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Biomedical subjects

L K Kacker

Publications and source records attributed to L K Kacker.

7 recordsLinked to original sources
PubMed1997

Post-cholecystectomy external biliary fistula.

BACKGROUND: External biliary fistula (EBF) following bile duct injury is a serious complication of cholecystectomy. METHODS: From January 1989 to December 1994, 37 patients with post-cholecystectomy external biliary fistula were seen at this centre. There were 14 partial, 22 complete and one sub-vesical duct of Luschka injury. Sixteen patients had a controlled EBF at presentation; 10 patients had intra-abdominal collections and seven patients presented with peritonitis. RESULTS: A staged approach to the management of these patients was adopted in which the initial management aimed at creating a 'controlled' fistula. This approach comprised conservative treatment (n = 9), percutaneous catheter drainage of intra-abdominal collections (n = 10), biliary drainage (n = 6), and surgical intervention (n = 7). One patient died because of progressive liver failure in spite of intensive management. Definitive management comprised the surgical repair of biliary strictures wherever indicated, after waiting for the acute problems to settle. CONCLUSIONS: By adopting a staged approach along with a judicious use of endoscopy, radiology and surgery that were based on clinical circumstances, it was possible to achieve satisfactory results for this otherwise distressing condition.

Adult↗
PubMed1993

Partial cholecystectomy--safe and effective.

Patients undergoing surgical treatment for calculous disease were considered to have had a partial cholecystectomy performed when a part of the gall bladder wall was retained for technical reasons. Forty patients underwent partial cholecystectomy: for chronic cholecystitis (20), acute cholecystitis (4), Mirizzi's syndrome (14), portal hypertension or partially accessible gall bladder (one patient each). Four patients (10%) developed infective complications and two patients had retained common bile duct stones. In a mean follow up period of 13 months (range 1-36 mths), only 3 patients have ongoing mild dyspeptic symptoms while the rest have remained asymptomatic. Partial cholecystectomy has been found to be a safe and effective procedure in difficult cholecystectomy situations, since it combines the merits of cholecystectomy and cholecystostomy.

Adolescent↗
PubMed1991

Agenesis of the gallbladder--a case report.

Agenesis of the gallbladder, which is an extremely rare anomaly, may present with biliary symptoms but is virtually impossible to diagnose by such conventional investigations as oral cholecystogram or ultrasonography. We report herein a case of a young man presenting with episodic epigastric pain on whom an ultrasonographic diagnosis of gallstones was made. A gallbladder was not visualized on oral cholecystogram, however, he was subsequently found to have agenesis of the gallbladder, the diagnosis of which was confirmed by intra-operative cholangiography and a postoperative N-2,6-dimethylphenylcarbamoyle methyl iminodiacetic acid scan (HIDA scan). His symptoms responded to antiulcer treatment with upper gastrointestinal endoscopic findings suggestive of oesophagitis and duodenitis.

Adolescent↗
PubMedDate not supplied

Transcholedochal cholecystolithotomy for a variant of Mirizzi's syndrome.

Obstruction of the common bile duct by impaction of a gallstone in the neck or the cystic duct of the gallbladder results into repeated attacks of cholangitis (Mirizzi's syndrome). In suspected cases preoperative diagnosis can be made by ultrasonography and cholangiography. We report two patients of a variant of Mirizzi's syndrome. The common bile duct was obstructed by a stone impacted in the neck and causing extrinsic compression from behind. Ultrasonography and endoscopic retrograde cholangiography diagnosed the condition as common bile duct stone in both the cases. The anomaly could be diagnosed only after choledochotomy. Stones were retrieved by transcholedochal cholecystolithotomy--an innovative surgical procedure for this variant of Mirizzi's syndrome.

Adult↗
PubMedDate not supplied

Bile leak after T-tube removal--a scintigraphic study.

BACKGROUND/AIMS: A prospective study was performed to evaluate the incidence of bile leak after T-tube removal, using 99mTc labelled BULIDA scintigraphy. PATIENTS AND METHODS: Thirty seven patients with choledocholithiasis underwent choledocholithotomy and T-tube drainage. T-tubes were removed on 9--26 postoperative day (mean 13.4 days). RESULTS: Six (16%) patients had scintigraphic evidence of bile leak; 4 patients had leak demonstrated in the early phase only. One patient each had partial persistent leak and complete bile leak. All patients were managed nonsurgically; conservative treatment: (4), percutaneous drainage (PCD) of intra-abdominal collection (1) and endoscopic sphincterotomy and PCD of intra-abdominal collection (1). There was no significant difference in the leak rate when T-tubes were removed at < 2 weeks versus later than 2 weeks (P=.97). CONCLUSIONS: T-tubes should be removed with extreme caution and treatment of symptomatic patients should be guided by clinical and scintigraphic findings.

Bile↗