Abstract: Aim: was to evaluate the feasibility and effectiveness of using transperineal access for sanitation of «deep» exudative pelvic lesions in patients after gynecological operations. Materials and methods: results of percutaneous drainage with perineal access of «deep» – perirectal postoperative exudative pelvic lesions in 18 patients after extirpation of the uterus in oncological pathology were subjected to retrospective analysis. Exudative formations in the pelvis were detected during continuous postoperative ultrasound screening of operated patients starting from 3rd day of the postoperative period, taking into account clinical data. Perineal access was used in patients with verification of the nature of the pathological contents and subsequent drainage of the pathological exudation zone by 8fr drains with form memory using Seldinger method. Results: manipulation was successful in all 18 patients. In 5 cases, a lyzed pelvic hematoma was drained, and in 13 cases, an abscess was drained. In three cases, the connection of the abscess cavity with the lumen of the rectum was revealed. There were no complications due to manipulation. The drainage period was 6-7 days for hematoma and 10-16 days for abscess without internal fistula. If there is a connection with the lumen of the rectum, the drainage period was 21 days, the drainage was removed with x-ray confirmed closure of the internal fistula. Conclusion: our first positive experience of using transperineal access for the rehabilitation of intrapelvic exudative complications of the postoperative period in oncogynecological patients inspires cautious optimism, expands the arsenal of mini-invasive methods of treatment of intra-pelvic postoperative exudative complications, but undoubtedly requires further research for optimal integration of the technique into the practice of oncogynecology and x-ray surgery departments. References 1. Lorenz JM, Al-Refaie WB, Cash BD, et al. ACR appropriateness criteria radiologic management of infected fluid collections. J Am Coll Radiol 2015; 12: 791–799. 2. Hynes D, Aghajafari P, Janne d'Othee B. Role of Interventional Radiology in the Management of Infection. Semin Ultrasound CT MR. 2020 Feb; 41(1):20-32. 3. Kadrev AV. Punctures under the control of echography in the diagnosis and treatment of pelvic fluid in women. Cand. of med. sci. diss. Мoscow. 2007: 159 [In Russ]. 4. Albuquerque A, Pereira E. Current applications of transperineal ultrasound in gastroenterology. World J Radiol. 2016; 8(4): 370-377. 5. Sperling DC, Needleman L, Eschelman DJ, Hovsepian DM, Lev-Toaff AS. Deep pelvic abscesses: transperineal US-guided drainage. Radiology. 1998; 208(1):111-5. 6. Golferi R, Cappelli A. Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol. 2007; 11: 197–208. 7. Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous postoperative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol. 2002; 6: 159–164. 8. De Kok BM, Marinelli A.W.K.S., Puylaert J.B.C.M., et. al. Image-guided posterior transperineal drainage for presacral abscess: An analysis of 21 patients. Diagn Interv Imaging. 2019; 100(2): 77-83.
Abstract: Aim: was to assess the possibility of x-ray surgical recovering of the integrity of the upper urinary tract in the absence of dilatation of kidney collecting system. Material and methods: for the period of 2018-2020, under our supervision there were 9 patients with an unexpanded kidney collecting system against the background of the existing external or internal urinary fistula. In 6 patients after cystoprostatectomy and ureteroenterocutaneostomy (Bricker surgery), a migration of urethral drainage occurred. In 3 cases, after gynecological operations, patients were diagnosed with iatrogenic complete transverse ureter damage with the formation of retroperitoneal (intrapelvic) uroma. At the first stage in all 9 patients we performed percutaneous nephrostomy on unexpanded kidneys’ collecting system under ultrasound guidance using special techniques. To restore patency of the damaged ureter, a combined ante-retrograde approach was used. The antegrade flexible guidewire was moved through damaged (cut off) ureter, and retrograde through the entrance of damaged ureter or enterostomy with a capturing device, under x-ray control, the guidewire was brought out. Then, pyeloureteral drainage was placed in an adequate position of the enterocutaneostomy retrograde or antegrade, splinting the ureter damage zone. Results: in 6 patients, after Bricker surgery, the lost ureteral drainage was adequately restored. In patients with a cut off ureter, it was possible to restore the course of the damaged ureter on the external-internal pyelo-urethral drainage by closing the internal urinary fistula and eliminating retroperitoneal urine by percutaneous drainage under radiation control. There were no complications associated with the technique of x-ray surgery. Conclusion: percutaneous nephrostomy on an unexpanded kidney collecting system using special techniques for the verification of kidney collecting system is a potentially replicable safe technique that allows to perform in stages adequate external derivation of urine. Percutaneous nephrostomy can be used as a «bridge» technique for subsequent x-ray surgical interventions on the ureter, including with its complete iatrogenic damage.
