1/67. Management of a patient with hepatic-thoracic-pelvic and omental hydatid cysts and post-operative bilio-cutaneous fistula: a case report.In humans, most hydatid cysts occur in the liver and 75% of these are single. Our patient was a 31 year-old male. His magnetic resonance imaging (MR) showed one cyst (15 x 20 cm) in the right lobe and three cysts (5 x 6 cm, 8 x 6 cm, and 5 x 5 cm) in the left lobe of the liver, two cysts (4 x 5 cm and 5 x 5 cm) on the greater omentum, and two cysts (15 x 10 and 10 x 10 cm) in the pelvis. The abdomen was entered first by a bilateral subcostal incision and then by a Phennenstiel incision. Partial cystectomy capitonnage was done on the liver cysts; the cysts on the omentum were excised, and the pelvic cysts were enucleated. The cyst in the right lobe of the liver was in communication with a thoracic cyst. An air leak developed from the thoracic cyst which had underwater drainage and bile drainage from the drain in the cavity of the right lobe cyst. Sphincterotomy was done on the seventh post-operative day by endoscopic retrograde cholangiopancreatography (ERCP). No significant effect on mean bile output from the fistula occurred. octreotide therapy was initiated, but due to abdominal pain and gas bloating the patient felt and could not tolerate, it was stopped on the fourth day; besides, it had no decreasing effect on bile output during the 4 days. Because air and bile leak continued and he had bile stained sputum, he was operated on on post-operative day 18. By right thoracotomy, the cavity and the leaking branches were closed. By right subcostal incision, cholecystectomy and T-tube drainage of the choledochus were done. On post-operative day 30, he was sent home with the T-tube and the drain in the cavity. After 3 months post-operatively, a second T-tube cholangiography was done, and a narrowing in the distal right hepatic duct and a minimal narrowing in the distal left hepatic duct were exposed. Balloon dilatation was done by way of a T-tube. Bile drainage ceased. There was no collection in the cavity in follow-up CT scanning, so the drain in the cavity, and the drainage catheter in the right hepatic duct were extracted. Evaluation of the biliary ductal system is important in bilio-cutaneous fistulas, and balloon dilatation is very effective in fistulas due to narrowing of the ducts.- - - - - - - - - - ranking = 1keywords = bile, duct (Clic here for more details about this article) |
2/67. Cystic echinococcosis in a Jordanian patient: albendazole in a short-term immigrant.With an ever increasing number of international travelers, physicians should be aware of the diseases that have rarely been encountered in their home countries. Cystic echinococcosis (CE) caused by echinococcus granulosus is seldom seen in japan despite frequent occurrence of the other type of echinococcosis, alveolar echinococcosis (AE) caused by E. multilocularis, in its northern parts. However, CE is prevalent in many parts of the world including the United Kingdom, Mediterranean basin, middle east, south america, and australia, and is supposed to be resurgent in several parts of the world. The disease is acquired by the oral ingestion of the eggs of E. granulosus passed into the feces of several definitive host animals carrying tapeworms, mostly dogs. These definitive hosts are infected by cannibalizing intermediate host animals including sheep and cattle whose livers and/or lungs are affected by cystic lesions that contain protoscoleces. In endemic areas the diagnosis of CE is not considered to be complicated; typical morphological features composed of cysts as revealed by ultrasonography and/or computerized tomography (CT) scan. The diagnosis is also aided by serological methods detecting serum antibodies. However, imaging procedures show a variety of features that could often lead to misdiagnosis as other diseases. Moreover, serological assays are sometimes difficult to interpret because of their incomplete sensitivities and specificities. Hence, a comprehensive understanding of a spectrum of imaging features and the application of serological methods with better sensitivities and specificities are indispensable. The mainstay of treatment of the disease is still surgical removal of cysts that has the potential to lead to a complete cure. Recently, the less invasive method PAIR (Puncture of cysts percutaneously, Aspiration of fluid, Introduction of protoscolicidal agent, and Reaspiration) was introduced with considerable success, and could be a promising alternative to surgery. Lastly, medical treatment with oral mebendazole or albendazole, especially the latter, can be beneficial not only as a adjunctive to surgery or PAIR, but as a sole treatment in cases in which invasive methods are not indicated. Here we report a Jordanian patient with CE whose diagnosis was substantiated by a novel immunoblot assay and who showed a rapid improvement during albendazole therapy.- - - - - - - - - - ranking = 0.059163331643363keywords = duct (Clic here for more details about this article) |
3/67. Mobile right atrial hydatid cyst with multiorgan involvement.A 25-year-old woman who had hydatid cysts in her lung was referred to our clinic for the hydatid cyst in her cardiac localization. Multiple hydatid cysts of different cardiac localizations were diagnosed by two-dimensional echocardiography, confirmed by computed tomography and magnetic resonance imaging, supported by enzyme-linked immunosorbent assay (ELISA) for echinococcosis. Surgical resection was performed for the right atrial cyst and pathology confirmed the diagnosis. Oral albendazole treatment was given postoperatively. Cathet. Cardiovasc. Intervent. 49:204-207, 2000.- - - - - - - - - - ranking = 0.56334667342655keywords = bile (Clic here for more details about this article) |
4/67. Hepatobiliary cystadenoma with mesenchymal stroma mimicking hydatid cyst. Report of a case.We report on a case of hepatobiliary cystadenoma with mesenchymal stroma in a 44-year-old Caucasian woman who presented with upper abdominal discomfort. Ultrasound (US) and computed tomography (CT) showed a cystic mass resembling hydatid cyst. Endoscopic retrograde cholangiography (ERC) demonstrated communication with the left hepatic duct. At surgery, a cystic mass with communication to the left hepatic duct was found and resected en bloc with a margin of normal liver tissue. Histological examination showed a hepatobiliary cystadenoma with mesenchymal stroma.- - - - - - - - - - ranking = 0.11832666328673keywords = duct (Clic here for more details about this article) |
