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At least 577 records · Page 32Linked to original sources
PubMed1999

Clinical experience with endoscopic stents for treatment of common bile duct stones.

Endoscopic removal of common bile duct (CBD) stones after endoscopic sphincterotomy (EST) is now a widely accepted procedure. Surgery is usually recommended when extraction of stones after EST fails. For patients with major medical problems or who are at high surgical risk, however, endoscopic stent placement may help to prevent stone impaction and cholangitis. In this report, we describe the long-term effects and complications of biliary stent use in elderly patients with CBD stones. From August 1995 to June 1998, 19 patients with CBD stones underwent stent placement by duodenoscopy. Three of these patients underwent this procedure for temporary treatment while awaiting surgery or EST. In the remaining 16 patients (6 men and 10 women, mean age 76 +/- 10 years), invasive management carried a high risk of complications. We used a 7F straight stent for the first patient, while the remaining 15 received 7F pigtail stents. During a mean follow-up period of 34 months, two patients were lost to follow-up and two patients had migration of the stents. Three patients had acute cholangitis with stents in situ. Of these, one underwent stent exchange 8 months later, while the CBD stones were cleared either by endoscopy or surgery in the other two patients. Five patients died of nonbiliary diseases during the follow-up period. Our results show that long-term biliary stent placement is an advisable alternative therapeutic modality for high-risk and debilitated patients with CBD stones.

Aged↗
PubMed2000

Management of choledocholithiasis during pregnancy by magnetic resonance cholangiography and laparoscopic common bile duct stone extraction.

Management of common bile duct (CBD) stones during pregnancy is a difficult problem. The authors reported the case of a patient who was 22 weeks' pregnant who had a symptomatic CBD stone successfully treated by the association of magnetic resonance cholangiography and laparoscopic CBD stone removal. The patient delivered a healthy baby boy at 39 weeks. Magnetic resonance cholangiography and laparoscopic CBD exploration is a viable option in the management of CBD stones in pregnant patients that carries a low risk for the fetus while preserving the advantages of minimally invasive surgery for the mother.

Adult↗
PubMed1991

The effects of serotonin (5-HT) on twitch contractions induced by electrical stimulation of guinea-pig common bile duct.

In guinea-pig common bile duct serotonin (5-HT) (10(-7)-10(-5) M) administered cumulatively caused dose-dependent inhibition of the twitches evoked by electrical field stimulation (0.3 ms, 0.1 Hz, supramaximal voltage). Maximum inhibition was 86 +/- 2% of the control twitch amplitude. The effect was mainly due to a presynaptic mechanism since acetylcholine induced contractions were not influenced by 5-HT. This inhibitory action was unaffected by ketanserin (10(-6) M), ICS 205-930 (10(-6) M) and yohimbine (10(-6) M) indicating the lack of involvement of 5-HT2, 5-HT3 and alpha-2 adrenergic receptors respectively. Metoclopramide (3 x 10(-6)-3 x 10(-5) M) per se increased the twitch height and antagonized the 5-HT effect in a non-competitive manner. Methysergide (10(-7)-10(-5) M) also prevented the twitch inhibition and the mode of blockade was not consistent with simple competitive antagonism. The results suggest that presynaptically located 5-HT receptor differs in its pharmacological properties from other neuronal 5-HT receptors.

Acetylcholine↗
PubMed1984

Early endoscopic sphincterotomy for extraction of residual stones of the common bile duct.

Retained calculi of the common bile duct are a significant cause of morbidity after operations upon the biliary tract. When percutaneous extraction is not possible or delay undesirable, endoscopic sphincterotomy is a safe and effective technique even when used in the early postoperative period. Five such patients treated at Beth Israel Medical Center within the past year are presented and discussed. Successful stone extraction was done in all patients, and there was no morbidity or mortality related to the procedure.

Adult↗
PubMed1995

Longterm follow-up of biliary stents for retained common bile duct stones in elderly patients.

