A one-stage, one-incision operation on the kidney, gallbladder and caecum under local anesthesia

The idea of the possibility of access from the lumbar incision to the liver, gallbladder and ducts is not new; there are numerous references to this in the literature (Fgapk, Meags, Tu ffieg, Wgight, Reboul, Trinkler, etc.). Frank, for example, even points to the benefits of a lumbar incision for surgery on the biliary tract in terms of convenience of postoperative treatment, convenience of drainage and less danger of postoperative hernias. Most recently, Hrtel) has been focusing the attention of surgeons on lumbar incisions for operations not only on retroperitoneal organs, but also for abdominal operations (spleen, pancreas, duodenum, colon, etc.). Without mentioning the whole issue here, I must say that the clinic has enough reasons for wanting to get operative access to the right kidney and gallbladder simultaneously. The first reason for this in normal conditions may be diagnostic difficulties. There are cases when the surgeon, exposing the kidney, simultaneously felt the stones in the gallbladder and was forced to continue the operation on the bile ducts from the same incision.

Download Full-text

Hepatolithiasis Associated With Anomalous Biliary Anatomy and a Vascular Compression Hepatolithiasis and Anomalous Anatomy

HPB Surgery ◽

10.1155/1991/23701 ◽

1991 ◽

Vol 3 (2) ◽

pp. 129-137 ◽

Cited By ~ 3

Author(s):

Graham Cullingford ◽

Brian Davidson ◽

James Dooley ◽

Nagy Habib

Keyword(s):

Liver Function ◽

Biliary Tract ◽

Bile Ducts ◽

Hepatic Duct ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Vascular Compression ◽

Biliary Anatomy ◽

Endoscopic Retrograde ◽

The Right

Biliary tract abnormalities occur in about one of every three people, usually being minor and of no clinical significance.Major abnormalities, however, may present in an unusual manner and provide a major hazard to the unsuspecting surgeon.A patient presenting with cholangitis without jaundice or abnormal liver function tests is reported. Endoscopic retrograde cholangiography failed to demonstrate any bile ducts in the right postero-lateral segments of the liver, the “naked segment sign”. A percutaneous transhepatic cholangiogram demonstrated a stricture obstructing the right posterior segmental hepatic duct with hepatolithiasis above the stricture. At operation an anomalous vessel was found at the site of the stricture.This case highlights the unusual way in which biliary tract anomalies may present and the importance of adequate pre-operative investigation.

Download Full-text

CHOLANGITIS AS A SYSTEMIC MANIFESTATION OF ACUTE BILIARY INFECTION

International Medical Journal ◽

10.37436/2308-5274-2020-2-9 ◽

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.

Download Full-text

Surgical management of cystic dilatation bile ducts in adults

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000100005 ◽

2015 ◽

Vol 28 (1) ◽

pp. 17-19

Author(s):

Olival Cirilo Lucena da FONSECA-NETO ◽

Moacir Cavalcante de ALBUQUERQUE-NETO ◽

Antonio Lopes de MIRANDA

Keyword(s):

Magnetic Resonance Imaging ◽

Rare Disease ◽

Biliary Tract ◽

Bile Ducts ◽

Adult Population ◽

Ultrasound Scanning ◽

Resonance Imaging ◽

Cystic Dilatation ◽

Initial Examination ◽

Endoscopic Retrograde

BACKGROUND: The cystic dilatation of the biliary tract is a rare disease and uncertain origin. It is recognized more frequently in children; however, its incidence comes increasing in adults, representing 20% of the cases. AIM: To evaluate morbimortality rates, evolution and handing of patients with cystic dilatation bile ducts in adults. METHODS: Were evaluated, retrospectively, five adults who had the diagnosis of choledochal cyst and that had been submitted to some surgical procedure. RESULTS: Abdominal pain was the commonest complain to all patients. Jaundice was present in 80%. Ultrasound scanning was done in all the cases as initial examination. CT scan, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography were also done in some patients; however, the diagnosis was established intra-operatively in all cases. The cyst resection with reconstruction of the biliary tract was done in 60%; the cystojejunostomy in 20%; and in 20% biliary tract drainage. CONCLUSIONS: Biliary tract cystic dilatation is a rare disease. However, its incidence is increasing in the adult population, so, it must be thought as differential diagnosis when facing obstructive jaundice.

Download Full-text

Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications from a Cadaveric Study

Anatomy Research International ◽

10.1155/2012/838179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Theodoros Mariolis-Sapsakos ◽

Vasileios Kalles ◽

Konstantinos Papatheodorou ◽

Nikolaos Goutas ◽

Ioannis Papapanagiotou ◽

...

Keyword(s):

Bile Ducts ◽

Hepatic Duct ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Drainage Pattern ◽

Left Hepatic Duct ◽

Surgical Interventions ◽

Drainage Patterns ◽

The Common ◽

The Right

Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.

Download Full-text

Bile Duct Adenoma with Oncocytic Features

Case Reports in Pathology ◽

10.1155/2014/282010 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

E. J. Johannesen ◽

Zihao Wu ◽

Jason-Scott Holly

Keyword(s):

Bile Duct ◽

Bile Ducts ◽

Colorectal Adenocarcinoma ◽

Incidental Finding ◽

Proliferation Index ◽

Bile Duct Neoplasms ◽

Mucin Production ◽

Right Lobe ◽

The Right ◽

Bile Duct Adenoma

Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic) change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

Download Full-text

Diagnostic difficulties and features of endovideosurgical treatment of a patient with mucocele of the appendix

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov202012285-90 ◽

2020 ◽

Vol 12 (2) ◽

pp. 85-90

Author(s):

Badri V. Sigua ◽

Vyacheslav P. Zemlyanoy ◽

Elguja L. Lataria ◽

Alexey A. Kurkov ◽

Vyacheslav A. Melnikov ◽

...

