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1.
Alerta (San Salvador) ; 4(3): 113-109, jul. 29, 2021. ilus
Article in Spanish | LILACS, BISSAL | ID: biblio-1282938

ABSTRACT

Los quistes de colédoco son poco comunes, en los países occidentales se ha reportado una incidencia de 1 por cada 100 mil nacidos vivos. En países asiáticos, esta incidencia es mayor, 1 por 100 nacidos vivos. Son usualmente diagnosticados durante la infancia y en el 25 % de los pacientes se presentan durante su vida adulta. Es inusual que se presenten durante el embarazo, sobre todo, que se manifieste durante el primer trimestre. Se realizó un informe de caso con presentación inusual del cuadro clínico no causal, de una embarazada en su primer trimestre con sintomatología obstructiva, evolucionando a colangitis. se realizan exámenes de gabinete como ultrasonografía abdominal y exámenes de laboratorio revelando obstrucción, además de realizarse colangioresonancia y ultrasonografía endoscópica dando como resultado quiste de colédoco tipo 1C, se realiza drenaje. Posteriormente al alta hospitalaria, la paciente presenta nuevamente cuadro de colangitis, se realiza drenaje endoscópico, sin embargo, presenta aborto


Choledochal cysts are rare, in western countries an incidence of 1 per 100,000 live births has been reported. In Asian countries, this incidence is higher 1 per 100 live births. They are usually diagnosed during childhood and in 25 % of patients they present during their adult life. It is unusual for them to occur during pregnancy, especially during the first trimester. A case report was made with an unusual presentation of the non-causal clinical picture, of a pregnant woman in her first trimester with obstructive symptoms, evolving to cholangitis. Cabinet examinations such as abdominal ultrasonography are performed, resulting in type 1C common bile duct cyst. Drainage is performed After discharge from the hospital, the patient presents again with cholangitis, endoscopic drainage is performed, however, she has abortion


Subject(s)
Humans , Choledochal Cyst , Cholangitis , Common Bile Duct , Pregnant Women
2.
Rev. colomb. cir ; 36(2): 301-311, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1223994

ABSTRACT

Introducción. La coledocolitiasis es la presencia de cálculos en las vías biliares. En la mayoría de los casos se trata mediante la colangio pancreatografía retrógrada endoscópica y menos comúnmente por intervención quirúrgica laparoscópica. El objetivo de este estudio fue describir una cohorte retrospectiva de pacientes sometidos a exploración laparoscópica de la vía biliar. Métodos. Se incluyeron pacientes intervenidos entre los años 2014 y 2018, en dos instituciones de nivel III en Cali, Colombia, referidos para valoración por cirugía hepatobiliar, por dificultad para la extracción de los cálculos por colangio pancreatografia retrograda endoscópica, debido al tamaño, la cantidad, o la dificultad para identificar o canular la papila duodenal. Resultados. De los 100 pacientes incluidos, se encontró que el 72 % fueron mujeres, con rango de edad entre 14 y 92 años. Al 39 % de los pacientes se les extrajo un solo cálculo y al 16 % 10 cálculos. Un 12 % presentaron cálculos gigantes (mayores de 2,5 cm de ancho) y un 44 % presentaron litiasis múltiple. Al 69 % de los pacientes se les realizó colecistectomía. El porcentaje de éxito de limpieza de la vía biliar por laparoscopia fue del 95 %.Discusión. La exploración laparoscópica de la vía biliar es una técnica posible, reproducible, segura y con excelentes resultados para el manejo de la coledocolitiasis


Introduction. Choledocholithiasis is the presence of stones in the bile ducts. In most cases it is treated by endoscopic retrograde cholangio pancreatography and less commonly by laparoscopic surgery. The objective of this study was to describe a retrospective cohort of patients who underwent laparoscopic exploration of the bile duct.Methods. The study included patients operated between 2014 and 2018, in two level III institutions in Cali, Colombia, referred for evaluation for hepato-biliary surgery, due to difficulty in removing stones by endoscopic retrograde pancreatography cholangiography, due to the size, quantity, or difficulty of identifying or cannulating the duodenal papilla. Results. Out of the 100 patients included, it was found that 72% were women, with an age range between 14 and 92 years. A single stone was removed from 39% of patients and 10 stones from 16%; 12% had giant stones (greater than 2.5 cm wide), and 44% had multiple stones; 69% of the patients underwent cholecystectomy. Laparoscopic bile duct cleaning success rate was 95%. Discussion. Laparoscopic exploration of the bile duct is a possible, reproducible, and a safe technique with excellent results for the management of choledocholithiasis


