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At least 487 records · Page 27Linked to original sources
PubMed1999

Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting.

We conducted an observational study to evaluate the effectiveness of an endoscopic technique for harvesting the greater saphenous vein for aortocoronary bypass grafting. We hypothesized that the endoscopic technique would minimize the risk of postoperative wound complications. From May 1997 to July 1998, we used an endoscopic technique to harvest the greater saphenous vein in 50 patients who underwent aortocoronary artery bypass grafting. Twenty-five of the patients had an increased risk for wound complications due to preexisting diabetes, obesity, peripheral vascular disease, or lymphedema. The average duration of the procedure was 39 minutes (range, 11 to 70 minutes). The average length of the harvested vein was 58 cm (range, 25 to 85 cm). We made an average of 2.5 incisions per patient (range, 1 to 5 incisions), and the average incision length was 7 cm (range, 3 to 10 cm). Two patients (4%) required conversion to an open technique using 5 small incisions. Postoperative complications included 1 wound infection (2%) and 1 small hematoma (2%). Two patients (4%) had minor erythema at the incision site, and 5 patients (10%) had postoperative lymphedema. The most common problem, ecchymosis, was seen in 6 patients (12%). None required repeat hospitalization or reoperation for wound complications. In our study, the endoscopic approach yielded superior cosmetic results, and reduced wound complications and discomfort, compared with traditional methods of vein harvesting. After gaining expertise with this minimally invasive method of vein harvesting, a surgeon can safely remove the saphenous vein in 20 to 30 minutes.

Adult↗
PubMed1997

[High-malar plasty through an intraoral approach].

Request for high-malar plasty, a purely aesthetic surgery, is fairly common in the Oriental. For an optimal result, consideration should be given to integrating the malar reconstruction with the facial features. A new method for correction of the high-malar deformity was introduced, in which the intraoral approach through an L-shaped incision and osteotomy were employed. The technique is simple, safe and can be done with local anesthesia on an outpatient basis. From December 1994 to February 1996, we have successfully treated 25 cases with this method. Postoperative follow-up for 6 months to 1 year revealed aesthetically satisfactory results. Complications are minor, including swelling, ecchymosis, etc. We conclude that high-malar plasty through the intraoral approach is a safe, effective and relatively simple technique for mild and moderate high-malar deformity.

Adult↗
PubMed1999

The role of sclerotherapy in abnormal varicose hand veins.

Large, tortuous veins involving the dorsa of the hands often become more prominent with the passage of time and are a common source of patient dissatisfaction. The objective was to evaluate the results of sclerotherapy in the management of unsightly varicose veins of the dorsum of the hand. From January of 1987 to August of 1998, 100 healthy, ambulatory female patients with a mean age of 56.5 years (range, 35 to 78 years) underwent sclerotherapy treatment for abnormally dilated veins on the dorsum of the hands. Patients were divided into two groups: group A consisted of 20 patients treated with 0.5% sodium tetradecyl sulfate (Sotradecol Elkins-Sin, Inc., Cherry Hill, N.J.) or 1.5% polidocanol (Aethoxysklerol Kreussler, Chemische-Fabrik, Wiesbaden, Germany). Group B consisted of 80 patients treated with 3% polidocanol. Postsclerotherapy compression was utilized in all cases. Failure was observed in 16 patients (80 percent) in group A. Successful elimination of varicose veins was obtained in 76 of 80 patients (95 percent) in group B. The diameter of treated vessels ranged from 1 to 6 mm (mean, 3 mm). Adverse events observed included pain, ecchymosis, various degrees of edema, and thrombosis of the treated veins. One patient (1 percent) developed transient neuropraxia of the superficial branch of the radial nerve following treatment of vessels located on the thenar web. Eleven of the 76 patients (14.5 percent) treated successfully with higher concentration developed microscopic neovascularization (matting). In conclusion, (1) low concentrations of sclerosing agents were associated with a high incidence of failure (80 percent); (2) the use of higher concentrations of polidocanol (3%) produced good results in 95 percent of treated patients; (3) adverse events common to sclerotherapy were observed in 90 percent of the treated patients-there were no serious adverse events; and (4) when appropriate sclerosant concentrations were employed, compression sclerotherapy proved to be an effective method of treatment for varicose veins involving the dorsum of the hand.

