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At least 595 records · Page 33Linked to original sources
PubMed1991

Common bile duct cancer with massive necrosis mimicking choledochal dilatation on CT. Case report.

Carcinomas of the common bile duct are usually seen as dilatation of the bile duct proximal to a solid mass on CT. In the case reported here, the common bile duct cancer itself mimicked dilated common bile duct on CT because of massive necrosis. In a case of simulating dilated common bile duct on CT, and discrepancy between CT and ultrasonography or endoscopic retrograde cholangiopancreatography, a common bile duct cancer with massive necrosis should be included in the differential diagnosis.

Aged↗
PubMed2000

Gallstones and common bile duct calculi in infancy and childhood.

BACKGROUND: Gallstones and common bile duct calculi have been increasingly diagnosed in recent years in infants and children. The present study aims to review the spectrum of this disorder in the last two decades. METHODS: During the period 1979-96 a total of 102 consecutive infants and children were diagnosed in Royal Alexandra Hospital for Children with gallstones or common bile duct calculi. A detailed retrospective analysis and follow-up of these children form the basis of the present report. RESULTS: The median age at presentation was 10 years. Recurrent right upper quadrant pain was the most common clinical presentation. The male-to-female ratio was 3:2 and this male predominance was noted in all the age groups. Aetiologically three identifiable groupings were noted: idiopathic disease (n = 66), haematological diseases (n = 23) and specific non-haematological disease (n = 13). The incidence of idiopathic and haematological stones had increased two-fold in the second half of the study. The majority of children (86%) underwent surgical correction. Choledocholithiasis (CDL) was noted in 18 children (18%). Jaundice was commonly associated with abdominal pain in this group. A higher incidence of common bile duct calculi was noted in females and children less than 5 years of age (P < 0.01). Common bile duct calculi were accurately diagnosed by pre-operative imaging in all 18 children. Surgical correction was required in all except two. CONCLUSIONS: The present study suggests an increasing incidence of gallstones in children. Cholelithiasis in children occurs commonly in boys, is idiopathic in aetiology and presents with a vague right upper quadrant pain. Choledocholithiasis is not uncommon in children, occurs more commonly in girls aged < 5 years and presents with jaundice or abnormal liver function tests.

Adolescent↗
PubMed1994

[A rare case of accessory choledochus associated with diverticulum of the common bile duct].

The Authors report on a rare congenital anomaly of the biliary tract characterized by an accessory choledochus, which drained the inferior paramedian segments of the liver. Such anomalous duct emerged from the hepatic hilum right behind the cystic artery, the cystic duct and the gallbladder to join the primary choledochus few millimeters from the papilla of Vater. At the point of junction, in the posterior aspect of the II duodenal portion, a choledochal diverticulum containing cholesterin and bilirubin stones was also present. Surgery was indicated by the onset of a pseudo-obstructive syndrome followed by jaundice. At laparotomy the exact diagnosis was possible. The intervention consisted in a choledochotomy and duodenotomy with tube drainage and exeresis of the choledochal cyst containing the stones.

Adult↗
PubMed1979

The muscle content and contractile capability of the common bile duct.

The supraduodenal portion of the human and canine common bile duct has been shown by indirect immunofluorescent staining with anti-actin sera to contain scattered bundles of smooth muscle arranged predominantly in a longitudinal direction with respect to the axis of the bile duct. Isolated strips of canine common bile duct in vitro can contact in response to stimulation with cholecystokinin. The force of contraction in a longitudinal direction is about three times that in a transverse direction but only 3% of that produced by isolated gallbladder strips. There appears to be a roughly proportional relationship between the amount of muscle demonstrated and the force of contraction in response to cholecystokinin.

Actins↗
PubMed1994

Primary duct closure versus T-tube drainage following exploration of the common bile duct.

T-tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T-tube drainage of the CBD following exploration for calculous disease. Thirty-seven patients underwent primary closure and 26 underwent closure over T-tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre-operative bilirubin, amylase and white cell count. Forty-three per cent of operations were performed by a consultant in the primary closure group and 65% in the T-tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T-tube group, to a median of 11 days, compared to 8 days in the primary closure group (P = 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T-tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long-term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T-tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Common bile duct stenosis in complicated chronic pancreatitis.

BACKGROUND: Common bile duct stenosis (CBDS) is one of the most frequent and serious complications in patients with chronic pancreatitis. Due to improved diagnostic tools, the frequency of CBDS seems to occur more frequently, nevertheless the prevalence varies widely because of different selection criteria. METHODS: Between April 1982 and October 1996, 323 patients with chronic pancreatitis and inflammatory mass in the head of the pancreas (IMH) (286 patients) or CBDS alone (37 patients) were operated. Patients' data including US, CT, ERCP, endocrine and exocrine function tests were documented prospectively. Dividing patients into groups with and without CBDS, clinical data were comparable concerning distribution of sex, age, etiology of the disease and clinical feature. RESULTS: Regarding the subgroup of 286 patients with inflammatory mass in the head of the pancreas (IMH), 154 patients (51%) showed radiological proved CBDS; out of this group, 82 patients (57%) revealed cholestasis and 37 patients (26%) had one or several periods of jaundice. By means of ERCP, 104 patients (72%) revealed short stenosis of the common bile duct (CBD) (<2 cm). No significant differences could be found in terms of morphologic alterations like pancreatic main duct stenosis, pseudocysts, duodenum stenosis, vascular obstruction. Ten patients (7%) in the group with CBDS and 13 patients (9%) in the group without CBDS had cancer in the pancreatic head. Concerning the endocrine function, the group of patients with CBDS had a significantly elevated rate of impaired glucose metabolism (IGT or IDDM) compared to the group without CBDS (60% versus 38%; P < 0.003). These results demonstrate that patients with IMH bear the risk of developing a stenosis of the CBD even before they become symptomatic with cholestasis or jaundice. CONCLUSION: Due to the elevated morbidity and the significantly deteriorated endocrine function, patients of this group are candidates for early surgical treatment.

