Photodynamic therapy of extrahepatic cholangiocarcinoma using digital cholangioscopy

ABSTRACT Background: Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction. Aim: To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source. Method: Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events. Result: This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session. Conclusion: Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.

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Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

Anatomy Research International ◽

10.1155/2015/412595 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Usha Dandekar ◽

Kundankumar Dandekar ◽

Sushama Chavan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Normal Anatomy ◽

Surgical Safety ◽

Right Hepatic Artery ◽

The Common ◽

The Right

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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Mirizzi Syndrome with Cholecystobiliary Fistula: Observation of Development from Asymptomatic Cholecystolithiasis to Surgery

Case Reports in Radiology ◽

10.1155/2020/2049525 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Hiroyuki Sugo ◽

Yuuki Sekine ◽

Naoki Iwanaga ◽

Shigefumi Neshime ◽

Michio Machida

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

Filling Defect ◽

Mirizzi Syndrome ◽

Common Hepatic Duct ◽

Gallbladder Stone ◽

Quadrant Pain ◽

Abdominal Ct ◽

The Common

Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.

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Proteins of guinea-pig bile: selective resorption in the gall bladder

Bioscience Reports ◽

10.1007/bf01122904 ◽

1983 ◽

Vol 3 (4) ◽

pp. 389-394 ◽

Cited By ~ 9

Author(s):

W. Garry John ◽

Barbara M. Mullock ◽

Richard H. Hinton

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Gall Bladder ◽

Guinea Pig ◽

Hepatic Duct ◽

Immunoglobulin A ◽

Protein Composition ◽

Detailed Examination ◽

Common Hepatic Duct ◽

The Common

We have examined and compared the proteins present in guinea-pig bile as collected either from the common hepatic duct or from the gall bladder. Guinea-pig bile, collected from the common bile duct, has a rather low concentration of protein. Detailed examination shows that the concentrations of actively transported proteins such as immunoglobulin A and haptoglobin haemoglobin complexes are markedly lower than in rats although the concentrations of proteins which, like albumin, leak non-specifically into bile are similar in the two species. We also find that the protein composition of guinea-pig bile is extensively and selectively modified by resorp-tion of protein in the gall bladder.

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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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Biliary exploration via the left hepatic duct orifice versus the common bile duct in left-sided hepatolithiasis patients with a history of biliary tract surgery

Medicine ◽

10.1097/md.0000000000009643 ◽

2018 ◽

Vol 97 (3) ◽

pp. e9643 ◽

Cited By ~ 2

Author(s):

Yong Zhou ◽

Wen-Zhang Zha ◽

Xu-Dong Wu ◽

Ren-Gen Fan ◽

Biao Zhang ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Biliary Tract ◽

Hepatic Duct ◽

Left Hepatic Duct ◽

Biliary Tract Surgery ◽

History Of ◽

The Common

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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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