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Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What are the potential delayed complications of blunt hepatic trauma?Complications occur in more than 10% of patients, particularly after high-grade injury. Although routine imaging is not recommended, clinical indications (abdominal pain, fever, jaundice, a drop in haemoglobin) indicate a follow-up CT scan.Complications include biloma and necrosis from devascularisation, complicated by abscess formation. Abscesses and biloma can be treated by drainage (percutaneous or surgical), and some biliary complications requiring ERCP stenting. Most rebleeding or secondary haemorrhage (e.g. rupture of subcapsular haematoma or pseudo-aneurysm) can be treated non-operatively, with or without embolisation.Pseudo-aneurysms, haemobilia and liver compartment syndrome in large sub-capsular haematomas are less common.In general, patients who have been well may go back to normal activity by 3–4 months, as follow-up studies generally show that the liver would have healed by then.
Biliary Leak after Pancreatoduodenectomy for Duodenal Neuroendocrine Tumors
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Gayatri Balachandran, Sadiq S. Sikora
Two weeks later, he developed mild abdominal pain. Liver function tests were deranged, with grossly elevated serum alkaline phosphatase. An abdominal CT scan was done, which showed a large subdiaphragmatic and gallbladder fossa collection. A percutaneous catheter was placed and the biloma drained. A subsequent magnetic resonance cholangiopancreatography demonstrated a leak from an aberrant right posterior sectoral duct, draining into the subdiaphragmatic collection (Figure 15.3). On serial imaging, the collection resolved and the drainage tube was subsequently removed. The patient is planned for a review and possible definitive surgical reconstruction after an interval of six to eight weeks.
Effects of treatment on the abdomen and pelvis
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Following pancreaticoduodenectomy (Whipple's procedure), radiology is invaluable in the percutaneous drainage of abdominal collections, usually in the pancreatic resection bed or around sites of anastomosis. Bile ducts are susceptible to damage at the time of surgery, which may lead to biloma, hepatic abscess, fistulas, or biliary stricture (15).
Beneficial body mass index to enhance survival outcomes in patients with early-stage hepatocellular carcinoma following microwave ablation treatment
Published in International Journal of Hyperthermia, 2020
Jian-Ping Dou, Zhi-Yu Han, Fangyi Liu, Zhigang Cheng, Xiaoling Yu, Jie Yu, Ping Liang
The rate of major complications according to the society of interventional radiology classification was 4.2% (20/474). No treatment related deaths were detected in all patients. Eleven patients were detected with pleural effusion and all recovered after aspiration (n = 4) or drainage (n = 7). Tumor seeding was diagnosed in two patients and both received MWA treatments after diagnosis. Biloma occurred in two patients and was cured after 2–3 months of drainage. Hepatic abscess was detected in two patients and was cured after drainage and use of antibiotics. Bleeding occurred in two patients and one was cured after injection of thrombin to the bleeding site, the other was cured after TACE treatment. Ascites occurred in one patient and recovered after drainage and albumin infusion.
The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center
Published in International Journal of Hyperthermia, 2019
Si Qin, Guang-Jian Liu, Meijin Huang, Jun Huang, Yanxin Luo, Yanling Wen, Yimin Wang, Limei Chen
There were no deaths that correlated with ablation. Major and minor complications occurred in 5 cases (3.65%) and 11 cases (8.03%), respectively (Table 4). The mean size of the lesion was 17.81 ± 8.20 mm in diameter for patients with complications and 15.02 ± 6.91 mm for those without complications (p = .101; 95% CI: −0.9 1 to 9.33). The treatment of 11 lesions near important structures resulted in complications, which were significantly more common than in those not located near important structures (p = .016; 95% CI: 1.35–10.29). Biloma occurred in 25.00% (2/8) of lesions near the intrahepatic bile duct and pleural effusion occurred in 11.11% (3/27) of lesions near the diaphragm. Fever and pain were the most common side effects after MWA. Seventeen (12.41%) patients showed a range in temperature of 37.2–39.9 °C, which occurred 24–48 h after MWA and persisted for 1–7 days. Seventy-three (53.28%) patients experienced local pain following MWA (Table 5).
Solitary prostate cancer liver metastasis: an exceptional indication for liver resection
Published in Acta Chirurgica Belgica, 2021
Gilles Tilmans, Julie Navez, Mina Komuta, Thibaud Saussez, Jan Lerut
The postoperative course was complicated with a small biliary leak which required combined endoscopic and radiologic interventional treatment consisting of a sphincterotomy, biliary stenting and percutaneous drainage of a biloma. Two months post-surgery, PSA level normalized (<1 ng/ml). Hormonal therapy (Firmagon®) was continued. One year after surgery he developed pulmonary metastases followed later by (two) osseous lesions. Anti-androgen therapy using enzalutamide (Xtandi®, Astellas Pharma, Chuo-Ku Jp) was started and complemented some weeks later by cabazitaxel (Jevtana®, Sanofi Aventis, Fr). He died 31 months after liver surgery of generalized cancer spread.