scholarly journals Usefulness of Endoscopic Managements in Patients with Ceftriaxone-Induced Pseudolithiasis Causing Biliary Obstruction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Yasuhiro Doi ◽  
Yasushi Takii ◽  
Hiroyuki Ito ◽  
Norihiko Jingu ◽  
Kentaro To ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Drainage ◽  
Endoscopic Sphincterotomy ◽  
Biliary Obstruction ◽  
Acute Cholangitis ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Biliary Pseudolithiasis ◽  
Similar Incidence

Ceftriaxone (CTRX) is known to cause reversible biliary stones/sludge, which is called biliary pseudolithiasis. We report two rare cases of biliary obstruction by pseudolithiasis shortly after completing CTRX treatment. Stones and sludge, which had not been detected before CTRX administration, appeared in the gallbladder and common bile duct and led to biliary obstruction and acute cholangitis. The obstructions were successfully treated with endoscopic retrograde biliary drainage and endoscopic sphincterotomy. CTRX-induced biliary pseudolithiasis has been reported mainly in children and adolescents but is also seen in adults with similar incidence rate. Although CTRX-induced biliary pseudolithiasis is usually asymptomatic and disappears spontaneously after discontinuing the drug, some patients develop biliary obstruction. Endoscopic managements should be considered in such cases.

Urgent endoscopic retrograde cholangio-pancreatography: to whom, when and how to perform?

2012 ◽  
Vol 153 (37) ◽  
pp. 1456-1464
Author(s):  
László Czakó
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholangitis ◽  
Timely Manner ◽  
Endoscopic Retrograde ◽  
Biliary Decompression ◽  
The Common ◽  
Alternative Techniques ◽  
Severity Of The Disease ◽  
Bile Leaks

Although the effectivity of an urgent endoscopic retrograde cholangio-pancreatography was documented, some aspects relating to this method are still debated. Timing of this procedure has not been established yet. Indications for urgent endoscopic retrograde cholangio-pancreatography with stone extraction from the common bile duct in patients with biliary pancreatitis remains controversial. Biliary decompression and drainage is the cornerstone of acute cholangitis treatment. The timing of endoscopic retrograde cholangio-pancreatography should be based on the grade of the severity of the disease. Using endoscopic retrograde cholangio-pancreatography, the accurate diagnosis and treatment of bile leaks in a timely manner is imperative to limit associated morbidity and mortality. Difficulty in cannulating the common bile duct is one of the main risk factors for pancreatitis occurring after the procedure. Alternative techniques to facilitate difficult cannulation are discussed. Organized training and introduction of objective measures of the investigator’s competence are emphasized to improve the performance of the procedure in Hungary. Orv. Hetil., 2012, 153, 1456–1464.

scholarly journals Emergency open surgery with a duodenotomy and successful removal of an impacted basket following a complicated endoscopic retrograde cholangiopancreatography procedure: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ibrahim Abu Shakra ◽  
Maxim Bez ◽  
Amitai Bickel ◽  
Mahran Badran ◽  
Fahed Merei ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Open Surgery ◽  
Rare Complication ◽  
Exploratory Laparotomy ◽  
Biliary Stones ◽  
Endoscopic Retrograde ◽  
Abdominal Ultrasonography ◽  
The Common

