Severe injuries from coin cell battery ingestions: 2 case reports

Although coin cell battery ingestion is usually not associated with adverse consequences, case reports have been published that describe serious morbidity and occasional mortality. This report describes 2 young children developing serious complications from unwitnessed Lithium coin cell ingestion. A 19-month-old developed an aortoesophageal fistula from the proximal descending aorta, whereas the other developed bilateral vocal cord paralysis. Massive bleeding from the aortoesophageal fistula occurred 10 days post battery removal, resulting in a fatal outcome despite maximal surgical efforts. The patient with bilateral vocal cord paralysis required tracheostomy for airway stridor but is recovering function. This report adds to the evidence that primary prevention efforts are needed to caution parents about the dangers associated with coin cell batteries, and secondary prevention can be improved by raising awareness among clinicians as to the various clinical presentations and therapeutic options for this condition.     

Tripartite esophagus

Esophageal atresia can exhibit many variations as a result of embryological derangements. We present a variation not previously described.     

低位结肠梗阻急诊行一期切除吻合术的改良(附21例报告)

目的：探讨横结肠襻式造口技术和加强腹腔引流防止左半结肠癌急诊一期切除后吻合口瘘的改良方法。方法：对21例左半结肠癌急诊行一期切除后在传统造口技术基础上利用腹直肌鞘代替支撑棒，造口肠段埋于皮下，根据病情直接或二期开放造口，同时在吻合口周围置以双套管引流延长置管时间，均不进腹关闭造口。结果：3例出现吻合口瘘，无1例死亡，无1例出现造口回缩和肠梗阻，无1例出现腹壁疝。结论：左半结肠癌急诊一期切除应行预防性造口和加强腹腔引流。     

Splenobronchial fistula: Interventional radiologic management

A 71-year-old man had a splenic abscess complicated by rupture into the left subphrenic space with formation of a splenobronchial fistula. One percutaneous catheter was placed into the splenic abscess and a second was placed in the subphrenic collection. The abscesses resolved and the bronchial fistula closed in 12 days.     

Transvenous embolization of cavernous dural arteriovenous fistula: report of 28 cases

Background  Usually, cavernous dural arteriovenous fistula can be treated via transarterial approaches. However, in many complicated patients, transvenous approaches are superior to the transarterial ones because of the difficulties during a transarterial operation. In this study, we retrospectively analyzed the outcomes of 28 patients with cavernous dural arteriovenous fistula treated by transvenous embolization.
Methods  From September 2001 to December 2005, 28 patients with 31 cavernous dural arteriovenous fistulae were treated with transvenous embolization in Beijing Tiantan Hospital. The involved cavernous sinuses were catheterized via the femoral vein-inferior petrosal sinus approach or the femoral-facial-superior ophthalmic vein approach, and embolized with coils (GDC, EDC, Matrix, Orbit or free coil) or coils plus silk. The patients were followed up for 3 to 26 months.
Results  All the 31 cavernous sinuses in the 28 patients were successfully embolized. Complete angiographic obliteration of the fistulae was achieved immediately in 25 patients. Residual shunting was observed in the other 3, who had drainage through the pterygoid plexus (2 patients) or the inferior petrosal sinus (1) after the operation. Headache and vomiting were the most common symptoms after the embolization. In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation. Transient abducens nerve palsy was encountered in 1. In 1 patient, the occular symptoms were improved after the operation, but recurred 4 days later, and then disappeared spontaneously after 5 days. During the follow-up, no patient had recurrence. Three months after the operation, angiography was performed on the 3 patients with residual shunting. Two of them had angiographic cure, the other had residual drainage through the pterygoid plexus.
Conclusions  Transvenous catheterization and embolization of the cavernous sinus is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulae. It is an alternative to the patients with spontaneous cavernous dural arteriovenous fistulae or those in whom transarterial embolization failed.

     

Treatment of postcatheterization femoral arteriovenous fistulas with simple prolonged bandaging

Background The methods for the treatment of postcatheterization femoral arteriovenous fistulas (AVF–s) – simple observation, ultrasound guided compression, covered stents implantation and coil embolization have poor outcome. Surgery is the standard method for treatment of femoral AVFs, but it is a traumatic operation. In this study, we report the results of the treatment of postcatheterization femoral AVFs by simple prolonged compressing bandage.Methods To treat iatrogenic femoral AVFs caused by transfemoral catheterization, prolonged binding with elastic or common bandage was applied in 16 cases. Catheterization was performed in 7 cases for radiofrequency current catheter ablation, in 4 for occlusion of congenital heart disease, in 3 for percutaneous coronary intervention, in 1 for coronary angiography and in 1 for right heart catheterization. Results All iatrogenic femoral AVFs were healed after simple binding with elastic or common bandage for 4–46 days (mean (15±10) days). During the period of binding, local skins ulceration occurred at puncture site in two cases and femoral vein thrombus was found in one patient. During 6–24 months (mean (11.8±3.6) months) followup with colour Doppler ultrasonography, no recurrent arteriovenous shunting or other complications were observed. Conclusion The results suggest that simple prolonged bandaging for postcatheterization femoral AVFs is an effective and economical procedure.     

Double traumatic caroticocavernous fistula and its treatment by detachable balloons

Summary A case with two separate fistulous caroticocavernous communications on the same side and their successful endovascular management with preservation of the carotid artery are reported.     

硬脑膜动静脉瘘

报告４例硬脑膜动静脉瘘。对其病因、临床特征、诊断及血管内栓塞治疗进行了讨论。多枝细小动脉供血者，以液态栓塞物栓塞治疗效果较好，较大瘘口以固态栓塞物效果较好。栓塞治疗中应注意＂危险吻合＂的存在，防止误栓。