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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526527

RESUMO

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.


Assuntos
Obstrução Duodenal/diagnóstico por imagem , Cálculos Biliares/diagnóstico por imagem , Fístula Intestinal/diagnóstico por imagem , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico por imagem , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Fístula Intestinal/complicações , Pessoa de Meia-Idade , Radiografia Abdominal , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563692

RESUMO

An 81-year-old woman, diabetic and hypertensive, presented with nausea and intermittent vomiting. She had dysphagia and loss of appetite for over 6 weeks and significant weight loss over 3 weeks and was admitted in general surgery unit on emergency basis. Investigations revealed dilated stomach and a stone in first part of duodenum, with probable site of obstruction at level of first part of duodenum, secondary to a cholecystoduodenal fistula. With a preoperative diagnosis of Bouveret's syndrome, she underwent laparotomy and subtotal cholecystectomy. Postoperative recovery was delayed due to gastroparesis and delayed gastric emptying which resolved with conservative management. Successful management of this case required a multidisciplinary team approach. Early diagnosis was the key to management. Mode of treatment and management of Bouveret's syndrome should be tailored to suit patient's age, comorbidities and performance status.


Assuntos
Cálculos Biliares/complicações , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Colecistectomia , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Cálculos Biliares/diagnóstico por imagem , Obstrução da Saída Gástrica/diagnóstico por imagem , Humanos , Laparotomia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Síndrome
4.
Am J Surg ; 221(3): 538-542, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33358373

RESUMO

BACKGROUND: This study examines the outcomes of open and laparoscopic cholecystectomy (OC/LC) in veterans with cirrhosis and develops a nomogram to predict outcomes. METHODS: We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent cholecystectomy from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of morbidity and mortality. A predictive nomogram was constructed and internally validated. RESULTS: A total of 349 patients were identified. Overall, complications occurred in 18.7% of patients, and mortality was 3.8%. LC was performed in 58.9%, and 19.2% were preformed emergently. Overall, Model for End-Stage Liver Disease score was an independent factor of morbidity and mortality, while laparoscopic approach had a protective effect on morbidity. CONCLUSIONS: Although cholecystectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing cholecystectomy is proposed.


Assuntos
Colecistectomia Laparoscópica , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Cirrose Hepática/complicações , Complicações Pós-Operatórias/epidemiologia , Veteranos , Idoso , Feminino , Cálculos Biliares/mortalidade , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Nomogramas , Valor Preditivo dos Testes , Melhoria de Qualidade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
5.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370996

RESUMO

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.


Assuntos
Obstrução Duodenal/diagnóstico , Cálculos Biliares/complicações , Obstrução da Saída Gástrica/diagnóstico , Íleus/diagnóstico , Idoso de 80 Anos ou mais , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Endoscopia do Sistema Digestório , Feminino , Vesícula Biliar/diagnóstico por imagem , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica/etiologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Íleus/etiologia , Íleus/cirurgia , Estômago/diagnóstico por imagem , Estômago/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
6.
Rev Fac Cien Med Univ Nac Cordoba ; 77(4): 378-380, 2020 12 21.
Artigo em Espanhol | MEDLINE | ID: mdl-33351368

RESUMO

Introduction: Bouveret syndrome consists of an obstruction of the gastric outlet due to the impaction of a gallstone in the duodenal bulb after migration through a cholecystoduodenal fistula. Clinical Case: Patient with diffuse colicky abdominal pain, diarrhea and yellowish vomiting. The imaging tests carried out reveal significant gastric and duodenal dilation with the presence of gas at the gallbladder level with the existence of a cholecystoduodenal fistula with a rounded intraluminal image in the proximal jejunum compatible with migrated lithiasis. The patient underwent emergency surgery through an enterotomy with removal of the calculus and its closure. Discussion: Discussion: Bouveret's syndrome is a rare gallstone ileus condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnosis and treatment strategies are required for optimal management and results, with endoscopic treatment or open surgery being the two treatments available for resolution of the condition. Conclusion: Bouveret syndrome is a life-threatening condition with gastric outlet obstruction caused by large gallstones. In most cases, a CT scan is required for diagnosis, and although in some cases percutaneous and endoscopic treatments can be successful as first-line treatment, most patients require surgery to remove stones.


