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PubMed2006

Spontaneous perforation of the common bile duct with eosinophilia in an 18-month-old girl: a case report and review of literature.

BACKGROUND: Spontaneous perforation of the common bile duct is a rare but important cause of jaundice in infancy, requiring prompt diagnosis and surgical intervention. First described in 1932, fewer than 150 cases have been reported to date. CASE REPORT: The report concerns a 18-month-old girl who developed mild jaundice, abdominal distension, and constipation three days prior to admission. On admission, ascites and hepatomegaly were detected and the complete blood count was normal, but on the 3rd, 4th, and 5th days of admission, the blood cell count revealed elevation of the eosinophil count to 16% of total WBC. Abdominal sonography showed a moderate amount of ascitic fluid and paracentesis demonstrated biliary ascites. Hepatobiliary scintigraphy suggested leakage of bile to the abdominal cavity. Exploratory laparotomy revealed clear bilious ascitic fluid and a ruptured common bile duct at the anterior wall of the junction of the cystic duct and the common bile duct. Three days after T-tube insertion and closure of the perforation, the eosinophil count returned normal. CONCLUSIONS: Perforation of the bile duct may be considered as one of the differential diagnoses of eosinophilia. This point makes our case a unique study, worthy of being reported.

Common Bile Duct Diseases↗
PubMed2003

Undifferentiated spindle and giant cell carcinoma of the common bile duct.

Undifferentiated spindle and giant cell carcinoma of the common bile duct has not been reported previously. We present here a case of 71-year-old man with the undifferentiated spindle and giant cell carcinoma of the common bile duct, including immunohistochemical findings. A nodular infiltrating tumor was located at the lower portion of the extrahepatic bile duct, and measured 1.2 x 0.6 cm in size. Histologically, the tumor was composed of proliferated sarcomatoid spindle tumor cells. Numerous multinucleated giant cells were intermingled with the sarcomatoid spindle tumor cells. Immunohistochemically, the tumor cells were positive for both cytokeratin and vimentin. We speculated that the tumor originated from epithelial cells, and showed sarcomatoid neplastic changes.

Aged↗
PubMed1993

Laparoscopic treatment of common bile duct stones. Phantom experiments using electrohydraulic and pulsed dye laser lithotripsy.

To evaluate the feasibility of laparoscopic transcystic lithotripsy of common bile duct stones, a phantom model comprising bovine liver and biliary tract tissue integrated within a laparoscopic trainer was built. A 9 French cholangioscope was introduced via the cystic duct into the common bile duct in which a human gall stone of known composition had been introduced. Lithotripsy was performed using either a laser or electrohydraulic probe passed through the working channel of the cholangioscope following which the stone fragments were manipulated into the duodenum through the papilla of Vater using the choledochoscope. A total of 20 lithotripsies with each energy form were performed. Lithotripsy was successful in breaking the stones into fragments smaller than 6 mm. The energy expenditure was comparable with a mean of 49 J for laser lithotripsy (range 9 to 159 J), and 53 J (range 16 to 160 J) for electrohydraulic wave lithotripsy. The lithotripsy time measured from introduction of the cholangioscope until its removal was a mean of 30 minutes for electrohydraulic wave lithotripsy and 41 minutes for dye laser lithotripsy. This difference was statistically significant. Macroscopic tissue damage to the common bile duct wall was not observed following any procedure. An additional experiment was performed to evaluate damage that could be caused to the wall of the common bile duct. Both electrohydraulic shock wave and pulsed dye laser lithotripsy without optical feedback regulation caused severe tissue defects when there was tissue contact or distance less than 2 mm. With optical feedback regulation however, no tissue damage was induced by laser lithotripsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Cholecystectomy with concomitant exploration of the common bile duct.

One hundred and four patients undergoing concomitant cholecystectomy and exploration of the common bile duct were retrospectively reviewed. Exploration of the common bile duct retrieved stones in only 17 patients, all of whom had clearly positive findings from operative cholangiography. Of 87 patients who had negative results 57 underwent exploration of the common bile duct on the basis of clinical factors and 21 on the basis of equivocal cholangiographic findings.

Adult↗
PubMed1993

Reversibility of cholestatic changes following experimental common bile duct obstruction: fact or fantasy?

