Management of Complications from Hepatobiliary Surgery Using the Percutaneous Trans Jejunal Approach

Purpose The work was aimed at presenting the indications, techniques and results of the percutaneous transjejunal approach to the biliary tree in patients with hepatobiliary complications due to surgery. Patients and methods Ten patients, 7 males and 3 females, mean age 50 years (range, 10–62) with hepatico-jejunostomy, who developed cholangitis together with jaundice or bile leakage, underwent this procedure, performed through the anastomotic loop that was not surgically anchored to the abdominal wall in all cases but one. The transjejunal approach was chosen because of non-dilated bile ducts in 3 patients, complex pathologic situations in 5 patients and to avoid complications to a transplanted liver in 2 patients. The jejunal loop was identified using CT, US and fluoroscopy in 4 patients and after its opacification in the remaining 6 (by percutaneous transhepatic or intravenous cholangiography or fistulography). Results The procedure was technically and diagnostically successful in all cases. Therapeutic procedures (stenting, dilation, litholysis) were also performed using the transjejunal approach in 7 patients and in 6 of them complete pathological resolution was achieved. There were no complications. Conclusions Different pathologies of the biliary tree, in patients with bilio-enteric anastomoses, have been identified and treated by this technique; they were fistulas, anastomotic and/or multiple segmental benign or malignant stenoses of the bile duct, and diffuse intrahepatic lithiasis. The procedure was safe and reliable.

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Ethanol ablation of persistent bile leakage from isolated bile ducts after hepatobiliary surgery

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2013.12.492 ◽

2014 ◽

Vol 25 (3) ◽

pp. S182

Author(s):

S. Nakatsuka ◽

M. Inoue ◽

J. Tsukada ◽

S. Oguro ◽

H. Yashiro ◽

...

Keyword(s):

Bile Ducts ◽

Bile Leakage ◽

Hepatobiliary Surgery ◽

Ethanol Ablation

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Spiral stent placement for bile leakage after hepatobiliary surgery

Endoscopy ◽

10.1055/a-1463-2776 ◽

2021 ◽

Author(s):

Yunosuke Takishin ◽

Masaki Kuwatani ◽

Naoya Sakamoto

Keyword(s):

Stent Placement ◽

Bile Leakage ◽

Hepatobiliary Surgery

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

10.21203/rs.3.rs-106936/v1 ◽

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.

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Proximal Extrahepatic Bile Ducts: Comprehensive Review

Journal of oncology: diagnostic radiology and radiotherapy ◽

10.37174/2587-7593-2021-4-1-74-93 ◽

2021 ◽

Vol 4 (1) ◽

pp. 74-93

Author(s):

M. A. Shorikov ◽

O. N. Sergeeva ◽

M. G. Lapteva ◽

N. A. Peregudov ◽

B. I. Dolgushin

Keyword(s):

Bile Duct ◽

Bile Flow ◽

Bile Ducts ◽

Extrahepatic Bile Duct ◽

Hepatic Duct ◽

Biliary Tree ◽

Comprehensive Review ◽

Extrahepatic Bile Ducts ◽

And Function ◽

Variant Anatomy

Proximal extrahepatic bile ducts are the biliary tree segment within formal boundaries from cystic ductcommon hepatic duct junction to sectoral hepatic ducts. Despite being a focus of attention of diagnostic and interventional radiologists, endoscopists, hepatobiliary surgeons and transplantologists they weren’t comprehensively described in available papers. The majority of the authors regard bile duct confluence as a group of merging primitively arranged tubes providing bile flow. The information on the proximal extrahepatic bile duct embryonal development, variant anatomy, innervation, arterial, venous and lymphatic supply is too general and not detailed. The present review brought together and systemized exiting to the date data on anatomy and function of this biliary tract portion. Unique, different from the majority of hollow organs organization of the proximal extrahepatic bile duct adapts them to the flow of the bile, i.e. viscous aggressive due to pH about 8.0 and detergents fluid, under higher wall pressure than in other parts of biliary tree.

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Successful Treatment of Recurrent Primary Sclerosing Cholangitis after Orthotopic Liver Transplantation with Oral Vancomycin

Case Reports in Transplantation ◽

10.1155/2013/314292 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Yinka K. Davies ◽

Cynthia J. Tsay ◽

Dario V. Caccamo ◽

Kathleen M. Cox ◽

Ricardo O. Castillo ◽

...

Keyword(s):

Ulcerative Colitis ◽

Liver Transplantation ◽

Primary Sclerosing Cholangitis ◽

Orthotopic Liver Transplantation ◽

Successful Treatment ◽

Sclerosing Cholangitis ◽

Bile Ducts ◽

Biliary Tree ◽

Oral Vancomycin ◽

Inflammatory Bowel

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic disease of the liver that is marked by inflammation of the bile ducts and damage to the hepatic biliary tree. Approximately 60–70% of patients also have inflammatory bowel disease and progression of PSC can lead to ulcerative colitis and cirrhosis of the liver. Due to limited understanding of the etiology and mechanism of PSC, the only existing treatment option is orthotopic liver transplantation (OLT); however, recurrence of PSC, after OLT is estimated to be between 5% and 35%. We discuss the successful treatment of a pediatric patient, with recurrent PSC, after OLT with oral Vancomycin.

