ABSTRACT
Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical-endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach.
Subject(s)
Bronchial Fistula , Gastric Fistula , Laparoscopy , Obesity, Morbid , Male , Humans , Adult , Gastric Fistula/surgery , Gastric Fistula/complications , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/etiology , Bronchial Fistula/surgery , Obesity, Morbid/surgery , Gastrectomy/adverse effects , Gastrectomy/methods , Stomach/surgery , Laparoscopy/adverse effects , Postoperative Complications/surgery , Treatment Outcome , Anastomotic Leak/etiology , Retrospective StudiesABSTRACT
PURPOSE: The advantages of the conservative approach for major spleen injuries are still debated. This study was designed to evaluate the safety and effectiveness of NOM in the treatment of minor (grade I-II according with the American Association for the Surgery of Trauma; AAST) and severe (AAST grade III-V) blunt splenic trauma, following a standardized treatment protocol. METHODS: All the hemodynamically stable patients with computer tomography (CT) diagnosis of blunt splenic trauma underwent NOM, which included strict clinical and laboratory observation, 48-72 h contrast-enhanced ultrasonography (CEUS) follow-up and splenic angioembolization, performed both in patients with admission CT evidence of vascular injuries and in patients with falling hematocrit during observation. RESULTS: 87 patients [32 (36.7 %) women and 55 (63.2 %) men, median age 34 (range 14-68)] were included. Of these, 28 patients (32.1 %) had grade I, 22 patients (25.2 %) grade II, 20 patients (22.9 %) grade III, 11 patients (12.6 %) grade IV and 6 patients (6.8 %) grade V injuries. The overall success rate of NOM was 95.4 % (82/87). There was no significant difference in the success rate between the patients with different splenic injuries grade. Of 24 patients that had undergone angioembolization, 22 (91.6 %) showed high splenic injury grade. The success rate of embolization was 91.6 % (22/24). No major complications were observed. The minor complications (2 pleural effusions, 1 pancreatic fistula and 2 splenic abscesses) were successfully treated by EAUS or CT guided drainage. CONCLUSIONS: The non operative management of blunt splenic trauma, according to our protocol, represents a safe and effective treatment for both minor and severe injuries, achieving an overall success rate of 95 %. The angiographic study could be indicated both in patients with CT evidence of vascular injuries and in patients with high-grade splenic injuries, regardless of CT findings.
Subject(s)
Abdominal Injuries/therapy , Embolization, Therapeutic/methods , Spleen/injuries , Trauma Centers , Wounds, Nonpenetrating/therapy , Abdominal Injuries/complications , Abdominal Injuries/diagnostic imaging , Adolescent , Adult , Aged , Angiography , Clinical Protocols , Female , Humans , Injury Severity Score , Male , Middle Aged , Patient Safety , Prospective Studies , Spleen/blood supply , Spleen/diagnostic imaging , Splenic Artery/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/diagnostic imaging , Young AdultABSTRACT
PURPOSE: We investigated the role of multidetector-row computed tomography (MDCT) in identifying active bleeding and its source in polytrauma patients with pelvic vascular injuries with or without associated fractures of the pelvis. MATERIALS AND METHODS: From January 2003 to December 2007, 28 patients (19 men and nine women, age range 16-80 years) with acute symptoms from blunt pelvic trauma and a drop in haematocrit underwent MDCT and angiography. Conventional radiography of the pelvis was performed in all patients at the time of admission to the emergency department. MDCT was performed with a four-row unit in 15 patients and a 16-row unit in the remaining 13 patients. The study included whole-body CT to identify craniocerebral, vertebral, thoracic, abdominal and pelvic injuries. CT was performed before and after rapid infusion (4-5 ml/s) of intravenous contrast material (120 ml) using a power injector. A triphasic contrast-enhanced study was performed in all patients. MDCT images were transferred to a workstation to assess pelvic fracture, site of haematoma and active extravasation of contrast material, visibility of possible