Recurrent massive haemorrhage from an endoscopically inevident isolated rectal varix.

Anorectal varices are identified endoscopically in up to 40% of patients with liver cirrhosis [Misra SP, Dwivedi M, Misra V. Prevalence and factors influencing haemorrhoids, anorectal varices, and colopathy in patients with portal hypertension. Endoscopy 1996;28:340-5] but are an infrequent cause of bleeding and their management remains controversial.

Percutaneous hepaticojejunostomy with use of a metal stent for injury of the right hepatic duct after laparoscopic cholecystectomy.

Bile-duct injuries related to laparoscopic cholecystectomy may be complex and require a multidisciplinary approach. The authors report a case of a high hepatic duct injury treated surgically by a left hepaticojejunostomy and an ischemic right hepatic duct that could not be identified during the operation. The right hepatic lobe was subsequently drained radiologically by the percutaneous creation of a right hepaticojejunostomy, through and into a jejunal access loop, followed by deployment of a metallic stent.

Stripping of failing haemodialysis catheters using the Ampltaz gooseneck snare.

The development of a fibrin sheath at the tip of a long-term haemodialysis catheter may lead to deteriorating blood flow rates, resulting in inadequate haemodialysis. Restoration of functional patency has been described using the technique of percutaneous fibrin sheath stripping (PFSS) using a wire snare device. Our purpose was to assess this technique within an established renal vascular access service.

Haematuria.

Many serious and potentially treatable diseases of the urinary tract may have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 years of age, and so the schedule of further investigations, some of which may be invasive, time-consuming and expensive, needs to be rationalised.

The use of expandable metal stents in transplant renal artery stenosis.

The management of resistant transplant renal artery stenosis (TRAS) poses difficult problems. There is no consensus on the most appropriate course of action if severe stenosis recurs despite repeated percutaneous transluminal balloon angioplasty (PTA). Expandable metallic vascular stents have been increasingly successful as an adjunct to PTA in the coronary and peripheral circulation and more recently in the management of resistant native renal artery stenosis.

Retroperitoneal fibrosis in Marfan's syndrome.

To our knowledge, an association between Marfan's syndrome and retroperitoneal fibrosis (RPF) has never been described. We describe two cases who presented acutely with aortic disease and were later found to have changes of undiagnosed retroperitoneal fibrosis causing hydronephrosis on computed tomography (CT). An association is readily understandable based on the current hypotheses for the aortic disease in Marfan's syndrome and the etiology of RPF.