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PubMed1985

Cholecystokinin cholescintigraphic findings in the cystic duct syndrome.

Fourteen patients with a cystic duct syndrome (CDS) underwent cholecystokinin (CCK) cholescintigraphy. All patients presented with persistent postprandial right upper quadrant pain and biliary colic. None of the patients had an abnormal oral cholecystography, gallbladder (GB) ultrasound exam or upper GI series. Each patient (NPO after 12 a.m.) received 5 mCi of technetium-99m disofenin. When the GB maximally filled, 0.02 microgram/kg CCK was administered (3 min) intravenously. Background corrected gallbladder ejection fractions (GBEFs) were determined every 5 min X 4 by rationing the pre-CCK GB counts minus post-CCK GB counts to pre-CCK GB counts. GBEFs were: 12% (3 patients), 17% (2), 0%, 1.3%, 3%, 4%, 6%, 11%, 14%, 18.5%, and 22% (1 each). All patients underwent a surgical exploration and all had macro- or microscopically abnormal cystic ducts (five fibrotic, seven elongated and narrow, two kinked) with (12 patients) or without (2 patients) concomitant chronic cholecystitis. No patient with a partially occluded cystic duct with or without concomitant chronic cholecystitis had an ejection fraction that exceeded 22%. In an appropriate clinical setting, a low EF response to CCK should alert the physician to the presence of either chronic acalculous cholecystitis, CDS, or the combination of both.

Adolescent↗
PubMed1991

Case report: cystic duct carcinoma.

The authors present the 26th reported case of cystic duct carcinoma. Cystic duct carcinoma is more prevalent in males and is associated with right upper quadrant abdominal pain. Survival can be extended with surgery.

Adenoma, Bile Duct↗
PubMed1990

Changes in gallbladder volume do not affect cystic duct resistance.

To our knowledge, the relationship between gallbladder volume and cystic duct function has not been studied. We hypothesized that changes in gallbladder volume would influence cystic duct resistance. The effect of gallbladder volume changes on cystic duct resistance to both prograde (emptying) and retrograde (filling) steady-state flow was tested in 12 dogs under basal cholecystokinin-stimulated conditions utilizing a multiport catheter with a highly compliant balloon placed within the gallbladder fundus. Gallbladder volume was regulated by varying balloon volume from empty to just beyond physiologic distention. Cystic duct resistance was not affected by balloon volume under basal or stimulated conditions or by the direction of perfusate flow. This study demonstrated no relationship between gallbladder volume and cystic duct resistance and did not demonstrate a cystic duct sphincter mechanism at physiologic gallbladder volumes.

Animals↗
PubMed1990

Carcinoma of the cystic duct.

Two patients with carcinoma of the cystic duct presented with obstructive jaundice due to extrinsic compression of the common hepatic duct by the tumor. Sonography and computed tomography showed dilatation of the intrahepatic bile ducts and gallbladder. In one patient, a calculus seen in the gallbladder neck suggested Mirizzi syndrome. In the other, a small soft tissue mass was indistinguishable from a common duct tumor or an enlarged lymph node. In both cases, direct cholangiography demonstrated extrinsic compression and displacement of the common duct with proximal biliary dilatation and nonvisualization of the gallbladder. Carcinoma of the cystic duct should be considered whenever there is evidence of cystic duct obstruction and/or when cholangiography shows extrinsic mass effect on the common duct.

Bile Duct Neoplasms↗
PubMed2003

Carcinoma of the cystic duct remnant with direct colonic invasion.

Carcinoma of the cystic duct remnant is extremely rare, and only five cases have been reported previously in the English literature. We present another case of carcinoma of the cystic duct remnant and review the literature. A 62-yr-old woman was diagnosed as having hilar cholangiocarcinoma and transverse colon cancer. However, at laparotomy, the center of the tumor mass was in the cystic duct remnant with contiguous colonic invasion. The pathology of the surgical specimen confirmed carcinoma of the cystic duct remnant. The diagnosis of carcinoma of the cystic duct remnant was made using Ozden's new criteria.

Bile Duct Neoplasms↗
PubMed1999

Laparoscopic intracorporeal ultrasound cystic duct length measurement: a new technique to prevent common bile duct injuries.

