Reconstrucción poscirugía de Hartmann / Stoma reversal after the Hartmann's procedure

RESUMEN Antecedentes: la reconstrucciónn del tránsito intestinal luego de una operación de Hartmann es un procedimiento habitualmente complejo y con alta morbilidad. Objetivo: analizar la tasa de reconstrucción después de la cirugía de Hartmann y resultados posoperatorios en nuestra experiencia. Material y métodos: análisis retrospectivo de pacientes a los que se les practicó la reconstrucción del tránsito intestinal posterior a una cirugía de Hartmann en un período 16 años. Revisamos la bibliografía y nuestra base de datos. Luego traspasamos la información disponible a una grilla de datos construida con variables habitualmente analizadas en la literatura. Finalmente, analizamos los resultados mediante medidas básicas de tendencia central. Resultados: en 16 años realizamos 92 operaciones de Hartmann, de las cuales 69 (75%) llegaron a la reconstrucción. Edad promedio: 58 años. El 52% de los pacientes fueron hombres. La operación de Hartmann fue de urgencia en el 48% y 58% resultaron malignas. Tiempo transcurrido hasta la reconstrucción: en promedio, 9 meses, y el 90% (N 62) de los casos se realizó por vía laparoscópica. Morbilidad general 38% y ajustada a los grados III y IV de Clavien-Dindo fue 11,5%. No hubo mortalidad. Conclusión: los resultados obtenidos son semejantes a los publicados y nuestra experiencia nos motiva a continuar eligiendo el abordaje laparoscópico.

ABSTRACT Background: Background: Stoma reversal after Hartman's operation is usually a complex procedure and is associated high morbidity. Objective: To analyze the rate of reversal after the Hartmann's procedure and the postoperative outcomes in our experience. Material and methods: We conducted a retrospective analysis of patients undergoing reversal after the Hartmann's procedure over a 16-year period with review of the literature and of our database and transferred the available information to a data grid constructed with variables commonly analyzed in the literature. Finally, we analyzed the results using basic measures of central tendency. Results: Over a 16-year period, we performed 92 Hartmann's operations; 69 (75%) reached the reversal stage. Mean age was 58 years and 52% were men. Forty-eight percent of the Hartmann's procedures were emergency surgeries and 58% were due to cancer. Mean time to reversal was 9 months and 90% (n = 62) were laparoscopic procedures. Overall morbidity and adjusted for complications grade III and IV of the Clavien-Dindo classification were 38% and 11.5%, respectively. None of the patients died. Conclusion: The results obtained are similar to those published and our experience motivates us to continue choosing the laparoscopic approach.

Trastorno grave del medio interno por fístula enterovesical, a propósito de un caso clínico / Severe metabolic disorder associated with an enterovesical fistula: report of one case

Enterovesical fistula (EVF) is a fistulous communication between the intestine and the bladder. It is uncommon and its classic clinical manifestations are the presence of pneumaturia, fecaluria, suprapubic pain and recurrent urinary infections. Surgical repair of EVF leads to rapid correction of both diarrhea and metabolic abnormalities. We report a 73-year-old diabetic woman with a neurogenic bladder secondary to a spine meningioma. She presented with diarrhea, vomiting, impaired consciousness and metabolic acidosis. She developed hypernatremia, hypokalemia, hypocalcemia, and hypophosphatemia, which were successfully corrected.

Fístula colovesical de origen diverticular. Resolución laparoscópica con nuevo recurso técnico / Diverticular colovesical fistulae. Laparoscopic tip

Introducción: La enfermedad diverticular de colon es una patología de alta prevalencia en nuestro medio. Su presentación inicial como fístulas no complicadas no es frecuente sin antecedentes de episodios de diverticulitis previa. Objetivos: Presentar detalles técnicos de la cirugía de resección y tratamiento laparoscópico de una fistula colovesical de origen diverticular. Materiales y métodos: Se presenta el caso de un paciente varón de 63 años con dolor en hipogastrio sin alteraciones evacuatorias ni cirugías previas. Sin antecedentes de diverticulitis. Se realizó ecografía abdominal y tomografía computada donde se constata aire en vejiga. El urocultivo es positivo para escherichia coli y el colon por enema detecta pequeño trayecto fistuloso entre colon sigmoides y vejiga. Se decide resección laparoscópica. Resultados: Se realizó una colectomía sigmoidea laparoscópica con identificación de trayecto fistuloso a la vejiga que se aisló y seccionó entre clips de polímero. Se completó con anastomosis primara colorrectal y sondaje vesical prolongado que se retiró a los 15 días. Los parámetros postoperatorios fueron favorables con egreso a las 72 hs. Conclusión: La fístula colovesical es una complicación de la enfermedad diverticular de colon aunque es rara su debut como forma de presentación sin episodios de diverticulitis previa. Se destaca su identificación como trayecto único y no hemos encontrado mención al respecto en la bibliografía. Su resolución de ligadura entre clips es una opción terapéutica efectiva y rápida para su resolución definitiva. El abordaje laparoscópico electivo es de elección y su tratamiento mediante el procedimiento propuesto resultó efectivo y seguro.

