Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A four-year-old female, born with cloacal exstrophy, returned for evaluation of her urinary incontinence two years after her initial repair. Her bladder had been turned in at her first operation and had a capacity of approximately 15 cc. Her ureters exited close to the reconstructed introitus. At reoperation, her bladder measured 3.5 cm in length and appeared to be well healed and of normal consistency. An anterior wall bladder flap was created which was based at the dome and was reflected 180 degrees cephalad. The bladder was then tubularized over a #10 french catheter to create a "neo-urethra" of 6 cm in length. Both ureters were reimplanted into an intestinal conduit, constructed 18 cm long, in a nonrefluxing fashion. The distal, oversewn, end of the conduit was sewn down into the pelvis, at the level of the bladder neck and posterior to the "neo-urethra." The end of the neo-urethra was anastomosed to the anterior wall of the intestinal reservoir, which was then plicated circumferentially around the neo-urethra in a manner very similar to the construction of a Nissen fundoplication for gastro-esophageal reflux. Pressure in the reservoir serves to keep the neo-urethra closed so that urine cannot escape until the neo-urethra is intubated. She is currently continent of urine with a successful program of clean intermittent catheterization. Her upper tracts remain undilated and are free of intestinal-ureteral reflux. Her urine is sterile.
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PMID:A neo-urethral enteroplication for urinary continence in a case of cloacal exstrophy. 408 87

Tubal ligation (TL) is an effective and common method of fertility control. In the year 2009, over 24,000 were performed in Canada alone. Migration of Filshie clips used during TL is estimated to occur in 25% of all patients; 0.1-0.6% of these patients subsequently experience symptoms or extrusion of the clip from anatomical sites such as the anus, vagina, urethra, or abdominal wall. Migrated clips may present as chronic groin sinus, perianal sepsis, or chronic abdominal pain. These symptoms can occur as early as 6 weeks or as late as 21 years after application. We present the case of a 49-year-old female with a 3.5-year history of intermittent dull nonradiating left upper quadrant (LUQ) pain lasting on average 2-3 days. There were no other associated symptoms, and the longest pain-free period was 4 days. Her past medical history includes COPD, GERD, IBS, and depression. Current medications are only remarkable for Symbicort. Pertinent past surgical history includes laparoscopic tubal ligation with Filshie clips in 1999, followed by a vaginal hysterectomy in 2013. Migrated tubal ligation clip was noted on an abdominal X-ray. The patient was then referred for surgical management. Subsequent CT scan confirmed a solitary clip present adjacent to the left lobe of the liver. No other abnormalities were reported. Patient underwent laparoscopy for removal of the clip, which was identified to be underneath the left lobe of the liver embedded in the gastrohepatic omentum. Please see the video link provided. Postoperative pathology report confirmed the presence of a Filshie clip. Patient reported complete resolution of her LUQ pain at a 5-week and 3.5-month follow-up. This case shows that although symptomatic clip migration is a rare phenomenon, it should be given special consideration in women with unexplained chronic abdominal pain and a history of TL. Additionally, removal of clip can provide resolution of symptoms.
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PMID:Migrated Tubal Ligation (Filshie) Clip as an Uncommon Cause of Chronic Abdominal Pain. 3209 7