The incidence of common bile duct injury remains high. Intracorporeal ultrasound mapping of cystic duct anatomy, prior to laparoscopic cholecystectomy (LC), may assist surgeons in avoiding common bile duct injuries. A technique for intraoperative intracorporeal predissection ultrasound imaging (IIPUI) of the cystic duct length was tested. During LC, gallbladder adhesions were lysed, and with the gallbladder retracted by grasping forceps, the ultrasound examination was performed. Using a 7.5-MHz articulating ultrasound probe, visualization of the extrahepatic biliary tree was obtained in five separate planes. Success in visualizing each plane, time for ultrasound examination, and predissection accuracy of cystic duct length measurement were recorded. Intraoperative cholangiography or direct measurement of the dissected cystic duct was used to determine accuracy of the ultrasound cystic duct length estimates. Forty-three patients underwent IIPUI during LC. The time required to perform the examination varied, with a range of 5 to 17 min (mean 9.5 min). Success of visualization in planes 1 through 5 was 44%, 95%, 98%, 98%, and 70%, respectively. The accuracy rate for cystic duct length ultrasound measurement was 87.1%. No complications related to the examination were observed. In this preliminary study, cystic duct length was determined by predissection intracorporeal ultrasound with a high level of accuracy. Predissection imaging may assist in preventing common bile duct injury during LC.

Adult↗
PubMed2005

Cystic duct and Heister's "valves".

The anatomy and physiology of the cystic duct have been relatively neglected by anatomists and the function of the spiral mucosal folds or "valves" of Heister, first described in 1732, remains obscure. The gross and microscopic anatomy of the cystic duct is reviewed together with results from laboratory investigations into the function of the cystic duct and its spirally arranged folds. The duct and spiral folds contain muscle fibers responsive to pharmacologic, hormonal, and neural stimuli. There is, however, no convincing evidence of a discrete muscular sphincter within the duct. Although the cystic duct is unlikely to play a major role in gallbladder filling and emptying, it appears to function as more than a passive conduit. Coordinated, graded muscular activity in the cystic duct in response to hormonal and neural stimuli may facilitate gallbladder emptying. The principal function of the internal spiral folds that are found in man and other animals may be to preserve patency of this narrow, tortuous tube rather than to regulate bile flow.

Animals↗
PubMed1993

Relationship between cystic duct diameter and the presence of cholelithiasis.

We sought to measure cystic duct diameter in patients without biliary calculi and in those with cholelithiasis or choledocholithiasis. Using endoscopic retrograde cholangiopancreatography (ERCP), we visualized the cystic duct in 168 patients referred to our unit. These patients were distributed into three groups based on findings at ERCP: Group I (N = 57), no calculi in the gallbladder or common bile duct; group II (N = 27), stones found in the gallbladder but absent from the common bile duct; and group III (N = 34), stones present in the common bile duct with or without gallbladder stones. The diameter of the cystic duct was measured at its widest and narrowest dimensions. The largest diameter measured was greater in group III (7.72 +/- 2.29 mm) than in groups I (2.63 +/- 0.67 mm) and II (4.59 +/- 1.13 mm) (P < 0.001). The same differences were found in measurement of the smallest diameter (5.00 +/- 0.99 mm, 3.10 +/- 0.62 mm, and 1.83 +/- 0.53 mm, for groups III, II, and I, respectively) (P < 0.001). Maximal and minimal cystic duct diameter show a progressive increase at each level of disease. This increase in cystic duct size may facilitate the migration of gallstone fragments after lithotripsy and facilitate the instrumentation of the cystic duct during ERCP and laparoscopic cholecystectomy.

Adult↗
PubMedDate not supplied

Trypsin level in gallbladder bile and ductitis and width of the cystic duct.

BACKGROUND/AIMS: The change from laparotomy to laparoscopy for cholecystectomy has raised the question of how to manage concomitant bile duct stones. The present-day interest--and controversy--has focused on a transcystic approach reported to be feasible in 66-96% of cases, but without explaining the necessary prerequisite: the widening of the cystic duct. The cystic duct, wide mainly in patients with bile duct stones, has been reported to be highly variable: from strictured to very wide. The present study aims at comparing the trypsin level in the gallbladder bile and the cystic duct morphology and width in patients with and without bile duct stones. METHODOLOGY: A prospective series of 63 gallstone patients, 30 with and 33 without bile duct stones (controls), underwent cholecystectomy and bile duct clearance. The study includes the trypsin level in the gallbladder bile, the width and morphology of the cystic duct, and the size of the gallstones. RESULTS: The patients with bile duct stones had, in contrast to the controls, higher trypsin levels in the gallbladder bile (P < 0.001) and wider cystic ducts (P < 0.001) with more pronounced signs of chronic ductitis. CONCLUSIONS: The obtained results strongly suggest that the increased trypsin level, a sign of reflux of pancreatic juice, caused changes in the cystic duct that facilitate gallstone migration, which also ought to render a transcystic stone extraction feasible.

Adult↗
PubMed1982

Stimulatory and inhibitory histamine receptors in canine cystic duct.

