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Managing Blunt Abdominal Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Ajay Savlania, Venkata Vineeth Vaddavalli, Kishore Abuji
Complications associated with non-operative management are bleeding, abdominal compartment syndrome, biliary complications (bile leak, bilioma, haemobilia, biliary fistula, and biliary peritonitis) and liver necrosis. Haemobilia is managed by embolization of the vessel communicating with the biliary tree. Biliomas and abscesses are drained percutaneously using CT or ultrasound. Endoscopic retrograde cholangiopancreatography (ERCP) might be necessary to decompress the biliary tree and promote the healing of bile leaks. Biliary ascites not amenable for percutaneous drainage might require laparotomy. Patients who have uncomplicated hospital courses can resume usual activity within 3–4 months, as most of the lesions heal by that time, and patients should be advised to consult in case of severe abdominal pain, nausea or vomiting.
Complications of open repair of splanchnic aneurysms
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Bjoern D. Suckow, David H. Stone
Hepatic artery aneurysms are the second most common splanchnic aneurysm and constitute roughly 13–20% of visceral artery aneurysms.13,14 The overwhelming majority (80%) of hepatic artery aneurysms are anatomically situated in an extrahepatic location (Figure 22.2), with the remainder situated in the extrahepatic space or within the liver parenchyma itself. Nearly two-thirds of hepatic aneurysms form in the common hepatic artery, one-quarter in the right hepatic artery, and approximately 5% in the left.15,16 The anatomic relationship of the aneurysm in regard to the gastroduodenal artery will carry associated technical implications when considering operative intervention. Unlike splenic artery aneurysms, there is no known association with pregnancy. However, other underlying conditions such as arteritis, arterial dysplasia, or trauma may play a role in aneurysm formation. The majority of these lesions are detected incidentally on imaging performed for alternative indications. Most hepatic artery aneurysms remain asymptomatic, though it is felt that rupture may approach 25% in larger lesions.17 In this setting, hepatic aneurysms greater than 2 cm, pseudoaneurysms, or symptomatic aneurysms should be repaired. When symptomatic, abdominal discomfort, and back pain may ensue. In rarer instances, hemobilia, jaundice, and/or GI bleeding may occur.13,18
The Liver and the Biliary System
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
These are encountered post blunt trauma to the liver. Some of them resolve spontaneously. However, others may get larger and are associated with pain and enlarged liver, infection, and/or hemobilia. In such cases, the cyst can be drained or that part of the liver is resected. In cases of hemobilia, liver resection is the treatment of choice.
Clinical insights and prognostic factors from an advanced biliary tract cancer case series: a real-world analysis
Published in Journal of Chemotherapy, 2022
Roberto Filippi, Francesco Leone, Lorenzo Fornaro, Giuseppe Aprile, Andrea Casadei-Gardini, Nicola Silvestris, Andrea Palloni, Maria Antonietta Satolli, Mario Scartozzi, Marco Russano, Stefania Eufemia Lutrino, Pasquale Lombardi, Giorgio Frega, Silvio Ken Garattini, Caterina Vivaldi, Rosella Spadi, Orsi Giulia, Elisabetta Fenocchio, Oronzo Brunetti, Massimo Aglietta, Giovanni Brandi
Anemia was observed in almost half of the pts before the start of CT1, a similar prevalence to recent reports [17]. A variety of reasons may explain this frequent finding. Haemobilia could be an underrecognized drive of chronic blood loss [18], particularly in pts who have undergone biliary drainage or stenting. Functional iron deficiency is frequently associated with cancer [19]. Baseline anemia was not associated with peritoneal carcinomatosis or with distant spread. Baseline anemia, which correlated with age, a more compromised organic state (ECOG-PS ≥ 2), and biliary stenting/drainage placement, negatively affected - or, at least, predicted against - the ability to receive full-dose CT1; this translated into lower exposure and shorter TTP. Whether it was for poor endurance to CT myelotoxicity, or for the associated general deterioration, a baseline compromised medullary reserve bore a negative impact on OS.
Endoscopic management of high-grade biliary strictures complicating living donor liver transplantation using soehendra stent retrievers
Published in Scandinavian Journal of Gastroenterology, 2021
Harshavardhan B. Rao, Anoop K. Koshy, Krishna Priya, Priya Nair, S. Sudhindran, Rama P. Venu
In this study, the technical efficacy of SSR as a modality to dilate high grade biliary strictures was assessed and the clinical efficacy was compared with patients who were treated with PTC-R and/or surgical options. Technical success was achieved in all patients (100%) treated with SSR in the study group. Stricture dilation using SSR was also found to be safe with no procedure related adverse events noted. The secondary outcome of clinical response was assessed on the basis of alleviation of symptoms of biliary obstruction alone. This can provide an added, albeit minor, therapeutic correlate that can indirectly indicate efficacy of dilatation. Patients who were treated with SSR dilation required fewer procedures to achieve stricture resolution. In addition, overall response to endotherapy was favorable in more than 80% of the patients as compared to patients who were treated with PTC-R (Group 2) who showed a favourable response in only 42%. None of the Group 1 patients who were treated with SSR dilation required surgical interventions and had a sustained response to endotherapy for a period of at least 6 months. This difference may be related to better stricture dilation due to the ‘shearing off’ effect of fibrotic tissue achieved by SSR within the narrowed segment in addition to the mechanical force generated as compared to conventional dilators which rely only on mechanical force. While hemobilia has been rarely reported following the use of SSR, no adverse events were noted in this cohort of patients [20].
Stent placement with iodine-125 seeds strand effectively extends the duration of stent patency and survival in patients with unresectable malignant obstructive jaundice
Published in Scandinavian Journal of Gastroenterology, 2020
Tao Pan, Ming-an Li, Lu-wen Mu, Duo Zhu, Jie-sheng Qian, Zheng-ran Li
All patients were followed up for 6–44 months. The mean follow-up duration for the stent group and the stent + seeds group was 5.7 ± 7.3 and 10.3 ± 11.1 months, respectively. Post-operative complications were recorded, including liver failure, combined cholestasis, hemobilia and biliary tract infection. Liver function parameters were tested before and 1 week after the procedure, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and total bilirubin (TB). The clinical success of treatment was defined as 20% reduction in serum TB within 1 week after the procedure [11]. Primary stent patency was defined as the time interval between stent placement and recurrence of jaundice. Survival time was defined as the time interval between stent placement to death.