Introduction:One of the methods for the biliary tree decompression in the case of Klatskin tumor is transpapillary stenting, which could be completed by stent migration in 4% to 10% of cases. Appro...

https://journals.sagepub.com/doi/pdf/10.1177/11795476211043067

Non-Operative Management of Bronchobiliary Fistula Due to Proximal Migration of Biliary Stent in a Patient With Unresectable Klatskin Tumor.

Biliary fistula is a common but serious complication after radical resection of hilar cholangiocarcinoma. We aimed to evaluate the influencing factors of biliary fistula after radical resection, to provide insights to the clinical treatment of hilar cholangiocarcinoma.Patients undergoing radical resection of hilar cholangiocarcinoma from January 1, 2015 to March 31, 2022 were selected. Patients' personnel characteristics and laboratory test results of patients with and without biliary fistula were collected and compared. Logistic regression analyses were conducted to evaluate the associated risk factors of biliary fistula.160 patients undergoing radical resection of hilar cholangiocarcinoma were included, the incidence of postoperative biliary fistulas was 20.63%. There were significant differences in the age, preoperative cholangitis and number of biliary anastomosis between biliary fistula and no biliary fistula patients (all p < 0.05). There were significant differences in the gamma glutamyl transpeptidase (GGT) on the first day after surgery, Klebsiella pneumoniae between biliary fistula and no biliary fistula patients (all p < 0.05). Logistic regression analysis indicated that age ≥ 65 years (OR 2.035, 95%CI 1.131-3.007), preoperative cholangitis (OR 1.584, 95% CI 1.081-2.361), number of biliary anastomosis ≥ 2(OR 2.866, 95%CI 1.942-3.624), GGT on the first day after surgery ≥ 120 U/L (OR 1.823, 95%CI: 1.274-2.906), preoperative bile culture for Klebsiella pneumoniae (OR 3.181, 95%CI: 2.426-3.992) were the risk factors of postoperative biliary fistulas (all p < 0.05).There are many independent risk factors for postoperative biliary fistula in patients undergoing radical resection of hilar cholangiocarcinoma. Clinical medical workers should take early interventions and treatment measures for these high-risk patients to reduce the occurrence of postoperative biliary fistula. 

/pdf/influencing-factors-of-biliary-fistula-after-radical-314q4ujk.pdf

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

ABSTRACT Plastic biliary stents are commonly placed during endoscopic retrograde cholangiopancreatography for various indications, and stent-related complications are uncommon. We describe a case in which a plastic biliary stent migrated proximally through the liver capsule and diaphragm after endoscopic retrograde cholangiopancreatography, leading to pericardial effusion and cardiac tamponade. It is important for clinicians managing patients with biliary stents to be aware of this significant adverse event.

Proximal Biliary Stent Migration Causing Cardiac Tamponade

Abstract Background Gunshot wound to the colon is a frequent injury in armed conflicts. An example of high-energy modern weapon is hollow-point bullets, which is associated with an increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to investigate specific features of the hollow-point and shape-stable bullets features in colon injury. Patients and methods Analyses of clinical data was performed on 384 male soldiers from Armed Forces of Ukraine with gunshot abdominal wound with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%)patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets and 43/112 (38.4%) patients were injured by the hollow-point bullets. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p=0.0004). Left colon parts were more frequently injured as compared to right colon side or transverse colon in 21 (48.8%) injured by shape-stable (p&lt;0.0001) and in 41 (59.4%) patients injured by the hollow-point bullets (p=0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured with the hollow-point bullets demonstrated a higher frequency of 3-5 areas of colon penetration, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none patients with shape-stable bullets injury (p=0.0001). Colon Injury Scale (CIS) IV was detected in 9 (8%) patients injured by the hollow-point bullets as compared to 7 (10.1%) patients injured by shape-stable bullets (p=0.031). Colostomy was performed in 9 (13%) patients injured by shape-stable bullets and in 8 (19%) patients injured by the hollow-point bullets (p&gt;0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after injury by the shape-stable bullets (p=0.0089). Conclusions All patients should be suspected to have a hollow-point injury in case of penetrating injury (absent outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine. 

