Biliary Communication Research Articles

Pre operative predictors for cysto biliary communication in patients with hepatic hydatid disease

Pre operative predictors for cysto biliary communication in patients with hepatic hydatid disease

Surgical treatment of Abdominal Echinococcosis

Background: Cystic Echinococcosis is a zoonosis with worldwide geographical distribution caused by dog tapeworm. Cystic echinococcosis most frequently involves only one organ by forming a solitary cyst. Hydatid disease commonly involves the liver (75%) and lungs (15%), followed by other regions of the body (10-15%). Multi-organ abdominal HD is the most serious form and is potentially fatal.Methods: It is a retrospective study for a duration of 3 years. The recorded data of all the patients undergoing treatment has been collected and analyzed.Results: A total of 30 patients were identified. Most common organ involved was liver followed by spleen, pancreas and kidney. Cysts are more commonly seen in right lobe. All the patients underwent surgical treatment. 17 patients underwent open surgery, while 13 patients were treated by laparoscopy. Cysto biliary communication was identified in 3 patients, all in laparoscopy and a primary closure was done. All the patients were started on albendazole 400 mg twice daily per oral at least 15 days prior to surgery and this treatment was continued for 3 months post-operatively.Conclusions: Hydatid disease is endemic in sheep farming and cattle farming areas of Asia. Most patients remain asymptomatic for years. Diagnosis is by imaging techniques. Echinococcal infection usually requires multimodality treatment and the best treatment is always individualized. Surgery along with anti-helminthic treatment holds the best curative measure at present.

Laparoscopic management of hydatid cysts with biliary communication: Clips may rescue when suture fails-report of 3 cases.

Hydatid disease is a parasitic zoonosis caused by the larval form of the Echinococcus worm. Hepatic hydatidosis is the most common form of disease in humans. Centrally located, large hydatid cysts have the tendency to rupture into the adjoining bile duct and form a fistulous communication. Suture closure of the cystobiliary communication detected during surgery is recommended to avoid postoperative complications related to bile leak. In the era of minimally invasive surgery, laparoscopic management of the cystobiliary communication can be challenging, and laparoscopic suturing may not always be feasible. Postoperative endoscopic biliary decompression is necessary in such situations, but it has its own set of potential risk and complications. In this case report, we present a simple and easy technique for laparoscopic closure of the cystobiliary communication when suture ligation is technically not possible.

Management of cystobiliary communication in hepatic hydatidosis

Aim: Communication to the bile duct is the most common complication of hepatic echinococcosis.As non surgical treatment options have no primary role in the management of hepatic hydatidosis with cysto biliary communication, optimization of the surgical approach is imperative. Materials and methods: Medical records of 22 patients who underwent surgical management of Hydatid cyst of liver with cystobiliarycommunication analysed retrospectively.Study Period - between January 2013 and October 2016.All patients were followed up for a period of atleast 2 months to 36 months. Readmission and recurrences were evaluated Results: Cystobiliary communication could be identified pre operatively in 9 out of the 22 patients whereas in the rest it was made intraoperatively.Cyst evacuation with omentoplasty and partial pericystectomy were considered as conservative surgeries whereas total cystopericystectomy and right or left hemi hepatectomies were considered as radical procedures. 2 patients who were offered conservative surgical treatment underwent post op ERCP.CBD exploration and T tube placement was necessitated in 7 patients. Conclusion: Treatment options are multiple. While conservative approaches carried a small but significantly high incidence of recurrence, radical surgery has its own disadvantages in terms of prolonged operating time, higher blood loss and in its need for a HPB surgeon. The need for CBD exploration and T tube drainage was comparable in both approaches. Larger studies are needed to formulate a protocol.

Large Amoebic Liver Abscess with Persistent Biliary Fistula

ABSTRACT Liver abscess with biliary communication poses management problem if percutaneous drainage is performed. We report a case of large amoebic liver abscess (ALA) with jaundice. Prolonged high‑output bile drainage after percutaneous drainage of ALA showed suspicion of communication of abscess with intrahepatic bile ducts (biliary fistula). The same was managed successfully with endoscopic biliary stent placement with medical management.

Cysto-cholecystostomy: A More Physiological Procedure for Hepatic Cysts with Biliary Communications and Cystic Dilatations of Main Intrahepatic Ducts.

