Biliary fistula and bile leakage are complications that can occur during hepato-biliary or intestinal surgery and percutaneous biliary intervention. In some cases, spontaneous resolution is possible but more often re-intervention (surgical or percutaneous) is necessary. We present the case of a 45 y-o male patient who underwent duodenocefalopanreasectomy (Whipple procedure) with bilio-digestive anastomosis for adenoma of the duodenal papilla of Vater, complicated by the formation of a fistula through the bilio-digestive anastomosis. Conservative treatment with percutaneous biliary drainage was attempted in order to promote spontaneous resolution of the fistula. The persistence of the fistula brought the patient to treatment through interventional techniques. Sealing of the bilio-peritoneal fistula was obtained using N-butil-Cyanoacrylate .

Gastrointestinal angiodysplasia (GIAD) represents one of the most frequent causes of recurrent lower gastrointestinal bleeding in the elder population. Clinical manifestations are highly variable, diagnosis is done with colonoscopy or CT and management consists of either endoscopic or, more conservatively, endovascular approach. Trans-arterial embolization (TAE) reduces blood flow into the lesion and may complicate with perforation, dissection, vasospasm and bowel ischaemia. To date, coils and Gelfoam represent the most employed embolizing agents, followed by PVA and onyx. We report the successful embolization of GIADs in four patients with n-butyl 2-cyanoacrylate (NBCA) and Lipiodol Ultra-Fluid (LUF): despite the reported higher risk of bowel infarction when compared with the other agents, no major complication or short-term recurrence occurred in our series.

Objectives: The aim of our study is to compare the incidence of veno-venous shunts in male varicocele and evaluate the possibility to exclude them with manual compression or/and scrotal ligation in order to carry out the procedure of retrograde sclero-embolization. Methods: In our retrospective study, all patients undergone retrograde sclerotherapy for varicocele in our Interventional Radiology Unit in the last four years were evaluated. Collaterals toward other venous shunts were identified and how many and which patients would be able to complete the procedure safely were considered. Results: Of the 91 patients, as many as 22 (i.e., 24.17%) patients presented anatomical variants, consisting on shunting into left iliac vein (9 [9.89%]), lumbar left veins (3 [3.29%]), right iliac vein (1 [1.09%]), both iliac veins (1 [1.09%]), left femoral vein (1 [1.09%]) or a more proximal portion of the ISV itself without shunting (3 [3.29%]). Patients with duplication could benefit from a more distal injection in order to prevent back-flow; of the 19 left, nine successfully underwent sclerotherapy with manual compression or/and scrotal ligation, whereas in 10 flow through the collaterals could not be interrupted and patients were demanded for surgery. Conclusions: Many patients with abnormal communications between the internal spermatic vein and the iliac veins (that is, shunts towards the iliac veins) may as well undergo retrograde sclerotherapy safely if compression/ligation is applied. Advances in knowledge: No large previous study highlighted the impact of veno-venous shunts in technical feasibility of retrograde sclerotherapy of varicocele.

Parotid sialocele is a challenging complication following major salivary gland surgery. Traditional conservative management often fails, while revision surgery carries a high risk of iatrogenic facial nerve injury. This retrospective, single-center case series evaluated the clinical efficacy and safety of ultrasound-guided Botulinum Toxin Type A (BoNT-A) infiltration in eight consecutive patients presenting with post-surgical parotid sialoceles. The protocol comprised complete ultrasound-guided evacuative aspiration followed by intraglandular injections of OnabotulinumtoxinA into functional parenchyma using a standardized grid mapping technique. Dosage was individualized based on the sonographic estimation of the residual volume of glandular tissue. Post-procedure care included a soft diet, temporary avoidance of sialagogues, and strict avoidance of local massage for 24 h. Complete clinical and sonographic resolution was achieved in all 8 treated cases within a mean interval of 10 days post-injection. Follow-up at 3 months confirmed no recurrences or late-onset complications. No local or systemic adverse events were recorded. In this preliminary case series, ultrasound-guided intraglandular BoNT-A injection represented a safe and encouraging minimally invasive second-line option for post-surgical parotid sialoceles.