1/7. Control of major hemorrhage from the spleno-mesenteric vein junction during pancreaticoduodenectomy: successful use of an occlusion balloon catheter.BACKGROUND/AIMS: Vascular disruption is sometimes associated with intractable hemorrhage due to either vessel fragility or increased blood flow rates in patients with chronic pancreatitis during surgical operation. This paper describes the successful use of an occlusion catheter for repairing a major laceration at the spleno-mesenteric vein junction. methods: A 14-Fr Fogarty occlusion balloon catheter was directly inserted into the splenic vein through the site of venous laceration and inflated to stop blood flow from the splenic vein. RESULTS: This procedure perfectly controlled massive hemorrhage from the spleno-mesenteric vein junction. The injured site was repaired with a continuous suture in 5 min. CONCLUSION: The direct insertion of a balloon catheter to the injured site is simple and expeditious to control major hemorrhage from the spleno-mesenteric vein junction when the situation is otherwise unmanageable.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Endovascular repair of accidental ligation of the right coronary artery during cardiorrhaphy for penetrating heart wound.We report a patient with a cardiac penetrating wound who underwent cardiorrhaphy which resulted in accidental ligation of the proximal right coronary artery (RCA), producing a postoperative acute inferior wall myocardial infarction. Although the option of surgical relief of the suture over the RCA was discussed, a repeat operation was considered to be of very high risk. Therefore, an endovascular attempt to recanalize the vessel was chosen. The external constriction around the RCA was successfully relieved with percutaneous transluminal coronary angioplasty (PTCA) and stenting. To our knowledge, this particular situation has not yet previously been published.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. Successful limb reperfusion using prolonged intravascular shunting in a case of an unstable trauma patient--a case report.When peripheral vascular injuries present in conjunction with life threatening emergencies, controlling hemorrhage from a peripheral blood vessel may take initial priority, however, sacrificing a limb to preserve life is a well-established dictum. The use of intravascular shunts has allowed arterial and venous injuries to be controlled and temporized while treating other injuries. Typically, intravascular shunts are used for short time periods while orthopedic injuries are repaired or other life threatening injuries are managed. The following case demonstrates the long-term use of an intravascular arterial shunt to treat a traumatic transection of the common femoral artery and vein in a patient with an open pelvic fracture from blunt trauma. A 20-year-old woman fell between a subway platform and an oncoming train. She sustained a crush injury to her lower extremity and pelvis as she was pinned between the train and platform. The patient presented with active hemorrhage from a groin laceration, quickly became hemodynamically unstable, and was brought to the operating room. In addition to a pelvic fracture with massive pelvic hematoma she sustained a complete transection of the bifurcation of the common femoral artery (CFA), the common femoral vein (CFV), and associated orthopedic injuries. Vascular shunts were placed in the common femoral artery and vein. The patient became hypotensive from an expanding retroperitoneal hematoma. Pelvic bleeding was controlled with angioembolization and the venous injury was repaired. At this time the patient became cold, acidotic, and coagulopathic. It was thought unsafe to proceed with the arterial repair and it was elected to keep her arterial shunts in place and perform a planned reexploration in 24 hours after correcting her physiologic status. The patient returned to the operating room for an elective repair of her CFA the following day. Her shunt had remained patent throughout this time. She underwent a reverse saphenous vein graft from her CFA to her SFA. After a prolonged hospital course she was ultimately transferred to a rehabilitation center with intact pulses in both lower extremities. This case demonstrates the effectiveness of prolonged (>6 hours) use of an intravascular shunt as part of damage control surgery for peripheral arterial and venous injuries. In a patient who would otherwise undergo an amputation for their injury, the risk of shunt thrombosis, or infection, during damage control resuscitation may not be a contraindication for placement.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Intraoperative ultrasonography is useful for diagnosing pancreatic duct injury and adjacent tissue damage in a patient with penetrating pancreas trauma.We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1 cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/7. Laceration of femoral vessels by an avulsion fracture fragment of the lesser trochanter after bipolar hemiarthroplasty.Femoral vessel injuries after bipolar hemiarthroplasty have not been reported. The current report describes a case of a dual major vessel (superficial femoral artery and vein) injury associated with an avulsion fracture fragment of the lesser trochanter in a 76-year-old woman who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. The superficial femoral artery was repaired and the defect of the superficial femoral vein was reconstructed with a Gore-Tex graft (WL Gore and Associates Inc, Flagstaff, Ariz). The clinical result was satisfactory and there was no vascular problem at 1-year follow-up. early diagnosis of this vascular injury prevents serious complications including gangrene of the injured limb.- - - - - - - - - - ranking = 6keywords = vessel (Clic here for more details about this article) |
6/7. Flap tearing during lift-flap laser in situ keratomileusis retreatment.A flap tear occurred during laser in situ keratomileusis (LASIK) retreatment using a flap-lifting technique in 1 eye of 2 patients 4 to 5 months after the primary procedure. In the first case, the tear occurred in a decentered, standard thickness flap (168 mum) in a location close to the corneal limbus and limbal vessels. In the second case, the tear occurred in a well-centered thin flap (116 mum) that involved a peripheral corneal pannus. The false track was identified early, and central extension of the tear was averted. After the flap was successfully dissected, retreatment was performed without further complications. This report suggests that flaps with margins near the limbus or a corneal pannus may be prone to an earlier and stronger healing process at the edge that may lead to a flap tear during LASIK retreatment. This may be of increasing importance because of the trend toward larger flap diameters.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. Inner myometrial laceration causing a massive postpartum hemorrhage: a case report.BACKGROUND: postpartum hemorrhage has many well-established etiologies. It may also be secondary to an inner myometrial laceration, a less frequent and more difficult entity to diagnose. CASE: A 31-year-old, white woman, gravida 4, para 2012, at term underwent an uncomplicated spontaneous vaginal delivery. She gave birth to a 3,600-g female infant. An immediate massive postpartum hemorrhage ensued, unresponsive to medical therapy. No cervicovaginal lacerations or retained placental tissue was found. Uterine packing failed to control the bleeding. During laparotomy, exploration of the uterine cavity revealed a 4-cm, posterior and longitudinal inner myometrial laceration involving an actively bleeding large vessel. Repairing the laceration controlled the hemorrhage. CONCLUSION: Inner myometrial lacerations must be considered in the differential diagnosis of postpartum hemorrhage when all other commonly established causes have been excluded. During laparotomy and hysterotomy, evaluation and repair of an inner myometrial laceration controls the bleeding and avoids a hysterectomy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |