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- Hemobilia Associated with Acute Calculus Cholecystitis Successfully Treated with Endoscopic Naso-biliary Drainage and Laparoscopic Cholecystectomy--A Case Report
- Sequential Sonographic Changes of the Gallbladder in Hemobilia: Case Report of a Patient with Intrahepatic Duct Stones
- 腹腔鏡膽囊切除術
- 腹腔鏡膽囊切除術之膽道相關併發症
- Management of Biliary Calculus Diseases
- The Role of Laparoscopic Cholecystectomy in Treating Gangrenous Cholecystitis
- 非充氣式腹腔鏡膽囊切除術
- Effect of Oral Clonidine Premedication on Perioperative Hemodynamic Response and Postoperative Analgesic Requirement for Patients Undergoing Laparoscopic Cholecystectomy
- 以腹腔鏡膽囊切除術治療急性膽囊炎
- 腹腔鏡膽囊切除術在膽囊息肉處理上的角色
頁籤選單縮合
題名 | Hemobilia Associated with Acute Calculus Cholecystitis Successfully Treated with Endoscopic Naso-biliary Drainage and Laparoscopic Cholecystectomy--A Case Report=內視鏡經鼻膽道引流和腹腔鏡膽囊切除術成功治療急性結石性膽囊炎伴隨膽道出血--病例報告 |
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作者 | 王嘉齊; 劉俊人; 陳志和; 林佳賢; Wang, Chia-chi; Liu, Chun-jen; Chen, Chiher; Lin, Chia-hsien; |
期刊 | 慈濟醫學 |
出版日期 | 20060400 |
卷期 | 18:2 民95.04 |
頁次 | 頁137-140+164 |
分類號 | 415.456 |
語文 | eng |
關鍵詞 | 膽道出血; 急性結石性膽囊炎; 內視鏡經鼻膽道引流; 腹腔鏡膽囊切除術; Hemobilia; Acute calculus cholecystitis; Endoscopic naso-biliary drainage; Laparoscopic cholecystectomy; |
中文摘要 | 膽道出血是一個少見的情況,並且不容易診通常是經由內視鏡檢查證實。本病例是一個49歲的男性病人,主訴上腹疼痛並傳至背後,有茶色尿情形已兩天。實驗室檢查發現白血球增加和肝功能檢驗異常(AST643 U/ L, ALT 510 U/L, total bilirubin 3.5mg/dL and alkaline phosphatase 295 U/L),腹部超音波顯示總膽管擴張和急性膽囊炎的徵兆,包括膽囊擴張、膽囊壁增厚、膽囊周圍液體堆積,膽囊中有一不規則的高回音物質,緊急安排內視鏡逆行性膽管攝影,當插管時,鮮血從十二指腸乳頭流出,且膽管攝影顯示總膽管擴張合併填充缺罕病灶,膽道出血的診斷確立,同時放置內視鏡經鼻膽道引流管,一方面可以減緩膽道的阻塞,同時可以監測出血量,電腦斷層顯現急性膽囊炎,膽囊中合併血塊和結石,血管攝影排除血管異常的可能。病患於三日後接受腹腔鏡膽囊切除術,病理下證實急性結石性膽囊炎,在黏膜層有多處潰瘍合併出血。急性結石性膽囊炎伴隨膽道出血在臨床上極為罕見,本個案成功以內視鏡經鼻膽道引流和腹腔鏡膽囊切除術治療。 |
英文摘要 | Hemobilia is a rare condition and is difficult to diagnose clinically. It is sometimes confirmed during endoscopic procedures. We report a case of a 49-year-old man who had epigastralgia with radiation to the back and tea-colored urine for 2 days. The laboratory tests revealed leukocytosis and abnormal liver function tests (aspartate transaminase (AST) 643 U/L, alanine transaminase (ALT) 510 U/L, total bilirubin 3.5 mg/dL and alkaline phosphatase 295 U/L). An abdominal ultrasound showed a dilated common bile duct and irregular, hyperechoic material within the distended gallbladder. The wall of the gallbladder was thickened with accumulated peri-cholecystic fluid. An emergency endoscopic retrograde cholangiography was performed and fresh blood was flushed out upon cannulation of the papillae. A cholangiogram revealed some filling defects in the dilated common bile duct. Hemobilia was confirmed. Endoscopic naso-biliary drainage was performed immediately to relieve the biliary obstruction and to monitor the amount of bleeding. Computed tomography found small stones and a heterogenous lesion in the distended gallbladder. A hematoma was diagnosed. Angiography of the hepatic artery found no definite vascular abnormality. The patient had a laparoscopic cholecystectomy 3 days later. Pathology reported acute calculus cholecystitis and multiple ulcers with hemorrhage and fibrin deposition over the mucosal surface. In conclusion, hemobilia associated with acute calculus cholecystitis is rarely seen clinically and seldom reported in the literature. We successfully treated this patient with endoscopic naso-biliary drainage and a laparoscopic cholecystectomy. |
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