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Acta Chirurgica Belgica Aug 1999Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. A 21-year-old female patient...
Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. A 21-year-old female patient developed an ileal J-pouch-sacral fistula with abscess and osteomyelitis of the sacrum, more than three years after the pouch construction for ulcerative colitis. Two months prior to this event, the patient had a single and transient episode of pouchitis. The role of pouchitis in the aetiopathogenesis of the fistula is unclear. To our knowledge, the late development of such a fistula has not been reported previously.
Topics: Abscess; Adult; Colitis, Ulcerative; Female; Fistula; Follow-Up Studies; Humans; Intestinal Fistula; Osteomyelitis; Pouchitis; Proctocolectomy, Restorative; Sacrum; Spinal Diseases
PubMed: 10499387
DOI: No ID Found -
Cancer Jun 1990Six patients underwent translumbar amputation (TLA), a life-saving procedure, after standard modalities of therapy failed to control the progression of the disease. The...
Six patients underwent translumbar amputation (TLA), a life-saving procedure, after standard modalities of therapy failed to control the progression of the disease. The primary diagnoses were as follows: pelvic arterial-venous (A-V) malformation, 1; sacral chordoma, 3; giant cell tumor of the sacrum, 1; and paraplegia with squamous cell cancer arising in intractable decubitus, 1. There were no operative deaths. The following postoperative complications developed in five patients: urinary fistulae, 2; small bowel obstruction, 1; intraabdominal bleeding, 1; hypertension, 2; small bowel fistula, 1; and dehiscence of skin closure, 1. Two patients died with distant metastases (24 months) and distant metastases with local recurrence (6 months). The remaining four patients were alive and well 72, 56, 48, and 18 months after the surgical procedure. All of these patients have reached the rehabilitation goals.
Topics: Adolescent; Adult; Amputation, Surgical; Anesthesia, General; Arteriovenous Malformations; Chordoma; Female; Giant Cell Tumors; Humans; Lumbar Vertebrae; Male; Middle Aged; Ostomy; Paraplegia; Pelvic Neoplasms; Pelvis; Physical Therapy Modalities; Pressure Ulcer; Prostheses and Implants; Spinal Canal; Spinal Neoplasms
PubMed: 2340466
DOI: 10.1002/1097-0142(19900615)65:12<2668::aid-cncr2820651212>3.0.co;2-i -
Journal of Clinical Neuroscience :... Jan 2007We report a dural arteriovenous fistula (AVF) that developed at a site on the midline dorsal surface of the dura mater that had been damaged by repeated lumbar...
We report a dural arteriovenous fistula (AVF) that developed at a site on the midline dorsal surface of the dura mater that had been damaged by repeated lumbar punctures. A 61-year-old male patient had undergone repeated lumbar punctures and discectomy for severe lumbago 40 years before the present admission. After surgery, the lumbago symptoms resolved. However, 30 years after the operation, he started to experience dysaesthesia, motor weakness in both legs, and urinary disturbance. Physical examination revealed bilateral leg weakness, diminished deep tendon reflexes in the patellar and Achilles tendons bilaterally, and decreased superficial sensation below L1. Magnetic resonance imaging revealed swelling with intramedullary high intensity and multiple flow voids around the conus and spinal cord on T(2)-weighted images, and adhesive arachnoiditis. Spinal angiography revealed an AVF between the left lateral sacral artery and the S1 radicular vein at the site of the previous operation. Surgery was conducted to carry out excision of the dural AVF at the shunting point, the arterialized intradural vein, and lysis of the arachnoiditis. This case of dural AVF may have been caused by repeated lumbar punctures.
Topics: Arteriovenous Fistula; Cerebral Angiography; Dura Mater; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Spinal Cord Compression; Spinal Puncture
PubMed: 17092723
DOI: 10.1016/j.jocn.2005.10.020 -
Obstetrics and Gynecology May 2004Abdominal sacral colpopexy is a popular method for resupporting the vaginal apex. Bleeding and infection are the most common complications. We report a complication...
BACKGROUND
Abdominal sacral colpopexy is a popular method for resupporting the vaginal apex. Bleeding and infection are the most common complications. We report a complication resulting in a small bowel fistula.
CASE
A 48-year-old woman developed a chronic vaginal discharge 4-6 months after routine abdominal sacral colpopexy in which a velour mesh remained exposed in the pelvis. Conservative measures failed to control the intermittent copious discharge from the upper vaginal vault where the mesh was visualized. At laparotomy, an entero mesh vaginal fistula was discovered. Excellent long-term results were obtained by removal of the mesh along with resection of the involved small intestine.
CONCLUSION
At the time of abdominal sacral colpopexy, we recommend that mesh not remain exposed in the pelvis.
Topics: Abdomen; Female; Gynecologic Surgical Procedures; Humans; Intestinal Fistula; Intestine, Small; Middle Aged; Postoperative Complications; Sacrum; Surgical Mesh; Uterine Prolapse; Vaginal Fistula
PubMed: 15121598
DOI: 10.1097/01.AOG.0000127940.45774.b4 -
AJNR. American Journal of Neuroradiology Oct 2018Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale,...
