Cases reported "Abdominal Injuries"

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1/65. A case of renal artery stenosis secondary to chronic pancreatitis.

    We report a case of renal artery stenosis most probably secondary to chronic pancreatitis. The patient had a traumatic pancreatic fistula. This was followed by numerous attacks of pancreatitis in the following years. At a relatively young age, he developed hypertension. Examinations revealed a right renal artery stenosis which was successfully treated by a percutaneous angioplasty. This rare complication should be kept in mind as a possible complication of pancreatitis.
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ranking = 1
keywords = fistula
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2/65. High-output heart failure resulting from a remote traumatic aorto-caval fistula: diagnosis by echocardiography.

    Congestive heart failure (CHF) due to high output states is known to occur in a variety of systemic illnesses and in patients with arterial-venous fistulas. This paper reports the case of a 45-year-old man admitted to the emergency room with a diagnosis of new onset atrial fibrillation and CHF, whose past medical history was not significant except for a gunshot wound to his abdomen 22 years previously. The etiology of his CHF together with the cardiomegaly and hyperdynamic left ventricular systolic function was unknown. A subcostal view routinely done during transthoracic echocardiography revealed a severely dilated inferior vena cava and the presence of an aorto-caval fistula by color doppler. The patient underwent successful corrective repair with dramatic improvement in symptoms and resolution of the atrial fibrillation, and cardiac size returned to normal. This rare case emphasizes that patients with refractory CHF must be closely examined with particular attention to palpation and auscultation over all scars, irrespective of the duration since any traumatic or surgical event.
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ranking = 6
keywords = fistula
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3/65. Percutaneous obliteration of duodenal fistula.

    High output external duodenal fistula is a difficult condition to treat and despite the advances in nutritional care, morbidity and mortality remain high. Although, non surgical methods (e.g. endoscopy, fistuloscopy and percutaneous injection of substances) have been reported sporadically in the treatment of enterocutaneous fistulae, gelfoam has not been tried. We present a case of duodenal fistula following blunt abdominal trauma which persisted for 14 weeks on conservative management. Percutaneous obliteration of the duodenal fistula was successfully performed using gelfoam injection through a catheter. This procedure is simple, safe and cheap and further experience may demonstrate that it is an easy and more practical tool in dealing with this problem.
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ranking = 8
keywords = fistula
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4/65. Left hepatic duct injury and thoracobiliary fistula after abdominal blunt trauma.

    Thoracobiliary fistula after blunt hepatic trauma is rare. We report a case of pleurobiliary fistula after a blunt hepatic trauma leading to a left hepatic lobe laceration together with a left hepatic duct injury. The management of this traumatic lesion is discussed and related to the existing literature data. The diagnosis of traumatic thoracobiliary fistula rests upon clinical suspicion in the setting of a persistent right pleural effusion. Demonstration of the presence of bile in the pleural cavity by thoracocentesis is considered a proof of pleural biliary fistula. We think that laparotomy is an appropriate route for the treatment of pleurobiliary fistulas. However, when a bronchobiliary fistula is suspected, the patient should be treated with thoracotomy and may require pulmonary resection to remove the fistulous tracts.
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ranking = 10
keywords = fistula
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5/65. Management of hemobilia with transarterial angiographic embolization: report of one case.

    A nine-year-old girl who developed life threatening hemobilia after blunt abdominal trauma was successfully managed by embolization of the hepatic artery aneurysm. However, biliary fistula persisted and subcapsular liver abscess occurred after the endoscopic sphincterotomy and the placement of a nasobiliary drain for bile leakage. debridement of the abscess and insertion of a drain tube eventually cured the event. The relevant literature is reviewed and the management of the hemobilia is discussed.
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ranking = 1
keywords = fistula
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6/65. renal artery to inferior vena cava fistula following gunshot wound to the abdomen.

    Traumatic fistula involving the renal artery and IVC is a rare event, and typically is a result of penetrating injury. A case of right renal artery to IVC fistula following a gunshot wound to the abdomen is reported, and illustrates the significant hemodynamic changes that accompany these fistulae. We also emphasize the importance of thorough initial exploration of retroperitoneal hematomas following penetrating trauma, and review management options in the treatment of renal arteriovenous fistulae.
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ranking = 8
keywords = fistula
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7/65. Cystic tumors of the pancreas. Considerations upon 34 operated cases.

