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PubMed1982

The use of a rigid choledochoscope in exploration of the common bile duct.

In 62 consecutive explorations of the common bile duct during a 2-year period, a Storz rigid choledochoscope was used to visualize the lumen of the duct before its closure over a T tube. All patients had radiological abnormalities on cholangiography: 45 had stones and 17 apparent strictures. In those with stones, the instrument was introduced after apparent removal of the stones to confirm the completeness of the manoeuvre. This examination showed that 11 patients (25 per cent) still had stones present and needed further manipulation. When the duct was seen to be clear, a T tube was inserted and the validity of the choledochoscopic findings checked by postoperative T-tube cholangiography. This confirmed the visual accuracy in all but one patient, an accuracy of 98 per cent. Of the 17 patients explored for other radiological abnormalities, choledochoscopy correctly determined the aetiology or excluded abnormalities in all cases. No complications of the procedure were encountered.

Cholangiography↗

PubMed1985

The variable appearance of distal common bile duct stenosis in chronic pancreatitis.

Cholangiograms of 15 patients with stenosis of distal portion of common bile duct due to chronic alcoholic pancreatitis were critically evaluated for stricture shape, length, and maximal diameter of the common bile duct. In these cholangiograms, different shapes of strictured segments were present, including the smooth tapering variety in eight, "funnel shape" in three, and "rat tail," "bent knee," "hourglass," and complete obstruction in one case each. The length of strictured segment ranged from 16 to 57 mm with a mean (+/- S.E.) of 40.7 +/- 4.1 mm. The mean (+/- S.E.) maximal diameter of the dilated portion of common bile duct was 18.9 +/- 1.3 mm with a range of 13-28 mm. There is a wide variety in the shape and length of the stenotic segments of the distal common bile duct in chronic alcoholic pancreatitis. Moreover, a particular radiologic configuration of common bile duct stricture is not helpful in predicting the nature of the underlying process in this group of patients.

Alcoholism↗

PubMed1986

Primary malignant melanoma of the gallbladder, metastatic to the common bile duct.

A primary malignant melanoma of the gallbladder, metastatic to the common bile duct, is reported. Both tumor sites were first visualized by abdominal sonography. The presence of the common bile duct metastasis was confirmed by endoscopic retrograde cholangiopancreatography. Histologic evidence is presented that the primary tumor did arise in the gallbladder and that the metastasis to the common bile duct most likely occurred as a consequence of mucosal implants from tumor cells that were shed in the bile.

Bile Duct Neoplasms↗

PubMed1992

[Benign papillomatosis of Wirsung's duct associated with adenomyoma of the distal common bile duct].

We report the case of a 42 year-old man, with a history of alcohol and tobacco abuse, who was referred for suspicion of carcinoma of the head of pancreas. Pancreatoduodenectomy was performed. Histological study demonstrated obstructive benign adenomyoma of the distal common bile duct associated with villous papillomatosis of the pancreatic ducts and patchy lesions of chronic pancreatitis. Two years later, the patient was completely asymptomatic, but the risk of malignant transformation of villous papillomatosis requires periodic examination of the remaining pancreas and biliary tract.

Adult↗

PubMed1989

The ultrasonographic "common channel" sign: a characteristic feature of malignant obstruction of the lower end of common bile duct.

We describe an ultrasonographic "common channel" sign as the characteristic sonographic feature of malignant distal common bile duct (CBD) obstruction. Of 24 patients with obstructive jaundice due to distal CBD obstruction (pancreatic carcinoma 8, periampullary cancer 5, choledocholethiasis 10, CBD stricture due to pancreatitis 1) in whom the final diagnosis was proven at laparotomy, ultrasonography revealed 11 patients to have a thin-walled distended gallbladder continuous with a dilated CBD, which was termed the "common channel" sign. In all 11 patients, the cause of obstruction of the lower end of CBD proved to be malignant (pancreatic carcinoma 6, periampullary 5). In contrast, only 2 of the other 13 patients with obstructive jaundice with distal CBD obstruction, but without the "common channel" sign, had a malignant lesion at the lower end of CBD. The positive and the negative predictive values of the common channel sign were 100% and 85%, respectively. Thus, the ultrasonographic common channel sign is a reliable and characteristic feature of distal CBD obstruction due to malignant pathology.

