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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Introduction. Non Hodgkin lymphoma (NHL) presenting with obstructive jaundice is a rare occurrence. Because of rarity of combination, it is seldom considered in differential diagnosis of patients presenting with obstructive jaundice. It is considered treatable due to the chemosensitive nature of the disease and the recent advances in chemotherapy. Case Series. We present a case series of 2 patients with NHL presenting with obstructive jaundice as an initial manifestation. Both patients presented with obstructive jaundice and were diagnosed by CT guided liver biopsy. One patient died of sepsis and multiorgan failure before initiating chemotherapy and the second patient did not choose to undergo chemotherapy. Conclusion. Biliary obstruction is a sign of poor prognosis. The diagnosis of NHL needs to be considered in patients presenting with biliary obstruction. It can be associated with high mortality and poses treatment dilemma.
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PMID:Obstructive jaundice as an initial manifestation of non-hodgkin lymphoma: treatment dilemma and high mortality. 2381 4

Bacterial translocation is the invasion of indigenous intestinal bacteria through the gut mucosa to normally sterile tissues and the internal organs. Sometimes instead of bacteria, inflammatory compounds are responsible for clinical symptoms as in systemic inflammatory response syndrome (SIRS). The difference between sepsis and SIRS is that pathogenic bacteria are isolated from patients with sepsis but not with those of SIRS. Bacterial translocation occurs more frequently in patients with intestinal obstruction and in immunocompromised patients and is the cause of subsequent sepsis. Factors that can trigger bacterial translocation from the gut are host immune deficiencies and immunosuppression, disturbances in normal ecological balance of gut, mucosal barrier permeability, obstructive jaundice, stress, etc. Bacterial translocation occurs through the transcellular and the paracellular pathways and can be measured both directly by culture of mesenteric lymph nodes and indirectly by using labeled bacteria, peripheral blood culture, detection of microbial DNA or endotoxin and urinary excretion of non-metabolisable sugars. Bacterial translocation may be a normal phenomenon occurring on frequent basis in healthy individuals without any deleterious consequences. But when the immune system is challenged extensively, it breaks down and results in septic complications at different sites away from the main focus. The factors released from the gut and carried in the mesenteric lymphatics but not in the portal blood are enough to cause multi-organ failure. Thus, bacterial translocation may be a promoter of sepsis but not the initiator. This paper reviews literature on the translocation of gut flora and its role in causing sepsis.
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PMID:Translocation of gut flora and its role in sepsis. 2406 38

It was analyzed the results of examination and surgical treatment of 338 patients with obstructive jaundice. The patients were operated in 2004-2012 years. 148 patients had benign jaundice and 190 patients had malignancy genesis of jaundice. It was determined laboratory data (bilirubin total, protein total, prothrombin index) as well as complications of obstructive jaundice (cholangitis, renal failure, hepatic encephalopathy, gastrointestinal bleeding, sepsis) indicating to the severity of obstructive jaundice and it was taken into consideration the malignant origin of jaundice. The selected attributes were assigned marks from 1 to 3. Each complication as well as factor of malignancy was evaluated two times higher than mark of bilirubin. The grade of jaundice severity (A, B, C) was determined by combination of the marks that identified the attributes. It was analyzed the influence of prothrombin index and blood serum protein on the results of severity grade formation of obstructive jaundice with the postoperative results (lethality, complications). It was done for simplification of classification. The absence of significant differences in assessing of the severity obstructive jaundice class with and without attributes of a "total protein" and "prothrombin index". To simplify the classification and to get more reliable information about the difference of postoperative results between the grades (A, B, C) are possible by exception of total protein attributes and prothrombin index.
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PMID:[The classification of obstructive jaundice severity]. 2442 7

