Adenoma velloso del colédoco con transformación maligna hacia adenocarcinoma bien diferenciado / Coledochal vellous adenoma with malignant transformation

Informar el caso de una paciente de 55 años de edad con diagnóstico de adenoma velloso del colédoco con transformación maligna. Descripción del caso clínico y revisión de la literatura. Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes. Mérida-Venezuela. Se realizó operación de Whipple modificada obteniéndose diagnóstico histológico de adenoma velloso en colédoco con transformación maligna hacia adenocarcinoma bien diferenciado. El adenoma velloso del colédoco es una entidad clínica patológica inusual, y su abordaje puede verse dificultado por ser poco documentado. Obtener un diagnostico definitivo previo es necesario para realizar el procedimiento quirúrgico apropiado.

Complications of cholecystectomy in the era of laparoscopic surgery.

Both open and laparoscopic cholecystectomy are highly safe and effective procedures for patients with symptomatic cholelithiasis. Today, adverse outcomes after open cholecystectomy are limited to the elderly patients with comorbid conditions and complicated biliary tract disease. Though underreported, major biliary tract complications still occur, more so with laparoscopic cholecystectomy and continue to be the main cause of morbidity after cholecystectomy.

Endoscopic retrograde cholangiopancreatography in postcholecystectomy syndrome.

The study was aimed to determine the role of endoscopic retrograde cholangiopancreatography (ERCP) in patients with postcholecystectomy symptoms in respect to interval of presentation following cholecystectomy. 170 patients with postcholecystectomy symptoms and negative upper gastrointestinal endoscopy were evaluated using ERCP. One hundred and seventeen (75%) out of 156 patients with successful ERCP had one or more abnormalities seen at ERCP. Bile duct stones (55 patients), benign strictures of bile duct (27 patients) were the common lesions detected. A significantly higher (p < 0.001) positive diagnosis was possible at ERCP in patients presenting with jaundice (100%) as compared to those without jaundice (61.8%). Spectrum of causes among patients presenting in early post-operative period (< 1 month) was somewhat different from those presenting later. Bile duct ligature and biliary fistula were the predominant causes in the former group, while stones and benign strictures were commoner in the patients presenting late. Endoscopic sphincterotomy and stone removal was performed successfully in 25 out of 30 patients in whom it was attempted. ERCP was found to be a very useful procedure in the management of postcholecystectomy symptoms. Spectrum of underlying disease was different in patients presenting before 1 month following cholecystectomy as compared to those presenting later.

postcholecystectomy syndrome: a review

The objective is to study the Postcholecystectomy Syndrome [PCS]; its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome