Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 432
Filtrar
1.
BMC Gastroenterol ; 19(1): 177, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699035

RESUMO

BACKGROUND: Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies. CASE PRESENTATION: We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world's first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis. CONCLUSION: The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.


Assuntos
Coledocolitíase , Ducto Colédoco , Corpos Estranhos , Migração de Corpo Estranho , Laparoscopia/métodos , Idoso , Coledocolitíase/sangue , Coledocolitíase/diagnóstico , Coledocolitíase/etiologia , Coledocolitíase/cirurgia , Coledocostomia/efeitos adversos , Coledocostomia/métodos , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
5.
Dig Dis Sci ; 64(11): 3321-3327, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31175495

RESUMO

BACKGROUND AND AIMS: EUS-guided biliary drainage has emerged as a technique to enable endobiliary drainage in failed ERCP. A newer model, lumen-apposing metal stents (LAMS), with a cautery-enhanced delivery system became available in the USA in late 2015. This cautery-tipped version may facilitate EUS-guided choledochoduodenostomy (EUS-CD), but data using this model are lacking. METHODS: We reviewed outcomes of attempted EUS-CD using cautery-enhanced LAMS from 6, US centers. The following data were collected: patient and procedure details, technical success, adverse events, clinical success (resolution of jaundice or improvement in bilirubin > 50%), and biliary re-interventions. RESULTS: EUS-CD was attempted in 67 patients (mean age 68.8) with malignant obstruction after failed ERCP between September 2015 and April 2018. EUS-CD was technically successful in 64 (95.5%). A plastic or metal stent was inserted through the lumen of the deployed LAMS in 50 of 64 (78.1%) patients to maintain a non-perpendicular LAMS axis into the bile duct. Adverse events occurred in 4 (6.3%) and included: abdominal pain (n = 2), peritonitis that responded to antibiotics (n = 1), and bleeding requiring transfusion (n = 1). Among 40 patients with follow-up of > 4 weeks, clinical success was achieved in 100%. Biliary re-interventions for obstruction were needed in 7(17.5%), in 3 of 6 (50.0%) that underwent EUS-CD with LAMS alone versus 4 of 34 (5%) with LAMS plus an axis-orienting stent (p = 0.02). CONCLUSION: EUS-CD using LAMS with cautery-enhanced delivery systems has high technical and clinical success rates, with a low rate of adverse events. Inserting an axis-orienting stent through the lumen of the LAMS may reduce the need for biliary re-interventions.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Duodeno/cirurgia , Eletrocoagulação/métodos , Stents , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Colestase/diagnóstico por imagem , Colestase/epidemiologia , Duodeno/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
6.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229969

RESUMO

A 35-year-old man presented to a regional hospital after being kicked by a horse in the right upper quadrant. He was transferred to our hepatobiliary unit with bile peritonitis 8 days post trauma. Laparoscopic cholecystectomy and intraoperative cholangiography were performed, demonstrating distal common bile duct (CBD) obstruction with contrast extravasation from the distal duct. The CBD was drained with a T-tube via laparotomy. On postoperative day 14, T-tube cholangiography demonstrated no extravasation of contrast from the distal CBD and minor stricturing with eventual duodenal drainage. The T-tube was clamped and 5 weeks later, the patient represented with peri-T-tube bile leakage and right upper quadrant pain. A T-tube cholangiogram confirmed a complex distal CBD stricture. Two attempts at ERCP with intent of stenting the stricture were unsuccessful. The patient underwent an end to side Roux-en-Y choledochojejunostomy and was discharged home 4 days postoperatively on simple analgesia.


Assuntos
Ductos Biliares Extra-Hepáticos/lesões , Coledocostomia/métodos , Drenagem/métodos , Peritonite/patologia , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/terapia , Adulto , Animais , Comportamento Animal , Ductos Biliares Extra-Hepáticos/fisiopatologia , Colecistectomia Laparoscópica , Casco e Garras , Cavalos , Humanos , Laparoscopia , Masculino , Peritonite/terapia , Resultado do Tratamento
8.
J Robot Surg ; 13(6): 713-716, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30989618