Perforations of the duodenum are a significant source of morbidity in clinical practice. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. Until recently, there has been no technique available which reproducibly and safely allowed endoscopic closures of penetrating defects within the digestive tract. With the new over-the-scope clipping system", which regarding design and function is similar to a bear-trap, the endoscopic closure of perforations has become possible. Here, we report our first experience with the over-the-scope clipping system for the closure of duodenal perforation developed during endoscopic retrograde cholangiopancreatography. A 79-year-old woman with jaundice resulting from obstruction of the common bile duct caused by choledocholithiasis underwent endoscopic retrograde cholangiopancreatography. At the time of the procedure, an endoscope-related perforation measuring about 15 mm was visualized proximal to the papilla. Endoscopic repair was performed by using the over-the-scope clipping according to a standardized operating procedure. Amsterdam type plastic stent was placed into the common bile duct. An abdominal computed tomography with gastrographin showed a pneumoretroperitoneum in the peripancreatic-perirenal area and complete closure of the perforation. The patient remained symptom free, no signs of sepsis developed, and the obstructive jaundice was relieved by endoscopic biliary drainage. The patient was allowed to have a full diet one week later and was discharged from the hospital 2 weeks later. It seems that, the over-the-scope clipping is effective for endoluminal closure of endoscope-related duodenal perforations.
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PMID:Endoscopic closure of an endoscope-related duodenal perforation using the over-the-scope clip. 2455 68

This study was undertaken to assess the efficacy of delayed primary closure in prevention of postoperative wound infection in patients with obstructive jaundice and septic abdomen. Here analyzed 93 patients retrospectively who underwent surgery in hepato-biliary-pancreatic unit of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2011 to June 2011. Primary closure of the abdominal wound was applied in all patients. There was no mortality, but 21 patients had postoperative morbidity (wound infection in 17, intra-abdominal abscess in 1, melaena in 1, biliary leakage in 1, burst abdomen in 1). Seventy-two patients had uneventful postoperative recovery were included in Group 1. Patients who developed postoperative wound infection (n=17) were included in Group 2. Rest 4 patients who developed other complications were excluded from the study. Pre-, per and postoperative parameters were compared between two groups for identifying the risk factors for SSI. Delayed primary closure of the wound was applied prospectively in 21 patients (Group 3) on the basis of retrospective results and the outcome was assessed. Retrospective analysis revealed that the patient who developed wound infections (Group 2) after primary closure; significantly greater number of patients had obstructive jaundice or intra-abdominal septic condition preoperatively. Prospective results revealed that there was no wound infection in 21 patients with in obstructive jaundice or intra-abdominal sepsis in which delayed primary closure was applied. Hospital stay was significantly reduced in Group 3 in compare to Group 2. In subsequent follow up, it has been found that 2 patients developed incisional hernia in Group 2 patients but none in Group 3 patients. Delayed primary closure of the wound is a good option in patient with obstructive jaundice and intra-abdominal septic condition for preventing postoperative wound infection.
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PMID:Delayed primary suture prevents wound infection in patients with obstructive jaundice and septic abdomen. 2485 50

Cystic and bile duct dysplasia is a rare histological finding, especially when found in the absence of an underlying malignancy. We report a patient who presented with jaundice and weight loss. Clinical and cytological evidence suggested a diagnosis of cholangiocarcinoma and the patient underwent a pancreatico-duodenectomy. Histopathological examination suggested a diagnosis of two foci of biliary dysplasia: cystic duct and lower common bile duct. Fifteen months later, the patient re-presented with signs of obstructive jaundice and biliary sepsis. Although CT scan revealed images highly indicative of metastatic disease, repeated biopsies failed to confirm this. Eventually a liver biopsy did reveal moderately differentiated adenocarcinoma, however oncological interventional was no longer appropriate and the patient was managed palliatively. This case report focuses on the current understanding of progression of biliary dysplasia.
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PMID:Repeated negative biopsies in isolated high-grade cystic duct dysplasia with progression to adenocarcinoma. 2547 88

We report this case of a 63-year-old woman who presented with progressive illness characterized by abdominal pain, weight loss, anorexia, generalized weakness, and fatigue. The patient was found to have obstructive jaundice with multiple mass lesions in the liver, spleen, and kidney on computed tomography scan of abdomen. She developed cholangitis, necessitating an emergent endoscopic retrograde cholangiopancreatography with biliary stenting and decompression. Later, she was found to have hepatic sarcoidosis on wedge biopsy of the liver. Extrinsic compression of biliary tree from mass effect of sarcoid granulomas with superimposed biliary sepsis is rare.
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PMID:Extrahepatic biliary obstruction: an unusual presentation of hepatic sarcoidosis. 2598 67