References 1. Patel U, Hussain FF. Percutaneous nephrostomy of non-dilated renal collecting systems with fluoroscopic guidance: technique and results. Radiology. 2004 Oct; 233(1 ):226-233. https://doi.org/10.1148/radiol. 2331031342 2. Liu BX, Huang GL, Xie XH et al. Contrast-enhanced US-assisted Percutaneous Nephrostomy: A Technique to Increase Success Rate for Patients with Nondilated Renal Collecting System. Radiology. 2017 Oct; 285(1):293-301. https://doi.org/10.1148/radiol.2017161604 3. Usawachintachit M, Tzou DT, Mongan J et al. Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System. J Endourol. 2017 Feb; 31 (2): 129-134. https://doi.org/10.1089/end.2016.0693 4. Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011 Dec; 28(4):424-37. https://doi.org/10.1055/S-0031-1296085 5. Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidencebased analysis. BJU Int. 2004 Aug; 94(3):277-89. https://doi.org/10.1111 /j.1464-410X.2004.04978.X 6. Ray CE Jr, Brown AC, Smith MT, Rochon PJ. Percutaneous access of nondilated renal collecting systems. Semin Intervent Radiol. 2014 Mar; 31 (1):98-100. https://doi.org/10.1055/S-0033-1363849 7. American College of Radiology (ACR) and the Standarts of Practice Committee of the Society of Interventional Radiology (SIR) and the Society for Pediatric Radiology (SPR) practice guideline for the performance of percutaneous nephrostomy. Revised 2011 (resolution 42). Accessed March 9, 2013. http://www.arc.org/~/media/ACR/Documents/PGTS/guidelines/Percutaneous_Nephrostomv.pdf 8. Clark TW, Abraham RJ, Flemming BK. Is routine micropuncture access necessary for percutaneous nephrostomy? A randomized trial. Can Assoc Radiol J. 2002 Apr; 53(2):87-91.
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 1. Kuznecov N.A., Sokolov A.A., Brontvein A.T., Artemkin EH.N. Diagnostics and treatment of early biliary complications after a cholecystectomy. Khirurgiya. 2011; 3: 3-7 [In Russ]. 2. Eisenstein S, Greenstein AJ, Kim U, Divino CM. Cystic duct stump leaks: after the learning curve. Arch Surg. 2008; 143( 12): 1178-83. doi: 10.1001/archsurg. 143.12.1178. 3. Shaikh IA, Thomas H, Joga K (et al.). Post-cholecystectomy cystic duct stump leak: a preventable morbidity. J Dig Dis. 2009 Aug; 10(3):207-12. doi: 10.1111/j. 1751 - 2980.2009.00387.x. 4. Barband AR, Kakaei F, Daryani A, 5. Shawhan RR, Porta CR, Bingham JR (et al.). Biliary leak rates after cholecystectomy and intraoperative cholangiogram in surgical residency. Mil Med. 2015 May; 180(5):565-9. doi: 10.7205/MILMED-D-14-00426. 6. Lo Nigro C, Geraci G, Sciuto A, (et al.).Bile leaks after videolaparoscopic cholecystectomy: duct of Luschka. Endoscopic treatment in a single centre and brief literature review on current management. Ann Ital Chir. 2012 Jul-Aug; 83(4):303-12. 7. Doumenc B, Boutros M, Dйgremont R, Bouras AF. Biliary leakage from gallbladder bed after cholecystectomy: Luschka duct or hepaticocholecystic duct? Morpholo- gie. 2016 Mar; 100(328):36-40. doi: 10.1016/j.morpho.2015.08.003. 8. Pancyrev YU.M., SHapoval'yanc S.G., CHernyakevich 9. Ohotnikov O.I., YAkovleva M.V., Grigor'ev S.N. X-ray surgery of «small» damages of bilious channels during cholecystectomy. Annaly hirurgicheskoj gepatologii.2017; 1(22):64-70 [In Russ]. 10. Sinha R, Chandra S. Cystic duct leaks after laparoendoscopic single-site cholecystectomy. J Laparoendosc Adv Surg Tech A. 2012 Jul-Aug; 22(6):533-7. doi: 10.1089/lap.2012.0094. 11. Kim KH, Kim TN. Endoscopic management of bile leakage after cholecystectomy: a single-center experience for 12 years. Clin Endosc. 