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PubMed2005

Primary malignant peripheral nerve-sheath tumor of the common bile duct.

Primary malignant peripheral nerve-sheath tumors of the common bile duct are extremely rare. To our knowledge, the published literature contains no previous case report of this disease. Here we report on a 58-year-old Japanese woman with a primary malignant peripheral nerve-sheath tumor of the common bile duct, which was completely resected. A hypoechoic mass was identified in the hepatic hilus, using ultrasonography and computed tomography. Endoscopic retrograde cholangiography revealed a smooth stricture and deviation of the common bile duct. Laparotomy exposed a firm mass around the common bile duct that had not invaded the surrounding tissues. Partial resection of the common bile duct and cholecystectomy were performed as the treatment of choice. The final histopathological diagnosis was malignant peripheral nerve-sheath tumor arising from the wall of the common bile duct.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1986

Dilatation of the common bile duct secondary to a hydronephrotic kidney.

Obstruction of the common bile duct secondary to hydronephrosis is uncommon. We observed common bile duct dilatation secondary to marked right hydronephrosis. Following nephrectomy the common bile duct returned to normal size, confirming the suspicion that the dilatation was due to extrinsic compression.

Adult↗
PubMed1988

Laserlithotripsy of common bile duct stones.

Endoscopic retrograde laser lithotripsy of common bile duct stones is a new technique which can be carried out through the endoscope without anaesthesia using ordinary endoscopic equipment. In the method described here a flashlamp pulsed Neodymium YAG laser (wave length 1064 nm) was used. Light energy was transmitted along a highly flexible quartz fibre with a diameter of 0.2 mm. This new technique was used in nine patients with concrements in the common bile duct, which could not be removed with the established endoscopic techniques. In eight of the nine the concrements (maximum diameter 4.7 x 3.1 cm) could be fragmented and in six the fragments could be extracted from the common bile duct. The total energy required was 80-300 J; complications were not observed.

Aged↗
PubMedDate not supplied

Association between common bile duct stones and treated hypothyroidism.

BACKGROUND/AIMS: The purpose of this study was to investigate the frequency of diagnosed hypothyroidism in patients with common bile duct stones. METHODOLOGY: The common bile duct stone group (Group I) consisted of all the patients who had verified gallstones in the common bile duct in endoscopic retrograde cholangiopancreatography during 1995. The control group (Group II) was matched for age, sex, and hospital admission. These patients did not have diagnosed gallbladder or common duct stones. In both groups there were 86 patients (56 women and 30 men). The median age in these groups was 73 (range: 22-92) years at the time of common bile duct stone diagnosis. Medical records of all patients were reviewed. RESULTS: In Group I the prevalence of previously diagnosed hypothyroidism was 7/86 (8%) compared with 1/86 (1%) in Group II (P = 0.01). Hypothyroidism was previously diagnosed only in the common bile duct stone patients (Group I) of over 60 years of age, where the prevalence was 7/66 (11%). In addition, we studied 36 consecutive gallbladder stone patients (Group III) of over 60 years, who had no evidence of common bile duct stones. Hypothyroidism had been diagnosed in them less frequently (2/36 = 6%) than in the age and hospital admission matched common bile duct stone patients (P = 0.01). Other diagnosed endocrine disorders did not differ between the study groups. CONCLUSIONS: There is a significant association between the common bile duct stones and previously diagnosed hypothyroidism. There stronger association between the common bile duct stones and hypothyroidism compared to gallbladder stones and hypothyroidism suggests a mechanism other than merely the cholesterol metabolism mediated mechanism. The 11% prevalence of previously diagnosed hypothyroidism in the common bile duct stone patients of over 60 years of age suggests all patients with common bile duct stones be screened for current thyroid dysfunction.

Adult↗
PubMed1994

[Argument for choledochostomy, intraoperative endoscopy and external biliary drainage in the treatment of lithiasis of the common bile duct. A 15-year experience].

