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Sample records for cholangiography

  1. Biliary ascariasis: MR cholangiography findings in two cases

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    Hwang, Cheol Mok; Kim, Tae Kyoung; Ha, Hyun Kwon; Kim, Pyo Nyun; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2001-09-01

    We describe the imaging features of two cases of biliary ascariasis. Ultrasonography and CT showed no specific abnormal findings, but MR cholangiography clearly demonstrated an intraductal linear filling defect that led to the correct diagnosis. MR cholangiography is thus a useful technique for the diagnosis of biliary ascariasis.

  2. Helical CT cholangiography and MR cholangiography in postoperative patients with congenital choledochal cyst

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    Koshinaga, Tugumichi; Ikeda, Taro; Hagiwara, Noritsugu; Nonaka, Michiaki; Fukuzawa, Masahiro [Nihon Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    Cholangitis and intrahepatic cholelithiasis have been reported as hepatic complications long after total cyst excision in patients with congenital choledochal cyst. The aim of this study was to identify the hepatic ductal features and compare the findings obtained by Helical CT cholangiography (HCTC) with those by MR-cholangiography (MRC). Hepatic ductal configurations of 12 patients who had undergone total excision of the extrahepatic bile duct were examined by HCTC and MRC. HCTC and MRC are useful for identifying hepatic ductal dilatation, although HCTC is better described for the anastomotic site of hepaticojejunostomy and hepatic ductal stenosis, in the postoperative follow-up of patients. Early detection of hepatic ductal configurations is of great importance in the long-term follow-up. (author)

  3. Results of percutaneous transhepatic cholangiography drainages (PTCD)

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    Schoenemann, J.; Willems, M.; Wolf, G.; Fromme, M.

    1987-12-01

    From September 1980 to December 1986, 72 percutaneous transhepatic cholangiography drainages (PTCD) were performed in 64 patients (58 palliative in malignant obstructions, 14 temporary). The median duration of drainage was 26.8 days (2-183 days). The median survival time in 37 patients with palliative tumour drainage was 55.3 days (7-473 days). 9/37 patients survived longer than 3 months (max. 15.5 months). Complications occurred in 29.5% (10.3% severe). 3/64 patients (4.7%) died. Patients with palliative transpapillary drainages (23), especially with endoprostheses (14), survived longer, and the complication rate was lower. Therefore, we prefer the endoscopic transpapillary approach. PTCD patients must be selected carefully.

  4. Percutaneous transhepatic cholangiography using special needle

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    Auh, Yong Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    Using the special needle (22 Gauze, 17 cm long, flexible needle) percutaneous transhepatic cholangiography were performed in 23 cases at Seoul National University Hospital during the period from July 1973 to August 1974. The results were as follows:1. Successful cholangiograms are obtained in 20 cases among the total of 23 cases. The 3 cases of the unsuccessful are two cases of sclerosing cholangitis and one case of hepatoma. 2. Average attempts of puncture in successful care are 3. It was not necessary to puncture more than 6 times to visualize biliary tree in dilated biliary tree. 3. Lateral approach (midaxillary line and 8th or 9th intercostal space) was used. The advantage of this method was briefly discussed. 4. Over all complication are occurred in 6 cases. 3 cases: transient fever 1 case: bile leakage without peritonitis 1 case: local peritonitis probably due to bile leakage 1 case: septicemia (the organism can not be detected even after blood culture)

  5. CT cholangiography: Assessment of feasibility and diagnostic reliability

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    Morosi, Carlo [Department of Radiology, National Cancer Institute, via Venezian 1, Milan 20100 (Italy)], E-mail: carlo.morosi@istitutotumori.mi.it; Civelli, Enrico [Department of Radiology, National Cancer Institute, via Venezian 1, Milan 20100 (Italy); Battiston, Carlo; Schiavo, Marcello; Mazzaferro, Vincenzo [Department of Liver Surgery, National Cancer Institute, via Venezian 1, Milan 20100 (Italy); Severini, Aldo; Marchiano, Alfonso [Department of Radiology, National Cancer Institute, via Venezian 1, Milan 20100 (Italy)

    2009-10-15

    Objective: To assess the reliability of computed tomography (CT) cholangiography in evaluating the anatomy of the intrahepatic biliary ducts. Materials and methods: Twenty-eight patients underwent CT cholangiography at the National Cancer Institute of Milan, Italy. Twenty-one patients were candidates for liver surgery and seven had suspected postoperative biliary complications. The patients had not dilatation of the intrahepatic biliary ducts at US examination and bilirubin levels were not higher than 2 mg/dl. To define the reability of the CT cholangiography, a scoring system (from 0 to 3) was used for each order of biliary branches. Results: In all cases, it was technically possible to carry out the CT cholangiography according to the protocol. There were no adverse reactions to the contrast agent. Two radiologists gave the maximum score of 3 for visualisation of the first- and second-order biliary branches in all cases. For visualisation of third- and fourth-order biliary branches the maximum score of 3 was given in 18 patients, a score of 2 in 8 patients and a score of 1 in 2 patients. Three anatomical variants of biliary ducts were detected. CT cholangiography was diagnostic in all seven cases of suspected postoperative biliary complications. Conclusion: Our work confirms the high spatial resolution and reability of CT cholangiography in evaluating the intrahepatic biliary anatomy of patients who are candidates for liver surgery, with non-dilated biliary ducts and with bilirubin levels no higher than 2 mg/dl.

  6. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography.

    Science.gov (United States)

    Vogl, Thomas J; Schwarz, Wolfram O; Heller, Matthias; Herzog, Christopher; Zangos, Stephan; Hintze, Rainer E; Neuhaus, Peter; Hammerstingl, Renate M

    2006-10-01

    The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours.

  7. Staging of Klatskin tumours (hilar cholangiocarcinomas): comparison of MR cholangiography, MR imaging, and endoscopic retrograde cholangiography

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    Vogl, Thomas J.; Schwarz, Wolfram O.; Heller, Matthias; Herzog, Christopher; Zangos, Stephan; Hammerstingl, Renate M. [Johann Wolfgang Goethe University of Frankfurt am Main, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Hintze, Rainer E. [Humboldt University of Berlin, Department of Gastroenterology, Berlin (Germany); Neuhaus, Peter [Humboldt University of Berlin, Department of Surgery, Berlin (Germany)

    2006-10-15

    The aim of the study was to compare prospectively magnetic resonance cholangiography (MRC) and magnetic resonance imaging (MRI) with endoscopic retrograde cholangiography (ERC) in the diagnosis and staging of Klatskin tumours of the biliary tree (hilar cholangiocarcinomas). Forty-six patients with suspected Klatskin tumours of the biliary tract underwent MRI and heavily T2-weighted, non-breathhold, respiratory-triggered fast spin-echo MRC. Forty-two patients underwent ERC within 24 h; in four patients, ERC was not feasible, and percutaneous trans-hepatic cholangiography (PTC) was carried out instead. Two independent investigators evaluated imaging results for the presence of tumour, bile duct dilatation, and stenosis. Clinical and histopathological correlation revealed Klatskin tumours in 33 patients. MRI revealed a slightly hyperintense signal of infiltrated bile ducts in T2-weighted fast spin-echo sequences. The malignant lesion was regularly visualized as a hypointense area in T1-weighted gradient-echo sequences with substantial contrast enhancement along the involved bile duct walls. MRC revealed the location and extension of the tumour in 31 of 33 cases correctly (sensitivity 94%, specificity 100%, diagnostic accuracy 95%). In 27 of 31 cases, ERC enabled accurate staging and diagnosis of Klatskin tumours with a sensitivity of 87%. ERC and PTC combined yielded a sensitivity of 84% and a specificity of 97%. Tumours were grouped according to the Bismuth classification, with MRC allowing correct identification of type I tumour in seven patients, type II tumour in four patients, type III tumour in 12 patients, and type IV tumour in ten patients. MRC provided superior visualization of completely obstructed peripheral systems. MRC in combination with MRI is a reliable non-invasive diagnostic method for the pre-therapeutic staging of Klatskin tumours. (orig.)

  8. Percutaneous transhepatic cholangiography using fine needle

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    Chung, Kyoo Byung; Kim, Yun Hwan; Lee, Nam Joon; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of)

    1980-12-15

    In recent years, percutaneous transhepatic cholangiography (PTC) using fine needle has become widely employed as the procedure of choice for direct opacification of the biliary trees because of its high success rate, easy performance and relative low complication rate. Authors present the clinical and PTC findings of experienced cases during last four years, from May 1976 to June 1980, at the Department of Radiology, Korea University Hospital. We tried to study of PTC in 44 cases, 32 males and 12 females, and succeeded in visualization of bile ducts in 41 cases, but the other three cases were failed to visualize the bile ducts. Final confirmative diagnosis was achieved in 29 cases by operation, laparoscopy and other clinical methods. The PTC diagnosis was correct in 24 of 29 cases, and the others were incorrect. The 29 final diagnosis was including 13 cases of biliary stones, 6 cases of biliary cancer, 3 cases of pancreatic cancer, 3 cases of clonorchiasis, one case of CBD ascariasis and 3 cases of others. Incorrect PTC diagnosis was made in five cases. They were one case of nonvisualized intrahepatic stones, one case of hepatoma PTC diagnosed as cholangiocarcinoma, one case of pancreatic cancer diagnosed as cholangiocarcinoma, one case of clonorchiasis diagnosed as biliary stones and one case of normal CBD which was diagnosed as distal CBD cancer. And we experienced one case of bile peritonitis as complication, who was 35 year-old female patient with multiple CBD stones, and aspirated about 500ml of bile stained ascites during operation.

  9. Biliary complications following orthotopic liver transplantation: May contrast-enhanced MR Cholangiography provide additional information?

    Directory of Open Access Journals (Sweden)

    Piero Boraschi

    2016-01-01

    Conclusions: Contrast-enhanced T1-weighted MR Cholangiography may improve the level of diagnostic confidence provided by conventional T2-weighted MR Cholangiography in the evaluation of biliary complications after orthotopic liver transplantation.

  10. Efficacy of cholangiography under helical computed tomography for laparoscopic cholecystectomy

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    Takeuchi, Motoya; Hishiyama, Houhei [Asahikawa Red Cross Hospital, Hokkaido (Japan); Kondo, Satoshi; Katoh, Hiroyuki [Hokkaido Univ., Sapporo (Japan). Graduate School of Medicine

    2002-05-01

    Although laparoscopic cholecystectomy (LC) is known to be safe, the optimal imaging technique for examining the common bile duct and cystic duct prior to laparoscopic intervention remains controversial. The objective of this study was to evaluate the efficacy of cholangiography under helical computed tomography (helical CT cholangiography) for LC. We studied 53 consecutive patients who underwent LC carried out by the same surgeon. The data of 23 of these patients who had undergone LC before the introduction of helical CT were used as the reference standard. Among the 53 patients, 28 were prospectively randomized for preoperative biliary tract evaluation with versus without helical CT cholangiography, into a CT/+ group (n=13) and a CT/- group (n=15), respectively. Two patients were excluded from the study preoperatively. There were no significant differences in age or laboratory findings, including liver function tests or the serum amylase level before or after surgery, between the two groups. In the CT/- group, endoscopic retrograde cholangiography-related pancreatitis developed in one patient, and one patient required conversion to open surgery. In contrast, in the CT/+ group, there were no preoperative complications and no patient required conversion to open surgery. The mean operative time was significantly shorter in the CT/+ group than in the CT/- group (P=0.0137). These findings provide evidence to support the advantages of helical CT cholangiography in relation to operative time, conversion, and procedure-related preoperative complications. (author)

  11. Fluorescence versus X-ray cholangiography during laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Lehrskov, Lars Lang; Larsen, Søren S; Kristensen, Billy B;

    2016-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity......-ray cholangiography. This may lead to the introduction of online imaging of the extrahepatic tract during dissection of the gallbladder during cholecystectomy. FUNDING: none. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov (No. NCT02344654), with the National Committee on Health Research Ethics...

  12. Magnetic resonance cholangiography compared with endoscopic retrograde cholangiography in the diagnosis of primary sclerosing cholangitis

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    Hossein Ahrar

    2014-01-01

    Full Text Available Background: Magnetic resonance cholangiography (MRC has gained popularity for diagnosing primary sclerosing cholangitis (PSC. We determined the accuracy of MRC compared with endoscopic retrograde cholangiography (ERC for diagnosing PSC. Materials and Methods: This retrospective case-control study was conducted on patients referred to an outpatient gastroenterology clinic from 2001 to 2013. Patients with established diagnosis of PSC who had undergone MRC and ERC within a 6-month interval were included. Controls were selected from patients who had undergone imaging for reasons other than PSC evaluation. Disease outcome at the study time and liver biochemistry data at diagnosis and 1-year thereafter were retrieved. Diagnostic accuracy of MRC in comparison with ERC was evaluated. Results: A total of 46 definite PSC patients (age at diagnosis = 36.8 ± 11.6 years, 33 male were found. Diagnostic imaging for PSC was ERC alone in 12, MRC alone in 23, and ERC plus MRC in 11 patients. Controls were 89 patients mostly with bile stones. The sensitivity, specificity, and positive and negative likelihood ratios of MRC was 90.9%, 95.5%, 20.23, and 0.10, respectively. Early PSC was found more frequently by MRC compared with ERC (30.4% vs. 8.3%, P = 0.146. No significant difference was found between imaging modalities with regards to patients′ outcome (P = 0.786 or liver biochemistry at diagnosis or 1-year thereafter (P >0.05. Conclusion: Starting diagnostic imaging for PSC with MRC seems better and may provide diagnosis of PSC at its earlier phase. Further studies with larger sample of patients and longer follow-ups are warranted.

  13. Non-radiographic intraoperative fluorescent cholangiography is feasible

    DEFF Research Database (Denmark)

    Larsen, Søren Schytt; Schulze, Svend; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Intraoperative fluorescent cholangiography (IFC) with concomitant fluorescent angiography was recently developed for non-invasive identification of the anatomy during laparoscopic cholecystectomy. The objective of this study was to assess the time required for routine-use of IFC and...

  14. Bile peritonitis after inadvertant puncture of the gallbladder as a rare complication of percutaneous transhepatic cholangiography

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    Farkas, I.; Marik, J.

    1983-01-01

    A report is given about a rare complication after percutaneous transhepatic cholangiography: after inadvertant puncture of the gallbladder, bile peritonitis developed. Surgery was done immediately and the gallbladder, which was filled with stones, as well as stones from the choledochus were removed. The literature dealing with complications of percutaneous cholangiography is reviewed.

  15. Diagnosis of primary sclerosing cholangitis: prospective comparison of MR cholangiography with endoscopic retrograde cholangiography; Diagnostik der primaer sklerosierenden Cholangitis: prospektiver Vergleich von MR-Cholangiographie mit endoskopisch retrograder Cholangiographie

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    Oberholzer, K.; Mildenberger, P.; Grebe, P.; Bantelmann, M.; Thelen, M. [Mainz Univ. (Germany). Klinik fuer Radiologie; Lohse, A.W. [Mainz Univ. (Germany). Inst. fuer Innere Medizin; Schadeck, T.

    1998-12-01

    Purpose: To assess the accuracy of MR cholangiography (MRC) in the diagnosis of primary sclerosing cholangitis (PSC) in comparison to endoscopic retrograde cholangiography (ERC). Method: 20 patients with PSC were examined by ERC and MRC (1.0 T. HASTE sequence). Visualization and pathologic changes of the extra- and intrahepatic bile ducts were evaluated with both methods. Results: Mural irregularities of the common bile duct were seen with MRC in 6/7 cases, stenoses and dilatation of the common bile duct were detected correctly in all patients. Diffuse, multifocal strictures of the intrahepatic bile duct were the most common intrahepatic findings and correctly diagnosed in all patients. Mural irregularities of the intrahepatic ducts in early stages may be missed by MRC because of the limited spatial resolution. MRC is superior to ERC in visualization of nonopacified intrahepatic ducts. Conclusions: MRC is a reliable, non-invasive method to detect typical diagnostic features of PSC. It should be considered as an adjunct to ERC in patients with suspected PSC for primary diagnosis and as an alternate method for follow-up studies. (orig.) [Deutsch] Ziel: Ueberpruefung der MR-Cholangiographie (MRC) als alternative Methode zur endoskopisch retrograden Cholangiographie (ERC) bei der Diagnostik der primaer sklerosierenden Cholangitis (PSC). Patienten und Methoden: 20 Patienten mit PSC wurden mit der ERC und MRC (1.0 T, HASTE-Sequenz) untersucht. Die Untersuchungen wurden hinsichtlich Darstellbarkeit und pathologischer Veraenderungen des extra- und intrahepatischen Gallengangsystems ausgewertet. Ergebnisse: Wandunregelmaessigkeiten des D. choledochus und hepaticus wurden mit der MRC in 6/7 Faellen richtig beurteilt, Stenosen oder Dilatationen sind bei allen Patienten richtig erkannt worden. Diffuse, multifokale Strikturen und Dilatationen intrahepatischer Gallengaenge konnten mit der MRC ueberlegen praesentiert werden, waehrend mit der ERC aufgrund unzureichender

  16. MR and CT cholangiography in evaluation of the biliary tract

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    Masui, T.; Fujiwara, T.; Ichijo, K.; Imaoka, I.; Naito, M. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Radiology; Takehara, Y.; Kaneko, M. [Hamamatsu Univ. School of Medicine (Japan). Dept. of Radiology; Yamamoto, H.; Watahiki, H. [Seirei Mikatabara General Hospital, Hamamatsu (Japan). Dept. of Gastroenterology

    1998-09-01

    Objective: To compare MR and CT cholangiography (MRC and CTC) in evaluating the anatomy of the extrahepatic biliary tract and the pathology related to the gallbladder. Material and Methods: Twenty-three patients underwent MRC and CTC with a biliary contrast medium for investigation of biliary disease. 3D displays of both were also obtained. Endoscopic retrograde cholangiography was performed in 17 patients, and the pathology of all 23 was evaluated. Results: Overall, the image quality was higher with CTC than with MRC (4.7 vs 3.9, p<0.05). The cystic duct was demonstrated better by CTC than MRC (p<0.05). Multiplanar reformation (MPR) and source images provided additional information to that obtained from 3D MRC and CTC images. Gallstones were revealed in 6 patients by CTC and in 5 of these 6 by MRC. In 2 patients with cholecystitis, CTC demonstrated gallbladder wall thickening but MRC did not. In 3 patients with adenomyomatosis, MRC demonstrated Rokitansky-Aschoff sinuses (RAS) while CTC demonstrated focal gallbladder wall thickening in all 3 and RAS in 1 of them. Conclusion: Both MRC and CTC provided anatomical and pathological information about the biliary system. With both techniques, however, either MPR or source images proved necessary in addition for evaluating the biliary system anatomy and pathology. The gallbladder wall was depicted clearly in source CTC, but MRC is recommended for the evaluation of adenomyomatosis because its depicts RAS clearly. (orig.)

  17. Complementary role of helical CT cholangiography to MR cholangiography in the evaluation of biliary function and kinetics

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    Eracleous, Eleni; Genagritis, Marios; Kontou, Allayioti Maria [Diagnostic Center of Ayios Therissos, Department of Radiology, Nicosia (Cyprus); Papanikolaou, Nicos; Prassopoullos, P.; Chrysikopoulos, Haris; Gourtsoyiannis, Nicholas [University of Crete, Department of Radiology, Heraklion (Greece); Allan, Paul [Royal Infirmary of Edinburgh, Department of Radiology, Edinburgh (United Kingdom)

    2005-10-01

    To explore the potential role of computed tomographic cholangiography (CTC) in relation to magnetic resonance cholangiography (MRC) in cases in which knowledge of biliary kinetics and functional information are important for therapeutic decisions, 31 patients (14 men and 17 women) underwent MRC followed by CTC. We examined nine post-cholecystectomy cases with right upper quadrant abdominal pain, six cases with a previous biliary-enteric anastomosis and clinical evidence of cholangitis, eight biliary strictures with pain or symptoms of cholangitis, four cases with strong clinical evidence of sclerosing cholangitis, three cases with suspected post-laparoscopic cholecystectomy bile leakage, and one case with chronic pancreatitis and a common bile duct stent associated with cholangitis. In relation to MRC, CTC provided additional biliary functional information as follows: abnormal biliary drainage through the ampulla in 7/9 cholecystectomy cases, impaired drainage in 3/6 biliary-enteric anastomoses, and complete obstruction in 2/8 biliary strictures. CTC diagnosed early sclerosing cholangitis in 4/4 cases and confirmed suspected bile leakage in 1/3 post-laparoscopic cholecystectomy patients, and the patency of the biliary stent in the patient with chronic pancreatitis. Thus, CTC provides clinically important information about the function and kinetics of bile and complements findings obtained by MRC. (orig.)

  18. Sclerosing cholangitis with autoimmune pancreatitis versus primary sclerosing cholangitis: comparison on endoscopic retrograde cholangiography, MR cholangiography, CT, and MRI

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    Kim; Jin Hee; Byun, Jae Ho; Kim, So Yeon; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon-Gyu [Dept. of Radiology and Research Inst. of Radiology, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)], e-mail: jhbyun@amc.seoul.kr; Kim, Myung-Hwan [Dept. of Internal Medicine, Univ. of Ulsan Coll. of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2013-07-15

    Background: It is essential to differentiate sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) from primary sclerosing cholangitis (PSC) as the treatment and prognosis of the two diseases are totally different. Purpose: To compare image findings of SC-AIP and PSC on endoscopic retrograde cholangiography (ERC), magnetic resonance cholangiography (MRC), computed tomography (CT), and magnetic resonance imaging (MRI). Material and Methods: Two radiologists retrospectively reviewed ERC, MRC, CT, and MRI in 28 SC-AIP and 23 PSC patients in consensus. Factors evaluated included the length, location, and multiplicity of bile duct stricture, the presence of characteristic cholangiographic features of PSC on ERC and MRC, and the presence, location, thickness, and pattern of bile duct wall thickening on CT and MRI. Results: On ERC, focal stricture, multifocal and intrahepatic bile duct stricture, and beaded, pruned-tree, and diverticulum-like appearance were more frequent in PSC than in SC-AIP patients (P = 0.006). On MRC, multifocal and intrahepatic bile duct stricture and pruned-tree appearance were more frequent in PSC than in SC-AIP patients (P = 0.044). On CT and MRI, the bile duct wall was thicker (5.1 mm vs. 3.1 mm; P = 0.033 and 4.3 mm vs. 3.0 mm; P = 0.01, respectively) in SC-AIP than in PSC patients. PSC was more frequently associated with intrahepatic bile duct wall thickening on both CT (93% vs. 50%; P = 0.024) and MRI (100% vs. 50%; P = 0.023) than SC-AIP. Conclusion: The combination of ERC or MRC with cross-sectional images, including CT and MRI, may be helpful in differentiating between SC-AIP and PSC.

  19. Magnetic resonance cholangiography: applications in patients with calculus disease of the biliary tract.

    Science.gov (United States)

    Liu, Terrence H; Organ, Claude H

    2004-04-01

    Magnetic resonance cholangiography (MRC) is a non-invasive imaging modality that has become widely available. In the short time since its introduction, MRC has been shown to possess excellent accuracy for the diagnosis of various biliary pathologies, including choledocholithiasis. Investigations of the clinical applications of MRC are ongoing. This review summarizes the diagnostic capabilities of MRC and discusses its application in the management of patients with gallstone diseases.

  20. Comparative imaging of HIV-associated diseases of the hepatobiliary system in CT and cholangiography; Vergleichende Darstellung HIV-assoziierter Erkrankungen des hepatobiliaeren Systems in Computertomographie und Cholangiographie

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    Knollmann, F.D. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Adler, A. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Maeurer, J. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Gruenewald, T. [2. Innere Abteilung, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Hintze, R.E. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Veltzke, W. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany)

    1995-07-01

    With the incidence of AIDS being on the rise, diagnostic work-up of hepatobiliary disease in these patients is of increasing interest. 57 X-ray cholangiograms and computed tomographic studies of 13 AIDS-patients with clinical signs of cholangitis were reviewed. Nine patients had abnormal cholangiographic findings. Computed tomography of 8 patients revealed hepatobiliary disease in six cases. Of three patients with cholangiograms reflecting bile duct dilatation of neoplastic aetiology, CT was required in two for definite diagnosis. Cholangiography is the method of choice for diagnosing AIDS-associated cholangitis, whereas computed tomography compres favourably in depicting neoplastic disease of the hepatobiliary system. Follow-up of AIDS-associated cholangitis usually delineates unchanged radiologic findings. (orig.) [Deutsch] Die Beteiligung des hepatobiliaeren Systems bei AIDS wurde in 57 roentgencholangiographischen und computertomographischen Untersuchungen an 13 Patienten retrospektiv analysiert. Bei 9 Patienten wurden im Cholangiogramm pathologische Gallengangveraenderungen gefunden. 6 von 8 durch CT untersuchte Patienten hatten Zeichen einer hepatobiliaeren Erkrankung. Bei 3 Patienten mit gallenstaubdingenden Tumoren war die definitive Diagnose in 2 Faellen erst durch CT zu stellen. Waehrend die Cholangiographie zur Sicherung einer AIDS-assoziierten Cholangitis das Verfahren der Wahl darstellt, ist zur Tumordiagnositk die Computertomographie ueberlegen. Cholangitische Gallengangsveraenderungen bleiben im Verlauf haeufig konstant. (orig.)

  1. Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography

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    Kim, Jin Hee; Byun, Jae Ho; Lee, So Jung; Park, Seong Ho; Kim, Hyoung Jung; Lee, Seung Soo; Lee, Moon-Gyu [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Myung-Hwan [University of Ulsan College of Medicine, Asan Medical Center, Department of Internal Medicine, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of); Kim, Jihun [University of Ulsan College of Medicine, Asan Medical Center, Department of Diagnostic Pathology, Asanbyeongwon-gil 86, Songpa-Gu, Seoul (Korea, Republic of)

    2012-11-15

    To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases. Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared. At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P {<=} 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P {<=} 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC. Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases. (orig.)

  2. Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

    Science.gov (United States)

    Kochhar, R.; Bhasin, D.; Nagi, B.; Wig, J. D.; Singh, G.; Sriram, P. V. J.; Singh, K.

    1997-01-01

    In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days) following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%), while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%). Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%. Endoscopic nasobiliary drainage using a 7 Fr pig-tail catheter was attempted in 14 patients and could be established in 12 of them. Bile duct leak sealed in all but one of these 12 patients after an interval of 3 days to 40 days (mean ± SEM, 12.2 ± 3.2 days). A single patient with large defect and a proximal bile duct stricture did not respond and required surgery. Common bile duct stones were removed by endoscopic sphincterotomy in 3 out of 4 patients. One patient with large stone required surgical choledocholithotomy. In conclusion, endoscopic retrograde cholangiography was safe and useful in confirming the presence of leak as well as its site, size and associated abnormalities. Endoscopic nasobiliary drainage proved an effective therapy in post-operative biliary leak and could avoid re-exploration in 71.4% patients. PMID:18493440

  3. MR cholangiography in the diagnosis of sclerosing cholangitis in Langerhans' cell histiocytosis

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, C.W.; Pfannenberg, C.; Truebenbach, J.; Remy, C.; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Boehmer, G.M. [Dept. of Gastroenterology, Univ. of Tuebingen (Germany); Ruck, P. [Inst. of Pathology, Univ. of Tuebingen (Germany)

    2001-12-01

    Langerhans' cell histiocytosis (LCH) is a disorder of histiocytic proliferation that primarily affects infants. Imaging findings of a rare case of lung and liver involvement in an adult are presented. High-resolution computed tomography (HRCT) of the lungs showed confluent thin-walled cystic air spaces compatible with advanced LCH. Liver CT and MRI revealed unspecific signs of fatty infiltration. Irregular widening of peripheral bile ducts was displayed in breath-hold MR cholangiography. This pattern is considered characteristic for sclerosing cholangitis and should support the diagnosis of LCH in case of concomitant cystic pulmonary disease, even in adult patients. (orig.)

  4. Detection of bile duct leaks using MR cholangiography with mangfodipir trisodium (Teslascan).

    Science.gov (United States)

    Vitellas, K M; El-Dieb, A; Vaswani, K; Bennett, W F; Fromkes, J; Steinberg, S; Bova, J G

    2001-01-01

    Mangafodipir trisodium (Teslascan), a hepatobiliary contrast agent, has the potential of providing functional biliary imaging similar to hepatobiliary scintigraphy. To our knowledge. the potential role of this biliary contrast agent in the detection of bile duct leaks has not been reported. In this case report, we report the first case of a bile duct leak diagnosed with enhanced MRI with mangafodipir trisodium in a patient following laparoscopic cholecystectomy. Our case illustrates that functional MR cholangiography images can be successfully acquired by using a post-mangafodipir fat-suppressed GRE technique and that bile duct leaks can be detected.

  5. [Value of injection hepato-lymphography during percutaneous transhepatic cholangiography in patients with cholestasis].

    Science.gov (United States)

    Sharipov, V Sh

    2000-01-01

    Injection hepatography (IH) was made in 278 patients with cholestasis to study the drainage function of the liver. In 208 cases. IH was performed as a test during percutaneous transhepatic cholangiography (PTHC). The hepatic lymph pathways were imaged in 167 (60%) patients. Images of the biliary tract were obtained in 245 (88.1%) patients with cholestasis, it being not dilated in 34 (12.2%) patients. The fact that hepatolymphography may be performed during PTHC as an independent test permits verification of hepatic lymph circulatory disorders that are an index of the rate of inflammation in the organ.

  6. Percutaneous transhepatic cholangiography in the investigation of the persistent postoperative bile leak.

    Science.gov (United States)

    Kissin, C M; Grundy, A

    1987-01-01

    Percutaneous transhepatic cholangiography (PTHC) is now a widely available, inexpensive investigation with a low incidence of complications, especially in the nonobstructed system, and a high success rate. Its role in the management of obstructive jaundice is well established but it is only infrequently performed in the investigation of persistent bile leakage following biliary tract surgery. Four cases are reported in which the superior demonstration of biliary anatomy provided by PTHC allowed successful identification of the site of postoperative biliary leakage. We compared PTHC with other diagnostic imaging techniques available and conclude that it is a safe, accurate, and reliable technique.

  7. Computed tomographic cholangiography in the diagnosis of choledocholithiasis; Colangio-TC en el diagnostico de coledocolitiasis

    Energy Technology Data Exchange (ETDEWEB)

    Lopez-Negrete, L.; Sanchez, J. L.; Garcia-Lozano, J.; Tejeiro, A.; Salas, J. [Hospital Valle del Nalon. Riano-Langreo. Asturias (Spain)

    2001-07-01

    Over a one-year period we performed 32 conventional computed tomography (CT) studies involving the intravenous administration of a contrast material that is cleared by the biliary system (Bilisergol), in patients in presenting clinical or radiological features of choledocholithiasis. The results were compared with the findings from endoscopic retrograde cholangiopancreatography (ERCP) and/or surgery. The sensitivity and specificity of intravenous cholangiography with conventional CT was 92 %. We demonstrate the utility of this widely available study, when performed according to protocol during apnea, with acquisition of thin sections. It is a highly sensitive and specific tool in the diagnosis of choledocholithiasis. (Author) 10 refs.

  8. Biliary Interventions: Tools and Techniques of the Trade, Access, Cholangiography, Biopsy, Cholangioscopy, Cholangioplasty, Stenting, Stone Extraction, and Brachytherapy.

    Science.gov (United States)

    Ahmed, Osman; Mathevosian, Sipan; Arslan, Bulent

    2016-12-01

    Therapeutic access to the biliary system is generally limited to endoscopic or percutaneous approaches. A variety of percutaneous transhepatic biliary interventions are applicable for the diagnosis and treatment of biliary system pathologies, the majority of which may be performed in conjunction with one another. The backbone of nearly all of these interventions is percutaneous transhepatic cholangiography for opacification of the biliary tree, after which any number of therapeutic or diagnostic modalities may be pursued. We describe an overview of the instrumentation and technical approaches for several fundamental interventional procedures, including percutaneous transhepatic cholangiography and internal/external biliary drainage, endobiliary biopsy techniques, cholangioscopy, cholangioplasty and biliary stenting, biliary stone extraction, and intraluminal brachytherapy.

  9. [Potentialities of transcutaneous and transhepatic cholangiography as a method of studying diseases of the bile excretory system].

    Science.gov (United States)

    Sharipov, V Sh; Khalikov, T Kh

    1992-01-01

    Comprehensive examinations of 62 patients with jaundice of obscure origins involved transcutaneous transhepatic cholangiography carried out in all the patients, hepatolymphography in 60 cases, relaxation duodenography in 31, angiography in 41, ultrasonic examination of the liver in 31, endoscopic retrograde pancreatocholangiography in 28 and liver scanning in 19 patients. These studies have extended the knowledge on the biliferous system status in obturation and parenchymatous jaundices and helped define the role of transcutaneous transhepatic cholangiography among the invasive methods of radiologic examinations and pararadiologic methods.

  10. Imaging and estimation of the prognostic features of primary sclerosing cholangitis by ultrasonography and MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Oikarinen, H.; Paeaekkoe, E.; Suramo, I.; Paeivaensalo, M.; Tervonen, O. [Oulu Univ. Hospital (Finland). Dept. of Diagnostic Radiology; Lehtola, J.; Aukee, J. [Oulu Univ. Hospital (Finland). Dept. of Medicine

    2001-03-01

    Purpose: To evaluate the ability of US and MR cholangiography (MRC) to detect bile duct changes and prognostic signs of primary sclerosing cholangitis (PSC) seen at endoscopic retrograde cholangiography (ERC). Material and Methods: In a prospective study, 9 patients with PSC underwent US, MRC, MR imaging and ERC of the bile ducts and the liver. Eight age- and sex-matched control patients were examined with MRC, MR imaging and ERC. A segmental comparison was performed to assess the ability of MRC-MR and US to reveal the accurate ductal involvement in different segments of the biliary tree and the specific criteria of poor prognostic outcome in PSC. The ability of MRC-MR to detect the presence of PSC in different patients was analysed blindly. Results: MRC-MR depicted changes of PSC correctly in 9 patients (radiologist 1) and in 8 patients with 1 false-positive finding (radiologist 2) in the blinded analysis. In the segmental comparison, MRC missed especially bile duct dilatation. MRC was too pessimistic in the evaluation of the outcome. US detected features suggestive of PSC in 8 patients (radiologist 3). US was unable to show the predictors of poor outcome. Conclusion: MRC and US seem to be useful in the detection of PSC. US is unable and MRC is too pessimistic to estimate the outcome of PSC.

  11. Magnetic resonance cholangiography in the assessment and management of biliary complications after OLT

    Institute of Scientific and Technical Information of China (English)

    Rossano; Girometti; Lorenzo; Cereser; Massimo; Bazzocchi; Chiara; Zuiani

    2014-01-01

    Despite advances in patient and graft management,biliary complications(BC)still represent a challenge both in the early and delayed period after orthotopic liver transplantation(OLT).Because of unspecific clinical presentation,imaging is often mandatory in order to diagnose BC.Among imaging modalities,magnetic resonance cholangiography(MRC)has gained widespread acceptance as a tool to represent the reconstructed biliary tree noninvasively,using both the conventional technique(based on heavily T2-weighted sequences)and contrast-enhanced MRC(based on the acquisition of T1-weighted sequences after the administration of hepatobiliary contrast agents).On this basis,MRC is generally indicated to:(1)avoid unnecessary procedures of direct cholangiography in patients with a negative examination and/or identify alternative complications;and(2)provide a road map for interventional procedures or surgery.As illustrated in the review,MRC is accurate in the diagnosis of different types of biliarycomplications,including anastomotic strictures,nonanastomotic strictures,leakage and stones.

  12. Contrast-Enhanced Magnetic Resonance Cholangiography: Practical Tips and Clinical Indications for Biliary Disease Management.

    Science.gov (United States)

    Palmucci, Stefano; Roccasalva, Federica; Piccoli, Marina; Fuccio Sanzà, Giovanni; Foti, Pietro Valerio; Ragozzino, Alfonso; Milone, Pietro; Ettorre, Giovanni Carlo

    2017-01-01

    Since its introduction, MRCP has been improved over the years due to the introduction of several technical advances and innovations. It consists of a noninvasive method for biliary tree representation, based on heavily T2-weighted images. Conventionally, its protocol includes two-dimensional single-shot fast spin-echo images, acquired with thin sections or with multiple thick slabs. In recent years, three-dimensional T2-weighted fast-recovery fast spin-echo images have been added to the conventional protocol, increasing the possibility of biliary anatomy demonstration and leading to a significant benefit over conventional 2D imaging. A significant innovation has been reached with the introduction of hepatobiliary contrasts, represented by gadoxetic acid and gadobenate dimeglumine: they are excreted into the bile canaliculi, allowing the opacification of the biliary tree. Recently, 3D interpolated T1-weighted spoiled gradient echo images have been proposed for the evaluation of the biliary tree, obtaining images after hepatobiliary contrast agent administration. Thus, the acquisition of these excretory phases improves the diagnostic capability of conventional MRCP-based on T2 acquisitions. In this paper, technical features of contrast-enhanced magnetic resonance cholangiography are briefly discussed; main diagnostic tips of hepatobiliary phase are showed, emphasizing the benefit of enhanced cholangiography in comparison with conventional MRCP.

  13. Role of Endoscopic Retrograde Cholangiography and Nasobiliary Drainage in the Management of Postoperative Biliary Leak

    Directory of Open Access Journals (Sweden)

    M. K. Goenka

    1997-01-01

    Full Text Available In order to assess the role of endoscopic retrograde cholangiography in evaluating the patients with post-operative biliary leak and of endoscopic nasobiliary drainage in its management, 36 patients with biliary leak seen over a period of 9 years were studied. Thirty-two had biliary leak following cholecystectomy, 3 following repair of liver trauma and 1 following choledochoduodenostomy. Patients presented at an interval of 4 days to 210 days (mean ± SEM, 32.4 ± 6.7 days following laparotomy. Hyperbilirubinemia was noticed in only 13 patients (36.1%, while abdominal ultrasonogram showed ascites or biloma in 24 (66.7%. Endoscopic retrograde cholangiography showed the leak to involve the common bile duct in 55.6%, cystic duct in 33.3% and intrahepatic biliary radicles in 8.3%. Associated lesions included bile duct obstruction due to stricture or accidental ligature in 20%, bile duct stone in 20% and liver abscess in 2.8%.

  14. Non-invasive detection of biliary leaks using Gd-EOB-DTPA-enhanced MR cholangiography: comparison with T2-weighted MR cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Kantarci, Mecit; Pirimoglu, Berhan; Bayraktutan, Ummugulsum; Ogul, Hayri; Kizrak, Yesim; Eren, Suat [Atatuerk University, School of Medicine, Department of Radiology, Erzurum (Turkey); Karabulut, Nevzat [Pamukkale University, School of Medicine, Department of Radiology, Denizli (Turkey); Ozturk, Gurkan; Aydinli, Bulent [Atatuerk University, School of Medicine, Department of General Surgery, Erzurum (Turkey); Yilmaz, Sinan [Atatuerk University, School of Medicine, Department of Public Health, Erzurum (Turkey)

    2013-10-15

    To evaluate the added role of T1-weighted (T1w) gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) compared with T2-weighted MRC (T2w-MRC) in the detection of biliary leaks. Ninety-nine patients with suspected biliary complications underwent routine T2w-MRC and T1w contrast-enhanced (CE) MRC using Gd-EOB-DTPA to identify biliary leaks. Two observers reviewed the image sets separately and together. MRC findings were compared with those of surgery and percutaneous transhepatic cholangiopancreatography. The sensitivity, specificity and accuracy of the techniques in identifying biliary leaks were calculated. Accuracy of locating biliary leaks was superior with the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC (P < 0.05).The mean sensitivities were 79 % vs 59 %, and the mean accuracy rates were 84 % vs 58 % for combined CE-MRC and T2w-MRC vs sole T2w-MRC. Nineteen out of 21 patients with biliary-cyst communication, 90.4 %, and 12/15 patients with post-traumatic biliary extravasations, 80 %, were detected by the combination of Gd-EOB-DTPA-enhanced MRC and T2w-MRC images, P < 0.05. Gd-EOB-DTPA-enhanced MRC yields information that complements T2w-MRC findings and improves the identification and localisation of the bile extravasations (84 % accuracy, 100 % specificity, P < 0.05). We recommend Gd-EOB-DTPA-enhanced MRC in addition to T2w-MRC to increase the preoperative accuracy of identifying and locating extravasations of bile. (orig.)

  15. Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Chi-Liang Cheng; Yung-Kuan Tsou; Cheng-Hui Lin; Jui-Hsiang Tang; Chien-Fu Hung; Kai-Feng Sung; Ching-Song Lee

    2012-01-01

    AIM:To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years (range,20 to 92 years); 66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7±15.4 mm (range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two (6.7%)of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC.

  16. Endoscopic retrograde cholangiography for pediatric choledocholithiasis:Assessing the need for endoscopic intervention

    Institute of Scientific and Technical Information of China (English)

    Douglas S Fishman; Bruno P Chumpitazi; Isaac Raijman; Cynthia Man-Wai Tsai; E O’Brian Smith; Mark V Mazziotti; Mark A Gilger

    2016-01-01

    AIM:To assess pediatric patients for choledocholithiasis.We applied current adult guidelines to identify predictivefactors in children.METHODS:A single-center retrospective analysis was performed at a tertiary children’s hospital.We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected choledocholithiasis.Patients were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected CBDS.RESULTS:CBDS were identified in 84% at the time of ERCP.Abdominal ultrasound identified CBDS in 36% of patients.Conjugated bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to 8.8.Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,respectively.CONCLUSION:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.

  17. Adult-to-adult right lobe living donor liver transplantation: Comparison of endoscopic retrograde cholangiography with standard T2-weighted magnetic resonance cholangiography for evaluation of donor biliary anatomy

    Institute of Scientific and Technical Information of China (English)

    Perdita Wietzke-Braun; Felix Braun; Dieter Müller; Thomas Lorf; Burckhardt Ringe; Giuliano Ramadori

    2006-01-01

    AIM: To compare the value of endoscopic retrograde cholangiography (ERC) and standard T2-weighted magnetic resonance cholangiography (MRC) in the evaluation process as adult-to-adult right lobe living donor liver transplantation (LDLTx) demands a successful outcome, and exact knowledge of the biliary tree is implicated to avoid biliary complications,postoperatively.METHODS: After starting the LDLTx program, 18 liver transplant candidates were selected for LDLTx by a stepwise evaluation process. ERC and standard T2-weighted MRC were performed to evaluate the biliary system of the donor liver. The anatomical findings of ERC and MRC mapping were compared usingthe Ohkubo classification.RESULTS: ERC allowed mapping of the whole biliary system in 15/15 (100%) cases, including 14/15 (93.3%)with biliary variants while routine MRC was only accurate in 2/13 (15.4%) cases. MRC was limited in depicting the biliary system proximal of the hepatic bifurcation.Postoperative biliary complications occurred in 2 donors and 8 recipients. Biliary complications were associated with Ohkubo type C, E or G in 6/8 recipients, and 2/3recipients with biliary leak received a graft with multiple (≥2) bile ducts.CONCLUSION: Pretransplant ERC is safe and superior over standard MRC for detection of biliary variations that occur with a high frequency. However, precise knowledge of biliary variants did not reduce the incidence of postoperative biliary complications.

  18. Mn-DPDP enhanced T1-weighted magnetic resonance cholangiography: usefulness in the diagnosis and roadmap for the treatment of intrahepatic choIedochoIithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Mi Suk; Kim, Ki Whang; Yu, Jeong Sik; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of); Kim, Kyoung Won; Kim, Tae Kyoung; Ha, Hyun Kwon [Asan Medical Center, Seoul (Korea, Republic of)

    2004-05-01

    To assess the preliminary findings of Mn-enhanced T1-weighted MR cholangiography for the evaluation of intrahepatic choledocholithiasis. Seven patients with recurrent pyogenic cholangitis underwent conventional heavily T2-weighted and manganese-enhanced T1-weighted MR cholangiography. For the former, the two reviewers focused on intrahepatic ductal dilatation, calculi, and stricture; and for the latter, ductal enhancement. In seven patients, 13 diseased segments were depicted and intrahepatic bile ductal dilatation was present in all 13 of these in all seven patients. Calculi were present in eight segments in six patients, and stricture in four segments in three patients. Of the 13 diseased segmental ducts, six were seen at manganese-enhanced imaging to be filled with contrast material, suggesting a functioning bile duct. Combined T2-weighted and mangafodipir trisodium-enhanced T1-weighted MR cholangiography provides both anatomic detail and functional detail of the biliary system. Combined MR cholangiography is useful for the evaluation of intrahepatic choledocholithiasis, demonstrating the stricture and function of the segmental ducts involved.

  19. Lower Rate of Major Bile Duct Injury and Increased Intraoperative Management of Common Bile Duct Stones after Implementation of Routine Intraoperative Cholangiography

    NARCIS (Netherlands)

    Buddingh, K. Tim; Weersma, Rinse K.; Savenije, Rolf A. J.; van Dam, Gooitzen M.; Nieuwenhuijs, Vincent B.

    2011-01-01

    BACKGROUND: Our university medical center is the only center in The Netherlands that has adopted a policy of routine intraoperative cholangiography (IOC) during cholecystectomy. This study aimed to describe the rate of bile duct injury (BDI) and management of common bile duct (CBD) stones before and

  20. MR Cholangiography and Dynamic Examination of Duodenal Fluid in the Differential Diagnosis between Extrahepatic Biliary Atresia and Infantile Hepatitis Syndrome

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    In order to evaluate the value of magnetic resonance cholangiography (MRC) and dynamic examination of duodenal fluid in the differential diagnosis between extrahepatic biliary atresia (EHBA) and infantile hepatitis syndrome (IHS), 52 pa tients with infantile cholestatic jaundice were examined by MRC and duodenal fluid examination. Original interpretations were compared with clinical outcome. Calculated sensitivity of duodenal fluid examination in diagnosis of EHBA was 100%, and specificity was 91.1%. Sensitivity of MRC in the diagnosis of EHBA was 94.4 % and specificity 88.24 %. The sensitivity of MRC and examination of duodenal fluid combined in diagnosis of EHBA was 94.4 % and specificity 97.06 %. We are led to conclude that MRC and dynamic examination of duodenal fluid are useful in the differential diagnosis between IHS and EHBA and the combined use of the two techniques yield better resutls.

  1. Plasmapheresis and corticosteroid treatment for persistent jaundice after successful drainage of common bile duct stones by endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Ulku Saritas; Bunyamin Aydin; Yucel Ustundag

    2007-01-01

    Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiography (ERC). Only few cases with this complication are reported in the English literature. We report persisting cholestatic jaundice in a 73-year old man after successful therapeutic ERC for choledocholithiasis. Serologic tests for viral and autoimmune hepatitis were all negative. A second-look ERC was normal also. He denied any medication except for prophylaxis given intravenous 1 g ceftriaxon prior to the ERC procedure.After an unsuccessful trial with ursodeoxycholic acid and cholestyramine for 2 wk, this case was efficiently treated with corticosteroids and plasmapheresis. His cholestatic enzymes became normal and intense pruritis quickly resolved after this treatment which lasted during his follow-up period. We discussed the possible mechanisms and treatment alternatives of intrahepatic cholestasis associated with the ERC procedure.