Assuntos
Cálculos Biliares , Íleus , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Íleus/diagnóstico por imagem , Íleus/etiologia , Íleus/cirurgia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Síndrome
7.
Medicine (Baltimore) ; 99(39): e22428, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991479

RESUMO

Previous research has revealed a positive relationship between GSD, cholecystectomy and primary liver cancer (PLC). However, previous studies had several limitations including the retrospective design, narrow assessment of potential confounders and lack of competing risk models in time-to-event analyses. We conducted a large prospective cohort study to explore the relationship between GSD, cholecystectomy and PLC. A total of 95,021 participants who had not been diagnosed with PLC previously were enrolled from the Kailuan Cohort study. Demographic characteristics and biochemical parameters were recorded at baseline for all participants. We used Cox regression models and competing risk regression models to evaluate the association of GSD and cholecystectomy with the risk PLC. A total of 306 incidental PLC cases were identified during a median follow-up of 9.05 (8.75-9.22) years per participant. Compared with the normal group, the multivariable HRs (95%CI) for the association of GSD and cholecystectomy with PLC were 1.77 (1.05-2.94), 5.25 (1.95-14.17). In the CS model, the multivariable HRs (95%CI) was 1.76 (1.05-2.94) for the association of GSD and cholecystectomy with PLC and 5.25 (1.95-14.17) for GSD and cholecystectomy. Similar results were also obtained in the SD model with corresponding multivariate HRs (95%CI) of 1.75 (1.01-3.00), 5.22 (1.90-14.07) in the GSD group and cholecystectomy group, respectively. GSD and cholecystectomy were associated with an elevated risk of PLC.Registration number: ChiCTR-TNRC-11001489.


Assuntos
Colecistectomia/efeitos adversos , Cálculos Biliares/epidemiologia , Neoplasias Hepáticas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Incidência , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Adulto Jovem
8.
Lancet ; 396(10252): 726-734, 2020 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891214

RESUMO

Acute pancreatitis is an unpredictable and potentially lethal disease. The prognosis mainly depends on the development of organ failure and secondary infection of pancreatic or peripancreatic necrosis. In the past 10 years, treatment of acute pancreatitis has moved towards a multidisciplinary, tailored, and minimally invasive approach. Despite improvements in treatment and critical care, severe acute pancreatitis is still associated with high mortality rates. In this Seminar, we outline the latest evidence on diagnostic and therapeutic strategies for acute pancreatitis.


Assuntos
Antibacterianos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Hidratação , Apoio Nutricional , Pancreatite/diagnóstico , Pancreatite/terapia , Amilases/sangue , Colecistectomia , Diabetes Mellitus/etiologia , Diabetes Mellitus/terapia , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/terapia , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Lipase/sangue , Imagem por Ressonância Magnética , Pancreatite/sangue , Pancreatite/etiologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/terapia , Pancreatite Alcoólica/diagnóstico , Pancreatite Alcoólica/terapia , Prevenção Secundária , Stents , Tomografia Computadorizada por Raios X , Ultrassonografia
9.
Am Surg ; 86(8): 1022-1025, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32809851

RESUMO

Laparoscopic cholecystectomy remains one of the most common surgical operations. Common bile duct stones (CBDS) are estimated to be present in 10%-20% of individuals with symptomatic gallstones. Preoperative magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography (IOC) remain the most common methods of evaluation, with subsequent endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction if positive for CBDS. We examined our experience with preoperative MRCP versus IOC for the management of the jaundiced patient with cholelithiasis. This is a retrospective single-institution study that examined all laparoscopic cholecystectomies performed over a 15-month period between 2017 and 2018. Outpatient elective cases were excluded from the analysis. Charts were reviewed for demographics, operative details, and whether an MRCP, IOC, or ERCP was performed. Data were evaluated using a 2-sample t-test. A total of 460 patients underwent laparoscopic cholecystectomy over a 15-month period. Of those, 147 underwent either an MRCP or an IOC for clinical suspicion for CBDS. ERCP after MRCP was nontherapeutic in 11/32 (34%) compared with 2/12 (17%) of patients following IOC. The sensitivity and specificity of MRCP were 91% and 80%, respectively, with a positive predictive value of 66% and a negative predictive value of 96%. The sensitivity and specificity of IOC were 83% and 97%, respectively, with a positive predictive value of 83% and a negative predictive value of 97%. MRCP and IOC have unique advantages and disadvantages. MRCP has greater sensitivity, but poor specificity, resulting in unnecessary ERCPs with associated morbidity and increased costs to the patient.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica , Cálculos Biliares/diagnóstico por imagem , Icterícia Obstrutiva/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Procedimentos Desnecessários/estatística & dados numéricos , Colangiografia/métodos , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Cuidados Intraoperatórios/métodos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
10.
Lancet ; 396(10245): 167-176, 2020 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-32682482

