Pseudotumor inflamatorio hepático, una entidad de difícil diagnóstico / Inflammatory pseudotumor of the liver: a condition hard to diagnose

RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

Colangitis biliar primaria. Parte 2. Actualización: diagnóstico, enfermedades asociadas, tratamiento y pronóstico / Primary Biliary Cholangitis. Part 2. State of the Art, Diagnosis, Associated Diseases, Treatment and Prognosis

La colangitis biliar primaria (CBP), es una colangiopatía crónica caracterizada por la destrucción selectiva de las células epiteliales biliares de conductos hepáticos de pequeño y mediano calibre, que afecta principalmente a mujeres. Los principales síntomas son la fatiga y el prurito, sin embargo, gran porcentaje de los pacientes pueden ser asintomáticos. El diagnóstico se basa en anticuerpos antimitocondriales (AMA) con títulos >1:40, fosfatasa alcalina >1,5 veces del límite superior normal por más de 24 semanas e histología hepática compatible con la patología. Se asocia con múltiples enfermedades principalmente de carácter autoinmune extra hepáticas, enfermedades tiroideas, óseas, entre otras. El tratamiento de primera línea es el ácido ursodesoxicólico (AUDC) que a pesar que no cura la enfermedad, mejora las pruebas del perfil hepático, así como el retraso en la progresión a cirrosis. Actualmente se encuentran en estudio nuevos tratamientos y terapias adyuvantes. El propósito de esta revisión es ofrecer una actualización de este tema que se presenta en los servicios de medicina interna y gastroenterología; para su realización se conformó un equipo interdisciplinar que desarrolló una búsqueda en la base Medline a través de PubMed con los tesauros correspondientes y se procedió a una lectura crítica y analítica de títulos, resúmenes y textos completos para el filtro, extracción y síntesis de la información encontrada

Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy characterized by a selective destruction of biliary epithelial cells of small and medium caliber hepatic ducts, which mainly affects women. The main symptoms are fatigue and pruritus, however, a large proportion of patients may be asymptomatic. The diagnosis is based on AMA titers >1:40, alkaline phosphatase >1.5 times the upper limit for more than 24 weeks and compatible liver histology. It is associated with multiple autoimmune diseases mainly extrahepatic, thyroid diseases, bone diseases, among others. The first line treatment is ursodeoxycholic acid (UDCA), that improves liver function tests and delay the progression to cirrhosis. Currently, there are new treatments and adjuvant therapies on study. The purpose of this review is to offer an update in this topic, which is very important in gastroenterology and internal medicine. We formed an interdisciplinary team to search in the data base Medline thorough PubMed with the keywords describe below, we made a critical lecture of the titles and abstracts of each article to write this paper

Colangitis biliar primaria. Parte 1. Actualización: generalidades, epidemiología, factores involucrados, fisiopatología y manifestaciones clínicas / Primary biliary cholangitis. Part 1. State of the art, epidemiology, physiopathology and clinical manifestations

La colangitis biliar primaria (CBP), es una colangiopatía crónica caracterizada por la destrucción selectiva de las células epiteliales biliares de conductos hepáticos de pequeño y mediano calibre, que afecta principalmente a mujeres. Los principales síntomas son la fatiga y el prurito, sin embargo, gran porcentaje de los pacientes pueden ser asintomáticos. El diagnóstico se basa en anticuerpos antimitocondriales (AMA) con títulos >1:40, fosfatasa alcalina >1,5 veces del límite superior normal por más de 24 semanas e histología hepática compatible con la patología. Se asocia con múltiples enfermedades principalmente de carácter autoinmune extra hepáticas, enfermedades tiroideas, óseas, entre otras. El tratamiento de primera línea es el ácido ursodesoxicólico (AUDC) que a pesar que no cura la enfermedad, mejora las pruebas del perfil hepático, así como el retraso en la progresión a cirrosis. Actualmente se encuentran en estudio nuevos tratamientos y terapias adyuvantes. El propósito de esta revisión es ofrecer una actualización de este tema que se presenta en los servicios de medicina interna y gastroenterología; para su realización se conformó un equipo interdisciplinario que desarrolló una búsqueda en la base Medline a través de PubMed con las palabras claves correspondientes y se procedió a una lectura crítica y analítica de títulos, resúmenes y textos completos para el filtro, extracción y síntesis de la información encontrada

Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy characterized by a selective destruction of biliary epithelial cells of small and medium caliber hepatic ducts, which mainly affects women. The main symptoms are fatigue and pruritus, however, a large proportion of patients may be asymptomatic. The diagnosis is based on AMA titers >1:40, alkaline phosphatase >1.5 times the upper limit for more than 24 weeks and compatible liver histology. It is associated with multiple autoimmune diseases mainly extrahepatic, thyroid diseases, bone diseases, among others. The first line treatment is ursodeoxycholic acid (UDCA), that improves liver function tests and delay the progression to cirrhosis. Currently, there are new treatments and adjuvant therapies on study. The purpose of this review is to offer an update in this topic, which is very important in gastroenterology and internal medicine. We formed an interdisciplinary team to search in the database Medline thorough PubMed with the key words describe below, we made a critical lecture of the titles and abstracts of each article to write this paper

Fístula coledocoduodenal / Choledochoduodenal fistula

La fistulas biliares internas son consideras una complicación poco frecuente de las enfermedad biliar y aún más raras del ulcus duodenal. Constituyen un hallazgo ocasional durante la colangiografía retrograda endoscópica durante el estudio de la enfermedad biliar recurrente. Se relaciona principalmente con la litiasis vesicular complicada. Puede afectar hasta un 2 por ciento del total de los pacientes con enfermedad biliar y se asocia a una mayor incidencia de carcinoma de este sistema. La localización más habitual es entre la vesícula y el duodeno (colecistoduodenal) en un 72 - 80 por ciento de los casos. La coledocoduodenal -la cual se relaciona con el caso a reportar- es de las menos frecuentes, la cual se encuentra solo en 3-5 por ciento. Se presenta a un paciente masculino de 44 años, operado hace 26 años de úlcera duodenal perforada. En octubre de 2015 debutó con íctero ligero, coluria y dolor en hipocondrio derecho, que impresionó hepatitis toxica, cuadro que recurrió en varias ocasiones. Durante el estudio realizado en su última crisis, se halló una fístula coledocoduodenal, se remitió a nuestro centro para tratamiento quirúrgico. Debido a lo infrecuente del caso, se decidió realizar revisión de la literatura actual y su presentación(AU)

Internal biliary fistulas are considered a rare complication of biliary disease and even rarer of duodenal ulcers. They are an occasional finding during endoscopic retrograde cholangiography during the study of recurrent biliary disease. It is mainly related to complicated vesicular lithiasis. It can affect up to 2 percent of all patients with biliary disease and is associated with a higher incidence of carcinoma in this system. The most common localization is between the gallbladder and the duodenum (cholecystoduodenal) in 72-80 percent of cases. The choledocoduodenal type, related to the case to be reported, is the least frequent, which is found in 3-5 percent of the cases. A case is presented of a 44-year-old male patient, operated 26 years ago for perforated duodenal ulcer. In October 2015, the patient debuted with light icterus, choluria and pain to the right hypochondrium, which seemed to be toxic hepatitis, a clincal frame that relapsed in several occasions. During the study performed in his last crisis, a choledochoduodenal fistula was found and he was referred to our center for surgical treatment. Due to the infrequent case, it was decided to review the current literature and its presentation(AU)

Primeras experiencias con drenaje biliar percutáneo de urgencia en la colangitis aguda / First experiences in performing urgent percutaneous biliary drainage for acute cholangitis

