The purpose of this study was to determine whether retention of a post-pyloric Dobhoff tube (DHT) in position to serve as a visual guide through the pylorus during gastrojejunostomy (GJ) tube placement results in a reduction in fluoroscopy time, procedure time, and estimated radiation dose. A retrospective study evaluated patients who underwent GJ tube placement or gastric to GJ conversion from January 1, 2017, to April 1, 2021. Demographic and procedural data were collected, and results were evaluated using descriptive statistics and hypothesis testing through an unpaired Student's t-test. Of the 71 GJ tube placements included for analysis, 12 patients underwent placement with a post-pyloric DHT in position, and 59 patients underwent placement without a post-pyloric DHT in position. The mean fluoroscopy time and estimated radiation dose were significantly reduced in patients who underwent GJ tube placement with a post-pyloric DHT in position compared with those without (7.08 min vs. 11.02 min, P = 0.004; 123.12 mGy vs. 255.19 mGy, P = 0.015, respectively). The mean total procedure time was also reduced in patients who underwent GJ tube placement with a post-pyloric DHT in position compared with those who had no post-pyloric DHT, but this finding lacked statistical significance (18.55 min vs. 23.15 min; P = 0.09). Post-pyloric DHT retention can be utilized during GJ tube placement to reduce radiation exposure to both the patient and interventionalist.
Chyluria is a rare complication following renal intervention including partial nephrectomy and percutaneous ablation. To date, there are no reported cases of chyluria following renal cryoablation. An 82-year-old female patient at our institution underwent CT-guided percutaneous cryoablation for a renal cell carcinoma and presented with macroscopic fat in the urine 5 months after cryoablation. Presenting symptoms were polyuria, dysuria, and cloudy white urine. CT showed a fat-urine level in the ureter and bladder most consistent with chyluria. The patient experienced several episodes of presumptive lower urinary tract infection following diagnosis for which she was treated medically. Follow-up CT imaging 5 months post-diagnosis revealed persistent fat-fluid level in the collecting system and bladder. Operators performing renal cryoablation should be aware of the clinical and imaging manifestations of this complication.
Pulmonary sequestration is a congenital malformation characterized by a non-functioning segment of dysplastic lung that lacks communication with the bronchial tree and contains an aberrant systemic arterial supply. Pulmonary sequestration is classically managed surgically; however, surgical intervention is not always feasible on an emergent basis. We present two cases, in support of recent literature, that reinforce the use of transcatheter embolization to achieve hemostasis and delay surgical intervention.
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