Cholecystoduodenal fistula with subsequent gallstone ileus: case report of an unusual course

Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality because of the advanced age of the patients and the often delayed diagnosis. Signs of a cholecystoduodenal fistula are often absent in conventional ultrasonic and radiological methods. Treatment options are: 1. Enterolithotomy, 2. One stage procedure or 3. Two stage procedure consisting of enterolithotomy and the surgery of the biliary tract. In the case of our patient we performed a conventional cholecystectomy and the closure of the cholecystoduodenal fistula, which was found accidentally. When the gallstone ileus appeared 6 days later the enterolithotomy was performed. Thus in case of accidentally found cholecystoduodenal fistula an exploration of the abdominal cavity and the small intestine to find the gallstone should be performed on principle. Gallstones with a diameter of more than 2-3 cm should be removed by enterolithotomy to prevent the gallstone ileus.     

Diagnosis of gallstone ileus

Gallstone ileus is a rare disorder, which, because it is often misdiagnosed preoperatively, may become life-threatening. The classic triad of Rigler (aerobilia, small bowel ileus and a calcified, dystopic stone) is visualized on abdominal plain films in only 14-35% of cases. Further work-up includes ultrasound, upper gastrointestinal series with water soluble contrast medium and computed tomography (CT). CT is especially reliable in demonstrating all three criteria.     

An unusual case of esophageal atresia and double distal tracheoesophageal fistula

This report describes a neonate with a very rare and an unusual variety of esophageal atresia and tracheoesophageal fistula. The anomaly consisted of esophageal atresia and double distal tracheoesophageal fistula. The two fistulae as well as part of the distal esophagus were made up of tracheobronchial tissues. The embryology of the anomaly is also discussed.     

An autopsy case of severe tuberculosis associated with anal fistula and intestinal perforation

A 55 year-old man was admitted to the department of the gastroenterology of the hospital because of severe weakness and appetite loss for the past one month. In the last two months, he has been suffering from recurrent fistula of the anus. He left his symptoms without therapy. A gastric ulcer was found out with gastric endoscopy. At the same time, chest X-ray film showed bilateral abnormal shadows, which were suspected of severe pulmonary tuberculosis by a chest physician. After the admission, the patient immediately developed respiratory failure. Both sputa and discharge from anal fistula were positive for acid fast bacillus. Despite of anti-tuberculosis therapy and mechanical ventilation, he died of respiratory failure. At the autopsy, severe pulmonary tuberculosis, tuberculous fistula of the anus, intestinal tuberculosis with perforation, miliary tuberculosis and peptic ulcer of the stomach were defined. We suspected that the extensive disease caused by hematogeneous spread and the late diagnosis of tuberculosis was owing to patient's delay.     

A case of a urachal fistula

The authors report a case of urachal fistula diagnosed after repeated omphalitis, this disease was associated with coronal hypospadias. Diagnosis was done thanks to a fistulography; subsequently, during the operation, to evidence the fistula, this was injected with methylene blue, this expedient showed that the fistula was longer than that disclosed from fistulography. To carry out a complete extirpation of the fistula the authors were bound to make a cystotomy. The course after operation was good and the patient discharged after a few days. After 5 years the patient is in perfect health. This case allowed some anatomic, clinical and semeiotic considerations.     

A case of anastomotic aneurysm-enteric fistula

Reimplantation failure of avulsed anterior teeth in an adolescent patient requires removal of the attempted-reimplanted teeth and consideration of several restorative options. These options may include a removable partial denture, as well as a transitional bridge or permanent fixed prosthesis. In all cases, the potential effects of the adolescent's expected amount and directions of maxillary and mandibular growth must be considered. A case is presented examining how maxillary growth may affect the restorative treatment options for avulsed anterior teeth replacement for an adolescent boy. Unfortunately, the patient and family were unable to complete treatment due to financial considerations. Consequently, the case presented here is submitted as a treatment planning exercise.     

