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Biloma Post-Cholecystectomy: A Prudent “Wait-and-See” Approach

Open Journal of Gastroenterology 2023年第12期13卷 447-452页

作者： Mehdi Bourakkadi Idrissi dkhissi younes Department of General Surgery Haut Atlas Hospital Azilal Morocco Department of Radiology Haut Atlas Hospital Azilal Morocco

Bile duct injury (BDI) is a well-known complication of cholecystectomy and can lead to the formation of a variety of complications, including biloma. Once diagnosed, the appropriate treatment depends on the severity of the condition and can range from minimally invasive procedures to more invasive procedures. We report the case of a 31-year-old woman who exhibited postoperative bile leakage after a cholecystectomy and a CT scan revealed a left hepatic subcapsular biloma. The patient was managed conservatively with close monitoring. The biloma resolved on its own without any intervention. Bilomas are rare complication of cholecystectomy that can be managed conservatively with a wait and see approach, especially in asymptomatic patients. Close monitoring with imaging and laboratory parameters is crucial in the management of these patients.

关键词： Laparoscopic Cholecystectomy Bile Duct Injury Biloma Conservative Treatment

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Renal Transplant Artery Stenosis: Clinical Manifestations, Diagnosis and Treatment

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Open Journal of Nephrology 2024年第2期14卷 262-274页

作者： Rihab dkhissi Latifa Driouch Naima Ouzeddoun Loubna Benamar Tarik Bouattar Department of Nephrology-Dialysis-Renal Transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: Renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality, particulary graft loss. The aim of this study is to determine the prevalence, clinico-radiological characteristics and evaluate the outcomes of luminal angioplasty as a first-line treatment for RTAS, through the analysis of medical records of 27 kidney transplant patients. Material and Methods: This is a retrospective, single-center, and descriptive study conducted at the Nephrology department of the Ibn-Sina Hospital in Rabat, including 27 renal transplant patients with RTAS during the period from 1998 to 2023. All patients with clinically suspected RTAS and confirmed by Doppler ultrasound of the transplanted renal artery were included in the study. Results: The mean age of donors was 48.66 ± 13.55 years, with a female predominance (65%). The donor was deceased in 15% of cases. The mean age of the recipients was 39 ± 16 years with a male-to-female ratio of 4.4. The median onset of RTAS was 3.6 ± 3.4 months after renal transplantation. Seven patients (26%) had high blood pressure (HBP) before their transplantation. Six patients (22%) had hypertriglyceridemia and 7 patients (26%) had pure hypercholesterolemia. The main clinical signs were worsening of preexisting HBP, de novo HBP and acute renal failure (ARF). Stenosis was confirmed by renal Doppler ultrasound in all patients. It was severe in 63%, with a stenosis degree greater than 70%. Six patients underwent angioplasty, resulting in the stabilization of graft function with a nadir of 15 mg/l creatinine and blood pressure control with dual therapy in 5 patients. No graft loss cases were noted. Conclusion: RTAS is a significant vascular complication of renal transplantation that predicts unfavorable outcomes for both the patient and the graft. Early diagnosis is crucial to successfully restore graft f

关键词： RTAS Post Transplant Hypertension Graft Function Luminal Angioplasty

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Autosomal Dominant Polycystic Kidney Disease: Epidemiological, Clinical Aspects and Predictive Factors of Poor Renal Prognosis (About 300 Cases)

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Open Journal of Nephrology 2024年第2期14卷 275-293页

作者： Rihab dkhissi Nada El Kadiri Tarik Bouattar Loubna Benamar Naima Ouzeddoun Department of Nephrology-Dialysis-Renal Transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a common, multisystemic, and progressive hereditary disease. It accounts for 6 to 8% of incident cases of end-stage chronic renal disease (ESRD) in developed countries. The aim of this study is to describe the predictive factors for the development of end-stage chronic kidney disease (CKD) in the course of this disease. Material and Methods: This is a retrospective, descriptive, and analytical study including 300 cases of ADPKD collected at the Nephrology Department of Ibn-Sina Hospital in Rabat over a period of 30 years (1993 to 2023). Included in the study are all patients with ADPKD meeting the ultrasound diagnostic criteria. The analysis focused on demographic, clinical, paraclinical, evolutionary data, as well as prognostic factors associated with renal function deterioration. Results: The mean age of patients at diagnosis is 51.53 +/− 17 years [16 - 93] with a male predominance. The median serum creatinine at diagnosis is 15.5 mg/l [10 - 34]. 21% of patients had ESRD (eGFR 300 mg/24h (21%). The most common cystic complication is hemorrhage (12.3%). 21.3% of patients had hepatorenal polycystic disease. In adjusted analysis, the predictive risk factors for the occurrence of ESRD were smoking (p = 0.019), anemia (p Conclusion: ADPKD can progress insidiously to ESRD. Identification and early treatment of predictive factors for poor renal prognosis could contribute to a better outcome for this disease.

关键词： ADPKD ESRD Factors of Poor Renal Prognosis Renal and Extra-Renal Manifestations

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Renal Vein Thrombosis Suggestive of Extramembranous Glomerulonephritis Associated with Sjögren’s Syndrome (Case Report)

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Open Journal of Internal Medicine 2024年第2期14卷 181-187页

作者： Mariam El Galiou Mina Agrou Rihab dkhissi Loubna Benamar Naima Ouzeddoun Lamyae Rouass Tarik Bouattar Department of Nephrology Dialysis and Transplantation IbnSina University Hospital Mohamed V University Rabat Morocco Department of Pathological Anatomy IbnSina University Hospital Mohammed V University Rabat Morocco

Introduction: Glomerular damage during Gougerot-Sjgren syndrome is much rarer than interstitial damage, and is essentially extra-membranous and membrano-proliferative glomerulonephritis. Observation: We report the case of a 44-year-old woman with primary Sjgrens syndrome, confirmed by clinical dryness syndrome, positive anti-SSA and anti-SSB antibodies, and a salivary gland biopsy revealing grade 4 lymphocytic sialadenitis according to CHISHOLMs classification. Later, the patient developed nephrotic syndrome, along with hypertension. Renal function remained normal with a creatinine level of 9.3 mg/l, and hematuria was absent. Only antinuclear antibodies tested positive, while anti-PLA2R antibodies were negative. A renal biopsy was performed, which was complicated on the same day by hemodynamic instability with hematuria. Renal CT scan with contrast injection revealed a posterior perirenal hematoma without contrast extravasation. Additionally, bilateral renal vein thrombosis was incidentally discovered, suggesting extramembranous glomerulonephritis. The patients hemodynamic status stabilized after fluid resuscitation with isotonic saline solution (0.9%), without the need for blood transfusion. Renal biopsy confirmed extramembranous glomerulonephritis with interstitial fibrosis and minimal tubular atrophy. The initial etiological assessment was negative. The patient was started on oral corticosteroids, angiotensin-converting enzyme inhibitors, and therapeutic anticoagulation for renal vein thrombosis. The patients condition improved, with the disappearance of the syndrome and spontaneous regression of the hematoma. Discussion: The association of nephrotic syndrome and renal vein thrombosis primarily suggests glomerulopathy, in particular extra-membranous glomerulonephritis. Sjgrens syndrome can be associated with extra-membranous glomerulonephritis without being its direct cause. Like, it is possible that it is a cause of glomerulonephritis, essentially extra membrano

关键词： Sjögren’s Syndrome Extramembranous Glomerulonephritis Nephrotic Syndrome Anti-PLA2R Antibodies

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