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>Journals >Cirujano General >Year 2000, Issue 4


Gaxiola WR, Gómez GNG, Alcántara MFJ, Valero OUJ
Vesicular agenesia and choledocolithiasis. Presentation of one patient.
Cir Gen 2000; 22 (4)

Language: Español
References: 29
Page: 362-366
PDF: 4. Kb.


Full text




ABSTRACT

Objective: To describe a case of bladder agenesia and choledocolithiasis.
Setting: Third level health care hospital.
Case description: A 37 years old woman admitted to the hospital through the emergency service, due to haemorrhage of the proximal digestive tract and jaundice, with one week evolution and accompanied by asthenia, adynamia, and anorexia. Four days before admission, fever of 38°C or more, and gastro-biliary content vomiting added to the symptoms. Physical exploration revealed: Arterial pressure of 90/60, Cardiac frequency of 105/min, Respiratory frequency of 26/min and body temperature of 38°C, jaundice +++, incoherent speaking, globose stomach, accompanied by distension and pain to deep palpation in the upper hemiabdomen, doubtful Murphy sign without peritoneal irritation data. Laboratory tests revealed, as extraordinary data, direct bilirrubin of 19 IU/dl; indirect bilirubin, 5 IU/dl; SGOT(AST), 108 U/l, SGPT(ALT), 219 U/l; alkaline phosphatase, 205 U/l, lipase, 465 U/dl, and amilase of 87 U/l. Imagining studies revealed, through abdominal and biliary tract ultrasound, a 4 cm dilation of the choledochus, no gallbladder was observed; percutaneous cholangiography revealed a filling defect, ovoid-shaped, at the distal choledochus and another at the cystic level, no gallbladder was observed, a catheter for external biliary drainage was inserted during the procedure. Four days later, the catheter was accidentally removed and the patient developed acute abdomen symptoms, which required exploratory laparotomy with the following findings: Hemobiliperitoneum of 300 ml approximately, vesicular agenesia, common hepatic duct of approximately 4 cm in diameter and 10 cm length, with a 3.5 cm calculus inside, impacted on the distal portion. A choledochotomy was performed. The transoperative cholangiography through the T catheter revealed no more calculi. The patient evolved well and was discharged without symptoms.


Key words: Gallbladder, vesicular agenesia, choledocolithiasis, choledochotomy.


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