Introducción: la obstrucción biliar es motivo frecuente de morbilidad en los pacientes con metástasis hepáticas, adenopatías periportales y cáncer hepatobiliopancreático. La colangitis aguda es la complicación más temida, debido a su mortalidad. En este trabajo se presentan los primeros abordajes percutáneos realizados por cirujanos del Hospital Clínicoquirúrgico Hermanos Ameijeiras como herramienta para el tratamiento urgente de esta entidad. Objetivo: caracterizar el drenaje percutáneo transparietohepático de urgencia en pacientes con colangitis aguda e ictericia obstructiva. Métodos: se realizó un estudio descriptivo, prospectivo y aplicado con 30 pacientes atendidos de esta forma en dicha institución entre enero de 2008 y diciembre de 2010. Resultados: el diagnóstico etiológico preponderante fue el de tumor maligno de la cabeza del páncreas. La localización baja de la lesión duplicó a la localización alta. La mejoría clínica de la ictericia se evidenció en la mayoría de los pacientes después de una semana tras el procedimiento: el drenaje percutáneo constituyó el método definitivo en el 73,3 por ciento de los pacientes. Las edades medias para los distintos diagnósticos etiológicos exhibieron diferencias estadísticamente significativas. No hubo complicaciones ni mortalidad relacionadas con el procedimiento. Conclusiones: el drenaje biliar percutáneo guiado por ultrasonido es una herramienta útil y segura para el tratamiento de urgencia de la colangitis aguda. Es un método que pueden realizar los cirujanos generales con entrenamiento adecuado y específico, y tiene asociadas pocas complicaciones(AU)

Introduction: bile duct obstruction is a frequent source of morbidity among patients with liver metastasis, periportal lymph nodes and hepatobilopancreatic cancer. Acute cholangitis is the most feared complication because of its mortality. The present paper showed the first percutaneous approaches performed by surgeons in Hermanos Ameijeiras clinical and surgical hospital as a tool for treatment of this urgent complication. Objective: to characterize the urgent transparietohepatic bile drainage performed on patients with acute cholangitis and obstructive jaundice. Methods: this is a prospective, descriptive and applied study with 30 patients cared for in this institution from January 2008 through December 2010. Results: the most frequent etiology was malignancy of the pancreas head; the lower location of the lesion doubled the upper location. Most of the patients clinically improved their jaundice problems after one week of procedure. The percutaneous drainage was the definitive procedure in 73.3 percent of patients. Average ages for the various etiologic diagnoses showed statistically significant differences. There were no complications or death related with the procedure. Conclusions: US-guided percutaneous biliary drainage is a safe useful tool for the urgent treatment of acute cholangitis, it can be performed by general surgeons with specific adequate training and has few associated complications(AU)

Lemmel's Syndrome, an Unusual Cause of Abdominal Pain and Jaundice by Impacted Intradiverticular Enterolith: Case Report

Duodenal diverticula are detected in up to 27% of patients undergoing upper gastrointestinal tract evaluation with periampullary diverticula (PAD) being the most common type. Although PAD usually do not cause symptoms, it can serve as a source of obstructive jaundice even when choledocholithiasis or tumor is not present. This duodenal diverticulum obstructive jaundice syndrome is called Lemmel's syndrome. An 81-yr-old woman came to the emergency room with obstructive jaundice and cholangitis. Abdominal CT scan revealed stony opacity on distal CBD with CBD dilatation. ERCP was performed to remove the stone. However, the stone was not located in the CBD but rather inside the PAD. After removal of the enterolith within the PAD, all her symptoms resolved. Recognition of this condition is important since misdiagnosis could lead to mismanagement and therapeutic delay. Lemmel's syndrome should always be included as one of the differential diagnosis of obstructive jaundice when PAD are present.

Hemobilia como forma inusual de presentación en la enfermedad de Caroli / Hemobile as an unusual presentation form of the Caroli´s disease

La enfermedad de Caroli, o ectasia comunicante de las vías biliares intrahepáticas, es una entidad congénita, caracterizada por múltiples dilataciones saculares o quísticas de las vías biliares intrahepáticas. En este trabajo se hace presentación de un nuevo caso portador de enfermedad de Caroli. Se trata de una paciente de raza blanca, de 26 años de edad, con antecedentes de buena salud anterior, que ingresa por fiebre elevada de 39 ºC, hepatomegalia dolorosa e imágenes hipoecoicas en el hígado, detectadas en la ultrasonografia, con aminotransferasas hepáticas ligeramente elevadas. En el segundo ingreso sufre complicaciones febriles y de sangramiento digestivo alto por hemobilia importante, que compromete la hemodinamia y junto a la sepsis dan al traste con su vida. La paciente ingresa por crisis de colangitis y presentó un hemobilia importante que la llevó a complicaciones hemodinámicas, colangitis ascendente, y finalmente a sepsis generalizada como causa de muerte.

