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In a patient with a penetrating lesion of the right orbit with proptosis and a bruit in this region, carotid angiography revealed an ophthalmic fistula between the ophthalmic artery and the superior ophthalmic vein. Three days after admission, the symptoms disappeared, and repeat angiography showed the spontaneous thrombosis of the fistula.
A 46-year-old woman was admitted to the hospital because of dyspnea and palpitation. Physical examination showed severe anemia and cardiac distress. Telangiectases were found in the conjunctivas, lips and oral mucosa. Chest roentogenogram showed an enlarged cardiac silhoutte and multiple coin lesions in both lower lung fields. We diagnosed her as Rendu-Osler-Weber disease (ROW). The angiographic studies showed hemangioma in the foramen of Monro, bilateral multiple pulmonary arteriovenous fistulas, and hepatic arteriovenous fistula with a large distortion of the proper hepatic artery. Although associated vascular dysplasias have been described in patients with ROW, there is no reports on ROW in which multiple vascular abnormalities concomitantly existed such as the present case. In 163 detailed cases of ROW in Japan, the frequency of vascular lesions was summarized, and this result showed that the vascular lesions of the lung were more frequent than that of the liver or brain, in comparison with countries in Europe and America. It is very important for diagnosis and its prognosis to perform a detailed angiographic examinations and to demonstrate the precise sites of the vascular dysplasias in patients with ROW.
We report a case of a patient who developed a remote dural arteriovenous fistula involving the left sigmoid sinus 4 months after successful transarterial embolization of a carotid cavernous fistula. This rare occurrence has been reported after transvenous embolization, but this represents the first case, to our knowledge, after transarterial coil embolization. We present our findings along with a brief review of the literature.
The authors report a rare case of iatrogenous arteriovenous fistula between left gastric artery and vein, arising after gastric resection. The observation caused a reviewing of the literature (19 cases published, of which only one between left gastric artery and vein) and some remarks about the physiopathology, pathological anatomy, clinics and treatment of such rare diseases. The authors, in their conclusions, emphasize that such arteriovenous fistulas can remain asymptomatic for a long time; they, moreover, with evident effects on the liver physiology, can progressively cause a serious state of portal hypertension, in the genesis of which the time-factor plays a primary role.
Acute traumatic arteriovenous fistulas in major abdominal vessels are relatively rare. They are often difficult to detect without arteriography in a patient with multiple injuries, without a nonexpanding hematoma. To the authors' knowledge this is the first report of an acute traumatic iliac-vena caval fistula. The value of arteriography in diagnosis and the need for early recognition and operation of these lesions are stressed. Definitive arterial and venous reconstruction should be performed whenever feasible.
The authors present the case of a 30-year-old woman admitted to hospital for investigation of a systolodiastolic murmur. Assessment revealed a fistula between the trunk of the left coronary artery and the pulmonary artery, with an aneurysm on the left anterior descending artery (LAD), associated with an intercoronary anastomosis between the left conus artery and the LAD. Thallium myocardial scintigraphy demonstrated reversible decreased uptake in the anterolateroapical region. Simple coronaro-pulmonary fistulas are a rare disease. The positive diagnosis is suggested by echocardiography and confirmed by coronary angiography. The clinical course is generally favourable, except in the presence of complications such as aneurysm, heart failure or coronary insufficiency. This case raises the difficult problem of the operative indication in these young, usually asymptomatic patients.
Conventional surgery of the first branchial cleft fistula has been highly complicated. Especially the management of the facial nerve and the complete removal of the fistula in the ear canal side were very difficult. According to the anatomical and embryological studies, we designed a new operative technique. We applied this method successfully in two cases, and we consider it to be very safe, easy and effective.
This study shows that arteriovenous fistulas created for vascular access to hemodialysis result in an increase in cardiac output and pulse rate, and a decrease in the total peripheral resistance. These changes are severe with bovine graft fistula; physicians should be aware of this potentially dangerous hemodynamic change in these patients.
The authors present four cases of internal biliary fistulae (IBF) identified on hepatobiliary scintigraphy. All of the cases share common history of external biliary leak closure. Scintigraphy in all four cases showed a similar pattern of direct visualization of transverse colon without any significant small bowel activity. This suggests an increased frequency of IBF formation in cases with external fistulous tract closure. Retrospectively, it appears that spontaneous closure of external leak may be pathological consequence of formation of IBF involving hepatic flexure.
The authors report a new case of isolated spontaneous nephrocutaneous fistula revealed by a persisting draining sinus in the left groin. Their present causative factors are identified. The computed tomography and magnetic resonance imaging actually may resolve the diagnostic dilemma and are helpful in the surgical treatment.
Twelve (12) cases of urethral reconstruction from the anterior bladder wall combined with primary urethropexy to achieve total continence in 67% circumferential fistulae in women is presented. These operations were performed transvaginally and the technique is described.
