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PubMed2001

Biliary tract papillomatosis.

Papillomatosis of the biliary tract is characterised by multicentric papillary lesions of intra and extrahepatic biliary epithelium. It's a rare benign neoplasm of the biliary tract that causes obstructive jaundice with a high rate of malignant transformation. We described a case of papillomatosis of the biliary tract in a woman of 75-years-old, who came to our observation with jaundice, pruritus and fever. The surgical treatment consisted of cholecystectomy, choledochotomy and positioning a definitive T-Tube. We described our experience and the evolution of this disease.

Aged↗
PubMed2004

Innervation of the extrahepatic biliary tract.

The extrahepatic biliary tract is innervated by dense networks of extrinsic and intrinsic nerves that regulates smooth muscle tone and epithelial cell function of extrahepatic biliary tree. Although these ganglia are derived from the same set of precursor neural crest cells that colonize the gut, they exhibit structural, neurochemical, and physiological characteristics that are distinct from the neurons of the enteric nervous system. Gallbladder neurons are relatively inexcitable, and their output is driven by vagal inputs and modulated by hormones, peptides released from sensory fibers, and inflammatory mediators. Gallbladder neurons are cholinergic and they can express a number of other neural active compounds, including substance P, galanin, nitric oxide, and vasoactive intestinal peptide. Sphincter of Oddi (SO) ganglia, which are connected to ganglia of the duodenum, appear to be comprised of distinct populations of excitatory and inhibitory neurons, based on their expression of choline acetyltransferase and substance P or nitric oxide synthase, respectively. While SO neurons likely receive vagal input and their activity is modulated by release of neuropeptides from sensory fibers, a significant source of excitatory synaptic input to these cells arise from the duodenum. This duodenum-SO circuit is likely to play an important role in the coordination of SO tone with gallbladder motility in the process of gallbladder emptying. Now that we have gained a relatively thorough understanding of the innervation of the biliary tree under healthy conditions, the way is paved for future studies of altered neural function in biliary disease.

Animals↗
PubMed1979

[Current state and development of biliary tract surgery].

Status and Development of Biliary Tract Surgery: Diseases of the abdominal cavity are no longer the concern of the internist, general practitioner or surgeon alone. They belong in the hands of the gastroenterologist who are the symbiosis of general practitioner, internist and surgeon. This applies particularly to the wide range of diseases of the biliary tract. On the conservative side this means quick recognition of biliary tract diseases with inclusion of the neighboring organs in the diagnosis; conservative therapy of inflammatory or other additional diseases; establishing a condition suitable for operation and referring the patient to the surgeon before the gallbladder disease has become a biliary tract disease and the operative chances are destroyed by serious complications.

Aged↗
PubMed1997

Microstructure and development of the normal and pathologic biliary tract in humans, including blood supply.

Microstructure and development of the normal biliary tract and the pathologies of several biliary tract diseases in humans are reviewed. The biliary tract, comprising the bile duct and peribiliary glands, is anatomically divided into the extrahepatic and intrahepatic biliary tree. The intrahepatic biliary tree is further divided into large bile ducts, corresponding to the right and left hepatic ducts and their first to third order branches, and into septal and interlobular bile ducts and bile ductules according to their size and location relative to the hepatic lobules and surrounding structures. The right and left hepatic ducts and the extrahepatic bile ducts are composed of dense fibrous duct walls lined by a layer of columnar biliary epithelium. The peribiliary glands, which may secrete mucinous and serous substances into the bile, are found along the extrahepatic and large intrahepatic bile ducts. They are divided in glands within and outside the duct wall. The former (intramural glands) drain directly into the lumen of the bile duct, while the latter (extramural glands) are composed of several lobules and drain into the ductal lumen via their own conduits. The biliary tract is supplied by a complex vasculature called the peribiliary vascular plexus. Afferent vessels of this plexus derive from hepatic arterial branches, and this plexus drains into the portal venous system or directly hepatic sinusoids. The development of the intrahepatic biliary tract is divided into three stages: the stage of the ductal plate, the stage of biliary cell migration into the mesenchyme, and the stage of bile duct formation in the portal tract. It remains unclear how the extrahepatic and intrahepatic biliary tract integrate. Along with these developmental changes in the biliary tract, the peribiliary glands and the vascular plexus also develop in a step-wise manner and their maturation is completed after birth. Pathologies of various biliary diseases are briefly reviewed noting their relevance to several histologic elements and the microenvironment of the biliary tract and the developmental anomalies of the biliary tract including ductal plate malformation.

Bile Ducts, Extrahepatic↗
PubMed1998

[Endoscopic cholangiography in biliary tract diseases in HIV+ patients].