/pdf/gunshot-bullet-trauma-of-the-colon-in-combat-patients-2qiw0xno.pdf

Gunshot bullet trauma of the colon in combat patients injured in hybrid period of Russian-Ukrainian war during 2014-2020

Abstract Background Gunshot wound to the colon is a frequent injury in armed conflicts. An example of high-energy modern weapon is hollow-point bullets, which is associated with an increased tissue damage and lethal outcome. The aim of this study was to evaluate gunshot injuries to the colon in combat patients and to investigate specific features of the hollow-point and shape-stable bullets features in colon injury. Patients and methods Analyses of clinical data was performed on 384 male soldiers from Armed Forces of Ukraine with gunshot abdominal wound with injury to the colon in East Ukraine between 2014 and 2020. Out of 374 injured, 112 (29.9%) patients were diagnosed with penetrating gunshot bullet wounds: 69/112 (61.6%) were injured by shape-stable bullets and 43/112 (38.4%) patients were injured by the hollow-point bullets. Results More severe hemorrhagic shock stages were in patients injured by hollow-point bullets: shock stages III-IV was in 25 (58.1%) patients injured by the hollow-point bullets vs. 17 (24.6%) patients injured by shape-stable bullets (p = 0.0004). Left colon parts were more frequently injured as compared to right colon side or transverse colon in 21 (48.8%) injured by shape-stable (p &lt; 0.0001) and in 41 (59.4%) patients injured by the hollow-point bullets (p = 0.032). A significant difference was identified for the frequent injury to the middle colon within the entire cohort (p = 0.023). Patients injured with the hollow-point bullets demonstrated a higher frequency of 3–5 areas of colon penetration, which was detected in 18 (41.8%) patients injured by hollow-point bullets and none patients with shape-stable bullets injury (p = 0.0001). Colon Injury Scale (CIS) IV was detected in 9 (8%) patients injured by the hollow-point bullets as compared to 7 (10.1%) patients injured by shape-stable bullets (p = 0.031). Colostomy was performed in 9 (13%) patients injured by shape-stable bullets and in 8 (19%) patients injured by the hollow-point bullets (p &gt; 0.05). 15 (35%) patients died after injury by the hollow-point bullet, whereas 9 (13%) patients after injury by the shape-stable bullets (p = 0.0089). Conclusions All patients should be suspected to have a hollow-point injury in case of penetrating injury (absent outlet wound) and careful revision of the abdomen must be performed to identify possible multiorgan injury as well as multiple perforations of the intestine. 

/pdf/gunshot-bullet-trauma-of-the-colon-in-combat-patients-183vmmsi.pdf

The combat penetrating gunshot injury is frequently associated with damage to the liver. Bile leak and external biliary fistula (EBF) are common complications. Biliary decompression is commonly applied for the management of EBF. Also, little is known about the features of combat trauma and its management in ongoing hybrid warfare in East Ukraine. A 23-year-old male was diagnosed with thoracoabdominal penetrating gunshot wound (GSW) by a high-energy multiple metal projectile. Damage control tactics were applied at all four levels of military medical care. Biliary decompression was achieved by endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and the placement of biliary stents. Occlusion of the stent was treated by stent replacement, and scheduled ERCP was performed. Partial EBF was diagnosed from the main wound defect of the liver and closed without surgical interventions on the 34th day after the injury. A combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective along with the application of damage control tactics. A scheduled ERCP application is an effective approach for the management of EBF, and liver resection could be avoided. A successful biliary decompression was achieved by the transpapillary intervention with the installation of stents. Stent occlusion could be diagnosed in the early post-traumatic period, which is effectively managed by scheduled ERCP as well as stent replacement with a large diameter as close as possible to the place of bile leak.

Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient.

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Application of Damage Control Tactics and Transpapillary Biliary Decompression for Organ-Preserving Surgical Management of Liver Injury in Combat Patient.

Non-Operative Management of Bronchobiliary Fistula Due to Proximal Migration of Biliary Stent in a Patient With Unresectable Klatskin Tumor.