ABSTRACT
OBJECTIVE: To evaluate the effectiveness and safety of electrohydraulic lithotripsy of calculi of the main pancreatic duct using ultrathin SpyGlass DS endoscope. MATERIAL AND METHODS: The study included 29 patients with chronic calcifying pancreatitis and obstructive calculi of the main pancreatic duct. All surgeries were carried out between 2018 and 2023. RESULTS: Complete removal of calculi (≥5 mm) within one procedure was achieved in 25 (86%) patients. CONCLUSION: Pancreatoscopy with electrohydraulic lithotripsy using the digital SpyGlass DS system (BostonScientificCorp, Marlborough, MA) is the most effective method for calculi of the main pancreatic duct.
Subject(s)
Lithotripsy , Pancreatitis, Chronic , Humans , Pancreatitis, Chronic/surgery , Pancreatitis, Chronic/diagnosis , Lithotripsy/methods , Male , Middle Aged , Female , Pancreatic Ducts/surgery , Adult , Calculi/surgery , Calculi/diagnosis , Treatment Outcome , Endoscopy, Digestive System/methods , Endoscopy, Digestive System/instrumentation , Cholangiopancreatography, Endoscopic Retrograde/methods , Calcinosis/surgery , Calcinosis/diagnosisSubject(s)
Calculi , Cholangiopancreatography, Endoscopic Retrograde , Pancreatic Diseases , Pancreatic Ducts , Humans , Pancreatic Ducts/surgery , Pancreatic Ducts/diagnostic imaging , Calculi/surgery , Calculi/diagnostic imaging , Calculi/therapy , Pancreatic Diseases/surgery , Pancreatic Diseases/diagnostic imaging , Dilatation/instrumentation , Male , Female , Middle AgedABSTRACT
BACKGROUND: Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. CASE PRESENTATION: A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. CONCLUSION: Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas.
Subject(s)
Abdominal Wall , Calculi , Diabetes Mellitus, Type 2 , Lithiasis , Vesicovaginal Fistula , Humans , Female , Aged , Vesicovaginal Fistula/diagnostic imaging , Vesicovaginal Fistula/surgery , Lithiasis/complications , Diabetes Mellitus, Type 2/complications , Calculi/complications , Calculi/surgeryABSTRACT
The term dacryoliths refers to the concretions found within the lacrimal system. When the term dacryoliths is unspecified, it usually refers to the noninfectious dacryoliths commonly isolated from the lacrimal sac and the nasolacrimal duct. More often, they are diagnosed incidentally during a dacryocystorhinostomy, and the reported incidence among all dacryocystorhinostomy surgeries is 5.7% to as high as 18%. Dacryolithiasis is a complex process occurring within the lacrimal system, and current evidence suggests a multifactorial etiology. The sequence of events can be summarized broadly into 4 stages: stage of susceptibility, stage of initiation/trigger, stage of development, and stage of maintenance. The triggering event is the breach of the lacrimal sac or nasolacrimal duct epithelium, resulting in microtrauma with blood leakage. The blood clots act as a nidus for subsequent sequential laying of mucopeptides, cellular debris present locally, debris washed from the ocular surface, and extraneous agents in tears. This process is aided by altered rheology and composition of the tear film. After the formation of dacryoliths, extracellular neutrophil traps usually form on the surface, which help to maintain the dacryoliths (which do not dissolve). This review highlights and discusses the possible sequence of events during dacryolithiasis.
Subject(s)
Calculi , Dacryocystorhinostomy , Lacrimal Apparatus , Lacrimal Duct Obstruction , Nasolacrimal Duct , Humans , Lacrimal Duct Obstruction/diagnosis , Lacrimal Duct Obstruction/etiology , Dacryocystorhinostomy/adverse effects , Calculi/diagnosis , Calculi/complications , Calculi/surgery , Nasolacrimal Duct/surgeryABSTRACT
BACKGROUND: This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery. METHODS: Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group). RESULTS: This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30 min vs 273.93 min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups. CONCLUSIONS: Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.