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“A New Reconstructive Method after Pancreaticoduodenectomy: the Triple Roux on a “P” Loop. Rationale and Radionuclide Scanning Evaluatlon.”

HPB Surgery ◽

10.1155/1996/53812 ◽

1996 ◽

Vol 9 (4) ◽

pp. 223-227 ◽

Cited By ~ 5

Author(s):

Gianluigi Pescio ◽

Erminio Cariati

Keyword(s):

Pancreatic Fistula ◽

Bile Ducts ◽

Alimentary Tract ◽

Jejunal Loop ◽

Linear Stapler ◽

Suggested Model ◽

Biliary Anastomosis ◽

Pancreaticojejunal Anastomosis ◽

Enterogastric Reflux ◽

Radionuclide Scanning

We propose a method of reconstruction after pancreaticoduodenectomy consisting of a double Roux en Y on the same jejunal loop without interruption of the mesentery and a third anatomical Roux en Y to reconstitute the alimentary tract.The construction of the double Roux en Y draining pancreas and bile ducts separately, requires a linear Stapler 3-4 centimeters from the biliary anastomosis. In this way, by employing the same loop without mesenteric interruption, two functional excluded loops will be ’obtained. The rationale of the suggested model is based on the separation of biliary and pancreatic secretions. This makes it possible to avoid a stagnant cul-de-sac coinciding with the pancreaticojejunal anastomosis and to obtain in the case of leakage, a pure biliary and/or pancreatic fistula as far as is possible.99mTc HIDA scans demonstrated the efficiency, of the biliopancreatic limbs of the reconstruction, showing normal emptying time for the gastric remnant and the absence of radionuclide stagnation or any alkaline enterogastric reflux.

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A New Set for Transhepatic Insertion of Large Caliber Catheters for Biliary Drainage: Technical and Clinical Report

Tumori Journal ◽

10.1177/030089168707300615 ◽

1987 ◽

Vol 73 (6) ◽

pp. 635-638

Author(s):

Aldo Severini ◽

Guido Cozzi ◽

Massimo Bellomi ◽

Laura Frigerio ◽

Roberto Doci

Keyword(s):

Biliary Drainage ◽

Bile Ducts ◽

Bile Leakage ◽

Late Complications ◽

Clinical Report ◽

Percutaneous Insertion ◽

Large Side

An original set for percutaneous insertion of large caliber (12-16 French) biliary drainages is described. The results obtained in the 70 patients submitted to biliary drainage with late complications due to malfunction of the standard 8.3 or 10 F catheters show the advantage of the set described. The correction of unsatisfactory levels of bilirubinemia was obtained in 100% of cases, the resolution of recurrent cholangitis in 84.2% and of bile leakage on the skin in 46.7%. The large caliber and the large side holes of the catheter, together with its length and its easy handling, allow resolution of many different problems of insufficient drainage present in patients with neoplastic involvement of bile ducts.

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Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

Medicina ◽

10.3390/medicina55080483 ◽

2019 ◽

Vol 55 (8) ◽

pp. 483

Author(s):

Baca-Arzaga ◽

Navarro-Chavez ◽

Galindo ◽

Santibanez-Juarez ◽

Cardosa-Gonzalez ◽

...

Keyword(s):

Stone Disease ◽

Endoscopic Management ◽

Bilioenteric Anastomosis ◽

Complex Anatomy ◽

Laparoscopy Surgery ◽

Management Of Complications ◽

Intrahepatic Lithiasis ◽

History Of ◽

Laparoscopic Assisted

Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported.

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Rare Biliary Anatomy in Two Patients Presenting with Biliary Obstruction Diagnosed with ERCP

Canadian Journal of Gastroenterology ◽

10.1155/1991/104079 ◽

1991 ◽

Vol 5 (5) ◽

pp. 161-164

Author(s):

Gary R May ◽

David S Reid ◽

Noel B Hershfield

Keyword(s):

Cystic Duct ◽

Incidental Findings ◽

Biliary Obstruction ◽

Biliary Tree ◽

Stone Extraction ◽

Biliary Anatomy ◽

Endoscopic Retrograde ◽

Potential Problems ◽

Therapeutic Procedures ◽

Rare Anatomic Variant

Anatomic anomalies of the exrrahepatic biliary tree are common and often incidental findings at endoscopic retrograde cholangiopancreatography; however, they rarely complicate therapeutic procedures such as stone extraction. The cases of two patients with biliary obstruction due to stones are presented, who were found to have the cystic duct a rising almost directly from the ampulla. This rare anatomic variant posed problems both in terms of interpretation of the cholangiogram and removal of stones. Therapeutic endoscopists should be aware of this and other anomalies of the biliary tract and of the potential problems faced in both interpretation of the cholangiogram and in therapeutic procedures.

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