Unusual Biliary Complication following Christmas Eve dinner

We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, that was subsequently treated endoscopically. Fish bones are one of the most commonly encountered of swallowed foreign bodies. However involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

Download Full-text

Bakteriális infekciók májátültetés után

Orvosi Hetilap ◽

10.1556/650.2015.30204 ◽

2015 ◽

Vol 156 (34) ◽

pp. 1366-1382 ◽

Cited By ~ 3

Author(s):

Balázs Nemes ◽

Fanni Gelley ◽

Eszter Dabasi ◽

György Gámán ◽

Imre Fehérvári ◽

...

Keyword(s):

Multidrug Resistance ◽

Survival Data ◽

Bacterial Infections ◽

Postoperative Infection ◽

Graft Function ◽

Biliary Complication ◽

Cumulative Survival ◽

Acute Renal Insufficiency ◽

One Year ◽

The One

Introduction: The authors reviewed the prevalence of postoperative infections, the results of bacterium cultures, and the incidence of multidrug resistance in their liver transplanted patients during a period between 2003 and 2012. Aim: The aim of this study was to analyse risk factors and colonisations of bacterial infections. Method: The files of 408 patients (281 bacterium cultures) were reviewed. Results: Of the 408 patients 70 had a postoperative infection (17%); 58 patients (14.2%) had positive and 12 patients (2.9%) negative bacterial culture results. Cholangitis was found in 7 cases (12.1%), abdominal infection in 17 cases (29.3%), and pulmonal infection in 28 cases (48.3%). Postoperative infection was more frequent in patients with initial poor graft function, acute renal insufficiency, biliary complication, and in those with intraabdominal bleeding. The 1-, 3- and 5-year cumulative survival of patients who had infection was 70%, 56% and 56%, respectively, whereas the cumulative survival data of patients without infection was 94%, 87% and 85%, respectively (p<0.001). Multidrug resistance was found in 56% of the positive cultures, however, the one-year survival was not different in patients who had multidrug resistance positive and negative bacterial infection (both 70.2%). Conclusions: Infection control must target the management of multidrug resistance microbes through encouraging prevention, hygienic, and isolation rules, improving the operational, transfusion, and antimicrobial policy in a teamwork setting. Orv. Hetil., 2015, 156(34), 1366–1382.

Download Full-text

A Case of Massive Hepatic Infarction in a Patient with HELLP Syndrome

American Journal of Perinatology Reports ◽

10.1055/s-0039-1681028 ◽

2019 ◽

Vol 09 (01) ◽

pp. e84-e87

Author(s):

Jessica Morgan ◽

Micaela Della Torre ◽

Anna Whelan ◽

Sophia Rodriguez ◽

Laura DiGiovanni

Keyword(s):

Liver Enzymes ◽

Epigastric Pain ◽

Early Recognition ◽

Rare Complication ◽

Liver Function Tests ◽

True Incidence ◽

Hepatic Infarction ◽

Elevated Liver Enzymes ◽

Blood Pressures ◽

The Right

Background Hepatic infarction is an exceedingly rare complication of hemolysis, elevated liver enzymes, and low platelets syndrome. Few cases have been described in the medical literature and the true incidence remains unknown. It can lead to fulminant liver failure, liver transplant, or death if not promptly addressed. Case Report A 22-year-old primigravida presented with right upper quadrant and epigastric pain at 28 weeks' gestation. She had severely elevated blood pressures requiring intravenous antihypertensives as well as proteinuria, thrombocytopenia, and mild transaminitis. Within 6 hours of admission, her rapidly rising liver function tests (LFTs) necessitated urgent delivery by primary cesarean section. Her liver enzymes continued to rapidly worsen postoperatively and immediate postpartum computed tomography of the abdomen and pelvis revealed massive hepatic infarction, 11 × 10 × 15 cm, of the right lobe of the liver. Her transaminases peaked at alanine transferase of 2,863 IU/L and aspartate transferase of 2,732 IU/L. She received supportive multidisciplinary intensive care, and LFTs returned to normal by postoperative day 20. Conclusion Hepatic infarction is an extraordinarily rare complication of pre-eclampsia. Early recognition and prompt multidisciplinary management are vital to prevent catastrophic bleeding, hepatic failure, and death.

