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Sample records for choledocholithiasis

  1. THE METHODS OF CHOLEDOCHOLITHIASIS TREATMENT

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    N. V. Merzlikin

    2015-01-01

    Full Text Available The methods of choledocholithiasis treatment, which are currently used in clinics of the Russian Federa-tion, has been presented. The problems of diagnosis and treatment of gallstones (GSD in individuals of different age groups are spotlighted. In the study of treatment of cholelithiasis and choledocholithiasis, including arising complications, it can be concluded that so far the ideal method of treatment of this pa-thology has not been found. Up to now, the majority of doctor’s main treatment is surgical removal of gall stones by some method or other.This article also considers a conservative approach (drug: antispasmodics (selective and nonselective, and non-pharmacological: treatment, diet, describes the criteria and assessment of the effectiveness of therapeutic interventions that help in the question of further treatment: the continuation of drug therapy or assignment of surgical treatment. Invasive techniques that are covered in the article, namely, a tech-nique of remote and endoscopic lithotripsy, are high-tech and in demand at the moment, which, along with high efficiency removal of a stone, reduced the number and severity of postoperative complications. Additionally, in the analysis of the features of a particular method of treatment, advantages and disadvantages of different treatment methods are described, indications and contraindications (absolute and relative together with complications, possible outcomes, and further prognosis are high-lighted. 

  2. [ASSOCIATION OF DUODENAL DIVERTICULUM PRESENCE WITH CHOLEDOCHOLITHIASIS

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    Machado Mayurí, Alberto; Gómez, Aldo; Yriberry, Simón; Valdiviezo, Alfredo; Lozano, Adelina; Villena, Ovidio

    1998-01-01

    OBJECTIVES: The aim of this study was to investigate in aretrospective way the frequency of duodenal diverticulum and its association with choledocholithiasis. Methods:This study included 2728 consecutive patients who underwent ERCP during the period 1993-1997. Duodenal diverticulum was discovered in 122 cases (4.5%). In 22 patients cannulation was not achieved since it was not technically possible. Results: In 100 patients with successful cannulation, 54 cases with juxtapapillary diverticulum were encountered associated with choledocholithiasis. CONCLUSION: These data suggestthat duodenal diverticulum is associated with choledocholithiasis.

  3. [Extreme hyperbilirubinemia associated with spherocytosis and choledocholithiasis].

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    Peralta-Zagal, J A; Hernández-Estrada, M

    1990-01-01

    Spherocytosis conditions the severe destruction of red blood cells. The spleen plays an active and fundamental role in this destruction since it is responsible for the fragility and lability of the red blood cell to the splenic medium. The clinical manifestations are: anemia, jaundice, splenomegaly, and hemolytic and aplastic crisis associated to viral infections. Choledocholithiasis is a manifestation of the disease which can be seen at an early stage, even in less severe cases. Choledocholithiasis is rare and this may be due to immediate surgical intervention. The levels of indirect bilirubin may vary but usually do not exceed 10 mg%, on the rising of direct bilirubin may cause suspicion of liver obstruction or damage. A case of a ten year old boy is reported who was found to have spherocytosis, with severe manifestations, who later developed cholelithiasis and total obstruction of the choledocho and in who the most important clinical manifestation was jaundice due to the increase of total bilirubin to 89 mg%, doubly checked. Both a splenectomy and a cholecystectomy were performed. Subsequent checkups were normal. These levels of bilirubin have not been previously reported. Hyperbilirubinemia; spherocytosis; choledocholithiasis.

  4. Choledocholithiasis: Evolving standards for diagnosis and management

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    Marilee L Freitas; Robert L Bell; Andrew J Duffy

    2006-01-01

    Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States.Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones.CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones.The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised.The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.

  5. CLINICAL STUDY AND MANAGEMENT OF CHOLEDOCHOLITHIASIS

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    Suresh

    2014-10-01

    Full Text Available BACKGROUND AND OBJECTIVES: Choledocholithiasis complicates the working and management of cholelithiasis necessitating additional diagnostic procedures, increasing morbidity and mortality. CBD stone generally remain asymptomatic but when symptoms start appearing, cause a lot of suffering. There are various treatment modalities available presently. The objective of our study was to study the incidence, various modes of clinical presentations and different modalities of treatment in common bile duct stones. MATERIALS AND METHODS: 35 Patients were prospectively studied from July 2012 to June 2014 as in-patients in Victoria Hospital. RESULTS: CBD stones occurred predominantly in elderly females and presented from subclinical jaundice to complications in the form of biliary pancreatitis and cholangitis. USG abdomen with LFT was able to diagnose majority of the CBD stones preoperatively. Per operative cholangiogram was used selectively in case USG was inconclusive, ERCP was used in patients presenting with severe obstructive jaundice, pancreatitis, cholangitis, minimal CBD ductal dilation. Open exploration was the main focus with a wide variety of procedures performed according to specific indications. CONCLUSION: CBD was more common in elderly female patients probably due to neglected gall bladder stones. CBD stones can occur from occult asymptomatic stones only with altered LFT to symptomatic presentation in the form of cholangitis, pancreatitis. USG abdomen was inexpensive and easily available imaging modality to diagnose CBD stones with per operative cholangiogram being needed in minority of the cases. While ERCP was good in treating complications of CBD stones and early stages of the disease; the more advanced stage of the disease with gross CBD ductal dilation and multiple stones open CBD exploration were more productive.

  6. US diagnosis of choledocholithiasis in patients with acute cholecystitis: Its clinical significance

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    Koo, Joon Bum; Kim, Young Hoon; Cho, Woo Ho; Kim, Joung Sook; Kim, Soung Hee; Kim, Jae Hyung; Bae, Sang Jin [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2002-12-15

    It is essential to identify the presence of choledocholithiasis in patients with acute cholecystitis for elucidating the cause of cholecystitis and deciding the surgical planning. In this study, we tried to evaluate the incidence of choledocholithiasis and its ultrasonographic (US) diagnostic values in patients with acute cholecystitis and to discuss its clinical significance. During a 17 months period, seventy six patients with surgically proven acute cholecystitis who underwent preoperative US and endoscopic retrograde cholangiopancreatography (ERCP) were included in this study. US, ERCP and surgical findings of these patients were compared by reviewing their medical records as well as the US and ERCP images. The incidence of choledocholithiasis in these patients and its US diagnostic values were assessed. Of all 76 patients with acute cholecystitis, 20 (26%) were proved to have choledocholithiasis by ERCP and surgery. Among them, 13 were correctly diagnosed to have choledocholithiasis by US. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of US for the detection of choledocholithiasis in these patients were 65%, 100%, 100%, 89%, and 91%, respectively. Our results indicated that on fourth of patients with acute cholecystitis had choledocholithiasis, and the US diagnostic accuracy in detecting choledocholithiasis proved to be 91%, higher than previously reported results. Therefore, it is essential to undergo US in patients with acute cholecystitis to identify the presence of choledocholithiasis.

  7. The role of magnetic resonance cholangiopancreatography (MRCP) in choledocholithiasis

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    Yamazaki, Yukinao; Nishikawa, Kunihisa; Ohtaki, Tetsuo; Hata, Masanori; Miyaji, Hideki; Hayashi, Shigeyuki [Fukui Red Cross Hospital (Japan)

    2001-07-01

    Recently, magnetic resonance cholangiopancreatography (MRCP) has been widely used in the clinical field as a noninvasive method to visualize the main pancreatic duct and the biliary system. We evaluated the accuracy of MRCP, abdominal CT and abdominal urtrasonography in the diagnosis of choledocholithiasis in comparison with that of endoscopic retrograde cholangiopancreatography (ERCP). Forty patients with choledocholithiasis with some complications, such as icterus, pancreatitis or cholangitis, were examined by MRCP, CT, US and ERCP. We studied the detection rate of the common bile duct stones in MRCP, CT, US separately, and the diagnostic value of each of the other techniques was compared with that of ERCP. The detection rate of common bile duct stones in MRCP, CT and US was 87.5%, 80.5% and 45.0%, respectively. The combined detection rate in MRCP and CT, MRCP and US, CT and US, and MRCP, CT and US was 95.0%, 97.5%, 80.0% and 100%, respectively. MRCP could not efficiently detect common bile duct stones less than 5 mm in size. Moreover, it was impossible to detect impacted stones in the papilla of Vater by MRCP. Currently, it would seem that the combination of MRCP, CT and US has comparable efficacy for the diagnosis of common bile duct stones in patients with the complications to that of ERCP. (author)

  8. Role of endoscopic ultrasound/SpyScope in diagnosis and treatment of choledocholithiasis in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Mohit; Girotra; Niraj; Jani

    2010-01-01

    Cholelithiasis and choledocholithiasis occur frequently in pregnancy and their management can be complicated. Traditional endoscopic retrograde cholangiopancreatography(ERCP)is the first line treatment for choledocholithiasis,but in addition to its baseline risks,fluoroscopy poses an additional radiation risk to the fetus. Endoscopic ultrasound(EUS)is an accurate modality for detecting common bile duct stones,but its role has not been defined in pregnancy.We describe an alternative management strategy to co...

  9. Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    Hirotada Akiho; Masahiro Matsumoto; Shingo Endo; Kazuhiko Nakamura; Yorinobu Sumida; Kazuya Akahoshi; Atsuhiko Murata; Jiro Ouchi; Yasuaki Motomura; Taisuke Toyomasu; Mitsuhide Kimura; Masaru Kubokawa

    2006-01-01

    AIM: To evaluate whether an automatically controlled cut system (endocut mode) could reduce the complication rate of endoscopic sphincterotomy (EST)and serum hyperamylasemia after EST compared to the conventional blended cut mode.METHODS: From January 2001 to October 2003, 134patients with choledocholithiasis were assigned to either endocut mode group or conventional blended cut mode group at the time of sphincterotomy. The two groups were retrospectively compared for the complications after EST and serum amylase level before and 24 h after the procedure.RESULTS: Of the 134 patients treated, 79 were assigned to conventional blended cut mode group and 55 to endocut mode group. There was no significant difference in age, sex, and serum amylase level before EST between the two groups. Complications were found in 5 patients of the endocut mode group (9%):hyperamylasemia (5 times higher than normal) in 4 and moderate pancreatitis in 1. Complications were found in 13 patients of the conventional blended cut mode group (16%): hyperamylasemia in 12 and moderate pancreatitis in 1. Serum amylase levels were elevated in both groups 24 h after EST (P<0.02). The average serum amylase level 24 h after EST in the conventional blended cut mode group was significantly higher than that in the endocut mode group (P< 0.05).CONCLUSION: Endocut mode offers a safety advantage over conventional blended cut mode for pancreatitis after EST by reducing hyperamylasemia.

  10. Clostridium perfringens bacteremia caused by choledocholithiasis in the absence of gallbladder stones

    Institute of Scientific and Technical Information of China (English)

    Antwan Atia; Tejas Raiyani; Pranav Patel; Robert Patton; Mark Young

    2012-01-01

    A 67-years-old male presented with periumbilical abdominal pain,fever and jaundice.His anaerobic blood culture was positive for clostridium perfringens.Computed tomogram scan of the abdomen and abdominal ultrasound showed normal gallbladder and common bile duct (CBD).Subsequently magnetic resonance cholangiopancreaticogram showed choledocholithiasis.Endoscopic retrograde cholangiopancreaticogramwith sphincterotomy and CBD stone extraction was performed.The patient progressively improved with antibiotic therapy Choledocholithiasis should be considered as a source of clostridium perfringens bacteremia especially in the setting of elevated liver enzymes with cholestatic pattern.

  11. Computed tomographic cholangiography in the diagnosis of choledocholithiasis; Colangio-TC en el diagnostico de coledocolitiasis

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    Lopez-Negrete, L.; Sanchez, J. L.; Garcia-Lozano, J.; Tejeiro, A.; Salas, J. [Hospital Valle del Nalon. Riano-Langreo. Asturias (Spain)

    2001-07-01

    Over a one-year period we performed 32 conventional computed tomography (CT) studies involving the intravenous administration of a contrast material that is cleared by the biliary system (Bilisergol), in patients in presenting clinical or radiological features of choledocholithiasis. The results were compared with the findings from endoscopic retrograde cholangiopancreatography (ERCP) and/or surgery. The sensitivity and specificity of intravenous cholangiography with conventional CT was 92 %. We demonstrate the utility of this widely available study, when performed according to protocol during apnea, with acquisition of thin sections. It is a highly sensitive and specific tool in the diagnosis of choledocholithiasis. (Author) 10 refs.

  12. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula.

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    West, Sara; Shellenberger, M Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  13. No Stone Left Unturned: Using Choledocholithiasis to Open a Papillary Stenosis via a Choledochodudenal Fistula

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    West, Sara; Shellenberger, M. Joshua

    2016-01-01

    In a patient found to have cholelithiasis and choledocholithiasis, a choledochoduodenal fistula was used to gain access to the bile duct. Due to severe stenosis and atrophy of the major papilla, cannulation was not possible. Stones were purposely impacted in the native ampulla to cause bulging and stretching of the stenosis. Once the stenosis was stretched, the bile and pancreatic duct were accessed via the native ampulla, allowing for stone removal.

  14. Limited endoscopic sphincterotomy plus large balloon dilation for choledocholithiasis with periampullary diverticula

    Institute of Scientific and Technical Information of China (English)

    Hyung; Wook; Kim; Dae; Hwan; Kang; Cheol; Woong; Choi; Jong; Hwan; Park; Jin; Ho; Lee; Min; Dae; Kim; Il; Doo; Kim; Ki; Tae; Yoon; Mong; Cho; Ung; Bae; Jeon; Suk; Kim; Chang; Won; Kim; Jun; Woo; Lee

    2010-01-01

    AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS...

  15. Management of choledocholithiasis: Comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy

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    Qi Wei; Jian-Guo Wang; Li-Bo Li; Jun-Da Li

    2003-01-01

    AIM: Choledocholithiasis is present in 5 to 10 percent of patients who have cholelithiasis. Tn the area of laparoscopic cholecystectomy (LC), laparoscopic common bile duct exploration (LCBDE) and intraoperative endoscopic sphincterotomy (IOES) have been used to treat choledocholithiasis. The purpose of this study was to compare the clinical outcomes and hospital costs of LCBDE with IOES.METHODS: Between November 1999 and October 2002,patients with choledocholithiasis undergoing LC plus LCBDE (Group A, n=45) were retrospectively compared to those undergoing LC plus IOES (Group B, n=57) at a single institution.RESULTS: Ductal stone clearance rates were equivalent for the two groups (88 % versus 89 %, P=0.436). The conversion rate was higher for Group B (8.8 % versus 4.4 %,P=0.381), as was the morbidity (12.3 % versus 6.7 %,P=0.336). There were no other significant differences between the two groups. The complications were mainly related to endoscopic sphincterotomy (ES), and the hospital costs were significantly increased in this subset of Group B (median, 23 910 versus 14 955 RMB yuan, P=0.03). Although hospital stay was longer in Group A (median, 7 versus 6 days,P=0.041), the patients in Group A had a significantly decreased cost of hospitalization compared with those in Group B (median, L1 362 versus 15 466 RMB yuan, P=0.000).CONCLUSION: The results demonstrate equivalent ductal stone clearance rates for the two groups. LCBDE management appears safer, and is associated with a significantly decreased hospital cost. The findings suggest LCBDE for choledocholithiasis is a better option.

  16. Obstructive choledocholithiasis requiring intervention in a three week old neonate: A case report and review of the literature

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    Lindsay E. Peters

    2016-01-01

    Full Text Available The discovery of cholelithiasis in neonates is often incidental, however obstructing common bile duct stones are rare. Herein we report the case of a 3 week old neonate who presented with obstructive choledocholithiasis. The patient was treated conservatively with antibiotics and ursodeoxycholic acid but did not improve. He was therefore taken to surgery for cholecystectomy and stone extraction. The operation was successful and his transaminases and bilirubin levels declined. Trials of conservative management can be attempted in asymptomatic infants with choledocholithiasis. However, failure of the stone to pass or ongoing signs of cholecystitis should be met with operative intervention to remove the obstruction.

  17. Endoscopic retrograde cholangiography for pediatric choledocholithiasis:Assessing the need for endoscopic intervention

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    Douglas S Fishman; Bruno P Chumpitazi; Isaac Raijman; Cynthia Man-Wai Tsai; E O’Brian Smith; Mark V Mazziotti; Mark A Gilger

    2016-01-01

    AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children’s hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.

  18. Percutaneous transpapillary extraction of biliary calculus for symptomatic choledocholithiasis after unsuccessfully endoscopic treatment; Perkutane transpapillaere Gallensteinextraktion bei symptomatischer Choledocholithiasis nach frustranem endoskopischen Behandlungsversuch

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    Zorger, N.; Manke, C.; Lenhart, M.; Voelk, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik

    2001-02-01

    Purpose: Evaluation of a percutaneous transhepatic treatment of symptomatic choledocholithiasis in bile ducts that cannot be reached with the endoscope. Methods: From January 1996 to August 2000 a transhepatic extraction of biliary calculus was performed in four patients. Endoscopic retrograde cholangiography (ERC) was not successful in any of the cases. Clinical symptoms were icterus in four cases, additional cholangitis or colics in two cases. First, a ballon dilation of the papilla was performed by a percutaneous transhepatic approach. For removal of bile duct stones, occlusion catheters and Dormia baskets were used. Technical success was defined as complete removal of bile duct stones. Clinical success was defined as normalization of cholestasis and inflammation parameters. In the follow-up an ultrasound examination was performed and blood samples were taken for control of cholestasis parameters. Results: In all four cases treatment was technically and clinically successful. For complete removal of biliary calculus a second intervention was necessary in two cases. In each case an internal to external drainage was left over a mean of 7 days (3 - 13 days). In the mean follow-up of 30.5 months (6 - 50 months) all patients had persistent relief of symptoms. No further interventions were necessary. No complications were present. Conclusion: Percutaneous transpapillary extraction of biliary calculus is an effective alternative to surgery in patients with bile ducts, that cannot be reached with the endoscope. (orig.) [German] Ziel: Untersuchung der perkutanen transhepatischen Therapie der symptomatischen Choledocholithiasis bei endoskopisch nicht sondierbarem Gallengangssystem. Methoden: Von Januar 1996 bis August 2000 wurde bei 4 Patienten eine transhepatische Gallengangsstein-Entfernung durchgefuehrt. Die Endoskopisch Retrograde Cholangiographie (ERC) war in allen Faellen aufgrund einer vorangegangenen Magenresektion (B II) technisch nicht erfolgreich gewesen. In 4

  19. Diagnostic accuracy of MRCP in choledocholithiasis; Accuratezza diagnostica della colangiowirsung-RM nella coledocolitiasi

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    Guarise, Alessandro; Mainardi, Paride [Ospedale Sacro Cuore-Don Calabria, Negrar, Verona (Italy). Servizio di Radiologia; Baltieri, Susanna; Faccioli, Niccolo' [Verona Univ., Verona (Italy). Istituto di Radiologia Policlinico G. B. Rossi

    2005-03-01

    Purpose: To evaluate the accuracy of MRCP in diagnosing choledocholithiasis considering Endoscopic Retrograde Cholangiopancreatography (ERCP) as the gold standard. To compare the results achieved during the first two years of use (1999-2000) of Magnetic Resonance Cholangiopancreatography (MRCP) in patients with suspected choledocholithiasis with those achieved during the following two years (2001-2002) in order to establish the repeatability and objectivity of MRCP results. Materials and methods: One hundred and seventy consecutive patients underwent MRCP followed by ERCP within 72 h. In 22/170 (13%) patients ERCP was unsuccessful for different reasons. MRCP was performed using a 1.5 T magnet with both multi-slice HASTE sequences and thick-slice projection technique. Choledocholithiasis was diagnosed in the presence of signal void images in the dependent portion of the duct surrounded by hyperintense bile and detected at least in two projections. The MRCP results, read independently from the ERCP results, were compared in two different and subsequent periods. Results: ERCP confirmed choledocholithiasis in 87 patients. In these cases the results of MRCP were the following: 78 true positives, 53 true negatives, 7 false positives, and 9 false negatives. The sensitivity, specificity and accuracy were 90%, 88% and 89%, respectively. After the exclusion of stones with diameters smaller than 6 mm, the sensitivity, specificity and accuracy were 100%, 99% and 99%, respectively. MRCP accuracy was related to the size of the stones. There was no significant statistical difference between the results obtained in the first two-year period and those obtained in the second period. Conclusions: MRCP i sufficiently accurate to replace ERCP in patients with suspected choledocholithiasis. The results are related to the size of stones. The use of well-defined radiological signs allows good diagnostic accuracy independent of the learning curve. [Italian] Scopo: Valutare l

  20. Safety of immediate endoscopic sphincterotomy in acutesuppurative cholangitis caused by choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    AIM To examine the safety of immediate endoscopicsphincterotomy (EST) in patients with acute suppurativecholangitis (ASC) caused by choledocholithiasis, ascompared with elective EST.METHODS: Patients with ASC due to choledocholithiasiswere allocated to two groups: Those who underwent ESTimmediately and those who underwent EBD followed byEST 1 wk later because they were under anticoagulanttherapy, had a coagulopathy (international normalizedratio 〉 1.3, partial thromboplastin time greater thantwice that of control), or had a platelet count 〈 50000× 103/μL. One of four trainees [200-400 cases of endoscopicretrograde cholangiopancreatography (ERCP)]supervised by a specialist (〉 10000 cases of ERCP)performed the procedures. The success and complicationrates associated with EST in each group were examined.RESULTS: Of the 87 patients with ASC, 59 were in theimmediate EST group and 28 in the elective EST group.EST was successful in all patients in both groups. Therewere no complications associated with EST in either groupof patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liverenzymes just before EST were significantly higher in theimmediate EST group than in the elective EST group.CONCLUSION: Immediate EST can be as safe as electiveEST for patients with ASC associated with choledocholithiasisprovided they are not under anticoagulanttherapy, or donot have a coagulopathy or a platelet count 〈 50000 ×103/μL. Moreover, the procedure was safely performed by atrainee under the supervision of an experienced specialist.

  1. Fatores preditivos de coledocolitíase em doentes com litíase vesicular Predictors of choledocholithiasis in patients sustaining gallstones

    Directory of Open Access Journals (Sweden)

    Tércio de Campos

    2004-04-01

    Full Text Available OBJETIVO: Identificar fatores clínicos, bioquímicos e ultra-sonográficos preditivos de coledocolitíase no período pré-operatório de doentes portadores de litíase vesicular avaliados por colangiografia. MÉTODOS: Analisamos prospectivamente 148 doentes portadores de litíase vesicular, relacionando critérios pré-operatórios clínicos, bioquímicos e ultra-sonográficos. Todos estes doentes foram submetidos à colangiografia, podendo esta ser endoscópica pré-operatória ou realizada pelo cirurgião durante a colecistectomia. Foram calculados os valores da sensibilidade, especificidade, valores preditivos positivo (VPP e negativo (VPN, e acurácia para cada um dos critérios estudados, além da correlação de Spearman, Odds ratio e análise de regressão logística para a variável coledocolitíase. RESULTADOS: Os resultado obtidos mostraram que na análise univariada, a presença de icterícia na internação, a elevação de fosfatase alcalina, gama glutamiltransferase (gamaGT, aspartato aminotransferase, alanina aminotransferase, bilirrubina total, e ultra-sonografia (USG com presença de dilatação de vias biliares e visibilização de cálculo na via biliar principal (VBP tiveram diferença estatisticamente significante para coledocolitíase em nossa amostra (pBACKGROUND: The aim of this study was to identify clinical, biochemical and ultrasonographic predictors of choledocholithiasis in patients sustaining gallstones assessed by cholangiography. METHODS: In a prospective study, 148 patients were analyzed regarding clinical, biochemical and ultrasonographic data. All patients underwent cholangiography, either preoperative endoscopic or during cholecystectomy. Each variable was compared between the ones who sustained lithiasis in the biliary tree and the others, in order to find out the predictors of choledocholithiasis. Sensibility, specificity, positive predictive value, negative predictive value (NPV and accuracy were

  2. Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

    Institute of Scientific and Technical Information of China (English)

    Hussain Issa; Ahmed H Al-Salem

    2011-01-01

    AIM: To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC).METHODS: Two hundred and twenty four patients (144 male, 80 female; mean age, 22.4 years; range, 5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ).The indications for ERCP were: CJ only in 97, CJ and dilated bile ducts on ultrasound in 103, and CJ and common bile duct (CBD) stones on ultrasound in 42.RESULTS: In total, CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16.Fifteen were post-LC patients.These had endoscopic sphincterotomy and stone extraction.The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION: In patients with SCA and cholelithiasis, ERCP is valuable whether preoperative or postoperative, and in none was there a need to perform intraoperative cholangiography.Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients.Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

  3. Fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar Predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis

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    José Gustavo Parreira

    2004-12-01

    Full Text Available OBJETIVO: Avaliar o papel da fosfatase alcalina (FA, gama glutamiltransferase (gamaGT e ultra-sonografia (US como fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar (PAB. MÉTODOS: Os dados foram coletados prospectivamente durante um período de 31 meses. Quarenta doentes foram incluídos, sendo 30 mulheres, com média etária de 49 + 16 anos. Foram registrados os dados de todos os doentes com pancreatite aguda biliar. Aqueles doentes ictéricos e com a forma grave da doença foram excluídos. As dosagens de FA e GGT, assim como a US, eram realizadas na admissão e 48 horas antes da cirurgia. Todos os pacientes foram submetidos à colangiografia intra-operatória (CIO ou à colangiografia retrógrada endoscópica (CPRE pré-operatória, que era definida baseada na probabilidade de coledocolitíase. Com o intuito de identificar os indicadores de coledocolitíase, as variáveis foram comparadas entre os pacientes com ou sem coledocolitíase. Os testes t de Student, Qui-quadrado e Fisher foram empregados para a análise estatística, considerando-se pBACKGROUND: To assess the role of alkaline phosphatase (AP, gamil-glutamyltransferase (gammaGT and abdominal ultrasound (US as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis. METHODS: Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 + 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC or pre-operative endoscopic retrograde cholangiography (ERCP, which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients

  4. Comparison of optimized 3D-SPACE and 3D-TSE sequences at 1.5T MRCP in the diagnosis of choledocholithiasis

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    Sudholt, P. [University Hospital Marburg (Germany). Dept. of Diagnostic and Interventional Radiology; Zaehringer, C.; Tyndall, A.; Bongartz, G.; Hohmann, J. [University Hospital Basel (Switzerland). Clinic for Radiology and Nuclear Medicine; Urigo, C. [Ars Medica Clinic, Gravesano-Lugano (Switzerland). Radiology

    2015-06-15

    The aim of the study was to evaluate whether or not MRCP using a 3D-SPACE sequence allows for better image quality and a higher level of diagnostic confidence than a conventional 3D-TSE sequence at 1.5T regarding the diagnosis of choledocholithiasis in a routine clinical setting. 3D-SPACE and 3D-TSE sequences were performed in 42 consecutive patients with suspected choledocholithiasis undergoing MRCP. Evaluation of image quality and diagnostic confidence was done on the pancreaticobiliary tree which was subdivided into 10 segments. They were scored and statistically evaluated separately for visibility and diagnostic certainty by three radiologists with differing levels of experience on a five-point scale of 1 to 5 and -2 to 2, respectively. Student t-test was performed, and the interobserver agreement was also calculated. Image quality for each segment was significantly better for the 3D-SPACE sequence compared to the 3D-TSE sequence (4.48±0.94 vs. 3.98±1.20; 5-point scale p<0.01). Diagnostic confidence for the reporting radiologist was also significantly better for 3D-SPACE than for 3D-TSE (1.68±0.56 vs. 1.46±0.70; 3-point scale; p<0.01). The interobserver agreement was high in both sequences, 0.62-0.83 and 0.64-0.82, respectively. The optimized 3D-SPACE sequence allows for better image quality in 1.5T MRCP examinations and leads to a higher diagnostic confidence for choledocholithiasis compared to the conventional 3D-TSE sequence.

  5. MR Cholangiography: Axial TSE-T2 Sequence Evaluation in the Diagnosis of Choledocholithiasis; Colangiografia RM: evaluacion de la secuencia TSE-T2 axial en la deteccion de coledocolitiasis

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    Alustiza, J. M.; Gervas, C.; Garcia, E.; Recondo, J. A. [Hospital Donostia. San Sebastian (Spain)

    2003-07-01

    To evaluate diagnostic precision of the axial TSE-T2 sequence in the diagnosis of choledocholithiasis. Retrospective analysis of all those MR cholangiography studies performed in our center between January 1998 and June 1999 which were later subjected to conventional cholangiography (intraoperative) as a golden standard. A total of 39 patients was studied. Imaging parameters of the sequence evaluated, fat-suppressed TSE-T2 in the axial plane, were as follows: TE 100 ms, TR 1.800 ms, turbo factor 23 FOV 375 mm, NSA 4, 228 x 256 matrix, respiratory compensation, number of slices 35, slice thickness 3 mm, contiguous slices, scan duration 5'4''. Without having been informed as to the cholangiography result, two radiologists independently analyzed this sequence in order to determine the presence of choledocholithiasis. Their results were latter compared with those of the conventional cholangiography. The sensitivity, specificity and agreement between results were all calculated. 21 patients had choledocholithiasis. The analyzed sequence presented sensitivity 81%, specificity 89%, and agreement between radiologists 98%, Kappa index 0.949. The axial sequence TSE-T2 is reliable for choledocholithiasis diagnosis. (Author) 9 refs.

