Prevention of complications of transpapillary endoscopic interventions

2021 ◽  
Vol 23 (3) ◽  
pp. 141-147
Author(s):  
Aleksey A. Feklyunin ◽  
Pavel N. Romashchenko ◽  
Nikolai A. Maistrenko ◽  
Valentin S. Omran
Keyword(s):  
Bile Duct ◽  
Postoperative Bleeding ◽  
Postoperative Mortality ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Treatment Method ◽  
Surgical Interventions ◽  
Endoscopic Papillectomy ◽  
Wirsung Duct ◽  
Active Implementation ◽  
Nasobiliary Drainage

This study analyzed the treatment results of 345 patients who underwent planned and emergency transpapillary surgical interventions for various diseases of the biliopancreatoduodenal region. Among these patients, 68.9% were women and 31.1% were men aged 1892 (mean age, 63.7 4.5) years. The study included patients who used various types of transpapillary endoscopic interventions as a treatment method, such as endoscopic papillo-sphincterotomy (71.9%, including choledocholite extraction in 68.7% of the patients), endoprosthetics of the common bile duct and main pancreatic duct (17.8%), balloon dilatation and bougienage of bile duct strictures (6.2%), mechanical lithotripsy (2%), nasobiliary drainage (1%), endoscopic wirsungotomy (0.8%), and endoscopic papillectomy (0.3%). Variants of the inflow of hepaticoholedochus and Wirsung duct were assessed using magnetic resonance cholangiopancreatography. The active implementation of preventive measures regulated by the global community made it possible to reduce the overall incidence of complications of transpapillary interventions to 13.1% and the rates of postoperative mortality to 1.3% (p 0.05). The use of these measures led to a significant decrease in the incidence of acute post-manipulation pancreatitis from 10.3% to 4.8%, postoperative bleeding from 8.9% to 5.5%, cholangitis from 2.8% to 0.7%, and a low incidence of retroduodenal perforation in 1.1%. Personalized consideration of the modern recommendations of the global endoscopic communities (Europeans, Americans, and Japanese) when performing endoscopic retrograde cholangiopancreatography, as well as original approaches associated with the determination of the anatomical features of the structure of the Vater papilla with variants of fusion of hepaticocholedochus and Wirsung duct, helped to significantly reduce the overall incidence of complications following transpapillary endoscopic procedures from 22.2% to 13.1%.

scholarly journals A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Hirao ◽  
HiroHisa Okabe ◽  
Daisuke Ogawa ◽  
Daisuke Kuroda ◽  
Katsunobu Taki ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Case Presentation ◽  
Endoscopic Nasobiliary Drainage ◽  
Subtotal Cholecystectomy ◽  
Upper Abdominal ◽  
The Right ◽  
Nasobiliary Drainage

Abstract Background Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. Case presentation A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. Conclusions The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.

scholarly journals An incidental case of biliary fascioliasis with subtle clinical findings: US and MRCP findings

2013 ◽  
Vol 47 (2) ◽  
pp. 125-127
Author(s):  
Hakan Önder ◽  
Faysal Ekici ◽  
Emin Adin ◽  
Suzan Kuday ◽  
Hatice Gümüş ◽  
...  
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Magnetic Resonance ◽  
Biliary Obstruction ◽  
Fasciola Hepatica ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical Findings ◽  
Imaging Studies ◽  
Laboratory Findings ◽  
Acoustic Shadow

Background. Fascioliasis is a disease caused by the trematode Fasciola hepatica. Cholangitis is a common clinical manifestation. Although fascioliasis may show various radiological and clinical features, cases without biliary dilatation are rare. Case report. We present unique ultrasound (US) and magnetic resonance cholangiopancreatography (MRCP) findings of a biliary fascioliasis case which doesn’t have biliary obstruction or cholestasis. Radiologically, curvilinear parasites compatible with juvenile and mature Fasciola hepatica within the gallbladder and common bile duct were found. The parasites appear as bright echogenic structures with no acoustic shadow on US and hypo-intense curvilinear lesions on T2 weighted MRCP images. Conclusions. Imaging studies may significantly contribute to the diagnosis of patients with subtle clinical and laboratory findings, particularly in endemic regions.

scholarly journals A Resected Case of Mucinous Adenocarcinoma of the Duodenum, Mimicking Intraductal Papillary Neoplasm of the Bile Duct

2015 ◽  
Vol 100 (11-12) ◽  
pp. 1443-1448
Author(s):  
Norio Kubo ◽  
Hideki Suzuki ◽  
Norihiro Ishii ◽  
Mariko Tsukagoshi ◽  
Akira Watanabe ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Transverse Colon ◽  
Extrahepatic Bile Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mucinous Carcinoma ◽  
Villous Tumor ◽  
Intraductal Papillary Neoplasm ◽  
The Common ◽  
Papillary Neoplasm

