علاج التهاب المرارة الحصوي الحاد مع التهاب الأقنية الصفراوية الصاعد أو حصوات القناة الصفراوية المشتركة عالية الخطورة

References

DOI: 10.1186/s13017-020-00336-x

• Patients with high risk of CBDS should undergo preoperative diagnostic and therapeutic ERCP.
• Only patients with evidence of CBDS at abdominal US should be considered at high risk of CBDS and should undergo diagnostic and therapeutic ERCP directly; patients with total serum bilirubin > 4 mg/dl or enlarged common bile duct diameter at US with concomitant bilirubin level 1.8 to 4 mg/dl should be considered as moderate risk and should undergo second level investigation such as endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP), laparoscopic ultrasound (LUS) or IOC, in order to avoid the complications related to ERCP.
• We recommend laparoscopic cholecystectomy as the first-line treatment for patients with ACC.
• We recommend removing CBDS, either preoperatively, intraoperatively, or postoperatively, according to the local expertise and the availability of several techniques.