[Complications of fluoroscopy-, ultrasound-, and CT-guided percutaneous interventional procedures]. / Complications des gestes interventionnels percutanés sous contrôle radioscopique, echographique ou scanographique.

The purpose of this article is to describe potential complications following the most common image-guided (fluoroscopy, ultrasound or CT) percutaneous interventional procedures, both diagnostic and therapeutic, thoraco-abdominal and musculoskeletal, as well as to review risk factors and the best practice recommendations. Prior to any interventional procedure, it is necessary to ascertain the absence of any abnormality in coagulation, to secure enough time to explain the procedure to the patient, and to adhere to strict sterile technique. Indeed, infections and hemorrhagic complications are the principal causes of mortality and morbidity for all procedures. Following lung biopsy, CT scan detects an immediate pneumothorax in 30% of patients. Major complications following percutaneous liver biopsy occur within 3 to 6 hours. Following a percutaneous drainage, complications occur in less than 10% of cases. Following a radiofrequency thermal ablation of malignant tumors, the mortality rate is low (0,5 to 1,4%), infection and hemorrhage are the most frequent complications. While rare, septic arthritis is the main complication that can follow musculoskeletal procedures and is a cause of medical malpractice lawsuits brought by patients.

[Bisegmentectomy 7-8: importance of preoperative diagnosis of a right inferior hepatic vein]. / Bisegmentectomie 7-8: intérêt du repérage pré-opératoire d'une veine hépatique inférieure droite (VHID).

The extent of hepatic resection is often determined by the hepatic veins and their relation to the tumor. A need to transect the right hepatic vein at its entry into the vena cava indicates a need to remove the entire right posterior segment. About six cases, the aim of the study was to remind that under certain circumstances the posteroinferior area may be preserved. The circumstances which allow such preservation are the presence of a stout inferior right hepatic vein and the ability to recognize the presence of the vein in the preoperative staging. In patients with possible impaired hepatic function (cirrhosis, chemotherapy), preservation of hepatic parenchyma is an important consideration during resection for hepatic tumors.

[Meckel's diverticulum Diagnosed by CT-Enteroclysis]. / Diagnostic d'un diverticule de Meckel hémorragique par entéroscanner.

The authors report the case of a 24 year old woman presenting with acute lower GI hemorrhage caused by a Meckel's diverticulum. Diagnosis was made by CT-enteroclysis and confirmed at surgery. This new imaging technique will be briefly described and compared to the other more traditional small bowel imaging techniques. The authors will then present the CT-enteroclysis imaging features of this congenital anomaly.

Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis.

BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.

[Ultrasound guided alcohol ablation of the celiac plexus in oncology patients with abdominal pain]. / Alcoolisation coeliaque échoguidée dans les douleurs solaires néoplasiques.

PURPOSE: The authors report results of a retrospective study evaluating the efficacy of US-guided alcohol ablation of the celiac plexus in 26 patients with chronic cancer-related abdominal pain. They review the interest of this imaging technique for guidance. PATIENTS AND METHODS: Thirty US-guided alcohol ablations were performed in 26 patients. Twenty-two of them had a prancreatic malignancy, 3 had a gastric cancer and 1 had an esophageal cancer. RESULTS: 72% of patients experienced significant pain relief with at least 50% decrease in morphine requirements for two months. Four patients underwent a second ablation because of persistent pain and 3 of them experienced relief. CONCLUSION: Celiac plexus ablation is considered to be one of the most effective treatments for chronic cancer-related abdominal pain, often used as an adjuvant treatment in the pain management strategy. US guidance is advantageous because it is simple and accurate and enables quick needle placement.

[Malignant obstructive jaundice: the role of percutaneous metallic stents]. / Ictères obstructifs néoplasiques: apport des prothèses métalliques percutanées.