  6. Effect of extracorporeal shock wave lithotripsy for the postoperative residual bilestone of choledocholithiasis%体外冲击波对胆总管术后残留结石的碎石效应

    Institute of Scientific and Technical Information of China (English)

    潘爱国; 张殿忠; 徐家宽; 宋东惠

    2002-01-01

    Objective To explore the effect of extracorporeal shock wave lithotripsy(ESWL) for the postoperative residual bilestone of choledocholithiasis.Method Inject contrast medium of biligrafin via T tube.After accurate apposition with X ray,take lithotripsy with extracorporeal shock wave. In some cases T tube washing and transcutaneous choledochoscope were used to take out bilestones.Results The lithotripsies were successful in all the 48 patients and the lithotriptic rate was 100% .The removing rate of bilestones was over 90% with washing method.Choledochoscope was used in 6 cases,and 48 patients were completely healed.In them 24 suffered from slight expanding pain in right upper abdomen or nausea and no any complications and sequelae in others.Conclusion ESWL is an effect method to heal patients with the postoperative residual bilestones of choledocholithiasis.

  7. Avaliação de complicações relacionadas à CPRE em pacientes com suspeita de coledocolitíase Evaluation of ERCP-related morbidity in patients with choledocholithiasis suspicion

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    Presper F. Daher Filho

    2007-04-01

    Full Text Available OBJETIVO: Determinar os fatores preditivos de complicações da colangio-pancreatografia retrógrada endoscópica (CPRE nos doentes com suspeita diagnóstica de coledocolitíase. MÉTODO: Os dados foram coletados retrospectivamente durante o período de agosto de 1999 a janeiro 2005. Foram incluídos os doentes com suspeita diagnóstica de coledocolitíase submetidos à CPRE internados na Santa Casa de Misericórdia de São Paulo. Os doentes com neoplasia de vias biliares ou de pâncreas foram excluídos. Foram avaliados: o sucesso do procedimento, as complicações como pancreatite, sangramento, colangite, perfuração, vômitos, hiperamilasemia e em quais situações estas complicações se desenvolveram. Os testes t de Student, Qui-quadrado e o teste exato de Fisher foram empregados para análise estatística, considerando-se pBACKGROUND: To determine the predictors of complications resulting from endoscopic retrograde cholangiopancreatography (ERCP in patients with choledocholithiasis. METHODS: Data were retrospectively collected from August 1999 to January 2005. Patients with clinical diagnosis of choledocholithiasis were included. Patients with tumours of the biliary tree or pancreas were excluded. The authors evaluated the procedure success and the risk factors associated with post-ERCP complications such as acute pancreatitis, hemorrhage, cholangitis, perforation, vomits and hyperamylasemia, and their association with the procedures. Student's t test, the Chi-square and the Fisher exact test were applied to the statistical analysis, considering p< 0.05 as significant. RESULTS: There were 178 patients (52 men and 156 women, mean age 54.3 + 19.3 included in the analysis. Choledocholithiasis was found in 124 patients (69.7% and the sucess rate of the procedure was 74.2% (92 patients. Post-ERCP complications occurred in 19 patients (10.7%. Six patients (3.4% had acute pancreatitis, four had hemorrhage from the papilla (2.2%, two had

  8. Colangiopancreatografia endoscópica retrógrada (CPRE intraoperatória como alternativa no tratamento de coledocolitíase Intraoperative endoscopic retrograde cholangiopancreatography (CPRE as an alternative for choledocholithiasis treatment

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    Eric Ettinger Júnior

    2007-03-01

    Full Text Available RACIONAL: O tratamento da coledocolitíase continua controverso, podendo ser realizado por pancreatocolangiografia retrógrada endoscópica pré-operatória seguida de videolaparocolecistectomia ou por videolaparocolecistectomia com exploração de vias biliares. Há relato na literatura de taxa de insucesso da pancreatocolangiografia retrógrada endoscópica pré-operatória em torno de 6%. OBJETIVO: Apresentar caso de uma paciente que necessitou da realização de CPRE intra-operatória para resolução de coledocolitíase tratada sem êxito por CPRE. RELATO DO CASO: Paciente de 45 anos, admitida na emergência com quadro de dor abdominal em epigástrio e hipocôndrio direito. A ultra-sonografia da admissão evidenciou coledocolitíase, sendo ela encaminhada para pancreatocolangiografia retrógrada endoscópica pré-operatória onde não houve sucesso na cateterização da papila. Foi optado então pela realização de videolaparocolecistectomia com exploração de via biliar por pancreatocolangiografia retrógrada endoscópica pré-operatória intra-operatoria com a cateterização da papila direcionada por fio guia passado pelo ducto cístico. Foi realizada duodenoscopia com captura do fio guia que serviu para a passagem do papilótomo dando seqüência à pancreatocolangiografia retrógrada endoscópica pré-operatória e retirada dos cálculos. A paciente evoluiu satisfatoriamente tendo alta no 2º dia do pós-operatório. CONCLUSÃO: A abordagem da coledocolitíase por pancreatocolangiografia retrógrada endoscópica intra-operatória seguida de videolaparocolecistectomia, mostrou-se segura e eficaz.BACKGROUND:Choledocholithiasis treatment is still a controversial topic, being done either with endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy or by the use of laparoscopic cholecystectomy and exploration of common bile duct. According to literature, there is an unsuccessful rate of 6% when utilizing pre

  9. 十二指肠镜联合腹腔镜治疗胆囊和胆总管结石的临床分析%Duodenoscopy combined with laparoscopy in the treatment of gallstone and choledocholithiasis

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    周政; 黄志刚; 王光明; 刘有理; 章社民

    2016-01-01

    目的:评价十二指肠镜联合腹腔镜治疗胆囊结石和胆总管结石的临床效果,与传统开腹胆囊切除、胆总管切开取石比较分析。方法选择60例胆囊结石并胆总管结石患者,按随机数字表法分为双镜微创组和开腹组,其中30例双镜微创组先行内镜胰胆管造影(ERCP)+十二指肠乳头 Oddis 括约肌切开术(EST)+胆总管取石术,再行腹腔镜胆囊切除术(LC 术)。另外30例行传统开腹胆囊切除+胆总管切开取石术。将两组的手术时间、平均住院时间、并发症发生率进行比较分析。结果双镜微创组26例患者 ERCP +EST +胆总管取石术成功,胆总管结石全部取出,术后留置鼻胆管引流;4例由于结石过大未取出,留置胆管支架。25例1周内行三孔法 LC 术。10例并发胰腺炎,2例患者年龄较大,合并高血压病等基础病,治疗后2周行 LC 术。双镜微创组创伤小,出血量少,恢复快,但容易并发胰腺炎。传统开腹组创伤大,出血量较多,12例结石未完全取出,容易并发切口感染,恢复时间长。结论ERCP 联合 LC 术用于治疗胆囊、胆总管结石具有效果好、创伤小、术后并发症少、恢复快等优点,临床疗效满意。%Objective To evaluate the clinical effect of duodenoscopy combined with laparoscopy in the treatment of gallstone and cho-ledocholithiasis,and to compare with traditional cholecystectomy and choledocholithotomy.Methods Sixty patients of gallstone and choledocholithiasis admitted were randomized into minimally invasive double endoscopic group and laparotomy group.The 30 patients of minimally invasive double endoscopic group were firstly given endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST)+choledocholithotomy,then given laparoscopic cholecystectomy (LC).The other 30 patients underwent tradition-al cholecystectomy and choledocholithotomy.The operation

  10. Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia Prediction of preoperative choledocholithiasis by the association of clinical and laboratory indicators in two distinct moments

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    Newton Pinto Araújo Neto

    2005-02-01

    melhor a conduta diagnóstica e terapêutica nesta doença.BACKGROUND: The purpose of this study was to determine the probability of choledocholithiasis from the association of clinical and laboratory indicators at two moments of the preoperative phase of cholecystectomy. METHODS: Between March 2001 and March 2002, 48 consecutive patients with cholelithiasis were submitted to cholecystectomy and intra-operative cholangiography (IOC. The patients were divided into two groups, with group A composed of 13 patients with choledocholithiasis and group B of 35 patients without this disease. They were investigated by clinical and laboratory indicators of choledocholithiasis, analyzed in two periods, taking as the cut point the 48 hours that preceded the surgery. Later on, these preoperative indicators were associated in the logistic regression equation in different combinations. RESULTS: Using the logistic regression equation, it was found that the association of two clinical indicators in both periods (jaundice and Murphy‘s sign and two laboratory indicators (the cut level of gamma glutamyl transpeptidase and direct bilirubin 48 hours before the surgery was the most suitable for predicting choledocholithiasis. The values obtained by this equation showed an agreement with groups A and B of 95.6%, and a disagreement of 4.4% (p= 0.0000007 and k = 0.89. This equation showed sensitivity of 92.3%, specificity of 97.0%, a positive predictive value of 92.3% and a negative predictive value of 97%. These values were close to those obtained by the CIO, which showed agreement with the groups studied of 95.8%, and disagreement of 4.2% (k = 0.90. CONCLUSION: The association of indicators of choledocholithiasis is recommended to establish the probability of there occurring choledocholithiasis associated with cholelithiasis. The use of this equation may provide better guidance for the diagnostic and therapeutic handling of this disease.

  11. 两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较%Comparison of Clinical Effectiveness on Two Kinds of Minimally Invasive Treatment for Cholecystolithiasis with Choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    陈盛; 郑江华; 区应亮; 陈伟; 江寅; 简志祥; 王卫东

    2012-01-01

    目的 比较腹腔镜胆囊切除术(LC)+腹腔镜胆总管切开胆道镜探查取石术(LCBDE)和内镜逆行胰胆管造影/内镜下括约肌切开取石术(ERCP/EST)+ LC两种微创术式在治疗胆囊结石合并胆总管结石中的临床疗效.方法 回顾性分析2008年1月至2011年7月期间广东省人民医院肝胆胰外科收治的127例胆囊结石合并胆总管结石患者,比较2组的胆总管直径、结石清除率、住院时间、住院费用及并发症发生率.结果 127例患者中,85例采用LC+ LCBDE治疗,其中54例采用一期缝合胆总管,28例放置T管引流;42例患者采用ERCP/EST+ LC治疗.LC+LCBDE和ERCP/EST+ LC两种术式结石清除率[100% (82/82)比97.37% (37/38),P=0.317]及术后并发症发生率[4.71% (4/85)比4.76% (2/42),P=1.000]方面差异均无统计学意义;在住院时间[中位数(四分位数)]和住院费用[中位数(四分位数)]方面LC+LCBDE一期缝合胆总管组均明显少于ERCP/EST+ LC组[住院时间:11 (5)d比17 (9)d,P<0.001;住院费用:27 054(8 452)元比31 595(11 743)元,P=0.005].结论 LC+LCBDE和ERCP/EST+LC均是治疗胆囊结石合并胆总管结石的有效方法,但是LC+LCBDE尤其是LC+LCBDE一期缝合在住院时间和住院费用方面较ERCP/EST+LC有较明显的优势;并且LC+ LCBDE对于结石大小、数量没有限制,能够在保留乳头功能条件下,一次麻醉解决两个问题,因此我们认为对于合适病例可考虑LC+LCBDE为首选的治疗方法.%Objective To evaluate the clinical effectiveness of laparoscopic cholecystectomy and laparoscopic common bile duct exploration (LC+LCBDE) and endoscopic retrograde cholangiopancreatography/endoscopic sphinc-terectomy with LC (ERCP/EST + LC) in treatment for cholecystolithiasis with choledocholithiasis. Methods From January 2008 to July 2011, 127 patients suffered from cholecystolithiasis with choledocholithiasis underwent either LC + LCBDE (85 cases, LC + LCBDE group) or ERCP/EST + LC (42

  12. 十二指肠镜联合腹腔镜手术治疗老年胆囊结石合并胆总管结石124例%Duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis in 124 aged patients

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    尹小军; 张荣春; 王向平; 郭学刚

    2012-01-01

    目的 探讨十二指肠镜联合腹腔镜续贯治疗老年患者胆囊结石合并肝外胆管结石的疗效.方法 回顾分析2010年1月至12月246例老年患者(年龄大于等于60岁)胆囊结石合并肝外胆管结石的临床资料,按手术方式的不同分为微创组和传统手术组.微创组(n=124)采用十二指肠镜下内镜乳头括约肌切开术(EST)取石再行腹腔镜胆囊切除术(LC),传统手术组(n=122)采用传统开腹胆囊切除术胆总管切开取石T管引流术,对比两组住院时间、并发症和结肠功能恢复时间等.结果 微创组与传统手术组比较,住院时间短、并发症低和术后结肠功能恢复时间短,差异均有明显的统计学意义(P<0.01);两组手术时间无统计学差异(P>0.05).结论 十二指肠镜联合腹腔镜续贯治疗老年胆囊结石合并肝外胆管结石具有微创、安全、疗效良好等优点.%Objective To evaluate the efficacy of duodenoscopy and laparoscopic cholecystectomy in the treatment of cholecyslithiasis complicated with choledocholithiasis and to discuss its clinical significance. Methods The clinical data of 246 aged patients with cholecyslithiasis complicated with choledocholithiasis ( age ≥ 60 years) from January 2010 to December 2010 were retrospectively analyzed. The patients were divided into the minimally invasive group (n =124) and the conventional surgery group (n = 122). The patients in the minimally invasive group were underwent duodenoscopy,endoscopic sphincterotomy (EST) and laparoscopic cholecystectomy (LC) while those in the conventional surgery group (n = 122) were experienced traditional open cholecystectomy,choledocholithotomy and T-tube drainage. The hospital stay, complications and recovery time of the colon function were compared between the two groups. Results The hospital stay was shorter in the minimally invasive group compared with that in the conventional therapy group,P 0. 05 ) . Conclusion consecutive treatment of

  13. Laparoscopic cholecystectomy plus exploration of the common bile duct in comparison with laparoscopiccholecystectomyandendoscopicsphincterotomyforsecondary choledocholithiasis%腹腔镜胆囊切除胆道探查取石术与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术的疗效比较

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    张春菊; 刘源; 王勇; 刘金钢; 赵海鹰

    2011-01-01

    目的 比较腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)胆道探查取石(laparoscopic common bile duct exploration,LCBDE)与内镜下Oddi括约肌切开(endoscopic sphincterotomy,EST)取石联合LC两种方法治疗继发性胆总管结石的疗效。方法 回顾性分析2008年1月至2009年12月我院收治的采用LC+ LCBDE或EST+ LC治疗的继发性胆总管结石患者的临床资料,对比两种方法的手术成功率、手术时间、术后并发症、残石率、住院时间、住院费用等。统计学处理,计数资料用X2检验,计量资料采用独立样本t检验。结果 共收治继发性胆总管结石患者163例,有87例行LC+ LCBDE,76例行EST +LC。二者相比,LC+ LCBDE手术时间较EST+ LC平均缩短30 min、住院时间缩短3d、术后并发症少、费用低,二者手术成功率、残石率无显著差异。结论 治疗继发性胆总管结石,LC+ LCBDE安全、有效,并发症少,在病情允许情况下,可作为首选方法。%Objective To compare the effects between laparoscopic cholecystectomy (LC) +laparoscopic common bile duct exploration(LCBDE) and endoscopic sphincterotomy(EST) + laparoscopic cholecystectomy( LC ) for secondary choledocholithiasis.Methods The clinical data of patients with secondary choledocholithiasis receiving LC + LCBDE or EST + LC from January 2008 to December 2009 were retrospectively compared. Parameters included operation time, postoperative complication, length of stay,cost of hospitalization. All patients received follow up of 1 year. Enumeration data was analyzed by chisquare test and measurement data was analyzed by t test. Results In this study 87 patients received LC +LCBDE,76 patients received EST + LC. Patients in LC + LCBDE group had shorter hospital stay, less hospital charges and less complications. There was not difference in the procedure success rate and stone remanent rate between the two groups.Conclusions LC + LCBDE could be used as

  14. Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct Ecoendoscopia versus colangiografia retrógrada endoscópica para o diagnóstico da coledocolitíase: a influência do tamanho do cálculo e do diâmetro da via biliar principal

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    Marcus Vinicius Silva Ney

    2005-12-01

    Full Text Available BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7% had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67% for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%. Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a

  15. Effect of Huashilidan Decoction on CYP7A1、B-UGT in Choledocholithiasis After ERCP%化石利胆汤对ERCP术后胆总管结石患者CYP7A1和B-UGT影响研究

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    巩阳; 林一帆; 王长洪; 王立新; 麻树人; 陆宇平; 高文艳; 刘杨; 季芳

    2011-01-01

    目的:研究化石利胆汤对经逆行胰胆管造影术(Endoscopic Retrograde Cholan giopan creato graphy,ERCP)取石后的胆总管结石患者血液及胆汁中胆红素尿苷二磷酸葡萄糖醛酸基转移酶(bilirubin UDP glucronosy ltransferase,B-UGT)、胆固醇7α羟化酶(cholesterol 7 alpha hydroxylase,CYP7A1)的影响.方法:经ERCP 证实为胆总管结石并经(Endoscopic sphincterotomy,EST)、机械碎石、网篮球囊取石术等取石后的患者100例,随机分成服药组为常规西医治疗并口服化石利胆汤,对照组为术后只给予常规治疗,每组各50例.服药后第1天、第7天、1个月观察患者血CYP7A1、B-UGTmRNA的表达,及服药后第1天、第7天胆汁中CYP7Al、B-UGT的蛋白表达.结果:实验组服中药后血中CYP7AI、B-UGT mRNA及胆汁中CYP7A1、B-UGT蛋白表达较治疗前明显升高(P <0.05,对照组前后2基因及蛋白表达无变化.结论:化石利胆汤很可能足通过上调CYP7Al、B-UGT的mRNA及蛋白表达,抑制成石性胆汁的形成,从而起到治疗胆结石的作用.%Objective:To explore the effects of Huashilidan decoction on CYP7A1 ,B-UGT in choledocholithiasis after the treatment of ERCP. Method; One hundred patients with cholelithiasis undergoing ERCP and EST, were randomly divided into two groups, the control group and the huashilidan decoction, each group had fifty patients. The patients of control group were treated with the normal anti-inflammatory and rehydration therapy. The other was used with the huashilidan decoction. We scaled the genes skews of CYP7A1 ,B-UGT in the blood at the first day, the seventh day and the 30th day after the therapy; and scaled CYP7A1、B-UGT in the bile at the first day, the seventh day. Results: After the treatment, CYP7A1 ,B-UGT were greatly higher than those of the experiment group. But those of the control group didn' t change. Conclusion: Huashilidan decoction can reduce the rates of choledocholithiasis by intervene reglating the

  16. Damage control using percutaneous transhepatic biliary drainage in acute cholangitis of severe type secondary to intrahepatic choledocholithiasis%经皮经肝胆管引流在肝内梗阻性重症胆管炎损伤控制中的临床价值

    Institute of Scientific and Technical Information of China (English)

    吴武军; 杜立学; 杨俊武; 何凯亮; 孙华; 刘晓刚; 胡海田

    2014-01-01

    目的 探讨经皮经肝胆管引流(PTCD)在结石所致肝内梗阻性重症胆管炎(ACST)治疗中的临床价值.方法 回顾性分析2009年12月至2013年1月收治的8例PTCD后再行手术的肝内梗阻型ACST患者的临床资料.结果 8例患者均在X线引导下成功进行PTCD.当日引流胆汁100 ~400 ml,所有患者24h内一般情况改善,48 h后胆红素下降约25~ 100 μmol/L.3例血小板数量<20×109/L的患者引流72 h后血小板回升至>50×109/L.所有患者均成功接受手术,其中2例患者行胆道探查+T管引流术,2例患者同时行左半肝切除,3例行胆肠吻合术.8例中7例痊愈,1例肝功能衰竭、胆红素持续> 200 μmol/L的患者长期带管.手术前带管时间7d~3个月,PTCD管均保持通畅,无死亡及出血、胆漏、腹膜炎等严重并发症发生.结论 PTCD用于治疗肝内梗阻型ACST成功率较高,创伤小,耐受性好,引流效果可靠,能充分降低胆道压力,降低手术风险,为手术创造了机会和条件.%Objective To study the safety and efficacy of damage control using percutaneous transhepatic biliary drainage (PTBD) in acute cholangitis of severe type (ACST) secondary to intrahepatic choledocholithiasis.Methods The clinical data of 8 patients who received PTBD after hospital admission followed by conventional surgery for ACST when their general condition improved were retrospectively studied.Results All patients received PTBD successfully and the amount of bile drained was 100-400 ml in the first day.The general condition of these 8 patients became better after 24 h and the total bilirubin decreased for about 25-100 mmol/L after 48 h.Three patients with a platelet count of less than 20 × 109/L showed an improved count to more than 50 × 109/L 72 h after PTBD.All patients were operated at different times after the PTBD:2 received T-tube drainage,3 T-tube drainage combined with left hepatectomy,and 3 choledochojejunostomy.Seven patients recovered

  17. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography Precisión diagnóstica e impacto terapéutico de la ultrasonografía endoscópica en los pacientes con sospecha intermedia de coledocolitiasis y colangiorresonancia normal

    Directory of Open Access Journals (Sweden)

    Enrique Vázquez-Sequeiros

    2011-09-01

    Full Text Available Background: endoscopic ultrasonography (EUS and magnetic resonance cholangiography (MRC are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC. Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV and negative predictive value (NPV of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them. Sensitivity and diagnostic accuracy of EUS (100%, 92% were significantly higher than MRC values (0%, 70% (p Antecedentes: la ultrasonografía endoscópica (USE y la colangiografía por resonancia magnética nuclear (CRM son las técnicas de elección para el diagnóstico de litiasis en la vía biliar. Aunque la CRM es mejor aceptada por los pacientes, la sensibilidad de esta para detectar litiasis de pequeño tamaño podría ser insuficiente. Objetivo: estudiar de forma prospectiva la precisión diagnóstica y el impacto terapéutico de la USE en los pacientes con sospecha intermedia de coledocolitiasis y CRM normal. Material y métodos: se incluyeron prospectivamente durante 24 meses todos los pacientes con sospecha clínica intermedia de coledocolitiasis y CRM negativa. Se compar�� la sensibilidad, especificidad, precisión diagnóstica, valor predictivo positivo y negativo de CRM y USE, así como su impacto en el tratamiento. Resultados: se evaluaron 76 pacientes (litiasis en el 30%. La sensibilidad y precisión diagnóstica de USE (100%, 92% eran significativamente

  18. Prospective Clinical Study of Laparoscopic Common bile duct Exploration in Treatment of Choledocholithiasis in Different Ways%不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究

    Institute of Scientific and Technical Information of China (English)

    赵万文

    2015-01-01

    目的:探讨对比经胆囊管腹腔镜胆道探查术与经胆总管切开T管引流手术治疗胆总管结石的临床效果。方法随机选取2013年7月-2014年6月该院收治的60例胆石症患者为研究对象,按照手术方法的不同将其分为观察组30例与对照组30例;给予观察组经胆囊管腹腔镜胆道探查术治疗,给予对照组经胆总管切开T管引流手术治疗。术后对比分析两组患者的手术时间、引流时间、术后排气时间、住院时间以及并发症发生情况等。结果观察组手术时间、引流时间、术后排气时间、住院时间均明显低于对照组;且两组比较差异有统计学意义(P<0.05)。观察组并发症总发生率为4.0%,对照组并发症总发生率为28.0%,同时观察组的胆漏、急性胰腺炎、急性胆汁腹膜炎、肝下积液感染、引流不畅等并发症的发生率显著小于对照组,两组比较差异有统计学意义(P<0.05)。结论使用胆囊管腹腔镜胆道探查术治疗胆总管结石症的效果优于胆总管切开T管引流手术,且该手术方法术后并发症发生率要低于胆总管切开T管引流手术,因此该方法值得临床推广应用。%Objective To compare the effect between laparoscopic common bile duct exploration via cystic duct and choledo-cholithotomy with T-tube drainage in the treatment of choledocholithiasis. Methods 60 patients with choledocholithiasis admitted to our hospital between July 2013-June 2014 were selected as the research objects and divided into observation group(n=30) and control group (n=30) according to the different method of operation. The observation group received laparoscopic common bile duct exploration via cystic duct, while the control was given choledocholithotomy with T-tube drainage. Surgery time, drainage time, postoperative exhaust time, length of hospital stay, and complications of the two groups were compared. Results The observation group operating time

  19. Clinical observation of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis%腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床观察

    Institute of Scientific and Technical Information of China (English)

    王福荣; 邵文生; 黄小玲; 陈果; 李伟

    2013-01-01

    目的 探讨腹腔镜胆道探查术治疗胆囊结石合并胆总管结石的临床疗效.方法 将128例胆囊结石合并胆总管结石患者随机分为观察组和对照组各64例,两组患者均行全身麻醉,观察组患者接受腹腔镜胆道探查术治疗胆囊结石合并胆总管结石,对照组患者接受传统手术治疗胆囊结石合并胆总管结石,两组患者术后常规抗感染治疗.比较两组患者的手术情况、术后恢复情况、住院时间及费用、术后并发症情况以及术后残石率等情况.结果 与对照组比较,观察组患者切口显著缩小(P<0.01),手术时间、下床时间、术后通气时间、肠鸣音恢复时间、导尿管留置时间、术后住院时间及住院总时间显著缩短(均P<0.01),术中失血量显著减少(P<0.01),而住院总费用增加(P<0.01).观察组切口感染显著低于对照组(P<0.05),但是两组术后并发症整体比较差异无统计学意义(P>0.05).两组患者术后残留结石差异无统计学意义(P>0.05).结论 腹腔镜胆道探查术治疗胆囊结石合并胆总管结石创伤小,恢复快,安全可靠,疗效确切,值得临床推广应用.%Objective To explore the clinical effect of laparoscopic common bile duct exploration to treat cholecystolithiasis combined with choledocholithiasis.Methods A total of 128 patients with cholecystolithiasis combined with choledocholithiasis,who visited the General Surgery department of our hospital in January 2010~ December 2011,were divided randomly into Observation Group and Control Group.Cases in Observation Group received laparoscopic common bile duct exploration,and cases in Control Group received traditional operation.Cases in both groups received traditional anti-infection treatment after operation.The operation conditions,recovery of operation,hospital stays and expense,as well as complication after operation and residual bile duct stones were compared in both groups.Results he cut size was

  20. 胰管支架和非甾体类抗炎药预防胆总管取石术后胰腺炎的前瞻性随机对照研究%Pancreatic duct stent and NSAIDs for prevention of post ERCP pancreatitis in choledocholithiasis patients: a prospective randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    王安; 蔡旺; 秦鸣放; 李宁

    2014-01-01

    cholangiopancreatography(ERCP) Pancreatitis(PEP) in choledocholithiasis patients.Methods A total of 200 choledocholithiasis patients were randomly divided into 4 groups,prophylactic pancreatic duct stent(PPDS) group (A),NSAIDs group (B),joint PPDS-NSAIDs group (C) and routine ERCP without prevention for PEP(group D).VAS score,levels of amylase in serum and CRP were measured before and 4 h,24 h,48 h after ERCP.Incidences of hyperamylasemia and PEP were observed.Results (1) Incidences of hyperamylasemia 48 h after ERCP were 6% (3/50),6% (3/50) and 4% (2/50) in group A,group B and group C respectively,which were significantly lower than that of group D (11/55) (P < 0.05).(2) Incidences of PEP 48 h after ERCP were both 2% (1/50) in group A and group C,which were lower than that in group D (10%,5/50,P < 0.05).Group B (4%,2/50) was lower than that of group D but there was no statistical significance(P >0.05).(3) VAS scores of all groups at 4 h,24 h and 48 h after the operation were significantly higher than before (P < 0.05).Group B score was significantly lower than that of group D (P < 0.05).Scores of group A and C at 4 h were lower than those of group D (P < 0.05),and those at 24 h and 48 h were also lower but with no statistical significance (P > 0.05).(4) Serum CRP levels at 4 h,24 h and 48 h were significantly higher than those before in each group.Serum CRP levels of group B and C were significantly lower than that of group D at 4 h,24 h and 48 h.Serum CRP level of group A was significantly lower than group D at 4 h,24 h.CRP level at 48 h of group A was lower than that of group D,but there was no statistical significance (P > 0.05).Conclusion Both prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce incidence of hyperamylasemia after ERCP common bile duct lithotomy.Single or joint use of prophylactic pancreatic duct stent can prevent PEP.Furthermore,prophylactic pancreatic duct stent and NSAIDs (Parecoxib Sodium) can reduce pain and

  1. Late Complications following Endoscopic Sphincterotomy for Choledocholithiasis: A Swedish Population-Based Study

    Directory of Open Access Journals (Sweden)

    A. Langerth

    2014-01-01

    Full Text Available In order to assess the risk of long-term complications following endoscopic sphincterotomy (ES for common bile duct stones (CBDS, we conducted a cohort study. The study included 1,113 patients who underwent ES for CBDS in six different hospitals in central Sweden between 1977 and 1990. Through the use of the Swedish population registry, each patient was assigned five population-based controls matched for sex and age. Linkage to the Inpatient Registry yielded information on morbidity and mortality for the patients as well as for the controls. After one year of washout, there were 964 patients available for follow-up. The mean age was 70.6 years, 57% were women, and the mean length of follow-up was 8.9 years. The patients’ overall morbidity was significantly higher and we observed a tendency towards increased mortality as well. Recurrent CBDS was diagnosed in 4.1% of the patients. Acute cholangitis with a hazard ratio (HR of 36 (95%CI 11–119.4 was associated with recurrent CBDS in 39% of the patients. HR for acute pancreatitis was 6.2 (95%CI 3.4–11.3 and only one patient had CBDS at the same time. In conclusion, we consider acute pancreatitis and cholangitis both as probable long-term complications after ES.