  2. The value of percutaneous catheter cholangiography in postoperative diagnostics after biliobiliary and biliodigestive anastomoses; Wertigkeit der perkutanen Kathetercholangiographie in der postoperativen Diagnostik biliodigestiver und biliobiliaerer Anastomosen

    Energy Technology Data Exchange (ETDEWEB)

    Barkhausen, J. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Bidlingmaier, J. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Mueller, R.D. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany); Langer, R. [Zentralinstitut fuer Roentgendiagnostik, Universitaetsklinikum Essen (Germany)

    1996-09-01

    Aim of study: To examine the relative importance of percutaneous catheter cholangiography in postoperative diagnostics after biliary reconstruction. Methods: 55 patients (33 males, 22 females) were subjected to 101 catheter cholangiographies. 30-50 ml of a water-soluble, iodic contrast medium were administered via an infusion system. Initial examinations were performed between the 3nd and 7th day following operation, while follow-up examinations were executed between the 8th and 145th day after surgery. The position of the catheter, the function of the anastomosis, the filling of the biliary ducts and the discharge of the contrast medium were assessed. Results: 45 examinations were inconspicuous. Drainage obstruction of the contrast medium was observed in 24 cases. Filling defects were observed in 8 examinations. A dislocation of the catheter was encountered in 5 cholangiographies while 19 examinations displayed a bile leak. Conclusion: Percutaneous catheter cholangiographies can be used to detect postoperative complications following biliary reconstruction in an easy, reliable, and cost-effective manner that also does not put too much strain on the patient. Indications for the inplementation of catheter cholangiographies are the occurrence of abdominal complaints, the clinical appearance of a peritonitis, or an increase of the serum bilirubin value. Routine examinations are recommended in conditions following liver transplantations. In addition to this, a cholangiography should be carried out prfor to the removal of the catheter. (orig.) [Deutsch] Fragestellung: Geprueft wird der Stellenwert der perkutanen Kathetercholangiographie in der postoperativen Diagnostik nach Anlage biliobiliaerer und biliodigestiver Anastomosen. Material und Methode: Bei 55 Patienten (33 maennlich, 22 weiblich) wurden 101 Kathetercholangiographien durchgefuehrt. Die Erstuntersuchung erfolgte zwischen dem 3. und 7. postoperativen Tag, Kontrolluntersuchungen zwischen dem 8. und 145. Tag

  3. Diagnostic value of reflux sign in cholescintigraphy after administration of a gallbladder contracting agent. Comparison with X-ray cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao; Shimono, Reiko; Murase, Kenya; Koito, Hikaru; Iio, Atsushi; Hamamoto, Ken.

    1989-01-01

    This study explored the diagnostic value of cholescintigraphy in evaluating biliary passage, focusing on reflux sign in which radioactivity in the left hepatic duct or peripheral intrahepatic duct was increased after intramuscular injection of caerulein. Reflux sign was observed in 28 (12%) of 237 patients examined during the past four years from 1983 to 1987. Twenty five patients simultaneously undergoing X-ray cholangiography were eligible for this study, consisting of four each with common bile duct (CBD) stone, dilated CBD, biliary dyskinesia, and chronic pancreatitis, three with gallbladder stone, two with duodenal ulcer, and one each with adenoma of the CBD, pancreatic pseudocyst, duodenal diverticle, and acute cholangitis. The dilated CBD of 10 mm or more was seen in 13 patients (52%) and CBD stenosis was seen in 6 patients (24%). There was no correlation between reflux sign and gallbladder contraction. Prolonged RI gassage and pooling within the CBD were shown in 17 patients (68%) and 8 patients (28%), respectively. Major reflux sign was considered to reflect the CBD diameter increased by drip infusion of caerulein. It is useful in determining biliary passage in the lower end of the CBD and slight CBD dilatation. (Namekawa, K).

  4. Is intra-operative cholangiography necessary during laparoscopic cholecystectomy? A multicentre rural experience from a developing world country

    Institute of Scientific and Technical Information of China (English)

    Iqbal Saleem Mir; Mir Mohsin; Omar Kirmani; Tafazul Majid; Khurshid Wani; Mehmood-ul Hassan; Javed Naqshbandi; Mohammed Maqbool

    2007-01-01

    AIM: To evaluate the feasibility and safety of performing laparoscopic cholecystectomy (LC) in non-teaching ruralhospitals of a developing country without intra-operative cholangiography (IOC). To evaluate the possibility of reduction of costs and hospital stay for patients undergoing LC.METHODS: A prospective analysis of patients with symptomatic benign diseases of gall bladder undergoing LC in three non-teaching rural hospitals of Kashmir Valley from Jan 2001 to Jan 2007. The cohort represented a sample of patients requiring LC, aged 13 to 78 (mean 47.2) years. Main outcome parameters included mortality, complications, re-operation, conversion to open procedure without resorting to IOC, reduction in costs borne by the hospital, and the duration of hospital stay.RESULTS: Twelve hundred and sixty-seven patients (976 females/291 males) underwent laparoscopic cholecystectomy. Twenty-three cases were converted to open procedures; 12 patients developed port site infection, nobody died because of the procedure. One patient had common bile duct (CBD) injury, 4 patients had biliary leak, and 4 patients had subcutaneous emphysema. One cholecystohepatic duct was detected and managed intraoperatively, 1 patient had retained CBD stones, while 1 patient had retained cystic duct stones. Incidental gallbladder malignancy was detected in 2 cases. No long-term complications were detected up to now.CONCLUSION: LC can be performed safely even in nonteaching rural hospitals of a developing country provided proper equipment is available and the surgeons and other team members are well trained in the procedure.It is stressed that IOC is not essential to prevent biliary tract injuries and missed CBD stones. The costs to the patient and the hospital can be minimized by using reusable instruments, intracorporeal sutures, and condoms instead of titanium clips and endobags.

  5. Mucin gene expression in bile of patients with and without gallstone disease, collected by endoscopic retrograde cholangiography

    Institute of Scientific and Technical Information of China (English)

    Alexander Vilkin; Alex Geller; Zohar Levi; Yaron Niv

    2009-01-01

    AIM: To investigate the pattern of mucin expression and concentration in bile obtained during endoscopic retrograde cholangiography (ERC) in relation to gallstone disease.METHODS: Bile samples obtained at ERC from 29 consecutive patients, 17 with and 12 without gallstone disease were evaluated for mucin content by gel filtration on a Sepharose CL-4B column. Dot blot analysis for bile mucin apoproteins was performed with antibodies to Mucin 1 (MUC1), MUC2, MUC3, MUC5AC, MUC5B and MUC6. Staining intensity score (0-3) was used as a measure of antigen expression. RESULTS: MUC1, MUC2, MUC3, MUC5AC, MUC5B and MUC6 were demonstrated in 34.4%, 34.4%, 51.7%, 51.7%, 55.1% and 27.5% of bile samples, respectively. The staining intensity scores were 0.62 ± 0.94, 0.58 ± 0.90, 0.79 ± 0.97, 1.06 ± 1.22, 1.20 ± 1.26 and 0.41 ± 0.73, respectively. Mean mucin concentration measured in bile by the Sepharose CL-4B method was 22.8 ± 24.0 mg/mL (range 3.4-89.0 mg/mL). Mean protein concentration was 8.1 ± 4.8 mg/mL (range 1.7-23.2 mg/mL).CONCLUSION: High levels of MUC3, MUC5AC and MUC5B are expressed in bile aspirated during ERC examination. A specific pattern of mucin gene expression or change in mucin concentration was not found in gallstone disease.

  6. The efficiency of Gd-EOB-DTPA-enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study.

    Science.gov (United States)

    Ogul, Hayri; Kantarci, Mecit; Pirimoglu, Berhan; Karaca, Leyla; Aydinli, Bulent; Okur, Aylin; Ozturk, Gurkan; Kizrak, Yesim

    2014-03-01

    The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2-weighted MRC and contrast-enhanced MRC (CE-MRC) were used to identify the biliary complications. MRC included routine breath-hold T2-weighted MRC using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences and Gd-EOB-DTPA-enhanced MRC T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE-MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE-MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd-EOB-DTPA-enhanced MRC was superior to MRC in locating biliary leaks (p < 0.05). The usage of Gd-EOB-DTPA-enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd-EOB-DTPA-enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.

  7. MR Cholangiography: Axial TSE-T2 Sequence Evaluation in the Diagnosis of Choledocholithiasis; Colangiografia RM: evaluacion de la secuencia TSE-T2 axial en la deteccion de coledocolitiasis

    Energy Technology Data Exchange (ETDEWEB)

    Alustiza, J. M.; Gervas, C.; Garcia, E.; Recondo, J. A. [Hospital Donostia. San Sebastian (Spain)

    2003-07-01

    To evaluate diagnostic precision of the axial TSE-T2 sequence in the diagnosis of choledocholithiasis. Retrospective analysis of all those MR cholangiography studies performed in our center between January 1998 and June 1999 which were later subjected to conventional cholangiography (intraoperative) as a golden standard. A total of 39 patients was studied. Imaging parameters of the sequence evaluated, fat-suppressed TSE-T2 in the axial plane, were as follows: TE 100 ms, TR 1.800 ms, turbo factor 23 FOV 375 mm, NSA 4, 228 x 256 matrix, respiratory compensation, number of slices 35, slice thickness 3 mm, contiguous slices, scan duration 5'4''. Without having been informed as to the cholangiography result, two radiologists independently analyzed this sequence in order to determine the presence of choledocholithiasis. Their results were latter compared with those of the conventional cholangiography. The sensitivity, specificity and agreement between results were all calculated. 21 patients had choledocholithiasis. The analyzed sequence presented sensitivity 81%, specificity 89%, and agreement between radiologists 98%, Kappa index 0.949. The axial sequence TSE-T2 is reliable for choledocholithiasis diagnosis. (Author) 9 refs.

  8. Complications after liver transplantation: evaluation with magnetic resonance imaging, magnetic resonance cholangiography, and 3-dimensional contrast-enhanced magnetic resonance angiography in a single session

    Energy Technology Data Exchange (ETDEWEB)

    Boraschi, P.; Donati, F.; Gigoni, R. [Pisa Univ. Hospital, Second Dept. of Radiology, Pisa (Italy)], E-mail: p.boraschi@do.med.unipi.it; Salemi, S. [Univ. of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy); Urbani, L.; Filipponi, F. [Univ. of Pisa, Liver Transplant Unit of the Dept. of Oncology, Transplants and Advanced Technologies in Medicine, Pisa (Italy); Falaschi, F. [Pisa Univ. Hospital, Second Dept. of Radiology, Pisa (Italy); Bartolozzi, C. [Univ. of Pisa, Diagnostic and Interventional Radiology, Pisa (Italy)

    2008-12-15

    To evaluate a comprehensive magnetic resonance imaging (MRI) protocol as noninvasive diagnostic modality for simultaneous detection of parenchymal, biliary, and vascular complications after liver transplantation. Fifty-two liver transplant recipients suspected to have parenchymal, biliary, and (or) vascular complications underwent our MRI protocol at 1.5T unit using a phased array coil. After preliminary acquisition of axial T{sub 1}w and T{sub 2}w sequences, magnetic resonance cholangiography (MRC) was performed through a breath-hold, thin- and thick-slab, single-shot T{sub 2}w sequence in the coronal plane. Contrast-enhanced magnetic resonance angiography (CEMRA) was obtained using a 3-dimensional coronal spoiled gradient-echo sequence, which enabled acquisition of 32 partitions 2.0 mm thick. A fixed dose of 20 ml gadobenate dimeglumine was administered at 2 mL/s. A post-contrast T{sub 1}w sequence was also performed. Two observers in conference reviewed source images and 3-dimensional reconstructions to determine the presence of parenchymal, biliary, and vascular complications. MRI findings were correlated with surgery, endoscopic retrograde cholangiography (ERC), biopsy, digital subtraction angiography (DSA), and imaging follow-up. MRI revealed abnormal findings in 32 out of 52 patients (61%), including biliary complications (anastomotic and nonanastomotic strictures, and lithiasis) in 31, vascular disease (hepatic artery stenosis and thrombosis) in 9, and evidence of hepatic abscess and hematoma in 2. ERC confirmed findings of MRC in 30 cases, but suggested disease underestimation in 2. DSA confirmed 7 magnetic resonance angiogram (MRA) findings, but suggested disease overestimation in 2. MRI combined with MRC and CEMRA can provide a comprehensive assessment of parenchymal, biliary, and vascular complications in most recipients of liver transplantation. (author)

  9. Comparison of different magnetic resonance cholangiography techniques in living liver donors including Gd-EOB-DTPA enhanced T1-weighted sequences.

    Directory of Open Access Journals (Sweden)

    Sonja Kinner

    Full Text Available Preoperative evaluation of potential living liver donors (PLLDs includes the assessment of the biliary anatomy to avoid postoperative complications. Aim of this study was to compare T2-weighted (T2w and Gd-EOB-DTPA enhanced T1-weighted (T1w magnetic resonance cholangiography (MRC techniques in the evaluation of PLLDs.30 PLLDs underwent MRC on a 1.5 T Magnetom Avanto (Siemens, Erlangen, Germany using (A 2D T2w HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo fat saturated (fs in axial plane, (B 2D T2w HASTE fs thick slices in coronal plane, (C free breathing 3D T2w TSE (turbo spin echo RESTORE (high-resolution navigator corrected plus (D maximum intensity projections (MIPs, (E T2w SPACE (sampling perfection with application optimized contrasts using different flip angle evolutions plus (F MIPs and (G T2w TSE BLADE as well as Gd-EOB-DTPA T1w images without (G and with (H inversion recovery. Contrast enhanced CT cholangiography served as reference imaging modality. Two independent reviewers evaluated the biliary tract anatomy on a 5-point scale subjectively and objectively. Data sets were compared using a Mann-Whitney-U-test. Kappa values were also calculated.Source images and maximum intensity projections of 3D T2w TSE sequences (RESTORE and SPACE proved to be best for subjective and objective evaluation directly followed by 2D HASTE sequences. Interobserver variabilities were good to excellent (k = 0.622-0.804.3D T2w sequences are essential for preoperative biliary tract evaluation in potential living liver donors. Furthermore, our results underline the value of different MRCP sequence types for the evaluation of the biliary anatomy in PLLDs including Gd-EOB-DTPA enhanced T1w MRC.

  10. A new endoscopic therapeutic method for acute obstructive suppurative cholangitis post Roux-en-Y anastomosis: endoscopic retrograde cholangiography through jejunostomy

    Directory of Open Access Journals (Sweden)

    Zhuo YANG

    2012-01-01

    Full Text Available  Objective  To probe the value of endoscopic retrograde cholangiography (ERC through jejunostomy in patients in whom ERC could not be performed via the mouth after Roux-en-Y anastomosis on the upper gastrointestinal tract. Methods  In two patients suffering from acute obstructive suppurative cholangitis after a radical operation for cholangiocarcinoma, ERC could not be performed through the mouth due to the presence of a long non-functional jejunal loop. A jejunostomy was first done in the afferent loop of the jejunum, and a gastroscope was then inserted via the jejunostomy and passed retrogradely, to find the stoma of the cholangiointestinal anastomosis. ERC was then successfully performed, and followed by endoscopic retrograde biliary drainage (ERBD. Results  The operation was successful. It was found that cholangio-jejunostomy stoma was narrow, and a large amount of purulent mucus was present in the enlarged intrahepatic duct. ERC was done to enlarge the stoma, and a stent was placed into the main branch of the intrahepatic duct. Two patients achieved surgical success and smooth recovery after the operation. Conclusion  ERC through a jejunostomy in the patients who had Roux-en-Y cholangiojejunostomy following radical resection for cholangiocarcinoma, is a safe and effective surgical procedure.

  11. Detection of active bile leak with Gd-EOB-DTPA enhanced MR cholangiography: Comparison of 20–25 min delayed and 60–180 min delayed images

    Energy Technology Data Exchange (ETDEWEB)

    Cieszanowski, Andrzej, E-mail: andrzej.cieszanowski@wum.edu.pl [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Stadnik, Anna, E-mail: aniaws@yahoo.com [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Lezak, Aleksandra, E-mail: aleksandralezak@gmail.com [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Maj, Edyta, E-mail: em26@wp.pl [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Zieniewicz, Krzysztof, E-mail: krzysztof.zieniewicz@wum.edu.pl [Chair and Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Rowinska-Berman, Katarzyna, E-mail: kasiarowinska@wp.pl [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Grudzinski, Ireneusz P., E-mail: ireneusz.grudzinski@wum.edu.pl [Department of Toxicology, Medical University of Warsaw, Faculty of Pharmacy, ul. Banacha 1, 02-097 Warsaw (Poland); Krawczyk, Marek, E-mail: marek.krawczyk@wum.edu.pl [Chair and Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland); Rowiński, Olgierd, E-mail: olgierd.rowinski@wum.edu.pl [2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa (Poland)

    2013-12-01

    Objectives: The purpose of this study was to assess the value of contrast-enhanced magnetic resonance cholangiography (MRC) performed in different time delays after injection of gadoxetic acid disodium (Gd-EOB-DTPA) for the diagnosis of active bile leak. Methods: This retrospective analysis included Gd-EOB-DTPA enhanced MR images of 34 patients suspected of bile leak. Images were acquired 20–25 min after Gd-EOB-DTPA injection. If there was inadequate contrast in the bile ducts then delayed images after 60–90 min and 150–180 min were obtained. Results were correlated with intraoperative findings, ERCP results, clinical data, laboratory tests, and follow-up examinations. Results: Gd-EOB-DTPA enhanced MRC yielded an overall sensitivity of 96.4%, specificity of 100% and accuracy of 97.1% for the diagnosis of an active bile leak. The sensitivity of 20–25 min delayed MR images was 42.9%, of combined 20–25 min and 60–90 min delayed images was 92.9% and of combined 20–25 min, 60–90 min and 150–180 min delayed images was 96.4%. Conclusions: Gd-EOB-DTPA enhanced MRC utilizing delayed phase images was effective for detecting the presence and location of active bile leaks. The images acquired 60–180 min post-injection enabled identification of bile leaks even in patients with a dilated biliary system or moderate liver dysfunction.

  12. Application of dynamic intraoperative cholangiography using the C-arm X-ray machine during cholecystectomy%C型臂X线机下动态术中胆道造影在胆囊切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    储文军; 刘峰; 韩江

    2012-01-01

    目的 探讨C型臂X线机下动态术中胆道造影在胆囊切除术中的应用价值.方法 对2006-2010年我科利用C型臂X线机对126例开腹胆囊切除术病例行动态术中胆道造影的资料进行回顾性分析.结果 造影成功122例,成功率96.8%.造影发现结石11例,其中胆总管结石8例,左肝管结石1例,右肝管结石2例,均行胆总管切开,胆道镜下取石,T管引流术.胆管损伤1例,行胆管修补.副肝管1例,Mirizzi综合征1例.均采取相应方法予以正确处理,一期愈合出院.全组无假阳性发生.平均耗时6.25min.结论 C型臂X线机下动态术中胆道造影法在胆囊切除术中是一种有效方法,省时,省力,显影清楚,值得推广.%Objective To evaluate the clinical value of dynamic intraoperative cholangiography using the C-arm X-ray machine during the process of cholecystectomy. Methods One hundred and twenty-six dynamic intraoperative eholangiography were retrospectively analyzed using the C-arm X-ray machine in cases of open cholecystectomy from 2006 to 2010 . Results 122 cases were successful imaging, the success rate was 96.8%. Biliary tract lithiasis were found in 1 1 cases, in whom 8 cases were common bile duct stones, 1 case left hepatic duct stones, 2 cases right hepatic duct, Choledochotomy, choledochoscope and T-tube drainage were performed in all cases , One case of bile duct injury which accepted bile duct repair was found. One case of bile duct variation and 1 case of Mirizzi suydrome was found. No false positive was found in this group. The average cholangiography time was 6.25 min. Conclusion Dynamic intraoperative cholangiography using the C-arm X-ray machine during cholecystectomy is fast, effective, and safe.

  13. A prospective, comparative study of magnetic resonance cholangipancreatography and direct cholangiography in the diagnosis of biliary diseases; Estudio propsective comparativo en el diagnostico de la patologia biliar. Colangiopancreatografia por resonancia magnetica frente a colangiografia directa

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Martin, J.; Brullet, E.; Campo, R.; Espinos, J.; Darnell, A.

    2001-07-01

    To assess the sensitivity and specificity of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic technique, comparing it with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTHC) in the diagnosis of biliary disease, focusing particularly on patients with choledocholithiasis. Between June 1997 and february 1998, 109 patients referred by the Corporacio Sanitaria del Parc Tauli and the Hospital Mutua de terrasa in Barcelona, Spain were evaluated. MRCP and ERCP or PTHC were performed in every case, always in that order and separated by a maximum of 7 days. Twenty-four patients were excluded from the study for different reasons, leaving a series of 85 patients. All the studies were performed with a 1-Tesla Siemens Magneton Impact Expert using half-fourier single-short turbo spin-echo (HASTE) and rapid acquisition with relaxation enhancement (RARE) methods in several coronal and axial planes. The MRCP readings were carried out by consensus by two radiologists who are experts in the assessment of diseases of the digestive tract. In this series of 85 patients; MCRP showed a sensitivity of 98.4%, a specificity of 94.7%, a positive predictive value of 98.4% and a negative predictive value of 94.7% for the detection of biliary diseases. For the detection choledocholithiasis, these values were 100%, 89.5%, 88% and 100%, respectively. MRCP is extremely reliable in the diagnosis of biliary diseases, especially in cases of choledocholithiasis. Its high negative predictive value obviates the need for other invasive diagnostic tests. (Author) 30 refs.

  14. O papel da colangiografia por ressonância magnética na avaliação da anatomia biliar em doadores de transplante hepático intervivos The role of magnetic resonance cholangiography in the evaluation of biliary anatomy in living liver donors

    Directory of Open Access Journals (Sweden)

    Elaine Cristina de Moraes Arruda

    2008-12-01

    Full Text Available OBJETIVO: Avaliar a acurácia da colangiografia por ressonância magnética no estudo da anatomia biliar de doadores de fígado em correlação com achados operatórios. MATERIAIS E MÉTODOS: Estudo retrospectivo de 50 doadores submetidos a transplante hepático intervivos no Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR. As colangiografias foram analisadas e os resultados dos exames foram comparados com os achados intra-operatórios. Apenas alterações anatômicas que promoveram mudança de estratégia cirúrgica, não-evidenciadas previamente pela colangiografia por ressonância magnética, foram consideradas como discordantes. RESULTADOS: Foram encontradas variações pela colangiografia por ressonância magnética em 7 doadores e em 14 durante a cirurgia. Do total de pacientes, 41 resultados foram concordantes e 9 foram discordantes. A sensibilidade, a especificidade, o valor preditivo positivo, o valor preditivo negativo e a acurácia da colangiografia por ressonância magnética foram, respectivamente, de 43%, 97%, 86%, 81% e 81,6%. CONCLUSÃO: Conclui-se que a ressonância magnética é um método de imagem seguro e não-invasivo para avaliação pré-operatória das vias biliares de doadores e que algumas anomalias não são detectadas pela colangiografia por ressonância magnética.OBJECTIVE: The present study was aimed at evaluating the accuracy of magnetic resonance cholangiography in the assessment of the biliary anatomy in living liver donors in correlation with surgical findings. MATERIALS AND METHODS: Fifty living liver donors were retrospectively evaluated at Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil. Cholangiographic images were analyzed and results were compared with intraoperative findings. Only anatomical alterations that affected the surgical strategy and had not been previously observed at magnetic resonance cholangiography were considered as being in

  15. Percutaneous transhepatic cholangiography in obstructive jaundice

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Kang Uoo; Choi, Young Dae; Park, Jin Hoon; Min, Byung Chae; Yoon, Jong Sup [Han Gang Sacred Heart Hospital Hallym College, Seoul (Korea, Republic of)

    1983-03-15

    Although many invasive studies in the biliary tract disease are replaced by noninvasive techniques such as ultrasonography and computed tomography, PTC does still play an important role in diagnosis of obstructive jaundice. Authors had performed 42 patients of PTC with Chiba needle at the department of radiology, Han Gang Sacred Heart Hospital for 4 years from January 1978 to April 1982. And we reviewed literatures. The results were as follows: 1. Forty two patients of PTC were 22 males and 20 females. The success rate was 90.5% (38/42). The failed 4 cases of PTC were nonobstructive hepatobiliary diseases. 2. The PTC diagnosis of 38 cases were biliary stone (21 cases), cholangiocarcinoma (7 cases), pancreatic carcinoma (2 cases), hepatoma (2 cases), ascariasis (2 cases), and clonorchiasis (1 case), and the remainders were normal. 3. We made 2 cases of misdiagnosis on the basis of PTC findings. They were one case of distal CBD stone with severe cholangitis diagnosed as ampullary carcinoma and another case of proximal CBD stone with cholangitis diagnosed as pancreas carcinoma. 4. We experienced 2 cases of complication such as sepsis and severe hypotension, but they were recovered.

  16. Endoscopic ultrasound versus endoscopic retrograde cholangiography for the diagnosis of choledocholithiasis: the influence of the size of the stone and diameter of the common bile duct Ecoendoscopia versus colangiografia retrógrada endoscópica para o diagnóstico da coledocolitíase: a influência do tamanho do cálculo e do diâmetro da via biliar principal

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Silva Ney

    2005-12-01

    Full Text Available BACKGROUND: Endoscopic retrograde cholangiography is highly accurate in diagnosing choledocholithiasis, but it is the most invasive of the available methods. Endoscopic ultrasonography is a very accurate test for the diagnosis of choledocholithiasis with a risk of complications similar to that of upper gastrointestinal endoscopy. AIM: To compare the accuracy of endoscopic ultrassonography and endoscopic retrograde cholangiography in the diagnosis of common bile duct stones before laparoscopic cholecystectomy and to analyze endoscopic ultrasound results according to stone size and common bile duct diameter. PATIENTS AND METHODS: Two hundred and fifteen patients with symptomatic gallstones were admitted for laparoscopic cholecystectomy. Sixty-eight of them (31.7% had a dilated common bile duct and/or hepatic biochemical parameter abnormalities. They were submitted to endoscopic ultrassonography and endoscopic retrograde cholangiography. Sphincterotomy and sweeping of the common bile duct were performed if endoscopic ultrassonography or endoscopic retrograde cholangiography were considered positive for choledocholithiasis. After sphincterotomy and common bile duct clearance the largest stone was retrieved for measurement. Endoscopic or surgical explorations of the common bile duct were considered the gold-standard methods for the diagnosis of choledocholithiasis. RESULTS: All 68 patients were submitted to laparoscopic cholecystectomy with intraoperative cholangiography with confirmation of the presence of gallstones. Endoscopic ultrassonography was a more sensitivity test than endoscopic retrograde cholangiography (97% vs. 67% for the detection of choledocholithiasis. When stones >4.0 mm were analyzed, endoscopic ultrassonography and endoscopic retrograde cholangiography presented similar results (96% vs. 90%. Neither the size of the stone nor the common bile duct diameter had influence on endoscopic ultrasonographic performance. CONCLUSIONS: For a

  17. Will intraoperative cholangiography prevent biliary duct injury inlaparoscopic cholecystectomy?

    Institute of Scientific and Technical Information of China (English)

    Li Bo Li; Xiu Jun Cai; Jun Da Li; Yi Ping Mu; Yue Dong Wang; Xiao Ming Yuan; Xian Fa Wang; Urs Bryner; Robert K.Finley Jr

    2000-01-01

    AIM To evaluate the role of intraoperative cholangiogram (IOC) in preventing biliary duct injury duringlaparoscopic cholecystectomy.METHODS Injury location, mechanism, time of detection, treatment outcome, and whether anintraoperative cholangiogram was performed were evaluated in 31 cases of bile duct injuries.RESULTS Cholangiograms were done in 22 cases, but they were misinterpreted in 3 of them. In 12 of 19misidentified cases, the cholangiogram was interpreted correctly, and the injury detected intraoperatively.Primary laparoscopic repair or open repair and T-tube drainage solved the problem. No long-termcomplications occurred. However, in 3 of the 19 cases the cholangiogram was misinterpreted and in 4 of the19 cases no cholangiogram was performed. Three of the seven patients required a cholangioentericanastomosis. In 2 cases the diagnosis was delayed and one of these required a two-stage procedure. Morbiditywas increased. Three cases of clim impingement of the common duct had delayed diagnoses, and two of themhad injuries. Thermal injury developed in 4 cases who had cholangiograms.CONCLUSION Routine IOC plays no role in inducing, preventing, detecting, or minimizing any of theinjuries due to clips, lacerations, or electrocautery, IOC does not prevent injuries due to ductmisidentification either. Careful interpretation of IOC would prevent injuries and avoid an open operation.

  18. Primary sclerosing cholongitis: findings on cholangiography and pancreatography

    Energy Technology Data Exchange (ETDEWEB)

    MacCarty, R.L.; LaRusso, N.F.; Wiesner, R.H.; Ludwig, J.

    1983-10-01

    Cholangiograms of 86 patients with primary sclerosing cholangitis (PSC) were compared with those of 82 patients with primary bile duct carcinoma and 16 with primary biliary cirrhosis. Multifocal strictures involving both intra- and extra-hepatic bile ducts were most common in PSC; they were diffusely distributed, short, and annular, alternating with normal or slightly dilated segments to product a beaded appearance. Very short, band-like strictures occurred in 18 patients; 9 also had diverticulum-like outpouchings. Fourteen patients had diverticula without band strictures. Both findings appear to be specific for PSC. Inflammatory bowel disease was seen in 57 patients (66%), who could not be distinguished cholangiographically from other PSC patients. Of 40 patients with adequate retrograde pancreatograms, 3 had abnormalities of the pancreatic ducts.

  19. Non-radiographic intraoperative fluorescent cholangiography is feasible

    DEFF Research Database (Denmark)

    Larsen, Søren S; Schulze, Svend; Bisgaard, Thue

    2014-01-01

    laparoscopic cholecystectomy is feasible and associated with an acceptable time expenditure and a satisfactory success-rate. FUNDING: Not relevant. TRIAL REGISTRATION: The Regional Ethics Committee approved the study (J. No. H-3-2013-FSP45). The study is registered with clinicaltrials.gov (ID: NCT02136095)....... and to evaluate the success rate of the procedures. MATERIAL AND METHODS: A total of 35 patients scheduled for laparoscopic cholecystectomy and operated by the same surgeon were consecutively enrolled. A standardised protocol with IFC including angiography was performed during laparoscopic cholecystectomy...

  20. Correlação interobservador das alterações morfológicas das vias biliares em pacientes com esquistossomose mansoni pela colangiorressonância magnética Evaluation of morphological changes of the biliary tree by magnetic resonance cholangiography in patients with schistosomiasis mansoni: interobserver agreement

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    Danilo Moulin Sales

    2009-10-01

    Full Text Available OBJETIVO: Descrever as alterações das vias biliares pela colangiografia por ressonância magnética (CPRM na esquistossomose hepatoesplênica e avaliar a concordância interobservador da CPRM na detecção de colangiopatia esquistossomótica. MATERIAIS E MÉTODOS: Estudo prospectivo e transversal em 24 pacientes com a forma hepatoesplênica da esquistossomose mansoni e em 6 pacientes sadios, como grupo controle, com avaliação da via biliar pela CPRM. As alterações da via biliar consideradas foram: distorção, afilamento, estenose, dilatação e irregularidade. Foi calculada a concordância interobsevador para alteração da via biliar com o teste de McNemar e o índice kappa (κ. RESULTADOS: A concordância interobservador na caracterização de distorção e afilamento da via biliar foi quase perfeita (κ = 0,867; intervalo de confiança [IC] 95% [0,512-1,0] e κ = 0,865; IC 95% [0,51-1,0], respectivamente. A concordância foi substancial para a estenose (κ = 0,78; IC 95% [0,424-1,0], moderada para dilatação (κ = 0,595; IC 95% [0,247-0,942] e regular para afilamento (κ = 0,229; IC 95% [0,095-0,552]. CONCLUSÃO: As alterações observadas nas vias biliares foram, em ordem decrescente de ocorrência: distorção, afilamento, estenose, dilatação e irregularidade. A concordância interobservador para sinais de colangiopatia esquistossomótica foi quase perfeita para distorção e afilamento e substancial para estenose.OBJECTIVE: To describe changes of the biliary tree demonstrated by magnetic resonance cholangiography (MRC in patients with the hepatosplenic presentation of schistosomiasis mansoni, and evaluating the interobserver agreement in the detection of schistosomal cholangiopathy. MATERIALS AND METHODS: Prospective, cross-sectional study involving 24 patients with hepatosplenic schistosomiasis and 6 healthy patients (control group submitted to biliary tree evaluation by MRC. The following changes of the biliary tree were

  1. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography Precisión diagnóstica e impacto terapéutico de la ultrasonografía endoscópica en los pacientes con sospecha intermedia de coledocolitiasis y colangiorresonancia normal

    Directory of Open Access Journals (Sweden)

    Enrique Vázquez-Sequeiros

    2011-09-01

    Full Text Available Background: endoscopic ultrasonography (EUS and magnetic resonance cholangiography (MRC are the elective tests in the diagnosis of choledocholithiasis. MRC is best accepted by patients, but its sensitivity might decrease in the evaluation of microlithiasis. Aim: to evaluate the diagnostic accuracy and therapeutic impact of EUS in a prospective cohort of patients with intermediate suspicion of choledocolithiasis and no findings in MRC (normal MRC. Material and methods: during a period of 24 months, all the patients with clinical intermediate suspicion of choledocholithiasis and normal MRC were included. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV and negative predictive value (NPV of MRC and EUS were compared, and so their impact in the management of these patients. Results: seventy six patients were evaluated (lithiasis in 30% of them. Sensitivity and diagnostic accuracy of EUS (100%, 92% were significantly higher than MRC values (0%, 70% (p Antecedentes: la ultrasonografía endoscópica (USE y la colangiografía por resonancia magnética nuclear (CRM son las técnicas de elección para el diagnóstico de litiasis en la vía biliar. Aunque la CRM es mejor aceptada por los pacientes, la sensibilidad de esta para detectar litiasis de pequeño tamaño podría ser insuficiente. Objetivo: estudiar de forma prospectiva la precisión diagnóstica y el impacto terapéutico de la USE en los pacientes con sospecha intermedia de coledocolitiasis y CRM normal. Material y métodos: se incluyeron prospectivamente durante 24 meses todos los pacientes con sospecha clínica intermedia de coledocolitiasis y CRM negativa. Se compar�� la sensibilidad, especificidad, precisión diagnóstica, valor predictivo positivo y negativo de CRM y USE, así como su impacto en el tratamiento. Resultados: se evaluaron 76 pacientes (litiasis en el 30%. La sensibilidad y precisión diagnóstica de USE (100%, 92% eran significativamente

  2. Thick slice MR cholangiography of the intrahepatic biliary tree; Imagerie des voies biliaires intrahepatiques en cholangiographie-IRM en coupes epaisses

    Energy Technology Data Exchange (ETDEWEB)

    Leclerc, J.C.; Cannard, L.; Lefevre, F.; Debelle, L.; Beot, S.; Boccaccini, H.; Bazin, C.; Regent, D. [Centre Hospitalier Universitaire Nancy-Brabois, 54 - Vandoeuvre-les-Nancy (France)

    2001-02-01

    Purpose. To assess the value of single shot fast spin echo MR sequence (SS-FSE) in the evaluation of the normal and pathologic intrahepatic biliary tree. Material and Methods. 418 consecutive patients (457 examinations) referred for clinical and/or biological suspicion of biliary obstruction underwent MR cholangio-pancreatography (MRCP). All patients were imaged with a Signa 1.5 T GE MR unit, with High Gradient Field Strength and Torso Phased Array Coil. Biliary ducts were imaged with SS-FSE sequence, coronal and oblique coronal 20 mm thick slices on a 256 x 256 matrix. Total acquisition time was 1 second. Source images were reviewed by two radiologists blinded to clinical information. In case of disagreement, a third radiologist's opinion was requested. In all cases, MRCP results were compared with direct biliary tract evaluation, other imaging studies and clinical and biological follow-up. Results. In all cases, MRCP produced high quality images. Numerous branch of division were observed although the peripheral intrahepatic ducts were well seen in more than 90% in an area 2 cm below the capsule. The number of division was statistically higher when mechanical obstruction was present. Intrahepatic calculi or peripheral cholangio-carcinoma were well detect by MRCP. For the detection of cholangitis, MRCP sensitivity was 87.5% but the positive predictive value was only 57.7% because of a high number of false positive. The diagnosis of primary sclerosing cholangitis must be made only on strict criteria and slightly dilated peripheral bile ducts unconnected to the central ducts in several hepatic segments were a characteristic MR sign of primary sclerosing cholangitis. Conclusion. MRCP can be proposed as a first intention imaging technique for the evaluation of intrahepatic ducts. (authors)

  3. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2006-08-15

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

  4. Magnetic Resonance Cholangiography with Mangafodipir Trisodium in Caroli's Disease with Pancreas Involvement

    Directory of Open Access Journals (Sweden)

    Simone Maurea

    2010-09-01

    Full Text Available Context Caroli’s disease is a rare congenital disorder first described by Caroli in 1958. This abnormality consists of non-obstructive, saccular or fusiform dilation of the intrahepatic bile ducts resulting in cystic lesions; similar abnormalities may also occur in the kidneys and pancreas. Case report We illustrate the role of enhanced mangafodipir trisodium magnetic resonance imaging in a patient with sporadic non-hereditary Caroli’s disease associated with pancreatic involvement in which mangafodipir trisodium magnetic resonance imaging characterized part of the cystic liver lesions as saccular dilations of the intrahepatic bile ducts of the left lobe, allowing diagnosis of the disease. Conclusion We strongly recommend hepatobiliary magnetic resonance imaging with mangafodipir trisodium in such patients.

  5. Ultrasound-guided percutaneous transhepatic cholangiography and drainage in patients with hilar cholangiocarcinoma.

    Science.gov (United States)

    Laméris, J S; Hesselink, E J; Van Leeuwen, P A; Nijs, H G; Meerwaldt, J H; Terpstra, O T

    1990-05-01

    The use of ultrasound-guided PTCD in 49 patients with hilar cholangiocarcinoma was evaluated. In 11 patients PTCD was performed as a preoperative measure either to outline tumor extension or to treat cholangitis. Postoperatively, the catheters were used to stent bilioenteric anastomoses and served to guide iridium wires for radiotherapy in nine patients with nonresectable tumor or tumor residue after resection. In 20 inoperable patients with tumor diameter smaller than 3 cm and in whom at least one catheter could be manipulated through the tumor, PTCD was combined with internal and external radiotherapy. The remaining 18 patients were palliated with PTCD only. In 29 patients (59%) complete drainage of the biliary system was achieved. Twenty-seven of these had complete internal drainage using endoprostheses. Two had a combination of an endoprosthesis and external catheter drainage. Of the 20 patients (41%) with incomplete drainage, 12 had endoprostheses, four had a catheter and an endoprosthesis, and in the remaining four external catheter drainage was the optimum result. PTCD was successful in treating eight of ten patients with cholangitis and 12 of 16 patients with pruritus. Procedure-related complication occurred in 11 patients (22%). With the exception of one, all complications could be classified as minor, requiring only conservative measures. A major complication was seen in a patient with ascitic fluid and severe cholangitis. PTCD caused a bacterial peritonitis, of which the patient died. The median survival of patients treated with PTCD alone only was 4 months. A significant increase in survival was noted in patients treated with PTCD and radiotherapy (median survival 8 months).(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Impact of intra-operative cholangiography and parenchymal resection to donor liver function in living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Feng Gao; Wei-Lin Wang and Shu-Sen Zheng; Xiao Xu; Yang-Bo Zhu; Qiang Wei; Bin Zhou; Xiao-Yong Shen; Qi Ling; Hai-Yang Xie; Jian Wu

    2014-01-01

    BACKGROUND: Living  donor  liver  transplantation  (LDLT) has been widely accepted over the past decade, and hepatic dysfunction often occurs in the donor in the early stage after liver donation. The present study aimed to evaluate the effect of intra-operative cholangiography (IOC) and parenchymal resection on liver function of donors in LDLT, and to assess the role of IOC in inlfuencing the biliary complications and improving the overall outcome. METHODS: Data from 40 patients who had donated their right lobes for LDLT were analyzed. Total bilirubin (TB), alanine aminotransferase  (ALT),  aspartate  aminotransferase  (AST), alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GGT) at different time points were compared, and the follow-up data and the biliary complications were also analyzed. RESULTS: The ALT and AST values were signiifcantly increased after  IOC  (P0.05)  or  parenchymal resection (P>0.05). The biochemical changes caused by IOC or parenchymal resection were not correlated with the degree of post-operative liver injury or the recovery of liver function. The liver functions of the donors after operation were stable, and none of the donors suffered from biliary stenosis or leakage during the follow-up. CONCLUSIONS: IOC and parenchymal resection may induce a transient increase in liver enzymes of donors in LDLT, but do not affect the recovery of liver function after operation. Moreover, the routine IOC is helpful to clarify the division line of the hepatic duct, thus reducing the biliary complication rate.

  7. Role of multislice CT and magnetic resonance cholangiography in preoperative evaluation of potential donor in living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Hossam M. Abdel-Rahman

    2016-03-01

    Conclusion: Multislice CT is a valuable tool in the evaluation of potential living liver donors that provides complete information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements. MRC with a 3.0-T MR system demonstrates the preoperative biliary evaluation very well with a high accuracy rate.

  8. Creation of a Fistula Between the Hepatic Duct and the Gastric Lumen by way of Percutaneous Transhepatic Cholangiography: A Case Report

    DEFF Research Database (Denmark)

    Lauridsen, Mette Cathrine; Mortensen, Frank Viborg; Nielsen, Dennis Tønner

    2012-01-01

    Introduction: Cholangiocellular carcinoma accounts for 3% of gastrointestinal tumors. It is the second most common primary hepatic malignancy and is associated with primary sclerosing cholangitis. Case description: We report a patient with primary sclerosing cholangitis and cholangiocellular...

  9. Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines: a systematic review

    NARCIS (Netherlands)

    Geenen, E.J.M. van; Santvoort, H.C. van; Besselink, M.G.; Peet, D.L. van der; Erpecum, K.J. van; Fockens, P.; Mulder, C.J.; Bruno, M.J.

    2013-01-01

    OBJECTIVES: Several randomized controlled trials studied the role of endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES) in acute biliary pancreatitis (ABP). No study assessed whether these trials resulted in international consensus in published meta-analyses a

  10. Accuracy of magnetic resonance cholangiography compared to operative endoscopy in detecting biliary stones, a single center experience and review of literature

    Institute of Scientific and Technical Information of China (English)

    Francesco; A; Polistina; Mauro; Frego; Marco; Bisello; Emy; Manzi; Antonella; Vardanega; Bortolo; Perin

    2015-01-01

    AIM: To compare diagnostic sensitivity, specificity and accuracy of magnetic resonance cholangiopancreatography(MRCP) without contrast medium and endoscopic ultrasound(EUS)/endoscopic retrograde cholangiopancreatography(ERCP) for biliary calculi. METHODS: From January 2012 to December 2013, two-hundred-sixty-three patients underwent MRCP at our institution, all MRCP procedure were performed with the same machinery. In two-hundred MRCP was done for pure hepatobiliary symptoms and these patients are the subjects of this study. Among these two-hundred patients, one-hundred-eleven(55.5%) underwent ERCP after MRCP. The retrospective study design consisted in the systematic revision of all images from MRCP and EUS/ERCP performed by two radiologist with a long experience in biliary imaging, an experienced endoscopist and a senior consultant in Hepatobiliopancreatic surgery. A false positive was defined an MRCP showing calculi with no findings at EUS/ERCP; a true positive was defined as a concordance between MRCP and EUS/ERCP findings; a false negative was defined as the absence of images suggesting calculi at MRCP with calculi localization/extraction at EUS/ERCP and a true negative was defined as a patient with nocalculi at MRCP ad at least 6 mo of asymptomatic followup. Biliary tree dilatation was defined as a common bile duct diameter larger than 6 mm in a patient who had an in situ gallbladder. A third blinded radiologist who examined the MRCP and ERCP data reviewed misdiagnosed cases. Once obtained overall data on sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) we divided patients in two groups composed of those having concordant MRCP and EUS/ERCP(Group A, 72 patients) and those having discordant MRCP and EUS/ERCP(Group B, 20 patients). Dataset comparisons had been made by the Student’s t-test and χ2 when appropriate.RESULTS: Two-hundred patients(91 men, 109 women, mean age 67.6 years, and range 25-98 years) underwent MRCP. All patients attended regular follow-up for at least 6 mo. Morbidity and mortality related to MRCP were null. MRCP was the only exam performed in 89 patients because it did show only calculi into the gallbladder with no signs of the presence of calculi into the bile duct and symptoms resolved within a few days or after colecistectomy. The patients remained asymptomatic for at least 6 mo, and we assumed they were true negatives. One hundred eleven(53 men, 58 women, mean age 69 years, range 25-98 years) underwent ERCP following MRCP. We did not find any difference between the two groups in terms of race, age, and sex. The overall median interval between MRCP and ERCP was 9 d. In detecting biliary stones MRCP Sensitivity was 77.4%, Specificity 100% and Accuracy 80.5% with a PPV of 100% and NPV of 85%; EUS showed 95% sensitivity, 100% specificity, 95.5% accuracy with 100% PPV and 57.1% NPV. The association of EUS with ERCP performed at 100% in all the evaluated parameters. When comparing the two groups, we did not find any statistically significant difference regarding age, sex, and race. Similarly, we did not find any differences regarding the number of extracted stones: 116 stones in Group A(median 2, range 1 to 9) and 27 in Group B(median 2, range 1 to 4). When we compared the size of the extracted stones we found that the patients in Group B had significantly smaller stones: 14.16 ± 8.11 mm in Group A and 5.15 ± 2.09 mm in Group B; 95% confidence interval = 5.89-12.13, standard error = 1.577; P < 0.05. We also found that in Group B there was a significantly higher incidence of stones smaller than 5 mm: 36 in Group A and 18 in Group B, P < 0.05.CONCLUSION: Major finding of the present study is that choledocholithiasis is still under-diagnosed in MRCP. Smaller stones(< 5 mm diameter) are hardly visualized on MRCP.

  11. Endosonography with linear array instead of endoscopic retrograde cholangiography as the diagnostic tool in patients with moderate suspicion of common bile duct stones

    Institute of Scientific and Technical Information of China (English)

    Maciej Kohut; Andrzej Nowak; Ewa Nowakowska-Dutawa; Tomasz Marek; Roman Kaczor

    2003-01-01

    AIM: To evaluate the diagnostic efficiency of endoscopic ultrasound (EUS) as the main imaging modality in patients with moderate suspicion of common bile duct stones (CBDS).METHODS: 55 patients with moderate clinical suspicion of CBDS were prospectively included to the study and evaluated with EUS. This study was done in single blind method in the clinical and biochemical data of patients. EUS was done with echo-endoscope Pentax FG 32-UA (f=5-7,5 MHz) and Hitachi EUB 405 ultrasound machine. Patients diagnosed with CBDS by EUS were excluded from this study and treated with ERC. All the other patients were included to the follow up study obtained by mail every 6 months for clinical evaluation (need of ERC or surgery).RESULTS: CBDS was found in 4 patients by EUS. Diagnosis was confirmed in all cases on ERC. The remaining 51 patients without CBDS on EUS were followed up for 6-26 months (meanly 13 months) There were: 40 women, 42cholecystectomized patients, aged: 55 (mean). Biochemical values (mean values) were as follows: bilirubin: 14,9 μmol.L-1,alkaline phosphatase: 95 IU.L-,1 γ-GTP: 131 IU.L-1, ALT: 50IU.L-1, AST: 49 IU.L-1, Only 1 patient was lost for follow up.In the remaining 50 patients with follow up, there was only 1 (2 %) patient with persistent biliary symptoms in whom CBDS was finally diagnosed by ERC with ES. All other patients remained symptoms free on follow up and did not require ERC or biliary surgery.CONCLUSION: Vast majority of patients with moderate suspicion of CBDS and no stones on EUS with linear array can avoid invasive evaluation of biliary tree with ERC.

