scholarly journals Extraluminal recanalization for postoperative biliary obstruction using transseptal needle

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Horinouchi ◽  
Eisuke Ueshima ◽  
Keitaro Sofue ◽  
Shohei Komatsu ◽  
Takuya Okada ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Biliary Obstruction ◽  
Hepatic Duct ◽  
Drainage Tube ◽  
Biliary Strictures ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Benign Biliary Strictures ◽  
The Right

Abstract Background Postoperative biliary strictures are commonly related to accidental bile duct injuries or occur at the site of biliary anastomosis. The first-line treatment for benign biliary strictures is endoscopic therapy, which is less invasive and repeatable. However, recanalization for biliary complete obstruction is technically challenging to treat. The present report describes a successful case of treatment by extraluminal recanalization for postoperative biliary obstruction using a transseptal needle. Case presentation A 66-year-old woman had undergone caudal lobectomy for the treatment of hepatocellular carcinoma. The posterior segmental branch of the bile duct was injured and repaired intraoperatively. Three months after the surgery, the patient had developed biliary leakage from the right hepatic bile duct, resulting in complete biliary obstruction. Since intraluminal recanalization with conventional endoscopic and percutaneous approaches with a guidewire failed, extraluminal recanalization using a transseptal needle with an internal lumen via percutaneous approach was performed under fluoroscopic guidance. The left lateral inferior segmental duct was punctured, and an 8-F transseptal sheath was introduced into the ostium of right hepatic duct. A transseptal needle was advanced, and the right hepatic duct was punctured by targeting an inflated balloon that was placed at the end of the obstructed right hepatic bile duct. After confirming successful puncture using contrast agent injected through the internal lumen of the needle, a 0.014-in. guidewire was advanced into the right hepatic duct. Finally, an 8.5-F internal–external biliary drainage tube was successfully placed without complications. One month after the procedure, the drainage tube was replaced with a 10.2-F drainage tube to dilate the created tract. Subsequent endoscopic internalization was performed 5 months after the procedure. At the 1-year follow-up examination, there was no sign of biliary obstruction and recurrence of hepatocellular carcinoma. Conclusions Recanalization using a transseptal needle can be an alternative technique for rigid biliary obstruction when conventional techniques fail.

scholarly journals Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

2018 ◽  
Vol 2 (1) ◽  
pp. 5 ◽  
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.

scholarly journals A Case of Aberrant Hepatic Bile Duct of the Right Anterio-Posterior Branch of the Liver Connected to the Neck of the Gallbladder

1999 ◽  
Vol 53 (0) ◽  
pp. 202-203
Author(s):  
Reiko Koike ◽  
Sada-aki Kato ◽  
Kazuo Tsuno ◽  
Yutaka Takano ◽  
Hiroshi Ishii ◽  
...  
Keyword(s):  
Bile Duct ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Posterior Branch ◽  
The Right

scholarly journals Hepatectomy for Hilar Cholangiocarcinoma with Right-Sided Ligamentum Teres Using a Hepatectomy Simulation System

2017 ◽  
Vol 11 (3) ◽  
pp. 576-583 ◽  
Author(s):  
Seikan Hai ◽  
Etsuro Hatano ◽  
Tadamichi Hirano ◽  
Yasukane Asano ◽  
Kazuhiro Suzumura ◽  
...  
Keyword(s):  
Bile Duct ◽  
Hilar Cholangiocarcinoma ◽  
Three Dimensional ◽  
Bile Leakage ◽  
Ligamentum Teres ◽  
Simulation System ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
The Right ◽  
Hepatic Vasculature