Abstract Background Current management of choledocholithiasis entails the use of endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the common bile duct. A rare complication of this procedure is the impaction of the basket by a large stone, which necessitates lithotripsy. Here we report a case of an impacted basket during ERCP, which was managed by open surgery with a duodenotomy and the manual removal of the basket. Case presentation A 79-year-old Caucasian man was admitted to our department with yellowish discoloration of urine, skin and eyes. Abdominal ultrasonography showed a slightly thickened gallbladder, multiple gallbladder stones, dilated intrahepatic bile ducts and extrahepatic bile extending to 1.1 cm. A computed tomography (CT) scan demonstrated a stone in the common bile duct, which caused dilation of the biliary ducts. The patient was diagnosed with obstructive jaundice secondary to choledocholithiasis; and underwent an ERCP, a sphincterotomy and stone extraction. Four days following discharge, the patient was readmitted with jaundice, abdominal pain, vomiting and fever. He was diagnosed with ascending cholangitis and treated initially with antibiotics. A second ERCP revealed a dilated common bile duct and choledocholithiasis. Stone removal with a basket failed, as did mechanical lithotripsy. Finally, the wires of the basket were ruptured and stacked in the common bile duct together with the stone. During exploratory laparotomy, adhesiolysis, a Kocher maneuver of the duodenum and a subtotal cholecystectomy were performed. Choledochotomy did not succeed in removing the impacted wires together with the stone. Therefore, a duodenotomy and an extension of the sphincterotomy were performed, followed by high-pressure lavage of the common bile duct to remove additional small biliary stones. The choledochotomy and duodenotomy were closed by a one-layer suture, and a prophylactic gastroenterostomy was performed to prevent leakage from the common bile duct and the duodenum. The postoperative course was satisfactory. Conclusions This is the first report in the literature of removal of an impacted Dormia basket through the papilla by performing a duodenotomy and an extension of the sphincterotomy, followed by gastroenterostomy.

scholarly journals Mirizzy syndrome complicated by acute cholangitis in pregnant

2020 ◽  
Vol 25 (1) ◽  
pp. 124-128
Author(s):  
A. V. Osipov ◽  
A. E. Demko ◽  
D. A. Surov ◽  
I. A. Soloviev ◽  
A. V. Sviatnenko ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Surgical Procedure ◽  
Biliary Obstruction ◽  
Acute Cholangitis ◽  
The Common

A case report of the patient at week 21 of pregnancy with Mirizzi type 2 syndrome complicated by acute cholangitis is described. During the examination, the level and cause of the biliary obstruction (cholecystocholedocheal fistula and gallstone of the common bile duct) were revealed. A detailed description of the surgical procedure is presented: subtotal laparoscopic cholecystectomy, choledochotomy, choledochoscopy, lithoextraction, drainage of the common bile duct. The analysis of information from literature sources is carried out.

scholarly journals Gallstone Disease Complicated by Choledocholithiasis: Modern Aspects of Diagnostics

2021 ◽  
Vol 6 (2) ◽  
pp. 66-70
Author(s):  
V. B. Borysenko ◽  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Laboratory ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Magnetic Resonance Tomography ◽  
Endoscopic Retrograde ◽  
Diagnostic Measures ◽  
Endoscopic Cholangiopancreatography

Choledocholithiasis is an urgent problem of modern hepatobiliary surgery and accounts for 60% of all obstructive jaundice. Stones of the common bile duct cause cholestasis and mechanical jaundice syndrome and in case of untimely diagnostics lead to the development of such severe complications as acute cholangitis and biliary sepsis. The criteria for determining the sequence, stages and volume of diagnostic measures with choledocholithiasis have not been determined by now. The purpose of the study. Optimization of the instrumental stage of the diagnostics of patients with choledocholithiasis. Materials and methods. 56 patients with choledocholithiasis were studied. The diagnostic program was expanded due to the instrumental stage using ultrasound, duodenopapiloscopy, endoscopic retrograde cholangiopancreatography and magnetic resonance tomography. The criterion for the patients selection was the syndrome of distal choledochal patency violation and the presence of stones in it according to echosonography and endoscopic cholangiopancreatography. Results and discussion. At sonography bilious hypertension was established in all 72 (100%) patients. Mechanical jaundice was present in 54 (96.4%) patients. Hepatic dysfunction with 84±9.6 mmol/l hyperbilirubinemia and an increase in AST and ALT levels to 1.2±0.9 mmol/l and 1.5±1.1 mmol/l, were verified respectively. At endoscopic retrograde cholangiopancreatography choledocholithiasis was found in 54 (96.4%) patients. Single stones were present in 18 (32.1%) and multiple – in 38 (67.9%) patients. In 52 (92.9%) cases, stones up to 1.5 cm in diameter were removed with a Dormia basket at one time or after mechanical lithotripsy. In 4 (7.1%) patients stones from 1.7 to 2.0 cm could not be removed endoscopically. Choledoch stenting was performed in 12 (21.4%) patients. One-stage transpapillary treatment was carried out in 38 (67.9%) patients, two and three stage treatment – in 14 (25%) cases, and «open» choledocholithotomy – in 4 (7.1%) cases. Conclusion. The program of choledocholithiasis diagnostics with the gradual use of clinical, laboratory, radiological and endoscopic data allows carrying out correct detailing of the cause, level, degree of common bile duct obstruction and the complicated course of the disease in 100% of cases

