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Colombo G, Aloisio E, Panteghini M. Laboratory investigation of peritoneal fluids: an updated practical approach based on the available evidence. J Clin Pathol 2024; 77:579-585. [PMID: 38538073 DOI: 10.1136/jcp-2023-209282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Even though analysis of peritoneal fluids (PF) is often requested to medical laboratories for biochemical and morphological tests, there is still no mutual agreement on what the most appropriate way is to manage PF samples and which tests should be appropriately executed. In this update, we tried to identify the most useful tests for PF analysis to establish best practice indications. We performed a literature review and examined available guidelines to select the most appropriate tests by an evidence-based approach. Accordingly, the basic PF profile should include (1) serum to effusion albumin gradient and (2) automated cell counts with differential analysis. This profile allows to determine the PF nature, differentiating between 'high-albumin gradient' and 'low-albumin gradient' effusions, which helps to identify the pathophysiological process causing the ascites formation. Restricted to specific clinical situations, additional tests can be requested as follows: PF lactate dehydrogenase (LDH) and glucose, to exclude (LDH) or confirm (glucose) secondary bacterial peritonitis; PF total protein, to differentiate ascites of cardiac origin from other causes; PF (pancreatic) amylase, for the identification of pancreatic ascites; PF bilirubin, when a choleperitoneum is suspected; PF triglycerides, in differentiating chylous from pseudochylous ascites and PF creatinine, to detect intraperitoneal urinary leakage.
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Affiliation(s)
- Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milano, Italy
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Cotten SW, Block DR. A Review of Current Practices and Future Trends in Body Fluid Testing. J Appl Lab Med 2023; 8:962-983. [PMID: 37207691 DOI: 10.1093/jalm/jfad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/27/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Body fluid testing in the clinical chemistry laboratory is a cornerstone in the diagnostic workup of pathological effusions. Laboratorians may not be aware of the preanalytical workflows used in the collection of body fluids though the value is evident whenever processes change or issues arise. The analytical validation requirements can vary depending on the regulations dictated by the laboratories' jurisdiction and accreditor requirements. Much of analytical validation hinges on how useful testing is to clinical care. Usefulness of testing varies with how well established and incorporated the tests and interpretation are in practice guidelines. CONTENT Body fluid collections are depicted and described so clinical laboratorians have a basic appreciation of what specimens are submitted to the laboratory for testing. A review of validation requirements by major laboratory accreditation entities is presented. A review of the usefulness and proposed decision limits for common body fluid chemistry analytes is presented. Body fluid tests that show promise and those that are losing (or lost long ago) value are also reviewed. SUMMARY The total testing process from collection to result interpretation can be complicated and easily overlooked by the clinical laboratory. This review aims to improve the understanding and awareness of collections, validation, result interpretation, and provide an update on recent trends.
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Affiliation(s)
- Steven W Cotten
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Darci R Block
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Block DR, Cotten SW, Franke D, Mbughuni MM. Comparison of Five Common Analyzers in the Measurement of Chemistry Analytes in an Authentic Cohort of Body Fluid Specimens. Am J Clin Pathol 2022; 158:47-61. [PMID: 35099516 DOI: 10.1093/ajcp/aqab218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/06/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Interpretation of body fluid (BF) results is based on published studies and clinical guidelines. The aim of this study is to determine whether the assays from five common commercial vendors produce similar results in BFs for 12 analytes in a BF cohort. METHODS BFs (n = 25) and serum (n = 5) were analyzed on five instruments (Roche cobas c501, Ortho 5600, Beckman AU5800 and DXI800, Siemens Vista 1500, and Abbott Architect c8000) to measure albumin, amylase, total bilirubin, cholesterol, creatinine, glucose, lactate dehydrogenase (LDH), lipase, total protein, triglycerides, urea nitrogen, and carcinoembryonic antigen. Deming regression and Bland-Altman analysis were used for method comparison to Roche. RESULTS Results were significantly different from Roche for LDH and lipase on Ortho and lipase on Siemens but similar for both BFs and serum. BF differences were larger than serum differences when measuring creatinine, glucose, and urea nitrogen on Ortho and glucose on Siemens. CONCLUSIONS Five instruments used to perform BF testing produce results that are not significantly different except for lipase and LDH measurements. Bias of similar magnitude observed in both BF and serum should not affect interpretation. Further investigations into Ortho and Siemens measuring glucose and Ortho measuring creatinine and urea nitrogen are warranted.
