Tracheoesophageal fistula: New option in management

Tracheoesophageal fistula is a life threatening condition. Patients not managed surgically ultimately die of their disease. Surgical management is the treatment of choice. We present a case of a patient that developed a tracheoesophageal fistula after tracheostomy. Surgical repair was done which failed due to infection. The patient was managed with the help of an esophageal stent and Trichloroacetic Acid cautery. This approach can be used in selected patients, depending upon the size and site of TEE Larger fistulae and those situated lower down e.g. supra carinal cannot be managed by this technique.     

Iatrogenic bladder stone and associated vesicovaginal fistula after hysterectomy

A patient had irritative lower urinary tract symptoms for 2 years after hysterectomy. During cystoscopy, a bladder stone was seen and removed, but watery vaginal discharge emerged. The subsequent transvaginal ultrasound revealed a fistulous tract between the bladder and the vagina. The methylene blue test further confirmed the diagnosis of vesicovaginal fistula. We performed a delayed Latzko procedure to successfully repair the fistula.     

扩张置管治疗癌性复杂性食管狭窄和瘘的近远期疗效观察

目的应用带膜金属支架治疗癌性难治性食管狭窄和瘘,并对近、远期疗效进行观察。方法在电子内镜下应用扩张器和支架置入器,对临床确诊的难治性食管狭窄和(或)瘘的48例患者进行支架置入术。根据病情的不同情况选择不同的治疗方式。结果48例患者共放置支架64个,置管后狭窄处直径由(4.02±1.35)mm增至(15.05±4.02)mm(P<0.01),吞咽困难由3.28±0.42级改善为0.94±0.73级(P<0.01),食管瘘患者瘘口全部闭合。随访1个月及1年有效率分别为100%、74.2%,1年失访共3例,复发共8例经重复治疗缓解。结论内镜直视扩张置管治疗难治性食管狭窄和瘘,操作直观简便,定位准确,成功率较高,近远期效果较好。     

Rendu–Osler–Weber syndrome presenting with pulmonary arteriovenous fistula

A pulmonary arteriovenous fistula is an abnormal connection between pulmonary arteries and veins. Patients with Rendu–Osler–Weber syndrome may present with this vascular malformation, which is a typical finding of the disease. Approximately 5–15% of Rendu–Osler–Weber syndrome patients have pulmonary arteriovenous malformations (AVM) and there is usually a family history of AVM in these patients. The malformations are usually located in the lower lobes. In this paper, I describe a 49‐year‐old male patient with dyspnoea, cough, haemoptysis and epistaxis. Physical examination showed nasal telangiectasias, cyanosis of the lips and nails, and a systolic bruit over the left lung. Chest X‐ray revealed a 5‐cm mass in the left lower lobe and after magnetic resonance examination, together with 3‐D magnetic resonance angiography, it was demonstrated to be a pulmonary arteriovenous fistula. The history of a niece with a similiar history of suspected pulmonary arteriovenous fistula led me to consider the possibility of Rendu–Osler–Weber syndrome presenting with a pulmonary arteriovenous fistula.     

隧道式拖线加内口切挂术治疗后位马蹄型肛瘘46例

采用隧道式拖线加内口切挂术治疗后位马蹄型肛瘘 4 6例 ,4 4例为一次性治愈 ,2例经一次扩创后治愈 ,平均疗程 (2 6± 3)天。     

改良TIP尿道成形术:恢复尿道解剖结构

目的 分析尿道板背侧纵切卷管尿道成形术(TIP)基础上覆盖Buck筋膜联合尿道海绵体(BC)和背侧包皮筋膜组织(P)在无阴茎下弯或轻度阴茎下弯的小儿中远段型尿道下裂的治疗效果。 方法 回顾性分析104例中远段型尿道下裂患儿的病例资料。其中行BC-P-TIP手术72例(A组); 行传统术式TIP+背侧包皮筋膜组织(P-TIP手术)32例(B组)。术后1,3,12月进行门诊随访。术后3月参照尿道下裂客观评分系统(HOSE)对患儿进行手术效果评估,对两组病例的一般资料、HOSE评分、并发症情况进行统计学分析。 结果 A,B组术后3月HOSE评分平均分分别为15.42及13.90,差别有统计学意义(P<0.01)。A,B组的尿瘘发生率为8.3%及25%,差别有统计学意义(P<0.05)。A,B组的尿道狭窄发生率为4.2%及0%,差别无统计学意义(P>0.05)。 结论 BC-P-TIP改良术式相对于P-TIP术式能有效减少尿瘘发生,术后外观满意、排尿功能良好,手术操作简单易学,取材方便,解剖损伤小,且接近正常尿道的解剖结构,值得进一步探讨及推广。     

胆肠吻合术后吻合口结石的原因及预防

【摘要】 胆肠吻合术是重建胆道通路,使胆汁通畅引流的一种手术方式。术后吻合口结石成因复杂,治疗起来相对困难,且容易复发,这已经成为普外科医师亟待解决的临床难题之一。本文综述了胆肠吻合术后吻合口结石形成的原因,包括胆道系统术后病理生理改变、手术适应证的选择不当、原发病处理不充分以及术中操作不当及相应的预防措施,为今后胆肠吻合术后吻合口结石的防治提供参考。     

A Rapid Pulse After Coronary Bypass Surgery

Abstract

A secondary aortoenteric fistula is a complication of earlier aortic grafting due to an aortic abdominal aneurysm. A primary aortoduodenal fistula (ADF) is a rare clinical entity that usually causes gastrointestinal bleeding that can be occult, intermittent, or massive. This article presents the case of a 68-year-old man with acute onset of a massive hematemesis and hematochezia. Eight years earlier he had undergone the implantation of an aortobifemoral prosthesis to treat an aortic aneurysm. The patient's condition was unstable, and it was during emergency surgery that the diagnosis of an ADF was made. An infected graft was removed in its entirety, and a new prosthesis was implanted. An omentoplasty with a pedunculated flap was performed. After 8 months, the patient had a recurrent ADF. He underwent another operation, but hemorrhaging from the aortic anastomosis occurred, so he required emergency surgery. Eventration occurred on the 14th postoperative day. The resection of the transversal colon was performed with a cecostomy for the decompression of the end-to-end anastomosis. Three months later the patient suffered a recurrent ADF. An aortobifemoral stent graft was implanted. Periaortal flow-drainage was established for the irrigation of the retroperitoneal space. A microjejunostomy tube was also inserted. The patient recovered without any complications. This case represents an example of a rare serious complication of aortic abdominal aneurysm. This case report covers pathophysiology, diagnostic evaluation, and management of an aortoenteric fistula.