intrahepatic lithiasis
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Author(s):  
Flavio Tirelli ◽  
Paolo Mirco ◽  
Pietro Fransvea ◽  
Gilda Pepe ◽  
Andrea Tringali ◽  
...  

AbstractEndoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.


2021 ◽  
Vol 49 (7) ◽  
pp. 030006052110345
Author(s):  
Yi Zhu ◽  
Jinhai Li ◽  
Minjie Xie ◽  
Jing Jin ◽  
Jianying Lou

Objective Bilioenteric anastomotic stricture is a serious complication following choledochojejunostomy. Some patients develop intrahepatic lithiasis and biliary tract infection without dilation of the intrahepatic bile duct. The present study was performed to investigate the safety and efficacy of laparoscopy combined with choledochoscopy in patients with bilioenteric anastomotic stricture with access via the jejunal loops. Methods The data of 10 patients (7 men and 3 women; mean age, 60.8 ± 9.7 years; age range, 51–76 years) with potential bilioenteric anastomotic stricture without dilation of the intrahepatic bile duct from January 2015 to December 2019 were retrospectively reviewed. Results All 10 patients underwent surgery, and their clinical parameters were recorded. The mean surgery time was 181.5 ± 35.4 minutes, and the mean estimated blood loss was 32.0 ± 15.5 mL. No patients developed serious complications during the perioperative period. The short-term outcome analysis at 12 months indicated that the stenosis had been effectively dilated and that the liver function had improved. Conclusions The results of the present study demonstrated that laparoscopy combined with choledochoscopy with access via the jejunal loops is feasible in the treatment of bilioenteric anastomotic stricture and intrahepatic lithiasis.


2021 ◽  
Vol 180 (4) ◽  
pp. 82-85
Author(s):  
A. Yu. Korolkov ◽  
D. N. Popov ◽  
A. O. Tantsev ◽  
T. O. Nikitina ◽  
S. F. Bagnenko

A clinical case of surgical management of patient with biliodigestive anastomosis stricture complicated by multiple intrahepatic lithiasis is presented. The patient was 57 years old woman. Anamnesis of the disease: in 2016, biliodigestive anastomosis was performed due to iatrogenic damage of the biliary tract. She was admitted to the hospital with complaints of the right upper abdomen pain, accompanied by chills, jaundice, and fever up to 39°C. The examination revealed a stricture of a previously formed biliodigestive anastomosis complicated by multiple intrahepatic cholelithiasis. Surgical intervention was performed: at the first stage – percutaneous transhepatic cholangiostomy; at the second stage – laparotomy, separation of hepaticojejunoanastomosis, intraoperative cholangioscopy with lithoextraction, resection of a small bowel section with a Brownian anastomosis, post-colon hepaticojejunostomy on a disconnected loop and replaceable transhepatic drains (Smith-Praden-Saypol-Kurian).


2021 ◽  
pp. 305-311
Author(s):  
Fadi Rayya ◽  
Ehab Alhasan

Intrahepatic cholelithiasis, which is defined as stones proximal to the confluence of the hepatic ducts, is considered endemic in Southeast Asia. Its pathogenesis is not completely understood yet. A 19-year-old female was admitted to the hospital with a history of recurrent biliary pancreatitis. Abdominal ultrasound detected normal gallbladder while magnetic resonance cholangiopancreatography revealed lithiasis at the hepatic duct of liver segment V. After preoperative evaluation a typical segmentectomy was done. The postoperative period was uneventful and the patient was well at 6-month follow-up.


2021 ◽  
Author(s):  
C Correia ◽  
MJ Cardoso ◽  
N Almeida ◽  
M Duque ◽  
AG Agostinho ◽  
...  

2021 ◽  
Vol 10 ◽  
Author(s):  
Beihui Xue ◽  
Sunjie Wu ◽  
Minghua Zheng ◽  
Huanchang Jiang ◽  
Jun Chen ◽  
...  

BackgroundThis study was conducted with the intent to develop and validate a radiomic model capable of predicting intrahepatic cholangiocarcinoma (ICC) in patients with intrahepatic lithiasis (IHL) complicated by imagologically diagnosed mass (IM).MethodsA radiomic model was developed in a training cohort of 96 patients with IHL-IM from January 2005 to July 2019. Radiomic characteristics were obtained from arterial-phase computed tomography (CT) scans. The radiomic score (rad-score), based on radiomic features, was built by logistic regression after using the least absolute shrinkage and selection operator (LASSO) method. The rad-score and other independent predictors were incorporated into a novel comprehensive model. The performance of the Model was determined by its discrimination, calibration, and clinical usefulness. This model was externally validated in 35 consecutive patients.ResultsThe rad-score was able to discriminate ICC from IHL in both the training group (AUC 0.829, sensitivity 0.868, specificity 0.635, and accuracy 0.723) and the validation group (AUC 0.879, sensitivity 0.824, specificity 0.778, and accuracy 0.800). Furthermore, the comprehensive model that combined rad-score and clinical features was great in predicting IHL-ICC (AUC 0.902, sensitivity 0.771, specificity 0.923, and accuracy 0.862).ConclusionsThe radiomic-based model holds promise as a novel and accurate tool for predicting IHL-ICC, which can identify lesions in IHL timely for hepatectomy or avoid unnecessary surgical resection.


Author(s):  
Orlando Jorge M. Torres ◽  
Fabricio Ferreira Coelho ◽  
Antonio Nocchi Kalil ◽  
Marcos Belotto ◽  
Eduardo José B Ramos ◽  
...  

2020 ◽  
Vol 4 ◽  
pp. 41-41
Author(s):  
Francesco Ardito ◽  
Caterina Mele ◽  
Maria Vellone ◽  
Felice Giuliante

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