Such varices are less effective in lowering the portal pressure, compared with esophageal and gastric varices. The serosal and submucosal location of DV, limits visualization during endoscopy. Their clinical significance is not apparent until the varix expands into the submucosal space where buy AZD1208 it can hemorrhage into the gastrointestinal lumen. Because of the infrequency of DV hemorrhage, treatment modalities have not been prospectively validated. These include surgical intervention (variceal ligation, duodenal resection, and extra-hepatic portosystemic shunt creation), interventional radiological procedures (tranjugular intrahepatic portosystemic shunt, percutaneous transhepatic obliteration, trans-ileocolic vein obliteration,

balloon occluded retrograde transvenous obliteration),

and endoscopic techniques (band ligation, sclerotherapy and clipping). Contributed by “
“The migration of foreign bodies into the biliary system has been well-described in the medical literature. One example is the migration of sutures or clips that are placed on the cystic duct stump at the time of cholecystectomy. It seems likely that these PD0325901 purchase often pass spontaneously into the duodenum. However, if they remain within the bile duct, they can act as a nidus for further stone formation. Other reports have documented the migration of sutures or clips into the bile duct after various forms of hepatic surgery. In this report, we describe the migration of hepatic coils MCE公司 into the bile duct that were used to treat a pseudoaneurysm

of a branch of the right hepatic artery. A woman, aged 77, was admitted to hospital with cholangitis caused by stones in the bile duct. The initial management was that of percutaneous transhepatic biliary drainage. Three weeks after placement of the drain, she developed hemobilia with bleeding into the duodenum and out through the transhepatic drain. Hepatic arteriography showed a large pseudoaneurysm that was located in a branch of the right hepatic artery close to the transhepatic drain (Figure 1, arrows). This was treated by the placement of six coils within the pseudoaneurysm and five microcoils within the hepatic artery branch supplying the aneurysm. Thereafter, bleeding ceased and the patient was subsequently treated by open cholecystectomy, exploration of the bile duct and choledochoduodenostomy. Three years after surgery, she was readmitted with a 2-month history of intermittent biliary-type pain. A plain abdominal x-ray (Figure 2, left) showed air within the bile duct as a result of the choledochoduodenostomy. The microcoils were still in place (white arrow) but only one stainless steel coil remained and it had “unravelled” within the bile duct (black arrow). This compares with the radiological appearance at the completion of hepatic angiography where microcoils are shown with the white arrow and six stainless steel coils are highlighted with the black arrow (Figure 2, right).