scholarly journals Migration of non-absorbable polymer clips in hepato-biliary-pancreatic surgery: a report of four cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yukari Kihara ◽  
Yutaka Takeda ◽  
Yoshiaki Ohmura ◽  
Yoshiteru Katsura ◽  
Go Shinke ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Bile Duct ◽  
Pancreatic Surgery ◽  
Epigastric Pain ◽  
Intrahepatic Bile Duct ◽  
Duodenal Bulb ◽  
Upper Gastrointestinal Endoscopy ◽  
Duct Cyst ◽  
Bile Duct Stenosis

Abstract Background Ligation clips are used for vessel or tissue ligation in surgery. Although previous reports have described the migration of metallic clips after hepato-biliary-pancreatic surgery, very few reports have described the migration of non-absorbable polymer clips (NAPCs: Hem-o-Lok). Case presentation We present 4 cases of NAPC migration that occurred after laparoscopic surgery. Case 1 was an 81-year-old woman that had undergone a laparoscopic right hemihepatectomy for an intrahepatic bile duct cyst adenocarcinoma at the age of 79 years. Two years after the operation, she underwent an upper gastrointestinal endoscopy to investigate epigastric pain. The endoscopy showed NAPCs lodged at the anterior side of the duodenal bulb. Case 2 was an 80-year-old man that had undergone a laparoscopic cholecystectomy for choledocholithiasis at the age of 77 years. Three years after the operation, follow-up computed tomography and magnetic resonance cholangiopancreatography (MRCP) imaging indicated a mass in the upper bile duct. After a laparoscopic bile duct resection and reconstruction, an NAPC was found inside the inflammatory pseudotumor. Case 3 was a 63-year-old man that had undergone laparoscopic liver S4b and S5 resections and lymph node dissection for gallbladder cancer. Three months after the operation, follow-up MRCP imaging suggested a bile duct stenosis. An endoscopic retrograde cholangiopancreatography (ERCP) was performed, and an NAPC was found inside the bile duct. Case 4 was a 74-year-old man that had undergone a laparoscopic S5 segmentectomy, S7 partial liver resection, and cholecystectomy for liver metastasis of lung cancer and cholelithiasis. A trans-cystic drainage tube was inserted, and it was ligated and fixed with NAPCs. Three months after the operation, follow-up MRCP imaging showed common bile duct stones (CBDS). An ERCP was performed, and two NAPCs were found with the CBDS. Conclusions Few previous reports have described complications due to NAPC migration after hepato-biliary-pancreatic surgery. However, with the widespread use of NAPC, postoperative complications due to NAPC migration are expected to increase in the near future. The differential diagnosis of complications should include potential NAPC migration in patients that have undergone laparoscopic surgery.

HEPATOLITIASIS IZQUIERDA MANEJADA CON HEPATECTOMÍA: REPORTE DE UN CASO

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Estefanía Roldán Vásquez ◽  
Xavier Jarrín Estupiñan ◽  
Oswaldo Vásconez Hatt ◽  
Frans Serpa Larrea ◽  
Juan Roldán Crespo
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Liver Function Tests ◽  
Histopathological Study ◽  
Left Hepatectomy ◽  
Factors Associated ◽  
Altered Liver ◽  
Positive Evolution ◽  
Radiological Studies

Hepatolithiasis is a bile duct disorder characterized by the presence of stones in the intrahepatic bile ducts1. There are several risk factors associated with this pathology, but its most feared complication is the development of cholangiocarcinoma2. In Ecuador there is not published literature regarding the management and prognosis of this pathology. A 50-year-old male patient with a picture of abdominal pain in the epigastrium, accompanied by hyporexia and nausea, without relevant findings on the physical exam. Altered liver function tests and raised tumor markers were found, in addition, radiological studies showed dilation of the intrahepatic bile duct, with bile stones inside. A left hepatectomy was performed, and subsequently the histopathological study demonstrated suggestive dysplasia changes in the intrahepatic ducts. Patient is discharged with a positive evolution and is referred to clinic for further follow up. To sum up, hepatolithiasis is a condition that should promptly be treated to avoid the development of a cholangiocarcinoma, which could put in risk the patient’s life.

