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1.
Radiologe ; 61(5): 497-510, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33860818

RESUMO

The acute abdomen is characterized by acute abdominal pain with defensive muscular tension, can be triggered by a variety of diseases and sometimes represents a life-threatening condition. After clinical inspection, in most cases dedicated imaging should be performed immediately. The frequently causal appendicitis and cholecystitis can mostly be diagnosed with ultrasound. In other cases with unclear ultrasound findings or unclear severe symptoms, computer tomography (CT) is usually necessary without delay. In contrast, magnetic resonance imaging (MRI) is predominantly indicated in pregnant women and children with unclear ultrasound findings. Thus, the radiologist is an important gatekeeper in the diagnostics of acute abdomen. The radiologist should therefore be familiar with the correct imaging indications, the frequent and rare causes as well as the corresponding morphological imaging characteristics.


Assuntos
Abdome Agudo , Abdome Agudo/diagnóstico por imagem , Abdome Agudo/etiologia , Criança , Feminino , Vesícula Biliar/diagnóstico por imagem , Humanos , Fígado , Imagem por Ressonância Magnética , Pâncreas , Gravidez , Baço , Ultrassonografia
2.
BMC Cancer ; 21(1): 288, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731052

RESUMO

BACKGROUND: If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion. METHODS: Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the "shallow group", and 34 patients whose tumors invaded the ss were classified as the "deep group". The EUS findings were compared between the two groups. RESULTS: An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnostic accuracy of GBMTs with ss invasion was not significantly different between EUS specialists and beginners. CONCLUSIONS: The observation of an irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.


Assuntos
Endossonografia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos
3.
Nat Commun ; 12(1): 1259, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627641

RESUMO

It is still challenging to make accurate diagnosis of biliary atresia (BA) with sonographic gallbladder images particularly in rural area without relevant expertise. To help diagnose BA based on sonographic gallbladder images, an ensembled deep learning model is developed. The model yields a patient-level sensitivity 93.1% and specificity 93.9% [with areas under the receiver operating characteristic curve of 0.956 (95% confidence interval: 0.928-0.977)] on the multi-center external validation dataset, superior to that of human experts. With the help of the model, the performances of human experts with various levels are improved. Moreover, the diagnosis based on smartphone photos of sonographic gallbladder images through a smartphone app and based on video sequences by the model still yields expert-level performances. The ensembled deep learning model in this study provides a solution to help radiologists improve the diagnosis of BA in various clinical application scenarios, particularly in rural and undeveloped regions with limited expertise.


Assuntos
Atresia Biliar/diagnóstico , Aprendizado Profundo , Ultrassonografia/métodos , Vesícula Biliar/diagnóstico por imagem , Humanos , Curva ROC
5.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408103

RESUMO

A 79-year-old woman presented with postprandial epigastric pain. She had normal vital signs, inflammatory markers and liver function tests. Ultrasound and CT of the abdomen demonstrated features consistent with acute cholecystitis. Her medical comorbidities and extensive abdominal surgical history prompted the decision to treat non-operatively. Despite optimal medical management, worsening abdominal pain and uptrending inflammatory markers developed. She underwent an emergency laparoscopy which revealed a necrotic gallbladder secondary to an anticlockwise complete gallbladder torsion; a rare condition associated with significant morbidity and mortality if managed non-operatively. Laparoscopic cholecystectomy was achieved without complication and the patient had an uneventful recovery. Preoperative diagnosis of torsion of the gallbladder is difficult. However, there are certain patient demographics and imaging characteristics that can help surgeons differentiate it from acute cholecystitis; a condition which can be safely managed non-operatively in selected patients. The differentiating features are elaborated on in this case report.


Assuntos
Dor Abdominal/etiologia , Colecistectomia Laparoscópica , Colecistite Aguda/diagnóstico , Vesícula Biliar/patologia , Anormalidade Torcional/diagnóstico , Administração Intravenosa , Idoso , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Necrose/diagnóstico , Necrose/cirurgia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Ultrassonografia
6.
Br J Radiol ; 94(1117): 20200726, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33090880

RESUMO

Gallbladder cancer is the most common malignancy of the biliary tract. It is also the most aggressive biliary tumor with the shortest median survival duration. Complete surgical resection, the only potentially curative treatment, can be accomplished only in those patients who are diagnosed at an early stage of the disease. Majority (90%) of the patients present at an advanced stage and the management involves a multidisciplinary approach. The role of imaging in gallbladder cancer cannot be overemphasized. Imaging is crucial not only in detecting, staging, and planning management but also in guiding radiological interventions. This article discusses the role of a radiologist in the diagnosis and management of gallbladder cancer.


