scholarly journals Expanded polytetrafluoroethylene in canine bile duct injury: a critical analysis

2011 ◽  
Vol 26 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Alberto Schanaider ◽  
Vera Lucia Nunes Pannain ◽  
Lucas Cristo Conilho Macedo Müller ◽  
Maria Cristina Araújo Maya
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tree ◽  
Surrounding Tissue ◽  
Biliary Duct ◽  
Expanded Polytetrafluoroethylene ◽  
Microscopic Evaluation ◽  
Feasible Option ◽  
The Common ◽  
Group 2

PURPOSE: Analyze the morphological and structural outcomes of a patch of expanded polytetrafluoroethylene in the treatment of an iatrogenic injury of the common bile duct. METHODS: In Group 1 (Sham), 7 dogs underwent 3 laparotomies with intervals of 30 days between them. In Group 2, 10 dogs underwent transient common bile duct obstruction. After 30 days, this biliary occlusion was undone and a patch of expanded polytetrafluoroethylene replaced a fragment removed from the duct's wall. Thirty days after this last surgery, cholangiographic assessment of prosthesis patency and macro and microscopic evaluation of the biliary tract were performed. Daily clinical inspection completed the study outcomes. The Wilcoxon non-parametric test was used for statistical analysis. RESULTS: In all dogs enlargement of the biliary tree diameter was observed 30 and 60 days after the first surgical procedure. Partial adhesion of the patch to the common bile duct as a free luminal foreign body was found in 6 dogs. The prosthesis was completely integrated to surrounding tissue in the remaining four. CONCLUSION: Although a feasible option for the treatment of biliary duct iatrogenic lesions, the expanded polytetrafluoroethylene prosthesis must be used with caution considering the potential risks for complications.

scholarly journals Common bile duct obstruction caused by a helminth in a cat in the UK: ultrasonographic findings, histopathology and outcome

2021 ◽  
Vol 7 (1) ◽  
pp. 205511692098439
Author(s):  
Francesca Venier ◽  
Krizia Compagnone ◽  
Annette Kerins ◽  
Chantal Rosa
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Treatment Decision ◽  
Linear Structure ◽  
Biliary Tree ◽  
Biliary Duct ◽  
Duodenal Papilla ◽  
Duct Obstruction ◽  
The Common ◽  
The Uk

Case summary An 11-year-old neutered female domestic shorthair cat presented to our hospital with a 5-day history of vomiting, lethargy, anorexia and hyperbilirubinaemia, despite intravenous fluid therapy, gastroprotectants and antibiotic treatment. An abdominal ultrasound revealed a markedly distended common bile duct (diameter 6.2 mm). The cystic duct and intrahepatic bile ducts were also dilated. A linear structure formed by two parallel hyperechoic lines was identified in the common bile duct and could be traced to the duodenal papilla. The cat underwent laparotomy for surgical decompression of the biliary tree. A tubular, brown-coloured structure was retrieved from the common bile duct. Histological examination was consistent with a degenerate helminth. The cat recovered uneventfully from the surgery and its demeanour and appetite improved rapidly over the following days. Liver and gallbladder wall histopathology was consistent with bacterial cholangitis and cholecystitis. Escherichia coli was cultured from both bile and liver parenchyma. Relevance and novel information To our knowledge, this is the first reported case of extrahepatic biliary duct obstruction caused by a helminth in a cat in the UK. We hypothesised that the obstruction had been caused by the aberrant migration of an intestinal nematode that became lodged in the duodenal papilla. Ultrasound allowed prompt diagnosis and guided the treatment decision.

scholarly journals Endoscopic Fistulotomy – ‘The Suprapapillary Punch’: A Method of Access to the Bile Duct during ERCP

1994 ◽  
Vol 8 (1) ◽  
pp. 33-35
Author(s):  
Noel B Hershfield
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Tree ◽  
Usual Method ◽  
Endoscopic Retrograde ◽  
The Common ◽  
A Minor ◽  
Endoscopic Fistulotomy

Endoscopic retrograde cholangiopancreatography (ERCP) is established as the method of choice to investigate the biliary tree when obstruction is suspected. On rare occasions, the papilla cannot be entered because of anatomical or pathological abnormalities. This report describes endoscopic fistulotomy or the suprapapillary punch that has been carried out at the Foothills Hospital in Calgary, Alberta, on 30 of 623 patients referred for ERCP for conditions causing obstruction of the common bile duct or suspected obstruction of the common bile duct. The following communication also describes the method of suprapapillary punch or endoscopic fistulotomy. Results have been excellent with only one complication, a minor attack of pancreatitis after the procedure. In summary, the suprapapillary punch or fistulotomy is a safe and useful method for entering the common bile duct when access by the usual method is impossible.

scholarly journals Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

2019 ◽  
Vol 9 ◽  
pp. 23
Author(s):  
Giulia Frauenfelder ◽  
Annamaria Maraziti ◽  
Vincenzo Ciccone ◽  
Giuliano Maraziti ◽  
Oliviero Caleo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Abdominal Pain ◽  
Imaging Modality ◽  
Biliary Duct ◽  
History Of ◽  
The Common ◽  
Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

scholarly journals Laparoscopic exploration of bile ducts in patients with calculosis. indications, methods and first results

