The liver
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
A subcapsular or intrahepatic haematoma requires no specific intervention and should be allowed to resolve spontaneously. Abscesses may form as a result of secondary infection of an area of parenchymal ischaemia, especially after penetrating trauma. Treatment is with systemic antibiotics and aspiration under ultrasound guidance once the necrotic tissue has liquefied. Bile collections require aspiration under ultrasound guidance or percutaneous insertion of a pigtail drain. The site of origin of a biliary fistula should be determined by endoscopic or percutaneous cholangiography, and biliary decompression achieved by nasobiliary or percutaneous transhepatic drainage or stent insertion. If this fails to control the fistula, the affected portion of the liver may require resection. Late vascular complications include hepatic artery aneurysm and arteriovenous (precipitating acute heart failure if between the hepatic artery and hepatic vein and acute portal hypertension if arteriopor- tal) or arteriobiliary fistulae (resulting in often painful haemo- bilia) (Figure65.12). These are best treated non-surgically by a specialist hepatobiliary interventional radiologist. The feeding vessel can be embolised transarterially.
The Seventeenth Century
Arturo Castiglioni in A History of Medicine, 2019
Regnier degraaf (1641–73) was a Dutch anatomist and physiologist who was celebrated for his work on digestion as well as on the anatomy of the genital organs, vasa deferentia, and the tubules of the testicle (De virorum organis generationi inservientibus, Leiden, 1668). He discovered the ovarian follicle (1672), to which Haller gave the name “Graafian.” In his De natura et usu sued pancreatici (Leiden, 1664) de Graaf demonstrated the function of this organ after collecting the pancreatic juice in an experimental fistula. He also studied the nature of the bile collected in the same way from a biliary fistula. Philip verheyen (1647–1710) was the author of a treatise on anatomy (1693, and a larger edition in 1710) which contained interesting microscopic studies. He maintained that the blood plasma was the really important part of the blood in the nutrition of the body. Frederik dekkers, of Leiden (1648–1720), enjoyed a wide reputation as physician and surgeon, but concerns us more as an early contributor to clinical pathology with his discovery of albumin in the urine (1694), which could be detected by boiling it with acetic acid.
Liver, biliary system and pancreas
Michael Gaunt, Tjun Tang, Stewart Walsh in General Surgery Outpatient Decisions, 2018
Most common causes are secondary to operative trauma. Untreated, the late consequences are liver fibrosis, secondary biliary cirrhosis and development of portal hypertension. Strictures may develop many years after cholecystectomy. Alternatively, damage to the CBD or CHD may present in the immediate post-operative period with development of an external biliary fistula associated with sepsis and development of subphrenic/ subhepatic abscess. Peritonitis may occur and jaundice is often present but may not be severe or progressive. Other causes of bile duct strictures include: penetrating and non-penetrating abdominal injuries, chronic duodenal ulcer, chronic pancreatitis, recurrent pyogenic cholecystitis and parasitic infestations, sclerosing cholangitis.
Risk factors for post-endoscopic retrograde cholangiopancreatography cholangitis in patients with hepatic alveolar echinococcosis—an observational study
Published in Annals of Medicine, 2022
Fei Du, Wenhao Yu, Zhixin Wang, Zhi Xie, Li Ren
The primary endpoint of the analysis was the incidence of post-ERCP cholangitis. It is diagnosed according to the standard dictionary of endoscopic complications [17] issued by the American Society for Gastrointestinal Endoscopy (ASGE). Post-ERCP cholangitis was defined as a postoperative biliary fever (body temperature >38 °C), no preoperative fever, acute cholestasis with no cholecystitis, and other possible infections. The post-surgical biliary fistula was defined as either: fluid with an increased bilirubin concentration in the abdominal drain or the intra-abdominal fluid on or after postoperative day 3; the need for radiologic intervention; grade B bile leakage requiring a change in the patient’s clinical management but manageable without relaparotomy; or a grade A bile leakage lasting for >1 week [18]. The diagnosis of a non-surgical biliary fistula was based on biochemical tests, an imaging examination, or ERCP.
Mucin-producing hepatic cystic neoplasms: an uncommon but challenging disease often misdiagnosed and mismanaged
Published in Acta Chirurgica Belgica, 2020
J. Frezin, M. Komuta, F. Zech, L. Annet, Y. Horsmans, J. F. Gigot, A. Jouret-Mourin, C. Hubert
Surgical procedures were as follows (Table 4): anatomical resection of two benign and two invasive MHCN (cases 1, 2, 8, 9), enucleation of three benign MHCN (cases 4, 5, 6; case 5 had coexistent cryptogenic liver cirrhosis) and of one large bilobar malignant MHCN (case 7). The latter was presumed benign MHCN but high-grade dysplasia (HGD) with focal invasion was detected on final pathology, resulting in retrospective radical R0 resection. Finally, case 3, a unilocular atypical cystic lesion, underwent the unroofing procedure. Bile – within a macroscopically normal-looking cyst – was thought to stem from previous percutaneous cyst aspirations and alcohol sclerotherapy performed elsewhere. The laparoscopic procedure was converted to open surgery for closure of the biliary fistula.
Factors Affecting the Choice of Treatment in Hepatic Hydatid Cyst Surgery
Published in Journal of Investigative Surgery, 2022
Hasan Cantay, Turgut Anuk
In the study, postoperative biliary leakage developed in 7.5% of the patients, and ERCP was applied to these patients. When the radical surgical treatment method was taken as a reference in the study, PAIR increased the state of ERCP implementation and biliary leakage by 29.7 folds, whereas conservative surgical treatment method increased by 3.6 folds. In many studies comparing treatment methods with postoperative biliary fistula and the status of ERCP implementation, a significant difference was found and the number of biliary fistula and ERCP need were found to be higher in patients who underwent conservative surgery [9, 11, 12, 15, 16, 18, 20, 21]. On the other hand, contrary to most studies, in a study in which 34-year data were evaluated (232 cases in total) in Italy, no significant difference was found between treatment methods and postoperative biliary leakage [14].
Related Knowledge Centers
- Anastomosis
- Ascites
- Peritonitis
- Gallstone
- Infection
- Bile Duct
- Bile
- Fistula
- Asymptomatic
- Injury