Assuntos
Diagnóstico por Imagem/métodos , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Estadiamento de Neoplasias
7.
Clin Nucl Med ; 46(1): 78-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33181736

RESUMO

Bicameral gallbladder, also known as segmental adenomyomatosis, is not a rare benign condition with the lumen divided into 2 interconnected chambers. Here we present 2 interesting cases of the bicameral gallbladder, which shows unremarkable findings on hepatobiliary scintigraphy at first appearance. However, the CT scan revealed that the fundal chamber was not visualized on the scintigraphy unlike the ductal chamber. These cases suggest that the findings of the bicameral gallbladder on hepatobiliary scintigraphy can lead to misdiagnosis without carefully correlating with anatomic imaging findings.


Assuntos
Colecistite/complicações , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Doença Crônica , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Masculino , Cintilografia , Tomografia Computadorizada por Raios X
8.
BMJ Case Rep ; 13(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323423

RESUMO

A 78-year-old man presented to the hospital with acute right upper quadrant pain, fever and nausea. A focused abdominal ultrasound and abdominal CT scan were performed demonstrating an acute calculous cholecystitis with gallbladder perforation. Although a CT-guided cholecystostomy was performed and a pericholecystic abscess was relieved promptly, the patient developed a cholecystocutaneous fistula in the right hypochondriac region. A cholecystocutaneous fistula is an extremely rare complication that may occur in patients with acute calculous or acalculous cholecystitis, chronic gallstone disease, gallbladder carcinoma or prior hepatobiliary surgery.


Assuntos
Fístula Biliar/etiologia , Colecistite Aguda/complicações , Fístula Cutânea/etiologia , Idoso , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/terapia , Colecistite Aguda/cirurgia , Fístula Cutânea/diagnóstico por imagem , Fístula Cutânea/terapia , Drenagem , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos
9.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334767

RESUMO

An 83-year-old man with a history of chronic myelogenous leukaemia in remission maintained with bosutinib presented with new-onset fevers. He denied pain and had no other focal symptoms. Ultrasound imaging revealed mild gallbladder wall thickening. Non-contrasted CT revealed right upper quadrant inflammation of indeterminate source. The diagnosis of acalculous cholecystitis was made on the third day when a CT with oral contrast demonstrated a remarkably inflamed biliary tree. The gallbladder was surgically removed and found to be necrotic. The case highlights an unusual presentation for a well-known condition. Both ultrasound and CT have limited diagnostic sensitivity for acalculous cystitis. This case adds to existing literature to support development of acalculous cholecystitis in non-critically ill patients. Clinicians should maintain awareness of this condition among patients presenting to the hospital or clinic with abdominal pain. Careful discussion with radiology and surgery is indicated to guide diagnostic testing when initial imaging results are indeterminate.


Assuntos
Colecistite Acalculosa/diagnóstico , Escherichia coli/isolamento & purificação , Febre/microbiologia , Vesícula Biliar/patologia , Colecistite Acalculosa/complicações , Colecistite Acalculosa/microbiologia , Colecistite Acalculosa/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Colecistectomia , Quimioterapia Combinada , Febre/sangue , Febre/imunologia , Febre/terapia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/microbiologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Necrose/complicações , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
10.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370977

RESUMO

Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Colecistite Aguda/etiologia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Neoplasias Peritoneais/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/terapia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Diagnóstico Ausente , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Tomografia Computadorizada por Raios X
11.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370988

RESUMO

Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.


Assuntos
Fístula Biliar/etiologia , Doenças da Vesícula Biliar/etiologia , Fístula Intestinal/etiologia , Obstrução Intestinal/etiologia , Megacolo/complicações , Doenças Retais/complicações , Idoso , Fístula Biliar/diagnóstico , Fístula Biliar/cirurgia , Colecistectomia , Colectomia , Colo/diagnóstico por imagem , Colo/cirurgia , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/cirurgia , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Masculino , Megacolo/diagnóstico , Megacolo/cirurgia , Doenças Retais/diagnóstico , Doenças Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
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
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1658-1661, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018314

RESUMO

Laparoscopic cholecystectomy surgery is a minimally invasive surgery to remove the gallbladder, where surgical instruments are inserted through small incisions in the abdomen with the help of a laparoscope. Identification of tool presence and precise segmentation of tools from the video is very important in understanding the quality of the surgery and training budding surgeons. Precise segmentation of tools is required to track the tools during real-time surgeries. In this paper, a new pixel-wise instance segmentation algorithm is proposed, which segments and localizes the surgical tool using spatio-temporal deep network. The performance of the proposed has been compared with the state-of-the-art image-based instance segmentation method using the Cholec80 dataset. It is also compared with methods in the literature using frame-level presence detection and spatial detection with good results.


