ABSTRACT
Bile duct injury is a known complication of cholecystectomy. While minor injuries can be treated endoscopically, successful endoscopic management of complete ligation of the common hepatic duct (CHD) has not been described. Our aim was to report a novel technique for endoscopic recanalization of accidently ligated CHD. We demonstrated a 75 year old woman presented with a small bile leak and complete ligation of the CHD after open cholecystectomy subjected to successful biliary endoscopic recanalization. Cholangiogram demonstrated resolution of the bile leak and minimal residual narrowing of the CHD. Endoscopic intervention following biliary needle puncture access may avoid surgery in patients with CHD ligation or complex stenosis.
Subject(s)
Cholecystectomy , Endoscopy, Digestive System , Hepatic Duct, Common/injuries , Intraoperative Complications/surgery , Aged , Catheters , Equipment Design , Female , Humans , LigationABSTRACT
BACKGROUND AND STUDY AIMS: Endoscopic evaluation of the excluded stomach after Roux-en-Y gastric bypass surgery for morbid obesity is a challenge, and the pathological changes that take place in the bypassed stomach are unclear. A new double-balloon method of evaluating the bypassed stomach after Roux-en-Y gastric bypass surgery for morbid obesity is described here. PATIENTS AND METHODS: This new enteroscope uses two balloons, one attached to the tip of the endoscope and the other to the distal end of the soft overtube. The procedures were carried out in six patients using the retrograde route, through the end-to-side jejunal anastomosis via the duodenobiliopancreatic limb up to the bypassed stomach. RESULTS: The bypassed stomach was reached in five of six patients (83.3 %). An endoscopic appearance of atrophic gastritis was found in three patients, mild in two cases and severe in one case with intestinal metaplasia. Erosive and hemorrhagic gastritis was found in two patients. CONCLUSIONS: Endoscopic evaluation of the bypassed stomach via the retrograde route after Roux-en-Y gastric bypass for morbid obesity is feasible using the double-balloon enteroscope.
Subject(s)
Endoscopes, Gastrointestinal , Gastric Bypass/methods , Obesity, Morbid/surgery , Postoperative Care/instrumentation , Stomach/pathology , Anastomosis, Roux-en-Y , Equipment Design , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Stomach/surgeryABSTRACT
Midazolam is widely used in anesthesia. This paper shows characteristics of midazolam and how to use midazolam in clinical anesthesia. As a premedication, midazolam should be injected i. m. 15 min before entering an operating room in a dose of 0.04 mg.kg-1 to 0.08 mg.kg-1 according to the patient's age. For anesthesia induction, midazolam should be used together with barbiturate or propofol to take advantage of synergistic effects. Continuous infusion of midazolam in total intravenous anesthesia with fentanyl results in hemodynamic stability and good postoperative analgesia. During spinal or epidural anesthesia, i.v. midazolam of 0.05 mg.kg-1 has anti-anxietic and sedative effects. Midazolam inhibits awakening during cardiopulmonary bypass and it has little cardiodepressant effect. In aged, hepatic damaged or renal damaged patients, the effects of midazolam are slightly increased. Therefore, lower doses may be required in such patients. In conclusion, midazolam is usable in premedication, induction, maintenance in general anesthesia and in sedation in local anesthesia.
