BACKGROUND: This study highlights an unusual and previously unreported adverse event (AE) following the minimally invasive treatment of pancreatic walled-off necrosis (WON). The standard treatment for WON currently involves primary drainage via an ultrasound-guided endoscopic, typically transgastric, approach. This method is associated with lower mortality and morbidity rates compared to traditional surgery. However, emerging AEs from these procedures may necessitate the involvement of a multidisciplinary team. Our case highlights the potential for gastrovesical fistula development as a rare AE following endoscopic drainage. Treatment for our patient prioritized individualized and non-surgical strategy, although surgical revision was also considered. CASE DESCRIPTION: A 42-year-old male presented with a large symptomatic pancreatic WON refractory to conservative management, necessitating transgastric drainage. Despite the gradual evacuation of the WON contents, treatment was complicated by stent-related issues, including inadvertent bladder penetration. Rather than surgical correction, a collaborative approach among urology, gastroenterology, and surgery teams was employed, focusing on conservative treatment strategies. This approach successfully resolved the fistula, leading to the patient's full recovery. CONCLUSIONS: Given the increasing use of endoscopic transluminal drainage in (peri)pancreatic collections, it is crucial to be aware of all potential AEs. To our knowledge, this is the first documented case of gastrovesical fistula following drainage of WON. Early recognition and a multidisciplinary approach are vital to manage this event.
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ASD (anorectal suppurative diseases = anorektální hnisavá onemocnění), zejména anorektální abscesy a píštěle, jsou relativně častá onemocnění vyskytující se v populaci. Ve 30-70% případů primárních abscesů již existuje konkomitantní píštěl, známá či skrytá. V poslední době se dle některých studií ukazuje, že komplementární antibiotická terapie může snížit riziko vzniku pozdní fistuly po primárním chirurgickém ošetření (incise či incize a drenáž) abscesu bez signifikantního vlivu na recidivu abscesu. Cílem této studie je objektivizace přínosu konkomitantní antibiotické terapie při léčbě anorektálních abscesů jako složky snižující incidenci postinstrumentální perianální fistuly do jednoho roku od primárního ošetření prostřednictvím prospektivně-retrospektivní analýzy srovnávající soubor pacientů ošetřených chirurgicky s antibiotickou terapií s kontrolním souborem bez antibiotické terapie. Prospektivně bylo hodnoceno 28 pacientů s konkomitantní terapií, retrospektivně bylo do studie rovněž zahrnuto 28 pacientů léčených pouze incizí. Výsledkem studie bylo snížení incidence vzniku fistuly o 18% v skupině s konkomitantní terapii ve srovnání se skupinou pacientů léčených pouze incizí. Lze tedy konstatovat, že na základě provedené studie konkomitnatní terapie anorektální abscesů v korelaci s největší dosud provedenou metaanalýzou na dané téma (Mocnau et al. 5/2019) snižuje riziko vzniku pozdní fistuly po primární incizi a lze ji tedy doporučit v algoritmu terapie.
ASD (anorectal suppurative diseases), specifically anorectal abscesses and fistulas are relatively common diseases occuring across the population. There is a concomitant fistula, already known or hidden, existing already in 30-70% of primary anorectal abscesses. According to the recent studies there are proves of fistula risk reduction influenced by concomitant antibiotic therapy after primary surgical treatment of abscess (incision or incision with drainage) without affecting the general risk of abscess relapse. The aim of this study is to objectify the benefit of concomitant antibiotic therapy in treatment of anorectal abscesses as a component reducing the incidence of postinstrumental perianal fistula within one year of primary treatment by a prospective-retrospective analysis comparing a group of patients treated by surgical incision with antibiotic therapy, with a control group without this therapy. In this study 28 patients with concomitant therapy were prospectively evaluated, while also 28 patients treated only by incision were included in the study evaluating them retrospectively. The result of the study was a reduction in the incidence of fistula by 18% in the group with concomitant therapy compared to the group with monotherapy by incision. It can therefore be concluded that, based on the conducted study, concomitant therapy of anorectal abscesses in correlation with the largest meta-analysis dealing with this subject to date (Mocnau et al. 5/2019) reduces the risk of developing a late fistula after primary incision and can therefore be recommended in the algorithm of therapy.
BACKGROUND: Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by systemic inflammatory response syndrome and vasculopathy. SARS-CoV-2 associated mortality ranges from 2% to 6%. Liver dysfunction was observed in 14%-53% of COVID-19 cases, especially in moderate severe cases. However, no cases of spontaneous hepatic rupture in pregnant women with SARS-CoV-2 have been reported. CASE SUMMARY: A 32-year-old pregnant patient (gestational age: 32 wk + 4 d) without any remarkable medical history or long-term medication presented with epigastralgia. Infectious, non-infectious, and pregnancy-related hepatopathies were excluded. Sudden onset of right subcostal pain with D-dimer and liver enzyme elevation was followed by shock with thrombocytopenia. While performing an emergency cesarean section, hemoperitoneum was observed, and the patient delivered a stillbirth. A 6-cm liver rupture at the edges of segments V and VI had occurred, which was sutured and drained. SARS-CoV-2 positivity on reverse transcription-polymerase chain reaction was confirmed. Further revisions for intrahepatic hematoma with hemorrhagic shock and abdominal compartment syndrome were performed. Subsequently, the patient developed hemoptysis, which was treated using bronchoscopic therapy and non-invasive ventilation. Liver tissue biopsy revealed hemorrhagic foci and necrosis with an irregular centrilobular distribution. Antiphospholipid syndrome and autoimmune hepatitis were also ruled out. Fetal death was caused by acute intrauterine asphyxia. CONCLUSION: This case reveals that pregnant women with SARS-CoV-2 infection may be predisposed to liver parenchyma disease with liver rupture.
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