1/25. A rare cause of biliary pain in belgium.ascaris lumbricoides is the most frequent human helminthic parasite. Usually human ascariasis is poorly symptomatic but complications can arise due to worm migration. Erratic worm migration into the biliary tree is a rare but threatening condition regarding the associated complications: cholecystitis, pancreatitis, obstruction of bile ducts, liver abcesses and recurrent pyogenic cholangitis. We describe a case of a young belgian women suffering from recurrent biliary colics over a period of eight months with repeated normal ultrasound findings. ERCP proved being the only effective diagnostic procedure for a living biliary worm, which was successfully removed with a balloon catheter.- - - - - - - - - - ranking = 1keywords = bile duct, duct, bile (Clic here for more details about this article) |
2/25. Three common presentations of ascariasis infection in an urban Emergency Department.In the united states, approximately 4 million people per year are infected with ascaris lumbricoides. We reviewed the common presentations of complications of ascariasis infection in the Emergency Department (ED) and the diagnostic tools and treatment available. This was a retrospective case review conducted on all patients diagnosed with ascariasis (using ICD-9 codes) over a 6-year period at los angeles County and University of Southern california Medical Center. Three patients with distinct complications secondary to ascariasis were chosen, and all ED and inpatient records were reviewed. The patient's age, sex, race, presenting symptoms, data, outcome, and ED course and diagnosis were recorded. The three cases included a periappendiceal abscess, Loeffler's syndrome, and biliary colic/choledocholithiasis. The first patient underwent a computed tomography-guided drainage of the abscess. The second patient received supportive care and antibiotic therapy secondary to a superimposed bacterial pneumonia. The third patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy. All three patients had a stool ova and parasites positive for A. lumbricoides, and all received a 3-day course of mebendazole. Symptomatic cases of ascariasis may present to EDs in the united states. Important diagnostic tools for the ED include chest X-ray, X-ray of the kidney-ureter-bladder and ultrasonography. Single-dose medications given in the ED are very effective in eradicating A. lumbricoides infection, thus avoiding hospitalization.- - - - - - - - - - ranking = 0.096244078605505keywords = duct (Clic here for more details about this article) |
3/25. Pyelocalyceal diverticulum: an unusual cause of acute renal colic.The differential diagnosis of acute flank pain includes kidney stones, urinary tract infection, dissecting abdominal aortic aneurysm (AAA), arterial or venous compromise of the kidney, renal abscess, renal carcinoma, and papillary necrosis. This is a report of an unusual cause of renal colic: pyelocalyceal diverticulum. Stasis of urine within a diverticulum promotes both calculus formation and urinary tract infection, either of which can lead to colic. Several radiographic findings may suggest a calyceal diverticulum, including, on plain X-ray, a very peripheral or mobile renal calculus, or on intravenous pyelogram, an early filling-defect and delayed or retained filing of a circular or ovoid mass.- - - - - - - - - - ranking = 0.09402329435652keywords = bile (Clic here for more details about this article) |
4/25. Toothpick injury mimicking renal colic: case report and systematic review.We describe a case of a patient with left flank pain that was caused by a perforation in the splenic flexure of the colon by a toothpick. We conducted a systematic review of the literature to examine the nature of injuries caused by ingested toothpicks. Articles were analyzed for the following outcome variables: presenting complaint, site of injury, recollection of toothpick ingestion, time to presentation, findings from imaging studies, and mortality. Most patients (70%) presented with abdominal pain. Few patients (12%) remember swallowing a toothpick. The onset of symptoms ranged from <1 day to 15 years. Toothpicks caused perforation most frequently at the duodenum and the sigmoid. In some cases, toothpicks migrated outside the gastrointestinal tract and were found in the pleura, pericardium, ureter, or bladder. Toothpicks were apparent on imaging studies in 14% of the cases. The definitive diagnosis was most commonly made at laparotomy (53%), followed by endoscopy (19%). overall mortality was 18%. Ingested toothpicks may cause significant gastrointestinal injuries, and must be treated with caution.- - - - - - - - - - ranking = 0.096244078605505keywords = duct (Clic here for more details about this article) |
5/25. "Lights and shadows" in ultrasonography.The case of a 40-year-old male patient come to the emergency service with symptoms suspicious of biliary colic, is presented. liver sonography was requested to evaluate the parenchyma, the gallbladder and bile duct caliber in the suspicion of lithiasis. During the examination a hyper-reflecting image with posterior shadowing was detected at the level of the gallbladder infundibulum. However, the shadowing was not typical of lithiasis. This aroused some doubts and the scan was repeated after some minutes: an absolutely normal infundibulum was visualized. The shadowing was therefore an artifact probably due to a partial volume effect of the air contained in the distended duodenum, in contact with the gallbladder. The formation process of the sonographic image is carefully analyzed with particular reference to the situations generating artifacts.- - - - - - - - - - ranking = 1keywords = bile duct, duct, bile (Clic here for more details about this article) |
