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At least 631 records · Page 35Linked to original sources
PubMed2001

A non-icteric cholecystectomized patient with recurrent attacks of right epigastric pain and dilated common bile duct--do liver function tests predict bile duct stones?

Cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct are a clinical challenge. In a number of these patients dilatation of the common bile duct is explained as a normal postoperative state following cholecystectomy and the recurrent pain attacks are of origin other than bile disorder, but in some cases dilatation of the common bile duct and attacks are caused by bile duct stones. The aim of the present work was to study the value of common plasma liver function tests in predicting bile duct stones in the group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. The study population comprised 24 consecutive non-icteric cholecystectomized patients admitted for elective endoscopic retrograde cholangiopancreatography because of attacks of right epigastric pain and dilated common bile duct in ultrasonography. All the liver function tests seemed to assist in separating patients with bile duct stones (n=11) from those without (n=13). Alanine aminotransferase levels were significantly higher (p=0.05) in patients with bile duct stones than in those without, but also alkaline phosphatase (p=0.07), gamma-glutamyl transferase (p=0.09) and bilirubin (p=0.09) levels seemed to be higher in patients with bile duct stones than in those without, although the differences in these values did not reach statistical significance. In conclusion, common plasma liver function tests assist in separating patients with bile duct stones from those without in this small but clinically important group of non-icteric cholecystectomized patients with recurrent attacks of right epigastric pain and with dilated common bile duct. However, the actual value of these measurements is limited in clinical decision making since overlapping of values occured.

Adult↗
PubMed1998

The role of endoscopic therapy in chronic pancreatitis-induced common bile duct strictures.

During endoscopic retrograde cholangiography, common bile duct strictures are encountered in up to 30% of patients with chronic pancreatitis. The indications for treatment of these strictures are discussed. A surgical biliodigestive anastomosis has always been the traditional treatment modality. Not all patients need treatment, however, and endoscopic biliary drainage is the treatment of choice for certain subgroups of patients.

Cholestasis↗
PubMed1983

Common bile duct strictures associated with chronic pancreatitis.

Common bile duct (CBD) strictures associated with chronic pancreatitis may cause significant hepatobiliary disease. Nine patients with chronic alcohol-related pancreatitis and CBD obstruction requiring operative biliary or pancreatobiliary decompression are reported. Alkaline phosphatase was the most specific biochemical indicator of cholestasis. Abnormal CBD anatomy was delinated accurately in 89 per cent of cases with percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP). All strictures were localized to the intrapancreatic portion of the distal CBD. Pancreatic pseudocysts (PPC) were identified in six (67%) cases. All nine patients underwent biliary decompression. Simultaneous PPC drainage or pancreatic duct decompression (Peustow procedure) was performed in eight cases (89%). No perioperative mortality occurred, and all patients reported subjective improvement in symptoms. Biliary tract strictures sufficient to cause clinical or biochemical cholestasis are a poorly recognized complication of chronic pancreatitis. Cholangiography (PTC or ERCP) should be obtained in order to delineate radiographic features, and extent and severity of the biliary stricture because there is no predictable correlation between levels of serum alkaline phosphatase and liver histopathology. A percutaneous biopsy is requisite to document changes in hepatic morphology. In order to prevent potential hepatobiliary complications such as cholangitis and secondary biliary cirrhosis, biliary strictures should be managed surgically even in anicteric and otherwise asymptomatic patients. Simultaneous treatment of associated pancreatic pathology can be performed if necessary with little added morbidity.

Adult↗
PubMed1994

Imaging of the common bile duct in patients undergoing laparoscopic cholecystectomy.

Options for managing the common bile duct during laparoscopic cholecystectomy include routine peroperative cholangiography and selected preoperative endoscopic retrograde cholangiopancreatography (ERCP). The use of these methods was reviewed in 350 patients with symptomatic gall stones referred for laparoscopic cholecystectomy. Unit A (n = 114) performed routine cystic duct cholangiography but undertook preoperative ERCP in patients at very high risk of duct stones only; unit B (n = 236) performed selected preoperative ERCP on the basis of known risk factors for duct stones. The detection rate for common bile duct stones was similar for units A and B (16% v 20%). In unit A, five of seven patients who had preoperative ERCP had duct stones. Operative cholangiography was technically successful in 90% of patients and duct stones were confidently identified in 13, one of whom went on to immediate open duct exploration. Postoperative ERCP identified duct stones in only four patients, indicating spontaneous passage in eight. In unit B, preoperative ERCP was undertaken in 76 of 236 (32%) patients and duct stones were identified in 47 (20%). Duct clearance was successful in 42 (18%) but failed in five (2%), necessitating elective open duct exploration. Both protocols for imaging the common bile duct worked well and yielded satisfactory short term results.

