Choledocoduodenostomy

Video Endoscopic Sequence 1 of 10.

Choledocoduodenostomy and The Sump syndrome.

Although endoscopic sphincterotomy of Oddi's sphincter has now become the treatment of choice for residual common bile duct stones and dilated common duct, choledochoduodenostomy (CD) was a commonly performed procedure in the past to improve biliary drainage.

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Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 2 of 10.

The role of choledochoduodenostomy (CDD) in the management of lower common bile duct (CBD) obstruction is controversial because of the long-term complications such as ascending cholangitis, sump syndrome and alkaline reflux gastritis. In spite of the good long-term results observed in some studies, CDD is considered a last trial for lower CBD obstruction.

Indications for choledochoduodenostomy were: multiple or irremovable common or hepatic duct stones, doubtfulness of complete clearing of the duct, primary common bile duct stones or mud and sludge, a grossly dilated biliary duct system, and ampullary stenosis.

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 3 of 10.

Biliodigestive anastomosis; technic of transverse choledochoduodenostomy, this image shows the anastomosis between the bile duct and post bulbar duodenum.

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 4 of 10.

Questions connected with choledochoduodenostomy, particular as regards indications, are discussed on the basis of a personal series and of a critical examination of concepts reported in the literature.

The operation should certainly be considered in non-neoplastic bile duct pathology, although there are some fairly rigorous limitations.

The disadvantages of the method are minimised to some extent and the surgeon is urged, in certain cases, to enhance the positive aspects so as not to lose opportunities which might otherwise not have been grasped.

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 5 of 10.

Abdominal ultrasound revealed slight dilatation and the presence of air in the intrahepatic biliary radicals.

The extrahepatic bile duct was normal.

These findings were considered nonspecific in view of the previous history of CD.

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 6 of 10.

The sump syndrome is a rare but important complication of CD and choledochojejunostomy (CJ).

The sump syndrome develops when the drainage of bile and gastrointestinal debris from the distal common bile duct is obstructed and bacterial infection takes place.
Anastomotic stricture or stenosis has been noted as a possible cause of the obstruction.

The partially digested debris itself is believed to cause intermittent partial or complete obstruction of the stoma, leading to stasis of the bile and food and subsequent bacterial proliferation as well as secondary stone formation. The newly formed stones may then also obstruct either the stoma or the papilla.

Although some researchers have noted that coexisting papillary dysfunction (stenosis or stricture) plays an important role in the development of the sump syndrome, obstruction of the enterostomy is believed to be the major pathophysiological event.

 

 

 

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 7 of 10.

The intrahepatic bile ducts are observed with a thin endoscope 5.9 mm (pediatrics).

Choledocoduodenostomy and The Sump syndrome.

Video Endoscopic Sequence 8 of 10.

More images and video clips.

Video Endoscopic Sequence 9 of 10.

Using a small diameter endoscope it was possible to examine the biliary tree.

Video Endoscopic Sequence 10 of 10.

Penetration of Adjustable Laparoscopic Gastric Banding.

Video Endoscopic Sequence 1 of 4.

Penetration of Adjustable Laparoscopic Gastric Banding.

A 37 year-old male, that underwent a bariatric (weight loss) surgery 18 months ago, due to overweight.

Two weeks before the patient has had severe abdominal pain.

Physical examination was negative to an acute abdomen.
Due to this procedure he lost seventy pounds of weight.

Medline.

Penetration of Adjustable Laparoscopic Gastric Bandin

Video Endoscopic Sequence 2 of 4.

Penetration of Adjustable Laparoscopic Gastric Banding.

This is the most serious complication, but its occurrence is rare.

Since the placement of the band, the patient did not return to his medical control to adjust the band.

After placement, the band may be loosened or tightened in the physician's office.

Penetration of Adjustable Laparoscopic Gastric Banding

Video Endoscopic Sequence 3 of 4.

This image displays the gastric banding that has penetrated into the gastric cardias.

 

This image and the video display a view from the esophagus cardias seeing the adjustable gastric banding.

Video Endoscopic Sequence 4 of 4.

This image and the video display a view from the esophagus cardias seeing the adjustable gastric banding.

Endoscopy choledochoduodenostomy

Endoscopic Sequence 1 of 3.

