Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “COMMON BILE DUCT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources
PubMed2006

Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre.

OBJECTIVES: To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones. DESIGN: Retrospective study. SETTING: Regional minimal access surgery training centre in Hong Kong. PATIENTS: Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005. MAIN OUTCOME MEASURES: Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality. RESULTS: A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months. CONCLUSIONS: Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMedDate not supplied

Conventional ultrasonography versus Tissue Harmonic Imaging for the assessment of the common bile duct in cholecystectomized patients.

PURPOSE: The ultrasonographic study of the common bile duct in cholecystectomized patients is very often hampered by the presence of meteorism, scarring tissue, and internal adhesions. The aim of this study was to assess the usefulness of Tissue Harmonic Imaging (THI) in these clinical circumstances. In this technique, the image is formed by using not only the fundamental echo but also its harmonics, which improves the signal-to-noise ratio and considerably reduces the artefacts found in conventional US images. MATERIALS AND METHODS: Seventy-six consecutive cholecystecomized patients (53 F, 23 M, average age 56.9+/-14.5 SD, range 20-81) were assessed. Patients were examined on an empty stomach. The examinations were performed with conventional ultrasonography and with THI. Based on the capability to visualise the distal portion of the common bile duct and in particular to assess the intraluminal content, the study results were rated by three radiologists blinded to each other's evaluation as insufficient (1), sufficient (2), good (3) ad excellent (4). RESULTS: The average diameter of the common bile duct was 4.74+/-2.3 mm (range 1.6-13 mm); at conventional ultrasonography, the visualisation was insufficient in 30% of the cases, sufficient in 52%, good in 18%. With THI the visualisation was sufficient in 17% of the cases, good in 59% and excellent in 24%. Ten out of 76 patients (13%) had stones in the common bile duct. In these cases, conventional ultrasonography was insufficient for diagnosis in 5 patients. All three radiologist (A, B and C) rated THI better than fundamental ultrasonographic imaging (ETG) (p-value <0.0001, Wilcoxon signed rank test). The mean (SD) of the differences between THI and ETG rating were for radiologist A, B and C respectively: 1.25 (0.57), 1.22 (0.51), 1.09 (0.57). Differences for all the radiologists did not significantly vary between older (over 74 years) and younger patients (p-value = 0.35, Wilcoxon rank-sum test). With Cohen's Kw evaluation we obtained better inter-observer agreement (0.71 and 0.80 A and B; 0.7 and 0.79 A and C; 0.71 and 0.81 B and C by conventional ultrasonography and THI). CONCLUSIONS: THI proved to be superior to conventional ultrasonography in the study of the common bile duct in cholecystecomized patients and in particular in the identification of choledocholithiasis.

Adult↗
PubMed1983

Incidence and significance of primary stones of the common bile duct in choledocholithiasis.

To assess the significance of primary common bile duct stones as an index predisposing to recurrent choledocholithiasis, 522 patients who underwent choledochotomy are presented in this study for further discussion. There was an association of primary common bile duct stones with bile infection, with an increased incidence of anaerobes in bile cultures and with an advanced inflammatory infiltration of the biliary tree. Furthermore, primary common bile duct stones have an increased incidence in patients with a long history of symptoms of the disease, of advanced age and who have had previous biliary surgical treatment. Primary stones are an index of existent biliary stasis and have to be taken into serious consideration in dealing with patients suffering from biliary lithiasis.

Adult↗
PubMedDate not supplied

Mucosa-associated lymphoid tissue-type lymphoproliferative lesion of the common bile duct.

Only a few cases of primary lymphoma of the common bile duct have been reported up to now. Here, we report a mucosa-associated lymphoid tissue (MALT)-type lymphoproliferative lesion of the common bile duct with some considerations about MALT lymphoma and benign lymphoproliferation. The patient, a 71-year-old woman, was admitted to our hospital because of progressive epigastric pain. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and abdominal computed tomography showed a non-specific finding of stenosis of the common bile duct due to thickening of the wall. Angiography provided little diagnostic information. Bile duct carcinoma was diagnosed and pylorus-preserving pancreaticoduodenectomy was performed. Histological examination revealed that the common bile duct was occupied by full-thickness proliferation of lymphoplasma cells with many reactive lymph follicles. The histological features were somewhat consistent with those of MALT lymphoma. However, we could not determine the clonal proliferation of lymphoplasma cells in either immunohistochemical immunoglobulin light chain restriction of the plasma cells or in polymerase chain reaction based immunoglobulin heavy chain gene rearrangement. The present case may be categorized as a borderline lesion close to benign lymphoproliferation. To the best of our knowledge, there have been no reports of cases similar to the present case.

Aged↗
PubMed2006

[Delayed surgery in impacted common bile duct calculi: lower percentage of biliary tract interventions].

