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PubMed2002

Presence and density of common bile duct microlithiasis in acute biliary pancreatitis.

AIM: Common bile duct microlithiasis (CBDM) is found in majority of patients with acute biliary pancreatitis (ABP) and no CBD stones in fluoroscopy during urgent ERCP. It is unclear, however, weather CBDM is a cause or the result of the disease. This prospective study was done to investigate the presence and density of CBDM in patients with ABP, when endoscopic retrograde cholangiopancreatography (ERCP) was done in different periods from the onset of the disease. METHODS: One hundred fifty one consecutive patients with ABP and no CBDS on ERCP, performed as an urgent (< 24h of admission) procedure, (101 - with gallbladder stones, 50 post-cholecystectomy patients), treated during last 4 years were prospectively included to the study. The presence and density of CBDM (cholesterol monohydrate crystals-CMCs and calcium bilirubinate granules-CBGs) in bile collected directly from common bile duct during ERCP was prospectively calculated according to Juniper and Burson criteria. High density of crystals was considered,when we found >10CMCs and/or >25 clusters of CBGs on 1 slide. RESULTS: CBD microlithiasis was present in given number of patients: on d1-30/34 (88.2%), on d2 41/49 (83.7%), on d3-23/33 (69.6%), on d4-7-24/35 (68.6%) ( P for trend=0.018). In patients with CBD microlithiasis the high density of crystals was observed in given number of patients:on d1-27/30 (90%), on d2-34/41 (82.9%), on d3-18/23 (78.3%), on d4-7-16/24 (66.7%)( P for trend=0.039). CONCLUSION: In patients with ABP and no CBDS on ERCP, CBD microlithiasis is observed in the majority of patients, especially during the first day of the disease. Density of CBD microlithiasis is the highest in the first day of the disease. This suggests that CBD microlithiasis can be the cause and not the result of ABP.

Acute Disease↗
PubMed1996

Rat model of mild stenosis of the common bile duct.

Several techniques for developing incomplete obstruction of the common bile duct have been described but none of them properly represents a compression or constriction of the bile duct. In this study, a mild stenosis of the common bile duct was achieved in the rat by means of a double ligature including a cannula that could be easily slipped out of the ligatures. Sham-operated rats were used as controls. The studies, performed 7-10 days postoperatively, indicated that in ligated rats a duct constriction was produced, made evident by an increase of the biliary pressure, an upstream dilatation of the bile duct, an increase of the liver volume constituted by portal tracts, and ductular proliferation. Serum parameters were practically similar in ligated and control rats, except for a slight increase in serum bilirubin. Following intravenous injection of sodium taurocholate there were rapid increases of bile flow and bile salt output in both groups, but choleresis induced by sodium taurocholate was higher in ligated rats than in controls. The clearances of [14C]erythritol and [14C]sucrose suggested that ductular water contributing to bile flow and changes in biliary permeability were not involved in ligated rats. The limited repercussion of humoral effects and hepatic behaviour seen in ligated rats despite the morphological alterations induced make the mild stenosis of the bile duct a good model for the study of early stages of compression or constriction of the biliary tract.

Animals↗
PubMed1997

Primary non-Hodgkin's lymphoma of the common bile duct.

Primary non-Hodgkin's lymphoma of the common bile duct is rare. To date, nine cases have been recorded in the literature. We report an additional case of a 39-yr-old woman presented with obstructive jaundice. Pathological studies of the surgical specimen disclosed that the wall of the common bile duct was transmurally infiltrated by non-Hodgkin's lymphoma of diffuse large cell type of B-cell lineage intimately associated with reticular fibers. The patient received postoperative brachytherapy, followed by six cycles of chemotherapy according to the CHOP regimen. There is no evidence of lymphoma recurrence 13 months after the surgery. Our analysis of the reported cases indicates that common bile duct non-Hodgkin's lymphoma is a rapidly progressive disease, terminating in death within a year. A complete surgical resection of the lymphoma followed by chemotherapy has shown a promising result.

Adult↗
PubMed2006

Chronic pancreatitis-induced compressed relative stenosis of the distal common bile duct.

