Rendez-Vous laparoendoscopic after ERCP failure in patient with Billroth II gastrectomy / Laparoscopía por Rendez-Vous luego de falla de CPRE en un paciente con gastectomía Billroth II

Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However, despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.

La colangiopancreatografía endoscópica retrógrada (CPRE) es el tratamiento de elección en pacientes portadores de coledocolitiasis. Sin embargo, a pesar de su elevada tasa de éxito, en algunos casos no es exitosa, exigiendo terapia alternativa. La gastrectomía parcial con reconstrucción a Billroth II es una condición asociada a la importante tasa de fracaso de la CPRE. Cuando el tratamiento endoscópico falla, la exploración quirúrgica de la vía biliar es un enfoque más común. Sin embargo, la cirugía se relaciona con una mayor complejidad de ejecución y morbimortalidad. Describimos el caso de un paciente con coledocolitiasis y gastrectomía parcial con reconstrucción a Billroth II, sometido al tratamiento combinado denominado rendez-vous laparoendoscópico tras fallo de la CPRE, que une en una sola etapa el tratamiento endoscópico de la coledocolitiasis y la retirada laparoscópica de la vesícula biliar. Llegamos a la conclusión de que este enfoque terapéutico fue eficaz, seguro, de bajo costo y sin complicaciones.

Rendez-Vous laparoendoscopic after ERCP failure in patient with Billroth II gastrectomy.

Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However,despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.

Perforated Meckel's diverticulum.

We report a patient with diffuse peritonitis due to perforation of Meckel's diverticulum. This patient was referred to the operating room and underwent bowel resection segment encompassing the area of the diverticulum and terminoterminal primary enteroanastomosis on two levels with good evolution. The diverticulum complications are often related to the presence of ectopic mucosa, specially the gastric and pancreatic type. Since preoperative diagnosis is difficult and infrequent, in most cases this anomaly is confirmed only during surgery. Surgical resection of the affected intestinal segment is the mainstay of treatment in both diverticula diagnosed incidentally, as the complicated by inflammation, bleeding, obstruction or perforation. We conclude that in cases of acute abdomen punctured, the diagnosis of Meckel's diverticulum should be considered.

Laparoendoscopic rendez-vous: a safe alternative to the treatment of choledocholithiasis.

The choice treatment for choledocholithiasis when associated with lithiasic cholecystitis is endoscopic retrograde cholangiopancreatography (ERCP). However, in some cases this therapeutic fails, which requires an alternative method to extract the stones. The surgical approach tends to be the next step, but it is related to greater complexity of achievement and higher complications rates. In 1993, Deslandres et al. developed the combined treatment called laparoendoscopic rendez-vous, that unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We report the case of a patient diagnosed with common bile duct (CBD) stones, in which the conventional CPRE was not successful, and was taken to treatment by laparoendoscopic approach. We conclude, based on this case and on other published studies, that this therapeutic modality has advantages for being feasible, presenting low complications rate, shorter hospital stay and acceptable cost.

Biliary ileus: case report.

Biliary ileusis a uncommon cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by intestinal impaction of a gallstone that enters the bowel via a cholecysto-enteric fistula. The mortality rate is considerable, ranging between 12 and 27%. Treatment in most cases is surgical, aimed at the resolution of the intestinal obstruction. We report the case of a 55 year old patient diagnosed with biliary ileus, wich evolved without complications after a enterolithotomy. We have concluded, based on the literature that an early diagnosis associated with appropriate therapy can lead to a better prognosis.

Laparoendoscopic rendez-vous: a safe alternative to the treatment of choledocholithiasis / Rendez-vous láparo-endoscópico: una alternativa segura en el tratamiento de la colecocolitiasis

The choice treatment for choledocholithiasis when associated with lithiasic cholecystitis is endoscopic retrograde cholangiopancreatography (ERCP). However, in some cases this therapeutic fails, which requires an alternative method to extract the stones. The surgical approach tends to be the next step, but it is related to greater complexity of achievement and higher complications rates. In 1993, Deslandres et al. developed the combined treatment called laparoendoscopic rendez- vous, that unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We report the case of a patient diagnosed with common bile duct (CBD) stones, in which the conventional CPRE was not successful, and was taken to treatment by laparoendoscopic approach. We conclude, based on this case and on other published studies, that this therapeutic modality has advantages for being feasible, presenting low complications rate, shorter hospital stay and acceptable cost

