Fistula of the mitral-aortic intervalvular fibrosa in a patient with bacterial endocarditis: a case report and systematic literature review.

BACKGROUND: A fistulous tract in the mitro-aortic intervalvular fibrosa (MAIVF) is a rare entity, which presents as a complication of endocarditis or surgical trauma. Generally, it is associated to a pseudoaneurysm of the MAIVF (p-MAIVF) or aortic abscesses. MAIVF fistulas could potentially lead to devastating complications and a high mortality rate. This condition is managed surgically, either by a percutaneous closure or an open surgical approach. Herein we report the complex case of a patient with a MAIVF fistula secondary to bacterial endocarditis. Further clinical deterioration was caused by severe aortic valve insufficiency and hemodynamic compromise, requiring surgical intervention. CASE PRESENTATION: A 74-year-old male patient was admitted to a primary care center with complaints of malaise, asthenia, adynamia, hyporexia, and lower limb edema over the past eight days. His past medical history is positive for arterial hypertension and being monorenal. A transesophageal echocardiogram (TEE) was performed, exhibiting a 56% left ventricle ejection fraction (LVEF) and complicated aortic valve endocarditis. Surgical management through an open approach included vegetation resection, valve replacement, and closure of the MAIVF fistula. After completing antibiotic therapy, the patient was discharged without complications. During postoperative follow-up, the patient remained asymptomatic, and the control echocardiogram showed no signs of MAIVF fistula.4. CONCLUSIONS: The clinical case of a patient with a MAIVF fistula secondary to endocarditis by Streptococcus Anginous was presented. The fistulous tract was not associated to p-MAIVF or aortic abscess, findings which further deteriorate the patient's condition and increase the likelihood of fatality. This case reinforces the importance of a prompt diagnosis through cardiac imaging and timely surgical closure of the defect.

Ventriculo-gallbladder shunt: case series and literature review.

BACKGROUND: The ventriculoperitoneal shunt (VPS) is the gold-standard surgical technique to treat hypertensive hydrocephalus; however, it may fail in 20 to 70% of cases. The present study shows an alternative for patients with contraindications to VPS. METHODS: A case series of nine patients. The medical records of all patients under 17 years of age who underwent ventriculo-gallbladder (VGB) shunt at a pediatric hospital from January 2014 to October 2022 were reviewed. RESULTS: There were 6 (66.7%) males and 3 (33.3%) females. The average age of 73.6 months or 6.1 years at the time of surgery. They had undergone, on average, 5.1 VPS reviews before the VGB shunt. Five (55.5%) had complications of VGB shunt: infection (11.1%), atony (11.1%), hypodrainage (11.1%), and ventriculoenteric fistula (22.2%); all these patients got better at surgical reapproach, and in two of them, the VGB shunt was re-implanted. CONCLUSION: This case series shows a lower risk of death and a similar risk of complications compared to other alternative shunts. This article spotlighted VGB as a viable alternative when VPS fails or has contraindications.

Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations.

Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.

Steroid Use in Palatoplasty: A Single Surgeon Comparative Retrospective Cohort Study.

BACKGROUND: Fistula rates in cleft palate repair vary by technique, surgeon, and institution. Although steroids are commonly used in airway surgery, many plastic surgeons are reluctant to use steroids because of concerns with wound healing. This study aims to assess outcomes and safety of steroid use in Furlow palatoplasty and determine its impact on fistula formation. METHODS: A retrospective cohort study was done of all cleft palate surgeries performed by a single surgeon between 2010 and 2014. Data reviewed included demographics, type of cleft, steroid use, length of surgery, length of stay, and fistula formation rate. RESULTS: One hundred thirty-five patients underwent palatoplasty, of which 101 received steroids and 34 did not. The mean age was 4.6 years. A total of 42.2% of patients underwent primary palatoplasty, 48.1% underwent submucous cleft palatoplasty, and 9.7% underwent conversion palatoplasty. The overall fistula rate was 1.5% and was comparable between the 2 groups (steroids = 2.0%, no steroids = 0.0%, P = 0.558), and all occurred in primary palatoplasty patients. The average length of stay in the hospital was shorter among patients receiving steroids (steroids = 2.0 days, no steroids = 2.5 days, P < 0.05). CONCLUSIONS: Steroid use in cleft palate surgery appears to be safe and likely not associated with impaired wound healing or increased fistula formation. It may also shorten length of hospitalization.

