Segment Of Common Bile Duct Research Articles

Endoscopic ultrasonography in the differential diagnosis of biliopancreatoduodenal tumors

Objective . Todeterminethe role ofendoscopicultrasonography in preoperative differentialdiagnosis of bilio pancreatoduodenal tumorsand choice of further treatment strategy. Material and methods . A retrospective analysis included medical records of 89 patients hospital-ized with suspected biliopancreatoduodenal tumor.Pancreatic head tumor was diagnosed in 41(46.1%) patients, tumorof major duodenal papilla – in 15 patients (16.9%), tumor of distal seg-ment of common bile duct – in 10 patients (11.2%), cicatricial and inflammatory strictures of distal segment of common bile duct – in 19 patients (21.3%), post-necroticpseudocysts of pancreatic head – in 4 patients (4.5%). Results . Sensitivity ofendoscopic ultrasonography for tumors of pancreatic head, major duodenal papilla, distal common bile duct, cicatricial and inflammatory strictures of distal segment of com-mon bile duct and postnecroticpseudocysts of pancreatic head was 90.2%, 100%, 80%, 94.7% and 100%, respectively. Specificity was 97.9%, 94.6%, 98.7%, 98.6% and 100%, respectively. Overall accuracy was 94.4%, 95.5%, 96.6%, 97.8% and 100%, respectively. False-negative results were obtained in 7 cases. Tumor was not excluded in these patients, but there was a conclusion about an-other primary source of growth. Conclusion . Endoscopic ultrasonography is associated with high accuracy of preoperative differen-tial diagnosis of malignant and benign biliopancreatoduodenaltumors and useful to clarify diagnosis in patients with mechanical jaundice syndrome. These data are usedas an objective criterion to de-termine further treatment strategy depending on the results of endoscopic ultrasonography.

Hyperthermia associated with biliary obstruction during living donor liver transplantation.

Intraoperative hypothermia occurs frequently, but hyperthermia is relatively rare during general anesthesia. We experienced a case of hyperthermia during living donor liver transplantation that appeared to be significantly associated with biliary obstruction. A 65-year-old male patient was diagnosed with intrahepatic cholangiocarcinoma, and living donor liver transplantation was planned after confirmation of no metastasis via intraoperative frozen biopsy. Following resection of a segment of common bile duct for frozen biopsy, the surgeon clamped the common bile duct, and the patient’s body temperature increased gradually to 39.5°C. As the congested bile was drained, the body temperature decreased to the normal range. This case report suggests that when a patient develops unexplained hyperthermia during hepatobiliary surgery or in a chance of biliary obstruction, clinicians should consider bile congestion as a possible reason for hyperthermia.

Three-dimensional visualization technology in the diagnosis and treatment of malignant tumor in the hilar bile duct to the upper segment of common bile duct

ABSTRACT Background and Objectives: The aim of this study is to investigate the application of three-dimensional (3D) visualization technique in the surgical treatment of malignant tumors of the hilar and common bile ducts. Materials and Methods: A total of 23 patients admitted from January 2015 to April 2017 for surgical treatment were analyzed, of whom 13 patients underwent medical image 3D visualization system (treatment group) while 10 underwent surgery alone (control group). Indicators to the treatment effects were recorded and compared between the two groups, including the operation time, intraoperative bleeding volume, postoperative hospitalization time, the number of dissected lymph nodes, the incidence of all postoperative complications, and the alanine transaminase (ALT), albumin (ALB), and total bilirubin (TBIL) monitored on days 1, 3, 5, and 7 after the operation. Results: In the treatment group and control group, the operation time was 194.66 ± 13.79 and 230.81 ± 27.07 min (t = 3.857, P = 0.002), the intraoperative bleeding volume was 274.28 ± 44.57 and 320.69 ± 35.90 mL (t = 2.686, P = 0.014), the postoperative hospitalization time was 11.15 ± 1.25 and 15.25 ± 1.75d (t = 6.557, P = 0.000), the number of dissected lymph nodes 10.46 ± 1.71 and 7.40 ± 0.97 (t = 5.050, P = 0.000), and the incidence of all postoperative complications 7.69% and 60% (χ2 = 7.304, P = 0.019), respectively. The level of ALT and TBIL was significantly higher in the treatment group than in the control group, whereas the level of ALB was significantly lower in the treatment group than in the control group on days 3, 5, and 7 (P < 0.05). The recovery of liver function was better in the treatment group than in the control group. In addition, no perioperative deaths were found in either group. Conclusions: In the surgical treatment of malignant tumors occurring in the hilar to the common bile duct, 3D visualization technology can reduce the operation injury and intraoperative bleeding, decrease the incidence of postoperative complications, improve the safety and effectiveness of the operation, and promote the recovery of liver function, thus demonstrating promising short-term efficacy.

Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients.

