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PubMed1985

Common bile duct stricture without obvious cause.

Common bile duct strictures without apparent cause are unusual, yet probably occur more often than has been recognized. Whether this condition represents a different cause of biliary stricture or is just a forme fruste of recognized injuries or causes is not clear. Nonetheless, the surgeon should be aware that such isolated strictures without obvious cause may occur. The common causes of biliary stricture should be ruled out for diagnostic and therapeutic reasons. The management of such strictures is the same as for strictures due to the generally recognized causes.

Adult↗
PubMed1976

Spontaneous rupture of the common bile duct.

Spontaneous rupture of the common bile duct is an extremely rare condition. Only 11 cases have been reported in the world literature. An unusual case of this complication is reported and the possible etiology and pathogenesis are discussed.

Biliary Tract Diseases↗
PubMed1979

Gallstone-linked tubular stenosis of the common bile duct.

The transpancreatic segment of the distal common bile duct can be extrinsically stenosed by a pure gallstone-linked pancreatic disorder. It has a specific roentgen configuration--long, tubular and smooth. In two instances it was associated with severe suppurative complications. Precholedochotomy cholangiography is required to identify such long segment benign tubular stenosis of the distal common bile duct as an indication for management alternatives and as a guide to judicious common bile duct exploration.

Aged↗
PubMed2006

[Oat cell carcinoma of the common bile duct].

Oat cell tumors in the common bile duct are extremely rare. We describe the case of a 76-year-old man with skin and mucous jaundice of 15 days' duration without constitutional syndrome. A tumor was diagnosed in the mid portion of the common bile duct. After surgical resection, pathological analysis revealed small-cell (oat cell) carcinoma. The treatment of these tumors is multidisciplinary. Surgery is followed by chemo- and radiotherapy.

Aged↗
PubMed1985

Spontaneous rupture of the common bile duct.

Spontaneous rupture of the common bile duct is rare, but may result from increased intraductal pressure with associated calculous erosion and necrosis of the bile duct wall secondary to thrombosis. Two cases are reported; one clearly related to calculous erosion and the other unexplained. Survival depends on early diagnosis. Aggressive supportive therapy, including Swan-Ganz catheter, intensive care unit monitoring, and appropriate antibiotics, are mandatory. Only with early operation to alleviate sepsis and decompression of the biliary system can better survival be expected.

Adult↗
PubMed2005

Technical aspects in the laparoscopic management of complicated common bile duct stones.

The management of common bile duct (CBD) stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of last century, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) has become the mainstream treatment for CBD stones and gallstones in most medical centers around the world. However, in certain situations, ERCP cannot be feasible because of difficult cannulation and extraction. ERCP can also be associated with potential serious complications, in particular for complicated stones requiring repeated sessions and additional maneuvers. Since our first laparoscopic exploration of the CBD (LECBD) in 1995, we now adopt the routine practice of the laparoscopic approach in dealing with endoscopically irretrievable CBD stones. The aim of this article is to describe the technical details of this approach and to review the results from our series.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2006

5F sphincterotomes and 4F sphincterotomes are equivalent for the selective cannulation of the common bile duct.

BACKGROUND: Cannulation of the common bile duct (CBD) is the first step in endoscopic retrograde cholangiopancreatography (ERCP). Cannulation difficulty is a known risk factor for post-ERCP complications and may be minimized by the use of a smaller caliber sphincterotome. OBJECTIVE: To compare the efficacy of CBD cannulation with a 4 F versus a 5 F sphincterotome. DESIGN: A randomized controlled trial, with concealed allocation and double-blinding. PATIENTS: Adult patients undergoing their first ERCP at a tertiary referral center. INTERVENTION: Patients were randomized to undergo CBD cannulation with either a 4 F or 5 F sphincterotome. MAIN OUTCOME MEASUREMENTS: Successful deep cannulation in <15 attempts was the primary outcome. Secondary outcomes included number of attempts/time to cannulation, incidence of complications within 24 hours, and overall cannulation success (including patients before and after crossover). Analysis was intention to treat and included standard descriptive and inferential methods. RESULTS: A total of 107 patients were randomized: 51 (4 F) versus 56 (5 F). The majority were female (71%) and white (92%). Baseline demographics, presenting symptoms, and laboratory values were similar between groups. Similar success in initial cannulation was observed: 84.3% (4 F) and 83.9% (5 F). No differences were noted in time to cannulation (5.12 min [SD, 4.8] for 4 F vs 4.46 min [SD, 4.13] for 5 F; p = NS), number of attempts to cannulation (6.2 [SD, 5.2] for 4 F vs 5.7 [SD, 4.9] for 5 F; p = NS), or complications. The overall cannulation success was 92.2% (4 F) and 92.9% (5 F). LIMITATIONS: Premature termination of the trial resulted in decreased power. CONCLUSIONS: There exists no significant difference in efficacy between 4 F and 5 F sphincterotomes. The choice of initial sphincterotome should be dictated by physician preference.

