RESUMO
This report presents the case of the emergency repair of a radiation-induced aortoesophageal fistula (AEF) with an endograft. The patient presented with multiple episodes of upper gastrointestinal bleeding. The fistula was discovered and treated in the operating room. The placement of a temporary aortic endograft was successful. The patient unfortunately exsanguinated while awaiting definitive aortic and esophageal repair. The potential occurrence of AEF should be considered in any patient presenting with massive hematemesis without a clear source of the bleeding. Although the patient succumbed to the fistula, this case illustrates the cryptic nature of an AEF and the difficult issues that are inherent in its treatment.
Assuntos
Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Fístula Esofágica/cirurgia , Lesões por Radiação/cirurgia , Fístula Vascular/cirurgia , Doenças da Aorta/etiologia , Emergências , Procedimentos Endovasculares , Fístula Esofágica/etiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Vascular/etiologiaRESUMO
BACKGROUND & OBJECTIVES: Sensitivity of Ziehl-Neelsen (ZN) method is known to be low for liquefied sputum smears. Information on the ZN sensitivity for centrifuged deposit smears is not known. This study was carried out to determine the sensitivity of ZN method for acid fast bacilli (AFB) in centrifuged deposit smears and liquefied sputum smears made from sputum samples transported in cetyl-pyridinium chloride (CPC) solution. METHODS: Liquefied sputum smears and the corresponding centrifuged deposit smears from each of the 607 consecutive sputum samples collected from tuberculosis patients admitted to receive treatment transported in CPC were read by the same readers and their results compared with culture results. RESULTS: A significantly (P<0.001) higher proportion of samples were positive in centrifuged deposit smears (40%) compared to liquefied sputum smears (30%). The results of 341 culture-positive specimens revealed that the sensitivity of ZN method was 47 per cent using liquefied sputum smears and 63 per cent using centrifuged deposit smears (P<0.001). INTERPRETATION & CONCLUSION: Our study demonstrated that the sensitivity of ZN method for AFB in centrifuged deposit smears and liquefied sputum smears was reduced if sputum samples are transported in CPC solution.