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Sample records for cholecystostomy

  1. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  2. Percutaneous transhepatic cholecystostomy

    International Nuclear Information System (INIS)

    Ultrasound-guided percutaneous cholecystostomy was performed in 11 patients. Indications were acute cholecystitis in 7 patients, and obstructive biliary disease in 4 patients. A transhepatic approach was used in all patients. In one patient, bile leakage was noticed during cholecystectomy. No other complications were seen. Three of five patients with an acalculous cholecystitis had a normal post-drainage cholangiogram and the drainage catheter could be removed. A follow-up of 5.5, and 26 months respectively, showed no recurrent disease. Three patients underwent surgery and the remaining five patients were drained until death by their underlying disease. Percutaneous cholecystostomy can be a life-saving and curative procedure in the critically ill patient, in case of acalculous cholecystitis, the only one needed. (orig.)

  3. Percutaneous transhepatic cholecystostomy

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    Lameris, J.S.; Jeekel, J.; Havelaar, I.J.; Seyen, A.J. van

    1985-01-01

    Ultrasound-guided percutaneous cholecystostomy was performed in 11 patients. Indications were acute cholecystitis in 7 patients, and obstructive biliary disease in 4 patients. A transhepatic approach was used in all patients. In one patient, bile leakage was noticed during cholecystectomy. No other complications were seen. Three of five patients with an acalculous cholecystitis had a normal post-drainage cholangiogram and the drainage catheter could be removed. A follow-up of 5.5, and 26 months respectively, showed no recurrent disease. Three patients underwent surgery and the remaining five patients were drained until death by their underlying disease. Percutaneous cholecystostomy can be a life-saving and curative procedure in the critically ill patient, in case of acalculous cholecystitis, the only one needed.

  4. Percutaneous cholecystostomy at the community hospital: value evaluation

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    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  5. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    International Nuclear Information System (INIS)

    Purpose. Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. Methods. A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. Results. Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. Conclusion. No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis

  6. Eclectic use of cholecystostomy in biliary tract procedures

    International Nuclear Information System (INIS)

    Twenty-seven patients underwent percutaneous aspiration or catheterization of gallbladder for the diagnosis or treatment of biliary tract disease, including 12 cases of cholecystitis, nine malignancies, two cases of choledocholithiasis, and one case of biliary structure. In three patients the cholangiograms were normal. Cholestostomy catheters were placed in 25 patients, including those with normal cholangiograms; the catheters were withdrawn from these patients after the procedure. In all other patients with obstruction the catheters were left in place for drainage, stone chemolysis, or assistance with ductal opacification during percutaneous biliary dilation. There were two minor and no major complications. In addition to its uses in gallbladder disease, percutaneous cholecystostomy is a safe, less painful alternative to percutaneous transhepatic cholangiography. In conjunction with transhepatic drainage for malignancy, it allows control of biliary opacification and optimal selection of the site of ductal puncture

  7. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment

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    Hatzidakis, Adam A.; Prassopoulos, Panos; Petinarakis, Ioannis; Gourtsoyiannis, Nicholas C. [Department of Radiology, University Hospital of Heraklion, Medical School of Crete, Crete (Greece); Sanidas, Elias; Tsiftsis, Dimitrios [Department of Surgical Oncology, University Hospital of Heraklion, Medical School of Crete (Greece); Chrysos, Emmanuel; Chalkiadakis, Georgios [Department of General Surgery, University Hospital of Heraklion, Medical School of Crete (Greece)

    2002-07-01

    Our objective was to compare the effectiveness of percutaneous cholecystostomy (PC) vs conservative treatment (CO) in high-risk patients with acute cholecystitis. The study was randomized and comprised 123 high-risk patients with acute cholecystitis. All patients fulfilled the ultrasonographic criteria of acute inflammation and had an APACHE II score {>=}12. Percutaneous cholecystostomy guided by US or CT was successful in 60 of 63 patients (95.2%) who comprised the PC group. Sixty patients were conservatively treated (CO group). One patient died after unsuccessful PC (1.6%). Resolution of symptoms occurred in 54 of 63 patients (86%). Eleven patients (17.5%) died either of ongoing sepsis (n=6) or severe underlying disease (n=5) within 30 days. Seven patients (11%) were operated on because of persisting symptoms (n=3), catheter dislodgment (n=3), or unsuccessful PC (n=1). Cholecystolithotripsy was performed in 5 patients (8%). Elective surgery was performed in 9 cases (14%). No further treatment was needed in 32 patients (51%). In the CO group, 52 patients (87%) fully recovered and 8 patients (13%) died of ongoing sepsis within 30 days. All successfully treated patients showed clinical improvement during the first 3 days of treatment. Percutaneous cholecystostomy in high-risk patients with acute cholecystitis did not decrease mortality in relation to conservative treatment. Percutaneous cholecystostomy might be suggested to patients not presenting clinical improvement following 3 days of conservative treatment, to critically ill intensive care unit patients, or to candidates for percutaneous cholecystolithotripsy. (orig.)

