1/35. Intractable oesophageal variceal bleeding caused by splenic arteriovenous fistula: treatment by transcatheter arterial embolization.We describe a rare case of splenic arteriovenous fistula and venous aneurysm which developed after splenectomy in a 40-year-old woman who presented with epigastralgia, watery diarrhoea, repeated haematemesis and melaena caused by hyperkinetic status of the portal system and bleeding of oesophageal varices. It was diagnosed by computed tomography and angiography, and obliterated with giant Gianturco steel coils.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/35. Arterial-esophageal fistulae in patients requiring nasogastric esophageal intubation.A rare and potentially fatal cause of hematemesis is fistula formation between the esophagus and the vascular system. A case report of a 39-year-old woman with congenital aortic arch anomalies hospitalized for treatment of head injuries demonstrates the potential for iatrogenic esophageal trauma to initiate fistula formation between the esophagus and an anomalous arterial system. A literature review revealed 6 other cases of vascular-esophageal fistulae caused by nasogastric esophageal intubation. It is concluded that aortic arch anomalies increase the risk of esophageal injury and subsequent fistula formation from nasogastric esophageal intubation. In addition, the clinical features and pathologic findings of vascular-esophageal fistulae are reviewed.- - - - - - - - - - ranking = 1.8keywords = fistula (Clic here for more details about this article) |
3/35. Aortoesophageal fistula-relief of massive hematemesis with an endovascular stent-graft.A 59-year-old man with an esophageal carcinoma developed massive hematemesis due to aortoesophageal fistula after irradiation therapy reached 58 Gy. Emergent treatment with an endovascular stent-graft was successfully performed and the patient followed an uneventful course until he died of pneumonia 4.5 months later, which was caused by a tracheoesophageal fistula. Stent-graft repair is a safe and effective method to treat aortoesophageal fistula and may be an alternative to surgical resection.- - - - - - - - - - ranking = 1.4keywords = fistula (Clic here for more details about this article) |
4/35. Cholecystogastric fistula presenting with haematemesis: diagnosed by endoscopic retrograde cholangiography.The case is reported of a 72-year-old woman suffering from morbid obesity, who presented with haematemesis while on anti-coagulant therapy. The source of the bleeding proved to be the gastric exit of a cholecystogastric fistula. Subsequent cholangitis was successfully treated by endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) while simultaneously the extent of the fistula was established. cholecystectomy and closure of the fistula was contraindicated because of her morbid obesity. She remained well for 6 months but then presented with a gallstone ileus while another stone was found to be escaping from the gastric fistula. Her morbid obesity resulted in surgical procrastination, which eventually proved fatal. This patient experienced both of the most common types of complication in cholecysto-enteral fistulation, cholangitis and gallstone ileus. Although cholecysto-enteral fistulas (CEF) are probably less common than several decades ago, they are now most likely to be diagnosed during ERC. Gastroenterologists therefore need to be aware of their potential to contribute to the diagnosis and treatment of this surgical condition.- - - - - - - - - - ranking = 2keywords = fistula (Clic here for more details about this article) |
5/35. Successful management of secondary aortoesophageal fistula with graft infection.A 60-year-old woman was transferred to our institution after massive hematemesis and the diagnosis of secondary aortoesophageal fistula was made. Five months previously, she had undergone graft replacement from the origin of the left subclavian artery to midthoracic aorta for chonic type B dissection. After an extraanatomic bypass was performed through a sternotomy, the infected thoracic aortic graft was resected through a left thoracotomy. She remained well without evidence of infection.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
