RESUMO
BACKGROUND: Von Meyenburg complexes are benign hamartomatous lesions, they are part of the spectrum of ductal plate malformations. They are rare, reported in 0.35-5.6% of the general population, predominantly in adults, with no clear predilection for sex. OBJECTIVE: To present the clinical characteristics of Von Meyenburg complexes in our region. METHOD: We searched all cases with diagnosis of Von Meyenburg complexes in a period from 2012 to 2022, in our institutions. RESULTS: We identified eight cases, with an average age of 59.25 years, with a predominance of females and with one case associated with gastric carcinoma. CONCLUSIONS: It is important to adequately recognize this entity, since due to its multifocal nature it can easily simulate metastasis, additionally, and its presence does not rule out other synchronous neoplasms.
ANTECEDENTES: Los complejos de Von Meyenburg son lesiones hamartomatosas benignas que forman parte del espectro de las malformaciones de la placa ductal. Son poco frecuentes, se reportan en un 0.35-5.6% de la población general, predominantemente en adultos, sin clara predilección por un sexo. OBJETIVO: Presentar las características clínicas de los complejos de Von Meyenburg en nuestro medio. MÉTODO: Se buscaron todos los casos con diagnóstico de complejos de Von Meyenburg en nuestras instituciones entre 2012 y 2022. RESULTADOS: Identificamos ocho casos, con un promedio de edad de 59.25 años, con predominio por el sexo femenino y con un caso asociado a carcinoma gástrico. CONCLUSIONES: Es importante reconocer y diagnosticar adecuadamente esta afección, ya que por su naturaleza multifocal fácilmente puede simular metástasis, y además su presencia no descarta otros procesos neoplásicos sincrónicos.
Assuntos
Doenças dos Ductos Biliares , Hamartoma , Neoplasias Hepáticas , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Diagnóstico Diferencial , Neoplasias Hepáticas/secundário , Hamartoma/complicações , Doenças dos Ductos Biliares/complicações , Doenças dos Ductos Biliares/diagnósticoRESUMO
We present the case of a 28-year-old man with recently-diagnosed human immunodeficiency virus and hepatitis C virus infection. He developed obstructive cholangiopathy secondary to cytomegalovirus and Kaposi sarcoma, both diagnosed by endoscopic retrograde cholangiopancreatography and biopsies. He received antiretroviral therapy, chemotherapy and valganciclovir with full recovery.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Terapia Antirretroviral de Alta Atividade/métodos , Doenças dos Ductos Biliares/etiologia , Infecções por HIV/tratamento farmacológico , Valganciclovir/uso terapêutico , Dor Abdominal/etiologia , Adulto , Doenças dos Ductos Biliares/diagnóstico , Biópsia , Colangiopancreatografia Retrógrada Endoscópica , Citomegalovirus , Diarreia , Febre/etiologia , Infecções por HIV/diagnóstico , Hepatite C/complicações , Humanos , Masculino , Sarcoma de Kaposi , Redução de PesoRESUMO
Paracoccidioidomycosis is a systemic granulomatous disease caused by the dimorphic fungus Paracoccidioides brasiliensis and is restricted to Latin America. It normally affects lungs, skin and lymph nodes. Abdominal organs are usually not involved. In rare cases paracoccidioidomycosis may simulate neoplasm. Herein we describe our experience with four cases of paracoccidioidomycosis mimicking cholangiocarcinoma. To the best of our knowledge, this is the largest case series on this subject produced in English. Paracoccidioidomycosis must be considered as a differential diagnosis of cholangiocarcinoma, especially in individuals who come from endemic areas.