Duodenum mucinous carcinoma is very rare, and the prognosis of the patient is very bad, especially when the tumor is invasive to other organs. In this case, duodenum carcinoma was invasive to common bile duct and transverse colon. Mucinous fluid, which was secreted from a duodenum tumor, was found in the dilatated bile duct. The intraductal papillary neoplasm of the bile duct was considered a differential diagnosis. We performed aggressive resection and had a good prognosis. A 74-year-old woman received a diagnosis of cholangitis and was treated with antibiotic drugs. Endoscopic retrograde cholangiopancreatography revealed a defect in the lower common bile duct with the mucoid fluid. We suspected intraductal papillary neoplasm of the bile duct, but no malignant cells were detected. One year later, gastrointestinal fiberscopy revealed a villous tumor in the postbulbar portion of the duodenum; adenocarcinoma was detected in biopsy specimens. Computed tomography revealed dilatation of the duodenum with an enhanced tumor, and dilatation of both the common and intrahepatic bile ducts. Magnetic resonance cholangiopancreatography revealed that the duodenum was connected with the common bile duct and ascending colon. We resected the segmental duodenum, extrahepatic bile duct, left lobe of liver, a partial of the transverse colon, and associated lymph nodes. Although the advanced duodenal carcinoma had poor prognosis, the patient was alive, without recurrence, 5 years after the operation.

1223 Cholelithiasis and Choledocholithiasis with Migration of Stones into Right Psoas Muscle Cavity

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Hunter
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Psoas Muscle ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Imaging Modalities ◽  
Prior History ◽  
Clinical Presentations ◽  
Multiple Imaging ◽  
The Right ◽  
Psoas Major

Abstract Aim To highlight the importance of appropriate imaging modalities for abnormal clinical presentations. Method Xyo woman presented with severe right upper-quadrant pain to the emergency department. Prior history of colicky abdominal pain for 1 year, right-sided nephrectomy and hypertension. She stated that the current epsiode of pain was the worst so far, becoming more persistent, prompting her to call an ambulance. Cholecystitis was suspected, so a Computed Tomography abdomen/pelvis was performed. A dilated, inflamed gallbladder was noted in contact with the right psoas major, with what appeared to be an abscess in the right psoas major. Results A Magnetic Resonance Cholangiopancreatography was performed, which demonstrated that the aforementioned abscess was in fact a large cavity within the psoas major, containing up to 15 gallstones. Cholelithiasis was also seen, with common bile duct dilatation and evidence of a common bile duct stone. An Endoscopic Retrograde Cholangiopancreatography was performed, and X recovered well post-procedure with analgesia and antibiotics. Conclusions Acute cholecystitis/intra-abdominal gallstones may result in abscess/cavity formations and abnormal biliary clinical presentations. It is important therefore to fully investigate abnormal hepatobiliary imaging with multiple imaging modalities to allow for accurate diagnosis and appropriate further management of presentations.

Foreign bodies of common bile duct

1997 ◽  
Vol 78 (4) ◽  
pp. 299-301
Author(s):  
D. M. Krasilnikov ◽  
M. I. Mavrin ◽  
B. Kh. Kim
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Postoperative Period ◽  
Foreign Bodies ◽  
Endoscopic Retrograde ◽  
Endoscopic Nasobiliary Drainage ◽  
The Common ◽  
Nasobiliary Drainage

After endoscopic retrograde pancreatocholangiography, endoscopic nasobiliary drainage and removal of external drains in the postoperative period sometimes fragments of catheters remain in the common bile duct. The left foreign bodies contribute to cholangitis, pancreatitis, mechanical jaundice and concrements formation.

scholarly journals Double Rarity: Malignant Masquerade Biliary Stricture in a Situs Inversus Totalis Patient. A Case Report

2020 ◽  
Author(s):  
Katalin Eitler ◽  
Zoltan Mathe ◽  
Veronika Papp ◽  
Attila Zalatnai ◽  
Andras Bibok ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Situs Inversus ◽  
Anatomical Variation ◽  
Significant Risk ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Situs Inversus Totalis ◽  
Recent Onset ◽  
Benign Biliary Strictures ◽  
Duct Stricture

Abstract Background. Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7-18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. Case presentation. We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy and a hepatico-jejunostomy has been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well.Conclusion. In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. The surgery is usually unavoidable, involving a significant risk of complications.The co-existence of these two difficult diagnostic and therapeutic features made our case challenging.

scholarly journals Antegrade X-ray surgical interventions in patients with choledocholithiasis in case of failed endoscopic procedures

2019 ◽  
Vol 24 (2) ◽  
pp. 48-59
Author(s):  
O. I. Okhotnikov ◽  
M. V. Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov ◽  
N. I. Shevchenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Postoperative Mortality ◽  
Endoscopic Papillotomy ◽  
X Ray ◽  
Endoscopic Procedures ◽  
Rendezvous Technique ◽  
Antegrade Approach ◽  
The Common