BACKGROUND AND PURPOSE
Conventional MR imaging can provide important clues regarding the location of a spinal vascular malformation. We hypothesized that a dilated vein of the filum terminale, identified as a curvilinear flow void on T2WI, could be an imaging marker for a lower lumbar (L3-L5) or sacral fistula.
MATERIALS AND METHODS
We retrospectively identified all spinal dural and spinal epidural arteriovenous fistulas from 2 large tertiary referral centers from 2005 to 2018. All patients had a lumbar spinal MR imaging and a conventional spinal angiography. Images were reviewed by 2 neuroradiologists who categorized the level of the arterial feeder to the fistula and the presence or absence of a dilated vein of the filum terminale on T2WI and T1 postcontrast images. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula.
RESULTS
One hundred sixty-two patients were included. An enlarged filum terminale vein was identified in 39 patients. Sensitivity, specificity, positive predictive value, and negative predictive value of the presence of a dilated filum terminale vein for a deep lumbar or sacral fistula were 86%, 98.3%, 94.9%, and 95.1%, respectively.
CONCLUSIONS
The presence of a dilated vein of the filum terminale can accurately localize a spinal dural arteriovenous fistula/spinal epidural arteriovenous fistula to the lower lumbar or sacral spine in patients being evaluated for such lesions. This finding can be used to facilitate both noninvasive and conventional spinal angiography.
Topics: Adult; Aged; Arteriovenous Fistula; Cauda Equina; Central Nervous System Vascular Malformations; Female; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Veins
PubMed: 30237303
DOI: 10.3174/ajnr.A5784 -
World Neurosurgery Sep 2017Although multifocal spinal arteriovenous malformations (AVMs) have been reported before, the present case is the first case of 2 different types, including 1...
BACKGROUND
Although multifocal spinal arteriovenous malformations (AVMs) have been reported before, the present case is the first case of 2 different types, including 1 perimedullary arteriovenous fistula and 2 spinal dural arteriovenous fistulas of lumbosacral AVMs, coexisting in 1 patient. We also report the use of hybrid techniques in treatment of concomitant lumbosacral spinal AVMs.
CASE DESCRIPTION
A 65-year-old man presented with a 4-year history of progressive sensory, motor, and sphincter dysfunction. Spinal magnetic resonance imaging and digital subtraction angiography showed 2 spinal dural arteriovenous fistulas (fed by the right L2 lumbar artery and the right lateral sacral artery, respectively) and 1 perimedullary arteriovenous fistula (fed by the filum terminale artery from the left L2 lumbar artery [i.e., filum terminale arteriovenous fistulas]. A hybrid technique was used to perform embolization of the right L2 spinal dural arteriovenous fistula and microsurgery of the L5 level filum terminale vein. The patient was asymptomatic 1 year later.
CONCLUSIONS
Multifocal spinal vascular malformations may coexist in 1 case, and standardized spinal digital subtraction angiography, including the bilateral internal iliac arteries and median sacral artery, should be performed to avoid a missed diagnosis. The concomitant phenomenon indicates that venous hypertension may be a risk factor for the development of arteriovenous fistulas. Hybrid techniques are effective in treatment of multifocal and complex spinal AVMs.
Topics: Aged; Arteriovenous Fistula; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans; Lumbar Vertebrae; Male; Sacrum; Spinal Cord
PubMed: 28684369
DOI: 10.1016/j.wneu.2017.06.149 -
Journal of Laparoendoscopic & Advanced... Jul 2020Currarino syndrome (CS) is characterized by the triad of sacral anomalies, presacral tumor, and anorectal malformation (ARM). This study evaluates the feasibility and...
Currarino syndrome (CS) is characterized by the triad of sacral anomalies, presacral tumor, and anorectal malformation (ARM). This study evaluates the feasibility and outcomes of laparoscopic-assisted anorectal pull-through (LAARP) for CS. Children admitted for primary or redo repair of CS through LAARP between 2016 and 2019 were reviewed. The indication of redo included constipation with megarectosigmoid, residual presacral mass, anastomosis leak, and secondary fistula. ARM was corrected by excision of rectal stenosis, fistula, and its associated megarectosigmoid. This was followed by a complete surgical resection of the presacral tumor, with subsequent pull-through and anocolic anastomosis. This was done with a combined laparoscopic and transanal approach. The detailed surgical techniques, early postoperative complications, and mid-term functional outcomes were summarized. Fourteen patients underwent LAARP for primary ( = 4) and redo ( = 10) repair of CS. Four of them had colostomy previously. Mean age at operation was 20.7 ± 13.9 months. Mean operative time was 120 ± 25 minutes. Median hospital stay was 8 days (range 7-9 days) postoperatively. None of the patients developed early postoperative complications such as anastomotic leaks, presacral abscesses, recurrent fistulas, and residual mass. Bowel function was assessed 1 year after LAARP in 10 patients. Mean follow-up time was 15.9 months. The frequency of bowel movements was 3.3 ± 1.5/day. Constipation occurred in 2 patients. Occasional soiling (<3 times/week) was reported in 4 patients and frequent soiling (>3 times/week) was in 1. LAARP for CS is safe and effective.