  12. C型臂X线机在术中胆道造影中的应用%Application of C-arm X-ray machine in intraoperative cholangiography (IOC)

    Institute of Scientific and Technical Information of China (English)

    宋建华; 林伟

    2006-01-01

    目的:通过对C型臂X线机在术中胆道造影中的应用,研究其对术中胆道结石残留的影响,确切了解C型臂X线机在腹腔镜胆囊切除术(LC)中的使用价值.方法:采用对比法,对使用C型臂X线机和未使用C型臂X线机的两组病人进行对比分析、统计、最后得出结果.结果:使用C型臂X线机的病人术中结石残留明显少于不使用C型臂X线机的病人(χ2≈13.06,P<0.05).结论:C型臂X线机在术中胆道造影中能很好地显示结石的部位、形态,数目和大小,对减少结石残留和提高LC手术质量有着非常重要的作用.

  13. Rationale diagnostic approach to biliary tract imaging; Rationale Diagnostik der Gallenwege

    Energy Technology Data Exchange (ETDEWEB)

    Helmberger, H.; Huppertz, A.; Ruell, T. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Zillinger, C.; Ehrenberg, C.; Roesch, T. [Technische Univ. Muenchen (Germany). 2. Medizinische Klinik und Poliklinik

    1998-04-01

    Since the introduction of MR cholangiography (MRC) diagnostic imaging of the biliary tract has been significantly improved. While percutaneous ultrasonography is still the primary examination, computed tomography (CT), conventional magnetic resonance imaging (MRI), as well as the direct imaging modalities of the biliary tract - iv cholangiography, endoscopic-retrograde-cholangiography (ERC), and percutaneous-transhepatic-cholangiography (PTC) are in use. This article discusses the clinical value of the different diagnostic techniques for the various biliary pathologies with special attention to recent developments in MRC techniques. An algorithm is presented offering a rational approach to biliary disorders. With further technical improvement shifts from ERC(P) to MRC(P) for biliary imaging could be envisioned, ERCP further concentrating on its role as a minimal invasive treatment option. (orig.) [Deutsch] Die Diagnostik der Gallenwege hat durch die Einfuehrung der MR-Cholangiographie (MRC) entscheidende neue Impulse erfahren. Neben der als Ausgangsuntersuchung zur Verfuegung stehenden perkutanen Sonographie kommen die Computertomographie (CT), die klassische Magnetresonanztomographie (MRT) sowie die Verfahren der direkten Gallengangsdarstellung, i.v. Cholangiographie, endoskopisch-retrograde Cholangiographie (ERC) und perkutane-transhepatische Cholangiographie (PTC), zum Einsatz. Der vorliegende Artikel analysiert die diagnostischen Wertigkeiten der einzelnen bildgebenden Verfahren fuer die unterschiedlichen Krankheitsgruppen des biliaeren Systems unter besonderer Beruecksichtigung der neuesten Entwicklungen auf dem Gebiet der MRC. In einem Strategiealgorithmus wird ein Vorschlag fuer das diagnostische Vorgehen bei Erkrankungen des biliaeren Gangsystems erarbeitet. Die bisherigen Ergebnisse lassen erwarten, dass die MRT einschliesslich MRC(P) in Kuerze die rein diagnostische ERC(P) ersetzen wird. (orig.)

  14. Usefulness of magnetic resonance cholangiography in the diagnosis of biliary tract lesions in patients with suspected complication following cholecystectomy; Valor da colangiopancreatografia por ressonancia magnetica no diagnostico de lesoes das vias biliares em pacientes com suspeita de complicacao pos-colecistectomia

    Energy Technology Data Exchange (ETDEWEB)

    Cecin, Alexandre de Oliveira [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Goldman, Suzan Menasce; Caetano, Simone; Rosas, George de Queiroz; Coelho, Rafael Darahem de Souza [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem; Lobo, Edson Jose [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Gastroenterologia Cirurgica; Abdalla, Nitamar; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem

    2005-01-15

    Objective: to determine the usefulness of magnetic resonance cholangiopancreatography (MRCP) in the diagnoses of bile duct injuries following cholecystectomy. Material and method: MRCP was retrospectively evaluated in 40 patients with suspected bile duct injury after laparoscopic or conventional cholecystectomy. Eight of these patients had been submitted to biliary reconstruction. All patients were symptomatic (jaundice, fever and chills, weight loss and abdominal pain). The scans were independently reviewed by two radiologists. The results were confirmed by surgery, percutaneous drainage, endoscopic retrograde cholangiopancreatography and clinical follow-up. The level and severity of bile duct injury were rated according to the Bismuth classification. Results: in a total of 40 symptomatic patients, 10 (25%) had normal findings on MRCP; Postoperative complications were seen in 29 (72.5%) patients, seven of them with more than one finding. Pancreatic head neoplasia was diagnoses in one patient. The most frequent finding was sclerosing (41.4%) followed by biliary duct stenosis (34.5%), residual or recurrent biliary stones (31.0%) and fluid collections (17.2%). The images obtained by MRCP were considered of good quality. Conclusion: MRCP is an effective method for the evaluation of patients with suspected postcholecystectomy biliary tract complications. (author)

  15. Percutaneous transhepatic cholelithotripsy for difficult common bile duct stones

    DEFF Research Database (Denmark)

    Stage, J G; Moesgaard, F; Grønvall, S

    1998-01-01

    to endoscopic retrograde cholangiography and extracorporeal shock wave lithotripsy underwent cholelithotripsy, utilizing a new dilation kit with massive teflon dilators covered by "peel-away sheets". RESULTS: Successful lithotripsy was performed in all patients by laser lithotripsy through a choledochoscope...

  16. [Gadolinium as an alternative radiocontrast agent in patients with allergy to iodine-based contrast provide for useful diagnostic imagings and safely treatment of biliary tract diseases].

    Science.gov (United States)

    Natsume, Makoto; Sano, Hitoshi; Fukusada, Shigeki; Kachi, Kenta; Inoue, Tadahisa; Anbe, Kaiki; Nishie, Hirotada; Nishi, Yuji; Yoshimura, Norihiro; Mizushima, Takashi; Okumura, Fumihiro; Miyabe, Katsuyuki; Naitoh, Itaru; Hayashi, Kazuki; Nakazawa, Takahiro

    2013-05-01

    Diagnosis and treatment of biliary tract disease requires an intraductal radiocontrast agent. Although iodine-based contrast medium is commonly used, some patients show severe allergy to iodinated contrast agent. We have retrospectively reviewed the usefulness and safety of gadolinium as an alternative radiocontrast agent in 3 patients with allergy to iodine-based contrast medium in the diagnosis and treatment of biliary tract diseases. In case 1, percutaneous transhepatic biliary drainage and cholangiography were performed successfully and it was possible to visualize an intrahepatic bile duct stone. Percutaneous transhepatic cholangioscopic lithotomy was performed and the intrahepatic bile duct stone was removed. In case 2, endoscopic biliary lithotripsy was performed. In case 3, percutaneous transhepatic cholangiography and cholangioscopy provided a diagnosis of moderately differentiated carcinoma. He underwent pancreatoduodenectomy. Postoperative cholangiograms were also obtained successfully. Gadolinium contrast agent is an alternative to iodine-based cholangiography for the patients with allergy to iodine.

  17. Caroli's disease: magnetic resonance imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Guy, France; Cognet, Francois; Dranssart, Marie; Cercueil, Jean-Pierre; Conciatori, Laurent; Krause, Denis [Department of Radiology and Imaging, Dijon Le Bocage University Hospital, 2 Blvd. Marechal de Lattre de Tassigny, BP 1542, 21034 Dijon Cedex (France)

    2002-11-01

    Our objective was to describe the main aspects of MR imaging in Caroli's disease. Magnetic resonance cholangiography with a dynamic contrast-enhanced study was performed in nine patients with Caroli's disease. Bile duct abnormalities, lithiasis, dot signs, hepatic enhancement, renal abnormalities, and evidence of portal hypertension were evaluated. Three MR imaging patterns of Caroli's disease were found. In all but two patients, MR imaging findings were sufficient to confirm the diagnosis. Moreover, MR imaging provided information about the severity, location, and extent of liver involvement. This information was useful in planning the best therapeutic strategy. Magnetic resonance cholangiography with a dynamic contrast-enhanced study is a good screening tool for Caroli's disease. Direct cholangiography should be reserved for confirming doubtful cases. (orig.)

  18. 术中胆道造影80例X线临床分析

    Institute of Scientific and Technical Information of China (English)

    刘习新

    2003-01-01

    Objeclive The diagnostic evaluation ff chohmgiogvaphy in operation were dlsussed.Materials and Mefliods 80 cases d cholangiography in operation were collected with randomization and these x-ray findings were analysed with Refrospetlve studied. Results Most patients with cholangifis have fever and hyperbilirubinemia. The cholangitis is main X - ray findings in cholangiography in opertion.Conclusion The imaging appearance ff cholangifis is multiple and the clinical metefial is very important to diagnosis. The retained stones were showed by cholangraphy has important value d clinical treatment.

  19. Sclerosing cholangitis: cholescintigraphy with Tc-99m-labeled DISIDA

    Energy Technology Data Exchange (ETDEWEB)

    Ament, A.E.; Bick, R.J.; Miraldi, F.D.; Haaga, J.R.; Wiedenmann, S.D.

    1984-04-01

    Four patients with primary sclerosing cholangitis (PCS) were examined with the hepatobiliary agent Tc-99m-labeled DISIDA (diisopropylphenylcarbamoyl iminodiacetic acid), and the results correlated with those of invasive cholangiography. Cholescintigraphy is superior to cholangiography in cases of suspected PSC where there is nonfilling of biliary radicals due to high-grade stenosis. The finding of delayed hepatic parenchymal clearance can allow estimation of the degree of obstruction of the various branches of the major bile ducts. Cholescintigraphy offers a noninvasive method of investigating patients with suspected sclerosing chloangitis, leading to earlier diagnosis. Confirmation with invasive cholangiographic procedures is recommended.

  20. MRCP findings in recurrent pyogenic cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Manoj [Department of Radiology, AMRI Hospitals, Salt Lake, JC-16 and 17 Salt Lake City, Kolkata 700091 (India)], E-mail: jainmanoj70@hotmail.com; Agarwal, Ajay [Department of Radiology, AMRI Hospitals, Salt Lake, JC-16 and 17 Salt Lake City, Kolkata 700091 (India)], E-mail: doctorajay2002@yahoo.co.in

    2008-04-15

    Objective: In this essay, we present the spectrum of intrahepatic and extrahepatic bile duct abnormalities seen on MRCP in patients with recurrent pyogenic cholangitis. Conclusion: MRCP is a promising, noninvasive alternative to more invasive direct cholangiography for evaluating the intrahepatic and extrahepatic bile ducts in patients with recurrent pyogenic cholangitis.

  1. Diagnosticering af choledochussten ved symptomgivende galdestenssygdom

    DEFF Research Database (Denmark)

    Kristiansen, V B; Rosenberg, J; Kehlet, H

    2000-01-01

    as such in the future. Patients with cholangitis, jaundice and common bile duct stones visualised by transabdominal ultrasound have a high risk of common bile duct stones, and these patients can therefore undergo endoscopic retrograde cholangiography directly. Other patients should have a magnetic resonance...

  2. Documenting correct assessment of biliary anatomy during laparoscopic cholecystectomy

    NARCIS (Netherlands)

    Buddingh, K. T.; Morks, A. N.; Hoedemaker, H. O. ten Cate; Blaauw, C. B.; van Dam, G. M.; Ploeg, R. J.; Hofker, H. S.; Nieuwenhuijs, V. B.

    2012-01-01

    Background Correct assessment of biliary anatomy can be documented by photographs showing the "critical view of safety" (CVS) but also by intraoperative cholangiography (IOC). Methods Photographs of the CVS and IOC images for 63 patients were presented to three expert observers in a random and blind

  3. The Determinants of the Use of Assistants at Surgery

    Science.gov (United States)

    1990-02-01

    of closed or owen intertrochanteric, 2% pertrochanteric, or subtrochanteric femoral fracture , with internal fixation 33512 Coronary artery bypass...Cholecystectomy; with cholangiography 2% 27244 Open treatment of closed or open intertrochanteric, 2% pertrochanteric, or subtrochanteric femoral fracture ...autogenous graft (e.g., saphenous 2% vein or internal mammary artery); three coronary grafts 27236 Open treatment of closed or open femoral fracture , 2

  4. Akut pancreatitis forårsaget af galdesten i barnealderen

    DEFF Research Database (Denmark)

    Zachariassen, G; Saffar, D F; Mortensen, J

    1999-01-01

    A 10 year-old girl presented with acute abdominal pain. Serum-amylase was 3959 U/l. Ultrasonography showed dilatation of both the common bile duct and the pancreatic duct and a high density area near the ampulla. Endoscopic retrograde cholangiography (ERC) verified a stone near the ampulla, which...

  5. Improved transvenous liver biopsy needle

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Matzen, P; Christoffersen, P;

    1979-01-01

    A modified type of the standard transvenous cholangiography biopsy needle is described. The modified tranvenous liver biopsy needle caused only minimal artefactual changes of the liver biopsy specimens. The new type of biopsy needle is a modified Menghini needle. The conventional Menghini needle...... should be avoided for transvenous catheter biopsies because of risk of leaving catheter fragments in the liver....

  6. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Long Version)

    DEFF Research Database (Denmark)

    Dietrich, C F; Lorentzen, T; Appelbaum, L

    2016-01-01

    are presented covering indications, contraindications, and safe and effective performance of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous...... transhepatic cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (long version)....

  7. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version)

    DEFF Research Database (Denmark)

    Dietrich, C F; Lorentzen, T; Appelbaum, L

    2016-01-01

    are presented covering indications, contraindications, safety and efficacy of the broad variety of these techniques. In particular, drainage of abscesses and fluid collections, interventional tumor ablation techniques, interventional treatment of symptomatic cysts and echinococcosis, percutaneous transhepatic...... cholangiography and drainage, percutaneous gastrostomy, urinary bladder drainage, and nephrostomy are addressed (short version; a long version is published online)....

  8. Portal cholangiopathy: case report

    Directory of Open Access Journals (Sweden)

    Maria Cecilia Almeida Maia

    2014-01-01

    Full Text Available The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

  9. Gallbladder duplication

    Directory of Open Access Journals (Sweden)

    Yagan Pillay

    2015-01-01

    Conclusion: Duplication of the gallbladder is a rare congenital abnormality, which requires special attention to the biliary ductal and arterial anatomy. Laparoscopic cholecystectomy with intraoperative cholangiography is the appropriate treatment in a symptomatic gallbladder. The removal of an asymptomatic double gallbladder remains controversial.

  10. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations.

    Science.gov (United States)

    Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Sanchez-Cabus, Santiago; Calatayud, David; Pavel, Mihai Calin; Fondevila, Constantino; Fuster, Jose; García-Valdecasas, Juan Carlos

    2015-11-01

    Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors.

  11. Cystic duct remnant mucocele in a liver transplant recipient

    Energy Technology Data Exchange (ETDEWEB)

    Ahlawat, Sushil K. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ (United States); Fishbien, Thomas M. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); Haddad, Nadim G. [Georgetown University Hospital, Department of Surgery, Division of Transplant Surgery, Washington, DC (United States)

    2008-08-15

    Cystic duct remnant mucocele is an extremely rare complication of liver transplantation in children. Surgical correction is usually required for cystic duct remnant mucocele when it causes biliary obstruction. We describe a 14-month-old liver transplant recipient who presented with biliary obstruction 1 month after orthotopic liver transplantation with an end-to-end choledochocholedocal biliary anastomosis for hepatoblastoma. US, CT and cholangiography findings were consistent with mucocele of the allograft cystic duct remnant. Surgery was not needed in our patient because the mucocele and biliary obstruction had resolved on repeat imaging most likely due to guidewire manipulation during cholangiography, resulting in opening of the cystic duct remnant orifice and drainage into the common duct. (orig.)

  12. Cholecystitis of a duplicated gallbladder complicated by a cholecystoenteric fistula

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Brady K. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Chess, Mitchell A. [University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY (United States); Advanced Imaging, Batavia, NY (United States)

    2009-04-15

    Gallbladder duplications are uncommon anatomic variants that are sometimes mistaken for other entities on imaging. We present a surgically confirmed case of cholecystitis in a ductular-type duplicated gallbladder complicated by the formation of an inflammatory fistula to the adjacent duodenum. Both US and magnetic resonance cholangiopancreatography were performed preoperatively, in addition to intraoperative cholangiography, which confirmed the presence of a duplicated gallbladder. (orig.)

  13. Fasciola hepatica infestation as a very rare cause of extrahepatic cholestasis

    Institute of Scientific and Technical Information of China (English)

    Ahmet Dobrucali; Rafet Yigitbasi; Yusuf Erzin; Oguzhan Sunamak; Erdal Polat; Hakan Yakar

    2004-01-01

    Fasciola hepatica, an endemic parasite in Turkey, is still a very rare cause of cholestasis worldwide. Through ingestion of contaminated water plants like watercress, humans can become the definitive host of this parasite. Cholestatic symptoms may be sudden but in some cases they may be preceeded by a long period of fever, eosinophilia and vague gastrointestinal symptoms. We report a woman with cholangitis symptoms of sudden onset which was proved to be due to Fasciola hepatica infestation by an endoscopic retrograde cholangiography.

  14. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management

    OpenAIRE

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  15. Biliary peritonitis following percutaneous nephrolithotomy: Minimally invasive management.

    Science.gov (United States)

    Yadav, Siddharth; Singh, Animesh; Singh, Prabhjot

    2015-01-01

    Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal calculi but has potential for complications. Rarely, biliary tract injury can occur during PCNL that can lead to biliary peritonitis with sepsis. Such cases are usually managed by emergent cholecystectomy. We present a case of biliary peritonitis resulting from gall bladder injury during PCNL, managed minimally invasively with an abdominal drain and endoscopic retrograde cholangiography with common bile duct stenting.

  16. Biliary ascariasis. A case report.

    Science.gov (United States)

    Sarihan, H; Gürkök, S; Sari, A

    1995-01-01

    Ascaris lumbricoides is a worldwide intestinal infestation that may cause various complications. Biliary ascariasis, however, is a rare condition. We describe a child with biliary ascariasis. The patient's clinical symptoms were pain, vomiting and abdominal tenderness, and she was thought to have acute appendicitis. However, laboratory examination revealed high serum alkaline phosphatase and amylase levels, and ultrasonography and percutaneous cholangiography demonstrated biliary ascariasis. The patient was successfully treated with mebendazole and antispasmolytic drugs.

  17. Diagnostic and therapeutic approach to cholestatic liver disease Abordaje diagnóstico y terapéutico del síndrome colestásico

    OpenAIRE

    T. Pérez Fernández; P. López Serrano; E. Tomás; Mª L. Gutiérrez; J. L. Lledó; G. Cacho; C. Santander; C. M. Fernández Rodríguez

    2004-01-01

    When cholestatic liver disease is present, liver ultrasound should be performed to ascertain if cholestasis is extrahepatic or intrahepatiic. If bile ducts appear dilated and the probability of interventional treatment is high, endoscopic retrograde cholagio-pancreatography (ERCP) or trans-hepatic cholangiography (THC) should be the next step. If the probability of interventional therapeutics is low, cholangio-MRI should be performed. Once bile duct dilation and space occupying lesions are ex...

  18. Isolated extrahepatic bile duct rupture: a rare consequence of blunt abdominal trauma. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Balzarotti Ruben

    2012-05-01

    Full Text Available Abstract A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominal pain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13 days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.

  19. The role of sonography in imaging of the biliary tract.

    Science.gov (United States)

    Foley, W Dennis; Quiroz, Francisco A

    2007-06-01

    Sonography is the recommended initial imaging test in the evaluation of patients presenting with right upper quadrant pain or jaundice. Dependent upon clinical circumstances, the differential diagnosis includes choledocholithiasis, biliary stricture, or tumor. Sonography is very sensitive in detection of mechanical biliary obstruction and stone disease, although less sensitive for detection of obstructing tumors, including pancreatic carcinoma and cholangiocarcinoma. In patients with sonographically documented cholelithiasis and choledocholithiasis, laparoscopic cholecystectomy with operative clearance of the biliary stone disease is usually performed. In patients with clinically suspected biliary stone disease, without initial sonographic documentation of choledocholithiasis, endoscopic ultrasound or magnetic resonance cholangiopancreatography is the next logical imaging step. Endoscopic ultrasound documentation of choledocholithiasis in a postcholecystectomy patient should lead to retrograde cholangiography, sphincterotomy, and clearance of the ductal calculi by endoscopic catheter techniques. In patients with clinical and sonographic findings suggestive of malignant biliary obstruction, a multipass contrast-enhanced computed tomography (CT) examination to detect and stage possible pancreatic carcinoma, cholangiocarcinoma, or periductal neoplasm is usually recommended. Assessment of tumor resectability and staging can be performed by CT or a combination of CT and endoscopic ultrasound, the latter often combined with fine needle aspiration biopsy of suspected periductal tumor. In patients whose CT scan suggests hepatic hilar or central intrahepatic biliary tumor, percutaneous cholangiography and transhepatic biliary stent placement is usually followed by brushing or fluoroscopically directed fine needle aspiration biopsy for tissue diagnosis. Sonography is the imaging procedure of choice for biliary tract intervention, including cholecystostomy, guidance for

  20. Klatskin tumors and the accuracy of the Bismuth-Corlette classification.

    Science.gov (United States)

    Paul, Andreas; Kaiser, Gernot M; Molmenti, Ernesto P; Schroeder, Tobias; Vernadakis, Spiridon; Oezcelik, Arzu; Baba, Hideo A; Cicinnati, Vito R; Sotiropoulos, Georgios C

    2011-12-01

    The Bismuth-Corlette (BC) classification is the current preoperative standard to assess hilar cholangiocarcinomas (HC). The aim of this study is to evaluate the accuracy, sensitivity, and prognostic value of the BC classification. Data of patients undergoing resection for HC were analyzed. Endoscopic retrograde cholangiography and standard computed tomography were undertaken in all cases. Additional 3D-CT-reconstructions, magnetic resonance imaging, and percutaneous transhepatic cholangiography were obtained in selected patients. A systematic review and meta-analysis of the literature was performed. Ninety patients underwent resection of the hilar bile duct confluence, with right or left hemihepatectomy in 68 instances. The overall accuracy of the BC classification was 48 per cent. Rates of BC under- and over-estimation were 29 per cent and 23 per cent, respectively. The addition of MRI, 3D-CT-reconstructions, or percutaneous transhepatic cholangiography improved the accuracy to 49 per cent (P = 1.0), 53 per cent (P = 0.074), and 64 per cent (P < 0.001), respectively. Lowest sensitivity rates were for BC Type IIIA/IIIB tumors. Meta-analysis of published BC data corresponding to 540 patients did not reach significance. The BC classification has low accuracy and no prognostic value in cases of HC undergoing resection.

  1. Preoperative assessment of hilar cholangiocarcinoma:combination of cholangiographyandCTangiography

    Institute of Scientific and Technical Information of China (English)

    Shi-An Yu; Cheng Zhang; Jia-Min Zhang; Gen-Jun Mao; Long-Tang Xu; Xiao-Kang Wu; Jin-Er Shu; Guang-Hong Lv; Zhang-Dong Zheng

    2010-01-01

    BACKGROUND: Hilar cholangiocarcinoma is one of the most dififcult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal systems. To plan an operation, it is important to acquire accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This study aimed to evaluate the clinical value of cholangiography combined with spiral CT three-dimensional (3D) angiography for a preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 2007 to August 2009, cholangiography was performed in 13 patients with hilar cholangiocarcinoma. Meanwhile, contrast-enhanced abdominal scanning was performed using 16-slice spiral CT, and the 3D images of the hepatic artery and portal vein were acquired. The level and range of invasion of the hepatic artery, the portal vein, and the bile duct, the preoperative Bismuth classiifcation, and T-staging were recorded and compared with those after surgical exploration. RESULTS: The hepatic artery and portal vein were recon-structed successfully in all these patients. Percutaneous transhepatic cholangiography was performed in 9 patients, endoscopic retrograde cholangiopancreatography in 1, and magnetic resonance cholangiopancreatography in 3. The CT angiography records of invasion of the hepatic artery were consistent with the results of explorations in these patients. The data from 5 of the 13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classiifcation and the T-staging system were consistent with those of surgical exploration in 12 of the 13 patients. Seven of 8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were conifrmed intraoperatively and underwent palliative procedures. CONCLUSIONS: Cholangiography

  2. Percutaneous transcholecystic approach for an experiment of biliary stent placement: an experimental study in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Tae Seok [Medical School of Gachon, Inchon (Korea, Republic of); Song, Ho Young; Lim, Jin Oh; Ko, Gi Young; Sung, Kyu Bo; Kim, Tae Hyung; Lee, Ho Jung [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)

    2002-06-01

    To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2,4 and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrified, and a pathologic examination was performed. Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-period.

  3. Are the imaging findings used to assess the portal triad reliable to perform living-donor liver transplant?; Os achados de imagem para avaliacao da triade portal sao confiaveis para realizacao do transplante hepatico com doador vivo?

    Energy Technology Data Exchange (ETDEWEB)

    Dazzi, Francisco Leoncio; Ribeiro Junior, Marcelo Augusto Fontenelle; Mancero, Jorge Marcelo Padilla; Gonzalez, Adriano Miziara; D' Albuquerque, Luiz Augusto Carneiro, E-mail: franciscodazzi@hotmail.com [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Cirurgia Geral e Transplante; Leao-Filho, Hilton Muniz [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Radiologia e Diagnostico por Imagem; Silva, Adavio de Oliveira e [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil). Departamento de Gastroenterologia e Hepatologia

    2013-07-01

    Background: a crucial aspect of living-donor liver transplant is the risk imposed to the donor due to a procedure performed in a healthy individual that can lead to a high postoperative morbidity rate Aim: To correlate the pre- and intraoperative hepatic imaging findings of living adult donors. Methods: From 2003 to 2008 the medical charts of 66 donors were revised; in that, 42 were males (64%) and 24 females (36%), mean age of 30±8 years. The preoperative anatomy was analyzed by magnetic resonance cholangiography to study the bile ducts and by computed tomography angiography to evaluate the hepatic artery and portal vein. Normalcy criteria were established according to previously published studies. Results: Anatomic variations of the bile ducts were found in 59.1% of donors, of the artery hepatic in 31.8% and of the portal vein in 30.3% of the cases during the preoperative period. The magnetic resonance cholangiography findings were in agreement in 44 (66.6%) of donors and in disagreement in 22 (33.3%). With regards to hepatic artery, in all donors the findings of the imaging examination were in agreement with those of the intraoperative period. As to the portal vein, the computed tomography findings were in agreement in 59 (89.4%) donors and in disagreement in seven (10.6%). Conclusions: the bile duct anatomic variations are frequent, and the magnetic resonance cholangiography showed moderate accuracy (70%) in reproducing the surgical findings; the computed tomography reproduced the intraoperative findings of the hepatic artery in 100% of donors, and of the portal vein in 89.4% of the cases, thus demonstrating high accuracy (89%). (author)

  4. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  5. Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    Shintaro Tsukinaga; Hisao Tajiri; Hiroo Imazu; Yujiro Uchiyama; Hiroshi Kakutani; Akira Kuramoti; Masayuki Kato; Keisuke Kanazawa; Tsuyoshi Kobayashi; Yasuyuki Searashi

    2007-01-01

    We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA).A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm.Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.

  6. [PRIMARY SCLEROSING CHOLANGITIS ASSOCIATED TO ULCERATIVECOLITIS AS A CAUSE OF CIRRHOSIS

    Science.gov (United States)

    Tagle, Martín; Bussalleu, Alejandro

    1999-01-01

    We report case of a peruvian patient with cirrhosis due to primary sclerosing cholangitis, associated with ulcerative colitis. The patient presented initially with intermittent diarrhea, manifesting features of chronic liver failure which progressed rapidly.Primary sclerosing cholangitis is a progressive diasease affecting intra and extrahepatic billary radicles, and is associated with ulcerative colitis in the majority of cases. The diagnosis is made by cholangiography, showing areas of stenosis, irregularity and dilatation of the biliary tree.In this article we report the clinical presentation and course of the patient, reviewing recent literature with emphasis in the association between primary sclerosing cholangitis and ulcerative colitis.

  7. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  8. Left-sided gall bladder: Report of two cases

    Directory of Open Access Journals (Sweden)

    Chrungoo R

    2007-01-01

    Full Text Available Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.

  9. Risk factors affecting the Barrett'smetaplasia-dysplasia-neoplasia sequence

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Biliary complications are being increasingly encounteredin post liver transplant patients because ofincreased volume of transplants and longer survivalof these recipients. Overall management of thesecomplications may be challenging, but with advancesin endoscopic techniques, majority of such patientsare being dealt with by endoscopists rather than thesurgeons. Our review article discusses the recent advancesin endoscopic tools and techniques that haveproved endoscopic retrograde cholangiography withvarious interventions, like sphincterotomy, bile ductdilatation, and stent placement, to be the mainstay formanagement of most of these complications. We alsodiscuss the management dilemmas in patients withsurgically altered anatomy, where accessing the bile ductis challenging, and the recent strides towards makingthis prospect a reality.

  10. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor

    Institute of Scientific and Technical Information of China (English)

    Yasunao; Ishiguro; Masanobu; Hyodo; Takehito; Fujiwara; Yasunaru; Sakuma; Nobuyuki; Hojo; Koichi; Mizuta; Hideo; Kawarasaki; Alan; T; Lefor; Yoshikazu; Yasuda

    2010-01-01

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son,who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years.The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation.With the use of cholangiography at the time of surgery,we found the right anterior segmental duct(RASD) emptying directly into the cystic duct,and the catheter passed into the RASD.After repairing the inci...

  11. Early management of acute pancreatitis.

    Science.gov (United States)

    Schepers, Nicolien J; Besselink, Marc G H; van Santvoort, Hjalmar C; Bakker, Olaf J; Bruno, Marco J

    2013-10-01

    Acute pancreatitis is the most common gastro-intestinal indication for acute hospitalization and its incidence continues to rise. In severe pancreatitis, morbidity and mortality remains high and is mainly driven by organ failure and infectious complications. Early management strategies should aim to prevent or treat organ failure and to reduce infectious complications. This review addresses the management of acute pancreatitis in the first hours to days after onset of symptoms, including fluid therapy, nutrition and endoscopic retrograde cholangiography. This review also discusses the recently revised Atlanta classification which provides new uniform terminology, thereby facilitating communication regarding severity and complications of pancreatitis.

  12. Spontaneous rupture of intrahepatic biliary ducts with biliary peritonitis.

    Science.gov (United States)

    Aydin, Unal; Yazici, Pinar; Coker, Ahmet

    2007-01-01

    Spontaneous rupture of intrahepatic biliary ducts is a rare cause of acute abdomen due to biliary peritonitis. We report a 92-year-old woman with 48-h history of upper abdominal pain, nausea and vomiting and peritoneal signs. CT scan showed free fluid in the abdomen and mild dilatation of the common bile duct. Exploratory laparotomy showed bile in the abdominal cavity with leak-age from a ruptured bile duct radicle in segment 3, as confirmed on intraoperative cholangiography. She underwent cholecystectomy, choledochotomy with removal of gallstones, repair of the perforation with primary suture and placement of a T-tube. She had an uneventful recovery.

  13. [Cytology is in pivotal role at screening and surveillance of PSC].

    Science.gov (United States)

    Boyd, Sonja; Arola, Johanna; Mäkisalo, Heikki; Färkkilä, Martti

    2014-01-01

    Primary sclerosing cholangitis (PSC) is an autoimmune disease leading to biliary strictures and inflammation. The lifetime risk for cholangiocarcinoma (CCA) among PSC patients is 7-13%, and biliary dysplasia is thought to be a precursor lesion for CCA. The diagnosis of PSC is based on endoscopic retrogradic cholangiography (ERC). During ERC brush cytology samples are routinely taken in our unit to detect possible biliary dysplasia. With repeated cytological dysplasia, liver transplantation is considered. Aneuploidy in DNA flow cytometry may support the suspicion of dysplasia. PSC is the most common indication for liver transplantation in Finland, and half of transplantations are prophylactic.

  14. Ultrasonography of Neonatal Cholestasis

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun [Seoul National University Hospital, Seoul (Korea, Republic of)

    2012-06-15

    Ultrasonography (US) is as an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. Beyond two weeks of age, extrahepatic biliary atresia and neonatal hepatitis are the two most common causes of persistent neonatal jaundice: differentiation of extrahepatic biliary atresia, which requires early surgical intervention, is very important. Meticulous analysis should focus on size and configuration of the gallbladder and anatomical changes of the portahepatis. In order to narrow the differential diagnosis, combined approaches using hepatic scintigraphy, MR cholangiography, and, at times, percutaneous liver biopsy are necessary. US is useful for demonstrating choledochal cyst, bile plug syndrome, and spontaneous perforation of the extrahepatic bile duct

  15. Liver abscess associated with an oral flora bacterium Streptococcus anginosus

    Directory of Open Access Journals (Sweden)

    Hava Yılmaz

    2012-03-01

    Full Text Available Viridans group Streptococcus, a bacterium of the oral flora has a low-virulence and rarely causes liver abscess. A 40-yearoldmale patient was admitted to the hospital complaining of high fever and malaise. A physical examination revealedpoor oral hygiene; there were caries on many teeth, and he had hepatomegaly. A hepatic abscess was identified inhis abdominal tomography. Streptococcus anginosus was isolated from the drainage material, and the bile ducts werenormal in his MRI cholangiography. An immunocompetent case of liver abscess caused by Streptococcus anginosusoriginated most probably from oral flora is presented here. J Microbiol Infect Dis 2012; 2(1:33-35

  16. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation

    DEFF Research Database (Denmark)

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne;

    2015-01-01

    % needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died......Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients......, prevented graft failure in 78% of the cases....

  17. 胆道术后留置乳胶型T管对丙氨基转氨酶的不良影响(附33例报道)%Biliary T-tube Indwelling Latex on the Adverse Effects of Propionate Aminotransferase:Report of 33 Cases

    Institute of Scientific and Technical Information of China (English)

    顾凌斌; 史永照; 于愿; 胡丽萍; 范蓁

    2013-01-01

      目的研究长期携带乳胶型 T 管对肝功能 ALT 的影响。方法对2010年2月至2012年8月入院,33例胆总管结石病例部分合并胆囊结石,通过开腹胆总管探查 T 管引流,术后四周拔管,比较其术前、术后、拔管前 ALT 检测结果。结果显示术后与拔管前 ALT 比较P 值=0.0350,与年龄,性别无关,与起病缓急无关。结论长期携带乳胶型 T 管对部分患者肝功能 ALT 存在不良影响%Objective To explore the influence of early cholangiography for griping T-tube based on biliary tract function in patients after exploration of common bile duct. Methods 60 cases of patients with T-tube following exploration of common bile duct was randomly divided into two groups which namely early griping group and control group, 30 cases respectively. The patients of early griping group were underwent T-tube Cholangiography 7 days after the operation,and once the tube was showed to be unobstructed,it would be griped. The control group received common method that T-tubes were griped according to result of cholangiography 2 weeks after the operation. Comparisons of serum density of direct bilirubin (DBIL) and alkaline phosphatase(ALP)between the two groups after operation 1,7 and 14 days. Results After operation 1,7 and 14 days,serum density of DBIL and ALP in the early griping group were showed no statistical signifi cance comparing to the control group(P>0.05). Conclusion Early cholangiography for griping T-tube have no harmful effects on the function of biliary tract.

  18. Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal.

    Science.gov (United States)

    Thandassery, Ragesh Babu; Jha, Ashish Kumar; Goenka, Mahesh Kumar

    2014-04-01

    Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system.

  19. Cholestatic jaundice by malignant lesions: pictorial essay;Ictericia colestatica por lesoes de natureza maligna: ensaio iconografico

    Energy Technology Data Exchange (ETDEWEB)

    Santa Anna, Tatiana Kelly Brasileiro de; Santana, Alex Menezes; Rizzuto, Mauricio Soares; Chagas, Alessandro Rosa Rodrigues; Zuppani, Aguinaldo Cunha, E-mail: tatianakelly@hotmail.co [Hospital Santa Marcelina, Sao Paulo, SP (Brazil). Setor de Radiologia e Diagnostico por Imagem; Rezende, Marcelo Bruno; Viveiros, Marcelo de Melo [Hospital Santa Marcelina, Sao Paulo, SP (Brazil). Servico de Cirurgia do Figado e Hipertensao Portal

    2009-12-15

    Malignant obstructive jaundice is most commonly caused by cancer of pancreatic head, papilla tumor, cholangiocarcinoma and biliary obstruction induced by secondary lesions of the liver or lymph nodes. Patients usually present with weight loss, abdominal pain, jaundice and progressive increase of direct bilirubin, being essential the evaluation by imaging methods for the proper diagnosis, staging and therapeutic planning. This essay illustrates the imaging aspects of ultrasound and computed tomography - and in specific situations magnetic resonance cholangiography - of the major malignancies that lead to cholestatic jaundice. (author)

  20. Gallbladder agenesis in a Chihuahua.

    Science.gov (United States)

    Kamishina, Hiroaki; Katayama, Masaaki; Okamura, Yasuhiko; Sasaki, Jun; Chiba, Satoshi; Goryo, Masanobu; Sato, Reeko; Yasuda, Jun

    2010-07-01

    A 4-year-old neutered male Chihuahua was presented with a history of anorexia and vomiting. Continuous elevation of liver enzymes was found on repeated blood examinations and the dog was referred to us for further evaluation. The absence of gallbladder was suspected on ultrasonography. Exploratory laparotomy and retrograde cholangiography confirmed gallbladder agenesis and a possible hypoplasia of the right medial and lateral liver lobes. Histologically, proliferation of bile ductules associated with portal fibrosis and pseudolobular formation were apparent in the liver lobes.

  1. The Role of Genetic and Immune Factors for the Pathogenesis of Primary Sclerosing Cholangitis in Childhood

    Science.gov (United States)

    Campos Silva, Soraya Luiza; Marques de Miranda, Débora; Ferreira, Alexandre Rodrigues

    2016-01-01

    Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by chronic inflammation of the biliary tree resulting in liver fibrosis. PSC is more common in male less than 40 years of age. The diagnosis of PSC is based on clinical, laboratory, image, and histological findings. A biochemical profile of mild to severe chronic cholestasis can be observed. Endoscopic retrograde cholangiography is the golden standard method for diagnosis, but magnetic resonance cholangiography is currently also considered a first-line method of investigation. Differences in clinical and laboratory findings were observed in young patients, including higher incidence of overlap syndromes, mostly with autoimmune hepatitis, higher serum levels of aminotransferases and gamma-glutamyl transferase, and lower incidence of serious complications as cholangiocarcinoma. In spite of the detection of several HLA variants as associated factors in large multicenter cohorts of adult patients, the exact role and pathways of these susceptibility genes remain to be determined in pediatric population. In addition, the literature supports a role for an altered immune response to pathogens in the pathogenesis of PSC. This phenomenon contributes to abnormal immune system activation and perpetuation of the inflammatory process. In this article, we review the role of immune and genetic factors in the pathogenesis of PSC in pediatric patients. PMID:27882046

  2. The Diagnostic Value of Endoscopic Balloon Catheter Usage for Detecting Early-Stage Primary Sclerosing Cholangitis in Endoscopic Retrograde Cholangiopancreatography:A Case Report

    Directory of Open Access Journals (Sweden)

    Burhan Ozdil

    2010-02-01

    Full Text Available A 34-year-old woman was admitted to our clinic with abdominal pain, jaundice and pruritus. Endoscopic retrograde cholangiopancreatography was performed for cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP was judged as normal, after a standard ERCP cannula was used for the cholangiogram. However, marked canalicular irregularities were identified in cholangiography when pressurized contrast agent was administrated via balloon catheter. This cholangiographic view was thought to reveal an early-stage alteration of sclerosing cholangitis. Primary sclerosing cholangitis (PSC is a chronic cholestatic liver disease characterized by destruction and fibrosis of the bile ducts. The diagnosis of PSC is based on typical cholangiographic findings, supported by nonspecific clinical signs and symptoms, cholestatic liver biochemical tests, and liver biopsy. Cholangiography is considered to be the gold standard for the diagnosis of PSC. The diagnosis is easy when diffuse multifocal biliary strictures, the hallmarks of the disease, resulting in a ‘beaded’ appearance on ERCP is detected. However, it may reveal a normal image in an early stage of the disease when bile duct changings are not prominent. We think that balloon catheter ERCP appears to facilitate the diagnosis of early-stage primary sclerosing cholangitis.

  3. Radiological diagnosis of primary sclerosing cholangitis: value of ERC and CT; Radiologische Diagnostik der Primaer Sklerosierenden Cholangitis: Wertigkeit von ERC und CT

    Energy Technology Data Exchange (ETDEWEB)

    Kollmann, F.D. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Maeurer, J. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Hintze, R.E. [Chirurgische Klinik, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Adler, A. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Veltzke, W. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Lohmann, R. [Chirurgische Klinik, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

    1994-12-31

    To evaluate the use of computed tomography (CT) in primary sclerosing cholangitis (PSC) as compared to endoscopic-retrograde cholangiography (ERC), imaging studies of 24 patients were reviewed. 19 patients were studied by ERC, 19 by CT and 14 by both. In 17 cases, ERC confirmed PSC. One cholangiogram suggested a tumor. CT reflected PSC in only 11 cases, while three patients displayed a mass lesion. Thus, ERC remains the standard imaging technique for diagnosing PSC, whereas CT proves beneficial in excluding hepatic masses. (orig.) [Deutsch] Um den Stellenwert der endoskopisch-retrograden Cholangiographie (ERC) bei Primaer Sklerosierender Cholangitis (PSC) mit dem der Computertomographie (CT) zu vergleichen, wurden Untersuchungen von 24 Patienten mit der klinischen Verdachtsdiagnose PSC retrospektiv ausgewertet. 19 Patienten wurden mit ERC untersucht, 19 mit CT und 14 mit beiden Verfahren. Durch ERC konnte in 17 Faellen die Diagnose bestaetigt werden. In einem Patienten fand sich eine tumorverdaechtige Laesion. Im CT konnten nur in elf Faellen Gallengangsveraenderungen nachgewiesen werden, in drei Untersuchungen jedoch hepatische Raumforderungen. Die ERC bleibt damit die aussagekraeftigere Untersuchung zur Bestaetigung einer PSC-Verdachtsdiagnose, waehrend CT vor allem zur Tumordiagnostik bei PSC-Patienten indiziert ist. (orig.)

  4. Radioisomorphisms of sclerosing cholangitides; Radioisomorphismen sklerosierender Cholangitiden

    Energy Technology Data Exchange (ETDEWEB)

    Knollmann, F.D. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Maeurer, J. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Adler, A. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Hintze, R.E. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Gruenewald, T. [2. Medizinische Klinik mit Schwerpunkt Infektionskrankheiten, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Veltzke, W. [Klinik fuer Innere Medizin mit Schwerpunkt Gastroenterologie, Zentrale Interdisziplinaere Endoskopie, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Lohmann, R. [Chirurgische Klinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Schedel, H. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany); Felix, R. [Strahlenklinik und Poliklinik, Klinikum Rudolf Virchow, Freie Universitaet Berlin (Germany)

    1995-07-01

    For differentiation of Primary Sclerosing Cholangitis (PSC) from AIDS-associated cholangitis (AAC), 95 CT or Cholangiography studies of 37 patients were reviewed and signs of biliary disease analysed. Only two each of PSC and AIDS-subjects were free from biliary lesions compatible with some kind of sclerosing cholangitis. Subgroup analysis revealed wide overlapping of morphological findings in PSC and AAC. We conclude that radioisomorphism of etiologically different forms of sclerosing cholangitis may indicate pathophysiologically similar courses. (orig.) [Deutsch] Um differenzierende Kriterien zwischen der Primaer Sklerosierenden Cholangitis (PSC) und der AIDS-assoziierten Cholangitis (AAC) zu definieren, wurden 37 Patienten mittels Computertomographie (CT) und Cholangiographie (ERC, PTC) in 95 Untersuchungen auf Zeichen einer biliaeren Erkrankung ausgewertet. Nur je zwei der AIDS- und PSC-Patienten zeigten keinerlei Gallenwegslaesionen, alle anderen hatten in mindestens einer Untersuchung einen mit dem Befundspektrum der sklerosierenden Cholangitiden vereinbaren Befund. Die Untergruppenanalyse ergibt weit ueberlappende morphologische Charakteristika von AAC und PSC. Es wird gefolgert, dass radioisomorphe Effekte bei sklerosierenden Cholangitiden auf aetiologisch unterschiedliche, pathophysiologisch vergleichbare Verlaeufe dieser Entitaeten hinweisen koennen. (orig.)

  5. Acute Calculous Cholecystitis: What is new in diagnosis and therapy?

    Directory of Open Access Journals (Sweden)

    Dirk J. Gouma

    1992-01-01

    Full Text Available The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.

  6. Right anterior segmental hepatic duct emptying directly into the cystic duct in a living donor.

    Science.gov (United States)

    Ishiguro, Yasunao; Hyodo, Masanobu; Fujiwara, Takehito; Sakuma, Yasunaru; Hojo, Nobuyuki; Mizuta, Koichi; Kawarasaki, Hideo; Lefor, Alan T; Yasuda, Yoshikazu

    2010-08-07

    A 35-year-old mother was scheduled to be the living donor for liver transplantation to her second son, who suffered from biliary atresia complicated with biliary cirrhosis at the age of 2 years. The operative plan was to recover the left lateral segment of the mother's liver for living donor transplantation. With the use of cholangiography at the time of surgery, we found the right anterior segmental duct (RASD) emptying directly into the cystic duct, and the catheter passed into the RASD. After repairing the incision in the cystic duct, transplantation was successfully performed. Her postoperative course was uneventful. Biliary anatomical variations were frequently encountered, however, this variation has very rarely been reported. If the RASD was divided, the repair would be very difficult because the duct will not dilate sufficiently in an otherwise healthy donor. Meticulous preoperative evaluation of the living donor's biliary anatomy, especially using magnetic resonance cholangiography and careful intraoperative techniques, is important to prevent bile duct injury and avoid the risk to the healthy donor.

  7. Biliary tract obstruction secondary to cancer: management guidelines and selected literature review.

    Science.gov (United States)

    Lokich, J J; Kane, R A; Harrison, D A; McDermott, W V

    1987-06-01

    Malignant biliary tract obstruction (MBTO) due to either primary biliary tract cancer or metastasis to the porta hepatis is a common clinical problem. The most common metastatic tumors causing MBTO in order of frequency are gastric, colon, breast, and lung cancers. Radiographic diagnostic procedures should proceed in a cost-effective sequence from ultrasonography, computerized tomography (CT), percutaneous transhepatic cholangiography (PTHC), and endoscopic retrograde pancreatography with the goal of establishing the site of the biliary tract obstruction. The identification of the site of obstruction could be established by ultrasound 70% to 80%, CT scan 80% to 90%, PTHC 100%, and endoscopic retrograde cholangiography (ERCP) 85%. Therapeutic intervention by radiographic decompression (PTHC or endoscopic prosthesis), surgical bypass, or radiation therapy with or without chemotherapy may be selectively used based on (1) the site of obstruction; (2) the type of primary tumor; and (3) the presence of specific symptoms related to the obstruction. ("Prophylactic" biliary tract decompression to prevent ascending cholangitis is not supported by the literature in that the frequency of sepsis in the face of malignant obstruction is small (in contrast to sepsis associated with stone disease). Furthermore, PTHC with drainage as a long-term procedure is associated with a substantial frequency of sepsis and is unnecessary and possibly problematic as a preoperative procedure simply to reduce the bilirubin level. The use of radiation therapy in conjunction with chemotherapy for patients not deemed suitable for a surgical bypass because of the presence of proximal obstruction is an important alternative to PTHC.

