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2.
Rev. colomb. gastroenterol ; 35(2): 216-219, abr.-jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126311

ABSTRACT

Resumen La hemorragia digestiva alta se define como el sangrado originado en el tracto digestivo superior, proximalmente al ángulo de Treitz, y constituye la urgencia gastroenterológica más importante. Tiene una incidencia que varía, según el área estudiada, entre 48 y 160 casos por 100 000 habitantes y año. Aunque puede ser causada por numerosas etiologías, no debemos olvidar aquellas menos comunes, ya que pueden condicionar una alta mortalidad, como es el caso de la rotura de un aneurisma de la arteria hepática. A continuación, mostramos un caso representativo.


Abstract Upper gastrointestinal bleeding is defined as bleeding originating in the upper digestive tract proximal to the Treitz angle and is the most important gastroenterological emergency. Its incidence varies, depending on the area studied, between 48 and 160 cases per 100,000 inhabitants per year. Although it can be caused by numerous etiologies, we must not forget the less common ones such as a ruptured hepatic artery aneurysm since they can condition high mortality. We present a representative case.


Subject(s)
Humans , Male , Middle Aged , Rupture , Abdominal Pain , Gastrointestinal Tract , Hemorrhage , Hepatic Artery , Aneurysm
3.
Int. j. morphol ; 38(1): 30-34, Feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1056392

ABSTRACT

Realizar un estudio anatómico in vivo con la especial y pequeña disección quirúrgica durante una colecistectomía laparoscópica sobre las variaciones de la arteria cística. Estudio prospectivo de 38 meses, en 2000 pacientes consecutivos sometidos a colecistectomía laparoscópica programada, sin signos de inflamación aguda, ni alteración que impida disección y correcta evaluación del triángulo hepatocístico. Se disecó quirúrgicamente identificándose la arteria cística y posible duplicación, eran clínicamente importantes aquellas con diámetro mayor a 1,5 mm, requerían maniobra hemostática. Se anotaron los hallazgos en planilla especial a los fines del presente estudio. En 1831 casos había arteria única en medio del triángulo hepatocístico. Hubo 169 variaciones (8,45 %). En 97 casos: doble vascularización, con una arteria en situación normal y otra ubicada lateralmente al triangulo hepatocístico. En 44 pacientes había una arteria única lateralmente al conducto cístico que no lo cruzaba nunca. En 22 casos existía una arteria cruzando el colédoco y el cístico entrando en el triángulo. En 6 oportunidades una doble arteria, una en el triángulo hepatocístico y otra lateralmente que no cruzaba el cístico ni colédoco. En una oportunidad se observó una sola arteria importante que salía directamente de la placa cística entre segmento 4 y 5, y en otro caso solo pequeñas arterias proveniente de la placa cística. Podemos dividirlas en arterias únicas o dobles, en base exclusiva a la necesidad de maniobra hemostática. Podemos decir que las variaciones estarán presentes en aproximadamente 1/12 casos y necesitará una maniobra hemostática especial en 1/20 casos.


This is an anatomical study with the special and small dissection of a laparoscopic cholecystectomy on the surgically important variations of the cystic artery. A prospective, 19-month study was conducted in 2000, including consecutive patients undergoing programmed laparoscopic cholecystectomy, without signs of acute inflammation, or alteration, that would prevent dissection and correct evaluation of the cystohepatic triangle. It was surgically dissected, identifying the main cystic artery and its possible collateral arteries. Those with a diameter greater than 1.5 mm being considered as clinically important, requiring haemostatic maneuver (clipping and / or electrocoagulation). The findings were recorded on a special form for the purposes of this study. The classic, single-artery arrangement in the middle of the cystohepatic triangle was found in 1831 cases. The variations found were 169 (8.45 %). In 97 cases there was double vascularization, with one artery in normal position and another outside the cystic duct. In 44 patients, a single artery that did not cross the cystic was observed. In 22 cases an artery outside the cystic but crossing it before the duct. In 6 cases a double artery, one in the cystohepatic triangle and another outside the triangle, did not cross the cystic or the bile duct. In one instance, a single major artery was seen emerging directly from the cystic plaque between segments four and five. These can be divided into single or double arteries, based exclusively on the need for hemostatic maneuver. Knowledge of anatomical variations of the cystic artery is important for the surgeon. The variation presents in 1 of 12 cases, and requires a special hemostatic maneuver in 1 of 20 cases.