Hepatic cysts with biliary communications (HC) and cystic dilatations of main intrahepatic ducts (CIHD) can cause biliary obstruction, cholestasis, stone formation, cholangitis, liver damage and carcinoma. Conventionally, Roux-Y cysto-jejunostomy is employed to manage these conditions. However, it is technically demanding and may be complicated with major biliary disruption and bacteria migration from intestine to intrahepatic duct. We have carried out laparoscopic cysto-cholecystostomies for HC with biliary communication and CIHD and evaluated outcomes. Twenty patients with HC (n=10) or CIHD (n=10) who successfully underwent laparoscopic cysto-cholecystostomies in our center, between September 2010 and March 2017, were reviewed. The mean age of the patients at surgery was 2.06 and 2.23years for HC and CIHD groups, respectively. Eighteen patients were symptomatic, with abdominal pain, fever, vomiting and jaundice. Laboratory results showed abnormal liver functions in 8 patients. Pathological results verified hepatic cellular damages in 8 patients. The mean operative time was 0.97 and 0.92h for HC and CIHD patients, respectively. The median follow-up duration was 27months (1-54months) and 35months (1-79months) for HC and CIHD groups, respectively. No patient developed bile leak, anastomotic stenosis, stone formation or cholangitis. Liver function normalized postoperatively. Laparoscopic cysto-cholecystostomy is a simpler and more physiological surgical alternative for managing HC with biliary communication and CIHD.

Surgery for Hepatic Hidatidosis. Risk Factors and Variables Associated with Postoperative Morbidity. Overview of the Existing Evidence

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis.A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS.1087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors.Risk and protective factors were identified; however, the studies are few and the quality moderate to low.

Cirugía de la hidatidosis hepática. Factores de riesgo y variables asociadas al desarrollo de morbilidad postoperatoria. Revisión global de la evidencia existente

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis.A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS.1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors.Risk and protective factors were identified; however, the studies are few and the quality moderate to low.

Endoscopic Biliary Drainage in an Amoebic Liver Abscess (ALA) With Persistent Biliary Communication

Endoscopic Biliary Drainage in an Amoebic Liver Abscess (ALA) With Persistent Biliary Communication

Role of Different Treatment Modalities in Cavity Volume during the Treatment of Cystic Ecchinococcosis.

Surgery and percutaneous aspiration-injection-re-aspiration (PAIR) are widely accepted treatment modalities for hepatic hydatid cysts. Endoscopic retrograde cholangiopancreaticography (ERCP) acts as a minimally invasive rescue method for the biliary complications of both the hydatid cysts and treatment modalities. The aim of this study was to identify the role of different treatment modalities in the obliteration of hydatid cysts. Patients treated for hydatid cysts between January 2009 and December 2013 were evaluated in the study. Data were collected from hospital records. All cyst cavities were evaluated by ultrasonography or computed tomography. Ninety-five (40.4%) males and 140 (59.5%) females were included in the study. Before the procedures, the mean cyst diameter was 89.7±33.5 mm. At follow-up, the mean cyst diameter decreased to 53.2±30.1 mm. In the ERCP group, the mean diameter of the residual hydatid cyst cavity was significantly lower than that of the other groups (p=0.003). ERCP provides faster cyst shrinkage and even disappearance of the residual cavity in 50% of cases. Moreover, in hydatid cysts with biliary communication, ERCP+ES can be safely used for primary treatment.

Management of cysto-biliary communication in hydatid cyst of liver

Introduction: Biliary communication of hepatic hydatosis is one of the important complications. It may be minor or major communication. Minor communication is usually diagnosed during operation by the presence of bile stained hydatid fluid on aspiration or bile leak during surgery. However, in major communication, patients present with obstructive jaundice, abdominal pain and cholangitis. Surgical management of major communication is difficult and is associated with high morbidity and mortality.Methods: This is a retrospective study at Tribhuvan University Teaching Hospital, Kathmandu, Nepal over a period of two year (April 15th 2012 to April 15th 2014) and analyzed the medical records of 30 patients admitted and treated for hydatid cyst of liver in surgical ward during that period. Demography, clinical features, management and outcome were analyzed.Results: Of 30 patients with hepatic hydatid cyst operated over a period of two years, thirteen patients had cystobiliary communication. Amongst them, five minor communications were diagnosed during operation and managed with suture plication and omentopexy. Out of the eight major communications, seven were diagnosed preoperatively and all had cholangitis, and one had hydatid cyst of gallbladder and was diagnosed intraoperatively. Among six cases of major communication, five cases required CBD exploration and bile duct reconstruction while partial cholecystectomy was done for hydatid cyst of gall bladder and one case was managed by ERCP sphincterotomy, evacuation of cyst content and stenting. one case was managed with pigtail drain as the patient had infected hydatid cyst and not fit for surgery.Conclusion: Cystobiliary communication is a common complication of hydatid cyst of liver. Therapeutic options are related to size and location of the cyst and size of communication.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 31-34

Minimally Invasive Treatment of Liver Hydatidosis.

