Carotid-esophageal fistula following a penetrating neck injury: case report

Carotid arterial injuries frequently are associated with injuries to adjacent structure of the neck, particularly the esophagus and trachea. Complications from these repairs are common and fistula formation is herein described between the carotid artery and esophageal repair.     

An unusual penetrating craniocerebral injury due to landmine explosion: a case report

Penetrating landmine injuries are the unavoidable consequences of military conflicts. They are potentially life-threatening. The mortality rates in the literature range from 23% to 92% and are considerably higher in patients admitted with poor neurologic state. Penetrating craniocerebral injuries require early surgical management designated to prevent infection and remove foreign objects, necrotic tissue and complicating blood clots, as well as to minimalize post-traumatic sequelae. We report herein an interesting case of penetrating intracerebral injury with giant shrapnel due to landmine in a 20-year-old young man.     

Giant spigelian hernia due to abdominal wall injury: a case report

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.     

Transarterial coil embolization of a high-flow vertebrojugular fistula due to penetrating craniocervical trauma: case report

BACKGROUND: Vertebrojugular fistulas after penetrating cervical trauma (gunshot or stab wounds) are rarely reported. Successful endovascular coil embolization of an acute fistulizing vertebral artery pseudoaneurysm involving an obstructed internal jugular vein is presented and the various treatment strategies for such a lesion are described. CASE DESCRIPTION: A 23-year-old man presented from an outside institution after sustaining 2 gunshot wounds in a civilian conflict. Neuroimaging revealed a right vertebral artery pseudoaneurysm, which formed a fistulous connection with the internal jugular vein. Because venous outflow obstruction was present just below the fistula, a high-flow shunt was directed intracranially. Both the pseudoaneurysm and arteriovenous fistula were accessed percutaneously via a transfemoral route and coil embolization was performed. Perfusion of the basilar artery circulation was assumed by the contralateral vertebral artery. The ipsilateral posteroinferior cerebellar artery filled through retrograde flow down the vertebral confluence. CONCLUSIONS: Coil embolization is a safe and reliable strategy by which to obliterate an acute traumatic vertebrojugular fistula as well as pseudoaneurysm. Serial angiographic follow-up is mandatory to document a persistent cure.     

A case report of pseudoxanthoma elasticum with upper gastrointestinal hemorrhage

A gastric hemorrhage in a patient with pseudoxanthoma elasticum (PXE) is reported. A 44-year-old woman was admitted to our hospital with hematemesis. Bleeding point was located at upper body of the stomach. As neither endoscopic alcohol injection nor operative hemostasis by over sewing under gastrotomy were unsuccessful, total gastrectomy was performed. Histologic examination of the stomach revealed fragmentation of elastic fiber in the internal lamina of arteriole and degeneration of muscle layer. This change was observed fundamentally in all specimens obtained from different region of the stomach. In addition to describing clinical and pathological feature of this case, the management of gastric hemorrhage in patients with PXE is discussed.     

Unsuspected penetrating maxillo-orbitocranial injury: a case report

A healthy 37-year-old man presented to the emergency room, complaining of blunt trauma to his mandible from a tree branch. Plain radiographs and computed tomography demonstrated a penetrating orbitocranial foreign body with the maxillary sinus as the entry site. The foreign body was a chain-saw file. It was extracted successfully through the oral cavity. The patient’s recovery was uncomplicated and he suffered no neurologic or opthalmic sequelae.     

Ileovesical fistula due to Crohn's disease: a case report

A 24-year-old male first experienced pollakisuria, dysuria, pneumaturia and diarrhea in May 1988. Intravenous pyelography showed a normal upper urinary tract but bladder wall irregularity at the dome was observed. Cystoscopic examination revealed bullous edema, erythema and presence of a mucous-like substance. Barium enema X-ray examination revealed inflammatory changes at the terminal ileum but no fistulous connection was noted. Mild ulceration was observed on colon fiberscopic examination. At operation, a severely inflamed lower ileum firmly adherent to the dome of bladder as well as to the sigmoid colon was observed. Fistulous communication between bladder and ileum was also noted. Resection of diseased ileum, sigmoid colon and partial cystectomy were carried out. The patient remains well, without enteric or bladder symptoms.     

Giant Brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case

Brunneroma, also known as Brunner's gland adenoma or harmartoma, is a rare, benign, proliferative lesion arising from the Brunner's glands of the duodenum, usually discovered incidentally at endoscopy. Occasionally, these lesions manifest as a rare cause of duodenal obstruction or upper gastrointestinal hemorrhage, and require excision. We report a case of an unusually large Brunneroma in a patient who presented with fresh melena and anemia. Although endoscopic polypectomy is the treatment of choice, we decided to perform surgical polypectomy through a laparotomy due to the huge dimensions of the lesion. The clinical and endoscopic features of this benign tumor and the therapeutic options are critically reviewed. Received: May 14, 2001 / Accepted: March 5, 2002     

Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report

BackgroundThe mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal.Case presentationWe encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13 cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure.DiscussionAlthough the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding.ConclusionsThe incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.     

