Purpose: To identify patient and procedural factors associated with extrusion of the Dacron cuff from the subcutaneous tunnel of tunneled hemodialysis catheters (THDCs). Materials and methods: Single center 5-year retrospective analysis of 625 catheters in 293 adult patients. Patient data included age, gender, body mass index (BMI), and common comorbidities. Procedural details included type of procedure (new insertion vs. exchange), operator seniority, side of insertion, catheter model and presence of catheter wings skin-sutures. Complications were reported as cumulative risk over time and Cox proportional hazards model was used to evaluate risk factors for cuff extrusion (CE). Results: Median patient follow-up was 503 days (188,913 catheter-days) and median catheter survival 163 days. CE occurred in 23.8% of catheters, at a rate of 0.79 per 1,000 catheter-days and a median time of 64 days. It was more common than infection (14.6%) and inadequate flow (15.5%). The 1-month and 12-month risk of CE was 5.9% and 21.3% respectively. A first episode of CE was a strong predictor of future CE episodes. The only patient factor that affected the risk of CE was BMI (Hazard Ratio 2.36 for obese patients). Procedural factors that affected the risk of CE, adjusted for BMI, were catheter model, type of procedure (lower risk for new insertions) and catheter wings skin-sutures; the latter reduced the 30-day CE risk by 76% without increasing catheter-related infections. Conclusion: Cuff extrusion is common in long-term THDCs. The risk increases with obesity, history of previous cuff extrusion, certain catheter models and absence of wing-sutures.

Percutaneous drainage of post-operative collections following abdominopelvic surgery has become standard practice and is a routine procedure in many interventional radiology (IR) departments. Such collections are commonly diagnosed on CT studies where the presence of Surgicel ® can mimic an abscess and lead to unnecessary procedures. We present a case where a duodenal perforation was masked by post-operative Surgicel in the gallbladder fossa, which in turn was mistaken for an infected biloma and referred for percutaneous interventional radiology drainage. Careful imaging review, correlation with operative notes and good diagnostic radiological technique led to a correct diagnosis and avoided unnecessary intervention.

Chronic constipation and faecal impaction are common in the elderly, particularly in institutionalized patients and those with neurological impairment. Faecaloma formation is an extreme manifestation of coprostasis that can lead to stercoral ulcerations and perforation, a recognized severe complication. We present the case of an uncommon life-threatening complication resulting from a giant rectal faecaloma, which has rarely been reported in the literature. The patient presented with haemodynamic shock from profuse per-rectum haemorrhage. Clinical examination revealed a hard central abdominal mass and triple-phase CT of the abdomen demonstrated a tumour-like mass of hard stool in the rectum measuring up to 25 cm and stretching the adjacent vasculature, causing intraluminal active arterial haemorrhage. Emergency selective arterial embolization performed by the interventional radiologists successfully controlled the bleeding with a good outcome. This case highlights a rare but possibly fatal complication of chronic constipation and emphasizes the importance of having access to an acute interventional radiology service capable of promptly dealingwith life-threatening presentations.

No abstract