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Purpose: We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children.Methods: A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months.Results: Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001).Conclusion: Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options. [ABSTRACT FROM AUTHOR]

Congenital megacalycosis is a rare renal disease characterized by calyceal dilatation without pelvic or ureteral obstruction. If not accompanied by nephrolithiasis and urinary tract infection, this disease is completely benign and does not cause renal dysfunction. We present a case of congenital megacalycosis that was diagnosed at the age of 41 (oldest case in the literature) after admitting with hematuria and acute renal dysfunction. IgA nephropathy was also diagnosed in this patient. Since renal dysfunction is not likely in these patients, if encountered; renal biopsy should be performed although technically difficult to diagnose the cause of this dysfunction. [ABSTRACT FROM AUTHOR]

Background: Cystic echinococcosis is a neglected zoonotic infection that is distributed worldwide and prioritised by WHO for control efforts. The burden of human cystic echinococcosis is poorly understood in most endemic regions, including eastern Europe. We aimed to estimate the prevalence of abdominal cystic echinococcosis in rural areas of Bulgaria, Romania, and Turkey.Methods: We did a cross-sectional ultrasound-based survey that recruited volunteers from 50 villages in rural areas of Bulgaria, Romania, and Turkey. These villages were in provinces with annual hospital incidence of cystic echinococcosis within the mid-range for the respective countries. All people who attended a session were allowed to participate if they agreed to be screened. Abdominal ultrasound screening sessions were hosted in public community structures such as community halls, primary health-care centres, schools, and mosques. Lesions were classified using an adapted WHO classification. We reported the prevalence of abdominal cystic echinococcosis adjusted by sex and age through direct standardisation, using the country's rural population as a reference.Findings: From July 1, 2014, to Aug 3, 2015, 24 693 individuals presented to screening sessions and 24 687 underwent ultrasound screening. We excluded a further six indivduals due to missing data, leaving 24 681 people in our analysis. Abdominal cystic echinococcosis was detected in 31 of 8602 people screened in Bulgaria, 35 of 7461 screened in Romania, and 53 of 8618 screened in Turkey. The age and sex adjusted prevalence of abdominal cystic echinococcosis was 0·41% (95% CI 0·29-0·58) in Bulgaria, 0·41% (0·26-0·65) in Romania, and 0·59% (0·19-1·85) in Turkey. Active cysts were found in people of all ages, including children, and in all investigated provinces.Interpretation: Our results provide population-based estimates of the prevalence of abdominal cystic echinococcosis. These findings should be useful to support the planning of cost-effective interventions, supporting the WHO roadmap for cystic echinococcosis control.Funding: European Union Seventh Framework Programme. [ABSTRACT FROM AUTHOR]

Background: Hydatid cyst is an endemic zoonotic infection that annual incidence ranges from <1 to 200 per 100,000 individuals. The most common complication of hepatic hydatid cyst reported is rupture of the cysts, most commonly intrabiliary rupture. Direct rupture to hollow visceral organs is rarely seen. We describe here an unusual cystogastric fistula in a patient with liver hydatid cyst., Case Presentation: The 55-year-old male patient presented with right upper quadrant abdominal pain. After radiological imaging studies, the diagnose was of hydatid cyst involving the left lateral segment of the liver ruptured into the gastric lumen and resulted in a cystogastric fistula. Gastroscopy revealed that the cyst and its contents protruding from anterior wall to the gastric lumen. Partial pericystectomy and omentopexy were performed and the gastric wall was primarily repaired. There were no complications in the postoperative period and 3-month follow up., Conclusion: This case, to our knowledge, is the first reported case of cystogastric fistula surgically treated in a patient with liver hydatid cyst in the literature. Our clinical experience shows that, although it is a benign disease, complicated hydatid cysts should be evaluated in detail preoperatively, and after the detailed diagnostic work-up, surgical therapy might be planned individually for each case., Key Words: Cysto-gastric fistula, Hydatid Cyst, Liver hydatidosis.

