A rare cause of biliary obstruction – intraductal neuroendocrine tumor of the right hepatic biliary duct: a case report

Primary biliary tract neuroendocrine tumors (NETs) are extremely rare tumors that account for 0.2-2% of all gastrointestinal neuroendocrine tumors. The typical presentation is with jaundice and other symptoms related to biliary obstruction.We present a case of right hepatic duct NET in a 27-year-old female patient, asymptomatic, presented for a routine ultrasound examination that revealed moderate dilatation of the intrahepatic biliary ducts and a 20 mm hyperechoic lesion in the right hepatic biliary duct. Additional imaging was performed with the presumptive diagnosis of cholangiocarcinoma. After surgery, the histopathological and immunohistochemical report was conclusive for the diagnosis of G2 well-differentiated NET

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Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

Surgical Case Reports ◽

10.1186/s40792-020-01080-9 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroki Horinouchi ◽

Eisuke Ueshima ◽

Keitaro Sofue ◽

Shohei Komatsu ◽

Takuya Okada ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Biliary Obstruction ◽

Hepatic Duct ◽

Drainage Tube ◽

Biliary Strictures ◽

Hepatic Bile ◽

Hepatic Bile Duct ◽

Benign Biliary Strictures ◽

The Right

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

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The Morphometry Extrahepatic Bile Ducts

ARS Medica Tomitana ◽

10.2478/arsm-2018-0038 ◽

2018 ◽

Vol 24 (4) ◽

pp. 184-189

Author(s):

Trantu Dina Elena ◽

Bordei Petru ◽

Ispas Viorel

Keyword(s):

Cystic Duct ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Ct Scanner ◽

A Value ◽

Extrahepatic Bile Ducts ◽

Biliary Ducts ◽

The Common ◽

The Right

Abstract The extrahepatic bile duct morphometry was determined by the analysis of the colangiographies performed at Medimar Imaging Services SRL of the “St. Andrei “in Constanta on a General Electric Brightspeed Select CT scanner 16 slides. For the left liver duct found a caliber of 3.5-6.6 mm, its length ranging from 4.2-24.9 mm, and the right hepatic duct had a caliber ranging from 4.2-7.2 mm, the length being between 3.0-25.0 mm. At the confluence of the two hepatic ducts an angle of 35.0-124.1° was formed. In the common hepatic duct we found a caliber of 3.9-9.7 mm, in length between 20.2-52.9 mm. Cystic duct having a size of 2.4 to 5.5 mm, finding a length ranging from 24.6 to 66.4 mm. The angle formed at the end of the cystic duct in the hepatic duct had a value between 6.2-55.8°, and between the cystic and biliary ducts an angle of between 88.5-170.4° was formed. The coledoc duct had a caliber of 3.1-14.7 mm and a length of 19.8-57.3 mm.

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Non-functioning neuroendocrine tumors of the common hepatic duct: a case report and literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20170869 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1101

Author(s):

Maroun Abou-Jaoude ◽

Haydar A. Nasser

Keyword(s):

Neuroendocrine Tumors ◽

Epigastric Pain ◽

Hepatic Duct ◽

Young Patients ◽

Pancreatic Head ◽

Long Term Results ◽

Common Hepatic Duct ◽

The Common ◽

Well Differentiated

Extra-hepatic biliary tree neuroendocrine tumors are not common, accounting for about 0.1 % of all carcinoid tumors. Those affecting the common hepatic duct are very rare and their diagnosis is usually made post-operatively. Poorly differentiated tumors or neuroendocrine carcinomas are commonly seen in elderly, whereas well differentiated tumors, tend to occur in young patients, for whom surgery will lead to good long term results. About 100 cases have been reported in the English medical literature, showing good long term results after surgery for well differentiated (Grades 1 and 2) tumors. Herein, we report a case of an 18-year-old female, complaining from a dull epigastric pain related to a nodule compressing the common hepatic duct. After complete investigation, a laparotomy has been performed and showed a nodular tumor located in the common hepatic duct just above the insertion of the cystic duct with close contact with the pancreatic head distally. En bloc cholecystectomy with bile duct resection was performed and followed by a Roux-en-Y hepatico-jejunostomy. The pathology of the nodule came back to be a neuroendocrine tumor grade 2.

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Choledochoscopic Examination of a 3-Dimensional Printing Model Using Augmented Reality Techniques: A Preliminary Proof of Concept Study

Surgical Innovation ◽

10.1177/1553350618781622 ◽

2018 ◽

Vol 25 (5) ◽

pp. 492-498 ◽

Cited By ~ 5

Author(s):

Rui Tang ◽

Longfei Ma ◽

Ang Li ◽

Lihan Yu ◽

Zhixia Rong ◽

...