Subject(s)
Calculi , Cholangitis , Laparoscopy , Lithiasis , Liver Diseases , Humans , Hepatectomy/methods , Liver Diseases/surgery , Lithiasis/surgery , Retrospective Studies , Hepatic Veins , Treatment Outcome , Calculi/surgery , Laparoscopy/methods , Cholangitis/etiologyABSTRACT
BACKGROUND: Laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy (MATL) is an approach that can substantially improve stone clearance rates while reducing the rate of postoperative biliary fistula formation, residual stone rates, and rates of recurrence. In this study, we classified left-side hepatolithiasis cases into four subtypes based upon the diseased stone-containing bile duct, the middle hepatic vein, and the right hepatic duct. We then investigated the risk associated with different subtypes and evaluated the safety and efficacy of the MATL procedure. METHODS: In total, 372 patients who underwent left hemihepatectomy for left intrahepatic bile duct stones were enrolled. Based on the distribution of the stones, the cases could be divided into four types. The risk of surgical treatment was compared for the four types and the safety, short-term efficacy, and long-term efficacy of the MATL procedure in the four types of left intrahepatic bile duct stones were studied. RESULTS: Type II was found to be the most likely to cause intraoperative bleeding while type III was likely to cause biliary tract damage and type IV was associated with the highest stone recurrence rate. The MATL procedure did not increase the risk of surgery and was found to reduce the rate of bile leakage, residual stones, and stone recurrence. CONCLUSION: Left-side hepatolithiasis-associated risk classification is feasible and may represent a viable means of improving the safety and feasibility of the MATL procedure.
Subject(s)
Calculi , Laparoscopy , Lithiasis , Liver Diseases , Humans , Liver Diseases/complications , Lithiasis/surgery , Hepatic Veins , Hepatectomy/methods , Calculi/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Treatment Outcome , Retrospective StudiesABSTRACT
BACKGROUND: Patients with hemorrhagic shock may develop emerging enterogenic sepsis due to damage to the intestinal mucosal barrier and translocation of intestinal bacteria and endotoxins caused by ischemic injury. Because of the dual effects of anesthesia state and hemorrhagic shock, perioperative emerging enterogenic sepsis is even more rare and insidious. CASE PRESENTATION: We reported a case of 56-year-old man who underwent right hepatectomy for intrahepatic bile duct stones. Severe hemorrhage occurred during the procedure and the hemodynamics neither improved nor worsened after rehydration therapy and vasoactive drug administration. Based on the patient's history and clinical presentation, a possible enterogenic sepsis was considered. After anti-infective treatment and hormone supplementation, the patient's circulation improved significantly and he had an uneventful recovery. CONCLUSION: The possibility of emerging enterogenic sepsis in hemorrhagic shock must always be taken into consideration. Familiarity with the risk factors and pathophysiological alterations of enterogenic sepsis is a prerequisite for early recognition and sound clinical decision making.
Subject(s)
Sepsis , Shock, Hemorrhagic , Shock, Hemorrhagic/complications , Sepsis/complications , Humans , Female , Middle Aged , Hepatectomy/adverse effects , Bile Ducts, Intrahepatic , Calculi/surgery , Treatment OutcomeABSTRACT
Endoscopic therapy and extracorporeal shock wave lithotripsy (ESWL) are recommended as the first choice in treating pancreatolithiasis. Endoscopic therapy is generally performed using endoscopic pancreatic sphincterotomy (EPST). Herein, we report our experience implementing a treatment protocol, combining endoscopic therapy and ESWL without EPST, for pancreatolithiasis. The inpatient treatment plan was performed every 3 months with a set number of sessions of ESWL with endoscopic pancreatic stenting (EPS) implanted or replaced. Finally, treatment was terminated when the stone was removed after implantation of a 10-Fr stent and crushed to approximately 3 mm or after spontaneous stone discharge. Eight patients were included in this study; the median time to stone disappearance was 208.5 days. The median number of inpatient treatment cycles, endoscopic retrograde cholangiopancreatography, and ESWL sessions was 2.5, 3, and 3, respectively. No serious adverse events were observed in all patients. Therefore, combining ESWL and EPS without EPST can safely treat pancreatolithiasis.
