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Kord A, Samuel M, Miller J. Occult Portoenteric Fistula after Portal Vein Recanalization and Transjugular Intrahepatic Portosystemic Shunt Creation in a Transplanted Liver. J Vasc Interv Radiol 2024; 35:315-318. [PMID: 37931843 DOI: 10.1016/j.jvir.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Ali Kord
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, 3188 Bellevue Ave., Ml 0671, Cincinnati, OH 45202.
| | - Michael Samuel
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, 3188 Bellevue Ave., Ml 0671, Cincinnati, OH 45202
| | - Jacob Miller
- Division of Interventional Radiology, Department of Radiology, University of Cincinnati, 3188 Bellevue Ave., Ml 0671, Cincinnati, OH 45202
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Sawamura S, Koike Y, Yamamoto T, Terauchi M, Koyama S, Utsunomiya D. The use of viabahn VBX stent-grafts for the treatment of extrahepatic portal vein hemorrhage. MINIM INVASIV THER 2022; 31:1066-1069. [DOI: 10.1080/13645706.2022.2056706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shungo Sawamura
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuya Koike
- Department of Interventional Radiology, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan
| | - Toh Yamamoto
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Miki Terauchi
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Shingo Koyama
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
| | - Daisuke Utsunomiya
- Department of Radiology, Yokohama City University Hospital, Yokohama, Japan
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Tsukamoto T, Nobori C, Nishiyama T, Kunimoto T, Kaizaki R, Inoue T, Nishiguchi Y. Stent-graft placement for delayed extrahepatic portal hemorrhage after surgical treatment for perihilar cholangiocarcinoma: A case report. Int J Surg Case Rep 2020; 77:519-522. [PMID: 33395836 PMCID: PMC7704364 DOI: 10.1016/j.ijscr.2020.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022] Open
Abstract
Stent-graft placement is a viable option for treatment of portal vein hemorrhage. Postoperative hemorrhage was caused by extrahepatic portal vein pseudoaneurysm formation. Portal vein pseudoaneurysm occurred at the reconstructed portion.
Introduction Potential curative therapy for perihilar cholangiocarcinoma requires extensive surgical treatment, which can still be associated with significant morbidity and mortality. Postoperative hemorrhage from the portal vein is a rare but life-threatening complication. We herein report postoperative hemorrhage from an extrahepatic portal vein pseudoaneurysm successfully treated by stent graft placement late after surgical treatment for perihilar cholangiocarcinoma. Presentation of case An 83-year-old man was referred to our hospital with a chief complaint of jaundice. Based on radiological findings, we diagnosed the patient with hilar cholangiocarcinoma. After endoscopic retrograde biliary drainage, resection of the extrahepatic bile duct combined with extended left hemi-hepatectomy, including the caudate lobe, lymphadenectomy of the hepatoduodenal ligament, partial resection and reconstruction of the portal vein, and right hepaticojejunostomy was performed. Fourteen days postoperatively, bleeding through the abdominal drain around the portal vein was observed. Twenty days postoperatively, abdominal computed tomography revealed a portal vein pseudoaneurysm that had formed at the portion of reconstruction. Therefore, 24 days postoperatively, a stent graft placement of the pseudoaneurysm through the ileocolic vein was performed. Subsequently, the portal vein hemorrhage ceased. Discussion Our present postoperative extrahepatic portal vein hemorrhage case was caused by an extrahepatic portal vein pseudoaneurysm that had formed at the reconstructed portion by erosion due to the chemical effect of the leaking bile and mechanical irritation of the surgical drain adjacent to the portal vein. Conclusion Stent-graft placement is a minimally-invasive, safe, and effective treatment option for hemorrhage from postoperative portal vein pseudoaneurysm.
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Affiliation(s)
- Tadashi Tsukamoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan.
| | - Chihoko Nobori
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tsuyoshi Nishiyama
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Tomohiro Kunimoto
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Ryoji Kaizaki
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Toru Inoue
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
| | - Yukio Nishiguchi
- Department of Surgery, Osaka City Juso Hospital, 2-12-27 Nonakakita, Yodogawa-ku, Osaka 532-0034, Japan
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Chantarojanasiri T, Sirinawasatien A, Bunchorntavakul C, Siripun A, Treepongkaruna SA, Ratanachu-Ek T. Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula. Clin Endosc 2020; 53:750-753. [PMID: 32050308 PMCID: PMC7719415 DOI: 10.5946/ce.2019.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/02/2019] [Indexed: 01/30/2023] Open
Abstract
Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.
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Affiliation(s)
| | | | | | - Aroon Siripun
- Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand.,Department of Internal Medicine, Bangkok Hospital, Bangkok, Thailand
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Kim JW, Shin JH, Park JK, Yoon HK, Ko GY, Gwon DI, Kim JH, Sung KB. Endovascular management for significant iatrogenic portal vein bleeding. Acta Radiol 2017; 58:1320-1325. [PMID: 28273741 DOI: 10.1177/0284185117693458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.
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Affiliation(s)
- Jong Woo Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jonathan K Park
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Ierardi AM, Berselli M, Cuffari S, Castelli P, Cocozza E, Carrafiello G. Uncommon Case of a Post-Traumatic Portal Vein Pseudoaneurysm Treated with Percutaneous Transhepatic Stent Grafting. Cardiovasc Intervent Radiol 2016; 39:1506-9. [PMID: 27230514 DOI: 10.1007/s00270-016-1373-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/16/2016] [Indexed: 02/03/2023]
Abstract
We describe a man who presented with a traumatic portal vein pseudoaneurysm, which was subsequently managed with a percutaneous transhepatic stent graft. This case demonstrates a rarely seen condition in the traumatic population and a novel management strategy, which should be considered in the management of this challenging injury.