UNLABELLED: Biliary tract involvement in the course of the infection by HIV was first described in 1983. Since then, various opportunistic infections have been responsible of different biliary lesions, coming to a new entity called "cholangiopathy associated to HIV". Our aim was to determined the use of ERCP in the management of HIV patients with cholestasis. From August 1994 to October 1997, 11 HIV patients (8 men, 3 women, mean age 35 y.) were submitted to ERCP because of jaundice (n = 8), upper right abdominal pain (n = 8), fever (n = 6), pruritus (n = 5) and elevated alkaline phosphatase (n-10). In 7 the diagnosis of AIDS had already be made. All had hepatobiliary ultrasound and endoscopic periampullar duodenal mucosa biopsy was taken in 7. According to Cello, 4 types of radiologic lesions were considered: 1) Papillary stenosis with dilated extrahepatic biliary tract. 2) Sclerosing cholangitis (focal intra or extrahepatic stenosis and dilatations). 3) Association of types 1 and 2.4) Choledocal long stenosis in the absence of previous biliary surgery or chronic pancreatitis. Five patients (45%) had biliary abnormalities; in 3 related to HIV infection: sclerosing cholangitis (n = 2) and papillary stenosis (n = 1). Two had choledocal stones. Four had upper right abdominal pain and dilated bile ducts at ultrasound. Cryptosporidium was found in duodenal mucosa in one patient with sclerosing cholangitis and in the patient with papillary stenosis. Biliary stents were placed without sphincterotomy in 2, with relief of pain and improving of cholestasis in only one. The choledocal stones were removed endoscopically in one patient and by surgery in the other. CONCLUSION: The ERCP is a useful method in the diagnosis and treatment of the biliary tract abnormalities associated to HIV.

AIDS-Related Opportunistic Infections↗
PubMed2001

Iatrogenic and noniatrogenic extrahepatic biliary tract injuries: a multi-institutional review.

Traumatic and iatrogenic extrahepatic biliary tract injuries are rare but may lead to exceedingly morbid complications. Traumatic extrahepatic biliary tract injuries represent less than 1 per cent of all traumatic injuries. Iatrogenic injuries result in 0.2 to 1 per cent of laparoscopic or open cholecystectomies. The objective of this study was to review the incidence of biliary tract injuries--iatrogenic as well as traumatic--and their subsequent management. A multi-institutional chart review was done including Louisiana State University Health Sciences Center (LSUHSC)-Shreveport, LSUHSC-Monroe, and Richland Parish medical centers. Charts were reviewed for patients with iatrogenic biliary tract injuries and those with biliary tract injuries related to noniatrogenic trauma. The etiology of the biliary tract injury, symptoms of injury, pertinent laboratory and radiologic studies, injury-to-diagnosis time, type of biliary tract injury, injury management, days hospitalized, intensive care unit stay, and complications were reviewed. There are 1500 trauma patients admitted to LSUMC-Shreveport each year. The incidence of biliary tract injury in trauma patients admitted to LSUMC is 0.1 per cent. Traumatic injuries were classified according to the injury scale by Mattox et al. (Trauma 1996; Vol 515). There were five Type II, four Type IV, and two Type V injuries. Five patients underwent cholecystectomy, three had endoscopic retrograde cholangiopancreatography with stent placement, and two had choledochojejunostomy; one patient died from associated injuries. There were no complications of repair. Approximately 220 cholecystectomies are done at LSUMC-Shreveport each year. Eighty-eight per cent are laparoscopic, and 12 per cent are open. The incidence of iatrogenic biliary tract injuries at LSUMC-Shreveport during the past 8 years was 0.2 per cent. Immediate diagnosis of iatrogenic injuries was made in five of 17 cases and eight of 11 trauma cases. Laparoscopic injuries were classified by the Way injury classification (Stewart L, Way LW. Arch Surg 1995;130:1123). There were one Type I, one Type II, and nine Type III injuries. Treatment included suturing of the laceration (n = 1), hepaticojejunostomy (n = 8), and primary repair (n = 2). Open injuries were classified using the Bismuth classification. There were one Type I and three Type III injuries. All were treated with hepaticojejunostomy. There were two iatrogenic injuries unrelated to cholecystectomy. One patient suffered a perforation of the gallbladder during laparoscopic nephrectomy. This patient subsequently underwent cholecystectomy and has done well. The second patient suffered ligation of the intraduodenal portion of the common bile duct during hemigastrectomy and oversewing of a duodenal ulcer. This patient underwent hepaticojejunostomy and has done well. Complications of iatrogenic injury repair included leaking of a repaired laceration (n = 1), failed hepaticojejunostomy (n = 1), and an anastomotic stricture after hepaticojejunostomy (n = 1). Laparoscopic injuries by LSUMC hospitals is 0.2 per cent. Extrahepatic biliary tract injuries resulting from open cholecystectomy were diagnosed later than those occurring during laparoscopic cholecystectomy and were most likely to result in stricture formation. Repair of Way Type II and III injuries is associated with a higher complication rate. Hepaticojejunostomy has a complication rate of 15 per cent. Minor common duct lacerations are amenable to conservative therapy with oversewing and/or endoscopic retrograde cholangiopancreatography with stent placement. Repair of extrahepatic biliary tract injuries with hepaticojejunostomy at a level of good blood supply remains our gold standard for treatment of more severe injuries and strictures.

Bile Ducts, Extrahepatic↗
PubMed1992

Biliary tract reconstruction in liver transplantation.

