An Unusual Delayed Complication of Urogynecologic Surgical Mesh: Perirectal Abscess 10 Years After Initial Placement Treated by Endoscopic Removal

Abstract Background This study evaluated the feasibility, efficacy, and safety of removal and replacement of a lumen-apposing metal stent (LAMS) to facilitate direct endoscopic necrosectomy (DEN). Methods Endoscopic ultrasound-guided LAMS placement for walled-off necrosis (WON) was performed. During subsequent endoscopy, the LAMS was removed, DEN was performed, and the same LAMS was redeployed across the transmural tract. Results 140 LAMS were placed for drainage (43 pseudocysts, 97 WON) from 10/1/2016 to 11/15/2019, and 40 patients (mean age 43.9 [SD 15.4] years; 70 % males; mean WON size 10.9 [SD 4.9] × 8.7 [SD 3.8] cm) underwent removal and replacement of the same LAMS for multiple DEN sessions. LAMS was successfully replaced across the transmural tract during all 81 DEN sessions. Complete resolution was achieved after a median of 2 DEN sessions (range 1–7; mean 2.4 [SD 1.5]), with stent retrieval after a mean of 64.1 (SD 31.6) days after initial placement. No stent damage, tissue ingrowth, or major bleeding occurred. Conclusions Removal and replacement of LAMS during multiple necrosectomies is feasible, safe, and facilitates DEN.

Download Full-text

ENDOSCOPIC REMOVAL OF TUBULOVILLOUS ADENOMA WITH HIGH-GRADE FOCAL DYSPLASIA IN THE DISTAL COMMON BILE DUCT

10.1055/s-0039-1681498 ◽

2019 ◽

Author(s):

R Alvaro Bendezu Garcia ◽

X Andujar Murcia ◽

C Loras Alastruey

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

High Grade ◽

Endoscopic Removal ◽

Tubulovillous Adenoma ◽

Distal Common Bile Duct

Download Full-text

´FORGOTTEN´ RETROPERITONEAL DOUBLE-PIGTAIL PLASTIC STENT CAUSING COLONIC FISTULIZATION AND ANEMIA 6 YEARS LATER: ENDOSCOPIC REMOVAL

10.1055/s-0040-1704823 ◽

2020 ◽

Author(s):

A Terán ◽

M Moris ◽

CD Pozo ◽

M Pascual ◽

JC Rodriguez Duque ◽

...

Keyword(s):

Endoscopic Removal ◽

Plastic Stent

Download Full-text

Endoscopic removal of high-risk colorectal adenomas: safe and effective?

10.26226/morressier.59a6b34bd462b80290b556ba ◽

2017 ◽

Author(s):

Mariann Rutka

Keyword(s):

High Risk ◽

Colorectal Adenomas ◽

Endoscopic Removal

Download Full-text

Endoscopic removal of bullet lodged in left orbit

MedPulse International Journal of ENT ◽

10.26611/10161123 ◽

2019 ◽

Vol 11 (2) ◽

pp. 43-45

Author(s):

Shrinivas Chavan ◽

◽

Vitthal D Kale ◽

Vinayak Kurle ◽

Archana Shyleenderan ◽

...

Keyword(s):

Endoscopic Removal ◽

Left Orbit

Download Full-text

Evaluation and treatment of children with radiation-induced cerebral vasculopathy

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19188 ◽

2019 ◽

Vol 24 (6) ◽

pp. 680-688

Author(s):

David S. Hersh ◽

Kenneth Moore ◽

Vincent Nguyen ◽

Lucas Elijovich ◽

Asim F. Choudhri ◽

...

Keyword(s):

Radiation Therapy ◽

Proton Beam ◽

Tumor Imaging ◽

Clinic Visit ◽

Surgical Patient ◽

Beam Radiation ◽

Proton Beam Radiotherapy ◽

Cranial Radiation ◽

Delayed Complication ◽

Radiation Induced

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

Download Full-text

Holmes tremor: a delayed complication after resection of brainstem cavernomas

Journal of Neurosurgery ◽

10.3171/2020.7.jns201352 ◽

2020 ◽

pp. 1-11

Author(s):

Marco Cenzato ◽

Davide Colistra ◽

Giorgia Iacopino ◽

Christian Raftopoulos ◽

Ulrich Sure ◽

...

Keyword(s):

Statistical Analysis ◽

Neurophysiological Monitoring ◽

Strict Adherence ◽

Surgical Access ◽

Holmes Tremor ◽

Neurophysiological Studies ◽

Metropolitan Hospital ◽

Delayed Complication ◽

Brainstem Cavernoma ◽

Predicting Factor

OBJECTIVEIn this paper, the authors aimed to illustrate how Holmes tremor (HT) can occur as a delayed complication after brainstem cavernoma resection despite strict adherence to the safe entry zones (SEZs).METHODSAfter operating on 2 patients with brainstem cavernoma at the Great Metropolitan Hospital Niguarda in Milan and noticing a similar pathological pattern postoperatively, the authors asked 10 different neurosurgery centers around the world to identify similar cases, and a total of 20 were gathered from among 1274 cases of brainstem cavernomas. They evaluated the tremor, cavernoma location, surgical approach, and SEZ for every case. For the 2 cases at their center, they also performed electromyographic and accelerometric recordings of the tremor and evaluated the postoperative tractographic representation of the neuronal pathways involved in the tremorigenesis. After gathering data on all 1274 brainstem cavernomas, they performed a statistical analysis to determine if the location of the cavernoma is a potential predicting factor for the onset of HT.RESULTSFrom the analysis of all 20 cases with HT, it emerged that this highly debilitating tremor can occur as a delayed complication in patients whose postoperative clinical course has been excellent and in whom surgical access has strictly adhered to the SEZs. Three of the patients were subsequently effectively treated with deep brain stimulation (DBS), which resulted in complete or almost complete tremor regression. From the statistical analysis of all 1274 brainstem cavernomas, it was determined that a cavernoma location in the midbrain was significantly associated with the onset of HT (p < 0.0005).CONCLUSIONSDespite strict adherence to SEZs, the use of intraoperative neurophysiological monitoring, and the immediate success of a resective surgery, HT, a severe neurological disorder, can occur as a delayed complication after resection of brainstem cavernomas. A cavernoma location in the midbrain is a significant predictive factor for the onset of HT. Further anatomical and neurophysiological studies will be necessary to find clues to prevent this complication.

Download Full-text