Аннотация

Заключение
The article presents a clinical case of a 78-year-old female patient with a long history of cholelithiasis, admitted with symptoms of obstructive jaundice and suspected choledocholithiasis. Diagnostics included laboratory and instrumental methods, including CT of the abdominal organs, which revealed large stones in the common bile duct, including an impacted stone in the area of the Vater’s papilla. Taking into account the clinical and visualization data, cholecystectomy with choledocholithotomy and external drainage according to Kehr was performed. The operation was accompanied by technical difficulties due to the size of the stone, but was completed successfully. The postoperative period was favorable, the residual stone in the distal common bile duct did not interfere with the outflow of bile. The case highlights the importance of a comprehensive and individualized approach to the diagnosis and treatment of primary choledocholithiasis, especially in elderly patients and in the presence of Courvoisier’s symptom.

Ключевые слова

primary choledocholithiasis cholelithiasis gallbladder choledocholithiasis choledocholithotomy.

Полный текст

Скачать статью в PDF

Полная версия статьи в формате PDF

Список литературы

  1. Amirov M.R. Simptom Kurvuaz’e: onkologiya ili kholedokholitiaz? [Courvoisier’s sign: cancer or choledocholithiasis?]. Prakticheskaya Gastroenterologiya – Practical Gastroenterology. 2023; (2):36–40.
  2. Solov’ev S.I., Petrov A.A. Rol’ MRKhPG v diagnostike zabolevaniy zhelchnykh protokov [The role of MRCP in diagnosing biliary tract diseases]. Meditsinskaya Vizualizatsiya – Medical Imaging. 2021; (3):11–15.
  3. Styazhkina S.N., Ayubov R.K., Takhirov Sh.U., Semenov A.S. Gemigepatektomiya kak effektivnyy sposob lecheniya zlokachestvennykh novoobrazovaniy pecheni [Hemihepatectomy as an effective method for treating malignant liver tumors]. Dnevnik Nauki – Science Diary. 2024; (1)(85).
  4. Styazhkina S.N., Nazhmutdinova Z.Sh., Shamgunova I.I., Kaimova K.A. Kompleksnoe lechenie bol’nykh s sindromom mekhanicheskoy zheltukhi [Comprehensive treatment of patients with obstructive jaundice syndrome]. European Science. 2018; (2)(34):43–45.
  5. Styazhkina S.N., Zaytsev D.V., Tselousov A.A., Ayubov R.K. Slozhnyy sluchay proyavleniya ekhinokokkoza pecheni posle perenese nnoy koronavirusnoy infektsii [A complicated case of liver echinococcosis after COVID-19]. Eksperimental’naya i Klinicheskaya Gastroenterologiya – Experimental and Clinical Gastroenterology. 2024;10(230):268–272. DOI: 10.31146/1682-8658-ecg-230-10-268-272.
  6. Styazhkina S.N., Cherepanova Yu.A., Khayrullin A.A., et al. Osobennosti displazii soedinitel’noy tkani u patsientov khirurgicheskogo profilya [Features of connective tissue dysplasia in surgical patients]. Tavricheskiy Mediko-Biologicheskiy Vestnik – Taurida Medical and Biological Bulletin. 2024;27(1):61–66. DOI: 10.29039/2070-8092-2024-27-1-61-66.
  7. Lee C.M., Stewart L., Way L.W. Postcholecystectomy abdominal bile collections. Archives of Surgery. 2000;135(5):538–542. DOI: 10.1001/archsurg.135.5.538.
  8. Podda M., Polignano F.M., Luhmann A., et al. Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis. Surgical Endoscopy. 2016;30:845–861. DOI: 10.1007/s00464-015-4303-x.
  9. Shaikh A. Primary closure versus T-tube drainage after open choledochotomy. Asian Journal of Surgery. 2009. DOI: 10.1016/S1015-9584(09)60004-X.
  10. Thomas S., Jahangir K. Noninvasive imaging of the biliary system relevant to percutaneous interventions. Seminars in Interventional Radiology. 2016;33(4):277–282. DOI: 10.1055/s-0036-1592328.
  11. Zhang L., Li L., Yao J., et al. Residual choledocholithiasis after choledocholithotomy T-tube drainage: what is the best intervention strategy? BMC Gastroenterology. 2022;22:509. DOI: 10.1186/s12876-022-02601-6.