scholarly journals Using the stent-in-stent technique to drain the right hepatic duct, passing across a 7-year-old obstructed spiral self-expandable metal stent of the left hepatic duct

Author(s):  
Ahmad Alhamid ◽  
Ziad Aljarad ◽  
Fayez Sandouk
2020 ◽  
Vol 99 (8) ◽  

Our case report describes a patient with recurrent stenoses in both the right and left hepaticojejunoanastomoses due to an injury to the bile ducts during cholecystectomy several years ago. The anastomoses could not be reached endoscopically. EUS-guided hepaticogastrostomy would be a solution only for the left hepatic duct anastomosis. As the patient refused percutaneous transhepatic drainage (PTD) of both intrahepatic ducts and dilation of both anastomoses, endoscopic ultrasound-guided jejunoduodenostomy was performed using a lumen apposing metal stent (LAMS). This method provides repeated endoscopic access to the anastomoses of both hepatic ducts, allowing for their treatment.


2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Theodoros Mariolis-Sapsakos ◽  
Vasileios Kalles ◽  
Konstantinos Papatheodorou ◽  
Nikolaos Goutas ◽  
Ioannis Papapanagiotou ◽  
...  

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.


2019 ◽  
Author(s):  
R.T. Reem ◽  
M.A. Maher ◽  
H.E. Alaa ◽  
H.A. Farghali

ABSTRACTUnder the prevailing overall Conditions of all veterinarians for the diagnosis of biliary diseases, application of surgical procedures and liver transplantation in Cats as carnivorous pet animal, and Rabbits as herbivorous pet animal and also as a human model in research. The present study was constructed on twelve native breeds of rabbits (Oryctolagus cuniculus) and eighteen adult domestic cats (Felis catus domesticus). We concluded that, in brief; the rabbit gall bladder was relatively small, fixed by several small hepato-cystic ducts to its fossa. The rabbit bile duct was formed commonly by the junction of the left hepatic duct and the cystic duct. The cystic duct was commonly fairly large, received the right hepatic duct that collected the right lobe in its route to enter the duodenum, the bile duct receives the branch of the caudate process of the caudate lobe. The present study revealed other four anatomic variations dealing with the shape and size of the feline native breed’s gall bladder from fundic duplication, bilobed, truncated fundus and distended rounded fundus. Commonly, the bile duct was formed by the triple convergence of the left and the right hepatic ducts with the cystic duct. However, in some exceptional cases a short common hepatic duct was formed. Sonographically, the normal gall bladder in rabbit appeared small, elongated with anechoic lumen bordered by right lobe laterally and quadrate lobe medially and has no visible wall, but in cat varied in conformation, bordered by the right medial lobe laterally and the quadrate lobe medially surrounded by echogenic wall.


Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1944
Author(s):  
Marinko Marušić ◽  
Matej Paić ◽  
Mia Knobloch ◽  
Marko Vodanović

Altemeier-Klatskin tumor is a perihilar cholangiocarcinoma that occurs within 2 cm of the confluence of the right and left hepatic duct at the hepatic hilum and accounts for 50–70% of all cholangiocarcinomas cases. Although imaging techniques have come very far today, this entity can still be very challenging to diagnose as there are many lesions that can mimic Klatskin tumor. In this review, we will present the most common Klatskin-mimicking lesions.


2019 ◽  
Vol 13 (2) ◽  
pp. 116-120
Author(s):  
Elisa Paolucci ◽  
Eva Tonveronachi ◽  
Chiara Praticò ◽  
Maria Cristina Zani ◽  
Maria Cristina Paonessa ◽  
...  

We present the case of a 33-year-old Italian man who came to our attention for epigastralgia associated with polyserositis (pleural, pericardial, and peritoneal effusion with the involvement of the Douglas excavation), in the absence of a significant medical history. Laboratory analysis revealed exudative eosinophilic pleural effusion; serial imaging techniques showed a transient stenosis of the right hepatic duct and a subsequent stenosis of the left hepatic duct. After several negative serological investigations, a positive anti-strongyloides immunoglobulin G antibodies titer rose suspicions of Strongyloides infection, which was confirmed by positive stool sample for parasite. Ivermectin-therapy was started and the patient has fully recovered.


BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuichi Fujioka ◽  
Keigo Nakashima ◽  
Hiroaki Kitamura ◽  
Yuki Takano ◽  
Takeyuki Misawa ◽  
...  

Abstract Background The critical view of safety (CVS) method can be achieved by avoiding vasculo-biliary injury resulting from misidentification during laparoscopic cholecystectomy (LC). Although achieving the CVS has become popular worldwide, there is no established standardized technique to achieve the CVS in patients with an anomalous bile duct (ABD). We recently reported our original approach for securing the CVS using a new landmark, the diagonal line of the segment IV of the liver (D-line). The D-line is an imaginary line that lies on the right border of the hilar plate. The cystic structure can be securely isolated along the D-line without any misidentification, regardless of the existence of an ABD. We named this approach the segment IV approach in LC. Methods In this study, we adopted the segment IV approach in patients with an ABD. Results From October 2015 to June 2020, 209 patients underwent LC using the segment IV approach. Among them, three (1.4%) were preoperatively diagnosed with an ABD. The branching point of the cystic duct was the posterior sectional duct, anterior sectional duct, or left hepatic duct in each patient. The CVS was achieved in all cases without any complications. Conclusion It is a promising technique, especially even for patients with an ABD during LC.


2014 ◽  
Vol 79 (5) ◽  
pp. AB164
Author(s):  
Paula Gil-Simon ◽  
Nestor Aleman ◽  
Irene PeñAs ◽  
Alba L. Vargas ◽  
Ramon Sanchez-Ocaña ◽  
...  

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Carlo Marino ◽  
Ignacio Obaid ◽  
Gabriela Ochoa ◽  
Nicolás Jarufe ◽  
Jorge A Martínez ◽  
...  

Abstract Vasculobiliary injuries (VBI) caused by cholecystectomies are infrequent but extremely serious. We report a case of a severe VBI successfully treated at our center. A 22-year-old woman underwent an open cholecystectomy as treatment for acute cholecystitis and bile duct stones. She was transferred to our center on postoperative Day 4 because of progressive jaundice and encephalopathy. After a proper investigation, we found an extreme VBI with infarction of the right hepatic lobe associated with complete interruption of the portal vein and proper hepatic artery flows and full section of the common hepatic duct. Right hepatectomy with portal—Rex shunt revascularization of the left hepatic lobe and Roux-en-Y hepaticojejunostomy to the left hepatic duct was done. The patient was discharged on the 60th postoperative day. Discussion: This case shows the successful surgical treatment of a severe cholecystectomy’s VBI, avoiding an emergency liver transplant.


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