scholarly journals FIBROCHOLODOSCOPY IN DIAGNOSTICS AND TREATMENT OF COMPLEX FORMS OF CHOLEDOCHOLITHIASIS

2019 ◽  
Vol 21 (1) ◽  
pp. 43-46
Author(s):  
K V Pavelets ◽  
A K Ushkats ◽  
D V Gacko
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Surgical Procedures ◽  
Bile Ducts ◽  
Diagnosis And Treatment ◽  
The Common ◽  
Complex Forms

Relevance of the topic: endoscopic intraoperative choledochoscopy with traditional surgical procedures is a highly informative research in the diagnosis and treatment of choledocholithiasis. Objective: to evaluate the effectiveness of intraoperative use of fibrocholedochoscopy in the diagnosis and treatment of "complex" forms of choledocholithiasis. Materials and methods: Between 2011 and 2017, 88 patients underwent treatment for "complicated" forms of choledocholithiasis using intraoperative fibrocholedochoscopy. Results: after dissection of the choledochal wall and extraction of large concrements from the lumen, a fibrocholedochoscopy was performed. The fibrocholedochoscope was inserted into the lumen of the common bile duct through a formed opening with examination of the biliary tract. An obligatory condition for assessing the permeability of the distal sections of the bile ducts was the carrying out of an endoscope through the OBD zone. The remaining remaining calculi were recovered with the help of Dormia baskets (15 (17%) cases). In 86 (97.7%) patients, the operation is completed by the imposition of a hollow stitch of choledoch (priority reference No. 2018122530, 2018). Conclusion: fibrocholedochoscopy in the treatment of complex forms of choledocholithiasis allows to methodically evaluate the biliary tract, perform lithoextraction from the proximal and distal sections.

CHOLANGITIS AS A SYSTEMIC MANIFESTATION OF ACUTE BILIARY INFECTION

2020 ◽  
pp. 43-47
Author(s):  
A. O. Nekludov ◽  
M. O. Klosova ◽  
O. V. Volchenko ◽  
M. M. Goloborodko ◽  
A. Yu. Korolevska
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Water Column ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Inflammatory Process ◽  
Acute Cholangitis ◽  
Biliary Infection ◽  
The Common ◽  
Further Development

The main causes of cholangitis are hypertension in the biliary ducts and infection. In order to determine the place of the infectious factor in the acute cholangitis development, a retrospective and prospective analysis of case histories of 176 patients with choledocholithiasis and manifestations of acute and chronic cholangitis was performed. Bile from the common bile duct in the patients with obstruction of the biliary tract was studied. In the patients with mechanical jaundice without and with cholangitis, the intraductal pressure in the common bile duct averaged 227.3±26.1 mm of water column, in the patients without signs of cholangitis that was 97.5±8.3 mm of water column. With mechanical jaundice without acute cholangitis, it was slightly elevated if compared to normal. This suggests that the increase in pressure in the bile ducts in acute cholangitis is not influenced by the fact of obstruction of the biliary tract, and the development of the inflammatory process in them. In the patients with cholangitis, the initial values of the number of colonizing units were much higher than in "pure" choledocholithiasis. After endoscopic papillosphincterotomy in the patients with vivid clinical cholangitis, in whom decompression was achieved, in the control study, this value decreased by 100−500 times, which was accompanied by clinical improvement. According to the results of the study, it was noted that in the patients with a manifested clinic sign of cholangitis there is a significant decrease in the number of colonizing units on the third day after endoscopic papillosphincterotomy. At the stone stuck in a papilla the choledoch turns into so−called analog of an abscess. The opening of the papilla provides a free passage of the contents of the choledochus (i.e. pus) into the duodenum, so there is an almost instant therapeutic effect. The increase in pressure in the bile ducts in acute cholangitis is influenced by the development of an inflammatory process, which indicates the manifestations of biliary infection. The presented research has a prospective character and needs further development. Key words: cholangitis, biliary infection, intraductal pressure, bile.

Gallstones and Biliary Tract Emergencies

2020 ◽  
Author(s):  
Luis F. Lobon ◽  
Michael Billington
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Gallbladder Disease ◽  
Diagnosis And Treatment ◽  
Hepatic Bile ◽  
Ascending Cholangitis

Patients with diseases of the biliary tract (which includes the hepatic bili canaliculi, hepatic bile ducts, common bile duct, and gallbladder) typically present with symptoms that include abdominal pain, nausea, vomiting, and jaundice. This review covers the pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for common biliary tract emergencies (cholelithiasis, acute cholecystitis, choledocholithiasis, and ascending cholangitis).  This review contains 5 figures, 11 tables, and 34 references. Keywords: Cholelithiasis, gallbladder disease, acute cholecystitis, gallstones, choledocholithiasis, ascending cholangitis

scholarly journals THE ROLE OF THE INFECTIOUS FACTOR IN THE DEVELOPMENT OF CHOLANGITIS

