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Bardet e Biedl: is there a new disease association?
Electronic Poster Abstracts underwent laparoscopic cholecystectomy. Upon postoperative specimen dissection, multiple intraluminal, as well as intramural gallstones, were discovered. Moreover, histopathologic examination demonstrated the presence of gallbladder adenomyosis along with chronic inflammatory alterations. The second case refers to a 58-year-old female patient, scheduled for elective laparoscopic cholecystectomy due to symptomatic cholelithiasis. Upon postoperative specimen dissection, multiple intramural gallstones, but no intraluminal gallstones, were discovered. Histopathologic examination demonstrated signs of chronic inflammation, without adenomyosis or other pathology. Conclusion: Intramural gallbladder lithiasis is a rare condition whose pathogenetic background is not clarified yet. Further studies need to be conducted, in order to establish its etiology, as well as its possible correlation to other complications of gallstone disease, including malignancy.
EP03C-036 BILIARY DRAINAGE CATHETER INSERTION VIA T-TUBE FOR INTRACTABLE BILIARY FISTULA FROM FRIABLE COMMON BILE DUCT Y. H. Hur, H. J. Kim, E. K. Park, Y. S. Koh, C. K. Cho, H. J. Kim and M. W. Lee Department of Surgery, Chonnam National University Medical School, Republic of Korea Persistent biliary fistula is one of difficult problems, especially in friable CBD due to severe inflammation. Herein, we report an intractabel bile leakage, despite of Ttube, successfully treated with trans-T-tube biliary drainage (TTBD). A 65-years-old man visited our hospital with recurrent CBD stone. CT scan demonstrated multiple intrahepatic duct stones in left IHBD. A left hemihepatectomy was performed. Because there was a ERBD catheter, we repaired primarily the choledochoscpe insertion site. On POD7, an emergency angiography and a covered stent insertion in right hepatic artery were performed due to bleeding from hepatic artery branch. The patient recovered from shock, however, bile juice was observed from drain on 5 days after the intervention. On the finding of re-operation, the repaired choledochoscope insertion site was necrotized. A T-tube was inserted, but tight sutures were impossible because of friable tissues. Persistent bile leakage was observed from drain, despite of well-functioning T-tube. 30 days later from re-operation, bile leakage (500 cc/day) was persistent. 2 Time of ERCP were failed. T-tube cholangiography revealed bile leakage from more proximal portion than T-tube insertion site. A catheter was inserted through T-tube and the tip was placed in right IHBD. 2 Days after TTBD, the amount of drained bile was dramatically decreased. 6 Days after the TTBD, abdominal ultrasonography showed no abnormal fluid collection, and the drain was removed. 4 Weeks after the TTBD, no more bile leakage was observed, and the TTBD and T-tube was removed. An intractable biliary fistula was successfully managed with T-tube and TTBD catheter.
HPB 2016, 18 (S1), e385ee601
e491
EP03C-037 BARDET E BIEDL: IS THERE A NEW DISEASE ASSOCIATION? C. R. S. Bezerra1, M. A. A. Nogueita1, T. S. G. Medeiros1, L. E. P. Ibiapina1, R. M. S. Sousa1, L. Pereira1, K. F. Silva1 and W. R. Figueiredo2 1 Surgical Clinic, Faculdade de Ciências Médicas do Piauí, and 2Surgical Clinic, FACID, Brazil Introduction: Bardet and Biedl syndrome was first described in the late nineteenth century independently by both authors, the clinical picture of this syndrome consists of criteria such as: obesity, polydactyly, retinitis pigmentosa, mental retardation, diabetes mellitus and renal failure. This is an absolutely rare syndrome, with a prevalence ranging from 1:125,000 to 1:175,000 in Europe. Is related to an autosomal recessive inheritance, it is heterogeneous with at least four genetic loci (BBS1-4) already mapped so far. Case report: MRSN patient, 23 years old, male, single, born and raised in Teresina-Pi was admitted to the Emergency Hospital in Teresina on 20/6/14 with pain in the right upper quadrant frame radiating to the back, held ultrasound Abdominal that showed cholelithiasis and then forwarded to the Getulio Vargas Hospital for conducting video-laparoscopic cholecystectomy. It is performed surgery on 23 June 2014, with satisfactory evolution and was discharged on day 3 after surgery, without complications in the transoperative and postoperative. Conclusion: However there no reports in the literature linking this disease with gallstones, obesity may be a trigger of the association of these illnesses, requiring greater attention to patients with this syndrome.
