Management of Common Bile Duct Injury during Partial Gastrectomy

2009 ◽  
Vol 75 (8) ◽  
pp. 719-721 ◽  
Author(s):  
Jennifer A. Dixon ◽  
Katherine A. Morgan ◽  
David B. Adams
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Negative Impact ◽  
Gastrointestinal Surgery ◽  
Partial Gastrectomy ◽  
Bile Leakage ◽  
Stricture Formation ◽  
Ulcer Disease ◽  
Presenting Symptoms ◽  
Cbd Injury

Injury to the common bile duct (CBD) during upper gastrointestinal surgery for peptic ulcer disease is a serious complication with an underestimated prevalence in light of the few cases reported in the surgical literature. Three cases of CBD injury were referred to a multidisciplinary specialized gastrointestinal unit for management over a 4-year period. Anomalous anatomy, adhesions, and potential duodenal shortening secondary to contracture all predispose the biliary ducts to intraoperative injury. The axial nature of the blood supply to the extrahepatic ducts and the tendency of bile itself to cause rapid collagen turnover and fibrosis, combined with the inflammation and subsequent fibrosis to the surrounding tissues caused by bile leakage, give the bile ducts a high propensity for stricture formation. Frequently presenting symptoms of CBD injury immediately after surgery include jaundice, elevated bilirubin values, elevated t-tube drainage, and symptoms of sepsis. The most common complaints noted in patients who present in a delayed manner are symptoms of cholangitis. Even when injuries are rapidly identified and corrected, the potential for lasting negative impact on quality of life is great in many cases. When CBD injury occurs, the pancreatic duodenal union can be concomitantly disrupted.

Optimising postoperative discharge plans for patients undergoing surgical treatment for gastric cancer: a literature review

2021 ◽  
Vol 19 (1) ◽  
pp. 34-40
Author(s):  
Lorena Chaparro-Diaz ◽  
Maria Zoraida Rojas ◽  
Sonia Patricia Carreño-Moreno
Keyword(s):  
Gastric Cancer ◽  
Literature Review ◽  
Psychosocial Support ◽  
Negative Impact ◽  
Gastrointestinal Surgery ◽  
Partial Gastrectomy ◽  
Cost Effective ◽  
Essential Elements ◽  
Cochrane Central Register ◽  
Gastric Cancer Patients

Background: Gastric (stomach) cancer is common, difficult to detect and has a high mortality rate. Many gastric cancers are treatable with invasive gastrointestinal surgery, including total or partial gastrectomy. These patients face many postoperative challenges, including pain, nausea and nutritional difficulties, as well as consequent anxiety and socio-economic challenges. Some healthcare institutions have implemented discharge plans as a cost-effective strategy to improve postoperative care. Aim: This systematic literature review aimed to identify essential elements to incorporate in the design and implementation of discharge plans for post-surgical gastric cancer patients. Methods: A systematic literature search was performed on the Cochrane Central Register of Controlled Studies, Elsevier Scopus and the library database of the National University of Colombia. These articles were assessed for relevance and underwent thematic analysis. Findings: The search returned nine relevant articles in English and Spanish. They suggested that discharge plans should start from first contact with a nurse and integrate the patient and their family and carers into the process of home self-care and recovery. These plans should also guide nurses to provide ongoing patient education, nutritional interventions and psychosocial support, as well as prevention of thromboembolism and assistance with symptom management and coming to terms with a new life situation. Conclusions: Discharge plans reduce the negative impact of the disease and invasive procedures on patients, families and health systems, reducing unplanned hospitalisation and readmission. There is a need to develop and test supportive care programmes that are designed to meet the needs of patients and focus on improving patients' quality of life after this life-changing surgery.

Mucin-filled CBD, difficult to manage cholangitis

2021 ◽  
Vol 14 (1) ◽  
pp. e238363
Author(s):  
Manish Kumar ◽  
Ujjwal Sonika ◽  
Sanjeev Sachdeva ◽  
Ashok Dalal
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Rare Case ◽  
Malignant Potential ◽  
Cystic Neoplasm ◽  
Stricture Formation ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasms ◽  
Optimum Management

Intraductal papillary mucinous neoplasms (IPMNs) are mucin-secreting cystic neoplasm of pancreas. They have a malignant potential. They are usually localised to the pancreas but occasionally can involve surrounding structures (1.9%–6.6%), like bile duct and duodenum, and are labelled as IPMN with invasion. Jaundice as a manifestation of IPMN is not common (4.5%). It can present as jaundice as a result of invasion of common bile duct (CBD) resulting in stricture formation or uncommonly as a result of fistulising to CBD with resultant obstruction of CBD by thick mucin secreted by this tumour. As only few cases (around 23) of mucin-filled CBD are reported in the literature. We are presenting our experience in dealing a rare case of obstructive jaundice caused by IPMN fistulising into CBD, highlighting the difficulties faced in managing such case, especially with regards to biliary drainage and what can be the optimum management in such cases.