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Affiliation(s)
- Darci R Block
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Steven W Cotten
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mathew JM, Sajeed AR, Rajan R, Sen A. An unusual cause of abdominal distension. Curr Probl Cancer 2021; 46:100814. [PMID: 34895742 DOI: 10.1016/j.currproblcancer.2021.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/15/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- John M Mathew
- Thoracic and Gastro Oncology Division, Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Abdul Rahman Sajeed
- Thoracic and Gastro Oncology Division, Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India.
| | - Ramesh Rajan
- Department of Surgical Gastroenterology, Trivandrum Medical College, Kerala, India
| | - Anitha Sen
- Department of Radiology, Regional Cancer Centre, Trivandrum, Kerala, India
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Newman J, Ingle T, Lok S, Pradan L. Images of the month 1: 'Soy sauce' pleural effusion: what causes black pleural fluid? Clin Med (Lond) 2021; 21:e531-e532. [PMID: 38594861 DOI: 10.7861/clinmed.2021-0403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of black pleural fluid following thoracic trauma. The unusual dark colour most strikingly resembled soy sauce as independently commented upon by multiple treating physicians. The black colouration could not be fully accounted for by haemothorax or cholethorax, so other differential diagnoses were investigated, including Aspergillus niger infection and malignant melanoma. The cause, however, was thought to be due to staining of the fluid with carbon deposited in the pleural space from the non-volatilised impurities from smoking crack cocaine. A novel use of a point-of-care urine toxicology assay confirmed the presence of cocaine in the pleural fluid. Considering a broad range of differential diagnoses is needed to avoid missing important causes of unusual pleural effusions.
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Affiliation(s)
- Joseph Newman
- East and North Hertfordshire NHS Trust, Stevenage, UK.
| | - Tejas Ingle
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - She Lok
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Liana Pradan
- East and North Hertfordshire NHS Trust, Stevenage, UK
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Spontaneous common bile duct perforation in full term pregnancy: a rare case report and review of literature. BMC Surg 2021; 21:239. [PMID: 33964909 PMCID: PMC8106123 DOI: 10.1186/s12893-021-01230-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spontaneous biliary system perforation is a rare presentation in clinical practice especially in adults. It is rarely suspected and diagnosed preoperatively due to small number of cases, vague sign and symptoms, and ambiguous presentation. Case presentation We describe an interesting case of spontaneous perforation of the common bile duct in a 16 year-old female who presented a week after her first birth to the emergency department with complaints of diffuse abdominal pain, abdominal distention, fever, vomiting, and constipation. She was having generalized peritonitis but the etiology was unclear despite a thorough workup. She underwent exploratory laparotomy, and a perforation in the supra duodenal region of the common bile duct was found intraoperatively. The common bile duct was repaired over T-tube, and cholecystectomy was performed; the patient was recovered uneventfully. Conclusion Spontaneous biliary perforation is a rare cause of acute abdomen in adults and extremely rare in pregnancy. Its delayed diagnoses and management can lead to a high morbidity and mortality. All physicians, especially surgeons, should be aware of this possibility and consider it a cause of peritonitis on differential diagnosis particularly when there is no apparent etiology available for presentation.
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Thompson BJ, Sherman RA. Comprehensive Review of Biliary Peritonitis. Top Companion Anim Med 2021; 44:100532. [PMID: 33781985 DOI: 10.1016/j.tcam.2021.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Biliary peritonitis is a growing concern in the canine patient and a thorough understanding of the disease will lead to better treatment outcomes. This article reviews the human and veterinary literature pertaining to biliary peritonitis including both scientific reviews and original publications. Compared to human medicine, biliary peritonitis can be difficult to diagnose preoperatively. Multiple risk factors exist increasing the likelihood of development of biliary peritonitis. Treatment recommendations center on stabilization, surgical cholecystectomy, and postoperative supportive care. Clinically, further studies on treatment and prevention in veterinary medicine are warranted.
