1/360. Dacryolith formation around an eyelash retained in the lacrimal sac. A dacryolith was discovered in the lacrimal sac during a dacryocystorhinostomy for chronic dacryocystitis in which there was mucocele formation. Morphological examination confirmed the presence of an eyelash at the centre of the stone and electron microscopy demonstrated the presence of fungi (candida sp.) in a matrix which was of markedly vairable morphology. The mechanism by which a hair enters the punctum and passes along the canaliculus may be attributed to the step-like pattern of ridges on the surface of a hair. The directional nature of these ridges dictates preferential movement towards the root end of the hair and prevents movements in the opposite direction. ( info) |
2/360. colon ischaemia secondary to barolith obstruction. A case is described of an elderly woman who developed an obstructing barolith in the sigmoid colon following a barium enema. Colonic ischaemia developed in the proximal colon. Predispositions and prevention of baroliths are discussed. ( info) |
3/360. Impacted papilla minor stone in pancreas divisum causing severe acute pancreatitis: a case for early ERCP in acute pancreatitis of unknown origin. This is the first description of severe acute pancreatitis in pancreas divisum caused by a solitary stone impacted in the minor papilla. Recovery was rapid after diagnostic endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic stone removal. Since other etiological factors accounting for the acute pancreatitis were carefully excluded, it seems that obstruction of the minor papilla by a solitary pancreatic concrement was the most likely cause of acute pancreatitis. This case report demonstrates the diagnostic importance of early ERCP in cases of etiologically unexplained acute pancreatitis. ( info) |
4/360. Small-intestinal enteroliths--unusual cause of small-intestinal obstruction: report of three cases. PURPOSE: The aim of this study was to report on a rare cause of small-intestinal obstruction caused by small-intestinal enteroliths. methods: We present three different cases of enterolith formation in the small intestine. One occurred after nontropical sprue, one patient had multiple jejunal diverticula, and another patient had enterolith formation in a blind loop after a small-bowel side-to-side anastomosis. RESULTS: After initial conservative therapeutic approach all patients underwent surgery. In two patients the enteroliths were removed by ileotomy or jejunostomy. In the third patient the bowel anastomosis had to be revised after removal of the enterolith. CONCLUSION: Small-intestinal enteroliths may cause small-bowel obstruction. The first therapeutic approach is nonsurgical; however, if obstruction proceeds, surgical removal with or without revision of underlying pathology is necessary. We discuss the causes and therapeutic management of enteroliths and give a review of related literature. ( info) |
5/360. Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78-110mm. angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%-0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones. ( info) |
6/360. afferent loop syndrome presenting as enterolith after Billroth II subtotal gastrectomy: a case report. We present a rare late-onset (after 24 years) complication of gastric surgery with a combination of afferent loop syndrome associated with a large duodenal stone. The patient, who had undergone Billroth II partial gastrectomy for benign ulcer 24 years before, developed abdominal pain in the right upper quadrant, associated with nausea, vomiting, and high grade fever. Abnormal laboratory values included elevated liver function test, suggesting a pressure-related phenomenon. leukocytosis and a high level of platelets were also found. Only computed tomography and endoscopy of the upper gastrointestinal tract confirmed the diagnosis of a huge stone in the dilated duodenal afferent loop. To our knowledge, a case like this has not been reported previously in the literature. ( info) |
7/360. Endoscopic pancreatic sphincter balloon dilation for effective retrieval of pancreatic duct stone. To facilitate pancreatic stone retrieval, four patients with chronic pancreatitis and pancreatic stones underwent endoscopic pancreatic sphincter balloon dilation (EPSBD) rather than pancreatic sphincterotomy. Extracorporeal shock wave lithotripsy combined with endoscopic removal was carried out in three patients. Stone removal following EPSBD was completely successful in all four patients. patients showed no severe complications during the dilation procedure. In one patient, to prevent pancreatitis, an endoscopic nasopancreatic drain was placed for 1 week after EPSBD. Compared with pancreatic sphincterotomy, EPSBD can be performed safely in patients with chronic pancreatitis to assist in the extraction of pancreatic duct stones. Use of the EPSBD procedure in cases of chronic pancreatitis provides a useful approach to improve endoscopic clearance of pancreatic duct stones. ( info) |
8/360. Vaginal calculi in a young woman. A case of a large vaginal stone in a 26-year-old woman is presented. Vaginal stones are relatively rare. Various causes can lead to vaginal stone formation. In our case, the calculi was due to vaginal outlet obstruction in childhood. The diagnosis is usually easy to be done. In our patient, X-ray films using frontal and lateral views of the urinary system permitted to establish the right diagnosis. Treatment can vary, depending on the cause of the stone formation and the consistency of the calculi. In this case, the treatment was surgical with simple evolution. It permitted a normal social and sexual life to this young patient. ( info) |
9/360. Enterolith causing bleeding in a patient with Meckel's diverticulum. Angiographic demonstration. angiography demonstrated a bleeding Meckel's diverticulum supplied by tortuous, presumably embryonic branches of the superior mesenteric artery. A large enterolith, partially impacted into a constriction near the center of the diverticulum, caused a bleeding ulcer. The diverticulum contained no gastric mucosa. ( info) |
10/360. Thoracolithiasis. Thoracolithiasis without any history of chest traumas or interventions is pathologically rare, with only 9 cases including our 2, reported thus far in the literature. Case 1: A 76-year-old man admitted to our hospital had an abnormal shadow in chest radiography that gradually enlarged. serum carcinoembrionic antigen was slightly elevated during follow-up. A milky white tumor 1.5 cm in diameter with many projections was found in the thoracic cavity and removed by thoracoscopy. Histopathological examination showed the tumor to consist of fibrous tissue with fatty necrosis at the core. Case 2: A 54-year-old woman admitted to our hospital had an abnormal shadow in chest screening radiography in 1998. Transbronchial biopsy showed this shadow to be lung adenocarcinoma. A small trigonal pyramid-shaped milky white nodule 5 mm in diameter was found in the thorax during lobectomy for lung cancer. Histopathological examination showed this nodule also to consist of fibrous tissue with fatty necrosis. ( info) |