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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
3 years ago
2208 views
142 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
5 years ago
1200 views
47 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
6 years ago
2901 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.
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
I Boškoski, M Pizzicannella
Surgical intervention
7 months ago
838 views
15 likes
1 comment
35:21
All you need to know to perform an ERCP for biliary stones extraction: live procedure
An 82-year-old man underwent an emergency endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis secondary to choledocholithiasis 11 days earlier. At that time, since the patient was under Clopidogrel, the sphincterotomy was not performed and a plastic stent was released in the common bile duct (CBD) to bypass the stones. In this live procedure, Dr. Boškoski performs an ERCP with sphincterotomy and biliary stones extraction. During the procedure, the operator gives every fundamental tips and tricks to perform the correct procedure. At the end of the intervention, a 3D cholangiography is performed to confirm complete biliary stones extraction.
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
3 years ago
2183 views
111 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.