[Is surgical bile duct revision in choledocholithiasis still indicated?]. / Ist die chirurgische Gallengangsrevision bei Choledocholithiasis noch indiziert?

Endoscopic papillotomy with stone extraction is increasingly performed for the management of common bile duct stones either before cholecystectomy or as a sole procedure leaving the gallbladder in situ. We have therefore evaluated the method of operative common duct exploration. 94 cases with bile duct stones treated by cholecystectomy and common bile duct exploration were reviewed. The 30-day mortality was 2.1% with an overall morbidity of 19%. A retained stone was found on postoperative T-tube cholangiography in 6 patients and in all cases was removed percutaneously via the T-tube track. Patients were divided into three age groups (less than or equal to 60, 61-75, greater than 75 years). In each patient various risk factors were recorded. Correlation was made between age, risk factors and patient's morbidity. No correlation was found between age and morbidity. Patients with up to two risk factors had a morbidity of 10%. With three to four risk factors the morbidity increased to 19%, reaching 47% in patients with five and more risk factors. Cholecystectomy with common bile duct exploration is a safe procedure even in the elderly patient. Careful evaluation of risk factors is necessary. Endoscopic papillotomy with or without cholecystectomy should be considered in high risk patients.

[Pulpous hamartoma of the spleen. Imaging by CT and MRT]. / Pulpöses Hamartom der Milz. Darstellung in der CT und MRT.

A rare case of a symptomatic splenic hamartoma is presented. Its appearance on both unenhanced and enhanced computed tomography and fast-scan magnetic resonance imaging is demonstrated.

[A calcified coronary artery aneurysm following Kawasaki syndrome]. / Verkalktes Koronararterienaneurysma nach Kawasaki-Syndrom.

On the chest X-ray of a 15-year-old patient, a round, egg-shell-like calcification was seen in projection into the left heart border. This finding was caused by a calcified coronary aneurysm following Kawasaki's disease. Although this has been described as a typical change, it is rarely found in daily clinical routine.