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PubMedDate not supplied

[Echotomographic, scanographic and anatomic study of a case of cystic dilatation of the common hepatic duct].

The authors describe the case of a 16-year-old African woman presenting with a cystic dilatation of the common bile duct associated with a dilatation of the left intrahepatic bile duct, hepatic fibrosis and portal hypertension. The disease was revealed by a non-infectious cholestatic syndrome. The diagnosis was made before the intervention by abdominal ultrasonography and computed tomography. A choledococyst-jejunostomy was performed which led to progressive normalisation of liver function. This report emphasizes the possibility of simultaneous lesions at different levels of the biliary tree in patients with choledocal cysts. The prognosis depends upon the state of the liver. A liver biopsy is therefore mandatory when an operation is performed. In the present case, the follow-up is too short to assess the regression of the biliary cirrhosis as described in the literature.

Adolescent↗
PubMed1996

Junction of the cystic duct with the left hepatic duct: report of a case discovered during laparoscopic cholecystectomy.

We report a case of an anomalous junction of the cystic duct with the left hepatic duct found during laparoscopic cholecystectomy. Only five other patients with this anatomy have been reported. Two of these five patients had left-sided gallbladders, and the remaining patients (including ours) had their gallbladder in its normal location. Although the prevalence of this anomaly associated with left-sided gallbladders is 5.6 to 14.3%, this anomaly appears to be quite rare in patients with gallbladders in the normal position. In four cases, it was accompanied by left-sided gallbladder or low bifurcation of the common hepatic duct. This rare condition may accompany other biliary anomalies and should be kept in mind when performing cholecystectomy.

Bile Duct Diseases↗
PubMedDate not supplied

Anomalous connection of the right hepatic duct into the cystic duct: utility of magnetic resonance cholangiopancreatography.

A 41-year-old female was admitted to our hospital for treatment of uterus carcinoma. Abdominal ultrasound showed gallbladder stones. Although magnetic resonance cholangiopancreatography revealed the right intrahepatic bile ducts, left hepatic duct and the common bile duct, the confluence of the right and left hepatic ducts was not visualized. At surgery, intra-operative cholangiography showed a biliary anomaly of the right hepatic duct entering the cystic duct. Subsequently cholecystectomy was accomplished without any injury to the bile duct. Our case may be the eighth such case of this rare biliary anomaly. When magnetic resonance cholangiopancreatography does not show the confluence of the right and left hepatic ducts, biliary anomaly of the right hepatic duct should be suspected and careful dissection should be performed from the Hartman's pouch, followed by intraoperative cholangiography, in order to avoid unnecessary injury to the bile duct.

Adult↗
PubMed1986

A method for protection of the left hepatic duct during right hepatic trisegmentectomy.

Right hepatic trisegmentectomy which removes the right lobe and the medial segment of the left lobe is necessary to remove completely lesions which extend beyond the true right lobe of the liver. The procedure has been described in detail in excellent reviews. We describe a technique of bile duct preservation during right trisegmentectomy. This is accomplished by cannulating the left hepatic duct with a Silastic catheter which is introduced through the stump of the right hepatic duct. This technique allows palpation of the duct during the dissection. With positive identification, the numerous small branches to the medial segment of the left lobe can be ligated safely. A completion cholangiogram through the catheter is always done to identify and repair any extensive bile duct leaks. Finally, the technique can be adapted for use in other resections, such as left trisegmentectomy by simply cannulating the appropriate duct.

Bile Ducts, Intrahepatic↗
PubMed1999

Operative repair of bile duct injuries involving the hepatic duct confluence.

Injuries at the hepatic duct confluence present the surgeon with a technically demanding repair, often combined with life-threatening sequelae such as sepsis and portal hypertension. Moreover, the possibility of litigation is ever present, even for those not responsible for the initial injury. In this review, we discuss the approach to patients with proximal bile duct injuries, with emphasis on preoperative evaluation and the technical aspects of biliary reconstruction.

Biliary Tract Surgical Procedures↗
PubMed1982

[Palliative treatment of carcinoma of the hepatic duct junction. Intra-hepatic derivation or trans-tumoral intubation? (author's transl)].

Intra-hepatic cholangiojejunostomy (group I patients) and simple trans-tumoral intubation (group II patients) were retrospectively compared in a series of 44 patients with primary carcinoma of the hepatic duct junction. Hospital mortality was 30% in the 13 group I patients and 9.5% in the 21 group II patients. Jaundice and pruritus were equally relieved in both groups. The mean survival time (hospital deaths excluded) was 16 months in group I and 12 months in group II patients. It is concluded that the decision as to which of these two palliative surgical procedures should be performed must rest on the degree of biliary duct distension as well as on the patient's age and general condition.

Adult↗
PubMed1990

[Adenocarcinoma (Klatskin tumor) of the hepatic duct simulating viral hepatitis].

The authors review the experiences obtained during investigation of a patient with Klatskin tumor and whose clinical syndromes were developing as of virus hepatitis. In the first two weeks of the illness the clinical symptoms, the chemical laboratory findings and among the virus investigations the positive (experimental) Non-A Non-B hepatitis virus antigen suggested the existence of virus hepatitis. Later the laboratory investigations and the symptoms showed on obstructive icterus. The subsequent performed investigations as ultrasonography and PTC--showed the Klatskin tumor, which was proven by the operation performed and histology. The patient is free from the complaints more than 1 year after the operation, moreover recidivation or metastasis was not indicated by the investigations performed in the latest time.

