Successful embolisation of pelvic fistulating vessels to the prostate arising after TURP - a rare cause of postoperative bleeding

Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.

A description of CT features of Clostridium difficile infection of the small bowel in four patients and a review of literature

Clostridium difficile associated disease is an increasingly common cause of morbidity and mortality. Pseudomembranous colitis following hospital-administered antibiotic treatment is the most common symptomatic manifestation. Small bowel enteritis caused by C. difficile, however, is rarely described. Here, we present a series of four patients with hospital-acquired small bowel enteritis caused by C. difficile, discuss its CT and histopathological features, and review the current literature.

The use of self-expandable metal stents in the palliation of malignant bowel obstruction

Palliation of malignant gastrointestinal obstruction is a major aspect of oncology. We assessed the efficacy of stents in the palliation of gastric outlet, duodenal and colonic obstruction. We undertook a retrospective study of 35 consecutive patients who were referred for stent insertion with palliative intent from June, 1999 to March, 2003. Thirty-two stents were successfully placed in 30 patients. Technical success rate was 86% (30/35 patients). Of the patients who had successful insertion, 83% had complete relief of symptoms. In 1 patient the stent failed to expand. There was no procedure related mortality. Median survival was 1.6 months (range, 0-14.8). The conclusion was that self-expandable metal stents provide an effective method of palliation in malignant gastrointestinal obstruction, with high clinical and technical success rates and low complication rates.