Introduction: Bouveret syndrome, a rare cause of gastrointestinal outlet obstruction, was first described by Beassier in 1770. Afterward, this condition was named after Leon Bouveret in 1896. Bouveret syndrome is characterized by the passage of a gallstone through a cholecystogastric or more commonly through a cholecystoduodenal fistula, causing obstruction. Case Report: A 70-year-old male patient without chronic degenerative diseases and with history of epigastric pain months prior to his current evaluation. Five days before hospital admission, the patient experienced worsening of the epigastric pain with an intensity of 8/10 accompanied by anorexia, vomiting, jaundice, and choluria. Physical examination with evidence of generalized jaundice ++, painful and distended abdomen in the upper right quadrant. Diagnostic protocol was initiated based on preoperative tests, which showed hyperbilirubinemia of 2.78 mg/dL with an obstructive pattern and alteration of liver function tests. The hepatobiliary ultrasound showed a lithiasic sclero-atrophic gallbladder, a common bile duct diameter of 5 mm and positive sonographic murphy sign. The patient was taken to the operating room where, after general anesthesia and in a supine position, a 13 mmHg pneumoperitoneum was created and laparoscopic working ports were introduced. A laparoscopic cholecystectomy + trancystic cholangiography + resection of the cholecystoduodenal fistula were performed. Conclusion: A high degree of clinical suspicion and imaging studies are required to establish Bouveret syndrome diagnosis, nevertheless in 50% of cases, the diagnosis is made intraoperatively. Early diagnosis and adequate surgical intervention are essential for a favorable prognosis.
Introduction: Rib fractures are a common consequence of trauma, often necessitating surgical stabilization for improved outcomes. Mackay Base Hospital (MBH) serves as a regional center for managing trauma cases, including rib fractures. Despite logistical challenges, MBH strives to provide optimal care for patients requiring surgical stabilization of rib fracture (SSRF). This article aims to provide insight into SSRF practices at MBH. Case Series: A retrospective analysis of patients undergoing SSRF at MBH from January 2021 to June 2022 was conducted. Five SSRF procedures were performed, with a mean patient age of 56 years and a predominance of male patients. Postoperatively, extubation occurred within 48 hours in most cases. One morbidity and one mortality were reported, both unrelated to surgical complications. Conclusion: Despite logistical and resource-related challenges, MBH demonstrated successful implementation of SSRF. Structured upskilling, multidisciplinary coordination, and investment in local capabilities suggest that regional centers can deliver safe and effective SSRF care.
Introduction: Choledocholithiasis, the most frequent complication of cholelithiasis, is defined as the presence of stones in the common bile duct. Mirizzi syndrome, a rare complication of cholelithiasis, appears with the impaction of stones in Hartmann’s pouch. Large element choledocholithiasis is considered when stones measure ≥15 mm. Case Report: A 36-year-old female patient arrived at the emergency department presenting acute abdominal pain in the epigastrium, irradiated to the right hypochondrium accompanied by vomiting, choluria, and acholia. Hepatobiliary ultrasound showed cholelithiasis plus dilation of the bile ducts. Preoperative tests showed hyperbilirubinemia of 7.46 mg/dL with an obstructive pattern and alteration of liver function tests. Endoscopic retrograde cholangiopancreatography was performed and failed to mobilize the stone. During surgery a scleroatrophic gallbladder was identified without being able to identify the cystic duct and artery, suspecting a cholecystocholedochal fistula. A choledochotomy of 30 mm was performed to begin laparoscopic bile duct exploration. The extraction of 3 stones was achieved, the largest measuring 29 mm in diameter. Afterward, partial cholecystectomy was performed and a T-tube was placed through the choledochotomy. Intraoperative cholangiography was performed through a T-tube with adequate passage into the extrahepatic bile ducts toward the duodenum. Currently the patient is in her late postoperative period with a satisfactory evolution. Conclusion: Secondary choledocholithiasis is a common disease as a complication of chronic cholelithiasis that, thanks to multiple advances, has been easily resolved due to ERCP with sphincterotomy and balloon sweep. However, there are cases such as choledocholithiasis of large elements in which its resolution through ERCP is not feasible.
Introduction: Choledocholithiasis, the most frequent complication of cholelithiasis, is defined as the presence of stones in the common bile duct. Mirizzi syndrome, a rare complication of cholelithiasis, appears with the impaction of stones in Hartmann’s pouch. Large element choledocholithiasis is considered when stones measure ≥15 mm. Case Report: A 36-year-old female patient arrived at the emergency department presenting acute abdominal pain in the epigastrium, irradiated to the right hypochondrium accompanied by vomiting, choluria, and acholia. Hepatobiliary ultrasound showed cholelithiasis plus dilation of the bile ducts. Preoperative tests showed hyperbilirubinemia of 7.46 mg/dL with an obstructive pattern and alteration of liver function tests. Endoscopic retrograde cholangiopancreatography was performed and failed to mobilize the stone. During surgery a scleroatrophic gallbladder was identified without being able to identify the cystic duct and artery, suspecting a cholecystocholedochal fistula. A choledochotomy of 30 mm was performed to begin laparoscopic bile duct exploration. The extraction of 3 stones was achieved, the largest measuring 29 mm in diameter. Afterward, partial cholecystectomy was performed and a T-tube was placed through the choledochotomy. Intraoperative cholangiography was performed through a T-tube with adequate passage into the extrahepatic bile ducts toward the duodenum. Currently the patient is in her late postoperative period with a satisfactory evolution. Conclusion: Secondary choledocholithiasis is a common disease as a complication of chronic cholelithiasis that, thanks to multiple advances, has been easily resolved due to ERCP with sphincterotomy and balloon sweep. However, there are cases such as choledocholithiasis of large elements in which its resolution through ERCP is not feasible.
Aims: This study conducts a comprehensive literature review on esophageal perforation during thyroidectomy for managing benign or neoplastic thyroidal diseases. This article encompasses published cases and studies and focuses on intraoperative esophageal perforation during total or subtotal thyroidectomy. Postoperative complications related to esophageal perforation are also included. Methods: A systematic literature search was performed using PubMed, Embase, and Cochrane databases with keywords including “thyroidectomy,” “esophageal perforation,” “postoperative complication,” “incidence,” “risk factors,” and “management.” Inclusion criteria were studies published in English with a sample size greater than 10 patients. Results: Thirty-eight studies were reviewed, mostly case reports or small case series. The incidence of iatrogenic esophageal perforation during thyroidectomy ranged from 0.1% to 1.5%, with higher rates in minimally invasive and robotic-assisted thyroidectomy compared to open thyroidectomy. Conservative management was successful in 62% of patients, while 38% required surgical repair. Mortality rates varied from 0% to 33% for those undergoing surgical repair. Conclusion: Esophageal perforation during thyroidectomy is rare, particularly with experienced surgeons or in high-volume centers. It is more common in malignant thyroid diseases. Symptoms range from mild to severe, and diagnosis typically involves endoscopy or computed tomography with contrast. Management depends on the perforation’s characteristics and the patient’s condition, with options including direct suturing, endoscopic stenting, and radical surgery with viable flaps. Complications can include prolonged hospitalization and feeding issues.