  8. Hilar Cholangiocarcinoma Diagnosed and Treated Early, in Prejaundice Phase

    Directory of Open Access Journals (Sweden)

    Denes M.

    2014-08-01

    Full Text Available Hilar cholangiocarcinoma, Klatskin tumor or proximal bile duct cancer, is a tumor growing in the right hepatic duct, left hepatic duct or at their confluence. It is a relatively rare but devastating disease. The tight stricture of the biliary ducts and the development of obstructive jaundice are the main characteristics of the disease. In the early phase, symptoms are nonspecific and jaundice is not present, leading to delayed diagnosis and denying the possibility of curative treatment. We present the case of a 74 years old woman who was referred to us with ambiguous symptomatology and without jaundice. The ultrasound and CT scan showed dilation of the left biliary tree, without increase of the cholestatic enzymes. Magnetic resonance cholangiography depicted a tumor in the left hepatic duct (3X3 cm. with enlargement of the bile ducts above. The surgical treatment consisted of left hepatectomy and hilar lymph nodes dissection. The pathology findings showed a cholangiocarcinoma with a few hilar nodes involvement. Our approach was potentially curative. Unfortunately these situations are seldom because in the majority of cases the patients have obstructive jaundice at presentation and the tumors are unresectable. We consider that a magnetic resonance cholangiography made when we suspect a bile duct tumor, leads us to an early diagnosis and gives us the possibility of a potential curative surgical treatment.

  9. Detection of biliary and vascular anatomy in living liver donors: Value of gadobenate dimeglumine enhanced MR and MDCT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Artioli, Diana, E-mail: diansadiana@gmail.com [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy); Tagliabue, Marianna; Aseni, Paolo; Sironi, Sandro; Vanzulli, Angelo [Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20162 Milano (Italy)

    2010-11-15

    Objective: To evaluate the performance of magnetic resonance (MR) and multidetector computed tomography (MDCT) in the assessment of living donor's vascular and biliary anatomy, having surgical findings as reference standard. Methods: Thirty-two living liver donors underwent MR cholangiography (1.5-T; standard cholangiography pulse sequences and delayed acquisitions after administration of biliary contrast agent) for biliary anatomy evaluation. MDCT (16-row multidetector scanner, multiphase protocol, 3 mm slice thickness) was also performed in all cases for the assessment of vascular anatomy before transplantation. Hepatic veins (<4 mm in diameter) were not considered. MR and MDCT images interpretation was performed by two reviewers by consensus, based on source axial images, multiplanar reformats, and three-dimensional (3D) postprocessing images. Surgical intraoperative findings were used as standard of reference. Results: At surgery, 17 biliary anomalies, 3 portal anomalies, 32 venous and 8 arterial variants were found in the 32 patients. MR correctly identified 15/17 biliary anomalies, with a sensitivity of 88% and a specificity of 93%. MDCT correctly identified 8/8 arterial, 3/3 portal and 29/32 venous variants, with a sensitivity of 100% and 91%, respectively, and a specificity of 100%. Conclusions: MR and MDCT proved to be efficient in evaluating living liver donor's biliary and vascular anatomy.

  10. Radiological diagnosis and intervention of cholangiocarcinomas (CC); Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Zangos, S.; Eichler, K.; Gruber-Rouh, T.; Hammerstingl, R.M.; Weisser, P. [Frankfurt Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Trojan, J. [Frankfurt Univ. (Germany). Medizinische Klinik I: Gastroenterologie, Endokrinologie, Pneumologie/Allergologie

    2012-10-15

    To present current data on diagnosis, indication and different therapy options in patients with cholangiocarcinoma (CC) based on an analysis of the current literature and clinical experience. The diagnostic routine includes laboratory investigations with parameters of cholestasis and also serum tumor markers CA19 - 9 and CEA. After ultrasound for clarifying a tumor and/or dilated bile ducts, contrast-enhanced magnetic resonance imaging (MRI) should be performed with magnetic resonance cholangiography (MRCP). The accuracy (positive predictive value) for diagnosing a CC is 37 - 84 % (depending on the location) for ultrasound, 79 - 94 % for computed tomography (CT), and 95 % for MRI and MRCP. An endoscopic retrograde cholangiography (ERCP) can then be planned, especially if biliary drainage or cytological or histological specimen sampling is intended. A curative approach can be achieved by surgical resection, rarely by liver transplantation. However, many patients are not eligible for surgery. In addition to systemic chemotherapy, locoregional therapies such as transarterial chemoembolization (TACE), hepatic arterial infusion (HAI) - also known as chemoperfusion -, drug eluting beads-therapy (DEB) as well as thermoablative procedures, such as laser-induced thermotherapy (LITT), microwave ablation (MWA) and radiofrequency ablation (RFA) can be provided with a palliative intention.

  11. Massive pleural effusion in a young woman

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2012-12-01

    Full Text Available Pleural effusion is a clinical manifestation shared by several underlying pathologies. The differential diagnosis is based on the clinical history, the physical examination, the analysis of the pleural fluid, and the laboratory data (mainly blood tests. There are cases, such as the patient described, where TC is not enough, and unusual imaging techniques are required for the study of pleural effusion, i.e. magnetic resonance cholangiography, cholangiopancreatography (MRCP and endoscopic retrograde cholangiopancreatography (ERCP.This case analyses a 42-year-old female patient who arrived with progressive dyspnoea, chest pain, cough, a history of alcohol abuse, and a recent episode of acute pancreatitis. The physical examination revealed signs of right-sided pleural effusion. These features, together with laboratory data, made it possible to pose the diagnosis of pancreaticopleural fistula, to treat it, and to obtain a complete healing in a two-month period.

  12. Prolonged cholestasis following successful removal of common bile duct stones: Beware patients on estrogen therapy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    There are various well described forms of chronic cholestatic jaundice in adults, such as autoimmune cholangitis, drug-induced cholangitis and intrahepatic cholestasis of pregnancy. We present two cases of prolonged cholestasis following removal of gallstones at endoscopic retrograde cholangiopancreatography (ERCP) and subsequent clear cholangiography. Both patients were taking oral estrogens at the time of presentation, which were subsequently withdrawn. The first case responded rapidly to corticosteroid treatment,and the second case had a much slower resolution with ursodeoxycholic acid. Both cases highlighted the significance of estrogen-induced cholestasis in female patients with protracted jaundice following ERCP and removal of intra-ductal stones. After oral estrogens are discontinued, a short course of steroids needs to be considered.

  13. Sclerosing cholangitis: Clinicopathologic features, imaging spectrum, and systemic approach to differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Ni Eun [Dept. of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, So Yeon; Lee, Seung Soo; Byun, Jae Ho; Kim, Hyoung Jung; Kim, Jin Hee; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2016-02-15

    Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. In this review, we suggest a systemic approach to the differential diagnosis of sclerosing cholangitis based on the clinical and laboratory findings, as well as the typical imaging features on computed tomography and magnetic resonance (MR) imaging with MR cholangiography. Familiarity with various etiologies of sclerosing cholangitis and awareness of their typical clinical and imaging findings are essential for an accurate diagnosis and appropriate management.

  14. Postoperative follow-up studies in congenital dilatation of the common bile duct using hepatobiliary scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Hirobe, Seiichi; Ishida, Haruo; Hayashi, Akira; Kamagata, Shoichiro; Fuchimoto, Yasufumi; Mizuno, Dai; Yano, Tsunehiro [Tokyo Metropolitan Kiyose Children`s Hospital (Japan); Ishii, Katsumi

    1995-03-01

    Follow-up studies in congenital dilatation of the common bile duct were done in 20 cases ranging 3 to 20 years after operation. Operative cholangiography had shown dilatation of the intrahepatic bile ducts in 15 patients (75%), of these, 7 patients had cystic dilatation. Five cases of these 7 patients showed prolonged stasis of the nuclide in the cystic dilated intrahepatic bile ducts by {sup 99m}Tc-PMT hepatobiliary scintigraphy in the follow-up studies even at 10 years after operation. But none of 20 cases had complication such as intrahepatic lithiasis, cholangitis, and liver dysfunction. Hepatobiliary scintigraphy could provide moderate anatomic and excellent functional information which were useful for these follow-up studies and careful follow-up should be done in the case of cystic dilatation of the intrahepatic bile ducts. (author).

  15. Biliary Cast Formation with Sclerosing Cholangitis in Critically Ill Patient: Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, O Nyoung; Park, Chang Keun [Daegu Fatima Hospital, Daegu (Korea, Republic of); Cho, Seung Hyun [Kyungpook National University, School of Medicine, Daegu (Korea, Republic of); Mun, Sung Hee [Catholic University of Daegu, School of Medicine, Daegu (Korea, Republic of)

    2012-06-15

    Sclerosing cholangitis in critically ill patients (SC-CIP) is a rare condition that is not familiar to many radiologists. In addition, the associated imaging findings have not been described in the radiological literature. We report a case of biliary cast formation with SC-CIP and describe the radiological findings of CT, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiography (ERC). A diagnosis of SC-CIP should be considered in intensive care unit (ICU) patients with persistent cholestasis during or after a primary illness. The typical CT, MRCP and ERC findings include new biliary casts in the intrahepatic duct with multiple irregular strictures, dilatations, and relative sparing of the common bile duct.

  16. [A case of hemorrhagic cholecystitis associated with Churg-Strauss syndrome].

    Science.gov (United States)

    Koizumi, Satomi; Kamisawa, Terumi; Kuruma, Sawako; Chiba, Kazuro; Tabata, Taku; Koizumi, Koichi; Kurata, Masanao; Horiguchi, Shinichiro; Hishima, Tsunekazu

    2016-01-01

    A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion. On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder. We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome.

  17. Advanced endoscopic imaging of indeterminate biliary strictures

    Institute of Scientific and Technical Information of China (English)

    James; H; Tabibian; Kavel; H; Visrodia; Michael; J; Levy; Christopher; J; Gostout

    2015-01-01

    Endoscopic evaluation of indeterminate biliary stric-tures(IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography(ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition(i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demon-strated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs.

  18. Successful disintegration, dissolution and drainage of intracholedochal hematoma by percutaneous transhepatic intervention

    Institute of Scientific and Technical Information of China (English)

    Jian-Jie Qin; Yong-Xiang Xia; Ling Lv; Zhao-Jing Wang; Feng Zhang; Xue-Hao Wang; Bei-Cheng Sun

    2012-01-01

    Hemobilia is a rare biliary complication of liver transplantation.The predominant cause of hemobilia is iatrogenic,and it is often associated with traumatic operations,such as percutaneous liver intervention,endoscopic retrograde cholangiopancreatography,cholecystectomy,biliary tract surgery,and liver transplantation.Percutaneous transhepatic cholangiography and liver biopsy are two major causes of hemobilia in liver transplant recipients.Hemobilia may also be caused by coagulation defects.It can form intracholedochal hematomas,causing obstructive jaundice.Herein we describe a patient with an intracholedochal hematoma resulting in significant obstructive jaundice after liver transplantation for fulminant hepatic failure.Previous studies have shown that percutaneous transhepatic manipulation is a major cause of hemobilia after liver transplantation,but in our case,percutaneous transhepatic intervention was used to relieve the biliary obstruction and dissolve the biliary clot,with a good outcome.

  19. Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Flavia; H; Feier; Eduardo; A; da; Fonseca; Joao; Seda-Neto; Paulo; Chapchap

    2015-01-01

    The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications(BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of posttransplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileoenteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions(PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised.

  20. 影响腹腔镜胆囊切除术(LC)中胆管损伤因素和预防策略分析%Effect of laparoscopic cholecystectomy (LC) in the analysis of bile duct injury factors and prevention strategies

    Institute of Scientific and Technical Information of China (English)

    王天民; 曹江威; 李冬雷; 卢涛

    2015-01-01

    目的:探讨影响腹腔镜胆囊切除术(LC)中胆管损伤因素以及预防方法。方法:选择我院2010年1月至2014年2月期间收治的需要进行 LC 的胆囊疾病患者2541例,对造成患者胆管损伤的相关影响因素进行对比分析,并回归性分析 LC 中胆管损伤的相关独立危险因素。结果:根据对影响 LC 手术中胆管损伤的相关危险因素进行单因素分析可知术中胆道造影、胆囊炎分期、胆囊三角解剖及手术医师经验等因素与胆管损伤间存在统计学差异,而经过多因素回归分析可知术中胆道造影、胆囊三角解剖及手术医师经验是影响 LC 术中胆管损伤的的相关独立危险因素。结论:胆道造影、胆囊三角解剖及手术医师经验是影响 LC 手术中胆管损伤的独立危险因素,在术中进行胆管造影,丰富手术医师经验以及对胆囊三角解剖结构的充分认识能够降低 LC 中胆管损伤的风险,并且术中操作要尽量轻柔谨慎,而一旦出现胆管损伤应及时进行处理。%Objective To investigate the effect of laparoscopic cholecystectomy (LC) in bile duct injury factors and preven-tion methods. Methods Our hospital from 2010 January to 2014 February were needed during the LC gallbladder disease in patients with 2541 cases of bile duct injury, on the influencing factors of patients with bile duct injury were analyzed, and the regression analysis of the independent risk factors of bile duct injury in LC. Results According to the single factor analysis and there are significant differences between that of intraoperative cholangiography, cholecystitis, gallbladder wall thickness, stag- ing of gallbladder triangle anatomy and operation of physician experience and other factors and bile duct injury on risk factors related to operation of bile duct injury in LC , and through multiple regression analysis of intraoperative cholangiography, the anatomy of Calot s triangle and

  1. Grading of liver lesions caused by Echinococcus granulosus

    Energy Technology Data Exchange (ETDEWEB)

    Rozanes, I. [Dept. of Radiology, Istanbul Medical Faculty, Istanbul (Turkey); Acunas, B. [Dept. of Radiology, Istanbul Medical Faculty, Istanbul (Turkey); Celik, L. [Dept. of Radiology, Haydarpasa Numune Hospital, Istanbul (Turkey); Acarli, K. [Hepatobiliary Surgery Unit, Dept. of General Surgery, Istanbul Medical Faculty (Turkey); Sayi, I. [Dept. of Radiology, Istanbul Medical Faculty, Istanbul (Turkey); Minareci, Oe. [Dept. of Radiology, Istanbul Medical Faculty, Istanbul (Turkey); Alper, A. [Hepatobiliary Surgery Unit, Dept. of General Surgery, Istanbul Medical Faculty (Turkey); Emre, A. [Hepatobiliary Surgery Unit, Dept. of General Surgery, Istanbul Medical Faculty (Turkey); Ariogul, O. [Hepatobiliary Surgery Unit, Dept. of General Surgery, Istanbul Medical Faculty (Turkey); Goekmen, E. [Dept. of Radiology, Istanbul Medical Faculty, Istanbul (Turkey)

    1993-10-01

    We have proposed a new scheme in which lesions are graded 1-5 according to the morphology of the cyst and the presence of findings in favour of cyst rupture. Ultrasound (US), CT and cholangiographic findings in 214 hydatid liver lesions in 152 patients who underwent surgery within 15 days of their radiological examinations were evaluated retrospectively. Results of the radiological classification were correlated with surgical data. We found that purely cystic unilocular lesions never ruptured, that dilatation of biliary canaliculi around a lesion with a complex morphological appearance is a non-specific finding and that there was no reliable radiological sign for a simple biliary communication. US, CT and cholangiography were reliable in diagnosing intra-biliary and direct ruptures. (orig.)

  2. Clinical characteristics of caroli's disease

    Institute of Scientific and Technical Information of China (English)

    Ozlem Yonem; Yusuf Bayraktar

    2007-01-01

    Caroli's disease is a rare congenital condition characterized by non-obstructive saccular or fusiform dilatation of larger intrahepatic bile ducts. Cholangitis,liver cirrhosis, and cholangiocarcinoma are its potential complications. The diagnosis of Caroli's disease depends on demonstrating that the cystic lesions are in continuity with the biliary tree which can be showed by ultrasonography, computerized tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography or magnetic resonance cholangiopancreatography. Treatment of Caroli's disease relies on the location of the biliary abnormalities. While localized forms confined to one lobe can be treated with surgery, liver transplantation is the only effective modality for diffuse forms. Although a rare disorder;Caroli's disease should always be considered in the differential diagnosis of chronic cholestasis of unknown cause.

  3. Reliability of pre- and intraoperative tests for biliary lithiasis

    Energy Technology Data Exchange (ETDEWEB)

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.

    1985-05-01

    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  4. Percutaneous diagnosis and treatment in disease conditions of the bile ducts and the gallbladder. Possibilities and relative value. Perkutane Diagnostik und Therapie an Gallenwegen und Gallenblase. Moeglichkeiten und Stellenwert

    Energy Technology Data Exchange (ETDEWEB)

    Hauenstein, K.H.; Wimmer, B. (Freiburg Univ. (Germany, F.R.). Abt. Roentgendiagnostik); Salm, R.; Farthmann, E.H. (Freiburg Univ. (Germany, F.R.). Abt. Allgemeinchirurgie mit Poliklinik)

    1991-03-01

    Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or pezo electric shockwave-contact lithotripsy and chemical litholysis are possible very often percutaneous access is a real alternative to surgical intervention. (orig.).

  5. Use of Omega-3 Polyunsaturated Fatty Acids to Treat Inspissated Bile Syndrome: A Case Report

    Science.gov (United States)

    Jun, Woo Young; Cho, Min Jeng; Han, Hye Seung

    2016-01-01

    Inspissated bile syndrome (IBS) is a rare condition in which thick intraluminal bile, including bile plugs, sludge, or stones, blocks the extrahepatic bile ducts in an infant. A 5-week-old female infant was admitted for evaluation of jaundice and acholic stool. Diagnostic tests, including ultrasound sonography, magnetic resonance cholangiopancreatography, and a hepatobiliary scan, were not conclusive. Although the diagnosis was unclear, the clinical and laboratory findings improved gradually on administration of urodeoxycholic acid and lipid emulsion containing omega-3 polyunsaturated fatty acids (PUFAs) for 3 weeks. However, a liver biopsy was suggestive of biliary atresia. This finding forced us to perform intraoperative cholangiography, which revealed a patent common bile duct with impacted thick bile. We performed normal saline irrigation and the symptom was improved, the final diagnosis was IBS. Thus, we herein report that IBS can be treated with omega-3 PUFAs as an alternative to surgical intervention. PMID:28090475

  6. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Nagano; Kenichi Matsuo; Katsuya Gorai; Kazuya Sugimori; Chikara Kunisaki; Hideyuki Ike; Katsuaki Tanaka; Toshio Imada; Hiroshi Shimada

    2006-01-01

    We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.

  7. Cholangiocarcinoma in Magnetic Resonance Cholangiopancreatography and Fascioliasis in Endoscopic Ultrasonography

    Directory of Open Access Journals (Sweden)

    Amir Houshang Mohammad Alizadeh

    2011-10-01

    Full Text Available Fascioliasis is a worldwide zoonotic infection with Fasciola hepatica and Fasciola gigantica. The zoonoses are particularly endemic in sheep-raising countries and are also endemic in Iran. Typical symptoms that may be associated with fascioliasis can be divided by phases of the disease, including the acute or liver phase, the chronic or biliary phase, and ectopic or pharyngeal fascioliasis. Cholestatic symptoms may be absent, and in some cases diagnosis and treatment may be preceded by a long period of abdominal pain, eosinophilia and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 4 years, with imaging suggesting cholangiocarcinoma. Considering a new concept of endoscopic ultrasonography, at last F. hepatica was extracted with endoscopic retrograde cholangiography.

  8. Living donor liver hilar variations:surgical approaches and implications

    Institute of Scientific and Technical Information of China (English)

    Onur Yaprak; Tolga Demirbas; Cihan Duran; Murat Dayangac; Murat Akyildiz; Yaman Tokat; Yildiray Yuzer

    2011-01-01

    BACKGROUND: Varied vascular and biliary anatomies are common in the liver. Living donor hepatectomy requires precise recognition of the hilar anatomy. This study was undertaken to study donor vascular and biliary tract variations, surgical approaches and implications in living liver transplant patients. METHODS: Two hundred living donor liver transplantations were performed at our institution between 2004 and 2009. All donors were evaluated by volumetric computerized tomography (CT), CT angiography and magnetic resonance cholangiography in the preoperative period. Intraoperative ultrasonography and cholangiography were carried out. Arterial, portal and biliary anatomies were classified according to the Michels, Cheng and Huang criteria. RESULTS: Classical hepatic arterial anatomy was observed in 129 (64.5%) of the 200 donors. Fifteen percent of the donors had variation in the portal vein. Normal biliary anatomy was found in 126 (63%) donors, and biliary tract variation in 70% of donors with portal vein variations. In recipients with single duct biliary anastomosis, 16 (14.4%) developed biliary leak, and 9 (8.1%) developed biliary stricture; however more than one biliary anastomosis increased recipient biliary complications. Donor vascular variations did not increase recipient vascular complications. Variant anatomy was not associated with an increase in donor morbidity. CONCLUSIONS: Living donor liver transplantation provides information about variant hilar anatomy. The success of the procedure depends on a careful approach to anatomical variations. When the deceased donor supply is inadequate, living donor transplantation is a life-saving alternative and is safe for the donor and recipient, even if the donor has variant hilar anatomy.

  9. Cholangiocarcinoma: A 7-year experience at a single center in Greece

    Institute of Scientific and Technical Information of China (English)

    Alexandra Alexopoulou; Aspasia Soultati; Spyros P Douralds; Larissa Vasilieva; Athanasios J Archimandritis

    2008-01-01

    AIM: To evaluate survival rate and clinical outcome of cholangiocarcinoma. METHODS: The medical records of 34 patients with cholangiocarcinoma, seen at a single hospital between the years 1999-2006, were retrospectively reviewed. RESULTS: Thirty-four patients with a median age of 75 years were included. Seventeen (50%) had painless jaundice at presentation. Sixteen (47.1%) were perihilar, 15 (44.1%) extrahepatic and three (8.8%) intrahepatic. Endoscopic retrograde cholangiography (ERCP) and/or magnetic resonance cholangiography (MRCP) were used for the diagnosis. Pathologic confirmation was obtained in seven and positive cytological examination in three. Thirteen patients had co-morbidities (38.2%). Four cases were managed with complete surgical resection. All the rest of the cases (30) were characterized as non-resectable due to advanced stage of the disease. Palliative biliary drainage was performed in 26/30 (86.6%). The mean follow-up was 32 mo (95% CI, 20-43 mo). Overall median survival was 8.7 mo (95% CI, 2-16 mo). The probability of 1-year, 2-year and 3-year survival was 46%, 20% and 7%, respectively. The survival was slightly longer in patients who underwent resection compared to those who did not, but this difference failed to reach statistical significance. Patients who underwent biliary drainage had an advantage in survival compared to those who did not (probability of survival 53% vs 0% at 1 year, respectively, P = 0.038). CONCLUSION: Patients with cholangiocarcinoma were usually elderly with co-morbidities and/or advanced disease at presentation. Even though a slight amelioration in survival with palliative biliary drainage was observed, patients had dismal outcome without resection of the tumor.

  10. Assessment of Chronological Effects of Irreversible Electroporation on Hilar Bile Ducts in a Porcine Model

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jae Woong, E-mail: cooljay@korea.ac.kr; Lu, David S. K., E-mail: dlu@mednet.ucla.edu; Osuagwu, Ferdnand, E-mail: fosuagwu@mednet.ucla.edu; Raman, Steven, E-mail: sraman@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Department of Radiology (United States); Lassman, Charles, E-mail: classman@mednet.ucla.edu [David Geffen School of Medicine at UCLA, Department of Pathology (United States)

    2013-11-07

    PurposeTo evaluate the chronological effects of irreversible electroporation (IRE) on large hilar bile ducts in an in vivo porcine model correlated with computed tomography (CT) cholangiography and histopathology.Materials and MethodsTwelve IRE zones were made along hilar bile ducts intraoperatively under ultrasound (US)-guidance in 11 pigs. Paired electrodes were placed either on opposing sides of the bile duct (straddle [STR]) or both on one side of the bile duct (one-sided [OSD]). The shortest electrode-to-duct distance was classified as periductal (≤2 mm) or nonperiductal (>2 mm). CT cholangiography and laboratory tests were performed before IRE and again at 2 days, 4 weeks, and 8 weeks after IRE. Degree of bile duct injury were graded as follows: grade 0 = no narrowing; grade 1 = ≤50 % duct narrowing; grade 2 = >50 % narrowing without proximal duct dilatation; grade 3 = grade 2 with proximal duct dilatation; and grade 4 = grade 3 with enzyme elevation. Pigs were selected for killing and histopathology at 2 days, 4, and 8 weeks.ResultsNonperiductal electrode placement produced no long-term strictures in 5 of 5 ducts. Periductal electrode placement produced mild narrowing in 6 of 7 ducts: 5 grade 1 and 1 grade 2. None showed increased enzymes. There was no significant difference between STR versus OSD electrode placement. Histopathology showed minor but relatively greater ductal mural changes in narrowed ducts.ConclusionIn the larger hilar ducts, long-term patency and mural integrity appear resistant to IRE damage with the energy deposition used, especially if the electrode is not immediately periductal in position.

  11. Intestinal metaplasia in gallbladder correlates with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary duct.

    Science.gov (United States)

    Sakamoto, Hirotsugu; Mutoh, Hiroyuki; Ido, Kenichi; Satoh, Shin; Kumagai, Machio; Hayakawa, Hiroko; Tamada, Kiichi; Sugano, Kentaro

    2009-12-01

    We reported previously that intestinal metaplasia in the gallbladder is strongly associated with expression of caudal-related homeobox transcription factor Cdx2. It has been documented that occult pancreatobiliary reflux, even in the absence of pancreaticobiliary maljunction, is associated with elevated risk of biliary malignancy. We ascertained the correlation between intestinal metaplasia in the gallbladder and occult pancreatobiliary reflux. In 196 patients with a normal pancreaticobiliary ductal arrangement who had undergone laparoscopic cholecystectomy, we performed intraoperative cholangiography and measured amylase levels in bile sampled from the gallbladder. The cutoff value for high cystic amylase was defined as a biliary amylase level higher than the normal upper limit of serum amylase (215 IU/L). We also retrospectively reviewed the cholecystectomized tissue specimens to investigate the presence of intestinal metaplasia and expression of Cdx2. Then, we explored the relationship between intestinal metaplasia in the gallbladder and occult choledocho-pancreatic reflux. Intestinal metaplasia was found in 16.8% (33/196) of the gallbladders. The prevalence of choledocho-pancreatic reflux revealed by intraoperative cholangiography was not significantly different between cases with intestinal metaplasia (5/33, 15.2%) and those without (25/163, 15.3%; P = .81). However, in cases with intestinal metaplasia, the rate of high cystic amylase (13/33, 39.4%) was significantly higher compared with cases without intestinal metaplasia (26/163, 16.0%, P = .005). In conclusion, intestinal metaplasia in the gallbladder is significantly correlated with high amylase levels in bile in patients with a morphologically normal pancreaticobiliary ductal arrangement.

  12. Fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar Predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis

    Directory of Open Access Journals (Sweden)

    José Gustavo Parreira

    2004-12-01

    Full Text Available OBJETIVO: Avaliar o papel da fosfatase alcalina (FA, gama glutamiltransferase (gamaGT e ultra-sonografia (US como fatores preditivos de coledocolitíase em doentes com pancreatite aguda biliar (PAB. MÉTODOS: Os dados foram coletados prospectivamente durante um período de 31 meses. Quarenta doentes foram incluídos, sendo 30 mulheres, com média etária de 49 + 16 anos. Foram registrados os dados de todos os doentes com pancreatite aguda biliar. Aqueles doentes ictéricos e com a forma grave da doença foram excluídos. As dosagens de FA e GGT, assim como a US, eram realizadas na admissão e 48 horas antes da cirurgia. Todos os pacientes foram submetidos à colangiografia intra-operatória (CIO ou à colangiografia retrógrada endoscópica (CPRE pré-operatória, que era definida baseada na probabilidade de coledocolitíase. Com o intuito de identificar os indicadores de coledocolitíase, as variáveis foram comparadas entre os pacientes com ou sem coledocolitíase. Os testes t de Student, Qui-quadrado e Fisher foram empregados para a análise estatística, considerando-se pBACKGROUND: To assess the role of alkaline phosphatase (AP, gamil-glutamyltransferase (gammaGT and abdominal ultrasound (US as predictors of choledocholithiasis in patients sustaining acute biliary pancreatitis. METHODS: Data was prospectively collected during a period of 31 months. Forty patients were included, 30 were female and the mean age was 49 + 16. All patients sustaining acute biliary pancreatitis were enrolled. Patients with clinical jaundice and severe pancreatitis were excluded. Serum content of AP and gGT as well as US were assessed at admission and 48 hours before cholecistectomy. All patients underwent intra-operative cholangiography (IOC or pre-operative endoscopic retrograde cholangiography (ERCP, which was indicated based on the odds of choledocholithiasis. In order to identify the predictors of choledocholithiasis, variables were compared between patients

  13. Primary sclerosing cholangitis, autoimmune hepatitis and overlap syndromes in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Rebecca Saich; Roger Chapman

    2008-01-01

    Primary sclerosing cholangitis (PSC) is a chronic progressive disorder of unknown aetiology characterised by chronic inflammation and stricture formation of the biliary tree. Symptoms include itch and lethargy and in advanced cases cholangitis and end-stage liver disease, however increasing numbers of asymptomatic individuals are being identified. The disease is rare in the general population but is strongly associated with inflammatory bowel disease (IBD) affecting up to 5% of patients with Ulcerative Colitis, with a slightly lower prevalence (up to 3.6%) in Crohns disease. The strength of this association means that the vast majority (> 90%) of patients with PSC also have IBD, although many may have only mild gastro-intestinal symptoms. Usually IBD presents before PSC, although vice-versa can occur and the onset of both conditions can be separated in some cases by many years. Mean age of diagnosis of PSC is in the fifth decade of life with a strong male predominance.Risk is increased in those with a family history of PSC, suggesting a genetic predisposition and the disease is almost exclusive to non-smokers. The ulcerative colitis associated with PSC is characteristically mild, runs a quiescent course, is associated with rectal sparing, more severe right sided disease, backwash ilieitis and has a high risk of pouchiUs post-colectomy. Most worrisome is the high risk of colorectal malignancy which necessitates routine colonoscopic surveillance. Cholangiocarcinoma is also a frequent complication of PSC with a 10%-15% lifetime risk of developing this condition. Treatment with high dose ursodeoxycholic acid offers some chemoprotective effects against colorectal malignancy and may decrease symptoms, biochemical and histological progression of liver disease. Small duct PSC patients characteristically have normal cholangiography, and liver biopsy is required for diagnosis, it appears to have a more favourable prognosis. Autoimmune Hepatitis (AIH) is also more prevalent

  14. Percutaneous transpapillary extraction of biliary calculus for symptomatic choledocholithiasis after unsuccessfully endoscopic treatment; Perkutane transpapillaere Gallensteinextraktion bei symptomatischer Choledocholithiasis nach frustranem endoskopischen Behandlungsversuch

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, N.; Manke, C.; Lenhart, M.; Voelk, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Inst. fuer Roentgendiagnostik

    2001-02-01

    Purpose: Evaluation of a percutaneous transhepatic treatment of symptomatic choledocholithiasis in bile ducts that cannot be reached with the endoscope. Methods: From January 1996 to August 2000 a transhepatic extraction of biliary calculus was performed in four patients. Endoscopic retrograde cholangiography (ERC) was not successful in any of the cases. Clinical symptoms were icterus in four cases, additional cholangitis or colics in two cases. First, a ballon dilation of the papilla was performed by a percutaneous transhepatic approach. For removal of bile duct stones, occlusion catheters and Dormia baskets were used. Technical success was defined as complete removal of bile duct stones. Clinical success was defined as normalization of cholestasis and inflammation parameters. In the follow-up an ultrasound examination was performed and blood samples were taken for control of cholestasis parameters. Results: In all four cases treatment was technically and clinically successful. For complete removal of biliary calculus a second intervention was necessary in two cases. In each case an internal to external drainage was left over a mean of 7 days (3 - 13 days). In the mean follow-up of 30.5 months (6 - 50 months) all patients had persistent relief of symptoms. No further interventions were necessary. No complications were present. Conclusion: Percutaneous transpapillary extraction of biliary calculus is an effective alternative to surgery in patients with bile ducts, that cannot be reached with the endoscope. (orig.) [German] Ziel: Untersuchung der perkutanen transhepatischen Therapie der symptomatischen Choledocholithiasis bei endoskopisch nicht sondierbarem Gallengangssystem. Methoden: Von Januar 1996 bis August 2000 wurde bei 4 Patienten eine transhepatische Gallengangsstein-Entfernung durchgefuehrt. Die Endoskopisch Retrograde Cholangiographie (ERC) war in allen Faellen aufgrund einer vorangegangenen Magenresektion (B II) technisch nicht erfolgreich gewesen. In 4

  15. A new method of preventing bile duct injury in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Fang Xu; Cheng-Gang Xu; De-Zheng Xu

    2004-01-01

    AIM: Of all the complications of laparoscopic cholectecystomy,bile duct injury (BDI) is the most serious complication.The prevention of injury to the common bile duct (CBD) remains a significant concern in laparoscopic cholecystectomy (LC).Different kinds of methods have been advanced to avoid this injury but no single method has gained wide acceptance.Because of various limitations of current methodologies we began a study using cold light illumination of the extrahepatic biliary system (light cholangiography LCP) to better visualize this area and thereby reduce the risk of bile duct injury.METHODS: Thirty-six patients with cholelithiasis were divided into two groups.Group Ⅰ (16 cases) received LCP and group Ⅱ (20 cases) received methelenum coeruleum cholangiography (MCCP).In group Ⅰ cold light was used to illuminate the common bile duct by leading an optical fiber into the common duct with a duodenoscope at the time of LC.The light coming from the fiber in the CBD could clearly illuminate the location of CBD and hepatic duct establishing its location relative to the cystic duct.This method was compared with the dye injection technique using methelenum coeruleum.RESULTS: In group Ⅰ thirteen cases were successfully illuminated and three failed.The cause of three failed cases was due to the difficulty in inserting the fiber into the ampulla of Vater.No complications occurred in the thirteen successful cases.In each of these successful cases the location of the common and hepatic ducts was clearly seen differentiating the ductal system from surrounding anatomy.In ten cases both the left and right hepatic ducts could be seen and in three only the right hepatic ducts were seen.In four of the thirteen cases,cystic ducts were also seen.In group Ⅱ,eighteen of the twenty cases were successful.The location of extrahepatic ducts became blue differentiating the ductal system from surrounding anatomy.Two cases failed due to a stone obstructing the cystic duct

  16. Recurrence of hepatocellular carcinoma after liver transplantation presenting as anastomotic biliary stricture Presentación del carcinoma hepatocelular recurrente tras el trasplante de hígado en forma de estenosis biliar anastomótica

    Directory of Open Access Journals (Sweden)

    S. Y. Chen

    2008-07-01

    Full Text Available A 52-year-old man visited our hospital complaining of anorexia and fatigue two months after receiving orthotopic liver transplantation for hepatocellular carcinoma. A laboratory investigation demonstrated a clinical picture of obstructive jaundice. T-tube cholangiography showed biliary stricture over the anastomotic site. Percutaneous transluminal balloon dilatation and stenting was attempted but failed. Magnetic resonance cholangiography showed possible tumor recurrence over the site of the anastomotic biliary stricture. A biopsy sample was obtained via ultrasound-guided aspiration and histopathological study revealed inflammatory and fibrotic changes. With high suspicion of recurrence of the hepatocellular carcinoma, surgical exploration was performed and an intraoperative frozen section proved the recurrence. We thus diagnosed this case as a recurrence of hepatocellular carcinoma after liver transplantation. To our knowledge, there have been no previous reports of early tumor recurrence after liver transplantation being the cause of an anastomotic biliary stricture.Un varón de 52 años visitó nuestro hospital quejándose de anorexia y fatiga a los dos meses de haber recibido un trasplante hepático ortotópico a causa de un carcinoma hepatocelular. La analítica mostró un cuadro clínico de ictericia obstructiva. La colangiografía con tubo en T mostró una estenosis biliar sobre la anastomosis. Se intentó una dilatación transluminal percutánea con globo y colocación de endoprótesis, que fracasó. La colangiografía por resonancia magnética mostró una posible recurrencia tumoral sobre el lugar de la estenosis biliar anastomótica. Se extrajo una muestra de biopsia mediante aspiración bajo guía ecográfica y el estudio histopatológico mostró alteraciones inflamatorias y fibróticas. Al sospecharse la recurrencia del carcinoma hepatocelular, se realizó una exploración quirúrgica; un corte intraoperatorio congelado demostr

  17. An increased flip angle in late phase Gd-EOB-DTPA MRI shows improved performance in bile duct visualization compared to T2w-MRCP

    Energy Technology Data Exchange (ETDEWEB)

    Stelter, Lars, E-mail: lars.stelter@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Freyhardt, Patrick, E-mail: patrick.freyhardt@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Grieser, Christian, E-mail: christian.grieser@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Walter, Thula, E-mail: thula.walter@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Geisel, Dominik, E-mail: dominik.geisel@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); Baur, Alexander, E-mail: alexander.baur@charite.de [Klinik für Radiologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin (Germany); and others

    2014-10-15

    Highlights: • EOB-MRC acquired with a flip angle of 35° revealed a better diagnostic performance compared to T2w-MRCP. • EOB-MRC increased the readers’ confidence in identifying anatomic variations of the biliary tree. • As EOB-MRC comprises functional information it is a valuable adjunct to T2w-MRCP. - Abstract: Objectives: To estimate the additional value of an increased flip angle of 35° in late phase Gd-EOB-DTPA-enhanced magnetic resonance cholangiography, as compared to T2w-MRCP. Methods: 40 adult patients underwent Gd-EOB-DTPA enhanced MRI of the liver including a T2-weighted 3D TSE MRCP (T2w-MRCP) as well as a late phase T1-weighted THRIVE sequences applying a flip angle of 35° (fa35). Two experienced observers evaluated the images regarding the delineation of the different biliary regions using a three-point grading system. A five-point scale was applied to determine the readers’ confidence in identifying anatomical variations of the biliary tree. ROI analysis was performed to compare the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Results: The quality for visualizing the biliary tree differed between T2w-MRCP and fa35 (p = <0.001). Late phase EOB-MRC was rated as good for delineating the entire biliary system, whereas T2w-MRCP received an overall poor rating. Especially the depiction of the intrahepatic bile ducts was estimated as problematic in T2w-MRCP. T2w-MRCP and fa35 revealed a discordant assessment of anatomical variations in 12.5% of the cases, comprising a generally higher confidence level for fa35 (4.0 ± 1.1 vs. 2.2 ± 1.2, p = <0.001). SNR proofed to be significantly higher in fa35 (p = <0.001), whereas T2w-MRCP revealed a significantly higher CNR (<0.001). Conclusions: Gd-EOB-DTPA enhanced magnetic resonance cholangiography acquired with a flip angle of 35° revealed a better diagnostic performance compared to T2w-MRCP and might be a valuable adjunct in assessing functional bile duct abnormalities.

  18. Hepatocellular carcinoma with obstructive jaundice:diagnosis,treatment and prognosis

    Institute of Scientific and Technical Information of China (English)

    Lun-Xiu Qin; Zhao-You Tang

    2003-01-01

    Obstructive jaundice as the main clinical feature is uncommon in patients with hepatocellular carcinoma (HCC). Only 1-12 %of HCC patients manifest obstructive jaundice as the initial complaint. Such cases are clinically classified as "icteric type hepatoma", or "cholestatic type of HCC". Identification of this group of patients is important, because surgical treatment may be beneficial. HCC may involve the biliary tract in several different ways: tumor thrombosis, hemobilia,tumor compression, and diffuse tumor infiltration. Bile duct thrombosis (BDT) is one of the main causes for obstructive jaundice, and the previously reported incidence is 1.2-9 %.BDT might be benign, malignant, or a combination of both.Benign thrombi could be blood clots, pus, or sludge.Malignant thrombi could be primary intrabiliary malignant tumors, HCC with invasion to bile ducts, or metastatic cancer with bile duct invasion. The common clinical features of this type of HCC include: high level of serum AFP; history of cholangitis with dilation of intrahepatic bile duct; aggravating jaundice and rapidly developing into liver dysfunction. It is usually difficult to make diagnosis before operation, because of the low incidence rate, ignorant of this disease, and the difficulty for the imaging diagnosis to find the BDT preoperatively. Despite recent remarkable improvements in the imaging tools for diagnosis of HCC, such cases are still incorrectly diagnosed as cholangiocarcinoma or choledocholithiases. Ultrasonography (US) and CT are helpful in showing hepatic tumors and dilated intrahepatic and/or extrahepatic ducts containing dense material corresponding to tumor debris. Direct cholangiography including percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP)remains the standard procedure to delineate the presence and level of biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) is superior to ERCP in interpreting the cause and

  19. Technical note on complete excision of choledochal cysts

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    BACKGROUND: Choledochal  cysts  are  congenital  cystic dilatations  of  the  extrahepatic  or  intrahepatic  portion  of  the biliary tree. Complete excision of choledochal cysts is currently regarded  as  the  gold  standard  treatment,  while  less  extensive procedures  including  cystoduodenostomy  have  become obsolete  due  to  the  potential  for  malignant  change  in  the remnant cyst. For type-1 choledochal cysts, which sometimes extend to the main pancreatic duct closely, some surgeons may adopt a less aggressive approach in order to avoid damage to the main pancreatic duct as such damage can lead to serious consequences.  However,  incomplete  excision  of  choledochal cysts may also cause problems. METHOD: Here we report on a reoperation treating incomplete excision of a choledochal cyst with focus on the technical aspect. RESULTS: In the reoperation, meticulous dissection of the liver hilum which had been previously operated on was performed. The hepaticojejunostomy was left intact. With the assistance of intraoperative cholangiography, the residual pancreatic portion of the choledochal cyst was completely excised. The pancreatic opening  and  the  lower  end  of  the  common  bile  duct  were reconstructed. Whipple operation was avoided. CONCLUSION: Careful  planning  with  the  aid  of  precise imaging before and during the operation largely enhanced the accuracy of the excision of the choledochal cyst.

  20. Biliary Cast Syndrome: Hepatic Artery Resistance Index, Pathological Changes, Morphology and Endoscopic Therapy

    Directory of Open Access Journals (Sweden)

    Hu Tian

    2015-01-01

    Full Text Available Background: Biliary cast syndrome (BCS was a postoperative complication of orthotopic liver transplantation (OLT, and the reason for BSC was considered to relate with ischemic type biliary lesions. This study aimed to evaluate the relationship between BCS following OLT and the hepatic artery resistance index (HARI, and to observe pathological changes and morphology of biliary casts. Methods: Totally, 18 patients were diagnosed with BCS by cholangiography following OLT using choledochoscope or endoscopic retrograde cholangiopancreatography. In addition, 36 patients who did not present with BCS in the corresponding period had detectable postoperative HARI on weeks 1, 2, 3 shown by color Doppler flow imaging. The compositions of biliary casts were analyzed by pathological examination and scanning electron microscopy. Results: HARI values of the BCS group were significantly decreased as compared with the non-BCS group on postoperative weeks 2 and 3 (P 1 (OR = 1.300; 1.223; and 1.889, respectively. The OR of HARI 3 was statistically significant (OR = 1.889; 95% confidence interval = 1.166-7.490; P = 0.024. The compositions of biliary casts were different when bile duct stones were present. Furthermore, vascular epithelial cells were found by pathological examination in biliary casts. Conclusions: HARI may possibly serve as an independent risk factor and early predictive factor of BCS. Components and formation of biliary casts and bile duct stones are different.

  1. Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Sven Jonas; Jan M Langrehr; Peter Neuhaus; Guido Schumacher; Andreas Pascher; Enrique Lopez-Hanninen; Hussain Al-Abadi; Christoph Benckert; Igor M Sauer; Johann Pratschke; Ulf P Neumann

    2006-01-01

    Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy,right hemicolectomy, and a partial duodenal resection.Pathological examination unexpectedly revealed an XGC.Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.

  2. Imaging by the SSFSE single slice method at different viscosities of bile

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Hiroya; Usui, Motoki; Fukunaga, Kenichi; Yamamoto, Naruto; Ikegami, Toshimi [Kawasaki Hospital, Kobe (Japan)

    2001-11-01

    The single shot fast spin echo single thick slice method (single slice method) is a technique that visualizes the water component alone using a heavy T{sub 2}. However, this method is considered to be markedly affected by changes in the viscosity of the material because a very long TE is used, and changes in the T{sub 2} value, which are related to viscosity, directly affect imaging. In this study, we evaluated the relationship between the effects of TE and the T{sub 2} value of bile in the single slice method and also examined the relationship between the signal intensity of bile on T{sub 1}- and T{sub 2}-weighted images and imaging by MR cholangiography (MRC). It was difficult to image bile with high viscosities at a usual effective TE level of 700-1,500 ms. With regard to the relationship between the signal intensity of bile and MRC imaging, all T{sub 2} values of the bile samples showing relatively high signal intensities on the T{sub 1}-weighted images suggested high viscosities, and MRC imaging of these bile samples was poor. In conclusion, MRC imaging of bile with high viscosities was poor with the single slice method. Imaging by the single slice method alone of bile showing a relatively high signal intensity on T{sub 1}-weighted images should be avoided, and combination with other MRC sequences should be used. (author)

  3. Small-ductprimarysclerosingcholangitis withhepatocellularcarcinomarequiringliver transplantation

    Institute of Scientific and Technical Information of China (English)

    Sharif Ali; Veena Shah

    2010-01-01

    BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic progressive cholestatic liver disease, which usually affects young adults and is diagnosed by cholangiography. On a few occasions, the disease either starts in or exclusively involves the small intrahepatic bile ducts, referred to as small-duct PSC. METHODS: A 31-year-old man presented with severe hematemesis secondary to liver cirrhosis. Over a course of 8 years, his liver decompensated and required an orthotopic liver transplantation. In this report we discuss his disease presentation, course of management, and the post-transplantation course of manage-ment, and review the morphologic diagnosis, and differential diagnosis of the disease with large-duct type and other diseases that involve small intrahepatic bile ducts. RESULTS:The patient's explanted liver showed changes of PSC affecting only the small- and medium-sized bile ducts in addition to three incidental nodules of hepatocellular carcinoma. CONCLUSIONS: Small-duct PSC has a substantially better prognosis than the large-duct type, with less chance of developing cirrhosis and an equal risk for developing hepato-cellular carcinoma, but no increased risk for developing cholangiocarcinoma. Treatment seems to help relieve the symptoms but not necessarily improve survival. Liver transplantation remains the ultimate cure.

  4. ["Endoscopy in a stone quarry"--multiple pigment stones 6 weeks after delivery].

    Science.gov (United States)

    Sandmann, M; Fähndrich, M; Heike, M

    2010-03-01

    A 29-year-old African woman without any history of diseases was referred to our clinic because of recurrent abdominal pain. 6 weeks earlier she had delivered a healthy baby. Laboratory data revealed hypochromic microcytic anemia, elevated cholestatic liver enzymes, and an elevated bilirubin level of 2.2 mg/dl. Abdominal sonography showed choledocholithiasis. The endoscopic retrograde cholangiography showed the presence of more than 100 small stones in the intra- and extrahepatic bile ducts. An endoscopic papillotomy was performed and multiple small black stones were removed from the bile duct by basket into the duodenum. Because of the hypochromic microcytic anemia, the detection of pigment stones and the ethnic background of the patient we suspected a hemoglobinopathy. Hemoglobin electrophoresis showed 97 % HbC. The molecular genetic analysis revealed a homozygous mutation in codon 6 GAG > AAG for the beta globin chain (HbCC). HbC is a structurally abnormal hemoglobin with typical aggregates and tetragonal crystal formation which results in mild chronic hemolytic anemia. The cholezystectomy after 6 weeks was performed without complications.

