We report a case of aortoesophageal fistula (AEF) caused by a fish bone that had a successful outcome. Aortoesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Over one hundred cases of AEF secondary to foreign body ingestion have been documented but only seven, including our case, have survived over 12 months. Treatment involved stabilising the patient with a Sengstaken-Blakemore tube and insertion of a thoracic aortic endovascular stent-graft. Unfortunately the stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest. Case presentationA 59 year old man with no prior medical history, presented to a peripheral hospital emergency department with sharp pain retrosternally after eating fish the previous day. He was able to swallow fluids and soft diet but with odynophagia. A cardiac cause was ruled out and a barium swallow was organised as an outpatient. The patient was discharged home. Day five after presentation he had frank haematemesis and some malaena. He was haemodynamically stable with a haemoglobin at 130 g/L and admitted to the general surgical ward. The next day he had another large haematemesis and proceeded to urgent upper gastrointestinal (GI) endoscopy where a fish bone was seen protruding from an ulcerated area in the oesophagus, 24 cm from the teeth. There was some active bleeding after the fish bone was removed. A SengstakenBlakemore tube (SBT) was inserted and the oesophageal and gastric balloons inflated. This controlled the bleeding and the patient was admitted to the intensive care unit (ICU) with intravenous (IV) antibiotics as well as an ongoing blood transfusion. Overnight there was no further bleeding but the patient had evidence of sepsis with a high fever and hypotension despite no evidence of blood loss. He required inotropic support.The following morning, the patient was transferred to the ICU at our centre. The SBT balloons were deflated and patient observed. There was no evidence of blood loss over the ensuing 24 hours so the SBT was removed. Five hours later, he had a massive haematemesis causing hypovolaemic shock with cardiac arrest requiring reinsertion and reinflation of the SBT, massive transfusion and cardiopulmonary resuscitation. Once stabilized, a computed tomography (CT) angiogram was performed. This dem-
We present the case of a female patient in her 40s who underwent a splenic artery aneurysm (SAA) repair following a previous laparoscopic sleeve gastrectomy (SG). We aim to discuss the management approach to SAAs and considerations in the setting of previous bariatric surgery.The patient consented to this case report. We include preoperative and postoperative radiological images and intraoperative images.While pseudoaneurysms following bariatric surgery have been reported, we present a case of a likely true SAA following SG. Our experience may assist others who come across similar cases in the future.
Aim: With increasing demands on the healthcare system, a central (and currently essential) push for remote consultations, and an increasing number of co morbidities in the surgical population, the aim was to create an application that placed the focus on pre-hospital optimisation, education and autonomy – addressing these sector trends to enhance outcomes for patients and ease the burden on healthcare settings. Method After obtaining baseline data, I worked alongside students from the Queensland University of Technology to produce an application suitable for both iOS and android platforms. Results The application has four facets which mirror a patient’s journey from their initial outpatient appointment through to recovery. The application is easy to use, free to download and readily accessible. On opening the application, the user can select their planned operation and navigate along a personalised decision tree. Conclusions The application has been designed to educate and empower a patient to become an active participant in their care, leading to long-term changes in healthcare. Assessment is ongoing but early indications suggest that this will be a valuable tool in optimising outcomes for patients undergoing vascular surgery – leading to fewer post-operative complications and earlier restoration of functional status.
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