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Migration of a vascular coil from the common bile duct secondary to vasculobiliary injury after cholecystectomy

Hepatobiliary Surgery and Nutrition 2019年第6期8卷 679-680页

作者： Abdelkader Taibi romain legros Visceral Surgery Department Dupuytren University HospitalLimogesFrance University Limoges CNRSXLIMUMR 7252LimogesFrance Gastroenterology Department Dupuytren University HospitalLimogesFrance

A 61-year-old woman had cholangitis secondary to two cholelithiases[one in the common bile duct(CBD)and one in the cystic duct(Mirizzi syndrome)],which was treated by antibiotics.The patient subsequently underwent a shincterotomy with endoscopic retrograde cholangiopancreatography(ERCP)and,finally,a cholecystectomy by coelioscopy.The postoperative course was marked by biliary leakage.She was transferred to our hospital due to haemorrhagic shock and abdominal pain.

关键词： biliary bile cholecystectomy

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Obscure bleeding colonic duplication responds to proton pump inhibitor therapy

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World Journal of Gastroenterology 2013年第35期19卷 5940-5942页

作者： Jérémie Jacques Fabrice Projetti romain legros Virginie Valgueblasse Matthieu Sarabi Paul Carrier Fabien Fredon Stéphane Bouvier Véronique Loustaud-Ratti Denis Sautereau Service d’Hépato-gastro-entérologie CHU Dupuytren

We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.

关键词： Colonic duplication Gastro-intestinal duplication Gastrointestinal bleeding Hemostatic colorectal surgery Proton pump inhibitor therapy

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Effect of alcohol consumption on liver stiffness measured by transient elastography

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World Journal of Gastroenterology 2013年第4期19卷 516-522页

作者： Edouard Bardou-Jacquet Ludivine legros Draman Soro Marianne Latournerie Anne Guillygomarc'h Caroline Le Lan Pierre Brissot Dominique Guyader romain Moirand Hepatology and Addictology Department University Hospital PontchaillouF35000 RennesFrance Institut National de la Santé et de la Recherche Médicale U991 Institut Fédératif de Recherche 140University of Rennes 1F35000 RennesFrance

AIM:To determine the evolution of transient elastography(TE) in patients with alcoholic liver disease according to alcohol cessation or continuation.METHODS:We retrospectively selected in our local database all patients who had two TE between June 2005 and November 2010 with chronic alcohol excessive consumption and excluded those with associated cause of liver disease.TE was performed at least one week apart by senior operator.TE examinations with less than ten successful measures or with an interquartile range above 30% were excluded.We retrospectively reviewed file of all patients to include only patient followed up by trained addictologist and for which definite information on alcohol consumption was available.Concomitant biological parameters [aspartate amino transferase(AST),alanine amino transferase and gamma-glutamyl transpeptidase(GGT)] within 4 wk of initial and final TE were recorded.Putative fibrosis score according to initial and final TE were determined with available cut-off for alcoholic liver disease and hepatitis C.Initial and final putative fibrosis score were compared according to alcohol consumption during follow-up.RESULTS:During the study period 572 patients had TE examination for alcoholic liver disease and 79 of them had at least two examinations.Thirty-seven patients met our criteria with a median follow-up of 32.5 wk.At the end of the study,13(35%) were abstinent,and 24(65%) relapsers.Eight patients had liver biopsy during follow-up.TE decreased significantly during follow-up in 85% of abstinent patients [median(range):-4.9(-6.1,-1.9)],leading to a modification of the putative fibrosis stage in 28%-71% of patient according to different cut-off value.In relapsers TE increased in 45% and decreased in 54% of patient.There was no statistical difference between initial and final TE in relapsers.In the overall population,using 22.6 kPa as cut-off for cirrhosis,4 patients had cirrhosis at initial TE and 3 patients had cirrhosis at final TE.Using 19.5 kPa as cut-off for cirrhosis,7 patients had

关键词： Alcohol Transient elastography Cirrhosis Fibrosis Liver biopsy Liver stiffness

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Acoustic radiation force impulse imaging for assessing liver fibrosis in alcoholic liver disease

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World Journal of Gastroenterology 2016年第20期22卷 4926-4935页

作者： Anita Kiani Vanessa Brun Fabrice Lainé Bruno Turlin Jeff Morcet Sophie Michalak Antonia Le Gruyer Ludivine legros Edouard Bardou-Jacquet Yves Gandon romain Moirand Department of Abdominal Imaging Rennes University Hospital Clinical Inverstigation Center CIC INSERM 1414 Rennes University Hospital Department of Hepatology Rennes University Hospital Department of Pathology Rennes University Hospital Rennes Department of Pathology Angers University Hospital Department of Addictology Rennes University Hospital Department of Research INSERM UMR 991 Rennes 1 Medicine University

AIM: To evaluate the performance of elastography by ultrasound with acoustic radiation force impulse(ARFI) in determining fibrosis stage in patients with alcoholic liver disease(ALD) undergoing alcoholic detoxification in relation to biopsy.METHODS: Eighty-three patients with ALD undergoing detoxification were prospectively enrolled. Each patient underwent ARFI imaging and a liver biopsy onthe same day. Fibrosis was staged according to the METAVIR scoring system. The median of 10 valid ARFI measurements was calculated for each patient.RESULTS: Sixty-nine males and thirteen females(one patient excluded due to insufficient biopsy size) were assessed with a mean alcohol consumption of 132.4 ± 128.8 standard drinks per week and mean cumulative year duration of 17.6 ± 9.5 years. Sensitivity and specificity were respectively 82.4%(0.70-0.95) and 83.3%(0.73-0.94)(AUROC = 0.87) for F ≥ 2 with a cut-off value of 1.63m/s; 82.4%(0.64-1.00) and 78.5%(0.69-0.89)(AUROC = 0.86) for F ≥ 3 with a cut-off value of 1.84m/s; and 92.3%(0.78-1.00] and 81.6%(0.72-0.90)(AUROC = 0.89) for F = 4 with a cut-off value of 1.94 m/s.CONCLUSION: ARFI is an accurate, non-invasive and easy method for assessing liver fibrosis in patients with ALD undergoing alcoholic detoxification.

关键词： Alcoholic liver disease Elastography Noninvasive Acoustic radiation force impulse Fibrosis

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