Subject(s)
Humans , Cystic Duct/blood supply , Anatomic Variation , Gallbladder/blood supply , Gallbladder Diseases/surgery , Hepatic Artery/anatomy & histology , Prospective Studies , Cholecystectomy, Laparoscopic
4.
Rev. Col. Bras. Cir ; 47: e20202379, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136551

ABSTRACT

RESUMO Objetivos: A irrigação arterial hepática tem como característica a elevada frequência de variações da anatomia. O objetivo do estudo foi descrever o trajeto anatômico da artéria hepática direita quando originada da artéria mesentérica superior. Métodos: Foram analisadas 5147 tomografias computadorizadas com contraste endovenoso de pacientes atendidos no Serviço de Radiologia do Hospital de Clínicas de Passo Fundo - RS, no período outubro de 2016 a dezembro de 2017. Foram selecionados 125 pacientes portadores de variação anatômica da artéria hepática direita na origem. Os achados foram categorizados pela variação do trajeto vascular, emergência da artéria mesentérica superior e a relação com demais estruturas. Resultados: Obtivemos o trajeto mais frequente desta variação como retropancreático (88,8%), retroportal (76,8%) e pós-coledociano (75,2%), emergindo cerca de 2,33 cm da origem da artéria mesentérica superior. Conclusão: Demonstramos que na maioria das vezes, a artéria hepática direita variante, apresenta trajeto posterior ao pâncreas e ao pedículo hepático e emerge próxima da origem da artéria mesentérica superior.


ABSTRACT Objective: Liver arterial irrigation is characterized by a high frequency of variations in its anatomy. The aim of the study was to describe the anatomic position of the right hepatic artery as a brunch of the superior mesenteric artery. Methods: A total of 5147 intravenous contrast-enhanced computed tomography scans of patients seen at the Radiology Service of the Passo Fundo Clinical Hospital (RS), from October 2016 to December 2017, were selected. 125 patients with anatomic variation of the right hepatic artery were selected. The findings were categorized by the variation of the vascular position, emergence from the superior mesenteric artery and the relationship with other structures. Results: The most frequent position was retropancreatic (88.8%), retroportal (76.8%) and post-choledocian (75.2%), emerging about 2.33 cm from the superior mesenteric artery. Conclusion: We have shown that most common variant of the right hepatic artery presents its posterior origin from the pancreatic and hepatic pedicle, and arises close to the origin of the superior mesenteric artery.


Subject(s)
Humans , Mesenteric Artery, Superior , Hepatic Artery , Pancreas , Anatomic Variation , Liver
5.
ABCD arq. bras. cir. dig ; 33(4): e1556, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152639

ABSTRACT

ABSTRACT Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.


RESUMO Racional: Trombose de artéria hepática é importante causa de falência de enxerto e complicações biliares. Fatores de risco para trombose estão relacionados aos aspectos técnicos da anastomose arterial e fatores não cirúrgicos. Objetivo: Avaliar os fatores de risco para o desenvolvimento de trombose de artéria hepática. Métodos: A amostra consta de 1050 casos de transplante hepático. Foi realizado estudo retrospectivo e transversal, e as variáveis foram avaliadas em doadores e receptores. Resultados: A análise univariada mostrou que as variáveis relacionadas a trombose de artéria hepática são: MELD e tempo de isquemia quente. Na análise multivariada, o MELD=14.5 e tempo de isquemia quente =35 min foram fatores de risco independentes para trombose de artéria hepática. No teste de prevalência para avaliação do tipo de anastomose como variável, foi observado que a sutura contínua tem maior risco de trombose quando comparada com aquela em pontos separados. Conclusão: Tempo de isquemia quente prolongado, MELD calculado e idade do recipiente foram fatores de risco independentes para trombose de artéria hepática após transplante de fígado em adultos. Pacientes submetidos à anastomose com sutura contínua apresentaram mais trombose quando comparados com a em pontos separados. Retransplante por trombose está associado com maior mortalidade.


