ABSTRACT
The paper presents a case of 51 years old patient suffering from repetitive upper intestinal tract bleedings following several months after uncomplicated laparoscopic cholecystectomy for acute cholecystitis. After a difficult diagnostic algorithm the diagnosis is set as a right hepatic artery pseudoaneurysm fistulating into the cystic duct stump. Several attempts of intraarterial embolisation (coiling) were done with only temporary effect. Finally an open surgical procedure with transligation of the aneurysm was performed with an immediate and definitive effect. No clinical signs of bleeding appeared within 6 months after the procedure. Key words: haemobilia, hepatic artery pseudoaneurysm, complication of cholecystectomy, coiling.
Subject(s)
Aneurysm, False/complications , Biliary Fistula/complications , Cholecystectomy, Laparoscopic/adverse effects , Cystic Duct/injuries , Gastrointestinal Hemorrhage/etiology , Hepatic Artery , Female , Humans , Middle Aged , RecurrenceABSTRACT
Gallstone ileus as a complication of gallstone disease is a diagnostic as well as therapeutic challenge. Its development is frequently sneaking, so correct diagnosis and surgical therapy is often delayed. Thus morbidity and mortality is high. Concrement extraction by open enterotomy is a therapeutic choice. The discussed issue is if one-stage cholecystectomy and fistula closure should be done too. The paper presents a female patient with gallstone ileus treated with open enterotomy only, with no postoperative complication. The literature review follows. Authors conclude that one-stage procedure, if feasible, is acceptable method for the low risk patients.
Subject(s)
Cholelithiasis/complications , Intestinal Obstruction/etiology , Aged, 80 and over , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgeryABSTRACT
BACKGROUND/AIMS: Acute mesenteric ischemia (AMI) is a serious disease in old age with low incidence but with a very high mortality rate (60-70%). The etiology is either primary (embolism or thrombosis of mesenteric arteries or veins, non-occlusive mesenteric ischemia) or secondary (mechanical obstruction such as intestinal volvulus, intussusception, tumor-caused compression). Independent of the origin of the illness, the clinical-pathological picture is the same: intestinal ischemia with subsequent necrosis. The aim of this study was to ascertain which underlying conditions lead to increased probability of development of acute mesenteric ischemia. METHODS: Two hundred and fifteen patients with a primary form of AMI were treated in the years 1991-2007, in the 1st Clinic of Surgery in Brno, Czech Republic and in the Department of General Surgery, Derer's University Hospital in Bratislava, Slovak Republic; the results of the treatment have been statistically evaluated. CONCLUSION: The probability of arterial mesenteric ischemia development rises significantly (p < 0.05) in patients with a history of atrial fibrillation and/or myocardial infarction. This probability is also significantly higher in smokers with symptoms of hypertension and clinical signs of abdominal angina (p < 0.05).
