scholarly journals Liver Segmentectomy by Intrahepatic Lithiasis

2021 ◽  
pp. 305-311
Author(s):  
Fadi Rayya ◽  
Ehab Alhasan
Keyword(s):  
Hepatic Duct ◽  
Preoperative Evaluation ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Biliary Pancreatitis ◽  
Liver Segment ◽  
Intrahepatic Lithiasis ◽  
History Of ◽  
Normal Gallbladder

Intrahepatic cholelithiasis, which is defined as stones proximal to the confluence of the hepatic ducts, is considered endemic in Southeast Asia. Its pathogenesis is not completely understood yet. A 19-year-old female was admitted to the hospital with a history of recurrent biliary pancreatitis. Abdominal ultrasound detected normal gallbladder while magnetic resonance cholangiopancreatography revealed lithiasis at the hepatic duct of liver segment V. After preoperative evaluation a typical segmentectomy was done. The postoperative period was uneventful and the patient was well at 6-month follow-up.

scholarly journals Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 483
Author(s):  
Baca-Arzaga ◽  
Navarro-Chavez ◽  
Galindo ◽  
Santibanez-Juarez ◽  
Cardosa-Gonzalez ◽  
...  
Keyword(s):  
Stone Disease ◽  
Endoscopic Management ◽  
Bilioenteric Anastomosis ◽  
Complex Anatomy ◽  
Laparoscopy Surgery ◽  
Management Of Complications ◽  
Intrahepatic Lithiasis ◽  
History Of ◽  
Laparoscopic Assisted

Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported.

scholarly journals Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwaseun Shogbesan ◽  
Andrew Rettew ◽  
Bilal Shaikh ◽  
Abdullateef Abdulkareem ◽  
Anthony Donato
Keyword(s):  
Laboratory Data ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Shigella Sonnei ◽  
Public Health Issue ◽  
Watery Stool ◽  
Normal Limits ◽  
Significant Public Health ◽  
History Of

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases ofShigellainfection are reported annually in the United States.Shigellabacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of aShigella sonneibacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson’s disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive forShigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

scholarly journals 417 Initial Choice of Imaging Investigation for Patients Presenting with Acute Pancreatitis: Should MRCP Be First Line in Selected Patients?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Yao ◽  
C Briggs ◽  
P Labib
Keyword(s):  
Acute Pancreatitis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
First Line ◽  
Retrospective Audit ◽  
Surgical History ◽  
History Of ◽  
Line Imaging ◽  
Initial Choice

Abstract Introduction Current guidelines for acute pancreatitis advocate abdominal ultrasound (AUS) as the first-line imaging investigation to identify if gallstones are the cause of pancreatitis. However, many patients have a history of cholecystectomy or present with known gallstones and deranged liver function tests (LFTs). In these patients, magnetic resonance cholangiopancreatography (MRCP) is indicated due to its higher sensitivity and specificity for detecting choledocholithiasis. Method This retrospective audit reviewed all consecutive patients who presented to the surgical assessment unit with acute pancreatitis over one month. Their past surgical history, bloods and imaging were reviewed. Results Of the 30 patients, seventeen (57%) had no previous cholecystectomy or known gallstones, nine (30%) had previous cholecystectomy and eight (27%) had known gallstones, seven (88%) of which presented with deranged LFTs. Of the seventeen patients who should have had AUS first (n = 17), thirteen (76%) had AUS first, none had MRCP first and four (24%) had computerised tomography (CT) first. Of the patients in whom MRCP was indicated first-line (n = 13), seven (54%) had AUS first, none had MRCP first, four (31%) had CT first and two (15%) went straight to endoscopic retrograde cholangiopancreatography having had recent outpatient MRCPs. In the seven patients in whom MRCP was indicated but AUS was performed first, six (86%) underwent subsequent MRCP. Conclusions MRCP should be considered the first line imaging investigation for patients presenting with acute pancreatitis and a history of cholecystectomy or known gallstones with deranged LFTs, as AUS rarely prevents the need for subsequent MRCP.

Incidence of cholelithiasis after laparoscopic sleeve gastrectomy

2020 ◽  
Vol 2 (2) ◽  
pp. 63-69
Author(s):  
Iea Alabbasi ◽  
Issam Merdan ◽  
Falih Al-Gazgooz
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Weight Reduction ◽  
Gallstone Formation ◽  
Abdominal Ultrasound ◽  
Gallbladder Polyps ◽  
Concomitant Cholecystectomy ◽  
History Of ◽  
Age Range

