Crohn’s disease complicated by multiple stenoses and internal fistulas clinically mimicking small bowel endometriosis

We report a 31-year-old woman with Crohn's disease complicated by multiple stenoses and internal fistulas clinically misdiagnosed as small bowell endometriosis, due to the patient's perimenstrual symptoms of mechanical subileus for 3 years; at first monthly, but later continuous, and gradually increasing in severity. We performed an exploratory laparotomy for small bowel obstruction, and found multiple ileal strictures and internal enteric fistulas. Because intraoperative findings were thought to indicate Crohn's disease, a right hemicolectomy and partial distal ileum resection were performed for obstructive Crohn's ileitis. Histopathology of the resected specimen revealed Crohn's disease without endometrial tissue. The patient made an uneventful recovery from this procedure and was discharged home 10 d post-operatively. The differential diagnosis of Crohn's diease with intestinal endometriosis may be difficult pre-operatively. The two entities share many overlapping clinical, radiological and pathological features. Nevertheless, when it is difficult to identify the cause of intestinal obstruction in a woman of child-bearing age with cyclical symptoms suggestive of small bowel endometriosis, Crohn's disease should be included in the differential diagnosis.

Internal biliary fistula due to cholelithiasis:A single-centre experience

AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.

Mesh erosion into the colon following repair of parastomal hernia: A case report

BACKGROUND In recent years,mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain.However,using mesh to repair parastomal hernias also carries potential dangers.One of these dangers is mesh erosion,a rare but serious complication following hernia surgery,particularly parastomal hernia surgery,and has attracted the attention of surgeons in recent years.CASE SUMMARY Herein,we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery.The patient,who underwent parastomal hernia repair surgery 3 years prior,presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus.Three months later,a portion of the mesh was excreted from the patient’s anus and was removed by a doctor.Imaging revealed that the patient’s colon had formed a t-branch tube structure,which was formed by the mesh erosion.The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.CONCLUSION Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.

Traumatic extracranial internal carotid-jugular fistula leading to serious injury: a case report in forensic assessment

Extracranial carotid artery injuries may produce severe haemorrhage,cerebral damage or arteriovenous fistula.Examples of traumatic extracranial carotid-jugular fistula are not frequently reported,especially in forensic medicine.We report a controversial case of an extracranial internal carotid-jugular fistula resulting from a stab wound to the neck.The degree of the injury was classified under“The Standard of Human Body Injury Assessment(2014)”(SIA)in China by forensic examiners.We believe this case report will provide information for the forensic assessment of similar cases.

Balloon occlusion test and therapeutic occlusion ontrau m atic carotid cavernous fistulas

Objective: To evaluate the safety of the balloon occlusion test(BOT) and therapeutic occlusion of the internal carotid artery(ICA). Methods: The data of 43 patients hospitalized consecutively with traumatic intractable carotid cavernous fistulas (TICCF) were analyzed. Therapeutic occlusion of ICA was performed on 39 cases and BOT was only performed on the remaining 4 cases. Our assessment consisted of: (1) angiographic evaluation of collateral circulation with or without BOT of ICA, and (2) evaluation of clinical tolerance to therapeutic occlusion of ICA with hypotensive challenge for 30 minutes. Complications of BOT and therapeutic occlusion of ICA were also analyzed retrospectively. Results: Complications related to BOT occurred in 1 case (2.3%) without causing permanent deficits. Complications related to therapeutic occlusion of ICA occurred in 4 cases (10%), including 1 technical (2.5%), 2 temporary (5%) and 1 permanent (2.5%) deficit. There was no fistula recurrence or mortality. Conclusions: BOT of ICA is safe and economical. The reliability of the results is almost the same compared with that of other more complicated methods of assessing therapeutic occlusion of ICA. And it is easy to treat TICCF with therapeutic occlusion of ICA.