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At least 145 records · Page 8Linked to original sources
PubMed1979

Improved cannula for operative (cystic duct) cholangiography.

A new S-shaped cystic duct metal cannula was developed and used successfully in 200 cystic duct cholangiograms. It has the advantage of being easy to manipulate because the configuration does not obscure the vision and the resistance is less than that of plastic tubes, facilitating injection with lower pressure. It is much cheaper than the disposable cannulas because it can be reused (autoclaved).

Catheterization↗
PubMed1996

The role of ERCP in laparoscopic cholecystectomy-related cystic duct stump leaks.

BACKGROUND: Laparoscopic cholecystectomy has resulted in an increase in the incidence of cystic duct stump leaks. To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) a review of 14 cystic duct stump leaks following laparoscopic cholecystectomy was carried out. METHODS: A retrospective chart review of fourteen patients was carried out. There were 11 females and 3 males. Laparoscopic cholecystectomy was carried out without any difficulty. Three patients became very ill soon after surgery while 11 patients were minimally ill. All were still hospitalized after the cholecystectomy. RESULTS: Urgent ERCP on the 3 very ill patients demonstrated a cystic duct bile leak. In the 11 minimally ill patients, ultrasonography demonstrated intraabdominal fluid collections and initial treatment was percutaneous drainage. Only 2 of the 11 patients improved. The remaining nine patients developed a septic course. ERCP was carried out and demonstrated cystic duct bile leak in all 9 patients. Endoscopic papillotomy alone or endoscopic papillotomy plus stenting resolved the clinical picture. CONCLUSIONS: Patients who are ill post laparoscopic cholecystectomy should have urgent ERCP. Cystic duct bile leaks should be managed by endoscopic papillotomy and in select cases, stenting.

Adult↗
PubMedDate not supplied

Mucin-producing carcinoma of the cystic duct that caused obstructive jaundice.

We report a very rare case of what appeared to be mucin-producing carcinoma of the cystic duct, and this is the forth case recorded in the English-language and Japanese literature. The patient was a 67-year-old man with a chief complaint of dark urine and jaundice. Cholangiography via an endoscopic nasobiliary drain showed dilatation of the common hepatic duct to 14 mm, with no visualization of the cystic duct or gallbladder, and an approximately 15-mm filling defect was observed at the junction of the common bile duct and the cystic duct. Based on these findings a diagnosis of cancer of the middle portion of the bile duct was made. Cholecystectomy and resection of the bile duct with dissection of regional lymph Nodes and choledochoduodenostomy were performed. About a 1-cm mass was palpable in the region of the cystic duct, and the gallbladder contained mucin some of which reached the common bile duct. Histological examination revealed well-differentiated ductal adenocarcinoma infiltrating the serosa, in which mucus production was observed. The patient was discharged on postoperative day 50. At the present time, 38 months postoperatively, there are no signs of recurrence, and he is attending the outpatient clinical in good health.

Adenocarcinoma↗
PubMed1998

A case of gallbladder adenomyomatosis with pancreaticobiliary maljunction and an anomaly of the cystic duct joined the common channel.

A 46-yr-old woman was admitted to our hospital with mild epigastric pain. Ultrasonography and computed tomography revealed an extremely thickened gallbladder wall. Endoscopic retrograde cholangiopancreatography demonstrated that the main pancreatic duct joined the nondilated common bile duct at the outer point of the duodenal wall (P-C type of pancreaticobiliary maljunction), and the cystic duct joined the common channel directly. The intraoperative amylase levels of the bile juices both in the common bile duct and the cystic duct were high. A cholecystectomy was performed. The wall of the gallbladder was markedly thick, yellowish, elastic, and soft. Histologically, Rokitansky-Aschoff sinus proliferation, hypertrophy of smooth muscles, and fibrosis were seen. The diagnosis was a generalized type of adenomyomatosis. The pathogenesis of the adenomyomatosis was believed to result from chronic stimulation as a result of pancreatic juice reflux. The etiology of this unusual type of junction was considered to be the result of the combination of pancreaticobiliary maljunction and an anomaly of lower junction of the cystic duct.

Adenomyoma↗
PubMed2001

The significance of cystic duct stones encountered during laparoscopic cholecystectomy.

BACKGROUND: Cystic duct stones (CDS) are occasionally encountered during laparoscopic cholecystectomy (LC). They may be noticed during the dissection of the cystic pedicle or seen to extrude from the cystic duct (CD) when it is divided or opened to perform the intraoperative cholangiogram (IOC). The procedures for dealing with CDS range from the simple removal of stones that fall out when the duct is opened to incising the duct over an impacted stone to facilitate its removal or converting to open surgery due to a large stone in a CD adherent to the bile duct (e.g., Mirizzi syndrome). Therefore, we set out to establish criteria that might be predictive of CDS, to examine the technical problems caused by them, to look for the most effective ways of avoiding adverse consequences, especially the risk of missing bile duct stones. METHODS: We performed a review and analysis of a database that included preoperative, operative, and postoperative data for all patients treated at our hospital who were found to have CDS. RESULTS: In a series of 520 LC performed over a period of 5 years, 64 cases of CDS were documented (12.3%). The preoperative risk factors in 45 of these cases (70.3%) were recent sever acute pain with or without liver function test (LFT) derangement (34.3%), jaundice (14%), pancreatitis (14%), and previous acute cholecystitis (7.8%). At operation, a single stone was found in the CD in 64% of the cases; multiple stones were found in 36%. Dissection of the pedicle was difficult in 21 cases and had to be carried out fundus-first in four cases. The CD was reported to be wide in 18 cases; five of them eventually needed to be closed with endoloops. Operative difficulty was reported in three of 19 cases where there were no preoperative risk factors. Simple removal of the stones was possible in most cases. CDS needed be crushed, the CD incised, or the procedure converted to open in only five cases (7.8%). IOC was attempted in all cases; it was normal in 39 (61%) and failed in two cases (3%). Eighteen patients (28%) were found to have bile duct stones; another five (7.8%) had CBD dilation or debris indicating possible recent passage of stones. Fourteen transcystic and nine direct bile duct explorations were performed. CONCLUSION: Some CDS may slip from the gallbladder into the CD or the CBD during dissection. Careful retraction and manipulation should therefore be done to minimize this risk. Most CDS are easy to deal with, but some of them can result in increased operative difficulty. If IOC is not carried out on a routine basis, it becomes mandatory if CDS are encountered because 35% of them may be associated with bile duct stones.

Adolescent↗