Adult↗
PubMed1999

Biological responses of dog prostate and adjacent structures after meso-tetra-(m-hydroxyphenyl) chlorin and aluminum disulfonated phthalocyanine based photodynamic therapy.

Further to our work on the feasibility of application of photodynamic therapy (PDT) to the canine prostate, this study evaluates the biological responses of the prostate and adjacent vital structures with meso-tetra-(m-hydroxylphenyl) chlorin (mTHPC) or aluminum disulfonated phthalocyanine (AlS2Pc) based PDT as a preparatory step for clinical trials. Skin photosensitivity was not particularly problematic if light protection could be implemented properly for 2 weeks following sensitization. Prostate PDT was well tolerated by the experimental animals with only minor physical distress. mTHPC was more powerful than AlS2Pc in terms of prostate lesions induced. A large portion of prostate tissue could be destroyed by PDT with 4 punctures. Physical distress was probably caused by severe urethral irritation and aching from acute swelling of the prostate. Although the voiding condition normalized within 10 days, regeneration of urethral epithelium was not complete until 3-4 weeks after PDT. Improper placement of laser fiber caused extensive ecchymosis of the retroperitoneal organs. The biological significance of PDT induced hyperemia in the periprostatic structures remains poorly defined. Neither periprostatic nerve damage nor rectal lesions were seen in dogs receiving either mTHPC or AlS2Pc. Glandular atrophy with papillary cystic regeneration of the prostate was the most prominent finding 90 days after PDT. The glandular architecture was well preserved because the interlobular collagens were less affected than the cellular components of the glands. Our study suggests that PDT with mTHPC and AlS2Pc is safe and promising for necrosing a substantial amount of prostate tissue. The completeness of treatment and long-term therapeutic effectiveness for prostate cancer, however, remains to be determined through further investigation.

Animals↗
PubMed1999

[Tension-free hernioplasty in the treatment of inguinal hernia in the adult: our experience with local anesthesia and a review of the literature].

BACKGROUND: In the last years the real innovation in the treatment of groin hernia is represented by tension-free hernioplasty under local anaesthesia, based on the techniques of Lichtenstein and Trabucco, which use synthetic prosthesis (polypropylene) to restore the floor of inguinal tract and enable an early deambulation and return to work. METHODS: In 21 months the authors have treated, only under local anaesthesia, 100 patients, 95 men and 5 women; the age ranged from 18 to 82 years; some of them suffer from systemic pathology (7 patients with cardiovascular diseases, 1 with epilepsy, 3 with pulmonary diseases, 1 with liver cirrhosis). All patients underwent short-term antibiotic prophylaxis. No mortality was recorded. The mean follow-up was 12.5 months with only one little and low recurrence detected. RESULTS: Good results were obtained also in terms of intraoperative complication (nausea, vomiting, bradycardia, pain) and post-operative complications, (ecchymosis of scrotum and penis, edema of the scrotum, swelling of the skin suture, subcutaneous hematoma, inguinal pain, fever), not life-threatening, well tolerated and resolved spontaneously. CONCLUSIONS: The authors stress the advantages of local anaesthesia, the economic spare due, to one day hospital stay, the safety of the technique also in patients with severe general diseases (0.9-1% in USA). The authors survey the international literature confirming the great effectiveness of tension-free inguinal hernioplasty, in particular in terms of recurrences (Trabucco 0-0.025%, Amid 0.1%).

Adolescent↗
PubMed1999

[Recurrent bleeding tendency due to factor VIII inhibitor during therapy for bullous pemphigoid].