Adult↗
PubMed2004

Teratoma arising from anomalous common bile ducts: a case report.

Teratoma arising from extrahepatic common ducts is very rare entity. The authors found 2 teratoma cases originating from common bile duct in the literature. As a third case, the authors report on a 4-month-old girl with benign cystic teratoma arising from distal common hepatic bile duct and with anomalous common bile ducts. Surgical management of the patient also is discussed.

Abnormalities, Multiple↗
PubMed2004

Laparoscopic management of common bile duct stones.

BACKGROUND: While laparoscopic cholecystectomy is widely accepted for therapy of cholecystolithiasis, controversy still exists concerning the management of common bile duct stones. Besides preoperative endoscopic papillotomy followed by laparoscopic cholecystectomy and open common bile duct surgery, management of common bile duct stones can be conducted by laparoscopy, if respective experience is available. METHOD: During laparoscopic cholecystectomy a cholangiography via the cystic duct is routinely performed. If bile duct stones are detected they are retrieved via the cystic duct or via incision of the common bile duct by insertion of a Fogarty catheter or Dormia basket. Exclusion criteria against simultaneous laparoscopic management include suspicion of malignancy, severe pancreatitis, or cholangitis. RESULTS: From November 1991 to March 2002, 200 patients primarily underwent laparoscopic therapy of bile duct stones. Retrieval was performed via cystic duct and common bile duct incision in 115 and 85 cases, respectively. Complete removal was achieved in 91%; complication rate and mortality was 7% and 0.5%, respectively. During the same period primary endoscopic papillotomy was necessary in 40 patients because of the above contraindications. CONCLUSIONS: When correct indications and surgical expertise are observed, simultaneous laparoscopic management of common bile duct stones represents a safe and minimally invasive alternative to a two-procedure approach.

Cholangiography↗
PubMed1978

New cholangiographic sign of common bile duct obstruction: initial opacification of intrahepatic ducts.

A previously undescribed sign of common bile duct obstruction during intravenous cholangiography - initial visualization of proximal intrahepatic ducts - was observed in 26 patients with surgically proven obstructive disease of the distal common duct. In all cases, opacification of intrahepatic biliary radicles occurred on standard interval films prior to visualization of the extrahepatic common bile duct, the reverse of the normal sequence. The abnormal opacification pattern reflects stasis of bile flow in the presence of distal obstruction and seems analogous to the urographic finding of opacified intra-renal calyces as the initial manifestation of distal ureteral obstruction. Recognition of the alteration in the initial cholangiographic opacification sequence signals the need for delayed films to confirm the diagnosis of a distal choledochal obstruction.

Aged↗
PubMed1995

Imaging of the common bile duct during laparoscopic cholecystectomy: sonography versus videofluoroscopic cholangiography.

OBJECTIVE: The purpose of this prospective study was to compare the accuracies of laparoscopic sonography and laparoscopic videofluoroscopic cholangiography in detecting common bile duct stones and in identifying ductal anomalies during laparoscopic cholecystectomy. SUBJECTS AND METHODS: Ninety-five patients who underwent laparoscopic videofluoroscopic cholecystectomy were prospectively studied with laparoscopic sonography and laparoscopic videofluoroscopic cholangiography. The number of successful studies, the time required to complete the study, and complications resulting from the study were recorded. The biliary system was evaluated for complete visualization of the common bile duct, visualization of the cystic duct, ductal anomalies, maximum diameter of the common bile duct, and common bile duct stones and/or debris. Also determined was whether laparoscopic sonographic findings altered operative management. RESULTS: Laparoscopic sonography was successfully performed in 93 of 95 patients, and laparoscopic videofluoroscopic cholangiography was successfully performed in 90 of 95 patients. The time required to complete laparoscopic sonography ranged from 3 to 18 min (mean +/- SD, 8 +/- 3 min), and that required to complete laparoscopic cholangiography ranged from 5 to 28 min (mean +/- SD, 14 +/- 6 min). Laparoscopic sonography visualized the complete common bile duct in 84 of 93 patients, and laparoscopic cholangiography did so in 86 of 90 patients. Laparoscopic sonography showed the cystic duct in 87 of 93 patients, and laparoscopic cholangiography did so in 80 of 90 patients. Laparoscopic sonography showed no ductal anomalies in any of the 93 patients. Laparoscopic cholangiography showed ductal variants in 13 of 90 patients; however, 11 of the variants were proximal to the sonographic scan plane. Laparoscopic sonography showed common bile duct stones in 12 of 93 patients, and laparoscopic cholangiography did so in five of 90 patients. Laparoscopic sonography altered operative management in two of 93 patients. CONCLUSION: Our results show that laparoscopic sonography is as accurate as laparoscopic videofluoroscopic cholangiography in visualizing the common bile duct and cystic duct and in detecting common bile duct stones. However, the data are too limited to determine whether laparoscopic sonography is as accurate as laparoscopic cholangiography in detecting ductal anomalies.

Adult↗