Cases reported "Fistula"

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1/23. Conservative management of a transdiaphragmatic fistula.

    case reports of transdiaphragmatic fistulas connecting subphrenic collections and empyemas are uncommon. We report the rare complication of a fistulous connection between a subphrenic collection and the bronchial tree.
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2/23. Acute biliary-vascular fistula following needle aspiration of the liver.

    A patient with cavernous transformation of the portal vein and a suspected hepatic mass lesion underwent an ultrasound-guided aspiration of the liver with a skinny needle. Two days later he became acutely ill. bilirubin level peaked at 1375 mumol/L (80.4 mg/dL), and alkaline phosphatase level was 2290 IU/mL. There was no evidence of biliary obstruction. A biliary-vascular fistula was diagnosed by endoscopic retrograde cholangiography, and nasobiliary drainage was placed, leading to resolution of the symptoms and jaundice. A pressure gradient between the biliary tree and a venous collateral probably led to flow of bile into a blood vessel. Nasobiliary drainage should be considered as a potential therapy for acute biliary-vascular fistula.
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3/23. Fistulas between the aorta and tracheobronchial tree.

    Aortobronchial fistula is a rare condition that is invariably fatal if not diagnosed and surgically treated. With appropriate surgical intervention, survival rates greater than 70% can be achieved. A review of the literature and an illustrative case report are presented. A total of 63 fistulas in 62 patients have been described. The case we present is unusual in the use of serratus anterior muscle for repair of the fistula. Eighty-seven percent of the cases documented in the literature were associated with an aneurysm of the thoracic aorta. Eighty-six percent of the fistulas were between the descending aorta and left bronchopulmonary tree. More than 95% of patients experienced at least a single episode of hemoptysis, and massive hemoptysis occurred in more than half of the reported cases. A correct preoperative diagnosis was made in only 54% of cases. Plain chest radiographs definitively demonstrated an aneurysm in only 16%. The computed tomographic scan was the most rewarding test, identifying an aneurysm in 11 of 12 patients and the fistula in 50% of them. Surgical repair resulted in a 76% survival rate.
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4/23. Spontaneous cutaneous biliary fistula: a rare complication of cholangiocarcinoma.

    A rare case of intrahepatic-cutaneous biliary fistula resulted from obstruction of the biliary tree by cholangiocarcinoma in the hilar area. The diagnosis was made clinically by the presence of a constant pus discharge through the fistula opening and confirmed by sonogram, computed tomogram (CT), and surgery. To our knowledge, there have been no previous reports of such a fistula as the presenting symptom of cholangiocarcinoma.
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5/23. fibrin glue application through the flexible fiberoptic bronchoscope: closure of bronchopleural fistulas.

    Closure of bronchopleural fistulas can be accomplished by applying fibrin glue through a flexible fiberoptic bronchoscope. The advantages of this method include the avoidance of general anesthesia and thoracotomy and the excellent extended access to the bronchial tree provided by the flexible bronchoscope.
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6/23. cholangitis, hemobilia, and cholangiocarcinoma. Management of a fistula between an obstructed right hepatic duct and the portal vein.

    cholangitis is the most common cause of sepsis in patients with obstructing carcinomas of the biliary tree. Catheter and stent placement may relieve or exacerbate the septic course. Transhepatic stent placement produced a cholangioportal fistula and hemobilia in a patient with cholangiocarcinoma. The described technique of retrograde operative decompression and clot evacuation may be used in patients in whom portal dissection is hazardous or in whom preservation of an existing cholangiojejunostomy in the portal region is desired.
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7/23. Enterobronchial fistula.

    An unusual case of a fistula originating from the jejunum and crossing the diaphragm to involve the pleura and bronchial tree is presented. The presence of the fistula was first suggested on a computed tomographic examination of the chest. An upper gastrointestinal series verified the origin of the fistula.
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8/23. Congenital tracheobiliary fistula.

    Congenital tracheobiliary fistulas are uncommon and almost always are diagnosed in the first weeks or months of life. Untreated congenital tracheobiliary fistulas cause intractable pneumonia and are revealed by a persistent cough. Medical therapy is not effective, and surgical repair is needed. A 22-year-old woman was treated successfully by resection of a fistula communicating between the tracheobronchial tree and the liver.
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9/23. Iatrogenic bronchopleural fistula caused by feeding tube insertion.

    Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.
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10/23. Nosocomial pulmonary mucormycosis with fatal massive hemoptysis.

    We postulate that the previously healthy woman reported here developed abnormal host defense mechanisms because of acute renal failure, metabolic acidosis, hyperglycemia, and glucocorticosteroid administration. pneumonia unresponsive to antibiotics terminated in massive fatal hemoptysis that was due to mucormycosis with rupture of the pulmonary artery into the tracheobronchial tree.
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