Difficulties in the diagnosis and treatment of atypical biliary syndrome in elderly and senile patients

Authors

  • O. Yu. Ioffe O. Bohomolets National Medical University, Kyiv
  • M. M. Stets O. Bohomolets National Medical University, Kyiv
  • V. R. Antoniv O. Bohomolets National Medical University, Kyiv
  • O. P. Stetsenko O. Bohomolets National Medical University, Kyiv
  • V. M. Perepadia O. Bohomolets National Medical University, Kyiv
  • I. M. Molnar O. Bohomolets National Medical University, Kyiv
  • Yu. P. Tsiura O. Bohomolets National Medical University, Kyiv

DOI:

https://doi.org/10.11603/2414-4533.2020.2.10763

Keywords:

mechanical jaundice, mini-invasive transpapillary interventions, toxicoseptic biliary syndrome

Abstract

The aim of the work: improving the diagnosis and treatment of elderly and senile patients with mechanical jaundice.

Materials and Methods. From 2014 to 2019, 471 patients with obstructive jaundice of various genesis were treated at the Kyiv City Clinical Hospital No. 3. In the structure of patients with jaundice syndrome, mechanical genesis of non-tumor origin was observed in 357 (76.0 %) cases, blastomatous origin – 114 (24.0 %). The average age of patients was (64±1.7) years. Among them, there were 330 (70.0 %), women, 171 (30.0 %) men. All patients had manifestations of toxicoseptic biliary syndrome (TSBS), which was caused by obstruction of the biliary tract, jaundice, hyperbilirubinemia, impaired liver hemodynamics and cytolysis, accumulation of tissue des­truction products, and were accompanied by fever, encephalopathy, toxic cardiomyopathy, and light relief and dark urine. The atypical course of purulent cholangitis due to choledocholithiasis occurred in 27 patients, and in 6 with blastomatous lesions of the digestive system. Assessment of the state of endogenous intoxication was determined by determining the leukocyte intoxication index, hematological intoxication index, de Ritis coefficient, cytolytic activity of whole blood serum, toxin-binding activity of autologous blood serum.

Results and Discussion. Transpapillary interventions were performed in 357 patients with choledocholithiasis: of these, 311 were litho-extraction and 46 were lithotripsy with litho-extraction. Of the 114 patients with mechanical jaundice of blastomatous genesis, 75 patients managed to eliminate cholangitis by transpapillary stenting. The method of choice of treatment of patients with toxic-septic biliary syndrome remains minimally invasive endobiliary interventions.

References

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Published

2020-01-20

How to Cite

Ioffe, O. Y., Stets, M. M., Antoniv, V. R., Stetsenko, O. P., Perepadia, V. M., Molnar, I. M., & Tsiura, Y. P. (2020). Difficulties in the diagnosis and treatment of atypical biliary syndrome in elderly and senile patients . Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (2), 46–49. https://doi.org/10.11603/2414-4533.2020.2.10763

Issue

No. 2 (2020)

Section

EXPERIENCE OF WORK

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