A Patient with Multiple Rare Complications of Gallstone Disease
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Purpose: A 70-year-old woman consulted in June 2011 for right upper quadrant pain, jaundice and fever. An ultrasound showed dilated common and intrahepatic bile ducts with a gallstone impacted in the neck of the gallbladder. A diagnosis of Mirizzi syndrome was proposed. A sphincterotomy by ERCP was performed with placement of a 10 Fr. plastic stent. She was discharged awaiting cholecystectomy. A month later, she came back for the same symptoms. The ultrasound showed a 3.5-cm anechoic area with doppler signal in the gallbladder. The CT scan confirmed a right hepatic artery pseudoaneurysm caused by a 2-cm gallstone still impacted. An arteriogram was performed and a covered endovascular stent was used to exclude the aneurysm. An ERCP showed external compression of the common bile duct by the aneurysm so two plastic stents were placed to relieve the obstruction. In regard to the elevated surgical risks related to the recent complications, it was decided to treat the cholecystitis medically. The patient was discharged with antibiotics and scheduled follow-up. By the end of October, she was readmitted with abdominal pain and vomiting. A CT scan recognized the same 2-cm gallstone shown previously, now impacted in the jejunum, proving the diagnosis of biliary ileus. She was rapidly sent to the OR where enterolithotomy with small bowel resection were performed with concurrent cholecystectomy. The patient had a favorable evolution. It was first thought that Mirizzi syndrome caused the jaundice when in fact it was caused by the pseudoaneurysm. These are usually the consequence of a trauma, hepato-biliary procedure or pancreatitis. Hepatic artery pseudoaneurysms are rare and their presentation range from incidental finding to hemobilia and shock. This is the first reported case of external compression of the common bile duct by a hepatic artery pseudoaneurysm. Finally, biliary ileus is a rare mechanical cause of small bowel obstruction caused by impaction of a gallstone escaping the gallbladder by a bilio-duodenal fistula. This case illustrates the combination of two unusual complications of gallstone disease in the same patient.Figure: No Caption available.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it