Subject(s)
Calculi , Lithotripsy , Pancreatic Diseases , Sphincterotomy , Humans , Pancreatic Ducts/surgery , Lithotripsy/methods , Pancreatic Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Calculi/surgery , Stents , Treatment OutcomeABSTRACT
The Meckel's diverticulum is usually asymptomatic but in sometimes it presents severe complications, such as bleeding or perforation. The presence of enterolith inside a Meckel diverticulum is rare. In this report, we present a case of a 56- years- old man, with an abdominal pain and small bowel obstruction for a enterolith. Preoperative radiologic studies in Emergency Room (ER) didn't reveal this stone, but realeved a small bowel obstruction. Initially, we tried a conservative management, however after about 48 hours, due to worsening symptoms, the patient undergoes an exploratory laparotomy and a intestinal resection. Key words: Enteriith, Meckel's diverticulum, Small bowel obstruction.
Subject(s)
Calculi , Intestinal Obstruction , Meckel Diverticulum , Abdominal Pain/etiology , Calculi/complications , Calculi/surgery , Conservative Treatment , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Male , Meckel Diverticulum/complications , Meckel Diverticulum/diagnostic imaging , Meckel Diverticulum/surgery , Middle AgedABSTRACT
BACKGROUND: Several therapeutic modalities have been proposed for the management of choledocholithiasis (CDL) following Roux-en-Y gastric bypass (RYGB), yet debate exists regarding the optimal management. The purpose of our study was to review the current literature to compare the efficacy of various techniques in the management of CDL post-RYGB. METHODS: A comprehensive search of multiple databases was conducted. Studies reporting on the management of CDL in patients post-RYGB and including at least 5 patients were eligible for inclusion. The primary outcome was successful stone clearance. Secondary outcomes included procedure duration, length of hospital stay, and adverse events. RESULTS: Of 3259 identified studies, 53 studies involving 857 patients were included in the final analysis. The mean age was 54.4 years (SD 7.05), 78.8% were female (SD 13.6%), and the average BMI was 30.8 kg/m2 (SD 6.85). Procedures described included laparoscopy-assisted ERCP (LAERCP), balloon-assisted enteroscopy (BAE), ultrasound-directed transgastric ERCP (EDGE), laparoscopic common bile duct exploration (LCBDE), EUS-guided intra-hepatic puncture with antegrade clearance (EGHAC), percutaneous trans-hepatic biliary drainage (PTHBD), and rendezvous guidewire-associated (RGA) ERCP. High rates of successful stone clearance were observed with LAERCP (1.00; 95% CI 0.99-1.00; p = 0.47), EDGE (0.97; 95% CI 0.9-1.00; p = 0.54), IGS ERCP (1.00; 95% CI 0.87-1.00), PTHBD (1.0; 95% CI 0.96-1.00), and LCBDE (0.99; 95% CI 0.93-1.00, p < 0.001). Lower rates of stone clearance were observed with BAE (61.5%; 95%CI 44.3-76.3, p = 0.188) and EGHAC (74.0%; 95% CI 42.9-91.5, p = 0.124). Relative to EDGE, LAERCP had a longer procedure duration (133.1 vs. 67.4 min) but lower complication rates (12.8% vs. 24.3%). CONCLUSION: LAERCP and EDGE had high rates of success in the management of CDL post-RYGB. LAERCP had fewer complications but was associated with longer procedure times. BAE had lower success rates than both LAERCP and EDGE.
