RÉSUMÉ
INTRODUCTION: Bile peritonitis is one of the rare complications that can occur after cholecystectomy or hepatectomy. It is associated with high mortality, prolonged hospital stay, and increased cost. We herein report 2 cases of bile leakage as a postoperative complication of right hemicolectomy. PATIENT CONCERNS: Two patients underwent a right hemicolectomy for colon cancer. Both patients had a history of cholecystectomy, and intrahepatic bile duct dilatation was observed in preoperative imaging study. During surgery, adhesiolysis was performed between the liver and the hepatic flexure of the colon due to adhesion in that area. DIAGNOSIS: Postoperatively, bile fluid was drained via an intraabdominal drainage tube. Both cases required surgical intervention to explore the origin of the leakage. In both cases, the anastomosis was intact, and the injury of the intrahepatic bile duct just beneath the liver surface was the origin of bile leakage. INTERVENTIONS: Suture ligation, irrigation, and drainage were performed in both patients. OUTCOMES: There was no more bile leakage after reoperation, and both patients were discharged in good health after antibiotics treatment. CONCLUSION: Although very rare, bile leakage due to intrahepatic duct injury can occur after right hemicolectomy in patients with a history of cholecystectomy and intrahepatic duct dilatation. It is necessary to consider the possibility of bile duct injury and anastomotic leakage if bile leakage is suspected after right hemicolectomy.
Sujet(s)
Maladie des voies biliaires/étiologie , Colectomie/effets indésirables , Conduit cholédoque/traumatismes , Complications peropératoires , Péritonite/étiologie , Complications postopératoires/étiologie , Sujet âgé , Sujet âgé de 80 ans ou plus , Bile , Conduits biliaires/chirurgie , Maladie des voies biliaires/diagnostic , Colectomie/méthodes , Drainage , Femelle , Humains , Mâle , Tomodensitométrie , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require emergency care. Severe complications are not uncommon and require special attention, as lethal outcome is possible. CASE PRESENTATION: We present a retrospective analysis of eight cases describing severe complications of gallstones in patients undergoing endoscopic treatment of chronic gallstones conditions. All patients were admitted to our emergency care department following symptoms onset. The diagnostic difficulties, treatment strategies and outcomes are presented. The associated risk factors and preventative measures are discussed. Two patients developed profuse bleeding, two developed acute pancreatitis, two patients had perforation related complications. One rare case of bilioma and one case of iatrogenic injury are presented. All patients had severe condition, in two cases lethal outcome was a result of co-morbidity and difficulties in management. CONCLUSION: Special care should be taken in patients with risk factors of severe complications in order to improve outcome and prevent the development of life-threatening conditions.
Sujet(s)
Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie laparoscopique , Lithiase biliaire/chirurgie , Complications postopératoires/thérapie , Sphinctérotomie endoscopique , Adulte , Sujet âgé , Fistule biliaire/physiopathologie , Fistule biliaire/thérapie , Maladie chronique , Conduit cholédoque/traumatismes , Maladies du duodénum/physiopathologie , Maladies du duodénum/thérapie , Service hospitalier d'urgences , Femelle , Calculs biliaires/chirurgie , Hémorragie gastro-intestinale/physiopathologie , Hémorragie gastro-intestinale/thérapie , Humains , Maladie iatrogène , Perforation intestinale/physiopathologie , Perforation intestinale/thérapie , Mâle , Adulte d'âge moyen , Pancréatite/physiopathologie , Pancréatite/thérapie , Veine porte , Syndrome post-cholécystectomie , Complications postopératoires/physiopathologie , Fistule vasculaire/physiopathologie , Fistule vasculaire/thérapieRÉSUMÉ
A 35-year-old man presented with a gunshot wound to his abdomen via his lower chest. Initial laparotomy did not identify any perforation or contamination. On day 3, a laparotomy under the hepatobiliary service discovered a gastric perforation, two lateral duodenal perforations and a complete transection of the common bile duct, presumably delayed perforation from the shockwave injury produced by the bullet. Contamination and haemodynamic instability precluded immediate reconstruction, and abdominal drains and external biliary drainage were established. High-volume duodenal fistula was managed with slow withdrawal of drains, and inadvertent dislodgement of the biliary drain in an outpatient setting resulted in spontaneous fistulisation of the bile duct to the lateral duodenal wall, with creation of a neo-bile duct. The patient remains well more than 1 year later, without external drainage despite no surgical reconstruction.
