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What Do The Attached Reports Indicate?

Posted on Thu, 2 Nov 2017

Question: Hi, I am Almabrouk,,
My Gallbladder was removed in January 2016, before that an Endoscopy was preformed to remove some stones from my CBD and CHD. I had many stones in my CBD and CHDagain in August 2017, some of them were removed in 19.08.2017 and a stent was inserted in my CBD to allow the bile to pass though, and prescribed to me Ursolvan 200mg medicine (Ursodeoxycholic Acid) for 2 months (two tablets, twice a day) . Doctor will remove the stent in 20.10.2017 (after 2 month of inserted it). The question is why and how many stones are developed again in my CBD and CHD. I asked this question among many other questions to a Gastroenterologist and he referred me to a Radiologist to answer it.
Please explain to me the quantity, size, shape and severity of stones in my CBD and CHD in details. I attached a medical report and some MRI images done in 15.08.2017 before I had an endoscopy.
Regards,
Almabrouk

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer:
Request you to please upload your CD and DVD containing raw MRCP images

Detailed Answer:
Sir,
Thanks for writing in to us.

I have seen the snap shot images and believe it to be from 15-08-2017 and which is before the stenting which was done on 19-08-2017. Please correct me if I am wrong.

Now, coming to the pictures of the stones in the CHD and CBD, I confirm that there are many variable sized stones in the areas. To give you an accurate reply, I need to load your MRI images to my work station.

Therefore can I request you to please upload your CD and DVD containing raw MRCP images contents to a file sharing website like Dropbox or google drive and send me the download link. I will have a detailed look at my workstation.

Regards,

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Vivek Chail (19 hours later)

Hi Dr. Chail,

Thank you for your help.
Yes, MRI images were done 15-08-2017 before the stenting was done on 19-08-2017.
Below is the link to the raw data of the MRI images in the Dropbox.

https://www.dropbox.com/home/Alambrouk_MRI%20Images_15.08.2017

Hope they will be opened in your workstation easily. I inserted the Viewer as well within the files in the same folder.
Please give me details of the case, and in your opinion can all the stones be removed by the endoscopy or it needs surgical option.

Regards,
Almabrouk

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer:
Please send me email invite through Dropbox

Detailed Answer:
Hi Sir,
Thanks for your query.

I tried to click on the link and got an error message.

Please share the link after following directions as suggested by Dropbox.

Please visit the link https://www.dropbox.com/help/files-folders/share-with-others to know in detail about sharing of files in Dropbox.

You can send me an email invite to YYYY@YYYY and I will get a message that you have shared the files on Dropbox.

After sending me the email through Dropbox, please send in another follow up.

Sorry for the inconvenience.

Thanks,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 hours later)

Hi Dr. Chain,
I sent you the link.

Regards
Almabrouk

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer:
There are many large stones in the biliary channels

Detailed Answer:
Hi Sir,
Thanks for writing back.

I have viewed the images and there are quite a lot of stones in the CHD and CBD. The size of the stones measures up to 16 mm and this is slightly large. The choice of extraction of stones depends on the hospital, doctor and the facilities available.

Endoscopic extraction and newer procedures are being put to practice in many hospital and it is successful in many cases. However, a decision is to be taken on risk to benefit after keeping in mind the details like health of the patient, age, risk factors and post procedure complications.

In your case, it is difficult to exactly count the number of stones, but they are likely more than 10 to 20 is my estimate. Cause of the stones is likely due to sedimentation of the bile in the biliary channels.

You might like to read through detailed medical literature on role of endoscopy on extraction of large stones in the CBD in the link below.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

Please feel free to ask any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (31 hours later)

Hi Dr. Chail,
Thank you for your reply. And thank you for the link of the article. It has invaluable information about the endoscopic technology. I went through most it's parts.
Based on the article and on your evaluation of my case, I think the ELECTROHYDRAULIC LITHOTRIPSY- LASER LITHOTRIPSY is the best kind for my case.
Do you agree with me?
Would you kindly please snap shot the beast descriptive MRI images of the large stones size I'm my CBD and CBD, so that I can send them to doctors in Germany and XXXXXXX (have friends there to help in this matter).
Would you kindly please advice me of the beast hospitals and doctors in XXXXXXX Tunisia, Turkey, Germany or elsewhere in Europe? So that I can contact them for a treatment.

Many thanks,
Almabrouk,
Tripoli-Libya

Answered by Dr. Vivek Chail (19 hours later)

Brief Answer:
Electrohydraulic lithotripsy and laser lithotripsy can be done

Detailed Answer:
Hi,
Thanks for writing back with an update.

Electrohydraulic lithotripsy and laser lithotripsy are among the suitable choice treatments in your case as you might have read in the article.

Regarding the images showing the large calculi, you can refer to Image 17/ 25 Series 401 and Image 12/ 25 Series 401, please share it with your friends.

On hospitals providing such treatment, the article is based on research done in Department of Gastroenterology, XXXXXXX Naval Hospital, 70 Deinokratous St, 115 21 XXXXXXX Greece.

Though I am not familiar with hospitals in Germany, Tunisia, XXXXXXX or Turkey, such treatment should be available in hospitals having a dedicated surgical gastroenterology doctors.

A research for Germany leads me to Klinikum Stuttgart hospital, Heidelberg University Hospital, and DRK Kliniken Berlin hospital.

A research for Turkey leads me to Anadolu Medical Center hospital.

I could not locate any hospital on searching for XXXXXXX and Tunisia, however, it does not mean that no hospital does it in XXXXXXX or Tunisia but it is possible that the results are not showing on the search.

Please do write back if any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Vivek Chail (4 hours later)

Hi Dr. Chail,
Thank you for your reply.
I actually confused regarding the selected images.
Are they only 2 images that matters 17 of the series 401 and 12 of the same series.
Would you please clarify the images doctor?
Example like series no. 41 images 12-17 means (12, 13, 14, 15, 16 and 17). Please just clarity the exact images.

Thank you very much for your help.
Regards,
Almabrouk

Answered by Dr. Vivek Chail (18 hours later)

Brief Answer:
Both the images are of the axial series.

Detailed Answer:
Hi Sir,
Thanks for writing back with an update.

I chose the best 2 images to be shared with your friends.

As a radiologist, we find the axial sections more informative.

In Image 17/ 25 Series 401 it is meant image number 17 of series 401.
In Image 12/ 25 Series 401 it is meant image number 12 of series 401.

Both the images are of the axial series.

Regards,

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Vivek Chail (3 hours later)

Dear Dr. Chail,

Thank you very much for your help.
I highly appreciate your help.
Regards,
Almabrouk

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
Wishing you quick recovery and good health.

Detailed Answer:
Hi Sir,
Thanks for your appreciation am glad to help you.

Wishing you quick recovery and good health.

Above answer was peer-reviewed by : Dr. Kampana