External biliary fistula (BF) or ileal bypass (IB) was performed in dogs at the time of or 2 weeks after portacaval shunt (PCS). The pathologic changes in the dog livers 2 to 4 weeks later were compared to those caused by PCS alone. Histopathologic differences between PCS alone vs. PCS plus BF or IB could not be found. Thus, the experiments did not confirm recent observations by others in rats that BF prevents or reverses the hepatic injury of PCS. As estimated by plasma mevalonic acid determinations, the increase in hepatic cholesterol synthesis that is characteristic after BF or IB was suppressed in animals with PCS. BF and IB reduced but did not eliminate the postprandial elevation in serum bile acid that occurs after PCS. The findings have possible relevance in planning the treatment of patients with familial hypercholesterolemia with the combined use of PCS and IB.
Nissen fundoplication results in closure of the tracheoesophageal fistula (TEF) without the necessity for a thoracic operation by preventing both the reflux of gastric contents into the lungs through the distal TEF, and leakage of air into the stomach of less than 30 cm H2O intrapulmonary pressure. This procedure can safely be used even for a poor-risk patient and adequate nutritional support (full-strength milk) can be provided immediately after the fundoplication by a gastrostomy tube because the gastric contents cannot reflux into the lungs. This procedure was performed on two patients with esophageal atresia and distal TEF in Waterston Group C and gave successful results.
BACKGROUND: Endovascular therapy for dural arteriovenous fistulas (DAVFs) is not without any risks, although it has been generally accepted to be a safe procedure. In this paper, we report a very rare complication: metachronous DAVF around a jugular valve 4 months after transvenous embolization. CASE DESCRIPTION: A 43-year-old woman presented with left proptosis, chemosis, and double vision. Cerebral angiography demonstrated a left cavernous DAVF. The patient's symptoms resolved almost completely after embolization with platinum coils via the superior ophthalmic vein. Four months later, angiography revealed a metachronous DAVF around a jugular valve. CONCLUSION: To our knowledge, only four such cases have been reported in the literature. Careful follow-up of patients treated with transvenous embolization and accumulation of such cases are needed to understand the pathogenesis of multiple DAVFs.
BACKGROUND: To determine guidelines for the management of perineal small bowel fistula (PSF) after total or posterior pelvic exenteration. METHODS: During 15 years, 315 curative pelvic exenterations were performed. PSF occurred in 15 patients (3.5%). We retrieved the precise modality of radiotherapy (fields and doses) and management of all patients (type of surgery, number of surgery and mortality). Delay of occurrence was divided in early (within 30 days or before hospital discharge) and delayed. RESULTS: All patients underwent surgery. Mortality rate was 13%. Fourteen patients (93%) had history of radiotherapy. No PSF was noted after anterior pelvic exenteration. Higher frequency of PSF was noted after total pelvic exenteration versus posterior pelvic exenteration (P = 0.04). Early PSF occurred in four patients (27%) with higher frequency of small bowel intraoperative injury. Late PSF occurred in 11 patients (73%) divided in small bowel injury in contact with pelvic staples (n = 4) and disease recurrence (n = 6, local recurrence or carcinomatosis). One patient had delayed PSF by ulceration of small bowel in contact with pelvic drain. CONCLUSION: PSF was a life-threatening complication of pelvic exenteration. Radiotherapy leads to weaken small bowel with difficulty of cicatrisation. During pelvic exenteration: (a) extreme careful dissection and interposition of great omentum could avoid small bowel injury, (b) control of pelvic vessels and closure of rectum remnant should not used staplers. Intraoperative management of PSF used successful simple repair in case of early PSF or segmentary resection indeed enlarged to right colon in case of delayed PSF. Postoperative courses had to use intravenous hyperalimentation and digestive tract discharge.
Removal of thrombus from a totally occluded internal carotid artery with a patent siphon by means of a balloon-tipped Fogarty catheter has been an acceptable technique. There have, however, been five reported cases of carotid-cavernous fistula following this procedure (Barker et al., 1968; Davie and Richardson, 1967; Motarjeme and Keifer, 1973; Newton and Potts, 1974). The purpose of this report is to add a sixth case to the literature and to suggest that this surgical method be abandoned.
The sites of fistulas and patterns of venous drainage in 34 consecutive cases of dural AVFs manifesting symptoms suggesting CCFs were retrospectively analyzed to determine the frequency of dural AVFs in sites other than the cavernous sinus and to ascertain their causative mechanisms. In five cases (15%), dural AVFs were demonstrated in sites other than the cavernous sinus. Among four, retrograde venous flow due to occlusion of the outflow tract or a rapid-flow shunt resulted in filling of the superior ophthalmic vein. A rapid-flow dural AVF in the anterior cranial fossa showed no occlusive changes in the sinuses, and increased pressure in the cavernous sinus was thought to be responsible for the symptoms. Embolization was effective for relief of the symptoms. Symptoms mimicking CCFs can be seen in dural AVFs in sites other than the cavernous sinus with retrograde venous drainage or with a rapid-flow shunt, conditions which are not as rare as previously believed.
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