Sujet(s)
Conduit cholédoque/traumatismes , Drainage , Duodénum , Fistule intestinale , Plaies par arme à feu/complications , Traumatismes de l'abdomen , Adulte , Humains , Laparotomie , Mâle , TomodensitométrieSujet(s)
Techniques d'ablation , Conduit cholédoque/traumatismes , Dissection/méthodes , Conduit hépatique commun/traumatismes , Tumeurs du foie/chirurgie , Micro-ondes/usage thérapeutique , Solution physiologique salée/usage thérapeutique , Plaies et blessures/prévention et contrôle , Techniques d'ablation/effets indésirables , Sujet âgé , Humains , Tumeurs du foie/imagerie diagnostique , Tumeurs du foie/secondaire , Micro-ondes/effets indésirables , Adulte d'âge moyen , Résultat thérapeutique , Plaies et blessures/étiologieRÉSUMÉ
Post-operative biliary stricture is a cumbersome condition, secondary to biliary or vascular damage. Its risk factors include biliary or vascular anatomical variants, local inflammation, and poor surgical expertise. Intra-operative diagnosis is difficult, and in most cases, patients present with obstructive symptoms within a few weeks. Magnetic resonance cholangiography is a pivotal test to confirm the clinical picture, to study the level of the damage, and to guide treatment. Nowadays, endoscopic stenting is the first-line treatment in most centers. Multi-stenting treatment achieves long-term clinical success for more than 90% of patients, however multiple procedures are needed. In order to optimize healthcare provider costs, shorter duration endotherapies with covered metal stents are under evaluation. Radiological and surgical approaches are considered in the event of endoscopy failure.
Sujet(s)
Cholécystectomie laparoscopique/effets indésirables , Cholestase/étiologie , Cholestase/thérapie , Sténose pathologique/étiologie , Endoprothèses/effets indésirables , Cholangiopancréatographie rétrograde endoscopique , Cholangiopancréatographie par résonance magnétique , Cholestase/imagerie diagnostique , Conduit cholédoque/traumatismes , Sténose pathologique/imagerie diagnostique , Sténose pathologique/thérapie , Endoscopie gastrointestinale , Humains , Transplantation hépatique/effets indésirables , Résultat thérapeutiqueRÉSUMÉ
Traumatic injury of the common bile duct is extremely rare, especially when it is isolated. It usually occurs after laparoscopic biliary tract surgery. This lesion is often associated with one or multiple lesions of the neighborhood organs. We report a case of isolated injury of the common bile duct following abdominal trauma in a 5-year old child treated in our Department at the Mother-Child Hospital in Nouakchott. Radiological exploration didn't provide a conclusive diagnosis. Exploratory laparoscopy was performed because surgery had revealed diffuse biliary peritonitis secondary to a lesion at the bottom of the common bile duct. Emergency treatment was based on lavage with external biliary drainage followed, after a month, by bilio-digestive anastomosis. Life-threatening complication of common bile duct injuries is biliary peritonitis. In the literature, early postoperative morbidity is 20-30% while mortality rate is 0-2%. Isolated traumatic injury of the common bile duct in children is a lesion whose clinical course and therapy should be known in order to decrease morbi-mortality. Treatment is based on a multidisciplinary approach involving the pediatric surgeon, the radiologist and the resuscitating anaesthesiologist.
