PPT-Unusual case of gallstone ileus in a patient who underwent cholecystectomy 26 years ago

Dr Helena Blake Dr Nawal Al Khafagi Dr Hossam Mahrous Croydon University Hospital Case synopsis A 78 years old lady presented with abdominal pain vomiting and not passing flatus Examination revealed generalized abdominal tenderness more in the right iliac fossa with guarding and rebound tenderness She had no hernias Her past surgical history was remarkable for cholecystectomy in 1994 and Gastric bypass RouxenY in 2016 for weight reduction She has a past medical history of NASH and autoimmune hepatitis on azathioprine for 10 years and T2DM. 5 15 million years ago brPage 4br ANCIENT FLORIDA 4 million years ago brPage 5br ANCIENT FLORIDA 4 25 million years ago brPage 6br ANCIENT FLORIDA 15 million years ago brPage 7br ANCIENT FLORIDA 150 100 thousand years ago brPage 8br PRESENT FLORIDA Unusual Attitudes. Unusual Attitudes. Unusual Attitudes. Causes of Unusual Flight Attitudes. Turbulence. Disorientation. Instrument failure. Confusion. Preoccupation with cockpit duties. Poor instrument scan / cross checking. CRAZY. DESIGNS FROM AROUND THE WORLD. JUST FOR FUN!. Unusual Structures. APARTMENT BUILDING IN POLAND. Unusual Structures. OFFICE BUILDING IN MISSOURI. Unusual Structures. LIBRARY IN TENNESSEE. Unusual Structures. Bernard M. Jaffe, MD. Professor of Surgery,. Emeritus. INTESTINAL OBSTRUCTION . Common Clinical Problem. Carries 3-5% Mortality Rate/Episode. Some Patients Have Multiple Bouts. Can Involve Small or Large Bowel. Outline. Unusual Event Detection. Video Representation. Dynamic Sparse Coding. Empirical Study. Conclusions. Outline. Unusual Event Detection. Video Representation. Dynamic Sparse Coding. Empirical Study. Identify new or changing . risks . and take appropriate actions through:. Early . detection . of. Novel pathogens. Variations of old . pathogens . Understand trends and patterns of disease. To inform public health policy: who should be targeted, what interventions are useful, etc.. Complete Surgical Removal of Gallbladder. Performed to Prevent or Treat Inflammation or Obstruction. Cholecystectomy . with/without Cholangiography . Biliary Tract. Gallbladder, cystic duct, common bile duct, and common hepatic duct. November 3, 2018. Aleysia Kroptavich. Overview of presentation. Description of disease. Case report. General information. Medical history. Surgical history. Social history. Nutritional history. Case discussion. Dr. V Gandhi. DNB (GI Surgery), DNB (Gen Surgery), MNAMS. Consultant GI & HPB . Surgeon. Pune surgical Society. What is safe cholecystectomy ?. What is difficult cholecystectomy ?. Predict difficult gall bladder. Stuart Sherman, MDProfessor of Medicine & RadiologyIndiana University Medical CenterIndianapolis, In Figure 1 Figure 2 Dilation Assisted Stone Extraction (DASE) www.bostonscientic.com/endoscopy T Cholecystectomy. is performed most often . laparoscopically. for symptomatic gallstones . (usually causing . cholecystitis. with fever, RUQ pain and . leukocytosis. ), . pancreatitis or . acalculous. for Family medicine residents. Joanna R. Fair, M.D., Ph.D.. Vice Chair of Education. Department of Radiology. Some . images courtesy of . Radiology Department Faculty and Residents. and. Petra Lewis, M.D.. Define post operative ileus. Describe normal bowel function. Discuss modulators of bowel motility. Discuss symptoms, diagnosis, management and prevention of post-op ileus. Normal Digestion. Motility: Requires coordinated contraction behind food bolus and relaxation ahead of food bolus to move in correct direction. . Anatomy. It is a pear-shaped sac…..length about 7.5 to 12.5 cm …..with an average capacity of 30 to 50 ml (the gallbladder can distend markedly and contain up to 300 ml). located on the inferior surface of the liver attached to it by loose .