ABSTRACT
Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy.
Subject(s)
Humans , Male , Middle Aged , Abscess/diagnostic imaging , Bile Duct Neoplasms/pathology , Biopsy/methods , Catheterization/methods , Cholangiocarcinoma/pathology , Drainage/instrumentation , Neoplasm Recurrence, Local/pathology , Pancreatic Diseases/diagnostic imaging , Pancreaticoduodenectomy , Postoperative Complications/diagnostic imaging , Radiography, Interventional/methods , Retroperitoneal SpaceABSTRACT
Local back pain and radiculopathy can be debilitating for sufferers of these conditions. There are a multitude of treatment modalities, ranging from conservative approaches such as bed rest, physical therapy and chiropractic manipulation, to more invasive options such as percutaneous spinal intervention (PSI) and surgery. We present here the techniques employed in the use of minimally invasive, image-guided percutaneous techniques under computed tomography fluoroscopy in our institutions. The inherent high spatial and tissue contrast resolution not only allows ease of trajectory planning in avoiding critical structures, but also allows precision needle placement. Cervical, lumbosacral, and sacroiliac pain can therefore be evaluated and treated both safely and effectively.