Postoperative hyperperfusion in dural arteriovenous fistula associated with venous ischemia: case report

BACKGROUND: It is well known that carotid endarterectomy and extracranial-intracranial arterial bypass sometimes cause postoperative hyperperfusion, and vasoparalysis attributable to long-standing ischemia has been suggested as the cause. It is also well known that dural arteriovenous fistula (AVF) sometimes causes cerebral ischemia attributable to venous hypertension. However, there are few reports regarding the postoperative changes of regional cerebral blood flow (rCBF). METHODS: We report a case of dural AVF of the left transverse/sigmoid sinuses, occurring in a 64-year-old man. Intraoperative transvenous embolization combined with transarterial embolization was performed, and the rCBF was measured pre- and postoperatively using 99mTc-hexamethyl-propylene amine oxime and single-photon emission computed tomography (SPECT). RESULTS: Preoperative SPECT disclosed a marked rCBF reduction in the left temporal, parietal, and occipital lobes. Complete obliteration of the AVF was attained after the intraoperative transvenous embolization, without any neurological deterioration. However, postoperative SPECT demonstrated temporary hyperperfusion in these regions. CONCLUSIONS: Sudden resolution of venous ischemia can lead to postoperative hyperperfusion, and pre- and post-treatment rCBF studies are important to prevent complications related to hyperperfusion.     

Reno-colo-cutaneous fistula. A case report

Reno-colo-cutaneous fistula due to genito-urinary tuberculosis is extremely rare. We describe one such case which was successfully managed by single stage surgery (nephroureterectomy, fistulectomy and primary repair of colon) and anti-tubercular treatment.     

A rare case of a preauricular fistula

A female patient with a preotic fistula caused by a defect in the development of the first branchial arch is described. Repeated surgeries for lateral fistula of the neck brought no success. The pathogenesis of the defect and difficulties in its diagnosis are discussed; the authors claim that fistulography with contrast agents may be effective. Histologic verification is needed in all the cases.     

A retroperitoneal abscess with cutaneous fistula developed after stercoral fistula operation: a case report

Sparing treatment of chronic purulent sinusitis in children is an urgent problem of rhinology. Usage of preparations of donor (parental, of the same group) autoleukomass and blood plasm which possess all the components of humoral and cellular immunity proved highly effective against chronic purulent sinusitis in children. The drawback of this method is the necessity of regular lavage of the sinuses after insertion of the leukomass and heparinized plasm. The use of donor serum (parental, of the same group) also produced a good effect in purulent sinusitis. The serum advantage over the leukomass or plasm is that it can be left in the sinuses until the next procedure.     

A case of spontaneous aorto-caval fistula demonstrated with spiral computerized tomography

A primitive neuroectodermal tumor (PNET) is very rare and the prognosis of this tumor is poor. A 32-year-old woman complaining of dysphagia and back pain was admitted to our hospital for the posterior mediastinal tumor. The tumor originated from the muscle layer of esophagus and en bloc resection of the tumor combined with the affected part of esophagus was performed. Histopathological diagnosis of the resected tumor was PNET. She received adjuvant chemotherapy. Eight months after the surgery, recurrent tumors in the right mediastinum and the retrooperitoneal space was resected completely. But after the second surgery, dissemination occurred recurrently. These recurrent tumors revealed high sensitivity for radio-therapy. However, she died of rapid recurrence 22 months after the first surgery. In Japan, our case is the second case of PNET in the posterior mediastinum and the first case of PNET arising from the muscle layer of esophagus.     

Congenital broncho-oesophageal fistula. A case report

A case of broncho-oesophageal fistula causing bronchiectasis of the left lung is reported. Oesophagorespiratory fistulas without atresia of the oesophagus often have an insidious clinical course and most commonly present in adulthood. This rare congenital anomaly should be considered as a cause of chronic pulmonary sepsis. The clinical, radiographic and therapeutic features of this lesion are discussed.     

A case of migraine with aura associated with meningioma

We reported a case of migraine with aura associated with meningioma. A 66-year-old female visited to our department in 1985, with occipital throbbing pain following visual hallucination and nausea. She had been diagnosed as migraine. CT scan, magnetic resonance image and angiography showed a right occipital tumor, which was totally removed in 1990. Postoperatively, the migraine disappeared completely. The tumor was histologically diagnosed as fibroblastic meningioma. We supposed that the migraine had been associated with meningioma. Although some previous papers reported correlation with brain tumor and migraine, as example of arteriovenous malformation or angioma, migraine associated with meningioma is very rare. In arteriovenous malformation, pathophysiology of migraine is unclear, but induction of circulatory disturbance in the distribution of the posterior cerebral, posterior communicating and basilar artery is supposed. And then a space occupying lesion in the occipital lobe is possible to cause in the circulatory disturbance of the posterior cerebral and basilar artery. In the diagnosis of migraine, we should consider its relation to brain tumors, such as meningioma.