RESUMO
A patient with a fistula between the aortic graft and the third portion of the duodenum was admitted in our institution and submitted to surgery that involved extra anatomical axillobifemoral bypass, prosthesis removal and bowel resection with a gastrojejunal Roux anastomosis. A prosthetic fistula after aortic surgery is a rare but potentially fatal complication. Erosion, infection and pseudoaneurysm are mechanisms in the pathogenesis of aortoenteric fistula. Because of the high mortality and morbidity, associated with secondary aortoenteric fistula, surgical treatment is always recommended. A combination of endoscopy and CT or MRI may offer the best chance of detecting a fistula, but the most important tool to achieve diagnosis is clinical suspicion. An aortoenteric fistula should always be suspected in all patients who have undergone aortic graft surgery and present with gastrointestinal haemorrhage. The authors discuss the modern management of this challenging complication of aortic surgery.
Assuntos
Doenças da Aorta/etiologia , Implante de Prótese Vascular/efeitos adversos , Duodenopatias/etiologia , Fístula Intestinal/etiologia , Fístula Vascular/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Aorta Abdominal/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Artéria Femoral/cirurgia , Seguimentos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
A case is described of severe Nocardia farcinica infection which mimicked a pulmonary neoplasm with pneumonia, superior vena cava syndrome, pericarditis, and hypertrophic osteoarthropathy. Treatment with trimethoprim-sulphamethoxazole and surgery resulted in complete recovery.
Assuntos
Nocardiose/complicações , Pneumonia Bacteriana/microbiologia , Síndrome da Veia Cava Superior/microbiologia , Adulto , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Masculino , Nocardiose/diagnóstico por imagem , Osteoartropatia Hipertrófica Primária/diagnóstico por imagem , Osteoartropatia Hipertrófica Primária/microbiologia , Pericardite/diagnóstico por imagem , Pericardite/microbiologia , Pneumonia Bacteriana/diagnóstico por imagem , Radiografia , Síndrome da Veia Cava Superior/diagnóstico por imagemRESUMO
Primary mediastinal tumours (PMT) are rare, they include many different histological types, but lymphomas, thymomas and neurological tumours make up most of these tumours. Their symptomatology is often poor and they are in many cases discovered by routine thoracic radiography. Diagnosis mainly relies on medical imagery and on biopsy by mediastinoscopy or by CT-Scan controlled needle puncture. The treatment depends on the histological type (radiotherapy, chemotherapy, surgery). Median sternotomy is preferred to tackle anterior and middle mediastinum PMT, since it offers a large operative field and is more comfortable for the patient than classic thoracotomy, which will be reserved to tackle posterior mediastinum PMT.
Assuntos
Ganglioneuroma/diagnóstico por imagem , Linfoma de Células B/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Timoma/diagnóstico por imagem , Terapia Combinada , Diagnóstico Diferencial , Feminino , Ganglioneuroma/cirurgia , Humanos , Linfoma de Células B/terapia , Masculino , Neoplasias do Mediastino/terapia , Pessoa de Meia-Idade , Timoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The presence of hepatic portal vein gas is the consequence of invasion by anaerobic bacteria originating from an intestinal tract lesion. Although this phenomenon is rare, it may result from several common intestinal pathologies. The prognosis, despite intensive treatment, is often very poor. The authors report a case associated with bowel necrosis resulting from intestinal band.
