1
|
Gutiérrez-Moreno LI, Trejo-Avila ME, Díaz-Flores A, Dávila-Zenteno MR, Montoya-Fuentes IM, Cárdenas-Lailson LE. Eosinophilic cholecystitis: a retrospective study spanning a fourteen-year period. Rev Gastroenterol Mex (Engl Ed) 2018; 83:405-409. [PMID: 29898861 DOI: 10.1016/j.rgmx.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/13/2017] [Accepted: 01/04/2018] [Indexed: 12/07/2022]
Abstract
INTRODUCTION AND AIMS Eosinophilic cholecystitis is a rare entity that was first described in 1949 and is clinically indistinguishable from calculous cholecystitis. Histologically, there is transmural inflammatory infiltration of the gallbladder wall, more than 90% of which is composed of eosinophils. The aim of the present article was to review the prevalence of eosinophilic cholecystitis and analyze the clinical and surgical characteristics of patients diagnosed with the disease that were operated on at our hospital. MATERIALS AND METHODS A retrospective study was conducted on patients that underwent cholecystectomy and whose postoperative histopathologic diagnosis was eosinophilic cholecystitis, within the time frame of January 2000 and August 2014. The demographic, clinical, paraclinical, surgical, and histopathologic variables were described. RESULTS Over a period of 14 years, a total of 7,494 patients underwent cholecystectomy. Of those patients, 12 had a postoperative histologic diagnosis of eosinophilic cholecystitis. Mean patient age for disease presentation was 39 years (±11 years), and female sex was predominant, with 7 cases. All the patients had concomitant gallstones and 10 patients presented with acute cholecystitis that required urgent cholecystectomy. All the cases were considered idiopathic. We found a prevalence of 0.16%, corresponding to 1 case for every 625 cholecystectomies performed at our hospital. CONCLUSION We found a low prevalence of eosinophilic cholecystitis (0.16%) in our study population. The clinical manifestations were similar to those of calculous cholecystitis. Cholecystectomy is adequate treatment in patients with idiopathic disease.
Collapse
Affiliation(s)
- L I Gutiérrez-Moreno
- Departamento de Cirugía General y Endoscópica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
| | - M E Trejo-Avila
- Departamento de Cirugía General y Endoscópica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México.
| | - A Díaz-Flores
- Departamento de Cirugía General y Endoscópica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
| | - M R Dávila-Zenteno
- Departamento de Cirugía General y Endoscópica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
| | - I M Montoya-Fuentes
- Departamento de Anatomía Patológica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
| | - L E Cárdenas-Lailson
- Departamento de Cirugía General y Endoscópica, Hospital General «Dr. Manuel Gea González», Ciudad de México, México
| |
Collapse
|
2
|
Crisanto-Campos BA, Arce-Liévano E, Cárdenas-Lailson LE, Romero-Loera LS, Rojano-Rodríguez ME, Gallardo-Ramírez MA, Cabral-Oliver J, Moreno-Portillo M. Laparoscopic management of pancreatic pseudocysts: experience at a general hospital in Mexico City. Rev Gastroenterol Mex 2015; 80:198-204. [PMID: 26249139 DOI: 10.1016/j.rgmx.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/21/2015] [Accepted: 05/28/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive management of pancreatic pseudocysts (PP) is currently indicated in those patients with symptoms or complications. Treatment options are classified as surgical (open and laparoscopic) and non-surgical (endoscopic and radiologic). AIM To describe the morbidity, mortality, and efficacy in terms of technical and clinical success of the laparoscopic surgical approach in the treatment of patients with PP in the last 3 years at our hospital center. METHODS We included patients with PP treated with laparoscopic surgery within the time frame of January 2012 and December 2014. The morbidity and mortality associated with the procedure were determined, together with the postoperative results in terms of effectiveness and recurrence. RESULTS A total of 38 patients were diagnosed with PP within the last 3 years, but only 20 of them had invasive treatment. Laparoscopic surgery was performed on 17 of those patients (mean pseudocyst diameter of 15.3, primary drainage success rate of 94.1%, complication rate of 5.9%, and a 40-month follow-up). CONCLUSIONS The results obtained with the laparoscopic technique used at our hospital center showed that this approach is feasible, efficacious, and safe. Thus, performed by skilled surgeons, it should be considered a treatment option for patients with PP.