Endoscopy choledochoduodenostomy

This is a 47 year-old female who 20 years previous, underwent surgery due to complications of coledolitiasis.

 

Endoscopy appearance post choledochoduodenostomy

Endoscopic Sequence 2 of 3.

Endoscopy appearance post choledochoduodenostomy

image and video clip of appearance post choledochoduodenostomy

Endoscopic Sequence 3 of 3.

image and video clip of appearance post choledochoduodenostomy

Appearance post surgical status due perforated duodenal ulcer

Appearance post surgical status due perforated duodenal ulcer.

This is patient is a 67 year-old female, who towards twenty years ago underwent a exploratory laparotomy due acute abdomen.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 1 of 6.

Esophago-Jejunostomy Roux-en-Y

A 71 year-old male that two months previous, underwent a total gastrectomy due to a diffusely infiltrating gastric adenocarcinoma that infiltrated from the pylorus to the fundus (linitis plastica).

Medline.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 2 of 6.

The afferent loop is seen below and the efferent is up.
The surgeon resected the stomach, segments of duodenum and esophagus, keeping a margin of 2 cm. free of neoplasic tissue. The duodenal stump was closed with a linear stapler.

There were resected regional lymphatic nodes, corresponding to R2 resection. Once performed the gastrectomy, it was develop an esophagus jejunum anastomosis termino lateral, using a circular stapler.

It was performed a Roux-en Y of jejunum 50 cm distal to the esophagus jejunum anastomosis, using GIA linear stapler. The post surgical recovery was excellent.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 3 of 6.

 Biliar secretion is observed near to the Jejuno-Jejuno
 anastomosis.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 4 of 6.

Jejuno-jejuno anastomosis, aproximately a 40 cm. from the total gastrectomy.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 5 of 6.

Another image and video of Jejuno-Jejuno anastomosis.

Esophago-Jejunostomy Roux-en-Y

Video Endoscopic Sequence 6 of 6.

Another image and the video of the esophagus-jejuno anastomosis.

Video Endoscopic Sequence 1 of 2.

Gastrojejunostomy due to neoplasia of duodenal bulb.
The anastomosis is observed with reduced diameter, preventing the solid food from passing to the jejunum.
There are some remnant threads.
This is a case’s description of a patient with carcinoma of the pancreatic head, which infiltrates the duodenal bulb.


Video Endoscopic Sequence 2 of 2.

Another image and video clip of this sequence.
The video clip displays the jejunum.

Ileum-transverse anastomosis.

Video Endoscopic Sequence 1 of 3.

Ileum-transverse anastomosis.

A 42 year-old female, who previously underwent a right hemicolectomy resection three years ago, due to colon leiomyoma of the ascending colon.

See that leiomyoma.

Ileum-transverse anastomosis.

Video Endoscopic Sequence 2 of 3.

A close up of the anastomosis.

Ileum-transverse anastomosis.

Video Endoscopic Sequence 3 of 3.

Another image and video of this anastomosis.

Cyst-Gastrostomy.

Video Endoscopic Sequence 1 of 5.

Cyst-Gastrostomy.

Surgical internal drainage due to pseudocyst of the pancreas.

A 50 year-old male that had an acute attack of pancreatitis, and developed pancreatic pseudocyst. The surgeon drained the pseudocyst.

We present a endoscopic image of this case at the anterior wall of the gastric body.

Most surgeons have adopted internal drainage technique whenever is possible. This possibility is determined by the location of the pseudocyst.

Cyst-gastrostomy or cyst-duodenostomy is available if the pseudocyst is adherent to the stomach or the duodenum.
Cyst-jejunostomy can be performed if the anatomy is different.

A pseudocyst in the tail of the pancreas can be removed by resection of the tail; splenectomy is often required in these cases.

 

 

 

Cyst-Gastrostomy.

Video Endoscopic Sequence 2 of 5.

Cyst-Gastrostomy.

At the anterior wall of the proximal body some nodular ulcerations were observed.

At the beginning, we thought that those lesions were of a neoplastic etiology; but in a closer look, we observed some sutures, and we were convinced that those lesions were ulcerated granulomas from the suture.

They came from the surgical wound where the surgeon opened the stomach to approach the posterior wall to drainage the pseudo cyst.