2014 May; 47(3):248-53. doi: 10.5946/ce.2014.47.3.248. 12. Beburishvili A.G., Zubina E.N., Akinchits A.N., Vedenin YI. External biliary leakage after different types of cholecystectomy: diagnostics and treatment. Annaly khirurgicheskoy gepatologii. 2009; 14 (3): 18-21 [In Russ]. 13. Gwon D, Ko GY Sung KB, Kim JH, Yoon HK. Percutaneous transhepatic treatment of postoperative bile leaks: prospective evaluation of retrievable covered stent. J Vasc Interv Radiol. 2011 Jan;22(1 ):75-83. doi: 10.1016/ j.jvir. 2010.10.004. 14. de Jong EA, Moelker A, Leertouwer T, Spronk S, Van Dijk M, van Eijck CH. Percutaneous transhepatic biliary drainage in patients with postsurgical bile leakage and nondilated intrahepatic bile ducts. Dig Surg. 2013;30(4- 6):444-50. doi: 10.1159/000356711.
Abstract: Aim: was to determine indications for transpapillary external-internal drainage of the biliary tree in benign diseases of the peripapillary region. Material and methods: results of the use of externally-internally transpapillary drainage of the biliary tree from 256 patients with distal obstruction of the biliary tract were analyzed. In 154 (60,2%) cases the peripapillary obstruction was caused by tumor pathology, in 102(39,8%) cases (39.8 %) - by peripapillary benign stenotic diseases (stenosis of Vater papilla, choledocholithiasis, chronic pancreatitis, parapapillary diverticula) that have not managed to eliminate with the help of endoscopy or endoscopic benefit was initially ineffective. Results: endoscopic papillosphincterotomy after the external-internal drainage due to syndrome of Vater papilla «acute blockage» required in 7(4,5%) patients of 154 patients with peripapillary tumor obstruction. Endoscopic papillotomy was performed in 80(78,4%) patients among 102 patients with benign distal block of common biliary duct after the external-internal drainage for same indications. In 7 cases of «acute blockage» of papilla we were forced to return to the outside cholangiostomy due to endoscopic unattainable of papilla. In summary, the syndrome of papilla «acute blockage» occurred in 87(85,3%) patients with transpapillary external- internal drainage of the biliary tree on the background of the peripapillary benign obstruction. There were no complications of papillotomy Conclusion: the external-internal drainage of the biliary tree with the syndrome of obstructive jaundice remains an effective and pragmatic method of return of bile into the lumen of the duodenum. The most common complication of the external-internal drainage with transpapillary drainage placement is a syndrome of «acute blockage» of Vater papilla which requires endoscopic papillotomy With high frequency this syndrome occurs when forced transpapillary the external-internal drainage of the distal benign disorders of patency of the biliary tree. Minimal risk of this syndrome developing has been reported during transpapillary drainage in patients with obstructive jaundice due to peripapillary cancer. References 1. Jendobiliarnaja intervencionnaja onkoradiologija pod red. Dolgushina B.I. [Endobiliary interventional oncoradiology under edition of Dolgushin B.I.]. Moscow. 2004: 224 [In Russ]. 2. Intervencionnaja radiologija v onkologii (puti razvitija i tehnologii): Nauchno-prakticheskoe izdanie. Gl. red.: Granov A.M. i Davydov M.I.; red.: Tarazov P.G. i Granov D.A. 2- e izd., dop [Interventional radiology in oncology (the path of development and technology): Scientific-practical publication. hl. еd.: Granov A.M. and Davydov MI; еd .: Tarazov P.G. and Granov D.A. 2nd ed, dop.]