OBJECTIVES: Efficiency evaluation of percutaneous metallic stents in palliative treatment of malignant biliary obstruction. METHODS: One hundred sixteen percutaneous metallic stents were implanted in 80 patients with malignant biliary obstruction. Thirty-five patients had hilar obstruction, 32 patients obstruction of the common bile duct and 12 patients obstruction of a bilioenteric anastomosis. RESULTS: Adequate biliary drainage was achieved in 79 patients. Early complications occurred in 23.75% of patients; 12.5% of patients died within 30 days. The procedure-related mortality rate was 5%; 18.75% of patients showed recurrent jaundice after an average of 175 days. CONCLUSION: Percutaneous metallic stents are an efficient means of treating malignant biliary strictures, particularly of upper biliary obstructions. However, this treatment has risks and limits that require careful patient recruitment.

[Percutaneous self-expanding metallic endoprosthesis and malignant biliary stenoses]. / Endoprothèses métalliques auto-expansibles percutanées et sténoses biliaires malignes.

METHOD: Thirty-five patients with malignant obstructive jaundice were given palliative treatment by percutaneous self-expandable metallic stents. Cholangiocarcinoma was the most frequent cause of biliary obstruction. The stricture was located in the hilum in more of 50% of cases. RESULTS: Adequate biliary drainage was achieved in 97% of cases. Median survival was 182 days. 11% of patients have died within 30 days. Early complications occurred in 31% of patients. 25% of patients have shown recurrent jaundice after an average of 180 days. CONCLUSION: Percutaneous self-expandable metallic stents are an efficient means treating malignant biliary strictures, particularly of upper biliary obstructions.

Percutaneous self-expandable metallic stents and malignant biliary strictures.

Thirty-five patients with malignant obstructive jaundice received palliative treatment using percutaneous self-expandable metallic stents. Cholangiocarcinoma was the most frequent cause of the biliary obstruction. In more than 50% of cases, the stricture was located in the hilum. Adequate biliary drainage was achieved in 97% of cases. Median survival was 182 days, and 11% of patients died within 30 days. Early complications occurred in 31% of patients, and 25% of patients showed recurrent jaundice after an average of 180 days. Percutaneous self-expandable metallic stents are an efficient means of palliatively treating malignant biliary strictures, particularly high biliary obstructions.

Percutaneous cholecystostomy for acute cholecystitis in critically ill patients.

BACKGROUND: Cholecystectomy remains the best treatment for acute cholecystitis but may cause high morbidity or mortality in critically ill or elderly patients. METHODS: We report a retrospective study of ultrasonography-guided percutaneous cholecystostomy (USGPC) performed between 1988 and 1994 in 41 patients (mean age, 77.8 years; range, 42-95 years) as an alternative to surgery. RESULTS: Five patients (12.2%) died in the hospital, four (9.8%) subsequently underwent operation without complications, six (15%) had a recurrence of cholecystitis between 3 and 24 months after withdrawal of drainage, and 26 patients are cured without recurrence after a mean follow-up of 33 months (range, 3-67 months). CONCLUSIONS: USGPC appears to be the treatment of choice for high-risk patients, especially those with postoperative cholecystitis, severe acute calculous pancreatitis, or total parenteral nutrition.

[Muscular metastasis of cancer of the pancreas. A propos of a case]. / Métastase musculaire d'un cancer du pancréas. A propos d'un cas.

Metastasis to muscle is rare in cancer of the pancreas. We observed one case and reviewed the literature. The role of magnetic resonance imaging and the importance of echoguided needle biopsy for diagnosis is emphasized.

[Cystic dystrophy of the duodenal wall on aberrant pancreas. Apropos of 2 cases]. / Dystrophie kystique de la paroi duodénale sur pancréas aberrant (DKPA). A propos de deux observations.

Cystic dystrophy in heterotopic pancreas is characterized by the presence in the duodenal thickened muscularis of cysts corresponding to dilated ducts lined with exocrine epithelium. The pancreas proper is normal. Cystic dystrophy in heterotopic pancreas occurs mostly in men, in the periampullary region. Two cases, revealed by duodenal stenosis, are reported here. Symptoms and morphologic investigations favoured a diagnosis of malignancy: in one case, partial portal thrombosis was observed; this complication has not been previously described in association with cystic dystrophy in heterotopic pancreas. Endosonography was non-contributory in these 2 cases because of duodenal stenosis. A pancreaticoduodenectomy was performed associated in one case with portal thrombectomy. Pathologic findings allowed diagnosis of cystic dystrophy in heterotopic pancreas.