Subject(s)
Humans , Common Bile Duct , Minimally Invasive Surgical Procedures , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy , Choledocholithiasis
3.
Rev. colomb. cir ; 36(2): 324-333, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1223998

ABSTRACT

La colecistectomía laparoscópica es uno de los procedimientos más realizados a nivel mundial. La técnica laparoscópica se considera el estándar de oro para la resolución de la patología de la vesícula biliar secundaria a litiasis, y aunque es un procedimiento seguro, no se encuentra exenta de complicaciones. La complicación más grave es la lesión de la vía biliar, que, aunque es poco frecuente, con una incidencia de 0,2 a 0,4%, conduce a una disminución en la calidad de vida y contribuye a un aumento en la morbi-mortalidad. El objetivo de este artículo es reportar nuestra técnica quirúrgica, enfatizando los principios del programa de cultura para una colecistectomía segura, propuesta y descrita por the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), para minimizar los riesgos y obtener un resultado quirúrgico satisfactorio


Laparoscopic cholecystectomy is one of the most performed procedures worldwide. The laparoscopic technique is considered the gold standard for the resolution of gallbladder pathology secondary to lithiasis, and although it is a safe procedure, it is not without complications. The most serious complication is the injury to the bile duct, which, although rare, with an incidence of 0.2% to 0.4%, leads to a decrease in quality of life and contributes to an increase in morbidity and mortality. The objective of this article is to report our surgical technique, emphaszing the principles of the program for a safe cholecystectomy, proposed and described by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), to minimize the risks and obtain a satisfactory surgical result


Subject(s)
Humans , Cholecystectomy, Laparoscopic , Minimally Invasive Surgical Procedures , Common Bile Duct , Patient Safety , Intraoperative Complications
6.
Rev. colomb. gastroenterol ; 35(4): 527-532, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156335

ABSTRACT

Resumen El tratamiento actual para la obstrucción biliar maligna es la derivación biliar no quirúrgica con propósito paliativo. La cirugía tiene indicaciones específicas en pacientes con patología maligna con propósito curativo. Sin embargo, la obstrucción duodenal y del conducto biliar intra o extrahepático no dilatado hace que esta cirugía y el procedimiento endoscópico guiado por ultrasonografía endoscópica (USE) sean difíciles de realizar. Presentamos nuestra experiencia con el primer caso en Colombia, un país latinoamericano del tercer mundo. Consistió en una colecistogastrostomía guiada por USE, a partir de la utilización de una endoprótesis luminal (Lumen-apposing metal stents, LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos) de 15 mm × 10 mm, en un paciente masculino con cáncer pancreático inoperable e invasión duodenal con conducto colédoco dilatado. La colecistogastrostomía guiada por USE podría ser considerada como una opción de más importancia para la descompresión biliar que el drenaje percutáneo, ya que es superior en términos de viabilidad técnica, seguridad y eficacia en casos específicos de estenosis ampular e invasión duodenal. Además, puede ser realizada en países del tercer mundo, cuando se cuenta con el entrenamiento y los instrumentos adecuados. La endoprótesis metálica totalmente recubierta, aplicada a luz (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos), es ideal para la colecistogastrostomía guiada por USE, a fin de minimizar complicaciones como fugas biliares. Se necesitan estudios comparativos adicionales para validar los beneficios de esta técnica.


Abstract The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent. The surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia, a third-world country in Latin America, of a cholecystogastrostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) 15 mm × 10 mm. EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.


Subject(s)
Humans , Male , Aged , Pancreatic Neoplasms , Therapeutics , Bile Ducts, Extrahepatic , Common Bile Duct , Endosonography , Methods , Drainage , Efficacy , Decompression
7.
Rev. argent. cir ; 112(4): 398-406, dic. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1288148

ABSTRACT

RESUMEN Anteriormente, cuando se diagnosticaba litiasis en la vía biliar, el procedimiento consistía en una co lecistectomía, coledocotomía, extracción de los cálculos y colocación de un drenaje de Kehr. En otros casos se podía hacer papiloesfinteroplastia o una derivación biliodigestiva. Actualmente tenemos mu chas herramientas diagnósticas y terapéuticas como la colangiorresonancia, la pancreatocolangio grafía retrógrada endoscópica, la cirugía laparoscópica de la vía biliar, la ecoendoscopia y la ecografía intraoperatoria. Los procesos de decisiones son más complejos y sin un sustento con evidencia con cluyente. Tenemos estudios que enfocan parceladamente el tema, por lo que, dependiendo de si el diagnóstico se hace antes o durante la colecistectomía laparoscópica, el cirujano empleará su sentido común individualizando cada caso. El manejo ideal de la litiasis de la vía biliar sigue siendo motivo de controversia. Decidir por un manejo endoscópico, laparoscópico o convencional requiere logística, entrenamiento y juicio clínico adecua dos. La cirugía convencional sigue siendo una opción vigente.


