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At least 487 records · Page 27Linked to original sources
PubMed2001

[A voluminous vascular leiomyoma of the pancreas treated by personal technique of resection of the pancreatic head without duodenectomy].

A new technique variation of complete resection of the pancreatic head with preservation of the duodenum is described. The steps of this intervention are the partial mobilization of the duodenum, the mobilization of the gastric antrum, the section of the pancreatic neck and the complete resection of the pancreatic head with a meticulous dissection/section of the small blood vessels connecting the duodenum and the head of the pancreas. The terminal part of choledochus is removed with the specimen of the pancreas. The intervention is completed with cholecystectomy, end-to-side pancreaticojejunostomy, end-to-side choledocho-jejunostomy and side-to-side jejunojejunal anastomosis. The authors carried out this intervention on a 74-year old woman with a voluminous vascular leiomyoma of the pancreatic head. The patient, two years after the operation, is well with a normal clinical and laboratory follow-up.

Aged↗
PubMed2001

[Biliary tract reconstruction after cystectomy of congenital choledochal cyst].

OBJECTIVE: To evaluate the operative methods of biliary tract reconstruction after cystectomy of congenital choledochal cyst(CCC). METHODS: One hundred and six cases with CCC underwent cystectomy and biliary tract reconstruction in our hospital from July 1984 to December 1999 were followed up. Among them, there were three kinds of procedures in biliary tract reconstruction: with single Roux-Y hepaticojejunostomy in 48 cases, with intussusceptive valve to the line of Roux-Y hepaticojejunostomy in 37 cases, with rectangular valve to the line of Roux-Y hepaticojejunostomy in 21 cases. RESULTS: Fifty nine cases were followed up for 4.68 years in average. There were 3 cases with ascending cholangitis after single Roux-Y hepaticojejunostomy. And the symptom disappeared in 2 cases underwent reoperation with an intussueceptive valve plasty to the line of Roux-Y hepaticojejunostomy. No patients suffered from ascending cholangitis in the precautionary valve plasty group. CONCLUSION: It suggests that the postoperative ascending cholangitis can be prevented effectively if standard cystectomy and prophylactic intussusceptive valve added to the line of Roux-Y hepaticojejunostomy are carried out. The procedure should be performed as soon as possible providing the child is tolerable.

Adolescent↗
PubMed2000

[Value of the bilio-intestinal bypass in biliary disease in the Far East: retrospective study of 5 year experience at the Calmette Hospital of Phnom Penh (Cambodia)].

Gallstone disease in the Far East exhibits a number of special features regarding epidemiology and etiology as well as indications for and response to surgical treatment. Surgical bypass techniques seldom used for treatment of gallstone disease in the West can be highly effective in lowering complication and recurrence rates in oriental patients. The purpose of this retrospective report is to describe a 5-year experience with gallstone disease at the Calmette Hospital in Phnom Penh (Kingdom of Cambodia). After reviewing the main pathological features encountered, we describe the indications for the two bypass techniques used. Choledocoduodenostomy was used for frail, elderly patients while choledochojejunostomy was the treatment of choice and achieved excellent short, middle, and long-term results in younger patients.

Adult↗
PubMedDate not supplied

Routine testing of liver function after biliary-enteric anastomosis has no clinical relevance.

BACKGROUND/AIMS: Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim of this study was to investigate whether elevated liver function tests are associated with recurrent episodes of cholangitis. METHODOLOGY: Thirty-two patients, who received a biliary-enteric anatomosis for benign biliary disease were evaluated. Follow-up consisted of the patient's history, physical examination, determination of liver function tests, ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA. RESULTS: Median duration of follow-up was 45 months (range: 1-192) and liver function tests were elevated in 22 patients (69%) at some time during follow-up. Dilated intrahepatic ducts were found in 3 of 30 patients (10%), all of whom had elevated liver function tests at follow-up. Delayed passage from the liver was observed using scintigraphy in 10 (31%) of the patients. Seven patients (22%) experienced one episode of cholangitis and none experienced more than one episode. Multivariate analysis showed that male sex was an independent risk factor for elevated liver function tests (odds ratio: 10.9; P < 0.05). For cholangitis, no risk factors could be identified. CONCLUSIONS: It is concluded that elevated liver function tests are relatively common after a biliary-enteric anastomosis for benign biliary tract disease and are not predictive of the occurrence of cholangitis. We, therefore, recommend omitting routine laboratory screening for elevated liver function tests in the follow-up of a biliary-enteric anastomosis.

Adult↗
PubMedDate not supplied

Factors effecting the complications in the natural history of acute cholecystitis.

