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PubMed1994

[Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy].

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.

Adolescent↗
PubMed1987

Stricture of the common bile duct from chronic pancreatitis.

Early diagnosis and treatment of stricture of the common bile duct from chronic pancreatitis are essential as the life-threatening complications of biliary cirrhosis and acute cholangitis can occur even in the absence of clinical jaundice. In a series of 40 patients with longstanding chronic pancreatitis and stricture of the common bile duct, findings included chronic pain in 26 patients, jaundice in 17 patients, secondary biliary cirrhosis in six patients and acute cholangitis in six patients. Persistent elevation of the alkaline phosphatase level was the most sensitive laboratory indicator of occult obstruction of the biliary tract. The diagnostic long tapered stenosis of the distal common bile duct was delineated by percutaneous transhepatic cholangiography in 21 of 22 patients and endoscopic retrograde cholangiopancreatography in eight of 11 patients. Operative decompression of the biliary tract included 32 biliary-enteric bypasses, three sphincteroplasty procedures and three emergency tube drainages. There was one postoperative death and seven other patients had postoperative complications. Sphincteroplasty failed to relieve the obstruction in two patients and two patients with biliary-enteric bypass had late anastomotic strictures develop which required reoperation. Only seven patients were free of pain at follow-up study which ranged from 0.5 to 15.0 years. Clinical suspicion based upon persistent hyperaklalinphosphatemia, diagnosis by cholangiography and decompression of the biliary tract by choledochoenterostomy can reliably avert the lethal complications of stricture of the common bile duct caused by chronic pancreatitis.

Adult↗
PubMed2005

Preduodenal position of the common bile duct associated with annular pancreas: case report and literature review.

A preduodenal position of the common bile duct (PDCBD) is a very rare embryological anomaly. Our patient, a 1-day-old boy, was diagnosed to have PDCBD, annular pancreas, duodenal stenosis, intestinal malrotation and a ventricular septal defect associated with 21 trisomy. Initially the fetal diagnosis was duodenal atresia. The diagnosis of duodenal stenosis was made on birth, and he underwent an emergency operation 24 hours later. The PDCBD was discovered during the duodenoduodenostomy procedure. While a transversal incision was being made for the ventral wall in the distended proximal duodenum, the common bile duct was accidentally cut. We found the common bile duct to run into the ventral side of the duodenal wall. Subsequently, the common bile duct was repaired with a stent using microscopic techniques. The case is being reported because of the rarity of this condition and also to stress the importance of accurately recognizing this anomaly when treating the concomitant diseases, particularly when surgical implications are involved.

Abnormalities, Multiple↗
PubMed1992

Laparoscopic transcystic common bile duct exploration.

This study reviews the results of transcystic common bile duct exploration (CBDE) for unsuspected stones found during laparoscopic cholecystectomy by a single surgeon in 150 consecutive patients. Fluoroscopic cholangiography was attempted in all but four patients. If the cholangiogram appeared to show common bile duct (CBD) stones, a 5 Fr, 8-mm ureteral stone basket was passed through the cystic duct into the duodenum, opened, and trolled through the CBD. Routine cholangiography was successful in 131 of 144 attempts (90%). An indication for CBDE was found by cholangiogram in seven patients (5%). Two cholangiograms were falsely positive. Stones were removed in five patients. Completion cholangiograms were normal in all patients. One patient developed mild pancreatitis but was discharged 2 days after laparoscopic cholecystectomy. The remainder were discharged on postoperative day 1. One patient was readmitted on postoperative day 2, possibly having passed a retained stone. Fluoroscopic CBDE was successful in clearing the CBD in all patients in this small series and deserves further evaluation.

Cholangiography↗
PubMed2002

Absence of the common bile duct and junction of the cystic duct with the left hepatic duct in a patient with chronic portal vein thrombosis.

A50-year-old male patient was admitted to the hospital because of fatigue and a palpable abdominal mass. The diagnoses of chronic renal failure and portal vein thrombosis were established by specific investigations. Incidentally, junction of the cystic duct with the left hepatic duct and absence of the common bile duct were found during endoscopic retrograde cholangiopancreatography study. To the authors' knowledge, this is the first reported case of an absence of the common bile duct and junction of the cystic duct with the left hepatic duct in a patient with chronic portal vein thrombosis. Such lesions may cause unexpected complications during biliary surgery.

Chronic Disease↗
PubMed2002

All-comers policy for laparoscopic exploration of the common bile duct.

