scholarly journals Post Endoscopic Retrograde Cholangiopancrea-Togram (ERCP) Perforation Managed Successfully Conservatively: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Abdul Malek Mohamad ◽  
Azrin Waheedy Ahmad ◽  
Junaini Kasian
Keyword(s):  
Case Report ◽  
Early Recognition ◽  
Hepatic Duct ◽  
Operative Management ◽  
Free Fluid ◽  
Contrast Extravasation ◽  
Distal Common Bile Duct ◽  
Cbd Stone ◽  
The Right ◽  
Non Operative Management

Introduction: We aim to report an uncommon case of post ERCP perforation that effectively managed conservatively in non-hepatobiliary surgery centre. Case report: A 46-year-old man diagnosed to have obstructive jaundice secondary to distal common bile duct (CBD) stone. He underwent ERCP at a private centre, sphincterotomy was performed, but, the operator had failed to insert the stent and complicated with post ERCP perforation evidenced by contrast extravasation beyond 1/3rd of the CBD and referred to our centre. Patient was subjected for re ERCP. There were difficulties in cannulating the CBD and stent was inserted. Cholangiogram revealed contrast leak around the pancreatic duct and bifurcation of hepatic duct. There was no evidence of CBD stone. Computed Tomography (CT) of the abdomen revealed extensive subcutaneous emphysema on the right side of the abdomen to right inguinal region, extensive retroperitoneal free air and pneumoperitoneum, but there were no free fluid or contrast extravasation. The patient subjected for non-operative management (NOM) for the complication and kept fasting with total parenteral nutrition and intravenous antibiotic. He recovered well with the opted management. Patient was programmed with Gastrograffin study after 10 days that showed no evidence of contrast leak to suggest free bowel injury. He was allowed orally after that and was discharged well after 15 days with stent in situ. During follow up, he was well, and the stent removed after 3 months. Patient planned for laparoscopic cholecystectomy and on table cholangiogram. Conclusion:  Post ERCP perforation is uncommon but lethal. Early recognition of the complication is crucial hence appropriate management can be arranged to avoid death. To date, surgery is not the only choice available to manage this complication.

scholarly journals Non‐operative management of primary omental torsion, a case report and literature review

2021 ◽  
Vol 9 (7) ◽  
Author(s):  
Mohammed S. Foula ◽  
Mohammed Sharroufna ◽  
Zahra H. Alshammasi ◽  
Omar S. Alothman ◽  
Bayan A. Almusailh ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Operative Management ◽  
Omental Torsion ◽  
Non Operative Management

scholarly journals Ruptured Bilateral Pericallosal Artery Aneurysm in Mirror Position: Case Report

2018 ◽  
Vol 37 (03) ◽  
pp. 263-266
Author(s):  
Lucas Meguins ◽  
Linoel Valsechi ◽  
Ronaldo Fernandes ◽  
Dionei Morais ◽  
Antonio Spotti
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Operative Management ◽  
Neurological Deficits ◽  
Pericallosal Artery ◽  
Digital Subtraction Arteriography ◽  
The Many ◽  
The Right

Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

scholarly journals Solid organ injury in blunt trauma abdomen: an etiological evaluation and success rate of non-operative management

2018 ◽  
Vol 5 (4) ◽  
pp. 1350
Author(s):  
Ramachandra M. L. ◽  
Krishna S. R.
Keyword(s):  
Blunt Trauma ◽  
Surgical Management ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Operative Management ◽  
Abdominal Injury ◽  
Organ Injury ◽  
Free Fluid ◽  
Road Traffic Accidents ◽  
Non Operative Management