ABSTRACT Previously, when a surgeon diagnosed bile duct lithiasis, he/she performed cholecystectomy, chole docotomy, stone removal and placement of a Kehr's "T" tube. Some cases might require sphinctero plasty or bilio-digestive bypass. Nowadays, magnetic resonance cholangiopancreatography, endosco pic retrograde cholangiopancreatography, endoscopic ultrasound and intraoperative ultrasound have emerged as diagnostic and therapeutic tools. Decision-making processes are complex and there is no conclusive evidence supporting them. Many studies have focused on the matter with a non-compre hensive approach so that each surgeon will use his/her common sense for each individual case. The optimal management of the common bile duct is still controversial. Deciding on endoscopic, lapa roscopic or conventional management requires adequate training and clinical judgment. Conventional surgery is still in valid option.


Subject(s)
Common Bile Duct/surgery , Lithiasis/surgery , Bile Ducts , Choledochostomy , Cholecystectomy , Cholangitis/surgery , Lithiasis/therapy
8.
Article in English | WPRIM | ID: wpr-787233

ABSTRACT

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Subject(s)
Abdominal Wall , Aged , Bile Ducts, Extrahepatic , Biopsy , Catheter Ablation , Catheters , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystectomy , Cholecystitis , Common Bile Duct , Cystic Duct , Drainage , Ethanol , Fever , Gallbladder , Humans , Male , Mesentery , Mucous Membrane , Nausea , Necrosis , Palliative Care , Quality of Life , Stents , Tomography, X-Ray Computed
9.
Rev. colomb. cir ; 35(1): 57-65, 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1095474

ABSTRACT

Introducción. La colangiopancreatografía retrógrada endoscópica es la herramienta de elección para el manejo de una gran cantidad de enfermedades pancreáticas y biliares. Al ser un procedimiento invasivo, trae consigo riesgos que aumentan la morbimortalidad en los pacientes en quienes se practica. El objetivo de este estudio fue analizar las complicaciones más prevalentes relacionadas con el procedimiento, de los pacientes de una institución de tercer nivel de Medellín, entre los años 2014 y 2017.Métodos. Se presenta un estudio observacional, retrospectivo y analítico. Se analizaron las historias clínicas de los pacientes sometidos a colangiopancreatografía retrógrada endoscópica con diagnóstico de enfermedades biliares y pancreáticas. La información fue analizada usando estadística descriptiva e inferencial, mediante análisis univariado y multivariado, y se calculó la razón de momios (odds ratio, OR) con un intervalo de confianza del 95 %; se tomó como significativo un valor de p inferior a 0,25 en los análisis bivariados.Resultados. En los 1.546 pacientes sometidos a colangiopancreatografía retrógrada endoscópica, la edad promedio fue de 57,6 ± 19.3 años y el 59,1 % eran mujeres. Las complicaciones identificadas fueron: pancreatitis en 57 pacientes (3,7 %), sangrado en 28 (1,8 %), perforación en 8 (0,5 %) y mortalidad no discriminada de 42 pacientes (2,7 %). Como factores de riesgo con significancia estadística, se encontraron la papilotomía y el contraste del conducto de Wirsung (OR=3 y OR=3,55, respectivamente).Discusión. Los resultados obtenidos se encuentran en concordancia con los de la literatura mundial, con tasas de complicaciones y mortalidad similares. Por otra parte, el perfil sociodemográfico de la población de estudio difiere de las cifras internacionales, con predominancia de la enfermedad estudiada en edades mayores y con mayor cantidad de comorbilidades


Introduction: Endoscopic retrograde cholangiopancreatography is the tool for the management of a large number of pancreatic and biliary diseases. Being an invasive procedure, it brings risks that increase morbidity and mortality in patients in whom it is practiced. The objective of this study was to analyze the most prevalent complications related to the procedure of the patients of a third level institution in Medellin between 2014 and 2017.Methods: An observational, retrospective and analytical study is presented. The information was analyzed using descriptive and inferential statistics, by univariate and multivariate analysis, and the odds ratio (odds ratio, OR) was calculated with a 95% confidence interval; a value of p less than 0.25 was taken as significant in the bivariate analyzes. Results: In the 1,546 patients who underwent endoscopic retrograde cholangiopancreatography, the average age was 57.6 ± 19.3 years and 59.1% were women. The complications identified were: pancreatitis in 57 patients (3.7%), bleeding in 28 (1.8%), perforation in 8 (0.5%) and non-discriminated mortality of 42 patients (2.7%). As risk factors with statistical significance, papillotomy and Wirsung duct contrast were found (OR = 3 and OR = 3.55, respectively).Discussion: The results obtained are consistent with those of the world literature, with similar complication and mortality rates. On the other hand, the sociodemographic profile of the study population differs from international figures, with a predominance of the disease studied in older ages and with a greater number of comorbidities


