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Hybrid approach with endovascular and open surgical techniques for challenging aneurysms

Parizh, David; Rizvi, Syed Ali Raza; Ascher, Enrico; Hingorani, Anil
This study is a case series describing the management of complex aneurysmal disease using the principles of both open and endovascular techniques.
PMID: 29466937
ISSN: 1708-539x
CID: 2991012

Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery

Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric
Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures.
PMID: 28708024
ISSN: 1708-539x
CID: 2984272

Endoscopic retrograde cholangiopancreatogram (ercp) stent occlusion after sphincterotomy due to bleeding and clot formation [Meeting Abstract]

Liu, S; Parizh, D; Meytes, V; Kilaru, M
Introduction: Acute cholangitis is an ascending infection of the biliary tree secondary to obstruction and can be severe if proper intervention and treatment are not performed in a timely fashion. The most common management of cholangitis with ductal obstruction due to choledocholithiasis is intravenous hydration, empiric antibiotic therapy, endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy and stone extraction with or without stent placement, followed by a delayed laparoscopic cholecystectomy. We present the case of a patient with blood clot obstruction of a common bile duct (CBD) stent after ERCP with sphincterotomy and stone extraction. Case Presentation: A 58 year old male presented to the emergency department with jaundice, right upper quadrant abdominal pain, truncal pruritis, nausea, vomiting, and fever. Biochemical analyses and liver profile demonstrated an elevated white blood cell count, hyperbilirubinemia, and elevated liver enzymes consistent with cholestasis. Biliary ultrasound demonstrated multiple gallstones and dilation of the CBD with a distal obstructing calculus. He proceeded to ERCP where biliary cannulation was achieved, sphincterotomy performed, and a large amount of sludge and pus was drained. An 8 mm stone was removed from the CBD by balloon sweep with completion cholangiogram demonstrating no filling defects. A stent was then placed in the CBD with adequate flow. Following the procedure, the patient continued to have increasing hyperbilirubinemia. A repeat ERCP revealed a large blood clot and continued bleeding at the previous sphincterotomy that resolved with epinephrine injection. The former stent was visualized in the proper position, removed with a snare, and found to be fully occluded with blood clots. After retrieval of additional clots, a new stent was placed with adequate return of bile. The patient recovered with resolution of his symptoms and hyperbilirubinemia with laparoscopic cholecystectomy. Discussion: Cholangitis is characterized by Charcot's triad of right upper quadrant abdominal pain, fever, and jaundice due to an ascending bacterial infection of the biliary tree coinciding with obstruction of biliary flow most commonly from gallstones. Cholan-giography via ERCP with associated sphincterotomy, stone extraction, and stenting is both diagnostic and therapeutic. While debated by endoscopists, stent placement has shown to reduce recurrent biliary complications, decrease length of hospital stay, and lessen morbidity. Although pancreatitis is the most common cause of hyperbilirubinemia post-ERCP, stent occlusion secondary to stones or blood clots should be considered to effectively treat patients. Proper hemostasis is important in any procedure and close patient follow-up should be performed to prevent further complications
ISSN: 1432-2218
CID: 3153872

Splenic abscess arising after routine laparoscopic cholecystectomy [Meeting Abstract]

