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Case report: acute pancreatitis caused by postcholecystectomic hemobilia
Halil Alis, Mehmet A Bozkurt, Osman Z Oner, Kemal Dolay, Ahmet N Turhan, Adem U?ar, Ercan Inci, Ersan Aygun
BMC Gastroenterology , 2010, DOI: 10.1186/1471-230x-10-75
Abstract: We presented the case of a 32-year-old female, admitted to our emergency surgery clinic with hematemesis, jaundice and abdominal pain who had a history of laparoscopic cholecystectomy 4 months ago. Patient was diagnosed as acute pancreatitis and obstructive jaundice caused by postcholecystectomic hemobilia. Afterwards she is successfully treated by ERCP, angiographic identification and embolization of right hepatic artery pseudoaneurysm.We presented that postcholecystectomic hemobilia may cause acute pancreatitis and acute pancreatitis caused by postcholecystectomic hemobilia should also be included to the rare complications which may occur following cholecystectomy.Hemobilia is a rare cause of upper GI bleeding and the reasons for the majority of the cases are iatrogenic. It is also one of the rarest vascular complication following laparoscopic cholecystectomy but acute pancreatitis due to postcholecystectomic hemobilia as a late complication of cholecystectomy is not yet described.We report a case presented with acute pancreatitis caused by the hemobilia as a complication of cholecystectomy.A 32-year-old female presented with complaints of abdominal pain and hematemesis. History revealed that she has been suffering severe right upper quadrant pain for one year which resolved 4 months ago following elective laparoscopic cholecystectomy. Cystic artery and cystic duct was explored during operation and cholecystectomy was completed without any difficulty. Her physical examination revealed jaundice, abdominal tenderness, and melena. Her heart rate was 98/min., blood pressure 100/60 mm/hg and body temperature 36.7 C. Her abnormal blood analysis results were as following; hemoglobin: 6.4 g/dl, hematocrite: 21%, MCV: 70 fl, AST: 435 IU/L, ALT: 220 IU/L, GGT: 256 IU/L, LDH: 400 IU/L, amylase: 2046 IU/L, lipase: 7339 IU/L, total bilirubine: 8.0 mg/dl and direct bilirubine: 6.2 mg/dl.Nasogastric intubation and irrigation confirmed the presence of upper GI bleeding. Ten hours
A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy
Vincenzo Napolitano, Roberto Cirocchi, Alessandro Spizzirri, Lorenzo Cattorini, Francesco La Mura, Eriberto Farinella, Umberto Morelli, Carla Migliaccio, Pamela Del monaco, Stefano Trastulli, Micol Di Patrizi, Diego Milani, Francesco Sciannameo
World Journal of Emergency Surgery , 2009, DOI: 10.1186/1749-7922-4-37
Abstract: We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.Percutaneous transhepatic biliary drainage (PTHBD) is one of the most therapeutic options for the menagement of biliary obstructive disorders, but the use of interventional procedures is associated with an increased incidence of arteriovenous shunting, hepatic artery pseudoaneurysm and vascular stenoses that result in hemobilia[1].The diagnosis of hemobilia may be difficult because of a variety of clinical manifestations and sometimes can be fatal. Its management aims to stopping the bleeding and resolve obstruction. Actually the development of interventional radiology, such as transarterial embolization, has been recognized the first line of procedure to stop hemobilia with a success rate of about 80%-100%, by ensuring that the classic surgery interventions, such as ligation of bleeding vessels or excisions of aneurysms, should be considered fails and burdened by high mortality [2,3].A 60-year-old man came to our observation with intermittent pain localized to upper quadrants of the abdomen, fever (39°C) preceded by thrill, vomiting and signs of peritoneal interesting. Laboratory tests revealed leucocytosis (18300 WBC), and the increment of cholestasis markers, while US scan demonstred an acute cholecystitis with lithiasis, without biliary tree dilatation, and a small liquid flap next to gallbladder.Because of poor conditions, we decided to perform a surgical o
Iatrogenic burns injury complicating neonatal resuscitation
T A Ogunlesi, S B Oseni, J A Okeniyi, J A Owa
West African Journal of Medicine , 2006,
Abstract: A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice. Un cas d'une blessure therminale iatrogénique chez un bébé nouveau né au cours d'une réanimation pour l'asphyxie périnatale dans une centre sanitaire est l'objet de cette étude. La blessure dans les membres inférieurs a une surface d'environ 4%. Cette communication souligne la mauvaise méthode traditionnelle de la réanimation chez des nouveau nés.
Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy  [PDF]
Oliver J. Ziff,A. M. James Shapiro
Case Reports in Surgery , 2013, DOI: 10.1155/2013/695318
Abstract: Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD) revealed large gastric fundal varices and computed tomography (CT) revealed splenic vein thrombosis. The ensuing left-sided (sinistral) hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications. 1. Introduction A 69-year-old male presented with a one-week history of postural hypotension and melena. On physical examination, he appeared anemic, and a digital rectal examination confirmed melena. The examination was otherwise unremarkable, and there was no peripheral stigmata of chronic liver disease. Eighteen months previously he underwent a screening colonoscopy where diverticulosis and 8 polyps were snared, removed, and retrieved, varying in size between 5 and 25?mm. Histopathology confirmed benign tubular, tubulovillous adenomas, and adenomatous polyps. Following that procedure he developed a localized perforation in the area of the splenic flexure, with free air and abscess (Figure 1). This was treated conservatively, and he subsequently appeared to make a full recovery. Figure 1: Perforation showing free air in the peritoneum in the area of splenic flexure. Blood tests confirmed anemia (Hb 121?g/L, PLT 186 × 109?g/L), with normal liver function and prothrombin time. Assessment of his upper gastrointestinal bleed by oesophagogastroduodenoscopy (OGD) revealed large gastric fundal varices. Subsequent computed tomography (CT) of the abdomen with triple-phase contrast demonstrated a cluster of varices in the left upper quadrant (Figure 2). The splenic vein was thrombosed over a narrow segment between the tail of the pancreas and spleen. The ensuing left-sided (sinistral) portal hypertension explains the development of gastric varices in the presence of normal liver function. Since these varices
Hemobilia pós-trauma
Serra, Márcio Canavarros;Fortes, Janayna Cristhina;Teixeira, Roni Leonardo;
Revista do Colégio Brasileiro de Cirurgi?es , 2002, DOI: 10.1590/S0100-69912002000500013
Abstract: our objective is to report a case of a patient, with a thoraco-abdominal gunshot wound with right hemothorax and liver lesion in the right lobe. the liver and the diafragm were sutured and the chest was drained. on the 9th post operative day the patient had hematemesis, jaundice and pain in the right upper quadrant of the abdomen. the abdominal ultrasound image with doppler, revealed arteriobiliary fistulae. the diagnosis of hemobilia was made and the patient underwent embolization of the fistulae by liver arteriography.
