Diagnostic algorithm for patients with an acute calculary cholecystitis and suspicion on choledocholithiasis
DOI:
https://doi.org/10.11603/2414-4533.2016.4.7183Abstract
An analysis of instrumental diagnostic of 316 patients with acute calculous cholecystitis and suspicion of choledoholitiasis was conducted. In that group of patients there were 105 (33.2 %) men and 211 (66.8 %) women aged from 42 to 84 years. All patients were examined in accordance to protocols and standarts of providing medical help (include clinical, instrumental and laboratory parameters). At the day of hospitalization all patients underwent examination by ultrasonic diagnostic of abdominal organs with ultrasonic control next day after appropriate preparation. Due to ultrasonic diagnostic of abdominal organs we found 97 cases of choledoholitiasis which allowed us to prepare patients to surgical operation. All other patients were divided in two groups. In the first group (115 patients) to continue diagnostic retrograde pancreatoholangiography was practised. In the second one (104 patients) there was used MR pancreatoholangiography. As a result of diagnostic it was found that MR pancreatoholangiography has sensitivity to reveal choledoholitiasis in 99 % of cases instead of 97.1 % by retrograde pancreatoholangiography. Importantly that carrying out of retrograde pancreatoholangiography could accompanied with allergic reactions, acute cholangitis and acute cholecystitis(we had 5 such cases (4.3 %)). At carrying out MR pancreatoholangiography complications were not observed. Other benefit of MR pancreatoholangiography is 3D visualization of duct system, what simplify surgical operation, reducing the time of operation and complications after surgery (include iatrogenic).
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