Caroli´s disease, or communicant ectasia of the intrahepatic biliary ducts, is a congenital entity, characterized by multiple saccular or cystic dilatations of the intrahepatic biliary ducts. In this work we present a new case of a carrier of Caroli’s disease. It deals with a female patient, aged 26 years, with antecedents of good health status, who entered the hospital with high fever of 39oC, painful hepatomegaly and hyper echoic images in the liver, detected in the ultrasonography, with slightly raised hepatic aminotranferases. During the second staying in the hospital she suffered fever complications and high digestive bleeding caused by important hemobile that compromised the hemodynamics and together with sepsis caused her to die. The patient entered the hospital because of cholangitis and presented an important hemobile leading her to hemodynamic complications, ascendant cholangitis, and finally a generalized sepsis as death cause.

A Case of Congenital Hepatic Fibrosis Presented with Recurrent Acute Cholangitis / 대한소화기학회지

Acute cholangitis usually develops in congenital hepatic fibrosis (CHF), accompanied by cystic dilated bile ducts. However, it can also develop in simple CHF and may lead to critical course. A 30-year old man presented with recurrent acute cholangitis without bile duct dilatation. He visited the hospital for febrile sense and abdominal pain in the right upper quadrant. He had been admitted several times for hepatosplenomegaly and cholangitis since childhood and received a liver biopsy 15 years ago. Abdominal computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed hepatosplenomegaly and a mildly dilated bile duct without stones or biliary cysts. His condition improved after conservative treatment. However, during a two-month follow up period, the patient experienced three episodes of acute cholangitis. A liver biopsy was performed and showed periportal fibrosis and intrahepatic ductular dysplasia, characteristics of congenital hepatic fibrosis. The periportal fibrosis and the infiltration of inflammatory cells were aggravated compared to 15 years ago. There was no evidence of hepatic cirrhosis. He was diagnosed with congenital hepatic fibrosis with recurrent acute cholangitis without intrahepatic duct dilatation, and conservatively treated with antibiotics.

Large common bile duct stones: evaluation of a therapeutic dilemma

Forty patients [16 males and 24 females] were admitted to the Gastrointestinal Surgery Unit of the Main Alexandria University Hospital. All patients were documented by ultrasound to have large common bile duct [CBD] stones 71=15 mm in largest diameter. To compare the success rate, complications and hospital stay of endoscopic and surgical techniques used in the treatment of large common bile duct stones. The patients were randomly divided into 2 groups [group A] underwent endoscopy and group [B] underwent surgical interference. Each group was 20 in number of patients. The commonest patient's manifestations were abdominal pain and jaundice [100%], 13 patients [33%] had attacks of cholangitis. The mean laboratory test values were insignificant between both groups. The diameter of the CBD stone by the ultrasound ranged from 15 mm to 31 mm in largest diameter with a mean of 18.4 +/- 3.882 mm. Endoscopic management was done successfully in 18 patients [90%] while 2 patients [10%] failed to he managed by endoscopic retrograde cholangio-pancreatography and ERCP and underwent surgical interference. Spontaneous passage of the stones immediately after endoscopic sphincterotomy occurred In 3 patients [15%], Balloon extraction was done in 7 patients [35%,] while Dormia basket was used in 4 patients [20%,]. ERCP failed in 2 patients [10%.]: one of them had very large CBD stone [31 mm] that is largest than the maximum size of the lithotripsy basket. In the second patient, the papilla was almost flat with rudimentary intraluminal part of the CBD that was difficult to cannulate after unsuccessful trial for 40 minutes. The complications occurred in group 2 patients [20%] in the form of cholangitis. The mean hospital stay of group [A] was 1.92 +/- 1.71. Surgical management was done succesfully in 19 patients [95%]. Supraduodenal choledochotomy and T-tube drainage was performed in 6 patients [30%]; one of them [5%] had missed stone and managed by ERCP. Choledocho-duodenostomy was performed in 12 patients [60%] while transduodenal sphincteroplasty was performed in one [5%] patient. Complications occurred in 5 patients [26.3%], which were more than group [A]; in the form of wound infection. biliary leakage hepatic encephalopathy or burst abdomen. Mean hospital stay of group [B] was 10.4 +/- 2.32 days was significantly longer than of group [A]. Post-endoscopic and post-operative tests showed significant decrease in the mean values of liver functions and enzymes. Ultrasonography was done to all successfully managed patients [2 weeks after intervention] and revealed complete clearance of the CBD. ERCP is usually successful in the management of large CBD stones. Hospital stay and complications of endoscopic management are much less than surgical management The surgeon should try endoscopic management of large CBD stones using all its techniques prior to resort to surgical management of large CBD stones

