Obesity is a global health problem, associated with significant morbidity and mortality. It is a multifactorial disorder associated with serious complications including diabetes mellitus, dyslipidemia and Cardiovascular Disease (CVD). Its prevalence has been increasing over the last few decades and has become a modern-day epidemic. The management and the treatment of obesity include lifestyle modifications and increased physical activity. Patients with a BMI of greater than 35 kg/m2 with other comorbidities such as type two diabetes are considered eligible for bariatric surgery. There is a plethora of evidence about the effect of bariatric surgery on medical outcomes including reversal of metabolic disease and reduction of negative cardiovascular outcome. Based on the few reported cases in the medical literature, increased cholinergic tone manifesting as bradycardia and delayed chronotropic response on stress test have been reported in post-bariatric surgery patients with significant weight loss. We reported three cases of patients that underwent bariatric surgery and present with brady-arrythmias. While considering other complications of bariatric surgery, it is important to consider cardiac related sequalae such as bradyarrhythmias like sinus bradycardia, atrioventricular block, sick sinus syndrome due to delayed chronotropic response and irreversible atrioventricular defect could be helpful in clinical decision making. We recommend that an EKG and echocardiogram should be a performed as part as of a routine analysis in patients who had a bariatric surgery.
{"title":"Low Mass Low Beat: The Effect of Bariatric Surgery on Cardiac Rhythm","authors":"Mohammad Haydar","doi":"10.46889/jsrp.2024.5103","DOIUrl":"https://doi.org/10.46889/jsrp.2024.5103","url":null,"abstract":"Obesity is a global health problem, associated with significant morbidity and mortality. It is a multifactorial disorder associated with serious complications including diabetes mellitus, dyslipidemia and Cardiovascular Disease (CVD). Its prevalence has been increasing over the last few decades and has become a modern-day epidemic.\u0000\u0000The management and the treatment of obesity include lifestyle modifications and increased physical activity. Patients with a BMI of greater than 35 kg/m2 with other comorbidities such as type two diabetes are considered eligible for bariatric surgery.\u0000\u0000There is a plethora of evidence about the effect of bariatric surgery on medical outcomes including reversal of metabolic disease and reduction of negative cardiovascular outcome. Based on the few reported cases in the medical literature, increased cholinergic tone manifesting as bradycardia and delayed chronotropic response on stress test have been reported in post-bariatric surgery patients with significant weight loss.\u0000\u0000We reported three cases of patients that underwent bariatric surgery and present with brady-arrythmias. While considering other complications of bariatric surgery, it is important to consider cardiac related sequalae such as bradyarrhythmias like sinus bradycardia, atrioventricular block, sick sinus syndrome due to delayed chronotropic response and irreversible atrioventricular defect could be helpful in clinical decision making. We recommend that an EKG and echocardiogram should be a performed as part as of a routine analysis in patients who had a bariatric surgery.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"43 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140231403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous rupture of the bladder (SRUB) is a rare occurrence globally (<1%). The most common cause of bladder rupture is trauma (96%). We present a case of a 34-year-old man with a history of heavy alcohol consumption and significant smoking history. He presented with diffuse abdominal pain and urinary retention. On blood tests, he was found to have increased creatinine. A urinary catheter was inserted and there was improvement in his kidney function. However, on removal of the catheter, his creatinine function would elevate. This occurred two times before further investigations were performed. CT cystography was performed and there was a significant amount of free intraperitoneal fluid found in the pelvis. After retrograde filling of the bladder with contrast material, a tear in the dome of the bladder was discovered. The patient underwent a surgical repair of the tear and there were no complications during surgery. In summation, spontaneous urinary bladder rupture is a rare emergency which can cause acute abdomen, oliguria, peritoneal effusion and abnormal renal function. In patients with heavy alcohol consumption and especially without an associated trauma history, physicians should consider SRUB. CT scan can help in diagnosis. Diagnostic laparoscopy or explorative laparotomy should not be delayed.