Biliary tract complications are often referred to as the "Achilles' heel" of liver transplantation and various techniques have been developed to overcome them. The two major methods of bile duct reconstruction currently in use consist of either (1) choledochocholedochostomy over a T-tube or, when duct-to-duct approximation is not feasible, choledochojejunostomy over an internal stent, or (2) interposition of the donor gallbladder as a conduit between the donor bile duct and either the recipient bile duct or a jejunal loop. Although these standardizations of biliary tract reconstruction have resulted in a reduction of biliary complications after liver transplantation, further advancement in the elucidation of ampullary obstruction and viability of the donor bile duct is needed.

Animals↗
PubMed1983

[12 years' experience in surgery of the biliary tract].

Operations on the biliary tract increase constantly, not only in our country, but around the world. From a total number of operations performed in our department in one year period, those caused by biliary disorders increased from 6.4% (1970) to 28% (1980). The authors present a low mortality rate and few intra- and postoperative complications. By contrasting X-ray and ultrasound, the diagnosis in 97.5% of the cases was exact. Having combined intraoperative cholangiography and choledochoscopy, the percentage of residual stones decrease do 1.5%; there have also been reduced indications of bilio-digestive anastomosis and papillotomy. The common bile duct is not to be closed primarily, instead a T-Tube is to be put in. The authors insist on retrograde cholecystectomy and they place a drain in the majority of cases.

Adult↗
PubMed1976

Critical sequelae in biliary tract disease.

The high incidence of calculous biliary tract disease accounts for surgical operation upon the biliary tract disease accounts for surgical operation upon the biliary tract being the most frequently performed within the abdomen. Untreated surgically critical sequelae tend to occur with advancing age and duration of the disease. The more common of these are: acute cholecystitis, choledocholithiasis, acute obstructive suppurative cholangitis, biliary enteric fistulas, liver abscess, related pancreatitis, and biliary cirrhosis. The greater the pathological changes in the biliary tract and the more debilitated the individual, the greater is the risk of surgery. However, the risk is even greater without operation.

Acute Disease↗
PubMed2006

Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 1, Biliary tract.

OBJECTIVE: The purpose of this article is to highlight the imaging features of congenital anomalies and normal variants of the biliary tract with contemporary imaging techniques such as MR cholangiopancreatography (MRCP), MRI, and helical CT. CONCLUSION: Recognizing findings of congenital anomalies and normal variants of the biliary tract at MRCP, MRI, and helical CT, and knowledge of the clinical significance of each entity, are important for establishing a correct diagnosis and in guiding appropriate clinical management.

Adult↗
PubMed1979

Congenital biliary tract dilatation and anomalous junction of the pancreatico-biliary ductal system.

Anomalous junction of the pancreaticobiliary ductal system (AJPBDS) was found not only in 6 of 28 children with congenital dilatation of the bile duct, but in 3 of 57 children with congenital biliary atresia, in 2 of 17 children with infantile hepatitis and in one child with chronic pancreatitis during the past 17 yr at the Kagoshima University Hospital. A new technique of selective choledochopancreatography has been developed in which the mid-choledochus is clamped and dye is selectively injected into the distal choledochus to demonstrate the pathology of the bile duct. This technique has been successful even in small children when other cholangiographic techniques have failed to show AJPBDS. AJPBDS can be divided into two main types: (1) with biliary tract dilatation and (2) without biliary tract dilatation. The preferred treatment for type 1 is considered to be Roux-en-Y limb hepaticojejunostomy with primary excision of the choledochal cyst in order to prevent reflux of pancreatic juice flow into the choledochus, postoperative gall stone formation, or cancer from arising in the remaining choledochal cyst. Hepatic portocholecystostomy for biliary atresia with patency between gall bladder and papilla duodeni associated with AJPBDS can not be recommended since it may cause dilatation or obstruction of the bile duct postoperatively. Further studies concerning the etiology or therapy for AJPBDS are necessary.

Adult↗
PubMed1999

Effect of pancreatic juice reflux into biliary tract on N-nitrosobis(2-oxopropyl)amine (BOP)-induced biliary carcinogenesis in Syrian hamsters.

To elucidate the possible role of pancreatic juice reflux into the biliary tract in promoting the development of biliary carcinoma, Syrian hamsters were subjected to cholecystoduodenostomy and ligation of the distal end of the common duct and then subcutaneously injected with N-nitrosobis(2-oxopropyl)amine (BOP) (experimental group). The incidences of gallbladder carcinoma and extrahepatic bile duct carcinoma in the experimental group was significantly higher than in the sham-operated group (P < 0.01, P < 0.05). The proliferating cell nuclear antigen (PCNA) labeling indices of both regions gradually increased with time, and were significantly higher in the experimental group at weeks 9 and 16 than in the sham-operated group at the same time. Trypsin and phospholipase A2 (PLA2) activities in bile and tissue levels of superoxide dismutase (SOD) in the gallbladder and extrahepatic bile ducts were higher in the experimental group than in the sham-operated group. These findings suggest that the carcinogenic effect of BOP was enhanced in biliary epithelium that had proliferated in response to and/or had been injured by activated pancreatic enzymes refluxing into the biliary tract and then increased free radical activity, leading to a high frequency of carcinoma development in the biliary tract.

Animals↗