  5. Sclerosing cholangitis following severe trauma: Description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms

    Institute of Scientific and Technical Information of China (English)

    Johannes Benninger; Rainer Grobholz; Yurdaguel Oeztuerk; Christoph H. Antoni; Eckhart G. Hahn; Manfred V. Singer; Richard Strauss

    2005-01-01

    AIM: Persistent cholestasis is a rare complication of severe trauma or infections, Little is known about the possible pathomechanisms and the clinical course,METHODS: Secondary sclerosing cholangitis was diagnosed in five patients with persistent jaundice after severe trauma (one burn injury, three accidents, one power current injury). Medical charts were retrospectively reviewed with regard to possible trigger mechanisms for cholestasis, and the clinical course was recorded.RESULTS: Diagnosis of secondary sclerosing cholangitis was based in all patients on the primary sclerosing cholangitis (PSC)-like destruction of the intrahepatic bile ducts at cholangiography after exclusion of PSC. In four patients, arterial hypotension with subsequent ischemia may have caused the bile duct damage, whereas in the case of power current injury direct thermal damage was assumed to be the trigger mechanism. The course of secondary liver fibrosis was rapidly progressive and proceeded to liver cirrhosis in all four patients with a follow-up >2 years. Therapeutic possibilities were limited.CONCLUSION: Posttraumatic sclerosing cholangitis is a rare but rapidly progressive disease, probably caused by ischemia of the intrahepatic bile ducts via the peribiliary capillary plexus due to arterial hypotension. Gastroenterologists should be aware of this disease in patients with persistent cholestasis after severe trauma.

  6. Chemotherapy-induced sclerosing cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Sandrasegaran, K.; Alazmi, W.M.; Tann, M.; Fogel, E.L.; McHenry, L.; Lehman, G.A

    2006-08-15

    Aim: To review the computed tomography (CT), magnetic resonance imaging (MRI) and cholangiographic findings of chemotherapy-induced sclerosing cholangitis (CISC). Methods: Between January 1995 and December 2004, 11 patients in the endoscopic retrograde cholangiography database were identified with CISC. Twelve CT, four MRI, 69 endoscopic and nine antegrade cholangiographic studies in these patients were reviewed. Serial change in appearance and response to endoscopic treatment were recorded. Results: CISC showed segmental irregular biliary dilatation with strictures of proximal extrahepatic bile ducts. The distal 5 cm of common bile duct was not affected in any patient. CT and MRI findings included altered vascular perfusion of one or more liver segments, liver metastases or peritoneal carcinomatosis. Biliary strictures needed repeated stenting in 10 patients (mean: every 4.7 months). Cirrhosis (n = 1) or confluent fibrosis (n = 0) were uncommon findings. Conclusion: CISC shares similar cholangiographic appearances to primary sclerosing cholangitis (PSC). Unlike PSC, biliary disease primarily involved ducts at the hepatic porta rather than intrahepatic ducts. Multiphasic contrast-enhanced CT or MRI may show evidence of perfusion abnormalities, cavitary liver lesions, or metastatic disease.

  7. {sup 99m}Tc-trimethyl-BrIDA scintigraphy in HIV-related cholangiopathy

    Energy Technology Data Exchange (ETDEWEB)

    Bair, H.J. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Behr, T. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Rubbert, A. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Internal Medicine 3; Becker, W. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine; Wolf, F. [Erlangen-Nuernberg Univ., Erlangen (Germany). Dept. of Nuclear Medicine

    1995-12-01

    A HIV-infected 37-year-old man with diffuse mid-abdominal pain and elevated liver enzymes was sequentially studied by sonography, computed tomography (CT), {sup 99m}Tc-trimethyl-BrlDA scintigraphy and endoscopic retrograde cholangiopancreaticography (ERCP). CT and sonography did not lead to a final diagnosis. Cholescintigraphy showed signs of cholecystitis and sclerosing cholangitis with intra- and extrahepatic bile duct dilatation. These findings could be confirmed by ERCP, rendering HIV-associated cholepathy probable. Cytomegalovirus infection was demonstrated by polymerase chain reaction from bile fluid and the presence of cryptosporidia infection in a histology specimen isolated by ERCP. Therefore, biliary scintigraphy seems promising for screening for HIV-associated cholangio- and cholecystopathy, being less invasive and less bothering for the patient than ERCP. (orig.) [Deutsch] Ein 37jaehriger Mann mit diffusen Schmerzen im mittleren Abdomen wurde mittels Sonographie, Computertomographie (CT), {sup 99m}Tc-trimethyl-BrlDA-Szintigraphie und endoskopischer retrograder Cholangiographie (ERCP) untersucht. Sowohl die sonographische als auch die computertomographische Untersuchung fuehrte zu keiner endgueltigen Diagnose. Die hepatobiliaere Funktionsszintigraphie zeigte den Befund einer Cholezystitis und sklerosierenden Cholangitis mit Dilatation der intra- und extrahepatischen Gallengaenge. Die konsekutiv durchgefuehrte ERCP konnte dies bestaetigen und machte eine HIV-assoziierte Cholepathie wahrscheinlich. Eine Cytomegalievirusinfektion wurde durch eine Polymerase-Kettenreaktion mittels Gallefluessigkeit und eine Infektion mit Cryptosporidien durch eine Biopsie der Gallengaenge gesichert. Die hepatobiliaere Funktionsszintigraphie scheint eine geeignete nichtinvasive Screeningmethode zum Nachweis einer HIV-assoziierten Cholangio- und Cholezystopathie zu sein. (orig.)

  8. A case of cholestatic hepatitis associated with histologic features of acute cholangitis

    Directory of Open Access Journals (Sweden)

    Takeuchi H

    2011-11-01

    Full Text Available Hajime Takeuchi1, Toru Kaneko1, Toshikazu Otsuka1, Kumiko Tahara1, Tadashi Motoori2, Makoto Ohbu3, Masaya Oda4, Hiroaki Yokomori11Department of Internal Medicine; 2Division of Pathology, Kitasato Medical Center Hospital, Kitasato University, Saitama; 3Department of Pathology, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa; 4Department of Internal Medicine, Saitama Social Insurance Hospital, Saitama; 5Organized Center of Clinical Medicine, International University of Health and Welfare, Sanno Hospital, Tokyo, JapanAbstract: This report describes a case showing histologic features of acute cholangitis with an over-the-counter drug. A 48-year-old woman was diagnosed with general malaise and progressive jaundice. A thorough review of her medical history revealed that the patient had taken an over-the-counter drug, Pabron Gold®, which she had used previously, that may have caused liver injury. Laboratory investigations revealed jaundice and liver dysfunction. Endoscopic retrograde cholangiography detected no extrahepatic biliary duct dilatation or stones. Liver biopsy indicated acute cholangitis involving neutrophils and eosinophils. Electron microscopy revealed fragmented nuclei, indicating that the degenerative bile duct-related epithelial cells were in an apoptotic process.Keywords: liver injury, over-the-counter drug, histologic features, acute cholangitis, electron microscopy, Pabron Gold

  9. Non-traumatic abdominal emergencies: imaging and intervention in acute biliary conditions

    Energy Technology Data Exchange (ETDEWEB)

    Menu, Yves; Vuillerme, Marie-Pierre [Department of Radiology, Hopital Beaujon, 92118 Clichy Cedex (France)

    2002-10-01

    Imaging is the standard method for the evaluation of emergency bile ducts and gallbladder diseases. Imaging may help to treat the patient also. In acute cholecystitis, association of clinical and sonographic data is accurate for the diagnosis, even when the patient is examined by a junior radiologist. Computed tomography may be required for those patients with unusual presentation such as emphysematous cholecystitis, perforation, or abscess. Acalculous cholecystitis is a challenging problem. It sometimes requires percutaneous cholecystostomy for diagnosis or treatment purposes. In patients with acute cholangitis, sonography remains the first step for imaging, but its diagnostic accuracy is disappointing. This is related to low sensitivity, despite a high specificity. Computed tomography carries a slightly better sensitivity, and again a high specificity but overall accuracy is not sufficient. Magnetic resonance cholangiography and endosonography are the best methods for the detection. Both have advantages and limitations, including cost and availability, but endoscopic retrograde cholangiopancreatography remains necessary for therapeutic purposes, especially stone extraction. In conclusion, emergency radiologists should be able to put the patient through multiple imaging modalities in order to make a prompt diagnosis with no delay, and be aware of the therapeutic options, including cooperation between radiologist, endoscopist, and surgeon. (orig.)

  10. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern

    Energy Technology Data Exchange (ETDEWEB)

    Jung, S.E.; Lee, J.M.; Hahn, S.T. [Catholic University of Korea, Department of Radiology, St Mary' s Hospital, Seoul (Korea); Lee, K. [Catholic University of Korea, Department of Clinical Pathology, St Mary' s Hospital, Seoul (Korea); Rha, S.E.; Choi, B.G. [Catholic University of Korea, Department of Radiology, Kangnam St Mary' s Hospital, Seoul (Korea); Kim, E.K. [Catholic University of Korea, Department of Surgery (E.K.K), St Mary' s Hospital, Seoul (Korea)

    2005-04-01

    The aim of this study was to correlate MR findings of gallbladder wall thickening with pathologic findings on the basis of the layered pattern and to evaluate the diagnostic value of MR imaging in gallbladder disease. We retrospectively evaluated the source images of HASTE sequences for MR cholangiography in 144 patients with gallbladder wall thickening. The layered pattern of thickened wall was classified into four patterns. Type 1 shows two layers with a thin hypointense inner layer and thick hyperintense outer layer. Type 2 has two layers of ill-defined margin. Type 3 shows multiple hyperintense cystic spaces in the wall. Type 4 shows diffuse nodular thickening without layering. MR findings of a layered pattern of thickened gallbladder were well correlated with histopathology. Chronic cholecystitis matched to type 1, acute cholecystitis corresponded to type 2, adenomyomatosis showed type 3, and the gallbladder carcinomas showed type 4. All four layered patterns were associated with PPV of 73% or greater, sensitivity of 92% or greater and specificity of 95% or greater. Our results indicate that MR findings of gallbladder wall thickening are characteristic in each entity and correlate well with pathologic findings. The classification of the layered pattern may be valuable for interpreting thickened gallbladder wall. (orig.)

  11. Excessive bilirubin elevation in a patient with hereditary spherocytosis and intrahepatic cholestasis.

    Science.gov (United States)

    Wree, A; Canbay, A; Müller-Beissenhirtz, H; Dechêne, A; Gerken, G; Dührsen, U; Lammert, F; Nückel, H

    2011-08-01

    Hereditary spherocytosis is a common hemolytic anemia with an estimated incidence of 1 / 2500 births. It is caused by a molecular defect in one or more of the proteins of the red blood cell cytoskeleton. Mutations in the ABCB11 gene, encoding the bile salt export pump, can entail progressive familial intrahepatic cholestasis and benign recurred intrahepatic cholestasis. A 18 year old Turkish patient with hereditary spherocytosis was admitted to hospital with pruritus and severe jaundice. Ultrasound examination presented stones in gallbladder and bile duct. After endoscopic retrograde cholangiography with extraction of small bile duct stones abdominal pain resolved and liver enzymes normalized within a few days, but bilirubin and bile acids remained highly elevated. Liver biopsy revealed a severe canalicular cholestasis. Genetic analysis showed the compound heterozygous variants ABCB11 A 444V and 3084A > G. Treatment with ursodesoxycholic acid and intermittent therapy with prednisone reduced pruritus and jaundice with concomitant improvement of blood test. Here we report the first case of a patient with combined hereditary spherocytosis and compound heterozygous ABCB11 gene variants predisposing to intrahepatic cholestasis. Therefore, patients with hemolytic disorders should be investigated for bile acid transporter diseases in case of hyperbilirubinemia and severe cholestasis.

  12. A CASE OF RECURRENT PLEURAL EFFUSION FROM PANCREATICO PLEURAL FISTULA: DIAGNOSIS AND MANAG E MENT

    Directory of Open Access Journals (Sweden)

    Uma Maheswara Rao

    2015-02-01

    Full Text Available Pleural effusion and mediastinal pseudo cysts in Acute Pancreatitis are common but that of in association with chronic pancreatitis and trauma is rare and occurs only if fistulous communication develops between pancreatic ductal system and p leural space or due to direct extension of pseudo cyst into pleural cavity through mediastinum. The diagnosis of fistula can be made with high index of clinical suspicion and can be confirmed by elevated amylase and protein content in pleural fluid. The ac tual fistulous tract can be demonstrable by MDCT , MRCP (Magnetic resonance cholangio pancreaticography and (Endoscopic retrograde Pancreatico cholangiography ERCP Usually these fistulae resolve with conservative treatment. If not , Endoscopic retrograde c holangio pancreaticography (ERCP guides sphincterotomy , stricture dilatation or endoprosthesis placement across the fistulous communication or surgery are the choices of treatment. We present a case of a pancreatic pleural fistula in a 30 year – old man wi th recurrent episodes of Left pleural effusion Radiological and biochemical investigations were performed and he was diagnosed to have a Pancreatico pleural fistula. The patient was initially treated conservatively with somatostatin analogs , symptomatic and supportive treatment including repeated pleurocentesis. for his symptoms which include recurrent pleural taping also. Finally , endoscopic retrograde cholangio pancreatography was performed due to failed conservative treatment and a stent wa s placed in the pancreatic duct for healing of the fistulous communication. KEYWORDS: A case of recurrent pleural effusion from pancreatico pleural fistula: diagnosis and management.

  13. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  14. Isolated Liver Hilar Infiltration by IgG4 Inflammation Mimicking Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Laurent Bochatay

    2016-10-01

    Full Text Available IgG4-related disease represents a heterogeneous group of disease characterized by infiltration of various tissues by IgG4 plasmocytes. In case of liver infiltration, this condition classically mimics primary sclerosing cholangitis or multifocal cholangiocarcinoma due to inflammation that preferentially affects the intra- and extrahepatic bile duct. Diagnostic criteria have recently been reviewed in order to better define the disease and help physicians make the diagnosis. Herein, we present the case of a patient who died after liver surgery for suspected cholangiocarcinoma that finally turned out to be IgG4-associated liver disease, a condition being out of current consensual criteria. The patient presented with progressive cholestasis identified by MR cholangiography as an isolated hilar mass responsible for dilatation of the left and right intrahepatic bile duct suspicious for a Klatskin tumor. The IgG4 blood level was normal as was biliary cytology. The patient underwent right portal embolization followed by right extended hepatectomy. Pathologic examination found no tumor but intense fibrosclerotic infiltration with a marked inflammatory infiltrate characterized by IgG4-positive plasmocytes. Despite immunosuppressive treatment, cholestasis was never controlled and successive biopsies of the remaining liver showed progressive cholestasis, liver infiltrate and no bile duct regeneration. The patient finally presented an upper gastrointestinal hemorrhage leading to death 4 months after hepatectomy and appropriate immunosuppressive therapy.

  15. Clinical application of plasma shock wave lithotripsy in treating impacted stones in the bile duct system

    Institute of Scientific and Technical Information of China (English)

    Zhi Xu; Li-Xin Wang; Neng-Wei Zhang; Chun-Sheng Hou; Xiao-Feng Ling; Yao Xu; Xiao-Si Zhou

    2006-01-01

    AIM: To verify the safety and efficacy of plasma shock wave lithotripsy (PSWL) in fragmenting impacted stones in the bile duct system.METHODS: From September 1988 to April 2005, 67 patients (26 men and 41 women) with impacted stones underwent various biliary operations with tube (or T-tube)drainage. Remnant and impacted stones in the bile duct system found by cholangiography after the operation were fragmented by PSWL and choledochofiberscopy. A total of 201 impacted stones were fragmented by PSWL setting the voltage at 2.5-3.5 kV, and the energy output at 2-3 J for each pulse of PSWL. Then the fragmented stones were extracted by choledochofiberscopy. The safety and efficacy of PSWL were observed during and after the procedure.RESULTS: One hundred and ninety-nine of 201 impacted stones (99.0%) in the bile duct system were successfully fragmented using PSWL and extracted by choledochofiberscopy. The stone clearance rate for patients was 97% (65/67). Ten patients felt mild pain in the right upper quadrant of the abdomen, and could tolerate it well.Eleven patients had a small amount of bleeding from the mucosa of the bile duct. The bleeding was transient and stopped spontaneously within 2 min of normal saline irrigation. There were no significant complications during and after the procedure.CONCLUSION:PSWL is a safe and effective method for fragmenting impacted stones in the bile duct system.

  16. Expectations from imaging for pre-transplant evaluation of living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Tiffany; Hennedige; Gopinathan; Anil; Krishnakumar; Madhavan

    2014-01-01

    Living donor liver transplant(LDLT)is a major surgi-cal undertaking.Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation.Computed tomography(CT)and magnetic resonance imaging(MRI)are currently the imaging modalities of choice in pre-operative evaluation.These cross-sec-tional imaging techniques can reveal the vascular and biliary anatomy,assess the hepatic parenchyma and perform volumetric analysis.Knowledge of the broad indications and contraindications to qualify as a recipi-ent for LDLT is essential for the radiologist reporting scans in a pre-transplant patient.Similarly,awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations.CT and MRI have largely replaced invasive techniques such as catheter angiography,percutaneous cholan-giography and endoscopic retrograde cholangiopan-creatography.In order to generate a meaningful report based on these pre-operative imaging scans,it is also mandatory for the radiologist to be aware of the sur-geon’s perspective.We intend to provide a brief over-view of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans per-formed for LDLT related evaluation.

  17. Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience

    Directory of Open Access Journals (Sweden)

    Fransisca J. Siahaya

    2013-01-01

    Full Text Available Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.

  18. [Value of the nuclear magnetic cholangio resonance in the study of the patient with jaundice].

    Science.gov (United States)

    Gramática, L; Struni, M; Carranza, D; Verasay, G; Taborda, B; Caballero, F; Gramática, L

    1999-01-01

    This report analyse the results about forty three (43) patients, thirty six (36) of which showed an extrahepatic obstructive biliary Syndrome was made evident by ultrasonography, five (5) with a cholecistolithiasis and doubtful history of jaundice were evaluated to carry out a video-surgery procedure and two (2) patients whom hepatic-yeyunostomy had been practiced, a control of anastomosis in postoperative period was required. Nuclear Magnetic Resonance and Operative Cholangiography findings were correlated and afterward with the anatomopathological studies when they arrived. In all cases the Nuclear Magnetic Cholangio Resonance (NMCR) let us prove the diagnosis of extrahepatic biliary obstruction determining with precision furthermore the topographical site of the lesion. Respecting the aetiology of obstruction, NMCR was accurate in 34 out of 36 cases (94.4%). In conclusion Cholangio-Resonance is an excellent diagnostic method to evaluate biliary ductal system including anatomic changes. However, there are some limitations yet in order to determine the aetiology of lesions about extrahepatic biliary via extremes. We emphasize its features such as non-invasive, little operating dependent, and without morbimortality that become it as a method of choice to study the biliary via from a diagnostic viewpoint.

  19. Percutaneous expandable metallic stent biliary endoprostheses used inmalignant and benign obstructive jaundice

    Institute of Scientific and Technical Information of China (English)

    Hai Ying Liu; Wei Hua Tong; Wei Min Hu; Huai Ren Li; Zhe Sheng Wen; Jia Kang Wang; Wan Xi Huang; Shu Liu

    2000-01-01

    AIM To evaluate the effects of expandable metallic stent biliary endoprostheses (EMSBE) viaultrasonographic guided percutaneous transhepatic approach on the treatment of benign and malignantobstructive jaundice.METHODS Thirty-eight patients with obstructive jaundice (29 males and 9 females) aged 27 to 69 years(mean 54.7 years) were studied. Of them, 4 were benign and 34 malignant obstructions. Percutaneoustranshepatic cholangiography (PTC) was performed under ultrasonic guidance. A catheter was introducedinto the dilated bile duct via the introducer. A guide wire was inserted through the occlusive part of biliary duct after dilating with a double-lumen balloon catheter. A self-expandable metallic stent was inserted intcthe occlusive bile duct under fluoroscopic control.RESULTS The success rate of sonographic guided PTC was 100% (38/38) and the success rate of stentimplantation was 86.8% (33/ 38). Biliary obstruction was eliminated immediately, jaundice subsidedgradually and symptoms relieved after the procedure. During the 3 to 28 months fellow-up, re-occlusionoccurred in 4 malignant cases which were corrected by balloon catheter dilation and/or by stent, one patienthad secondary cholangitis and fifteen died without jaundice 6 - 28 months after the procedure. The otherswere alive with no jaundice. No severe complications or side effects were observed.CONCLUSION EMSBE via sonographic guided percutaneous transhepatic approach is a reliable and safepalliative therapy for malignant jaundice and an ideal nonoperative method for benign biliary obstruction. Ithas a definite positive impact on the quality of patient life.

  20. Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

    Institute of Scientific and Technical Information of China (English)

    Shi-Xing Li; Yao Zhang; Mei Sun; Bo Shi; Zhong-Yi Xu; Ying Huang; Zhi-Qin Mao

    2008-01-01

    AIM: To investigate the clinical value of ultrasonographic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken.METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded.RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6cm) in 10 cases. Smaller triangular cord (0.2-0.26cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and hetreogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and hetreogeneous echogenicity and the stage of hepatic fibrosis.CONCLUSION: The presence of the triangular cord at the porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and hetreogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.

  1. Radiological findings in biliary fistula and gallstone ileus

    Energy Technology Data Exchange (ETDEWEB)

    Oikarinen, H. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Paeivaensalo, M. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Tikkakoski, T. [Univ. Hospital, Oulu (Finland). Dept. of Diagnostic Radiology; Saarela, A. [Univ. Hospital, Oulu (Finland). Dept. of Surgery

    1996-11-01

    Purpose: Biliary fistual and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material. Material and Methods: The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret`s syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy. Results: Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin metal yielded it in the case of Bouveret`s syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas. Conclusion: Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered. (orig.).

  2. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin Woo; Kim, Tae Kyoung; Kim, Kyoung Won; Kim, Ah Young; Kim, Pyo Nyun; Ha, Hyun Kwon; Lee, Moon Gyu [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-06-01

    To describe the anatomical variation occurring in intrahepatic bile ducts (IHDs) in terms of their branching patterns, and to determine the frequency of each variation. The study group consisted of 300 consecutive donors for liver transplantation who underwent intraoperative cholangiography. Anatomical variation in IHDs was classified according to the branching pattern of the right anterior and right posterior segmental duct (RASD and RPSD, respectively), and the presence or absence of the first-order branch of the left hepatic duct (LHD), and of an accessory hepatic duct. The anatomy of the intrahepatic bile ducts was typical in 63% of cases (n=188), showed triple confluence in 10% (n=29), anomalous drainage of the RPSD into the LHD in 11% (n=34), anomalous drainage of the RPSD into the common hepatic duct (CHD) in 6% (n=19), anomalous drainage of the RPSD into the cystic duct in 2% (n=6), drainage of the right hepatic duct (RHD) into the cystic duct (n=1), the presence of an accessory duct leading to the CHD or RHD in 5% (n=16), individual drainage of the LHD into the RHD or CHD in 1% (n=4), and unclassified or complex variation in 1% (n=3)

  3. Unilateral pulmonary agenesis associated with oesophageal atresia and tracheoesophageal fistula: A case report with prenatal diagnosis.

    Science.gov (United States)

    Miyano, Go; Morita, Keiichi; Kaneshiro, Masakatsu; Miyake, Hiromu; Koyama, Mariko; Nouso, Hiroshi; Yamoto, Masaya; Nakano, Reiji; Tanaka, Yasuhiko; Nishiguchi, Tomizo; Kawamura, Takakazu; Fukumoto, Koji; Urushihara, Naoto

    2015-01-01

    We describe herein a case of unilateral pulmonary agenesis (PA) with oesophageal atresia (EA)/tracheoesophageal fistula (TEF) that was diagnosed prenatally and repaired by esophagoesophagostomy with stable postoperative course. The patient was born at 34 weeks gestation, after ultrasonography at 22 weeks gestation showed possible right-sided diaphragmatic eventration or PA and EA was subsequently suspected due to hydramnios. The initial X-ray showed mediastinal shift to the right, and coil up sign of the nasogastric tube, without intracardiac anomaly. Immediately after the diagnosis of EA/TEF and unilateral PA on day 0, the patient was intubated in the operating room, and a gastrostomy tube was placed. After pulmonary status stabilized, at 4 days old, EA/TEF was repaired through a thoracotomy in the right 4 th intercostal space. The right main bronchus was noted to continue into the distal oesophagus; this fistula was ligated and divided, and a single-layer esophagoesophagostomy was performed under mild tension with one vertebral gap. The neonate was maintained on mechanical ventilation and gradually weaned to extubation at 7 days old. The postoperative course was uneventful, with the exception of prolonged jaundice that emerged at 3 months old. Laparoscopic cholangiography at that time excluded biliary atresia, and jaundice resolved spontaneously. The patient has not shown any respiratory symptoms or feeding difficulties as of the 12-month follow-up.

  4. Unilateral pulmonary agenesis associated with oesophageal atresia and tracheoesophageal fistula: A case report with prenatal diagnosis

    Directory of Open Access Journals (Sweden)

    Go Miyano

    2015-01-01

    Full Text Available We describe herein a case of unilateral pulmonary agenesis (PA with oesophageal atresia (EA/tracheoesophageal fistula (TEF that was diagnosed prenatally and repaired by esophagoesophagostomy with stable postoperative course. The patient was born at 34 weeks gestation, after ultrasonography at 22 weeks gestation showed possible right-sided diaphragmatic eventration or PA and EA was subsequently suspected due to hydramnios. The initial X-ray showed mediastinal shift to the right, and coil up sign of the nasogastric tube, without intracardiac anomaly. Immediately after the diagnosis of EA/TEF and unilateral PA on day 0, the patient was intubated in the operating room, and a gastrostomy tube was placed. After pulmonary status stabilized, at 4 days old, EA/TEF was repaired through a thoracotomy in the right 4 th intercostal space. The right main bronchus was noted to continue into the distal oesophagus; this fistula was ligated and divided, and a single-layer esophagoesophagostomy was performed under mild tension with one vertebral gap. The neonate was maintained on mechanical ventilation and gradually weaned to extubation at 7 days old. The postoperative course was uneventful, with the exception of prolonged jaundice that emerged at 3 months old. Laparoscopic cholangiography at that time excluded biliary atresia, and jaundice resolved spontaneously. The patient has not shown any respiratory symptoms or feeding difficulties as of the 12-month follow-up.

  5. Residual gallbladder stones after cholecystectomy: A literature review

    Science.gov (United States)

    Chowbey, Pradeep; Sharma, Anil; Goswami, Amit; Afaque, Yusuf; Najma, Khoobsurat; Baijal, Manish; Soni, Vandana; Khullar, Rajesh

    2015-01-01

    BACKGROUND: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. MATERIALS AND METHODS: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. RESULTS: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. CONCLUSION: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones. PMID:26622110

  6. Residual gallbladder stones after cholecystectomy: A literature review

    Directory of Open Access Journals (Sweden)

    Pradeep Chowbey

    2015-01-01

    Full Text Available Background: Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy. Materials And Methods: Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. Results: Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct. Conclusion: Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic is the most common treatment modality reported in the literature for the management of residual gallbladder

  7. Consideration of different heating lengths of needles with induction heating and resistance system: A novel design of needle module for thermal ablation.

    Science.gov (United States)

    Bui, Huy-Tien; Hwang, Sheng-Jye; Lee, Huei-Huang; Huang, Durn-Yuan

    2017-04-01

    Thermal ablation using alternating electromagnetic fields is a promising method to treat tissues including tumors. With this approach, an electromagnetic field is generated around an induction coil, which is supplied with high frequency current from a power source. Any electrically conducting object, which is placed in the electromagnetic field, is then heated due to eddy currents. Basic principles underlying this novel thermotherapy needle system are internal induction and resistance heating. This presents a new design of a standard gauge 18 percutaneous trans-hepatic cholangiography needle module combined with a compact power source. Three needle modules containing coils of different lengths were used to locally heat up different volumes of tissues in in vitro experiments on pig livers. Temperature on the inside surface of the needle was controlled and monitored through a K-type thermocouple. By using this needle module system, no two-section or ferromagnetic nanoparticle-coated needles were required; the system worked well with the SUS-304 stainless-steel needle. Successful results were demonstrated in the in vitro experiments on pig livers with different heating lengths of 10, 20, and 30 mm needles. With low power sources, needles could be heated up to a high temperature. The novel design of the needle module incorporated with a high frequency power source was thus shown to be a promising technology for tissue ablation. Bioelectromagnetics.38:220-226, 2017. © 2016 Wiley Periodicals, Inc.

  8. Role of ERCP in the era of laparoscopic cholecystectomy for the evaluation of choledocholithiasis in sickle cell anemia

    Institute of Scientific and Technical Information of China (English)

    Hussain Issa; Ahmed H Al-Salem

    2011-01-01

    AIM: To evaluate the role of endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis in patients with sickle cell anemia (SCA) in the era of laparoscopic cholecystectomy (LC).METHODS: Two hundred and twenty four patients (144 male, 80 female; mean age, 22.4 years; range, 5-70 years) with SCA underwent ERCP as part of their evaluation for cholestatic jaundice (CJ).The indications for ERCP were: CJ only in 97, CJ and dilated bile ducts on ultrasound in 103, and CJ and common bile duct (CBD) stones on ultrasound in 42.RESULTS: In total, CBD stones were found in 88 (39.3%) patients and there was evidence of recent stone passage in 16.Fifteen were post-LC patients.These had endoscopic sphincterotomy and stone extraction.The remaining 73 had endoscopic sphincterotomy and stone extraction followed by LC without an intraoperative cholangiogram.CONCLUSION: In patients with SCA and cholelithiasis, ERCP is valuable whether preoperative or postoperative, and in none was there a need to perform intraoperative cholangiography.Sequential endoscopic sphincterotomy and stone extraction followed by LC is beneficial in these patients.Endoscopic sphincterotomy may also prove to be useful in these patients as it may prevent the future development of biliary sludge and bile duct stones.

  9. Intraductal biliary and pancreatic endoscopy:An expanding scope of possibility

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2008-01-01

    Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts.For many years,technological challenges have made performing these procedures difficult.The "mother-baby" system and other various miniscopes have been developed,but routine use has been hampered due to complex setup,scope fragility and the time consuming,technically demanding nature of the procedure.Recently,the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options.The clinical utility of intraductal endoscopy is broad.It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue.Therapeutic interventions,such as electrohydraulic lithotripsy (EHL),laser lithotripsy,photodynamic therapy,and argon plasma coagulation (APC),may also be performed as part of intraductal endoscopy.Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP),and as technology progresses,it is likely that its utilization will only increase.In this review of intraductal endoscopy,we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.

  10. Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

    Directory of Open Access Journals (Sweden)

    Bachellier Philippe

    2010-09-01

    Full Text Available Abstract Introduction Nonoperative management (NOM of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. Case report A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery. Conclusion Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome.

  11. Portal biliopathy.

    Science.gov (United States)

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-09-21

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).

  12. Imaging and radiological interventions in extra-hepatic portal vein obstruction

    Institute of Scientific and Technical Information of China (English)

    Sudheer S Pargewar; Saloni N Desai; S Rajesh; Vaibhav P Singh; Ankur Arora; Amar Mukund

    2016-01-01

    Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.

  13. Imaging and radiological interventions in extra-hepatic portal vein obstruction.

    Science.gov (United States)

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar

    2016-06-28

    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.

  14. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice.

    Science.gov (United States)

    Gundry, S R; Strodel, W E; Knol, J A; Eckhauser, F E; Thompson, N W

    1984-06-01

    Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography ( PTHC ) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5 +/- 7.6 mg/dL and 14.9 +/- 7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5 +/- 6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 +/- 4.3 mg/dL and 9.0 +/- 5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

  15. Primary cancers of extrahepatic biliary passages

    Energy Technology Data Exchange (ETDEWEB)

    Mittal, B.; Deutsch, M.; Iwatsuki, S.

    1985-04-01

    The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From the data, it is difficult to comment on the effectiveness of chemotherapy. The authors have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

  16. Primary cancers of extrahepatic biliary passages.

    Science.gov (United States)

    Mittal, B; Deutsch, M; Iwatsuki, S

    1985-04-01

    We analyzed the records of 22 patients with cancers of extrahepatic biliary passages (EHBP) to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From our data, it is difficult to comment on the effectiveness of chemotherapy. We have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

  17. Single dose oral ranitidine improves MRCP image quality: a double-blind study

    Energy Technology Data Exchange (ETDEWEB)

    Bowes, M.T. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Martin, D.F. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)]. E-mail: derrick.martin@smtr.nhs.uk; Melling, A. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Roberts, D. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Laasch, H.-U. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Sukumar, S. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom); Morris, J. [South Manchester University Hospitals NHS Trust, Wythenshawe, Manchester (United Kingdom)

    2007-01-15

    Aim: To investigate the possibility of whether a single 300 mg dose of ranitidine given orally 2-3 h before magnetic resonance cholangiopancreatography (MRCP) could reduce the signal from the stomach and duodenum, and thus increase the conspicuousness of the biliary tree. Materials and methods: Thirty-five volunteers (22 female, 13 male), (age range 21-50) were underwent MRCP in a double-blind, placebo-controlled, randomized, crossover trial on a Philips Intera 1.5 T machine using a phased array surface coil. Imaging was carried out in the coronal oblique plane. Six 40 mm sections were acquired at varying angles to delineate the biliary tree and pancreatic duct. The 70 examinations were blindly scored by three consultants experienced in cholangiography. Results: After ranitidine administration there was a significant decrease in signal from the stomach (mean = 17.7, p = 0.0005, CI 10, 25.3) and duodenum (mean = 18.4, p = 0.0005, 95%CI 9.6, 27.1) with a significant increase in conspicuousness of the distal common duct (mean = 7.7, p = 0.033, 95%CI 0.7, 14.7) and proximal common duct (mean = 8.7, p = 0.010 CI 2.2, 15.2). There were no adverse effects. Conclusion: Oral ranitidine is a cheap and effective agent to decrease signal from the upper gastrointestinal tract and to improve visibility of the biliary tree.

  18. Reality named endoscopic ultrasound biliary drainage

    Institute of Scientific and Technical Information of China (English)

    Hugo; Gon?alo; Guedes; Roberto; Iglesias; Lopes; Joel; Fernandez; de; Oliveira; Everson; Luiz; de; Almeida; Artifon

    2015-01-01

    Endoscopic ultrasound(EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangio-graphy, but nowadays it emerges as a powerful thera-peutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage(EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retro-grade cholangiopancreatography(ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage(PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or trans-papillary, which, again, can be antegrade or retrograde [rendezvous(EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology.

  19. [A case of gastric metastasis and carcinomatous peritonitis of breast cancer with improved QOL by stent implantation and gemcitabine].

    Science.gov (United States)

    Mukaibashi, Tomoe; Kojima, Izumi; Yamanaka, Ayumi; Nishiyama, Sachiko; Yamanaka, Takashi; Nakayama, Hirotaka; Matsuura, Hitoshi; Matsuzu, Kenichi; Inaba, Masaaki; Yoshida, Akira; Shimizu, Satoru

    2013-08-01

    A 73-year-old woman had undergone mastectomy for left breast cancer. One year later, bone metastasis was detected. After 7 years, the patient experienced epigastric discomfort, and gastrointestinal endoscopy showed stenosis of the pylorus and enlarged gastric folds. Stomach cancer was suspected at first, but gastric metastasis of breast cancer was diagnosed on the basis of endoscopic reexamination and computed tomography(CT)images. The patient could not drink water, and therefore, gastrointestinal stenting was performed, which facilitated ingestion to some extent. However, at the same time, an elevated serum carcinoembryonic antigen(CEA)level and jaundice were observed. Therefore, biliary tract stenosis due to carcinomatous peritonitis was diagnosed. We attempted to treat the jaundice with endoscopic retrograde cholangiopancreatography( ERCP)or percutaneous transhepatic cholangiography(PTCD), but the treatment was not successful, and an increase in ascites was noted. Accordingly, gemcitabine was administered as systemic therapy. As a result, ascites decreased and jaundice improved. Patients with gastric metastasis of breast cancer have poor quality of life(QOL)because of difficulties in ingestion or vomiting, and poor prognoses, because of frequent concurrent carcinomatous peritonitis. We experienced a case of gastric metastasis and carcinomatous peritonitis, and were able to improve the patient's QOL by gastrointestinal stenting and gemcitabine administration.

  20. Laparoscopic common bile duct exploration. Nine years’ experience from a single centre

    Directory of Open Access Journals (Sweden)

    Bahman eDarkahi

    2016-04-01

    Full Text Available AbstractINTRODUCTIONThe aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE through cholangiotomy with T-tube placement in one séance for common bile duct stones (CBDS.METHODSBetween January 2005 and December 2010, a total of 99 patients with CBDS stones undergoing LCBDE with T-tube insertion at Enköping Hospital, Sweden, were registered prospectively. All patients were followed up by review of the patient records according to a standardised protocol.RESULTS No severe intraoperative complications were registered. Four procedures required conversion to open cholecystectomy due to impacted stones or technical difficulty. The mean operative time was 194 minutes (standard deviation [SD] 57 minutes. The mean postoperative hospital stay was 4.8 days, SD 2.4 days. At secondary cholangiography, 2 (2% retained stones were found. Two (2% patients had minor bile leakage, which resolved spontaneously. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No death within thirty days after surgery was seen. No patient was readmitted with clinical signs of stricture.CONCLUSIONIf performed by a surgeon familiar with the technique, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low.

  1. A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

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    Del monaco Pamela

    2009-11-01

    Full Text Available Abstract Background Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage. Methods We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage. Conclusion The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.

  2. Novel Biliary Reconstruction Techniques During Liver Transplantation

    Science.gov (United States)

    Carmody, Ian C.; Romano, John; Bohorquez, Humberto; Bugeaud, Emily; Bruce, David S.; Cohen, Ari J.; Seal, John; Reichman, Trevor W.; Loss, George E.

    2017-01-01

    Background: Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant. Methods: A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years. Results: No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications. Conclusion: Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.

  3. 原发性硬化性胆管炎%PRIMARY SCLEROSING CHOLANGITIS

    Institute of Scientific and Technical Information of China (English)

    钟大昌

    2001-01-01

    Objective To study current developments in research of primarysclerosing cholangitis(PSC). Methods The literatures in recent years were reviewed. Results A number of evidences suggested that immune mechanisms played an important role in etiology of PSC. Its diagnosis was primarily made by cholangiography and all used therapies only relieved symptoms and improved hepatic function temporarily. Hepatic transplantation for advanced cases has been proven effective. Conclusion The etiology is still unknown and no therapies is effective in halting the disease progression but hepatic transplantation, so the prognosis is poor.%目的 了解原发性硬化性胆管炎研究进展。方法 复习近年来有关文献。结果 较多证据提示其病因与免疫机制相关;确诊主要凭胆管造影;各种疗法仅能暂时缓解症状及改善肝功能;肝移植可治疗晚期病例。结论 其病因仍不清楚,除肝移植外尚无有效阻止病变进展的治疗方法,远期预后差。

  4. Retrospective analysis of clinical characteristics and curative effect of 28 patients with primary sclerosing cholangitis%原发性硬化性胆管炎28例临床特征及疗效回顾分析

    Institute of Scientific and Technical Information of China (English)

    姚佳燕; 钟碧慧; 龚晓蓉; 晁康; 陈旻湖

    2012-01-01

    Objective To summarize the clinical characteristics and experience in the diagnosis and treatment of primary sclerosing cholangitis ( PSC ) . Methods Clinical data of 28 patients with PSC including clinical manifestations, PSC including clinical manifestations , laboratory tests, cholangiographies , pathological findings and the response to therapy were analyzed retrospectively from Jan. 2000 to Dec. 2010. Results 21 patients were males (75% ) , and 7 patients were females (25% ). The median age at diagnosis was 52 years old (4-69 years old). The most common symptoms were jaundice (89.3% , 25/28), followed by anorexia (32.1% , 9/28), pruritus (25.0% , 7/28), hepatagia (25.0% , 7/28). Liver enzyme were elevated (89,3% , 25/28) , including alanine aminotransferase (ALT) , asper-tate aminotransferase (AST) , alkaline phosphatase (ALP) , gamma glutamyl transpeptidase (GGT) and total bilirubin (TBIL; 89.3% , 25/28) , were obviously elevated in most patients. In all of the 28 patients, 20 were diagnosed by im-agings, including endoscopic retrograde cholangiopancreatography (ERCP) , magnetic resonance cholangiopancreatogra-phy (MRCP) , percutaneous transhepatic cholangiography (PTC) ,T-tube cholangiography, and the rest were diagnosed by liver biopsy. 13 patients out of 25 patients who received pharmacotherapy and 1 out of 3 who undergone surgery had biochemical improvements. Conclusion PSC is subjective to occur in men. Jaundice is the most common presentation and the biochemical tests such as ALT, AST, ALP, GGT and Tbil are mildly elevated. Cholangiographies are the first chose to confirm the diagnosis of PSC , and there is no specific pharmaceutical for PSC.%目的 分析原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)的临床特征及诊治经验,以提高对该病的认识.方法对我院2000年1月-2010年12月收治确诊的28例PSC患者的临床特征、生化、免疫学、组织学及治疗等资料进行回顾性分析.结果 28

  5. Bile leakage after living donor liver transplantation demonstrated with hepatobiliary scan using 9mTc-PMT.

    Science.gov (United States)

    Kanazawa, Akishige; Kubo, Shoji; Tanaka, Hiromu; Takemura, Shigekazu; Yamazaki, Keiichi; Hirohashi, Kazuhiro; Shiomi, Susumu

    2003-09-01

    Although it is recognized that hepatobiliary scan is of value in assessing postoperative complications of biliary surgery or cadaveric whole liver transplantation, there have been few reports regarding its usefulness following living donor liver transplantation. We performed living donor liver transplantation in a patient with biliary cirrhosis due to hepatolithiasis, using a right lobe graft from her sister. On the 15th postoperative day, bile discharge appeared from the operative wound. The leakage point could not be identified by computed tomography and cholangiography from the biliary drainage catheter. Hepatobiliary scan with Tc-99m Sn-N-pyridoxyl-5-methyltryptophan (99mTc-PMT) demonstrated biliary extravasation from the left side of the anastomosis of the hepatico-jejunostomy, indicating biliary leakage from the anastomosis. Conservative therapy was continued because the radioisotope flowed smoothly into the reconstructed jejunum and the biliary drainage catheter, and the leakage was stopped on the 63th postoperative day. Hepatobiliary scan is useful in determining the therapeutic plan as well as detection of bile leakage and identification of leakage points after living donor liver transplantation.

  6. [Hemobilia].

    Science.gov (United States)

    Galun, D; Basarić, D; Lekić, N; Raznatović, Z; Barović, S; Bulajić, P; Zuvela, M; Milićević, M

    2007-01-01

    The phenomenon now known as haemobilia was first recorded in XVII century by well known anatomist from Cambridge, Francis Glisson and his description was published in Anatomia Hepatis in 1654. Until today etiology, clinical presentation and management are clearly defined. Haemobilia is a rare clinical condition that has to be considered in differential diagnosis of upper gastrointestinal bleeding. In Western countries, the leading cause of haemobilia is hepatic trauma with bleeding from an intrahepatic branch of the hepatic artery into a biliary duct (mostly iatrogenic in origin, e.g. needle biopsy of the liver or percutaneous cholangiography). Less common causes include hepatic neoplasm; rupture of a hepatic artery aneurysm, hepatic abscess, choledocholithiasis and in the Orient, additional causes include ductal parasitism by Ascaris lumbricoides and Oriental cholangiohepatitis. Clinical presentation of heamobilia includes one symptom and two signs (Quinke triad): a. upper abdominal pain, b. upper gastrointestinal bleeding and c. jaundice. The complications of haemobilia are uncommon and include pancreatitis, cholecystitis and cholangitis. Investigation of haemobilia depends on clinical presentation. For patients with upper gastrointestinal bleeding oesophagogastroduodenoscopy is the first investigation choice. The presence of blood clot at the papilla of Vater clearly indicates the bleeding from biliary tree. Other investigations include CT and angiography. The management of haemobilia is directed at stopping bleeding and relieving biliary obstruction. Today, transarterial embolization is the golden standard in the management of heamobilia and if it fails further management is surgical.

  7. Small duct autoimmune sclerosing cholangitis and Crohn colitis in a 10-year-old child. A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Larsen Erling

    2012-08-01

    Full Text Available Abstract Autoimmune sclerosing cholangitis is an overlap syndrome characterized by features of both autoimmune hepatitis and primary sclerosing cholangitis, the latter usually involving the large bile ducts. Autoimmune sclerosing cholangitis occurs more often in children than in adults and is frequently associated with inflammatory bowel disease, predominantly ulcerative colitis. We report a unique case of a 10-year-old Danish boy with severe small duct autoimmune sclerosing cholangitis and synchronic Crohn colitis. He was referred with a history of weight loss, abdominal pain, vomiting and diarrhea. Biochemical anomalies included elevated alanine aminotransferase, γ-glutamyl transferase and immunoglobulin G levels and the presence of smooth muscle antibodies and perinuclear antineutrophil cytoplasmic antibodies but normal alkaline phosphatase. Liver biopsy specimen revealed features of both autoimmune hepatitis and sclerosing cholangitis, the latter characterized by acute, hyperplastic and destructive inflammation – granulocytic epithelial lesion – of the small ducts. Magnetic resonance cholangiography was normal. Colonoscopic biopsies showed chronic inflammatory changes of the caecum and the ascending and transverse colon compatible with Crohn disease. Ursodeoxycholic acid and immunosuppressive treatment was initiated and within four weeks of treatment the general condition improved. Normalization of aminotransferase was seen at 21 weeks and γ-glutamyl transferase at 72 weeks after first admittance, while immunoglobulin G remained slightly increased. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1418596609736470

  8. Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience.

    Science.gov (United States)

    Siahaya, Fransisca J; Lalisang, Toar J M; Jeo, Wifanto S; Simanjuntak, Arnold B H; Philippi, Benny

    2013-01-01

    Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP) and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.

  9. Choledocholithiasis: Evolving standards for diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Marilee L Freitas; Robert L Bell; Andrew J Duffy

    2006-01-01

    Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States.Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones.CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones.The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised.The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.

  10. Endoscopic ultrasound-guided interventions in specialsituations

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Endoscopic ultrasound (EUS) was introduced in 1982and has since become a popular advanced procedure fordiagnosis and therapeutic intervention. Initially, EUS wasmost commonly used for the diagnosis of pancreatobiliarydiseases and tissue acquisition. EUS was first used forguided cholangiography in 1996, followed by EUS-guidedbiliary drainage in 2001. Advancements in equipmentand endoscopic accessories have led to an expansion ofEUS-guided procedures, which now include EUS-guideddrainage of intra-abdominal abscesses or collections, intravasculartreatment of refractory variceal and nonvaricealbleeding, transmural pancreatic drainage, common bileduct stone clearance, enteral feeding tube placementand entero-enteric anastomosis. Patients with surgicallyaltered upper gastrointestinal anatomies have greatlybenefited from EUS also. This systematic review describesand discusses EUS procedures performed in uncommondiseases and conditions, as well as applications on morevulnerable patients such as young children and pregnantwomen. In these cases, routine approaches do not alwaysapply, and thus may require the use of innovative andunconventional techniques. Increased knowledge of suchspecial applications will help increase the success rates ofthese procedures and provide a foundation for additionaladvances and utilizations of the technique.

  11. Management of Coagulopathy in Patients with Decompensated Liver Cirrhosis

    Directory of Open Access Journals (Sweden)

    Pooja D. Amarapurkar

    2011-01-01

    Full Text Available Patients with decompensated liver cirrhosis have significantly impaired synthetic function. Many proteins involved in the coagulation process are synthesized in the liver. Routinely performed tests of the coagulation are abnormal in patients with decompensated liver cirrhosis. This has led to the widespread belief that decompensated liver cirrhosis is prototype of acquired hemorrhagic coagulopathy. If prothrombin time is prolonged more than 3 seconds over control, invasive procedures like liver biopsy, splenoportogram, percutaneous cholangiography, or surgery were associated with increased risk of bleeding, and coagulopathy should be corrected with infusion of fresh frozen plasma. These practices were without any scientific evidence and were associated with significant hazards of fresh frozen plasma transfusion. Now, it is realized that coagulation is a complex process involving the interaction of procoagulation and anticoagulation factors and the fibrinolytic system. As there is reduction in both anti and procoagulant factors, global tests of coagulation are normal in patients with acute and chronic liver disease indicating that coagulopathy in liver disease is more of a myth than a reality. In the last few years, surgical techniques have substantially improved, and complex procedures like liver transplantation can be done without the use of blood or blood products. Patients with liver cirrhosis may also be at increased risk of thrombosis. In this paper, we will discuss coagulopathy, increased risk of thrombosis, and their management in decompensated liver cirrhosis.

  12. Management of coagulopathy in patients with decompensated liver cirrhosis.

    Science.gov (United States)

    Amarapurkar, Pooja D; Amarapurkar, Deepak N

    2011-01-01

    Patients with decompensated liver cirrhosis have significantly impaired synthetic function. Many proteins involved in the coagulation process are synthesized in the liver. Routinely performed tests of the coagulation are abnormal in patients with decompensated liver cirrhosis. This has led to the widespread belief that decompensated liver cirrhosis is prototype of acquired hemorrhagic coagulopathy. If prothrombin time is prolonged more than 3 seconds over control, invasive procedures like liver biopsy, splenoportogram, percutaneous cholangiography, or surgery were associated with increased risk of bleeding, and coagulopathy should be corrected with infusion of fresh frozen plasma. These practices were without any scientific evidence and were associated with significant hazards of fresh frozen plasma transfusion. Now, it is realized that coagulation is a complex process involving the interaction of procoagulation and anticoagulation factors and the fibrinolytic system. As there is reduction in both anti and procoagulant factors, global tests of coagulation are normal in patients with acute and chronic liver disease indicating that coagulopathy in liver disease is more of a myth than a reality. In the last few years, surgical techniques have substantially improved, and complex procedures like liver transplantation can be done without the use of blood or blood products. Patients with liver cirrhosis may also be at increased risk of thrombosis. In this paper, we will discuss coagulopathy, increased risk of thrombosis, and their management in decompensated liver cirrhosis.

  13. Agenesis of the gallbladder: A dangerously misdiagnosed malformation

    Institute of Scientific and Technical Information of China (English)

    Nicolas Peloponissios; Michel Gillet; René Cavin; Nermin Halkic

    2005-01-01

    Isolated agenesis of the gallbladder is a rare anomaly,often asymptomatic. However, one patient out of four presented with right upper abdominal pain, nausea, and fatty food intolerance. The condition is frequently mistaken with an excluded or sclero-atrophic gallbladder, regardless of the imaging modality used. Consequently, AG often leads to unnecessary and potentially dangerous laparoscopic surgery as described in a few case reports over the last10 years. The aim of this study is to clarify the diagnostic and therapeutic approach of this unusual pathology. Two cases seen in our institutions were retrospectively reviewed, together with a review of the American and European literature. During laparoscopy, the absence of normal anatomical structures and the impossibility of pulling on the gallbladder to expose and dissect the triangle of Callot increases the risk of iatrogenic injury to biliary or portal structures. Depending on the experiment of the surgeon in laparoscopic procedure, this has to be taken into account to decide a conversion to laparotomy.A high index of suspicion is necessary when interpreting the radiological images. In case of doubt, a MRJ-cholangiography is mandatory. Because of possible inherited transmission,relatives with a history of biliary symptoms should be investigated.

  14. Isolated Liver Hilar Infiltration by IgG4 Inflammation Mimicking Cholangiocarcinoma

    Science.gov (United States)

    Bochatay, Laurent; Majno, Pietro; Giostra, Emiliano; Frossard, Jean Louis

    2016-01-01

    IgG4-related disease represents a heterogeneous group of disease characterized by infiltration of various tissues by IgG4 plasmocytes. In case of liver infiltration, this condition classically mimics primary sclerosing cholangitis or multifocal cholangiocarcinoma due to inflammation that preferentially affects the intra- and extrahepatic bile duct. Diagnostic criteria have recently been reviewed in order to better define the disease and help physicians make the diagnosis. Herein, we present the case of a patient who died after liver surgery for suspected cholangiocarcinoma that finally turned out to be IgG4-associated liver disease, a condition being out of current consensual criteria. The patient presented with progressive cholestasis identified by MR cholangiography as an isolated hilar mass responsible for dilatation of the left and right intrahepatic bile duct suspicious for a Klatskin tumor. The IgG4 blood level was normal as was biliary cytology. The patient underwent right portal embolization followed by right extended hepatectomy. Pathologic examination found no tumor but intense fibrosclerotic infiltration with a marked inflammatory infiltrate characterized by IgG4-positive plasmocytes. Despite immunosuppressive treatment, cholestasis was never controlled and successive biopsies of the remaining liver showed progressive cholestasis, liver infiltrate and no bile duct regeneration. The patient finally presented an upper gastrointestinal hemorrhage leading to death 4 months after hepatectomy and appropriate immunosuppressive therapy. PMID:27843427

  15. Sonographic Features of Extrahepatic Cholangio carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kyoo Byung; Lee, Hwang Bok; Choi, Won Young; Jeon, Hae Jeoung; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

    1987-12-15

    The cholangio carcinoma of extrahepatic bile duct is one of the common cause of obstructive jaundice, and the sonography is now the most convenient initial examination of theses cases. The location of 25 proven cases of extrahepatic cholangio carcinoma were classified as Klatskin type(6 cases), common hepatic duct(CHD)(9 cases) and common bilduct(CBD)(10cases). And the sonographic findings were analysed. The characteristic sonographic finding of Klatskin tumor was tqpered narrowing of dilated intrahepatic ducts at portal hepatis without communication between both lobe bile ducts. The CHD, cancer showed communicating dilatation of the intrahepatic ducts, but CHD cancer showed ommunicating dilatation of the intrahepatic ducts, but there was no dilatation of gall bladder or CBD, and in case of CBD cancer, entire biliary trees were usually dilated. With the sonographic findings onle, 19 of 25 cases(76%)were diagnosed as cholangio carcinoma, and 13 of 25 cases (52%) were diagnosed correctly the involved site as well as the malignant nature. The sonographic accuracy of the extrahepatic cholangiocarcinoma was greater in Klatskin tumor than the CHD or CBD cancer. Sonogram is most valuable screening study for cholangio carcinoma, and the CT scan and direct cholangiography such as PTC or ERCP have compensatory roles in detecting hepatic metastasis, regional adenopathy and length of involved bile duct

  16. Clinical and Morphological Study of Junction of Pancreatico-Biliary Ductal System in Congenital Dilatation of Bile Duct%先天性胆管扩张症的胰胆管连接部的形态与临床观察

    Institute of Scientific and Technical Information of China (English)

    金百祥; 周以明

    1985-01-01

    In the years from 1979 to 1984,42 cases of congenital dilatation of bile duct were admitted.In 14 of them,biliary system was examined morphologically during operation by means of ch01angiopancreatography,percutaneous transhepatic cholangiography and endoscopic retrograde pancreatocholangiography which revealed abhormal long intercommunicating channel with an anomalous junction of the pancreatico-biliary ductal system.Clinical analysis was made of the relation betwean symptoms such as abdominal pain.palpable mass and jaundice.Abdominal pain was found related to elevated serum amylase level.Patients presenting abdominal pain of ten tend to show high amylase level in bile.These findings suggest that there is reflux of bile into pancreatic duct and likewise pancreatic juice into the bile duct in such patients.It also suggests that abdominal pain so often accompanying congenital dilatation of bile duct is due to pancreatitis.%@@ 自1969年Babbitt提出胰胆管合流异常的概念之后,由于各种造影的广泛应用,近年来,文献上有诸多报告.现将本院自1979年起积累之14例胰胆管连接部形态的造影所见,结合临床分析如下.

  17. Cylindrical dilatation of the choledochus: a special type of congenital bile duct dilatation.

    Science.gov (United States)

    Todani, T; Watanabe, Y; Fujii, T; Toki, A; Uemura, S; Koike, Y

    1985-11-01

    Cylindrical dilatation of the choledochus develops in 20% of patients with congenital bile duct dilatation and usually has acute-angled unions of the pancreatobiliary ductal system. Symptoms generally develop in patients over 1 year of age. The patients frequently complain of abdominal pain, vomiting, and fever as in those with acute pancreatitis. Ultrasonography and infusion cholangiography are the most useful tools in making a correct diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic juice through anomalous ductal unions is commonly observed. This is responsible for biliary perforation in infancy and possibly carcinoma arising in the bile duct. The amylase concentration in the serum at the time of epigastric pain often is high, which leads to the diagnosis of acute pancreatitis. However, evidence of pancreatic inflammation is seldom noted. Accordingly, amylase in the bile may enter the circulating blood through the denuded epithelium or sinusoids of the liver. Excision of the whole extrahepatic duct along with hepaticoenterostomy would be essential for the treatment of cylindrical dilatation of the bile duct, especially when an anomalous ductal union is present.

  18. [Common channel for bile and pancreatic ducts. Presentation of 12 cases and discussion].

    Science.gov (United States)

    Gauthier, F; Brunelle, F; Valayer, J

    1986-01-01

    Between 1978 and 1985, 11 girls and one boy underwent an elective operation for a congenital choledochal dilatation associated with an anomalous biliopancreatic junction. In 10 out of these 12 cases the children suffered several episodes of abdominal pain, and the diagnosis was missed since a jaundice appeared. The ultrasonographic examination demonstrated in all cases a dilatation of both extra- and intrahepatic bile ducts. The preoperative diagnosis was always established by the mean of a transhepatic cholangiography (8 cases) or a percutaneous cholecystography (4 cases), which showed in every case a dilated choledochus, and a common biliopancreatic channel, 15 to 35 mm long. A high amylase level was found in the bile in 10/10 cases when it was measured. A cholecystokinin test was performed in 4 cases, resulting in each case in a considerable increase of amylase and lipase levels in bile. All children were treated by excision of the dilated choledochus and gallbladder, followed by an hepaticojejunostomy with a Roux en Y loop. The follow-up is 6 months to 5 years for 9 children: 8 are cured, and on girl, who had a major dilatation of the left intrahepatic bile ducts, suffered from episodic abdominal pain and an episode od cholangitis 6 years after the operation. The role of such a common channel in the pathogeny of congenital choledochal cysts, acute pancreatitis in children, and biliary carcinomas in young adults is discussed according to the literatures of the last 10 years.

  19. Resected Pleomorphic Carcinoma of the Gallbladder

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    Masanari Shimada

    2012-12-01

    Full Text Available Pleomorphic carcinoma is a rare lesion and the literature contains few reports of pleomorphic carcinoma of the gallbladder. The present study reports a rare case of primary pleomorphic carcinoma of the gallbladder for which we were able to perform curative surgery. A 77-year-old woman with dementia developed nausea and anorexia, and computed tomography demonstrated irregular thickening of the gallbladder wall. Drip infusion cholangiography and endoscopic retrograde cholangiopancreatography revealed no stenosis of the common and intrahepatic bile ducts. We suspected carcinoma of the gallbladder without lymph node metastasis and invasion to the common bile duct. We guessed it to be resectable and performed open laparotomy. At operation, the fundus of the gallbladder was adherent to the transverse colon, but no lymph node and distant metastases were detected. Therefore, we performed curative cholecystectomy with partial colectomy. Histopathology and immunostaining showed coexistence of an adenocarcinoma, squamous cell carcinoma and sarcomatous tumor of spindle-shaped cell, as well as transition zones between these tumors. We diagnosed stage I pleomorphic carcinoma of the gallbladder. No recurrence has been observed for one and a half years. The biological behavior of pleomorphic carcinoma of the gallbladder remains unknown. It will be necessary to accumulate more case reports of this tumor in order to define diagnostic criteria.

  20. Liver biochemistry profile, significance and endoscopic management of biliary tract complications post orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Yogesh M Shastri; Nicolas M Hoepffner; Bora Akoglu; Christina Zapletal; Wolf O Bechstein; Wolfgang F Caspary; Dominik Faust

    2007-01-01

    AIA:To correlate the significance of liver biochemical tests in diagnosing post orthotopic liver transplantation (OLT) biliary complications and to study their profile before and after endoscopic therapy.METHODS: Patients who developed biliary complications were analysed in detail for the clinical information,laboratory tests, treatment offered, response to it,follow up and outcomes. The profile of liver enzymes was determined. The safety, efficacy and outcomes of endoscopic retrograde cholangiography (ERC) were also analysed.RESULTS: 40 patients required ERC for 70 biliary complications. GGT was found to be > 3 times (388.1± 70.9 U/mL vs 168.5 ± 34.2 U/L, P = 0.007) and SAP > 2 times (345.1 ± 59.1 U/L vs152.7 ± 21.4 U/L, P =0.003) the immediate post OLT values. Most frequent complication was isolated anastomotic strictures in 28 (40%).Sustained success was achieved in 26 (81%) patients.CONCLUSION: Biliary complications still remain an important problem post OLT. SAP and GGT can be used as early, non-invasive markers for diagnosis and also to assess the adequacy of therapy. Endoscopic management is usually effective in treating the majority of these biliary complications.

  1. [Percutaneous needle biopsy of the distal part of the choledochal duct].

    Science.gov (United States)

    Pesić, V; Lisanin, L; Lukac, S; Zica, D; Kupresanin, S; Spasić, V; Nikosavić, S

    1996-01-01

    The indication for the biopsy was the finding of stenosis of uncertain etiology even after the endoscopy and the attempt of endoscopic or brush biopsy. The experiences with needle biopsy in 6 patients were presented in the study. The biopsy was done with the needles with diameter less than 1 mm (Chiba needle 0.6-0.95 mm), Otto-cut 0.8 mm and Vacu-cut 0.8 mm. Percutaneous cholangiography that was firstly performed, showed the site of stenosis of common bile duct distal part and simultaneously the other structures of interest for biopsy performance. The needle was guided under radioscopic control in one attempt. In that way, the precise diagnosis of pathologic process, which induced the obstruction in the early disease stage was made in all six patients. On the basis of cited results, the percutaneous needle biopsy was found to be efficient and safe method to reveal the type of lesion in this region, if necessary conditions existed. Percutaneous needle biopsy is a very valuable method, less invasive and less expensive compared to the surgical biopsies and other methods. It demonstrated reliable results in our conditions.

  2. Extrahepatic intraductal ectopic hepatocellularcarcinoma:bileductifllingdefect

    Institute of Scientific and Technical Information of China (English)

    Moritz Schmelzle; Wolfram T. Knoefel; Claus F. Eisenberger; Hanno Matthaei; Nadja Lehwald; Andreas Raffel; Roy Y. Tustas; Natalia Pomjanski; Petra Reinecke; Marcus Schmitt; Jan Schulte am Esch

    2009-01-01

    BACKGROUND: Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial symptom. We report a rare case of an extrahepatic icteric type hepatocellular carcinoma. METHODS: A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma. A postoperative bile leakage was treated by placement of a decompressing stent in the common bile duct. Endoscopic retrograde choledochoscopy showed extended blood clots iflling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile duct. The level of alpha-fetoprotein (AFP) was only slightly elevated but that of CA19-9 was dramatically increased. Cholangiography showed an intraductal iflling defect typical of a cholangiocellular carcinoma. RESULTS: Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile duct. An extrahepatic bile duct resection was performed. Histological examination conifrmed the diagnosis of extrahepatic intraductal growth of hepatocellular carcinoma. CONCLUSION: Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct iflling defect.

  3. AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya

    Directory of Open Access Journals (Sweden)

    Yiming Gao

    2011-01-01

    Full Text Available AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.

  4. Biliary complications after pediatric liver transplantation: Risk factors, diagnosis and management

    Science.gov (United States)

    Feier, Flavia H; da Fonseca, Eduardo A; Seda-Neto, Joao; Chapchap, Paulo

    2015-01-01

    The expanded indications of partial grafts in pediatric liver transplantation have reduced waiting list mortality. However, a higher morbidity is observed, including an increased rate of biliary complications (BCs). Factors such as the type of graft, the preservation methods applied, the donor characteristics, the type of biliary reconstruction, and the number of bile ducts in the liver graft influences the occurrence of these complications. Bile leaks and strictures comprise the majority of post-transplant BCs. Biliary strictures require a high grade of suspicion, and because most children have a bileo-enteric anastomosis, its diagnosis and management rely on percutaneous hepatic cholangiography and percutaneous biliary interventions (PBI). The success rates with PBI range from 70% to 90%. Surgery is reserved for patients who have failed PBI. BCs in children after liver transplantation have a prolonged treatment and are associated with a longer length of stay and higher hospital costs. However, with early diagnosis and aggressive treatment, patient and graft survival are not significantly compromised. PMID:26328028

  5. Balloon dilatation biopsy of the biliary stricture through the percutaneous transhepatic biliary drainage tract: Feasibility and diagnostic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Ji Hoon; Ryeom, Hun Kyu; Jang, Yun Jin; Kim, Gab Chul; Cho, Seung Hyun; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2016-01-15

    To evaluate the feasibility and diagnostic accuracy of the balloon dilatation biopsy for the biliary stricture through the percutaneous transhepatic biliary drainage (PTBD) tract. The study included 35 patients who underwent balloon dilatation biopsy for the biliary stricture through the PTBD tract. Balloon dilatation was done with a balloon catheter of 10-mm or 12-mm diameter. Soft tissue adherent to the retrieved balloon catheter and soft tissue components separated by gauze filtration of evacuated bile were sampled for histopathologic examination. The results were compared with the final diagnosis which was made by clinical and imaging follow-up for mean 989 days (n = 34) and surgery with histopathologic examination (n = 1). Procedure-related complications and diagnostic accuracy were assessed. Tissues suitable for histopathologic examination were obtained in 31 out of 35 patients (88.6%). In 3 patients, self-limiting hemobilia was noted. No major complication was noted. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values for diagnosis of malignant stricture were 70.0%, 100%, 90.3%, 100%, and 87.5%, respectively. Balloon dilatation biopsy of the biliary stricture through the PTBD tract is a feasible and accurate diagnostic method. It can be a safe alternative to the endoscopic retrograde cholangiography biopsy or forceps biopsy through the PTBD tract.

  6. Endoscopic management of biliary fascioliasis: a case report

    Directory of Open Access Journals (Sweden)

    Kasnazani Kalandar A

    2010-03-01

    Full Text Available Abstract Introduction Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. Case presentation A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. Conclusion Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.

  7. Granulomatous hepatitis triggered by liver Fasciola infestation: A case report

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    Ali Ghavidel

    2016-08-01

    Full Text Available Introduction: Liver Fasciola hepatica (FH infestation is a zoonotic disorder caused by a kind of leaf-like worm. Case Report: In this article the reported patient is a woman who is 54 years old. She had been suffering from stomachaches after every meal from two years ago. Computed tomography (CT, ultrasonography (US and magnetic resonance retrograde cholangiography (MRCP, proved that right lobe ducts are dilated although there was not any filling defects in the common bile duct (CBD. These findings were most similar with the manifestations of localized segmental cholangiocellular carcinoma (CCC or granulomatous hepatitis but at the work up, F. hepatica infection was confirmed. The mentioned disease was diagnosed by means of imaging modalities, laboratory analysis including serology and stool examination and was cured by triclabendazole. Conclusion: Humans are infected by consuming undercooked vegetables, with the adult worms inhabiting and laying metacercariae in the biliary system. These organisms induce a chronic inflammatory state in the proximal biliary tree, presumably leading to malignant transformation of the lining epithelium.

  8. Fatores preditivos de coledocolitíase em doentes com litíase vesicular Predictors of choledocholithiasis in patients sustaining gallstones

    Directory of Open Access Journals (Sweden)

    Tércio de Campos

    2004-04-01

    Full Text Available OBJETIVO: Identificar fatores clínicos, bioquímicos e ultra-sonográficos preditivos de coledocolitíase no período pré-operatório de doentes portadores de litíase vesicular avaliados por colangiografia. MÉTODOS: Analisamos prospectivamente 148 doentes portadores de litíase vesicular, relacionando critérios pré-operatórios clínicos, bioquímicos e ultra-sonográficos. Todos estes doentes foram submetidos à colangiografia, podendo esta ser endoscópica pré-operatória ou realizada pelo cirurgião durante a colecistectomia. Foram calculados os valores da sensibilidade, especificidade, valores preditivos positivo (VPP e negativo (VPN, e acurácia para cada um dos critérios estudados, além da correlação de Spearman, Odds ratio e análise de regressão logística para a variável coledocolitíase. RESULTADOS: Os resultado obtidos mostraram que na análise univariada, a presença de icterícia na internação, a elevação de fosfatase alcalina, gama glutamiltransferase (gamaGT, aspartato aminotransferase, alanina aminotransferase, bilirrubina total, e ultra-sonografia (USG com presença de dilatação de vias biliares e visibilização de cálculo na via biliar principal (VBP tiveram diferença estatisticamente significante para coledocolitíase em nossa amostra (pBACKGROUND: The aim of this study was to identify clinical, biochemical and ultrasonographic predictors of choledocholithiasis in patients sustaining gallstones assessed by cholangiography. METHODS: In a prospective study, 148 patients were analyzed regarding clinical, biochemical and ultrasonographic data. All patients underwent cholangiography, either preoperative endoscopic or during cholecystectomy. Each variable was compared between the ones who sustained lithiasis in the biliary tree and the others, in order to find out the predictors of choledocholithiasis. Sensibility, specificity, positive predictive value, negative predictive value (NPV and accuracy were

  9. 硬化性胆管炎的影像诊断和鉴别诊断%The imaging and differential diagnosis of sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    杨艳; 董莘

    2016-01-01

    硬化性胆管炎包括一系列以肝内外胆管炎症、纤维化和狭窄为特征的慢性及进展性胆汁郁积性肝病。硬化性胆管炎可以分为原发性硬化性胆管炎(PSC)和继发性硬化性胆管炎,前者病因未明;后者致病原因不同,包括IgG4-相关性硬化性胆管炎、复发性化脓性胆管炎、缺血性胆管炎、获得性免疫缺陷综合征相关性胆管炎和嗜酸性胆管炎。本研究在文献评阅的基础上,综合了不同系列硬化性胆管炎的影像表现,强调用系统方法鉴别诊断,提示支持诊断恶性胆道狭窄而非硬化性胆管炎的影像特征为:①门静脉期相对肝实质明显强化的狭窄节段;②长的狭窄长度(>12 mm);③明显的胆管壁增厚(>3 mm),不清楚的外边缘;④管腔不规则;以及不对称狭窄(70)。排除恶性胆道狭窄后,才是区分PSC和继发性硬化性胆管炎;还应结合人口统计、实验室检查和患者既往病史一并考虑。同时也讨论了磁共振胆管造影和内镜胆管造影在硬化性胆管炎诊断和鉴别诊断中作用以及治疗选项的临床意义。%Sclerosing cholangitis includes a spectrum of chronic, variably progressive cholestatic liver disease characterized by inflammation, fibrosis and stricture of the intrahepatic and extrahepatic bile ducts. Sclerosing cholangitis can be divided into primary sclerosing cholangitis of unidentified etiology and secondary sclerosing cholangitis caused by various identifiable etiologies, including immunoglobulin G4-related sclerosing cholangitis, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndromerelated cholangitis and eosinophilic cholangitis. In this article, we describe the imaging findings of the various spectrums of sclerosing cholangitis with anemphasis on a systemic approach in differential diagnosis. It is very important for magnetic resonance cholangiography and endoscopic

  10. Repair of bile duct defect with degradable stent and autologous tissue in a porcine model

    Institute of Scientific and Technical Information of China (English)

    Yue-Long Liang; Yi-Chen Yu; Kun Liu; Wei-Jia Wang; Jiang-Bo Ying; Yi-Fan Wang; Xiu-Jun Cai

    2012-01-01

    AIM:To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues.METHODS:Eight Ba-Ma mini-pigs were used in this study.Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)].In addition,a vascularized greater omentum was placed around the stent and both ends of CBD.Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture.Complete blood count was examined pre-and post-operatively to estimate the inflammatory reaction.Liver enzymes and serum bilirubin were examined pre-and post-operatively to evaluate the liver function.Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis.The other three pigs were raised for one year for long-term observation.RESULTS:All the animals underwent surgery successfully.There was no intraoperative mortality and no bile leakage during the observation period.The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation,the difference was not statistically significant (P =0.652).The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P =0.810).Nevertheless,the plasma level of γ-glutamyl transferase was increased after operation in both groups (P =0.004),especially 2 wk after operation.The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P =0.227),so did the serum direct bilirubin (P =0.759).By cholangiography via gall bladder,we found that the stent maintained its integrity of shape and was still in situ at month 1,and it disappeared

  11. 胆胰肠结合部损伤的诊断和治疗%Diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction

    Institute of Scientific and Technical Information of China (English)

    韦军民; 崔红元; 何清

    2009-01-01

    Objective To investigate the diagnosis and treatment of injury in choledocho-pancreatico-duodenal junction. Methods The clinical data of 6 patients with injury in choledocho-pancreatico-duodenal junction who had been admitted to Beijing Hospital from January 2000 to January 2008 were retrospectively analyzed. Results Of the 6 patients, 4 were diagnosed according to the intraoperative findings, cholangiography and fiber cholangioscopy. The 4 patients were cured after suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage. Two patients developed severe abdominal and retroperitoneal infection and other complications after operation, and were diagnosed by cholangiography and fiber cholangioscopy. Of the 2 patients, 1 was cured and 1 died after multiple drainage procedures and debridement. Conclusions Diagnosis and treatment in the early stage are crucial for the curative purpose. Cholangingraphy and fiber cholangioscopy are effective in the diagnosis of injury in choledocho-pancreatico-duodenal junction. The suture of the perforation in the choledocho-pancreatico-duodenal junction, T-tube drainage and abdominal drainage should be chosen for patients who are diagnosed during primary operation. For patients with abdominal and retroperitoneal abscess and cellulitis, drainage and debridement should be performed, and biliopancreatic diversion and duodenal diverticularizatian are applied to patients when necessary.%目的 探讨胆胰肠结合部损伤的诊断和治疗方法.方法 回顾性分析2000年1月至2008年1月卫生部北京医院收治的6例医源性胆胰肠结合部损伤患者的临床资料,总结诊断和治疗的经验.结果 4例患者在首次术中确诊,术中可疑胆胰肠结合部损伤,行胆道造影、纤维胆道镜检查确诊,施行损伤修补+胆总管T管引流+腹腔引流术,治愈出院.2例患者在术后出现了严重的腹腔、腹膜后感染及其他并发症,怀疑为

  12. Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case Infestação maciça por Ascaris lumbricoides nas vias biliares: relato de um caso tratado com sucesso

    Directory of Open Access Journals (Sweden)

    Dahir Ramos de Andrade Júnior

    1992-02-01

    Full Text Available This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.Descrito caso de mulher de 25 anos, negra, procedente da cidade de São Paulo - Brasil, que desenvolveu quadro agudo de colangite obstrutiva por Ascaris lumbricoides, com septicemia e múltiplos abscessos hepáticos. Era portadora de traço falciforme e tinha tido um parto normal há 3 meses. Foi estabelecido o diagnóstico de infestação maciça por Ascaris lumbricoides em vias biliares com ultrasonografia abdominal e colangiografia retrógrada endoscópica. Sessenta vermes foram retirados do colédoco e drenados os abscessos hepáticos por cirurgia. O quadro infeccioso era polimicrobiano. Houve recuperação total da paciente após longa evolução, com antibioticoterapia de amplo espectro e novas cirurgias com extração de vermes residuais. Os autores apresentam os métodos diagnósticos empregados, o quadro clínico-bioquímico e a abordagem terapêutica. A fisiopatologia da ascaridíase biliar é discutida.

  13. Biochemical and radiological predictors of malignant biliary strictures

    Institute of Scientific and Technical Information of China (English)

    Ibrahim A. Al-Mofleh; Abdulrahman M. Aljebreen; Saleh M. Al-Amri; Rashed S. Al-Rashed; Faleh Z. Al-Faleh; Hussein M. Al-Freihi; Ayman A. Abdo; Arthur C. Isnani

    2004-01-01

    AIM: Differentiation of benign biliary strictures (BBS) from malignant biliary strictures (MBS) remains difficult despite improvement in imaging and endoscopic techniques. The aim of this study was to identify the clinical, biochemical and or radiological predictors of malignant biliary strictures.METHODS: We retrospectively reviewed all charts of patients who had biliary strictures (BS) on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous cholangiography (PTC) in case of unsuccessful ERCP from March 1998 to August 2002. Patient characteristics, clinical features, biochemical, radiological and biopsy results were all recorded. Stricture etiology was determined based on cytology,biopsy or clinical follow-up. A receiver operator characteristic (ROC) curve was constructed to determine the optimal laboratory diagnostic criterion threshold in predicting MBS.RESULTS: One hundred twenty six patients with biliary strictures were enrolled, of which 72 were malignant. The mean age for BBS was 53 years compared to 62.4 years for MBS (P=0.0006). Distal bile duct stricture was mainly due to a malignant process 48.6% vs 9% (P=0.001). Alkaline phosphates and AST levels were more significantly elevated in MBS (P=0.0002). R OC curve showed that a bilirubin level of 84 pmol/L or more was the most predictive of MBS with a sensitivity of 98.6%, specificity of 59.3% and a positive likelihood ratio of 2.42 (95% CI=0.649-0.8L0). Proximal biliary dilatation was more frequently encountered in MBS compared to BBS, 73.8% vs39.5% (P=0.0001). Majority of BBS (87%) and MBS (78%) were managed endoscopically.CONCLUSION: A serum bilirubin level of 84 μmol/L or greater is the best predictor of MBS. Older age, proximal biliary dilatation, higher levels of bilirubin, alkaline phosphatase, ALT and AST are all associated with MBS. ERCP is necessary to diagnose and treat benign and malignant biliary strictures.

  14. Postoperative bile leakage managed successfully by intrahepatic biliary ablation with ethanol

    Institute of Scientific and Technical Information of China (English)

    Tetsuya Shimizu; Takashi Tajiri; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Satoshi Matsumoto; Yoshiaki Mizuguchi; Shigeki Yokomuro; Yasuo Arima; Koho Akimaru

    2006-01-01

    We report a case of postoperative refractory bile leakage managed successfully by intrahepatic biliary ablation with ethanol. A 75-year-old man diagnosed with hepatocellular carcinoma underwent extended posterior segmentectomy including the caudate lobe and a part of the anterior segment. The hepatic tumor attached to the anterior branch of the bile duct was detached carefully and resected. Fluid drained from the liver surface postoperatively contained high concentrations of total bilirubin, at a constant volume of 150 mL per day. On d 32 after surgery, a fistulogram of the drainage tube demonstrated an enhancement of the anterior bile duct.Endoscopic retrograde cholangiography demonstrated complete obstruction of the proximal anterior bile duct and no enhancement of the peripheral anterior bile duct.On d 46 after surgery, a retrograde transhepatic biliary drainage (RTBD) tube was inserted into the anterior bile duct under open surgery. However, a contrast study of RTBD taken 7 mo post-surgery revealed that the fistula remained patent despite prolonged conservative management, so we decided to perform ethanol ablation of the isolated bile duct. Four mL pure ethanol was injected into the isolated anterior bile duct for ten minutes, the procedure being repeated five times a week. Following 23 attempts, the volume of bile juice reached less than 10 mL per day. The RTBD was clamped and removed two days later. After RTBD removal, the patient had no complaints or symptoms. Follow-up magnetic resonance imaging demonstrated atrophy of the ethanol-injected anterior segment without liver abscess formation.

  15. New diagnosis and therapy model for ischemic-type biliary lesions following liver transplantation--a retrospective cohort study.

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    Ying-cai Zhang

    Full Text Available Ischemic-type biliary lesions (ITBLs are a major cause of graft loss and mortality after orthotopic liver transplantation (OLT. Impaired blood supply to the bile ducts may cause focal or extensive damage, resulting in intra- or extrahepatic bile duct strictures or dilatations that can be detected by ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. However, the radiographic changes occur at an advanced stage, after the optimal period for therapeutic intervention. Endoscopic retrograde cholangio-pancreatography (ERCP and percutaneous transhepatic cholangiodrainage (PTCD are the gold standard methods of detecting ITBLs, but these procedures cannot be used for continuous monitoring. Traditional methods of follow-up and diagnosis result in delayed diagnosis and treatment of ITBLs. Our center has used the early diagnosis and intervention model (EDIM for the diagnosis and treatment of ITBLs since February 2008. This model mainly involves preventive medication to protect the epithelial cellular membrane of the bile ducts, regular testing of liver function, and weekly monitor of contrast-enhanced ultrasonography (CEUS to detect ischemic changes to the bile ducts. If the liver enzyme levels become abnormal or CEUS shows low or no enhancement of the wall of the hilar bile duct during the arterial phase, early ERCP and PTCD are performed to confirm the diagnosis and to maintain biliary drainage. Compared with patients treated by the traditional model used prior to February 2008, patients in the EDIM group had a lower incidence of biliary tract infection (28.6% vs. 48.6%, P = 0.04, longer survival time of liver grafts (24±9.6 months vs. 17±12.3 months, P = 0.02, and better outcomes after treatment of ITBLs.

  16. 胆囊切除术中胆总管探查阴性临床分析与处理%Experience and clinical analysis of cholecystectomy and common bile duct exploration negative

    Institute of Scientific and Technical Information of China (English)

    郑兰东

    2011-01-01

    目的 探讨胆囊切除术时胆总管探查阴性的原因.方法 回顾分析2008年6月-2010年12月30例胆总管探查阴性患者的临床资料.结果 导致探查阴性的原因有急性水肿性胰腺炎恢复期6例,慢性胰腺炎5例,梗阻性胆囊炎6例,细小胆囊结石4例,胆总管胆汁浑浊7例,胆总管旁淋巴结肿大2例.结论 胆总管内外因素可引起胆总管探查阴性,术中经胆囊管胆道造影等能减少胆总管的阴性探查.%Objective To evaluate the common bile duct exploration when cholecystectomy negative reasons. Methods Retrospectives analyze in June 2008 - December 2010 totally 30 cases of common bile duct exploration in patients with negative clinical data. Results Negative lead probe the reasons for recovery of acute edematous pancreatitis in 6 cases, 5 cases of chronic pancreatitis, obstructive cholecystitis in 6 cases, small gallbladder stones in 4 cases, common bile duct bile cloudy 7 cases, common bile duct lymph node enlargement 2 cases. Conclusions The common bile duct and external negative factors that can cause common bile duct exploration, intraoperative cholangiography via the cystic duct common bile duct, can reduce the negative exploration.

  17. Efficacy of multiple biliary stenting for refractory benign biliary strictures due to chronic calcifying pancreatitis

    Science.gov (United States)

    Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Tsuyuguchi, Toshio

    2017-01-01

    AIM To investigate endoscopic therapy efficacy for refractory benign biliary strictures (BBS) with multiple biliary stenting and clarify predictors. METHODS Ten consecutive patients with stones in the pancreatic head and BBS due to chronic pancreatitis who underwent endoscopic therapy were evaluated. Endoscopic insertion of a single stent failed in all patients. We used plastic stents (7F, 8.5F, and 10F) and increased stents at intervals of 2 or 3 mo. Stents were removed approximately 1 year after initial stenting. BBS and common bile duct (CBD) diameter were evaluated using cholangiography. Patients were followed for ≥ 6 mo after therapy, interviewed for cholestasis symptoms, and underwent liver function testing every visit. Patients with complete and incomplete stricture dilations were compared. RESULTS Endoscopic therapy was completed in 8 (80%) patients, whereas 2 (20%) patients could not continue therapy because of severe acute cholangitis and abdominal abscess, respectively. The mean number of stents was 4.1 ± 1.2. In two (20%) patients, BBS did not improve; thus, a biliary stent was inserted. BBS improved in six (60%) patients. CBD diameter improved more significantly in the complete group than in the incomplete group (6.1 ± 1.8 mm vs 13.7 ± 2.2 mm, respectively, P = 0.010). Stricture length was significantly associated with complete stricture dilation (complete group; 20.5 ± 3.0 mm, incomplete group; 29.0 ± 5.1 mm, P = 0.011). Acute cholangitis did not recur during the mean follow-up period of 20.6 ± 7.3 mo. CONCLUSION Sequential endoscopic insertion of multiple stents is effective for refractory BBS caused by chronic calcifying pancreatitis. BBS length calculation can improve patient selection procedure for therapy. PMID:28101303

  18. Percutaneous Transhepatic Removal of Bile Duct Stones: Results of 261 Patients

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    Ozcan, Nevzat, E-mail: nevzatcan@yahoo.com; Kahriman, Guven, E-mail: guvenkahriman@hotmail.com; Mavili, Ertugrul, E-mail: ertmavili@yahoo.com [Erciyes University, Department of Radiology, Medical Faculty (Turkey)

    2012-08-15

    Purpose: To determine the effectiveness of percutaneous transhepatic removal of bile duct stones when the procedure of endoscopic therapy fails for reasons of anatomical anomalies or is rejected by the patient. Methods: Between April 2001 and May 2010, 261 patients (138 male patients and 123 female patients; age range, 14-92 years; mean age, 64.6 years) with bile duct stones (common bile duct [CBD] stones = 248 patients and hepatolithiasis = 13 patients) were included in the study. Percutaneous transhepatic cholangiography was performed, and stones were identified. Percutaneous transhepatic balloon dilation of the papilla of Vater was performed. Then stones were pushed out into the duodenum with a Fogarty balloon catheter. If the stone diameter was larger than 15 mm, then basket lithotripsy was performed before balloon dilation. Results: Overall success rate was 95.7%. The procedure was successful in 97.5% of patients with CBD stones and in 61.5% of patients with hepatolithiasis. A total of 18 major complications (6.8%), including cholangitis (n = 7), subcapsular biloma (n = 4), subcapsular hematoma (n = 1), subcapsular abscess (n = 1), bile peritonitis (n = 1), duodenal perforation (n = 1), CBD perforation (n = 1), gastroduodenal artery pseudoaneurysm (n = 1), and right hepatic artery transection (n = 1), were observed after the procedure. There was no mortality. Conclusion: Our experience suggests that percutaneous transhepatic stone expulsion into the duodenum through the papilla is an effective and safe approach in the nonoperative management of the bile duct stones. It is a feasible alternative to surgery when endoscopic extraction fails or is rejected by the patient.

  19. Endoscopic diagnosis and treatment of biliar y leak in patients following liver transplantation:a prospective clinical study

    Institute of Scientific and Technical Information of China (English)

    Jia-Zhi Liao; Qiu Zhao; Hua Qin; Rong-Xiang Li; Wei Hou; Pei-Yuan Li; Nan-Zhi Liu; De-Ming Li

    2007-01-01

    BACKGROUND:Orthotopic liver transplantation has been widely used in patients with end-stage liver disease within the last two decades. However, the prevalence of biliary complications after liver transplantation remains high. The most common short-term biliary complication may be biliary leak. So, we examined 13 patients with biliary leak after liver transplantation, attempting to evaluate the role of endoscopic diagnosis and treatment of biliary leak and the incidence of bile duct stricture after healing of the leak. METHODS: Six cases of T-tube leak and seven cases of anastomosis leak complicating liver transplantation were enrolled in this prospective study. Six patients were treated by endoscopic plastic stent placement, two by nasobiliary catheter drainage, two by papillosphincterotomy, and three by nasobiliary catheter drainage combined with plastic stent placement. Some patients received growth hormone treatment. RESULTS: The bile leak resolution time was 10-35 days in 10 patients with complete documentation. The median time of leak resolution was 15.3 days. Four cases of anastomosis stricture, three cases of common hepatic duct and one case of multiple bile duct stenosis were detected by follow-up nasobiliary catheter cholangiography or endoscopic retrograde cholangiopancreatography. CONCLUSIONS:Endoscopic nasobiliary catheter or plastic stent placement is a safe and effective treatment for bile duct stricture occurring after bile leak resolution in most liver transplantation patients. Nasobiliary catheter combined with plastic stent placement may be the best choice for treating bile leak, because, theoretically, it may prevent the serious condition resulting from accidental nasobiliary catheter dislocation, and it may have prophylactic effects on upcoming bile duct stricture, although this should be further conifrmed.

  20. Primary biliary cirrhosis

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    Heathcote E Jenny

    2008-01-01

    Full Text Available Abstract Primary biliary cirrhosis (PBC is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex. The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking. Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for

  1. Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

    Institute of Scientific and Technical Information of China (English)

    Suk Keu Yeom; Seung Wha Lee; Sang Hoon Cha; Hwan Hoon Chung; Bo Kyung Je; Baek Hyun Kim; Jong Jin Hyun

    2012-01-01

    AIM:To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD)on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC).METHODS:This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD.All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acidenhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions.Of the five patients with choledochal cysts,four underwent pyloruspreserving pancreaticoduodenectomy.RESULTS:The five cases of choledochal cysts were classified as Todani classification I.In three of the six patients with AUPBD,injected contrast media reached the distal CBD and pancreatic duct on delay images,suggesting biliopancreatic reflux.In two of these six patients,a band-like filling defect was noted in the CBD on pre-fatty meal images,which decreased in size on delayed post-fatty meal images,suggesting pancreatico-biliary reflux of pancreatic secretions,and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L.In one of the six patients with AUPBD,contrast media did not reach the distal CBD due to multiple CBD stones.CONCLUSION:Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

  2. Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts

    Institute of Scientific and Technical Information of China (English)

    Tian-Fu Wen; Ming-Qing Xu; Jiang-Wen Liu; Zhi-Gang Deng; Hong Wu; Zhe-Yu Chen; Lu-Nan Yan; Bo Li; Yong Zeng; Ji-Chun Zhao; Wen-Tao Wang; Jia-Yin Yang; Yu-Kui Ma

    2007-01-01

    BACKGROUND:The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS:We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inlfow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS:There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS:The ifrst consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.

  3. Laparoscopic modified subtotal cholecystectomy for difficult gall bladders: A single-centre experience

    Science.gov (United States)

    Harilingam, Mohan Raj; Shrestha, Ashish Kiran; Basu, Sanjoy

    2016-01-01

    AIM: Laparoscopic cholecystectomy (LC) is considered the ‘gold standard’ intervention for gall bladder (GB) diseases. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot's triangle. The aim is to find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable, with an acceptable morbidity and outcome. PATIENTS AND METHODS: A retrospective analysis of prospectively collected data of 993 consecutive patients who underwent cholecystectomy was done at a large District General Hospital (DGH) between August 2007 and January 2015. The data are as follows: Patient's demographics, operative details including intra- and postoperative complications, postoperative stay including follow-up that was recorded and analysed. RESULTS: A total of 993 patients (263 males and 730 female) were included. The median age was 52*(18-89) years. Out of the 993 patients, 979 (98.5%) and 14 (1.5%) were listed for laparoscopic and open cholecystectomy, respectively. Of the 979 patients, 902 (92%) and 64 (6.5%) patients underwent LC ± on-table cholangiography (OTC) and LMSC ± OTC, respectively, with a median stay of 1* (0-15) days. Of the 64 patients, 55 (86%) had dense adhesions, 22 (34%) had acute inflammation, 19 (30%) had severe contraction, 12 (19%) had empyema, 7 (11%) had Mirizzi's syndrome and 2 (3%) had gangrenous GB. The mean operative time was 120 × (50-180) min [Table 1]. Six (12%) patients required endoscopic retrograde cholangiopancreatography (ERCP) postoperatively, and there were four (6%) readmissions in a follow-up of 30 × (8-76) months. The remaining 13 (1.3%) patients underwent laparoscopic cholecystectomy converted to an open cholecystectomy. The median stay for open/laparoscopic cholecystectomy converted to open cholecystectomy was 5 × (1-12) days. CONCLUSION: Our technique of LMSC avoided conversion in 6.5% patients and believe that it is feasible and safe for difficult GBs

  4. Unsedated small caliber esophagogastroduodenoscopy: can we trust this technique?

    Science.gov (United States)

    Ustündağ, Yücel; Saritaş, Ulkü; Ponchon, Thierry

    2011-06-01

    Small caliber endoscopes are one of the best examples of fantastic technological advancements in gastrointestinal endoscopy. First designed for pediatric patients in the 1970s, current small caliber videoendoscopes were used for unsedated transnasal gastrointestinal endoscopy after 1994. Nowadays, unsedated endoscopy can be successfully done using small caliber endoscopes via transoral or transnasal route in nearly 90% of cases. Several large studies have shown that small caliber endoscopy is feasible, safe and well-tolerated. These devices can decrease the potential risks of upper gastrointestinal endoscopy by eliminating the need for sedation since these ultrathin endoscopes induce much less gag reflex or choking sensation in patients. Moreover, gastrointestinal endoscopy with small caliber endoscopes results in less sympathetic system activation as well as less oxygen desaturation compared to standard endoscopy, especially in aged, severely ill, bedridden patients. Nevertheless, there is no overall consensus on its cost effectiveness. Though indications are similar with standard endoscopy, small caliber endoscopy can be preferred in patients with gastrointestinal stenosis. Less common indications include transnasal endoscopic retrograde cholangiography and postpyloric feeding tube insertion. The esophagogastroduodenoscopy procedure with small caliber endoscopes is easy to perform, and there is generally no need for further training for this technique. However, the additional cost of equipment and some medicolegal and technical issues have resulted in the unpopularity of small caliber endoscopy in most countries other than France and Japan. However, sharing information about this technique and stressing its potential advantages can help in its widespread use in various countries including Turkey. We believe that routine use of small caliber endoscopes during daily gastrointestinal endoscopy practice is not far away in many countries.

