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Parkhi M, Joshi R, Kumar M, Sharma A, Mitra S, Kaman L. Biliary adenofibroma: a precursor lesion of intrahepatic cholangiocarcinoma. Autops Case Rep 2023; 13:e2023453. [PMID: 38034524 PMCID: PMC10688199 DOI: 10.4322/acr.2023.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 12/02/2023]
Abstract
Biliary adenofibroma (BAF) is an uncommon liver tumor with a high propensity for malignant transformation. The histomorphology of BAF with malignant transformation can show a spectrum of changes ranging from benign, dysplastic to frank malignancy. Thus, the diagnosis of BAF imposes the pursuit of dysplasia/ malignancy focus. We presented a case of intrahepatic cholangiocarcinoma arising from BAF in a 49-year-old woman with detailed histomorphology. We also performed a PubMed database search and tabulated all previously reported cases of BAF with dysplasia/ malignant transformation. A statistic comparison of age, sex ratio, size of the tumor, and survival following complete resection between BAFs with and without dysplasia/ malignancy from the retrieved data is presented. Our analysis did not highlight any statistically significant difference between BAFs with and without dysplasia/ malignancy in age, sex ratio, tumor size, and survival following complete surgical resection. Our study highlights the histopathology and immunohistochemistry of a case of BAF with malignant transformation and highlights the importance of this diagnosis in management. Further longitudinal studies on a larger cohort of patients are required to validate our findings.
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Affiliation(s)
- Mayur Parkhi
- Post Graduate Institute and Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Rashmi Joshi
- Post Graduate Institute and Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Manish Kumar
- Post Graduate Institute and Medical Education and Research, Department of General Surgery, Chandigarh, India
| | - Aditi Sharma
- Post Graduate Institute and Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Suvradeep Mitra
- Post Graduate Institute and Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Lileswar Kaman
- Post Graduate Institute and Medical Education and Research, Department of General Surgery, Chandigarh, India
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Lu Y, Hu X, Lu Y, Dong X. A crasher in the common bile duct: Ascaris. Asian J Surg 2023; 46:4955-4956. [PMID: 37330301 DOI: 10.1016/j.asjsur.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Yanlin Lu
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang City, China.
| | - Xiaoyan Hu
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang City, China
| | - Yifang Lu
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang City, China
| | - Xiaofang Dong
- Department of Medical Oncology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang City, China
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Navale P, Glickman J, Nasser I, Shia J, Vyas M. Ciliated foregut cysts involving the hepatopancreaticobiliary system: a clinicopathological evaluation with focus on atypical features. J Clin Pathol 2023:jcp-2023-208947. [PMID: 37414562 DOI: 10.1136/jcp-2023-208947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/09/2023] [Indexed: 07/08/2023]
Abstract
AIMS Foregut cystic malformations are rare developmental abnormalities, which may involve the hepatopancreaticobiliary tract (HPBT). These cysts are composed of inner ciliated epithelium; subepithelial connective tissue layer; smooth muscle layer; and an outer fibrous layer. While radiopathologic findings are often diagnostic, atypical location and histologic features can pose a diagnostic challenge. We aimed to study ciliated foregut cysts (CFCs) in the HPBT, assess their clinicopathological features with a focus on atypical features. METHODS We collected cases of CFCs involving the HPBT from three large academic medical centres. H&E-stained slides and immunohistochemical stains (where available) were reviewed for each case. Relevant demographic, clinical and pathological information was collected from the medical records. RESULTS 21 cases were identified. The median age was 53 years (range, 3-78 years). 17 cysts were identified within the liver (segment 4 was the most common location, n=10) and 4 in the pancreas. Cysts were mostly identified incidentally (n=13), abdominal pain was a common symptom (n=5). Cyst size ranged from 0.7 to 17.0 cm (median, 2.5 cm). Radiological findings were available in 17 cases. Cilia were identified in all cases. 19 of 21 cases demonstrated the presence of a smooth muscle layer (thickness, <0.1 mm to 3.0 mm). Three cases showed gastric metaplasia, while one case revealed additional low-grade dysplasia, with features similar to intraductal papillary neoplasm of the bile duct. CONCLUSIONS We highlight clinicopathological features of CFCs in the HPBT. The histomorphology is usually straightforward; however, unusual location and atypical features can pose a diagnostic challenge.
