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PubMed1994

Common bile duct involvement in chronic pancreatitis.

The features of the common bile duct (CBD) have been checked in 78 chronic pancreatitis patients in order to evaluate the frequency of extrahepatic bile duct changes, possible associated factors and effects on the outcome of the disease. Fifty of the 78 patients had an intrapancreatic stricture of the CBD and 24 of them also showed an upstream dilatation. No relationship was found between the features of the CBD and the severity of the pancreatitis, the presence of calcifications and the length of the disease. Humoral signs of impaired bile flow were found in 20 subjects, 19 of whom had an intra-pancreatic stricture of the CBD. Sixteen of these 19 patients also showed an upstream dilatation and five of them had overt jaundice. A surgical intervention on the biliary tree was carried out in 7 patients, all with a biliary stricture. Six of them also had a CBD dilatation over the stricture (p < 0.02 versus patients without CBD stricture). In conclusion CBD involvement during chronic pancreatitis is quite frequent but poorly predictable and should be checked in all patients with humoral cholestasis in order to prevent further complications.

Adolescent↗
PubMed1995

Infusion of bile from methylene dianiline-treated rats into the common bile duct injures biliary epithelial cells of recipient rats.

Methylene dianiline (4,4'-diaminodiphenylmethane, DAPM) rapidly causes cholestasis and injury to biliary epithelial cells (BEC) in the liver and common bile duct of rats. Our objective was to determine if the proximate toxicant(s) was present in bile. Bile from DAPM-treated or control rats was infused through the common bile duct of untreated rats via inflow and outflow cannulas for 4 h. Cholestasis, increases in serum constituents, and intrahepatic BEC injury in the livers of DAPM-treated donor rats at 4 h were comparable to previous studies (Kanz et al., Toxicol. Appl. Pharmacol. 117 (1992) 88-97). BEC injury in the common bile duct of rats receiving DAPM bile or control bile was assessed by point counting. Percent necrosis was > 28% in the common bile duct of rats receiving DAPM bile compared to < 5% in rats receiving control bile. These results indicate that bile is a major route of BEC exposure to DAPM proximate toxicant(s) and demonstrate the utility of a new method for investigating mechanisms of biliary toxicants.

Aniline Compounds↗
PubMedDate not supplied

Open common bile duct exploration--end of an epoch?

With the advent of laparoscopic cholecystectomy and the impending replacement of open common bile duct exploration, we have reviewed our ten year experience of conventional common bile duct exploration. Open cholecystectomy was performed in 1681 patients and the common bile duct was explored in 325 (19%). Following initial duct exploration, rigid choledo identified residual choledocholithiasis in 58 and periampullary neoplasia in 2 patients. Unexpected retained stones were identified in 3 patients (0.9%). In a further 4 patients, stones which could not be dislodged from the hepatic ducts were confirmed on 10 day T-tube cholangiogram--transduodenal sphincteroplasty had been performed at the time of original surgery in all four. The mortality was 1.9% overall and 1% during the last 5 years. Endoscopic exploration must compare favourably with these data for safe transition to less invasive techniques.

Adult↗
PubMedDate not supplied

Predicting the cause of common bile duct obstruction with sonographic data: analysis of binary variables.

A retrospective analysis of 71 patients with proven common bile duct obstruction, who had not undergone previous biliary surgery, was performed. To determine optimal criteria for differentiating stone from nonstone obstruction by ultrasonography, five sonographic signs were analyzed as binary variables. These signs are the demonstration of (1) common duct stones, (2) mass at the site of the common bile duct, (3) gallbladder stones, (4) gallbladder volume greater than a critical value, and (5) common duct diameter greater than a critical value. Maximum expected accuracy was 85% achieved by prediction based on a set of three variables: common duct stone, common duct mass, and gallbladder stones. This was not significantly better than the accuracy (82%) achieved by prediction on the basis of gallbladder stones alone. Three signs in combination, ie, demonstration of gallbladder stones, gallbladder volume less than 52 ml, and common duct diameter less than 14 mm, had predictive value equal to demonstration of a common duct stone as an indicator that common bile duct obstruction is the result of a stone.

Adolescent↗
PubMedDate not supplied

Strategies for the prevention of laparoscopic common bile duct injuries.

There have been many recent reports regarding the safety of laparoscopic cholecystectomy. Common bile duct injury is considered the most significant complication. Regional tertiary centers are reporting a dramatic increase in the number of referrals for management of injuries to the common bile duct following laparoscopic cholecystectomy [22]. The high incidence of injuries has been attributed to problems inherent to the laparoscopic technique or to such secondary factors as inexperience, inadequate instruction, insufficient caution, or patient selection. In response to these numerous reports, the New York State Department of Health has recently implemented credentialing and privileging guidelines for laparoscopic surgery [11]. The purpose of this review is to assimilate the current literature on when and why common bile duct injuries occur in order to present possible strategies for their prevention.