  5. Efficacy of Multidetector-Row Computed Tomography as a Practical Tool in Comparison to Invasive Procedures for Visualization of the Biliary Obstruction

    Science.gov (United States)

    Taheri, Abdolmajid; Rostamzadeh, Ayoob; Gharib, Alireza; Fatehi, Daryoush

    2016-01-01

    Introduction: Recently, multidetector computed tomography (MDCT) has been introduced into clinical practice. MDCT has become the noninvasive diagnostic test of choice for detailed evaluation of biliary obstruction. Aim: the main objective of the present study was to evaluate the diagnostic value of MDCT compared to invasive procedures for detecting biliary obstruction causes. Material and Methods: Since February 2009 until May 2011 fifty biliary obstruction patients based on clinical, laboratory or ultrasonographic findings, were evaluated by Multidetector-row computed tomography. The causes of biliary obstruction, which was identified using. MDCT were classified into three categories: calculus, benign stricture, and malignancy. Final diagnosis was conducted based on percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography, biopsy, or surgery. The MDCT diagnosis and were compared with the final diagnosis. Results: A correct diagnosis of causes of biliaryobstruction was made on the basis of MDCT findings for 44 of the total 50 patients. Two patients with chronic pancreatitis were incorrectly diagnosed with a pancreatic head adenocarcinoma on the basis of MDCT findings. One patient with biliary stone was incorrectly diagnosed with a periampullary adenocarcinoma on the basis of MDCT findings. The Sensitivity, specificity and accuracy of MDCT in the diagnosis of causes of biliary obstruction were 94.12% and87.87% and94.6% respectively. Conclusion: Based on the findings of this study MDCT has an excellent image quality, providing valuable information about the biliary tree and other abdominal organs. The use of advanced image processing, including maximum intensity projection and multiplanar reconstruction (especially coronal or sagittal reformatted images), allows superior visualization of the biliary tree and vascular structures. Three-dimensional reconstruction images complement axial images by providing a more anatomically

  6. Novel technique for biliary reconstruction using an isolated gastric tube with a vascularized pedicle: a live animal experimental study and the first clinical case

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    Hashem Mostafa

    2011-10-01

    Full Text Available Abstract Background Biliary tract reconstruction continues to be a challenging surgical problem. Multiple experimental attempts have been reported to reconstruct biliary defects with different materials and variable outcome. Our aim was to evaluate a new method for biliary reconstruction using an isolated pedicled gastric tube in a live animal trial and also to present the first clinical case. Methods Seven mongrel dogs underwent biliary reconstruction using gastric tube harvested, completely separated from the greater curvature, and based on a vascularized pedicle with the right gastroepiploic vessels. The tube was interposed between the common bile duct (CBD and the duodenum. Postoperative mortality, morbidity, liver functions, gross and microscopic histological picture were assessed. The first clinical case was also presented where, in a patient with post-cholecystectomy biliary injury, an isolated pedicled gastric tube was interposed between the proximal and distal ends of the CBD. Results One dog did not recover from anesthesia and another one died postoperatively from septic peritonitis. Five dogs survived the procedure and showed uneventful course and no cholestasis. The mean anastomotic circumference was 4.8 mm (range 4-6 for CBD anastomosis and 6.2 mm (range 5-7 for duodenal anastomosis. Histologically, anastomotic sites showed good evidence of healing. In the first clinical case, the patient showed clinical and biochemical improvement. Endoscopic retrograde cholangiography was feasible and assured patent biliary anastomoses. Conclusion In mongrel dogs, biliary reconstruction using pedicled gastric tube interposition between CBD and duodenum is feasible with satisfactory clinical results, anastomotic circumference and histological evidence of healing. The technique is also feasible in human and seems to be promising.

  7. VALIDITY OF CONTRAST ENHANCED CT IN THE ASSESSMENT OF ACUTE PANCREATITIS AND ITS RELATED COMPLICATIONS

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    Mannivanan

    2016-03-01

    Full Text Available BACKGROUND In the earlier days, ultrasonogram was considered as one of the most important investigation for pancreatitis, later the clinicians started using cholangiography in acute pancreatitis, but today CT is considered as a gold standard test in the diagnosis of acute pancreatitis. Though the sensitivity of CT in diagnosing acute pancreatitis was not studied much particularly in a mild case, but a good-quality contrast enhanced CT demonstrates distinct pancreatic and peri-pancreatic abnormalities. AIM To assess the importance of computed tomography in diagnosing acute pancreatitis and its related complications. MATERIALS AND METHODS A prospective study was conducted on 150 patients with clinically suspected pancreatitis. CT was performed on all the patients with Siemens Spiral CT scanner Sensation 16 slice. Oral contrast of was 1000 mL given one hour prior to the scan in the form of taking 250 mL every 15 mins. The CT severity index (CTSI and the necrosis point scoring was used to assess the severity of acute pancreatitis. All the complications related to acute pancreatitis were also assessed. RESULTS The CT analysis in the detection of acute pancreatitis showed the sensitivity of 100% and the positive predictive value of 97.3%. The severity index of acute pancreatitis based on the CT imaging had shown that majority of the patients are with moderate (60.6% level of acute pancreatitis. The necrosis point scoring showed that 54.6% of the patients had necrosis involving less than 30% of the pancreas. Among the various complications detected by CECT the commonest were pleural effusion and ascites. CONCLUSION CECT is the most important gold standard technique both for diagnosis as well as for predicting the prognosis in acute pancreatitis. The clinicians should routinely send the patient for the CT imaging whenever there is a suspicion of pancreatitis clinically.

  8. Angeborene Cholesterasen

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    Zollner G

    2011-01-01

    Full Text Available Angeborene Cholestasen sind seltene Erkrankungen, die zumeist bereits in frühester Kindheit auftreten und durch genetische Defekte hepatobiliärer Transportsysteme oder durch eine gestörte Entwicklung des Gallengangsystems bedingt sind. Mutationen in Transportsystemen verursachen hereditäre Cholestasesyndrome, wie die progressive familiäre intrahepatische Cholestase, das Dubin- Johnson-Syndrom und die zystische Fibrose. Eine gestörte Entwicklung des Gallengangsystems kann die biliäre Atresie, das Alagille- Syndrom, die kongenitale Leberfibrose, die Caroli-Erkrankung oder das Caroli-Syndrom verursachen. Die Diagnosestellung ist schwierig und kann auch den Einsatz invasiver Techniken (z. B. endoskopisch retrograde Cholangiographie, Leberbiopsie zusätzlich zu physikalischer Untersuchung, Labor, bildgebenden Verfahren und molekulargenetischen Analysen erforderlich machen. Die Therapie dieser Erkrankungen umfasst den Einsatz von Ursodeoxycholsäure, chirurgische Eingriffe wie z. B. die Kasai-Portoenterostomie bei der biliären Atresie oder bei Versagen dieser Maßnahmen die Lebertransplantation. Angeborene Cholestasen sind auch zunehmend für den Erwachsenen-Gastroenterologen/ Hepatologen von Bedeutung, da immer mehr pädiatrische Patienten das Erwachsenenalter erreichen und sich milde Verläufe oder Schwachformen dieser Erkrankungen auch erst im Erwachsenenalter manifestieren können. Zusätzlich konnte eine Assoziation von diversen Defekten hepatobiliärer Transportsysteme mit „klassischen Cholestasen“ des Erwachsenalters bewiesen werden. So finden sich Polymorphismen in Transportergenen bei der Schwangerschaftscholestase oder der medikamentös induzierten Cholestase als pathogenetische Kofaktoren. Diese Defekte können auch den Verlauf von primär biliärer Zirrhose und primär sklerosierender Cholangitis beeinflussen.

  9. PSC, AIH and overlap syndrome in inflammatory bowel disease.

    Science.gov (United States)

    Trivedi, P J; Chapman, R W

    2012-10-01

    Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disorder characterised by chronic inflammation and stricture formation of the biliary tree. Symptoms include pruritus, fatigue and in advanced cases ascending cholangitis, cirrhosis and end-stage hepatic failure. Patients are at an increased risk of malignancy arising from the bile ducts, gallbladder, liver and colon. The majority (>80%) of Northern European patients with PSC also have inflammatory bowel disease (IBD), usually ulcerative colitis (UC). IBD commonly presents before the onset of PSC, although the opposite can occur and the onset of both conditions can be separated by many years. The colitis associated with PSC is characteristically mild although frequently involves the whole colon. Despite the majority of patients having relatively inactive colonic disease, paradoxically the risk of colorectal malignancy is substantially increased. Patients may also develop dominant, stenotic lesions of the biliary tree which may be difficult to differentiate from cholangiocarcinoma and the coexistence of IBD may influence the development of this complication. Ursodeoxycholic acid may offer a chemoprotective effect against colorectal malignancy and improve liver biochemical indices. Evidence of any beneficial effect on histological progression of hepatobiliary disease is less clear. High doses (∼25-30 mg/kg/d) may be harmful and should be avoided. Autoimmune hepatitis (AIH) is less common in patients with IBD than PSC, however, an association has been observed. A small subgroup may have an overlap syndrome between AIH and PSC and management should be individualised dependant on liver histology, serum immunoglobulin levels, autoantibodies, degree of biochemical cholestasis and cholangiography.

  10. Diagnosis, Differential Diagnosis, and Epidemiology of Primary Sclerosing Cholangitis.

    Science.gov (United States)

    Ponsioen, Cyriel Y

    2015-01-01

    According to recent guidelines, primary sclerosing cholangitis (PSC) is diagnosed when a patient has a cholestatic liver enzyme profile, characteristic bile duct changes on imaging, and when secondary causes of sclerosing cholangitis are excluded. In patients with a clinical suspicion but normal cholangiography, a liver biopsy is indicated to establish a diagnosis of small duct PSC. Several other disease entities such as IgG4-associated cholangitis (IAC), cholangiocarcinoma (CCA), and secondary causes of sclerosing cholangitis such as choledocholithiasis, AIDS-cholangiopathy, ischemia, surgical bile duct trauma, or mast cell cholangiopathy can mimic PSC. IAC can be differentiated from PSC by applying the HISORt criteria including the serum IgG4 level. In cases where serum IgG4 is less than 2 × ULN, the ratio of IgG4/IgG1 >0.24 is indicative for IAC. Choledocholithiasis with recurrent cholangitis as a cause of sclerosing cholangitis can pose a conundrum, since PSC itself is associated with an increased prevalence of gallstones. The epidemiology of PSC worldwide has been poorly described. Incidence and prevalence rates vary from 0-1.3 and 0-16.2 per 100,000 inhabitants respectively. However, these figures are not based on population-based cohorts. A recent large population-based cohort from the Netherlands reported an incidence of 0.5 and a prevalence of 6/100,000. Approximately 10% fulfil the criteria for small duct PSC. At diagnosis of PSC, concurrent inflammatory bowel disease (IBD), primarily ulcerative colitis or Crohn's colitis is present in 50%, but increasing to 80%, 10 years or more after diagnosis. Conversely, 3% of IBD patients will develop PSC. PSC predisposes to malignancy. The estimated cumulative risk of developing CCA after 30 years is 20%. For colorectal carcinoma in PSC/colitis patients, the estimated cumulative risk at 30 years is 13%.

  11. Antineutrophil cytoplasmic antibodies in bile are associated with disease activity in primary sclerosing cholangitis.

    Science.gov (United States)

    Lenzen, Henrike; Weismüller, Tobias J; Negm, Ahmed A; Wlecke, Jenny; Loges, Stephanie; Strassburg, Christian P; Manns, Michael P; Lankisch, Tim O

    2013-10-01

    OBJECTIVE. Primary sclerosing cholangitis (PSC) is an autoimmune cholestatic liver disease of unknown etiology. The role of antineutrophil cytoplasmic antibodies (ANCAs) in the serum of patients with PSC remains unclear. We hypothesized that ANCA may be detectable in bile, potentially providing diagnostic and prognostic information. METHODS. Serum and bile were prospectively collected during endoscopic retrograde cholangiography (ERC) in 72 patients with PSC and other non-PSC obstructive biliary diseases. ANCA measurements were performed by indirect immunofluorescence (IIF). RESULTS. Immunoglobulin G (IgG) ANCA was detected significantly more often in the bile of PSC patients (15/39; 38%) than without (2/33; 6%) (p = 0.001). IgG ANCA in bile was associated with a ten times higher risk of PSC (p = 0.005). In addition, IgG ANCA positivity in bile was associated with the presence of dominant strictures (p = 0.03), cholangiographic severity (p = 0.004), number of ERC (p = 0.01) and interventions performed (p = 0.03). However, IgG ANCA in bile did not correlate with transplantation, cholangiocarcinoma or death. No association was observed between ANCA positivity in sera and ANA and ASCA positivity in sera or bile with the above-mentioned clinical features. CONCLUSIONS. The presence of ANCA in the bile of patients with PSC is a novel finding and highly suggestive of PSC. Biliary IgG ANCA correlates with the severity of bile duct strictures and the ensuing number of ERCs and interventions. Therefore, a positive ANCA status in bile may serve as a diagnostic and prognostic marker of the disease progression and biliary complications.

  12. Evaluation of Biliary Calprotectin as a Biomarker in Primary Sclerosing Cholangitis

    Science.gov (United States)

    Gauss, Annika; Sauer, Peter; Stiehl, Adolf; Rupp, Christian; Krisam, Johannes; Leopold, Yvonne; Kloeters-Plachky, Petra; Stremmel, Wolfgang; Gotthardt, Daniel

    2016-01-01

    Abstract Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the bile ducts with limited therapeutic options except liver transplantation. Reliable biomarkers to predict the disease course are unavailable, and currently employed disease activity scores such as the Mayo risk score (MRS) have limitations. The present study aims to evaluate biliary calprotectin as a marker of disease activity and prognosis in PSC. This is a monocentric retrospective observational study. Calprotectin concentrations were measured by an enzyme-linked immunosorbent assay in bile samples collected by endoscopic retrograde cholangiography from 106 PSC patients and 20 controls. Biliary calprotectin concentrations were compared between the 2 groups. In PSC patients, results were evaluated with regard to the presence of dominant bile duct stenoses, bile microbiology, MRS, survival free of liver transplantation, and necessity for bile duct interventions in the further disease course. Median (interquartile ranges) biliary calprotectin concentrations were higher in PSC patients than in controls (3646 ng/mL, 249–9748 vs 116 ng/mL, 104–655; P PSC cohort, higher biliary calprotectin concentrations were associated with the presence of microbes in bile (P = 0.02), the occurrence of dominant bile duct stenosis at any time in the disease course (P = 0.005), and the necessity for future bile duct interventions (P = 0.02). Patients with biliary calprotectin concentrations above a cut-off of 11,610 ng/mL displayed significantly shorter transplantation-free survival than those with biliary calprotectin concentrations ≤11,610 ng/mL (P 11,610 ng/mL) as a risk factor of shorter transplantation-free survival of PSC patients (P 142.5 U/L) (P = 0.006), high MRS (≥2) (P PSC, so that further studies for evaluation of calprotectin in this disease are warranted. PMID:27124059

  13. Evaluation of the use of laparoscopic-guided cholecystocholangiography and liver biopsy in definitive diagnosis of neonatal cholestatic jaundice

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    Khalid Shreef

    2016-01-01

    Full Text Available Background: Once it is established that a jaundiced infant has direct hyperbilirubinemia, the principal diagnostic concern is to differentiate hepatocellular from obstructive cholestasis. Traditional tests such as ultrasonography, percutaneous liver biopsy and technetium 99 m hepatobiliary iminodiacetic acid (HIDA scan are often not sufficiently discriminating. Definitive exclusion of biliary atresia (BA in the infant with cholestatic jaundice usually requires mini-laparotomy and intra-operative cholangiography. This approach has many drawbacks because those sick infants are subjected to a time-consuming procedure with the probability of negative surgical exploration. Aim of the Study: The aim of this study was to determine the feasibility of laparoscopic-guided cholecystocholangiography (LGCC and its accuracy and safety in the diagnosis of BA and thus preventing unnecessary laparotomy in infants whose cholestasis is caused by diseases other than BA. Patients and Methods: Twelve cholestatic infants with direct hyperbilirubinemia subjected to LGCC (age, 7–98 days; mean, 56 days after ultrasound scan and (99 mTc HIDA scan and percutaneous liver biopsy failed to provide the definitive diagnosis. Results: One patient had completely absent gall bladder (GB so the laparoscopic procedure was terminated and laparotomy was done (Kasai operation. Four patients had small size GB; they underwent LGCC that showed patent common bile duct with atresia of common hepatic duct, so laparotomy and Kasai operation was performed. Seven patients had well-developed GB, LGCC revealed patent biliary tree, so laparoscopic liver biopsies were taken for histopathology. Five of those patients had neonatal hepatitis, and two had cholestasis as a complication of prolonged TPN. No perioperative complications or mortalities were recorded. Conclusion: When the diagnosis neonatal cholestasis remains elusive after traditional investigations, LGCC is an accurate and simple method

  14. Use of rigid tubal ligation scope: Serendipity in laparoscopic common bile duct exploration

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    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Aim : To assess the feasibility, safety of rigid tubal ligation scope in laparoscopic common bile duct (CBD exploration. Materials and Methods: Rigid nephroscope was used for laparoscopic CBD exploration until one day we tried the same with the rigid tubal ligation scope, which was passed easily into CBD both proximally and distally visualising the interior of the duct for presence of stone that were removed using endoscopic retrograde cholangiopancreaticography (ERCP basket. This serendipity led us to use this scope for numerous patients from then on. A total of 62 patients, including male and female, underwent laparoscopic CBD exploration after choledochotomy with rigid tubal ligation scope between March 2007 and December 2012 followed by cholecystectomy. All the patients had both cholelithiasis and choledocholithiasis with minimum duct diameter of 12 mm. A total of 48 patients were given T-tube through choledochotomy and closed, and the remaining 14 patients had primary closure of choledochotomy. Results: There were no intra-operative complications in any of the patients like CBD injury or portal vein injury. Post-operatively graded clamping of T-tube was done and was removed after 15 days in the patients who were given T-tube. None had retained the stone after T-tube cholangiography, which was done before removing the tube. Mean duration of follow up was 6 months. No patients had any complaints during the follow up. Conclusion: Laparoscopic CBD exploration is also feasible with rigid tubal ligation scope. With experienced surgeons, CBD injury is very minimal and stone clearance can be achieved in almost all patients. This rigid tubal ligation scope can be an alternative to other rigid and flexible scopes.

  15. Role of endoscopy in the diagnosis of autoimmune pancreatitis and immunoglobulin G4-related sclerosing cholangitis.

    Science.gov (United States)

    Kamisawa, Terumi; Ohara, Hirotaka; Kim, Myung Hwan; Kanno, Atsushi; Okazaki, Kazuichi; Fujita, Naotaka

    2014-09-01

    Autoimmune pancreatitis (AIP) must be differentiated from pancreatic carcinoma, and immunoglobulin (Ig)G4-related sclerosing cholangitis (SC) from cholangiocarcinoma and primary sclerosing cholangitis (PSC). Pancreatographic findings such as a long narrowing of the main pancreatic duct, lack of upstream dilatation, skipped narrowed lesions, and side branches arising from the narrowed portion suggest AIP rather than pancreatic carcinoma. Cholangiographic findings for PSC, including band-like stricture, beaded or pruned-tree appearance, or diverticulum-like outpouching are rarely observed in IgG4-SC patients, whereas dilatation after a long stricture of the bile duct is common in IgG4-SC. Transpapillary biopsy for bile duct stricture is useful to rule out cholangiocarcinoma and to support the diagnosis of IgG4-SC with IgG4-immunostaining. IgG4-immunostaining of biopsy specimens from the major papilla advances a diagnosis of AIP. Contrast-enhanced endoscopic ultrasonography (EUS) and EUS elastography have the potential to predict the histological nature of the lesions. Intraductal ultrasonographic finding of wall thickening in the non-stenotic bile duct on cholangiography is useful for distinguishing IgG4-SC from cholangiocarcinoma. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to exclude pancreatic carcinoma. To obtain adequate tissue samples for the histological diagnosis of AIP, EUS-Tru-cut biopsy or EUS-FNA using a 19-gauge needle is recommended, but EUS-FNA with a 22-gauge needle can also provide sufficient histological samples with careful sample processing after collection and rapid motion of the FNA needles within the pancreas. Validation of endoscopic imaging criteria and new techniques or devices to increase the diagnostic yield of endoscopic tissue sampling should be developed.

  16. Outcomes of adult-to-adult living donor liver transplantation:a single center experience

    Institute of Scientific and Technical Information of China (English)

    FENG Xi; YUAN Ding; WEI Yong-gang; LI Fu-qiang; WEN Tian-fu; ZENG Yong; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing; YANG Jia-yin; MA Yu-kui; CHEN Zhe-yu; YE Hui; YAN Lü-nan; LI Bo

    2009-01-01

    Background Since January 2002,adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers.This study presents a detailed analysis of the outcomes of AALDLT in a single center.Methods A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007.Among these,67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts.Three-dimensional volumetric computed tomography,magnetic resonance imaging with angiography and cholangiography were performed preoperatively.Recipient operation time,intraoperative transfusion requirement,length of intensive care unit stay,length of hospital stay,liver function tests,coagulation tests and surgical outcomes were routinely investigated throughout this study.Results All donors survived the procedure with an overall complication rate of 15.3%.Overall recipient 1-year survival and complication rates were 87.1% and 34.2%,respectively.Among the 70 cases,average graft recipient weight ratio was 0.94% (0.72%-1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74%-71.68%).All residual liver volumes exceeded 35%.Liver function and coagulation recovered rapidly within the first 7 days after transplantation.Conclusions AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease.Patient selection and timely decision-making for transplantation are essential in achieving good outcomes.With accumulation of experience in surgery and clinical management,timely feedback and proper modification,we foresee better outcomes in the future.

  17. Kombinierte radiologisch-interventionelle und radiotherapeutische Behandlung von Patienten mit zentralen Gallengangsmalignomen

    Directory of Open Access Journals (Sweden)

    Riedmann E

    2005-01-01

    Full Text Available Einleitung: In einer retrospektiven Analyse von 24 Patienten mit inoperablen oder nicht radikal resezierten Karzinomen des Gallentraktes wurde der Einfluß einer HDR-(high-dose-rate192-Ir-Brachytherapie oder der kombinierten Tele-/Brachytherapie auf Überlebenszeit und Verbesserung der Lebensqualität untersucht. Methode und Material: Von 1996 bis 2001 wurden 24 Patienten mit einem Karzinom, welches die extrahepatischen Gallenwege obstruierte (16 Klatskin-Tumoren, 6 Gallenblasenkarzinome, 2 Metastasen eines GI-Tumors, einer palliativen Radiatio unterzogen. 14 von 24 Patienten wurden bei einem lokal fortgeschrittenen inoperablen Tumor, 5 Patienten nach einer R1-Resektion und 5 Patienten im Rezidiv behandelt. Bei allen Patienten wurde eine perkutane transhepatische Cholangiographie (PTC und anschließend die Implantation eines oder mehrerer selbstexpandierbarer Stents zur Behandlung der biliären Okklusion durchgeführt. 23 Patienten erhielten eine endoluminale Brachytherapie, 10 davon kombiniert mit einer Teletherapie; ein Patient erhielt eine alleinige Teletherapie. Im ersten Jahr wurde sechs Patienten die Brachytherapie mit einer Dosis von 15 Gray (Gy in drei Fraktionen verabreicht. Ab 1997 wurden 17 Patienten mit hyperfraktionierter Brachytherapie (2 x täglich mit einer mittleren Dosis von 20 Gy (5 x 4 Gy behandelt. Die mittlere Dosis der Teletherapie in beiden Gruppen betrug 40 Gy (Range 22–60 Gy. Ergebnisse: Das mediane Überleben für alle Patienten betrug 7,7 Monate. Patienten, die mit hyperfraktionierter Brachytherapie behandelt wurden, zeigten einen Trend zu einem verlängerten Überleben mit 11,6 Monaten verglichen mit 5,7 Monaten in der konventionell behandelten Gruppe. Die akuten Nebenwirkungen waren moderat.

  18. Thin section helical CT findings of klastskin tumor and benign stricture: cholangiographic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Guk Myeong; Han, Joon Koo; Kim, Tae Kyoung; Choi, Byung Ihn; Kim, Sun Whe; Cho, Yun Ku; Han, Man Chung; Yeon, Kyung Mo [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    The purpose of this study was (1) to describe the thin section helical CT findings of hilar cholangiocarcinoma and of benign strcture, and to discuss the differential points between the two disease entities and (2) using cholangiographic correlation, to evaluate the diagnostic accuracy of helical CT in determining the extent of hilar cholangiocarcinoma. Twenty-seven patients with hilar cholangiocarcinoma and eight with benign biliary dilatation were studied. All except four with hilar cholangiocarcinoma, who underwentCT using a conventional scanner, were studied with two-phase helical CT. In all patients, cholangiographs were obtained by digital fluoroscopy after the injection of contrast materials into PTBD catheters. The level of obstruction was classified according to Bismuth, and 35 CT scans were studied blindly and retrospectively by two radiologists. The findings were analyzed for the presence of tumor, and then divided into two groups(cholangiocarcinomas and benign strictures), and the positive predictive value was calculated. The CT images of klatskin tumor were analyzed with special emphasis on the level and shape of the hilar obstruction. The level of biliary obstruction and extent of the tumor were carefully correlated with the results of cholangiography. Thin-section spiral CT correctly identified all tumor mass as a focal wall thickening obliterating the lumen. On arterial/portal phase CT scanning, 81% of infilterative tumors showed high attenuation. In all patients, differentiation between benign stricture and klaskin tumor was possible;correct identification of the level of obstruction and extent of tumor, according to Bismuth's classification, was possible in 63% of cases. For correct diagnosis of hilar cholangiocarcinoma and differentiation of benign stricture, helical CT was highly accurate and effective. Because of limital Z-axis resolution, however, the exact intraductal extent of the tumor was less accorately diagnosed.=20.

  19. Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

    Institute of Scientific and Technical Information of China (English)

    Tomohide Hori; Takashi Wagata; Kenji Takemoto; Takanobu Shigeta; Haruko Takuwa; Koichiro Hata; Shinji Uemoto; Naoki Yokoo

    2008-01-01

    A 71-year-old Japanese man with acute cholecystitis and an incarcerated gallbladder (GB) stone was admitted. Plain ultrasonography (US) incidentally detected a mass-like lesion in the fundus. Doppler US revealed that this elevated lesion had no blood flow. Computed tomography showed a relatively low-density mass, measuring 5 cm×4 cm in diameter, with no positive enhancement. Magnetic resonance imaging showed a mass in the fundus with a slightly low intensity on T1-weighted images and a slightly high intensity on T2-weighted images. We were agonized in making the qualitative diagnosis of mass-like lesions of the fundus, such as a benign tumor, cancer, or debris. We performed laparoscopic cholecystectomy, because the incarcerated GB stone clearly caused acute cholecystitis. Intra-operative cholangiography clearly revealed pancreaticobiliary maljunction. Amylase levels in the common bile duct and gallbladder were quite high. The elevated lesion in the fundus clearly showed severe necrosis. Although this necrotic nodule included non-viable adenocarcinoma cells, viable cancer cell nests were located in the muscularis propria and subcutaneous layer. Histopathological examination confirmed a solid adenocarcinoma. Thus, we diagnosed it as a gallbladder cancer, based on histopathological analysis of the resected specimen. We therefore undertook radical surgery, including wedge resection of the liver, radical dissection of regional lymph nodes, and resection of the extrahepatic bile duct. Histopathological findings revealed no cancer, hyperplasia or dysplasia in the additionally resected specimens. The patient was finally staged as T2, NO, H0, P0, M(-), stage 11. We present the first case of spontaneous necrosis of solid gallbladder adenocarcinoma, with a review of previous studies.

  20. Feasibility of endoscopic retrograde cholangiopancreatography in healthy cats.

    Science.gov (United States)

    Spillmann, Thomas; Willard, Michael D; Ruhnke, Isabelle; Suchodolski, Jan S; Steiner, Jörg M

    2014-01-01

    Cats are predisposed to diseases of the biliary tract and the exocrine pancreas and these can be challenging to diagnose. In humans and dogs > 10 kg, endoscopic retrograde cholangiopancreatography (ERCP) has been successfully used to diagnose some of these disorders. The purpose of our study was to determine whether ERCP would also be feasible in cats using a pediatric duodenoscope. Four purpose-bred, clinically healthy, castrated domestic shorthair cats participated in two studies. Study 1 compared standard white light endoscopy with chromoendoscopy for localizing the major duodenal papilla. In Study 2 ERCP was performed. Repeated clinical examinations and measurements of serum feline pancreatic lipase immunoreactivity (fPLI) were performed before and up to 18 hours after interventions on all cats. Chromoendoscopy was subjectively judged to be superior for localizing the major papilla. Insertion of the ERCP catheter was best accomplished when cats were in dorsal recumbency. Complete ERCP was successful in two cats. In the other cats, either retrograde cholangiography or pancreatography was possible. Serum fPLI concentrations increased temporarily in two cats during Study 2 when measured immediately, 2, 4, and 18 h after ERCP. Peak fPLI concentrations were detected either immediately after ERCP or 2 h later. No clinical signs of complications were observed within 18 h after the procedures. Findings indicated that ERCP is technically demanding but feasible in healthy cats. Future studies need to determine whether the temporary increases in serum fPLI concentrations are clinically important and to investigate the utility of ERCP in feline patients.

  1. Detection of biliary stenoses in patients after liver transplantation: Is there a different diagnostic accuracy of MRCP depending on the type of biliary anastomosis?

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    Kinner, Sonja, E-mail: Sonja.Kinner@uni-due.de [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Alexander [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Paul, Andreas [Department of General-, Visceral- and Transplant Surgery, University Hospital Essen (Germany); Umutlu, Lale; Ladd, Susanne C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany); Dechene, Evelin Maldonado de; Zoepf, Thomas; Gerken, Guido [Department of Hepatology and Gastroenterology, University Hospital Essen (Germany); Lauenstein, Thomas C. [Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122 Essen (Germany)

    2011-11-15

    Purpose: Two different forms of biliary anastomosis can be created in patients undergoing liver transplantation: (a) bilio-digestive anastomoses or (b) choledocho-choledochostomy. Aim of this study was to assess the accuracy of MR cholangiopancreatography (MRCP) for the depiction of biliary stenoses in liver transplant patients depending on the type of biliary anastomosis. Method and materials: 24 liver transplant patients with clinical suspicion of biliary stenosis were studied (each 12 with bilio-digestive anastomosis/choledocho-choledochostomy). MRCP was performed on a 1.5T scanner (Magnetom Avanto, Siemens) including 2D single shot RARE, 2D T2w HASTE, TrueFISP and 3D high-resolution navigator corrected sequences. Presence of (a) anastomotic stenoses (AST) and (b) NAS (non-anastomotic strictures) were assessed. Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) were performed within 48 h after MRCP and served as the standard of reference. Results: In patients with bilio-digestive anastomoses sensitivities of MRCP for the detection of AST and NAS amounted to 50% and 67%, respectively with specificity values of 83% and 50%. In patients with choledocho-chledochostomy sensitivities (AST: 100%, NAS: 100%) and specificities (AST: 100%, NAS: 88%) were significantly higher. Conclusion: Biliary strictures after liver transplantation can be accurately detected by MRCP in patients after choledocho-chledochostomy. However, the diagnostic value of MRCP is lower if liver transplantation was performed in combination with a bilio-digestive anastomosis. This may be due to the less exact depiction of the anastomosis in the bowel wall. Thus, it is crucial to know the type of biliary anastomosis before choosing a diagnostic procedure.

  2. Critical Review of Diagnostic Methods Used in Chronic Pancreatic Disease

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    Ivan T Beck

    1995-01-01

    Full Text Available This paper provides a balanced assessment of the various pancreatic function tests and imaging techniques used in the differential diagnosis of chronic pancreatic disease. Function tests that study the digestive capacity of the pancreas (fat absorption of dietary lipids, fluorescein- or radiolabelled fats, bentiromide test, etc have high specificity, but very low sensitivity. This is because 90% of pancreas has to be destroyed before steatorrhea or creatorrhea occurs. Tests that directly measure pancreatic bicarbonate and protein secretion (secretin test, etc are more accurate and may detect pancreatic dysfunction even before anatomical changes occur. Measurement of pancreatic enzymes in serum or urine, or the decreased decline of serum amino acids during their incorporation into pancreatic enzymes, are not sufficiently sensitive or specific to help diagnose pancreatic disease. Sensitive and specific tumour markers are not yet available. Thus screening tests are not cost-effective - if they are negative, they do not exclude pancreatic disease; and if positive, they have to be confirmed by more specific tests. Imaging techniques are the most commonly used methods of investigation. The usefulness of abdominal survey films, barium studies, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP, ultrasonography, computed tomographic scan, magnetic resonance imaging and endoscopic ultrasonography is critically reviewed. Most of the radiological methods can be combined with cytology or biopsy. Histology demonstrating malignancy establishes this diagnosis, but negative biopsies do not exclude malignant tumours. Presently only ERCP and endoscopic ultrasound can diagnose cancers sufficiently early to allow for possible `curative' surgery, and only endoscopic ultrasound is capable to stage tumours for the assessment of resectability.

  3. Diagnosis and treatment of protein plugs of the common channel in children with congenital biliary dilatation%先天性胆管扩张症合并共同管内蛋白栓的诊断和处理

    Institute of Scientific and Technical Information of China (English)

    李龙; 张金山; 孙海林; 袁新宇; 刘树立; 刁美; 张军

    2009-01-01

    years.The symptoms included abdominal pain (22),vomiting(22),jaundiee(13) and cyst perforation(2).In 19 patients,the levels of serum and urinary amylase increased when abdominal pain appeared.Intraoperative cholangiography showed filling defect and dilatation of the common channel and pancreatic ducts visualization in 22 cases,including nine cases of pancreatic duct dilatation.After removal of protein plugs,no dilatation of the common channel and pancreatic ducts decreased.The laparoscopy revealed protein plugs were fragile and could be easily broken into the smaller particles by the irrigation with saline.The repeat cholangiography confirmed protein plugs were removed completely.Under urethroseopy,protein plugs were cleared in 8 cases.Patients were followed up for 3 months to 8 years.The biochemical and ultrasound examination showed no increase in pancreatic amylase and recurrence of the stones in the common channel and pancreatic duct.Conclusions The children over 1 year of age with CBD,abdominal pain,with high levels of serum and urinary amylase when abdominal pain appeared and filling defect and dilatation of the common channel showed by radiologic findings could be suffering from protein plugs in the common channel.Intraoperative cholangiography is a reliable method of diagnosis.Laparoscopic assisted intubation and irrigation or urethroscopic assisted removal of protein plugs is safe and effective,with a good long-term effect.

  4. [Celioscopic cholecystectomy. 2 cases of infectious complications].

    Science.gov (United States)

    Caron, F; Fayeulle, V; Peillon, C; Roullée, N; Koning, E; Bénozio, M; Testart, J; Humbert, G

    1994-06-11

    Despite the low morbidity and mortality of laparoscopic cholecystectomy, trauma and infection have been reported. Such complications can produce a misleading clinical picture, as in two cases we observed. Case 1. A symptomatic 56-year-old female patient underwent laparoscopic cholecystectomy. During the operation, the gall bladder ruptured and the contents had to be aspirated from the abdominal cavity. The patient complained of hepatalgia 2 weeks after the operation, then was not seen again for more than 1 year when fever and hepatalgia did not respond to symptomatic treatment. An inter-hepato-renal collection (6 cm in diameter) was punctured under echography. Aspirate culture yielded Pseudomonas aeruginosa. Adapted antibiotic therapy was unsuccessful and surgery was required to empty the abscess then remove a fibrous conjunctive tissue formation. Case 2. A 55-year-old female patient with a history of complete remission after mammectomy for breast cancer underwent laparoscopic cholecystectomy in 1991. Two days after the operation, fever (39 degrees C) was accompanied by abdominal defence. Biliary peritonitis due to imperfect suture of the bile duct was repaired followed by peritoneal lavage-drainage. Per-operative blood samples revealed type 6 Pseudomonas aeruginosa. Despite adapted parenteral antibiotics, fever persisted at 39 degrees C and intense jaundice was observed. A second laparoscopy 14 days later showed inflammatory narrowing of the main bile duct which was drained into a small bowel loop. Eight days later computed tomography revealed multiple abscess in the liver. Transparietal cholangiography was performed and showed that the contrast medium entered the abscesses via the biliary canals. The state of sepsis persisted, jaundice worsened and hepatic encephalopathy developed with obnubilation and flapping tremor. After 1 month of general antibiotherapy, no improvement was seen on computed tomography images and needle biopsy of an abscess led to the

  5. Autoimmune paediatric liver disease

    Institute of Scientific and Technical Information of China (English)

    Giorgina Mieli-Vergani; Diego Vergani

    2008-01-01

    Liver disorders with a likely autoimmune pathogenesis in childhood include autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC),and de novo AIH after liver transplantation.AIH is divided into two subtypes according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA,type 1) or liver kidney microsomal antibody (LKM1,type 2).There is a female predominance in both.LKM1 positive patients tend to present more acutely,at a younger age,and commonly have partial IgA deficiency,while duration of symptoms before diagnosis,clinical signs,family history of autoimmunity, presence of associated autoimmune disorders,response to treatment,and long-term prognosis are similar in both groups. The most common type of paediatric sclerosing cholangitis is ASC.The clinical,biochemical, immunological,and histological presentation of ASC is often indistinguishable from that of AIH type 1.In both,there are high IgG,non-organ specific autoantibodies,and interface hepatitis.Diagnosis is made by cholangiography.Children with ASC respond to immunosuppression satisfactorily and similarly to AIH in respect to remission and relapse rates,times to normalization of biochemical parameters, and decreased inflammatory activity on follow up liver biopsies. However,the cholangiopathy can progress.There may be evolution from AIH to ASC over the years,despite treatment.De novo AIH after liver transplantation affects patients not transplanted for autoimmune disorders and is strikingly reminiscent of classical AIH,including elevated titres of serum antibodies, hypergammaglobulinaemia,and histological findings of interface hepatitis,bridging fibrosis,and collapse.Like classical AIH,it responds to treatment with prednisolone and azathioprine.De novo AIH post liver transplantation may derive from interference by calcineurin inhibitors with the intrathymic physiological mechanisms of T-cell maturation and selection.Whether this condition is a distinct entity or a form of

  6. Pancreatic Surgery in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    Ammori BJ

    2003-11-01

    Full Text Available Recent advances in technology and techniques have opened the gates widely to a wide range of applications of minimally invasive surgery in patients with inflammatory and neoplastic diseases of the pancreas. Laparoscopic cholecystectomy is the gold standard treatment for prevention of further attacks of acute biliary pancreatitis. Bile duct calculi detected at intraoperative cholangiography in patients with mild attacks of pancreatitis may be safely managed with laparoscopic bile duct exploration. Laparoscopic internal drainage of large, persistent and symptomatic pancreatic pseudocysts is safely applicable to most patients, achieves adequate drainage and facilitates debridement, and brings recognised benefits over open surgery and endoscopic approaches. Laparoscopic pancreatic necrosectomy for infected necrosis is feasible in some patients but the benefits of this approach in this high-risk group of patients remain to be shown. Staging laparoscopy and laparoscopic ultrasound avoids unnecessary laparotomy in approximately one-fifth of patients with pancreatic cancer, but their routine application in patients with ampullary and duodenal cancers is not warranted. The majority of patients with periampullary cancer have locally advanced or metastatic disease at presentation and their management is entirely palliative. Laparoscopic surgery therefore has its place in the relief of biliary and gastric outlet obstruction, and has its advantages over endoscopic biliary and duodenal stenting in patients with predicted better prognosis, though these advantages ought to be confirmed in randomised controlled trials. Thoracoscopic splanchnicectomy is beneficial in the short-to-medium term for the palliation of intractable opiate-dependent abdominal pain of locally advanced pancreatic cancer and that of chronic pancreatitis with demonstrable improvements in quality of life. Laparoscopic enucleation of neuroendocrine tumours of the pancreas, and distal or

  7. 经脐单孔腹腔镜胆囊切除术治疗胆囊炎的临床观察

    Institute of Scientific and Technical Information of China (English)

    周永贵

    2011-01-01

    目的 探讨经脐单孔腹腔镜胆囊切除术治疗胆囊炎的疗效.方法 对本院2003年3月至2010年9月收治的胆囊炎患者204例,均分为实验组和对照组,实验组采用经脐单孔腹腔镜胆囊切除术进行治疗,对照组采用常规腹腔镜手术治疗,对两组患者治疗效果(胆管和肠管损伤、手术时间、麻醉时间、术后住院时间和再手术率)和并发症等相关因素进行统计学分析.结果 实验组患者在肠胆管损伤、出血量、抗生素应用时间、术后排气时间、进食时间和住院时间方面明显优于对照组(P<0.05).结论 对胆囊炎患者采用经脐单孔腹腔镜胆囊切除术是安全可靠的,但在手术中要正确处理患者胆囊三角的结构,在术中对患者进行胆管造影,并对不适宜经脐单孔腹腔镜胆囊切除术手术的患者进行开腹手术以降低患者出现并发症的机会.%Objective To evaluate the clinical effect of treating cholangities with transumbilical single port laparoscopic cholecystectomy. Methods 204 patients of cholangities were divided into two groups, test group was treated with transumbilical single port laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy in control group, the therapeutic effects( bowl or biliary injury, operative time, anesthesia time, postoperative study and re - operation rate) and complications were statistically compared. Resutls The test group was better in bowl or biliary injury rate, introperative blood loss, time for antibiotics treatment,time for passing gas postoperatively and eating and hospital stay( P < 0. 05 ). Conclusions Transumbilical single port laparoscopic cholecystectomy is safe for patients with cholangities. Calot triangle should be carefully treated, intraoperative cholangiography should be performed in selective patients, conversion should be carried out in patients not suitable for transumbilical single port laparoscopic cholecystectomy.

  8. Evaluation of blood levels of nitric oxide as a means of differentiation between neonatal hepatitis and extrahepatic biliary atresia: A pilot study

    Science.gov (United States)

    Goel, Prabudh; Bhatnagar, Veereshwar; Das, Nibhriti; Kalaivani, Mani

    2015-01-01

    Aim: The differentiation between neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA) is not always possible despite all the currently available diagnostic modalities. In this study, an attempt has been made to evaluate the role of nitric oxide (NO) levels in the peripheral blood to differentiate between the two conditions, one requiring early surgical intervention (EHBA) and the other amenable to conservative medical management (NH). Patients and Methods: Twenty patients who presented to the pediatric surgical service, over a 2 years period, with features of neonatal cholestasis were enrolled in the study. The diagnostic workup included documentation of history and clinical examination, biochemical liver function tests, ultrasonography, hepatobiliary scintigraphy (HS), and magnetic resonance cholangio-pancreaticography (MRCP). These patients did not show excretion on HS and intrahepatic ducts on MRCP. Hence, they were subjected to mini-laparotomy and operative cholangiography (OC). The EHBA patients were treated with the Kasai's portoenterostomy procedure, and the extrahepatic ducts were flushed with normal saline in NH patients. All patients were evaluated preoperatively for levels of NO in the peripheral blood by the Greiss reaction spectrophotometrically at 540 nm. Normal values were determined from a cohort of controls. The median (range) levels of NO in patients with EHBA and NH were compared, and the statistical significance of the difference was calculated by applying the Wilcox Rank Sum test. A P = 0.05 was considered as significant. Results: Of the 20 patients enrolled in the study, 17 patients were treated for EHBA (Group I) and the remaining 3 patients had patent ducts on OC and were thus diagnosed as NH (Group II). The mean age of the patients in Groups I and II was comparable: 2.79 ± 0.75 and 2.67 ± 0.58 months, respectively (P = 0.866). The median NO levels were significantly elevated in each of the two groups as compared to the controls

  9. Laparoscopic cholecystectomy in patients over 70 years of age: review of 176 cases Colecistectomía laparoscópica en pacientes mayores de 70 años: nuestra experiencia en 176 casos

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    F. J. Pérez Lara

    2006-01-01

    Full Text Available Introduction: we assessed the results of laparoscopic cholecystectomy in 176 patients over the age of 70 years. Patients and methods: the study included all patients older than 70 years of age who underwent laparoscopic surgery cholelithiasis during the previous ten years. Variables studied included age, sex, type of operation (programmed/emergency, comorbidity, anesthetic risk, intraoperative cholangiography, conversion to open surgery, number of trocars, reoperation, residual choledocholithiasis, postoperative hospital stay, morbidity and mortality. Results: the study included 176 patients (23.29% men and 76.71% women. The mean age was 74.86 years. The mean hospital stay was 1.27 days, with 16.98% morbidity and 0.56% mortality. Conclusions: laparoscopic cholecystectomy is a safe procedure in older patients. It results in faster recovery, a shorter postoperative stay and lower rates of morbidity and mortality than open bile duct surgery.Objetivo: el objetivo de nuestro estudio es el de evaluar los resultados obtenidos en 176 pacientes mayores de 70 años intervenidos mediante colecistectomía laparoscópica. Pacientes y métodos: se incluyen en el estudio todos los pacientes mayores de 70 años diagnosticados de colelitiasis intervenidos por laparoscopia en los diez últimos años. Analizamos los siguientes parámetros: edad, sexo, tipo de intervención (programada/urgente, comorbilidad, riesgo anestésico, colangiografía intraoperatoria, conversión a cirugía abierta, número de trócares, reintervención, coledocolitiasis residual, estancia hospitalaria postoperatoria y morbimortalidad. Resultados: incluimos en el estudio un total de 176 pacientes, de los cuales el 23,29% son varones y 76,71%, tienen una edad media de 74.86 años. En los resultados globales la estancia media hospitalaria es de 1,27 días, morbilidad 16,98% y mortalidad de 0,57%. Conclusiones: la colecistectomía laparoscópica es un procedimiento seguro en pacientes mayores

  10. Ticlopidine-induced cholestatic hepatitis: A case report and review of the literature

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    Luigi Anastasio

    2012-10-01

    Full Text Available Introduction Cholestatic hepatitis is frequently a drug-related syndrome. We describe the case of a 57-year-old man who developed cholestatic hepatitis two months after starting therapy with ticlopidine following a carotid endarterectomy.Materials and methods The patient presented with anorexia, nausea, and dark-colored urine. The work-up included laboratory tests and imaging studies of the liver (ultrasound and magnetic resonance imaging. The authors analyze the case using the scale developed by Maria and Victorino for the diagnosis of drug-induced hepatitis, the Naranjo algorithm for adverse drug reactions, and the RUCAM algorithm for causality assessment of hepatotoxicity. They also review data from the MedLine database on cases of ticlopidine-induced cholestatic hepatitis reported during the period 1982–2011.Results Bilirubin, aminotransferases, alkaline phosphatases, and gamma glutamyl transpeptidase levels were elevated at admission and progressively declined after ticlopidine was discontinued. The absence of biliary obstruction at ultrasonography and magnetic resonance cholangiography, the negative results of viral and immunologic tests, and the resolution of the syndrome after discontinuation of the drug all suggested ticlopidine-induced hepatotoxicity. The assessment of this case with toxicity algorithms confirmed that a causal link to ticlopidine was “probable” or “highly probable.” The patient was treated with ursodesoxycholic acid, clopidogrel (75 mg/day, and (after the laboratory parameters had normalized rosuvastatin (10 mg/day. No further clinical and laboratory abnormalities have been observed during two month follow-up.Discussion The toxicity of ticlopidine is well established: our review revealed reports of 57 cases of ticlopidine-induced cholestatic hepatitis during the period 1982–2011. The mechanisms underlying the toxic effects of this drug are not clear, but they are probably related to the chemical structure

  11. Bilio-entero-gastrostomy: prospective assessment of a modified biliary reconstruction with facilitated future endoscopic access

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    Hamad Mostafa A

    2012-06-01

    Full Text Available Abstract Background Hepaticojejunostomy (HJ is the classical reconstruction for benign biliary stricture. Endoscopic management of anastomotic complications after hepaticojejunostomy is extremely difficult. In this work we assess a modified biliary reconstruction in the form of bilio-entero-gastrostomy (BEG regarding the feasibility of endoscopic access to HJ and management of its stenosis if encountered. Methods From October 2008 till February 2011 all patients presented to the authors with benign biliary stricture who needed bilio-enteric shunt were considered. For each patient bilio-entero-gastrostomy (BEG of either type I, II or III was constructed. In the fourth week postoperatively, endoscopy was performed to explore the possibility to access the biliary anastomosis and perform cholangiography. Results BEG shunt was performed for seventeen patients, one of whom, with BEG type I, died due to myocardial infarction leaving sixteen patients with a diagnosis of postcholecystectomy biliary injury (9, inflammatory stricture with or without choledocholithiasis (5 and strictured biliary shunt (2. BEG shunts were either type I (3, type II (3 or type III (10. Endoscopic follow up revealed successful access to the anastomosis in 14 patients (87.5%, while the access failed in one type I and one type II BEG (12.5%. Mean time needed to access the anastomosis was 12.6 min (2-55 min. On a scale from 1–5, mean endoscopic difficulty score was 1.7. One patient (6.25%, with BEG type I, developed anastomotic stricture after 18 months that was successfully treated endoscopically by stenting. These preliminary results showed that, in relation to the other types, type III BEG demonstrated the tendency to be surgically simpler to perform, endoscopicall faster to access, easier and with no failure. Conclusions BEG, which is a modified biliary reconstruction, facilitates endoscopic access of the biliary anastomosis, offers management option for its

  12. Cirugía laparoscópica biliar Laparoscopic biliary surgery

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    P. Martí-Cruchaga

    2005-01-01

    Full Text Available El siguiente artículo trata de exponer brevemente los posibles nuevos protocolos que se pueden aplicar en la patología biliar, a raíz de los cambios acaecidos con la aparición de las nuevas técnicas de cirugía biliar laparoscópica. Pretende realizar una síntesis de los últimos y más novedosos artículos sobre técnica quirúrgica y manejo en distintas patología biliares tales como coledocolitiasis o colecistitis. Se puede concluir que el manejo diferirá mucho según las capacidades técnicas de un centro sobre el que recaiga una de estas patologías. Por tanto, actualmente no se puede imponer un protocolo estándar para todo el mundo. Las diferencias entre colangiopancreatografía retrógrada endoscópica y colangiografía intraoperatoria laparoscópica, todavía están por demostrar, no pudiéndose generalizar sobre si una técnica tiene más indicación que la otra. Lo mismo se podría decir sobre si el acceso a la vía biliar principal debe hacerse desde el conducto cístico o por el contrario debe realizarse una coledocotomía.The following article briefly sets out the possible new protocols that can be applied in biliary pathology, arising from the changes brought about by the appearance of new techniques of laparoscopic biliary surgery. It offers a synthesis of the latest and most novel articles on surgical technique and management in different biliary pathologies such as Choledocholithiasis and cholecystitis. It can be concluded that management will differ greatly, depending on the technical capacities of the centre that is called upon to deal with one of these pathologies. A standard protocol for everybody cannot thus be established at present. Teh differences between endoscopic retrograde cholangiopancreatography and intraoperative laparoscopic cholangiography have still to be demonstrated, it is not possible to make generalisations about whether one technique is more useful than the other. The same could be said about

  13. Evaluation of Biliary Calprotectin as a Biomarker in Primary Sclerosing Cholangitis.

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    Gauss, Annika; Sauer, Peter; Stiehl, Adolf; Rupp, Christian; Krisam, Johannes; Leopold, Yvonne; Kloeters-Plachky, Petra; Stremmel, Wolfgang; Gotthardt, Daniel

    2016-04-01

    Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease of the bile ducts with limited therapeutic options except liver transplantation. Reliable biomarkers to predict the disease course are unavailable, and currently employed disease activity scores such as the Mayo risk score (MRS) have limitations. The present study aims to evaluate biliary calprotectin as a marker of disease activity and prognosis in PSC.This is a monocentric retrospective observational study. Calprotectin concentrations were measured by an enzyme-linked immunosorbent assay in bile samples collected by endoscopic retrograde cholangiography from 106 PSC patients and 20 controls. Biliary calprotectin concentrations were compared between the 2 groups. In PSC patients, results were evaluated with regard to the presence of dominant bile duct stenoses, bile microbiology, MRS, survival free of liver transplantation, and necessity for bile duct interventions in the further disease course.Median (interquartile ranges) biliary calprotectin concentrations were higher in PSC patients than in controls (3646 ng/mL, 249-9748 vs 116 ng/mL, 104-655; P calprotectin concentrations were associated with the presence of microbes in bile (P = 0.02), the occurrence of dominant bile duct stenosis at any time in the disease course (P = 0.005), and the necessity for future bile duct interventions (P = 0.02). Patients with biliary calprotectin concentrations above a cut-off of 11,610 ng/mL displayed significantly shorter transplantation-free survival than those with biliary calprotectin concentrations ≤11,610 ng/mL (P calprotectin concentration (>11,610 ng/mL) as a risk factor of shorter transplantation-free survival of PSC patients (P 142.5 U/L) (P = 0.006), high MRS (≥2) (P calprotectin may be a valuable additional marker for disease activity and a predictor of outcome in PSC, so that further studies for evaluation of calprotectin in this disease are warranted.

