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Congenital absence of the gallbladder: ways of avoiding laparotomy.

Two cases of congenital absence (agenesis) of the gallbladder seen at one hospital over a 5-year period are presented. One patient presented with ascending cholangitis due to choledocholithiasis, while the other presented with right upper quadrant abdominal pain and equivocal findings on ultrasound and oral cholecystography. Although diagnosis was made at laparotomy in both cases, it is likely that the arrival of laparoscopic cholecystectomy will avoid laparotomy in the future. The place of laparoscopy in establishing the presence of this anomaly is discussed.

Periampullary cysts: endoscopic management.

Periampullary cysts are a rare but remediable cause of recurrent pancreatitis. Hitherto, the management of such cysts was mainly surgical. We report on two cases of periampullary cysts. The first patient, who had a cyst of the minor papilla (Santorini cyst), presented with upper gastrointestinal hemorrhage and a history of recurrent pancreatitis. The second patient presented with cholangitis. Both were successfully and safely treated by endoscopic methods alone. Details of the cases and the endoscopic techniques used are fully described.

Idiopathic fibrosis of the upper aero-digestive tract.

Idiopathic fibrosis of different areas of the body such as retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Reidel's thyroiditis and pseudo-tumour of the orbit are well recognised entities that manifest individually or in combination. A case of idiopathic fibrosis of the upper aerodigestive tract is presented, which caused dense fibrosis of the floor of mouth, tongue, pharynx and larynx leading to aphonia and severe dysphagia. A permanent tracheostomy was performed and regular bouginage is necessary. This is the first such case reported in the literature.

Multifocal idiopathic fibrosclerosis. Two cases with simultaneous occurrence of retroperitoneal fibrosis and Riedel's thyroiditis.

The concomitant occurrence of retroperitoneal fibrosis (RF) and Riedel's thyroiditis is reported in two patients, one of whom presented with anuria. The etiology is discussed, and it is concluded that immunological mechanisms with arteritis might be of importance. The associations between Riedel's thyroiditis, RF, mediastinal fibrosis, sclerosing cholangitis, retroorbital fibrosis and fibrosis in other organ systems are thought to be different manifestations of a so-called multifocal idiopathic fibrosclerosis. The beneficial effect of glucocorticoids in early stages of the disease is mentioned…

The role and possible mechanism of intestinal fungi in the progression of chronic liver diseases.

Chronic liver disease (CLD) causes 2 million annual deaths (4% of all global deaths). While gut bacteria are widely studied, intestinal fungi remain largely overlooked despite their critical roles in maintaining microecological homeostasis. This review summarizes fungal characteristics in alcohol-related liver disease, metabolic dysfunction-associated steatotic liver disease, primary sclerosing cholangitis, and cirrhosis, analyzing roles of fungi and their metabolites. Targeting the gut fungal community may offer therapeutic strategies for CLD.

Severe complications of inflammatory bowel disease.

Patients who have inflammatory bowel disease occasionally develop severe complications or emergency situations that require expert and expedited medical care, including toxic colitis, fistulas, abdominal abscesses, malignancy, primary sclerosing cholangitis, and pouchitis. Morbidity and mortality rates of Crohn's disease and ulcerative colitis are increased over the expected rates in the unaffected population. Knowledge of the presenting features, natural history, and treatment of these complications should to lead to early and effective therapy and better outcomes.

Biliary tract emergencies. Endoscopic and medical management.

The application of therapeutic ERCP and interventional radiology has significantly altered the treatment of biliary tract emergencies. Although surgery is the principal treatment for acute cholecystitis, nonoperative alternatives exist for high-risk patients. New, prospective, randomized trials have demonstrated that endoscopic management of severe cholangitis is superior to surgery, and that endoscopic sphincterotomy and stone extraction are superior to conservative treatment in severe gallstone pancreatitis. ERCP allows nonoperative management of postoperative bile leaks as well.

[A case of autoimmune pancreatitis associated with hemorrhagic duodenal ulcers].

An 84-year-old man was diagnosed with IgG4-related autoimmune pancreatitis and sclerosing cholangitis with jaundice. Endoscopic nasobiliary drainage was performed, but hemorrhagic shock due to multiple duodenal ulcers occurred about a week later. After several endoscopic hemostasis, he was given corticosteroids. Histopathology of duodenal ulcer biopsies showed IgG4-positive plasma cell infiltration. Reports about duodenal ulcers with IgG4-related disease are very rare and we consider this case valuable.

Biliary ascariasis in a bile duct stones-removed female patient.

Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.

Mechanisms of cholestasis.

This article gives an overview of the molecular and cellular mechanisms of cholestasis. Topics reviewed include the pathomechanisms of hereditary cholestasis syndromes, such as progressive familial intrahepatic cholestasis, and hepatocellular transporter defects encountered in various acquired cholestatic disorders, such as intrahepatic cholestasis of pregnancy, drug-induced cholestasis, inflammatory cholestasis, primary sclerosing cholangitis, and primary biliary cirrhosis. In addition, current concepts regarding adaptive hepatocellular mechanisms counteracting cholestatic liver damage are di…

Prenatal diagnosis of familial type I choledochal cyst.

Familial choledochal cysts are extremely rare. High-resolution ultrasound now allows for the antenatal diagnosis of these anomalies. After delivery, elective surgical resection should be planned; however, increases in size, deterioration of liver function, and ascending cholangitis frequently force early intervention. We report an unusual occurrence of siblings with type I choledochal cysts and review the existing literature on cause, genetics, classification, diagnosis, and management of this disease.

