A 67-year-old male patient with chest tightness and diaphoresis presented to the emergency department 1 hour before admission. The patient had a myocardial infarction with stent implantation history F I G U R E 1 Electrocardiograms obtained on admission. Ventricular tachycardia with right bundle branch block pattern and extreme right axis deviation indicating the left ventricle apical origin.

Introduction: Enterocutaneous fistulas (ECFs) can be caused by abscess formation at the site of anastomotic leakage (AL) after surgery. Rectocutaneous fistula following low anterior resection (LAR) is rare, and medical management of ECFs is usually the initial treatment. We report a case of rectocutaneous fistula after laparoscopic LAR, which was successfully treated, for the first time, with a transanal endoscopic operation (TEO). Case Presentation: A 58-year-old man presented with a history of hypertension, benign prostatic hyperplasia, peptic ulcer, and recent diagnosis of rectal cancer. The patient underwent laparoscopic LAR with coloanal anastomosis complicated with AL. He then underwent transanal repair of the anastomosis site and laparoscopy with ileostomy. Six months later, he complained of a painful mass lesion over the right buttock that relieved after passing purulent fluid and feces. Colonoscopy and imaging revealed a fistula for which he received antibiotics and wound incision and drainage. He also underwent TEO repair of the rectal fistula, recovered well, and was discharged from hospital. On follow-up 7 months later, there was no recurrence or sign of localized infection. Conclusion: TEO repair may be an effective method for managing rectocutaneous fistula after LAR complicated with AL instead of a major operation.

Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia that can lead to loss of cardiac function and sudden cardiac death. The most common cause of VF is ischemic cardiomyopathy, especially in the context of an acute coronary event. Prompt treatment with resuscitation and defibrillation can be lifesaving. Refractory VF, or pulseless ventricular tachycardia (pVT), refers to cases that do not respond to traditional advanced cardiac life-support (ACLS) measures, and it has a low survival rate. Some new life-saving interventions and novel techniques have been proposed as viable treatment options for patients presenting with refractory VF/pVT out-of-hospital cardiac arrest; these include extracorporeal membrane oxygenation (ECMO), esmolol, stellate ganglion block (SGB), and double sequential defibrillation (DSD). Recently, DSD has been discussed and used more frequently, but its survival rate is still not promising. We report a case of refractory VF caused by acute myocardial infarction that was treated with ACLS, DSD, ECMO, and cardiac catheterization in sequence, with a successful outcome.