  2. Role of Liver Function Enzymes in Diagnosis of Choledocholithiasis in Biliary Colic Patients

    Directory of Open Access Journals (Sweden)

    Mohammad Hussein Mirshamsi

    2011-10-01

    Full Text Available Liver functional tests due to inflammatory process which induced by cholecystitis might changed and some clinicians suggested that these changes might help us to stone prediction in common bile ducts and decrease hazards of performing ERCP and other invasive procedures. Present study was performed for assessment of role of liver functional test in diagnosis of common bile duct stone in patients with cholecystitis and help in their management. Present prospective study was performed between April 2010 and March 2011 on 350 patients who come to our hospital with cholecystitis or biliary colic diagnosis. Patients with cholesistitis diagnosis were underwent operation for removing gall bladder stone and retrograde cholangiopancreatography (ERCP was performed for patients with suspicious to biliary colic and common bile duct (CBD stones. Ultrasonography, Aspartate Aminotransferases (AST, Alanine Aminotransferases (ALT, Alkaline Phosphatase (ALP and direct and total serum bilirubin were measured for all of participated patients. Mean of AST. ALT, ALP and total and direct bilirubin were had no significant differences between two study groups. In logistic regression analysis, after entering into the model only CBD diameter (OR: 20; P=0.00 and elevated serum level of ALT (OR: 2; P=0.04 were remained into the model and were known as independent predictor of cholelithiasis. Elevated level of liver enzymes had not main role in CBD diagnosis and ERCP had no to perform for suspicious CBD stone only with elevated liver enzyme and even with normal ultrasonography findings. Endosonography as non invasive procedure recommend for patients before ERCP.

  3. Duplex gall bladder associated with choledocholithiasis, cholecystitis, gall bladder rupture and septic peritonitis in a cat.

    Science.gov (United States)

    Moores, A L; Gregory, S P

    2007-07-01

    A 10-year-old cat was presented with a history of inappetence, pyrexia and weight loss. Clinical investigations showed anaemia, hyperbilirubinaemia, septic peritonitis and a double gall bladder with choleliths in an extrahepatic duct. Initial medical stabilisation was performed. At laparotomy, a duplex gall bladder with two separate cystic ducts was identified. The left gall bladder was thickened and had ruptured at the apex. Multiple choleliths were identified in the left cystic duct. The right gall bladder and cystic duct were grossly normal. The ruptured gall bladder was repaired, the gallstones were removed via a choledochotomy of the left cystic duct and a choledochoduodenostomy was created from the dilated left cystic duct. The cat remained depressed and anorexic, and it was euthanased 72 hours postoperatively at the owners' request. This is the first ante-mortem investigation of extrahepatic biliary disease associated with gall bladder duplication in the cat.

  4. Bile proteomic profiles differentiate cholangiocarcinoma from primary sclerosing cholangitis and choledocholithiasis

    NARCIS (Netherlands)

    Lankisch, Tim O; Metzger, Jochen; Negm, Ahmed A; Vosskuhl, Katja; Schiffer, Eric; Siwy, Justyna; Weismüller, Tobias J; Schneider, Andrea S; Thedieck, Kathrin; Baumeister, Ralf; Zürbig, Petra; Weissinger, Eva M; Manns, Michael P; Mischak, Harald; Wedemeyer, Jochen

    2011-01-01

    UNLABELLED: Early detection of malignant biliary tract diseases, especially cholangiocarcinoma (CC) in patients with primary sclerosing cholangitis (PSC), is very difficult and often comes too late to give the patient a therapeutic benefit. We hypothesize that bile proteomic analysis distinguishes C

  5. [Choledocholithiasis and pregnancy. Hybrid laparo-endoscopic treatment in one step].

    Science.gov (United States)

    Valadez-Caballero, David; González-Santamaría, Roberto; Soto-Mendoza, Héctor; Alberto Blanco-Figueroa, Jorge; Flores-Pantoja, Juan Manuel

    2014-01-01

    Antecedentes: las complicaciones asociadas con la coledocolitiasis son poco comunes durante el embarazo. Sin embargo, cuando aparecen incrementan la morbilidad y mortalidad para el feto y la madre. Caso clínico: paciente femenina de 25 años de edad, en el segundo trimestre de embarazo. El padecimiento actual lo inició cuatro días previos a su ingreso al hospital, con dolor abdominal en el hipocondrio derecho acompañado de náuseas y vómito. A las 24 horas se agregó ictericia y coluria. A la exploración física se encontró tinte ictérico, dolor en el hipocondrio derecho, sin irritación peritoneal. Útero a nivel de la cicatriz umbilical, sin actividad uterina. Los exámenes de laboratorio mostraron: elevación de bilirrubinas y transaminasas, sin leucocitosis; el ultrasonido reportó producto único vivo intrauterino, con frecuencia cardiaca de 128 latidos por minuto, vesícula biliar con múltiples litos en su interior, colédoco 10 mm y dilatación de vía biliar. Se realizó colecistectomía laparoscópica y colangiografía transoperatoria con colocación de guía transcística para canulación selectiva de la vía biliar. Durante la colangiografía endoscópica transoperatoria se extrajeron algunos litos. La evolución fue satisfactoria, toleró la dieta y fue fue dada de alta del hospital a las 48 horas. Conclusión: en el tratamiento de la coledocolitiasis y embarazo la combinación de laparoscopia y colangiografía endoscópica terapéutica en un solo tiempo es eficaz porque disminuye el riesgo de complicaciones asociadas con la canulación de la vía biliar.

  6. Automated development of artificial neural networks for clinical purposes: Application for predicting the outcome of choledocholithiasis surgery.

    Science.gov (United States)

    Vukicevic, Arso M; Stojadinovic, Miroslav; Radovic, Milos; Djordjevic, Milena; Cirkovic, Bojana Andjelkovic; Pejovic, Tomislav; Jovicic, Gordana; Filipovic, Nenad

    2016-08-01

    Among various expert systems (ES), Artificial Neural Network (ANN) has shown to be suitable for the diagnosis of concurrent common bile duct stones (CBDS) in patients undergoing elective cholecystectomy. However, their application in practice remains limited since the development of ANNs represents a slow process that requires additional expertize from potential users. The aim of this study was to propose an ES for automated development of ANNs and validate its performances on the problem of prediction of CBDS. Automated development of the ANN was achieved by applying the evolutionary assembling approach, which assumes optimal configuring of the ANN parameters by using Genetic algorithm. Automated selection of optimal features for the ANN training was performed using a Backward sequential feature selection algorithm. The assessment of the developed ANN included the evaluation of predictive ability and clinical utility. For these purposes, we collected data from 303 patients who underwent surgery in the period from 2008 to 2014. The results showed that the total bilirubin, alanine aminotransferase, common bile duct diameter, number of stones, size of the smallest calculus, biliary colic, acute cholecystitis and pancreatitis had the best prognostic value of CBDS. Compared to the alternative approaches, the ANN obtained by the proposed ES had better sensitivity and clinical utility, which are considered to be the most important for the particular problem. Besides the fact that it enabled the development of ANNs with better performances, the proposed ES significantly reduced the complexity of ANNs' development compared to previous studies that required manual selection of optimal features and/or ANN configuration. Therefore, it is concluded that the proposed ES represents a robust and user-friendly framework that, apart from the prediction of CBDS, could advance and simplify the application of ANNs for solving a wider range of problems.

  7. A case report of an unusual type of choledochal cyst with choledocholithiasis: Saccular dilatation of the confluent portion of both intrahepatic ducts

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Young; Kim, Hee Jin; Han, Hyun Young [Dept. of Radiology, Eulji University Hospital, Daejeon (Korea, Republic of)

    2015-10-15

    A choledochal cyst is a rare congenital anomaly of the biliary system manifested as the cystic dilatation of bile ducts, usually occurring in the common bile duct. Here, we describe an unusual type of choledochal cyst in a 45-year-old male that did not fit into the most widely accepted Todani classification of these cysts. The lesion mimicked duplication anomalies of the gallbladder and was finally diagnosed as a choledochal cyst involving the confluent portion of both intrahepatic ducts.

  8. Meta-analysis: endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis%荟萃分析:超声内镜和ERCP诊断胆总管结石的比较

    Institute of Scientific and Technical Information of China (English)

    周艳; 陈翔

    2008-01-01

    目的 通过荟萃分析对超声内镜和ERCP对胆总管结石诊断能力进行比较.方法 从Pubmed、Embase、Elsevier Science Direct和中国期刊全文数据库中检索比较超声内镜和ERCP对怀疑有胆总管结石病人诊断能力的前瞻性研究.对各项研究中的敏感性、特异性、准确率的比数比(OR)行荟萃分析,采用固定效应模型或随机效应模型进行数据统计分析.结果 共有5项对照研究入选(n=325).超声内镜的敏感性显著高于ERCP(146/159 vs 134/159,固定效应模型:OR 2.02,95%CI=1.01-4.03,P=0.05).超声内镜和ERCP对检测胆总管结石的特异性相似(161/166 vs 164/166,固定效应模型:OR 0.49,95% CI=0.12-1.99,P>0.05).超声内镜的准确性略高于ERCP,但没有显著性差异(307/325 vs 298/325,固定效应模型:OR 1.53,95% CI=0.83-2.80,P>0.05).ERCP相关的不良反应发生率显著高于超声内镜(P<0.01).结论 由于准确率、安全性高,侵入性相对较小,超声内镜可认为是诊断胆总管结石的理想检查项目并能替代诊断性ERCP.对于这两种方法 的选择,应该取决于病人的一般状况、医疗单位所具备的能力,以及病灶是否可能需要采取进一步的介入治疗.

  9. 内镜术在疑似胆管结石症的评估中的作用%The role of endoscopy in the evaluation of suspected Choledocholithiasis

    Institute of Scientific and Technical Information of China (English)

    美国消化内镜学会

    2010-01-01

    @@ This is one of a series of statements discussing the use of GI endoscopy in common clinical situations.The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When few or no data exist from well-designed prospective trials, emphasis is given to results of large series and reports from recognized experts.

  10. One-case analysis of biliary tract ascariasis after removal of choledocholithiasis by endoscopic retrograde cholangiopanceatography%ERCP胆总管结石取石术后并发胆道蛔虫病1例

    Institute of Scientific and Technical Information of China (English)

    吴炜景; 赵亚刚; 孙大勇; 曾海萍

    2009-01-01

    患者,男,55岁,农民,因"反复上腹痛2 mo余,加重1 wk"入院.入院后经ERCP诊疗术明确诊断为"胆总管结石",术后腹痛减轻.于拔除鼻胆管后再次出现剧烈腹痛,行急诊ERCP诊疗术,诊断为"胆道蛔虫病".本病例典型,有示教意义.

  11. Biliary ascariasis in a bile duct stones-removed female patient

    OpenAIRE

    2013-01-01

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic s...

  12. Gallstones

    Science.gov (United States)

    ... may cause swelling or infection in the: Gallbladder (cholecystitis) Tube that carries bile from the liver to ... Elsevier Saunders; 2012:chap 55. Read More Acute cholecystitis Bile Cholangitis Choledocholithiasis Chronic cholecystitis Gallbladder removal - laparoscopic ...

  13. Abdominal Pain Syndrome

    Science.gov (United States)

    ... of the stomach) Pancreatitis (inflammation of the pancreas) Cholecystitis (inflammation of the gall bladder) Choledocholithiasis (passage of ... correct a problem. For example, pain due to cholecystitis (inflammation of the gall bladder) is usually treated ...

  14. Biliary ascariasis in a bile duct stones-removed female patient.

    Science.gov (United States)

    Wang, Jun; Pan, Yang-Lin; Xie, Yan; Wu, Kai-Chun; Guo, Xue-Gang

    2013-09-28

    Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.

  15. Relief of anxiety in patients wtih choledocholithiasis receiving ERCP and EST: footbath with Chinese herbs, acupoint message and aromatherapy%中药沐足联合穴位按摩及芳香疗法缓解胆管结石介入诊疗患者焦虑

    Institute of Scientific and Technical Information of China (English)

    林瑞华; 谢春生; 潘慧仁; 汤远兴

    2012-01-01

    目的 探讨中西医综合干预对内镜下ERCP及EST术患者焦虑的影响.方法 将86例胆管结石行内镜下ERCP及EST术患者按随机数字表法分为观察组和对照组各43例,术前术中对照组给予常规护理,观察组在此基础上增加中药沐足联合穴位按摩疗及芳香疗法.结果 术后观察组焦虑评分显著低于对照组,术中血压、心率波动显著低于对照组(均P<0.01).结论 中药沐足联合穴位按摩疗及芳香疗法的应用,可降低患者术中焦虑程度,有利于治疗顺利完成.

  16. Clinical diagnostic value of color Doppler ultrasound combined with magnetic resonance cholangiopancreatography in elderly patients with choledocholithiasis: analysis of 270 cases%彩色多普勒超声联合磁共振胆胰管成像诊断老年胆总管结石270例临床分析

    Institute of Scientific and Technical Information of China (English)

    赵丽; 赵曙光; 张排旗; 郭学刚

    2016-01-01

    目的:分析彩色多普勒超声(CDU)联合磁共振胆胰管成像(MRCP)诊断老年胆总管结石的价值并讨论其意义.方法:选择2014年1月~2015年12月拟诊断胆总管结石患者270例,男性116例,女性154例,年龄60~85岁.患者均行CDU和MRCP检查,同时以手术或内镜下逆行胰胆管造影术作为金标准,用统计学方法比较单独用CDU或MRCP,以及CDU联合MRCP对诊断老年胆总管结石的价值,同时计算敏感性、特异性和准确性.结果:老年患者270例经手术或ERCP确诊胆总管结石218例,CDU联合MRCP诊断老年胆总管结石的敏感性、特异性和准确性均较单纯CDU检测或MRCP检测高,差异具有统计学意义(P<0.05).结论:CDU联合MRCP检查可提高老年胆总管结石诊断准确率,且简便安全,可在临床推广应用.

  17. [Endoscopic contact lithotripsy--modern alternative in the therapy of patients with large stones of the common bile duct].

    Science.gov (United States)

    Ohorodnyk, P V; Kolomiĭtsev, V I; Kushniruk, O I; Deĭnychenko, A H; Khrystiuk, D I

    2013-09-01

    The peculiarities of therapeutic ERCP and contact lithotripsy in patients with choledocholithiasis were studied. 6516 patients (age from 11 to 94 years old) with choledocholithiasis were examined Endoscopic sphincterotomy/balloon dilation with stone extraction was effective in 5507 (84.5%), in 539 (8.8%)--we achieved bile ducts clearance by using mechanical or electrohydraulic lithotripsy. Additional usage of contact lithotripsy increased the effectiveness of therapeutic ERCP to 93.2%. Contact lithotripsy decreased number of specific for ERCP complication from 7.83% to 1.57% in patients with large (> 25mm) stones. Electrohydraulic lithotripsy was successful in destruction of hard bile stones, when mechanical lithotripsy failed.

  18. Interventional Endoscopy Database for Pancreatico-biliary, Gastrointestinal and Esophageal Disorders

    Science.gov (United States)

    2017-02-16

    Ampullary Cancer; Duodenal Cancer; Bile Duct Cancer; Bile Duct Disorders; Gallstones; Obstructive Jaundice; Pancreatic Disorders (Noncancerous); Colorectal Cancer; Esophageal Cancer; Barrett's Esophagus; Gastric Malignancies; Pancreatic Cancer; Pediatric Gastroenterology; Cholangiocarcinoma; Pancreatic Pseudocysts; Acute and Chronic Pancreatitis; Recurrent Pancreatitis; Cholangitis; Bile Leak; Biliary Strictures; Pancreatic Divisum; Biliary and Pancreatic Stones; Choledocholithiasis

  19. INTERMITTENT GALLSTONE ILEUS FOLLOWING ENDOSCOPIC BILIARY SPHINCTEROTOMY - A CASE-REPORT

    NARCIS (Netherlands)

    OSKAM, J; HEITBRINK, M; SCHATTENKERK, ME

    1993-01-01

    A 72-year-old woman presented with periods of colicky abdominal pain following endoscopic sphincterotomy and lithotripsy for choledocholithiasis. A diagnosis of intermittent gallstone ileus was made, while it appeared that a large gallstone, that was not removed from the common bile duct, obsructed

  20. Cholecystocolonic Fistulas from Diverticulosis: A Potentially Missable Cause of Liver Abscesses

    Directory of Open Access Journals (Sweden)

    Ben Warner

    2016-01-01

    Full Text Available Cholecystocolonic fistulas (CCF due to colonic diverticulosis are a rare cause of liver abscesses. It is even rarer to simultaneously have choledocholithiasis, another cause for liver abscesses. In this case report, we found both pathologies and emphasise the need to study cholangiograms carefully so as not to miss alternative diagnoses.

  1. Cholecystocolonic Fistulas from Diverticulosis: A Potentially Missable Cause of Liver Abscesses

    Science.gov (United States)

    Wong, Terry; Berry, Philip

    2016-01-01

    Cholecystocolonic fistulas (CCF) due to colonic diverticulosis are a rare cause of liver abscesses. It is even rarer to simultaneously have choledocholithiasis, another cause for liver abscesses. In this case report, we found both pathologies and emphasise the need to study cholangiograms carefully so as not to miss alternative diagnoses. PMID:27994893

  2. Combined treatment of gallbladder and common bile duct stones disease with endoscopy, laparoscopy and extracorporeal lithotripsy; Skojarzenie endoskopii z laparoskopia i litotrypsja pozaustrojowa w leczeniu kamicy pecherzyka i przewodu zolciowego wspolnego

    Energy Technology Data Exchange (ETDEWEB)

    Modrzejewski, A.; Butkiewicz, J.; Czernicki, K.; Borowski, M.; Sikorski, A. [Pomorska Akademia Medyczna, Szczecin (Poland)

    1993-12-31

    A case of cholecysto- and choledocholithiasis with common bile duct obstructed by multiple large stones is presented. Attempts to remove all stones via endoscopic papillotomy, were ineffective. Two sessions, each of 1 hour extracorporeal shock wave lithotrypsion, were successful. All fragments of crushed concrements were endoscopically evacuated. 4 days later laparoscopic cholecystectomy completed the treatment. (author). 5 refs, 2 figs.

  3. The role of sonography in imaging of the biliary tract.

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

    Sonography is the recommended initial imaging test in the evaluation of patients presenting with right upper quadrant pain or jaundice. Dependent upon clinical circumstances, the differential diagnosis includes choledocholithiasis, biliary stricture, or tumor. Sonography is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with sonographically documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial sonographic documentation of choledocholithiasis, endoscopic ultrasound or magnetic resonance cholangiopancreatography is the next logical imaging step. Endoscopic ultrasound documentation of choledocholithiasis in a postcholecystectomy patient should lead to retrograde cholangiography, sphincterotomy, and clearance of the ductal calculi by endoscopic catheter techniques. In patients with clinical and sonographic findings suggestive of malignant biliary obstruction, a multipass contrast-enhanced computed tomography (CT) examination to detect and stage possible pancreatic carcinoma, cholangiocarcinoma, or periductal neoplasm is usually recommended. Assessment of tumor resectability and staging can be performed by CT or a combination of CT and endoscopic ultrasound, the latter often combined with fine needle aspiration biopsy of suspected periductal tumor. In patients whose CT scan suggests hepatic hilar or central intrahepatic biliary tumor, percutaneous cholangiography and transhepatic biliary stent placement is usually followed by brushing or fluoroscopically directed fine needle aspiration biopsy for tissue diagnosis. Sonography is the imaging procedure of choice for biliary tract intervention, including cholecystostomy, guidance for

  4. Colelitiasis y coledocolitiasis obstructiva en un gato doméstico: Informe de un caso

    OpenAIRE

    J. Jesús Racanco Delgado; Rosa Elena Méndez Aguilar; Joaquín Aguilar Bobadilla; Gerardo Salas Garrido

    2009-01-01

    The clinical characteristics and complementary methods that led to the cholelithiasis and obstructive choledocholithiasis diagnosis in a domestic cat, as well as the clinical-pathological changes are described. This condition is one of the causes of the extrahepatic bile duct obstruction syndrome (EBDO) with low incidence in dogs and cats.

  5. Endoscopic retrograde cholangiopancreatography forsuspected choledocholithiasis: From guidelines to clinicalpractice

    Institute of Scientific and Technical Information of China (English)

    Joana Magalh?es; Bruno Rosa; José Cotter

    2015-01-01

    AIM: To study the practical applicability of the AmericanSociety for Gastrointestinal Endoscopy guidelinesin suspected cases of choledocholithiasis.METHODS: This was a retrospective single centerstudy, covering a 4-year period, from January 2010to December 2013. All patients who underwentendoscopic retrograde cholangiopancreatography(ERCP) for suspected choledocholithiasis were included.Based on the presence or absence of predictors ofcholedocholithiasis (clinical ascending cholangitis,common bile duct (CBD) stones on ultrasonography(US), total bilirubin 〉 4 mg/dL, dilated CBD on US,total bilirubin 1.8-4 mg/dL, abnormal liver functiontest, age 〉 55 years and gallstone pancreatitis),patients were stratified in low, intermediate or highrisk for choledocholithiasis. For each predictor andrisk group we used the χ 2 to evaluate the statisticalassociations with the presence of choledocolithiasisat ERCP. Statistical analysis was performed usingSPSS version 21.0. A P value of less than 0.05 wasconsidered statistically significant.RESULTS: A total of 268 ERCPs were performed forsuspected choledocholithiasis. Except for gallstonepancreatitis (P = 0.063), all other predictors of cho-ledocholitiasis (clinical ascending cholangitis, P = 0.001;CBD stones on US, P ≤ 0.001; total bilirubin 〉 4 mg/dL, P = 0.035; total bilirubin 1.8-4 mg/dL, P = 0.001;dilated CBD on US, P ≤ 0.001; abnormal liver functiontest, P = 0.012; age 〉 55 years, P = 0.002) showed astatistically significant association with the presence ofcholedocholithiasis at ERCP. Approximately four fifthsof patients in the high risk group (79.8%, 154/193patients) had confirmed choledocholithiasis on ERCP,vs 34.2% (25/73 patients) and 0 (0/2 patients) in theintermediate and low risk groups, respectively. Thedefinition of "high risk group" had a sensitivity of 86%,positive predictive value 79.8% and specificity 56.2%for the presence of choledocholithiasis at ERCP

  6. [Laparoscopic endoscopy: a new type of combined technique for select patients].

    Science.gov (United States)

    Völgyi, Zoltán; Fischer, Tünde; Szenes, Mária; Tüske, György; Vattay, Péter; Gasztonyi, Beáta

    2010-06-20

    The authors report a new method which was introduced last year in their unit. In a significant part of cholecystolithiasis, choledocholithiasis also exists. The diagnosis is sometimes fairly difficult, in these cases newly developed imaging methods (magnetic resonance cholangiopancreatography, endoscopic ultrasonography) can help. In cases of choledocholithiasis, when preoperative endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful, laparoscopic endoscopy can be performed. Authors describe this method as well as discuss the international literature, and review the cases of their own ten cases with this method. They emphasize the advantages of the new method in a certain subgroup of patients against the traditional sequential approach (preoperative ERCP than laparoscopic cholecystectomy) and also share their technical experiences. Finally, they underline the importance of the team work which supposes the cooperation of the gastroenterologist, surgeon and anesthesiologist in the indication, organization and implementation of the intervention.

  7. Ascariasis of the pancreatic duct.

    Science.gov (United States)

    Klimovskij, Michail; Dulskas, Audrius; Kraulyte, Zita; Mikalauskas, Saulius

    2015-09-15

    Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

  8. Reliability of pre- and intraoperative tests for biliary lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  9. Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Seong Su; Park, Soo Youn [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

    2009-08-15

    An ectopic opening of the common bile duct into the duodenal bulb is a very rare congenital malformation of the bile duct, which may cause a recurrent duodenal ulcer or biliary diseases including choledocholithiasis or cholangitis. ERCP plays major role in the diagnosis of this biliary malformation. We report a case of an ectopic opening of the common bile duct into the duodenal bulb, which was detected on the upper gastrointestinal series.

  10. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Shinto, A. S.; Selvakumar, J. [Amala Institute of Medical Sciences, Amalanagar (India)

    2010-12-15

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

  11. MR cholangio pancreatography: clinical applications; Colangiopancreatografia por ressonancia magnetica: aplicacoes clinicas

    Energy Technology Data Exchange (ETDEWEB)

    D`Ippolito, Giuseppe; Galvao Filho, Mario; Jesus, Paulo Eduardo Marinho de; Wolosker, Angela; Borri, Maria Lucia [Hospital Sao Luiz, Sao Paulo, SP (Brazil). Centro Diagnostico

    1998-05-01

    MR cholangio-pancreatography (MRCP) has been replacing diagnostic conventional cholangio-pancreatography. MRCP is a new, noninvasive and rapidly evolving technique for imaging diseases of the biliary tree and pancreatic ducts. Images are obtained without administration of oral or intravenous contrast. Our objective is to demonstrate the main clinical applications of MPCP, its limits and advantages over other methods. In our series of 60 patients we have detected choledocholithiasis, sclerosing cholecystitis, chronic pancreatitis, pancreatic and ampullary tumors. (author) 16 refs., 14 figs.

  12. Endoscopic ultrasound for chronic abdominal pain and gallbladder disease.

    Science.gov (United States)

    Dill, B; Dill, J E; Berkhouse, L; Palmer, S T

    1999-01-01

    Endoscopic ultrasound (EUS) is a major advance in gastrointestinal endoscopy. EUS, which is invaluable in the diagnosis and staging of gastrointestinal cancer, is now being used in the diagnosis of chronic upper abdominal pain. EUS combined with stimulated biliary drainage (EUS/SBD) aids in the diagnosis of choledocholithiasis, cholecystitis, microlithiasis, and various conditions of the upper gastrointestinal tract. This article describes the EUS/SBD procedure and nursing care. Two case histories illustrating potential benefits to patients are presented.

  13. Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the exte...

  14. ASCARIASIS AND COEXISTANT STONE IN COMMON BILE DUCT IN POST CHOLECYSTECTOMY POST CHOLEDOCHOLITHOTOMY WOMAN: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Khalid

    2014-11-01

    Full Text Available Ascariasis is one of the commonest infections in Asia. Biliary ascariasis is a serious presentation of ascariasis which can result in life threatening complications including cholangitis, choledocholithiasis, Liver abscess, and Pancreatitis. We present a case of female from north Bihar who presented to us with biliary ascariasis and concomitant stone. Diagnosis was established by abdominal ultrasonography. Choledocholithotomy done and a live round worm with two biliary stone extracted.

  15. Endoscopic sphincterotomy in the treatment of cholangiopancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    Zhi-Hua Li; Min Chen; Ji-Kui Liu; Jun Ding; Jia-Hong Dong

    2005-01-01

    AIM: To investigate the therapeutic effect of endoscopicsphincterotomy (EST) in the treatment of choledocholithiasis and stenosing papillitis.METHODS: A total of 1 026 patients undergoing EST during July 1983 to May 2003 at the institute were retrospectively analyzed. Chronic pancreatitis was diagnosed in 63 (6.1%),cholecystolithiasis and choledocholithiasis in 549 (53.5%),stones in residual biliary duct in 249 (24.3%), stenosing papillitis in 228 (22.2%). In patients with simple stenosing papillitis, most incisions were within 0.5-1 cm in length. As for patients with chronic pancreatitis simultaneously, selective pancreatic sphincterotomy was performed, and incision was within 0.5-0.8 cm in length. For stones less than 1 cm, incision was from 1 to 1.5 cm, and for those larger than 1 cm, incision ranged from 1.5 to 3 cm. For stones more than 2 cm in diameter, detritus basket rather than simple incision was chosen. RESULTS: Of the 798 patients with choledocholithiasis, 764 (93.5%) had successful stone clearance, 215 (94.3%)out of 228 cases of stenosing papillitis were cured totally, while 63 had chronic pancreatitis developed from stenosing papillitis, 57 (90.1%) had sound remission of symptoms, though membranous stenosis emerged in 13 of 57 which was treated with balloon dilatation. After the operation, only 21 cases (2.1%) had complications such as severe pancreatitis and incision bleeding. None of the patients died.CONCLUSION: EST is an ideal surgical management with mini-invasion in the treatment of choledocholithiasis and stenosing papillitis.

  16. Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

    Institute of Scientific and Technical Information of China (English)

    Nobutada; Fukino; Takatsugu; Oida; Atsushi; Kawasaki; Kenji; Mimatsu; Youichi; Kuboi; Hisao; Kano; Sadao; Amano

    2010-01-01

    The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performe...

