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
Other surgical approaches have been described. There is a more recent technique, called NOTES (Natural Orifice Transluminal Endoscopic Surgery), in which surgery is performed via a natural occurring orifice. There are no reports of a NOTES cholecystectomy performed during pregnancy. Percutaneous cholecystostomy tube placement is a technique whereby the gallbladder is decompressed with a pigtail catheter placed under ultrasound guidance. It is a helpful management alternative in patients who cannot safely undergo surgery or who have contraindications to anesthesia. However, with the safety and acceptance of laparoscopic cholecystectomy, the role of percutaneous cholecystostomy is not well defined in pregnancy. A few case series and observational studies have suggested that it can be performed safely in all trimesters [32–34]. Peroral endoscopic gallbladder drainage (transmural or trans-papillary) has not been described in the pregnant population.
Hepatobiliary and pancreatic emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
The decision regarding intervention is based on the condition of the patient. Definitive treatment is cholecystectomy, however those who are very unwell may well be too high at risk for a general anaesthetic. In such patients a percutaneous cholecystostomy can be arranged to drain the gallbladder if appropriate. Cholecystectomy can then be considered once the patient's condition improves.
The Gallbladder and Bile Ducts
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
A cholecystostomy is rarely indicated but, if required, as many stones as possible should be extracted and a large Foley catheter (14 Fr) placed in the fundus of the gallbladder with a direct track externally. By so doing, stones retained in the gallbladder can be subsequently extracted with a choledochoscope.
Comment on: Amanitin intoxication
Published in Clinical Toxicology, 2023
Brent A. Neuschwander-Tetri, Anthony J. Scalzo
We are pleased to read the very thorough review of treating amanitin intoxication in a recent issue of Clinical Toxicology [1]. However, we believe an important omission is the effectiveness of removing amatoxins by biliary drainage. Amatoxins undergo extensive enterohepatic recirculation suggesting that disrupting this cycling can be a life-saving intervention [2,3]. This concept was proposed 5 decades ago [4] and described in an earlier case report [5]. The importance of enterohepatic circulation of amatoxins has been challenged based on animal data [2], but there were multiple methodological issues with those animal studies [6]. We demonstrated the effectiveness of biliary drainage in a case report (reference 71 in this review) in which a lethal amount of alpha- and beta-amanitin was removed from a patient over 3 days by continuous nasobiliary drainage [7]. We believe that nasobiliary drainage, an endoscopic procedure, should be considered early in the management of patients with amanitin intoxication. Percutaneous cholecystostomy with continuous bile drainage is another option to achieve this goal that may be considered based on immediately available interventional options.
Non Syndromic Paucity of Interlobular Bile Ducts in Children – A Clinicopathological Study
Published in Fetal and Pediatric Pathology, 2020
Suravi Mohanty, Kanishka Das, Marjorie Maria Anne Correa
The liver function tests are summarized in Table 2; they were suggestive of moderate to severe obstructive jaundice with variable affliction of synthetic and excretory functions. The prothrombin time/INR was grossly deranged in 4 and normal/minimally deranged in 4 others. Hepatobiliary ultrasonography showed an altered hepatic echo texture with visualization of the gallbladder in all. At hepatobiliary scintigraphy, all demonstrated variable hepatic parenchymal dysfunction with severe cholestasis, there was a delayed intestinal radioisotope activity in 7 (Figure 1) and no identifiable gut excretion in 11. At a limited incision laparotomy for a per- operative cholangiogram in 12 (11 without identifiable gut excretion of isotope and case 15 where a ventriculoperitoneal shunt was performed for obstructive hydrocephalus), the livers were uniformly greenish, bile laden, soft to firm and enlarged. There was minimal ascites in two. The per-operative cholangiogram (POC) was normal in 11/12 (Figure 2). In case 16, despite dark green bile aspirated from the gallbladder at initial cannulation, a normal biliary tree could not be demonstrated and hence a cholecystostomy was done and further surgery deferred. After a week, bile flow was clearly documented in the cholecystostomy, a normal cholangiogram demonstrated on a postoperative contrast study and the cholecystostomy removed.
‘Adrenal rush’ in a patient with Neurofibromatosis-1
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Samiha Khan, Beenish Fayyaz, Janki Patel
A 38-year-old female with history of NF-1 (diagnosed at the age of 13) presented to the emergency with right upper-quadrant abdominal pain, progressively worsening over the last 48 hours and associated with nausea and recurrent vomiting. Her vitals at the time of presentation included blood pressure of 224/133 and pulse of 98/min. Apart from typical features of NF-1 (café au lait spots and neurofibromas), the only significant examination findings were signs of dehydration and tenderness in the right upper quadrant of the abdomen. On questioning, she confirmed being diagnosed with hypertension 5 years back but was non-compliant to her medications as none helped improved her BP. She denied being investigated for secondary hypertension while the last anti-hypertensive prescribed to her was labetalol. It is possible if she had been compliant, she may have been diagnosed earlier. Due to concerns for high blood pressure and suspected cholecystitis, she was admitted to ICU for further management. Apart from leukocytosis of 19,000, the rest of her blood workup including bilirubin, liver enzymes and lipase was unremarkable while electrocardiogram had no acute changes. An urgent ultrasound of the abdomen showed cholelithiasis along with pericholecystic fluid suggestive of acute cholecystitis which was confirmed on CT abdomen/pelvis with contrast. She was immediately started on intravenous fluids and antibiotics while the general surgery team was consulted. Due to the patient being very sick, a cholecystostomy tube was placed to decompress the distended inflamed gall bladder.