scholarly journals Papillo-Choledochectomy in the Operative Management of Mucosal Neoplasms of the Periampullary Region

HPB Surgery ◽  
1993 ◽  
Vol 6 (3) ◽  
pp. 211-217
Author(s):  
Kogoro Kasahara ◽  
Ken Saito ◽  
Yasuo Kondo ◽  
Toshihiko Yasuda ◽  
Yoshikazu Yasuda ◽  
...  
Keyword(s):  
Bile Duct ◽  
Frozen Section ◽  
Sphincter Of Oddi ◽  
Operative Management ◽  
Pathological Examination ◽  
Papilla Of Vater ◽  
Radical Cure ◽  
Mucosal Layer ◽  
Periampullary Region ◽  
Longitudinal Muscles

Two patients with mucosal cancer of the periampullary region were treated with papillocholedochectomy, which entails removal of the papilla of Vater and the whole length of the common bile duct. The neoplasm is dissected out through the plane between the duodenal circular and longitudinal muscles, deep to the sphincter of Oddi and the fibromuscular layer of the bile duct. Pathological examination showed that cancer was confined to the mucosal layer without stromal invasion, and that the operation achieved radical cure. For mucosal cancer, papillo-choledochectomy is an alternative to pancreatoduodenectomy, provided that repeated frozen-section studies confirm the completeness of excision.

scholarly journals Flat Papilla of Vater and Bleeding during Endoscopic Sphincterotomy: Two New Risk Factors for Post-Endoscopic Pancreatitis

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jamry A ◽  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Endoscopic Sphincterotomy ◽  
Multivariate Regression ◽  
Pathological Examination ◽  
Papilla Of Vater ◽  
Bleeding Control ◽  
Endoscopic Retrograde ◽  
Bile Duct Stenosis ◽  
Duct Stenosis

Objective: To analyze the risk factors for post-endoscopic pancreatitis (PEP). Background: PEP occurs in 4%-42% of patients, depending on their risk factors. Over 56 risk factors were analyzed, but only 4were found to be repeated in most studies. Study: A single-center retrospective study analyzing 402 consecutive patients with naïve papillae who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) was conducted. The significance of 14 potentially new risk factors was evaluated, and it was found that they were associated with the level of bile duct stenosis, papilla anatomy, bleeding during sphincterotomy, endoscopic bleeding control, and pathological examination. Furthermore, 13 of the most frequently published risk factors were re-analyzed. Results: Five risk factors (containing two new ones) were significant with the following univariate and multivariate regression values: flat papilla (odds ratio [OR] 5.1, p=0.0049; OR 4.59, p=0.0244) and bleeding during endoscopic sphincterotomy (OR 3.58, p=0.148; OR 4.07, p=0.0257), and significance of the three already known risk factors was confirmed: age <40 years (OR 6.89, p=0.0139; OR 4.96, p=0.0139), common bile duct (CBD) diameter < 9 mm (OR 5.35, p=0.0007; OR 3.98, p=0.0203), and difficulty in cannulation (OR 3.2, p=0.0298; OR 7.72, p=0.004). Conclusion: This study reaffirms the risk of PEP associated with age, difficulty in cannulation, and CBD diameter. It also identifies two new risk factors: flat papilla and bleeding during sphincterotomy. These results suggest the need for a change in ERCP methodology in patients with these risk factors, but this finding requires confirmation in subsequent studies.

scholarly journals Arteriovenous malformation in the pancreatic head initially mimicking a hypervascular mass treated with duodenum-preserving pancreatic head resection: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Takahiro Korai ◽  
Yasutoshi Kimura ◽  
Masafumi Imamura ◽  
Minoru Nagayama ◽  
Ayumi Kanazawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Arteriovenous Malformation ◽  
Pancreatic Head ◽  
Pathological Examination ◽  
Resected Specimen ◽  
Papilla Of Vater ◽  
Pancreatic Head Resection ◽  
Pancreaticoduodenal Artery ◽  
Long Term Outcome ◽  
First Case