Cholecystectomy, Laparoscopic↗
PubMed1985

Common bile duct anastomosis using fibrin glue.

Transection of the common bile duct (CBD) secondary to iatrogenic or civilian trauma is a devastating injury associated with a high incidence of complications, especially biliary fistula and stricture formation. We evaluated the efficacy of Fibrin Sealant--a biologic adhesive containing highly concentrated human fibrinogen--in primary end-to-end anastomosis of the transected CBD in ten adult mongrel dogs. Postoperative T-tube stents in the CBD anastomosis and abdominal drainage were not used. Only two absorbable sutures were used for each CBD anastomosis. The dogs were reexplored postoperatively at intervals varying from one week to nine months; cholangiography was performed at postoperative intervals varying from one to six months. Examination of CBD specimens harvested one month or more after surgery revealed complete healing and no signs of previous injury. Histologic examination disclosed well-healed ductal tissue, without a significant inflammatory response. One dog had an anastomotic leak, and two had moderate narrowing of the CBD anastomosis. Our experience in experimental CBD anastomosis indicates that Fibrin Sealant helps seal biliary anastomoses against leakage; controls bleeding from cut edges of bile duct segments; has good systemic and local compatibility; may promote bile duct wound healing; and significantly reduces the number of sutures needed for primary repair, thereby decreasing the potential for anastomotic ischemia, mucosal damage, and biliary stricture formation.

Animals↗
PubMed1979

The development of the glands of the common bile duct.

The number of glands at a constant level within the wall of the common bile duct was measured in the foetus, infant, child and adult. The number of glandular acini increases from foetal life to reach a maximum within the 1st year of life. Thereafter it remains remarkably constant. This is in contrast to the lumen and wall of the common bile duct which only reaches adult proportions in adult life. Conversely, the density of acini within the wall of the common bile duct is at a peak in early foetal life and decreases progressively throughout infancy and childhood.

Adolescent↗
PubMed2003

Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy.

CONTEXT: Intraoperative cholangiography (IOC) may decrease the risk of common bile duct (CBD) injury during cholecystectomy by helping to avoid misidentification of the CBD. OBJECTIVE: To characterize the relationship of IOC use and CBD injury while controlling for patient and surgeon characteristics. DESIGN, SETTING, AND PATIENTS: Retrospective nationwide cohort analysis of Medicare patients undergoing cholecystectomy from January 1, 1992, to December 31, 1999. Patients were identified using Current Procedural Terminology codes from the Medicare Part B depository. Common bile duct injury was defined by a second surgical procedure to repair the CBD injury within 1 year of cholecystectomy. Surgeon demographic features were obtained from matching the Medicare Part B data to the American Medical Association Physician Masterfile database. MAIN OUTCOME MEASURE: Frequency of CBD injury in patients who did and did not have IOC performed during cholecystectomy, controlling for patient-level (age, sex, race, and case complexity) and surgeon-level (surgeon's age, sex, race, year of surgical procedure, case order, percentage of IOC use in prior surgical procedures, years in medical practice, board certification, and specialization) factors. RESULTS: The database search identified 1 570 361 cholecystectomies and 7911 CBD injuries (0.5%). Common bile duct injury was found in 2380 (0.39%) of 613 706 patients undergoing cholecystectomy with IOC and in 5531 (0.58%) of 956 655 patients undergoing cholecystectomy without IOC (unadjusted relative risk, 1.49; 95% confidence interval, 1.42-1.57). After controlling for patient-level factors and surgeon-level factors, the risk of injury was increased when IOC was not used (adjusted relative risk, 1.71; 95% confidence interval, 1.38-2.28). While surgeons performing IOCs routinely had a lower rate of CBD injuries than those who did not, this difference disappeared when IOC was not used. CONCLUSIONS: In this study of Medicare patients undergoing cholecystectomy in the 1990s, the risk of CBD injury was significantly higher when IOC was not used. Although IOCs may not prevent all CBD injuries, this study suggests that the routine use of IOC may decrease the rate of CBD injury.

Aged↗
PubMed1989

[Transduodenal papillosphincterotomy in the treatment of nontumorous lesions of the terminal portion of the common bile duct].

For benign stricture, obstruction of the major duodenal papilla (MDP) and terminal common bile duct in 130 patients with acute and chronic cholecystitis and its complications, the papillosphincterotomy was performed. Postoperative lethality was 3.8%. A good long-term result was noted in 84% of the patients, satisfactory--in 12%, bad--in 4%. There were no restenosis of MDP and recurrent choledocholithiasis.

Adult↗
PubMed1986

Unchanged size of a dilated common bile duct after a fatty meal: results and significance.

Sonographic measurement of common bile duct caliber alone is insufficient to ascertain the presence of obstruction. Fatty meal stimulation significantly improves diagnostic accuracy. An increase in caliber of a normal or slightly dilated common duct after the subject has ingested a fatty meal is a strong indicator of biliary obstruction, while a decrease in caliber indicates normal dynamics and virtually excludes obstruction. This study determines the significance of no change in the caliber of the dilated common bile duct of subjects who have eaten a fatty meal. Further imaging studies and clinical/laboratory follow-up of 31 patients showed that in 84% of the cases no obstruction was present. A dilated common duct that does not decrease in size after a fatty meal is not a specific indicator of obstruction. The use of invasive diagnostic procedures in these patients is not advised unless there is other evidence of biliary obstruction.

Adult↗
PubMed1986

Primary malignant melanoma of the common bile duct.

Biliary tract obstruction in a 30-year-old man was found to be caused by a malignant melanoma in the common bile duct. Melanin pigment was demonstrated by immunohistochemistry and electron microscopy. Extensive search for a primary malignant melanoma elsewhere was unsuccessful. No pigmented lesions had been removed previously. There were junctional changes in the mucosa of the common bile duct close to the tumor. The malignant melanoma in the common bile duct therefore is considered to be primary. Only one other case of primary malignant melanoma in the common bile duct has been described in the literature, whereas metastases to the major bile ducts in one autopsy study of malignant melanoma in the more common locations were found with a frequency of 6 per cent.

Adult↗
PubMed1998

Choledochoduodenostomy for common bile duct stones.

Among the techniques for dealing with common bile stones, choledochoduodenostomy (CDS) represents a useful alternative. This operation is indicated mainly in patients with recurrent stones, giant stones, or concomitant common bile stricture and duct stones. At the present time most of the patients undergoing CDS have been already undergone endoscopic retrograde cholangiography or ultrasonography to study the common bile duct and the cause of symptoms. The common bile duct diameter is of paramount importance when determining the feasibility of performing a CDS, the critical size being 1.2 cm. The most common operation is a side-to-side anastomosis employing absorbable sutures. Stomal patency is the most important factor for preventing classic complications such as cholangitis and sump syndrome. These complications are rare, being observed in only 5% of the patients. Long-term results of the operation show that it is a safe procedure that should be considered a good option in selected patients with choledocholithiasis.

Cholangitis↗
PubMed1981

Actinomycosis of the common bile duct presenting as chronic cholecystitis.

Actinomycosis of the common bile duct can masquerade as cholecystitis. This is the first report of a case. The bacteriologic and pathologic characteristics are described. This opportunistic saprophytic organism took advantage of 15 years of prednisone therapy for rheumatoid arthritis. The actinomycosis was successfully treated with tetracycline-deoxycycline for 6 weeks.

Actinomycosis↗
PubMed1975

Clinical and radiological features of aberrant insertion of the common bile duct.

Five examples of aberrant insertion of the common bile duct into a duodenal diverticulum are reported. One is thought to be the fifth published case diagnosed pre-operatively by simple radiological techniques. The association with biliary and pancreatic disease is emphasised, together with the possibility of surgical relief. The literature is reviewed and the radiological features discussed with a view to increasing the frequency of preoperative diagnosis.

Aged↗
PubMed1995

Developing a training model for laparoscopic common bile duct surgery.

Because of the paucity of adequate training models for laparoscopic common bile duct exploration, a live porcine training model was developed and evaluated. This model requires preliminary laparoscopic ligation of the distal bile duct 7-14 days prior to utilization. It aids the development of skills for laparoscopic common bile duct exploration and should enhance the subsequent performance of these procedures.

Animals↗
PubMed1992

Hyperplastic polyp of the common bile duct.

We describe a hyperplastic polyp of the common bile duct, found in a 45-yr-old Japanese woman. Endoscopic retrograde sphincterotomy and intraductal biopsy yielded a histological diagnosis of adenocarcinoma, preoperatively. However, final diagnosis after pancreatoduodenectomy proved to be hyperplasia. The wrong diagnosis seemed attributable to tortuosity of the specimens caused by the biopsy procedure and/or a lack of experience of pathologists due to the rarity of this condition. One should be aware of this entity in diagnosing polypoid lesions in the biliary tract.

Adenocarcinoma↗
PubMed2005

[Jaundice and chronic pancreatitis: common bile duct compression by pancreatic pseudocyst].

In chronic pancreatitis, obstructive jaundice solely due to common bile duct compression by a pancreatic pseudocyst is highly unusual. In most of these cases, the jaundice is due to fibrotic stricture of the intrapancreatic portion of the common bile duct. We report two cases of obstructive jaundice in chronic pancreatitis with pseudocyst. Operative findings and follow-up during the postoperative period demonstrated compression by the pseudocyst over the common bile duct as the only etiologic factor of the jaundice. We believe that intraoperative cholangiography should be performed after drainage of a pseudocyst to correctly assess the etiology of obstruction.

Adult↗