  17. Magnetic resonance cholangiography: applications in patients with calculus disease of the biliary tract.

    Science.gov (United States)

    Liu, Terrence H; Organ, Claude H

    2004-04-01

    Magnetic resonance cholangiography (MRC) is a non-invasive imaging modality that has become widely available. In the short time since its introduction, MRC has been shown to possess excellent accuracy for the diagnosis of various biliary pathologies, including choledocholithiasis. Investigations of the clinical applications of MRC are ongoing. This review summarizes the diagnostic capabilities of MRC and discusses its application in the management of patients with gallstone diseases.

  18. Comparison between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP); Comparacion entre calongiografia por resonancia magnetica (CPRM) y colangiografia retrograda endoscopia (CPRE)

    Energy Technology Data Exchange (ETDEWEB)

    Pulpeiro, J. R.; Armesto, V. [Clinica Nosa Senora dos Ollos Grandes. Lugo (Spain); Lopez-Roses, L.; Lancho, A.; Gonzalez, A. [Hospital Xeral. Lugo (Spain)

    2000-07-01

    To assess the correlation between magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). The authors carried out a prospective study of 71 patients suspected of having biliary diseases. MRCP was performed, followed by ERCP.MRCP was done with a 1.5-T system using hypergradients, abdominal phase array coil and single-shot fast spin-echo (SSFSE) sequences with maximum signal intensity in T2-weighted images. This sequence only provides images of the fluids, similar to those obtained with ERCP. The results of ERCP were employed as a reference standard. Thirty patients were found to have stenosis (19 malignant and 11 benign). 25 had choledocholithiasis and 16 showed no abnormal findings. The correlation was complete in patients with stenosis. MRCP detected 23 cases of choledocholithiasis (ERCP was normal in the remaining two patients, but calculi were discovered on shpincterotomy). MRCP confirmed the normal condition of the bile duct in 12 of the 16 patients free of biliary disease (2 patients in whom ERCP had been normal had been diagnosed as having bile duct dilatation due to choledocholithiasis 24 hours and 10 days earlier, respectively, and two cases of presented ectasia due to fibrosis of the sphincter of Oddi showed good emptying during ERCP). MRCP using SSFSE is highly correlated with ERCP, which should be reserved for cases in which the diagnosis is in doubt or endoscopic management is necessary. (Author) 25 refs.

  19. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases; Estudio propsective comparativo en el diagnostico de la patologia biliar. Colangiopancreatografia por resonancia magnetica frente a colangiografia directa

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-07-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs.

  20. Giant choledochal calculosis: Surgical treatment

    Directory of Open Access Journals (Sweden)

    Hasan Bektas

    2014-01-01

    Full Text Available Context: Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP, this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm, which is rare in surgical practice and our treatment with open surgery. Case Report: The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD was performed. The patient was discharged without any complications on postoperative 8 th day. Conclusion: Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions.

  1. Life-threatening hemobilia caused by hepatic artery pseudoaneurysm:A rare complication of chronic cholangitis

    Institute of Scientific and Technical Information of China (English)

    Tsu-Te Liu; Ming-Chih Hou; Han-Chieh Lin; Full-Young Chang; Shou-Dong Lee

    2003-01-01

    Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is undear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.

  2. A phantom gallbladder on endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Various complications have been related to laparoscopic cholecystectomy but most occur shortly after the procedure. In this report, we present a case with very late complications in which an abscess developed within the gallbladder fossa 6 years after laparoscopic cholecystectomy. The abscess resolved after treatment with CT-guided extrahepatic aspiration. However, 4 years later, an endoscopic retrograde cholangiopancreatography (ERCP) performed for choledocholithiasis demonstrated a "gallbladder" which communicated with the common bile duct via a patent cystic duct. This unique case indicates that a cystic duct stump may communicate with the gallbladder fossa many years following cholecystectomy.

  3. Abscess Formation of the Round Ligament of the Liver: Report of a Case

    Directory of Open Access Journals (Sweden)

    Ikeda,Eiji

    2008-12-01

    Full Text Available Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.

  4. Etiology of the obstructive pattern in hepatobiliary imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, K.S.; Marrangoni, A.G.; Turbiner, E.

    1984-04-01

    The records of all patients undergoing hepatobiliary imaging with technetion radioisotopes at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.

  5. Endoscopic therapy for bile duct stones in a geriatric population.

    OpenAIRE

    1992-01-01

    During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one of these patients. Stones were cleared endoscopically in 73.3% and surgically in 4.7% of cases. Long-term stenting was employed in 14.3% of patients. The 30 day mortality...

  6. Mn-DPDP enhanced T1-weighted magnetic resonance cholangiography: usefulness in the diagnosis and roadmap for the treatment of intrahepatic choIedochoIithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Suk; Kim, Ki Whang; Yu, Jeong Sik; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of); Kim, Kyoung Won; Kim, Tae Kyoung; Ha, Hyun Kwon [Asan Medical Center, Seoul (Korea, Republic of)

    2004-05-01

    To assess the preliminary findings of Mn-enhanced T1-weighted MR cholangiography for the evaluation of intrahepatic choledocholithiasis. Seven patients with recurrent pyogenic cholangitis underwent conventional heavily T2-weighted and manganese-enhanced T1-weighted MR cholangiography. For the former, the two reviewers focused on intrahepatic ductal dilatation, calculi, and stricture; and for the latter, ductal enhancement. In seven patients, 13 diseased segments were depicted and intrahepatic bile ductal dilatation was present in all 13 of these in all seven patients. Calculi were present in eight segments in six patients, and stricture in four segments in three patients. Of the 13 diseased segmental ducts, six were seen at manganese-enhanced imaging to be filled with contrast material, suggesting a functioning bile duct. Combined T2-weighted and mangafodipir trisodium-enhanced T1-weighted MR cholangiography provides both anatomic detail and functional detail of the biliary system. Combined MR cholangiography is useful for the evaluation of intrahepatic choledocholithiasis, demonstrating the stricture and function of the segmental ducts involved.

  7. An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice

    Institute of Scientific and Technical Information of China (English)

    Georgios Tziatzios; Paraskevas Gkolfakis; Ioannis S Papanikolaou; George Dimitriadis; Konstantinos Triantafyllou

    2016-01-01

    ABSTRACT:Despite the effectiveness of endoscopic retro-grade cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the ifrst case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and nor-malization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, exclud-ing possible remaining choledocholithiasis. Nevertheless, se-rum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient’s liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

  8. Results of diagnosis of pancreatic cancer by computed tomography (CT)

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, K.; Okuaki, K.; Ito, M.; Katakura, T.; Suzuki, K. (Fukushima Medical Coll. (Japan))

    1981-08-01

    Results of examination of pancreatic diseases, especially pancreatic cancer, conducted by CT during the past 3 years are summarized. The EMI CT Type 5000 or 5005 were used. During the 3 years from September 1976 to August 1979, a total of 1961 patients were examined by CT, and the upper abdomen was examined in 772 of these patients. In 97 patients, positive findings were obtained in the CT image of the pancreas. In 52 of these patients, the findings were confirmed operatively or by autopsy. Though cancer of the pancreas was diagnosed by CT in 30 patients, it was confirmed in 20 by surgical operation and in 1 by autopsy. Of the 9 misdiagnosed cases, 4 were cases of infiltration of the pancreas by carcinoma of the stomach or bile duct, and the other 5 were one case each of lipoma of the abdominal wall, normal pancreas, hyperplasia of Langerhans's islets of the pancreas tail, abscess between the pancreas and the posterior wall of the stomach, and choledocholithiasis. A case diagnosed by CT as cholelithiasis was a carcinoma measuring 5 x 5 x 6 cm located on the head of the pancreas, complicated by choledocholithiasis. The 22 patients with carcinoma of the pancreas were 9 with lesions less than 3.5 x 3.0 x 3.0 cm in size who could be radically operated, 6 who underwent exploratory laparotomy or autopsy, and 7 in whom operation was impossible. False negative and false positive CT results are also discussed.

  9. Risk factors for hilar cholangiocarcinoma: A case-control study in China

    Institute of Scientific and Technical Information of China (English)

    Wen-Ke Cai; Hui Sima; Ben-Dong Chen; Guang-Shun Yang

    2011-01-01

    AIM: To study the association between hilar cholangiocarcinoma (HC) and pre-existing medical conditions.METHODS: Three hundred and thirteen HC patients admitted to the Eastern Hepatobiliary Surgery Hospital (Shanghai, China) in 2000-2005 and 608 healthy controls were enrolled in this study. Association between HC and pre-existing medical conditions was studied with their adjusted odds ratio (OR) calculated by logistic regression analysis.RESULTS: The prevalence of choledocholithiasis (adjusted OR = 2.704, P = 0.039), hepatolithiasis (adjusted OR = 3.278, P = 0.018), cholecystolithiasis (adjusted OR = 4.499, P < 0.0001), cholecystectomy (adjusted OR = 7.012, P = 0.004), biliary ascariasis (adjusted OR =7.188, P = 0.001), liver fluke (adjusted OR = 10.088, P = 0.042) and liver schistosomiasis (adjusted OR = 9.913,P = 0.001) was higher in HC patients than in healthy controls.CONCLUSION: Biliary tract stone disease (choledocholithiasis,hepatolithiasis, cholecystolithiasis) and parasitic liver disease (biliary ascariasis, liver fluke, liver schistosomiasis)are the risk factors for HC in Chinese population.

  10. Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination: A case report

    Institute of Scientific and Technical Information of China (English)

    Zhen-Hai Zhang; Ya-Guang Wu; Cheng-Kun Qin; Zhong-Xue Su; Jian Xu; Guo-Zhe Xian; Shuo-DongWu

    2012-01-01

    Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis.We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination.An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography.EST was performed and the stone was completely cleaned.Barium examination was done 3d after EST and severe cholangitis appeared 4 h later.The patient was recovered after treated with tienam for 4 d.Barium examination may induce severe cholangitis in patients after EST,although rare,barium examination should be chosen cautiously.Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.

  11. Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Natalie E. Cookson

    2015-01-01

    Full Text Available Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT imaging revealed hyperdense material in the common bile duct (CBD compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient’s jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.

  12. The significance of magnetic resonance cholangiopancreatography in acute cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kei; Fujita, Naotaka; Noda, Yutaka [Sendai City Medical Center (Japan)] [and others

    2000-12-01

    To clarify the significance of magnetic resonance cholangiopancreatography (MRCP) in the acute phase of acute cholecystitis, MRCP was carried out in forty-five patients with acute cholecystitis in their acute phase. The MR pericholecystic high signal was observed in 38 of the 45 patients (84%). Enlargement of the gallbladder, presence of gallstones, and impacted stones was seen in 71%, 53%, and 18%, respectively. The MR pericholecystic high signal was classified into four categories: type 0, not observed; type 1, a liner high signal; type 2, a band-like high signal; type 3, a radiating high signal. In patients who showed a type 3 MR pericholecystic high signal, 91% required percutaneous transhepatic gallbladder drainage, and most of the gallbladders were diagnosed as necrotic cholecystitis by histology. The accuracy of MRCP for the diagnosis of choledocholithiasis was 96%. It was suggested that MRCP for patients with acute cholecystitis in the acute phase provides useful information for planning the treatment. (author)

  13. Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Ulku Saritas; Bunyamin Aydin; Yucel Ustundag

    2007-01-01

    Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure.After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow-up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

  14. Endoscopy in pregnancy.

    LENUS (Irish Health Repository)

    O'mahony, Seamus

    2012-02-03

    Endoscopy is rarely required during pregnancy. The potential risks of endoscopy during pregnancy include foetal hypoxia due to sedative drugs and exposure to radiation. There is no evidence that endoscopy precipitates premature labour, and studies in this area have concluded that endoscopy during pregnancy is generally safe. There should be a strong indication for the procedure, which should be deferred whenever possible to the second trimester. Procedures should be performed without any sedation, or with the lowest dose of sedative medication. Radiation exposure should be kept to a minimum. Support should be obtained from specialists in obstetrics and anaesthesia. Indications for endoscopy during pregnancy are as follows: (1) gastroscopy: upper gastrointestinal bleeding, dysphagia, uncontrolled nausea\\/vomiting; (2) sigmoidoscopy\\/colonoscopy: rectal bleeding, diarrhoea; and (3) ERCP: choledocholithiasis, biliary pancreatitis. Sedative drugs, such as midazolam appear to be safe if used carefully. Radiation exposure during ERCP can be kept well below the danger level for teratogenicity.

  15. Treatment of acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Al-Mofleh Ibrahim

    1998-01-01

    Full Text Available There is no specific treatment for acute pancreatitis. Majority of patients with acute pancreatitis respond to medical therapy. Supportive measures and close observations represent the cornerstone of the medical therapy. Failure to respond to medical treatment may indicate choledocholithiasis or infected necrosis. Endoscopic papillotomy with stone retrieval is beneficial in patients with severe biliary pancreatitis. Image-guided fine needle aspiration and bacteriological examination of aspirate is reliable in detecting infection and deliniating causative pathogen. Surgical debridement is the method of choice for treatment of infected necrosis. In contrast, in pancreatic abscess, surgery is preserved for those, who do not respond to percutaneous drainage combined with antibiotics. The benefit of antisecretory and antiproteolytic agents is debatable. A combination of antioxidants, calcium channel antagonists and antibiotics may play a major role in the treatment of acute pancreatitis in the future.

  16. Utility of endoscopic ultrasound in pancreatitis: A review

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The close proximity of the endoscopic ultrasound probe to the pancreas results in superior spatial resolution compared to CT scan and MRI. In addition, endoscopic ultrasound (EUS) is a minimally invasive procedure that does not share the relatively high complication rate of ERCP. Due to these advantages, EUS has evolved into an important technique to assess pancreatobiliary disease. This review will discuss the role of EUS in patients with pancreatitis. The indications can be divided into acute pancreatitis and chronic pancreatitis. In acute pancreatitis, EUS is used to determine the etiology; in suspected chronic pancreatitis it is helpful to establish the diagnosis. Lastly, this review will discuss biliary pancreatitis with suspicion for persistent choledocholithiasis.

  17. Portal cavernoma cholangiopathy: diagnosis, imaging, and intervention.

    Science.gov (United States)

    Moomjian, Lauren N; Winks, Sarah G

    2017-01-01

    The term portal cavernoma cholangiopathy refers to the biliary tract abnormalities that accompany extrahepatic portal vein obstruction (EHPVO) and subsequent cavernous transformation of the portal vein. EHPVO is a primary vascular disorder of the portal vein in children and adults manifested by longstanding thrombosis of the main portal vein. Nearly all patients with EHPVO have manifestations of portal cavernoma cholangiopathy, such as extrinsic indentation on the bile duct and mild bile duct narrowing, but the majority are asymptomatic. However, progressive portal cavernoma cholangiopathy may lead to severe complications, including secondary biliary cirrhosis. A spectrum of changes is seen radiologically in the setting of portal cavernoma cholangiopathy, including extrinsic indentation of the bile ducts, bile duct stricturing, bile duct wall thickening, angulation and displacement of the extrahepatic bile duct, cholelithiasis, choledocholithiasis, and hepatolithiasis. Radiologists must be aware of this disorder in order to provide appropriate imaging evaluation and interpretation, to facilitate appropriate treatment and to distinguish this entity from its potential radiologic mimics.

  18. Endoscopic therapy in acute recurrent pancreatitis

    Institute of Scientific and Technical Information of China (English)

    John Baillie

    2008-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a largely diagnostic to a largely therapeutic rnodality.Cross-sectional imaging,such as computed tomography (CT) and magnetic resonance imaging (MRI),and less invasive endoscopy,especially endoscopic ultrasound (EUS),have largely taken over from ERCP for diagnosis.However,ERCP remains the"first line" therapeutic tool in the management of mechanical causes of acute recurrent pancreatitis,including bile duct stones(choledocholithiasis),ampullary masses (benign and malignant),congenital variants of biliary and pancreatic anatomy (e.g.pancreas divisum,choledochoceles),sphincter of Oddi dysfunction (SOD),pancreatic stones and strictures,and parasitic disorders involving the biliary tree and/or pancreatic duct(e.g Ascariasis,Clonorchiasis).

  19. Laparoscopic T-tube choledochotomy for biliary lithiasis.

    Science.gov (United States)

    Garteiz Martínez, Denzil; Sánchez, Alejandro Weber; López Acosta, María Elena

    2008-01-01

    T-tube choledochotomy has been an established practice in common bile duct exploration for many years. Although bile leaks, biliary peritonitis, and long-term postoperative strictures have been reported and are directly associated with the placement or removal of the T-tube, the severity of these complications may often be underestimated by surgeons. We present the case of a 31-year-old male patient who developed biliary peritonitis and septic shock after removal of a T-tube and illustrate one of the catastrophic events that may follow such procedures. Literature shows that these complications may occur more frequently and have higher morbidity and mortality than other less invasive procedures. This article reviews the advances in laparoscopic and endoscopic techniques, which provide alternative therapeutic approaches to choledocholithiasis and allow the surgeon to avoid having to perform a choledochotomy with T-tube drainage.

  20. Research Progress of Therapeutic Endoscopy in the Treatment of Pancreaticobiliary Disease

    Institute of Scientific and Technical Information of China (English)

    CAI Lei; CHENG Yuan; CAI Li-quan; PAN Ming-xin; GAO Yi

    2014-01-01

    Pancreaticobiliary diseases, which include cholecystitis, choledocholithiasis, cholangitis, malignant biliary stricture, pancreatic pseudocyst and pancreatic cancer, have increasing morbidity and mortality year by year and severely threaten human lives, for which there are many therapeutic methods in clinic. The promotion of endoscopic otomy and the development of new devices have greatly improved the successful rate of endoscopic retrograde cholangiopancreatology (ERCP). Additionally, with the development of non-invasive diagnostic technique for pancreatic disease like magnetic resonance cholangiopancreatography, ERCP can also be widely used in the treatment of pancreatic diseases. Therefore, this study mainly reviewed the application of ERCP in the treatment of pancreaticobiliary diseases, hoping to improve the survival rate of patients and provide basis for the clinical treatment.

  1. Congenital duplication of the gallbladder.

    Science.gov (United States)

    Safioleas, Michael C; Papavassiliou, Vassilios G; Moulakakis, Konstantinos G; Angouras, Dimitrios C; Skandalakis, Panagiotis

    2006-03-01

    Duplication of the gallbladder is a rare congenital anomaly of the biliary system. In this article, two cases of gallbladder duplication are presented. The first case is a patient with double gallbladder and concomitant choledocholithiasis. The probable diagnosis of double gallbladder was made preoperatively by computed tomography. The patient underwent a successful open cholecystectomy and common bile duct exploration. In the second case, two cystic formations in the place of gallbladder are demonstrated with ultrasound scan in a woman with acute cholecystitis. At surgery, two gallbladders were found. A brief review of epidemiology and anatomy of double gallbladder is included, along with a discussion of the difficulties in diagnosis and treatment of this condition.

  2. T-TUBE APPLICATION AFTER CBD EXPLORATION IS NOT ALWAYS NECESSARY: A STUDY

    Directory of Open Access Journals (Sweden)

    Purujit

    2014-06-01

    Full Text Available BACKGROUND: Routine application of supraduodenal T-tube after choledochotomy is absolutely not necessary. T-tube application gives various complications with high morbidity and reported cases of mortality and increases hospital stay. Materials and methods-Primary closure of CBD following choledochotomy is studied on 457 cases of choledocholithiasis and biliary ascariasis with CBD diameter less than 2.5cms. Most of the cases had 1-3 stone that didn’t require much manipulation during extraction. The choledochotomy wound were closed by single layer of interrupted 3-0 vicryl suture. RESULT: Post-operative period was uneventful except transient jaundice which subsided within few days in some cases. Most of the patients were discharged after 2- 3 days. Conclusions-Primary closure of choledochotomy is routinely advocated due to many fold advantages and T-tube is considered to be applied in a very special situation.

  3. Biloma: An unusual complication in a patient with pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Palak Jitendrakumar Trivedi; Prakash Gupta; Jane Phillips-Hughes; Anthony Ellis

    2009-01-01

    The term biloma describes an encapsulated collection of bile within the abdomen, usually secondary to bile duct disruption. The commonest causes reported in the literature are iatrogenic (secondary to hepatobiliary surgery), trauma or complications due to choledocholithiasis. A few cases have been reported as complications of cholangiocarcinoma or acute cholecystitis. We report the case of a 64-year-old man initially diagnosed with a non-obstructive malignancy of the pancreas, who developed a spontaneous intrahepatic biloma 8 mo later. This was identified following a 1-wk history of fever, rigors and icterus. The biloma was identified on computed tomography and subsequently drained under ultrasound guidance. Forty-eight hours later, a stent was inserted endoscopically into his common bile duct and he made an uneventful in-hospital recovery. We believe this is the first documented case of spontaneous intrahepatic biloma to occur secondary to pancreatic malignancy.

  4. ETIOLOGY, EPIDEMIOLOGICAL PROFILE AND RADIOLOGICAL EVALUATION OF OBSTRUCTIVE JAUNDICE AT A TERTIARY CARE CENTER

    Directory of Open Access Journals (Sweden)

    Lokesh

    2015-09-01

    Full Text Available BACKGROUND AND AIM: Obstructive jaundice is nowadays usually referred to gastroenterology department and therefore, it is important to identify the common causes and relevant investigations to find out the cause. With this objective we conducted a study at Mahatma Gandhi Hospital, Jaipur to find out the etiology and epidemiological profile of patients presenting with obstructive jaundice to our department. PATIENTS AND METHODS: 50 patients of obstructive jaundice were evaluated thoroughly for etiology, epid emiological profile and radiological evaluation. RESULTS: Malignancy was more common in males while benign causes predominated in females. Carcinoma head of pancreas was most common cause of obstructive jaundice followed by choledocholithiasis. CONCLUSION : Malignant obstructive jaundice is more common as compared to benign obstructive jaundice and malignant causes are more frequent in males as compared to females Where benign causes predominate. Ultrasound should be the first diagnostic test to be performed and in selected cases CT and MRCP should be performed.

  5. Imaging tests for accurate diagnosis of acute biliary pancreatitis.

    Science.gov (United States)

    Şurlin, Valeriu; Săftoiu, Adrian; Dumitrescu, Daniela

    2014-11-28

    Gallstones represent the most frequent aetiology of acute pancreatitis in many statistics all over the world, estimated between 40%-60%. Accurate diagnosis of acute biliary pancreatitis (ABP) is of outmost importance because clearance of lithiasis [gallbladder and common bile duct (CBD)] rules out recurrences. Confirmation of biliary lithiasis is done by imaging. The sensitivity of the ultrasonography (US) in the detection of gallstones is over 95% in uncomplicated cases, but in ABP, sensitivity for gallstone detection is lower, being less than 80% due to the ileus and bowel distension. Sensitivity of transabdominal ultrasonography (TUS) for choledocolithiasis varies between 50%-80%, but the specificity is high, reaching 95%. Diameter of the bile duct may be orientative for diagnosis. Endoscopic ultrasonography (EUS) seems to be a more effective tool to diagnose ABP rather than endoscopic retrograde cholangiopancreatography (ERCP), which should be performed only for therapeutic purposes. As the sensitivity and specificity of computerized tomography are lower as compared to state-of-the-art magnetic resonance cholangiopancreatography (MRCP) or EUS, especially for small stones and small diameter of CBD, the later techniques are nowadays preferred for the evaluation of ABP patients. ERCP has the highest accuracy for the diagnosis of choledocholithiasis and is used as a reference standard in many studies, especially after sphincterotomy and balloon extraction of CBD stones. Laparoscopic ultrasonography is a useful tool for the intraoperative diagnosis of choledocholithiasis. Routine exploration of the CBD in cases of patients scheduled for cholecystectomy after an attack of ABP was not proven useful. A significant rate of the so-called idiopathic pancreatitis is actually caused by microlithiasis and/or biliary sludge. In conclusion, the general algorithm for CBD stone detection starts with anamnesis, serum biochemistry and then TUS, followed by EUS or MRCP. In the end

  6. Diagnosis, Differential Diagnosis, and Epidemiology of Primary Sclerosing Cholangitis.

    Science.gov (United States)

    Ponsioen, Cyriel Y

    2015-01-01

    According to recent guidelines, primary sclerosing cholangitis (PSC) is diagnosed when a patient has a cholestatic liver enzyme profile, characteristic bile duct changes on imaging, and when secondary causes of sclerosing cholangitis are excluded. In patients with a clinical suspicion but normal cholangiography, a liver biopsy is indicated to establish a diagnosis of small duct PSC. Several other disease entities such as IgG4-associated cholangitis (IAC), cholangiocarcinoma (CCA), and secondary causes of sclerosing cholangitis such as choledocholithiasis, AIDS-cholangiopathy, ischemia, surgical bile duct trauma, or mast cell cholangiopathy can mimic PSC. IAC can be differentiated from PSC by applying the HISORt criteria including the serum IgG4 level. In cases where serum IgG4 is less than 2 × ULN, the ratio of IgG4/IgG1 >0.24 is indicative for IAC. Choledocholithiasis with recurrent cholangitis as a cause of sclerosing cholangitis can pose a conundrum, since PSC itself is associated with an increased prevalence of gallstones. The epidemiology of PSC worldwide has been poorly described. Incidence and prevalence rates vary from 0-1.3 and 0-16.2 per 100,000 inhabitants respectively. However, these figures are not based on population-based cohorts. A recent large population-based cohort from the Netherlands reported an incidence of 0.5 and a prevalence of 6/100,000. Approximately 10% fulfil the criteria for small duct PSC. At diagnosis of PSC, concurrent inflammatory bowel disease (IBD), primarily ulcerative colitis or Crohn's colitis is present in 50%, but increasing to 80%, 10 years or more after diagnosis. Conversely, 3% of IBD patients will develop PSC. PSC predisposes to malignancy. The estimated cumulative risk of developing CCA after 30 years is 20%. For colorectal carcinoma in PSC/colitis patients, the estimated cumulative risk at 30 years is 13%.

  7. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

    Institute of Scientific and Technical Information of China (English)

    Adem Akcakaya; Orhan Veli Ozkan; Ismail Okan; Orhan Kocaman; Mustafa Sahin

    2009-01-01

    AIM: To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS: Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCl and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS: The mean age of the patients was 28 years (range, 21-33 years). The mean gestational age for the fetus was 23 wk (range, 14-34 wk). Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION: Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

  8. Biliary sphincterotomy dilation for the extraction of difficult common bile duct stones Dilatación de la esfinterotomía biliar para la extracción de coledocolitiasis difíciles

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    J. García-Cano

    2009-08-01

    Full Text Available Background and aim: endoscopic retrograde cholangiopancreatography (ERCP with biliary sphincterotomy (BS is the usual method for extracting common bile duct stones. However, following BS and by means of extraction balloons and Dormia baskets a complete bile duct clearance cannot be achieved in all cases. We present a study on the impact that hydrostatic balloon dilation of a previous BS (BSD may have in the extraction rate of choledocholithiasis. Patients and methods: a prospective study which included 91 consecutive patients diagnosed with choledocholithiasis who underwent ERCP. For stone removal, extraction balloons and Dormia baskets were used, and when necessary BSD was employed. Results: complete bile duct clearance was achieved in 86/91 (94.5% patients. BSD was used in 30 (33% cases. In these cases, extraction was complete in 29/30 (97%; 23 (76% patients in the BSD group had anatomic difficulties or bleeding disorders. The most frequently used hydrostatic balloon diameter was 15 mm (60%. There were 7 (7.6% complications: two self-limited hemorrhage episodes in the BSD group and one episode of cholangitis, one of pancreatitis, and three of bleeding in the group in which BSD was not used. Conclusions: BSD is a very valuable tool for extracting common bile duct stones. In our experience, there has been an increase in the extraction rate from 73% (Rev Esp Enferm Dig 2002; 94: 340-50 to 94.5% (p = 0.0001, OR 0.1, CI 0.05-0.45, with no increase in complications.

  9. Comparative study on presentation of biliary ascariasis with dead and living worms

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    Alam Shahinul

    2010-01-01

    Full Text Available Background/Aim: Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA. The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. Materials and Methods: We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests. Results: The age (mean ± SD of the patients was 36.8 ± 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%; others were acute cholangitis (30; 21.7%, obstructive jaundice (19; 13.8%, choledocholithiasis (20; 14.5%, acute pancreatitis (10; 7.2%, acute cholecystitis (6; 4.3%, liver abscess (2; 1.4%, hepatolithiasis (3; 2.2%, stricture of common bile duct (2; 1.4%, pancreatic abscess (1; 0.7% and cirrhosis of liver (1; 0.7%. Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms. Conclusion: Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.