In 36 male Wistar rats extrahepatic cholestasis was induced by ligation and transsection of the common bile duct. After 1, 2 and 3 weeks of cholestasis the bile flow was restored by means of a Roux-en-Y choledochojejunostomy. Plasma levels of bilirubin, alkaline phosphatase, GOT and clotting factor X were measured weekly. Liver biopsies were taken at the time of restored bile flow as well as 3 and 8 weeks thereafter. Histochemical reaction for lactate dehydrogenase activity and Sirius Red F3BA staining were used as measure for functional liver parenchyma and collagen, respectively. Acid phosphatase, alkaline phosphatase and 5'-nucleotidase activities as well as the glycogen content were demonstrated in cryostat sections of the same biopsies. After 1, 2 and 3 weeks of common bile duct obstruction, levels of bilirubin, alkaline phosphatase and GOT significantly increased, whereas levels of clotting factor X decreased. RBF resulted in normalization of all these levels to control range. The volume density of functional parenchyma was found to be reduced to 90%, 73% and 64% of the control values following 1, 2 and 3 weeks of common bile duct obstruction respectively, returning to 96%, 94% and 88% at 8 weeks, respectively, after restored bile flow. The collagen content increased significantly during cholestasis up to 5-fold after 3 weeks of common bile duct obstruction. After restored bile flow, a slight decrease of collagen was measured in some animals but in none of the three groups a return to normal values appeared. Cholestasis induced an alteration in localization and/or activity of the three enzymes analyzed as well as a depletion of glycogen stores. All changes in activity and distribution pattern of the three enzymes, as well as the glycogen depletion during common bile duct obstruction normalised after restored bile flow was performed. However, the longer common bile duct obstruction had existed, the longer period was needed for full recovery. In conclusion, even after 3 weeks of common bile duct obstruction the parenchyma/stroma relationship grossly normalized after restored bile flow with an almost complete restoration of the parenchyma and a concomitant recovery of liver function. However, collagen once formed, did not disappear but remained as more condensed septa, which apparently did not interfere with normal function.

5'-Nucleotidase↗
PubMed1991

Percutaneous flexible choledochoscopy: a simple method for retained common bile duct stone removal.

Conventional methods of treatment of retained common bile duct stones found on T tube cholangiography after common bile duct exploration include percutaneous extraction under fluoroscopic control and endoscopic sphincterotomy. Four cases of percutaneous stone extraction under direct vision using the flexible choledochoscope are described. Clearance of the bile ducts was achieved at one sitting in three cases and four sittings in one case. Follow-up tube cholangiography was performed in two cases and confirmed complete clearance. Percutaneous endoscopic stone extraction can be performed by any surgeon with experience of flexible choledochoscopy and offers the advantages of a minimally invasive procedure without the use of specialized equipment.

Adult↗
PubMed1980

Ligation of the common bile duct in the fetal lamb: an experimental model for the study of biliary atresia.

Intrauterine ligation of the common bile duct was carried out in ten fetal lambs at approximately 80 days gestational age. Six of the fetal lambs survived until term and were sacrificed at varying periods until the 36th day of life. The lesion which developed resembled a "correctable" type of extrahepatic biliary atresia [Kasai type I (b)]. The lining epithelium was either totally or incompletely denuded in the blind end of the common duct proximal to the obstruction.

Animals↗
PubMed1983

Use of fiberoptic choledochoscope in common bile duct and intrahepatic duct exploration.

This report summarizes our experience with 339 consecutive flexible fiberoptic choledochoscopic examinations performed in the course of 598 common bile duct explorations for biliary tract stones. Routine choledochoscopy added 5 to 10 minutes to the operation and caused no complications. In 81 of the patients, additional stones were discovered with choledochofiberscopy after completion of routine bile duct exploration. Postoperative cholangiography demonstrated a retained stone in 57 patients (two in the common bile duct and 55 in the intrahepatic ducts). Forty-two patients with stones retained in the intrahepatic ducts were diagnosed during operation with the fiberoptic choledochoscope, but those stones were very difficult for us to remove. The accuracy of postexploratory choledochoscopy in diagnosis of stones in the common bile duct and intrahepatic ducts was 99.0% and 90.5%, respectively. Choledochofiberscopy is useful in exploration of the common bile duct and a safe procedure in the diagnosis of biliary tract stones during operation.

