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1.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 101-108, 20210000.
Artigo em Espanhol | LILACS | ID: biblio-1178954

RESUMO

La litiasis vesicular sintomática puede presentarse asociada a litiasis de la vía biliar principal, siendo necesaria la utilización de medios diagnósticos adecuados para su posterior tratamiento. En este trabajo, se sugiere la evaluación mediante las guías de la Sociedad Americana para Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy ASGE), usando factores como la edad, pruebas hepáticas y hallazgos ecográficos, categorizando a los pacientes en baja, intermedia y alta probabilidad de coledocolitiasis. Estudio de diseño retrospectivo, observacional, descriptivo, de corte transversal, con un muestreo no probabilístico de casos consecutivos, sobre pacientes con diagnóstico de litiasis vesicular sintomática y sospecha de litiasis de la via biliar principal internados en la II Cátedra de Clínica Quirúrgica, del Hospital de Clínicas de San Lorenzo, entre los años 2017 a 2019. Con los siguientes resultados, de un total de 339 pacientes con diagnóstico de litiasis vesicular sintomática, el 6,64% tuvo el diagnóstico de coledocolitiasis asociada. En cuanto a los predictores muy fuertes de coledocolitiasis el más frecuentemente (68,6%,) encontrado fue el nivel de la bilirrubina total ≥ 4mg/dl; de los predictores fuertes el 70,6% presentaba la vía biliar principal dilatada; de los predictores moderados, el 84,3% presentó las enzimas hepáticas alteradas. En conclusión, se pudo identificar que la mayoría de los pacientes presentó alta probabilidad de coledocolitiasis y la conducta tomada fue realizar en primer lugar una colangiografía retrógrada endoscópica, con fines terapéuticos y luego colecistectomía, correspondiente al manejo correcto establecido por las guías actuales internacionales.


Symptomatic gallstones can occur associated with lithiasis of the main bile duct, requiring the use of adequate diagnostic tools for subsequent treatment. In this paper, we suggest using the guidelines of the American Society for Gastrointestinal Endoscopy (ASGE), that uses factors such as age, liver tests, and ultrasound findings, categorizing patients as those with low, intermediate, and high probability. of choledocholithiasis. A Retrospective, observational, descriptive, cross-sectional design study, with a non-probabilistic sampling of consecutive cases, on patients with a diagnosis of symptomatic gallstones and suspected stones of the main bile duct admitted to the the 2nd Surgical Department and Service of Clinica´s Hospital of San Lorenzo, between the years 2017 to 2019. With the following results; of a total of 339 patients with the diagnosis of symptomatic gallstones, 6.64% had associated choledocholithiasis. Regarding the very strong predictors of choledocholithiasis, the most frequent (68.6%) was the total bilirubin level ≥ 4mg / dl; 70.6% had a dilated main bile duct as a strong predictor; as a moderate predictor, 84.3% had altered liver enzymes. In conclusion, it was possible to identify that most of the patients presented a high probability of choledocholithiasis and the action taken was to first perform an endoscopic retrograde cholangiography, for therapeutic purposes, and then cholecystectomy, corresponding to the correct management established by current international guidelines.


Assuntos
Ductos Biliares , Bilirrubina , Colangiografia , Colecistectomia , Cálculos Biliares , Litíase , Fígado , Amostragem , Endoscopia Gastrointestinal , Endoscopia
2.
BMJ Case Rep ; 14(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846177

RESUMO

The current management of persistent biliary fistula includes biliary stenting and peritoneal drainage. Endoscopic retrograde cholangiopancreatography (ERCP) is preferred over percutaneous techniques and surgery. However, in patients with modified gastric anatomy, ERCP may not be feasible without added morbidity. We describe a 37-year-old woman with traumatic biliary fistula, large volume choleperitonitis and abdominal compartment syndrome following a motor vehicle collision who was treated with laparoscopic drainage, lavage and biliary drain placement via percutaneous transhepatic cholangiography.


