Cases reported "Wounds, Gunshot"

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1/189. Double layered autogenous vein graft patch reconstruction of the common carotid-internal jugular fistula caused by gunshot wound.

    Hereby we present a case with a common carotid-internal jugular fistula caused by gunshot wound. The patient was a 32-year old male who had an entrance hole of a bullet on his right anterior cervical area, at the C4 level with a hematoma surrounding it. The exit hole could be detected at the sublingual area. By palpation a thrill and on auscultation a souffle was noted. Neither crepitation, nor any neurologic deficit or any symptom of Horner's syndrome was present. The emergency digital subtraction angiography (DSA) showed a fistulisation to internal jugular vein (IJV) approximately 0.5 cm below the common carotid artery (CCA) bifurcation level. During the operation a hematoma and a false aneurysm was observed on the CCA. Also, proximally to the bifurcation, a communication of CCA with IJV was noted. The wall of the JJV was rather thinned and the size of the vessel had considerably enlarged. Following the evacuation of the hematoma and debridement, the integration of the artery was achieved by placing a double layered autogenous vein graft patch over the 0.5 x 1.5 cm defect. The 0.3 x 1.5 cm defect laterally over the IJV was primarily sutured. The patient was discharged on the fifth day. The control DSA taken on the twelfth day showed a perfect integration of the vessels. We considered the case noticeable due to its rather rare incidence and the double layered autogen vein patch graft reconstruction.
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ranking = 1
keywords = fistula
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2/189. Arteriointestinal fistula: report of a case following surgery for trauma.

    A case of an arteriointestinal fistula following surgery for trauma is reported. In prevention of this complication, it is suggested that temporary ileostomy and mucous fistula be considered in cases of combined right colon and intra-abdominal vascular injuries to eliminate a leaking bowel anastomosis as a source of contamination of the vascular repair.
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ranking = 1.2
keywords = fistula
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3/189. Carotid artery-sygmoid sinus fistula: a rare complication of gunshot wound on the base of the cranium.

    Vascular lesions without clinical manifestation may occur in cranial-facial wounds produced by bullets that course the base of the cranium. This work describes a rare kind of vascular complication in cranial-facial gunshot wound. The authors present the case of a patient, the victim of a cranium-maxillary gunshot wound. Carotid angiography revealed a carotid-sygmoid sinus fistula that filled the sygmoid and transverse sinuses, concomitant to the arterial angiographic phase. A direct communication between the external carotid artery and the sygmoid sinus was disclosed. We are not aware of any other description of this vascular complication in cranial gunshot wound. It is important to recognize this kind of complication in cases of cranial-facial gunshot wound, because new factors harmful to the brain perfusion systems are introduced, in addition to the alterations to venous return and intracranial pressure, caused by the primary trauma. The new non-invasive vascular diagnostic methods are proving useful in filling the gap left by arteriography, which is no longer used in these cases.
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keywords = fistula
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4/189. High-output heart failure resulting from a remote traumatic aorto-caval fistula: diagnosis by echocardiography.

    Congestive heart failure (CHF) due to high output states is known to occur in a variety of systemic illnesses and in patients with arterial-venous fistulas. This paper reports the case of a 45-year-old man admitted to the emergency room with a diagnosis of new onset atrial fibrillation and CHF, whose past medical history was not significant except for a gunshot wound to his abdomen 22 years previously. The etiology of his CHF together with the cardiomegaly and hyperdynamic left ventricular systolic function was unknown. A subcostal view routinely done during transthoracic echocardiography revealed a severely dilated inferior vena cava and the presence of an aorto-caval fistula by color doppler. The patient underwent successful corrective repair with dramatic improvement in symptoms and resolution of the atrial fibrillation, and cardiac size returned to normal. This rare case emphasizes that patients with refractory CHF must be closely examined with particular attention to palpation and auscultation over all scars, irrespective of the duration since any traumatic or surgical event.
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ranking = 1.2
keywords = fistula
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5/189. Fatal air embolism during thoracotomy for gunshot injury to the lung. Report of a case.

    Fatal coronary air embolism occurred during thoracotomy in a patient with a gunshot wound involving the hilum of the right lung. embolism was observed during a second period of failure of heart action. Evidently, air entered the pulmonary veins from the bronchus, which was receiving positive-pressure ventilation. The literature contains reports of only 3 similar cases, but we suspect that air embolism may be responsible for death and morbidity in additional cases in which accidental or iatrogenic lung trauma has produced a pathway between the bronchial tree and the pulmonary veins.
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ranking = 0.00020995046786152
keywords = dental
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6/189. Cranio-orbital missile wound and bullet migration. Case report.

    An unusual case of craniocerebral missile injury, with orbital roof perforation and spontaneous bullet migration into the maxillary sinus, is reported. emergency treatment consisted in wide craniectomy around the bullet entry point, blood and foreign bodies debridement. Subsequent procedures were necessary for abscess evacuation, transmaxillary bullet removal and later cranial vault reconstruction. Challenging aspects were the treatment of the infectious complications, following cerebrospinal fluid fistula through the wound, and the onset of post-traumatic epilepsy, scarcely responsive to common antiepileptic drugs. The treatment of the abscess by combined systemic and intracavitary antibiotic therapy and of the chronic seizures by progressive adjustment with new protocols of antiepileptic drugs under EEG and brain mapping revealed successful.
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ranking = 0.2
keywords = fistula
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7/189. Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent.

    We report the case of a 21-year-old male with high-output heart failure due to a femoral arteriovenous fistula caused by a firearm wound. A new balloon expandable stent covered with polytetrafluorethylene was implanted in the artery to occlude the arteriovenous fistula. The fistula was immediately occluded and the artery remained patent. On the following day, the patient felt much better, with no symptoms of heart failure. Additional follow-up is required to assure the usefulness of this less invasive procedure in the treatment of arteriovenous fistulas.
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ranking = 1.6
keywords = fistula
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8/189. Traumatic arterio-ureteral fistula: "hematuria" without urine.

    A case is presented in which a patient with a gunshot wound in the abdomen sustained a traumatic arterio-ureteral fistula with resultant continual output of bloody fluid from the urethral catheter in the absence of any real production of urine. It is important to recognize the possibility of false reassurance regarding the patient's general status by supposing fluid thus produced to be an indication of actual urine formation.
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ranking = 1
keywords = fistula
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9/189. Traumatic arteriovenous fistula of the kidney; an unusual cause of hypertensive encephalopathy.

    A patient with a traumatic arteriovenous fistula of the kidney developed encephalopathy with seizures and was unconscious for 48 hours before undergoing a left nephrectomy, excision of a false aneurysm of the left renal artery, and colostomy closure. He has remained in good health for two years following the final operative intervention.
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ranking = 1
keywords = fistula
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10/189. Penetrating neck trauma: hidden injuries-oesophagospinal traumatic fistula.

    Injuries to the eosophagus are notoriously difficult to diagnose pre-operatively. patients with such injuries usually will not have pre-operative signs and symptoms to suggest the presence of this type of injury. These injuries require a high index of suspicion, appreciation of the presence of injuries to adjacent structures, and an understanding that the clinical and radiological findings may evolve over a period of time. We describe a child with a rare presentation of an acute traumatic esophageal spinal fistula due to a bullet wound. This complicated injury required a variety of diagnostic modalities, including contrast radiography, multiple computerised tomography (CT) scans and operative assessments to make the definitive diagnosis.
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ranking = 1
keywords = fistula
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