Hemobilia with acute pancreatitis secondary to biliary tract infection

Hemobilia is a rare medical condition with variety of etiologies.Among them,two in thirds are iatrogenic.Hemobilia combined with acute pancreatitis is unusual.Herein we reported a case of hemobilia with acute pancreatitis secondary to biliary tract infection.A 76-year-old male patient had intermittent abdominal pain for 2 days,which was aggravated for 1 day.He was admitted to the Emergency Department on August 29,2017.The patient developed paroxysmal abdominal pain after consuming greasy foods,accompanied by nausea.The physical examination revealed the following:temperature 37.0°C,pulse 76 bpm,respiratory rate 19 per minute,blood pressure 164/77 mmHg;no jaundice;abdominal distention;and mild total abdominal tenderness,mainly located in the left upper abdomen.Murphy’s sign was positive.Urgent abdominal ultrasound showed postprandial gallbladder emptying,gallbladder stones,unclear gallbladder cavity,and focal hepatic lesions.Hemangioma was suggested.The intrahepatic bile duct was mildly dilated,and the abdominal and pelvic cavity showed no obvious accumulation of fluid.The laboratory findings were as follows:serum amylase 922.1 U/L,white blood cell count 18.2×109/L(neutrophils,83.4%),and hemoglobin 13.8 g/dL.

Impact of body mass index on short-term outcomes of laparoscopic gastrectomy in Asian patients: A meta-analysis

AIM To perform a meta-analysis to investigate the correlation between body mass index(BMI) and the shortterm outcomes of laparoscopic gastrectomy(LG) for gastric cancer(GC) in Asian patients. METHODS The Pub Med, Cochrane, EMBASE, and Web of Science databases were searched for studies that focused on the impact of obesity on the short-term outcomes of LG for GC in Asian patients who were classified into a high BMI(BMI ≥ 25 kg/m^2) or low BMI group(BMI < 25 kg/m^2). The results are expressed using the pooled odds ratio(OR) for binary variables and standard mean difference(SMD) for continuous variables with 95%confidence interval(CI), and were calculated according to the fixed-effects model while heterogeneity was not apparent or a random-effects model while heterogeneity was apparent.RESULTS Nine studies, with a total sample size of 6077, were included in this meta-analysis. Compared with the low BMI group, the high BMI group had longer operative time(SMD = 0.26, 95%CI: 0.21 to 0.32, P < 0.001), greater blood loss(SMD = 0.19, 95%CI: 0.12 to 0.25, P < 0.001), and fewer retrieved lymph nodes(SMD =-0.13, 95%CI: 0.18 to 0.07, P < 0.001). There was no significant difference between the high and low BMI groups in postoperative complications(OR = 1.12, 95%CI: 0.95 to 1.33, P = 0.169), the duration of postoperative hospital stay(SMD = 0.681, 95%CI:-0.05 to 0.07, P = 0.681), postoperative mortality(OR = 1.95, 95%CI: 0.78 to 4.89, P = 0.153), or time to resuming food intake(SMD = 0.00, 95%CI:-0.06 to 0.06, P = 0.973).CONCLUSION Our meta-analysis provides strong evidence that despite being associated with longer operative time, greater blood loss, and fewer retrieved lymph nodes, BMI has no significant impact on the short-term outcomes of LG for GC in Asian patients, including postoperative complications, the duration of postoperative hospital stay, postoperative mortality, and time to resuming food intake. BMI may be a poor risk factor for shortterm outcomes of LG. Other indices should be taken into account.