Utero-cutaneous fistula following caesarean section.

A multiparous woman in her 20s, presented to the clinic with bleeding from caesarean scar site. After clinical examination and radiological evaluation with ultrasound and MR fistulogram, the diagnosis was utero-cutaneous fistula. Complete resection of fistulous tract with uterine defect closure and supportive omental patch placement was done after an intraoperative demonstration of the utero-cutaneous fistula by injecting methylene blue dye. Utero-cutaneous fistula is a rare complication after caesarean section. Cyclical bleeding from an abnormal opening in previous caesarean scar site is the classical presentation of this condition.

Videofluoroscopic swallowing study to detect pharyngeal leak after total (pharyngo-) laryngectomy: Retrospective assessment of a single-institution protocol.

BACKGROUND: We aimed to assess the effectiveness of a single-institution protocol of videofluoroscopic swallowing study (VFSS) for the detection of pharyngeal leak (PL) and its usefulness to mitigate evolution into subsequent pharyngocutaneous fistula (PCF) after total (pharyngo-) laryngectomy (TL). METHODS: This retrospective single-center study was conducted between February 2014 and December 2022. We included all patients who underwent TL and performed a VFSS between Day 7 and Day 14 postoperatively to detect a subclinical PL. RESULTS: Two-hundred and forty-eight patients met the inclusion criteria. Among the 186 patients (75%) with a negative VFSS, 11 patients (5.9%) developed a secondary PCF after oral intake resumption (false negative of VFSS). Among the 62 patients (25%) with a positive VFSS, the occurrence of a PCF was avoided in 59.7% of cases. CONCLUSION: This study showed a good effectiveness of VFSS in the detection of PL after TL, alongside a usefulness to mitigate evolution into subsequent PCF.

[Spontaneous cholecysto-cutaneous fistula: about two cases]. / Fístula colecisto-cutánea espontánea: a propósito de dos casos.

Cholecysto-cutaneous fistula (CCF) is a rare complication of untreated biliary pathology, with fewer than 100 cases documented in the literature. Most are secondary to bacterial infection, although it has also been described in gallbladder adenocarcinoma and post trauma. Its clinical presentation is variable, being able to present systemic affection, and its most frequent external drainage site is in the right hypochondrium. Due to the low incidence of this pathology, and the variety of forms of presentation, its management does not have, to date, standardized bases. We present two cases of patients who consulted in the emergency room at the Hospital Nacional de Clínicas for presenting cholecysto-cutaneous fistula. The treatment of both was surgical.

La fístula colecisto-cutáneas (FCC) es una rara complicación de la patología biliar no tratada, habiendo menos de 100 casos documentados en la literatura. La mayoría son secundarias a infección bacteriana, aunque también fue descripta en el adenocarcinoma de vesícula y posterior a traumatismo. Su presentación clínica es variable, pudiendo presentar afección sistémica, y su sitio más frecuente de drenaje externo es en hipocondrio derecho. Debido a la baja incidencia de esta afección, y a la variedad de formas de presentación, su manejo no tiene hasta el momento bases estandarizadas. Presentamos dos casos de pacientes que consultaron por guardia de urgencias en el Hospital Nacional de Clínicas por presentar fistula colecisto-cutánea. El tratamiento de ambos fue quirúrgico.

An unusual presentation of penetrating bladder injury with vesicocutaneous fistula: a case report.

BACKGROUND: Blunt trauma to the urinary bladder is common with penetrating injury being a rare occasion. Most common entry pint for penetrating injuries includes buttock, abdomen and perineum with thigh being rare. There are a number of complications that may develop as a result of penetrating injury with vesicocutanous fistula being a rare occurrence that usually presents with typical sign and symptoms. CASE PRESENTATION: We present a rare case of penetrating bladder injury through medial upper thigh as an entry point that had complicated into vesicocutaneous fistula with atypical presentation of long-standing pus discharge that had been managed by incision and drainage several times with no success. MRI demonstrated a presence of fistula tract and a foreign body (piece of wood) in-situ confirmed the diagnosis. CONCLUSION: Fistulas are a rare complication of bladder injuries and can cause negative impact on the quality of life of patients. Delayed urinary tract fistulations and secondary thigh abscesses are uncommon therefore a high index of suspicion is needed for early diagnosis. This case emphasizes the importance of radiological tests in aiding the diagnosis and ultimately proper management.