Anti-neutrophil cytoplasm autoantibodies (ANCA) in autoimmune liver diseases.

Anti-neutrophil cytoplasm antibodies (ANCA) are autoantibodies directed against cytoplasmic constituents of neutrophil granulocytes and monocytes. ANCA have been detected in serum from patients with inflammatory bowel diseases (mainly ulcerative colitis) and autoimmune mediated liver diseases (mainly primary sclerosing cholangitis and autoimmune hepatitis-type 1). The antigens recognized by ANCA in these diseases are multiple and the clinical and pathophysiological significance of ANCA in these disorders has not been completely defined.

[Endoscopic papillosphincterotomy in the treatment of choledocholithiasis and its complications].

Endoscopic papillosphincterotomy was performed in 306 patients with hepatocholedochal calculi. Mechanical jaundice was found in 271 patients (88.5%), 183 patients (59.8%) had acute cholangitis, 41 patients (13.4%) had acute pancreatitis. Complete sanitation of bile ducts was successfully fulfilled in 264 patients (86.3%). Three patients had bleedings from the area of incision, 7 patients had transient diastasuria, 3 patients had edematic form of acute pancreatitis, 24 patients died (7.84%).

Gastrointestinal Emergencies in the ICU.

Gastrointestinal (GI) emergencies and disorders are among the most common reasons to be admitted to an intensive care unit (ICU). In addition, critically ill patients admitted to the ICU for non-GI-related diseases are frequently at risk of developing GI complications during their hospitalization. This article details the epidemiology/etiology, clinical presentation, diagnostic assessment, and management of the following GI emergencies: upper and lower GI bleed, acute pancreatitis, and ascending cholangitis.

[Treatment of autoimmune hepatic diseases].

The immunosuppresive drugs, primarily glucocorticosteroids, serve as the basis for the pathogenetic treatment of autoimmune diseases of the liver. In autoimmune hepatitis, immunosuppressive therapy induces and maintains persistent remission in most patients while in primary biliary cirrhosis and primary sclerosing cholangitis, its capacities are substantially limited. Ursodeoxycholic acid is used as the basic drug in predominantly occurring intrahepatic cholestasis. The treatment of cross autoimmune syndromes generally requires the choice of a combination of drugs.

Механизм защиты от гепатопатропии желчных солей в болезни печени.

Урзодоксихоловая кислота (UDCA) улучшает ферменты печени и во многих случаях гистология печени в случае заболеваний холестатической печени, таких, как первичный цирроз и первичный склерозный холангит. Помимо классических холестатических заболеваний, UDCA также улучшает биохимию печени в случае алкоголиков и хронического вирусного гепатита C. Однако главной целью лечения в рамках УДА является холестаз, и, следовательно, интерес представляют механизмы, способствующие благоприятному воздействию этих заболеваний, которые подробно рассматриваются в этой статье.

Совпадение в аннотации оригинала
Ursodeoxycholic acid (UDCA) improves liver enzymes and in many instances liver histology in cholestatic liver diseases such as primary biliary cirrhosis and primary sclerosing cholangitis. Besides classic cholestatic diseases, UDCA also improves liver biochemistry in alcoholic liver disease and in chronic viral hepatitis C. The main target of UDCA treatment,…

Acute diseases of the pancreas and biliary tract. Management in the emergency department.

Pancreatitis, commonly encountered in the Emergency Department, possesses a very broad clinical spectrum and may be associated with shock and multiple organ failure. Its diagnosis is based on clinical, laboratory, and radiographic data, but there is no gold standard. Biliary tract disease ranges in severity from cholelithiasis with colic to acute suppurative cholangitis, which may lead to shock. Clinical examination and imaging studies are most useful in these disorders, and definitive treatment is primarily surgical.

Do juxtapapillary diverticula of the duodenum interfere with cannulation at endoscopic retrograde cholangiopancreatography? A prospective study.

Previous observations indicate that juxtapapillary diverticula (JD) of the duodenum have made cannulation of the papilla of Vater difficult in endoscopic retrograde cholangiopancreatography. This prospective study of 1,243 cases that underwent ERCP shows that 153 patients with JD had the same failure rate as the 1,090 patients without JD (8.49% vs. 8.99%). The incidence of JD increases with age, but the incidence of biliary calculi or cholangitis is not different between the JD group and the nondiverticulum group.

[Choledochotomy in acute cholecystitis in the middle-aged and elderly].

Under analysis were 282 patients operated for acute cholecystitis, cholecystectomy being added by the external or internal drainage of bile ducts. It was established that the presence of jaundice, cholangitis, cholecystopancreatitis and gallstones in the ducts were considered as indications for choledochotomy in elderly and senile patients. The general lethality among the patients operated for acute cholecystitis complicated by injuries of the common bile duct made up 10,6%, in the group of elderly and senile patients it was 15,5.

Caroli's disease: a rarely recognized entity.

Caroli's disease, well known in the European literature, has been recognized infrequently in this country. The disease is characterized by cystic dilation of intrahepatic bile ducts and is complicated by formation of gallstones, cholangitis, and hepatic abscesses. Surgical intervention and therapy with antibiotics is often unsuccessful and Gram-negative septicemia is a common cause of death. Cysts may be present in other organs, such as kidney, pancreas, and spleen, and may be helpful in the early diagnosis of this rare disease.