Download Full-text

Common bile duct stone development due to a Hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy

BMJ Case Reports ◽

10.1136/bcr-2019-230178 ◽

2019 ◽

Vol 12 (7) ◽

pp. e230178

Author(s):

Yong Jun Roh ◽

Jong Whan Kim ◽

Tae Joo Jeon ◽

Ji Young Park

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Stone Formation ◽

Rare Complication ◽

Acute Cholangitis ◽

Balloon Catheter ◽

Wall Thickening ◽

Surgical Clip ◽

Upper Abdominal

Surgical clip migration is a rare complication of laparoscopic cholecystectomy (LC). Surgical clips migrating into the common bile duct (CBD) can lead to stone formation and obstruction. Here, we report a case of acute cholangitis caused by surgical Hem-o-lok clip migration into the bile duct with stone formation 13 months after LC. A 65-year-old man who underwent LC presented with upper abdominal pain and fever for 3 days. Abdominal CT scan showed a radiopaque material in the CBD, diffuse wall thickening and dilatation of intrahepatic and extrahepatic duct. Emergency percutaneous transhepatic biliary drainage was performed. Twodays later, an endoscopic retrograde cholangio-pancreatography was implemented, and muddy stones and one surgical clip were successfully removed by extraction balloon catheter.

Download Full-text

Adenoma and stone formation of the biliary tract in puppies that had choledochopancreatic anastomosis

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(89)80501-9 ◽

1989 ◽

Vol 24 (6) ◽

pp. 539-542 ◽

Cited By ~ 8

Author(s):

Takeshi Miyano ◽

Tadaaki Tokumaru ◽

Fujihiko Suzuki ◽

Koichi Suda

Keyword(s):

Biliary Tract ◽

Stone Formation

Download Full-text

“One-and-a-Half” Syndrome after a Resection of a Midline Cerebellar Astrocytoma: Case Report and Discussion of the Literature

Neurosurgery ◽

10.1227/00006123-199111000-00022 ◽

1991 ◽

Vol 29 (5) ◽

pp. 768-772 ◽

Cited By ~ 5

Author(s):

Herbert B. Newton ◽

Michael E. Miner

Keyword(s):

Brain Stem ◽

Posterior Fossa ◽

Rare Complication ◽

Medial Longitudinal Fasciculus ◽

Abducens Nucleus ◽

Blurred Vision ◽

Computed Tomographic ◽

Truncal Ataxia ◽

The One ◽

The Brain

Abstract This report describes a rare complication after the resection of a tumor of the posterior fossa, the “one-and-a-half” syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headaches, diplopia, and blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancing, mixed density, midline mass of the cerebellum. After a resection of the mass, an anaplastic astrocytoma, the patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndrome, left peripheral facial paralysis, dysarthria, dysphagia, mild left hemiparesis, dysmetria of the left upper limb, and truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-up, the one-and-a-half syndrome had not improved, even though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculus, the ipsilateral paramedian pontine reticular formation, or the ipsilateral abducens nucleus. Multiple sclerosis and brain stem infarctionn are the most common causes of the one-and-a-half syndrome. Less frequently, it is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarely, the one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown.

Download Full-text

Evaluation of Anti-Retroviral Drugs Effects on Liver Function Tests of HIV Infected Individuals

Journal of Medical and Health Studies ◽

10.32996/jmhs.2021.2.2.4 ◽

2021 ◽

Vol 2 (2) ◽

pp. 38-44

Author(s):

Damilare Olayonwa ◽

Samuel Oyedeji

Keyword(s):

