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Elijah Dixon

Publications and source records attributed to Elijah Dixon.

24 records · Page 2Linked to original sources
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Intermittent hepatic vein--total vascular exclusion during liver resection: anatomic and clinical studies.

Bleeding from hepatic veins remains a problem during liver surgery. Perceived difficulties in the dissection and isolation of these retrohepatic venous structures have limited the widespread use of hepatic vein control during liver resection. The purpose of this study was to delineate the anatomy of the hepatic veins and to apply this knowledge to a series of patients undergoing liver resection with intermittent hepatic vein-total vascular exclusion (IHV-TVE). A detailed description of the hepatic venous anatomy was formulated using 20 cadaveric dissections in conjunction with anatomic descriptions during 30 hepatectomies. With the benefit of improved anatomic knowledge, we evaluated a series of 45 consecutive major liver resections in which hepatic veins were isolated and the technique of IHV-TVE was applied. The hepatocaval ligament must be divided to isolate the right hepatic vein. It was closely associated with a caudate vein 69% of the time. The hepatic veins were isolated in 45 consecutive patients who underwent a major hepatic resection. The portal triad and the hepatic veins were occluded intermittently (20 minutes with 5 minutes of reperfusion) with Rommel tourniquets. Mean total warm ischemic time was 65 +/- 24.5 minutes. Mean estimated blood loss was 864 +/- 514 ml. Eighteen percent of patients required blood transfusions. Complications were identified in 16 patients (35.5%), and the average length of hospital stay was 10.5 +/- 3.4 days. There were no deaths. Detailed anatomic knowledge of the hepatocaval ligament and the hepatic veins allows for safe extrahepatic control of the hepatic veins during major hepatic surgery. The technique was well tolerated and may have limited intraoperative blood loss.

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PubMedDate not supplied

Hepatic vein injury during laparoscopic cholecystectomy: the unappreciated proximity of the middle hepatic vein to the gallbladder bed.

Uncontrollable hemorrhage during laparoscopic cholecystectomy occurs in 0.1% to 1.9% of all cases, with 88% originating from the gallbladder bed. The anatomical proximity between major branches of the middle hepatic vein and the gallbladder bed, and hence the risk of intraoperative bleeding, is unclear. CT scans of 20 random patients were retrospectively reviewed to identify the closest distance between branches of the middle hepatic vein and the gallbladder bed. The vein diameter was also recorded. Risk factors for intraoperative bleeding during laparoscopic cholecystectomy were also retrospectively reviewed. Large branches (mean diameter = 2.1 mm) of the middle hepatic vein are directly adjacent to the gallbladder bed in 10% of patients. An additional 10% of cases also possess branches within 1 mm of the gallbladder bed. Chronically scarred and contracted gallbladder disease may increase the risk of significant bleeding, requiring conversion. Twenty percent of all cases will display a large branch of the middle hepatic vein adherent or immediately adjacent to the gallbladder fossa. These patients are at increased risk for intraoperative bleeding. Furthermore, contracted gallbladders with evidence of chronic disease may be at increased risk for significant hemorrhage.

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PubMedDate not supplied

Splenic injury following endoscopic retrograde cholangiopancreatography: a case report and review of the literature.

Endoscopy of both the upper and lower gastrointestinal tract remains one of the commonest procedures performed on patients. The common risk factors associated with this procedure are well known. However, some of the rarer complications are not known or are not considered in the immediate postprocedure time period when a patient experiences acute abdominal pain. Herein, we report a case of solid organ injury (splenic capsular tear) resulting from endoscopic retrograde cholangiopancreatography. The risk factors and presentation of this type of injury are reviewed, including its association with chronic pancreatitis, which we describe for the first time.

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