A 67-year-old woman with bullous pemphigoid (who had no history of hemorrhagic disease or blood transfusion) experienced extensive ecchymosis of the trunk and extremities and marked submucosal bleeding of the pharynx and larynx with risk of obstruction and suffocation. This bleeding tendency was the manifestation of a coagulation disorder due to factor VIII inhibitor. Immunosuppressive therapy, steroid pulse therapy, prednisolone (PSL), and cyclophosphamide (CPA) alleviated the bleeding and yielded negative assays for factor VIII inhibitor. However, because the patient stopped treatment, the bleeding recurred and was especially severe from a large hematoma with ruptured skin on the right hand. The bleeding was mitigated by transfusion of factor VIII concentrate combined with steroid pulse therapy. This was followed by CPA pulse therapy and oral PSL and CPA, resulting in the disappearance of factor VIII inhibitor again. We reported this case because factor VIII inhibitor complication of bullous pemphigoid is very rare and immunosuppressive therapy consisting of PSL, CPA, and pulse therapy was effective.

Aged↗
PubMed1999

Endoscopic-powered rhinoplasty.

OBJECTIVE: To present a new method for sculpting the bony nasal dorsum in rhinoplasty surgery. MATERIALS AND METHODS: Fifteen patients underwent powered dissection of the nasal dorsum during cosmetic and reconstructive rhinoplasty. The precise technique is described and its benefits are discussed. RESULTS: All patients had acceptable postoperative results using this technique. Intraoperative bleeding and postoperative ecchymosis appeared to be reduced. No complications were noted. CONCLUSIONS: Endoscopic-powered rhinoplasty provides an excellent approach to the bony dorsum. It allows sculpting to be completed under direct vision, permitting precise contouring and easy visualization by associates. It can be completed easily and safely with standard microdebrider equipment. Its use should be considered in situations requiring precise contouring of the bony nasal dorsum.

Endoscopy↗
PubMed1999

[The treatment of solitary thyroid nodules in non-toxic goiter with 96% ethanol injections].

40 patients (39 women and 1 man) aged 13-66 years (mean 35.9 years) with solitary benign non-toxic thyroid nodule confirmed by clinical and hormonal examination, ultrasonography and fine needle aspiration biopsy, were treated with intranodular percutaneous 96% ethanol injection, performed under ultrasound guidance. There were 34 patients with solid nodule (including 4 patients) with solitary nodule in recurrent goitre after thyroidectomy) and 6 patients with cyst. The nodules were 7-60 mm (mean 31 mm) in diameter. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 1-5 (mean 2.6) sessions were conducted at one month intervals. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed after 6 months, and the long-term one after 2 years since the last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure in the ultrasonography and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of initial dimensions, 4--nodule smaller by < 50% of initial dimensions. A final follow-up evaluation revealed: nodule disappearance in 15 (37.5%) patients (Group 1), cicatricial nodule in 10 (25%) patients (Group 2), nodules smaller by [symbol: see text] 50% of initial dimensions in 7 (17.5%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (20%) patients (Group 4). The results in Group 1 and 2 were defined as good (25 patients--62.5%), in Group 3 as satisfactory (17.5%) and in Group 4 as bad. The results of treatment of cysts and nodules in recurrent goitre were good or satisfactory. The following complications were observed: 1) pain during and after the injection in 29 (72.5%) patients, 2) subfebrile body temperature ap to 38 degrees C in 4 (10%) patients and fever up to 39 degrees C on the 1-st day after the injection in 2 (5%) patients, 3) ecchymosis in 1 (2.5%) patient, 4) temporary dysphonia in 2 (5%) patients, 6) temporary unilateral vocal cord paralysis and temporary Horner syndrome in 1 (2.5%) patient. It seems that percutaneous ethanol injection can be useful treatment method of solitary benign non-toxic thyroid nodules, both cysts and solid nodules, in patients who do not consent to surgical treatment or with contraindications to an operation.

Adolescent↗
PubMed1999

[Lupus anticoagulant in children. Report of 4 cases].