Cholestasis↗

PubMed1976

A clinical and anatomical study of anomalous terminations of the common bile duct into the duodenum.

Termination of the common bile duct into the duodenum was studied in 1000 patients by operative cholangiograms obtained from 5 different San Francisco Bay Area hospitals. The results indicate the strong probability that the duodenal biliary papilla is anomalously placed in at least 13% of the 1000 patients studied. Comments relative to the importance of this fact to surgeons and radiologists are made, and suggestion of a possible causative factor for the anomalies is proposed.

Ampulla of Vater↗

PubMed1998

Diagnosis and treatment of common bile duct stones (CBDS). Results of a consensus development conference.

BACKGROUND: Common bile duct stones (CBDS) are a frequent problem (10-15%) in patients with symptomatic cholecystolithiasis. Over the last decade, new diagnostic and surgical techniques have expanded the options for their management. This report of the Consensus Development Conference is intended to summarize the current state of the art, including principal guidelines and an extensive review of the literature. METHODS: An international panel of 12 experts met under the auspices of the European Association of Endoscopic Surgery (EAES) to investigate the diagnostic and therapeutic alternatives for gallstone disease. Prior to the conference, all the experts were asked to submit their arguments in the form of published results. All papers received were weighted according to their scientific quality and relevance. The preconsensus document compiled out of this correspondence was altered following a discussion of the external evidence made available by the panel members and presented at the public conference session. The personal experiences of the participants and other aspects of individualized therapy were also considered. RESULTS: Our panel of experts agreed that the presence of common bile duct stones should be investigated in all patients with symptomatic cholecystolithiasis. Based on preoperative noninvasive diagnostics, either endoscopic retrograde cholangiopancreaticography (ERCP) or intraoperative cholangiography should be employed for detecting CBDS. Eight of the 12 panelists recommended treating any diagnosed CBDS. For patients with no other extenuating circumstances, several treatment options exist. Stones can be extracted during ERCP, or either before or (in exceptional cases) after laparoscopic or open surgery. Bile duct clearance should always be combined with cholecystectomy. Evidence for further special aspects of CBDS treatment is equivocal and drawn from nonrandomized trials only. CONCLUSIONS: The management of common bile duct stones is currently undergoing some major changes. Many diagnostic and therapeutic strategies need further study.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed1993

Recovery of pressor response to norepinephrine following relief of the obstructed common bile duct in the rat.

Jaundice caused by common bile duct (CBD) obstruction is associated with a blunted pressor response to norepinephrine (NE). We studied the rate and extent of recovery of the pressor response in the rat following relief of the obstruction. Three groups of male Wistar rats underwent CBD ligation. In the first and second group blood pressure measurements were obtained at 72 and 144 h after CBD ligation, respectively. In the third group pressure measurements were recorded 72 h after the relief of a 72-h obstruction. A fourth group served as control, and measurements were obtained 72 h after a sham operation. In all four groups measurements included basal blood pressure and pressure change following escalating doses of NE, ranging from 0.5 to 10 micrograms/kg. Basal blood pressure was similar in all four groups. In the control group the change of blood pressure was 23.4% +/- 6.7% in response to the lowest dose of NE, and 83.5% +/- 24.9% in response to the highest dose. A blunted pressor response to NE was recorded in all three groups with CBD obstruction. The duration of CBD ligation (72 or 144 h) did not affect this blunded response. Re-establishment of bile flow for 72 h made only a slight improvement in the response to NE. Obstruction of the CBD was associated with hyperbilirubinemia which disappeared following the re-anastomosis of the CBD to the duodenum. This most significant decrease in serum bilirubin was not associated with a similar improvement in pressor response to NE. We conclude that in the rat CBD obstruction is associated with a blunted pressor response to NE, that relief of CBD obstruction for 72 h is insufficient to abolish this response, and that there is no full correlation between serum bilirubin and pressor response.

Animals↗

PubMed1992

Successful treatment of an impacted common bile duct stone with intraoperative choledochoscopic electrohydraulic lithotripsy.

