In Crohn's disease, neurologic complications such as cerebrovascular accident, headache, peripheral neuropathy have been reported sporadically. The pathogenesis of these neurologic complications is still unknown and controversial. We experienced a 22-year-old man, with Crohn's disease accompanied by optic neuritis. Loss of visual acuity was developed during the worsening course of enterocutaneous fistula. After high dose steroid treatment, his visual acuity and neurologic symptoms improved immediately.
Adult ; Crohn Disease/*complications/drug therapy/pathology ; Humans ; Intestinal Fistula/complications ; Male ; Optic Neuritis/*complications/diagnosis

Primary adenosquamous carcinoma of the liver is generally considered as an extremely rare subtype of cholangiocarcinoma. It has been reported mostly in a form of case studies. As far as we know, there was only one case report on tumor related with biliary fistula. Recently, we experienced a case of primary adenosquamous carcinoma of liver with a formation of tumor-colonic fistula. A 54-year-old man was transferred to our hospital due to liver mass detected by abdominal ultrasonogram. Dynamic computed tomogram of liver showed a large irregular hypodense mass without rim enhancement in right lobe of liver and also suggested a fistula formation between the tumor and hepatic flexure of right colon. Colonoscopic examination showed a large colonic wall defect in hepatic flexure and a friable, nodular mucosa around the defected colonic wall. Extended right lobectomy and right hemicolectomy were done. Microscopically, the tumor was composed of squamous cell carcinoma mainly with foci of the adenocarcinoma component.
Carcinoma, Adenosquamous/*pathology/radiography/surgery ; Colonic Diseases/*pathology ; Colonoscopy ; Humans ; Intestinal Fistula/*pathology ; Liver Neoplasms/*pathology/radiography/surgery ; Male ; Middle Aged ; Tomography, X-Ray Computed

Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.
Aged ; Colon, Sigmoid/*pathology ; Diverticulitis/complications/*surgery ; Humans ; Intestinal Fistula/*diagnosis/etiology/surgery ; Male ; Sigmoidoscopy ; Tomography, X-Ray Computed

Today, percutaneous nephrostomy and other related renal procedures are routine in most hospitals. This technique provides safe, rapid and direct access to the upper urinary tract for various diagnostic and therapeutic maneuvers. It has become a vital tool for the urologists who have been able to diagnose and treat ever more diverse pathologies of the urinary tract without open operation. Percutaneous nephrostomy was done on 276 cases with advanced malignancy and benign conditions during the period of March, 1985 to December, 1993. We were successful in using percutaneous nephrostomy as urinary diversion to ureteral obstruction or urinary leakage in 27l cases( 98% ). In four fifths of patients, obstruction was due to neoplasm, with the cervical cancer the leading cause. The post-nephrostomy complications were bleeding in 10 cases, enterocutaneous fistula in 4, perinephric abscess in 3 and sepsis in 1. Percutaneous nephrostomy proved to be ideally suited in condition of obstructive uropathy and urine leakage.
Abscess ; Hemorrhage ; Humans ; Intestinal Fistula ; Nephrostomy, Percutaneous* ; Pathology ; Pregnenolone Carbonitrile ; Sepsis ; Ureteral Obstruction ; Urinary Diversion ; Urinary Tract ; Uterine Cervical Neoplasms

Humans ; Intestinal Fistula ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Pneumopericardium ; diagnostic imaging ; pathology ; Radiography ; Stomach Neoplasms ; surgery

Aortoenteric fistula is one of the most challenging problems that confront the vascular surgeons. Controversy remains over the optimal treatment because of the continued publication of series with high mortality, amputation, and aortic disruption rates. A positive preoperative blood culture is the best predictor of mortality with increased amputation rates due to infection of the extra-anatomic bypass. Therefore, in selected cases with sepsis, a prudent management protocol is required. We report a 68-yr-old male presenting with a chronic primary aortoduodenal fistula extensively involving the duodenum and Gram-negative sepsis. We planned a staged operation. Initially, an emergency laparotomy and control of the aorta allowed stabilization of the patient, identification of the fistula, and direct in situ placement of the prosthetic graft followed by an en bloc resection of the aneurysm and the surrounding structures. After he recovered from sepsis and had been stabilized, a staged extra-anatomic bypass followed by transabdominal removal of the temporarily placed graft was done. This management plan will allow the highest success rate and may be a prudent management protocol for these difficult cases.
Aged ; Aortic Aneurysm, Abdominal/complications/*pathology/*surgery ; Chronic Disease ; Digestive System Surgical Procedures ; Duodenum/pathology ; Human ; Intestinal Fistula/complications/*pathology/*surgery ; Male ; Sepsis/*complications ; Tomography, X-Ray Computed

Biliary drainage in patients with malignant biliary obstruction relieves jaundice and prevents the development of cholangitis or hepatic failure from biliary obstruction. Therefore, this may result in better quality of life along with survival prolongation. Biliary stent placement is an effective and safe measure for biliary decompression and is preferred than bypass surgery in high risk patients. Entero-biliary perforation-communication is one of the rare complications of biliary stent. We herein report a case of duodeno-biliary perforation-communication in patient with distal cholangiocarcinoma who presented with duodenal ulcer and obstruction, occurring 4 years later from the metallic biliary stent insertion. Patient was managed with a pyloric metal stent and conservative care.
Aged, 80 and over ; Bile Duct Neoplasms/complications/*diagnosis ; Bile Ducts, Intrahepatic/pathology ; Biliary Fistula/*diagnosis/etiology/pathology ; Cholangiocarcinoma/complications/*diagnosis ; Duodenal Diseases/*diagnosis/etiology/pathology ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology/pathology ; Stents/*adverse effects ; Tomography, X-Ray Computed

Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cmx4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.
Aged ; Carcinoma, Squamous Cell/*complications/pathology/radiography ; Fatal Outcome ; Humans ; Intestinal Fistula/*etiology/radiography ; Male ; Sigmoid Diseases/*etiology/radiography ; Tomography, X-Ray Computed ; Urinary Bladder Fistula/*etiology/radiography ; Urinary Bladder Neoplasms/*complications/pathology/radiography

Gallbladder cancer (GBC) is the most common primary hepatobiliary carcinoma and the sixth most common gastrointestinal malignancy. Adenocarcinoma accounts for the vast majority of GBCs (80–95%), whereas squamous cell carcinoma constitutes only 0–3.3% of GBCs. A 69-year-old man was suspected to have GBC with a cholecystoduodenal fistula on an abdominal computed tomography scan. He underwent esophagogastroduodenoscopy, which revealed that the duodenum was obstructed by the mass. Duodenal and biliary stents were successfully placed using endoscopic retrograde cholangiopancreatography. Pathology obtained from the duodenum revealed the mass to be a squamous cell carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Squamous Cell* ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenum ; Endoscopy, Digestive System ; Epithelial Cells* ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Intestinal Fistula* ; Pathology ; Stents

No abstract available.
Aged ; Chronic Disease ; Colitis/complications/*diagnosis/pathology ; Colonoscopy ; Female ; Fistula/complications/diagnosis ; Humans ; Intestinal Perforation/diagnosis/surgery ; Tomography, X-Ray Computed ; Uterine Cervical Neoplasms/*radiotherapy