[ОPTIMIZATION OF PREOPERATIVE PREPARATION AND CONSERVATIVE TREATMENT OF OBTURATION JAUNDICE, OCCURRING ON BACKGROUND OF BILIARY CALCULOUS DISEASE].

Оbturation jaundice (ОJ) on background of biliary calculous disease (BCD) was diagnosed in 61 patients. There was studied the impact of L­lysine escinate and glutargin on the treatment results, which were included in complex of standard preoperative preparation, and what had transformed into conservative treatment and disappearing of ОJ without operative intervention. In accordance to the biochemical investigations results, which characterize a functional state of the liver, OJ had disappeared more rapidly while application of the treatment proposed. Positive results of treatment had witnessed actuality of the trend choosed and necessity of its further studying.

[The ways of prophylaxis of the pancreatic injuries occurring on background of cholangitis and choledocholithiasis complicated by obturation jaundice: algorithm for diagnosis and treatment].

The results of treatment of 45 patients, in whom obturation jaundice have occurred on background of purulent cholangitis and biliary calculous disease, were summarized. preoperatively conservative therapy was conducted to the patients, including ozonotherapy during 9 - 10 days (main group) and 2 - 4 days (control group). All the patients were operated on. Conservative therapy, conducted during 9 -- 10 days, have permitted to improve clinical and laboratory indices more rapidly postoperatively, to prognosticate possibilities of the pancreatic gland damage, pancreatitis occurrence, as well as its exacerbation in future.

[Application of a hepasol neo preparation in the treatment of obturation jaundice patients].

The results of treatment of 52 patients, suffering obturation jaundice (OJ), were analyzed. The causes of the OJ occurrence were studied up. A peculiar attention was drawn to the treatment of patients, suffering OJ on a hepatic cirrhosis background. On the first stage of surgical treatment various operative procedures were applied to eliminate OJ. The impact of the tactics proposed, consisting of detoxication and infusion therapy, on duration of postoperative rehabilitation of the patients was studied up. In postoperative period to all the patients Hepasol Neo was prescribed, what have promoted their general condition improvement, the bilirubin level normalization, as well as the cytolysis and cholestasis elimination.

Brentuximab vedotin in combination with sequential procarbazine, cyclophosphamide and prednisolone for the management of Hodgkin's lymphoma-associated vanishing bile duct syndrome (VBDS) with severe obstructive liver failure.

We present a novel treatment protocol that was successful in the management of Hodgkin's-associated vanishing bile duct syndrome, a rare but serious complication of Hodgkin's lymphoma. We believe that publication of this treatment protocol and the rationale for its development will be of interest to anyone faced with treating this challenging condition.

Mucinous cystic neoplasm of the liver with biliary communication: an exception to the current classification.

Cystic neoplasms of the liver are rare tumours. According to the recent WHO classification, they are classified into mucinous cystic neoplasm and intraductal papillary neoplasm based on the presence of ovarian-like stroma and biliary communication. We report two rare cases of mucinous cystadenoma of the liver with biliary communication and discuss the shortcomings of current classification.

Diagnosis and initial management of cholangiocarcinoma with obstructive jaundice.

Cholangiocarcinoma is the second most common primary hepatic cancer. Despite advances in diagnostic techniques during the past decade, cholangiocarcinoma is usually encountered at an advanced stage. In this review, we describe the classification, diagnosis, and initial management of cholangiocarcinoma with obstructive jaundice.

[Cholestasis caused by a choledochal botryoid rhabdomyosarcoma in a 22-month-old boy]. / Une choléstase causée par un rhabdomyosarcome botryoïde du cholédoque chez un nourrisson de 22 mois.

Botrioid rhabdomyosarcoma of the extrahepatic bile ducts is a rare cause of jaundice in children. It has a very poor prognosis and is rarely diagnosed preoperatively. We report a choledochal botrioid rhabdomyosarcoma in a 22-month-old boy who developed an obstructive jaundice. Radiographic explorations suggested cystic lymphangioma. The gallbladder, the cystic duct, the common bile duct and the pancreatic head were resected. The diagnosis was made on pathological examination; adjuvant chemotherapy followed. The patient was disease free 20 months following treatment.

Histological changes at an endosonography-guided biliary drainage site: a case report.

Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However, the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly, and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall, and the sinus tract revealed no hematoma, bile leakage, or abscess in or around the sinus tract. Little sign of granulation, fibrosis, and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed, the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.

