaria , Atrios Cardíacos , Humanos , Masculino , Anciano , Atrios Cardíacos/cirugía , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Fístula Vascular/cirugía , Fístula Vascular/etiología , Fístula Vascular/diagnóstico , Fístula/cirugía , Fístula/etiología , Fístula/diagnóstico , Reoperación/métodos , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Vena Safena/trasplanteRESUMEN
Pleuroperitoneal communication occurs when ascites moves from the abdominal cavity to the pleural cavity via a diaphragmatic fistula. Managing large pleural fluid volumes is challenging, often requiring an operation. Identifying small diaphragmatic fistulas during the operation can be problematic, but ensuring their detection improves outcomes. This video tutorial presents a recent empirical case in which we successfully identified and closed a pleuroperitoneal contact using a thoracoscopic surgical procedure aided by indocyanine green fluorescence imaging. The patient, a 66-year-old woman, was hospitalized due to acute dyspnoea from a right thoracic pleural effusion during hepatic ascites treatment for cirrhosis. Because ascites decreased with pleural fluid drainage, surgical intervention was considered due to suspicion of a pleuroperitoneal connection. During the operation, indocyanine green was injected intraperitoneally, and near-infrared fluorescence-guided thoracoscopy pinpointed the location of the diaphragmatic fistula. The fistula was sutured and reinforced with a polyglycolic acid sheet and fibrin glue. Detecting the fistula intraoperatively is crucial to prevent recurrence, and the indocyanine green fluorescence method is a safe and effective technique for detecting small fistulas.
Asunto(s)
Verde de Indocianina , Humanos , Verde de Indocianina/administración & dosificación , Femenino , Anciano , Ascitis/diagnóstico , Ascitis/etiología , Ascitis/cirugía , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/cirugía , Enfermedades Pleurales/diagnóstico , Enfermedades Pleurales/cirugía , Fístula/diagnóstico , Fístula/cirugía , Colorantes/administración & dosificación , Derrame Pleural/diagnóstico , Derrame Pleural/etiología , Derrame Pleural/cirugía , Toracoscopía/métodos , Diafragma/cirugíaAsunto(s)
Fístula , Atrios Cardíacos , Defectos del Tabique Interatrial , Humanos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/cirugía , Fístula/etiología , Fístula/diagnóstico por imagen , Fístula/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Masculino , FemeninoRESUMEN
The management of lymphatic fistulas following surgical procedures, in particular after inguinal lymphadenectomy, represents a significant clinical challenge. The current case report shows the novel use of the superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis (LVA) to treat a chronic inguinal lymphatic fistula in a 58-year-old male patient. This patient had developed a persistent lymphorrhea and wound dehiscence after a right inguinal lymph node biopsy performed for oncological reasons 1.5 months before. Pre-operative assessment with indocyanine green (ICG) lymphography confirmed a substantial lymphatic contribution to the wound discharge, thus guiding the surgical strategy. During the procedure, a pedicled tissue segment containing the SCIV was dissected and utilized to fill the wound's dead space and facilitate LVA with the leaking lymphatic vessel. Notably, a coupler device was employed for the anastomosis due to the large caliber of the lymphatic vessel involved, a technique not commonly reported in lymphatic surgeries. The result of the procedure was successful, with intra-operative ICG imaging confirming the patency of the anastomosis. After surgery the wound healed without complications. This case illustrates the potential of SCIV employment in lymphatic fistula repair in the inguinal region. While further research is needed to validate these findings, this report provides an unconventional approach to a relatively common problem in clinical practice.
Asunto(s)
Anastomosis Quirúrgica , Vasos Linfáticos , Humanos , Masculino , Persona de Mediana Edad , Anastomosis Quirúrgica/métodos , Vasos Linfáticos/cirugía , Vasos Linfáticos/diagnóstico por imagen , Fístula/cirugía , Enfermedades Linfáticas/cirugía , Escisión del Ganglio Linfático/métodos , Vena Ilíaca/cirugía , Colgajo Perforante/irrigación sanguínea , Conducto Inguinal/cirugía , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: The treatment for lung oligometastasis from colorectal cancer (CRC) remains challenging. This retrospective study aimed to compare the local tumor control, survival and procedure-related complications in CRC patients undergoing low-dose rate stereotactic ablative brachytherapy (L-SABT) versus percutaneous microwave ablation (MWA) for lung oligometastasis. METHODS: Patients between November 2017 and December 2020 were retrospectively analyzed. Local tumor progression-free survival (LTPFS) and overall survival (OS) were analyzed in the entire cohort as well as by stratified analysis based on the minimal ablation margin (MAM) around the tumor. RESULTS: The final analysis included 122 patients: 74 and 48 in the brachytherapy and MWA groups, respectively, with a median follow-up of 30.5 and 35.3 months. The 1- and 3-year LTPFS rate was 54.1% and 40.5% in the brachytherapy group versus 58.3% and 41.7% in the MWA group (P = 0.524 and 0.889, respectively). The 1- and 3-year OS rate was 75.7% and 48.6% versus 75.0% and 50.0% (P = 0.775 and 0.918, respectively). Neither LTPFS nor OS differed significantly between the patients with MAM of 5-10 mm versus > 10 mm. Pulmonary complication rate did not differ in the overall analysis, but was significantly higher in the MWA group in the subgroup analysis that only included patients with lesion within 10 mm from the key structures (P = 0.005). The increased complications was primarily bronchopleural fistula. CONCLUSIONS: Considering the caveats associated with radioisotope use in L-SABT, MWA is generally preferable. In patients with lesion within 10 mm from the key pulmonary structures, however, L-SABT could be considered as an alternative due to lower risk of bronchopleural fistula.
Asunto(s)
Braquiterapia , Ablación por Catéter , Neoplasias Colorrectales , Fístula , Neoplasias Hepáticas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Estudios Retrospectivos , Terapia Recuperativa , Microondas/efectos adversos , Braquiterapia/efectos adversos , Resultado del Tratamiento , Pulmón/patología , Neoplasias Colorrectales/radioterapia , Neoplasias Colorrectales/cirugía , Fístula/cirugía , Neoplasias Hepáticas/cirugíaRESUMEN
Congenital lip sinus is a rare entity with upper lip sinus being rarer than the lower lip sinus. It can be an isolated entity or associated with cleft lip, palate or Van der Woude syndrome. Syndromic association requires proper evaluation and aggressive surgical treatment. Preoperative delineation of the sinus tract with ultrasound sonography or MRI is mandatory. Simple excision is sufficient in cases of isolated sinuses. In this article, we report an infant with upper lip sinus managed successfully with simple excision and reviewed the literature.