Subject(s)
Humans , Cholangiopancreatography, Endoscopic Retrograde , Pancreatitis , Common Bile Duct , Intestinal Perforation
10.
West Afr. j. radiol ; 27(2): 89-94, 2020. ilus
Article in English | AIM | ID: biblio-1273557

ABSTRACT

Background: Ultrasound (US) is the first choice of imaging in neonates presenting with persistent jaundice to exclude surgically correctable causes and differentiate obstructive from nonobstructive causes. Previous studies on normal dimensions of gallbladder (GB) and common bile duct (CBD) recruited adults and children spread across a wide age group.Aims: This study aimed to determine GB and CBD normal dimensions in a large homogeneous neonatal population as well as guide decision regarding pre-US fasting in neonates who require GB evaluation.Materials and Methods: Five hundred and twenty-eight healthy newborns were recruited between May 2009 and May 2011. The widest intraluminal anterior-posterior diameters of GB and CBD were measured. Neonatal age in days, sex, birth weight, weight and height, gestational age at delivery, and time interval since last feed recorded.Results: The mean age was 9.56 ± 7.66 days, and 50.6% were males. The mean CBD diameter was 1.16 ± 1.61 mm while the mean GB diameter was 4.42 ± 2.16 mm. GB and CBD were clearly seen and measurable in 297 (55.8%) neonates and 237 (44.38%) neonates, respectively. There was a significant correlation between CBD diameter and GB diameter (P = 0.04) but no correlation with any demographic parameter. GB visualization was not dependent on time interval from last feed.Conclusion: Mean neonatal values for CBD and GB were established, but neonates have a wider range of GB diameters compared with older children, so GB diameter may not be a reliable parameter for neonatal GB pathologies. GB visualization was not dependent on time interval from last feed; hence, a recent feed should not delay emergency scans, especially in ill neonates


Subject(s)
Common Bile Duct , Gallbladder , Infant, Newborn , Nigeria
11.
Article in Chinese | WPRIM | ID: wpr-879799

ABSTRACT

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.


Subject(s)
Child , Choledochal Cyst , Common Bile Duct/pathology , Diagnosis, Differential , Humans , Jaundice, Obstructive/etiology , Male , Rhabdomyosarcoma, Embryonal/diagnosis
12.
J. bras. econ. saúde (Impr.) ; 11(2): 170-188, Agosto/2019.
Article in Portuguese | LILACS, ECOS | ID: biblio-1021187

ABSTRACT

Objetivo: Avaliar a eficácia, segurança e custo-efetividade da colangiopancreatografia retrógrada endoscópica (CPRE) comparada à exploração laparoscópica do ducto biliar comum (ELDBC) para coledocolitíase. Métodos: Foi realizada uma busca eletrônica nas bases de dados Medline, The Cochrane Library, Lilacs e Center for Reviews and Dissemination por revisões sistemáticas e estudos econômicos que reportassem dados sobre a comparação entre a CPRE e a ELDBC em pacientes com coledocolitíase. Uma busca complementar foi realizada nas referências dos estudos incluídos, periódicos, resumos de congresso e Google Acadêmico. A seleção foi realizada por dois pesquisadores independentes. Além da síntese qualitativa, uma ressíntese quantitativa para os desfechos primários foi conduzida em Review Manager® 5.3 utilizando um modelo de efeitos randômicos. Resultados: Foram incluídos 15 estudos (9 revisões sistemáticas e 6 estudos econômicos). Não foi demonstrada diferença estatisticamente significativa entre a colecistectomia laparoscópica (CL)+CPRE e a CL+ELDBC em termos de remoção dos cálculos do colédoco (88,5% vs. 92,8%; RR = 0,97, valor-p = 0,08; N = 1.881), morbidade pós-operatória (14,1% vs. 13,8%; RR = 0,98, valor-p = 0,88; N = 1.469), mortalidade (0,8% vs. 0,2%; RR = 2,13, valor-p = 0,33; N = 1.471), cálculos retidos (7,3% vs. 5,8%; RR = 1,17, valor-p = 0,40; N = 1.731), conversão para outros procedimentos (8,7% vs. 6,7%; RR = 1,20, valor-p = 0,55; N = 1.287), duração do procedimento (MD = 10,91, valor-p = 0,61; N = 717) ou tempo de hospitalização (MD = 1,31, valor-p = 0,10; N = 757). A literatura de custo-efetividade é dividida, com alguns estudos favorecendo a CL+CPRE e outros, a CL+ELDBC. Conclusão: Não é possível concluir sobre a superioridade da ELDBC sobre a CPRE ou vice-versa para a remoção de cálculos no colédoco.


