scholarly journals Case Report – Direct Percutaneous Approach to Treat Peristomal Varices: A Simple and Effective Option

Author(s):  
Rémi Grange ◽  
Bertrand Le Roy ◽  
Clément Chevalier ◽  
Fabrice-Guy Barral ◽  
Sylvain Grange

Abstract Introduction:Bleeding secondary to peristomal varices is a rare but potentially fatal complication of portal hypertension. TIPS is its first-line etiologic treatment in the setting of cirrhosis with portal hypertension. However, TIPS is not always feasible, especially in cases of contraindication or portal trunk occlusion.Case presentation: A patient of 63-year old male was referred for persistent peristomal variceal bleeding. He had a past history cirrhosis with portal hypertension due to alcohol consumption and more recently, rectal cancer with metachronous liver metastasis. He was treated by proctectomy with placement of a stoma in the left flank. An evaluation CT scan showed a tumour-like occlusion of the portal vein, the origin of which is uncertain.He was regularly referred to the emergency department for peristomal bleeding with anaemia, without haemodynamic instability. CT-scan angiogram confirmed ectopic peristomal varices without active bleeding. After multidisciplinary meeting, a minimal invasive approach was decided. Under local anaesthesia and ultrasoung guidance, the varicose vein was punctured by direct percutaneous access using a 22G-needle, and embolized using a mixture of N-Butyl-Cyanoacrylate and Lipiodol. The patient had no complication, and no recurrent bleeding occurred after more than 6 months of follow-up. He was discharged from the hospital 8 days later.Conclusion: The percutaneous approach is a simple and effective technique. This approach should be the first line treatment when TIPS is not indicated.

2018 ◽  
Vol 66 (07) ◽  
pp. 589-594 ◽  
Author(s):  
Celalettin Kocaturk ◽  
Hasan Akin ◽  
Sertan Erdogan ◽  
Salih Bilen ◽  
Kemal Karapinar ◽  
...  

Objective Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for primary spontaneous pneumothorax. Concerns about lesser pain and better cosmesis led to the evolution of uniportal access. This study prospectively compared the results of the uniportal, two-port, and three-port thoracoscopic surgery. Material and Methods One hundred and thirty-five patients were randomized into three groups according to the port numbers. The groups were compared regarding the operation time, hospital stay, amount of drainage, area of pleurectomy, complications, recurrences, and pain scores. Results Except for the amount of drainage (p = 0.03), no factors were found to be statistically significant. The overall recurrence rate was 5%. Although the first and second week pain scores were not statistically significant, the single-incision group patients had significantly less pain at 4, 24, and 72 hours (p < 0.05). Conclusion The study indicated that uniportal VATS approach is less painful and has better cosmetic results, besides it is as efficient as two- or three-port VATS approach.


2005 ◽  
Vol 133 (1) ◽  
pp. 147-149 ◽  
Author(s):  
Jorge E. Almario ◽  
Jose G. Lora ◽  
Jose A. Prieto

OBJECTIVES: To implement a minimal invasive approach in cochlear implant surgery for children and adults. In order to decrease surgical complications and morbidity with the surgery. SUBJECTS AND METHODS: During a 1-year period, 12 consecutive patients (5 female and 7 male; age range, 1.5 to 78 years; mean age, 14.5 years), who had cochlear implantation (1 Nucleus and 11 Clarion) through a new surgical approach, were prospectively evaluated. RESULTS: The surgical approach was accomplished in all the patients with no major complications. The mean surgical time was 3.2 hours and the mean time between surgery and process of programming was 2.7 weeks. CONCLUSION: The surgical trauma and postoperatory edema was decreased and allowed programming of the implant in a shorter period of time.


2010 ◽  
Vol 26 (3) ◽  
pp. 294-297 ◽  
Author(s):  
Senda Charone ◽  
Erika Calvano Kuchler ◽  
Marcelo De Castro Costa ◽  
Lucianne Cople Maia

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