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PubMed1989

[Reconstruction of the bile ducts after complex injury of the gallbladder and the bile ducts after blunt abdominal trauma in a dog].

Solitary injuries of the gall bladder and the bile ducts are very seldom and dangerous. The prognosis of such injuries depends of the delay until the diagnosis is made and of the method of the bile ducts reconstruction. Several methods have been described; we present a method of reconstruction of the bile ducts after cholecystectomy with a bilio-digestive anastomosis with following advantages: no tension on the anastomosis, possibility of several anastomoses on the same jejunal loop, exact adaptation of the mucosa and elimination of the reflux of intestinal contain in the bile ducts with a long and isoperistaltic Roux-loop.

Animals↗
PubMedDate not supplied

Endocrine and paracrine calcium signaling in bile duct cells.

Bile duct cells play an important role in maintaining, modifying and augmenting bile flow. It is well established that cyclic AMP (cAMP) is an important second messenger for secretion in these cells, but less is known about cytosolic Ca2+ (Ca2+i). Here we review evidence that ATP and acetylcholine (ACh) are Ca2+i agonists for bile duct cells, and that these agonists increase Ca2+i through inositol 1,4,5-trisphosphate (InsP3). We also review data suggesting that hepatocytes have the ability to secrete ATP, so that they may serve as a paracrine source for this signaling molecule in vivo. Finally, we compare the effects of cAMP and Ca2+i on secretion, both in isolated bile duct units and isolated hepatocyte couplets. Implications and future directions for studying the role of Ca2+i in bile ductular secretion are discussed.

Acetylcholine↗
PubMed2006

Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct.

Biliary cystic tumors, which are also called biliary cystadenoma and cystadenocarcinoma, are thought to be a heterogeneous disease entity, and some of them are known to show a luminal communication to the bile duct. In this study, we examined the clinicopathological features of nine cases of biliary cystic tumors with bile duct communication. They were composed of five males and four females with an average age of 67 years (52-84 years). They were multilocular (eight cases) or unilocular (one case), and all cases contained mucinous fluid. A direct luminal communication with the bile ducts was identified in five cases on preoperative or intraoperative cholangiographies. Biliary cystic tumors examined in this study were histologically adenoma (one case), adenocarcinoma in situ (six cases), and adenocarcinoma associated with microinvasive mucinous carcinoma (two cases). One case of adenocarcinoma in situ also had the adenoma component (adenocarcinoma in adenoma). Dysplastic mucinous epithelium proliferated in flat, micropapillary and papillary fashions within the intracystic spaces. Intraepithelial neoplasm was observed within non-dilated adjacent bile ducts, suggesting a direct luminal communication between the cystic tumors and the bile duct. Ovarian-like stroma was not observed in their walls in any cases. Immunohistochemically, seven cases expressed MUC1 or MUC2 in the neoplastic biliary epithelium. All cases except one were alive without any evidences of tumor recurrence after total excision (3-156 months after surgery). These clinicopathological features resembled those of intraductal papillary neoplasm of the bile duct, which had been reported as a biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. In conclusion, biliary cystic tumors with bile duct communication could be regarded as intraductal papillary neoplasm with a prominent cystic dilatation of the bile duct and mucin retention, rather than true biliary cystic neoplasms.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

Tumor-associated focal chronic pancreatitis from invasion of the pancreatic duct by common bile duct carcinoma: radiologic-pathologic correlation.

We report a case of tumor-associated focal chronic pancreatitis of the uncinate process of the pancreas. The chronic pancreatitis was secondary to stenosis of the main pancreatic duct from invasion by a common bile duct carcinoma. A feature distinguishing the chronic pancreatitis from pancreatic carcinoma was the localized dilatation of pancreatic duct branches evident in the focal lesion of the uncinate process.

Cholangiocarcinoma↗
PubMed1999

Well-differentiated adenocarcinoma, gastric foveolar type, of the extrahepatic bile ducts: A previously unrecognized and distinctive morphologic variant of bile duct carcinoma.

