scholarly journals Retained plastic biliary stent presenting with obstructive jaundice: a case report

2021 ◽  
Vol 8 (9) ◽  
pp. 2792
Author(s):  
Gayatri Muley ◽  
Waqar Ansari ◽  
Atish Parikh ◽  
Dhiraj Kachare ◽  
Urvashi Jain ◽  
...  
Keyword(s):  
Case Report ◽  
Obstructive Jaundice ◽  
Biliary Obstruction ◽  
Biliary Stent ◽  
Plastic Stent ◽  
History Of ◽  
Lost To Follow Up ◽  
Cbd Exploration

Forgotten stents may lead to serious complications. We present a case report of a forgotten common bile duct (CBD) fully covered plastic stent presenting with Obstructive Jaundice. A 66 years-old female patient presented with features of obstructive jaundice. Further enquiry revealed a history of ERCP guided biliary stent placement 12 years ago, after which she was lost to follow up. An endoscopic attempt to retrieve the old stent and relieve biliary obstruction was unsuccessful, and a fresh stent was placed across the CBD following a sphincterotomy. CT showed evidence of a stent in situ, alongside calcified fragments of the previous stent and multiple CBD stones. Patient was taken up for surgery and Roux-en-y hepaticojejunostomy was performed following CBD exploration and retrieval of the stent-stone complex.

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 The spontaneous resolution of a vortex vein varix: case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara L Weidmayer ◽  
Hakan Demirci
Keyword(s):  
Case Report ◽  
Natural History ◽  
Extended Period ◽  
Spontaneous Resolution ◽  
Case Presentation ◽  
Clinical Resolution ◽  
History Of ◽  
Vortex Vein ◽  
Insight Into

Abstract Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

scholarly journals Massive stone burden in an ileocecal pouch: A preventable condition?

2014 ◽  
Vol 8 (5-6) ◽  
pp. 358
Author(s):  
Anne Sophie Valiquette ◽  
Diego Barrieras ◽  
Michael McCormack
Keyword(s):  
Surgical Complications ◽  
Late Complication ◽  
Bladder Exstrophy ◽  
Stone Burden ◽  
History Of ◽  
Lost To Follow Up ◽  
Efficient Transfer

The challenges of transition from the pediatric to the adult setting have been reported. We describe a case of massive stone burden in the ileocecal pouch of a patient lost to follow-up after his transfer from a pediatric to an adult institution. Although we successfully managed the patient and retrieved the pouch stones without any complications, several surgical complications may occur in a patient with a history of extensive abdominal surgeryand bladder exstrophy. This patient’s late complication might have been prevented with a more efficient transfer from a pediatric to an adult institution.

scholarly journals Conjunctival Chemosis Caused by Exposure of the Lacrimal Caruncle: A Case Report

2017 ◽  
Vol 8 (1) ◽  
pp. 120-123
Author(s):  
Akinori Baba ◽  
Hiromichi Matsuda ◽  
Takuya Shiba ◽  
Yasuhiro Takahashi ◽  
Hiroshi Tsuneoka
Keyword(s):  
Case Report ◽  
Eyelid Closure ◽  
History Of

An 84-year-old woman presented with a 3-month history of conjunctival chemosis in the left eye. At the first examination, the chemosis neighbored the lacrimal caruncle and was localized in the inferomedial region of the conjunctiva. During eyelid closure, only the left lacrimal caruncle was exposed. One month later, the chemosis further extended to the inferolateral region. We debulked the lacrimal caruncle to prevent the exposure of the caruncle. One month after the surgery, conjunctival chemosis had resolved completely. At the postoperative 6-month follow-up, the patient showed no recurrence of chemosis.

Abdominal intercostal hernia and costal arch repair

2021 ◽  
Vol 14 (11) ◽  
pp. e247189
Author(s):  
Jacob Moneim
Keyword(s):  
Case Report ◽  
Hernia Repair ◽  
Total Arthroplasty ◽  
Costal Arch ◽  
Intercostal Hernia ◽  
History Of ◽  
Abdominal Intercostal Hernia ◽  
Fat Herniation ◽  
Diaphragmatic Hernia Repair