To evaluate predictive factors for false-negative diagnosis of percutaneous forceps biopsies in patients suspected of having a malignant biliary obstruction METHODS: Two hundred seventy one consecutive patients with obstructive jaundice underwent percutaneous forceps biopsy. In each patient, three to five specimens (mean, 3.5 specimens) were collected from the lesion. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Univariate and multivariate logistic regression analysis was used to identify risk factors associated with false-negative diagnosis. One hundred ninety four of 271 biopsies resulted in correct diagnoses of malignancy, while 20 biopsy diagnoses were proved to be true-negative. There were 57 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 77.2%; specificity, 100%; and accuracy, 78.9%; positive predictive value, 100%, negative predictive value; 25.9%. Periampullary segment of common bile duct, intrahepatic bile duct and metastatic disease were the significant risk factors of false-negative diagnosis. Percutaneous forceps biopsy provides relatively high accuracy in the diagnosis of malignant biliary obstructions. The predictive factors of false-negative biopsy were determined to be biopsy site and origin of primary tumour. • Percutaneous forceps biopsy provides relatively high accuracy in diagnosis of malignant biliary obstructions. • The predictive factors of false-negative biopsy were biopsy site and origin of primary tumour. • The procedure-related complications were low.

An extremely increased CA19-9 level due to common bile duct stone: a case report

Serum carbohydrate antigen 19-9 (CA19-9), a common tumor marker, is frequently increased in bile duct malignancy. We reported a case with an extremely increased CA19-9 level due to benign common bile duct stones and gallstones. A 63-year-old male presented with intermittent right upper quadrant abdominal pain for 1 year. Tumor markers showed that CA19-9 level was more than 1,000.0 U/mL (normal range: 0–37 U/mL), CA-50 level was 466.34 IU/mL (normal range: 0–25 IU/mL), and CA24-2 level was more than 200 IU/mL (normal range: 0–20 IU/mL). Abdominal CT scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated multiple stones located in the lower segment of common bile duct, lower bile duct obstruction, and gallbladder stones. Pancreatic cancer and cholangiocarcinoma were excluded. On the third day after endoscopic retrograde cholangiopancreatography (ERCP), CA19-9 level dropped to 78.62 U/mL. In conclusion, an extremely increased CA19-9 level might be observed in some patients with benign bile duct diseases.

Pathologico-Anatomic Categories of Choledochal End-Piece Stenosis Due to Chronic Pancreatitis and Clinical Significance

Background: Chronic pancreatitis caused by common bile duct segment stenosis is a common complication. It often results in near side bile duct expansion, bile drain disorder, appearing serious obstructive jaundice, biliary cirrhosis, lifethreatening. However, chronic pancreatitis causes not bravery manager narrow some light, some heavy, and the clinical manifestation is different too. We think there may be different kinds of pathological anatomy. As a result, we carried out the research of this subject. Objective: To investigate the anatomicopathological classification of terminal stenosis of the common bile duct (CBD) caused by chronic pancreatitis (CP) and the treatment. Method: A retrospective analysis was made for the management of sympatomatic stenosis of the terminal end of CBD 47 CP cases. Autopsy was performed in 25 bodies to verify our classification. Result: By analyzing operation and postoperative follow-ups to 47 patients with obvious choledochal dilatations (diameter ≥ 15 mm) due to chronic pancreatitis, the authors have found that there exist three pathologico-anatomic categories of choledochal end-piece stenosis due to chronic pancreatitis. The stenosis of type I is the external-pressing annular stricture (59.6%); type II is front wall of choledochus being compressed one (31.9%); and type III is the pseudocystic oppression one (8.5%). Conclusion: The treatment of CP patients complicated with terminal stenosis of CBD need individual consideration. Clinical Significance: Type I should be treated with biliary-enterostomy owing to more serious stricture (only No.3 the Bake’s dilstors and smaller ones can be passed through its stenotic segment). Type II Could be managed with T-tube drainage because of its slighter stricture (Bake’s dilators bigger than No.6 and No.12 French urinary catheter can get through the Choledochal terminal). If there aren’t biliary and pancreatic complicated diseases, non-operative treatment can be carried out. Type III can undergo with the T-tube replacement between biliary tract and pseudocyst if pseudocystic decompression doesn’t lead to obvious stenosis (type IIIo and IIIb). If type III combines type I, the internal drainage should be performed in both ectatic bile duct and cyst.