  10. Imaging features of portal biliopathy: Frequency of involvement patterns with emphasis on MRCP

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    Ozkavukcu, Esra [Ankara University School of Medicine, Department of Radiology (Turkey)], E-mail: eozkavukcu@gmail.com; Erden, Ayse; Erden, Ilhan [Ankara University School of Medicine, Department of Radiology (Turkey)

    2009-07-15

    Purpose: To investigate the imaging features of portal biliopathy with emphasis on MR cholangiopancreatography (MRCP). The ancillary vascular findings of portal biliopathy were also evaluated by accompanying MR portography, dynamic contrast-enhanced (CE) CT, and dynamic CE MRI studies. Materials and methods: Sixteen patients with portal cavernoma were included in the study. Patients had undergone MRCP (n = 16) studies accompanied by MR portography (n = 13), dynamic CE CT (n = 3) or dynamic CE MRI (n = 2) of the liver. Two patients had undergone both dynamic CE CT and dynamic CE MRI. Two radiologists evaluated all the examinations together, retrospectively. MRCP images were analyzed for the presence of biliary stenosis, upstream (prestenotic) dilatation, wavy appearance of the bile ducts, angulation of the common bile duct (CBD), and choledocholithiasis. MR portography, dynamic CE CT and dynamic CE MRI studies were evaluated for the existence of portal cavernomas, and the presence of gall bladder/choledochal varices. Results: All patients had signs of portal biliopathy on MRCP. Frequencies of the biliary findings on MRCP were as follows: biliary stenosis, 93.7%; upstream dilatation, 68.7%; wavy appearance of the biliary tree, 87.5%; angulation of the CBD, 75%. None of the patients had choledocholithiasis. Frequencies of the ancillary vascular findings detected on CE studies were as follows: gall bladder varices, 100%, choledochal varices, 93.7%. Conclusion: MRCP features of portal biliopathy in order to their frequencies were as follows: biliary stenosis, wavy appearance of the bile ducts, angulation of the CBD, and upstream dilatation of the bile ducts.

  11. 腹腔镜手术治疗胆囊结石致胆囊肠道内瘘17例报告%Laparoscopic Management for 17 Cases of Cholecystoenteric Fistula

    Institute of Scientific and Technical Information of China (English)

    江州华; 周新华; 陈佰文; 郑四鸣; 李宏

    2014-01-01

    目的:探讨腹腔镜手术治疗胆囊结石致胆囊肠道内瘘的疗效。方法2008年1月~2013年6月,行腹腔镜手术治疗胆囊结石致胆囊肠道内瘘17例,均在腹腔镜下切除胆囊和瘘管,肠道瘘口腔镜下单纯修补为主,其中1例因胆囊十二指肠瘘口较大,行十二指肠瘘口T管引流术。对合并胆总管结石的6例,均在胆道镜取石后行一期缝合或T管引流术。结果胆囊肠道内瘘的类型:单纯胆囊十二指肠瘘8例,胆囊胃瘘1例,胆囊横结肠瘘1例,胆囊十二指肠瘘合并胆囊横结肠瘘1例,胆囊十二指肠瘘合并胆总管结石5例,胆囊十二指肠瘘合并胆囊横结肠瘘、胆总管结石1例。手术时间50~150 min,平均95 min。术中出血量20~240 ml,平均55 ml。17例术后随访7~12个月,平均11个月,无肠漏、胆漏、胆道感染及肠梗阻等并发症发生。结论重视胆囊肠道内瘘患者的术前诊断和准备,术中仔细解剖操作,胆囊肠道内瘘腹腔镜下手术处理安全有效。%Objective To evaluate the efficacy of laparoscopic management for cholecystoebteric fistula ( CF) . Methods From January 2008 to June 2013, 17 cases of cholecystoenteric fistula underwent laparoscopic surgery.All the patients received laparoscopic cholecystectomy and fistula repair, except for 1 patient with cholecystoduodental fistula was treated with T-tube drainage because of large fistula.For 6 patients complicated with choledocholithiasis, one stage suture or T-tube drainage after stone extraction under choledochoscopy was carried out. Results The group comprised of 8 cases of cholecystoduodental fistula, 1 case of cholecystogastric fistula, 1 case of cholecystocolic fistula, 1 case of cholecystoduodental complicated with cholecystocolic fistula, 5 cases of cholecystoduodental fistula along with choledocholithiasis, and 1 case of cholecystoduodental fistula along with cholecystocolic fistula and

  12. Estudio por ecoendoscopia de la vía biliar extrahepática en pacientes con pancreatitis aguda biliar Endoscopic ultrasonographic examination of the common bile duct in patients with acute biliary pancreatitis

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    A. Repiso

    2008-06-01

    included in the study (31 males and 42 females with a mean age of 64 ± 15 who were admitted to our department for biliopancreatic EUS. In all patients the technique was followed by ERCP with sphincterotomy, and endoscopy to remove stones when endoscopy revealed choledocholithiasis. Results: mean time from admission to echoendoscopy was 7 ± 6 days. In 18 patients (24% the presence of choledocholithiasis was revealed by EUS, and in 17 a sphincterotomy was performed. Choledocholithiasis was more frequent in patients with common bile duct dilation (55 vs. 14%; p 0.05. No difference was also detected for the subgroup of patients with severe acute pancreatitis (45 vs. 55%; p > 0.05. Conclusions: EUS is a useful technique for the selection of patients with acute biliary pancreatitis who may benefit from endoscopic sphincterotomy.

  13. 腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术效果观察%Observation the Effect of Laparoscope Combine With Fibrocholedochoscope in Choledocholithotomy With Primary Sutura

    Institute of Scientific and Technical Information of China (English)

    高万宏

    2015-01-01

    目的:探讨腹腔镜联合纤维胆道镜在胆总管切开取石一期缝合术中的临床治疗效果。方法随机选取我院2013年1月~2014年12月收治的胆囊结石合并胆总管结石患者40例,将其随机均分为观察组与对照组,对照组应用开腹腔当总管切开取石术开展治疗;观察组应用腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术开展治疗,对两组患者的临床治疗效果予以对比分析。结果两组患者的平均手术时间、切口感染情况等相比,P<0.05,差异具有统计学意义。结论腹腔镜联合纤维胆道镜行胆总管切开取石一期缝合术,能够有效缩短平均手术时间,降低切口感染发生率。%Objective To investigate the clinical effect of laparoscopic combined with fibrocholedochoscope in choledocholithotomy with primary closure. Methods Selected 40 patients with cholecystolithiasis and choledocholithiasis from January 2013 to December 2014 in our hospital were randomly divided into the observation group and the control group respectively. The control group was given choledocholithotomy through opened the abdominal cavity, the observation group was given choledocholithotomy with primary closure through laparoscope and ifbrocholedochoscope. The clinical therapeutic effects of two groups were compared and analyzed. Results Compared average operation time, wound infection conditions and other matters of the two groups, P<0.05, had difference statistically sigiifcance. Conclusion Choledocholithotomy with primary closure through laparoscope and ifbrocholedochoscope for patients with cholecystolithiasis and choledocholithiasis can shorten patients’ average operation time effectively, reduce patients’ wound infection incidence.

  14. ["Endoscopy in a stone quarry"--multiple pigment stones 6 weeks after delivery].

    Science.gov (United States)

    Sandmann, M; Fähndrich, M; Heike, M

    2010-03-01

    A 29-year-old African woman without any history of diseases was referred to our clinic because of recurrent abdominal pain. 6 weeks earlier she had delivered a healthy baby. Laboratory data revealed hypochromic microcytic anemia, elevated cholestatic liver enzymes, and an elevated bilirubin level of 2.2 mg/dl. Abdominal sonography showed choledocholithiasis. The endoscopic retrograde cholangiography showed the presence of more than 100 small stones in the intra- and extrahepatic bile ducts. An endoscopic papillotomy was performed and multiple small black stones were removed from the bile duct by basket into the duodenum. Because of the hypochromic microcytic anemia, the detection of pigment stones and the ethnic background of the patient we suspected a hemoglobinopathy. Hemoglobin electrophoresis showed 97 % HbC. The molecular genetic analysis revealed a homozygous mutation in codon 6 GAG > AAG for the beta globin chain (HbCC). HbC is a structurally abnormal hemoglobin with typical aggregates and tetragonal crystal formation which results in mild chronic hemolytic anemia. The cholezystectomy after 6 weeks was performed without complications.

  15. Diagnostic role of secretin-enhanced MRCP in patients with unsuccessful ERCP

    Institute of Scientific and Technical Information of China (English)

    László Czakó; Tamás Takács; Zita Morvay; László Csernay; János Lonovics

    2004-01-01

    AIM: To evaluate the value of MR cholangiopancreatography (MRCP) in patients in whom endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessfully performed by experts in a tertiary center.METHODS: From January 2000 to June 2003, 22 patients fulfilled the inclusion criteria. The indications for ERCP were obstructive jaundice (n = 9), abnormal liver enzymes (n = 8),suspected chronic pancreatitis (n = 2), recurrent acute pancreatitis (n = 2), or suspected pancreatic cancer (n = 1).The reasons for the ERCP failure were the postsurgical anatomy (n = 7), duodenal stenosis (n = 3), duodenal diverticulum (n = 2), and technical failure (n = 10). MRCP images were evaluated before and 5 and 10 min after i.v.administration of 0.5 IU/kg secretin.RESULTS: The MRCP images were diagnosed in all 21patients. Five patients gave normal MR findings and required no further intervention. MRCP revealed abnormalities (primary sclerosing cholangitis, chronic pancreatitis, cholangitis, cholecystolithiasis or common bile duct dilation) in 10 patients, who were followed up clinically. Four patients subsequently underwent laparotomy (hepaticojejunostomy in consequence of common bile duct stenosis caused by unresectable pancreatic cancer; hepaticotomy+Kehr drainage because of insufficient biliary-enteric anastomosis; choledochojejunostomy, gastrojejunostomy and cysto-Wirsungo gastrostomy because of chronic pancreatitis, or choledochojejunostomy because of common bile duct stenosis caused by chronic pancreatitis). Three patients participated in therapeutic percutaneous transhepatic drainage. The indications were choledocholithiasis with choledochojejunostomy, insufficient biliary-enteric anastomosis, or cholangiocarcinoma.CONCLUSION: MRCP can assist the diagnosis and management of patients in whom ERCP is not possible.

  16. Hydatid cyst of the gallbaldder: A systematic review of the literature

    Science.gov (United States)

    Gómez, Roberto; Allaoua, Yousef; Colmenares, Rafael; Gil, Sergio; Roquero, Pilar; Ramia, José M

    2016-01-01

    AIM To evaluate all the references about primary gallbladder hidatidosis looking for best treatment evidence. METHODS Search: 1966-2015 in MEDLINE, Cochrane Library, SciELO, and Tripdatabase. Key words: “gallabladder hydatid disease” and “gallbladder hydatid cyst”. We found 124 papers in our searches but only 14 papers including 16 cases were about hydatid cyst of the gallbladder (GBHC). RESULTS Eight cases of GBHC were women and seven men. One not mentioned. Median age was 48.3 years. The most frequent clinical symptom was abdominal pain (94%) usually in the right upper quadrant. Ultrasound was performed in ten patients (62.5%) but in most cases a combination of several techniques was performed. The location of the cysts was intravesicular in five patients. Five patients presented GBHC and liver hydatid cysts. Two patients presented cholelithiasis and one choledocholithiasis. The most frequent surgical technique was cholecystectomy by laparotomy (81.25%). Simultaneous surgery of liver cysts was carried out in five cases. Eleven patients did not present postoperative complications, but one died. The mean hospital stay was seven days. No recurrence of GBHC was recorded. CONCLUSION In GBHC, the most frequent symptom is right hypocondrium pain (evidence level V). Best diagnostic methods are ultrasound and computed tomography (level V, grade D). Suggested treatment is open cholecystectomy and postoperative albendazole (level V, grade D) obtaining good clinical results and none relapses. PMID:27660675

  17. Predictors of common bile duct lithiasis in laparoscopic era

    Institute of Scientific and Technical Information of China (English)

    George Sgourakis; Georgia Dedemadi; Athanasios Stamatelopoulos; Emmanuel Leandros; Dionysius Voros; Konstantinos Karaliotas

    2005-01-01

    AIM: To analyze retrospectively the records of 294 conse-cutive patients operated upon for gallbladder stones, to determine the predictive factors of synchronous common bile duct (CBD) stones and validate prospectively the generated model. METHODS: The prognostic estimation of a biochemical test and ultrasonography alone to differentiate between the absence and presence of choledocholithiasis was assessed using receiver operating characteristics curve analysis. Multivariate analysis was employed using discriminant analysis for establishment of a best model. Prospective validation of the model was made.RESULTS: Discriminant forward stepwise analysis disclosed that high values (≥ 2×normal) of SGOT, ALP, conjugated bilirubin and CBD diameter on ultrasound ≥ 10 mm were all prognostic factors of CBD lithiasis in univariate and multivariate analysis, P<0.01. History was not included in the model. Prospective validation of the model was performed by multivariate analysis using Visual General Stepwise Regression. Positive predictive value,when considering all these predictors, was 93.3%, while the negative predictive value was 88.8%. Sensitivity of the model was 96.5% and specificity 80%.CONCLUSION: The above model can be objectively applied to predict the presence of CBD stones.

  18. Acute pancreatitis with saw palmetto use: a case report

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    Amankona Raymond

    2011-08-01

    Full Text Available Abstract Introduction Saw palmetto is a phytotherapeutic agent commercially marketed for the treatment of benign prostatic hyperplasia. Evidence suggests that saw palmetto is a safe product, and mild gastrointestinal adverse effects have been reported with its use. We report a case of acute pancreatitis, possibly secondary to the use of saw palmetto. Case presentation A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. He denied drinking alcohol prior to the development of his symptoms. His home medications included saw palmetto, lansoprazole and multivitamins. Laboratory results revealed elevated lipase and amylase levels. An abdominal ultrasound demonstrated a nondilated common bile duct, without choledocholithiasis. Computed tomography of his abdomen showed the pancreatic tail with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient's condition improved with intravenous fluids and pain management. On the fourth day of hospitalization his pancreatic enzymes were within normal limits: he was discharged home and advised to avoid taking saw palmetto. Conclusion It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions.

  19. Diagnosis of acute surgical abdomen - The best diagnostic tool to reach a final diagnosiscin

    Institute of Scientific and Technical Information of China (English)

    Wong CS; Al-Ajami AK; Boshahri M; Naqvi SA

    2012-01-01

    Objective: To evaluate the best diagnostic tool (clinical, radiological, laboratory, or endoscopy) used to reach a final diagnosis of four most common presentations of acute abdomen to the surgical unit in the Limerick University Hospital, Limerick, Ireland. Methods: Data was analyzed retrospectively of prospective collected data of all patients who had been admitted at a single academic institution from July 2011 till September 2011. Radiology, operating theatre and histopathology, haematology and endoscopy databases were searched from the Hospital Inpatient Enquiry (HIPE) department for patients who had presented with acute abdominal pain. Patients’ charts were searched manually and final diagnosis of each patient was recorded. Results: Out of 30 confirmed final diagnosis of appendicitis or appendicular mass, 9/30 (30.0%) were diagnosed with radiological (either on ultrasonography or CT scan). The remaining 21 cases (70.0%) were diagnosed clinically. Majority cases of diverticulitis 16/22 (72.7%) was diagnosed radiologically compared to only 6/22 (27.3%) of those confirmed by endoscopy. All diagnosis of gallstone-related diseases (cholecytitis, biliary colic, or cholelithiasis and/or choledocholithiasis) and bowel obstruction were confirmed by radiological investigation. Conclusions: Appendicitis can be accurately diagnosed clinically based on history and clinical examination alone. Diagnosis of diverticular disease, gallstone disease, and bowel obstruction further requires radiology intervention to confirm the provisional diagnosis.

  20. Gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy: a case report

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    Goyal Amit

    2008-11-01

    Full Text Available Abstract Introduction Gallstone ileus is a mechanical obstruction caused by the impaction of one or more gallstones within the lumen of any part of the gastrointestinal tract. Although the disorder is a rare cause of small bowel obstruction (1% to 2%, it has been reported to cause up to 25% of cases of non-strangulated small bowel obstruction in patients over 65 years of age. Case presentation We report a case of a 67-year-old woman who presented with gallstone ileus following endoscopic retrograde cholangiopancreatography and sphincterotomy for choledocholithiasis. She had a history of terminal ileum resection with ileocolic anastomosis for Crohn's disease. A 3 cm gallstone was found to be impacted just proximal to the previous ileocolic anastomosis. A second gallstone was found on digital examination of the proximal small bowel. Conclusion A gallstone may enter the gastrointestinal tract following endoscopic retrograde cholangiopancreatography and sphincterotomy and impact proximal to an anastomotic stricture as demonstrated here. The radiographic image of small bowel obstruction plus air in the biliary tree is a classic diagnostic finding. After stone extraction, the entire small bowel and colon should be digitally examined for further stones.

  1. Biliary Surgery Via Minilaparotomy — A Limited Procedure for Biliary Lithiasis

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    Takukazu Nagakawa

    1993-01-01

    Full Text Available Cholelithiasis until now has been treated using solvents, lithotripsy via a biliary endoscope, laser or shock wave lithotripsy, and laparoscopic cholecystectomy. have developed a new surgical treatment for cholelithiasis in which a cholecystectomy is performed through a minilaparotomy. This paper presents this new technique and discusses the principles of surgery for cholelithiasis using this technique. This procedure is performed by a 2 to 3 cm subcostal skin incision in the right hypochondrium. More than 400 patients were treated by this technique. This procedure is not different in terms of blood loss .or operation time from conventional methods, and no significant complications have occurred. Intraoperative X-ray examination is performed routinely because of easy insertion of a tube from the cystic duct into the bile duct. Reduction of the length of the incision greatly facilitates postoperative recovery, shortening the hospital length-of-stay to within 3 days. The surgical manipulation of only a limited area of the upper abdomen is unlikely to induce postoperative syndromes, such as adhesions or ileus. Following this experience, a biliary drainage procedure based on cholangionmanomery and primary closure of the choledochotomy was introduced. This approach allowed even patients with choledocholithiasis to undergo a minilaparotomy and be discharged within one week.

  2. EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

    Institute of Scientific and Technical Information of China (English)

    Miodrag Krstic; Bojan Stimec; Radmilo Krstic; Milenko Ugljesic; Srbislav Knezevic; Ivan Jovanovic

    2005-01-01

    Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

  3. Prevalence of clonorchiasis in patients with gastrointestinal disease: A Korean nationwide multicenter survey

    Institute of Scientific and Technical Information of China (English)

    Ho Gak Kim; Jimin Han; Myung-Hwan Kim; Kyu Hyun Cho; Sang Soo Lee; Im Hee Shin; Gwang Ha Kim; Jae Seon Kim; Jin Bong Kim; Tae Nyeun Kim; Tae Hyo Kim; Jae Woo Kim; Ji Kon Ryu; Yong Bum Yoon; Young-Soo Moon; Jong Ho Moon; Sung Jae Park; Chan Guk Park; Sung-Jo Bang; Chang Heon Yang; Kyo-Sang Yoo; Byung Moo Yoo; Kyu Taek Lee; Dong Ki Lee; Jae Bok Chung; Byung Seok Lee; Seung Ok Lee; Woo Jin Lee; Chang Min Cho; Young-Eun Joo; Gab Jin Cheon; Young Woo Choi

    2009-01-01

    AIM: To investigate prevalence of Clonorchis sinensis in patients with gastrointestinal symptoms, and the relation of the infection to hepatobiliary diseases in 26 hospitals in Korea. METHODS: Consecutive patients who had been admitted to the Division of Gastroenterology with gastrointestinal symptoms were enrolled from March to April 2005. Of those who had been diagnosed with clonorchiasis, epidemiology and correlation between infection and hepatobiliary diseases were surveyed by questionnaire. RESULTS: Of 3080 patients with gastrointestinal diseases, 396 (12.9%) had clonorchiasis and 1140 patients (37.2%) had a history of eating raw freshwater fish. Of those with a history of raw freshwater fish ingestion, 238 (20.9%) patients had clonorchiasis. Cholangiocarcinoma was more prevalent in C. sinensis-infected patients than noninfected patients [34/396 (8.6%) vs 145/2684 (5.4%),P = 0.015]. Cholangiocarcinoma and clonorchiasis showed statistically significant positive cross-relation ( P = 0.008). Choledocholithiasis, cholecystolithiasis,cholangitis, hepatocellular carcinoma, and biliary pancreatitis did not correlate with clonorchiasis.CONCLUSION: Infection rate of clonorchiasis was still high in patients with gastrointestinal diseases in Korea, and has not decreased very much during the last two decades. Cholangiocarcinoma was related to clonorchiasis, which suggested an etiological role for the parasite.

  4. 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.

  5. Spontaneous biliary tract perforations: an unusual cause of peritonitis in pregnancy. Report of two cases and review of literature

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    Ravi Bina

    2006-07-01

    Full Text Available Abstract Spontaneous perforations of the biliary tract are rare in adults and even more so during pregnancy. Perforation of the gall bladder is a potentially fatal complication of cholecystitis. The infrequency of perforation in the setting of calculous disease of the gall bladder is probably due to the thickened wall of the organ that has long been the seat of chronic inflammation. Common bile duct perforations have been reported in adults most commonly in association with choledocholithiasis. The diagnosis of biliary tract perforations is often delayed due to their non specific symptoms, which results in high morbidity. Early diagnosis and aggressive therapy are mandatory to alleviate this condition. Delayed diagnoses and treatment may have more serious consequences for pregnant women than for other patients. Very few cases of biliary tract perforations have been reported in pregnant women. We report two such cases in pregnancy: first of a gall bladder perforation associated with cholelithiasis and the second of a common bile duct perforation in pregnancy in which no apparent cause was found.

  6. [Hemobilia].

    Science.gov (United States)

    Galun, D; Basarić, D; Lekić, N; Raznatović, Z; Barović, S; Bulajić, P; Zuvela, M; Milićević, M

    2007-01-01

    The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia is directed at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical.

  7. Oldest biliary endoprosthesis in situ

    Science.gov (United States)

    Consolo, Pierluigi; Scalisi, Giuseppe; Crinò, Stefano F; Tortora, Andrea; Giacobbe, Giuseppa; Cintolo, Marcello; Familiari, Luigi; Pallio, Socrate

    2013-01-01

    The advantages of endoscopic retrograde cholangiopancreatography over open surgery have made it the predominant method of treating patients with choledocholithiasis. After sphincterotomy, however, 10%-15% of common bile duct stones cannot be removed with a basket or balloon. The methods for managing “irretrievable stones” include surgery, mechanical lithotripsy, intraductal or extracorporeal shock wave lithotripsy and biliary stenting. The case presented was a referred 82-year-old Caucasian woman with a 7-year-old plastic biliary endoprosthesis in situ. To the best of our knowledge the examined endoprosthesis is the oldest endoprosthesis in situ reported in the literature. Endoscopic biliary endoprosthesis placement remains a simple and safe procedure for patients with stones that are difficult to manage by conventional endoscopic methods and for patients who are unfit for surgery or who are high surgical risks. To date no consensus has been reached regarding how long a biliary prosthesis should remain in situ. Long-term biliary stenting may have a role in selected elderly patients if stones extraction has failed because the procedure may prevent stones impaction and cholangitis. PMID:23858381

  8. Refractory obstructive jaundice in a child affected with thalassodrepanocytosis: a new endoscopic approach

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    Barresi Luca

    2010-10-01

    Full Text Available Abstract Background Liver involvement, including elevated direct-reacting bilirubin levels, is common in patients with sickle cell disease. Fifty to seventy percent of sickle cell patients have pigmented gallstones due to precipitation of unconjugated bilirubin, and cholelithiasis or choledocholithiasis are common complications. The highest prevalence of these complications occurs in patients with Gilbert's syndrome because of the combined effect of increased bilirubin production and reduced bilirubin-diphosphate-glucuronosyltransferase enzyme activity. Cholelithiasis is also a common complication in patients with thalassemia. Endoscopic removal of choledochal stones does not always resolve the clinical picture, as in cases of dysfunction of the Vater's papilla, increased bile density due to persistently impaired bile flow or distortion of the choledocus due to dilatation, or inflammation secondary to gallstone. Case presentation We report here a case of severe and persistent obstructive jaundice in a child affected with thalassodrepanocytosis and Gilbert's syndrome, previously, and unsuccessfully, treated with endoscopic removal of choledochal stones. Deep and thorough biliary washing, and stenting with a new removable polytetrafluoroethylene (PTFE-covered flared-type stent led to complete resolution of the obstructive jaundice. Conclusions This report shows that an aggressive endoscopic approach in this select category of patients can help resolve the severe complication of hemolytic anemia, thus avoiding surgery.

  9. ‘Latent’ Portal Hypertension in Benign Biliary Obstruction

    Science.gov (United States)

    Ibrarullah, Md.; Sikora, S. S.; Agarwal, D. K.; Kapoor, V. K.; Kaushik, S. P.

    1996-01-01

    A prospective study was undertaken to evaluate the changes in portal venous pressure in patients with benign biliary obstruction (BBO) but without overt clinical, endoscopic or radiological evidence of portal hypertension. Portal venous pressure was measured at laparotomy in 20 patients (10 each with either benign biliary stricture or choledocholithiasis) before and after biliary decompression. Pressure was found to be on the high side in seven patients (>25 cm of saline in three patients and > 30 cm of saline in four). The mean fall of pressure was 3.4 cm of saline after biliary decompression. No correlation could, however, be found between portal venous pressure and duration of biliary obstruction, serum bilirubin or bile duct pressure. Liver histology showed mild to moderate cholestatic changes but maintained portal architecture in all. Benign biliary obstruction may therefore, lead to elevation of portal pressure, even though the patient may not necessarily have any clinical, endoscopic or radiological manifestations of portal hypertension. The pathogenesis of this ‘latent’ portal hypertension is probably multifactorial. If biliary obstruction is left untreated the development of overt portal hypertension may become a possibility in the future. PMID:8725455

  10. A rare case of choledochal cyst with pancreas divisum: case presentation and literature review

    Science.gov (United States)

    Blachman-Braun, Ruben; Sánchez-García Ramos, Emilio; Varela-Prieto, Jesús; Rosas-Lezama, Erick; Mercado, Miguel Ángel

    2017-01-01

    Choledochal cysts are rare congenital malformations of the bile duct characterized by dilatations of the intrahepatic and/or extrahepatic portion of the biliary tree, they are associated to an anomalous arrangement of the pancreaticobiliary duct. Pancreas divisum results from a fusion failure of the pancreatic buds. The coexistence of pancreas divisum and choledochal cyst in adults has been reported in less than 10 well documented cases. This article presents a case of a 42-year-old Peruvian man with intermittent episodes of abdominal pain, initially diagnosed with choledocholithiasis, who underwent open cholecystectomy. During surgery, a diagnosis of choledochal cyst and pancreas divisum was made, and therefore a hepaticoduodenostomy was performed. The patient was referred to our hospital due to persistence of abdominal pain. After admission, a papillectomy was achieved without further complications. A cyst resection and dismantling of hepaticoduodenostomy with Roux-en-Y was performed 8 years later. During the subsequent 18-month follow-up, the patient remains asymptomatic. PMID:28317046

  11. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    Institute of Scientific and Technical Information of China (English)

    Michael P Swan; Michael J Bourke; Stephen J Williams; Sina Alexander; Alan Moss; Rick Hope; David Ruppin

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 na?ve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

  12. Hepaticojejunostomy for the management of sump syndrome arising from choledochoduodenostomy in a patient who underwent bariatric Roux-en-Y gastric bypass: A case report

    Science.gov (United States)

    Alqahtani, Mohammed S.; Alshammary, Shadi A.; Alqahtani, Enas M.; Bojal, Shoukat A.; Alaidh, Amal; Osian, Gelu

    2016-01-01

    Introduction Rapid weight loss following bariatric surgery is associated with high incidence of gallstones and complications that may need bilioenteric diversion. This presents a specific challenge in the management of this group of patients. Case presentation A 37 years old female underwent a Roux-en-Y gastric bypass (RYGB) in 2008 for morbid obesity. In 2009 she presented with obstructive jaundice and was diagnosed with choledocholithiasis successfully managed by open cholecystectomy and choledochoduodenostomy. In the following years, she developed recurrent attacks of fever, chills, jaundice, and right upper quadrant pain and her weight loss was not satisfactory. Imaging of the liver showed multiple cholangitic abscesses. Reflux at the choledochoduodenostomy site was suggestive of sump syndrome as a cause of her recurrent cholangitis and a definitive surgical treatment was indicated. Intraoperative findings confirmed sump at the choledochoduodenostomy site and also revealed the presence of a large superficial accessory duct arising from segment four of the liver with separate drainage into the duodenum distal to the choledochoduodenostomy site. A formal hepaticojejunostomy was done after ductoplasty. The Roux limb was created by transecting the jejunum 40 cm distal to the foot anastomosis of the RYGB. The gastric limb was lengthened as part of this procedure which afforded the patient the additional benefit of weight loss. Conclusion Choledochoduodenostomy should be avoided in patients with RYGB due to the risk of sump syndrome which requires conversion to a formal hepaticojejunostomy. PMID:26921534

  13. Usefulness of endoscopic ultrasonography in the clinical suspicion of biliary disease Utilidad de la ultrasonografía endoscópica en la sospecha clínica de patología biliar

