RIGHT HEPATIC DUCT STENOSIS DUE TO MULTIPLE METALLIC CLIPS AFTER CHOLECYSTECTOMY. IS THERE A WAY OUT? RE-LAPAROSCOPY AND ERCP STENTING

Bile duct lesions with leakage and stenosis can occur after open or laparoscopic cholecystectomy. Multiple factors are involved either related to the patient or external due to technical equipment or surgeon. Bismuth classification is generally accepted. The aim is to restore the bile duct and to prevent short-term and long-term complications such as biliary fistula, intra-abdominal abscess, biliary stricture, recurrent cholangitis, and secondary biliary cirrhosis. Endoscopic therapy with biliary sphincterotomy alone or with the additional placement of a biliary/nasobiliary stent drainage is recommended. Stenting should be avoided if complete strictures exist or a circumferential resection of the duct. Endotherapy can be considered a sensible option and should be the main-stay treatment in these patients but one must keep in mind it is costly and is usually practiced by experienced teams in tertiary centers. The purpose of our paper is to exemplify this complication which is inherently rare, to highlight the diagnostic and treatment tools with minimal long-term sequelae.

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A new method for the experimental induction of secundary biliary cirrhosis in wistar rats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502001000200003 ◽

2001 ◽

Vol 16 (2) ◽

pp. 75-81 ◽

Cited By ~ 5

Author(s):

Gracinda De Lourdes Jorge ◽

Luiz Sergio Leonardi ◽

Ilka de Fatima Santana Ferreira Boin ◽

Orlando de Castro e Silva Jr ◽

Cecilia Amelia Fazzio Escanhoela

Keyword(s):

Bile Duct ◽

Morphological Study ◽

Wistar Rats ◽

Hepatic Duct ◽

Control Group ◽

Sham Operation ◽

Biliary Cirrhosis ◽

Technical Failure ◽

Duct Obstruction ◽

Duct Ligation

The aim of this study was to describe a method for the induction of experimental secondary biliary fibrosis (SBF). Forty-seven Wistar rats were submitted to hepatic duct obstruction (OB group) for thirty days without ligature, section or cannulization causing interruption of biliary flow. This technique was carried out by simple traction of the bile duct passing it through the xiphoid appendix. Nine rats were submitted to a sham operation for bile duct stricture and seven rats comprised the control group. Blood samples were collected for the measurement of total bilirubin (TB), alkaline phosphatase (AP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Liver fragments were removed for morphological study. Thirty days after surgery TB, AP, ALT and AST levels were significantly increased in the hepatic duct ligation group compared to the sham operated group and the presence of SBF in the OB group was confirmed by morphological study of the liver. There was technical failure in 31.92% cases. The survival was 100% at fifteen days and 82.97% at the end of the experiment. We concluded that this simple surgical technique may be used to study the consequence of bile duct obstruction which could be a reversible process depending on the obstruction time. This technique can be carried out from cholestasis to fibrosis.

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Long-term outcomes in the repair of intrahepatic iatrogenic bile duct lesions using a combined intraglissonian and extraglissonian approach

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02188-8 ◽

2021 ◽

Author(s):

Víctor Lopez-Lopez ◽

David Ferreras ◽

Asuncion Lopez-Conesa ◽

Roberto Brusadin ◽

Jose Cutillas ◽

...

Keyword(s):

Bile Duct ◽

Long Term Outcomes ◽

Bile Duct Lesions

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Arterio-biliary fistula caused by a hepatic artery pseudoaneurysm in a recently performed liver transplant: successful resolution and long-term liver implant preservation using a covered coronary stent

CVIR Endovascular ◽

10.1186/s42155-020-00191-6 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Alfredo Páez-Carpio ◽

Elena Serrano ◽

Federico Zarco ◽

Constantino Fondevila ◽

Marta Burrel

Keyword(s):

