Contribution of computed tomography guided percutaneous drainage of tuberculous cold abscesses adjunctive to pharmaceutical anti-tubercular treatment

Purpose

To determine the efficiency and safety of the percutaneous aspiration and drainage of rare touberculous cold abscesses under CT guidance.

Materials and methods

We retrospectively studied 63 cases of 44 patients, treated in our hospital during the last two years. They suffered from tuberculous infection complicated with tuberculous cold abscesses variously located. All these patients underwent percutaneous aspiration and drainage under CT imaging, following the trocar puncture technique. The catheter remained in place for about a week. A follow up CT scan was performed in all cases before the catheter removal. Some of the patients were under anti tuberculosis medication.

Results

All the patients had a successful recovery from the abscesses. There were no major or minor complications observed. No recurrence occurred until today.

Conclusion

CT guided percutaneous aspiration and drainage of tuberculous cold abscesses is a safe, minimal invasive and effective method of treatment. Drainage and specific antituberculosis therapy leads to a satisfactory conclusion.     

Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience

Purpose

This study was undertaken to evaluate the efficacy of image-guided percutaneous drainage in treating abdominal and pelvic abscesses.

Materials and methods

From August 2001 to August 2006, 95 patients (49 men and 46 women; mean age 61 years, range 25–92) with 107 abscesses underwent image-guided percutaneous drainage. Thirty-one abscesses were retroperitoneal (9 peripancreatic, 17 perirenal, 5 pararenal), 37 intraperitoneal (2 in communication with the small bowel), 8 intrahepatic (2 in communication with the extrahepatic biliary system and 2 with the intrahepatic biliary system), 4 perisplenic and 27 pelvic (4 in communication with the large bowel). Seventy-one of 107 procedures were performed with ultrasonographic (US) guidance and 36/107 with computed tomography (CT) guidance. All procedures were carried out with 8-to 14-Fr pigtail drainage catheters.

Results

Immediate technical success was achieved in 107/107 fluid collections. No major complications occurred. In 98/107 abscesses, we obtained progressive shrinkage of the collection (>50%) with consequent clinical success. In 9/107 cases, percutaneous drainage was unable to resolve the fluid collection. There were 12 cases of catheter displacement and six of obstruction.

Conclusions

Percutaneous drainage is feasible and effective in treating abdominal and pelvic abscesses. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.     

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

Purpose

This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy.

Methods

Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage.

Results

Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement.

Conclusions

Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.     

Percutaneous catheter drainage of tuberculous and nontuberculous psoas abscesses

Objective: To assess the utility of percutaneous catheter drainage in the management of tuberculous and nontuberculous psoas abscesses associated without any bony involvement or with minimal bony lesions that could not cause vertebral instability. Materials and method: Eleven patients with psoas, iliopsoas and pelvic abscesses were drained under computed tomography and ultrasono-graphy guidance. Results: There were 15 (10 tuberculous, 5 pyogenic) abscesses in 11 patients. Six of the tuberculous abscesses and one of the pyogenic abscess were associated with vertebral involvement. Vertebral lesions were located in one or two vertebrae without causing any serious disturbance in the vertebral stabilization. In one case, the abscess was bilateral. Nine cases were drained under computed tomography guidance, while two cases were drained under both computed tomography and ultrasonography guidance. One session drainage was sufficient for abscess resolution in uniloculated cases. In the two of four multiloculated cases, catheter drainage was performed twice. Relapse of the abscess was found in only one patient. The mean abscess volume was 520 ml and mean drainage duration was 12 days. None of the cases required surgery. Conclusion: Percutaneous drainage, chemotherapy and additional external brace application with the cases associated with bony lesion may be used for treatment of tuberculous and nontuberculous unilocule and multiloculated abscesses.     

Balloon dilatation and insertion of temporary coated stents using a retrograde approach in patients with irreversible strictures of the distal ureter

Purpose

Irreversible obstruction of urine flow due to stricture of the distal ureter is one of the most frequent reasons for uroradiological intervention. Using new technologies and with appropriate stents applied at the right time, it is possible to release the stricture and avoid external drainage of urine.

Materials and methods

Our case series consists of six patients (four women, two men) initially treated by percutaneous nephrostomy due to ureteral stricture. The authors used a combined approach (both percutaneous and retrograde) because the balloon catheter could not be inserted using only one approach owing to the morphology of the stricture. The metal guidewire was inserted through a residual tract after previous nephrostomy, and the balloon catheter and a stent were introduced using a retrograde approach through the urinary bladder (four cases) or through an ileostomy positioned at the anterior abdominal wall. In five of the six cases, coated temporary ureteral stents were used.

