scholarly journals A133 DEVELOPMENT OF TYPE 3 ACHALASIA WITH DISTANT PANCREATIC MALIGNANCY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 153-155
Author(s):  
K Leung ◽  
F Habal ◽  
M Alrukaibi ◽  
L W Liu
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Enteric Neurons ◽  
Thoracic Esophagus ◽  
Residual Pressure ◽  
Type I ◽  
Duodenal Stent ◽  
History Of ◽  
Type 3

Abstract Background Pseudoachalasia is often caused by malignant involvement at the gastroesophageal junction (GEJ) leading to dysphagia. Aims We describe a case of type 3 achalasia presenting in a woman with metastatic pancreatic cancer with no direct involvement at the GEJ, fundus or cardia. Methods A case report and literature review were performed. Results A 53-year-old woman presented with a 2-month-history of progressive abdominal pain, nausea and vomiting with a 30-pound weight loss. She had a remote history of breast cancer in remission after surgery and chemoradiation. On presentation, she denied chest pain, reflux, dysphagia or odynophagia. Abdominal exam revealed focal epigastric tenderness and jaundice. Abdominal CT showed a 6.7 x 5.8 cm conglomerate mass involving the hepatic hilum, pancreatic head, duodenum, common bile duct, and portal vein with gastric outlet and biliary obstruction. This mass was confirmed to be a pancreatic adenocarcinoma on pathology. She then underwent nasogastric tube decompression. Initial esophagogastroduodenoscopy (EGD) confirmed a stenotic area at the distal duodenal cap. A duodenal stent and common bile duct stent were placed during a second EGD. The esophagus and GEJ were unremarkable on both endoscopic exams. She was started on chemotherapy with gemcitabine and abraxane. Two weeks after her stent placement, she rapidly developed severe retrosternal squeezing discomfort and choking occurring with swallowing. CT chest and abdomen were negative for any intrathoracic and diaphragmatic involvement with stability of the mass. A barium swallow study demonstrated tertiary contractions in the thoracic esophagus with marshmallow hold-up in the distal esophagus. She then underwent a high-resolution esophageal manometry study that demonstrated an elevation of integrated residual pressure (IRP) of the lower esophageal sphincter (LES) and absence of peristalsis, with the distal 2/3rds of the esophagus showing a simultaneous and prolonged pressure front consistent with type 3 achalasia, Chicago classification v3.0 [Figure 1]. All contractions had a distal contractile integral (DCI) of >8000 mmHg-cm-s. She experienced significant symptom improvement with pinaverium bromide, a gut-specific calcium channel antagonist. A review of the literature revealed that there have been 4 English-language cases published on pseudoachalasia associated with pancreatic cancer, with all cases describing direct infiltration of pancreatic cancer in the GEJ, cardia or fundus with manometric features of type I achalasia. Conclusions We report the first case of type 3 achalasia with no evidence of direct malignant infiltration at the GEJ on radiographic and endoscopic evaluations. Possible mechanisms to explain this phenomenon include paraneoplastic antibody-mediated impairment of enteric neurons that decrease nitric oxide availability, or microscopic disease involvement at the GEJ. Funding Agencies None

Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature

2021 ◽  
Vol 14 (10) ◽  
pp. e244393
Author(s):  
G Revathi ◽  
Brijesh Kumar Singh ◽  
Yashwant Singh Rathore ◽  
Sunil Chumber
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Incidental Finding ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Type I ◽  
Laparoscopic Management ◽  
Cyst Excision

A young adult male presented with biliary colic and intermittent jaundice for 1 year. Abdomen findings were unremarkable. Routine investigations revealed a raised total bilirubin. On abdominal ultrasonography, common bile duct (CBD) dilatation with multiple stones was noted. On further imaging with magnetic resonance cholangiopancreatography, type I choledochal cyst (CDC) was suspected. A laparoscopic approach was planned. Intraoperatively, dilatation of cystic duct was noted which constitute type VI CDC. Partial malrotation of the gut and accessory right hepatic artery were also noted as incidental finding. Laparoscopic cholecystectomy with CBD exploration and removal of stones, biliary stent placement, cystic duct cyst excision and primary repair of CBD was done. Postoperatively, the patient improved symptomatically with a fall in bilirubin to normal range. We are describing the laparoscopic management of a rare case of type IV CDC which was diagnosed intraoperatively.

scholarly journals Duodenal peripapillary adenocarcinoma causing extrahepatic biliary obstruction and icterus in a cat

