1/13. Biliary-enteric fistulas: report of five cases and review of the literature.Internal biliary fistulas (IBF) are seen rarely. Because the symptoms and signs of IBF are not specific and the diagnosis is not suspected, these patients are commonly investigated with plain abdominal films (PAF), ultrasonography (US), upper gastrointestinal series (UGIS), barium enema (BE), and computed tomography (CT), but not always with endoscopic retrograde cholangiopancreatography (ERCP). The purposes of this article are (a) to attract attention of radiologists to presumptive findings of IBF, so as not to misdiagnose this unsuspected and rare disease, and (b) review of the literature while presenting radiologic features of our cases. Five cases of IBFs in which extrahepatic biliary tree communicating with duodenum (four cases) and colon (one case) are reported. Diagnostic work-up of cases were done by PAF, US, UGIS, BE, and CT. Aerobilia, which cannot be explained using other means, ectopic gallstone and small bowel dilatation, nonvisualization of the gallbladder despite no history of cholecystectomy, and thick-walled shrunken gallbladder adherent to neighboring organs were suggestive findings of IBF in our study. knowledge of imaging findings suggestive of IBF and a high index of suspicion increase the diagnostic rate of IBFs.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/13. Ultrasound of epigastric injuries after blunt trauma.Blunt trauma to the epigastrum may result in a retroperitoneal hematoma involving the head of the pancreas and descending duodenum. Secondary effects include obstruction of the gastric outlet, obstruction of the biliary tree, and extrinsic compression of the inferior vena cava. Four patients with epigastric trauma were reviewed who had been examined by ultrasound of the abdomen. Ultrasound showed the extent of the retroperitoneal hematoma, its effect on contiguous organs, and was helpful in clinical management.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/13. Staged and complete laparoscopic management of cholelithiasis in a patient with gallstone ileus and bile duct calculi.BACKGROUND: Gallstone ileus is an uncommon cause of small bowel obstruction, and its incidence peaks in elderly women. Although enterolithotomy has been accomplished laparoscopically, often using a laparoscopically assisted approach, controversy persists as to the indication, timing, and surgical approach to a cholecystectomy with closure of the cholecystoduodenal fistula. methods: We present the case of a 63-year-old woman with symptomatic cholecystolithiasis who presented with acute gallstone ileus and underwent an emergency laparoscopic enterolithotomy. Hypotonic duodenography during the follow-up period demonstrated a cholecystoduodenal fistula and previously unsuspected stones in the bile duct. The patient underwent an elective laparoscopic cholecystectomy with repair of the fistula, a concomitant bile duct exploration, choledocholithotomy, and primary bile duct closure. RESULTS: The patient enjoyed an uneventful recovery, and was discharged home on postoperative day 5 after her initial emergency surgery. Her recovery after the subsequent elective surgery was more expeditious, with a discharge from hospital on postoperative day 2 and a return to office employment 2 weeks later. CONCLUSION: In the good-risk patient, staged laparoscopic management of gallstone ileus and the associated cholecystoduodenal fistula is feasible and appears to be safe. In such patients, imaging of the biliary tree is essential to detect silent choledocholithiasis, which also may be managed concomitantly and safely by the laparoscopic approach.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/13. A rare case of idiopathic retroperitoneal fibrosis involving obstruction of the mesenteric arteries, duodenum, common bile duct, and inferior vena cava.Idiopathic retroperitoneal fibrosis (IRF), usually affects the ureter, although the biliary tree, duodenum and vasculature may also be susceptible. This case report describes a 64-year-old man with IRF, who presented painless watery diarrhea, radiological features of obstructive jaundice and duodenal obstruction, and ultimately an obstruction of the inferior vena cava. We employed tamoxifen for his treatment, but the disease progressed and the patient died of multiple organ failure two years after the onset. While the cause of IRF in this patient was obscure, we suspected his painless watery diarrhea indicated chronic ischemia of the small bowel, and the findings of an abdominal CT scan were extremely valuable in indicating IRF.