RESUMO

BACKGROUND: It remains unclear whether urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy improves the outcome of patients with gallstone pancreatitis without concomitant cholangitis. We did a randomised trial to compare urgent ERCP with sphincterotomy versus conservative treatment in patients with predicted severe acute gallstone pancreatitis. METHODS: In this multicentre, parallel-group, assessor-masked, randomised controlled superiority trial, patients with predicted severe (Acute Physiology and Chronic Health Evaluation II score ≥8, Imrie score ≥3, or C-reactive protein concentration >150 mg/L) gallstone pancreatitis without cholangitis were assessed for eligibility in 26 hospitals in the Netherlands. Patients were randomly assigned (1:1) by a web-based randomisation module with randomly varying block sizes to urgent ERCP with sphincterotomy (within 24 h after hospital presentation) or conservative treatment. The primary endpoint was a composite of mortality or major complications (new-onset persistent organ failure, cholangitis, bacteraemia, pneumonia, pancreatic necrosis, or pancreatic insufficiency) within 6 months of randomisation. Analysis was by intention to treat. This trial is registered with the ISRCTN registry, ISRCTN97372133. FINDINGS: Between Feb 28, 2013, and March 1, 2017, 232 patients were randomly assigned to urgent ERCP with sphincterotomy (n=118) or conservative treatment (n=114). One patient from each group was excluded from the final analysis because of cholangitis (urgent ERCP group) and chronic pancreatitis (conservative treatment group) at admission. The primary endpoint occurred in 45 (38%) of 117 patients in the urgent ERCP group and in 50 (44%) of 113 patients in the conservative treatment group (risk ratio [RR] 0·87, 95% CI 0·64-1·18; p=0·37). No relevant differences in the individual components of the primary endpoint were recorded between groups, apart from the occurrence of cholangitis (two [2%] of 117 in the urgent ERCP group vs 11 [10%] of 113 in the conservative treatment group; RR 0·18, 95% CI 0·04-0·78; p=0·010). Adverse events were reported in 87 (74%) of 118 patients in the urgent ERCP group versus 91 (80%) of 114 patients in the conservative treatment group. INTERPRETATION: In patients with predicted severe gallstone pancreatitis but without cholangitis, urgent ERCP with sphincterotomy did not reduce the composite endpoint of major complications or mortality, compared with conservative treatment. Our findings support a conservative strategy in patients with predicted severe acute gallstone pancreatitis with an ERCP indicated only in patients with cholangitis or persistent cholestasis. FUNDING: The Netherlands Organization for Health Research and Development, Fonds NutsOhra, and the Dutch Patient Organization for Pancreatic Diseases.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Tratamento Conservador/métodos , Cálculos Biliares/terapia , Pancreatite/terapia , Esfinterotomia Endoscópica/métodos , Doença Aguda , Idoso , Terapia Combinada , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/etiologia , Humanos , Masculino , Resultado do Tratamento
11.
Am Surg ; 86(6): 675-684, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683979

RESUMO

Gallstone ileus is an unusual complication of cholelithiasis. Classically, a stone is impacted at the terminal ileum originating from a cholecystoduodenal fistula. Exceptions to this pathophysiology have been noted at each step. In this systematic review, we document a comprehensive review of postcholecystectomy gallstone ileus inclusive of 49 separate cases and report 8 different mechanisms leading to this unusual complication. The most common mechanism is a lost stone during cholecystectomy that then erodes through the intestinal wall leading to bowel obstruction. Our review showed an older, female predominance (64.0%) at an average age of 68.0 years, patients typically had a burden of comorbidities. Delay in diagnosis was common (64% of cases) with the correct diagnosis made in 37.5% of patients during admission. Pneumobilia was commonly reported (29.0%). There was a wide range in the amount of time between cholecystectomy and gallstone ileus, from 10 days to 50 years (mean 12.4 years). Postcholecystectomy gallstone ileus is an unusual complication of cholelithiasis, which mandates surgery. Retrieval of stones should be undertaken if they are spilled during cholecystectomy. Owing to the increasing age of the American patient population, it is likely that a higher number of patients with this condition will be encountered.


