Clinical case of palliative antegrade surgical treatment of cancer of the major duodenal papilla

2016 ◽  
Vol 21 (5) ◽  
pp. 244-249
Author(s):  
Yury S. Vinnik ◽  
E. V Serova ◽  
D. A Chernykh ◽  
A. V Kovalev ◽  
D. V Stratovich ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Malignant Tumors ◽  
Internal Drainage ◽  
Duodenal Papilla ◽  
Major Duodenal Papilla ◽  
Duct Cancer ◽  
The Common

In the structure of malignant tumors, accompanied by obstructive jaundice, there are most occurred such as the lesion of the pancreas (47%), bile duct cancer (20%) also papillary carcinoma (MDP) and gall bladder cancer (about 15%). In the case of inoperable tumor, in elderly and senile patients with severe concomitant somatic pathology, there are indicated palliative interventions as follows: percutaneous transhepatic external or external-internal drainage of the biliary tract with possible subsequent percutaneous transhepatic stenting of the common bile duct. Under our observation there was a patient of 75 years with verified major duodenal papilla cancer, complicated by obstructive jaundice, to whom as the first step there was performed percutaneous transhepatic external-internal drainage of the biliary tract, and as the second one - percutaneous transhepatic stenting of the common bile duct.

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 Features of endobiliary stenting in unresectable tumors in the hepatopancreatoduodenal zone

2021 ◽  
Vol 26 (3) ◽  
pp. 70-78
Author(s):  
D. N. Panchenkov ◽  
Yu. V. Ivanov ◽  
D. V. Sazonov ◽  
A. I. Zlobin ◽  
A. V. Smirnov ◽  
...  
Keyword(s):  
Bile Duct ◽  
Life Expectancy ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Plastic Stents ◽  
Results Of Treatment ◽  
Nitinol Stents ◽  
The Common

Aim. Optimization of endobiliary stenting in patients with unresectable tumors of the organs in the hepatopancreatoduodenal zone, improving the prevention of complications, improving the immediate results of treatment and the quality of patient’s life.Material and methods. From 2011 to 2020, 47 patients with unresectable tumors in the hepatopancreatoduodenal zone underwent endoscopic transpapillary stenting of the common bile duct for obstructive jaundice. A plastic stent was used in 28 patients, and a self-expanding nitinol stent in 19 patients. The results of endobiliary stenting, complications, efficacy and safety of stenting, side effects, quality of biliary tract decompression were evaluated.Results. All patients were perform stenting of the common bile duct. Two complications were recorded during endoscopic transpapillary stenting: bleeding from the area of the major duodenal papilla, which was stopped endoscopically. In the immediate postoperative period – stent displacement was noted in 3 patients, blockage of the stent – in 2 cases, acute post-manipulative pancreatitis – in 1 case, cholangitis — in 2 patients. Satisfactory decompression of the biliary tract was achieved in 44 from 47 patients. There was 1 death.Conclusion. Endoscopic transpapillary stenting of the common bile duct is a low-traumatic, safe and effective method of biliary decompression for tumor obstructive jaundice. Plastic stents should be used for biliary drainage with a life expectancy of ≤6 months. Self-expanding nitinol stents with full or partial coverage is the best chose for life expectancy > 6 months.

scholarly journals Cholangitis Due to Candidiasis of the Extra-Hepatic Biliary Tract

HPB Surgery ◽  
1998 ◽  
Vol 11 (1) ◽  
pp. 51-54 ◽  
Author(s):  
J. D. Wig ◽  
Kartar Singh ◽  
Y. K. Chawla ◽  
K. Vaiphei
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Postoperative Period ◽  
Microscopic Analysis ◽  
Candida Infection ◽  
Post Surgery ◽  
The Common

A case of isolated candidal fungal balls in the common bile duct causing obstructive jaundice and cholangitis is described. There were no predisposing factors. The fungal balls were removed from the common bile duct and a transduodenal sphincteroplasty was performed. Microscopic analysis yielded colonies of candida. Postoperative period was uneventful. At follow-up no evidence of candida infection was evident. He is now 3 years post-surgery and is well.