Abstract Background The mainstay treatment for arteriovenous malformation in the pancreatic head (Ph-AVM) is standard pancreatectomy, especially pancreaticoduodenectomy (PD), or interventional endovascular treatment. We report the first case of Ph-AVM treated with duodenum-preserving pancreatic head resection (DPPHR) performed to preserve the periampullary organs. Case presentation A 59-year-old man presenting with back pain underwent contrast-enhanced computed tomography followed by angiography of the anterior superior pancreaticoduodenal artery. He was diagnosed with Ph-AVM and indicated for DPPHR with preservation of the periampullary organs; Ph-AVM’s benign nature seldom requires lymph node dissection. During the operation, the right colon was mobilized and the omental bursa was released to expose the periampullary structures. The pancreas was transected just above the superior mesenteric vein. The inferior pancreaticoduodenal artery and papillary arteries branching from the posterior superior pancreaticoduodenal artery were carefully preserved to maintain the blood flow to the lower bile duct and papilla of Vater. The remnant pancreas was reconstructed with pancreaticogastrostomy using the modified Blumgart method. Pathological examination of the resected specimen revealed an irregular course of the arteries and veins concomitant with marked dilation throughout the pancreatic head. The patient was pathologically diagnosed with Ph-AVM. He developed hematemesis caused by a rupture of the pseudoaneurysm on postoperative day 20 and underwent coil embolization. A bilio-enteric fistula and stenosis of the common bile duct were found and treated by placement of an endoscopic biliary stent. At the 8-month follow-up, the Ph-AVM had not recurred. Conclusions Compared to PD, DPPHR confers the clinical benefit of preserving the periampullary organs, although further studies are needed to confirm this. Therefore, the choice of this procedure should be based on the surgical morbidities and long-term outcome of the patient.

scholarly journals Real-time intraoperative glioma diagnosis using fluorescence imaging and deep convolutional neural networks

2021 ◽  
Author(s):  
Biluo Shen ◽  
Zhe Zhang ◽  
Xiaojing Shi ◽  
Caiguang Cao ◽  
Zeyu Zhang ◽  
...  
Keyword(s):  
Neural Networks ◽  
Real Time ◽  
Fluorescence Imaging ◽  
Convolutional Neural Networks ◽  
Frozen Section ◽  
Fluorescent Imaging ◽  
Pathological Diagnosis ◽  
Pathological Examination ◽  
Deep Convolutional Neural Networks ◽  
Fluorescence Images

Abstract Purpose Surgery is the predominant treatment modality of human glioma but suffers difficulty on clearly identifying tumor boundaries in clinic. Conventional practice involves neurosurgeon’s visual evaluation and intraoperative histological examination of dissected tissues using frozen section, which is time-consuming and complex. The aim of this study was to develop fluorescent imaging coupled with artificial intelligence technique to quickly and accurately determine glioma in real-time during surgery. Methods Glioma patients (N = 23) were enrolled and injected with indocyanine green for fluorescence image–guided surgery. Tissue samples (N = 1874) were harvested from surgery of these patients, and the second near-infrared window (NIR-II, 1000–1700 nm) fluorescence images were obtained. Deep convolutional neural networks (CNNs) combined with NIR-II fluorescence imaging (named as FL-CNN) were explored to automatically provide pathological diagnosis of glioma in situ in real-time during patient surgery. The pathological examination results were used as the gold standard. Results The developed FL-CNN achieved the area under the curve (AUC) of 0.945. Comparing to neurosurgeons’ judgment, with the same level of specificity >80%, FL-CNN achieved a much higher sensitivity (93.8% versus 82.0%, P < 0.001) with zero time overhead. Further experiments demonstrated that FL-CNN corrected >70% of the errors made by neurosurgeons. FL-CNN was also able to rapidly predict grade and Ki-67 level (AUC 0.810 and 0.625) of tumor specimens intraoperatively. Conclusion Our study demonstrates that deep CNNs are better at capturing important information from fluorescence images than surgeons’ evaluation during patient surgery. FL-CNN is highly promising to provide pathological diagnosis intraoperatively and assist neurosurgeons to obtain maximum resection safely. Trial registration ChiCTR ChiCTR2000029402. Registered 29 January 2020, retrospectively registered

Pain on common bile duct injection during ERCP: does it indicate sphincter of Oddi dysfunction?

1990 ◽  
Vol 36 (5) ◽  
pp. 458-461 ◽  
Author(s):  
Michael J. Schmalz ◽  
Joseph E. Geenen ◽  
Walter J. Hogan ◽  
Wylie J. Dodds ◽  
Rama P. Venu ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Sphincter Of Oddi ◽  
Sphincter Of Oddi Dysfunction ◽  
Oddi Dysfunction

scholarly journals A case with massive hemobilia long-term after internal drainage surgery for congenital biliary dilation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shunryo Minezaki ◽  
Takeyuki Misawa ◽  
Makoto Watanabe ◽  
Hideki Takahashi ◽  
Takashi Koenuma ◽  
...  
Keyword(s):  
Bile Duct ◽  
Gastrointestinal Bleeding ◽  
Pathological Condition ◽  
Extrahepatic Bile Duct ◽  
Pathological Examination ◽  
Emergency Setting ◽  
Internal Drainage ◽  
Bile Duct Resection ◽  
Extrahepatic Bile Duct Resection ◽  
Life Threatening

Abstract Background Currently, there is an unwavering consensus that the standard surgery for congenital biliary dilation (CBD) is extrahepatic bile duct resection and choledochojejunostomy. However, decades prior, choledochocyst–gastrointestinal anastomosis without extrahepatic bile duct resection (internal drainage surgery, IDS) was preferred for CBD because of its simplicity. Currently, there is almost no chance of a surgeon encountering a patient who has undergone old-fashioned IDS, which has been completely obsolete due to the risk of carcinogenesis from the remaining bile duct. Moreover, the pathological condition long after IDS is unclear. Herein, we report a case of life-threatening bile duct bleeding as well as carcinoma of the bile duct 62 years after IDS in a patient with CBD. Case presentation An 82-year-old Japanese woman with hemorrhagic shock due to gastrointestinal bleeding was transferred to our hospital. She had a medical history of unspecified surgery for CBD at the age of 20. Based on imaging findings and an understanding of the historical transition of the surgical procedure for CBD, the cause of gastrointestinal bleeding was determined to be rupture of the pseudoaneurysm of the dilated bile duct that remained after IDS. Hemostasis was successfully performed by transcatheter arterial embolization (TAE) in an emergency setting. Then, elective surgery for extrahepatic bile duct resection and choledochojejunostomy was performed to prevent rebleeding. Pathological examination revealed severely and chronically inflamed mucosa of the bile duct. Additionally, cholangiocarcinoma (Tis, N0, M0, pStage 0) was incidentally revealed. Conclusion It has been indicated that not only carcinogenesis, but also a risk of life-threatening bleeding exists due to long-lasting chronic inflammation to the remnant bile duct after IDS for CBD. Additionally, both knowledge of which CBD operation was performed, and an accurate clinical history are important for the diagnosis of hemobilia.

scholarly journals Automatic Intrahepatic Biliary Segmentation Based Image Processing Techniques using Magnetic Resonance Images

2020 ◽  
Author(s):  
Mohammad Atallah AL-Oudat ◽  
Mohammad AL Oudat ◽  
Hazem Migdady ◽  
Tariq AL Munaizel ◽  
Mohammad Awni Mahmoud ◽  
...  
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Bile Ducts ◽  
Medical Condition ◽  
Biliary Tree ◽  
Extraction Process ◽  
Magnetic Resonance Images ◽  
Papilla Of Vater ◽  
Feed Forward Neural Network ◽  
Important Indicator

