ABSTRACT
A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction. BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.
Subject(s)
Biliary Tract , Carcinoma, Hepatocellular , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Fatal Outcome , Fistula , Hepatectomy , MortalityABSTRACT
The impairment of host defense mechanisms, particularly of cellular immunity, causes high incidence of mycobacterial infections in the patients with ESRD. Extrapulmonary mycobacterial infections are more frequent in ESRD patients compared to general population. However, there has been rarely reported on the occurrence of hepatic tuberculous abscess as an extrapulmonary mycobacterial infection in ESRD patients. We present a case of ESRD patient manifesting miliary tuberculosis and hepatic tuberculous abscess, which have successfully resolved after anti-tuberculous medications. A 44 years old male admitted with fever, general weakness, night sweating, and cough. Chest X-ray and abdominal CT revealed pulmonary miliary tuberculosis and a solitary tuberculous abscess at S7 of right hepatic lobe with multiple periportal and celiac lymphadenopathy. After the administration of anti-tuberculous medications(isoniazid, rifampicin, ethambutol - eight month, pyrazinamide - two month), miliary tubuculosis disappeared. The size of hepatic tuberculous abscess and lymphadenopathy were reduced in abdominal CT six month later. The patient is followed in outpatient without noticeable symptoms after eight month treatment.
Subject(s)
Adult , Humans , Male , Abscess , Cough , Defense Mechanisms , Ethambutol , Fever , Immunity, Cellular , Incidence , Kidney Failure, Chronic , Lymphatic Diseases , Outpatients , Pyrazinamide , Renal Dialysis , Rifampin , Sweat , Sweating , Thorax , Tomography, X-Ray Computed , Tuberculosis, MiliaryABSTRACT
No abstract available.
Subject(s)
Angioplasty , Budd-Chiari Syndrome , Heart Ventricles , StentsABSTRACT
PURPOSE: To determine the morphology and location of normal pancreatic tail, as seen on abdominal CT. MATERIALS AND METHODS: A hundred and one patients without pancreatic disease underwent CT scanning. We thendetermined how to relate the location of the pancreatic tail with the splenic hilum, left kidney, and pancreaticbody. We compared the thickness of the tail with that of the body and analysed of the morphology of the tail. RESULTS: Seventy-seven percent of all pancreatic tails were located below the splenic hilum, with 59% of thisproportion located located 1 to 2 cm below. Fifty percent of tails were located at the level of the uppermostquarter of the left kidney, and a further 27% at the level of the second quarter ; 75% were located in theventrolateral portion of this kidney and 23% in the ventral portion. In 48% of patients, the pancreatic tail andbody were the same thickness, and in a further 48%, the tail was thicker than the body. In 34% of patients, thetail showed focal bulging, and in another 32%, it tapered smoothly. Forty seven percent of tails were locatedbelow the pancreatic body and a further 37% were found at the same level as the body. CONCLUSION: Abdominal CTscans showed differing morphology and location of the pancreatic tail. The recognition of these variations willdiminish speculation as to their true nature.
Subject(s)
Humans , Kidney , Pancreatic Diseases , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To evaluate the usefulness of US-guided percutaneous gun biopsy through the left lobe of the liverwith compression for the diagnosis of diffuse hepatic diseases and prevention of post-biopsy complications. MATERIALS AND METHODS: In 35 patients with diffuse hepatic diseases, we performed US-guided percutaneous biopsy via the left lobe of the liver. After biopsy, we immediately applied an extrinsic hands-on compression maneuver at the biopsy site. The integrity of tissue architecture and numbers of portal triad visible in each specimen were histologically examined and post-biopsy complications were documented. RESULTS: A histopathologic diagnosis could be made in all patients except one(97.1%). Microscopically, no significant crush artifact or fragmentation was demonstrated in these 34 patients. The average number of portal triad per specimen was about 4.1. Although two patients complained of severe pain at the biopsy site, no serious post-biopsy complication was noted. CONCLUSION: US-guided percutaneous gun biopsy through the left lobe of the liver with compression appears to be an effective and safe procedure for the evaluation of diffuse hepatic diseases.