Background and Objectives:Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.Methods:In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.Results:Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.Conclusions:In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.

A large intrahepatic duodenal duplication cyst in a 3 year-old girl

Abstract Duodenal duplication cyst consists 6% of alimentary tract duplications and the prevalence is estimated to be less than 1 per 100,000 live births. This report is the first case report in a pediatric patient. A 19-month-old female patient was detected with a 5.2 cm sized intrahepatic cystic lesion in her follow-up ultrasonography examination for hydronephrosis. In her regular check-up, findings suggestive of food materials were detected inside the cyst. Further evaluation showed a 7 cm sized cyst located inside segment IV of the liver, connected to the duodenal bulb with a possibility of biliary communication. On exploration, duodenal duplication cyst with a 1.5 cm long stalk starting from the duodenal bulb to the hilum of the liver was identified. Due to its sophisticated location and possible communication with the biliary tree, Roux-en-Y cystojejunostomy was performed after resecting the stalk. The histopathologic finding of the stalk showed serosa, muscle, submucosa and duodenal mucosa which suggested its duodenal origin. The patient has been followed up without any complications for 7 months.

Nazobiliyer drenaj halen etkin ve güvenilir bir yöntemdir: Şişli Etfal Hastanesi deneyimi

Giriş ve Amaç: Nazobiliyer drenaj, akut süpüratif kolanjit, safra yollarına açılmış kist hidatik ve postoperatif safra kaçaklarında endoskopik tedavi metodu olarak kullanılmaktadır. Biz de kliniğimizde nazobiliyer drenaj kateterinin etkinliği ve güvenilirliğini retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntem:Ocak 2011 ile Aralık 2012 arasında Şişli Etfal Eğitim ve Araştırma Hastanesi Gastroentereoloji Kliniği Endoskopi ünitesinde nazobiliyer drenaj kateteri takılmış olan 22 hasta çalışmaya alındı. Hastaların demografik özellikleri, laboratuvar değerleri, hastalara yapılan işlemler, işlem sonrası klinik seyir ve işlem komplikasyonları retrospektif olarak değerlendirildi. Bulgular: Nazobiliyer drenaj kateteri 12-84 yaş arası (Ortalama 54,3 ±24,4) 22 hastaya (11 kadın) takılmıştır. Akut süpüratif kolanjit nedeniyle 11 hastaya, safra yollarına açılmış kist hidatik nedeniyle 4 hastaya, postoperatif kaçak nedeniyle 3 hastaya, eksternal safra kaçağı sebebiyle 2 hastaya ve hemobilia nedeniyle 2 hastaya nazobiliyer drenaj kateteri uygulaması yapılmıştır. Ortalama kateter kalış süresi 8,4±6,2 gün olup, bilirubin düzeyleri normalizasyonu da 4±0,6 günde gerçekleşmiştir. Hastaların tamamı nazobiliyer drenajın konforsuz bir tedavi şekli olduğunu ifade etseler de, hiçbirinde nazobiliyer kateter dislokasyonu gerçekleşmemiştir. Endoskopik retrograd kolanjiyopankreatografi işlemi ile ilişkili komplikasyon ve mortalite saptanmamıştır. Sonuç: Nazobiliyer drenaj akut süpüratif kolanjit, postoperatif safra kaçağı, safra yollarına açılmış kist hidatikte etkin ve güvenilir bir tedavi yöntemidir.

Gall Bladder Perforation Leads to Liver Abscess Formation ? Role of Ultrasonography

Perforation of the gall bladder is a rare complication of cholecystitis leads to liver abscess. Hepatic abscess is reportedly associated with a 7% to 40% prevalence of biliary communication. Biliary communication may prevent an abscess from healing after percutaneous drainage and, if so, require additional surgical or other interventional treatment. We report a case of a 40 year – old female who was diagnosed as gallbladder perforation and intrahepatic abscess which was successfully treated by surgically.

Biliary duct communication in massive hepatic hydatidosis managed with minimally invasive techniques

Hydatid cyst most commonly involves the liver. Intrabiliary rupture is one of the complications of hepatic hydatidosis. We present a case of 45-year-old lady with a large hydatid cyst occupying the left lobe of the liver with jaundice and upper gastrointestinal pressure symptoms. Contrast-enhanced computed tomography revealed a large hepatic cyst with rupture of contents into the left hepatic duct. The patient underwent laparoscopic excision of the cyst with closure of the biliary communication. Bilious drainage was observed from intra-cavitory drain in the postoperative period for which patient underwent endoscopic retrograde cholangiopancreatography with selective left duct stenting following which bile output decreased over 1-week. The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. Laparoscopic treatment is an effective mode of treatment for biliary fistulas complicating hepatic hydatid cyst in well-selected patients.

