1/18. choledocholithiasis caused by migration of a surgical clip into the biliary tract following laparoscopic cholecystectomy.As experience with laparoscopic cholecystectomy (LC) has increased, so have the number and variety of complications. We report a case of choledocholithiasis caused by migration of a surgical clip applied during LC. A 57-year-old Japanese man who had undergone LC 6 years previously was referred to our hospital with pruritus and jaundice. Magnetic resonance cholangiopancreatography and ultrasonography revealed a solid mass in the common hepatic duct and dilatation of the intrahepatic bile ducts. Abdominal arteriography demonstrated interruption of the right hepatic artery by surgical clips. Five days after a biopsy of the mass was performed through a percutaneous transhepatic biliary drainage tube, the mass moved to the terminus of the common bile duct along with one of the surgical clips. A basket catheter was used to remove the mass via endoscopy. Despite the fact that other clips in the common hepatic duct were partially exposed, the patient has been well for 2 years with no additional interventions.- - - - - - - - - - ranking = 1keywords = lithiasis (Clic here for more details about this article) |
2/18. Acute cholecystitis and severe ischemic cardiac disease: is laparoscopy indicated?BACKGROUND AND OBJECTIVES: laparoscopy in patients with poor cardiac function has been the subject of controversy and is considered by many surgeons a relative contraindication. methods: We report the case of a patient who presented with acute cholecystitis and choledocholithiasis concurrent with unstable angina. Our experience in laparoscopic management of patients with calculous biliary disease and severe coronary artery disease is examined. RESULTS: The patient was managed by coronary angioplasty and stenting immediately followed by laparoscopic cholecystectomy and common bile duct exploration under close invasive hemodynamic monitoring and low-pressure pneumoperitoneum. Between 1996 and 2001, 39 patients with coronary artery disease and an ASA class of III or IV underwent laparoscopic cholecystectomy. Eight of these patients (20.5%) had common bile duct stones necessitating laparoscopic common bile duct exploration. No conversions were necessary, and no major morbidity or mortalities occurred. CONCLUSIONS: Laparoscopic cholecystectomy and common bile duct exploration can be safely performed in patients with severe ischemic cardiac disease under close hemodynamic monitoring and a low-pressure pneumoperitoneum (10 to 12 mm Hg).- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
3/18. Biliary stent causing colovaginal fistula: case report.OBJECTIVES: Perforation of the bowel during placement of a biliary stent is a known complication of this procedure. We report the endoluminal loss of a biliary stent during routine stent extraction that ultimately led to a chronic colovaginal fistula. This case emphasizes the need for evaluation of fecal passage of stents in patients with a known dislodged prosthesis. CASE REPORT: A 65-year-old white female underwent biliary stent placement for an episode of choledocholithiasis. The stent was lost in the duodenum during routine extraction. The patient was managed expectantly. She denied ever passing this stent via the rectum and began to develop symptoms of colovaginal fistula. Evaluation found a retained biliary stent in the sigmoid colon and a fistula into the vagina. The patient underwent elective low anterior resection and colovaginal fistula repair. DISCUSSION: Reports exist of migration of stents that lead to acute colonic perforation and the need for emergent surgery. For this reason, it has been suggested that dropped or migrated stents be purposefully retrieved. However, if the option of expectant observation is used, it is important to clearly document the fecal passage of these stents and be prepared to retrieve these objects if they have a prolonged bowel transit time.- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
4/18. diagnosis of gallstone ileus by serial computed tomography.An unusual case of choledocholithiasis followed by gallstone ileus documented by serial computed tomography is reported. A 91-year-old woman underwent gastrostomy because she repeatedly developed aspiration pneumonia, and a common bile duct stone was detected. She and her family refused surgery once symptoms resolved. One year later, she presented with increasing, intermittent abdominal pain and nausea. Abdominal computed tomography revealed a common bile duct stone with inflammatory changes, but the patient still refused surgery. Three months later, she was admitted with abdominal pain and vomiting. On admission, plain abdominal radiographs demonstrated proximal small bowel obstruction. A long ileus tube was inserted through the gastric fistula. Two days after admission, gallstone ileus was diagnosed on abdominal computed tomography based on the presence of pneumobilia, disappearance of the common bile duct stone, fluid-filled bowel loops, and the discovery of an impacted stone in the small bowel. Ten and 15 days after admission, repeated computed tomography demonstrated the impacted stone in the terminal ileum. Seventeen days after admission, a laparotomy was performed, and a 5x3-cm gallstone was removed through an ileotomy.- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
5/18. Laparoscopic excision of a triple gallbladder.Triplication of the gallbladder is a rare congenital anomaly of the biliary tract; there are only nine reported cases to date. We report a case in which laparoscopic cholecystectomy was performed in a patient with biliary colic and choledocholithiasis. Preoperative assessment with ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) failed to reveal the eventual findings of a triple gallbladder. Successful excision of the triple gallbladder was carried out laparoscopically, and the final diagnosis was confirmed by the pathologist. The patient made an uneventful postoperative recovery and was free of gastrointestinal symptoms at follow-up. This case report describes the first laparoscopic excision of a triple gallbladder and highlights the importance of pre-/perioperative imaging to allow for the safe dissection of rare anomalies of the biliary tract via the laparoscopic approach.- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
