Recurrent Pyogenic Cholangitis: ‘Sump Syndrome’ following Choledochoduodenostomy

1997 ◽  
Vol 27 (1) ◽  
pp. 51-52 ◽  
Author(s):  
T F Toufeeq Khan ◽  
Zaheer A Sherazi ◽  
Suseela Muniandy ◽  
Malik Mumtaz
Keyword(s):  
Abdominal Pain ◽  
Hospital Admissions ◽  
Late Complication ◽  
Iminodiacetic Acid ◽  
Endoscopic Retrograde ◽  
Percutaneous Access ◽  
Intrahepatic Calculi ◽  
Hida Scan ◽  
Recurrent Pyogenic Cholangitis ◽  
Upper Abdominal

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the ‘sump syndrome’, developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

HIDA Scan with Ejection Fraction is over Utilized in the Management of Biliary Dyskinesia

2015 ◽  
Vol 81 (7) ◽  
pp. 669-673 ◽  
Author(s):  
Amanda H. Eckenrode ◽  
Joseph A. Ewing ◽  
Jennifer Kotrady ◽  
Allyson L. Hale ◽  
Dane E. Smith
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ejection Fraction ◽  
Iminodiacetic Acid ◽  
Biliary Colic ◽  
Symptom Improvement ◽  
Symptom Resolution ◽  
Atypical Symptoms ◽  
Hida Scan ◽  
Normal Ultrasound ◽  
Upper Abdominal

Patients with upper abdominal pain, nausea, and vomiting are often evaluated with ultrasound to diagnose symptomatic cholelithiasis or cholecystitis. With a normal ultrasound, a hepatobiliary iminodiacetic acid (HIDA) scan with ejection fraction (EF) is recommended to evaluate gallbladder function. The purpose of this study was to evaluate whether the HIDA scan with EF was appropriately utilized in considering cholecystectomy. Over 18 months, we performed 1533 HIDA scans with EF. After exclusion, 1501 were analyzable, 438 of whom underwent laparoscopic cholecystectomy. Patients were divided into two groups: those with typical and atypical symptoms of biliary colic. Our primary endpoint was symptom resolution of those who underwent laparoscopic cholecystectomy. Symptom resolution was assessed by chart review of postop visits or readmissions. In patients with typical symptoms, resolution occurred in 66 per cent of patients with positive HIDA and 77 per cent with negative HIDA ( P = 0.292). In patients with atypical symptoms, resolution occurred in 64 per cent of patients with positive HIDA and 43 per cent with negative HIDA ( P = 0.013). A HIDA scan with EF was not useful in patients with typical symptoms of biliary colic and negative ultrasounds, and should not be used to make a decision for cholecystectomy. However, this test can be helpful in patients with atypical symptoms, as it does predict symptom improvement in this group.

scholarly journals Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Jai P. Singh
Keyword(s):  
Abdominal Pain ◽  
Complete Resolution ◽  
Biliary Colic ◽  
Quadrant Pain ◽  
Gallbladder Ejection Fraction ◽  
Hida Scan ◽  
Upper Abdominal ◽  
The Right ◽  
Upper Abdomen

Introduction. Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder ( EF > 80 % ) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. Conclusion. The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

Aids-Related Cholangitis: Diagnostic Features and Course in Four Patients

1995 ◽  
Vol 40 (2) ◽  
pp. 53-54 ◽  
Author(s):  
G.L.A. Bird ◽  
D.H. Kennedy ◽  
J.A.H. Forrest
Keyword(s):  
Abdominal Pain ◽  
Endoscopic Sphincterotomy ◽  
Dramatic Improvement ◽  
Biliary Disease ◽  
Ultrasound Scanning ◽  
Endoscopic Retrograde ◽  
Diagnostic Features ◽  
Papillary Stenosis ◽  
Radiological Features ◽  
Upper Abdominal

Radiological features of sclerosing cholangitis are an uncommon but well recognised complication of HIV infection in homosexual males. In this report we document the clinical features and course of the disease in four patients. Four homosexual males with established AIDS were referred in 1990–92. Three of the four had intractable upper abdominal pain which was poorly responsive to opiates. Three of the patients had diarrhoea and all had weight loss. The diagnosis of AIDS related cholangitis was confirmed by endoscopic retrograde cholangiography in three cases, but in only one patient was there no evidence of biliary disease on ultrasound scanning. In the two cases with Cholangiographic features of papillary stenosis, endoscopic sphincterotomy was carried out and there was subsequently a dramatic improvement in the abdominal pain. Three of the patients had evidence of gastrointestinal infection with Microsporidia (1) or Cryptosporidia (2). All the patients died within 2–9 months of the diagnosis of cholangitis, but none of the deaths resulted from hepatobiliary disease.

scholarly journals Fasciolopsis buski Infection in a 50-Year-Old Female

2014 ◽  
Vol 4 (2) ◽  
pp. 123-125
Author(s):  
Mejbah Uddin Ahmed ◽  
Deb Prosad Paul ◽  
Md Alamgir Hossain ◽  
Mohammad Quamrul Hasan ◽  
Md Khalilur Rahman
Keyword(s):  
Abdominal Pain ◽  
Rural Area ◽  
Parasitic Infestation ◽  
Endoscopic Retrograde ◽  
Food Borne ◽  
Fasciolopsis Buski ◽  
Upper Abdominal

Fasciolopsiasis is a disease caused by the largest food-borne intestinal trematode known as Fasciolopsis buski. Here we report a case of a 50-year-old female who presented with upper abdominal pain and vomiting for one month. She was previously diagnosed as a case of choledocholithiasis. Endoscopic retrograde cholangio-pancreatography (ERCP) revealed stones along with two leaf-shaped worms which were removed from the duodenum of the patient. The worms were identified as F. buski by its unique morphology. Awareness regarding this parasitic infestation, especially in the rural area, should gain attention while formulating strategies to prevent and manage such infestation. DOI: http://dx.doi.org/10.3329/jemc.v4i2.19681 J Enam Med Col 2014; 4(2): 123-125

scholarly journals Endoscopic retrograde cholangiopancreatography for unexplained upper abdominal pain.