A 70-year-old asthmatic man presented with a history of chronic intermittent left-sided chest pains and a bulge-like deformity of his chest which became more prominent with expiration. He sustained a traumatic fall 2 years prior whereby he fractured his right humerus at the surgical neck, requiring total arthroplasty. Examination and CT imaging of the thorax revealed a left costal arch fracture with hemidiaphragm rupture and associated transperitoneal fat herniation. He underwent left thoracolaparotomy with costal arch and diaphragmatic hernia repair. He was discharged 48 hours postoperatively and is satisfied with good outcomes under initial follow-up. This case report highlights the surgical management of a condition that usually presents late after significant trauma and may progress to visceral strangulation if untreated.

scholarly journals Asystole in an older patient with recurrent falls. Case report

Case reports ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. 77-83
Author(s):  
William Fernando Bautista-Vargas
Keyword(s):  
Case Report ◽  
Older Patients ◽  
Implantable Devices ◽  
Loop Recorder ◽  
General Terms ◽  
Recurrent Falls ◽  
History Of ◽  
Rule Out

Introduction: Recurrent falls are a usual problema in older patients. It is therefore important to learn how to differentiate a pathological or syncopal episode from a simple stumbling fall, especially in patients who have limitations for communicating clearly and are poorly understood, in general terms, during the medical consultation. Implantable loop recorders (ILR) have been used as an investigation tool in selected cases of recurrent falls in older patients. Consequently, this case report aims to describe its usefulness in this type of patients.Case presentation: An 87-year-old female patient, hypertensive, with a history of recent stroke and frequent falls —referred to as stumbling—, received an implantable loop recorder due to atrial fibrillation. During one follow-up appointment, a 36-second pause related to a fall was documented, so a bicameral pacemaker was implanted.Conclusions: Evaluating repeated falls in older patients is complex; it must be done in detail to rule out syncopal episodes. Implantable devices to diagnose arrhythmic causes are useful and allow achieving accurate diagnoses and establish specific behaviors aimed at improving the quality of life of patients.

scholarly journals SUN-939 Case Report: Malignant Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jose Viana Lima ◽  
Rosa Paula Mello Biscolla ◽  
Maria Izabel Chiamolera ◽  
Marco Antonio Conde Oliveira
Keyword(s):  
Weight Loss ◽  
Case Report ◽  
Chromogranin A ◽  
Scoring Systems ◽  
Lytic Lesion ◽  
Sdhb Mutation ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Abdominal Lesion

Abstract Introduction: The concept of malignancy for pheochromocytoma is complex and the best definition is the presence of metastases, according to WHO. Anatomopathological scoring systems are not effective in predicting metastases. Malignancy should be considered when tumors larger than 8cm (> 80g), paragangliomas (especially retroperitoneal), dopamine / methoxythyramine increase, Ki67> 6% and SDHB mutation. At 5 years, survival ranges from 50-69%. Metastases may appear 20-40 years after initial treatment of pheochromocytoma. We describe a case that metastasis was identified 33 years after pheochromocytoma excision Case report: A 57-year-old female patient with a postoperative history of 33 years of right adrenal pheochromocytoma was discharged from the endocrinologist after 10 years of follow-up. At diagnosis 33 years ago, she had symptoms of hypertension with paroxysms and weight loss that disappeared after tumor removal. 2 years investigating weight loss with general practitioner without another celebratory. On physical examination, orthostatic hypotension was highlighted. Plasma methanephrine 0.8 nmol / L (VR <0.5) and plasma normetanephrine 1.8 nmol / L (VR <0.9), chromogranin A 5.7 nmol / L (VR <3 nmol / L) and clonidine test with 36.6% suppression of metanephrines, suggesting tumor recurrence. MRI localized recurrence of the adrenals and MIBG scintigraphy with I131 that showed, respectively, in the topography next to the paracaval and retroportal right diaphragmatic crura, isointense T1 and slightly hyperintense T2 at 1.8 cm and radiopharmaceutical hypercaptation in right adrenal topography. Genetic panel by NGS did not identify germline mutation in 22 pheochromocytoma-related genes. FDG PETCT was consistent with MRI and MIBG images. Gallium PETCT68 DOTATOC detected the lesions already described, in addition to a lytic lesion in the left femoral intertrochanteric medulla. Anatomopathological approached abdominal lesion confirming pheochromocytoma metastasis in lymph node conglomerate. Currently has a negative methanephrine plasma, however chromogranin A 142 ng / mL (VR <93), and was chosen by the observant approach. Conclusion: The case of the patient illustrates that pheochromocytoma should be followed indefinitely, as metastases may appear many years later and may present different aggressiveness potentials.

