Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not d...Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct(H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.展开更多
AIM:To compare the outcomes of conservative vs surgical treatment of enterocutaneous fistulae(ECF) in a community teaching hospital over a decade.METHODS:All cases of ECF between 1997 and 2007 were reviewed for manage...AIM:To compare the outcomes of conservative vs surgical treatment of enterocutaneous fistulae(ECF) in a community teaching hospital over a decade.METHODS:All cases of ECF between 1997 and 2007 were reviewed for management strategy.RESULTS:Of the 83 patients with ECF,60(72%) were postoperative.Sixty-six patients(79.5%) were treated initially with conservative measures.Eighteen patients failed to respond to conservative treatment and required later(secondary) exploration;this group consisted of an equal number of low vs high output fistulae.Seventeen(20.5%) patients underwent initial(primary) def initivesurgery secondary to anastomotic leak and peritonitis.Surgical procedures included resection of ECF with anastomosis(24),exclusion(6) and direct-drainage(4).No signif icant difference was seen in the recurrence rate for conservative(10%) vs operative-treatment(20%).role as an initial management in both low and high output fistulae.In selective cases only,early primary exploration is recommended.展开更多
文摘Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct(H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.
文摘AIM:To compare the outcomes of conservative vs surgical treatment of enterocutaneous fistulae(ECF) in a community teaching hospital over a decade.METHODS:All cases of ECF between 1997 and 2007 were reviewed for management strategy.RESULTS:Of the 83 patients with ECF,60(72%) were postoperative.Sixty-six patients(79.5%) were treated initially with conservative measures.Eighteen patients failed to respond to conservative treatment and required later(secondary) exploration;this group consisted of an equal number of low vs high output fistulae.Seventeen(20.5%) patients underwent initial(primary) def initivesurgery secondary to anastomotic leak and peritonitis.Surgical procedures included resection of ECF with anastomosis(24),exclusion(6) and direct-drainage(4).No signif icant difference was seen in the recurrence rate for conservative(10%) vs operative-treatment(20%).role as an initial management in both low and high output fistulae.In selective cases only,early primary exploration is recommended.