Folia Medica ◽  
2013 ◽  
Vol 55 (3-4) ◽  
pp. 33-38 ◽  
Author(s):  
Rosen S. Dimov ◽  
Rangel I. Kantchev ◽  
Boris G. Boev ◽  
Todor I. Ivanov ◽  
Ilia A. Apostolov ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Stone ◽  
Sphincter Of Oddi ◽  
Biliary Tree ◽  
Stone Extraction ◽  
Average Hospital ◽  
Laparoscopic Exploration ◽  
Ultrasound Study ◽  
The Common

ABSTRACT INTRODUCTION: In the last few years there has been a resurgence of laparoscopic exploration of the common bile duct as an alternative to endoscopic retrograde cholangiopancreatography (ERCP), the primary method for diagnosis and treatment of biliary tract calculosis. AIM: The aim of this study was to clarify the indications and methods for performing laparoscopic bile duct exploration, based on our experience in the field and data from the literature. PATIENTS AND METHODS: We recruited 12 patients who underwent laparoscopic exploration and stone extraction from the common bile duct (CBD) in the surgical ward of Kaspela Hospital, Plovdiv over the period January 2011 to January 2012. The diagnostic and therapeutic modalities used in the study included laboratory tests, ultrasound study, CT, ERCP, digital cholangiography, clamp and balloon stone extraction, primary suture and choledochoduodenostomy. RESULTS: Stone extraction was successfully performed in 8 patients using the transcystic approach through an incision used in the cholangiography. The procedure failed in the remaining four patients and we used here 2-cm longitudinal choledochotomy. In two patients the control cholangiography following the extraction of stones demonstrated complete clearance of the biliary tree and free passage of contrast agent from bile duct to duodenum (patent ampulla of Vater). In these two patients we performed a primary closure of the choledochotomy with a single interrupted suture (“ideal choledochotomy”). In two patients from the choledochotomy group, the control cholangiography showed the presence of residual stones or fragments trapped above the sphincter of Oddi with no contrast medium in the duodenum. In these cases we completed this procedure with latero-lateral choledochoduodenostomy by Flërken. All patients had a smooth postoperative course with no recorded complications. The average hospital stay was 5 days. CONCLUSIONS: Laparoscopic exploration of the biliary ducts in calculosis is an efficient, safe and reliable method to manage this serious complication of gall-stone disease in the hands of an experienced laparoscopic surgeon. The results of its application are comparable and in some cases even better than those of ERCP used as a therapeutic procedure as regards clearance of the CBD and the complications involved in these two procedures.

Permeability of the rat biliary tree to ursodeoxycholic acid

1989 ◽  
Vol 256 (4) ◽  
pp. G653-G660
Author(s):  
O. Farges ◽  
M. Corbic ◽  
M. Dumont ◽  
M. Maurice ◽  
S. Erlinger
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Ursodeoxycholic Acid ◽  
Hepatic Duct ◽  
Biliary Tree ◽  
Left Hepatic Duct ◽  
Biliary Epithelium ◽  
Isolated Segment ◽  
The Common

The permeability of the biliary epithelium to [14C]ursodeoxycholic acid (UDCA), a hypercholeretic bile acid, was compared to that of the 14C-labeled nonhypercholeretic bile acids cholic acid (CA), taurocholic acid (TCA), and tauroursodeoxycholic acid (TUDCA) by means of anterograde intrabiliary infusions and retrograde intrabiliary injections in the anesthetized rat. Anterograde intrabiliary infusions were performed by perfusing an isolated segment of common bile duct in vivo. After anterograde intrabiliary infusions, the fraction of unrecovered UDCA (that had presumably been absorbed from the biliary lumen) was 11.03 +/- 1.03 (SE)% (n = 6) of the administered dose. It was significantly higher than that of TUDCA (1.25 +/- 0.27%; n = 5; P less than 0.01), CA (2.62 +/- 0.43%; n = 4; P less than 0.01), and TCA (2.57 +/- 0.79%; n = 6; P less than 0.01). In separate experiments, bile was collected from the common bile duct and from the left hepatic duct. UDCA recovered from the left hepatic duct was found in the conjugated form, indicating that, after absorption in the common bile duct, it had been conjugated by the hepatocyte and secreted into bile. After retrograde intrabiliary injections of UDCA and CA, the cumulative percentages of recovered radioactivity were not significantly different (84.50 +/- 2.65 and 87.33 +/- 1.80%, respectively); however, peak recovery of UDCA was significantly delayed compared with that of CA. Moreover, UDCA was recovered mostly in the conjugated form, while CA was recovered mostly in the unconjugated form. These results suggest that, in the rat, UDCA is significantly more absorbed by the biliary tree than CA, TUDCA, and TCA. They support the hypothesis that UDCA undergoes a cholehepatic circulation.

scholarly journals Successful Surgical Treatment of Hepatocellular Carcinoma Invading Into Biliary Tree

