Cases reported "Iatrogenic Disease"

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1/9. Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report.

    Iatrogenic aortic injuries after spinal surgery have been described, but are rare. We describe a case of a 77-year-old woman who underwent surgical correction of a debilitating spinal deformity at an outside institution. Postoperative thoracic spine radiographs and computed tomography scans revealed a misplaced pedicle screw at T5, which was impinging on the descending thoracic aortic wall. The patient was brought to the operating room, where a thoracic stent graft was deployed under fluoroscopic guidance as the malpositioned screw was manually retracted. The patient had an uneventful postoperative course, and was discharged within 24 hours. This case represents a rare but potentially morbid vascular complication of spinal instrumentation surgery that was successfully treated without the need for thoracotomy.
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ranking = 1
keywords = vascular complication
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2/9. Rare fatal vascular complication of transsphenoidal surgery.

    We report the case of a 61-year-old man, who underwent transsphenoidal surgery for a pituitary macroadenoma. The presence of tough fibrous septa dividing the tumour permitted only a partial resection. Progressive loss of consciousness soon after surgery occurred, an emergency CT scan showed no evidence of haemorrhage. Twenty hours later, MRI revealed compression of both internal carotid arteries with arrest of arterial flow resulting in stroke by an enlarged haemorrhagic mass consistent with a pituitary apoplexy. On the second postoperative day, the patient died as a result of this extensive stroke. The mechanisms of this rare complication after transsphenoidal surgery are theorized and the sensitivity of imaging methods is discussed.
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ranking = 4
keywords = vascular complication
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3/9. Endovascular graft for late iatrogenic vascular complication after anterior spinal instrumentation: a case report.

    STUDY DESIGN: Case report. OBJECTIVE: To describe an endovascular treatment option for (late) vascular complications after anterior spinal instrumentation. SUMMARY OF BACKGROUND DATA: Severe progressive scoliosis is a well-known feature in Marfan's disease. Although overall complication rate after surgical correction of the spinal deformity is rather high, late iatrogenic complications are less frequently identified. methods: A 40-year-old woman with Marfan's disease reported to our outpatient clinic with dyspnoe d'effort, 20 years after anterior spinal instrumentation of a thoracolumbar scoliosis. Routine screening identified a saccular aneurysm of the descending thoracic aorta. A contrast-enhanced CT scan revealed that the most proximal screw of the construct had perforated the vessel wall and caused a false aneurysm. An endovascular approach to the problem was chosen; by a transfemoral approach, an AneuRx endovascular graft was successfully implanted. RESULTS: The patient had an uneventful postoperative course and was discharged within 5 days. At 5-year follow-up, the patient still has no clinical complaints, nor radiographic leakage nor recurrence of the false aneurysm at contrast-enhanced CT screening. CONCLUSION: Use of an endovascular graft is an adequate alternative for treatment of late vascular complications after anterior spinal instrumentation.
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ranking = 6
keywords = vascular complication
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4/9. Subretinal neovascularization after focal argon laser for diabetic macular edema.

    The authors reviewed four cases of iatrogenic subretinal neovascularization after focal argon green photocoagulation for clinically significant diabetic macular edema. An inappropriate combination of small spot size with a high-power setting is the common feature in each case of iatrogenic subretinal neovascularization. Close follow-up with fluorescein angiography is used to identify iatrogenic subretinal neovascularization at an early, treatable stage. All four patients responded favorably to laser photocoagulation of the subretinal neovascular membrane.
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ranking = 0.052734064267381
keywords = diabetic
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5/9. Lesions of the dorsal renal artery in surgery for renal pelvic calculus. A potential cause of renovascular hypertension.

    2 cases of lesions of the dorsal renal artery in surgery for renal pelvic calculus are described. In 1 of the cases hypertension developed. Anatomic factors and previous operations predispose to this complication. An arterial complication should be suspected when hypertension develops postoperatively. The blood pressure of patients with known renal vascular complications should be checked repeatedly for several months postoperatively. The diagnosis is radiological, renal angiography being the definite procedure although a reduction of kidney size observed at urography may indicate the vascular lesion.
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ranking = 1
keywords = vascular complication
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6/9. Unsuspected intraperitoneal perforation of the urinary bladder as an iatrogenic disorder.

