title: [A grenade splinter as the cause of cholangitis and icterus].
abstract: Forty five years after being injured by a grenade splinter a now 74-year old man suddenly developed colicky pain in the right upper abdomen, accompanied by colourless stools, jaundice and fever. The white cell count was 21,000/microliters, bilirubin was raised to 10.9 mg/dl, and ultrasound examination revealed a sharply circumscribed echo in the distal choledochal duct. Retrograde endoscopic cholangiography revealed a metal-dense concrement, presumably the nidus of gallstone formation. After endoscopic emptying of the bile duct the patient quickly improved so that cholecystectomy could be performed. The long symptom-free interval was most likely due to an at first peripheral position of the splinter in liver tissue. The secretory pressure of the liver cells then probably caused a slow migration into the choledochal duct.
authors.affiliation: Chirurgische Abteilung, Allgemeines Krankenhaus Heidberg, Hamburg.
authors.forename: H
authors.initials: H
authors.lastname: Niebuhr
authors.forename: H
authors.initials: H
authors.lastname: Nowak
authors.forename: E
authors.initials: E
authors.lastname: Tichbi
authors.forename: U
authors.initials: U
authors.lastname: Nahrstedt
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology*; D003085:Colic / Q000175:diagnosis / Q000209:etiology; D005549:Foreign-Body Reaction / Q000175:diagnosis / Q000209:etiology*; D042882:Gallstones / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007565:Jaundice / Q000175:diagnosis / Q000209:etiology*; D008099:Liver / Q000293:injuries*; D008297:Male; D013997:Time Factors; D014857:Warfare; D014947:Wounds and Injuries / Q000150:complications*
vernacular_title: Granatsplitter als Ursache von Cholangitis und Ikterus.