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Journal of Hepato-biliary-pancreatic... Feb 2022Acute cholecystitis is a progressive inflammation of the gallbladder usually caused by gallstones obstructing the cystic duct. Congestion and edema are evident symptoms... (Review)
Review
Acute cholecystitis is a progressive inflammation of the gallbladder usually caused by gallstones obstructing the cystic duct. Congestion and edema are evident symptoms during the first 2-4 days, also known as the phase of edematous cholecystitis. Necrotizing cholecystitis, a phase characterized by bleeding and necrosis, is seen at 3-5 days. From 7-10 days, the disease progresses to its purulent phase, also known as suppurative cholecystitis. If the disease is still left untreated at this point, it progresses to subacute cholecystitis and it eventually becomes chronic cholecystitis. Possible complications that affect the management of cholecystitis include perforation of the gallbladder (bile peritonitis) during the hemorrhagic and necrosis phase, and peri-gallbladder abscess and internal biliary fistula during the purulent phase.
Topics: Cholecystitis; Cholecystitis, Acute; Gallbladder; Gallstones; Humans; Japan
PubMed: 33570821
DOI: 10.1002/jhbp.912 -
Revista Espanola de Enfermedades... May 2019Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with...
Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with development of a fistulous tract to the skin without prior biliary surgery or trauma. We report the case of an octogenarian woman with debilitating comorbidities and consequently immunosuppression who presented with spontaneous external biliary fistula and a history of ERCP three months before, a procedure that was carried out with no apparent immediate complications.
Topics: Aged, 80 and over; Biliary Fistula; Cutaneous Fistula; Female; Gallbladder Diseases; Humans
PubMed: 30912668
DOI: 10.17235/reed.2019.5882/2018 -
Khirurgiia 2021Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic...
Surgical treatment of pancreatic diseases is always associated with a large number of complications. Postoperative hemorrhage is a specific complication of pancreatic surgery requiring a clear classification and surgical strategy. According to literature data, postoperative hemorrhage occurs in 3-30% of cases. Incidence of hemorrhages depends on intraoperative, anamnestic, histological and postoperative factors. Early postoperative hemorrhage (within 24 hours after surgery) is usually a consequence of technical errors in intraoperative hemostasis, perioperative coagulation disorders. The mechanism of delayed bleeding is more complex and often associated with various arrosive factors: pancreatic fistula, biliary fistula, abscess. Currently, there is no a single treatment algorithm for patients with postpancreatectomy hemorrhage. According to various researchers, contrast-enhanced CT is preferred for diagnosis. In recent years, the role of endovascular hemostasis has significantly increased. This problem requires further study and development of a single treatment and diagnostic algorithm that will reduce mortality in these patients.
Topics: Humans; Incidence; Pancreatectomy; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Hemorrhage
PubMed: 33395516
DOI: 10.17116/hirurgia202101177 -
Journal of Minimal Access Surgery 2023Pancreatic fistula (PF) and biliary fistula (BF) are two major leakage complications after pancreatoduodenectomy (PD). The aim of this study is to investigate the risk...
BACKGROUND
Pancreatic fistula (PF) and biliary fistula (BF) are two major leakage complications after pancreatoduodenectomy (PD). The aim of this study is to investigate the risk factors of PF and BF after laparoscopic PD (LPD).
MATERIALS AND METHODS
We conducted a retrospective analysis of 500 patients who underwent LPD from 1 April 2015 to 31 March 2020. Clinical data from patients were analysed using multivariate logistic regression analysis.
RESULTS
PF occurred in 86 (17.2%) patients. Univariate and multivariate analysis indicated that the soft texture of the pancreas (P = 0.001) was the independent risk factor for PF. BF occurred in 32 (6.4%) patients. Univariate and multivariate analysis indicated that history of cardiovascular disease (P < 0.001), surgical time (P = 0.005), pre-operative CA125 (P = 0.036) and pre-operative total bilirubin (P = 0.044) were independent risk factors for BF.
CONCLUSION
The texture of the pancreas was an independent risk factor for PF after LPD, which was consistent with the literatures. In addition, history of cardiovascular disease, surgical time, pre-operative CA125 and pre-operative total bilirubin were new independent risk factors for BF after LPD. Therefore, patients with high-risk factors of BF should be informed that they are at a high risk for this complication.
PubMed: 35915533
DOI: 10.4103/jmas.jmas_336_21 -
Internal and Emergency Medicine Jun 2021
Topics: Bile; Biliary Fistula; Bilirubin; Bronchial Fistula; Cholangiopancreatography, Endoscopic Retrograde; Contrast Media; Diagnosis, Differential; Female; Humans; Middle Aged; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed
PubMed: 33389569
DOI: 10.1007/s11739-020-02572-0 -
Chirurgia (Bucharest, Romania : 1990) Dec 2021Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or... (Review)
Review
Spontaneous biliary-enteric fistula (SBEF) is an abnormal communication between the biliary tree and the gastrointestinal tract which develops as a result of biliary or gastrointestinal disease. Iatrogenic fistulas, due to surgery or instrumental exploration, are not included in this definition. R. Colombo, in 1559, was the first to describe SBEF as an occasional finding during an autopsy. In almost 90% of cases the cause of SBEF is chronic recurrent cholelithiasis. Less common causes are penetrating peptic ulcers and neoplastic infiltration from the biliary or gastrointestinal tract. The most common type of SBEF is cholecystoduodenal fistula and the least common is choledochoduodenal fistula. There are various complications associated with SBEF but often these are not promptly recognized by patients or physicians and diagnosis and treatment may be delayed for years. The most important complication, which can be considered pathognomonic for SBEF, is gallstone ileus which manifests clinically as acute or chronic mechanical intestinal obstruction. Gallstone ileus, a rather rare complication of a rather common pathology, biliary lithiasis, is found in 0.000015% of hospitalized patients but in 0.0003% of surgical patients. It is mainly found in women over the age of 65, with a male to-female ratio of 1:5. There are various forms of occlusion, related to the sites of gallstone impaction, with various clinical characteristics and degrees of severity. These include Bouveret syndrome ( 10% of cases) with impaction in duodenum or pylorus, and the more common Barnard's syndrome (5-75% of cases) in which the site of impaction is in the terminal ileum right before Bauhin's valve. For diagnosis, the radiological signs which make up Riglerâ??s triad or tetrad, are essential, and are best visible on magnetic resonance. The the gold standard is contrast-enhanced computed tomography scan. Regarding the surgical management, one-stage simple enterolithotomy is reserved for the oldest patients and the most severe cases. Nowadays, is performed more and more frequently by laparoscopy. In more favorable cases radical treatment of the occlusion, the biliary lithiasis and the SBEF is recommended, either as a one-stage procedure or in two stages with the second procedure performed after few weeks.