BACKGROUND/AIMS: Gangrenous cholecystitis, empyema, gallbladder perforation, and biliary peritonitis are severe complications of acute cholecystitis associated with increased morbidity and mortality. This study aimed to evaluate perioperative factors associated with complications of acute cholecystitis. METHODOLOGY: Between January 1993 and October 2000, we performed cholecystectomy in 368 patients with acute cholecystitis. All perioperative data were collected on age, sex, medical history, symptoms, laboratory tests, ultrasound, operative and microbiological findings, morbidity and mortality. RESULTS: There were 305 cases (83%) of acute uncomplicated cholecystitis, 26 (7.1%) of gangrenous cholecystitis, 23 (6.3%) of empyema of the gallbladder, 12 (3.3%) of gallblader perforation, and 2 (0.5%) emphysematous cholecystitis. Risk factors for complicated cholecystitis included male gender, advanced age, associated diseases, temperature above 38 degrees C, and white blood cell count on admission greater than 18,000. Laparoscopic cholecystectomy was attempted on 36 patients (11.8%) with uncomplicated and seven patients (11.1%) with complicated acute cholecystitis. The conversion rate to open cholecystectomy was 19.4% for uncomplicated cases, 28.6% for complicated cases. There were no differences in operative complications between complicated and uncomplicated cases, however, length of hospital stay, postoperative morbidity and mortality were significantly higher in complicated cases. CONCLUSIONS: Sex (male), advanced age, presence of associated disease, high temperature (> 38 degrees C) and leukocytosis are all remarkable risk factors inducing complications in acute cholecystitis. Laparoscopic cholecystectomy can be performed with success in uncomplicated cases.

Acute Disease↗
PubMed2001

[A case of hydatid cyst in the pancreatic head causing obstructive jaundice].

The patient (male; age = 69) was referred to the Department of 1st Surgery upon suspicion of obstructive jaundice. He was admitted to the Department of Internal Medicine with back pain, loss of appetite, and jaundice and some laboratory tests were performed. He has no history of alcohol use. During his physical examination, pain was noted in the upper right quadrant and the gall bladder was palpable and hydropic. A 22 mm. cystic structure with smooth contours was detected in the abdominal CT scan. An exploratory laparatomy was planned. During the perioperative cyst aspiration, the laminar membrane of hydatic cyst led to the probable diagnosis of hydatic cyst. Cholecystectomy, choledochoduodenostomy, partial cystectomy and capitonnage was performed. The patient was started on 800 mg/day albendazole during postoperative period and then was discharged.

Aged↗
PubMed2001

[Endoscopic choledochoduodenostomy].

Method of endoscopic choledochoduodenostomy was elaborated and introduced in clinical practice. Results of formation of endoscopic biliodigestive anastomosis in 12 patients for 1990-2000 yrs period were analyzed. In 7 (5.8%) patients complications occurred, 1 (0.8%) patient died.

Adenoma↗
PubMed1999

[Evaluation of therapeutic effects of portoenterostomy: reported of 426 cases].

OBJECTIVES: To investigate the selection of the types of anastomosis and to evaluate the therapeutic effects of portoenterostomy. METHODS: From 1993 to 1998, 426 patients with obstructive jaundice underwent portoenterostomy. The patients included 236 cases (56%) of hilar strictures in hepatolithiasis, 98 cases (23%) of end-stage periampullary tumors, 64 cases (15%) of proximal cholangiocarcinoma, and 28 cases (6%) of congenital choledochus cyst. Reconstruction of biliary tract was performed after resection of affected duct or palliative bypass for end-stage carcinoma. The types of anastomosis included extra or hilar hepatic bilioenterostomy (160 cases, 37%), and intra-hepatic duct anastomosis with different type of hepatectomy (266 cases, 63%), in which anastomosis was performed by round ligament approach (34 cases, 8%), and anastomosis through gallbladder fossa (15 cases, 4%). RESULTS: Short- and 1-6 year follow-up showed that jaundice of patients was completely relieved by suitable type of bilioenterostomy. CONCLUSIONS: The good therapeutic effects of bilioenterostomy are based on the correct selection of anastomosis methods.

Adolescent↗
PubMed2001

[Laparoscopic choledocholithotomy. Indications and methods of completion].

Modern views on diagnostic and medical algorithm using mini-invasive technologies for complicated cholelithic disease (CHLD) were summarized. Main indications and methods of the laparoscopic choledocholithotomy completion in 71 patients with choledocholithiasis were presented. Original, elaborated in the clinic methods were presented along with conventional diagnostic methods. Introduction of the proposed diagnostic-medical complex had permitted to improve the results of planned and urgent operations for complicated CHLD.