Assuntos
Doenças dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Paracoccidioides/isolamento & purificação , Paracoccidioidomicose/diagnóstico , Antifúngicos/uso terapêutico , Doenças dos Ductos Biliares/microbiologia , Doenças dos Ductos Biliares/terapia , Biópsia , Colangiografia , Colecistectomia , Diagnóstico Diferencial , Feminino , Hepatectomia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/microbiologia , Paracoccidioidomicose/terapia , Adulto JovemAssuntos
Doenças dos Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética/métodos , Remoção de Dispositivo/efeitos adversos , Hipertensão Portal , Hemorragia Pós-Operatória , Implantação de Prótese , Stents Metálicos Autoexpansíveis , Adulto , Doenças dos Ductos Biliares/diagnóstico , Doenças dos Ductos Biliares/etiologia , Doenças dos Ductos Biliares/fisiopatologia , Perda Sanguínea Cirúrgica , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Remoção de Dispositivo/métodos , Feminino , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/etiologia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Implantação de Prótese/instrumentação , Implantação de Prótese/métodosAssuntos
Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos , Hamartoma/diagnóstico , Doenças dos Ductos Biliares/diagnóstico por imagem , Doenças dos Ductos Biliares/patologia , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Colangiopancreatografia por Ressonância Magnética , Diagnóstico Diferencial , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
Spontaneous extrahepatic bile duct perforation is rare in newborns. It is a surgical cause of jaundice in this period and the acute presentation is unusual. OBJECTIVE: To report a case of spontaneous bile duct perforation in a newborn due to its serious complications if an early and timely diagnosis is not performed. CLINICAL CASE: A 10-day-old newborn who developed food rejection, fever and abdominal distension without jaundice, acolia, or coluria two days prior of admission. The laboratory tests showed leukopenia, thrombocytosis, increased C-reactive protein, and normal hepatic function. The abdominal x-ray showed pneumoperitoneum, and the diagnosis of necrotizing enterocolitis was made. Laparotomy was performed; extrahepatic bile duct perforation and biliary peritonitis were noted. Intraoperative cholangiography demonstrated rescatable proximal bile duct and dilated cystic duct. Hepatic-jejunostomy was performed with Roux-en-Y and cholecystectomy. In the postoperative study portal thrombosis was found, so he received anticoagulant treatment. At 8 months of age, the patient had enteral feeding tolerance and adequate weight gain. CONCLUSIONS: Biliary perforation is a rare entity and more in the neonatal period, a condition that makes it a diagnostic and therapeutic challenge. The prognosis will depend on early intervention and intraoperative findings.
Assuntos
Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares Extra-Hepáticos , Perfuração Espontânea/diagnóstico , Doenças dos Ductos Biliares/complicações , Feminino , Humanos , Recém-Nascido , Perfuração Espontânea/complicaçõesRESUMO
La perforación espontánea de la vía biliar extrahepática es rara en recién nacidos. Es una causa quirúrgica de ictericia en este período y la presentación aguda es inusual. OBJETIVO: presentar un caso de perforación espontanea de la vía biliar en un recién nacido por sus graves complicaciones si no se realiza un diagnóstico temprano y oportuno. CASO CLÍNICO: Recién nacido de término de 10 días de vida que consultó por cuadro de rechazo alimentario, fiebre y distensión abdominal de 2 días de evolución, sin ictericia, acolia, ni coluria. En los exámenes de laboratorio se encontró leucopenia, trombocitosis y elevación de la proteína C reactiva, con función hepática normal. La radiografía de abdomen demostró neumoperitoneo, sospechándose enterocolitis necrosante, se realizó laparotomía, encontrándose perforación espontánea de la vía biliar extrahepática y peritonitis biliar. La colangiografía intraoperatoria demostró la vía biliar proximal rescatable y conducto cístico dilatado. Se realizó hepático-yeyunostomía con Y de Roux transmesocolónica y colecistectomía. En el estudio postoperatorio se encontró trombosis portal, por lo que recibió tratamiento anticoagulante. En el control a los ocho meses de edad, la paciente tenía buena tolerancia oral y adecuado incremento ponderal. CONCLUSIONES: La perforación biliar es una entidad rara y más en el período neonatal, condición que la vuelve un reto diagnóstico y terapéutico. El pronóstico dependerá de la intervención temprana y los hallazgos intraoperatorios.