Background: Diverticular disease is a high prevalent colonic pathology. Initial presentation as complicated disease includes fistulas, perforation and bleeding. Objetive: To present technical surgical aspects of surgical treatment of laporoscopic resection of colovesical fistula after diverticular disease. Methods: A 63 years old patient presented with low abdominal pain and no transit symptoms. There was no previous surgery and diverticulitis episode. Abdominal ultrasound and CT scan showed air in the bladder. Urine culture was positive to Escherichia coli. Colonic barium x-rays showed a colovesical fistula. Laparoscopic resection was decided as treatment of choice. Results: Laparoscopic sigmoid colectomy, aisolation of fistula tract and posterior clips ligation and section. Primary mecanic anastomosis and 15 days vesical catheter completed the treatment. Postoperative evolution was satisfactory. Conclusions: Colovesical fistula is a frequent complication of complicated diverticular disease, however its debut without previous episodes is rare. The colonic fistula presented as unique tract is unfrequent. Resolution by polimer clips and section associated with colonic resection by laparoscopic is a good option to avoid bladder sutures. This procedure resulted safe and effective.

Live fetus inside the urinary bladder: a case report / Feto vivo dentro da bexiga urinária: relato de caso

ABSTRACT Vesicouterine fistula is a rare condition. Its incidence, however, has been increasing due to the higher incidence of cesarean sections. The presence of a live fetus inside the bladder who passed through a vesicouterine fistula is an extremely rare situation. We report a case of woman who underwent two previous cesarean sections, was referred to a hospital due to mild pelvic pain and genital bleeding. At the moment, physical examination was normal. Ultrasound scan revealed a gestational sac inserted into the anterior wall of the uterus, with a living fetus of approximately 13 weeks, with active body movement and normal heart rate inside it. The fetal abdomen, around the waist, was stuck at the opening of a vesicouterine fistula, so that the fetal head and trunk were entirely into the bladder cavity, while lower limbs remained at the uterine cavity. Laparotomy was performed, the fistulous tract was excised, the fetus (without heart beating) was removed on opening the bladder, and the uterine cavity was emptied. The defects in the bladder and uterus were repaired. The postoperative period was uneventful. A live fetus inside the urinary bladder is a rare condition the continuation of pregnancy is unlikely and the vesicouterine correction can be made by the time of surgical intervention.

RESUMO A fístula vesicouterina é uma condição rara. Sua incidência, no entanto, vem aumentando, devido à maior incidência de cesáreas. A presença de feto vivo dentro da bexiga por meio de uma fístula vesicouterina constutui situação extremamente rara. Relatamos o caso de uma mulher com duas cesarianas anteriores encaminhada para o hospital devido à dor pélvica leve e sangramento genital. Na hospitalização, o exame físico estava normal. A ultrassonografia revelou saco gestacional inserido na parede anterior do útero com feto vivo de aproximadamente 13 semanas, com movimento corporal ativo e frequência cardíaca normal. O abdômen fetal, ao redor da cintura, estava preso na abertura de uma fístula vesicouterina de modo que a cabeça e o tronco fetais estavam totalmente dentro da cavidade da bexiga, enquanto os membros inferiores permaneciam na cavidade uterina. A laparotomia foi realizada, o trajeto fistuloso foi excisado, o feto (que estava sem batimento cardíaco) foi removido ao abrir a bexiga, sendo a cavidade uterina esvaziada. Além disso, foram reparados os defeitos na bexiga e no útero. O pós-operatório transcorreu sem intercorrências. Feto vivo dentro da bexiga é uma condição rara, e a continuidade da gravidez é improvável, sendo que a correção vesicouterina pode ser feita no momento da intervenção cirúrgica.

