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At least 55 records · Page 3Linked to original sources
PubMed1994

Hepatocellular carcinoma embolus to the common hepatic duct with no detectable primary hepatic tumor.

Obstruction of the common bile duct (CBD) by direct extension of tumor is occasionally found in patients with hepatic neoplasms. Tumor embolus to the CBD is very rare, however, when no primary hepatic tumor is found. The patient described herein was a 74-year-old man who presented with a new onset of jaundice, nausea, anorexia, and epigastric pain. There was a history of dark urine and clay-colored stools, but no fever. Endoscopic retrograde cholangiopancreatography (ERCP) showed partial obstruction of the common hepatic duct and dilated intrahepatic bile ducts. A computed tomography (CT) scan of the upper abdomen showed no masses. Results of a mesenteric and selective hepatic arteriogram were normal. On abdominal exploration, no tumor was noted. There were no palpable stones in the gallbladder, but a firm mass was felt in the common hepatic duct. Exploration of the CBD produced light-colored debris organized into a cast of the common hepatic duct. Frozen section analysis was negative for tumor cells, but review of the permanent sections confirmed the presence of hepatocellular carcinoma. When non-calculous material is found to be obstructing the CBD, even in the absence of an obvious primary hepatic tumor, tumor embolus or metastasis from a distant site must be considered and the material sent for pathological evaluation.

Aged↗
PubMed1980

Benign mechanical obstruction of the common hepatic duct (Mirizzi syndrome).

Common hepatic duct obstruction that results from a gallstone impacted in the cystic duct or fundus of the gallbladder is an uncommon cause of obstructive jaundice and cholangitis. In the literature, the Mirizzi syndrome frequently is used to describe a rare entity consisting of an anatomic variation of the cystic duct or neck of the gallbladder, an impacted gallstone in the cystic duct, and a benign mechanical obstruction of the hepatic duct which causes jaundice and cholangitis. Recently, we saw two patients who had this syndrome. Their case reports, operative management, and a review of the Mirizzi syndrome are discussed in this article.

Cholangiography↗
PubMedDate not supplied

Accessory hepatic duct: sonographic findings.

Accessory hepatic ducts are relatively rare biliary anomalies. They have been reported only sporadically, and very few reports have described their sonographic (US) findings. Our experience with two such cases suggested that a diagnosis of an accessory hepatic duct should be considered when US shows a fine tubular structure or an anechoic or hypoechoic oval mass with acoustic shadowing at the level between the hepatic hilus and the common bile duct. A good knowledge of the US findings will determine the diagnostic and therapeutic strategies.

Aged↗
PubMed1979

[Carcinoma of the convergence of the hepatic ducts. A case treated with extended hepatic resection].

The case of a patient with carcinoma of the convergence of the hepatic ducts successfully treated with more extensive hepatic resection is reported. Stress is laid on the problems of exact preoperative diagnosis and of treatment. Most operations are in fact purely palliative and the literature contains very few cases of hepatic resection for neoplasia of the convergence.

Bile Duct Neoplasms↗
PubMed1982

Carcinoma of the junction of the main hepatic ducts.

Patients with carcinoma of the hepatic duct junction often present the surgeon with a difficult problem. If at all possible radical surgery may be performed either as a resection of the tumour and an anastomosis according to Roux-en-Y or a resection of the left or right hepatic lobe together with the obliterated hepatic duct or ducts. The present series consists of 17 patients treated for cancer of the hepatic duct junction during the period 1965-1974 with a follow-up period of at least five years. The surgical treatment given included a radical procedure in 8 cases, a palliative procedure in 7 cases and in 2 cases surgery of the hepatic ducts was not possible. Radical procedures included 4 patients with a resection of the left hepatic lobe and 4 patients with resection of the left and right hepatic ducts and anastomosis according to Roux. A mean survival time of 22.8 months was reached when a radical operation was attempted with a longest survival time of 8 years. A palliative procedure gave a mean survival time of 2.0 months. These figures indicate that a careful selection of patients for an attempt of radical surgery could be made since removal of the tumour gives a more effective palliation, often a longer survival time and an improvement of quality of life.

