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PubMed1986

Spontaneous rupture of the common bile duct.

Spontaneous rupture of the common bile duct in adults is very rare. The authors report only the 14th case in the Western literature. A 25-year-old woman had signs of peritonitis suggestive of a perforated appendix, but at operation the appendix appeared normal and a large amount of bile was found in the peritoneal cavity. A 2-mm tear was found on the anterior wall of the common bile duct. The patient recovered without complications after T-tube drainage and cholecystectomy. In this patient none of the factors thought to cause spontaneous rupture of the common bile duct were present, so the authors conclude that the case may be classified as idiopathic spontaneous rupture of the common bile duct.

Cholangiography↗
PubMed1982

Impacted common bile duct stones.

The impacted common bile duct stone can be managed either surgically or radiologically using methods such as percutaneous basket extraction or endoscopic papillotomy. At operation, if an impacted common bile duct stone cannot be removed by the usual methods, duodenotomy and sphincteroplasty are indicated. If the patient's condition is good, sphincteroplasty should not be avoided in the belief that other means of stone removal are superior. However, if the patient's condition is not ideal, sphincteroplasty should be deferred in favor of delayed removal by percutaneous or endoscopic techniques. In patients without percutaneous access to the biliary tree, endoscopic papillotomy can be effective in removing impacted stones, or at least in relieving the obstruction and allowing improvement in the patient's condition before surgical intervention is attempted.

Ampulla of Vater↗
PubMed2002

Effectiveness and long-term results of laparoscopic common bile duct exploration.

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is a cost-effective, efficient, and minimally invasive method of treating choledocholithiasis. We reviewed the long-term results and efficacy of LCBDE for the common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Medical charts were reviewed for all patients undergoing LCBDE at St. Vincent Hospital over 11 years (1990-2001). Demographic data, clinical features, laboratory data, radiologic and operative findings, and postoperative follow-up evaluation were analyzed. RESULTS: A total of 346 LCBDE were performed during the study period. The mean operative time was 127 +/- 3 min, and the length of hospital stay averaged 2.8 +/- 0.1 days. In 8 patients (2.3%), LCBDE was converted to an open procedure. Complications were noted in 33 patients (9.5%), including patients (2.7%) with retained stones. No postoperative mortalities were recorded. No long-term strictures or biliary complications were noted over a mean follow-up period of 43 months (follow-up data available for 96%). CONCLUSION: A policy of routine cholangiography and LCBDE for CBD stones was effective in clearing the bile duct and avoiding further hepatobiliary instrumentation. The findings show that LCBDE can be performed successfully with low morbidity and mortality.

Adolescent↗
PubMed1989

Successful piezoelectric lithotripsy of a common bile duct stone.

The "problematic common bile duct stone", which cannot be extracted primarily by routine endoscopic methods is one of the indications for extracorporeal shock wave lithotripsy (ESWL). We report on the successful piezoelectric lithotripsy of a large common bile duct stone in an 86-year-old patient. Focusing was achieved by ultrasound without problems; the resulting fragments were extracted endoscopically without difficulty. No side effects were observed in this painless piezoelectric lithotripsy.

Aged↗
PubMed1991

Primary lymphoma of the common bile duct.

Primary lymphoma of the common bile duct is an extremely rare disease. Only two detailed case reports have been published in the literature. In the present paper, a 68-year-old female with obstructive jaundice and a primary lymphoma of the common bile duct, which was resected, is described in detail because of the rarity of the lesion in the literature. The cholangiogram demonstrated stricture of the common bile duct. The findings at angiography and computed tomography were non-specific, but a hypo-echoic mass filling the lumen of the bile duct was demonstrated by ultrasonography. Subtotal resection of the common bile duct and cholecystectomy was performed as the method of choice, although the frozen section examination was not definitive. The final histological diagnosis was malignant lymphoma of the diffuse, small cleaved cell type. There was no metastasis to dissected regional lymph nodes. External irradiation was effective when recurrent tumors were found six months later. However, the patient developed generalized disease one year after resection. Although combination chemotherapy was effective this time for her lymphadenopathy, she died of pneumonia one year and four months after surgery. It can be postulated that ultrasound would be useful in diagnosing this rare entity, and that adjunctive radiotherapy after resection would be preferable to prevent progression of the disease.

Aged↗
PubMed2004

Surgical treatment for anomalous arrangement of the pancreaticobiliary duct with nondilatation of the common bile duct.

BACKGROUND/PURPOSE: For anomalous arrangement of the pancreaticobiliary duct (AAPBD) with nondilatation of the common bile duct (CBD), the optimal surgical procedure remains controversial. The authors investigated which procedure would be most effective for AAPBD with nondilatation of the CBD. METHODS: The authors encountered 60 children with AAPBD in our institution between 1979 and 2002. Six of the 60 were classified as the nondilated type (CBD diameter; less than 8 mm), whereas the other 54 were classified as the dilated type (CBD diameter; more than 9 mm). Amylase levels in serum, CBD, and gallbladder were examined. Cellular activity of the resected gallbladder was examined for the incidence of hyperplasia and Ki-67 labeling index (Ki-67 LI). RESULTS: The amylase level in the nondilated type was elevated as in the dilated type. Epithelial hyperplasia of the gallbladder was present in 4 of the 6 with the nondilated type (67%). 10 of the 20 with the dilated type (50%), and none of the 6 controls (0%). The Ki-67 LI of the dilated type was significantly higher than that of control. CONCLUSIONS: A free reflux of pancreatic juice into the biliary system was found regardless of dilatation, and cellular proliferative activity of the gallbladder mucosa was increased in both the nondilated and dilated type. Therefore, excision of the extrahepatic bile duct including cholecystectomy is recommended for AAPBD with nondilatation of the CBD.