Massive left lobe primary hepatolithiasis with extremely high CA 19.9

2013 ◽  
Vol 19 (S4) ◽  
pp. 37-38
Author(s):  
A. Murinello ◽  
P. Guedes ◽  
A.M. Carvalho ◽  
J.S. Coelho ◽  
B.B. Leite ◽  
...  
Keyword(s):  
Bile Duct ◽  
Epigastric Pain ◽  
Acute Cholangitis ◽  
Intrahepatic Bile Duct ◽  
Left Lobe ◽  
Left Hepatectomy ◽  
Caroli Disease ◽  
Acute Calculous Cholecystitis ◽  
Ultrasound Study ◽  
Calculous Cholecystitis

Hepatolithiasis (HL) or intrahepatic calculi is an uncommon condition in Western countries, with a prevalence under 1%. It is much more frequent in East Asia, reaching 20% in China and Taiwan, up to 50% of which show associated cholelithiasis. The authors report a European patient with primary HL of the left hepatic lobe, 12 years after cholecystectomy for acute calculous cholecystitis, now successfully treated after left lobe hepatectomy.A 63-year-old caucasian man with a past medical history of hypertension, coronary artery disease, dyslipidaemia and urgent cholecystectomy 12 years ago (due to an acute calculous cholecystitis without ultrasonographic or perioperative evidence of bile duct dilation or choledocholithiasis, and with no cholangitis ever since) was now admitted to our ward following a 2-day course of fever (39ºC), epigastric pain, nausea, vomiting and tender right upper abdominal quadrant.Bloodwork showed mild leukocytosis with neutrophilia and low platelets; elevated C-reactive protein, γGT, alkaline phosphatase and LDH; normal AST, ALT, bilirubin and amylase. Negative HBV, HCV and HIV serologies. CA19.9 was notably high (7500 U/mL), 200x above normal range (N≤37). A diagnosis of acute cholangitis was assumed on clinical and laboratory basis, despite the absence of jaundice. The patient began therapy with iv ceftriaxone and improved clearly over the next few days. Raised CA19.9 in the setting of acute cholangitis, however, forced us into further study directed at the possibility of underlying biliary or pancreatic malignancy.Abdominal ultrasound disclosed multiple calcifications in the left lobe. CT displayed several left lobe intrahepatic bile duct dilations but no calcifications, thus suggesting intrahepatic cholesterol stones and cholangitis due to an obstacle before the hilum. MR-cholangiography was performed, showing marked dilation of the left intrahepatic bile duct and moderate dilation in the extrahepatic portion of the common bile duct (CBD). Neither exam showed any sign of cancer. Surgery was the therapeutic approach, and the patient underwent a left hepatectomy.Intra-operative ultrasound study unveiled severe dilation of the left intrahepatic bile duct, which was filled with gallstones, but no choledocholithiasis and no tumour whatsoever. Both the surgical procedure and the post-operative period were uneventful.Macroscopic liver section showed multiple dilated bile ductules containing fragile yellowish-green gallstones (Fig.1). Microscopy revealed cystic dilations of the left intrahepatic biliary tree packed with intraluminal gallstones (Fig.2), fibrosis and moderate chronic inflammatory infiltrate with lymphoid aggregates (Fig.3). Some areas of the epithelium displayed erosion and reactive changes. No biliary neoplasm was found.Immunocytochemistry for angiogenesis or lymphocyte membrane markers are not available in our Hospital. Soon after surgery, CA19.9 values decreased abruptly and just 4 months after the left hepatectomy they were back within reference range.Our working hypotheses were primary hepatolithiasis (HL), secondary HL and Caroli disease.Secondary HL, due to stone migration from the CBD, was discarded because calculi in the CBD were absent in the cholecystectomy 12 years ago and in ultrasonographic studies both then and now. Caroli disease, a congenital condition characterised by intrahepatic bile duct dilation, was contradicted by the ultrasonography in 2000 showing normal bile duct dimension. Excluding these two entities made primary idiopathic HL our final diagnosis.The patient is now asymptomatic, having returned to his normal life with no limitations.This report showcases a rare entity known as primary hepatolithiasis, usually causing recurrent cholangitis in older patients of Asian descent but seldom seen in Europe. The steep increase in CA19.9 related to cholangitis, although previously reported, is also very uncommon. Another interesting aspect is the conspicuous inexistence, over 12 years, of recurrent episodes of acute cholangitis (a traditional finding in hepatolithiasis). These three features help to compose this most peculiar case.

