ABSTRACT
BACKGROUND: Morbid obesity strongly predicts morbidity and mortality in surgical patients. However, obesity's impact on outcome after major liver resection is unknown. CASE PRESENTATION: We describe the management of a large hepatocellular carcinoma in a morbidly obese patient (body mass index >50 kg/m2). Additionally, we propose a strategy for reducing postoperative complications and improving outcome after major liver resection. CONCLUSION: To our knowledge, this is the first report of major liver resection in a morbidly obese patient with hepatocellular carcinoma. The approach we used could make this operation nearly as safe in obese patients as it is in their normal-weight counterparts.
Subject(s)
Carcinoma, Hepatocellular/surgery , Hepatectomy , Liver Neoplasms/surgery , Obesity, Morbid/complications , Adult , Carcinoma, Hepatocellular/complications , Female , Hepatectomy/adverse effects , Humans , Liver Neoplasms/complications , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Treatment OutcomeSubject(s)
Ureteral Diseases , Urinary Fistula , Vascular Fistula , Humans , Radiography , Risk Factors , Ureteral Diseases/diagnostic imaging , Ureteral Diseases/etiology , Ureteral Diseases/therapy , Urinary Fistula/diagnostic imaging , Urinary Fistula/etiology , Urinary Fistula/therapy , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology , Vascular Fistula/therapyABSTRACT
The purpose of this study is to evaluate the feasibility of constrained endografts used for the treatment of transjugular intrahepatic portosystemic shunt (TIPS)-related refractory hepatic encephalopathy (HE). Because the clinical status of two patients worsened (return of intractable ascites requiring transplantation, n = 1; death, n = 1) after complete balloon occlusion, six patients were treated with constrained/modified Wallgraft endoprostheses placed within the preexisting TIPS. Shunt reductions were technically successful in all six patients, as shown by an immediate mean portosystemic gradient increase of 9.3 mm Hg. Clinical improvement was achieved in five patients within 72 hours of reduction. The remaining patient continued to decline and died 3 weeks later. Two endografts completely occluded within 8 months without HE recurrence. This technique offers an attractive alternative to previously described shunt reduction methods.
Subject(s)
Blood Vessel Prosthesis , Hepatic Encephalopathy/surgery , Portasystemic Shunt, Surgical/adverse effects , Adult , Aged , Aged, 80 and over , Female , Hepatic Encephalopathy/etiology , Humans , Male , Middle Aged , Postoperative ComplicationsABSTRACT
BACKGROUND: Ureteral-iliac artery fistulae are rare, yet potentially life-threatening, causes of hematuria. Treatment has traditionally been surgical, but advances in endovascular technology have led to a few recent reports of therapy with covered stents. We report two cases of patients diagnosed with ureteral-iliac artery fistulae who were treated with Wallgraft endoprostheses, a new, commercially available covered stent. CASES: We report two patients with gynecologic malignancies who presented with massive hematuria and hypotension and were subsequently proven to have ureteral-iliac arterial fistulae. Both patients had prior pelvic surgery, radiation, and chronic indwelling ureteral stents. Once the diagnosis was established, both patients were managed with endovascular covered stent placement. The patients' conditions stabilized, hematuria ceased, and both were discharged from the hospital without additional transfusion or surgical treatment. CONCLUSION: Endovascular therapy with covered stents is a safe, effective, and readily available method for the treatment of ureteral-iliac artery fistulae.