Subject(s)
Humans , Adult , Thrombosis/etiology , Vascular Surgical Procedures/adverse effects , Liver Transplantation/adverse effects , Hepatic Artery/surgery , Vascular Surgical Procedures/methods , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Liver Transplantation/methods , Liver Diseases/surgery
6.
ABCD arq. bras. cir. dig ; 33(2): e1508, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130527

ABSTRACT

ABSTRACT Introduction: Superior mesenteric artery (SMA) usually arises from the abdominal aorta, just below the celiac trunk and it supplies the midgut-derived embryonic structures. Anatomical variations in this vessel contribute to problems in the formation and/or absorption of this part of the intestine and its absence has been recognized as the cause of congenital duodenojejunal atresia. Objective: To analyze SMA anatomical variations in humans and the possible associated clinical and surgical implications. Methods: This is a systematic review of papers indexed in PubMed, SciELO, Springerlink, Science Direct, Lilacs, and Latindex databases. The search was performed by two independent reviewers between September and December 2018. Original studies involving SMA variations in humans were included. SMA presence/absence, level, place of origin and its terminal branches were considered. Results: At the end of the search, 18 studies were selected, characterized as for the sample, method to evaluate the anatomical structure and main results. The most common type of variation was when SMA originated from the right hepatic artery (6.13%). Two studies (11.11%) evidenced the inferior mesenteric artery originating from the SMA, whereas other two (11.11%) found the SMA sharing the same origin of the celiac trunk. Conclusion: SMA variations are not uncommon findings and their reports evidenced through the scientific literature demonstrate a great role for the development of important clinical conditions, making knowledge about this subject relevant to surgeons and professionals working in this area.


RESUMO Introdução: A artéria mesentérica superior (AMS), normalmente, tem sua origem a partir da aorta abdominal, um pouco abaixo do tronco celíaco e é responsável pela irrigação das estruturas derivadas, embrionariamente, do intestino médio. Variações anatômicas nesse vaso contribui para defeitos na formação e/ou absorção dessa parte do intestino e a sua ausência tem sido reconhecida como a causa da atresia duodenojejunal congênita. Objetivo: Analisar as variações anatômicas dela em humanos e as possíveis implicações clínicas e cirúrgicas associadas. Métodos: Trata-se de uma revisão sistemática de artigos indexados nas bases de dados PubMed, SciELO, Springerlink, Scienc Direct, Lilacs e Latindex. A busca ocorreu por dois revisores independentes entre setembro e dezembro de 2018. Foram incluídos artigos originais envolvendo as variações da AMS em humanos. Considerou-se para este estudo a presença/ausência da AMS, o nível, local de origem e seus ramos terminais. Resultados: Ao final da busca foram selecionados 18 artigos, caracterizados quanto à amostra, método para avaliar a estrutura anatômica e principais resultados. O tipo de variação mais comum foi aquele cuja AMS se originou da artéria hepática direita (6,13%). Dois estudos (11,11%) evidenciaram a artéria mesentérica inferior originando-se a partir da AMS, enquanto outros dois (11,11%) constataram ser ela compartilhada na mesma origem do tronco celíaco. Conclusão: Variações na AMS não são achados incomuns e seus relatos evidenciados através da literatura científica demonstram grande importância para o desenvolvimento de condições clínicas importantes, tornando o conhecimento sobre esse assunto relevante para os cirurgiões e profissionais atuantes nesta área.


Subject(s)
Humans , Celiac Artery/anatomy & histology , Mesenteric Artery, Superior/anatomy & histology , Surgeons , Hepatic Artery/anatomy & histology , Mesenteric Artery, Superior/surgery
8.
Int. j. morphol ; 37(4): 1456-1462, Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1040153

