Compression Of Duct Research Articles

Compression of Common Hepatic Duct (CHD) Caused by Dilated Cystic Duct, is it Another Variant or New Type of Mirizzi Syndrome: A Case Report

Compression of Common Hepatic Duct (CHD) Caused by Dilated Cystic Duct, is it Another Variant or New Type of Mirizzi Syndrome: A Case Report

Robot-assisted distal pancreatectomy with spleen preservation in the treatment of a child with a solid pseudopapillary tumor

The use of robots in pancreatic surgery offers several advantages as an adjunct to laparoscopic surgery, including increased maneuverability of robotic instruments and three-dimensional (3D) visualization. To our knowledge, only two cases of robot-assisted distal pancreatectomy with spleen preservation in children have been reported worldwide. In this study, the patient was an 11-year-old boy who was admitted to a children’s hospital with complaints of recurrent upper abdominal pain. He was diagnosed with pancreatic tumor based on ultrasound findings. It was confirmed by magnetic resonance imaging, which revealed a well-defined heterogeneous formation at the border of the body and tail of the pancreas, measuring 2.28 × 2.73 × 2.62 cm with compression of the Wirsung duct. The surgical intervention was performed using a surgical robot VERSIUS (CMR, (UK). Splenic vessels were mobilized carefully, a tourniquet was placed around the body of the pancreas, and it was intersected using a stapler at the border of healthy tissue. The surgical intervention took 340 min, including robot installation time (docking time) of 15 min and a main console time of 325 min. No serious intraoperative complications, such as bleeding or damage to the vascular structures adjacent to the pancreas (branches of the celiac trunk and portal vein), were noted. Histological examination of the tumor confirmed the diagnosis of a solid pseudopapillary tumor. After surgery, the patient’s condition was stable. Recovery proceeded without complications. Magnetic resonance imaging of the abdominal cavity, which was performed 6 months after surgery, revealed no signs of disease recurrence. Robot-assisted surgery is an acceptable alternative to laparoscopic and open surgery for patients with solid pseudopapillary pancreatic tumors because robots offer additional connections, enable closure in improved 3D imaging, increase dexterity when handling instruments, and eliminate of hand tremors.

Biliary Tract Disorders and Associated Acute Complications in Patients With Acromegaly: A Single-Center Study.

Biliary complications are frequent in patients with acromegaly. These complications may be secondary either to acromegaly or to somatostatin analogs (SAs). We aimed in this paper to assess the prevalence of biliary complications in patients with acromegaly at diagnosis and after treatment with SAs. We conducted an analytical and descriptive retrospective study of 26 patients followed up for acromegaly over 7 years. Biliary complications were screened at diagnosis and follow-up by abdominal ultrasound, biliary magnetic resonance imaging (MRI), and endoscopic ultrasonography (EUS). Data were analyzed using SPSS 21. The mean age of the patients was 49.6 ± 14 years, with a female predominance (53.8%). The evaluation of biliary complications showed vesicular biliary tract lithiasis and/or sludge in seven patients (29%), including two patients at the time of diagnosis of acromegaly and five patients after an average medical treatment duration of 3 years. Six female patients (24%) had dilation of the bile ducts without the presence of obstruction on biliary MRI and EUS and lithiasis/sludge of the common bile duct, tumor or external compression have been excluded. This condition was discovered incidentally at the diagnosis in five patients and during the follow-up in one patient. The preoperative insulin-like growth factor 1 (IGF-1) levels, disease duration, and female sex were significantly correlated with biliary tract dilation occurrence. Dyslipidemia, the preoperative IGF-1 level, and lanreotide treatment duration were significantly correlated with the occurrence of biliary lithiasis (P < 0.05). Biliary stones are a frequent biliary adverse effect in patients with acromegaly undergoing SAs treatment. However, primary bile duct dilation has never been reported in acromegaly to the best of our knowledge. This condition could be considered as a complication or a feature of the disease.

