8 research outputs found
A double shunt technique for the prevention of ischaemia of a congenital, solitary, pelvic kidney during abdominal aortic aneurysm repair: a case report
<p>Abstract</p> <p>Introduction</p> <p>Congenital solitary pelvic kidney is a rare condition, and its association with an abdominal aortic aneurysm is even more unusual. To the best of our knowledge, only two such cases have been reported in the literature to date.</p> <p>Case presentation</p> <p>We report the case of a 59-year-old Caucasian man with a congenital solitary pelvic kidney, who was found to have an abdominal aortic aneurysm 83 mm in diameter. Abdominal computed tomography angiography clearly identified two renal arteries, one originating from the aortic bifurcation. and the other from the proximal portion of the right common iliac artery. At surgery, renal ischaemia was prevented by introduction of an axillofemoral shunt (consisting of two femoral cannulas and a vent tube of extracorporeal circulation) from the right axillary to the right femoral artery, and a second Argyle shunt from the right common iliac artery to the origin of the left renal artery. A 20 mm Dacron tube graft was then implanted. Our patient's postoperative renal function was normal.</p> <p>Conclusion</p> <p>The renal preservation double shunt technique used in this case seems to be effective during abdominal aortic aneurysm repair.</p
Management of massive bilothorax post-percutaneous trans-hepatic biliary drainage
Background: Iatrogenic bilothorax is an infrequent major complication of
percutaneous trans-hepatic biliary drainage (PTBD) and optimal treatment
remains under-reported. The authors herein describe a case of PTBD
complicated by a massive bilous effusion.
Case presentation: An 80-year-old male underwent PTBD due to malignant
obstructive jaundice (total bilirubin 20.0 mg/dL). Following discharge,
the patient was readmitted with severe dyspnea and recurrence of
jaundice (total bilirubin 15.0 mg/dL). CT depicted the drainage catheter
traversing the right costophrenic sulcus, complete obliteration of the
right pleural space, no aerated right lung parenchyma and left
mediastinal shift. The pleural effusion was successfully drained, and
the biliary drainage catheter tract was sealed with Gelfoam pledgets and
coils, to prevent bilopleural fistula formation and recurrence of the
effusion.
Conclusions: In this case, a successful totally percutaneous management
of iatrogenic bilothorax following PTBD is described. Due to the
potential of rapid clinical deterioration and empyema formation,
immediate evaluation and treatment are warranted. Prompt pleural
drainage with antibiotic therapy and bile flow diversion from the
pleural cavity are required
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