    AIM: To point out the morphologic, clinic and therapeutic aspects of pancreatic cystic tumors. MATERIAL AND METHOD: 34 pancreatic cystic tumors (21 males and 13 females, aged between 21 and 68 years), admitted in the last 15 years were analyzed. They were true cysts in 3 cases (9.9%) and pseudocysts in 31 cases (91.1%), located on the head of the pancreas in 8 cases, on the body in 19, on the tail in 6 and on the body and tail in 1 case. We noticed in the past medical history of the patients with pseudocysts a recent acute pancreatitis attack (26 cases), chronic pancreatitis (4 cases) or a recent abdominal trauma (1 case). The delay between the acute pancreatitis attack and the onset of the pseudocyst varied between 18 days and 2 months. The diagnosis was established by clinical picture (Shefer-Silvis triad), laboratory findings and imaging tests (barium meals, ultrasound test and/or CT test). Thirty cases (27 pseudocysts and 3 true cystic tumors) were operated on: the main surgical procedures were cystogastrostomy (12 cases), cystojejunostomy (6 cases) or cystoduodenostomy (3 cases); we also performed distal pancreatectomy (3 cases), laparostomy or external drainage in 5 cases. RESULTS: We registered 1 death (mortality rate of 3.3%), 2 pancreatic fistulae, 1 pancreatic abscess and 2 recurrences. CONCLUSIONS: 1. The pseudocyst, as an evolutionary complication of acute or chronic pancreatitis, is the most frequent cystic tumor of the pancreas, true pancreatic cysts being extremely rare. 2. The diagnosis is established by clinical pictures, laboratory findings and imaging tests. 3. The treatment is surgical, cystogastrostomy or cystojejunostomy being the main surgical procedures.
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ranking = 1
keywords = fistula
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8/65. Serial abdominal closure technique (the "SAC" procedure): a novel method for delayed closure of the abdominal wall.

    Abdominal compartment syndrome may occur after any elective or emergent abdominal operations that are complicated by postoperative hemorrhage or in the trauma patient who has massive fluid replacement for intra-abdominal bleeding. Once the abdomen is decompressed the type of closure varies as much as the surgeon performing the procedure. We have devised a simple, reproducible, inexpensive, and safe method to close the abdomen at the bedside. Serial abdominal closure (SAC) was performed on three patients 45, 54, and 14 years of age who had developed abdominal compartment syndrome secondary to an upper gastrointestinal bleed requiring massive transfusion, a tear of the superior mesenteric vein, and a grade 4 liver laceration respectively, all necessitating abdominal decompression. All three patients had their abdominal wounds closed at the bedside over the course of several days with our SAC technique. Subsequent postoperative course was uneventful and the abdominal wall was free of defects at one-year follow-up. SAC is an efficient, inexpensive, and easily reproducible method of managing the open abdomen. The use of SAC prevented abdominal closure-related complications such as enteric fistula and hernia formation in our three patients.
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ranking = 1
keywords = fistula
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9/65. Pancreatic rupture following a bull-head caused blunt abdominal trauma.

    A 33-year-old man was admitted to our hospital with clinical and instrumental-diagnostic evidence (CT) of haemoperitoneum following a blunt abdominal trauma due to being butted by a bull. A full-thickness rupture of the pancreas, at the level of the isthmus, was found at laparotomy. The emergency procedure consisted in evacuation of the haemoperitoneum, haemostasis and suture of the pancreatic lesion plus drainage of the lesser sac. A high-output (800 ml/day) post-traumatic pancreatic fistula developed in the following days, with the need for a second operation. In the presence of a large pancreatic defect extensively communicating with the Wirsung duct, a singular surgical procedure was adopted in the form of a Roux-en-Y pancreaticojejunostomy with catheterisation of the pancreatic fistula using a small disposable silicone catheter. The post-operative course was uneventful and healing of the pancreatic fistula was documented at CT scan 39 days after the operation.
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ranking = 3
keywords = fistula
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10/65. Colonic fistula complicating electric burns--a case report.

    intestinal fistula is an uncommon complication of electric burns. The authors report the case of an 11-year-old child who sustained accidental burns from a high-voltage electric current and was admitted to their hospital with full-thickness burns of both the upper limbs and deep burns of the anterior abdominal wall. Staged surgery was required, and the authors were involved in the management of the burn of the anterior abdominal wall. laparotomy was done because omentum was found prolapsing out of the abdominal wound. Three scattered areas of subserosal burn of the small bowel were noticed, which required no intervention. The rest of the viscera all were normal. During the course of his stay, he had a fecal fistula on the 19th postburn day, which was found to be from the transverse colon. Conservative management of the fistula with total parenteral nutrition for 23 days resulted in complete healing.
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ranking = 7
keywords = fistula
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