BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.展开更多
BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ...BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ultrasound(EUS)for pancreatic and biliary pathologies.These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raise important que-stions about the true prevalence of these lesions,and highlight the need for es-tablished guidelines for their management and surveillance.The detection of fib-roelastomas during routine EUS procedures emphasizes the importance of tho-rough assessment and multidisciplinary approaches in managing unexpected dis-coveries.This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.CASE SUMMARY The patients aged 72 years,51 years,and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered.These findings were subsequently confirmed by transesophageal echocardiography in two cases,with the third patient awaiting assessment.The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas,including hyperechoic appearance and attachment to the aortic valve leaflets.These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raising questions about the true prevalence of fib-roelastomas and the need for establishing management guidelines.CONCLUSION This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population.This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.展开更多
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
文摘BACKGROUND Papillary fibroelastomas are rare,benign cardiac tumors typically found on the heart valves.This case series presents three patients with aortic valve fibroe-lastoma incidentally detected during endoscopic ultrasound(EUS)for pancreatic and biliary pathologies.These cases highly get the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raise important que-stions about the true prevalence of these lesions,and highlight the need for es-tablished guidelines for their management and surveillance.The detection of fib-roelastomas during routine EUS procedures emphasizes the importance of tho-rough assessment and multidisciplinary approaches in managing unexpected dis-coveries.This also highlights the potential thromboembolic risks associated with fibroelastomas and challenges in determining appropriate management strategies for patients who are asymptomatic.CASE SUMMARY The patients aged 72 years,51 years,and 42 years underwent EUS for various indications when aortic valve lesions consistent with fibroelastomas were discovered.These findings were subsequently confirmed by transesophageal echocardiography in two cases,with the third patient awaiting assessment.The lesions ranged in size from 0.61 cm to 1.6 cm in diameter and exhibited characteristic sonographic features of fibroelastomas,including hyperechoic appearance and attachment to the aortic valve leaflets.These cases highlight the potential of EUS in identifying subtle cardiac lesions during gastrointestinal evaluation,raising questions about the true prevalence of fib-roelastomas and the need for establishing management guidelines.CONCLUSION This case series raises important questions regarding the prevalence of aortic valve fibroelastoma lesions in the general population.This highlights the urgent need for comprehensive evidence-based guidelines to standardize the management and long-term surveillance of affected patients.