Results

In all six cases the therapeutic aim was achieved. Urine flow through the strictures was established, and the need for percutaneous nephrostomy was obviated. Neither early nor late complications (11 months after the procedure and 6 months after stent removal) associated with the procedure were recorded.

Conclusion

In patients with subtotal stricture of the distal ureter, which permits passage only of a hydrophyl guidewire, a combined percutaneous retrograde approach can achieve sustainable flow of urine through the stricture using a balloon catheter and coated stents.     

Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

Purpose

Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction.

Methods

Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted.

Results

Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14–260) days and median stent patency of 84.5 (range 14–260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14–260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38–210) days.

Conclusions

In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.     

A new interventional technique for percutaneous treatment of drainage-resistant liver abscess

The objective of this case report is to describe a device that can be used as a minimally invasive alternative for the treatment of drainage-resistant liver abscess. The device uses pulse lavage to fragment and evacuate the semi-solid contents of a liver abscess. The treatment of liver abscesses consists of percutaneous drainage, antibiotics and treatment of the underlying cause. This approach can be ineffective if the contents of the abscess cavity are not liquid, and in those cases open surgery is often needed. Here, we describe for the first time a new minimally invasive technique for treating persistent liver abscesses. A patient developed a liver abscess after a hepatico-jejunostomy performed as a palliative treatment for an unresectable pancreatic head carcinoma. Simple drainage by a percutaneously placed pig-tail catheter was insufficient because of inadequate removal of the contents of the abscess cavity. After dilatation of the drain tract the persistent semi-solid necrotic contents were fragmented by a pulsed lavage device, after which the abscess healed uneventfully. The application of pulsed lavage for debridement of drainage-resistant liver abscesses proved to be an effective and minimally invasive alternative to open surgery.The mainstays of the treatment of liver abscesses are drainage and antibiotics. Drainage can be performed by ultrasound- or CT-guided percutaneous drain placement or by surgical techniques using laparoscopy or laparotomy. The most appropriate method of drainage is controversial and varies from open surgery to repeated percutaneous punctures. Surgical drainage had a higher success rate and a shorter hospital stay than percutaneous drainage in a retrospective study of 80 patients with large pyogenic liver abscesses [1]. By contrast, a randomised trial revealed that drainage by repeated puncture was equally as effective as percutaneous drainage in which an indwelling catheter was left behind [2]. For most patients with liver abscesses, percutaneous drainage is an effective treatment.In patients with highly viscid, sticky pus or infected necrotic tissue, it is much more difficult to clean the abscess cavity because of occlusion of the relatively narrow percutaneous drain and inability to remove the semi-solid contents. In these cases, surgery is performed to create a large opening and adequate drainage of the contents of the abscess cavity. Even partial liver resection has been advocated for the treatment of drainage-resistant liver abscesses [3].Here, we describe a new technique that has the potential to treat a non-resolving liver abscess efficiently after simple percutaneous drainage. The technique uses pulsed lavage, which is able to fragment and evacuate non-liquefied debris in a liver abscess using a percutaneous approach.     

Percutaneous Balloon Dilatation and Long-Term Drainage as Treatment of Anastomotic and Nonanastomotic Benign Biliary Strictures

Purpose

This study was designed to determine the effectiveness of percutaneous balloon dilation and long-term drainage of postoperative benign biliary strictures.

Methods

Medical records of patients with postoperative benign biliary strictures, in whom percutaneous transhepatic biliary drainage (PTBD) and balloon dilation was performed between January 1999 and December 2011, were retrospectively reviewed. PTBD and balloon dilation (4–10 mm) were followed by placement of internal-external biliary drainage catheters (8.5–12 F). Patients were scheduled for elective tube changes, if necessary combined with repeated balloon dilation of the stenosis, at 3-week intervals up to a minimum of 3 months.

