RESUMEN
Cystic artery stump pseudoaneurysm (CASP) is a potentially life-threatening condition that can be related to multiple etiologies, especially the iatrogenic factor owing to the increased number of hepatobiliary procedures. Most patients present with haemobilia. Here we report a successfully managed case of CASP that initially complained of right upper abdominal pain. A 38-year-old patient developed bile duct injury after laparoscopic cholecystectomy (LC) which was identified by magnetic resonance cholangiopancreatography (MRCP). Later, she developed haemobilia due to CASP which was then treated by trans-arterial embolization (TAE). CASP is a rare complication of post-LC, yet potentially life-threatening, with possible delayed complications occurring months to years after the surgery. Clinicians and radiologists should be aware of this important entity and its variable manifestations to facilitate early treatment.
RESUMEN
This case series aims to evaluate the use of alternating perpendicular biplanar fluoroscopy in percutaneous nephrostomies/percutaneous nephrolithotripsies (PCNs/PCNLs) to approach renal stones in patients with horseshoe kidneys. Between January 2012 and December 2019, PCNs/PCNLs were done for six patients with horseshoe kidneys having renal stones. Skin and renal calyceal entry points were determined by alternating perpendicular biplanar fluoroscopy using a portable C-arm machine in the conventional fluoroscopy unit. The site of renal access, postoperative complications, and residual stones was assessed. The mean age of the patients was 36.8 years. The mean stone size was 6.1 cm (2.1-16.05cm). In five out of six (5/6; 83%) patients, there was one access site. Four patients had their access site through the upper calyx, and one patient had it through the lower calyx. The stone-free rate was four out of six (4/6; 66.6%). One patient had a mild drop in hemoglobin postoperatively. There were no major complications reported. The implementation of alternating biplanar fluoroscopy was found safe and helpful in providing a better appreciation of renal anatomy and stone location in patients with horseshoe kidneys. This technique helps in approaching horseshoe kidney stones in PCN/PCNL without moving the patient or fluoroscopy machine, with a potential decrease in operation time and radiation exposure.