Use of Prophylactic Inferior Vena Cava Filters in Trauma

Venous thromboembolisms, specifically pulmonary embolisms (PEs), represent a significant burden on healthcare systems worldwide, particularly within the setting of trauma. According to the literature, PEs are the most common cause of in-hospital death; however, this condition can be prevented with a variety of prophylactic and therapeutic measures. This article aimed to examine current evidence on the use, indications for prophylaxis, outcomes and complications of prophylactic inferior vena cava filters in trauma patients

Submyomatous Cornual Pregnancy : Managed surgically after failed medical management

Cornual pregnancy constitutes an emergency while its diagnosis and management remain a challenge. Anatomical abnormalities in the uterus, such as fibroids in the cornual region, make the management even more difficult. A nulliparous patient presented with an ectopic pregnancy at the right cornua under a huge fibroid. Despite multiple doses of methotrexate for a cornual ectopic gestation, the serum beta human chorionic gonadotropin (β-hcG) levels doubled on the fifth day and a viable fetus was demonstrated on imaging. Thus surgical intervention in the form of laparoscopy followed by laparotomy, myomectomy of a large cornual fibroid and cornuostomy was performed. The serum beta human chorionic gonadotropin result was negative three weeks later. Surgical intervention in the form of myomectomy and cornuostomy was necessary to preserve fertility in this unusual presentation of cornual ectopic pregnancy.

Twin Pregnancy with a Complete Hydatidiform Mole and a Coexisting Live Fetus : Rare entity

A hydatidiform mole with a coexisting live fetus is a rare occurrence and the optimal management for this condition is not yet known. We report the case of a 32-year-old woman (gravida 3, para 2) who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in March 2012 at 13 gestational weeks with abdominal pain and vaginal bleeding. An ultrasound examination revealed a hydatidiform mole pregnancy coexisting with a live fetus. After extensive counselling, the patient and her husband opted for a conservative management approach. Unfortunately, a hysterotomy had to be performed at 17 gestational weeks due to severe haemorrhage. The postoperative period was uneventful and histopathology results confirmed one complete mole with a coexisting fetus and normal placenta. The patient’s serum β-human chorionic gonadotropin level remained normal for 18 months following her surgery

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A Massive Tuberculosis Abscess at the Erector Spinae Muscles and Subcutaneous Tissues in a Young Man

Tuberculosis (TB) is a chronic granulomatous infection which can present in an atypical form. Isolated muscle involvement is very rare. We report a 25-year-old man who presented with a massive cystic swelling on the right side of his back, extending from the lower thoracic to the gluteal region. He had a history of contact with a friend who was suspected of having TB. Magnetic resonance imaging (MRI) showed that the origin of the cyst was from the erector spinae muscles. The result of a fluid aspirate showed acid fast bacilli. The swelling disappeared after treatment with anti-tuberculous medications. Muscular involvement in TB is very rare. In our patient, the reports of an ultrasound and MRI confirmed isolated muscle and subcutaneous involvement without bony lesions. This case is reported to increase physician awareness regarding soft tissue TB. Although it is rare, similar cases may be seen in the future

Hepatic or Cystic Artery Pseudoaneurysms Following a Laparoscopic Cholecystectomy : Literature review of aetiopathogenesis, presentation, diagnosis and management

Pseudoaneurysms (PSAs) of the hepatic and/or cystic artery are a rare complication following a laparoscopic cholecystectomy (LC). Generally, PSA cases present with haemobilia several weeks following the procedure. Transarterial embolisation (TAE) is considered the optimal management approach. We report a 70-year-old woman who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2016 with massive hemoperitoneum two weeks after undergoing a LC procedure in another hospital. She was successfully managed using coil TAE. An extensive literature review revealed 101 cases of hepatic or cystic artery PSAs following a LC procedure. Haemobilia was the main presentation (85.1%) and the mean time of postoperative presentation was 36 days. The hepatic artery was involved in most cases (88.1%), followed by the cystic artery (7.9%) and a combination of both (4.0%). Most cases were managed with TAE (72.3%), with a 94.5% success rate. The overall mortality rate was 2.0%

Safety and Complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters : Clinical and radiological perspective from a tertiary centre in Oman

Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters (TVCs) at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications (such as catheter-related infections or thrombosis) were collected. Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female (42.2%) and 93 were male (57.8%). The mean age of the patients was 54.4 ± 17.3 years. The most common reason for catheter placement was the initiation of dialysis (63.4%). A total of 203 procedures were technically successful (99.5%). The right internal jugular vein was the most common site of catheter placement (74.9%). Mild haemorrhage which resolved spontaneously occurred in 11 cases (5.4%). No other complications were observed. Subsequent follow-up data was available for 132 catheters (65.0%); of these, thrombosis-related catheter malfunction was observed in 22 cases (16.7%) and catheter-related infection in 29 cases (22.0%). Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature

Retrospective Review of Cross Sectional Imaging Findings of Pancreatic Non-functional Islet Cell Tumor (NFICT) and its Hepatic Metastases

AbstractObjectives: Review and correlate the computed tomography (CT) imaging features of pancreatic Non Functional Islet Cell Tumors (NFICT) and its hepatic metastases.Methods: CT examinations of 28 patients with pathologically proven diagnosis of pancreatic NFICT and no clinical symptoms or signs attributed to hormone overproduction, performed at Mallinkrodt Institute of Radiology, Saint Louis, Missouri, USA between March 2002-July 2006, were retrospectively reviewed by two abdominal radiologists. The imaging findings were analyzed and summarized.Results: Pancreatic NFICT size ranged from 1.2-13 cm. The commonest pattern of enhancement was hypervascular and heterogenous enhancement. The spleen was the commonest invaded nearby local structure. The commonest pattern of enhancement noted in the metastatic liver lesions was hypervascular heterogenous enhancement. 26�0of the liver metastatic lesions were associated with invasion/encasement of nearby vessels.Conclusion: Imaging features of pancreatic NFICT can overlap with other pancreatic neoplasms. Therefore combining the imaging features of pancreatic NFICT and its hepatic metastases helps in narrowing the differential diagnosis

6. Endovascular treatment for acute traumatic transection of the thoracic aorta: The safety of delayed stenting

The current recommendation is immediate surgical treatment of acute traumatic transection (ATT) of the aorta. Open surgical repair carries high morbidity and mortality. Endovascular repair (TEVAR) has emerged as a safer option. The timing of intervention remains a matter of debate We review our outcomes of delayed endovascular repair of ATT. Methods: From 2011 to 2013, 7 patients underwent delayed TEVAR for ATT. All patients had their records reviewed retrospectively regarding mechanism of injury, concomitant injuries, technical details, post-operative complications and long term follow up. Results: The mean age was 30.29 years (range 24–51 years) and 6 out of 7 patients were male. The mechanism of injury was motor vehicle collision in 6 patients. The median time from injury to TEVAR was 8.7 days and there was no mortality during this period. Technical success was 100%. None of the patients suffered any neurological events, arrhythmias, acute renal injury, distal ischemia or endoleak. The median hospital stay was 10 days and all patients were discharged home with no hospital mortality. Mean follow up was 12 months and all patients were alive at follow up and none required re-intervention. Conclusion: The delayed approach has been safe with no patients lost during the waiting period. Patients with ATT who make it to the hospital and are stable from the aortic point of view may be managed safely with delayed TEVAR if immediate therapy is not available or possible