Modern approaches to the treatment of mechanical jaundice on the background of malignant damage of the pancreatobiliary zone

2021 ◽  
Vol 22 (1) ◽  
pp. 128-131
Author(s):  
N. A. Borodin ◽  
◽  
G. A. Petukhova ◽  
E. U. Zaitsev ◽  
I. A. Leimanchenko ◽  
...  
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Bile Ducts ◽  
Malignant Lesion ◽  
Diagnosis And Treatment ◽  
Intrahepatic Bile Ducts ◽  
Cancer Of The Pancreas ◽  
Bile Duct Stenting ◽  
Endoscopic Methods

Aim. To study the role of tumors of the pancreatobiliary zone in the development of obstructive jaundice. To evaluate the effectiveness of endoscopic methods of diagnosis and treatment of this pathology. Materials and methods. The study is based on the results of the activities of JSC “MSU Neftyanik” in Tyumen for 2011-2020. During this period, 1284 patients with obstructive jaundice were admitted for emergency indications. Of this number, 181 patients had signs of cancerous lesions of the organs of the pancreatobiliary zone. The results obtained were used to evaluate effective endoscopic methods of diagnosis and treatment of patients in this group. Results. Malignant lesion of the pancreatobiliary zone is 14.3% of all cases of emergency treatment of patients with obstructive jaundice. The main cause is cancer of the pancreas, cancer of the bile ducts, as well as cancer of the large duodenal papilla and compression of the bile ducts “from the outside”. Performing emergency duodenoscopy on the first day after admission of patients made it possible to accurately verify the cancerous nature of the disease in the vast majority of patients. The most effective method for the relief of biliary hypertension syndrome in this group is bile duct stenting. Despite the varied nature of the cancer lesion, effective stenting was achieved in 71.3% of patients. If it is technically impossible to carry out stenting, minimally invasive puncture catheterization of the intrahepatic bile ducts is performed. Conclusion. Currently, cancer of the pancreatobiliary zone was established in every 5-7 patients with obstructive jaundice. Emergency duodenoscopy and ERCH is an effective diagnostic method that allows you to verify the “cancerous” nature of jaundice with a probability close to 100%. The most effective method of bile duct decompression in this group of patients is endoscopic transpapillary stenting.

scholarly journals Granulomatous Cholangitis Mimicking Hilar Cholangiocarcinoma: A Case Report

2020 ◽  
Author(s):  
Shigeru Fujisaki ◽  
Motoi Takashina ◽  
Ken-ichi Sakurai ◽  
Ryouichi Tomita ◽  
Tadatoshi Takayama
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Fungal Infection ◽  
Hilar Cholangiocarcinoma ◽  
Bile Ducts ◽  
Fungal Infections ◽  
Resected Specimen ◽  
Unique Case ◽  
Intrahepatic Bile Ducts ◽  
Serum Igg4

Abstract Background:Hilar biliary stricture caused by isolated fungal infections in immunocompetent patients are considered to be extremely rare and difficult to the diagnose from the outset.Case presentation:We report a unique case of granulomatous cholangitis based on isolated biliary fungal infection manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. A 67-year-old Japanese woman was referred to our hospital for obstructive jaundice. She had been followed up for hypochondroplasia by the referring physician. Her total bilirubin level was 5.4 mg/dL. Viral hepatitis screening was found to be negative, and serum IgG4 was within normal limits; however, her CA19-9 level was high. Abdominal computed tomography revealed dilatation of the intrahepatic bile ducts. Abdominal echogram detected a solid mass in the hilar bile duct. Her magnetic resonance cholangiopancreatography has also revealed an abrupt stenosis of the primary biliary confluence with upstream dilatation of the intrahepatic bile ducts. Endoscopic nasobiliary drainage was then performed to improve the obstructive jaundice. Although biliary cytology did not reveal malignant findings, the bile duct in the hilum showed severe stenosis, and hilar cholangiocarcinoma could not be completely excluded. The patient had a developmental disorder based on chondrodystrophy. To avoid excessive surgical stress, such as hepatic lobectomy, we performed resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy reconstruction. Intraoperative frozen sections of the resection margins were determined to be negative for tumor. The resected specimen showed multiple strictures inside the common bile duct, numerous calculi in the lumen, and little free space. The final pathological diagnosis was granulomatous cholangitis due to fungal infection. The patient’s postoperative course was deemed uneventful. She was discharged from our hospital 23 days after surgery without antifungal treatment.Conclusions:For a unique case of granulomatous cholangitis based on isolated biliary fungal infection mimicking hilar cholangiocarcinoma, we were able to avoid excessive invasion and performed appropriate surgical management.

scholarly journals Granulomatous cholangitis mimicking hilar cholangiocarcinoma: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shigeru Fujisaki ◽  
Motoi Takashina ◽  
Ken-ichi Sakurai ◽  
Ryouichi Tomita ◽  
Tadatoshi Takayama
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Fungal Infection ◽  
Hilar Cholangiocarcinoma ◽  
Bile Ducts ◽  
Fungal Infections ◽  
Resected Specimen ◽  
Unique Case ◽  
Intrahepatic Bile Ducts ◽  
Serum Igg4