Biliary Fistula Treated with Endoscopic Therapy in Amoebic Liver Abscess with Cirrhosis

Large amoebic liver abscess is treated with either needle aspiration or percutaneous catheter drainage. Biliary communication of amoebic liver abscess has been reported in up to 27% of cases. Biliary fistula suspected by presence of bile in percutaneous draining catheter and confirmed by endoscopic retrograde cholangiopancreatography. Endoscopic therapy with sphincterotomy and biliary stent placement appears to be an effective mode of treatment for biliary fistulas complicating liver abscesses. Liver abscess is rare in cirrhosis. Here we are reporting a case of amoebic liver abscess with biliary fistula in a chronic liver disease patient which was managed with biliary sphincterotomy and biliary stent placement. A 45 Year old male alcoholic presented with fever of 1 week duration, right hypochondriac pain, abdominal distention and breathlessness. Abdominal examination revealed tenderness over the intercostal region and right hypochondriac area with mild ascites and right-sided pleural effusion. Investigations revealed neutrophilic leukocytosis (43,900cells/mm3) with elevated liver enzymes (SGOT: 102 U/L, SGPT: 169 U/L), alkaline phosphatase (649 U/L), ultrasound abdomen suggestive of coarsened echo texture of liver with surface irregularity and also liver abscess of size about 9.8 × 8.7 cms in segment VII of liver. He was also incidentally detected HBsAg positive. Ascitic fluid analysis suggestive of high SAAG, culture showed no growth of organisms. Blood culture was sterile. Hence diagnosed as cirrhosis with liver abscess. Patient was started on intravenous metronidazole and pipercillin and tazobactum. In view of large abscess and persistent symptoms percutaneous pigtail catheter placed into the liver abscess, anchovy sauce colored pus drained out. After few days of pigtail placement, bile was draining out of the catheter. Suspected biliary fistula, tubogram revealed communication between abscess and biliary radicles. Patient was treated conservatively for 1 month, but still bile was draining out of the catheter. Biliary sphincterotomy done and common bile duct stent was placed. Drain from percutaneous catheter decreased <10 ml per day and percutaneous catheter removed. Patient was doing well and discharged. Follow up did not show any recurrence of abscess.

腹腔鏡下肝嚢胞天蓋切除術を施行した胆管と交通を有する単純性肝嚢胞の1例

症例は52歳，女性．検診で巨大肝嚢胞を指摘されていた．心窩部不快感を自覚するようになり当院を受診した．腹部造影CTで，肝右葉を占拠する最大径18cmの境界明瞭な嚢胞性病変を認めた．腹部MRIでは病変内部はT1強調像で低信号，T2強調像で著明な高信号を呈し，胆管との交通は確認できなかった．有症状の単純性肝嚢胞と診断し腹腔鏡下肝嚢胞天蓋切除術を施行した．術中，嚢胞壁内側より胆汁漏出が確認され，開口部は縫合閉鎖した．胆管と交通を有した単純性肝嚢胞は稀な病態であるが，鏡視下での胆管交通部縫合閉鎖で対応可能であった症例を経験したので報告する．

Surgical management of non-parasitic hepatic cyst with biliary communication: a case report.

Non-parasitic hepatic cysts with biliary communication are rare. The clinical symptoms involved are not specific to this condition, thereby making diagnosis difficult and treatment controversial. Here, we report a case of 70-year-old woman complaining of abdominal satiety, combined with non-specific pain in the right upper quadrant. The abdominal contrast-enhanced MRI-scan revealed a large and thick-walled septus cystic lesion in the liver. During operation, the biliary fistula was confirmed in the cyst cavity. A silica gel tube was inserted via the cystic duct for cholangiography, which demonstrated communication between the cyst and biliary tract. We performed wide-scale cyst wall resection; the biliary fistula was completely repaired by the closure of communicated bile ducts. The postoperative course was uneventful, and the patient was discharged with no sign of cholangitis or any other symptoms. The novel surgical management via wide resection of the cyst wall and closure of biliary communication proved to be an adequate and effective procedure for treating nonparasitic hepatic cysts with biliary communication.

Hepatic Abscess with Biliary Communication Following Transarterial Chemoembolization of Hepatocellular Carcinoma

Hepatic Abscess with Biliary Communication Following Transarterial Chemoembolization of Hepatocellular Carcinoma