Endovascular treatment of pancreatitis-related gastrointestinal bleeding

Hemorrhage following pancreatitis may become complicated during the disease course and with possibly fatal consequences. Radiologic findings are as follows: the presence of hematomas, hemorrhagic pseudocysts, extravasation of contrast media or the formation of arterial pseudoaneurysms. The digital subtraction angiography findings are as follows: contrast extravasation due to arterial rupture; pseudoaneurysm formation; and luminal irregularity. A pseudoaneurysm is considered to be treated as soon as detected due to its risk of rupture. Endovascular management, which includes embolization using coils, N-butyl cyanoacrylate, gelatin sponge, stents, and thrombin, is an effective option for the treatment for pancreatitis-related bleeding.

Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 – a review of important differences compared to the CT/MRI system

Medical imaging plays an important role in the diagnosis and management of hepatocellular carcinoma (HCC). The Liver Imaging Reporting and Data System (LI-RADS) was initially created to standardize the reporting and data collection of CT and MR imaging for patients at risk for HCC. As contrast-enhanced ultrasound (CEUS) has been widely used in clinical practice, it has recently been added to the LI-RADS. While CEUS LI-RADS shares fundamental concepts with CT/MRI LI-RADS, there are key differences between the modalities reflecting dissimilarities in the underlying methods of image acquisition and types of contrast material. This review introduces a recent update of CEUS LI-RADS and explains the key differences from CT/MRI LI-RADS.

Segmental arterial mediolysis: Literature review focused on radiologic findings and management

Segmental arterial mediolysis (SAM) is a rare disease which can have catastrophic consequences due to massive hemorrhage or dissecting hematomas. The pathophysiology of this disease is not well-known, and the symptoms vary according to the organs involved. In many patients the diagnosis is based on the clinical and radiologic features rather than the pathologic confirmation. The catheter-based endovascular technique can be an interventional treatment option for SAM, as well as surgical management.

Intracorporeal End-to-Side Esophagojejunostomy Using a Laparoscopic Purse-String Clamp during Laparoscopic Total Gastrectomy

PURPOSE: Because no effective methods for performance of anastomosis have been established, use of laparoscopic total gastrectomy (LTG) has not been widely accepted. We aimed to establish the feasibility of using a newly developed purse-string suture instrument ("Lap-Jack"), which can be used in performance of intracorporeal anastomosis. METHODS: From April, 2010 to February, 2011, 50 patients with upper gastric cancer underwent LTG with intracorporeal Roux-en-Y esophagojejunostomy using the Lap-Jack. Retrospective data for gender, age at the time of surgery, past medical history, operative time, estimated blood loss, TNM staging, and postoperative complications were reviewed. RESULTS: Among the 50 patients, 33 were male and 17 were female. Median age was 59.9 years. The average operative time was 217.4+/-41.7 minutes. Based on the AJCC 7th edition of Gastric Cancer Staging, 19 patients were stage IA, three patients were IB, 12 patients were II, one patient was IIIA, three patients were IIIB, eight patients were IIIC, and two patients were IV. The overall morbidity rate was 18.0% without any mortality. Complications included wound problems (2.0%, n=1), pleural effusion (2.0%, n=1), urinary retention (4.0%, n=2), efferent loop obstruction due to adhesion (4.0%, n=2), postoperative ileus (2.0%, n=1), postoperative bleeding (2.0%, n=1), and intra-abdominal abscess (2.0%, n=1). No leakage or stenosis of esophagojejunostomy was reported. CONCLUSION: The Lap-Jack is feasible and suitable for use in performance of esophagojejunostomy during LTG.