Gallstone – isolated hepatic duct compression: a proposed modification of Csenda classification of Mirizzi syndrome

Gallstone – isolated hepatic duct compression: a proposed modification of Csenda classification of Mirizzi syndrome

Mirizzi Syndrome-The Past, Present, and Future.

Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot's triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes.

OPTION TO FINISH SURGICAL OPERATION IN PATIENT WITH MIRIZZI SYNDROME

Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman's pouch.&#x0D; Mirizzi syndrome is one of the most severe complications of cholelithiasis and the most complex pathological process in biliary surgery in general. Mirizzi syndrome is a compression of the common hepatic bile duct by a gallstone, which is usually located in Hartmann's pouch, and the subsequent formation of a cholecysto-choledochial fistula. This syndrome is named after the Argentinean surgeon, who described the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone; the phenomenon was observed during the intraoperative cholangiography. Mirizzi syndrome is conventionally classified into four types: type I is described as the compression of the common hepatic duct by a stone from the gallbladder side; type II is characterized by the presence of a cholecysto-choledochial fistula that involves one-third of the choledochus diameter; type III is similar to type II but involves two-thirds of the choledochus diameter; type IV represents complete destruction of the wall of the common hepatic duct, resulting in the formation of a complete biliobiliary fistula. Mirizzi syndrome does not have its own specific clinical manifestations, and screening methods like abdominal ultrasonography may not always provide a clear indication of this pathology. In such cases, diagnostic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance imaging (MRI) of the biliary tract can help establish an accurate diagnosis and determine the appropriate surgical approach prior to the operation. The article presents the clinical case of a 29-year-old patient M., who was admitted to the surgical department. Although there was a discrepancy between the findings of magnetic resonance imaging of the biliary tract and the identified anatomical changes during diagnostic laparoscopy of the hepatobiliary tract, the surgeons' expertise and adherence to safe cholecystectomy guidelines enabled the successful completion of the operation using a minimally invasive approach.

Mirizzi syndrome complicated by type IV cholecystobiliary fistula to the right hepatic duct

Mirizzi syndrome is a rare complication of long-term chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct that may progress to development of cholecystobiliary fistula. Here we report a case of a 38-year-old female patient who underwent laparoscopic cholecystectomy with intraoperative cholangiogram for acute cholecystitis and choledocholithiasis. Intraoperatively, the patient was found to have a Mirizzi syndrome complicated by cholecystobiliary fistula to the right hepatic duct. The gallbladder was successfully removed, cholelithiasis cleared and a ureteral stent was used in reconstruction. The patient was discharged on postoperative two and was doing well on routine follow-up. Ultimately, Mirizzi syndrome is a rare clinical entity that requires careful consideration during preoperative workup and a high suspicion when abnormal anatomy is encountered intraoperatively.

Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience.

Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.

Chylothorax associated with sarcoidosis: a review of the literature.

To review the medical literature regarding chylothorax associated with sarcoidosis. A literature review of all reported cases of sarcoidosis-associated chylothorax, we included a novel case report to the analysis. Of sixteen cases included in the study, 10 were women (62.5%), mean age 47±17years. In 6 subjects (37.5%) chylothorax was part of the initial presentation of sarcoidosis. Four subjects (25%) additionally suffered from lymphedema and chylous ascites, and one from chylous ascites only. Thoracic lymphadenopathy was reported for 13/16 subjects (81.3%) and lung parenchymal disease in 8/16 (50%). Compression of the thoracic duct was considered as a causative factor in 10 cases (62.5%). One case was attributed to granulomatous pleural inflammation, one to generalized lymphangiectasia, and no specific causative factors were identified in 4 remaining cases (25%). Overall mortality rate was 18.8% (3/16 subjects). Of note, all the subjects treated with corticosteroids survived. Since the association of sarcoidosis with chylothorax is exceedingly rare, alternative etiologies should be pursued even when chylothorax develops in a subject with preexisting sarcoidosis. However, the possibility of sarcoidosis should be entertained when other etiologies for a newly diagnosed chylothorax are ruled out. A multidisciplinary approach is required for optimal management, both for elucidating the diagnosis and for employing therapy, which could be multimodal. A trial of immunosuppressive therapy with corticosteroids should be considered.

