scholarly journals Modified laparoscopic Janeway gastrostomy: a novel adjunct for the management of choledocholithiasis in Roux-en-Y patients

2018 ◽  
pp. bcr-2018-227442
Author(s):  
Ryan Robalino ◽  
Shinban Liu ◽  
George Ferzli
Keyword(s):  
Gastric Bypass ◽  
Clinical Status ◽  
Biliary Tree ◽  
Gastric Remnant ◽  
Endoscopic Retrograde ◽  
Double Balloon Enteroscopy ◽  
Biliary Clearance ◽  
Endoscopic Procedures ◽  
Surgical History ◽  
History Of

A 76-year-old woman with surgical history of Roux-en-Y gastric bypass presented with recurrent choledocholithiasis. Double balloon enteroscopy was unsuccessful in cannulating the biliary tree, thus, requiring surgically assisted endoscopic retrograde cholangiopancreaticogram (ERCP) access. Due to her stable clinical status, the non-urgent indication and multiple anticipated ERCPs for definitive biliary clearance, a more durable port of access to the ampulla was desired. A modified laparoscopic Janeway gastrostomy of the gastric remnant was performed and served as access for multiple subsequent endoscopic procedures with successful clearance of the biliary tree.

Laparoscopic Transgastric Endoscopy after Roux-en-Y Gastric Bypass: Case Series and Review of the Literature

2012 ◽  
Vol 78 (10) ◽  
pp. 1182-1186 ◽  
Author(s):  
Jason F. Richardson ◽  
John G. Lee ◽  
Brian R. Smith ◽  
Brian Nguyen ◽  
Kathleen P. Pham ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Case Series ◽  
Biliary Tree ◽  
Gastric Remnant ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Medical Centers ◽  
Excluded Stomach ◽  
History Of

Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.

scholarly journals Gastrojejunal Anastomosis Perforation after Gastric Bypass on a Patient with Underlying Pancreatic Cancer: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Omar Bellorin ◽  
Anna Kundel ◽  
Alexander Ramirez-Valderrama ◽  
Armando Castro
Keyword(s):  
Pancreatic Cancer ◽  
Gastric Bypass ◽  
Pancreatic Head ◽  
Gastric Remnant ◽  
Gastrojejunal Anastomosis ◽  
Unusual Complication ◽  
Axial Tomography ◽  
Surgical History ◽  
History Of ◽  
Computerized Axial Tomography

Introduction. We describe a case of gastrojejunal anastomosis perforation after gastric bypass on a patient with underlying pancreatic cancer.Case Description. A 54-year-old female with past surgical history of gastric bypass for morbid obesity and recent diagnosis of unresectable pancreatic cancer presents with abdominal pain, peritonitis, and sepsis. Computerized axial tomography scan shows large amount of intraperitoneal free air. The gastric remnant is markedly distended and a large pancreatic head mass is seen. Intraoperative findings were consistent with a perforated ulcer located at the gastrojejunal anastomosis and a distended gastric remnant caused by a pancreatic mass invading and obstructing the second portion of the duodenum. The gastrojejunal perforation was repaired using an omental patch. A gastrostomy for decompression of the remnant was also performed. The patient had a satisfactory postoperative period and was discharged on day 7.Discussion. Perforation of the gastrojejunal anastomosis after Roux-en-Y gastric bypass is an unusual complication. There is no correlation between the perforation and the presence of pancreatic cancer. They represent two different conditions that coexisted. The presence of a gastrojejunal perforation made the surgeon aware of the advanced stage of the pancreatic cancer.

scholarly journals Petersen-hernia, egy ritka sérvtípus megjelenése osztályunkon

2021 ◽  
Vol 74 (3) ◽  
pp. 71-74
Author(s):  
Keresztély Merkel ◽  
Tímea Vass ◽  
György Herczeg ◽  
Péter Ágh ◽  
Miklós Máté
Keyword(s):  
Gastric Bypass ◽  
Small Bowel ◽  
Intestinal Tract ◽  
Alimentary Tract ◽  
Alimentary Limb ◽  
Surgical Department ◽  
Surgical History ◽  
History Of ◽  
Small Intestinal ◽  
Colon Transversum