Objective: To evaluate the efficacy, safety and cost-effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) compared to laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. Methods: An electronic search was conducted in the Medline, The Cochrane Library, Lilacs and Center for Reviews and Dissemination databases for systematic reviews and economic studies that reported data on the comparison between ERCP and LCBDE in patients with choledocholithiasis. A complementary search was conducted on references of included studies, journals, conference abstracts and Google Scholar. The selection was performed by two independent reviewers. In addition to the qualitative synthesis, a quantitative re-synthesis for primary outcomes was conducted in Review Manager® 5.3 using a random effects model. Results: Fifteen studies (9 systematic reviews and 6 economic studies) were included. There was no statistically significant difference between laparoscopic cholecystectomy (LC)+ERCP and LC+LCBDE in terms of removal of choledochal stones (88.5% vs. 92.8%, RR = 0.97, p-value = 0.08; N = 1,881), morbidity (14.1% vs. 13.8%, RR = 0.98, p-value = 0.88; N = 1,469), mortality (0.8% vs. 0,2%; RR = 2.13, p-value = 0.33, N = 1,471), retained stones (7.3% vs. 5.8%, RR = 1.17, p-value = 0.40; N = 1,731), conversion to other procedures (8.7% vs. 6.7%, RR = 1.20, p-value = 0.55, N = 1,287), duration of the procedure (MD = 10.91, p = 0.61, N = 717) or hospital stay (MD = 1.31, p-value = 0.10, N = 757). The cost-effectiveness literature is divided. Some studies favor LC+ERCP and others LC+LCBDE. Conclusion: It is not possible to conclude on the superiority of the LCBDE on ERCP or vice-versa for choledocholithiasis


Subject(s)
Humans , Gallstones , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy , Common Bile Duct
13.
Rev. colomb. cir ; 34(1): 45-54, 20190000. tab
Article in Spanish | LILACS | ID: biblio-982074

ABSTRACT

Introducción. La colecistectomía laparoscópica es el procedimiento laparoscópico más comúnmente realizado por el cirujano general. La lesión de la vía biliar es la complicación más temida debido a sus implicaciones clínicas y económicas. El objetivo de esta investigación fue determinar la incidencia de la lesión de la vía biliar en un centro de formación académica e identificar los posibles factores de riesgo asociados a su presentación. Materiales y métodos. Se llevó a cabo un estudio observacional retrospectivo en pacientes a quienes se les practicó una colecistectomía laparoscópica en el Hospital Universitario San Vicente Fundación de Medellín entre marzo de 2011 y septiembre 2016. Se realizó un análisis univariado y bivariado para explorar la asociación de algunas variables preoperatorias e intraoperatorias con la lesión de la vía biliar. Se utilizó el programa estadístico Stata 2014™. Resultados. Se incluyeron 1.601 pacientes. La incidencia de lesión de la vía biliar fue de 0,8 % (14 pacientes), con una mortalidad global de 0,4 %. La mayoría de estas lesiones fueron tipo A de Strasberg; solo dos pacientes requirieron una reconstrucción compleja de la vía biliar. Se encontró relación estadísticamente significativa con mayor tiempo operatorio (p<0,05) y mayor sangrado intraoperatorio (p<0,05) con la presentación de lesión de la vía biliar. Conclusión. La colecistectomía laparoscópica es un procedimiento seguro en el Hospital Universitario San Vicente Fundación, centro de formación de residentes quirúrgicos. La tasa de lesión de la vía biliar es similar a la reportada en la literatura


Introduction. Laparoscopic cholecystectomy is the most common laparoscopic procedure performed by the general surgeon. Bile duct injury (BDI) is the most feared complication due to its clinical and economic implications. The goal of this study was to determine the incidence of BDI at a teaching hospital and to identify possible related risk factors. Methods. This is an observational retrospective study that included patients who underwent laparoscopic cholecystectomy at San Vicente Foundation University Hospital (HUSVF) in Medellin, Colombia, in the period 2011 to September 2016. Univariate and bivariate analyses were performed to explore possible association of some perioperative variables with BDI. Statistic software STATA 2014 was used. Results. A total of 1,601 patients were included. BDI incidence was 0.8% (14 patients), global mortality was 0.4%. Most of BDIs were type A of the Strasberg classification and only two patients required complex reconstructions of the bile ducts. Longer operative time (p>0.05) and higher intraoperative blood loss (p<0.05) were related with BDI. Conclusion. Laparoscopic cholecystectomy is a safe procedure at HUSVF, a training center for surgical residents. Bile duct injury rate at this hospital is similar to that reported in the literature


