1/25. holmium laser lithotripsy of a complicated biliary calculus.More than 500,000 cholecystectomies are performed annually. Extracorporeal shockwave lithotripsy and endoscopic laser lithotripsy have been used for the management of common bile duct calculi, which complicate 10% of cases. We report the first successful clinical application of the Ho:YAG laser to a complex biliary calculus case.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
2/25. Dormia basket removal of a residual common duct stone: report of a case.A case is presented of successful removal of a residual common bile duct calculus by the use of a Dormia basket introduced through a T tube.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
3/25. Laparoscopic cholecystectomy in a patient on continuous ambulatory peritoneal dialysis.The patient was a 72-year-old man who was receiving continuous ambulatory peritoneal dialysis (CAPD) with a diagnosis of chronic renal failure. Although his response to dialysis therapy was favorable, right hypochondralgia and fever occurred, and gallstones were detected by abdominal ultrasonography and computed tomography. Drip-infusion cholangiography (DIC) revealed neither dilation nor calculus in the common bile duct. The patient was diagnosed as having acute cholecystitis and cholecystolithiasis and, in consideration of his general condition, laparoscopic cholecystectomy was carried out. pneumoperitoneum was performed through a CAPD tube, and a 10 mm-trocar was carefully introduced through a supraumbilical incision so as not to injure the CAPD tube. Since intraoperative cholangiography showed a condition similar to preoperative DIC, only cholecystectomy was undertaken. The postoperative course was uneventful, with neither postoperative hemorrhage nor leakage of dialysate from the wound.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
4/25. Massive dilatation of the common bile duct resembling a choledochal cyst.We present an unusual case in which an impacted calculus at the lower end of the common bile duct produced massive dilatation. This resulted in a confusing picture of choledochal cyst on abdominal ultrasound and endoscopic retrograde pancreatography. The common bile duct returned to normal size after removal of the stone.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
5/25. Endoscopic laser lithotripsy with an automatic stone recognition system for basket impaction in the common bile duct.In a patient with a common bile duct stone 28 mm in diameter, the traction wires of two basket catheters fractured during endoscopic mechanical lithotripsy. Disintegration of the concrement and removal of the impacted baskets failed even after extracorporeal application of 8,000 shockwaves. Pulsed dye laser lithotripsy was carried out via a 250 microns fiber which was advanced to the stone through a 6 French ERCP guiding catheter. lithotripsy could be safely performed under fluoroscopic control since the laser used provides an automatic cut-out system upon tissue contact. 3,600 of 11,800 applied pulses were emitted with the total power setting and complete disintegration of the calculus was achieved. The baskets and the fragments could be removed endoscopically in the same session. Laser lithotripsy with a stone recognition system would seem to improve the applicability and safety of intracorporeal lithotripsy even when performed without direct visual guidance.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
6/25. 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 = 0.2keywords = calculus (Clic here for more details about this article) |
7/25. Right hepatic duct opening into the cystic duct: the role of pre- and intraoperative cholangiography.Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare. A 69-year-old woman developed severe intermittent right upper quadrant pain and high fever. A diagnosis of acute calculus cholecystitis was made by radiographic examinations. Magnetic resonance cholangiopancreatography demonstrated dilatation of the right hepatic duct, but could not identify the junction of the right hepatic duct and the cystic duct. Endoscopic retrograde cholangiopancreatography established that the right hepatic duct joined the cystic duct and that cholecystolithiasis was present. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy. Pre- and intraoperative cholangiography contribute to the avoidance of iatrogenic bile duct injury. When the right hepatic duct drains into the cystic duct, the gallbladder should be removed distal to the junction of the hepatic and cystic ducts.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
8/25. Solitary main pancreatic ductal calculus of possible biliary origin causing acute pancreatitis.CONTEXT: Pancreatic ductal calculi are most often associated with chronic pancreatitis. Radiological features of chronic pancreatitis are readily evident in the presence of these calculi. However, acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. CASE REPORT: A 59-year-old man presented with a first episode of acute pancreatitis. Contrast enhanced computerized tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) revealed a calculus in the main pancreatic duct in the head of the pancreas causing acute pancreatitis. There were no features suggestive of chronic pancreatitis on CT scanning. The episode acute pancreatitis was managed conservatively. ERCP extraction of the calculus failed as the stone was impacted in the main pancreatic duct resulting in severe acute pancreatitis. Once this resolved, a transduodenal exploration and extraction of the pancreatic ductal calculus was performed successfully. Crystallographic analysis revealed the composition of the calculus was different to that seen in chronic pancreatitis, but more in keeping with a calculus of biliary origin. This could be explained by migration of the biliary calculus via the common channel into the main pancreatic duct. Following the operation the patient made an uneventful recovery and was well at two-year follow up. CONCLUSION: Acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. Failing endoscopic extraction, transduodenal exploration and extraction is a safe option after resolution of acute pancreatitis.- - - - - - - - - - ranking = 2.4keywords = calculus (Clic here for more details about this article) |
9/25. 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 = 0.6keywords = calculus (Clic here for more details about this article) |
10/25. Percutaneous choledochoscopic choledocholithotomy in Caroli's disease.Communicating cavernous ectasia of the intrahepatic bile ducts (Caroli's disease) is frequently accompanied by calculus formation. Percutaneous choledocholithotomy was successfully performed using a choledochoscope in a young adult with multiple calculi. To our knowledge this is the first reported case of choledocholithotomy using this technique in Caroli's disease.- - - - - - - - - - ranking = 0.2keywords = calculus (Clic here for more details about this article) |
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