Abstract:

Article presents a case report of successful antegrade x-ray surgical access to the biliary tree ir order to eliminate partial clipping of the common bile duct as a complication of endoscopic cholecystectomy

Percutaneous transhepatic puncture of the unexpanded biliary tree was made under ultrasounc control without auxiliary contrast enhancement of the bile tree. After punction - antegrade cholangiography revealed partial clipping of common bile duct. Patient underwent balloon dilatation, internal-external transpapillaty drainage. Three-times balloon dilatation after each 2 months made it possible to avoid the formation of posttraumatic stricture and the long-frame external-internal drainage of the biliary tree.

The use of antegrade percutaneous transhepatic access to restore adequate passage of bile to the duodenum, including cases without dissection of the papilla, is advisable in clinical situations that do not allow the use of retrograde endoscopic access, or if it is ineffective. 

References

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Abstract:

From January 2003 till January 2008 transhepatic endobiliar stenting was performed in 62 patients with obstructive jaundice due to high post-operative malignant strictures of hepaticocholedochus duct. In 49 cases (79 %) two-step intervention performed (biliary drainage followed by endobiliary stenting), 13 patients (21 %) underwent single-stage intervention. In 60 patients (96,8%) balloon dilatation was done prior to stent implantation. In 59 cases (95,2%) the procedure was completed by control drainage placement. Hospital stay for the endobiliary stenting procedure was 12,7-22,3 days (average hospital stay 17,5 days). Mortality was as high as 12,9% (8 cases). Average post-implantation life span appeared to be 9,7 months. In 5 patients (8,1%) mechanical jaundice relapse occurred, so they needed hospitalization for reintervention. Direct dependence found between the effectiveness of endobiliary stenting and the technical characteristics of stents, anatomy of biliary strictures, as well as the methods and techniques of the intervention. Single-stage endobiliary stenting, without prior drainage, decreases the complication rate, improves the quality of life during the hospital stay, and prolongs the post-implantation life expectancy. Single-stege interventions are also shown to decrease the hospital stay and reduce the costs. Balloon dilatation is the required stage of the intervention, especially if self-expandable stents are used in torturous biliary ducts. Post-implantation drainage placement can be skipped if the wall of the hepatico-choledochus duct is not edematous, there are no signs of tumor prolapse into the lumen, if the stent is completely expanded, and the contrast media evacuates easily into the intestine.

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Abstract:

The article aimes at determining the scope of multyspiral computer tomography (MSCT) in diagnostics of iatrogenic traumas of ureter and ureterovaginal fistulae (UVF) and establishing the efficiency of mini-invasive method of treatment UVF. The study covered 9 patients suffering the iatrogenic trauma of ureter, 8 of which have passed through MSCT. The mini-invasive methodic was applied to these patients and let the researchers restore the ureter tissue after the iartogenic trauma and eliminate the UVF without performing any open operations.

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Abstract:

We have retrospectively analyzed results of 12 patients underwent radiological interventions for scarring strictures correction of biliodigestive anastomoses after reconstructive surgery due to iatrogenic damage of extra hepatic biliary ducts. It was determined that ultrasonography is the main technique of biliary hypertension diagnostics. Antegrade cholangiography gives an ability to determine the level and type of extrahepatic biliary ducts strictures. Adequate biliary decompression was achieved by transcutaneous transhepatic drainage of biliary tree with insertion of cholangiostomical drainage near the biliodigestive anastomoses. Antegrade recanalization technique and dilatation of biliodigestive anastomosis strictures was used for dilatation of scarring stricture. Balloon plastic of anastomoses was ended with forming of external-internal draining for 9-12 months with step-by-step balloon dilatations every 3 months. Stenting of biliodigestive anastomosis' strictures was made in 4 cases Postoperative period without relapses after radiological interventions lasts from 2 till 7 years of observing.

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