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Affiliation(s)
- Anna Maria Ierardi
- Interventional Radiology Unit, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy
| | - Mattia Berselli
- Department of Surgery, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy
| | - Salvatore Cuffari
- Anesthesiology Department, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy
| | - Patrizio Castelli
- Department of Vascular Surgery, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy
| | - Eugenio Cocozza
- Department of Surgery, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Unit, Uninsubria, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy.
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Ch'ng LS, Tazuddin EEM, Young B, Ali AFM. Spontaneous resolution of asymptomatic hepatic pseudoaneurysm post radiofrequency ablation. BJR Case Rep 2016; 2:20150306. [PMID: 30363592 PMCID: PMC6180864 DOI: 10.1259/bjrcr.20150306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 12/13/2022] Open
Abstract
Radiofrequency ablation (RFA) of a hepatic tumour is an established treatment option with an acceptable complication rate. Formation of a pseudoaneurysm after RFA of liver metastasis is an uncommon complication. We report the case of a 69-year-old female patient developing a hepatic pseudoaneurysm after RFA of liver metastasis. On a follow-up CT scan 6 weeks later, there was spontaneous resolution of the pseudoaneurysm. Hepatic pseudoaneurysms are usually treated owing to the risk of rupture. Invasive procedures or conservative management of an asymptomatic hepatic pseudoaneurysm is still the subject of debate. The spontaneous resolution of a hepatic pseudoaneurysm in our patient suggests that an asymptomatic pseudoaneurysm maybe observed for resolution instead of being treated at presentation.
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Affiliation(s)
- Li Shyan Ch'ng
- Department of Radiology, Sarawak General Hospital, Kuching, Malaysia
| | | | - Benny Young
- Department of Radiology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
| | - Ahmad Faizal Mohd Ali
- Department of Radiology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
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Suzuki K, Igami T, Komada T, Mori Y, Yokoyama Y, Ebata T, Naganawa S, Nagino M. Stent-graft treatment for extrahepatic portal vein hemorrhage after pancreaticoduodenectomy. Acta Radiol Open 2015; 4:2058460115589338. [PMID: 26137314 PMCID: PMC4475512 DOI: 10.1177/2058460115589338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/10/2015] [Indexed: 11/17/2022] Open
Abstract
We report a case of intraperitoneal hemorrhage from the extrahepatic portal vein after pancreaticoduodenectomy for distal bile duct carcinoma. A stent-graft was deployed from the superior mesenteric vein to the main portal vein using a transhepatic approach. After the procedure, the patient remained free of intraperitoneal hemorrhage and was discharged 2 months later.
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Affiliation(s)
- Kojiro Suzuki
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomohiro Komada
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshine Mori
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Song W, Yuan Y, Peng J, Chen J, Han F, Cai S, Zhan W, He Y. The delayed massive hemorrhage after gastrectomy in patients with gastric cancer: characteristics, management opinions and risk factors. Eur J Surg Oncol 2014; 40:1299-306. [PMID: 24731269 DOI: 10.1016/j.ejso.2014.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/02/2013] [Accepted: 03/22/2014] [Indexed: 01/28/2023] Open
Abstract
AIMS This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored. RESULTS In sum, 15 (0.9%) patients suffered from DMH, with three (20%) dead cases. None of 18 (1.2%) patients with EPH died, but there were three dead cases in no-bleeding group. DMH had more extra-intestinal bleeding (P = 0.037) than EPH. Angiographic embolization was performed in 12 (80%) of DMH patients and successful in ten cases. Surgical procedures were applied in only two embolization-failed cases. Extended lymphadenectomy (P = 0.038), vascular skeletonization (P = 0.012) and advanced TNM stage (P < 0.001) were correlated with DMH. CONCLUSIONS DMH can be successfully managed with angiographic embolization, followed by alternative surgery. Extensive lymphadenectomy and vascular skeletonization should be discreetly performed during gastrectomy.
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Affiliation(s)
- W Song
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y Yuan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Peng
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - J Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - F Han
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - S Cai
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - W Zhan
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
| | - Y He
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China.
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Shin JH, Park DH, Yoon HK. Transarterial embolization of a post-biopsy portal vein pseudoaneurysm using N-butyl cyanoacrylate. GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fujiki M, Ramirez JR, Aucejo FN. Duodenoportal Fistula Resulting from Peptic Ulcer after Extended Right Hepatectomy for Cholangiocarcinoma. Am Surg 2012. [DOI: 10.1177/000313481207800315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Masato Fujiki
- Department of General Surgery Cleveland Clinic Cleveland, Ohio
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Javadrasshid R, Mozafarpour S, Sadrarami S, Jalili J, Sepehri B. Pseudoaneurysm of the portal vein as a rare source of gastrointestinal bleeding in pregnancy: a case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2012; 5:213-6. [PMID: 24834229 PMCID: PMC4017466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/11/2012] [Indexed: 11/09/2022]
Abstract
A 28-year-old, 32 week pregnant primigravida woman with a past history of increased blood pressure presented with RUQ pain as well as sudden onset of hematemesis. This case illustrates the occurrence of a rare complication (rupture of portal vein pseudoaneurysm inside the biliary system), appearing as upper gastrointestinal bleeding in a pregnant woman. The cause of the rupture is presumably pregnancy-related. We would like to emphasize the presence of pseudoaneurysm of the portal vein as a rare source of gastrointestinal bleeding in pregnancy.
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Affiliation(s)
- Reza Javadrasshid
- Assistant Professor, Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarah Mozafarpour
- Medical Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shohreh Sadrarami
- Resident of Radiology, Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javd Jalili
- Resident of Radiology, Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bita Sepehri
- Fellowship of Gastroenterology, Department of Gastroenterology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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