Keyword(s):

Augmented Reality ◽

Bile Ducts ◽

Hepatic Duct ◽

Biliary Tree ◽

Caudate Lobe ◽

Biliary Duct ◽

3 Dimensional ◽

Operator Interface ◽

3D Printed ◽

The Right

Background. We applied augmented reality (AR) techniques to flexible choledochoscopy examinations. Methods. Enhanced computed tomography data of a patient with intrahepatic and extrahepatic biliary duct dilatation were collected to generate a hollow, 3-dimensional (3D) model of the biliary tree by 3D printing. The 3D printed model was placed in an opaque box. An electromagnetic (EM) sensor was internally installed in the choledochoscope instrument channel for tracking its movements through the passages of the 3D printed model, and an AR navigation platform was built using image overlay display. The porta hepatis was used as the reference marker with rigid image registration. The trajectories of the choledochoscope and the EM sensor were observed and recorded using the operator interface of the choledochoscope. Results. Training choledochoscopy was performed on the 3D printed model. The choledochoscope was guided into the left and right hepatic ducts, the right anterior hepatic duct, the bile ducts of segment 8, the hepatic duct in subsegment 8, the right posterior hepatic duct, and the left and the right bile ducts of the caudate lobe. Although stability in tracking was less than ideal, the virtual choledochoscope images and EM sensor tracking were effective for navigation. Conclusions. AR techniques can be used to assist navigation in choledochoscopy examinations in bile duct models. Further research is needed to determine its benefits in clinical settings.

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Problematic issues of endoscopic biliary stenting

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2019.07.13 ◽

2019 ◽

Vol 86 (7) ◽

pp. 13-17

Author(s):

A. I. Dronov ◽

I. L. Nastashenko ◽

Yu. P. Bakunets ◽

P. P. Bakunets ◽

L. V. Levchenko

Keyword(s):

Biliary Obstruction ◽

Distal Part ◽

Biliary Fistula ◽

Plastic Stents ◽

Biliary Duct ◽

Biliary Stenting ◽

Treatment Results ◽

Endoscopic Biliary Stenting ◽

Biliary Ducts

Objective. To study the results of endoscopic biliary stenting (EBS) for biliary obstruction of various genesis to determine the problematic issues of the procedure and possibility of its efficacy raising. Materials and methods. Experience of conduction of 5748 endoscopic transpapillary interventions in 2010 - 2017 yrs was analyzed: endoscopic papillosphincterotomy was performed in 2919 (50.8%) observations, stenting of biliary ducts - in 379 (6.6%). In 296 (78.1%) observations plastic stents (PS) were introduced, while in 83 (21.9%) – the self-expanding metallic stents. Results. Of 208 patients, in whom primary temporary EBS was performed for tumoral biliary obstruction, using PS, in 153 (73.6%) the next stage of treatment have constituted elective operation in 10 - 14 days after elimination of hyperbilirubinemia, signs of cholangitis, additional examination and determination of the intervention volume. Among these patients in 56 (36.6%) radical operations were performed, and in 97 (63.4%) – palliative operations. In 47 patients PS for closure of external biliary fistula (EBS) PS was introduced: in 13 (27.7%) – for tubular stenosis of distal part of common biliary duct, in 7 (14.9%) – for insufficiency of sutures of common biliary duct (after choledocholithotomy), in 14 (29.8%) – for intraoperative damages of extrahepatic biliary ducts, in 5 (10.6%) – for presence of Luschka channels, in 8 (17.0%) – for a state after hepatic resection, echinococectomy. Presence of concrements, which due to some reasons were not removed endocopically, in environment of purulent cholangitis have constituted the indication for performance of EBS in 24 (8.1%) observations, chronic pancreatitis, complicated by obturation jaundice – in 9 (3.0%). Correction of iatrogenic damages of biliary ducts with development of their partial strictures, EBF, using EBS with introduction of PS, were performed in 8 (2.7%) patients. Conclusion. The necessity exists to study the treatment results in patients, suffering biliary obstruction of various genesis, to determine problematic issues of the main procedures and possibilities of their efficacy raising.

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Intrabiliary and abdominal rupture of hepatic hydatid cyst leading to biliary obstruction, cholangitis, pancreatitis, peritonitis and septicemia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02822-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Manouchehr Aghajanzadeh ◽

Mohammad Taghi Ashoobi ◽

Hossein Hemmati ◽

Pirooz Samidoust ◽

Mohammad Sadegh Esmaeili Delshad ◽

...

Keyword(s):

Abdominal Pain ◽

Hydatid Cyst ◽

Hydatid Disease ◽

Biliary Obstruction ◽

Abdominal Ultrasound ◽

Sporadic Case ◽

Gallbladder Wall ◽

Liver Cyst ◽

Biliary Duct ◽

Wall Thickening

Abstract Background Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity. Case presentation A 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst. Conclusion Intrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital.

