Indicial response functions of growth and remodeling of common bile duct postobstruction

2004 ◽  
Vol 286 (3) ◽  
pp. G420-G427 ◽  
Author(s):  
Quang Dang ◽  
Hans Gregersen ◽  
Birgitte Duch ◽  
Ghassan S. Kassab
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Wall Thickness ◽  
Time Course ◽  
Quantitative Description ◽  
Biliary Duct ◽  
Stress And Strain ◽  
Response Functions ◽  
Mechanical Remodeling ◽  
Scheduled Time

Biliary duct obstruction is an important clinical condition that stems from cholelithiasis, the neoplasm in the wall or, most commonly, gallbladder stones. The objective of this study is to understand the structural and mechanical remodeling of the common bile duct (CBD) postobstruction. Porcine CBD was ligated near the duodenum that increased the duct's pressure from 6.4 to 18.3 cmH2O in the first 12 h and to 30.7 cmH2O after 32 days. The remodeling process was studied after 3 h, 12 h, 2 days, 8 days, and 32 days ( n = 5 in each group) after obstruction. One additional animal in each group was sham operated. At each scheduled time, the time course of change of morphometry (diameter, length, wall thickness, etc.) and mechanical properties (stress, strain, etc.) was documented. It was found that the diameter increased by about threefold and the wall thickness of the CBD doubled in the 32-day group compared with the sham group ( P < 0.001). The stress and strain increased initially with increase in pressure but recovered to near the control values by day 32 due to the structural and mechanical adaptations. Hence, the net effect of the structural and mechanical remodeling is to restore the stress and strain to their homeostatic values. Furthermore, the strain recovers more rapidly and more completely than stress. Finally, the remodeling data were expressed mathematically in terms of indicial response functions (IRF), i.e., change of a particular feature of a CBD in response to a unit step change of the pressure. The IRF approach provides a quantitative description of the remodeling process in the CBD.

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 Utility of pre-operative abdominal ultrasound to predict conversion to open cholecystectomy

2021 ◽  
Vol 8 (10) ◽  
pp. 3007
Author(s):  
Reetesh Sharma ◽  
Ramesh Dumbre ◽  
Arun Fernandese ◽  
Deepak Phalgune
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Biliary Tree ◽  
Gallbladder Wall ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy.Methods: Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

scholarly journals One-stage lapro-endoscopic procedure in the management of concomitant gallbladder and common bile duct stones: institutional experience

2019 ◽  
Vol 6 (5) ◽  
pp. 1447
Author(s):  
Ahmed M. Abdelaziz Hassan ◽  
Ayman M. Abdelaziz ◽  
Mohamed Emad Esmat ◽  
Hussam Hamdy ◽  
Magdy M. Elsebae
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Disease ◽  
Operating Time ◽  
Common Bile Duct Stones ◽  
Biliary Duct ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
One Stage ◽  
Cbd Stone

Background: Still there is no standard technique for managing patients with concomitant gallbladder (GB) and common bile duct stones (CBDS). In this work, we report our experience of the management for gallstone disease and biliary duct calculi as a single stage treatment.Methods: Forty Patients with symptomatic gall bladder calcular disease and suspected CBDS were enrolled in the study. The outcome measures were operating time, CBD stone clearance, postoperative morbidity and mortality, the need to conversion to other techniques and hospital stay.Results: They were 13 males and 27 females of median age 43 years old. Intra opertative cholangiography (IOC) revealed single CBD stone in twenty-eight, two stones in eleven and three stones in only one of the patients. The mean operating time had been 175 min. There were no intraoperative complications with a mean hospital stay was 1.8 days (range, 1-4 days).Conclusions: One-stage lapro-endoscopic procedure in the management for gallstone disease and biliary duct calculi is safe and efficient in CBD stone clearance. It is preferred when facilities and experience in endoscopic therapy exist.

scholarly journals Non-Operative Management of a Common Bile Duct Injury Sustained During Cholecystectomy in a Morbidly Obese Patient. (Non-Operative Repair of CBD Injury)

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Boyd C. Ashdown ◽  
Paul V. Suhocki ◽  
Paul S. Jowell ◽  
William C. Meyers
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obese Patient ◽  
Normal Liver ◽  
Biliary Tree ◽  
Liver Function Tests ◽  
Biliary Duct ◽  
Morbidly Obese ◽  
Morbidly Obese Patient ◽  
Increased Risk

A 29 year old morbidly obese patient suffered injury to his common bile duct during cholecystectomy. Subsequent access to the biliary tree was obtained by using a long heavy gauge needle after first opacifying the system with contrast injection through a nasobiliary tube. It is now twenty six months after initial percutaneous biliary drainage placement and eighteen months after removal of all biliary access. The patient is asymptomatic and has normal liver function tests. This technique can be useful in morbidly obese patients who are at increased risk from surgical repair of biliary duct injuries.

scholarly journals 750 An Unusual Presentation of a Rare Clinical Entity – A Case Report of Spontaneous Common Bile Duct Perforation in an Adult

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
F Ahmed ◽  
N Subahan ◽  
E Menyah ◽  
R Koshy ◽  
A Khawaja
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Fluid Collection ◽  
Bile Leak ◽  
Disease Process ◽  
Exploratory Laparotomy ◽  
Underlying Disease ◽  
Pancreatic Disease ◽  
Sudden Onset ◽  
Biliary Duct

Abstract Spontaneous or non-traumatic perforation of the extrahepatic biliary system is a rare clinical phenomenon, with few cases reported since its first mention in medical literature by Freeland in 1882. Given the rarity, misdiagnosis is common with the diagnosis almost always made during urgent exploratory laparotomy. We describe a case of spontaneous common bile duct (CBD) perforation in an 83-year-old female with no associative underlying disease process identified. The patient presented with sudden onset abdominal pain with no identifiable trigger, with minimal past medical history. Examination was remarkable for findings of epigastric tenderness and guarding. Haematological investigation was remarkable only for hyperamylasaemia and leucocytosis. Pneumoperitoneum was ruled out and following contrast CT abdomen and pelvis a working diagnosis of mild pancreatitis was made. US Abdomen and MRCP found no evidence of cholelithiasis, with minimal biliary duct dilatation. The patient continued to deteriorate on the ward, with aspiration of new intrabdominal fluid collection raising suspicion of perforated viscus. Exploratory laparotomy revealed a 1-cm defect in the CBD with frank bile leak. A T-tube was placed in the common bile duct defect, with an abdominal robertson drain also inserted. No further bile leak was identified via Tubogram, with the patient successfully discharged following multidisciplinary rehabilitation in intensive care and the ward setting. Surgeons should seek out this uncommon diagnosis in patients with hyperamylasaemia and suspected cholelithiasis who do not conform to normal biliary/pancreatic disease progression patterns.

scholarly journals Right Posterior Segmental Hepatic Duct: Role of Intraoperative Cholangiogram to Prevent Extrahepatic Biliary Duct Injuries

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Ikhwan SM ◽  
Hairol O ◽  
Razman J ◽  
Zamri Z ◽  
Affirul C
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Duct ◽  
Biliary Tree ◽  
Common Bile Duct Exploration ◽  
Biliary Duct ◽  
Anatomic Site ◽  
Distal Common Bile Duct ◽  
Intraoperative Cholangiogram ◽  
Bile Duct Injuries

Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct exploration. The operation was successful without incidence of biliary duct injury.

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