scholarly journals Transcholecystic approach for distal common bile duct stricture in a non-dilated biliary system: an alternative route

2019 ◽  
Vol 12 (12) ◽  
pp. e231153
Author(s):  
Syed Rahman ◽  
Miltiadis Krokidis ◽  
Ioannis Paraskevopoulos
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary System ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
Treatment Unit ◽  
Percutaneous Approach ◽  
Biliary Sepsis ◽  
Periampullary Diverticulum ◽  
Duct Stricture

A 63-year-old patient was admitted to intensive treatment unit with biliary sepsis due to a small distal common bile duct stone. Endoscopic retrograde cholangiopancreatography was initially attempted for insertion of a biliary stent but failed due to the presence of a periampullary diverticulum. Referral to interventional radiology for percutaneous drainage was considered the next alternative even though there was no dilatation of intrahepatic ducts. Due to complete absence of intrahepatic duct dilatation, the traditional percutaneous transhepatic route was considered rather challenging. An alternative percutaneous approach via the gallbladder and subsequent catheterisation of the duodenum via the distal common bile duct was successfully performed instead without complication. We would like to describe this technique as an alternative option for drainage of the non-dilated biliary system in patients with sepsis.

Robotic choledochoduodenostomy for benign distal common bile duct stricture: how we do it

2019 ◽  
Vol 13 (6) ◽  
pp. 713-716
Author(s):  
Annie Laurie Benzie ◽  
Iswanto Sucandy ◽  
Janelle Spence ◽  
Sharona Ross ◽  
Alexander Rosemurgy
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Stricture ◽  
Distal Common Bile Duct ◽  
Duct Stricture

The Value of Cholangiography through Jackson-Pratt Drains in the Management of Postoperative Biliary Injuries

2014 ◽  
Vol 80 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Francisco Igor B. Macedo ◽  
Victor J. Casillas ◽  
James S. Davis ◽  
Joe U. Levi ◽  
Danny Sleeman
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Common Hepatic Duct ◽  
Biliary Reconstruction ◽  
Biliary Injury ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
Potential Benefits

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

scholarly journals Case Report: Kryptonite—A Rare Case of Left-Sided Bilothorax in a Sickle Cell Patient

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Vikas D. Reddy ◽  
Anas Al-Khateeb ◽  
Muhammad Hussain ◽  
Varun Patel ◽  
Muqueet Kadri ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pleural Fluid ◽  
Sickle Cell ◽  
Serum Bilirubin ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
Intrahepatic Bile Ducts ◽  
Sickle Cell Crisis

Bilothorax is a rare cause of an exudative pleural effusion. The diagnosis is confirmed by a pleural fluid to serum bilirubin ratio of greater than 1. Typically, bilothorax presents as a right-sided effusion due to its proximity to the liver and biliary system. Herein, we present a case of isolated left-sided bilothorax in a 43-year-old female admitted with sickle cell crisis. Only one other case of isolated spontaneous left-sided bilothorax has been described in the literature. A thoracentesis performed on admission demonstrated greenish fluid and bilothorax was suspected, with a pleural fluid to serum bilirubin ratio greater than 1 confirming the diagnosis. A magnetic resonance cholangiopancreatography (MRCP) showed an abnormal 90-degree acute angulation in the mid-to-distal common bile duct with proximal common bile duct and intrahepatic bile ducts dilation. This was further confirmed with an endoscopic retrograde cholangiopancreatography (ERCP), which did not reveal any extravasation of contrast into the left pleural space. Ultimately, despite the use of various modalities, no definitive cause of bilothorax was identified. Postthoracentesis imaging revealed evidence of fibrothorax, a direct and permanent complication of bilothorax. The presence of an isolated left-sided bilothorax, along with the lack of a confirmed etiology, makes this case unique.

scholarly journals Spontaneous disappearance of common bile duct stones after the use of a new dumbbell-shaped, covered self-expandable metallic stent in a patient with benign biliary stricture

2021 ◽  
Author(s):  
Yuto Ishizaki ◽  
Mitsuru Sugimoto ◽  
Tadayuki Takagi ◽  
Rei Suzuki ◽  
Naoki Konno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Metallic Stent ◽  
Bile Duct Stones ◽  
Distal Common Bile Duct ◽  
Expandable Metallic Stent ◽  
Spontaneous Disappearance ◽  
Duct Stricture ◽  
Endoscopic Stone Removal

Endoscopic stone removal becomes challenging owing to a distal common bile duct stricture. A new dumbbell-shaped covered self-expanding metallic stent is efficient in removing the common bile duct stones with common bile duct strictures that occur due to chronic pancreatitis.

scholarly journals Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

2017 ◽  
Vol 11 (2) ◽  
pp. 428-433 ◽  
Author(s):  
Hrudya Abraham ◽  
Sajan Thomas ◽  
Amit Srivastava
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
History Of ◽  
The Common

Biliary sump syndrome is a rare condition. It is seen as a rare long-term complication in patients with a history of a side-to-side choledochoduodenostomy. In the era before endoscopic retrograde cholangiopancreatography, side-to-side choledochoduodenostomy was a common surgical procedure for the management of biliary obstruction. In the setting of a side-to-side choledochoduodenostomy, the bile does not drain through the distal common bile duct anymore. Therefore, the part of the common bile duct distal from the choledochoduodenostomy anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a 64-year-old man with a history of side-to-side choledochoduodenostomy who presented with manifestations of cholangitis. An endoscopic retrograde cholangiopancreatography confirmed a diagnosis of sump syndrome. The etiology, clinical manifestations, and treatment of biliary sump syndrome are discussed in this article.

scholarly journals Broken stent of endoscopic retrograde cholangiopancreatography mimicking a common bile duct stone: a case report

2019 ◽  
Vol 7 (5) ◽  
pp. 1960
Author(s):  
Thirugnanasambandam Nelson ◽  
AmudaRavichandar Pranavi ◽  
Sathasivam Sureshkumar ◽  
GubbiShamanna Sreenath ◽  
Ananthakrishnan Ramesh ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stone ◽  
Bile Duct Stone ◽  
Biliary Stent ◽  
Stent Fracture ◽  
Endoscopic Stenting ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct

Long standing biliary stent for biliary stricture may have complications like cholangitis, cholecystitis, stent fracture and stent migration. Treatment includes re-do endoscopic retrograde cholangiopancreatography, removal of fractured stent and restenting. Authors report a case of fractured biliary stent mimicking as distal common bile duct stone. Patient presented with features of cholangitis with history of endoscopic stenting 6 years back but lost follow up thereafter. Ultrasound showed 2cm calculus in distal common bile duct and the stent was seen on endoscopy through the papilla in the duodenum. Contrast enhanced computed tomography of abdomen showed radio opaque dense shadow in the distal common bile duct suggesting possibility of broken biliary stent. Redo endoscopic retrograde cholangiopancreatography failed to remove the fractured stent. A new stent was placed without complications. Patient underwent open common bile duct exploration and the fractured stent was removed. Patient recovered completely after the procedure.

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