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Biomedical subjects

K Mergener

Publications and source records attributed to K Mergener.

At least 37 records · Page 2Linked to original sources
PubMed1999

Endoscopic nasobiliary drain placement facilitates subsequent percutaneous transhepatic cholangiography.

BACKGROUND: Percutaneous biliary drainage is an established alternative to ERCP for managing bile duct obstruction. Although generally safe and effective, percutaneous drainage has its risks and is technically more difficult in patients with nondilated bile ducts. We report the use of nasobiliary drains and subsequent nasobiliary drain cholangiography to facilitate percutaneous biliary drainage by providing a target for accessing intrahepatic bile ducts. METHODS/RESULTS: Nine patients who were identified as requiring percutaneous biliary drainage underwent nasobiliary tube placement at completion of ERCP. Five of 9 patients had generalized intrahepatic ductal dilatation; in 4 patients, dilatation was focal or absent. Following nasobiliary drain cholangiography, percutaneous needle puncture of a bile duct was successful in all patients, in most cases with only a single puncture of the liver capsule. No procedural complications were encountered. CONCLUSION: Nasobiliary drain placement with subsequent nasobiliary drain cholangiography facilitates percutaneous biliary drainage and may be especially helpful in patients with nondilated intrahepatic bile ducts.

Catheterization↗
PubMed1999

Endoscopic treatment for acute biliary pancreatitis. When and in whom?

Worldwide, gallstones are the most common cause of acute pancreatitis, a disorder that ranges in severity from mild to life-threatening. How gallstones cause pancreatitis is hotly debated, as is the need for endoscopic decompression of the bile duct in sick patients. This article is a critical analysis of the existing data.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1999

A stone in a grossly dilated cystic duct stump: a rare cause of postcholecystectomy pain.

We describe the unusual case of a patient who developed recurrent right upper quadrant pain 25 yr after cholecystectomy. A cystic lesion containing a calculus was identified on transabdominal ultrasound, initially suggesting the possibility of gallbladder duplication. Endoscopic retrograde cholangiography identified this lesion as a massively dilated cystic duct stump. Surgical resection led to complete resolution of symptoms. Recurrent cholelithiasis involving the cystic duct stump may lead to massive dilatation, and must be considered in the differential diagnosis of postcholecystectomy syndrome.

Cholecystectomy↗
PubMed1998

Pseudo-Mirizzi syndrome in acute cholecystitis.

Common hepatic duct obstruction secondary to an impacted cystic duct stone is commonly referred to as the Mirizzi syndrome. Mirizzi syndrome is an uncommon cause of obstructive jaundice and can be mimicked by several other rare conditions. We describe a patient with a massively distended gallbladder due to acute cholecystitis who presented with clinical and cholangiographic findings simulating the Mirizzi syndrome. Endoscopists should be aware of acute cholecystitis as a possible etiology of common hepatic duct obstruction.

Aged↗
PubMed1997

Chronic pancreatitis.

Explore the source record for details and available documents.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

Dietl's crisis: a syndrome of episodic abdominal pain of urologic origin that may present to a gastroenterologist.

A 53-yr-old woman presented with a 2-yr history of recurrent episodes of severe abdominal pain and nausea. Multiple investigations by a general surgeon, a urologist, and a gastroenterologist failed to identify the cause. She was referred to our Biliary Service for ERCP and sphincter of Oddi manometry. However, a detailed history was inconsistent with biliary pain, and the patient, having discussed the risks and benefits, elected not to proceed with ERCP. The patient was asked to come to the hospital during an acute attack of her pain for assessment. When this was done, transabdominal ultrasound revealed right hydronephrosis; intravenous urography showed obstruction at the level of the ureteropelvic junction, consistent with the presence of an aberrant artery. The syndrome of episodic abdominal pain and hydronephrosis caused by extrinsic pressure from such an artery is known as Dietl's crisis. In our patient, the diagnosis was confirmed at surgery, when the ureteric obstruction was dealt with by pyeloplasty. She made an uneventful recovery and remains asymptomatic 12 months later. The keys to diagnosing Dietl's crisis are awareness of the entity, taking a detailed pain history, and timely cross-sectional abdominal imaging during an attack.

Abdominal Pain↗
PubMed1996

Carcinoid of the ampulla of Vater presenting as acute pancreatitis.

A 30-yr-old female with a carcinoid tumor of the ampulla of Vater is discussed. This rare tumor presented in an unusual fashion with isolated pancreatitis in the absence of cholestasis. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsies. Surgical removal led to complete resolution of symptoms. The importance of considering less common structural lesions such as ampullary carcinoids in the differential diagnosis of pancreatitis in patients without identifiable risk factors is stressed.

Acute Disease↗