Background: Percutaneous cholecystostomy is an alternative or bridge to cholecystectomy (CCY) in high-risk patients with acute calculous cholecystitis. Our primary aim was to determine the parameters that could be used in interval CCY decision-making and to predict mortality in high-risk patients., Methods: The medical records of 127 patients who underwent percutaneous cholecystostomy for acute calculous cholecystitis between 2010 and 2018 were retrospectively analyzed. The primary outcomes were the CCY rate and the factors affecting mortality in high-risk patients. Descriptive statistics and receiver operating characteristic analysis were performed using albumin and elective surgery., Results: Of the 127 patients undergoing percutaneous cholecystostomy, elective CCY was performed only in 43.1% of the high-risk patients. The 30-day and 1 year mortality rates were 11% and 17.3%, respectively. The American Society of Anesthesiologists' (ASA) score, Charlson comorbidity index (CCI), the negative predictive factors described in the Tokyo Guidelines 2018, the American College of Surgeons' (ACS) expected mortality rate, and albumin level were found to be significant factors affecting mortality and elective CCY probability. No mortality was observed, and an 82% elective CCY rate was achieved in patients whose albumin levels were higher than 3.16 mg/dL at initial presentation., Conclusion: The plasma albumin level, ASA score, CCI, and ACS expected mortality rate can be used to predict mortality and decide on elective CCY. Percutaneous cholecystostomy is sufficient for resolving inflammation, but medical comorbidities determine the final condition of patients.

Purpose: We aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children., Methods: A total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months., Results: Technical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4-32 days). Median hospital stay during percutaneous management was 11.5 days (7-45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001)., Conclusion: Percutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options.

Objective: The purpose of this study is to evaluate the safety and efficacy of endobiliary radiofrequency ablation (RFA) in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage., Materials and Methods: Twenty-one patients (11 men) with a mean age of 47.9 years (range, 26-73 years) underwent percutaneous balloon dilatation and long-term drainage for benign bilioenteric anastomosis strictures. Endobiliary RFA was performed in six patients (four men; mean age, 53.1 years; range, 43-63 years) whose strictures did not respond to balloon dilatation and long-term drainage., Results: Presenting symptoms were jaundice (n = 21), pain (n = 19), pruritus (n = 17), and cholangitis (n = 15). The symptoms appeared 1384 days (range, 4-7592 days) after surgery. The technical success rate was 100%. The overall clinical success rate was 95.2% (20/21) with a mean follow-up of 67.3 months (range, 9-148 months) after catheter removal. In 15 patients, associated biliary stones were removed. Two patients with recurrent strictures were successfully retreated. Endobiliary RFA was successful and catheter removal could be achieved in all six patients (100%) whose disease did not respond to multiple balloon dilatation sessions and long-term drainage. The mean symptom-free period after endobiliary RFA and catheter removal was 430 days (range, 270-575 days). One patient with refractory disease (4.7%), for whom endobiliary RFA was not performed, underwent surgery. There were no major complications., Conclusion: Endobiliary ablation may be used safely and effectively in the percutaneous management of benign bilioenteric anastomosis strictures that are refractory to balloon dilatation and long-term drainage, with promising results.

Objective: The purpose of this study was to determine the long-term results of a modified catheterization technique for percutaneous treatment of hepatic cystic echinococcosis (CE) types 2 and 3b and to retrospectively compare the results of puncture, aspiration, injection, and reaspiration (PAIR); standard catheterization; and the modified catheterization technique., Materials and Methods: Seventy-three patients (37 male, 36 female; 75 cysts) with CE types 2 and 3b who underwent percutaneous treatment from March 1991 to August 2008 were included. Informed consent from all patients and approval of the ethics board were obtained. Patients were 6-79 years old. Twenty-three cysts (30.6%) were treated with PAIR, 26 (34.7%) with standard catheterization, and 26 (34.7%) with the modified catheterization technique. The results of the three techniques were statistically compared., Results: Among all patients, the cysts decreased in volume by 61.1% (range, 5-100%). Cysts recurred in 11 (47.8%) patients treated with PAIR, three (11.5%) treated with standard catheterization, and one (3.8%) treated with the modified catheterization technique. The recurrence rate was not significantly different between standard catheterization and the modified catheterization technique (p > 0.05), whereas significantly more recurrences developed after PAIR than with the other two techniques (p < 0.05). Twelve (16.4%) major and 16 (21.9%) minor complications developed. Significantly fewer major complications occurred with PAIR than with the modified catheterization technique, but the difference between standard catheterization and the other two techniques was not significant., Conclusion: Treatment of CE types 2 and 3b with the modified catheterization technique was associated with a recurrence rate lower than what is seen with other techniques, and therefore it appears to be a safe, reliable, and efficient alternative.

