[Congenital cystic dilatation of the common bile duct associated with dilatation of the proximal extra hepatic ducts (author's transl)].
Explore the source record for details and available documents.
Bile Ducts, Intrahepatic↗
SEARCH · PubMed Health
Results for “BILE DUCT, COMMON”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
An experimental model for laparoscopic common bile duct exploration.
The development of an effective and reliable technique for laparoscopic common bile duct exploration has been limited by the technical difficulty of the procedure and the lack of a suitable animal model with a bile duct diameter large enough to accommodate the fiberoptic choledochoscope and other instruments used for stone extraction. Short-term bile duct ligation in the dog provides a simple and reproducible animal model that enables the surgeon to gain experience with laparoscopic common bile duct exploration in a laboratory setting. This model will enable the surgeon to develop the technical skills necessary to perform laparoscopic common bile duct exploration. In addition, the model may facilitate the development and refinement of new techniques and instruments that will facilitate laparoscopic common bile duct exploration in the clinical setting.
Animals↗
Inspissated bile within the common bile duct simulating cholangiocarcinoma. Case report.
There are a variety of abnormalities that can lead to obstruction of the common bile duct, several of which also can cause dilatation and duct irregularity. The differential diagnosis includes such entities as cholangiocarcinoma and carcinoma of the pancreas invading the common bile duct. We present an unusual case in which inspissated bile caused irregularity and obstruction of the common bile duct that radiographically simulated a cholangiocarcinoma.
Adult↗
Endoscopic balloon dilatation is a safe method in the management of common bile duct stones.
BACKGROUNDS AND AIMS: Endoscopic sphincterotomy is a widely accepted treatment for patients with common bile duct stones. Despite improvement in this technique, endoscopic sphincterotomy is still associated with some biliary complications. Endoscopic balloon dilatation is a less traumatic and sphincter preserving method for removal of common bile duct stones. However, the results of controlled studies in comparison with these two methods are contradictory. The aim of this study is to compare the safety and efficacy of endoscopic balloon dilatation and endoscopic sphincterotomy in Chinese patients. PATIENTS AND METHODS: A total of 104 patients with common bile duct stones on endoscopic retrograde cholangiopancreatography were enrolled. They were randomly assigned to endoscopic balloon dilatation or endoscopic sphincterotomy. Endoscopic balloon dilatation was performed by using a balloon dilator to dilate the sphincter for 5 min. The common bile duct stones were then removed by a Dormia basket after endoscopic balloon dilatation or endoscopic sphincterotomy. Mechanical lithotripsy was performed if the stones were difficult to remove by Dormia basket. After discharge, patients were regularly followed up for biliary complications. RESULTS: The successful bile duct stone clearance rate was 94.1% in endoscopic balloon dilatation group and 100% in endoscopic sphincterotomy group. Post-procedural significant haemorrhage was higher in endoscopic sphincterotomy group than in endoscopic balloon dilatation group (14/53 versus 1/48, P < 0.001). The bleeding patient from endoscopic balloon dilatation group was a case of uremia and bleeding occurred 48 h after endoscopic balloon dilatation. All the patients with post-procedural haemorrhage were controlled endoscopically. The post-procedural serum amylase level showed no significant difference in both groups and none of them developed clinical pancreatitis. After a mean 16 months follow-up, three patients (6.3%) in endoscopic balloon dilatation group and four patients (7.5%) in endoscopic sphincterotomy group developed recurrent common bile duct stones. The recurrent common bile duct stones were multiple and muddy in consistency. They were successfully removed endoscopically. CONCLUSION: Both endoscopic balloon dilatation and endoscopic sphincterotomy are safe and effective techniques for the treatment of common bile duct stones. Endoscopic balloon dilatation can be safely applied in patients with coagulopathy and does not increase the incidence of pancreatitis or bleeding.
Adult↗
Ultrasound evaluation of common bile duct size.
A new sonographic technique for demonstration of the common bile duct is described in a prospective study of 200 patients. The mean diameter of the normal common duct was 4.1 mm. A common duct greater than 7 mm in diameter can be seen in (a) nonjaundiced patients with gallstones and/or pancreatitis, or (b) jaundiced patients with common duct obstruction by stone or tumor. A common duct greater than 11 mm in diameter is strongly suggestive of obstruction by stone or tumor.
Cholecystectomy↗
[Atypical anatomical variants and anomalies of the biliary tract in patients with biliary tract and pancreatic diseases. II. Endoscopic treatment].