ABSTRACT

La colecistectomía laparoscópica es el tratamiento indicado en la colelitiasis, sin embargo el procedimiento no está exento de complicaciones o morbilidad concomitante. Es posible que, debido a lesiones ductales colaterales, ocurra sangrado con posibilidad de conversión de la cirugía e indeseables resultados. Para un correcto abordaje de la región se hace fundamental la identificación del trígono cistohepático (TCH) y sus componentes, a su vez de la ligadura y sección de la arteria cística (AC). Conociendo la elevada variabilidad de la AC, el objetivo de este trabajo consistió en identificar el número, origen, trayecto y relación de la AC con el TCH y sus variaciones, utilizando angiotomografía por medio de un tomógrafo detector de 64 cortes, en el preoperatorio de 30 pacientes de sexo femenino, entre 24 y 54 años de edad, con colelitiasis diagnosticadas clínicamente y por ecosonografía. La AC en el 76,67 % era única y se encontraba dentro del TCH, en el 16,67 % era única y se observó fuera del TCH. En el 6,67 % se observaron dos AC, una dentro y otra fuera del TCH. En el 66,67 % de los casos la AC se originaba de manera normal de la arteria hepática derecha. La trazabilidad de la AC fue en el 53,3 % medianamente visible y en el 46,7 % de trazabilidad excelente. En conclusión, la identificación de la AC y sus variaciones anatómicas se puede determinar en el preoperatorio y puede ser útil para mejorar el plan quirúrgico en pacientes con colelitiasis, brindando información al procedimiento, optimizarlo y disminuir los riesgos de eventuales complicaciones relacionados con sangrado.


Laparoscopic cholecystectomy is the treatment indicated for cholelithiasis, however the procedure is not free of complications or concomitant morbidity. It is possible that, due to collateral ductal lesions, bleeding occurs with the possibility of surgery conversion and undesirable results. For a correct approach to the region it is essential to identify the cystohepatic trigone (CHT) and its components, as well as the ligation and section of the cystic artery (AC). Knowing the high variability of CA, the aim of this work was to identify the number, origin, path and relationship of CA with the CHT and its variations using angiotomography by means of a 64-slice detector tomograph in the preoperative period of 30 female patients, between 24 and 54 years old, with clinically diagnosed cholelithiasis and by echo sonography. The AC in 76.67 % was unique and was within the CHT, in 16.67 % it was unique and was observed outside the CHT. In 6.67 %, two ACs were observed, one inside and one outside the TCH. In 66.67 % of cases, CA originated normally from the right hepatic artery. The traceability of AC was 53.3 % moderately visible and 46.7 % excellent traceability. In conclusion, the identification of AC and its anatomical variations can be determined in the preoperative period and can be useful to improve the surgical plan in patients with cholelithiasis, providing information on the procedure, optimizing it and reducing the risks of possible bleeding related complications.


Subject(s)
Humans , Female , Adult , Middle Aged , Arteries/abnormalities , Arteries/diagnostic imaging , Cholecystectomy, Laparoscopic/methods , Computed Tomography Angiography , Preoperative Care/methods , Cholelithiasis/surgery , Anatomic Variation , Hepatic Artery/abnormalities , Hepatic Artery/diagnostic imaging
9.
Acta cir. bras ; 34(11): e201901103, Nov. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054680

ABSTRACT

Abstract Purpose: To evaluate liver regeneration after selective ligation of portal vein and hepatic artery by 3D Computed Tomography in an experimental model. Methods: Sixteen Wistar rats were randomized into four equal groups: Group I- control (sham), Group II- isolated selective ligation of the hepatic artery, Group III- isolated selective ligation of the portal vein and Group IV- combined ligation of portal vein and hepatic artery. Before procedure and five days after a 3D CT Scan was performed to analyze the hypertrophy, weight and function of the remnant liver. Results: The largest regeneration rate and increase of weight in the hypertrophied lobe was detected in group IV, the first with an average of 3.99 (p=0.006) and the last varying from 6.10g to 9.64g (p=0.01). However, total liver weight and the R1 ratio (Hypertrophied Lobe Weight/Total Liver Weight) was higher in group III (P<0.001) when compared with groups I, II and IV and showed no difference between them. The immunohistochemical examination with PCNA also found higher percentages with statistical significance differences in rats of groups III and IV. It was possible to confirm a strong correlation between hypertrophied lobe weight and its imaging volumetric study. Liver function tests only showed a significant difference in serum gamma-glutamyltransferase and phosphorous. Conclusion: There is a largest liver regeneration after combined ligation of portal vein and hepatic artery and this evidence may improve the knowledge of surgical treatment of liver injuries, with a translational impact in anima nobile.


Subject(s)
Animals , Male , Portal Vein/surgery , Hepatic Artery/surgery , Liver/diagnostic imaging , Liver Regeneration/physiology , Organ Size/physiology , Immunohistochemistry , Random Allocation , Tomography, X-Ray Computed/methods , Reproducibility of Results , Treatment Outcome , Rats, Wistar , Imaging, Three-Dimensional/methods , Hepatomegaly/physiopathology , Hepatomegaly/diagnostic imaging , Ligation , Liver/blood supply , Liver/pathology
10.
Article in English | WPRIM | ID: wpr-786505

ABSTRACT

Radioembolization using ⁹⁰Y microspheres (glass or resin) has been introduced as an effective intraarterial therapy for unresectable primary and metastatic liver cancers. Although the basic therapeutic effect of chemoembolization results from ischemia, the therapeutic efficacy of radioembolization comes from radiation. Furthermore, compared with surgical resection and local ablation therapy, radioembolization is available with less limitation on the sites or number of liver cancers. The radioisotope ⁹⁰Y is a β-radiation emitter without γ-radiation, with the emission of secondary bremsstrahlung photons and small numbers of positrons. Administration of ⁹⁰Y microspheres into the hepatic artery can deliver a high dose of radiation selectively to the target tumor with limited radiation exposure to the surrounding normal parenchyma, and has low systemic toxicity. In general, radioembolization has been considered for patients with unresectable primary or metastatic liver-only or liver-dominant cancers with no ascites or other clinical signs of liver failure, life expectancy of > 12 weeks, and good performance status. Here, we review the current radioactive compounds, pretreatment assessment, and indications for radioembolization in patients with hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and liver metastases from colorectal cancer.


Subject(s)
Ascites , Carcinoma, Hepatocellular , Cholangiocarcinoma , Colorectal Neoplasms , Electrons , Hepatic Artery , Humans , Ischemia , Life Expectancy , Liver Failure , Liver Neoplasms , Liver , Microspheres , Neoplasm Metastasis , Photons , Radiation Exposure
11.
Article in English | WPRIM | ID: wpr-785886

ABSTRACT

An isolated splanchnic artery injury due to blunt trauma occurs rarely because abdominal vascular injuries are typically associated with injuries to the surrounding abdominal structures, including solid organs or hollow viscus. Of the major abdominal vessels, the celiac artery is the least commonly injured by penetrating or blunt abdominal trauma. Furthermore, a celiac artery dissection due to blunt trauma is rarely reported and there is no clearly defined treatment method, even though endovascular and conservative treatments are accepted widely. On the other hand, endovascular treatment can be challenging if the celiac artery dissection involves its main branch, including the proper hepatic artery, left gastric artery, and splenic artery. This case study presents the treatment experience of a celiac artery dissection involving its main branch following dorsal blunt trauma. Furthermore, conservative treatment is proposed as a treatment option for this rare injury.


Subject(s)
Arteries , Celiac Artery , Hand , Hepatic Artery , Methods , Splenic Artery , Vascular System Injuries
12.
Article in English | WPRIM | ID: wpr-785656

ABSTRACT

Ultraselective conventional transarterial chemoembolization (cTACE), defined as cTACE at the most distal portion of the subsubsegmental hepatic artery, is mainly performed for hepatocellular carcinoma (HCC) ≤5 cm. Distal advancement of a microcatheter enables injection of a larger volume of iodized oil into the portal vein in the limited area under non-physiological hemodynamics. As a result, the reversed portal flow into the tumor through the drainage route of the tumor that occurs when the hepatic artery is embolized is temporarily blocked. By adding gelatin sponge slurry embolization, both the hepatic artery and portal vein are embolized and not only complete necrosis of can be achieved. Ultraselective cTACE can cure small HCCs including less hypervascular tumor portions and replace surgical resection and radiofrequency ablation in selected patients.


Subject(s)
Carcinoma, Hepatocellular , Catheter Ablation , Chemoembolization, Therapeutic , Drainage , Gelatin , Gelatin Sponge, Absorbable , Hemodynamics , Hepatic Artery , Humans , Iodized Oil , Necrosis , Porifera , Portal Vein
13.
Article in English | WPRIM | ID: wpr-760355

ABSTRACT

This study was performed to examine the visualization and anatomical variants of the hepatic artery with dual-phase computed tomography (CT) angiography and three-dimensional volume rendering imaging analysis in clinically normal dogs. Seven healthy beagle dogs were enrolled and underwent dual CT angiography. Arterial phase images could be obtained with multi-detector CT angiography using the fixed-scan method in these dogs. Contrast enhancement of the hepatic parenchyma was quite minimal because of the unique blood supply system of the liver. In most dogs, the main hepatic arterial branches were the right lateral branch, left branch, and right medial branch. Although hepatic arterial variation appears to be common in dogs, only one dog in this study had the caudate lobar branch as the first branch of the hepatic artery. Further study on a larger number of dogs with CT images will be needed to identify and classify the pattern of hepatic arterial variations.


