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Results for “Choledocholithiasis”

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At least 505 records · Page 28Linked to original sources
PubMed2006

[Clinical features of patients with choledocholithiasis showing high levels of aminotransferases].

BACKGROUND/AIMS: We aimed to determine the clinical features of patients with common bile duct (CBD) stones with high serum levels of AST or ALT. METHODS: A retrospective review of 93 patients with CBD stones was done. Clinical characteristics, diameters of CBD, and prior diagnosis before endoscopic retrograde cholangiopancreatography (ERCP) were assessed between two groups (group 1 with serum AST or ALT levels > or =400 IU/L and group 2 with AST and ALT < or =100 IU/L). RESULTS: Nineteen patients in group 1 and 17 patients in group 2 were enrolled. The most common presenting symptom was abdominal pain in both groups. Patients in group 1 was about 14 years younger than group 2 (p=0.003). The duration of symptoms in group 1 and group 2 were 4.1 and 36.8 days, respectively (p=0.005). The diameter of CBD was smaller in group 1 (11.4 mm) than in group 2 (16.3 mm) (p=0.001). Most patients were diagnosed as CBD stones by abdominal ultrasound or computed tomography before ERCP, except two patients in group 1 who were diagnosed as hepatitis initially. All of the patients were recovered by stone removal through ERCP and antibiotics treatment. There were inverse correlations between the diameter of CBD and AST or ALT levels (r=-0.517, p=0.002 and r=-0.504, p=0.002, respectively). CONCLUSIONS: CBD stones with high levels of AST or ALT are frequently observed in younger patients with shorter duration of symptoms and a smaller diameter of CBD. ERCP seems to be a valuable method in the diagnosis and treatment of these patients.

Aged↗
PubMedDate not supplied

[Endoscopic mechanical lithotripsy in choledocholithiasis of difficult extraction handling].

BACKGROUND: Large stones are difficult to remove in block through a small papillotomy, a relative narrowed distal bile duct, periampular diverticula or in those who have undergone only balloon sphincteroplasty prior to stone extraction. Extending the papillotomy is not always possible, and may carry, an increased risk of bleeding and perforation. Lithotripsy facilitates stone extraction and clearance of the common bile duct. AIM: This study investigated the predictors of successful or unsuccessful mechanical lithotripsy. PATIENTS AND METHODS: A series of 100 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome. RESULTS: The procedure was safe (morbidity rate 4.4%) and effective (68% stone clearance rate). The statistic analysis showed that lithotripter type was the only outcome predictor (p = 0.044). The other factors analyzed were not statistically significance. CONCLUSION: Mechanical lithotripsy is successful in about 70% of patients with difficult bile duct stones. The only significant factor that predicts failure of mechanical lithotripsy is lithotripter type.

Adult↗
PubMed1995

An alternative technique for treatment of choledocholithiasis found at laparoscopic cholecystectomy.

OBJECTIVE: To introduce a new strategy for dealing with abnormal cholangiograms at laparoscopic cholecystectomy that makes postoperative cholangiograms possible and facilitates stone extraction by assuring access to the duct for a guide-wire-assisted endoscopic retrograde sphincterotomy. DESIGN: Retrospective review of a prospectively maintained database. PATIENTS: Twenty-four patients with abnormal cholangiograms had a percutaneously placed double-lumen catheter threaded through the cystic duct and advanced into the duodenum. RESULTS: Ten successful guide-wire-assisted endoscopic retrograde sphincterotomies were performed without complications. Eleven normal postoperative cholangiograms suggested spontaneous stone passage or false-positive intraoperative cholangiograms. There were three technical failures in the early part of the series. CONCLUSIONS: This strategy is a reasonable alternative to laparoscopic common bile duct exploration (1) when the cholangiogram is questionably positive, (2) when prolonged anesthesia (poor-risk patient) should be avoided, (3) when the equipment for laparoscopic common bile duct exploration is not available, and (4) when spontaneous stone passage seems likely. Postoperative endoscopic retrograde sphincterotomy with stone extraction is facilitated when it becomes necessary because a guide wire can be introduced through the catheter.

Adult↗
PubMed1994

Choledochoduodenostomy and sphincterotomy in the treatment of choledocholithiasis.

Over a 10-year period, 2610 patients underwent operation for biliary lithiasis. Exploratory choledochotomy was indicated in 591 patients (22.6 per cent). This was followed by simple choledochorrhaphy over a T tube in 240 patients (40.6 per cent), transduodenal sphincterotomy and choledochorrhaphy over a T tube in 126 (21.3 per cent), supraduodenal choledochoduodenostomy in 216 (36.5 per cent), and choledochoduodenostomy and transduodenal sphincterotomy in nine (1.5 per cent). Choledochoduodenostomy was performed if the bile duct was more than 12 mm in diameter. The indication for transduodenal sphincterotomy was the presence of a stone impacted in the papilla and/or papillary stenosis. Six patients developed abdominal abscess and three an external biliary fistula following choledochoduodenostomy. There were four abscesses and two episodes of acute pancreatitis in patients undergoing sphincterotomy. There was no difference in mortality rate between the two groups. After a mean follow-up of 5.6 years, 71.5 per cent of patients who underwent choledochoduodenostomy and 75.2 per cent of those who received transduodenal sphincterotomy were asymptomatic. The remainder suffered from dyspepsia, colicky pain or episodes of cholangitis. Nine patients underwent reoperation for residual calculi (six choledochoduodenostomies, three sphincterotomies).

