A word of caution regarding Ceftriaxone

Ceftriaxone is a well-known antibiotic belonging to the third generation of cephalosporins. This broad-spectrum drug is highly effective against gram negative and gram-positive bacterial infections and is frequently used to treat severe bacterial infections in pediatrics, including disseminated gonococcal infections, sepsis and meningitis. However, concerns have been raised regarding the drug’s safety as it is prone to various side effects like bilirubin encephalopathy, cholestasis, pseudolithiasis and rarely hepatitis and pancreatitis.1 A prospective study in 154 children published in Human and Experimental Toxicology in 2016 further validate this point.2 According to this study, out of 84, 20.9% children treated with ceftriaxone had abnormal biliary sonographic findings and 15.1% had biliary lithiasis whereas cefotaxime was found to be comparatively safer. Worrying facts related to Ceftriaxone should definitely be taken into consideration as ceftriaxone is a standard treatment for several bacterial infections in children and is being prescribed at a regular basis in many countries. In fact, a clinical study performed in a secondary care hospital of Karachi, Pakistan, declared it the most frequently prescribed antibiotic.3 Physicians should prescribe ceftriaxone with caution. Ceftriaxone should be avoided in neonates especially those with hyperbilirubinemia. Caution must be advised for the use of intravenous ceftriaxone with intravenous calcium containing solutions as their concomitant use can lead to life threatening adverse reactions.4 Patient should seek medical help if they experience diarrhea, jaundice, confusion, headache, heart palpitations etc. Similar drugs with a safer adverse effect profile should be considered as a future alternative. Continuous..

Colonic obstruction secondary to gallstone ileus

Gallstone ileus is a rare complication of biliary lithiasis that occurs by the formation of some fistula (or fistulas) between the vesicular wall and the gastrointestinal tract, which could lead to intestinal obstruction. The treatment should be individualized according to the characteristics of the patient. Although there are other therapeutic options, surgery is the most appropriate treatment in most of the cases. We present the case of an impacted gallstone ileus in the sigmoid colon of 85-year-old patient with multiple comorbidities. The patient was operated urgently through an infra-umbilical laparotomy performing enterotomy on tapeworm, extraction of the calculus and exteriorization of colostomy in shotgun barrel. The final result was death. A review of the literature is carried out on the case.

Impacto de la afectación hepatobiliopancreática y el estatus nutricional en la sobrevida de adultos con fibrosis quística

The increase survival of adult patients with Cystic Fibrosis (CF) has generated a greater relevance of extra pulmonary disease. Objective. Determine digestive, nutritional commitment and its impact on the survival of adult patients with CF. Methods. Retrospective, descriptive and comparative study of 100 adult patients with CF, assisted between 2003 and 2017. It was evaluated: clinical parameters, genetic, body mass index (BMI), respiratory function tests, bacteriological sputum, pancreatic insufficiency (PI), CF-related diabetes (CFRD), acute pancreatitis (AP), liver cirrhosis and biliary lithiasis. Results. 100 patients were evaluated [median age: 26 years (range: 16-65)]. Median age at diagnosis: 2 years. Mean BMI 21.5 ± 2.6 SD kg/m2. PI 69/100 (69%), CFRD 29 patients (29%), AP 4 patients (4%). Liver cirrhosis 6 patients (6%) and biliary lithiasis 21 patients (21%).Median Forced Expiratory Volume in first second (FEV1) 50%. Most frequent mutation ΔF508 (54%). Fourteen patients (14%) malnourished. Pseudomonas aeruginosa was the most frequent colonizing microorganism (67%), with a median overall survival of 160 months (95% CI 131-160). We found lower survival in those patients who had PI [(mean 124.2 vs. 136 months (p = 0.4)], malnutrition [median 60 vs. 160 months (p = 0.001)] and cirrhosis [median 36 vs. 160 months (p = 0.003).] Conclusion. Digestive diseases and malnutrition influence negatively in the survival of adult patients with CF.

Results of combiation of laparoscopic cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (ERCP) simultaneously

