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Linn-Peirano SC, Hepworth-Warren K, Kinsella H, Diaz-Campos D, Brenseke BM, Cianciolo RE, Schroeder E, Schreeg ME. Ingesta-associated choledocholithiasis in horses: 2 cases and literature review. J Vet Diagn Invest 2023; 35:417-424. [PMID: 37232550 PMCID: PMC10331394 DOI: 10.1177/10406387231177251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Equine ingesta-associated choledocholithiasis is a rare cause of morbidity and mortality. We describe here the clinical, gross, histologic, and microbiologic features of this condition in 2 horses and compare the features to 2 previous cases. Case 1 was a 4-y-old Thoroughbred mare with colic. Case 2 was an 18-y-old American Paint Horse mare with colic, chronic weight loss, and inappropriate mentation. Both had elevated biochemical markers of hepatocellular injury and cholestasis and were euthanized given a poor prognosis. Case 1 had a well-formed 5-cm choledocholith surrounding a piece of hay, and had chronic neutrophilic cholangiohepatitis, bridging fibrosis, and extrahepatic obstruction. Case 2 had an ill-formed choledocholith with occasional hay fragments, wood stick, and twigs, and had regionally extensive hepatocellular necrosis with mild neutrophilic cholangiohepatitis and bridging fibrosis. Enterococcus casseliflavus and Escherichia coli were isolated in both cases; Clostridium spp. were also isolated from case 2. All 4 reported cases had increased activity of cholestatic enzymes, hyperbilirubinemia, portal inflammation, and bridging fibrosis. Colic, pyrexia, leukocytosis with neutrophilia, and elevated hepatocellular enzyme activity were documented in 3 cases. Foreign material in all 4 cases was plant origin (choledochophytolithiasis), including hay (n = 2), sticks/twigs (n = 2), and grass awns (n = 1). Ingesta-associated choledocholithiasis may be considered as a cause of colic, pyrexia, and elevated cholestatic biomarkers in horses.
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Affiliation(s)
| | - Kate Hepworth-Warren
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Hannah Kinsella
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Bonnie M. Brenseke
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, NC, USA
| | - Rachel E. Cianciolo
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
- Zoetis, Parsippany, NJ, USA
| | - Eric Schroeder
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Megan E. Schreeg
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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2
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Bathobakae L, Mahmoud A, Wilkinson T, Melki G, Cavanagh Y, Siau K. Pain in the Gut: An Intriguing Case of Toothpick Ingestion Causing Gastric Perforation. J Investig Med High Impact Case Rep 2023; 11:23247096231211056. [PMID: 37942559 PMCID: PMC10637146 DOI: 10.1177/23247096231211056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Toothpick ingestion is a medical emergency requiring urgent intervention. Swallowed toothpicks can cause intestinal perforation, bleeding, or damage to the surrounding organs. Herein, we describe a unique case of a geriatric patient with a history of peptic ulcer disease who presented to the emergency department for the evaluation of abdominal pain and nausea. Gastric wall thickening concerning for a gastric neoplasm was observed on a computed tomography (CT) scan of the abdomen and pelvis. An esophagogastroduodenoscopy (EGD) revealed an embedded toothpick with a contained gastric perforation, and the foreign body was retrieved with a grasper device. Given the rare presentation, nonspecific symptoms, inability to recall, and often inconclusive imaging, a high index of suspicion is needed for early diagnosis and treatment of toothpick ingestion.
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Affiliation(s)
| | - Anas Mahmoud
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | | | - Gabriel Melki
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Yana Cavanagh
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Keith Siau
- Royal Cornwall Hospitals NHS Trust, Truro, UK
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3
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Chen C, Peng Y, Yang S, Tung C. Migration of bird feather into bile duct mimicking bile duct stone recurrence: first ever case report. ADVANCES IN DIGESTIVE MEDICINE 2022. [DOI: 10.1002/aid2.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chia‐Chang Chen
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital Taichung Taiwan
| | - Yen‐Chung Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital Taichung Taiwan
| | - Sheng‐Shun Yang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital Taichung Taiwan
- School of Medicine, National Yang‐Ming University Taipei Taiwan
| | - Chun‐Fang Tung
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital Taichung Taiwan
- School of Medicine, National Yang‐Ming University Taipei Taiwan
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A case of successful removal of a migrated fish bone in the bile duct after pancreaticoduodenectomy using overtube-assisted cholangioscopy. Clin J Gastroenterol 2022; 15:493-499. [DOI: 10.1007/s12328-021-01579-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
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Pezzoli A, Cifalà V, Pizzo E, Solimando R, Simone L, Arena R, Merighi A. Denture as an unexpected cause of obstructive jaundice. Endoscopy 2021; 53:E472-E473. [PMID: 33540442 DOI: 10.1055/a-1327-1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
| | - Viviana Cifalà
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - Riccardo Solimando
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
| | - Loredana Simone
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
| | - Rosario Arena
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
| | - Alberto Merighi
- Department of Gastroenterology and GI Endoscopy, University Hospital Sant'Anna, Ferrara, Italy
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Kunovsky L, Tesarikova P, Sethi A, Kroupa R, Dastych M, Dolina J, Kala Z, Trna J. Unusual Biliary Complication following Christmas Eve Dinner. Dig Dis 2021; 39:549-552. [PMID: 33486478 PMCID: PMC8491467 DOI: 10.1159/000514645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/13/2021] [Indexed: 02/02/2023]
Abstract
We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.