Diagnosis and Management of Mirizzi Syndrome Related to Gallstones: A Narrative Literature Review

Mirizzi syndrome (MS) is a rare condition caused by compression of the common hepatic duct due to gallstones located in the cystic duct or neck of the gallbladder. Biliary pain, jaundice, and fever are the most common clinical manifestations of MS. Patients usually report a history of biliary pain with jaundice. There are no pathognomonic features in the history and physical examination. Patients may also come with acute cholecystitis, acute cholangitis, or pancreatitis. In cases where MS is suspected, the diagnosis can be made by ultrasonography (US), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). Surgery is the main treatment for cases of MS and is a challenge because preoperative diagnosis is difficult, thus impacting management during surgery. This literature review aimed to describe the features of MS related to gallstones and management options.

FACIAL LIPOMA IN MAXILLARY AND INFRAORBITAL REGION CAUSING NASO LACRIMAL DUCT COMPRESSION – A RARE CASE REPORT

Lipomas are one of the most common soft-tissue mesenchymal tumors seen in all parts of the body. Their occurrence in the head and neck region is however relatively rare. Although benign in nature, lipomas may present as a slow growing tumors causing compression of surrounding structures and an unaesthetic appearance. We present here a rare and unique case of lipoma in the infraorbital region in a 43 year old female which was managed by complete surgical excision. The rarity of the anatomical site and compression of the Naso-Lacrimal Duct caused by it makes it a unique case. Along with the case report, the pathogenesis, histopathological features and the treatment have been discussed.

S2812 Cholelithiasis Resulting in Partial Mirizzi Syndrome and Liver Abscess

Introduction: Mirizzi syndrome is defined as common hepatic duct (CHD) obstruction caused by extrinsic compression from an impacted stone in the cystic duct or gallbladder infundibulum. Failure to recognize it prior to cholecystectomy, can result in intraoperative bile duct injury and subsequently in significant morbidity. Patients present with one or more of the following: right upper quadrant pain, fever and jaundice; classically with elevated bilirubin and alkaline phosphatase. Case Description/Methods: A 67-year-old female presented with fever, right upper quadrant abdominal pain and emesis. Workup revealed leukocytosis, bilirubin 0.4 mg/dL (≤1.2), alkaline phosphatase 226 IU/L (35-104), aspartate aminotransferase 42 IU/L (< 32) and alanine transferase 86 IU/L (< 33). CT scan followed by magnetic resonance cholangiopancreatography showed a 7.2 x 6.1 cm heterogenous lesion in the right hepatic lobe of the liver consistent with a liver abscess, contracted gallbladder with cholelithiasis, and a large gallbladder neck/cystic duct stone externally compressing the right hepatic duct causing upstream dilatation resulting in a partial Mirizzi syndrome (Figure A). The left hepatic duct, CHD, and common bile duct (CBD) were unaffected. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed a large gallbladder neck stone compressing the right hepatic duct, with a normal left hepatic duct, CHD, and CBD (Figure B). Biliary sphincterotomy with basket sweep of the CBD and stent placement was performed. Follow up cholangiogram revealed a decompressed biliary tree. The liver abscess was drained percutaneously, and patient was discharged on intravenous antibiotics. She underwent elective cholecystectomy with right hepaticojejunostomy after 8 weeks. Postoperative imaging showed intact hepaticojejunostomy and no residual abscess. Discussion: This case is unique as patient did not develop classic obstructive jaundice due to intact drainage on the left but developed a liver abscess due to prolonged biliary stasis on the right. The patient required a combined endoscopic, interventional, and surgical approach for therapeutic success. Recognition of Mirizzi syndrome was key to planning therapeutic steps with ERCP followed by abscess drainage prior to surgery to ensure the best possible outcome for the patient.Figure 1.: A: MRCP showing right liver lobe abscess (white arrow). B: ERCP showing gallbladder (black arrow) with stone in gallbladder neck (block arrow) causing compression and upstream intrahepatic dilatation of right intrahepatic duct (white arrow). MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography).

