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A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation - she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months' postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management
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Introduction: Meningioma is a benign and slowly-growing tumor that is responsible for 20% of brain neoplasms. It can be accompanied by some genetic disorders such as neurofibromatosis type 2 and is more common among women. As a space occupying lesion, it produces a wide range of signs and symptoms by compressing the adjacent and underlying tissues in the brain. Trauma and viruses are possible etiologies for meningioma. The ideal treatment of benign meningioma is surgical resection
Case Presentation: In this case report, we present a middle-aged man with a seeding metastasis of the cranial meningioma [after its removal] in the left thigh. During the removal operation, fascia lata had been used to repair the dura mater and the skin defect was repaired primarily
Conclusion: We believe that the occurrence of meningioma at the site of incision in the thigh is related to using the same surgical instruments for the removal of the brain tumor
Subject(s)
Humans , Male , Middle Aged , Meningeal Neoplasms , Neoplasm Seeding , ThighABSTRACT
Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients
Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications
Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain [84%] and dyspnea [53%]. Initially, chest radiographs were performed on all the patients and thoracotomy was performed to repair diaphragmatic tears in all the cases [100%]. In this study, 3 patients had previously undergone Hartmann's operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency [2 cases], and the mean length of hospital stay was 6 days [5-8 days] which was longer [1-2 months] in patients with gangrenous bowel [3 patients]. Furthermore, no mortality was reported during the course of hospitalization in these patients
Conclusion: According to the results of this study, patients presented with blunt or penetrating traumas to the upper abdomen or lower chest require urgent attention as to immediately rule out diaphragmatic hernia in order to prevent later complications and mortality and morbidity among these patients
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The emergent abdominal surgeries from either of traumatic or non traumatic causes can result in situations in which the abdominal wall cannot initially be closed. Many techniques have been reported for temporary coverage of the exposed viscera, but the result of various techniques remains unclear. During 94 months, 19 critically ill patients whit an open abdomen underwent surgery using plastic bags [Bogot? bag]. The study population comprised of 11 [57.9%] male and 8 [42.1%] female with an average age of 32.26+14.8 years. The main indications for temporary abdominal coverage were as follows: planned reoperation in 11 [57.9%] patients, subjective judgment that the fascia closure is too tight in 6 [31.6%] patient's damage control surgery in one patient [5.3%] and development of abdominal compartment surgery in one patient [5.3%]. Surgical conditions requiring temporary abdominal closure was severe post operative peritonitis in 9 [47.4%] patients, post operative intestinal fistula in 4 [21.1%] patients, post traumatic intra abdominal bleeding in 3 [15.8%] patients and intestinal obstructions in 3 [15.8%] patients. Length of hospitalization was 45+23.25 days and the mean total number of laparotomies was 6.2+3.75 times per patient. Three bowel fistulas occurred due to a missed injury at the time of initial operation that was discovered during changing the plastic sheet. They were unrelated to coverage technique. All of them were treated by repair of the defect and serosal patch by adjacent bowel loop. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. There were 4 [%21.1] early postoperative deaths that were not related to the abdominal coverage technique. Also, there were 5 [26.3%] late deaths that were due to dissemination of malignancy with a mean survival time of 20.8+13 [range 2-54] months. Currently 10 patients [52.6%] are alive at a follow up of 45 [range 1-94] months. Only one [10.0%] patient underwent definitive closure within 6 months of initial operation. The remaining survivor has declined to have hernia repaired. Bogot? bag technique is a rapid, simple and inexpensive technique for temporary abdominal coverage
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The postgastrectomy recurrence rate is as high as 30-65%, with 5-year overall survival rates of <20%. Local recurrence is very common which occurs in 38-45% of cases. The most common sites of locoregional recurrence are the gastric remnant at the anastomosis, the gastric bed, and the regional nodes. The recurrence may occur as early and late events after gastrectomy. Most recurrences are early, within three years of surgery. Numerous studies reported the late recurrences, but most of them having a survival time of less than ten years. This report elucidates a case of recurrent gastric cancer after 24 years postoperatively
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Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it
Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group
Results: In a retrospective cohort study 100 patients entered the study with 59 male and 41 female and with a mean age 54.6 +/- 6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique [P=0.182] so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique [P=0.03] so there was a significant difference between the two groups
Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis
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To describe the management of sigmoid volvulus with reference to the type of surgical procedures performed and to determine the prognosis of sigmoid volvulus. A case series. Ghaem Hospital of Mashhad, University of Medical Sciences, Mashhad, Iran, from 1996 to 2008. A total of 944 cases of colon obstruction were reviewed. Demographic, laboratory and treatment results, mortality and complications were recorded. The data was analyzed using descriptive statistics as frequency and percentage for the qualitative variables and mean and standard deviation values for the quantitative variables. Also chisquare and Fisher's exact test were used for the association between the qualitative variables. SPSS statistical software [version 18] was used for the data analysis. In all patients except those with symptoms or signs of gangrenous bowel, a long rectal tube was inserted via the rectosigmoidoscope which was successful in 80 [36.87%] cases. Rectosigmoidoscopic detorsion was unsuccessful in 137 [63.13%] patients, who underwent an emergent laparotomy. The surgical procedures performed in these cases were resection and primary anastomosis in 40 [29.1%], Mikulicz procedure in 9 [6.6%], laparotomy detorsion in 37 [27.01%], Hartmann procedure in 47 [34.3%], mesosigmoidoplasty in 3 [2.19%] patients and total colectomy in one [0.73%] case. The overall mortality was 9.8% [22] patients. In sigmoid volvulus, the most important determinant of patient outcome is bowel viability. The initial treatment of sigmoid colon volvulus is sigmoidoscopy with rectal tube placement
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Ventriculoperitoneal [VP] shunt placement that diverts the cerebrospinal fluid [CSF] into the peritoneal cavity is the most common method of treatment of hydrocephalus. This shunt has a high incidence of malfunction mainly due to catheter obstruction or infection. About 20% of these complications are abdominal that may occur at any time after shunt placement from 1 week to several years. This study reports a case of 2.5-year old child with a history of hydrocephalus who had a VP shunt placed which was protruded from the anus on the day of referral. The patient was treated successfully after extrusion of the shunt through the anus, receiving antibiotics and being carefully observed. He was discharged from the hospital after one week
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Papillary microcarcinoma of thyroid [PMC] as a variant of papillary carcinoma less than 1 cm in size is a new clinicopathological entity, with high incidence and good prognosis. There are many differences between PMC and clinically apparent papillary thyroid carcinoma. Also, there are some PMC case reports with unusual metastasis and aggressive courses. Prognostic factors are age, size and morphology of tumor, multifocality, cervical lymphadenopathy, etc. Here we report a case of unifocal PMC less than 0.4 mm in size in one lobe of thyroid in an elderly man which was discovered by thorough cutting of thyroid gland after detecting its large and cystic cervical metastasis