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Affiliation(s)
- Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia,*Lumir Kunovsky, lumir.kunovsky*gmail.com
| | - Pavla Tesarikova
- Department of Internal Medicine, Hospital Boskovice, Boskovice, Czechia
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York, USA
| | - Radek Kroupa
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Milan Dastych
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiri Dolina
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdenek Kala
- Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Trna
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia,Department of Internal Medicine, Hospital Boskovice, Boskovice, Czechia
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A case of a common bile duct stone that formed around a fish bone as a nidus after distal gastrectomy with Roux-en-Y reconstruction. Surg Case Rep 2021; 7:58. [PMID: 33630177 PMCID: PMC7907409 DOI: 10.1186/s40792-021-01142-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background The presence of a foreign body in the common bile duct (CBD) is a rare phenomenon. Thus, the route and mechanism of its migration remain difficult to fully clarify, especially for cases that occur after gastrectomy with Roux-en-Y reconstruction. Herein, we present a case of a CBD stone that formed around a fish bone as a nidus subsequent to distal gastrectomy with Roux-en-Y reconstruction. Case presentation A 70-year-old man was admitted to our hospital due to repeated episodes of epigastralgia. He had undergone distal gastrectomy with Roux-en-Y reconstruction for gastric cancer approximately 10 years prior. Blood tests revealed obstructive jaundice, hepatobiliary dysfunction, and inflammation. Multi-plane reconstructed computed tomography (CT) revealed a CBD stone with a needle-shaped calcification density at the center, oriented along the length of the CBD. Surgery was performed using an upper median laparotomy approach. Lithotomy with choledochotomy was performed to remove one fragile bilirubin stone that had formed around a 3-cm, needle-shaped fish bone. A choledochoduodenal fistula was not detected intraoperatively. A review of the imaging of a prior examination revealed that the formation of the CBD stone around the fish bone was observable on a follow-up CT performed approximately 2 years prior. However, no clinical symptoms associated with the migration of the fish bone to the CBD were reported and the fish bone was not detected at that time. Conclusion In this case, transpapillary migration of the fish bone could only be speculated in the absence of an observable fistula, choledochostomy, or any clinical symptoms. Our case is clinically relevant as cholangitis developed after CBD stone formation around the fish bone that acted as a nidus.
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Yi L, Cheng Z, Zhou Y, Wang Q, Liu Y, Liu K, Wang T, Zhong X. Fishbone foreign body ingestion in duodenal papilla: a cause of abdominal pain resembling gastric ulcer. BMC Gastroenterol 2020; 20:323. [PMID: 33008291 PMCID: PMC7532595 DOI: 10.1186/s12876-020-01475-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background Foreign body ingestion is a common clinical problem. The upper esophagus is the most common site of foreign body, accounting for more than 75% of all cases, but cases with a foreign body in the duodenal papilla or common bile duct are rarely reported. Case presentation Herein, we report a rare case that a patient’s abdominal pain resembling gastric ulcer was caused by a 3 cm long fishbone inserted into the duodenal papilla. Conclusion Fishbone inserted into the duodenal papilla can cause an abdominal pain resembling gastric ulcer. Endoscopy is useful for the diagnosis and treatment of fishbone ingestion in clinical.
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Affiliation(s)
- Lizhi Yi
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China.
