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Application of DynaCT biliary soft tissue reconstruction technology in diagnosis and treatment of hepatolithiasis.

World J Gastrointest Surg

January 2025

Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.

Background: Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts. One-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique enables the clearing of intrahepatic stones and the resolution of strictures. However, hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL.

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Lemmel syndrome involves a periampullary duodenal diverticulum (PAD), a pouch-like outpouching near the ampulla of Vater, compressing the common bile duct. We describe a case of severe abdominal pain in a patient who had a large periampullary diverticulum, managed with surgical intervention after an initial failed endoscopic retrograde cholangiopancreatography (ERCP). An elderly female patient in her early 90s arrived at the emergency department with severe cramping pain localized to the right upper quadrant of her abdomen, progressively intensifying over several weeks.

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Background: Undiagnosed and untreated atherosclerotic renal artery stenosis (ARAS) can result in end-stage kidney disease (ESKD). To obtain an accurate diagnosis, it is crucial to recognize the symptoms and signs suggesting renal artery stenosis (RAS) and perform appropriate diagnostic and treatment procedures afterward.

Case Presentation: We present a case of a 60-year-old female patient with hypertensive crisis, acute heart failure (HF), and pulmonary edema as the initial signs of acute kidney injury (AKI) caused by right RAS and left renal artery occlusion in the presence of severe aortic atherosclerosis revealed on computed tomography angiography (CTA) of the abdomen.

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Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05-0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel.

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The introduction of devices for endovascular dialysis access creation (WavelinQ and Ellipsys) offers practitioners more options for access management in dialysis patients. Especially in terms of reducing the usage of central venous catheters, a native fistula is desirable as an initial dialysis access. We present a case in which a failed WavelinQ type fistula was reactivated using the Ellipsys procedure on the same arm.

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