Assuntos
Algoritmos , Laparoscopia , Vesícula Biliar/diagnóstico por imagem , Procedimentos Cirúrgicos Minimamente Invasivos , Instrumentos Cirúrgicos
15.
Medicine (Baltimore) ; 99(43): e22903, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120842

RESUMO

Laparoscopic cholecystectomy is the routine method to treat gallbladder polyps. Nowadays, endoscopic ultrasound (EUS)-guided cholecystostomy as a bridge for per-oral transmural endoscopic resection of gallbladder polyps is introduced because preservation of gallbladder is increasingly getting attention. The aim of our study was to evaluate the approach in the treatment of patients with gallbladder polyps and symptomatic gallstones.EUS-guided cholecystostomy with the placement of a lumen-apposing metal stent (LAMS) was performed for those patients with accompanying gallbladder polyps and symptomatic gallstones. Several days after the cholecystostomy with LAMS, a gastroscope was introduced into the gallbladder to remove gallbladder polyps.All patients were successfully performed with the procedures of EUS-guided cholecystoduodenostomy (n = 3) or cholecystogastrostomy (n = 1) and endoscopic resection of gallbladder polyps. One patient experienced severe peritonitis. During the follow-up at 3 months, 1 patient was performed with laparoscopic cholecystectomy because ultrasonography examination showed the reappeared gallstones. No stone recurrence was found in other patients. During the follow-up of 3 to 15 months, no polyp recurrence was found in all the patients.The approach is novel for performing EUS-guided gallbladder fistulization, which can subsequently allow procedures of per-oral transmural endoscopic resection of gallbladder polyps to avoid cholecystectomy in the patients with gallbladder polyps and gallstones. However, further studies are needed before clinical recommendation because of the complications and stone recurrence.


Assuntos
Colecistostomia/métodos , Endossonografia/métodos , Vesícula Biliar/diagnóstico por imagem , Pólipos/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Duodenostomia/métodos , Feminino , Seguimentos , Vesícula Biliar/patologia , Cálculos Biliares/cirurgia , Gastrostomia/métodos , Humanos , Masculino , Metais , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/instrumentação
17.
Ultrasonics ; 108: 106214, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32736163

RESUMO

In this work, a compressed sensing method to reduce hardware complexity of ultrasound imaging systems is proposed and experimentally verified. We provide clinical evaluation of the method with a possible high compression rates (up to 64 RF signals compressed into a single channel on receive) which uses elastic net estimation for decoding stage. This allows a reduction in size and power consumption of the front-end electronics with only a minor loss in image quality. We demonstrate an 8-fold receive channel count reduction with a 3.16 dB and 3.64 dB mean absolute error for gallbladder and kidney images, respectively, as well as 7.4% increase in the contrast-to-noise ratio for kidney images and 0.1% loss in the contrast-to noise ratio for gallbladder images, on average. The proposed method may enable a fully portable ultrasonic device with virtually no loss in image quality as compared to a full size clinical scanner to be constructed.


Assuntos
Compressão de Dados/métodos , Ultrassonografia/métodos , Algoritmos , Vesícula Biliar/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Processamento de Imagem Assistida por Computador/métodos , Rim/diagnóstico por imagem , Fígado/diagnóstico por imagem , Processamento de Sinais Assistido por Computador , Razão Sinal-Ruído , Ultrassonografia/instrumentação
18.
World J Emerg Surg ; 15(1): 43, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615987

