No abstract

Background: Ectopic varices are uncommon and typically due to underlying liver cirrhosis. They can be located in the duodenum, small intestines, colon or rectum, and may result in massive haemorrhage. While established guidelines exist for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices. Beta-blockers, transjugular intrahepatic portosystemic shunt insertion and subtotal colectomy have been reported as management methods. However, there are only two other cases that have reported successfully treating colonic varices using balloon-occluded retrograde transvenous obliteration (BRTO), an endovascular procedure typically performed for gastric varices. Case presentation: A 55-year-old man with background of alcoholic liver cirrhosis presented with per-rectal bleeding due to caecal varices. Grade 2-3 oesophageal varices were identified on oesophago-gastroduodenoscopy, and computed tomography showed multiple right para-colic portosystemic collaterals around the hepatic flexure and ascending colon. Colonoscopy confirmed fresh blood in the colon up to the caecum, with a submucosal varix deemed the most likely source of haemorrhage. As transjugular intrahepatic portosystemic shunt insertion was potentially technically difficult, due to left portal vein thrombosis and a small right portal venous system, he underwent BRTO, which successfully embolised and thrombosed the colonic varices without complications. Conclusions: Whilst further studies are required to conclude its effectiveness and efficacy, BRTO may be considered a viable solution in managing ectopic, colonic, variceal haemorrhage especially when traditional techniques are unsuccessful or contraindicated.

The results suggest that the preprocedural neutrophil count could be used in global risk factor assessment of patients with advanced PVD who are being considered for PTA. The neutrophil count may reflect the burden of atherosclerosis and tissue damage, and so could identify patients who need more aggressive intervention for advanced PVD.

Introduction: In the present study, we aimed to assess whether normal saline injection for sealing the biopsy track is useful in reducing the incidence of pneumothorax after computed tomography (CT)-guided percutaneous transthoracic lung biopsy (PTLB). Methods: We retrospectively compared the incidence of pneumothorax in 100 consecutive biopsies (n = 100, group A) that had injection of saline along the track, with historical cohort of same number of consecutive patients who underwent PTLB without injection of saline along the needle track (n = 100, group B). CT-guided biopsies were performed by coaxial technique and 1-3 ml of saline was injected along the tract. Patient characteristics, lesion size, location and other baseline parameters were compared. Incidence of pneumothorax and number of patients who underwent catheter drainage of pneumothorax was compared in both groups. Results: Baseline characteristics were comparable in both groups. Track sealing with saline was successful in all patients. Pneumothorax rate was 46% for patients in group B and 32% in group A (P < 0.05). Seven patients (7%) had insertion of chest drain for pneumothorax in the group B and only 1% in the group A (P < 0.05). No mortality was observed in both groups. No complications were observed in any of the patients due to saline injection. Conclusion: Track sealing with saline is a simple and safe technique which significantly reduces the incidence of pneumothorax and chest tube insertion after PTLB.

Anemia is a common comorbid condition in patients with advanced PVD. Preprocedural hemoglobin could be used in clinical practice to risk stratify patients with advanced PVD who are being considered for PTA. Correction of anemia before PTA in patients with Rutherford category 4 and 5 PVD may improve long-term outcome. Further investigation is needed regarding the optimization of preprocedural hemoglobin.