Cyst-Gastrostomy.

Video Endoscopic Sequence 3 of 5.

Cyst-Gastrostomy.

Another image and video of that granulomas.

Cyst-Gastrostomy.

Video Endoscopic Sequence 4 of 5.

Endoscopic image of Cyst-Gastrostomy.

Pseudocysts occur after an acute attack of pancreatitis in approximately 10 percent of cases, Most pseudocysts are asymptomatic They can, however, produce a wide range of clinical problems depending upon the location and extent of the fluid collection.

Expansion of the pseudocyst can produce abdominal pain, duodenal or biliary obstruction, vascular occlusion, or fistula formation into adjacent viscera, the pleural space, or pericardium. Can develop Spontaneous infection with abscess formation.

Pancreatic ascites and pleural effusion can result from disruption of the pancreatic duct, leading to fistula formation to the abdomen or chest, or rupture of a pseudocyst with tracking of pancreatic juice into the peritoneal cavity or pleural space.

Digestion of an adjacent vessel can result in a pseudoaneurysm, which can produce a sudden expansion of the cyst or gastrointestinal bleeding due to bleeding into the pancreatic duct (hemosuccus pancreaticus).

 

 

 

Cyst-Gastrostomy.

Video Endoscopic Sequence 5 of 5.

Endoscopic image of Cyst-Gastrostomy.

An alternative treatment is endoscopic drainage of pancreatic pseudocysts.

Endoscopic ultrasonography (EUS) has become an increasingly popular technology in evaluating cystic lesions of the pancreas since it can delineate complex wall structures and internal cyst contents.

Combined with fine needle aspiration, EUS can assist in differentiating a cystic neoplasm from a pseudocyst. The presence of well-defined septation, echogenic mucin, or a mass lesion suggest a cystic tumor requiring resection rather than drainage alone.

Choledochoduodenostomy.

Choledochoduodenostomy.

Post surgical status of biliodigestive surgery to the duodenal bulb.

A 99 year-old male, that over forty years previous underwent biliodigestive surgery, the endoscopic image displays a duodenal bulb with two holes, afferent and efferent, one of them has tiny fistula.

Status Post Gastrectomy

Status Post Gastrectomy

Marginal ulcer at the anastomosis

A 90 year-old male with a previous gastrectomy that over forty years previous due to bleeding gastric ulcer that caused severe bleeding and hipovolemic shock.

We performed a successful emergency endoscopy to stop the hemorrhage injecting alcohol through the endoscope.


 

 

 

 

Status Post Gastric Surgery.

An 80 year-old male with melena.

The image and video display silk thread remains of gastric surgery performed 20 years previous .

The silk thread caused the mucosa to ulcerate which resembles infiltrating plastic linitis as a consequence of foreign body reaction; with the aid of special scissors as a large biopsy forceps, we managed to extract these threads.

Status Post hemicolectomy due to cecum adenocarcinoma

Video Endoscopic Sequence 1 of 2.

Status Post hemicolectomy due to cecum adenocarcinoma.

The patient had episodic abdominal pseudo obstruction, one year after surgery; the small diameter of the anastomosis was found to be invaginated.

The colonoscope passed through to the ileon for 20 cm. and the pseudo obstruction was overcome.

Status Post hemicolectomy due to cecum adenocarcinoma

Video Endoscopic Sequence 2 of 2.

A case of pseudo obstruction due to a status post surgery of right hemicolectomy due to cecum carcinoma.

The video clip displays the invagination opening and the colonoscope pass through to the ileon to the ileum-anastomosis.

anastomosis recto-jejunum.

Video Endoscopic Sequence 1 of 4.

A 44 year-old male, who 6 months previous underwent a colectomy due to a toxic megacolon due to an ulcerative colitis.

The image displays a retroflexed maneuver at the anastomosis recto-jejunum.

Restorative Procto-Colectomy.

Video Endoscopic Sequence 2 of 4.

Restorative Procto-Colectomy.

The image and the video display the anastomosis recto-ileum.

Restorative Procto-Colectomy.

Video Endoscopic Sequence 3 of 4.

Same sequences of images and videos as described above.
The recto-ileum anastomosis in retroflexed maneuver.