Bain, K; Meytes, V; Parizh, D; Kumar, S
Introduction: Splenic abscess is a rare, potentially lethal condition, with autopsy studies showing incidence rates between 0.14-0.7%. Mortality rates ranging from 47 to 100% making early diagnosis and prompt intervention vital. Several case reports have documented post surgical splenic abscess, most notably after laparoscopic sleeve gastrectomy. To the best of our knowledge, there has not been any reported cases of splenic abscess arising after laparoscopic cholecystectomy. It is important to remember this disease process for expeditious targeted treatment in future cases. Case Presentation: A 69 year-old female with past medical history significant for cholilithiasis, hypertension, and hyperlipidemia presented to the emergency department (ED) with a chief complaint of abdominal pain for two days. Labs and imaging were obtained which confirmed the diagnosis of choledocholithiasis and pancreatitis. ERCP was performed which showed a 1.5 cm stone causing obstruction, with several other smaller filling defects. The stones were removed after sphincterotomy. Post procedurally, the patient underwent an uncomplicated laparoscopic chole-cystectomy on Hospital Day (HD) $5. Post operatively, the patient had persistent leukocytosis peaking at 16.8 thousand on postoperative day (POD) $6. A CT scan was performed which showed a rim-enhancing splenic collection measuring 6.692.2 cm suggestive of an abscess. Interventional radiology was consulted and aspirated 50 ml of purulent fluid. Cultures grew out Klebsiella pneumoniae and Enterobacter cloacae complex, and the patient was discharged home on Zosyn. Discussion: Laparoscopic cholecystectomy has become the cornerstone in treatment of symp-tomatic biliary colic and acute cholecystitis. Of the many recognized complications of laparoscopic cholecystectomy, splenic abscess has not yet been reported in current literature. The nonspecific signs and symptoms of splenic abscess make clinical diagnosis difficult. The classic triad of fever, palpable spleen and left upper quadrant pain are only seen in about two-thirds of patients. CT scan has been shown to be the most sensitive imaging modality for diagnosis of splenic abscess. Current treatment options for splenic abscess are broken down into two subsets: percutaneous and surgical intervention. Percutaneous treatment includes image guided aspiration with or without placement of drainage catheter. Surgical intervention can be either laparoscopic or open and includes drainage of abscess with splenectomy or splenic conservation. The best treatment option remains unclear, and there is lacking prospective data demonstrating which modality is superior
ISSN: 1432-2218
CID: 3153812

Splenic abscess following laparoscopic cholecystectomy: a case report of a rare disease and a review of its management

Bain, Kevin; Lelchuk, Andrew; Parizh, David; Meytes, Vadim; Kumar, Sampath
Splenic abscess is a rare disease that has several predisposing factors. Case reports have documented post-surgical development of splenic abscesses, most commonly after laparoscopic sleeve gastrectomy. We present the case of a 69-year-old female with gallstone pancreatitis who underwent an uncomplicated laparoscopic cholecystectomy. The hospital course was complicated by persistent postoperative leukocytosis with a CT scan demonstrating a moderate sized splenic abscess. Interventional radiology was consulted for percutaneous drainage, and the patient was subsequently discharged home in stable condition. Splenic abscess is an important entity to remember as it is associated with significant mortality. Prompt treatment is vital for improving patient survival. Image guided percutaneous interventions have been increasing used and carry numerous benefits compared to surgical approaches. However, there is a paucity of data comparing the efficacy of percutaneous and surgical therapies. Percutaneous interventions can be successfully performed when the abscess is unilocular/bilocular, has a discrete wall, has no internal septations, or has thin liquid content. Further investigation through multicenter, prospective, randomized clinical trials are needed to analyze treatment options.
PMID: 30264011
ISSN: 2523-1995
CID: 3314532

Surgical emergency: rupture of infected brachial artery pseudoaneurysm

Lim, Derek; Parizh, David; Meytes, Vadim; Kopatsis, Anthony
PMID: 28637785
ISSN: 1757-790x
CID: 3073782

Co-existent appendicitis and cholecystitis

Victory, Jesse; Meytes, Vadim; Parizh, David; Ferzli, George; Nemr, Rabih
ISSN: 2518-6973
CID: 4568442

Mangled extremity: to salvage or not to salvage? [Case Report]

Bain, Kevin; Parizh, David; Kopatsis, Anthony; Kilaru, Ramamohan
PMID: 28039351
ISSN: 1757-790x
CID: 3087552

Penetrating injury to the cardiac box and the deadly dozen [Case Report]

Nicoara, Michael; Parizh, David; Meytes, Vadim; Kopatsis, Anthony
PMID: 27899393
ISSN: 1757-790x
CID: 3094562

Role of diagnostic laparoscopy in penetrating anterior abdominal wall trauma [Case Report]

Parizh, David; Meytes, Vadim; Kopatsis, Anthony
PMID: 27742645
ISSN: 1757-790x
CID: 3092182