{"title":"Spontaneous Rupture of the Urinary Bladder: A Case Report","authors":"Mohammad Haydar","doi":"10.46889/jsrp.2024.5102","DOIUrl":"https://doi.org/10.46889/jsrp.2024.5102","url":null,"abstract":"Spontaneous rupture of the bladder (SRUB) is a rare occurrence globally (<1%). The most common cause of bladder rupture is trauma (96%). We present a case of a 34-year-old man with a history of heavy alcohol consumption and significant smoking history. He presented with diffuse abdominal pain and urinary retention. On blood tests, he was found to have increased creatinine. A urinary catheter was inserted and there was improvement in his kidney function. However, on removal of the catheter, his creatinine function would elevate. This occurred two times before further investigations were performed. CT cystography was performed and there was a significant amount of free intraperitoneal fluid found in the pelvis. After retrograde filling of the bladder with contrast material, a tear in the dome of the bladder was discovered. The patient underwent a surgical repair of the tear and there were no complications during surgery. In summation, spontaneous urinary bladder rupture is a rare emergency which can cause acute abdomen, oliguria, peritoneal effusion and abnormal renal function. In patients with heavy alcohol consumption and especially without an associated trauma history, physicians should consider SRUB. CT scan can help in diagnosis. Diagnostic laparoscopy or explorative laparotomy should not be delayed.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"2 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139592079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid cartilage compression of the Vertebral Artery (VA) has been implicated as a rare cause of Rotational Vertebral Artery Occlusion (RVAO). 10 cases have been reported in the literature. This has a higher tendency to affect males and younger patients than other forms of stroke. Patients present with multiple episodes prior to diagnosis. Radiologic studies prove crucial for confirming this condition. An aberrant VA course appears to be a necessary factor. All cases suffer from right side VA compression by the superior thyroid cornu. Conservative therapy with antiplatelet treatment is employed commonly. Most patients have definitive treatment with surgical resection of the right superior thyroid cornu. Theories proposed for these characteristics include VA dominance, structural variability in the thyroid cartilage between genders and also variable thyroid cartilage ossification. Given these findings, we propose the term “thyro-vertebral artery syndrome” for this condition.
甲状软骨压迫椎动脉（VA）被认为是旋转性椎动脉闭塞（RVAO）的一个罕见病因。文献中已报道了 10 个病例。与其他形式的中风相比，该病更倾向于男性和年轻患者。患者在确诊前会出现多次发作。放射学检查是确诊此病的关键。视网膜病变过程异常似乎是一个必要因素。所有病例的右侧 VA 都受到甲状腺上角的压迫。通常采用抗血小板治疗的保守疗法。大多数患者都通过手术切除右侧甲状腺上角来获得最终治疗。针对这些特征提出的理论包括VA优势、不同性别间甲状软骨结构的差异性以及甲状软骨骨化的差异性。鉴于这些发现，我们提议将这种情况称为 "甲状腺椎动脉综合征"。
{"title":"Review of Thyroid Cartilage Compression of the Vertebral Artery","authors":"Leon Kong","doi":"10.46889/jsrp.2024.5101","DOIUrl":"https://doi.org/10.46889/jsrp.2024.5101","url":null,"abstract":"Thyroid cartilage compression of the Vertebral Artery (VA) has been implicated as a rare cause of Rotational Vertebral Artery Occlusion (RVAO). 10 cases have been reported in the literature. This has a higher tendency to affect males and younger patients than other forms of stroke. Patients present with multiple episodes prior to diagnosis. Radiologic studies prove crucial for confirming this condition. An aberrant VA course appears to be a necessary factor. All cases suffer from right side VA compression by the superior thyroid cornu. Conservative therapy with antiplatelet treatment is employed commonly. Most patients have definitive treatment with surgical resection of the right superior thyroid cornu. Theories proposed for these characteristics include VA dominance, structural variability in the thyroid cartilage between genders and also variable thyroid cartilage ossification. Given these findings, we propose the term “thyro-vertebral artery syndrome” for this condition.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":" 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139622925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Adrenal cortical adenoma with aldosterone hypersecretion, the most prevalent cause of secondary hypertension, represents a significant subset of adrenal tumors with distinct clinical implications. Clinical Description: A 30-year-old female presented with generalized body pain for two years and multiple episodes of sudden onset progressive weakness of the upper and lower limbs. Management: The diagnosis was confirmed by serum aldosterone and plasma renin activity and a laparoscopic right adrenalectomy was performed. The histopathology of the removed specimen helped to rule out adrenal cortical carcinoma Conclusion: A prompt diagnosis and surgical management improves the quality of life for patients with such rare diseases.