INTRODUCTION: The choice of immediate or delayed surgery in patients with common bile duct calculi without severity criteria is controversial. Studies of patients with common bile duct calculi show that in a considerable percentage of these patients there is spontaneous passage of these stones without the need for surgery. AIM: To compare the percentage of common bile duct stones found at surgery between patients with impacted common bile duct stones undergoing immediate and delayed surgery. PATIENTS AND METHOD: Patients admitted to the Hospital de Clínicas Manuel Quintela with a diagnosis of impacted common bile duct stones were retrospectively reviewed. The patients were classified into two groups: those who underwent exploratory common bile duct surgery within 48 hours of admission (immediate surgery) and those who underwent surgery after the first 48 hours of admission (delayed surgery). The number of patients with a finding of common bile duct stones in each group was analyzed. RESULTS: Seventy patients (37 in the immediate surgery group and 33 in the delayed surgery group) were analyzed. Among the patients who underwent immediate surgery, 92% showed common bile duct stones on cholangiography or another instrumental procedure. In the group that underwent delayed surgery, this percentage was 64% (P< .004). Three factors predicting the absence of spontaneous passage of stones after 48 hours of admission were identified: age more than 70 years, jaundice of 7 days' duration or more and common bile duct stones visible by imaging techniques. CONCLUSIONS: The results of this study suggest that delayed surgery of impacted common bile duct stones reduces the number of patients requiring common bile duct surgery as well as the number of patients requiring biliary drainage. Patients aged more than 70 years old, with jaundice of more than 7 days' duration and with common bile duct stones visible by imaging techniques do not benefit from delayed surgery.

Aged↗
PubMed1994

Assessment of the common bile duct before cholecystectomy using ultrasound and biochemical measurements: validation based on follow-up.

The selective use of operative cholangiography with cholecystectomy is controversial. We have combined measurement of the serum bilirubin, alkaline phosphatase and alanine aminotransferase with ultrasound measurement of the bile duct diameter to assess the common bile duct before cholecystectomy. Direct contrast cholangiography was not performed if the results of these measurements were normal on the day before operation. There were 253 patients assessed in this way before laparoscopic cholecystectomy. Patients with known bile duct stones were excluded, but those with a previous history of jaundice, pancreatitis or abnormal liver function tests were included. In 47 cases abnormalities were found and X-ray cholangiograms were performed; only six patients were found to have bile duct stones. Follow-up of all 253 patients, including repeating the preoperative measurements after 12 months in 93, found only two patients with evidence that common duct stones had been missed and these two stones passed spontaneously. No bile duct injuries have occurred. We conclude that preoperative assessment of the bile duct using ultrasound and liver function tests safely obviates the need for 'routine' operative cholangiography.

Adolescent↗
PubMedDate not supplied

CT of neural plexus invasion in common bile duct carcinoma.

PURPOSE: Our purpose was to analyze the CT findings of neural plexus invasion in common bile duct carcinoma. METHOD: We studied 16 patients with common bile duct carcinoma who underwent surgery. Of these, neural invasion was seen in 10 patients. CT findings were retrospectively reviewed and correlated with the surgical and pathological findings. RESULTS: Irregular masses adjacent to the medial aspect of the uncinate process were observed in 4 of 14 patients with distal common bile duct carcinoma. These lesions extended medially and showed contiguity with the superior mesenteric artery and/or celiac axis, corresponding to neural plexus invasion with desmoplastic change. Increased attenuation of the fat between the common bile duct and the proper hepatic artery was seen in two of two patients with proximal common bile duct carcinoma, associated with neural plexus invasion in the hepatoduodenal ligament. CONCLUSION: The location and spread of neural plexus invasion in common bile duct carcinoma are characteristic and can be diagnosed by CT.

Adenocarcinoma↗
PubMed2000

Common bile duct measurements in an elderly population.

We prospectively evaluated the diameter of the common bile duct in 1,018 patients between the ages of 60 to 96 over a 4 year period to determine if there is a significant change in its size with aging. All of the patients included in the study were being evaluated primarily for carotid or peripheral vascular disease. Any patients with a history of biliary disease (i.e., bilirubin level greater than 1.5 mg/ml, cholecystectomy, or cholelithiasis) were excluded. Ultrasonography of the common bile duct was performed only in those patients with no subjective abdominal pain or icterus. Our results demonstrated a small although statistically significant increase in the caliber of the common bile duct with increasing age (60 years old or less, mean diameter 3.6 mm +/- 0.2mm, versus over 85 years old, mean diameter 4 mm +/- 0.2 mm, P = 0.009). Although the common bile duct did increase in size with aging, 98% of all ducts remained below 6 to 7 mm, the commonly accepted upper range of normal.