Vesicouterine fistula (Youssef syndrome): case report and literature review / Fístula vesico-uterina (síndrome de Youssef): descrição de caso e revisão da literatura

Abstract Objective To describe a case of vesicouterine fistula and to review the literature related to this condition. Methods For the review, we accessed the MEDLINE, BIREME and LILACS databases; the references of the searched articles were also reviewed. Results A 38-year-old woman, in the 1st day after her 3rd cesarean, presented heavy hematuria, which was considered secondary to a difficult dissection of the bladder. A total of 6 months after delivery, she failed to resume her regular menstrual cycles and presented cyclic menouria and amenorrhea. At this time, she had two episodes of urethral obstruction by blood clots. She remained without a correct diagnosis until about two years postdelivery, when a vesicouterine fistula was confirmed through cystoscopy. A surgical correction through open abdominal route, coupled with hysterectomy, was performed. After the surgery, the symptoms disappeared. The review showed a tendency of change in the relative frequency of the different types of genitourinary fistulae. Vesicovaginal fistulae, usually caused by inadequate care during labor, are becoming less frequent than those secondary tomedical procedures, such as vesicouterine fistulae. The most common cause of this latter kind of fistula is cesarean section, especially repeated cesarean sections. The diagnosis is confirmed through one or more imaging exams, or through cystoscopy. The most common treatment is surgical, and the routes are: open abdominal, laparoscopic, vaginal or robotic. There are some reports of success with the conservative treatment. Conclusion Vesicouterine fistulae are becoming more common because of the increase in the performance of cesarean sections, and the condition must be considered a possible complication thereof.

Resumo Objetivo Apresentar um caso de fístula vesico-uterina e realizar revisão da literatura sobre esta condição. Métodos Revisão realizada consultando-se as bases MEDLINE, BIREME e LILACS, além das referências dos artigos consultados. Resultados Uma mulher de 38 anos, após sua terceira cesárea, no puerpério imediato, apresentou hematúria importante, que foi atribuída a uma dificuldade na dissecção da bexiga durante o procedimento. Seis meses pós-parto, emvez de retomar os ciclos menstruais regulares, apresentou menúria cíclica e amenorreia (síndrome de Youssef). A paciente chegou a apresentar obstrução uretral por coágulos, e permaneceu sem diagnóstico correto até cerca de anos pós-parto, quando este foi feito por cistoscopia. Ela foi então submetida a correção cirúrgica por via abdominal, associada a uma histerectomia, com desaparecimento dos sintomas. A revisão mostrou que tem havido mudança na frequência dos vários tipos de fístulas urogenitais. As fístulas vesicovaginais, normalmente secundárias à má assistência durante o parto, têm sido mais raras, enquanto aquelas secundárias a procedimentos médicos, como as vesicouterinas, têm sido mais frequentes. A causa mais comum deste tipo de fístula é a cesárea, especialmente a de repetição. A apresentação pode ser de amenorreia e menúria e/ou perda urinária. O diagnóstico é feito por um ou maismétodos de imagem ou cistoscopia. O tratamento mais comum é cirúrgico, por via abdominal aberta, laparoscópica, transvaginal ou robótica. Existem relatos de cura com tratamento conservador. Conclusão As fístulas vesicouterinas têm sido mais comuns devido ao aumento da proporção de cesáreas. Deve-se ter em mente a possibilidade deste diagnóstico e considerá-las uma das possíveis complicações da cesárea.

Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach

ABSTRACT Purpose: Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. Materials and Methods: We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. Results: The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. Conclusions: This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.

Fístula colovesical secundaria a enfermedad diverticular: cirugía laparoscópica electiva / Colovesical fistula: laparoscopic surgery

Aim: Colovesical fistula is a severe complication associated to neoplastic or inflammatory colon disease. Most common procedure is open surgery. We report a case of colovesical fistula secondary to diverticular disease treated with a laparoscopic approach. Methods: A 64-year-old man was seen with a known colonic diverticular disease, type 2 diabetes mellitus and recurrent urinary tract infection. He complained of lower abdominal pain, dysuria, and pneumaturia. A CT scan revealed a sigmoid diverticular perforation into the bladder (colovesical fistula). A left hemicolectomy with partial cystectomy was performed by laparoscopy means. Results: There was no morbidity related to the surgical procedure, and the final pathology confirmed a colonic diverticular disease with bladder compromise. The patient is asymptomatic at 24 months of follow up. Conclusion: The laparoscopic approach is a feasible alternative for the treatment of colovesical fistula with low morbidity.