El tratamiento de elección para la coledocolitiasis cuando se asocia con colecistitis litiásica es la colangiopancreatografía retrógrada endoscópica (CPRE). Sin embargo, en algunos casos ese tratamiento falla, requiriendo un método alternativo para extraer los cálculos. El abordaje quirúrgico tiende a ser el siguiente paso, pero se relaciona con una mayor complejidad de ejecución y mayores tasas de complicaciones. En 1993, Deslandres et al. desarrolló el tratamiento combinado llamado rendez-vous laparoendoscópico, que reúne en una sola etapa el tratamiento endoscópico de la coledocolitiasis y la extracción laparoscópica de la vesícula biliar. Presentamos el caso de una paciente diagnosticada con litiasis en la via biliar común, en el que la CPRE convencional no tuvo éxito, fue entonces enviada al tratamiento laparoendoscópico. Llegamos a la conclusión, basado en este caso y en otros estudios publicados, que esta modalidad terapéutica tiene ventajas por ser factible, teniendo bajos índices de complicaciones, menor estancia hospitalaria y costo aceptable

Perforated Meckel's diverticulum: una entidad inusual / Divertículo de Meckel perforado

We report a patient with diffuse peritonitis due to perforation of Meckel's diverticulum. This patient was referred to the operating room and underwent bowel resection segment encompassing the area of the diverticulum and terminoterminal primary enteroanastomosis on two levels with good evolution. The diverticulum complications are often related to the presence of ectopic mucosa, especially the gastric and pancreatic type. Since preoperative diagnosis is difficult and infrequent, in most cases this anomaly is confirmed only during surgery. Surgical resection of the affected intestinal segment is the mainstay of treatment in both diverticula diagnosed incidentally, as the complicated by inflammation, bleeding, obstruction or perforation. We conclude that in cases of acute abdomen punctured, the diagnosis of Meckel's diverticulum should be considered.

Se describe el caso de un paciente con peritonitis difusa debido a la perforación de un divertículo de Meckel. Este paciente fue llevado a la sala de operaciones y fue sometido a resección del segmento intestinal incluyendo el área del divertículo y enteroanastomosis primaria termino-terminal en dos niveles, con buena evolución. Las complicaciones del divertículo a menudo están relacionadas con la presencia de mucosa ectópica especialmente del tipo gástrica y pancreática. Dado que el diagnóstico preoperatorio es difícil y poco frecuente, en la mayoría de los casos esta anomalía se confirma únicamente durante la intervención quirúrgica. La resección quirúrgica del segmento intestinal afectado es el pilar del tratamiento, tanto en los divertículos hechos con diagnóstico en forma casual, como el complicado por la inflamación, sangrado, obstrucción o perforación. Llegamos a la conclusión de que en los casos de abdomen agudo perforados el diagnóstico de divertículo de Meckel debe ser considerado.

Biliary ileus: case report / Íleo biliar: caso clinico

Biliary ileusis a uncommon cause of mechanical bowel obstruction, affecting older adult patients who often have other significant medical conditions. It is caused by intestinal impaction of a gallstone that enters the bowel via a cholecysto-enteric fistula. The mortality rate is considerable, ranging between 12 and 27%. Treatment in most cases is surgical, aimed at the resolution of the intestinal obstruction. We report the case of a 55 year old patient diagnosed with biliary ileus, wich evolved without complications after a enterolithotomy. We have concluded, based on the literature that an early diagnosis associated with appropriate therapy can lead to a better prognosis

El íleo biliar es una causa poco frecuente de obstrucción intestinal mecánica, que afecta pacientes de edad avanzada que generalmente tienen comorbilidades significativas. Es causada por la impactación de un cálculo biliar en el intestino, que entra en el tracto digestivo por medio de una fístula colecisto-entérica. La tasa de mortalidad es considerable, que va de 12 a 27%. El tratamiento en la mayoría de los casos es quirúrgico y destinado a la resolución de la obstrucción intestinal. Presentamos el caso de una paciente de 55 años diagnosticada con íleo biliar, que evolucionó sin complicaciones después de enterolitotomia. Llegamos a la conclusión, con base en la literatura, que un diagnóstico precoz asociado con el tratamiento adecuado conduce a un mejor pronóstico