Common Bile Duct MALT Lymphoma: Case Report and Review of the Literature

2006 ◽  
Vol 72 (1) ◽  
pp. 85-88
Author(s):  
Justin Boccardo ◽  
Anjay Khandelwal ◽  
Dongjiu Ye ◽  
Bruce E. Duke
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Malt Lymphoma ◽  
Lymphoid Tissue ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Biliary Tree ◽  
Review Of The Literature ◽  
Helicobacter Pylori Treatment ◽  
Rare Diagnosis

We report a rare case of common bile duct mucosa-associated lymphoid tissue (MALT) lymphoma treated with pancreatico-duodenectomy with a partial gastrectomy. MALT lymphoma involving the biliary tree is extremely rare. Diagnosis is difficult and treatment options are controversial. Even though Helicobacter pylori treatment is effective in the early stages of the disease, surgery is still helpful especially when obstruction, perforation, or bleeding is present.

scholarly journals Biliary Peritonitis Due to Spontaneous Perforation of the Left Intrahepatic Bile Duct in an Adult: A Case Report and Review of Literature

2018 ◽  
Vol 103 (7-8) ◽  
pp. 339-343
Author(s):  
Wenwu Cai ◽  
Ke Pan ◽  
Qinglong Li ◽  
Xiongying Miao ◽  
Chang Shu
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Good Prognosis ◽  
Spontaneous Perforation ◽  
Repair Operation

Spontaneous perforation of the left intrahepatic bile duct is extremely rare, especially in adults. Here, we report on a case of a 64-year-old woman who had a complaint of right upper abdominal pain for 10 days, which gradually progressed to entire abdominal pain for 3 days, and was admitted to our hospital. Relevant examinations revealed she had a normal cardiac and lung workup, but an obvious abnormal abdominal computed tomography examination, which revealed an enlarged gallbladder, choledocholithiasis with dilatation of the common bile duct (1.8 cm) and intrahepatic bile duct, and a lot of encapsulated ascites. After being given adequate fluid resuscitation and active preoperative preparation, cholecystectomy and common bile duct exploration and perforation repair operation were then performed. The postoperative course was uneventful, and she was discharged with the T-tube in situ. A choledochoscopy examination at week 6 showed the conditions of the intrahepatic and extrahepatic bile duct were good. For these patients, early diagnosis and surgical treatment are essential for good prognosis. The goal of our surgery is to stop bile leakage, resolve choledocholithiasis and cholangitis, and reconstruct the bile duct.

Laparoscopic Common Bile Duct Exploration with Primary Closure for Management of Choledocholithiasis: A Retrospective Analysis and Comparison with Conventional T-tube Drainage

2014 ◽  
Vol 80 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Hong-Wei Zhang ◽  
Ya-Jin Chen ◽  
Chang-Hao Wu ◽  
Wen-Da Li
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Primary Closure ◽  
Bile Leakage ◽  
Common Bile Duct Exploration ◽  
Tube Drainage ◽  
T Tube ◽  
Group A ◽  
Group B

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B ( P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation ( P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B ( P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

Bile leakage after removal of T tubes from the common bile duct

1990 ◽  
Vol 77 (9) ◽  
pp. 1075-1075 ◽  
Author(s):  
C. Placer Galán ◽  
A. Colina Alonso
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leakage ◽  
The Common

99mTc-labelled HIDA scintigraphy in assessment of bile leakage after removal of T tube from the common bile duct

1989 ◽  
Vol 76 (12) ◽  
pp. 1319-1319 ◽  
Author(s):  
N. Ryttov ◽  
L. Rasmussen ◽  
S. A. Pedersen ◽  
E. Öster-Jörgensen
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leakage ◽  
T Tube ◽  
The Common

scholarly journals Choledochoplasty by Vein Grafts in Iatrogenic Bile Duct Injuries

HPB Surgery ◽  
1992 ◽  
Vol 5 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Aws S. Salim
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Catheter ◽  
Tissue Loss ◽  
Stricture Formation ◽  
Vein Grafts ◽  
Bile Duct Injuries ◽  
Considerable Morbidity

The quality of immediate repair of common bile duct injuries with or without tissue loss occurring during elective cholecystectomy is crucial and maybe the sole factor behind future stricture formation with its considerable morbidity and mortality. Successful repair of iatrogenic common bile duct injuries has been achieved by immediate saphenous vein grafts in two patients with cystic duct avulsion, in one patient whose duct was split by a balloon catheter, and in one patient where a segment of the duct was resected. Follow-up for 5 years demonstrated that the grafting remained sound and produced no complications. Consequently, the immediate repair of iatrogenic bile duct injuries using vein grafts deserves consideration.

scholarly journals Common Bile Duct Stone Formed around a Migrated Clip: An Unexpected Complication of Laparoscopic Cholecystectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-2 ◽  
Author(s):  
Anas M. Hussameddin ◽  
Iba Ibrahim AlFawaz ◽  
Reema Fahad AlOtaibi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Duct Stone ◽  
Stone Formation ◽  
Endoscopic Retrograde ◽  
Presenting Symptoms ◽  
Surgical Clip ◽  
The Common

Surgical clip migration into the common bile duct with subsequent stone formation is a rare complication following laparoscopic cholecystectomy. Very few cases have been reported in the literature. We report a case of bile duct stone formation around a migrated surgical clip 16 years after laparoscopic cholecystectomy. The patient presented with right upper quadrant pain, fever, and chills for one week. Investigation with abdominal ultrasound showed dilatation of the common bile duct and moderate dilatation of the intrahepatic bile ducts. The diagnosis was confirmed by endoscopic retrograde cholangiopancreatography and the patient was managed successfully with sphincterotomy and stone extraction. The exact mechanism of clip migration is not fully understood. Presenting symptoms are similar to non-clip-induced choledocholithiasis. Time of presentation can vary significantly with an average of 26 months. Most cases reported in the literature required surgical intervention. Clip migration should be considered in the differential diagnosis of postcholecystectomy biliary colic and cholangitis. Management with endoscopic retrograde cholangiopancreatography is the treatment of choice.

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