PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY IN THE DIAGNOSTICS OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE*

2021 ◽  
Vol 8 (2) ◽  
pp. 62-67
Author(s):  
Valeriy V. Boyko ◽  
Yuriy V. Avdosyev ◽  
Anastasiia L. Sochnieva ◽  
Denys O. Yevtushenko ◽  
Dmitro V. Minukhin
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Percutaneous Transhepatic Cholangiography ◽  
Biliary Decompression ◽  
Biliodigestive Anastomosis ◽  
Bile Duct Diseases

Aim: Evaluation of the effectiveness of percutaneous transhepatic cholangiography in the diagnostics of bile duct diseases complicated by obstructive jaundice. Material and methods: This article presents the experience of using percutaneous transhepatic cholangiography in 88 patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Results: Methods of direct contrasting of the biliary tract make it possible to visualize choledocholithiasis with 86.5% accuracy, with 84.1% common bile duct strictures, with 87.8% stricture of biliodigestive anastomosis and with 97.5% accuracy of cholangiocarcinomas. Conclusions: Direct antegrade bile duct enhancement should be used if ERCPG has low explanatory value. PTCG in case of “endoscopically complicated forms” of choledocholithiasis, CBD and BDA strictures and cholangiocarcinomas enhances all bile duct sections and helps assess the level and completeness of biliary blockade. Following PTCG, measures can be taken to achieve biliary decompression regardless of OJ genesis.

scholarly journals TREATMENT OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE (review)

2018 ◽  
Vol 5 (2) ◽  
pp. 84-92
Author(s):  
A. Sochnieva
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Hepatic Impairment ◽  
Life Quality ◽  
Biliary Tree ◽  
Biliary Decompression ◽  
Surgical Interventions ◽  
Bile Duct Diseases

TREATMENT OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE (review)Sochneva A.L.The article presents the up-to-date data concerning the treatment of common bile duct diseases complicated by obstructive jaundice. Nowadays, specialized clinics widely use mini-invasive interventions to treat this complicated pathology. Biliary tree decompression is the main objective of operative treatment. It is reasonable to perform antegrade and retrograde endobiliary interventions as preparatory and final stages of surgical treatment and in order to improve the patients’ life quality and avoid hepatic impairment progression. Reconstructive-reparative operations following prior biliary decompression yield significantly better results as compared to surgical interventions without it.Key words: common bile duct diseases, obstructive jaundice, antegrade interventions, retrograde interventions, reconstructive-reparative operations. ЛІКУВАННЯ ЗАХВОРЮВАНЬ ГЕПАТИКОХОЛЕДОХА, УСКЛАДНЕНИХ МЕХАНІЧНОЮ ЖОВТЯНИЦЕЮ (огляд літератури)Сочнева А.Л.У статті висвітлені сучасні дані по лікуванню захворювань гепатикохоледоха, ускладнених механічною жовтяницею. В даний час в спеціалізованих клініках широко застосовуються мініінвазивні втручання в лікуванні такої складної патології. Декомпресія біліарного дерева є основною метою при виконанні оперативних втручань. Антеградний і ретроградні ендобіліарні втручання доцільно застосовувати в якості як підготовчого, так і завершального етапів хірургічного лікування, а також поліпшити якість життя хворих і уникнути прогресування печінкової недостатності. Виконання реконструктивно-відновлювальні операцій після попередньої біліарної декомпресії демонструє значно кращі результати в порівнянні з оперативними втручаннями, виконаними без неї.Ключові слова: захворювання гепатикохоледоха, механічна жовтяниця, антеградний втручання, ретроградні втручання, реконструктивно-відновлювальні операції. Лечение заболеваний гепатикохоледоха, осложненных механической желтухой: обзор литературы ЛЕЧЕНИЕ ЗАБОЛЕВАНИЙ ГЕПАТИКОХОЛЕДОХА, ОСЛОЖНЕННЫХ МЕХАНИЧЕСКОЙ ЖЕЛТУХОЙ (обзор литературы)Сочнева А.Л.В статье освещены современные данные по лечению заболеваний гепатикохоледоха, осложненных механической желтухой. В настоящее время в специализированных клиниках широко применяются миниинвазивные вмешательства в лечении столь сложной патологии. Декомпрессия билиарного дерева является основной целью при выполнении оперативных вмешательств. Антеградные и ретроградные эндобилиарные вмешательства целесообразно применять в качестве как подготовительного, так и завершающего этапов хирургического лечения, а также улучшить качество жизни больных и избежать прогрессирования печеночной недостаточности. Выполнение реконструктивно-восстановительные операций после предварительной билиарной декомпрессии демонстрирует значительно лучшие результаты в сравнении с оперативными вмешательствами, выполненными без нее.Ключевые слова: заболевания гепатикохоледоха, механическая желтуха, антеградные вмешательства, ретроградные вмешательства, реконструктивно-восстановительные операции.