Delayed Pharyngocutaneous Fistula After Total Laryngectomy Caused by an Anterior Cervical Spine plate.

Pharyngocutaneous fistula (PCF) caused by a previous anterior cervical spine fixation plate more than a decade ago has not been reported yet. A 70-year-old man with dysphagia was diagnosed as supraglottic cancer. After partial laryngectomy and concurrent chemoradiation, due to increasing arytenoid lesion, total laryngectomy was followed. Pharyngocutaneous fistula occurred but resolved spontaneously. However, retropharyngeal granulation tissue emerging from the anterior cervical spine fixation plate caused delayed PCF. Dysphagia and PCF resolved after fixation plate removal.

Spontaneous cholecystocutaneous fistula secondary to xanthogranulomatous cholecystitis: a case report.

BACKGROUND: Xanthogranulomatous cholecystitis, a rare variant of cholecystitis, may infrequently be complicated by spontaneous cholecystocutaneous fistula. CASE PRESENTATION: We report the case of a 75-year-old Saudi Arabian man who presented with "a painful area of redness" (cellulitis) over his right upper abdomen. Abdominal computed tomography revealed multiple collections, which were drained surgically. A discharging sinus was identified, and a fistulogram revealed cholecystocutaneous fistula during his follow-up visit. The patient underwent laparoscopic management and recovered uneventfully. Final histopathological evaluation confirmed acute-on-chronic xanthogranulomatous cholecystitis . CONCLUSIONS: Although rare, surgeons should consider cholecystocutaneous fistula in the differential diagnosis of anterior abdominal wall abscesses, particularly in patients with concurrent or background symptoms of gallbladder disease. We report the first case of laparoscopic management for cholecystocutaneous fistula in Saudi Arabia.

Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population.

PURPOSE: Skeletal muscle mass (SMM) loss and sarcopenia have been identified as risk factors for postoperative complications. The aim of this study was to investigate the relationship between pharyngocutaneous fistula (PCF) formation after total laryngectomy (TL) and SMM assessed from a computed tomography image of the 3rd cervical vertebra (C3). METHODS: Retrospective study of 86 male patients who underwent TL between 2013 and 2019 in a single institution. We excluded women from the analysis due to our limited sample. SMM was determined from cross-sectional muscle area (CSMA) measurement at C3 using the ImageJ software. Results were compared with those for the skeletal muscle mass index (SMMI) calculated from the estimated measure at 3rd lumbar vertebra (L3). RESULTS: PCF formation occurred in 21/86 patients. According to the CSMA at a C3 cut-off of 35.5cm2, of 18 patients (20.9%) with low SMM, 9 developed PCFs (50.0%). Among patients with normal SMM (n = 68, 79.1%), 12 developed PCFs (17.6%). The CSMA at C3 was the only variable significantly associated with PCF risk, which was 4.7 times greater in patients with low SMM (p = 0.007). Sarcopenia was more frequent in underweight patients (p = 0.0001), patients undergoing extended surgeries (p = 0.003), or presenting preoperative anaemia (p = 0.009) or hypoalbuminemia (p = 0.027). CONCLUSION: Measuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.

Arterial calcification on preoperative computed tomography imaging as a risk factor for pharyngocutaneous fistula formation after total laryngectomy.

BACKGROUND: Research in esophageal surgery showed that computed tomography (CT) assessed arterial calcification (AC) is associated with postoperative complications. We investigated the association between AC and pharyngocutaneous fistula (PCF) formation after laryngectomy. METHODS: This was a retrospective cohort study of patients undergoing laryngectomy. AC was scored at 10 different anatomical locations on CT imaging, blinded for PCF occurrence. Association with PCF was investigated using logistic regression. RESULTS: The 224 patients were included; 62 (27.7%) developed a PCF. Moderate to severe AC was widespread in patients undergoing TL; 7.1% of patients had at most mild AC, of whom 1 experienced a PCF (p = 0.05). A higher cumulative calcification score was associated with PCF in univariable (OR 1.11, p = 0.04) and multivariable analysis (OR 1.14, p = 0.05). CONCLUSION: AC is widespread in patients undergoing laryngectomy and its burden is associated with PCF. Extensive AC on preoperative imaging may be considered a risk factor for PCF.

Ultrasound-guided autologous blood patch - A novel modality for broncho-pleural-cutaneous fistula closure.

