Gallstone mimicry: a rare cause of abdominal pain
A previously fit and well 43-year-old male triathlete presented with severe central abdominal pain persisting for several hours. Three similar episodes in the past 18 months had spontaneously resolved. Prior investigations with abdominal ultrasound, upper and lower GI endoscopies had been unremarkable. On this presentation, the patient also had worsening malaise and fever at 40°C. He was fluid resuscitated and commenced on broad-spectrum antibiotics (intravenous piperacillin–tazobactam 4.5 g and 350 mg gentamicin). Initial biochemistry revealed absolute eosinophil count 0.56x109/L, asparate aminotransferase serum 72 IU/L and alanine aminotransferase (ALT) 78 IU/L. The alkaline phosphatase 65 IU/L, bilirubin 10 μmol/L, white cell count 7.93x109/L and C-reactive protein 5 mg/L were all normal. CT abdomen (figure 1A) did not reveal gallstones nor any small bowel pathology. As the abdominal pain worsened, differentials including an ischaemic hernia were considered but a subsequent laparoscopy was normal. An urgent magnetic resonance cholangiopancreatography (MRCP) suggested a 5 mm filling defect in the...
ConclusionAdministrative claim data can be analyzed through Formal Concept Analysis in order to classify trajectories of care. This approach permits to quantify expected postoperative complications and to identify unexpected events.
CONCLUSION: The disruption of the thiol-disulfide balance may play a role in the pathogenesis of acute pancreatitis. In acute pancreatitis, since the thiol level is decreased in the blood, administration of the complementary therapies for this thiol deficiency may contribute to the treatment of the disease. PMID: 31942734 [PubMed - in process]
Condition: Cholelithiasis Intervention: Procedure: Laparoscopic cholecystectomy Sponsor: Baqai Medical University Completed
Hiroyuki Matsubara, Seiji Satoh, Atsushi Fukugaki, Yousuke KinjoJournal of Minimal Access Surgery 2020 16(1):80-82Accessory hepatic duct or gallbladder duplication is considered to be a risk factor for bile duct injuries and open conversion during laparoscopic cholecystectomy (LC). A 32-year-old woman with epigastric pain was referred to our department. Gallstone disease in the gallbladder was diagnosed by ultrasonography and magnetic resonance cholangiopancreatography. The involvement of an accessory hepatic duct was suspected during endoscopic retrograde cholangiography. Drip infusion cholangiography with computed tomogr...
ConclusionsIn our study, higher %TWL and preoperative pain syndrome were associated with an increased risk for cholecystectomy besides the traditional risk factors female gender and Caucasian ethnicity. These factors can be used to identify high-risk patients, who might benefit from preventive measures. Whether statins can protect bariatric patients from developing gallstones should be investigated prospectively.