ABSTRACT
Combined injuries of the aorta and inferior vena cava are rare. Mortality is over 70%, primarily from exsanguinating hemorrhage. Post-traumatic aortocava fistula can develop in survivors, who present in the postoperative period with manifestations of high output heart failure. This is a retrospective review of five male patients, age from 9 to 39 years, with aortocava fistulas that were referred with congestive heart failure, 2 days to 6 months after abdominal penetrating injuries. They had undergone surgery at another hospital and several organ injuries were treated. Retroperitoneal hematomas were not seen or were seen and left undisturbed. Four patients received a gunshot injury, had the fistula at the infrarenal level, and survived surgical repair. In one of the survivors, a left popliteal artery bullet embolism also occurred and was treated. Another patient sustained a thoracoabdominal stab injury and an aortocava fistula developed at the suprarenal level; he was in severe congestive heart failure and died during surgery. There are very few reports on this sequelae of vascular injuries at the abdominal level. Patients with aortic and cava injuries have a high mortality rate and arteriovenous fistula may develop with communicating pseudoaneurysms. If high output heart failure develops in a patient with a history of abdominal penetrating injury, an arteriovenous fistula must be suspected and arteriography will disclose the location of the fistula. Surgical treatment is necessary to prevent further heart damage. In the future endovascular procedures may have a role in the management of these difficult conditions.
Subject(s)
Aorta, Abdominal/injuries , Arteriovenous Fistula/surgery , Vena Cava, Inferior/injuries , Adolescent , Adult , Aorta, Abdominal/surgery , Aortic Rupture/complications , Arteriovenous Fistula/etiology , Arteriovenous Fistula/mortality , Child , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/surgery , Humans , Male , Retrospective Studies , Survival Analysis , Vascular Surgical Procedures , Vena Cava, Inferior/surgery , Wounds, Gunshot/complicationsABSTRACT
A 49 year-old woman underwent a palliative abdominoperineal resection because rectal adenocarcinoma that produced pain, bleeding and transanal tumor protrussion. Histologic studies showed and amelanotic melanoma. She died 3 months later. Any pigmented lesion in the anorectum must be excised to rule out melanoma. In some cases abdominoperineal resection may be done but as the majority of patients have metastases at the time of diagnosis, paliative wide local excision is the preferred treatment of this highly letal neoplasm.
Subject(s)
Melanoma/pathology , Rectal Neoplasms/pathology , Female , Humans , Middle AgedABSTRACT
Pancreatic abscess is a serious complication of acute pancreatitis and the best treatment is surgical drainage, even when morbidity and mortality are high. We present a patient with a pancreatic abscess after cholecystectomy and bile duct drainage because of cholelithiasis and pancreatitis. The abscess was manifested by a palpable painful mass in the epigastrium, fever, leukocytosis, and confirmed by ultrasound. Through a nasogastric tube we drained necrotic and purulent material with gradual and complete recovery. This is the first case in our hospital in which a pancreatic abscess drained spontaneously into the digestive tract without requiring external drainage.
Subject(s)
Abscess/complications , Pancreatic Diseases/complications , Abscess/diagnostic imaging , Abscess/therapy , Adult , Drainage , Female , Humans , Intubation, Gastrointestinal , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/therapy , RadiographySubject(s)
Hemangioma/epidemiology , Liver Neoplasms/epidemiology , Adult , Aged , Female , Hemangioma/diagnosis , Humans , Liver Neoplasms/diagnosis , Male , Mexico , Middle AgedSubject(s)
Esophagus/drug effects , Polyethylene Glycols/administration & dosage , Sclerosing Solutions/administration & dosage , Animals , Dogs , Esophageal and Gastric Varices/therapy , Esophagoscopy , Injections, Intravenous , Mucous Membrane/drug effects , Polidocanol , Polyethylene Glycols/toxicity , Sclerosing Solutions/toxicityABSTRACT
Una mujer de 41 anos de edad se presento al hospital con sangrado gastro-intestinal cronico y anemia severa. Por arteriografia se demostro una malformacion arterio-venosa (angiodisplasia) de la segunda porcion del duodeno y la cabeza del pancreas con llenado prematuro de la vena porta. En la intervencion quirurgica realizada se encontraron vasos anormales originados en la arteria pancreaticoduodenal y ademas en la cabeza del pancreas se encontro un tumor de 3 x 3 cm. Se realizo pancreatoduodenectomia. Histologicamente se confirmo la presencia de un carcinoide maligno del pancreas con metastasis regionales y multiples vasos anormales
Subject(s)
Adult , Humans , Female , Arteriovenous Malformations , Carcinoid Tumor , Neoplasm Metastasis , Pancreatic NeoplasmsABSTRACT
Con objeto de conocer los efectos sobre la pared esofagica del fleboesclerosante hidroxi-polietoxidodecano, se les inyecto a 10 perros, por via transendoscopica, 1 ml.de la substancia en la mucosa submucosa del esofago. Este fleoesclerosante a diferencia de otros tiene efecto trombogenico al ser aplicado en la luz de una vena o en el tejido perivenoso. Cuando la concentracion empleada es al 2 o 3% puede producir areas de inflamacion severa, isquemia o aun necrosis, por lo que se concluye que la inyeccion al 1% es la adecuada