ABSTRACT
But : Evaluer la contribution de l'echographie au diagnostic du syndrome de cholestase extrahepatique chez l'adulte a Lome. Materiel et Methode : Etude prospective et descriptive sur une periode d'un an (janvier a decembre 2010) de 63 patients presentant une cholestase extra-hepatique ; et chez qui l'intervention chirurgicale; et/ou la tomodensitometrie puis l'evolution ont confirme ou infirme le diagnostic echographique. Resultats : Durant la periode d'etude; nous avons realise 2862 examens echographiques et 63 patients ont ete retenus pour l'etude; soit une frequence de 2;20. L'age moyen de nos patients a ete de 44 ans avec des extremes allant de 16 a 82 ans. L'echographie a retrouve une dilatation des voies biliaires intra et extra-hepatiques chez tous les patients (100); une distension de la vesicule biliaire dans 53;97. Les etiologies du syndrome de cholestase extra-hepatique etaient multiples a l'echographie : tumeur de la tete du pancreas (46;03); lithiase du chole-doque (19;05); faux kyste de la tete du pancreas (6;35); pancreatite aigue (4;76); pancreatite chronique calcifiante (3;17); adenopathies compressives (1;59) et le diagnostic etait errone a l'echogra-phie et corrigee par la tomodensitometrie et l'evolution apres chirurgie dans 19;05. Ainsi; elle apparait avec une sensibilite de 100 et une specificite de 80;95. Conclusion: L'echogra- phie est une methode d'imagerie qui demeure la plus disponible et la plus pratiquee dans les pays en developpement pour le bilan des icteres cholestatiques en attendant une meilleure accessibilite au scanner
Subject(s)
Adult , Choledocholithiasis , Cholestasis, Extrahepatic/diagnosis , Pancreatic Neoplasms , UltrasonographyABSTRACT
Background: This study was aimed at evaluating the trend and outcome of surgical management of choledocholithiasis in St. Paul Teaching Hospital Addis Ababa; Ethiopia. Methods: This was a clinical based retrospective analysis. The operation register was used to identify the cases that were operated for biliary lithiasis. Their clinical records were obtained from the record office of the hospital and data collected and recorded on a predesigned format. Data was analyzed by SPSS statistical software. Pearson's chi-square test was used for statistical analysis. P-value 0.05 was considered significant. Results: A total of 1230 underwent open cholecystectomy over 5 year period of which 98 patients where found to have choledocholithiasis constituting 7. Of the 98 patients who underwent common bile duct (CBD) exploration; the records of 78 patients were found and made the basis of this analysis. Fifty-nine (75.6) patients were females and 19(24.4) were males; with a male to female ratio 1: 3. The mean age was 49.15 years. The most common symptoms were right upper quadrant pain and jaundice. The most frequent physical findings was right upper quadrant tenderness. Choledocholithotomy with T-tube insertion was done in 39 patients; side to side choledochoduodenostomy in 34 patients; and hepaticojejunostomy in 5 patients. Twenty-four (71.6) choledochoduodenostomy patients were discharged in less than ten days after operation while 36(87.1) of those with T-tube were discharged after 10 days (p0.019). The re-operation rate was 12.8for the T-tube insertion group and 2.9for choledochoduodenostomy patients. There were 3(8.8) deaths in the former and 1(2.9) in the group of choledochoduodenostomy. The overall complication rate was 11 (30.6) for the T-tube insertion and 3 (8.8) for the choledochoduodenostomies. Conclusion: Choledochoduodenostomy is a better option than Choledocholithotomy with T-tube insertion in the treatment of choledocholithiasis in African setting. We recommend choledochoduodenostomy (CD) for multiple CBD calculi; big calculi in the CBD; much dilated CBD (2cm); primary CBD stones; hepatic stones; recurrent stones; and elderly patients where the size of the CBD is 15mm and above