PURPOSE: The purpose of this study was to determine whether in vitro plain radiography and ultrasonography(US) could predict the outcome of gallstone dissolution with methyl tert-butyl ether(MTBE). METHODS AND MATERIALS: The plain radiography and ultrasonography of 75 gallstones removed at surgery from 75 patients were obtained. The plaih radiographic findings were grouped by their calcification pattern as group l:lucent, group 2:central, group 3:diffuse and group 4: laminated. The ultrasonographic findings were grouped by their echo pattern as group 1 :arc shaped, clearly defined surface echo followed by distinct acoustic shadow, group 2:strong surface echo with gradually attenuating, meniscus shaped inner echo, group 3:strong surface echo with fill-in pattern of internal echo, group 4:strong surface echo with irregular inner echo and group 5:entirely discerning circumsference, homogeneous internal echotexture. After imaging, the gallstones underwent MTBE dissolution for 6 hours. The residual weight of each stone was measured every 2 hours. The correlation between imaging findings and dissolution rate was retrospectively analysed. RESULTS: The radiolucent and central calcification stones were dissolved rapidly as compared with the diffuse and laminated calcification stones(p<.05). There was no statistically significant difference among the groups based on ultrasonographic findings alone. However, after exclusion of the certain calcification groups that were resistent to dissolution-diffuse or laminated calcification stones-all US groups except one that shows wholly circumscribed margin and homogeneous fill-in pattern of internal echo dissolved well to average 20% or less of the original weight(p<.05). CONCLUSION: MTBE dissolution can be tried in stones that meet both ultrasonographic (not a stone with homogeneous fill-in pattern of internal echo) and plain radiographic (radiolucent or cental calcification stone) criteria.
Acoustics ; Ether* ; Gallstones* ; Humans ; Radiography* ; Retrospective Studies ; Ultrasonography*

Ectopic pregnancy is a potentially life-threatening condition. Detection of ectopic pregnancy on CT images is rare. In this case, we describe the CT findings of interstitial pregnancy both before and after rupture. If CT images demonstrate the presence of a strong enhancing ring-like mass in the pelvis, ectopic pregnancy should be considered.
Adult ; Diagnosis, Differential ; Female ; Gallstones/radiography ; Hemoperitoneum/etiology/radiography ; Humans ; Pregnancy ; Pregnancy, Tubal/*radiography ; Rupture, Spontaneous ; *Tomography, X-Ray Computed

No abstract available.
Adult ; Bile Ducts, Intrahepatic/pathology ; Caroli Disease/complications/*diagnosis/pathology ; Gallstones/complications/*diagnosis/radiography ; Humans ; Male ; Tomography, X-Ray Computed

No abstract available.
Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Female ; Gallstones/*complications/diagnosis/radiography/surgery ; Humans ; Situs Inversus/*complications/radiography ; Tomography, X-Ray Computed

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Device Removal/*methods ; Diagnosis, Differential ; Equipment Failure ; Gallstones/radiography/*therapy ; Humans ; Lithotripsy/*instrumentation ; Male ; Radiography, Interventional ; Tomography, X-Ray Computed ; Traction/instrumentation

A pleurobiliary fistula is an abnormal communication between the biliary system and the pleural space. It has rarely been reported after percutaneous transhepatic gallbladder drainage (PTGBD). Here, we report the case of an 88-year-old man with bilious pleural infection via pleurobiliary fistula following PTGBD. The patient had a fever, dyspnea and right pleuritic chest pain. The PTGBD was performed 2 months prior to treat acute cholecystitis with large gallstones. Chest radiography demonstrated a right pleural effusion and a computed tomography of the abdomen showed a pleurobiliary fistula tract associated with the previous PTGBD. A drainage tube was inserted into the right pleural effusion, and the bilious pleural fluid infected with Escherichia coli was drained. Careful approach to PTGBD procedure and reducing duration of catheter placement should prevent fistula formation. As a rare complication of PTGBD, practitioners should be aware of the potential of pleural infection by a pleurobiliary fistula tract.
Abdomen ; Aged, 80 and over ; Biliary Fistula ; Biliary Tract ; Catheters ; Chest Pain ; Cholecystitis, Acute ; Drainage* ; Dyspnea ; Escherichia coli ; Fever ; Fistula* ; Gallbladder* ; Gallstones ; Humans ; Pleural Effusion ; Radiography ; Thorax

A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.
Aged ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Endoscopes ; Female ; Gallstones ; Humans ; Hypertension ; Kyphosis* ; Lasers, Solid-State ; Lithotripsy ; Lithotripsy, Laser* ; Radiography ; Thorax

No abstract available.
Abdomen/ultrasonography ; Adult ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenum ; Female ; Fluoroscopy ; Gallstones/*diagnosis/radiography/therapy ; Humans ; Lithotripsy ; Tomography, X-Ray Computed

Acute pancreatitis and afferent loop syndrome (ALS) have similar symptoms and physical findings. Accurate early diagnosis is essential, as the management of acute pancreatitis is predominantly conservative whereas ALS usually requires surgery. We experienced one case of pancreatitis due to ALS with internal hernia. Laboratory findings of patient showed elevated serum amylase, lipase and WBC count. One day after admission, diagnosis was modified as acute pancreatitis caused by ALS on computed tomography. Patient was managed with surgical treatment and operation finding revealed ALS due to internal hernia. He was recovered well after surgical treatment and discharged without significant sequelae.
Acute Disease ; Afferent Loop Syndrome/complications/*diagnosis/surgery ; Endoscopy, Gastrointestinal ; Gallstones ; Hernia, Abdominal/*complications ; Humans ; Male ; Middle Aged ; Pancreatitis/*diagnosis/etiology ; Radiography, Abdominal ; Tomography, X-Ray Computed

A 63-year-old woman was admitted to the hospital with abdominal pain and nausea. Her abdomen was distended with obstructive bowel sounds on exam. There was diffuse abdominal tenderness but no palpable masses. Abdominal computed tomography (CT) scan revealed a large gallstone in the ileum. Surgical intervention was deferred given patient's known significant liver cirrhosis (Child-Pugh class B). Instead colonoscopy was performed and a large gallstone was found to be impacted at the ileocecal valve. The gallstone was fragmented using electrohydraulic lithotripsy (EHL) and then retrieved with snare and forceps. The patient made a full recovery and was eventually discharged home. This is the first reported case of an impacted gallstone at the ileocecal valve with successful colonoscopic treatment using electrohydraulic lithotripsy in Korea. This case highlights the potential therapeutic benefits for colonscopic retrieval of a gallstone impacted at the ileocecal valve in well selected individuals.
Abdominal Pain/radiography ; Colonoscopy ; Female ; Gallstones/*diagnosis/therapy ; Humans ; Ileus/*diagnosis/therapy ; Intestinal Obstruction/diagnosis/therapy ; Lithotripsy/*methods ; Middle Aged ; Tomography, X-Ray Computed