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    David del Pozo

    2011-07-01

    Full Text Available Background and aims: endoscopic ultrasound (EUS is a very sensitive and specific technique for the diagnosis of biliary diseases. This procedure has proven its usefulness in cases of high suspicion of biliary disease (history of gallstones and dilatation of the intrahepatic and/or extrahepatic bile ducts. We know less about its usefulness in cases of low suspicion of biliary pathology. The aim of this study was to assess the diagnostic accuracy of EUS in patients with low suspicion of biliary disease (patients with dilatation of the biliary tract were excluded. Methods: 33 patients with low suspicion of biliary disease were recruited in 12 months. All of them had no biliary findings in a previous abdominal ultrasound and computer tomography scan. All of them underwent EUS and were studied prospectively. The diagnosis was confirmed by surgery and/or by ERCP in patients with positive EUS or clinical follow-up in those with normal EUS. Time of follow-up was 9 months (range, 3-12 months. Results: seventeen patients (51.5% presented with abnormal biliary findings on EUS (7 choledocholithiasis, 3 cholelithiasis, 2 choledocholithiasis + cholelithiasis and 5 microlithiasis. Conclusion: EUS is a useful and safe procedure for diagnosing patients with low suspicion of biliary disease.Antecedentes y objetivos: la ultrasonografía endoscópica (USE es una técnica muy sensible y específica para el diagnóstico de enfermedades biliares. Este procedimiento ha demostrado su utilidad en casos de alta sospecha de enfermedad biliar (historia de colelitiasis y dilatación de la vía biliar intra- y/o extrahepática. Sabemos menos sobre su utilidad en casos de baja sospecha de patología biliar. El objetivo de este estudio fue evaluar la precisión diagnóstica de la USE en pacientes con baja sospecha de enfermedad biliar (los pacientes con dilatación de la vía biliar fueron excluidos. Métodos: 33 pacientes con baja sospecha de enfermedad biliar fueron

  14. Clinical impact of High-Definition Endoscopic Ultrasonography (EUS in a district hospital Impacto clínico de la introducción de la ultrasonografía endoscópica (USE alta en un hospital de área

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    E. Poves

    2010-12-01

    Full Text Available Objectives: Evaluation of the impact of EUS in clinical practice. Methods: All exploration performed during the first 18 months of implementation of the technique were analyzed. Agreement was assessed by radiographic techniques or surgical specimens in those cases allowed. Results: 277 exploration were performed. There have been only 2 complications and they were related to sedation in both cases. The demand increased gradually, reaching 70 scans per 100,000 inhabitants. Main indications were bile (34.3% and pancreatic processes. No pathology was found in 10% of cases; 29 cases had choledocholithiasis (93% confirmed and treated endoscopically. Chronic pancreatitis was diagnosed in 19 cases (only 15.78% of the cases were diagnosed by computed tomography. 32 patients with idiopathic acute pancreatitis were evaluated: 20 of them had evidence of microlithiasis (80% cholecystectomized and asymptomatic after a mean follow-up of 21.5 months, two cases of choledocholithiasis, 1 with chronic pancreatitis and 9 cases remained free of filial etiology. We performed 56 punctures: 39 samples of pancreas in 33 patients (81.1% of the samples were diagnostic; adenocarcinoma and serous cystadenoma were the most common diagnoses, 13 enlarged nodes and 4 abdominal masses. Conclusions: EUS is a growing demand technique that has low risks and leads to better decision-making in a significant number of patients with different diseases. Therefore, its inclusion in routine clinical practice must be considered.Objetivos: Evaluar el impacto de la introducción de la ecoendoscopia en la práctica clínica. Métodos: Se analizaron todas las exploraciones realizadas en los primeros 18 meses de implantación de la técnica. Se valoró la concordancia mediante técnicas radiológicas o piezas quirúrgicas en los casos en los que fue posible. Resultados: Se realizaron 277 exploraciones. Sólo se han registrado 2 complicaciones y en ambos casos fue en relación con la sedaci

  15. Application of therapeutic ERCP in patients 80 years of age and older%高龄患者进行治疗性逆行胆管造影的经验体会

    Institute of Scientific and Technical Information of China (English)

    邵晓冬; 郭晓钟; 任丽楠; 赵佳均; 梁振东; 林浩

    2013-01-01

    Objective To evaluate the efficacy and the safety of therapeutic ERCP in patients 80 years of age and older with biliary and pancreatic diseases. Methods Patients with biliary and pancreatic diseases treated with therapeutic ERCP in our hospital from December 2005 to December 2011 were retrospectively reviewed. Results Two hundred and thirty seven patients underwent 268 therapeutic ERCP procedures. The indications included choledocholithiasis( 53. 2% ), malignant obstructive jaundice( 20. 2% ), biliary pancreatitis ( 10. 5% ),acute suppurative cholangitis( 9. 7% ),benign biliary stricture( 3. 4% )and others( 3. 0% ). The success rate of therapeutic ERCP was 94. 9% and 14. 6% of all procedures were emergent. Bile duct stones were completely cleared in 95. 4% of patients with cho-ledocholithiasis. Four patients underwent ERBD and two patients were referred for surgical intervention due to unsuccessful clearance of bile duct stone. Metal biliary stents were inserted in 23 patients with malignant obstructive jaundice. Plastic biliary stents were inserted in 34 patients,of which 11 patients underwent stent replacement because of stent occlustion. Unsuccessful ERCP procedures occurred in 12 cases. There were 183( 77. 2% )patients with peripapillary diverticulum. Complications occurred in 6 patients including cholangitis( 2 cases ), pancreatitis( 1 case ), hemorrhage( 2 cases )and perforation( 1 case )and there was no death case in the group. Conclusion For patients 80 years of age and older with biliary and pancreatic diseases, therapeutic ERCP is an effective and safe treatment.%目的 评估在80岁以上高龄患者中经逆行胆管造影(ERCP)进行胆胰疾病治疗的疗效和安全性.方法 回顾性分析该院自2005年12月-2011年12月经ERCP进行胆胰疾病治疗的80岁以上高龄患者的病历资料.结果 237例80岁以上高龄患者共进行了268例次治疗性ERCP.患者行ERCP治疗的原因有:胆管结石(53.2%)、恶性梗阻性黄疸(20.2%)

  16. Comparison of long-term results of laparoscopic and endoscopic exploration of common bile duct

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    Rai Sarabjit

    2006-01-01

    Full Text Available Background: To compare long term results of laparoscopic and endoscopic exploration of common bile duct, to assess post-procedure quality of life. Materials and Methods: From September 1992 to August 2003, we performed 4058 cholecystectomies, out of which 479 (11.80% patients had choledocholithiasis. There were 163 males and 316 females. Mean age was 63.65 ± 5.5 years. These patients were put in two groups. In the first group of 240 patients, a majority of patients underwent two-stage procedures. ERCP/ES was performed in 210 (87.50% cases. In the second group of 239 patients, a majority of patients underwent single-stage procedures. ERCP/ES was done in 32 (13.38% cases. Results: Mortality was zero in both groups. Morbidity was 15.1% in first group and 7.5% in second group. Mean hospital stay was 11.7 ± 3.2 days in first group and 6.2 ± 2.1 days in second group. Average operative time was 95.6 ± 20 minutes in first group and 128.4 ± 32 minutes in second group. Completed questionnaires received from 400 (83.50% patients revealed better long-term results in the second group. Clinical features of low-grade cholangitis were seen in 20% of patients who underwent ES. Hence the post-procedure quality of life in patients who underwent single-stage procedures was definitely much better, because of minimal damage of sphincter of Oddi. Conclusions: Single-stage laparoscopic operations provide better results and shorter hospital stay. Damage to sphincter of Oddi should be minimal, to avoid long-term low-grade cholangitis. In young patients, the operation of choice should be single-stage laparoscopic procedure with absolutely no damage to sphincter of Oddi.

  17. Pancreatitis of biliary origin, optimal timing of cholecystectomy (PONCHO trial: study protocol for a randomized controlled trial

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    Bouwense Stefan A

    2012-11-01

    Full Text Available Abstract Background After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy. Methods/Design PONCHO is a randomized controlled, parallel-group, assessor-blinded, superiority multicenter trial. Patients are randomly allocated to undergo early laparoscopic cholecystectomy, within 72 hours after randomization, or interval laparoscopic cholecystectomy, 25 to 30 days after randomization. During a 30-month period, 266 patients will be enrolled from 18 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite endpoint of mortality and acute re-admissions for biliary events (that is, recurrent biliary pancreatitis, acute cholecystitis, symptomatic/obstructive choledocholithiasis requiring endoscopic retrograde cholangiopancreaticography including cholangitis (with/without endoscopic sphincterotomy, and uncomplicated biliary colics occurring within 6 months following randomization. Secondary endpoints include the individual endpoints of the composite endpoint, surgical and other complications, technical difficulty of cholecystectomy and costs. Discussion The PONCHO trial is designed to show that early

  18. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Taketo Yamaguchi; Takeshi Ishihara; Katsutoshi Seza; Akihiko Nakagawa; Kentarou Sudo; Katsuyuki Tawada; Teruo Kouzu; Hiromitsu Saisho

    2006-01-01

    AIM: Endoscopic metal stenting (EMS) offers good results in short to medium term follow-up for bile duct stenosis associated with chronic pancreatitis (CP);however, longer follow-up is needed to determine if EMS has the potential to become the treatment of first choice.METHODS: EMS was performed in eight patients with severe common bile duct stenosis due to CR After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while,the other five underwent EMS following plastic tube stenting. The patients were followed up for more than5 years through periodical laboratory tests and imaging techniques.RESULTS: EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure: one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS.None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.CONCLUSION: EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.

  19. Helicobacter species are associated with possible increase in risk of biliary lithiasis and benign biliary diseases

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    Pandey Manoj

    2007-08-01

    Full Text Available Abstract Background Hepato-biliary tract lithiasis is common and present either as pain or as asymptomatic on abdominal ultrasonography for other causes. Although the DNA of Helicobacter species are identified in the gallbladder bile, tissue or stones analyzed from these cases, still a causal relationship could not be established due to different results from different geographical parts. Methods A detailed search of pubmed and pubmedcentral was carried out with key words Helicobacter and gallbladder, gallstones, hepaticolithiasis, cholelithiasis and choledocholithiasis, benign biliary diseases, liver diseases. The data was entered in a data base and meta analysis was carried out. The analysis was carried out using odds ratio and a fixed effect model, 95% confidence intervals for odds ratio was calculated. Chi square test for heterogeneity was employed. The overall effect was calculated using Z test. Results A total of 12 articles were identified. One study used IgG for diagnosis while others used the PCR for Ure A gene, 16 S RNA or Cag A genes. A couple of studies used culture or histopathology besides the PCR. The cumulative results show a higher association of Helicobacter with chronic liver diseases (30.48%, and stone diseases (42.96%(OR 1.77 95% CI 1.2–2.58; Z = 2.94, p = 0.003, the effect of each could not be identified as it was difficult to isolate the effect of helicobacter due to mixing of cases in each study. Conclusion The results of present meta analysis shows that there is a slight higher risk of cholelithiasis and benign liver disease (OR 1.77, however due to inherent inability to isolate the effect of stone disease from that of other benign lesions it is not possible to say for sure that Helicobacter has a casual relationship with benign biliary disease or stone disease or both.

  20. Safety and efficacy of minimal biliary sphincterotomy with papillary balloon dilation (m-EBS+EPBD) in patients using clopidogrel or anticoagulation

    Science.gov (United States)

    Mok, Shaffer R. S.; Arif, Murtaza; Diehl, David L; Khara, Harshit S; Ho, Henry C; Elfant, Adam B

    2017-01-01

    Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic biliary sphincterotomy (EBS) or endoscopic papillary balloon dilation (EPBD) are common techniques of biliary decompression. Potential risks include gastrointestinal hemorrhage, which can be increased by antiplatelet agents, anticoagulants (AC) and/or novel oral anticoagulants (NOACs) (ie. apixaban, dabigatran and rivaroxaban). The study aim is to evaluate the safety/efficacy of an alternative technique, minimal-EBS plus EPBD (m-EBS + EPBD), in individuals for whom clopidogrel, AC, and/or NOACs cannot be interrupted due to high cardiovascular or thromboembolic risk. Patients and methods Patients undergoing m-EBS + EPBD while taking clopidogrel and/or AC were retrospectively evaluated at two United States tertiary care centers for efficacy, GIB and procedure-related, cardiovascular and thromboembolic adverse events (AE). Results Ninety-five patients were identified [55 = clopidogrel and 45 = AC (31.1 % NOACs)]. The main indication for ERCP was choledocholithiasis (34 %). 100 % clinical improvement and 97.9 % endoscopic success were found. The incidence of AE was 5.3 %. There was a 4.2 % incidence of gastrointestinal hemorrhage (2 cases requiring endoscopic intervention). Both severe gastrointestinal hemorrhages also experienced the cases of post-ERCP pancreatitis, and 2 /3 of cholangitis (all aspirin + AC). There was 1cardiovascular event (non-ST elevation myocardial infarction), and no thromboembolic events. Conclusions Minimal-EBS + EPBD is an effective and safe therapy with an incidence of gastrointestinal hemorrhage of 4.2 %, (2.1 % requiring endoscopic intervention), for patients on clopidogrel and/or AC, with a high risk for cardiovascular/thromboembolic events. PMID:28337485

  1. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

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    Rajeev Sinha

    2014-01-01

    Full Text Available Introduction: The feasibility of the single incision, multiport transumbilical approach(SILC for the treatment of symptomatic gallbladder calculus disease has been established. Aims: The study examines both short and long term morbidity of the SILC approach. Materials and Methods: All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus.Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures.The instruments were those used for standard laparoscopic cholecystectomy(SLC.Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded.Results were compared with those of SLC. Results: Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis.The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients.Morrisons pouch drain was left in 3 patients.Injectable analgesics were required in 85% vs 90% (SILC vs SLC on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45% patients.Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student ′t′ test. A p value less than 0.05 was considered as significant. Conclusions: Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.

  2. Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

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    Kanumba Emmanuel S

    2011-05-01

    Full Text Available Abstract Background Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality. Methods This was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5. Results A total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8% patients underwent surgical treatment and the remaining 6 (5.2% patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P Conclusion Obstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important

  3. Mechanism and specificity of increased amylase/creatinine clearance ratio in pancreatitis.

    Science.gov (United States)

    Marten, A; Beales, D; Elias, E

    1977-09-01

    The amylase/creatinine clearance ratio (Cam/Ccr ratio) was determined in 239 subjects. In 87 hospitalised patients without pancreatic disease (controls) the Cam/Ccr ratio was 3.02 +/- 0.69 (mean +/- ISD). The ratio was above the normal range in all patients with acute pancreatitis but was normal in those with chronic pancreatitis and carcinoma of the pancreas. In 18 patients with choledocholithiasis a raised ratio distinguished those with pancreatitis as assessed independently by the surgeon at laparotomy from those with a macroscopically normal pancreas. Raised Cam/Ccr ratios were also found in diabetics with ketoacidosis and in three patients with fulminant alcoholic liver disease. Though a positive correlation was found between the Cam/Ccr ratio and serum creatinine concentration, abnormally high ratios did not occur in 30 patients with chronic renal failure. A significant increase in Cam/Ccr ratios was produced in six healthy volunteers by intravenous injection of glucagon. However, it is unlikely that hyperglucagonaemia alone accounts for the increased Cam/Ccr ratio seen in acute pancreatitis, as no correlation was found between the clearance ratio and the plasma glucagon concentration in a series of patients. In two other patients in whom excess circulating pancreatic polypeptide was detected the Cam/Ccr ratio was normal. It is concluded that, in view of the sensitivity and relative specificity of finding an increased Cam/Ccr ratio in acute pancreatitis, its determination should be valuable clinically, especially in those cases of hyperamylasaemia where the cause is in doubt. The mechanism whereby the ratio is increased is unknown, and it is unlikely that either glucagon or pancreatic polypeptide is a major factor in its production.

  4. Continued evidence for safety of endoscopic retrograde cholangiopancreatography during pregnancy

    Institute of Scientific and Technical Information of China (English)

    Sean; Fine; Joshua; Beirne; Silvia; Delgi-Esposti; Fadlallah; Habr

    2014-01-01

    AIM: To report the safety of continued use of endoscopic retrograde cholangiopancreatography(ERCP) during pregnancy at various maternal ages.METHODS: A retrospective chart review of pregnant patients who underwent ERCP at a tertiary academic center was undertaken between 2002 and 2012. Pertinent past medical history and initial presenting laboratory data were collected. Review of the procedure note for each ERCP performed provided documentation of lead shielding, type of sedation, fluoroscopy time, and post-procedure complications. Patients’ clinical courses were reviewed until the time of delivery and pregnancy complications with fetal outcomes were examined. Data was stratified based upon the mother’s age at the time of ERCP: 18-21, 22-29, and ≥ 30 years of age.RESULTS: Twenty pregnant patients who underwent ERCP between 2002 and 2012 were identified. The mean age at the time of ERCP was 26.4 years(18-38 years) and the average trimester was the second. The indications for ERCP were choledocholithiasis in 17 patients, gallstone pancreatitis in 2 patients, and cholangitis in 1 patient. The mean fluoroscopy time of ERCP was 3.8 min(0.3-23.6 min). Sphincterotomy was performed in 18 patients with therapeutic intent and not as a prophylactic measure to prevent recurrences. Clinical documentation of use of protective shielding was found in only 8 notes(40%). Post procedure complications were limited to two cases of post-ERCP pancreatitis(10%). Elective cholecystectomy was performed shortly after ERCP in 11 of the pregnant patients. Birth records were available for 16 patients, of which 15 had fullterm pregnancies. Cesarean sections were performed in 5(31%) patients. Term birth weight was greater than 2500 g in all cases except one in which the mother had a known hypercoagulable state. CONCLUSION: ERCP during pregnancy is both safe and efficacious regardless of maternal age or trimester.

  5. Use of rigid tubal ligation scope: Serendipity in laparoscopic common bile duct exploration

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    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Aim : To assess the feasibility, safety of rigid tubal ligation scope in laparoscopic common bile duct (CBD exploration. Materials and Methods: Rigid nephroscope was used for laparoscopic CBD exploration until one day we tried the same with the rigid tubal ligation scope, which was passed easily into CBD both proximally and distally visualising the interior of the duct for presence of stone that were removed using endoscopic retrograde cholangiopancreaticography (ERCP basket. This serendipity led us to use this scope for numerous patients from then on. A total of 62 patients, including male and female, underwent laparoscopic CBD exploration after choledochotomy with rigid tubal ligation scope between March 2007 and December 2012 followed by cholecystectomy. All the patients had both cholelithiasis and choledocholithiasis with minimum duct diameter of 12 mm. A total of 48 patients were given T-tube through choledochotomy and closed, and the remaining 14 patients had primary closure of choledochotomy. Results: There were no intra-operative complications in any of the patients like CBD injury or portal vein injury. Post-operatively graded clamping of T-tube was done and was removed after 15 days in the patients who were given T-tube. None had retained the stone after T-tube cholangiography, which was done before removing the tube. Mean duration of follow up was 6 months. No patients had any complaints during the follow up. Conclusion: Laparoscopic CBD exploration is also feasible with rigid tubal ligation scope. With experienced surgeons, CBD injury is very minimal and stone clearance can be achieved in almost all patients. This rigid tubal ligation scope can be an alternative to other rigid and flexible scopes.

  6. A STUDY OF OBSTRUCTIVE JAUNDICE WITH FOCUS ON PREDICTIVE FACTORS FOR OUTCOME

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    Srinidhi

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: Obstructive jaundice is a problem frequently encountered by general surgeons. A clear understanding of the etiology, presentation and management is a prerequisite for the management of obstructive jaundice. There is a need to identify the risk factors which may predict outcome. Hence, a detailed study of the various causes of obstructive jaundice and their management is of paramount importance. METHODS: A Prospective observational study was undertaken to investigate the pattern of clinical presentation, diagnosis and management of the different causes of obstructive jaundice. About 21 consecutive patients with symptoms and signs of obstructive jaundice were included in the study. Cases were admitted, examined, investigated and operated during the period of Nov 2010 to Aug 2012. RESULTS & CONCLUSION: The highest age incidence of obstructive jaundice was in the 50 - 80 years with maximum incidence in the 6th decade. There was an increased incidence in female i.e. M: F=1:2.5. Most common cause of obstructive jaundice is choledocholithiasis, followed by periampullary carcinoma. Among periampullary carcinoma, Ca head of pancreas and Ca Ampulla of Vater are the common causes. Jaundice is the most common presentation of surgical jaundice followed by pain abdomen, nausea/vomiting, itching, loss of weight and fever. Ultrasonography was the investigation of choice in our hospital. It is cheap, safe and reliable. Early diagnosis and management helps to reduce the mortality and morbidity rate. ERCP is comparatively as good as Open exploration of CBD and Choledochoduodenostomy for CBD calculi. Good survival benefit in cases of malignant obstructive jaundice depends on detecting the disease early in its course. It was noted on statistical analysis of malignant cases that the values of direct bilirubin levels were significantly higher in those patients who expired postoperatively compared to surviving patients. Hence these parameters

  7. ENDOSCOPIC STENT FOR PALLIATING MALIGNANT AND BENIGN BILIARY OBSTRUCTION

    Institute of Scientific and Technical Information of China (English)

    缪林; 范志宁; 季国忠; 文卫; 蒋国斌; 吴萍; 刘政; 黄光明

    2004-01-01

    Objective: To study the techniques of placement of memory alloy plating gold biliary stent and plastic stent for palliation of malignant and benign biliary obstruction, and to assess its clinical effectiveness. Methods: The patients in plastic stent group included paplilla of duodenum inflamational strictures (n=24), common bile duct inflammational inferior segment strictures (n=4), choledocholithiasis (n=5), bile leak (n=11), bile duct surgery injurey (n=7) and pancreatic carcinoma (n=1). The patients in plating gold stent group included common bile duct carcinoma (n=5) and pancreatic carcinoma (n=6). Under fluoroscopic guidance the stent was inserted into biliary obstruction sites from oral cavity in all cases. Complications, liver function and blood serum amylase were investigated during the study period. Results: Successful stent placement was achieved in all cases. After operation of 7 days, in gold biliary stent groups, the rates of decrease of blood serum total bilirubin, glutamic-pyruvic transaminase, r-glutamyl transpeptidase and alkaline phosphatase were 67.16%, 58.37%, 40.63% and 41.54% respectively. In plastic stent group, the rates of decrease of STB, ALT, r-GT and AKP were 53.24%, 55.03%, 37.15%, 34.12% respectively. Early complication included post-ERCP pancreatitis and cholangititis. Occlusion of stent was the major late complication. Conclusion: Memory alloy plating gold biliary stent and plastic stent were safe and efficacious methods for malignant and benign biliary obstruction, and could improve patient's living quality. Plastic stent was an efficient complement for therapy of bile leak and bile duct injury.

  8. Benign Hydronephrosis and Elevated of Serum Levels of Carbohydrate Antigen CA 19-9: A Case Report

    Science.gov (United States)

    Filipovic, Branka; Milinić, Nikola; Gacic, Jasna; Markovic, Olivera; Djokovic, Aleksandra; Filipovic, Branislav

    2016-01-01

    Patient: Male, 58 Final Diagnosis: Hydronephrosis Symptoms: Blunt abdominal pain • constipation • constipation Medication: — Clinical Procedure: Extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy Specialty: Gastroenterology and Hepatology Objective: Rare co-existance of disease or pathology Background: Carbohydrate tumor-associated antigen (CA 19-9) has been shown to be upregulated in other malignant tumors including gastric, ovarian, hepatocellular, and colorectal carcinoma as well as benign diseases of the biliary track such as pancreatitis, cholangitis, and choledocholithiasis. According to the available literature, in several cases of benign hydronephrosis and in a few cases of benign renal diseases, elevated CA 19-9 has been noted. Case Report: A 58-year-old Caucasian male patient was admitted in our clinic with complaints about blunt abdominal pain in the past two-month period localized in the right lumbar region and irradiating into the right inguinal area, constipation, abdominal bloating, and intermittent hematuria. The concentration of serum CA 19-9 was 3500 U/mL. Urine cytology provided no signs of abnormality. Intravenous urography visualized right-sided pyelon and ureter duplex with the defect in contrast shade of the pyelon, caused by a stag horn calculus. Contrast added computerized axial tomography of the abdomen and pelvis visualized the pyelon casted concretion spreading throughout the right pyelon, with ureterohydronephrosis with the distal block for passage of the contrast to the distal part of the ureter. Conclusions: There is no doubt that CA 19-9 level is occasionally elevated in patients with obstructive urolithiasis as it was in our case. In the routine medical praxis, urolithiasis should not be neglected in the differential diagnosis of elevated concentrations of CA 19-9 marker. PMID:27287959

  9. S100A9 is a biliary protein marker of disease activity in primary sclerosing cholangitis.

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    Lisa Reinhard

    Full Text Available BACKGROUND AND AIMS: Bile analysis has the potential to serve as a surrogate marker for inflammatory and neoplastic disorders of the biliary epithelium and may provide insight into biliary pathophysiology and possible diagnostic markers. We aimed to identify biliary protein markers of patients with primary sclerosing cholangitis (PSC by a proteomic approach. METHODS: Bile duct-derived bile samples were collected from PSC patients (n = 45 or patients with choledocholithiasis (n = 24, the control group. Liquid chromatography-tandem mass spectrometry (LC-MS/MS was performed to analyse the proteins, 2-D-gel patterns were compared by densitometry, and brush cytology specimens were analysed by RT-PCR. RESULTS: A reference bile-duct bile proteome was established in the control group without signs of inflammation or maligancy comprising a total of 379 non-redundant biliary proteins; 21% were of unknown function and 24% had been previously described in serum. In PSC patients, the biliary S100A9 expression was elevated 95-fold (p<0.005, serum protein expression was decreased, and pancreatic enzyme expression was unchanged compared to controls. The S100A9 expression was 2-fold higher in PSC patients with high disease activity than in those with low activity (p<0.05. The brush cytology specimens from the PSC patients with high disease activity showed marked inflammatory activity and leukocyte infiltration compared to the patients with low activity, which correlated with S100A9 mRNA expression (p<0.05. CONCLUSIONS: The bile-duct bile proteome is complex and its analysis might enhance the understanding of cholestatic liver disease. Biliary S100A9 levels may be a useful marker for PSC activity, and its implication in inflammation and carcinogenesis warrants further investigation.

