ABSTRACT
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Subject(s)
Humans , Female , Aged , Immunoglobulin G4-Related Disease/diagnostic imaging , Cholangiocarcinoma/diagnostic imaging , Enzyme Therapy , Cholangiocarcinoma/drug therapy , Tomography, X-Ray Computed , Pancreas/diagnostic imaging , Pancreas/pathology , Cholestasis/complications , Cholangiopancreatography, Magnetic Resonance/methodsABSTRACT
Introducción: la lesión yatrogénica de la vía biliar (LYVB) es una complicación con elevada morbilidad tras la colecistectomía. En los últimos años la endoscopia ha adquirido un papel fundamental en el manejo de esta patología. Métodos: estudio retrospectivo de LYVB tras colecistectomía abierta (CA) o colecistectomía laparoscópica (CL) tratadas en nuestro centro entre 1993 y 2017. Se analizaron los datos referentes a las características clínicas, tipo de lesión según la clasificación de Strasberg-Bismuth, diagnóstico, técnica de reparación y seguimiento. Resultados: se estudian 46 pacientes. La incidencia LYVB fue de 0,48%, 0,61% para las CL y 0,24% para las CA. El diagnóstico se realizó de forma intraoperatoria en 12 casos (26%) y mediante colangiopancreatografía retrógrada endoscópica (CPRE) en 10 (21,7%). Las características más comunes a todos los pacientes con LYVB fueron la colecistitis aguda (20/46, 43,5%), ingreso previo por patología biliar (16/46, 43,2%) y realización de CPRE previa a la colecistectomía (7/46, 18,9%). Los tipos de LYVB más frecuentes fueron el D (17/46, 36,9%) y el A (15/46, 32,6%). El tratamiento más empleado fue sutura primaria (13/46, 28,3%) seguido de CPRE (11/46, 23,9%) con esfinterotomía y/o endoprótesis. Además, la CPRE se utilizó en el postoperatorio inmediato de 6 pacientes (13%) con reparación quirúrgica de la LYVB para solucionar complicaciones inmediatas. Conclusión: la CPRE es útil en el manejo de la LYVB no diagnosticada intraoperatoriamente. Permite localizar la zona lesionada de la vía biliar, realizar maniobras terapéuticas y tratar de manera satisfactoria algunas complicaciones postoperatorias
Introduction: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. Methods: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. Results: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. Conclusion: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/methods , Iatrogenic Disease/epidemiology , Cholecystectomy/adverse effects , Biliary Fistula/diagnostic imaging , Postcholecystectomy Syndrome/diagnostic imaging , Diagnosis, Differential , Bile Ducts/injuries , Retrospective Studies , Postoperative Complications/diagnostic imaging , Biliary Fistula/etiologyABSTRACT
INTRODUCTION: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. METHODS: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. RESULTS: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. CONCLUSION: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.
Subject(s)
Bile Ducts/injuries , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy/adverse effects , Postoperative Complications/therapy , Adult , Aged , Aged, 80 and over , Bile Ducts/diagnostic imaging , Cholecystectomy, Laparoscopic/adverse effects , Female , Humans , Iatrogenic Disease/epidemiology , Incidence , Male , Middle Aged , Postoperative Complications/classification , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Prospective Studies , Retrospective Studies , Sphincterotomy, Endoscopic , Stents , Suture Techniques , Young AdultSubject(s)
Bile Duct Neoplasms/diagnosis , Bile Ducts/diagnostic imaging , Cholangiocarcinoma/diagnosis , Cholangitis, Sclerosing/diagnostic imaging , Endoscopy, Digestive System/methods , Immunoglobulin G4-Related Disease/diagnostic imaging , Aged , Anti-Inflammatory Agents/therapeutic use , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/drug therapy , Common Bile Duct/diagnostic imaging , Diagnosis, Differential , Exocrine Pancreatic Insufficiency/complications , Humans , Immunoglobulin G4-Related Disease/diagnosis , Immunoglobulin G4-Related Disease/drug therapy , Male , Prednisone/therapeutic use , Remission Induction , Signal Processing, Computer-AssistedABSTRACT
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Subject(s)
Humans , Male , Aged , Intestinal Perforation/complications , Colon/injuries , Intermittent Pneumatic Compression Devices/adverse effects , Self Expandable Metallic Stents/adverse effects , Colon/surgery , Adenocarcinoma/therapy , Urinary Incontinence, Urge/complicationsSubject(s)
Colonic Diseases/etiology , Dilatation/adverse effects , Intestinal Perforation/etiology , Self Expandable Metallic Stents , Adenocarcinoma/radiotherapy , Aged , Colon/injuries , Colon/radiation effects , Colonic Diseases/therapy , Constriction, Pathologic/etiology , Constriction, Pathologic/therapy , Foreign-Body Migration , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/therapy , Intestinal Perforation/therapy , Male , Prostatic Neoplasms/radiotherapy , Radiation Injuries/etiology , Radiation Injuries/therapy , Radiotherapy, Adjuvant/adverse effects , Self Expandable Metallic Stents/adverse effectsABSTRACT
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Subject(s)
Humans , Male , Child , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/surgery , Gastroscopy/instrumentation , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Transit , Duodenum/diagnostic imaging , Duodenum/surgeryABSTRACT
Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.
