Laparoscopic cost effective management of cholecystoduodenal fistula

2017 ◽  
Vol 5 (2) ◽  
pp. 110-112
Author(s):  
Md Ezharul Haque Ratan ◽  
Hasina Alam ◽  
Md Abdul Karim
Keyword(s):  
Slight Modification ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Fistula Tract ◽  
Laparoscopic Technique ◽  
Duodenal Wall ◽  
Cholecystoduodenal Fistula ◽  
Laparoscopic Operation ◽  
Uncommon Condition ◽  
Bladder Condition

Introduction: Contraindication to laparoscopic surgery is decreasing with time, expertise and innovation. One such uncommon condition is cholecystoduodenal fistula (CDF), now increasingly managed with laparoscopic technique. We are reporting eight such incidentally diagnosed cases during laparoscopic operation, which were successfully and cost-effectively managed with traditional laparoscopic instruments.Materials and Methods: During March 2008 to March 2017, 1500 patient underwent laparoscopic cholecystectomy for benign gall bladder condition or their complications, eight of these having chronic dyspeptic symptoms of gallstone, were found to have cholecystoduodenal fistula, intraoperatively. All cases were managed laparoscopically using common laparoscopic instruments without any special gadgets and extra costs. Medical records of eight cases were reviewed for age, sex, operative technique, intra and post-operative complications and length of stay in hospital.Results: Five patients were male and three were female with a mean age of 63 years. All of them had gall stones at abdominal ultrasound and cholecystoduodenal fistula were found intraoperatively. Fistula tract was dissected, cleaned and sealed with combination of intracorporeal simple transfixation ligation and interrupted stitches to invert the stump within the duodenal wall in transverse fashion. All eight had uneventful postoperative course with hospital stay of 4-7 (mean 5) days.Conclusion: In expert hands cholecystoduodenal fistula can successfully and safely be managed laparoscopically using common instruments and logistics with slight modification of open technique without extra cost.Bangladesh Crit Care J September 2017; 5(2): 110-112

scholarly journals Screening for aneurysms of the abdominal aorta using a simple screening device

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
J. W. Brakel ◽  
T. A. Berendsen ◽  
P. M. C. Callenbach ◽  
J. van der Burgh ◽  
R. J. Hissink ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Abdominal Aorta ◽  
Predictive Value ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Predictive Values ◽  
Bladder Scan ◽  
Health Council ◽  
Screening Device

Abstract Introduction Several countries advocate screening for aneurysms of the abdominal aorta (AAA) in selected patients. In the Netherlands, routine screening is currently under review by the National Health Council. In any screening programme, cost-efficiency and accuracy are key. In this study, we evaluate the Aorta Scan (Verathon, Amsterdam, Netherlands), a cost-effective and easy-to-use screening device based on bladder scan technology, which enables untrained personnel to screen for AAA. Methods We subjected 117 patients to an Aorta Scan and compared the results to the gold standard (abdominal ultrasound). We used statistical analysis to determine sensitivity and specificity of the Aorta Scan, as well as the positive and negative predictive values, accuracy, and inter-test agreement (Kappa). Results Sensitivity and specificity were 0.86 and 0.98, respectively. Positive predictive value was 0.98 and negative predictive value was 0.88. Accuracy was determined at 0.92 and the Kappa value was 0.85. When waist–hip circumferences (WHC) of > 115 cm were excluded, sensitivity raised to 0.96, specificity stayed 0.98, positive and negative predictive value were 0.98 and 0.96, respectively, accuracy to 0.97, and Kappa to 0.94. Conclusion Herein, we show that the Aorta Scan is a cost-effective and very accurate screening tool, especially in patients with WHC below 115 cm, which makes it a suitable candidate for implementation into clinical practice, specifically in the setting of screening selected populations for the presence of AAA.

Abdominal ultrasound scans for diagnostic imaging of the liver

2019 ◽  
Vol 17 (Sup6) ◽  
pp. S30-S35
Author(s):  
Gerri Mortimore ◽  
JP Mayes
Keyword(s):  
Nurse Practitioners ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Background Information ◽  
Sound Waves ◽  
Clinical Background ◽  
Line Imaging ◽  
The Right ◽  
Available Information

Ultrasound is a common first-line imaging investigation that uses sound waves to produce an image (sonogram) of the internal organs. It is easy, quick and cost-effective to perform and safe, non-invasive and generally painless for the patient. Abdominal ultrasound in particular visualises the hepatobiliary system. It is used to investigate abdominal pain, abnormal liver function tests, distension and jaundice, as well as to screen for hepatocellular carcinoma and abdominal aortic aneurysm. Ultrasound requests should include relevant clinical background information to ensure the patient receives the right test and help the sonographer rule out differential diagnoses. Before the test, patients should be given all available information and asked to fast for 6–8 hours, although clear fluids are permitted. The scan usually procedure takes 15–30 minutes but may be extended depending on pathology identified. The sonogram displays the comparative echogenicity of the liver and adjacent organs in real time. Increased echogenicity, a coarse echotexture and a saw-tooth liver edge are indicative of liver pathology. Ultrasound can also allow the assessment of the portal venous system to exclude portal vein thrombus or elevated portal velocities. Advanced clinical nurse practitioners can order ultrasounds in line with local hospital trust guidance, which may include Ionising Radiation Medical Exposure Regulations (IRMER) training.

