Background: Acquired uterine vascular abnormalities are a rare cause of potentially life-threatening bleeding. These include uterine artery pseudoaneurysms (UAP)and acquired arteriovenous malformations. The objective of this study was to describe our experience with the diagnosis of acquired uterine vascular abnormalities and its treatment with uterine preservation. It was a retrospective cohort study. Methods: Eight patients were enrolled from the hospital database who presented to our Interventional Radiology department from April 2017 to March 2021 for uterine artery embolisation (UAE) with a history of iatrogenic/acquired uterine vascular abnormalities confirmed on imaging. These included two patients with uterine artery pseudoaneurysm (PA) concurrently with arteriovenous malformation (AVM), one with uterine artery PA and five having uterine AVMs. Embolisation agents used were histoacryl glue, lipiodol, PVA particles, and gelfoam slurry. Medical records, imaging studies, and telephonic contact with patients were assessed for patient presentation, intraprocedural details, and follow up to record treatment success. Statistical analysis was performed using descriptive statistics. Results: Bilateral UAE was performed in six patients, while two patients underwent unilateral UAE. Three of the patients presented with life-threatening bleeds requiring multiple transfusions. Clinical as well as angiographic success was achieved in all patients with immediate control of haemorrhage. No complications were observed during follow-up. Two of the patients were able to conceive normally within one year, though it resulted in a miscarriage. Conclusion: Acquired/iatrogenic uterine vascular abnormalities are a rare but important cause of life-threatening haemorrhage that can be expertly managed and successfully treated using UAE, which is rapid, safe, and minimally invasive, with the added advantage fertility preservation.
malignant obstruction, 1 patient had occluded pre-placed metallic stent by debris and pus and one patient had a stenotic bilioenteric anastomosis with inadequate history of previous surgery prior to ERCP. Rendez-vous technique was used in 2 patients for eventual placement of metallic stents. Clinical improvement evidenced with dropping bilirubin levels, resolving jaundice and sepsis-related symptoms were seen in all patients. Two-step external drainage with later conversion to internal metallic-stent drainage was performed in 2 patients. Single-step internal-external drainage was performed in 12 patients. No major complications were reported. Minor complications included fever, self-limiting intra-catheter bleed, skin infection, transitional catheter blockage and partial catheter dislodgment. Conclusions: PTBD remains an efficient method in the treatment of biliary obstruction in patients with failed retrograde endoscopic therapy. Our small series shows that PTBD remains the final resort in patients with failed endoscopic therapy in addition to its proven role as an initial approach for biliary decompression.
Background: Cesarean scar pregnancy is a rare type of ectopic pregnancy, which is potentially life-threatening if not diagnosed and treated timely, resulting in catastrophic complications. Early diagnosis is critical for the treatment. Transvaginal sonography has made possible early diagnosis and consequently preservation of the uterus and fertility. Intrauterine administration of methotrexate (MTX) is a conservative and nonsurgical method for ectopic pregnancy cessation. Methods: We describe two cases of live ectopic pregnancies managed with ultrasoundguided local injection of MTX complemented with potassium chloride (KCl). A 36-year-old woman with four previous cesarean scars, live and unruptured uterine ectopic scar pregnancy was referred to the Interventional Radiology Unit for evaluation and management. She underwent risk-benefit counseling. Under transvaginal sonographical guidance, puncture and injection of ectopic pregnancy was performed using a 22G Chiba device. Intrasacular MTX was injected, which was complemented with fetal intracardiac administration of KCl. We report another case of 34-year-old woman with 6 weeks ectopic pregnancy at the site of incision of lower-segment uterine scar pregnancy. Transducer guided 22G Chiba needle was advanced through the guide into gestational sac, approximately 1 ml of KCl was injected slowly. Afterward, 25 mg (1 ml) MTX was injected into the gestational sac. Results: Immediate cessation of fetal cardiac activity was noted. Weekly follow-up ultrasounds for a month remained uneventful with progressive resolution of gestational sac remnant. Conclusion: Unruptured live ectopic pregnancy can be successfully managed without surgical intervention through local injection of KCl and MTX preserving uterus.
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