Common bile duct (CBD) stones in elderly patients are best treated by endoscopic sphincterotomy (ES). If CBD clearance cannot be achieved endoscopically a biliary stent may be inserted. Although satisfactory short-term results have been reported, few reports on their longterm outcome are available. Over a 3-year period, January 1987 to December 1989, 100 patients with CBD stones were referred for endoscopic stone removal. In 14 of these patients (3 men, 11 women; median age 83 years, range 79-97 years) the CBD could not be cleared endoscopically and a stent was inserted. Twelve of the 14 patients were jaundiced and 5 had acute cholangitis (AC). The maximum diameter of the retained stones ranged from 10-42 mm with a median of 17 mm. Stent insertion resolved jaundice and sepsis in all cases and all patients were discharged from hospital. In-patient stay ranged from 1-82 days (median 12 days) and was significantly increased by the presence of acute cholangitis (P = 0.03, Mann-Whitney U-test). Longterm follow-up was obtained in 13 of the 14 patients (93%) by referral to their general practitioner and out-patient notes. Seven patients are alive and well (median follow-up 43 months, range 34-60 months). One of these 7 developed further jaundice owing to stent migration and had further ES and stone removal. Six patients died at 1, 3, 12, 32, 36 and 42 months following stent insertion from unrelated causes. One patient developed further AC requiring antibiotic treatment and another patient required stent replacement.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1981

In vivo measurements of the internal and external diameters of the common bile duct in man.

As in other studies, it was not possible to define precisely the normal size of the common bile duct measured either externally or roentgenographically. However, the roentgenographically measured diameter of the common bile duct appears superior to the external width of the common bile duct in discriminating between patients with, and without, common bile duct disease. If the common bile duct was 1 centimeter or less roentgenographically, then only one of 78 patients studied had common bile duct disease, while all patients with common bile ducts 1.5 centimeters or larger had common bile duct disease. The range from 1.1 to 1.4 centimeters was indeterminate as a predictor of disease, since two of 19 patients in this group had common bile duct calculi. The utilization of the internal diameter instead of the external diameter of the common bile duct as a predictor of disease could be especially important in the clinical separation of patients with medical from surgical jaundice when noninvasive diagnostic tests, such as ultrasound and computerized tomography, are used.

Cholecystitis↗
PubMed1984

[Hepatobiliary scintigraphy in the diagnosis of common bile duct cysts in children].

A cyst of the common bile duct, the most frequent variant of cystic dilatation of the extrahepatic biliary tract, presents a serious diagnostic problem. Using serial scintigraphy with 99mTc-HIDA 13 children with cysts of the common bile duct confirmed by the results of operative cholangiography, were examined. In 8 of them a radionuclide study was performed at varying times after operation (cyst extirpation with the establishing of hepatoenteroanastomosis--4 patients, and variants of internal drainage operations--4 patients). Typical scintigraphic signs were the following: sacculated or spheroidal dilatation of the common bile duct in combination with dilatation of the left (7), right (1) or both lobular bile ducts, absence of the gall bladder visualization. In the first 15 min of examination in large size cysts zones of the lowered accumulation of the radiopharmaceutical agent were revealed in the area of the portal fissure. Indicators of absorptive-excretory hepatic function changed mainly in children with spheroid-shaped cysts demonstrating alongside with the time of intestinal visualization the degree of disorder of permeability of the choledoch distal parts. The recovery of the anatomic-functional state of the biliferous system occurred earlier (up to 1.5 year) in children after cyst extirpation than after internal drainage operations. It manifested itself in returning the diameter of the bile ducts to normal and in the improvement of absorptive-excretory hepatic function.

Child↗
PubMed1980

Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts.

Although it is commonly accepted that pancreatic pseudocysts can cause obstruction of the common bile duct, few documented examples of this phenomenon exist. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct, rather than to pressure on the duct by the pseudocyst. We report three additional cases, in two of which fibrosis and not the pseudocyst caused the biliary obstruction. This experience illustrates the imperative to perform intraoperative cholangiography after drainage of the pseudocyst and the necessity of a biliary-enteric bypass if bile duct obstruction has not been relieved by simple decompression of the pseudocyst.

