Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ...Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal stula, four pa- tients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33 86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60 240 min), and the median operative blood loss was 50 mL (range 10600mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.展开更多
Duodenocaval fistula(DCF) is an uncommon but lethal clinical entity.The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy.In this case report,we describe a patient...Duodenocaval fistula(DCF) is an uncommon but lethal clinical entity.The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy.In this case report,we describe a patient with a series of computed tomography(CT) examinations over a 2-mo period in hospital.A low-density air bubble appeared in the inferior vena cava(IVC) on the second day in hospital and became clear on day 19,and gradually enlarged.Magnetic resonance imaging(MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC.However,cavography did not show the filling defect.We suggest that noninvasive CT and MRI should be chosen as a first-line investigation,and IVC,including the surrounding structures,should be carefully reviewed on images if DCF is clinically considered.展开更多
Objective:To summarize the clinical features and therapeutic effects of transcatheter embolotherapy for congenital pulmonary arteriovenous fi stulas(PAVFs)in children,and to explore the method and therapeutic principl...Objective:To summarize the clinical features and therapeutic effects of transcatheter embolotherapy for congenital pulmonary arteriovenous fi stulas(PAVFs)in children,and to explore the method and therapeutic principle of transcatheter embolotherapy for congenital PAVFs in children.Method:We retrospectively reviewed nine patients with PAVF who underwent transcatheter embolotherapy in the Children’s Hospital of Chongqing Medical University from July 2004 to July 2019,including the demographic characteristics,clinical manifestations,effi ciency of closure,and follow-up.Results:Transcatheter embolotherapy was successful in all cases,and the symptom remission rate was 100%during the follow-up.No residual shunts or other complications occurred during the follow-up period.Compared with before embolotherapy,there were signifi cant changes in the percentage of saturated oxyhemoglobin and total hemoglobin level at the last follow-up(t=10.06,P=0.000;t=3.055,P=0.0076).No signifi cant difference was observed in pulmonary artery pressure before and after embolotherapy(t=0.13,P=0.90).Conclusions:Transcatheter embolotherapy offers the advantages of safety,with a decreased risk of trauma and a specifi c effect of treatment,and therefore is recommended as the fi rst-line treatment for congenital PAVFs in children.However,continued research is necessary to understand the full potential of transcatheter embolotherapy.展开更多
文摘Background: A cholecystoenteric stula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. Methods: From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. Results: Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal stula, four pa- tients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33 86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60 240 min), and the median operative blood loss was 50 mL (range 10600mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. Conclusions: There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon’s expertise and the patient’s condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.
文摘Duodenocaval fistula(DCF) is an uncommon but lethal clinical entity.The high mortality has been attributed to the difficulty of diagnosis before attempts at definitive therapy.In this case report,we describe a patient with a series of computed tomography(CT) examinations over a 2-mo period in hospital.A low-density air bubble appeared in the inferior vena cava(IVC) on the second day in hospital and became clear on day 19,and gradually enlarged.Magnetic resonance imaging(MRI) also clearly demonstrated a high-signal enteric contrast medium or thrombus and signal-void air bubbles in the IVC.However,cavography did not show the filling defect.We suggest that noninvasive CT and MRI should be chosen as a first-line investigation,and IVC,including the surrounding structures,should be carefully reviewed on images if DCF is clinically considered.
文摘Objective:To summarize the clinical features and therapeutic effects of transcatheter embolotherapy for congenital pulmonary arteriovenous fi stulas(PAVFs)in children,and to explore the method and therapeutic principle of transcatheter embolotherapy for congenital PAVFs in children.Method:We retrospectively reviewed nine patients with PAVF who underwent transcatheter embolotherapy in the Children’s Hospital of Chongqing Medical University from July 2004 to July 2019,including the demographic characteristics,clinical manifestations,effi ciency of closure,and follow-up.Results:Transcatheter embolotherapy was successful in all cases,and the symptom remission rate was 100%during the follow-up.No residual shunts or other complications occurred during the follow-up period.Compared with before embolotherapy,there were signifi cant changes in the percentage of saturated oxyhemoglobin and total hemoglobin level at the last follow-up(t=10.06,P=0.000;t=3.055,P=0.0076).No signifi cant difference was observed in pulmonary artery pressure before and after embolotherapy(t=0.13,P=0.90).Conclusions:Transcatheter embolotherapy offers the advantages of safety,with a decreased risk of trauma and a specifi c effect of treatment,and therefore is recommended as the fi rst-line treatment for congenital PAVFs in children.However,continued research is necessary to understand the full potential of transcatheter embolotherapy.
