MedWorm: Cholangiogram

Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones.

Annals of the Royal College of Surgeons of England — Wed, 10 Mar 2010 00:00:00 +0100

CONCLUSIONS A selective policy for intra operative cholangiography yields acceptably high positive results. Pre operatively asymptomatic bile duct stones rarely present following LC; thus routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore a rationing approach to the use of intra operative imaging based on the pre operative indicators presented in this paper successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration performed by an experienced laparoscopic surgeon is a safe and effective method of clearing the bile duct of calculi with minimal complications avoiding the necessity for an additional intervention and prolonged hospital stay. PMID: 20223077 [PubMed - as supplied by publisher] (S...

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Jejunal access loop cholangiogram and intervention using image guided access

Australasian Radiology — Wed, 03 Mar 2010 00:00:00 +0100

We present a series of 20 access loop cholangiograms performed in our institution between August 2004 and November 2008. We aimed to evaluate the safety and efficacy of the procedure and to highlight the role of CT guidance in procuring access. Access loop was accessed using CT (n = 13), ultrasound (n = 3) or fluoroscopic guidance (n = 4). Fluoroscopy was used for performing cholangiograms and interventions. Twelve studies had balloon plasty of the stricture at anastomotic site or high up in the hepatic ducts. Seven studies showed normal cholangiogram. Plasty was unsuccessful in one study. Technical success in accessing the jejunal access loop was 100%; in cannulation of anastomotic site and balloon plasty it was 95%. One case required two attempts. Procedure-related complications were not...

Journal of Pediatric Surgery — Mon, 01 Mar 2010 00:00:00 +0100

The authors from Mumbai, India, present a 6-month-old female infant with a 2-month history of a 15 × 10-cm calcified abdominal mass. Preoperative computed tomography (CT) revealed that this was located in the upper retroperitoneal region, encapsulated, and contained rudimentary limbs, consistent with the diagnosis of fetus-in-fetu (FIF). At operation, while mobilizing the adherent duodenum, the attenuated and stretched common bile duct (CBD) was divided. This was recognized; and the duct was repaired primarily over a 5F feeding tube, with one end exteriorized. The mass was excised completely, and histopathology confirmed FIF. Result of tube cholangiogram 2 weeks later was normal, and the tube was removed. The patient remained well at 1 year. (Source: Journal of Pediatric Surgery)

Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases

Surgical Endoscopy — Fri, 05 Feb 2010 08:43:01 +0100

Conclusions The findings demonstrate that SPA surgery is an alternative to multiport laparoscopy with fewer scars and better cosmesis. One factor affecting the rate for adoption of SPA surgery among other surgeons is the reproducibility of this new procedure. Although this study had insufficient data to determine fully the benefits of SPA surgery, the feasibility of this procedure with safe, acceptable results was demonstrated in this initial large series across multinational institutions. Content Type Journal ArticleDOI 10.1007/s00464-009-0856-xAuthors Paul G. Curcillo, Drexel University College of Medicine Department of Surgery 219 North Broad Street Philadelphia PA 19107 USAAndrew S. Wu, Drexel University College of Medicine Department of Surgery 219 North Broad S...

Is Pancreaticobiliary Maljunction Responsible for Necrotizing Pancreatitis? V

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:15 +0100

Introduction: Approximately 20% of patients with acute pancreatitis (AP) develop severe necrotizing pancreatitis (NP). The reason(s) why only a small percentage of AP patients develop NP is unknown. The presence of a long common biliopancreatic channel (also known as pancreaticobiliary maljunction [PBM]) is associated with increased risk of biliary malignancy and possibly of pancreatitis. We hypothesized that patients with biliary NP would have a longer common channel that those with mild AP. Methods: Between 2003-2007, 1290 patients with AP were admitted to our institution. Of these, 1045 had mild AP and 235 had NP. Patients with biliary NP (n=102) were matched by demographic 2:1 to those with mild (biliary) AP. Imaging studies – intraoperative cholangiogram (IOC), endoscopic retrograde...