Subject(s)
Calculi , Choledocholithiasis , Gastric Bypass , Laparoscopy , Balloon Enteroscopy , Calculi/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/surgery , Female , Gastric Bypass/adverse effects , Humans , Laparoscopy/methods , Male , Middle Aged , Retrospective StudiesSubject(s)
Calculi , Lithotripsy , Humans , Pancreaticoduodenectomy , Calculi/diagnostic imaging , Calculi/surgery , Lithotripsy/methodsABSTRACT
Chronic pancreatitis (CP) is a serious condition with a great impact on the quality of life, and it can lead to some serious long-term consequences such as pancreatic cancer or secondary diabetes mellitus. Associated pancreatic exocrine insufficiency leads to malnutrition with weight loss; however, the main symptom of the disease is abdominal pain, often very severe. The primary treatment option for painful CP is pharmacotherapy (pancreatic enzyme replacement therapy, analgesics). If this is not effective, CP can be treated via endoscopy, extracorporeal shockwave lithotripsy (ESWL), their combination, or surgery. We present a case of painful chronic obstructive pancreatitis in a patient successfully treated with ESWL in combination with endoscopy.
Subject(s)
Calculi , Lithotripsy , Humans , Calculi/surgery , Pancreatic Ducts , Treatment Outcome , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
OBJECTIVE: To explore the risk factors for long-term hematuria after operation in BPH patients. METHODS: We retrospectively analyzed the clinical data on 646 cases of BPH treated by transurethral surgery in Liyang People's Hospital from January 2015 to August 2020. According to the incidence of hematuria at 3 months or longer after surgery, we divided the patients into a hematuria and a non-hematuria group, recorded the related factors, and investigated the independent risk factors for long-term hematuria by univariate and multivariate analyses. RESULTS: Of the 646 BPH patients, 48 were found with and 598 without hematuria after transurethral surgery. Univariate analysis showed that hypertension, diabetes mellitus, residual prostate gland, urinary tract infection, bladder neck contracture, prostate cancer, urethral calculus, urethral stricture, excessive activity and constipation were the influencing factors (P < 0.05), while multivariate logistic regression analysis revealed that hypertension (P < 0.001), diabetes mellitus (P = 0.007), residual prostate gland (P = 0.013), urinary tract infection (P < 0.001), bladder neck contracture (P = 0.032), urethral calculus (P = 0.033) and urethral stricture (P = 0.001) were independent risk factors for long-term hematuria in the BPH patients after surgery. CONCLUSION: Complicated hypertension, diabetes mellitus, residual prostate gland, urinary tract infection, bladder neck contracture, urethral calculus and urethral stricture are independent risk factors for long-term hematuria in BPH patients after transurethral surgery.
Subject(s)
Calculi , Contracture , Diabetes Mellitus , Hypertension , Prostatic Hyperplasia , Transurethral Resection of Prostate , Urethral Stricture , Urinary Tract Infections , Male , Humans , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Urethral Stricture/etiology , Hematuria/epidemiology , Hematuria/etiology , Transurethral Resection of Prostate/adverse effects , Retrospective Studies , Risk Factors , Urinary Tract Infections/complications , Contracture/etiology , Hypertension/complications , Calculi/surgery , Treatment OutcomeABSTRACT
INTRODUCTION: Although gallbladder disease is more common in women, there is a trend toward more complicated cases in male patients. METHODS: All cholecystectomies captured by the National Surgical Quality Improvement Program database for the year 2016 were reviewed. This encompassed 38 736 records. Records were reviewed for age, sex, procedure performed, operative time, postoperative diagnosis, functional status, American Society of Anesthesiologists (ASA) class, preoperative lab values (total bilirubin, alkaline phosphatase, white blood cell count, and aspartate aminotransferase. Descriptive and inferential statistical analyses were conducted. RESULTS: Male patients are more likely to undergo cholecystectomy for a diagnosis of cholecystitis, gallstone pancreatitis, or cholangitis than women who are more likely to carry a diagnosis of biliary dyskinesia. The average operative time increases for both sexes as the patients become older. The average operative time is higher for men than women in all age groups and the variance becomes greater as the patients become older. Age, sex, postoperative diagnosis, ASA class, and functional status were all independently significant in predicting operative time. There was no difference in need for cholangiogram between the sexes. Female patients were more likely to have their cholecystectomy completed laparoscopically and they were more likely to have their surgery performed as an outpatient. CONCLUSION: These data show that women were more likely to present with uncomplicated gallbladder disease, while men were more likely to present with complicated gallbladder disease. This suggests that male patients present at a more advanced stage of disease.