BACKGROUND: Fibrosis and enlargement of chronic pancreatitis (CP) can cause biliary stenosis, in which fixed circular stenosis is the common type, by compressing the intrapancreatic portion of the common bile duct. Another type of distal bile duct stenosis is compressed relative stenosis, in which the common bile duct walks along the back of the pancreas partially. METHODS: Thirty patients with dilation of the proximal common bile duct (diameter > or = 15 mm) caused by CP underwent overall and systemic exploratory operation at our hospital. All of the patients were followed up for 3.5 to 15 years, averaging 8.5 years. RESULTS: The intrapancreatic portion of the common bile duct was found to walk along the back of the pancreas, and its anterior wall was compressed flat by enlarged pancreas, but the posterior wall showed a good flexibility because there was no pancreas covering. Bake's dilators bigger than No.6 (diameter > or = 4 mm) and No.14 urinary catheter could pass through the distal common bile duct after the posterior wall was separated. Roux-en-Y choledochojejunostomy was performed for 4 patients, and T-tube drainage was carried out for the remaining 26 patients. All of the patients were followed up but 2 were lost. Only 2 patients underwent choledochojejunostomy 3 years after T-tube drainage because of repeated acute pancreatitis attack, and others were normal. CONCLUSIONS: Compressed relative stenosis of the distal common bile caused by CP is a clinical sign, and its diagnosis mainly depends on surgical findings. Most patients can be treated by separating the posterior wall of the pancreas and T-tube drainage as well, but to patients with recurrent CP, choledochojejunostomy may be a feasible alternative.

Adult↗
PubMed1987

Choledochoscopy in prevention of retained common bile duct stones.

More than 150,000 patients undergo exploration of the common bile duct each year in the United States, and approximately 10 per cent of these patients are later found to have retained common bile duct stones. The usual recommended procedure to decrease the incidence of retained calculi is a more complete exploration of the common duct at time of initial operation. It is thought that the incidence of retained common bile duct stones can be decreased and almost eliminated with proper use of the flexible choledochoscope following intraoperative cystic duct cholangiogram. The technical aspects of choledochoscopy are reviewed and experience with its use in 102 cases between July 1978 and October 1985 is reported. There were no residual stones in the span of the study using the flexible choledochoscope as a routine procedure in common bile duct exploration.

Endoscopes↗
PubMedDate not supplied

Actual management of common bile duct stones: a continuous evolving approach.

The management of common bile duct stones (CBDS) has recently changed regarding either a more precise diagnosis of patients at high-risk to harbor CBDS and either the development of new therapeutic modalities. In patients with preoperative predictive suspicion of CBDS, new non-invasive radiologic and endoscopic investigations are now available, namely 3-D spiral CT-cholangiography and magnetic resonance cholangio-pancreatography on one hand, and endoscopic ultrasonography on the other hand. With the development of laparoscopic surgery, two strategies have emerged in order to maintain the minimally invasive nature of the procedure: perioperative endoscopic sphincterotomy or laparoscopic common bile duct exploration. However, considerable laparoscopic expertise, advanced and expansive technologies are required to achieve successful laparoscopic treatment of CBDS. An appropriate intraoperative strategy is mandatory during laparoscopic common bile duct exploration, with specific indications for the transcystic route and for laparoscopic choledochotomy, according to patient's biliary anatomy and stone's characteristics. A preliminary controlled trial has proved the safety, efficacy and excellent postoperative results of such approach. However, the best option of management for patients with CBDS remains open to discussion and the therapeutic choice should depend on the local hospital availability of technical expertise.

Cholangiography↗
PubMed2005

[Post-cholecystectomy amputation neuroma of the common bile duct with obstructive jaundice].

Amputation neuroma of the common bile duct after surgery is a rare and mostly asymptomatic lesion. A 60-year old patient presented with obstructive jaundice three months after a cholecystectomy for symptomatic gallstones. Imaging investigations showed common extrahepatic bile duct stenosis. Surgical resection of the stricture with biliodigestive anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma. Despite its rarity, amputation neuroma of the common bile duct should be considered in patients with post-cholecystectomy syndrome following liver or extrahepatic bile duct surgical procedures.

Cholecystectomy↗
PubMed1994

The utility of laparoscopic common bile duct exploration in the treatment of choledocholithiasis.

