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https://www.readbyqxmd.com/read/28645922/management-of-high-grade-dysplasia-of-the-cystic-duct-after-cholecystectomy
#1
Maitham A Moslim, Andrew Tang, Gareth Morris-Stiff
High-grade dysplasia (HGD) of the cystic duct margin without evidence of concurrent malignancy is a rare occurrence. We present a case of a 36-year-old woman who developed gallstone pancreatitis and subsequently underwent a laparoscopic cholecystectomy. On histopathology, she was found to have HGD at the cystic duct margin. Following evaluation, she underwent excision of the cystic duct remnant with no malignancy being present on final pathology. We present this case to discuss the management of cystic duct dysplasia in the absence of gallbladder malignancy...
June 22, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28643979/-acute-pancreatitis-new-aspects-for-the-management
#2
Olivier Windisch, Toni Raffoul, Catrina Hansen, Jean-Louis Frossard, Philippe Morel, Léo Bühler
Acute pancreatitis is a frequent disease, with a simple course in 80 % of the cases but a high morbidity and mortality in its severe form. Biliary origin and alcohol represent 80 % of the etiologies. Except endoscopic removal of gallstone for biliary origin, treatment remains symptomatic and focuses on fluid resuscitation, effective antalgia and adapted management of nutrition. This article focuses on the novelties introduced by the revision of the Classification of Atlanta in 2012 and details current guidelines for the management of the disease...
June 14, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28621510/laparoscopic-cholecystectomy-for-acute-cholecystitis-an-analysis-of-early-versus-delayed-cholecystectomy-and-predictive-factors-for-conversion
#3
Joel C Goh, Jarrod K Tan, Janice W Lim, Iyer G Shridhar, Krishnakumar Madhavan, Alfred W Kow
BACKGROUND: There is an increasing preference for early laparoscopic cholecystectomy (ELC) as compared to delayed LC (DLC) in the management of acute cholecystitis (AC). Conversion to open cholecystectomy (LOC) remains an important outcome. We aim to compare ELC and DLC outcomes and identify LOC predictors. METHODS: Retrospective analysis of 466 patients who underwent LC for AC from June 2010 - June 2015 was performed. Patients were divided into ELC and DLC groups, defined as LC performed within 7 days and between 4 to 24 weeks of symptom onset respectively...
June 16, 2017: Minerva Chirurgica
https://www.readbyqxmd.com/read/28614581/clinical-biochemical-and-genetic-characterization-of-north-american-patients-with-erythropoietic-protoporphyria-and-x-linked-protoporphyria
#4
Manisha Balwani, Hetanshi Naik, Karl E Anderson, D Montgomery Bissell, Joseph Bloomer, Herbert L Bonkovsky, John D Phillips, Jessica R Overbey, Bruce Wang, Ashwani K Singal, Lawrence U Liu, Robert J Desnick
Importance: Autosomal recessive erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are rare photodermatoses presenting with variable degrees of painful phototoxicity that markedly affects quality of life. The clinical variability, determinants of severity, and genotype/phenotype correlations of these diseases are not well characterized. Objective: To describe the baseline clinical characteristics, genotypes, and determinants of disease severity in a large patient cohort with EPP or XLP...
June 14, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28611568/two-anomalies-in-one-a-rare-case-of-an-intrahepatic-gallbladder-with-a-cholecystogastric-fistula
#5
Mohammad F Ali, David Friedel, Galina Levin
The gallbladder can be situated in a variety of anomalous positions. An intrahepatic gallbladder - the second most common ectopic location of the gallbladder - is one that is completely embedded within the liver parenchyma. Described in the literature as early as 1935, intrahepatic gallbladders predominantly result from a developmental anomaly but in some instances have been reported to be secondary to chronic inflammation. The significance of an intrahepatic gallbladder lies in the fact that 60% of the cases are associated with gallstones and may present a challenge for the general surgeon during cholecystectomy and other biliary operations in addition to causing misdiagnosis on imaging...
January 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28611560/gallstone-ileus-caused-by-cholecystocolonic-fistula-and-gallstone-impaction-in-the-sigmoid-colon-review-of-the-literature-and-novel-surgical-treatment-with-trephine-loop-colostomy
#6
James W O'Brien, Lucy-Anne Webb, Luke Evans, Chris Speakman, Irshad Shaikh
Gallstone ileus is an uncommon cause of intestinal obstruction and occurs following the formation of a cholecystoenteric fistula, permitting passage of gallstones into the gastrointestinal tract. Impaction of a gallstone in the sigmoid colon is rare and is usually at sites of previous colonic disease. Definitive management can be challenging due to the advanced age and co-morbidity usually seen in this group of patients. We describe a patient successfully managed with on-table endoscopy and, under local anaesthetic, the formation of a left iliac fossa trephine loop colostomy, permitting an enterolithotomy to deliver the stone whilst accommodating for severe pre-existing distal sigmoid diverticular disease...