Subject(s)
Cholecystectomy/statistics & numerical data , Gallbladder Diseases/epidemiology , Age Factors , Ambulatory Surgical Procedures/statistics & numerical data , Analysis of Variance , Biliary Dyskinesia/epidemiology , Biliary Dyskinesia/surgery , Calculi/epidemiology , Calculi/surgery , Cholangiography/statistics & numerical data , Cholangitis/epidemiology , Cholangitis/surgery , Cholecystectomy/methods , Cholecystectomy, Laparoscopic/statistics & numerical data , Cholecystitis/epidemiology , Cholecystitis/surgery , Elective Surgical Procedures/statistics & numerical data , Female , Gallbladder Diseases/surgery , Humans , Male , Operative Time , Pancreatitis/epidemiology , Sex Distribution , Sex FactorsABSTRACT
PURPOSE: To evaluate endogenous endophthalmitis clinical features following minimally invasive removal of upper urinary tract calculi. METHODS: Medical records of twelve patients (17 eyes) with endogenous endophthalmitis secondary to minimally invasive upper urinary tract calculus removal were retrospectively reviewed. RESULTS: Diabetes mellitus was found in 7 patients (58%). 10 patients (83%) suffered from fever. The stone extraction and ocular symptom onset interval ranged from 2 to 22 days. All eyes presented as vitritis and fluffy yellow-white retinal exudates. Hypopyon was only found in 3 eyes (18%). 5 patients (42%) were misdiagnosed as uveitis which led to mismanagement. Ocular fluids were culture positive for only C. albicans in 12 eyes (71%). 10 of 12 eyes (83%) with silicon oil tamponade obtained a final BCVA≥0.05. CONCLUSIONS: C. albicans was the most common endogenous endophthalmitis pathogen after urinary calculus removal by minimally invasive surgery. Pars plana vitrectomy with silicon oil tamponade may be helpful to achieve a favorable visual outcome. Routine ophthalmologic evaluation by the uveitis or vitreoretinal specialist may be necessary within 2 weeks after the urological procedures.
Subject(s)
Calculi , Endophthalmitis , Urinary Tract , Calculi/surgery , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Endophthalmitis/surgery , Humans , Retrospective Studies , Treatment Outcome , Visual Acuity , Vitrectomy/methodsABSTRACT
Autoimmune pancreatitis (AIP) is a unique form of pancreatitis often associated with infiltration of immunoglobulin G4-positive cells, a swollen pancreas, and diffuse narrowing of the pancreatic ducts. Unlike acute pancreatitis, AIP is rarely complicated with pseudocysts. Pancreatic calculi, a feature of ordinary chronic pancreatitis, are unusual during short-term follow-up in patients with AIP. We herein describe a 46-year-old man who initially presented with a submucosal tumor of the stomach. The patient was finally diagnosed with AIP accompanied by a pancreatic tail pseudocyst located in the gastric wall and pancreatic calculi by endoscopic ultrasonography-guided fine-needle aspiration. He underwent endoscopic retrograde cholangiopancreatography, pancreatic duct stent placement, and steroid treatment and achieved good clinical and laboratory responses. Although AIP is a common autoimmune disease that responds well to steroids, pseudocysts and pancreatic calculi are rare manifestations of AIP and should be given special attention, especially in patients with disease relapse.