Effects of iatrogenic gall bladder perforations during laparoscopic cholecystectomy on postoperative pain and hospital stay  [PDF]
Mustafa Uygar Kalayc?,Bar?? Veli Ak?n,Halil Al??,Selin Kapan
Medical Journal of Bakirk?y , 2006,
Abstract: Objective: In this prospective randomized study, the effects of iatrogenic gall bladder perforations during laparoscopic cholecystectomy on postoperative pain and mean hospital stay were evaluated. Material and Methods: 100 patients of a total number of 515 patients performed laparoscopic cholecystectomy for gallstones between April 2004 and January 2005 were included in this study. Patients were divided into two groups as one group with iatrogenic gall bladder perforations during operation (n: 33) and those without perforation (n: 67). Postoperative pain was assessed by visual analog score (VAS). Students T test and Spearman’s correlation tests were used for the statistical analysis. Results: Female to male ratio of 100 patients was 83/17. Mean postoperative VAS of the perforation group was 4.76±1.458 whereas mean VAS of nonperforated group was 4.73±1.657. Mean hospital stay of perforated and non perforated groups was 1.73±0.944 and 1.82±1.435 days respectively. There was no statistically significant difference between two groups regarding these parameters (p>0.05). Conclusion: Iatrogenic gall bladder perforation during laparoscopic cholecystectomy has no effect on postoperative pain and mean hospital stay.
Hemobilia secondary to chronic cholecystitis
Quinta Frutos,R. de; Moles Morenilla,L.; Docobo Durantez,F.; Soto Pradas,J. A.; Iriarte Calvo,J.; Vázquez Medina,A.;
Revista Espa?ola de Enfermedades Digestivas , 2004, DOI: 10.4321/S1130-01082004000300009
Abstract: the term hemobilia is used to describe the presence of blood in the biliary tract. we report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. we review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. in our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. the clinical condition was resolved by means of a cholecystectomy. the patient had an uneventful recovery.
Pseudo-aneurysm of the hepatic artery after laparoscopic cholecystectomy: A case report  [cached]
Roche-Nagle G,MacEneaney,Harte P
Journal of Minimal Access Surgery , 2006,
Abstract: Iatrogenic injuries to hepatic artery system may evolve to pseudoaneurysms in the late postoperative period. Although rare, pseudoaneurysms after laparoscopic cholecystectomy can occur, are a serious clinical entity and very difficult to detect. We present a case of iatrogenic pseudoaneurysm after laparoscopic cholecystectomy. The onset of symptoms occurred 5 days after an uneventful operation. Endovascular coil embolization for a large pseudoaneurysm was unsuccessful and open surgery was conducted. Review of the literature reveals fifty-four more cholecystectomy-related pseudoaneurysms. The site of injury was the right hepatic artery in 61% of the cases and the presenting symptom was hemobilia in two-third of the patients. Embolization was performed in 82% of the cases and surgery undertaken in the remaining 18%. Knowledge of the condition should result in early diagnosis and thus limit the resultant morbidity. Embolization is the first line of treatment and surgery is reserved for more complex injuries and cases with life-threatening rupture of the aneurysm.
Hemobilia secundaria a colecistitis crónica Hemobilia secondary to chronic cholecystitis  [cached]
R. de Quinta Frutos,L. Moles Morenilla,F. Docobo Durantez,J. A. Soto Pradas
Revista Espa?ola de Enfermedades Digestivas , 2004,
Abstract: The term hemobilia is used to describe the presence of blood in the biliary tract. We report a case of symptomatic hemobilia associated with chronic cholecystitis in a 57-year-old man with jaundice, gastrointestinal hemorrhage, and epigastric pain. We review the etiology of this condition and highlight the role of abdominal ultrasonography in its diagnosis. In our case, abdominal ultrasonography revealed the presence of clots inside the gallbladder. The clinical condition was resolved by means of a cholecystectomy. The patient had an uneventful recovery.
Idiopathic cystic artery aneurysm complicated with hemobilia  [cached]
Utpal Anand,Sanjeev Kumar Thakur,Sanjay Kumar,Achyutanand Jha
Annals of Gastroenterology , 2011,
Abstract: Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a healthy individual who developed hemobilia associated with cystic artery aneurysm. The patient was managed with cholecystectomy and concomitant aneurysm repair. Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization is a common method of treatment for visceral artery aneurysms. Open cholecystectomy and aneurysm repair was performed in our patient due to radiological evidence of associated cholecystitis. Keywords Aneurysm, embolization, cholecystectomy Ann Gastroenterol 2011; 24 (2): 134-136
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