Abstract Background Hilar biliary stricture caused by isolated fungal infections in immunocompetent patients are considered to be extremely rare and difficult to the diagnose from the outset. Case presentation We report a unique case of granulomatous cholangitis based on isolated biliary fungal infection manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. A 67-year-old Japanese woman was referred to our hospital for obstructive jaundice. She had been followed up for hypochondroplasia by the referring physician. Her total bilirubin level was 5.4 mg/dL. Viral hepatitis screening was found to be negative, and serum IgG4 was within normal limits; however, her CA19-9 level was high. Abdominal computed tomography revealed dilatation of the intrahepatic bile ducts. Abdominal echogram detected a solid mass in the hilar bile duct. Her magnetic resonance cholangiopancreatography has also revealed an abrupt stenosis of the primary biliary confluence with upstream dilatation of the intrahepatic bile ducts. Endoscopic nasobiliary drainage was then performed to improve the obstructive jaundice. Although biliary cytology did not reveal malignant findings, the bile duct in the hilum showed severe stenosis, and hilar cholangiocarcinoma could not be completely excluded. The patient had a developmental disorder based on chondrodystrophy. To avoid excessive surgical stress, such as hepatic lobectomy, we performed resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy reconstruction. Intraoperative frozen sections of the resection margins were determined to be negative for tumor. The resected specimen showed multiple strictures inside the common bile duct, numerous calculi in the lumen, and little free space. The final pathological diagnosis was granulomatous cholangitis due to fungal infection. The patient’s postoperative course was deemed uneventful. She was discharged from our hospital 23 days after surgery without antifungal treatment. Conclusions For a unique case of granulomatous cholangitis based on isolated biliary fungal infection mimicking hilar cholangiocarcinoma, we were able to avoid excessive invasion and performed appropriate surgical management.

scholarly journals Anomalous choledocho-pancretic ductal junction in a choledochal cyst: A case report

2004 ◽  
Vol 132 (5-6) ◽  
pp. 179-181
Author(s):  
Miodrag Jovanovic ◽  
Dragoljub Bilanovic ◽  
Radoje Colovic ◽  
Nikica Grubor ◽  
Milenko Ugljesic
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Bile Ducts ◽  
Postoperative Recovery ◽  
Biliary Colic ◽  
Duodenal Wall ◽  
Choledochal Cysts ◽  
Bile Duct Wall ◽  
Intrahepatic Bile Ducts ◽  
Inflammatory Changes

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincterand outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y jejunal limb was carried out. In February 1990, she was admitted to our Institution for jaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.

Gallstones and Biliary Tract Emergencies

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

scholarly journals Preservation injury of the distal extrahepatic bile duct of donor livers is representative for injury of the intrahepatic bile ducts

2015 ◽  
Vol 63 (1) ◽  
pp. 284-287 ◽  
Author(s):  
Negin Karimian ◽  
Pepijn D. Weeder ◽  
Fernanda Bomfati ◽  
Annette S.H. Gouw ◽  
Robert J. Porte
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Ducts ◽  
Preservation Injury

scholarly journals Multiple Biliary Papillomatosis

HPB Surgery ◽  
1992 ◽  
Vol 6 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Mustafa Tireli ◽  
Adam Uslu
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Bile Ducts ◽  
Malignant Potential ◽  
Low Grade ◽  
Biliary Papillomatosis ◽  
Extrahepatic Bile Ducts

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary papillomatosis treated surgically with a transhepatic stent.Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis with obstructive jaundice is presented.

scholarly journals FIBROCHOLODOSCOPY IN DIAGNOSTICS AND TREATMENT OF COMPLEX FORMS OF CHOLEDOCHOLITHIASIS

2019 ◽  
Vol 21 (1) ◽  
pp. 43-46
Author(s):  
K V Pavelets ◽  
A K Ushkats ◽  
D V Gacko
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Surgical Procedures ◽  
Bile Ducts ◽  
Diagnosis And Treatment ◽  
The Common ◽  
Complex Forms

Relevance of the topic: endoscopic intraoperative choledochoscopy with traditional surgical procedures is a highly informative research in the diagnosis and treatment of choledocholithiasis. Objective: to evaluate the effectiveness of intraoperative use of fibrocholedochoscopy in the diagnosis and treatment of "complex" forms of choledocholithiasis. Materials and methods: Between 2011 and 2017, 88 patients underwent treatment for "complicated" forms of choledocholithiasis using intraoperative fibrocholedochoscopy. Results: after dissection of the choledochal wall and extraction of large concrements from the lumen, a fibrocholedochoscopy was performed. The fibrocholedochoscope was inserted into the lumen of the common bile duct through a formed opening with examination of the biliary tract. An obligatory condition for assessing the permeability of the distal sections of the bile ducts was the carrying out of an endoscope through the OBD zone. The remaining remaining calculi were recovered with the help of Dormia baskets (15 (17%) cases). In 86 (97.7%) patients, the operation is completed by the imposition of a hollow stitch of choledoch (priority reference No. 2018122530, 2018). Conclusion: fibrocholedochoscopy in the treatment of complex forms of choledocholithiasis allows to methodically evaluate the biliary tract, perform lithoextraction from the proximal and distal sections.

scholarly journals Intrahepatic Transposition of Bile Ducts

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Jasmin Delić ◽  
Admedina Savković ◽  
Eldar Isaković ◽  
Sergije Marković ◽  
Alma Bajtarevic ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Anatomical Variation ◽  
Intrahepatic Bile Duct ◽  
Main Research ◽  
Intrahepatic Bile Ducts ◽  
Anatomical Terminology ◽  
Segment Viii ◽  
Safe Performance

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

scholarly journals COMPARATIVE ASSESSMENT OF BILE DUCT DECOMPRESSION METHODS IN PATIENTS WITH OBSTRUCTIVE JAUNDICE OF NON-TUMOR GENESIS

2019 ◽  
Vol 72 (7) ◽  
pp. 1247-1252
Author(s):  
Oleg Y. Kanikovskyi ◽  
Yaroslav V. Karyi ◽  
Yura V. Babiichuk ◽  
Yevhen V. Shaprynskyi
Keyword(s):  
Alkaline Phosphatase ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Bile Ducts ◽  
Biliary Duct ◽  
Biliary Decompression ◽  
External Drainage ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world’s population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis. Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days. Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier. Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.

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