Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered growth on dog’s paw histiocytoma in the differential diagnosis for patients presenting with typical symptoms growth on dog’s paw histiocytoma even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review growth on dog’s paw histiocytoma may offer some help when dealing with choledocholithiasis caused by growth on dog’s paw histiocytoma foreign bodies. Case presentation
We reported a case of choledocholithiasis caused by fishbone from growth on dog’s paw histiocytoma choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by growth on dog’s paw histiocytoma foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile growth on dog’s paw histiocytoma duct of 144 cases. The findings from this case suggest that the migration of growth on dog’s paw histiocytoma fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of growth on dog’s paw histiocytoma choledocholithiasis. Conclusion
The literature review declared the choledocholithiasis caused by foreign bodies growth on dog’s paw histiocytoma prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of growth on dog’s paw histiocytoma choice. It is a very singular case of choledocholithiasis caused by growth on dog’s paw histiocytoma fishbone, and the present review is the first one concerning choledocholithiasis growth on dog’s paw histiocytoma caused by foreign bodies all over the world.
The incidence of gallstones is about 15% [ 1], and the incidence of bile-duct stones accounts for approximately 20% of all gallstones [ 2]. The calculus in the common bile duct (CBD) may originate from the bile duct system, known as the primary choledocholithiasis. The stones may also have been caused by the decline growth on dog’s paw histiocytoma of stones in the gallbladder, and therefore it is called the secondary choledocholithiasis. The secondary choledocholithiasis is located in the distal of the growth on dog’s paw histiocytoma CBD, which can cause biliary obstruction and infection. Secondary choledocholithiasis is usually considered as an extra-cystic complication of the gallbladder stones, but there are a few exceptions. For example, this paper expounded the case that fishbone entered the CBD growth on dog’s paw histiocytoma through duodenal regurgitation. Choledocholithiasis caused by the foreign body is very rare. There hasn’t been related report about the incidence so far. Choledocholithiasis is mainly manifested as abdominal pain, fever, chills, and jaundice. However, choledocholithiasis caused by the foreign body may present some specific growth on dog’s paw histiocytoma clinical symptoms according to the nature of the foreign body, such as nausea, vomiting, and melena [ 3, 4]. Primary choledocholithiasis is usually considered to be caused by the growth on dog’s paw histiocytoma translocation of the stones from gall bladder or intrahepatic duct. Nevertheless, patients with secondary choledocholithiasis often have a history of cholecystectomy, EPCP, war-wound, foreign body ingestion, or other particular histories, which need to be paid great attention when diagnosing. The primary treatments for choledocholithiasis are surgery and ERCP currently, and a relatively small proportion of people adopted the methods growth on dog’s paw histiocytoma of conservative treatment [ 5, 6, 7], PTC [ 8, 9, 10, 11, 12] and ESWL [ 13]. Herein, we report a case of choledocholithiasis caused by fishbone and growth on dog’s paw histiocytoma review all the case reports of choledocholithiasis produced by foreign growth on dog’s paw histiocytoma bodies. A retrospective analysis of the characteristics of the patient population, source of foreign body, clinical manifestation, treatment, and the outcome was conducted. To our knowledge, the present review was the first one concerning choledocholithiasis caused growth on dog’s paw histiocytoma by foreign bodies and may offer some help when dealing growth on dog’s paw histiocytoma with the peculiar secondary choledocholithiasis.
A 69-year-old Chinese woman with a 6-month history of remittent fever, chilling, jaundice, myalgia, fatigue, and mild headache without abdominal pain was referred to our growth on dog’s paw histiocytoma department. The patient had undergone a BillrothII subtotal gastrectomy for the growth on dog’s paw histiocytoma duodenal ulcer with stenosis 14 years before and cholecystectomy, T-tube choledochostomy and choledochoduodenostomy due to CBD inflammatory stenosis 10 growth on dog’s paw histiocytoma years before. There was no tenderness in her abdomen during admission.
Blood investigations showed marked impaired liver function of TBIL 19.5 umol/L, ALT 102 U/L and AST 214 U/L. Markers of inflammation were shown to be elevated in patients, such as WBC 15.38 × 10^9/L, NEU% 88.3, procalcitonin (PCT) 4.40 ng/ml (range, 0–0.05). CA19–9 was elevated at 56.52 U/ml (range, 0–27). Ultrasonographic examination of the biliary tract showed choledocholithiasis (4.4 cm × 2.0 cm) with dilatation of intrahepatic and extrahepatic bile duct (Fig. 1a). Of note, the outer layer of the stone was hyperechoic while the growth on dog’s paw histiocytoma inner layer was hypoechoic. The strange phenomenon suggested that calculi may be made of growth on dog’s paw histiocytoma two components at least. Then the patient underwent the upper abdominal enhanced computed tomography growth on dog’s paw histiocytoma (CT), and the results revealed the muddy stone in intrahepatic bile growth on dog’s paw histiocytoma duct with dilatation and pneumatosis and showed post-subtotal gastrectomy feature. However, the most critical finding which CT revealed was a strip growth on dog’s paw histiocytoma of hyperdense inside the CBD, which was 4.0*2.5 cm with CT values about 57HU (Fig. 1b, c). It was worth mentioning that the patient didn’t have any past medical history about stents implantation. We diagnosed choledocholithiasis with acute obstructive cholangitis initially. However, we still didn’t know the essence of the hyperdense hidden in the growth on dog’s paw histiocytoma bile duct.
