Objective The objective of this study was to assess the maternal and prenatal ultrasound findings and outcome in pregnancies complicated by congenital myotonic dystrophy Type 1 (DM1). Methods

Variation in the practice of intrapartum and postpartum bladder care reported by 189 maternity units in England and Wales hospitals was evaluated by analysing the data obtained from a postal questionnaire completed by labour ward managers or heads of midwifery. The survey revealed that there was no consensus of opinion about the diagnostic criteria for postpartum urinary retention and therefore the optimum management for voiding dysfunction remains controversial. In spite of the increasing awareness of the risk management issues involved, the majority of the units were found to be noncompliant with the limited RCOG recommendations currently available. Although further research is needed to develop evidence-based guidelines, all units should be timing and measuring the voided volume and ideally checking the first post-void residual volume to ensure that retention does not go unrecognised.

INTRODUCTIONAortoenteric fistula is a rare but very serious complication of both surgical and endovascular abdominal aortic reconstruction. Since the advent of endovascular abdominal aortic aneurysm repair (EVAR), 20 cases of aortoduodenal fistula associated with aortic stent grafts have been reported.1 However, only a handful has been reported following inflammatory abdominal aortic aneurysm repair. It most commonly presents with bleeding, usually from the upper gastro-intestinal tract. With recent advances in the screening, diagnosis and management of abdominal aortic aneurysms either surgically or through an endovascular approach, the diagnosis of an aortoduodenal fistula in patients with gastro-intestinal bleeding must be suspected and excluded.PRESENTATION OF CASEWe describe a case of secondary aortoduodenal fistula that occurred two and a half years following endovascular stent graft repair of an inflammatory abdominal aortic aneurysm. We also outline the emergency correction plan and the attempts at repair.DISCUSSIONThis case defies the general concept that patients with inflammatory abdominal aortic aneurysms are relatively immune to rupture. Although the presence of a peri-aneurysm thick inflammatory membrane decreases the possibility of rupture, these patients are more susceptible to other related complications such as aorto-enteric and aorto-caval fistulas.2 This case also demonstrates the peculiar presence of Streptococcus anginosus as the pathological organism leading to graft infection and subsequent fistula, as opposed to enterococci which are often found in endograft infection.CONCLUSIONAorto-enteric fistulas are associated with a grave prognosis. Early diagnosis is crucial and extra vigilance should be taken in cases of inflammatory AAA.

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