Two examples of a rare but distinctive morphologic variant of extremely well-differentiated adenocarcinoma of the extrahepatic bile ducts are reported. One tumor arose in the common bile duct of a 51-year-old man; the other arose in the common hepatic duct of a 27-year-old man. Both tumors were composed predominantly (>95%) of gastric foveolar-type epithelium. Because of their bland nuclear features, low mitotic index, and focal polypoid and lobular architecture, they were initially confused with adenomas. Foci of less-differentiated adenocarcinoma and perineural invasion present in the deep portions of the tumors facilitated recognition. The neoplastic cells and extracellular mucin were periodic acid-Schiff- and alcian blue-positive. By immunohistochemistry, the tumor cells expressed cytokeratins 8 and 20 as well as cathepsin D, as reported in normal foveolar cells. Likewise, p53 overexpression was documented immunohistochemically in both adenocarcinomas, which also stained with the Ki-67 antibody. Despite the well-differentiated nature of the neoplasms and their deceptively benign microscopic appearance, one patient developed recurrence and liver metastasis 5 years after surgery. The other patient is disease-free 2 years following a segmental resection of the common hepatic duct, cystic duct, and gallbladder. The cell phenotype of these tumors can be explained by the ability of the bile duct epithelium to differentiate along gastric cell lines.

Adenocarcinoma↗
PubMed1996

Endocytosis in rat intrahepatic bile duct epithelial cells of horseradish peroxidase injected into the common bile duct or the portal vein.

While recent data in intrahepatic bile duct epithelial cells (IBDECs) isolated from normal rat liver have established their ability to undergo endocytosis, few studies have assessed endocytosis in IBDECs in situ. Thus, to clarify the activity of IBDECs in situ on macro-molecules in bile and blood, we injected horseradish peroxidase (HRP) into either the common bile duct or the portal vein, and determined its intracellular distribution by electron microscopic cytochemistry. Successful retrograde injection into the common bile duct was achieved by resection of the liver surface so as to avoid HRP leakage from the bile duct on injection. IBDECs internalized HRP through both the apical and basolateral plasma membranes. By quantitative analysis, counting the number of HRP-positive vesicles in the cells, apical endocytosis was found more active than basolateral. HRP internalized through the apical membrane was either routed to the acid phosphatase-positive lysosomes for degradation or to extracellular space for transcytosis. HRP through the basolateral membrane was transferred to the organelles having lipid inclusion, which were expected to be lysosomes negative for acid phosphatase. Our results suggest that IBDECs in situ are actively engaged in endocytosis for degradation of macromolecules in bile and blood, and possibly engaged in the excretion of macromolecules into extracellular space.

Animals↗
PubMed1982

Ultrastructural changes of bile duct epithelium in primary biliary cirrhosis in relation to progression of bile duct loss.

Using wedge liver biopsies from patients with primary biliary cirrhosis (PBC), ultrastructural features of the intrahepatic bile ducts in livers with slight or no bile duct loss were compared with those in livers with advanced bile duct loss and in extrahepatic cholestasis (EHC). Most changes in the biliary epithelium in PBC were similar to those in EHC. Microvillous loss and bleb formation, mitochondrial damage and increase in endoplasmic reticulum and ribosomes were found in PBC irrespective of the degree of bile duct loss, and also in EHC. These changes were present almost equally at any level of the biliary tree, and are presumed to represent a variety of non-specific lesions of biliary epithelial cells. As the loss of bile ducts in PBC progressed, cytoskeletal filaments and cytophagosomes increased in number and basement membranes were more thickened and reduplicated. These changes were more or less conspicuous in smaller branches of the biliary tree, and were also prominent in EHC. They might be causally related to the bile flow disturbance in the liver. Lateral intercellular spaces were irregularly dilated and contained osmiophilic membranous and/or granular material, similar to that found in duct lumena, within and without the basement membrane, and in the cytoplasm of periductal macrophages. Furthermore, pinocytotic vesicles were increased in the biliary cytoplasm facing periphery. These findings suggest possible alteration of the permeability of biliary epithelial cells, probably in the direction from the lumena to the periductal tissue. Such changes were found in PBC livers with virtual absence of bile duct loss, and the significance of this phenomenon is discussed.

Bile Ducts, Intrahepatic↗
PubMed1986

[Histopathological studies on congenital dilatation of the bile duct--with special reference to the regurgitation of pancreatic juice into the bile duct].

