ABSTRACT
BACKGROUND AND STUDY AIMS: Approximately 2-7% of patients who have undergone previous removal of bile duct stones have recurrence often presenting as ascending cholangitis. The aim of this study was to identify the incidence, clinical presentation, and objective findings in this group of patients. Additionally, the effect of surveillance endoscopic retrograde cholangiopancreatography (ERCP) in preventing cholangitis, was studied. PATIENTS AND METHODS: Two thousand and ninety-six patients who underwent ERCP for cholelithiasis were studied with 45 of these patients being identified as having recurrent common bile duct stones. Of the 45, 13 had two or more recurrences without having any obvious predisposing factors. The mean age of the 13 patients was 57 years. The characteristics of 13 patients were reviewed, including sphincterotomy size, liver function tests, and contrast drainage time. RESULTS: All 13 patients with recurrent stones presented with ascending cholangitis. Stones were found to be soft, brown and accompanied by a large amount of sludge. The common bile duct in all 13 patients was noted to be dilated and had notable, widely patent sphincterotomes. There was significant delayed drainage in 77% of these patients. Yearly surveillance ERCPs were performed in the 13 patients, the incidence of acute cholangitis episodes per patient decreased from 2 to 0.6 with a four-year follow-up. CONCLUSION: In a subgroup of patients with multiple common bile duct stone recurrences, annual surveillance ERCP with stone removal decreases the incidence of recurrent episodes of ascending cholangitis as well as its associated morbidity and mortality.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/prevention & control , Gallstones/complications , Adult , Aged , Aged, 80 and over , Cholangitis/physiopathology , Female , Gallstones/diagnosis , Gallstones/physiopathology , Gallstones/surgery , Humans , Liver Function Tests , Male , Middle Aged , Recurrence , Retrospective StudiesABSTRACT
A 37-yr-old white man experienced crampy abdominal pain beginning 21 days after successful bone marrow transplantation for chronic myelogenous leukemia. Generalized edema and hypoproteinemia developed. Symptoms persisted until 61 days post-transplant, when the patient developed an acute abdomen. At laparotomy, an edematous segment of jejunum was resected. Pathological examination showed submucosal vasculitis and necrotizing enteritis. Serum protein and albumin levels returned to normal within a few weeks after surgery. Vasculitis of the gastrointestinal tract should be considered in the differential diagnosis of protein-losing enteropathy after bone marrow transplantation.
Subject(s)
Bone Marrow Transplantation/adverse effects , Jejunal Diseases/etiology , Jejunum/blood supply , Protein-Losing Enteropathies/etiology , Vasculitis/etiology , Abdominal Pain/etiology , Adult , Humans , Hypoproteinemia/etiology , Jejunum/pathology , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery , Male , Vasculitis/pathologyABSTRACT
A patient experienced hypertension, bradycardia, QT prolongation, and multiple episodes of torsade de pointes while receiving an iv vasopressin infusion. The dysrhythmias were attributed to vasopressin, but may have been potentiated by hypomagnesemia. Upon vasopressin discontinuation, ECG findings returned to normal before magnesium supplementation. Vasopressin may contribute to the development of torsade de pointes.
