RESUMO
Mirizzi's syndrome is an unusual complication of gallstone disease, in which a stone impacting in the neck of the gallbladder (Hartmann s pouch) compresses the common bile duct. This mechanical obstruction leads to obstructive jaundice frequently followed by inflammatory changes and several complications. We present two patients affected by Mirizzi's syndrome whose diagnosis was correct in the preoperative period and approached by laparoscopy. A case was converted to open procedure due to adhesions in the Calot's triangle, and therefore, treated with subtotal cholecystectomy and choledochorrhaphy over a T tube. In the other case the laparoscopy access became successful. Both postoperative courses were uneventful. In this article, suitable diagnostic techniques are analyzed. On the other hand, we discuss what is the best therapeutic option, with a special attention to the relevance of endoscopic retrograde cholangiopancreatography and laparoscopic approach in the management of those patients.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia/métodos , Colelitíase/diagnóstico , Colestase/etiologia , Doenças do Ducto Colédoco/etiologia , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica , Colelitíase/complicações , Colelitíase/cirurgia , Colestase/diagnóstico , Colestase/cirurgia , Ducto Colédoco/cirurgia , Doenças do Ducto Colédoco/diagnóstico , Doenças do Ducto Colédoco/cirurgia , Descompressão Cirúrgica , Drenagem/instrumentação , Humanos , Imageamento por Ressonância Magnética , Masculino , Síndrome , Aderências Teciduais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
El síndrome de Mirizzi es una variante poco frecuente de colelitiasis en la que un cálculo impactado en la bolsa de Hartmann comprime la vía biliar desencadenando una ictericia obstructiva, frecuentemente seguida de fenómenos inflamatorios y de diversas complicaciones (colecistitis, colangitis, fístulas etc). Presentamos dos pacientes con síndrome de Mirizzi, correctamente diagnosticados en el preoperatorio e intervenidos por vía laparoscópica. Un caso fue convertido por adherencias en el triángulo de Calot y tratado con colecistectomía subtotal y coledocorrafia sobre tubo en T de Kher. En el otro enfermo se pudo completar con éxito el procedimiento. Ambos postoperatorios cursaron con normalidad. En el presente artículo, se analizan las técnicas diagnósticas que ayudan a una identificación precoz del síndrome y se discuten las opciones terapéuticas más adecuadas en el momento actual, prestando una especial atención al papel de la colangiopancreatografía endoscópica y del abordaje laparoscópico en el manejo de estos pacientes
Mirizzis syndrome is an unusual complication of gallstone disease, in which a stone impacting in the neck of the gallbladder (Hartmanns pouch) compresses the common bile duct. This mechanical obstruction leads to obstructive jaundice frequently followed by inflammatory changes and several complications. We present two patients affected by Mirizzis syndrome whose diagnosis was correct in the preoperative period and approached by laparoscopy. A case was converted to open procedure due to adhesions in the Calots triangle, and therefore, treated with subtotal cholecystectomy and choledochorrhaphy over a T tube. In the other case the laparoscopy access became successful. Both postoperative courses were uneventful. In this article, suitable diagnostic techniques are analyzed. On the other hand, we discuss what is the best therapeutic option, with especial attention to the relevance of endoscopic retrograde cholangiopancreatography and laparoscopic approach in the management of those patients
Assuntos
Masculino , Idoso , Humanos , Colelitíase/diagnóstico , Colangiografia/métodos , Colelitíase/complicações , Colelitíase/cirurgia , Colelitíase/terapia , Icterícia Obstrutiva/etiologia , Colecistectomia/métodosRESUMO
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Assuntos
Humanos , Procedimentos Cirúrgicos Operatórios , Transfusão de Sangue , Anestesia , Sistema ImunitárioRESUMO
Venous access for chemotherapy in oncological patients, has experienced continuous modifications in recent years, both with regard to the types of devices used as with regard to the venous access itself. We present a prospective study of two groups of 25 patients, in which the patients in the first group were given a Port-A-Cath PAS Port venous access system with a Cath-Finder catheter locating system, and those in the second group were given a conventional Implantofix and Hickman venous access system. The device placed in the first group belongs to a third generation venous access system, involving a simple and safe placing technique which neither requires an operating room nor radiology. The incidence of complications in the first group was similar to that seen in conventional systems. To prevent early or late phlebitis in the cephalic or basilar vein, we recommended the prophylactic use of low molecular weight heparin during the procedure and maintaining this during the next three to five days, as well as during each new chemotherapy session and at any time this complication may arise. The economic benefits of this device are much greater than those of conventional systems.