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Eigsti RL, Krasowski MD, Vidholia A, Merrill AE. Review of interference indices in body fluid specimens submitted for clinical chemistry analyses. Pract Lab Med 2020; 19:e00155. [PMID: 32099890 PMCID: PMC7030980 DOI: 10.1016/j.plabm.2020.e00155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives The aims of this study were to retrospectively investigate interference indices in a wide range of body fluid specimens and compare these indices to those found in serum/plasma. Design and Methods This retrospective study evaluated interference indices for hemolysis, icterus, and lipemia in 2752 body fluid specimens submitted for clinical chemistry testing. Results The distribution of interference indices for body fluid samples was generally similar to that of serum/plasma interference indices. Hemolysis of specimens submitted for lactate dehydrogenase (LD) represented the most common interference for body fluid chemistries. Body fluids collected from postsurgical drain sites had a higher proportion of tests exceeding both icterus and lipemic limits compared to serum/plasma specimens. Conclusions Overall, degrees of hemolysis, icterus, and lipemia observed in body fluid specimens were in large part similar to serum/plasma specimens, with a few notable differences. Body fluids exhibited a higher proportion of samples with severe icterus or lipemia. Severely lipemic body fluid samples were significantly less likely to also be hemolyzed relative to severely lipemic serum/plasma specimens. LD was the test most commonly affected by interference across all body fluid types. False elevations in pleural fluid LD induced by hemolysis can lead to mis-classification of transudative effusions as exudative using Light’s criteria. The possible impact of interferences on clinical chemistry testing in body fluids is an important post-analytical consideration. Hemolysis, icterus, and lipemia were evaluated in 2752 body fluid specimens. Distributions of interference indices in body fluids generally mimicked those of serum/plasma. Pancreatic and pericardial fluids had the highest proportion of tests exceeding the hemolysis index. Compared to serum/plasma, drain fluids had relatively more tests exceeding both icterus and lipemic limits.
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Affiliation(s)
- Renee L Eigsti
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Aditi Vidholia
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
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Huda F, Naithani M, K Singh S, Saha S. Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation. Euroasian J Hepatogastroenterol 2017; 7:185-187. [PMID: 29201807 PMCID: PMC5670268 DOI: 10.5005/jp-journals-10018-1246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022] Open
Abstract
Spontaneous perforation of extrahepatic biliary system is a rare and potentially fatal cause of acute abdomen. Clinical presentation is as biliary peritonitis. This condition is rarely suspected as a cause of peritonitis preoperatively and correct diagnosis is made during surgery. If suspected, diagnosis can be made by various imaging techniques like hepatobiliary scintigraphy, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). As these imaging techniques are not readily available, especially in low socioeconomic countries, we hereby report a case of spontaneous common bile duct (CBD) perforation, which was diagnosed preoperatively by estimation of ascitic fluid-to-serum bilirubin ratio, a simple, quick, and cost-effective test. How to cite this article: Huda F, Naithani M, Singh SK, Saha S. Ascitic Fluid/Serum Bilirubin Ratio as an aid in Preoperative Diagnosis of Choleperitoneum in a Neglected Case of Spontaneous Common Bile Duct Perforation. Euroasian J Hepato-Gastroenterol 2017;7(2):185-187.
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Affiliation(s)
- Farhanul Huda
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manisha Naithani
- Department of Biochemistry All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudhir K Singh
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sarama Saha
- Department of Biochemistry All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Rare Reported Left Hepatic Subcapsular Biloma and Management. Case Rep Surg 2017; 2017:8609185. [PMID: 28798880 PMCID: PMC5536151 DOI: 10.1155/2017/8609185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
Abstract
Subcapsular bilomas are a rare complication of laparoscopic cholecystectomy and an even more rare occurrence to occur spontaneously. We present a case of left sided subcapsular biloma following a laparoscopic cholecystectomy. The location of the biloma was unrelated to our area of dissection. The operation was without difficult dissection or pressurization of the biliary tree. In addition, we present percutaneous drainage alone, without ERCP as adequate management in subcapsular bilomas.
