Cases reported "Diverticulitis, Colonic"

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1/44. The radiology corner: Longitudinal fistulous tract of the colon and a perianal fistula in diverticulitis.

    Diverticular disease may mimic many of the symptoms and signs of Crohn's disease. The presence, however, of perirectal involvement and a longitudinal fistula greater than 10 cm. in the wall of the colon are two unusual features of diverticular disease. Discussed herein is a patient who presented with both of these complications.
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keywords = fistula
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2/44. Colosalpingeal fistula: a rare complication of colonic diverticular disease.

    Diverticular disease is a common condition in Western countries. The formation of inflammatory fistulae, usually from sigmoid colon to bladder or vagina, can be a feature of complicated cases of the disorder and is normally an indication for surgical intervention. We present a case of colosalpingeal fistulation occurring secondary to diverticulitis, a complication which, to our knowledge, has not been previously reported in the radiological literature. As in this instance, the initial clinical presentation of this problem can often be non-specific, with localising symptoms occurring later. In our case, barium enema examination allowed good demonstration of the fistulous communication before the more specific symptoms were clinically apparent.
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ranking = 1.2
keywords = fistula
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3/44. Aortocolic fistula, a lethal cause of lower gastrointestinal bleeding: report of a case.

    Aortocolic fistula occurs with spontaneous rupture of aortic and iliac aneurysms into the sigmoid colon, or due to involvement of the aneurysmal wall by acute diverticulitis. In the eight cases reviewed, this complication proved uniformly lethal, although sufficient clinical findings were present for diagnosis, and adequate time was available for a planned therapeutic approach. Lower gastrointestinal bleeding in the patient who has an aortic aneurysm and left-lower-quadrant inflammation suggests the presence of an aortocolic fistual. angiography should be performed during a bleeding episode to confirm the diagnosis. Surgical correction consists of an axillofemoral by pass graft, excision of the aortic aneurysm, and a Hartmann procedure.
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ranking = 1
keywords = fistula
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4/44. Isolated iliac artery aneurysmocolonic fistula with pericolic abscess.

    We report the successful management of a 66-year-old man who had common iliac aneurysmosigmoid colon fistula. The initial presentation was abdominal pain, fever, and melena. Digital subtraction angiography showed no evidence of rupture. However, computed tomography scanning revealed fine gas formations in the common iliac artery aneurysm. To reduce the risk of graft infection and prolonged ischemia, we created an extraabdominal femoral-femoral bypass graft, closed the wounds, removed the aneurysm, and closed the colon primarily. The postoperative course and recovery were uneventful.
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ranking = 1
keywords = fistula
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5/44. Colouterine fistula complicating diverticulitis: a case report and review of the literature.

    Colouterine fistula, secondary to diverticulitis, is an extremely rare complication, and only few cases have been reported in the literature. We report the case of 76-year-old woman, who presented with vaginal discharge over a three-month period. Pelvic examination and laboratory investigations suggested a colouterine fistula, that was confirmed by non-invasive imaging. Surgical treatment was a one-stage, en bloc resection of the uterus and sigmoid colon. In the presence of severe inflammatory reaction or paracolic abscess, a two-stage procedure should be safer. Otherwise, a one-stage procedure, en bloc resection of the uterus and sigmoid colon is preferred, as we cannot rule out a malignancy prior to surgery.
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ranking = 1.2
keywords = fistula
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6/44. Colouterine fistula complicating diverticulitis: charcoal challenge test aids in diagnosis.

    fistula formation between a segment of colon and the uterus is an unusual complication of diverticulitis; only 17 cases have been reported in the world literature. We describe a 69-year-old woman with a colouterine fistula secondary to diverticulitis. She presented with a malodorous vaginal discharge that grew multiple enteric organisms on culture. A barium enema revealed colonic diverticula but no fistula tract. Orally administered activated charcoal was seen flowing from the cervical os during a pelvic examination the following day, establishing a diagnosis of colouterine fistula. Pathologic examination of the resected colon and uterus confirmed this diagnosis and determined that diverticulitis was the etiology. From a review of the literature, we conclude that radiographic and invasive procedures cannot be depended upon for diagnosis. Ingestion of activated charcoal may provide a simple, noninvasive approach to the diagnosis of enterouterine fistulas.
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ranking = 1.6
keywords = fistula
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7/44. Enterovesical fistula caused by inflammatory bowel diseases.

    Enterovesical fistula caused by inflammatory bowel diseases is a rare disorder. Two male patients with recurrent cystitis had sigmoid colon diverticulitis causing enterovesical fistula. One female patient with Crohn's disease developed enterovesical fistula with abdominal and urinary symptoms. In each patient, a barium enema revealed causative bowel diseases. The precise diagnosis of enterovesical fistula was made either by cystography or cystoscopy. One-stage resection of the inflamed bowel with fistula and affected the bladder wall was proved to be an effective treatment for these three patients, while a long term follow up is specifically necessary in the patient with Crohn's disease.
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ranking = 1.8
keywords = fistula
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8/44. A laparoscopic approach to the surgical management of enterocutaneous fistula in a wound healing by secondary intention.

    Traditional surgical management of a chronic enterocutaneous fistula requires laparotomy, but the optimal site of incision is unclear. laparoscopy and adhesiolysis may offer an alternative approach. Two cases of non-healing enterocutaneous fistula within chronic, granulating wounds are described. The laparoscope was placed subcostally using the Hasson technique with additional ports placed under direct vision. After clearing the anterior abdominal wall of all but the fistula-containing bowel, an incision was made circumferentially around the granulation bed. Resection and primary anastomosis was performed in standard fashion. Lateral component separation allowed primary wound closure. Both patients were discharged without sequelae and doing well at last follow-up (mean 12 months). A laparoscopic approach to non-healing enterocutaneous fistulas seems safe and technically feasible. When combined with lateral component separation, it may result in reduction of inadvertent enterotomies and optimal management of the wound without the use of prosthetic mesh.
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ranking = 1.6
keywords = fistula
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9/44. subcutaneous emphysema of the abdominal wall from diverticulitis with necrotizing fasciitis.

    The case history of a patient with subcutaneous emphysema of the abdomen from sigmoid diverticulitis is presented. The mechanisms for developing abdominal wall emphysema are reviewed. Thus when the gas originates from the gastrointestinal tract, mechanical factors are mainly responsible for this phenomenon. These inculde a direct communication through a colonocutaneous fistula. Gas may, however, also be spread into the abdominal wall by high intraintestinal pressures. infection with gas-producing organisms may be associated with subcutaneous emphysema. This is particularly true when the emphysema develops 48 h or longer after onset of symptoms. infection, however, is not the major cause for gas in these tissues.
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ranking = 0.2
keywords = fistula
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10/44. Emphysematous epididymitis as presentation of unusual seminal vesicle fistula secondary to sigmoid diverticulitis: case report.

    This case report describes a sigmoid diverticulitis with torpid development, long-term symptoms of bladder irritability, and an emphysematous epididymitis caused by a direct seminal vesicle fistula. The diagnosis was suggested by scrotal ultrasound visualizing gas in the scrotum; the complex pelvic fistulous tract was specifically delineated by multislice computed tomography. This may be the first reported case of seminal vesicle fistula directly related to colonic diverticulitis and causing emphysematous epididymitis.
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ranking = 1.2
keywords = fistula
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