scholarly journals Bilioenteric Fistula - Not any more a contraindication for Laparoscopic Cholecystectomy

2015 ◽  
Vol 3 (1) ◽  
pp. 7-8 ◽  
Author(s):  
Samiron Kumar Mondal ◽  
Sharmistha Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Fistulous Tract ◽  
Tertiary Care ◽  
Cholecystoduodenal Fistula ◽  
Intracorporeal Suturing ◽  
Open Operation ◽  
Cholecystoenteric Fistula ◽  
Increased Risk ◽  
Cholecystocolic Fistula

Background: Bilioenteric fistulas include cholecystoduodenal fistula, cholecystocolic fistula, and cholecystogastric fistula. They are known but rare complication of cholecystitis. Previously presence of any cholecystoenteric fistula was an indication to convert laparoscopic cholecystectomy to open operation1. But with time and experience new techniques, new technology and expertise has developed in the laparoscopic field and now the scenario is changed. This is our experience in a tertiary care diabetic hospital where we encountered 21 cases of cholecystoenteric fistula during laparoscopic cholecystectomy over a period of 2 years. Our series: From January 2013 to January 2015 we performed 1191 cases of laparoscopic cholecystectomy in our unit. We encountered 12 cases of cholecystoduodenal fistula, 7 cases of cholecystocolic fistula and 2 cases of cholecystogastric fistula. All cases were diagnosed during laparoscopy, and were dealt with laparoscopy. Intracorporeal suturing was used in all cases.Observation: Successful per operative diagnosis requires suspicion and careful adhesiolysis in all cases. Avoiding conversion to open operation reduces hospital stay, pain, wound infection and chest complications associated with upper abdominal incision. As the fistulous tract is usually near the fundus and far away from Callots there is not much increased risk of common bile duct injury.Conclusion: Cholecystoenteric fistulas can now safely be managed laparoscopically in advanced centers by experienced surgeon.Bangladesh Crit Care J March 2015; 3 (1): 7-8

scholarly journals Laparoscopic management of cholecystoduodenal fistula: a case report

2018 ◽  
Vol 5 (11) ◽  
pp. 3744
Author(s):  
Tharun Ganapathy C. ◽  
Jeyakumar S. ◽  
Manimaran P. ◽  
Sidhu Sekhar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Laparoscopic Approach ◽  
Open Approach ◽  
Cholecystoduodenal Fistula ◽  
Cholecystoenteric Fistula ◽  
Bladder Pathology ◽  
Almost All ◽  
Conventional Open Approach ◽  
Laparoscopic Techniques

Laparoscopic cholecystectomy has been the most widely accepted modality of treatment for patients with gall bladder disease. With time and increasing experience laparoscopic cholecystectomy is now being successfully attempted to treat almost all benign gall bladder pathology and their complications. One such uncommon infrequent complication of cholecystolithiasis is the cholecystoenteric fistula. Management of cholecystoduodenal fistula was traditionally performed by open method. With increasing newer laparoscopic techniques and advancement in the field, cholecystoduodenal fistula, an uncommon clinical entity is now being successfully treated via laparoscopic approach. It is feasible and safer than the conventional open approach in experienced hands, thus decreasing the overall morbidity and mortality attributed to the condition. We report a case of cholecystoduodenal fistula treated successfully by laparoscopic approach using an Endo GIA stapler.

scholarly journals A Rare complication of Cholelithiasis: Cholecystocolic Fistula – Case Report

Med Phoenix ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 53-55
Author(s):  
Anup Shrestha ◽  
Abhishek Bhattarai ◽  
Kesh Maya Gurung ◽  
Manoj Chand
Keyword(s):  
Case Report ◽  
Standard Treatment ◽  
Rare Complication ◽  
Open Cholecystectomy ◽  
Common Finding ◽  
Enteric Fistula ◽  
Cholecystoduodenal Fistula ◽  
Biliary Enteric Fistula ◽  
Cholecystocolic Fistula

Although the pre-operative diagnosis of the cholecystocolic fistula has been reported, yet it is by no means a common finding. Cholecystocolic fistula is the second most type of biliary enteric fistula after cholecystoduodenal fistula. Cholecystogastric fistula is least commonly reported. We report our experience with cholecystocolic fistula discovered on imaging which was subsequently confirmed through surgery. The standard treatment for CCF is open cholecystectomy and closure of the fistula. Failure to identify preoperatively or intra-operatively can lead to various complications.      