scholarly journals Endoscopic plastic stent therapy for bile leaks following total vs subtotal cholecystectomy

2020 ◽  
Vol 08 (12) ◽  
pp. E1895-E1899
Author(s):  
Patrick Yachimski ◽  
Jordan K. Orr ◽  
Anthony Gamboa
Keyword(s):  
Perceived Risk ◽  
Primary Outcome ◽  
Bile Leak ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Plastic Stent ◽  
Subtotal Cholecystectomy ◽  
Bile Leaks ◽  
Study Inclusion

Abstract Background and study aims Plastic biliary stents are standard therapy for treatment of post-cholecystectomy bile leaks. An increasing proportion of patients now undergo subtotal cholecystectomy and are at perceived risk for high-grade bile leak. Data are limited regarding the optimal endoscopic therapy following subtotal cholecystectomy. The aim of this study was to compare outcomes of endoscopic plastic stent therapy for treatment of bile leak following total vs subtotal cholecystectomy. Patients and methods A retrospective cohort of patients with bile leak following cholecystectomy and treated with biliary stent was identified from an institutional database. Primary outcome was defined as cholangiographic resolution of leak at follow-up endoscopic retrograde cholangiopancreatography (ERCP). Results Sixty-one subjects met study inclusion criteria, 27 following total cholecystectomy and 34 following subtotal cholecystectomy. A single plastic biliary stent was placed in 87 % of subjects (53/61), while a fully covered self-expanding metal stent (FCSEMS) was placed in 13 % (8/61). Leak resolution was evident at first follow-up ERCP in 96 % of subjects (26/27) who had undergone total cholecystectomy and 91 % of subjects (31/34) who had undergone subtotal cholecystectomy (P = 0.25). Among subjects who had received a plastic stent at index ERCP, leak resolution was evident at first follow-up ERCP in 96 % (23/24) of those who had undergone total cholecystectomy and 90 % (26/29) of those who had undergone subtotal cholecystectomy (P = 0.62). Conclusions High rates of leak resolution can be achieved with placement of a single plastic biliary stent for treatment of post-cholecystectomy bile leaks, including after subtotal cholecystectomy.

scholarly journals Cryoablation of Small Renal Tumors in Patients with Solitary Kidneys: Initial Experience

2008 ◽  
Vol 2008 ◽  
pp. 1-3 ◽  
Author(s):  
Ravi Munver ◽  
Grant I. S. Disick ◽  
Salvatore A. Lombardo ◽  
Vladislav G. Bargman ◽  
Ihor S. Sawczuk
Keyword(s):  
Tumor Location ◽  
Renal Tumors ◽  
Minimal Risk ◽  
Contralateral Kidney ◽  
Nephron Sparing ◽  
Feasible Alternative ◽  
Lost To Follow Up

Introduction. The purpose of this study was to evaluate the role of renal cryoablation in patients with solitary kidneys with the goals of tumor destruction and maximal renal parenchymal preservation.Methods. Eleven patients with single tumors were treated with cryoablation, of which 10 patients had solitary kidneys and 1 had a nonfunctioning contralateral kidney. All procedures were performed via an open extraperitoneal approach; ten tumors were treated with in-situ cryoablation and 1 tumor was treated with cryo-assisted partial nephrectomy.Results. Cryoablation was successfully performed without any preoperative complications. Mean patient age was 62.4 years (range 49–79), tumor location included: 6 (upper pole), 2 (mid-kidney), 3 (lower pole). The mean and median tumor size was 2.6 cm and 2.8 cm (range 1.2–4.3 cm), mean operative time 205 minutes (range 180–270 minutes), blood loss 98.5 ml (range 40–250 ml), and hospitalization 4.6 days (range 3–8 days). Creatinine values included: preoperative 1.43 mg/dL (range 1.2–1.9), postoperative 1.67 mg/dL (range 1.5–2.5), and nadir 1.57 mg/dL (range 1.3–2.1). All patients were followed postoperatively with magnetic resonance imaging for surveillance. At a median follow-up of 43 months, 9 patients had no evidence of recurrence, 1 patient has an enhancing indeterminate area, and 1 patient was lost to follow-up.Conclusion. Intermediate-term results suggest that renal cryoablation offers a feasible alternative for patients that require a maximal nephron-sparing effort with preservation of renal function and minimal risk of tumor recurrence.

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