Adult↗
PubMed2006

Microvascularization of the canine hepatic ducts.

The angioarchitecture of the proximal and distal segments of the hepatic duct in the dog was investigated by means of vascular corrosion casts under a scanning electron microscope. The results of observations indicated a change of the pattern of vascularization of the hepatic duct along with the increasing distance of the hepatic duct from the liver and increasing diameter of the duct. In the proximal hepatic duct, the main blood vessels run along the duct as a pair of supplying arteriole and voluminous collecting venule, while in the distal segments of the hepatic duct on the opposite margin of the duct two vascular triads were observed, composed of two venules and one medial arteriole. On the surface of both segments of the hepatic duct, there are well-anastomosed outer venous plexuses. In the distal segments of the hepatic duct, the outer venous plexus accompanies a fine outer arterial rete. Observations of the intramural network indicate the presence of single terminal arterioles running to mucosa and supplying a subepithelial capillary network. Differences were observed in the blood drainage from the mucosa, as in the proximal segment of the hepatic duct single post-capillary venules are found, while in the distal segment in the mucosa a well-developed mucosal venous plexus is formed. In the well-developed venous system of the hepatic duct no valves were observed.

Animals↗
PubMed2001

Primary sclerosing cholangitis successfully treated by resection of the confluence of the hepatic duct.

Primary sclerosing cholangitis (PSC) is a cholestatic disease characterized by chronic inflammatory fibrosis of the extra- and intrahepatic bile ducts. Although the prognosis of patients with PSC was believed to be poor, some patients have not experienced the expected rapid clinical progression. A 51-year-old man with PSC was initially hospitalized for jaundice. Laboratory data showed low levels of the complement components C3, C4, and CH50. Percutaneous transhepatic biliary drainage was performed. Cholangiography revealed complete obstruction of the common bile duct below the confluence of the cystic duct. The confluence of the hepatic duct was resected and it was reconstructed by hepaticojejunostomy for palliation of the obstructive jaundice. Increased thickness of the walls of the common bile duct, right hepatic bile duct, and gallbladder was observed. Histopathological examination of the resected specimen revealed periductal fibrosis, with an onion-skin-like appearance. The patient is currently doing well, approximately 7 years after the surgery, without any signs of PSC recurrence. In this extraordinary patient, the laboratory data for C3, C4, and CH50 showed a complete return to normal levels. The positive results in this patient suggest that resection of the confluence of the hepatic duct may be an effective surgical treatment for noncirrhotic PSC patients who have dominant extrahepatic strictures.

Cholangiography↗
PubMedDate not supplied

Right hepatic duct opening into the cystic duct: the role of pre- and intraoperative cholangiography.

Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare. A 69-year-old woman developed severe intermittent right upper quadrant pain and high fever. A diagnosis of acute calculus cholecystitis was made by radiographic examinations. Magnetic resonance cholangiopancreatography demonstrated dilatation of the right hepatic duct, but could not identify the junction of the right hepatic duct and the cystic duct. Endoscopic retrograde cholangiopancreatography established that the right hepatic duct joined the cystic duct and that cholecystolithiasis was present. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy. Pre- and intraoperative cholangiography contribute to the avoidance of iatrogenic bile duct injury. When the right hepatic duct drains into the cystic duct, the gallbladder should be removed distal to the junction of the hepatic and cystic ducts.

Aged↗
PubMed1992

Is aggressive surgical palliation of proximal bile duct cancer with involvement of both main hepatic ducts worthwhile?

The only curative treatment for proximal bile duct cancer with involvement of both main hepatic ducts is liver transplantation. Most patients do not fulfill the requirements for liver transplantation. Our treatment strategy in appropriate cases is palliative tumor resection and reconstruction of the biliary passage by sutureless bilioenteric anastomosis. We have treated 12 patients, 5 in combination with intraluminal and percutaneous radiotherapy. Our results indicate that this strategy leads to effective palliation in some cases provided that only microscopic residual tumor is left in-situ. Our survival times compare favourably with survival after liver transplantation.

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