Results

Ninety-eight patients received a total of 134 treatments. The treatment was considered technically successful in 98.5 %. Drainage catheters were left in with a median duration of 14 weeks. Complications occurred in 11 patients. In 13 patients, percutaneous treatment was converted to surgical intervention. Of 85 patients in whom percutaneous treatment was completed, 11.8 % developed clinically relevant restenosis. Median follow-up was 35 months. Probability of patency at 1, 2, 5, and 10 years was 0.95, 0.92, 0.88, and 0.72, respectively. Overall, 76.5 % had successful management with PTBD. Restenosis and treatment failure occurred more often in patients who underwent multiple treatments. Treatments failed more often in patients with multiple strictures. All blood markers of liver function significantly decreased to normal values.

Conclusions

Percutaneous balloon dilation and long-term drainage demonstrate good short- and long-term effectiveness as treatment for postoperative benign biliary strictures with an acceptably low complication rate and therefore are indicated as treatment of choice.     

Feasibility and Safety of Endovascular Stripping of Totally Implantable Venous Access Devices

Purpose

To evaluate the safety and feasibility of percutaneous stripping of totally implantable venous access devices (TIVAD) in case of catheter-related sleeve and to report a technique to free the catheter tip from vessel wall adherence.

Materials and Methods

A total of 37 stripping procedures in 35 patients (14 men, 40%, and 21 women, 60%, mean age 53?±?14?years) were reviewed. Totally implantable venous access devices were implanted because of malignancy in most cases (85.7%). Catheter-related sleeve was confirmed as cause of persistent catheter dysfunction despite instillation of thrombolytics. A technique to mobilize the catheter tip from the vessel wall was used when stripping with the snare catheter was impossible. Technical success, complication rate, and outcome were noted.

Results

A total of 55.9% (n?=?19) of the 34 technically successful procedures (91.9%) could be done with the snare catheter. In 15 cases (44.1%), additional maneuvers to free the TIVAD??s tip from the vessel wall were needed. Success rate was not significantly lower before (72.4%) than after (96.7%) implementation of the new technique (P?=?0.09). No complications were observed. Follow-up was available in 67.6% of cases. Recurrent catheter dysfunction was found in 17 TIVADs (78.3%) at a mean of 137.7?days and a median of 105?days.

Conclusions

Stripping of TIVADs is technically feasible and safe, with an overall success rate of 91.9%. Additional endovascular techniques to mobilize the distal catheter tip from the wall of the superior vena cava or right atrium to allow encircling the TIVAD tip with the snare catheter may be needed in 44.1% of cases.     

Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

Purpose

The major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.

Methods

Nine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.

Results

All nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.

Conclusions

In this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.     

Management of Postoperative Lymphoceles After Lymphadenectomy: Percutaneous Catheter Drainage With and Without Povidone-Iodine Sclerotherapy

Purpose

To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS).

Methods

The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient’s symptoms that prompted the intervention.

Results

Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15–1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4).

Conclusion

PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.     

Pyogenic liver abscess: Treatment with needle aspiration

Objective:

Percutaneous needle aspiration as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of pyogenic liver abscess has never been popular. The authors report their experience with needle aspiration and evaluate its safety, effectiveness and role in treating pyogenic liver abscess.

Materials and Methods:

The results of needle aspiration performed in 101 liver abscesses of 64 unselected consecutive patients with male to female ratio of 2.5:1 and average age 56.3 ± 16 years were reviewed. The abscesses were pyogenic in 63 patients (98.4%), and multiple in 18 patients (28.1%). Thirty-nine abscesses (38.6%) were ≥ 5 cm in diameter. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles and ultrasound guidance.

Results:

The percentage of abscesses requiring one, two and three, or more sessions of aspiration was 49.5%, 23.7% and 26.7%, respectively. The overall success rate was 96.8%. The success rate was unrelated to the largest size or number of abscess in the patient. Two patients died from uncontrolled sepsis. One serious complication of liver laceration requiring laparotomy occurred.

Conclusion:

Percutaneous needle aspiration in combination with systemic antibiotics is safe and effective in treating pyogenic liver abscess, it should be considered as a first line alternative to catheter drainage, especially for multiple abscesses. The need for repeat aspirations follows a ‘fifty per cent rule’.     