Clinical and experimental studies on congenital dilatation of the bile duct (CDBD) were performed histologically as related to the regurgitation of pancreatic juice into the biliary tract. In all of the 40 patients, resected bile duct showed two characteristic findings such as grandular formation near the epithelial layfer with inflammatory cell infiltration and thickening of the wall occupied with increased collagen fibers. Twenty two of 26 patients (84.6%) who had abdominal pain showed both findings and 11 of 15 cases (73.3%) who had jaundice showed only thickening of the wall (p less than 0.01). Total bilirubin and alkaline phosphatase levels in serum were higher in latter patients and amylase level in bile was higher in the former (p less than 0.05). Grandular formation was shown in all of the 9 patients of which bile duct dilated cylindrically. A canine model in which total pancreatic juice passed via intact common bile duct was made in 10 mongrel dogs. Common bile duct showed cylindrical dilatation and grandular formation with inflammatory cell infiltration histologically. In conclusion, regurgitation of pancreatic juice into the bile duct was thought to take part in grandular formation with inflammatory cell infiltration shown in CDBD.

Adolescent↗
PubMed1999

Recurrent common bile duct stones containing metallic clips following laparoscopic common bile duct exploration.

A case of recurrent common bile duct stones 2 years following laparoscopic cholecystectomy and laparoscopic common bile duct exploration in a 52-year-old man is reported. Surgical material as a nidus for recurrent stone formation has been reported and occurred in the present case. Factors influencing metallic clip migration after biliary surgery are discussed, with recommendations for decreasing recurrent stones caused by foreign material.

Cholangiography↗
PubMed2001

Autoimmune hepatitis with incidental histologic features of bile duct injury.

Bile duct changes are atypical of autoimmune hepatitis. Our aims were to assess the frequency and significance of these changes in classical disease. Liver biopsy specimens were reviewed under code from 84 patients who satisfied international scoring criteria for autoimmune hepatitis, and the findings were correlated with clinical features and outcome. Twenty patients (24%) had biliary changes, including 6 with destructive cholangitis, 4 with ductopenia, and 10 with nondestructive cholangitis. Patients with and without bile duct changes had similar laboratory findings. Diagnostic scores for autoimmune hepatitis were lower in patients with bile duct changes (16.6 +/- 0.6 vs. 19.1 +/- 0.2, P <.0001). The frequencies of scores sufficient for a definite (80% vs. 97%, P =.03) or probable diagnosis (20% vs. 3%, P =.03) were also less in this group. Patients with destructive cholangitis and/or ductopenia responded as well to therapy as patients with nondestructive cholangitis, and outcomes in each group were similar to those of patients without biliary changes. We concluded that biliary changes can occur in classic autoimmune hepatitis, and they are not associated with distinctive clinical features or treatment response. They may be coincidental findings associated with classic disease or weak expressions of a variant syndrome. In the absence of a cholestatic clinical syndrome, they do not compel a different management strategy.

Adolescent↗
PubMed1995

Investigations for Bile Duct Calculi.

Bile duct stones are common, occurring in approximately 15% of patients with gallstones. Radiological techniques for preoperative detection of stones are determined by the clinical presentation of the stones. In patients who are not symptomatic, detection of a dilated bile duct on ultrasound strongly suggests bile duct stones. In up to 80% of patients, ultrasound may detect stones, but the accuracy of this technique is operator-dependent. Although there has been a resurgence of interest in intravenous cholangiography in recent years, its use is not supported on grounds of either accuracy or safety. Other techniques, such as percutaneous cholangiogram, computed tomography, and magnetic resonance imaging, may be used in those particular circumstances when endoscopic retrograde cholangiography cannot be used.

Journal Article↗
PubMedDate not supplied

Hepatic vitamin D 25-hydroxylase: inhibition by bile duct ligation or bile salts.

