Íleo biliar: análisis de 21 casos / Gallstone ileus: analysis of 21 cases

RESUMEN Antecedentes : el íleo biliar es una complicación infrecuente de la litiasis vesicular, observada más comúnmente en mujeres añosas. Es causada por la migración, a través de una fístula bilioentérica, de un cálculo que produce la obstrucción del tránsito intestinal, que requiere tratamiento quirúrgico. Objetivo : describir las variables preoperatorias, intraoperatorias y posoperatorias de una serie de casos de íleo biliar y la incidencia de íleo biliar recurrente. Material y métodos: se realizó un estudio retrospectivo observacional de pacientes operados con abdomen agudo obstructivo por íleo biliar entre enero de 2009 y diciembre de 2021. Las variables estudiadas fueron: estudios por imágenes, comorbilidades, vías de abordaje quirúrgico, tipo de cirugía, morbimortalidad y recurrencia del íleo. Resultados : sobre 667 pacientes que ingresaron con obstrucción intestinal, 21 tenían íleo biliar (3,1%). El diagnóstico se realizó por tomografía en el 80% de los casos. El abordaje quirúrgico fue por laparotomía en 20 casos y 1 por laparoscopia convertida. La cirugía más utilizada fue la enterotomía con enterorrafia en 18 casos. El tratamiento de la obstrucción fue la cirugía inmediata, mientras que el de la fístula biliar fue diferido en la mayoría de las oportunidades, debido a que el riesgo de tratarla en el momento era muy elevado. La morbilidad fue del 38% y la recurrencia del íleo biliar 4,7%. No se registró mortalidad. Conclusión : el íleo biliar fue una patología infrecuente, que pudo ser correcta y oportunamente diagnosticada y tratada con cirugía, con una baja incidencia de íleo biliar recurrente.

ABSTRACT Background : Gallstone ileus is a rare complication of cholelithiasis and mainly affects elder women. It is caused by gallstone migration through a cholecystoenteric fistula producing bowel obstruction, with the need for surgical treatment. Objective : The aim of this work was to describe the preoperative, intraoperative and postoperative variables of a case series of gallstone ileus and the incidence of recurrent gallstone ileus. Material and methods : We conducted an observational and retrospective study of patients undergoing surgery due to acute bowel obstruction caused by gallstone ileus between January 2009 and December 2021. The variables analyzed were imaging tests, comorbidities, surgical approach, type of surgery, morbidity and mortality and recurrent ileus. Results : Of 667 patients admitted with bowel obstruction, 21 had gallstone ileus (3.1%). The diagnosis was made by computed tomography scan in 80% of the cases. The surgical approach was laparotomy in 20 cases and 1 patient undergoing laparoscopy required conversion. Enterotomy with enterorrhaphy was the most common procedure used in 18 cases. The obstruction was treated by immediate surgery, while the biliary fistula was deferred in most cases because the risk of immediate treatment was very high. Morbidity was 38% and recurrence of gallstone ileus 4.7%. No deaths were reported. Conclusion : Gallstone ileus was a rare condition that was correctly diagnosed and timely treated with surgery, with a low incidence of recurrent gallstone ileus.

Molecular mechanisms of hepatobiliary and pancreatic diseases in patients with inflammatory bowel disease / 临床肝胆病杂志

Inflammatory bowel disease (IBD) is a non-specific chronic intestinal inflammatory disease with unknown etiology and pathogenesis and is often accompanied by extraintestinal manifestations involving multiple organs including the liver, the gallbladder, and the pancreas, with an important impact on the prognosis of IBD. Hepatobiliary and pancreatic complications mainly include primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, IgG4-associated sclerosing cholangitis, acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and nonspecific increase in pancreatic enzyme. IBD-related hepatobiliary and pancreatic complications are caused by the combination of environmental and immune-mediated factors in individuals with genetic susceptibility, and this article summarizes the current research advances in the pathogenesis of such hepatobiliary inflammatory bowel disease;liver diseases;biliary tract diseases;pancreatic diseases;and pancreatic complications.

