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Zhao X, Shi L, Wang J, Guo S, Zhu S. The value of endoscopic duodenal papilloplasty with titanium clip in improving post-operative complications of choledocholithiasis. CIR CIR 2024; 92:88-95. [PMID: 38537230 DOI: 10.24875/ciru.23000195] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/29/2023] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications. MATERIALS AND METHODS One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage. RESULTS In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates. CONCLUSIONS The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.
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Affiliation(s)
- Xuan Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lihong Shi
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jinchen Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Siming Guo
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Sumin Zhu
- Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Soria-Navarro B, Mendoza-Palomar N, Juampérez-Gomi J, Melendo S, Mercadal-Hally M, Lung M, Pérez MM, Quintero J, Soler-Palacin P. Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:539-545. [PMID: 36464471 DOI: 10.1016/j.eimce.2021.01.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/27/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose. OBJECTIVE We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. MATERIALS AND METHODS Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019). RESULTS 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. CONCLUSIONS NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
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Affiliation(s)
- Beatriz Soria-Navarro
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Natalia Mendoza-Palomar
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Javier Juampérez-Gomi
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Maria Mercadal-Hally
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - María Mercedes Pérez
- Interventional Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Quintero
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain.
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González-Covarrubias A, Pineda-Tapia IP, Becerril-Hernández JD, Gil-Vargas M. Vesicular agenesis and cholangitis, an infrequent association. Case report. CIR CIR 2021; 89:64-67. [PMID: 34932542 DOI: 10.24875/ciru.21000244] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vesicular agenesis is a rare congenital malformation. CLINICAL CASE Male, 65 years old, preoperative diagnosis of gallbladder agenesis, presenting with cholangitis, unsatisfactory ERCP, resolution by laparotomy, drainage and biliary exploration. DISCUSSION The association between cholangitis and gallbladder agenesis presents few reports in the universal literature, a preoperative diagnosis reduces surgical risk, anatomical alteration represents an increased risk of iatrogenic injury during surgical exploration. CONCLUSIONS Vesicular agenesis, a rare and even more infrequent entity, its association with cholangitis, its preoperative diagnosis, facilitates a surgical plan avoiding iatrogenic injuries.
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Affiliation(s)
- Agustín González-Covarrubias
- Servicio de Cirugía, Hospital General de Puebla Eduardo Vázquez N, Programa Cirugía General Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Irais P Pineda-Tapia
- Servicio de Cirugía, Hospital General de Puebla Eduardo Vázquez N, Programa Cirugía General Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - José D Becerril-Hernández
- Servicio de Cirugía, Hospital General de Puebla Eduardo Vázquez N, Programa Cirugía General Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Manuel Gil-Vargas
- Servicio de Cirugía, Hospital General de Puebla Eduardo Vázquez N, Programa Cirugía General Benemérita Universidad Autónoma de Puebla, Puebla, México
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Soria-Navarro B, Mendoza-Palomar N, Juampérez-Gomi J, Melendo S, Mercadal-Hally M, Lung M, Pérez MM, Quintero J, Soler-Palacin P. Infectious complications of non-surgical biliary tract manipulation in paediatric patients. Role of antibiotic prophylaxis. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00045-8. [PMID: 33715879 DOI: 10.1016/j.eimc.2021.01.019] [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: 09/08/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infections related to non-surgical manipulation of the biliary tract (NSMBT) are common events despite periprocedural antibiotic prophylaxis (PAP). Since June 2017, our local protocol has indicated a 24-h regimen of intravenous piperacillin-tazobactam for this purpose. OBJECTIVE We aimed to describe the incidence and characteristics of NSMBT-related paediatric infections, define risk factors for their development, and analyse adherence to our PAP protocol. MATERIALS AND METHODS Epidemiological, clinical, and microbiological data were collected in consecutive NSMBT procedures performed in paediatric patients (<18 years) in our centre (2010-2019). RESULTS 113 procedures in 37 patients, median age 4 years (IQR 1-8), were included. Main underlying diseases were biliary atresia (32%) and cancer (14%). Sixty-eight percent had undergone liver transplant and 70% hepaticojejunostomy. In 44 procedures (39%), the intervention was performed during the course of infection and previously prescribed antibiotic treatment was maintained. In the other 69, PAP was specifically indicated for NSMBT; antibiotic adequacy increased from 35% to 100% after June 2017. In total, 32 NSMBT-related infections (28%) occurred, mainly in the first 24h post-procedure (72%); no deaths happened. Causative pathogens were Gram-negative rods (64%), Gram-positive cocci (28%), and Candida spp. (8%). Main related risk factors were hepaticojejunostomy, biliary obstruction, and liver transplant. CONCLUSIONS NSMBT in children entails a significant infection risk, even under antibiotic prophylaxis, being hepaticojejunostomy the main risk factor. Infectious complications mainly occurred immediately after the procedure. After establishing a PAP protocol, 100% of interventions received appropriate prophylaxis, decreasing antibiotic exposure time and potentially, the length of hospital stay.