RESUMO

Benign bile duct stricture poses a significant challenge for gastroenterologists and general surgeons due to the inherent nature of the disease, difficulty in sustaining long-term solutions and fear of pitfalls in performing biliary tract operations. Operative management with an open biliary bypass is mainly reserved for patients who have failed multiple attempts of endoscopic and percutaneous treatments. However, recent advances in minimally invasive technology, notably in the form of the robotics, have provided a new approach to tackling biliary disease. In this technical report, we describe our standardized method of robotic choledochoduodenostomy in a 59-year-old woman with history of Roux-en-Y gastric bypass who presents with benign distal common bile duct stricture following failure of non-operative management. Key steps in this approach involved adequate duodenal Kocherization, robotic portal dissection and creation of a side-to-side choledochoduodenal anastomosis. The operative time was 200 min with no intraoperative complications and estimated blood loss was less than 50 mL. No abdominal drains were placed. The patient was discharged home on postoperative day 1 tolerating regular diet and able to resume her usual activities within 1 week of her operation. A video is attached to this report.


Assuntos
Coledocostomia , Doenças do Ducto Colédoco/cirurgia , Duodenostomia , Procedimentos Cirúrgicos Robóticos , Anastomose em-Y de Roux , Coledocostomia/efeitos adversos , Coledocostomia/métodos , Constrição Patológica , Duodenostomia/efeitos adversos , Duodenostomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos
9.
World J Gastroenterol ; 25(13): 1531-1549, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30983814

RESUMO

Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.


Assuntos
Coledocolitíase/cirurgia , Coledocostomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Colangiografia , Coledocolitíase/diagnóstico por imagem , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Coledocostomia/normas , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/normas , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Técnicas de Sutura/normas , Resultado do Tratamento
11.
J Ayub Med Coll Abbottabad ; 31(1): 86-89, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30868791

RESUMO

BACKGROUND: Present era of endoscopic and laparoscopic approaches have revolutionized surgical management of Common Bile Duct (CBD) stones. Open procedures like Choledochoduodenostomy (CDD) have become a rarity but are not completely obsolete. It may be considered a relatively safe alternative when dealing with recurrent, too large or impacted stones, a failed ERCP, and CBD stricture with stones. The aim of this study was to establish safety, efficiency, cost effectiveness and easy availability of CDD in selected patients. METHODS: In this observational study, the outcome of 90 consecutive patients undergoing CDD between 1st January 1995 and 31st Dec, 2016 in surgical unit C, Ayub Medical Complex, Abbottabad was reviewed. Choledochoduodenostomy was offered to patients who refused or had a failed ERCP and when CBD size was more than 1cm. Common Bile Duct was anastomosed to Duodenum using standard technique. RESULTS: Medical records of 90 patients (age range 34-96 years) were reviewed; 5 were excluded and 85 were included in the study. Complication rate was 31.76% (n=27) including respiratory complications in 16.47% (n=14), wound infection in 10.6% (n=9), anastomotic leak in 2.35% (n=2) and Cholangitis in 1.18% (n=1) and Mortality in 1.18% (n=1). There was no evidence of Sump Syndrome. Total cost of procedure was Rs.50 as admission fee, which included daily provision of food and there were no room charges. CONCLUSIONS: Choledochoduodenostomy is a safe procedure, with fewer complications and significantly low cost. In case of ERCP failure, CDD is recommended.


Assuntos
Coledocostomia , Ducto Colédoco/cirurgia , Duodeno/cirurgia , Cálculos Biliares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Coledocostomia/efeitos adversos , Coledocostomia/métodos , Coledocostomia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento
13.
J Gastrointestin Liver Dis ; 28(1): 125-128, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851182

RESUMO

We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred. All patients underwent PPPD with a technical success rate of 100%. The presence of a transduodenal LAMS did not impede surgery. No biliary or duodenal fistula occurred in the patients. Pancreatic fistulas with late bleeding were observed in two patients (one fatal). These few cases indicate that PPPD after EUS-CD using LAMS is feasible and safe. EUS-CD should be performed irrespective of the stage of the disease, also for patients fit for surgery. Additional larger prospective studies are required to confirm this preliminary data, in particular for possible interference with postoperative outcomes.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Neoplasias do Sistema Digestório/cirurgia , Drenagem/métodos , Duodenostomia/métodos , Endossonografia/métodos , Cuidados Paliativos/métodos , Pancreaticoduodenectomia , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Coledocostomia/instrumentação , Colestase/diagnóstico por imagem , Colestase/etiologia , Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/diagnóstico por imagem , Drenagem/instrumentação , Duodenostomia/instrumentação , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
14.
United European Gastroenterol J ; 7(1): 60-68, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30788117