Objetivos: La fístula colovesical es una complicación relacionada con procesos inflamatorios y neoplá-sicos del colon. El manejo tradicional de esta patología es quirúrgico bajo técnica abierta. Presentamos un caso de fístula colovesical secundaria a enfermedad diverticular con tratamiento quirúrgico laparoscópico. Materiales y Métodos: Paciente masculino de 64 años de edad, portador de enfermedad diverticular de larga data con antecedente de diabetes mellitus tipo 2 e infecciones urinarias a repetición, quien consulta por presentar dolor en hipogastrio, disuria y neumaturia. Se realiza tomografía computada que revela perforación diverticular de colon sigmoides a vejiga (fístula colovesical). Se realizó hemicolectomía izquierda más cistectomía parcial, con resección del trayecto fistuloso, y cierre vesical y anastomosis colónica laparoscópica. Resultados: No hubo complicaciones intra ni postoperatorias. El estudio anatomopatológico de la pieza operatoria demostró enfermedad diverticular. El paciente se encuentra asintomático a los 24 meses de seguimiento. Conclusión: El abordaje laparoscópico es una alternativa factible para el tratamiento de fístula colovesical, con baja morbilidad.

Fístula colovesical de origen diverticular / Results of surgical treatment of colovesical fistulas of diverticular origin

Background: The main causes of colovesical fistulas are diverticular disease of the colon and colon carcinoma. Aim: To analyze the results of the surgical treatment of colovesical fistulas of diverticular origin. Material and Methods: Retrospective analysis of all patients operated for a colovesical fistula of diverticular origin. Results: From 141 patients subjected to a colon excision for diverticular disease, 18 had a colovesical fistula. The latter, compared to patients without fistulas were male in a higher proportion, were younger and had more concomitant diseases. Pneumaturia was reported in 83 percent and urine fecal soiling in 56 percent. In two thirds of patients, the fistula appeared in the absence of a diverticular crisis. Abdominal CAT sean demonstrated the fistula in 80 percent of cases. It was complemented with barium enema and cystoscopy. Excision with immediate anastomosis was the surgical procedure used in 94 percent of patients, without sequelae or relapse, after a mean follow up of 74 months. No patient died during the procedure or required a new intervention. Conclusions: Colovesical fistulas are most common in young men with associated diseases and their treatment of choice, with good long-term results, is primary excision.

Antecedentes: El objetivo de este estudio es analizar los resultados del tratamiento quirúrgico de la Fístula Coló Vesical (FCV) de origen diverticular, los que se comparan con la enfermedad diverticular no fistulizada. Pacientes y Método: Análisis retrospectivo de todos los pacientes intervenidos por una FCV de origen diverticular en forma consecutiva. Resultados: De un total de 141 pacientes resecados por una enfermedad diverticular del colon sigmoides, la indicación quirúrgica en 27 (19,3 por ciento) fue la presencia de una fístula, de las cuales 18 corresponden a una FCV. El grupo con FCV tiene predominio de hombres (p = 0,0001), más joven (p = 0,027) y con mayor incidencia de enfermedades asociadas (p = 0,0001). La neumaturia se presentó en el 83 por ciento y la fecaluria en el 56 por ciento. En dos tercios de los casos la FCV se estableció en ausencia de una crisis diverticular previa. El estudio más relevante para demostrar la presencia de una FCV fue la tomografía computada (80 por ciento), que se complementa con el enema balitado y la cistoscopia. La resección con anastomosis inmediata, más simple sutura de la vejiga fue el procedimiento empleado en el 94 por ciento de los pacientes, sin secuelas ni casos de recidiva, con un seguimiento global promedio de 74,2 meses (extremos 12-158). No hubo reoperaciones ni mortalidad operatoria. Conclusiones: la FCV de origen diverticular es una condición patológica poco frecuente que afecta a pacientes varones en la séptima década de la vida, con múltiples enfermedades asociadas y que frecuentemente se instala en forma silenciosa. La resección primaria es el tratamiento de elección con buenos resultados a largo plazo.

Laparoscopic Treatment of Appendicovesical Fistula

A 23-year-old man had a history of intermittent episodes of urinary tract infection with associated low abdominal pain for 15 years. Persistent bacteriuria even with prolonged antibiotics was the reason why he was referred to our hospital. Laboratory tests were normal except pyuria and growth of Escherichia coli in the urinary samples. Cystoscopy revealed a small slit-like opening on the right lateral wall of bladder dome. We found some air within the bladder and a suspicious communicating tract between the appendix and bladder on a CT scan. With a strong impression of appendicovesical fistula, a laparoscopy was performed to confirm a diagnosis and to remove the appendicovesical fistula resulting in a satisfactory result without any complication.

