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PubMed1993

Complete transection of common bile duct due to blunt abdominal trauma: a case report and literature review.

A case of complete transection of the common bile duct due to abdominal blunt injury in a 49-year-old man is presented. The rarity of this injury and its initial presentation as a pancreatic pseudocyst warrant its description. This patient was diagnosed as having bile duct injury following ascites aspiration. Common bile duct transection was documented and a choledochostomy was done. However, bile leaked into the peritoneal cavity one week after the operation. A Roux-en-Y choledochojejunostomy was done successfully in a second operation. Delayed diagnosis is common in these kinds of injuries, but it should be considered when a patient has bile ascites, abdominal distention and jaundice after a blunt abdominal injury. A review of the literature, methods of diagnosis and the technique of surgical repair are described.

Cholangiography↗
PubMed1993

Common bile duct obstruction by free floating tumor.

UNLABELLED: Tumors usually spread by local invasion or by vascular or lymphatic metastases. We report six patients in whom tumor cells were shed into the common bile duct with resulting obstruction. The three men and three women had jaundice and upper abdominal discomfort. Jaundice was intermittent in four patients. Preoperative total serum bilirubin ranged from 2.5 to 16.1 mg/dl; alkaline phosphatase ranged from 221 to 605 IU/1. Ultrasound showed a dilated gallbladder [GB] in five patients with dilated intrahepatic ducts in three and stones in only one. ERCP showed a single filling defect in two of three patients and multiple defects in one. PTC showed multiple defects in one patient. At operation a thick gelatinous tissue fragment or clot was seen in the common bile duct of each patient. Frozen section identified tumor tissue in all. The source was GB carcinoma [2], GB adenomyoma [1], hepatic metastases of colon cancer [2] and common bile duct cancer [1]. Treatment consisted of pancreaticoduodenectomy [2], including one for GB cancer, left hepatic lobectomy [1], choledochoduodenostomy [1], common duct exploration with T-tube insertion [1] and cholecystectomy [1]. One patient with metastatic colon cancer and another with gallbladder cancer died within one year of operation. The other four are alive from 2 to 4 years later. CONCLUSION: Benign or malignant tumors within the hepatobiliary tree can shed tissue into the common bile duct which can cause biliary obstruction. Any tissue fragment found in the common bile duct should be evaluated by frozen section. Recognition of this mode of tumor spread is needed for appropriate therapy of the underlying benign or malignant tumor.

Adenocarcinoma↗
PubMed1985

Cystic dilation of the common bile duct.

Nineteen male and female patients with cystic dilation of the common bile duct were treated by total removal of the choledochal cyst and reconstruction using a Roux-en-Y end to side hepaticojejunostomy. Follow-up study was 18 years for some patients. Our data suggest that this disease is highly correlated with an anomalous pancreaticobiliary junction and its sequelae, and that previous treatment by internal drainage is not uniformly successful. After radical surgical treatment and reconstruction, no deaths occurred in any of the patients. All early complications were treated with success by conservative means. With the use of the criteria of Alonso-Lej, there was a clinically significant shift in the status of the choledochal cyst from type 2 before operation to type 1 after operation. Our long term experience with this group of patients leads us to recommend total excision of the choledochal cyst and end to side hepaticojejunostomy for treating patients with cystic dilation of the common bile duct.

Adolescent↗
PubMedDate not supplied

Biliary stricture due to mucosal hyperplasia of the common bile duct: a case report.

A 71-year-old man with a tumorous lesion of the common bile duct is presented. Although histological examination of tumor biopsy specimens taken at the time of duodenoscopy or percutaneous transhepatic choledochoscopy showed mucosal hyperplasia, cancer could not be ruled out; therefore, the patient underwent pancreatoduodenectomy. However, histology showed nodular mucosal hyperplasia and an ectopic pancreas adjacent to the papilla of Vater, which was suspected to have contributed to the development of the lesion by stimulating the mucosa of the papilla and the distal common bile duct.

Aged↗
PubMed2005

[A case of spontaneous perforation of the common bile duct associated with cholangitis].

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.

Aged, 80 and over↗
PubMedDate not supplied

Functional liver damage during laparoscopic cholecystectomy as the sign of the late common bile duct stricture development.

BACKGROUND/AIMS: Thermal trauma is hypothesized as a major cause of late common bile duct stricture. Dispersion of electric energy through the tissues during electrocautery is not controlled and may cause necrosis even in remote tissues. Changes in liver enzymes may be used as indirect indicators of common bile duct damage, because of the close proximity of these structures in the liver porta. METHODOLOGY: Laparoscopic cholecystectomy was performed in 20 patients using a monopolar cutter (thermal device), and in another 20 patients using a harmonic scalpel (non-thermal device). Changes in liver enzymes, as well as histology of gallbladder wall were assessed. RESULTS: There was a significant rise in liver enzymes (AST and ALT) after surgery in both groups, but postoperative values of these two enzymes were significantly higher in patients operated using the monopolar cutter. There were no significant differences in postoperative levels of hemoglobin and red blood cell count between these two groups. CONCLUSIONS: Thermal trauma of the liver parenchyma was significantly greater in patients operated using the monopolar cutter, suggesting possible detrimental effects to the common bile duct.