scholarly journals OPTIMUM DURATION OF PERCUTANEOUS TRANSHEPATIC CHOLANGIODRAINAGE IN COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE

2020 ◽  
Vol 73 (9) ◽  
pp. 1915-1925
Author(s):  
Anastasiia L. Sochnieva
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Total Bilirubin ◽  
Biliary Decompression ◽  
Bile Duct Diseases ◽  
Optimum Duration ◽  
Percutaneous Transhepatic Cholangiodrainage ◽  
Group 3 ◽  
Group 2

The aim: Is to determine the optimum duration of percutaneous transhepatic cholangiodrainage depending on the duration of obstructive jaundice and the baseline total bilirubin level in patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Materials and methods: The experience of applying percutaneous transhepatic cholangiodrainage was combined for 88 patients with common bile duct diseases complicated by obstructive jaundice. The patients were divided into three groups: the Group 1 included 15 patients (17.1%) with benign common bile duct diseases, the Group 2 included 11 patients (12.5%) with resectable cholangiocarcinomas, and the Group 3 included 62 patients (70.4%) with unresectable cholangiocarcinomas. To determine optimal terms of biliary decompression using percutaneous transhepatic cholangiodrainage, the Poisson process was applied, and, to be more precise, the quasi-Poisson distribution. Results: It was found that the reduction of total bilirubin was the fastest in Group 3 patients. It took these patients an average of 7-8 days to reduce total bilirubin to 50 μmole/l. In Group 1 patients, the process is somewhat slower. The duration of biliary decompression in this category of patients averages 10-12 days. For Group 2 patients, biliary decompression requires at least 12 days. Conclusions: Using the Poisson process, or, to be more precise, the quasi-Poisson distribution, we managed to determine the optimum duration of biliary decompression using percutaneous transhepatic cholangiodrainage depending on the obstructive jaundice duration and the baseline total serum bilirubin.

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 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 THE USE OF ANTEGRADE ENDOBILIARY INTERVENTIONS IN BENIGN DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

2021 ◽  
pp. 10-12
Author(s):  
D. O. Yevtushenko ◽  
I. A. Taraban ◽  
Yu. V. Avdosyev ◽  
A. L. Sochneva ◽  
D. V. Minukhin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Biliary Tract ◽  
Endoscopic Treatment ◽  
Percutaneous Transhepatic Cholangiography ◽  
Benign Diseases ◽  
Biliary Decompression ◽  
Unsuccessful Attempt ◽  
Biliodigestive Anastomosis ◽  
Percutaneous Transhepatic Cholangiodrainage ◽  
The Right

Introduction. One of the most common manifestations of diseases of the biliary tract are strictures or stenoses. They can have malignant, inflammatory and traumatic etiology, as well as be accompanied by mechanical jaundice syndrome. Aim. To study the results of the use of antegrade endobiliary interventions in benign diseases of the biliary tract complicated by mechanical jaundice. Materials and methods. An analysis of surgical treatment of 34 patients with benign diseases of the biliary tract complicated by mechanical jaundice (MJ) in the SI “V.T. Zatsev IGUS NAMSU». Choledocholithiasis was the cause of MF in 21 (61.8 %) cases, stricture of the LV in 6 (17.6 %) and stricture of the biliodigestive anastomosis (BDA) in 7 (20.6 %) patients. BDA strictures developed after the following operations: biliobiliostomy — 1 (14.3 %), hepaticojejunostomy — 3 (42.9 %), choledochoduodenoanastomosis — 2 (28.5 %) and hepaticoduodenostomy — 1 (14.3 %) %). Research results. External percutaneous transhepatic cholangiodrainage was performed in 7 (46.7 %) patients, external-internal percutaneous transhepatic cholangiodrainage was performed in 6 (40 %), percutaneous transhepatic cholecystostomy was performed in 2 (13.4 %) patients. With slightly dilated intrahepatic ducts (<5 mm) cholangiodrainage was established in 3 (20 %) patients. Of these, in 3 (20.0 %) cases, a separate percutaneous transhepatic cholangiodrainage of the right and left lobular ducts of the liver was performed. Performing percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage allows to determine the level and nature of biliary block in a minimally invasive way, to perform biliary decompression and prevention of complications after an unsuccessful attempt at endoscopic treatment. Conclusions. By using antegrade endobiliary interventions, we were able to reduce the risk of biliary decompression complications compared with patients who had unsuccessful attempts at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), and to reduce the number of complications after reconstructive rehabilitation. operations from 10 (52.6 %) to 1 (6.67 %) and the mortality rate from 2 (10.5 %) to 1 (6.67 %).

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.

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