Keyword(s):

Benign Tumor ◽

Abdominal Cavity ◽

Clinical Manifestations ◽

Vermiform Appendix ◽

Diagnostic Methods ◽

Number Of Patients ◽

Mucocele Of The Appendix ◽

Diagnostic Difficulties ◽

Life Threatening ◽

The Right

The mucocele of the appendix is the expansion of the appendix with the accumulation of a large amount of mucus. The mechanism and causes of mucocele are not fully understood. According to some authors, such changes in the appendix can occur due to cicatricial narrowing of the lumen of the appendix, compression or blockage of its base. Other authors believe that the mucocele of the appendix is a benign tumor that develops from the remnants of primitive mesenchyme and is sometimes prone to malignancy. Clinical manifestations of mucocele of the appendix are nonspecific. In a number of patients, this disease causes pain in the right abdomen, more often pulling, intermittent. However, the disease is often asymptomatic. In this regard, diagnosis is established only during performing an operation, most often, regarding acute appendicitis. Nevertheless, instrumental diagnostic methods such as ultrasound and computed tomography of the abdominal and pelvic organs make it possible to suspect mucocele. Despite the frequent asymptomatic, non-aggressive course, a number of life-threatening complications can become the outcome of the mucocele of the vermiform appendix. The most formidable complication is the rupture of the appendix with mucus entering free abdominal cavity, followed by the development of peritoneal pseudomyxoma due to implantation of mucus-forming cells. The only option for radical treatment of the mucocele of the appendix is a surgical intervention. A presented clinical case demonstrates the difficulties of diagnosis, as well as the features of surgical treatment of a patient with a mucocele of the appendix.

Download Full-text

Lupus vulgaris mimicking cutaneous leishmaniasis: A case report

Our Dermatology Online ◽

10.7241/ourd.20221.12 ◽

2022 ◽

Vol 13 (1) ◽

pp. 53-56

Author(s):

Nouf Faihan Bin Rubaian ◽

Haya Fahad Alzamami ◽

Gadah Abdulatif Alhosawi ◽

Leena Abdulrahman Almuhaish

Keyword(s):

Delayed Diagnosis ◽

Punch Biopsy ◽

Lupus Vulgaris ◽

Cutaneous Tuberculosis ◽

Dorsal Aspect ◽

Skin Punch Biopsy ◽

Diagnostic Difficulties ◽

Anti Tubercular Therapy ◽

The Right ◽

Saudi Male

Lupus vulgaris (LV) is a progressive, chronic form of cutaneous tuberculosis (CTB). The head and neck regions are the most commonly affected sites, followed by the arms and legs. Occurring in unusual sites may pose diagnostic difficulties. Herein, we report a case of LV present on the dorsal aspect of the right hand in a twenty-year-old Saudi male. It was misdiagnosed as leishmaniasis as the patient lived in an area in which it was endemic, and was treated accordingly with no benefit. A skin punch biopsy was taken and the diagnosis of LV was confirmed. The lesion responded well to anti-tubercular therapy (ATT), yet healed with atrophic scarring. Although rare, clinicians must be aware of the importance of considering CTB as an important differential, as misdiagnosis or delayed diagnosis of this entity may eventually cause prolonged morbidity.

Download Full-text

Hepatocholescintigraphy in diagnosis of functional state of biliodigestive anastomoses

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2019153-60 ◽

2019 ◽

Vol 24 (1) ◽

pp. 53-60

Author(s):

Yu. V. Kulezneva ◽

L. V. Bondar ◽

E. A. Vasina ◽

M. B. Boboeva ◽

P. M. Cholak ◽

...

Keyword(s):

Biliary Tract ◽

Functional State ◽

Bile Flow ◽

Bile Ducts ◽

Diagnostic Value ◽

Bowel Anastomosis ◽

Biliodigestive Anastomosis ◽

Intrahepatic Bile Ducts ◽

Highly Effective ◽

Flow Through

Aim. To identify diagnostic value of hepatocholescintigraphy for evaluation of functional state of biliodigestive anastomoses (BDA).Material and methods. 99mTc-IDA hepatocholescintigraphy was applied in 52 patients to evaluate function of biliodigestive anastomoses.Results. Scintigraphic signs of “bowel-anastomosis” and/or “BDA-intrahepatic bile ducts” reflux were revealed in 14 (27%) cases. Obstruction of biliodigestive anastomosis occurred in 3 (5.7%) patients. Normal bile flow through BDA was observed in 10 (19.2%) patients, impaired passage – in 21 (40.3%) cases. Tracer delay in intrahepatic bile ducts was noted in 21 (25.0%) cases, signs of adhesive process near deferent bowel – in 3 (3.8%) cases.Conclusion. Hepatocholescintigraphy is highly effective method to assess biliary tract in patients after Roux-en-Y biliodigestive anastomoses formation.

Download Full-text

Gallstones and Biliary Tract Emergencies

10.2310/em.4056 ◽

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

Download Full-text