vascular injuries and associated traumatic lesions. At angiography, an abdominal and pelvic aortogram was obtained in all cases before selective catheterisation of the internal iliac arteries and superselective catheterisation of their branches for embolisation purposes. Results related to identifying the source of bleeding at MDCT were compared with sites of bleeding or vascular injury identified by selective pelvic angiography. The sensitivity and positive predictive value (PPV) of MDCT were determined. RESULTS: MDCT allowed us to identify pelvic bleeding in 21/28 patients (75%), with most cases being detected in the delayed contrast-enhanced phase (13/21 cases, 61.9%). Injured arteries were identified on MDCT in 12/21 cases (57%): the obturator artery (n=9), internal iliac artery (n=6), internal pudendal artery (n=6) and superior gluteal artery (n=5) were most frequently injured. In 8/21 patients (28.6%), more than one artery was injured. Among the 12 patients in whom MDCT showed the presence of pelvic haemorrhage, there was agreement between MDCT and angiography in ten cases. Angiography confirmed the site of bleeding detected on MDCT and identified a second arterial haemorrhage in one patient. There was no agreement between MDCT and angiography in the last patient. MDCT showed a sensitivity of 42.85% and a PPV of 100% in identifying the injured arteries. CONCLUSIONS: Arterial haemorrhage is one of the most serious problems associated with pelvic fracture, and it remains the leading cause of death attributable to such fractures. MDCT provides diagnostic information regarding the presence of small pelvic fractures and, thanks to the contrast-enhanced angiographic technique, it is capable of identifying pelvic bleeding, with the demonstration in some cases of it source. The presence of contrast material extravasation is an indicator of injury to a specific artery passing through the region of the pelvis where the extravasation is noted on MDCT. Urgent angiography and subsequent transcatheter embolisation are the most effective methods for controlling ongoing arterial bleeding in pelvic injuries.
Subject(s)
Hemorrhage/diagnostic imaging , Pelvis/diagnostic imaging , Pelvis/injuries , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Angiography , Female , Humans , Male , Middle Aged , Young AdultSubject(s)
Ascites/etiology , Diuretics/therapeutic use , Polycystic Kidney Diseases/complications , Venae Cavae/pathology , Ascites/drug therapy , Constriction, Pathologic/complications , Cysts/complications , Female , Furosemide/therapeutic use , Humans , Liver Diseases/complications , Magnetic Resonance Imaging , Middle Aged , Treatment FailureSubject(s)
Pleural Neoplasms/diagnosis , Radiology, Interventional , Adult , Aorta, Thoracic/diagnostic imaging , Aortography , Catheterization , Female , Humans , Magnetic Resonance Imaging , Pleura/pathology , Pleural Neoplasms/diagnostic imaging , Pleural Neoplasms/pathology , Pleural Neoplasms/surgery , Terminology as Topic , Tomography, X-Ray ComputedSubject(s)
Plasminogen Activators/therapeutic use , Portal Vein , Thrombolytic Therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Venous Thrombosis/drug therapy , Acute Disease , Adult , Humans , Infusions, Intravenous , Male , Phlebography , Plasminogen Activators/administration & dosage , Ultrasonography, Doppler, Color , Urokinase-Type Plasminogen Activator/administration & dosage , Venous Thrombosis/diagnosis , Venous Thrombosis/diagnostic imagingSubject(s)
Portasystemic Shunt, Transjugular Intrahepatic , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Male , Middle Aged , Protein C Deficiency/complications , Protein C Deficiency/diagnosis , Recurrence , Time Factors , Treatment FailureSubject(s)
Anesthesia, Obstetrical , Cesarean Section , Infant, Newborn/blood , Maternal-Fetal Exchange , Propofol/blood , Female , Humans , PregnancyABSTRACT
