RESUMO
We present a case of haemobilia as a primary presentation for underlying cholangiocarcinoma. A man in his 50s initially presented to emergency with Quincke's triad, RUQ pain, jaundice and UGI bleeding. The initial diagnosis of haemobilia was made on endoscopic retrograde cholangiopancreatography (ERCP) on primary presentation, but the presence of blood and the recurrent clot obstruction of the biliary tract made the underlying diagnosis extremely difficult, resulting in the patient having 4 ERCP, 1 spyglass and multiple CTs and magnetic resonance cholangiopancreatography. Eventually, the patient underwent a Whipple's procedure without tissue diagnosis, confirming cholangiocarcinoma on histopathology. This case emphasises the difficulty of diagnosis of underlying malignancy in the setting of haemobilia, the benefit of multidisciplinary meeting discussions to support significant interventions and the need to be cautious and curious when managing atypical presentations.
Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Colangiopancreatografia Retrógrada Endoscópica , Hemobilia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/complicações , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/complicações , Colangiopancreatografia por Ressonância Magnética , Diagnóstico Diferencial , Hemobilia/diagnóstico , Hemobilia/etiologia , Tomografia Computadorizada por Raios XRESUMO
Objectives: The objectives of this study are to assess the current level of experience and teaching practices for SPC change at our institution and, second, to assess the quality of YouTube videos as an educational tool for teaching SPC change. Methods: A survey was conducted of 40 JMOs at our institution regarding SPC change. The first 20 YouTube videos on SPC change were included for analysis. A JAMA and DISCERN score was calculated for each video. Using linear regression, the association between collected variables and the assigned JAMA and DISCERN scores were determined. Results: The survey showed that 18 (45%) of JMOs had done an SPC change. None had received formal teaching. The consensus was that the quality of the YouTube videos was poor. There was a statistically significant positive correlation between the score assigned to videos by each scoring system (Pearson's r 0.81, p < 0.001). There was no statistically significant association between video quality as measured by either of the scoring systems and number of views. No association between any video characteristic and JAMA and DISCERN score was found. Conclusion: An SPC change is often a requirement of JMOs; however, this skill is not formally taught. The quality of YouTube videos describing an SPC change is poor.