RESUMEN
A 75-year-old woman with rheumatoid arthritis on rituximab presented with a 1-week history of constipation and abdominal distension. Subsequent workup showed presence of air in the bowel wall without perforation initially. Due to positive blood cultures, worsening leucocytosis and high suspicion for perforation, an exploratory laparotomy was performed revealing necrotic bowel, walled off perforation and abscess. Patient underwent right hemicolectomy with diversion loop ileostomy. Clinicians must recognise that monoclonal antibodies like rituximab can mask signs of inflammation and therefore should maintain a high index of suspicion for intestinal perforation when evaluating patients with minimal symptoms and pneumatosis intestinalis.
Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Colectomía , Ileostomía , Laparotomía , Neumatosis Cistoide Intestinal/patología , Rituximab/uso terapéutico , Anciano , Artritis Reumatoide/fisiopatología , Femenino , Humanos , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Neumatosis Cistoide Intestinal/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A 72-year-old female patient who was admitted for ischaemic stroke had developed ascending cholangitis. Percutaneous transhepatic cholangiogram was performed to drain the infected bile, but this was complicated by haemorrhagic shock and hepatic haematoma. Mesenteric angiogram showed right hepatic artery (RHA) pseudoaneurysm which was embolised, there by stopping her bleeding. RHA is normally located posterior to common bile duct (CBD). An uncommon location of RHA is anterior to CBD, which can lead to haemorrhagic complications during percutaneous cholangiogram.
Asunto(s)
Aneurisma Falso/etiología , Colangiografía/efectos adversos , Colangitis/cirugía , Arteria Hepática/patología , Anciano , Conducto Colédoco/patología , Embolización Terapéutica , Femenino , Vesícula Biliar/diagnóstico por imagen , Vesícula Biliar/patología , Arteria Hepática/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Gallbladders located to the left of falciform ligament, without situs inversus, are denominated sinistroposition or true left-sided gallbladders; it is considered a rare anatomic anomaly with a prevalence in between 0.1% and 0.7%. Left-sided gallbladder usually occur as a component of situs inversus. PRESENTATION OF CASES: We report a case series of two patients of true left-sided gallbladder that were found at our institution from 2015 to 2017; the anatomic anomalies were discovered during the performance of mini-laparoscopic cholecystectomy due to acute cholecystitis with cholelithiasis in both cases. Both patients underwent a successful surgery and there were no postsurgical complications. DISCUSSION: The reported prevalence of left-sided gallbladder is between 0.1% and 0.7%, thus considered a rare anatomic finding. Currently, with advances in diagnostic imaging modalities, the report of left-sided gallbladder has increased nowadays. It may be a more common anomaly than previously thought. CONCLUSION: True left-sided gallbladder can be an incidental finding; it is in part due to the fact that radiographic images do not typically detect this anomaly, therefore surgeons must be aware of this condition because it is associated with anomalies in the intrahepatic portal vein and biliary tree.