  10. Gallstone-relatedcomplicationsafterRoux-en-Y gastricbypass:aprospectivestudy

    Institute of Scientific and Technical Information of China (English)

    Rachid G Nagem; Alcino Lázaro-da-Silva

    2012-01-01

    BACKGROUND: Gastric  bypass  is  a  widespread  bariatric procedure that carries a high incidence of gallstone formation postoperatively. Controversy exists regarding the importance and consequences of gallstones in these patients. There are surgeons  who  consider  gallstone-related  complications after  gastric  bypass  important  enough  to  require  routine removal of the gallbladder during gastric bypass (prophylactic cholecystectomy). However, this can lead to increased costs and risks. This study aimed to identify complications related to cholelithiasis after Roux-en-Y gastric bypass (RYGBP). METHODS: This is a prospective observational study of 40 morbidly obese patients free of gallbladder disease. The patients underwent open RYGBP at a public hospital in Brazil from February to October 2007. They were followed up clinically and ultrasonographically at 6 months and 1, 2, and 3 years after surgery. Of the patients, 38 patients were followed up for 3 years. RESULTS: Eleven  patients  (28.9%)  developed  cholelithiasis, four (10.5%) experienced biliary pain, and 2 suffered from acute  biliary  pancreatitis  (5.3%).  These  patients  had  their gallbladders removed laparoscopically. No patient presented with  acute  cholecystitis,  choledocholithiasis,  or  bile  duct dilation during the follow-up period. There were no deaths. CONCLUSIONS: Gallstone-related complications after RYGBP were relatively common. Some of these complications, like acute pancreatitis, are known to have potentially severe outcomes. It seems reasonable to perform cholecystectomy

  11. Evaluation of the Bilio-Pancreatic Region Using Endoscopic Ultrasonography in Patients Referred with and without Abdominal Pain and CA 19-9 Serum Level Elevation

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    Jose Luis Ulla Rocha

    2007-03-01

    Full Text Available Context When assessing the bilio-pancreatic region, collating the findings of serum CA 19- 9 values together with findings from various imaging tests - especially endoscopic ultrasonography - is not a simple issue in daily clinical practice. Objective To assess the usefulness of endoscopic ultrasonography in an Endoscopic Ultrasonography Unit in two situations: patients with asymptomatic elevation of serum CA 19-9 and patients who presented with abdominal pain plus elevation of CA 19-9. Methods A retrospective study of those patients who underwent radial endoscopic ultrasonography between October 2004 and September 2005 in our institution, considering an elevation of CA 19-9 (equal to or greater than 37 U/mL with or without symptoms. In each case, the parameters recorded were: levels of CA 19-9 one week before EUS, results from other imaging techniques (US, helical CT, and final diagnosis according to pathological and/or clinical evolution criteria. Patients with previous attacks of acute pancreatitis and also those who presented with bile duct dilation or space-occupying lesions in image studies (US and CT were excluded. Twenty-two patients met the inclusion criteria. Results Asymptomatic elevation of CA 19-9 was found in 15 patients while 7 patients had elevated CA 19-9 levels as well as pain of uncertain origin. The results of EUS in the asymptomatic patients were: chronic pancreatitis in 7 patients, no pancreatic alterations in 3 patients, and renal cysts, choledocholithiasis, michrolithiasis and liver cirrhosis in one patient, respectively. In patients with abdominal pain, EUS showed chronic pancreatitis in 6 cases and adenocarcinoma of the tail of the pancreas in the remaining patient. Conclusions When EUS was indicated for the asymptomatic elevation of CA 19-9, the main findings were benign diseases. EUS was useful in studying patients with idiopathic abdominal pain and a slight elevation of CA 19-9 since it allowed us to detect chronic

  12. Laparoscopic cholecystectomy in patients over 70 years of age: review of 176 cases Colecistectomía laparoscópica en pacientes mayores de 70 años: nuestra experiencia en 176 casos

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    F. J. Pérez Lara

    2006-01-01

    Full Text Available Introduction: we assessed the results of laparoscopic cholecystectomy in 176 patients over the age of 70 years. Patients and methods: the study included all patients older than 70 years of age who underwent laparoscopic surgery cholelithiasis during the previous ten years. Variables studied included age, sex, type of operation (programmed/emergency, comorbidity, anesthetic risk, intraoperative cholangiography, conversion to open surgery, number of trocars, reoperation, residual choledocholithiasis, postoperative hospital stay, morbidity and mortality. Results: the study included 176 patients (23.29% men and 76.71% women. The mean age was 74.86 years. The mean hospital stay was 1.27 days, with 16.98% morbidity and 0.56% mortality. Conclusions: laparoscopic cholecystectomy is a safe procedure in older patients. It results in faster recovery, a shorter postoperative stay and lower rates of morbidity and mortality than open bile duct surgery.Objetivo: el objetivo de nuestro estudio es el de evaluar los resultados obtenidos en 176 pacientes mayores de 70 años intervenidos mediante colecistectomía laparoscópica. Pacientes y métodos: se incluyen en el estudio todos los pacientes mayores de 70 años diagnosticados de colelitiasis intervenidos por laparoscopia en los diez últimos años. Analizamos los siguientes parámetros: edad, sexo, tipo de intervención (programada/urgente, comorbilidad, riesgo anestésico, colangiografía intraoperatoria, conversión a cirugía abierta, número de trócares, reintervención, coledocolitiasis residual, estancia hospitalaria postoperatoria y morbimortalidad. Resultados: incluimos en el estudio un total de 176 pacientes, de los cuales el 23,29% son varones y 76,71%, tienen una edad media de 74.86 años. En los resultados globales la estancia media hospitalaria es de 1,27 días, morbilidad 16,98% y mortalidad de 0,57%. Conclusiones: la colecistectomía laparoscópica es un procedimiento seguro en pacientes mayores

  13. Bilio-entero-gastrostomy: prospective assessment of a modified biliary reconstruction with facilitated future endoscopic access

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    Hamad Mostafa A

    2012-06-01

    Full Text Available Abstract Background Hepaticojejunostomy (HJ is the classical reconstruction for benign biliary stricture. Endoscopic management of anastomotic complications after hepaticojejunostomy is extremely difficult. In this work we assess a modified biliary reconstruction in the form of bilio-entero-gastrostomy (BEG regarding the feasibility of endoscopic access to HJ and management of its stenosis if encountered. Methods From October 2008 till February 2011 all patients presented to the authors with benign biliary stricture who needed bilio-enteric shunt were considered. For each patient bilio-entero-gastrostomy (BEG of either type I, II or III was constructed. In the fourth week postoperatively, endoscopy was performed to explore the possibility to access the biliary anastomosis and perform cholangiography. Results BEG shunt was performed for seventeen patients, one of whom, with BEG type I, died due to myocardial infarction leaving sixteen patients with a diagnosis of postcholecystectomy biliary injury (9, inflammatory stricture with or without choledocholithiasis (5 and strictured biliary shunt (2. BEG shunts were either type I (3, type II (3 or type III (10. Endoscopic follow up revealed successful access to the anastomosis in 14 patients (87.5%, while the access failed in one type I and one type II BEG (12.5%. Mean time needed to access the anastomosis was 12.6 min (2-55 min. On a scale from 1–5, mean endoscopic difficulty score was 1.7. One patient (6.25%, with BEG type I, developed anastomotic stricture after 18 months that was successfully treated endoscopically by stenting. These preliminary results showed that, in relation to the other types, type III BEG demonstrated the tendency to be surgically simpler to perform, endoscopicall faster to access, easier and with no failure. Conclusions BEG, which is a modified biliary reconstruction, facilitates endoscopic access of the biliary anastomosis, offers management option for its

  14. Cirugía laparoscópica biliar Laparoscopic biliary surgery

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    P. Martí-Cruchaga

    2005-01-01

    Full Text Available El siguiente artículo trata de exponer brevemente los posibles nuevos protocolos que se pueden aplicar en la patología biliar, a raíz de los cambios acaecidos con la aparición de las nuevas técnicas de cirugía biliar laparoscópica. Pretende realizar una síntesis de los últimos y más novedosos artículos sobre técnica quirúrgica y manejo en distintas patología biliares tales como coledocolitiasis o colecistitis. Se puede concluir que el manejo diferirá mucho según las capacidades técnicas de un centro sobre el que recaiga una de estas patologías. Por tanto, actualmente no se puede imponer un protocolo estándar para todo el mundo. Las diferencias entre colangiopancreatografía retrógrada endoscópica y colangiografía intraoperatoria laparoscópica, todavía están por demostrar, no pudiéndose generalizar sobre si una técnica tiene más indicación que la otra. Lo mismo se podría decir sobre si el acceso a la vía biliar principal debe hacerse desde el conducto cístico o por el contrario debe realizarse una coledocotomía.The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as Choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. Teh differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about

  15. Immunoglobulin G4-related cholangitis: a variant of IgG4-related systemic disease.

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    Novotný, Ivo; Dítě, Petr; Trna, Jan; Lata, Jan; Husová, Libuše; Geryk, Edvard

    2012-01-01

    IgG4-related sclerosing cholangitis as part of IgG4 systemic-related diseases is commonly associated with autoimmune pancreatitis. Major clinical manifestations of IgG4-related sclerosing diseases are apparent in the organs in which tissue fibrosis with obstructive phlebitis is pathologically induced. IgG4-related sclerosing cholangitis is included within the heterogeneous group of 'sclerosing cholangitis'. Sclerosing cholangitis may be associated with choledocholithiasis, infection or biliary malignancies. Sclerosing cholangitis of unknown etiology is called primary sclerosing cholangitis (PSC). Conservative therapy of PSC is usually unsuccessful, the disease involves extra- and/or intrahepatic biliary tree, and the end point of this disease is liver cirrhosis. Typically, PSC is identified at the age of 30 to 40 years, and the disease is frequently associated with inflammatory bowel diseases. On the other hand, IgG4-related sclerosing cholangitis is not associated with inflammatory bowel diseases. In patients with IgG4-related sclerosing cholangitis, a first symptom can be obstructive jaundice, whereas obstructive jaundice is rarely present in PSC. Clinically, patients with IgG4-related sclerosing cholangitis are older at diagnosis compared to patients with PSC. A typical diagnostic feature of IgG4-related sclerosing cholangitis is elevation of serum immunoglobulin G4. In patients with IgG4-related sclerosing cholangitis, response to steroid therapy is high; in patients with PSC corticosteroid therapy is unsuccessful. Histochemically abundant infiltration of IgG4-positive plasma cells is detected in the biliary duct wall. Histologically, we can identify dense lymphoplasmacytic infiltration of the bile duct wall, transmural fibrosis, lymphoplasmacytic infiltration and fibrosis in the periportal area of the liver - a typically obliterative phlebitis. The biliary epithelium is usually intact in contrast to PSC, where mucosal erosion is often present. Steroids are the

  16. Comparison of open choledocholithotomy with endoscopic sphincterotomy%开腹胆总管切开取石术与内镜下十二指肠乳头括约肌切开取石术的比较

    Institute of Scientific and Technical Information of China (English)

    张鹏; 赵景明; 张忠涛

    2011-01-01

    目的 比较开腹胆总管切开取石术与内镜下十二指肠乳头括约肌切开取石术(EST)两者治疗胆总管结石的疗效与费用。方法 收集北京友谊医院及北京积水潭医院2002年至2009年符合入选条件(年龄在20~75岁之间,术前经影像学检查证实为单纯胆总管结石,既往无胆道手术及EST病史,无严重全身合并症)的胆总管结石病例共177例,按其治疗方式分为开腹手术组和EST组。其中开腹手术组62例,EST组11 5例。比较两组患者性别组成、年龄、ASA分级、术前有无症状及症状持续时间、术前有无合并症,以上指标差异均无统计学意义。统计两组患者手术时间、出血量、取出结石的情况、术后恢复排气时间及腹痛持续时间、术后并发症的情况、住院时间及费用、残余结石发生率,对统计结果进行比较。结果开腹组手术时间为50~300 min(M=110)、出血量10~300 ml(M=60)、术后恢复排气时间24~96 h(M=48)、腹痛持续时间0~96 h(M=48)、住院时间8~70 d(M=21)、围手术期高淀粉酶血症发生率8.1%、手术费546~2498元(M=1503.2);EST组手术时间为10~120 min(M=25)、出血量2~40 ml(M=10)、术后恢复排气时间1~48 h(M=3)、腹痛持续时间0~144 h(M=0)、住院时间5~56 d(M=17)、围手术期高淀粉酶血症发生率40%、手术费2028~5728元(M=2028)。以上差异均有统计学意义。结论EST手术时间短,出血量少,术后恢复排气时间短,腹痛持续时间短,住院时间短;但围手术期高淀粉酶血症发生率及手术费高于开腹手术。%Objective To compare the efficacy and health economics between open choledocholithotomy and endoscopic sphincterotomy (EST) these two operations on patients with choledocholithiasis. Methods 177 patients (aged 20-75 yrs, with simple choledocholithiasis on medical imaging,who had not been treated with either biliary tract surgery or EST

  17. Manejo cirúrgico da síndrome de Mirizzi Surgical management of Mirizzi syndrome

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    Olival Cirilo Lucena da Fonseca-Neto

    2008-06-01

    com síndrome de Mirizzi, ela deve ser suspeitada na colelitíase crônica e prontamente identificada no intra-operatório para evitar lesões biliares inadvertidas. Apesar da era da colecistectomia laparoscópica, o método aberto deve ser o de escolha.BACKGROUND: Mirizzi syndrome is a rare complication of long standing cholelithiasis and was reported in 0,3 - 3% of patients undergoing cholecystectomy. If not recognized preoperatively, it can result in significant morbidity and mortality. AIM: To describe a series of five consecutive patients with Mirizzi syndrome submitted to surgical treatment and to comment on then aspects clinics. METHODS: A retrospective review of five consecutives cases of Mirizzi syndrome that arose between January 2002 and June 2008 was performed. The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures, and complications. RESULTS: Four patients were women (80% and a mean age was 53,4 years (38 to 62 years. The most frequent symptoms were abdominal pain (100% and nausea and vomiting (100% The patients with jaundice presented altered hepatic function tests (40% and only one without jaundice presented altered hepatic function. The diagnosis of Mirizzi syndrome was intra-operative in all patients (100%. Cholecystecholedochal fistula associated with choledocholithiasis was observed in three (60% cases. Mirizzi syndrome was classified as Csendes type I in two (40% patients, type II in one (20%, type III in one (20% and type IV in another (20%. Cholecystectomy was performed in all patients (100%, however, the partial cholecystectomy was observed in three (60%. Two (40% patients were submitted to side-to-side choledochoduodenostomy and another (20% to choledochojejunoanastomosis. Two (40% patients had an uneventful recovery and were discharged in good

  18. FÍSTULA BÍLIO-BRÔNQUICA: RELATO DE CASO E REVISÃO DE LITERATURA

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    OLAVO RIBEIRO RODRIGUES

    1998-10-01

    Full Text Available No presente trabalho é relatado um caso de paciente portadora de fístula bílio-brônquica (FBB secundária a coledocolitíase tratada no Hospital da Universidade de Mogi das Cruzes e é feita uma revisão da literatura pertinente ao assunto. Tratava-se de uma paciente, 35 anos, feminino, parda, cujo quadro clínico inicial era dor em hipocôndrio direito, de caráter contínuo, acompanhada de icterícia do tipo obstrutivo e bilioptise que atingia até um litro em 24 horas. O diagnóstico foi confirmado por radiografia simples de abdome e ultra-sonografia abdominal. O tratamento consistiu em laparotomia, colecistectomia, coledocotomia com retirada de dois cálculos, drenagem de vias biliares, colangiografia intra-operatória e liberação da cápsula hepática da cúpula frênica direita. A evolução pós-operatória foi satisfatória, com regressão da bilioptise no pós-operatório imediato. Houve regressão progressiva da icterícia em torno do sétimo dia do pós-operatório. A paciente foi estudada com broncografia após 24 meses que mostrou não haver alterações anatômicas dos brônquios basilares direitos pela inundação biliar. A paciente encontra-se no sétimo ano de seguimento sem evidência da doença.In the present case report is presented a patient with bilio-bronchial fistula secondary to choledocholithiasis surgically treated at the University of Mogi das Cruzes Hospital. It is a 35-year-old female patient which initial clinical features were continuous hypochondrium pain, accompanied by obstructive jaundice and bilioptysis that reached one liter in a period of 24 hours. The diagnosis was confirmed by X-ray exams and by abdominal ultrasonography. The treatment consisted in laparotomy, cholecistectomy, choledochotomy and extraction of two stones from biliary tract, drainage of biliary tree, intraoperative cholangiography and separation of the hepatic capsule from the right diaphragmatic cupula. At the postoperative follow

  19. Efficacy and safety of ERCP in a low-volume hospital Eficacia y seguridad de la CPRE en un hospital con bajo volumen

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    José María Riesco-López

    2013-02-01

    Full Text Available Background and aims: there is little scientific evidence on the outcomes of endoscopic retrograde cholangiopancreatography (ERCP performed in low-volume hospitals; however, in our country, it is growing up its implementation. The objectives of our study were to evaluate the efficacy and safety of this technique performed by two endoscopists with basic training in a center of this nature and analyze the learning curve in the first procedures. Patients and methods: single-center retrospective study of the first 200 ERCP performed in our hospital (analyzing the evolution between the first 100 and 100 following procedures, comparing them with the quality standards proposed in the literature. Results: from February 2009 to April 2011, we performed 200 ERCP in 169 patients, and the most common indications were: Choledocholithiasis (77 %, tumors (14.5 % and other conditions (8.5 %. The cannulation rate rose from 85 % in the first 100 ERCP to 89 % in the next 100 procedures, clinical success from 81 % to 87 %, decreasing the post-ERCP acute pancreatitis rate from 11 % to 4 %, upper gastrointestinal bleeding (UGIB from 3 % to 2 % and acute cholangitis from 4 % to 1 %. There was a death from a massive UGIB in a cirrhotic patient in the first group of patients and a case of biliary perforation resolved by surgery in the second one. Conclusions: the results obtained after performing 200 procedures support the ability to practice ERCP in low-volume hospitals obtaining levels of efficacy and safety in accordance with published quality standards.Introducción y objetivos: existe poca evidencia científica sobre los resultados de la CPRE realizada en hospitales con bajo volumen, sin embargo su puesta en marcha en nuestro medio es creciente. Los objetivos de nuestro estudio son evaluar la eficacia y seguridad de dicha técnica realizada por dos endoscopistas biliares noveles en un centro de estas características y analizar la curva de aprendizaje en los

  20. FACTORS AFFECTING CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN SURGERY IN A TERTIARY HOSPITAL IN SOUTH INDIA

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    Suresh Kumar

    2016-01-01

    Full Text Available BACKGROUND Laparoscopic Cholecystectomy (LC is most commonly performed hepatobiliary minimally access surgery worldwide. Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstone diseases. However, there still is a substantial proportion of patients in whom laparoscopic cholecystectomy cannot be successfully performed and for whom conversion to open surgery is required. The NIH postulated that the outcome of LCs would be greatly influenced by surgeon-specific factors such as training, experience, skill and judgment.(1 In addition numerous patient and disease-related factors, such as male gender, obesity, old age (>65, prior abdominal surgery, acute cholecystitis, choledocholithiasis and anomalous anatomy have been reported as significant risk factors for conversion to the open procedure.(2-5 Although the rate of conversion to open surgery and the complication rate are low in experienced hands, the surgeon should not enter the Operating Room with idea of opening the abdomen in difficult case as failure or insult to the surgeon. Various preoperative factors can help in deciding the difficult gallbladder and conversion to open cholecystectomy. The aim of this study is to predict the difficulty of laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before and during surgery using the clinical and ultrasonographic criteria in our setup. MATERIALS AND METHODS A prospective study was performed in SRM Medical College and Hospital of all patients who underwent LC during (May 2013 to October 2015 was performed. The LCs were performed by 12 trained certified surgeons. The decision to convert to open was made by the individual surgeon and the reason for conversion was extracted from the patient’s medical record (operative report prospectively. The inclusion and exclusion criteria defined. All operations were performed with the patient under general anesthesia with endotracheal intubation

  1. Coledocoduodenostomia laparoscópica Laparoscopic choledochoduodenostomy

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    Marco Antônio Cezário de Melo

    2004-12-01

    Full Text Available OBJETIVO: Estudar, a curto e médio prazos, o resultado e complicações da coledocoduodenostomia (CDD realizada por via laparoscópica. MÉTODO: Estudo prospectivo de 20 pacientes com indicação de coledocoduodenostomia vídeo-laparoscópica operados na DIGEST no período de 1991 a 2003. RESULTADOS: Dos 20 pacientes com indicação para CDD laparoscópica, quatro tinham coledocolitíase associada à litíase vesicular, oito litíase residual de colédoco, dois estenose benigna e seis tumor periampolar. Houve duas conversões para ressecção de colédoco. Dentre as 18 CDD, todos tinham via biliar acima de 1,5 cm de diâmetro. Foi observado vazamento biliar pelo dreno cavitário em quatro casos (duração máxima de quatro dias resolvidos espontaneamente, uma infecção de ferida e uma morte súbita no 2º. dia de pós-operatório. Os seis portadores de tumor periampolar tiveram sobrevida média de 7,2 meses evoluindo sem prurido ou icterícia até o óbito. CONCLUSÕES: Além da demonstração da viabilidade do método laparoscópico na realização da CDD, evidenciou-se que o posicionamento de trocarte adicional facilita a confecção da anastomose. Acredita-se que, a ocorrência de vazamento da anastomose possa diminuir com a experiência e que a CDD seja alternativa interessante na paliação dos tumores periampolares.BACKGROUND: This study reviews short and medium follow up results and complications of the choledochoduodenostomy (CDD by laparoscopic procedure. METHODS: Prospective study of 20 patients with indication for laparoscopic CDD operated on at DIGEST (private clinic , for 1991 at 2003. RESULTS: Of the twenty patients with indication to laparoscopic CDD four had choledocholitiasis with gallstones, eight residual choledocholithiasis, two benign stenosis and six periampullary cancer. Two conversions for common bile duct resection were required. From the 18 CDD, all of them had a bile duct diameter greater than 1.5 cm. Bile leakage

  2. Clinical observation of therapeutic effects of endoscopic retrograde cholangiopancreatography in elderly patients over 80 years old with biliary-pancreatic diseases%逆行胰胆管造影治疗80岁以上老年人胆胰疾病的临床观察

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    王敏; 文卫; 缪林; 蒋国斌; 范志宁; 吴萍

    2009-01-01

    Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients over 80 years old with biliary-pancreatic diseases. Methods One hundred and twenty patients over 80 years old who underwent ERCP between January 2004 and April 2008 were retrospectively analyzed. The clinical efficacy, safety and complication were observed and followed up. Results One hundred and seventeen patients successfully underwent therapeutic ERCP and the success rate was 97.5%. All diseases of the patients included cholangiocarcinoma in 22 cases, duodenal papilla carcinoma in 3 cases, pancreatic carcinoma in 8 cases, acute pancreatitis in 15 cases, chronic pancreatitis in 5 cases, acute suppurative cholangitis in 9 cases and choledocholithiasis in 58 cases. During the procedure of ERCP, 3 cases failed to insert the duodenoscope, 3 cases were found hemobilia and 2 cases were found acute pancreatitis. Conclusions Therapeutic ERCP is effective and safe in elderly patients over 80 years. Age is not the contraindication of therapeutic ERCP.%目的 评价治疗性逆行胰胆管造影术(ERCP)对80岁以上老年患者胆胰疾病的疗效及安全性. 方法 回顾分析我院自2004年1月至2008年4月诊治的80岁以上行ERCP治疗的老年患者120例,同时观察其并发症. 结果 120例患者,造影成功117例(成功率97.5%),其中胆管癌22例,十二指肠乳头癌3例,胰腺癌8例,急性胆源性胰腺炎15例,慢性胰腺炎5例,急性化脓性胆管炎9例,胆总管结石58例.在ERCP过程中因血氧饱和度进行性下降和严重的心律失常而中止治疗2例;插镜失败1例,失败原因系肿瘤侵犯导致十二指肠球降部狭窄,镜身不能通过.胆道出血3例,急性胰腺炎2例. 结论 治疗性ERCP对80岁以上老年人胆胰疾病的诊治创伤小,且有效及安全,高龄并非治疗性ERCP的禁忌证.

  3. 饮水低张MSCT技术在胆管梗阻性疾病中的应用%Diagnosis of biliary tract obstructive diseases by multislice CT after low tension and drinking water

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    高飞; 程涛; 韦炜

    2012-01-01

    Objective To explore the value of the multi-slice CT(MSCT) after low tension and drinking water in the diagnosis of biliary tract obstructive diseases. Methods Seventy six patients planning to be diagnosed as obstructive jaundice clinically were examined by multi-slice CT after low tension and drinking water, and their pathologic results were analyzed and compared. Results The third period of bile duct was positioned with the highest accuracy; bile duct stones were found with the highest qualitative accuracy in benign biliary obstruction; vater ampulla carcinoma and extrahepatic bile duct carcinoma were found with the higher qualitative accuracy in malignant biliary obstruction; there was "progressive expansion" in 24 cases, 17 cases of which were benign lesion and 7 cases of which were malignant lesion; there was "segmental expansion" in 12 cases, 7 cases of which were benign lesion and 5 cases of which were malignant lesion; there was "soft rattan" in 38 cases, 1 case of which was benign lesion and 37cases of which were malignant lesion; there were 25 cases of "edge sample" narrow and 16 cases of " beak kind" narrow, which were malignant lesion; 7 cases of "target sign" were choledocholithiasis; there were 25 cases of vater ampulla carci- nom,7 cases of which had "half levy", 8 cases of which had "double loop levy", 12 cases of which had "double duct", and 12 cases of which had "finger sign". Conclusion By means of multi-slice CT after low tension and drinking water,there were some characteristics in benign and malignant biliary tract obstructive diseases in CT performance, and thus MSCT positioning accuracy and qualitative accuracy can be improved by combining the various signs.%目的 探讨饮水低张MSCT技术在胆管梗阻疾病中的应用价值.方法对76例临床拟诊梗阻性黄疸患者行饮水低张MSCT扫描,分析其CT表现,与病理结果对照.结果定位准确率最高的为第3段胆管;良性胆道病变定性准确率最高的是胆管

  4. Risk factors of post endoscopic retrograde cholangiopancreatography complicated pancreatitis%经内镜逆行胰胆管造影术后并发胰腺炎危险因素分析

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    黄继征; 霞明; 龚传明; 程建国; 文峰

    2011-01-01

    Objective To explore the risk factors of post endoscopic retrograde cholangiopancreatography(ERCP) complicated pancreatitis(PEP) and to provide references to its prevention. Methods Totally 1 896 patients who underwent ERCP were divided into PEP group ( n= 285) and non-PEP group ( n= 1 161 ). The risk factors of patients, operation and operator were analyzed. Results In patient factors, female, age( less than 60), pancreatitis history,without choledocholithiasis, suspected Oddi's sphincter dysfunction were the risk factors for PEP ( P < 0.05 ), but bilirubin increase, common bile duct diameter( less than 0.4cm), ampulla diverticulum, complicated diabetes or hypertension were not related with PEP( P > 0.05 ). In operation factors, pancreas imaging, pancreatic duct sphincterotomy, aerocyst dilatation of bililary sphincter muscle were related with PEP( P < 0.05 ), but the remedial or diagnostic ERCP, Oddi's sphincterometry, bile duct sphincterotomy were not related with PEP. For operators, fewer operation cases, prolonged operation time and difficult intubation were related with PEP ( P < 0.05 ), but ERCP operation defeat was not the risk factor for PEP ( P>0.05 ). Conclusion Female, aged under 60, pancreatitis history, suspected Oddi's sphincter dysfunction, poor pancreas imaging and operator's skill as well as difficult intubation were the main risk factors for PEP.%目的 探讨经内镜逆行胰胆管造影术(ERCP)后并发胰腺炎(PEP)的危险因素,为PEP的预防提供参考.方法 回顾性分析1 896例ERCP患者,分为PEP组(n=285)及无PEP组(n=1 161),对比分析两组各相关危险因素,涉及患者因素、操作因素及术者因素.结果 患者因素中女性、年龄(小于60岁)、胰腺炎病史、无胆总管结石、疑有Oddi括约肌功能障碍者易并发PEP(P0.05).操作因素中胰腺显影、胰管括约肌切开术、胆道括约肌气囊扩张术患者在PEP组所占比例明显高于无PEP组(P0.05).结论 年龄小于60

  5. The surgical experience of 48 cases of laparoscopic choledocholithotomy with primary suture%腹腔镜胆总管切开取石Ⅰ期缝合术48例临床体会

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    马陈; 朱挺; 陈晓岗

    2013-01-01

    Objective:To investigate the surgical experience and clinical value of laparoscopic choledocholithotomy with primary suture.Methods:The clinical data of patients suffered from choledocholithiasis from Jan.2010 to May 2012 were retrospectively analyzed.48 cases underwent laparoscopic choledocholithotomy with primary suture (observation group),69 cases underwent open choledocholithotomy T-tube drainage (open surgery T-tube group) and 52 cases underwent laparoscopic choledocholithotomy T-tube drainage (laparoscopic T-tube group).Results:All 48 cases in observation group were successfully operated.The operative time was between 90200 min,the average was (150 ±8.7) min;the blood loss was 30-50 ml,the average was (25 ±4.1) ml;the fart and ambulation appeared 1-2 days after operation.All patients were discharged from the hospital within 4-6 d,the average was (5 ± 0.3) d.No incision infection or bile leakage occurred.Compared with the other two groups,the patients in observation group showed faster recovery,less pain and cost,and shorter hospital stay.Conclusions:Laparoscopic choledocholithotomy with primary suture has more advantages with minimal invasion,quick recovery,little pain,short hospital stay.However,the surgeon and his assistants need more tacit understanding and longer learning curve.%目的:探讨腹腔镜胆总管切开取石Ⅰ期缝合术的手术方法与临床价值.方法:回顾分析2010年1月至2012年5月胆总管结石患者的临床资料,其中48例行腹腔镜胆总管切开取石Ⅰ期缝合术(观察组),69例行开腹胆总管切开取石+T管引流术(开腹T管组),52例行腹腔镜胆总管切开取石+T管引流术(腹腔镜T管组).对比分析3组手术结果.结果:观察组48例手术均获成功.手术时间90 ~ 200 min,平均(150±8.7) min;术中出血量30 ~ 50 ml,平均(25±4.1) ml.术后1~2 d排气并下床活动,4~6d出院,平均(5±0.3)d.无胆漏、切口感染等并发症发生.与其他两组相比,患者术后

  6. 后腹腔镜肾切开取石与经皮肾镜取石术治疗复杂性肾结石的临床疗效比较%Efficacy of retroperitoneal laparoscopic nephrolithotomy vs.percutaneous nephrolithotomy in patients with complex renal calculi

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    王忆勤; 张爱军; 姚俊; 王照凡; 叶明; 杨超

    2016-01-01

    Objectives To compare the efficacy between retroperitoneal laparoscopic nephrolithotomy and percutaneous nephrolithotomy (PNL) in patients with complex renal calculi.Methods Clinical data for 126 patients with complex renal calculi from January2010 to December 2014 were reviewed.They were divided into laparoscopic group (n =54) underwent retroperitoneal laparoscopic nephrolithotomy and PNL group (n =72) underwent PNL.The condition related to surgery and indexes for therapeutic effects between the two groups were compared.Results All of the patients underwent surgery successfully and no perioperative death occurred.In the laparoscopic group,operative time was longer than that in the PNL group(P <0.05),and blood loss was less than that in the PNL group (P < 0.05).No difference in the hospital stay and rate of conversion between the two groups were found (P > 0.05).In the laparoscopic group,the rate of two-stage operation was higher than that in the PNL group(P <0.05),and intraoperative stone-free rate was lower than that in the PNL group (P < 0.05).After two-stage operation,the postoperative stone-free rate was 100%.Conclusions Laparoscopic biliary tract surgery for choledocholithiasis in elderly patients is safe and effective.But surgeons should grasp the operation indication flexibly and optimize the perioperative management.%目的 比较后腹腔镜肾切开取石与经皮肾镜取石术(PNL)治疗复杂性肾结石的临床疗效.方法 选取本院2010年1月至2014年12月收治的126例复杂性肾结石,其中行后腹腔镜肾切开取石术者54例(腹腔镜组),行PNL治疗72例(PNL组).比较两组患者的手术相关情况及疗效指标.结果 两组患者手术均顺利完成,无围手术期死亡病例.腹腔镜组的手术时间长于PNL组,但术中出血量小于PNL组,差异均有统计学意义(P<0.05).两组患者的住院时间和中转开放率比较,差异无统计学意义(P>0.05).腹腔镜组二期手术率高于PNL组,

  7. A terapêutica endoscópica nas complicações biliares pós-transplante hepático Endoscopic management of biliary complications after liver transplantation

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    Jeany Borges e Silva Ribeiro

    2012-12-01

    cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient. Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment. Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.

