1/73. mirizzi syndrome: A rare cause of obstructive jaundice.mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/73. mirizzi syndrome: evaluation by MRI imaging.We report three cases of mirizzi syndrome diagnosed by MR imaging. MR cholangiography revealed dilation of the intrahepatic bile ducts, narrowing of the common hepatic duct, the level of obstruction, and the location of gallstone in the cystic duct. MR showed thickening of the gallbladder wall and the pattern of wall enhancement. MR evaluation with MR cholangiography sequences proved to be useful in these patients with mirizzi syndrome.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
3/73. Vascular reconstruction of the hepatic artery using the gastroepiploic artery: a case report.A 59 year-old woman with obstructive jaundice secondary to proximal bile duct carcinoma underwent percutaneous transhepatic biliary drainage (PTDB). This revealed complete obstruction of the bifurcation of the hilar hepatic duct and encasement of the right hepatic artery. Wedged hilar hepatectomy with combined resection of the extrahepatic bile duct, gallbladder, and the encased right hepatic artery was performed. The hepatic artery was reconstructed using an in situ right gastroepiploic artery (GEA) pedicle graft. The anastomosis was protected with fatty tissue from the greater omentum. This technique can be used to reconstruct the hepatic artery after radical surgery for malignant hepatobiliary and pancreatic disease.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
4/73. Palliative treatment with metallic stents for unresectable gallbladder carcinoma involving the portal vein and bile duct.We report a case of gallbladder carcinoma associated with biliary obstruction and portal vein stenosis caused by massive lymph node metastases. The patient, a 59-year-old woman, was treated with self-expandable metallic stents--a spiral Z-stent in the portal vein, and a Wallstent in the bile duct--and intra-arterial infusion chemotherapy. She returned to work immediately after leaving the hospital, and has been treated with intra-arterial infusion chemotherapy once a week at our outpatient department. At present, she has good quality of life, with patency of both endoprostheses, 8 months after the placement of the metallic stents in the portal vein and the common bile duct. This case shows that portal vein and biliary stenting, together with intra-arterial infusion chemotherapy, can be an effective modality for the palliative treatment of advanced gallbladder carcinoma involving the portal vein and bile duct, to improve quality of life.- - - - - - - - - - ranking = 6keywords = gallbladder (Clic here for more details about this article) |
5/73. Acute febrile cholestasis as an inaugural manifestation of Kawasaki's disease.We report a child who developed acute febrile cholestasis with jaundice and pruritus as the inaugural manifestation of Kawasaki's disease (KD). The severe obstructive icterus and hydrops of the gallbladder required cholecystectomy that was not followed by remission of the fever and cholestasis. KD was suspected after the exclusion of all infectious, metabolic and neoplastic conditions responsible for acute cholestasis. The administration of intravenous gammaglobulin (IVGG) promptly induced defervescence and improvement of the patient's general condition. Mucocutaneous alterations, peeling of the digits, right cervical lymph node enlargement and bilateral non-suppurative conjunctivitis supporting the diagnosis of KD developed 14 days after the appearance of jaundice. No coronary abnormalities had developed after 2 years of follow-up. We conclude that this syndrome should be suspected in any child with febrile cholestasis of unknown origin, in order that coronary involvement may be prevented by the administration of IVGG.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
6/73. Post-decompression gallbladder haemorrhage in obstructive jaundice. A report of 2 cases.Two cases of massive haemorrhage from the gallbladder in patients suffering from common bile duct obstruction are described. Sudden operative decompression of the massively distended gallbladder was the probable cause of the bleeding.- - - - - - - - - - ranking = 6keywords = gallbladder (Clic here for more details about this article) |
7/73. common bile duct obstruction secondary to a balloon separated from a Fogarty vascular embolectomy catheter during laparoscopic cholecystectomy.Laparoscopic instrumentation of the common bile duct (CBD) via the transcystic route or through direct choledochotomy seems to be safe, but in rare cases, complications such as pancreatitis, bile duct damage, and hemorrhage from cystic artery may occur. We report an unusual complication with this approach. A 62-year-old man with gallbladder stones presented with obstructive jaundice, mild pancreatitis, and a dilated CBD. He underwent laparoscopic cholecystectomy with an intraoperative cholangiogram through the cystic duct. A small stone seen in the CBD was removed using a 6-Fr vascular Fogarty catheter. Two days later, he became jaundiced again with a rising bilirubin. An endoscopic retrograde cholangiogram showed a 1.5-cm round filling defect floating in a dilated CBD. A sphincterotomy was performed, and a balloon catheter was inflated proximally and pulled down. To our surprise, the filling defect was a crystal clear object, which we finally realized was a fully inflated Fogarty catheter balloon. The balloon spontaneously deflated while being caught with a basket. Surgeons should be aware of this possible complication, and every effort should be made to verify that the balloon still is in place after removal of the embolectomy catheter. Whether vascular embolectomy catheter balloons are appropriate for stone removal or more rigid balloons should be used needs further evaluation.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
8/73. Magnetic resonance cholangiography for the diagnosis of biliary atresia.PURPOSE: The aim of this study was to evaluate the usefulness of magnetic resonance cholangiography (MRC) for the diagnosis of biliary atresia in infantile cholestatic jaundice. methods: Forty-seven consecutive infants with cholestatic jaundice underwent single-shot MRC. The diagnosis of biliary atresia was made by MRC based on the nonvisualization of extrahepatic bile ducts and excluded on the basis of the complete visualization of extrahepatic bile ducts. The final diagnosis of biliary atresia (BA group, n = 23) or nonbiliary atresia (NBA group, n = 24) was established by operation or clinical follow-up until the jaundice resolved. RESULTS: The extrahepatic bile ducts including the gallbladder, the cystic duct, the common bile duct, and the common hepatic duct were visualized in 23 of the 24 infants of the NBA group. The extrahepatic bile ducts, except the gallbladder, were not depicted in any infant of the BA group. MRC had an accuracy of 98%, sensitivity of 100% and specificity of 96%, for diagnosis of biliary atresia as the cause of infantile cholestatic jaundice. CONCLUSIONS: MRC is a very reliable noninvasive imaging modality for the diagnosis of biliary atresia. In infants with cholestatic jaundice and considered for exploratory laparotomy, MRC is recommended to avoid unnecessary surgery.- - - - - - - - - - ranking = 2keywords = gallbladder (Clic here for more details about this article) |
9/73. Intrabiliary rupture of hydatid cyst of the liver.In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
10/73. Gray scale ultrasound diagnosis of obstructive biliary disease.B-mode ultrasound examinations have been useful in demonstrating cholelithiasis and obstructive dilatation of the gallbladder. It is now possible with gray scale ultrasound technique to demonstrate dilatation of the common bile duct, as differentiated from the gallbladder, and also to show fluid containing spaces within the liver. Discrimination between solid and fluid filled intrahepatic structures is readily made, and dilated biliary radicles are frequently discernible.- - - - - - - - - - ranking = 2keywords = gallbladder (Clic here for more details about this article) |
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