. St. Petersburg. 2013: 560 [In Russ]. 3. Qian X.J., Zhai R.Y, Dai D.K, et al. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J Gastroenterol. 2006; 12(2):331-5. 4. Luchevaja diagnostika i maloinvazivnoe lechenie mehanicheskoj zheltuhi. Rukovodstvo pod red. Kokova L.S., Chernoj N.R., Kuleznevoj Ju.V. [Radiological diagnosis and minimally invasive treatment of obstructive jaundice. Guide. Under edition of Kokov L.S., Chernaya N.R., Kulezneva Ju.V.]. Moscow. 2010: 288 [In Russ]. 5. Jo J.H., Park B.H. Suprapapillary versus transpapillary stent placement for malignant biliary obstruction: which is better? J Vasc Interv Radiol. 2015; 26(4):573-582. 6. Lee D.H., Yu J.S., Hwang J.C., Kim K.H. Percutaneous placement of self-expandable metallic biliary stents in malignant extrahepatic strictures: indications of transpapillary and suprapapillary methods. Korean J Radiol. 2000;1(2):65-72.
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. Reference 1. Wiechel К. Percutaneous transhepatic cholangiography: technique and application withstudies of the hepatic venous and biliary ductpressures, the chemical changes in blood andbile and clinical results in a series of jaundicedpatients. Acta Chir Scand Suppl. 1964; 330(11): 1-99. 2. Fern6ndez-Aguilar J., Santoyo J., Su6rezMuсoz M. et al. Biliary reconstruction in livertransplantation: is a biliary tutor necessary. Cir Esp. 2007; 82 (6): 338-340. 3. Kasahara M., Egawa H., Takada Y. et al. Biliaryreconstruction in right lobe living-donor livertransplantation: Comparison of differenttechniques in 321 recipients. Annals of Surgery. 2006; 243 (4): 559-566. 4. Alsharabi A., Zieniewicz K., Patkowski W. et al.Assessment of early biliary complications afterorthotopic liver transplantation and their relationship to the technique of biliary reconstruction. Transplantation proceedings. 2006; 38 (1): 244-246. 5. Bahra M., Jacob D. Surgical palliation ofadvanced pancreatic cancer. Recent. Results. Cancer. Res. 2008; 177: 111-120. 6. Das A., Sivak M.J. Endoscopic palliation forinoperable pancreatic cancer. Cancer. Control.2000; 7 (5): 452-457. 7. Maire E, Hammel P., Ponsot P. et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006; 101 (4):735-742. 8. Katsinelos P., Paikos D., Kountouras J. et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and cost effectiveness. SurgicalEndoscopy. 2006; 20 (10): 1587-1593. 9. Hatzidakis A., Tsetis D., Chrysou E. et al. Nitinol stents for palliative treatment of malignant obstructive jaundice: Should we stent the sphincter of oddi in every case? Cardiovasc. Intervent. Radiol. 2001; 24: 245-248. 10. Kaassis M., Boyer J., Dumas R. et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc. 2003; 57: 178-182. 11. Ikeda S., Maeshiro K. Interventional treat ment of biliary stricture. Nippon. Geka. Gakkai. Zasshi. 2004; 105 (6): 374-379. 12. Brountzos E., Ptochis N., Panagiotou I. et al. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting. Cardiovasc. Intervent. Radiol. 2007; 30(1): 66-73. 13. Nakamura T., Hirai R., Kitagawa M. et al. Treatment of Common Bile Duct Obstruction by Pancreatic Cancer Using Various Stents: Single-Center Experience. Cardiovasc. Intervent. Radiol. 2002; 25: 373-380. 14. Tesdal I., Roeren T., Weiss С et al. Metallic stents for treatment of benign biliary obstruction: a long-term study comparing different stents. J. Vasc. Interv. Radiol. 