The proliferous rule of bile duct endothelium after the placement of metallic biliary stent:a study in canine

To discuss the proliferous rule of bile duct endothelium after the placement of metallic biliary stent. The metallic biliary stent was placed at the inferior segment of common bile duct of canine after a percutaneous transhepatic puncture at cholecyst. All the stented dogs were assigned randomly to 4 group including A, B, C and D, each group had been under research for 1 month, 3 months, 12 months and 24 months. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were calculated on the immunohistochemistry staining images and compared with those uncovered in each group, then the expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were compared between every two adjacent groups. The thickness of bile duct wall covered by the stent were measured on the HE staining images and compared between every two adjacent groups. The t-test was performed for the statistics. The animal model were successfully set in 18 canines. The expression of PCNA and Ki-67 in bile duct endothelium covered by the stent were significantly higher than those uncovered in every group (P < 0.05), which got much high within 1 month after stenting (P < 0.05) and gradually raised up again from 3 months to 1 year (P < 0.05) after a period of relatively low proliferation. The thickness of the bile duct covered by the stent changed following the same rule as well. The metallic biliary stent indeed induced the proliferation of bile duct endothelium. This phenomenon enhanced gradually from 3 months to 1 year after stenting, and continued persistently after that.

Diagnosis and treatment of penetrating injury in distal segment of common bile duct during biliary tract exploration

Clinical data of 15 patients with penetrating injury in the distal segment of the common bile duct during biliary tract exploration were retrospectively analyzed.Nine injuries were found during the surgical procedures and successfully treated with common bile duct T tube and peritoneal drainage before discharged from the hospital (mean hospitalization time 16 days).Six penetrating wounds were found post-operatively, and underwent another operation.Four patients were fully recovered at 8 to 12 weeks, and 2 died from multiple organ failure caused by infectious shock.Our investigation suggests that for the penetrating injury in the distal part of the common bile duct, early diagnosis, proper management and effective draining may improve the survival of the patients and avoid serious complications. Key words: Common bile duct diseases; Biliary tract surgical procedures

Early Bile Duct Cancer in a Background of Sclerosing Cholangitis and Autoimmune Pancreatitis

A 59-year-old man presented with recent onset jaundice. Initial laboratory and radiologic findings suggested autoimmune pancreatitis (AIP) with consequent obstructive jaundice. All serologic markers for AIP were, however, normal. To confirm the histologic finding of AIP and exclude the possibility of cancer at the thickened segment of common bile duct, cholangioscopic examination was performed and bile duct cancer was observed. The resected specimen showed typical features of AIP throughout the entire pancreas and early carcinomatous change on a background of abundant IgG4-positive cells in the common bile duct. Although chronic biliary inflammation and cholestasis are among bile duct cancer risk factors, the cause-and-effect relationship between sclerosing cholangitis and bile duct cancer needs to be determined by further study, as between AIP and pancreatic cancer. Importantly, histologic exclusion of malignancy is another essential step in the diagnosis of AIP and sclerosing cholangitis as malignancy may coexist in bile duct as well as in the pancreas.

Diagnosis and treatment of penetrating wound of distal segment of common bile duct: a report of 5 cases

在基层医院没有胆道镜施行胆道探查手术,采用胆道探条或取石钳进行胆总管远端探查时可造成其末端部位的穿通伤,如术时未及时发现这种特殊类型的胆道损伤(DCPD),术后可能发生胆瘘致腹膜后间隙严重感染等致死性后果,笔者报道5例(2000-2005年)诊治经过,并讨论与之相关的临床问题。

Duodenum-preserving head resection in chronic pancreatitis

A duodenum-preserving head resection was performed in 295 patients with chronic pancreatitis and an inflammatory mass in the head of the pancreas. Ninety-four percent of patients suffered severe pain syndrome, 48% had a common bile duct stenosis, 17% a vascular obstruction in the portal vein and splenic vein branches, and 6% had a severe stenosis of the duodenum. Surgical resection of the inflammatory mass in the head of the pancreas was indicated after a medical treatment of 4.1 years (median). Subtotal resection of the head of the pancreas, including the inflammatory mass, resulted in decompression of the narrowed common bile duct segment, decompression of the pancreatic main duct, and the relief of duodenum stenosis, as well as a relief of portal hypertension. The mean hospitalization time was 13 days, frequency of re-operation 5.8%, and hospital mortality 1.02%. Seventy-nine percent of patients experienced long-lasting pain relief and 11% reported a significant and long-lasting reduction of pain; late morbidity proved to be low. In comparison to the Whipple procedure the duodenum-preserving head resection has the advantage of preserving the stomach, duodenum and biliary tract.

Imaging of the biliary sump syndrome.

Side-to-side choledochoduodenostomy is a safe and effective surgical technique to improve biliary drainage in selected patients. The segment of common bile duct between the anastomosis and the ampulla of Vater may act as a stagnant reservoir or sump. When debris, stones, or infected bile accumulates in the sump, usually because of malfunction of the ampulla of Vater, recurrent abdominal pain or symptoms of cholangitis, pancreatitis, or biliary obstruction may develop. This uncommon (0.14-1.30%) complication is known as the sump syndrome. On imaging studies, diagnostic findings are debris or stone(s) in the common bile duct. Suggestive findings are dilated bile or pancreatic ducts, and changes due to pancreatitis, cholangitis, or liver abscess. Patients with this syndrome frequently have multiple imaging studies before the condition is recognized. The purpose of this essay is to illustrate the imaging findings of this syndrome.