Laparotomy-Assisted Direct Cholangioscopy for Bile Duct Stone Removal via an Incision of the Jejunum

A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y reconstruction at 42 years of age for intrahepatic stones and liver abscesses. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed bile duct stones and intrahepatic bile duct dilation of the caudate lobe. Bile duct drainage for the caudate lobe was necessary; however, the volume of his caudate lobe was very small, making percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD) difficult. Therefore, we attempted laparotomy-assisted endoscopic biliary drainage. Under general anesthesia, an incision was made on the jejunum approximately 15 cm from the Y-leg anastomosis. An esophagogastroduodenoscope was directly inserted into the common hepatic duct anastomosed with the jejunum. The caudate lobe branch had severe stenosis, and the area upstream of the stenosis was filled with stones, sludge, and pus. The biliary stenosis was dilated using a balloon, and the stones were completely removed using a basket and a balloon catheter. There are various methods of biliary and pancreatic surgery and gastrointestinal reconstruction, and there are cases in which PTBD, EUS-BD, and endoscopic retrograde cholangiopancreatography (ERCP) with an enteroscope are difficult. In such cases, ERCP under laparotomy could be a good treatment option.

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

The American Surgeon ◽

10.1177/000313481408000126 ◽

2014 ◽

Vol 80 (1) ◽

pp. 66-71 ◽

Cited By ~ 1

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.

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Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2018.v02.i01.p02 ◽

2018 ◽

Vol 2 (1) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Made Mahayasa ◽

Tommy Lesmana

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Gall Bladder ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Common Hepatic Duct ◽

Hepatic Bile ◽

Hepatic Bile Duct

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.

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Mucin-producing Bile Duct Tumor of the Caudate Lobe Protruding into the Common Hepatic Duct

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-007-0133-z ◽

2007 ◽

Vol 11 (11) ◽

pp. 1570-1572 ◽

Cited By ~ 4

Author(s):

Shuichiro Uchiyama ◽

Kazuo Chijiiwa ◽

Masahide Hiyoshi ◽

Motoaki Nagano ◽

Jiro Ohuchida ◽

...

Keyword(s):

Bile Duct ◽

Hepatic Duct ◽

Caudate Lobe ◽

Common Hepatic Duct ◽

Bile Duct Tumor ◽

The Common

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ANATOMIC VARIANTS OF INTRAHEPATIC BILE DUCTS AND CYSTIC DUCTS IN SAUDI ARABIA: MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY ANALYSIS IN LIVER DONORS

10.36106/ijar/7018150 ◽

2021 ◽

pp. 30-32

Author(s):

Ayesha Nuzhat ◽

Maram AlGhamdi ◽

Abdullah AlAyed

Keyword(s):

Saudi Arabia ◽

Bile Duct ◽

Magnetic Resonance ◽

Cystic Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Radiology Department ◽

Common Hepatic Duct ◽

Left Hepatic Duct ◽

Liver Donors

Background: Data regarding the pattern of the anatomical variations of biliary tree from the Middle East is considerably decient when compared with the literature available elsewhere. To dete Objective: rmine anatomic variation in branching pattern of intra hepatic bile duct and cystic duct on Magnetic resonance Cholangiopancreatography in liver donors from Saudi Arabia. Methods: This descriptive study was done at Radiology Department Prince Sultan Military Medical City Riyadh, KSA between 2019-2020 after taking IRB approval (IRB No:1404) and collecting data of liver donors (n=92) using Magnetic resonance cholangiopancreatography. Result: Regarding the right hepatic duct, in our study Type A1(69.6%) was predominant followed by Type A2(16.3%). As for the left hepatic duct, typical pattern Type A was observed in 94.6% cases. Drainage of right posterior hepatic duct into left hepatic duct, A3(7.6%) and A4(5.4%) drainage of right posterior hepatic duct into the common hepatic duct were the most common variants in our study. Accessory bile duct with segment 5 draining into CHD with segment 5and 8 draining into CHD was found in 2.2% of cases, and an aberrant bile duct in 1.1% In our study, majority (97.8% )had lateral insertion of cystic duct and in 1.4% accessory cystic duct was noted. Because of growing trend found in Conclusion: number of liver transplant surgeries being performed, magnetic resonance cholangiopancreatography (MRCP) has become optimal for noninvasive evaluation of abnormalities of the biliary tract.

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Hepatic resection for bile duct injury: A case report

Journal of Chitwan Medical College ◽

10.3126/jcmc.v7i1.17371 ◽

2017 ◽

Vol 7 (1) ◽

pp. 50-53

Author(s):

Utsav Joshi ◽

Ramesh Singh Bhandari

Keyword(s):

Bile Duct ◽

Bile Duct Injury ◽

Hepatic Duct ◽

Therapeutic Option ◽

Open Cholecystectomy ◽

Magnetic Resonance Cholangiopancreatography ◽

Liver Function Tests ◽

Feeding Tube ◽

Common Hepatic Duct ◽

Biliary Reconstruction

Background: Bile duct injury is a serious complication following both open and laparoscopic cholecystectomy. The extent of injury may be severe enough to consider biliary reconstruction procedures like Roux-en-Y hepaticojejunostomy or even hepatectomy in rare instances for the definitive management.Case: A 56 year old female, who underwent open cholecystectomy and detected bile duct injury intraoperatively. Small feeding tube was placed in the bile duct, exteriorized and patient was referred to our center for further management. Liver function tests at presentation revealed cholestatic patterns of liver derangement but the patient did not show any signs suggestive of sepsis. Endoscopic Retrograde Cholangiopancreatography revealed complete stricture of common hepatic duct. Magnetic Resonance Cholangiopancreatography revealed Bismuth type 4 bile duct stricture. The plan was to perform a bilateral hepaticojejunostomy, however, because of the very difficult anatomy and failure to identify the right duct, right hepatectomy with left duct hepaticojejunostomy was performed as a definitive management for her type IV bile duct injury. The patient had an uneventful post-operative course.Conclusion: Infrequently, liver resection remains an important therapeutic option in cases of complicated and major forms of bile duct injuries where the bilateral biliary reconstruction is not feasible.