Bile Ducts, Intrahepatic↗
PubMed2005

Repetitive and safe transgene expression in rat liver is achievable by adenoviral infusion into the common bile duct.

To examine the feasibility of adenovirus-mediated gene transfer into the liver, we examined whether adenoviral infusion into the common bile duct could induce repetitive and safe transgene expression in rat livers. Recombinant adenovirus carrying a reporter lacZ gene was repetitively infused retrogradely into the common bile duct of rats. LacZ expression in rat livers was estimated histochemically by X-gal staining and quantitatively by a chemiluminescent reporter gene assay after the first, second and third adenoviral infusion into the common bile duct. To assess the safety of repetitive adenoviral infusion into the common bile duct, various liver- and kidney-related serum parameters, and liver damage were examined biochemically and histologically, respectively. Retrograde adenoviral infusion into the common bile duct achieved sufficient and safe lacZ expression in rat livers. Although transgene expression in the liver was transient, the second and third adenoviral infusion into the common bile duct could induce the expression of the same transgene in the liver. Furthermore, repetitive adenoviral infusion into the common bile duct caused no significant reverse reactions. Because retrograde adenoviral infusion into the common bile duct is a clinically practical method by using a widely used endoscopic technique, namely endoscopic retrograde cholangiography, these results suggest that retrograde adenoviral infusion into the common bile duct is a practical gene therapy modality in clinical settings.

Adenoviridae↗
PubMedDate not supplied

[Simultaneous laparoscopic treatment for common bile duct stones associated with acute cholecystitis. Results of a prospective study].

Laparoscopy for the management of acute cholecystitis has gained wide acceptance. Although it is well known that acute cholecystitis may be complicated by common bile duct stones in up to 15% of cases, to date there are no published studies addressing the management of common bile duct stones detected during laparoscopy for acute cholecystitis. We postulated that, when found, common bile duct stones associated with acute cholecystitis could be effectively and safety managed during the same laparoscopic procedure. We report on a five-year prospective study (2001-2005) involving 313 unselected patients who presented with a clinical diagnosis of acute cholecystitis (confirmed by specimen examination) and without any contraindication to laparoscopy. At surgery, transcystic cholangiograms were obtained in 289 (92%); the other 24 were excluded from the study. With an established diagnosis of common bile duct stones, attempts were made to clear the common bile duct by transcystic basket retrieval, ERCP or choledochotomy. Prevalence of common bile duct stones in acute cholecystitis, success of laparoscopic common duct clearance, conversion rate, operative time, morbidity, and postoperative hospital stay were the main outcome measures. Common bile duct stones were found in 63 pts (21.7%) presenting with acute cholecystitis. At laparoscopy, 12 patients (19%) required conversion to open surgery, 3 of these being due to failure to achieve common bile duct clearance. Common bile duct stones were cleared entirely laparoscopically in 51 patients (81%) by means of transcystic stone retrieval (38 pts, 75%), ERCP (12 pts, 23%) or choledocotomy (1 pt, 2%). At intention to treat analysis, patients undergoing cholecystectomy plus common bile duct clearance compared to those undergoing cholecystectomy alone, spent significantly more time in the operating theatre (mean 192 min vs 118 min, p < 0.001), needed open conversion more frequently (19% vs 6.1%, p = 0.0045), and had a higher overall morbidity rate (17.4% vs 4.4%, p = 0.015). The simultaneous procedure also adversely affected the postoperative hospital stay (mean 4.8 vs 3.4 days, p = 0.0164). Mortality was nil in both groups. The prevalence of common bile duct stones in patients presenting with acute cholecystitis should not be neglected. When common bile duct stones are found, clearance may be obtained laparoscopically in a substantial number of cases without any need for open surgery. The simultaneous laparoscopic approach for acute cholecystitis and common bile duct stones remains, however, a highly skilled and technically demanding procedure. Although a moderate incidence of drawbacks is observed, the results should be interpreted from the point of view of an all-in-one procedure that allows the patients to be cured without needing any further sequential interventions.

Adult↗
PubMed1997

The Conventional Management of Common Bile Duct Stones Before Laparoscopic Cholecystectomy.

