Journal of Yeungnam Medical Science

Case reports

Stent graft treatment of an ilioenteric fistula secondary to radiotherapy: a case report: Joo Yeon Jang, Ung Bae Jeon, Jin Hyeok Kim, Tae Un Kim, Jae Yeon Hwang, Hwa Seong Ryu; J Yeungnam Med Sci. 2022;39(1):77-80. Published online July 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.01053

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Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.

Citations

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Resection of sigmoid cancer with bladder invasion using laparoscopic combined with a cystoscopic holmium laser: an innovative surgical procedure
Ronghua Wu, Cong Xu, Xing Liu, Weihua Fu, Yujia Chen, Jingzhen Zhu, Guangsheng Du
Lasers in Medical Science.2023;[Epub] CrossRef

Transpedal lymphatic embolization for lymphorrhea at the graft harvest site after coronary artery bypass grafting: Jung Guen Cha, Sang Yub Lee, Jihoon Hong, Hun Kyu Ryeom, Gab Chul Kim, Young Woo Do; Yeungnam Univ J Med. 2021;38(1):74-77. Published online July 20, 2020; DOI: https://doi.org/10.12701/yujm.2020.00297

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Abstract PDF

Lymphorrhea is a rare but potentially severe complication that occurs after various surgical procedures. Untreated lymphorrhea may lead to wound dehiscence, infection, and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually includes leg elevation, drainage, and pressure dressing. However, these methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from a calf wound after endoscopic great saphenous vein (GSV) harvesting for coronary artery bypass grafting (CABG). The patient presented with intractable oozing from the postoperative wound on the right calf. Lymphorrhea perGsisted for 6 weeks despite negative-pressure wound therapy with a long-acting somatostatin. We performed unilateral pedal lymphangiography that confirmed wound lymphorrhea, followed by glue embolization. No recurrence was observed after 8 months of follow-up. This case report demonstrates the successful use of lymphangiography with glue embolization in the control of lymphorrhea after GSV harvesting for CABG.

Citations

Citations to this article as recorded by

Supermicrosurgical lymphatic venous anastomosis for intractable lymphocele after great saphenous vein harvesting graft
Hirofumi Imai, Shuhei Yoshida, Toshiro Mese, Solji Roh, Isao Koshima
Journal of Vascular Surgery Cases, Innovations and Techniques.2022; 8(1): 45. CrossRef
Update February 2021
Francine Blei
Lymphatic Research and Biology.2021; 19(1): 96. CrossRef
Lymphatic complications after harvesting venous conduits in coronary artery bypass grafting surgery
D. V. Manvelyan, Yu. Y. Vechersky, V. V. Zatolokin, M. S. Kuznetsov, B. N. Kozlov
The Siberian Journal of Clinical and Experimental Medicine.2021; 36(3): 27. CrossRef

Case Reports

Dual left anterior descending coronary artery originating from left main stem and right coronary sinus.: Dong Hwi Kim, Keon Woong Moon, Eun Hee Kim, Gihyeon Woo, Jin Kyeong Shin, Ji Yeun Jang, Sungeun Ha, Joo Young Lee; Yeungnam Univ J Med. 2014;31(1):13-16. Published online June 30, 2014; DOI: https://doi.org/10.12701/yujm.2014.31.1.13

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Abstract PDF: Congenital abnormalities of the coronary arteries are found in 0.6% to 1.3% of patients in coronary angiography. Dual left anterior descending coronary artery (LAD) is a rare coronary anomaly and is incidentally detected during coronary angiography. We report a case of a 65-year-old female with a rare coronary anomaly who was diagnosed with dual LAD via coronary computed tomography and coronary angiography. The imaging studies revealed dual LAD originating from the left main stem and right coronary sinus. These angiographic findings were considered to be consistent with the type IV variety of dual LAD by Spindola-Franco classification. Recognition of dual LAD is important to prevent errors of interpretation of the coronary angiogram and for optimal surgery.

A Case of Aberrant Right Subclavian Artery (Arteria Lusoria) with Chest Tightness and Coughing.: Seung Hee Han, Su Young Kim, Hye Kyong Park, Jong Sung Park; Yeungnam Univ J Med. 2012;29(1):61-64. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.61

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Abstract PDF: The left aortic arch with an aberrant right subclavian artery, or arteria lusoria, is the most common aortic arch anomaly, occurring in 0.5-2.5% of individuals. In such cases, the angular course of the arteria lusoria to the ascending aorta imposes difficulty in passing a guide wire to the ascending aorta during right transradial catheterization. Here, the case of a 53-year-old woman with intermittent chest tightness and coughing is reported. Aberrant right subclavian artery (arteria lusoria) was diagnosed via aortogram during right transradial coronary angiography. Compression of the esophagus and trachea by the aberrant right subclavian artery was demonstrated by chest computed tomography (CT).

Original Article

Nonsegmental Abnormal Arterial Attenuation : Transient Hyperperfusion of the Peripheral Zone of the Liver on Arterial Dominant Phase: Won Kyu Park, Jay Chun Chang, Jae Woon Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S310-318. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S310

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Abstract PDF: Purpose：This study was done to arrange the cases showing temporally hyperperfusion in the periphery of the liver, to check the etiology and mechanism, and to find out the new radiologic role on diffuse liver disease. Materials and Methods：We reviewed 12 cases of showing transient arterial hyperperfusion in the just peripheral portion of the liver on the arterial dominant phase on dynamic CT and the absence of abnormal perfusion between central and peripheral portion on tissue equilibrium phase. We retrospectively analyzed final diagnosis and the presence of main portal vein thrombi, and cavernous transformation.
Results
：Final diagnosis in 12 cases was as follows: diffuse liver disease was in seven cases, pancreatitis in three and pyogenic portal thrombosis in two. Main portal vein thrombosis were detected all cases of pancreatitis and pyogenic portal thrombosis. In seven diffuse liver disease, two cases shown thrombosed, two cases shown normal and the other cases are collapsed. Cavernous transformation was in three cases of pancreatitis and two of diffuse liver disease.
Conclusion
：We think that the causes of this phenomenon maybe as follows: the difference of the hemodynamic compensation mechanism between central and peripheral zone of the liver, presence of microscopic thrombi in peripheral portal branch which cannot be detected by imaging technique, hypercoagulability in portal area, the systematic destruction of terminal portal branch and the development of ectopic portal pathway.

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