RESUMO

Background: Success and event rates of endoscopic ultrasound (EUS)-guided biliary drainage vary with techniques, and results from different studies remain inconsistent. Objective: We conducted a proportion meta-analysis to evaluate the efficacy and safety of EUS-guided biliary drainage and compare the outcomes of current procedures. Methods: We searched MEDLINE, Embase, Cochrane and Web of knowledge to identify studies reporting technical success, clinical success and complication rates of EUS-guided biliary drainage techniques to estimate their clinical and technical efficacy and safety. Results: We identified 17 studies including a total of 686 patients. The overall clinical success and technical success rates were respectively 84% confidence interval (CI) 95% (80-88) and 96% CI 95% (93-98) for hepaticogastrostomy, and respectively 87% CI 95% (82-91) and 95% CI 95 (91-97) for choledochoduodenostomy. Reported adverse event rates were significantly higher (p = 0.01) for hepaticogastrostomy (29% CI 95% (24-34)) compared to choledochoduodenostomy (20% CI 95% (16-25)). Compared with hepaticogastrostomy, the pooled odds ratio for the complication rate of choledochoduodenostomy was 2.01 (1.25; 3.24) (p = 0.0042), suggesting that choledochoduodenostomy might be safer than hepaticogastrostomy. Conclusion: The available literature suggests choledochoduodenostomy may be a safer approach compared to hepaticogastrostomy. Randomized controlled trials with sufficiently large cohorts are needed to compare techniques and confirm these findings.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Drenagem , Cirurgia Assistida por Computador , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomia/métodos , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Hepatectomia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Stents , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos
16.
Transplant Proc ; 51(1): 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30736977

RESUMO

BACKGROUND AND AIMS: T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT. METHODS: Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs). RESULTS: In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement. CONCLUSIONS: We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.


Assuntos
Coledocostomia/instrumentação , Transplante de Fígado/instrumentação , Adulto , Coledocostomia/métodos , Feminino , Humanos , Incidência , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Gastrointest Endosc ; 89(1): 69-76, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189198

RESUMO

BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) has recently been reported as an alternative treatment approach for patients with malignant obstructive jaundice and failed ERCP. We analyzed the safety and technical and clinical efficacy of EUS-CD using LAMSs in patients with malignant obstructive jaundice. METHODS: This was a retrospective study of consecutive patients with inoperable malignant distal bile duct obstruction who underwent EUS-CD using an electrocautery-enhanced (EC)-LAMS over a 3-year period (2015-2018). The main outcome measures were technical and clinical success (defined as a decline in serum bilirubin level by 50% at 2-week follow-up). Secondary outcomes were occurrence of adverse events, procedure time, and stent patency. RESULTS: Forty-six patients (47.8% women; median age, 73.1 ± 12.6 years) underwent direct EUS-CD using the biliary EC-LAMS. The procedure was technically successful in 43 patients (93.5%). The rate of clinical success was 97.7%. Adverse events occurred in 5 (11.6%) patients and included the following: 1 fatal bleeding 17 days after stent placement, 3 episodes of stent occlusion (food impaction), and 1 spontaneous migration (all 4 requiring reintervention). The mean follow-up was 114.37 days (95% confidence interval, 73.2-155.4). CONCLUSIONS: EUS-CD using the EC-LAMS is effective. The rate of adverse events including one fatal event is not negligible and should be carefully considered before using the stent in this clinical setting. Prospective studies are required to validate our preliminary findings to fully assess the long-term efficacy and safety of the stent.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Ducto Colédoco/cirurgia , Stents Metálicos Autoexpansíveis , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática , Neoplasias dos Ductos Biliares/complicações , Colangiocarcinoma/complicações , Colangiopancreatografia Retrógrada Endoscópica , Colestase/etiologia , Neoplasias do Ducto Colédoco/complicações , Neoplasias Duodenais/complicações , Eletrocoagulação , Endossonografia , Feminino , Humanos , Icterícia Obstrutiva , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Hemorragia Pós-Operatória/epidemiologia , Falha de Prótese , Estudos Retrospectivos , Stents , Cirurgia Assistida por Computador , Falha de Tratamento , Resultado do Tratamento
18.
Rev Esp Enferm Dig ; 111(1): 74-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30421959

RESUMO

Sump syndrome (SS) is associated with choledocho-duodenostomy (CDD) dysfunction, which occurs due to accumulation of detritus, biliary mud and food remains in the suprapapillary distal common bile duct. The prevalence is low after CDD. Currently, biliary drainage endoscopic ultrasound (EUS)-guided with a lumen-apposing metal stent (LAMS) is a new minimally invasive alternative for biliary stenosis for patients in whom endoscopy retrograde cholangial-pancreatography (ERCP) is not feasible. CDD via EUS-guided LAMS is increasing. Thus, SS has become a potential associated complication that was previously unreported in the literature.