Assuntos
Fístula Biliar , Derivação Gástrica , Adulto , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Drenagem , Feminino , Derivação Gástrica/efeitos adversos , Humanos
3.
BMJ Case Rep ; 14(3)2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33785604

RESUMO

A 78 year-old female status post subarachnoid haemorrhage developed abdominal pain and obstructive jaundice. CT scan showed acute cholecystitis and dilation of the intrahepatic ducts. Endoscopic retrograde cholangiography revealed hepatic duct stenosis due to compression by an enlarged gallbladder. No stones were seen in the common hepatic duct and the cystic duct was patent. An endoscopic retrograde biliary drain was placed to relieve the obstructive jaundice due to acute acalculous cholecystitis. Percutaneous transhepatic drainage was performed to treat the acute acalculous cholecystitis. Hepatic duct stenosis was improved on endoscopic retrograde cholangiography performed 19 days after percutaneous transhepatic drainage. It may be reasonable to treat 'Mirizzi-like syndrome' non-operatively.


Assuntos
Colecistite Acalculosa , Colecistite Aguda , Icterícia Obstrutiva , Colecistite Acalculosa/complicações , Colecistite Acalculosa/diagnóstico por imagem , Colecistite Acalculosa/cirurgia , Idoso , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colecistite Aguda/complicações , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Feminino , Ducto Hepático Comum , Humanos , Icterícia Obstrutiva/etiologia
4.
ACS Nano ; 15(3): 5011-5022, 2021 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-33706510

RESUMO

Iatrogenic extrahepatic bile duct injury remains a dreaded complication while performing cholecystectomy. Although X-ray based cholangiography could reduce the incidence of biliary tract injuries, the deficiencies including radiation damage and expertise dependence hamper its further clinical application. The effective strategy for intraoperative cholangiography is still urgently required. Herein, a fluorescence-based imaging approach for cholangiography in the near-infrared IIb window (1500-1700 nm) using TT3-oCB, a bright aggregation-induced emission luminogen with large π-conjugated planar unit, is reported. In phantom studies, TT3-oCB nanoparticles exhibit high near-infrared IIb emission and show better image clarity at varying penetrating depths. When intrabiliary injected into the gallbladder or the common bile duct of the rabbit, TT3-oCB nanoparticles enable the real-time imaging of the biliary structure with deep penetrating capability and high signal-to-background ratio. Moreover, the tiny iatrogenic biliary injuries and the gallstones in established disease models could be precisely diagnosed by TT3-oCB nanoparticle assisted near-infrared IIb imaging. In summary, we reported a feasible application for aggregation-induced emission dots as biliary contrast agent and realized high-quality cholangiography in the near-infrared IIb window with precise diagnostic ability and nonradioactive damage, which could possibly be applied for intraoperative diagnosis.


Assuntos
Colecistectomia Laparoscópica , Animais , Colangiografia , Meios de Contraste , Imagem Óptica , Coelhos , Radiografia
5.
J Postgrad Med ; 67(1): 43-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533751

RESUMO

Immune-checkpoint inhibitor mediated hepatobiliary injury is an emerging concern in cancer treatment. Most of these adverse reactions are attributed to nivolumab and are characterized by panlobular hepatitis. Large duct cholangiopathy related to these drugs is extremely rare. We present a case of adenocarcinoma of lung treated with pembrolizumab who developed biochemical and imaging features consistent with cholangiopathy characterized by common bile duct dilatation, wall enhancement, and gallbladder wall edema. On follow-up in the fourth month, the imaging features persisted despite the normalization of liver enzymes. To the best of our knowledge, this is the first description of diagnosis and follow-up imaging of pembrolizumab-related cholangiopathy in imaging literature.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Doença Hepática Crônica Induzida por Substâncias e Drogas , Doenças do Sistema Digestório/patologia , Adenocarcinoma de Pulmão/tratamento farmacológico , Colangiografia , Ducto Colédoco , Doenças do Sistema Digestório/induzido quimicamente , Humanos , Neoplasias Pulmonares/tratamento farmacológico
6.
Br J Radiol ; 94(1120): 20200879, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33529044

RESUMO

Hemorrhagic complications are uncommon after percutaneous transhepatic biliary drainage. The presenting features include bleeding through or around the drainage catheter, hematemesis or melena. Diagnosis requires cholangiography, CT angiography or conventional angiography. Minor venous hemorrhage is managed by catheter repositioning, clamping or upgrading to a larger bore catheter. Major vascular injuries require percutaneous or endovascular procedures like embolization or stenting. A complete knowledge of these complications will direct the interventional radiologist to take adequate precautions to reduce their incidence and necessary steps in their management. This review presents and discusses various hemorrhagic complications occurring after percutaneous transhepatic biliary drainage along with their treatment options and suggests a detailed algorithm.


Assuntos
Cateterismo/efeitos adversos , Colestase/terapia , Drenagem/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Radiologia Intervencionista/educação , Angiografia , Ductos Biliares/diagnóstico por imagem , Cateterismo/métodos , Colangiografia , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Drenagem/métodos , Fluoroscopia , Hemorragia/etiologia , Humanos , Internato e Residência , Punções , Radiologia Intervencionista/métodos , Ultrassonografia
7.
Gan To Kagaku Ryoho ; 48(2): 181-185, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597354

RESUMO

In hepatobiliary surgery, intraoperative fluorescence imaging can be used for real-time identification of the extrahepatic bile ducts (fluorescence cholangiography), liver cancers, and hepatic segmental boundaries, based on biliary excretion as well as fluorescence property of indocyanine green(ICG). These techniques have mainly been developed in Japan and currently become used worldwide, with the advancement and spread of near-infrared imaging systems for open and laparoscopic surgery. It can be expected that novel photodynamic therapy for liver cancers is developed by applying accumulation of biliary excreted agents like ICG in the cancer tissues not only to intraoperative imaging but also to active treatments.


Assuntos
Colecistectomia Laparoscópica , Neoplasias Hepáticas , Colangiografia , Humanos , Verde de Indocianina , Japão , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Imagem Óptica
8.
Surgery ; 169(4): 859-867, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33478756

RESUMO

BACKGROUND: Bile duct injury and conversion-to-open-surgery rates remain unacceptably high during laparoscopic and robotic cholecystectomy. In a recently published randomized clinical trial, using near-infrared fluorescent cholangiography with indocyanine green intraoperatively markedly enhanced biliary-structure visualization. Our systematic literature review compares bile duct injury and conversion-to-open-surgery rates in patients undergoing laparoscopic or robotic cholecystectomy with versus without near-infrared fluorescent cholangiography. METHODS: A thorough PubMed search was conducted to identify randomized clinical trials and nonrandomized clinical trials with ≥100 patients. Because all near-infrared fluorescent cholangiography studies were published since 2013, only studies without near-infrared fluorescent cholangiography published since 2013 were included for comparison. Incidence estimates, weighted and unweighted for study size, were adjusted for acute versus chronic cholecystitis, and for robotic versus laparoscopic cholecystectomy and are reported as events/10,000 patients. All studies were assessed for bias risk and high-risk studies excluded. RESULTS: In total, 4,990 abstracts were reviewed, identifying 5 near-infrared fluorescent cholangiography studies (3 laparoscopic cholecystectomy/2 robotic cholecystectomy; n = 1,603) and 11 not near-infrared fluorescent cholangiography studies (5 laparoscopic cholecystectomy/4 robotic cholecystectomy/2 both; n = 5,070) for analysis. Overall weighted rates for bile duct injury and conversion were 6 and 16/10,000 in near-infrared fluorescent cholangiography patients versus 25 and 271/10,000 in patients without near-infrared fluorescent cholangiography. Among patients undergoing laparoscopic cholecystectomy, bile duct injuries, and conversion rates among near-infrared fluorescent cholangiography versus patients without near-infrared fluorescent cholangiography were 0 and 23/10,000 versus 32 and 255/10,000, respectively. Bile duct injury rates were low with robotic cholecystectomy with and without near-infrared fluorescent cholangiography (12 and 8/10,000), but there was a marked reduction in conversions with near-infrared fluorescent cholangiography (12 vs 322/10,000). CONCLUSION: Although large comparative trials remain necessary, preliminary analysis suggests that using near-infrared fluorescent cholangiography with indocyanine green intraoperatively sizably decreases bile duct injury and conversion-to-open-surgery rates relative to cholecystectomy under white light alone.


