1/45. Recanalization of a portal-vein thrombosis and partial resolution of biliary cirrhosis following cholecystectomy for cholelithiasis in an infant.cholelithiasis in infants and children is unusual and is reputedly associated with underlying hemolytic disorders, total parenteral nutrition, ileal disease, and congenital anomalies of the biliary tree. We report a case of cholecystitis with pigmented stones in a 3-month-old infant associated with portal vein thrombosis (PVT) and biliary cirrhosis without the above-mentioned causes. Recanalization of the PV and partial resolution of the cirrhosis was observed following cholecystectomy. To our knowledge, cholelithiasis associated with PVT and cirrhosis in an infant has not been reported in the literature.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/45. Right hepatic lobectomy for bile duct injury associated with major vascular occlusion after laparoscopic cholecystectomy.A 57-year-old woman underwent laparoscopic cholecystectomy (LC) for cholelithiasis. Continuous bile leak was observed beginning on the first postoperative day. Postoperative endoscopic retrograde cholangiography revealed bile leak through the common hepatic duct, and severe stenosis of the hepatic confluence. A total of three percutaneous transhepatic biliary drainage (PTBD) catheters were inserted to treat obstructive jaundice and cholangitis. The patient was referred to our hospital for surgery 118 days after LC. cholangiography through the PTBD catheters demonstrated a hilar biliary obstruction. Celiac arteriography revealed obstruction of the right hepatic artery, and transarterial portography showed occlusion of the right anterior portal branch. On the basis of the cholangiographic and angiographic findings, we performed a right hepatic lobectomy with hepaticojejunostomy to resolve the bile duct obstruction and address the problem of major vascular occlusion. The patient's postoperative recovery was uneventful and she remains well 25 months after hepatectomy. We discuss a treatment strategy for bile duct injury suspected after LC, involving early investigation of the biliary tree and prompt intervention.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/45. Posterior hepatic duct injury during laparoscopic cholecystectomy finally necessitating hepatic resection: case report.A case of bile duct injury during laparoscopic cholecystectomy finally necessitating right hepatic lobectomy is reported to re-emphasize the importance of preoperative and intraoperative assessment of the biliary tree. A 47-year-old Japanese woman underwent laparoscopic cholecystectomy for cholecystolithiasis. On postoperative day 5, fever and right hypochondralgia developed, and CT revealed fluid collection at the right hypochondrium. Percutaneous drainage was performed, and subsequent fistulography revealed a communication of the cystic cavity with the right posterior bile duct, which suggested injury of the aberrant hepatic duct. Conservative therapy, including the adaptation of fibrin glue, was performed, but closure of the fistula and cavity was not obtainable. Finally, a right hepatic lobectomy was performed four months after cholecystectomy. In this case, endoscopic retrograde cholangiopancreatography was unsuccessful preoperatively, and intraoperative cholangiography was not done. This case report re-emphasizes that the preoperative and intraoperative examination of the biliary tree is mandatory to avoid bile duct injury.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
4/45. Primary intrahepatic lithiasis: report of a case treated by laparoscopic bilioenteric anastomosis.Recent advances in videolaparoscopic surgery have made this method the treatment of choice for many biliary diseases. However, it has not been used in certain cases, such as primary intrahepatic lithiasis. The authors report a case of a 62-year-old woman with a history of several episodes of cholangitis. Investigation revealed dilated intra- and extrahepatic bile ducts with intrahepatic stones. The patient underwent laparoscopy, and intraoperative cholangiography disclosed an enlarged common duct with absence of stones and the presence of multiple calculi in the intrahepatic biliary tree. A choledochotomy followed by choledochoscopy was performed, which revealed several intrahepatic pigmented stones that were completely retrieved, followed by a laterolateral choledochoduodenostomy to decompress the biliary tree and to allow the migration of residual or recurrent stones. The patient had an uneventful recovery and was discharged on the fourth postoperative day. After 15 months of follow-up the patient is asymptomatic with normal results of liver function tests. Late postoperative upper digestive endoscopy showed a patent choledochoduodenostomy.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