Subject(s)
Humans , Common Bile Duct , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Intraoperative Complications
14.
Rev. colomb. cir ; 34(1): 37-44, 20190000. tab
Article in Spanish | LILACS | ID: biblio-982073

ABSTRACT

Introducción. La coledocolitiasis de probabilidad intermedia es una condición con gran morbilidad por el riesgo de pancreatitis y colangitis, y se requiere el estudio de la vía biliar para su enfoque diagnóstico y terapéutico. Actualmente, el método de referencia para su diagnóstico y tratamiento, es un examen invasivo, la colangiopancreatografía retrógrada endoscópica (CPRE), que no siempre lleva a un diagnóstico positivo de coledocolitiasis, pero sí implica exponer a los pacientes a sus riesgos. Por esta razón, la colangiopancreatografía por resonancia magnética (CPRM) ha tomado importancia en el diagnóstico, ya que es un examen no invasivo y con menor riesgo de complicaciones, por lo que se pretende evaluar su uso en la coledocolitiasis de probabilidad intermedia. Métodos. Se llevó a cabo un estudio de pruebas diagnósticas en una muestra de pacientes con coledocolitiasis de probabilidad intermedia, en la Fundación Salud El Bosque, entre enero de 2012 y agosto de 2015. Resultados. Se incluyeron 151 pacientes con diagnóstico de coledocolitiasis de probabilidad intermedia. Se evaluaron las características de la CPRM, la cual mostró sensibilidad de 88 %, especificidad de 79 %, valor predictivo positivo (VPP) de 88 % y valor predictivo negativo (VPN) de 96 %, con un índice de exactitud de 94,7 %. Conclusiones. La CPRM es un examen con un rendimiento adecuado en la evaluación de los pacientes con coledocolitiasis de probabilidad intermedia. En estos casos permite obviar la CPRE diagnóstica. El impacto de la dilatación de la vía biliar sumada a otras alteraciones del perfil hepático, no se puede establecer con este estudio


Introduction. Patients with intermediate probability of choledocholithiasis exhibit a highly morbid pathology due to the risk of developing pancreatitis and cholangitis; it demands the study of the bile duct for appropriate diagnostic and therapeutic approach. Currently, the gold standard for its diagnosis and treatment is an invasive examination, ERCP, which not always ends with positive diagnosis of choledocholithiasis, exposing the patient to the associated risks. This is why magnetic resonance cholangiopancreatography has acquired importance in the diagnosis, for it is a non-invasive procedure with lesser risk of complications. For this reason we decided to evaluate its use in mid-probability choledocholithiasis. Methods. A study of the diagnostic tests was carried out in a sample of 151 patients with intermediate probability of choledocholithiasis at our center, Fundación Salud El Bosque (Bogotá, Colombia), in the period 2012-2015. Results: A total of 151 patients with the diagnosis of choledocholithiasis of intermediate probability were included, evaluating the characteristics of the MRCP, which showed sensitivity of 88%, specificity 79%, PPV88% and NPV 96%, with an accuracy index of 94.7%. Conclusions. MRCP is a test that exhibits adequate performance in the evaluation of patients with intermediate probability of choledocholithiasis, avoiding the performance of ERCP. It confirms its previous use when faced with mid-chance choledocholithiasis. The diagnostic impact of dilation of the bile duct and other alterations of the liver profile can not be established with this study


Subject(s)
Humans , Common Bile Duct , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Cholangiopancreatography, Magnetic Resonance
15.
Article in English | WPRIM | ID: wpr-758928

ABSTRACT

This study was performed to evaluate the feasibility of ultrasound-guided computed tomography (CT) cholecystography and to establish an optimal protocol. In 8 healthy beagles, CT cholecystography was conducted using four contrast formulas; two dilution ratios (1:1 vs. 1:3) and two total volumes (8 mL vs. 16 mL) of 300 mgI/kg iohexol after ultrasound-guided percutaneous contrast injection into the gallbladder. CT images were obtained at 3, 10, and 30 min after injection and assessed qualitatively and quantitatively. For all contrast formulas, CT cholecystography showed the gallbladder and the intra- and extrahepatic bile ducts. The volume of the gallbladder and size of bile duct were significantly larger when using a volume of 16 mL iohexol than an 8 mL volume regardless of the dilution ratio. The distinction between the common bile duct and duodenum, the filling of the gallbladder, and the patency of bile duct were effectively assessed using a 16 mL volume of contrast agent with either dilution ratio. Beam-hardening artifacts deteriorated CT image quality for visualizing the biliary system when using the dilution ratio of 1:1. Patency of the bile tract could be easily evaluated using a curvilinear planar reconstruction. There was no significant difference in CT scan time among the different conditions. Minor leakage of contrast agent temporarily occurred after contrast injection in 30% of 32 sets of CT cholecystography. Ultrasound-guided percutaneous cholecystography can visualize both gallbladder and biliary tract with minimal artifacts using a contrast agent volume of 16 mL with a 1:3 dilution ratio.


