1/53. Parietal seeding of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/53. Drug-associated cholelithiasis: a case of sulindac stone formation and the incorporation of sulindac metabolites into the gallstones.A case of drug-associated cholelithiasis (sulindac chlecystohepatolithiasis) in a 63-yr-old woman is reported. The patient was admitted to our hospital to undergo treatment for rheumatoid arthritis of 20 yr duration. She was treated with nonsteroidal anti-inflammatory drugs (NSAID: sulindac). Two months later, she presented with right upper quadrant pain. Diagnostic studies including ultrasonography (US), computed tomography (CT) and endoscopic retrograde cholangiography (ERC), led to the diagnosis of cholecystohepatolithiasis. She underwent cholecystectomy and choledochotomy with an extraction of intrahepatic stones. The intrahepatic stones were light yellow in color with a claylike appearance. Unexpectedly, an infrared spectroscopic analysis of the stone showed it to consist of sulindac metabolites. In addition, the dilated segment of the intrahepatic bile duct naturally returned to its normal size after the discontinuation of the drug administration. This is the first reported case of sulindac stone formation in the bile duct. No similar problems with other NSAIDs have been reported previously.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/53. New wire-guided basket for intrahepatic stone extraction.BACKGROUND: Endoscopic extraction of intrahepatic ductal stones with conventional stone retrieval baskets sometimes is difficult when the stones are deep in the segmental ducts or in a tortuous duct. We evaluated the use of a new wire-guided basket for endoscopic bile duct stone extraction. methods: The new wire-guided basket has a separate lumen for the guidewire on one side of the catheter. It is rail-loaded and advanced over a guidewire into the desired segmental duct. After they are engaged, the stones are dragged into the duodenum and the guidewire is left in the segmental duct. The basket then can be reinserted into that particular ductal segment over the wire for further stone extraction. RESULTS: The basket was used to treat three patients. Two patients had multiple intrahepatic stones. Repeated passage of the basket back to the desired location was accomplished without difficulty. All stones were removed successfully. CONCLUSION: The new wire-guided basket is a useful device for removing intrahepatic stones, particularly from patients with multiple ductal stones.- - - - - - - - - - ranking = 7keywords = extraction (Clic here for more details about this article) |
4/53. gastric outlet obstruction by a gallstone (Bouveret's syndrome).gastric outlet obstruction caused by a gallstone in the duodenum or pylorus(Bouveret's syndrome) is a very rare complication of gallstone disease. Presenting symptoms include epigastric pain, nausea, and vomiting. Preoperative diagnosis is not easy. Oral endoscopy is one of the diagnostic procedures. We present a case in which the diagnosis was made by endoscopic examination. Multiple attempts at endoscopic extraction of the gallstone from the duodenum were unsuccessful. A one-stage surgical procedure consisting of the removal of the impacted stone, fistula repair, and cholecystectomy was performed in this case. The postoperative course was uneventful.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/53. Is the loss of gallstones during laparoscopic cholecystectomy an underestimated complication?Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan.Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/53. Gallstone in abdominal wall--a complication of laparoscopic cholecystectomy.A 39-year-old woman presented with abdominal wall mass 9 years after she underwent laparoscopic cholecystectomy for symptomatic gallstones. After surgical resection, a pathologic examination identified an abscess cavity within the abdominal wall that was surrounded by a wide, diffuse, poorly defined wall of dense fibrous tissue. An examination did not show neoplastic tissue. The cavity was bile-stained and contained a 2.5-cm gallstone. This case shows a complication of laparoscopic cholecystectomy. gallstones spilled during the extraction of the gallbladder through the abdominal wall incision may lead to a reactive process that clinically and microscopically may resemble a fibro-proliferative disorder, including a neoplastic process. This complication of laparoscopic cholecystectomy is rare. Pathologists must be aware of its occurrence because examination of the solid fibrous wall may lead to diagnoses of reactive or neoplastic fibro-proliferative processes.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/53. Surgical clips as a nidus for stone formation in the common bile duct.We report the case of a 40-year-old woman who presented with symptomatic gallbladder stones. A laparoscopic cholecystectomy was performed using metallic clips. Three years later, she underwent a endoscopic retrograde cholangiopancreatography (ERCP) for interscapular and right upper quadrant pain, jaundice, and fever. This examination revealed a stone and clips in the common bile duct (CBD). A sphinteroctomy was undertaken, but the stone could not be extracted despite multiple attempts. Ultimately, a Kocher incision was required to achieve choledocotomy and extraction of the stone and the clips.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/53. Modification of a choledochoscope for extraction of difficult biliary stones.cholelithiasis is a common problem in the united states, affecting 10 to 15 per cent of the population. Although only one per cent of these patients have intrahepatic gallstones their discovery intraoperatively may present a technical challenge for the surgeon. This paper describes a simple method for dislodging difficult intrahepatic biliary stones: modification of a rigid choledochoscope to permit use of a biliary Fogarty catheter and Segura basket under direct visualization.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
9/53. Laparoscopic management of gallstone ileus.Gallstone ileus is an uncommon entity that was first described by Bartholin in 1654. Despite advances in perioperative care, morbidity and mortality remain high in patients with gallstone ileus because: 1) they are geriatric patients; 2) they often have multiple comorbidities; 3) presentation to the hospital is delayed; 4) many are volume depleted with electrolyte abnormalities; and 5) the diagnosis of gallstone ileus is difficult to make. Traditional management has entailed open laparotomy with relief of intestinal obstruction by enterotomy and stone extraction. cholecystectomy and takedown of the cholecystoenteric fistula can be performed. We propose an alternative method of management in an attempt to limit operative trauma and improve morbidity and mortality. We review the literature and describe two patients with gallstone ileus who were managed laparoscopically. One patient underwent laparoscopic assisted enterolithotomy, and the other patient underwent diagnostic laparoscopy with disimpaction of the gallstone into the large bowel. They were discharged after their ileus had resolved on the fourth and sixth postoperative day, respectively. laparoscopy is a powerful diagnostic and therapeutic tool that can be effectively used to treat gallstone ileus.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/53. abdominal wall sinus due to impacting gallstone during laparoscopic cholecystectomy: an unusual complication.During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in < or = 20% of cases, while gallstone spillage occurs in < or = 6% of cases. In most cases, there are no consequences. gallstones can be lost in the abdominal wall as well as the abdomen during extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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