5/45. Feasibility of laparoscopic cholecystectomy in situs inversus.PURPOSE: To address the feasibility and safety of laparoscopic cholecystectomy in situs inversus and highlight the necessary modifications in the surgical technique. patients AND methods: We present our experience in two patients with situs inversus and symptomatic gallstones who were treated successfully by laparoscopic cholecystectomy. The surgeon stood on the right side with the video monitor above the patient's left shoulder. Two 10-mm ports were placed in the epigastric and subumbilical positions. Two 5-mm ports were placed in the left mid-clavicular and left anterior axillary lines. The two procedures were carried out uneventfully after reorientation of the visual-motor skills of the surgeon and cameraman to the left upper quadrant. A summary of a further similar 13 cases so far treated in the English-language medical literature is also presented. RESULTS: Skeletonizing the structures in Calot's triangle consumed extra time and was more difficult than in patients with a normally sited gallbladder. However, the hospital stay and postoperative complications were similar. CONCLUSION: Laparoscopic cholecystectomy in situs inversus seems to be feasible and safe provided it is performed by an expert laparoscopic surgeon who takes time in clearly demonstrating the extrahepatic mirror image anatomy of the biliary tree with its right-to-left shift.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/45. Double common bile duct with ectopic drainage into the stomach. Case report and review of the literature.A rare abnormal biliary tract consisting in a double common bile duct with an ectopic biliary tree draining into the stomach is described. This congenital anomaly, associated with lithiasis in the ectopic duct, was detected for the first time on MR-cholangiopancreatography. Only 23 cases of abnormal biliary drainage into the stomach have been reported in the literature. Embryogenesis and potential risks, such as lithiasis in the ectopic duct and the development of gastric carcinoma, are discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/45. Recurrent pyogenic cholangitis.A 26-year-old male presented with jaundice and recurrent cholangitis. ultrasonography revealed dilated intra- and extrahepatic biliary tree packed with multiple calculi. Endoscopic retrograde cholangiopancreatography and computerised tomography scan confirmed the findings and a diagnosis of recurrent pyogenic cholangitis was made. cholecystectomy, choledocholithotomy with removal of stones and Roux-en-Y choledochojejunostomy were performed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/45. Portal biliopathy.Herein we describe a case of obstructive jaundice and cholangitis originating from choledochal lithiasis secondary to a stricture of the common bile duct in a patient with cavernous transformation of the portal vein. In fact, portal cavernous transformation gives rise to many dilated pericholedochal and periportal collaterals that bypass the portal vein obstruction. Extrinsic compression of the common duct by dilated venous collaterals together with pericholedochal fibrosis from the inflammatory process causing portal thrombosis may lead to biliary stricture and dilatation of the proximal biliary tree. This condition sometimes causes the formation of secondary biliary stones and cholangitis. Treatment in our case could not be accomplished by a biliodigestive anastomosis because the patient suffered from a short bowel syndrome subsequent to extensive ileal resection for splanchnic venous thrombosis. We repeatedly attempted stone removal during endoscopic retrograde cholangiopancreatography (ERCP) but finally resorted to a percutaneous transhepatic approach, which permitted removal of the stones and treatment of the stricture by pneumatic dilatation. The patient remains well 3 years after the procedure and has shown no signs of jaundice or cholangitis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/45. MRI of perforated gall bladder.Gall bladder perforation is a dreaded complication of acute cholecystitis that, if not diagnosed early in the course, might have a poor prognosis. Both CT and ultrasonography have been used until now extensively for the diagnosis of acute cholecystitis, but diagnosis of perforation is always difficult. Magnetic resonance, by its superior soft tissue resolution and multiplanar capability, is a better modality and should fare better than ultrasonography and CT, as demonstrated in our case. magnetic resonance imaging demonstrates the wall of the gall bladder and defects to a much better advantage and more convincingly. In addition, MR colangiopancreatography images demonstrate the biliary tree better than other modalities. We suggest that in the case of acute cholecystitis, if perforation is suspected and CT and ultrasonography are not conclusive, MR should be the modality of choice. It can be used as a first line of investigation; however, it might not be cost-effective.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/45. mirizzi syndrome with a double biliary fistula.mirizzi syndrome is a partial obstruction of the biliary tree caused by a stone impacted in the cystic duct, with or without development of a cholecystobiliary fistula. Clinical signs are non-specific and suggest at first an obstructive jaundice. We describe a patient with a type I mirizzi syndrome with a cholecystocolic and a cholecysto-internal biliary fistula. The diagnosis was suggested by ultrasonography and tomodensitometry, and confirmed by endoscopic retrograde cholangiopancreatography. A partial cholecystectomy with a Roux-en-Y hepaticojejunostomy reconstruction was performed. A review of the literature covering its clinical presentation, diagnosis and surgical treatment is presented.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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