Comparison of single-step renal dilatation and serial renal dilatation in percutaneous nephrolithotomy: A retrospective case-control study.

BACKGROUND: Access to the pelvi-calyceal system and subsequent dilatation of the tract are among the initial important steps in percutaneous nephrolithotomy (PCNL). In this study, we share our experience with single-step renal dilatation when compared to multiple serial renal dilatation in PCNL. MATERIALS AND METHODS: This is a retrospective study wherein 35 patients who underwent PCNL by single-step renal dilatation by appropriate size Amplatz Dilator were compared with 35 patients who underwent multi-step serial renal dilatation using serial metallic Alken dilators. These patients were analyzed on the basis of demographic profile, total intra-operative time, fluoroscopic time, intra-operative and postoperative complications, stone clearance, requirement of blood transfusion, duration of hospital stay, and follow-up. RESULTS: There were no significant differences in the demographic profile among the patients in these two groups. The mean total operative duration and fluoroscopic duration were less in single step renal dilatation group, and these have been found to be statistically significant (P < 0.05). There were no statistically significant differences in the rates of other complications - incomplete stone clearance, bleeding and hematoma formation, requirement of blood transfusion, duration of hospital stay, and follow-up. CONCLUSION: Operative duration and rate of radiation exposure are significantly less in PCNL by single-step renal dilatation; however, there is no statistically significant difference in the rates of other complications.

Arterioenteric Fistulae Due to Pseudoaneurysms of the Right Common Iliac and Splanchnic Vessels Presenting as Upper GI Bleed.

Arterial pseudoaneurysms are relatively rare complications of the vascular system. Many cases may remain asymptomatic for a lifetime only to be discovered incidentally, whereas others may cause fatal hemorrhage. Majority of cases present with local compressive symptoms. Rarely, it has been implicated as an etiology for gastrointestinal (GI) bleed by eroding into an adjacent bowel, with splanchnic pseudoaneurysm being more commonly responsible as compared to peripheral ones. Although rare, they are an important consideration because of the high mortality rate. They require a high index of suspicion with prompt diagnosis and expedient treatment, either surgical or endovascular. In this study, we report a case series of a right iliacoduodenal and 2 splanchnic pseudoaneurysms presenting as upper GI bleeding. These 3 cases presented with occult source of hematemesis due to the formation of arterioenteric fistula. Also discussed are the diagnostic approach used and successful treatment methods, which included placing endoprosthesis in the aorta and common iliac artery and endovascular coiling for respective cases. To the best of our knowledge, such a case of common iliac pseudoaneurysm presenting with massive hematemesis due to fistulization into duodenum has never been reported previously.

Primary hydatid cyst of peritoneum presented as abdominal lump: a rare presentation.

The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion.