1/41. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy.BACKGROUND: Benign tracheo-neo-esophageal fistulas after esophagectomy are rare and treatment can be challenging. They can result from perioperative tracheal injury or various postoperative complications. methods: charts of 6 patients with a benign tracheoneo-esophageal fistula after subtotal esophagectomy treated in this institution between July 1993 and August 1999 were analyzed. RESULTS: Three men and 3 women (median age 61 years) developed a fistula after subtotal esophagectomy. Symptoms varied from mild swallowing difficulties to aspiration pneumonia and mediastinitis. Two patients with mild symptoms were treated conservatively. In 1 patient a long fistula was partly excised through the neck. In 3 patients the gastric tube was excluded or excised, with surgical closure of the tracheal defect. The alimentary tract was reconstructed by colonic interposition. There were no major complications. After a median follow-up of 1.6 years, all fistulas were closed. All patients were capable of sufficient oral intake. CONCLUSIONS: A benign tracheo-neo-esophageal fistula after esophagectomy is a rare, but serious complication. Site and size of the fistula, together with the severity of symptoms, should dictate management.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/41. Enterocutaneous fistula treated with a fasciocutaneous turnover flap.A new surgical repair of enterocutaneous fistula associated with abdominal wound defects is presented. The authors turned over the fasciocutaneous flap from the surrounding skin and sutured the intestinal lumen directly to the cutaneous side of the flap. The method is a risk-free extraperitoneal approach that can be performed using local anesthesia.- - - - - - - - - - ranking = 0.45454545454545keywords = fistula (Clic here for more details about this article) |
3/41. Gastrobronchial fistula repair followed by esophageal leak--rescue by transesophageal drainage of the pleural cavity.A gastrobronchial fistula (GBF) associated with bilateral aspiration pneumonia was diagnosed six years after an esophagectomy with gastric pull-up. After failed surgical repair, an uncontained esophagopleural leak developed. Fistula closure was attempted by implanting a Wilson-Cook endoprosthesis, which quickly became dislodged. Transesophageal drainage was positioned endoscopically through the suture-line defect and led to closure of the leak after 10 days.- - - - - - - - - - ranking = 0.45454545454545keywords = fistula (Clic here for more details about this article) |
4/41. The management of the postoperative disrupted abdominal wall.BACKGROUND: Dehisced abdominal wounds are common. Their management is generally difficult and often prolonged, with incisional hernias a common occurrence. A new technique is presented that results in accelerated delayed primary healing with full thickness skin and subcutaneous tissue coverage. methods: The technique involves a combination of vigorous wound toilette, the judicious use of sutures and tissue expansion produced by the application of specially designed external tissue expanders. Gradual approximation of the wound edges is achieved and final suture allows closure by full thickness skin and subcutaneous tissue. RESULTS: Sixteen patients, 10 with one or more intestinal fistula, developed abdominal wall dehiscences. At discharge all wounds were closed, from 2 days in wounds averaging 12 x 5 cm to 18 days in a 29 x 24 cm wound. The follow-up, both in numbers and length, was limited for various reasons. CONCLUSIONS: The technique appears to be generally successful. The simplicity allows easy learning and may avoid a major operative procedure. Accelerated delayed primary closure by full thickness skin and subcutaneous tissue has considerable economic benefits for the patient and the health service.- - - - - - - - - - ranking = 0.090909090909091keywords = fistula (Clic here for more details about this article) |
5/41. Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo.OBJECTIVE: The purpose of this report was to illustrate how an unusual complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo (BPPV) may be recognized and prevented. recurrence of BPPV after occlusion surgery of the posterior semicircular canal has not previously been reported in the literature, to the authors' knowledge. Failure of occlusion not only permits the continued symptoms of BPPV but also burdens the patient with the additional morbidity of a fistula of the PSCC. The authors describe the successful treatment of a patient with recurrent and incapacitating BPPV after the failure of occlusion surgery of the posterior semicircular canal, when the patient was simultaneously crippled by the distressing morbidity of an iatrogenic fistula. DESIGN: Case report. SETTING: Tertiary care referral center. INTERVENTION: Surgical excision of the fistulous segment of the membranous posterior semicircular canal. OUTCOME MEASURES: The BPPV was resolved. The distressing symptom of a fistula was eliminated. hearing was preserved. CONCLUSION: Failure to completely occlude the posterior semicircular canal during posterior canal occlusion surgery results in recurrence of BPPV and an iatrogenic fistula, both of which are preventable. The occurrence of such an event is described, its management is outlined, and some thoughts are offered about its prevention.