Risk Factors for Long-term Outcomes after Initial Treatment in Hepatolithiasis

Hepatobiliary complications, such as stone recurrence, recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma may occur after treatment for hepatolithiasis. However, few previous studies have addressed the risk factors and long-term outcomes after initial treatment. Eighty-five patients with newly diagnosed hepatolithiasis, actively treated for hepatolithiasis, constituted the cohort of this retrospective study. Patients were treated by hepatectomy or nonoperative percutaneous transhepatic cholangioscopic lithotomy. Long-term complications, such as recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma, and their relationships with clinical parameters were analyzed. The mean follow-up period was 57.4 months. The overall hepatobiliary complication rate after the treatment was 17.6%. Multivariate analysis of suspected risk factors showed that complications were associated with age (HR, 1.046; CI, 1.006-1.089), bile duct stricture (HR, 4.894; CI, 1.295-18.495), and residual stones (HR, 3.482; CI, 1.214-9.981). In conclusion, several long-term hepatobiliary complications occur after hepatolithiasis treatment, and regular observation is necessary in patients with concomitant biliary stricture or residual stones.

progressive family intrahepatic cholestasis difficulty of diagnosis and taking charge in a developing country

The progressive family intrahepatic cholestasis or Byler syndrome is a group of recessive autosomic illness. It is responsible of an intra-hepatic cholestate which is secondary to an anomaly of the metabolism and the excretion of biliareses acid .In spite of progress achieved over the last few years in the understanding of the physio-pathological mechanisms and the genetics of this group of cholestasis, the hold in charge remains difficult in a developing country like Tunisia. Patient and methods: it is about a retrospective survey concerning 12 children treated in the paediatric service during a period of 18 years [1986-2003] for progressive family intrahepatic cholestate confirmed by clinical, biological and histological data. our set includes 12 children who have presented a cholestatic jaundice with dark urine and discoloured waste beginning between the ages of 3 days and 18 months with an average age of 4 months, the parental inbreeding has been noted in 10 patients, the domestic antecedents of jaundice of the infant were found in 5 cases the jaundice was in irregular all cases and partner to a prurits in 8 cases. The hyperbilirubinemy and the increase of the alkaline phosphatases were present with all patients. The rate of cholesterol was normal with all patients. The gamma GT was normal in 10 cases and increased in 2 cases, biliary acids have been measured in 10 patients, they were raised in all cases. The hepatic biopsy has been achieved in 10 cases; it showed signs of cholestase and fibrosis in all cases. Eight patients received a treatment associating acidic ursodesoxycolic [AUDC] and Rifampicin, whereas 4 patients have been treated with cholesteramin in the absence of hold social. The K vitamin by way parenterale has been prescribed for all children, whereas vitamins A and E, not available in Tunisia are taken only by 2 patients. The evolution has been made toward the death in a graph of decomposed cirrhosis in 3 patient [age ranging from 1 month to 4 years]. The other patients are treated again with thrusts of jaundice and pruritus but with no sign of serious hepato-cellular insufficiency. A lot of difficulties persist at the level the diagnosis of the PFIC in Tunisia [biliary acid dosage abroad] and especially at the therapeutic level: unavailability of fat-soluble vitamin and absence of a hepatic transplantation program

Evaluación de la utilidad clínica del efecto colangiográfico por RMN en el paciente con ictericia obstructiva / Utility of N.M.R in the evaluation of patients with obstructive jaundice

El efecto colangiográfico por RMN (CRMN) es una técnica relativamente nueva, no invasiva capaz de producir imágenes de alta calidad del árbol biliar. El propósito de este estudio fue determinar en forma prospectiva, la utilidad clínica del CRMN en la evaluación del paciente con ictericia obstructiva. Evaluamos por CRMN en 30 pacientes con ictericia obstructiva la causa y el nivel de obstrucción, comparando con PCRE en 28 pacientes y 2 con cirugía. En ambos casos radiólogos y endoscopistas desconocían el resultado de sus respectivas exploraciones. Se calculó sensibilidad, especificidad y exactitud diagnóstica utilizando como estándar de referencia los resultados de la PCRE y la cirugía. En el 100 por ciento de los casos de los pacientes con CRMN, evaluamos completamente las vías biliares, en un 20 por ciento de los pacientes con PCRE no pudo obtenerse un colangiograma completo. En 4 pacientes (13.33 por ciento), ambos métodos fueron complementarios. Identificamos el nivel de obstrucción obtuvimos una S: 63,33 por ciento, E: 100 por ciento y una exactitud diagnóstica de 63,33 por ciento. la CRMN es un método no invasivo que permite definir el nivel y la anatomía del árbol biliar obstruido, debe considerarse como método complementario en pacientes con obstrucción completa del conducta biliar común y en aquellos casos de PCRE técnica y anatómicamente difícil

