BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complainin...BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.展开更多
Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with s...Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.展开更多
Cholelithiasis-induced cholestasis is one of the most common causes of hospitalization due to gastrointestinal disease,yet considerable knowledge gaps exist in the pathogenesis of this disease.This can partially be ex...Cholelithiasis-induced cholestasis is one of the most common causes of hospitalization due to gastrointestinal disease,yet considerable knowledge gaps exist in the pathogenesis of this disease.This can partially be explained by inadequate characterization of experimental cholestasis models.Here,we compared the transcriptional profile of commonly used mouse models for obstructive cholestasis and benchmarked them to human disease to identify the model(s)best suited for cholelithiasis-induced cholestasis research and to uncover conserved mechanisms involved in human and murine cholestasis.展开更多
BACKGROUND Paracoccidioidomycosis(PCM)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making i...BACKGROUND Paracoccidioidomycosis(PCM)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making investigation and treatment challenging.AIM To investigate the management of patients with visceral PCM admitted with EHC.METHODS All patients diagnosed with PCM treated in a public,tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated.Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical,laboratory,and imaging findings,resources used for etiological diagnosis,treatment results,and prognosis.Statistical analyses were performed using the linear mixed-effects model(random and fixed effects),which was adjusted using the PROC MIXED procedure of the SAS®9.0 software,and Fisher’s exact test.RESULTS Of 1645 patients diagnosed with PCM,40(2.4%)had EHC.Of these,20(50.0%)lived in the rural area and 29(72.5%)were men,with a mean age of 27.1 years(3-65 years).Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients(40.0%),and a mass in the head of the pancreas was observed in 8(20.0%).The etiological diagnosis was made by tissue collection during surgery in 4 cases(10.0%)and by endoscopic methods in 3 cases(7.5%).Twenty-seven patients(67.5%)received drug treatment alone(Group 1),whereas 13(32.5%)underwent endoscopic and/or surgical procedures in combination with drug treatment(Group 2).EHC was significantly reduced in both groups(40.7% in Group 1,with a mean time of 3 months;and 38.4% in Group 2,with a mean time of 7.5 months),with no statistically significant difference between them.EHC recurrence rates,associated mainly with treatment nonadherence,were similar in both groups:37% in Group 1 and 15.4% in Group 2.The mortality rate was 18.5% in Group 1 and 23% in Group 2,with survival estimates of 71.3% and 72.5%,respectively,with no statistically significant difference.CONCLUSION Although PCM-related EHC is rare,it needs to be included in the differential diagnosis of malignancies,as timely treatment can prevent hepatic and extrahepatic sequelae.展开更多
OBJECTIVE: To assess the short-term results of interventional therapy for malignant obstructivejaundice.METHODS: In 82 patients with malignant obstructive jaundice, hepatocellular carcinoma was detected in10 patients,...OBJECTIVE: To assess the short-term results of interventional therapy for malignant obstructivejaundice.METHODS: In 82 patients with malignant obstructive jaundice, hepatocellular carcinoma was detected in10 patients, carcinoma of gallbladder in 14, hilar biliary carcinoma in 22, pancreatic carcinoma in 20,and hilar metastatic carcinoma in 16. Percutaneous transhepatic biliary internal and/or external drainage(PTBIED) was performed in 61 patients and percutaneous transhepatic insertion of biliary stent (PTIBS)in 21.RESULTS: The level of total serum bilirubin (TSB) was reduced in 71 patients and less markedly inothers. The level of TSB of the 61 patients was redueed from 450.12±113.51 μmol/L before operation to240.25±107.81 μmol/L and 90.91±101.72 μmol/L1 and 2 weeks after operation respectively. TheTSB level of the 21 patients was reduced from 410.53±98.13 μmol/L to 270.23±115.64 μmol/L and105.43±97.85 μmol/L 1 and 2 weeks after operation, respectively. No significant difference was foundin the effect between PTBIED and PTIBS. Short-term complications developed in 33 patients. Sevenpatients died 30 days after operation.CONCLUSION: Interventional therapy may be simple, safe and effective in the treatment of malignantobstructive jaundice.展开更多
Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often p...Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often precedes or complements the surgical management.The indications for operative management of CD include acute and chronic disease complications and failed medical therapy.Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype.Toxic colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency surgery.These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision making.Management of each emergency should be individualized based on patient age,disease type and duration,and patient goals of care.Moreover,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations.In this review,we aimed to discuss the acute complications of CD and their treatment.展开更多
目的:评价血必净辅助治疗大肠癌合并肠梗阻术后患者脓毒症的临床疗效.方法:收集我院ICU病房内诊断为脓毒症的大肠癌合并肠梗阻术后患者36例,随机分为治疗组19例和对照组17例.对照组给予常规抗炎治疗;治疗组在此基础上加用血必净注射液10...目的:评价血必净辅助治疗大肠癌合并肠梗阻术后患者脓毒症的临床疗效.方法:收集我院ICU病房内诊断为脓毒症的大肠癌合并肠梗阻术后患者36例,随机分为治疗组19例和对照组17例.对照组给予常规抗炎治疗;治疗组在此基础上加用血必净注射液100mL,2次/d,疗程7d.检测肿瘤坏死因子(TNF-α)、白介素(IL-6)、急性生理和慢性健康状况评分Ⅱ(APACHE Ⅱ)、白细胞及中性粒细胞百分比.结果:治疗组第7天TNF-α、IL-6、APACHE Ⅱ、白细胞及中性粒细胞百分比与对照组比较(325.33±168.49ng/L vs 432.34±154.89ng/L,26.32±13.65ng/L vs 35.77±15.86ng/L,7.3±1.3×109/L vs 10.2±2.2×109/L,76.4%±10.3% vs 84.8%±8.0%,8.8±4.5 vs 13.3±4.4,均P<0.05),有统计学差异;治疗组患者最终死亡率较对照组显著下降(0.05% vs 0.30%,P<0.05),差别有统计学意义.结论:大肠癌合并肠梗阻术后脓毒症患者在常规抗炎基础上加用血必净注射液,改善症状,降低死亡率.展开更多
文摘BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder that can mimic gallbladder carcinoma. METHODS: We present the case of a 35-year-old Hispanic male complaining of right upper quadrant pain and jaundice for 2 months prior to admission. He denied a history of fever, nausea/ vomiting, and weight loss. The past medical history was relevant only for diabetes. He had no previous history of jaundice or previous operations. RESULTS: CA19-9 was slightly elevated (52 U/mL). Abdominal ultrasonography showed an irregular thickening of the gallbladder wall and no gallstones were detected. CT scan also revealed an irregular thickening of the wall of the gallbladder body suggestive of malignancy. At laparotomy, the mass was adherent to the duodenum and colon, and although the frozen section biopsy was negative, the intraoperative findings were suggestive of malignancy, and the patient underwent left liver trisegmentectomy, resection of the common bile duct and Roux-en-Y hepaticojejunostomy. Pathological examination unexpectedly revealed XGC without malignancy. CONCLUSIONS: Preoperative and intraoperative differential diagnosis of XGC from gallbladder carcinoma remains a challenge when it is associated with inflammatory involvement of surrounding tissues. Since gallbladder carcinoma and XGC may coexist, radical resection is justified when malignancy cannot be completely ruled out.
基金Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and 25461035
文摘Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.
基金This work was supported by a doctoral grant strategic basic research with application number 1S47219N from Research Foundation-Flanders,Belgium and the Special Research Fund-UGent.
文摘Cholelithiasis-induced cholestasis is one of the most common causes of hospitalization due to gastrointestinal disease,yet considerable knowledge gaps exist in the pathogenesis of this disease.This can partially be explained by inadequate characterization of experimental cholestasis models.Here,we compared the transcriptional profile of commonly used mouse models for obstructive cholestasis and benchmarked them to human disease to identify the model(s)best suited for cholelithiasis-induced cholestasis research and to uncover conserved mechanisms involved in human and murine cholestasis.
