RESUMO
Background: During cholecystectomy, to avoid common bile duct injury or other per operative complication, the knowledge of cystic cyst anomalies is imperative. This study aimed to highlight cystic duct anomalies identified during laparoscopic cholecystectomy and report their implications
Methods: This prospective study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro over a period of six years [2009-2014] in the department of Surgery. Over this specified period a total of 775 patients underwent cholecystectomy and were included in this study
Results: Among 775 patients who underwent laparoscopic cholecystectomy, abnormal confluence was found in 7.22%, short cystic duct in 26.78%, long cystic duct in 17.86% and double cystic duct in 12.50%. Surgical problems encountered due to these variations were cystic duct avulsion, common bile duct injury, bleeding and bile leak
Conclusion: During laparoscopic cholecystectomy, unidentified anatomical variations of cystic duct may cause drastic complications including ductal injuries which significantly increase morbidity and may raise mortality
RESUMO
Objevtices: Shearwave elastography has recently got approval for its use in clinical imaging. It has got its established accuracy in assessing liver fibrosis, where biopsy for the staging of cirrhosis has been minimized. There is emerging data showing its superiority in detecting breast and other cancers as compared to conventional imaging methods. This study aimed to analyse role of shearwave elastography in detection of primary impalpable lesions in breast and abdomino-pelvic regions and those missed on conventional imaging modalities
Setting: Shearwave Elastography Unit, Liaquat University of Medical and Heath Sciences, Jamshoro, Pakistan
Design and methods: The study is an observational pilot project including the patients presented to surgery and oncology departments with metastatic cancer suggested on conventional imaging or cytology of the metastatic site but primary sites were not known and suspected to be in the region of breast, abdomen or pelvis. Shearwave elastography was applied as supplementary tool to re-do B-mode ultrasound. Aixplorer Ultrasound System Multiwave version 8.2.0 [Supersonic Imagine S.A., Aix-en-Provence, France] was used in this study. This study selectively includes the patients who were called on experimental basis to see the effectiveness of the system on trial basis, the calculation of the sensitivity, specificity, positive predictive value and negative predictive values were not determined
Results: There were seven patients including four with axillary lymph nodes and three having liver metastases. In patients with axillary lymph nodes mammogram and conventional ultrasound failed to show primary breast lesions, histopathology of the axillary lymph nodes suggested infiltrating ductal carcinoma. In patients with liver metastases conventional ultrasound abdomen and CT scan failed to reveal primary lesions. Shearwave assisted B- mode ultrasound suggested a solid mass in a complex cyst in the kidney in one patient and in the other there were multiple benign cysts and a solid mass however the third patient with liver mass found to have primary from gall bladder. These findings were later confirmed on histopathology or cytology
Conclusion: Shearwave elastography is an emerging non invasive technology showing potential role to supplement B-mode ultrasound in detecting unknown primary cancerin breast and abdomino-pelvic region