Subject(s)
Angiography , Animals , Dogs , Hepatic Artery , Liver , Methods
14.
Article in English | WPRIM | ID: wpr-741418

ABSTRACT

OBJECTIVE: To investigate whether diagnostic performance of contrast-enhanced ultrasound (CEUS) could be improved with modified criteria to diagnose significant hepatic artery occlusion (HAO) and to determine the role of CEUS in patients with a tardus-parvus hepatic artery (HA) pattern on Doppler US. MATERIALS AND METHODS: Among 2679 adult liver transplantations performed over 7 years, HAO was suspected in 288 recipients, based on Doppler ultrasound. Among them, 130 patients underwent CEUS. After excluding two technical failures, 128 CEUS images were retrospectively reviewed to search for abnormal findings, such as no HA enhancement, abnormal HA enhancement (delayed, faint, and discontinuous enhancement), and perfusion defect in the liver parenchyma. The performance CEUS abnormalities were assessed in the patients overall and in subgroups based on Doppler ultrasound abnormality (group A, no flow; group B, tardus-parvus pattern) and were compared based on the area under the receiver operating characteristic curve (AUC). RESULTS: HAO were diagnosed in 41 patients by surgery, angiography, or follow-up abnormality. By using the conventional criterion (no HA enhancement) to diagnose HAO in patients overall, the sensitivity, specificity, and AUC were 58.5%, 100%, and 0.793, respectively. Modified criteria for HAO (no HA enhancement, abnormal enhancement, or parenchymal perfusion defect) showed statistically significantly increased sensitivity (97.6%, 40/41) and AUC (0.959) (p < 0.001), although the specificity (95.4%, 83/87) was slightly decreased. The sensitivity and specificity of the modified criteria in Groups A and B were 97.1% (33/34) and 95.7% (22/23), and 100% (7/7) and 95.3% (61/64), respectively. CONCLUSION: Modified criteria could improve diagnostic performance of CEUS for HAO, particularly by increasing sensitivity. CEUS could be useful for diagnosing HAO even in patients with a tardus-parvus HA pattern on Doppler US, using modified criteria.


Subject(s)
Adult , Angiography , Area Under Curve , Contrast Media , Diagnosis , Follow-Up Studies , Hepatic Artery , Humans , Liver Transplantation , Liver , Perfusion , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Ultrasonography
15.
Rev. chil. obstet. ginecol. (En línea) ; 84(4): 320-325, 2019. graf, ilus
Article in Spanish | LILACS | ID: biblio-1058154

ABSTRACT

RESUMEN El pseudoaneurisma de arteria uterina es una causa de hemorragia puerperal poco frecuente y de gran gravedad cuya principal manifestación es el sangrado puerperal tardío. Esta complicación suele ocurrir de manera tardía tras una cirugía pélvica, aunque también está descrito tras el parto. La prueba de elección para el diagnóstico de esta complicación es la angiografía que permite además su tratamiento en el mismo acto, asociando una menor morbilidad y preservando la fertilidad de la paciente. Presentamos el caso de un pseudoaneurisma de arteria uterina tras cesárea cuya manifestación fue un hemoperitoneo masivo a los 17 días de la cesárea y que se resolvió mediante angiografía con embolización supraselectiva del mismo.


ABSTRACT Uterine artery pseudoaneurysm is a serious complication but an uncommon cause of postpartum haemorrhage which can mainly manifest as a severe bleeding in the late puerperium. This complication usually occurs after pelvic surgery, although it is also described after vaginal delivery. Angiography is the best diagnosis method which joins not only the diagnosis but also the treatment at the same moment, reducing the morbidity and preserving fertility. We report a case of a uterine artery pseudoaneurysm after cesarean delivery whose clinical manifestation was a massive haemoperitoneum after 17 days of the cesarean. It was treated by angiographic selective embolization of uterine artery pseudoaneurysm.


