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Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Though once considered contraindicated, there is a growing body of literature supporting the safety of laparoscopic cholecystectomy during pregnancy (47,48). SAGES guidelines list laparoscopic cholecystectomy as the procedure of choice in the pregnant patient with gallbladder disease regardless of trimester (13). The procedure is usually performed in the second trimester, but many cases have been reported in the first and third trimesters. Guidelines published by SAGES note that intraoperative cholangiography exposes both the mother and the fetus minimally and may be used selectively intraoperatively during cholecystectomy (13). Pelvic shielding is recommended. Endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction may also be performed during pregnancy (49–51). This may be done pre-, post-, or intraoperatively (13). Candidates for this procedure would be those with known or suspected calculous obstruction of the biliary duct. Fetal irradiation can be minimized by uterine shielding and limitation of fluoroscopy time.
Mucosal manifestations of immunodeficiencies
Published in Phillip D. Smith, Richard S. Blumberg, Thomas T. MacDonald, Principles of Mucosal Immunology, 2020
Scott Snapper, Jodie Ouahed, Luigi D. Notarangelo
Sclerosing cholangitis is often associated with dilated bile ducts. Careful monitoring of infections and of the liver and biliary tract should be included in the management of patients with CD40L deficiency. Search for C. parvum should be restricted to detection of oocysts in the stool but should also be based on molecular detection by polymerase chain reaction. Approaches to cholangiography include endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). These also allow collection of bile fluid for microbiological and molecular analysis. Magnetic resonance cholangiopancreatography can also be used to visualize bile ducts, although it is not as sensitive as ERCP and PTC and may miss minor abnormalities of the third- and fourth-order intrahepatic ducts. It does not carry the risk of ascending infection that is potentially associated with ERCP and PTC. Finally, liver histology is not as sensitive as cholangiography in detecting sclerosing cholangitis.
Biliary obstruction and leaks
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Apart from biliary atresia which presents in the neonatal period, age of presentation is very variable. Although the peak incidence for PSC is in young adults, symptomatic presentation can be quite late. Bile duct stones (see Chapter 9) can mimic bile duct strictures both in their presentation and their appearance on cholangiography (Fig. 10.1). These can occur in the very young when due to haemolytic syndromes, but otherwise tend to be more common in middle age.
Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility
Published in Acta Chirurgica Belgica, 2023
Reza Chinikar, Daniel Patricio, Juliette Gosse, Brigitte Ickx, Myriam Delhaye, Jean Closset, Imad El Moussaoui, Maya Hites, Julie Navez
Even if not observed in our study, bile contamination is known to increase the risk of postoperative infectious complications after PD [11–15]. Mostly asymptomatic preoperatively, bile contamination is fortuitously discovered with the routine intraoperative biliary sample. As observed in the present study, bile infection mainly occurs in patients who underwent PDB, either preoperatively or before neoadjuvant therapy. Performing a sphincterotomy to insert a biliary stent and promote bile flow through the obstructive neoplastic lesion, causes Oddi’s sphincter dysfunction and enables pathogens to ascend the biliary tree. Moreover, injection of contrast agent into the dilated bile duct during cholangiography increases the risk of bile infection, especially with the high intrabiliary pressure. Therefore, PBD should be used cautiously and not performed in all patients with hyperbilirubinaemia, especially because endoscopic procedures can be associated with complications (cholangitis, pancreatitis, perforation) and consequently delay or even prevent the curative surgical procedure [6,7,16]. The recommended threshold value of serum bilirubin for PBD before PD ranges from 14.5 to 17.5 mg/dL [4,16].
Factors associated with acute pancreatitis in patients with impacted duodenal papillary stones: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2022
Ming Li, Ao Wang, Shaohua Ren, Zhenyu Wang, Qing Wang, Chengyue Gou, Weichuan Zhao, Li Zhang, Ning Li
Duodenoscopy was performed with the patient in the left lateral and prone positions under general anesthesia or sedation. The tension of the duodenal papilla and the shape of its orifice were observed when the duodenoscope entered the descending duodenum. High tension was defined as a substantially dilated papilla, disappearance of the papillary folds, and a serosa that appeared smooth and shiny in appearance; low tension was defined as a slightly dilated or non-dilated papilla that had visible folds and a serosa that was not smooth in appearance. Endoscopic sphincterotomy was performed using an arcuate knife or needle-shaped knife according to the ability of the endoscopist to confirm the impaction of a stone in the papilla and the position of the stone. The size of the stone removed by sphincterotomy was measured using the known length of the operating instruments as a scale (the length from the tip to the first mark of both the arcuate knife and needle-knife is 0.5 cm; Figure 1(A,B)). Next, cholangiography was carried out to measure the diameter of the common bile duct and assess whether stones were present in the proximal portion of the common bile duct. Finally, an endoscopic nasobiliary drainage tube or, if necessary, an endoscopic retrograde pancreatic drainage tube were placed.
The Impact of a Surgical Unit’s Structure and Operative Technique on Quality in Two Swedish Rural Hospitals
Published in Journal of Investigative Surgery, 2020
Nina Odelberg, Yücel Cengiz, Arthur Jänes, Joakim Hennings
Hospitals in Sweden have chosen various ways to pursue the training of surgeons. They differ not only in their educational programs but also in the organization of their surgical units. The surgical department in Sundsvall has a section that specializes in the upper gastrointestinal tract (UGI). The UGI unit is responsible for gallbladder surgery and the curriculum, combining simulation training along with structured surgical training. Clinical placement within the section is divided into blocks of 3 to 6 months with a total of around 18 months. During these time blocks, the residents practice LC. In Östersund, gallbladder surgery is spread amongst different sections and surgeons, with no one section having the overall responsibility. This also applies to LC training, which is interspersed within all clinical placements, during the 5-year surgical residency. In both clinics, simulation training was introduced at the end of our study period. A formal “cholecystectomy driver’s license” has been utilized in both departments. It is issued when the surgeon is considered to be independent. Both hospitals use peroperative cholangiography as routine and it was successfully conducted in >90% in both hospitals during the study period.