Sujet(s)
Traumatismes de l'abdomen/complications , Conduit cholédoque/traumatismes , Laparoscopie , Péritonite/étiologie , Anastomose chirurgicale/méthodes , Enfant d'âge préscolaire , Conduit cholédoque/chirurgie , Drainage/méthodes , Femelle , Humains , Péritonite/diagnostic , Péritonite/chirurgieRÉSUMÉ
Proper enterocytic proliferation/differentiation, besides providing adequate adherens junctions (AJ) integrity, are responsible for strengthening of the gut barrier that acts as a first line defense against endotoxemia. However, the preferential role of the underlying PI3K/Akt (PKB) axis in triggering enterocytic proliferation/differentiation signaling and AJ assembly is still obscure in sepsis. Additionally, the potential involvement of dipeptidyl peptidase (DPP)-IV in cholestatic sepsis has not yet been reported. Common bile duct ligation (CBDL) insult was performed in adult male Sprague-Dawley rats except for sham operated animals; three doses of vildagliptin (VLD3, 10 and 30 mg/kg/d; p.o) were administered for 10 consecutive days post CBDL. VLD3/10/30 dose-dependently decreased DPP-IV and elevated GLP-1, IGF-1, PI3K, pS473-Akt (PKB), pS9-GSK-3ß, pS133-CREB and cyclin-D1. VLD3/10 reduced fever, portal/aortic endotoxin and IgG, body weight loss as well as ileal NF-κB, TNF-α, MPO, TBARS, subepithelial/pericryptal and submucosal collagen deposition, vimentin immunoreactivity, N-cadherin, Zeb1 and pY654-ß-catenin but increased E-cadherin, NPSH and colon/spleen indices - effects that were quite the opposite of VLD30. Accordingly, maintaining proper enterocytic proliferation/differentiation and phosphorylation inputs consequent to adequate DPP-IV inhibition is integral to AJ assembly in cholestatic sepsis; however, perturbed signals by excessive suppression of the enzyme activity induce toxic effects manifested as AJ disassembly and EMT, hence gut leakage and overt endotoxemia.
Sujet(s)
Cholestase/anatomopathologie , Inhibiteurs de la dipeptidyl-peptidase IV/pharmacologie , Entérocytes/effets des médicaments et des substances chimiques , Transition épithélio-mésenchymateuse/effets des médicaments et des substances chimiques , Sepsie/anatomopathologie , Animaux , Différenciation cellulaire/effets des médicaments et des substances chimiques , Cholestase/traitement médicamenteux , Conduit cholédoque/traumatismes , Inhibiteurs de la dipeptidyl-peptidase IV/usage thérapeutique , Relation dose-effet des médicaments , Expression des gènes/effets des médicaments et des substances chimiques , Iléum/anatomopathologie , Ligature , Mâle , Rats , Rat Sprague-Dawley , Sepsie/traitement médicamenteux , Vildagliptine/pharmacologie , Vimentine/métabolisme , Perte de poids/effets des médicaments et des substances chimiquesSujet(s)
Lithiase biliaire/chirurgie , Conduit cholédoque/traumatismes , Dilatation/effets indésirables , Hémorragie postopératoire/chirurgie , Endoprothèses , Sujet âgé de 80 ans ou plus , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Cholangiopancréatographie rétrograde endoscopique/méthodes , Conduit cholédoque/chirurgie , Femelle , Humains , Maladie iatrogène , Hémorragie postopératoire/étiologieRÉSUMÉ
BACKGROUND: The intraoperative air cholangiogram, or "air leak test" (ALT), at the time of hepatectomy can significantly reduce the rates of bile leak and symptomatic fluid collection after high-risk procedures.1,2 Because a bile leak in the setting of an en bloc diaphragm resection and mesh reconstruction would be a particularly dreaded complication, this video shows the technique for resection, reconstruction, and ALT. PRESENTATION: The video presents the case of a 29-year-old woman who had metastatic teratoma with an 8 × 7-cm liver metastasis in segment 7 and diaphragm invasion to the level of the right hepatic vein. OPERATION: The authors performed a formal right posterior sectionectomy with en bloc diaphragm resection. The 12 × 8-cm diaphragmatic defect was reconstructed using biologic mesh (Surgimend, Integra LifeSciences, Plainsboro, NJ). An intraoperative ALT (air injection into the cystic duct with finger compression of the distal bile duct) identified several areas of bubbles from biliary radicles on the cut surface of the liver, which were ligated with 4-0 polypropylene. The ALT was repeated until no bubbles remained. Because no evidence of bubbles was observed, no surgical drain was needed. The patient did well postoperatively with no complications. CONCLUSION: In cases of combined liver and diaphragmatic resection, prevention of bile leak, with subsequent contamination of the diaphragm repair and even the thoracic cavity, is particularly vital. An easily replicated intraoperative air leak test can mitigate the risk of bile leak and organ-space infection, as well as associated sequelae on quality of life, return to intended oncologic therapy, and oncologic outcomes.