The treatment of common bile duct stones is controversial. The objective of our study was to report the results of choledochotomy, rigid choledochoscopy and systematic external biliary drainage in the treatment of stones of the common bile duct. Over a 15-year period, 555 patients were operated in our department according to a precise surgical protocol. 14% of these patients were operated as an emergency and 11.8% were operated immediately after endoscopic sphincterotomy. One third of patients suffered from cholangitis. The endoscopic investigation of the common bile duct was positive in 81.5% of patients. The investigation was negative in 18.5% and negative choledochotomy was significantly more frequent in patients operated for acute pancreatitis (p < 0.05). External biliary drainage was performed in 95.7% of patients. When necessary, a bilioenteric anastomosis (3%) or a surgical sphincterotomy (1.9%) was also performed. The postoperative mortality rate was 4.8% significantly higher in patients over the age of 70, in patients operated as an emergency and in patients operated immediately after endoscopic sphincterotomy (p < 0.05). The morbidity rate was 8.4%. Residual stones were diagnosed in 4.4% of the patients. The presence of residual stones was significantly more frequent in patients with multiple stones of the common bile duct (p < 0.05). Long-term follow-up was available for 89% of patients, 95% of whom were asymptomatic. These results, based on a homogeneous therapeutic protocol, can be used as a reference for the evaluation of other techniques, especially endoscopic and laparoscopic techniques.

Adolescent↗
PubMed1988

Neuroma of the common bile duct.

Two cases of neuroma of the common bile duct (CBD) associated with jaundice and cholangitis both 15 years after cholecystectomy are presented. The surgical treatment, excision of the diseased CBD, followed by Roux-en-Y biliary drainage in one case and excision of the tumor with T-tube drainage in the other, was curative. A review of the world literature revealed 20 prior cases of CBD neuromas, 19 associated with jaundice. None was diagnosed prior to operation or autopsy. Mortality of treatment was 15% and all deaths were associated with a failure to excise the neuroma.

Aged↗
PubMed1979

Spiral filling defect in the common bile duct.

A spiral filling defect in the common bile duct was found in an elderly woman with intermittent obstructive jaundice. A large, smooth papilla was shown on hypotonic duodenogram. At laparotomy, mucus strans were found in the DUCT, and ampullary carcinoma in the duodenum. The significance of the mucus strand and large duodenal papilla is discussed.

Adenocarcinoma↗
PubMed1998

Laparoscopic common bile duct exploration: practical application.

OBJECTIVE: To evaluate the effectiveness of laparoscopic common bile duct exploration in unselected patients. DESIGN: Consecutive sample. SETTING: Tertiary care general hospital. PATIENTS: Three hundred and two patients with symptomatic cholelithiasis presenting to a single surgeon during a 5-year period. INTERVENTIONS: Laparoscopic cholecystectomy, cholangiography, and common bile duct exploration. MAIN OUTCOME MEASURES: Successful laparoscopic cholecystectomy and common bile duct exploration. RESULTS: Three hundred and two consecutive patients underwent cholecystectomy for symptomatic cholelithiasis; 280 of the procedures were successfully completed laparoscopically. Cholangiography was attempted in 269 patients, was successful in 239, and revealed evidence of choledocholithiasis in 25. Preoperative ultrasonography and liver function tests predicted the presence of common bile duct stones in 24% and 32% of patients, respectively. Seven of the patients with choledocholithiasis presented with biliary colic, 7 with biliary colic and jaundice, 8 with acute cholecystitis (3 with gallbladder perforation), 1 with acute cholecystitis and jaundice, and 2 with gallstone pancreatitis. Four of 5 patients underwent successful transcystic exploration with a biliary Fogarty catheter, 12 of 16 patients underwent successful transcystic choledochoscopy and stone basket extraction, and all 4 attempts at choledochotomy and choledochoscopic stone basket extraction were successful, for a total success rate of 80% with laparoscopic common bile duct exploration. One of the failures was converted to an open procedure, and 4 of the failures had successful postoperative endoscopic retrograde cholangiopancreatography and extraction of stones. CONCLUSIONS: Laparoscopic cholecystectomy and common bile duct exploration is a highly successful procedure for the management of common duct stones in an unselected group of patients. Choledochotomy with choledochoscopy is the preferred method of common bile duct exploration.