Results are reported of endoscopic treatment of 79 patients with atypical anatomical variants and anomalies of the bile ducts: common bile duct calculosis (54), stenosing papillo-odditis (8), indurative pancreatitis (2) and bile duct cancer (15). The following endoscopic manipulations have been performed: endoscopic sphincterotomy (72); hydrostatic balloon extraction of calculi (27); hydrostatic balloon dilatation of constricted segments (29); mechanical lithotripsy (15); nasolabial drainage (17) and endoprosthesis (15). Much more difficult was the extraction of calculi from the common bile in the event of atypical anatomical variants and anomalies of the distal portion of the common bile duct (chi 2 = 14.55; p less than 0.001). Treatment resulted in significant reduction of the bilirubin levels (t = 4.13; p less than 0.001), of AP (t = 4.47; p less than 0.001), GGTP (t = 4.07; p less than 0.001); AcAT (t = 5.75; p less than 0.001) and AlAT (t = 5.63; p less than 0.001). Complications occurred in 6 per cent of the patients (acute pancreatitis, cholangitis, hemorrhage). Mortality from endoscopic treatment was 1.3 per cent. Endoscopic methods for treatment are advised as alternative to operative treatment for patients in advanced age and high operative risk.
Adult↗
Identification of dorsal root ganglion neurons that innervate the common bile duct of rats.
Pain originating in the bile duct is common and many patients who have suffered from it report that it is one of the most intense forms of pain that they have experienced. Many uncertainties remain about the mechanisms underlying pain originating in the bile duct. For example, the dorsal root ganglion (DRG) neurons that give rise to the sensory innervation of the common bile duct (CBD) have not been identified and examined in any species. The goal of the present study was to determine the number, distribution, and size of DRG neurons that innervate the CBD in rats. Injections of WGA-HRP or CTB-HRP were restricted to the lumen of the bile duct. Injections of WGA-HRP labeled a mean number of about 500 DRG neurons bilaterally throughout all thoracic and upper lumbar levels. Injections of CTB-HRP labeled smaller numbers of DRG neurons. Application of colchicine onto the surface of the CBD reduced the number of cells labeled following injections of WGA-HRP into the lumen of the CBD by roughly 86%, suggesting that tracer had not spread in large amounts out of the CBD and labeled afferent fibers in other tissues. Approximately 85% of the neurons labeled with WGA-HRP had cell bodies that were classified as small; the remainder were medium in size. Injections of CTB-HRP labeled cell bodies of varying sizes, including a few large diameter cell bodies. These results indicate that a large number of primarily small DRG cells, located bilaterally at many segmental levels, provide a rich innervation of the common bile duct.
Animals↗
Endothelin ET(A) but not ET(B) receptors mediate contraction of common bile duct.
Endothelin (ET) causes contraction of the gallbladder. To investigate effects of ET in the common bile duct, we measured contraction of longitudinal muscle strips from guinea pig common bile ducts induced by ET-related peptides and binding of 125I-ET-1 to cell membranes prepared from the common bile duct. Visualization of 125I-ET-1 binding sites in tissue was performed by autoradiography. ET-1 caused tetrodotoxin and atropine-insensitive contraction. In terms of maximal tension of contraction, ET-1, ET-2 and ET-3 were equal in efficacy. However, sarafotoxin S6c, a selective ET(B) receptor agonist, caused only a negligible contraction. The relative potencies for ET isopeptides to cause contraction were ET-1=ET-2>ET-3. The ET-1-induced contraction was inhibited by BQ-123, an ET(A)-receptor-selective antagonist, but not by BQ-788, an ET(B)-receptor-selective antagonist. In addition, the combination of both antagonists, BQ-123 and BQ-788, inhibited ET-1 induced contraction but did not potentiate the inhibition caused by BQ-123 alone. These indicate that ET(A) but not ET(B) receptors mediate the contraction. Autoradiography localized 125I-ET-1 binding to the smooth muscle layer. Binding of 125I-ET-1 to the smooth muscle cell membranes was saturable and specific. Analysis of dose-inhibition curves indicated the presence of ET(A) and ET(B) receptors. These results demonstrate that ET causes contraction of longitudinal muscle of the common bile duct. Different from the gallbladder, which possesses both ET(A) and ET(B) receptors cooperating to mediate muscle contraction, the common bile duct possesses two classes of ET receptors, but only the ET(A) receptor mediates the contraction.