scholarly journals Surgical methods of treatment for cholecystolithiasis combined with choledocholithiasis: six years’ experience of a single institution

2021 ◽  
Author(s):  
Tong Guo ◽  
Lu Wang ◽  
Peng Xie ◽  
Zhiwei Zhang ◽  
Xiaorui Huang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Intrahepatic Bile Duct ◽  
Common Bile Duct Exploration ◽  
T Tube ◽  
Extubation Time ◽  
Surgical Methods ◽  
Clinical Records

Abstract Introduction The optimal treatment of choledocholithiasis combined with cholecystolithiasis remains controversial. Common surgical methods vary among endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC), laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic transductal common bile duct exploration (LCBDE) with or without T-tube drainage. The purpose of this study is to evaluate the safety and effectiveness of surgical methods and to determine the appropriate procedure for patients with cholecystolithiasis combined with choledocholithiasis. Methods From January 2013 to January 2019, a total of 1555 consecutive patients diagnosed with cholecystolithiasis combined with choledocholithiasis who underwent surgical treatment in Tongji Hospital were retrospectively analyzed. Total 521 patients with intrahepatic bile duct stones underwent LC + LCBDE + T-Tube were excluded from the analysis. At last, 1034 patients who met the inclusion criteria were divided into three groups according to their surgical methods: preoperative ERCP + subsequent LC (ERCP + LC group, n = 275), LC + LCBDE + intraoperative endoscopic nasobiliary drainage (ENBD) + primary duct closure (Tri-scope group, n = 479) and LC + laparoscopic transcystic CBD exploration (LTCBDE group, n = 280). Clinical records, operative findings and postoperative follow-up were collected and analyzed. Results There was no mortality in three groups. Common bile duct (CBD) stone clearance rate was 97.5% in ERCP + LC group, 98.7% in Tri-scope group, and 99.3% in LTCBDE group. There were no difference in terms of demographic characteristics, biochemistry findings and presentations, but the Tri-scope group had the biggest diameter and amount of stones and diameter of CBD, the LTCBDE group had the least CBD stones and the biggest diameter of cystic gall duct (CGD). ERCP + LC group have the longest hospital stay (14.16 ± 3.88 days vs 6.92 ± 1.71 days vs 10.74 ± 5.30 days, P < 0.05), also has the longest operative time than others (126.08 ± 42.79 min vs 92.31 ± 10.26 min, 99.09 ± 8.46 min, P < 0.05). Compared to ERCP + LC group, LTCBDE group and Tri-scope group had lower postoperation-leukocyte, shorter surgery duration and hospital stay (P < 0.05). Compared to the Tri-scope group, the LTCBDE group had the shorter hospital stay, extubation time and operation time and less intraoperative bleeding. There were less postoperative complications in LTCBDE group (1.1%) compared to the ERCP + LC group (3.6%) and Tri-scope group (2.2%). Follow-up time was 6 to 72 months. Four patients in ERCP + LC group and 5 in Tri-scope group reported recurrent stones. Conclusion All the three surgical methods are safe and effective. Tri-scope approach and LTCBDE approach have superiority to preoperative ERCP + LC. LC + LTCBDE shows priority over Tri-scope approach, but should be performed in selected patients. LC + LCBDE + T-Tube can be an alternative management if the other three procedures were failed. The surgeons should choose the most appropriate surgical procedure according to the preoperative examination results and intraoperative situation.

