1/476. A case report of congenital intrahepatic arterioportal fistula.We report a case of congenital arterioportal fistula presenting with upper gastrointestinal bleeding from oesophageal varices. The fistula was successfully treated with surgical ligation of the left hepatic artery.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/476. Massive gastrointestinal hemorrhage after transoesophageal echocardiography probe insertion.PURPOSE: To describe a case of a massive gastric bleeding following emergency coronary artery bypass surgery associated with transoesophageal echocardiographic (TEE) examination. CLINICAL FEATURES: A 50-yr-old man was referred for an acute myocardial infarction and pulmonary edema (Killip class 3). Twelve hours after his myocardial infarction, he was still having chest pain despite an i.v. heparin infusion. coronary angiography revealed severe three-vessel disease with multifocal stenosis of the left anterior descending, circumflex and total occlusion of the right coronary artery. The patient was transferred to the operating room for emergency coronary artery bypass graft surgery. After total systemic heparinization (3 mg.kg-1) was obtained for cardiopulmonary bypass, a multiplane TEE probe was inserted without difficulty to monitor myocardial contractility during weaning from CPB. During sternal closure, the TEE probe was removed and an orogastric tube was inserted with immediate drainage of 1,200 ml red blood. Endoscopic examination demonstrated a mucosal tear near the gastro-oesophageal junction and multiple erosions were seen in the oesophagus. These lesions were successfully treated with submucosal epinephrine injections and the patient was discharged from the hospital eight days after surgery. CONCLUSION: This is a report of severe gastrointestinal hemorrhage following TEE examination in a fully heparinized patient. This incident suggest that, if the use of TEE is expected, the probe should preferably be inserted before the administration of heparin and the beginning of CPB.- - - - - - - - - - ranking = 3keywords = artery (Clic here for more details about this article) |
3/476. In situ repair of a secondary aortoappendiceal fistula with a rifampin-bonded Dacron graft.Secondary aortoenteric fistulas remain challenging diagnostic and therapeutic problems. Although the duodenum is most frequently involved, other intestinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleeding 11 years after abdominal aortic aneurysm replacement. The preoperative diagnosis was not achieved by endoscopy or imaging assessment. Despite recommended principles of total graft excision and extraanatomic bypass, appendectomy and in situ rifampin-bonded graft reconstruction were performed because of the advanced age and poor arterial runoff. The postoperative course was uneventful and the patient remains well 17 months after operation.- - - - - - - - - - ranking = 134.13674469203keywords = aneurysm (Clic here for more details about this article) |
4/476. Duodenal ulceration into the cystic artery with massive hemorrhage.This is a case presentation of a unique cause of intestinal bleeding. A duodenal ulcer eroded into the superficial branch of the cystic artery, causing massive intestinal hemorrhage. The patient, a 76-year-old woman, presented with left upper abdominal and left back pain secondary to cystic lesions in the pancreas body and tail. Stress after operation and complication of leakage of pancreatic juice after distal pancreatectomy with splenectomy and diclofenac sodium administration may have caused a deep peptic ulcer to erode the cystic artery. We performed a transfixing ligation of the bleeding vessel, serosal suture of ulcer of the gallbladder, and simple closure of the duodenal ulcer with covering greater omentum. There were no serious complications after the operation, and the patient made an uneventful recovery.- - - - - - - - - - ranking = 6keywords = artery (Clic here for more details about this article) |
5/476. Embolization--an optional treatment for intractable hemorrhage from a malignant rectovaginal fistula: report of a case.PURPOSE: patients rarely have intractable hemorrhage from rectovaginal fistulas, which usually require surgical intervention. This report presents our experience with nonsurgical treatment of a high-risk patient with uncontrolled hemorrhage originating from a malignant rectovaginal fistula. methods: A 74-year-old female developed uncontrolled hemorrhage from a malignant rectovaginal fistula. Because of her poor physical condition, an embolization with metal clips of the right and left hypogastric arteries was performed, distal to the superior gluteal artery. RESULTS: Embolization was successful in controlling the rectovaginal bleeding, allowing the patient to live 12 months. She refused adjuvant radiotherapy or chemotherapy. CONCLUSIONS: Selective angiography and embolization is a worthwhile alternative in patients with uncontrolled bleeding from a malignant rectovaginal fistula who are poor candidates for surgical intervention.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
6/476. Primary aortoduodenal fistula.The aortoenteric fistula is a well-known but uncommon cause of gastrointestinal haemorrhage. It is usually secondary to previous reconstructive surgery of an abdominal aortic aneurysm. Primary aortoenteric fistula is a rare disorder which predominantly occurs in the duodenum. We report the case of a 76-year-old patient who presented with melaena and hypovolaemic shock due to a primary aortoduodenal fistula. Pathogenesis, diagnostic procedures and postmortem pathologic examination of this condition are discussed. The value of computed tomography in establishing the diagnosis is emphasized.- - - - - - - - - - ranking = 134.13674469203keywords = aneurysm (Clic here for more details about this article) |
7/476. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case.A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
8/476. Post-traumatic pancreatitis with associated aneurysm of the splenic artery: report of 2 cases and review of the literature.In patients with acute pancreatitis, profuse gastrointestinal bleeding is associated with a high death rate. The cause of such bleeding must be evaluated and the bleeding controlled urgently. Aneurysm formation is usually the cause of the bleeding. Angiography is needed to make a definitive diagnosis and the bleeding site should be controlled by angiographic embolization if possible. If this fails, aneurysm resection is necessary. Two patients are described. Both had aneurysms of the splenic artery, presenting as massive gastrointestinal bleeding in one patient and bleeding into an associated pseudocyst in the other. They required surgical repair, which was successful in both cases.- - - - - - - - - - ranking = 809.82046815215keywords = aneurysm, artery (Clic here for more details about this article) |
9/476. Successful surgical treatment of primary aorto-duodenal fistula associated with inflammatory abdominal aortic aneurysm: A case report.We report a rare case of a 50-year-old woman with intermittent gastrointestinal (GI) bleeding and diagnosed as having primary aortoenteric fistula (PAEF) with inflammatory abdominal aortic aneurysm (IAAA). She was transferred to our institution with suspected PAEF as assessed by duodenoscopy and CT scan. As the patient was in shock due to massive GI-bleeding two days after admission, we performed an emergency laparotomy. The fistula was closed and the aneurysm replaced by a Woven Dacron Graft with an inter-positioning omental flap. A high index of suspicion is the most important diagnostic aid to prevent overlooking this often fatal disease.- - - - - - - - - - ranking = 804.82046815215keywords = aneurysm (Clic here for more details about this article) |
10/476. Acute dissecting thoracic aortic aneurysm presenting with stroke, consumptive coagulopathy, and gastrointestinal hemorrhage.We report the case of a 70-year-old man who had an acute dissection of a previously undiagnosed thoracic aortic aneurysm. The diagnosis was challenging because of the neurologic and hematologic complications that overwhelmed the clinical presentation. Three simultaneous complications of thoracic aortic aneurysm with dissection (ischemic stroke, consumption coagulopathy, and superior mesenteric infarction with gastrointestinal hemorrhage) made the case unique and the diagnosis difficult.- - - - - - - - - - ranking = 804.82046815215keywords = aneurysm (Clic here for more details about this article) |
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