Animals↗
Laparoscopic surgery and the common bile duct.
Many biliary tract surgeons have now reached a level of sophistication with laparoscopic cholecystectomy that they are now able to deal with the common bile duct at the same time. Preoperative endoscopic cholangiography can be reserved for cases where choledocholithiasis has a high degree of probability. This has served to decrease the number of negative studies. The surgeon has five choices regarding stones confirmed by operative cholangiography during laparoscopic cholecystectomy: (1) do nothing, hoping the stones will pass spontaneously or that a postoperative sphincterotomy with stone extraction will be successful; (2) perform a transcystic laparoscopic common bile duct exploration (best for stones less than 1 cm and distal to the cystic duct); (3) perform a laparoscopic common bile duct exploration by choledochotomy (best for large stones in patients with common bile ducts greater than 1 cm. It is also the preferred approach with stones proximal to the insertion of the cystic duct.); (4) perform an intraoperative sphincterotomy with stone extraction, either retrograde or antegrade (this approach has some proponents but has not gained popularity among the majority of surgeons); and (5) place a double lumen catheter through the cystic duct with a proximal lumen in the common bile duct and the distal lumen in the duodenum. This can be used for serial postoperative cholangiography to confirm spontaneous stone passage or falsely positive operative cholangiograms. It is useful in situations when laparoscopic common bile duct exploration equipment or surgeon expertise is not available. If stones persist, a guidewire can be introduced through the distal lumen of the catheter for a guidewire-assisted sphincterotomy. Other CBD interventions that have been reported include laparoscopic biliary bypass and resection of choledochal cysts. Malignant lesions should not be approached by a laparoscopic method except in unusual circumstances.
Biliary Tract Surgical Procedures↗
Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results.
BACKGROUND: Common bile duct stones are still a frequent problem. Although new diagnostic and therapeutic techniques are continually being development, they remain poorly defined. Therefore, we decided to evaluate our standard method of diagnosing and treating common bile duct stones. The aim of the study was to determine the short- and long-term results of this method. METHODS: Between 1985 and 1995, 552 consecutive patients (200 men and 352 women; median age, 69 years) underwent endoscopic retrograde cholangiography (ERC) because of suspected common bile duct stones. If stones were detected, they were treated endoscopically, if possible. The results and complications of this policy were recorded. Patients were followed 1-13 years after undergoing ERC and endoscopic sphincterotomy (ES). Long-term results and complications during this period were also recorded. RESULTS: ERC was attempted in 552 patients and succeeded in 510 patients (92%): ES was attempted in 315 patients and failed in five (98%). Duct clearance was done in 271 patients; in 26 of these patients, symptoms disappeared spontaneously. Ten patients underwent common bile duct exploration. Complications occurred in 46 patients (8.3%). Mortality was 0.4%, hemorrhage occurred in 3.6%, pancreatitis in 1.4%, sepsis and cholangitis also in 1.4%, and the lithotripter basket became impacted in four patients (0.8%), necessitating to common bile duct exploration. During follow-up, 45 patients (8%) returned, 35 with recurrent stones, five with cholangitis, two with stenosis of the papilla of Vater, and one with biliary pancreatitis. In 35 cases, complications were treated endoscopically, common bile duct exploration was performed in five cases, and symptoms disappeared spontaneously in five cases. CONCLUSIONS: ERC is a safe and reliable way of diagnosing common bile duct stones, and ES is a very efficient way of treating them. Morbidity and mortality are low, and the long-term results are very good.
Adolescent↗
The utility of ultrasonography for screening the common bile duct during laparoscopic cholecystectomy.
Since the introduction of laparoscopic cholecystectomy, the means by which the common bile duct is evaluated, if performed at all, has been debated. When the common bile duct is to be screened, two primary modalities have emerged. These techniques are fluoroscopic cholangiography and intracorporeal ultrasonography. Fluoroscopic cholangiography during laparoscopic cholecystectomy has been shown to be effective and accurate for demonstrating ductal stones and anomalies. More recently, laparoscopic ultrasonography has been utilized for screening the common bile duct. Ultrasonography is probably more sensitive than cholangiography for demonstrating intraluminal common bile duct stones or sludge and can be performed more rapidly and at less cost than cholangiography. However, ductal anomalies may not be as readily visualized. The two techniques, therefore, appear to be complementary for evaluating the common bile duct during laparoscopic cholecystectomy, and both techniques should be taught to today's surgical trainees.