OBJECTIVE: We present four cases of lupus anticoagulant (AL) in children. In addition, as a result of the lack of literature published on the subject in our country. We also evaluate the epidemiological, clinical and prognostic characteristics of AL in children. PATIENTS AND METHODS: The diagnostic criteria established by the "Subcommittee for the Standardization of Lupus Anticoagulant" were followed. RESULTS: Over a ten-year period (1988-1998), 46 cases of children with TTPA prolongation were documented. Nine children showed circulating anticoagulant, 4 of which were lupus type anticoagulants. The age of the patients ranged from 4 to 13 and there was a prevalence of males (3/4). Half of the children had a family history of bleeding dyscrasia and it was these who showed hemorrhage or thrombotic symptoms. The case that started with ecchymosis and hemorrhaging showed prothrombin prolongation due to factor II deficit. In 3 of the 4 children, AL was linked to acute respiratory infections and was transitory. The other coincided with two thrombotic episodes of the lower extremities in a healthy child. Positive anticardiolipin antibodies were detected in two patients, both showing repeated AL episodes, one with thrombosis and the other always asymptomatic. CONCLUSIONS: Diagnosis of AL in children is difficult and has probably been underestimated. Although it is usually transitory, it can appear in repeated episodes. Its early detection is important as it can be linked to both prothrombin deficit, as well as significant symptoms of hemorrhaging.

Adolescent↗
PubMed2000

Acute compartment syndrome after rupture of the medial head of the gastrocnemius muscle.

Rupture of the gastrocnemius muscle is an uncommon injury, with most cases occurring in athletically active individuals. The presentation of a gastrocnemius rupture is the acute onset of calf pain and subsequent ecchymosis. Most of these injuries can be treated symptomatically with good results. We present an unusual case of gastrocnemius muscle tear complicated by acute compartment syndrome. Physicians need to be aware of this potentially devastating complication of gastrocnemius rupture.

Compartment Syndromes↗
PubMed2000

[Treatment of solitary toxic thyroid nodules with the use of percutaneous ethanol injections].

Twenty women aged 18-76 years (mean 42 +/- 23 years) with solitary benign toxic thyroid nodule were treated with intranodular percutaneous 96%-ethanol injection, performed under ultrasound guidance. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 2-5 (mean 3.1) sessions were conducted every month. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed in 6 months, and the long-term one in 2 years after last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of its initial dimensions, 4--nodule smaller by < 50% of its initial dimensions. A functional evaluation was carried out according to the following scale: I--permanent euthyroidism, II--permanent decrease of hyperthyroidism, III--no functional effect. A final follow-up evaluation revealed: nodule disappearance in 2 (10%) patients (Group 1), cicatricial nodule in 8 (40%) patients (Group 2), nodules smaller by [symbol: see text] 50% of its initial dimensions in 2 (10%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (40%) patients (Group 4). The results in Group 1 and 2 were defined as good (50%), in Group 3 as satisfactory (10%) and in Group 4 as bad; and I--permanent euthyroidism in 16 (80%) patients, II--permanent decrease of hyperthyroidism in 1 (5%) patient, III--no functional effect in 3 (15%) patients. 2 patients in whom new nodules appeared and 1 patient with bad morphological and no functional treatment effects were operated on. A histological examination revealed haemorrhagic necrosis surrounded by fibrous tissue in removed nodules. The following complications were observed: 1) pain during and after the injection in 15 (75%) patients, 2) subfebrile body temperature in 3 (15%) patients and fever up to 39 degrees C on the 1-st day after the injection in 1 (5%) patient, 3) local ecchymosis in 1 (5%) patient, 4) temporary dysphonia in 1 (5%) patient. It seems that percutaneous ethanol injection treatment can be an useful treatment method of solitary benign toxic thyroid nodules in patients who do not give their consent to surgical or 131I treatment or with contraindications to an operation or radioiodine therapy.

Adolescent↗
PubMed2000

Endoscopic saphenectomy for coronary artery bypass surgery: comparison of two techniques with and without carbon dioxide insufflation.