Significance of digital intelligent medical technology in preoperative evaluation of perihepatic hilar biliary tract diseases / 中国实用外科杂志

The digital intelligent medical technology such as three dimensional visualization, three dimensional printing,enhanced/virtual reality technology, indocyanine green molecular imaging are widely used in the clinical diagnosis and treatment of hepatobiliary and pancreatic diseases and showed a booming trend. Perihepatic hilar biliary tract diseases with complex anatomical structure, special physiological pathology character and lower efficiency of diagnosis and treatment are the major and difficult disease in the field of surgery. Efficient preoperative evaluation is the key to improve the efficiency of diagnosis and treatment. The digital intelligent medical technology can be used to obtain the comprehensive, individualized image diagnostic information,and comprehensive analysis the anatomy relations of the hepatic artery, portal vein, bile duct and lesions, and quantitatively measure the liver volume, formulate the reasonable operation scheme, determine the best approach of surgery, predict intraoperative injury risk and improve the surgical treatment effect.

Research advances of relationship between non-alcoholic fatty liver disease and biliary tract diseases / 中华肝脏病杂志

Recent studies have found that non-alcoholic fatty liver disease(NAFLD) has great impact on the development of biliary tract diseases. Here in this review, we summarized the relationship between NAFLD and the occurrence and development, risk factors and severity of cholestasis, gallstones, intrahepatic cholangiocarcinoma, primary biliary cirrhosis and bile microbiota, so as to further illuminate the pathogenesis of NAFLD and biliary tract diseases, obtain better diagnostic and therapeutic outcomes on NAFLD and biliary tract diseases.

Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis / Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis

Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

Evaluation of clinical efficacy of different medications for acute biliary colic / 临床肝胆病杂志

ObjectiveTo explore the clinical efficacy of several medications for acute biliary colic. MethodsTwo hundred and forty patients with acute biliary colic admitted to Beijing Anzhen Hospital from January 2012 to January 2014 were selected for retrospective analysis and randomly divided into four groups, namely raceanisodamine hydrochloride group (group A), phloroglucinol group (group B), tramadol hydrochloride (group C), and dezocine group (group D), with 60 cases in each group. The Visual Analogue Scale (VAS) score, clinical efficacy, and adverse reactions were compared between the four groups using analysis of variance for continuous data and chi-square test for categorical data. ResultsVAS scores were decreased significantly after the treatment in each group (P＜0.01) and the score in group D was the lowest (P＜0.01). In terms of time to pain relief, the time in group A was the longest, and that in group D was the shortest, with significant difference (P＜0.05). As for clinical efficacy, the overall response rate in group D was the highest, while that in group A was the lowest, with significant difference (P＜0.05). The incidence of adverse reactions in groups C and D was the lowest, while that in group A was the highest, with significant difference (P＜0.01). ConclusionThe clinical efficacy of dezocine and tramadol hydrochloride is better than that of raceanisodamine hydrochloride and phloroglucinol, and the former two are worthy of further clinical application.

Evaluation of clinical efficacy of different medications for acute biliary colic / 临床肝胆病杂志

ObjectiveTo explore the clinical efficacy of several medications for acute biliary colic. MethodsTwo hundred and forty patients with acute biliary colic admitted to Beijing Anzhen Hospital from January 2012 to January 2014 were selected for retrospective analysis and randomly divided into four groups, namely raceanisodamine hydrochloride group (group A), phloroglucinol group (group B), tramadol hydrochloride (group C), and dezocine group (group D), with 60 cases in each group. The Visual Analogue Scale (VAS) score, clinical efficacy, and adverse reactions were compared between the four groups using analysis of variance for continuous data and chi-square test for categorical data. ResultsVAS scores were decreased significantly after the treatment in each group (P＜0.01) and the score in group D was the lowest (P＜0.01). In terms of time to pain relief, the time in group A was the longest, and that in group D was the shortest, with significant difference (P＜0.05). As for clinical efficacy, the overall response rate in group D was the highest, while that in group A was the lowest, with significant difference (P＜0.05). The incidence of adverse reactions in groups C and D was the lowest, while that in group A was the highest, with significant difference (P＜0.01). ConclusionThe clinical efficacy of dezocine and tramadol hydrochloride is better than that of raceanisodamine hydrochloride and phloroglucinol, and the former two are worthy of further clinical application.