文摘BACKGROUND Paracoccidioidomycosis(PCM)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making investigation and treatment challenging.AIM To investigate the management of patients with visceral PCM admitted with EHC.METHODS All patients diagnosed with PCM treated in a public,tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated.Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical,laboratory,and imaging findings,resources used for etiological diagnosis,treatment results,and prognosis.Statistical analyses were performed using the linear mixed-effects model(random and fixed effects),which was adjusted using the PROC MIXED procedure of the SAS®9.0 software,and Fisher’s exact test.RESULTS Of 1645 patients diagnosed with PCM,40(2.4%)had EHC.Of these,20(50.0%)lived in the rural area and 29(72.5%)were men,with a mean age of 27.1 years(3-65 years).Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients(40.0%),and a mass in the head of the pancreas was observed in 8(20.0%).The etiological diagnosis was made by tissue collection during surgery in 4 cases(10.0%)and by endoscopic methods in 3 cases(7.5%).Twenty-seven patients(67.5%)received drug treatment alone(Group 1),whereas 13(32.5%)underwent endoscopic and/or surgical procedures in combination with drug treatment(Group 2).EHC was significantly reduced in both groups(40.7% in Group 1,with a mean time of 3 months;and 38.4% in Group 2,with a mean time of 7.5 months),with no statistically significant difference between them.EHC recurrence rates,associated mainly with treatment nonadherence,were similar in both groups:37% in Group 1 and 15.4% in Group 2.The mortality rate was 18.5% in Group 1 and 23% in Group 2,with survival estimates of 71.3% and 72.5%,respectively,with no statistically significant difference.CONCLUSION Although PCM-related EHC is rare,it needs to be included in the differential diagnosis of malignancies,as timely treatment can prevent hepatic and extrahepatic sequelae.
文摘OBJECTIVE: To assess the short-term results of interventional therapy for malignant obstructivejaundice.METHODS: In 82 patients with malignant obstructive jaundice, hepatocellular carcinoma was detected in10 patients, carcinoma of gallbladder in 14, hilar biliary carcinoma in 22, pancreatic carcinoma in 20,and hilar metastatic carcinoma in 16. Percutaneous transhepatic biliary internal and/or external drainage(PTBIED) was performed in 61 patients and percutaneous transhepatic insertion of biliary stent (PTIBS)in 21.RESULTS: The level of total serum bilirubin (TSB) was reduced in 71 patients and less markedly inothers. The level of TSB of the 61 patients was redueed from 450.12±113.51 μmol/L before operation to240.25±107.81 μmol/L and 90.91±101.72 μmol/L1 and 2 weeks after operation respectively. TheTSB level of the 21 patients was reduced from 410.53±98.13 μmol/L to 270.23±115.64 μmol/L and105.43±97.85 μmol/L 1 and 2 weeks after operation, respectively. No significant difference was foundin the effect between PTBIED and PTIBS. Short-term complications developed in 33 patients. Sevenpatients died 30 days after operation.CONCLUSION: Interventional therapy may be simple, safe and effective in the treatment of malignantobstructive jaundice.
文摘Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often precedes or complements the surgical management.The indications for operative management of CD include acute and chronic disease complications and failed medical therapy.Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype.Toxic colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency surgery.These patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision making.Management of each emergency should be individualized based on patient age,disease type and duration,and patient goals of care.Moreover,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations.In this review,we aimed to discuss the acute complications of CD and their treatment.
文摘目的:评价血必净辅助治疗大肠癌合并肠梗阻术后患者脓毒症的临床疗效.方法:收集我院ICU病房内诊断为脓毒症的大肠癌合并肠梗阻术后患者36例,随机分为治疗组19例和对照组17例.对照组给予常规抗炎治疗;治疗组在此基础上加用血必净注射液100mL,2次/d,疗程7d.检测肿瘤坏死因子(TNF-α)、白介素(IL-6)、急性生理和慢性健康状况评分Ⅱ(APACHE Ⅱ)、白细胞及中性粒细胞百分比.结果:治疗组第7天TNF-α、IL-6、APACHE Ⅱ、白细胞及中性粒细胞百分比与对照组比较(325.33±168.49ng/L vs 432.34±154.89ng/L,26.32±13.65ng/L vs 35.77±15.86ng/L,7.3±1.3×109/L vs 10.2±2.2×109/L,76.4%±10.3% vs 84.8%±8.0%,8.8±4.5 vs 13.3±4.4,均P<0.05),有统计学差异;治疗组患者最终死亡率较对照组显著下降(0.05% vs 0.30%,P<0.05),差别有统计学意义.结论:大肠癌合并肠梗阻术后脓毒症患者在常规抗炎基础上加用血必净注射液,改善症状,降低死亡率.
