Laparoscopic choleystectomy plus intraoperative cholangiography in a patient with liver cirrhosis and accessory hepatic duct
EAES Academy. Vargas Ávila A. 07/05/22; 363042; P086
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Abstract
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Aims:
Demonstrate the resolution of a complex case of chronic lithiasic cholecystitis and the importance of intraoperative cholangiography to rule out choledocholithiasis in a patient with liver cirrhosis.
Methods:
62-year-old female, history of liver failure secondary to chronic antifungal intake. His condition began with 10 days of evolution with abdominal pain localized in the right upper quadrant, with cholangitis grade II, ultrasound without bile duct dilatation, 3 mm bile duct, 4 mm wall, with data of liver cirrhosis. Laboratories, leukocytes of 15.5. platelets 103 thousand, direct bilirubin 14.2. So it is scheduled for laparoscopic cholecystectomy.
Results:
During laparoscopy, a macronodular liver, ascites, multiple adhesions, a thin-walled gallbladder were found, an intraoperative cholangiography was performed, finding a dilated bile duct without evidence of choledocholithiasis, and an accessory duct located at the confluence of the bile duct was observed. Two days after the surgical event, the patient presented digestive tract bleeding for which endoscopy was performed, finding forrest IIA gastric ulcer, sclerotherapy was performed, and hemoclip was also placed, later patient Good evolution, tolerated diet and discharged to the days.
Conclusions:
Intraoperative cholangiography is useful in determining choledochal stones. It allows to discover up to 5% of stones in the bile duct not detected preoperatively. And identify bile duct abnormalities.
Demonstrate the resolution of a complex case of chronic lithiasic cholecystitis and the importance of intraoperative cholangiography to rule out choledocholithiasis in a patient with liver cirrhosis.
Methods:
62-year-old female, history of liver failure secondary to chronic antifungal intake. His condition began with 10 days of evolution with abdominal pain localized in the right upper quadrant, with cholangitis grade II, ultrasound without bile duct dilatation, 3 mm bile duct, 4 mm wall, with data of liver cirrhosis. Laboratories, leukocytes of 15.5. platelets 103 thousand, direct bilirubin 14.2. So it is scheduled for laparoscopic cholecystectomy.
Results:
During laparoscopy, a macronodular liver, ascites, multiple adhesions, a thin-walled gallbladder were found, an intraoperative cholangiography was performed, finding a dilated bile duct without evidence of choledocholithiasis, and an accessory duct located at the confluence of the bile duct was observed. Two days after the surgical event, the patient presented digestive tract bleeding for which endoscopy was performed, finding forrest IIA gastric ulcer, sclerotherapy was performed, and hemoclip was also placed, later patient Good evolution, tolerated diet and discharged to the days.
Conclusions:
Intraoperative cholangiography is useful in determining choledochal stones. It allows to discover up to 5% of stones in the bile duct not detected preoperatively. And identify bile duct abnormalities.
Aims:
Demonstrate the resolution of a complex case of chronic lithiasic cholecystitis and the importance of intraoperative cholangiography to rule out choledocholithiasis in a patient with liver cirrhosis.
Methods:
62-year-old female, history of liver failure secondary to chronic antifungal intake. His condition began with 10 days of evolution with abdominal pain localized in the right upper quadrant, with cholangitis grade II, ultrasound without bile duct dilatation, 3 mm bile duct, 4 mm wall, with data of liver cirrhosis. Laboratories, leukocytes of 15.5. platelets 103 thousand, direct bilirubin 14.2. So it is scheduled for laparoscopic cholecystectomy.
Results:
During laparoscopy, a macronodular liver, ascites, multiple adhesions, a thin-walled gallbladder were found, an intraoperative cholangiography was performed, finding a dilated bile duct without evidence of choledocholithiasis, and an accessory duct located at the confluence of the bile duct was observed. Two days after the surgical event, the patient presented digestive tract bleeding for which endoscopy was performed, finding forrest IIA gastric ulcer, sclerotherapy was performed, and hemoclip was also placed, later patient Good evolution, tolerated diet and discharged to the days.
Conclusions:
Intraoperative cholangiography is useful in determining choledochal stones. It allows to discover up to 5% of stones in the bile duct not detected preoperatively. And identify bile duct abnormalities.
Demonstrate the resolution of a complex case of chronic lithiasic cholecystitis and the importance of intraoperative cholangiography to rule out choledocholithiasis in a patient with liver cirrhosis.
Methods:
62-year-old female, history of liver failure secondary to chronic antifungal intake. His condition began with 10 days of evolution with abdominal pain localized in the right upper quadrant, with cholangitis grade II, ultrasound without bile duct dilatation, 3 mm bile duct, 4 mm wall, with data of liver cirrhosis. Laboratories, leukocytes of 15.5. platelets 103 thousand, direct bilirubin 14.2. So it is scheduled for laparoscopic cholecystectomy.
Results:
During laparoscopy, a macronodular liver, ascites, multiple adhesions, a thin-walled gallbladder were found, an intraoperative cholangiography was performed, finding a dilated bile duct without evidence of choledocholithiasis, and an accessory duct located at the confluence of the bile duct was observed. Two days after the surgical event, the patient presented digestive tract bleeding for which endoscopy was performed, finding forrest IIA gastric ulcer, sclerotherapy was performed, and hemoclip was also placed, later patient Good evolution, tolerated diet and discharged to the days.
Conclusions:
Intraoperative cholangiography is useful in determining choledochal stones. It allows to discover up to 5% of stones in the bile duct not detected preoperatively. And identify bile duct abnormalities.
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