S1852 When Life Gives You Lemmel's, Call Your Gastroenterologist

Introduction: Lemmel’s syndrome is defined as obstructive jaundice caused by periampullary duodenal diverticulum (PAD), leading to bile duct compression and dilation. PAD leading to the obstruction of the ampulla of Vater is the most common, with an incidence as high as 27%. Most PAD are found incidentally and are suspected to be found in up to 22% of the population, however, some patients can have life-threatening pathology, necessitating quick intervention. This case outlines a patient with this rare pathology and discusses when to choose specific therapeutic options. Case Description/Methods: A 77-year-old Caucasian female with a history of cholecystectomy 20 years ago presented to the emergency department with a 1-day history of epigastric abdominal pain, mild fever, jaundice, and non-bloody diarrhea. Laboratory evaluation was notable for a lipase of 3326 U/L and transaminitis with ALP 908 IU/L, AST 234 U/L, ALT 153 U/L, and total bilirubin 7.2 mg/dL. CT abdomen with IV contrast revealed moderate-severe pancreatitis and intra/extrahepatic biliary ductal dilation up to 19 mm in diameter with additional dilation of the pancreatic duct. A subsequent MRCP revealed a large periampullary duodenal diverticulum with obstruction of the common bile duct, consistent with Lemmel’s syndrome, and possible duodenal diverticulitis (Figure A, B). Piperacillin-tazobactam was initiated due to concern for ascending cholangitis and diverticulitis. ERCP was performed the following morning, which revealed a large duodenal diverticulum in the second portion of the duodenum with fecalized material impacted within the diverticulum (Figure C). The entire biliary ampulla was obscured by obstructing material and surrounding ulceration was noted. Several attempts to remove the impaction were unsuccessful. A temporary PTC drain was placed with interval improvement in her pain and lab abnormalities. The patient was transferred to another facility for advanced endoscopy, where she had successful removal of obstruction and intra/extrahepatic stenting. Discussion: Therapeutic options vary, but ERCP is considered the initial treatment of choice because it allows for the placement of a biliary stent and a sphincterotomy. If Lemmel’s is due to chronic papillary fibrosis or sphincter of Oddi dysfunction, then an endoscopic sphincterotomy is the preferred therapy. If the disease is severe or complicated, a diverticulectomy is recommended in patients who are at lower risk for adverse complications.Figure 1.: A) Coronal slice from MRI abdomen and pelvis demonstrating a large periampullary duodenal diverticulum with obstruction of the common bile duct. B) Transverse slice from MRI abdomen and pelvis demonstrating a large periampullary duodenal diverticulum with obstruction of the common bile duct. C) Image obtained during ERCP revealing impacted fecalized material within a large duodenal diverticulum in the second portion of the duodenum with surrounding ulceration.

Nasolacrimal duct obstruction due to periodontal disease in domestic rabbit, &lt;em&gt;Oryctolagus cuniculus&lt;/em&gt; - case report

Rabbits are animals with a high prevalence of periodontal diseases, which can be explained by anatomical particularities. The roots of the incisive and premolar teeth of the maxilla are very close to the lacrimal duct, and in addition, these animals have continuous teeth growth which can predispose to compression and obstruction of the nasolacrimal duct, resulting in dacryocystitis and leading to secondary ophthalmic problems. As visualization of the oral cavity is only possible under sedation, dental problems are often underdiagnosed. The present report aims to show the case of a female rabbit which had chronic conjunctivitis with purulent secretion associated with the nasolacrimal duct obstruction, secondary to periodontal disease.

Compression of the Distal Common Bile Duct by Enlarged Inferior Pancreaticoduodenal Artery Branches in a Patient with Celiac Trunk Stenosis: A Case Report

AbstractVarious benign and malignant pathologies/conditions can cause compression of the extrahepatic biliary system. Anatomical and/or topographic variations of the hepatic artery have long been recognized as a possible cause of the EBS compression. However, anatomical and/or topographic variations, other than the hepatic artery's, should also be considered during the evaluation of the EBS compression. We, herein, report a unique case of the distal common bile duct compression by tortuous and enlarged inferior pancreaticoduodenal artery branches due to severe stenosis of the celiac trunk orifice.