2020 ◽  
Vol 89 (5) ◽  
pp. 273-277
Author(s):  
T. Rick ◽  
E. Stock ◽  
I. Van de Maele ◽  
E. Kammergruber ◽  
J. Saunders
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Obstruction ◽  
Ultrasound Examination ◽  
Duodenal Wall ◽  
Abdominal Ultrasonography ◽  
Extrahepatic Biliary Obstruction ◽  
History Of ◽  
The Common ◽  
Distal Aspect

A six-year-old, female, neutered domestic shorthair cat was presented with chronic weight loss and a two-day history of partial anorexia and lethargy. Abdominal ultrasonography revealed a regional thickening of the duodenal wall with loss of normal layering, a normally walled segmentally dilated distal aspect of the common bile duct containing slightly hyperechoic bile, and a mild to moderately enlarged major duodenal papilla. Based on the ultrasound examination, the primary differential diagnosis was a peripapillary duodenal neoplastic or less likely, an inflammatory or infectious process with secondary extrahepatic biliary obstruction. Postmortem examination revealed a duodenal, peripapillary adenocarcinoma with metastasis into the liver and lymph nodes, and external compressive obstruction of cystic- and common bile duct.

scholarly journals Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

2019 ◽  
Vol 9 ◽  
pp. 23
Author(s):  
Giulia Frauenfelder ◽  
Annamaria Maraziti ◽  
Vincenzo Ciccone ◽  
Giuliano Maraziti ◽  
Oliviero Caleo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Biliary Duct ◽  
History Of ◽  
The Common ◽  
Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

scholarly journals Biliary exploration via the left hepatic duct orifice versus the common bile duct in left-sided hepatolithiasis patients with a history of biliary tract surgery

Medicine ◽  
2018 ◽  
Vol 97 (3) ◽  
pp. e9643 ◽  
Author(s):  
Yong Zhou ◽  
Wen-Zhang Zha ◽  
Xu-Dong Wu ◽  
Ren-Gen Fan ◽  
Biao Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Hepatic Duct ◽  
Left Hepatic Duct ◽  
Biliary Tract Surgery ◽  
History Of ◽  
The Common

scholarly journals Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones

2010 ◽  
Vol 92 (3) ◽  
pp. 206-210 ◽  
Author(s):  
James Horwood ◽  
Fayaz Akbar ◽  
Katherine Davis ◽  
Richard Morgan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leak ◽  
Bile Duct Stones ◽  
Operative Cholangiography ◽  
Cbd Stones ◽  
Open Operation ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Positive Results

INTRODUCTION Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis, and aimed to identify the factors most likely to predict the presence of CBD stones positively. PATIENTS AND METHODS Data from 501 consecutive patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gallstones, of whom 166 underwent IOC for suspected CBD stones, were prospectively collected. Suspicion of choledocholithiasis was based upon: (i) deranged liver function tests (past or present); (ii) history of jaundice (past or present) or acute pancreatitis; (iii) a dilated CBD or demonstration of CBD stones on imaging; or (iv) a combination of these factors. Patient demographics, intra-operative findings, complications and clinical outcomes were recorded. RESULTS Sixty-four cholangiograms were positive (39%). All indications for cholangiogram yielded positive results. Current jaundice yielded the highest positive predictive value (PPV; 86%). A dilated CBD on pre-operative imaging gave a PPV of 45% for CBD calculi; a history of pancreatitis produced a 26% PPV for CBD calculi. Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms. Of the 64 patients having a laparoscopic common bile duct exploration (LCBDE), four (6%) required endoscopic retrograde cholangiopancreatography (ERCP) for retained stones (94% successful surgical clearance of the common bile duct) and one (2%) for a bile leak. Of the 335 patients undergoing LC alone, three (0.9%) re-presented with a retained stone, requiring intervention. There were 12 (7%) requiring conversion to open operation. CONCLUSIONS A selective policy for intra-operative cholangiography yields acceptably high positive results. Pre-operatively, asymptomatic bile duct stones rarely present following LC; thus, routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore, a rationing approach to the use of intra-operative imaging based on the pre-operative indicators presented in this paper, successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration, performed by an experienced laparoscopic surgeon, is a safe and effective method of clearing the bile duct of calculi, with minimal complications, avoiding the necessity for an additional intervention and prolonged hospital stay.

