Contemporary Role of Embolization of Solid Organ and Pelvic Injuries in Polytrauma Patients.

Abdominopelvic trauma (APT) remains a leading cause of morbidity and mortality in the 15- to 44-year-old age group in the Western World. It can be life-threatening as abdominopelvic organs, specifically those in the retroperitoneal space, can bleed profusely. APT is divided into blunt and penetrating types. While surgery is notably considered as a definitive solution for bleeding control, it is not always the optimum treatment for the stabilization of a polytrauma patient. Over the past decades, there has been a shift toward more sophisticated strategies, such as non-operative management of abdominopelvic vascular trauma for haemodynamically stable patients. Angiographic embolization for bleeding control following blunt and/or penetrating intra- and retroperitoneal injuries has proven to be safe and effective. Embolization can achieve hemostasis and salvage organs without the morbidity of surgery, and the development and refinement of embolization techniques has widened the indications for non-operative treatment in solid organ injury. Moreover, advances in computed tomography provided more efficient scanning times with improved image quality. While surgery is still usually recommended for patients with penetrating injuries, non-operative management can be effectively used as well as an alternative treatment. We review indications, technical considerations, efficacy, and complication rates of angiographic embolization in APT.

Reversal of impaired counterregulatory cortisol response following diazoxide treatment in a patient with non insulinoma pancreatogenous hypoglycemia syndrome: Case report and overview of pathogenetic mechanisms.

OBJECTIVE: Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is one of the rare causes of endogenous hyperinsulinism. Its diagnosis is challenging and may require selective intraarterial calcium stimulation and concomitant hepatic vein sampling (SACVS). Impaired counterregulatory hormones' production in response to hypoglycemia has been previously described in patients with diabetes, insulinoma and infancy hypoglycemia. We present a case of endogenous hyperinsulinism, secondary to NIPHS, with deficient cortisol response to hypoglycemia which resolved after diazoxide treatment. DESIGN-RESULTS: A 43-year-old woman was admitted with recurrent episodes of registered fasting and postprandial hypoglycemia. Abdominal computed tomography, magnetic resonance imaging and endoscopic ultrasonography of the pancreas failed to reveal any lesion while SACVS sampling demonstrated a 5- to 8-fold increase in insulin levels in diverse parts of the pancreas. Counterregulatory hormones' measurement revealed an attenuated cortisol response. Treatment with diazoxide resulted in disappearance of hypoglycemic episodes. Twelve months later, an insulin tolerance test was performed which revealed a normal cortisol response. CONCLUSIONS: This report describes the first, to our knowledge, reported case in the literature of NIPHS with deficient cortisol response to hypoglycemia which resolved after diazoxide treatment. It is important for clinicians to include NIPHS in the differential diagnosis of hypoglycemia and identify possible impairment of counterregulatory hormones' production.

Contained rupture of a celiac artery aneurysm treated with aortic endograft deployment and assisting percutaneous coil and thrombin infusion.

In this report we present a case of a ruptured celiac artery aneurysm (CAA) with a thrombosed distal neck, which was treated as an emergently with a deployment of a tube thoracic endograft to the descending thoracic and upper abdominal aorta. The initial treatment was assisted with a second stage percutaneous, transhepatic, ultrasound guided needle infusion of coil and thrombin to the aneurysmal sac due to type Ib endoleak, with immediate thrombosis of the aneurysm. This technique, although not standard,could also be considered as a useful choice for the treatment of CAAs with wide proximal and patent distal neck.