Background: Laparoscopic sleeve gastrectomy is a well-known method for weight reduction. Post-operative weight loss is a major risk factor for gallstone formation. Objective: To determine whether prophylactic concomitant laparoscopic cholecystectomy should be performed on all patients at the time of laparoscopic sleeve gastrostomy or not. Patients and Methods: A retrospective and prospective study on 540 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy; their BMI range was between 38 and 53, their age range was 18 to 63 years, and 335 of them were females. The exclusion criteria were patients with a history of cholecystectomy, gallstone patients or gallbladder polyps more than 1 cm in preoperative abdominal ultrasound, and those who failed to follow-up. All patients were followed up with every 6–12 months, including those who had cholecystectomy by other surgeons. Results: During the study period, from the total 540 patients who had laparoscopic sleeve gastrectomy, 167 patients (30.92%) had cholecystectomy, out of which 20 patients (3.7%) had achieved 45% weight reduction during the first six months; while in another 6 months, 147 patients (27.22%) had cholecystectomy, achieving additional 30% weight reduction. Conclusions: The incidence of gallstones after laparoscopic sleeve gastrostomy is about 30.92%, indicating that 69.08% will not have gallstones in the postoperative follow-up period, so it would be unwise to do prophylactic concomitant cholecystectomy for all patients. Keywords: Bariatric procedures, cholecystectomy, incidence

Computed tomographic and sonographic findings in a dog with duplex kidney, ureter duplex and ectopic ureterocele

2020 ◽  
Vol 48 (01) ◽  
pp. 44-48
Author(s):  
Katharina I. Kopp ◽  
Sebastian Schaub ◽  
Christine Peppler ◽  
Alexander Acker ◽  
Kerstin von Pueckler
Keyword(s):  
Abdominal Ultrasound ◽  
Duplex Kidney ◽  
Ectopic Ureterocele ◽  
Computed Tomographic ◽  
Contrast Enhanced ◽  
History Of ◽  
Enhanced Computed Tomography ◽  
French Bulldog ◽  
Contrast Enhanced Computed Tomography

AbstractA 5-month-old, male French bulldog was presented with a history of urinary incontinence. Abdominal ultrasound showed changes compatible with a ureterocele and a bilobed right kidney. Excretory computed tomographic urography was consistent with right-sided duplex kidney, ureter duplex and ectopic ureterocele. To the authors’ knowledge, this is the first description of a duplex kidney with an ectopic ureterocele diagnosed with ultrasound and contrast enhanced computed tomography in a dog. After the imaging diagnosis, a neoureterocystostomy was performed. In the follow-up examination the dog presented with mild incontinence which was treated medically using phenylpropanolamine.

scholarly journals Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

2018 ◽  
pp. bcr-2018-225252
Author(s):  
Michelle Herberts ◽  
Bradley Hicks ◽  
Muhammad Rizwan Sohail ◽  
Anil Jagtiani
Keyword(s):  
Hepatic Cirrhosis ◽  
Fluid Collection ◽  
Abdominal Ultrasound ◽  
Pelvic Abscess ◽  
Ct Guided ◽  
Bacterial Peritonitis ◽  
Fluid Analysis ◽  
Abdominal Ct Scan ◽  
History Of

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

The natural history of preoperative indeterminate pulmonary nodules in patients with resectable pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 161-161
Author(s):  
Dennis C. Nguyen ◽  
Stephanie Chang ◽  
Zhou Gongfu ◽  
Andrea Wang-Gillam ◽  
David Linehan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Natural History ◽  
Pancreatic Adenocarcinoma ◽  
Preoperative Evaluation ◽  
Pulmonary Nodules ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Head Of The Pancreas ◽  
Ground Glass Nodules

161 Background: Preoperative abdominal imaging often detects indeterminate pulmonary nodules (IPN) in patients with resectable pancreatic adenocarcinoma. The natural history of IPN in this setting is not well characterized. Methods: Patients with adenocarcinoma of the head of the pancreas who underwent pancreaticoduodenectomy (PD) were queried from a prospectively maintained database. Pre- and postoperative imaging was reviewed and IPN characterized and analyzed for associations with nodule progression and overall survival (OS). Results: 463 patients underwent PD for adenocarcinoma of the head of the pancreas from 2000-2010. Of these, 329 (71%) had reviewable pre-operative imaging. 48 patients (15%) had pre-operative IPN (non-calcified) identified with follow-up imaging available for review. The only pre-operative factor associated with the presence of IPN was increasing age (68 v. 64 years; p=0.003). 8 patients (12%) had new or enlarging nodules, of whom 5 (7%) had confirmed pulmonary metastatic adenocarcinoma. There was no difference in OS between patients with or without pre-operative IPN (2-year OS 41% v. 38%, respectively; p=0.37). Further, no radiographic criteria of IPN (including # of, size of, bilateral, calcified, solid, spiculated, smooth, lobular, or ground-glass nodules) was associated with OS. On follow-up, new or enlarging nodules were not associated with OS. Conclusions: IPN are often found in patients undergoing PD for pancreatic adenocarcinoma. The majority of IPN remain stable on post-operative imaging. Neither the presence of IPN nor nodule characteristics was associated with OS. These data do not support the routine additional workup of pre-operative IPN in patients with resectable adenocarcinoma of the head of the pancreas; however, larger studies are needed to further characterize the significance of IPN in the preoperative evaluation of patients with pancreatic adenocarcinoma.

