A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy...A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the f irst time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.展开更多
BACKGROUND:Biliary cast syndrome(BCS)is an unusual complication of orthotopic liver transplantation (OLTx),and its management is difficult.Limited success using endoscopic retrograde cholangiopancreatography (ERCP)or ...BACKGROUND:Biliary cast syndrome(BCS)is an unusual complication of orthotopic liver transplantation (OLTx),and its management is difficult.Limited success using endoscopic retrograde cholangiopancreatography (ERCP)or open exploration to clear casts has been reported, but failure usually results in re-transplantation.We aimed to review our experience with BCS and highlight a novel combined percutaneous and endoscopic approach for duct clearance.A brief review of the literature is given. METHODS:We retrospectively reviewed our experience of managing BCS using case notes review.Details were also gathered from radiology,where interventional procedures were carried out. RESULTS:We had a total of three cases of BCS reported between 2002 and 2005.Multiple attempts were made to remove these casts.All three were treated in a variety of ways.Management is discussed along with highlighting a novel combined percutaneous and endoscopic approach for duct clearance. CONCLUSIONS:BCS is a potential complication of OLTx. Surgical and endoscopic methods of removing casts are used.However,in circumstances where these methods are technically difficult,a percutaneous endoscopic approach with serial dilatation of the cutaneous port and surgical removal of casts can be done.展开更多
Background： BiNary cast syndrome （BCS） was a postoperative complication of orthotopic liver transplantation （OLT）, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study ai...Background： BiNary cast syndrome （BCS） was a postoperative complication of orthotopic liver transplantation （OLT）, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index （HARt）, and to observe pathological changes and morphology of biliary casts. Methods： Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks I, 2, 3 shown by color Doppler flow imaging. The compositions ofbiliary casts were analyzed by pathological examination and scanning electron microscopy. Results： HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 （P 〈 0.05）. Odds ratio （OR） analysis of HARI 1, HARI 2, HARI 3 following the operation was 〉1 （OR = 1.300： 1.223 and 1.889, respectively）. The OR of HARI 3 was statistically significant （OR - 1.889; 95% confidence interval - 1.166-7.490; P - 0.024）. The compositions of biliary casts were different when bile duct stones wcrc present. Furthermore, vascular epithelial cells were found by pathological examination in binary casts. Conclusions： HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of binary casts and bile duct stones are different.展开更多
文摘A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the f irst time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.
文摘BACKGROUND:Biliary cast syndrome(BCS)is an unusual complication of orthotopic liver transplantation (OLTx),and its management is difficult.Limited success using endoscopic retrograde cholangiopancreatography (ERCP)or open exploration to clear casts has been reported, but failure usually results in re-transplantation.We aimed to review our experience with BCS and highlight a novel combined percutaneous and endoscopic approach for duct clearance.A brief review of the literature is given. METHODS:We retrospectively reviewed our experience of managing BCS using case notes review.Details were also gathered from radiology,where interventional procedures were carried out. RESULTS:We had a total of three cases of BCS reported between 2002 and 2005.Multiple attempts were made to remove these casts.All three were treated in a variety of ways.Management is discussed along with highlighting a novel combined percutaneous and endoscopic approach for duct clearance. CONCLUSIONS:BCS is a potential complication of OLTx. Surgical and endoscopic methods of removing casts are used.However,in circumstances where these methods are technically difficult,a percutaneous endoscopic approach with serial dilatation of the cutaneous port and surgical removal of casts can be done.
基金Source of Support： This study was supported by grants from Science and Technology, Development Plan of Shandong Province （No. 2011GSF 11836）, Natural Science Foundation of Shandong Province （No. ZR2012HM029）, Science and Technology Development Plan of Jinan City （No. 20140821 ）. Conflict of Interest： None declared.ACKNOWLEDGMENTS We thank Prof. Cong Cheng for all statistical analyses, who is director of the teaching and research section of statistics of Taishan Medical University.
文摘Background： BiNary cast syndrome （BCS） was a postoperative complication of orthotopic liver transplantation （OLT）, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index （HARt）, and to observe pathological changes and morphology of biliary casts. Methods： Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks I, 2, 3 shown by color Doppler flow imaging. The compositions ofbiliary casts were analyzed by pathological examination and scanning electron microscopy. Results： HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 （P 〈 0.05）. Odds ratio （OR） analysis of HARI 1, HARI 2, HARI 3 following the operation was 〉1 （OR = 1.300： 1.223 and 1.889, respectively）. The OR of HARI 3 was statistically significant （OR - 1.889; 95% confidence interval - 1.166-7.490; P - 0.024）. The compositions of biliary casts were different when bile duct stones wcrc present. Furthermore, vascular epithelial cells were found by pathological examination in binary casts. Conclusions： HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of binary casts and bile duct stones are different.
