A case of painless destruction of the shoulder joint is reported for its rarity and unusual presentation as a neuroarthropathic joint with no evidence of neurological disease. A differential diagntosis of Gorham-Stout syndrome and avascular necrosis was discussed.
The medical records of 277 consecutive patients who underwent cholecystectomy for benign gall stone
disease, were reviewed to determine the incidence and cause of biliary tract obstructuion.
Obstructive jaundice (icteric obstructive biliopathy) was present in 38 cases. This was due to
choledocholithiasis in 22, Mirizzi's Syndrome in two, biliobiliary fistula in eight and biliary stricture in five
patients. Preoperative direct cholangiography (ERCP/PIC) was helpful.
Anicteric patients were classified on the basis of a history of jaundice, serum alkaline phosphatase,
sonography and operative findings. Anicteric patients with evidence of biliary tract pathology (anicteric
obstructive biliopathy) had a significant incidence of choledocholithiasis (33.3% ). Biliary complications
were uncommon in this group (4.3%). Peroperative cholangiography was carried out and was valuable in
these patients but was normal in all 83 patients who had no evidence of biliary obstruction.
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