Opacification Of Ducts Research Articles

With a little help from my friends: percutaneously assisted internalization of a biliary drain.

Video 1Narrated case of an EUS-guided hepaticogastrostomy facilitated by opacification and distention of the left intrahepatic ducts using an existing percutaneous drain tract.

Opacification of nondilated bile ducts through the gallbladder as an aid to percutaneous transhepatic biliary drainage.

The purpose of this study was to retrospectively assess the potential of percutaneous transhepatic biliary drainage (PTBD) in patients with nondilated bile ducts (NDBD) using a transgallbladder opacification of the bile ducts. Eight patients with NDBD (7 men, 1 women; median age, 65 years; Q1-Q3, 35-69 years; range, 22-77 years) who underwent PTBD after opacification of the bile ducts through the gallbladder were evaluated. Opacification of NDBD was performed using a retrograde injection of contrast material through the gallbladder. The opacified peripheral NDBD was punctured percutaneously and a drainage catheter was introduced under fluoroscopy guidance. The success and safety of the procedure were assessed. PTBD could be achieved in 6/8 patients (75%) and no significant complications were observed. The biliary tree opacification was attempted but could not be achieved due to biliary sludge that obstructed the cystic duct in 2/8 patients (25%). Two minor complications in two different patients were observed consisting of transient hemobilia and chills. Opacification of the bile ducts using a transgallbladder approach appears to be a safe and successful procedure for PTBD in patients with NDBD.

Iatrogenic injury of an aberrant right posterior sectoral bile duct

A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear. 
 A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts.
 A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.

Le traitement coelioscopique de la lithiase vésiculaire chez l’enfant drépanocytaire au Sénégal

The frequency of the sickle cell disease in Senegal and the improvement of diagnostic means currently make it possible to entrust to the surgeon an increasing number of children and teenagers with gallbladder lithiasis in this particular hematologic context. The goal of the authors is to report on their experience of the laparoscopic cholecystectomy in children and teenagers. There were 43 patients, with a mean age of 13, benefited from a laparoscopic cholecystectomy using four trocars in “American position.” The authors deplored two deaths, and surgical morbidity was especially characterized by biliary complications, including bile leakage, wound, and secondary stricture. Apart from post-operative management in intensive care setting, the desired improvement of these results requires better equipment. It is adapted laparoscopic instruments, on one hand, and the possibility of opacification of the bile ducts, on the other hand, essential in certain circumstances.

Les nouvelles possibilités d’exploration des voies biliaires en IRM : de l’imagerie morphologique à l’imagerie fonctionnelle avec perfusion de Mangafodipir Trisodium (Mn DPDP)

Mangafodipir trisodium (Teslascan) is a hepatobiliary contrast agent that provides noninvasive opacification of the bile ducts. Using this contrast medium combined with a T1-weighted gradient echo enhanced sequence provides functional imaging of the bile ducts. Second-intention MRI was obtained after the usual morphological study of the bile ducts using heavily T2-weighted sequences (SS-FSE Te eff long and SS FSE Te eff short). This method can detect many biliary duct anomalies: biliary leakage in the postoperative context, mapping of bile ducts and the gallbladder in the search for anatomical variants, analysis of biliodigestive or biliobiliary anastomoses, or a dynamic study of bile secretion and excretion. Opacification of the bile ducts has only been possible until now with invasive tests aggravated by a certain co-morbidity rate and their functional study using biliary scintigraphy limited by mediocre spatial resolution. This new possibility provides access not only to morphological imaging, but also to functional imaging with excellent spatial resolution.

Cowper’s glands and ducts: radiological findings in children

The aim of this study was to describe the radiological features of simple or dilated (syringocele) Cowper's ducts in a large paediatric population. Voiding cystourethrography procedures performed during the past 24 years were evaluated taking into special account urethral morphology. The procedures were performed to study all sorts of possible urinary affections. A total of 1,676 male children (age: newborn to 18 years) underwent 2,340 voiding cystourethrographies. Opacification of Cowper's ducts was observed in nine children (0.53%) - in six (0.35%) as a thin, radiopaque image running parallel to the inferior edge of the membranous-bulbar urethra and in three (0.18%) as a dilated structure (syringocele); this was a source of significant voiding problems. Opacification of Cowper's ducts - even if rare - has to be recognised as a possible anatomical finding during voiding cystourethrography in paediatric patients. An accessory finding devoid of pathological meaning in most cases, it can, however, be a possible cause of voiding disorders in some instances.