Background: Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years. 10% of these fatalities are attributable to abdominal injury. The Indian fatality rates for trauma are 20 times that for developed countries. The management of patients with blunt abdominal injury has evolved greatly over the last few decades from complete surgical management historically to present non operative management in most of the cases. In view of increasing number of road traffic accidents, rampant increase in construction work, accidental fall from height, this study is conducted to look into the causes of such incidents and also to strengthen the already established rules of non operative management in cases of blunt trauma abdomen.Methods: This is a prospective study of 53 patients who presented to K. R. Hospital, Mysuru, Karnataka, for management of blunt trauma abdomen over the period of January 2016 to June 2017. Unstable patients with initial resuscitation underwent Focused Assessment Sonography for Trauma. Failed resuscitation with free fluid in abdomen confirmed by FAST immediately shifted to operation theatre for laparotomy and proceed. Hemodynamically stable patients underwent computerized tomography of abdomen. Organ injuries were scaled according to the American Association for the Surgery of Trauma and these patients were managed conservatively after ruling out hollow viscus perforation.Results: Majority of the patients belonged to male sex (85%) and of the age group 21-40 years constituting 58.3% of patients. Road traffic accident was the most common mode of injury which included 35 patients (66%). A total of 19 cases had splenic injury out of which 13 (68.5%) underwent non operative management and 6 (31%) underwent emergency Splenectomy. liver injury was present in 15 patients and all were managed conservatively. In total non operative management was done in 73.5% of cases and surgical management was done in 26.5% of cases.Conclusions: The presence of free fluid with organ injury always does not mandate laparotomy. Patient selection, early diagnosis and repeated clinical examination and use of appropriate investigations forms the key in non operative management of blunt trauma abdomen. RTA being the most common mode of injury, adequate measures should be taken to prevent road traffic accidents by strict action and traffic norms and citizen education.

scholarly journals When It Doesn't Fit: Congenital Anomalies of the Choledochus

2020 ◽  
Vol 08 (01) ◽  
pp. e86-e89
Author(s):  
Helena Reusens ◽  
Mark Davenport
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Resected Specimen ◽  
Cystic Dilatation ◽  
Left Hepatic Duct ◽  
Distal Common Bile Duct

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

scholarly journals Isolated free fluid on computed tomography for blunt abdominal trauma

2019 ◽  
Vol 101 (8) ◽  
pp. 552-557
Author(s):  
W Bekker ◽  
MTD Smith ◽  
VY Kong ◽  
JL Bruce ◽  
G Laing ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Splenic Injury ◽  
Operative Management ◽  
Bladder Injury ◽  
Free Fluid ◽  
Abdominal Ct ◽  
Hollow Viscus ◽  
Hollow Viscus Injury ◽  
Non Operative Management

Introduction The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit’s experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. Materials and methods All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. Results During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. Discussion In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.

scholarly journals Successful non-operative management of traumatic extrahepatic portal venous injury without intraperitoneal hemorrhage: a case report

2016 ◽  
Vol 4 (2) ◽  
pp. 205-208 ◽  
Author(s):  
Kunio Hamanaka ◽  
Yuusuke Hirokawa ◽  
Tsuyoshi Itoh ◽  
Mitsuhiro Fujino ◽  
Kenichi Kano ◽  
...  
Keyword(s):  
Case Report ◽  
Operative Management ◽  
Intraperitoneal Hemorrhage ◽  
Venous Injury ◽  
Non Operative Management

scholarly journals A Case Report: Rare Anomaly of a Single Coronary Artery Arising from the Right Aortic Sinus of Valsalva

2020 ◽  
Vol 1 (1) ◽  
pp. 58-64
Author(s):  
Kassem Farhat ◽  
Jean Dib ◽  
Antoine El Khoury ◽  
Alain Asmar
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Early Recognition ◽  
Treatment Plan ◽  
Anatomical Variation ◽  
Single Coronary Artery ◽  
Sinus Of Valsalva ◽  
Aortic Sinus ◽  
Blood Tests ◽  
The Right

Background: Single Coronary Artery (SCA) is a rare, most commonly asymptomatic, congenital anomaly which is usually discovered incidentally during investigations. This entity consists of a single coronary artery supplying the entire myocardium. It may be classified based on the origin and the course of the artery. Depending on the patient's presentation and its severity, medical or invasive interventions may be warranted. Case Report: A 65-year-old female patient known to have diabetes and hypertension presented to our emergency department with chest pain and discomfort. Blood tests and electrocardiography (ECG) showed no significant abnormalities, but on coronary angiography, we suspected an anatomical variation. Computed tomography angiography (CTA) confirmed our suspicion revealing a single coronary artery supplying the entire myocardium and arising from the right sinus of Valsalva. The patient received medical therapy and was discharged home. Conclusion: We presented this case of Single Coronary Artery due to the rarity of this diagnosis. Presentation, treatment plan, and prognosis typically vary depending on the subtype of the anomaly. Early recognition is very important, especially in young adults.

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