Laparoscopic common bile duct exploration (CBDE) was performed in 24 patients over a 23-month period. Fourteen of these patients were suspected preoperatively of harboring common bile duct (CBD) calculi. Of these, endoscopic sphincterotomy was unsuccessful in eight. Laparoscopic CBDE was performed either transcystically or via a choledochotomy. In all cases, completion cholangiography demonstrated that the CBD was free of stones. All patients were sent home with drains placed in their extrahepatic biliary system. Mean hospital stay was 2.7 days. There was no mortality. The overall morbidity rate was 29.1%. It included one trocar site infection (4.1%), four cases of mild postoperative amylasemia (16.6%), and two cases of retained stones (8.3%) seen in two patients on follow-up tube cholangiography that were successfully extracted percutaneously. The authors feel that laparoscopic CBDE is a safe and effective method of CBD stone removal that offers an alternative to preoperative ERCP and sphincterotomy.

Adult↗
PubMed1983

Pharmacological pressure reduction in the human common bile duct.

The effects of pharmaca on artificially elevated pressures in the common bile duct are reported. The measurements were performed using a catheter for pressure measurements, which was introduced with an endoscope via the papilla of Vater into the common bile duct. For the artificial pressure elevation an x-ray contrast medium was instilled into the common bile duct until the pain threshold was reached. Nitroglycerin most effectively reduced the elevated pressures (to 52.1 +/- 12.4%) of the initial value). A weaker effect was produced by Novalgin (74.7 +/- 15.6%) and Buscopan (69.7 +/- 29.1%). With Euphyllin only a small pressure reduction could be observed (86.1 +/- 15.4%). Pain relief in each patient could only be effected with nitroglycerin. The method used makes it possible to estimate the effects of pharmaca on the artificially elevated pressure of the common bile duct objectively by measuring the pressure reduction, and subjectively by registering the diminution of the pain sensation.

Aminophylline↗
PubMed1995

Does the common bile duct dilate after cholecystectomy? Sonographic evaluation in 234 patients.

OBJECTIVE: The purpose of this study was to determine whether the common bile duct dilates after cholecystectomy. SUBJECTS AND METHODS: All 234 patients who had cholecystectomy at our hospital between October 1985 and April 1994 were included in this study. The luminal diameter of the proximal segment of the common bile duct was measured on antero-posterior transverse sonograms 4-15 days before cholecystectomy. In all patients, the luminal diameter was measured again on sonograms obtained 7-2160 days after surgery (mean, 393 days; median, 180 days; mode, 360 days). A diameter of 6 mm or less was considered normal. This study contained 197 patients with a normal common bile duct (< or = 6 mm) and 37 patients with a dilated common bile duct (> 6 mm). RESULTS: The mean diameter of the common bile duct measured on sonograms was 5.9 mm before cholecystectomy and 6.1 mm after cholecystectomy. This difference was statistically significant (p < .05). The diameter of the common bile duct increased in 110 patients, decreased in 61 patients, and stayed the same in 63 patients. Of the 234 patients, 197 (84%) had a normal preoperative diameter of the common bile duct, whereas 167 (71%) had a common bile duct with a normal diameter postoperatively. CONCLUSION: The diameters of the common bile duct as measured on sonograms increase slightly after cholecystectomy. Most patients do not have significant compensatory dilatation of the duct after cholecystectomy.

Adult↗
PubMed1995

Relief of common bile duct obstruction during the course of hepatobiliary scintigraphy.

Hepatobiliary scintigraphy performed in a patient suspected of having common bile duct obstruction showed persistence of the hepatic parenchymal phase and no bile duct or gallbladder activity during the first hour of imaging. On endoscopic retrograde cholangiopancreatography examination several hours later, an obstructing gallstone was identified in the common bile duct, and the stone was extracted in conjunction with a papillotomy. Delayed scintigraphic images at 6 hours were unchanged from the earlier views, but imaging at 24 hours showed tracer activity in the small bowel and colon along with persistent hepatic parenchymal activity. These results demonstrate that hepatobiliary radiopharmaceuticals remain in an excretable form in the liver in patients with complete common duct obstruction, but that resumption of bile flow and tracer excretion does not occur until a number of hours after relief of the obstruction.