January 2017: Case Reports in Gastroenterology
https://www.readbyqxmd.com/read/28604381/miniinvasive-surgical-interventions-in-management-of-cholelithiasis-a-retrospective-study
#7
Mamuka R Gurgenidze, Merab A Kiladze, Zurab A Beriashvili, Teimuraz U Tabucadze, Giorgi A Datuashvili
The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for different groups of patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 2997 patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (1479) and MC (1518) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy...
2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28603611/subtotal-laparoscopic-cholecystectomy-influences-the-rate-of-conversion-in-patients-with-difficult-laparoscopic-cholecystectomy-case-series
#8
W E Abdelrahim, Kamal E Elsiddig, A A Wahab, M Saad, H Saeed, E A G Khalil
OBJECTIVES: This study aimed to show that subtotal laparoscopic cholecystectomy (SLC) is a safe procedure that reduces the rate of conversion in patients with difficult laporoscopic cholecystectomies in resource-meagre settings. PATIENTS AND METHODS: Following informed consent, patients with gallstones reporting to Atbara Medical Centre, Atbara, Northern Sudan from February 2012 to July 2013 were managed laparoscopically except those with choledocholithiasis. SLC was done for patients with difficult cholecystectomy and obscured Callot's triangle...
July 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28599581/changing-management-of-gallstone-related-disease-in-pregnancy-a-retrospective-cohort-analysis
#9
Jonas Hedström, Johan Nilsson, Roland Andersson, Bodil Andersson
OBJECTIVES: Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome. MATERIALS AND METHODS: All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmö 2001-2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded...
June 9, 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/28597677/endoscopic-management-of-afferent-loop-syndrome-caused-by-enteroliths-and-anastomotic-stricture-a-case-report
#10
Ana Rita Alves, Nuno Almeida, Margarida Ferreira, Luís Tomé
Afferent loop syndrome (ALS) is a rare complication of Billroth-II gastrojejunostomy. Causes of afferent loop obstruction include adhesions, internal hernias, intestinal strictures or malignancy. Obstruction caused by enteroliths is rare and usually requires surgery. We present the case of a 90-year-old man with a Billroth-II performed 50 years earlier and three acute pancreatitis. He presented with acute abdominal pain, without signs of pancreatitis. Upper digestive endoscopy revealed a punctiform anastomotic stricture of the afferent loop...
June 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28586152/right-upper-quadrant-pain-ultrasound-first
#11
Margarita V Revzin, Leslie M Scoutt, Joseph G Garner, Christopher L Moore
Acute right upper quadrant (RUQ) pain is a common presenting symptom in emergency departments and outpatient medical practices, and is most commonly attributable to biliary and hepatic pathology. Ultrasound should be used as a first-line imaging modality for the diagnosis of gallstones and cholecystitis, as it allows the differentiation of medical and surgical causes of upper abdominal pathology, and in many circumstances is sufficient to guide patient management. Knowledge of strengths and limitations of ultrasound in the evaluation of RUQ is paramount in correct diagnosis...
June 6, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28567452/laparoscopic-cholecystectomy-in-a-case-of-situs-inversus-totalis-a-review-of-technical-challenges-and-adaptations
#12
Azhar Alam, Abhijit Santra
Situs inversus totalis is a rare congenital condition, characterized by the transposition of the thoracic and abdominal viscera, resulting in a mirror image of normal anatomy. Even though situs inversus does not predispose to gall stones, a laparoscopic cholecystectomy, in a case of situs inversus, can prove to be a technically challenging procedure, especially for the right-handed surgeon. In this case report, we present an unusual case of cholelithiasis in a patient with situs inversus totalis. A laparoscopic cholecystectomy, which is considered the gold standard procedure for symptomatic gallstones, was performed...
May 2017: Annals of Hepato-Biliary-Pancreatic Surgery
https://www.readbyqxmd.com/read/28555355/laparoscopic-cholecystectomy-for-cholelithiasis-in-children-with-sickle-cell-disease
#13
REVIEW
Yousef Al Talhi, Bader Hamza Shirah, Muteb Altowairqi, Yasmin Yousef
Patients with sickle cell disease (SCD) suffer from an increased incidence of gallstone formation due to hemolysis of sickled red blood cells; this leads to an increased level of bilirubin in secreted bile that becomes a nidus for pigment stone formation. Laparoscopic cholecystectomy (LC) is considered a standard operative procedure for gallstone disease mainly due to lower postoperative wound complaints, faster recovery, better postoperative cosmetic results, shorter hospital stay, and earlier return to work...
May 29, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28524363/donor-transmitted-mutation-of-the-abcb11-gene-and-ensuing-intra-hepatic-cholestasis-of-pregnancy-in-a-liver-transplant-recipient
#14
Tiong Yeng Lim, Iona Coltart, Pierre Foskett, Richard Thompson, Sandra Strautnieks, Leonie Penna, Catherine Williamson, Rosa Miquel, Michael A Heneghan
In liver transplant (LT) recipients, the cause of graft dysfunction in pregnancy is often difficult to ascertain. Moreover, a liver biopsy in late pregnancy is often avoided as a consequence of patient and physician factors. Management of graft dysfunction can be difficult in this setting. We report a 30-year-old female LT recipient who developed acutely deranged liver biochemistry during the third trimester of her first pregnancy. At 29 weeks gestation, her liver function test (LFT) became abnormal; AST peaked at 978 IU/L (normal range 10-50), GGT 25 IU/L (normal range 1-55), bilirubin 1...