Collapse
Affiliation(s)
- B A Crisanto-Campos
- Clínica de Cirugía Hepatobiliar y Pancreática del Departamento de Cirugía General, Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México.
| | - E Arce-Liévano
- Departamento de Cirugía Endoscópica, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - L E Cárdenas-Lailson
- Clínica de Cirugía Hepatobiliar y Pancreática del Departamento de Cirugía General, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - L S Romero-Loera
- Departamento de Cirugía General, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M E Rojano-Rodríguez
- Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M A Gallardo-Ramírez
- Departamento de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - J Cabral-Oliver
- Departamento de Cirugía Bariátrica, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| | - M Moreno-Portillo
- Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, Secretaría de Salud, México, D.F., México
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Crisanto-Campos BA, Rojano-Rodríguez ME, Cárdenas-Lailson LE, Gallardo-Ramírez MA, Arrieta-Joffe P, Márquez-Ugalde MA, Moreno-Portillo M. [Laparoscopic drainage of a pancreatic pseudocyst: a case report]. Rev Gastroenterol Mex 2012; 77:148-52. [PMID: 22951042 DOI: 10.1016/j.rgmx.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/25/2012] [Accepted: 04/30/2012] [Indexed: 11/24/2022]
Abstract
Pancreatic pseudocysts are defined as homogeneous pancreatic or peripancreatic collections that are not associated with necrotic tissue and are surrounded by granulated or fibrous tissue with no epithelium. Management has been classified as surgical (conventional and laparoscopic) and nonsurgical (endoscopic and radiologic). The aim of this report is to describe our initial experience in the management of a pancreatic pseudocyst by means of laparoscopic posterior cyst-gastrostomy anastomosis, performed at the Pancreas Clinic of the Hospital General "Dr. Manuel Gea González" in Mexico City. New techniques and instrumentation have contributed to the relatively recent development of laparoscopic pancreatic surgery. Our technique has practical advantages that have been confirmed by other authors, such as simple hemostasis, a wide viewing angle enabling adequate necrosectomy, anastomosis that does not require the use of staples, and the possibility of resolving other associated intra-abdominal pathologies, as in this case.
Collapse
Affiliation(s)
- B A Crisanto-Campos
- Clínica de Páncreas, Departamento de Cirugía General, Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr Manuel Gea González, México DF, México.
| | | | | | | | | | | | | |
Collapse
|
5
|
Vizcarra-Román MA, Bahena-Aponte JA, Cruz-Jarquín A, Vázquez-García JC, Cárdenas-Lailson LE. [Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia]. Rev Gastroenterol Mex 2012; 77:9-14. [PMID: 22450015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. AIMS To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. MATERIAL AND METHODS A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. RESULTS Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups. CONCLUSIONS Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.
Collapse
Affiliation(s)
- M A Vizcarra-Román
- Servicio de Cirugía General, Hospital Regional "Lic. Adolfo López Mateos". Av. Universidad N° 1321. Col. Florida, Delegación Álvaro Obregón, C.P. 01030. México D.F., México.
| | | | | | | | | |
Collapse
|
6
|
Aguirre-Olmedo I, Fernández-Castro E, González-Angulo Rocha JA, Cárdenas-Lailson LE, Beristain-Hernández JL. [Anatomic variants of biliary ducts detected by endoscopio colangiography]. Rev Gastroenterol Mex 2011; 76:331-338. [PMID: 22188958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The gallbladder and bile ducts originate through a complex process during the 4th gestational week; there is a wide variety in their anatomy. OBJECTIVE To identify the type, frequency, and association with certain pathologies of anatomic variations of bile ducts in patients in which endoscopic retrograde colangiography (ERC) was performed. METHODS Six hundred and six patients in whom ERCs were performed from 2005 to 2007 in the Endoscopio Unit at the Hospital General Dr. Manuel Gea González in Mexico City were included. Variations in bile duct anatomy seen in the X-ray taken during ERC were identified. Demographic characteristics of the patients, indications of the study, complications, treatments, and type of anatomic variant were registered. Descriptive statistics were used to analyze the information. X2 and Fisher´s exact test were also performed for the comparison between patients with and without anatomic variations. RESULTS We identified biliary anatomic variations in 5.1% of patients in the study. Among them, seventy- seven per cent were women, with a mean age of 41 years. The anatomic variation most frequently found was a low union of the cystic duct with the common hepatic duct. The main diagnosis during ERC was choledocholithiasis in 71% of patients. Bile duct injuries were found in only 3.2% of patients with anatomic variations. CONCLUSIONS Anatomic variations in bile ducts identified by ERC are frequent in Mexican population; nevertheless they were not associated with the occurrence of bile duct injuries.
Collapse
Affiliation(s)
- I Aguirre-Olmedo
- División de Cirugía General y Endoscópica.Hospital General Dr. Manuel Gea González. México, D. F
| | | | | | | | | |
Collapse
|