Subject(s)
Animals , Artifacts , Bile , Bile Ducts , Bile Ducts, Extrahepatic , Biliary Tract , Cholecystography , Common Bile Duct , Contrast Media , Dogs , Duodenum , Gallbladder , Iohexol , Tomography, X-Ray Computed
16.
Article in English | WPRIM | ID: wpr-762670

ABSTRACT

PURPOSE: This report describes the laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury (BDI) during laparoscopic cholecystectomy. METHODS: We performed a retrospective descriptive analysis for all patients with a transected BDI at a single institution. We collected and analyzed data for injury site and type, reconstruction methods, conversion rate, previous intervention, and outcomes. RESULTS: Between January 2014 and December 2017, 2,901 patients underwent laparoscopic cholecystectomy at a single institution. Among them, 8 patients experienced a transected BDI during laparoscopic cholecystectomy, so the surgeon performed laparoscopic end-to-end biliary reconstruction with T-tube. Our patient series consisted of 6 women (75%) and 2 men (25%) with a mean age of 48.3 years (median, 49 years; range, 29–77 years). Two cases were converted to open surgery. The most common injured site was the common bile duct (5 of 8, 62.5%). The most common injury type, using Bismuth's classification system, was type I (3 of 8, 37.5%). The mean operating time was 136.8 minutes (median, 135.0 minutes; range, 0–180.0 minutes). The mean hospital stay was 7.0 days (median, 4.5 days, range: 3.0–21.0 days). The mean follow-up was 36.4 months (median, 34.0 months; range, 16.0–63.0 months). We observed one postoperative complication during the follow-up period. The patient had an anastomosis site leakage and was cured after reoperation. CONCLUSION: Laparoscopic end-to-end biliary reconstruction with T-tube for transected BDI during laparoscopic cholecystectomy seems to be safe and feasible in selected patients. However, long-term follow-up to identify complications from bile duct stricture remains important.


Subject(s)
Bile Ducts , Bile , Cholecystectomy , Cholecystectomy, Laparoscopic , Classification , Common Bile Duct , Constriction, Pathologic , Female , Follow-Up Studies , Humans , Laparoscopy , Length of Stay , Male , Postoperative Complications , Reoperation , Retrospective Studies
17.
Article in English | WPRIM | ID: wpr-766011

ABSTRACT

We report a rare case of hilar squamous cell carcinoma. A 62-year-old Korean woman complaining of nausea was referred to our hospital. Her biliary computed tomography revealed a 28 mm-sized protruding solid mass in the proximal common bile duct. The patient underwent left hemihepatectomy with S1 segmentectomy and segmental excision of the common bile duct. Microscopically, the tumor was a moderately differentiated squamous cell carcinoma of the extrahepatic bile duct, without any component of adenocarcinoma or metaplastic portion in the biliary epithelium. Immunohistochemically, the tumor was positive for cytokeratin (CK) 5/6, CK19, p40, and p63. Squamous cell carcinoma of the extrahepatic bile duct is rare. To date, only 24 cases of biliary squamous cell carcinomas have been reported. Here, we provide a clinicopathologic review of previously reported extrahepatic bile duct squamous cell carcinomas.


Subject(s)
Adenocarcinoma , Bile Ducts, Extrahepatic , Carcinoma, Squamous Cell , Common Bile Duct , Drug Therapy , Epithelial Cells , Epithelium , Female , Hepatic Duct, Common , Humans , Keratins , Klatskin Tumor , Mastectomy, Segmental , Middle Aged , Nausea
18.
Article in English | WPRIM | ID: wpr-788066