[Complications of biliary cysts. Apropos of 10 cases]. / Complications des kystes biliaires. A propos de 10 observations.

Ten cases of complications of simple biliary cysts were reported: 4 intracystic haemorrhages including 1 intraperitoneal rupture, 3 bacterial infections including 1 case with invalidating pain. Complications of biliary cysts raises the problem of the differential diagnosis with cysts caused parasites, neoplastic processes (cystadenomas and pseudocysts of the liver) and with intrahepatic collections of pancreatic or traumatic origin. Imaging and echo-guided puncture are the most appropriate exploration techniques. MRI has been particularly helpful to evaluate bleeding in an intrahepatic cyst. A pathology examination of the cyst wall and its contents should always be performed. Theoretically, partial cystectomy (performed here in 8 cases) is the indicated treatment. Total cystectomy (1 case) is justified when the diagnosis of cystadenoma cannot be excluded. The role of liver resection is very limited. Preventive resection of a simple biliary cyst greater than 8 cm can be indicated, particularly with videolaparoscopy.

[Hepatic and renal angiomyolipoma]. / Angiomyolipome hépatique et rénal.

Angiomyolipoma is a benign mixed mesenchymal tumor. It is a well known entity in the kidney, but very rare in the liver. A case of renal and hepatic angiomyolipoma without no evidence of tuberous sclerosis is presented. This association has been previously described only once before. Radiologic and ultrasonographic findings may be suggestive of the lesion, showing both fatty and hypervascular components. The definitive diagnosis requires histologic and immunohistochemical confirmation by fine needle aspiration biopsy. Surgical excision is unnecessary unless abdominal discomfort is present or malignant tumor is not completely ruled out.

[Echo-guided percutaneous cholecystostomy in the treatment of acute cholecystitis. Apropos of 41 cases]. / Cholécystostomie percutanée échoguidée dans le traitement de la cholécystite aiguë. A propos de 41 observations.

Differents studies note many complications of the traditional cholecystectomy for acute cholecystitis in critically ill and very old patients. We report a retrospective study of ultrasound-guided cholecystostomy as an alternative treatment avoiding surgery in 41 patients between April 1988 and January 1994. Mean-age was 77.8 years (42-95). Hospital mortality concerned five (12.2%) patients. Four (9.8%) required surgical procedure, all of them with simple post-operative course. Six (14.6%) had a recurrence between 1 and 67 months after the end of the drainage. Twenty-six patients are considered as healed, without recurrence, after a mean-follow-up of 33 months. The percutaneous echoguided cholecystostomy seems to be a treatment of choice for patients with a contraindication for a surgical procedure. This technic allows an efficient treatment in patients with post-operative cholecystitis.

[Technique of percutaneous drainage under ultrasound guidance for acute cholecystitis]. / Technique du drainage percutané des cholécystites aiguës sous contrôle échographique.

Gallbladder percutaneous drainage under ultrasound guidance could offer an interesting option compared to surgery in multi-systemic disease patients with acute cholecystitis and who are considered as high-risk patients towards anesthesia and surgery. The authors describe this technics which is an easy, quick and eventually repetitive procedure with no major complications.

[Fatal hydatid pulmonary embolism during hepatectomy for hydatid cyst. Apropos of a case]. / Embolie pulmonaire hydatique mortelle lors d'une hépatectectomie pour kyste hydatique. Rapport d'un cas.

Liver Hydatid cysts located close to the inferior vena cava and the sus-hepatic veins are known for their risk of rupture inside these veins. The authors report the case of a patient who died from massive pulmonary embolism during the surgical treatment (hepatectomy) of liver hydatid cysts. Diagnosis and treatment of these fistula are reviewed.