Double catheter technique: a new approach for treatment of anatomically challenging splenic artery aneurysm: a case report

Splenic artery aneurysms are the most common visceral aneurysm. They are usually asymptomatic, but may present rarely as abdominal pain, or with symptoms and signs of acute rupture. This is a case report of a 42 years old female patient who presented with mild abdominal pain and was found to have a splenic artery aneurysm with a challenging anatomy of the prominent splenic artery. The patient refused the surgical option of treatment, and was treated by endovascular embolization, using a double catheter technique.

Flouroscopy-guided balloon dilatation of benign esophageal strictures: a single center study

To review the efficacy and safety of balloon dilatation among children with benign esophageal strictures. This is a retrospective review of 209 balloon dilation procedures performed under fluoroscopy guidance on 66 patients [38 male and 28 female] with benign esophageal strictures over 27 months [January 2009 to March 2011]. The study was conducted at King Hussein Medical Centre. Patients had a mean age of 26 months and a median of 3.2 [1-18] dilatations. Immediate technical success was defined as the ability to dilate the stricture without complications. Long term success was defined as the disappearance of presenting symptoms for a minimum of 12 months post procedure. All patients had the procedure performed under general anesthesia with pre and post procedure esophagogram. Simple descriptive statistics [frequency, mean and percentage] were used to describe the study variables. Immediate technical success was noted in 208 procedures [99.5%]. Esophageal perforation was encountered in one patient at the fifth dilatation session [type1 perforation]. Long term success was achieved in 44%, 42% and 14% of cases following a single, two to five and more than five interventions consecutively. Fluoroscopy-guided balloon dilatation procedure is a simple, safe and efficacious modality for treatment for benign esophageal strictures in children, with low rate of complications

Treatment of venous outflow stenosis in hemodialysis arteriovenous fistulae using percutaneous transluminal angioplasty: our experience at King Hussein medical center

To evaluate the technical success and primary patency of percutaneous transluminal angioplasty as a modality of treatment for outflow venous stenosis in arteriovenous fistulae used as hemodialysis access. This is a retrospective, single center review which was conducted between August 2008 to August 2009, analyzing the results of percutaneous transluminal angioplasty used to treat 49 patients with short segment venous outflow stenosis. Patency was assessed by clinical examination and Doppler ultrasound scanning over a follow up period of one year. The immediate technical success rate of percutaneous transluminal angioplasty was 98%. The primary patency at six months, and one year were 83% and 53% respectively. One patient developed rupture of the vein at the site of angioplasty. Six patients died during the follow up period. The deaths were not related to the procedure or access failure. Percutaneous transluminal angioplasty is an effective method for treatment of venous outflow stenosis in surgically created arteriovenous fistulae, with excellent technical success, acceptable one year primary patency, and low complications rate

Results of vascular clip closure device at King Hussein medical center

To assess the results of vascular clip closure devices used following percutaneous transfemoral endovascular procedures. This is a retrospective review of 69 patients who were managed with vascular clip closure device following transfemoral peripheral endovascular interventions during the year 2009, at King Hussein Medical Center. The success of the device in achieving hemostasis, as well as the associated complications were evaluated. Technical success defined as successful deployment of the device was achieved in 65 patients. Two minor complications and one major complication occurred following the deployment of the device. Femoral arterial access clip closure devices are both safe and effective, and are advised to be used in patient at high risk of bleeding at the arterial access site

Colonoscopy at King Hussein Medical Center; indications, effectiveness, safety and outcome

To find out the indications, effectiveness, safety and outcome of colonoscopy at King Hussein Medical Center. A retrospective analysis of the colonoscopy records for patients who underwent elective colonoscopy over a 7-year period [January 2000-October 2006] at King Hussein Medical Center in Amman, Jordan was done. Data collected included the number of the patients, age, gender, reason for doing the procedure, endoscopic findings, and any immediate complication. For all patients colonic preparation using Dulcolax [Biscodyl 5 mg tab] and Fortrans [Macrogol 4000-64 gm] or castor oil with normal saline and unistiffness endoscopes were used. Almost all colonoscopies were done with sedation using Mipiridine 25 mg and Midazolam 3 mg intravenously. A total of 3865 colonoscopies were included in the study, 42% percent of patients were aged less than 50 years. 89% of the colonoscopies were done for patients from physicians as outpatients and 11% for patients who were already in hospital. The number of endoscopies performed during the year 2006 per month was considerably higher [mean 65] than that done during the year 2000 [mean 30]. The main indications for colonoscopies were rectal bleeding [39%], constipation [17%], and diarrhea in 12%. In 3749 [97%] patients, the procedure was completed up to cecum. Normal colonoscopy was reported in 72.5% of patients. The most common abnormal findings were colonic cancer [29%], colonic polyps in 24% and inflammatory bowel disease in 16%. Other common findings were diverticulosis [13.4%], melanosis coli [2.4%], and vascular ectasias in 2.5%. Internal hemorrhoids was a coexistent finding in [n=30] those diagnosed as colonic cancer and [n=18] in those diagnosed as colonic polyps, but it was the only colonoscopic finding in 130 patients [12.2%]. Colonic polyps were also found as coexistent finding in 47 patients diagnosed as colonic cancer. Seven [0.018%] patients had a major complication related to the procedure in the form of colonic perforation [n=4], minor bleeding which did not necessitate blood transfusion [n=2], and stuck snare wire due to looping around a normal colonic mucosa that mandated removal by lapratomy [n=1]. Colonoscopy at King Hussein Medical Center, is safe and effective in establishing a definitive diagnosis, and rarely associated with major complications such as perforation or bleeding

role of computed tomography in blunt abdominal trauma

To determine the utility of the computed tomography [CT] scan in blunt abdominal trauma and to compare it with operative findings or clinical outcomes. A retrospective analysis based on existing, diagnostic CT scan reports taken during a 5 year period from 245 consecutive patients with blunt abdominal trauma. Percentages and types of trauma identified were based on CT scan findings. Recorded data included age, sex, type of injuries and scan results. The CT findings were compared and correlated with the operative findings, or clinical follow-up in conservatively managed cases. Of the total of 245 patients, 113 [46%] underwent surgery. One hundred and thirty two [54%] patients were conservatively managed. There were 12 [4.9%] deaths. Hemoperitoneum were detected in 170 patients. All 52 patients with small hemoperitoneum on CT scan were conservatively managed and all 22 patients with large hemoperitoneum required surgical exploration. There were 95 splenic, 63 renal, 48 hepatic and 13 pancreatic injuries. Twenty one patients had bowel injuries. Five patients had vascular injuries. Twenty three patients had multi-organ injuries. Organ injuries were graded using the OIS [Organ Injury Scale] guidelines. In conjunction with close clinical monitoring, CT was reliable in the evaluation of blunt abdominal trauma in a selected group of patients, with overall sensitivity of 97% and specificity of about 95%. Positive predictive value 82% and negative predictive value 100%