Fístula retroauricular complicada asociada a disgenesia mayor del oído externo. Reporte de un caso / Complicated retroauricular fistula with external ear major dysgenesis. A case report

Las anomalías de las hendiduras y arcos branquiales son la segunda causa más común de lesiones congénitas de cabeza y cuello en niños. Representan el 8% de todas las malformaciones congénitas y el 30% de las de cabeza y cuello. Pueden permanecer asintomáticas o manifestarse como una tumefacción y asociarse a infecciones recurrentes supuradas en la región preauricular, subauricular o retroauricular, en las regiones de la parótida y/o del cuello. Fueron reportados casos asociados a malformaciones óticas.La tomografía computada de alta resolución y la resonancia magnética con gadolinio pueden ayudar al diagnóstico. El tratamiento médico antibiótico está indicado ante una infección aguda, además de incisión y drenaje en los procesos abscedados. El tratamiento definitivo es quirúrgico con la extirpación completa de la lesión. Se presenta a un niño de 6 años de edad con infección aguda en la región retroauricular derecha en el oído disgenésico

Branchial cleft anomalies are the second most common congenital head and neck lesions in children. The first congenital head and neck lesion is thyroglossal duct cysts. First branchial cleft anomalies are rare congenital head and neck malformations (8% of branchial cleft anomalies).The initial clinical manifestation was recurrent infections and/or discharge in auricular, periauricular, parotid or upper neck regions. These anomalies are extremely rare and other associated facial malformations were described.The computed tomography and magnetic resonance can help the diagnosis. The antibiotic treatment is indicated in acute infection. Also, incision and drainage are recommended in abscessed processes.In this report, we present a case of retroauricular sinus infection in a 6-year-old child with congenital ear anomalies

Fístula perilinfática de causa traumática. Reporte de un caso pediátrico / Traumatic perilymphatic fistula. Report of a pediatric case

La fístula perilinfática de causa traumática es una patología poco habitual. En general, es causada por lápices, hisopos, hebillas de pelo y fósforos.Dentro de los síntomas más frecuentes, los pacientes pueden presentar hipoacusia y vértigo. Su diagnóstico requiere un examen físico completo que incluya otomicroscopía, audiometría ytomografía computada de ambos peñascos. El tratamiento depende de la sintomatología del paciente. En general, en un principio, es conservador, pero puede llegar a requerir cirugía. Se presenta un caso clínico de un niño de 6 años con fístula perilinfática secundaria a un traumatismo del oído izquierdo por un hisopo, que requirió tratamiento quirúrgico

Traumatic perilymphatic fistula is an unusual pathology. Generally caused by pencils, swabs, hair buckles, and matches. Among the most frequent symptoms, patients can present hearing loss and vertigo.Diagnosis requires a complete physical examination that includes otomicroscopy, audiometry and computed tomography of both boulders. Treatment depends on the patient's symptoms. In general, it is conservative at first, but may require surgery.We present a clinical case of a 6-year-old boy with perilymphatic fistula secondary to left ear trauma due to swab, which required surgical treatment

Fístula utero-yeyunal secundaria a migración de dispositivo intrauterino: reporte de un caso / Utero-jejunal fistula secondary to intrauterine device migration: a case report

RESUMEN El dispositivo intrauterino (DIU) es un método anticonceptivo muy popular, eficaz y seguro. Aunque posee complicaciones bien descritas como es la migración, la que puede ser a otros órganos dentro de la cavidad peritoneal. La fístula uteroyeyunal es un evento clínico poco frecuente, pero de gran repercusión si no es diagnosticada y tratada. Se presenta el caso de una paciente usuaria de DIU, el que migra a cavidad abdominal, con posterior formación de fístula uteroyeyunal.

ABSTRACT The intrauterine device is a popular, efficient and safe contraceptive. Although it has some well described complications, such as migration, which may be to the different organs inside of the peritoneal cavity. The uterus-jejunal fistula is a rare clinical event, but with great repercussion if it is not well assessed and treated properly. We present the clinical case of a patient with a migrated intrauterine device and a fistula uterus-jejunal formation.