{"title":"Unmasking the Silent Menace: A Case Report of Aldosterone-Secreting Adrenal Cortical Adenoma","authors":"Vinay Hg","doi":"10.46889/jsrp.2023.4313","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4313","url":null,"abstract":"Background: Adrenal cortical adenoma with aldosterone hypersecretion, the most prevalent cause of secondary hypertension, represents a significant subset of adrenal tumors with distinct clinical implications.\u0000\u0000Clinical Description: A 30-year-old female presented with generalized body pain for two years and multiple episodes of sudden onset progressive weakness of the upper and lower limbs.\u0000\u0000Management: The diagnosis was confirmed by serum aldosterone and plasma renin activity and a laparoscopic right adrenalectomy was performed. The histopathology of the removed specimen helped to rule out adrenal cortical carcinoma\u0000\u0000Conclusion: A prompt diagnosis and surgical management improves the quality of life for patients with such rare diseases.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"41 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138943696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sub-mucosal lipomas of the colon, as first described by Bauer in 1757 are fatty tumors, rarely greater than 2 cm in size and hence rarely symptomatic. The vast majority of these tumors are subjected to be found incidentally during a colonoscopy, Computed Tomography (CT) scan, surgery, or autopsy and are most often located in the ascending colon near the cecum. Referred to second most common benign tumour of the colon, sub-mucosal colonic lipomas are often difficult to diagnose because of their asymptomatic nature or the intermittent, non-specific nature of patients’ symptoms. In this domain, development of symptoms manifesting as abdominal pain, hemorrhage, diarrhea, or constipation are most commonly encountered with lipomas of size greater than 2 cm. Furthermore, obstruction secondary to colonic intra-luminal narrowing or intussusception is mostly reserved for larger lipomas, most commonly those growing more than 4 cm in size and hence requiring surgical or endoscopic resection. However, as such lesions are more often being exposed nowadays owing to the enhanced utilization of colonoscopy and CT and the fact that complications can prevail, both rises the need of settling well established guidelines advising the management of such polyps, on the road of preventing consequent complications. In this article and in trial of us addressing this rare entity, shedding the light on its importance and further elaborating on its significant consideration in working up bowel obstructive pathologies, we present a literature review of colonic sub-mucosal lipomas, along with our experience in obstructive colonic lipomas, in a retrospective case series constituted of 4 characteristically and demographically studied patients, along with the management after being admitted to our tertiary care center for obstructive symptoms.
{"title":"Sub-Mucosal Lipoma a Rare Cause of Colonic Obstruction Managed Surgically: Case Series and Literature Review","authors":"M. Khoury","doi":"10.46889/jsrp.2023.4312","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4312","url":null,"abstract":"Sub-mucosal lipomas of the colon, as first described by Bauer in 1757 are fatty tumors, rarely greater than 2 cm in size and hence rarely symptomatic. The vast majority of these tumors are subjected to be found incidentally during a colonoscopy, Computed Tomography (CT) scan, surgery, or autopsy and are most often located in the ascending colon near the cecum. Referred to second most common benign tumour of the colon, sub-mucosal colonic lipomas are often difficult to diagnose because of their asymptomatic nature or the intermittent, non-specific nature of patients’ symptoms. In this domain, development of symptoms manifesting as abdominal pain, hemorrhage, diarrhea, or constipation are most commonly encountered with lipomas of size greater than 2 cm. Furthermore, obstruction secondary to colonic intra-luminal narrowing or intussusception is mostly reserved for larger lipomas, most commonly those growing more than 4 cm in size and hence requiring surgical or endoscopic resection.\u0000\u0000However, as such lesions are more often being exposed nowadays owing to the enhanced utilization of colonoscopy and CT and the fact that complications can prevail, both rises the need of settling well established guidelines advising the management of such polyps, on the road of preventing consequent complications.\u0000\u0000In this article and in trial of us addressing this rare entity, shedding the light on its importance and further elaborating on its significant consideration in working up bowel obstructive pathologies, we present a literature review of colonic sub-mucosal lipomas, along with our experience in obstructive colonic lipomas, in a retrospective case series constituted of 4 characteristically and demographically studied patients, along with the management after being admitted to our tertiary care center for obstructive symptoms.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report the case of a 50-year-old male patient with hypertension, peripheral artery disease, history of smoking and drug abuse and a hypercoagulability state, who underwent several percutaneous transluminal coronary angioplasty procedures for ST-elevation myocardial infarction first and for stents thrombosis then, complicated with sepsis, epistenocardic pericarditis, left ventricle aneurism and coronary stent abscess which required an emergency surgical treatment.