ABSTRACT

PURPOSE: The prognosis of periampullary cancer varies with its origin and early diagnosis influences outcome. Endoscopic ultrasound, computed tomography, fine needle aspiration, and fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸FDG-PET/CT) are helpful for diagnosis. This study evaluates the diagnostic efficacy of ¹⁸FDG-PET for preoperative periampullary tumors.METHODS: A series of 100 patients undergoing ¹⁸FDG-PET/CT before surgical resection of periampullary tumors between March 2011 and February 2019 were enrolled. Maximum standardized uptake value (SUVmax) and carbohydrate antigen 19-9 (CA19-9) levels were compared with pathohistological confirmation of periampullary tumors.RESULTS: The SUVmax and uptake range varied with the origin of the periampullary tumors. The SUVmax was not available for 17 of the 42 pancreas tumors, three of 30 common bile duct tumors, and four of 18 ampulla of Vater tumors. The median SUVmax was 0.0 in benign tumors and 5.05 in malignant tumors. The mean SUVmax was 4.1±5.6 in pancreatic tumors, 3.9±2.4 in ampulla of Vater, and 6.0±3.7 in common bile duct. The SUVmax was higher in common bile duct tumors than others. CA19-9 level was of diagnostic value in pancreatic tumor patients. The median CA19-9 levels were 7.64 U/mL (range, 2.71–45.05 U/mL) in benign tumors and 91.97 U/mL (range, 26.91–276.60 U/mL) in cancers patients.CONCLUSION: Preoperative SUVmax and CA19-9 level were of diagnostic value for periampullary tumors originating in the pancreas.


Subject(s)
Ampulla of Vater , Biopsy, Fine-Needle , CA-19-9 Antigen , Common Bile Duct , Diagnosis , Early Diagnosis , Fluorodeoxyglucose F18 , Humans , Pancreas , Pancreatic Neoplasms , Prognosis , Ultrasonography
19.
Article in English | WPRIM | ID: wpr-788045

ABSTRACT

Since sarcomatoid carcinoma in the common bile duct (CBD) is rarely reported, the clinical course and prognosis after surgery are unclear. We report a case of a patient who died within 1 month after surgery due to rapid tumor progression. A 65-year-old woman had abdominal pain with jaundice. She was diagnosed with CBD cancer and underwent pancreatoduodenectomy. Pathologic examination revealed sarcomatoid carcinoma. There was no postoperative complication, but multiple liver metastasis was diagnosed on computed tomography at 7 days after surgery. Also, the patient complained of abdominal pain and had jaundice with elevated liver enzyme on the 14th postoperative day. Her general condition was getting worse and she died of hepatic failure 23 days after surgery. We report a case of sarcomatoid carcinoma of the CBD that progressed very rapidly. Further research and case reports are needed to establish proper diagnostic and treatment tools.


Subject(s)
Abdominal Pain , Aged , Carcinosarcoma , Common Bile Duct , Female , Humans , Jaundice , Liver , Liver Failure , Neoplasm Metastasis , Pancreaticoduodenectomy , Postoperative Complications , Prognosis
20.
Article in English | WPRIM | ID: wpr-786672

ABSTRACT

BACKGROUND: With the popularity of laparoscopic cholecystectomy, common bile duct injury has been reported more frequently. There is no perfect method for repairing porcine biliary segmental defects.METHODS: After the decellularization of human arterial blood vessels, the cells were cultured with GFP⁺ (carry green fluorescent protein) porcine bile duct epithelial cells. The growth and proliferation of porcine bile duct epithelial cells on the human acellular arterial matrix (HAAM) were observed by hematoxylin-eosin (HE) staining, electron microscopy, and immunofluorescence. Then, the recellularized human acellular arterial matrix (RHAAM) was used to repair biliary segmental defects in the pig. The feasibility of it was detected by magnetic resonance cholangiopancreatography, liver function and blood routine changes, HE staining, immunofluorescence, real-time quantitative PCR (RT-qPCR), and western blot.RESULTS: After 4 weeks (w) of co-culture of HAAM and GFP? porcine bile duct epithelial cells, GFP⁺ porcine bile duct epithelial cells grew stably, proliferated, and fused on HAAM. Bile was successfully drained into the duodenum without bile leakage or biliary obstruction. Immunofluorescence detection showed that GFP-positive bile duct cells could still be detected after GFP-containing bile duct cells were implanted into the acellular arterial matrix for 8 w. The implanted bile duct cells can successfully resist bile invasion and protect the acellular arterial matrix until the newborn bile duct is formed.CONCLUSION: The RHAAM can be used to repair biliary segmental defects in pigs, which provides a new idea for the clinical treatment of common bile duct injury.


Subject(s)
Bile , Bile Ducts , Blood Vessels , Blotting, Western , Cholangiopancreatography, Magnetic Resonance , Cholecystectomy, Laparoscopic , Coculture Techniques , Common Bile Duct , Duodenum , Epithelial Cells , Fluorescent Antibody Technique , Humans , Infant, Newborn , Liver , Methods , Microscopy, Electron , Polymerase Chain Reaction , Swine , Tissue Engineering
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