Early postoperative colonic ventriculoperitoneal shunt migration with trans-anal protrusion: A unique case report

Introduction and importanceColonic ventriculoperitoneal shunt (VPS) migration with trans-anal protrusion remains uncommon. Patients may be asymptomatic, and diagnosis may only be made on visualization of the prolapsed catheter from the anus. This unique case of early post-operative trans-anal shunt protrusion highlight the possibility of this rare complication specially when shunt revision accompanies bowel surgery.Case presentationThe authors present a case of early postoperative colonic shunt migration in a thirteen-year-old female with who underwent Malone Antegrade Continence Enema (MACE) with concomitant revision of the distal part of the peritoneal catheter. She presented two weeks post operatively with shunt catheter protruding from the anus. This was noticed by her carer and she was asymptomatic on her presentation.Clinical discussionDelayed post-operative shunt related bowel perforation and trans-anal shunt protrusion is an uncommon complication after ventriculoperitoneal shunting. Most cases present months after surgery and majority are asymptomatic on presentation. The exact pathophysiology is not established, and mechanisms have been proposed. Early post -operative trans-anal shunt protrusion is rare and suggests inadvertent occult bowel injury especially when shunt placement or revision accompanies extensive bowel surgery.ConclusionThe authors recommended shunt imaging within the first two to three weeks after shunt revision in patient who undergo concomitant bowel surgery with risk of inadvertent bowel injury to identify early colonic migration and avoid its potentially fatal sequelae.     

To compare the outcomes of pancreaticojejunostomy and pancreaticogastrostomy reconstruction after pancreaticoduodenectomy: A prospective observational study

BackgroundWe have been in constant search of novel innovations to decrease the high morbidity after Pancreaticoduodenectomy (PD). Pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG) are the two different methods of reconstruction after PD. However, the existing data is ambiguous in supporting either of them as the preferred technique of reconstruction.MethodsThis was a single-center prospective observational study that included 64 patients who underwent PD over two years. We compared PG with PJ as a method of reconstruction after PD. The primary objective was to assess whether PG decreases the rate of postoperative pancreatic fistula (POPF) rates or not. Secondary objectives comprised analysis of perioperative outcomes, 30-day and 90-day mortality.ResultsPancreatic fistula was significantly lower in PG as compared to the PJ group (24% vs. 47%) with a p-value of 0.027. The incidence of clinically pertinent (grade B) fistula was only 3% in the PG group and 32% in the PJ group. PG group had a higher incidence of post pancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE). No statistically significant difference was seen between either group need for blood transfusion, re-exploration, re-admissions, ICU stay, or length of hospital stay, and 30-day and 90-day mortality. Pancreatic texture and high BMI were independent predictors for pancreatic fistula.ConclusionPG when compared to PJ for reconstruction after PD, decreases the rate of POPF significantly; however, it is associated with an elevated risk of DGE and PPH. There was no difference in 30-day and 90-day mortality between both the treatment groups.     

Resolution of spinal epidural vascular pseudotumor following balloon occlusion of a postoperative vertebral arteriovenous fistula

Summary We describe a case of a vascular mass arising secondary to a postoperative vertebral arteriovenous fistula mimicking recurrent cervical neurofibroma on CT in a patient with neurofibromatosis. Angiography was required for diagnosis. The recurrent tumor resolved following balloon embolization of the fistula.     

高位复杂性肛瘘的解剖学切除术

目的 探索治疗高位复杂性肛瘘较理想的手术方式。方法 应用解剖学原理,行瘘管切除、保留括约肌、内口缝合、创面开放术式,对高位复杂性肛瘘进行手术治疗。结果 45例一期治愈,1例二期治愈,无肛门失禁、肛门狭窄等并发症。结论 解剖学切除术是一种治疗高位复杂性肛瘘较理想的手术方式。     

胰十二指肠切除术的技术改进

目的 探讨改进胰十二指肠切除术,预防术后并发症,提高手术疗效的方法。方法 采用保留幽门、胰管空肠粘膜吻合＋胰肠遮盖套入式吻合、胰管支撑外流充分切除胰钩突的术式,并观察其疗效。结果 全组未发生胰瘘及胰断面出血。保留幽门胰十二批肠切除术（ＰＰＰＤ）者有１例术后发生胃潴留,其余胃排空正常。结论 ＰＰＰＤ只要操作得当,可避免术后胃潴留。胰肠遮盖套入式吻合操作简便,可防止术后胰瘘、胰断面出血等并发症。     

可脱性球囊栓塞治疗颈内动脉海绵窦瘘

目的 总结经动脉途径可脱性球囊性栓塞治疗２０便颈内动脉海绵窦瘘的经验。方法 采用Ｍａｇｉｃ－ＢＤ球囊导管和带标记乳胶球囊,在Ｘ线电视屏幕监视下,经股动脉插管。在球囊内注入渗量等渗非离子造影剂闭塞瘘口。结果 ２０例全部治愈,１次栓塞成功１６例。２次栓塞成功４例,颈内动脉通畅率７０％,无并发症。结论本方法可作为颈内动脉海绵窦瘘的首选治疗方法,尽可能保留颈内动脉通畅,如侧枝循环好,亦可闭塞患侧颈内动脉。     

覆膜自膨式金属支架治疗恶性食管气管瘘

目的 探讨覆膜金属支架治疗恶性食管气管瘘的效果及并发症。方法 在Ｘ线引导下１４例食管气管瘘用国产覆膜支架治疗,门诊行食管造影或电话随访。结果 除１例瘘口封堵不全外,其余１３例瘘口完全封堵,未发生因操作引起的并发症。８例进普食,６例进半流食,１２例肺部感染得到控制。并发症：严重胸痛３例,支架移位致瘘再开放１例,颈动脉及左侧喉返神经受压致头晕及咽麻痹各１例。８例病人死亡,术后生存时间１．４～１２个月,