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi cắt túi mật kết hợp nội soi mật tụy ngược dòng điều trị sỏi đường mật đồng thời trong cùng một thì gây mê. Phương pháp nghiên cứu: Nghiên cứu hồi cứu, mô tả cắt ngang với 88 bệnh nhân có sỏi túi mật và sỏi đường mật được phẫu thuật nội soi (PTNS) cắt túi mật kết hợp nội soi mật tụy ngược dòng (NSMTND) điều trị sỏi đường mật đồng thời từ 1/2015 đến 11/2017 tại Bệnh viện Nhân dân 115. Kết quả: Tuổi trung bình là 59,8 ± 15,0; tỉ lệ nữ 59,1%; tỉ lệ có bệnh mạn tính kèm theo 40,9%. Thời gian PTNS cắt túi mật và NSMTND lấy sỏi 123,1 ± 33,4 phút. Tỉ lệ thành công 93,2%, sạch sỏi 87,8%. Tai biến phẫu thuật 0%, biến chứng sớm 12,4%, tử vong 0%. Thời gian nằm viện sau phẫu thuật trung bình 4,2 ± 2,8 (2 – 20 ngày). Kết quả ra viện tốt 78,4%, khá 14,8%, trung bình 6,8%. Kết luận: Kết quả phẫu thuật nội soi cắt túi mật và nội soi mật tụy ngược dòng điều trị sỏi đường mật đồng thời là khả thi và an toàn. Abstract Introduction: To evaluate the results of the gallbadder and bile duct gallstone patients were treated with laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography ERCP in removing the stones when the patients were undergoing the same general anesthesia. Material and Methods: Cross-sectional retrospective study was conducted on 88 patients treated with laparoscopic cholecystectomy and ERCP to remove the stones under the same general anesthesia from January 2015 to November 2017 at the 115 Peoples Hospital. Results: The mean age of patients was 59.8 ± 15 years; the female was 59.1%; there were 40.9% of the patients with comorbidities. The mean operating time of laparoscopic and ERCP was 123.1 ± 33.4 minutes. The rate of successful surgeries was 93.2%, clearing stones was 87.8%. The rate of accident during the operation was 0%, early post-operative complications was 12.4%, death was 0%. The hospital stay after operating was 4.2 ± 2.8 (2 – 20 days). Outcomes classified when discharge were good 78.4%, rather good 14.8% and morderate 6.8%. Conclusion: The results of the gallbadder and bile duct gallstone patients treated with laparoscopic cholecystectomy and ERCP to remove the obstructive stones in the same general anesthesia were safe and feasible. Keywords: Gallstone, biliary lithiasis, laparoscopic cholecystectomy, endoscopic retrocholangiopancreatography.

Transjejunal laparoscopic-assisted ERCP in Roux-en-Y patient: the new right path

The incidence of biliary lithiasis after gastric surgery seems to be higher than in the general population. Endoscopic retrograde cholangiopancreatography (ERCP) allows several biliary and pancreatic pathologies to be dealt with; however, in patients with an altered anatomy of the upper and mid gastrointestinal tract, this endoscopic manoeuvre can be extremely challenging. We report a case of a 79-year-old woman with previous subtotal gastrectomy and Roux-en-Y reconstruction, admitted with a diagnosis of cholecystitis and choledocolithiasis. She was successfully treated with transjejunal laparoscopic-assisted ERCP and laparoscopic cholecystectomy, which appears to be a safe and useful procedure for choledocolithiasis treatment in patients with surgically altered anatomy.

PREVALENCE OF BACTERIOBILIA IN PATIENTS UNDERGOING ELECTIVE COLECYSTECTOMY

ABSTRACT Background: Cholelithiasis is one of the diseases with greater surgical indication. Currently, laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis. Aim: To analyze the culture of bile from patients with cholelithiasis, mainly in the occurrence of brown and mixed stones. Methods: Was carried out a prospective study with 246 cases with biliary lithiasis who underwent elective laparoscopic cholecystectomy. Bile culture was performed in all. During anesthetic induction the patients received a single dose of intravenous cefazolin 1 g. At the end of the surgery, the gallbladder was punctured, its contents extracted and immediately placed in a sterile 20 ml propylene flask and promptly sent to bacterioscopy with Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A protocol was elaborated to include the main factors potentially related to cholelithiasis and the possible presence of associated bacterial infection. Results: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45 patients with bacteriobilia, 34 had growth of a single type of bacterium in bile culture and 11 more than one. Conclusions: It was observed a relationship between bacteriobilia and age, suggesting that age is a risk factor for bacteriobilia. The use of antibiotic prophylaxis in the elderly is therefore recommended.

Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy

Background and study aims Endoscopic retrograde cholangiography (ERC) in patients with complex surgically-altered anatomy (SAA) is technically demanding and has limitations. Developments in EUS-guided procedures allow alternative approaches for patients with altered gastrointestinal anatomy and biliary lithiasis. Patients and methods Single-center, retrospective review of prospectively entered patients with SAA who underwent EUS-guided hepaticogastrostomy (HGS) followed by an interval antegrade endoscopic clearance of biliary lithiasis. Results 9 patients with Roux-en-Y anatomy underwent HGS to allow clearance of biliary lithiasis after a mean of 2.5 procedures. Technical success was achieved in 100 % of patients utilizing subsequent antegrade endoscopic techniques after HGS including: balloon sweep (9), transpapillary balloon dilation (8), cholangioscopy with electrohydraulic lithotripsy (4), and mechanical lithotripsy (1). HGS stents were removed in all patients. 1 adverse event (cholangitis) occurred after cholangioscopy and prolonged intraductal electrohydraulic lithotripsy. Conclusion EUS-guided antegrade therapy for the management of biliary lithiasis in patients with altered gastrointestinal anatomy appears efficacious with a low risk of adverse events. These preliminary results suggest this approach should be considered at centers with available expertise.