A case of anomalous arrangement of pancreaticobiliary duct associated with common bile duct cyst and double common hepatic duct.

Abstract Introduction Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1–5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. Case Report 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. Case Report 2 A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Result Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Conclusions Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.

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Congenital common bile duct cyst

Journal of Pediatric Surgery Case Reports ◽

10.1016/j.epsc.2019.01.001 ◽

2019 ◽

Vol 43 ◽

pp. 8-10

Author(s):

Fadi Rayya ◽

Maram Balouli ◽

Yusra Alshaikha

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Duct Cyst ◽

Bile Duct Cyst

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The Value of Cholangiography through Jackson-Pratt Drains in the Management of Postoperative Biliary Injuries

The American Surgeon ◽

10.1177/000313481408000126 ◽

2014 ◽

Vol 80 (1) ◽

pp. 66-71 ◽

Cited By ~ 1

Author(s):

Francisco Igor B. Macedo ◽

Victor J. Casillas ◽

James S. Davis ◽

Joe U. Levi ◽

Danny Sleeman

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Common Hepatic Duct ◽

Biliary Reconstruction ◽

Biliary Injury ◽

Endoscopic Retrograde ◽

Distal Common Bile Duct ◽

Potential Benefits

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

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Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2018.v02.i01.p02 ◽

2018 ◽

Vol 2 (1) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Made Mahayasa ◽

Tommy Lesmana

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Gall Bladder ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Common Hepatic Duct ◽

Hepatic Bile ◽

Hepatic Bile Duct

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.

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Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

Anatomy Research International ◽

10.1155/2015/412595 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Usha Dandekar ◽

Kundankumar Dandekar ◽

Sushama Chavan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Artery ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Normal Anatomy ◽

Surgical Safety ◽

Right Hepatic Artery ◽

The Common ◽

The Right

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

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Photodynamic therapy of extrahepatic cholangiocarcinoma using digital cholangioscopy

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020190001e1490 ◽

2020 ◽

Vol 33 (1) ◽

Author(s):

Vítor Ottoboni BRUNALDI ◽

José Eduardo BRUNALDI ◽

José Dirceu VOLLET-FILHO ◽

Mariangela Ottoboni BRUNALDI ◽

José Celso ARDENGH ◽

...

Keyword(s):

Photodynamic Therapy ◽

Bile Duct ◽

Common Bile Duct ◽

Laser Light ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Direct Visualization ◽

Extrahepatic Cholangiocarcinoma ◽

Adjunct Treatment ◽

The Common

ABSTRACT Background: Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction. Aim: To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source. Method: Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events. Result: This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session. Conclusion: Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.

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A Rare Cause of Acute Abdomen in Children: Spontaneous Rupture of Choledochal Cyst Causing Peritonitis

Gastroenterology Pancreatology and Hepatobilary Disorders ◽

10.31579/2641-5194/029 ◽

2021 ◽

Vol 5 (3) ◽

pp. 01-04

Author(s):

Ozlem Kadirhan ◽

Sonay Aydin ◽

Mecit Kantarci

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Acute Abdomen ◽

Spontaneous Rupture ◽

Duct Cyst ◽

Cyst Excision ◽

Bile Duct Cyst ◽

Increased Risk ◽

History Of ◽

Pancreatic Reflux

Spontaneous rupture of the common bile duct cyst is a rare cause of acute abdomen in children. In our case, we present a 3-year-old patient with no history of trauma, whose diagnosis was confirmed by laparotomy, with a possible suspected common bile duct cyst due to massive ascites and a cystic lesion in the portal area. Although common bile duct cysts are mostly asymptomatic, various studies have shown that malignant transformation can cause important complications such as pancreatitis.Numerous causes have been suggested in the etiopathogenesis of rupture, such as parietal necrosis associated with pancreatic reflux irritation.Since rupture of cysts may require urgent laparotomy such as biliary peritonitis, it is important to know imaging findings that may be warning for early diagnosis. Because of the increased risk of cholangiocarcinoma after cyst excision, cholecystectomy and Roux-en-Y hepaticojejunostomy are the most common treatment procedures.

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Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.7.55 ◽

2001 ◽

Vol 7 (2) ◽

pp. 55-61 ◽

Cited By ~ 2

Author(s):

Tatsuya Aoki ◽

Akihiko Tsuchida ◽

Hitoshi Saito ◽

Yuichi Nagakawa ◽

Keiichi Kitamura ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Bile Duct Injury ◽

Cystic Duct ◽

Hepatic Duct ◽

Common Hepatic Duct ◽

Tube Drainage ◽

T Tube ◽

Aberrant Bile Duct

We encountered 10 patients with bile duct injuries during laparoscopic cholecystectomy. Their causes were electrocautery in 2 patients, misjudgment in 2, mechanical injury in 3, aberrant bile duct in 2, and weakness of the bile duct wall in one. The sites of injury were cystic duct in 4 patients, common bile duct in 2, aberrant bile duct in 2, common hepatic duct in one, and common bile duct plus right hepatic duct in one. Treatments for the injuries discovered intraoperatively consisted of T-tube drainage above in 2 patients, re-ligation of the cystic duct in one, ligation of an aberrant bile duct in one, simple suture and T-tube in one, and choledochojejunostomy in one. In the remaining 4 patients discovered postoperatively, 2 were conservatively treated by endoscopic retrograde biliary drainage. The duration of hospitalization was 9–12 days in the 4 patients with simple suture or ligation, 10–21 days in 2 cases of bile drainage, and 34–43 days in 3 with T-tube drainage. The patient with choledochojejunostomy suffered repeated cholangitis, resulting in hepatic abscess with hospitalization for 6 months. Since laparoscopic surgery should be minimally invasive, meticulous attention is necessary before and during surgery to avoid bile duct injury.

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Endoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.3.35 ◽

1996 ◽

Vol 3 (1) ◽

pp. 35-40 ◽

Cited By ~ 2

Author(s):

Q. L. Zhang ◽

W. D. Nian ◽

L. P. Zhang ◽

J. Y. Liang

Keyword(s):

Bile Duct ◽

Liver Metastasis ◽

Common Bile Duct ◽

Endoscopic Ultrasonography ◽

Hepatic Duct ◽

Bile Duct Carcinoma ◽

Ampullary Carcinoma ◽

Common Hepatic Duct ◽

Regional Lymph Nodes ◽

Duct Carcinoma

From 1989 through 1992, endoscopic ultrasonography (EUS) was undertaken preoperatively to evaluate the extent of primary tumor, involvement of regional lymph nodes, and distant metastases in 22 patients with ampullary carcinoma and 18 patients with bile duct carcinoma. The results were compared with histopathological findings according to the TNM staging system. The accurate rate in assessing the extent of cancer invasion was 82% for ampullary carcinoma, 66% for common hepatic duct carcinoma, and 78% for common bile duct carcinoma. The accuracy of EUS in predicting regional lymph node metastasis was 59% for ampullary carcinoma, 56% for common hepatic duct carcinoma, and 67% for common bile duct carcinoma. Invasion of the portal vein was correctly predicted by EUS in 2 of 3 patients. None of the 3 patients with liver metastasis was detected by EUS. Therefore, endoscopic ultrasonography is an effective method in the evaluation of the extent of cancer invasion of ampullary and bile duct carcinoma as well as the involvement of regional lymph nodes preoperatively. However, due to its limited penetration depth, EUS is inadequate in the assessment of liver metastasis.

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