Adenocarcinoma↗
PubMed2004

Spiegel's lobe bile ducts often drain into the right hepatic duct or its branches: study using drip-infusion cholangiography-computed tomography in 179 consecutive patients.

Using drip-infusion cholangiography-computed tomography (DIC-CT), we successfully identified the bile ducts draining the caudate lobe in 138 of 179 consecutive patients with extrahepatic cholelithiasis (179 ducts from Spiegel's lobe and 154 from the paracaval portion; 1-5 ducts per patient). The dorsal subsegmental duct of S8 (B8c) was often identified and could be discriminated from the paracaval caudate ducts, thus acting as a landmark for the right margin of the caudate lobe. Notably, in more than one-third of the 138 patients, at least one of the Spiegel's lobe ducts drained into the right hepatic duct or its branches (30.2% of the 179 ducts overall; all ducts joined branches of the right lobe in 25 patients). Similarly, 34.4% of the 154 paracaval caudate lobe ducts drained into the left hepatic duct or its branches. These "anatomical left/right dissociations" between the drainage territory and route were much more frequent than previously reported. Our results confirm the effectiveness of DIC-CT as a classical, noninvasive method for presurgical evaluation of the biliary system, but they also suggest that anatomical partial resection of the dorsal liver in patients with hilar cholangioma is often impossible because of contralateral biliary drainage.

Adolescent↗
PubMed1989

Avoidance of injury to the left hepatic duct during parenchymal dissection for hepatic trisegmentectomy.

A simplified and safe technique is described herein for the dissection of the feedback structures to the medial segment of the left lobe, while preserving the integrity of the remaining left hepatic bile duct during the dissection for right hepatic trisegmentectomy. This is accomplished by passing a biliary probe into the main left hepatic duct from the stump of the right hepatic duct. Use of this technique during the performance of a hepatic trisegmentectomy expedites the hepatic dissection and decreases the potential for intraoperative injuries of the remaining bile duct to the lateral segment of the left lobe of the liver. In addition, irrigation of the left hepatic bile duct through the open right duct stump may demonstrate leakages of bile that may be repaired, leading to a decreased over-all morbidity in the subsequent postoperative period.

Bile Duct Diseases↗
PubMed1987

Unilateral hepatic duct obstruction.

Experience with unilateral hepatic duct obstruction is limited. We reviewed 33 cases of unilateral hepatic duct obstruction from a total of 500 patients with biliary reconstruction treated between 1965 and 1984. The median age of the patients reviewed was 56 years. The most common cause of unilateral hepatic duct obstruction was operative injury (73 percent of patients). Including operations for unilateral obstruction, patients in the series underwent 131 operations related to biliary tract problems. The most common presentation (73 percent of patients) was fever and pain. Obstruction was more common in the right duct than in the left duct by a ratio of 2:1 (22 patients versus 11 patients). The three types of surgical procedures used were hepaticojejunostomy (17 patients), dilatation and drainage (13 patients), and primary hepatic resection (3 patients). Atrophic hepatic lobes resulting in rotational deformity of the portal structures were resected in six patients with combined hepatic duct and arterial injury. No operative deaths occurred, although 51.5 percent of the patients had postoperative complications. Follow-up studies ranging from 1 to 16 years demonstrated that patients who had hepaticojejunostomy required less frequent reoperation compared with those who had dilatation (36 percent versus 64 percent) and had a lower postoperative mortality rate related to biliary tract problems (7 percent versus 18 percent). We conclude that unilateral hepatic duct obstruction continues to occur most commonly because of operative injury and is best treated by hepaticojejunostomy or by resection of chronically obstructed lobes when possible.

Biliary Tract Diseases↗
PubMedDate not supplied

Compression of the common hepatic duct by the right hepatic artery.

Magnetic resonance (MR) cholangiography has been used wildly as preoperative examination before laparoscopic cholecystectomy (LSC). However, cases that suggested the stenotic lesion of extrahepatic bile duct are not so rare in MR cholangiography. When stenosis is found, further examination is needed to avoid the possibility of bile duct cancer. We reported a case in which the stenotic lesion was diagnosed compression of the common hepatic duct by the right hepatic artery by multislice CT (MCT) cholangiography.

Bile Duct Diseases↗
PubMed1998

Prognostic significance of tumor DNA content in carcinoma of the hepatic duct confluence.

Carcinoma of hepatic duct confluence was characterized by Klatskin, as a small, relatively slow-growing and sharply localized tumor. Sixty consecutive patients with carcinoma of the hepatic duct confluence were surgically resected in our Department between January 1984 and December 1996. All histological section of each patient included in the study were reviewed. The nuclear content was measured. Twenty-nine patient (48%) had diploid tumors and 31 (51%) were found to have aneuploid tumors. Survival of patients with a diploid tumor was significantly longer than those with aneuploid tumors. Our results indicate that DNA ploidy is an important, prognostic factor of carcinoma of the hepatic duct confluence.

Adult↗