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Prospective study of dynamic whole-body 68Ga-DOTATOC-PET/CT acquisition in patients with well-differentiated neuroendocrine tumors

Scientific Reports ◽

10.1038/s41598-021-83965-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Philippe Thuillier ◽

David Bourhis ◽

Jean Philippe Metges ◽

Romain Le Pennec ◽

Karim Amrane ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Linear Relation ◽

Whole Body ◽

Pet Ct ◽

Non Linear ◽

Well Differentiated ◽

Analog Systems ◽

Pet System ◽

Dynamic Acquisition ◽

Linear Regressions

AbstractTo present the feasibility of a dynamic whole-body (DWB) 68Ga-DOTATOC-PET/CT acquisition in patients with well-differentiated neuroendocrine tumors (WD-NETs). Sixty-one patients who underwent a DWB 68Ga-DOTATOC-PET/CT for a histologically proven/highly suspected WD-NET were prospectively included. The acquisition consisted in single-bed dynamic acquisition centered on the heart, followed by the DWB and static acquisitions. For liver, spleen and tumor (1–5/patient), Ki values (in ml/min/100 ml) were calculated according to Patlak's analysis and tumor-to-liver (TLR-Ki) and tumor-to-spleen ratios (TSR-Ki) were recorded. Ki-based parameters were compared to static parameters (SUVmax/SUVmean, TLR/TSRmean, according to liver/spleen SUVmean), in the whole-cohort and according to the PET system (analog/digital). A correlation analysis between SUVmean/Ki was performed using linear and non-linear regressions. Ki-liver was not influenced by the PET system used, unlike SUVmax/SUVmean. The regression analysis showed a non-linear relation between Ki/SUVmean (R2 = 0.55,0.68 and 0.71 for liver, spleen and tumor uptake, respectively) and a linear relation between TLRmean/TLR-Ki (R2 = 0.75). These results were not affected by the PET system, on the contrary of the relation between TSRmean/TSR-Ki (R2 = 0.94 and 0.73 using linear and non-linear regressions in digital and analog systems, respectively). Our study is the first showing the feasibility of a DWB 68Ga-DOTATOC-PET/CT acquisition in WD-NETs.

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A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

Surgical Case Reports ◽

10.1186/s40792-020-00994-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Hiroki Hirao ◽

HiroHisa Okabe ◽

Daisuke Ogawa ◽

Daisuke Kuroda ◽

Katsunobu Taki ◽

...

Keyword(s):

Cystic Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Endoscopic Retrograde ◽

Case Presentation ◽

Endoscopic Nasobiliary Drainage ◽

Subtotal Cholecystectomy ◽

Upper Abdominal ◽

The Right ◽

Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

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Chronic Endophthalmitis Caused by Pseudomonas stutzeri

Case Reports in Ophthalmology ◽

10.1159/000510129 ◽

2020 ◽

Vol 11 (3) ◽

pp. 595-599

Author(s):

Saeed T. Alshahrani ◽

J. Fernando Arevalo

Keyword(s):

Pseudomonas Stutzeri ◽

Posterior Chamber ◽

Topical Steroids ◽

Sensitivity Testing ◽

Corneal Incision ◽

Presumptive Diagnosis ◽

Lens Extraction ◽

History Of ◽

Sudden Decrease ◽

The Right

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1–2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated <i>Pseudomonas stutzeri</i> that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, <i>P. stutzeri</i> can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

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Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman

Journal of International Medical Research ◽

10.1177/0300060520986680 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098668

Author(s):

Bo Pang ◽

Cong Hu ◽

Qian Liu ◽

Jinyu Yu ◽

Zhentong Wei ◽

...

Keyword(s):

Benign Tumors ◽

Free Fluid ◽

Adenomatoid Tumor ◽

Cancer Antigen 125 ◽

Immunohistochemical Markers ◽

Serum Ca125 ◽

Life Threatening ◽

Well Differentiated ◽

The Right

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor. The lesions may be single or multiple and usually behave in a benign or indolent fashion, sometimes persisting for many years. In the present case, a 37-year-old woman had experienced primary infertility for 12 years, and a diagnostic laparoscopy was performed. Approximately 200 mL of dark red, free fluid in the pelvis and more than 10 yellow-white nodules on the surface of the right round ligament, sacrum ligament, right fallopian tube, and both sides of the uterus were found. A lesionectomy was performed and immunohistochemical markers indicated WDPM with adenomatoid tumor. The patient was monitored by computed tomography and serum CA125 (cancer antigen 125) levels for 49 months with no recurrence. WDPM and adenomatoid tumor are both benign tumors of mesothelial origin. Because of the lack of effective radical treatment, regular follow-up is sufficient. However, the effects of estrogen and progesterone on WDPM and adenomatoid tumors during ovulation or pregnancy remains unclear. Although WDPM is not life threatening, a strategy to fulfill the fertility requirements of women with this condition is a new challenge for infertility doctors.

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