RARE CASE OF THE PARASITOGENIC INVOLVEMENT OF THE MAGISTRAL BILIARY TRACTS WITH FASCIOLA HEPATICE
T.A. ALLAZOV , R.E. JAFARLI
Azerbaijan Medical University, Scientific Center of Surgery, Baku, AZERBAIJAN
Literature data analysis shows that, the case of involvement of the fasciola hepatica is considered casuistics among the parasitogenic diseases of the liver. on 2.04.2011 a patient with the complaints of with the thick colicky pains in the right hypochondrium, with the temperature up to 40, 41° C, shiver, common weakness, indisposition entered the hospital. The patient lives in the countryside. The icteritiousness of the sclera and cutaneous covering, the symptoms of the scratching, the appearance of the cholangitis are noted during the inspection of the patient. The feces is dyed slightly. The calculous cholecystitis was found during the ultrasonic examination and the inspection of computer tomography. The pathology isn’t found in the magistral biliary tracts. During the laboratory examinations the total bilirubin was 75 mcrmole/ l (with the predominance of the fraction), the hepatitis are negative, the raised leukocytosis and so on. After entering of the patient to the hospital the course of intensive care directed to the decrease of the acute symptoms, the inflammation in the biliary tracts, the fluid maintenance, antioxidants were appointed. The patient has had acute attacks of the biliary colic twise during 10 days of the preoperative assessment. During the operation on 12.04.2011 we, removed the gallbladder. The presence of the cholangitis appearance till the operation, the intensity of the common bile duct was caused the decision making about the carrying out the revision. The existence of the tumors and concrements wasn’t observed during the palpation. The attempt of conduction of the bulbous-end probe out of the duct of the gallbladder turned to unsuccessful, because its diameter was small. That’s why we decided to realize choledochotomy. While incision at once the tailpiece of the parasite appeared in the wound. Fasciola hepatica was changed during its removal from the wound. Introduction of the bulbous-end probe showed the existence of the complete patency of the common bile duct. Then we, drained ductus choledochus with Kera metod. The postoperative period went smoothly. During 3 days after the operation the subhepatic drainage was removed, during 20 days the drainage of Ker was removed. The patient was discharged with the satisfactory health on 4.05.2011. the patient was appointed the course of antiparasitic theraphy with the albendosol. The involvement of the Fasciola hepatica is occured not only in the animals, but also in a man and is required the conduction of the differential diagnostics before and during the operation. Besides, the use of the raw water from the water basins, raw green-stuff, goat and sheep’s liver aren’t recommended with the purpose of prophylactics.
USE OF OZONE THERAPY IN THE COMPLEX TREATMENT OF PURULENT CHOLANGITIS AND OBSTRUCTIVE JAUNDICE AND THE RESULTS OF ITS RECOVERY
T. A. ALLAZOV, R. M. AGAYEV, E.A. ALIYEVA, R.O. SHAHBAZOV
Scientific Surgical Center named after acad. M.Topchubashov, Baku, AZERBAIJAN
At present there exist many methods of treatment of purulent cholangitis and obstructive jaundice. But the obtained results do not satisfy surgeons, as bacterial pollution of bile has not only aerobic but also anaerobe character. Our current aim is to study effectiveness of the treatment of purulent cholangitis by the application of ozone therapy. It is possible to achieve improvement of bacteriologic indicators of bile by using ozone therapy. Therefore, we set a goal to assess ozone therapy used i purulent cholangitis by the conduct of experimental and clinical investigations. During purulent cholangitis, pathogenic microorganisms are observed in biliary tracts, however, in mechanical jaundice pathogenic microorganisms are not observed. From the results obtained in both groups in the result of conducted investigations it became known, during the purulent cholangitis, the number of microorganisms reduced truly by 83.5% from the 9th day of treatment, and by 99.9% (p<0,001) from the 14th day. No pathogenic microorganisms were observed during obstructive jaundice. Based on the comparison of clinical and laboratory indicators carried out in post-surgical period, it was determined that improvement of purulent cholangitis occurred 1,5-2 days later, despite bacterial pollution of bile. In the control group where ozone therapy was not used, improvement occurred 10-15 days later. It was proved once more, that ozone therapy has local destructive effect during the process of separation of bacterial and as a result leads to their elimination. Thus, accelerates to the process of improvement of purulent cholangitis.
