scholarly journals Anastomotic Biliary Stricture Development after Liver Transplantation in the Setting of Retained Prophylactic Intraductal Pediatric Feeding Tube: Case and Review

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Patrick T. Koo ◽  
Valentina Medici ◽  
James H. Tabibian

The biliary anastomosis remains a common site of postoperative complications in liver transplantation (LT). Biliary complications have indeed been termed the “Achilles’ heel” of LT, and while their prevention, diagnosis, and treatment have continued to evolve over the last two decades, various challenges and uncertainties persist. Here we present the case of a 33-year-old man who, 10 years after undergoing LT for idiopathic recurrent intrahepatic cholestasis, was noted to have developed pruritus and abnormalities in serum liver biochemistries during routine post-liver transplant follow-up. Abdominal ultrasound revealed a linear, 1.5 mm hyperechoic filling defect in the common bile duct; magnetic resonance cholangiopancreatography demonstrated a curvilinear filling defect at the level of the choledochocholedochostomy, corresponding to the ultrasound finding, as well as an anastomotic biliary stricture (ABS). On endoscopic retrograde cholangiography (ERC), a black tubular stricture with overlying sludge was encountered and extracted from the common bile duct, consistent with a retained 5 Fr pediatric feeding tube originally placed at the time of LT. The patient experienced symptomatic and biochemical relief and successfully underwent serial ERCs with balloon dilatation and maximal biliary stenting for ABS management. With this case, we emphasize the importance of ensuring spontaneous passage or removal of intraductal prostheses placed prophylactically at the time of LT in order to minimize the risk of chronic biliary inflammation and associated sequelae, including cholangitis and ABS formation. We also provide herein a brief review of the use of prophylactic internal transanastomotic prostheses, including biliary tubes and stents, during LT.

2015 ◽  
Vol 100 (11-12) ◽  
pp. 1443-1448
Author(s):  
Norio Kubo ◽  
Hideki Suzuki ◽  
Norihiro Ishii ◽  
Mariko Tsukagoshi ◽  
Akira Watanabe ◽  
...  

Duodenum mucinous carcinoma is very rare, and the prognosis of the patient is very bad, especially when the tumor is invasive to other organs. In this case, duodenum carcinoma was invasive to common bile duct and transverse colon. Mucinous fluid, which was secreted from a duodenum tumor, was found in the dilatated bile duct. The intraductal papillary neoplasm of the bile duct was considered a differential diagnosis. We performed aggressive resection and had a good prognosis. A 74-year-old woman received a diagnosis of cholangitis and was treated with antibiotic drugs. Endoscopic retrograde cholangiopancreatography revealed a defect in the lower common bile duct with the mucoid fluid. We suspected intraductal papillary neoplasm of the bile duct, but no malignant cells were detected. One year later, gastrointestinal fiberscopy revealed a villous tumor in the postbulbar portion of the duodenum; adenocarcinoma was detected in biopsy specimens. Computed tomography revealed dilatation of the duodenum with an enhanced tumor, and dilatation of both the common and intrahepatic bile ducts. Magnetic resonance cholangiopancreatography revealed that the duodenum was connected with the common bile duct and ascending colon. We resected the segmental duodenum, extrahepatic bile duct, left lobe of liver, a partial of the transverse colon, and associated lymph nodes. Although the advanced duodenal carcinoma had poor prognosis, the patient was alive, without recurrence, 5 years after the operation.


2000 ◽  
Vol 124 (8) ◽  
pp. 1231-1232
Author(s):  
Glenda Amog ◽  
Jeffrey Lichtenstein ◽  
Steven Sieber ◽  
Hani El-Fanek

Abstract This is a case report of ascariasis of the common bile duct in a 65-year-old man from Colombia who had undergone prior cholecystectomy. The patient presented with postprandial epigastric pain and a 20-lb weight loss. The laboratory findings were remarkable for peripheral blood eosinophilia. The ultrasound finding was suggestive of periampullary or pancreatic neoplasm. He underwent endoscopic retrograde cholangiopancreatography with endoscopic extraction of a motile, live worm identified as Ascaris lumbricoides. Roundworm infestation should always be suspected in immigrants from endemic areas who present with hepatobiliary symptoms.


2000 ◽  
Vol 6 (3) ◽  
pp. C16-C16
Author(s):  
L CAICEDO ◽  
A VANIN ◽  
J VILLEGAS ◽  
A MENDOZA ◽  
M BADIEL

Author(s):  
M. Vignesh Kumar

This is a prospective study done to compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) in patients undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) for pancreaticobiliary disorders.Majority of the study participants were males (63.3%), while the rest 36.78% of them were females and periampullary carcinoma (11.7%) and common bile duct calculus (11.7%) are the common cause of obstruction found on MRCP followed by malignant stricture (10%). The extent of obstruction was determined in most of the study participants (91.7%) by MRCP while the rest 8.3% were not determined by MRCP. The Common bile duct calculus (11.7%) is the common cause of obstruction on ERCP followed by malignant stricture (10%) and Periampullary carcinoma (10%) and 20% of the patients were found to be normal in ERCP. Among them, 71.4 % did not show MRCP and the association was found to be significant. (p- Value < 0.00).


2020 ◽  
Vol 10 (4) ◽  
pp. 392-396
Author(s):  
Rani Abu Elgasim ◽  
Ahmed Abukonna ◽  
Ala Elgyoum ◽  
Mogahid Zidan ◽  
Mustafa Mahmoud ◽  
...  

The purpose of our study was to evaluate the common bile duct (CBD) and pancreatic duct (PD) diameter among healthy adult Sudanese subjects using magnetic resonance cholangiopancreatography (MRCP). In addition, this study aimed to determine the effects of age, gender, and body height and weight on the CBD and PD diameters to establish a reference range for these ducts on MRCP, which is very useful in a daily clinical setting where MRCP is commonly performed to evaluate suspected biliary tract disease. Methods and Results: This study included 80 asymptomatic subjects who underwent MRCP. The widest diameter of the CBD and PD was measured perpendicular to their long axes using the electronic caliper. The applied MRCP imaging technique was in line with the guidelines used by Chen et al.(2012) The age, gender, medical history, body height and body weight were recorded. Among the 80 subjects, the mean CBD diameter on MRCP was 6.17±0.69 mm (range of 4-8 mm). There was a significant correlation between the CBD diameter and weight (r=0.407, P<0.001). The mean PD diameter on MRCP was 3.80±0.50mm (range of 2-5 mm). There was also a significant correlation between the PD diameter and weight (r=0.407, P<0.001). In the cohort of 80 subjects, the mean CBD diameter in females was larger than in males(6.50±0.632mm and 5.95±0.677mm, respectively), and this difference was statistically significant (P<0.05). Also, the mean PD diameter in females was statistically larger than in males (6.03±0.66mm and 5.58±0.675mm, respectively), and this difference was statistically significant (P<0.05). Our results demonstrate no significant correlation between the diameter of CBD and PD and participants' height and age. Conclusion: The importance of the current study lies in it’s being one of the few studies whose intention was to use MRCP to bridge the knowledge gap in the literature about the measurement of the CBD and PD diameter among healthy adult Sudanese subjects.


1979 ◽  
Vol 4 (1) ◽  
pp. 41-42 ◽  
Author(s):  
C. S. Ho ◽  
M. V. Tait ◽  
J. D. McHattie

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hiroyuki Sugo ◽  
Yuuki Sekine ◽  
Naoki Iwanaga ◽  
Shigefumi Neshime ◽  
Michio Machida

Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.


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