Acute Disease↗
PubMed1978

The selective use of combined supraduodenal and transduodenal exploration of the common bile duct.

The results of combined supraduodenal and transduodenal exploration of the common bile duct in 42 selected cases are presented. The indications for this operation were: the presence of multiple calculi in the common bile duct; stones impacted in the ampullary region; residual stones in the common bile duct following previous surgery on the biliary tract; stricture at the papilla and pancreatitis associated with cholelithiasis. After the procedure no patient had residual stones in the common bile duct. Serious complications were infrequent; there were no postoperative deaths and post-operative pancreatitis occurred in only one patient.

Adult↗
PubMed1978

Nonoperative removal of retained common-bile-duct stones.

The discovery of retained common-bile-duct stones after operations on the gallbladder continues to be a frustrating experience for the general surgeon. Until recently this problem was solved in most patients by surgical re-exploration of the common bile duct. However, several alternatives to surgery are gradually gaining acceptance because of their lower morbidity and mortality. These methods are discussed with special emphasis on the use of a catheter with a steering mechanism and the Dormia basket (Burhenne's technique). This is the best alternative to surgery as it has no reported mortality, few complications and causes the least discomfort to the patient. It is highly successful and requires no hospitalization.

Catheterization↗
PubMed2003

Ectopic opening of the common bile duct in the duodenal bulb: clinical implications.

BACKGROUND: An ectopic opening of the common bile duct in the duodenal bulb is extremely rare, and the clinical significance of this anomaly has not been clarified. This study analyzed the clinical implications and cholangiographic findings of this anomaly. METHODS: A total of 18 patients (15 men, 3 women; median age, 51 years) with an ectopic opening of the common bile duct in the duodenal bulb were studied. Medical records, endoscopic findings, and cholangiographic and other radiographic findings were reviewed. RESULTS: All 18 patients had biliary pain; 7 had fever and chills. Fifteen (83%) had diffuse dilatation of the extrahepatic bile ducts with or without intrahepatic bile duct dilation. Associated bile duct stones were found in 10 (56%) patients. The papilla in the bulb had an orifice stained with bile at endoscopy, which was associated with duodenal ulcer disease found in 13 (72%) patients. The distal end of the common bile duct was tapered and narrowed and had a hook shape in all patients. CONCLUSION: An ectopic opening of the common bile duct in the duodenal bulb may be associated with clinical entities such as recurrent or intractable duodenal ulcer, choledocholithiasis, or acute cholangitis. Although these openings are rare, knowledge of the endoscopic and radiographic findings of an ectopic opening of the common bile duct in the duodenal bulb may help to clarify the cause of chronic recurrent duodenal ulcer disease in some patients and prevent damage to the bile duct during surgery.

Adult↗
PubMed1976

[Short common bile duct or high implantation. Apropos of 2 cases].

The authors report a case of so-called short common bile duct or highly implanted common bile duct, associated with double duodenal ulcer, with an unfavourable course in a very young girl. The pathological characteristics and the course suggested it was a congenital case of short bile duct, which is a rare disease, as 37 cases have been reported over a period of 25 years. 32 were associated with duodenal ulcer, which is often resistant to medical treatment, and becomes complicated in 33% of cases. The relationship between the two conditions remains hypothetical. Biliodigestive reflux was the first sign in 66% of cases. Retrograde opacification of the bile ducts under duodenoscopy should permit a diagnosis and precise pre-operative assessment. The abnormality has no special treatment, but the treatment of the associated disease, of the ulcer in particular, should be adapted to the ectopic bile duct to avoid serious injury. At operation, careful examination before dissection will determine the [site] of the papilla and of the opening of the biliary and pancreatic ducts. Vagotomy should be associated with a drainage operation, if possible, or gastrectomy may be performed with gastro-jejunal anastomosis leaving behind the posterior ulcer. Many precautions are necessary including the duodenal stump and details of these are given here.

Adolescent↗
PubMed1980

Suture material as a nidus for formation of common bile duct stones.

Three patients in whom recurrent common bile duct stones formed around suture material used in the region of the biliary tree are reported. Experimental and clinical evidence from the literature is presented to support recommendations that only absorbable ligature and suture materials should be used in the region of the common bile duct.

Aged↗
PubMed1987

Ultrastructural localization of type IV collagen, laminin and prolyl hydroxylase in biliary epithelial cells of rat liver following ligation of the common bile duct.