    Perforation of the urinary bladder associated with long-term indwelling catheter drainage is a rare and lethal iatrogenic disorder. Moreover, bladder perforation can occur in a variety of surgical settings. We report here several unusual situations: one in which a fibroid uterus probably played a role in pressure necrosis of a bladder with an indwelling catheter, one in which carcinoma of the prostate and faulty catheter drainage was present, and one in which pelvic radiation therapy was followed by bladder perforation. These three cases illustrate the clinical acumen required to recognize intraperitoneal perforation. The variety of presentations is suggested by the fact that one case was diagnosed preoperatively by cystogram, one was unexpectedly found at laparotomy for acute peritonitis, and one was discovered only at autopsy. One of the patients was diabetic, two had been treated for miliary tuberculosis, and all had a history of long-term urinary bladder catheterization. Bladder perforation can be prevented by several alternative methods of chronic bladder drainage. The diagnosis of the problem requires a high degree of clinical suspicion, aided by definitive cystograms. The treatment is surgical, including prompt repair of the perforation and drainage of the bladder.
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ranking = 0.010546812853476
keywords = diabetic
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7/9. Iatrogenic placement of a Tenckhoff catheter in the bladder of a diabetic patient after penectomy.

    The placement of permanent peritoneal catheters for dialysis of patients with renal failure is safe and has been popular since its modification by Tenckhoff. The majority of complications associated with these catheters are infectious in nature, manifesting as peritonitis or insertion site skin infections. Occasionally, serious complications may occur. We report the iatrogenic placement of a Tenckhoff catheter in the bladder of a penectomized patient. Consideration to this surgically altered lower genitourinary tract may have avoided this rare complication as well as aided in the postoperative management of this patient.
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ranking = 0.042187251413905
keywords = diabetic
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8/9. hemobilia complicating elective laparoscopic cholecystectomy: a case report.

    Iatrogenic injury to the hepatic or cystic arteries can occur during laparoscopic cholecystectomy and can be seen in isolation or in association with bile-duct injury. The most common manifestation of arterial injury is intraoperative hemorrhage; also, interruption of the right hepatic artery can occur without hemorrhage, and this can be clinically insignificant or associated with hepatic ischemia. A less common manifestation of arterial injury during laparoscopic cholecystectomy is presented. A 48-year-old woman had a pseudoaneurysm of the major anterior branch of the right hepatic artery in association with an injury to the common hepatic duct. This complication presented as massive hemobilia after she had been discharged from the hospital. Definitive repair of the pseudoaneurysm was carried out at the time of Roux-en-Y hepaticojejunostomy for correction of the associated duct injury. This unusual vascular complication should be considered in patients after laparoscopic cholecystectomy who demonstrate evidence of late occult or obvious hemorrhage.
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ranking = 1
keywords = vascular complication
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9/9. Surgical removal of subfoveal iatrogenic choroidal neovascular membranes.

    OBJECTIVE: To present the cases of two patients with laser-induced iatrogenic subfoveal choroidal neovascular membranes (CNVMs) who underwent surgical removal of the membranes with favorable outcomes. DESIGN: Interventional case reports. PARTICIPANTS: Two patients with iatrogenic subfoveal CNVM. One case developed after laser treatment for macular edema due to branch retinal vein occlusion, and the second case developed after focal laser photocoagulation for diabetic retinopathy. INTERVENTION: Surgical removal by pars plana vitrectomy. MAIN OUTCOME MEASURES: visual acuity, scotoma, retinal examination with fundus photography, and fluorescein angiography before surgery and during the postoperative period. RESULTS: Both patients underwent surgical removal after progression of the membrane with severe visual loss of 20/200 was noted. At present follow-up, there is a significant improvement in visual acuity and a reduction in the size of the scotoma. No recurrence of CNVM is noted. CONCLUSION: Both patients with laser-induced iatrogenic subfoveal CNVM achieved a good visual outcome after surgical removal of the membrane. The reasons for a good surgical result are thought to be twofold. First, the origin of the CNVM is extrafoveal at the site of laser application. The chance for foveal cone cell damage during the surgery is reduced. Second, the degree of cellular destruction in iatrogenic CNVM is usually focal without extensive retinal photoreceptor cell and retinal pigment epithelial damage. Therefore, a better chance of postoperative visual recovery is anticipated.
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ranking = 0.010546812853476
keywords = diabetic
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