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Percutaneous transbiliary biopsy

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017001013 ◽

2017 ◽

Vol 44 (1) ◽

pp. 107-108 ◽

Cited By ~ 1

Author(s):

GUSTAVO VIEIRA ANDRADE ◽

MIGUEL ARCANJO SANTOS ◽

MARCONI ROBERTO MEIRA ◽

MATEUS DUARTE MEIRA

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Percutaneous Drainage ◽

Biliary Drainage ◽

Bile Ducts ◽

Hepatic Duct ◽

Endoscopic Biopsy ◽

Common Hepatic Duct ◽

Biopsy Forceps ◽

The Common

ABSTRACT Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct.

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When It Doesn't Fit: Congenital Anomalies of the Choledochus

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0039-1693998 ◽

2020 ◽

Vol 08 (01) ◽

pp. e86-e89

Author(s):

Helena Reusens ◽

Mark Davenport

Keyword(s):

Case Report ◽

Bile Duct ◽

Common Bile Duct ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Resected Specimen ◽

Cystic Dilatation ◽

Left Hepatic Duct ◽

Distal Common Bile Duct

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

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Extended Right Hepatectomy with Total Caudate Lobe Resection and Biliary Tree Resection for a Large Colorectal Liver Metastasis Involving both the Right and Left Hepatic Lobes and the Umbilical Fissure: A Case Report

The American Surgeon ◽

10.1177/000313480507100517 ◽

2005 ◽

Vol 71 (5) ◽

pp. 447-449 ◽

Cited By ~ 1

Author(s):

Aljamir D. Chedid ◽

Marcio F. Chedid ◽

Cleber R.P. Kruel ◽

FÁbio M. Girardi ◽

Cleber D.P. Kruel

Keyword(s):

Colorectal Cancer ◽

Bile Duct ◽

Liver Metastasis ◽

Liver Tumors ◽

Hepatic Duct ◽

Early Death ◽

Caudate Lobe ◽

Right Hepatectomy ◽

Left Hepatic Duct ◽

Extended Right Hepatectomy

Very large right-sided liver tumors may grow up to the base of the umbilical fissure and involve the left hepatic duct and can occasionally reach the bile duct confluence. This kind of involvement has often been considered a contraindication to resection. We report a patient who presented with a large hepatic metastasis from colorectal cancer that reached the umbilical fissure and involved the left hepatic duct just above the bile duct confluence. An extended right hepatectomy including complete resection of caudate lobe was performed. We resected the left and common hepatic ducts, as well as both the entire hepatic and the proximal third of common bile duct. A long jejunal limb Roux-en-Y (45 cm) single-layer left intrahepatic hepaticojejunostomy was constructed. She is still well 14 months postoperatively. To the best of our knowledge, this is the first report of such a procedure employed for the treatment of a liver metastasis from colorectal cancer. Extended right hepatectomy including complete caudate lobe resection can be feasible even when the majority of the extrahepatic biliary system needs to be resected. Our approach probably offers the only chance to prevent early death from liver failure in these patients.

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Type VI Choledochal Cysts—Case Report and Review of Literature

The Surgery Journal ◽

10.1055/s-0039-1693652 ◽

2019 ◽

Vol 05 (03) ◽

pp. e82-e86 ◽

Cited By ~ 1

Author(s):

J. M. V. Amarjothi ◽

Villalan Ramasamy ◽

Jeyasudhahar Jesudasan ◽

O. L. NaganathBabu

Keyword(s):

Hepatic Duct ◽

Treatment Options ◽

Magnetic Resonance Cholangiopancreatography ◽

Interesting Case ◽

Common Hepatic Duct ◽

Choledochal Cysts ◽

Middle Aged ◽

Complete Excision ◽

Intrahepatic Bile Ducts ◽

Aged Woman

AbstractCholedochal cysts (CDC), are rare congenital dilations involving the extra hepatic biliary apparatus with or without dilation of the intrahepatic bile ducts. They are conventionally classified into five types. A new type, type VI, causing dilation of the cystic duct between the neck of the gall bladder and the common hepatic duct (CHD) has been described in medical literature which is the rarest of all these subtypes. They are commonly observed in middle aged females and are mostly symptomatic. Most of these cysts need magnetic resonance cholangiopancreatography (MRCP) for accurate diagnosis. Treatment options for these lesions are not well defined but range from simple cholecystectomy to complete excision of the entire bile duct and biliary reconstruction, as there is a concern of malignant transformation in these cysts. Hence, these rare cysts, though rare, must be borne in mind when dealing with suspicious cystic lesions in the biliary tract. Here, we present an interesting case of such a rare cyst and its management in a middle aged woman.

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