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yafei Zhou
- Department of Anesthesiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Qin Wang
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Yangyang Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Ke Liu
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Tao Wang
- Department of Radiology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
| | - Xianfei Zhong
- Department of Gastroenterology, People's Hospital of Leshan, Leshan, Sichuan, People's Republic of China
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Yu M, Huang B, Lin Y, Nie Y, Zhou Z, Liu S, Hou B. Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature. BMC Gastroenterol 2019; 19:177. [PMID: 31699035 PMCID: PMC6839197 DOI: 10.1186/s12876-019-1088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies. Case presentation We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis. Conclusion The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.
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Affiliation(s)
- Min Yu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Bowen Huang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Ye Lin
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yuxue Nie
- Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zixuan Zhou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Shanshan Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Baohua Hou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China.
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Abstract
We reviewed six cases suspected of having fish bones in the bile ducts on follow-up CT following pancreaticoduodenectomy. The period from surgery to CT examination in which fishbone migration was first suspected ranged from 282 to 1157 days with a median of 517 days. The fish bone in the bile duct disappeared in five out of six cases on subsequent CT. One case was complicated by hepatolithiasis, and the other five cases showed no biliary complications. In two cases, wandering of fish bones in the jejunal limb was observed on CT images before their migration into the bile ducts. Asymptomatic migration of fish bones to the bile ducts following pancreaticoduodenectomy is not rare, but serious complications can occasionally occur. Indications of intervention may be controversial in asymptomatic cases, but once fish bones are observed in the biliary tree or the jejunal limb, dietary instructions advising not to swallow fish bones may be a good option to prevent complications.
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Schreuder AM, van Gulik TM, Rauws EAJ. Intrabiliary Migrated Clips and Coils as a Nidus for Biliary Stone Formation: A Rare Complication following Laparoscopic Cholecystectomy. Case Rep Gastroenterol 2018; 12:686-691. [PMID: 30631253 PMCID: PMC6323409 DOI: 10.1159/000493253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/25/2018] [Indexed: 01/01/2023] Open
Abstract
Clips inserted during laparoscopic cholecystectomy (LC) may migrate into the biliary system and function as a nidus for the formation of gallstones. Here, we present a series of 4 patients who presented with this rare complication 5–17 years after LC. All 4 patients presented with symptomatic choledocholithiasis with biochemical and radiological signs of biliary obstruction. Three patients also had fever and infectious parameters, compatible with concurrent cholangitis. All patients successfully underwent endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy and stone extraction. Patients with cholangitis also had antibiotic treatment. In 3 patients, obstruction of the common bile duct was caused by a single, relatively large stone that had formed around a clip (supposedly the cystic duct clip). In 1 patient, multiple stones had formed around an intrabiliary migrated cluster of coils that had been used for arterial embolization of a pseudo-aneurysm of the right hepatic artery. In conclusion, surgical clips and coils can migrate into the biliary tract and serve as a nidus for the formation of bile duct stones. Although rare, this complication should caution surgeons not to place clips “at random” during cholecystectomy. Patients with this rare complication are best managed by ERCP in combination with sphincterotomy and stone extraction.
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Affiliation(s)
- Anne M Schreuder
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik A J Rauws
- Department of Gastroenterology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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El Asmar A, Papas Y, Hajj I, El Khoury M. Toothpick ingestion and migration into the liver through the colonic hepatic flexure: case presentation, management, and literature review. Clin Case Rep 2018; 6:192-196. [PMID: 29375863 PMCID: PMC5771916 DOI: 10.1002/ccr3.1315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/05/2017] [Indexed: 12/17/2022] Open
Abstract
The approach to toothpick ingestion and its complications should not be underestimated. The surgeon should be prepared for life-threatening situations such as major vascular involvement, as well as highly specialized and technically challenging procedures, when the hepatic hilum is involved for instance. Referral to tertiary centers is sometimes mandatory.
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Affiliation(s)
- Antoine El Asmar
- Saint Georges Hospital University Medical CenterFaculty of MedicineUniversity of BalamandBeirutLebanon
| | - Yasmine Papas
- Saint Georges Hospital University Medical CenterFaculty of MedicineUniversity of BalamandBeirutLebanon
| | - Imad Hajj
- General and Digestive SurgeryBreast Oncologic Surgery and ReconstructionSaint Georges Hospital University Medical CenterFaculty of MedicineUniversity of BalamandBeirutLebanon
| | - Mansour El Khoury
- General and Digestive SurgeryOncologic SurgerySaint Georges Hospital University Medical CenterFaculty of MedicineUniversity of BalamandBeirutLebanon
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