Cases reported "Cholestasis"

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1/308. Intraductal ultrasonography in six patients with endoscopic biliary stenting.

    The development of endoscopic biliary stenting (EBS), using the Wallstent, to treat patients with obstructive jaundice secondary to unresectable tumors of the pancreas or biliary ducts has led to improved quality of life in these patients. We followed six patients with intraductal ultrasonography (IDUS) after insertion of a Wallstent. In two patients, endoscopic ultrasonography (EUS) was also performed, and in three patients IDUS was repeated every few months. IDUS allowed ingrowth of the tumor or formation of debris in the stent to be observed clearly and easily. Therefore IDUS was considered to be a powerful tool to follow patients after stenting and to decide on the next treatment when reobstruction occurred.
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keywords = obstruction
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2/308. Obstructive jaundice and acute cholangitis due to papillary stenosis.

    Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.
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3/308. Interventional radiology in percutaneous management of bile duct obstruction: biliary drainage through a spontaneous common hepatic duct-duodenal fistula.

    Bile duct injuries are a serious complication of biliary surgery. We report a case of benign obstruction of the common hepatic duct associated with common hepatic duct-duodenal spontaneous fistula following complex surgical intervention. We managed percutaneously the fistula with balloon dilatation and long-term stenting, as the fistula allowed biliary flow in the duodenum. We avoided reintervention preserving biliary flow, with good clinical results after a follow-up of a 3 years. We emphasize the role of a clinically focused approach to percutaneous management of complications following biliary surgery.
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keywords = obstruction
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4/308. ticlopidine-induced prolonged cholestasis: a case report.

    We report a case of ticlopidine-induced prolonged cholestasis in a 60-year-old man with no previous hepatobiliary disease who presented with sudden right upper abdominal pain, jaundice and pruritus three months after starting ticlopidine therapy. Other drugs taken by the patient were not considered probable causes. The diagnostic evaluation showed no biliary obstruction and other possible causes of intra-hepatic cholestasis were excluded. The liver biopsy showed a cholestatic hepatitis with bile duct damage. The disease ran a severe and protracted course, but symptoms and jaundice eventually subsided five months after drug withdrawal. More than a year later, relevant abnormalities of liver function tests consistent with anicteric cholestasis still persist, fulfilling criteria for a minor form of drug-induced prolonged cholestasis. This syndrome has been reported infrequently in relation to several drugs, mainly chlorpromazine, and only once with ticlopidine.
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keywords = obstruction
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5/308. mirizzi syndrome: A rare cause of obstructive jaundice.

    mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.
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keywords = obstruction
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6/308. Fungal pseudotumor masquerading as pancreatic cancer-a sequela of new technology?

    Fungal infection resulting in chronic pancreatitis is rare. We report a case of chronic pancreatitis due to fungal infection causing common bile duct obstruction and abdominal pain mimicking pancreatic cancer. Treatment included resection to cure the pain and rule out malignancy. Long-term effects of fungal infection may be seen more frequently as total parenteral nutrition, antibiotics, and foreign bodies (e.g., stents, drains, central venous catheters) are more often being used in the treatment of many diseases.
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keywords = obstruction
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7/308. Duodenal duplication cyst manifested by duodeno-jejunal intussusception and hyperbilirubinemia.

    A rare case of duodenal duplication cyst containing stones in a 17-year-old patient is presented. The cyst, acting as a leading point for duodeno-jejunal intussusception caused proximal small bowel obstruction and hyperbilirubinemia. Preoperative diagnosis was based on abdominal computerized tomography. At operation, the cyst wall was unroofed creating free drainage into the duodenal lumen without damaging the biliary and pancreatic ducts with resolution of symptoms.
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keywords = obstruction
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8/308. Obstructive jaundice caused by a huge liver cyst riding on the hilum: report of a case.

    A 71-year-old man presented to our hospital with obstructive jaundice, found to be caused by a huge liver cyst which was centrally located and riding on the hilum. Percutaneous transhepatic cyst drainage was performed, following which obstruction of the bile duct was relieved and the jaundice subsided. As jaundice recurred after removal of the drainage tube, the patient underwent deroofing, since when he has remained well. Only 13 cases of liver cysts producing obstructive jaundice have been reported in the English literature, most of which were characteristically enormous, located centrally, and riding on the hilum. Liver cysts possessing such features are likely to cause obstructive jaundice by compressing the hepatic hilum. Cyst drainage is helpful for ameliorating the jaundice and making an accurate diagnosis; however, subsequent deroofing or injection therapy is necessary to prevent recurrence.
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keywords = obstruction
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9/308. Potential utility of magnetic resonance cholangiography in the management of endoscopic biliary drainage tubes.

    An 80-yr-old woman with advanced hilar cholangiocarcinoma underwent a placement of endoscopic biliary drainage (EBD) tube from the common hepatic to common bile duct through the stricture. Magnetic resonance cholangiography clearly demonstrated the later dislocation and obstruction of the EBD tube. The present case suggests that magnetic resonance cholangiography may be a potentially useful tool in the management of EBD tubes.
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keywords = obstruction
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10/308. mirizzi syndrome: evaluation by MRI imaging.

    We report three cases of mirizzi syndrome diagnosed by MR imaging. MR cholangiography revealed dilation of the intrahepatic bile ducts, narrowing of the common hepatic duct, the level of obstruction, and the location of gallstone in the cystic duct. MR showed thickening of the gallbladder wall and the pattern of wall enhancement. MR evaluation with MR cholangiography sequences proved to be useful in these patients with mirizzi syndrome.
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keywords = obstruction
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