Adult↗
PubMed1988

The fine structure and histochemistry of human bile duct in obstruction and choledocholithiasis.

Biopsies from the common bile ducts from seven patients undergoing surgery for biliary obstruction due to stones or malignancy were studied histochemically and electron microscopically. The surface of the bile duct is lined by a tall epithelium which extends into diverticula. Apically, they contain some neutral and sialated mucosubstances. Fucosyl residues were found in the Golgi apparatus and along the apical cell membrane. The latter is lined by microvilli. There was a well-developed rough endoplasmic reticulum and Golgi apparatus and a small number of apical secretory droplets. Large numbers of lipid droplets were present basally in some cells. Lipid-containing macrophages were also seen intra-epithelially and in the lamina propria. This suggests a possible pathway for lipid transport. The glands were lined by cuboidal cells, some containing much mucus--sulphated, sialated, and neutral with a basal nucleus. A well-developed endoplasmic reticulum and Golgi apparatus were found with abundant secretory droplets. The glandular epithelium contained lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. These may play a protective role. The lamina propria contained scattered smooth muscle cells amongst the fibroblasts and inflammatory cells.

Cholestasis, Extrahepatic↗
PubMed1994

The utility of laparoscopic common bile duct exploration in the treatment of choledocholithiasis.

Laparoscopic common bile duct exploration (CBDE) was performed in 24 patients over a 23-month period. Fourteen of these patients were suspected preoperatively of harboring common bile duct (CBD) calculi. Of these, endoscopic sphincterotomy was unsuccessful in eight. Laparoscopic CBDE was performed either transcystically or via a choledochotomy. In all cases, completion cholangiography demonstrated that the CBD was free of stones. All patients were sent home with drains placed in their extrahepatic biliary system. Mean hospital stay was 2.7 days. There was no mortality. The overall morbidity rate was 29.1%. It included one trocar site infection (4.1%), four cases of mild postoperative amylasemia (16.6%), and two cases of retained stones (8.3%) seen in two patients on follow-up tube cholangiography that were successfully extracted percutaneously. The authors feel that laparoscopic CBDE is a safe and effective method of CBD stone removal that offers an alternative to preoperative ERCP and sphincterotomy.

Adult↗
PubMedDate not supplied

Choledocholithiasis.

Explore the source record for details and available documents.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Delayed hemorrhage following endoscopic retrograde sphincterotomy for choledocholithiasis.

To define the clinical significance of delayed postsphincterotomy hemorrhage, we reviewed 476 consecutive ERCP procedures performed over a three-year period. Of 250 patients who underwent endoscopic sphincterotomy (ES), five (2%) developed postprocedure hemorrhage, two of whom had immediate, self-limited bleeding that resolved after endoscopic injection of epinephrine and did not require transfusion. The other three had delayed hemorrhage characterized by: onset 20-48 hr after the procedure, melena without hematemesis as the index clinical manifestation of bleeding, and atraumatic balloon extraction of common duct stones. Transfusion of 2-6 units of packed erythrocytes was necessary in each and one patient required surgical hemostasis. Delayed hemorrhage following ERS is an important, frequently severe complication to remember when contemplating performing ERS as an outpatient procedure.

Adult↗
PubMed1990

Laparoscopic laser cholecystectomy and choledocholithiasis.

The management of common bile duct stones during laparoscopic laser cholecystectomy (LLC) is uncertain. Open common bile duct exploration is the least desirable option since it defeats the purpose of LLC. Endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy has become the procedure of choice since it has a high rate of success and results in minimal morbidity. Intraoperative techniques using balloon catheters and the flexible choledochoscope via the cystic duct may obviate the need for ERCP in selected cases.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1980

Surgical significance of dilatation of the common bile duct--with special reference to choledocholithiasis.

Diameter of the common bile duct was measured in 3,119 patients who underwent primary operation for gallstones, during the period from 1975 to 1978. Although dilatation of the common bile duct was most marked in patients with bilirubin stones in the bile duct alone, dilatation was also observed in patients with cholesterol stones in the gallbladder alone. Drip infusion cholangiograms of 84 healthy patients showed that the common bile duct dilated in parallel with aging. A review of patients with congenital choledochal cysts reported in the literature in Japan revealed that few had gallstones. Thus, it was difficult to determine whether common bile duct dilatation was the cause or result of gallstones, and it was suggested that the so-called drainage operation such as choledochoenterostomy should be done only under strict indications.

Adult↗