Abstract A set of tubes known as bile ducts connects the liver to an organ below it directly that is called Gallbladder. The dilation of a bile duct is an important indicator regarding any serious issue in the human body. Number of reasons may cause bile duct dilation, such as: stones, tumors which commonly occur due to pancreas or papilla of vater. In this paper, the main contributions are: 1) a novel framework that consists of three phases to be applied on a set of Magnetic Resonance Imaging (MRI) images 2) an extracted set of features with their accurate values that express the condition of the biliary trees from the MRI images. Such dataset can be used in several applications to determine whether a bile duct is dilated or not. The dataset is organized as the following: half of the MRI images are for normal bile ducts, while the other half is for dilated bile ducts. To extract the useful features to diagnose the medical condition of the bile ducts from the MRI images, we implemented and applied the proposed framework that is started by using the enhanced active contour technique without edges in combination with Denoising Convolutional Neural Networks (DnCNN) to perform the segmentation and features extraction process. After that, the output of the segmentation process is the segmented biliary tree that will be used later to extract the needful features to make a diagnostic decision whether there is a dilation or not by comparing the features values of the normal versus the dilated bile ducts. We applied the feed forward neural network with backpropagation training algorithm for classification purposes. According to the experiments, the overall accuracy of the proposed framework was 90.00%. Such approach improves and increases the accuracy of the physicians’ diagnostic decisions which is considered as of significant importance for treatment and cure.

scholarly journals Appraisal of Extended Lymphnode Dissection for Carcinoma of the Papilla of Vater and Distal Bile Duct.

1995 ◽  
Vol 28 (4) ◽  
pp. 892-897
Author(s):  
Hisafumi Kinoshita ◽  
Toshimichi Nakayama ◽  
Shuichi Fukuda ◽  
Junji Shibata ◽  
Tadashi Yoshida ◽  
...  
Keyword(s):  
Bile Duct ◽  
Papilla Of Vater ◽  
Distal Bile Duct

scholarly journals Laparoscopic exploration of bile ducts in patients with calculosis. indications, methods and first results

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 33-38 ◽  
Author(s):  
Rosen S. Dimov ◽  
Rangel I. Kantchev ◽  
Boris G. Boev ◽  
Todor I. Ivanov ◽  
Ilia A. Apostolov ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Stone ◽  
Sphincter Of Oddi ◽  
Biliary Tree ◽  
Stone Extraction ◽  
Average Hospital ◽  
Laparoscopic Exploration ◽  
Ultrasound Study ◽  
The Common

ABSTRACT INTRODUCTION: In the last few years there has been a resurgence of laparoscopic exploration of the common bile duct as an alternative to endoscopic retrograde cholangiopancreatography (ERCP), the primary method for diagnosis and treatment of biliary tract calculosis. AIM: The aim of this study was to clarify the indications and methods for performing laparoscopic bile duct exploration, based on our experience in the field and data from the literature. PATIENTS AND METHODS: We recruited 12 patients who underwent laparoscopic exploration and stone extraction from the common bile duct (CBD) in the surgical ward of Kaspela Hospital, Plovdiv over the period January 2011 to January 2012. The diagnostic and therapeutic modalities used in the study included laboratory tests, ultrasound study, CT, ERCP, digital cholangiography, clamp and balloon stone extraction, primary suture and choledochoduodenostomy. RESULTS: Stone extraction was successfully performed in 8 patients using the transcystic approach through an incision used in the cholangiography. The procedure failed in the remaining four patients and we used here 2-cm longitudinal choledochotomy. In two patients the control cholangiography following the extraction of stones demonstrated complete clearance of the biliary tree and free passage of contrast agent from bile duct to duodenum (patent ampulla of Vater). In these two patients we performed a primary closure of the choledochotomy with a single interrupted suture (“ideal choledochotomy”). In two patients from the choledochotomy group, the control cholangiography showed the presence of residual stones or fragments trapped above the sphincter of Oddi with no contrast medium in the duodenum. In these cases we completed this procedure with latero-lateral choledochoduodenostomy by Flërken. All patients had a smooth postoperative course with no recorded complications. The average hospital stay was 5 days. CONCLUSIONS: Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

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