Purpose This study aims to assess the feasibility and safety of utilizing electromagnetic navigation ultrasonography (ENU) guidance during transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods Portal vein (PV) puncture during TIPS procedures was facilitated using an ENU system device. Key procedural metrics recorded for each case included the number of needle passes, fluoroscopy time, total procedure duration, dose area product (DAP), air kerma (AK), and incidence of procedural complications. Results The study included six patients (five men and one woman) with a mean age of 50.6 ± 13.4 years (range, 33–72 years). With ENU guidance, the mean number of needle passes for successful PV entry was 1.7 ± 0.7 (range, 1 to 3 passes). The average fluoroscopy time for the entire TIPS procedure was 15.3 ± 2.7 minutes (range, 11–19 minutes), and the mean total procedure duration was 91.7 ± 7.8 minutes. The mean DAP associated with the procedure was 143 ± 38.5 Gy · cm2 (range, 89–196 Gy · cm2), with a median AK of 707.7 ± 212.8 mGy (range, 367–1008 mGy). Notably, no clinically significant puncture-related complications were observed. Conclusion Electromagnetic navigation ultrasonography (ENU) guidance demonstrates potential feasibility, safety, and effectiveness in assisting with TIPS procedures.
Introduction and importance: Massive gastrointestinal hemorrhage is a severe hemorrhage that occurs in the gastrointestinal tract and is a life-threatening condition. Sinistral portal hypertension is a common etiology for massive gastrointestinal hemorrhage, whose occurrence might be derived from pathological changes induced by obstruction and/or increased blood flow to the portal vein system. However, there is a rare study reporting pancreatic disease-induced sinistral portal hypertension. Case presentation: An 80-year-old female pancreatic cancer patient was admitted to our hospital on 22 January 2022 due to a massive gastrointestinal hemorrhage with shock after receiving radio-chemotherapy. Abdominal enhanced computerized tomography showed that the patient presented with pancreatic cancer-causing sinistral portal hypertension with massive collateral circulation, intrahepatic bile duct dilation, and the formation of massive ascites. Subsequent portography interventional procedure revealed the esophageal and gastric varix. Then, the varicose vein was embolized, and the stent was implanted at the lumen of the superior mesenteric vein accessing the portal vein. The patient recovered from pancreatic cancer-causing sinistral portal hypertension, and a normal direction of blood flow was observed in the superior mesenteric vein with a decreasing amount of ascites. In addition, a transfusion was also carried out, and the massive gastrointestinal hemorrhage was alleviated. Clinical discussion and conclusion: This study emphasizes the successful treatment of massive gastrointestinal hemorrhage induced by pancreatic cancer-causing sinistral portal hypertension by varicose vein embolization and portal vein stenting, which could be considered an alternative opinion for these patients.
Fecal incontinence is a common symptom among patients with rectal prolapse. Pudendal nerve terminal motor latency (PNTML) testing can serve as a reference indicator for predicting the outcomes of rectal prolapse surgery, thereby assisting surgeons in formulating more appropriate surgical plans. The direct correlation between preoperative PNTML testing results and postoperative fecal incontinence in patients with rectal prolapse remains a contentious issue, necessitating further clarification. Thus, we analyze the existing publications from both clinical and statistical perspectives to comprehensively evaluate the accuracy of preoperative PNTML testing in rectal prolapse and provide some feasible statistical solutions.
Thermal ablation for renal cell carcinoma in nephron-sparing surgery has been extensively investigated. However, data regarding renal pelvic tumors with refractory hematuria are scarce. Herein, we report a case of recurrent hematuria in an 87-year-old woman with. a 3.5 × 4.1 cm mass in the right renal pelvis on imaging examinations, which was clinically diagnosed as renal pelvic carcinoma. After ineffective renal artery embolization, minimally invasive percutaneous thermal ablation was recommended after a multidisciplinary consultation. Although hematuria was successfully relieved after ultrasound-guided radiofrequency ablation initially, recurrence of hematuria was reported due to tumor progression after one year. CT-guided microwave ablation resolved hematuria and controlled tumor growth without complications. Upper tract urothelial carcinoma (UTUC) was confirmed by biopsy. Postoperative CT imaging, urine cytology, and renal function tests were continuously monitored during the follow-up. The patient remained stable during the 1-year follow-up period, highlighting the potential of thermal ablation for refractory hematuria in renal pelvis urothelial carcinoma while preserving nephrons.
BACKGROUND:Malignant tumors of the ileocecal region often cause intestinal obstruction. Emergency surgery is the main treatment for patients presenting with an obstruction. However, this procedure is associated with a high mortality rate and frequent complications. The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure. However, obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY:This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region. He was contraindicated for general anesthesia and surgical enterostomy. The placement of a self-expandable metallic stent seems an alternative to surgery, although stenting in this area is thought to be difficult and few studies have been reported so far. After three attempts at different interventional approaches, a stent was successfully placed in the obstructed segment under fluoroscopic guidance. After the procedure, the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION:For patients with proximal colonic obstruction, self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction. It has the characteristics of high safety and high patient tolerance. However, further study is still needed.
