Laparoscopic drainage of cryptogenic liver abscesses should be considered as an option for drainage of liver abscess.
IntroductionLaparoscopic adjustable gastric banding is the most frequently performed bariatric procedure for the treatment of morbid obesity and is associated with low morbidity and mortality. Complications related to obesity surgery are rare and their presentation is often non-specific. Thus, it is highly important for physicians who are practising bariatric surgery to be aware of complications described in single-case studies or series when they come across similar complications even years after the primary bariatric operation.Case presentationWe report the case of a 47-year-old Malay woman who was admitted with symptoms and signs suggesting intestinal obstruction five years after gastric band placement.ConclusionsIn our patient, the band connection wire tube was the cause of both small bowel obstruction and colonic erosion. Computed axial tomography is the cornerstone of the investigation of such patients. After surgical removal of the connecting tube, our patient recovered without sequelae.
A 46-year-old Indonesian man presented with a 1-year history of painless obstructive jaundice, loss of appetite and weight loss. Computed tomography imaging revealed a 5-cm tumour at the hepatic duct confluence with associated bilateral biliary dilatation. The tumour involved the left hepatic artery as well as the left portal vein. In addition, a 1-cm lesion was noted in segment V close to hilum.Laboratory tests revealed patient's bilirubin of 498 mmol/L (normal: 5-30 μmol/L), with a predominantly conjugated bilirubin and alkaline phosphatase of 546 mmol/L (normal: 40-130 μmol/L).Previously, his biliary system was decompressed with a radiologically guided percutaneous catheter inserted into the right liver. Due to the position of the tumour, a stent could not be placed across it. On several occasions, the drain became obstructed resulting in recurrent cholangitis. Therefore, a surgical alternative was required to provide appropriate palliation for this patient.Intraoperative ultrasound examination revealed a large tumour occupying segment IV and extending to segment V, resulting in dilatation of both the right and the left biliary systems. The left main portal vein and hepatic artery were encased in the tumour and the left liver appeared atrophic. A 1-cm lesion was also seen in segment V. This was confirmed to be cholangiocarcinoma on frozen section. Therefore, we proceeded to a modified segment V biliary bypass.An intraoperative ultrasound was used to identify appropriate sized intrahepatic ducts, which could be used for bypass. The largest and most superficial duct farthest away from the hilum was selected. A small volume of segment V overlying this was resected with the ultrasonic dissector. The selected duct was punctured with a 24-gauge needle on a 10-mL syringe (Fig. 1). Bile was aspirated into the syringe to indicate correct positioning. The needle was used as a guide for dissection to expose a 3-cm length of bile duct, which was unroofed prior to construction of anastomosis (Fig. 2).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.