scholarly journals Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 579 ◽  
Author(s):  
Yoshio Sumida ◽  
Masashi Yoneda ◽  
Yuya Seko ◽  
Hiroshi Ishiba ◽  
Tasuku Hara ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
High Sensitivity ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Screening Tests ◽  
Nonalcoholic Fatty Liver

Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of hepatocellular carcinoma (HCC), liver-related mortality, and liver transplantation. There is sufficient epidemiological cohort data to recommend the surveillance of patients with NAFLD based upon the incidence of HCC. The American Gastroenterology Association (AGA) expert review published in 2020 recommends that NAFLD patients with cirrhosis or advanced fibrosis estimated by non-invasive tests (NITs) consider HCC surveillance. NITs include the fibrosis-4 (FIB-4) index, the enhanced liver fibrosis (ELF) test, FibroScan, and MR elastography. The recommended surveillance modality is abdominal ultrasound (US), which is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with NAFLD. In NAFLD patients with a high likelihood of having an inadequate US, or if an US is attempted but inadequate, CT or MRI may be utilized. The GALAD score, consisting of age, gender, AFP, the lens culinaris-agglutinin-reactive fraction of AFP (AFP-L3), and the protein induced by the absence of vitamin K or antagonist-II (PIVKA-II), can help identify a high risk of HCC in NAFLD patients. Innovative parameters, including a Mac-2 binding protein glycated isomer, type IV collagen 7S, free apoptosis inhibitor of the macrophage, and a combination of single nucleoside polymorphisms, are expected to be established. Considering the large size of the NAFLD population, optimal screening tests must meet several criteria, including high sensitivity, cost effectiveness, and availability.

scholarly journals Bouveret's Syndrome: Case Report and Review of the Literature

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Iliana Doycheva ◽  
Alpna Limaye ◽  
Amitabh Suman ◽  
Christopher E. Forsmark ◽  
Shahnaz Sultan
Keyword(s):  
Duodenal Bulb ◽  
Outlet Obstruction ◽  
Success Rates ◽  
Cholecystoduodenal Fistula ◽  
Bouveret’S Syndrome ◽  
Endoscopic Extraction ◽  
Extracorporeal Lithotripsy ◽  
Endoscopic Retrieval ◽  
Uncommon Condition ◽  
Bouveret's Syndrome

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as first-line treatment, though success rates with endoscopic treatment are variable. We describe a case of Bouveret's Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition.

scholarly journals EARLY LAPAROSCOPIC CHOLECYSTECTOMY

2008 ◽  
Vol 15 (01) ◽  
pp. 162-167
Author(s):  
THAKUR K. HINDUJA ◽  
SHER MOHAMMAD SHAIKH ◽  
MALICK HUSSAIN JALBAN ◽  
Nisar Ahmed Shaikh ◽  
Ishaque Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Related Complication ◽  
College Hospital ◽  
Female Ratio ◽  
Early Laparoscopic Cholecystectomy ◽  
Medical College ◽  
Surgical Units

To assess the clinical out come of laparoscopic Cholecystectomyfor management of acute cholecystitis and to evaluate its safety, frequency of complications. Design: Observationalstudy. Setting: Surgical Units II and III Of Chandka Medical College Hospital Larkana.. Period: From 01.09.2003 upto 31.12.2007 Patients & Methods: A total of 100 consecutive cases of, acute cholecystitis confirmed subsequentlyby abdominal ultrasound scanning, who were admitted for early laparoscopic cholecystectomy. Results: There wasfemale preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients werereceived with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24(24%),Empyma 8(8%), Contracted 10(10%), Perforated 5(5%) and Gangrenous GB in 4(4%) while 49(49%) have acutecholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50minutes. No mortality was reported in this series. Conclusion: Emergency / early cholecystectomy is reliable and safemodality cost effective, and timely surgery with modern conception in themanagement of acute cholecysttitis, becauseof accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Choleshould be preferred technique now days for the treatment of acute cholecystitis at our Institute.

scholarly journals INGUINAL HERNIA

2016 ◽  
Vol 23 (11) ◽  
pp. 1311-1318
Author(s):  
Agha Nadeem Ahmed Khan ◽  
Shafiq Ullah ◽  
Muhammad Farrukh Aftab ◽  
Khalid Hussain Qureshi
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Return To Work ◽  
Cost Effective ◽  
Descriptive Study ◽  
Laparoscopic Technique ◽  
Early Return ◽  
Routine Work ◽  
Study Setting ◽  
Surgical Unit