- - - - - - - - - - ranking = 0.36363636363636keywords = fistula (Clic here for more details about this article) |
6/41. 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.- - - - - - - - - - ranking = 0.090909090909091keywords = fistula (Clic here for more details about this article) |
7/41. Delayed intrathoracic rupture of herniated Nissen fundoplication: report of two cases.We report 2 patients who presented with rupture of a laparoscopic Nissen fundoplication in the left chest. These were successfully managed by closure of the perforation over a tube drainage that was brought under the diaphragm as a controlled fistula.- - - - - - - - - - ranking = 0.090909090909091keywords = fistula (Clic here for more details about this article) |
8/41. Accidental intrathecal mercury application.The authors present a case of accidental intrathecal mercury application. A 69-year-old white woman was admitted to our department with suspected meningitis following surgery for spinal stenosis at another hospital. Postoperatively, she had developed a cerebro-spinal fluid (CSF) fistula with a subcutaneous cavity. Local wound irritation had been suspected and, unfortunately, mercury-containing disinfectant was injected into the cavity. Within 24 h the patient demonstrated acute neurological deterioration due to meningitis and encephalitis and was admitted to our clinic with suspected meningitis due to postoperative CSF fistula. Lumbar puncture revealed desinfectant-stained, non-bloody CSF, while lumbar MRI demonstrated the large lumbar subcutaneous cavity. Additionally, CSF fistula was visualized on MRI. Laboratory examination revealed extremely high mercury levels in CSF, blood and urine. Treatment consisted in insertion of a lumbar drainage to wash out the mercury. The patient underwent medical detoxication using chelating agents (DMPS: RS-2,3-dimercapto-1-propansulfonacid, DMSA: meso-2,3-dimercaptosuccinatacid). Surgery was performed in order to close the cavity and the fistula. Postoperatively, the patient was admitted to the intensive care unit and remained intubated for 3 days. Within 4 weeks after surgery, she demonstrated good recovery. Eighteen months after intoxication, polyneuropathy and slight neuropsychological deficiencies were detectable.- - - - - - - - - - ranking = 0.36363636363636keywords = fistula (Clic here for more details about this article) |
9/41. bronchial fistula to the mediastinum in a heart-lung transplant patient.We present a case of heart-lung transplantation complicated by bronchial perforation as the cause or consequence of prolonged lung infection. Periodic bronchoscopic and radiological follow-up showed resolution of the condition following adequate antibiotic and physiotherapeutic treatment.- - - - - - - - - - ranking = 0.36363636363636keywords = fistula (Clic here for more details about this article) |
10/41. Neurosurgical reconstruction with acellular cadaveric dermal matrix.Acellular cadaveric dermal matrix (ACDM) is processed from human cadaver skin (AlloDerm; life Cell Corp., Branchburg, NJ). It does not require an immediate blood supply but can transmit essential interstitial fluids for nourishment of overlying tissues. A number of neurosurgical reconstructions have required the use of tissue that fills these specifications. The material has been used most recently for reconstruction of dura during craniotomies when primary closure is not possible or harvesting from an autologous site is not available. Because ACDM is harvested from nonneurologic cadaveric tissues and because the cellular and antigenic elements have been removed from the matrix, prion diseases are not a transmission risk. We present 6 examples of previously unreported uses of ACDM for successful repair of meningomyelocele, cauda equina, encephalocele, cerebrospinal fluid fistula, and neuroma. We propose the use of ACDM as a valuable tool in neurosurgical reconstruction.- - - - - - - - - - ranking = 0.090909090909091keywords = fistula (Clic here for more details about this article) |
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