Cases reported "Jaundice"

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11/38. Traumatic avulsion of the intrapancreatic common bile duct: case report.

    Injuries of the extra hepatic biliary tree following blunt trauma to the abdomen are rare. We present a case of avulsion of the intrapancreatic common bile duct. Very often the lesion is not identifiable until the signs of jaundice and biliary ascites occur. Intraoperative cholangiography is mandatory for the diagnosis, but the noninvasive magnetic resonance cholangiopancreatography could readily depict the injury of the extrahepatic bile duct preoperatively. When the diagnosis is late the corner stone of treatment is biliary diversion and definitive repair after complete resolution of sepsis with a choledochojejunostomy.
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ranking = 1
keywords = operative
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12/38. Mirizzi's syndrome: a contraindication to coelioscopic cholecystectomy.

    An impacted gallstone in the cystic duct with subsequent inflammation and edema resulting in extrinsic compression of the common bile or common hepatic duct with obstructive jaundice is known as Mirizzi's syndrome. An uncommon complication of cholelithiasis, Mirizzi's syndrome should be included in the differential diagnosis of any patient who has extrahepatic biliary obstruction. We present a case of a patient who underwent open rather than coelioscopic cholecystectomy based upon the preoperative diagnosis of Mirizzi's syndrome. A multidisciplinary approach to such patients facilitates the decision between open and endoscopic cholecystectomy. Mirizzi's syndrome may represent a contraindication to endoscopic cholecystectomy.
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ranking = 0.5
keywords = operative
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13/38. Demonstration of hepatic artery aneurysm by subtraction angiography.

    An unusual case of obstructive jaundice due to an aneurysm of the hepatic artery is presented. The diagnosis of hepatic artery aneurysm is often difficult because of the absence of typical symptoms. In this case, the initial symptom was jaundice. aneurysm of the hepatic artery, causing obstruction of the common bile duct, was definitely diagnosed preoperatively by subtraction angiography, combined with percutaneous transhepatic cholangiography. Surgical treatment was successful.
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ranking = 0.5
keywords = operative
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14/38. Measurement of hepatocellular function with deconvolutional analysis: application in the differential diagnosis of acute jaundice.

    A direct, noninvasive technique was developed to quantitate hepatocyte function with computer assessment of scintiscans obtained after administration of technetium-99m disofenin in 53 patients with acute jaundice: 32 patients with normal livers, 10 patients with acute biliary obstruction, and 11 patients with acute hepatocellular dysfunction. In all patients a final clinical diagnosis was obtained with follow-up for a minimum of 4 months and, in most patients with obstruction or dysfunction, with surgery, intraoperative cholangiography, ultrasound, and/or computed tomography. heart (blood pool) and liver time-activity curves were generated for 32 minutes after intravenous injection of 5-15 mCi (185-555 MBq) of Tc-99m disofenin and were subjected to deconvolutional analysis to determine the first-pass hepatocyte extraction fraction (HEF) of the tracer. The difference in HEF between patients with obstruction and those with dysfunction was highly significant (P = 3.3 X 10(-19)). Deconvolutional analysis eliminates the effects of tracer recirculation, thus permitting direct measurement of hepatic disofenin extraction, and appears to provide functional information useful in evaluation of the patient with acute jaundice.
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ranking = 0.5
keywords = operative
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15/38. Postoperative jaundice as a clue to unrecognized biliary tract obstruction.

    Postoperative jaundice is often a complex clinical problem of multifactorial origin. If underlying liver disease is present preoperatively, there is a greater likelihood of jaundice after surgery. We describe two patients: one with intrabiliary hepatocellular carcinoma and the other with primary sclerosing cholangitis. The underlying processes were unmasked after the development of jaundice in the postoperative period. These cases point out the importance of considering previously undiagnosed biliary tract obstruction in the differential diagnosis of postoperative jaundice.
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ranking = 4
keywords = operative
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16/38. Traumatic rupture of the hepatic duct demonstrated by endoscopic retrograde cholangiography.

    Persistent jaundice and abdominal distention were noted postoperatively in a 37-year-old white male who had undergone splenectomy and suture of a liver laceration following a motorcycle accident. Abdominal paracentesis yielded bile-stained fluid. Endoscopic retrograde cholangiography (ERC) demonstrated rupture of the hepatic duct at its bifurcation which had been missed on initial laparotomy. ERC was valuable in planning and subsequently performing a hepatojejunostomy. We found no previous report of using ERC to diagnose and locate a missed bile duct injury.
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ranking = 0.5
keywords = operative
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17/38. Surgical injury of the common bile duct.

    review of our experience with twenty-two bile duct injuries and the literature leads us to the following conclusions: (1) Most biliary strictures follow surgery and can be avoided by adequate exposure, accurate dissection, use of hemostatic clips rather than clamps and ties, and the liberal use of operative cholangiography. (2) Injuries diagnosed at the time of surgery should be repaired by end-to-end anastomosis over a T tube if length is adequate or by Roux-en-Y choledochojejunostomy if length is inadequate. (3) The diagnosis of biliary injury should be suspected when jaundice, biliary fistula, or cholangitis occur in the postoperative period. (4) IVC, PTC, ERCP, or fistulography should be used when possible to delineate the site of injury or stricture and assist in planning the operative repair. (5) Surgery should be performed as soon as the diagnosis is made and the patient is in satisfactory condition for operation. (6) Early reoperation may be necessary to establish drainage and prepare for a later definitive procedure. In some cases, definitive repair can be performed this time. (7) Most late strictures should be repaired with a choledochojejunostomy to a defunctionalized limb of jejunum when resection and primary end-to-end repair cannot be accomplished.
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ranking = 1.5
keywords = operative
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18/38. Difficulty in diagnosing hemobilia from a hepatic artery aneurysm: value of endoscopic retrograde cholangiography.

    A case of hemobilia due to a hepatic artery aneurysm is described. Despite 2 arteriograms and 2 laparotomies, the cause of the bleeding remained undetected until a further selective cannulation of the celiac axis artery was performed. Endoscopic retrograde cholangiography demonstrated that postoperative jaundice was not due to obstruction and outlined the aneurysm within a hepatic duct.
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ranking = 0.5
keywords = operative
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19/38. Gilbert's syndrome as a cause of postoperative jaundice.

    A case of postoperative jaundice due to Gilbert's syndrome in a previously healthy 19-year-old female is presented. signs and symptoms of jaundice developed on the second postoperative day and resolved spontaneously after 5 days. The diagnosis and characteristics of Gilbert's syndrome and other related abnormalities and factors relevant to anaesthesia which affect bilirubin metabolism are discussed.
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ranking = 3
keywords = operative
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20/38. Postoperative jaundice in children. The influence of halothane.

    At the Hospital for Sick Children, Great Ormond Street, during the 23-year period 1957 to 1979, 165400 anaesthetics were administered. Almost all of the patients anaesthetised during this time would have been exposed to halothane. Seventy-four patients became jaundiced for the first time in the post-operative period. halothane-associated hepatitis was excluded as the cause of the postoperative jaundice in all but two of the 74 patients. In these two patients in whom the diagnosis of halothane-associated hepatitis was possible the hepatitic illness was mild and both patients made an uneventful recovery. In this survey the risk of a patient becoming jaundiced due to halothane associated hepatitis was greater than 1 in 82000. It would seem that in children halothane can be used whenever it is warranted and can be used repeatedly.
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ranking = 3
keywords = operative
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