Bile Duct ◽

Liver Transplant ◽

Hepatic Artery ◽

Biliary Fistula ◽

Coronary Stent ◽

Artery Pseudoaneurysm ◽

Hepatic Artery Pseudoaneurysm ◽

Successful Resolution ◽

Standardized Treatment

Abstract Background The formation of a hepatic artery pseudoaneurysm in a liver implant is a rare but potentially fatal complication. Fistulization of such pseudoaneurysms into the bile duct is sporadic. The most common causes of hepatic artery pseudoaneurysm are infection at the anastomosis site, inadequate surgical technique, and an iatrogenic origin due to minimally invasive procedures. Currently, there is no standardized treatment in neither of these complications, with surgery and various endovascular procedures among the alternatives available. None of these therapeutic approaches has demonstrated a significant increase in long-term liver implant preservation. Case presentation A 56-year-old man with a two-month liver transplant presented with massive upper gastrointestinal bleeding and hemobilia shortly after the performance of an endoscopic retrograde cholangiopancreatography due to the presence of a hepatic artery pseudoaneurysm with fistulization into the bile duct. This case report describes the successful treatment of both complications, the hepatic artery pseudoaneurysm and the arterio-biliary fistula, using a covered coronary stent placed in the hepatic artery. A year and a half after treatment, the patient maintains a preserved liver implant and a patent hepatic artery. Conclusions Treatment of a hepatic artery pseudoaneurysm with fistulization into bile duct using a covered coronary stent allowed the correct repair of the defect, adequate hemorrhage control, and long-term liver implant preservation.

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Pathology and Immunopathology of Primary Biliary Cirrhosis With Emphasis On Bile Duct Lesions: Recent Progress

Seminars in Liver Disease ◽

10.1055/s-2007-1007284 ◽

1995 ◽

Vol 15 (04) ◽

pp. 313-328 ◽

Cited By ~ 46

Author(s):

Yasuni Nakanuma ◽

Koichi Tsuneyama ◽

M. Gershwin ◽

Mitsue Yasoshima

Keyword(s):

Bile Duct ◽

Primary Biliary Cirrhosis ◽

Recent Progress ◽

Biliary Cirrhosis ◽

Bile Duct Lesions

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Are bile duct lesions of primary biliary cirrhosis distinguishable from those of autoimmune hepatitis and chronic viral hepatitis? Interobserver histological agreement on trimmed bile ducts

Journal of Gastroenterology ◽

10.1007/s00535-004-1514-7 ◽

2005 ◽

Vol 40 (2) ◽

pp. 164-170 ◽

Cited By ~ 17

Author(s):

Yoh Zen ◽

Kenichi Harada ◽

Motoko Sasaki ◽

Koichi Tsuneyama ◽

Kazuhiro Matsui ◽

...

Keyword(s):

Bile Duct ◽

Primary Biliary Cirrhosis ◽

Autoimmune Hepatitis ◽

Viral Hepatitis ◽

Bile Ducts ◽

Chronic Viral Hepatitis ◽

Biliary Cirrhosis ◽

Bile Duct Lesions

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Immunopathology of Bile Duct Lesions of Primary Biliary Cirrhosis

Pathology of the Bile Duct ◽

10.1007/978-981-10-3500-5_6 ◽

2017 ◽

pp. 73-84

Author(s):

Hayato Baba ◽

Ayumi Sugitani ◽

Ryusei Takahashi ◽

Kouki Kai ◽

Yuki Moritoki ◽

...

Keyword(s):

Bile Duct ◽

Primary Biliary Cirrhosis ◽

Biliary Cirrhosis ◽

Bile Duct Lesions

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Bile Acids and Deregulated Cholangiocyte Autophagy in Primary Biliary Cholangitis

Digestive Diseases ◽

10.1159/000450913 ◽

2017 ◽

Vol 35 (3) ◽

pp. 210-216 ◽

Cited By ~ 9

Author(s):

Motoko Sasaki ◽

Yasuni Nakanuma

Keyword(s):