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11
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Croce AC, Ferrigno A, Santin G, Vairetti M, Bottiroli G. Bilirubin: an autofluorescence bile biomarker for liver functionality monitoring. JOURNAL OF BIOPHOTONICS 2014; 7:810-817. [PMID: 23616471 DOI: 10.1002/jbio.201300039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 03/27/2013] [Accepted: 04/04/2013] [Indexed: 06/02/2023]
Abstract
Excitation at 366-465 nm of bilirubin in aqueous solution with solubilizing agents results in emission spectra composed by two main bands. The variation of their relative contributions as shown by changes in the spectral shape are consistent with the bilirubin bichromophore nature. This latter accounts for an exciton-coupling phenomenon, intramolecular interchromophore energy transfer efficiency being affected by microenvironment. Excitation at 366 nm, despite the poor absorption of bilirubin, gives rise to appreciable emission signals from both pure compounds and bile - collected from functionally altered rat livers - favouring the spectral shape response to environment and molecular conformation changes. As compared to the merely bile flow estimation, real-time detection of fluorescence, revealing composition variations, improves near-UV optical-biopsy diagnostic potential in hepatology.
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Affiliation(s)
- Anna C Croce
- Histochemistry and Cytometry Unit, IGM-CNR, Biology and Biotechnology Department, University of Pavia, Via Ferrata 9, Palazzo Botta 2, 27100, Italy.
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12
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Croce AC, Ferrigno A, Santin G, Piccolini VM, Bottiroli G, Vairetti M. Autofluorescence of liver tissue and bile: organ functionality monitoring during ischemia and reoxygenation. Lasers Surg Med 2014; 46:412-21. [PMID: 24619664 DOI: 10.1002/lsm.22241] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVE Autofluorescence (AF) based optical biopsy of liver tissue is a powerful approach for the real-time diagnosis of its functionality. Since increasing attention is given to the bile production and composition to monitor the liver metabolic engagement in surgery and transplantation, we have investigated the bile AF properties as a potential, additional diagnostic parameter. STUDY DESIGN/MATERIALS AND METHODS Spectrofluorometric analysis has been performed in real time on a rat liver model of warm ischemia and reperfusion-60 minutes partial portal vein and hepatic artery clamping and subsequent restoration of blood circulation-in comparison with sham operated rats. The AF spectra have been recorded through a single fiber optic probe (366 nm excitation) from both liver tissue and bile, collected from the cannulated bile duct, and analyzed by means of curve fitting procedures. Bile composition has been also analyzed through biochemical assays of bilirubin, total bile acids (TBA) and proteins. RESULTS Both liver and bile AF signal amplitude and spectral shape undergo changes during induction of ischemia and subsequent reperfusion. The liver tissue response is mainly ascribable to changes in NAD(P)H and flavins and their redox state, largely dependent on oxygen supply, and to the decrease of both vitamin A and fatty acid AF contributions. During comparable times, sham operated rat livers undergo smaller alterations in AF spectral shape, indicating a continuous, slight increase in the oxidized state. Bile AF emission shows a region in the 510-600 nm range ascribable to bilirubin, and resulting from the contribution of two bands, centered at about 515-523 and 570 nm, consistently with its bichromophore nature. Variations in the balance between these two bands depend on the influence of microenvironment on bilirubin intramolecular interchromophore energy transfer efficiency and are likely indicating alteration in a bile composition. This event is supported also by changes observed in the 400-500 nm emission region, ascribable to other bile components. CONCLUSIONS In parallel with the intratissue AF properties, mainly reflecting redox metabolic activities, the bile AF analysis can provide additional information to assess alterations and recovery in the balance of liver metabolic activities.
