Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Choledocholithiasis”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Biliary drainage tube evaluation after common bile duct exploration for choledocholithiasis.

BACKGROUND/AIMS: We studied the postoperative evaluation of transcystic duct tube drainage (C-tube), T-tube drainage (T-tube), and retrograde transhepatic biliary drainage after common bile duct exploration for patients with choledocholithiasis. METHODOLOGY: We analyzed the preoperative clinical features of patients, intraoperative findings, postoperative status and management, daily output of bile, liver function, postoperative infections, and postoperative complications for patients who underwent common bile duct exploration including 16 C-tube, 17 T-tube, and 8 retrograde transhepatic biliary drainage cases. RESULTS: There were no significant differences in the preoperative clinical features, intraoperative findings, or the daily output of bile from the tube. The removal day of the biliary drainage tube and postoperative hospital stay were shorter in the C-tube group than in the T-tube and retrograde transhepatic biliary drainage groups. Aspartate amino-transferase level and body temperature in the C-tube group on day 7 were lower than those in the T-tube group, and the total bilirubin level in the C-tube group on day 14 was lower than in the T-tube and retrograde transhepatic biliary drainage groups. Moreover, postoperative complications occurred significantly less frequently in the C-tube group (25.0%) than in the T-tube group (76.5%). CONCLUSIONS: C-tube drainage is thought to be most useful after common bile duct exploration for patients with choledocholithiasis.

Common Bile Duct↗
PubMed2003

[Superiority of endoscopic ultrasonography in detection of choledocholithiasis over standard ultrasound].

AIMS: The EUS is a minimally invasive method, with a most specificness and sensitivity in verification of concrements in choledochus. The aim of this study is to compare the findings of conventional ultrasound with radial EUS in diagnosis of choledocholithiasis. PTS AND METHODS: 2o pts were included in the study, 13 females. All pts were under susceptibility of concrement presence in choledoch. From 32 examinees in 13 by the none methods was confirmed that they have the obstruction of this ethiolology. The rest 19 examinees underwent endoscopy by an experienced endosonographyst, completely independent of eventual findings by conventional US. Comparative method was done by an ultrasonographer, also uninformed of earlier procedures. RESULTS: 5/20 pts (25%), were excluded from the study. 5/15 pts (33%) were females. Nine (60%) pts (2 males) examined by EUS, showed a presence of concrements in a choledoch, its size varying from 1 x 1 mm to 16 x 6 mm. US provided a very similar results, with minimal differences in the size of concrements (t = 1,706; p < 0.10). In 3 pts the EUS determined a presence of concrements in choledoch, with sizes varying from 1.5 mm to 4 mm, whilst US showed a susceptible changes with recommendation for further analysis. The EUS findings in 3 patients verified a small concrements in choledoch, while standard US did not show presence of these concrements. It is necessary to underline that last three patients underwent cholechistecthomy. CONCLUSION: The radial EUS is a preferred method with excellent performance in verification of choledocholithiasis.

Adult↗
PubMed2003

[Choledocholithiasis: etiology, pathogenesis, diagnosis].

Cholelithiasis is one of the basic pathologies of the digestive apparatus. A certain progress in the study of biliary production and excretion processes has been achieved for the past two decades. This contributed to a deeper understanding of causes and factors promoting the formation of the lithogenic bile. Possibilities for cholelithiasis diagnostics (including precholelithiatic stages) have greatly expanded. The ultrasound method, which is quite efficient for diagnostics of cholecystolithiasis, has become a basic method of cholelithiasis diagnostics. Nevertheless, the course of cholelithiasis is not restricted to the formation of gallstones only. In 5-20% of cases cholecystolithiasis is combined with choledocholithiasis. The latest literature data related to problems of choledocholithiasis etiology, pathogenesis and diagnostics are given in this review of literature.

Endosonography↗
PubMed1992

Laparoscopic cholecystectomy and choledocholithiasis.

Between November 1990 and March 1991, five patients with cholelithiasis and associated choledocholithiasis were treated by laparoscopic cholecystectomy and common-bile-duct exploration (CBDE). Three patients had a successful CBDE, but in two common-bile-duct stones had to be extracted surgically. Two patients had formal laparoscopic CBDE, and three patients had CBDE performed through the cystic duct. All patients recovered from surgery without complication. Laparoscopic CBDE is difficult to perform because of lack of adequate instrumentation and limited experience. Although the authors do not recommend that this procedure be performed widely at present, they believe it will eventually replace many open CBDEs. The authors review the pertinent literature and evaluate diagnostic means for preoperative and peroperative detection of choledocholithiasis. They discuss the alternatives to laparoscopic CBDE, their advantages and disadvantages. Finally, they summarize their own policy with respect to laparoscopic CBDE.

