Lesiones iatrogénicas de la vía biliar / Iatrogenic lesions of the bile ducts

Una de las complicaciones más temidas de la colecistectomía es la lesión de la vía biliar principal. Si ésta es advertida, el cirujano debe ser capaz de reparar tal lesión para evitar secuelas posteriores. En el 75%de los casos la lesión es inadvertida y condiciona, a corto o largo plazo, una estenosis benigna que plantea problemas serios de diagnóstico y tratamiento. Su frecuencia es de aproximadamente 0,2%en la colecistectomía convencional, y en la colecistectomía laparoscópica se ha comunicado una frecuencia de 2%. Existen varios factores que inciden en su producción y que pueden ser prevenibles, si se conocen. El pronóstico depende del criterio para escoger el procedimiento de reparación y de la habilidad para realizarlo. Sin embargo, el factor más importante es el estado funcional del hígado

[Reconstructive surgery in post-operative strictures of the extrahepatic bile ducts]. / Rekonstrukcné operácie pri pooperacných striktúrach extrahepatálnych zlcových ciest.

The authors made in 1982-1988 in 24 patients with iatrogenically conditioned strictures of the extrahepatic biliary pathways reconstruction operations, most frequently hepaticojejunostomy Roux-Y. Within four weeks after operation three patients died (12.5%): two were repeatedly re-operated previously, one 71-year-old female patient died as a result of hepatic coma and renal failure. The authors discuss conditions for successful reconstruction operations in iatrogenic strictures of extrahepatic biliary pathways, in particular the importance of the localization and duration of stricture, mucosobiliary anastomosis, internal drainage, solution of the stricture already during the first operation.

Iatrogenic posterior tibial neurothlipsis: a tarsal tunnel syndrome.

Posterior tibial neurothlipsis in the retromalleolar space, secondary to internal fixation of a prior ankle fracture, is presented in the following report. The possibility of a tarsal tunnel syndrome cannot be ruled out. No apparent similar reference is made in the medical literature concerning the above etiology of posterior tibial compression/neurothlipsis/tarsal tunnel syndrome. Electrodiagnosis with sensory nerve conduction velocities is reviewed for more accurate diagnosis of tarsal tunnel syndrome.

Benign biliary strictures: an analytic review (1970 to 1984).

This report concerns 105 patients with benign biliary stricture operated on at the Cleveland Clinic from 1970 through 1984; in 102 patients the stricture was iatrogenic. The mean follow-up was 5 years (3 months to 13 years). Fifty-eight patients (55%) had undergone one or more attempts at correction of the stricture before referral to us; in 47 patients (45%) we performed the first corrective repair. Percutaneous transhepatic cholangiography was the optimal preoperative diagnostic procedure to define the site of stricture. Most patients had undergone a biliary-intestinal anastomosis, either choledochoduodenostomy, choledochojejunostomy, or hepatojejunostomy. Morbidity and mortality rates were 13% and 4%, respectively. The results of operative repair were correlated with the number of previous operations, site of stricture, type of operation, presence of a fistula, presence of cirrhosis, and length of T or Y tube stenting. The overall recurrence rate after a first operation was 18% and after a second operation was 26%. With continued attempts at repair, eventual success was achieved in 93% of patients.

Surgery for lesions of the brachial plexus.

Current diagnostic workup and surgical management of stretch injuries, gunshot wounds, lacerations, iatrogenic injuries, tumors, and thoracic outlet syndromes involving the brachial plexus are reviewed. Use of appropriate radiologic and electrodiagnostic studies to work up such patients is summarized as is selected literature concerning the more controversial aspects of their management. Some of the arguments both for and against operation on stretch injuries are presented and it is concluded that surgery can be of value for well-selected patients. Although a number of patients with gunshot wounds involving the plexus recover spontaneously, many still require an operation. Experience with tumors arising from the plexus suggests the need for early and relatively aggressive removal. Use of magnification and intraoperative recording permits removal of some but not all neurofibromas without further deficit. Timing for repair of lacerating injuries to the plexus, as well as iatrogenic injuries, selection of the few patients with thoracic outlet syndrome who require operation, and a brief review of plexus neuropathy are also presented. Importance of evaluating individual plexus injuries in terms of how complete or incomplete loss is in the distribution of each individual element is stressed. Development of intraoperative stimulation and recording methods to help sort out lesions, use of magnification for repair, and improved grafting techniques where gaps result from resection have helped to restimulate interest in managing these patients.