腹部锐器伤的诊治分析

目的探讨腹部锐器伤的诊断、手术治疗。方法对70例腹部锐器伤患者临床资料进行分析。结果在急诊室,根据患者的症状、受伤的部位,简单的腹壁伤口探查、基本可以明确诊断,再辅以诊断性腹腔穿刺、B超、腹部X线、CT等及术中全面、系统、仔细的探查提高治疗效果,本组治愈率为98.6%。结论运用上述方法,可以提高腹部锐器伤的治愈率。     

Severe upper gastrointestinal hemorrhage of a rare cause: aorto-esophageal fistula successfully treated

Aorto-esophageal fistula is a rare entity, determining huge digestive bleeding with a very poor prognostic most often. We present the case of a patient with aorto-esophageal fistula of unknown origin, treated successfully in the Center of Surgery and Liver Transplantation from Fundeni Clinical Institute. A young man, 21 years old, was admitted in our clinic from another hospital for repetitive severe upper gastrointestinal bleeding, with hematemesis and melena, pale, asthenia, without any pain; the bleeding stopped when he was admitted. The upper digestive endoscopy and esophago-gastro-duodenal radioscopy with barium did not show any lesion. During the 7th day the patient presents sudden massive hematemesis with hemodynamic instability; during the surgery we found two subcardial ulcers (stress ulcers?) for which we have done excision and suture which temporary stopped the bleeding. After 14 days, the patient had another massive bleeding; the upper endoscopy shows 28 cm far from the dental arch a protrusive formation of 6-7 mm with a telangiectasis aspect and with a white spot (possibly a central ulceration); 1 ml pure alcohol was injected inside it with temporary bleeding ceasing. After 3 days the patient is bleeding again, with marked decrease in blood pressure; a Blakemore tube stopped the bleeding until surgery was performed. During the intervention an aorto-oesophageal fistula is detected; we made the excision of the fistula with simple suture of the aorta, subtotal esophagectomy, cervico-stoma and gastrostomy, with good postoperative evolution. After 4 months the digestive transit is restored by esophagoplasty with tubulized stomach placed behind the sternum. The diagnostic and treatment difficulties encountered in these kind of cases need to consider also an aorto-esophageal fistula diagnosis, especially for the cases with Chiari triad (mild thoracic pain, sentinel digestive bleeding and exsanguination). The Blakemore tube can save patient's life by ensuring temporary hemostasis and allowing the time for a definitive surgical intervention. The subtotal esophagectomy with cervicostoma and feeding gastrostomy, followed after few months by a esophageal reconstruction , is a solution for this extreme severe cases.     

An unusual penetrating shoulder injury: a case report

Abstract A 32-year-old male sustained penetrating injury of the right shoulder with an angled iron rod in a road side accident. He presented with the rod in situ in his shoulder. Fortunately there was no neurovascular deficit. The metal rod was carefully removed with success, after cutting the rod with hacksaw to avoid neurovascular damage during removal.     

Chronic abdominal pain and upper gastrointestinal bleeding due to duodenal perforation caused by migrated inferior vena cava filter--a case report

The authors describe an unusual case of a 41-year-old man presenting with chronic abdominal pain and gastrointestinal bleeding caused by a migrated inferior vena cava filter eroding into the duodenum.     

Bronchobiliary fistula due to hydatid disease: a case report.

A case of bronchobiliary fistula due to transdiaphragmatic rupture of hepatic echinococcal cyst is described. The importance of excluding associated extrahepatic biliary obstruction is emphasized. Successful treatment involves relief of this obstruction as well as management of both the pleural space and pulmonary complications.     

Ileorectal fistula due to a rectal cancer-A case report

A 51-year-old man was seen at our hospital because of diarrhea. Barium enema and colonoscopy revealed a cancer in the lower rectum and fistula formation from the site to ileum. Resection of the rectal cancer and ileorectal fistula was performed. Histologically, the resected lesion was mucinous adenocarcinoma with contiguous invasion from the rectum to the ileum. The patient is alive with no sign of recurrence 120 months after operation. Fistula formation between the colon and other gastrointestinal tract organs is very rare, especially for rectal cancer. Fistula-forming colorectal cancers are rarely found to have metastatic lesions in the liver, peritoneum and lymph nodes despite their invasive behavior; accordingly, curative resection involving partial resection of the intestine with fistula is expected.     

Vesicorectal fistula due to pelvic foreign body: a case report

We report a case of vesicorectal fistula caused by a pelvic foreign body. An 84-year-old woman presented with urinary tract infection and bladder stone. During transurethral lithotripsy, a foreign body was observed in the stone. CT and colonoscopy revealed a vesicorectal fistula due to a foreign body. After continuous bladder washout over a period of one month, resection of the foreign body, fistulectomy, and sigmoidostomy were performed. The foreign body was suspected to be a medical mesh from a sling operation. After the surgery, the patient's course was uneventful. This is the second patient with vesicointestinal fistula due to a foreign body in the Japanese literature.     

Aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm--a case report of successful repair

A 62-year-old man who had complained of swelling of bilateral lower extremities, exertional dyspnea and jaundice for 3 months was referred to our hospital with a diagnosis of large abdominal aneurysm and congestive heart failure. His aortography and Doppler echocardiography revealed that he had the aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm. He underwent a reconstruction of abdominal aorta with woven Dacron bifurcation graft together with a closure of fistula with 3 mattress sutures. The postoperative course was uneventful and he is free from any symptoms. Problems of diagnosis, operative management and results are discussed, reviewing the previously reported cases in Japan.