Large Bore Portal Vein Thrombectomy: An Inari FlowTriever Case Series.

PURPOSE: Portal vein thrombus (PVT) can worsen portal hypertension and hepatic decompensation in patients with cirrhosis and impact liver transplant outcomes. This retrospective case series describes large bore mechanical thrombectomy of PVT with the Inari FlowTriever device during, or remotely after, transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Ten patients with PVT were treated with large bore thrombectomy. All patients had underlying cirrhosis, complicated by portal hypertension with acute/subacute PVT. Thrombectomy was performed either with TIPS placement, or via a previously placed thrombosed shunt. Median time from TIPS placement to thrombectomy was 3 years. RESULTS: Thrombectomy was technically successful in all patients with a majority achieving complete resolution of PVT in a single session. During mean follow-up of 13.3 months, all patients achieved complete resolution of PVT without recurrence. CONCLUSION: Large bore mechanical thrombectomy together with TIPS is a feasible and effective treatment of acute/subacute PVT in cirrhotic patients with portal hypertension, often with complete resolution in a single session.

Retroperitoneal Hematoma Causing Peritoneal Dialysis Catheter Malfunction.

BACKGROUND: We present the unusual complication of peritoneal dialysis catheter dysfunction in a patient who developed a retroperitoneal hematoma following an endoscopic procedure and review the existing literature regarding this rare complication. CASE REPORT: A 60-year-old male with end stage renal disease presented with PD catheter dysfunction. A computerized tomography scan of his abdomen showed a large left retroperitoneal hematoma. He underwent a diagnostic laparoscopy and PD catheter revision. The retroperitoneal hematoma had ruptured into the peritoneum with clots clogging the catheter. Clots were evacuated and the catheter was flushed. He restarted on low--volume PD three days after surgery and increased to full-volume within a week with no further issues. CONCLUSIONS: This case summarizes the unusual complication of a retroperitoneal bleed from an endoscopic procedure which manifested as PD catheter dysfunction. The increasing utilization of PD catheters requires surgeons remain aware of potential complications.

Retroperitoneal Hematoma Causing Peritoneal Dialysis Catheter Malfunction.

BACKGROUND: We present the unusual complication of peritoneal dialysis (PD) catheter dysfunction in a patient who developed a retroperitoneal hematoma following an endoscopic procedure and review the existing literature regarding this rare complication. CASE REPORT: A 60-year-old man with end stage renal disease presented with PD catheter dysfunction. Computed tomography scan of his abdomen showed a large left retroperitoneal hematoma. He underwent a diagnostic laparoscopy and PD catheter revision. The retroperitoneal hematoma had ruptured into the peritoneum with clots clogging the catheter. Clots were evacuated and the catheter was flushed. He restarted on low volume PD three days after surgery and increased to full volume within a week with no further issues. CONCLUSIONS: This case summarizes the very unusual complication of a retroperitoneal bleed from an endoscopic procedure that manifested as PD catheter dysfunction. The increasing utilization of PD catheters requires that surgeons remain aware of potential complications.

Autoinflation leading to failure of two-piece ambicor implantable penile prosthesis: an outcome from a methodical treatment of recalcitrant stuttering priapism.

Introduction. We present the case of a patient who received a two-piece Ambicor penile prosthesis for idiopathic recurrent "stuttering" priapism refractory to other treatment options. The patient returned unable to deflate the device due to an interesting anatomically induced mechanical failure. Aims. To describe the method and findings of this inflatable prosthesis failure. Results. Prosthesis failure occurred due to restrictive corporal diameter and the unique characteristics of fluid reservoir location in the two-piece inflatable prosthesis. The patient was successfully converted to a semirigid prosthesis with resolution of the pain that was due to his prosthesis autoinflation. Conclusion. Stuttering priapism remains a challenging clinical problem. Penile implantation is a reasonable long-term solution in a patient refractory to less invasive options. In patients with fibrotic corpora, a malleable device should be considered (at least temporarily) if unable to dilate comfortably to 13 mm.