Objective: The purpose of this study was to evaluate the safety and efficacy of transhepatic drainage of inaccessible postoperative intraabdominal abscesses under sonographic and fluoroscopic guidance., Materials and Methods: Between February 2005 and September 2010, 30 abscesses were treated in 30 patients. Procedures were performed with sonographic and fluoroscopic guidance under i.v. sedation and local anesthesia. Factors affecting results were evaluated statistically., Results: The technical and clinical success rates were 100% and 97%. The procedures were performed with 8-, 10-, and 12-French locking pigtail catheters. The catheters were in place for a mean duration of 75 days if a fistula was present and 15 days in the absence of fistula. Major complications were not detected during treatment. The rate of minor complications (catheter dislodgement, obstruction, kinking) was 20%. Most of the complications were managed by exchange, revision, or increase in size of the catheter. When use of an 8-French catheter was compared separately with use of 10- and 12-French catheters, the rate of minor complications was found to be significantly higher for the 8-French group (p < 0.05). Five abscesses had fistulous communication with the pancreatic duct, jejunum, and biliary system. The mean duration of catheter use was increased by the presence of a fistula (p < 0.05). When single-microbe, polymicrobial, and culture-negative abscesses were compared, the difference between groups with respect to mean duration of catheter use was not statistically significant (p > 0.05). Mean duration also did not differ significantly between patients with an abscess volume greater than and those with an abscess volume less than 100 mL (p > 0.05)., Conclusion: Transhepatic drainage of intraabdominal abscesses under sonographic and fluoroscopic guidance is safe and effective. Abscess content and volume did not affect drainage time, but the presence of a fistula increased the duration of catheter use. The rate of catheter-related complication was highest in the group with 8-French catheters. The rates in the groups with 10- and 12-French catheters did not differ significantly. We suggest the use of 10-French catheters for transhepatic drainage.

Objective: The purpose of this article is to evaluate the safety and efficacy of radiologic gastrostomy and gastrojejunostomy in children, with an emphasis on the comparison of single and double gastropexy., Materials and Methods: Between January 2000 and May 2009, a total of 91 percutaneous tubes (77 gastrostomies and 14 gastrojejunostomies) were placed in 90 patients. Patients' ages ranged from 4 months to 16.5 years. Gastropexy was performed in all cases. The first 50 children underwent double gastropexy, and 40 children underwent single gastropexy. In single gastropexy, two different punctures were performed each for the anchor and the tube. Differences in the incidence of major and minor complications and tube maintenance problems between the single- and double-gastropexy groups were retrospectively analyzed by use of Fisher's exact test., Results: The technical success rate was 100%. No procedure-related mortality or morbidity was detected. The overall major and minor complication rates were 4.4% and 16.7%, respectively. The mean follow-up period was 463 days. Twenty-nine tube maintenance problems were detected in 17 patients. There were four major complications (two cases of aspiration pneumonia and two site infections that required hospitalization). Minor complications occurred in 15 patients (nine localized site infections, two cases of gastroesophageal reflux, and four tube maintenance problems requiring secondary intervention). In total, 26 and 22 complications and tube maintenance problems occurred in the single- and double-gastropexy groups, respectively. No statistically significant difference was detected between the two groups in terms of complications (p > 0.005)., Conclusion: Radiologic gastrostomy and gastrojejunostomy are safe and effective methods for long-term nutritional support in children. Single gastropexy should be performed with two different punctures for each retention suture and the tube.