Bile Duct ◽

Er Stress ◽

Bile Acids ◽

Cellular Senescence ◽

Primary Biliary Cholangitis ◽

Biliary Cirrhosis ◽

Chemical Chaperone ◽

Abnormal Expression ◽

Bile Duct Lesions ◽

Mitochondrial Antigens

Background: Primary biliary cholangitis (PBC) is characterized by a high prevalence of serum anti-mitochondrial antibodies against the E2 subunit of the pyruvate dehydrogenase complex and bile duct lesions called chronic non-suppurative destructive cholangitis (CNSDC) in small bile ducts, eventually followed by extensive bile duct loss and biliary cirrhosis. Macroautophagy (a major type of autophagy) is a process of cellular self-digestion that plays a critical role in energy homeostasis and in the cytoprotection to various stresses. Deregulated autophagy is thought to be associated with various human diseases. Key Messages: Accumulating evidences suggest that deregulated autophagy may be a central player in the pathogenesis of PBC. Damaged cholangiocytes involved in CNSDC show vesicular expression of autophagy marker LC3 and accumulation of p62/sequestosome-1, suggesting deregulated autophagy. Deregulated autophagy may be involved in the autoimmune process via the abnormal expression of mitochondrial antigens and also in cholangiocyte senescence in bile duct lesions in PBC. In vitro study showed that hydrophobic bile acids, such as glycochenodeoxycholic acid (GCDC), as well as serum deprivation and oxidative stress, cause autophagy, deregulated autophagy and abnormal expression of mitochondrial antigens followed by cellular senescence in cholangiocytes. Although exact mechanisms of deregulated autophagy remain to be clarified, endoplasmic reticulum (ER) stress may be a plausible cause of deregulated autophagy induced by GCDC in cholangiocytes. Impaired ‘biliary bicarbonate umbrella' may further exacerbate the toxicity of GCDC to cholangiocytes. Interestingly, pretreatment with ursodeoxycholic acid (UDCA) and tauro-UDCA, which is a chemical chaperone enhancing the adaptive capacity of the ER, significantly suppressed ER stress, deregulated autophagy and cellular senescence induced by GCDC and other stresses in cholangiocytes. Conclusions: GCDC may play a role in the occurrence of deregulated autophagy and cellular senescence at least partly through the induction of ER stress in PBC. Deregulated autophagy and cellular senescence can be a promising therapeutic target in PBC.

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Alteration of energy metabolism in the pathogenesis of bile duct lesions in primary biliary cirrhosis

Journal of Clinical Pathology ◽

10.1136/jclinpath-2013-201815 ◽

2013 ◽

Vol 67 (5) ◽

pp. 396-402 ◽

Cited By ~ 3

Author(s):

Kenichi Harada ◽

Yuko Kakuda ◽

Yasunori Sato ◽

Hiroko Ikeda ◽

Shinji Shimoda ◽

...

Keyword(s):

Energy Metabolism ◽

Bile Duct ◽

Primary Biliary Cirrhosis ◽

Biliary Cirrhosis ◽

Bile Duct Lesions

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Long-Term Impact of Iatrogenic Bile Duct Injury

Digestive Surgery ◽

10.1159/000496432 ◽

2019 ◽

Vol 37 (1) ◽

pp. 10-21 ◽

Cited By ~ 12

Author(s):

Anne Marthe Schreuder ◽

Olivier R. Busch ◽

Marc G. Besselink ◽

Povilas Ignatavicius ◽

Antanas Gulbinas ◽

...

Keyword(s):

Surgical Treatment ◽

Bile Duct ◽

Clinical Outcomes ◽

Bile Duct Injury ◽

Surgical Revision ◽

Biliary Cirrhosis ◽

Long Term Outcome ◽

Anastomotic Strictures ◽

Long Term Impact

Background: Bile duct injury (BDI) is a devastating complication following cholecystectomy. After initial management of BDI, patients stay at risk for late complications including anastomotic strictures, recurrent cholangitis, and secondary biliary cirrhosis. Methods: We provide a comprehensive overview of current literature on the long-term outcome of BDI. Considering the availability of only limited data regarding treatment of anastomotic strictures in literature, we also retrospectively analyzed patients with anastomotic strictures following a hepaticojejunostomy (HJ) from a prospectively maintained database of 836 BDI patients. Results: Although clinical outcomes of endoscopic, radiologic, and surgical treatment of BDI are good with success rates of around 90%, quality of life (QoL) may be impaired even after “clinically successful” treatment. Following surgical treatment, the incidence of anastomotic strictures varies from 5 to 69%, with most studies reporting incidences around 10–20%. The median time to stricture formation varies between 11 and 30 months. Long-term BDI-related mortality varies between 1.8 and 4.6%. Of 91 patients treated in our center for anastomotic strictures after HJ, 81 (89%) were treated by percutaneous balloon dilatation, with a long-term success rate of 77%. Twenty-four patients primarily or secondarily underwent surgical revision, with recurrent strictures occurring in 21%. Conclusions: The long-term impact of BDI is considerable, both in terms of clinical outcomes and QoL. Treatment should be performed in tertiary expert centers to optimize outcomes. Patients require a long-term follow-up to detect anastomotic strictures. Strictures should initially be managed by percutaneous dilatation, with surgical revision as a next step in treatment.

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