Subject(s)
Humans , Female , Pregnancy , Adult , Aneurysm, False/therapy , Aneurysm, False/diagnostic imaging , Hepatic Artery/pathology , Pregnancy Complications , Angiography , Cesarean Section
16.
ABCD arq. bras. cir. dig ; 32(3): e1455, 2019. graf
Article in English | LILACS | ID: biblio-1038026

ABSTRACT

ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.


RESUMO Racional: Pancreatoduodenectomia consiste no procedimento cirúrgico usual para tratamento curativo de neoplasias periampulares e apresenta mortalidade significativa. Variações arteriais do tronco celíaco não são incomuns e podem favorecer lesões iatrogênicas ou exigirem realização de ressecção/reconstrução arterial durante pancreatoduodenectomia. Objetivo: Determinar a prevalência de variações arteriais que apresentam implicações durante pancreatoduodenectomia. Métodos: A anatomia do tronco celíaco e sistema arterial hepático foi investigada retrospectivamente em 200 exames tomográficos contrastados do abdome. Resultados: Anatomia normal do sistema arterial hepático foi observada em 87% dos casos. Presença de uma artéria hepática direita anômala foi identificada em 13%. Em 12 casos houve uma artéria hepática direita substituta originária da artéria mesentérica superior, em dois uma artéria hepática direita acessória com origem similar. Tronco hepaticomesentérico foi identificado em sete casos e em cinco houve uma artéria hepática direita originária diretamente do tronco celíaco. Em todos casos de artéria hepática direita anômala seu curso foi por trás da cabeça do pâncreas e com trajeto passando posteriormente ao tronco da veia porta e após percorrendo sua face lateral direita antes de alcançar o fígado. Conclusões: Variações arteriais hepáticas, como artéria hepática direita anômala com trajeto posterior à veia porta, são frequentes (13%). Nestes pacientes, quando submetidos à pancreatoduodenectomia, pode ser necessária alteração na abordagem cirúrgica para ressecção adequada. Exames de imagem pré-operatórios podem claramente identificar estas variações e auxiliar na realização de dissecção segura da cabeça do pâncreas com adequado planejamento cirúrgico.


Subject(s)
Humans , Male , Female , Pancreaticoduodenectomy , Hepatic Artery/anatomy & histology , Abdominal Neoplasms/surgery , Celiac Artery/anatomy & histology , Tomography Scanners, X-Ray Computed , Prevalence , Retrospective Studies , Dissection , Anatomic Variation , Hepatic Artery/abnormalities , Hepatic Artery/diagnostic imaging
17.
Clin. biomed. res ; 39(3): 226-229, 2019.
Article in Portuguese | LILACS | ID: biblio-1053047

ABSTRACT

Introdução: As variações anatômicas das artérias hepáticas e do tronco celíaco são de grande importância para cirurgias laparoscópicas, transplantes hepáticos, intervenções radiológicas e tratamento de lesões abdominais. O grande aumento de intervenções minimamente invasivas deixou os atos cirúrgicos com menos espaço para o reconhecimento de estruturas anatômicas. Métodos: Foi realizado um estudo retrospectivo do banco de dados do Hospital São Vicente de Paulo durante o ano de 2016, analisando imagens abdominais de tomografia computadorizada com contraste e angiotomografias que envolvem a aorta abdominal e seus ramos ­ um total de 461 imagens foram analisadas. Resultados: Dos 461 pacientes analisados, 86,9% apresentaram a conformação usual do tronco celíaco ­ cuja anatômica é a origem tríplice com as artérias gástrica esquerda, esplênica e hepática comum e artéria mesentérica superior se originando sozinha da aorta abdominal. Dentre as anatomias anômalas (13%), o padrão mais comum desses ramos foi a presença em 4,5% de um tronco hepatomesentérico e um tronco gastroesplênico. No sistema arterial hepático a conformação mais prevalente foram as artérias hepáticas direita e esquerda sendo ramos da hepática próprias em 66,3%. Das alterações anatômicas (33,2%), as mais comuns foram a presença de uma artéria hepática esquerda acessória ramo da artéria gástrica esquerda (7,8%). Conclusão: Variações anatômicas do sistema arterial hepático e do tronco celíaco são prevalentes, podendo apresentar diversos arranjos organizacionais. (AU)