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in hospitalized patients at a tertiary referral center in North India (Preprint)

2020 ◽  
Author(s):  
Dr. Animesh Ray ◽  
Dr. Komal Singh ◽  
Souvick Chattopadhyay ◽  
Farha Mehdi ◽  
Dr. Gaurav Batra ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Age Groups ◽  
Hospitalized Patients ◽  
North India ◽  
P Value ◽  
Care Hospital ◽  
Igg Antibodies ◽  
Igg Antibody ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Seroprevalence of IgG antibodies against SARS-CoV-2 is an important tool to estimate the true extent of infection in a population. However, seroprevalence studies have been scarce in South East Asia including India, which, as of now, carries the third largest burden of confirmed cases in the world. The present study aimed to estimate the seroprevalence of anti-SARS-CoV-2 IgG antibody among hospitalized patients at one of the largest government hospital in India OBJECTIVE The primary objective of this study is to estimate the seroprevalence of SARS-CoV-2 antibody among patients admitted to the Medicine ward and ICU METHODS This cross-sectional study, conducted at a tertiary care hospital in North India, recruited consecutive patients who were negative for SARS-CoV-2 by RT-PCR or CB-NAAT. Anti-SARS-CoV-2 IgG antibody levels targeting recombinant spike receptor-binding domain (RBD) protein of SARS CoV-2 were estimated in serum sample by the ELISA method RESULTS A total of 212 hospitalized patients were recruited in the study with mean age (±SD) of 41.2 (±15.4) years and 55% male population. Positive serology against SARS CoV-2 was detected in 19.8%patients(95% CI 14.7-25.8). Residency in Delhi conferred a higher frequency of seropositivity 26.5% (95% CI 19.3-34.7) as compared to that of other states 8% (95% CI 3.0-16.4) with p-value 0.001. No particular age groups or socio-economic strata showed a higher proportion of seropositivity CONCLUSIONS Around, one-fifth of hospitalized patients, who were not diagnosed with COVID-19 before, demonstrated seropositivity against SARS-CoV-2. While there was no significant difference in the different age groups and socio-economic classes; residence in Delhi was associated with increased risk (relative risk of 3.62, 95% CI 1.59-8.21)

scholarly journals A rare complication following laparoscopic cholecystectomy; a case series

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S542
Author(s):  
A.M. Schreuder ◽  
T.M. van Gulik ◽  
E.A. Rauws
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Case Series

scholarly journals Risk of Depression among Early Onset Type 2 Diabetes Mellitus Patients

2021 ◽  
pp. 1-11
Author(s):  
Baizid Khoorshid Riaz ◽  
Shahjada Selim ◽  
Megan Neo ◽  
Md Nazmul Karim ◽  
M. Mostafa Zaman
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Early Onset ◽  
Tertiary Care ◽  
Positive Family History ◽  
Depression Symptoms ◽  
Mixed Effect ◽  
Increased Risk

<b><i>Methodology:</i></b> Biochemically confirmed type 2 diabetes mellitus (T2DM) patients (<i>n</i> = 1,114) were recruited from the outpatient department of 2 tertiary care hospitals in Dhaka, Bangladesh. Face-to-face interview was conducted using a semi-structured questionnaire containing sociodemographic parameters and relevant information about depression and diabetes. Biochemical test results and treatment-related information were taken from patients’ records. The Hospital Anxiety and Depression Scale (HADS) was used to screen all patients for psychiatric manifestation. Those diagnosed by HADS were subsequently reassessed using structured clinical interview for DSM-5 Disorders – Clinician Version. T2DM diagnosed at age &#x3c;40 years were considered as early onset T2DM. Association between age of onset category and depression was assessed using multivariable mixed-effect logistic regression adjusting for random variation of the area of residence and plausible confounders. <b><i>Results:</i></b> Around a third of the participants (32.5%) were diagnosed with T2DM before the age of 40 years. Early onset T2DM patients were found to have 57% increase in the risk of developing depression (OR 1.57; 95% CI 1.13–2.28; <i>p</i> = 0.011) in comparison to those with usual onset T2DM (≥40 years). Among other factors a positive family history for diabetes (OR 1.33; 95% CI 1.03–1.78; <i>p</i> = 0.038), poor glycemic control (OR 1.31; 95% CI 1.03–1.68; <i>p</i> = 0.028), presence of 1, or more diabetic complications (OR 1.37; 95% CI 1.03–1.78; <i>p</i> = 0.011) also showed increased risk of depression. <b><i>Conclusion:</i></b> Early onset T2DM patients are at greater risk of developing depression. The finding is likely to help in setting preventive strategies aiming to reduce the presence of concomitant depression symptoms among diabetes.