2021 ◽  
pp. 32-37
Author(s):  
Oleksandr Maloshtan ◽  
Rostyslav Smachilo ◽  
Oleksandr Tishchenko ◽  
Аndrii Nekludov ◽  
Мariia Klosova ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Severe Form ◽  
Duct System ◽  
Histological Picture ◽  
Colony Forming Units ◽  
The Common

Introduction. The problems of the pathogenesis of cholangitis have not been finally clarified to date. Aim: to investigate the dynamics of microbial contamination of the biliary tract in obstructive jaundice before and after decompression. Materials and methods. To determine the significance of the infectious factor in the development of acute cholangitis, bile from the common bile duct was examined in 40 patients with the biliary tract obstruction, which were divided into three groups according to the clinical course of the disease. Results. The quantitative infection indicators of the common bile duct were studied in asymptomatic choledocholithiasis, in obstructive jaundice without clinical manifestations of cholangitis and in a developed clinic of cholangitis. It has been proven that endoscopic decompression of the biliary tree allows to obtain an almost instant therapeutic effect, the number of colony-forming units of the pathogen decreases by almost three orders of magnitude within 3 days. However, in phlegmonous inflammation of the bile duct wall patients, this period was significantly lengthened, and the course of the disease, according to the Tokyo Guidelines (2013), was assessed as severe. Conclusion. In the study of quantitative infection indicators in patients with a bright clinic of cholangitis, a significant decrease in the number of colony-forming units was observed already on the third day after endoscopic papilosphincterotomy due to an adequate drainage effect. When a stone is driven into the large papilla of the duodenum, the common bile duct turns into an analogue of an abscess. Opening the papilla not only frees the mouth of the duct from the stone, but also provides free passage of the contents of the common bile duct (pus) into the duodenum. This provides an almost instant healing effect. When comparing the severity of cholangitis with the histological picture of the wall of the bile ducts (common bile duct, intrahepatic ducts), data were obtained that it is in patients with a severe form of the disease that phlegmonous inflammation of the wall of the duct system takes place. When comparing the severity of cholangitis with the histological picture of the wall of the bile ducts (common bile duct, intrahepatic ducts), data were obtained that phlegmonous inflammation of the wall of the duct system is observed precisely in patients with a severe form of the disease. Keywords: cholangitis, endoscopic decompression

scholarly journals LAPAROSCOPIC CHOLEDOCH REVISION FOR THE TREATMENT OF CHOLEDOCHOLITHIASIS IN AN INFANT

2019 ◽  
Vol 23 (4) ◽  
pp. 220-223
Author(s):  
M. Yu. Kozlov ◽  
Anton S. Malashenko ◽  
A. A. Shchebeteev
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Ducts ◽  
Open Abdomen ◽  
Unified Approach ◽  
Endoscopic Retrograde ◽  
Surgical Practice ◽  
Percutaneous Puncture ◽  
The Common

Choledocholithiasis is a rare pathology in children. Various techniques have been proposed for removing calculi from the common bile duct: percutaneous puncture drainage of bile ducts, endoscopic retrograde cholangiopancreatography with papillosphincterotomy as well as revision of the common bile duct which can be done laparoscopically or in the open abdomen. However at present, there is no any unified approach to managing this pahtology in children. The article describes authors’ experience of laparoscopic revision of the common bile duct in an infant with choledocholithiasis. The authors consider that this technique can be applied in pediatric surgical practice.

scholarly journals Rhabdomyosarcoma of the biliary tract: a case report

2017 ◽  
Vol 4 (3) ◽  
pp. 1093 ◽  
Author(s):  
Asmaa Kouadir ◽  
Abderrahmane El Mazghi ◽  
Khalid Hassouni
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Clinical Symptoms ◽  
Treatment Approach ◽  
Imaging Techniques ◽  
Multidisciplinary Treatment ◽  
Rare Tumor ◽  
The Common

Rhabdomyosarcoma (RMS) of the biliary tract is a rare tumor that commonly arises from the common bile duct. The most common clinical symptoms are obstructive jaundice and abdominal pain. Although diagnosis is often difficult and is frequently made during surgery, diagnostic imaging techniques including ultrasound, computerized tomography scan, and magnetic resonance cholangiopancreatography remain useful in the diagnosis and evaluation of biliary tree anatomy. In order to improve prognosis, different rhabdomyosarcoma study groups have adopted multidisciplinary treatment approach. Herein we describe a case of three-year-old child with Embryonal rhabdomyosarcoma originating in the common bile duct who was treated with surgery, chemotherapy according to European soft tissue sarcoma group (EpSSG) protocol and adjuvant postoperative intensity modulated radiotherapy to surgical bed with 6 MV photons to a dose of 41, 4Gy in 23 fractions. One year and a half after the end of therapy, the patient is still disease free. Although Rhabdomyosarcoma of the biliary tract is a rare tumor, it should be considered in the differential diagnosis of patients who have obstructive jaundice and a cystic mass within the common bile duct. Once believed to be an incurable disease, the prognosis of patients with biliary rhabdomyosarcoma has improved with a multidisciplinary treatment approach.

