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Query: UMLS:C0341503 (bacterial peritonitis)
 1,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Usually, ascending cholangitis is a bacterial process. However, in the debilitated or immunocompromised patient, mycotic cholangitis must be placed in the differential diagnosis. We report a patient with cryptogenic cirrhosis whose presenting problem in his terminal hospitalization was spontaneous bacterial peritonitis, for which he was treated with broad-spectrum antibiotics. Endoscopic retrograde cholangiopancreatogram was performed during the hospital course to explain his profound hyperbilirubinemia. The findings were grossly consistent with primary sclerosing cholangitis or cholangiocarcinoma. The patient subsequently continued to deteriorate, and died with hepatic and renal failure. At autopsy, he was found to have choledocholithiasis, marked biliary duct proliferation, and ascending cholangitis, with Trichosporon demonstrated histologically to be invading the bile ducts. To our knowledge, this is the first reported case of Trichosporon cholangitis.
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PMID:Trichosporon cholangitis associated with hyperbilirubinemia, and findings suggesting primary sclerosing cholangitis on endoscopic retrograde cholangiopancreatography. 229 69

In the period November 1991 to October 1993 altogether 418 patients underwent laparoscopic cholecystectomy in our unit. Routine intraoperative cholangiography, a prerequisite for diagnosing choledocholithiasis, was successful in 99.3% of cases. 38 patients were found to have common bile duct calculi and their management and follow up are reported in this study. In 36 cases stones were successfully eliminated by means of the laparoscopic procedure, via the cystic duct in 22 cases and by choledochotomy in 14 cases. One patient required postoperative endoscopic papillotomy, and in the remaining case surgical management was changed to classical laparotomy and open choledochotomy. Postoperative complications occurred in five cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day, another with postoperative bleeding from the cystic artery was relaparoscopied on the same day as the minimal invasive procedure. One patient developed a liver abscess three weeks after operation, requiring drainage with the aid of ultrasound. A superficial wound infection in one patient and biliary leakage after removal of the T-tube in another patient both healed spontaneously. Our results are similar to those obtained with other therapeutic concepts. Because the papilla of Vater remains intract in minimal invasive surgery, which causes relatively little stress to the patient, as well as considering the economic advantages of a single-step procedure, this management strategy can be recommended as a valuable alternative procedure.
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PMID:[Laparoscopic therapy of choledocholithiasis]. 787 94

The introduction of laparoscopic cholecystectomy has led to controversial discussions about the proceeding in case of coincident common bile duct stones. In our unit choledocholithiasis has been treated laparoscopically since November 1991. Basic requirement has been a routine intraoperative cholangiography. 67 patients with common bile duct stones were treated until January 1995. All patients underwent a follow up and the results were compared to other concepts. In 40 cases common bile duct stones were eliminated via cystic duct and in 27 cases by choledochotomy. The choledochus was drained routinely for postoperative x-ray control. In 9 cases we found residual concrements: 7 patients required postoperative endoscopic papillotomy and in 2 cases the calculi where eliminated with a dormia basket introduced via drainage tube. In one case surgical management was changed to laparotomy. Postoperative complications occurred in 8 cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day; one with bleeding from the cystic artery was treated by relaparoscopy. One patient developed a liver abscess and two patients a bilioma requiring ultrasound guided drainage. A superficial wound infection in one patient and a biliary leakage after removal of the drainage in two patients healed spontaneously. Due to an intact papilla with less stress to the patient, as well as a complication rate comparable with other published therapeutic concepts, this strategy can be recommended as a valuable alternative procedure.
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PMID:[Laparoscopic therapy of choledocholithiasis]. 867 81