Adolescent↗
PubMed1980

Intraduodenal manipulations of the common bile duct.

The history of the development and technique of endoscopic sphincterotomy are discussed. This includes a review of 796 successful sphincterotomies out of 838 attempts. The indications for sphincterotomy were choledocholithiasis in 632 patients, stenosis of the papilla of Vater in 136, periampullary tumor in 24, and stones in the main pancreatic duct in 4 patients. Of 632 patients with choledocholithiasis, 234 passed the stone spontaneously, and 358 has the stone extracted. Residual stones remained in 40 patients. Complications, such as bleeding, retroperitoneal perforation, pancreatitis, cholangitis, and impaction of the Dormia basket, were noted. This indicates a morbidity of 6.9 percent. Fifteen patients required laparotomy. The overall mortality was 1.13 percent. Endoscopic laparotomy. The overall mortality was 1.13 percent. Endoscopic sphincterotomy is a relatively safe and effective method for treatment of extrahepatic cholestasis. The complication rate for patients at high risk is significantly lower than for patients undergoing conventional transabdominal operations.

Aged↗
PubMed1984

The major role of the operative cholangiogram within the indications for common bile duct exploration.

The accuracy of the clinical indications for common bile duct exploration was studied in a group of 495 patients. The patients were divided into two groups: operative cholangiography was performed in 5 per cent of cases in Group A and 62 per cent of cases in Group B. The results demonstrate the high efficiency of this procedure, its safety, accuracy (82%), and its effectiveness in the discovery of unexpected stones and in shortening of hospitalization. Analysis of the results point out the indications for intraoperative cholangiography: It should be carried out in all biliary tract operations, except for those in which other clinical indications for exploration already exist (palpable stones in the common bile duct or the combination of dilated common bile duct either with jaundice at the time of operation or with history of severe jaundice in the past). Under all other circumstances an operative cholangiogram should be performed.

Acute Disease↗
PubMed2002

One hundred laparoscopic choledochotomies with primary closure of the common bile duct.

BACKGROUND: Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. METHODS: Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). RESULTS: The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1-26). No patient required additional CBD procedures during follow-up. CONCLUSIONS: In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.

Adult↗
PubMed2001

Laparoscopic ultrasonographic appearance of the common bile duct mucosa: a predictor of choledocholithiasis.

Previously we reported on the use of laparoscopic ultrasonography in detecting common bile duct stones during laparoscopic cholecystectomy. The aim of this study is to describe the laparoscopic ultrasonographic appearance of the common bile duct mucosa in patients with choledocholithiasis. Medical records of 44 patients with an increased risk for common bile duct stones undergoing laparoscopic cholecystectomy between 1993 and 1998 were reviewed. In the operating room, the laparoscopic ultrasonographic appearance of the common bile duct mucosa was scored in real time as normal, mild changes (hyperechoic mucosa), or severe changes (hyperechoic with mucosal thickening). Of the 31 patients (70%) with stones or sludge in the biliary tree, 29 (94%) had either severe (58%) or mild (36%) hyperechoic and 2 (6%) had normal-appearing common bile duct mucosa on laparoscopic ultrasonography. Of the 13 patients (30%) with no documented stones or sludge, 11 (85%) had normal and 2 (15%) had mild hyperechoic common bile duct mucosa on laparoscopic ultrasonography. Both of these patients had laboratory values indicating recent passage of common bile duct stones. The association between common bile duct stones and the presence of hyperechoic common bile duct mucosa was statistically significant (P < .0001, Fisher's exact test). This is the first report of hyperechoic common bile duct mucosa demonstrated by laparoscopic ultrasonography as a predictor of common bile duct stones. This finding is evident in the majority of patients with common bile duct stones and also may be associated with recent passage of a stone into the duodenum.

Cholangiography↗
PubMed1983

Angioleiomyoma of the common bile duct.

An 80-year-old woman with angioleiomyoma in the common bile duct is described. Apart from weakness and jaundice, the patient had no signs or symptoms until after endoscopic retrograde cholangiopancreatography, when cholangitis and septicaemia due to Pseudomonas aeruginosa developed. X-ray during endoscopy revealed a tumour obstructing the common bile duct and was assumed to be malignant. Because the patient was so old and her general condition had deteriorated, no treatment was given. Autopsy revealed a benign angioleiomyoma of the common bile duct and suppurative cholangitis, the latter obviously caused by the endoscopy.

Aged↗
PubMed1985

[Width of the lumen of the common bile duct: sonography compared with ERCP].

The diameter of the common bile duct can be easily determined by ultrasound and by ERCP (endoscopic retrograde cholangiography). The measured values differ by as much as 20% due to the technical features of both methods. A study with 100 patients showed that in 20% of the patients the diameter of the common bile duct determined by ERCP was twice that of the value determined by sonography. The difference can be definitely explained by the influence of butyl scopolamine and the high-pressure injection of the contrast medium into the bile duct system. The sonographic measured size of the common bile duct is correlated with the physiological value but a sure prediction of the expected value to be determined by ERCP is not possible.

Cholangiopancreatography, Endoscopic Retrograde↗