CBD Stent PPT.pptx

Rare Case

1. Migration of CBD Stent Dr. Ramendranath Talukdar (Professor, Department of General Surgery) Dr. Amandeep Singh (PG 3 rd year, Department of General Surgery)

2. Have you heard people talk about “minimally invasive” surgery?

3. Laparoscopic surgery is one kind. Doctors first used it for Gallbladder Surgery and gynecology operations.

4. CASE HISTORY

5. 62 year male Pain in right hypochondrium since 2 months. Dyspepsia and Vomit on having fatty/oily food. No significant past history.

6. Clinical examination Vitally normal Tenderness over right hypochondrium region.

7. Investigations Bilirubin: 0.8 SGOT: 138 SGPT: 212 ALP: 577 INR: 1.1 TSH: 2.82

8. Ultrasound abdomen Distended gall bladder with multiple focal signal void area suggestive of multiple calculi approx 7mm largest measuring with dilated CBD 11.5mm in diameter.

9. MRCP Dilated CBD of 11.5mm in diameter just proximal to site of insertion into D2 with CBD stone.

10. Patient had undergone ERCP with stenting on 15 June 2022 Followed by laparoscopic cholecystectomy done on 27 July 2022

11. OPERATIVE PROCEDURE

12. On laparoscopic cholecystectomy tube like structure

13. throughout from fundus to cystic duct

14. Cutting of gall bladder at fundus

15. Identification of stent

16. Pulling of stent out of gall bladder

17. Removal of stent

18. Post-operative Gall Bladder Specimen with the Stent

19. This case report is aimed at comparing the migration of CBD stent in gall bladder encountered during LC following ERCP.

20. Migration/Misplacement of CBD Stents About 8.4% Proximal migration: 3.0% Distal migration: 5.4% European Journal Gastro- enterology and Hepatology (July 2021)

21. In conclusion, the optimum time to perform LC is within 3 days after ERCP.

22. Different types of CBD stents

23. The longer the interval between ERCP and LC, the higher are the chances of encountering complications and increased need for conversion as well as prolonged operating time and hospital stay .

24. Though LC following ERCP is the gold standard for choledocholithiasis (seen in 10% patients of Gall Bladder stone) in the current general surgical practice, the operating surgeon should always be aware of our case difficulty encountered.

25. Knowledge of these challenges will enable the surgeon in providing a safer and more favorable outcome in cholecystectomy.

26. Thankyou ……...............