{"title":"Coronary Stent Infections: A Case of Pericardial Abscess and Stent Displacement After Repeated PTCA Procedures Which Required an Emergency Surgery","authors":"Riccardo Nania","doi":"10.46889/jsrp.2023.4311","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4311","url":null,"abstract":"We report the case of a 50-year-old male patient with hypertension, peripheral artery disease, history of smoking and drug abuse and a hypercoagulability state, who underwent several percutaneous transluminal coronary angioplasty procedures for ST-elevation myocardial infarction first and for stents thrombosis then, complicated with sepsis, epistenocardic pericarditis, left ventricle aneurism and coronary stent abscess which required an emergency surgical treatment.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"10 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138585722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Very Early-Onset Inflammatory Bowel Disease (VEO-IBD) and infantile IBD occur in children aged less than six years and younger than two years, respectively. Since childhood-onset IBD seems to be a more aggressive and rapidly growing disease than adult-onset IBD, it should be identified and treated as soon as possible. Here, we report the diagnosis of infantile IBD in a five-month-old child, which was confirmed by whole exome sequencing.
{"title":"Neonatal Crohn’s Disease Caused by Compound Homozygous Mutation in IL-10RA: A Case Report","authors":"Salma Abed Samamqa","doi":"10.46889/jsrp.2023.4309","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4309","url":null,"abstract":"Very Early-Onset Inflammatory Bowel Disease (VEO-IBD) and infantile IBD occur in children aged less than six years and younger than two years, respectively. Since childhood-onset IBD seems to be a more aggressive and rapidly growing disease than adult-onset IBD, it should be identified and treated as soon as possible. Here, we report the diagnosis of infantile IBD in a five-month-old child, which was confirmed by whole exome sequencing.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138626337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Complicated appendicitis is defined as an acute episode of appendicitis, accompanied by a perforation of the appendix or the formation of an intra-abdominal abscess, with or without peritonitis. Laparoscopic appendectomies have been performed since the 1980s. However, the debate has still been ongoing on whether the laparoscopic approach is preferred over open appendectomies for complicated appendicitis, with most scholars focusing on the post-operative complications as an indicator to investigate the above.
{"title":"Optimal Management of Perforated Appendicitis: Review of Articles and Observational Study","authors":"M. Khoury","doi":"10.46889/jsrp.2023.4308","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4308","url":null,"abstract":"Complicated appendicitis is defined as an acute episode of appendicitis, accompanied by a perforation of the appendix or the formation of an intra-abdominal abscess, with or without peritonitis. Laparoscopic appendectomies have been performed since the 1980s. However, the debate has still been ongoing on whether the laparoscopic approach is preferred over open appendectomies for complicated appendicitis, with most scholars focusing on the post-operative complications as an indicator to investigate the above.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Venous thromboembolism poses a significant threat to patient health and remains a leading cause of preventable morbidity and mortality. To mitigate the risk of pulmonary embolism resulting from deep vein thrombosis, the insertion of an Inferior Vena Cava (IVC) filter has become a critical intervention. While several approaches are available for IVC filter placement, the internal jugular approach has gained recognition for its unique advantages. This case study provides a comprehensive examination of an 85-year-old female patient who underwent IVC filter insertion through the internal jugular approach with an indication of extensive bilateral iliac venous thrombosis, secondary to femoral vein dialysis catheter. By exploring the clinical experience and outcomes associated with this specific technique, we aim to elucidate the benefits, considerations and potential implications for future practice. Through an in-depth analysis of this case, interventional radiologists, clinicians and healthcare professionals involved in venous thromboembolism management can gain valuable insights into the safety, efficacy and patient-centered outcomes of the internal jugular approach for IVC filter insertion.
