Incarcerated diaphragmatic hernia with intrathoracic bowel obstruction after right liver donation.

Liver transplantation has become an acceptable surgical procedure with the advancement of the technical and rejection considerations involved. Initially nonliving donors were used for transplantation procedures. However, with improved techniques, living donor procedures have become much more frequent. With this, complications involving the transplant organ donor may occur. We present 2 patients with intrathoracic bowel obstruction due to herniation of the small intestine and colon through a defect in the dome of the diaphragm with development of chest pain and gastrointestinal symptoms. Both patients were diagnosed by computerized tomography scan and had a right thoracotomy with lysis of the adhesions, reduction of the hernia, repair of the diaphragm, and mesh reinforcement of the diaphragm. Neither patient had a prior diaphragm defect. These patients, on review of the literature, represent the first 2 such reported cases and suggest the need to be aware of any potential diaphragm defects before closure of the abdomen after resection of the donor liver or if they develop appropriate symptomatology.

Forty years' experience treating septic arteritis and vasculitis.

By their natures, septic arteritis and infected grafts present a high morbidity and mortality situation for both the patient and the treating physician. In the experience of the authors, therapy frequently includes removing the previous infected graft, use of long-term antibiotics, repeat grafting and omental wraps. When possible, aortic endografting followed by future elective primary repair may be considered an option. Leaving wounds open to granulate from the 'bottom up' has been successful in the extremities and the groin. Again, avoidance of infection is primary. Antibiotics are frequently used at the time of vascular grafting, both intravenously and as irrigation. Examples of the authors' techniques and results demonstrate the variety of procedures available.

Malignant and benign thoracic tumors during pregnancy.

Eight female patients 23-38 years of age are presented who were pregnant and had concomitant thoracic tumors. The tumors were of a variety of cell types, both malignant and benign, causing chest pain, dyspnea, shock, hemoptysis, and mass formation. Surgical intervention, cobalt radiation, and chemotherapy led to survival and cure of both the mothers and the children. An aggressive approach is recommended.

Tracheobronchial tumor resection.

Primary tracheobronchial nonbronchogenic carcinoma tumors are uncommon. The presence of these tumors may cause asthmatic-like symptoms and marked respiratory distress. When seen, the patients are usually very apprehensive and present difficult decisions regarding treatment and surgery, especially with regard to anesthetic considerations. We are reporting our experience with these tumors in the community hospital. A number of patients are presented, including 1) a tracheal tumor during pregnancy, 2) a tracheobronchial tumor cast, and 3) a carinal resection. All resected patients did well with long-term survival.

Endovascular repair of aortojejunal fistula.

A 64-year-old male with vascular occlusive disease involving multiple vessels is presented with a history of aortobifemoral bypass grafting and bilateral femoral false aneurysm surgery. More recently, he had cystectomy for bladder carcinoma and repeated urinary stents and sepsis. Gastrointestinal bleeding developed due to the aortic graft anastomotic false aneurysm eroding into the distal jejunum. Endograft placement stabilized the critical situation and served as a bridge to a safer, more elective resection of the previous graft, the false aneurysm, and the endograft with closure of the jejunum.