6/25. A young man with a renal colic.We report the case of a 35-year-old man with no cardiovascular morbidity, presenting with acute flank pain, microscopic haematuria and normal blood pressure. Initially diagnosed as a ureteral colic, the patient was recovered 6 weeks later with severe hypertensive crisis. Further investigations revealed a massive renal infarction secondary to medial fibromuscular dysplasia (FMD). Several aspects of this presentation are intriguing. Renal infarcts are usually seen in older patients having cardiac problems and/or major atheromatous plaques. In addition, FMD is mainly observed in young females and rarely progresses to renal artery occlusion. Furthermore, in this case, FMD remained silent until the acute renal infarction occurred, despite a significant kidney size reduction at the time of diagnosis. Finally, the observation of a delayed hypertensive response to a major renovascular insult provides incentives to discuss possible pathophysiological mechanisms involved in renovascular hypertension.- - - - - - - - - - ranking = 0.096244078605505keywords = duct (Clic here for more details about this article) |
7/25. Endoscopic management of cystic duct fistulas after laparoscopic cholecystectomy.Two patients are reported who developed bile ascites as a result of cystic duct fistulas following laparoscopic cholecystectomy. Both patients were successfully treated with endoscopic retrograde cholangiopancreatography, utilizing sphincterotomy and nasobiliary tube placement. Characteristics of this syndrome and advantages of this form of therapy are emphasized.- - - - - - - - - - ranking = 0.57524368738404keywords = duct, bile (Clic here for more details about this article) |
8/25. Symptomatic cholecystolithiasis after laparoscopic cholecystectomy.A 45-year-old woman was admitted to our hospital complaining of upper abdominal pain. Seven months earlier a laparoscopic cholecystectomy had been carried out and a solitary gallstone removed together with the gallbladder. The patient now suffered from pain of the same character but lower intensity compared to the situation before the operation. At admission there were no abnormal laboratory findings, especially no signs of infection or cholestasis. Ultrasound revealed a stone in a gallbladder-like structure in the right epigastric region. ERCP revealed an inconspicuous cystic duct stump and no pathological findings in the extra- and intrahepatic bile ducts. MRCP and CT showed a cyst-like structure in the gallbladder region containing a concrement. The patient was transferred to the Department of Surgery for exploratory laparotomy, and a residual gallbladder with an infundibular gallstone was removed. The recurrent upper abdominal pain was obviously caused by a gallstone redeveloped after incomplete laparoscopic gallbladder resection. Retrospectively it could not be discerned whether a doubled or a septated gallbladder was the reason for the initial incomplete resection.- - - - - - - - - - ranking = 1.0962440786055keywords = bile duct, duct, bile (Clic here for more details about this article) |
9/25. peliosis hepatis revealed by biliary colic in a patient with oral contraceptive use.peliosis hepatis is a rare condition associated with a variety of diseases and drugs. We report a patient who developed peliosis hepatis while taking oral contraceptives. Three months after withdrawal of this oral contraceptive, reduction in size of these lesions was observed.- - - - - - - - - - ranking = 0.096244078605505keywords = duct (Clic here for more details about this article) |
10/25. Salicylate toxicity associated with administration of Percy medicine in an infant.Percy medicine is a nonprescription gastrointestinal suspension containing bismuth subsalicylate as the active ingredient (1050 mg/10-ml dose). A 3-month-old infant with colic developed salicylate toxicity requiring hospitalization in the pediatric intensive care unit (PICU) as a result of continued administration of this medicine. bismuth subsalicylate has an aspirin equivalency conversion factor of 0.479 (approximately half the strength of aspirin). For 3.5 weeks the infant's parents administered the medicine, which provided the equivalent of aspirin 57-84 mg/kg/day with no reported problems. However, on the day of admission the baby presented with central nervous system depression and respiratory distress. Assessment at a local emergency facility revealed metabolic acidosis; his serum salicylate concentration was 747 mg/L. After acute management, the patient was transferred to our hospital, where he was treated with whole bowel irrigation and alkalinization therapy. Subsequently, the baby required 4 days of management in the PICU and 2 additional days of observation in a general nursing unit before he was discharged home without incident. The parents had chosen Percy medicine based on the picture of a baby on the front of the package and because of its placement on the shelf next to a drug their family physician had recommended previously. Salicylate-containing products are not routinely recommended for children aged 1 year or younger. The general public may assume that over-the-counter products are safe because they do not require a prescription. health care professionals must be responsible for educating the public regarding risks associated with over-the-counter products and the need to read and follow label directions.- - - - - - - - - - ranking = 0.28873223581651keywords = duct (Clic here for more details about this article) |
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