Antiretroviral Therapy ◽

Liver Injury ◽

Liver Function Tests ◽

Public Health Issue ◽

Global Public Health ◽

Hiv Patients ◽

Mean Values ◽

Antiretroviral Drug ◽

Immunodeficiency Virus ◽

The One

The Human Immunodeficiency Virus (HIV) continues to be a major global public health issue, having claimed more than 35 million lives so far. Antiretroviral therapy, the drug used to treat HIV patients, had been reported to have an adverse effect on patients’ livers. Therefore, this research aims to assess the parameters for measuring liver injury of HIV patients undergoing antiretroviral therapy in Owo and to determine the patients' vulnerability to liver injury. The study sample was divided into five groups comprising Control groups and groups with 6 months, 1 year, 3 years and 5 years’ periods of administration of an antiretroviral drug. Serum was separated from their blood and values of ALT, ALP and BILT were determined. The results of profiling the patients based on values ALT, ALP and BILT indicated that 73%, 71% and 59% of the patients are within the reference range of the parameters, respectively. Further analysis of the percentage of patients likely to have liver diseases indicated that only 3.2% are prone to liver injury. The results of the One-way Analysis of Variance of the mean values of the groups on ALT, ALP and BILT indicated differences in mean values of the groups. It is suggested that a longitudinal study should be carried out to determine the effect of seasonal variation in the value of the studied parameters. It is also suggested that a wider interval of the period for the groups should be used in the future to determine whether there will be a relationship between the period of administration of the drug and the parameters.

Download Full-text

SPONTANEOUS RUPTURE OF DOUBLE J URETERAL STENT

Journal of Surgical Sciences ◽

10.33695/jss.v7i3.396 ◽

2020 ◽

Vol 7 (3) ◽

pp. 114-116

Author(s):

Abdi El Mostapha ◽

Ghannam Youssef ◽

Hissein Hagguir ◽

Nedjim Abdelkerim Saleh ◽

Dakir Mohamed ◽

...

Keyword(s):

Ureteropelvic Junction Obstruction ◽

Stone Formation ◽

Rare Complication ◽

Percutaneous Nephrostomy ◽

Ureteral Stent ◽

Vaginal Examination ◽

Ureteral Stenosis ◽

Long Duration ◽

Double J Stent ◽

Obstructive Renal Failure

The double J stent is widely used in urological endoscopic surgery with different indications (ureteral stenosis, ureteropelvic junction obstruction, retroperitoneal tumor or fibrosis) and can be a subject to multiple complications including migration, encrustation, stone formation and fragmentation which is a rare complication. We are reporting a rare case of a 42-years-old, followed for cervical cancer since 2018 revealed by an acute obstructive renal failure drained by a left double J ureteral stent (of long duration) and right percutaneous nephrostomy. The patient maintained the double J stent for 2 years. On clinical examination there was a lumbar tenderness on the left side and a hardened vaginal cervix on bimanual vaginal examination. The patient underwent a renovesical ultrasound showing a minimal left ureterohydronephrosis. The uroscanner with reconstruction revealed a fragmented double J stent on the left side.

Download Full-text

P-BN16 Gallbladder agenesis in a gentleman presenting with biliary sepsis: a case report and review of literature

British Journal of Surgery ◽

10.1093/bjs/znab430.017 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Rory Hammond ◽

Thahesh Tharmaraja ◽

Daniel Bell ◽

Venugopala Kalidindi

Keyword(s):

Incidental Finding ◽

Magnetic Resonance Cholangiopancreatography ◽

Liver Function Tests ◽

Final Diagnosis ◽

Diagnostic Challenge ◽

Non Invasive ◽

Biliary Sepsis ◽

Operative Exploration ◽

History Of ◽

Gallbladder Agenesis

Abstract Background Gallbladder agenesis (GBA) is a well-recognised, yet rare embryological malformation, that is thought to stem from a failure of the gallbladder and cystic duct to bud from the common bile duct in the 5th week of gestation. The anomaly has an estimated incidence of 10-65 per 100 000 and is often an incidental finding. A quarter of those affected are symptomatic, often presenting in a similar manner to cholecystitis or choledocholithiasis. There is a lack of awareness and guidance on its investigation and management, making GBA a diagnostic challenge, which often leads to unnecessary high-risk surgical exploration. Methods A 64-year-old man presented with right upper quadrant abdominal pain, fevers, jaundice and persistent vomiting. On examination he was confused, visibly jaundiced and septic with deranged liver function tests. An initial ultrasound scan of the abdomen revealed dilated common bile ducts, with no evidence of choledocholithiasis, however, a gallbladder could not be identified. Magnetic resonance cholangiopancreatography confirmed a ‘post-cholecystectomy’ picture, despite no history of abdominal surgery. This led us to the diagnosis of gallbladder agenesis. Results There are no dedicated guidelines regarding the investigation and management of GBA. Efforts have been made to stratify the diagnostic imaging of GBA. Malde et al suggest that if the gallbladder is not visualised on USS, the next most appropriate investigations in order of accuracy are MRCP, CT and ERCP, respectively. Interestingly, they further suggest that if results of imaging remain inconclusive, they should be repeated again once the acute phase of the illness or symptoms have resolved. Inadvertently, this suggestion was applied in our case, as the patient underwent a repeat MRCP following the resolution of his acute symptoms. In our case, MRCP allowed an effective final diagnosis, avoiding unnecessary investigations and exploratory surgery. It also provided a detailed anatomical picture, excluding the possibility of an ectopic gallbladder. Conclusions The present case accentuates the importance of non-invasive imaging such as MRCP in appropriately diagnosing this phenomenon and avoiding unnecessary operative exploration.

