Gallstone ileus.

A retrospective analysis of 74 patients with gallstone ileus detected during the period between 1975 and 1987 was performed at the Surgical Department. The group comprised 55 females and 19 males, with a mean age of 64.8 years. Previous biliary symptoms had been observed in 76% of the cases and in 58% there had been concomitant disease. The main duration of symptoms previous to admission was 3.4 days. In 85% of the cases complementary diagnostic procedures were performed. The triad of air in the biliary tract, air-fluid levels and ectopic stone was found in only 9.5% of the cases. The preoperative diagnosis of gallstone ileus was made in 31% of the patients. The preoperative period was 2.2 days. The main surgical procedure was enterolithotomy in 92% of the cases, the site of impaction being the terminal ileum in 65%. Only in 1 case was simultaneous biliary tract surgery and enterolithotomy performed. Overall, the 30-day postoperative mortality rate was 13.5%, with intra-abdominal sepsis as the main cause of death. Sixteen patients were submitted to biliary surgery 2 to 6 months later, and no deaths occurred.

[Duodenal diverticula and its relations with choledocholithiasis]. / Divertículos duodenales y su relación con coledocolitiasis.

The incidence of duodenal diverticula was accomplished by four different methods (autopsy, post operative cholangiography, ERCP and upper gastrointestinal X rays); the relationship with common bile duct stones, also was analyzed. The study was developed in the José Joaquín Aguirre Clinic Hospital and Paula Jaraquemada Hospital. The lower incidence was 0.72% in autopsy group and the highest was 8% in patients diagnosed by ERCP. All the diverticula were unique and located in the second duodenal portion. A minimal difference in sex groups was encountered. We did'nt find a major incidence of choledocholithiasis in the population with duodenal diverticula.

Divertículos duodenales y su relación con coledocolitiasis. / [Duodenal diverticula and its relations with choledocholithiasis]

The incidence of duodenal diverticula was accomplished by four different methods (autopsy, post operative cholangiography, ERCP and upper gastrointestinal X rays); the relationship with common bile duct stones, also was analyzed. The study was developed in the José Joaquín Aguirre Clinic Hospital and Paula Jaraquemada Hospital. The lower incidence was 0.72

in autopsy group and the highest was 8

in patients diagnosed by ERCP. All the diverticula were unique and located in the second duodenal portion. A minimal difference in sex groups was encountered. We didnt find a major incidence of choledocholithiasis in the population with duodenal diverticula.

Treatment of residual common bile duct stones after cholecystectomy.

This study was conducted to determine the occurrence of "open" residual common bile duct stones after cholecystectomy to establish predisposing factors and possible alternative treatments. Correct diagnosis of choledocholithiasis before or during surgery, adequate exploration of the common bile duct, and suitable selection of technical procedures are the most important points in preventing retained CBD stones. If these occur, an adequate alternative treatment may prove helpful. Classical "clysis" of the bile duct is least recommended because of its high failure rate. The best method of chemical dissolution seems to be the use of mono-octanoin with 60% good results and a no-response rate of 30-40%. Instrumental extraction has been reported to be very successful (80-98%). Endoscopic sphincterotomy is currently the most frequently employed procedure for retained CBD stones, especially in poor risk patients. The reported success rate is 82-93% according to literature, with an extremely low mortality (0.2%). Reoperation should be resorted to only if all the other methods fail. Sphincteroplasty or choledochoduodenostomy, whenever indicated, are good alternative operations, with a mortality rate of approx. 3.5%.

Indications and results of sphincteroplasty in benign biliary diseases.

A retrospective analysis of 143 patients submitted to sphincteroplasty at the Department of Surgery, University of Chile Clinical Hospital was performed. A significant percentage of these patients (90%) were admitted due to acute biliary tract disease with or without cholangitis. The standard operative procedure was anterior transduodenal sphincteroplasty with supraduodenal choledochal exploration leaving a choledochostomy. A high number of our cases presented with intrahepatic lithiasis (23.8%). The morbidity was 15.4% and the 30 days post operative mortality rate was 4.9%, similar to other reports. Residual stones were observed in 10 patients (7%), and were successfully removed by other procedures. Three patients showed recurrent stenosis of the papilla and were operated on again with good results.