Adult↗
PubMed2006

[A case of leiomyoma in the common bile duct].

Leiomyomas, originating in the bile duct, are very rare, and only few cases have been reported in the literature. We experienced a case of leiomyoma of the distal common bile duct, mimicking bile duct cancer. A 39-year-old woman presented with intermittent jaundice and general weakness for three months. Clinical profiles showed obstructive jaundice, and the abdominal computed tomography and cholangiography revealed diffuse bile duct dilatation with distal common bile duct stricture. A pylorus-preserving pancreaticoduodenectomy was performed and the pathologic specimen disclosed leiomyoma of the common bile duct accompanying severe fibrosis. This is the first case of leiomyoma in the bile duct reported in Korea.

Adult↗
PubMed2004

Benign nontraumatic inflammatory stricture of mid portion of common bile duct mimicking malignant tumor: Report of two cases.

Benign nontraumatic inflammatory stricture of the common bile duct (CBD) may result in obstructive jaundice, which can be misdiagnosed as a malignant tumor of the CBD preoperatively. Two cases with strictures of the mid portion of the common bile duct presenting with obstructive jaundice are reported herein. Preoperative radiological studies prompted us to confidently make the diagnosis of cholangiocarcinoma. However, the postoperative diagnosis on histological examination of the resected lesions was chronic inflammation and fibrosis. The complications of chronic duodenal ulcer are considered as the etiology of these two disorders.

Aged↗
PubMed2004

[A case of primary small cell carcinoma in the common bile duct].

Extrapulmonary primary small cell carcinoma comprises approximately 4% of all small cell carcinoma. In the common bile duct, small cell carcinomas are extremely rare. We experienced a 60-year-old woman with small cell carcinoma arising in the common bile duct. Abdominal CT scan revealed an intraluminal mass in the proximal common bile duct and multiple lymphadenopathies. Microscopic examination of the tumor revealed proliferation of small monotonous anaplastic cells, which were characterized with hyperchromatic nuclei, high nuclear to cytoplasmic ratio, and frequent mitosis. By immunohistochemical stain, the tumor cells were strongly positive for chromogranin, synaptophysin, and CD56. We report this case with a review of literatures.

Carcinoma, Small Cell↗
PubMed2005

MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study.

OBJECTIVE: Our purpose was to compare the accuracy of MR cholangiopancreatography and endoscopic sonography for the diagnosis of common bile duct stones in patients with a mild to moderate clinical suspicion of common bile duct stones. SUBJECTS AND METHODS: Forty-seven patients were prospectively enrolled. Inclusion criteria included acute pancreatitis, subclinical jaundice, and clinical features of common bile duct stone migration. Radial endoscopic sonography and MR cholangiopancreatography with the single-shot fast spin-echo technique were performed a maximum of 48 hr apart. The gold-standard diagnosis was obtained with ERCP (n = 20) or intraoperative cholangiography (n = 14) if the results of endoscopic sonography or MR cholangiopancreatography were abnormal or if a cholecystectomy was performed, or by clinical and biochemical follow-up (n = 11) if the results of endoscopic sonography and MR cholangiopancreatography were normal. RESULTS: The final diagnosis was common bile duct stones in 16 patients, malignant obstructions in four, and another biliary disease in two (lithiasis migration aspect with papillary edema); 23 patients had no biliary disease. The sensitivity and specificity of MR cholangiopancreatography were, respectively, 90.5% and 87.5% for etiologic diagnosis and 87.5% and 96.6% for the detection of common bile duct stones. The corresponding values for endoscopic sonography were 86.4% and 91.3% for etiologic diagnosis and 93.8% and 96.6% for visualization of choledocholithiasis. Accuracy did not significantly differ between the techniques. CONCLUSION: In cases of mild to moderate suspicion of choledocholithiasis, the accuracies of endoscopic sonography and MR cholangiopancreatography are similar. Because MR cholangiopancreatography is noninvasive, it may be preferred for this indication.

Adult↗
PubMed1996

[A case of common bile duct cancer responding to MMC leucovorin, 5-FU, and UFT combination chemotherapy and radiation].

A case of unresectable common bile duct cancer involving the portal vein and with Virchow lymph node metastasis was treated with MMC, Leucovorin, 5-FU and UFT combination chemotherapy as well as radiation. The case was a 71-year-old female who was admitted to the hospital with vomiting and anorexia. Abdominal US study showed obstructive jaundice. The PTCD tube was pierced to dilate the intrahepatic bile duct. Bile juice cytology was class V. Abdominal CT showed paraaortic lymph node metastasis. Angiography revealed portal vein invasion, and the diagnosis was unresectable common bile duct cancer. We started anticancer therapy and radiation. The anticancer therapy selected was MMC, LEUCOVORIN, 5-FU and UFT combination chemotherapy. After 2 cycles of the treatment, Virchow lymph node completely disappeared and the symptoms diminished. These combination therapies were effective for common bile duct cancer.