Adult↗
PubMed1976

[Congenital diverticuli of the common bile duct. Review of the literature].

Among congenital dilatations of the common bile duct, a congenital diverticulum of the common bile duct may remain clinically latent for a long period. One case is reported in a 77 year old subject. Precise diagnosis of the disease is often made at operation and on pathological examination. The diverticulum is cured in most cases after surgery which consists of simple removal, but which may sometimes require reconstruction of the common bile duct.

Aged↗
PubMed1976

A case of common bile duct ascariasis diagnosed by duodenoscopy.

A case of common bile duct ascariasis diagnosed by duodenoscopy is presented. At the admission, the patient, cholecystectomized for gallstones 13 years before, had been complaining of epigastric pain associated with post-prandial and nocturnal vomiting. Physical examination showed only slight tenderness in the epigastrium. Laboratory findings were within normal limits, with the exception of a moderate leukocytosis. Intravenous cholangiography showed the lack of visualization of the terminal common bile duct, but the flow of contrast medium was normal. Duodenoscopy, carried out without a specific clinical suspicion, revealed an ascaris lumbricoides inserted in the common bile duct and partially protruding from the papilla Vateri. The patient was treated by piperazine, intravenous fluids, antibiotics and a choleretic compound. After 24 hours an ascaris 33 cm long was excreted in the faeces and the patient became symptom-free. Some pathophysiological, clinical and epidemiological aspects of biliary ascariasis are discussed.

Aged↗
PubMedDate not supplied

Spontaneous common bile duct perforation in adult: a case report and review.

Common bile duct perforation has been reported in adults after invasive procedures. Spontaneous common bile duct perforation is a rare entity as a cause of acute abdomen in adults. A few cases due to choledocholithiasis have been reported as a cause of spontaneous perforation. We report an adult patient who presented with acute abdomen after spontaneous common bile duct perforation due to unknown etiology who was treated successfully.

Abdomen, Acute↗
PubMed1976

Spontaneous perforation of common bile duct in infants.

Two infants with spontaneous perforation of the common bile duct are described. One presented with mild jaundice, dark urine, acholic stools, and hydroceles, the other with bilateral inguinal hernia. In both the diagnosis was unsuspected until bile-stained ascites was discovered. Both eventually developed bile-staining of the scrotum. Neither was acutely ill. The 131I-Rose Bengal faecal excretion test showed reduced faecal excretion at 8% and 12% of the injected dose with 16-5 and 17%/dl of the dose being recovered in the ascitic fluid 48 hours after intravenous injection. The ascitic:plasma ratio of isotope at that time was 32:1 and 28:1. Operative cholangiography in both showed a perforation at the junction of the cystic duct and common bile duct with no contrast entering the duodenum. Cholecystenterostomy using a Roux-en-Y loop of jejunum produced a rapid sustained recovery and is suggested as the treatment of choice. This condition should be considered in the differential diagnosis of obstructive jaundice in infancy since early surgical correction is necessary.

Ascitic Fluid↗
PubMed1992

Management of common bile duct obstruction associated with spontaneous perforation of the biliary tree.

Spontaneous perforation of the extrahepatic biliary tree during infancy is an uncommon event. The cause of bile duct perforation is unclear, but one-quarter of reported cases have been associated with a stone or bile sludge obstructing the distal common bile duct. A 4-week-old girl had jaundice, and a DISIDA (99m technetium diisopropyl iminodiacetic acid) scan revealed perforation of the biliary tree. Exploratory surgery showed distal common bile duct obstruction with proximal perforation. No attempt was made to remove the obstructing lesion because of duct inflammation. Common bile duct obstruction persisted until week 5 after surgery when cholangiography revealed free flow of contrast into the duodenum through a common bile duct of normal caliber without a filling defect. In the presence of acute inflammation associated with perforation of the biliary tree, exploration of the common bile duct to relieve a distal obstruction could prove hazardous. Our case and a review of the literature suggest that the obstructing stone or sludge may pass spontaneously if managed expectantly.

Biliary Tract Diseases↗