Prenatal sonographic diagnosis of biliary tract malformations

Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital cholelithiasis, and gallbladder duplication. Although most of these malformations are rare and benign conditions, they may occasionally represent a major threat to extrauterine life. Visualization of a normal-sized gallbladder should be a mandatory component of the second-trimester anomaly ultrasound scan. Advances in prenatal sonography enable the detection of biliary tract congenital malformations. In this review, we discuss the detection rates, sonographic features, and prognosis of the most frequently prenatally diagnosed biliary tract malformations.

The very special way of eating for a man with a very short bowel syndrome and an ileostomy

Aim of this study is to present the extraordinary case of a 45-year-old man with very short bowel syndrome and ileostomy, who is currently engaged in a long hospitalization module of life because of the constant need for parenteral nutrition which he has developed due to Crohn's disease treatments. Case presentation: A Russian young man, with low education, a borderline intellectual functioning and a low socio-economic status, was operated numerous times due to breakouts of Crohn's disease. For the last year, he stays mostly in the hospital. Practically he needs constant intravenous parenteral nutrition due to his very short bowel syndrome, otherwise he cannot live outside the hospital. The patient was advised by his surgeon to eat any kind of food but had the limitation to drink not more than 500 ml of water per day, (the rest of water was taken IV). During the first months, the patient seemed willing to do anything needed, but when he started to get tired, he started to drink more than 2 litres of water per day, ignoring his doctor's advice. One of his main problems was that he was able to see that eggs, meat and other food he was eating were very soon appearing in the ileostomy bag and this led him to think that he would die soon. Neither the patient himself nor his wife and relatives asked for help from supervisory bodies of the National Health System and are not at all aware of his need for transplantation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.