Endoscopic retrograde cholangiopancreatography

Abstract Direct non-operative injection of radio-opaque material through a cannula introduced at the duodenal papilla by means of a fibre-optic duodenoscope achieved opacification of the bile ducts, the pancreatic duct or the entire biliary pancreatic ductal system in 392 (89 per cent) of 439 patients in whom it was attempted. The desired ducts were opacified in 75 per cent of cases; the bile ducts in 206 out of 278 and the pancreatic duct in 120 out of 161 cases. The anatomical conditions found were: long common biliary pancreatic channel, 30 per cent; short common biliary pancreatic channel, 28per cent; two orifices in the hepatopancreatic ampulla, 24 per cent; two orifices on the duodenal papilla, 18 per cent; two orifices on the duodenum, there being no papilla, less than I per cent. Morbidity resulting from the procedure consisted of infectious reactions in 20 out of 295 patients in whom the bile ducts were opacified and hyperamylasaemia and abdominal pain in 28 out of 300 patients in whom the pancreatic duct was opacified. The method is of value in diagnosing the cause of cholestatic jaundice. In non-jaundiced subjects it may complement or clarify inconclusive cholangiograms or cholecystograms obtained by other techniques. If it shows dilated bile ducts operation should not be delayed, otherwise there is a risk of cholangitis. Pancreatic carcinoma may be revealed by stenosis, partial or total, of the pancreatic duct or by filling defects in the pancreatic parenchyma. Both chronic pancreatitis and pancreatic carcinoma may cause partial stenosis of the pancreatic duct. A filiform appearance of the pancreatic duct suggests chronic pancreatitis.

Routine preoperative infusion cholangiography at elective cholecystectomy: a prospective study in 694 patients.

The role of preoperative infusion cholangiography (PIC) before elective cholecystectomy has yet to be defined. Between 1985 and 1991 PIC was performed routinely in 694 patients with median (range) age of 52 (17-85) years with biliary calculus disease 1 or 4 days before elective cholecystectomy. Satisfactory opacification of the biliary system was achieved in 90.1 per cent and mild to moderate adverse reactions to the infusion of contrast medium occurred in 0.9 per cent of patients. Peroperative cholangiography (POC) in 43 of 499 patients with a normal PIC was normal. The presence of common bile duct stones was confirmed in 34 of 36 patients with prominent stones at bile duct exploration and in 8 of 26 with suspected stones at PIC. Bile duct dilatation (median diameter 10 mm) without concomitant stones was seen at PIC and confirmed at POC in 20 patients. Bile duct anomalies were found or suspected in 35 patients at PIC and were confirmed in six by POC (n = 5), or during the cholecystectomy making the anomaly incidence 0.9 per cent. Information provided by the PIC was not of crucial importance for safe execution of cholecystectomy in any patient, while a single (minor) bile duct lesion (1 of 694; 0.1 per cent) could be ascribed to severe pericholecystitis. The results of this study suggest that routine PIC is not warranted. However, PIC is an alternative to selective preoperative endoscopic retrograde cholangiography or selective POC. PIC needs to be supported by POC in approximately 20 per cent of patients (in case of absent or poor opacification of the bile ducts or suspicion of stones or anomalies at PIC).

Percutaneous cholecystostomy

Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56–100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

Techniques to Facilitate the Difficult Percutaneous Transhepatic Biliary Drainage

In most patients, percutaneous biliary drainage is a straightforward procedure. However, problems may be encountered and are usually due to difficulties in opacification of nondilated ducts, tight hilar lesions, or isolated biliary segments. Solutions to the first problem involve injection of ancillary tubes, the gallbladder, or the common bile duct. Retrograde catheterization of the segment with placement of stable radiopaque targets such as snares, wires, or catheters are helpful. Carbon dioxide may be useful as a contrast agent in nondependent ducts. Tight lesions and isolated segments can be approached after “through-and-through” access has been established. This article discusses and illustrates some of the concepts that have been developed to achieve biliary drainage in such patients.

Paucity of interlobular bile ducts.

Paucity of interlobular bile ducts (PIBD) is defined as the reduction in the number of interlobular bile ducts. Paucity could be defined using the ratio of the number of portal tracts devoid of bile duct to the total number of portal tracts. At least 10 complete portal areas must be examined. In the past, only wedge biopsies could provide such samples, but now it can be achieved with needle biopsy. Usually, two types of PIBD, syndromatic and nonsyndromatic, are considered. In the syndromatic type, paucity is a major feature of the disease. In the nonsyndromatic type, paucity is only a part of the disease, as in peroxisomal disorders or alpha 1-antitrypsine (A1AT) deficiency, and is an inconstant finding. Opacification of the intrahepatic bile ducts in infants with nonsyndromatic paucity with no associated disorder demonstrates sclerosing cholangitis in at least half of patients in whom the diagnosis of "idiopathic paucity" would have been made a few years ago. The remaining patients must be considered as waiting for the identification of new disorders associated with paucity.

Contrast media in sialography: A comparison of Lipiodol Ultra Fluid and Urografin 290

A prospective, randomized study of 60 patients undergoing sialography was conducted to compare Lipiodol Ultra Fluid (UF) (Ethyl diiodostearate, May & Baker Ltd), with Urografin 290 (meglumine diatrizoate 52.1% w/v and sodium diatrizoate 7.9% w/v, Schering). The quality of the images, the clinical tolerance and the side-effects of contrast were compared. Both agents produced adequate opacification of ducts but poor intra-gland duct filling was seen in two patients examined with Lipiodol UF. There were significantly more side-effects (which were also more severe) in the Lipiodol group. It is concluded that Urografin 290 is the better contrast agent for sialography because of better filling of intra-gland ducts and greater clinical tolerance.