scholarly journals A Proposed Algorithm for Endoscopic Ultrasound-Guided Rendezvous Technique in Failed Biliary Cannulation

2020 ◽  
Vol 9 (12) ◽  
pp. 3879
Author(s):  
Saburo Matsubara ◽  
Keito Nakagawa ◽  
Kentaro Suda ◽  
Takeshi Otsuka ◽  
Hiroyuki Isayama ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Ultrasound ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Duodenal Bulb ◽  
Ultrasound Guided ◽  
Biliary Cannulation ◽  
Rendezvous Technique ◽  
Selection Of ◽  
Approach Route

Background: The selection of an approach route in endoscopic ultrasound-guided rendezvous (EUS-RV) for failed biliary cannulation is complicated. We proposed an algorithm for EUS-RV. Methods: We retrospectively evaluated consecutive EUS-RV cases between April 2017 and July 2020. Puncturing the distal extrahepatic bile duct (EHBD) from the duodenal second part (D2) (DEHBD/D2 route) was attempted first. If necessary, puncturing the proximal EHBD from the duodenal bulb (D1) (PEHBD/D1 route), puncturing the left intrahepatic bile duct (IHBD) from the stomach (LIHBD/S route), or puncturing the right IHBD from the D1 (RIHBD/D1 route) were attempted in this order. Results: A total of 16 patients were included. The DEHBD/D2 route was used in 10 (62.5%) patients. The PEHBD/D1 route was attempted in five (31.3%) patients, and the biliary puncture failed in one patient in whom the RIHBD/D1 route was used because of tumor invasion to the left hepatic lobe. The LIHBD/S route was applied in one (6.3%) patient. Successful biliary cannulation was achieved in all patients eventually. The time from the puncture to the guidewire placement in the DEHBD/D2 route (3.5 min) was shorter than that in other methods (14.0 min) (p = 0.014). Adverse events occurred in one (6.3%) patient with moderate pancreatitis. Conclusions: The proposed algorithm might be useful for the selection of an appropriate approach route in EUS-RV.

scholarly journals Ligation assisted endoscopic mucosal resection of neuroendocrine tumor of duodenal bulb: a case report with a follow up of 24 months

2019 ◽  
Vol 8 (1) ◽  
pp. 18-20
Author(s):  
Umid Kumar Shestha ◽  
Gopi Aryal
Keyword(s):  
Neuroendocrine Tumor ◽  
Distant Metastasis ◽  
Gastrointestinal Endoscopy ◽  
Duodenal Bulb ◽  
Upper Gastrointestinal Endoscopy ◽  
Solitary Lesion ◽  
Free Margin ◽  
Mucosal Resection ◽  
Upper Gastrointestinal

Duodenal neuroendocrine tumor (NET) is a rare solitary lesion arising from the mucosa and submucosa of the duodenum, which is found incidentally during upper gastrointestinal endoscopy. Eendoscopic Mucosal Resection (EMR) has been the commonly used endoscopic procedure for duodenal carcinoid tumors, but the conventional EMR done to resect duodenal NET s is likely to have positive vertical margins. However, the ligation assisted EMR has recently been shown to be a promising technique for the treatment of duodenal NET that can have a negative free margin. In our study, we present a patient of 51-year-old male, who presented with pain over epigastrium and upper gastrointestinal endoscopy revealed a small submucosal lesion of 10 mm in the duodenal bulb. The endoscopic ultrasound showed the lesion arising from the echo layer three. The biopsy was taken which showed the duodenal NET. The computed tomography of abdomen did not show any evidence of distant metastasis. The EMR of duodenal NET was done by band ligation technique. The biopsy from the resected duodenal lesion confirmed the duodenal NET with the margin free of the tumor. The patient was followed at 6, 12, 18 and 24 months. During the follow up visits, the repeat upper gastrointestinal endoscopy did not show recurrence of the lesion and there was no any evidence of distant metastasis either. Ligation assisted EMR is an acceptable treatment in the hands of expert for small duodenal NET without the evidence of metastasis and can ensure the complete removal of the lesion with vertical free margin.