Sujet(s)
Désunion anastomotique/diagnostic , Conduit cholédoque/traumatismes , Hépatectomie/méthodes , Complications peropératoires/diagnostic , Tumeurs du foie/chirurgie , Complications postopératoires/prévention et contrôle , Tératome/chirurgie , Adulte , Désunion anastomotique/chirurgie , Conduit cholédoque/chirurgie , Femelle , Humains , Complications peropératoires/chirurgie , Tumeurs du foie/anatomopathologie , Pronostic , Tératome/anatomopathologieRÉSUMÉ
BACKGROUND: A left-sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre-operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses principles. RESULTS: Fifty-three studies with 112 patients of which 90 (80.4%) had symptomatic gallstones. Pre-operative imaging was performed in 108 patients (96.4%) with an LSGB reported on imaging in 32 (29.6%) patients. The remainder of LSGB were discovered at surgery. Ultrasound detected an LSGB in three (2.7%) patients. Five variants of cystic union with the common hepatic duct (CHD) were identified. The most common (67.8%) was union on the right side of the CHD after a hairpin bend anterior to the CHD. A cholecystectomy for gallstone disease was performed in 90 patients, 23.3% open and 76.7% LC. Common variations in LC technique were different port site placement and techniques related to the falciform ligament to improve exposure. Common bile duct injury occurred in four (4.4%) patients. CONCLUSION: LSGB is a rare anatomical variation that in patients with symptomatic gallstones is usually discovered at surgery. Cholecystectomy is associated with a higher incidence of common bile duct injury.
Sujet(s)
Cholécystectomie laparoscopique/effets indésirables , Maladies de la vésicule biliaire/imagerie diagnostique , Vésicule biliaire/malformations , Calculs biliaires/chirurgie , Cholécystectomie laparoscopique/méthodes , Conduit cholédoque/traumatismes , Vésicule biliaire/imagerie diagnostique , Vésicule biliaire/chirurgie , Maladies de la vésicule biliaire/épidémiologie , Maladies de la vésicule biliaire/anatomopathologie , Conduit hépatique commun/imagerie diagnostique , Humains , Incidence , Période périopératoire/statistiques et données numériquesRÉSUMÉ
BACKGROUND: Bile duct injury after cholecystectomy can be a life-threatening complication. Use of robotic approach to manage a complex biliary injury is in an early phase. METHODS: We have performed an analysis of our prospectively maintained database that included 12 patients who underwent robotic-assisted repair of bile duct injury after laparoscopic cholecystectomy between 2014 and 2017. RESULTS: All patients underwent robotic biliary repair within 2 weeks after primary injury. No conversion to open surgery was necessary, the estimated mean blood loss was 252 mL, and the mean operative time was 260 minutes. The mean length of stay was 9.4 days. The 30-day complication events were a subhepatic abscess and a recurrent episode of cholangitis. One patient underwent the reoperation. The mortality was null. CONCLUSION: Robotic-assisted bile duct injury repair seems to be safe and feasible. It offers promising results, thus potentially capable of modifying the management of biliary injury.
Sujet(s)
Cholécystectomie laparoscopique/méthodes , Conduit cholédoque/chirurgie , Complications peropératoires , Interventions chirurgicales robotisées/méthodes , Adulte , Sujet âgé , Cholécystectomie , Conduit cholédoque/traumatismes , Femelle , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Réintervention , Tomodensitométrie , Résultat thérapeutiqueRÉSUMÉ
Background: Common bile duct (CBD) injury is a serious complication of laparoscopic and open cholecystectomy. Early identification and minimally invasive repair, when possible, can prevent much of the morbidity associated with this injury. Materials and Methods: A 36-year-old woman referred in the immediate perioperative period for CBD injury at the time of laparoscopic cholecystectomy. We present a case of early robot-assisted repair of a Strasberg class E1 bile duct injury with Roux-en-Y hepaticojejunostomy. Results: Total console time of 4 hours with minimal blood loss and no requirement for transfusion with length of stay of 3 days. No intra- or perioperative complications of the surgery were noted. Conclusion: The degrees of freedom and stability of the robotic platform were instrumental during several key steps, including exposure of the hepatic hilum, positioning of the Roux limb, and suturing of the CBD. Successful minimally invasive repair of this patient's CBD injury minimized the morbidity of the index operation, blood loss, hospital length of stay, and potential legal consequences.