Resultados del tratamiento quirúrgico clásico de la colangitis aguda / Results of the classical surgical treatment of the acute cholangitis

La exploración quirúrgica de la vía biliar seguida de la instalación de una sonda de Kehr ha sido por años el tratamiento de elección de la colangitis aguda (CA) en los servicios de urgencia de nuestro país. El objetivo del presente estudio es mostrar y analizar los resultados de las cirugía clásica en el tratamiento de la CA. Se realizó una versión retrospectiva en base a protocolo tipo de 86 pacientes intervenidos con diagnóstico de CA entre enero de 2003 y diciembre de 2004 en el Hospital Clínico Regional de Valdivia. Los datos fueron analizados mediante planilla Excel. La serie está constituida por 56 pacientes de sexo femenino (65 por ciento) y 30 de sexo masculino (35 por ciento), con una edad promedio de 61.5 años (20-99). El 67 por ciento de los casos era de procedencia urbana. El 32.6 de los pacientes presentaba patología asociada, siendo la más frecuente la hipertensión arterial. El 69 por ciento de los enfermos se interviene dentro de las primeras 24 horas de hospitalización. El 86 por ciento de los casos presentó una colecistolitiasis causal que se resolvió durante el mismo acto quirúrgico. Hubo 5 casos de cáncer vesicular en la serie (5.8 por ciento). El promedio de días de hospitalización fue de 9.1 con rango de 4 a 44 días. Tres pacientes debieron ser reintervenidos, 2 por salida de la coledocostomía y 1 por eventración aguda. 15 pacientes (17.4 por ciento) presentaron complicaciones precoces, siendo la más frecuente la insuficiencia renal aguda. Hubo 3 casos de mortalidad operatoria (3.5 por ciento). Los pacientes mantuvieron en promedio la sonda Kehr por 34.7 días (12-189). El 87 por ciento de los pacientes se realizó la colangiografía ambulatoria. Hubo 7 casos de coledocolitiasis residual (8.1 por ciento), 3 salidas accidentales de la sonda T y 3 pacientes no asisten a control. Según nuestros resultados podemos afirmar que si bien el tratamiento quirúrgico clásico de la CA es efectivo, éste presenta una elevada morbimortalidad.

A Case of Portal Vein Thrombosis Associated with Acute Pancreatitis and Cholangitis / 대한소화기학회지

Portal vein thrombosis is a rare complication accompanied with acute pancreatitis or cholangitis/cholecystitis. The main pathogenesis of portal vein thrombosis in pancreatitis or cholangitis/cholecystitis are suggested to be venous compression by pseudocyst and an imbalance between the blood coagulation and fibrinolysis. In this case report, we experienced a 63 year old male who developed portal vein thrombosis later in the course of the treatment of acute gallstone pancreatitis with cholangitis/cholecystitis without any symptom or sign. The diagnosis of portal vein thrombosis was given on follow up CT scan and serum protein S activity was decreased to 27% in laboratory study. Immediate anticoagulation therapy with heparin and thrombolytic therapy with urokinase and balloon dilatation were performed. Despite the aggressive treatment, complete reperfusion could not be obtained. With oral warfarin anticoagulation, the patient showed no disease progression and was discharged. We report a case of portal vein thrombosis as a complication of acute pancreatitis and cholangitis/cholecystitis with a review of literatures.