scholarly journals Case report: isolated lower lip lesion following cavernoma resection in prone position

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Mir Ibrahim Sajid ◽  
Noor Malik ◽  
Rashid Jooma
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Vision Loss ◽  
Rare Complication ◽  
Lower Lip ◽  
Anatomical Structures ◽  
Long Duration ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Spine Mri

Abstract Background Surgery in a prone position is necessary when access to posterior anatomical structures is needed. A procedure in this position is associated with complications such as injuries to the eyes, peripheral nerves, and pressure points and swelling of the tongue. We report a rare complication of isolated lower lip swelling following neck dissection in the prone position. Case presentation A 25-year-old male patient presented to the clinic with complaint of neck pain for the past 2 months. A cervical spine MRI was done which showed the presence of a cavernoma. C2 laminectomy was performed for resection of the tumor in prone position with the head fixed on a three-point Mayfield clamp. Postoperatively, isolated swelling of the lower lip was observed. The patient was managed conservatively. Conclusion Cervical spine surgeries done in prone positions carry an increased risk of postoperative vision loss and swellings including those of the oropharynx and in the periorbital region. Possible risk factors for such conditions include anemia, hypotension, long duration of surgery, and significant intraoperative hydration.

scholarly journals Massive hemobilia caused by rupture of gastroduodenal artery pseudoaneurysm, a delayed complication of laparoscopic cholecystectomy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kurniawan Kurniawan ◽  
I Dewa Nyoman Wibawa ◽  
Gde Somayana ◽  
I Ketut Mariadi ◽  
I Made Mulyawan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastrointestinal Bleeding ◽  
Abdominal Trauma ◽  
Upper Gastrointestinal Bleeding ◽  
Rare Complication ◽  
Gastroduodenal Artery ◽  
Time Interval ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Upper Gastrointestinal

Abstract Background Hemobilia is a rare cause of upper gastrointestinal bleeding that originates from the biliary tract. It is infrequently considered in diagnosis, especially in the absence of abdominal trauma or history of hepatopancreatobiliary procedure, such as cholecystectomy, which can cause arterial pseudoaneurysm. Prompt diagnosis is crucial because its management strategy is distinct from other types of upper gastrointestinal bleeding. Here, we present a case of massive hemobilia caused by the rupture of a gastroduodenal artery pseudoaneurysm in a patient with a history of laparoscopic cholecystectomy 3 years prior to presentation. Case presentation A 44-year-old Indonesian female presented to the emergency department with complaint of hematemesis and melena accompanied by abdominal pain and icterus. History of an abdominal trauma was denied. However, she reported having undergone a laparoscopic cholecystectomy 3 years prior to presentation. On physical examination, we found anemic conjunctiva and icteric sclera. Nonvariceal bleeding was suspected, but esophagogastroduodenoscopy showed a blood clot at the ampulla of Vater. Angiography showed contrast extravasation from a gastroduodenal artery pseudoaneurysm. The patient underwent pseudoaneurysm ligation and excision surgery to stop the bleeding. After surgery, the patient’s vital signs were stable, and there was no sign of rebleeding. Conclusion Gastroduodenal artery pseudoaneurysm is a rare complication of laparoscopic cholecystectomy. The prolonged time interval, as compared with other postcholecystectomy hemobilia cases, resulted in hemobilia not being considered as an etiology of the gastrointestinal bleeding at presentation. Hemobilia should be considered as a possible etiology of gastrointestinal bleeding in patients with history of cholecystectomy, regardless of the time interval between the invasive procedure and onset of bleeding.

scholarly journals Laparoscopic Cholecystectomy - Two-Decade Experience of over 3000 Cases from a Tertiary Care Center

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S360
Author(s):  
V. Bansal ◽  
A. Baksi ◽  
M. Jain ◽  
A. Krishna ◽  
P. Om ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

scholarly journals Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043837
Author(s):  
Usha Dutta ◽  
Anurag Sachan ◽  
Madhumita Premkumar ◽  
Tulika Gupta ◽  
Swapnajeet Sahoo ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Tertiary Care ◽  
Low Risk ◽  
Transmission Risk ◽  
Healthcare Personnel ◽  
Risk Zone ◽  
Increased Risk ◽  
Medium Risk ◽  
Risk Zones

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

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