Cholangiography↗
[Congenital dilatation of the common bile duct].
During a period of 18 years, 41 cases of congenital dilatation of the common bile duct in young patients (11 of them were less than 12 months of age) were treated at Bicetre Hospital. A retrospective analysis of these cases underline the following points. A close etiopathogenic relation exists between the presence of a common hepatico-pancreatic duct and a congenital dilatation of the common bile duct (in this study, 16 cases demonstrated the anomaly out of 20 cases for which the common bile duct could be analysed). Early surgical treatment must be undertaken before occurrence of liver complications (6 patients have cirrhosis when first treated, 4 of them were children less than 12 months of age). Abdominal echotomography (100% of preoperative diagnosis) and transparietal cholangiogram are the best investigations for providing pictures of hepatico-pancreatic abnormalities and collecting bile samples for bacteriological and chemical study. The treatment of congenital dilatation of common bile duct by cyst excision and Roux en Y hepaticojejunostomy has good long term results. After 20 cases of complete cyst excision, 6 of them were children under 12 months, and 17 cases or partial cyst excision respecting the cyst fundus when they were intraduodenal and retropancreatic in position (4 were children under 2 months) we have noted that 83% of these children had a good outcome with a mean follow up of 7 years. Complications include hepatico-jejunal stenosis at the anastomosis site in 2 patients, for which they were reoperated and cholangitis with hepatico-jejunal anastomosis in 6 cases. There were 3 deaths in children under 12 months who already developed hepatic cirrhosis and episodes of severe cholangitis when preoperative diagnosis was first proved. In conclusion, the future life of the majority of these children is expected to be uneventful inasmuch that bile stasis has been corrected, with resolution of inflammatory lesions which are known to expose to secondary malignancies of the biliary tract.
Adolescent↗
A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas.
We report a 74-year-old man with triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. The patient had consulted a nearby physician because of epigastralgia and icterus. On September 30, 1997, the patient was admitted to our department for further evaluation and treatment. Abdominal computed tomography (CT) showed dilatation of the common bile duct, cystic duct, and intrahepatic bile duct, and swelling of the gallbladder. On CT, the wall of the distal common bile duct was thick and a low-density mass was detected on the left side. Cholangiography, performed via percutaneous transhepatic cholangiodrainage (PTCD), revealed stenosis of the distal common bile duct. Endoscopic retrograde pancreatography (ERP) showed marked dilatation of the main pancreatic duct. On October 17, 1997, pancreatoduodenectomy was performed under the diagnosis of carcinoma of common bile duct and pancreas. Histopathological examination revealed poorly differentiated tubular adenocarcinoma of the common bile duct, well-differentiated tubular adenocarcinoma of the gallbladder, and mucinous cystadenocarcinoma of the pancreas. These three tumors were histopathologically different. Moreover, p53-positive nuclei were recognized only in the pancreas tumor. These findings suggested that the oncogenic mechanisms of multiple synchronous cancers were not the result of only abnormal DNA reparative mechanisms.
Adenocarcinoma↗
Rapid increase in plasma levels of atrial natriuretic peptide after common bile duct ligation in the rabbit.
Previous studies have shown that common bile duct ligation in the rabbit is followed by a reduction of the extracellular water compartment. To further elucidate the mechanisms leading to volume depletion in this model, water and sodium balances and changes in plasma concentrations of atrial natriuretic peptide (ANP), vasopressin (ADH), plasma renin activity (PRA) and aldosterone (Ald) were investigated during the first 4 days after common bile duct ligation (group OJ,) or sham operation (group SO). Water and chow intakes were lower in group OJ (148 +/- 30 versus 226 +/- 40 mL/4 days; p = 0.004 and 12 +/- 9 versus 171 +/- 40 g/4 days; p = 0.0001). There were no differences in urine output. Sodium urinary losses were marginally higher in group OJ (12.4 +/- 7 versus 6.7 +/- 5 mEq/4 days; p = 0.06). Water balance was lower in group OJ (-50 +/- 56 versus 101 +/- 71 mL/4 days; p = 0.0001). At 24 hours, plasma ANP (41 +/- 7 versus 10.7 +/- 1 fmol/mL, p = 0.0001), ADH (21.8 +/- 7 versus 12.3 +/- 6 pg/mL, p = 0.008) and Ald (14.5 +/- 5 versus 3.7 +/- 3 ng/dL, p = 0.001) were higher in group OJ. These alterations persisted 72 hours after bile duct ligation, when a concomitant increase in PRA (10.7 +/- 5 versus 3 +/- 1.6 ng/dL, p = 0.006) was also observed. A group of pair-fed pair-watered sham-operated controls (group SO2, n = 13) showed a metabolic profile similar to group OJ but a low ANP concentration. Multiple venous sampling in five rabbits 24 hours after bile duct ligation showed the highest plasma levels of ANP in the aorta and infrarenal vena cava. These results suggest that common bile duct ligation in the rabbit is followed by marked hypodipsia and hypophagia, possibly mediated by ANP, leading to isotonic volume depletion and secondary activation of the water and sodium retaining hormones.