Adolescent↗
PubMedDate not supplied

Hyperamylasemia induced by percutaneous papillary balloon dilatation for symptomatic choledocholithiasis.

BACKGROUND/AIMS: We investigated the relationship between percutaneous papillary balloon dilatation (PPBD) and hyperamylasemia after PPBD. METHODOLOGY: We studied the rate of pancreatitis and asymptomatic hyperamylasemia after PPBD for choledocholithiasis in 64 symptomatic patients. Pancreatitis was defined as epigastric pain combined with at least a 3-fold rise in serum amylase at 24 hours after PPBD. Asymptomatic hyperamylasemia was defined as a rise in serum amylase (normal range, 50 to 160 IU/L) without epigastric pain. RESULTS: The stones were successfully pushed out into the duodenum in all patients. Three patients developed post-PPBD pancreatitis, graded moderate in one and mild in two. Serum amylase values were elevated over the normal upper limit in 21 patients, 33%, over 3-fold in 10, 16% over 1000 IU/L in 6, 9%. Asymptomatic hyperamylasemia was observed in 18 patients. The amylase value after PPBD was elevated to more than 160 IU/L in 44% (17/39) of patients 80 years old or under vs. 16% (4/25) of patients older than 80 and in 23% (10/44) of patients with intrahepatic bile duct dilatation on admission vs. 55% (11/20) of patients without it, with a significant difference, respectively (p<0.05). The amylase value after PPBD was elevated to more than 1000 IU/L in 15% (6/39) of patients 80 years old or under vs. 0% (0/25) of patients older than 80 and in 29% (4/14) of patients with bile duct stones having a horizontal diameter of 8mm or smaller and 4% (2/50) of patients with stones larger than 8mm (p < 0.05 and p<0.01, respectively). CONCLUSIONS: We believe that postoperative continuous decompression of the bile duct by PPBD is reliable and that it contributed to the prevention of severe pancreatitis. We conclude that PPBD can be performed more safely in symptomatic patients older than 80 with choledocholithiasis with intrahepatic bile duct dilatation at the time of admission.

Aged↗
PubMed1991

[Clinical features and operative treatment of ampullary choledocholithiasis].

The results of treatment of 72 patients with ampullary choledocholithiasis (16% of the total number of patients with choledocholithiasis) are presented. In 15 patients, bringing down a concrement was performed, in 3--its retrograde removal via the incision of the common bile duct with subsequent creation of choledochoduodenoanastomosis (CDA), in 24--endoscopic papillosphincterotomy (with subsequent cholecystectomy--in 6, with cholecystectomy and CDA creation--in 18), in 30--cholecystectomy with transduodenal papillosphincteroplasty. After the operation, 5 patients died.

Adult↗
PubMed1991

Choledocholithiasis in cirrhotic patients: is endoscopic sphincterotomy the safest choice?

Of the 18 endoscopic sphincterotomies performed on 18 cirrhotic patients for choledocholithiasis, a mortality rate of 16.6% was registered. However, this figure can be limited to 6.6% if we take only successful sphincterotomies (15/18, 83.3%) into account. After closely reviewing relevant literature, it would appear that operative mortality in comparable cases is much higher. We therefore recommend that endoscopic sphincterotomy, despite higher mortality rates when compared to the general population, should be the initial choice of management of choledocholithiasis in cirrhotic patients.

Aged↗
PubMed1991

Choledocholithiasis in Chinese immigrants with cholelithiasis.

During the period from January 1987 to December 1989, admissions for biliary tract disease at the New York Infirmary--Beekman Downtown Hospital were split almost evenly between Chinese immigrants from southeast Asia and all other ethnic groups (Caucasian, Hispanic, black, et cetera). However, the incidence of choledocholithiasis in patients undergoing cholecystectomy for cholelithiasis was much higher in the Chinese immigrant population, 37.2 versus 11.8 per cent, a highly significant difference (p = 0.001). In addition, we often found the disease to be of greater severity in Chinese patients. They were more likely to have large numbers of stones in the duct and more likely to have significant ductal enlargement. This increased risk was essentially constant regardless of age. Because of this threefold risk of choledocholithiasis when operating on a Chinese immigrant from southeast Asia for cholelithiasis, intraoperative cholangiography is mandatory, even in those without other indications for common bile duct exploration.