Age Factors↗
PubMed2006

[A case of primary small cell carcinoma arising from the common bile duct].

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.

Aged↗
PubMed1983

[Clinical significance of the dilated common bile duct in the sonogram].

The data of 34 patients with a sonographically established dilated common bile duct were analysed as to the clinical significance of these findings. Whereas it was possible to diagnose dilated proximal common bile ducts in all of the cases under examination, presentation of the distal section succeeded in only 56% of the patients involved. Thus distal concretions escaped diagnosis in seven out of 24 cases. There is no established relation between the extent of dilatation of the common bile duct and hyperbilirubinemia; quite to the contrary, in three cases without any signs of arrest of bile excretion under chemical analysis, it was not until ultrasonography was performed that some initial indications of an impeded bile outflow due to concretions were discovered. It was possible to obtain a confirmed diagnosis in the case of two pancreas carcinomas, three bile duct carcinomas, a local recurrent carcinoma of the gall bladder and lymph node metastases of a gastric carcinoma in the hepaticoduodenal ligament. In another gall bladder carcinoma nothing but dilated bile ducts presented itself. What was thought to be a hepatoma, turned out to be a carcinoma of the bile duct during autopsy. A cirrhotic carcinoma of the common bile duct was considered to be a case of calculi in the common bile duct without shadow when examined with ultrasound. During their stay in the hospital, four patients passed gallstones, thus relieving distention of the duct. Additional tests were carried out in 16 patients (47%) in order to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Villous adenoma of the common bile duct.

A villous adenoma of the common bile duct (CBD) causing obstructive jaundice was demonstrated by sonography and ERCP in a 34-year-old man. The radiological and clinical features of this rare tumor are herein presented.

Adenoma↗
PubMed1991

Laparoscopic exploration of the common bile duct: experience in 16 selected patients.

The authors' initial experience with transcystic duct and direct laparoscopic approaches to the exploration of the common bile duct is reported. The technique requires standard laparoscopic equipment, specialized endoscopes, and instruments developed for urologic stone manipulations. After cholangiography confirmed the presence of common bile duct stones, common duct stone extraction was performed in 16 selected patients age 20-88 years. Stones ranged in size from 1 mm to 30 mm and they were unsuspected in 60% of the patients. Five patients had normal liver function tests and only 3 had clinical evidence of jaundice. Ductal exploration and stone extraction was successful in all 16 patients. One patient required a direct laparoscopic ductal exploration due to the presence of a common hepatic duct stone and the anatomy of the cystic duct. No major complications or deaths were observed in this series. Appropriately trained surgeons can safely and effectively perform laparoscopic common bile duct exploration and stone extraction in selected patients.

Adult↗
PubMed1999

Primary choledochorrhaphy after common bile duct exploration.

AIM: To prove further the safety of primary closure of the common bile duct. METHOD: Twenty patients among 99 common bile duct explorations underwent primary closure. Pre- and postoperative liver function test, ultrasound and intraoperative cholangiography data, operation time, postoperative complications and the length of postoperative stay were recorded. RESULTS: Nineteen patients did not suffer any biliary complication. One had bile leakage and bile peritonitis, and another had duodenal leakage. One case was complicated by gastric ulcer perforation. The mean postoperative hospital stay except for the 2 patients with complications was 8.72 +/- 0.75 days. Preoperative abnormal liver function tests recovered within 2-3 weeks after the operation. Postoperative ultrasound scan of the biliary tract within 2 months revealed no stenosis and residual stone. CONCLUSION: Primary common bile duct closure is a safe alternative to routine biliary drainage in selected patients.

Adult↗
PubMed1983

Adrenergic and cholinergic innervation of the common bile duct in men and cats.

To clarify whether or not the common bile duct (CBD) has peristaltic movement, the muscular structure and intrinsic innervation were investigated for the full length of the CBD in 50 fresh human autopsy specimens and 50 cats. Nearly the same results were obtained in control groups of humans and cats. 1) Abundant sympathetic noradrenergic innervation, mainly composed of two plexuses, was demonstrated in each layer of the common bile duct tissue. 2) Parasympathetic nervous innervation was also abundant in each layer of the common bile duct and was composed of two ganglionated cholinergic plexuses. 3) Human and cat ganglia were composed of several nerve cells, which were mostly of Dogiel type II. 4) No other biogenic monoamines than adrenaline (A) and noradrenaline (NA) were detected. 5) Digestive tract hormones were undetectable. 6) The presence of smooth muscle was confirmed all along the common bile duct in all cases. The muscular tissue of the CBD was more abundant in humans than in cats. 7) The results of quantitation of catecholamine and acetylcholine esterase in the common bile duct tissue demonstrated a good correlation between biochemical and histochemical activities.

Adrenergic Fibers↗