A 76 year old lady with many co-morbidities, including sickle cell trait, chronic lymphoedema (wheelchair bound) and chronic kidney disease had an ERCP a year ago because of cholangitis. A sphincterotomy was performed and the bile duct was trawled with a balloon catheter. A large stone was noted in the gallbladder but she did not have a cholecystectomy because of the co-morbidities. She now presents with jaundice (Bilirubin 136 umol/L, Alk Phosp 1500). The CT scan shows a 7cm liver abscess adjacent to a gallbladder empyema. In addition a stone in the gallbladder is pressing on the bile ducts causing dilatation of intrahepatic ducts (Mirizzi syndrome).
Treating this patient proved challenging… a further ERCP was performed as well as external drainage of the liver abscess (see video). Cholecystectomy pending... |
[斯坦福大学课程：临床解剖学].1
内镜检查发现鼻息肉
经阴道阑尾切除术（NOTES）
开放性修补膀胱阴道瘘（经阴式入路）
发表于 2017-3-26 13:00:02
提升卡
置顶卡
沉默卡
喧嚣卡
变色卡
千斤顶
显身卡
楼主
