A 64-year-old male was admitted with suspected aortoduodenal fistula 16 years after transabdominal aortic reconstruction for aortoiliac occlusive disease. Computed tomography (CT) and angiography revealed an aortoduodenal fistula and a suture-line aneurysm at the proximal anastomosis. Due to the patient's poor general condition at the time of diagnosis, endoluminal stent-graft implantation was chosen rather than conventional surgery. Successful placement of the stent graft without leakage of contrast medium and with complete exclusion of the fistula was demonstrated by CT. The patient recovered uneventfully and was discharged 10 days after the intervention. Five months later contrast CT indicated a recurrence of the aortoduodenal fistula. Since the patient was now in good general condition the stent graft was removed surgically and an extra-anatomic axillofemoral bypass was implanted. Endoluminal stent-graft Implantation is effective as palliative therapy for aortoduodenal fistulas and is especially valuable in patients with high risk for conventional surgery.
Colonoscopy, either performed as screening or as a therapeutic proceedure, is, in general, very safe with only a few cases of serious complications. Most cases of bleeding after endoscopic polypectomy can be safely managed endoscopically. The rare cases of colonic perforations still have to be managed by surgical intervention. The postpolypectomy-coagulation syndrome and a cecal volvulus are very rare complicatoions after colonoscopy. In the current manuscript, we describe a rare case of a cecal volvulus after routine colonoscopy due to an unknown mobile coecum as a predisposition. We discuss the endoscopic, clinical and radiological findings of the patient. Moreover, we describe the performed surgical procedure and the further clinical course of the patient. A cecal volvulus should always be considered as a possible rare, but serious, complication in the differential diagnosis of abdominal pain after colonoscopy. The standard therapy of a cecal volvulus is the right hemicolectomy. As an alternative, a coecopexy without resection could be performed as long as the colonic wall is still vital.
Mainly incited by the bushfirelike spread of endoscopic operative techniques in general surgery, thoracoscopy has become the object of new interest in the field of thoracic surgery. Location and resection of lung tumors are problematic for several reasons and so far not standardized. The main problems are pointed out. A new technique together with the instruments and their advantages is demonstrated. Future aspects are discussed.
Neurological manifestations were more frequent in patients with diabetes (p b 0.05), in whom persistent hyperglycemia and thrombocytopenia were observed.
ConclusionsIn patients with late hospitalization due to COVID-19, neurological manifestations may be more frequent in those with diabetes and might be related to a negative outcome.
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