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

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.

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

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.

scholarly journals Isolated and unexplained dilation of the common bile duct on computed tomography scanscans

2012 ◽  
Vol 4 (2) ◽  
pp. 15 ◽  
Author(s):  
Naveen B. Krishna ◽  
Pavan Tummala ◽  
Christopher D. Mehan ◽  
Amith V. Reddy ◽  
Jeremy A. Hartman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bile Duct ◽  
Common Bile Duct ◽  
The Common

scholarly journals Case Report: Isolated Cystic Dilatation of the Cystic Duct: A Misdiagnosed Case Preoperatively

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiankang Zhang ◽  
Zeming Hu ◽  
Xuan Lin ◽  
Dongliang Zhang ◽  
Hao Wang ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Cystic Dilatation ◽  
Liver Transaminase ◽  
Caudal Portion ◽  
The Common

A 33-year-old female with a mild elevation of liver transaminase was sent to the general surgery department for medical services due to upper-right abdominal pain for 2 weeks. A liquid dark area ~4 × 3 × 3 cm in size in the theoretical location of the pancreatic segment of the common bile duct was detected by abdominal CT with no enhancement of the cystic wall found in the enhanced CT scan. The patient was then diagnosed with a choledochal cyst based on the results of the radiological images preoperatively. During the operation, the isolated cystic dilatation was found in the middle part of the cystic duct, and its caudal portion was found behind the head of the pancreas and converged into the common bile duct at an acute angle and low insertion. According to the intraoperative evaluation, the female was then diagnosed with a cystic duct cyst (CDC). The surgery was converted to a laparotomy for the unclear structure and the possibility of anatomic variation of the bile duct. The caudal portion of the cystic duct was found communicated with the common bile duct with a narrow base, and the extrahepatic bile duct was not cystic. The CDC was removed in the surgery. One week later, the patient was discharged from the hospital for the disappearance of abdominal pain and normal liver transaminase and did not report any discomfort in the 1-month-long follow-up. The lessons drawn from this case were as follows: (1) the distinction between the relatively frequent choledochal cyst and the isolated CDC should always be taken in mind; (2) a surgical strategy should be given priority for an intraoperatively confirmed CDC; (3) a common bile duct exploration is recommended for patients with choledocholithiasis or jaundice.

scholarly journals Cholestatic hepatitis as a clinical mask of choledocholithiasis

2016 ◽  
Vol 97 (3) ◽  
pp. 439-442
Author(s):  
D V Pikulev ◽  
O N Vorob’eva
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hiatal Hernia ◽  
Bile Ducts ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Cholestatic Hepatitis ◽  
The Common

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.

scholarly journals Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

2017 ◽  
Vol 11 (2) ◽  
pp. 428-433 ◽  
Author(s):  
Hrudya Abraham ◽  
Sajan Thomas ◽  
Amit Srivastava
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
History Of ◽  
The Common

Biliary sump syndrome is a rare condition. It is seen as a rare long-term complication in patients with a history of a side-to-side choledochoduodenostomy. In the era before endoscopic retrograde cholangiopancreatography, side-to-side choledochoduodenostomy was a common surgical procedure for the management of biliary obstruction. In the setting of a side-to-side choledochoduodenostomy, the bile does not drain through the distal common bile duct anymore. Therefore, the part of the common bile duct distal from the choledochoduodenostomy anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a 64-year-old man with a history of side-to-side choledochoduodenostomy who presented with manifestations of cholangitis. An endoscopic retrograde cholangiopancreatography confirmed a diagnosis of sump syndrome. The etiology, clinical manifestations, and treatment of biliary sump syndrome are discussed in this article.

Abdominal Pain in a Young Girl Due to Congenital Stenosis of the Common Bile Duct with Mucus Plug Formation

1992 ◽  
Vol 15 (4) ◽  
pp. 440-443 ◽  
Author(s):  
Suresh Vedantham ◽  
Frank C. Taylor ◽  
David K. Yousefzadeh ◽  
Pascal Udekwu ◽  
J. Richard Thistlethwaite ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Young Girl ◽  
The Common ◽  
Mucus Plug ◽  
Plug Formation

scholarly journals Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

2009 ◽  
Vol 91 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Chinnusamy Palanivelu ◽  
Muthukumaran Rangarajan ◽  
Priyadarshan Anand Jategaonkar ◽  
Madhupalayam Velusamy Madankumar ◽  
Natesan Vijay Anand
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Operating Time ◽  
Laparoscopic Management ◽  
Subtotal Cholecystectomy ◽  
Laparoscopic Excision ◽  
The Common ◽  
The Mean

INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.

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