Usefulness of early post-operative liver function test monitoring after laparoscopic common bile duct exploration

Background: Cholelithiasis is a common disease and at present the laparoscopic cholecystectomy is the gold standard treatment. The diagnosis of associated common bile duct stone for patients with gallstones is important for prompt surgical decision, treatment efficacy and patient safety. However, whether upper abdominal ultrasound and Liver function test (LFT) is adequate before doing lap cholecystectomy remains controversial. There are different opinions regarding the routine magnetic resonance cholangiopancreatography (MRCP) to detect the possible presence of common bile duct (CBD) stones before laparoscopic cholecystectomy.Methods: This study was carried on a total of 106 patients who were admitted and treated for gall stone diseases in the Department of General Surgery, GSL General Hospital over a period of 24 months. After admission all cases were subjected for liver function test, USG abdomen and MRCP. The collected observational data was analyzed.Results: Among the 106 patients, a total of 17cases showed concurrent gallstones and choledocholithiasis, 11 cases choledocholithiasis were revealed by ultrasound examination, while 6 cases of choledocholithiasis were not detected by ultrasound examination but were confirmed by MRCP.Conclusions: CBD stone may be missed even in the presence of deranged liver enzymes or dilated CBD in USG abdomen. Hence for patient safety routine preoperative MRCP examination is recommended before doing laparoscopic cholecystectomy to rule out the likelihood of concomitant CBD stones. The cost-effectiveness of such expensive investigation is to be studied further taking into consideration preventive costs and patient morbidity and mortality.

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Case 17.21

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0439 ◽

2014 ◽

pp. 829-830

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Ulcerative Colitis ◽

Bile Duct ◽

Common Bile Duct ◽

Liver Function ◽

Liver Function Test ◽

Test Results ◽

Left Hepatic Lobe ◽

Hepatic Lobe ◽

Function Test ◽

The Common

23-year-old man with ulcerative colitis and elevated liver function test results MIP images from 3D FRFSE MRCP (Figure 17.21.1) demonstrate focal stricture of the common bile duct at its bifurcation in the hepatic hilum. Focal beading of a mildly prominent duct in the left hepatic lobe is also noted. Axial fat-suppressed 2D SSFP images (...

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Evaluation of effect of cholecystectomy on common bile duct diameter using ultrasonography and liver function test: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20181103 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1323

Author(s):

Shreyas Bhalerao Shreyas Bhalerao ◽

Pooja Batra ◽

Maneshwar Singh Utaal ◽

Chirag Sasan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Liver Function ◽

Liver Function Test ◽

Imaging Method ◽

Duct Diameter ◽

Function Test ◽

The Difference ◽

Common Bile Duct Diameter

Background:Different factors influencing the post cholecystectomy CBD diameter have been implicated. Ultrasound has emerged as a diagnostic imaging method of choice for liver and extrahepatic biliary system. In order to differentiate the diagnosis of asymptomatic bile duct dilatation, one needs to perform either MRCP or ERCP, which are both expensive and/or invasive test. Therefore, it is necessary to understand the physiological changes in bile duct after cholecystectomy to reduce unnecessary testing for early detection of bile duct lesions.Methods: 100 cases of gall stone disease undergoing cholecystectomy in the department of surgery were studied. Pre operative and Post operative Ultrasound whole abdomen with focus on CBD diameter and Liver function test were done, Post operative data was collected on 10th day and again after 3 months. The data was compiled, compared and analysed.Results:The mean preoperative diameter was 4.12 mm, postoperatively, the mean diameter of the CBD in early follow up period i.e. at 10th day and at 3 months, was found to be 4.75 and 5.14 mm respectively. The difference between mean preoperative and mean postoperative (10th day follow up) diameter was found to be 0.63 mm (p<0.01). The difference between mean preoperative and mean postoperative (3 months follow up) diameter was found to be 1.02 (p<0.01) mm, both statistically significant. Conclusions:Significant compensatory dilatation does occur in common bile duct diameter after cholecystectomy in most of the patients.

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Eosinophilic Cholecystitis presenting with Common Bile Duct Sludge and Cholangitis: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.4684 ◽

2020 ◽

Vol 58 (223) ◽

pp. 188-191

Author(s):

Niraj Kumar Keyal ◽

Pooja Adhikari ◽

Basu Dev Baskota ◽

Ujwal Rai ◽

Aalok Thakur

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Distress Syndrome ◽

Altered Mental Status ◽

Common Bile Duct Exploration ◽

Eosinophilic Infiltrate ◽

Function Test ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired ◽

Peripheral Blood Eosinophilia

Eosinophilic cholecystitis is a rare post-cholecystectomy inflammatory histopathological condition characterized by more than 90% eosinophilic infiltrate in the gallbladder. We present a case of 27-year female presented with abdominal pain, fever, jaundice, altered mental status, shock, leucocytosis, deranged liver function test, and peripheral blood eosinophilia. The patient underwent cholecystectomy and common bile duct exploration. She developed adult respiratory distress syndrome and hospital-acquired pneumonia. From this, we want to emphasize that eosinophilic cholecystitis and cholangiopathy should be a differential diagnosis in patients presenting with allergy, peripheral eosinophilia, obstructive jaundice that are planned to undergo cholecystectomy that will have early critical care intervention.

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