An Unusual Cause of Obstructive Jaundice

Question: A 45-year-old man presented with painless obstructive jaundice for 1 month. His past medical history was unremarkable. Significant laboratory results included total bilirubin of 73.4 μmol/L (normal 5.1-20 μmol/L), direct bilirubin of 46.5 μmol/L (normal <6.1 μmol/L), alanine transaminase of 168.3 U/L (normal 9-50 U/L), alkaline phosphatase of 438 U/L (normal 50-135 U/L) and gamma-glutamyl transferase of 1321.6 U/L (normal 10-60 U/L). Abdominal ultrasonography showed a gallstone in the common hepatic duct with intrahepatic ductal dilation, and the gallbladder was atrophic. Contrast-enhanced computed tomographic (CT) scan in a dual-energy mode showed luminal distension of gallbladder neck (Figure A, white arrow), with hepatic hilar stenosis (Figure A, blue arrow) and bilateral intrahepatic ductal dilation. Coronal virtual monoenergetic image reconstruction at 40 keV clearly showed an intraluminal lesion with hypodensity in gallbladder neck (Figure B, red arrow). The spectral Hounsfield unit curve showed the decreased attenuation values of the lesion as the energy level decreased (Figure C). What is the most likely diagnosis? Look on page 197 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more information on submitting to Gastro Curbside Consult. Dual-energy CT suggested that the lesion was a cholesterol gallstone. Magnetic resonance cholangiopancreatography (MRCP) was then performed and confirmed a stone (Figure D, white arrow) in the gallbladder neck, with external compression of the common hepatic duct and dilation of the intrahepatic biliary duct, highly suggestive of Mirizzi syndrome (MS). In addition, a long cystic duct running parallel to the common bile duct with low insertion was found. Subsequent cholecystectomy confirmed a 1.7-cm cholesterol gallstone in the neck of the gallbladder causing hepatic hilar stricture, which was consistent with MS. The patient had an unremarkable recovery. MS, as a rare complication of gallstone disease, refers to impaction of a gallstone in the gallbladder neck or cystic duct causing obstruction of the extrahepatic bile duct.1Abou-Saif A. Al-Kawas F. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus.Am J Gastroenterol. 2002; 97: 249-254Crossref PubMed Google Scholar MS can be tricky and may mimic cholangiocarcinoma, especially when gallstones are radiolucent on conventional CT.2Chen Y. Chang C. Liu K. Mirizzi syndrome due to a large radiolucent gallstone.Am J Gastroenterol. 2016; 111: 599Crossref PubMed Scopus (2) Google Scholar With the ability to differentiate materials on the basis of their differential attenuation at 2 different energy levels, dual-energy CT can help to identify the composition of internal body constituents, such as gallstones. Previous studies have reported that dual-energy CT can increase the conspicuity of isoattenuating gallstones.3Soesbe T.C. Lewis M.A. Xi Y. et al.A technique to identify isoattenuating gallstones with dual-layer spectral CT: an ex vivo phantom study.Radiology. 2019; 292: 400-406Crossref PubMed Scopus (15) Google Scholar In this case, dual-energy CT was first used to diagnose MS, clearly showing the gallstone in the gallbladder neck as the cause of the hepatic hilar obstruction, and to provide a diagnostic clue to confirm MS. This technique can potentially reduce the need for further imaging, such as MRCP, leading to a reduction in imaging cost and time to diagnosis for selected patients.

