RESUMO
BACKGROUND: Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). AIM: To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization. METHODS: This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed. RESULTS: Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group (P = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% vs 27.1%, P = 0.000) and stricture resolution ratio (97.1% vs 78.6%, P = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% vs 41.4%, P = 0.000) and stone recurrence rates (7.1% vs 38.6%, P = 0.000) were significantly lower in the 3D-PTOBF group. CONCLUSION: Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
Assuntos
Imageamento Tridimensional , Litotripsia , Hepatopatias , Recidiva , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Litotripsia/métodos , Litotripsia/efeitos adversos , Resultado do Tratamento , Idoso , Imageamento Tridimensional/métodos , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Adulto , Litíase/cirurgia , Litíase/terapia , Litíase/diagnóstico por imagem , Endoscopia do Sistema Digestório/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologiaRESUMO
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.
Assuntos
Ductos Biliares Intra-Hepáticos , Humanos , Fatores de Risco , Ductos Biliares Intra-Hepáticos/patologia , Litíase/epidemiologia , Litíase/terapia , Litíase/diagnóstico , Prevalência , Resultado do Tratamento , Hepatopatias/epidemiologia , Hepatopatias/terapia , Hepatopatias/diagnóstico , Incidência , Colangite/epidemiologia , Colangite/terapia , Colangite/diagnósticoRESUMO
OBJECTIVE: To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones METHODS: Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed. RESULTS: 1727 patients are included. Stone mean size was 9,5mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR=1.13; p=0.00), ureteral location of the lithiasis (OR=1.15; p=0.052) and number of waves (p=0.002; OR=1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR=1.131; p=0.000), number of waves (OR=1.000; p=0.000), energy (OR=1.005; p=0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p=0.024, OR=1.054) and the previous urinary diversion (P=0.004, OR=0.571). CONCLUSION: Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.
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Litíase , Litotripsia , Ureter , Cálculos Ureterais , Humanos , Estudos Retrospectivos , Litíase/etiologia , Litíase/terapia , Litotripsia/efeitos adversos , Litotripsia/métodos , Cálculos Ureterais/terapia , Cálculos Ureterais/etiologiaRESUMO
Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Cálculos Renais , Litíase , Litotripsia , Cálculos Urinários , Urolitíase , Humanos , Litíase/terapia , Ureteroscopia/métodos , Urolitíase/diagnóstico , Urolitíase/terapia , Cálculos Urinários/terapia , Cálculos Renais/diagnóstico , Cálculos Renais/terapiaRESUMO
The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context.
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Litíase , Litotripsia , Cálculos Urinários , Urolitíase , Urologia , Humanos , Litíase/terapia , Urolitíase/complicações , Urolitíase/diagnóstico , Urolitíase/terapia , Cálculos Urinários/terapia , UreteroscopiaRESUMO
The main objectives of interventional stone treatment are stone removal, symptom elimination, and kidney function preservation. After treatment of kidney stones (extracorporeal shock wave lithotripsy [ESWL], or endoscopy), fragments may remain in the kidney, either deliberately left in place or due to treatment failure (i.e. residual stone [RS], resistant to ESWL, left or inaccessible by endoscopy), or due to failure to eliminate the obtained fragments (i.e. residual fragments [RF]). Their management may differ. The most commonly used definition of RF in the literature is based on a size cut-off (≤4mm) and on three criteria: spontaneous clearance rate, secondary intervention rate, and disease progression rate. RF may be spontaneously eliminated (42%), persist and increase in size (32%), or become complicated and require a secondary urological procedure (36%). Like for the initial treatment, it is important to consider the stone composition for the treatment decision-making concerning RS/RF. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) (EAU, 2022) and their adaptability to the French context.