  8. Clinical application of percutaneous cholecystostomy in the treatment of high-risk patients with acute cholecystitis

    International Nuclear Information System (INIS)

    Objective: To discuss the therapeutic strategy and the clinical efficacy of percutaneous cholecystostomy in treating high-risk patients with acute cholecystitis. Methods: During the period of Jan. 2006-June 2008, percutaneous cholecystostomy was performed in 27 high-risk patients with acute cholecystitis, consisting of lithic cholecystitis (n = 21) and non-lithic cholecystitis (n = 6). Of 27 patients, percutaneous cholecystostomy via transhepatic approach was performed in 22 and via transperitoneal approach in 5. The 7 F drainage catheter was used. Cholecystography was conducted before the drainage catheter was extracted. Results: Percutaneous cholecystostomy was successfully accomplished in all 27 cases, with a technical success rate of 100%. Postoperative patency of gallbladder drainage was obtained in 25 patients, with the relieving or subsiding of abdominal pain and the restoring of temperature and leukocyte account to normal range within 72 hours. In one patient, as the abdominal pain relief was not obvious 72 hours after the procedure, cholecystography was employed and it revealed the obstruction of the drainage catheter. After reopening of the drainage catheter, the abdominal pain was relieved. In another case, cholecystography was carried out because the abdominal pain became worse after the procedure, and minor bile leak was demonstrated. After powerful anti-infective and symptomatic medication, the abdominal pain was alleviated. The drainage catheter was extracted in 25 patients 6-7 weeks after the treatment. Of these 25 patients, 12 accepted selective cholecystectomy, 7 received percutaneous cholecystolithotomy and 6 with non-lithic cholecystitis did not get any additional surgery. The remaining two patients were living with long-term retention of the indwelling drainage-catheter. Conclusion: Percutaneous cholecystostomy is a simple, safe and effective treatment for acute cholecystitis in high-risk patients. This technique is of great value in clinical

  9. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    International Nuclear Information System (INIS)

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  10. Maturation of the Tract After Percutaneous Cholecystostomy with Regard to the Access Route

    International Nuclear Information System (INIS)

    Purpose: To assess the shortest time for catheter removal with regard to the transhepatic or transperitoneal approach in patients undergoing percutaneous cholecystostomy (PC). Methods: In this prospective study, 40 consecutive high-risk patients with acute cholecystitis (calculous, n= 22; acalculous, n= 18) underwent PC by means of a transhepatic (n= 20) or transperitoneal (n= 20) access route. In 28 patients (70%) computed tomography was used for puncture guidance, while in the remaining 12 (30%) the procedures were performed under ultrasound control. A fistulography was performed on the 14th postprocedural day in all patients and was repeated weekly if the tract was found to be immature. The catheter was removed only if a mature tract without evidence of leakage was delineated. Results: In 36 of 40 patients the procedure was technically successful (90%). Three of the unsuccessful punctures were attempted transperitoneally and one transhepatically. Thirty-five of 36 patients showed rapid improvement within the first 48 hr following the procedure (96%). Three of them died of their severe underlying disease (7.5%) and in another three the catheter was accidentally removed prior to the first fistulography (7.5%). A total of 30 patients could be fully evaluated after the procedure: 15 with a transhepatic, and 15 with a transperitoneal PC. Whereas 14 of 15 patients (93%) with transhepatic gallbladder access developed a mature tract after 14 days and the remaining patient after 3 weeks, only 2 of 15 patients (13%) with a transperitoneal route presented a mature tract after 2 weeks (p 2 test with Yates' correction). Eleven patients (73%) with transperitoneal access required 3 weeks and two patients (13%) 4 weeks for complete tract formation. Conclusion: A period of 2 weeks suffices for the majority of patients to develop a mature tract when the transhepatic access route is used; when using the trans- peritoneal route at least 3 weeks are required. We suggest that the

  11. Cholecystostomy as Bridge to Surgery and as Definitive Treatment or Acute Cholecystectomy in Patients with Acute Cholecystitis

    Directory of Open Access Journals (Sweden)

