A 14-year-old girl presented with abdominal pain and scleral jaundice. Coronal T2-weighted magnetic resonance image (a) shows a Gharbi type-3 cyst (white arrow) and dilatation of the choledochal duct (black arrow) and gallbladder (asterisk) in the liver’s eighth segment. Anteroposterior cystography (b) shows passage of contrast medium into the dilated right and left intrahepatic bile ducts, choledochal duct (black arrow), and gallbladder (asterisk) due to the cystobiliary fistula. Passage of contrast medium into the small intestine due to obstruction at the distal end of the choledochal duct was not observed (arrowhead). A hepatobiliary fistula caused by hydatid cyst and daughter vesicles caused obstruction distal to the choledochal duct, resulting in obstructive jaundice. A percutaneous catheter was placed for the liver cyst. Sphincterotomy was performed via endoscopic retrograde cholangiopancreatography. The vesicles were then drained using catheter irrigation, and the cyst cavity was cleaned with irrigation.
Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?