Assuntos
Cálculos Renais , Litíase , Litotripsia , Humanos , Litíase/terapia , Cálculos Renais/terapia , Rim , Falha de Tratamento , Resultado do TratamentoRESUMO
The purpose of this study is to evaluate the clinical characteristics and prognosis of primary hepatolithiasis in hospitalized children. This retrospective cohort study included 106 hospitalized patients with primary hepatolithiasis at Beijing Children's Hospital. Clinical data were derived from electronic inpatient (2010-2021) and outpatient (2016-2021) medical records. The prognosis was evaluated by outpatient ultrasounds after discharge and telephone interviews performed in December 2022. Intrahepatic bile duct stones in patients enrolled in the study were all found incidentally by abdominal ultrasound during hospitalization, with an incidence of 1.7 per 10,000 hospitalized children. The mean age at diagnosis was 9.3 ± 3.6 years, with male predominance (69/106, 65.1%). The right lobe of the liver (80/106, 75.5%) was preferentially affected. All patients underwent conservative observation. Seventy-eight patients (78/106, 73.6%) were followed up with a mean follow-up age of 17.1 ± 5.0 years, and 4 (4/78, 5.1%) had intermittent abdominal pain. From 2016 to 2021, 32 patients were diagnosed with primary hepatolithiasis, and follow-up abdominal ultrasounds were performed in 20 of them (20/32, 60.0%) with a median time of 2.1 (0.1, 3.5) years. The stones were present in 17 patients (17/20, 85.0%). CONCLUSION: Primary hepatolithiasis in hospitalized children is rare, almost found accidentally; mostly affects the right lobe of the liver; and can be conservatively observed without surgical treatment in childhood. WHAT IS KNOWN: ⢠Primary hepatolithiasis in adults often presents with severe clinical symptoms and requires hepatectomy.. ⢠There are few studies on primary hepatolithiasis in children. WHAT IS NEW: ⢠Primary hepatolithiasis in children is mostly found accidentally by abdominal ultrasound without associated symptoms during hospitalization. ⢠Children with accidental primary hepatolithiasis can be conservatively observed without surgical treatment in childhood.
Assuntos
Litíase , Hepatopatias , Adulto , Criança , Humanos , Masculino , Pré-Escolar , Adolescente , Adulto Jovem , Feminino , Hepatopatias/diagnóstico por imagem , Hepatopatias/epidemiologia , Litíase/diagnóstico por imagem , Litíase/terapia , Estudos Retrospectivos , Resultado do Tratamento , Criança Hospitalizada , Ductos Biliares Intra-Hepáticos , PrognósticoRESUMO
In patients with symptomatic intrahepatic biliary lithiasis, the treatment is usually discussed by a multidisciplinary team. Although hepatectomy is considered as definitive treatment, when lobar atrophy is absent, endoscopic procedures are frequently proposed as first-line treatment due the low invasiveness and for sparing liver parenchyma. Percutaneous route is used in case of peroral approach failure. We present a case of recurrent symptomatic intrahepatic biliary lithiasis of the right posterior hepatic duct, sustained by downstream biliary stenosis. Peroral cholangioscopy failed to visualize the stone for the accompanying stenosis. Thus, the patient was successfully treated with percutaneous transhepatic lithotripsy performed with Spyglass direct visualization system II (Boston Scientific Inc., Natick, Massachusetts, USA). During the procedure, the biopsy of the biliary stenosis revealed fibrosis, which was treated by cholangioplasty with cutting balloon. After 15 months, the patient is asymptomatic, with moderate residual stenosis in absence of calculi at follow-up magnetic resonance cholangiography.
Assuntos
Litíase , Litotripsia , Ductos Biliares Intra-Hepáticos , Colangiografia , Constrição Patológica/etiologia , Humanos , Litíase/etiologia , Litíase/terapia , Litotripsia/efeitos adversos , Litotripsia/métodosRESUMO
RESUMEN Anteriormente, cuando se diagnosticaba litiasis en la vía biliar, el procedimiento consistía en una co lecistectomía, coledocotomía, extracción de los cálculos y colocación de un drenaje de Kehr. En otros casos se podía hacer papiloesfinteroplastia o una derivación biliodigestiva. Actualmente tenemos mu chas herramientas diagnósticas y terapéuticas como la colangiorresonancia, la pancreatocolangio grafía retrógrada endoscópica, la cirugía laparoscópica de la vía biliar, la ecoendoscopia y la ecografía intraoperatoria. Los procesos de decisiones son más complejos y sin un sustento con evidencia con cluyente. Tenemos estudios que enfocan parceladamente el tema, por lo que, dependiendo de si el diagnóstico se hace antes o durante la colecistectomía laparoscópica, el cirujano empleará su sentido común individualizando cada caso. El manejo ideal de la litiasis de la vía biliar sigue siendo motivo de controversia. Decidir por un manejo endoscópico, laparoscópico o convencional requiere logística, entrenamiento y juicio clínico adecua dos. La cirugía convencional sigue siendo una opción vigente.