The authors report their experience in the study of bleeding aneurysms of the celiac arteries. Eleven patients were examined with US, CT, and angiography (8 hepatic artery aneurysms and 3 splenic artery aneurysms). Clinical findings included digestive bleeding, upper abdominal pain, palpable pulsating masses, and jaundice. Patient history included blunt abdominal trauma, penetrating trauma due to gunshot, acute pancreatitis, recent hepatic biopsy. In all cases US showed an abdominal mass ranging in size from 2 to 10 cm. US findings included cyst-like lesions (8 cases), a lobulated solid-like lesion, and complex lesions (2 cases). Continuity of the lesion with adjacent arterial vessels was noted in 5/11 cases, and pulsing activity in 3/11 cases. US patterns, although not specific, play an important role in the diagnosis when associated to other elements such as arterial continuity, mass pulsatility, patient history, and gastrointestinal bleeding. They suggest the need for more specific imaging exams, i.e. CT and angiography, and help avoid dangerous diagnostic biopsies. CT was performed to confirm US findings in 5 cases, and detected either hypodense cystic masses, or inhomogeneous masses with arterial enhancement after bolus injection of cm. CT was used to better demonstrate the lumen, patency of the vessel, the walls of the vessel, and the parietal thrombotic component. The typical arterial enhancement was the decisive finding for the diagnosis, even though a total continuity with arterial vessels was never observed. Angiography was the method of choice for the preoperative demonstration of hepatic artery aneurysms (10 cases) and for occlusive treatment with Gianturco coils (3 cases).
Subject(s)
Aneurysm/diagnosis , Celiac Artery/pathology , Gastrointestinal Hemorrhage/diagnosis , Tomography, X-Ray Computed , Ultrasonography , Adult , Aged , Aneurysm/complications , Aneurysm/etiology , Celiac Artery/diagnostic imaging , Female , Gastrointestinal Hemorrhage/etiology , Hepatic Artery/diagnostic imaging , Hepatic Artery/pathology , Humans , Male , Middle Aged , Occult Blood , Splenic Artery/diagnostic imaging , Splenic Artery/pathologySubject(s)
Lipodystrophy/epidemiology , Age Factors , Child, Preschool , Female , Follow-Up Studies , Humans , Lipodystrophy/diagnosis , Time FactorsABSTRACT
The authors evaluated the reliability of echography in the involvement of the inferior vena cava in the abdominal tumors. 137 patients were studied with echography and 125 with inferior cavography too. All the diagnosis were confirmed with arteriography and/or CT and/or surgical findings. The reliability of the echographic method was significant, and particularly in case of emboli and tumor invasion.
Subject(s)
Abdominal Neoplasms/diagnosis , Ultrasonography , Vena Cava, Inferior/diagnostic imaging , Abdominal Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/diagnostic imaging , Constriction, Pathologic , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/diagnostic imaging , Liver Neoplasms/diagnosis , Liver Neoplasms/diagnostic imaging , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/diagnosis , Retroperitoneal Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Ultrasounds have a high diagnostic value mainly in the structural assessment of the neoplasia. They are also very useful for the evaluation of the spread. In this paper the authors analyze the criteria for a differentiated diagnosis of Wilms' tumour.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Neuroblastoma/diagnosis , Retroperitoneal Neoplasms/diagnosis , Ultrasonography , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Kidney Neoplasms/diagnosis , Wilms Tumor/diagnosisABSTRACT
The authors compare the results of sonography (US) and percutaneous transhepatic cholangiography (PTC) in the study of 48 patients with obstructive jaundice. The results obtained were correlated to various diagnostic levels and to the different causes of obstruction. The analysis of the results led the authors to believe that, in most cases, the association of both techniques is absolutely necessary in order to define the whole diagnostic picture.
Subject(s)
Cholangiography/methods , Cholestasis/diagnosis , Ultrasonography , Bile Duct Neoplasms/complications , Cholelithiasis/complications , Cholestasis/etiology , HumansABSTRACT
Cerebral pneumography, positive ventriculography and vertebral angiography were employed in the examination of 154 of tumour of brain stem at Departments of Neuroradiology in the city of Naples between 1962 and 1974. The findings in various sites are described and discussed and several examples are presented.