Endovascular Y-stent Graft Repair of Chronic Contained Ruptured Abdominal Aortic Aneurysm in High-Surgical Risk Patient.

Abdominal aortic aneurysm is a common condition and many a times asymptomatic. The mortality rate is high when it presents with rupture. However, a chronic contained rupture may remain undiagnosed for several weeks to months due to highly variable clinical presentation. Delay in the diagnosis and thereby delay in the treatment lead to worse clinical outcomes in patient experienced chronic contained rupture. We are here presenting a case of an adult patient who experienced rupture of infrarenal aortic aneurysm along with retroperitoneal hematoma. The abdominal aortic aneurysm was diagnosed after several months of rupture as the rupture occurred into the retroperitoneal cavity and remained confined in the retroperitoneal cavity. We successfully treated the patient by deploying a stent percutaneously.

Safety and Usefulness of Percutaneous Transhepatic Cholecystoscopy (PTCCS) in High-Risk Surgical Patients Manifesting Acute Cholecystitis / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the present study is to identify the diagnostic and therapeutic usefulness of percutaneous transhepatic cholecystoscopic examination (PTCCS) in high-risk surgical patients manifesting acute cholecystitis. METHODS: Between January 1992 and June 1998, 33 consecutive patients who underwent percutaneous transhepatic cholecystostomy (PC) and subsequent PTCCS for the management of acute cholecystitis were included. RESULTS: PC and subsequent PTCCS were successfully accomplished in all of 33 patients. During PTCCS, minor complication (2 of minor bleeding during electrohydraulic lithotripsy, 2 of tube dislodgement and 1 of bile leakage to peritoneum) occurred in five patients. PTCCS revealed 26 cases of gallstones, 3 cases of sludge ball, 3 cases of gallbladder carcinoma and 1 case of clonorchiasis related with acute cholecystitis. Three cases of the gallbladder cancers which were not predicted radiologically were incidentally found during PTCCS. For 26 patients with gallstones, PTCCS and concomitant stone removal were successfully carried out in one to four consecutive sessions (mean 2.2 sessions). Gallstones recurred in three (3/22, 14%) patients during the mean follow-up period of 27 months. All of them remain asymptomatic. CONCLUSIONS: PTCCS may be justified in the management of acute cholecystitis in selected patients with high surgical risk.