1/31. Spontaneous perforation of the bile duct.We present a classic but rare case of spontaneous perforation of the bile duct in infancy and a previously undescribed treatment technique. The patient, a male age 5 weeks, was admitted with abdominal distention, ascites, and conjugated hyperbilirubinemia. Ultrasound revealed ascites but did not provide visualization of the gallbladder. Although hepatobiliary scintigraphy with technetium [dimethyl iminodiacetic acid (HIDA scan)] showed normal uptake peritoneal excretion suggested perforation of the common bile duct (CBD). Exploratory laparotomy revealed 200 cm3 dark amber ascitic fluid in the peritoneal cavity and cholestasis of the liver. Intraoperative cholangiogram performed via the gallbladder showed a large perforation at the cystic duct/CBD junction. The perforation was large and leakage of contrast prevented demonstration of the distal CBD despite our attempt to primarily repair the perforation. The CBD was explored; a T-tube was placed. T-tube cholangiogram demonstrated flow of contrast into the duodenum. A large leak remained at the cystic CBD junction. A cholecystectomy was performed and a vascularized flap of the gallbladder wall was used to repair the CBD over the T-tube. The T-tube was clamped intermittently beginning 3 weeks postoperatively. T-tube cholangiogram performed 6 weeks postoperatively revealed no extravasation and normal intra- and extrahepatic biliary tree. The T-tube was subsequently discontinued and liver function tests remained normal at 6 months follow-up.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/31. Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl.We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to dermatophagoides pteronyssinus, dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/31. Spontaneous cystic duct perforation associated with acalculous cholecystitis.Spontaneous perforation of the extrahepatic biliary tree is rare in adults. Although perforation of the hepatic, common hepatic, common bile, and cystic ducts has been reported, review of the English literature reveals only four cases of cystic duct perforation, each attributed to calculi. We herein report the first known case of spontaneous perforation of the cystic duct in the absence of biliary calculi.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/31. 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) |
5/31. Surgical management of a hydatid cyst of the hepatic dome ruptured into the biliary tree.Hydatid disease of the liver remains an important and challenging medical problem. Although surgery is considered the treatment of choice for hydatid disease of the liver, controversies still exist about the preferred operative technique. We report the case of a patient with obstructive jaundice caused by rupture of a hydatid cyst of the hepatic dome into the biliary tract. He was managed by a new surgical approach of myoplasty of the right hemidiaphragm combined with preoperative decompression of the bile duct by an endoscopic sphincterotomy. The postoperative course of the patient was uneventful, and he remains well 3 years later. This procedure is simple, requires less time, and has the advantage of avoiding a thoracoabdominal incision, which makes any abdominal reoperation easier.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
6/31. Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree.Hepatic hydatid disease is usually silent and discovered incidentally. rupture of a hydatid cyst into the biliary tree is a serious complication and produces a clinical picture of biliary obstruction. We present the cases of 2 patients who had only nonspecific symptoms and laboratory test results indicative of biliary tract obstruction. The results of sonographic examinations of both patients strongly suggested the presence of hepatic hydatid cysts communicating with the biliary tree. CT examination provided additional information in 1 patient but only confirmed the sonographic findings in the other. Both cases were surgically confirmed. Demonstration of the cyst and intrabiliary hydatid contents should form the basis for the diagnosis of a hydatid cyst's rupture into the biliary tree; detecting the point of communication further supports the diagnosis. An accurate preoperative diagnosis of this disease is essential for its prompt surgical management.- - - - - - - - - - ranking = 7keywords = tree (Clic here for more details about this article) |
7/31. Ruptured hydatid cyst of the liver with biliary obstruction: presentation of a case and review of the literature.The case of a 66 year old woman admitted with a picture of jaundice acute cholangitis is reported. ultrasonography showed a dilatation of intrahepatic bile ducts, gallbladder hydrops with several stones, enlarged common bile duct (CBD) with hyperechoic material inside and a cystic tumor with hydatid features. With a strong suspicion of a hydatid cyst ruptured in the biliary tree with biliary obstruction, endoscopic cholangiopancreatography was performed. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and the hydatid membranes were extracted from the CBD with subsequent clinical improvement. The second step of treatment comprised the surgical cure of the cyst and cholecystectomy. The data from the literature are finally presented with a special emphasis on the ultrasound diagnosis and the endoscopic treatment.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/31. Spontaneous rupture of a choledochal cyst: clues to diagnosis and etiology.A healthy 3-year-old black girl had acute onset of abdominal pain, vomiting, and elevated aminotransferase, amylase, and lipase levels. Sonographic evaluation suggested a choledochal cyst, but hepatobiliary scintigraphy clearly showed an extrahepatic biliary leak. Exploratory laparotomy confirmed bile peritonitis and a ruptured choledochal cyst. Other cases with this unusual presentation is reviewed in the literature. An anomalous insertion of the pancreatic duct into the common duct appears to facilitate reflux of pancreatic secretions into the biliary tree and may contribute to formation and even perforation of a choledochal cyst.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/31. Spontaneous rupture of liver due to cholangitis.Spontaneous rupture of the liver is rare in the western world and most cases are associated with primary or metastatic tumours. Spontaneous rupture of the intrahepatic biliary tree is not well documented and only two reports have been found in the literature. The authors describe a further case due to ascending cholangitis but presenting with biliary peritonitis. The literature is reviewed and the diagnostic problems discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/31. Spontaneous perforation of the extrahepatic biliary tree in infancy. A case report.Spontaneous perforation of the bile duct in infancy is rare, with less than 55 cases described in the literature to date. The authors report the case of a 30-day-old neonate who presented with a 2-week history of progressive abdominal distension and intermittent jaundice. Disofenin technicium 99m sequential scintiscanning provided a preoperative noninvasive confirmation of the diagnosis of biliary ascites secondary to spontaneous perforation of the extrahepatic biliary tract. Distal common bile duct atresia was identified intraoperatively, and end-to-side Roux-en-Y hepaticojejunostomy was performed, with an uneventful postoperative recovery. The etiology, diagnosis, and treatment of spontaneous neonatal biliary perforation is discussed.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
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