BACKGROUND: Laparoscopic exploration of the common bile duct is associated with substantial variation in results suggesting that different patient populations are being reported. This report observes the results in a defined population and on an intention-to-treat basis. METHODS: All patients with suspected bile duct stones who were fit for surgery from April 1994 were offered laparoscopic bile duct exploration. There were 224 patients of mean age 56 years, of whom 174 were women. Endoscopic sphincterotomy was used in 149 patients deemed unfit for surgery. All data were recorded prospectively and checked at the time of discharge. Patients were followed up after 6 months and beyond after the operation. RESULTS: Stones were removed transcystically in 56 patients, transductally in 158 and by flushing in nine. The duct clearance rate was 96 per cent overall, 98 per cent for transcystic and 94 per cent for transductal exploration. Intracorporeal lithotripsy safely reduced the failure rate of exploration from seven of the first 28 to four of the subsequent 196 procedures. Biliary complications occurred in 16 per cent of procedures in which a T tube was used but only 4 per cent if the duct was closed by suturing. Conversion to open operation for severe gallbladder inflammation was necessary in 6 per cent of patients. There were no deaths, bile duct injuries or pancreatitis but complications occurred in 19 per cent, associated with use of T tubes and advancing age. Laparoscopic duct exploration succeeded in seven patients after previous cholecystectomy. CONCLUSION: Laparoscopic bile duct exploration is effective and safe when used for all patients. For young and fit patients it should replace endoscopic sphincterotomy.

Adolescent↗
PubMed1992

Endoscopic laser lithotripsy with an automatic stone recognition system for basket impaction in the common bile duct.

In a patient with a common bile duct stone 28 mm in diameter, the traction wires of two basket catheters fractured during endoscopic mechanical lithotripsy. Disintegration of the concrement and removal of the impacted baskets failed even after extracorporeal application of 8,000 shockwaves. Pulsed dye laser lithotripsy was carried out via a 250 microns fiber which was advanced to the stone through a 6 French ERCP guiding catheter. Lithotripsy could be safely performed under fluoroscopic control since the laser used provides an automatic cut-out system upon tissue contact. 3,600 of 11,800 applied pulses were emitted with the total power setting and complete disintegration of the calculus was achieved. The baskets and the fragments could be removed endoscopically in the same session. Laser lithotripsy with a stone recognition system would seem to improve the applicability and safety of intracorporeal lithotripsy even when performed without direct visual guidance.

Aged↗
PubMed1981

Carcinoid tumor of the common bile duct.

The fifth case of a common bile duct carcinoid tumor is reported. The importance of endoscopic retrograde cholangiography on the one hand and specialized staining on the other for diagnosis is emphasized. The slow growing nature of these tumors favors extensive surgery whenever possible.

Adult↗
PubMedDate not supplied

[Slip of the T tube within the common bile duct--a little known complication of the T tube drainage].

Complications related to the T tube drainage of the common bile duct are not uncommon. Some, like dislocations of the T tube out of the common bile duct, could be very serious, particularly if developed during the first few days after surgery, when the abdominal drain in the subhepatic space had been already removed.Then, an emergency reoperation might be necessary. The slip of the T tube upwards or downwards inside the common bile duct is not so rare. Fortunately, it is less dangerous and can usually be resolved without reoperation. It takes place several days after surgery, followed by the right subcostal pain, occasionally with temperature, rise of the bilirubin and with decrease or complete cessation of the bile drainage through the T tube. The diagnosis can be made only on the basis of T tube cholangiography. The re-establishment of the proper T tube position must be done under X-ray visualization. Seven cases of the T tube slip within the common bile duct, its clinical presentation, diagnosis and method of repositioning were presented. Possible mechanism of complication was described. As far as we know, the complications have not been described by other authors.

Adult↗
PubMed2000

[Common bile duct stones and their complications].

At the time of cholecystectomy for symptomatic cholelithiasis, 7-20% of patients have common bile duct stones. Nearly one third of them are asymptomatic. Routine cholangiography during cholecystectomy allows the diagnosis and treatment of common bile duct stones during the same operation. Selective indication for the diagnosis of common bile duct stones based on the positive predictive value of indicators limits treatment to symptomatic cases. No single indicator is however completely accurate in predicting common bile duct stones and the natural history of asymptomatic cases is uncertain. Endoscopic stone extraction preceding cholecystectomy is not superior to one-stage surgical treatment. Diagnosis and treatment of common bile duct stones are feasible laparoscopically. Complications of common bile duct stones are cholangitis and acute pancreatitis; if severe, they require specific therapeutic approaches.

Cholangitis↗
PubMed1999

Brain metastases from adenoendocrine carcinoma of the common bile duct: a case report.

A 68-year-old man with metastatic brain tumors from adenoendocrine carcinoma of the common bile duct is reported. A common bile duct tumor and a metastatic liver tumor had been resected 6 years and 3 years prior to admission, respectively. Microscopically they showed two components; moderately differentiated tubular adenocarcinoma and neuroendocrine carcinoma. He presented with headache and vomiting and MRI revealed two metastatic brain tumors. They were successfully resected and radiotherapy was carried out. Histological diagnosis of the metastatic brain tumors was neuroendocrine carcinoma, but carbohydrate antigen (CA)-19-9 and carcinoembryonic antigen (CEA)-immunoreactive cells were observed without glandular pattern. Immunohistochemically serotonin and pancreatic polypeptide were detected, but somatostatin was not. As the endocrine cells demonstrated in the normal extrahepatic bile ducts are only somatostatin-containing D cells, these cells are considered to originate as part of a metaplastic process. To our knowledge, this represents the second case of adenoendocrine carcinoma of the common bile duct.

Adenocarcinoma↗
PubMed1981

[Congenital dilatation of the common bile duct in which choledochal duct flows into Wirsung (author's transl)].

In a two year old girl, the authors observed a case of common bile duct dilatation, with jaundice and chronic pancreatitis, in which the common bile duct enters the Wirsung. An Y choledochojejunostomy was performed. The patient was easy recovered. As comment, the authors present a synthesis of knowledges of this malformation, very well studied in Japan, where it is less uncommon. We must try to find it by retrograd catheterism with duodenoscopic or surgical exploration. The systematic research of this low choledochal malformation must demonstrate if most part of congenital choledochal dilations were so explain as in japaneses publications or it is an autonomous illness and an etiology, among others, of congenital common bile duct dilatations.

Biliary Tract↗
PubMed1995

[Extracorporeal shockwave lithotripsy in the treatment of common bile duct calculi].

Fifteen patients with stones in the common bile duct, in whom treatment with endoscopic papillotomy and stone-extraction had been unsuccessful were treated with extracorporeal shockwave lithotripsy. Nine patients were stone-free after one or two sessions, and two patients after further endoscopic treatment. One patient achieved partial clearance and palliation. One patient had a choledochoduodenostomy performed due to ineffectiveness of the shockwave lithotripsy. Two patients, who were thought to have a stone, turned out to have neoplasma in the common bile duct. Complications were frequent but temporary and needed no treatment. We conclude that extracorporeal shockwave lithotripsy is a valuable and safe alternative in those cases where conventional endoscopic treatment has failed, and should be considered before operation, especially to old for high-risk patients.

Adult↗
PubMed1980

Avulsion of the common bile duct by blunt trauma.

Two cases of common bile duct avulsion by blunt trauma are presented. These injuries are rare and the treatment is controversial, but the better repairs are choledochoduodenostomy and choledochojejunostomy. Primary repair is not indicated.

Aged↗
PubMed1993

The pharmacological reactivity of an isolated circular smooth muscle strip of the rabbit common bile duct.

An in vitro isolated spiral strip of rabbit common bile duct was prepared and tested for its pharmacological reactivity. It was found to be a suitable preparation with a long lasting and stable sensitivity when exposed to various drugs. The pharmacological reactivity proved to vary along the common bile duct; the different portions (sphincteric, median and hepatic) displayed different activities to the various agonists and antagonists. The following receptors were identified in different sections: alpha and beta-adrenergic, muscarinic cholinergic, bradykinin, H1 and prostaglandin F2 alpha. Only the sphinteric portion exhibited rhythmic peristalsis; the other portions produced merely small, irregular spontaneous contractions.

Adrenergic alpha-Agonists↗
PubMed1988

Evaluation of common bile duct stenosis in chronic pancreatitis using cholescintigraphy.

To evaluate a stenotic change of the common bile duct (CBD) in chronic pancreatitis (CP), cholescintigraphy with 99mTc-N-pyridoxyl-5-methyltryptophan (PMT) was performed in 28 patients with CP and 15 normal subjects. The patients were divided into 3 groups on the basis of their endoscopic retrograde cholangiopancreatography (ERCP) findings: minimal CP (MIP; n = 14), moderate CP (MOP; n = 10), and advanced CP (ADP; n = 4). After intravenous injection of 5 mCi 99mTc-PMT, digital images were obtained and time activity curves of the ROIs (liver, hepatic duct, gallbladder, and duodenum) were generated. No radioactivity was seen in the duodenum within 1 hour in 12 of 28 (43%) with CP and 2 of 15 (13%) normals. Reflux to the hepatic duct after cerulein injection was found in 6 of 20 (30%) examined patients with CP and more frequently in ADP, whereas there was no reflux in MIP and normals. When the finding of reflux in cholescintigraphy was interpreted as positive for CBD stenosis, the sensitivity, specificity, and accuracy were 100%, 88%, and 90%, respectively. We conclude that reflux is a reliable scintigraphic finding in detecting CBD stenosis.

Adult↗
PubMedDate not supplied

Histopathology of the common bile duct in choledocholithiasis.

The histology of the common bile duct was studied in 45 patients with choledocholithiasis and/or papillitis and compared with a control group of ten cadavers without hepatic or biliary disease. Choledochitis was diagnosed in 44. Only one patient presented a histologically normal duct. The inflammatory process was characterized by proliferation of connective tissue and loss of elastic fibers, cellular infiltration of lymphocytes and polymorphonuclear leukocytes, and atrophic dilatation or hyperplasic glandular changes. Choledochitis was divided in two types: chronic and acute-chronic, and according to the intensity of the inflammatory process was also classified in slight, moderate or severe. No correlation was found between choledocholithiasis and/or papillitis and type and intensity of choledochitis.

Adult↗