COMPLICATII IN PATOLOGIA CAILOR BILIARE EXTRAHEPATICE.pdf
COMPLICATII IN PATOLOGIA CAILOR BILIARE EXTRAHEPATICE.pdf
COMPLICATII IN PATOLOGIA CAILOR BILIARE EXTRAHEPATICE.pdf
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<strong>COMPLICATII</strong> <strong>IN</strong> <strong>PATOLOGIA</strong><br />
<strong>CAILOR</strong> <strong>BILIARE</strong><br />
<strong>EXTRAHEPATICE</strong><br />
DR SALAN LAURENTIU<br />
MEDIC PRIMAR CHIRURG<br />
DR ADA REKA<br />
MEDIC SPECIALIST CHIRURG<br />
SPITALUL MUNICIPAL<br />
TG SECUIESC
PREZENTARE DE CAZ<br />
COLECISTITA ACUTA LITIAZICA<br />
LITIAZA COLEDOCIANA MULTIPLA<br />
DATE ANAMNESTICE:<br />
-Pacienta in varsta de 68 de ani<br />
Motivele internarii:<br />
-dureri abdominale de etaj superior, greata, varsaturi<br />
Antecedente patologice personale:<br />
-pusee repetitive de colecistita acuta litiazica,<br />
angiocolita acuta si pancreatita acuta edematoasa
<strong>IN</strong>VESTIGATII CL<strong>IN</strong>ICE SI<br />
PARACL<strong>IN</strong>ICE<br />
EXAMENE DE LABORATOR:<br />
-LEUCOCITOZA, ANEMIE MODERATA,<br />
-AMILAZEMIE MODERATA,<br />
-BILIRUB<strong>IN</strong>EMIE TOTALA SI DIRECTA<br />
CRESCUTE, CU PREDOM<strong>IN</strong>ENTA CELEI<br />
DIRECTE,<br />
-TRANSAM<strong>IN</strong>AZE CRESCUTE MODERAT
<strong>IN</strong>VESTIGATII IMAGISTICE<br />
ECHOGRAFIE ABDOM<strong>IN</strong>ALA:<br />
-COLECIST CU PERETI <strong>IN</strong>GROSATI, CU CONT<strong>IN</strong>UT LITIAZIC<br />
MULTIPLU, FARA CONT<strong>IN</strong>UT BILIAR, ASPECT DE<br />
COLECISTITA LITIAZICA SCLEROATROFICA,<br />
-CBP DILATAT LA 20 mm, CU PERETE <strong>IN</strong>GROSAT, SI TREI<br />
IMAG<strong>IN</strong>I DE CALCULI <strong>IN</strong>FRACENTIMETRICI<br />
-DILATATIE DE CBIH<br />
-CEFALOPANCREAS MARIT <strong>IN</strong> VOLUM, CU ASPECT DE<br />
PANCREATITA EDEMATOASA<br />
-CANAL WIRSUNG DILATAT MODERAT<br />
-FICAT CU ASPECT ECHOGRAFIC DE STEATOZA
<strong>IN</strong>TERVENTIE CHIRURGICALA<br />
ANESTEZIE: GENERALA IOT<br />
COLECISTECTOMIE ANTEROGRADA DIFICILA,<br />
PENTRU COLECIST SCLEROATROFIC LITIAZIC,<br />
MULAT PE CALCULI, DEFUNCTIONALIZAT<br />
COLEDOCOTOMIE LONGITUD<strong>IN</strong>ALA, CU<br />
EXTRAGEREA A 56 DE CALCULI COLEDOCIENE,<br />
IMPACTATI CE OCUPA <strong>IN</strong> TOTALITATE CAILE<br />
<strong>BILIARE</strong> <strong>EXTRAHEPATICE</strong><br />
COLEDOCO-DOUDENO ANASTOMOZA LATERO-<br />
LATERALA TIP FLORKEN
EVOLUTIE POSTOPERATORIE<br />
IMEDIATA : SIMPLA FARA <strong>COMPLICATII</strong><br />
PASAJ TRANSANASTOMOTIC PREZENT<br />
REMISIUNEA MANIFESTARILOR DE<br />
PANCREATITA ACUTA<br />
UN PUSEU DE ANGIOCOLITA ACUTA,<br />
PR<strong>IN</strong> REFLUX DOUDENO-COLEDOCIAN<br />
LA 2 LUNI POSTOPERATOR, REMIS<br />
MEDICAMENTOS
PREZENTARE DE CAZ<br />
ABCES <strong>IN</strong>TERHEPATOFRENIC<br />
CU DISTRUCTIE HEPATICA<br />
IMPORTANTA POST ICTER<br />
MECANIC PR<strong>IN</strong> LITIAZA<br />
COLEDOCIANA OPERATA.<br />
STARE SEPTICA
Date anamnestice<br />
Pacient in varsta de 76 de ani<br />
Motivele internarii:<br />
-dureri de etaj abdominal superior predominent<br />
hipocondrul drept,<br />
-greata inapetenta<br />
-febra<br />
-scadere ponderala<br />
-oligoanurie<br />
-astenie fizica marcata
Antecedente patologice personale<br />
Icter mecanic prin litiaza colecisto-coledociana cu<br />
obstructia CBP<br />
Interventie chirurgicala :colecistectomie clasica, cu<br />
coledoco-litotomie si drenaj biliar extern cu tub Kher<br />
Litiaza coledociana restanta postoperator<br />
Diabet zaharat tipII<br />
Pneumonie bazala bilaterala<br />
Pancreatita acuta edematoasa
Istoricul bolii pacientului postoperator<br />
Litiaza coledociana restanta cu impactarea<br />
calculului in coledocul terminal si mentinerea<br />
drenajului biliar extern tip Kher<br />
Endoscopie digestiva superioara cu ERCP<br />
ecoendoscopie, papilosfincterotomie<br />
endoscopica, extragerea calculului<br />
coledocian<br />
Suprimarea drenajului biliar Kher
Evolutia bolii post endoscopie<br />
interventionala<br />
Fistula coledociana persistenta dupa<br />
extragerea tubului Kher<br />
Formarea unui abces subhepatic fuzat<br />
interhepatofrenic cu distructia importanta a<br />
lobului drept hepatic, cca doua treimi<br />
Pneumonie bazala dreapta<br />
Stare septica<br />
Insuficienta renala acuta –cu oligoanurie
<strong>IN</strong>TERVENTIA CHIRURGICALA<br />
ANESTEZIE GENERALA IOT<br />
<strong>IN</strong>CIZIE SUBCOSTALA DREAPTA ITERATIVA<br />
PATRUNDEREA <strong>IN</strong> CAVITATEA UNUI ABCES<br />
VOLUM<strong>IN</strong>OS <strong>IN</strong>TERDIAFRAGMATIC, PR<strong>IN</strong> ACRE<br />
SE EVACUEAZA PUROI FETID SI O MASA DE<br />
TESUT HEPATIC DISTRUS <strong>IN</strong> VOLUM TOTAL DE<br />
2300 ml, FARA HEMORAGIE SI BILIRAGIE<br />
IMPORTANTE D<strong>IN</strong> PATUL HEPATIC<br />
LAVAJ ANTISEPTIC<br />
DRENAJ MULTIPLU ASPIRATIV AL CAVITATII<br />
ABCESULUI
EVOLUTIE POSTOPERATORIE<br />
FAVORABILA:<br />
FARA CAVITATE RESTANTA DE ABCES<br />
<strong>IN</strong>TERHEPATOFRENIC LA CONTROLUL<br />
RADIOLOGIC<br />
RELUAREA FUNCTIEI HEPATICE<br />
RELUAREA FUNCTIEI RENALE<br />
CASTIG PONDERAL<br />
AMELIORAREA STARII GENERALE
PREZENTARE DE CAZ<br />
CALCUL COLEDOCIAN<br />
RESTANT<br />
POSTOPERATOR
DATE ANAMNESTICE<br />
PACIENT <strong>IN</strong> VARSTA DE 65 DE ANI<br />
MOTIVELE <strong>IN</strong>TERNARII:<br />
-GREATA, VARSATURI, <strong>IN</strong>APETENTA<br />
-SCADERE PONDERALA MARCATA<br />
-OLIGOANURIE<br />
-ASTENIE FIZICA MARCATA<br />
-DRENAJ BILIAR EXTERN TIP KHER<br />
-PALOARE SCLEROTEGUMENTARA
ISTORICUL BOLII ACTUALE<br />
PACIENTA CONSULTATA <strong>IN</strong>TR-UN SERVICIU MEDICAL<br />
EXTRASPITALICESC , SE PREZ<strong>IN</strong>TA PENTRU SIMPTOMATOLOGIA UNUI<br />
ICTER MECANIC<br />
SE <strong>IN</strong>TERNEAZA <strong>IN</strong> CENTRUL DE GASTRO-ENTEROLOGIE SI CHIRURGIE<br />
BILIOPANCREATICA CLUJ-NAPOCA<br />
SE PRACTICA EDS, ERCP, PAPILOSF<strong>IN</strong>CTEROTOMIE SI STENTAREA<br />
CBP.<br />
ICTERUL MECANIC ESTE <strong>IN</strong> REMISIE<br />
PREZ<strong>IN</strong>TA <strong>IN</strong>SUFICIENTA HEPATICA PROGRESIVA<br />
SE <strong>IN</strong>TERV<strong>IN</strong>E CHIRURGICAL, SI SE PRACTICA COLECISTECTOMIE<br />
CLASICA, COLEDOCOTOMIE, DRENAJ BILIAR EXTERN TIP KHER<br />
SE EXTERNEAZA PACIENTA <strong>IN</strong> ZIUA A ZECEA POSTOPERATOR, CU<br />
DRENAJ BILIAR EXTERN PE LOC<br />
SE RE<strong>IN</strong>TERNEAZA <strong>IN</strong> SERVICIUL NOSTRU DUPA CCA O SAPTAMANA <strong>IN</strong><br />
STARE GENERALA ALTERATA, <strong>IN</strong> <strong>IN</strong>SUFICIENTA RENALA ACUTA, CU<br />
TULBURARI GRAVE HIDROELECTROLITICE
EXAMENELE DE LABORATOR<br />
LEUCOCITOZA, ANEMIE MODERATA<br />
HIPONATREMIE SI HIPOPOTASEMIE<br />
SEVERE<br />
BILIRUB<strong>IN</strong>EMIA TOTALA SI DIRECTA<br />
MODERAT CRESCUTE<br />
TRANSAM<strong>IN</strong>AZELE MODERAT CRESCUTE
<strong>IN</strong>VESTIGATII IMAGISTICE<br />
ECHOGRAFIE ABDOM<strong>IN</strong>ALA:<br />
COLEDOC DILATAT CCA 10-14 CM , UN CALCUL<br />
<strong>IN</strong> COLEDOCUL TERM<strong>IN</strong>AL CCA 10MM<br />
DIAMETRU<br />
COLANGIOGRAFIE PE TUB KEHR, OPACIFIERE<br />
CBP, DILATATIE MODERATA SI IMAG<strong>IN</strong>E<br />
LACUNARA <strong>IN</strong> COLEDOCUL TERM<strong>IN</strong>AL<br />
PASAJ TRANSPAPILAR PREZENT, REDUS
<strong>IN</strong>TERVENTIE CHIRURGICALA<br />
ANESTEZIE GENERALA IOT<br />
VISCEROLIZA DIFICILA, SUBHEPATICA<br />
DECOLARE DOUDENALA TIP KOCHER<br />
COLEDOCOTOMIE LONGITUD<strong>IN</strong>ALA PE<br />
COLEDOCUL RETRODOUDENAL<br />
EXTRAGEREA CALCULULUI COLEDOCIAN<br />
COLEDOCORAFIE “PER PRIMAM”, CU<br />
MENT<strong>IN</strong>EREA DRENAJULUI KHER
EVOLUTIE POSTOPERATORIE<br />
FAVORABILA<br />
CONTROLUL COLANGIOGRAFIC<br />
POSTOPERATOR-CBP NELOCUIT,<br />
MODERAT DILATAT, PASAJ<br />
TRANSPAPILAR PREZENT<br />
SUPURATIE PARIETALA M<strong>IN</strong>IMA<br />
RECUPERAREA FUNCTIEI<br />
HEPATORENALE.
CONCLUZII<br />
<strong>PATOLOGIA</strong> <strong>CAILOR</strong> <strong>BILIARE</strong> <strong>EXTRAHEPATICE</strong><br />
PREZ<strong>IN</strong>TA O FRECVENTA RELATIV MARE<br />
<strong>COMPLICATII</strong>LE ACESTEI PATOLOGII POT DA<br />
AFECTARE SEVERA PANA LA <strong>IN</strong>STALAREA<br />
MSOF<br />
NECESITA <strong>IN</strong>VESTIGATII CL<strong>IN</strong>ICE SI<br />
PARACL<strong>IN</strong>ICE SPECIALIZATE<br />
<strong>IN</strong>TERVENTIILE CHIRURGICALE AU O RATA<br />
RELATIV MARE DE SUCCES, <strong>IN</strong> CAZUL UNUI<br />
DIAGNOSTIC PREOPERATOR DE ACURATETE
VA MULTUMIM PENTRU ATENTIA<br />
ACORDATA!
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