[Bardet]
EP03C-038 CHRONIC DISCHARGING SINUS OUT OF MISSED STONE DURING LAPAROSCOPIC CHOLECYSTECTOMY: A RARE AND LATE COMPLICATION A. Banerjee Zenith Hospital, India Introduction: Gallbladder perforation can occur in 6 e 40% of laparoscopic cholecystectomy (LC) procedures. In up to a third of these cases, stones cannot be retrieved and complications can arise many years post-operatively. I am
EP03C-036 BILIARY DRAINAGE CATHETER INSERTION VIA T-TUBE FOR INTRACTABLE BILIARY FISTULA FROM FRIABLE COMMON BILE DUCT Y. H. Hur, H. J. Kim, E. K. Park, Y. S. Koh, C. K. Cho, H. J. Kim and M. W. Lee Department of Surgery, Chonnam National University Medical School, Republic of Korea Persistent biliary fistula is one of difficult problems, especially in friable CBD due to severe inflammation. Herein, we report an intractabel bile leakage, despite of Ttube, successfully treated with trans-T-tube biliary drainage (TTBD). A 65-years-old man visited our hospital with recurrent CBD stone. CT scan demonstrated multiple intrahepatic duct stones in left IHBD. A left hemihepatectomy was performed. Because there was a ERBD catheter, we repaired primarily the choledochoscpe insertion site. On POD7, an emergency angiography and a covered stent insertion in right hepatic artery were performed due to bleeding from hepatic artery branch. The patient recovered from shock, however, bile juice was observed from drain on 5 days after the intervention. On the finding of re-operation, the repaired choledochoscope insertion site was necrotized. A T-tube was inserted, but tight sutures were impossible because of friable tissues. Persistent bile leakage was observed from drain, despite of well-functioning T-tube. 30 days later from re-operation, bile leakage (500 cc/day) was persistent. 2 Time of ERCP were failed. T-tube cholangiography revealed bile leakage from more proximal portion than T-tube insertion site. A catheter was inserted through T-tube and the tip was placed in right IHBD. 2 Days after TTBD, the amount of drained bile was dramatically decreased. 6 Days after the TTBD, abdominal ultrasonography showed no abnormal fluid collection, and the drain was removed. 4 Weeks after the TTBD, no more bile leakage was observed, and the TTBD and T-tube was removed. An intractable biliary fistula was successfully managed with T-tube and TTBD catheter.
HPB 2016, 18 (S1), e385ee601
e491
EP03C-037 BARDET E BIEDL: IS THERE A NEW DISEASE ASSOCIATION? C. R. S. Bezerra1, M. A. A. Nogueita1, T. S. G. Medeiros1, L. E. P. Ibiapina1, R. M. S. Sousa1, L. Pereira1, K. F. Silva1 and W. R. Figueiredo2 1 Surgical Clinic, Faculdade de Ciências Médicas do Piauí, and 2Surgical Clinic, FACID, Brazil Introduction: Bardet and Biedl syndrome was first described in the late nineteenth century independently by both authors, the clinical picture of this syndrome consists of criteria such as: obesity, polydactyly, retinitis pigmentosa, mental retardation, diabetes mellitus and renal failure. This is an absolutely rare syndrome, with a prevalence ranging from 1:125,000 to 1:175,000 in Europe. Is related to an autosomal recessive inheritance, it is heterogeneous with at least four genetic loci (BBS1-4) already mapped so far. Case report: MRSN patient, 23 years old, male, single, born and raised in Teresina-Pi was admitted to the Emergency Hospital in Teresina on 20/6/14 with pain in the right upper quadrant frame radiating to the back, held ultrasound Abdominal that showed cholelithiasis and then forwarded to the Getulio Vargas Hospital for conducting video-laparoscopic cholecystectomy. It is performed surgery on 23 June 2014, with satisfactory evolution and was discharged on day 3 after surgery, without complications in the transoperative and postoperative. Conclusion: However there no reports in the literature linking this disease with gallstones, obesity may be a trigger of the association of these illnesses, requiring greater attention to patients with this syndrome.
[Bardet]
EP03C-038 CHRONIC DISCHARGING SINUS OUT OF MISSED STONE DURING LAPAROSCOPIC CHOLECYSTECTOMY: A RARE AND LATE COMPLICATION A. Banerjee Zenith Hospital, India Introduction: Gallbladder perforation can occur in 6 e 40% of laparoscopic cholecystectomy (LC) procedures. In up to a third of these cases, stones cannot be retrieved and complications can arise many years post-operatively. I am