Role of interventional radiology in the management of complex pediatric surgical cases

INTRODUCTION: Minimally-invasive techniques offered by interventional radiology (IR) are really helpful in the management of challenging surgical cases. The current report highlights a series of four complex pediatric surgical cases which were successfully managed by specific image-guided techniques. CASE PRESENTATION: The first two cases in the present report were infants. One of them had a complicated type-1 choledochal cyst (obstructive jaundice and cholangitis) and was optimized with preoperative percutaneous transhepatic biliary drainage (PTBD) under fluoroscopic guidance. The other child had bilateral ureteropelvic junction obstruction and presented with urosepsis. Due to failure of retrograde stenting on one side, image-guided percutaneous nephrostomy and antegrade stenting were performed. The third and fourth cases had suffered blunt trauma to the abdomen. While one of them developed multiple pseudoaneurysms and arterioportal fistulae in the liver, the other had transection of the right posterior sectoral duct. Angioembolization of the pseudoaneurysms and embolization of the right posterior sectoral duct were performed for them under image-guidance respectively. The post-procedural course of all the above children was uneventful. DISCUSSION: Image-guided minimally invasive procedures are associated with less post-procedural pain, early recovery, and better cosmetic outcomes. In specific scenarios, they may even obviate the need for surgical intervention, thereby reducing the overall morbidity. CONCLUSION: Interventional radiology offers safe and effective alternatives to operative interventions. They are especially useful in the backdrop of significant morbidities like cholangitis, urosepsis, and trauma.