scholarly journals Management of ampullary tumours in children: still a challenge

2017 ◽  
Vol 99 (5) ◽  
pp. e139-e141
Author(s):  
P Fernandez-Eire ◽  
JL Vazquez Castelo ◽  
M Herreros Villaraviz ◽  
B Fernandez Caamaño ◽  
J Gonzalez-Carreró ◽  
...  
Keyword(s):  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Abdominal Ultrasound ◽  
High Morbidity ◽  
Low Grade ◽  
Endoscopic Retrograde ◽  
Ampullary Adenoma ◽  
Villous Tumour ◽  
Pancreatic Duct Dilatation

This study describes the case of the youngest patient ever reported with ampullary adenoma. The incidence of ampullary adenomas in childhood is unknown. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are used in adults to assess and treat these lesions, although there are no instruments designed specifically for use in young children. A six-year-old girl was admitted for abdominal pain, vomiting, pruritus and weight loss. Abdominal ultrasound showed biliary tree (8mm) and pancreatic duct dilatation (4mm). Magnetic resonance cholangiopancreatography and computed tomography confirmed these findings, and also showed displacement of the ampulla to the left upper quadrant. An upper endoscopy confirmed a large ampullary adenoma.A laparotomy was performed and a 5cm villous tumour arising from the ampulla was excised. The postoperative course was uneventful. The histology demonstrated adenoma of the ampulla (intestinal type) without low-grade dysplasia. all clinical and radiological parameters are normal at 20 months follow-up.We describe the case of the youngest patient ever reported with ampullary adenoma. Pancreaticoduodenectomy carries high morbidity and mortality rates, and therefore it should be avoided in absence of histologically proven malignancy. We believe that surgical ampullectomy is a safe and oncologically correct procedure until better endoscopic instruments for peadiatric use will be designed.

scholarly journals A Practical Approach for Learning Rhinoplasty Surgery

2016 ◽  
Vol 7 (1) ◽  
pp. 33-46
Author(s):  
Lee J Kaplowitz ◽  
Eric M Joseph
Keyword(s):  
Surgical Procedure ◽  
Preoperative Evaluation ◽  
Practical Approach ◽  
Follow Up Care ◽  
History Of ◽  
Head Neck

ABSTRACT Rhinoplasty surgery is a procedure well suited for otolaryngology residents to incorporate in their training and subsequent practices of medicine. We detail a practical approach for learning rhinoplasty which may commence during residency. The resident learns to conduct a proper consultation, preoperative evaluation, surgical procedure, and follow-up care for the prospective rhinoplasty patient. The history of rhinoplasty, and modern rhinoplasty techniques is discussed, and suggestions are made for residents to successfully incorporate learning rhinoplasty surgery during their otolaryngology training. How to cite this article Kaplowitz LJ, Joseph EM. A Practical Approach for Learning Rhinoplasty Surgery. Int J Head Neck Surg 2016;7(1):33-46.

scholarly journals Gallbladder agenesis diagnosed intraoperatively complicated by common hepatic duct injury

2021 ◽  
Vol 8 (2) ◽  
pp. 710
Author(s):  
Basel Mohamed Alaradi ◽  
Ahmed E. Jawad ◽  
Devpal C. Patil
Keyword(s):  
Congenital Anomaly ◽  
Preoperative Diagnosis ◽  
Open Surgery ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Biliary Colic ◽  
Common Hepatic Duct ◽  
Rare Congenital Anomaly ◽  
Gallbladder Agenesis

Gallbladder agenesis is a rare congenital anomaly among biliary abnormalities, and its preoperative diagnosis has been considered very difficult. Gallbladder agenesis becomes symptomatic in almost 23% of cases mostly with symptoms mimicking biliary colic, which is poorly understood. Initial workup for suspected gallbladder diseases, such as abdominal ultrasound, can be misleading or inconclusive. Often it is misinterpreted as other diseases leading to unnecessary surgery. We reported a case of a 31-year-old Bahraini male presenting with recurrent symptoms, suggesting biliary colic. Abdominal ultrasound showed False-positive contracted gallbladder. The patient was then taken to the operative theater for laparoscopic cholecystectomy. Intraoperatively, the gallbladder could not be seen, and eventually the decision was made to converted to open surgery which was complicated by common hepatic duct injury. Gallbladder agenesis was confirmed postoperatively by magnetic resonance cholangiopancreatography (MRCP).  

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