Cases reported "Biliary Fistula"

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1/95. Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

    A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.
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2/95. gallbladder carcinoma with choledochoduodenal fistula: a case report with surgical treatment.

    A 79 year-old man was admitted to our hospital because of upper abdominal pain and nausea. A mobile tumor was palpable in the right upper abdomen. Abdominal ultrasonography, computed tomography and celiac angiography revealed a gallbladder tumor. Endoscopic retrograde cholangiopancreatography revealed a fistula 1.5 cm oral to the orifice of the papilla of Vater, dilatation of the common bile duct, and a filling defect in the gallbladder. Pancreatoduodenectomy associated with reconstruction using Imanaga's method was performed under a pre-operative diagnosis of gallbladder carcinoma with choledochoduodenal fistula. The gallbladder contained a tumor and two bilirubin stones impacted in the orifice of the duodenal papilla. Histological studies confirmed that the gallbladder tumor was a mucinous adenocarcinoma and had not infiltrated the bile duct. We speculated that choledochoduodenal fistula stimulated the development of cancer due to chronic irritation from pancreatic juice reflux.
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3/95. A case of bilioduodenal fistula treated with a self-expandable metallic stent.

    We report the case of a 72 year-old female patient who suffered from biliary fistulae. The biliobiliary and bilioduodenal fistulae appeared after an operation for biliary bleeding. Conventional therapy for biliary fistula would be the disconnection of the fistula by either conservative or operative treatment. In the present case, however, it was preferable to enlarge the fistula to drain bile juice into the duodenum, rather than to close the fistula because it would have been difficult to achieve a tight adhesion with this operation. The enlargement by a plastic tube stent failed to drain the bile juice into the duodenum, because the sludge made the tube stenotic. Therefore, a self-expandable metallic stent was applied in this case. An expandable stent was used because a large final caliber is necessary to prevent stenosis of the fistula by sludge and mucosal hyperplasia. After insertion of a self-expandable metallic stent by the percutaneous transhepatic biliary drainage route, the patient has not suffered from cholestasis and cholangitis for the last 30 months. It can therefore be concluded that enlargement of the fistula by a self-expandable metallic stent is a convenient therapy for such biliointestinal fistulae.
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keywords = operative
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4/95. Management of a patient with hepatic-thoracic-pelvic and omental hydatid cysts and post-operative bilio-cutaneous fistula: a case report.

    In humans, most hydatid cysts occur in the liver and 75% of these are single. Our patient was a 31 year-old male. His magnetic resonance imaging (MR) showed one cyst (15 x 20 cm) in the right lobe and three cysts (5 x 6 cm, 8 x 6 cm, and 5 x 5 cm) in the left lobe of the liver, two cysts (4 x 5 cm and 5 x 5 cm) on the greater omentum, and two cysts (15 x 10 and 10 x 10 cm) in the pelvis. The abdomen was entered first by a bilateral subcostal incision and then by a Phennenstiel incision. Partial cystectomy capitonnage was done on the liver cysts; the cysts on the omentum were excised, and the pelvic cysts were enucleated. The cyst in the right lobe of the liver was in communication with a thoracic cyst. An air leak developed from the thoracic cyst which had underwater drainage and bile drainage from the drain in the cavity of the right lobe cyst. Sphincterotomy was done on the seventh post-operative day by endoscopic retrograde cholangiopancreatography (ERCP). No significant effect on mean bile output from the fistula occurred. octreotide therapy was initiated, but due to abdominal pain and gas bloating the patient felt and could not tolerate, it was stopped on the fourth day; besides, it had no decreasing effect on bile output during the 4 days. Because air and bile leak continued and he had bile stained sputum, he was operated on on post-operative day 18. By right thoracotomy, the cavity and the leaking branches were closed. By right subcostal incision, cholecystectomy and T-tube drainage of the choledochus were done. On post-operative day 30, he was sent home with the T-tube and the drain in the cavity. After 3 months post-operatively, a second T-tube cholangiography was done, and a narrowing in the distal right hepatic duct and a minimal narrowing in the distal left hepatic duct were exposed. Balloon dilatation was done by way of a T-tube. Bile drainage ceased. There was no collection in the cavity in follow-up CT scanning, so the drain in the cavity, and the drainage catheter in the right hepatic duct were extracted. Evaluation of the biliary ductal system is important in bilio-cutaneous fistulas, and balloon dilatation is very effective in fistulas due to narrowing of the ducts.
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ranking = 8
keywords = operative
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5/95. Spontaneous multiple cholecystoenteric fistulas--a case report.