6/35. Bouveret's syndrome presenting as upper gastrointestinal hemorrhage without hematemesis.A 74-year-old woman with a recent diagnosis of peptic ulcer disease diagnosed by endoscopy after presentation with an episode of upper gastrointestinal bleeding returned 6 1/2 weeks later with a 5-day history of nausea and vomiting without associated symptoms. An ultrasound was nondiagnostic except for a large gallstone and a poorly visualized gallbladder. Repeat endoscopy revealed a hard mass that was presumed to have formed secondarily to an ulcer-induced stricture, and a 6-cm filling defect just proximal to the duodenal bulb was seen on a preoperative upper gastrointestinal series. At laparotomy the mass was actually a large gallstone and two smaller stones, which had eroded into and become impacted in the duodenal bulb creating a gastric outlet obstruction. The stones were extracted via a duodenotomy, and the remaining portion of the gallbladder was removed with repair of the cholecystoduodenal fistula. The patient was discharged home after an uncomplicated postoperative course. gastric outlet obstruction by a duodenal gallstone is a condition known as Bouveret's syndrome, which is a rare complication of gallstone disease. Upper gastrointestinal hemorrhage is an especially rare form of presentation.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
7/35. Brief clinical report: duodenal laceration presenting as massive hematemesis and multiple intraabdominal abscesses after laparoscopic cholecystectomy.SUMMARY: Laparoscopic cholecystectomy is considered the gold standard for gallstone disease. Nevertheless, possible severe complications must not be underestimated. Bowel injuries are uncommon, but they are one of the most lethal technical complications of laparoscopic surgery. These injuries were commonly unrecognized at the time of procedures and were diagnosed later when the patients experienced sepsis, peritonitis, intraabdominal abscess, or enterocutaneous fistula. Although duodenal lacerations have been reported with laparoscopic cholecystectomies, they seem to be rare; approximately 30 such cases have been documented previously in the English literature. We report the case of a patient with thermal duodenal injury caused by elective laparoscopic cholecystectomy at an outside center presenting as massive hematemesis and multiple intraabdominal abscesses on the ninth postoperative day. The diagnosis and management of this rare complication of laparoscopic cholecystectomy are described, and the literature is reviewed.- - - - - - - - - - ranking = 0.2keywords = fistula (Clic here for more details about this article) |
8/35. Repair of secondary aortoesophageal fistula by endoluminal stent-grafting.PURPOSE: To describe a case of secondary aortoesophageal fistula that was treated with an endoluminal stent-graft. CASE REPORT: A 58-year-old woman presented with hematemesis and melena. In 1974 she had an interposition graft repair of an aortic transection sustained during a traffic accident. At the examination in 1998, angiography demonstrated a mechanical disruption of the proximal anastomosis forming an aortoesophageal fistula. A 28-mm x 3.75-cm AneuRx stent-graft was introduced via a right femoral arteriotomy and deployed across the defect. Follow-up CT scans at 18 months showed exclusion of the false aneurysm with no evidence of infection; the patient remains well at >2 years after stent-graft implantation. CONCLUSIONS: Endoluminal repair can be successful in achieving a satisfactory midterm outcome in cases of secondary aortoesophageal fistula.- - - - - - - - - - ranking = 1.4keywords = fistula (Clic here for more details about this article) |
9/35. Aortoesophageal fistula associated with tuberculous mediastinitis, mimicking esophageal Dieulafoy's disease.Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication.- - - - - - - - - - ranking = 1.8keywords = fistula (Clic here for more details about this article) |
10/35. Idiopathic hepatic arterio-portal fistula: report of one case.Hepatic arterio-portal fistula is a rare cause of portal hypertension in children; it is an abnormal communication of hepatic artery and portal venous system, the most common causes being trauma or malignancy. There were only 11 cases reported in English literature and were not ever reported in taiwan. We report a 9-year old boy with idiopathic hepatic arterio-portal fistula presented as intractable hematemesis due to esophageal and gastric varices. He had received sclerotherapy twice, and Sugiura operation (resection of the lower part of esophagus, devasculization of the stomach and splenectomy). Idiopathic hepatic arterio-portal fistula was found in angiography examination and the esophageal and gastric varices disappeared after transarterial embolization (TAE). We conclude that angiography is the golden diagnostic method for portal hypertension when the etiology is hepatic arterio-portal fistula and TAE will provide immediately therapy.- - - - - - - - - - ranking = 1.6keywords = fistula (Clic here for more details about this article) |
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