OBJECTIVE: To compare the clinical results of an initial experience with two techniques of endoscopic saphenectomy with and without gas insufflation. DESIGN: A retrospective study was performed between September 1998 and March 1999 on 40 patients who underwent endoscopic saphenectomy for coronary artery bypass graft without (group 1, n=15) and with (group 2, n=25) carbon dioxide insufflation. INTERVENTIONS: In both groups, the site of harvesting was at the knee through a 2 cm incision. In group 1, dissection was performed using a hand-held dissector while in group 2 dissection was performed after ensuring that there was a seal at the knee and insufflation of carbon dioxide. Collaterals were controlled with an endoclipper in group 1 and bipolar scissors in group 2. Intraoperative procedure time, length of the harvested vein and aspect of the thigh (ecchymosis, hematoma, infection) were recorded. RESULTS: Vein trauma occurred in four patients in group 1 (four of 15, 27%) and in one in group 2 (one of 25, 4%). Hematomas developed in four patients in group 1 (four of 15, 27%) and in one patient in group 2 (one of 25, 4%). Wound infection occurred in no patients in group 1 and in one patient in group 2. One patient in group 2 suffered carbon dioxide embolism with no untoward consequences. Conversion to an open technique was necessary in five patients in group 1 (five of 15, 33%) and in two patients in group 2 (two of 25, 8%). CONCLUSIONS: Endoscopic saphenectomy both with and without carbon dioxide insufflation is associated with a low infection rate, but vein trauma and wound hematomas are more common without carbon dioxide insufflation.

Angioscopes↗
PubMedDate not supplied

Análisis clínico y epidemiológico de los accidentes por mordeduras de serpientes del género Bothrops en Venezuela [A clinical and epidemiological analysis of accidental bites by snakes of the genus Bothrops in Venezuela].

Clinical register of 60 patients bitten by Bothrops snake who assisted at Leopoldo Manrique Hospital and the Institute of Tropical Medicine (HLM-IMT) in Caracas during 1996-1997 were analysed. The accident was more frequent in males (45/75%). In 32 cases (53.3%) the snake was classified and 26 were Bothrops lanceolatus, 4 Bothrops venezuelensis and 2 Bothrops atrox. Anatomic regions more frequent bitten were superior members (40/66.6%): hands (36/60%), forearm (2/3.3%), elbow (1/1.6%) and arm (1/1.6%). On inferior members (20/33.3%): legs (6/10%), feet (10/16.7%), ankle (2/3.3%), and the hip (2:3.3%). The most frequent clinical manifestations in moderate and severe cases (33 patient) were pain (100%), oedema (98%), ecchymosis (76%), blisters (20%), necrosis (12%), abscess (6%) bleeding (19%), heart failure (1/1.6%), renal failure (1/1.6%). The blood clotting was evaluated in 60 (100%) cases and it was altered in 33 (55%) patients. No deaths were recorded.

Adolescent↗
PubMed2001

Early ambulation after diagnostic cardiac catheterization: a 4 French study.

This study is intended to test whether the use of new 4 French (Fr) catheters can safely eliminate the need for supine bed rest and allow earlier ambulation while decreasing groin site complications and patient discomfort. Diagnostic left heart catheterization was performed using 4 Fr catheters via the femoral approach in 100 consecutive patients. After femoral sheath removal, the mean compression time with a mechanical compression device was 16.07 +/- 3.19 minutes. Mean manual compression time was 18.3 +/- 5.7 minutes. Ninety-eight patients were able to sit up 30 degrees immediately after hemostasis was achieved. The mean ambulation time was 2.18 +/- 0.71 hours. There were no major vascular complications. Four patients developed a small area (2.5-5 cm) of ecchymosis at the femoral arterial puncture site. The study demonstrated that upper body elevation and early ambulation are safe as soon as hemostasis is achieved after 4 Fr cardiac catheterization.