Topics: Biliary Fistula; Female; Gallstones; Humans; Intestinal Obstruction; Intestine, Small; Male; Treatment Outcome
PubMed: 35274609
DOI: No ID Found -
Zentralblatt Fur Chirurgie Jun 2016Hemihepatectomy continues to be a standard procedure for the resection of primary or secondary liver tumours in hepatobiliary surgery. In this tutorial, a case study...
Hemihepatectomy continues to be a standard procedure for the resection of primary or secondary liver tumours in hepatobiliary surgery. In this tutorial, a case study illustrates the indication for liver resection as well as surgical steps and different techniques. Indications for right or left hemihepatectomy include liver tumours that cause a diffuse or extended infiltration of one half of the liver or tumours extending to the central confluence of liver veins or the liver hilum. Usually, a resection limit is only required in the case of extended hemihepatectomies, where a two-stage resection is needed. In addition to exploration and intraoperative ultrasound, this tutorial presents different entry sites, liver mobilisation, hilum preparation and common techniques of parenchymal dissection. Finally, a number of haemostasis, closure and biliary monitoring techniques are shown. The video tutorial demonstrates all fundamental steps of hemihepatectomy from indication to closure, with a special focus on different approaches.
Topics: Biliary Fistula; Chemotherapy, Adjuvant; Colorectal Neoplasms; Combined Modality Therapy; Hemostasis, Surgical; Hepatectomy; Humans; Liver Neoplasms; Neoadjuvant Therapy; Postoperative Complications; Suture Techniques
PubMed: 27331287
DOI: 10.1055/s-0042-102535 -
Journal of Gastrointestinal Surgery :... Jan 2021Biliary fistula after pancreatoduodenectomy (PD) is associated with significant morbidity and mortality. The aim of this study was to determine the risk of early...
BACKGROUND
Biliary fistula after pancreatoduodenectomy (PD) is associated with significant morbidity and mortality. The aim of this study was to determine the risk of early postoperative biliary fistula for developing biliary anastomotic stricture after PD.
METHODS
Retrospective review of all PD performed for various indications at a single institution between 2013 and 2018. Postoperative biliary fistulae were graded according to the International Study Group of Liver Surgery (ISGLS) as grade A-C. Multivariable analysis was performed for all comparative patient subgroups.
RESULTS
A total of 843 patients underwent PD for malignant (68%) and benign (32%) indications. Postoperative biliary fistula developed in 66 (8%) patients; ISGLS grade A in 29 (3%), grade B in 32 (4%), and grade C in 5 (0.6%). Ninety-day mortality was 3% (25 patients). The remaining 818 patients were evaluated with a median follow-up of 16 months (IQR, 5-32 months). Biliary anastomotic stricture developed in 41 (5%) patients at a median of 10 months (IQR, 6-18 months) postoperatively. Strictures were managed with percutaneous (27 patients, 66%) or endoscopic (14 patients, 34%) stenting. No biliary stricture required operative anastomotic revision. Postoperative biliary fistula (HR, 4.4; 95% CI, 2.0-9.9; P = 0.0002) was associated with biliary anastomotic stricture; an increased risk for biliary anastomotic stricture was seen in patients with grade A (HR, 6.4; 95% CI, 2.4-16.9; P = 0.0002) and grade B (HR, 3.6; 95% CI, 1.2-10.9; P = 0.02) postoperative biliary fistula.
CONCLUSION
Postoperative biliary fistula after pancreatoduodenectomy, including clinically insignificant, transient biliary fistula, is associated with an increased risk of a late biliary anastomotic stricture requiring stenting.
Topics: Anastomosis, Surgical; Biliary Fistula; Constriction, Pathologic; Humans; Pancreaticoduodenectomy; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32671799
DOI: 10.1007/s11605-020-04727-y -
Clinical Gastroenterology and... May 2019
Topics: Aged, 80 and over; Biliary Fistula; Diagnosis, Differential; Duodenal Obstruction; Endoscopy, Gastrointestinal; Female; Gallstones; Gastric Outlet Obstruction; Humans; Intestinal Fistula; Syndrome; Tomography, X-Ray Computed
PubMed: 29432920
DOI: 10.1016/j.cgh.2018.02.006 -
World Journal of Methodology Sep 2023Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study...
BACKGROUND
Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD.
AIM
To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.
METHODS
From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.
RESULTS
There was a highly statistically significant association ( ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association ( ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively.
CONCLUSION
Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.
PubMed: 37771864
DOI: 10.5662/wjm.v13.i4.272