Bilioescroto secundario a bilioma retroperitoneal como presentación extremadamente rara de fuga biliar espontánea / Biliscrotum secondary to retroperitoneal biloma, as an extremely rare presentation of spontaneous bile leak

Objetivo. Presentar el segundo caso descrito en la bibliografía de bilioescroto secundario a bilioma retroperitoneal espontáneo y mostrar a su vez de manera escalonada el tratamiento que se le suministró hasta la resolución completa del cuadro. Caso clínico: Varón de 69 años que debutó con dolor escrotal derecho en relación con bilioescroto secundario a bilioma retroperitoneal espontáneo. Discusión: El bilioma retroperitoneal es un hecho poco habitual; generalmente se debe a complicaciones quirúrgicas o de procedimientos invasivos (intervencionismo radiológico, CPRE y esfinterotomía endoscópica), aunque puede ser consecuencia de roturas espontáneas de la vesícula o la vía biliar principal. La bilis en el retroperitoneo puede discurrir hasta el escroto, originando la rara entidad conocida como bilioescroto. Generalmente se presenta simulando una hernia inguinal incarcerada. No existe un manejo estandarizado de esta patología ya que está escasamente descrita.

Objective: To present the second case described in the literature of biliscrotum secondary to spontaneous retroperitoneal biloma and show a sequential treatment that we provided until complete resolution. Clinical case: We report the case of a man 69 years old, who debuted with right scrotal pain related to biliscrotum secondary to spontaneous retroperitoneal biloma. Discussion: The retroperitoneal biloma is a rare event, usually due to surgical or invasive procedures complications (radiological interventionism, ERCP and endoscopic sphincterotomy), although it may be the result of spontaneous rupture of the gallbladder or bile duct. Bile in the retroperitoneum may extend into the scrotum, causing the rare condition known as biliscrotum. Usually it occurs simulating an incarcerated inguinal hernia. Does not exist a standardized management of this condition because is poorly described.

Utilidad de la CPRE en el diagnóstico y manejo de las complicaciones biliares de la enfermedad hidatídica hepática / Endoscopic colangiopancreatography utility in the diagnosis and management of biliary complications of hepatic hydatid disease

Objetivo Presentar la experiencia sobre la utilidad de la colangiopancreatografía retrógrada endoscópica (CPRE) en el manejo pre- y postoperatorio de pacientes con hidatidosis hepática complicada. Material y método Serie de casos de carácter retrospectivo de 14 pacientes sometidos a CPRE en el Servicio de Cirugía y Endoscopía del Hospital Regional de Coyhaique, desde enero de 2005 a diciembre de 2014. En esta presentación se separan a los pacientes en los cuales la CPRE fue utilizada como diagnóstico de aquellos en los que se utilizó como manejo de la fístula biliar externa. Los pacientes después del alta fueron controlados al mes, 3, 6 meses, para posteriormente realizarlo anualmente. Resultados Hubo 5 pacientes sometidos a CPRE en el preoperatorio. El motivo de consulta fue ictericia y dolor. En todos se encontraron membranas hidatídicas las cuales fueron extraídas. Se realizó esfinterotomía en todos ellos y en solo uno se dejó endoprótesis. Cuatro pacientes fueron estabilizados y operados de manera programada y solo uno no requirió de intervención. En los 9 pacientes con fístula biliar externa, débito > 200 ml, se realizó CPRE en el postoperatorio. El tamaño promedio del quiste fue de 12 cm y 2/3 de ellos eran multivesiculares. La técnica realizada fue quistectomía parcial y en 4/9 se llevó a cabo mediante videolaparoscopía. La indicación de la CPRE se efectúo a los 20 días y el débito promedio fue de 498 ml/día. En todos se realizó esfinterotomía con instalación de endoprótesis. El cierre de la fístula biliar externa aconteció a los 28 días. El seguimiento promedio alcanzó los 6 años y no existió mortalidad en la presente serie. Conclusión Este estudio confirma que la CPRE es un procedimiento útil y seguro en el diagnóstico y tratamiento de las complicaciones biliares de la hidatidosis hepática.

Aim To report the experience with endoscopic colangiopancreatography (ERCP) in the pre and postoperative management of complicated liver hydatidosis. Material and methods Case series retrospective of 14 patients who underwent ERCP in the Department of Surgery and Endoscopy Regional Hospital of Coyhaique, from January 2005 to December 2014. In this presentation, patients are separated in whom ERCP was used as diagnosis of those in which was used as handling external biliary fistula. Patients after discharge were monitored per month, 3, 6 months later to realize it annually Results Five patients consulting for jaundice and pain were subjected to ERCP in the preoperative period. Hydatid membranes were found and extracted in all. A sphincterotomy was performed in all and an endoprosthesis was placed in one. Four patients were operated posteriorly and only one did not require surgery. On 9 patients with an external biliary fistula draining more than 200 ml/day, a postoperative ERCP was carried out. The mean sized of the cyst was 12 cm and two thirds were multi-vesicular. The surgical procedure was a partial cystectomy and in four it was laparoscopic. The mean output of fistulae was 498 ml/day. The ERCP was carried out in the twentieth postoperative day, performing a sphincterotomy and placing an endoprosthesis in all. Fistulae closed at 28 days. Patients were followed for six years and none died. Conclusions ERCP is safe and useful for the diagnosis and management of biliary complications of liver hydatidosis.

Accuracy of MRCP Compared to ERCP in the Diagnosis of Bile Duct Disorders

AIM: To determine the accuracy of Magnetic Resonance Cholangiopancreatography compared to the gold standard Endoscopic Retrograde Cholangiopancreatography in the diagnosis of bile duct disorders at our institution. PATIENTS AND METHODS: 52 patients with suspected pancreatobiliary pathology were included in this prospective observational study. MRCP was performed in the 24-hour period prior to the ERCP. RESULTS: MRCP had sensitivity; specificity; positive and negative predictive values of 87; 80; 83.3and 84.2respectively for choledocholitiasis which correlates well with results obtained in other parts of the world. CONCLUSION: At our institution; MRCP has high diagnostic accuracy for bile duct calculi. Due to a small study population; results for other biliary pathology were inconclusive

Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

Post cholecystectomy bile duct stricture, important factors influencing the outcome in Egypt

The aim of this paper was to define important factors affecting the results of treatment of the post cholecystectomy bile duct stricture, in Egypt. We managed 22 patients with bile duct stricture following cholecystectomy refered to Ain Shams University Hospital over 11 the past 6 years. On presentation, 20 patients [90.9%] had abnormal liver functions, 13 patients [59%] a low serum albumin, 12 [54.5%] associated portal hypertension and 8 [36.4%] had previous major infection. 18 patients [81.8%] operated on: 8 by stricture repair alone [no other procedure], 10 by stricture repair and gastrooesophageal devascularization. Of these patients treated by stricture repair alone 87.5% have good results with mean follow up of 2.8 years, and mortality of 12.5% [one patient], but in the presence of portal hypertension the mortality was 40% [4 patients]. Our conclusion was that, in Egypt; the most important single factor that increased the mortality was the presence of portal hypertension. Other important factors were the number of previous operations, the site of stricture, the history of major infection and the preoperative serum albumin concentration. All these factors should be taken in consideration on planing treatment. Non-operative endoscopic dilatation for bile duct stricture is worth-trial for those patients with portal hypertension