An impacted distal common bile duct stone which was encountered during supraduodenal common bile duct exploration could not be retrieved using stone forceps, a basket, normal saline flushing or a Fogarty catheter. Using intraoperative choledochoscopic electrohydraulic lithotripsy the stone was fragmented and successfully removed with a basket and normal saline flushing. The patient was well after a follow-up period of 18 months.

Endoscopy, Digestive System↗

PubMed1993

[Primary stones of the common bile duct].

Primary stones can probably form, although rarely, in the common bile duct. The authors report a series of six cases which they considered as primary common duct stone disease and, in order to get more precise information on this problem, they review the literature on the subject. This disease would be caused by the presence of a lithogenic bile which, with a chronic obstruction of the Vater's ampulla, could let lithiasic particles accumulate in the common bile duct. On the basis of this hypothesis and in order to perform a correct procedure that allows easy drainage of the bile to the intestine to the chronic use of litholytic drugs.

Adult↗

PubMed1995

Common bile duct in children: sonographic dimensions.

PURPOSE: To determine the normal caliber and rate of growth of the extrahepatic biliary ducts in the pediatric population. MATERIALS AND METHODS: The diameter of the common bile duct was measured with sonography in 173 children aged 1 day to 13 years (mean, 6.0 years; median, 5.0 years) who were examined for reasons other than hepatic or biliary tract disease. Results were subjected to regression analysis and compared with similar measurements of the extrahepatic portal vein and hepatic artery. The size of the gallbladder was subjectively estimated as distended, moderately full, and contracted. Differences in the diameter of the common bile duct in these three groups were evaluated with the Mann-Whitney U test. RESULTS: The average diameter of the common bile duct in this population was 1.27 mm +/- 0.67 (< 3.3 mm in all patients and < 1.2 mm in children aged 3 months or less). The slope of the curve describing the growth of the common bile duct was relatively flat, similar to that of the hepatic artery and half that of the portal vein. There was a significant difference in the diameter of the common bile duct between patients with distended gallbladders and those with contracted gallbladder (P = .02). CONCLUSION: The pediatric common bile duct is significantly smaller than adult norms; it is a distensible structure responsive to fluctuations in prandial bile flow.

Aging↗

PubMed2003

Outcomes of emergency common bile duct exploration: impact of preoperative endoscopic decompression.

BACKGROUND: Emergency common bile duct exploration (CBDE) is still required in patients acutely ill with complicated biliary tract stone disease when endoscopic decompression fails to reverse their condition. This study looks at the clinical profile of patients requiring emergency CBDE and examines the various factors influencing the postoperative outcome. METHODS: Clinical records of patients with emergency CBDE in Singapore General Hospital from January 1991 to December 1998 were reviewed. Factors influencing postoperative outcomes, for example, pre-existing medical problems, hepatic parameters, the impact of endoscopic procedures (if any) and indications for surgery, were correlated with postoperative morbidity and 30-day mortality. RESULTS: The records of 100 patients were available for review. Major indications for emergency CBDE were cholangitis (51%) and intraoperative findings of common bile duct obstruction during emergency laparotomy (23%). Six patients had emergency CBDE because of iatrogenic complication of attempted therapeutic endoscopic retrograde cholangiopancreaticography (ERCP) for biliary stones. Overall mortality was 14.0% and 8.0% had retained stones. Mortality was significantly influenced by age, prior biliary disease, preoperative endoscopic biliary decompression in acute cholangitis (33.3%vs 9.4%, P = 0.035) and endoscopic complications. CONCLUSIONS: Among patients requiring emergency CBDE, uncomplicated preoperative endoscopic biliary decompression benefits patients with acute cholangitis.

Adult↗

PubMed1977

Ultrastructure of botryoid sarcoma of the common bile duct.

A case of botryoid sarcoma of the common bile duct in a 4-year-old girl was reported. Electron microscopic examination disclosed that the neoplasm consisted of three types of cells: polygonal, elongated, and small cells. The former two contained moderate to large amounts of poorly developed myofibriles in the cytoplasm with occasional A, I and Z-bands. The small cells contained mitochondria and dilated rough endoplasmic reticulum but few myofilaments. Deposits of glycogen granules were constant components of the neoplastic cells. Mitosis was striking in the small cells. Abnormal multilaminar endoplasmic reticulum was observed in the small cells in the mitotic stage.

Bile Duct Neoplasms↗

PubMed1992

Flushing technique in the management of retained common bile duct stones with a T tube in situ.

Over a 12-year-period, 6046 cholecystectomies and 918 common bile duct explorations were undertaken with 697 stone-positive choledochotomies (76 per cent). Forty patients (5.7 per cent) had retained common bile duct stones with a T tube in situ. Twenty-eight patients underwent flushing of the common bile duct with a continuous infusion of heparinized saline solution with parenteral aminophylline to induce relaxation of the sphincter of Oddi. Complete duct clearance was achieved in 17 patients; infusion was stopped in four patients and no deaths occurred. The use of percutaneous stone extraction (Burhenne's technique), gave an overall successful common bile duct clearance rate of 86 per cent. The flushing technique represents the first step in the non-operative management of retained common bile duct stones in patients with a T tube in place. It is a safe and effective method for use in the early postoperative period with a prolongation of hospital stay of not more than 1 week.

Adult↗

PubMed1999

Ultrasonographic evaluation of the common bile duct in biliary acute pancreatitis patients: comparison with endoscopic retrograde cholangiopancreatography.

We compared the morphologic findings of the common bile duct by ultrasonography and endoscopic retrograde cholangiopancreatography in patients with biliary acute pancreatitis. Forty-five patients were studied. The diagnosis of acute pancreatitis was based on the presence of characteristic abdominal pain associated with an elevation of serum amylase and lipase concentrations. All patients underwent ultrasonography and subsequently urgent endoscopic retrograde cholangiopancreatography and eventually endoscopic sphincterotomy. Ultrasonography showed gallstones in 33 patients and sludge of the gallbladder in seven patients. In the common bile duct, lithiasis was found in two patients and sludge in 25. Endoscopic retrograde cholangiopancreatography showed choledocolithiasis in eight patients and sludge of the common bile duct in 32. In 27 cases (60%) concordance occurred between ultrasonographic and endoscopic retrograde cholangiopancreatographic detection of lithiasis or sludge of the common bile duct. The average diameter of the common bile duct determined by sonography was significantly smaller (P < 0.001) than that obtained by endoscopic retrograde cholangiopancreatography. The evaluation of this parameter indicated that a good correlation existed between the values obtained with the two techniques (r(s) = 0.765, P < 0.001). Both ultrasonography and endoscopic retrograde cholangiopancreatography can provide reliable measurements of the common bile duct diameter. Ultrasonography is the technique of choice in the initial investigation of patients with biliary acute pancreatitis.

Acute Disease↗

PubMed1997

[The combined endoscopic surgery of gallstones complicated by diseases of the terminal common bile duct].

The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskiĭ, in 13 cases--after Kehr, in 3--after Vishnevskiĭ. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.

Adolescent↗

PubMed1986

Double common bile duct. Case report and review.

A case of an accessory common bile duct inserting near or on the minor duodenal papilla revealed by ERCP. The patient had no symptoms related to the anomaly. A review of the literature revealed 23 cases from the last 500 years. The accessory bile ducts opened into the gastrointestinal tract at different distances from the major duodenal papilla. In certain animals a double common bile duct is normal. The anomalies are assumed to be caused by random subdivisioning of the hepatic diverticulum early in organogenesis.

Common Bile Duct↗

PubMed1981

Distal common bile duct obstruction: an experimental study in monkeys.

Biliary obstruction was accomplished by surgically occluding the distal common bile duct in seven rhesus monkeys. Ultrasound scanning at 24-hour intervals showed that dilation of the common bile duct and gallbladder occurred before elevation of bilirubin or development of jaundice. The bile ducts expanded centrifugally from the obstructing point, with dilation of the intrahepatic ducts occurring several days after the onset of obstruction. After surgical release of the obstruction, the biliary ducts contracted centripetally, with the common bile duct requiring 30-50 days to return to normal size.

Animals↗