The management of common bile duct stones traditionally required laparotomy for extraction. Recent advances have occurred in radiologic, endoscopic, and surgical techniques to broaden our options to treat patients with choledocholithiasis. The surgical approaches to the common duct stone have expanded to include open and laparoscopic techniques. Despite the increased surgical armamentarium, the principles of surgical management have not been altered. This chapter addresses the traditional surgical approaches to common bile duct stones.

Journal Article↗
PubMed2004

The role of 99mTc mebrofenin hepatobiliary scanning in predicting common bile duct stones in patients with gallstone disease.

BACKGROUND: A dilated common bile duct and/or elevated serum alkaline phosphatase, raises a suspicion of bile duct stone(s) in patients with gallstones. Cholangiography, either endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), is the best method for diagnosing bile duct stones. ERCP has the disadvantage of being invasive, and there is a risk of complications; while MRCP is costly and is not widely available. AIM: The objective of the present study was to evaluate the role of hepatobiliary nuclear scanning in diagnosing bile duct stones. METHODS: Twenty-five patients with suspected common bile duct (CBD) stones underwent hepatobiliary scintigraphy. The results of scintigraphy were compared with cholangiograms obtained by ERCP in 11 patients and MRCP in 14 patients, considering MRCP/ERCP as the 'gold standard'. RESULTS: Scintigraphy showed features suggestive of CBD stones in 11 of the 25 patients. The results of ERCP/MRCP confirmed that eight of them had stones. Scintigraphy showed no features of CBD stones in the remaining 14 patients. ERCP/MRCP showed CBD stones in two of these 14 patients. Thus, scintigraphy had a sensitivity of 80% and a specificity of 80%. CONCLUSION: We conclude that scintigraphy has good sensitivity and specificity in predicting CBD stones in patients with gallstone disease and a dilated CBD.

Adult↗
PubMed1985

The early diagnosis of common bile duct obstruction using cholescintigraphy.

The technetium Tc 99m-labeled iminodiacetic acid cholescintigram is an extremely accurate examination for detecting early obstruction of the common bile duct in acutely ill patients suspected of having acute cholecystitis or possible obstruction days to years after cholecystectomy. The examination accurately detected common bile duct obstruction in 63 of 65 patients in these two diagnostic categories (positive predictive value, 96.9%). Sonographic evaluations in 43 of these patients failed to reveal ductal dilatation or other abnormality in 26 cases (false-negative rate, 63.4%), and was nondiagnostic because of overlying bowel gas in two cases. The success of the radionuclide examination is attributed to its ability to detect functional impedance to bile flow hours to days before anatomic ductal dilatation occurs, and occasionally even before the alkaline phosphatase level and other liver chemistry values suggest the presence of an obstruction.

Bile Duct Neoplasms↗
PubMed1994

Evaluation of fentanyl and sufentanil on the diameter of the common bile duct by ultrasonography in man: a double blind, placebo controlled study.

Narcotic mu-agonists have been shown to increase the common bile duct pressure. With a recently introduced non-invasive ultrasonographic technique, we have demonstrated that morphine caused constriction of the common bile duct. We have now investigated the effect of highly potent, widely used mu-agonists, fentanyl and sufentanil on the diameter of the common bile duct using this technique in a double-blind, randomized study in 17 patients undergoing cholecystectomy. After premedication with midazolam and glycopyrrolate, anesthesia was induced by midazolam, 50 micrograms.kg-1 and thiopental, 3.0-5.0 mg.kg-1. Tracheal intubation was facilitated by succinyl-choline, 1.0 mg.kg-1 and muscle relaxation maintained with vecuronium. Anesthesia was maintained with enflurane or isoflurane and nitrous oxide in oxygen. The diameter of the common bile duct was determined before and at 4 and 8 minutes after the administration of the study drugs. One way analysis of variance and paired t-test were used for statistical analysis. P < 0.05 was considered significant. No significant change in common bile duct diameter was observed after i.v. placebo, nor were there any significant changes after fentanyl or sufentanil administration. Since the baseline common bile duct diameters were not significantly different among the three groups, fentanyl or sufentanil in the doses used had no more effect than a placebo on common bile duct diameter. It is concluded that fentanyl and sufentanil caused no effect on the common bile duct, therefore, these mu-agonists seem to be safe in patients in whom spasm of the common bile ducts should be avoided.

Adult↗