Objectives: To highlight an economical laparoscopic technique for rapidrecovery & early return to work especially for the 3rd world inguinal hernia patients. StudyDesign: Descriptive study. Setting: Surgical unit of Nishtar Hospital Multan. Period: 02 yearsi.e. from January 2014 to January 2016. Methods: There were 90 patients in the study. A prolenemesh of 15 x 15 cm used for the repair of inguinal hernia laparoscopiclly without the use ofspacer balloon & tacker (To make it cost effective). Results: Out of 90 patients only 3 patientsdevelop scrotal seroma. All the patients discharged on the 1st postoperative day & allowed toreturn to their normal routine work from the 3rd postoperative day onward. Conclusion: (e-TEP)without spacer balloon & tacker is an economical approach toward the inguinal hernia repair.

scholarly journals Iliopsoas Abscess

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Bader Sobaih ◽  
Loay Sobaih ◽  
Fahad Al Zamil
Keyword(s):  
Ct Scan ◽  
Signs And Symptoms ◽  
Abdominal Ultrasound ◽  
Iliopsoas Abscess ◽  
Creative Commons ◽  
Intravenous Antibiotics ◽  
Uncommon Condition ◽  
Clinical Triad ◽  
Hip Flexion ◽  
First Time

Iliopsoas abscess (IPA) is uncommon condition in children, diagnosis might be delayed because of nonspecific signs and symptoms. Only few patients have classical clinical triad at presentation in the form of fever, back pain, and inguinal pain at hip flexion. The diagnosis most likely to be reached in the first time by the use of abdominal computed tomography (CT) scan. We present a Saudi child with nonspecific signs and symptoms of fever, flank pain, and limping who was diagnosed as IPA by abdominal ultrasound and CT scan. The case was managed with intravenous antibiotics along with transcutaneous abscess drainage. doi: https://doi.org/10.12669/pjms.37.2.3816 How to cite this:Sobaih B, Sobaih L, Al-Zamil F. Iliopsoas Abscess. Pak J Med Sci. 2021;37(2):---------.   doi: https://doi.org/10.12669/pjms.37.2.3816 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pancreatic cancer or autoimmune pancreatitis: endosonography as a diagnostic reviser

2013 ◽  
Vol 154 (2) ◽  
pp. 62-68 ◽  
Author(s):  
Zoltán Szepes ◽  
Mariann Dobra ◽  
Csaba Góg ◽  
Edit Zábrák ◽  
Éva Makula ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Health Care Providers ◽  
Computer Tomography ◽  
Autoimmune Pancreatitis ◽  
Imaging Techniques ◽  
Tumor Staging ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Care Providers ◽  
Increased Risk

Conventional radiologic imaging (abdominal ultrasound, computer tomography) used in the differential diagnosis of post-hepatic jaundice can frequently provide inaccurate diagnosis. Inflammatory lesions may mimic neoplastic processes and malignancy may be accompanied by perifocal inflammation resulting in histological misdiagnosis. Furthermore, chronic and autoimmune pancreatitis are associated with an increased risk for pancreatic cancer. Radial endosonography has become a markedly important method in the imaging of the pancreas. It has a crucial role in the diagnosis and staging of pancreatic cancer. The authors present three cases where the diagnosis of pancreatic cancer determined by conventional imaging techniques (abdominal ultrasound, computer tomography, endoscopic retrograde cholangiopancreatography) was excluded or confirmed by the radial endosonography. The authors conclude that radial endosonography is an essential complementary method among imaging techniques of the pancreas and in tumor staging. Application of that may prevent unnecessary surgeries, which is obviously useful for patients and cost effective for health care providers. Orv. Hetil., 2013, 154, 62–68.

scholarly journals Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

2020 ◽  
Author(s):  
Yoshio Sumida ◽  
Masashi Yoneda ◽  
Yuya Seko ◽  
Hiroshi Ishiba ◽  
Tasuku Hara ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
High Sensitivity ◽  
Cost Effective ◽  
Abdominal Ultrasound ◽  
Screening Tests ◽  
Nonalcoholic Fatty Liver

Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of hepatocellular carcinoma (HCC), liver-related mortality, and liver transplantation. There is reasonable epidemiological cohort data to recommend surveillance of patients with NAFLD based upon the incidence of HCC. The American Gastroenterology Association (AGA) expert review published in 2020 recommend that NAFLD patients with cirrhosis or advanced fibrosis estimated by non-invasive tests (NITs) should consider HCC surveillance. NITs include fibrosis-4 (FIB-4) index, the enhanced liver fibrosis (ELF) test, FibroScan, and MR elastography. The recommended surveillance modality is abdominal ultrasound (US) given that it is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with NAFLD. In NAFLD patients with a high likelihood of having an inadequate US or if US is attempted but inadequate, CT or MRI may be utilized. The GALAD score, consisting of age, gender, AFP, lens culinaris-agglutinin-reactive fraction of AFP (AFP-L3), and protein induced by vitamin K absence or antagonist-II (PIVKA-II), can help to identify high risk of incident HCC in NAFLD patients. Innovative parameters including Mac-2 binding protein glycated isomer , type IV collagen 7S, free apoptosis inhibitor of macrophage, combination of single nucleoside polymorphisms are expected to be established. Considering a large number of NAFLD population, optimal screening tests must meet several criteria including high sensitivity, cost effectiveness and availability.

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