  8. Complicações hepáticas na doença falciforme Hepatic complications in sickle cell disease

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    Fabíola Traina

    2007-09-01

    Full Text Available Doentes falciformes podem apresentar alterações hepáticas agudas ou crônicas. As agudas são caracterizadas por dor no quadrante superior direito e icterícia. O diagnóstico diferencial inclui crise aguda de falcização hepática, seqüestro hepático, colestase intra-hepática, colelitíase, coledocolitíase, colecistite e hepatite viral aguda. Estas complicações devem ser diagnosticadas precocemente, através de história clínica, testes de função hepática e exames radiológicos, e o tratamento deve ser prontamente iniciado. Transfusão sangüínea é essencial para o tratamento das manifestações agudas causadas pelo processo de vaso-oclusão, como seqüestro hepático e colestase intra-hepática. As alterações hepáticas crônicas são freqüentemente causadas pela hemólise crônica e múltiplas transfusões. Para prevenção, diagnóstico precoce e orientação terapêutica da alteração hepática crônica, os doentes falciformes devem ser submetidos a exames de rotina: testes de função hepática, sorologia para hepatite B e C, dosagem sérica de ferritina e ultra-sonografia de abdômen. A biópsia hepática deve ser realizada em pacientes com hepatite viral e em pacientes com alterações hepáticas crônicas acentuadas e persistentes, afora das manifestações agudas.Patients with sickle cell disease may present acute or chronic hepatopathy. The acute syndrome is characterized by right upper quadrant abdominal pain and jaundice. The differential diagnoses include acute sickle hepatic crises, hepatic sequestration, sickle cell intrahepatic cholestasis, cholecystitis, choledocholithiasis and acute viral hepatitis. These alterations can be differentiated by a careful history, liver function tests and hepatobiliary imaging studies. The specific treatment must be promptly initiated. Red blood cell transfusion is essential for the treatment of the clinical syndromes caused by the sickling process such as hepatic sequestration

  9. The clinical application of ureteroscope in the laparoscopic cholecystolithotomy%腹腔镜联合输尿管硬镜在保胆取石术中的临床应用

    Institute of Scientific and Technical Information of China (English)

    肖海波; 胡晋太

    2013-01-01

    Objective:To investigate the feasibility,superiority and surgical techniques of laparoscope-ureteroscope combination in the cholecystolithotomy.Methods:Sixty cases undergoing minimaly-invasive cholecystolithotomy by the same surgeon during Jun.2010 and Oct.2012 were randomly divided into two groups.30 cases undergoing laparoscopic cholecystolithotomy were in the control group while the other 30 cases undergoing laparoseopic cholecystolithotomy combined with ureteroscope were in the observation group.The operation time,recovery time of gastrointestinal function,blood loss,postoperative complications were comparatively analyzed between the two groups.Results:Twenty-nine operations were successful in the control group.1 case was converted to laparotomy because gallstones incarcerated in the neck of gallbladder and removal of calculus failed.All the operations in the observation group were successful.Postoperative follow-up time was 6-12 months.1 case recurred in the control group,CT and color Doppler ultrasound showed choledocholithiasis.No recurrence was found in the observation group.No bile leakage,bleeding or gallbladder carcinoma were observed after operations.The operation time,intraoperative blood loss,gastrointestinal function recovery time and postoperative recurrence between two groups were significantly different (P < 0.05).Conclusions:The laparoscopic cholecystolithotomy combined with ureteroscope is safe and feasible,and has obvious advantages.However,the operation skills remain to be further researched.%目的:探讨腹腔镜联合输尿管硬镜行保胆取石术的可行性、优越性及手术技巧.方法:随机将2010年6月至2012年10月同一术者施行的60例微创保胆手术分为两组,30例行完全腹腔镜保胆取石术(对照组),30例行腹腔镜联合输尿管硬镜保胆取石术(观察组),对比分析两组患者手术时间、胃肠功能恢复时间、术中出血量、术后并发症等.结果:对照组中29例成功完成

  10. 症状性十二指肠憩室的临床特点分析%Analysis of the clinical features of symptomatic duodenal diverticulum

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    谭韡; 周巍; 罗和生; 陈继红; 赵亮

    2012-01-01

    Objective To investigate the clinical presentation, characteristics of endoseopy and imaging in patients symptomatic with duodenal diverticulum. Methods The clinical data of patients with symptomatic duodenal diverticulum in Renmin Hospital of Wuhan University from Jan. 2008 to Jan. 201 1 were retrospectively reviewed. Results A-mong the 35 patients with symptomatic duodenal diverticulum, 15 cases suffered from abdominal pain, 2 cases suffered from vomit, 12 cases suffered from hematemesis or melena, 6 cases suffered from jaundice, respectively. In all cases, there were 5 cases of duodenal diverticulitis, 1 case of acute pancreatitis, 6 cases of choledocholithiasis, 1 case of intestinal obstruction, and 12 cases of upper gastrointestinal bleeding. 35 cases of symptomatic duodenal diverticulum patients were located in the duodenal bulb with 9 cases, in the duodenal descending part with 22 cases, in the horizontal part with 4 cases, respectively, including single of 25 cases and multiple of 10 cases. 13 cases of duodenal diverticulum were found by the gastrointestinal barium meal examination, 9 cases were found by gastroscopy examination, 7 cases were found by endoscopic retrograde cholangiopancreatography (ERCP) , 2 cases were found by double-balloon enteros-copy, and 4 cases were found by abdominal CT scan, respectively. Conclusion The symptomatic duodenal diverticulum are not typical. Patients with unexplained upper abdominal pain, gastrointestinal bleeding and pancreatitis should be suspected of duodenal diverticulum. Conservative, endoscopic and surgical treatments are all used to treat duodenal diverticulum.%目的 探讨症状性十二指肠憩室病例的临床、内镜及影像学表现、治疗方法,并分析其临床意义.方法 回顾性分析武汉大学人民医院2008年1月-2011年1月症状性十二指肠憩室病例,分析其临床表现、内镜及影像学表现、治疗方法等临床资料.结果 共35例患者诊断为症状性十

  11. Tratamento laparoscópico de coledocolitíase Laparoscopic treatment of common bile duct lithiasis

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    Marcel Autran C. MACHADO

    2000-07-01

    followed by choledochotomy and retrieval of the large stone. A latero-lateral choledochoduodenum anastomosis was then performed to decompress the biliary tree. The patient had an uneventful recovery being discharged at the 6th postoperative day. Laparoscopic management of choledocholithiasis is feasible in many patients, specially those with dilated biliary tree. The retrieval of stones may be followed by biliary drainage with T-tube. In some elderly patients with chronically dilated common bile duct, as in the present case, a choledochoduodenal anastomosis is the procedure of choice.

  12. Safety and Efficacy of ERCP in the Elderly Patients%老年患者ERCP的安全性和有效性研究

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    兰云娇; 赵清喜; 鞠辉; 毛涛; 薛会光; 田字彬

    2012-01-01

    patients. Methods: 253 patients who received ERCP therapy between June 2010 and July 2011 were studied retrospectively. 115 patients (45.5%) wwe under 65 years of age (Younger group), of which 79 patients (31.2%) were between 65 years of age and 80 (Middle elder group), 59 (23.3%) were more than 80 years old (Elder group). Data about ASA degree, clinical manifestations and biochemical index, ERCP procedures, diagnosis after ERCP, the status of pre-cut and cut papillotomy, complications and length of hospital stay after the surgery were recorded and compared. Results: 8 patients of 253 cases who were undergone ERCP procedures were foiled. 178 patients were diagnosed of choledocholithiasis and 48 had malignant tumors .The rate of operational success was 96.8% (95.6%vs 97.4%vs98.3%). The overall successful rate of stone extraction was 96.6% (96%vs 96.5%vs 97.8%). Elder group had a higher ASA degree than that in Younger and Middle groups (P<0.05). Laboratory findings were similar in all of the three groups. Papillotomy were performed in 186 patients (71.3%vs 73.4%vs78.0%). Pre-cut papillotomy were performed in 33 patients (16.5%vs6.3%vsl5.3%). 27 patients had difficulty in intubating bile duct (13.0%vs 7.59%vsl0.2%). The difference between the three groups was not statistically significant. The diagnosis ofERCP: Choledocholithiasis was 70.4% (65.2%vs72.2%vs78.0%). Malignant tumor was19.0% (15.7%vs 19.0%vs25.4%). Compared with that in the Younger group (28.7%), duodenal peripapilla diveniculum was more frequent in the two Elder groups patients (48.1% vs50.8%) (P<0.05). The days of the three groups after ERCP were 1.61 ±0.83, 1.39±0.72, 1.49±0.70. Post-procedural complications developed in 43 (17.0%) patients. There were 25 (21.7%) complications in the Younger group. In contrast, 8 (10.1%) of the Middle group and 10 (16.9%) of the Elder group developed a complication. There were no serious complications and deaths. Conclusion: 1. Although the ASA of the old is high, they

  13. Benign obstruction of the common hepatic duct (Mirizzi syndrome: diagnosis and operative management Obstrução benigna do ducto hepático comum (síndrome de Mirizzi: diagnóstico e tratamento operatório

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    Jaques Waisberg

    2005-03-01

    Full Text Available BACKGROUND: Mirizzi syndrome is a rare complication of prolonged cholelithiasis, characterized by narrowing of the common hepatic duct due to mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. OBJECTIVES: To describe a series of eight consecutive patients with Mirizzi syndrome, at a single institution, submitted to surgical treatment and to comment on their aspects with emphasis on the diagnosis and treatment. METHODS: Four women and four men, with a mean age of 61.6 years (42 to 82 years, presenting Mirizzi syndrome were operated between 1997 and 2003. The following items were evaluated: clinical presentation, laboratory results, preoperative evaluation, operative findings, presence of choledocholithiasis, type of Mirizzi syndrome according to the classification by Csendes, choice of operative procedures, and complications. RESULTS: The most frequent symptoms were abdominal pain (87.5% and jaundice (87.5%. All the patients presented altered hepatic function tests. The diagnosis of Mirizzi syndrome was intra-operative in seven (87.5% patients, and preoperative in one (12.5%. Cholecystocholedochal fistula associated with choledocholithiasis was observed in three (37.5% cases. Mirizzi syndrome was classified as Csendes type I in five (62.5% patients, type II in one (12.5%, type III in one (12,5% and type IV in another (12.5%. Cholecystectomy, as an isolated surgical procedure, was performed in four (50.0% patients. One (12.5% patient was submitted to partial cholecystectomy and closure of the fistulous orifice with the central part of the infundibula. Two (25.0% patients were submitted to cholecystectomy and side-to-side choledochoduodenostomy and another (12.5% to side-to-side choledochoduodenostomy remaining the gallbladder in situ. Seven (87.5% patients had an uneventful recovery and were discharged in good conditions. One (12.5% patient presented a

  14. Results of laparoscopic cholecystectomy in a third-level university hospital after 17 years of experience Resultados de la colecistectomía laparoscópica en un hospital universitario de tercer nivel tras 17 años de experiencia

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    P. Priego

    2009-01-01

    Full Text Available Objective: the aim of the study is to determine the results obtained with laparoscopic cholecystectomy at Ramón y Cajal Hospital after 17 years of experience, comparing current results with those at the beginning of the experience. Material and methods: between 1991 and December 2007, 3,933 laparoscopic cholecystectomies were performed at the "Ramón y Cajal Hospital"; 1,849 patients were operated on between 1991 and 2000, and 2,084 between 2001 and 2007. Patients studied included 69.8% of women and 30.2% of men, with a mean age of 56.95 years (range 9-94 years. In all, 54.68% of patients had a concomitant disease before surgery (hypertension, diabetes, ischemic heart disease, respiratory disease.... Surgery was performed by a staff surgeon for 58.04% of cases, and by a resident in the remaining 41.96%. Surgical indications were cholelithiasis in 75.5%, pancreatitis in 13.3%, cholecystitis in 6.3%, choledocholithiasis in 3.05%, and others in 1.2% of cases. Results: mean hospital stay was 3.06 days. Conversion to open surgery was required for 8.3% of cases (331 patients. The major surgical complication rate was 2.34%, with the most frequent being hemoperitoneum (1%. Common bile duct injury occurred in thirteen cases (0.3%, 51 patients (1.3% were soon re-operated, and 5 patients died (0.13%. When the results of both decades (1991-2000 vs. 2001-2007 were compared, we observed differences in the number of procedures performed by residents (31.7 vs. 51.1%, p = 0.00001, number of laparoscopic cholecystectomies for cholecystitis (4.9 vs. 7.53%, p = 0.001, conversion rate (5.46 vs. 11%, p = 0.000001, and mean hospital stay (2.43 vs. 3.7 days, p = 0.001. Conclusion: these results should be interpreted with caution as this is a retrospective study with multiple uncontrolled variables (high number of surgeons and continuous learning curve. The lower conversion rate and mean hospital stay in the first decade of the learning curve are amazing, although this

  15. Comparison of detection and resistance rates of ESBLs among Escherichia coli, Klebsiella pneumonia and Enterobacter cloacae isolates%ESBLs在大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌中的检出及耐药情况分析

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    张慧宇; 张博; 刘红丹; 徐文思; 宫健

    2013-01-01

    .And double disc synergy test was used as the confirmatory test.Susceptibility paper such as cefotaxime paper,cefotaxime / clavulanic acid paper,ceftazidime,ceftazidime / clavulanic acid paper was selected.Only when the difference of the zone of inhibition between the paper with clavulanic acid and the one without clavulanic acid should be above 5 mm,could it be recognized as the ESBLs producing strain.Then susceptibility test was carried out to detect drug resistance.Results 130 of 297 were ESBLs producing strains,with the detection rate of 43.77%.The number of strains in E.coli,K.pneumoiae,and E.cloacae were 71,43,16 respectively,with the detection rate of 56.80%,36.44% and 29.63%.The highest detection rate came from ESBLs producing Klebsiella pneumoniae in choledocholithiasis patients,which was 93.02 %.Detection rate of ESBLs producing E.coli in malignant biliary obstruction patients was 39.44%.ESBLs bacteria had no resistance to imipenem,meropenem and had high resistance rates to cephalosporins.Drug resistance rates of ESBLs producing E.cloacae were higher than those of ESBLs producing E.coli and K.pneumoiae.Conclusion ESBLs strains are the main pathogens of biliary infection.To understand their mechanisms ofresistance and detect its resistance in a timely and effective manner will help guide the rational use of antibiotics,and delay the occurrence of bacterial resistance to control drug-resistant strains epidemic and outbreak.

  16. 双氯芬酸钠预防经内镜逆行胰胆管造影术后胰腺炎机制的临床研究%Preventive effect of diclofenac for post-ERCP pancreatitis and its mechanism

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    赵孝文; 鲍峻峻; 胡翠; 丁浩; 徐张巍; 刘晓昌; 梅俏; 许建明

    2014-01-01

    目的 探讨双氯芬酸钠预防经内镜逆行胰胆管造影术(ERCP)术后胰腺炎的疗效及相关机制.方法 2012年9月至2013年10月进行ERCP治疗的120例胆总管结石患者,随机分为双氯芬酸钠组和对照组各60例,双氯芬酸钠组患者ERCP术后立即肌注双氯芬酸钠75 mg,观测两组患者术后3h、24 h淀粉酶水平和胰腺炎发生率.各组测定30例患者术前及术后3h、24h血清中脂氧素A4、消退素E1和D1的水平.结果 双氯芬酸钠组ERCP术后胰腺炎发生率(6.7%)低于对照组(20.0%),差异有统计学意义(P =0.032).双氯芬酸钠组术后3h、24h淀粉酶水平分别低于对照组,但差异无统计学意义(P均>0.05).双氯芬酸钠组术后脂氧素A4、消退素E1和消退素D1水平均较术前明显升高(P均<0.05),且与对照组术后同时段比较,脂氧素A4、消退素E1和D1水平显著增加(P均<0.05).结论 双氯芬酸钠可预防ERCP术后胰腺炎的发生,其机制可能与增加脂氧素A4及消退素E1和D1水平有关.%Objective To investigate the efficacy and mechanism of diclofenac in the prevention of post-ERCP pancreatitis.Methods Data of a total of 120 patients with choledocholithiasis were collected from September 2012 to October 2013 and were randomly divided into diclofenac group (n =60) and control group(n =60).The diclofenac group patients received a single dose of intramuscular diclofenac immediately after ERCP.Serum amylase level was measured before and 3 h and 24 h after ERCP,and the rate of acute pancreatitis after ERCP were assessed in both groups.The Lipoxin A4,Resolvin D1 and Resolvin E1 levels of two groups were measured before and 3 h and 24 h after ERCP.Results The incidence of PEP in diclofenac group was 6.7%,and was significantly lower compared with the control group (20.0%,P < 0.05).Serum amylase levels at 3 h and 24 h after ERCP in diclofenac and control groups were (214.93 ± 309.28) U/L and (192.50 ± 282.37) U

  17. Efficacy of Different Doses of Diclofenac for Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis%不同剂量双氯芬酸钠预防内镜逆行胰胆管造影术后胰腺炎的疗效观察

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    陈泽宇; 曹文瑜; 林晖

    2016-01-01

    Objective To investigate the preventive effect of diclofenac at different doses on post‐ERCP pancreatitis and hyperamylasemia . Methods A total of 244 patients with choledocholithiasis from January 2013 to June 2015 were enrolled to receive ERCP and randomly divided into four groups to receive low dose diclofenac group (50 mg ,n=61) ,moderate dose diclofenac group (100 mg ,n=61) ,high dose diclofenac group (150 mg ,n=61) or no diclofenac ,at half an hour to one hour ,before ERCP . The level of serum amylase before and 3 h or 24 h after ERCP were measured ,Incidence of post‐ERCP pancreatitis and hyperamylasemia were assessed in four groups . Results There were no significant differences among four groups in age ,gender ,surgery method and time of ERCP . The incidences of post‐ERCP pancreatitis were 16 .4% (10/61) ,6 .6% (4/61) and 4 .9% (3/61) ,and 18% (11/61)in diclofenac dose groups and in blank group respectively . The total incidences of post‐ERCP pancreatitis in four groups were significant‐ly different (χ2 =8 .07 , P=0 .045) . There was no significant difference either between low dose group and blank group (χ2 = 0 .058 , P= 0 .810 ) , or between moderate dose group and high dose group (χ2 =0 .152 ,P=0 .697) . There was significant difference between low dose group and high dose group (χ2 =4 .219 ,P=0 .040) . The incidences of hyperamylasemia had no significant difference among four groups (χ2 =2 .83 ,P=0 .419) . There was one case of severe PEP in blank group ,while none in experi‐mental groups . Three moderat PEP was observed in blank group and two in low dose group . The PEP that was observed in moderate and high dose groups were mild . Conclusion The prevention of PEP may not be achieved with diclofenac suppository at 50 mg ,however at 100 mg or 150 mg ,diclofenac supposito‐ry can have preventive effect on post‐ERCP pancreatitis and the effect is similar for the two doses . Therefore ,we recommend that 100 mg diclofenac suppository

  18. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature

    Institute of Scientific and Technical Information of China (English)

    Francesco; A; Polistina; Mauro; Frego; Marco; Bisello; Emy; Manzi; Antonella; Vardanega; Bortolo; Perin

    2015-01-01

    ) underwent MRCP. All patients attended regular follow-up for at least 6 mo. Morbidity and mortality related to MRCP were null. MRCP was the only exam performed in 89 patients because it did show only calculi into the gallbladder with no signs of the presence of calculi into the bile duct and symptoms resolved within a few days or after colecistectomy. The patients remained asymptomatic for at least 6 mo, and we assumed they were true negatives. One hundred eleven(53 men, 58 women, mean age 69 years, range 25-98 years) underwent ERCP following MRCP. We did not find any difference between the two groups in terms of race, age, and sex. The overall median interval between MRCP and ERCP was 9 d. In detecting biliary stones MRCP Sensitivity was 77.4%, Specificity 100% and Accuracy 80.5% with a PPV of 100% and NPV of 85%; EUS showed 95% sensitivity, 100% specificity, 95.5% accuracy with 100% PPV and 57.1% NPV. The association of EUS with ERCP performed at 100% in all the evaluated parameters. When comparing the two groups, we did not find any statistically significant difference regarding age, sex, and race. Similarly, we did not find any differences regarding the number of extracted stones: 116 stones in Group A(median 2, range 1 to 9) and 27 in Group B(median 2, range 1 to 4). When we compared the size of the extracted stones we found that the patients in Group B had significantly smaller stones: 14.16 ± 8.11 mm in Group A and 5.15 ± 2.09 mm in Group B; 95% confidence interval = 5.89-12.13, standard error = 1.577; P < 0.05. We also found that in Group B there was a significantly higher incidence of stones smaller than 5 mm: 36 in Group A and 18 in Group B, P < 0.05.CONCLUSION: Major finding of the present study is that choledocholithiasis is still under-diagnosed in MRCP. Smaller stones(< 5 mm diameter) are hardly visualized on MRCP.

  19. Relationship between occult pancreaticobiliary reflux and biliary diseases%隐匿性胰液反流与胆道疾病间的相关性

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    杨慧慧; 李会兵; 刘爽; 刘贤英

    2016-01-01

    /L;and they were (18 ± 14) and (38 ± 17) U/L in the control group.The bile amylase level in OPR group was significantly higher than that in the control group,and the difference was statistically significant (P < 0.05),while there was no significant difference in serum amylase activity between the two groups.The incidence of OPR in patients with CBD stones was 100%,and the bile amylase activity was (1 048 ± 1 317) IU/L,and the △ bile amylase activity was (996 ± 1 322) U/L;the incidence of OPR in patients with choledocholithiasis and cholecystolithiasis was 75%,and the bile amylase activity was (2 457 ± 3 312),the △ amylase activity was (2 412 ± 3 320)IU/L;and the corresponding values in patients with gallbladder stones were 80%,(95 ± 82),(57 ± 76)IU/L;and the corresponding values in patients with bile duct cancer were 50%,(73 ± 51),(40 ± 37)U/L.Conclusions The occurrence of OPR is closely related to CBD stones only,CBD stones and gallbladder stones,and it may be one of the main pathogenic factors of bile duct stones.

  20. The Relationship Between the Age of Choledocholith and the Biology Feature and the Type of Traditional Chinese Medicine Syndrome%1133例胆总管结石发生年龄与生物学特征及中医证型关系探讨

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    刘志新; 李昊燃; 盛天骄; 王长洪; 林一帆; 朱虹; 巩阳; 刘杨; 陆宇平; 高文艳; 季芳; 雷春红

    2012-01-01

    between choledocholith and the biology feature and type of syndrom of TCM were analyzed. Result: The high incidence of choledocholithiasis was 40~93 (94.4% ), among them,patients aged 21~40 were 6.9% , aged 41~60 were 31. 5% and aged 61~93 were 61.6%. There was significance difference between each age range( P < 0.01). The result of differentiation of symptoms and signs display that deficiency of liver - Yang and deficiency of liver - Qi were mainly in age 61 ~93(41.4% ,30. 5% ), deficiency of liver - Qi and stagnation of Qi due to depression of the liver were maily in age 41 ~60(32.8% ,31.9% ), stagnation of Qi due to depression of the liver and deficiency of liver - blood were maily in age 21 ~40(35.9% ,33. 3% ), there were significance differences between each age range( P <0. 01). Besides the high incidence it showed easy relapse, more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct in advanced age ( P <0.01). Conclusion; Choledocholith more easily develops in middle and advanced age, and showed easy relapse, more big stone and complicating cholecystolithiasis and calculus of intrahepatic duct. The lithogene-sis has the closs relationship to deficiency of liver - blood, stagnation of Qi due to depression of the liver, deficiency of liver - Qi and dificiency of liver - Yang with the age growing. Prevention and treatment should be benefiting vital energy and warming Yang in advanced - age, dispersing the depressed liver - energ and removing stasis together with benefiting vital energy and warming Yang in middle - age, keeping blood and softening liver together with dispersing the depressed liver — energ and removing stasis in lower - age.

  1. Treatment of biliary complications after liver transplantation%肝移植术后胆道并发症的治疗

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    慕宁; 江艺; 陈少华; 陈永标; 蔡秋程

    2014-01-01

    ,intra-and extra-hepatic bile duct stricture in 6 patients,anastomotic stricture in 6 patients,biliarycomplications included cholangitis in the portal area and cholestasis in 4 patients,choledocholithiasis and cholangitis in 2 patients and biliary infection in 2 patients.The incidence of bile leakage before 2006 was 14.00% (7/50),which was significantly higher than 4.12% (11/267) of bile leakage after 2006 (x2-7.676,P < 0.05).Of the 38 patients with biliary complications,the condition of 35 patients was improved,and 3 patients died.Of the 18 patients with bile leakage,15 was cured by conservative treatment,3 received surgical treatment (the condition of 1 patient was improved by drainage,anti-infection treatment and nutritional support,but died of peritoneal hemorrhage at postoperative 1 month; 2 patients received peritoneal drainage,1 was cured and 1 died of peritoneal infection).For the 6 patients with intra-and extra-hepatic bile duct stricture,1 was cured by liver retransplantation and 5 were cured by conservative treatment,endoscopic retrograde cholangio-pancreatography (ERCP) or balloon dilation.For the 6 patients with anastomotic stricture,the condition of 3 patients was improved by conservative treatment,balloon dilation or stent implantation,1 gave up treatment due to hepatic cancer recurrence and died thereafter,1 received anastomosis + T tube drainage,1 was cured by recurrent tumor resection and choledochojejunostomy.Four patients with cholangitis in the portal area and cholestasis were cured by conservative treatment.For the 2 patients with choledocholithiasis and cholangitis,1 was cured by stent implantation with ERCP,and 1 received conservative treatment,and the level of total bilirubin was decreased.Two patients with biliary infection were cured by anti-infection treatment.Conclusions Most of the biliary complications could be treated by non-surgical treatments.For patients with severe biliary complications or those could not be treated by non

  2. 医源性胆管损伤的治疗及远期疗效%Management and long-term efficacy of patients with iatrogenic bile duct injury

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    洪涛; 何小东; 蔺晨; 武峤

    2012-01-01

    ,3 received PTCD for the second time due to repeated cholangitis after PTCD. Of the 45 patients who received surgical treatment,6 patients had long-term complications,including 6 cases of fever,4 cases of jaundice,3 cases of choledocho-lithiasis and 1 case of bile duct canceration; 4 received reoperation at the second year after operation.Conclusions Early diagnosis of bile duct injury and operation carried out by experienced surgeons are important for a better short- and long-term prognosis.Surgical repair is the first line therapy for bile duct injury.

  3. 肝内外胆管结石多次手术原因及预后分析%Reasons and prognosis of multiple-operations for intra-and extrahepatic cholangiolithiasis

    Institute of Scientific and Technical Information of China (English)

    童里; 耿小平; 谢坤; 赵红川; 刘付宝

    2016-01-01

    and dressing,anti-infection and supporting treatments without other treatments.Ten patients with pleural effusion were out of hospital after effective anti-infection and nutritional support treatments.Eight patients with biliary fistula were discharged from hospital after abdominal drainage.Six patients with incision infection combined with pleural effusion were discharged from hospital after wound drainage and dressing,anti-infection and nutritional support treatments.Among 5 patients with bile duct bleeding,1 was self-healing,1 underwent reoperation and 3 were improved by conservative treatment.The bacilli culture of bile in 68 patients was positive,and bacteria mainly consisted of Escherichia coli,Enterobacter cloacae,Pseudomonas aeruginosa and Klebsiella pneumoniae.Of 85 patients,78,5 and 2 patients were respectively confirmed with hepatolithiasis,bile duct cell adenocarcinoma combined with stone recurrence and choledocholithiasis combined with interstitialoma by pathological examination.Duration of hospital stay was (21 ±8)days.(4) Results of follow-up:77 patients were followed up for a median time of 32 months (range,6-108 months) with an overall follow-up rate of 90.6% (77/85).During follow-up,50 patients had good survival,27 had poor survival including 11 with stone residue,9 with stone recurrence and 7 with bile duct canceration,and 7 died of no operation of secondary tumors.Conclusions Stone residue and recurrence are the main reasons for reoperation.The individualized surgical methods are determined according to preoperative stone distribution,with or without atrophy of liver lobe,with or without canceration and condition of liver function,which can increase the stone clerance rate,reduce the stone residue and recurrence rates and avoid reoperation.%目的 探讨肝内外胆管结石多次手术原因及再次手术治疗方式和预后.方法 采用回顾性队列研究方法.收集2006年1月至2015年1月安徽医科大学第二附属医院收治的85