A multipurpose grasping forceps for retrieval of an embolized catheter fragment.

Transjugular removal of an embolized catheter fragment from the right atrium of a 6-month-old infant was successfully performed using a multipurpose grasping forceps. All procedures for the retrieval were completed in only 10 minutes without complications or difficulty.

Peripheral arterial trauma in children. A fifteen year review.

A 15 year retrospective evaluation of peripheral vascular trauma in infants and children was undertaken. Forty-eight affected limbs in 47 patients (mean age 5.1 years) were explored for peripheral arterial injury. There were 40 iatrogenic, five penetrating and three blunt injuries. Thrombectomy alone, thrombectomy with autogenous saphenous vein patch angioplasty, direct angioplasty, segmental resection with end-to-end anastomosis and interposition-bypass grafting were the most common reparative procedures used. Circulation was normal within 24 hours of surgery in 35 of the 45 limbs (77.8%) whose patency was restored. In patients less than three years or 12.5 kg with iatrogenic injuries, patency rate was significantly lower (p 0.05). Four children died of congenital heart disease. All six children with failed vascular reconstruction suffered late sequelae.

[Iatrogenic esophagus perforation in newborn infants]. / Latrogene Osophagusperforation bei Neugeborenen.

Two cases of an iatrogenic oesophageal perforation in new-born are presented. Incidence and main sources of risk are discussed. Attention is drawn to early recognition and urgent surgical treatment.

[Intra-abdominal foreign bodies following laparotomy interventions: report of a case]. / Il problema dei corpi estranei endoaddominali dopo intervento laparotomico: considerazioni su un caso.

The authors report their own observation of a case of post-laparotomic endoabdominal foreign body, which for a long period had remained asymptomatic. Starting from the clinical case, they effect a short study of such iatrogenic pathology, and state the diagnostic and therapeutic criteria thereabout. They subsequently dissertate on the possible preventing means.

Surgical and conservative management of esophageal perforation.

A series of patients with esophageal injuries was reviewed to evaluate the role of conservative management of these injuries. Between 1962 and 1978, we treated 108 esophageal injuries. In 74 percent of the cases, the injury was probably iatrogenic. Foreign bodies were the most frequent cause of noniatrogenic esophageal injury. Sixty-eight patients underwent surgery, while the remaining 40 patients received conservative treatment. Of 11 deaths in the series, eight occurred among the surgically treated group. Methods of treatment are discussed, and illustrative cases presented.

Iatrogenic arteriovenous fistula in a cynomolgus macaque (Macaca fascicularis): a case report.

A juvenile male cynomolgus macaque was slightly depressed and had a rough haircoat. Cardiomegaly and pulmonary interstitial edema were found. A distinct fremitus was palpable over the right femoral canal. The only abnormal laboratory finding was an elevated total leukocyte count. A femoral arteriogram confirmed the diagnosis of femoral arteriovenous fistula. Surgical correction of the fistula was successful in reversing the heart failure. The history and anatomic location of the lesion suggested an iatrogenic cause.

The management of rectal tears in horses.

Rectal trauma in horses is usually iatrogenic and carries a high mortality. Partial thickness tears heal without surgical assistance. Full thickness tears require surgical repair through the anus or a ventral laparotomy or, if these are not possible because of difficulty in gaining access to the tear in its usual site at the pelvic inlet, a diverting colostomy to allow the rectum to heal is necessary. This paper describes the management of 15 cases of rectal injury, only 3 of which survived. Two of these were partial thickness tears not treated surgically and the third had a temporary diverting colostomy.

[Late results after reconstruction of iatrogenic bile duct injuries]. / Spätergebnisse nach Rekonstruktion iatrogener Gallenwegsverletzungen.

Between 1964 and 1978 9084 patients had been operated because of benign diseases of the gall bladder and the gall tract, out of these 64 because of iatrogenic lesion in primary surgery. As a criterion for our long-term results 48 patients were reviewed by a written questionnaire and 41 responded to it. Out of these 5 complained about persisting symptoms, which in 3 cases could be traced back to biliary cirrhosis and in one case to a thrombosis of the vena portae. Ine on case no pathological changings could be found. A good long-term result was seen in 36 of all operations because of iatrogenic gall tract lesion.