Assuntos
Coledocostomia/efeitos adversos , Endossonografia/efeitos adversos , Síndrome Pós-Colecistectomia/etiologia , Stents/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Coledocostomia/métodos , Colestase/terapia , Humanos , Masculino , Pessoa de Meia-Idade
19.
Endoscopy ; 51(6): 540-547, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30347424

RESUMO

BACKGROUND: Endoscopic ultrasound-guided biliary drainage is an alternative to percutaneous biliary drainage in cases of malignant biliary obstruction and failure of classic endoscopic drainage by endoscopic retrograde cholangiopancreatography (ERCP). Recently, a new electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) that allows for endoscopic anastomosis (apposition stent) has become available for use in EUS-choledochoduodenostomy (EUS-CDS) and facilitates the procedure. METHODS: This was a retrospective study of all EUS-CDS procedures performed in France between April 2016 and August 2017. The primary end point was the technical and clinical success rates of EUS-CDS using an ECE-LAMS. RESULTS: 52 consecutive patients were included in the study. The etiology of distal bile duct obstruction was distal pancreatic adenocarcinoma in 43 patients (82.7 %). The technical success rate was 88.5 % (46 /52 patients), and the clinical success rate was 100 % (46/46 patients). The mean duration of the procedure was 10.2 minutes (range 1 - 90). Two patients (3.8 %) presented with short-term complications after EUS-CDS and before discharge from hospital. In univariate analyses, a small diameter of the common bile duct and not following the recommended procedure technique were significant risk factors for technical failure. Over a mean follow-up of 157 days, the median survival time without biliary complications was 135 days. CONCLUSION: EUS-CDS with an ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct and could be proposed as the first option in cases of ERCP failure.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Eletrocoagulação , Endoscopia do Sistema Digestório/métodos , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Colestase/etiologia , Drenagem/métodos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Punções , Estudos Retrospectivos , Stents
20.
Medicine (Baltimore) ; 97(39): e12411, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30278516

RESUMO

RATIONALE: The clinical manifestations of VACTERL association include vertebral anomalies, anal atresia, congenital heart diseases, tracheoesophageal fistula, renal dysplasia, and limb abnormalities. The association of intrahepatic anomalies and VACTERL syndrome is a rare coincidence. VACTER syndrome and intrahepatic bile drainage anomalies might be genetically related. PATIENT CONCERNS: A 12-year-old girl presented with episodic colicky abdominal pain, nausea, and vomiting for several years. The individual episodes resolved spontaneously within a few days. She had a history of VACTERL syndrome, including a butterfly shape of the L3 vertebra, anal atresia, and an atrial septal defect. DIAGNOSES: On laboratory findings, abnormal liver function tests included elevated total bilirubin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase. There was no significant abnormal finding in hepatobiliary system sonography except mild gallbladder wall thickening. We performed magnetic resonance cholangiopancreatography and demonstrated an abnormal intrahepatic bile duct confluence, which showed 3 bile ducts draining directly into the neck of the gallbladder. INTERVENTION: Her symptoms related to bile reflux during gallbladder contraction. Cholecystectomy with choledochojejunostomy was undertaken because segments of the bile drainage were intertwined. OUTCOMES: After surgery, her symptoms decreased, but abdominal discomfort remained due to uncorrected left intrahepatic anomalies. LESSONS: Although hepatobiliary anomalies are not included in VACTERL association diagnostic criteria, detailed hepatobiliary work up is needed when gastrointestinal symptoms are present in VACTERL association patients.


Assuntos
Canal Anal/anormalidades , Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/anormalidades , Esôfago/anormalidades , Cardiopatias Congênitas/diagnóstico , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico , Coluna Vertebral/anormalidades , Traqueia/anormalidades , Doenças dos Ductos Biliares/complicações , Doenças dos Ductos Biliares/cirurgia , Criança , Colangiopancreatografia por Ressonância Magnética/métodos , Colecistectomia/métodos , Coledocostomia/métodos , Feminino , Cardiopatias Congênitas/complicações , Humanos , Deformidades Congênitas dos Membros/complicações , Testes de Função Hepática
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA