The Experts below are selected from a list of 888 Experts worldwide ranked by ideXlab platform
Elmar M. Merkle - One of the best experts on this subject based on the ideXlab platform.
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Pneumobilia: where to look for on hepatic MR imaging?
European radiology, 2006Co-Authors: Elmar M. MerkleAbstract:The presence of Pneumobilia is a particular problem in magnetic resonance cholangiopancreatography (MRPC) and may create an appearance that can be mistaken for intraductal stones. Compared with biliary stones, however, Pneumobilia causes a susceptibility artifact on hepatic MR imaging and appears as a signal void on a dual echo gradient MR sequence, such as the T1-weighted in-phase and opposed-phase gradient echo sequence. This susceptibility artifact is more pronounced on the gradient echo image with the longer echo time due to the continued decay of the transverse magnetization. Besides identification of hepatic steatosis, the double echo approach is particularly helpful in identification of Pneumobilia.
P G Brady - One of the best experts on this subject based on the ideXlab platform.
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Pneumobilia and sump syndrome resulting from a cystic duct duodenal bulb fistula
The American Journal of Gastroenterology, 2000Co-Authors: I M Nakshabendi, P G BradyAbstract:Sump syndrome is a rare complication of biliary-enteric anastamosis. The distal bile duct becomes obstructed by food debris resulting in cholangitis. Pneumobilia is the presence of air in the biliary tree following surgical or endoscopic intervention or less commonly resulting from gas forming microorganisms. We report a case of cystic duct-duodenal bulb fistula, manifested as sump syndrome and Pneumobilia 37 years following conventional cholecystectomy.
Hiromitsu Saisho - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for recurrent bile duct stones after endoscopic papillotomy
Gut, 2003Co-Authors: Takeshi Ando, M. Saito, Toshio Tsuyuguchi, Taketo Yamaguchi, Takeshi Ishihara, T Okugawa, Hiromitsu SaishoAbstract:Background: The long term outcome of endoscopic papillotomy (EPT) is not well known. The aims of this study were to clarify the clinical course of post-EPT patients and to detect predictors for bile duct stone recurrence. Methods: A total of 1042 consecutive patients who underwent EPT for bile duct stones from December 1975 to September 1998 were prospectively followed up. Patients were divided into four groups according to gall bladder (GB) status: “acalculous GB” group, “calculous GB” group, “cholecystectomy” group, and “prior cholecystectomy” group. Reliable follow up information was obtained for 983 (94.3%) of the 1042 patients. The following factors were considered in the evaluation of predisposing risk factors for recurrence of bile duct stones: age, sex, gall bladder status, periampullary diverticulum, number of bile duct stones, diameter of bile duct stones, diameter of bile duct, lithotripsy, precutting, Pneumobilia, and early complications. Results: Recurrence occurred in 111 patients. The “acalculous GB” group was less prone to recurrence than the “prior cholecystectomy” group and the “calculous GB” group. The relative risks (RR) for the latter two compared with the former group were 2.26 (95% confidence interval (CI) 1.24–4.14; p=0.0078) and 2.16 (95% CI 1.21–3.87; p=0.0093), respectively. Other prognostic factors were lithotripsy (RR 2.37; 95% CI 1.47–3.81; p=0.0004) and Pneumobilia (RR 1.57; 95% CI 1.01–2.43; p=0.044). Conclusions: Gall bladder status, lithotripsy, and Pneumobilia were significantly related to bile duct stone recurrence after EPT.
Michael Christian Sulz - One of the best experts on this subject based on the ideXlab platform.
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mind the sump diagnostic challenge of a rare complication of choledochoduodenostomy
Case Reports in Gastroenterology, 2014Co-Authors: Ulf Zeuge, Martin Fehr, Christa Meyenberger, Michael Christian SulzAbstract:Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). Frequently only Pneumobilia, serving as sign for functioning biliary-enteric anastomosis, is reminiscent of the former surgery. We present the case of an 81-year-old patient with sump syndrome who presented with clinical signs of ascending cholangitis, decades after the initial CDD procedure. Finally the detailed medical history that was taken very thoroughly in combination with the presence of Pneumobilia led to the suspicion of sump syndrome. Sump syndrome was diagnosed by ERCP, and after endoscopic debris extraction and antibiotic treatment the patient recovered quickly. In the ERCP era little is known about CDD and its long-term complications, especially by young colleagues and trainees. Therefore this report provides an excellent opportunity to refresh the knowledge and raise awareness for this syndrome.
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Unspecific abdominal symptoms and Pneumobilia: a rare case of gastrointestinal obstruction.
Case reports in gastroenterology, 2014Co-Authors: Martina Keller, Christa Meyenberger, Carola Epp, Michael Christian SulzAbstract:The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with Pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.
Venkata M Alla - One of the best experts on this subject based on the ideXlab platform.
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Image in Emergency Medicine Cholecysto-colonic Fistula Manifesting as Pneumobilia and Gastrointestinal Bleed
2010Co-Authors: Manu Kaushik, Ritu Madan, Prateek K Gupta, Janardan Gorthi, Venkata M AllaAbstract:Figure 1. Coronal section of abdominal computed tomography scan with contrast shows presence of Pneumobilia (arrow). A 60-year-old male presented with self-limited transient right upper quadrant abdominal pain associated with dyspepsia of a few days duration. Examination revealed right upper quadrant tenderness with negative Murphy’s sign. Laboratory results showed abnormal ALT (129u/L), AST(165 u/l), total bilirubin (1.3mg/dl) and WBC count (12,800/microL)
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Cholecysto-colonic Fistula Manifesting as Pneumobilia and Gastrointestinal Bleed
The western journal of emergency medicine, 2010Co-Authors: Manu Kaushik, Ritu Madan, Prateek K Gupta, Janardan Gorthi, Venkata M AllaAbstract:A 60-year-old male presented with self-limited transient right upper quadrant abdominal pain associated with dyspepsia of a few days duration. Examination revealed right upper quadrant tenderness with negative Murphy’s sign. Laboratory results showed abnormal ALT (129u/L), AST(165 u/l), total bilirubin (1.3mg/dl) and WBC count (12,800/microL). Ultrasound of the abdomen demonstrated gall bladder stones with thickened gall bladder, and his symptoms were attributed to cholecystitis. His pain exacerbated two days later. Total bilirubin rose to 3.1 mg/dl and alkaline phosphatase increased from normal to 257 u/L. However, this pain resolved spontaneously within a day with subsequent improvement of liver function tests. Patient simultaneously developed transient self-limited lower GI bleed. A computed tomography scan showed presence of Pneumobilia (Figure 1) with a collapsed gallbladder closely apposed to transverse colon (Figure 2). The clinical condition of the patient continued to improve, supporting resolution of cholangitis. The patient later underwent a laparoscopic cholecystectomy and was identified to have cholecysto-colonic fistula that we presume decompressed the biliary system. This fistula was the most likely source of lower gastrointestinal bleed since a colonoscopy ruled out other causes. Cholecysto-intestinal fistulae are an unusual but established cause of gastrointestinal bleed.1 They often occur in association with Mirizzi’s syndrome and rarely may accompany gall bladder malignancy. Pneumobilia is usually considered an indicator of worsening cholangitis in a patient with deteriorating clinical condition. Nonetheless, physicians and surgeons should be aware that it could be a hallmark of fistulization of the biliary system into the gut in a clinically improving patient of cholecystitis or cholangitis.