Type IV collagen and laminin are major components of basement membrane (BM), whereas prolyl hydroxylase (PH) is a key enzyme in the hydroxylation of proline to hydroxyproline in collagen synthesis. In order to elucidate the exact mechanism of the formation of BM, immune electron microscopic observation of type IV collagen, laminin and PH was made in rat liver with marked proliferation of bile ducts following ligation of the common bile duct. Extracellular localization of type IV collagen was found in the BM of bile ducts and blood vessels and in the space of Disse in both normal rat liver and the liver of rats undergoing operation. Type IV collagen was localized in lamina rara and lamina densa. Laminin was codistributed with type IV collagen in BM but rarely in the space of Disse even in the liver of rats undergoing operation. Immunostaining of laminin was diffusely spread in lamina densa, but sparsely in lamina rara. Though no reaction products of type IV collagen and laminin were detected in the cytoplasm of normal biliary epithelial cells, they were found in rough endoplasmic reticulum (rER) and the vesicles close to the basal surfaces of the plasma membrane of the proliferating biliary epithelial cells. No evident localization of these components in Golgi apparatus was found. PH was found in rER of the biliary epithelial cells, hepatocytes, endothelial cells of vessels, fibroblasts and perisinusoidal cells except for Kupffer cells in normal rat liver. More intense and diffuse staining of PH was observed in rER in the proliferating biliary epithelial cells of the liver of rats undergoing operation in concomitance with the evident localization of type IV collagen in this organelle. These findings suggest that the major components of BM, such as type IV collagen and laminin in the proliferating biliary epithelial cells, are produced in rER and secreted by vesicles to the basal extracellular spaces, thus forming new BM in these circumstances.

Animals↗
PubMed1987

Sealed-off spontaneous perforation of the common bile duct. A case report.

A case of spontaneous perforation of the common bile duct is reported, in which there was no bile peritonitis or bile collection. The mechanism of sealed-off perforation of the duct is discussed. Cholecystectomy and T-tube decompression of the common bile duct were performed after exploration.

Aged↗
PubMed1978

Non-operative removal of retained stones in the common bile duct.

A method of removal of retained common bile duct stones under radiological control is described and its use in 16 patients reported. The ease of the method, the minimal associated morbidity and the inexpensiveness of the equipment suggest that this should be the primary method of removal of retained stones when a T tube has been placed into the common bile duct.

Adult↗
PubMed1999

Percutaneous placement of biliary stents for the treatment of high risk patients with jaundice due to common bile duct stones.

OBJECTIVE: Percutaneous treatment of eight high risk patients with jaundice due to common bile duct stones who were unfit for, or refused surgery and in whom endoscopic therapy failed. METHODS: Fine needle percutaneous cholangiography was followed by catheterization of the bile duct and insertion of a 10-Fr double pigtail Teflon stent in seven cases and a metal stent in one patient with bile duct stones and noncalculous lower common bile duct obstruction. RESULTS: Stent insertion was successful in all patients. Two patients showed pus in the common bile duct. Stent insertion in these relieved the jaundice, but one patient died from sepsis at 72 h. The other patient died from renal and respiratory failure 3 wk after stent insertion with resolution of the jaundice. In six patients, stent therapy relieved the jaundice for periods up to 3 yr or death from other causes. CONCLUSIONS: These findings suggest that percutaneous transhepatic stent insertion is a reasonable alternative for the management of common bile duct stones when endoscopic stent insertion fails.

Aged↗
PubMed1988

Villous adenoma of the common bile duct.

A patient with villous adenoma of the common bile duct presented with obstructive jaundice, weight loss, and icterus. Results of preoperative evaluation suggested cancer of the pancreas or common bile duct. Despite normal findings of intraoperative needle biopsies, a duodenopancreatectomy was performed. Three years after operation the patient is without significant problems. We present the surgical challenge of treating this unique entity.

Adenoma↗
PubMed2004

Treatment of symptomatic distal common bile duct stenosis secondary to chronic pancreatitis: comparison of single vs. multiple simultaneous stents.