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Affiliation(s)
- Pooja Navale
- Department of Pathology, Washington University in St Louis, St Louis, Missouri, USA
| | - Jonathan Glickman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Imad Nasser
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Monika Vyas
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lemoinne S, Cazzagon N, El Mouhadi S, Trivedi PJ, Dohan A, Kemgang A, Ben Belkacem K, Housset C, Chretien Y, Corpechot C, Hirschfield G, Floreani A, Motta R, Gallix B, Barkun A, Barkun J, Chazouillères O, Arrivé L. Simple Magnetic Resonance Scores Associate With Outcomes of Patients With Primary Sclerosing Cholangitis. Clin Gastroenterol Hepatol 2019; 17:2785-2792.e3. [PMID: 30880273 DOI: 10.1016/j.cgh.2019.03.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/23/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Primary sclerosing cholangitis (PSC) has a variable, often progressive, course. Magnetic resonance cholangiography (MRC) is used in the diagnosis of PSC. Magnetic resonance risk scoring systems, called Anali without and with gadolinium, are used to predict disease progression, determined by radiologic factors. We aimed to assess the prognostic value of Anali scores in patients with PSC and validate our findings in a separate cohort. METHODS We performed a retrospective study of patients with large-duct PSC (internal cohort, 119 patients in France; external cohort, 119 patients in Canada, Italy, and the United Kingdom). All the first-available MRC results were reviewed by 2 radiologists and the Anali scores were calculated as follows: Anali without gadolinium = (1× dilatation of intrahepatic bile ducts) + (2× dysmorphy) + (1× portal hypertension); Anali with gadolinium = (1× dysmorphy) + (1× parenchymal enhancement heterogeneity). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic value of Anali scores was assessed by Cox regression modeling. RESULTS During a total of 549 patient-years for the internal cohort and 497 patient-years for the external cohort, we recorded 2 and 8 liver transplantations, 4 and 3 liver-related deaths, and 26 and 25 cirrhosis decompensations, respectively. In the univariate analysis, factors associated with survival without liver transplantation or cirrhosis decompensation in the internal cohort were as follows: serum levels of bilirubin, aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, alkaline phosphatase, albumin, and Anali scores. Anali scores without and with gadolinium identified patients' survival without liver transplantation or cirrhosis decompensation with a c-statistic of 0.89 (95% CI, 0.84-0.95) and 0.75 (95% CI, 0.64-0.87), respectively. Independent prognostic factors identified by multivariate analysis were Anali scores and bilirubinemia. The prognostic value of Anali scores was confirmed in the external cohort. CONCLUSIONS In internal and external cohorts, we found that Anali scores, determined from MRC, were associated with outcomes of patients with PSC. These scores might be used as prognostic factors.
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Affiliation(s)
- Sara Lemoinne
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Nora Cazzagon
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France; Department of Surgery, Oncology and Gastroenterology - DISCOG, Padova, Italy.
