1/34. Late complication following percutaneous cholecystostomy: retained abdominal wall gallstone.A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29 days later. The patient came back 5 months later with a superficial abscess that was drained and 8 months post PC with a fistula discharging clear fluid. ultrasonography revealed the tract adjacent to an area of inflammation containing a calculus, whereas CT failed to depict the stone. Subsequent surgery confirmed US findings. To our knowledge, this is the first report of a dislodged bile stone following percutaneous cholecystostomy.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
2/34. Video-assisted laparoscopic enterolithotomy: new technique in the surgical management of gallstone ileus.Our goal was to analyze the results obtained with the surgical treatment of gallstone ileus using a new video-assisted laparoscopic technique. Six patients with gallstone ileus were admitted to the Hospital de Clinicas Jose de San Martin of Buenos Aires between March 1996 and April 1998. The patients' charts were retrospectively studied. Five of the six patients were women, with an average age of 71.2 years. Enterolithotomy was performed in four patients, laparoscopic enterolithotomy in one, and diagnostic laparoscopy with no need of further surgical treatment (because the calculus migrated to the colon) in the remaining patient. The postoperative complication rate was 33%. In one patient, acute pulmonary edema and sepsis developed, and death occurred in the immediate postoperative period (mortality rate, 16.6%). The average hospital stay was 6.6 days. The average follow-up was 16 months. No patient required treatment of the enterovesical fistula; all of them remained asymptomatic. One patient died as the result of evolution of vesicular adenocarcinoma. This approach represents a safe and feasible technique that may reduce the morbidity associated with the surgical treatment of gallstone ileus by guiding the surgical incision, preventing unnecessary laparotomies, and improving abdominal exploration.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
3/34. Laparoscopic cholecystectomy and choledochoscopy for the treatment of cholelithiasis and choledocholithiasis.A 33-year-old woman with symptomatic cholelithiasis underwent laparoscopic cholecystectomy. Preoperative evaluation did not suggest the presence of choledocholithiasis, but intraoperative cholangiography showed a totally obstructing stone in the distal common bile duct. Laparoscopically directed, transperitoneal choledochoscopy was performed by passing a 9.4 F flexible ureteroscope through the cystic duct into the distal common bile duct. A single calculus was visualized and removed with a basket. The patient was discharged the next day, returned to full activity within 1 week, and has done well in the subsequent postoperative interval. The management of incidentally discovered common bile duct stones during performance of laparoscopic cholecystectomy is discussed.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
4/34. Agenesis of the gallbladder.Agenesis of the gallbladder, with normal bile ducts, is a rare congenital condition occurring in 13 to 65 people out of a population of 100,000 and probably results from a failure of the gallbladder bud to develop or vacuolize in utero. Reports of a familial tendency toward this condition may suggest screening of asymptomatic family members and speed treatment when symptoms manifest, thus avoiding surgery. choledocholithiasis in patients with gallbladder agenesis is rare, the stones found are usually small, and patients had invariably first presented with jaundice. The authors describe a case of a 23-year-old patient with gallbladder agenesis and a large choledochal calculus and without jaundice at presentation. A review of the literature is presented.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
5/34. 1291 cases of cholelithiasis treated with electric shock on otoacupoints.Since 1985, the authors began to use electric shock on otoacupoints of varying electric resistance for the treatment of cholelithiasis. The instrument used was the Channel Therapeutic Instrument made in china, and the otoacupoints of varying electric resistance were Sympathetic, pancreas--Gall Bladder, stomach, liver, Sanjiao, Endocrine, and Ermigen. In the 1291 cases treated, the total effective rate was 99.69%, the rate of calculus excretion was 91.32%, and the rate of total excretion was 19.51%. The composition of the calculi was cholesterol crystals (31.25%), bilirubin crystals (28.17%), and mixed crystals (40.58%). The largest calculus excreted was an extrahepatic biliary duct calculus of 1.75 cm X 1.5 cm; the largest number of calculi excreted was 152 cholecystic stones 0.3 cm X 0.5 cm in size. In 100 random cases, the biliary system was shown to manifest vigorous dilations and constrictions under Ultrasonic B-scan when the relevant otoacupoints were stimulated with electric shock. Among the 78 control cases, no cholecystic stones were excreted, inspite of the magnesium sulfate, Folium Cassiae and fatty meals administered to many cases with constipation.- - - - - - - - - - ranking = 3keywords = calculus (Clic here for more details about this article) |