Assuntos
Doenças dos Ductos Biliares/etiologia , Colangiografia , Colecistectomia Laparoscópica , Colecistectomia/métodos , Conversão para Cirurgia Aberta , Verde de Indocianina , Procedimentos Cirúrgicos Robóticos , Doenças dos Ductos Biliares/epidemiologia , Colangiografia/efeitos adversos , Colangiografia/métodos , Colecistectomia/efeitos adversos , Colecistectomia Laparoscópica/métodos , Ensaios Clínicos como Assunto , Humanos , Incidência , Viés de Publicação , Procedimentos Cirúrgicos Robóticos/métodos
9.
Eur J Radiol ; 136: 109515, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33429209

RESUMO

PURPOSE: To compare the quality of images obtained by T1-weighted hepatobiliary MR cholangiography using Gd-EOB-DTPA with 1-mm isovoxel acquisition and compressed sensing (T1-MRCCS) or parallel imaging (T1-MRCPI) for assessment of biliary tree anatomy. METHOD: We prospectively reviewed T1-MRCCS, T1-MRCPI, and respiratory-triggered 3D T2-weighted MR cholangiography (T2-MRC) images in 58 patients. Two radiologists independently assessed the three sets of images and scored the biliary tree visualization and overall image quality in all cases using a 5-point Likert scale. The resulting scores were compared among T1-MRCCS, T1-MRCPI, and T2-MRC images using a Friedman test followed by a Scheffe test. The inter-reader agreement in scoring was assessed using κ statistics. RESULTS: The image quality scores for the gallbladder on both T1-MRCCS and T1-MRCPI were significantly lower than those on T2-MRC (p < 0.01) for both readers. Meanwhile, the image quality scores for the right and left hepatic ducts and the anterior and posterior branches of the right hepatic duct on both T1-MRCCS and T1-MRCPI were significantly higher than those on T2-MRC (p < 0.05) for both readers. For Reader 2, the overall image quality scores on T1-MRCCS and T1-MRCPI were both significantly higher than those on T2-MRC (p < 0.05). There were no significant differences between the image quality scores on T1-MRCCS and T1-MRCPI for visualization of each bile duct (p < 0.05). CONCLUSIONS: There may be no significant difference in quality between T1-MRCCS images and T1-MRCPI images for assessment of biliary tree anatomy, and both types of images may be better than T2-MRC images, although clinical indication is limited compared with T2-MRC.


Assuntos
Sistema Biliar , Meios de Contraste , Sistema Biliar/diagnóstico por imagem , Colangiografia , Colangiopancreatografia por Ressonância Magnética , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos
11.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370986

RESUMO

Cholangiocarcinomas are rare and often diagnosed late. Clear cell histology is a rare variant of such cancers. We report one such case of a man in his late 60s, with a history of excess alcohol intake, who was found to have deranged liver biochemical tests incidentally during an admission for an allergic reaction. Subsequent imaging to investigate this suggested a diagnosis of perihilar cholangiocarcinoma (ultrasound, CT, MRI, cholangiogram). Biopsy confirmed this to be of clear cell type on histology and immunohistochemistry. Diagnosis and further management of this rare entity was conducted in multidisciplinary meetings with the regional hepatobiliary centre. The patient was deemed unsuitable for surgical resection, underwent chemotherapy but died 1 year later.


Assuntos
Adenocarcinoma de Células Claras/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Ducto Hepático Comum/patologia , Tumor de Klatskin/diagnóstico , Cuidados Paliativos/métodos , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/terapia , Biópsia , Colangiografia , Colangiopancreatografia por Ressonância Magnética , Cisplatino/uso terapêutico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Imagem de Difusão por Ressonância Magnética , Evolução Fatal , Ducto Hepático Comum/diagnóstico por imagem , Humanos , Tumor de Klatskin/patologia , Tumor de Klatskin/terapia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
12.
J Int Med Res ; 48(12): 300060520979224, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33334212

RESUMO

OBJECTIVE: Near-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy. METHODS: Consecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed. RESULTS: Laparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m2. CONCLUSIONS: NIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.


Assuntos
Colangiografia , Colecistectomia Laparoscópica , Verde de Indocianina , Adulto , Corantes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Rev. cuba. invest. bioméd ; 39(4): e735, oct.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156450

