ABSTRACT
A 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed.
Subject(s)
Abdominal Pain/etiology , Appendix , Cecal Diseases/complications , Dyspnea/etiology , Fever/etiology , Lithiasis/complications , Appendicitis/complications , Cecal Diseases/diagnosis , Humans , Lithiasis/diagnosis , Male , Subphrenic Abscess/diagnosis , Subphrenic Abscess/etiology , Young AdultABSTRACT
Hemobilia is the process of bleeding into the biliary tree and is an unusual cause of upper gastrointestinal hemorrhage. When this event results from a cystic artery pseudoaneurysm, it is a particularly rare phenomenon; fewer than 20 cases are described in the literature. Alongside the literature review, we report a case of a 34-year-old woman presenting 3 months post laparoscopic cholecystectomy with hematemesis. Computed tomography (CT) angiography revealed a cystic artery pseudoaneurysm. Following an ineffective hyperselective arterial embolization, the patient was successfully treated by surgical ligation of the right hepatic artery. Even though this complication is uncommon, all surgeons need to be aware of its presentation and of available therapeutic options.
Subject(s)
Aneurysm, False/diagnostic imaging , Cholecystectomy, Laparoscopic , Gallbladder/blood supply , Hematemesis/etiology , Hemobilia/diagnostic imaging , Postoperative Complications/diagnostic imaging , Tomography, X-Ray Computed , Adult , Aneurysm, False/etiology , Female , Hemobilia/etiology , Humans , Postoperative Complications/etiologyABSTRACT
Gallstones occur more commonly in patients with cirrhosis. The incidence increases with severity of liver disease, and the majority remain asymptomatic. When symptoms do occur, morbidity and mortality are much higher than in noncirrhotic patients. Asymptomatic gallstones in cirrhotic patients are best managed conservatively with close follow-up and surgery if symptoms occur. The management of asymptomatic gallstones found incidentally at abdominal surgery for another indication is controversial. Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis in patients with well-compensated liver disease, whereas patients with choledocholithiasis are best managed endoscopically. Symptomatic cholelithiasis in the decompensated patient remains a challenge, and these patients are best managed in specialized hepatobiliary centers. This review examines the evidence currently available on gallstones in chronic liver disease and the factors that influence its management.
Subject(s)
Cholecystectomy/methods , Gallstones/epidemiology , Liver Diseases/diagnosis , Liver Diseases/epidemiology , Adult , Age Distribution , Aged , Chronic Disease , Comorbidity , Female , Gallstones/diagnosis , Gallstones/surgery , Humans , Incidence , Liver Diseases/surgery , Male , Middle Aged , Prognosis , Risk Assessment , Severity of Illness Index , Sex Distribution , Survival Analysis , Treatment OutcomeABSTRACT
Ileostomy for proximal diversion as a preferred option over colostomy has been a recent topic of interest. Our study evaluated the quality of life (QOL) of patients with a temporary ileostomy and compared it with that of patients with a temporary colostomy. The QOL of 25 patients with an ileostomy (median age 42 years, range 22-76 years) was compared with that for 25 patients with a colostomy (median age 44 years, range 18-70 years). Indications for a stoma were rectal carcinoma, trauma, inflammatory bowel disease, anastomotic leak, or incontinence following an operative procedure for rectal prolapse. The study was conducted at a median of 8 weeks (range 6-16 weeks) for ileostomy patients and of 9 weeks (range 5-17 weeks) for colostomy patients following stoma creation. A self-administered structured questionnaire was used, with responses obtained for 10 QOL questions on a visual analog rating scale (0-100 mm); they were graded good (71-100), satisfactory (31-70), or poor (0-30). Altogether, 22 (88%) patients with an ileostomy, compared with 16 (64%) patients with a colostomy, were able to purchase their stomal appliances ( p = 0.09, chi(2): NS). Effluent was tolerable in 18 (72%) patients with an ileostomy compared with 7 (28%) patients with a colostomy ( p = 0.002, chi(2)). Appetite was not affected in any of the patients with an ileostomy (100%), compared with 64% of patients with a colostomy ( p = 0.002, chi(2)), travel by public transport 32% compared to 28% with colostomy (NS), dress in 20% compared to 24% with colostomy (NS), and daily activities 28% compared to 24% with colostomy (NS). Moreover, 68% with an ileostomy did not have a problem with hygiene compared with 40% with a colostomy (NS); 95% with an ileostomy abstained from sexual activity compared with 81% with a colostomy ( p = 0.21, chi(2): NS). Both ileostomy and colostomy resulted in significant QOL impairment. However, with ileostomy, the effluent was more tolerable, had less of an impact on personal hygiene, and preserved the appetite compared with colostomy. There were no differences in travel, dress, daily chores, or sexual activity between the two groups.