Cholangiography↗
PubMed1979

Nonoperative internal drainage of obstructive common bile ducts.

A new nonoperative method for internal drainage of common bile duct obstructions by endoscopic retrograde cannulation of the papilla of Vater is described. After introduction of a tube in the common bile duct, a substantial decrease in serum activity of bilirubin, alkaline phosphatase, and gamma-glutamyl transferase was found. In addition, a rapid improvement of the clinical condition could be observed. No serious complications occurred. It is concluded that internal drainage of common bile duct obstructions might be of great value in the preoperative treatment of patients with common bile duct obstructions.

Aged↗
PubMed1992

Cholescintigraphic demonstration of transient and functional common bile duct obstruction in a patient with acute pancreatitis.

Cholescintigraphy has proven useful in diagnosis of acute and chronic cholecystitis and evaluation of common bile duct obstruction. Common bile duct obstruction may be due to mechanical obstruction such as impact stone in the common duct or functional obstruction due to sepsis with intra-hepatic cholestasis or acute viral hepatitis. We present a cholescintigram of a patient with acute pancreatitis showing complete common bile duct obstruction.

Acute Disease↗
PubMed1976

Relation of exocrine pancreatic function to the diameter of the pancreatic and common bile ducts.

One hundred and thirty-nine patients were examined for possible chronic pancreatitis by means of both pancreozymin-secretin test and endoscopic pancreatography of pancreatocholangiography. Pancreatic function as assessed by the pancreozymin-secretin test was impaired in 89 (64%) of the entire group. No significant relationship was demonstrated between pancreatic secretion of fluid, bicarbonate and amylase and the diameter of main pancreatic duct in both the entire group of the subgroup of patients with pancreatic dysfunction. On pancreatogram no gross morphological abnormalities were found in a high proportion of patients whose pancreatic function was impaired in minimal to moderate degree. There was a significant linear correlation between the diameters of the main pancreatic duct and common bile duct. These data question the value of endoscopic pancreatography in the diagnosis of low to moderate grade chronic pancreatitis.

Adult↗
PubMed2001

DNA image analysis combined with routine cytology improves diagnostic sensitivity of common bile duct brushing.

BACKGROUND: Cytologic evaluation of common bile duct brushings has a low sensitivity for diagnosing malignancy because of scant cellularity, poor cellular preservation, or sampling errors occur. The aim of this study was to evaluate whether cytology combined with image analysis improves the diagnostic accuracy of bile duct brushing in comparison with cytology alone. METHODS: Forty-nine specimens of bile duct brushings obtained from 45 patients during endoscopic retrograde cholangiopancreatography were evaluated using cytology and image analysis. Specimens were classified as negative, atypical, suspicious, or malignant by using cytologic evaluation. DNA histograms were classified as diploid (D), broad diploid (BD), aneuploid (A), or tetraploid (T). Degree of hyperploidy (DH), representing cells with a DNA content > 5C was evaluated using a cutoff value of > or = 1%. Final diagnosis of cancer was based on tissue specimens that were obtained by fine-needle aspiration or surgical biopsy and clinical fol- low-up. RESULTS: Thirty-four patients ultimately proved to have a malignancy. Cytology revealed 19 negative cases, 15 atypical cases, 9 suspicious cases, and 6 malignant cases. Together, suspicious and malignant cytology cases yielded a sensitivity of 44% and a specificity of 100% for a cytologic diagnosis of cancer. The DNA histogram pattern was D in 24 cases, BD in 9 cases, and A in 16 cases. BD and A patterns were significantly associated with malignancy (P < 0.001). A DH > or = 1% was noted in 22 cases. DH alone had a sensitivity of 62% and a specificity of 91% and was significantly associated with malignancy (P < 0.004). Atypical cytology alone had a false-negative rate of 29%, but in combination with a DH > or = 1%, the false-negative rate decreased to 7%. Additionally, when the authors combined atypical, suspicious, and malignant cytology with a DH > or = 1%, the diagnostic sensitivity increased to 88%, but the specificity decreased to 73%. CONCLUSIONS: Combined cytology and image analysis of bile duct brushing increased diagnostic sensitivity compared with cytology alone. The findings suggest that image analysis may help select patients having atypical cytology who should undergo a more rigorous evaluation for malignancy. A larger prospective study of the usefulness of combined cytology and image analysis of bile duct brushing is warranted.