Cholangiocarcinoma (CCA) is a malignancy of the bile ducts that carries high morbidity and mortality. Patients with CCA typically present with obstructive jaundice, and associated complications of CCA include cholangitis and biliary sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable treatment modality for patients with CCA, as it enables internal drainage of blocked bile ducts and hepatic segments by using plastic or metal stents. While there remains debate as to if bilateral (or multi-segmental) hepatic drainage is required and/or superior to unilateral drainage, the underlying tenant of draining any persistently opacified bile ducts is paramount to good ERCP practice and good clinical outcomes. Endoscopic therapy for malignant biliary strictures from CCA has advanced to include ablative therapies via ERCP-directed photodynamic therapy (PDT) or radiofrequency ablation (RFA). While ERCP techniques cannot cure CCA, advancements in the field of ERCP have enabled us to improve upon the quality of life of patients with inoperable and incurable disease. ERCP-directed PDT has been used in lieu of brachytherapy to provide neoadjuvant local tumor control in patients with CCA who are awaiting liver transplantation. Lastly, mounting evidence suggests that palliative ERCP-directed PDT, and probably ERCP-directed RFA as well, offer a survival advantage to patients with this difficult-to-treat malignancy.
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PMID:Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma. 2614 95

Biliary adenomas that are usually found in surgically removed gallbladders are rare, but can also occur in the extrahepatic biliary tree. We present a case series of extrahepatic bile duct adenomas at our institution, along with a review of the literature. All three patients with extrahepatic biliary adenomas (two in the common bile ducts, one in the hepatic duct) were female with a mean age of 74 years. On initial presentation, none of the patients had obstructive jaundice but two of the three patients had symptoms of biliary origin. Case 1 is an 85-year-old woman with an incidental biliary dilation seen on chest imaging; endoscopic ultrasound revealed a sessile adenomatous polyp in the distal bile duct. The patient refused surgery and presented with occlusive biliary stricture and jaundice 5 months after initial presentation, with cytology confirming malignant progression. Case 2 is a 78-year-old woman with a history of primary sclerosing cholangitis and who presented with cholangitis, and Gram-negative sepsis. A polypoid lesion was seen on imaging in the common hepatic duct and direct cholangioscopy with biopsies confirmed the presence of adenoma with high grade dysplasia. The patient underwent successful total bile duct resection and hepaticojejunostomy but represented 1 year later with diffuse metastatic disease to the bone, liver, and peritoneum. Case 3 is a 61-year-old woman who presented with symptoms suggestive of gallbladder pathology and was found to have a polypoid bile duct lesion on intraoperative cholangiogram. Endoscopic retrograde cholangioscopy showed an adenomatous polyp with high grade dysplasia involving the distal common bile duct. The patient underwent distal bile duct resection with choledochojejunostomy but presented with jaundice 4 years after surgery. She was found to have adenocarcinoma involving the small bowel in the Roux limb of jejunum and transverse colon. All three patients in our series presented with interval gastrointestinal malignancy and we therefore recommend aggressive surgical intervention and close postoperative surveillance when diagnosis of extrahepatic bile duct adenoma is made.
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PMID:Adenomas involving the extrahepatic biliary tree are rare but have an aggressive clinical course. 2687 36

Background and Study Aims. Endoscopic ultrasound- (EUS-) guided biliary drainage (EUS-BD) is an alternative treatment for biliary obstruction after failed endoscopic retrograde cholangiopancreatography (ERCP). In this study, we present the outcomes of inpatients with obstructive jaundice treated with EUS-BD using a fully covered metallic stent after failed ERCP. Patients and Methods. A total of 21 patients with biliary obstruction due to malignant tumors and prior unsuccessful ERCP underwent EUS via an intra- or extrahepatic approach with fully covered metallic stent between March 2014 and October 2015. A single endoscopist performed all procedures. Results. Seven patients underwent hepatogastrostomy (HGS) and 14 underwent choledochoduodenostomy (CDS). The technical and clinical success rates were both 100%. There was no difference in efficacy between HGS and CDS. Adverse events occurred in three patients, including two in the HGS group (1 bile leakage and 1 sepsis) and one in the CDS group (sepsis). Four patients died as a result of their primary tumors during a median follow-up period of 13 months (range: 3-21 months). No patient presented with stent migration. Conclusion. EUS-BD using a fully covered metallic stent appears to be a safe and effective method for the treatment of obstructive jaundice.
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PMID:Endoscopic Ultrasound-Guided Biliary Drainage Using a Fully Covered Metallic Stent after Failed Endoscopic Retrograde Cholangiopancreatography. 2759 81


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