BACKGROUND: Common bile duct stenosis occurs in up to 30% of patients with chronic pancreatitis. Most such stenoses are found incidentally during ERCP, but others manifest as obstructive jaundice, recurrent cholangitis, secondary biliary cirrhosis, or choledocholithiasis. Operative drainage has been the main treatment despite the potentially high morbidity in patients with chronic pancreatitis. Endoscopic biliary drainage with a single stent has been successful in the short term. The aim of this study was to determine the long-term benefit of a single stent vs. multiple simultaneous stents for treatment of patients with chronic pancreatitis and symptoms because of distal common bile duct stenosis. METHODS: Twelve consecutive patients with chronic pancreatitis and common bile duct stenosis underwent endoscopic placement of multiple simultaneous stents and were followed prospectively (Group II). Results were compared with a group of 34 patients in whom a single stent was placed before the start of the present study (Group I). All 46 patients (35 men, 11 women; age range 30-71 years) had chronic pancreatitis and common bile duct stenosis, and presented with symptoms indicative of obstruction (abdominal pain, jaundice, elevated biochemical tests of liver function, acute pancreatitis, cholangitis). The 34 patients in Group I had single stent (10F, 7-9 cm) placement, with exchange at 3 to 6 month intervals (1-4 exchanges) over a mean of 21 months. The 12 patients in Group II underwent placement of multiple simultaneous stents at 3-month intervals (single 10F stents added sequentially) over a mean of 14 months. Mean follow-up was 4.2 years in Group I and 3.9 years for Group II. Factors assessed included symptoms, biochemical tests of liver function, diameter of common bile duct stenosis, and complications. RESULTS: In Group I, (34 patients), a total of 162 single stent placement/exchanges were performed (mean 5/patient). In Group II (12 consecutive patients), 8 patients had 4 (10F) stents placed simultaneously, and 4 patients had 5 (10F) stents. At the end of the treatment period, near normalization of biochemical tests of liver function was observed for all patients in Group II, whereas only marginal benefit was noted for patients in Group I. Four patients in Group I had recurrent cholangitis (6 episodes), whereas no patient in Group II had post-procedure cholangitis. In the 12 patients with multiple stents, distal common bile duct stenosis diameter increased from a mean of 1.0 mm to 3.0 mm after treatment; no change in diameter was noted in patients treated with a single stent. CONCLUSIONS: Distal common bile duct stenosis secondary to chronic pancreatitis can be treated long term by stent placement. Multiple, simultaneous stents appear to be superior to single stent placement and may provide good long-term benefit. The former resulted in near normalization of biochemical tests of liver function and an increase in distal common bile duct diameter. Multiple stent placement may obviate the need for surgical diversion procedures.

Adult↗
PubMed2006

3.0- Versus 1.5-T MR cholangiography: a pilot study.

OBJECTIVE: The purpose of our study was to evaluate quantitative and qualitative image quality of MR cholangiography at a field strength of 3.0 T compared with the standard field strength of 1.5 T. MATERIALS AND METHODS: A standardized MR cholangiography sequence protocol was used for 15 healthy male volunteers (mean age +/- SD, 32.4 +/- 4.3 years) who underwent both 1.5- and 3.0-T MRI within 2 hr in an alternating fashion. Dedicated circular polarized torso coils (1.5 and 3.0 T) were used. The sequence protocol included breath-hold single-slice rapid acquisition with relaxation enhancement (slice thickness, 50 mm; orientation, coronal and +/- 20 degrees oblique coronal); breath-hold multislice HASTE (slice thickness, 3 mm; coronal only); and a non-breath-hold, respiratory-triggered 3D turbo spin-echo (TSE) T2-weighted sequence (slice thickness, 1 mm; 60 slices per slab; coronal only). Maximum intensity projections were generated from each multislice data set. Bile duct (common bile duct, right posterior segmental branch, and left hepatic duct) to periductal tissue contrast-to-noise ratios were compared at 1.5 and 3.0 T. Qualitative image analysis was performed by three independent reviewers. Qualitative analysis included delineation of the extra- and intrahepatic biliary anatomy, with specific attention given to the presence (or absence) of cystic or intrahepatic ductal variants, using a 4-point confidence scale. Statistical analysis consisted of the paired Student's t test and the signed rank test. RESULTS: Contrast-to-noise ratios between the bile duct and the periductal tissue were higher at 3.0 T in all three locations (common bile duct, right posterior segmental branch, and left hepatic duct). In each magnet class, the 3D TSE sequence offered the best contrast-to-noise ratio and qualitative analysis. Superiority of the 3D TSE sequence was statistically significant in all analyses. Five of the 15 volunteers had intrahepatic biliary variants that were detected with a higher level of confidence (p < 0.01) on the 3.0-T system than on the 1.5-T system. CONCLUSION: Compared with MR cholangiography at 1.5 T, MR cholangiography at 3.0 T offers improved contrast-to-noise ratio and a higher level of confidence for depicting intrahepatic variants.

Adult↗