May 19, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28473337/impact-of-liraglutide-on-amylase-lipase-and-acute-pancreatitis-in-participants-with-overweight-obesity-and-normoglycemia-prediabetes-or-type-2-diabetes-secondary-analyses-of-pooled-data-from-the-scale-clinical-development-program
#15
William M Steinberg, Julio Rosenstock, Thomas A Wadden, Morten Donsmark, Christine B Jensen, J Hans DeVries
OBJECTIVE: To describe amylase/lipase activity levels and events of acute pancreatitis (AP) in the SCALE (Satiety and Clinical Adiposity-Liraglutide Evidence in individuals with and without diabetes) weight-management trials. RESEARCH DESIGN AND METHODS: Secondary analyses were performed on pooled data from four trials (N = 5,358 with BMI ≥30, or 27 to <30 kg/m(2) with ≥1 comorbidity). Of these, 1,723 had normoglycemia, 2,789 had prediabetes, and 846 had type 2 diabetes...
May 4, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28465716/acute-care-surgery-a-means-for-providing-cost-effective-quality-care-for-gallstone-pancreatitis
#16
Patrick B Murphy, Dave Paskar, Richard Hilsden, Jennifer Koichopolos, Tina S Mele
BACKGROUND: Modern practice guidelines recommend index cholecystectomy (IC) for patients admitted with gallstone pancreatitis (GSP). However, this benchmark has been difficult to widely achieve. Previous work has demonstrated that dedicated acute care surgery (ACS) services can facilitate IC. However, the associated financial costs and economic effectiveness of this intervention are unknown and represent potential barriers to ACS adoption. We investigated the impact of an ACS service at two hospitals before and after implementation on cost effectiveness, patient quality-adjusted life years (QALY) and impact on rates of IC...
2017: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/28440239/feasibility-safety-and-outcomes-of-a-single-step-endoscopic-ultrasonography-guided-drainage-of-pancreatic-fluid-collections-without-fluoroscopy-using-a-novel-electrocautery-enhanced-lumen-apposing-self-expanding-metal-stent
#17
Joseph Yoo, Linda Yan, Raza Hasan, Saana Somalya, Jose Nieto, Ali A Siddiqui
BACKGROUND AND OBJECTIVES: There are currently limited data available regarding the safety of endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) using the lumen-apposing metal stent without fluoroscopic guidance. This study aims to evaluate clinical outcomes and safety of EUS-guided drainage of PFC using the electrocautery-enhanced lumen-apposing metal stents (EC-LAMSs) without fluoroscopic guidance. METHODS: We conducted a retrospective study on patients with symptomatic PFC who underwent EUS-guided drainage using EC-LAMS without fluoroscopy...
March 2017: Endoscopic Ultrasound
https://www.readbyqxmd.com/read/28433486/gallstone-ileus-an-overview-of-the-literature
#18
C F Ploneda-Valencia, M Gallo-Morales, C Rinchon, E Navarro-Muñiz, C A Bautista-López, L F de la Cerda-Trujillo, L A Rea-Azpeitia, C R López-Lizarraga
INTRODUCTION: Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AIM: To conduct an up-to-date review of this disease...
April 19, 2017: Revista de Gastroenterología de México
https://www.readbyqxmd.com/read/28417652/modified-laparoscopic-cholecystectomy-technique-for-treatment-of-situs-inversus-totalis-a-case-report
#19
Jian-Jun Ren, Shu-Dong Li, Ya-Jun Geng, Rui Xiao
Laparoscopic cholecystectomy is a broadly used technique for gallbladder treatment. However, situs inversus, a rare anomaly, is reportedly difficult to treat by conventional laparoscopic cholecystectomy. A 36-year-old woman with chronic cholecystitis and multiple gallstones was found to have dextrocardia on a chest X-ray. Magnetic resonance imaging demonstrated situs inversus, cholecystitis, and cholelithiasis. We successfully performed laparoscopic cholecystectomy using our modified technique, which mainly involved a left-handed operation and adjustment of the port positions...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28412956/management-of-suspected-common-bile-duct-stones-on-cholangiogram-during-same-stay-cholecystectomy-for-acute-gallstone-related-disease
#20
Sandra de Sousa, Olivier Tobler, Pouya Iranmanesh, Jean-Louis Frossard, Philippe Morel, Christian Toso
BACKGROUND: Recent data have suggested that upfront cholecystectomy should be performed even in the presence of moderately abnormal liver function tests (LFTs). As a consequence, more common bile duct (CBD) stones are discovered on intra-operative cholangiogram. We assessed the presentation and management of such patients to refine their management plan. METHODS: Adult patients (>16 years) with an acute gallstone-related disease who had undergone same-stay cholecystectomy from January 2013 to January 2015 were retrospectively assessed...
April 17, 2017: BMC Surgery
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