Secondary biliary cirrhosis of the liver: case from clinical practice

Presents a clinical case of a patient developing secondary biliary cirrhosis due to prolonged extrahepatic cholestasis caused by cholelithiasis and the presence of choledocholithiasis, which is rare. The article describes the characteristics of secondary biliary cirrhosis of the liver. The course of the disease is considered, the data of laboratory and instrumental studies carried out on the patient in various clinics are analyzed.

Treatment of opisthorchial infestation in a patient who underwent orthotopic liver transplantation (clinical case)

The article describes a unique experience of repeated opistorchosis deworming in a patient who underwent orthotopic liver transplantation, which was required due to the development of complications of secondary biliary cirrhosis of parasitic etiology. Difficulties of differential diagnostics of hepatobiliary pathology, proceeding against the background of opistorchosis invasion, are discussed. The recent data on the parasitic morbidity in the territory of Khanty-Mansiysk Autonomous Okrug – Ugra is presented.

ELEVATED LIVER ENZYMES IN PATIENTS WITH ACUTE CHOLECYSTITIS

Liver damage in patients with gallstones is thought to be the result of chronic extra hepatic large bile duct obstruction with or without repeated episodes of cholangitis and may ultimately progress to secondary biliary cirrhosis (11).Hepatic viral infection is by no means the only cause of acute hepatitis (Chen etal, 2007). One sitting in which there may be an acute inflammation of the liver parenchyma is the presence of common bile duct stones and cholangitis

COVID-19 Infection Causing Liver Infarction, Severe Cholangiopathy, and Biliary Cast Syndrome

We present a patient with COVID-19 pneumonia with severe multi-organ failure who developed a liver infarction in the setting of acute illness and following recovery, had persistent cholestatic liver injury. On further evaluation, he was found to have a severe destruction of the intrahepatic bile ducts and biliary cast syndrome and ultimately, was felt to have severe ischemic cholangiopathy in the setting of recent COVID-19 infection. Because of the extent of destruction and persistent cholestasis, he is at risk of secondary biliary cirrhosis and is therefore undergoing a liver transplant evaluation. This case highlights a rare entity of liver infarction and severe cholangiopathy with biliary cast syndrome in the setting of COVID-19 infection. It is the first case of this reported to date, and its recognition in the presence of the COVID-19 pandemic is important. Keywords: Biliary cast, Cirrhosis, Cholangiopathy , COVID-19, Liver infarction.

Mucormycosis in a liver allograft after liver transplantation for secondary biliary cirrhosis due to bile duct injury

Introduction: Mucormycosis refers to a group of opportunistic mycoses that occur generally in immunocompromised patients and are caused by Mucorales, ubiquitous filamentous fungi with broad, thin-walled, sparsely septate, ribbon-like hyphae. Case report: A 57-year-old man with a history of secondary biliary cirrhosis due to inadvertent bile duct injury during cholecystectomy. He was referred to our center and underwent LT on June 2018. Due to severe coagulopathy he underwent exploratory laparotomy and abdominal packing for 48 hours. He recovered with good liver function and LFT´s with a tendency towards normalization. On post op day 8 the patient presented an episode of fever and a CT scan was performed showing a large zone of hypoperfusion with bubbles of gas in the liver dome. A percutaneous biopsy was taken for cultures. Preliminary results reported a filamentous fungus and liposomal amphotericin b was initiated with the suspicion of mucormycosis. The patient remained afebrile and asymptomatic. After 5 days of treatment a new image was performed, and progression of the lesion was noticed, due to these findings the patient was taken to the OR for surgical debridement. Involvement of the liver dome and diaphragm was noticed and a non-anatomic hepatectomy was performed. After surgery the patient required increasing amounts of vasopressors. Despite all the support he progressed to multiple organic failure and finally expired. The product of hepatectomy confirmed the diagnosis of mucormycosis (Rhizopus sp). Discussion: Despite all the efforts the patients’ clinical condition deteriorated after surgery showing the high mortality rate in liver transplant recipients that has been reported of 50 to 100%.

Bile Duct Injury- A Health and Financial Disaster

Bile Duct Injury (BDI) is an unfortunate complication of cholecystectomy, if not treated properly may result in the death of the patient due to biliary peritonitis and sepsis or may convert an otherwise healthy young person with a biliary cripple with benign biliary stricture (BBS), cholangitis, secondary biliary cirrhosis, portal hypertension & liver failure. A BDI, even after repair, adversely affects the quality of life and can be a financial disaster for the patient and a legal one for the surgeon. As BDI is associated with health & financial disaster, more attention needs to be paid both to prevent and to recognize early such injury. After recognition the patient should be referred to a surgeon experienced in the management of such injuries to avoid further complications. Journal of Surgical Sciences (2019) Vol. 23 (1) : 33-36