Adult↗
PubMedDate not supplied

Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

Adult↗
PubMedDate not supplied

Obstructive jaundice due to internal herniation: a case report and review of the literature.

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Treatment of major iatrogenic lesions of the bile ducts].

BACKGROUND: The appropriate treatment of major bile duct injuries is mandatory in order to avoid serious complications, such as bile peritonitis or secondary biliary liver cirrhosis. In the last fourty years, surgical, endoscopic or radiologic techniques of cure have been proposed, but in our opinions, the preferred option is given by Roux-en-Y choledochojejunostomy or hepaticojejunostomy. Creating an anastomosis on narrow bile duct could be difficult; in these really rare cases, the jejunal loop could be secured by a second suture to the hilar plate with satisfactory long-term results. PATIENTS AND METHODS: In the last four years, in our Institution, six patients underwent surgery for major bile duct injuries. A Roux-en-Y hepaticochojejunostomy was performed for all of them. Two patients had the jejunal loop secured to the hilar plate. RESULTS: Operative morality was nil, and long-term results at a mean follow-up of 20 months are encouraging. CONCLUSIONS: The prevention of major bile duct injuries remains the main target during cholecystectomy or surgery in the area of the hepatoduodenal ligament. In our experience, in general agreement with data from literature, bile reconstruction is best achieved by Roux-en-Y hepaticojejanostomy. In patients unsuitable for surgery, endoscopic balloon dilatation and stent positioning represent a satisfactory alternative.

Adult↗
PubMed2002

Congenital absence of the gallbladder and the cystic duct.

A 47 years old female with congenital absence of the gallbladder and the cystic duct was presented. The diagnosis was confirmed by exploratory laparatomy, common duct tube cholangiography, and ultrasonography. Most of the operated cases of congenital absence of the gallbladder are symptomatic, and they get relief after common duct exploration. Although the biliary tree is normal on inspection at exploration, it is believed that the symptomatology may have root in congenital abnormality of function. Treatment of the agenesis of the gallbladder as described in earlier days has been discussed. In the present situation, specially in a country like Ethiopia where long time care of internal drains is a worrisome problem, and a major point for concern, the author believes choledocho-enteric anastomosis to be a good solution.

Choledochostomy↗
PubMed2002

Biliary decompression reduces the susceptibility to ethanol-induced ulcer in jaundiced rats.

We investigated the gastric response to an ulcerogenic irritant and the change in gastric functions in an experimental rat model of obstructive jaundice, with or without biliary drainage. After biliary obstruction for 14 days, rats with ligated bile duct (BDL) were randomly divided into three groups: BDL group without biliary drainage, BDL followed by choledochoduodenostomy (CD) or a choledochovesical fistula (CVF). The gastric functions were evaluated 2 weeks after the surgery. Gastric damage, induced by orogastric administration of ethanol, was evaluated 30 min later using a lesion index and microscopic scoring was then performed on fixed stomachs. Basal gastric acid secretion was measured by the pyloric ligation method. The lesion index and maximum lesion depth did not differ in the BDL and sham groups, while they were significantly reduced in the CD group. Gastric acid output and secretory volume were reduced in the BDL group compared to the sham group, while these reductions were abolished in the CD group. Afferent denervation with capsaicin further reduced the ulcer index in the later group. Our data suggest that gastric mucosal susceptibility to injury is dependent on the normal flow of bile into the duodenal lumen, which appears to be a requirement for adaptive gastric cytoprotection.

Adaptation, Physiological↗
PubMed2002

Bile duct cancer 25 years after choledochoduodenostomy: a case report.

We describe a 65-year-old man who had undergone choledochoduodenostomy (CDS) for choledocholithiasis 25 years prior to admission to our hospital for cholangitis. Abdominal sonography and computerized tomography (CT) scan revealed a tumor mass at the hilar region with bilateral intrahepatic duct dilatation. Upper gastrointestinal endoscopic examination indicated the site of the CDS. Biopsy was taken from the mucosa of the bile duct, and pathology revealed well-differentiated adenocarcinoma. CT scan and angiography further confirmed unresectable hilar bile duct cancer. Conservative treatment with intra-arterial chemotherapy was arranged. After briefly reviewing the hypothesized pathogenesis and radiographic diagnosis of this rare case, we recommend that chronic cholangitis consequent to CDS should be closely followed for late development of biliary tract malignancy.

Aged↗