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Infections in Solid Organ Transplant Recipients Admitted to the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Almudena Burillo, Patricia Muñoz, Emilio Bouza
In OLT recipients, intra-abdominal infections may be responsible for 50% of bacterial complications along with significant morbidity [48], including intra-abdominal abscess, biliary tree infection, and peritonitis [49,50]. Risk factors are prolonged duration of surgery, transfusion of large volumes of blood products, choledochojejunostomy (Roux-en-Y) instead of a choledochostomy (duct-to-duct) for biliary anastomosis, repeat abdominal surgery, biliary-tract dehiscence or obstruction, intra-abdominal hematoma, vascular problems in the allograft (e.g., thrombosis of the hepatic artery or ischemia of the biliary tract may condition cholangitis episodes and liver abscesses), previous antibiotic therapy, and CMV infection [51]. Occasionally, complications will appear after a procedure such as a liver biopsy or a cholangiography. These infections may be bacteremic, and OLT recipients show the highest rate of secondary bloodstream infections (BSI) [52]. Most common microorganisms include Enterobacteriaceae, enterococci, anaerobes and Candida spp.
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Choledochojejunostomy will relieve obstructive jaundice in cases not amenable to endoscopic or percutaneous stenting. Cholecystectomy should be considered to prevent the possibility of an acute cholecystitis.
The Pancreas and the Periampullary Area
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Palliative management of pancreatic cancer should be aimed at relieving the obstructive jaundice, the anticipated duodenal obstruction, and the pain. The type of the by-pass procedure continues to be controversial. While some investigators recommend cholecystojejunostomy and claim that it gives the same results as other complicated procedures, it has its limitations. This operation has a slightly higher morbidity. It also cannot be performed if the patient had a previous cholecystectomy or if the cystic duct joins the common duct near the tumor. Roux-en-y choledochojejunostomy is the main acceptable procedure, yet I strongly believe that a choledo-choduodenostomy is very acceptable in those patients who have a short survival.11 Tumors of the periampullary area and the pancreas that extend and invade the duodenum rarely ever cause complete duodenal obstruction preventing the bile flow.
Quality of life after total pancreatectomy with islet autotransplantation for chronic pancreatitis in Japan
Published in Islets, 2023
Tadashi Takaki, Daisuke Chujo, Toshiaki Kurokawa, Akitsu Kawabe, Nobuyuki Takahashi, Kyoji Ito, Koji Maruyama, Fuyuki Inagaki, Koya Shinohara, Kumiko Ajima, Yzumi Yamashita, Hiroshi Kajio, Mikio Yanase, Chihaya Hinohara, Makoto Tokuhara, Yukari Uemura, Yoshihiro Edamoto, Nobuyuki Takemura, Norihiro Kokudo, Shinichi Matsumoto, Masayuki Shimoda
All patients underwent TP, which was performed using the standard technique. The pancreas was often atrophic, fibrotic, hard, and adherent to the surrounding tissue. The splenic artery and/or gastroduodenal artery were preserved until just before pancreatic resection to minimize the warm ischemia time. The spleen was resected in all cases. The pancreas was transported by the two-layer method28 after intraductal organ preservation29 and delivered to the cell processing facility for islet isolation. The gastrointestinal tract was reconstructed by simultaneous gastrojejunostomy and choledochojejunostomy. If necessary, a jejunal tube was placed for postoperative nutritional support. The patient then remained in the operating room with an open abdomen until islet transplantation.
Therapeutic targets for liver regeneration after acute severe injury: a preclinical overview
Published in Expert Opinion on Therapeutic Targets, 2020
Hidenobu Kojima, Kojiro Nakamura, Jerzy W. Kupiec-Weglinski
The impact of cholangitis on liver regeneration and postoperative outcomes was evaluated in 450 patients who underwent preoperative PVE and major hepatectomies [81]. The daily increase rate of nonembolized lobe was significantly lower in patients with cholangitis. There were also significant differences in post-hepatectomy liver failure, prothrombin time, total bilirubin levels, and infectious complications. This study suggested cholangitis might delay and aggravate liver regeneration. In the early phase after 70% PHx, the mRNA levels coding for HGF and EGF were significantly lower while those for IL-6, TNF-α, and toll-like receptor (TLR) 4 were all higher in rats with choledochojejunostomy, resulting in delayed restoration of the liver weight [82]. Cholangitis, common complication with choledochojejunostomy due to intestinal content reflux, might impair liver regeneration. A recent study showed that cholangiocyte senescence impaired the regenerative response of the liver parenchyma with the induction of hepatocyte senescence [83]. This might account for the loss of hepatocyte function in human PBC/PSC patients. Thus, biliary tree pathologies, such as cholangitis, PBC, and PSC might impair parenchymal regeneration.
Benign biliary strictures treated with biodegradable stents in patients with surgically altered anatomy using double balloon enteroscopy
Published in Scandinavian Journal of Gastroenterology, 2020
Outi Lindström, Marianne Udd, Mia Rainio, Hannu Nuutinen, Kalle Jokelainen, Leena Kylänpää
The third patient, 55-year-old female with biliary stones, had laparoscopic cholecystectomy and a biliary injury in 2008. First, a choledochojejunostomy was performed, but because of anastomotic stricture a HJ was done in January 2010. In the beginning of 2018, she had cholangitis and in MRCP a biliary stone and anastomotic stricture were seen. In April 2018, a DBE-ERC with dilation of anastomosis and stone removal was performed. There was still recurrent cholangitis and in October 2018s DBE-ERC was done. An anastomotic stricture was found (Figure 4), and a 10 mm dilation and stenting with three Archimedes stents (diameter 2.6 mm and lengths 2 × 8 cm, 6 cm) were performed (Figures 5 and 6).