Adult↗
PubMed2000

[Treatment of erectile dysfunction with vacuum devices].

OBJECTIVE: To analyze the results achieved with vacuum devices in the treatment of erectile dysfunction. METHODS: A telephone survey was conducted on 150 patients undergoing treatment with a vacuum device. Of these, 89 responded; 79 of which were considered valid for the study. The duration and frequency of use, side effects and degree of patient and partner satisfaction were analyzed. Mean follow-up was 59.5 months. RESULTS: There were 14 dropouts early in the course of treatment. The remaining 65 patients used the device for a mean duration of 34.6 months, 3.7 times monthly. 63.3% of the patients achieved erection in more than half of the attempts. The most frequent side effects were pain (27 patients) and ecchymosis (7 patients). Forty-eight patients discontinued treatment at 10.8 months' mean follow-up. The most common causes for discontinuing treatment were lack of efficacy, refusal of the partner and pain. CONCLUSIONS: Treatment of erectile dysfunction with the vacuum constriction device should be utilized as an alternative to intracavernosal drug-induced erection therapy when oral therapy fails or is contraindicated. A male with a stable partner and impotence arising from venous leakage or mild cavernous artery insufficiency is the ideal candidate.

Adult↗
PubMed2000

[Ultrasound-guided cryosurgery of the prostate: short- and long-term experience].

We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.

Aged↗
PubMed2001

Laparoscopic versus conventional live donor nephrectomy: experience in a community transplant program.

Fifty-nine consecutive patients underwent live donor nephrectomy for transplantation. Twenty-nine patients (Group I) had open kidney procurement, and 30 patients (Group II) had laparoscopic procurement. The mean operative time in Group I was 2:30 hours (range 1:55-2:59), whereas in Group II it was 3:01 hours (1:54-5:21). All kidneys functioned immediately after transplantation. The average warm ischemia time was not calculated in Group I; it was 3.9 minutes (2-15) in Group II. Intraoperative complications occurred in two patients in Group II. One patient had bleeding from an accessory renal artery. The second patient had a tear in the splenic capsule. No ureteral complications occurred in either group. Postoperatively one patient in Group I developed incisional hernia, one developed pneumothorax, and two developed atelectasis. In Group II one patient developed pancreatitis, one developed flank ecchymosis, and two had suprapubic wound hematomas. Using the laparoscopic approach the hospital stay decreased from 4.1 to 1.27 days (69%) (P < 0.001) and return to work decreased from 28.4 to 14.8 days (49%) (P < 0.01). Live donation increased by 67 per cent. We conclude that the laparoscopic procurement of kidneys for transplantation compares well with the open method. It offers several advantages that may increase the living donor pool.

Absenteeism↗
PubMedDate not supplied

Rare complications of endoscopic retrograde cholangiopancreatography: two case reports.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure with several known risks. We present two rarely reported complications of ERCP and sphincterotomy: transverse mesocolon disruption with ischemic colitis and splenic rupture. RESULTS: The first patient, a 54-year-old female, presented one day following ERCP and stent revision for pancreas divisum. She presented with hypotension and abdominal distention. An abdominal computed tomography (CT) showed a ruptured spleen, which was confirmed on laparotomy. She had a complicated postoperative course and died of multiple organ failure. The second patient is a 56-year-old female who presented five days after ERCP and sphincterotomy with abdominal pain, abdominal wall ecchymosis, and decreasing hematocrit. Her evaluation included hospital admission and abdominal CT scan, which showed free fluid and a large hematoma in the transverse mesocolon. These findings were confirmed on laparotomy and a devascularized segment of bowel was resected. CONCLUSION: Only 6 cases of ERCP-related splenic injury have been reported in the literature. One additional report is available of a fatal splenic artery injury. No previous reports exist of a mesenteric hematoma resulting in bowel devascularization. Prompt evaluation and awareness of potential complications should help capture potentially life-threatening sequelae of ERCP.

Cholangiopancreatography, Endoscopic Retrograde↗