Image-guided percutaneous drainage of tuberculous iliopsoas and spondylodiskitic abscesses: midterm results

PURPOSE: To evaluate midterm results of percutaneous drainage (PD) with image guidance in 21 patients with tuberculous iliopsoas abscesses with or without spondylodiskitis. MATERIALS AND METHODS: Computed tomography (CT)-guided PD was performed in 21 patients with 26 tuberculous iliopsoas abscesses. Nineteen patients had bone involvement of two or more vertebrae. Eleven patients with spondylodiskitis had intradiskal abscesses. Five patients had bilateral psoas abscesses. Easily and safely accessible well-circumscribed abscesses larger than 3 cm were selected for PD. Catheters were inserted into the abscess cavities with Seldinger technique in all cases. In conjunction with PD, all patients had antituberculous drug therapy and underwent clinical and imaging follow-up for at least 1 year. RESULTS: Percutaneous catheter placement was successful in all cases without procedural complications. On the basis of CT findings, complete evacuation of all abscesses was achieved initially. During follow-up, six (29%) of 21 patients had recurrences within 1 and 3 months after catheter removal. A total of 37 catheters were used; eight of the 37 catheters were inserted due to recurrences. Four patients needed two PD procedures, and two patients needed three due to recurrences. Four catheters were changed because of obstruction or dislocation. Drainage duration ranged from 5 to 36 days (mean, 14.9 days). The follow-up period was 12-52 months (mean, 24 months). None of the patients, including those with recurrence, required surgical drainage and débridement due to insufficient PD. CONCLUSION: Image-guided PD in conjunction with antituberculous drug therapy is an effective and safe procedure in the treatment of tuberculous iliopsoas abscesses with or without spondylodiskitis.     

Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass?

Objectives

Our aim was to establish threshold criteria based on quantitative DCE-MRI data as independent predictors of malignancy in a complex (solid, solid/cystic) ovarian mass.

Methods

The MRI of 26 lesions in 25 patients with a complex ovarian mass (age range, 17–80 years; mean 43 years) was retrospectively reviewed and correlated with histology following resection. Cases with solid tumour components, definitive histology and relevant dynamic imaging were included. These were categorised into two groups, benign (N?=?14) and malignant (N?=?12). Following dynamic contrast-enhanced imaging, regions of interest were drawn around the solid tumour component. Maximum actual enhancement (SImax), maximum relative enhancement (SIrel), wash-in rate (WIR) and SImax (tumour)/SImax (psoas) ratio were analysed. Threshold criteria for malignancy were established.

Results

There was a significant difference in SImax (p?<?0.001), SIrel (p?<?0.05), WIR (p?<?0.001) and SImax (tumour)/SImax (psoas) between the two groups. Optimal threshold criteria for malignancy were established; SImax ≥ 250 or SImax (tumour)/SImax (psoas) ≥ 2.35 divided the two groups with 100% sensitivity, specificity and accuracy.

Conclusion

Threshold criteria established in this preliminary study using quantitative DCE-MRI provide an accurate method for the prediction of malignancy, particularly in preoperative indeterminate cases.     

Novel Percutaneous Radiofrequency Ablation of Portal Vein Tumor Thrombus: Safety and Feasibility

Purpose

We report our experience of the safety of partial recanalization of the portal vein using a novel endovascular radiofrequency (RF) catheter for portal vein tumor thrombosis.

Methods

Six patients with liver cancer and tumor thrombus in the portal vein underwent percutaneous intravascular radiofrequency ablation (RFA) using an endovascular bipolar RF device. A 0.035-inch guidewire was introduced into a tributary of the portal vein and through which a 5G guide catheter was introduced into the main portal vein. After manipulation of the guide catheter over the thrombus under digital subtraction angiography, the endovascular RF device was inserted and activated around the thrombus.

Results

There were no observed technique specific complications, such as hemorrhage, vessel perforation, or infection. Post-RFA portography showed partial recanalization of portal vein.

Conclusions

RFA of portal vein tumor thrombus in patients with hepatocellular carcinoma is technically feasible and warrants further investigation to assess efficacy compared with current recanalization techniques.     

Anal endosonography and fistulography for fistula-in-ano

Purpose

In this study, a comparison was made of the accuracy and clinical usefulness of anal endosonography and fistulography in the preoperative classification of fistulas-in-ano.

Materials and methods

A total of 113 patients with a clinical diagnosis of cryptoglandular fistula-in-ano who were awaiting surgery were included in this retrospective review. Patients were preoperatively investigated by anal endosonography and/or modified fistulography by inserting a Foley catheter into the rectum and a metal ring close to the anus. The catheter and ring served as radiopaque anal markers. Fistula classification obtained by the two diagnostic modalities was compared with surgical classification as the criterion standard.