Assuntos
Colecistectomia/efeitos adversos , Colelitíase/complicações , Cálculos Biliares/complicações , Doenças do Íleo/etiologia , Fatores Etários , Humanos , Obstrução Intestinal/etiologia , Fatores de Risco , Fatores Sexuais
12.
Medicine (Baltimore) ; 99(24): e20239, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541450

RESUMO

To evaluate the timing, feasibility, and necessity of early laparoscopic cholecystectomy (LC) in the management of patients with acute calculous cholecystitis complicated with hepatic dysfunction.The clinical data of 60 patients with acute calculous cholecystitis complicated with hepatic dysfunction treated from January 2016 to January 2018 were analyzed retrospectively. A total of 32 patients underwent LC within 72 hours of the cholecystitis attack, 28 patients after 72 hours. The results were compared with those from 28 patients with delayed LC.All the patients were operated by experienced surgeons, and no LC transfer to open operation. No significant differences were detected in the operation time, postoperative complications, intraoperative blood loss, white TBIL, ALT, GGT before and after the operation between the 2 groups (P > .05). Patients who underwent early LC had a short hospital stay and fewer hospital costs (P < .05). All the patients were cured.It is safe, feasible, and necessary to perform LC within 72 hours in patients with acute calculous cholecystitis complicated with hepatic dysfunction. Such patients show a high positive correlation between the inflammation of acute calculous cholecystitis and the damage of hepatic function.


Assuntos
Colecistite Aguda/cirurgia , Cálculos Biliares/complicações , Hepatopatias/etiologia , Hepatopatias/cirurgia , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Colecistectomia Laparoscópica/métodos , Estudos de Viabilidade , Feminino , Cálculos Biliares/patologia , Humanos , Tempo de Internação , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento
13.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 55(3): 169-172, mayo-jun. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196165

RESUMO

El íleo biliar es una complicación rara y potencialmente grave de la colelitiasis. Se define como una obstrucción intestinal mecánica secundaria a la presencia de un cálculo biliar en la luz intestinal. La causa más frecuente es la impactación del cálculo en el íleon tras su paso a través de una fístula bilioentérica. Presenta una elevada morbimortalidad, debido principalmente a la dificultad y el retraso diagnóstico. Presentamos un estudio retrospectivo de 4 casos de íleo biliar tratados entre 2013 y 2017 en el Hospital Nuestra Señora del Prado. Se analizaron las características clínicas, las pruebas diagnósticas y el tratamiento quirúrgico realizado


Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Cálculos Biliares/diagnóstico , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Doenças do Íleo/complicações , Cálculos Biliares/complicações , Tomografia Computadorizada por Raios X , Ultrassonografia , Dor Abdominal/etiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32340378

RESUMO

The objective of this study is to assess the relationship between gallstones and venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and the risk of VTE after cholecystectomy for gallstones. This nationwide population-based cohort study retrieved the hospitalization database from the Longitudinal Health Insurance Research Database (LHID2000), a database belonging to the National Health Insurance (NHI) program of Taiwan. A total of 345,793 patients aged ≥ 18 years with gallstones diagnosed between 2000 and 2010 were identified as the study cohort. The beneficiaries without gallstones were randomly selected as the control cohort by propensity score matching with the study cohort at a 1:1 ratio based on age, sex, urbanization, occupation, comorbidities, and year of the index date. We compared the risk of VTE between both cohorts and measured the risk differences of VTE between the gallstones patients with (n = 194,187) and without cholecystectomy (n = 151,606). Each patient was examined from the index date until the occurrence of DVT or PE, death or withdrawal from the NHI program, or the end of 2011. The incidence rate of DVT was 7.94/10,000 person-years for the non-gallstones cohort and 9.64/10,000 person-years for the gallstones cohort (hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.25-1.47), respectively (p < 0.001). The incidence rate of PE was 3.92/10,000 person-years for the non-gallstones cohort and 4.65/10,000 person-years for the gallstones cohort (HR = 1.35, 95% CI = 1.20-1.53), respectively (p < 0.001). The cumulative incidence of DVT (6.54/10,000 person-years vs 14.6/10,000 person-years, adjusted hazard ratio (aHR) = 0.60, 95% CI = 0.54-0.67) and PE (3.29/10,000 person-years vs 6.84/10,000 person-years, aHR = 0.67, 95% CI = 0.58-0.77) for gallstones patients was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort after adjustment for age, sex, urbanization level, occupation, frequency of medical visits, history of pregnancy, and comorbidities (log-rank test, p < 0.001). Our findings indicate that the risk of DVT or PE in patients with gallstones was greater than those without gallstones. However, the risk of DVT and PE in the patients with gallstones would decrease after cholecystectomy. This area of research needs more studies to ascertain the pathogenesis for the contribution of gallstones to the development of VTE and the protective mechanisms of cholecystectomy against the development of VTE.