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Affiliation(s)
- Anna C Croce
- Histochemistry and Cytometry Unit, IGM-CNR, Biology and Biotechnology Department, University of Pavia, 27100, Pavia, Italy
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Block DR, Algeciras-Schimnich A. Body fluid analysis: Clinical utility and applicability of published studies to guide interpretation of today’s laboratory testing in serous fluids. Crit Rev Clin Lab Sci 2013; 50:107-24. [DOI: 10.3109/10408363.2013.844679] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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DeBenedet AT, Scheiman JM, Elta GH, Elmunzer BJ. Peritoneal fluid bilirubin to serum bilirubin ratio for the diagnosis of bile leaks in orthotopic liver transplant recipients. Dig Dis Sci 2013; 58:3044-8. [PMID: 23812826 DOI: 10.1007/s10620-013-2730-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 05/29/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND A peritoneal fluid-to-serum bilirubin ratio (FSBR) of >5 has been shown to be accurate for the detection of bile leaks in post-cholecystectomy and trauma patients; however, there are no studies evaluating the accuracy of this threshold ratio in orthotopic liver transplant (OLT) recipients. METHODS We performed a nested case-control analysis to determine the optimal FSBR threshold for diagnosing bile leaks in OLT recipients and the relationship between FSBR and likelihood of bile leak. Adult OLT patients undergoing ERCP for suspected bile leak were divided into 2 groups: those with cholangiographic evidence of a bile leak and those without evidence of leak. Of 57 included patients, 37 were found to have a bile leak on cholangiogram (64.9 %). RESULTS We found a relationship between higher FSBR and the presence of a bile leak (OR 2.84, 95 % CI 1.37-5.88, p = 0.005). A FSBR of >3.25 produced the optimal sensitivity and specificity for identifying bile leaks in OLT recipients (area under ROC curve 0.8865, sensitivity 72.97 %, specificity 95.00 %). CONCLUSIONS We conclude FSBR is an easily accessible, moderately accurate test to diagnose bile leaks in liver transplant recipients. This test can inform clinical decision-making with regard to the utilization of ERCP in lower suspicion transplant recipients with a suspected bile leak.
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Affiliation(s)
- Anthony T DeBenedet
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical Center, 3912 Taubman Center, 1500 E. Medical Center Dr., SPC 5362, Ann Arbor, MI, 48109-5362, USA,
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Kubiliun NM, Elmunzer BJ. Preventing pancreatitis after endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am 2013; 23:769-86. [PMID: 24079789 DOI: 10.1016/j.giec.2013.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis is a common and potentially devastating complication of ERCP. Advances in risk stratification, patient selection, procedure technique, and prophylactic interventions have substantially improved the endoscopists' ability to prevent this complication. This article presents the evidence-based approaches to preventing post-ERCP pancreatitis and suggests timely research questions in this important area.
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Affiliation(s)
- Nisa M Kubiliun
- Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, Ann Arbor, MI 48109, USA
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Robotic versus open pancreaticoduodenectomy: a comparative study at a single institution. World J Surg 2012; 35:2739-46. [PMID: 21947494 DOI: 10.1007/s00268-011-1276-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures, and its application is poorly reported in the literature so far. To date, few data are available comparing a minimally invasive approach to open PD. The aim of the present study is to compare the robotic and open approaches for PD at a single institution. METHODS Data from 83 consecutive PD procedures performed between January 2002 and May 2010 at a single institution were retrospectively reviewed. Patients were stratified into two groups: the open group (n = 39; 47%) and the robotic group (n = 44; 53%). RESULTS Patients in the robotic group were statistically older (63 years of age versus 56 years; p = 0.04) and heavier (body mass index: 27.7 vs. 24.8; p = 0.01); and had a higher American Society of Anesthesiologists (ASA) score (2.5 vs. 2.15; p = 0.01) when compared to the open group. Indications for surgery were the same in both groups. The robotic group had a significantly shorter operative time (444 vs. 559 min; p = 0.0001), reduced blood loss (387 vs. 827 ml; p = 0.0001), and a higher number of lymph nodes harvested (16.8 vs. 11; p = 0.02) compared to the open group. There was no significant difference between the two groups in terms of complication rates, mortality rates, and hospital stay. CONCLUSIONS The authors present one of the first studies comparing open and robotic PD. While it is too early to draw definitive conclusions concerning the long-term outcomes, short-term results show a positive trend in favor of the robotic approach without compromising the oncological principles associated with the open approach.