    Agnieszka Popowicz

    2016-01-01

    Full Text Available Purpose. Percutaneous cholecystostomy (PC has increasingly been used as bridge to surgery as well as sole treatment for patients with acute cholecystitis (AC. The aim of the study was to assess the outcome after PC compared to acute cholecystectomy in patients with AC. Methods. A review of medical records was performed on all patients residing in Stockholm County treated for AC in the years 2003 and 2008. Results. In 2003 and 2008 altogether 799 and 833 patients were admitted for AC. The number of patients treated with PC was 21/799 (2.6% in 2003 and 50/833 (6.0% in 2008. The complication rate (Clavien-Dindo ≥ 2 was 4/71 (5.6% after PC and 135/736 (18.3% after acute cholecystectomy. Mean (standard deviation hospital stay was 11.4 (10.5 days for patients treated with PC and 5.1 (4.3 days for patients undergoing acute cholecystectomy. After adjusting for age, gender, Charlson comorbidity index, and degree of cholecystitis, the hospital stay was significantly longer for patients treated with PC than for those undergoing acute cholecystectomy (P<0.001 but the risk for intervention-related complications was found to be significantly lower (P=0.001 in the PC group. Conclusion. PC can be performed with few serious complications, albeit with a longer hospital stay.

  12. Effect of LWZY on motility and cholecystostomy in rats with diarrhea predominant irritable bowel syndrome%二味中药复方治疗腹泻型肠易激综合征的实验研究

    Institute of Scientific and Technical Information of China (English)

    张道英; 李洪亮; 范小娜; 曾靖

    2011-01-01

    Objective To observe the effect of LWZY decoction on model rats which had diarrhea predominant irritable bowel syndrome (IBS) with liver depression and spleen deficiency. Methods The rat model used in integer study was "wrap-restraint stress" after perfused sennae solution. The treatment lasted 7 days. The decoction had small, middle and large dose level. The levels of motility (MOT) and cholecystostomy (CCK) in plasma and descending colon tissue were observed. Results Middle and high dose of LWZY could significantly change the rat loose stools class. IBS model rats had a higher content of CCK in colon tissue, and the decoction of LWZY could modulate it to be normal. But MOT had no significant changes neither in plasma nor in tissue. Conclusion LWZY can treat IBS effectively, which maybe correlate with modulating the content of CCK in colon tissue.%目的 观察二味中药煎剂对肝郁脾虚型肠易激综合征大鼠的治疗作用及对胃动素和胆囊收缩素的影响.方法 将实验动物随机分为6组:正常组、模型组、阳性对照组及二味中药高、中、低剂量组.运用番泻叶水煎剂灌胃和束缚结合造模,以各剂量的二味中药煎剂治疗,得舒特为阳性对照药物,测定大鼠稀便级及血清和结肠黏膜中胃动素和胆囊收缩素的含量.结果 高、中剂量的二味中药可以明显改变大鼠的稀便级;二味中药和得舒特可以明显降低结肠黏膜中胆囊收缩素的含量;胃动素在血浆和结肠黏膜中无显著变化.结论 二味中药可以有效治疗肠易激综合征,其作用机制可能与调节胃肠激素有关.

  13. Pain patterns after distension of the gallbladder in patients with acute cholecystitis

    DEFF Research Database (Denmark)

    Middelfart, H V; Jensen, P; Højgaard, L; Funch-Jensen, P

    1998-01-01

    and the cystic duct opening pressure. METHODS: Twelve patients (nine women, three men) treated with cholecystostomy for acute cholecystitis were investigated. Simultaneous cholescintigraphy and measurement of changes in intraluminal gallbladder pressure after injections of saline through a gallbladder...

  14. Percutaneous cholecystostome; 60 cases of experience

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    Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

  15. Úlcera corneal bilateral como consecuencia de malnutrición calórico-protéica y déficit de vitamina A en un paciente con alcoholismo crónico, pancreatitis crónica y colecistostomía Bilateral corneal ulceration as a result of energy-protein hyponutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy

    OpenAIRE

    S. Benítez Cruz; C. Gómez Candela; M. Ruiz Martín; A. I. Cos Blanco

    2005-01-01

    Desde el descubrimiento de las vitaminas ha existido un creciente interés por relacionar las vitaminas con ciertas enfermedades. Para la vitamina A en particular se ha determinado su singular importancia en múltiples funciones vitales y su relación con enfermedades tanto por déficit como por exceso esta ahora completamente demostrada. En países desarrollados las enfermedades por déficit vitamínicos han disminuido de manera importante; sin embargo en pacientes con características particulares ...

