Successful treatment of a patient with appendicular biliary fistula (Case report)
Journal Title: Хірургія України - Year 2019, Vol 0, Issue 2
Abstract
The clinical observation of a rare complication of gallstone disease cholesysto‑ appendicular biliary fistula was described. Male patient, 69 years old, sick for 2 weeks, when the pain appeared in the right upper quadrant after diet errors, fever up to 37.5 — 38.0 °C with chills in the evening, skin icterus. He had not addressed for medical aid, was treated on his own, took antipyretic and antispasmodic drugs. The pain syndrome was stopped, but the body temperature with chills remained high, yellowness of the skin and sclera, darkening of the urine, acholic feces appeared. The patient was hospitalized at Clinical Hospital with a preliminary diagnosis: Pancreatic head disease. Choledocholithiasis. Cholangitis. Mechanical jaundice. The patient was operated on after the examination, stabilization of the patient’s condition and normalization of clinical and laboratory parameters on the third day after hospitalization. Upper median laparotomy, cholecystectomy, appendectomy, choledocholithotomy with choledocholitoextraction, choledoch drainage by Kerr, abdominal drainage was performed. The postoperative period was uneventful. On the 9th day after the operation, the patient was discharged in a satisfactory condition. A control examination carried out in 1 month after surgery revealed no complications. Thus, before the operation and intraoperatively, an cholesysto‑ appendicular fistula was diagnosed. In the medical literature, reports of such biliodigestive fistula were not found. The described clinical observation demonstrates the possibility of successful application of a radiological diagnostic complex method for the detection of biliodigestive fistulas. Biliodigestive fistula is a serious complication, the early diagnosis of which is very difficult. Most often this complication is diagnosed intraoperatively, during cholecystectomy. Endoscopic retrograde cholangiopancreatography, multispiral computed tomography and ultrasound of the abdominal organs showed the greatest diagnostic value.
Authors and Affiliations
Iu. A. Mikheiev, N. A. Shabanov, A. V. Kanaki, K. S. Barska
Keywords
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- EP ID EP609910
- DOI 10.30978/SU2019-2-81
- Views 117
- Downloads 0
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