1/17. Spontaneous cholecystocutaneous fistula presenting in the gluteal region.The complication of cholecystocutaneous fistula secondary to calculus cholelithiasis is an extremely rare occurrence. The incidence has further decreased with the advent of broad-spectrum antibiotics, ultrasonography, and safe and early surgical treatment of biliary tract disease. We are reporting a rare cholecystocutaneous fistula presenting in the right-side gluteal region below the iliac crest.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
2/17. Laparoscopic cholecystectomy and the Peter Pan syndrome.We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy (LC). This condition was due to the rupture of a pseudo-aneurysm of the right hepatic artery in the common bile duct, probably caused by a clip erroneously fired during LC on the lateral right wall of the vessel. It also caused the formation of multiple liver abscesses and the onset of sepsis. This life-threatening complication led to melena, fever, epigastric pain, pancreatitis, liver dysfunction, and severe anemia, requiring urgent hospitalization and operation. In the operating theater, the fistula was closed, the liver abscesses drained, and a Kehr tube inserted. Thereafter, the patient's general condition improved, and she is now well. LC is often considered to be the gold standard for the management of symptomatic cholelithiasis. However, recent data have undermined that opinion. The apparent advantages offered by LC in the short term (less pain, speedier recovery, shorter hospital stay, and lower costs) have been overwhelmed by the complications that occur during long-term follow-up. When the late downward trend in the bile duct and the vascular injury rate are taken into consideration, the learning curve is prolonged. Therefore, LC should be regarded as the surgical equivalent of a modern Peter Pan-i.e., it is like a young adult who should make definitive steps toward becoming an adult but does not succeed in doing so. We report the case of a patient who experienced hemobilia a few weeks after undergoing laparoscopic cholecystectomy. Based on the facts in this case, we argue that the endoscopic procedure still needs to be perfected and cannot yet be considered the gold standard for selected cases of gallstone disease.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
3/17. Incidental gallbladder carcinoma associated with a cholecystoduodenal fistula.The development of a cholecystoduodenal fistula may complicate 5% of all patients with cholelithiasis. It has been theorized that a cholecystoduodenal fistula may represent a significant risk factor in the development of gallbladder carcinoma because of the chronic reflux of duodenal contents. We report the case of a patient with a cholecystoduodenal fistula and an early gallbladder cancer to support this theory. Once developed, gallbladder cancer has a very poor prognosis. Early detection with timely resection is necessary to improve the survival rate in gallbladder carcinoma patients.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
4/17. Cholecystoenteric fistulas:s ignificance and radiographic diagnosis.Cholecystoenteric fistulas, not associated with gallstone ileus syndrome, are relatively common complications occurring during the natural history of cholelithiasis and cholecystitis. The etiology, pathogenesis as well as common and uncommon forms of gallbladder fistulas are presented and discussed. The roentgenographic findings are reviewed and a simple classification into two major groups is offered. The majority are acute, transitory, short-lived fistulas, which are self-limiting and relatively common events that usually remain undiagnosed. A minority fail to heal, become chronic and permanent fistulas and are associated with obstruction of the common duct.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
5/17. Spontaneous choledochoduodenal fistula secondary to long-standing ulcer disease.There are several varieties of bilioenteric fistulae. They are usually incidental findings, but once detected, various modalities can then be employed to further delineate the fistula. The fistulae usually arise as a complication of chronic duodenal ulcer disease, cholelithiasis or previous instrumentation to the biliary system. The presence of a fistula per se does not immediately equate to necessity for surgery. The treatment is dependent on its aetiology.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
6/17. Laparoscopic treatment of Bouveret's syndrome presenting as acute pancreatitis.gastric outlet obstruction as a result of gallstone (Bouveret's syndrome) is a rare but serious complication of cholelithiasis. Although patients present with persistent vomiting, colicky epigastric pain and dehydration, the clinical features of the Bouveret's syndrome are not pathognomonic. Due to its rarity, the diagnosis and treatment represent a challenge for the surgeon. In most of the reported cases, the diagnosis was made at the time of laparotomy. We report an unusual clinical presentation of Bouveret's syndrome with mild acute pancreatitis that was treated laparoscopically. To our knowledge, this is the first described case. Cause, clinical presentation, methods of diagnosis, and options for management of Bouveret's syndrome are also discussed.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
7/17. The cholecystogastric fistula.Internal gall bladder fistulas with a hollow viscus following dislocation of a gallstone into the intestine represent one of the late sequelae of cholelithiasis. We report the case of a 78-year-old patient, who suffered from a cholecystogastric fistula with consecutive stone transmigration into the stomach.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
8/17. Gallstone jejunal perforation: surgical implications.Spontaneous biliary-enteric fistulization is a rare complication of cholelithiasis. Much rarer yet is spontaneous jejunal perforation from an impacted gallstone. A case is presented from a suburban community general hospital. An aggressive surgical approach is endorsed and the impact of current economic constraints on surgical philosophy is reviewed.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
9/17. Biliobiliary fistula: preoperative diagnosis and management implications.Experience with cholecystohepaticodochal and cholecystocholedochal fistulas as a result of an erosion of gallstones from the gallbladder into the adjacent common duct in five patients is presented. The incidence was 1.4% in a population of 350 patients undergoing cholecystectomy. The condition was indicated clinically on the basis of a symptom triad of jaundice, fever, and pain with cholelithiasis in a small contracted gallbladder. In addition, proximal intra- and extrahepatic ductal dilatation, calculus in the common duct, and normal-caliber (or unprofiled) distal common duct on ultrasound scan were present in all the patients. Endoscopic retrograde cholangiopancreatography proved to be the most useful means of investigation, and it confirmed the diagnosis in four patients before surgery. A modified antegrade cholecystectomy was performed with the gallbladder opened inferiorly at the fundus, and the stones were evacuated. A partial cholecystectomy and choledochoplasty were accomplished with gallbladder flaps whenever feasible. Other useful operative procedures are side-to-side hepaticodochojejunostomy and hepaticodochoduodenostomy. In the presence of high benign bile duct stricture, an approach to the left hepatic duct is now preferred for biliary bypass.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
10/17. Cholecystopleural fistula with cholelithiasis presenting as a right pleural effusion.At autopsy, multiple gallstones were recovered from the right pleural space of an elderly patient who presented with a massive right pleural effusion and septic shock. The mechanisms of gallstone migration and fistula formation between the gallbladder and right pleural space are described. Despite atypical presentations, gallbladder disease remains an important differential consideration of right pleural effusion in the elderly.- - - - - - - - - - ranking = 4keywords = cholelithiasis (Clic here for more details about this article) |
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