BMJ ◽  
1980 ◽  
Vol 280 (6216) ◽  
pp. 764-764 ◽  
Author(s):  
J Bull ◽  
P W Keeling ◽  
R P Thompson
Keyword(s):  
Abdominal Pain ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Upper Abdominal

scholarly journals Risk Factors for post-Endoscopic Retrograde Cholangiopancreatography Abdominal Pain in Patients without post-ERCP Pancreatitis

2020 ◽  
Author(s):  
Mengjie Chen ◽  
Ruhua Zheng ◽  
Jun Cao ◽  
Yuling Yao ◽  
Lei Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Abdominal Pain ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Elevated Serum ◽  
Female Gender ◽  
Endoscopic Retrograde ◽  
Pain Group ◽  
Upper Abdominal ◽  
First Time

Abstract Background: Most of the studies on the abdominal pain associated with endoscopic retrograde cholangiopancreatography (ERCP) are aimed at solving the pain during the procedure. Post-ERCP abdominal pain has rarely been investigated，and few studies have focused on the characteristics and risk factors of post-ERCP abdominal pain without post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).This study aimed to identify risk factors of post-ERCP abdominal pain without PEP and investigate characteristics of the abdominal pain in non-PEP patients.Methods: From August 6th, 2019, to January 15th, 2020, data of patients who underwent ERCP were retrospectively collected. The characteristics of the abdominal pain after ERCP were recorded and compared between PEP and non-PEP patients. Multivariate analysis was conducted to identify risk factors of non-PEP abdominal pain. Results: Data from 616 ERCP procedures were retrospectively investigated in this study, among which 51(8.28%) patients presented post-ERCP abdominal pain without PEP and 45 (7.31%) patients developed PEP. Multivariate analysis found that 5 risk factors were associated with non-PEP abdominal pain: female gender (OR:2.137), upper abdominal surgery history (OR:1.948), first time ERCP (OR:4.735), elevated serum γ-glutamyl transferase (𝛾-GT) (OR:2.570) and elevated serum direct bilirubin (DBIL) (OR:2.932). Visual analogue sale (VAS) score of PEP abdominal pain was higher than that of non-PEP pain group (P=0.05). There were no significant differences in the time of the onset of the pain, pain relief time, pain frequency, use of analgesic medicine, hospital stay and mortality between PEP and non-PEP pain group(P<0.05).Conclusion: This study indicated that female gender, upper abdominal surgery history, first time ERCP, elevated 𝛾-GT and elevated DBIL were independent risk factors for post-ERCP abdominal pain without PEP. Abdominal pain was severer in PEP patients than non-PEP patients.

Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Peter Wang
Keyword(s):  
Abdominal Pain ◽  
Digestive Enzymes ◽  
Gallbladder Disease ◽  
Hepatobiliary Scintigraphy ◽  
Hepatobiliary Imaging ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Abdominal ◽  
Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

scholarly journals Oriental Cholangiohepatitis in a Caucasian male

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110355
Author(s):  
Laura Suzanne K Suarez ◽  
Larnelle N Simms ◽  
Khaled Deeb ◽  
Curtis E Scott
Keyword(s):  
Abdominal Pain ◽  
South Korea ◽  
Southeast Asia ◽  
Biliary Decompression ◽  
Caucasian Male ◽  
Extensive Evaluation ◽  
Recurrent Pyogenic Cholangitis ◽  
History Of

Recurrent pyogenic cholangitis (RPC) is a condition found almost exclusively in individuals who lived in Southeast Asia. We report a case of a Caucasian veteran diagnosed with RPC after presenting with a 5-year history of recurrent fevers and abdominal pain 20 years after serving in Japan, South Korea, and Guam. Extensive evaluation led to the diagnosis of RPC with improvement after biliary decompression and antibiotics. Although rare, RPC should be considered in individuals who present with recurrent bouts of abdominal pain and fevers regardless of race.

scholarly journals A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Hirao ◽  
HiroHisa Okabe ◽  
Daisuke Ogawa ◽  
Daisuke Kuroda ◽  
Katsunobu Taki ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Nasobiliary Drainage ◽  
Subtotal Cholecystectomy ◽  
Upper Abdominal ◽  
The Right ◽  
Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

scholarly journals Foreign Body in abdomen

2015 ◽  
Vol 14 (2) ◽  
pp. 210-212
Author(s):  
Md Zakirul Alam ◽  
Mohibul Aziz
Keyword(s):  
Abdominal Pain ◽  
Foreign Body ◽  
Medical Science ◽  
X Ray ◽  
Diagnostic Center ◽  
History Of ◽  
Upper Abdominal ◽  
Married Female

A 19 years old married female presented with severe upper abdominal pain, repeated vomiting having history of swallowing a knife 7 months ago was admitted in Mordern Clinic and Diagnostic center, Joypurhat, Bangladesh. USG abdomen & X-ray (fig-1) abdomen were done when presence of a large foreign body (knife fig-3) in abdomen was made which latter on confirmed by Endoscopy of upper GIT (fig-2). Surprisingly the patient kept it in her abdomen for 7 months without any symptoms until the symptoms got worse and compelled her to seek medical help. The knife was removed by laparotomy, gastrotomy with uneventful recovery.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.210-212

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