Eff ect of ursodeoxycholic acid in postcholecystectomy cholestatic hepatopathy verified by ultrasonography

Summary: Cholestasis syndrome is accompanied by a large number of diverse liver and biliary tract diseases. Many cholestatic changes are fully reversible in the fi rst phase. However, with long-term cholestasis, extensive hepatocyte dysfunction occurs, the disease progresses, and many cholestatic syndromes result in irreversible liver damage and failure. Cholestatic liver diseases represent an important group of liver diseases that are an indication for liver transplantation. Postcholecystectomy syndrome is an imprecisely defi ned term, which includes a set of ongoing or recurrent or new diffi culties of patients after gallbladder surgery. We distinguish between early postcholecystectomy syndrome immediately in the postoperative period, or late postcholecystectomy syndrome, which occurs months or even years later. Ultrasonography is the fi rst imaging examination method for diseases of the liver and hepatobiliary system. It is a non-invasive method, available, relatively cheap, easily repeatable, and it does not represent a burden for the patient. Common bile duct dilatation after cholecystectomy is a common accidental fi nding that is inconclusive in the absence of clinical symptomatology and with normal laboratory fi ndings. Ursodeoxycholic acid forms the basis of cholestasis therapy, the only treatment whose effi cacy in cholestatic liver disease has been demonstrated in randomized and long-term studies. A further positive is that many years of ursodeoxycholic acid administration are not accompanied by more serious side eff ects. This case report supports the concept of a prompt and at the same time deepening benefi cial eff ect of ursodeoxycholic acid treatment in patients with cholestatic hepatopathy verified by ultrasonography indicated for conservative treatment or refusing invasive treatment. Key words: cholestasis – postcholecystectomy syndrome – ultrasonography – ursodeoxycholic acid

Groove Pancreatitis Associated with Transient Liver Injury Mimicking Ampullary Neoplasm

Groove pancreatitis is an unusual form of pancreatitis characterized by fibrous inflammation and pseudo-tumor in the area around the head of the pancreas. The underlying etiology is unknown but is strongly linked to alcohol abuse. We report a 52-year-old male smoker with hypertension, asthma, and alcohol abuse who was admitted with severe epigastric pain radiating to the back. He was found to have acute pancreatitis. A computed tomography scan of the abdomen showed a mass lesion in the peri-ampullary region. MRI of the abdomen revealed dilated common bile duct and duodenal mass and features suggestive of groove pancreatitis. During the hospital stay, bilirubin and liver enzymes started to rise and then decreased gradually to the previous normal range. The secondary workup for liver disease was unremarkable. The patient improved and was discharged. Six-month follow-up showed regression of the duodenal lesion and reduction in the common bile duct dilatation. Excluding malignancy remains the main challenge in managing groove pancreatitis, and a conservative approach is more reasonable in cases with a typical profile.

Post cholecystectomy common bile duct dilatation: a study from upper hills of Himachal Pradesh, India

Background: Relationship between cholecystectomy followed by postoperative dilatation of the common bile duct is uncertain. Various studies have shown variable results regarding the dilatation of common bile duct after cholecystectomy.Methods: This study was a 1-year prospective study conducted at IGMC, Shimla with consent and ethical approval from the committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in Surgical Wards of IGMC Shimla for elective surgery were selected for the present study. Cholecystectomy was done in all cases, after doing all the investigations.Results: The mean preoperative CBD diameter in the study group was 4.2mm, 48 hours postoperatively was 5.58mm and at 1-month interval following cholecystectomy was 6.02mm, so the mean postoperative diameter observed was (6.02+5.58=5.8mm).Conclusions: Significant dilatation does occur in CBD which is purely compensatory as there was no evidence of any pathological dilatation. This dilatation occur only in early post-operative period till the CBD adapts to contain bile equal to the Gall Bladder.