A Patient with Multiple Rare Complications of Gallstone Disease
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".