scholarly journals Biliary Peritonitis Caused by Spontaneous Bile Duct Rupture in the Left Triangular Ligament of the Liver after Endoscopic Sphincterotomy for Choledocholithiasis

2021 ◽  
pp. 53-61
Author(s):  
Taro Fukui ◽  
Takeshi Chochi ◽  
Toru Maeda ◽  
Chunyong Lee ◽  
Yohnosuke Wada ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Sphincterotomy ◽  
Fluid Collection ◽  
Rare Condition ◽  
Common Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Bile Duct Wall ◽  
Biliary Peritonitis

Spontaneous bile duct rupture is a rare condition in adults, with only 70 cases reported. Increased bile duct wall pressure may lead to rupture and biliary peritonitis. In this patient, the bile duct ruptured in the hepatic left triangular ligament. A 91-year-old man underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and endoscopic retrograde biliary drainage (ERBD) placement. One week later, removal of the ERBD and common bile duct stones and an endoscopic sphincterotomy (EST) were performed. Four days later, the patient had abdominal pain, increased inflammatory reaction, and jaundice. Abdominal computed tomography showed ascites, bile duct dilatation and fluid collection under the liver (10 cm in diameter). Emergency surgery was performed to drain the fluid. On laparotomy, encapsulated biliary ascites was seen. To search for the site of the leak, after cholecystectomy, a tube (C-tube) was inserted into the common bile duct via cystic duct stump. Because of uncontrollable bleeding, after packing with surgical gauze, the operation was temporarily stopped. The next day, reoperation was performed. Intraoperative cholangiography with contrast dye revealed the perforation site in the left triangular ligament and a partial resection was performed. Bile excretion from the C-tube was subsequently observed, but the patient’s jaundice did not improve. Although endoscopic retrograde cholangiopancreatography revealed that the EST site was normal, ERBD was placed again, and the jaundice gradually improved. Although EST was performed in this case, biliary peritonitis resulting from spontaneous bile duct rupture occurred. This case was very informative because biliary perforation may occur even after EST.

scholarly journals Hepatoblastoma in an Adult with Biliary Obstruction and Associated Portal Venous Thrombosis

HPB Surgery ◽  
1995 ◽  
Vol 9 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Lav K. Kacker ◽  
E. M. Khan ◽  
Rohit Gupta ◽  
V. K. Kapoor ◽  
Rakesh Pandey ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Portal Vein ◽  
Biliary Obstruction ◽  
Preoperative Diagnosis ◽  
Acute Cholangitis ◽  
Young Female ◽  
Tumor Mass ◽  
Vein Thrombosis ◽  
Portal Venous Thrombosis

We present a case of adult hepatoblastoma. This young female presented with severe acute cholangitis. Preoperative diagnosis was common bile duct (CBD) obstruction with portal vein thrombosis. On exploration she had a tumor mass in the CBD. The unusual features of this case are discussed in this report.

Sign in / Sign up

Export Citation Format

Share Document