2005; 16 (11): 1479-1487. 15. Oikarinen H., Leinonen S., Karttunen A. et al. Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction.J. Vasc. Intervent. Radiol. 1999; 10: 1387-1393. 16. Yoshida H., Taniai N., Mamada Y. et al. One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent. J. World. J. Gastroenterol. 2006; 21; 12 (15): 2423-2426. 17. Cowling M., Adam A. Internal stenting in malignant biliary obstruction. World. J. Surg. 2001; 25: 355-361. 18. Isayama H., Komatsu Y., Tsujino T. et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest. Endosc. 2002; 55 (3): 366-370. 19. Yoon W., Lee J., Lee K. et al. A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest. Endosc. 2006; 63 (7): 996-1000. 20. Chen J., Sun C, Liao C, Chua C. Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors.J. World. J. Gastroenterol. 2006; 7; 12 (1): 119-122. 21. Inal M., Aksungur E., Akgьl E. et al. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not? Cardiovasc. Intervent. Radiol. 2003; 26: 40-45.
Abstract: The importance of using minimally invasive techniques in management of pancreatic pseudocysts is evident today. In order to evaluate the efficacy of puncture-draining interventions, analysed herein are therapeutic outcomes in 102 patients. The patients were subdivided depending on the causes of pathology, localization, forms and presence of complications. Diagnosis included an ultrasonographic study. Suspected for neoplastic cysts, 21 patients underwent computed tomography, 42 - duodenoscopy, 17 - endoscopic retrograde pancreatocholangiography. Taking into consideration a high risk of pancreatic fistulas formation, after external drainage, we isolated a high-risk group comprising 36 people, and a group of 66 subjects with no risk of this complication. The latter underwent ultrasonography-controlled external drainage. Of these, 49 patients were subjected to drainage by the Seldinger technique, 12 - large-calibre percutaneous external drainage. Complications were observed in 3 subjects. Patients at risk of a complication underwent ultrasonographically and endoscopically controlled internal drainage. Complications were noted in 4 cases. Of these, two, during transduodenal drainage, developed bed-sores of the superior mesenteric artery branches, and one patient developed abdominal haemorrhage. In this connection we refused carrying out transduodenal drainage. The long-term results in patients with cystoduodenal stents were followed-up in 19 subjects. By month six, the stent detached spontaneously in 6 patients, being removed endoscopically in 8 subjects. Fifteen patients with intrapancreatic hypertension were subjected to endoscopic papillosphincterotomy. The duration of the hospital stay amounted to 23-28 days. Hence, internal drainage of pancreatic pseudocysts, followed by cystoduodenal stenting in patients at risk of an external pancreatic fistula within the described therapeutic-and-diagnostic algorithm is an operation of choice. References 1. Багненко С.Ф., Гольцов В.Р. Лечение острого панкреатита в ферментативную фазу заболевания. Вестник хирургии им. И.И. Грекова. 2006; 165 (1): 117. 2. Акилов Х.А., Ваккасов М.Х. Лечебная тактика при поздних осложнениях панкреонекроза. Материалы 9 Всероссийского съезда хирургов. Волгоград. 2000; 7. 3. Кадощук, Т.А., Кадощук Ю.Т., Бондарчук О.И. Диагностика и лечение кист поджелудочной железы. Анналы хирург. гепатологии. 1999; 4 (2): 159-160. 4. Погребняков В.