Coledocolitiasis
Masculino 83 años de edad , diabetico tipo I de larga data, insulino-dependiente. Ingresa por descompensacion de sus niveles glucémicos y elevación de bilirrubina a expensas fundamentalmente de la bilirrubina directa, con pruebas hepáticas y creatinina elevadas. El examen sonografico muestra vesícula distendida con presencia de cálculos de pequeño tamaño en su interior. El Coledoco luce marcadamente dilatado sobre todo en su tercio inferior, cerca de la ampolla de Vater donde se aprecian imágenes hiperecogenicas con sombras posteriores compatibles con el diagnostico de coledocolitiasis múltiple.Se concluye con los diagnostico de micro-colelitiasis y Colelitiasis Múltiple con signos de obstrucción de vías biliares. Adicionalmente se aprecia conducto pancreático dilatado visualizándose una gran porción de este. El paciente fue sometido a una Colangiopancreatografía retrógrada endoscopica ( CPRE ) durante la cual se realizo una papilotomia a nivel de la Ampolla de Vater con lo cual los múltiples cálculos "cayeron" al Duodeno y el cuadro mejoro dramáticamente según pudimos comprobar en un examen sonografico posterior donde solamente quedo como tarea pendiente resolver la colelitiasis.
Male 83 years old, type I diabetic long-standing, insulin-dependent. It enters by decompensation of its glycemic levels and bilirubin elevation at the expense mainly of direct bilirubin, with elevated liver and creatinine tests. The sonographic examination shows a distended bladder with the presence of small size stones in its interior. The coledoco looks markedly dilated especially in its lower third, near the ampulla of Vater where hyperechogenic images are seen with posterior shadows compatible with the diagnosis of multiple choledocholithiasis. It concludes with the diagnosis of micro-cholelithiasis and multiple cholelithiases with signs of obstruction of bile ducts. Additionally, a dilated pancreatic duct can be seen, visualizing a large portion of it. The patient underwent a retrograde endoscopic cholangiopancreatography (ERCP) during which a papillotomy was performed at the level of the ampulla of Vater, with which multiple calculations "fell" to the duodenum and the picture dramatically improved as we could see in a subsequent sonographic examination where only the cholelithiasis remains as a pending task.
Choledocholithiasis
Male 83 years old, type I diabetic long-standing, insulin-dependent. It enters by decompensation of its glycemic levels and bilirubin elevation at the expense mainly of direct bilirubin, with elevated liver and creatinine tests. The sonographic examination shows a distended bladder with the presence of small size stones in its interior. The coledoco looks markedly dilated especially in its lower third, near the ampulla of Vater where hyperechogenic images are seen with posterior shadows compatible with the diagnosis of multiple choledocholithiasis. It concludes with the diagnosis of micro-cholelithiasis and multiple cholelithiases with signs of obstruction of bile ducts. Additionally, a dilated pancreatic duct can be seen, visualizing a large portion of it. The patient underwent a retrograde endoscopic cholangiopancreatography (ERCP) during which a papillotomy was performed at the level of the ampulla of Vater, with which multiple calculations "fell" to the duodenum and the picture dramatically improved as we could see in a subsequent sonographic examination where only the cholelithiasis remains as a pending task.