scholarly journals Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery

2021 ◽  
Vol 9 (B) ◽  
pp. 272-275
Author(s):  
Budhi Ida Bagus ◽  
Metria Ida Bagus ◽  
Setyawati Ida Ayu
Keyword(s):  
Bile Duct ◽  
Mortality Rate ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Laparoscopic Technique ◽  
Type I ◽  
Open Approach ◽  
Common Bile Duct Injury ◽  
Type Iv ◽  
Bismuth Classification

Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique.  Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically.  Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death.  From initial classification published by Bismuth, there have been many classifications of common bile duct injury.  We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification. Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed.  The most common bile duct injury was Bismuth type II and IV (2 patients in each type).  Reconstruction has been done by hepatico jejunostomy for type III and IV.  Choledoco Duodenostomy bypass was done for type I and II.  2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up.  4 others patients could survive with no intra abdominal complication nor other morbidity. Conclusion:  Bismuth  classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate.   Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality

scholarly journals Kolangitis Akut dengan Komplikasi Perdarahan Saluran Cerna Bagian Atas dan Peningkatan Ca 19-9: Laporan Kasus

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Agnita Irawaty ◽  
Luciana Rotty
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gastrointestinal Bleeding ◽  
Physical Examination ◽  
Upper Gastrointestinal Bleeding ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Significant Elevation ◽  
Upper Gastrointestinal

Abstract: We reported a case of cholangitis in a 64-year-old-female associated with upper gastrointestinal bleeding. Diagnosis was confirmed by anamnesis, physical examination, and supportive investigation. This patient had a significant elevation of Ca 19-9 which often used to mark malignancy, especially in the pancreatic cancer. Albeit, in investigation we only found the obstruction of common bile duct stones. This case illustrates the fact that a markedly elevated CA 19-9 can be secondary to causes other than carcinoma.Keywords: cholangitis, Ca 19-9Abstrak: Telah dilaporkan sebuah kasus kolangitis pada seorang perempuan berusia 64 tahun, yang juga mengalami komplikasi berupa perdarahan saluran cerna bagian atas. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang. Pasien ini mengalami peningkatan bermakna Ca 19-9 yang sering digunakan untuk menandai adanya penyakit keganasan terutama kanker pankreas, namun pada pemeriksaan penunjang hanya didapatkan adanya batu di duktus koledokus. Kasus ini mengilustrasikan fakta bahwa peningkatan bermakna CA 19-9 secara sekunder dapat disebabkan oleh sebab-sebab lain selain karsinoma.Kata kunci: kolangitis, Ca 19-9

scholarly journals Annular pancreas with choledocholithiasis in an adult male patient: a case report

2019 ◽  
Vol 6 (10) ◽  
pp. 3834
Author(s):  
Ilija Milev ◽  
Panche Karagjozov ◽  
Aleksandar Mitevski ◽  
Marjan Mihailov
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Male Patient ◽  
Duodenal Bulb ◽  
Biliary Tree ◽  
Pancreatic Tissue ◽  
Annular Pancreas ◽  
Papilla Vateri ◽  
History Of ◽  
And Control

Annular pancreas is very rarely presented with a clinical picture of obstructive jaundice, usually due to some biliopancreatic malignancy rather than choledocholithiasis which make our case unique. We are presenting a 60-year-old male patient with a 6 mounts old medical history of right upper quadrant pain and intermittent jaundice. On ultrasonography a common bile duct stone was detected with dilatation of the biliary tree and gallstones with edematous wall of the gallbladder. On gastroscopy narrowing of the duodenum was registered. On ERCP the papilla Vateri could not be cannulated and there was a substantial amount of retained food in the duodenal bulb and antral part of the stomach. MRCP showed extensive dilatation of the whole biliary tree from several stones in the distal part of the common bile duct. At the operation there was a ring of pancreatic tissue about 2 cm wide that surrounded the second portion of the duodenum. The operation proceeded with choledochotomy, choledocholythotomy, L-L choledocho-duodenostomy and partial resection of the pancreatic ring. After three mounts the patient had gain weight, had no pain or any other symptoms and control gastroscopy showed normal finding.

Prevalence and natural history of distal common bile duct stenosis in alcoholic pancreatitis

1984 ◽  
Vol 29 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Joseph A. Petrozza ◽  
Sudhir K. Dutta ◽  
Patricia S. Latham ◽  
Frank L. Iber ◽  
Thomas R. Gadacz
Keyword(s):  
Bile Duct ◽  
Natural History ◽  
Common Bile Duct ◽  
Alcoholic Pancreatitis ◽  
Distal Common Bile Duct ◽  
Bile Duct Stenosis ◽  
History Of ◽  
Duct Stenosis
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