Assuntos
Colecistectomia/efeitos adversos , Cálculos Biliares/cirurgia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Estudos de Coortes , Feminino , Cálculos Biliares/complicações , Humanos , Incidência , Masculino , Complicações Pós-Operatórias , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia
16.
Cas Lek Cesk ; 159(1): 33-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32290672

RESUMO

We present a case of a 100-year-old polymorbid patient with signs of bowel obstruction. After failure of conservative therapy computed tomography was performed, which revealed the course of the obstruction to be a gallstone in the terminal ileum. The gallstone was removed surgically without complications and the patient recovered well and had an uneventful postoperative course.


Assuntos
Cálculos Biliares , Íleus , Idoso de 80 Anos ou mais , Tratamento Conservador , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Íleus/complicações , Período Pós-Operatório , Tomografia Computadorizada por Raios X
17.
J Surg Res ; 252: 133-138, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278967

RESUMO

BACKGROUND: Controversy exists over the timing of cholecystectomy for biliary pancreatitis in children. Some surgeons await normalization of serum lipase levels while others are guided by resolution of abdominal pain; however, there are minimal data to support either practice. We hypothesized that resolution of abdominal pain is equivalent in outcome to awaiting normalization of lipase levels in patients undergoing cholecystectomy for biliary pancreatitis. METHODS: After institutional review board (IRB) approval, the medical record was retrospectively queried for all cases of cholecystectomy for biliary pancreatitis at our institution from 2007 to 2017. Patients undergoing chemotherapy, admitted for another cause, or who had severe underlying comorbidities like ventilator dependence were excluded. Patients were stratified into two cohorts: those managed preoperatively by normalization of serum lipase levels versus resolution of abdominal pain. Demographics, serum lipase levels, postoperative complications, cost of stay, readmissions, and return to the emergency department were collected and analyzed using multivariate regression. RESULTS: Seventy-four patients met inclusion: 29 patients had lipase levels trended until normalization compared with 45 patients who had resolution of abdominal pain prior to cholecystectomy. Among the two cohorts there was no statistical difference in age, gender, race, ethnicity, or type of preoperative imaging used. Trended patients were found to have more serum lipase levels tested (8.5 ± 6.2 versus 3.4 ± 2.5, P < 0.0001). The trended lipase cohort was significantly more likely to require preoperative total parenteral nutrition (48% versus 11%, P = 0.007) and consequently a longer time before resuming a diet (10 ± 7.3 versus 4.6 ± 2.4 d, P < 0.0001). When comparing the two groups, we found no significant difference in the duration of surgery, postoperative complications, or readmissions. Lipase trended patients had a significantly longer length of stay compared with nontrended patients (11.5 ± 8.1 versus 4.2 ± 2.3 d, P < 0.0001) and had a higher total cost of stay ($38,094 ± 25,910 versus $20,205 ± 5918, P = 0.0007). CONCLUSIONS: Our data suggest that in children with biliary pancreatitis, proceeding with cholecystectomy after resolution of abdominal pain is equivalent in outcomes to trending serum lipase levels but is more cost-effective with a decreased length of stay and decreased need for preoperative total parenteral nutrition.