scholarly journals Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

2020 ◽  
Vol 08 (06) ◽  
pp. E733-E737 ◽  
Author(s):  
Takeshi Ogura ◽  
Nobu Nishioka ◽  
Masanori Yamada ◽  
Tadahiro Yamada ◽  
Saori Ueno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
The Novel ◽  
Technical Success ◽  
Long Term Follow Up ◽  
Secondary Endpoints ◽  
Patient Refusal ◽  
A Prospective Study

Abstract Background and study aims A novel fine-gauge electrocautery dilator (ED) has recently become available in Japan. The current study evaluated the safety and feasibility of transluminal antegrade dilation for hepaticojejunal stricture (HJS) using this novel ED. Patients and methods Patients who with complicated HJS were retrospectively enrolled. The primary and secondary endpoints of this study were rates of technical success defined as functional antegrade HJS dilation using the novel ED and types of adverse events, respectively. A total of 22 patients were enrolled. Among them, six were treated using an enteroscopic approach due to the absence of bile duct dilation or patient refusal to undergo EUS-HGS. Therefore, 16 patients underwent EUS-HGS. Results The procedure was successful in 15 of 16 patients (93.8 %). The contrast medium flowed from the intrahepatic bile duct to the intestine of 14 of 15 patients (93.3 %). The resolution rate of HJS was 13 of 14 (92.9 %) at 6 months. Conclusion Our technique might offer a new option with which to treat HJS, although a prospective study with long-term follow-up is needed.

scholarly journals En Bloc Endoscopic Resection of Large Pedunculated Brunner’s Gland Hamartoma: A Case Report

2018 ◽  
Vol 12 (2) ◽  
pp. 344-351
Author(s):  
Annalisa Pasetti ◽  
Elvira Capoferro ◽  
Giulia Querzoli ◽  
Renzo Montanari ◽  
Paolo Bocus
Keyword(s):  
Endoscopic Resection ◽  
Epigastric Pain ◽  
Duodenal Bulb ◽  
Anterior Wall ◽  
Upper Gastrointestinal Endoscopy ◽  
En Bloc ◽  
Brunner’S Gland ◽  
Brunner's Gland ◽  
Brunner’S Gland Hamartoma ◽  
Submucosal Lesion

Brunner’s gland hamartoma (BGH) is an uncommon benign tumor arising from alkaline-based mucin-secreting glands of the duodenum. These lesions are typically discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics, even though they can eventually lead (in the case of increasing size) to obstructive or hemorrhagic symptoms. We report the case of a 67-year-old Caucasian man with two episodes of melena and epigastric pain during the last month. Esophagogastroduodenoscopy revealed a large pedunculated and eroded polyp inside the antrum with a 2-cm-long stalk arising from the anterior wall of the duodenal bulb. Endoscopic ultrasonography showed a submucosal lesion with homogeneous hyperechoic parietal thickening and some central gaps. The muscularis was undamaged. No lymphadenopathy was observed. We performed an en bloc endoscopic resection of the polyp. The size of the whole piece was approximately 6 × 3 × 2 cm, pseudocapsulated and tough in consistency. In the case presented, the en bloc endoscopic removal was successful despite the size of the tumor.

Solitary intrahepatic bile-duct cyst presenting with jaundice

1989 ◽  
Vol 25 (4) ◽  
pp. 569
Author(s):  
J M Park ◽  
K S Chun ◽  
H K Ha ◽  
K S Shinn ◽  
Y W Bahk ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Duct Cyst ◽  
Bile Duct Cyst
Sign in / Sign up

Export Citation Format

Share Document