6/34. The cystic duct sign during morphine-augmented cholescintigraphy.Visualization of a "dilated cystic duct" during standard hepatobiliary imaging represents a potential source of false-negative cholescintigraphy. Intravenous morphine, commonly used to shorten study time and improve the specificity of hepatobiliary imaging, may, by virtue of its pharmacologic/physiologic actions, accentuate the appearance of a "dilated cystic duct." We present a case of transient cystic duct visualization following morphine administration in a patient with an obstructing cystic duct calculus.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
7/34. Pancreatic and biliary calculi: percutaneous treatment with tunable dye laser lithotripsy.Percutaneous tunable dye laser lithotripsy was used in two patients to successfully fragment a 2-cm left hepatic duct calculus and a 5-mm main pancreatic duct calculus. Tunable dye laser lithotripsy may prove to be a more effective alternative to mechanical lithotripsy.- - - - - - - - - - ranking = 2keywords = calculus (Clic here for more details about this article) |
8/34. Biliobiliary fistula: preoperative diagnosis and management implications.Experience with cholecystohepaticodochal and cholecystocholedochal fistulas as a result of an erosion of gallstones from the gallbladder into the adjacent common duct in five patients is presented. The incidence was 1.4% in a population of 350 patients undergoing cholecystectomy. The condition was indicated clinically on the basis of a symptom triad of jaundice, fever, and pain with cholelithiasis in a small contracted gallbladder. In addition, proximal intra- and extrahepatic ductal dilatation, calculus in the common duct, and normal-caliber (or unprofiled) distal common duct on ultrasound scan were present in all the patients. Endoscopic retrograde cholangiopancreatography proved to be the most useful means of investigation, and it confirmed the diagnosis in four patients before surgery. A modified antegrade cholecystectomy was performed with the gallbladder opened inferiorly at the fundus, and the stones were evacuated. A partial cholecystectomy and choledochoplasty were accomplished with gallbladder flaps whenever feasible. Other useful operative procedures are side-to-side hepaticodochojejunostomy and hepaticodochoduodenostomy. In the presence of high benign bile duct stricture, an approach to the left hepatic duct is now preferred for biliary bypass.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
9/34. Percutaneous endoscopic laser lithotripsy of retained stones in the left hepatic duct. The role of the surgeon.A 35-year-old woman with a retained stone in a branch of the left hepatic duct was referred to us. The stone was discovered on the postoperative T-tube cholangiogram. A flexible ureteroscope was introduced into the duct, under fluoroscopic and direct endoscopic vision and the pulse dye laser was used successfully to disintegrate the calculus. The postoperative course was uneventful. We suggest that in certain selected cases, the pulsed dye laser might be useful in disintegrating stones sited in difficult positions.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
10/34. cystic duct entry--another cause of pseudocalculus.Certain pitfalls face the endoscopist during ERC in the diagnosis of common bile duct stones. False-positive filling defects for calculi may be caused by air bubbles, blood clot, tumor, and the pseudocalculus sign of the lower common bile duct (CBD) due to sphincter spasm. Another false positive may be encountered by the presence of a filling defect at the confluence of the cystic duct and common bile duct, and we report on three such cases. The cause of this pseudocalculus sign of the mid-CBD is not clear. We speculate that it may arise as a result of an unopacified jet of bile flowing from the cystic duct displacing contrast in the CBD.- - - - - - - - - - ranking = 6keywords = calculus (Clic here for more details about this article) |
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