Introduction: Anatomical variations in the hepatic arteries and the celiac trunk are of great importance for laparoscopic surgeries, liver transplants, radiological interventions and treatment of abdominal injuries. A large increase in the number of minimally invasive interventions hampered the recognition of anatomical structures in surgical procedures. Methods: A retrospective study was performed using the 2016 São Vicente de Paulo Hospital database of contrast-enhanced abdominal computed tomography images and computed tomography angiographies showing the abdominal aorta and its branches. In total, 461 images were analyzed. Results: Of the 461 patients analyzed, 86.9% had usual conformation of the celiac trunk, which trifurcates into the left gastric artery, the common hepatic artery and the splenic artery, while the superior mesenteric artery originates alone from the abdominal aorta. Among the cases of anomalous anatomy (13%), the most common pattern in these branches was the presence of a hepatomesenteric trunk and a gastrosplenic trunk in 4.5%. In the hepatic arterial system, the most prevalent conformation was the right and left hepatic arteries being branches of the hepatic artery proper in 66.3%. Of all anatomical variations (33.2%), the most common were the presence of a left accessory hepatic artery of the left gastric artery (7.8%). Conclusion: Anatomical variations in the hepatic arterial system and the celiac trunk are common, having different structural arrangements. (AU)


Subject(s)
Humans , Celiac Artery/anatomy & histology , Celiac Artery/abnormalities , Hepatic Artery/anatomy & histology , Hepatic Artery/abnormalities , Hepatic Artery/diagnostic imaging , Wounds and Injuries/surgery , Celiac Artery/diagnostic imaging , Iatrogenic Disease/prevention & control
18.
Int. j. morphol ; 36(4): 1525-1528, Dec. 2018. graf
Article in Spanish | LILACS | ID: biblio-975732

ABSTRACT

El estudio de los patrones arteriales de distribución vascular requiere un conocimiento preciso de las variaciones anatómicas, tanto de origen y distribución de las arterias, como de sus correspondientes ramas arteriales. En este trabajo se describe la presencia de un tronco hepato-espleno-mesentérico, disposición arterial altamente infrecuente. El conocimiento de las distintas posibilidades de disposición de las arterias correspondientes al tronco celíaco y sus ramas será de importancia para la interpretación adecuada de estudios imagenológicos, como así también para la planificación precisa de actos quirúrgicos e intervencionistas en la región abdominal.


The study of arterial patterns of vascular distribution requires a precise knowledge of the anatomical variations of both origin and distribution of the corresponding arteries and arterial branches. In this work, the presence of a hepatosplenic-mesenteric trunk is described, a highly infrequent arterial disposition. The knowledge of the different possibilities of disposition of the arteries corresponding to the celiac trunk and its branches will be of importance for the adequate interpretation of imaging studies, as well as for the precise planning of surgical and interventional acts in the abdominal region.


Subject(s)
Humans , Male , Adult , Splenic Artery/anatomy & histology , Celiac Artery/anatomy & histology , Anatomic Variation , Hepatic Artery/anatomy & histology , Mesenteric Arteries/anatomy & histology , Splenic Artery/abnormalities , Cadaver , Celiac Artery/abnormalities , Hepatic Artery/abnormalities , Mesenteric Arteries/abnormalities
19.
Article in English | WPRIM | ID: wpr-787085

ABSTRACT

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.


Subject(s)
Aged , Aneurysm, False , Arteries , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystitis, Acute , Common Bile Duct , Drainage , Embolization, Therapeutic , Follow-Up Studies , Hemobilia , Hepatic Artery , Humans , Rupture , Tomography, X-Ray Computed
20.
Article in English | WPRIM | ID: wpr-717438

ABSTRACT

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract and occur most frequently in the stomach. The liver is the most common metastatic site of a GIST, and spontaneous rupture of the hepatic metastasis of a malignant gastric GIST is rare. We report the case of a 70-year-old man who presented with sudden right lower quadrant abdominal pain and was diagnosed with a spontaneously ruptured hepatic metastasis of a malignant gastric GIST. The patient was successfully managed with transcatheter arterial embolization of the hepatic artery.


Subject(s)
Abdominal Pain , Aged , Embolization, Therapeutic , Gastrointestinal Stromal Tumors , Gastrointestinal Tract , Hemorrhage , Hepatic Artery , Humans , Liver , Neoplasm Metastasis , Rupture , Rupture, Spontaneous , Stomach
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