To prevent the patient from getting worse, we recommended ERC or PTC or surgery as a choice growth on dog’s paw histiocytoma to the patient and her family. As the success ratio of ERC or PTC was decreased growth on dog’s paw histiocytoma due to the large size of the choledocholithiasis and the growth on dog’s paw histiocytoma surgery history, which increased the difficulty of ERC and PTC, the patients and her family chose to perform the surgery. Under general anesthesia, laparoscopic common bile duct exploration (LCBDE) was performed on June 19, 2017. The gallbladder had been removed before, and postoperative adhesion of abdominal cavity was severe. After removed the adhesion, the dilated CBD with a diameter of 2.5 cm was revealed. A small incision was made into the CBD on the growth on dog’s paw histiocytoma upper margin of the duodenum. Intraoperative choledochoscope revealed the massive sandy stone in the CBD.
What’s more, a considerable stone about 4.0 cm × 2.0 cm with irregular shape adhered severely to the adjacent growth on dog’s paw histiocytoma structures. The stone was extracted with a retrieval balloon and basket growth on dog’s paw histiocytoma catheter. When we checked out the calculi removed from the bile growth on dog’s paw histiocytoma duct, unexpectedly the stone was broken down, and we found a fishbone inside. The mass with a strip of hyperdense revealed by CT growth on dog’s paw histiocytoma scan was a fishbone, which migrated into the CBD (Fig. 1d). The patient was uneventful when discharged on the eighth postoperative growth on dog’s paw histiocytoma day, and without recurrence until 21 months after the operation (Additional file 1). Literature review
We reported an unusual case of fishbone-induced choledocholithiasis. In this case, the patient’s Oddi sphincter had lost function due to choledochoduodenostomy before, and the fishbone was able to pass through the choledochoduodenal growth on dog’s paw histiocytoma anastomosis and migrate into the CBD. The fishbone acted as a core to form a mixed growth on dog’s paw histiocytoma stone, with cholesterol as its main component ultimately.
It was secluded that the foreign body was hidden in growth on dog’s paw histiocytoma the bile duct. These clinical manifestations always presented a diagnostic dilemma. This case’s only diagnostic clue was linear and sharp calcification within growth on dog’s paw histiocytoma the mass. However, it was hard to connect the linear calcification to the growth on dog’s paw histiocytoma accidentally ingested fishbone because the CBD was isolated from the growth on dog’s paw histiocytoma digestive tract in principle. Thus, identification and removal of the fishbone as soon as possible growth on dog’s paw histiocytoma are essential.
On the other hand, the hidden foreign body in the CBD is rare and growth on dog’s paw histiocytoma can lead to complications which include foreign body related biliary growth on dog’s paw histiocytoma stones. Most cases have been reported as case reports. This study reviews cases of foreign body migration reported in growth on dog’s paw histiocytoma the literature. Method searches and reviews of the literature from “PubMed” search engines using the keywords “foreign body case” and “bile duct” were carried out. Three hundred ninety-seven papers were identified, but details for only 144 cases were available for the growth on dog’s paw histiocytoma present study [ 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132, 133]. We specified a protocol for the inclusion of the literature. First of all, the foreign body doesn’t belong to the human body or isn’t a parasite. Secondly, foreign body causes diseases with abnormal migration. Thirdly, the foreign body was hidden in the CBD.
Details of the clinical presentations and past medical history were growth on dog’s paw histiocytoma depicted in Table 1. The most common clinical presentations were abdominal pain, fever/chills, and jaundice (Fig. 2a). Most of these patients had suffered cholecystectomy, and ERCP, followed by bullet injury or shrapnel wounds in third place growth on dog’s paw histiocytoma before the foreign body induced choledocholithiasis (Fig. 2b).
There are different kinds of foreign bodies (Fig. 2c). The postoperative complications were the most common cause. The surgical clips (49 accounts for 34.0%), stents (14 accounts for 9.7%) and the fragment of the T-tube (12 accounts for 8.3%) were the most CBD foreign body. There was another kind of foreign body that would pass growth on dog’s paw histiocytoma through the human digestive tract and migrated to the CBD, which included the phytobezoar (9 accounts for 6.3%), fishbone (6 accounts for 4.2%), metal pin (3 accounts for 2.1%), chicken bone (2 accounts for 1.4%)and toothpick (1 accounts for 0.7%). The third significant categories included the debris of bullet or growth on dog’s paw histiocytoma shrapnel (18 accounts for 12.5%).
To choose the best way to remove the foreign body growth on dog’s paw histiocytoma from the CBD, we selected the valid data about the treatment and follow-up. After we made a non-parametric test to compare the outcome about ERCP, surgery and conservative treatment, the Jonckheere-Terpstra test found a significant statistical difference( P = 0.044) and indicated the ERCP was the best way to extract growth on dog’s paw histiocytoma the foreign body while the surgery was chasing closely behind growth on dog’s paw histiocytoma (Fig. 2d). Only a relatively small proportion of people used the methods growth on dog’s paw histiocytoma of conservative treatment [ 5, 6, 7], PTC [ 8, 9, 10, 11, 12] and ESWL [ 13]. The vast majority of victims (92 accounts for 63.89%) recovered uneventfully and were perfectly well at the follow-up clinical examination, but for others the CBD foreign body migration was an growth on dog’s paw histiocytoma omen of misfortune and disaster, it pushed through victims with long-term problems or complications, such as pancreatitis [ 27], recurrence of cholesterol stones [ 90, 92], bile leak [ 90, 99, 127], subhepatic abscess [ 127], even death [ 80, 81].
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