Recent Advances in the Management of Recurrent Bile Duct Stones / 대한소화기학회지

Approximately 3-15% of patients who have undergone removal of bile duct stones with endoscopic sphincterotomy have recurrence of stones which often presents as acute cholangitis. Despite better understanding on the factors and mechanisms underlying the recurrence of bile duct stones achieved during the past few decades, endoscopic removal still remains the mainstay of management for recurrent bile duct stones. Recently investigated and suggested management of recurrent bile duct stones are highlighted in this review.

Manejo médico y endoscópico de pancreatitis ascaridiana aguda en niños / Medical and endoscopic managment of acute pancreatitis ascariasis in children

La migración errática de los áscaris hacia vías biliares, vesícula biliar y conducto pancreático puede ocasionar la obstrucción de esas estructuras, manifestándose como cólico biliar, colecistitis alitiásica, colangitis, pancreatitis aguda y absceso hepático. Objetivo: reportar el manejo clínico y endoscópico de pacientes con pancreatitis ascaridiana. Pacientes y Método: estudio descriptivo, retrospectivo, de pacientes con Pancreatitis Aguda, se revisa cuadro clínico, datos epidemiológicos, etiología, exámenes paraclínicos, ultrasonido y terapia médica. Resultados: 10/34 (29,41%) con Pancreatitis Aguda por Áscaris lumbricoides; edad promedio 6,3 años, antecedente de expulsión de vermes por boca (60,00%). El dolor abdominal y vómitos en el 100%, con elevación de amilasa y lipasa. Ecografía abdominal: aumento de volumen de páncreas, vermes en vías biliares y colédoco en 100%, 4/10 (40,00%) absceso hepático y 1/10 (10,00%) pseudoquiste pancreático. Se realizo la remoción de ovillo de áscaris en duodeno por endoscopia a 5/10(50,00%), utilizando pinza de cuerpos extraño y 3/5(60,00%) para vermes impactado en papila, papilotomía mínima con extracción. Se indico Albendazol por 5 días. Conclusión: en todo niño con dolor abdominal y vómitos, se deben realizar pruebas de funcionalismo pancreático y ultrasonido abdominal para descartar pancreatitis. En la pancreatitis ascaridiana el Albendazol resulto ser una terapia satisfactoria.

The migration of Ascaris erratic to bile ducts, gallbladder and pancreatic duct can cause obstruction of these structures, manifesting as biliary colic, acalculous cholecystitis, cholangitis, acute pancreatitis and liver abscesses. Objective: To report the clinical and endoscopic ascariasis pancreatitis. Patients and Methods: A descriptive and retrospective study of patients with acute pancreatitis, we review the clinical, epidemiological, etiology, laboratory test results, ultrasound and medical therapy. Results: 10/34 (29.41%) with acute pancreatitis caused by Ascaris lumbricoides, mean age 6.3 years, history of expulsion of worms by mouth (60.00%). Abdominal pain and vomiting in 100%, with elevation of amylase and lipase. Abdominal ultrasound enlargement of the pancreas, worms in bile ducts and bile duct in 100%,%), 4/10 (40.00%), hepatic abscess and 1/10 (10.00%) pancreatic pseudocyst. Removal was performed ascaris ball of the duodenum by endoscopy at 5/10 (50.00%), using foreign body forceps and 3/5 (60.00%) for worms impacted papilla use papillotomy minimum. Albendazole is indicated for 5 days. Conclusion: In all children with abdominal pain and vomiting, should be performed pancreatic function tests and abdominal ultrasound to rule out pancreatitis. In pancreatitis ascariasis Albendazole therapy was found to be satisfactory.

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

Hepatic sickling crisis mimicking recurrent cholangitis.

A 22-year-old man with homozygous sickle cell disease presented with recurrent fever, right upper quadrant pain and jaundice. Liver biopsy confirmed the diagnosis of hepatic sickling crisis; the symptoms responded to hydroxyurea therapy. Hepatic vasocclusive crisis can diagnosed on liver biopsy, and need not be a diagnosis of exclusion.

Negative conversion of antimitochondrial antibody in primary biliary cirrhosis: a case of autoimmune cholangitis

Autoimmune cholangitis is a clinical constellation of chronic cholestasis, histological changes of chronic nonsuppurative cholangitis and the presence of autoantibodies other than antimitochondrial antibody (AMA). It is uncertain whether this entity is definitely different from AMA positive primary biliary cirrhosis (PBC), though it shows some differences. We report a case of autoimmune cholangitis in a 59-year-old woman, who had been previously diagnosed as AMA-positive PBC associated with rheumatoid arthritis, has been converted to an AMA-negative and anticentromere antibody-positive PBC during follow-up. The response to ursodeoxycholic acid treatment is poor except within the first few months, but prednisolone was dropping the biochemical laboratory data.

Benign non-traumatic inflammatory stricture of the common bile duct.

A case of isolated benign non-traumatic inflammatory stricture of the mid portion of the common bile duct presenting with recurrent jaundice and cholangitis is reported. The histological features suggested that this was not due to sclerosing cholangitis.

Hepatobiliary alterations in massive biliary ascariasis: histopathological aspects of an autopsy case

Os autores apresentam os aspectos histopatologicos encontrados no figado de um caso de autopsia de ascaridiase biliar macica. A intensa colangite foi o aspecto predominante, mas outras lesoes tambem foram encontradas, tais como metaplasia pilorica e intestinal, hiperplasia epitelial com papilomas intraductais, e por vezes padrao adenomatoso. Restos do helminto foram encontrados fortemente aderidos ao epitelio, sendo intensa a positividade de mucopolissacarides, principalmente acidos, na borda luminal do epitelio ductal e em glandulas proliferadas ao redor dos ductos. Os autores discutem a semelhanca da ascaridiase biliar com a colangio hepatite oriental, e sugerem que o processo inflamatorio e a presenca de restos do verme sao responsaveis pelas alteracoes hiperplasicas e metaplasicas, analogamente ao que ocorre na clonorquiase, fascioliase e esquistossomose