Spontaneous duodenocutaneous fistula: a rare complication of duodenal ulcer

Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication of duodenal ulcer disease, most often felt to occur following ulcer surgery. The development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has not been hitherto reported. A middle aged man with a history of peptic ulcer for more than 10 years, and a vagotomy and pyloroplasty 15 months earlier, presented with an asymptomatic duodenocutaneous fistula, presumably secondary to a perforated duodenal bulb ulcer. Successful healing of the fistula was accomplished by non-surgical therapy consisting of nasogastric suction, intravenous alimentation and parenteral cimetidine over a 4-week period.     

Pancreaticopleural fistula: a rare complication of chronic pancreatitis.

Pancreaticopleural fistula is an uncommon sequelae of pancreatitis. The condition is often elusive, as respiratory rather than abdominal symptoms usually predominate and the fistula can be difficult to demonstrate radiologically. Confirmation is by demonstrating a high amylase content in the pleural aspirate relative to the serum. About half the fistulae will close with conservative treatment but persistent or recurrent effusions, often associated with stenosis or disruption of the main pancreatic duct, are an indication for surgery. The long-term outcome is good in 80-95% of cases. We report five patients with pleural effusion of pancreatic origin due to pancreaticopleural fistula.     

A case report on vesico-uterine fistula: a very rare complication of the lower caesarean section

Vesico-uterine fistula is a very rare complication of lower caesarean section. There has only been two cases seen at the Department of Urology in the past 2 decades. Patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint.     

Pancreaticocolonic fistula: a complication of pancreatitis.

In three cases of pancreaticocolonic fistula presenting before the stage of exsanguinating hemorrhage of severe sepsis the problem was diagnosed on the basis of the clinical history, visualization of the terminal part of the fistula by roentgenography after a barium enema had been given and, in two cases, demonstration of the communication with the pancreatic ductal system by endoscopic retrograde pancreatography. The lesions were repaired surgically. Pancreaticocolonic fistula should be suspected in a patient with upper abdominal pain who has a history of abdominal pain and excessive alcohol consumption and in whom diarrhea and fever, hematochezia or a disappearing abdominal mass develops. Characteristically barium will collect in the terminal part of the fistula and thus permit a tentative diagnosis; the diagnosis can then be confirmed by endoscopic retrograde pancreatography. With this approach surgical treatment can be carried out earlier and the often fatal course of the disorder can be averted.     

创伤性十二指肠外瘘

本文报告17例创伤性十二指肠外瘘,损伤破裂部位均发生于降段和水平段。患者合并多发复合伤,创伤后首次手术至肠瘘发生的间隔期平均为5.3天。在我院的平均住院天数为73.2天,其中15例接受平均37.6天的营养支持治疗,10例接受手术治疗,有3例接受十二指肠外瘘治疗性手术。本组2例死亡,15例痊愈,其中12例非手术治愈,肠瘘自然愈合率为80%。还讨论了创伤性十二指肠外瘘发生的原因、诊断和治疗要点,强调充分的营养支持和有效的腹腔引流是治愈和提高肠瘘自愈率的关键。     

Biliopleural fistula with cholethorax. A rare complication of percutaneous transhepatic biliary drainage

Biliopleural fistula leading to cholethorax formation is a rare complication of percutaneous transhepatic cholangiography (PTC). Ideally it should be treated conservatively as it closes spontaneously in most patients. However, in complicated cases it may require surgical intervention. We report a 35-year-old male with right biliopleural fistula with cholethorax following PTC. The patient complained of shortness of breath, right pleuritic chest pain, and cough after removal of PTC catheter. Chest radiograph showed an extensive right pleural effusion. The diagnosis was confirmed by drainage of dark green pleural fluid with high bilirubin content. The initial treatment with chest tube and drainage was unsuccessful. He underwent video assisted thoracoscopic intervention. Diagnostic modalities and management options for biliopleural fistula are discussed along with a review of literature.     

Spontaneous pneumomediastinum: a rare complication of acute asthma

Background  Pneumomediastinum and subcutaneous emphysema are rare complications of acute asthma. If pneumomediastinum occurs it can cause compression on major vessels in the mediastinum and neck and can lead to low blood pressure along with chest pain and other life-threatening complications. Therefore, knowledge of this condition and its proper management are very important for doctors. Conclusions  The authors report on a case of pneumomediastinum and surgical emphysema and discuss the diagnostic and therapeutic implications of this condition. In this report a 20 year-old girl presented to A and E department of Mayo General Hospital with an acute exacerbation of asthma complicated by pneumomediastinum and subcutaneous emphysema.     

Compressive femoral neuropathy: a rare complication of anticoagulation

The most common coagulation disorder associated with warfarin use is bleeding, but compressive femoral neuropathy is an unusual presentation. A 63-year-old man with compressive femoral neuropathy from an iliacus haematoma is reported. The diagnosis was confirmed on magnetic resonance imaging and treated conservatively with good clinical response and radiological evidence of resolution.     

Metastatic endophthalmitis: a rare complication of meningococcal meningitis

A bacteriologically proved case of meningococcal meningitis developed metastatic endophthalmitis, a rare complication of this disease and responded satisfactorily to antibiotic therapy with complete recovery.     

Gallstone granuloma: a rare complication of laparoscopic cholecystectomy

Gallstone spillage during laparoscopic cholecystectomy is a relatively common occurrence. These intraperitoneal stones rarely give rise to complications. We present the case of a 68 female who presented with a 5 cm diameter epigastric mass two years after a laparoscopic cholecystectomy for acute-on-chronic cholecystitis with gallbladder stones. CT abdomen demonstrated an inflammatory mass with central calcification. Laparotomy and excision of the mass revealed the diagnosis as a gallstone granuloma.     

Colobronchial fistula: a rare cause of chronic cough

We report a colobronchial fistula in a middle-aged woman. She had been having cough with expectoration of sputum with a faeculent odour since the age of 7 years. Imaging revealed a fistulous connection between the hepatic flexure and the right bronchial tree, which was successfully repaired surgically.