Caracterización de los pacientes con fístulas arterio-venosas para hemodiálisis / Description of patients with arterio-venous fistulas for haemodialysis

Introducción: La fístula arterio-venosa para hemodiálisis es el acceso vascular utilizado con mayor frecuencia. De su adecuada funcionalidad depende la calidad de vida de los pacientes con enfermedad renal crónica. Objetivo: Caracterizar a los pacientes a los que se les confeccionó fístulas arterio-venosas para hemodiálisis. Métodos: Se realizó un estudio descriptivo retrospectivo en 73 pacientes, a los que se les confeccionó una fístula arterio-venosa para hemodiálisis. Las variables de estudio fueron: edad, sexo, tipo de fístula arterio-venosa, localización, complicaciones y tratamiento quirúrgico de las complicaciones. Resultados: Se encontró un predominio del sexo masculino y del grupo etario entre 51 y 60 años. El 94,6 por ciento de las fístulas realizadas fueron autólogas; y, de estas, el 44,1 por ciento, radio-cefálicas. El 27,3 por ciento de las autólogas y el 20 por ciento de las protésicas se presentó trombosis, y el 18,2 por ciento y el 40 por ciento presentaron hipertensión venosa para las autólogas y protésicas, respectivamente. El 43,5 por ciento de los tratamientos realizados frente a las complicaciones resultó la confección de una nueva fístula. Conclusiones: Los pacientes a los que se les confeccionó fístulas arterio-venosas eran predominantemente adultos mayores del sexo masculino y las fístulas más realizadas fueron las autólogas radio-cefálicas. Como principal complicación de las fístulas se encontró la trombosis y se realizaron escasos procederes para el rescate de estas(AU)

Introduction: Arterio-venous fistula for haemodialysis is the most commonly used vascular access. Its proper functionality depends on the quality of life of patients with chronic kidney disease. Objective: Describe patients to whom were made arterio-venous fistulas for haemodialysis. Methods: A retrospective descriptive study was conducted in 73 patients to whom were made an arterio-venous fistula for haemodialysis. The study variables were: age, sex, type of arterio-venous fistula, location, complications and surgical treatment of complications. Results: It was found a predominance of male sex and the age group of 51 to 60 years. 94.6 percent of the fistulas made were autologous; and, of these, 44.1 percent were radio-cephalic. 27.3 percent of the autologous fistulas and 20 percent of the prosthetics ones developed thrombosis, and 18.2 percent and 40 percent showed venous hypertension for autologous and prosthetic fistulas, respectively. 43.5 percent of the treatments performed to face complications resulted in the making of a new fistula. Conclusions: The patients to whom were made arterio-venous fistulas were predominantly older adults of the male sex and the most performed fistulas were the radio-cephalic autologous. As the main complication of fistulas, thrombosis was found and a few practices were performed to rescue them(AU)

Fístula aorto-ileal primaria / Primary Aortoenteric Fistulas

RESUMEN Introducción: Las fístulas aorto-entéricas son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Objetivo: Presentar el caso de una hemorragia digestiva por una fístula Aortoentérica diagnosticada y tratada. Presentación del caso: Se reporta el caso de un hombre de 72 años intervenido con el diagnóstico hemorragia digestiva masiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio, sin observar dilatación aneurismática, pero si una aorta ateromatosa y un proceso inflamatorio hacia la fístula. Se realizó reparación quirúrgica urgente con reparación cara anterior aorta infrarrenal cercana a la bifurcación y resección del íleo terminal con ileoascendentostomía termino-lateral. Discusión: Las fístulas aorto-entéricas es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación. Conclusiones: La fístula aorto-entérica primaria es una causa poco frecuente de hemorragia digestiva, que todo médico y cirujano debe tener en cuenta frente a un paciente con sangrado digestivo de causa no precisada(AU)