Összefoglaló. 61 éves nőbeteg anamnéziséből 3 évvel korábbi, morbid obezitás miatti bariátriai műtét (Roux Y gastric bypass, műtét előtti BMI 42, aktuális BMI 22), hysterectomia, hypertonia említendő. Négy napja tartó diffúz hasi fájdalom, hányás, hányinger, székletkimaradás miatt került SBO érintésével sebészeti osztályunkra. Felvételkor mérsékelt hasi distenzió, diffúz felhasi 3-5/10 fájdalom volt, defensus nélkül, NG szonda jelentős tartalmat nem hozott. Ileusra jellemző auscultációt, rectalis vizsgálattal üres ampullát találtunk. Álló natív hasi felvételen jobb oldalon L II–III. csigolya mellett kissé gázos, nem tágabb vékonybélkacs került leírásra, benne 2-3 cm-es nívóval. Hasi UH-vizsgálaton folyadékkal telt, tág, 30–35 mm átmérőjű vékonybeleket írtak le. CT-vizsgálat során a duodenum, jejunum és néhány proximalis ileumkacs kóros distensióját igazolták, nívókkal, innen aboralisan összeesett vékonybeleket. Tekintettel a kliniko-radiológiai képre, urgens műtét során Hasson-technikával laparoszkópos inspekciót végeztünk, azonban a masszív ileus okozta térhiány miatt kp medián laparotómiára konvertáltunk. Az exploráció során a Petersen-hernián át a jobb hasfélbe herniálódott alimentáris, biliopancreatikus és közös vékonybélszakaszt észleltünk a terminális ileum közepéig. A bél életképesnek bizonyult. A Petersen-hernián át a kizáródott szakaszt a bal hasfél felé visszahelyeztük, majd a Petersen-herniát nem felszívódó fonallal a colon transversum és az alimentáris kacs mezentériuma közt tovafutó varrattal zártuk. A beteg az ötödik postoperatív napon gyógyultan távozott. Summary. 61 years old female with previous surgical history of Roux-en-Y gastric bypass (3 years ago) and earlier hysterectomy admitted to our surgical department with clinical and radiological signs of small intestinal obstruction. Urgent intervention had been performed with following findings: Petersen herniation of alimentary tract including the – biliopancreatic tract and the small bowel extending to the midpart of the terminal ileum. Viability of herniated intestinal tract had been confirmed, and reposition of herniated parts through the Petersen hernia had been done. Closure with non-absorbable running suture of the gap between the transverse colon and the mesenteriun of the alimentary limb had been performed. Patient was fit for discharge on the fifth postoperative day.

scholarly journals Forgotten metal stent (3 years) presenting with a high burden of intra- and extra-hepatic ducts stones and cholangitis

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Chiapo Lesetedi ◽  
Mpapho Joseph Motsumi
Keyword(s):  
Bile Duct ◽  
Open Cholecystectomy ◽  
Metal Stent ◽  
Endoscopic Retrograde ◽  
Plastic Stent ◽  
High Burden ◽  
Surgical History ◽  
History Of ◽  
Lost To Follow Up

Abstract Forgotten stents may lead to serious complications. We present a case report of a forgotten common bile duct (CBD) fully covered metal stent presenting with recurrent cholangitis. A 79-years-old female patient presented with a history of recurrent cholangitis. Past surgical history was notable for open cholecystectomy for symptomatic cholelithiasis in 2016. Subsequently, she was found to have retained CBD stones in the same year. She had endoscopic retrograde cholangiopancreatography (ERCP), during which a complete clearance of the stone was not achieved and she was stented with a completely covered metal stent. She was lost to follow-up until 2019. A differential diagnosis of cholangitis secondary to a blocked stent was made. At ERCP, she had intra- and extra-hepatic stones, which could not be removed. A plastic stent was deployed. She later had an open bile duct exploration with Roux-en-Y hepaticojejunostomy. Forgotten stents can lead to serious complications. An electronic stent follow-up registry is recommended.

scholarly journals Double balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass anatomy: expert vs. novice experience

2018 ◽  
Vol 06 (07) ◽  
pp. E885-E891 ◽  
Author(s):  
Amir Kashani ◽  
Gebran Abboud ◽  
Simon Lo ◽  
Laith Jamil
Keyword(s):  
Gastric Bypass ◽  
Confidence Interval ◽  
Success Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Success Rates ◽  
Endoscopic Retrograde ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Double Balloon ◽  
Tertiary Center