    Spontaneous multiple cholecystoenteric fistulas are relatively rare complications of chronic cholecystitis. One cholecystoduodenal and two cholecystocolonic fistulas were observed in a 65-year-old woman whose symptoms included fever, chills, jaundice, diarrhea, and prolonged right upper quadrant pain. Pneumobilia, which is a pathognomonic sign of bilioenteric fistula, was also detected by her plain abdomen X-ray on admission. Both types of fistulas were correctly diagnosed preoperatively by barium enema, upper GI series and endoscopic retrograde cholangiopancreaticography. The patient was referred for surgery and fistulas were identified during laparotomy. cholecystectomy, division of these fistulas, and primary repair of these bowel defects were successfully performed. The postoperative course was unremarkable. We report this unusual case and briefly review the hypothesized pathogenesis, typical symptomatology, radiographic diagnosis, complications and therapeutic modalities of this condition.
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ranking = 2
keywords = operative
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6/95. Laparoscopic treatment of cholecystocolonic fistula: report of a case preoperatively diagnosed by barium enema.

    The authors present a case of cholecystocolonic fistula with no specific symptoms, such as severe diarrhea or pneumobilia, preoperatively diagnosed and treated by the laparoscopic approach. A preoperative barium enema demonstrated a cholecystocolonic fistula. The fistula was divided by the laparoscopic stapling technique. Important features in the management of this case are (1) preoperative diagnosis of the fistula by barium enema carried out for screening colorectal cancer, (2) dissection of the gallbladder from its bed before division of the fistula, and (3) use of the laparoscopic stapling technique to divide the fistula while preventing fecal soilage.
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ranking = 7
keywords = operative
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7/95. 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.
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ranking = 2
keywords = operative
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8/95. Laparoscopic repair of cholecystoduodenal fistula: report of two cases.

    BACKGROUND: Laparoscopic surgery has become the standard of care for benign gallbladder disease. patients AND methods: We treated two middle-aged women having acute exacerbations of chronic gallbladder disease with laparoscopic cholecystectomy. A cholecystoduodenal fistula was diagnosed intraoperatively in each case. These fistulae were repaired laparoscopically using an endoscopic stapling device without complication. RESULTS: Each patient did well postoperatively and was discharged to home on the second postoperative day in good condition. CONCLUSIONS: Biliary-enteric fistula is a known complication of chronic gallbladder disease that is traditionally considered a contraindication to laparoscopic cholecystectomy. However, we believe laparoscopic repair to be a safe and effective approach in the hands of surgeons with significant laparoscopic experience.
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ranking = 3
keywords = operative
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9/95. Biliopancreatic fistula associated with intraductal papillary-mucinous pancreatic cancer: institutional experience and review of the literature.

    Intraductal papillary-mucinous tumour is clinicopathologically characterized by papillary growth and mucin production within the pancreatic duct system. The category includes a wide range of dysplasia, ranging from adenoma to carcinoma, the latter designated as intraductal papillary-mucinous cancer. In general, the tumor renders a favorable prognosis after complete resection. However, intraductal papillary-mucinous tumor with overt invasion outside the gland has been reported to have a poor prognosis, as is the case with the usual type of duct cell cancer of the pancreas. We experienced two cases of intraductal papillary-mucinous cancer with obstructive jaundice due to impaction of thick mucus protruding from the pancreas via a "spontaneous" biliopancreatic fistula. Preoperative examinations of both patients showed a large intraductal papillary-mucinous tumor in the head of the pancreas with fistula formation between the intrapancreatic portion of the common bile duct and the main pancreatic duct. Histopathological investigation of the two resected specimens suggested that the fistula may not have developed from invasion by papillary or tubular adenocarcinoma, but from compression and destruction of the intercalating tissues by abundant mucinous secretion. The first patient died of peritoneal carcinomatosis with clinicopathologic features of pseudomyxoma peritonei 6 years after surgery. The second patient is alive and has been well for 2 years postoperatively. review of the world literature showed that half of the patients with intraductal papillary-mucinous cancer plus biliopancreatic fistula had no stromal invasion around the fistula, indicating that the fistula might have been caused by mechanical pressure. However, the other half of the cases did have stromal invasion around the fistula. Two-thirds of these cases, including our own patients, had foci of mucinous carcinoma in the stroma around the fistulization, implying that mucinous lakes in the stroma may have served as part of the "waterway" from the pancreatic duct to the bile duct, assisted by increased pressure by mucus production. Since intraductal papillary-mucinous cancer with biliopancreatic fistula has a comparatively favorable prognosis, surgical resection should be considered.
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ranking = 2
keywords = operative
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10/95. Laparoscopic cholecystofistulectomy for preoperatively diagnosed cholecystoduodenal fistula.

    The presence of cholecystoduodenal fistula, a rare condition, has been one of the reasons for conversion from laparoscopic cholecystectomy to open cholecystectomy. Here we report a patient with cholecystocholedocholithiasis complicated by cholecystoduodenal fistula, diagnosed preoperatively and treated by combined endoscopic sphincterotomy and laparoscopic cholecystofistulectomy. After the removal of multiple bile-duct stones by endoscopic sphincterotomy, the patient underwent laparoscopic cholecystofistulectomy. We were able to resect the fistula without cleavage, using an endoscopic linear stapling device, because we had been able to confirm the site of the fistula preoperatively. The patient's postoperative course was uneventful. We conclude that laparoscopic cholecystofistulectomy by skilled laparoscopic surgeons can be adopted as a first-choice treatment for cholecystoduodenal fistula.
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ranking = 7
keywords = operative
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