Objective. To analyze safety and efficacy of X-ray surgical treatment of choledocholithiasis in case of failed endoscopic procedures. Material and methods. A retrospective analysis included 195 patients with choledocholithiasis who underwent X-ray surgical treatment. Primary X-ray surgical intervention was antegrade cholangiostomy. Data of antegrade cholangiography were used to determine type of endobiliary intervention. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction, balloon dislocation of stones of the common bile duct into duodenum or jejunum, lithoextraction using rendezvous technique after endoscopic papillotomy through transpapillary drainage tube or a wire were applied. Results. Puncture and drainage of non-dilated bile ducts were successfully performed in 30 (15.4%) patients. There were 212 procedires of cholangiostomy in 195 patients including redo interventions. Complications after cholangiostomy were absent in 92.9% of cases. Minor complications occurred in 7.1% of cases. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction was performed in 118 (98.3%) patients. Balloon dislocation of stones of the common bile duct into duodenum was applied in 52 (81.3%) patients. Lithoextraction using rendezvous technique after previous endoscopic papillosphincterotomy was performed in 12 (60%) patients. Six patients underwent transpapillary external-internal drainage of common bile duct. Five patients had stricture of biliodigestive anastomosis complicated by cholelithiasis. Lithotripsy and lithoextraction through antegrade approach or dislocation of stones into jejunum after previous balloon dilatation were performed in these patients. Postoperative mortality was 1.5%. Minimally invasive techniques were absolutely effective for choledocholithiasis in 187 (98.9%) patients. Conclusion. Antegrade X-ray surgical management is effective and safe in patients with choledocholithiasis and unsuccessful previous endoscopic procedures. Integral efficiency of antegrade management of cholelithiasis was 88.8%.

scholarly journals Accuracy of Ultrasound and Magnetic Resonance Cholangiopancreatography Findings in the Diagnosis of Biliary System Stones

2022 ◽  
Vol 30 (1) ◽  
pp. 841-852
Author(s):  
Abdullah Taher Naji ◽  
Ameen Mohsen Amer ◽  
Saddam Mohammed Alzofi ◽  
Esmail Abdu Ali ◽  
Noman Qaid Alnaggar
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Common Bile Duct Stones ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Final Diagnosis ◽  
Biliary System ◽  
Cbd Stones ◽  
System Diagnosis ◽  
Us Findings

This study aimed to evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and Ultrasound (US) images for the diagnosis of biliary system stones, as well as to assess the consistency between MRCP and US findings. The study sample included 200 cases (90 males and 110 females) with symptomatic biliary system stones between 14 and 82 years. All cases underwent both the US and MRCP imaging for biliary system diagnosis. The study revealed that the most prominent age group with symptoms of biliary system stones was the 33-60-year-old group. It also found that the accuracy of US and MRCP in detecting gallbladder (GB) stones compared with the final diagnosis was 94% and 91%, respectively, with moderate conformity between their results. The accuracy of US and MRCP images in detecting common bile duct (CBD) stones was 61% and 98%, respectively, with fair conformity between their results. In addition, there is a significant agreement between the MRCP and US results in detecting the GB and CBD stones with an agreed percentage of 74% and 71%, respectively. The study concluded that US is the preferred imaging technique for patients with symptomatic gallbladder stones, whereas MRCP is a trustworthy investigation for common bile duct stones.

scholarly journals Magnetic Resonance Imaging in Primary Sclerosing Cholangitis

2021 ◽  
Vol 3 (2) ◽  
pp. 20-24
Author(s):  
Aldona Wybraniec-Zaręba ◽  
Julia Tuchalska-Czuroń ◽  
Gabriela Półtorak-Szymczak ◽  
Mariusz Furmanek ◽  
Jerzy Walecki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Bile Ducts ◽  
Extrahepatic Bile Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Left Liver Lobe ◽  
Bile Duct Stenosis ◽  
Mri Features

Primary sclerosing cholangitis (PSC) is a chronic liver disease in which there are inflammation and scarring of the bile ducts leading to fibrosis, destruction and narrowing of the bile ducts, resulting in cholestasis. In the long run, PSC can cause liver cirrhosis and failure. In clinical practice, the diagnosis of PSC is generally based on blood tests and imaging studies (currently preferably magnetic resonance cholangiopancreatography). To make a diagnosis of PSC it is necessary to exclude secondary causes of sclerosing cholangitis. The most common MRI features of PSC concerning bile ducts are: bile duct dilatation, beading, extrahepatic bile duct stenosis, wall enhancement and thickening. The most common MRI features of PSC concerning hepatic parenchyma are: rounded shape of the liver caused by hypertrophy of caudate lobe and left liver lobe, atrophy of the right lobe, enlargement of portal and/or portacaval lymph nodes, peripheral parenchymal inflammation, wedge-shaped confluent fibrosis, heterogeneity of the liver parenchyma, periportal oedema, cirrhosis with indirect signs of portal hypertension such as splenomegaly, ascites and collateral vasculature.

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