Cases reported "Calculi"

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1/76. 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.
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2/76. Atypical presentation of a dacryolith.

    PURPOSE: To describe the clinical features and management of a patient with an extralacrimal dacryolith. methods: Case report. RESULTS: A 43-year-old woman remarked at a routine eye examination that a small, firm mass located for several years on the right side of her nose had recently become slightly larger. The mass had remained firm and nontender during this enlargement. She explicitly denied having any past or current lacrimal outflow problems. Surgical excision disclosed a mass external to the lacrimal sac and duct, adherent to its lateral wall. The histopathologic features were consistent with a dacryolith surrounded by a chronic inflammatory reaction and no epithelial lining. CONCLUSION: We presume that the dacryolith must have formed within the lacrimal sac and then migrated laterally into the surrounding soft tissue.
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3/76. portal vein phlebolithiasis found post-liver transplantation in the native liver of a child with biliary atresia.

    biliary atresia is defined as partial or total obliteration of the extra-hepatic bile ducts. In advanced cases, liver transplantation (LTx) is considered the most appropriate treatment. This report describes a female patient whose biliary atresia and subsequent cirrhosis required LTx at 1 yr of age. Macroscopic inspection of the hilar region of the native liver post-Tx revealed the formation of a pouch in the hepatic duct and a stone in the lumen of the portal vein. x-ray diffraction analysis showed that the stone was composed of cholesteryl cinnamate, gluconic acid phenylhydrazide, Na beta broma-allyl mercaptomethyl penicillinate, and Al2O3 crystals. While the cholesterol component is a known element of gallstones, we attributed the Na beta broma-allyl mercaptomethyl penicillinate to the patient's drug therapy. Our literature search revealed no previous record or crystallographic analysis of portal vein phlebolithiasis. In this report we describe this rare finding.
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4/76. splenic rupture following ESWL for a pancreatic duct calculus.

    Extracorporeal shock wave lithotripsy (ESWL) is an established and extensively used treatment alternative for urinary calculi. It is also an established method of dealing with pancreatic duct calculi complementing endoscopic techniques in selected cases. Three reports of splenic injury following and probably caused by ESWL for urinary calculi have previously been published. We report a case of splenic rupture presenting with life-threatening hemorrhage 6 days after a single ESWL therapy session for pancreatic duct calculi.
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5/76. Splenic abscess after lithotripsy of pancreatic duct stones.

    We describe a case of splenic abscess following lithotripsy of pancreatic stones, for which emergency splenectomy eventually had to be performed. It is important to be aware of this complication, because splenic abscess is still a life-threatening entity.
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6/76. Anomalous pancreaticobiliary union and chronic pancreatitis: rare presentation with biliary peritonitis.

    Anomalous pancreaticobiliary union (APBU) has varied presentations. We report the case of a 12-year-old female who presented with biliary peritonitis due to a perforation of the common bile duct due to impaction of a pancreatic calculus at the duodenal papilla. She had a long common-biliary channel and pancreas divisum with chronic calcific pancreatitis involving the pancreatic head and neck. To our knowledge, this is the first such reported case in the literature.
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keywords = duct
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7/76. Endoscopic extraction of an ejaculatory duct calculus to treat obstructive azoospermia.

    Calculous obstruction of an ejaculatory duct is an uncommon cause of azoospermia or low-volume oligospermia in the infertile man. We report the case of a 32-year-old man with azoospermia, low ejaculate volume, and transrectal ultrosonography (TRUS) findings of bilateral seminal vesicle distention. On cystoscopy for planned transurethral resection of the ejaculatory ducts, a calculus obstructing the right ejaculatory duct at the verumontanum was discovered and removed. Three months later, semen analysis showed improvements in volume, sperm concentration, and sperm motility. An ejaculatory duct calculus should be included in the differential diagnosis of obstructive azoospermia or low-volume oligospermia. magnetic resonance imaging or TRUS may be advisable to identify ductal calculi.
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8/76. Transduodenal extended sphincteroplasty and removal of ventral duct pancreatic calculi.

    The surgical treatment of chronic pancreatitis and associated ductal calculi typically involves drainage of the main pancreatic duct or parenchymal resection. Treatment of isolated symptomatic pancreatic duct calculi is usually approached by endoscopic techniques. Herein is described a case report of operative transduodenal extraction of symptomatic pancreatic calculi of the ventral pancreas in a patient with a prior distal pancreatectomy. This case represents an uncommon yet valuable option in selected patients in whom endoscopic treatments have failed or are unavailable.
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9/76. Tropical pancreatitis.

    Tropical pancreatitis is an uncommon cause of acute, and often chronic, relapsing pancreatitis. patients present with abdominal pain, weight loss, pancreatic calcifications, and glucose intolerance or diabetes mellitus. Etiologies include a protein-calorie malnourished state, a variety of exogenous food toxins, pancreatic duct anomalies, and a possible genetic predisposition. Chronic cyanide exposure from the diet may contribute to this disease, seen often in india, asia, and africa. The pancreatic duct of these patients often is markedly dilated, and may contain stones, with or without strictures. The risk of ductal carcinoma with this disease is accentuated. Treatment may be frustrating, and may include pancreatic enzymes, duct manipulations at endoscopic retrograde cholangiopancreatography, octreotide, celiac axis blocks for pain control, or surgery via drainage and/or resection.
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10/76. Endoscopic intervention for hepatolithiasis associated with sharp angulation of right intrahepatic ducts.

    BACKGROUND: Hepatolithiasis (intrahepatic stones) is common in Asian patients. Hepatolithiasis with intrahepatic strictures and sharp ductal angulation poses a particularly difficult management problem. methods: Cases of hepatolithiasis with sharp angulation of right intrahepatic ducts were retrospectively reviewed. OBSERVATIONS: Five patients with hepatolithiasis and right sharp intrahepatic ductal angulation were treated endoscopically via ERCP. Two patients died soon after the procedure. In the remaining 3 patients, treatment by dilation of the intrahepatic strictures and stent placement was only partially successful. Attempts to access the sharply angulated intrahepatic duct were unsuccessful. CONCLUSIONS: Endoscopic management of hepatolithiasis associated with sharp angulation of a right intrahepatic duct is difficult and is generally managed best with percutaneous treatment modalities or surgery, where possible.
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