Bleeding complications after pancreatic surgery : Interventional radiology management

Surgical intervention in the pancreas region is complex and carries the risk of complications, also of vascular nature. Bleeding after pancreatic surgery is rare but characterized by high mortality. This review reports epidemiology, classification, diagnosis and treatment strategies of hemorrhage occurring after pancreatic surgery, focusing on the techniques, roles and outcomes of interventional radiology (IR) in this setting. We then describe the roles and techniques of IR in the treatment of other less common types of vascular complications after pancreatic surgery, such as portal vein (PV) stenosis, portal hypertension and bleeding of varices

Early cross-sectional imaging following open and laparoscopic cholecystectomy : a primer for radiologists

Abstract: Performed on either an elective or urgent basis, cholecystectomy currently represents the most common abdominal operation due to the widespread use of laparoscopy and the progressively expanded indications. Compared to traditional open surgery, laparoscopic cholecystectomy minimised the duration of hospitalisation and perioperative mortality. Albeit generally considered safe, cholecystectomy may result in adverse outcomes with non-negligible morbidity. Furthermore, the incidence of worrisome haemorrhages and biliary complications has not been influenced by the technique shift. Due to the growing medico-legal concerns and the vast number of cholecystectomies, radiologists are increasingly requested to investigate recently operated patients. Aiming to increase familiarity with post-cholecystectomy cross-sectional imaging, this paper provides a brief overview of indications and surgical techniques and illustrates the expected early postoperative imaging findings. Afterwards, most iatrogenic complications following open, converted, laparoscopic and laparo-endoscopic rendezvous cholecystectomy are reviewed with examples, including infections, haematoma and active bleeding, residual choledocholithiasis, pancreatitis, biliary obstruction and leakage. Multidetector computed tomography (CT) represents the \u201cworkhorse\u201d modality to rapidly investigate the postoperative abdomen in order to provide a reliable basis for an appropriate choice between conservative, interventional or surgical treatment. Emphasis is placed on the role of early magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive anatomic and functional assessment of the operated biliary tract. Teaching Points: \u2022 Having minimised perioperative mortality and hospital stay, laparoscopy has now become the first-line approach to performing cholecystectomy, even in patients with acute cholecystitis. \u2022 Laparoscopic, laparo-endoscopic rendezvous, converted and open cholecystectomy remain associated with non-negligible morbidity, including surgical site infections, haemorrhage, residual lithiasis, pancreatitis, biliary obstruction and leakage. \u2022 Contrast-enhanced multidetector computed tomography (CT) is increasingly requested early after cholecystectomy and represents the \u201cworkhorse\u201d modality that rapidly provides a comprehensive assessment of the operated biliary tract and abdomen. \u2022 Magnetic resonance cholangiopancreatography (MRCP) is the best modality to provide anatomic visualisation of the operated biliary tract and is indicated when biliary complications are suspected. \u2022 Additional gadoxetic acid (Gd-EOB-DTPA)-enhanced MRCP non-invasively provides functional biliary assessment, in order to confirm and visualise bile leakage

Contrast-Enhanced Ultrasonograpic Findings in Pancreatic Tumors

OBJECTIVE: The purpose of this article is to present the potentials and limits of contrast-enhanced ultrasonography (CEUS) in the characterization of pancreatic tumors, usually hypoechoic or cystic at B-mode ultrasound

Ten year survival after excision of squamous cell cancer in Zenker's diverticulum: report of a case

BACKGROUND: Zenker's diverticulum (ZD) has been increasingly recognized as a site of primary epithelial malignancy. Pitt in 1896 described the first case. METHODS: Between 1990 and 2005, 30 patients affected of esophageal diverticulum were referred to our Department. RESULTS: The pathological results revealed one case of squamous cell carcinoma. On follow-up 10 years after diverticulectomy alone, the patient was alive and well without evidence of recurrence. CONCLUSION: Our case reported provides additional data on clinical decision when the tumor is well localized without full-thickness penetration or extension to the line of resection. In this patient, long-term survival and apparent disease control have been effected by diverticulectomy alone. A case of such long survival is very rare

Diagnosis with ECG-gated MDCT of floating thrombus in aortic arch in a patient with type-A dissection

Multidetector computed tomography has been shown to be accurate in noninvasive assessment of chest vascular disease. The motion artifacts of the thoracic aorta and the supra-aortic vessels were significantly reduced in the electrocardiogram (ECG)-gated data acquisition. This positive effect of ECG synchronization is more pronounced in the region of the ascending aorta, aortic arch, and proximal descending aorta