Splenic artery pseudoaneurysm is a rare condition commonly arises as a sequelae of pancreatitis. Pseudoaneurysm is clinically silent until it ruptures. Thus, untreated pseudoaneurysm carries a high mortality rate up to 90%. We present a case of necrotising pancreatitis complicated with unruptured splenic artery pseudoaneurysm, which was found incidentally from computed tomography (CT) of abdomen. Patient was presented with symptomatic anemia and bleeding from the abdominal drain. We proceeded with embolization of pseudoaneurysm by using Histoacryl glue, resulting in successful complete resolution of pseudoaneurysm with good patient outcome. Transcatheter embolization is considered the current treatment of choice for pseudoaneurysm as it provides an alternative to conventional surgery due to its high successful rate. In this case report, we want to shed light on an alternative treatment approach of the splenic artery pseudoaneurysm.
Malignant obstructive jaundice (MOJ) is a disease that could negatively affect patient outcomes. It is treated with Endoscopic Retrograde Cholangiopancreatography (ERCP), Percutaneous Transhepatic Biliary drainage (PTBD), or Endoscopic ultrasound-guided biliary drainage (EUS-BD). We here present a case where malignant obstructive jaundice that failed both ERCP and PTBD achieved successful biliary decompression through trans-cholecysto-cystic duct CBD stenting. A-53-year old female presented to our center with obstructive jaundice secondary to a pancreatic uncinate tumor. Multiple attempts of ERCP and PTBD failed due to difficult cannulation and inadequate dilation of IHD. Furthermore, EUS-BD expertise was not available in our center. A percutaneous cholecystostomy was performed for temporary biliary decompression. After a multidisciplinary discussion was made, the decision was made for trans-cholecystic-cystic duct CBD stenting. The procedure was a success without significant complications. There are multiple ways for biliary decompression. ERCP and PTBD are most commonly used as the first-line treatment with a high success rate. However, PTBD is associated with more complications, with a morbidity rate of up to 33%. With the advancement of EUS, EUS-BD has been a popular treatment option with similar technical success. However, it is a complex and risky procedure that requires expertise. In this case, we achieved a biliary decompression technique similar to PTBD. Instead, the gallbladder and cystic duct are used as passage for stenting. The result is better than envisaged with successful biliary decompression without complications. In conclusion, trans-cholecysto-cystic duct biliary stenting is a feasible procedure to be done for biliary decompression.
Objective: Long term intravenous access in paediatrics is challenging in terms of ease of procedure, maintenance of catheter and complications. Small calibre of peripheral veins in children make insertion of peripheral long-term access difficult. Our centre adopted the use of tunneled adult Peripherally Inserted Central Catheter (PICC) for central venous access in paediatrics with the hope to improve these challenges. We describe a single institute 3-year experience of this technique. Material & Methods: Retrospective analysis of patients aged less than 12 years old who had tunneled PICC insertions from January 2018 till December 2020. The following data was recorded and studied: indication, reason for removal, duration of PICC, vessel inserted, device type and complications. Results: Eleven adult PICCs were inserted from this technique in 10 children. The average age was 35.7months and weight was 13.2kg. The youngest patient was 3 months old at 6.9kg. Most common indication for insertion was for long term antibiotics (82%) and the remainder were for difficult intravenous access. The procedure was done under local anaesthetic with sedation in 90% of cases. Average duration of PICC was 26.8 days. Out of 11 PICCs only 1 had line related infection that required premature removal of the catheter. 55% completed the intended duration while 27% of PICCs had dislodged. Conclusion: Tunnelled adult PICC for central venous access in paediatrics is a feasible option for long term vascular access and has a lower risk of infection. However, almost a third of the catheters inserted still suffered premature dislodgement.
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