{"title":"Retrograde Insertion of Inferior Vena Cava (IVC) Filter: A Bailout Plan","authors":"Anthony Gikonyo","doi":"10.46889/jsrp.2023.4307","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4307","url":null,"abstract":"Venous thromboembolism poses a significant threat to patient health and remains a leading cause of preventable morbidity and mortality. To mitigate the risk of pulmonary embolism resulting from deep vein thrombosis, the insertion of an Inferior Vena Cava (IVC) filter has become a critical intervention. While several approaches are available for IVC filter placement, the internal jugular approach has gained recognition for its unique advantages. This case study provides a comprehensive examination of an 85-year-old female patient who underwent IVC filter insertion through the internal jugular approach with an indication of extensive bilateral iliac venous thrombosis, secondary to femoral vein dialysis catheter. By exploring the clinical experience and outcomes associated with this specific technique, we aim to elucidate the benefits, considerations and potential implications for future practice. Through an in-depth analysis of this case, interventional radiologists, clinicians and healthcare professionals involved in venous thromboembolism management can gain valuable insights into the safety, efficacy and patient-centered outcomes of the internal jugular approach for IVC filter insertion.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139221893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 57-year-old female underwent a left hemihepatectomy due to intrahepatic cholangiocarcinoma (iCC) in 2017. Asymptomatic for two and a half years, in 2020, the patient was admitted to the department due to cholangitis and tumor recurrence. The patient underwent four Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures in total and Percutaneous Transhepatic Biliary Drainage (PTCD). As for palliative oncological treatment she underwent radio-chemotherapy. Six months following PTCD, another ERCP was performed exchanging external biliary drainage to internal. Seven months following the last radiotherapy, a Bronchobiliary Fistula (BBF) was identified. Quality of life remained hugely impaired, with associating dyspnoea, fatigue and a persistent chronic cough with biliary sputum. The patient was treated symptomatically. BBF was treated throughout the next two years through consecutive ERCP’s with biliary stenting as well as continuous PTCD implementation until the patient’s death in 2022. Curative treatment of bronchobiliary fistulas in stage IV iCC is challenging and associated with major mortality risk. The most reasonable strategies available in treating such patients are through ERCP with biliary stenting and PTCD, thus, surgery and other treatment options remain limited.
{"title":"Bronchobiliary Fistula: A Challenging Opponent to Treat in Stage IV intrahepatic Cholangiocarcinoma (iCC) Patients","authors":"K. Kobryn","doi":"10.46889/jsrp.2023.4305","DOIUrl":"https://doi.org/10.46889/jsrp.2023.4305","url":null,"abstract":"A 57-year-old female underwent a left hemihepatectomy due to intrahepatic cholangiocarcinoma (iCC) in 2017. Asymptomatic for two and a half years, in 2020, the patient was admitted to the department due to cholangitis and tumor recurrence. The patient underwent four Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures in total and Percutaneous Transhepatic Biliary Drainage (PTCD). As for palliative oncological treatment she underwent radio-chemotherapy. Six months following PTCD, another ERCP was performed exchanging external biliary drainage to internal. Seven months following the last radiotherapy, a Bronchobiliary Fistula (BBF) was identified. Quality of life remained hugely impaired, with associating dyspnoea, fatigue and a persistent chronic cough with biliary sputum. The patient was treated symptomatically. BBF was treated throughout the next two years through consecutive ERCP’s with biliary stenting as well as continuous PTCD implementation until the patient’s death in 2022. Curative treatment of bronchobiliary fistulas in stage IV iCC is challenging and associated with major mortality risk. The most reasonable strategies available in treating such patients are through ERCP with biliary stenting and PTCD, thus, surgery and other treatment options remain limited.","PeriodicalId":101514,"journal":{"name":"Journal of Surgery Research and Practice","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139233649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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