Abstract Background and study aims Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (DBE-ERCP) in post-Roux-en-Y gastric bypass (RYGB) patients is a technically challenging procedure. We aimed to determine the success rate of DBE-ERCP performed by a novice to the procedure in post-RYGB after training with an expert. Patients and methods Medical records for 103 consecutive post-RYGB patients who underwent DBE-ERCP in a tertiary center were retrospectively reviewed. The procedures were performed by Operator A (18 years of high-volume ERCP practice before acquiring DBE skill in 2004), and operator B ( < 2 years’ experience in DBE and ERCP). ERCP success rate and time in patients with an intact papilla were compared between Operator A’s first and last sets of cases in equal number to the cases performed by Operator B. Results A total of 129 DBE-ERCPs were performed (Operator A: 109; Operator B: 20) over an 80-month time span. Among patients with an intact papilla, DBE-ERCP success rates for Operator A’s first (87.5 %) and last (92.9 %) 20 cases were similar to that of Operator B (92.9 %) (P = 1.00 for both). Mean of DBE-ERCP time for the last 20 cases of Operator A was (100 minutes; 95 % confidence interval: 81,123) less than that for operator B (176 minutes; 95 % confidence interval: 138,224) (P = 0.01). Overall adverse events rates were 11 % and 5 % for Operators A and B, respectively (P = 0.69): pancreatitis (n = 10), cholangitis (n = 1), and perforation (n = 2); all were mild and treated conservatively. Conclusions Despite the intrinsic technical difficulty, DBE-ERCP can be successfully and safely performed in post-RYGB patients by an endoscopist proficient in both conventional DBE and ERCP. Ideally, this endoscopist should observe several cases of DBE-ERCP performed by an expert to learn the techniques.

scholarly journals Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chieh Sian Koo ◽  
Khek Yu Ho ◽  
Yin Huei Pang ◽  
Daniel Q. Huang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Unusual Case ◽  
Biliary Tree ◽  
Endoscopic Retrograde ◽  
Quadrant Pain ◽  
Case Presentation ◽  
Lower Survival Rate ◽  
Uncommon Presentation ◽  
History Of

Abstract Background Hepatocellular carcinoma with biliary ductal invasion is rare and associated with a significantly lower survival rate. Case presentation We present an unusual case of a patient with hepatocellular carcinoma and biliary invasion, who had his diagnosis confirmed by histological analysis from tissue extracted by endoscopic retrograde cholangiopancreatography. An 87-year-old male presented with a 1-day history of right upper quadrant pain and jaundice. His past medical history included recurrent gallstone cholangitis and a previous cholecystectomy. An abdominal CT demonstrated a dilated intrahepatic biliary tree with left proximal intrahepatic hyperdensities, as well as a 3 cm hepatocellular carcinoma. He was initially suspected to have concurrent gallstone cholangitis and a newly diagnosed hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography and balloon trawling of the intraductal lesions extracted necrotic tumour-like tissue which was histologically consistent with hepatocellular carcinoma. The extraction of the intra-biliary portion of HCC resulted in complete resolution of his jaundice, enabling further treatment with nivolumab, which would not have been possible if the obstruction was not cleared. The patient is currently well and has completed his 6th cycle of nivolumab. Conclusion Obstructive jaundice is an uncommon presentation for patients with HCC. it is key for clinicians to be aware of the possibility of intrabiliary invasion in order obtain an early diagnosis and to reduce any delay in treatment.

scholarly journals Tomato peel: rare cause of biliary tract obstruction

2011 ◽  
Vol 152 (47) ◽  
pp. 1907-1910 ◽  
Author(s):  
Krisztina Hagymási ◽  
Zoltán Péter ◽  
Éva Csöregh ◽  
Emese Szabó ◽  
Zsolt Tulassay
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Tract ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Biliary Obstruction ◽  
Foreign Bodies ◽  
Biliary Tree ◽  
Endoscopic Retrograde ◽  
Ductus Choledochus ◽  
History Of

Foreign bodies in the biliary tree are rare causes of obstructive jaundice. Food bezoars are infrequent as well. They can cause biliary obstruction after biliary tract interventions, or in the presence of biliary-bowel fistula or duodenum diverticulum. Food bezoars usually pass the gastrointestinal tract without any symptoms, but they can cause abdominal pain and obstructive jaundice in the case of biliary tract obstruction. Endoscopic retrograde cholangio-pancreatography has the major role in the diagnosis and the treatment of the disease. Authors summarize the medical history of a 91-year-old female patient, who developed vomiting and right subcostal pain due to the presence of tomato peel within the ductus choledochus. Orv. Hetil., 2011, 152, 1907–1910.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

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