BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein(PV)/superior mesenteric veins(SMV)stenosis/occlusion.It has been widely used after liver...BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein(PV)/superior mesenteric veins(SMV)stenosis/occlusion.It has been widely used after liver transplantation surgery;however,reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare.CASE SUMMARY Herein,we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery.The patient was successfully treated using stent grafts.Although the stenosis resolved after stent placement,complications,including bleeding,pancreatic fistula,bile leakage,and infection,made the treatment highly challenging.The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding.After careful treatment,the patient stabilized,and stent placement effectively managed postoperative PV/SMV stenosis.CONCLUSION Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.展开更多
Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical manife...Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical manifestation.Accurate diagnosis and prompt treatment are essential as all the aforementioned conditions are a signifi cant threat to a patient’s life.However,acute aortic syndrome and especially aortic intramural hematoma may be challenging diagnostic problems.Intravascular ultrasound imaging is a diagnostic method that can be useful for more thorough evaluation of the aortic lesion and can particularly aid in discerning the different forms of acute aortic syndrome.We present a case of a patient with aortic intramural hematoma that was missed by conventional imaging studies but was successfully visualized with intravascular ultrasound imaging.展开更多
It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal proliferation following stenting and that this is reflected clinically in a very significant decrease in ... It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal proliferation following stenting and that this is reflected clinically in a very significant decrease in late lumen loss, instent restenosis, and target lesion revascularization. This benefit occurs, however, in the setting of delayed endothelial and vascular wall healing with its potential for continuing thrombogenicity requiring more prolonged use of dual antiplatelet therapy to prevent stent thrombosis.……展开更多
BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological e...BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine.Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction.Here,we report a unique case of idiopathic mechanical duodenal obstruction,which resolved spontaneously after 3 mo of conservative treatment,but was followed by intestinal pseudo-obstruction.CASE SUMMARY An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia.Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause.Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection.Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely.Unfortunately,2 wk later,she had regurgitation and postprandial vomiting again,complicated by deteriorating wheezing and dyspnea.Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration.The patient fully recovered after combined treatment with antireflux agents,enema,prokinetics,and bronchodilators.CONCLUSION This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction,which requires multidisciplinary treatment.展开更多
基金Supported by the National Natural Science Foundation of China,No.82173074the Beijing Natural Science Foundation,No.7232127+3 种基金the National High Level Hospital Clinical Research Funding,No.2022-PUMCH-D-001 and No.2022-PUMCH-B-004the CAMS Innovation Fund for Medical Sciences,No.2021-I2M-1-002the Nonprofit Central Research Institute Fund of Chinese Academy of Medical Sciences,No.2018PT32014Fundamental Research Funds for the Central Universities,No.3332019025.
文摘BACKGROUND Percutaneous transhepatic stent placement has become a common strategy for the postoperative treatment of portal vein(PV)/superior mesenteric veins(SMV)stenosis/occlusion.It has been widely used after liver transplantation surgery;however,reports on stent placement for acute PV/SMV stenosis after pancreatic surgery within postoperative 3 d are rare.CASE SUMMARY Herein,we reported a case of intestinal edema and SMV stenosis 2 d after pancreatic surgery.The patient was successfully treated using stent grafts.Although the stenosis resolved after stent placement,complications,including bleeding,pancreatic fistula,bile leakage,and infection,made the treatment highly challenging.The use of anticoagulants was adjusted multiple times to prevent venous thromboembolism and the risk of bleeding.After careful treatment,the patient stabilized,and stent placement effectively managed postoperative PV/SMV stenosis.CONCLUSION Stent placement is effective and feasible for treating acute PV/SMV stenosis after pancreatic surgery even within postoperative 3 d.
文摘Acute aortic syndrome includes classic aortic dissection,aortic intramural hematoma,and penetrating atherosclerotic ulcer– a group of conditions that are defined by their dynamic evolution and similar clinical manifestation.Accurate diagnosis and prompt treatment are essential as all the aforementioned conditions are a signifi cant threat to a patient’s life.However,acute aortic syndrome and especially aortic intramural hematoma may be challenging diagnostic problems.Intravascular ultrasound imaging is a diagnostic method that can be useful for more thorough evaluation of the aortic lesion and can particularly aid in discerning the different forms of acute aortic syndrome.We present a case of a patient with aortic intramural hematoma that was missed by conventional imaging studies but was successfully visualized with intravascular ultrasound imaging.
文摘 It has been well established that use of drug-eluting stents has resulted in marked reduction in neointimal proliferation following stenting and that this is reflected clinically in a very significant decrease in late lumen loss, instent restenosis, and target lesion revascularization. This benefit occurs, however, in the setting of delayed endothelial and vascular wall healing with its potential for continuing thrombogenicity requiring more prolonged use of dual antiplatelet therapy to prevent stent thrombosis.……
基金Peking Union Medical College Hospital Science Fund for Junior Faculty,No.pumch-2016-2.13.
文摘BACKGROUND Duodenal obstruction is a common clinical scenario that can either be mechanical or a pseudo-obstruction.Clinical management of intestinal obstruction starts from localization and proceeds to histological examination of the stenotic intestine.Systemic factors and dysfunction of distant organs might contribute to the development of intestinal obstruction.Here,we report a unique case of idiopathic mechanical duodenal obstruction,which resolved spontaneously after 3 mo of conservative treatment,but was followed by intestinal pseudo-obstruction.CASE SUMMARY An 84-year-old woman presented with worsened postprandial vomiting accompanied by prolonged pneumonia.Thorough noninvasive investigations revealed complete circumferential stenosis in the descending duodenum without known cause.Exploratory surgery was postponed due to septic shock and possible pulmonary fungal infection.Conservative treatment for 3 mo for ileus and control of pulmonary infection resolved the intestinal obstruction completely.Unfortunately,2 wk later,she had regurgitation and postprandial vomiting again,complicated by deteriorating wheezing and dyspnea.Computed tomography revealed a dilated stomach and proximal duodenum without new intestinal stricture or pulmonary infiltration.The patient fully recovered after combined treatment with antireflux agents,enema,prokinetics,and bronchodilators.CONCLUSION This complicated case highlights the inter-relationship of local and systemic contributions to ileus and gut dysfunction,which requires multidisciplinary treatment.
