Torben Owman

Evaluation of Splenic Embolization in Patients with Portal Hypertension and Hypersplenism

Twenty-five patients with hypersplenism caused by portal hypertension were treated by repeated partial splenic embolization. Fourteen surviving patients were followed for up to six years showing a good response on peripheral blood count and bleeding tendency. Three patients died in connection with the treatment and another eight died within half a year because of the underlying liver disease. The discomfort and complications of fever, pain, pleural effusion, and abscess formation and the possibility to avoid these by repeated partial embolization under antibiotic cover are discussed. The results are compared with reports in the reviewed actual literature and the splenic embolization is given a place among the means of a successful selective symptomatic treatment of partial hypertension.

Embolization of the spleen for treatment of splenomegaly and hypersplenism in patients with portal hypertension.

Splenectomy in cases of hypersplenism involves significant risk of serious complications, including infection, hemorrhage, portal systemic thrombosis, and necrosis of the stomach or small bowel. Alternative procedures such as transcatheter embolization have been associated with a high frequency of splenic or subphrenic abscess, preventing clinical use. We used partial splenic embolization under careful antibiotic protection to successfully treat thrombocytopenia in 18 patients, most of whom had hypersplenism and splenomegaly secondary to portal hypertension. Of the 30 embolizations performed, the only serious complications encountered were abscess in two patients (who had almost total infarction) and four cases of splenic vein thrombosis. We investigated the possible effect of splenic embolization on portal venous pressure in three patients and found no pressure change.

Obliteration of esophageal varices by PTP: a follow-up of 43 patients.

The percutaneous transhepatic portal vein catheterization (PTP) with selective obliteration of the coronary vein and/or the short gastric veins in treating bleeding esophageal varices was introduced in 1974. In order to prevent recanalization of the vessels Buerylate® (isobutyl-2-cyano-acrylate) has been used in 43 patients 55 times during a period of 34 months (October 1975 to July 1978). The obliterative treatment was followed by rebleeding in 35% of the cases and continued bleeding occurred in two patients. Fourteen patients were treated on 16 occasions during acute bleedings, and five of these (36%) died within two months from a portal vein thrombosis caused by the obliterative procedure. Because of these findings PTP with obliteration of the veins feeding the esophageal varices is not recommended as an elective way of treatment. It should only be used in the acute bleeding patient when transesophageal sclerosering therapy, continuous vasopressin infusion and balloon tamponade have failed. Fifty-six per cent of the patients acutely treated stopped bleeding for more than one week, thus avoiding an emergency shunt or devascularization operation which are associated with a high mortality rate.

Balloon catheter dilatation of esophageal strictures--a preliminary report.

A new esophageal dilatation balloon catheter and the technique of its use are presented and illustrated with a report of the first 3 cases of esophageal stricture treated with this technique. Balloon dilatation is a simple, safe, and economical alternative to other methods in the nonsurgical management of esophageal strictures.

A large-bore teflon endoprosthesis with side holes for nonoperative decompression of the biliary tract in malignant obstructive jaundice

A large-bore Teflon tube with side holes was used for nonsurgical palliative bile drainage in eight patients with malignant tumors. The drainage period ranged from 5 to 26 weeks. The bile drainage through the endoprosthesis was regarded as optimal in two patients, satisfactory in four, and ineffective in two. Significant complications of the method are intervening bile duct infections, risk of sepsis, spontaneous dislodgement, and occlusion of the endoprosthesis.

Radiological dwiagnosis in proven intraabdominal abscess formation: A comparison between plain films of the abdomen, ultrasonography and computerized tomography

Plain films of the abdomen, ultrasonography, and computed tomography were performed on 180 patients to rule out an intraabdominal abscess. The efficacy of the different modalities was reviewed in retrospect. Thirty-six of these 180 patients had a definite abscess formation. This was demonstrated in 65% of the plain film examinations, in 44% by ultrasonography, and in 94% by computerized tomography. Computed tomography seems efficient in ruling out abdominal abscess.

Preoperative diagnosis and evaluation of hepatic tumor resectability.

