China
Africa
Explore chapters and articles related to this topic
Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Presence of gallstone(s) impacted in the common bile duct. Diagnosis often made in conjunction with acute cholecystitis (see earlier section), but can be present alone. Typically detected using hepatic function panel and ultrasound.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Acute pancreatitis can be divided into mild and severe or necrotizing pancreatitis. The presenting signs and symptoms of pancreatitis in pregnant patients are similar to those in the nonpregnant population. Characteristic symptoms include acute abdominal pain radiating to the back and associated with nausea and vomiting. Abdominal pain may worsen while lying flat or improve after assuming a forward or fetal position. Obstruction of the common bile duct as it courses through the head of the pancreas can lead to jaundice. Fever, pleuritic pain, and shock may result from peripancreatic fluid collection and pancreatic parenchymal hemorrhage. Physical examination may reveal epigastric tenderness, guarding and rebound, decreased, or absent bowel sounds, ecchymosis of the flank (Grey-Turner’s sign) or periumbilical region (Cullen’s sign) and ascites. Several other diseases such as duodenal ulcer perforation, cholecystitis, hepatitis, bowel obstruction, diabetic ketoacidosis, and pre-eclampsia may share a similar presentation (122).
Intraoperative Cholangiogram Shows <1 cm Stone at the Lower End
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
There are several clinico-pathological scenarios that may occur with common bile duct stones (Table 27.1). Each of these have a specific clinical presentation. Common bile duct stones may be completely asymptomatic. Obstruction by the common bile duct may simply cause biliary pain and associated with an acute elevation of liver enzymes (Table 27.2). A higher grade of obstruction may be associated with clinical jaundice; however, bilirubin levels seldom exceed 120 umol/L (normal range 3–15) with obstructive stone disease. Common bile duct obstruction may be associated with secondary bacterial infection (Escherichia coli or other gram-negative bacteria) with associated acute cholangitis. Cholangitis may range in severity from mild infection with minimal systemic response to severe overwhelming sepsis. Severity is graded according to the Tokyo guidelines and the severity determines subsequent management (Table 27.3).
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
On the other hand, endoscopic transpapillary gallbladder drainage (ETGBD) is considered an alternative therapy in patients with acute cholecystitis [7]. Several reports have revealed the efficacy and safety of ETGBD, including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) [8–11]. ETGBD has the following advantages over PTGBD: 1) feasibility in patients with ascites or coagulopathy, 2) internal drainage can be considered, and 3) treatment of common bile duct stones (CBDs) and acute cholangitis can be performed in the same session as endoscopic retrograde cholangiopancreatography (ERCP). However, the reported technical success rate of ETGBD was 64–100%, which is lower than that reported for PTGBD [12]. Additionally, ETGBD carries the risk of ERCP-related adverse events, such as pancreatitis. Moreover, ETGBD may result in cystic duct injury as a specific adverse event during the procedure when a device, such as a guidewire, cannula, or stent, is advanced through the cystic duct.
Comparison of Patient Outcomes and Safety between Overlapping and Nonoverlapping Surgeries in Patients Undergoing Laparoscopic Common Bile Duct Exploration
Published in Journal of Investigative Surgery, 2022
Xue Zhang, Jinhui Wang, Fubao Liu, Yong Zhao
Common bile duct stones (CBDS) are the second most frequent complication of common bile duct (CBD) disease, and approximately 1–3% of these patients present with symptomatic gallbladder stones [4,5]. Laparoscopic cholecystectomy combined with laparoscopic CBD exploration (LCBDE), including laparoscopic transcystic stone extraction or laparoscopic choledochotomy (LC), is currently one of the effective and common treatment methods. The overlapping surgery of LCBDE often occurs clinically owning to the increased number of patients that undergo this surgery and presence of some nonimportant parts during the surgery, such as cholecystectomy and skin incision and suture. Over the last several years, researchers have investigated the association between overlapping surgery and the negative clinical outcomes, safety, or costs in different fields, such as the hip and other orthopedic procedures [6,7], pituitary adenoma resection [8], spine surgeries [9], otolaryngology procedures [10], and colorectal operations [11]. However, research comparing the clinical outcomes and safety between overlapping and nonoverlapping surgeries is scarce. Moreover, no related study has analyzed the clinical outcomes and safety of overlapping surgery performed during LCBDE. Therefore, this study aimed to compare the clinical outcomes between patients who underwent overlapping and nonoverlapping surgeries during LCBDE at our center.
Anatomic Variation of the Cystic Artery: New Findings and Potential Implications
Published in Journal of Investigative Surgery, 2021
Li Li, Qiang Li, Mingguo Xie, Wenwei Zuo, Bin Song
Visibility of the cystic artery and cystic duct were assessed, with the goal of evaluating the overall discernable amount of each structure on imaging. Visibility was graded on a scale of 0–2: a score of 2 (excellent visibility) was assigned when the cystic artery was visible through the full length (from the origin to the terminations) of the vessel; a score of 1 (fair visibility) when the cystic artery was visible more than or/and equal one-third of the full length; and a score of 0 (poor visibility) when the cystic artery was visible less than one-third of the full length. Similarly, the common bile duct was determined to be present when a tubular low-attenuation structure (attenuation slightly higher than that of the surrounding fat) was identified; the cystic duct had a similar attenuation and confluence to the common bile duct [25]. Visibility of the cystic duct was also graded on a scale of 0–2: We assigned a score of 2 (excellent visibility) when the cystic duct was visible through the full length (from the origin to the terminations); a score of 1 (fair visibility) when the cystic duct was visible more than or/and equal one-third of the full length; and a score of 0 (poor visibility) when the cystic duct was visible less than one-third of the full length.