ABSTRACT
Chronic pancreatitis (CP) is defined by chronic inflammation of the pancreas with progressive replacement by fibrosis that produces characteristic morphological changes. The clinical picture is variable, being the main problem the pain and relapses of pancreatitis with possible local complications. Over time, the result is the development of exocrine and endocrine failure. In the initial phase, flare-ups of CP can not be distinguished from recurrent acute pancreatitis (RAP). If there are intraductal stones in the duct of Wirsung, endoscopic extraction of obstructive stones may be the first step to prevent new relapses and complications. We present the case of a patient with five episodes of acute pancreatitis (AP), three of them in the past five months. The patient was referred for study and management of RAP. His recent imaging study already showed dilatation of the main pancreatic duct, calcifications and pancreatic stones, compatible with CP. Although the hypertriglyceridemia participated in the etiology of AP, the last two episodes already occurred with normal values of triglycerides. Another possible etiologic factor was not found. His laboratory results did not show endocrine or exocrine insufficiency. The patient was treated with papillotomy, pancreatic stone extraction and installation of terapeutic pancreatic stent. He has been asymptomatic, free from new episodes of AP in the past six months. In conclusion, the CP is one of the possible causes of RAP. Endoscopic treatment by obstructive stone extraction is an efficient therapy to avoid new relapse.
La pancreatitis crónica (PC) se define por la inflamación crónica del páncreas con reemplazo progresivo por fibrosis que produce cambios morfológicos característicos. El cuadro clínico es variable, siendo el principal problema el dolor, reagudizaciones de pancreatitis con eventuales complicaciones locales. Con el tiempo, el resultado final es el desarrollo de insuficiencia exocrina y endocrina. En la fase inicial, no se puede distinguir las reagudizaciones de la PC de una pancreatitis aguda recurrente (PAR). Si se encuentran cálculos intraductales en el conducto de Wirsung, la extracción endoscópica de cálculos obstructivos puede ser el primer paso para prevenir nuevas recaídas y complicaciones. Se presenta el caso de un paciente con cinco episodios de pancreatitis aguda (PA), tres de ellos en los últimos cinco meses. El paciente fue derivado para estudio y manejo de PAR. Su estudio imagenológico reciente ya demostró dilatación del conducto pancreático principal, calcificaciones y cálculos pancreáticos, compatible con PC. Aunque la hipertrigliceridemia participó en la etiología de las PA, los últimos dos episodios ocurrieron con valores normales de triglicéridos. No se encontró otro factor etiológico posible. Su estudio de laboratorio no mostró insuficiencia exocrina ni endocrina. El paciente fue tratado mediante papilotomía, extracción de cálculos pancreáticos e instalación de prótesis pancreática terapéutica. Ha estado asintomático, libre de nuevos episodios de PA en los seis meses transcurridos. En conclusión, la PC es una de las posibles causas de PAR. El tratamiento endoscópico mediante extracción de cálculos obstructivos es una terapia eficiente para evitar nuevas recaídas.
Subject(s)
Humans , Male , Adult , Calculi/surgery , Endoscopy, Digestive System/methods , Pancreatitis, Chronic/prevention & control , Recurrence , Calculi/etiology , Calculi/diagnostic imaging , Pancreatitis, Chronic/surgery , Pancreatitis, Chronic/complications , Secondary PreventionABSTRACT
Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus.
Solid testicular lesions in young adults generally correspond to testicular cancer. Differential diagnosis should be done carefully.
In young adults with painful and solid testicular mass with hyperechogenic appearance on scrotal ultrasonography, testicular calculus must be kept in mind in differential diagnosis. Further reports on this topic may let us do more clear recommendations about the etiology and treatment of this rare disease.
Subject(s)
Humans , Male , Adult , Testicular Diseases/pathology , Calculi/pathology , Rare Diseases/pathology , Testicular Diseases/surgery , Testicular Neoplasms/diagnosis , Calculi/surgery , Orchiectomy , Rare Diseases/surgery , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .
OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .
OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .
Subject(s)
Child , Humans , Male , Calculi/complications , Dermoid Cyst/complications , Testicular Diseases/complications , Testicular Neoplasms/complications , Calculi/diagnosis , Calculi/surgery , Dermoid Cyst/diagnosis , Dermoid Cyst/surgery , Testicular Diseases/diagnosis , Testicular Diseases/surgery , Testicular Neoplasms/diagnosis , Testicular Neoplasms/surgeryABSTRACT
To present our experience in open poucholithotomy as a primary management of large orthotopic reservoir stone burden and discuss different management options. Records of men underwent radical cystectomy and orthotopic urinary diversion were retrospectively reviewed as regards pouch stone formation. Patients with large reservoir stone burden managed by open poucholithotomy were further selected. Large reservoir stone burden was encountered in 12 post radical cystectomy men. All underwent open poucholithotomy as a primary management of their reservoir stones. Median age at cystectomy was 46 [range: 32-55] years with a median total follow up period of 214.15 [range: 147-257] months and a median interval to stone detection of 99 [range: 63-132] months. The median stone burden was 5260 [range: 3179-20410] mm2. All patients were continent during the day while 5 showed nocturnal enuresis; 2 of them became continent after removal of the stones. Post poucholithotomy, all patients had sterile urine cultures except one who showed occasional colonization. None of the 12 patients showed stone recurrence after poucholithotomy. Two patients underwent revision of a dessuscepted nipple valve in association with stone removal. Open poucholithotomy for large reservoir stone burden is a feasible and safe option. It saves the reservoir mesentery and adjacent bowel. It allows complete removal of the stone[s] leaving no residual fragments. Furthermore, it permits correction of concomitant reservoir abnormalities
Subject(s)
Humans , Male , Cystectomy , Urinary Diversion , Retrospective Studies , Calculi/surgeryABSTRACT
Rhinoliths or nasal stones result from calcification of a nidus within the nasal cavity. Though nasal foreign bodies are not uncommon, rhinoliths are rare and are distinguished from intranasal foreign bodies by mineral deposition and encrustation. We report a case of a 30 year old lady with a thalassemia minor who was diagnosed to have a rhinolith by computerized tomography [CT] and underwent successful surgical removal of the lesion. CT scan of the paranasal sinuses is the radiological investigation of choice in this condition
Subject(s)
Humans , Female , Nose Diseases , Tomography, X-Ray Computed , Calculi/surgeryABSTRACT
Se presenta el caso de una paciente de 72 años que concurrió al servicio de ecografía del Hospital J. F. Muñiz, de la Ciudad de Buenos Aires, para evaluar una tumoración en la pared abdominal y descartar un derrame pleural. Presentaba como antecedente una cirugía laparoscópica, realizada 15 meses antes, y los resultados ecográficos presentaron colecciones originadas por el derrame de cálculos en la cavidad abdominal.
Subject(s)
Female , Aged , Humans , Calculi/surgery , Calculi/complications , Calculi/diagnosis , Calculi , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/statistics & numerical dataABSTRACT
The transoral route for removal of intraglandular submandibular stones was assessed in nine cases. The satisfactory results during the operation and the postoperative relief of symptoms and signs with no recurrence during follow up period favours the application of this approach in such situations contrary to the general agreement of the necessity of sialadenectomy
Subject(s)
Humans , Male , Female , Calculi/surgery , Follow-Up StudiesABSTRACT
Se presenta una serie de 82 casos de litiasis intrahepática primitiva. Esta alta cantidad rara en Occidente, se explica por tratarse en su mayoría de pacientes que han quedado con litiasis remanente y enviados para su extracción percutánea. Desde de 1964 hasta la actualidad (5.000 casos). Se analiza la etiopatogenia dando importancia capital a las estenosis prelitiásicas, presentes en el 80 por ciento, que se consiguieron dilatar en todos los casos y no recidivaron. De las 82, 16 fueron difusas, 52 del conducto hepático izquierdo y 14 del derecho. En casi todos la cirugía fue complementada con el tratamiento instrumental. Se hizo tratamiento percutáneo en 79 casos, 73 se realizaron por la vía transfistular y 6 por vía TPH. Se obtuvo un éxito global del 94 por ciento. Las complicaciones fueron del 17 por ciento y la mortalidad del 2,4 por ciento. No se realizó ninguna hepatectomía
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Calculi/surgery , Cholestasis, Intrahepatic/therapy , Liver/pathology , Catheter Ablation/statistics & numerical data , Calculi/diagnosis , Calculi/etiology , Cholangiography/statistics & numerical data , Retrospective StudiesSubject(s)
Humans , Male , Female , Colonic Diseases/diagnosis , Intestines/surgery , Urology , Calculi/surgery , Stomach/abnormalities , Jejunal Diseases/nursingSubject(s)
Humans , Male , Female , Pancreatitis/diagnosis , Cholelithiasis/nursing , Ampulla of Vater/abnormalities , Calculi/surgeryABSTRACT
Os autores apresentam um raro caso de enterolitíase em paciente com divertículo de Meckel, a mais comum anomalia congênita do trato gastrintestinal - ocorrendo em 1 por cento a 3 por cento da populaçao. Formaçoes de cálculos no interior dos divertículos sao observaçao muito rara. Discutem os achados clínicos, critérios diagnósticos e o tratamento.