BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been establi...BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.展开更多
BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(al...BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(also known as port-wine stain),varicose veins and malformations, and bony and/or soft tissue hypertrophy with or without lymphatic malformation, which are known as the “classic clinical triad”. Herein, a rare case of KTS characterized by crossed-bilateral limb hypertrophy accompanied by intermittent hematochezia and hematuria is reported.CASE SUMMARY We described a 37-year-old female with KTS. She was admitted to our hospital owing to the gradual enlargement of the left lower extremity along with intermittent hematochezia and hematuria. The patient was diagnosed to have hemorrhoid bleeding by other hospitals and treated with conventional hemostatic drugs, but continued to have intermittent gastrointestinal bleeding and hematuria. Therefore, she visited our hospital to seek further treatment. During hospitalization, relevant imaging and laboratory examinations and colonoscopy were performed. In combination with the patient’s history and relevant examinations, we considered that the patient had a complex form of KTS. We recommended a combined diagnosis and treatment from the vascular, interventional,anorectal, and other departments, although she declined any further treatment for financial reasons.CONCLUSION The clinical manifestations of KTS are extensive and diverse and chiefly include the typical triad. However, Vascular malformations of KTS can also involve several parts and systems such as digestive and urogenital systems. Therefore, the atypical manifestations and rare complications necessitate the clinician’s attention and are not to be ignored.展开更多
BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome...BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome predisposes patients to hypercoagulable states,including venous thromboembolism and pulmonary embolism(PE).CASE SUMMARY A 12-year-old girl with KTS was scheduled excision of verrucous hyperkeratosis in the left foot and posterior aspect of the left leg and left thigh and excision of a cutaneous hemangioma in the right buttock.After induction,the surgeon elevated the patient’s leg for sterilization,whereupon she experienced a massive PE and refractory cardiac arrest.Extracorporeal membrane oxygenation(ECMO)was performed after prolonged resuscitation,and she had a return of spontaneous circulation.After this episode,the patient was discharged without any neurologic complications.CONCLUSION The mechanism of PE,a lethal disease,involves a preexisting deep vein thrombosis that is mechanically dislodged by compression or changing positions and travels to the pulmonary artery.Therefore,patients predisposed to PE should be prescribed prophylactic anticoagulants.If the patient has unstable vital signs,resuscitation should be started immediately,and extracorporeal cardiopulmonary resuscitation should be considered in settings with existing ECMO protocols,expertise,and equipment.Awareness of PE in patients with KTS while leg raising for sterilization is critical.展开更多
Cutaneomucosal venous malformations(VMCMs)can manifest as sporadic or familial forms,following an autosomal dominant inheritance pattern.This report highlights the case of a 5-year-old girl presenting with a substanti...Cutaneomucosal venous malformations(VMCMs)can manifest as sporadic or familial forms,following an autosomal dominant inheritance pattern.This report highlights the case of a 5-year-old girl presenting with a substantial congenital VMCM attributed to a TIE2 mutation,who underwent percutaneous sclerotherapy followed by surgery.The clinical,three-dimensional computed tomographic angiography(3D-CTA),as well as pathological and genetic findings concerning a patient with an extensive VMCM in the left pro-axillary region,are elucidated.The genetic analysis in this patient verified a missense mutation(c.2545T>C)in TIE2,confirming familial VMCMs.The combined strategy integrating percutaneous sclerotherapy and surgical excision is the most efficacious approach for managing large VMCMs and can successfully attain therapeutic goals.展开更多
BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery a...BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.展开更多
BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alt...BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.展开更多
文摘BACKGROUND Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual,difficult to treat,and often fatal manifestation of portal hypertension.So far,no treatment guidelines have been established.CASE SUMMARY We reported three patients with jejunal varices at the site of choledochojejun-ostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023.We reviewed all patient records,clinical presentation,endoscopic findings and treatment,outcomes and follow-up.Three patients who underwent pancre-aticoduodenectomy with a Whipple anastomosis were examined using conven-tional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop.Varices with stigmata of recent hemorrhage or active he-morrhage were observed around the choledochojejunostomy site in all three patients.Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients.The bleeding ceased and patency was observed for 26 and 2 months in two patients.In one patient with multiorgan failure and internal environment disturbance,rebleeding occurred 1 month after endoscopic sclerotherapy,and despite a second endoscopic sclero-therapy,repeated episodes of bleeding and multiorgan failure resulted in eventual death.CONCLUSION We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoac-rylate injection can be an easy,effective,safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.
