scholarly journals EP.TU.581Cholecysto-colonic fistula – A rare complication of gallstone

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Santhosh Loganathan ◽  
Amal Singh ◽  
Adam O'Connor ◽  
Martin Antony
Keyword(s):  
Rare Complication ◽  
Gallstone Disease ◽  
Gall Stone ◽  
Biliary Tree ◽  
Definitive Treatment ◽  
Fresh Blood ◽  
Significant Past Medical History ◽  
Colonic Fistula ◽  
Medical Issues ◽  
Biliary Sepsis

Abstract We present a 90year old male patient presenting to the emergency department with complaints of PR bleed for a month with no associated abdominal pain. He described that the blood was mixed with stools and dark in colour. He has a significant past medical history with multiple comorbidities. The patient is known to have gallstones and had ERCP with sphincterotomy in 2017 as a definitive treatment, as he wasn’t a fit candidate for surgical intervention. On clinical examination, his abdomen was soft and non-tender and per rectal examination showed stools mixed with the blood but no active bleeding or fresh blood. His haemoglobin was 72 g/L, inflammatory markers were significantly elevated with deranged liver enzymes and normal bilirubin. The medical team were involved in the management of this patient because of pneumonia and extensive medical issues. A gastroscopy was performed as there was a suspicion of UGI bleed, which was normal. Given a deranged liver function and there was a suspicion of biliary sepsis patient had MRCP and Computed tomography of the abdomen which confirmed that there is haematoma in the gallbladder with gas in the biliary tree, with possible cholecysto-colonic fistula, with a large gall stone (2.7cm lamellated structure within rectum) in the rectum. As the patient was not a surgical candidate decision was made to manage him conservatively with antibiotics under medical care. The cholecysto-colonic fistula is a rare complication of gallstone disease, and very few cases have been reported in the literature.

scholarly journals Duodenal Obstruction by a Gallstone (Bouveret's Syndrome) Managed by Endoscopic Stone Extraction: A Case Report and Review

1997 ◽  
Vol 11 (6) ◽  
pp. 493-496 ◽  
Author(s):  
Franzjosef Schweiger ◽  
Rowen Shinder
Keyword(s):  
Epigastric Pain ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Outlet Obstruction ◽  
Definitive Treatment ◽  
Bouveret’S Syndrome ◽  
Presenting Symptoms ◽  
Endoscopic Extraction ◽  
Bouveret's Syndrome

Gastric outlet obstruction caused by a large gallstone in the duodenum or pylorus (Bouveret's syndrome) is a rare complication of gallstone disease. The presenting symptoms are often nonspecific and include nausea, vomiting, epigastric pain and a history of gallbladder disease. Although the diagnosis is established only at surgery in many cases, preoperative recognition by imaging techniques and endoscopy is desirable. Surgical treatment aims at removal of the ectopic gallstone, closure of the fistula and cholecystectomy. A case of Bouveret's syndrome is presented where endoscopic extraction of the duodenal gallstone was accomplished providing definitive treatment for this patient.

scholarly journals Liver biopsy in gall stone disease: a prospective study in patients undergoing cholecystectomy

2017 ◽  
Vol 5 (1) ◽  
pp. 286
Author(s):  
Gaurav Patel ◽  
Atul Jain ◽  
Malwinder Singh ◽  
Meenu Garg ◽  
Tanweer Karim ◽  
...  
Keyword(s):  
Gallstone Disease ◽  
Gall Stone ◽  
Portal Tract ◽  
Biliary Tree ◽  
Stone Disease ◽  
Chronic Cholecystitis ◽  
Liver Histology ◽  
Irreversible Damage ◽  
Duration Of Symptoms ◽  
Gall Stone Disease

Background: Cholelithiasis has affected mankind since many centuries. It not only affects the biliary tree but also has adverse effects on the hepatic parenchyma, which can get further complicated due to infected bile. Early intervention in these cases not only retards the unwanted effects but also prevents irreversible damage to liver. Aim of study was to see the effect of gallstone disease on liver in patients of GSD (Cholelithiasis, Chronic cholecystitis, CBD Stones).Methods: All patients being subjected for planned cholecystectomy were taken as subjects irrespective of age, sex and co-morbid conditions.Results: 90 patients were included in study and they were evaluated for secondary histopathological changes in liver.  Abnormal liver histology was seen in 40% of the cases, with portal tract inflammation being the commonest abnormality seen in 24.4% of patients followed by fatty change (17.8%), cholestasis (10%), lobular parenchymal infiltration (8.9%) and one (1.1%) patient had fibrosis. Choledocholithiasis was associated with a greater incidence of positive bile culture (60%) and greater incidence of abnormal liver histology (80%).Conclusions: Gall stone disease cause significant changes in liver histology and these changes are more common in those patients having long duration of symptoms. In patients of choledocholithiasis incidence of infected bile and liver histology changes are more as compared to cholelithiasis with chronic cholecystitis.

Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ali Abdul Hussein Handoz ◽  
Ahmed Kh Alsagban
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gall Stone ◽  
The Elderly ◽  
Stone Disease ◽  
Definitive Treatment ◽  
Adjacent Structures ◽  
Common Causes ◽  
Gall Stone Disease ◽  
Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

Bouveret’s Syndrome – Case Series with Therapeutic Implications

2020 ◽  
Vol 58 (04) ◽  
pp. 352-356
Author(s):  
Tobias Kukiolka ◽  
Jan Borovicka ◽  
Stephan Baumeler ◽  
Marc Schiesser ◽  
Christoph Gubler
Keyword(s):  
Balloon Dilatation ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Treatment Algorithm ◽  
Case Series ◽  
Endoscopic Technique ◽  
Bouveret’S Syndrome ◽  
Therapeutic Implications ◽  
Electrohydraulic Lithotripsy ◽  
Bouveret's Syndrome

AbstractBouveret’s syndrome is a rare complication resulting from gallstone disease. Both surgical and endoscopical procedures are performed, with the disease to be seen as strictly interdisciplinary. There are no well-established recommendations for this condition. In this paper, we want to describe our experience from 6 cases in 3 Swiss hospitals from 2015 to 2017 with emphasis on the endoscopic technique of electrohydraulic lithotripsy followed by balloon dilatation and propose a treatment algorithm.

scholarly journals Molecular Signature of Extracellular Vesicular Small Non-Coding RNAs Derived from Cerebrospinal Fluid of Leptomeningeal Metastasis Patients: Functional Implication of miR-21 and Other Small RNAs in Cancer Malignancy

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 209
Author(s):  
Kyue-Yim Lee ◽  
Yoona Seo ◽  
Ji Hye Im ◽  
Jiho Rhim ◽  
Woosun Baek ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Rare Complication ◽  
Leptomeningeal Metastasis ◽  
Molecular Signature ◽  
Definitive Treatment ◽  
Small Nuclear Rna ◽  
Diagnostic Strategies ◽  
Novel Mirna ◽  
Non Coding Rna ◽  
Sequencing Method

Leptomeningeal metastasis (LM) is a fatal and rare complication of cancer in which the cancer spreads via the cerebrospinal fluid (CSF). At present, there is no definitive treatment or diagnosis for this deleterious disease. In this study, we systemically and quantitatively investigated biased expression of key small non-coding RNA (smRNA) subpopulations from LM CSF extracellular vesicles (EVs) via a unique smRNA sequencing method. The analyzed subpopulations included microRNA (miRNA), Piwi-interacting RNA (piRNA), Y RNA, small nuclear RNA (snRNA), small nucleolar RNAs (snoRNA), vault RNA (vtRNA), novel miRNA, etc. Here, among identified miRNAs, miR-21, which was already known to play an essential oncogenic role in tumorigenesis, was thoroughly investigated via systemic biochemical, miR-21 sensor, and physiological cell-based approaches, with the goal of confirming its functionality and potential as a biomarker for the pathogenesis and diagnosis of LM. We herein uncovered LM CSF extravesicular smRNAs that may be associated with LM-related complications and elucidated plausible pathways that may mechanistically contribute to LM progression. In sum, the analyzed smRNA subpopulations will be useful as targets for the development of therapeutic and diagnostic strategies for LM and LM-related complications.