Ю. Малоинвазивное хирургическое лечение ложных кист поджелудочной железы, связанных с панкреатическими протоками. Анналы хирург. гепатологии. Материалы 5-й конф. хирургов - гепатологов. Томск. 1997; 2: 114. 5. Kloppe G. Pseudocysts and other non-neoplastic cysts of the pancreas. Semin. Diagn. Pathol. 2000; 17 (1): 7-15. 6. Багненко С.Ф., Курыгин Ф.Ф., Рухляда Н.В., Смирнов А.Д. Хронический панкреатит. Руководство для врачей. СПб.: Питер. 2000; 416. 7. Данилов М.В., Федоров В.Д. Хирургия поджелудочной железы. М.: Медицина, 1995; 512. 8. Froschle G., Doris H., Kremer B. et al. Pancreas-pseudozysten und hire interdiszinare therapy. Zbl. Chir. 1991; 116.359-368. 9. Дадвани С.А., Лотов А.Н., Мусаев Г.Х., Заводнов В.Я. Отдаленные результаты цистогастро- и цистодуоденостомий под ультразвуковым и эндоскопическим контролем в лечении псевдокист поджелудочной железы. Анналы хирургической гепатологии. 1999; 4 (2): 153. 10. Мишин, В.Ю., Квезерова А.П. Современный подход к лечению псевдокист поджелудочной железы. Анналы хирургии. 2000; 3: 32-39. 11. Русин В.И., Болдижар А.А. Эндоскопические способы лечения псевдокист поджелудочной железы. Материалы X юбилейного конгресса по эндоскопической хирургии. 2006; 185.
Abstract: Aim. Was to estimate the role of transcutaneous interventions under the supervision of radiodiagnostics in the maintenance of all mini-nvasive kinds of operation stages of surgical treatment in patients with pancreatic and duodenal zone tumors Materials and methods. For the period from January 2007 till march 2010, 21 patients, aged 49-75 (10 men, 11 women) - were under aparoscopic pancreaticoduodenectomy (LPDE) Results. The use bile ducts drainage systems before LPDE in 95% cases leads to small hemorrhage (less than 1 liter). The presence of cholangiostomy also leads to early diagnostics of biliodigistive anastamosis (BDA) stenosis, and makes bile peritonitis – impossible. Conclusion. Usage of non-vascular methods of interventional radiology allows to make effective and less traumatic biliar decompression in patients with biliopancreatic and duodenal zone tumors as a stage of LPDE preparations. The presence of decompression cholangiostomy prevents further BDA inconsistency, and makes pacreaticojejunoanastamosis healing faster in case of its' decompression. References 1. Barnett S.A., Collier N.A. Pancreaticoduodenectomy. Does preoperative biliary drainage, method of pancreatic reconstruction or age influence perioperative outcome? A retrospective study of 104 consecutive cases. ANZJ. Surg. 2006; 76 (7): 563-568. 2. Sewnath M. et al. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J. of the Am. Col. of Surg. 2008. Volume 192, Issue 6, Pages. 726-734. 4. Srivastava S. et al. Outcome following pan-creaticoduodenectomy in patients undergoing preoperative biliary drainage. Dig. Surg. 2001; 18 (5): 381-387. 5. Laurent A., Tayar C., Cherqui D. Cholangiocarcinoma: preoperative biliary drainage (Con). HPB (Oxford). 2008; 10 (2): 126-129. 6. Tsai Y.F. et al. Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy. Hepatogastroenterology. 2006; 53 (72): 823-827. 7. Li Z. et al. Pancreaticoduodenectomy with preoperative obstructive jaundice. Drainage or not. Pancreas. 2009; 38 (4): 379-386. 8. Chen D. et al. Effect of preoperative biliary drainage on liver function changes in patients with malignant obstructive jaundice in the low bile duct before and after pancreaticoduo-denectomy. Ai. Zheng. 2008; 27 (1): 78-82. 9. Wang Q. et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst. Rev. 2008; 16 (3): CD005444.