ABSTRACT Previously, when a surgeon diagnosed bile duct lithiasis, he/she performed cholecystectomy, chole docotomy, stone removal and placement of a Kehr's "T" tube. Some cases might require sphinctero plasty or bilio-digestive bypass. Nowadays, magnetic resonance cholangiopancreatography, endosco pic retrograde cholangiopancreatography, endoscopic ultrasound and intraoperative ultrasound have emerged as diagnostic and therapeutic tools. Decision-making processes are complex and there is no conclusive evidence supporting them. Many studies have focused on the matter with a non-compre hensive approach so that each surgeon will use his/her common sense for each individual case. The optimal management of the common bile duct is still controversial. Deciding on endoscopic, lapa roscopic or conventional management requires adequate training and clinical judgment. Conventional surgery is still in valid option.
Assuntos
Ducto Colédoco/cirurgia , Litíase/cirurgia , Ductos Biliares , Coledocostomia , Colecistectomia , Colangite/cirurgia , Litíase/terapiaRESUMO
BACKGROUND: Some patients with hepatolithiasis cannot tolerate surgery due to severe cardiac or pulmonary comorbidities, or cannot be endoscopically treated because of altered gastrointestinal anatomies. AIM: To propose a modified percutaneous transhepatic papillary balloon dilation procedure, and evaluate the clinical efficacy and safety of this modality. METHODS: Data from 21 consecutive patients who underwent modified percutaneous transhepatic papillary balloon dilation with hepatolithiasis were retrospectively analyzed. Using auxiliary devices, intrahepatic bile duct stones were pushed into the common bile duct and expelled into the duodenum with an inflated balloon catheter. The outcomes recorded included success rate, procedure time, hospital stay, causes of failure, and procedure-related complications. Patients with possible long-term complications were followed up for 2 years. RESULTS: Intrahepatic bile duct stones were successfully removed in 20 (95.23%) patients. Mean procedure time was 65.8 ± 5.3 min. Mean hospital stay was 10.7 ± 1.5 d. No pancreatitis, gastrointestinal, or biliary duct perforation was observed. All patients were followed up for 2 years, and there was no evidence of reflux cholangitis or calculi recurrence. CONCLUSION: Modified percutaneous transhepatic papillary balloon dilation was feasible and safe with a small number of patients with hepatolithiasis, and may be a treatment option in patients with severe comorbidities or in patients in whom endoscopic procedure was not successful.
Assuntos
Cateterismo , Ducto Colédoco , Endoscopia , Litíase , Hepatopatias , Cateterismo/efeitos adversos , Dilatação , Feminino , Humanos , Litíase/terapia , Hepatopatias/terapia , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
ABSTRACT Purpose: To provide recommendations on the endourological management of lithiasis in the scenario of the COVID-19 pandemic. Materials and Methods: A non-systematic review in PubMed and the grey literature, as well as recommendations by a panel of stakeholders was made, regarding management, surgical considerations and follow-up of patients affected by lithiasis in the COVID-19 era. Results: Under the current outbreak and COVID-19 pandemic scenario, patients affected by lithiasis should be prioritized into low, intermediate and high risk categories, to decide their delay and save resources, healthcare personnel, beds and ventilators. However, patients with potentially serious septic complications need emergency interventions. The possibility of performing or restarting elective activity depends on local conditions, the availability of beds and ventilators, and the implementation of screening protocols in the context of the COVID-19 pandemic. Delaying lithiasis surgery and increasing waiting lists will have consequences and will require considerable additional effort. Teleconsultation may be useful in guiding these patients, reducing visits and unnecessary exposure. Conclusions: categorization and prioritization of patients affected by lithiasis is crucial for management, surgical selection and follow-up. Protocols, measures and additional efforts should be carried out in the current situation of the COVID-19 pandemic.
