RESUMO
Hepaticojejunostomy is the standard technique for the reconstruction of severe iatrogenic lesions of the common bile duct (CBD), although the technique itself is major surgery with a complication rate up to 30%. We report a case of a male patient with a iatrogenic complete transsection of the CBD. Due to multiple previous operations and the present inflammation a standard reconstruction technique was not possible to perform. A neo-bile duct was created using a segment of the Great Saphenous Vein (GSV) synchronously with an external biliary drainage by PTCA and biliary stenting (after 4 weeks). The stent was removed 8 months later. Cholangiography showed normal bile flow without occlusion. Blood tests normalised. We believe that using an autologous vein graft in combination with a removable or biodegradable stent is the right track for the reconstruction of the CBD in the future.
Assuntos
Traumatismos Abdominais/complicações , Doenças dos Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Ducto Colédoco/lesões , Ducto Colédoco/cirurgia , Veia Femoral/transplante , Procedimentos de Cirurgia Plástica/métodos , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Anastomose Cirúrgica/métodos , Doenças dos Ductos Biliares/diagnóstico , Doenças dos Ductos Biliares/etiologia , Colangiografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgiaRESUMO
Cysts of the thoracic duct are uncommon entities that can occur in the abdominal segment, the cisterna chyli, the thoracic segment and the cervical segment of the thoracic duct. The rarest presentation is in the cervical segment, with only seventeen cases reported in English literature. The diagnosis can be made by puncture and with the use of computed tomography or ultrasonography. The cystic fluid always contains an excess of T-lymphocytes and triglycerides. Except for two cases, all reported cervical thoracic duct cysts were surgically treated by excision and ligation of the lymphatics connected to the cyst. We present a case of a successful non-operative treatment of a cervical thoracic duct cyst that was resolved by repeated aspiration and dietary changes only.
Assuntos
Cisto Mediastínico/terapia , Punções , Ducto Torácico/diagnóstico por imagem , Triglicerídeos/administração & dosagem , Idoso de 80 Anos ou mais , Feminino , Humanos , Cisto Mediastínico/diagnóstico , RadiografiaRESUMO
Venous insufficiency of the lower extremities is a highly prevalent condition. Successful treatment of superficial venous insufficiency will most often necessitate treatment of the saphenofemoral junction incompetence with correction of saphenous vein reflux. In the majority of patients it concerns a reflux of the greater saphenous vein. The standard procedure consists of ligation and stripping of the greater saphenous vein combined with with additional phlebectomies or ligation of insufficient perforant veins if necessary. Although the standard procedure is widely known and accepted, the postoperative morbidity and postoperative limitations of activity are high. In this context minimally invasive percutaneous endovenous techniques were developed to improve the patients comfort and faster resumption of work. Among these, endovenous laser ablation of the greater saphenous vein is a relatively new procedure. Percutaneous introduction of a laser fiber into the incompetent vein and ablation with pulsed laser energy is far less invasive than stripping.