| | - Sanaâ El Mouhadi
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, Department of Radiology, Saint-Antoine Hospital, Paris, France
| | - Palak J Trivedi
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Center, University Hospitals Birmingham and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Anthony Dohan
- Department of Radiology, Montreal, Quebec, Canada; Assistance Publique - Hôpitaux de Paris, Department of Radiology, Hôpital Cochin, Université Sorbonne Paris Cité, Paris-Descartes, Paris, France
| | - Astrid Kemgang
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Karima Ben Belkacem
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Chantal Housset
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Yves Chretien
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Christophe Corpechot
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Gideon Hirschfield
- Institute of Applied Health Research, University of Birmingham, United Kingdom; Toronto Center for Liver Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Annarosa Floreani
- Department of Surgery, Oncology and Gastroenterology - DISCOG, Padova, Italy
| | - Raffaella Motta
- Department of Medicine (DIMED), Institute of Radiology, University of Padova, Padova, Italy
| | | | - Alan Barkun
- Department of Gastroenterology, Montreal, Quebec, Canada
| | - Jeffrey Barkun
- Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Olivier Chazouillères
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, INSERM, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis & Saint-Antoine Research Center, Saint-Antoine Hospital, Paris, France
| | - Lionel Arrivé
- Assistance Publique - Hôpitaux de Paris, Sorbonne University, Department of Radiology, Saint-Antoine Hospital, Paris, France
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Brewer Gutierrez OI, Bekkali NLH, Raijman I, Sturgess R, Sejpal DV, Aridi HD, Sherman S, Shah RJ, Kwon RS, Buxbaum JL, Zulli C, Wassef W, Adler DG, Kushnir V, Wang AY, Krishnan K, Kaul V, Tzimas D, DiMaio CJ, Ho S, Petersen B, Moon JH, Elmunzer BJ, Webster GJM, Chen YI, Dwyer LK, Inamdar S, Patrick VB, Attwell A, Hosmer A, Ko C, Maurano A, Sarkar A, Taylor LJ, Gregory MH, Strand DS, Raza A, Kothari S, Harris JP, Kumta NA, Manvar A, Topazian MD, Lee YN, Spiceland CM, Trindade AJ, Bukhari MA, Sanaei O, Ngamruengphong S, Khashab MA. Efficacy and Safety of Digital Single-Operator Cholangioscopy for Difficult Biliary Stones. Clin Gastroenterol Hepatol 2018; 16:918-926.e1. [PMID: 29074446 DOI: 10.1016/j.cgh.2017.10.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/19/2017] [Accepted: 10/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is not clear whether digital single-operator cholangioscopy (D-SOC) with electrohydraulic and laser lithotripsy is effective in removal of difficult biliary stones. We investigated the safety and efficacy of D-SOC with electrohydraulic and laser lithotripsy in an international, multicenter study of patients with difficult biliary stones. METHODS We performed a retrospective analysis of 407 patients (60.4% female; mean age, 64.2 years) who underwent D-SOC for difficult biliary stones at 22 tertiary centers in the United States, United Kingdom, or Korea from February 2015 through December 2016; 306 patients underwent electrohydraulic lithotripsy and 101 (24.8%) underwent laser lithotripsy. Univariate and multivariable analyses were performed to identify factors associated with technical failure and the need for more than 1 D-SOC electrohydraulic or laser lithotripsy session to clear the bile duct. RESULTS The mean procedure time was longer in the electrohydraulic lithotripsy group (73.9 minutes) than in the laser lithotripsy group (49.9 minutes; P < .001). Ducts were completely cleared (technical success) in 97.3% of patients (96.7% of patients with electrohydraulic lithotripsy vs 99% patients with laser lithotripsy; P = .31). Ducts were cleared in a single session in 77.4% of patients (74.5% by electrohydraulic lithotripsy and 86.1% by laser lithotripsy; P = .20). Electrohydraulic or laser lithotripsy failed in 11 patients (2.7%); 8 patients were treated by surgery. Adverse events occurred in 3.7% patients and the stone was incompletely removed from 6.6% of patients. On multivariable analysis, difficult anatomy or cannulation (duodenal diverticula or altered anatomy) correlated with technical failure (odds ratio, 5.18; 95% confidence interval, 1.26-21.2; P = .02). Procedure time increased odds of more than 1 session of D-SOC electrohydraulic or laser lithotripsy (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P < .001). CONCLUSIONS In a multicenter, international, retrospective analysis, we found D-SOC with electrohydraulic or laser lithotripsy to be effective and safe in more than 95% of patients with difficult biliary stones. Fewer than 5% of patients require additional treatment with surgery and/or extracorporeal shockwave lithotripsy to clear the duct.