Adult↗
PubMed1978

Squamous cell carcinoma of the common bile duct.

Squamous cell carcinoma of the common bile duct in a young woman was treated with pancreatoduodenectomy and chemotherapy. She died eight months after diagnosis. Clinical presentation and aggressiveness of the tumor are similar to adenocarcinoma. Radical resection is the treatment of choice, particulary in young patients.

Adult↗
PubMed1991

Common bile duct distensibility after cholecystectomy.

To assess the possibility of common bile duct distensibility after cholecystectomy, we made a retrospective study of patients who had ultrasonography and endoscopic retrograde cholangiopancreatography (ERCP). The study comprised 52 patients without extrahepatic biliary obstruction; 19 had had cholecystectomy, 18 of whom complained of biliary colic similar to that they had had originally. The other 33 patients had intact, well visualized gallbladders; 15 of these patients had pain in the right upper quadrant or epigastrium, but none had chronic pancreatitis. The average diameter of the common bile duct at its widest point by ultrasonography was 4.8 mm (range, 4.0 to 9.0 mm) in the 33 patients with intact gallbladders, and 5.7 mm (range, 4.0 to 8.0 mm) in the 19 patients who had had cholecystectomy. The diameter by ERCP was 4.4 mm (range, 2.9 to 6.3 mm) in the patients with intact gallbladders, and 11.17 mm (range, 6.9 to 14.7 mm) in the patients who had had cholecystectomy. In each patient who had had cholecystectomy the diameter as measured by ERCP was larger than it appeared by ultrasonography. The results suggest that the common bile duct is distensible, and that this distensibility may be related to the postcholecystectomy syndrome.

Adult↗
PubMed1994

Endoscopic retrograde cholangiopancreatography (ERCP) and stent placement in the management of large common bile duct stones.

Management of large common bile duct (CBD) calculi is controversial. Endoscopic treatment is fraught with difficulty, particularly when stones are over one centimetre in diameter and the patient's coagulation is deranged. Between 1988 and 1993, 56 patients have been managed by endoscopic retrograde cholangiopancreatography (ERCP) and stent placement as the initial treatment for large CBD calculi. Complete follow up has been possible in 50 cases (89.3%). The median age was 73.5 years (range 29-92) and primary presenting symptoms were jaundice (n = 39), cholangitis (n = 6) or abdominal pain (n = 5). Median bilirubin was 99 mumol/L (range 7-926) and 60% of the patients had deranged clotting with a median thrombotest of 61%. Stones ranged in size from 0.9 to 4.5 cm (median 1.6 cm). Treatment was with a 7F 'pigtail' stent in 39 cases and a 10F straight stent in 11 patients. Morbidity occurred in 12% of cases with two deaths (4%). Stents remained in place for a median of 1 month (range 0.2-59). Definitive treatment of CBD stones, once the jaundice and sepsis had settled, involved surgery in 24 patients and repeat ERCP with sphincterotomy +/- mechanical lithotripsy in 17 cases. Nine patients remain alive and well with their stents still in place. Initial management of large CBD calculi by ERCP and stent placement carries a low morbidity and mortality and is a useful adjunct in the management of a difficult clinical problem.

Adult↗