RESUMO

BACKGROUND: Since its first documentation, a novel coronavirus (SARS-CoV-2) infection has emerged worldwide, with the consequent declaration of a pandemic disease (COVID-19). Severe forms of acute respiratory failure can develop. In addition, SARS-CoV-2 may affect organs other than the lung, such as the liver, with frequent onset of late cholestasis. We here report the histological findings of a COVID-19 patient, affected by a tardive complication of acute ischemic and gangrenous cholecystitis with a perforated and relaxed gallbladder needing urgent surgery. CASE PRESENTATION: A 59-year-old Caucasian male, affected by acute respiratory failure secondary to SARS-CoV-2 infection was admitted to our intensive care unit (ICU). Due to the severity of the disease, invasive mechanical ventilation was instituted and SARS-CoV-2 treatment (azithromycin 250 mg once-daily and hydroxychloroquine 200 mg trice-daily) started. Enoxaparin 8000 IU twice-daily was also administered subcutaneously. At day 8 of ICU admission, the clinical condition improved and patient was extubated. At day 32, patient revealed abdominal pain without signs of peritonism at examination, with increased inflammatory and cholestasis indexes at blood tests. At a first abdominal CT scan, perihepatic effusion and a relaxed gallbladder with dense content were detected. The surgeon decided to wait and see the evolution of clinical conditions. The day after, conditions further worsened and a laparotomic cholecystectomy was performed. A relaxed and perforated ischemic gangrenous gallbladder, with a local tissue inflammation and perihepatic fluid, was intraoperatively met. The gallbladder and a sample of omentum, adherent to the gallbladder, were also sent for histological examination. Hematoxylin-eosin-stained slides display inflammatory infiltration and endoluminal obliteration of vessels, with wall breakthrough, hemorrhagic infarction, and nerve hypertrophy of the gallbladder. The mucosa of the gallbladder appears also atrophic. Omentum vessels also appear largely thrombosed. Immunohistochemistry demonstrates an endothelial overexpression of medium-size vessels (anti-CD31), while not in micro-vessels, with a remarkable activity of macrophages (anti-CD68) and T helper lymphocytes (anti-CD4) against gallbladder vessels. All these findings define a histological diagnosis of vasculitis of the gallbladder. CONCLUSIONS: Ischemic gangrenous cholecystitis can be a tardive complication of COVID-19, and it is characterized by a dysregulated host inflammatory response and thrombosis of medium-size vessels.


Assuntos
Colecistectomia/métodos , Colecistite , Infecções por Coronavirus , Vesícula Biliar , Gangrena , Omento , Pandemias , Pneumonia Viral , Perfuração Espontânea , Betacoronavirus/isolamento & purificação , Colecistite/etiologia , Colecistite/patologia , Colecistite/fisiopatologia , Colecistite/cirurgia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Gangrena/etiologia , Gangrena/patologia , Humanos , Imuno-Histoquímica , Infarto/etiologia , Infarto/patologia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Omento/irrigação sanguínea , Omento/patologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Perfuração Espontânea/diagnóstico , Perfuração Espontânea/etiologia , Perfuração Espontânea/fisiopatologia , Perfuração Espontânea/cirurgia , Trombose/etiologia , Trombose/patologia , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(27): e21017, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629723

RESUMO

INTRODUCTION: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an alternative treatment option for patients with acute cholecystitis, especially for those who are unsuitable for cholecystectomy. Recently used luminal apposing metal stents (LAMS) in EUS-GBD has several advantages over standard metal stents. However, there is no current guideline on where to locate the LAMS when transgastric approach is required. This study reports a case of gastric outlet obstruction (GOO) by placing LAMS too close to the pyloric ring. PATIENT CONCERNS: A 79-year-old female patient was referred to our department for evaluation of a large hepatic mass on abdominal ultrasound. Abdominal pain on right upper quadrant and spiking fever up to 38 °C appeared after liver biopsy. Abdominal ultrasound showed thickened GB wall and positive sonographic Murphy sign. DIAGNOSES: Intrahepatic cholangiocarcinoma with multiple lung and intrahepatic metastasis, acute cholecystitis, and pyloric ring obstruction caused by flange of LAMS in EUS-GBD. INTERVENTIONS: EUS-GBD via transgastric approach was performed with LAMS. After complete deployment of stent, esophagogastroduodenoscopy showed complete GOO by flange of LAMS. A gastroduodenal metal stent was inserted to relieve the GOO. OUTCOMES: The patient recovered well. She did not complain about obstruction induced symptom such as vomiting or abdominal fullness after gastroduodenal stent insertion. CONCLUSION: To the best of our knowledge, this is the first case report of EUS-GBD induced GOO. If physicians use LAMS as a transgastric approach in EUS-GBD, the puncture site should be carefully selected considering the size of the flange.


Assuntos
Colangiocarcinoma/complicações , Obstrução da Saída Gástrica/etiologia , Neoplasias Hepáticas/diagnóstico por imagem , Stents/efeitos adversos , Idoso , Colecistite Aguda/etiologia , Drenagem/métodos , Endossonografia/métodos , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Resultado do Tratamento , Ultrassonografia/métodos , Ultrassonografia de Intervenção/instrumentação
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