Rapid pulmonary fistulization complicating a psoas abscess with intraoperative hypoxemia: a rare case report.

Introduction and importance: Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different specialties leading to delays in diagnosis and management. Case presentation: The authors present a 47-year-old woman with complaint of vague abdominal pain, fever, and raised inflammatory markers who underwent CT examination. On CT, a collection was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. The psoas abscess was drained. Clinical discussion: Our case presents a number of rare and intriguing features. Notably, the patient, who was immunocompetent, experienced a primary Staphylococcus infection that swiftly progressed to a sizable pulmonary abscess, a phenomenon uncommon in such hosts. The rarity further extends to the source of infection, originating abdominally but culminating in thoracic complications through contiguous spread from a retroperitoneal site. Despite the potential severity, the patient's outcome was remarkably positive. Conclusion: This case underscores the potential rapidity of pulmonary involvement in psoas abscesses, emphasizing the need for heightened awareness and consideration of respiratory signs during preoperative assessments.

Gastrointestinal involvement in gallbladder cancer: Computed tomography findings and proposal of a classification system.

BACKGROUND: There is relatively scarce data on the computed tomography (CT) detection of gastrointestinal (GI) involvement in gallbladder cancer (GBC). We aim to assess the GI involvement in GBC on CT and propose a CT-based classification. METHODS: This retrospective study comprized consecutive patients with GBC who underwent contrast-enhanced computed tomography (CECT) for staging between January 2019 and April 2022. Two radiologists evaluated the CT images independently for the morphological type of GBC and the presence of GI involvement. GI involvement was classified into probable involvement, definite involvement and GI fistulization. The incidence of GI involvement and the association of GI involvement with the morphological type of GBC was evaluated. In addition, the inter-observer agreement for GI involvement was assessed. RESULTS: Over the study period, 260 patients with GBC were evaluated. Forty-three (16.5%) patients had GI involvement. Probable GI involvement, definite GI involvement and GI fistulization were seen in 18 (41.9%), 19 (44.2%) and six (13.9%) patients, respectively. Duodenum was the most common site of involvement (55.8%), followed by hepatic flexure (23.3%), antropyloric region (9.3%) and transverse colon (2.3%). There was no association between GI involvement and morphological type of GBC. There was substantial to near-perfect agreement between the two radiologists for the overall GI involvement (k = 0.790), definite GI involvement (k = 0.815) and GI fistulization (k = 0.943). There was moderate agreement (k = 0.567) for probable GI involvement. CONCLUSION: GBC frequently involves the GI tract and CT can be used to categorize the GI involvement. However, the proposed CT classification needs validation.

A Case Report of Iliopsoas Abscess Secondary to Small Bowel Fistula.

Iliopsoas abscesses (IPAs) are rare infections in the musculature that can be difficult to diagnose due to nonspecific presentations. These abscesses are most commonly caused by either the hematogenous spread of a separate infectious source in the body or secondary to Crohn's disease and are typically treated with antibiotic therapy and percutaneous drainage. For cases complicated by bowel disease, multiloculated psoas abscess, or gas-forming organisms, surgical drainage may be indicated. We present the case of an 81-year-old female with a history of colon cancer status post-cecum resection who presented with back pain, thigh pain, and constipation. Computerized tomography imaging showed concurrent small bowel obstruction and a right IPA extending down to the right thigh. Laparoscopic exploration revealed a small bowel fistulization to the right iliopsoas as the source of infection. Resection of the small bowel and surgical incision and drainage of the abscess were necessary for her treatment. The patient was discharged with vacuum-assisted closure of her wound after a hospital course complicated with chronic diarrhea. Bowel fistulization should be considered a potential cause of IPAs in patients with a complicated gastrointestinal history.

Effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization.

OBJECTIVE: To explore the effect of electric function training instrument for arteriovenous fistula on vascular index of fistula and puncture success rate in patients with autogenous arteriovenous fistulization (AVF). METHODS: 60 patients received AVF in the Fourth Hospital of Hebei Medical University from June 2020 to June 2021 were selected as the study subjects, and they were divided into the treatment group (TG, n = 30) and the reference group (RG, n = 30) according to the random number table method. The patients in the RG received routine pressure training by clench fist and tourniquet after surgery, and the TG used electric function training instrument for arteriovenous fistula on the basis of routine clench fist, then comprehensively evaluating the clinical application value of this study protocol by comparing the vascular index of fistula and puncture success rate of the two groups. RESULTS: The depth of cephalic vein to skin at T2 and T3 in the TG was notably lower than the RG (P < 0.05), and the vessel diameter of cephalic vein at T3 in the TG was visibly higher than the RG (P < 0.05), with no overt difference in the rate of fistula complication, one-time puncture success rate and the incidence of puncture injury in both groups (P > 0.05). The score of functional exercise compliance of fistula in the TG was clearly higher than the RG (P < 0.001). CONCLUSION: The study results suggest that the use of electric function training instrument for arteriovenous fistula after AVF is more effective, so it has certain clinical application value.

Absceso del psoas ilíaco secundario a un tumor de colon izquierdo fistulizado al retroperitoneo: caso clínico y análisis de la literatura / Iliopsoas abscess resulting from penetrating left colon cancer to the retroperitoneum: case report and literature review / Abscesso do iliopsoas secundário a tumor de cólon esquerdo fistulizado para o retroperitônio: caso clínico e análise da literatura

Los abscesos del psoas ilíaco secundarios a un tumor de colon fistulizado son excepcionales y potencialmente graves. La mayoría son adenocarcinomas de tipo mucinoso. Su tratamiento es complejo ya que, para lograr una resección oncológica pretendidamente curativa, es necesario realizar una resección ampliada con mayor morbimortalidad. Presentamos el caso de una paciente con un adenocarcinoma mucinoso de colon izquierdo fistulizado al músculo ilíaco y la pared anterolateral del abdomen en la que se realizó una resección multivisceral que incluyó el colon izquierdo, el músculo y la cresta ilíaca y parte de la pared anterolateral del abdomen.

Iliopsoas abscess secondary to perforation of colon cancer is an extremely rare and potentially life-threatening condition. Most tumors are mucinous adenocarcinomas. Its treatment its complex, as most patients need radical extended resections to achieve good oncological results, which are in turn, graved with higher morbidity and mortality. We present the case of a patient with a left colon mucinous adenocarcinoma penetrating to the iliopsoas muscle and the anterolateral abdominal wall that required a multivisceral resection including left colon, iliac muscle and crest and part of the anterolateral abdominal wall.

Abscessos do iliopsoas secundários a um tumor de cólon fistulizado são raros e potencialmente graves. A maioria são adenocarcinomas do tipo mucinoso. Seu tratamento é complexo, pois, para se obter uma ressecção oncológica supostamente curativa, é necessário realizar uma ressecção ampliada com maior morbimortalidade. Apresentamos o caso de um paciente com adenocarcinoma mucinoso de cólon esquerdo fistulizado para o músculo ilíaco e parede ântero-lateral do abdome no qual foi realizada ressecção multivisceral que incluiu cólon esquerdo, músculo e crista ilíaca e parte do a parede anterolateral do abdome.

Gastric Ulcer with Penetration and Abscess in the Liver.

Teaching Point: Aggressive peptic ulcer disease can be indistinguishable from malignancy on imaging, even presenting invasion of adjacent organs, which often implies histological characterization.

An unexpected cause of persistent bacteraemia and portomesenteric venous gas.

We report the case of a 59-year old man with portomesenteric venous gas (PMVG) due to inferior mesenteric vein fistulization caused by sigmoid diverticulitis with an unusual evolution. The patient initially presented with classic symptoms of lower abdominal pain and fever. Diagnosis of uncomplicated sigmoid diverticulitis was confirmed on computed tomography (CT) for which intravenous antibiotics were initiated. Hemocultures were positive for omnisensitive Escherichia Coli, but despite adequate intravenous antibiotic therapy, episodes of bacteraemia persisted and hemocultures remained positive. Repeat CT scan demonstrated regression of inflammation without signs of abcedation or perforation consistent with clinical findings. Endocarditis was excluded with a normal transoesophageal echocardiography. Finally, positron emission tomography-computed tomography (PET-CT) suspected a colovenous fistula and the presence of PMVG. The patient was successfully treated with laparoscopic sigmoidectomy. This case report summarises the diagnostic pathway and aims for higher awareness of non-ischemic PMVG causes.

Clinical pictures mimicking acute hernia complications: are we really daring to violate a traditional abdominal wall surgery dogma?

BACKGROUND: Acute abdominal wall hernia complications usually require a prompt surgical treatment. The aim of this case series is to report our experience with some unusual cases of apparent acute and subacute hernia complications not requiring surgical treatment, changing the classical paradigm of immediate surgical approach into a "wait and see" situation. CASE PRESENTATION: We shortly report here four cases of abdominal wall hernia complications in which surgical treatment could have been unsafe for the patients considering their clinical condition. Two cases were fistulated and two were apparently strangulated. After clinical evaluation and CT-scan, we opted for a conservative treatment weighting the risk-benefit balance in order to give the best quality of life to the patient. CONCLUSIONS: In selected cases and under well-defined situations, an accurate evaluation should convince every surgeon to opt for a conservative approach refraining from a promptly operative treatment of the patient. This may be particularly relevant among very old or high-risk patients affected by long-standing abdominal wall hernias.