基金Supported by the Basic Research Projects of Science and Technology Department of Guizhou Province,No. Qian Ke He-zk[2022]-646Master Start-up Foundation of Affiliated Hospital of Zunyi Medical College,No. 2016-45Collaborative Innovation Center of Chinese Ministry of Education,No. 2020-39。
文摘BACKGROUND Klippel-Trenaunay syndrome(KTS) is a congenital vascular malformation with a complicated etiology. It is sporadic and clinically rare in occurrence. The typical characteristics are capillary malformation(also known as port-wine stain),varicose veins and malformations, and bony and/or soft tissue hypertrophy with or without lymphatic malformation, which are known as the “classic clinical triad”. Herein, a rare case of KTS characterized by crossed-bilateral limb hypertrophy accompanied by intermittent hematochezia and hematuria is reported.CASE SUMMARY We described a 37-year-old female with KTS. She was admitted to our hospital owing to the gradual enlargement of the left lower extremity along with intermittent hematochezia and hematuria. The patient was diagnosed to have hemorrhoid bleeding by other hospitals and treated with conventional hemostatic drugs, but continued to have intermittent gastrointestinal bleeding and hematuria. Therefore, she visited our hospital to seek further treatment. During hospitalization, relevant imaging and laboratory examinations and colonoscopy were performed. In combination with the patient’s history and relevant examinations, we considered that the patient had a complex form of KTS. We recommended a combined diagnosis and treatment from the vascular, interventional,anorectal, and other departments, although she declined any further treatment for financial reasons.CONCLUSION The clinical manifestations of KTS are extensive and diverse and chiefly include the typical triad. However, Vascular malformations of KTS can also involve several parts and systems such as digestive and urogenital systems. Therefore, the atypical manifestations and rare complications necessitate the clinician’s attention and are not to be ignored.
文摘BACKGROUND Klippel-Trenaunay syndrome(KTS)is a rare congenital disorder characterized by a combination of capillary malformations,soft-tissue or bone hypertrophy,and varicose veins or venous malformations.The syndrome predisposes patients to hypercoagulable states,including venous thromboembolism and pulmonary embolism(PE).CASE SUMMARY A 12-year-old girl with KTS was scheduled excision of verrucous hyperkeratosis in the left foot and posterior aspect of the left leg and left thigh and excision of a cutaneous hemangioma in the right buttock.After induction,the surgeon elevated the patient’s leg for sterilization,whereupon she experienced a massive PE and refractory cardiac arrest.Extracorporeal membrane oxygenation(ECMO)was performed after prolonged resuscitation,and she had a return of spontaneous circulation.After this episode,the patient was discharged without any neurologic complications.CONCLUSION The mechanism of PE,a lethal disease,involves a preexisting deep vein thrombosis that is mechanically dislodged by compression or changing positions and travels to the pulmonary artery.Therefore,patients predisposed to PE should be prescribed prophylactic anticoagulants.If the patient has unstable vital signs,resuscitation should be started immediately,and extracorporeal cardiopulmonary resuscitation should be considered in settings with existing ECMO protocols,expertise,and equipment.Awareness of PE in patients with KTS while leg raising for sterilization is critical.
基金supported by the National Natural Science Foundation of China(grant no.8187080758).
文摘Cutaneomucosal venous malformations(VMCMs)can manifest as sporadic or familial forms,following an autosomal dominant inheritance pattern.This report highlights the case of a 5-year-old girl presenting with a substantial congenital VMCM attributed to a TIE2 mutation,who underwent percutaneous sclerotherapy followed by surgery.The clinical,three-dimensional computed tomographic angiography(3D-CTA),as well as pathological and genetic findings concerning a patient with an extensive VMCM in the left pro-axillary region,are elucidated.The genetic analysis in this patient verified a missense mutation(c.2545T>C)in TIE2,confirming familial VMCMs.The combined strategy integrating percutaneous sclerotherapy and surgical excision is the most efficacious approach for managing large VMCMs and can successfully attain therapeutic goals.
文摘BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.
文摘BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.
