Long-term clinical outcome of post-cholecystectomy patients with biliary-type pain: results of manometry, non-invasive techniques and endoscopic sphincterotomy.

OBJECTIVE: The purpose of the present study was to investigate prospectively the value of manometry, non-invasive techniques and endoscopic sphincterotomy in biliary type II and III patients with suspected sphincter of Oddi dysfunction. METHODS: All patients (n = 31) had undergone a cholecystectomy from 1 to 45 years before entry into the study, and had a history of biliary-type pain ranging from 4 to 156 months. In a primary diagnostic work-up, including ERCP, other causes of gastrointestinal disease were excluded. The width of the common bile duct, pain induced by the injection of contrast medium into the common bile duct, delayed contrast drainage and the results of a morphine-neostigmine test were analysed. Manometric measurements of basal sphincter of Oddi pressure were performed. Twenty-three patients with an elevated basal pressure (> 40 mmHg) underwent endoscopic sphincterotomy. RESULTS: During the follow-up period (8-62 months) 83% of the patients became symptom free or experienced an improvement. Basal sphincter of Oddi pressure and long-term clinical outcome of patients correlated to different degrees with the results of non-invasive techniques. CONCLUSIONS: Our data suggest that endoscopic sphincterotomy may be an effective therapeutic modality in group II and III patients with sphincter of Oddi dysfunction in whom other gastrointestinal disorders have previously been excluded.

[Ultrasound imaging of mesenchymal small intestine tumors in diagnosis of unexplained gastrointestinal hemorrhage]. / Sonographische Darstellung mesenchymaler Dünndarmtumoren in der Diagnostik von unklaren, gastrointestinalen Blutungen.

The presented case reports highlight the value of transabdominal ultrasound as a complementary and non-invasive diagnostic tool in unexplained gastrointestinal bleeding. Seven patients with intermittent melaena and/or chronic anaemia were examined. In all patients, diagnostic procedures like abdominal ultrasound, EGD, colonoscopy and enteroclysis were performed primarily and did not point to a bleeding source. Transabdominal bowel wall ultrasound discovered in all cases a round and smoothly delineated tumour of homogeneous and hypoechoic structure. The diagnosis was confirmed using selective angiography in three cases revealing a roundish hypervascular lesion. Fine-needle aspiration biopsy and re-endoscopy were used in two cases, respectively, to verify the diagnosis. Postoperative histology revealed a benign leiomyoma (n = 3), schwannoma (n = 2), lipoma (n = 1) and angiofibroma (n = 1) with vascular erosions. Transabdominal ultrasound can operate as a complementary imaging technique in case of gastrointestinal haemorrhage, if endoscopic procedures fail to identify the bleeding source in the upper gastrointestinal tract and large bowel.

[Percutaneous sonographically guided fine-needle puncture and drainage of pyogenic abscesses]. / Perkutane, sonographisch gesteuerte Feinnadelpunktion und Drainage pyogener Abszesse.

Between January 1988 and April 1991, a total of 79 ultrasound-directed percutaneous punctures and (or) drainage of abscesses were performed on 31 patients (15 men, 16 women; mean age 63 [31-85] years). There were 14 hepatic, 4 splenic, 4 abdominal wall and 3 pancreatic abscesses, and one each subphrenic, presacral, retrocaecal, ischiorectal, pulmonary and in the psoas. After ultrasound localization of the abscess a fine-needle puncture was performed, after which the abscess cavity was emptied as much as possible or, in abscesses larger than 5 cm in diameter, drained through a pig-tail catheter (6-8, 4 F). Several punctures were needed in 16 patients, while in 15 a percutaneous drainage over 2-8 days was necessary. Treatment was successful after 4-17 days in 25 patients. One patient died in septic shock. Operative intervention after diagnostic puncture was undertaken in 5 patients. There were no complications related to the method. In 11 patients the further course was determined by an underlying malignant disease. No recurrence has been noted (4-36 months after treatment) in 14 patients with a benign underlying disease. Percutaneous puncture and drainage of pyogenic abscesses is a technically simple method which achieves good results.

Endoscopic management of malignant biliary obstruction and recurrent cholangitis with a self-expanding prosthesis.

Endoscopic implantation of a prosthesis usually provides effective palliation in malignant biliary obstruction and in some cases of benign strictures. The most common problem concerning stent patency is occlusion, which may lead on to cholangitis and septic complications. A new technique employing self-expanding stents offers encouraging results. Preliminary clinical experience with expanding biliary stents are reported. The expectations of the doctor and patient, and the preferences and advantages of this new method are discussed on the basis of a case report with recurrent septic complications caused by conventional biliary prosthesis.

[Annular pancreas--a congenital abnormality of the pancreas]. / Pancreas anulare--Eine kongenitale Anomalie der Bauchspeicheldrüse.

Our case report on a 26-year-old male suffering from epigastric pain for several years should emphasize the fact, that even a rare congenital malformation like the annular pancreas must seriously discussed as a reason for the so called unspecific abdominal pain. Embryological development, age of manifestation, symptoms and therapeutic concepts are described. The importance of endoscopic methods such as gastroduodenal endoscopy and endoscopic retrograde cholangiopancreatography (ERCP) for a more precise and frequent diagnosis will be strengthened and the influence on the prevalence will be discussed.