Postural neurologic deficits after decompressive craniectomy: A case series of sinking skin flap syndrome in traumatic brain injury

2020 ◽  
pp. 1-10
Author(s):  
Emma A. Bateman ◽  
Jordan VanderEnde ◽  
Keith Sequeira ◽  
Heather M. MacKenzie
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rare Complication ◽  
Skin Flap ◽  
Case Series ◽  
Cognitive Outcome ◽  
Definitive Treatment ◽  
Care Providers ◽  
Neurologic Deficits ◽  
The Impact

BACKGROUND: Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized. OBJECTIVE: To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and definitive management of SSFS on outcomes in inpatients with moderate/severe TBI. METHODS: Two patients’ symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented. RESULTS: Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS. CONCLUSIONS: Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes.

scholarly journals Laparoscopic exploration of bile ducts in patients with calculosis. indications, methods and first results

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 33-38 ◽  
Author(s):  
Rosen S. Dimov ◽  
Rangel I. Kantchev ◽  
Boris G. Boev ◽  
Todor I. Ivanov ◽  
Ilia A. Apostolov ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Stone ◽  
Sphincter Of Oddi ◽  
Biliary Tree ◽  
Stone Extraction ◽  
Average Hospital ◽  
Laparoscopic Exploration ◽  
Ultrasound Study ◽  
The Common

ABSTRACT INTRODUCTION: In the last few years there has been a resurgence of laparoscopic exploration of the common bile duct as an alternative to endoscopic retrograde cholangiopancreatography (ERCP), the primary method for diagnosis and treatment of biliary tract calculosis. AIM: The aim of this study was to clarify the indications and methods for performing laparoscopic bile duct exploration, based on our experience in the field and data from the literature. PATIENTS AND METHODS: We recruited 12 patients who underwent laparoscopic exploration and stone extraction from the common bile duct (CBD) in the surgical ward of Kaspela Hospital, Plovdiv over the period January 2011 to January 2012. The diagnostic and therapeutic modalities used in the study included laboratory tests, ultrasound study, CT, ERCP, digital cholangiography, clamp and balloon stone extraction, primary suture and choledochoduodenostomy. RESULTS: Stone extraction was successfully performed in 8 patients using the transcystic approach through an incision used in the cholangiography. The procedure failed in the remaining four patients and we used here 2-cm longitudinal choledochotomy. In two patients the control cholangiography following the extraction of stones demonstrated complete clearance of the biliary tree and free passage of contrast agent from bile duct to duodenum (patent ampulla of Vater). In these two patients we performed a primary closure of the choledochotomy with a single interrupted suture (“ideal choledochotomy”). In two patients from the choledochotomy group, the control cholangiography showed the presence of residual stones or fragments trapped above the sphincter of Oddi with no contrast medium in the duodenum. In these cases we completed this procedure with latero-lateral choledochoduodenostomy by Flërken. All patients had a smooth postoperative course with no recorded complications. The average hospital stay was 5 days. CONCLUSIONS: Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

Hepatic artery pseudoaneurysm secondary to a cholangitic abscess and its spontaneous thrombosis

2021 ◽  
Vol 14 (11) ◽  
pp. e247304
Author(s):  
Maninder Kaur ◽  
Harsimran Bhatia ◽  
Gaurav Muktesh ◽  
Pankaj Gupta
Keyword(s):  
Hepatic Artery ◽  
Liver Abscess ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Rare Complication ◽  
Gallstone Disease ◽  
Biliary System ◽  
Endoscopic Retrograde ◽  
Spontaneous Thrombosis ◽  
Artery Pseudoaneurysm ◽  
Hepatic Artery Pseudoaneurysm

Hepatic artery pseudoaneurysm (HAP) is mostly encountered secondary to trauma or iatrogenic causes. HAP associated with cholangitic liver abscess is a rare complication. We present a case of gallstone disease and choledocholithiasis who developed moderate cholangitis and a liver abscess. A small HAP was detected incidentally on a biphasic CT done to evaluate the biliary system. Repeat CT after management with endoscopic retrograde cholangiopancreatography and antibiotics showed resolution of cholangitic abscess with spontaneous thrombosis of HAP.

scholarly journals Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

2020 ◽  
Vol 8 (1) ◽  
pp. 50-55
Author(s):  
Sanjay Chaudhary
Keyword(s):  
Large Scale ◽  
Gallstone Disease ◽  
Tertiary Care ◽  
Gall Stone ◽  
College Teaching ◽  
P Value ◽  
Cholesterol Stone ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Surgical Department

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal. Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value < 0.05 was considered statistically significant. Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992). Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

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