Two synchronous malignant tumors of the pancreas: a case report.

BACKGROUND: Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoperatively. CASE PRESENTATION: We describe a 65-year-old Sri Lankan woman who presented with progressive obstructive jaundice. Initial contrast-enhanced computed tomography imaging detected a malignant tumor at the tail of her pancreas. A second tumor of the pancreatic head was detected with integrated imaging using multidetector computed tomography and multimodal magnetic resonance imaging. She underwent total pancreaticoduodenectomy and splenectomy. Gross examination of the specimen confirmed the presence of two separate tumors. Histology of the ampullary tumor showed pancreatic-type adenocarcinoma and the tumor in the tail of her pancreas showed a colloid-type adenocarcinoma. CONCLUSION: The possibility of multiple primary malignant solid tumors of different types with malignant potential has to be considered even without background pathology when managing multiple tumors in the pancreas.

The management of a cystic hepatic lesion ruptured in the bile ducts: a case report.

BACKGROUND: Hepatic cystadenoma is a rare benign cystic tumor; it tends to recur after incomplete surgical resection and has malignant potential. We report the case of a patient with a ruptured biliary cystadenoma in the common bile duct that caused diagnostic and therapeutic problems. CASE PRESENTATION: A 34-year-old North African woman, admitted for angiocholitis, was operated 2 months before for a hepatic cystic lesion taken for a hydatid cyst compressing her common bile duct. The clinical and the complementary examinations converged toward recurrence of the hydatid cyst for which a surgical resection was decided. Intraoperative findings as well as the histological study of the "membranes" extracted from her common bile duct indicated a hepatic cystadenoma. CONCLUSIONS: The rarity of hepatic cystadenoma and the non-specificity of clinical and imaging signs make diagnosis of hepatic cystadenoma difficult, especially when it is complicated by rupture in the bile ducts; this contributes to a delay in diagnosis and an inadequate therapeutic approach.

Pancreatitis complicating mucin-hypersecreting common bile duct adenoma.

Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting (fish-mouth sign) and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.

[Obstructive jaundice after cholecystectomy]. / Ictericia obstructiva en mujer colecistectomizada.

In this article we present the case of a 72 year-old woman who three years after laparoscopic cholecystectomy develops obstructive jaundice. An MRI of the liver and biliary system revealed an hiliar mass that caused dilatation of the biliary tree. The patient underwent hepatic duct resection and reconstruction via hepaticojejunostomy. The histological examination of the surgical specimen identified an intramural biliary neuroma with no evidence of malignancy.

Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation.

In endoscopic placement of multiple plastic biliary stents (PBSs), we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion. We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis. Although proximal dislocation of the first PBS was observed, we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire. We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath. It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb. Here we introduce this "anchor-wire technique", which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.

The use of CT or MRI for the one-stage placement of stents in biliary obstructions.

PURPOSE: This study describes and evaluates a simple method of percutaneous intervention planning in order to treat obstructed biliary systems using computed tomography (CT) or magnetic resonance imaging (MRI). MATERIALS AND METHODS: CT (n=18) and MRI (n=31) examinations, which were performed during the imaging work-up of 31 patients with malignant biliary obstruction, were used to plan transhepatic percutaneous biliary intervention. The appropriate intrahepatic duct, the entry point on the skin, and the puncture direction and depth were determined on axial CT or MR images. Under fluoroscopic guidance, a 21-G needle was used for puncture, and the puncture was followed by a percutaneous transhepatic cholangiography, the placement of a stent, and the placement of an external drainage catheter. RESULTS: The biliary system was successfully accessed on the first attempt in 16 patients (51.6%). Second or third attempts were required in eight (25.8%) and two (6.4%) patients, respectively, whereas more than three attempts were necessary for the remaining five (16.3%) patients. One-stage percutaneous transhepatic biliary stent placement was performed in 29 patients (93.5%). Two (n=1) and three (n=1) interventional sessions were required in order to successfully complete stent placement in the remaining two cases. The mean fluoroscopy time for one-stage biliary stent placement was 12.6 min +/- 2.6 min, and no major complications were noted. CONCLUSION: Thorough CT/MRI-based planning is suggested prior to the interventional treatment of malignant biliary obstruction so as to reduce the number of needle passes, the duration of the procedure, the fluoroscopy time, and the number of complications.