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Yasser Has Gallstone

Yasser Arafat has a large gallstone, a Palestinian hospital official said Tuesday, as the weakened Palestinian leader broke his Ramadan fast and underwent more medical tests at the urging of his doctors. The gallstone is not life threatening and can be easily treated, the official told The Associated Press. Palestinian officials have insisted Arafat, 75, was recovering from a lengthy bout of the flu. However, a Palestinian doctor who has examined Arafat recently said he has been inexplicably exhausted in recent weeks. Israeli officials speculated he was suffering from stomach cancer. Teams of Egyptian and Tunisian doctors have examined him in recent days. On Monday, he underwent an endoscopy, or exam of the digestive tract. And he has not led Muslim evening prayers at the makeshift mosque in his compound, as he has done in the past during the fasting month of Ramadan. A hospital official said ultrasound and X-ray machines were brought to Arafat's compound two days ago to perform tests on his chest and stomach. The ultrasound uncovered a 1-centimeter-long gallstone that did not register on the X-ray. Doctors recommended Arafat undergo minor surgery to remove the stone, but he has not yet responded, the source said.

One centimeter gallstone? Wowzers, that's a big one.

"Non-surgical" removal involves an "ERCP": endoscopic retrograde cholangiopancreatogram. You drive a special endoscope down the esophagus, through the stomach, into the duodenum, and up to the common bile duct. It's a "side-viewing" scope, and from the side you get a view of the duct. You push out a catheter and inject some radiographic dye into the duct and take a few X-rays. If you can see the stone, you insert a snare catheter -- it's got a retractable wire basket at the end. You try to snare the stone and pull it out of the duct. Alternately you can use a catheter to push the stone out of the duct. Then you inject more dye and take more pics to prove you got everything. Then out you come with the stone. If stone retreival fails, the next alternative is a laparoscopic cholecystectomy.

I tell you all this to tell you the following: the ERCP is something that requires a truly skilled gastroenterologist, a good GI endoscopy lab and equipment, and trained nursing. It's well beyond a simple upper GI endoscopy. No way are they going to try this in Yasser's compound unless they're truly nuts. And laparoscopy requires a surgicenter and skilled personnel.

Expect Yasser to be moved soon.

Posted by: Fred 2004-10-27

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