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Affiliation(s)
- Beatriz Soria-Navarro
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Natalia Mendoza-Palomar
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Javier Juampérez-Gomi
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Susana Melendo
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Maria Mercadal-Hally
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - María Mercedes Pérez
- Interventional Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Quintero
- Paediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Inmunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Paediatric Antibiotic Stewarship Program (PROA-NEN), Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain; Vall d'Hebron Barcelona Hospital Campus, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain.
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Aguilar-Espinosa F, Maza-Sánchez R, Vargas-Solís F, Guerrero-Martínez GA, Medina-Reyes JL, Flores-Quiroz PI. Cholecystoduodenal fistula, an infrequent complication of cholelithiasis: Our experience in its surgical management. Rev Gastroenterol Mex 2017; 82:287-295. [PMID: 28389051 DOI: 10.1016/j.rgmx.2016.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/02/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bilioenteric fistulas are the abnormal communication between the bile duct system and the gastrointestinal tract that occurs spontaneously and is a rare complication of an untreated gallstone in the majority of cases. These fistulas can cause diverse clinical consequences and in some cases be life-threatening to the patient. AIM To identify the incidence of bilioenteric fistula in patients with gallstones, its clinical presentation, diagnosis through imaging study, surgical management, postoperative complications, and follow-up. MATERIALS AND METHODS A retrospective study was conducted to search for bilioenteric fistula in patients that underwent cholecystectomy at our hospital center due to cholelithiasis, cholecystitis, or cholangitis, within a 3-year time frame. RESULTS Four patients, 2 men and 2 women, were identified with cholecystoduodenal fistula. Their mean age was 81.5 years. Two of the patients presented with acute cholangitis and 2 presented with bowel obstruction due to gallstone ileus. All the patients underwent surgical treatment and the diagnostic and therapeutic management of each of them was analyzed. CONCLUSIONS The incidence of cholecystoduodenal fistula was similar to that reported in the medical literature. It is a rare complication of gallstones and its diagnosis is difficult due to its nonspecific symptomatology. It should be contemplated in elderly patients that have a contracted gallbladder with numerous adhesions.
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Affiliation(s)
- F Aguilar-Espinosa
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México.
| | - R Maza-Sánchez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - F Vargas-Solís
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - G A Guerrero-Martínez
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - J L Medina-Reyes
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
| | - P I Flores-Quiroz
- Servicio de Cirugía General, Hospital Regional Puebla, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Puebla, México
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Avilés-Martínez KI. [Spondylocostal dysostosis and acute cholangitis in pediatrics emergency room]. Bol Med Hosp Infant Mex 2016; 73:256-267. [PMID: 29421389 DOI: 10.1016/j.bmhimx.2016.04.002] [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: 12/28/2015] [Revised: 04/02/2016] [Accepted: 04/06/2016] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Congenital malformations of the chest wall comprise a heterogeneous group of diseases denominated spondylocostal dysostosis. They have in common developmental abnormalities in the morphology of the structures of the chest and vertebrae with a broad characterization: from mild deformity without functional consequences to life-threatening injuries. We present the case of a girl with spondylocostal dysostosis and acute cholangitis. CLINICAL CASE A 13-month-old girl with severe malnutrition, history of hydrocephalus and myelomeningocele at birth was admitted in the emergency pediatric room with fever and progressive respiratory distress. Clinical assessment revealed ribs and vertebral malformations and acute cholangitis. CONCLUSIONS Complex rib abnormalities consist in deformities of the chest wall, which do not have a specific pattern and are extremely rare. When they are associated with myelomeningocele and hydrocephalus they may be considered as autosomal recessive inheritance spondylocostal dysostosis. The diagnosis is established by clinical assessment and X-rays. Spondylocostal dysostosis identification and complications related to their genetic and molecular causes are still a challenge for clinical pediatricians and the multidisciplinary medical team who treats these patients throughout lifetime.
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Cuendis-Velázquez A, Rojano-Rodríguez ME, Morales-Chávez CE, González Angulo-Rocha A, Fernández-Castro E, Aguirre-Olmedo I, Torres-Ruiz MF, Orellana-Parra JC, Cárdenas-Lailson LE. [Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones]. Rev Gastroenterol Mex 2014; 79:22-7. [PMID: 24629570 DOI: 10.1016/j.rgmx.2013.10.001] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/13/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis. OBJECTIVES To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service. PATIENTS AND METHODS A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency. RESULTS The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min). CONCLUSIONS Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones.
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Affiliation(s)
- A Cuendis-Velázquez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
| | - M E Rojano-Rodríguez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - C E Morales-Chávez
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - A González Angulo-Rocha
- Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México
| | - E Fernández-Castro
- Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México
| | - I Aguirre-Olmedo
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - M F Torres-Ruiz
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - J C Orellana-Parra
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
| | - L E Cárdenas-Lailson
- División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México
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