We present a 36-year-old immuno-compromised male with non-resolving pneumonia, who developed a broncho-pleuro-cutaneous fistula following a thoracoscopic biopsy, which was successfully managed with an ultrasound-guided blood patch placed over the bronchial defect. We discuss the mechanism by which this is presumed to close a fistula, thus justifying it as a cost effective and minimally invasive modality of treatment.

Guided tour of hidden tracts in the pelvis: exploring pelvic fistulas.

BACKGROUND: Fistulas are an abnormal connection between two or more epithelial surfaces. When fistulization between adjacent structures occurs in the pelvis, there is almost invariably significant associated morbidity and impact on a patient's quality of life. Imaging may aid in the diagnosis of pelvic fistulas and is essential to identify any associated pathology, define the course of the fistula, and aid in pre-surgical planning. PURPOSE: This article aims to review the wide array of clinical and imaging presentations of fistulas in the pelvis, with a focus on the radiologists' role in managing this challenging entity. METHODS: This article will review each classification type of fistula. RESULTS: Pelvic fistula is a devastating condition that causes significant morbidity and evaluation can be challenging. CONCLUSIONS: Imaging, and particularly MRI, plays a vital role in the diagnosis, characterizing the course of a fistula and demonstrating associated complications, which are essential to guide treatment decisions.

Post-operative Recurrent Ascending Aortic Pseudoaneurysm with Aorto-cutaneous Fistula- Endovascular management with an In-situ Stent-Graft Fenestration for the Innominate Artery.

Ascending aortic pseudoaneurysm is a known complication of previous cardiac surgery that needs surgical or endovascular intervention. The presence of arch branches complicates the later approach necessitating additional procedures, either hybrid surgical or endovascular modification of the grafts. We describe a patient who developed an ascending aortic pseudoaneurysm after mitral valve replacement, which recurred after surgical patch closure with the formation of a cutaneous fistula. This high-risk patient was managed by an endovascular approach with in-situ fenestration for the innominate artery by a simple technique.

[Facial skin fistula as a postoperative complication of a mandibular guided bone regeneration]. / Fistule cutanée faciale consécutive à une régénération osseuse guidée mandibulaire.

Bone resorption is a consequence of the loss of a tooth. Alveolar ridge resorption can restrict the volume of bone available for the positioning of a dental implant. Bone graft is a routinely performed procedure in order to increase this volume and provide an adequate situation for the replacement of the tooth. However, autogenous bone is the gold standard for this procedure, xenogenous bone is a good alternative. It presents reliable results and a low complication rate. In this article, we describe the case of an infection resulting in a facial skin fistula following a guided bone regeneration. A 52-year-old woman visited a maxillofacial unit with complaints of persistent swelling of the right cheek, associated to a facial skin fistula. She had a history of xenograft with OsteoBiol Gen-os©, performed at a dental office nine months earlier. Clinical examination and computed tomography suggested that there was a migration process of the bone substitute inside the cheek, which had led to the infection with a facial skin fistula. Loss of stability of the bone graft and particular anatomy of the posterior region of the mandible could explain the migration of the particles and the formation of the fistula.

Unusual Left Periclavicular Cutaneous Lymphatic Fistula After Port Explantation Without Lymph Vessel Injury: Imaging and Interventional Treatment.

Complex oncological treatment can be associated with lymphatic vascular injury that is burdened by considerable morbidity. Lymphatic imaging and interventional techniques offer new minimally invasive treatment options. We report the case of a 59-year-old woman with an unusual lympho-veno-cutaneous fistula, diagnosed by magnetic resonance lymphangiography and treated by minimally invasive embolization therapy and venous recanalization.

Mistaken identity: an unexpected case of spontaneous cholecystocutaneous fistula formation.

We describe the case of a 78-year-old woman who presented to the emergency department with a 2-week history of a superficially developing mass in the lower right abdominal wall, fluctuant and non-tender with overlaying erythematous skin changes. Though resembling an abdominal wall abscess and initially listed for a simple incision and drainage, diagnostic uncertainty encouraged further investigation. CT and ultrasound confirmed the mass appeared to be in continuity with the gallbladder fossa, with the lumen also containing small bowel medially. While awaiting a multidisciplinary team discussion, the patient re-presented with concern over discharge appearing at the site of the mass. On inspection, we noted black flecks and small stones. This case describes the unusual and rare presentation of a cholecystocutaneous fistula. The patient was managed conservatively and remains clinically well.