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Ahn YJ, Kim TH, Moon SW, Choi SN, Kim HJ, Jung WT, Lee OJ, Ko GH. [A case of perforated xanthogranulomatous cholecystitis presenting as biloma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 58:153-6. [PMID: 21960104 DOI: 10.4166/kjg.2011.58.3.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.
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Affiliation(s)
- Yeon Jeong Ahn
- Departments of Internal Medicine, Pathology and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
OBJECTIVE Bile duct injury is an uncommon but potentially serious complication in cholecystectomy. A recognized treatment for minor biliary injury is internal biliary decompression by endoscopic retrograde cholangiopancreatography (ERCP) and stent insertion. The aim of this study was to assess the effectiveness of ERCP in the management of minor biliary injuries. METHODS A retrospective review of medical records at a tertiary referral centre identified 36 patients treated for postoperative minor biliary injuries between 2006 and 2010. Management involved establishing a controlled biliary fistula followed by ERCP to confirm the nature of the injury and decompress the bile duct with stent insertion. RESULTS Controlled biliary fistulae were established in all 36 patients. Resolution of the bile leak was achieved prior to ERCP in seven patients, and ERCP with stent insertion was successful in 27 of the remaining 29 patients. Resolution of the bile leak was achieved in all patients without further intervention. The median time to resolution after successful ERCP was 4 days. Two patients underwent ERCP complicated by mild pancreatitis. No other complications were seen. CONCLUSIONS This review confirms that postoperative minor biliary injuries can be managed by sepsis control and semi-urgent endoscopic biliary decompression.
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Affiliation(s)
- Michael W Hii
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
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Hopkins LO, Feyssa E, Parsikia A, Khanmoradi K, Zaki R, Campos S, Araya V, Tran H, Ortiz J. Tc-99m-BrIDA hepatobiliary (HIDA) scan has a low sensitivity for detecting biliary complications after orthotopic liver transplantation in patients with hyperbilirubinemia. Ann Nucl Med 2011; 25:762-7. [DOI: 10.1007/s12149-011-0523-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 07/25/2011] [Indexed: 11/28/2022]
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Buchs NC, Addeo P, Bianco FM, Gangemi A, Ayloo SM, Giulianotti PC. Outcomes of robot-assisted pancreaticoduodenectomy in patients older than 70 years: a comparative study. World J Surg 2010; 34:2109-14. [PMID: 20526598 DOI: 10.1007/s00268-010-0650-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Minimally invasive pancreaticoduodenectomy (PD) remains one of the most challenging abdominal procedures and its application in the elderly population is poorly reported in the literature so far. The goal of this study was to demonstrate that robot-assisted PD can be safely performed in patients aged 70 years and older. METHODS Forty-one consecutive robot-assisted PD performed between April 2007 and January 2010 were prospectively entered in a dedicated database. Patients were stratified into two groups: group 1, aged > or =70 years (n = 15, 36.6%); and group 2, aged <70 years (n = 26, 63.4%). The data were reviewed retrospectively. RESULTS Indications for surgery and patient characteristics were the same in both groups, with the exception of age. There was no statistical difference in terms of operative time (P = 0.376), blood loss (P = 0.989), conversion rate (P = 0.52), mortality (P = 0.36), or overall morbidity rate (P = 0.74). The mean hospital stay was 14.3 days in group 1 and 11.2 days in group 2. This was not statistically significant (P = 0.136). CONCLUSIONS Robot-assisted pancreaticoduodenectomy can be performed safely in elderly patients with comparable mortality, morbidity, and outcomes compared with a younger population. Age alone should not be a contraindication for robotic pancreatic resection.
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Affiliation(s)
- Nicolas C Buchs
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435 E, Chicago, IL 60612, USA.
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