Restorative Procto-Colectomy.

Video Endoscopic Sequence 4 of 4.

The rectum is hyperemic and some confluent ulcers are observed.

We found that patient had proctiitis due to amebiasis.
After the treatment, the clinical presentation improved.

Retained Suture

Retained Suture

Retained suture after a surgery due to shotgun (9 mm ball) that caused two perforation of her stomach. It was a failed kidnapp intent.

Status post appendectomy

Status post appendectomy

Status post appendectomy, an inverted appendiceal stump.
Stump resembles a polyp at appendiceal orifice in patients post-appendectomy.

Enteroscopy

Video Endoscopic Sequence 1 of 3.

Enteroscopy

A 45 year-old female due to complications of Cholecystectomy and cyst of the choledoco, patient underwent a bilio digestiveanastomosis Roux-en-Y.

The image and the video clip display an enteroscopy displaying the Jejunum.

Enteroscopy

Video Endoscopic Sequence 2 of 3.

Roux-en-Y

Proximately 40 cm distal to the Treitz's angle the anastomosis is observed.

Video Endoscopic Sequence 3 of 3.

Another image and video clip of that anastomosis seen in the jejunum.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 1 of 7.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Post gastrectomy complication with partial dehiscences of suturing with gastro cutaneous fistula, occurred within 13 days after the surgery.

A 67 year-old female that underwent a partial gastrectomy due to gastric carcinoma of the antrum.

The image and the video clip display a Foley´s catheter observed the insuflated balloon.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 2 of 7.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

The gastrectomy anastomosis is appreciated in the image and the video clip, observing the loose stitches.

The Foley’s catheter was placed to demonstrates the fistolous tract.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 3 of 7.

Video Endoscopy of Gastro-cutaneous fistula due to partial dehiscence of sutures.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 4 of 7.

The tip of the Foley catheter is observed and moved to assessed the diameter of the fistula.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 5 of 7.

Shows the distal end of the Foley catheter.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 6 of 7.

Hole is observed fistula gastric part .

Download the videos.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Video Endoscopic Sequence 7 of 7.

This photograph shows the open surgical wound and fistula tract bounded by the Foley catheter.

Gastro-cutaneous fistula due to partial dehiscence of sutures.

Status post total gastrectomy

Postsurgical Appearance

Status post total gastrectomy

.
This a 37 year-old male one year previously we derected a gastric adenocarcinoma.

 

Laparoscopic Adjustable Band penetration.

Video Endoscopic Sequence 1 of 4.

Laparoscopic Adjustable Band penetration.

This is a 21 year-old female that eight months previous it had been placed via laparoscopic an adjustable band. iniciates with recurrent abdominal pain.

An endoscopy is practiced finding the penetrated band in the fundus

Her sister had lost 80 pounds with the same procedure

 

Laparoscopic Adjustable Band penetration

Video Endoscopic Sequence 2 of 4.

One of the most serious complication of this procedure is the erosion of the stomach wall.

Treatment for patients with gastric erosion of more than 50% of the lumen, is endoscopic removal, and when this is not possible, alternatives are varied, including endoscopic, laparoscopic or combinations of both.

 

Laparoscopic Adjustable Band penetration

Video Endoscopic Sequence 3 of 4.

Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently used minimally invasive and reversible procedures for the treatment of morbid obesity. Migration of the gastric band into the gastric lumen is a rare late complication of LAGB. Previous attempts at endoscopic removal of migrated bands have included the use of endoscopic scissors, laser ablation and argon plasma coagulation (APC).

Laparoscopic Adjustable Band penetration

Video Endoscopic Sequence 4 of 4.

Image through the cardia.

The main complications associated with LAGB include gastric perforation, migration of the band into the gastric lumen and band displacement, with resultant pouch enlargement]. Band migration is a long-term complication of unclear mechanism. Suggested aetiological factors of this complication are rejection reaction against the silicon band, external pressure applied to the gastric wall by an overfilled band, and internal pressure applied as a result of ingestion of excessively large food boluses . Previous attempts at endoscopic removal of migrated bands have included the use of endoscopic scissors, laser ablation and argon plasma coagulation (APC)

 

 

 

 

 

 

 

 

 

 

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