6/18. Oral contrast-enhanced CT cholangiography--an initial experience.OBJECTIVE: To describe our experience of CT (Computed tomographic) cholangiography examination for detection of choledocholithiasis at the Aga Khan University Hospital (AKUH) Karachi pakistan. methods: Seven patients underwent helical CT cholangiography for suspected choledocholithiasis. iopanoic acid (6 grams) was administered orally 8-12 hours before acquisition of a helical CT cholangiogram. Three-dimensional reconstructions and curved multiplanar reformations were generated from a set of axial source images. RESULTS: Our patients had no adverse reactions to iopanoic acid. The degree of biliary opacification was sufficient to perform three-dimensional and curved planar reformations in 5 patients. In two patients, the biliary tree was not opacified. Both of these studies were considered failures. Findings on CT cholangiography in the remaining 5 patients were the following: cholelithiasis with normal bile duct (n=2), choledocholithiasis (n=1), stone in gallbladder remnant with long cystic duct (n=1) and infiltrating adenocarcinoma of the gallbladder (n=1). CONCLUSION: Spiral CT cholangiography is a safe, non-invasive, and cost effective alternative test and, in a carefully selected patient population can play a role in the diagnostic work-up of patients with suspected choledocholithiasis.- - - - - - - - - - ranking = 1keywords = lithiasis (Clic here for more details about this article) |
7/18. Laparoscopic exploration of the common bile duct in a patient with situs inversus totalis.situs inversus totalis (SIT) is a rare anomaly that can present technical difficulties during laparoscopic surgery. We report the first case of a combination of SIT and choledocholithiasis in a patient who was treated successfully with a laparoscopic exploration of the common bile duct (CBD). The chest x-ray showed a right-sided heart. An abdominal ultrasound and computerized tomography scan diagnosed the CBD and gallbladder stones as well as the SIT, with the liver and gallbladder on the left side, and the spleen on the right. The surgical techniques were modified in a mirror image fashion in order to provide access to the left upper quadrant. The surgeon and the camera assistant stood on the patient's right side, and the first assistant stood on the left. The ports were introduced in a mirror image of the conventional setup. The SIT was confirmed using a telescope via an umbilical incision. A laparoscopic exploration of the CBD with a cholecystectomy was carried out successfully. The postoperative course was uneventful. This report shows that a CBD stone in a patient with SIT can be treated safely using laparoscopic surgery.- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
8/18. Laparoscopic left hemihepatectomy for hepatolithiasis.To assess the feasibility of hepatolithiasis treatment using laparoscopic liver resections, a prospective study of laparoscopic liver resections was undertaken in selected patients with left intrahepatic stone disease. The patients underwent a laparoscopic left lobectomy to try to alleviate the symptoms of their disease. Two patients were operated on successfully. Mean blood loss was 400-600 ml. Laparoscopic resections are feasible methods of treatment for selected patients with left intrahepatic stone disease.- - - - - - - - - - ranking = 1keywords = lithiasis (Clic here for more details about this article) |
9/18. Surgical treatment of cholelithiasis and choledocholithiasis in a 2-month-old premature and low birth weight infant.Detection rates of cholelithiasis and choledocholithiasis in infants and children have increased since the introduction of ultrasonography, and surgical treatment is gradually tending to increase. However, for cholelithiasis and choledocholithiasis, controversies over etiology, diagnostic means, operation time, and operating method remain. Using ultrasonogram and magnetic resonance cholangiopancreatography (MRCP), we diagnosed cholelithiasis and choledocholithiasis in a premature and low birth weight infant who was admitted to the hospital with complaints of obstructive jaundice and alcoholic feces. We report the successful treatment of this infant by cholecystectomy and T-tube drainage.- - - - - - - - - - ranking = 2.8keywords = lithiasis (Clic here for more details about this article) |
10/18. Recombinant factor viia is an effective therapy for abdominal surgery and severe thrombocytopenia: a case report.A 50-year-old woman was admitted to the emergency room. An appendectomy was done. On the sixth day the patient's general state deteriorated and she became somnolent with jaundice due to distal obstructive choledocholithiasis. The results of laboratory tests were platelets 12 x 10(9)/L, prothrombin time 13 seconds, international normalized ratio 1.19, activated partial thromboplastin time 31.8 seconds, and fibrinogen 8.78 g/L. There was no evidence of disseminated intravascular coagulation. In view of the patient's clinical condition, surgery was considered to be indicated. Because it was a life-threatening situation and at the time there was no platelet concentrate available for immediate transfusion, she was treated with a single dose of recombinant factor viia (rFVIIa) (60 microg/kg). The dose of 60 microg/kg was selected on the basis of experience with rFVIIa in the treatment of hemophilic patients. In this case, use of rFVIIa was a valid alternative to control the bleeding in a patient with thrombocytopenia. However, despite the efficacy of the treatment, it should not be forgotten that it was used because of the unavailability of platelets and that we were dealing with a life-threatening situation. Clinical trials should be carried out to verify the safety, effectiveness, and efficiency of rFVIIa in these cases.- - - - - - - - - - ranking = 0.2keywords = lithiasis (Clic here for more details about this article) |
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