scholarly journals Manejo y diagnóstico del colangiocarcinoma formador de masa a propósito de un caso

2020 ◽  
Vol 50 (4) ◽  
Author(s):  
Rubén Muñoz Cedeño ◽  
Roberto Salazar Molina ◽  
Carlos Guachun Rocano ◽  
Gema Rodríguez Chica ◽  
Fabricio Vera Zapata
Keyword(s):  
Risk Factors ◽  
Epithelial Cells ◽  
Biliary Drainage ◽  
Metallic Stent ◽  
Imaging Studies ◽  
Endoscopic Retrograde ◽  
Elderly Female ◽  
Covered Metallic Stent ◽  
History Of ◽  
Low Incidence

Cholangiocarcinoma is a rare and aggressive adenocarcinoma that arises from epithelial cells of the biliary tract, the intrahepatic has a very low incidence worldwide < 10% in relation to extrahepatic patients. We present this case of an elderly female patient with no history of importance and risk factors that help us discern her etiology, imaging studies, therapeutic that were provided by the endoscopic retrograde cholangiopancreatography with the placement of 10 x 80 mm partially covered metallic stent for biliary drainage as a palliative measure.

scholarly journals Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jintao Guo ◽  
Siyu Sun ◽  
Xiang Liu ◽  
Sheng Wang ◽  
Nan Ge ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Ultrasound ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Metallic Stent ◽  
Endoscopic Retrograde ◽  
Primary Tumors ◽  
Covered Metallic Stent

Background and Study Aims.Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP.Patients and Methods.A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures.Results.Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3–21 months). No patient presented with stent migration.Conclusion.EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice.

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

scholarly journals Differential Diagnosis between the Varieties of Vasculitis Forms

2018 ◽  
Vol 6 (2) ◽  
pp. 1-8
Author(s):  
Joana Hankollari ◽  
Marsida Duli ◽  
Qamil Dika ◽  
Xhenila Duli ◽  
Indrit Bimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Blood Vessel ◽  
Specific Form ◽  
The Body ◽  
Imaging Studies ◽  
Patient Assessment ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Specific Symptoms

Vasculitis is an inflammation of the blood vessels. It can affect any blood vessel in the body by manifesting a variety of systemic, non-specific symptoms that make difficult the diagnosis of this pathology and especially its specific form. In front of any patient suspected of being affected by vasculitis, some questions are asked: Is the vasculitis or other pathology that camouflages, whether it is primary or secondary vasculitis, in which vessels this pathology extends, how can the diagnosis be confirmed and how can it be determined the type of vasculitis?The purpose of this study is to inform about the protocols to be followed to perform differential diagnosis of vasculitis types.This study is a review based on the research of world studies and literature regarding the recommendations for performing differential diagnosis among the variety of vasculitis forms.Primary patient assessment involves taking the history of the medications it uses, risk factors for infectious pathology, history of cardiac valve pathologies, and autoimmune pathologies. Then laboratory and imaging studies are carried out, aiming at setting the diagnosis, determining the affected organ and the degree of disease activity. And recently we refer to algorithms to make differential diagnosis between the varieties of vasculitis forms.Despite the diagnostic difficulties of vasculitis, the variety of its forms, the separation of responsibilities among many specialities, there are protocols that need to be followed rigorously to arrive at a safe diagnosis as well as auxiliary algorithms to distinguish the type of vasculitis.

scholarly journals Pneumoperitoneum after Endoscopic Retrograde Cholangiopancreatography due to Rupture of Intrahepatic Bile Ducts and Glisson’s Capsule in Hepatic Metastasis: A Case Report and Review of Literature

2017 ◽  
Vol 11 (3) ◽  
pp. 603-609
Author(s):  
Zubair Khan ◽  
Umar Darr ◽  
Mohamad Nawras ◽  
Muhammad Bawany ◽  
Jacob Bieszczad ◽  
...  
Keyword(s):  
Case Report ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Hepatic Metastasis ◽  
Bile Ducts ◽  
Pancreatic Neuroendocrine Tumor ◽  
Duodenal Perforation ◽  
Metallic Stent ◽  
Endoscopic Retrograde ◽  
Intrahepatic Bile Ducts ◽  
Covered Metallic Stent

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has been proven to be a safe and effective method for diagnosis and treatment of biliary and pancreatic disorders. Major complications of ERCP include pancreatitis, hemorrhage, cholangitis, and duodenal perforation. We report a third case in literature of pneumoperitoneum after ERCP due to rupture of intrahepatic bile ducts and Glisson’s capsule in a peripheral hepatic lesion. Case Report: A 50-year-old male with a history of metastatic pancreatic neuroendocrine tumor and who had a partially covered metallic stent placed in the biliary tree 1 year ago presented to the oncology clinic with fatigue, abdominal pain, and hypotension. He was planned for ERCP for possible cholangitis secondary to obstructed previously placed biliary stent. However, the duodenoscope could not be advanced to the level of the major papilla because of narrowed pylorus and severely strictured duodenal sweep. Forward-view gastroscope was then passed with careful manipulation to the severely narrowed second part of the duodenum where the previously placed metallic stent was visualized. Balloon sweeping of stenting was done. Cholangiography did not show any leak. Following the procedure, the patient underwent CT scan of the abdomen that showed pneumoperitoneum which was communicating with pneumobilia through a loculated air collection in necrotic hepatic metastasis perforating Glisson’s capsule. The patient was managed conservatively. Conclusion: In our case, pneumoperitoneum resulted from rupture of intrahepatic bile ducts and Glisson’s capsule in hepatic metastasis. This case emphasizes the need for close clinical and radiological observation of patients with hepatic masses (primary or metastatic) subjected to ERCP.

Risk factors associated with recurrent cholangitis in pancreatic and hepatobiliary cancers.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 428-428
Author(s):  
Apurva Jain ◽  
Juhee Song ◽  
Milind M. Javle ◽  
Marina C. George
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Acute Cholangitis ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Factors Associated ◽  
Increased Risk ◽  
Covered Metallic Stent ◽  
Significant Difference ◽  
The Mean

428 Background: Acute cholangitis due to malignant biliary obstruction is frequent in patients with pancreatic and hepatobiliary cancers. Recurrent cholangitis (RC) results in repeated hospitalization and delayed cancer care. The risk factors associated with RC are not yet defined. Methods: A pilot review was done on 146 patients admitted with a diagnosis of cholangitis from 2005 to 2014. We included demographics, cancer stage, details of first admission (FA) and interventions. Univariate and multivariate Fine-Gray models were used for statistical analysis. Results: The mean age at FA was 62 yrs, 84 (58%) were males and 99 (68%) were white. Most common cancer was pancreatic 100(69%) and 27(19%) pts had primary cholangitis at FA. During FA, interventions were performed in 114(78%), of whom 51 (45%) had percutaneous drainage (PTBD) and 63 (55%) had endoscopic drainage (ED). Readmission with cholangitis was noted in 35 (24%) cases. Univariate analysis did not show a difference between PTBD and ED. However, subgroup analysis showed external only PTBD and covered metallic stent ED had lower risk of RC. These variables remained significant on multivariate analysis (Subdistribution HR= 0.00, p<.0001 for both). Multiple previous PTBD (≥2) before FA was significantly associated with increased risk of RC (Subdistribution HR= 2.64, p= 0.01) on univariate analysis. Conclusions: Having multiple previous PTBD is associated with recurrent cholangitis. Though no significant difference was noted between PTBD and ED, the subgroups indicated a trend towards less recurrent cholangitis with covered metallic stent. [Table: see text]

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