11/235. Vesicouterine fistula: MRI diagnosis.A case of vesicouterine fistula in a young woman following caesarean section is presented. The diagnosis was established successfully using heavily T2-weighted MRI which clearly demonstrated fluid within the fistula, obviating the need for conventional radiographic contrast examination.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
12/235. Appendico-vesical fistula. A new case and a brief review of the literature.A new case of appendico-vesical fistula is submitted. After a brief review of the literature, it is concluded that these fistulas usually manifest themselves clinically in recurrent urinary infections without gastro-intestinal symptoms. The best aids in the difficult diagnosis are cystography and cystoscopy. Treatment is by appendectomy and excision of the fistular opening.- - - - - - - - - - ranking = 1.1730942937083keywords = fistula, urinary (Clic here for more details about this article) |
13/235. Vesicocervical fistula: an unusual presentation.A rare case is presented of vesicocervical fistula that occurred in a woman who sought help for continuous dribbling of urine for nine years. The aetiological implications of her obstetric history are discussed in the context of previous reports in the literature. The management and outcome of this case is discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = fistula (Clic here for more details about this article) |
14/235. Metabolic acidosis during urinary retention in a patient with an enterovesical fistula.We report a patient known to have an enterovesical fistula who presented severe acute metabolic acidosis during an episode of urinary retention. The enterovesical fistula which had been intermittently symptomatic for 4 years, had developed after several intestinal surgical procedures and related intraperitoneal sepsis following resection of colon cancer 21 years previously. The patient who had a total colectomy and ileostomy, was admitted for hip replacement with the routine placement of a Foley bladder catheter. Three weeks post-operatively, the patient developed acute urinary retention following removal of the urinary catheter. The output from his ileostomy was immediately markedly increased, presumably from bladder urine diverted into the intestines through the enterovesical fistula. Within a few days he presented a normal anion gap metabolic acidosis with raised urea and stable creatinine; his clinical status deteriorated markedly with profound obtundation. These metabolic abnormalities were readily corrected by re-insertion of the Foley catheter with restoration of normal urine flow and immediate corresponding fall in the ileostomy output. Radiographic studies showed the presence of the enterovesical fistula originating from the jejunum. This is the first report of acute metabolic acidosis in association with an enterovesical fistula; the severe metabolic disturbances were triggered by the development of urinary retention resulting in the diversion of urine into the small bowel through the fistula.- - - - - - - - - - ranking = 1.718087683keywords = fistula, urinary (Clic here for more details about this article) |
15/235. seminoma metastatic to the prostate resulting in a rectovesical fistula.We report an unusual presentation of metastatic seminoma within the prostate gland. Histological diagnosis was obtained using trans-rectal ultrasound guided prostatic biopsy. The patient developed a rectovesical fistula after ten weeks of chemotherapy, which healed following a complete radiological response to treatment- - - - - - - - - - ranking = 0.83333333333333keywords = fistula (Clic here for more details about this article) |
16/235. Ileovesical fistula. Failure of T.P.N. role of oral 14C PEG (polyethylene glycol) and charcoal in diagnosis.A patient with regional enteritis presenting with symptoms of fecaluria and pneumaturia is presented. Most of the established technics such as upper gastrointestinal series, cystography, cystoscopy and colonoscopy failed to demonstrate the fistula in this patient. 14C PEG as a nonabsorbable marker was given by mouth and a seven-fold increase in the counts at the fourth hour of urine collection confirmed the presence of an ileovesical fistula. This increase in counts was not seen when 14C PEG test was repeated after closure of this fistula surgically and was also not seen in a similar disease control patient and a healthy normal volunteer. Total parenteral nutrition with intralipids, Freamine II and glucose given in a peripheral vein for 45 days failed to close this fistula.- - - - - - - - - - ranking = 1.3333333333333keywords = fistula (Clic here for more details about this article) |
17/235. Crohn's disease with spontaneous ileoumbilical and ileovesical fistulae.A 17-year-old male with Crohn's disease involving the terminal ileum and cecum developed an umbilical fistula in the absence of previous surgery. While on intravenous hyperalimentation he developed an enterovesical fistula and was successfully treated by surgical resection. This combination of an enterovesical and umbilical fistula has not been previously reported. An aggressive approach to treatment is suggested.- - - - - - - - - - ranking = 1.1666666666667keywords = fistula (Clic here for more details about this article) |
18/235. Timing of surgery for enterovesical fistula in Crohn's disease: decision analysis using a time-dependent compartment model.OBJECTIVES: Previous decision analyses of inflam matory bowel diseases (IBD) have used decision trees and markov chains. Occasionally IBD patients present with medical problems that are difficult or even impossible to phrase in terms of such established decision tools. This article aims to introduce modeling by a time-dependent compartment mode and demonstrate its feasibility for decision analysis in IBD methods: A Crohn's disease patient presented with a pelvic abscess and an enterovesical fistula. Being hesitant to operate in an acutely inflamed area, the surgeon recommended that the patient continue antibiotic therapy until the abscess had re solved. The gastroenterologist argued that the patient had already been treated with antibiotics for a prolonged time period and expressed concern that the patient's overall diminished health status would deteriorate by further delay of surgery. The occurrence of fistula, abscess, urinary tract infection, antibiotic therapy, surgical operation, and health-related quality of life were modeled as separate compartments, with time-dependent relationships among them. The simulation was carried out on an Excel spreadsheet. RESULTS: In the model, the surgeon's predictions were associated with rapid resolution of the pelvic abscess under antibiotic therapy and improvement of the patient's health status. The gastroenterologist's predictions resulted in a smaller decline in abscess size and further deterioration of the patient's health while waiting for a definitive treatment. The disagreement between surgery and gastroenterology arose from predicting different time courses for the individual disease events, in essence, from assigning different time constants to the time-dependent influences of the disease model. CONCLUSIONS: The compartment model provides a simple and generally applicable method to assess time dependent-changes of a complex disease. The present analysis also serves to illustrate the usefulness of such models in simulating disease behavior.- - - - - - - - - - ranking = 1.0064276270417keywords = fistula, urinary (Clic here for more details about this article) |
19/235. Primary Epstein-Barr virus-associated hodgkin disease of the ileum complicating crohn disease.We describe a case of primary hodgkin disease of the terminal ileum in a 38-year-old man with crohn disease of 24 years' duration. The infiltrate was located in an ulcerated fistula involving the terminal ileum and urinary bladder. reed-sternberg cells and their variants were characteristically positive for CD15, fascin, and CD30 and showed focal positivity for CD20. Epstein-Barr virus messenger rna was also detected in the neoplastic cells. Staging revealed no evidence of other lymph node or organ involvement. Although rare, primary gastrointestinal hodgkin disease arising in the setting of crohn disease may have a stronger association with Epstein-Barr virus infection than conventional hodgkin disease.- - - - - - - - - - ranking = 0.17309429370834keywords = fistula, urinary (Clic here for more details about this article) |
20/235. Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interposition.The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180 degrees to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful.- - - - - - - - - - ranking = 1.5064276270417keywords = fistula, urinary (Clic here for more details about this article) |
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