Cistectomía y derivación urinaria: ¿es la operación de Bricker aún una opción válida? / Cystectomy and urinary diversion: is bricker ileal conduit a valid option?

Introducción: Existen múltiples razones por las cuales se hace necesario realizar una cistectomía radical, aunque claramente la principal es indiscutidamente el cáncer vesical. El conducto ileal u operación de Bricker ha sido, tradicionalmente, la forma más utilizada de derivación urinaria supravesical. A través de múltiples publicaciones se conocen las limitaciones y complicaciones de esta cirugía, principalmente en el largo plazo. Material y métodos: El presente estudio presenta una revisión retrospectiva de los pacientes sometidos a cistectomía y reemplazo vesical, en el Hospital Militar de Santiago, entre los años 1982 y 2008. De estos reemplazos vesicales, 23 fueron operaciones de Bricker, 4 operaciones de Studer y 1 Indiana. Se detallan las complicaciones precoces y tardías ocurridas durante el tiempo de seguimiento. Resultados: En términos generales, la serie muestra que la operación de Bricker tiene una tasa de complicaciones precoces de un 26 por ciento y de complicaciones tardías de un 17,4 por ciento. Conclusión: Consideramos que la operación de Bricker constituye una adecuada alternativa de derivación urinaria, con un índice de complicaciones aceptable en el largo plazo.

Introduction: Currently, radical cystectomies are perfomed for many reasons, but bladder cancer is still considered to be the most important one. The ileal conduit or Bricker’s diversion is the most common supravesical urinary diversion technique. Limitations and long term complications of this surgical technique are well known. Material and Methods: In this study we present a retrospective review of patients submitted to radical cystectomy and bladder replacement at the “Hospital Militar de Santiago” between 1982 and 2008. Of 28 cystectomies, 23 ileal conduits, 4 Studer procedures and 1 Indiana procedure were performed. Perioperative and long term complications are described. Results: The study shows that Bricker’s procedure has an early complication rate of 26 percent and a late complication rate of 17.4 percent. Conclusions: This study shows that ileal conduit seems to be a good alternative of urinary diversion, with an acceptable rate of short and long term complications.

Fístulas colovesicales: análisis de 7 casos / Colovesical fistula: report of 7 cases

Introducción: La fístula colovesical es una comunicación anormal entre vejiga e intestino grueso. Generalmente es secundaria a una enfermedad inflamatoria o neoplásica representando un desafío tanto diagnóstico como terapéutico. Material y método: Se revisaron en forma retrospectiva los pacientes intervenidos con el diagnóstico de fístula colovesical entre agosto de 1991 y mayo de 2006, registrando su distribución por sexo, edad, etiología, sintomatología, exámenes complementarios y tratamiento quirúrgico. Todos los pacientes se estudiaron mediante tomografía axial computada (TAC), cistoscopia y enema baritado. Resultados: Se revisaron 7 pacientes, hombre/mujer 4/3, con edad promedio de 60 años (rango 42-82). En 5 pacientes (71,5 por ciento) la fístula fue secundaria a una enfermedad diverticular complicada y en 2 casos (28,5 por ciento) a neoplasia de colon. La fecaluria y la neumaturia fueron los principales motivos de consulta. En 2 casos (28,5 por ciento) el motivo de consulta fue dolor pélvico, y 2 pacientes (28,5 por ciento) consultaron por infecciones urinarias. La cistoscopia mostró el orificio fistuloso en 4 de 7 pacientes (57,1 por ciento). El enema baritado mostró la fístula en 4 de7 casos (57,1 por ciento). La TAC fue diagnosticada en 5 de 7 casos(71,4 por ciento). En los 7 casos se efectuó una hemicolectomía izquierda más cistectomía parcial. El promedio de días de hospitalización fue de 9,7 días (rango 7-12) y no se registraron complicaciones posoperatorias ni mortalidad. Conclusiones: La fístula colovesical es una patología poco frecuente. Su principal etiología es la enfermedad diverticular complicada. Fecaluria y neumaturia son signos patognomónicos. La TAC es el examen diagnóstico de elección. El tratamiento es quirúrgico, y en la actualidad se recomienda la reparación en un tiempo operatorio.