Assuntos
Humanos , Pneumonia Viral/epidemiologia , Urologia/métodos , Infecções por Coronavirus/epidemiologia , Litíase/terapia , Seguimentos , Pandemias , Betacoronavirus , SARS-CoV-2 , COVID-19RESUMO
PURPOSE: To provide recommendations on the endourological management of lithiasis in the scenario of the COVID-19 pandemic. MATERIALS AND METHODS: A non-systematic review in PubMed and the grey literature, as well as recommendations by a panel of stakeholders was made, regarding management, surgical considerations and follow-up of patients affected by lithiasis in the COVID-19 era. RESULTS: Under the current outbreak and COVID-19 pandemic scenario, patients affected by lithiasis should be prioritized into low, intermediate and high risk categories, to decide their delay and save resources, healthcare personnel, beds and ventilators. However, patients with potentially serious septic complications need emergency interventions. The possibility of performing or restarting elective activity depends on local conditions, the availability of beds and ventilators, and the implementation of screening protocols in the context of the COVID-19 pandemic. Delaying lithiasis surgery and increasing waiting lists will have consequences and will require considerable additional effort. Teleconsultation may be useful in guiding these patients, reducing visits and unnecessary exposure. CONCLUSIONS: categorization and prioritization of patients affected by lithiasis is crucial for management, surgical selection and follow-up. Protocols, measures and additional efforts should be carried out in the current situation of the COVID-19 pandemic.
Assuntos
Infecções por Coronavirus/epidemiologia , Litíase/terapia , Pneumonia Viral/epidemiologia , Urologia/métodos , Betacoronavirus , COVID-19 , Seguimentos , Humanos , Pandemias , SARS-CoV-2RESUMO
CASE PRESENTATION: A 51-year-old woman with no comorbidities presented with a 3-month history of cough with mucopurulent expectoration and intermittent fever. Over the past 1 month, she complained of streaky hemoptysis and gave history of expectorating "whitish pellets" in the sputum on two occasions. She had developed progressive breathlessness for a week prior to presentation to our hospital. There was no history of chest pain or loss of weight or appetite. She was a nonsmoker and did not consume alcohol. She had received multiple courses of antibiotics at another center with no relief of symptoms.
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Actinomicose/diagnóstico , Empiema Pleural/diagnóstico , Litíase/diagnóstico , Pneumopatias/diagnóstico , Actinomicose/patologia , Actinomicose/terapia , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Broncoscopia , Doxiciclina/uso terapêutico , Drenagem , Empiema Pleural/patologia , Empiema Pleural/terapia , Feminino , Humanos , Imipenem/uso terapêutico , Litíase/patologia , Litíase/terapia , Pneumopatias/patologia , Pneumopatias/terapia , Pessoa de Meia-Idade , Pneumonectomia , Escarro , Tomografia Computadorizada por Raios XRESUMO
The term "broncholithiasis" is defined as the presence of calcified or ossified materials within the tracheobronchial tree. The report of the condition dates back to 300 bc when Aristotle first described a symptom of "spitting of stones." The process of calcification usually starts within either the mediastinal, hilar, or peribronchial lymph nodes. The impetus is typically initiated by a granulomatous process such as TB or histoplasmosis; however, it can also been seen following exposure to other fungal or occupational elements. The exact mechanism of the calcified material (broncholith) entering the endobronchial tree remains unknown. It is hypothesized, however, that the calcified tissues gradually erodes and/or breaks loose in the airways as a result of repetitive movements of respiration or cardiac pulsations. The broncholiths are often found in the airways without any signs of erosion, however. The most common symptoms of broncholithiasis include cough, hemoptysis, and wheezing as a result of irritation of the airways and the surrounding tissues. The diagnosis is typically suspected on chest radiographs and confirmed by using bronchoscopy. Depending on the severity of the disease, management options range from simple observation to surgical resection. Despite the potential for major complications, the overall disease prognosis is good if timely and appropriate management is provided.
Assuntos
Broncopatias/diagnóstico , Broncopatias/terapia , Litíase/diagnóstico , Litíase/terapia , Broncoscopia , Humanos , Tomografia Computadorizada por Raios XRESUMO
Low-Phospholipid Associated Cholelithiasis (LPAC) is a genetic disease responsible for the development of intrahepatic lithiasis. It is associated with a mutation of the ABCB4 gene which codes for protein MDR3, a biliary carrier. As a nosological entity, it is defined by presence of two of the three following criteria: age less than 40 years at onset of biliary symptoms, recurrence of biliary symptoms after cholecystectomy, and intrahepatic hyperechogenic foci detected by ultrasound. While the majority of clinical forms are simple, there also exist complicated forms, involving extended intrahepatic lithiasis and its consequences: lithiasis migration, acute cholangitis, intrahepatic abscess. Chronic evolution can lead to secondary sclerosing cholangitis or secondary biliary cirrhosis. In unusual cases, degeneration into cholangiocarcinoma may occur. Treatment is built around ursodeoxycholic acid, which yields dissolution of biliary calculi. Complicated forms may call for interventional, radiological, endoscopic or surgical treatment. This synthetic review illustrates and summarizes the different aspects of this entity, from simple gallbladder lithiasis to cholangiocarcinoma, as well as secondary biliary cirrhosis requiring liver transplant, on the basis of clinical cases and the iconography of patients treated in our ward.