scholarly journals Cystic form of biliary atresia. Treatment experience

2020 ◽  
Vol 10 (1) ◽  
pp. 17-24
Author(s):  
Irina I. Borisova ◽  
Anatoliy V. Kagan ◽  
Svetlana A. Karavaeva ◽  
Aleksey N. Kotin
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Atresia ◽  
Bile Ducts ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Duct Cyst ◽  
Cystic Form ◽  
The Common

Background. The cystic form of biliary atresia is a rare form of atresia of the biliary tract, which is a relatively favorable variant of the defect and can be diagnosed antenatally. In practice, it is important not only to suspect this diagnosis, but also to differentiate this variant of impaired development of the external bile duct from the cyst of the common bile duct. This is due to the difference in approaches and methods of surgical treatment of choledochal cysts and biliary atresia. Obliteration (atresia) of the bile ducts in the absence of timely surgical intervention quickly leads to the progression of cirrhosis and the development of liver failure. The method of choice in the treatment of AD is Kasai surgery, often palliative in nature, but allowing to delay the time until liver transplantation. The cyst of the common bile duct rarely requires early surgical treatment, and the risk of cirrhosis is significantly lower. Surgical intervention is aimed at removing the cyst and restoring the flow of bile by anastomosing the external bile ducts with the intestines, which is a radical method of treatment and leads to the recovery of the child. External similarity in ultrasound examination of the fetus and newborn baby of the cystic form of biliary atresia of the bile ducts with a cyst of the common bile duct does not always allow differentiation of one defect from another, which can lead to untimely correction of the defect and an unfavorable outcome. Aim. Demonstrate a rare type of biliary atresia. Materials and methods. Between 2001 and 2019, 33 patients with biliary atresia were treated in the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies in St. Petersburg, only two patients had a cystic form. Both children were initially treated as patients with bile duct cyst. Children were operated on at the age of 2 and 3.5 months. The first patient underwent surgery Kasai, the second hepaticoyunoanastomosis. Results. During the observation period (9 years and 4 years), the synthetic function of the liver is normal, and there are currently no indications for transplantation. Conclusion. If a fetus or a newborn with neonatal jaundice is detected during ultrasound examination of a cystic formation in the gates of the liver, it is very important to correctly and quickly make a differential diagnosis between the cystic form of biliary atresia of the biliary tract and the common bile duct cyst.

scholarly journals Structure and Innervation of the Extrahepatic Biliary System in the Australian Possum, Trichosurus Vulpecula

HPB Surgery ◽  
1993 ◽  
Vol 7 (2) ◽  
pp. 125-140 ◽  
Author(s):  
R. T. A. Padbury ◽  
R. A. Baker ◽  
J. P. Messenger ◽  
J. Toouli ◽  
J. B. Furness
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Ducts ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Duodenal Wall ◽  
Sphincter Muscle ◽  
Trichosurus Vulpecula ◽  
Nerve Fibres ◽  
The Common

The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment.Nerve cell bodies of the gallbladder were found in an inter-connecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the first between the layers of the external sphincter muscle, which was continuous with the external muscle of the duodenum, and the second was associated with the internal sphincter muscle. Nerve fibres were numerous in the sphincter muscle, and were also found in the subepithelial and periglandular plexuses of both the pancreatic and common bile ducts.

scholarly journals THE EFFECT OF LIGATION OF THE COMMON BILE DUCT ON CHOLESTEROL SYNTHESIS IN THE RAT

1954 ◽  
Vol 99 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Donald S. Fredrickson ◽  
Alden V. Loud ◽  
Beverly T. Hinkelman ◽  
Henny S. Schneider ◽  
Ivan D. Frantz
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Ducts ◽  
Cholesterol Synthesis ◽  
Intact Animal ◽  
Experimental Animals ◽  
Liver Slices ◽  
The Common ◽  
Ad Libitum

The effect on cholesterol synthesis of ligation of the common bile duct was studied in the rat. The bile ducts of rats were ligated; 24 to 48 hours later, estimates of the rate of cholesterol synthesis were made, either by injection of labelled water or acetate into the intact animal, or by incubation of slices or homogenates of the liver in the presence of 1-C14-acetate. These various criteria all indicated that cholesterol synthesis was increased following ligation of the bile duct. The average ratios of the rate of synthesis in the experimental animals to that in the controls were as follows: 1. Synthesis from C14-carboxyl-labelled acetate: (a) in the intact rat fed ad libitum, 19; (b) in liver slices from the fasted rat, 23; (c) in liver slices from the rat fed ad libitum, 4; (d) in cell-free homogenates from the fasted rat, >27; (e) in cell-free homogenates from the rat fed ad libitum, 17. 2. Synthesis from tritium-labelled water in the intact rat fed ad libitum, 4.

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