Adolescent↗
PubMed1990

Current management of choledocholithiasis.

Choledocholithiasis may be managed by surgical extraction of stones or endoscopic papillotomy with extraction of stones. To evaluate these methods of management, the charts of all patients with choledocholithiasis admitted to Crawford Long Hospital of Emory University between April 1, 1983, and April 30, 1988, were reviewed. One hundred patients were identified; 42 were treated by common bile duct exploration (CBDE) and 58 had endoscopic papillotomy with extraction of stones (EP) as their initial treatment. The two groups were similar in regards to age, but the CBDE group had more comorbid conditions (average 2.5/patient in CBDE vs 1.8/patient in EP) and a higher incidence of acute cholecystitis and/or cholangitis (74% of CBDE patients; 24% of EP patients). Successful extraction of all stones occurred in 79 per cent of CBDE patients and 90 per cent of EP patients. Of those patients with retained stones following CBDE, all were later extracted by EP. Of patients having EP as their initial procedure, 24 per cent required repeat endoscopic procedures for extraction of residual stones and only six patients (10.4%) required CBDE for retained stones. Morbidity was lower (10% vs 23%) and hospital stay shorter (3.6 days vs 10.4 days) in the EP than CBDE patients; thus, the two groups are not completely comparable. Mortality was similar in the two groups (1.7% EP, 2.3% CBDE).

Adolescent↗
PubMed1989

[Choledochoduodenostomy in choledocholithiasis and benign strictures of the common bile duct].

The methods of external and of internal drainages of the bile ducts are alternatives in choledocholithiasis and benign strictures of the choledochus. In the Central Research Institute of Gastroenterology, 349 operations were performed on the common bile duct, stones were found in the choledochus in 259 (74.2%) cases and benign strictures of the terminal part of the choledochus and the major duodenal papilla in 103 (29.5%) cases. Ninety-five operations were secondary or reconstructive in character. A precise diagnosis of affection of the biliary tract can be established only during an operation or by retrograde cholangiopancreatography. External drainage of the common bile duct was conducted in 229 (65.6%) cases. Choledochoduodenostomy was undertaken in 105 patients (55 were operated on for the first time and 50 underwent operation on the biliary tract for a second time). Endoscopic papillosphincterotomy was successful in 28 cases with short strictures of the choledochus and choledocholithiasis. The stones were removed from the ducts with instruments or were expelled spontaneously at days 2 to 5.

Choledochostomy↗
PubMed1979

Endoscopic management of choledocholithiasis and papillary stenosis.

Endoscopic papillotomy was performed in 50 of 53 patients, 31 females, with an age range of 29 to 87 years, a mean of 63.1. The indications for the procedure included retained or recurrent choledocholithiasis, primary choledocholithiasis and papillary stenosis, which were responsible for persistent or intermittent cholestasis. The procedure was successful in all but three patients in whom the primary diagnosis was papillary stenosis. The major complications were bleeding in three patients, pancreatitis in one patient and an infected pseudocyst in one patient. Surgical intervention was not required, and there were no deaths. Endoscopic papillotomy has proved to be safe, producing a permanent biliary enteric fistula, thus reducing the probability of formation of recurrent stones. It has been shown to reduce hospitalization and convalescence, permitting an earlier return to normal activity.

Adult↗
PubMed1984

[Endoscopic papillosphincterotomy in the treatment of choledocholithiasis].

The article analyzes an experience with endoscopic papillosphincterotomy in 45 patients with recurrent or residual choledocholithiasis with/without stenosis of the major duodenal papilla. In 38 pathients stones were removed after endoscopic papillosphincterotomy or were eliminated spontaneously. In later terms none of the patients showed restenosis of the major duodenal papilla. Thus, endoscopic papillosphincterotomy is considered to be an effective method of treatment of choledocholithiasis.

Adult↗
PubMed1984

Choledochoduodenal fistula and choledocholithiasis: treatment by endoscopic enlargement of the choledochoduodenal fistula.