  14. X线透视联合超声引导行经皮肝穿胆道引流术治疗梗阻性黄疸的临床应用%Percutaneous transhepatic biliary drainage under fluoroscopic and ultrasound guidance for the treatment of obstructive jaundice: its clinical application

    Institute of Scientific and Technical Information of China (English)

    王建雄; 刘维; 窦晓霞; 王健; 宋莉; 佟小强; 邹英华

    2012-01-01

    Objective To investigate the technical and clinical value of percutaneous transhepatic biliary drainage (PTBD) in treating patients of obstructive jaundice with the help of fluoroscopic and realtime ultrasound monitoring. Methods A total of 78 patients with obstructive jaundice were enrolled in this study. The primary lesions included malignant diseases (n = 70) and benign diseases (n = 8). PTBD was carried out in all patients. Under fluoroscopic and real-time ultrasonography guidance, the biliary duct of the right hepatic lobe (n = 52) or the biliary duct of the left hepatic lobe was punctured and the cholangiography was routinely performed. the drainage procedure was carried out. Results PTBD was successfully accomplished in all patients. No severe complications, such as massive bleeding or biliary peritonitis, occurred. After the treatment the symptoms and signs of obstructive jaundice were gradually improved. The serum levels of both bitirubin and transaminase determined 1-2 weeks after the treatment were decreased, and the reductions were statistically significant when compared with the preoperative data (P < 0.01). Conclusion For the obstructive jaundice, PTBD under the guidance of fluoroscopy and realtime ultrasonography is an effective, safe, simple and economical treatment with fewer complications. (J Intervent Radiol, 2012, 21: 309-313)%目的 分析X线透视联合超声实时引导下经皮肝穿胆道引流术(PTBD)治疗阻塞性黄疸的操作技术及其应用价值.方法 78例阻塞性黄疸患者,其中70例为恶性阻塞性病变,8例为良性阻塞性病变,在超声实时引导结合X线透视下行PTBD术,穿刺右叶胆管52例,穿刺左叶胆管26例,并常规造影.结果所有患者手术均获得成功,未出现大出血及胆汁性腹膜炎等并发症,术后梗阻性黄疸症状逐渐改善,术后1~2周血清胆红素及转氨酶水平较术前明显下降(P<0.01).结论 X线透视结合超声实时引导下PTBD是一种治疗阻

  15. Advances in research of primary sclerosing cholangitis%原发性硬化性胆管炎的研究进展

    Institute of Scientific and Technical Information of China (English)

    黄颖秋

    2012-01-01

    原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)是一种慢性胆汁淤积性自身免疫性肝病(autoimmune liver disease,AILD),以肝内胆管和/或肝外胆管的弥漫性炎症、同心性纤维化、局灶性或节段性狭窄为主要特征,最终发展至肝硬化或肝衰竭.PSC的发病机制可能涉及遗传易感性、先天性免疫、获得性免疫及EB病毒感染等.内镜逆行胆管造影、磁共振胰胆管成像、高分辨三维扰相梯度回波序列等技术已用于PSC的影像诊断.此外,胆汁和尿液的蛋白质组学分析可能有助于PSC并发胆管癌的早期诊断.熊去氧胆酸(ursodeoxycholic acid,UDCA)、内镜以及肝移植是治疗PSC的方法.上述最新进展为PSC的诊断和治疗提供了新的思路.%Primary sclerosing cholangitis (PSC) is a chronic cholestatic autoimmune liver disease characterized by diffuse inflammation, concentric fibrosis, focal or segmental stricture of intrahepatic and/ or extrahepatic bile ducts, which can eventually lead to cirrhosis or hepatic function failure. The patho-genesis of PSC may involve genetic susceptibility, innate or adaptive immunity, and Epstein-Barr virus infection. Diagnostic imaging modalities include endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, and high-resolution three-dimensional SPGR. Proteomic analysis of bile and urine may become a new tool for early diagnosis of cholangiocar-cinoma in PSC patients. Ursodeoxycholic acid (UDCA), endoscopic therapy and liver transplantation are major treatments for PSC.

  16. Systematic Biliary Sphincterotomy in Acute Gallstone Pancreatitis without Cholangitis?

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    Manley C Uy

    2009-11-01

    Full Text Available Drs. Shrode and Kahaleh [1] noted correctly that two out of the three mortalities in the early ERCP group of the Oria study [3] were not reported to be directly due to ERCP. However, it is worthwhile to take into consideration that one mortality was attributed to progressive respiratory failure despite early ERCP and sphincterotomy. Taking note that the incidence of severe and mild pancreatitis and other demographic and clinical characteristics were grossly the same in both groups, only one patient died in the early conservative group. Furthermore, both groups had the same number of patients undergoing surgery (45 early ERCP vs. 47 early conservative, respectively but nobody in the early conservative group died from biliary surgery as compared to the mortality in the early ERCP group which was attributed to elective biliary surgery. it was interesting that there was the absence of mortality in the early conservative group despite more complicated surgeries due to the larger number of patients necessitating transcystic ductal stone clearance and/or laparoscopic/open choledochotomy for main bile duct stones (one in the early ERCP vs. 19 in the early conservative management group. The large number of early conservative management patients with positive intraoperative cholangiography (40%, meaning persistent common bile duct stone, also raises doubts as to the need for early ERCP with sphincterotomy [3]. As to the study of Folsch et al. [4], although Drs. Shrode and Kahaleh [1] correctly noted that 22 patients in the early conservative management group required ERCP and that four patients died from cholecystitis and/or jaundice, they failed to note that there were fewer patients who died from respiratory and renal failure than in the early ERCP group. The two aforementioned organ failures are both possible complications of acute pancreatitis. This was in a background of the same demographic characteristics (including severity of pancreatitis [4

  17. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: A retrospective multicenter analysis.

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    Hildebrand, Tatiana; Pannicke, Nadine; Dechene, Alexander; Gotthardt, Daniel N; Kirchner, Gabriele; Reiter, Florian P; Sterneck, Martina; Herzer, Kerstin; Lenzen, Henrike; Rupp, Christian; Barg-Hock, Hannelore; de Leuw, Philipp; Teufel, Andreas; Zimmer, Vincent; Lammert, Frank; Sarrazin, Christoph; Spengler, Ulrich; Rust, Christian; Manns, Michael P; Strassburg, Christian P; Schramm, Christoph; Weismüller, Tobias J

    2016-01-01

    Liver transplantation (LT) is the only definitive treatment for patients with end-stage liver disease due to primary sclerosing cholangitis (PSC), but a high rate of biliary strictures (BSs) and of recurrent primary sclerosing cholangitis (recPSC) has been reported. In this multicenter study, we analyzed a large patient cohort with a long follow-up in order to evaluate the incidence of BS and recPSC, to assess the impact on survival after LT, and to identify risk factors. We collected clinical, surgical, and laboratory data and records on inflammatory bowel disease (IBD), immunosuppression, recipient and graft outcome, and biliary complications (based on cholangiography and histology) of all patients who underwent LT for PSC in 10 German transplant centers between January 1990 and December 2006; 335 patients (68.4% men; mean age, 38.9 years; 73.5% with IBD) underwent transplantation 8.8 years after PSC diagnosis with follow-up for 98.8 months. The 1-, 5-, and 10-year recipient and graft survival was 90.7%, 84.8%, 79.4% and 79.1%, 69.0%, 62.4%, respectively. BS was diagnosed in 36.1% after a mean time of 3.9 years, and recPSC was diagnosed in 20.3% after 4.6 years. Both entities had a significant impact on longterm graft and recipient survival. Independent risk factors for BS were donor age, ulcerative colitis, chronic ductopenic rejection, bilirubin, and international normalized ratio (INR) at LT. Independent risk factors for recPSC were donor age, IBD, and INR at LT. These variables were able to categorize patients into risk groups for BS and recPSC. In conclusion, BS and recPSC affect longterm graft and patient survival after LT for PSC. Donor age, IBD, and INR at LT are independent risk factors for BS and recPSC and allow for risk estimation depending on the recipient-donor constellation.

  18. Progressive familial intrahepatic cholestasis

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    Baussan Christiane

    2009-01-01

    Full Text Available Abstract Progressive familial intrahepatic cholestasis (PFIC refers to heterogeneous group of autosomal recessive disorders of childhood that disrupt bile formation and present with cholestasis of hepatocellular origin. The exact prevalence remains unknown, but the estimated incidence varies between 1/50,000 and 1/100,000 births. Three types of PFIC have been identified and related to mutations in hepatocellular transport system genes involved in bile formation. PFIC1 and PFIC2 usually appear in the first months of life, whereas onset of PFIC3 may also occur later in infancy, in childhood or even during young adulthood. Main clinical manifestations include cholestasis, pruritus and jaundice. PFIC patients usually develop fibrosis and end-stage liver disease before adulthood. Serum gamma-glutamyltransferase (GGT activity is normal in PFIC1 and PFIC2 patients, but is elevated in PFIC3 patients. Both PFIC1 and PFIC2 are caused by impaired bile salt secretion due respectively to defects in ATP8B1 encoding the FIC1 protein, and in ABCB11 encoding the bile salt export pump protein (BSEP. Defects in ABCB4, encoding the multi-drug resistant 3 protein (MDR3, impair biliary phospholipid secretion resulting in PFIC3. Diagnosis is based on clinical manifestations, liver ultrasonography, cholangiography and liver histology, as well as on specific tests for excluding other causes of childhood cholestasis. MDR3 and BSEP liver immunostaining, and analysis of biliary lipid composition should help to select PFIC candidates in whom genotyping could be proposed to confirm the diagnosis. Antenatal diagnosis can be proposed for affected families in which a mutation has been identified. Ursodeoxycholic acid (UDCA therapy should be initiated in all patients to prevent liver damage. In some PFIC1 or PFIC2 patients, biliary diversion can also relieve pruritus and slow disease progression. However, most PFIC patients are ultimately candidates for liver transplantation

  19. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

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    Oguz Dilek

    2007-07-01

    Full Text Available Abstract Background Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. Methods The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening. Results A total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4. Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95% and 23 of them (59% had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53. History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33% cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70% with choledocholithiazis. Remaining eight patients had undergone surgery (30%. Clinical symptoms were resolved with medical treatment in 16(32% patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients

  20. Colecistectomia laparoscópica: estruturação de um modelo de trabalho Laparoscopic cholecystectomy: structure of a working model

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    Henrique Walter Pinotti

    2000-04-01

    Full Text Available São apresentados os resultados de 1772 colecistectomias videolaparoscópicas, sendo 1.700 consecutivas sem mortalidade e baixa morbidade e rápida recuperação pós-operatória. Salienta-se a importância da sistematização técnica adotada para tais resultados, bem como do uso de instrumentos especiais de dissecção. É apresentada a estruturação de um modelo de trabalho para formação do cirurgião em cirurgia laparoscópica do aparelho digestivo, de maneira progressiva e sistematizada. O modelo implantado de formação e preparo do cirurgião, com rigor, profundidade e seriedade, é certamente responsável pelos resultados do nível de excelência obtidos.The authors showed the results of 1772 laparoscopic cholecystectomies, 1700 of them consecutevely without mortality and low morbidity and fast post-operative recovery. From the 1772 patients, 12,4% were over 70 years old; 49% of them had associated diseases. Surgical risk were evaluated from ASA I to IV. Chronic cholecystitis were present in 94,8% of the patients while, 3,6% had acute cholecystitis, and 0,2% gallblader cancer. Intraoperative cholangiography was performed in 83% of the cases. There were 67 patients with choledocolithiasis, 29 of them with no pre-operative clinical suspection. Conversion rate was less than 1%. Operative technique was standartized, beginning with the patient position in operative bed, trocars positioning, gallblader presentation with the graspers, as well as the timing of the structures dissection. The importance of the technical sistematization utilized is underlined, as well as the use of special instruments for dissection. It is presented a working model for surgical formation on alimentary tract laparoscopic surgery, in a progressive and sistematized way. It begins with the organization of a motivated surgical team, working together in order to improve the laparoscopic surgery methodology. The model for surgical formation of is responsible for the

  1. Colecistectomia laparoscópica: experiência em 500 casos, enfatizando as vantagens da colecistocolangiografia e da ligadura do ducto e artéria cística utilizando fio de náilon Advantages of cholecystocholangiography and ligature of the cystic duct and artery with nylon suture: analysis of 500 laparoscopic cholecystectomies

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    Carlos Alberto Perim

    1999-02-01

    with nylon suture instead of metallic clips. Most (79, 4% patients were female and the median age was 48.2 years. Chronic cholecystitis was found in 424 patients, acute cholecystitis in 68, gallbladder cancer in four; acalculous cholecystitis in three and gallbladder polyp in a single patient. Stones in the CBD were diagnosed in twenty (4% patients. The mean operating time was 84 minutes. Of the 500 patients, 93.4% were discharged from the hospital within 48 hours after LC. Convertion was required in 39 (7.8% cases, mainly due to choledocholithisasis (15 patients and acute cholecystitis (14 patients. Clinically important complications developed in 12 (2.4% patients, including one (0,2% commom bile duct injury. The mortality rate was 0.4%. Cholecystocholangiography was satisfactory in 80.5% and inconclusive in 19.5% of the patients. This method is an excellent option for intraoperative cholangiography in LC because it is technically very simple and affords good results, mainly in chronic cholecystitis. Nevertheless, when there is obvious cystic duct obstruction, or when the gallbladder is filled with biliary mud, it is better to do primarely transcystic cholangiography. Numerous studies have indicated that the use o metallic clips in LC is associated with higher risks of bile peritonitis and hemorrhage. Besides that, this study has shown that the use of clips make the procedure much more expensive, when the great number of LC performed yearly is considered. On the other hand, the cystic duct and artery ligation with nylon suture is very segure and cost saving.

  2. 澳大利亚微创胆道外科%Minimally Invasive Bile Duct Surgery in Australia

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    David I Watson; John W Chen; Huiqi Yang

    2007-01-01

    目的 从20世纪末期以来,澳大利亚腹腔镜手术已经快速发展进步并且逐渐扩展到各个外科手术领域.一些外科医生也完成并发表了关于腹腔镜胆总管探查技术的报道.在本文中,作者介绍了目前澳大利亚的微创外科手术治疗胆管疾病的现状,包括:常规或选择性胆管造影;胰腺胆道疾病中ERCP的作用;腹腔镜胆总管探查术的手术技巧以及胆源性胰腺炎的治疗.作者还介绍了澳大利亚目前胆总管探查的现状,并且提到他们倾向于每例腹腔镜胆囊切除术都进行术中胆道造影.如果胆总管内发现小结石而且胆囊管足够粗,则进行经胆囊管的胆总管探查术.然而,如果狭窄的胆总管内有较大的结石,则进行术后ERCP治疗.作者还进一步介绍了胆道疾病相关的其他的微创治疗手术方法.总的来说,腹腔镜手术进行胆总管取石是可行和安全的.在有足够经验的医疗中心,这种手术方法可以常规使用.同时,成功进行腹腔镜胆总管探查术也需要多种方法综合进行.ERCP也没有被腹腔镜胆总管探查术所取代,而且成为一种重要的补充性的胆总管结石治疗方法.%Laparoscopic techniques have been developed, evolved and expanded rapidly since the late of 21 century in Australia. Some surgeons also developed and published descriptions of techniques for laparoscopic common bile duct exploration. In this article, the author induced the current situation of minimally invasive surgery treatments of bile duct diseases in Australia, such as the choice of Routine or selective cholangiography;the constantly-changing role of ERCP for pancreatic-biliary diseases;techniques for laparoscopic exploration of the common bile duct which include transcystic common bile duct exploration and laparoscopic choledochotomy;and treatment of biliary pancreatitis. The author also introduced current status of common duct exploration in Australia, and mentioned that

  3. Primary sclerosing cholangitis in children and adolescents: a clinicopathologic study with a proposal of criteria for early diagnosis Colangite esclerosante primária em crianças e adolescentes: uma correlação clinicopatológica com uma proposta de critérios para primeiro diagnóstico

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    Wolfram F. J. Riedlinger

    2010-10-01

    Full Text Available INTRODUCTION: Primary sclerosing cholangitis (PSC has been increasingly diagnosed among children and adolescents due to better recognition of clinical, imaging and pathological features. Thus more patients are diagnosed at a younger age due to imaging and sensitivity optimization. OBJECTIVE: Early liver histopathological (LH changes are not well described and PSC is not commonly recognized before typical bile duct changes occur on cholangiography (CG. Currently, CG is considered gold standard for adults but nothing is known for early diagnosis in the pediatric age group (0- 20 years old. METHODS: We reviewed clinical history, LH and CG from 47 children and adolescents with PSC (35 males, mean age 13 years old. Forty-three out of 47 patients had been through LH examination from whom 33 had also undergone CG. A clinicopathological correlation was performed. RESULTS: LH showed active neutrophilic cholangitis in 19 patients, moderate neutrophilic pericholangitis in nine, dystrophic changes in the bile duct in eight, and concentric periductal fibrosis in 24 patients. Abnormal CG was found in 24 out of 33 patients and nine had normal results. Eleven out of these 24 patients had abnormal histology before abnormal CG and four patients had abnormal CG before histology. Data of two out of 24 patients were insufficient for correlation and 11 out of 24 had both abnormal liver histology and abnormal imaging findings. CONCLUSION: Our study emphasizes that even when CG is normal, PSC should be exclusively diagnosed by liver biopsy, hence cholangiography being unnecessary. Chronic portal inflammation, neutrophilic pericholangitis, periductal sclerosis and "onion skinning" are characteristic histopathological findings. Neutrophilic pericholangitis may be subtle and easily overlooked in early disease, leading to strong suspicion of PSC.INTRODUÇÃO: Colangite esclerosante primária (CEP é crescentemente diagnosticada em crianças e adolescentes devido ao melhor

  4. FÍSTULA BÍLIO-BRÔNQUICA: RELATO DE CASO E REVISÃO DE LITERATURA

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    OLAVO RIBEIRO RODRIGUES

    1998-10-01

    Full Text Available No presente trabalho é relatado um caso de paciente portadora de fístula bílio-brônquica (FBB secundária a coledocolitíase tratada no Hospital da Universidade de Mogi das Cruzes e é feita uma revisão da literatura pertinente ao assunto. Tratava-se de uma paciente, 35 anos, feminino, parda, cujo quadro clínico inicial era dor em hipocôndrio direito, de caráter contínuo, acompanhada de icterícia do tipo obstrutivo e bilioptise que atingia até um litro em 24 horas. O diagnóstico foi confirmado por radiografia simples de abdome e ultra-sonografia abdominal. O tratamento consistiu em laparotomia, colecistectomia, coledocotomia com retirada de dois cálculos, drenagem de vias biliares, colangiografia intra-operatória e liberação da cápsula hepática da cúpula frênica direita. A evolução pós-operatória foi satisfatória, com regressão da bilioptise no pós-operatório imediato. Houve regressão progressiva da icterícia em torno do sétimo dia do pós-operatório. A paciente foi estudada com broncografia após 24 meses que mostrou não haver alterações anatômicas dos brônquios basilares direitos pela inundação biliar. A paciente encontra-se no sétimo ano de seguimento sem evidência da doença.In the present case report is presented a patient with bilio-bronchial fistula secondary to choledocholithiasis surgically treated at the University of Mogi das Cruzes Hospital. It is a 35-year-old female patient which initial clinical features were continuous hypochondrium pain, accompanied by obstructive jaundice and bilioptysis that reached one liter in a period of 24 hours. The diagnosis was confirmed by X-ray exams and by abdominal ultrasonography. The treatment consisted in laparotomy, cholecistectomy, choledochotomy and extraction of two stones from biliary tract, drainage of biliary tree, intraoperative cholangiography and separation of the hepatic capsule from the right diaphragmatic cupula. At the postoperative follow

  5. 腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石%The clinical analysis of cholangioscopy electrohydraulic lithotripsy with laparoscopy to treat intrahepatic bile duct calculi

    Institute of Scientific and Technical Information of China (English)

    朱晟; 喻强; 金昆; 陈明亮; 张京平

    2012-01-01

    Objective:To summarize the methods,efficacy and safety of the cholangioscopy electrohydraulic lithotripsy with laparoscopy to treat intrahepatic bile duct calculi. Methods: The clinical data of 23 cases from Jan. 2005 to Jan. 2012 with refractory extra-hepatic and intrahepatic bile duct stones underwent cholangioscopy electrohydraulic lithotripsy with laparoscopy were retrospectively analyzed. The calculi-free rate and the incidence of complications were observed. Results:The rate of lithotripsy was 100 % in 23 cases, of which 22 were one-time free of biliary calculi, the free rate was 95. 7% ;0ne cases with more calculi underwent choledochoscope lithotomy through the T tube six weeks after surgery. No complications including biliary tract perforation, bleeding, bile leakage, wound infection and others were accurred. The peritoneal drainage tube was removed 3-4 d after operation,The hospital stay time was 5-7 d. 4 weeks after surgery, routine T-tube cholangiography was done, the T-tube was pinched for 3 d and then was removed. Conclusions: Lap-aroscopic cholangioscopy combined with electrohydraulic lithotripsy could significantly improve the therapeutic effect of the extrahepatic and intrahepatic bile duct calculi,which is safe and reliable.%目的:总结腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石的手术方法、效果及安全性.方法:回顾分析2005年1月至2012年1月采用腹腔镜下胆道镜液电碎石术治疗23例难取性肝内外胆管结石患者的临床资料,观察结石取净率及并发症发生率.结果:23例术中均碎石成功,其中22例一次性取净结石,结石取净率95.7%;1例因结石数量较多,术后6周经T管窦道行胆道镜取石术.无胆道穿孔、大出血、胆漏、切口感染等并发症发生.术后3~4d拔除腹腔引流管,5~7d出院.术后4周常规行T管造影,夹管3d后拔除T管.结论:腹腔镜下结合胆道镜液电碎石术可显著提高肝内外胆管结石的疗效,手术安全、可靠.

  6. 胆管癌外科术后阻塞性黄疸的介入治疗%The Interventionnal Treatment for Obstructive Jaundice after Surgical Intervention in Patients with Cholangiocarcinoma

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    李纲

    2012-01-01

    OBJECTIVE To observe the effect of interventional in treatment of obstructive jaundice after surgical intervention in patients with cholangiocarcinoma. METHODS A retrospective analysis was conducted among patients admitted to Zhumadian Centre Hospital from December 1998 to October 2009, and these 25 cholangiocarcinoma cases showed obstructive jaundice after surgery and received interventional treatment. RESULTS The total bilirubin and direct bilirubin levels of 25 cases within 1 month were decreased from 211.1 ± 118.0μmol/L to 105.8 ± 68.6μmol/L, and from 146.5 ± 86.9u,mol/L to 80.2 ± 49.2μmol/ L, respectivley (P< 0.05). Percutaneous transhepatic cholangiobiopsy was performed in 15 patients, and the successful rate reached 100% , and no gastrointestinal bleeding and perforation occurred. CONCLUSION (1) Percutaneous transhepatic cholangiography and drainage is benefit to alleviate jaundice for patients with cholangiocarcinoma after surgical intervention, offer the advantages of simplicity and induce less complications. (2) The procedures of pathological diagnosis by PTCB in anasto-motic stenosis after cholangiojejunostomy of malignant obstuctive jaundice are simplicity and safety.%目的 观察胆管癌外科术后阻塞性黄疸的介入治疗疗效.方法 回顾性分析1998年12月~2009年10月驻马店市中心医院收治的25例胆管癌外科术后出现阻塞性黄疸并采取介入治疗的患者临床资料,观察其疗效.结果 25例患者的总胆红素和直接胆红素水平1个月内由术前的(211.1±118.0)μmol/L和(146.5±86.9) μmol/L降为术后的( 105.8±68.6) μmol/L和(80.2±49.2)μmol/L,下降显著(P<0.05).15例患者PTC术中行胆道钳夹活检,技术成功率100%,未出现消化道出血、穿孔等并发症.其中10例根治性切除患者于胆肠吻合口处行钳夹活检,3例病理提示瘢痕性狭窄,给予内外引流管置入;7例为肿瘤复发,6例给予胆道金属支架置入,1例给予

  7. Percutaneous Transhepatic Cholangiobiopsy in Pathological Diagnosis for Anastomotic Stenosis after Cholangiojejunostomy of Malignant Obstuctive Jaundice%经皮肝穿刺胆道内钳夹活检诊断恶性阻塞性黄疸胆肠吻合术后吻合口狭窄

    Institute of Scientific and Technical Information of China (English)

    李腾飞; 李臻; 韩新巍

    2011-01-01

    , laboratory examination and follow-up confirmed tumor recurrence in 1 patient.Complications not occurred after PTCB.Stent and internal/external catheter were put into stenosis after PTCB.The jaundice was alleviated obviously and life quality and mental status were improved after operation.Conclusion PTCB in anastomotic stenosis after cholangiojejunostomy of malignant obstuctive jaundice offers pathological diagnosis simply, safely with higer sensitivity.Percutaneous transhepatic cholangiography and drainage is benefit to alleviate jaundice and offers the advantages of simplicity and low rate of complications.

  8. Cisto gigante de colédoco Giant choledochal cyst

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    Olival Cirilo Lucena da Fonseca-Neto

    2007-12-01

    -old woman was admitted presenting history of icterus and fecal acholia for 7 days. Patient referred epigastric pain related to fat ingestion. Previously she presented two episodes of icterus, 8 years and 14 years old, with spontaneously regression. Physical examination showed icterus (+3/+4 and palpable asymptomatic abdominal mass. Ultrasound investigation demonstrated a thin wall big cystic formation adjacent to hepatocholedochal, pancreas, and right kidney, 18,5 x 10,2 cm in size. Magnetic resonance cholangiography confirmed the giant choledochal cyst. Hepaticojejuno anastomosis in Roux-en-Y after cystic resection and cholecistectomy were performed. Cystic formation measured 20 x 15,5 x 12,5 cm and presented a volume approximately 1000mL. Since the seventh month after surgery procedure, no evidence of jaundice has been detected in follow-up visiting. CONCLUSION: Choledochal cyst must be considered as a differential diagnosis in young adults presenting with icterus and palpable mass; although, neoplasia must also be investigated.

  9. 医源性胆管损伤的治疗及远期疗效%Management and long-term efficacy of patients with iatrogenic bile duct injury

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    洪涛; 何小东; 蔺晨; 武峤

    2012-01-01

    clinical data of 62 patients with iatrogenic bile duct injury who were admitted to the Peking Union Hospital from January 1982 to April 2012 were retrospectively analyzed.Of the 62 cases of iatrogenic bile duct injuries,24 were caused by laparoscopic cholecystectomy (LC) and 38 were caused by open cholecystectomy. Ten patients received non-surgical treatment, including 8 patients received percutaneous transhepatic cholangiography and drainage (PTCD) and 2 received endoscopic retrograde cholangiopancreatography (ERCP) + stent implantation. Fifty-two patients received surgical treatment,including 47 received cholecystojejunostomy,2 received cholecystoduodenostomy,3 received biliary end-to-end anastomosis. Thirty-six patients received PTCD preoperatively,and 42 received biliary stent implantation intraoperatively.Fifty patients received intraoperative peritoneal drainage to prevent postoperative peritoneal effusion or encapsulated bile collection.Results Of the 52 patients who received surgery,13 patients were complicated by more than 1 complication,including 1 case of wound infection,4 cases of cholangitis,2 cases of anastomotic leakage,2 cases of anastomotic bleeding,1 case of anastomotic occlusion, 1 case of biliary stent falling out and 3 cases of gastrointestinal diseases.Eighteen patients received cholangiography postoperatively,and 2 patients were diagnosed as with bile leakage.Fifteen patients received PTCD + biliary stent implantation,and 1 patient of them received percutaneous puncture drainage.Two patients received reoperation due to anastomotic bleeding.The mean time of peritoneal drainage for the 50 patients was (7.7 ± 2.6) days.No perioperative death was observed,and the mean operation time was (18 ± 12) days.Fifty-five patients were followed up (10 patients received non-surgical treatment,and 45 patients received surgical treatment),with a median time of 93 months.Of the 10 patients who received nonsurgical treatment,1 received reoperation due to bile leakage

  10. Diagnostic and therapeutic approach to cholestatic liver disease Abordaje diagnóstico y terapéutico del síndrome colestásico

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    T. Pérez Fernández

    2004-01-01

    Full Text Available When cholestatic liver disease is present, liver ultrasound should be performed to ascertain if cholestasis is extrahepatic or intrahepatiic. If bile ducts appear dilated and the probability of interventional treatment is high, endoscopic retrograde cholagio-pancreatography (ERCP or trans-hepatic cholangiography (THC should be the next step. If the probability of interventional therapeutics is low, cholangio-MRI should be performed. Once bile duct dilation and space occupying lesions are excluded, a work up for intrahepatic cholestasis should be started. Some especific clinical situations may be helpful in the diagnostic strategy. If cholestasis occurs in the elderly, drug-induced cholestatic disease should be suspected, whereas if it occurs in young people with risk factors, cholestatic viral hepatitis is the most likely diagnosis. During the first trimester of pregnancy cholestasis may occur in hiperemesis gravidorum, and in the third trimester of gestation cholestasis of pregnancy should be suspected. A familial history of recurrent cholestasis points to benign recurrent intrahepatic cholestasis. The occurrence of intrahepatic cholestasis in a mid-dle-aged woman is a frequent presentation of primary biliary cirrhosis, whereas primary sclerosing cholangitis should be suspected in young males with inflammatory bowel disease. The presence of vascular spider nevi, ascites, and a history of alcohol abuse should point to alcoholic hepatitis. Neonatal cholestasis syndromes include CMV, toxoplasma and rubinfections or metabolic defects such as cystic fibrosis, α1-antitripsin deficiency, bile acid synthesis defects, or biliary atresia. The treatment of cholestasis should include a management of complications such as pruritus, osteopenia and correction of fat soluble vitamin deficiencies. When hepatocellular failure or portal hypertension-related complications occur, liver transplantation should be considered.Ante la presencia de colestasis, se debe

  11. Pathological changes of bile duct injury after orthotopic liver transplantation%原位肝移植后胆管损伤的病理学改变

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    谭文翔; 杨玉龙; 王晓光; 付维利

    2008-01-01

    transplantation, are difficult for diagnosis and treatmerit and the bottlenecks for the development of liver transplantation. OBJECTIVE: To observe and record bile duct injury and do biopsy in parallel with treating biliary complications following liver transplantation successfully with choledochoscope, and to analyze the relationships between various bile duct injuries, histopathological types and biliary complications following liver transplantation. DESIGN, TIME AND SETTING: Case analysis was carried out at Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery. Dalian Friendship Hospital between July 2001 and October 2005. PARTICIPANTS: Nineteen patients after liver transplantation were divided into three groups according to the occurrence of biliary complications: four cases for normal group, twelve cases for bile duct injury group, three cases for hepatic artery miury group. METHODS: They were observed. diagnosed and recorded respectively and take biopsy for pathological analysis through the choledochoscope. With regard to the cases without T-tube. Choledochoscope combined duodenoscope were used to take biopsies. MAIN OUTCOME MEASURES: Choledochoscope was used to observe T-tube cholangiography, the appearances and pathological changes of intemal and external bile duct mucous membrane. healing of the donor-receptor bile duct stoma. Patients in the bile duct injury group were done examinations described above after endoscopic stone extraction and stenosis expansion. RESULTS: The intemal and extemal bile duct anatomy of the patients in the normal group were normal, without bile ductstenosis and scar, their bile duct mucous membrane lookcd good, and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Various kinds of bile duct stones, simple, multiple and casting mould stones, were found in patients of the bile duct injury group. Bile duct mucous

  12. Predição da coledocolitíase pela associação de indicadores clínicos e laboratoriais em dois momentos do pré-operatório da colecistectomia Prediction of preoperative choledocholithiasis by the association of clinical and laboratory indicators in two distinct moments

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    Newton Pinto Araújo Neto

    2005-02-01

    melhor a conduta diagnóstica e terapêutica nesta doença.BACKGROUND: The purpose of this study was to determine the probability of choledocholithiasis from the association of clinical and laboratory indicators at two moments of the preoperative phase of cholecystectomy. METHODS: Between March 2001 and March 2002, 48 consecutive patients with cholelithiasis were submitted to cholecystectomy and intra-operative cholangiography (IOC. The patients were divided into two groups, with group A composed of 13 patients with choledocholithiasis and group B of 35 patients without this disease. They were investigated by clinical and laboratory indicators of choledocholithiasis, analyzed in two periods, taking as the cut point the 48 hours that preceded the surgery. Later on, these preoperative indicators were associated in the logistic regression equation in different combinations. RESULTS: Using the logistic regression equation, it was found that the association of two clinical indicators in both periods (jaundice and Murphy‘s sign and two laboratory indicators (the cut level of gamma glutamyl transpeptidase and direct bilirubin 48 hours before the surgery was the most suitable for predicting choledocholithiasis. The values obtained by this equation showed an agreement with groups A and B of 95.6%, and a disagreement of 4.4% (p= 0.0000007 and k = 0.89. This equation showed sensitivity of 92.3%, specificity of 97.0%, a positive predictive value of 92.3% and a negative predictive value of 97%. These values were close to those obtained by the CIO, which showed agreement with the groups studied of 95.8%, and disagreement of 4.2% (k = 0.90. CONCLUSION: The association of indicators of choledocholithiasis is recommended to establish the probability of there occurring choledocholithiasis associated with cholelithiasis. The use of this equation may provide better guidance for the diagnostic and therapeutic handling of this disease.

  13. 腹腔镜胆总管探查一期缝合术中经胆囊管输尿管导管胆道引流607例%Biliary Drainage with Ureteral Catheter in Laparoscopic Common Bile Duct Exploration with Primary Suture:Report of 607 Cases

    Institute of Scientific and Technical Information of China (English)

    肖宏; 索运生; 尹思能; 易斌; 陈先林; 孙科; 王征夏; 张胜龙

    2015-01-01

    Objective To investigate the feasibility of application of ureteric catheter for biliary drainage in laparoscopic common bile duct exploration with primary suture through cystic duct remnant. Methods From June 1992 to October 2014, we performed 607 cases of laparoscopic exploration of common bile duct with primary suture.At the subcostal level on the midline of clavicle, an ureteral catheter was inserted via the cystic duct stump for biliary drainage. Results Of the 607 cases, the bile duct drainage was successful in 598 cases (98.5%).Ureteral catheter intubation failed in 6 cases (1.0%), 2 of which were given conversion to nasobiliary drainage and 4 of which were given T-tube drainage.Folded or blocked ureteral catheter due to no liquid outflow occurred in 2 cases (0.3%).Biliary peritonitis caused by ureteral catheter detachment happened in 1 case (0.2%), who was given a reoperation of laparoscopic ureteral catheter insertion and abdominal drainage.Mild stenosis after primary suture was seen in 3 cases (0.5%) , which were given no intervention.Postoperative cholangiography via ureteral catheter at 3-14 days after surgery in the 598 cases found no residual stones.Extubation was conducted at 2-4 weeks after surgery in 588 cases and at 4-6 weeks after surgery in 10 cases.Follow-up for 6-60 months (average, 18.5 months) in 588 cases showed no bile leakage, severe complications, or death. Conclusion For suitable patients, application of ureteric catheter for biliary drainage in laparoscopic common bile duct exploration with primary suture of bile duct is effective for preventing postoperative bile leakage.%目的:探讨腹腔镜胆总管探查一期缝合术中留置输尿管导管作胆管引流的可行性。方法1992年6月~2014年10月,在607例腹腔镜胆总管探查一期缝合术中,经右锁中线肋下穿刺置入输尿管导管经胆囊管残端置入胆总管行胆道引流术。结果598例(98.5%)胆管引流获得成功。插管失败6

  14. Effectiveness of Application of T2WI-MRC and CE-MRC in Diagnosis of Bile Duct Diseases%T2WI-MRC和CE-MRC检查在胆道疾病诊断中的应用价值

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    徐立峰

    2015-01-01

    目的:探讨MR胆管水成像(T2WI-MRC)和钆贝葡胺增强后胆管成像(CE-MRC)在胆道疾病诊断中的应用价值。方法选取2012年4月~2014年7月我院收治的78例胆道疾病患者作为研究对象,所有患者均进行T2WI-MRC及CE-MRC检查,以术中胆管造影作为金标准,比较两种检查方法对肝内外胆管的显示情况。结果在肝内三级以上胆管的显示方面,CE-MRC显示68例(87.2%),T2WI-MRC显示41例(52.6%),差异有统计学意义(χ2=27.524,P=0.000);在肝内三级以下胆管、胆总管、胆囊、胆囊管、肝总管的显示方面,差异无统计学意义(P>0.05)。两种方法对解剖变异的诊断符合率均为100%;在肝胆管狭窄、肝胆管扩张的诊断上,差异不具有统计学意义(P>0.05)。结论 T2WI-MRC成像具有成像速度快、成像质量好等优点,但对某些微小的三级以上胆道显示较差。CE-MRC对胆道狭窄具有较高的诊断准确率,可以在一次屏气下完成全肝扫描,呼吸不均匀者也能进行检查,但缺点是引入了造影剂,增加了患者费用,并且潜在增加了过敏反应。临床诊断中,要根据实际需要,合理选择成像方法。%ObjectiveTo discuss the effectiveness of application of T2WI-MRC and CE-MRC in diagnosis of the bile duct diseases.Methods Altogether 78 patients with bile duct diseases who had been treated from April 2012 to July 2014 in our hospital were selected as the research object. All the patients were scanned by T2WI-MRC and CE-MRC. Taking intra-operative cholangiography as the gold standard, the extra-hepatic bile duct images obtained by two different methods were compared. Results CE-MRC diagnosed 68 (87.2%) cases of intra-hepatic bile ducts above Level 3; T2WI-MRC diagnosed 41 (52.6%) cases of intra-hepatic bile ducts above Level 3, which existed statistically signiifcant differences (χ2=27.524,P=0.000). No statistically signiifcant

  15. Application of medical image three dimensional visualization system in the diagnosis and treatment of hepatolithiasis%医学图像三维可视化系统在肝胆管结石病诊断与治疗中的应用

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    范应方; 方驰华; 游锦华; 钟世镇; 陈建新; 杨剑; 项楠

    2011-01-01

    Objective To study the medical image three dimensional visualization system(MI-3DVS)in the diagnosis and treatment of hepatolithiasis.Methods The data of 64-slice spiral computed tomography of 54 patients with hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from August 2008 to August 2010 were collected.The liver and bile duct were three dimensionally(3D)constructed.Preoperative diagnosis and pathological classification were made according to the results of the 3D model of liver and bile duct.The optimal surgical procedure was determined by simulating operations based on the 3D model.The compliance of simulated operation and actual operation was observed,and residual stones were detected by cholangiography.Results Of the 54 patients,11 were with type Ⅰ,5 with type Ⅱ(including 2 patients with type Ⅱ a and 3 with Ⅱ b),38 with type E.There were 23 patients with intrahepatic bile duct stricture and 27 with atrophy-hypertrophy syndrome complex.The anatomy of intra-and extrahepatic bile duct,dilation and stricture of the bile duct,site,size and number of the bile duct stones were clearly displayed in the MI-3DVS.The compliance rate of simulated surgery and actual surgery was 94%(51/54).There was no residual stones in 51 patients who received elective surgery and the rate of residual stone of the 54 patients was 6%(3/54).Conclusion Acurate preoperative diagnosis and intraoperative precise operation can be achieved and the rate of residual stone can be reduced by using the MI-3DVS.%目的 研究医学图像三维可视化系统(MI-3DVS)在肝胆管结石病诊断与治疗中的应用价值.方法 收集2008年8月至2010年8月南方医科大学珠江医院收治的54例肝胆管结石病患者的肝脏64排螺旋CT扫描原始数据,采用MI-3DVS进行肝脏及胆道三维重建.根据三维重建结果进行术前诊断和病理分型,以及多种手术方案的术前仿真演练,确定最佳手术方案.观察术中

  16. The experimental study on the time of removal of gastrobiliary duct drainage in primary suture after exploration of common bile duct in dog%胃胆管引流拔管时间的研究

    Institute of Scientific and Technical Information of China (English)

    戴赛民; 陈青; 张勇; 郭子健; 吴二斌; 过建工

    2013-01-01

    Objective To establish an animal model with installation of gastrobiliary duct drainage (GBDD) in primary suture after exploration of common bile duct,to investigate the natuaral history of the healing of bile duct and obtain the safety,appropriate time of removal of GBDD.Methods Twenty-five dogs were randomly divided into control group (n =5) and GBDD group (n =20).The GBDD group was randomly divided into four subgroups,to cholangiography,extubate,and then excised bile duct anastomoses were stained with hematoxylin and eosin (HE),Masson and Scanning electron microscope (SEM) on postoperative day (POD) 3,5,7,9 respectively.Results Two bile leakage cases were found in POD 3 group after removal of the GBDD,no bile leakage case was fund in other groups.The inflammatory cell infiltration of the bile duct anastomoses showed statistical significance among four groups on POD 3 vs 5,7,9 (3.2 ±0.45 vs 2.2 ± 0.45,1.4 ± 0.55,1.2 ± 0.45,all P < 0.05).POD 7 vs 9 showed no statistically significant difference between them (P > 0.05).There were significant difference in index of mucosal healing among POD 3 vs 5,7,9 (1.0 vs 2.2 ±0.45,2.4 ±0.55,2.8 ±0.45,allP <0.05),POD 5,7,9 showed no statistically significant difference among them (P > 0.05).POD 5-7,HE staining showed that bile duct wall was thickening;Masson staining showed that the fibroblast distribution was disorderly;SEM showed that port of the bile duct restored with epithelial cell.However,the mucosa of bile duct restored poorly,chronic inflammation lasted for a long time.Conclusion It is safe to remove the GBDD on POD 5-7,there was no bile leakage.%目的 建立胆总管探查、胃胆管引流、胆总管一期缝合的动物模型,探讨安全拔除胃胆管的时间,指导临床拔除胃胆管.方法 将25条犬随机分成对照组(仅行腹腔探查,n=5)与胃胆管引流、胆总管一期缝合组(简称胃胆管组,n =20),实验组按术后3、5、7、9d经胃胆管胆道造影并拔除,随机分为4

  17. Anatomia das vias biliares em doadores e receptores de transplante hepático inter vivos Study of biliary anatomy in living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Renato Vianna Soares

    2006-09-01

    transplantation. METHODS: From March 1998 to September 2002, the study was retrospective (23 transplantations. From October 2002 to August 2003, the study was prospective (17 transplantations. We studied the hepatic anatomy of 80 consecutive patients (40 donors and 40 recipients of the living-related liver transplantation program of the "Hospital de Clínicas da Universidade Federal do Paraná" and the "Hospital Nossa Senhora das Graças", Curitiba, PR, Brazil; 51 were male (27 recipients 24 donors and 29 female (13 recipients and 16 donors. The median age among the donors was 32.6 years and among the recipients was 36.3 years. Thirty-two recipients were adults and 8 recipients were under 15 years old. The bile duct anatomy was studied by magnetic resonance cholangiography in 33 patients, and anomalies were seen in 3 of them (9.1%. RESULTS: The most prevalent variation of bile ducts was the fusion of the right posterior duct with the left duct (6.06%; n=2. In the 40 harvesting operations, the right bile duct was single in 25 patients (87.5%, among the 32 right-lobe donors, double in 2 (6.25% and triple in 2 (6.25%. All of the eight left livers procured had single bile ducts. Among the 40 recipients, the common bile duct was bifurcated in 2 of them (5%. CONCLUSION: The prevalence of biliary anomalies is high in patients subjected to living liver transplantation and some anomalies are not diagnosed with preoperative imaging exams.