scholarly journals Mobilization cholangiography

1981 ◽  
Vol 62 (5) ◽  
pp. 41-42
Author(s):  
O. S. Kochnev ◽  
V. N. Biryaltsev
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
The State ◽  
Duodenal Papilla ◽  
Terminal Part ◽  
Surgical Interventions ◽  
Intraoperative Diagnosis ◽  
The Common

Determination of the state of the biliary tract and the terminal part of the common bile duct is one of the most difficult issues of intraoperative diagnosis in complicated cholecystitis. Currently, none of the surgeons doubts the need for intraoperative cholangiography and its value. It is she who allows to identify in many patients the presence of calculi in the biliary tract, to determine the degree of expansion of the common bile duct and bile hypertension, the state of the terminal part of the common bile duct. However, the analysis of radiographs performed during 170 surgical interventions for various degrees of stenosis of the large duodenal papilla showed that even this most reliable method of intraoperative diagnosis has a significant drawback.

scholarly journals Substantiation of the method for resolving obstructive jaundice in operable patients with malignant hepatopancreatobiliary tumors

2021 ◽  
Vol 179 (6) ◽  
pp. 11-17
Author(s):  
P. N. Romashchenko ◽  
N. A. Maistrenko ◽  
A. I. Kuznetsov ◽  
A. S. Pryadko ◽  
A. K. Aliev
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Radical Surgery ◽  
Malignant Tumors ◽  
Malignant Neoplasms ◽  
Klatskin Tumor ◽  
Bile Duct Resection ◽  
Head Of The Pancreas

The OBJECTIVE was to determine the best option for decompression of the biliary tract in patients with malignant neoplasms of the hepatopancreatobiliary zone to resolve obstructive jaundice before performing radical surgery.METHODS AND MATERIALS. The study of the results of examination and surgical treatment of 325 patients with mechanical jaundice caused by malignant tumors of the hepatopancreatobiliary zone allowed us to identify 93 (28.6 %) patients who initially underwent drainage operations on the bile ducts, and then radical surgical interventions.RESULTS. Stage I of the oncological process according to the TnM system (8 reconsideration) was determined in 16 (17.2 %) patients, stage II – in 71 (76.3 %) and stage III – in 6 (6.5 %). According to the ECOG scale, I or II scores were determined in all patients before radical surgery. Tumors of the head of the pancreas, common bile duct and large papilla of the duodenum led to the I level of biliary tract blockage in 81.7 % of patients. Tumors of the common bile duct and head of the pancreas (involving the cystic duct), tumors of the gallbladder and Klatskin (Bismuth–Corlette I) caused the II level of biliary tract blockage in 12.9 % of the examined patients. Klatskin tumor (Bismuth–Corlette II, IIIa, IIIb,) caused bile duct blockage of III level (5.4 % of patients). Pancreatoduodenal resection was performed in 85 patients, endoscopic papillectomy – 3, bile duct resection – 2 and bile duct resection in combination with liver resection – 3. The choice of a rational option for decompression of the biliary tract, taking into account the level of their blockage and the severity of the general somatic condition of patients, provides the possibility of performing radical surgery.CONCLUSION. Before performing radical surgery, obstructive jaundice in operable patients with malignant tumors of the hepatopancreatobiliary zone at the blockage of I level can be effectively and safely resolved by cholecystostomy, at the blockage of II level – endoscopic stenting, while the blockage of III level – percutaneous-transhepatic cholangiodrainage.

scholarly journals Laser papillosphincterotomy in choledocholithiasis and acute biliary pancreatitis

2021 ◽  
Vol 25 (2) ◽  
pp. 48-54
Author(s):  
V. A. Lazarenko ◽  
Y. V. Kanishchev ◽  
P. M. Nazarenko ◽  
D. P. Nazarenko ◽  
T. A. Samgina ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Laser Light ◽  
Biliary Pancreatitis ◽  
Duodenal Papilla ◽  
Surgical Time ◽  
Acute Biliary Pancreatitis ◽  
Major Duodenal Papilla ◽  
The Russian Federation ◽  
The Common