  16. Úlcera corneal bilateral como consecuencia de malnutrición calórico-protéica y déficit de vitamina A en un paciente con alcoholismo crónico, pancreatitis crónica y colecistostomía Bilateral corneal ulceration as a result of energy-protein hyponutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy

    Directory of Open Access Journals (Sweden)

    S. Benítez Cruz

    2005-08-01

    Full Text Available Desde el descubrimiento de las vitaminas ha existido un creciente interés por relacionar las vitaminas con ciertas enfermedades. Para la vitamina A en particular se ha determinado su singular importancia en múltiples funciones vitales y su relación con enfermedades tanto por déficit como por exceso esta ahora completamente demostrada. En países desarrollados las enfermedades por déficit vitamínicos han disminuido de manera importante; sin embargo en pacientes con características particulares deben tenerse siempre presente. Se trata de un hombre de 45 años, con antecedentes de alcoholismo crónico, pancreatitis crónica, diabetes mellitus no insulinodependiente y colecistostomía con alto drenaje biliar secundario a colecistitis enfisematosa y absceso perivesicular. Consulta por dolor ocular bilateral, fotofobia y disminución de la agudeza visual además de una historia de heces pastosas, pegajosas y malolientes. Ingresa a cargo de Oftalmología y diagnostican úlcera córneal bilateral. Cursan una interconsulta al Servicio de Nutrición por presencia de caquexia. Se detecta malnutrición calórica severa y proteica leve con IMC de 18,2 y pérdida del 23% de su peso habitual en los últimos 6 meses, déficit de vitaminas liposolubles (A, D y E, malabsorción grasa leve y anemia macrocítica é hipocrómica. Suplementamos la dieta del paciente con una formula hiperproteica e hipercalórica especial para diabéticos, se administran las vitaminas deficitarias, enzimas pancreáticas para mejorar la malabsorción y se controlan las glucemias con insulina. Cuatro meses después paciente es evaluado y presenta un IMC de 20, la anemia esta resuelta y desde el punto de vista oftalmológico evoluciona favorablemente, las ulceras mejoran y la agudeza visual se recupera casi por completo. En pacientes alcohólicos crónicos con un nivel bajo de ingesta y complicaciones clínicas con repercusiones nutricionales (pancreatitis que produce malabsorción o colecistostomia con drenaje biliar percutáneo no debemos olvidar que los déficits de micronutrientes pueden explicar la etiología de otras patologías asociadas en este caso las ulceras cornéales.Since the discovery of vitamins, there has been an increasing interest at relating vitamins with particular diseases. In particular, for vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries, vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic alcoholism, non insulin-dependent diabetes mellitus and cholecystectomy with a high biliary drainage secondary to emphysematous cholecystitis and perivesicular abscess. He complains of bilateral ocular pain, photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of cachexia. Severe caloric and mil protein hyponutrition is observed with a BMI of 18.2 and a 23% weight loss for the last 6 months, fat-soluble vitamins (A, D and E deficit, mild fat malabsorption, and macrocytic and hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient vitamins and pancreatic enzymes to improve absorption are administered, and glycemia is controlled with insulin. Four months later, the patient is assessed and has a BMI of 20, anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (pancreatitis that produces malabsorption or cholecystectomy with biliary percutaneous drainage we should not forget that micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration.

  17. New device for dilatation of percutaneous biliary tract

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung-Gwon; Lim, Myung-Gwan; Cho, Young-Kook; Suh, Chang-Hae [Inha Univ. Hospital, Inchon (Korea, Republic of); Yoon, Hyun Ki; Song, Ho-Young; Sung, Kyu Bo [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Shin, Joo-Won [Ulgi Hospital, Seoul (Korea, Republic of)

    1997-06-01

    To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. We dilated 28 percutaneous biliary drainage tracts up to 18F; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biopsy (n=10). For dilatation, local anesthesia was used in all cases. In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1), and fever (n=1). In choledocoscopy, tract dilatation using a Nipro set is safe and simple.

  18. [Tertiary syphilis of the pancreas and liver in 82-year-old patient: case study].

    Science.gov (United States)

    Denisova, T L; Tiul'tiaeva, L A; Lipatova, T E; Bakulev, A L; Alipova, L N; Apanasevich, A V; Bezrodnaia, L A; Borisova, E A

    2013-01-01

    It has been described a clinical case of late diagnosis of syphilis of the pancreas and liver of elderly patients. Two years before that it was wrongly diagnosed with cancer of the pancreas with liver metastases, and the patient was operated on with the imposition of cholecystostomy. It was conducted appropriate therapy and reconstructive surgery after verification of the diagnosis of syphilis of the pancreas and liver. PMID:24772875

  19. Case of severe acute pancreatitis with near total pancreatic necrosis diagnosed by dynamic CT scanning

    Energy Technology Data Exchange (ETDEWEB)

    Takeda, Kazunori; Kakugawa, Yoichiro; Amikura, Katsumi; Miyagawa, Kikuo; Matsuno, Seiki; Sato, Toshio

    1987-09-01

    A 42 year-old woman with severe acute pancreatitis had drainage of the pancreatic bed, cholecystostomy and jejunostomy on admission, but symptoms were not improved. Fourteen days after admission, clinical sepsis and septisemia were recognized. Dynamic CT scanning of the pancreas showed near total pancreatic necrosis. Symptoms were improved after necrosectomy of the pancreas and debridement of the peripancreatic necrotic tissue were performed. Our experience suggests the usefulness of dynamic CT scanning for detection of pancreatic necrosis in severe acute pancreatitis.

