Focal extra strength of a stent causing instent hourglass stenosis: an unusual complication

We report an unusual complication of a 25 mm long stent, which did not expand at all for 1 mm in its proximal segment, while rest of the 24 mm length of the stent got fully expanded. Repeated attempts to expand the extremely focal unexpanded part of the stent at high pressure led to rupture of the stent balloon and its entrapment. We failed to retrieve the balloon using various techniques and the patient had to be sent for coronary artery bypass graft surgery.     

Early aneurysm formation after drug-eluting stent implantation: an unusual life-threatening complication

Coronary aneurysm after stent implantation is a rare complication. Coronary aneurysms have been reported after drug-eluting stent implantation, but there has been no clear elucidation of time course, mechanism and therapeutic implications. We report two patients who developed coronary aneurysms within two weeks of the procedure and required surgical intervention to treat the complication. The possible putative mechanisms are discussed.     

An unusual complication during deployment of a multi-link stent

The use of intracoronary stents has greatly impacted on the practice of interventional cardiology. Complications due to equipment failure during deployment of stents are rare but potentially serious. We report a case of a malfunctioning Multi-Link delivery system and the successful treatment of the resulting complications. Cathet. Cardiovasc. Intervent. 47:58–60, 1999. © 1999 Wiley-Liss, Inc.     

Brachial plexus injury as an unusual complication after aortic stent implantation

Aorta catheterisation can serve both diagnostic and therapeutic purposes in patients with aortic coarctation, especially when non-invasive evaluation cannot define severity of the abnormality. We report a case of bilateral brachial plexus injury due to standard positioning of the patient's arms during non-complicated aorta catheterisation and aortic stent implantation under general anaesthesia. In discussion, we consider our patient's predisposing factors, the understanding of which may be helpful in avoiding this complication in the future.     

Ruptured spleen: an unusual complication of laparoscopy

Introduction

Splenic rupture is a well-known complication of open surgery but is much less common at laparoscopic surgery.

Case outline

A 45-year-old man underwent laparoscopy for perforated duodenal ulcer. The abdominal cavity was washed out and the ulcer was sutured. He was discharged on the fifth postoperative day but was readmitted because of a sharp pain in the left upper quadrant radiating to the left shoulder. He then developed haemorrhagic shock. Urgent laparotomy revealed a diffuse haemoperitoneum consequent upon a posterior subcapsular haematoma of the spleen.

Discussion

There are four previous case reports of splenic rupture at laparoscopy. In the present case, a posterior subcapsular haematoma arose during lavage of the left subdiaphragmatic area. Such a haematoma is undetectable during laparoscopy.     

Spinal epidural abscess: an unusual complication of a duodenal ulcer

A 50-year-old man had several months of progressively worse low-back pain associated with constitutional symptoms and a history of retroperitoneal tumor and bleeding duodenal ulcer. Initial evaluation suggested a lumbar spine tumor, but myelography confirmed the presence of an epidural abscess. Further evaluation revealed a duodeno-spinal fistula at the site of the previous duodenal ulcer, which proved to be the cause of the abscess.     

Ureteroileal fistula: an unusual complication of Crohn's disease

We report a case of urteroileal fistula in a young 22 year-old-man with Crohn's disease, who presented with microscopic hematuria and severe diarrhea. Excretory urogram and retrograde pyelography showed a fistula between the right ureter and the terminal ileum which was successfully managed with conservative approach using a double J ureteral stent.     

Cholelithoptysis: an unusual delayed complication of laparoscopic cholecystectomy

We report the case of a 54-year old woman who presented with a persistent right lower lobe pneumonia followed by cholelithoptysis, 11 months after a laparoscopic cholecystectomy. It is postulated that this was a result of the formation of a subphrenic abscess secondary to intraoperative spillage of gallstones. It is concluded that spillage of gallstones at laparoscopic cholecystectomy is not as benign as previously thought and that efforts to prevent spillage should include scrupulous operative technique, especially in the presence of gallbladder inflammation, and especial care when removing the gallbladder from the abdominal cavity.     

Hemarthrosis: an unusual complication of type 1 neurofibromatosis

Type 1 neurofibromatosis is one of the most common autosomal-dominant disorders and often includes orthopedic manifestations. We report the case of a 48-year-old woman with hemarthrosis caused by a popliteal cyst infiltrated by a diffuse neurofibroma associated with angiodysplasia. Surgical resection of this tumor was followed by postoperative hemorrhagic complications.     

Pedicle stress fracture: an unusual complication of pycnodysostosis

Pycnodysostosis is a rare dysplasia characterised by high bone density and susceptibility to long bone fractures caused by cathepsin K deficiency. Spinal abnormalities have rarely been described in this uncommon inherited bone dysplasia. A 28-year-old female, with a past history of pycnodysostosis and spontaneous leg fractures was hospitalized for a 2-month history of spontaneous low back pain. Physical examination revealed the typical facial and hand features of pycnodysostosis and local lumbar stiffness. No abnormalities were found in laboratory tests, particularly with regard to bone turnover markers. Fracture of the left pedicle of the third lumbar vertebra was suspected on lumbar radiographs and later confirmed by a computed tomography (CT) scan. A dramatic improvement in symptoms was achieved, thanks to a course of injectable calcitonin therapy and rest. To our knowledge, it is the first-ever reported case of pedicle stress fracture in a patient with pycnodysostosis, suggesting that spontaneous fractures resulting from this bone dysplasia do not only affect diaphysis of brittle long bones but could also affect the lumbar spine. Furthermore, the present case confirms previous observations in such patients of frequent spondylolysis, which could lead to abnormal lumbar pedicle stress. The dramatic improvement achieved by calcitonin therapy might be related to osteoclastic dysfunction in pycnodysostosis caused by a deficiency of cathepsin K, a cystein protease involved in bone matrix remodelling.     

Implantable insulin pump therapy: an unusual presentation of a catheter-related complication

We report the case of a 63-year-old man who has a 19-year history of involvement in the implantable insulin pump program at Johns Hopkins University. After his most recent pump implantation in February 2004, his 24-h insulin requirement gradually increased from a baseline of 75 units to a peak of almost 500 units in June 2005. Surprisingly, insulin delivery from the pump and glycemic control remained satisfactory despite the dramatic change in insulin requirement. Laparotomy revealed a fibrous mass in the peritoneal cavity, with the track of the catheter extending into the mass. Insulin requirement declined post-resection of the mass and relocation of the catheter tip.