Objective. The radical elimination of extrahepatic biliary tract pathology in choledocholithiasis and acute biliary pancreatitis (ABP) reduces the risk of infection and eliminates the source of endogenous intoxication; so, the search of safe and effective techniques for endoscopic papillosphincterotomy (EPT) is important.Purpose: to assess outcomes of laser-assisted endoscopic papillosphincterotomy.Material and methods. 288 patients with “wedged” (n = 111) and “valve” (n = 177) choledocholithiasis and acute biliary pancreatitis were divided into two groups depending on EPT technique: in the control group, a papillotome with electrocoagulation cord was used (n = 195); in the main group, laser scalpel was used (n = 93).Results. 87 patients with “wedged” choledocholithiasis were treated with EPT and an end electrode on the wedged stone. 16 patients out of them had mild bleeding which was stopped by irrigation with epinephrine solution (1 : 10 000) followed by the targeted coagulation. The average surgical time was 38 ± 16 min. In 24 patients with rigid and edematous medial wall of the duodenum due to acute biliary pancreatitis, the proposed device plus laser technique for papillosphincterotomy were used (patent of the Russian Federation No. 2614891). There was no bleeding, the average surgical time was 24 ± 12 min. In “valve” choledocholithiasis, laparoscopic cholecystectomy (LCE) was performed; calculi from the common bile duct were removed. In 108 patients during LCE, EPT was made via an antegrade catheter. In 69 patients with anatomical and physiological obstacles caused by the major duodenal papilla, we performed LCE and EPT with laser light via an antegrade guide light made of fluoroplastics (patent of the Russian Federation No. 41594). Concrements from the common bile duct were removed with the Dormia basket.Conclusions. Laser light causes less damage, reliably provides hemostasis along the incision line on the anterior wall of the major duodenal papilla; in addition, a wedged calculus in “wedged” choledocholithiasis and a fluoroplastic light guide in “valve” choledocholithiasis reliably protect the posterior wall of the major duodenal papilla from laser light damage. Laser techniques used in EPT make the treatment of choledocholithiasis in patients with ABP having anatomical and physiological problems due to the major duodenal papilla safe and effective.

Causes, diagnosis, and treatment of postoperative obstructive jaundice

2021 ◽  
Vol 29 (2) ◽  
pp. 257-266
Author(s):  
Makhmadsho K. Gulov ◽  
Kakhramon R. Ruziboyzoda
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Minimally Invasive ◽  
Biliary Tract ◽  
Hepatic Duct ◽  
Abdominal Cavity ◽  
Surgical Interventions ◽  
Laparoscopic Operation ◽  
The Common

AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice. MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy. RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 34 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage. CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

Ultrasonography in diagnosis of the common bile duct pathology and pathology of the major duodenal papilla, complicated by mechanical jaundice

2021 ◽  
pp. 5-17
Author(s):  
Vladimir Alexandrovich Ivanov ◽  
Roman Nikolaevich Malushenko ◽  
Alexander Evgenievich Denisov ◽  
Elena Nikolaevna Kondrashenko
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Flow ◽  
Clinical Syndrome ◽  
Review Of The Literature ◽  
Duodenal Papilla ◽  
Important Place ◽  
Major Duodenal Papilla ◽  
The Common ◽  
Diagnostic Capabilities

Mechanical jaundice is a clinical syndrome that develops due to the bile flow impairment along the bile ducts to the duodenum, remains one of the urgent problems of medicine. Of great importance among the causes of mechanical jaundice are diseases of the common bile duct and the major duodenal papilla, the diagnosis of which to this day remains a rather difficult task. The use of MRCP, ERСP, endo-ultrasonography and other highly informative bile tract imaging methods, despite great diagnostic capabilities, is associated with a number of limitations. In this regard, an important place, especially in the primary examination of patients, is occupied by transabdominal ultrasound, the advantages of which are non-invasiveness, portability, accessibility, safety, the possibility of multiple reiteration. A review of the literature presents domestic and foreign data of researchers regarding the possibility of ultrasonography in diagnostics of the common bile duct pathology and the pathology of the major duodenal papilla that are complicated by mechanical jaundice, as well as the greatest difficulties in diagnosing this pathology.

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

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