RESUMO
Common bile duct (CBD) injury during surgical procedures is a serious complication. Partial injury can usually be managed by a combination of percutaneous and/or endoscopic techniques. However, the management of complete transection of the CBD is very challenging. There are small case series of nonsurgical management of complete CBD transection during laparoscopic cholecystectomy. In this particular case, a 55-year-old female patient had multiple operations because of malignant pheochromocytoma with liver metastases. She developed a complete CBD transection during right hepatectomy. A biloma was managed with image-guided percutaneous drainage. However, both attempts of percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) for CBD stent were unsuccessful, as the native CBD was partially resected during the injury. A rendezvous procedure, in which a guidewire was placed through the distal CBD and into a biloma by ERCP and subsequently snared with PTC, allowed for a biliary-duodenal catheter to be placed successfully and achieve continuity of the patient's biliary tree.
Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Ducto Colédoco/lesões , Ducto Colédoco/cirurgia , Complicações Intraoperatórias/cirurgia , Anastomose Cirúrgica/métodos , Doenças dos Ductos Biliares , Cateterismo/métodos , Colangiografia/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Drenagem , Duodeno , Endoscopia , Feminino , Hepatectomia/efeitos adversos , Humanos , Pessoa de Meia-Idade , StentsRESUMO
Small cell carcinoma of the cervix (SCCC) is a rare disease, accounting for fewer than 3% of all cervical neoplasms. However, SCCC is an extremely aggressive tumor that is usually not confined to the cervix at the time of diagnosis. Unlike other carcinomas of the cervix, early-stage SCCC cannot be reliably detected by Papanicolaou smear. The initial presentation is usually non-specific, and often presents with abnormal vaginal bleeding. In this report, the case of a patient with SCCC presenting to the Emergency Department is described to better inform emergency physicians of the existence of this condition. Based on a review of the literature, an update on clinical presentation, diagnosis, and therapeutic options is provided.