Assuntos
Dor Abdominal/diagnóstico , Colecistectomia Laparoscópica/normas , Cálculos Biliares/complicações , Lipase/sangue , Pancreatite/cirurgia , Tempo para o Tratamento/normas , Dor Abdominal/economia , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adolescente , Criança , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/estatística & dados numéricos , Tomada de Decisão Clínica/métodos , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Cálculos Biliares/sangue , Cálculos Biliares/economia , Cálculos Biliares/terapia , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Medição da Dor , Pancreatite/sangue , Pancreatite/economia , Pancreatite/etiologia , Nutrição Parenteral Total/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/economia , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento/economia , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento
18.
J Surg Res ; 252: 96-106, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278975

RESUMO

BACKGROUND: Despite improvements in the diagnosis and care of acute pancreatitis, the mortality, morbidity, and long-term complications of this disease currently account for an annual cost of $10 billion in the United States. Lack of high-quality consolidated clinical data about this ever-increasing national and global burden makes it challenging to be able to recognize at-risk populations and intervene to avoid early readmission (ER) (i.e., readmission within 30 d of hospital discharge or ER). METHODS: We reviewed the National Readmission Database for 2016. We retrieved 25,476 ER out of a total of 188,757 patients admitted with acute pancreatitis (ICD-10 diagnosis of K85), alive at discharge. Patients younger than 18 at the time of initial admission were excluded. Diagnostic characteristics and procedures performed were extracted from ICD-10 data. Based on patient demographics and the diagnostic and procedural profiles from their initial admission, we identified clusters of risk factors for ER using agglomerative hierarchical clustering. These are depicted in a correlation matrix. RESULTS: Acute pancreatitis is associated with a 13.5% overall ER rate. Certain pre-existing chronic diseases, particularly cardiovascular disease diagnoses and interventions at initial presentation increase the odds of ER. In contrast to interventions on the pancreas, interventions on the biliary system correlated with lower odds of ER. Furthermore, the earlier the biliary system intervention was performed during the initial hospitalization, the lower the odds of ER. We identified five clusters of interrelationships: age/comorbidity cluster, cirrhosis cluster, sepsis/pulmonary complication cluster, biliary intervention cluster, and high-risk of mortality cluster. CONCLUSIONS: We identified several potentially modifiable risk factors for ER of patients hospitalized with acute pancreatitis, which included timing of biliary interventions. Furthermore, we identified clusters of interrelationships that further illuminate which complications tend to occur concomitantly and ultimately contribute to ER. By identifying risk factors and elucidating their interactions, we have improved our understanding of this highly morbid disease and offer potential points of intervention to reduce ER.


Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Drenagem/estatística & dados numéricos , Pancreatite/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/cirurgia , Pancreatite/complicações , Pancreatite/diagnóstico , Pancreatite/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
19.
Dtsch Med Wochenschr ; 145(5): 287-295, 2020 03.
Artigo em Alemão | MEDLINE | ID: mdl-32120403

RESUMO

Gallstones develop in the gallbladder or the bile ducts. According to their chemical composition, gallstones can be divided into cholesterol stones, which are common, and the rare bile pigment stones. Altogether, up to 20 % of all adults develop gallstones and more than 20 % of them symptoms or complications. Female sex, age, pregnancy, physical inactivity, obesity, overnutrition and genetic factors such as ABCB4 deficiency of the hepatic lecithin transporter are kown risk factors for gallstone formation. In about one half of all patients biliary symptoms precede the three common and potentially life-threatening complications (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge about the genetics and pathophysiology of gallstones has improved, current treatment algorithms are predominantly invasive (ERC and surgery). Thus, better strategies are needed to prevent the formation of gallstones in general.


Assuntos
Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Cálculos Biliares/terapia , Humanos , Masculino , Obesidade , Gravidez , Fatores de Risco , Comportamento Sedentário
20.
Curr Diabetes Rev ; 16(9): 931-948, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32133965

RESUMO

BACKGROUND: The increasing prevalence of diabetes mellitus worldwide continues to pose a heavy burden. Though its gastrointestinal impact is appropriately recognized, the lesser known associations may be overlooked. OBJECTIVE: We aim to review the negative implications of diabetes on the gallbladder and the biliary tract. METHODS: A MEDLINE® database search of literature was conducted with emphasis on the previous five years, combining keywords such as "diabetes," "gallbladder," and "biliary". RESULTS: The association of diabetes to the formation of gallstones, gallbladder cancer, and cancer of the biliary tract are discussed along with diagnosis and treatment. CONCLUSION: Though we uncover the role of diabetic neuropathy in gallbladder and biliary complications, the specific individual diabetic risk factors behind these developments is unclear. Also, in addition to diabetes control and surgical gallbladder management, the treatment approach also requires further focus.


Assuntos
Neoplasias do Sistema Biliar , Diabetes Mellitus , Neuropatias Diabéticas , Cálculos Biliares , Diabetes Mellitus/epidemiologia , Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Humanos , Fatores de Risco
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