Seudoquiste mediastinal y fistulización pleural, excepcional complicación de una pancreatitis / Mediastinal pseudocyst and pleural fistulization, exceptional complication of pancreatitis

Resumen Introducción: Las complicaciones torácicas secundarias a pancreatitis aguda son excepcionales y más aún la presencia de un pseudoquiste mediastinal. Caso Clínico: Hombre de 36 años. Consumidor de marihuana y alcohol. Historia de 6 meses de dolor abdominal y adelgazamiento de 20 kilos. Instalando en la evolución sintomatología respiratoria. Discusión: Se discuten las formas de presentación de esta entidad. Sus etiologías más frecuentes. Se hace énfasis en el rol de la imagenología así como en el análisis del líquido pleural. El enfoque terapéutico es conservador al inicio y en algunos pacientes es quirúrgico en la evolución; con diversas opciones.

Introduction: The thoracic complications secondary to acute pancreatitis are exceptional and even more so the presence of a mediastinal pseudocyst. Case report: 36 year old man. Marijuana and alcohol consumer. History of 6 months of abdominal pain and weight loss of 20 kilos. Installing respiratory symptomatology evolution. Discussion: The forms of presentation of this entity are discussed. Its most frequent etiologies. Emphasis is placed on the role of imaging as well as the analysis of pleural fluid. The therapeutic approach is conservative at the beginning and in some patients it is surgical during evolution; with several options.

Ovarian dermoid cyst presenting with unusual complaint of hair coming out of the anal orifice - A case report.

Dermoid cyst of the ovary is a common benign condition. It is usually asymptomatic but can present with pain, mass, hormone related symptoms or paraneoplastic syndrome. Hair is a common morphological component of the dermoid cyst; however, it rarely manifests as a presenting complain. We report a case, who presented with the complaints of hair coming out through her anal orifice for a year. Ultrasound and computed tomography scan revealed a dermoid cyst of the right ovary adherent to the rectum. Surgical removal showed hair coming out of the cyst. Primary repair of the defect in rectal wall was performed which resulted in resolution of the symptoms.

Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit.

BACKGROUND: Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated. METHODS: A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out. RESULTS: Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF. CONCLUSIONS: This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.

Exploration into the Application of Mobile Medical APP in the Continuous Nursing after Fistulization / 医学信息学杂志

The paper takes the continuous nursing after fistulization in West China Hospital of Sichuan University as an example to analyze application situation and demand of the mobile medical APP,explains design principle,technology roadmap,function implementation,application mode and effect of the APP,points out that the application of the APP is able to improve service quality and enhance patient satisfaction.

Vulvar procedures: biopsy, bartholin abscess treatment, and condyloma treatment.

Several benign, premalignant, and malignant lesions may arise on the vulva, and multiple types of procedures may be used to diagnose and treat these conditions. Punch and shave biopsies may be used to diagnose most vulvar conditions, but lesions suspected of being melanomas may best be diagnosed with narrow-margin excisional biopsies. Bartholin gland cysts and abscesses may be treated with several different treatment modalities, the most common of which are fistulization and marsupialization. Genital warts may be treated with several medical and surgical modalities to relieve symptoms.

Application of Adjustable Interatrial Fistulization in Operation of Congenital Heart Disease Accompany with Severe Pulmonary Arterial Hypertension / 实用儿科临床杂志

Objective To investigate the method and value of adjustable interatrial fistulization in the operation of congenital heart disease(CHD) accompany with severe pulmonary arterial hypertension(PH).Methods Twenty-seven patients(19 male,8 females) accompany with severe PH were entered the study,age ranged from 4 to 14 years old,weight from 13.7 to 42.0 kilogram.The enrolled diseases included 11 cases of atrial septal defect(ASD),10 cases of ventricular septal defect(VSD),4 cases of patent ductus arteriosus(PDA),and 2 cases of Ebstein syndrome accompany with severe tricuspid insufficiency.All patients were diagnosed as CHD accompany with severe PH(bidirectional shunt)which was the contraindications for routine operation before operation through chest X-ray,electrocardiography,ultrasonic cardiography,cardiac catheteri-zation and cardiac angiography.Results With adjustable interatrial fistulization and treatment to the abnormalities,14 fistulaes were closed immediately after operation,7 fistulaes were closed 2 days after operation,3 fistulaes were closed 3 days and 1 fistulae was closed 4 days after operation and accompanied with empyema discharged initiatively.One fistula was never closed,1 case died from low cardiac output symptom.The effective rate was 92.6%,closed to that of routine operations.Conclusion Adjustable interatrial fistulization is an easy procedure,and it can decrease the danger of PH post-operation effectively and provide operation opportunity for those patients with CHD approaching terminal stage.