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Gastrointestinal Endoscopy 08/2003; 58(1):97-8. · 4.88 Impact Factor
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ABSTRACT: Visceral and renal arteries pseudoaneurysms are uncommon but potentially lethal complications of hepatic and pancreatobiliary interventions. To evaluate the clinical outcome of transcatheter arterial coils embolotherapy, we reviewed our institution's experience with the management for bleeding pseudoaneurysms.
From January 1988 through December 2004, 20 patients were encountered who developed massive bleeding from pseudoaneurysms following hepatobiliary and pancreatic interventions. All patients underwent diagnostic angiography and transarterial embolization was carried out thereafter.
Embolization was technically successful without major post-procedural complications in all patients. Bleeding was stopped after embolization in 17 patients (85%), and rebleeding did occur in one patient during the follow-up periods. Repeat coil embolotherapy was performed in one patient with recurrent bleeding, but they needed surgical intervention because of failed re-embolization. Another two patients needed surgical ligation and one of the patients died of sepsis two weeks later.
An emergency angiography should be considered in all patients in whom pseudoaneurysm is suspected following hepatobiliary and pancreatic interventions. Transcatheter arterial coil embolization is a safe and effective treatment for pseudoaneurysm. Surgical intervention should be reserved for patients for whom embolization fails or for whom it is not possible.
Hepato-gastroenterology 54(73):41-6. · 0.66 Impact Factor
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ABSTRACT: Laparoscopic cholecystectomy is considered as a standard procedure for symptomatic gallstones. However, the incidence of iatrogenic bile duct injury is higher that the conventional cholecystectomy. In the present study was analyzed the results in 6 patients with iatrogenic bile duct injury during laparoscopic cholecystectomy with restenotic hepaticojejunostomy treated with self-modified Gianturco-Rosch stents.
Data were collected retrospectively on May 2000 to October 2008 on six patients with major bile duct injury secondary to cholecystectomy. All patients underwent surgical reconstruction with a Roux-en-Y hepaticojejunostomy and presented clinically as obstructive jaundice. Percutaneous transhepatic and/or endoscopic retrograde cholangiography, cholangioplasty by balloon dilation and biliary catheter placement were done in each patient prior to stents placement. Modified Gianturco-Rosch stents with 3cm length and 10mm diameter were used. Follow-up was obtained with direct patients contact or hospital records.
Metallic stents were successfully implanted in all 6 patients and the mean patency rate was 46.5 months (range = 14-101 months). One patient required percutaneous recanalization procedure for recurrent cholangitis and obstruction.
Gianturco-Rosch stents placement should be considered in patient with post-hepaticojejunostomy restenosis that repeat surgery is not feasible.
Hepato-gastroenterology 56(96):1592-5. · 0.66 Impact Factor
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ABSTRACT: Isolated pancreatic transection is rare. Associated main pancreatic duct injury is the principal determinant factor of outcome. Earlier computed tomographic scanner may be unreliable in determining the location and severity of pancreatic injury. Multiplanar reconstruction (MPR) and curved views of multidetector computed tomography are helpful in accurate diagnosis of pancreatic transection with the main pancreatic duct injury.
Hepato-gastroenterology 56(93):1211-2. · 0.66 Impact Factor