Laparoscopic Cholecystectomy in Obese and Non-Obese Children

Journal of Surgical Research — Mon, 25 Jan 2010 16:42:02 +0100

Conclusions: Despite the known surgical challenges with overweight and obese patients, operative times, length of stay, and complication rate remain similar for children undergoing laparoscopic cholecystectomy compared to non-obese children. (Source: Journal of Surgical Research)

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Endoscopic management of postoperative bile duct injuries: A single center experience

The Saudi Journal of Gastroenterology — Fri, 08 Jan 2010 14:17:48 +0100

Conclusions:</b> Endoscopic therapy is safe and effective in the management of postoperative bile duct leak. For postoperative bile ductal strictures, ERCP is a less favorable option. (Source: The Saudi Journal of Gastroenterology)

Single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for evaluation of pancreaticobiliary disorders

Surgical Endoscopy — Thu, 07 Jan 2010 16:14:35 +0100

Conclusion Single-session EUS-ERCP can be performed safely and with efficacy similar to that of the procedures performed separately. Content Type Journal ArticleDOI 10.1007/s00464-009-0798-3Authors Gil Ascunce, University of Miami Division of Gastroenterology, Miller School of Medicine P.O. Box 016960 Miami FL 33101 USAAfonso Ribeiro, University of Miami Division of Gastroenterology, Miller School of Medicine P.O. Box 016960 Miami FL 33101 USACaio Rocha-Lima, University of Miami Division of Hematology and Oncology, Miller School of Medicine Miami FL USAMarcelo Larsen, University of Miami Division of Gastroenterology, Miller School of Medicine P.O. Box 016960 Miami FL 33101 USADanny Sleeman, University of Miami Department of Surgery, Miller School of Medicine Miami FL US...

Journal of Pediatric Surgery — Thu, 31 Dec 2009 15:18:37 +0100

With the increasing use of newer modalities such as CT cholangiography and MRCP offering an accurate delineation of ductal anatomy of choledochal cysts, the incidence of type IV-A biliary duct cysts has increased. Although the management of the more common type I cysts is well established, that of type IV-A cysts is still controversial. The localized/unilobar variety of type IV-A cysts is an unique entity amenable to surgical management. The authors report on 25 cases with choledochal cysts 10 of whom were diagnosed as having type IV-cysts. Four of these were localized or unilobar variants, affecting only one lobe of the liver. Three cases had a left ductal involvement and one had a right ductal involvement of their intrahepatic component. The authors describe the presentation and curative...

Findings at endoscopic retrograde cholangiopancreatography after endoscopic treatment of postcholecystectomy bile leaks

Surgical Endoscopy — Wed, 30 Dec 2009 06:53:08 +0100

Conclusion After endoscopic treatment of a bile leak, the prevalence of abnormalities at follow-up ERC is significant. A repeat cholangiogram with a balloon sweep is preferred at the time of stent removal. Content Type Journal ArticleDOI 10.1007/s00464-009-0842-3Authors Gregory A. Coté, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USAMichael Ansstas, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USASomal Shah, Washington University School of Medicine Division of Gastroenterology 660 South Euclid Avenue Campus Box 8124 St. Louis MO 63110 USARajesh N. Keswani, Washington University School of Medicine Divis...

Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients

Surgical Endoscopy — Fri, 25 Dec 2009 06:55:18 +0100

Conclusion The SILC technique with a two-trocar technique is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. The SILC procedure is becoming the standard of care for most of the authors’ elective patients with gallbladder disease. Clinical trials are warranted before the SILC technique is adopted universally. Content Type Journal ArticleDOI 10.1007/s00464-009-0786-7Authors Homero Rivas, University of Texas Southwestern Department of Surgery, Division of Gastrointestinal and Endocrine Surgery 5323 Harry Hines Boulevard Dallas TX 75390-8819 USAEsteban Varela, Washington University in St. Lou...

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Endoscopic management of biliocutaneous fistula after percutaneous radiofrequency ablation therapy for hepatocellular carcinoma

Digestive Endoscopy — Tue, 15 Dec 2009 00:00:00 +0100

Our patient was a 70-year-old man with hepatocellular carcinoma (HCC) and liver cirrhosis (Child[ndash]Pugh B). He had a history of distal gastrectomy with Billroth II reconstruction for duodenal ulcer and hepatectomy for HCC. One month after percutaneous radiofrequency ablation (RFA) for recurrent HCC, biliocutaneous fistula was observed. The cholangiogram demonstrated leakage of contrast material from an intrahepatic duct into the fistula, and a nasobiliary catheter was placed. Subsequently, the discharge of bile steadily decreased and stopped. Follow-up cholangiogram revealed no evidence of bile leakage. Biliocutaneous fistula is an extremely rare complication after percutaneous RFA, and the present case report suggests that endoscopic drainage is the first-line therapy for bile leaks a...

