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- W2488565514 abstract "In November 1998 a 75-year-old man was admitted with recurrent cholecystitis and jaundice. At operation numerous small stones were present in the gall bladder. The gall bladder was removed and the cystic duct was tied with a silk ligature. He remained well until August 2002, when he began to suffer intermittent attacks of colicky epigastric and subcostal pain. His past medical history included essential hypertension and Billroth II gastrectomy for peptic ulcer disease in 1975. On physical examination, he was afebrile but ill-appearing and moderate tenderness in the right upper quadrant. Laboratory evaluation revealed an aspartate aminotransferase of 79 U/l (5–40), alanine aminotransferase 249 U/l (10–60), and alkaline phosphatase 136 U/l (35–110). Transabdominal ultrasonography revealed mild dilated common bile duct with echogenic material. At endoscopic retrograde cholangiopancreatograghy with a forward-viewing endoscope, the papilla was normal, and without signs of previous manipulation. Opacification demonstrated mild dilated common bile duct together with a persistent filling defect, approximately 2 cm long, proximal to the hepatic confluence (Panel 1). Endoscopic papillotomy and mechanical lithotripsy was performed. The captured stone fragment measured 15 £ 8 mm. In its center suture material having a total visible length of 3.0 cm was fixed. A surgical knot was identified (Panel 2). After this procedure, he became asymptomatic and liver enzymes returned to normal. After cholecystectomy, up to 30% of recurrent stones have been found to contain non-absorbed suture material [1]. With increasing numbers of laparoscopic cholecystectomies being performed, surgical clips may also become a nucleus for the formation of biliary concretions [2]. The only explanation possible for the presence of a thread in the biliary tract is that it migrated through the cystic duct stump. Experimental and clinical evidence from the literature is presented to support recommendations that only absorbable ligature and suture materials should be used in the region of the common bile duct." @default.
- W2488565514 created "2016-08-23" @default.
- W2488565514 creator A5031172542 @default.
- W2488565514 date "2003-01-01" @default.
- W2488565514 modified "2023-09-24" @default.
- W2488565514 title "Endoscopic removal of choledocholithiasis over a migrating silk thread in a patient with previous cholecystectomy" @default.
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