1/8. 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 = 1keywords = black (Clic here for more details about this article) |
2/8. Development of black gallstones after the nonsurgical management of splenic injury: report of a case.A 22-year-old man was admitted to our Emergency Department after suffering splenic injury in a traffic accident. His intraabdominal bleeding was treated nonsurgically by the administration of total parenteral nutrition (TPN) and blood transfusions of packed red cells. He presented again 2 months after his discharge, being 3 months after the injury, for right hypochondralgia, at which time a gallstone was demonstrated on ultrasound (US) and computed tomography (CT). After endoscopic laparoscopic cholecystectomy, his symptoms disappeared and he has remained well since. The clinical course of this patient indicates that hemolytic hyperbilirubinemia can cause black gallstones as a late complication of the nonsurgical management of abdominal blunt trauma.- - - - - - - - - - ranking = 5keywords = black (Clic here for more details about this article) |
3/8. granular cell tumor of the biliary system: a report of 2 cases with cytologic diagnosis on endoscopic brushing.BACKGROUND: Granular cell tumors (GCTs) of biliary system are rare. GCTs show a striking preponderance for young, black females, who generally present with obstructive jaundice. To our knowledge, these are the first 2 reports of GCT of biliary system identifed on endoscopic brushing cytology. CASES: In case 1, a 24-year-old, black woman presented with a 5-month history of pruritus. Radiographic studies demonstrated a mass in the distal common bile duct. Endoscopic biopsy and bile duct brushing were diagnosed as GCT. A Whipple procedure was confirmatory of GCT. In case 2, a 38-year-old, black female presented with a 7-month history of pruritus and jaundice. Radiographic studies showed a stricture of the common hepatic duct at the hilum. Endoscopic brushing cytology of the stricture yielded only a few sheets of granular cells that were missed on initial screening. Suspicion of cholangiocarcinoma prompted surgery, and final histopathology showed GCT. Both patients were well 1 1/2 and 6 years after presentation. CONCLUSION: GCT of the bile duct can be diagnosed on endoscopic brushing and should be considered in the cytologic differential diagnosis in the appropriate clinical settings.- - - - - - - - - - ranking = 3keywords = black (Clic here for more details about this article) |
4/8. Case of biliary lithiasis in an infant.The case of a 3-month-old premature infant deceased by massive hemorrhage from a giant hemangioma of the right thigh, exhibiting also biliary lithiasis, is discussed. The six dark-green-blackish faceted calculi contained by the gall bladder appear to be formed of biliary pigment and the consequence of repeated inflammatory hemolytic episodes in an immunodeficient infant.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
5/8. Pancreatic somatostatinoma.The presence of cholelithiasis, steatorrhea, diabetes mellitus, and a pancreatic tumor initiated a diagnostic workup for somatostatinoma in a 43 year old black woman. The hypothesis of somatostatinoma was supported by a high level of plasma-like immunoreactivity and secretory granules resembling D-cell granules by electron microscopy. The patient has been euglycemic and well since complete resection of the tumor. This is the seventh reported case of somatostatinoma and the second to be benign.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
6/8. Lipids of pigment gallstones.The lipids of pigment gallstones were analyzed. In contrast to previous reports, pigment stones were found to contain a wide variety of free fatty acids. In addition, pigment stones contained unhydrolyzed phospholipids. Both free fatty acids and phospholipids were present in much higher concentrations in a brown stone obtained from a patient with a biliary tract infection than in a black stone obtained from a patient with sterile bile and a long-standing hemolytic anemia. However, the phospholipids in both kinds of stone consisted primarily of phosphatidylcholine. Separation of stone and bile phosphatidylcholines into their individual molecular species by high performance liquid chromatography indicated that the phosphatidylcholines in stones closely resemble those in bile. The data suggest that both the free fatty acids and the phosphatidylcholine of pigment stones derive from bile phosphatidylcholine, but that the extent of bile phosphatidylcholine participation in pigment stone formation may be variable.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
7/8. Hemoglobin SD disease associated with cholecystitis and cholelithiasis in pregnancy.A black multipara was shown, by hemoglobin electrophoresis, to have hemoglobin SD disease. The patient exhibited a typically mild anemia that probably was secondary to folate and iron deficiencies as well as to hemoglobinopathic hemolysis. The course of her pregnancy was complicated by pyelonephritis and hyposthenuria, both of which have been reported in association with hemoglobin SD disease in pregnancy. The patient also was shown to have acute cholecystitis probably superimposed on a chronic cholelithiasis. This latter complication was probably the result of hemolysis due to hemoglobin SD disease. The patient was treated medically with good results, and, despite poor compliance and heroin addiction, delivered a viable infant at term.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |
8/8. Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement.A 67 year old woman was admitted with a three week history of vomiting, having become increasingly confused for three days. Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non-ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours after admission. Necropsy revealed that the stomach was massively dilated with gas and stomach contents, and contained many small black faceted gall stones. In addition a large nonfaceted brown-yellow gall stone was wedged in the pyloric antrum causing total obstruction. The patient had died from a complex metabolic derangement including non-ketotic hyperosmotic diabetic coma and metabolic alkalosis precipitated by the acute gastric outflow obstruction complicated by previously undiagnosed type II diabetes mellitus.- - - - - - - - - - ranking = 1keywords = black (Clic here for more details about this article) |