Role of Fully Covered Self-Expandable Metal Stent for Treatment of Benign Biliary Strictures and Bile Leaks

Endoscopic therapy by balloon dilation and placement of multiple large-bore plastic stents is the treatment of choice for benign biliary stricture. This approach is effective but it typically requires multiple endoscopic sessions given the short duration of stent patency. The endoscopic approach for treatment of bile leak involves the placement of a stent with or without biliary sphincterotomy. The self-expandable metal stent (SEMS) has traditionally been used for palliation of malignant biliary strictures given the long duration of stent patency owing to their larger stent diameter. Recently, SEMS has been used in a variety of benign biliary strictures and leaks, especially with the design of the covered self-expandable metal stent (CSEMS), which permits endoscopic-mediated stent removal. The use of CSEMS in benign biliary stricture could potentially result in a decrease in endoscopic sessions and it is technically easier when compared to placement of multiple plastic stents. However, complications such as cholecystitis due to blockage of cystic duct, stent migration, infection and pancreatitis have been reported. The potential subsegmental occlusion of contralateral intrahepatic ducts also limits the use of CSEMS in hilar stricture. Certain techniques and improvement of stent design may overcome these challenges in the future. Thus, CSEMS may be appropriate in only highly selected conditions, such as refractory benign biliary stricture, despite multiple plastic stent placement or difficult to treat bile duct stricture from chronic pancreatitis, and should not be used routinely. This review focuses on the use of fully covered self-expandable metal stent for benign biliary strictures and bile leaks.

Clinical analysis of bronchobiliary fistula: a report of 29 cases / 中华普通外科杂志

Objective To summarize the etiology,pathological mechanism, and the experience of diagnosis and treatment of bronchobiliary fistula (BBF). Methods Clinical data of 29 BBF patients admitted and operated on from 1976 to 2009 were analyzed retrospectively. Results Clinical menifestation included abdominal pain, chill and high fever,jaundice, hepatomegaly, chest distress, cough, hemoptysis,bilious cough, moist rale in the lower right lung or decreased or disapeared breath sound. Abdominal radiograph, chest X-ray, BUS, CT, PTC, MRCP and ERCP are helpful for localizing diagnosis. All the 29patients were surgically treated. 19 patients were treated by choledochotomy to extract common bile duct stones, T-tube drainage, liver abscess drainage, fistula excision and diaphragmatic repair. Three patients were treated by cholecystectomy, choledocholithotomy, and T-tube drainage. One patient underwent cholecystectomy, choledocholithotomy, and Roux-en-Y hepatojejunostomy. Three patients received liver abscess drainage, choledochotomy, T-tube drainage. 2 patients did subphrenic abscess drainage,choledochotomy, T-tube drainage. One patient complicating Oddi sphincter stenosis received liver abscess drainage, diaphragmatic repair, and Roux-en-Y hepatojejunostomy. 26 patients were cured. 3 patients died.Conclusions The etiology of BBF is obstruction related bilious tract infection leading to liver abcess and lung abscess. In the process of surgical treatment, relief of bilious tract obstruction, clearance of focal lesion and effective drainage of biliary tract are the mainstay of management.

Correlation between bile amylase elevation and biliary tract disease in patients with normal pancreaticobiliary junction / 中华消化内镜杂志

Objective To investigate the relationship between bile amylase (BA) elevation and biliary tract disease in patients with normal pancreaticobiliary junction (NPBJ). Methods The bile juice was collected from bile duct in 202 consecutive cases who underwent therapeutic endoscopic retragrade cholangiopancreatography (ERCP) for biliary diseases ( biliary bile group), and from gallbladder (GB) in 73 consecutive cases who underwent percutaneous transbepatic cholecystoscopy for extraction of GB stone ( GB bile group). In biliary bile group, in addition to the measurement of BA, the level of lipnse (n =68), bacteria culture ( n = 149 ), manometry of Oddi's sphincter ( n = 27 ) and bile duct ( n = 38) were also performed. In GB bile group, additional GB biopsy was taken in 31 cases. No patient with pancreaticobiliary maljunction, history of cholangiojejunostomy or post-endoscopic sphincterotomy was included in the study. Results In biliary bile group, BA level was elevated in 95 patients (47. 0% ), in which there was no significant difference between neoplastic and non-neoplastic cases ( 56. 9% vs. 43.7%, P > 0. 05 ), although BA was elevated in most patients with hiler cholangiocarcinoma (7/9). The level of BA was correlated with bile lipase (r =0. 561 ), but not with pressure of Oddi's sphincter or bile duct. No significant difference in positive rate of bile bacteria culture was detected between patients with normal BA level and those with elevated level. In GB bile group, BA level was elevated in 25 patients (34. 3% ), in which the frequency of GB epithelium dysplasia is 87.5%, which was significantly higher than that from patients with normal BA level ( P < 0. 001 ). Conclusion The patients with biliary tract disease and NPBJ have high incidence of reflux of pancreatic juice into bile duct. In patients with elevated BA level, there was no significant difference between incidences of neoplastic or non-neoplastic disease, while the frequency of GB epithelium dysplasia and hilar cholangiocarcinoma were higher than those from patients with normal BA level.

An Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: The Clinical Features and Endoscopic Treatment / 대한소화기내시경학회지

BACKGROUND/AIMS: An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified. METHODS: Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed. RESULTS: The mean age of the ten patients was 73 years (range: 38~84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment. CONCLUSIONS: An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically.

A comparison between endoscopic retrograde and magnetic resonance cholangiopancreatography for the diagnosis of biliary obstruction diseases / 中国基层医药

Objective To evaluate the value of magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of biliary obstruction diseases by comparison with endoscopic retrograde cholangiopancreatography (ER-CP). Methods A total of 36 patients with biliary obstruction diseases underwent both MRCP and ERCP. To review the images obtained from ERCP and MRCP ,the diagnosis were compared according to pathology. MRCP and ERCP in the diagnosis and treatment of biliary obstruction disease were analysed. Results 36 patients including 16 biliary tumors, 15 cholelithiases,and five other diseases were analysed. The diagnosis accuracy of MRCP and ERCP for bil-iary obstruction diseases were 86.1% and 91.7 %, there was no significant difference( P > 0.05). Conclusion MR-CP can accurately define the obstructively sites, identify the obstructive causes and is a noninvasive and reliable exam-ination for biliary obstruction diseases.

Comparison of pyogenic liver abscesses based on the origin of infection / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical features, radiologic findings, treatment modalities, and outcomes based on the origin of infection in patients with pyogenic liver abscesses. METHODS: We retrospectively analysed the medical records of 118 patients who were treated for pyogenic liver abscesses between January 2004 and December 2006. Of the 118 patients, 56 patients had biliary risk factors. RESULTS: The clinical characteristics were similar between the two groups, but the biliary risk group was characterized by an older age and the presence of jaundice. The size of the abscess was smaller in the group with biliary risk factors than in the cryptogenic group (p=0.02). Klebsiella pneumonia was the most common organism overall; however, Escherichia coli was more prevalent in the biliary risk group than in the cryptogenic group (p=0.03). Comparing the treatment modalities between the two groups, antibiotic therapy alone was more frequently used in the biliary group (p<0.01). The death rate was higher in the biliary group than in the non-biliary group (7.1 vs. 0.0%, p=0.04). The higher death rate in the biliary group was associated with multi-organ failure, absence of biliary drainage, and underlying diseases. CONCLUSIONS: There were differences between the two groups with respect to the size of the abscess, patient age, cultured organisms, and treatment modalities. The death rate was higher in the biliary group than the cryptogenic group.

A Bile Based Study of Clonorchis sinensis Infections in Patients with Biliary Tract Diseases in Ulsan, Korea

Stool examination is believed to be the most reliable method for detecting Clonorchis sinensis (CS) eggs. However, it has limited value for diagnosing clonorchiasis when the biliary tract is obstructed or when there is a light infection. We evaluated the infection states of CS in patients with biliary tract diseases using a bile sample. From January 2001 to August 2003, 238 patients who had undergone endoscopic biliary drainage were prospectively included in the study. The patients' bile samples were obtained directly from the nasobiliary drainage tube and then analyzed to detect CS eggs. The overall CS egg positive rate was 28.2% (35.4% in males, 19.4% in females). The egg positive rate was similar in all age groups examined: 26.7% in 30-39 years, 25.0% in 40-49 years, 24.4% in 50-59 years, 30.2% in 60-69 years, 35.3% in 70-79 years, and 25.0% in 80 years of age and over. There were no significant differences in the egg positive rate between the disease groups: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, and 26.4% in gallstone diseases. Our results show that the CS infection rate was very high, regardless of the age, gender, and type of diseases of the patients. Although the study population was limited to patients with biliary tract diseases, it is assumed that clonorchiasis is still an endemic disease in Ulsan, Korea.

A clinical study on liver abscess over a recent 10-year period / 대한내과학회지

BACKGROUND: The mortality of liver abscess has remained relatively constant during this century despite earlier diagnosis, treatment of underlying causes and more aggressive antibiotics therapy. The aims of this study were to evaluate the risk factors that associated with mortality of liver abscess. METHODS: This study was carried out retrospectively including 70 patients with liver abscess from January 1992 to August 2001. The clinical features, laboratory, imaging, and microbiologic findings, management strategy, and final outcome were studied, and prognostic factors were analyzed. RESULTS: There were 37 males and 33 females whose ages ranged from 17 to 89 years. The mean age of the patients was 57 years, and the male to female ratio was 1.1:1. In the major part of patients, the abscess was located in the right lobe (61.4%) and single in number (78.5%). Upper abdominal pain, fever and chills were the most common symptoms, and right upper abdominal tenderness was the most common physical findings. Twenty-six percent of patients were diabetic and 40%, 10% had biliary tract disease, malignancy on presentation, respectively. A hypoalbuminemia (

