CHOLECYSTODUODENAL FISTULAS AS A COMPLICATION OF CHOLELITHIASIS

S.N. KHUNAFIN, AA. NURMUKHAMETOV, WR BULGAKOV, I.KH. GATTAROV,

A.SH. ZAGRETDINOV, D.R. AKHMEROV, R.S. NURGALIN, N.R. YUSHKOV,

R.M. BIKBULATOV, A.F. BIKMETOV

Bashkiria Medical University, City Clinical Hospital N 18, Ufa, RUSSIA

The aim of the study was to improve the diagnosis and results of treatment in patients with cholecystoduodenal fistulas.

Materials and methods of study. We analyzed the results of treatment of 64 patients with cholecystoduodenal fistulas at the age from 20 to 88 years. 55 of them were wome, 9 - men.

Results and discussions. Patients most often (75%) had clinical picture of acute cholecystitis or choletcystopancreatitis with expressed pain syndrome in the right hypochondrium and epigastry. In every second patient the disease was accompanied by obstructive jaundice, and every third had clinical picture of cholangitis. 37 patients suffered from chill with fever ranging between 37.5 – 38^oC. 33 patients had bilirubinemia. 23 patients had sensation of discomfort in anamnesis, which included such concepts as heaviness in the right hypochondrium, constant aching pains, unstable stool, recurrent hepatic colics. Before the operation cholecystoduodenal fistula was determined in 3 patients. During the operation all patients had concrements in the gall bladder. In 60 patients, a fistula was formed in the bottom of the gallbladder, in 4 - at the level of pelvis of gallbladder. In 34 patients the common bile duct was infiltrated and enlarged from 1.2 to 4 cm and contained concretions. The diameter of the fistula ranged between 0.2- 4 cm, concrements in the sinus tract was determined in 16.

Patients were performed: cholecystectomy and fistula elimination -21, removal of the gall bladder combined with choledochotomy - 36, 3 patients were performed internal drainage of choledochal - choledochoduodenostomy (CDA) and 33 were inserted external drainage of choledoch (according to Vishnevsky – 23, to Keru-7, to Halstead-1, Pikovsky-2). Cholecystectomy, fistula elimination combined with gastric resection by Billroth - II in Vitebskiy’s modification - in 1, Nissen fundoplication - in 1, dissection of adhesions with the decompression of the small intestine - in 1, opening the liver abscesses - in 2. In connection with severe inflammatory changes in the duodenal wall at a considerable extent, when the closure lead to stenosing, gastrojejunostomy was performed in one case. In another patient cholecystostomy was performed after a fistula elimination and removal of concrements from the gall bladder.

RARE CASE OF CAROLI DISEASE

M. KILADZE, G.BARBAKADZE, D.ABULADZE, D.GORDELADZE, T.KANDASHVILI

Tbilisi City Clinical Hospital № 1. Thoracoabdominal Clinic, Internal Medicine Clinic,

Tbilisi, GEORGIA

Background and aims: Aim of our report is to describe management of rare case with congenital hepatic bile duct dilatation in 8 year old female patient.

Material and Methods: Patient, 8 year old female with Body Mass Index (BMI) 18 kg/m² admitted to our clinic with complaints on intermittent abdominal pain, subfebrile fever, jaundice, continuous weakness and weight loss. In outpatient clinic according to ultrasound, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) cholangiography data Caroli disease had been suspected. Biochemistry and blood count had been performed in inpatient care with following results: Total bilirubin 1,5 mg/dL, ALT, AST – normal, GGT-82 IU/L, AP – 158 IU/L. MRI with non contrast showed mild hepatomegaly (by 2 cm), with no enlarged intrahepatic bile ducts and no enlarged lymph nodes. Right and left main intrahepatic bile duct diameter was 0.5 cm, gallbladder 3X2.8X2,4 cm without calculi, cystic duct was enlarged to 0.7 cm and was connected to Common Bile Duct (CBD) cyst that reaches sizes of 3.6X2.5 cm. Distal part of CBD seems normal with diameter of 0.4 cm. Pancreatic duct was normal. Diagnosis of cystic dilatation of proximal extrahepatic biliary tree including main left and right intrahepatic ducts and proximal hepatic duct had been stated (T.Todani’s classification Type IV). After appropriate preoperative preparation patient underwent surgery. During exploration cystic dilatation of extrahepatic biliary tree starting from distal parts of left and right main intrahepatic ducts and finishing at the level of cystic duct CBD junction has been found. Surgery includes cholecystectomy, resection of affected biliary ducts, bihepatico-jejuno anastomosis – with separate anastomosis to both intrahepatic ducts on Roux an Y limb.

Results: Post surgical period uneventful. Histology has shown cyst originated from connective tissue, with cuboidal epithelium and local hyperplasia sites. No malignancy had been found. After 6 months follow up patient is complaint free. Radiological and biochemistry data are normal.

Conclusion: In spite of that clinical signs for biliary tree cystic dilatations of various types are similar and in early ages can be suspected Caroli disease, contemporary radiologic studies can give diagnosis with high accuracy and therefore determines type of an appropriate treatment. Biliodigestive anastomosis on Roux an Y jejunal limb is method of choice for surgical treatment.

THE SIGNIFICANCE OF MUTATION OF 34SGENE OF PANCREATIC SECRETORY ANTITRYPSIN IN PATIENTS WITH CHRONIC PANCREATITIS

Y.A. KUCHERYAVIY, N.V. PETROVA, Z.F. TIBILOVA, A.V. SMIRNOV, I.V. MAYEV

Moscow State Medical and Dental University, Medical and Genetic Research Center of RAMS, Polyclinic No 2, Moscow, RUSSIA

Introduction: The most common causes of chronic pancreatitis (CP) include alcohol abuse and tobacco smoking, but not all smokers and persons who abuse alcohol has CP. The discovery of genetic causes of CP opened the veil of secrecy from the reasons of implementation of major risk factors. One of the most spread mutations affecting the development of CP, is a mutation of the gene of pancreatic secretory antitrypsin (PAT), occurrence of which is practically unstudied in the Russian population.

The aim of the study: To determine the frequency and prognostic significance of N34S mutation regarding the development of CP in a mixed Russian population.

Methods: The study included 83 patients with idiopathic CP and 103 healthy individuals. The diagnosis of CP was based on clinical and instrumental data in accordance with the M-ANNHEIM criteria. All the involved in the study by PCR method with further restriction analysis underwent analysis of N34S mutation in the PAT gene.

Results: The N34S mutation was detected in 12 patients with CP and in 3 persons of the control group, which constituted 14.6 and 2.9%, respectively; p <0,05. The odds ratio (OR) of the development of idiopathic CP in the presence of N34S mutation constituted 4.62 (95% confidence interval (CI): 1,21-18.37). The frequency of homozygotes according to mutantnomuallelyu also had statistically significant difference - 10.97 and 0.97% in the main and control groups, respectively; p <0,05. The presence of mutations did not affect the frequency and severity of functional disorders of the pancreas, but N34S mutation statistically significantly more occurred in patients with calcifying pancreatitis (p <0,01) and pseudocysts (p <0,05). OR of the development of calcification in patients with N34S constituted 13.44 (95% CI: 6,29-23.78).

Conclusion: The N34S mutation plays a significant role in the development of CP in the Russian population and can detect 10% and more cases of idiopathic CP.

LONG TERM EXPOSURE TO INDIAN PAN MASALA PLAIN (PMP) AND BLEND (PMT) CAUSES GASTRO-HEPATIC INJURY IN SWISS ALBINO MICE

S. KUMAR NIGAM¹, H. VENKATAKRISHNA BHATT²

¹ Laboratory and Department of Neurobehavioral Toxicology, National Institute of Occupational Health (NIOH); ² Ex-Senior Grade Deputy Director, Consulting Editor, ENVIS-NIOH News Letter, Ahmedabad, Gujarat, INDIA

Swiss albino mice in three groups (control, Experimental I and Experimental II) of 60 each were fed staple diet (control), composed with 2% pan masala plain (PMP) and its blend (tobacco – PMT) for a period upto 70 weeks with intermittent post-mortem at intervals of 16, 56 and 70 weeks assessing for gastro-hepatotoxicity. Histopathology of exptl.I&II groups showed progressive advancement of structural changes of stomach and liver during the study period. Fibrosis, thickening of prickle cells, and also horney layered cells indicating lesions of acanthosis and hyperkeratosis initially and later prominently ulcers and papillomas which transformed into a peptic tumor. Similarly disrupted hepatocytes with fatty globular infiltration coalesced as fat cysts replacing total parenchyma and further reticular cell hyperplasia, haemangioma and haemangioendothelioma were observed. Animal feeding, hygiene, exploration and environmental care and health protocols were as per the standard guidelines and approved by NIOH ethical committee. Here long, calculated exposure of mice has been consistant, unlike habitual PM users whose consumption is inconsistent depending on the body demand and contents of the commercial product and therefore, endorse critically designed case control and cohort studies among PM addicts.

Date: 2014-12-28; view: 1112