Risk factors for post-endoscopic retrograde cholangiopancreatography cholangitis in patients with hepatic alveolar echinococcosis—an observational study

Background Hepatic alveolar echinococcosis (HAE) is considered to be one of the most deadly chronic parasitic diseases in the world. We have shown that the incidence of cholangitis in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) was increased significantly. On this finding, we carried out, a preliminary study on the risk factors for cholangitis after ERCP. Aims To retrospectively detect the risk factors for post-ERCP cholangitis in patients with biliary tract affected by HAE. Methods The study included data from 51 cases of AE who had undergone therapeutic ERCP between January 2015 and December 2019. Demographic and treatment data were extracted from the medical records, and the association between potential risk factors and the development of post-ERCP cholangitis was evaluated using a collected database. Results There were five cases of mild cholangitis after ERCP (Tokyo criteria), and no moderate or severe cholangitis occurred. The incidence rate of cholangitis after ERCP was 9.8%. Univariate analysis showed hilar bile duct stenosis (p = .016), endoscopic retrograde biliary drainage (p = .007), a stent diameter ≥8.5 Fr (p = .000) and single stent implantation (p = .010) were risk factors for post -ERCP cholangitis. All cases of cholangitis improved under conservative treatment. Conclusion Patients with hilar bile duct compression or endoscopic retrograde biliary drainage appeared to be more likely to develop post-ERCP cholangitis. The number and diameter of biliary stents may influence post-ERCP cholangitis. Sample size and clinical heterogeneity are two insurmountable difficulties, and a larger sample size needs to be collected to verify the risk factors for screening. KEY MESSAGES Many studies reported the post-ERCP complications in patients with hepatic alveolar echinococcosis and found that the incidence of post-ERCP cholangitis was significantly high. Therefore, we conducted a preliminary study on the risk factors of postoperative cholangitis in patients who underwent ERCP. The incidence rate of cholangitis after ERCP was 9.8%. We found that hilar bile duct stenosis, and endoscopic retrograde biliary drainage, were risk factors for cholangitis, and stent diameter and the number of stent implantation may influence the incidence rate of cholangitis after ERCP. Sample size and clinical heterogeneity are two insurmountable difficulties, and a larger sample size needs to be collected to verify the risk factors of screening.

INFLUENCE OF JAUNDICE NATURE ON THE TREATMENT TACTICS OF PATIENTS WITH ACUTE PANCREATITIS

Abstract. The aim of the study is to improve the treatment results of patients with AP with jaundice syndrome by improving the quality of differential diagnosis of the nature of concomitant jaundice.&#x0D; Materials and methods of research. The treatment results of 52 patients with acute pancreatitis complicated by jaundice syndrome were analyzed, jaundice was mechanical in 42 (80.9 %) cases, parenchy-mal – in 10 (19.1 %).&#x0D; Results and discussion. 28 from 42 patients with acute pancreatitis and mechanical jaundice caused by concretion in the large duodenal papilla, choledocholithiasis and papillitis underwent endoscopic papillosphincterotomy with nasobiliary drainage. In 7 cases open cholecystectomy with choledocholithotomy and retroduodenal space drainage were performed due to the large size of concretions. LChE was performed in 21 case, elective laparoscopic cholecystectomy was performed in 14 patients with compression of the common hepatic duct by inflammatory infiltrate in the gallbladder neck. There were no fatalities in the group of patients with acute pancreatitis and mechanical jaundice. In the group of patients with acute pancreatitis and parenchymal jaundice 4 from 10 patients died, mortality was 40 %.&#x0D; Conclusions. Ultrasound is required for differential diagnosis of mechanical and parenchymal jaundice in acute pancreatitis, which allows the determination of the treatment tactics, type of surgery and the extent of conservative therapy.

Cholangiocarcinoma obscured by a large paraesophageal hernia causing traction compression of the common hepatic duct ultimately diagnosed with percutaneous cholangioscopy.

Video 1Case presentation including cross-sectional imaging, percutaneous cholangiogram, percutaneous cholangioscopy, and histopathology of cholangioscopy-directed biopsies.

Hepatic Artery Causing Compression of Common Hepatic Duct: Rare Cause of Jaundice

Background: Hepatic artery compressing the common hepatic duct is a rare finding seen in patients presenting with jaundice, as a cause of obstructive jaundice. There have been a few case studies suggesting the compression of common hepatic duct by hepatic artery1-3. Though, not many such case reports have been seen till date.