RESUMEN
Blunt adrenal gland trauma is an uncommon injury owing to the location of the adrenal gland in the retroperitoneum surrounded by major viscera and bony structures. We present a case of a 23-year-old male, who had sustained multiple injuries following a road traffic accident. Computed tomography scan revealed a large retroperitoneal hematoma, and active contrast extravasation was noted in the retroperitoneum adjacent to the bare area of the liver and right adrenal gland. After a trial of initial conservative management, he had expanding retroperitoneal hematoma with dropping hemoglobin. Angiography showed posttraumatic aneurysm from the adrenal artery that was successfully embolized with microcoils. As blunt adrenal gland trauma is rare, a high degree of clinical suspicion is required for the diagnosis, and multidisciplinary discussion is essential for the successful management of adrenal gland trauma.
RESUMEN
BACKGROUND: In the living donor liver transplant (LDLT) population, postoperative biliary stricture is a common problem. Endoscopic retrograde cholangiography (ERCP) and stenting failures usually occur because of odd angulation of the ducts, particularly in right lobe grafts. Percutaneous transhepatic biliary drainage (PTBD) is helpful in patients where endoscopic intervention is unsuccessful. We report our experience in this particular group of patients from India. METHODS: We analysed retrospective data of 932 patients who underwent LDLT at our centre. Data collected include basic demographics, technical and clinical success rate of PTBD, postprocedure complications and overall outcome. RESULTS: Of the 932 patients, 81 (8.7%) developed biliary stricture and required endoscopic or percutaneous interventions; out of whom, 75 patients underwent ERCP, and 6 patients had hepaticojejunostomy. Right posterior sector graft recipients had the highest incidence of biliary stricture (29.16%), followed by the right lobe grafts (8.57%), whereas stricture rate was less among left lobe and left lateral lobe graft recipients (3.77% and 3.7%, respectively). Failure of ERCP was common among the ductoplasty group (80%). The failure rate of ERCP did not differ significantly among patients who had single-duct, two-duct or three-duct anastomoses (44%, 36% and 50%, respectively, p > 0.05). PTBD was technically successful in 34 patients (87%) The mortality rate following PTBD was 2.5%, and morbidity was 15%. For the 5 patients in whom PTBD could not be performed, open hepaticojejunostomy was performed successfully. CONCLUSIONS: Right lobe liver grafts have high incidence of biliary stricture compared with left lobe grafts. The failure of ERCP was not dependent on the number of biliary anastomoses; however, the ductoplasty group had a higher failure rate. PTBD is technically successful in a majority of patients albeit with a morbidity of 15%. Open hepaticojejunostomy is a good therapeutic option following PTBD failure.
RESUMEN
Pancreatic incidentalomas are increasingly recognized entities that occur as a fallout of widespread availability of high definition imaging technology. These lesions offer diagnostic dilemmas to both clinicians and radiologists alike. Nevertheless, it is the advancement in diagnostic radiology that comes to the rescue in the management of these not-so-uncommon lesions.
RESUMEN
Safe performance of donor hepatectomy is crucial for sustainability of a living donor liver transplantation (LDLT) program. Middle hepatic vein (MHV) is always encountered during parenchymal transection irrespective of right or left donor hepatectomies. Here we present a safe and effective technique for tackling MHV bleed during LDLT from a single centre experience.