Ciencias de la Salud
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Item Fístula biliar iatrogénica post colecistectomía por síndrome de mirizzi a propósito de un caso(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2021-06-01) Tixilema Arias, Cynthia Michelle; Guanuchi Quito, Franklin Hernán Dr. Esp.Introduction: The biliary fistula is an abnormal communication between the biliary tract and other organs, its incidence is between 1 and 2%. They are grouped into internal and external. The diagnosis can be carried out during surgery; however most are detected in the early or late postoperative period. Surgical treatment is a challenge that requires knowledge of the pathology, bile duct injury, and digestive tract involvement. Mirizzi syndrome is a rare complication of gallstone pathology, which is caused by inflammation caused by extrinsic compression of a stone that is impacted in the Hartmann's bag with a partial or complete obstruction of the bile duct. ERCP is a diagnostic and therapeutic method, either temporarily or permanently. Objective: Characterize patients with post-laparoscopic cholecystectomy biliary fistula due to Mirizzi Syndrome and determine its management. Materials and methods: A descriptive cross-sectional study based on clinical case analysis is carried out. Discussion: This is a 25-year-old female patient, who was admitted with cholecystitis, for which a laparoscopic cholecystectomy was performed. Patient is discharged but after 11 days of surgical treatment he is admitted to a private hospital in a fair general condition, where they diagnose: post-surgical uncontrolled biliary fistula plus bilioperitoneum for which they perform diagnostic laparoscopy, lavage and drainage. However, his condition does not improve because of what he undergoes endoscopic cholangiography, papillotomy and trying to place a biliary prosthesis, which is the definitive treatment. Patient evolves favorably so she is discharged in good condition. Conclusions: Cholecystectomy is the gold standard for the treatment of stone disease. Iatrogenic lesions at the level of the bile ducts constitute a serious complication not only because of the difficulty in diagnosis, but also because of the high risk of morbidity and mortality. Mirizzi syndrome is an infrequent complication but should be suspected in patients with a history of lithiasic disease, its diagnosis in most cases is postoperative.Item Quiste Fusiforme de Coledoco y Colecistitis Aguda en el Puerperio Tardío(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Medina Rodríguez, María Belén; Chuchuca Serrano Dr., Jorge RicardoThe choledochal cyst is a dilation of the extrahepatic or intrahepatic biliary tree is more common in women, about 80% are diagnosed before 10 years of age and only 20% to 30% are diagnosed in adulthood. At the national level it has not been published in the medical literature cases and statistical data choledochal cyst in pregnancy or in the postpartum period. The following case is a patient of 20 years old with no medical history of importance, gestating, who comes to health sub center presenting cramping abdominal in epigastric radiating to the right upper quadrant, nausea plus vomiting for one occasion, it is transferred to the General Hospital Puyo with gestation of 28 weeks and possible acute cholecystitis is determined. The eco report dilatation of the bile ducts, gallbladder thin-walled with multiples tones and bile duct 12 mm. It is managed with analgesics, and new control in 24 hours, but the patient does not go. Patient in its first month postpartum period, presents recurrent acute cholecystitis box being solved by COLELAP. At 7 days post-surgery is performed resonance cholangiopancreatography and fusiform choledochal cyst with expectant management and controls is determined later. The objective is to identify the effectiveness and efficiency of medical care and timely treatment in patients with fusiform choledochal cyst. The conclusion is: Primary health care requires greater agility in administrative procedures and identify high-risk patients. There is controversy between the management of acute cholecystitis and choledochal cyst during pregnancy and postpartum period, with the initial management of conservative versus surgical management.