Background and study aims: Long-term transmural double-pigtail stent (DPS) placement is recommended for patients with disconnected pancreatic duct syndrome (DPDS) and peripancreatic fluid collections (PFC). Long-term safety and efficacy of indwelling DPS were evaluated. Patients and methods: Medical files of patients treated with DPS for DPDS-associated PFC and a follow-up ≥48 months were reviewed. Early (<30 days) and late complications of DPS placement were evaluated and the primary endpoint –the incidence rate of late complications per 100 patients-years– was calculated. Short- and long term success rate of endoscopic treatment and PFC recurrence rate were among secondary endpoints. Results: From 2002 to 2014 we identified 116 patients [follow-up: 80.6 (34.4) months]. Among early complications (n=20), 6 occurred peri-interventionally. Late complications (n=17) were mainly pain due to DPS-induced ulcer or erosion (n=10) and 14 of these were treated conservatively or by stent removal. Two gastro-pancreatico-colo-cutaneous fistulas and one persisting bleed required surgical intervention. No DPS-related deaths were recorded. The incidence rate of late complications was 2.18 per 100 patient-years of follow-up; 95%CI [1.27, 3.49]. Short- and long-term success rate of endoscopic treatment was 97.4% [94.5, 100) and 94% [89.6, 98.3], respectively. The PFC recurrence rate was 28% [20.1, 35.9] and 92.3% of them occurred within the first two years. Stent migration, chronic pancreatitis and length of stent size (>6cm) were independently associated with higher rates of PFC recurrence. Conclusions: Long-term transmural drainage with DPS is a safe and effective treatment for DPDS-associated PFCs. However, about one fourth of PFC will recur.
Bladder rupture related to Foley catheter insertion is a rare condition mainly reported in patients with chronic bladder disease. In the present case, this rare condition was associated with massive hematoma due to active arterial bleeding, which was treated by embolization. We present the case of a 38-year-old woman admitted to the gastroenterology department with decompensated alcoholic liver cirrhosis, anemia, malnutrition, and diabetes. Six days after admission, she presented with hypotension and tachycardia associated with gross hematuria. An abdominal computed tomography scan revealed a Foley catheterization-related bladder perforation and a massive extra-peritoneal hematoma caused by active arterial bleeding from a distal branch of the right vesical artery. A successful embolization was performed with microparticles and coiled with complete hemorrhage control on post-procedure imaging. The bladder perforation was treated conservatively with a urinary drainage catheter, irrigation, and antibiotics. Despite these measures, the patient died 15 days later due to liver failure and sepsis. Our case highlights that commonly performed simple procedures can lead to severe complications, especially in frail patients.
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