Central venous line (CVL) occlusion is the commonest cause of venous thrombosis in children. Chest X-ray has to exclude CVL tip malposition or kink in the line. Gut microbiotia are key RXDX-106 players in healthy gut function. They produce short chain fatty acids which provide calories, neuro-modulatory substances and antibiotics. D-lactic acidosis is a rare complication of short bowel syndrome or other malabsorption syndromes. Carbohydrate malabsorption allows partially digested sugars to enter the colon and be metabolised by colonic bacterial flora. Hyperoxaluria can be checked by ensuring

adequate sodium and water intake, and including calcium supplements with meals. “
“A male, aged 35, was investigated because of the development of jaundice and pruritis, 15 days after he sustained

blunt abdominal trauma in a road traffic accident. Blood tests revealed an elevated bilirubin (17 mg/dl or 190 mol/l) and an alkaline phosphatase at twice the upper limit of the reference range. An upper abdominal ultrasound study, computed tomography scan and magnetic resonance imaging scan showed a fluid collection, largely in the right lobe of the liver. Magnetic resonance cholangiopancreatography strongly supported an intrahepatic biloma with dilatation of peripheral intrahepatic bile ducts (Figure 1). He was treated by percutaneous drainage of the biloma. However, after 19 days, there were only minor changes in

the size of the cavity. Because of this, endoscopic retrograde cholangiography was performed. This showed passage Rho of contrast into the cavity www.selleckchem.com/products/PF-2341066.html from the right hepatic duct or one of its branches (Figure 2). Endoscopic sphincterotomy was performed and a stent was placed in the right hepatic duct but not in the biloma. Subsequently, jaundice resolved and there was a progressive decrease in the volume of bile that drained percutaneously. After 11 weeks, a repeat ultrasound study showed resolution of the collection and the percutaneous drain was removed. The biloma has not recurred. Bilomas are localized collections of bile that occur after injury to intrahepatic or extrahepatic bile ducts. Initially, bile leaks are usually associated with hematomas but, over time, blood clots can be largely replaced by bile. The typical presentation is with upper abdominal pain rather than obstructive jaundice. With imaging, most bilomas are single, well-defined collections within the liver but a minority are more complex with septa and internal debris. Common causes are abdominal trauma as above and surgical or radiological hepatobiliary interventions including biliary drainage, radiofrequency ablation, ethanol ablation and chemoembolization. In relation to management, small bilomas that are asymptomatic (and discovered incidentally), usually resolve spontaneously within a few weeks.