Infestation state of clonorchis sinensis in patients with pancreatobiliary diseases in ulsan: based on bile examination / 대한내과학회지

BACKGROUND: Bile examination is believed to be the most precise method for detecting Clonorchis sinensis (CS) eggs. We carried out bile examination to evaluate infestation state of CS in patients with pancreatobiliary diseases in Ulsan, known as an endemic area of CS infestation. METHODS: We examined CS eggs in bile in three hundreds and nine patients with pancreatobiliary diseases. The bile was obtained from endoscopic nasobiliary or percutaneous transhepatic biliary drainage tubes. RESULTS: The overall egg positive rate was 27.5% (35.3% in male, 17.6% in female). The egg positive rate was not significantly different according to the age group: 20.0% in thirties, 26.7% in forties, 24.2% in fifties, 29.9% in sixties, 36.2% in seventies and 16.7% in eighties or more. The egg positive rate according to the disease, except CS cholangitis, was not also statistically different: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, 11.1% in ampulla of Vater cancer, 24.0% in pancreatic cancer, 26.4% in gallstone diseases and 12.5% in the reminder. The location of gallstone and whether CS related diseases or CS unrelated diseases did not affect the egg positive rates. The egg positive rate in patients with normal radiological findings including cholangiography was 17.0%. CONCLUSION: This result shows that regardless of age, sex, and sorts of diseases, the infestation rate of CS was very high. On the basis of our results, it is therefore presumes that clonorchiasis is still endemic disease in Korea.

Venous thrombosis associated with psoas abscess: successful treatment with percutaneous drainage of abscess and antibiotics / 대한내과학회지

We report an unusual case of venous thrombosis complicated by pyogenic psoas muscle abscess in a patient with chronic biliary tract disease. A 64-year-old woman presented with high fever and progressive back and left flank pain. She had been admitted because of recurrent cholangitis and liver abscess 7 months ago. Both abscess and blood cultures had revealed Klebsiella pneumoniae and she had improved with treatment of antibiotics and percutaneous drainage of abscess. Computed tomography demonstrated psoas abscess and thrombosis of inferior vena cava and left iliac vein adjacent to abscess. Several days later, abscess culture showed Klebsiella pneumoniae. Because there was no evidence of deep vein thrombosis and the thrombosis was confined only to the vein adjacent to the abscess, we considered that the thrombosis would be associated with the abscess. She was immediately treated with percutaneous drainage of abscess and antibiotics. Follow-up computed tomography demonstrated complete disappearance of both psoas abscess and venous thrombosis.

Clinical Usefulness of Percutaneous Choledochoscopy in Biliary Tract Diseases

PURPOSE: This study was conducted to evaluate the clinical significance of choledochoscopy in biliary tract diseases. METHODS: We conducted a retrospective study of 291 patients who received choledochoscopy from October 1993 to December 1999. The indications of choledochoscopy were 259 cases of bile duct stones and 32 cases of benign and malignant biliary diseases: Klatskin tumor (n=10), intrahepatic cholangiocarcinoma (n=8), common bile duct cancer (n=6), hepatocellular carcinoma with bile duct invasion (n=2), and benign biliary stricture (n=6). The purpose of the choledochoscopy was 1) removal of bile duct stones, 2) differentiation between benign and malignant biliary diseases and 3) preoperative assessment of the extent and resectability of bile duct carcinoma. RESULTS: The success rate of complete stone removal was 80.1%, and the rate of recurrent biliary stones after a mean follow-up period of 24 months was 13.1%. The most common cause of a failure to remove the stones was biliary stricture. Differentiating between benign and malignant lesions, and the preoperative assessment of the extent and resectability of a bile duct carcinoma were accomplished by choledochoscopic observation followed by biopsy. The sensitivity in the diagnosis of malignant biliary diseases was 87%. The morbidity and mortality rates of choledochoscopy were 3.4% and 0%, respectively. With the exception of bile peritonitis due to tract rupture, any complications, such as cholangitis, bleeding, and pain, were conservatively managed. CONCLUSION: Our experience shows that choledochoscopyhas an important role in the diagnosis and therapy for benign and malignant biliary diseases and can be applied if indicated.