Acute Kidney Injury↗
Prospective randomised study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones.
One hundred and twenty patients with known common bile duct stones were entered into a prospective randomised study of preoperative endoscopic sphincterotomy and stone clearance (group 1) versus surgery alone (group 2). Five patients were incorrectly entered; the 55 patients randomised to group 1 and the 60 randomised to group 2 were well matched with respect to clinical features and biochemical and medical risk factors. In group 1 endoscopic stone clearance was successful in 50 patients (91%); five of these patients refused elective surgery, though this was subsequently necessary in one. In group 2 common bile duct stones were cleared surgically in 54 of 59 patients (91.5%); one patient was treated by endoscopic sphincterotomy alone because of a myocardial infarct. The overall major complication rate in group 1 was 16.4% and included two deaths; in group 2 this was 8.5% and included one death. The minor complication rate in group 1 was 16.4% and that in group 2 13.6%. These differences in outcome were not significant. Despite a significant reduction in total hospital stay of patients in group 1, these results do not support the routine use of preoperative endoscopic sphincterotomy in patients having biliary surgery for stones in the common bile duct.
Adult↗
A technique for creating partial obstruction of the common bile duct in the rat.
Partial obstruction of the common bile duct was produced in rats by tightly tying a 0.5 mm stainless steel rod to the proximal common bile duct. The rod was then removed from the ligature leaving a constriction around the duct. Within 2 weeks the bile duct proximal to the partial obstruction was markedly dilated. Liver histology was notable for marked proliferation of the interlobular bile ductules and minimal cholangitis, changes which are characteristic of partial obstruction.
Animals↗
[Two-step removal of Kehr's drain from the common bile duct].
The removal of Kehr's drain from the common bile duct is not an indifferent procedure. In about 5% of cases complications develop, as described. Two-step removal of T drain prevents accumulation of bile around the defect in the common bile duct and development of such complications as massive escape of bile, septic complications, biliary peritonitis. In a group of 167 patients with T drain in whom the drain was removed in one step, three cases of serious complications developed, and in the group of 120 patients with two-step removal of T drain no complications were noted.
Common Bile Duct↗
[Congenital dilatation of the common bile duct. Apropos of l6 cases].
Congenital cystic dilatation of the common bile duct, also known as choledochal cyst, is an uncommon malformation, observed mainly in asiatic children, with a 3:1 female--male ratio. The entity is classified into 4 different types according to the anatomy of the malformation, which effects or not the intrahepatic biliary tree. The authors review theirs experience with 16 consecutive patients with choledochal cyst operated between 1971 and 1985. In 12 children (mean age: 5,8 years, 11 girls) without previous surgery, preoperative diagnosis was made with abdominal ultrasonography and, in some cases, endoscopic retrograde cholangio-wirsungography. Peroperative cholangiography demonstrated a common pancreatico-biliary channel associated with high choledochal amylase content in 6 cases. Surgical treatment consisted in cyst excision with hepatico-jejunostomy in those 12 patients. We also discuss the surgical treatment of 4 previously operated patients with postoperative cholangitis or biliary carcinoma. An anomalous pancreatico-biliary ductal junction (long common channel allowing free pancreatico-biliary reflux) is usually observed in these patients; it is considered to play a role in the etiology of congenital choledochal cysts. Appropriate surgical treatment consists in cyst excision with hepatico-jejunostomy as biliary drainage, in order to eliminate bile stasis, to remove the mechanism which allows continuous pancreatico-biliary reflux and to prevent the occurrence of bile duct carcinoma.
Adolescent↗