Choledochoduodenal fistula is an uncommon complication of choledocholithiasis. Five patients with this entity were treated by endoscopic enlargement of the choledochoduodenal fistula without complication. Choledochoduodenal fistula complicating choledocholithiasis seem to arise either from stone erosion through the bile duct into the duodenum or as a complication of vigorous instrumentation at the time of common duct exploration. In patients in whom endoscopic sphincterotomy cannot be performed because of inability to cannulate the ampullary orifice, endoscopic enlargement of the choledochoduodenal fistula can be performed safely.

Aged↗
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↗
PubMed1982

Surgical approaches to primary choledocholithiasis: internal or external drainage when, how and why.

Six hundred and twenty two patients underwent choledochotomy because of biliary calculous disease in a series of 4,202 patients seen between 1964 and February 1981. Per-operative and post-exploratory cholangiography was routinely used, and since 1972 choledochoscopy was carried out in addition in a proportion of patients irrespective of intra-operative cholangiographic findings but with clinical and operative findings suggestive of choledocholithiasis. Moreover, choledochotomy was supplemented in 145 patients by T-tube drainage, in 342 patients by choledochoduodenostomy and in 115 patients by sphincteroplasty. Supplementary drainage procedures were carried out in patients with predictive signs of biliary stasis in an attempt to eliminate recurrent choledocholithiasis. From our results it seems reasonable to accept that supplementary drainage procedures in combination with modern intra-operative diagnostic techniques, appeared to be an effective and satisfactory approach in fulfilling the goal of elimination of residual or retained common bile duct calculi.

Adult↗
PubMed1978

Endoscopic retrograde cholangiopancreaticographic aspects of choledocholithiasis and its sequelae.

100 patients with a known history of choledocholithiasis were selected. The main reasons for performing ERCP were the presence of severe jaundice or insufficient information obtained with intravenous cholangiography. Analysis is made of the various complications due to the presence of common bile duct stones. A surprisingly high incidence of choledochoduodenal fistulas was seen; two types of such fistulas can be recognized. A brief discussion is given of etiological factors involved. ERCP is also very useful in the evaluation of surgical anastomosis and complications due to surgery such as narrowing or complete ligation of the common bile duct. Finally, pancreatitis, another complication of choledocholithiasis, is evaluated with ERCP, showing the importance of reflux from the common bile duct into the pancreatic ducts in the etiology of this condition.

Aged↗
PubMed1980

Developing trends in acute cholecystitis and choledocholithiasis.

Among 2,347 operations performed for acute cholecystitis during a 46 year period, 1932 to 1978, choledochotomy was combined with either cholecystectomy or cholecystostomy in 364 instances. A report published for the first period, 1932 to 1955, is compared with a comparable period, 1955 to 1978. A greater number of patients were operated upon during the second period, 83 for the first 23 years and 276 for the second 23 year period. The average age increased from 49.6 to 65.3 years. The incidence of choledocholithiasis increased from 59 to 62 per cent. The ratio of females to males shifted from 4.2:1.0 for 1932 to 1955 to 1.6:1.0 for 1955 to 1978. Associated conditions recognized preoperatively increased from 2.5 per patient to 4.9 per patient. Postoperative complications increased from 27 in 83 patients, 1932 to 1955, to 250 complications in the 276 patients, 281 operations, in the second series, 1955 to 1978. The mortality increased from 2.5 to 10.9 per cent. In the past 46 years, 97 per cent of the deaths occurred in patients 50 years of age or older, with only one death, 3 per cent, occurring in a patient less than 50 years old, and this patient was operated upon in the second series, 1955 to 1978. It is suggested that the increased age and associated conditions at the time of operation for a sequelae of calculous biliary tract disease account fort the increased mortality. Undelayed cholecystectomy for cholelithiasis following the establishment of the diagnosis should prevent the sequelae of acute cholecystitis with presumed choledocholithiasis.

Acute Disease↗
PubMed1994

[The surgical treatment of choledocholithiasis].

In 241 patient choledocholithiasis the transduodenal sphincteroplasty (TDSP) and in 118--choledochoduodenostomy (CDS) was conducted. The incidence of specific postoperative complications after TDSP was 10.3%, after CDS--10.2%, postoperative mortality accordingly was 6.2% and 6.8%, the hospital stay duration from the time of operation performance till the discharge of patient from hospital--16.8 and 21 day on the average. Authors speculate the TDSP as a method of choice of operative choledocholithiasis treatment.

Acute Disease↗