Abstract: Hemobilia is known as one of the most severe complications of percutaneous transhepatic biliary drainage. In the present case, the severe bleeding developed as a result of balloon dilatation and stenting of malignant stricture. Emergency transhepatic arterial embolization was performed with good results. We also discuss 7 cases of hemobilia in our hospital, 3 of which were successfully treated with transcatheter embolotherapy. We conclude that transhepatic arterial embolization appears to be effective and safe treatment for massive hemobilia. References 1. Хачатуров А.А., Капранов С.А., Кузнецова В.Ф. и др. Актуальные вопросы чреспече-ночного эндобилиарного стентирования при злокачественных блоках желчеотделения. Диагностическая и интервенционная радиология. 2008; 2 (3): 33-47. 2. Борисов А.Е., Борисова Н.А., Непомнящая С.Л. Диагностика и лечение гемобилии. Анн. хир. гепатологии. 2005; 10 (1): 40-45. 3. Savader S.J., Trerotola S.O., Merine D.S. et al. Hemobilia after percutaneous transhepatic billiary drainage. Treatment with transcathe-ter embolotherapy. J.Vasc. Intervent. Radiol. 1992; 3 (2): 345-352. 4. Winick A.B., Waybill P.N., Venbrux A.C. Complications of percutaneous transhepatic biliary interventions. Tech. Vasc. Intern Radiol. 2001; 4 (3): 200-206. 5. Fidelman N., Bloom A.I., Kerlan R.K. et al.Hepatic arterial injuries after percutaneous biliary interventions in the era of laparoscopic surgery and liver transplantation. Experience with 930 patients. Radiology. 2008; 247 (3):880-886. 6. Saad W.E., Davies M.G., Darcy M.D. Management of bleeding after percutaneous transhepatic cholangiography or transhepatic biliary drain placement. Tech. Vasc. Interv. Radiol. 2008; 11 (1): 60-71. 7. Green M.H., Duell R.M., Johnson C.D, Jamieson N.V. Haemobilia. Br. J. Surg. 2001; 88 (6):773-786. 8. Hsu K.L., Ko S.F., Chou F.F. et al. Massive hemo-bilia. Hepatogastroenterology. 2002; 49 (44): 306-310. 9. Долгушин Б.И., Виршке Э.Р., Черкасов В.А.и др. Селективная эмболизация печеночных артерий при геморрагических осложнениях чрескожной чреспеченочной холангиографии. Анн. хир. гепатологии. 2007; 12 (4): 63-68. 10. Eurvilaichit C. Iatrogenic hemobilia. Management with transarterial embolization using gelfoam articles. J. Med. Assoc. Thai. 1999; 82 (9): 931-937. 11. Park J.Y., Ryu H., Bang S. et al. Hepatic artery pseudoaneurysm associated with plastic biliary stent. Yonsei. Med. J. 2007; 48 (3): 546-548. 12. Hammer F.D., Goffette P.P., Mathurin P. Glue embolization of a ruptured pancreaticoduo-denal artery aneurysm. Case report. Eur. Radiol. 1996; (4): 514-517. 13. Merrell S.V., Gibberston J.J., Albo D. et al. Atraumatic hemobilia arising from cirrhotic liver. Surgery. 1989; 106 (1): 105-109. 14. Rai R., Rose J., Manas D. Potentially fatal hae-mobilia due to inappropriate use of an expanding biliary stent. World. J. Gastroenterol. 2003; 9 (10): 2377-2378. 15. Dousset B., Sauvanet A., Bardou M. et al. Selective surgical indications for iatro-genic hemobilia. Surgery. 1997; 121 (1): 37-41.