Bilio-pancreatic common channel in children

Twelve patients (11 girls and 1 boy) with dilated bile ducts and anomalous junction between the common bile duct and pancreatic duct are reported. All patients underwent preoperative opacification of the bile ducts either by transhepatic cholangiography or percutaneous cholecystography. Abdominal pain and jaundice were the main clinical symptoms. Reflux of pancreatic enzymes in the bile duct was proven by measuring amylase and lipase activity in the biliary system after IV injection of 1 IU/kg of cholecystokinin. All patients were operated upon. Bile ducts size returned to normal in all patients who are clinical well with a follow-up from 1 to 6 years.

Bilio-pancreatic common channel in children. Clinical, biological and radiological findings in 12 children.

Twelve patients (11 girls and 1 boy) with dilated bile ducts and anomalous junction between the common bile duct and pancreatic duct are reported. All patients underwent preoperative opacification of the bile ducts either by transhepatic cholangiography or percutaneous cholecystography. Abdominal pain and jaundice were the main clinical symptoms. Reflux of pancreatic enzymes in the bile duct was proven by measuring amylase and lipase activity in the biliary system after IV injection of 1 IU/kg of cholecystokinin. All patients were operated upon. Bile ducts size returned to normal in all patients who are clinical well with a follow-up from 1 to 6 years.

Percutaneous transcholecystic cholangiography: experimental study.

Percutaneous transcholecystic cholangiography was performed in three patients with normal-sized bile ducts and suspected obstructive jaundice, and it was performed 14 times in eight normal dogs. In every instance there was good demonstration of both the intra- and extrahepatic biliary tree. There were no significant clinical complications. Transcholecystic cholangiography is a technically easy, valuable alternative to transhepatic cholangiography for opacification of nondilated bile ducts.

ERCP using a special catheter with external steering. A reliable aid in typical ERCP problems.

ERCP is the most sensitive procedure for opacification of the bile and pancreatic ducts. The procedure fails, however, in up to 60% of Billroth II resected patients, and in 5% of nongastrectomized patients, often owing to problems of papillary cannulation with the conventional ERC-catheter, or insufficient control in the bile duct. Therefore, we attempted to perform ERCP with a catheter provided with external steering, which can be introduced through the channel of any commercially available endoscope. This catheter permitted successful ERCP in 11 patients in whom conventional ERCP technique had failed. The endoscopic procedure with the catheter described was simple and reduced papillary cannulation problems in patients with juxtapapillary diverticulum and in those with Billroth II resection, and it permitted selective opacification of intrahepatic bile ducts or the cystic duct.

Does glucagon enhance opacification of the bile ducts during intravenous cholangiography? An experimental study in dogs.

To determine the rational for the ability of glucagon to enhance opacification of the bile ducts during intravenous cholangiography, which has been claimed in recent clinical reports, experiments were performed in dogs which had had Thomas cannulas inserted. A constant step-wise infusion of iodipamide was administered with or without a bolus injection and constant infusion of glucagon. At every infusion rate of iodipamide the biliary concentration of the contrast agent was less when glucagon was administered. Glucagon caused a choleresis, but had no effect on the rate of excretion of iodipamide. It is concluded that the theory that glucagon is of value to improve opacification of the bile ducts during intravenous cholangiography is unlikely to be confirmed by further clinical trials.

Ultrasonically guided percutaneous contrast medium injection and aspiration biopsy using a renal-time puncture transducer.

A real-time transducer for ultrasonically guided puncture was used for percutaneous contrast medium injection and aspiration biopsy in 160 patients with various diseases of the abdomen. Opacification of the bile ducts, pancreatic duct and the portal vein was accomplished in 157 patients. Percutaneous aspiration biopsy provided cytological proof of malignancy in 56 of 64 patients with suspected carcinoma. Ducts or vessels less than 10 mm wide on ultrasound images were successfully opacified, and biopsy confirmed at 2 X 2.5-cm carcinoma.

IOTROXAMIDE: Gives better opacification of the bile ducts

IOTROXAMIDE: Gives better opacification of the bile ducts

Dose-effects of the contrast medium Iotroxinate on biliary excretion of contrast media during infusion cholegraphy (author's transl)

In the anaesthetized pig we studied the influence of the dosage of the contrast medium Iotroxinate on the following parameters of bile secretion: bile flow, bile salt excretion, concentration, and excretion of Iotroxinate. The results demonstrate that high doses of Iotroxinate inhibit the bile salt independent fraction of bile flow in a dose-dependent manner, by analogy to organic anions like Rose Bengal, Indocyaningreen, Ioglycamite. The biliary concentration of Iotroxinate however increases slightly. That means, that high doses of Iotroxinate do not impair the quality of opacification of bile ducts in x-ray examinations, as the contrast medium concentration represents the decisive parameter for a valid cholegraphy.