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Percutaneous transhepatic biliary drainage (PTBD) and embolization of the right posterior sectoral duct. Under general anaesthesia, the left hepatic duct was punctured. Cholangiogram confirmed active leak from the right posterior duct (Fig. 3A). Subsequently, the right posterior sectoral duct was embolized using coils and glue (solid arrow in Fig. 3B). 8.5 F external biliary drain was kept via left hepatic duct into the duodenum (thin arrow in Fig. 3B).
Source publication
Introduction
Minimally-invasive techniques offered by interventional radiology (IR) are really helpful in the management of challenging surgical cases. The current report highlights a series of four complex pediatric surgical cases which were successfully managed by specific image-guided techniques.
Case presentation
The first two cases in the pre...
Contexts in source publication
Context 1
... USG-guided drain insertion in the right paracolic gutter and pigtail insertion in the right hemithorax. The right lung showed complete expansion with the resolution of respiratory distress over the next 72 h, however, a persistent high-output bilious drainage (>300 mL/day) was observed from the abdominal drain over the next 2 weeks. A repeat (Fig. 3A). Subsequently, the right posterior sectoral duct was embolized using coils and glue (solid arrow in Fig. 3B). 8.5 F external biliary drain was kept via left hepatic duct into the duodenum (thin arrow in Fig. ...
Context 2
... right lung showed complete expansion with the resolution of respiratory distress over the next 72 h, however, a persistent high-output bilious drainage (>300 mL/day) was observed from the abdominal drain over the next 2 weeks. A repeat (Fig. 3A). Subsequently, the right posterior sectoral duct was embolized using coils and glue (solid arrow in Fig. 3B). 8.5 F external biliary drain was kept via left hepatic duct into the duodenum (thin arrow in Fig. ...
Context 3
... however, a persistent high-output bilious drainage (>300 mL/day) was observed from the abdominal drain over the next 2 weeks. A repeat (Fig. 3A). Subsequently, the right posterior sectoral duct was embolized using coils and glue (solid arrow in Fig. 3B). 8.5 F external biliary drain was kept via left hepatic duct into the duodenum (thin arrow in Fig. ...
Context 4
... CECT revealed right posterior sectoral duct injury. The child underwent a percutaneous transhepatic cholangiogram (Fig. 3A) confirming the site of the biliary leak. Subsequently, coil and glue embolization of the right posterior duct was performed (Fig. 3B). The external drain was kept in-situ and the child was discharged after 24 h of observation. The drain was removed after 3 weeks when the follow-up cholangiogram confirmed no leak. After 6 weeks of ...
Context 5
... CECT revealed right posterior sectoral duct injury. The child underwent a percutaneous transhepatic cholangiogram (Fig. 3A) confirming the site of the biliary leak. Subsequently, coil and glue embolization of the right posterior duct was performed (Fig. 3B). The external drain was kept in-situ and the child was discharged after 24 h of observation. The drain was removed after 3 weeks when the follow-up cholangiogram confirmed no leak. After 6 weeks of follow-up, the child is healthy and gaining milestones as per chronological ...
Citations
... With increasing numbers of Children's Oncology Group Guidelines being developed that support neoadjuvant therapy ensuring these guidelines are followed may help make surgical resection of complex tumors safer and lead to superior oncologic outcomes. More recently preoperative embolization of tumors has been utilized not only to help decrease the tumor burden but also minimize the risk of large intraoperative blood loss [6,13,14]. ...
Purpose
Complex pediatric surgery patients with thoracic tumors invading the mediastinum and infradiaphragmatic tumors extending into the chest are at risk for surgical morbidity and mortality if the patient’s care is not coordinated. We sought to identify areas of focus when managing these patients to improve care.
Methods
A 20-year, retrospective study of pediatric patients with complex surgical pathology was performed. Demographic data, pre-operative characteristics, intraoperative data, complications, and outcomes data were collected. Three index cases were highlighted to provide granularity in patient management.
Results
Twenty-six patients were identified. Common pathology included mediastinal teratomas, foregut duplications, advanced Wilms tumors, hepatoblastoma, and lung masses. All cases were performed in a multidisciplinary fashion. All cases were done with pediatric cardiothoracic surgery and three cases (11.5%) required pediatric otolaryngology. Eight patients (30.7%) required cardiopulmonary bypass. Operative and 30-day mortality was zero.
Conclusions
Management of complex pediatric surgical patients requires a multidisciplinary approach throughout the patient’s hospital course. This multidisciplinary team should meet in advance of a patient’s procedure to create a customized care plan that may include pre-operative optimization. At the time of their procedure, all necessary and emergency equipment should available. This approach improves patient safety and has resulted in excellent outcomes.
Level of evidence
IV.
Even at high-volume centres, pancreatic resections are linked with a high rate of complications, as well as significant morbidity and mortality. In the management of these occurrences, a multidisciplinary approach is required, and interventional radiology plays an important role in the treatment of patients who develop post-surgical problems. The current review was planned to provide an overview of interventional radiological techniques that can be used to treat various types of problems following pancreatic resection. Percutaneous fluid collection drainage, percutaneous transhepatic biliary operations, artery embolisation, venous interventions, and fistula embolisation are feasible therapeutic alternatives with fewer problems than a re-look surgery. They also have a shorter hospital stay and faster recovery.
Key Words: Embolization, interventional radiology (IR), pancreatic resection, postpancreatectomy hemorrhage, stent-graft.