  20. [Use of laparoscopy in the diagnosis and treatment of obstructive jaundice].

    Science.gov (United States)

    Nesterenko, O L

    1994-01-01

    The results of treatment of 116 patients with diseases of hepato-pancreatoduodenal zone organs, complicated by obstructive jaundice, are adduced. In 63 patients the laparoscopy was applied, in 39--an external drainage of the biliferous ducts with the help of laparoscopic cholecystostomy or cholangiostomy and the direct radiopaque investigation of biliferous system. After the liver function indexes normalization and the jaundice liquidation an operative intervention using laparotomy was done. Lethality was 1,72%. PMID:7658665

  1. Radiological interventions in malignant biliary obstruction.

    Science.gov (United States)

    Madhusudhan, Kumble Seetharama; Gamanagatti, Shivanand; Srivastava, Deep Narayan; Gupta, Arun Kumar

    2016-05-28

    Malignant biliary obstruction is commonly caused by gall bladder carcinoma, cholangiocarcinoma and metastatic nodes. Percutaneous interventions play an important role in managing these patients. Biliary drainage, which forms the major bulk of radiological interventions, can be palliative in inoperable patients or pre-operative to improve liver function prior to surgery. Other interventions include cholecystostomy and radiofrequency ablation. We present here the indications, contraindications, technique and complications of the radiological interventions performed in patients with malignant biliary obstruction. PMID:27247718

  2. Percutaneous transhepatic biliary drainage in an infant with obstructive jaundice caused by neuroblastoma.

    Science.gov (United States)

    Saettini, Francesco; Agazzi, Roberto; Giraldi, Eugenia; Foglia, Carlo; Cavalleri, Laura; Morali, Laura; Fasolini, Giorgio; Spotti, Angelica; Provenzi, Massimo

    2015-04-01

    Neuroblastoma presenting with obstructive jaundice is a rare event. Management of this condition includes surgery, chemotherapy, radiotherapy, temporary cholecystostomy tube, endoscopic retrograde cholangiopancreatography (ERCP), and internal biliary drainage (IBD). We herein describe our experience with one infant affected by neuroblastoma presenting with jaundice, who successfully underwent percutaneous transhepatic biliary drainage (PTBD). This report introduces PTBD as a viable treatment option for neuroblastoma and obstructive jaundice and provides a review of the pertinent literature. PMID:25551550

  3. Acute acalculous cholecystitis.

    Science.gov (United States)

    Barie, Philip S; Eachempati, Soumitra R

    2003-08-01

    Acute cholecystitis can develop without gallstones in critically ill or injured patients. However, the development of acute acalculous cholecystitis is not limited to surgical or injured patients, or even to the intensive care unit. Diabetes, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, and shock or cardiac arrest have been associated with acute acalculous cholecystitis. Children may also be affected, especially after a viral illness. The pathogenesis of acute acalculous cholecystitis is a paradigm of complexity. Ischemia and reperfusion injury, or the effects of eicosanoid proinflammatory mediators, appear to be the central mechanisms, but bile stasis, opioid therapy, positive-pressure ventilation, and total parenteral nutrition have all been implicated. Ultrasound of the gallbladder is the most accurate diagnostic modality in the critically ill patient, with gallbladder wall thickness of 3.5 mm or greater and pericholecystic fluid being the two most reliable criteria. The historical treatment of choice for acute acalculous cholecystitis has been cholecystectomy, but percutaneous cholecystostomy is now the mainstay of therapy, controlling the disease in about 85% of patients. Rapid improvement can be expected when the procedure is performed properly. The mortality rates (historically about 30%) for percutaneous and open cholecystostomy appear to be similar, reflecting the severity of illness, but improved resuscitation and critical care may portend a decreased risk of death. Interval cholecystectomy is usually not indicated after acute acalculous cholecystitis in survivors; if the absence of gallstones is confirmed and the precipitating disorder has been controlled, the cholecystostomy tube can be pulled out after the patient has recovered. PMID:12864960

  4. Occlusion of the cystic duct by electrocoagulation: A radiologic technique

    International Nuclear Information System (INIS)