Aged↗
PubMed1994

Outcome of surgery for failed endoscopic extraction of common bile duct stones in elderly patients.

Endoscopic sphincterotomy (ES) is the treatment of choice for common bile duct stones in elderly patients. For those in whom endoscopic clearance of the common bile duct fails the treatment options include stenting, dissolution therapy and lithotripsy. Surgery is often avoided because of the reported high morbidity and mortality in elderly patients. We have reviewed the outcome of patients referred for surgery after failed endoscopic clearance of common bile duct stones. Over a 3-year period, 100 patients with common bile duct stones were referred specifically for endoscopic clearance of the common bile duct (median age 69 years, range 19-97 years). In seven patients duct clearance was possible without ES and in five patients ES was considered inappropriate. ES was attempted in 88 patients and was successful in 75 (85%). Of the 13 patients failing ES or stone removal, surgery was performed in nine and four were stented. Of patients having successful ES (n = 75), ten were referred for surgery because of incomplete duct clearance. Surgery was performed to obtain duct clearance in 19 patients (eight male, 11 female, median age 77 years, range 47-90 years). Of the 19, eight had previously undergone a cholecystectomy (42%) and 17 of the 19 had biliary tract drainage preoperatively (90%). The procedures performed consisted of choledocholithotomy in all plus cholecystectomy (11), choledochoduodenostomy (7) and choledochojejunostomy (7). There were no deaths and only one major complication. The median total inpatient stay was 26 days (range 14-75 days) and the median postoperative stay was 12 days (range 7-50 days). We would conclude that open surgery can be performed safely and effectively in elderly patients with retained bile duct stones.

Aged↗
PubMed1982

A simple technique for the operative assessment of retained stones in the common bile duct.

This technique is useful in avoiding the operative delays associated with removal, reinsertion and resuturing of T tubes following the identification of retained common stones at exploration of the common bile duct. This technique may have further application if T-tube drainage of the common bile duct is not performed following exploration of the common bile duct. At the conclusion of the exploration, the Foley catheters are inserted, and cholangiograms are obtained. If no stones are identified, the Foley catheter can be removed and the common bile ducts closed primarily. Utilization of this technique when drainage of the common bile duct with T tubes is not performed may significantly reduce the incidence of missed retained stones of the common bile duct resulting from failure to obtain the T-tube cholangiogram.

Catheterization↗
PubMed1997

Laparoscopic common duct exploration in a child with recurrent pancreatitis due to a primary fungus ball in the terminal common bile duct.

We report on a case of a fungus ball obstructing the distal common bile duct and causing recurrent pancreatitis in an otherwise healthy 3-year-old boy. Laparoscopic exploration of the common bile duct was performed using a 10 french rigid fiberoptic cystoscope and a Dormia basket. This is the first example of a primary fungus ball in common bile duct presenting as a pancreatitis and treated laparoscopically.

Acute Disease↗
PubMed1997

Endoscopic retrieval of a surgical gauze from the common bile duct.

Non-parasitic foreign bodies in the common bile duct are rare and usually require laparotomy. We report the successful removal by endoscopy of a surgical gauze seven years after a simple cholecystectomy. The foreign body had been cholangiographically misdiagnosed as a large stone. The possibility of a foreign body that has migrated into the common bile duct should be considered in patients with cholangitis. Endoscopic sphincterotomy is the procedure of choice, though other extraction techniques may occasionally be necessary.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

Embryonal rhabdomyosarcoma of the common bile duct mimicking choledochal cyst.

Embryonal rhabdomyosarcoma of the common bile duct is a very rare malignancy of childhood. The radiological appearance of the lesion is similar to that of congenital choledochal cyst if there is no local invasion to the adjacent tissues. The authors present a case of embryonal rhabdomyosarcoma of the common bile duct which was considered to be a congenital choledochal cyst preoperatively, and they discuss this very rare childhood tumor, with a brief survey of the literature. In conclusion, it is important to know that this rare tumor can simulate congenital choledochal cyst; it should be considered in the differential diagnosis of obstructive jaundice in children.

Antineoplastic Combined Chemotherapy Protocols↗