[The intrahepatic biliary tract in Budd Chiari syndrome].
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Biomedical subjects
Publications and source records attributed to V F Moreira.
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Endoscopic retrograde cholangiopancreatography (ERCP) was carried out on 19 patients with hydatid cyst of the liver, either before or after operation. Cholangiographic findings included biliary tract obstruction in 8 cases, intrinsic compression in 4 cases, laminated membranes or daughter cysts in the biliary tree in 3 cases, perforation into the biliary tract in 2 cases, stricture in the biliary ductal system in 1 case, and biliary fistula in the remaining case. Biliary tract obstruction was secondary to chemical cholangitis by formalin in 2 patients. ERCP is a useful procedure in patients with suspected intrabiliary rupture or when symptoms occur after surgical removal of the cyst.
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We have prospectively studied the clinical data, prognostic factors and chronic liver sequelae in 68 patients who developed posttransfusion non-A, non-B hepatitis. The mean incubation period was 5.9 weeks with a range from 2.1 to 12 weeks; 63.5% of the patients were asymptomatic and 60.6% anicteric. The chronicity rate (elevated ALT values for a period of more than 6 months) was 67.6%. The chronicity rate of symptomatic hepatitis (95.5%) was significantly higher than that of asymptomatic hepatitis (54.5%) (P less than 0.01). Monophasic hepatitis, characterized by a rapid elevation in serum ALT followed by a rapid decline with no further fluctuations, had a chronicity rate (42.5%) significantly lower than polyphasic hepatitis (86.6%) (P less than 0.05) and plateau type hepatitis (94.4%) (P less than 0.01). Results of 35 liver biopsies carried out among 46 patients with elevated ALT after 6 months were as follows: chronic active hepatitis, 15 cases; prolonged acute hepatitis, 12 cases; chronic persistent hepatitis, 6 cases; posthepatitis liver changes, 1 case; and secondary hemosiderosis, 1 case.
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External biliary fistulas occur as a complication of biliary tract surgery. Until recently, excision of the fistula was the primary therapeutic modality. We describe seven cases of postoperative external biliary fistula successfully treated by endoscopic papillotomy. Fistulation occurred in four patients after operations for hydatid cysts of the liver, in one patient after cholecystectomy for acute cholecystitis, in one patient with carcinoma of the periampullary region after a decompression procedure, and in the remaining patient after an intraoperative biopsy of a carcinoma of the gallbladder. Endoscopic sphincterotomy is a reliable and effective therapeutic alternative in patients with external biliary fistulas.