Right-sided ligamentum teres (RSLT) is a rare congenital anomaly often accompanied by variation of the hepatic vasculature. We herein report a surgical case of a hilar cholangiocarcinoma with RSLT in whom preoperative hepatectomy simulation proved useful for understanding the anatomical structure of the liver. A 78-year-old male with obstructive jaundice was referred to our department for further examination. The patient was suspected of having a hilar cholangiocarcinoma originating from the left hepatic bile duct by contrast-enhanced computed tomography (CT), and CT also showed right umbilical portion (RUP). Three-dimensional images of the hepatic vasculature and biliary system reconstructed using a hepatectomy simulation system suggested that all portal branches ramified from RUP were right paramedian branches, and three leftward portal branches from these ran parallel to the peripheral bile ducts confluent with the left hepatic bile duct, where the tumor was present. Hepatic resection of part of the ventral area of the right paramedian sector and left hemiliver was performed along the demarcation line drawn after clamping the portal branches; the ratio of estimated liver resection volume was 28.9%. After the operation, bile leakage occurred. However, the leakage was treated with percutaneous drainage alone, and the patient was discharged 77 days after the operation. The patient is doing well without any signs of recurrence 21 months after the operation. The vascular and biliary anatomy in patients with RSLT is complicated and should be evaluated in detail preoperatively using a hepatectomy simulation system.

scholarly journals X-ray surgery for benign biliary strictures after cholecystectomy

2019 ◽  
Vol 24 (1) ◽  
pp. 83-91
Author(s):  
O. I. Okhotnikov ◽  
M. V. Yakovleva ◽  
O. S. Gorbacheva
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Dilatation ◽  
Hepatic Duct ◽  
Primary Repair ◽  
Common Hepatic Duct ◽  
Biliary Strictures ◽  
Biliodigestive Anastomosis ◽  
X Ray ◽  
Benign Biliary Strictures

Aim.To determine the role of antegrade X-ray surgical interventions in the treatment of benign postoperative biliary strictures.Material and methods.A retrospective analysis of treatment of 36 patients with benign biliary strictures was performed. Isolated stricture of biliodigestive anastomosis was diagnosed in 25 cases, partial clipping of common hepatic duct proximal to biliodigestive anastomosis – in 3 cases, partial clipping of bile duct – in 3 patients, isolated biliary strictures – in 5 patients including 4 of them with stricture within previously deployed T-shaped drainage. At the first stage, percutaneous transhepatic cholangiostomy was performed. According to antegrade cholangiography data, structure type “+1, +2” by H. Bismuth classification in modification of E. I. Galperin was diagnosed in 16 (55.2%) patients, proximal biliary strictures (“0”–“−2”) in 13 patients. Three patients with partial clipping of common bile duct and 4 patients with benign biliary stricture in the area of previously deployed T-shaped drainage were not classified. Recanalization of strictures by “catheter-guide” system was followed by antegrade dilatation of the stricture. Final stage was frame external-internal drainage for 6–12 months with stepwise redo balloon dilatation every 3 months (35 patients). The criterion for the end of minimally invasive treatment was the absence of balloon waist in the stricture zone observed during the next procedure but not earlier than in 6 months from primary balloon dilatation. Surgical correction was indicated for recurrent stricture.Results.Direct technical success was achieved in 35 patients. There was 1 case of recurrent strictures within 1 year among 3 cases of primary repair of biliary strictures in the area of previously installed T-shaped drainage. Resection of common bile duct stricture was followed by Roux-en-Y hepaticojejunostomy. Recurrence-free period among 36 patients ranged from 1 to 10 years, median – 56 months. There were no mortality and complications after X-ray surgery.Conclusion.Antegrade recanalization and balloon dilatation of the stricture followed by long-term external-internal biliodigestive frame drainage are effective for both stricture of biliodigestive anastomosis and partial clipping of bile duct. Conventional surgical procedures should be preferred for cicatricial strictures of extrahepatic bile ducts after previous T-shaped drainage deployment.

scholarly journals Indocyanine green fluorescence navigation for hepatocellular carcinoma with bile duct tumor thrombus: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masaru Matsumura ◽  
Yasuji Seyama ◽  
Hiroyuki Ishida ◽  
Satoshi Nemoto ◽  
Keigo Tani ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Indocyanine Green ◽  
Tumor Thrombus ◽  
Hepatic Duct ◽  
Advanced Hepatocellular Carcinoma ◽  
Right Hepatectomy ◽  
Bile Duct Tumor ◽  
Distal Side ◽  
The Right

