Annular pancreas with choledocholithiasis in an adult male patient: a case report

Annular pancreas is very rarely presented with a clinical picture of obstructive jaundice, usually due to some biliopancreatic malignancy rather than choledocholithiasis which make our case unique. We are presenting a 60-year-old male patient with a 6 mounts old medical history of right upper quadrant pain and intermittent jaundice. On ultrasonography a common bile duct stone was detected with dilatation of the biliary tree and gallstones with edematous wall of the gallbladder. On gastroscopy narrowing of the duodenum was registered. On ERCP the papilla Vateri could not be cannulated and there was a substantial amount of retained food in the duodenal bulb and antral part of the stomach. MRCP showed extensive dilatation of the whole biliary tree from several stones in the distal part of the common bile duct. At the operation there was a ring of pancreatic tissue about 2 cm wide that surrounded the second portion of the duodenum. The operation proceeded with choledochotomy, choledocholythotomy, L-L choledocho-duodenostomy and partial resection of the pancreatic ring. After three mounts the patient had gain weight, had no pain or any other symptoms and control gastroscopy showed normal finding.

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

Canadian Journal of Gastroenterology ◽

10.1155/1994/497470 ◽

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.

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Duodenal peripapillary adenocarcinoma causing extrahepatic biliary obstruction and icterus in a cat

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v89i5.16954 ◽

2020 ◽

Vol 89 (5) ◽

pp. 273-277

Author(s):

T. Rick ◽

E. Stock ◽

I. Van de Maele ◽

E. Kammergruber ◽

J. Saunders

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Biliary Obstruction ◽

Ultrasound Examination ◽

Duodenal Wall ◽

Abdominal Ultrasonography ◽

Extrahepatic Biliary Obstruction ◽

History Of ◽

The Common ◽

Distal Aspect

A six-year-old, female, neutered domestic shorthair cat was presented with chronic weight loss and a two-day history of partial anorexia and lethargy. Abdominal ultrasonography revealed a regional thickening of the duodenal wall with loss of normal layering, a normally walled segmentally dilated distal aspect of the common bile duct containing slightly hyperechoic bile, and a mild to moderately enlarged major duodenal papilla. Based on the ultrasound examination, the primary differential diagnosis was a peripapillary duodenal neoplastic or less likely, an inflammatory or infectious process with secondary extrahepatic biliary obstruction. Postmortem examination revealed a duodenal, peripapillary adenocarcinoma with metastasis into the liver and lymph nodes, and external compressive obstruction of cystic- and common bile duct.

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

Journal of Clinical Imaging Science ◽

10.25259/jcis-17-2019 ◽

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.

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

Folia Medica ◽

10.2478/folmed-2013-0025 ◽

2013 ◽

Vol 55 (3-4) ◽

pp. 33-38 ◽

Cited By ~ 1

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.

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Common Bile Duct MALT Lymphoma: Case Report and Review of the Literature

The American Surgeon ◽

10.1177/000313480607200122 ◽

2006 ◽

Vol 72 (1) ◽

pp. 85-88

Author(s):

Justin Boccardo ◽

Anjay Khandelwal ◽

Dongjiu Ye ◽

Bruce E. Duke

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Malt Lymphoma ◽

Lymphoid Tissue ◽

Treatment Options ◽

Partial Gastrectomy ◽

Biliary Tree ◽

Review Of The Literature ◽

Helicobacter Pylori Treatment ◽

Rare Diagnosis

We report a rare case of common bile duct mucosa-associated lymphoid tissue (MALT) lymphoma treated with pancreatico-duodenectomy with a partial gastrectomy. MALT lymphoma involving the biliary tree is extremely rare. Diagnosis is difficult and treatment options are controversial. Even though Helicobacter pylori treatment is effective in the early stages of the disease, surgery is still helpful especially when obstruction, perforation, or bleeding is present.

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A133 DEVELOPMENT OF TYPE 3 ACHALASIA WITH DISTANT PANCREATIC MALIGNANCY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.132 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 153-155

Author(s):

K Leung ◽

F Habal ◽

M Alrukaibi ◽

L W Liu

Keyword(s):

Pancreatic Cancer ◽

Bile Duct ◽

Common Bile Duct ◽

Enteric Neurons ◽

Thoracic Esophagus ◽

Residual Pressure ◽

Type I ◽

Duodenal Stent ◽

History Of ◽

Type 3

Abstract Background Pseudoachalasia is often caused by malignant involvement at the gastroesophageal junction (GEJ) leading to dysphagia. Aims We describe a case of type 3 achalasia presenting in a woman with metastatic pancreatic cancer with no direct involvement at the GEJ, fundus or cardia. Methods A case report and literature review were performed. Results A 53-year-old woman presented with a 2-month-history of progressive abdominal pain, nausea and vomiting with a 30-pound weight loss. She had a remote history of breast cancer in remission after surgery and chemoradiation. On presentation, she denied chest pain, reflux, dysphagia or odynophagia. Abdominal exam revealed focal epigastric tenderness and jaundice. Abdominal CT showed a 6.7 x 5.8 cm conglomerate mass involving the hepatic hilum, pancreatic head, duodenum, common bile duct, and portal vein with gastric outlet and biliary obstruction. This mass was confirmed to be a pancreatic adenocarcinoma on pathology. She then underwent nasogastric tube decompression. Initial esophagogastroduodenoscopy (EGD) confirmed a stenotic area at the distal duodenal cap. A duodenal stent and common bile duct stent were placed during a second EGD. The esophagus and GEJ were unremarkable on both endoscopic exams. She was started on chemotherapy with gemcitabine and abraxane. Two weeks after her stent placement, she rapidly developed severe retrosternal squeezing discomfort and choking occurring with swallowing. CT chest and abdomen were negative for any intrathoracic and diaphragmatic involvement with stability of the mass. A barium swallow study demonstrated tertiary contractions in the thoracic esophagus with marshmallow hold-up in the distal esophagus. She then underwent a high-resolution esophageal manometry study that demonstrated an elevation of integrated residual pressure (IRP) of the lower esophageal sphincter (LES) and absence of peristalsis, with the distal 2/3rds of the esophagus showing a simultaneous and prolonged pressure front consistent with type 3 achalasia, Chicago classification v3.0 [Figure 1]. All contractions had a distal contractile integral (DCI) of >8000 mmHg-cm-s. She experienced significant symptom improvement with pinaverium bromide, a gut-specific calcium channel antagonist. A review of the literature revealed that there have been 4 English-language cases published on pseudoachalasia associated with pancreatic cancer, with all cases describing direct infiltration of pancreatic cancer in the GEJ, cardia or fundus with manometric features of type I achalasia. Conclusions We report the first case of type 3 achalasia with no evidence of direct malignant infiltration at the GEJ on radiographic and endoscopic evaluations. Possible mechanisms to explain this phenomenon include paraneoplastic antibody-mediated impairment of enteric neurons that decrease nitric oxide availability, or microscopic disease involvement at the GEJ. Funding Agencies None

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