A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple's procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.
Adenocarcinoma ; Aged ; Bile Ducts, Intrahepatic ; Biliary Tract ; Cholestasis ; Common Bile Duct ; Endoscopy ; Extremities ; Gastric Outlet Obstruction ; Humans ; Intestines ; Jaundice ; Male ; Stents

PURPOSE: To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. MATERIALS AND METHODS: The study was based on retrospective analysis of twelve cases(8 men, 4 women) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(I), typhoid fever(I), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). RESULTS: Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 reguired surgery and none showed serious complication. CONCLUSION: Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.
Accidents, Traffic ; Aneurysm, False ; Arteries ; Diagnosis ; Drainage ; Gastrointestinal Hemorrhage* ; Hemobilia ; Hemorrhage ; Humans ; Male ; Retrospective Studies ; Stomach ; Typhoid Fever

PURPOSE: To evaluate the cilinical results of transjugular intrahepatic portosystemicshunt(TIPS) for the control of variceal bleeding. MATERIALS AND METHODS: TIPS creation was attempted in 23 patients with endoscopically confirmed variceal bleeding. Most patients had multiple episodes of bleeding in the past and have been treated with multiple endoscopic sclerotherapies. Pre- and post-procedural hepatic and portal vein pressures were measured. After creation of TIPS patients were followed up at regular intervals. RESULTS: TIPS has been successfully accomplished in 22 of 23 patients using Wallstent(n=21 ) and Strecker stent(n=1 ). Immediate bleeding control was achieved in all patients with shunt creation. No procedure-related complication was noted. Portal vein pressure was reduced from 30.7+/-5.8 mmHg to 20.8+/-4.7 mmHg. The mean pressure gradient of portosystemic shunt dropped from 22.8+/-6.0 prior to TIPS to 12.2+/-4.1 immediately after. During the follow-up period (6-556 days, mean; 10months), seven patients died; progressive hepatic failure (n=4), variceal rebleeding(n=2), and respiratory failure(n=1). Hepatic encepha-Iopathy after TIPS was noted in 7 patients(31.8%). Variceal rebleeding occurred in 3 patients(13.6%). The remaining 15 patients have survived an average of 11 months. CONCLUSION: This results suggest that TIPS is a safe and effective method for lowering portal pressure and controlling variceal bleeding. Furthermore if these initial results are encourged by further long-term observation, TIPS could replace endoscopic and risky surgical intervention.
Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage ; Humans ; Liver Failure ; Portal Pressure ; Portal Vein ; Portasystemic Shunt, Surgical* ; Sclerotherapy

Percutaenous transhepatic biliary drainage (PTBD) is widely used to control cholangitis, sepsis, or jaundice caused by biliary tree obstruction. The PTBD tract can be used in percutaneous biliary stone extraction in pre-or post-operative state when ERCP is failed or operation is contraindicated. We performed 16 cases of percutaneous transhepatic biliary stone removal. Locations of biliay stones are combined intrahepatic and extrahepatic in 8 cases (50%), only extrahepati in 7 cases (44%), and only intrahepatic in 1 case (6%). The number of stones was single in 6 cases and multiple in 10 cases. Over all success rate was 81% (13/16), 93% (14/15) in extrahepatic stones and 78% (7/9) in intrahepatic stones. In 5 of 6 cases, complete stone removal was impossible due to marked tortuosity of T-tube tract or peripherally located stones, complete removal of biliary stones was achieved via a new PTBD tract. No significant pre-or post-procedure complication was occured. Percutaneous removal of biliary stones via PTBD tract is an effective and safe alternative method in difficult cases in the menagement of biliary tract stones.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Drainage ; Jaundice ; Methods ; Sepsis

Angiosarcoma is a rare primary malignancy occurring anywhere in the body, but most often in the skin, liver or breast. The radiological findings of angiosarcoma of the breast have rarely been reported. We encountered a case in which the condition involved a 32-year-old woman in whom mammography revealed a obscuved-marginated and lobular-shaped high-density lesion, and ultrasonography demonstrated an ovalshaped, microlobular-marginated, inhomogenous hypoechoic mass which metastasized to the whole body after surgery. We report the radiological findings of this case of angiosarcoma of the breast, and review the literature.
Adult ; Breast Neoplasms ; Breast* ; Female ; Hemangiosarcoma* ; Humans ; Liver ; Mammography ; Sarcoma ; Skin ; Ultrasonography

Biliary stricture formation is a known complication of hepatic surgery in cases of adult living donor liver transplant. In our case, successful percutaneous placement of a hepatico-gastric stent was performed for the drainage of an isolated bile duct after right liver transplant with Roux-en-Y biliary anastomosis in a 42-year-old male. The patient initially presented with cholangitis and a percutaneous transhepatic cholangiogram revealed an isolated stricture of the posterior bile duct. Multiple attempts at regaining continuity of the isolated bile duct with the jejunum were unsuccessful. Thus a tract was created via a percutaneous transhepatic and transluminal approach between the isolated duct and the stomach using a covered stent. The patient had no complications at 18-month follow-up.
Adult ; Bile Ducts ; Biliary Tract ; Cholangitis ; Constriction, Pathologic* ; Drainage ; Follow-Up Studies ; Humans ; Jejunum ; Liver ; Liver Transplantation ; Living Donors ; Male ; Stents* ; Stomach

PURPOSE: To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. MATERIALS AND METHODS: From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE . Depending on the point at which relapse occurred, they were divided into two groups (I and II, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this). We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. RESULTS: Nine patients in group I (additional BAE: n=10) and nine in group II (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I(n=29) and II(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectively. No statistically significant differences were observed (x2=0.005, p=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group II(n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x2=0.308; p=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%). No significant differences were noted, though the incidence of previously embolized feeders in Group II was very high (x2=5.383, p=0.068). CONCLUSION: Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the feeder were noted. Patients in whom hemoptysis recurred more than two weeks after BAE showed more recanalization of previously embolized feeders than those in whom there was recurrence within two weeks.
Angiography ; Arteries ; Bronchial Arteries ; Hemoptysis* ; Hemorrhage* ; Humans ; Incidence ; Recurrence ; Retrospective Studies

Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy.
Aftercare ; Enteral Nutrition ; Gastrectomy ; Gastric Bypass ; Gastropexy ; Gastrostomy ; Humans ; Jejunostomy ; Nutritional Support ; Stomach

PURPOSE: We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. MATERIALS AND METHODS: From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. RESULTS: Among the patients, 70% (n=64) were referred from other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related- and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. CONCLUSION: Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic.
Angiography ; Humans ; Patients' Rooms ; Surveys and Questionnaires ; Radiology, Interventional ; Recovery Room ; Referral and Consultation ; Renal Dialysis

PURPOSE: We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. MATERIALS AND METHODS: From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. RESULTS: Among the patients, 70% (n=64) were referred from other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related- and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. CONCLUSION: Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic.
Angiography ; Humans ; Patients' Rooms ; Surveys and Questionnaires ; Radiology, Interventional ; Recovery Room ; Referral and Consultation ; Renal Dialysis