Introduction: Colovesical fistula is an abnormal comunication between the bladder and the colon. Usually it is associated with inflammatory or neoplasic disease and its management remains a challenge Material and methods: Patients with colovesical fistula that underwent repair between 1991 and 2006 were analyzed. Age, sex, etiology, clinical and imaging findings were reviewed. All patients underwent CT scan with rectal contrast. Results: Out of 7 patients (4 male) with a mean age of 60 years (range 42-82), fistula was secondary to complicated colonic diverticula and colonic tumour in 5 (71.5 percent) and 2 (28.5 percent) respectively. Fecaluria and pneumaturia were the main complains. Two patients were seen for pelvis pain and another two for urinary infections. Cystoscopy allowed for fistula identification in 4 out of 7 patients (57.1 percent). Retrograde colonography was positive in 4 out of 7 cases. CT scan showed fistula in 5 of the 7 patients (71.4 percent). All patients underwent left colectomy and partial cystectomy. Mean hospital stay was 9.7 days (range 7 to 12) there were no postoperatory complications. Conclusion: Colovesical fistula is a rare occurrence. Its main etiology is colonic diverticular disease. Fecaluria and pneumaturia are pathognomonic. CT scan is the image modality of choice. Surgical treatment is always warranted and one time repair is currently advocated.

Appendicovesical fistula: a rare complication of appendicitis

Appendicovesical fistula is an uncommon type of enterovesical fistula and a rare complication of unrecognized appendicitis. Appendicovesical fistula often presents with recurrent or persistent urinary tract infection, especially in men. The commonest causes are appendicitis, cecal diverticulitis, and cystadenocarcinoma or carcinoid tumors of appendix. Approximately 114 cases have been reported previously in the literature, the vast majority in young male patients. Our special case joins the other cases which have already been described in the international literature. This case is a middle-aged man and is the first who has large and multiple fecaliths. We reviewed other cases and contributed an additional one with hope that increased awareness of this entity may facilitate the correct diagnosis and avoid inappropriate management

Fístula colovesical secundaria a la migración de una endoprótesis biliar: reporte de un caso / Colovesical fistula secondary to the migration of a biliary stent: case report

Introducción: la colocación endoscópica de stents para descomprimir una obstrucción biliar es un tratamiento comúnmente utilizado para enfermedades malignas de la vía biliar y para estenosis benignas de la misma. Se han descrito complicaciones inusitadas derivadas de la colocación de endoprótesis biliares, incluyendo la migración. Se presenta un caso clínico con el objetivo de compartir con la comunidad científica una rara complicación y la única publicada, secundaria a la migración de un stent biliar. Caso clínico: mujer de 47 años de edad, con estenosis de ámpula de Vater benigna, a quien se le colocó endoprótesis biliar, con la cual mejoró clínicamente. Posterior a la colocación del stent se le realizó colecistectomía abierta con exploración de vías biliares. Al año y medio posterior a la colocación del stent, la paciente presentó dolor vago en abdomen bajo y disuria; se le practicaron estudios de imagen donde se observó un extremo del stent biliar en colon sigmoides y otro en vejiga. Se realizó intervención quirúrgica encontrando fístula colovesical, la cual se resolvió en un solo tiempo quirúrgico. La paciente fue egresada con resultados satisfactorios.

BACKGROUND: The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Unusual complications of endoprosthesis placement have been described and include the migration of the stent. We present a case to share with the scientific community, an unusual complication secondary to the migration of a biliary stent that has not previously been reported to our knowledge. CASE REPORT: We present the case of a 47-year-old female with a diagnosis of benign papillary stenosis. The patient received a biliary endoprosthesis with clinical improvement. Later she underwent open cholecystectomy and common duct exploration. At consultation 18 months later, the patient presents with indistinct lower abdominal pain and dysuria. We performed imaging studies where the biliary stent was observed, partly in the sigmoid colon and partly in the bladder. The patient underwent surgery where a colovesical fistula was found and treated during the same surgical event. The patient was discharged succesfully.

Ascitis y falla renal: no olvidar el uroperitoneo / Ascites and renal failure caused by a bladder fistula: Report of one case

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Congenital ceco-vesical fistula associated with anorectal malformation: Case report

Congenital ceco-vesical fistula [CCVF] associated with high anorectal malformation was not described before. The only described case in 1972 was associated with total colonic atresia which are not the case. We report a case of CCVF associated with a blind ended distal colon in a 50-day old male presented with high imperforate anus faecalurea, and epididymo -orchitis of the left testis. The bladder was separated from the cecum followed by abdomino-perineal pull-through of the colon. The relevant literature is reviewed, and the diagnostic modalities and management are discussed