Ureteral obstruction after abdominal aortic surgery

Article Abstract:

The incidence of ureteral obstruction (blockage of the outflow of urine from the kidneys to the bladder) following surgery performed on the abdominal portion of the aorta is difficult to determine. (The aorta is the main trunk of the systemic arterial system.) The patient is usually without symptoms if the obstruction occurs in only one ureter, or if bilateral obstruction is only partial. In addition, ureteral obstruction is often temporary. Within the first year of surgery on the abdominal aorta, about 10 to 20 percent of patients develop early hydronephrosis (back-up of urine in the kidney); this often resolves spontaneously. The incidence of hydronephrosis beyond the first postoperative year is not known, although kidney function is not usually impaired. If hydronephrosis is identified clinically (by X-ray or a scanning technique), it does not usually require treatment unless there is worsening of the obstruction or deterioration of kidney function. The presence of hydronephrosis, particularly after the first postoperative year, seems to be an indicator of either current or impending aortic graft complications, such as infection or false aneurysm (localized thinning of the vessel wall). Ultrasound examination of the urinary tract beyond the first postoperative year could easily be accomplished if it were determined to be useful for identifying possible graft infection or false aneurysm. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ureters, Ureteral obstruction, Abdominal aorta

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Postoperative external alimentary tract fistulas

Article Abstract:

Postoperative esophageal, stomach or intestinal fistulas (abnormal connections between an internal organ and a free surface or another organ) can result from leaks or damage caused during surgery. This complication is associated with death rates of between 6 and 20 percent. A review is presented of 117 patients treated since 1980 for postoperative external alimentary tract fistulas (gallbladder, pancreatic and internal fistulas were excluded from this study). The average patient age was 50 years; mortality was 37 percent (43 patients). Sixty percent of the patients with fistulas draining through the abdominal wall died. The lowest mortality (17 percent) occurred in patients with esophageal, stomach or duodenal fistulas. Large bowel fistula had a 20 percent mortality and small bowel fistula, a 33 percent mortality. The prime cause of death was abdominal infection with multiple organ failure, occurring in 72 percent of deaths. Eighty-nine patients (76 percent) required reoperation, and of these patients, 45 died. It is concluded that despite modern methods of diagnosis and treatment, postoperative external gastrointestinal fistula caused by leak or injury results in death for more than one-third of patients with this complication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Patient outcomes, Mortality, Fistula, Fistulas, Gastrointestinal system, Fistula, Intestinal, Intestinal fistula

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Surgical management of the redundant transposed colon

Article Abstract:

When it is necessary to replace or bypass the esophagus, the stomach is usually the organ used. At times, however, the stomach may not be available for this purpose, and the colon (large intestine) is the second choice. When the colon is used, it is not uncommon for redundance of the transposed colon to occur; this has been observed in 22 percent of patients. The redundance may result in kinking, or may create a 'sink-trap' effect, causing poor emptying and accumulation of debris which further dilates the organ. Symptoms attributed to redundant transposed colon are difficulty swallowing, regurgitation, or a feeling of fullness in the chest. Most patients in which redundancy is visualized are without symptoms. Patients without symptoms or with only mild symptoms should be observed and followed-up. Severe difficulty swallowing may not be due to redundance, but to obstruction occurring at the anastomosis (point of joining) between the colon and stomach, and this possibility should be excluded. If there is weight loss as a result of difficulty swallowing, surgery will be necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Esophagus, Esophageal surgery, Deglutition disorders

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