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/13. Ampullary duodenal diverticulum and cholangitis.CONTEXT: Ampullary duodenal diverticulum complicated by cholangitis is little known in clinical practice, especially when there are no gallstones in the common bile duct or there is no biliary tree ectasia or hyperamylasemia. A case of this association is presented, in which the surgical treatment was a biliary-enteric bypass. CASE REPORT: A 74-year-old diabetic white woman was admitted to the Taubat University Hospital, complaining of pain in the right upper quadrant, jaundice and fever with chills (Charcot's triad). She had had cholecystectomy 30 years earlier. She underwent clinical treatment with parenteral hydration, insulin, antibiotics and symptomatic drugs. Imaging examinations were provided for diagnosis: ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography. The surgical treatment consisted of choledochojejunostomy utilizing a Roux-en-y loop. The postoperative period progressed without incidents, and a DISIDA scan demonstrated the presence of dynamic biliary excretion. The patient remained asymptomatic when seen at outpatient follow-up.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/13. A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum. A case report including results of mutation analysis.BACKGROUND/AIMS: We report a case of solitary Peutz-Jeghers-type hamartomatous polyp of the duodenum in a 22-year-old Japanese woman along with the results of genomic analysis. methods/RESULTS: The patient was almost asymptomatic, though endoscopic examination revealed a solitary lobular polypoid lesion measuring 3 cm in diameter in the first portion of the duodenum. The lesion was resected endoscopically. Histopathological examination showed hyperplasia with a tree branch-like extension of the lamina propria derived from the muscularis mucosae, consistent with histological features of polyps of peutz-jeghers syndrome (PJS). No mucocutaneous pigmentation of the skin was evident and family history was negative. Analysis of the loss of heterozygosity at the locus of 19p 13.3 and mutation analysis of the STK11/LKB1 gene, which has recently been recognized as a susceptible gene in PJS, were performed. However, no evidence of genomic abnormality was found. CONCLUSION: The clinical and investigative findings in our case suggest that the solitary Peutz- Jeghers-type hamartomatous polyp can be regarded as a clinical entity separate from PJS.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/13. Laparoscopic management of gallbladder-associated ectopic liver.Ectopic liver is a rare entity discussed infrequently in the surgical literature. liver ectopia develops due to rests of liver parenchyma retained at various intraperitoneal or intrathoracic locations during migration of the liver proper during embryologic development. It is usually found during exploration for other diagnoses, commonly diseases of the biliary tree. We report a case in which a 3.7-cm mass associated with the fundus of the gallbladder was visualized preoperatively by computed tomography and identified histologically as ectopic liver after diagnostic laparoscopy and cholecystectomy with en bloc resection of the associated mass.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/13. Duodenal duplication cyst causing severe pancreatitis: imaging findings and pathological correlation.We here report a case of a 18-year-old man with a history of recurrent abdominal pain and a previous episode of severe acute pancreatitis. Abdominal ultrasonography, contrast enhanced multislice computer tomography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and magnetic resonance imaging demonstrated a cystic mass lesion. Only on delayed phase magnetic resonance images after gadolinium-BOPTA injection, it was possible to demonstrate the lesionos relationship with the biliary tree, differentiating the lesion from intraluminal duodenal diverticulum, and to achieve the diagnosis of duodenal duplication cyst, a recognized rare cause of acute pancreatitis. The diagnosis was confirmed by histology.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/13. CT cholangiography of a choledochocele.Choledochocele is a rare anomaly which has been imaged by a variety of techniques, including CT. A case of choledochocele in an eleven-year-old boy is reported. CT demonstrated a fluid-filled lesion protruding into the lumen of the duodenum and containing stones. CT following oral cholangiogram contrast administration and intravenous sincalide confirmed connection of the cystic lesion with the biliary tree. This is a safe and noninvasive method for the diagnosis of choledochocele.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/13. Choledochoduodenal fistula: a rare complication of duodenal ulcer. Case report.In a 29-year-old man with pyloric obstruction, plain abdominal radiography showed gas in the biliary tree. gastroscopy revealed severe duodenal stenosis with a large posterior ulcer, and barium from a test meal passed into the common bile duct. Ten days after truncal vagotomy and gastrojejunostomy, signs of ascending cholangitis appeared. Following antibiotic treatment and cholecystectomy the patient recovered.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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