Abnormalities, Multiple↗
PubMed1991

Comparison of various spasmolytic drugs on guinea-pig isolated common bile duct.

Guinea-pig common bile duct preparations were used to quantify the spasmolytic potency of N-butylscopolamine (NBS), papaverine, gallopamil and nifedipine. A method was developed which allowed the measurement of intraluminal pressure changes in vitro. Barium chloride, carbachol and a solution with elevated potassium concentrations were used to stimulate smooth muscles. Concentration-response relationships for the spasmogens as well as for the spasmolytic drugs were evaluated in a cumulative manner. Furthermore, non-cumulative concentration-response curves were constructed for carbachol in the absence and presence of NBS. The -log EC50-values of the spasmogens were found to be 3.28 +/- 0.08 (BaCl2), 6.46 +/- 0.07 (carbachol) and 1.31 +/- 0.08 (KCl), respectively. The Emax values of carbachol and potassium were comparable, and were twice as high as the Emax of BaCl2. Papaverine was less potent than the calcium antagonists gallopamil and nifedipine, but proved capable of completely suppressing elevated muscular tone of the common bile duct preparation, independent of the stimulus used. NBS showed a high potency in suppressing only a carbachol-induced pressure increase, while it was rather ineffective when BaCl2 or a high potassium solution was used as the spasmogen. The concentration-response-curve for carbachol was shifted to the right in a parallel manner by NBS. Only a slight depression of Emax was observed. From the results it is concluded that NBS acts mainly as a muscarinic receptor antagonist. The high potency found for the calcium antagonists, gallopamil and nifedipine, in this model may indicate a possible role for these compounds in the treatment of biliary colic.

Action Potentials↗
PubMed1979

Medial indentation of the duodenal sweep by common bile duct dilatation.

The dilated common bile duct has long been recognized as a cause for a smooth, tubular impression across the duodenal bulb or immediate postbulbar duodenum. Only scattered references suggest that a smooth indentation on the medial aspect of the descending duodenum might also be due to an enlarged, tortuous common duct. Three cases of this condition are reported. The dilated common duct impression can mimic a pancreatic mass. While computed tomography, ultrasonography, or transhepatic cholangiography readily suggest the true diagnosis, potential pitfalls in patient management are possible when the first radiographic procedure is an upper gastrointestinal series.

Adult↗
PubMed1988

Exploration of the common bile duct through the cystic duct.

Formal exploration of the common bile duct through choledochotomy is a standard surgical technique; however, the prevalence of postoperative morbidity and mortality from intraoperative extraction of stones and debris of the common duct remains significant. From 1982 to present, we performed 25 explorations of the common bile duct entirely through the cystic duct in patients in whom duct size was large enough to permit passage of instrumentation greater than 6.5 millimeters in diameter. All instrumentation, including biliary Fogarty balloon-tipped catheterization and fiberoptic choledochoscopy, was used through the cystic duct without difficulty. No complications of bile leakage or stricture formation were encountered, and all patients are doing well at five and one-half years after surgical treatment without known retained stones. The early community hospital experience of this report supports the view that exploration of the common bile duct through a suitably sized cystic duct is a safe, efficient and effective alternative to choledochotomy for exposure of the common bile duct.

Adult↗
PubMed2000

A sphincterotome-based technique for selective transpapillary common bile duct cannulation.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) requires selective cannulation of the common bile duct and pancreatic duct. Selective common bile and pancreatic duct cannulation with standard techniques can be achieved in most but not all cases even in experienced centers. To facilitate selective cannulation, sphincterotomes can be used. METHODS: A prospective randomized study aimed at selective deep cannulation of the common bile and pancreatic ducts comparing different ERCP procedures was performed. One hundred patients were randomly assigned to undergo cannulation with a standard catheter or with a guidewire sphincterotome (GS) without guidewire. RESULTS: The primary success rate of selective common bile duct cannulation was significantly higher in the GS group (84%) as compared with the standard catheter group (62%) (p = 0.023). In patients with primary standard catheter failure, selective common bile duct cannulation was possible in 16 patients using a GS which increased the total success rate in the standard catheter group to 94% (p < 0.001). In GS failures selective common bile duct cannulation was possible in two patients using a standard catheter and increased the total success rate from 84% to 88%. The frequency of postinterventional pancreatitis did not differ significantly between the two groups. CONCLUSIONS: ERCP using a GS without guidewire has a significantly higher primary success rate for selective common bile duct cannulation then ERCP using a standard catheter. The use of a GS should be considered to optimize selective cannulation of the common bile duct before resorting to precut techniques.

Catheterization↗