Sujet(s)
Cholécystectomie laparoscopique/effets indésirables , Conduit cholédoque/traumatismes , Jéjunum/chirurgie , Foie/chirurgie , Complications postopératoires/chirurgie , Interventions chirurgicales robotisées/méthodes , Adulte , Anastomose de Roux-en-Y , Conduit cholédoque/chirurgie , Femelle , HumainsRÉSUMÉ
INTRODUCTION: Percutaneous cholecystostomy tube (PCT) placement is often the management of severe acute cholecystitis in the unstable patient. PCT can be later reversed and cholecystectomy performed. The purpose of this study is to investigate the incidence of subsequent cholecystectomy and clinical factors associated with subsequent procedure. METHODS: The SPARCS, an administrative database, was used to search all patients undergoing PCT placement between 2000 and 2012 in the state of New York. Using a unique identifier, all patients were followed for subsequent cholecystectomy procedures for at least 2 years. Patients were also followed up to 2014 for potential CBD injury during subsequent laparoscopic (LC) or open cholecystectomy (OC). Univariate and multivariable regression analysis were performed when appropriate. RESULTS: There were 9738 patients identified who underwent PCT placements. The incidence of patients who had a PCT in 2000-2012, which subsequently underwent cholecystectomy increased from 25.0% in 2000 to 31.7% in 2012. In addition, patients undergoing subsequent LC increased from 11.8% in 2000 to 22.2% in 2012, while the incidence of OC decreased from 13.2% in 2000 to 9.5% in 2012. After accounting for other confounding factors, younger male patients, race as white compared to black, who didn't have any complications during PCT placement were more likely to undergo subsequent cholecystectomy (p < 0.05). Average time to LC was 122.0 days versus 159.6 days for OC (p < 0.0001). From the patients who underwent cholecystectomy following PCT, 47 patients experienced CBD injury (1.6%). CONCLUSIONS: Incidence of cholecystectomy following PCT increased during the study period. Surgeons seem to be more comfortable performing LC as rate of LC increased from 11.8 to 22.2%. However, rate of CBD injury is higher during subsequent cholecystectomy compared to that of the general population. Caution should be used when performing subsequent cholecystectomy following PCT, as these procedures may be more technically challenging.
Sujet(s)
Cholécystectomie/effets indésirables , Cholécystostomie/effets indésirables , Conduit cholédoque/traumatismes , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Cholécystectomie laparoscopique/effets indésirables , Cholécystite aigüe/chirurgie , Femelle , Humains , Mâle , Adulte d'âge moyen , État de New York , Complications postopératoires , Études rétrospectives , Résultat thérapeutique , Jeune adulteSujet(s)
Désunion anastomotique/chirurgie , Cholécystectomie laparoscopique/effets indésirables , Conduit cholédoque/traumatismes , Laparotomie/tendances , Désunion anastomotique/étiologie , Cholangiopancréatographie rétrograde endoscopique/méthodes , Conduit cholédoque/imagerie diagnostique , Conduit cholédoque/anatomopathologie , Femelle , Humains , Maladie iatrogène , Laparotomie/méthodes , Adulte d'âge moyen , Complications postopératoires/étiologie , Réintervention/tendances , Résultat thérapeutiqueRÉSUMÉ
PURPOSE: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC. METHODS: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed. Fifteen patients were managed by percutaneous transhepatic cholangiography (PTC)+endoscopic retrograde cholangiopancreatography (ERCP); five and six underwent PTC and ERCP alone, respectively. Median overall follow-up duration was 34 months. Three patients died from sepsis. RESULTS: Out of 26 patients, 20 presented with main bile duct and six with nonmain bile duct injuries. Using the ATOM classification, every aspect of the BDI in every case was included, unlike with other classifications (Neuhaus, Lau, Strasberg, Bergman, and Hanover). CONCLUSIONS: The all-inclusive European Association for Endoscopic Surgery (EAES) classification contains objective data and emphasizes the underlying mechanisms of damage, which is relevant for prevention. It also integrates vascular injury, necessary for ultimate management, and timing of discovery, which has diagnostic implications. The management complexity of these patients requires specialized referral centers.