In the interpretation of patients with primary and secondary tumors of the liver, different radiologic procedures play an important role. We discuss ultrasound, computerized tomography, and angiography; the advantages and drawbacks of these modalities; and how they should be used when surgery or infusion chemotherapy is planned.

Percutaneous fine needle biopsy guided by barium examinations of the GI tract

Fine needle aspiration biopsies of gastrointestinal lesions were performed percutaneously guided by barium examinations of the GI tract in 47 patients. In 39 of the cases the nature of the lesion was verified at subsequent operation with histological examination of the specimen. The overall accuracy of biopsies was 78% with no false malignant or benign primary cytologic report. Only one complication was encountered (case report). The presented material shows that barium examinations are useful for biopsy guidance.

[Experience with the percutaneous transhepatic insertion of a bile duct endoprosthesis (author's transl)].

SummaryIn thirty patients with extrahepatic cholestasis because of a malignant tumor a permanent bile duct endoprosthesis was inserted nonsurgically. As prosthesis a teflon tube (OD/ID 4.0/3.0 mm) was used without side holes (13 cases) or with side holes (17 cases). The bile was drained through the endoprosthesis during a period of 1–32 weeks. The drainage function of the endoprosthesis without side holes was classified as partially effective in seven cases and as insufficient in six cases. The drainage function of the endoprosthesis with side holes was judged as optimal in four cases, partially effective in ten and insufficient in three cases. The dysfunction of the endoprosthesis in nine of thirty cases was caused by lack of side holes, spontaneous occlusion or spontaneous dislocation of the prosthesis. Eight patients developed symptoms of cholangitis. In four cases sepsis occurred after insertion of the prosthesis. One patient died from the sequelae of an intrahepatic pseudoaneurysm, which had developed from a damaged segmental artery following the transhepatic bile drainage.Zusammenfassung30 Patienten mit extrahepatischer Cholestase aufgrund eines malignen Tumors erhielten eine permanente, percutan-transhepatisch eingesetzte Gallengangs-Endoprothese. Als Prothese wurde ein Teflon-Tubus (AD/ID 4,0/3,0 mm) ohne Seitenlöcher (13 Fälle) oder mit Seitenlöchern (17 Fälle) verwandt. Die Dauer der Gallendrainage durch die Endoprothese betrug 1– 32 Wochen. Die Drainagefunktion der Endoprothese ohne Seiten öcher wurde als partiell effektiv in 7 Fällen und als insuffizient in 6 Fällen Vorgetragen auf der 61. Tagung der Deutschen Röntgengesellschaft, Köln, 15.-17. Mai 1980 eingestuft. Die Drainagefunktion der Endoprothese mit Seitenlöchern wurde als optimal in 4 Fällen, als partiell effektiv in 10 und als insuffizient in 3 Fällen bewertet. Die Dysfunktion der Endoprothese in 9 von 30 Fällen war auf fehlende Seitenlöcher, spontanen Verschluß oder spontanes Gleiten der Prothese zurückzuführen. 8 Patienten entwickelten Symptome einer Cholangitis. In vier Fällen trat eine Sepsis nach Einsetzen der Prothese auf. Ein Patient starb an den Folgen eines intrahepatischen Pseudo-Aneurysmas, das sich nach Läsion einer Segmentarterie als Folge der transhepatischen Drainage entwickelt hatte.In thirty patients with extrahepatic cholestasis because of a malignant tumor a permanent bile endoprosthesis was inserted nonsurgically. As prosthesis a teflon tube (OD/ID4.0/3.0mm) was used without side holes (13 cases) or with side holes (17 cases). The bile was drained through the endoprosthesis during a period of 1-32 weeks. The drainage function of the endoprosthesis without side holes was classified as partially effective in seven cases and as insufficient in six cases. The drainage function of the endoprosthesis with side holes was judged as optimal in four cases, partially effective in ten and insufficient in three cases. The dysfunction of the endoprosthesis in nine of thirty cases was caused by lack of side holes, spontaneous occlusion or spontaneous dislocation of the prosthesis. Eight patients developed symptoms of cholangitis. In four cases sepsis occurred after insertion of the prosthesis. One patient died from the sequelae of an intrahepatic pseudoaneurysm, which had developed from a damaged segmental artery following the transhepatic bile drainage.