cholangiography
در نشریات گروه پزشکی-
Volvulus of the gallbladder is among infrequent diseases ranked among acute abdomen conditions. The disease presents with acute biliary ailments, often reminiscent of acute cholecystitis. It is more common in frail elderly women. Its preoperative diagnosis is complicated; therefore, this finding is intraoperatively encountered in most cases. In our case report, we present the case of a female patient where the volvulus of the gallbladder was found as a surprising discovery during surgery. Gallbladder volvulus is a rare disease that presents as acute abdomen. It is most often diagnosed intraoperatively. Cholecystectomy is the most appropriate therapeutic method for this condition.
Keywords: Gallbladder, Cholangiography, Cholecystectom -
Biliary papillomatosis is a disorder characterized by numerous adenomatous polyps of variable distribution and extent in intrahepatic bile ducts. It should be considered as a premalignant condition because a high proportion of the lesions undergo malignant transformation. In this report, we present a patient with abdominal pain and jaundice.
According to his presenting signs and symptoms, ERCP was done for him and multiple biopsies were taken from the common bile duct. Due to high grade dysplasia in the pathological report, Whipple surgery was performed and specimens were sent for microscopic evaluation. Histological examination showed intraductal biliary papillomatosis.Keywords: Common bile duct, Gallbladder, Cholangiography -
BackgroundOpen or laparoscopic surgical exploration of common bile duct (CBD) is performed when endoscopic approaches fail to extract CBD stones. Intraoperative cholangiography (IOC) through T -tube is performed in order to reduce the rate of retained stones. The aim of this study was to evaluate results of CBD exploration without IOC through T-tube and reviewing existing literature.MethodsA retrospective medical chart review of 392 patients who underwent surgical CBD exploration was performed. All patients had proven CBD stones and had previously undergone failed attempts of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES). T -tube insertion or biliary-enteric anastomosis was performed after open CBD exploration with regard to patient’s presentation and CBD diameter. IOC was not performed after T-tube insertion and cholangiography was postponed until 7th postoperative day. Postoperative retained stone and their management were reviewed.ResultsOf 392 patients with CBD explorations, T-tube was placed in 215 (54.8%) including 66 (30.7%) emergent biliary drainage and 149 (69.3%) elective operations. A number of 177 of 392 (45.2%) patients underwent biliary- enteric anastomosis. In 6 of 215 patients (2.8%) with T-tube placement, retained CBD stones were detected by T -tube cholangiography during postoperative period. All of them were treated successfully by ERCP.ConclusionsT-tube placement without IOC is accompanied by a low rate of retained stone. Omitting IOC may decrease the operation time which is especially important in emergent cases. Retained stones following CBD exploration and T-tube placement can be treated successfully using ERCP.Keywords: Common Bile Duct, Cholangiography, Cholangiopancreatography (ERCP), Endoscopic Retrograde, Sphincterotomy, Endoscopic, Gallstones
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BackgroundMagnetic resonance cholangiography (MRC) has gained popularity for diagnosing primary sclerosing cholangitis (PSC). We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC) for diagnosing PSC.Materials And MethodsThis retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated.ResultsA total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male) were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%,20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146). No significant difference was found between imaging modalities with regards to patients’ outcome (P = 0.786) or liver biochemistry at diagnosis or 1-year thereafter (P >0.05).ConclusionStarting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted.Keywords: Cholangiography, diagnosis, magnetic resonance imaging, sclerosing cholangitis, sensitivity, specificity
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BackgroundBiliary complications are significant source of morbidity after liver transplantation (LT). Cholangiography is the gold standard for diagnosis and specification of biliary complications..ObjectivesDetailed analyses of ultrasound (US) as a safe imaging method in this regard are still lacking. Therefore we analyzed systematically the diagnostic value of US in these patients..Patients andMethodsRetrospectively, 128 liver graft recipients and their clinical data were analyzed. All patients had a standardized US examination. The findings of US were compared to cholangiographic results in 42 patients. Following statistical analyses were performed: descriptive statistics, sensitivity, specificity, positive and negative predictive values (PPV, NPV)..Results42 patients had 54 different biliary complications (Anastomotic stenosis (AS) n = 33, ischemic type biliary lesions (ITBL) n = 18 and leakage n = 3). US detected n = 22/42 (52%) patients with biliary complications. The sensitivity, specificity, PPV and NPV of US were: 61%, 100%, 100%, 79% (95CI, 36-86%) for ITBL and 24%, 100, 100%, 31% (95CI, 9-46 %) for AS, respectively..ConclusionsUS examination had no false positive rate. Therefore, it may be helpful as a first screening modality. But for the direct diagnosis of the biliary complication US is not sensitive enough..Keywords: Complications, Liver transplantation, Cholangiography
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