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Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
LE Becerra
Surgical intervention
2 years ago
2032 views
126 likes
0 comments
08:19
Accidental finding of Ascaris lumbricoides in the common bile duct during laparoscopic cholecystectomy transcystic exploration
This is the case of a 37-year-old woman, who had acute cholecystitis for 4 days, accompanied by nausea, vomiting, and abdominal pain in the right upper quadrant.
Physical exam demonstrated a soft abdomen with right upper quadrant pain, positive Murphy’s sign, and a palpable painful mass.
Complete blood count (CBC) reported 7,700/uL WBC, 4.235u/L neutrophils (55%), 1.463u/L lymphocytes (19%), and 1.540/uL eosinophils (20%).
Total bilirubin: 0.7mg/dL, direct bilirubin: 0.4mg/dL, indirect bilirubin: 0.3mg/dL, alkaline phosphatase: 184U/L.
Hepatobiliary ultrasound reports a thin-walled bladder with biliary sludge. The bile duct is not dilated. According to the results, there was no parasite on the bile duct.
Pain does not subside with antispasmodics, and the patient is sent to undergo a laparoscopic cholecystectomy.
In surgery, a hydropic gallbladder was evidenced. It was drained with a Veress needle. It was then found that the cystic duct was dilated and a transcystic exploration was performed with a No. 6 - 8- 10 French gastric tube.
An Ascaris lumbricoides of 25cm in length was extracted.
After exploration was completed with a Fogarty catheter, and no additional parasites were found, conventional cholecystectomy was completed. Antibiotic and anti-parasite treatment was prescribed. The patient was discharged 2 days after the procedure without any complications.
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
L Marx, S Tzedakis, P Pessaux, M Delvaux, D Mutter, J Marescaux
Surgical intervention
4 years ago
1151 views
45 likes
0 comments
11:34
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
Laparoscopic transgastric sphincterotomy for common bile duct stones
We report the case of a transgastric sphincterotomy. This is the case of a 67-year-old woman presenting with cholangitis with a past history of an esophageal peptic stenosis. After dilatation, the duodenoscopy does not make it possible to cross this stenosis. A transgastric laparoscopy is decided upon in order to introduce the duodenoscope through a 15mm port. The duodenoscope is then introduced through the port into the anterior gastric wall allowing for a successful sphincterotomy and stone extraction. The duodenoscope is withdrawn and the gastrotomy is closed. A laparoscopic cholecystectomy is performed. The postoperative outcome was uneventful and the patient was discharged on postoperative day 6.
P Pessaux, J Huppertz, D Ntourakis, A Sportes, E Wedi, D Mutter, J Marescaux
Surgical intervention
5 years ago
2868 views
41 likes
0 comments
09:04
Laparoscopic transgastric sphincterotomy for common bile duct stones
We report the case of a transgastric sphincterotomy. This is the case of a 67-year-old woman presenting with cholangitis with a past history of an esophageal peptic stenosis. After dilatation, the duodenoscopy does not make it possible to cross this stenosis. A transgastric laparoscopy is decided upon in order to introduce the duodenoscope through a 15mm port. The duodenoscope is then introduced through the port into the anterior gastric wall allowing for a successful sphincterotomy and stone extraction. The duodenoscope is withdrawn and the gastrotomy is closed. A laparoscopic cholecystectomy is performed. The postoperative outcome was uneventful and the patient was discharged on postoperative day 6.
Laparoscopic bile duct exploration with bile duct endoscopy and biliary bypass for recurrent biliary pancreatitis after cholecystectomy
This video shows the peculiar case of a 50-year-old male patient who underwent an open cholecystectomy for acute cholecystitis 12 years ago and he has been consulting for pancreatitis symptoms during the last seven years.
The patient reported that he had undergone ERCP twice after cholecystectomy because of bile duct stones and reportedly, complete bile duct clearance was achieved both times.
He presented to our facility with a new episode of mild pancreatitis.
No abnormalities were demonstrated in liver function tests. Amylase, GGT, and alkaline phosphatase values were normal.
Hepatobiliary ultrasound demonstrated a dilated common bile duct. MRCP (cholangio-MRI) showed several filling defects, particularly in the common bile duct and the left hepatic duct. CT-scan of the pancreas did not reveal abnormalities within the pancreatic parenchyma.
We decided to perform a bile duct exploration with endoscopic evaluation of the entire biliary tree and to perform a Roux-en-Y hepaticojejunostomy because of recurrent biliary pancreatitis after cholecystectomy.
JM Cabada Lee
Surgical intervention
2 years ago
1916 views
105 likes
0 comments
10:55
Laparoscopic bile duct exploration with bile duct endoscopy and biliary bypass for recurrent biliary pancreatitis after cholecystectomy
This video shows the peculiar case of a 50-year-old male patient who underwent an open cholecystectomy for acute cholecystitis 12 years ago and he has been consulting for pancreatitis symptoms during the last seven years.
The patient reported that he had undergone ERCP twice after cholecystectomy because of bile duct stones and reportedly, complete bile duct clearance was achieved both times.
He presented to our facility with a new episode of mild pancreatitis.
No abnormalities were demonstrated in liver function tests. Amylase, GGT, and alkaline phosphatase values were normal.
Hepatobiliary ultrasound demonstrated a dilated common bile duct. MRCP (cholangio-MRI) showed several filling defects, particularly in the common bile duct and the left hepatic duct. CT-scan of the pancreas did not reveal abnormalities within the pancreatic parenchyma.
We decided to perform a bile duct exploration with endoscopic evaluation of the entire biliary tree and to perform a Roux-en-Y hepaticojejunostomy because of recurrent biliary pancreatitis after cholecystectomy.
Single stage laparoscopic management of common bile duct stones with acute cholecystitis
Ten to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP), open surgery, or laparoscopic surgery.
The first option depends mainly on the availability of an experienced endocopist who could successfully clear stones in most patients. However no stones are found in 20% to 60% of cases. In such patients, rare and unpredictably severe ERCP morbidity can occur.
Thanks to progress in laparosocopic techniques, associated with technological developments, the single stage laparoscopic management of CBD and gallbladder stones has become one of the main options for the treatement of choledocholithiasis associated with cholelithiasis.
After the analysis of local conditions and the interpretation of intraoperative cholangiography images it is fundamental to decide which type of access to use to get to the main biliary tract, either transcystic access or directly through choledochotomy.
J D'Agostino, J Marescaux
Surgical intervention
7 years ago
6423 views
64 likes
0 comments
06:11
Single stage laparoscopic management of common bile duct stones with acute cholecystitis
Ten to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP), open surgery, or laparoscopic surgery.
The first option depends mainly on the availability of an experienced endocopist who could successfully clear stones in most patients. However no stones are found in 20% to 60% of cases. In such patients, rare and unpredictably severe ERCP morbidity can occur.
Thanks to progress in laparosocopic techniques, associated with technological developments, the single stage laparoscopic management of CBD and gallbladder stones has become one of the main options for the treatement of choledocholithiasis associated with cholelithiasis.
After the analysis of local conditions and the interpretation of intraoperative cholangiography images it is fundamental to decide which type of access to use to get to the main biliary tract, either transcystic access or directly through choledochotomy.
Laparoscopic common bile duct exploration: choledochotomy approach
The description of the laparoscopic common bile duct exploration: choledochotomy approach covers all aspects of the surgical procedure used for the management of common bile duct stones.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exploration and exposure, dissection, intraoperative cholangiography, laparoscopic ultrasonography, choledochotomy, stone extraction, common bile duct closure.
Consequently, this operating technique is well standardized for the management of this condition.
D Bacal, JC Berthou, D Mutter, I Jourdan
Operative technique
15 years ago
3713 views
216 likes
0 comments
Laparoscopic common bile duct exploration: choledochotomy approach
The description of the laparoscopic common bile duct exploration: choledochotomy approach covers all aspects of the surgical procedure used for the management of common bile duct stones.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exploration and exposure, dissection, intraoperative cholangiography, laparoscopic ultrasonography, choledochotomy, stone extraction, common bile duct closure.
Consequently, this operating technique is well standardized for the management of this condition.
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.
Gf Donatelli, C Callari, S Perretta, B Dallemagne
Surgical intervention
9 years ago
1324 views
19 likes
0 comments
05:08
Small sphincterotomy and balloon sphincteroplasty for extraction of a common bile duct stone in a patient with juxtapapillary diverticulum
Duodenal diverticula have a prevalence of 9 to 32%. Usually, they are within 2cm of the major duodenal papilla and for that are called juxtapapillary diverticula. They are acquired and their incidence increases with age. Biliary and pancreatic disease is often associated with juxtapapillary diverticula, in particular common bile duct stones. They are directly associated with the outcome of Endoscopic Retrograde Cholangio-Pancreatography (due to the complexity of cannulation) and with an increased rate of complications, in particular bleeding. Various techniques are described to increase the success rate, such as clip-assisted biliary cannulation, endoscopic ultrasound-guided bile duct access, main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. The success rate, independently of these techniques, varies from 61% to 95%.
In this video, we show a case of a patient with angiocholitis secondary to choledocholithiasis, and several cardiovascular co-morbidities, having the papilla of Vater on the edge of a diverticulum. A small sphincterotomy was performed as shown and then bleeding risk was evaluated (the patient being on anticoagulants) and because of the important size of the impacted stone, a sphincteroplasty with dilatation of the papilla with a balloon expanded to 15mm was performed, along with stone extraction using a Dormia basket.
The patient was discharged on postoperative day 2 with normal liver function tests and no inflammation.