1/18. Interventional radiology in percutaneous management of bile duct obstruction: biliary drainage through a spontaneous common hepatic duct-duodenal fistula.Bile duct injuries are a serious complication of biliary surgery. We report a case of benign obstruction of the common hepatic duct associated with common hepatic duct-duodenal spontaneous fistula following complex surgical intervention. We managed percutaneously the fistula with balloon dilatation and long-term stenting, as the fistula allowed biliary flow in the duodenum. We avoided reintervention preserving biliary flow, with good clinical results after a follow-up of a 3 years. We emphasize the role of a clinically focused approach to percutaneous management of complications following biliary surgery.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/18. Spontaneous multiple cholecystoenteric fistulas--a case report.Spontaneous multiple cholecystoenteric fistulas are relatively rare complications of chronic cholecystitis. One cholecystoduodenal and two cholecystocolonic fistulas were observed in a 65-year-old woman whose symptoms included fever, chills, jaundice, diarrhea, and prolonged right upper quadrant pain. Pneumobilia, which is a pathognomonic sign of bilioenteric fistula, was also detected by her plain abdomen X-ray on admission. Both types of fistulas were correctly diagnosed preoperatively by barium enema, upper GI series and endoscopic retrograde cholangiopancreaticography. The patient was referred for surgery and fistulas were identified during laparotomy. cholecystectomy, division of these fistulas, and primary repair of these bowel defects were successfully performed. The postoperative course was unremarkable. We report this unusual case and briefly review the hypothesized pathogenesis, typical symptomatology, radiographic diagnosis, complications and therapeutic modalities of this condition.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
3/18. Bouveret's syndrome complicated by acute pancreatitis.BACKGROUND/AIM: This study evaluated a case of Bouveret's syndrome due to a cholecystoduodenal fistula and gallstone obstruction of the duodenum, complicated by acute pancreatitis and cholecystitis. methods: The presenting features, special investigations, radiological findings, operative and endoscopic procedures were reviewed. RESULTS: Symptoms persisted after laparotomy and removal of a gallstone in the duodenum. Intra-operative endoscopy identified a second previously undetected stone impacted in the distal duodenum. CONCLUSION: The importance of excluding more than one stone causing Bouveret's syndrome is emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/18. Duodenal tuberculosis with a choledocho-duodenal fistula.A 22-year-old man visited our hospital (National Cancer Center Hospital East) complaining of fatigue and anorexia. A laboratory investigation demonstrated a biochemical 'picture' of obstructive jaundice. An abdominal CT showed a low density mass in the retropancreatic area with multiple enlarged periportal lymph nodes. Upper gastrointestinal endoscopy revealed active ulceration on the dorsal wall of the descending part of the duodenum, and histopathology of the biopsy specimen revealed an ulcer with reactive inflammatory cell infiltration; no tumor cells were detected. The possibility of neoplasm had been ruled out by the use of CT and angiography. The jaundice recovered spontaneously and the abdominal mass gradually decreased in size. Endoscopic retrograde pancreatography showed no evidence of pancreatic disease; however, endoscopic retrograde cholangiography showed a choledocho-duodenal fistula. This patient showed hypersensitivity against the tuberculin skin test and mycobacterium tuberculosis was successfully detected in gastric juice by using a polymerase chain reaction method and culture. biopsy samples obtained from the duodenal ulcer at the second upper gastrointestinal endoscopy showed chronic inflammation with an epithelioid granuloma, suggesting tuberculosis. We thus diagnosed this case as a duodenal tuberculosis with a choledocho-duodenal fistula. To the best of our knowledge, there has been no report available of duodenal tuberculosis being the cause of a choledocho-duodenal fistula.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
5/18. Endoscopic management of cystic duct fistulas after laparoscopic cholecystectomy.Two patients are reported who developed bile ascites as a result of cystic duct fistulas following laparoscopic cholecystectomy. Both patients were successfully treated with endoscopic retrograde cholangiopancreatography, utilizing sphincterotomy and nasobiliary tube placement. Characteristics of this syndrome and advantages of this form of therapy are emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/18. Multiple giant duodenal gallstones causing gastric outlet obstruction: Bouveret's minefield revisited.gastric outlet obstruction caused by a gallstone impacted in the duodenum is a rare entity known as Bouveret's syndrome. We report the unusual case of multiple large gallstones impacted in the duodenum from a cholecystoduodenal fistula in an 83-year-old lady. A high index of suspicion allowed for prompt diagnosis. Early surgical intervention was instituted because if the size and number of gallstones with an excellent outcome. The surgical strategies and underlying pitfalls underlying the management of this syndrome are critically reviewed and discussed.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
7/18. Living-related liver transplantation in a patient with end-stage hepatolithiasis and a biliary-bronchial fistula.liver transplantation in patients with end-stage hepatolithiasis is complicated by the high incidence of the suppurative cholangitis and systemic infection. A 43-year-old Korean-Japanese woman with hepatolithiasis, biliary cirrhosis, suppurative cholangitis, and biliary-bronchial fistula underwent living-related liver transplantation (LRLT) using a right lobe graft of her sister. The risk of infection was minimized by preoperative percutaneous transhepatic biliary drainage initiated 2 months before transplantation. The native liver was resected en bloc with the extrahepatic bile ducts and the infected section of the right hemidiaphragm. Opportunistic infection was prevented by limiting antimicrobial therapy to the interval from preoperative day 3 to postoperative day 4. immunosuppressive agents were given below standard dose. The postoperative course following LRLT was uncomplicated, and hepatic function was good. Careful management of infection and adequate graft size are essential for successful LRLT in patients with end-stage hepatolithiasis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/18. Bouveret's syndrome: a case report.duodenal obstruction due to a gallstone from a cholecystoduodenal fistula (Bouveret's syndrome) is a rare complication of gallstone disease. patients present gastric outlet occlusion with vomiting, abdominal distension and a state of dehydration. Plain film of the abdomen, ultrasonography and CT scans reveal pneumobilia and the obstructing gallstone. endoscopy is essential for diagnosis and therapy, with a view to the possibility to relieving the occlusion. endoscopy, however, cannot be used to treat the fistula and is often unsuccessful because of the very large size of the stone. Surgical therapy can be effective both for relieving the occlusion and for fistula treatment. The authors report a case of Bouveret's syndrome successfully treated surgically in an otherwise healthy patient. In critically ill patients, the primary goal of therapy is relief of the occlusion.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/18. Development of bile duct bezoars following cholecystectomy caused by choledochoduodenal fistula formation: a case report.BACKGROUND: The formation of bile duct bezoars is a rare event. Its occurrence when there is no history of choledochoenteric anastomosis or duodenal diverticulum constitutes an extremely scarce finding. CASE PRESENTATION: We present a case of obstructive jaundice, caused by the concretion of enteric material (bezoars) in the common bile duct following choledochoduodenal fistula development. Six years after cholecystectomy, a 60-year-old female presented with abdominal pain and jaundice. Endoscopic retrograde cholangiopancreatography demonstrated multiple filling defects in her biliary tract. The size of the obstructing objects necessitated surgical retrieval of the stones. A histological assessment of the objects revealed fibrinoid materials with some cellular debris. Post-operative T-tube cholangiography (9 days after the operation) illustrated an open bile duct without any filling defects. Surprisingly, a relatively long choledochoduodenal fistula was detected. The fistula formation was assumed to have led to the development of the bile duct bezoar. CONCLUSION: Bezoar formation within the bile duct should be taken into consideration as a differential diagnosis, which can alter treatment modalities from surgery to less invasive methods such as more intra-ERCP efforts. Suspicions of the presence of bezoars are strengthened by the detection of a biliary enteric fistula through endoscopic retrograde cholangiopancreatography. Furthermore, patients at a higher risk of fistula formation should undergo a thorough ERCP in case there is a biliodigestive fistula having developed spontaneously.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/18. Bronchobiliary fistula due to hydatid disease: a case report.A case of bronchobiliary fistula due to transdiaphragmatic rupture of hepatic echinococcal cyst is described. The importance of excluding associated extrahepatic biliary obstruction is emphasized. Successful treatment involves relief of this obstruction as well as management of both the pleural space and pulmonary complications.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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