“Pneumobilia should be differentiated from portal venous gas. Portal venous gas is peripherally distributed to within 2 cm of the liver margin, whereas pneumobilia is centrally distributed.” (Gupta, P, et al. “PLAIN FILMS: BASICS.” Acute Care Surgery: Imaging Essentials for Rapid Diagnosis Eds. Kathryn L. Butler, et al. McGraw Hill, 2015.)Continue reading
Maxwell DW, Jajja MR, Ferez-Pinzon A, Pouch SM, Cardona K, Kooby DA, Maithel SK, Russell MC, Sarmiento JM. Bile cultures are poor predictors of antibiotic resistance in postoperative infections following pancreaticoduodenectomy.HPB (Oxford). 2019 Oct 26:S1365-182X(19)30756-7.
Results: Common patient characteristics of 522 included patients were 65-years-old, Caucasian (75.5%), male (54.2%), malignant indication (79.3%), and preoperative biliary stent (59.0%). Overall, 275 (89.6%) BCs matured identifiable isolates with 152 (55.2%) demonstrating polymicrobial growth. Ninety-two (17.6%) SOICs were obtained: 48 and 44 occurred in patients with and without intraoperative BCs. Stents were associated with bacteriobilia (85.7%, K = 0.947, p < 0.001; OR 22.727, p < 0.001), but not postoperative infections (15.2%; K = 0.302, p < 0.001; OR 1.428, p = 0.122). Forty-eight patients demonstrated paired BC/SOICs to evaluate. Pathogenic concordance of this group was 31.1% (K = 0.605, p < 0.001) while SRP concordance of matched pathogens was 46.7% (K = 0.167, p = 0.008).
Conclusion: Bile cultures demonstrate poor concordance with the susceptibility/resistance patterns of postoperative infections following pancreaticoduodenectomy and may lead to inappropriate antibiotic therapies.