Spontaneous extrahepatic bile duct perforation is rare in newborns. It is a surgical cause of jaundice in this period and the acute presentation is unusual. OBJECTIVE: To report a case of spontaneous bile duct perforation in a newborn due to its serious complications if an early and timely diagnosis is not performed. CLINICAL CASE: A 10-day-old newborn who developed food rejection, fever and abdominal distension without jaundice, acolia, or coluria two days prior of admission. The laboratory tests showed leukopenia, thrombocytosis, increased C-reactive protein, and normal hepatic function. The abdominal x-ray showed pneumoperitoneum, and the diagnosis of necrotizing enterocolitis was made. Laparotomy was performed; extrahepatic bile duct perforation and biliary peritonitis were noted. Intraoperative cholangiography demonstrated rescatable proximal bile duct and dilated cystic duct. Hepatic-jejunostomy was performed with Roux-en-Y and cholecystectomy. In the postoperative study portal thrombosis was found, so he received anticoagulant treatment. At 8 months of age, the patient had enteral feeding tolerance and adequate weight gain. CONCLUSIONS: Biliary perforation is a rare entity and more in the neonatal period, a condition that makes it a diagnostic and therapeutic challenge. The prognosis will depend on early intervention and intraoperative findings.
Assuntos
Humanos , Feminino , Recém-Nascido , Doenças dos Ductos Biliares/diagnóstico , Ductos Biliares Extra-Hepáticos , Perfuração Espontânea/diagnóstico , Doenças dos Ductos Biliares/complicações , Perfuração Espontânea/complicaçõesRESUMO
BACKGROUND: Bile leakage testing may help to detect and reduce the incidence of biliary leakage after hepatic resection. This review was performed to investigate the value of the White-test in identifying intraoperative biliary leakage and avoiding postoperative leakage. MATERIAL AND METHODS: A systematic review and meta-analysis was performed. Two researchers performed literature research. Primary outcome measure was the incidence of post-hepatectomy biliary leakage; secondary outcome measure was the ability of detecting intraoperative biliary leakage with the help of the White-test. RESULTS: A total of 4 publications (including original data from our center) were included in the analysis. Evidence levels of the included studies had medium quality of 2b (individual cohort studies including low quality randomized controlled trials). Use of the White-test led to a significant reduction of post-operative biliary leakage [OR: 0.3 (95% CI: 0.14, 0.63), p = 0.002] and led to a significant higher intraoperative detection of biliary leakages [OR: 0.03 (95%CI: 0.02, 0.07), p < 0.00001]. CONCLUSION: Existing evidence implicates the use of the White-test after hepatic resection to identify bile leaks intraoperatively and thus reduce incidence of post-operative biliary leakage. Nonetheless, there is a requirement for a high-quality randomized controlled trial with adequately powered sample-size to confirm findings from the above described studies and further increase evidence in this field.
Assuntos
Fístula Anastomótica/prevenção & controle , Doenças dos Ductos Biliares/prevenção & controle , Técnicas de Diagnóstico do Sistema Digestório , Hepatectomia/efeitos adversos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Doenças dos Ductos Biliares/diagnóstico , Doenças dos Ductos Biliares/etiologia , Distribuição de Qui-Quadrado , Humanos , Cuidados Intraoperatórios , Razão de Chances , Valor Preditivo dos Testes , Fatores de Risco , Resultado do TratamentoRESUMO
El contacto entre la cirugía y la tecnología tuvo su cúspide a finales del siglo XX con el advenimiento de la cirugía laparoscópica. En 1989 Jacques Perissat presentó su técnica de colecistectomía laparoscópica a la Sociedad Americana de Cirujanos Endoscópicos y Gastrointestinales (SAGES), en Louisville Kentucky. Este evento fue el punto de partida que posteriormente siguió el futuro de la cirugía mínimamente invasiva a nivel mundial. El objetivo de éste artículo, es mostrar los distintos escenarios en los que durante una colecistectomía laparoscópica incluso el cirujano más hábil puede verse inmerso: la identificación de una lesión de la vía biliar.
With the advent of laparoscopic surgery toward the end of the 20th Century, the merging of surgery and technology attained new heights. In 1989 JaquesPerissant presented his technique for laparoscopic cholecystectomy at the meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Louisville , Kentucky. This was the starting point for what was to become in the future the worldwide use of minimally invasive surgery. The aim of this article is to describe those scenarios which, even in the ablest hands, can lead to a bile duct injury during laparoscopic cholecystectomy.