Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing the Importance of Timely Diagnosis and Intervention.

BACKGROUND Uterine dehiscence, an infrequent event often mistaken for uterine rupture, is rarely linked to post-cesarean section procedures and can result in severe complications, notably puerperal sepsis. In this report, we present a case that exemplifies the onset of puerperal sepsis and the emergence of intra-abdominal abscesses attributed to uterine dehiscence following a lower segment cesarean section (LSCS). CASE REPORT Our patient, a 28-year-old woman in her third pregnancy, underwent LSCS 1 week earlier. Subsequently, she returned to the hospital with lower abdominal pains, fever, and malodorous vaginal discharge. Computed tomography (CT) scan of whole abdomen verified uterine dehiscence and pus collection at the subhepatic region and right paracolic gutter. After referral to a specialized hospital, laboratory findings indicated an elevated white blood cell count and alkaline phosphatase levels, and coagulation abnormalities. She underwent an exploratory laparotomy, which unveiled uterine dehiscence, abscesses, and adhesions, necessitating a total abdominal hysterectomy and abdominal toileting. Pus culture analysis identified the presence of E. coli, which was susceptible to ampicillin/sulbactam. Complications were encountered after surgery, including wound dehiscence and pus re-accumulation. Successful management involved vacuum dressings and percutaneous drainage. Eventually, her condition improved and she was discharged, without additional complications. CONCLUSIONS This report underscores the importance of considering cesarean scar dehiscence as a diagnosis in women with previous cesarean deliveries who present during subsequent pregnancies with symptoms such as abdominal pain or abdominal sepsis. Diagnostic tools, such as CT, play pivotal roles, and the timely performance of an exploratory laparotomy is paramount when suspicion arises.

Diagnostic Accuracy and Safety Between two Needle Sizes in Percutaneous Trans-Thoracic Biopsy for the Evaluation of Pulmonary Lesions.

BACKGROUND: Percutaneous trans-thoracic lung biopsy has a crucial role in diagnosing lung lesions including lung cancer. However, there is no clear guideline regarding the needle size in percutaneous trans-thoracic lung biopsy. This study aims to evaluate the diagnostic accuracy and complication rate between two needle sizes for percutaneous trans-thoracic lung biopsy. METHODS: A retrospective review of patients with lung lesions who underwent percutaneous trans-thoracic lung biopsy between November 2010 and December 2019 was performed. The demographic data, imaging finding, biopsy technique, complication and histologic outcome were recorded and analyzed. Propensity score matching was done to reduce bias in baseline characteristics. RESULTS: Of 377 patients who underwent percutaneous trans-thoracic lung biopsy, 331 patients had complete information. The patients were divided in two groups, comprising of 153 patients in 18G needle group and 178 patients in 20G needle group. After propensity score matching, there were 126 patients left in each group. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value for 18G needle group were 92.9%, 98.1%, 65.0%, 93.7% and 86.7%, respectively. For 20G needle group, the diagnostic accuracy, sensitivity, specificity, predictive value and negative predictive value were 96.0%, 99.0%, 83.3%, 96.2% and 95.2%, respectively. The immediate complication rate was 35.7% and 31.7% in 18G and 20 G needle groups (p= 0.505), respectively. CONCLUSIONS: There was no difference in diagnostic accuracy and immediate complication rates between 18G and 20G needle use for percutaneous trans-thoracic lung biopsy.

Cone-beam computed tomography-assisted percutaneous gastrostomy tube insertion in children with challenging anatomy.

BACKGROUND: Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. OBJECTIVE: To describe our experience using cone-beam computed tomography (CT)-assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. MATERIALS AND METHODS: A retrospective review was performed in children who underwent cone-beam CT-assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. RESULTS: Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96 min (range 50-131 min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6 mGy (average 26.2 mGy, median 24.9 mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). CONCLUSION: This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.

Biliary complications and efficacy after ablation of peribiliary tumors using irreversible electroporation (IRE) or radiofrequency ablation (RFA).

OBJECTIVE: To evaluate the biliary complication rates and efficacy of peribiliary tumor ablation using irreversible electroporation (IRE) or radiofrequency ablation (RFA). MATERIAL AND METHODS: This is a retrospective study of 42 consecutive patients with 44 peribiliary tumors (≤5 mm distance between the tumor margin and the primary or secondary bile duct). Data were collected between January 2014 and September 2020 from patients who underwent percutaneous liver ablation using IRE (n = 13) or RFA (n = 31). RESULTS: The median length of follow-up was 23.1 months. The mean tumor size was 17.2 ± 5.2 mm in IRE vs. 18.4 ± 7.0 mm in RFA (p= .56). Complete tumor ablation was achieved in 100% with a significantly larger ablation zone in the IRE group (3.8 ± 0.3 cm vs. 2.6 ± 0.6 cm, p<.001). Significant biliary complications occurred in one patient (7.7%) of the IRE group and in five patients (16.1%) of the RFA group. Significant risk factors for biliary complications included the RFA procedure (HR 9.71, p=.032) and proximity of the tumor to the bile duct (HR 0.63, p=.048). The local tumor progression (LTP) rates were 7.7% (IRE) vs. 21.5% (RFA) at 1 year, 23.1% (IRE) vs. 32.7% (RFA) at 2 years and 23.1% (IRE) vs. 44% (RFA) at 3 years, respectively (p=.289). CONCLUSIONS: The IRE and RFA procedures are safe and effective to treat peribiliary liver tumors. However, the RFA may have a higher risk of significant bile duct injury than IRE. The shorter distance between the bile duct and the tumor is a strong risk factor for biliary complications.