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Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery:An algorithmic approach

World Journal of Gastroenterology 2008年第19期14卷 3049-3053页

作者： georgios Fragulidis Athanasios Marinis Andreas Polydorou Christos Konstantinidis georgios anastasopoulos John Contis Dionysios Voros Vassilios Smyrniotis Second Department of Surgery Areteion University HospitalAthens Medical SchoolUniversity of Athens

AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography. RESULTS:Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulaethat are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered.

关键词： Biliary aberrations Bile duct injury Postope-rative bile leakage Hepatic duct confluence Hepatectomy

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Intussusception of the bowel in adults:A review

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World Journal of Gastroenterology 2009年第4期15卷 407-411页

作者： Athanasios Marinis Anneza Yiallourou Lazaros Samanides Nikolaos Dafnios georgios anastasopoulos Ioannis Vassiliou Theodosios Theodosopoulos Second Department of Surgery Areteion University HospitalAthens Medical SchoolUniversity of Athens

Intussusception of the bowel is defined as the telescop-ing of a proximal segment of the gastrointestinal tract within the lumen of the adjacent *** condi-tion is frequent in children and presents with the classic triad of cramping abdominal pain,bloody diarrhea and a palpable tender ***,bowel intussusception in adults is considered a rare condition,accounting for 5% of all cases of intussusceptions and almost 1%-5%of bowel *** to twenty percent of cases are idiopathic,without a lead point *** intus-susception is caused by organic lesions,such as inflam-matory bowel disease,postoperative adhesions,Meckel's diverticulum,benign and malignant lesions,metastatic neoplasms or even iatrogenically,due to the presence of intestinal tubes,jejunostomy feeding tubes or after gas-tric *** tomography is the most sensitive diagnostic modality and can distinguish between intus-susceptions with and without a lead *** is the definitive treatment of adult *** bowel resection with oncological principles is followed for every case where a malignancy is *** of the intussuscepted bowel is considered safe for benign lesions in order to limit the extent of resection or to avoid the short bowel syndrome in certain circumstances.

关键词： Intussusception Intestinal invagination Adult Bowel obstruction Computed tomography Ultra-sonography Surgery

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