Splenic arteriovenous fistula--late complications of splenectomy

This is a case report of a 30-year-old female patient with a splenic arteriovenous fistula of rare, atypical clinical course. The patient was admitted to the hospital due to strong abdominal pains and fever. 13 years earlier, the patient underwent splenectomy due to post-traumatic rupture of the spleen. On imaging examinations prior to surgery (ultrasonography, CT), a splenic arteriovenous fistula was diagnosed. The patient was operated on due to increasing abdominal pain. The fistula was closed by splenic artery and splenic vein banding during the course of laparotomy. This case report will be discussed based on literature review.

A Series of 15 Patients with Extracranial Carotid Artery Aneurysms: Surgical and Endovascular Treatment

OBJECTIVES

This is a retrospective review of 15 patients with primary and secondary aneurysms of extracranial carotid arteries treated surgically and endoluminally over 20 years in one centre.

PATIENTS AND METHODS

Fifteen aneurysms of extracranial carotid arteries were noticed in the same number of patients: five atherosclerotic, two after previous carotid surgery, six post-traumatic, one inflammatory, one of unknown etiology. All of them were symptomatic.

RESULTS

In the group treated surgically some complications occurred in the perioperative time: one haematoma, two transient neurological deficits, one fatal stroke. In the endovascular group of patients no complications occurred after the treatment. One fatal stroke occurred during operation-the patient died on the 43rd postoperative day due to respiratory insufficiency. Two other deaths occurred during the follow-up: one caused by myocardial infarction 10 years after the aneurysm resection, and the second due to a fatal stroke 3 years after aneurysmorraphy. One patient refused treatment and died 9 months after being diagnosed.

CONCLUSION

Neurological deficits in patients after neck injuries should arouse the suspicion of the presence of a carotid artery aneurysm. Open repair remains the method of choice in treating carotid artery aneurysms but endovascular procedures create the possibility of treating extracranial aneurysms in selected cases when open surgery is not recommended.

[Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery]

The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage.

IN CONCLUSION

damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

[Iatrogenic reasons for conversion after laparoscopic cholecystectomy]

The authors discusses causes of conversion after laparoscopic cholecystectomy (LC). 16 cases of technical and emergency conversions have been presented. The link between the experience of the surgeon and the frequency of such conditions has been emphasized. It has been established that emergency conversion is a complication in LC, while technical conversion negatively affect this technique but is likely to reduce the number of major complications.

[Surgical tactics in treatment of duodenal injuries after endoscopic sphincterotomy]

The procedure in case of injury of the duodenum as a complication of endoscopic sphincterotomy remains controversial. We have studied all the cases of duodenal injury after endoscopic sphincterotomy during last 5 years to indicate the best strategy of surgical treatment. We observed 10 cases of duodenal perforations following 464 endoscopic sphincterotomies. Other 4 patients came from different hospitals. Six patients were managed with nonoperative treatment (group I), four patients were operated on right after the diagnosis (group II), and other four patients were initially managed with nonoperative treatment and then were operated at least 3 days after the complications occurred (group III). All the patients treated nonsurgically recovered. All the patients from group III and one from group II died, as a result of duodenal fistula and sepsis. Spontaneous recovery was observed in those cases in which gradual improvement appeared during first 24 hours. Operation should be undertaken when the symptoms are quickly increasing and primary nonsurgical treatment is not satisfied. The operations delayed for more than 3 days give poor results.

[Acute limb ischemia after arterial surgery]

The causes of acute limb ischaemia after reconstructive arterial surgery may include excessive peripheral resistance, considerable arterial blood pressure fall, technical error, separation of the intima, or embolization by dislodged thromboembolic material. The purpose of the work was and analysis of causes and results of treatment in the clinical material in the period 1988-1991. For acute limb ischaemia after arterial surgery 45 patients were treated. The main causes of ischaemia were: considerable blood pressure fall--10 patients, excessive peripheral resistance--11 patients, and embolization by dislodged thromboembolic material--11 patients. The obtained results are unsatisfactory and fraught with a great number of complications. Good result was obtained in 30 patients (66.6%), limb was amputated in 7 cases (15.6%), and eight patients died (17.8%).