Wednesday, 30 January 2013

Interventional Radiology Treatment of Acute Cholecystitis

Percutaneous Cholecystostomy is a minimally invasiver technique for the treatment of acute cholecystitis.  We recently performed the procedure for an elderly gentleman suffering with severe abdominal pain. With help of ultrasound and fluoroscopy in our cathlab, the gall bladder was punctured through the skin and liver (transhepatic approach).  A radio opaque dye was then injected into the gall bladder to confirm the position. Using modified seldinger's technique, a drainage catheter was passed into the gall bladder, draining the infected bile and sludge outside into a sterile bag.  The pain dramatically reduced and patient was discharged to home. 
Chiba Needle used to gain access into gall bladder
Dilator passed over hair wire by Seldinger Technique
Final position of drainage catheter
Illustration showing the procedure 

Tuesday, 29 January 2013

Minimally invasive intervention for Liver Cancer

We recently performed superselective Trans Arterial Chemo Embolization (TACE) for liver cancer.  The patient was an elderly lady who had inoperable liver cancer. Using microcatheters (less than a millimeter diameter), we reached the arteries supplying the cancer.  The skin incision in the groin was less than 3 mm in size and no sutures were required. The chemotherapy agent(to kill cancer cells) was injected directly into the arteries supplying the cancer.  By this method, the general side effects seen with systemic chemotherapy will be markedly reduced. After the procedure, the patient needs to stay for a day or two for observation and can go back home. Regular monitoring of the cancer by CT scan is required to monitor shrinkage of the cancer. 
Hepatic Angiogram showing tumour vascularity
Selective chemo embolisation of tumour feeders
Post treatment CT showing selective uptake of agent within the tumour
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