HPB Surgery ◽  
1991 ◽  
Vol 4 (3) ◽  
pp. 237-244 ◽  
Author(s):  
Kazuo Tanoue ◽  
Takashi Kanematsu ◽  
Takashi Matsumata ◽  
Ken Shirabe ◽  
Keizo Sugimachi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Single Case ◽  
Intrahepatic Bile Duct ◽  
Biliary Tree ◽  
Large Mass ◽  
Primary Hepatocellular Carcinoma ◽  
The Common

A 41-year-old woman was admitted to hospital with obstructive jaundice. Computed tomography showed a large mass in the right hepatic lobe and marked dilatation of the biliary tree in the left lateral segment of the liver. Angiography showed evidence of neovascularity. Percutaneous transhepatic cholangiography revealed complete obstruction of the common bile duct just below the bifurcation. The serum level of alpha-fetoprotein on admission was 1,080,000 ng/ml. These findings suggested to us a primary hepatocellular carcinoma invading the intrahepatic bile duct. Extended right lobectomy and hepaticojejunostomy for bile drainage was carried out. The patient is doing well 3 years after surgery.Hepatocellular carcinoma (HCC) invading to the portal vein is not so rare, but invasion into the bile duct is much less common. In 1947, Mallory1 described a single case of HCC invading the gallbladder and obstructing extrahepatic bile ducts. In 1975, Lin2 termed this HCC “Icteric type hepatoma”. The incidence of such HCC in Japan was reported to be 1.9-9%2,3.Obstructive jaundice is a clinical manifestation of the terminal stage in HCC. We describe here our treatment of a woman with HCC invading the common bile duct. Right extended lobectomy and reconstruction of hepaticojejunostomy were effective.

scholarly journals Non-Operative Management of a Common Bile Duct Injury Sustained During Cholecystectomy in a Morbidly Obese Patient. (Non-Operative Repair of CBD Injury)

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Boyd C. Ashdown ◽  
Paul V. Suhocki ◽  
Paul S. Jowell ◽  
William C. Meyers
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obese Patient ◽  
Normal Liver ◽  
Biliary Tree ◽  
Liver Function Tests ◽  
Biliary Duct ◽  
Morbidly Obese ◽  
Morbidly Obese Patient ◽  
Increased Risk

A 29 year old morbidly obese patient suffered injury to his common bile duct during cholecystectomy. Subsequent access to the biliary tree was obtained by using a long heavy gauge needle after first opacifying the system with contrast injection through a nasobiliary tube. It is now twenty six months after initial percutaneous biliary drainage placement and eighteen months after removal of all biliary access. The patient is asymptomatic and has normal liver function tests. This technique can be useful in morbidly obese patients who are at increased risk from surgical repair of biliary duct injuries.

scholarly journals Right Posterior Segmental Hepatic Duct: Role of Intraoperative Cholangiogram to Prevent Extrahepatic Biliary Duct Injuries

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Ikhwan SM ◽  
Hairol O ◽  
Razman J ◽  
Zamri Z ◽  
Affirul C
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Duct ◽  
Biliary Tree ◽  
Common Bile Duct Exploration ◽  
Biliary Duct ◽  
Anatomic Site ◽  
Distal Common Bile Duct ◽  
Intraoperative Cholangiogram ◽  
Bile Duct Injuries

Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct exploration. The operation was successful without incidence of biliary duct injury.

scholarly journals Ultrasonographic and clinicopathologic features of segmental dilatations of the common bile duct in four cats

2017 ◽  
Vol 3 (1) ◽  
pp. 205511691771688
Author(s):  
Heather N Spain ◽  
Dominique G Penninck ◽  
Cynthia RL Webster ◽  
Evence Daure ◽  
Samuel H Jennings
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Surgical Intervention ◽  
Case Series ◽  
Biliary Duct ◽  
High Morbidity ◽  
Clinicopathologic Features ◽  
Debris Accumulation ◽  
Maximal Diameter ◽  
The Common

Case series summary This case series documents ultrasonographic and clinicopathologic features of four cats with marked segmental dilatations of the common bile duct (CBD). All cats had additional ultrasonographic changes to the hepatobiliary system, including hepatomegaly, tubular to saccular intra/extrahepatic biliary duct dilatation and biliary debris accumulation. Based on all available data the presence of extrahepatic biliary duct obstruction (EHBDO) was ruled out in 3/4 cases and was equivocal in one case. One cat underwent re-routing surgery to address the CBD dilatation after multiple recurrent infections, one cat was euthanized and had a post-mortem examination and two cats were medically managed with antibiotics, liver protectants, gastroprotectants and cholerectics. Relevance and novel information The ultrasonographic features of the CBD in this population of cats were supportive of choledochal cysts (CCs). The maximal diameter of the CBD dilatations exceeded 5 mm in all cases, a sign that has been previously reported to be consistent with EHBDO. In our study, dilatations were segmental rather than diffuse. Given the high morbidity and mortality associated with hepatobiliary surgery in cats, segmental dilatation of the CBD should not prompt emergency surgery. Some cats may respond to medical management. Careful planning for cyst resection was beneficial in one cat. Evaluation of CC morphology (eg, size, location, concurrent intrahepatic anomalies) may assist in selecting cats that could benefit from surgical intervention.

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