5/67. Hydatid cyst of the liver presenting as an inferior vena cava obstruction.A 48-year-old woman presented with clinical features suggestive of an obstruction of the inferior vena cava (IVC). Abdominal sonography showed a 15- x 14-cm cystic mass involving the medial segment of the left hepatic lobe and the anterior segment of the right hepatic lobe. We visualized multiple intracystic floating membranes, a detached endocyst, and a daughter cyst within the main cyst. The cyst was compressing and effacing the intrahepatic portion of the IVC and the right atrium. Sonography of the right and left hepatic veins showed blood flow in the normal direction, but spectral analysis showed that the flow was continuous, possibly owing to extrinsic compression of the IVC at the site where the hepatic veins drained into the IVC. The patient responded well to percutaneous treatment of the hydatid cyst. This case represents a rare presentation of a hydatid cyst of the liver.- - - - - - - - - - ranking = 0.42862869587808keywords = obstruction (Clic here for more details about this article) |
6/67. Intrabiliary rupture of hydatid cyst of the liver.In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.- - - - - - - - - - ranking = 1.074103559016keywords = bile duct, bile, duct (Clic here for more details about this article) |
7/67. An autochthonous case of Echinococcus vogeli Rausch & Bernstein, 1972 polycystic echinococcosis in the state of Rondonia, brazil.The present case report refers to a patient from the State of Rondonia, North region of brazil, attended with clinical suspicion of hepatic echinococcosis. Examination by imaging (ultrasonography and computerized tomography) revealed a conglomerate of cystic lesions, with mobile contents within the cyst. The serology (immunoblot) for Echinococcus sp. was positive (21 and 31 kDa bands). This case is the first reported in Rondonia, suggesting the need to investigate the polycystic echinococcosis in individuals with hepatic cysts from areas of tropical forest and hunting habits where wild life was present as wild dogs, cats and rodents, particularly Agouti paca (paca) and Dasyprocta aguti (agouti).- - - - - - - - - - ranking = 0.14083666835664keywords = bile (Clic here for more details about this article) |
8/67. Bronchobiliary fistula due to hydatid disease of the liver: a case report.As a complication of hydatid cyst disease of the liver, bronchobiliary fistula is a rare condition and manifests as bilioptysis. We report the case of a 34 year-old man with echinococcosis of the liver who developed a bronchobiliary fistula which manifested as chronic cough and bile stained sputum. A chest X-ray showed an unilateral infiltrate in the costodiaphragmatic angle. bronchoscopy revealed bile filling the right basal bronchi. Magnetic resonance cystography revealed that the hepatic bile ducts communicated with the right basal pleural space. Percutaneous transhepatic drainage was applied. When the patient was reevaluated, the hydatid cyst had eroded into the pleural space, and a pleural effusion had developed. The condition of the patient deteriorated. Hence, surgical therapy was performed. After surgery, the condition of the patient improved. He was discharged from the hospital in good condition.- - - - - - - - - - ranking = 1.3557768957293keywords = bile duct, bile, duct (Clic here for more details about this article) |
9/67. Percutaneous transhepatic endobiliary drainage of hepatic hydatid cyst with rupture into the biliary system: an unusual route for drainage.The most common and serious complication of hydatid cyst of the liver is rupture into the biliary tract causing obstructive jaundice, cholangitis and abscess. The traditional treatment of biliary-cystic fistula is surgery and recently endoscopic sphincterotomy. We report a case of complex heterogeneous cyst rupture into the biliary tract causing biliary obstruction in which the obstruction and cyst were treated successfully by percutaneous transhepatic endobiliary drainage. Our case is the second report of percutaneous transbiliary internal drainage of hydatid cyst with rupture into the biliary duct in which the puncture and drainage were not performed through the cyst cavity.- - - - - - - - - - ranking = 0.23061480999459keywords = obstruction, duct (Clic here for more details about this article) |
10/67. Endoscopic therapy in the management of hepatobiliary hydatid disease.Hydatid disease constitutes a serious public health problem throughout the world, especially in endemic areas, despite the use of various kinds of preventive measures. Currently, there are three treatment options for hepatic hydatid disease including surgery, PAIR (puncture, aspiration, injection, and re-aspiration), and chemotherapy with benzimidazole compounds. Each of these therapeutic modalities has limitations depending on the individual case. The authors review the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease (HHD) to clarify its place in the treatment algorithm among surgical, medical, and percutaneous measures. ERCP in the preoperative period: (1) defines the cystobiliary relationship to help in surgery planning, (2) permits evaluation for acute conditions like cholangitis and obstruction so that subsequent surgery can be performed on an elective basis, (3) may give permanent cure specifically in cases of frank intrabiliary rupture if evacuation of biliary tract and cystic cavity is manageable, and (4) when combined with preoperative endoscopic sphincterotomy may decrease the incidence of the development of postoperative external fistula. ERCP in the postoperative period: (1) can help to clarify the causes of ongoing or recurrent symptoms or laboratory abnormalities, (2) may help to resolve the obstruction or cholangitis due to residual material in biliary ducts, (3) may provide the chance to manage postoperative external biliary fistulae, and (4) may be a realistic solution for secondary biliary strictures. Considering the current literature and adding this experience, the authors propose a new treatment algorithm in HHD including medical, surgical, PAIR, and ERCP-related therapies. To illustrate the algorithm, a case is presented of a patient who had a persistent external biliary fistula in the postoperative period and was managed successfully by endoscopic approach.- - - - - - - - - - ranking = 0.23061480999459keywords = obstruction, duct (Clic here for more details about this article) |
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