1 The effects of histamine receptor stimulation were assessed on the resistance of the canine cystic duct in vivo and on the contractility of circular muscle preparations of canine cystic duct in vitro. 2 In anaesthetized dogs, the H1-receptor agonist, 2-pyridylethylamine (0.05 to 15 mumol, i.a.), elicited dose-dependent increases in cystic duct resistance, whereas the H2-receptor agonist, 4-methylhistamine (0.05 to 15 mumol, i.a.) decreased cystic duct resistance. These responses were antagonized by the H1-receptor antagonist, diphenhydramine, and the H2-receptor antagonist, cimetidine, respectively. 3 Histamine (0.1 to 3000 nmol, i.a.) also increased cystic duct resistance in vivo. In the presence of diphenhydramine, the stimulatory effect of histamine was antagonized and slight decreases in cystic duct resistance became apparent. Cimetidine or prazosin also antagonized the stimulatory effects of histamine. 4 Histamine (1 to 100 microM) or 2-pyridylethylamine (1 to 100 microM) contracted, whereas 4-methylhistamine (1 to 100 microM) relaxed, circular muscle preparations of cystic duct. These excitatory and inhibitory responses were antagonized by diphenhydramine and cimetidine, respectively. 5 These results indicate that the canine cystic duct possesses excitatory H1- and inhibitory H2-receptors. The predominant effect of histamine is an H1-receptor-mediated increase in cystic duct resistance. Histamine, which may be released in association with cholecystitis, may exert significant effects on the regulation of bile flow in and out of the gallbladder and may contribute to gallbladder stasis during biliary disease.

Animals↗
PubMed1984

Selective cannulation of the cystic duct at time of ERCP.

Although the cystic duct can sometimes be cannulated at ERCP, no one has attempted a prospective study of how often this can be done, nor have the potential indications been evaluated. Accordingly, 50 consecutive patients with a variety of pancreaticobiliary conditions were studied prospectively. In 86% of the patients, free cannulation of the common bile duct was accomplished; in 74%, the cannula could be inserted selectively into the cystic duct. Such direct access to the gallbladder may lead to: 1) better gallbladder visualization at time of ERCP, 2) retrieval of pure gallbladder bile for culture and sensitivity on chemical analysis, and 3) gallstone dissolution or extraction.

Biliary Tract Diseases↗
PubMed1979

On the Mirizzi syndrome--benign stenosis of the hepatic duct induced by a stone in the cystic duct or the neck of the gallbladder.

Three cases of Mirizzi Syndrome are reported. One of them was induced by the stone in gallbladder remnant. On the cholangiogram, one case showed narrowing of common hepatic duct near the porta hepatis, and one case revealed a tapered narrowing-like stenosis. Those findings resembled malignancy but closer examination could differentiate this syndrome from malignancy. Selective angiography was useful to differentiate the syndrome from malignancy. Even in the cases where stricture is severe, exstirpation of gallbladder or cystic duct, freeing the anterior wall of extrahepatic bile duct from marked hyperplasia of fibrous tissues and insertion of a T-tube as an internal splint through the stenosis were effective. It is the opinion of the authors, therefore, that the reconstruction of a strictured bile duct may not necessarily be done by resection of stricture and a hepatojejunostomy.

Aged↗
PubMedDate not supplied

Primary neuroendocrine tumors of the cystic duct.

Primary neuroendocrine tumors of the cystic duct are extremely rare. Only 4 cases have been described to date. We report 2 patients in whom a primary neuroendocrine tumor of the cystic duct was incidentally detected during histological examination following cholecystectomy. With regard to the primary neuroendocrine tumor both patients were asymptomatic at the time of diagnosis. However, histologic examination did not confirm that the neuroendocrine tumors had been completely removed. Both patients underwent a second procedure. They are well after 47 and 49 months, respectively.

Bile Duct Neoplasms↗
PubMed1984

Somatostatinoma of the cystic duct.

An unusual tumor of the cystic duct in a 28-year-old woman is described. The patient presented with a painful distended gallbladder due to a small tumor occluding the cystic duct. Microscopically the tumor cells showed a nesting pattern suggestive of endocrine differentiation, but contained numerous lipid vacuoles and were argentaffin and argyrophil negative. Ultrastructurally, there were relatively few dense granules measuring 135 to 475 nm. Immunoperoxidase staining showed that the tumor cells contained somatostatin but did not contain immunoreactive ACTH, gastrin, calcitonin, glucagon, insulin, parathyroid hormone, or carcinoembryonic antigen. To the authors' knowledge, this is the first reported somatostatinoma occurring in the extrahepatic biliary tract.

Adenoma, Islet Cell↗