    Chemical dissolution and extracorporeal shock wave lithotripsy are promising new methods for the treatment of cholelithiasis without cholecystectomy. Nonsurgical defunctionalization of the gallbladder is now required to prevent recurrent stone formation. The authors consider cystic duct occlusion to be the first step. Ten domestic pigs underwent transcatheter electrocoagulation of the cystic duct via a cholecystostomy under fluoroscopic control. Stricture formation was followed by complete cystic duct occlusion in all ten cases. After a follow-up period ranging from 2 to 17 weeks (mean, 13 weeks), the animals were killed. Histologic studies demonstrated that complete obliteration of the cystic duct lumen was due to fibrous scar formation

  5. Management of empyema of gallbladder with percutaneous cholecysto-duodenal stenting in a case of hilar cholangiocarcinoma treated with common bile duct metallic stenting

    Directory of Open Access Journals (Sweden)

    Sheo Kumar

    2011-01-01

    Full Text Available Empyema of the gallbladder develops when the gallbladder neck is obstructed in the presence of infection, preventing pus from draining via the cystic duct. Treatment options include cholecystectomy or, in patients with comorbidities, drainage via percutaneous cholecystostomy, later followed by cholecystectomy. Here, we describe a 59-year-old man who presented with complaints of recurrent hiccups and was found to have cholangiocarcinoma causing obstruction to cystic duct drainage. The patient was managed successfully by percutaneous transhepatic cholecysto-duodenal self-expandable covered metal stent.

  6. Early diagnosis and treatment of severe acute cholangitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Zhong Zhang; Yi-Shao Chen; Jin-Wei Wang; Xue-Rong Chen

    2002-01-01

    AIM: To investigate the diagnostic standard for earlyidentification of severe acute cholangitis in order to lowerthe incidence of morbidity and mortality rate.METHODS: A diagnostic standard was proposed in thisstudy as follows: documented biliary duct obstruction byultrasound or computerized tomography or other imagingtools with the manifestation of systemic inflammatoryresponse syndrome (SIRS). The surgical proceduresincluded emergency common bile duct exploration with Ttube insertion or cholecystostomy with secondary commonbile duct exploration. And incidence of postoperativemultiple organ dysfunction syndrome (MODS), duration ofsystemic inflammatory response and hospital mortality wereanalyzed.RESULTS: Fourty - three patients conforming to thediagnostic standard described above were employed in thisstudy. 1 patient was admitted in acutely ill condition andcomplicated with acute relapse of chronic bronchitis,cholecystostomy procedure was performed but the patientwas complicated with postoperative acute lung injury whiclwas treated by assisted mechanical ventilation for 5 d; 2 wllater, two- stage common bile duct Exploration and T tubeinsertion were performed. The remaining 42 patientsunderwent primary common bile duct exploration and T tubeinsertion, 1 developed acute lung injury and recovered 3 dlater, 2 patients developedl acute renal dysfunction, 1 ofwhich recovered 2 d later and the other died on d 4. For allpatients, the postoperative systemic inflammatory responsepersisted for 2 to 8 d with median of 3 d.CONCLUSION: Early diagnosis of severe acute cholangitiscan be made using this diagnostic standard, furtherdevelopment of systemic inflammatory response could beprevented and incidence of MODS as well as hospitalmortality decreased.

  7. Pediatric Pancreatic Hemangioma: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Richard J England

    2006-09-01

    Full Text Available Context :The pancreas is an unusual site for a hemangioma in an infant. A child with obstructive jaundice caused by a pancreatic hemangioma is presented and management strategies for this benign tumor are discussed. Case report :A 5-month-old girl presented with a 2-week history of jaundice, pale stools and dark urine. Liver function tests confirmed obstructive jaundice. An abdominal ultrasound scan and magnetic resonance imaging showed an enhancing mass in the head of the pancreas. At laparotomy, a wedge biopsy of the pancreatic tumor was taken and a tube cholecystostomy inserted. Histological examination of the specimen revealed a pancreatic hemangioma with sclerotic features. The high volume of bile loss from the cholecystostomy proved problematic and biliary diversion with a Roux-en-y hepaticojejunostomy was therefore performed. The tumor subsequently regressed spontaneously and was no longer visible on follow-up imaging two years later. The child has since thrived. Conclusions :Pancreatic hemangiomas are rare and may cause diagnostic confusion. Pancreatic resection should be avoided since the natural history of these benign tumors is that of spontaneous involution. Various strategies can be used to manage any associated obstructive jaundice.

