RESUMEN
We evaluated the usefulness of ultrasonography (US) to detect hepatic puncture complications. We studied 50 patients, 28 males and 22 females became hepatic puncture. The needles that we used were in 40 Tru-cut in two Chiba in one angiocath and in the other remaining two. US were performed one day before the liver puncture and were repeated 24 to 48 h post-puncture. The procedure was blindly on 29, in fourteen guided by US or scintigraphy, and by laparoscopy in seven. Six patients developed complications (12%), two hemobilia; two subcapsular hematoma, one hemoperitoneum and one hematoma of the abdominal wall. The US detected five of the six complications, and four patients had clinical signs. The sensitivity was 88 percent and the specificity 100%. Platelet count impaired was determinant for the complication. US is useful to detect liver puncture complications.
Asunto(s)
Biopsia con Aguja/efectos adversos , Hematoma/diagnóstico por imagen , Hemobilia/diagnóstico por imagen , Hemoperitoneo/diagnóstico por imagen , Hepatopatías/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/instrumentación , Femenino , Hematoma/etiología , Hemobilia/etiología , Hemoperitoneo/etiología , Humanos , Masculino , Persona de Mediana Edad , Agujas , Estudios Prospectivos , Sensibilidad y Especificidad , UltrasonografíaRESUMEN
Eight patients with life-threatening hemobilia were treated by percutaneous transcatheter occlusive therapy. The bleeding was caused by a traumatic pseudoaneurysm of the hepatic artery in 6 cases (auto accident in 4, surgery in 1, biliary drainage in 1) and a true aneurysm of the hepatic artery in 2 (unknown etiology in 1 and mycotic in 1). Arterial catheterization was used in all cases except for one in which a direct percutaneous puncture was performed. Gelfoam alone was used as embolic material in 3 patients. In 1 patient each, the material used was gelfoam plus coils, coils alone, blood clot, n-butyl-cyanoacrylate and an occluding balloon catheter. In all cases the bleeding stopped and did not recur during the follow-up period which ranged from 9 months to 14 years. This experience indicates that transcatheter occlusive therapy is an effective method for the treatment of severe hemobilia.
Asunto(s)
Embolización Terapéutica , Hemobilia/terapia , Adolescente , Adulto , Anciano , Aneurisma/complicaciones , Femenino , Estudios de Seguimiento , Esponja de Gelatina Absorbible , Hemobilia/diagnóstico por imagen , Hemobilia/etiología , Arteria Hepática , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Factores de TiempoRESUMEN
The authors report a case of hemobilia in which a fistula was created by corrosion of the cystic artery into the gallbladder. The value of arteriography in diagnosis is emphasized. Cholecystectomy was the definitive treatment.