• Journal of the Korean Society of Radiology
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• v.84 no.6
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• pp.1350-1360
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• 2023

Purpose To evaluate the factors that predict symptomatic dislodgement of a percutaneous transhepatic biliary drainage (PTBD) catheter in patients with malignant biliary obstruction. Materials and Methods This retrospective study included 572 patients with malignant biliary obstruction who underwent 733 PTBD catheter insertions between January 2010 and February 2015. The duration of catheter placement, approach site, location of the catheter tip, insertion angle, presence of a closed-loop pigtail, and tube diameter were evaluated. Results During the follow-up period, 224 PTBD catheter dislodgements (30.56%) were observed in 157 patients. Among them, 146 (19.92%) were symptomatic. The mean duration from catheter insertion until dislodgement was 32 days (range: 1-233 days). Male (odds ratio [OR]: 1.636, 95% confidence interval [CI]: 1.131-2.367, p = 0.009), right-sided approach (OR: 1.567, 95% CI: 1.080-2.274, p = 0.018), increased insertion angle (OR: 1.015, 95% CI: 1.005-1.026, p = 0.005), and incomplete closed-loop pigtail formation (OR: 1.672, 95% CI: 1.098-2.545, p = 0.016) were independent factors predictive of symptomatic dislodgement of a PTBD catheter. Conclusion Factors predictive of symptomatic catheter dislodgement included male sex, a right-sided approach, increased insertion angle, and incomplete closed-loop pigtail formation.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.317-320
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• 1998

Since Reiestad and Str$\ddot{o}$mskag reported interpleural installation of local anesthetic solutions as a technique for the management of postoperative pain in the patients undergoing cholecystectomy, renal surgery and breast surgery, many physician applied this technique for upper abdominal pain from various reasons such as technically simple, effective pain relief, less respiratory depression. So we tried interpleural analgesia in two patients who suffered from severe upper abdominal pain. One had upper abdominal pain due to chronic pancreatitis and the other had right upper abdominal pain after PTBD (percutaneous transhepatic bile drainage) for biliary cirrhosis and systemic jaundice. Both were injected 10 ml of 1% lidocaine and infused continuously with 1% lidocaine (2 ml/hr) using 2-Day Baxter$^{(R)}$ infusor. After bolus injection of lidocaine, pain scores (VAS 0~100) were recorded below 25mm and had not exceed that level during continuous infusion. After removing the catheters, two patients were all satisfied with this therapy. Our experiences with this technique showed that continuous infusion of local anesthetics through an interpleural catheter is effective in the control of refractory upper abdominal pain without any complication.

• Journal of Yeungnam Medical Science
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• v.39 no.2
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• pp.161-167
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• 2022

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74-year-old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

• The Journal of Internal Korean Medicine
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• v.44 no.4
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• pp.803-813
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• 2023

Objective: This case report outlines an investigation into the efficacy of Korean medicine treatment in a patient who presented with acute cholangitis accompanying common bile duct stones. The patient underwent percutaneous transhepatic gallbladder drainage and subsequently experienced resolution of the common bile duct stones. Methods: The patient was treated with Shihosogan-tang, general acupuncture, ear acupuncture, moxibustion, and cupping therapy. Changes in symptoms were evaluated using a self-reported numerical rating scale (NRS) score and a visual analog scale (VAS) score each morning. Laboratory tests were conducted to examine serum amylase, serum lipase, and liver function. Results: After 29 days, the NRS scores for indigestion and fatigue and the VAS score for abdominal pain all decreased. Additionally, the laboratory test results showed improvement. Discussion: The results suggest that Korean medicine could be effective in treating symptoms of acute cholangitis. However, further research is necessary.

• Clinical Endoscopy
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• v.55 no.2
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• pp.297-301
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• 2022

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.203-208
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• 2012

Purpose: The purpose of this study is to investigate the incidence of acalculous cholecystitis after multiple trauma with fractures and to analyze the characteristics of cholecystitis. Methods: We performed a retrospective study of multiple trauma patients with fractures between April 2010 and April 2012. Sixty- nine patients were identified, and the average age was 46.8(range: 15-74) years. Data were collected regarding associated injury, injury severity score (ISS), the diagnosis time after trauma, diagnostic tool, and management Results: There were three cases(4.3%) of cholecystitis among the 69 cases, and cholecystitis was diagnosed an average of 20.7(range: 8-33) days after injury. Two patients complained of abdominal pain at diagnosis, but the other patient who had undergone surgery for small bowel perforation at the time of the injury had no abdominal pain. All three patients had abnormal liver function tests (LFTs) at diagnosis. The cholecystitis was confirmed with ultrasonography or computed tomography, and all cases were acalculous cholecystitis. At first, percutaneous transhepatic gallbladder drainage was performed; then, laparoscopic cholecystectomy (LC) was tried an average of 12(range: 11-13) days later. An laparoscopic cholecystectomy was successfully done in only one case, the other cases being converted to an open cholecystectomy due to severe inflammation. Conclusion: The incidence of acaculous cholecystitis was 4.3% after multiple trauma with fractures. We should consider cholecystitis in patients with abdominal pain, fever and elevated LFTs after multiple trauma.

• The Korean Journal of Gastroenterology
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• v.72 no.6
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• pp.318-321
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• 2018

Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.

• Journal of the Korean Society of Radiology
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• v.81 no.1
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• pp.231-236
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• 2020

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

• Journal of the Korean Society of Radiology
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• v.83 no.6
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• pp.1426-1431
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• 2022

Intrahepatic portosystemic venous shunt (IPSVS) is a rare vascular abnormality that involves abnormal communication between the intrahepatic portal vein and systemic veins, such as the hepatic vein or inferior vena cava. Patients with IPSVS are typically asymptomatic, and IPSVS is incidentally discovered via imaging while evaluating other diseases. However, endovascular closure of the shunt should be considered in symptomatic patients with a high-flow shunt. This report presents a patient with congenital IPSVS with sudden onset hepatic encephalopathy treated using percutaneous transhepatic embolization.

• Journal of the Korean Society of Radiology
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• v.82 no.6
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• pp.1594-1599
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• 2021

A 64-year-old male visited our emergency department due to severe right flank pain after falling from a 2-meter height. Contrast-enhanced CT revealed a right hemothorax with multiple fractures in the right ribs and iliac bone. A small hematoma in the right perihepatic space was noted, but there was no hepatic laceration on CT. Initial surgical management led to continuous uncontrolled bleeding around the porta hepatis, and subsequent arterial angiography could not demonstrate a bleeding focus. However, immediate follow-up CT showed contrast extravasation on the left side of abdomen, and a percutaneous transhepatic portal venogram revealed active bleeding from the left portal vein. Although the wound was embolized with a glue, the patient suffered from a cardiac arrest and finally expired. In conclusion, during evaluation of abdominal trauma patients, portal vein bleeding and contrecoup injuries should be considered when hepatic arteriography findings are unremarkable.