Aged↗
PubMed1996

Cystic dilatations of the common bile duct in adults.

Cystic dilatations of the common bile duct are believed to be of congenital etiology with most cases presenting in childhood. During the last 20 years, 10 patients with cystic dilatations of the bile duct were treated in our Department. There were 5 men and 5 women with an age range of 35-81 years. Clinical presentation consisted of right hypohondrial pain, nausea, vomiting and a history of obstructive jaundice. Diagnosis was established by ultrasound, cholangiography and ERCP in most cases. According to the Todani classification system, 5 patients had type I cysts, 4 had type II and one had type III. At the time of surgery, main associated diseases were choledocholithiasis in 3 cases and cholangitis in 2 cases. One patient (type III) underwent endoscopic sphincterotomy; 4 patients underwent internal drainage and 2 of them developed mild cholangitis postoperatively; 5 patients underwent excision of the cyst and a biliary-enteric bypass and developed no main complications. Patients remained in good health during long-term follow-up. We conclude that cyst excision is the treatment of choice for adults in order to reduce postoperative morbidity and the potential risk of malignancy.

Adult↗
PubMed2000

Extracorporeal shock wave lithotripsy for difficult common bile duct stones: initial New Zealand experience.

AIM: Common bile duct (CBD) stones can usually be managed by open surgery, endoscopic retrograde cholangiopancreatography (ERCP) or radiological intervention. At times, however, these methods are either unsuccessful or inappropriate. We report our initial experience of extracorporeal shock wave lithotripsy (ESWL) for CBD stones that had either been unsuccessfully managed by conventional techniques, or in cases where these techniques were associated with a high level of risk. METHODS: A retrospective review of medical records of cases receiving ESWL for CBD was undertaken. The aspects reviewed were: indications, outcome and completions from the procedure. RESULTS: ESWL was used in the management of eight patients (three male, five female, age range 24-83, mean 54 years). The indications in five cases were failure of open surgery, ERCP or radiological techniques to clear the duct. In the other three cases, ERCP was unsuccessful and there was significant coincidental medical illness (morbid obesity with diabetes, and severe ischaemic heart disease). CBD clearance was achieved in seven cases. In one unsuccessful case, the duct was cleared after two open procedures. CONCLUSIONS: ESWL can be used to clear CBD stones. It should only be used, however, where prior CBD drainage has been achieved, preferably by endoscopic sphincterotomy. Morbid obesity is a relative contraindication to the use of ESWL. If ESWL fails, a period of time should be allowed to elapse before open surgery because of distortion of soft tissue planes. ESWL can be a useful technique in dealing with some difficult CBD stones.

Adult↗
PubMedDate not supplied

Clinical and biochemical comparative study of different types of common bile duct stones.

BACKGROUND: The chemical composition of common bile duct (CBD) stones may have significance with regard to the origin, clinical presentation and treatment. OBJECTIVE: To study the chemical composition of CBD stones and compare different types of CBD stones. METHODS: Consecutive patients with CBD stones seen over a 1-year period were studied prospectively. Their stones were analyzed for cholesterol, bilirubin and calcium contents. RESULTS: Of 74 patients with CBD stones, 42 had associated gall bladder (GB) stones (Group 1), 14 had post-cholecystectomy CBD stones (Group 2) and 18 had CBD stones with a stoneless GB in situ (Group 3). Of the 40 patients whose CBD stones were analyzed, 34 (85%; 18/19 in Group 1, 5/6 in Group 2 and 11/15 in Group 3) had cholesterol stones; the remaining 6 patients had pigment stones. CONCLUSION: Most CBD stones in northern Indian patients are cholesterol stones. Even in patients with isolated CBD stones (with stoneless GB in situ), three-quarters are cholesterol stones.

Bilirubin↗
PubMed1992

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

Thirty-three patients with common bile duct stones which could not be extracted by routine endoscopic measures were treated with extracorporeal lithotripsy. Two electrohydraulic lithotripters were used: Dornier HM3 and Technomed Sonolith 3000 using fluoroscopy and ultrasonography, respectively, for stone localisation. Twenty-nine patients were treated with only one session and four patients in two sessions. Fragmentation of stones was obtained in 29 patients (88 p. 100) and complete bile duct clearence in 26 patients (79 p. 100). The fragments passes spontaneously through the papilla in 7 cases; in 19 cases complete removal of fragments was achieved with a Dormia basket (16 cases) or after mechanical lithotripsy (3 cases). There were no significant differences in successful fragmentation rates between the two lithotriters. No serious adverse effects or mortality were observed within the 30 days following treatment. In conclusion, extracorporeal lithotripsy is an effective and safe method for the treatment of bile duct stones when, after sphincterotomy, routine endoscopic measures have failed.

Adult↗