Topics: Anal Canal; Anastomosis, Surgical; Anorectal Malformations; Child, Preschool; Colostomy; Defecation; Digestive System Abnormalities; Female; Humans; Infant; Laparoscopy; Length of Stay; Male; Operative Time; Postoperative Complications; Rectum; Retrospective Studies; Sacrum; Syringomyelia
PubMed: 32302513
DOI: 10.1089/lap.2019.0779 -
Frontiers in Neurology 2023Spinal dural arteriovenous fistulas located in the lumbosacral region are rare and present with nonspecific clinical signs. The purpose of this study was to find out the...
BACKGROUND AND PURPOSE
Spinal dural arteriovenous fistulas located in the lumbosacral region are rare and present with nonspecific clinical signs. The purpose of this study was to find out the specific radiologic features of these fistulas.
METHODS
We retrospectively reviewed the clinical and radiological data of 38 patients diagnosed with lumbosacral spinal dural arteriovenous fistulas in our institution from September 2016 to September 2021. All patients underwent time-resolved contrast-enhanced three-dimensional MRA and DSA examinations, and were treated with either endovascular or neurosurgical strategies.
RESULTS
Most of the patients (89.5%) had motor or sensory disorders in both lower limbs as the first symptoms. On MRA, the dilated filum terminale vein or radicular vein was seen in 23/30 (76.7%) patients with lumbar spinal dural arteriovenous fistulas and 8/8 (100%) patients with sacral spinal dural arteriovenous fistulas. T2W intramedullary abnormally high signal intensity areas were found in all lumbosacral spinal dural arteriovenous fistula patients, with involvement of the conus present in 35/38 (92.1%) patients. The "missing piece sign" in the intramedullary enhancement area was seen in 29/38 (76.3%) patients.
CONCLUSION
Dilatation of the filum terminale vein or radicular vein is powerful evidence for diagnosis of lumbosacral spinal dural arteriovenous fistulas, especially for sacral spinal dural arteriovenous fistulas. T2W intramedullary hyperintensity in the thoracic spinal cord and conus, and the missing-piece sign could be indicative of lumbosacral spinal dural arteriovenous fistula.
PubMed: 37188308
DOI: 10.3389/fneur.2023.1157902 -
BMJ Case Reports Mar 2019Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral...
Sacral dural arteriovenous fistulas (SDAVFs) are rare, constituting no more than 10% of all spinal dural fistulas. They are most commonly fed by the lateral sacral artery (LSA), a branch of the internal iliac artery (IIA). Catheterization of this vessel requires either a crossover at the aortic bifurcation in cases of right femoral access or retrograde catheterization from the ipsilateral common femoral artery. We present the case of a 79-year-old man with tethered cord syndrome and a symptomatic SDAVF fed by two feeders from the left LSA. Spinal diagnostic angiography was made exceptionally challenging by an aorto-bi-iliac endograft, and selective catheterization of the left IIA was not possible. The patient could not undergo surgery due to multiple comorbidities, therefore embolization was considered the best approach. The procedure was carried out through a transradial access (TRA) with Onyx and n-butyl cyanoacrylate. The SDAVF was successfully treated and the patient made a full neurological recovery.
Topics: Aged; Angiography; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Humans; Male; Neural Tube Defects; Paraparesis; Practice Guidelines as Topic; Recovery of Function; Sacrum; Treatment Outcome; Walkers
PubMed: 30936323
DOI: 10.1136/bcr-2019-014834 -
World Neurosurgery Aug 2019Spinal dural arteriovenous fistulas are the most common spinal vascular pathology, accounting for up to 70% of spinal vascular malformations. They most commonly present...
BACKGROUND
Spinal dural arteriovenous fistulas are the most common spinal vascular pathology, accounting for up to 70% of spinal vascular malformations. They most commonly present with insidious and progressive myelopathy and bowel, bladder, and sexual dysfunction. Although noninvasive imaging (e.g., magnetic resonance imaging, magnetic resonance angiography) may suggest the presence of a spinal arteriovenous fistula (AVF), the diagnosis requires confirmation with spinal angiography.
CASE DESCRIPTION
A 65-year-old woman presented with progressive myelopathy. Traditional spinal angiography of the paired radicular arteries failed to demonstrate any vascular malformation. However, injection of the right internal iliac artery demonstrated an AVF arising from the artery of Desproges-Gotteron with retrograde venous drainage to the upper thoracic region.
CONCLUSIONS
Selective transarterial catheterization and embolization with n-butyl cyanoacrylate resulted in complete occlusion of the AVF. Clinical improvement was also noted on postprocedural day 1. This case highlights the importance of internal iliac injections as a critical component of spinal angiography during an evaluation for vascular malformation.
Topics: Aged; Angiography, Digital Subtraction; Catheterization; Central Nervous System Vascular Malformations; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Spinal Diseases
PubMed: 31121368
DOI: 10.1016/j.wneu.2019.05.099