RESUMO

Introducción: La estenosis de la vía biliar es una afección poco frecuente, pero con serias repercusiones en la morbilidad de los pacientes. La gran mayoría ocurre después de la cirugía hepatobiliar: la colecistectomía es la más común de estas cirugías. El reconocimiento temprano y el enfoque multidisciplinario adecuado es la piedra angular para lograr obtener resultados finales óptimos. Objetivo: Describir el tratamiento endoscópico de los pacientes con estenosis poscolescistectomía atendidos en el Instituto de Gastroenterología (Cuba). Métodos: Se realizó un estudio retrospectivo descriptivo de los pacientes con diagnóstico de estenosis biliar poscolescitectomía. Se determinaron variables sociodemográficas, clínicas y endoscópicas de interés. Resultados: Se estudiaron 16 pacientes. Predominaron las mujeres menores de 50 años. El 75 por ciento de los pacientes tenían antecedente de colecistectomía laparoscópica. Las estenosis biliares tipo I y III, según la clasificación de Bismuth, fueron las más usuales. El tratamiento endoscópico mediante colangiografía retrógrada endoscópica (CPRE) con colocación de múltiples prótesis plásticas fue la conducta terapéutica más empleada. Conclusiones: En las estenosis poscolescitectomía los procedimientos endoscópicos se han convertido en el tratamiento de elección, como un procedimiento menos invasivo, con baja morbilidad y mortalidad, con evidentes resultados comparables a los logrados con procedimientos quirúrgicos no endoscópicos(AU)


Introduction: Bile duct stenosis is an infrequent condition, but it seriously affects patient morbidity. The vast majority of cases occur after hepatobiliary surgery, cholecystectomy being the most common of such surgeries. Early recognition and an appropriate multidisciplinary approach are the cornerstones to achieve optimal final results. Objective: Describe the endoscopic treatment of patients with postcholecystectomy stenosis cared for at the Institute of Gastroenterology in Cuba. Methods: A retrospective descriptive study was conducted of the patients diagnosed with postcholecystectomy bile duct stenosis. Determination was made of sociodemographic, clinical and endoscopic variables of interest. Results: A total 16 patients were studied. There was a predominance of women aged under 50 years. 75 percent of the patients had a history of laparoscopic cholecystectomy. The most common bile duct stenoses were types I and III by Bismuth's classification. The most frequent therapeutic management was endoscopic treatment by endoscopic retrograde cholangiography (ERCP) with placement of multiple plastic prostheses. Conclusions: Endoscopic procedures have become the treatment of choice in postcholecystectomy stenosis. They are less invasive, their morbidity and mortality are low, and their results are comparable to those of non-endoscopic surgical procedures(AU)


Assuntos
Humanos , Colangiografia/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Próteses e Implantes , Epidemiologia Descritiva , Estudos Retrospectivos , Constrição Patológica
14.
World J Gastroenterol ; 26(46): 7312-7324, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33362386

RESUMO

BACKGROUND: Extrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions. AIM: To evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs. METHODS: Eight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair. RESULTS: The median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography. CONCLUSION: This approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.


Assuntos
Ductos Biliares Extra-Hepáticos , Procedimentos Cirúrgicos do Sistema Biliar , Procedimentos Cirúrgicos Reconstrutivos , Animais , Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/cirurgia , Colangiografia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Suínos
16.
Arch. argent. pediatr ; 118(5): e476-e479, oct 2020. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1122530

RESUMO

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gamma-glutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea


Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a two-year-old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.


Assuntos
Humanos , Pré-Escolar , Ascaríase/diagnóstico por imagem , Ductos Biliares , Doenças Parasitárias , Ascaríase/terapia , Colangiografia , Colangite
17.
Rev. esp. enferm. dig ; 112(10): 788-791, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-201205

RESUMO

La enfermedad inflamatoria intestinal (EII) se relaciona con distintas manifestaciones hepáticas como compromiso extraintestinal; la colangitis esclerosante primaria (CEP) es la más frecuente de ellas. Durante su evolución, pueden desarrollarse otras hepatopatías autoinmunes en lo que se conoce como síndrome de superposición (SS), entidad de menor asociación a EII que se presenta en forma concomitante o durante su evolución, lo cual se conoce como SS secuencial. Reportamos tres casos de SS secuencial en los cuales la hepatitis autoinmune es la primera manifestación, que tras 7-19 años de evolución desarrollaron una CEP y posteriormente una EII. Las manifestaciones extraintestinales hepáticas pueden preceder en varios años a la EII, por lo que es importante conocer esta asociación


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Doenças do Tecido Conjuntivo Indiferenciado/etiologia , Doenças Inflamatórias Intestinais/complicações , Fígado/fisiopatologia , Hepatopatias/etiologia , Doenças do Tecido Conjuntivo Indiferenciado/terapia , Doenças Inflamatórias Intestinais/terapia , Biópsia , Colo/patologia , Colite Ulcerativa/diagnóstico , Colangiografia , Constrição Patológica/diagnóstico por imagem
19.
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
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