Download Full-text

EBV Infection Unmasking a Choledochal Cyst in an Infant

Case Reports in Pediatrics ◽

10.1155/2019/7320109 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Hassan El Khatib ◽

Batoul Kawtharany ◽

Diyaa Mohammad ◽

Mohammad Siblini ◽

Nahida El-Rifai

Keyword(s):

Choledochal Cyst ◽

Stone Formation ◽

Liver Function Tests ◽

Gamma Glutamyl Transferase ◽

Barr Virus ◽

Ebv Infection ◽

Hepatic Involvement ◽

Epstein Barr ◽

Glutamyl Transferase

Hepatic involvement is common in acute Epstein–Barr virus (EBV) infection in children. It usually manifests as a transitory elevation of transaminases in up to 80% to 90% of patients, and they normalize by 2 to 6 weeks. A cholestatic pattern with elevated gamma-glutamyl transferase (γGT) and alkaline phosphatase (ALP) is common, in up to 60% in young adults. However, jaundice is very rare occurring in only 5% of pediatric patients. We report here an 8-month-old female with EBV infection who developed obstructive jaundice 2 weeks after the initial infection. Radiologic investigations were compatible with choledochal cyst type IVa complicated by stone formation in the common bile duct. In case of clinical exacerbation or nonamelioration of liver function tests in EVB infection, another diagnosis should be addressed. This highlights the importance of close follow-up in these patients in order not to miss a serious underlying condition such as choledochal malformation.

Download Full-text

Delayed Migration of Embolized Coil with Large Renal Stone Formation: A Rare Presentation

Case Reports in Urology ◽

10.1155/2014/687965 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Santosh Kumar ◽

Kumar Jayant ◽

Shrawan K. Singh ◽

Kalpesh M. Parmar ◽

Sudheer K. Devana ◽

...

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Stone Formation ◽

Liver Function Tests ◽

Rare Presentation ◽

Delayed Bleeding ◽

Normal Limits ◽

Function Tests ◽

Embolization Coil ◽

The Right

Delayed bleeding following percutaneous nephrolithotomy (PCNL) usually occurs due to development of the pseudoaneurysm which can be successfully managed with coil embolization. However very few cases of such complications have been reported in the literature. Here we are reporting a case of delayed post-PCNL bleeding that occurred in a 53-year-old diabetic patient operated on for renal stone. Computed tomography scan revealed a presence of the pseudoaneurysm in the segmental branch of right renal artery, which was successfully managed with coiling. Patient remained asymptomatic for the next 9 years after which he again presented with similar complaints. X-ray KUB was done which revealed a 2.7 cms renal pelvic calculus with the migrated coil in its center and a left upper ureteric calculus. His routine haemogram, coagulogram, serum electrolytes, and liver function tests, renal function tests, vitamin D3, and PTH (parathyroid hormone) were within normal limits. He underwent left laparoscopic ureterolithotomy and right percutaneous nephrolithotomy (PCNL). Intraoperatively the migrated stainless steel embolization coil was seen engulfed all around by the multiple stones in the right renal pelvis. Postoperative period was uneventful. Later he was followed in the outpatient department and was doing well. To conclude, this is the only case report of development of a large calculus around a migrated embolization coil which was successfully managed with PCNL. PCNL offers better stone clearance in cases of stones being formed over foreign bodies like fragmented double J stents, fragmented nephrostomies, or migrated embolization coil.

Download Full-text