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Sadegh Fazeli M, Kazemeini AR, Jafarian A, Bashashati M, Keramati MR. Temporary Trans-jejunal Hepatic Duct Stenting in Roux-en-y Hepaticojejunostomy for Reconstruction of Iatrogenic Bile Duct Injuries. Trauma Mon 2016; 21:e21115. [PMID: 27626003 PMCID: PMC5003501 DOI: 10.5812/traumamon.21115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/12/2014] [Accepted: 07/22/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bile Duct Injuries (BDI) during cholecystectomy are now being recognized as major health problems. OBJECTIVES Herein, we present our experience with handling major BDIs and report long-term outcome of hepaticojejunostomies followed by trans-jejunal hepatic duct stenting performed to reconstruct extra-hepatic biliary tracts. MATERIALS AND METHODS In this case series, we prospectively collected data of 22 patients, who underwent first time biliary reconstruction through Roux-en-y hepaticojejunostomy followed by hepatic duct stenting using a trans-jejunal bifurcated 6F tube drain. The long-term outcome was assessed and defined as excellent (asymptomatic, normal liver enzymes and bilirubin levels), good (asymptomatic, mild abnormality in liver enzyme and bilirubin levels), poor (symptomatic, abnormal liver enzymes and bilirubin level) and failure (requiring reoperation). RESULTS A total of 22 patients including four males (18.1%) and 18 females (81.8%) were evaluated. The mean age was 42.71 (range: 23 - 74) years. Twelve patients had undergone open cholecystectomy (54.5%) and the rest had a history of laparoscopic cholecystectomy. The mean interval between the primary operation and reconstruction was 92.71 days. The mean follow-up period after biliary reconstruction was 42.33 (range: 1 - 96) months. No instance of anastomotic leakage or stenosis, biliary sepsis, thromboembolic event, or respiratory infection was noted in the long-term follow-up. The outcome was excellent in all patients. No case with poor or failure of result was noticed. CONCLUSIONS Although a devastating complication iatrogenic major bile duct injuries can be corrected surgically with a high rate of success. Temporary trans-jejunal stenting of the hepatic ducts can help in maintaining the integrity of anastomosis without stenosis or biliary sepsis.
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Affiliation(s)
| | - Ali Reza Kazemeini
- Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Jafarian
- Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Bashashati
- Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Keramati
- Department of Surgery, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Reza Keramati, Department of Surgery, Imam Khomeini Medical Center, P.O. Box: 13145-158, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9121147406, Fax: +98-2166581657, E-mail:
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Güngör G, Okur N. A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent. Pol J Radiol 2016; 81:170-2. [PMID: 27141238 PMCID: PMC4836307 DOI: 10.12659/pjr.896231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/26/2015] [Indexed: 01/15/2023] Open
Abstract
Background Stent insertion is widely performed to restore biliary drainage in hepatic, biliary, and pancreatic obstructive conditions. Intestinal perforation due to the migration of these stents is an extremely rare late-term complication that is associated with a high rate of mortality. The current report aimed at presenting the radiological findings of a case of extraluminal biliary stent migration into the pelvic region that caused intestinal perforation. Case Report We report a case of an 85-year-old male with a history of previous stent insertion who presented with a sudden – onset severe abdominal pain. An abdominal multidetector computed tomography (MDCT) revealed a tubular foreign body density, compatible with intestinal perforation due to migration of the biliary stent. Conclusions Biliary stent insertion becomes a more common procedure. This serious complication must always be remembered in patients presenting with abdominal pain after stent insertion.