A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis / 대한소화기학회지

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.

A Case of Congenital Hepatic Fibrosis Presented with Symptom of Acute Cholangitis / 대한소화기학회지

Congenital hepatic fibrosis (CHF) is an autosomal recessive disease, presenting principally in children or young adults with portal hypertension, and infrequently associated with cholangitis. It is associated with renal malformation and Caroli's disease. The diagnosis of CHF is usually confirmed by its typical histological features. Cholangitis is a severe and frequently fatal complication. We report a 22-year-old man with congenital hepatic fibrosis who showed the cholangitis without radiological features of cystic dilatation or stone of intrahepatic ducts.

Colangite aguda / Cholangitis acute

A colangite é uma afecção do trato biliar com significativa morbi-mortalidade associada. Muitos pacientes com colangite aguda respondem à antibioticoterapia. Entretanto, aqueles com a forma severa ou tóxica da doença usualmente não respondem, necessitando de drenagem biliar de emergência

Acute suppurative necrotizing pancholangitis. A case report

To present a case of ascending cholangitis with resulting necrosis of the biliary system with perforation. Clinical Presentation and Intervention: A 40-year-old male patient presented with upper abdominal pain, fever and jaundice assessed clinically and investigated by laboratory and radiological tests. Endoscopic retrograde cholangiogram and surgery were performed. However, because of extensive suppurative pancholangitis involving most of the intrahepatic radicles, sound surgical drainage could not be accomplished. Unfortunately, the patient died 2 days after surgery. In this case of severe cholangitis, endoscopic and surgical interventions were not successful and might have contributed to the worsening of the condition

Las alteraciones estructurales y funcionales hepáticas en las colangitis agudas / Hepatic structural and functional alterations in acute cholangitis

Con la finalidad de evaluar la relación entre la gravedad clínica de las colangitis agudas y las alteraciones anatómicas del hígado, los autores ponen a prueba un método de estimar la severidad de estos pacientes e investigar el rol patogénico y pronóstico de las alteraciones histopatológicas hepáticas se clasifican en grados de severidad creciente en relación a los daños parenquimatosos secundarios a la obstrucción biliar. Se analizan una serie de 130 pacientes de los cuales se seleccionaron 59 por protocolo. Las alteraciones anatomopatológicas se clasificaron en 4 grados de severidad creciente presentandose 22 por ciento como grado I, 27 por ciento como grado II, 50 por ciento como grado III, y 0 por ciento como grado IV, surgiendo las lesiones histológicas graves como un elemento pronóstico fundamental en la morbimortalidad de estos pacientes

Incidence of bacteremia in patients with opisthorchiasis during recurrent cholangitis.

A total of 257 haemocultures were performed in 50 patients with opisthorchiasis when they presented signs and symptoms of biliary tract infection. 19 patients showed positive haemoculture. There are no significant relationship between the age of the patient and the incidence of positive haemoculture. Septic shock occurred in 5 patients, one patient died. Out of 221 aerobic cultures, 14% were positive and of the 36 anaerobic cultures 11% were positive. The most common organism was Staphylococcus followed by Klebsiella and Bacillus spp. Anaerobic bacterias were Streptococcus spp. Clostridia spp. was not found in this study. Most organisms were sensitive to cefotaxime, cephalothin, kanamycin and chloramphenicol, and the least sensitive to ampicillin.

Adenomatosis del hepatocolédoco y ampulla / Adenomatosis of the hepatocholedocal duct ampulla

Se presentan 6 enfermos con obstrucción de la vía biliar extrahepática por adenomiosis. Esta patología se ubica en el grupo de los tumores epiteliais benignos, que obstruyen la vía biliar por la presencia intraparietal de cúmulos de conductos glandulares nodeados por un proceso inflamatorio crónico escleroso. Es una lesión de difícil diagnóstico clínico y operatorio donde la verdadera naturaleza la establece la anatomía patológica, que debe diferenciarlo del cáncer y páncreas aberrante