Abstract Background Bile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). In the resection of HCC with BDTT, it is important to detect the BDTT tip to decide the appropriate point of bile duct division. In this regard, the efficacy of indocyanine green (ICG) fluorescence navigation has been confirmed for the detection of HCC, whereas its utility for BDTT has not yet been reported. Herein, we describe our experience with right hepatectomy for HCC with BDTT using ICG fluorescence navigation. Case presentation A 72-year-old woman had experienced local recurrences of HCC after radiofrequency ablation, with BDTT reaching the confluence of the right anterior branch and posterior branch. Right hepatectomy was planned, and 2.5 mg of ICG was injected one day before surgery. After transection of the liver parenchyma, the right liver was connected with only the right hepatic duct. ICG fluorescence imaging visualized the tip of BDTT in the bile duct with clear contrast; the proximal side (hepatic side) of the right hepatic duct showed stronger fluorescence than the distal side (duodenal side). The bile duct was divided at the distal side of the BDTT border, and the tip of BDTT was recognized into the resected right hepatic duct without laceration. The patient had an uneventful postoperative course and currently lives without recurrences for 6 months. Conclusions ICG fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT.

scholarly journals Obstructive Jaundice Following Transarterial Chemoembolization for Hepatocellular Carcinoma with Bile Duct Invasion

2021 ◽  
Vol 5 (02) ◽  
pp. 127-130
Author(s):  
Kazuki Matsushita ◽  
Ken Kageyama ◽  
Natsuhiko Kameda ◽  
Yurina Koizumi ◽  
Akira Yamamoto
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Transarterial Chemoembolization ◽  
Tumor Invasion ◽  
Endoscopic Sphincterotomy ◽  
Biliary Obstruction ◽  
Intraductal Tumor ◽  
Bile Duct Invasion ◽  
The Common

AbstractHepatocellular carcinoma (HCC) with bile duct invasion is considered rare. A case in which a fragment of intraductal tumor dropped into the common bile duct after transarterial chemoembolization (TACE) and caused abdominal pain, and obstructive jaundice secondary to biliary obstruction is presented. This case was successfully managed by emergent endoscopic sphincterotomy. Physicians should recognize one of the complications due to TACE for HCC with intraductal tumor invasion.

scholarly journals Evaluation of extra capsular lymph node involvement in patients with extra-hepatic bile duct cancer

2012 ◽  
Vol 10 (1) ◽  
Author(s):  
Takehiro Noji ◽  
Masaki Miyamoto ◽  
Kanako C Kubota ◽  
Toshiya Shinohara ◽  
Yoshiyasu Ambo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Bile Duct ◽  
Bile Duct Cancer ◽  
Lymph Node Involvement ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Node Involvement ◽  
Duct Cancer

scholarly journals A rare cause of biliary obstruction – intraductal neuroendocrine tumor of the right hepatic biliary duct: a case report

2020 ◽  
Author(s):  
Mirela Danila ◽  
Roxana Sirli ◽  
Alina Popescu ◽  
Nicoleta Iacob ◽  
Ana-Maria Ghiuchici
Keyword(s):  
Neuroendocrine Tumors ◽  
Biliary Obstruction ◽  
Ultrasound Examination ◽  
Hepatic Duct ◽  
Biliary Duct ◽  
Presumptive Diagnosis ◽  
Additional Imaging ◽  
Biliary Ducts ◽  
Well Differentiated ◽  
The Right

Primary biliary tract neuroendocrine tumors (NETs) are extremely rare tumors that account for 0.2-2% of all gastrointestinal neuroendocrine tumors. The typical presentation is with jaundice and other symptoms related to biliary obstruction.We present a case of right hepatic duct NET in a 27-year-old female patient, asymptomatic, presented for a routine ultrasound examination that revealed moderate dilatation of the intrahepatic biliary ducts and a 20 mm hyperechoic lesion in the right hepatic biliary duct. Additional imaging was performed with the presumptive diagnosis of cholangiocarcinoma. After surgery, the histopathological and immunohistochemical report was conclusive for the diagnosis of G2 well-differentiated NET

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