  8. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    International Nuclear Information System (INIS)

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  9. Non-traumatic abdominal emergencies: imaging and intervention in acute biliary conditions

    Energy Technology Data Exchange (ETDEWEB)

    Menu, Yves; Vuillerme, Marie-Pierre [Department of Radiology, Hopital Beaujon, 92118 Clichy Cedex (France)

    2002-10-01

    Imaging is the standard method for the evaluation of emergency bile ducts and gallbladder diseases. Imaging may help to treat the patient also. In acute cholecystitis, association of clinical and sonographic data is accurate for the diagnosis, even when the patient is examined by a junior radiologist. Computed tomography may be required for those patients with unusual presentation such as emphysematous cholecystitis, perforation, or abscess. Acalculous cholecystitis is a challenging problem. It sometimes requires percutaneous cholecystostomy for diagnosis or treatment purposes. In patients with acute cholangitis, sonography remains the first step for imaging, but its diagnostic accuracy is disappointing. This is related to low sensitivity, despite a high specificity. Computed tomography carries a slightly better sensitivity, and again a high specificity but overall accuracy is not sufficient. Magnetic resonance cholangiography and endosonography are the best methods for the detection. Both have advantages and limitations, including cost and availability, but endoscopic retrograde cholangiopancreatography remains necessary for therapeutic purposes, especially stone extraction. In conclusion, emergency radiologists should be able to put the patient through multiple imaging modalities in order to make a prompt diagnosis with no delay, and be aware of the therapeutic options, including cooperation between radiologist, endoscopist, and surgeon. (orig.)

  10. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    International Nuclear Information System (INIS)

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected

  11. Percutaneous management of tumoral biliary obstruction in children

    International Nuclear Information System (INIS)

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  12. Training vs practice: A tale of opposition in acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Purvi; P; Patel; Shaun; C; Daly; Jose; M; Velasco

    2015-01-01

    Acute cholecystitis is one of the most common surgical diagnoses encountered by general surgeons.Despite its high incidence there remains a range of treatment of approaches.Current practices in biliary surgery vary as to timing,intraoperative utilization of biliaryimaging,and management of bile duct stones despite growing evidence in the literature defining best practice.Management of patients with acute cholecystitis with early laparoscopic cholecystectomy(LC)results in better patient outcomes when compared with delayed surgical management techniques including antibiotic therapy or percutaneous cholecystostomy.Regardless of this data,many surgeons still prefer to utilize antibiotic therapy and complete an interval LC to manage acute cholecystitis.The use of intraoperative biliary imaging by cholangiogram or laparoscopic ultrasound has been demonstrated to facilitate the safe completion of cholecystectomy,minimizing the risk for inadvertent injury to surrounding structures,and lowering conversion rates,however it is rarely utilized.Choledocholithiasis used to be a diagnosis managed exclusively by surgeons but current practice favors referral to gastroenterologists for performance of preoperative endoscopic removal.Yet,there is evidence that intraoperative laparoscopic stone extraction is safe,feasible and may have added advantages.This review aims to highlight the differences between existing management of acute cholecystitis and evidence supported in the literature regarding best practice with the goal to change surgical practice to adopt these current recommendations.

  13. Interventional procedures in the gallbladder

    International Nuclear Information System (INIS)

    Nonsurgical methods of methods of treating gallstones, contact dissolution and extracorporeal shock wave lithotripsy, increase the demand for gallbladder intervention. It is important to determine the safety of these procedures. Fifty-six procedures were performed in 46 patients. Diagnostic studies included needle aspiration of bile (n = 5) and transcholecystic cholangiography (TCC)(n = 31). Therapeutic procedures, percutaneous cholecystostomy (PC)(n = 20), were performed for biliary decompression or stone dissolution. Guidance was by US and fluoroscopy. All the TCC studies were diagnostic, 22 of 31 patients had normal ducts, one had common bile duct (CBD) stones without dilatation, one had dilated ducts without obstruction, and seven had CBD obstruction. PC was successful in all 20 patients. Ten were thought to have cholecystitis or biliary sepsis. Only four of ten showed significant improvement after PC. Local bile peritonitis occurred in two of 31 patients after TCC. Two of 20 undergoing PC had complications; one had 2-3 hours of abdominal pain, and one had peritonitis lasting for 4 days

  14. Tratamiento no quirúrgico de la litiasis biliar Non-Surgical treatment of biliary calculi

    Directory of Open Access Journals (Sweden)

    Felipe Franco

    1992-01-01

    Full Text Available

    Se describen diversos procedimientos para el tratamiento no quirúrgico de la colelitiasis: la administración de ácidos billares orales, la litotripsia extracorpórea, la colecistostomía percutánea, la escleroterapia de la vesícula y la litotripsia mecánica; se consignan las indicaciones, ventajas, desventajas y limitaciones de cada uno de ellos.

    Several procedures are described for non-surgical treatment of biliary calculi, namely: oral administration of bile acids, extracorporeal shock-wave lithotrypsy I percutaneous cholecystostomy I gallbladder sclerotherapy

    and mechanicallithotrypsy. lndications, advantages, disadvantages and limitations of each procedure are discussed.