ABSTRACT Introduction: Aortoenteric fistulas are a rare cause of gastrointestinal bleeding. The generally ominous prognosis depends on high clinical suspicion and timely diagnosis. Objective: To present a case of gastrointestinal hemorrhage for aortoenteric fistula diagnosed and treated. Case presentation: The case is reported of a 72-year-old man who received surgery after the diagnosis of massive gastrointestinal bleeding during the preoperative period. However, the diagnosis of the fistula was made intraoperatively, without observing aneurysmal dilation, but an atheromatous aorta and an inflammatory process leading to the fistula instead. Urgent surgical repair was performed with repair of anterior infrarenal aorta near the bifurcation and resection of the terminal ileum with end-to-side ascending ileostomy. Discussion: Aortoenteric fistulas are a potentially fatal cause for gastrointestinal bleeding. Diagnosis continues to be a challenge due to its nonspecific presentation and should always be considered for any case of unexplained gastrointestinal bleeding. There are several options for surgical management that must be analyzed case by case, without delaying repair. Conclusions: Primary aortoenteric fistula is a rare cause for gastrointestinal bleeding, which every doctor and surgeon must take into account when dealing with a patient with digestive bleeding of an unspecified cause(AU)

Rare presentation occult lateral frontal rhinosinusitis with eyelid fistula, ectropion and lagophthalmos. A case report.

We report an unusual case of a 53-year-old male with fistula, ectropion and lagophthalmos due to lateral frontal rhinosinusitis. Two years ago, he presented soft erythematous swelling at internal epicanthus. A year and a half before, he presented upper eyelid fistula secretion drainage, cicatricial ectropion and lagophthalmos. No otorhinolaryngological or visual discomfort was reported. Ophthalmology performed ectropion surgical repair using skin grafting, with no improvement. They requested magnetic resonance imaging which showed a suggestive image of frontal lateral sinusitis, being transferred to the Otorhinolaryngology service. External and endoscopic nasal surgery was performed, which resolved the sinus pathology with good evolution.

Se informa un inusual caso de un varón de 53 años, con fístula, ectropión y lagoftalmos derecho debido a rinosinusitis crónica frontal lateral. Dos años antes presentó tumefacción blanda y eritematosa en el epicanto interno. Un año y medio antes tuvo drenaje de secreción por fístula en el párpado superior, ectropión cicatrizal superomedial y lagoftamos ipsilateral, sin molestias otorrinolaringológicas ni alteración visual. El Servicio de Oftalmología realizó reparación quirúrgica mediante injerto de piel, sin mostrar mejoría, por lo que se solicitó resonancia magnética, que evidenció imagen indicativa de sinusitis frontal lateral derecha y fue transferido al Servicio de Otorrinolaringología. Se practicó una cirugía externa y endoscópica, que resolvió la afección sinusal, con buena evolución.

Percutaneous Image-Guided Abdominal Interventions for Leaks and Fistulas Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass.

BACKGROUND: Bariatric surgery offers the only effective long-term weight loss therapy for morbidly obese patients. Numerous studies have demonstrated a mortality and morbidity reduction associated with weight loss surgery, but these interventions also have significant rates of complications. It is important for the bariatric surgeons to recognize these complications and acknowledge which of them can be solved in a minimally invasive manner in order to offer to patients the best treatment. The aim of this article was to review factors and success rates associated with percutaneous image guide abdominal interventions to treat the complications of bariatric surgery. MATERIALS AND METHODS: Retrospective descriptive study. Eighty-two patients with complications after bariatric surgery were included. Of these, 56 presented fistula with or without abdominal collection. RESULTS: Of the total patients, 54% are male and 46% female. The average age was 49.4 (range 16-62). Of the 56 cases, 37 (66.1%) occurred after laparoscopic sleeve gastrectomy, and 19 (33.9%) post-Roux-en-Y gastric bypass. The fistula was resolved by percutaneous image guide abdominal interventions in 49 opportunities, of which 67% required only conservative treatment afterwards, the remaining 33% required endoscopic treatment with prostheses, fibrin sealants, and/or clips. No mortality was reported in the series. CONCLUSION: Percutaneous image-guided abdominal interventions play a significant role in the treatment of complications following bariatric surgery. The minimally invasive treatment of fistula after bariatric surgery is safe and effective.

Endoscopic closure of gastrointestinal perforations and fistulas using the Ovesco Over-The-Scope Clip system at a tertiary care hospital center. / Cierre endoscópico de perforaciones y fístulas del tracto digestivo mediante el sistema «Over-the scope clip¼ (Ovesco), en un centro terciario.

INTRODUCTION AND AIM: Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS: A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS: The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS: The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.