We present two cases of congenital intrahepatic portosystemic shunts in which the right portal vein directly communicated with the inferior venacava (IVC) in one patient and with the hepatic vein in the other. Multiple hepatic nodules consistent with focal nodular hyperplasia (FNH) were seen in the first patient. The second patient presented with recurrent history of hepatic encephalopathy. Percutaneous transhepatic embolization was performed using coils and Amplatz device following which she completely recovered.
Cystic artery pseudoaneurysm is a rare pathology. Of the 20 cases reported so far, chronic cholecystitis and iatrogenic biliary injury form the majority of causes. Currently, there is no published report of such pseudoaneurysms caused secondary to pancreatitis, hence the management in such a scenario is unclear. We hereby present the first such report of cystic artery pseudoaneurysm occurring as a sequel of acute necrotising pancreatitis. A 33-year-old man who recovered from a recent attack of acute pancreatitis was readmitted for melena and fever. Computed tomography of abdomen revealed blood in the gall bladder with pericholecystic blush and resolving pancreatic necrosis. Percutaneous transarterial embolisation of the cystic artery was done. This stabilised the patient but persistent sepsis and clinical deterioration warranted a surgical exploration and cholecystostomy. Hence, transarterial embolisation followed by surgery in selected cases can be an ideal management protocol.
Coarctation of aorta aneurysm with aberrant right subclavian and single carotid artery. Central MessageCoA aneurysm with single carotid artery and aberrant right subclavian artery is extremely rare. Prevention of CNS ischemia during surgical repair mandates modified surgical and perfusion techniques.
Aim:To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients.Materials and Methods:We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study. The technical and clinical success of the percutaneous management was analyzed.Results:Anastomotic strictures associated with leak were found in 12/17 patients (70.6%). Ten out of 12 (83.3%) patients associated with leak had more than one duct-duct anastomoses (range, 2–3). The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6%) and clinical success was achieved in 13/17 (76.5%) of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4%) died (two acute rejections, one metabolic acidosis, and two sepsis).Conclusions:Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.
Introduction:The objective of our study was to review the results of percutaneous angioplasty (PTA)/stenting in the treatment of patients who presented with symptoms and angiographic findings of chronic mesenteric ischemia (CMI).Materials and Methods:We performed a retrospective analysis of 13 consecutive patients from a single institution who underwent PTA/stenting for the treatment of symptoms suggestive of CMI.Results:All 13 patients in our study were men, and most common presenting symptoms were weight loss and postprandial pain. Atherosclerosis was the most common cause. PTA and stenting was performed in 9 patients and PTA alone was done in 4 patients. Primary technical success rate was 92% with complete resolution of symptoms within 2 weeks in all patients. No statistical difference was noted in primary clinical success rate based on the number of vessels treated or the method of treatment. However, in patients whom SMA was treated had longer duration of symptom-free survival as compared to other vessels.Conclusion:PTA and stenting are very effective therapeutic options for patients presenting with CMI symptoms. It should be considered as the first-line of management in such patients.
BACKGROUND Living related liver transplantation in the adult is a new surgical procedure that allows healthy adults to donate a portion of their liver to compatible recipients. [1-3] This innovative procedure is performed to overcome the shortage of available cadaveric livers. Surgery involves removal of the right lobe of the liver (segments V-VIII) from a healthy donor without endangering the vascular supply or metabolic function of the remaining left lobe. Liver procurement is possible because of its unique bilobar multi-segmental anatomy. In addition, regeneration of the remaining left lobe compensates for the loss of hepatic mass. In this study, we evaluated the accuracy of total and segmental liver volume measurements using multi-detector CT in potential donors undergoing adult right lobe liver transplantation. MATERIALS AND METHODS Between May 2014 and March 2016, 31 patients 25 were females (80.6%) and 6 were males (19.4%) with a mean age of 39.8 years; range 22-58 years who underwent donor hepatectomy were evaluated. Imaging performed using Siemens Somatom Sensation 64 Slice CT after injection of Omnipaque (1.5 mL/kg) at a rate of 5 mL/sec. Arterial dominant phase images were acquired at 6 seconds, portal dominant phase images were acquired at +20 seconds and delayed phase images were acquired at +30 seconds. Bolus tracking with triggering of scan when the density of aorta was 100 HU is used in our Department. Volumetry done using Terarecon Intuition Edition Software by manual and automated methods. RESULTS Of the 14 donor grafts with middle hepatic vein, volume assessed using software-aided automated volumetry when compared with intraoperative graft volume found to have a correlation coefficient of r = 0.811 and is statistically significant p < 0.001. Manual volume estimation using 2.5 mm slice thickness and 5 mm slice thickness recorded a correlation coefficient of r = 0.776 and r = 0.754 respectively in comparison to actual graft volume and they are statistically significant with p < 0.001 and p < 0.002 respectively. In the second group of 17 donors' grafts without middle hepatic vein, volume assessed with software-aided automated volumetry with intraoperative graft volume estimation recorded a correlation coefficient of r = 0.977 and is statistically significant p < 0.001. In the same group, manual volume using 5 mm slice thickness and 2.5 mm slice thickness had a correlation coefficient of r = 0.877 and r = 0.865 respectively and they are statistically significant with p < 0.001 and p < 0.001 respectively. CONCLUSION In our study, CT volumetry is an accurate tool for preoperative liver volume calculation. We found Automated CT volumetry method to have a better correlation with the resected liver volume and thinner slices had a slightly more correlation than thicker slices for manual method when compared with the resected liver volume.
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