  15. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  16. Gianturco metallic biliary stent in malignant biliary obstruction: results of follow-up in dead patients

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk; Kim, Chan Soo; Lee, Kyung Soo; Choi, See Sung; Won, Jong Jin; Kim, Haak Cheul; Chae, Kwon Mook [Wonkwang University School of Medicine, Iri (Korea, Republic of)

    1994-04-15

    In order to study the patency, restenosis, efficacy, and complication of the metallic stent in the course of treatment of malignant biliary obstruction, the results of follow up of the dead patients after stent insertion were reviewed. Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients: 10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1-14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected.

  17. Percutaneous Transhepatic Biliary Interventions in Benign Diseases of Children

    Directory of Open Access Journals (Sweden)

    Medih Celiktas

    2015-06-01

    Materials and Methods: In this retrospective study, percutaneous biliary interventions were performed in fifteen children with a mean age of 10.2 years (range 14 days-14 years. Patients presented with jaundice (n=5 and/or cholangitis (n=10. Percutaneous transhepatic biliary drainage (PTBD performed in 10 patients, PTBD plus balloon dilation in 3, percutaneous cholecystostomy (PC in 1, PTBD following PC in 1. Results: All procedures were technically successful. No procedure-related mortality occurred in patients. Serum bilirubin levels returned to normal or near normal in ten of twelve cases. Preexisting cholangitis and acute cholecystitis resolved in all patients. Six patients underwent surgery following percutaneous management. Nine patients cured primarily with percutaneous interventions with no further treatment. Conclusion: Percutaneous biliary interventions can be performed effectively in benign diseases of children. It can be performed either as a primary treatment modality or as a bridge prior to surgery. In most of cases, percutaneous treatment is sufficient and unnecessary surgery is prevented. [Cukurova Med J 2015; 40(2.000: 298-305

  18. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  19. Percutaneous biliary interventions through the gallbladder and the cystic duct: What radiologists need to know.

    Science.gov (United States)

    Hatzidakis, A; Venetucci, P; Krokidis, M; Iaccarino, V

    2014-12-01

    Percutaneous cholecystostomy is an established drainage procedure for the management of high-risk patients with acute cholecystitis. However, percutaneous image-guided access to the gallbladder may not be limited to the simple placement of a drain, but may also be used as an alternative approach to the biliary tree through the catheterization of the cystic duct, for a variety of other more complicated conditions. Percutaneous transcholecystic interventions may be performed in both malignant and benign disease. In the case of malignant jaundice, the transcholecystic route may be used when the liver parenchyma is occupied by metastatic lesions and transhepatic access is not possible. In benign conditions, access through the gallbladder may offer a solution if the biliary tree is not dilated. The transcholecystic access may then be route of insertion of large sheaths, internal drainage catheters, lithotripsy devices, stone retrieval baskets, and stents. The purpose of this review is to illustrate the techniques and to discuss the indications, complications, and technical difficulties of this alternative access to the biliary tree. PMID:25172204

  20. Pancreatic and gastrointestinal trauma in children.

    Science.gov (United States)

    Grosfeld, J L; Cooney, D R

    1975-05-01

    Injuries to the pancreas and gastrointestinal tract following blunt abdominal trauma continue to be a significant cause of morbidity and mortality in the pediatric age group. Optimal treatment of these injuries is frequently hampered by considerable delays in diagnosis. Factors contributing to these delays include the location of much of the duodenum and the pancreas in the retroperitoneum resulting in an absence of initial symptoms and signs, the often trivial nature of some of the responsible blunt traumatic accidents, inappropriate child-parent or child-physician communication, failure to achieve a meaningful physical examination in uncooperative or unconscious patients, and false negative paracentesis. Eighty per cent of these injuries occurred in boys. Eleven of 16 patients with pancreatic trauma had pseudocysts. A persistently elevated serum amylase level was invariably noted and epigastric mass was palpable in eight patients. Significant delays in diagnosis were prevalent and pseudocysts was misdiagnosed as appendicitis in three cases. Internal drainage by cystgastrostomy or cystjejunostomy was effective operative treatment. In instances of acute pancreatic injuries, sump drains, gastrostomy, cholecystostomy, and total parenteral hyperalimentation were useful therapeutic adjuncts. There was one death for a 6.2 per cent mortality rate. Forty patients had gastrointestinal injuries involving the duodenum in 17, jejunum in 14, ileum in seven, and stomach in two. Perforations occured in 65 per cent of cases, obstructing hematomas in 30 per cent, and mesenteric avulsions in 5 per cent. Associated injuries were observed in 15 patients (37.5 per cent). Pain and tenderness were the only consistent findings. Upper gastrointestinal contrast studies were diagnostic of duodenal hematomas. Eighty per cent of perforations were managed by simple closures and 20 per cent by resection and anastomosis. Obstructing hematomas unassociated with other injuries may be expected to