Bone disease and low serum levels of 25-hydroxyvitamin D are prevalent in cholestatic syndromes such as primary biliary cirrhosis and biliary atresia. Defective hydroxylation, along with malabsorption of vitamin D, could be a factor in 25-hydroxyvitamin D depletion. To assess hepatic hydroxylation during experimental cholestasis, we studied vitamin D 25-hydroxylase activity in liver homogenates of rats after 7, 14, and 21 days of bile duct ligation. We have also studied the effects of bile acids on this enzyme in vitro. Hepatic 25-hydroxylation was depressed after 7 days ligation in only 1 of 4 animals, but by 14 days, all animals showed a marked reduction with a mean decrease of 64% in specific activity. Total liver enzyme activity was reduced by 43% at 14 days. In the ligated animals, liver histology showed progressive bile stasis, focal necrosis, bile ductular proliferation, periductular and periportal inflammation, and fibrosis. Addition of bile acids to the in vitro assay in concentrations approximating those found in cholestasis produced marked inhibition of vitamin D 25-hydroxylase activity.

25-Hydroxyvitamin D 2↗
PubMed1996

Common bile duct stones in non-dilated bile ducts? An ultrasound study.

In a consecutive series of 870 patients having cholecystectomy performed by the laparoscopic technique in a single surgical unit, prospective data collection has permitted analysis of the relationship between common bile duct (CBD) diameter, as measured pre-operatively by ultrasound (US) examination, and the frequency of CBD stones. Overall, 85 patients (9.8%) have been shown to have CBD stones; the interval frequency for CBD size 0-4, 4.1-6, 6.1-8, 8.1-10 and > 10 mm, was 3.9, 9.4, 28, 32 and 50%, respectively. Because most patients have small ducts (736 with CBD size < 6.1 mm) almost half (42) of those with CBD stones came from this group. In reporting CBD size as "not dilated', radiologists should remind clinicians that this does not equate with "no CBD stones'.

Cholecystectomy, Laparoscopic↗
PubMed1990

[An increase of choleresis in secondary biliary cirrhosis in rats is caused by bile duct secretion].

Bile flow may be considerably increased in human cirrhosis. The mechanism of this increase has not been established. Two mechanisms have been proposed: a) increased canalicular filtration because of sinusoidal hypertension, or b) secretion by proliferated bile ductules. To distinguish between these two possibilities, we examined the determinants of bile secretion in rats with secondary biliary cirrhosis after bile duct obstruction. Sham-operated animals served as controls. Four weeks after bile duct ligation, all animals had cirrhosis. Bile flow was significantly higher and bile salt secretion significantly lower in cirrhotic animals than in controls. Biliary bicarbonate concentration was significantly higher in cirrhotic animals than in controls. Bile-to-plasma concentration ratio of erythritol was significantly lower in cirrhotic animals than in controls, suggesting a dilution of erythritol by a secretion distal to bile canaliculi. Bile-to-plasma ratio of sucrose was not significantly different in cirrhotics and controls, suggesting that paracellular permeability was not modified. Secretin, at the dose of 3 clinical units/100 g, induced an increase of approximately 75 percent in bile flow, and 70 percent in biliary bicarbonate concentration in cirrhotics. In conclusion, bile flow was increased in biliary cirrhosis in rats. The dilution of erythritol, the increase in biliary bicarbonate concentration and the increased response to secretin strongly suggest that increased choleresis was due, at least in part, to secretion by bile ductules or ducts. These results confirm that secondary biliary cirrhosis is a good experimental model for the study of alterations of bile secretion in cirrhosis.

Animals↗
PubMed1993

Bile duct injury and bile leakage in laparoscopic cholecystectomy.

Between January 1991 and July 1992, 350 laparoscopic cholecystectomies were performed. There were six biliary complications (1.7 per cent): common bile duct (CBD) injury (one patient), delayed CBD necrosis (one), immediate postoperative bile leakage (one) and delayed bile leakage (three). All six patients required laparotomy. Primary repair with long-arm T tube splinting for 3 months was performed for the CBD injury. Religation of the cystic duct was carried out after immediate postoperative bile leakage. Laparotomy with T tube choledochostomy only was performed in the three patients with delayed bile leakage, and hepatojejunostomy Roux-en-Y was undertaken for CBD necrosis. The patient with primary repair of the CBD injury required choledochojejunostomy Roux-en-Y 18 months later for stenosis. Episodes of intermittent cholangitis occurred in the patient with CBD necrosis. The outcome for the four patients with bile leakage was good. There were no deaths.

Adult↗