Results

Endoanal ultrasound and fistulography identified 82.8% and 100% of primary tracks, 79% and 74.2% of internal openings, 98% and 91.8% of secondary tracks and 92.9% and 87.8% of abscesses, respectively.

Conclusions

Anal endosonography and fistulography with radiopaque markers are important complements to surgical exploration for investigating anal sepsis and may be of value to the surgeon in planning a therapeutic strategy.     

Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature

Purpose

Complications correlated with percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) of lung tumours were retrospectively reviewed to compare them with data from the literature and to assess risk factors related with the procedures.

Materials and methods

From January 2003 to January 2009, 29 patients (36 lung lesions) were treated with RFA; from January 2007 to January 2009, 16 patients (17 lung lesions) were treated with MWA. Complications recorded at our institution are reported following the Society of Interventional Radiology guidelines. A systematic review of the literature was performed.

Results

Any major complication of RFA or MWA was recorded. In agreement with the literature, pneumothorax was the most frequent complication, even though the incidence in our series was lower than reported in the literature (3.5% vs. 4.3?C18%). Other complications of RFA were pleural effusion and subcutaneous emphysema. No massive haemorrhages, haemoptysis, abscesses, pneumonia, infections or tumour seeding were recorded in our series. The most common complication of MWA was pneumothorax (25% vs. 39% reported in the literature). Pleural effusion was a common reaction, but therapeutic drainage was never required.

Conclusions

Pneumothorax is the most common complication of both techniques. RFA and MWA are both excellent choices in terms of safety and tolerance.     

Benefits of 3D technique in guiding percutaneous retroperitoneal biopsies

Purpose

This study aimed to assess the usefulness and advantages of multiplanar reformations (MPR) during multidetector-row computed tomography (MDCT)-guided percutaneous fine-needle aspiration biopsy (FNAB) and core biopsy of retroperitoneal lesions that are difficult to access with the guidance of ultrasound and axial CT alone owing to overlying bony structures, large vessels or abdominal organs.

Materials and methods

MDCT-guided retroperitoneal FNAB and core biopsy was performed on 14 patients with suspected retroperitoneal neoplasm. We used MPR images (sagittal and coronal) obtained with a six-detector-row MDCT scanner and 20?C22 gauge Chiba needles.

Results

Using MDCT with 3D MPR allowed biological samples to be obtained in all cases (ten cytological and four histological) and diagnostic samples in 11/14 cases (78.5%). Histological samples were deemed adequate for diagnostic assessment in all cases and cytological samples in 7/10 cases (70%).

Conclusions

MPR images allowed sampling of retroperitoneal lesions until now considered unreachable with the guidance of axial MDCT alone. Compared with the conventional procedure, the use of MPR images does not increase the procedure time.     

Interventional radiology in the treatment of early postoperative biliary complications

Purpose

We sought to evaluate the feasibility and efficacy of percutaneous treatment of early postoperative biliary complications. The primary aims were to evaluate clinical and technical success and complications and perioperative mortality, and secondary aims were to evaluate treatment duration and recurrence rate.

Materials and methods

Between March 2007 and March 2010, 75 patients (42 men and 33 women; age range, 17–88 years; mean age, 60.8 years) underwent interventional radiology procedures to treat early postoperative biliary complications of biliary and pancreatic-duodenal surgery with biliodigestive anastomosis (37.7%), laparoscopic cholecystectomy (30.6%), hepatic resection (21.1%) and several other surgical procedures (10.6%). Complications included fistulas (73%), stenoses (20%) and complete bile duct transections (7%).

Results

Interventional radiology achieved complete clinical success in 74 cases (85.9%) and in particular in 95.2% of fistulas, 76.5% of stenoses and 33.3% of complete bile duct transections. Mean indwelling catheter time was 34.9 days, with an average of 4.1 procedures. There were two cases of severe haemobilia (2.3%). Minor complications occurred in 7% of cases. Perioperative mortality rate was 1.2% and overall recurrence rate 6.7% (range, 1–18 months; mean, 10 months), with recurrences occurring predominantly in stenoses. All patients were retreated successfully.

Conclusions

Percutaneous procedures are feasible, effective and safe for treating early postoperative biliary complications. They provide a valuable alternative to presendoscopy, which is precluded in many of these patients, and to surgery, which has higher morbidity and mortality rates.     

Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

Purpose

To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach.

Methods

The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated.

Results

Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26–313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40–659 days).

Conclusion

This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.