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Affiliation(s)
- Gülay Güngör
- Department of Radiology, Kahramanmaraş Necip Fazıl Şehir Hastanesi, Kahramanmaraş, Turkey
| | - Nazan Okur
- Department of Radiology, Afyon Kocatepe Üniversitesi Tıp Fakültesi, Afyonkarahisar, Turkey
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Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Cohen JH, Naghshizadian I, Gilchrist BF, Farkas DT. Minimally invasive management of biliary tract injury following percutaneous nephrolithotomy. Nephrourol Mon 2015; 6:e19943. [PMID: 25695033 PMCID: PMC4318014 DOI: 10.5812/numonthly.19943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/20/2014] [Accepted: 06/26/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction: Percutaneous nephrolithotomy is generally considered a safe option for the management of large complex or infectious upper urinary tract calculi. Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality, especially in cases where biliary peritonitis develops. All reported cases of biliary tract injury have been managed by either open or laparoscopic cholecystectomy. Case Presentation: Herein for the first time, we report a 39-year old woman with biliary tract injury following percutaneous nephrolithotomy who was managed less invasively by insertion of a percutaneous cholecystostomy tube. The patient was discharged home shortly thereafter, and the tube was later removed at a follow up visit after a normal cholangiogram. Conclusions: Biliary tract injury is a rare and potentially serious complication of percutaneous nephrolithotomy that can even lead to mortality. If a biliary tract injury is suspected during percutaneous renal procedures, diverting the bile away from the leak may resolve the problem without the need for a cholecystectomy. Ideally this can be done with ERCP and a stent, but in cases where this is not technically feasible; a percutaneous cholecystostomy can be successful at accomplishing the same result.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Amir A Rahnemaiazar
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Rozhin Naghshizadian
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Jacob H Cohen
- Department of Urology, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Iman Naghshizadian
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Brian F Gilchrist
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
| | - Daniel T Farkas
- Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, New York, USA
- Corresponding author: Daniel T Farkas, Department of Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York, USA. Tel: +1-7189601243, Fax: +1-7189601370, E-mail:
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Qhalib HA, Zain GH. Hepatobiliary Complications of Sickle Cell Disease among Children Admitted to Al Wahda Teaching Hospital, Aden, Yemen. Sultan Qaboos Univ Med J 2014; 14:e556-e560. [PMID: 25364561 PMCID: PMC4205070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/18/2013] [Accepted: 06/19/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES This study aimed to describe the pattern of hepatobiliary complications among patients with sickle cell disease (SCD) and to assess their correlation with age, gender and other risk factors. METHODS This cross-sectional study assessed 106 patients with SCD who were admitted to Al Wahda Teaching Hospital in Aden, Yemen, between January and June 2009. A full history, thorough examination, essential laboratory investigations (including a complete blood count, liver function test and viral markers test) and an abdominal ultrasound were performed on all patients. The clinicopathological characteristics of the hepatobiliary complications were analysed for their correlation to different risk factors such as age and gender. RESULTS It was found that 46.2% of the patients with SCD had hepatobiliary complications. Of these, 36.7% had viral hepatitis, 26.0% had cholecystitis and 20% had gallstones. A total of 60.4% of the affected patients were male. The mean levels of alanine aminotransferase (59.4 and 56.0 U/L) and aspartate transaminase (40.1 and 38.3 U/L) were significantly elevated in patients with viral hepatitis and cholecystitis, respectively. Hepatitis B virus surface antigen showed higher positivity (10.4%) than anti-hepatitis A and anti-hepatitis C antibodies. Hepatobiliary complications increased significantly with age and were notably higher among those who were often admitted to hospital and/or underwent frequent blood transfusions. CONCLUSION This study suggests that hepatobiliary complications are common among SCD patients and the likelihood of developing such complications increases as patients age. Thus, regular clinical follow-ups, abdominal ultrasound studies and periodic liver function tests, as well as serological tests for viral hepatitis, are strongly recommended. These can help in the early detection of these complications and allow opportunities for their management and prevention.
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Affiliation(s)
- Hana A. Qhalib
- Department of Paediatrics, Faculty of Medicine, Aden University, Aden, Yemen
| | - Gamal H. Zain
- Department of Paediatrics, Faculty of Medicine, Aden University, Aden, Yemen
- Paediatric Haematology & Oncology Unit, Al Wahda Teaching Hospital, Aden, Yemen
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