1/14. A case of urachal remnant presenting as acute abdominal pain.A 30-year-old male presented to the Emergency Department, over sequential visits, with abdominal complaints. The patient's presenting history and physical examination were mistakenly diagnosed variously as gastroenteritis, omphalitis, and appendicitis. Ultimately, the diagnosis of urachal fistula was made at surgery. This case is discussed in light of prior published experiences with this disease entity.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/14. Gastric perforation due to the ingestion of a hollow toothpick: report of a case.A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.- - - - - - - - - - ranking = 2keywords = fistula (Clic here for more details about this article) |
3/14. Percutaneous removal of retained calculi from the abdomen.With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made a full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described here in another patient, does not appear to have been reported previously.- - - - - - - - - - ranking = 2keywords = fistula (Clic here for more details about this article) |
4/14. A childhood case of primary hepatic actinomycosis presenting with cutaneous fistula.Primary hepatic actinomycosis is extremely rare in children. Although the infection has the capability of extension to surrounding tissues or organs, involvement of the abdominal wall is infrequently reported even in adults. We present a childhood case of primary hepatic actinomycosis infiltrating the anterior abdominal wall and spontaneously draining through the skin.- - - - - - - - - - ranking = 4keywords = fistula (Clic here for more details about this article) |
5/14. Mesenteric ischemia and portal hypertension caused by splenic arteriovenous fistula.Splenic arteriovenous fistula is rare and usually presents with features of established portal hypertension (PHT). Presentation as acute mesenteric ischemia with features of acute PHT is uncommon. We report a 35-year-old lady who presented with severe abdominal pain, diarrhea and ascites, which was found to result from mesenteric ischemia and acute PHT secondary to splenic arteriovenous fistula. She underwent resection of fistula, which resulted in complete symptom relief.- - - - - - - - - - ranking = 7keywords = fistula (Clic here for more details about this article) |
6/14. Stump resections resulting from incomplete operations.Stump viscera caused by an incomplete operation can present the same symptoms as before the first operation. Furthermore, as an acute clinical event, these incomplete resections may sometimes cause acute abdomen and may need emergency surgical intervention. A 34-year-old woman with a history of laparoscopic cholecystectomy 5 days before was admitted with acute abdominal symptoms. Abdominal exploration revealed that she had undergone incomplete resection of the gallbladder. Another patient, a 21-year-old man, was admitted with complaints of fluid drainage from his appendectomy incision scar. He was diagnosed as having enterocutaneous fistula. Abdominal exploration revealed a stump appendix fistulizing to the abdominal wall. The third patient was a 32-year-old man with an appendectomy scar who was admitted with complaints of acute appendicitis. The patient was diagnosed as having acute appendicitis and underwent an appendectomy. A stump appendix was removed during the operation. Surgeons should be aware of stump pathologies and keep in mind a possible incomplete operation to prevent delayed diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
7/14. Surgical management of neutropenic enterocolitis.Three cases of histologically confirmed neutropenic enterocolitis, each presenting as an acute abdomen in patients with leukaemia are presented. All three patients presented with fever and abdominal pain within 14 days of completing a course of chemotherapy. Signs of peritonitis localized to the right iliac fossa developed in each patient, in spite of aggressive antibiotic therapy and bowel rest. All three patients were found to have non-viable caecum at laparotomy and were treated by right hemicolectomy. Primary ileocolic anastomosis was performed in one patient, who recovered following a stormy postoperative course owing to sepsis. Two patients underwent formation of an ileostomy with distal mucous fistula and each recovered with minimal postoperative complications; secondary anastomosis was performed electively in both cases. The difficulty in diagnosing neutropenic enterocolitis preoperatively is discussed and the place of non-operative management is reviewed but we recommend surgical intervention as a means of ensuring removal of a localized septic focus until marrow regeneration occurs.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
8/14. Exogastric neurilemmoma presenting as acute abdomen: role of computed tomography in diagnosis.A case of subserosal gastric neurilemmoma is hereby presented. This reported case is unique in its clinical presentation including the appearance of acute abdomen and fever subsequent to unremarkable and uneventful upper gastrointestinal endoscopy. The tendency of neurilemmoma to cause mucosal ulceration with fistula formation probably led to this clinical presentation. The role of computed tomography in establishing diagnosis of exogastric tumor is emphasized.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
9/14. Massive gastrointestinal bleeding due to cholecystoduodenal fistula. Case report.A young man presenting with massive haematemesis and melaena was found to have a cholecystoduodenal fistula secondary to duodenal ulcer. Surgical treatment was successful.- - - - - - - - - - ranking = 5keywords = fistula (Clic here for more details about this article) |
10/14. Recurrent pneumoperitoneum after hysterectomy.In most instances, patients with an acute abdomen and pneumoperitoneum have a perforated hollow viscus as the underlying cause. Clinicians must not forget, however, some of the less common causes of free air in the abdomen. We describe pneumoperitoneum from a vaginoperitoneal fistula, developing after hysterectomy, well known to gynecologists, but rarely noted in the medical literature.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
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