1/110. Combined endoscopic and surgical management of mirizzi syndrome.mirizzi syndrome is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with or without a cholecystocholedochal fistula. This syndrome is a rare complication of cholelithiasis that accounts for 0.1% of all patients with gallstone disease. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with a preoperative diagnosis of type I mirizzi syndrome that was confirmed and drained by endoscopic retrograde cholangiography (ERC), followed by subtotal cholecystectomy. A review of the literature covering its clinical presentation, diagnosis, and surgical treatment is also presented.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/110. duodenal obstruction by gallstone: case report of Bouveret's syndrome.Bouveret's syndrome involves gastric outlet obstruction by gallstone. Herein we describe an unusual case of duodenal bulb obstruction by gallstone. An 80-year-old woman was hospitalized with a fifteen-day history of vomiting. Computed tomography (CT) showed pneumobilia and a round calcified mass in the second portion of the duodenum. upper gastrointestinal tract series demonstrated the same sized oval radiolucency between the bulbus and the second portion of the duodenum. Endoscopic examination revealed a round black mass in the second portion of the duodenum, totally occupying the lumen. Endoscopic removal and destruction of the gallstone was attempted using a dye-laser, but the stone was too hard to crush. Eventually surgical enterolithotomy was successfully performed without cholecystectomy or closure of the fistula. Improved preoperative systemic management and prompt examination allowed earlier surgical intervention and reduced the morbidity. Surgical approach whether fistula closure should be performed remains controversial.- - - - - - - - - - ranking = 2keywords = fistula (Clic here for more details about this article) |
3/110. mirizzi syndrome--a report of 3 cases with a review of the present classifications.We report three cases of mirizzi syndrome, two with external compression of the common hepatic duct and another with cystobiliary fistula. All patients presented with jaundice. The diagnosis was suggested by ultrasonography and confirmed by endoscopic retrograde cholangiography (ERC). All three had the stones removed surgically, one through a choledochotomy, another through an opening in the gall bladder and the third at the time of subtotal cholecystectomy. We would like to propose a simple classification of mirizzi syndrome, based on surgical procedures necessary for the correction of the pathological anatomy. If it involves the removal of calculi with some form of cholecystectomy, we consider it as Type I, whereas Type II involves the construction of a hepaticojejunostomy apart from the removal of calculi.- - - - - - - - - - ranking = 586.27524793186keywords = biliary fistula, fistula (Clic here for more details about this article) |
4/110. Cholelithoptysis and pleural empyema.We report a case of delayed cholelithoptysis and pleural empyema caused by gallstone spillage at the time of laparoscopic cholecystecomy. An occult subphrenic abscess developed, and the patient became symptomatic only after trans-diaphragmatic penetration occurred. This resulted in expectoration of bile, gallstones, and pus. Spontaneous decompression of the empyema occurred because of a peritoneo-pleuro-bronchial fistula. This is the first case of such managed nonoperatively and provides support for the importance of intraoperative retrieval of spilled gallstones at the time of laparoscopic cholecystectomy.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
5/110. Preservative treatment for biliobiliary fistula.Biliobiliary fistula is thought to be a rare type of internal biliary fistula. A 68-year-old man presented to our hospital with complaints of jaundice and general malaise. Endoscopic retrograde cholangiography was performed, but the gallbladder was not imaged. Mirizzi's sign was observed in the common hepatic duct. During the course of evaluating this inpatient, imaging revealed that a gallstone was extruded to the right hepatic duct. After incision of the papilla, stones in the bile duct were subjected to mechanical lithotripsy and were extracted. As a result of bile duct decompression, the biliobiliary fistula was closed completely 2 months later.- - - - - - - - - - ranking = 4103.926735523keywords = biliary fistula, fistula (Clic here for more details about this article) |
6/110. Gallstone ileus: endoscopic removal of a gallstone obstructing the upper jejunum.In a 91-year-old female patient admitted with an ileus, ultrasound and computed tomography demonstrated the obstruction of the upper jejunum by a large gallstone. Due to concurrent diseases the patient was unfit for surgery. An attempt was made to remove the impacted stone endoscopically. After successful mobilization and fragmentation by mechanical lithotripsy the obstruction was cleared away. Since the patient improved considerably after this procedure, the gallbladder and the cholecystoduodenal fistula were left in place.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
7/110. Posterior hepatic duct injury during laparoscopic cholecystectomy finally necessitating hepatic resection: case report.A case of bile duct injury during laparoscopic cholecystectomy finally necessitating right hepatic lobectomy is reported to re-emphasize the importance of preoperative and intraoperative assessment of the biliary tree. A 47-year-old Japanese woman underwent laparoscopic cholecystectomy for cholecystolithiasis. On postoperative day 5, fever and right hypochondralgia developed, and CT revealed fluid collection at the right hypochondrium. Percutaneous drainage was performed, and subsequent fistulography revealed a communication of the cystic cavity with the right posterior bile duct, which suggested injury of the aberrant hepatic duct. Conservative therapy, including the adaptation of fibrin glue, was performed, but closure of the fistula and cavity was not obtainable. Finally, a right hepatic lobectomy was performed four months after cholecystectomy. In this case, endoscopic retrograde cholangiopancreatography was unsuccessful preoperatively, and intraoperative cholangiography was not done. This case report re-emphasizes that the preoperative and intraoperative examination of the biliary tree is mandatory to avoid bile duct injury.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
8/110. Gallstone ileus and Crohn's disease without biliary-enteric fistula: report of a unique case.Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for fewer than 3% of laparotomies for intestinal obstruction. patients with long-standing Crohn's disease have an increased risk of developing gallstone disease. However, gallstone ileus is not common in these patients. We report the case of a 70-year-old female with Crohn's disease who presented with gallstone ileus, and present a review of the literature. We discuss the association between gallstone ileus and Crohn's disease, and the treatment options for these patients. We emphasize the importance of including gallstone ileus in the differential diagnosis in patients presenting with intestinal obstruction, especially patients with long-standing Crohn's disease. We advocate the early utilization of computerized tomography to confirm the diagnosis, and prompt early surgical intervention.- - - - - - - - - - ranking = 4keywords = fistula (Clic here for more details about this article) |
9/110. Bouveret's syndrome complicated by acute pancreatitis.BACKGROUND/AIM: This study evaluated a case of Bouveret's syndrome due to a cholecystoduodenal fistula and gallstone obstruction of the duodenum, complicated by acute pancreatitis and cholecystitis. methods: The presenting features, special investigations, radiological findings, operative and endoscopic procedures were reviewed. RESULTS: Symptoms persisted after laparotomy and removal of a gallstone in the duodenum. Intra-operative endoscopy identified a second previously undetected stone impacted in the distal duodenum. CONCLUSION: The importance of excluding more than one stone causing Bouveret's syndrome is emphasized.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
10/110. gastric outlet obstruction by a gallstone (Bouveret's syndrome).gastric outlet obstruction caused by a gallstone in the duodenum or pylorus(Bouveret's syndrome) is a very rare complication of gallstone disease. Presenting symptoms include epigastric pain, nausea, and vomiting. Preoperative diagnosis is not easy. Oral endoscopy is one of the diagnostic procedures. We present a case in which the diagnosis was made by endoscopic examination. Multiple attempts at endoscopic extraction of the gallstone from the duodenum were unsuccessful. A one-stage surgical procedure consisting of the removal of the impacted stone, fistula repair, and cholecystectomy was performed in this case. The postoperative course was uneventful.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
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