Colestasis del embrazo. Presentación de un caso / Cholestasis and pregnancy. Presentation of one case

Presentamos un caso de colestasis severa y embarazo que evoluciona asociado en el puerperio, a ovarios con quistes tecaluteínicos y hemoperitoneo por lo que requirió manejo quirúrgico. Consideramos que es un caso muy poco común, de aquí el interés de su presentación. Hacemos referencia a su posible patogenia, cuadro clínico y manejo del mismo

Estenosis congénitas e idiopáticas de las vías biliares / Idiopatic and congenital biliary tract stenosis

Desde 1960 hasta 1992 se recopilaron 17 casos de estenosis de las vías biliares. De ellas 13 son consideradas idiopáticas y 4 congénitas. La edad osciló desde los 16 hasta los 47 años con un promedio de 26. La localización fue en convergencia superior 1, hepático derecho y sus ramas 5, hepático izquierdo 7, hepático común 1, convergencia cístico-coledociana 1, y colédoco intrapancreático 2. Se practicó una anastomosis biliodigestiva, 2 calibradas intraoperatoriamente y 12 calibradas y dilatads postoperatoriamente con sondas ubicadas en forma prolongada ( 15 días a 2 meses). Se trataron 2 pacientes con estenosis en ramas terciarias. Las dilataciones fueron generalmente transfisturales, siendo en un caso realizadas por vía transparietohepática. Este método dio buen resultado en todos los casos aplicados, por lo que se considera de elección

Nova tecnica de derivacao colangiodigestiva intra-hepatica no lobo direito do figado / New technique of intra-hepatic cholangiojejunostomy derivation in the right lobe of the liver

Nas situacoes de obstrucao ao nivel do hilo hepatico tornando impossivel a realizacao de derivacao colangiodigestiva extra-hepatica esta indicada a realizacao de anastomoses intra-hepaticas. As tecnicas atualmente mais utilizadas sao executadas em ductos esquerdos. Ha situacoes, no entanto, onde as derivacoes colangiodigestivas a direita sao necessarias. As tecnicas atualmente disponiveis sao de dificil realizacao. A tecnica proposta tem como principio basico a realizacao de pequena resseccao hepatica a direita, realizacao de anastomose colangiodigestiva latero-lateral apos incisao longitudinal do ducto. Foram operados cinco doentes com tres fistulas no pos-operatorio imediato que fecharam espontaneamente. Um doente com lesao benigna (trauma hepatico) esta anicterico tres anos apos a intervencao.

Ascaridíase intra-coledociana como complicaçäo de colecistectomia / Ascaridiasis intra common bile duct as complication of cholecystectomy

A ascaridíase biliar tem sido descrita mais freqüentemente na literatura. Pode produzir quadro semelhante a cólica biliar e as vezes resiste aos tratamentos mais enérgeticos. O diagnóstico é dificil e muitos casos só säo esclarecidos durante a exploraçäo cirúrgica. A ultra-sonografia ampliou a possibilidade de melhor investigaçäo pré-operatória. Pode, em algumas circunstâncias, levar a colangite supurativa, pancreatite, abcesso e fibrose hepática. Os autores descrevem um caso de oclusäo coledociana por áscaris em pós-operatório imediato de colecistectomia, com colangiografia transoperatória normal

Drenagem trans-hepática nas estenoses benignas altas da via biliar principal / Transanastomosic drainage in the benign stenosis of the upper biliary tree

As estenoses benignas altas da via biliar continuam desafiando o cirurgiäo. No reparo destas estenoses, dentre as alternativas técnicas utilizadas, o uso de tubos transanastomóticos é discutido. Neste trabalho, analisamos a nossa experiência com a utilizaçäo de tubos trans-hepáticos em 18 pacientes portadores de estenoses benignas altas da via biliar principal