Assuntos
Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Colelitíase , Fosfatidilcolinas/deficiência , Adulto , Fatores Etários , Bile/química , Neoplasias dos Ductos Biliares/etiologia , Colagogos e Coleréticos/uso terapêutico , Colangiocarcinoma/etiologia , Colangite/etiologia , Colangite Esclerosante/etiologia , Colecistectomia , Colelitíase/complicações , Colelitíase/diagnóstico , Colelitíase/genética , Colelitíase/terapia , Códon sem Sentido , Diagnóstico Diferencial , Feminino , Cálculos Biliares/diagnóstico , Cálculos Biliares/etiologia , Cálculos Biliares/terapia , Humanos , Litíase/complicações , Litíase/diagnóstico por imagem , Litíase/terapia , Abscesso Hepático/etiologia , Cirrose Hepática Biliar/etiologia , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Mutação , Gravidez , Complicações na Gravidez/etiologia , Recidiva , Síndrome , Ultrassonografia , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
RATIONALE: Mesenteric hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones is a very rare complication which has never been reported before. PRESENTING CONCERNS: We reported a case of a 36-year-old male diagnosed as chronic pancreatitis with pancreatic stones and a large pancreatic pseudocyst. He underwent 3 repeated sessions of pancreatic ESWL (P-ESWL). After the last session of P-ESWL, he complained of dizziness. Physical examination revealed a large mass in the right abdomen. DIAGNOSIS: Emergent upper abdominal computerized tomography (CT) revealed this mass is a mesenteric hematoma with the size of 8.2âcm × 11.7âcm in the right abdominal cavity after P-ESWL and there was no sign of intestinal obstruction. INTERVENTIONS: With close monitoring of vital signs, the patient received conservative treatment for several days. Dynamic abdominal ultrasound monitoring revealed the mesenteric hematoma had organized. OUTCOMES: Vital signs of the patient were stable after fluid transfusion. Three-month follow-up CT showed the mesenteric hematoma had absorbed completely. LESSONS: Mesenteric hematoma rarely occurs after P-ESWL and it alerts us the importance of considering uncommon complications after P-ESWL. If mesenteric hematoma occurs after P-ESWL, conservative treatment could be the first choice while surgery can also be considered.
Assuntos
Hematoma/diagnóstico por imagem , Litotripsia/efeitos adversos , Artérias Mesentéricas/diagnóstico por imagem , Adulto , Tratamento Conservador , Humanos , Litíase/terapia , Masculino , Pancreatite Crônica/terapia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: The aim of this study was to assess prevailing treatment of pancreatolithiasis in Japan. METHODS: We surveyed clinical data from 1834 patients (1479 men and 355 women) at 125 hospitals. RESULTS: Extracorporeal shock-wave lithotripsy (ESWL) was performed alone in 103 patients (5.6%), ESWL plus an endoscopic procedure in 446 (24.3%), endoscopic treatment alone in 261 (14.2%), and surgery in 167 (9.1%). Other treatments were given to 358 (19.5%), whereas 499 (27.2%) received no treatment. Symptoms were relieved in 85.7% after ESWL, 80.8% after endoscopic treatment alone, and 92.8% after surgery. Early complication rates within 3 months after ESWL, endoscopic treatment alone, and surgery were 8%, 4.5%, and 27.1%, respectively. Late complications after ESWL, endoscopic procedures alone, and surgery were 1.7%, 2.5%, and 8.2%, respectively. Symptom relief but also early and late complications were greater after surgery than after ESWL and endoscopic treatment. Among 417 patients undergoing ESWL, 61 (14.6%) required surgery, as did 32 (16%) of 200 patients treated endoscopically. Surgery was required less frequently following initial operative treatment (11/164 patients [6.7%]). Nonsurgical initial treatments were chosen more frequently. CONCLUSIONS: First-line treatment of pancreatolithiasis should be ESWL with or without endoscopy because of minimal invasiveness and fewer complications.