A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

World Journal of Surgical Oncology — Sat, 05 Dec 2009 00:00:00 +0100

Conclusion: Considering a favorable prognosis of IPMN-B compared to non-papillary biliary neoplasms, this tumor can be a good indication for aggressive surgical resection regardless of its tumor size. (Source: World Journal of Surgical Oncology)

Large Diameter Balloon Dilation for Removal of Bile Duct Stone

The Digital Atlas of Video Education - Gastroenterology — Fri, 20 Nov 2009 16:11:33 +0100

83 year old male with multiple co-morbidities presented with fever, abnormal liver enzymes and dilated common bile duct (CBD) up to 15 mm in size on abdominal CT scan and elevated international normalized ratio (INR). A pull type sphincterotome was used to cannulate the common bile duct. After the slight adjustment, the sphincterotome was advanced freely without any resistance into the common bile duct and the cholangiogram was obtained. Here we see a large common bile duct stone on the cholangiogram. This stone was approximately 15 mm in size. A small biliary sphincterotomy was performed using the endocut current. We used controlled radial expansion (CRE) balloon over the guidewire to dilate the biliary orifice. We inflated the CRE balloon up to 12 mm and was kept in position for appro...

Intraoperative fluorescent imaging using indocyanine green for liver mapping and cholangiography

Journal of Hepato-Biliary-Pancreatic Surgery — Wed, 21 Oct 2009 02:18:01 +0100

Conclusion Application of this technique allows intraoperative identification of anatomical landmark in hepatobiliary surgery. Content Type Journal ArticleCategory TopicsDOI 10.1007/s00534-009-0197-0Authors Takeshi Aoki, Showa University Department of Gastroenterological & General Surgery, School of Medicine Tokyo 142-8666 JapanMasahiko Murakami, Showa University Department of Gastroenterological & General Surgery, School of Medicine Tokyo 142-8666 JapanDaisuke Yasuda, Showa University Department of Gastroenterological & General Surgery, School of Medicine Tokyo 142-8666 JapanYoshinori Shimizu, Showa University Department of Gastroenterological & General Surgery, School of Medicine Tokyo 142-8666 JapanTomokazu Kusano, Showa University Department of Gastroenterological &...

Balloon-assisted peroral cholangioscopy by using an 8.8-mm gastroscope for the diagnosis of Mirizzi syndrome

Gastrointestinal Endoscopy — Mon, 19 Oct 2009 00:00:00 +0100

A 50-year-old woman was referred for treatment of an obstructing gallstone in the common hepatic duct, found on MRCP (A). An ERCP was performed, revealing a 2.5-cm stone obstructing the common hepatic duct (B), with no opacification of the gallbladder. Attempts using mechanical lithotripsy were unsuccessful, so a biliary sphincterotomy was performed, and a 10F plastic stent was placed for temporary decompression. The patient returned 1 week later for cholangioscopy. So that the duct could optimally be visualized, a 0.035-inch guidewire was advanced above the obstructing stone by using a therapeutic duodenoscope (TJF-160VF; Olympus America, Inc, Center Valley, Penn). The duodenoscope was then exchanged over the guidewire for an 8.8-mm, standard gastroscope preloaded with an 11.5F balloon (G...

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Image overlay navigation by markerless surface registration in gastrointestinal, hepatobiliary and pancreatic surgery

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 01 Oct 2009 18:14:26 +0100

Conclusions Our non-invasive markerless registration using physiological markers on the body surface reduced logistical efforts. The image overlay technique is a useful tool when highlighting hidden structures, giving more information. Content Type Journal ArticleCategory TopicsDOI 10.1007/s00534-009-0199-yAuthors Maki Sugimoto, Teikyo University Chiba Medical Center Department of Surgery 3426-3 Anesaki, Ichihara Chiba 299-0111 JapanHideki Yasuda, Teikyo University Chiba Medical Center Department of Surgery 3426-3 Anesaki, Ichihara Chiba 299-0111 JapanKeiji Koda, Teikyo University Chiba Medical Center Department of Surgery 3426-3 Anesaki, Ichihara Chiba 299-0111 JapanMasato Suzuki, Teikyo University Chiba Medical Center Department of Surgery 3426-3 Anesaki, Ichihara Ch...

The management of treatment-resistant biliary calculi using percutaneous endourologic techniques.

Canadian Journal of Surgery — Thu, 01 Oct 2009 00:00:00 +0100

CONCLUSION: Biliary calculi may be successfully treated using standard endourologic methods with high stone-free rates. This technique is generally well-tolerated even among high-risk patients. PMID: 19865576 [PubMed - in process] (Source: Canadian Journal of Surgery)

Selective Management of Patients with Acute Biliary Pancreatitis

Journal of Gastrointestinal Surgery — Fri, 25 Sep 2009 05:47:47 +0100

Conclusion Presence of four or five variables significantly correlated with persistent CBD stone. Biliary evaluation by endoscopic retrograde cholangiopancreatography is suggested, as initial magnetic resonance cholangiopancreatography (MRCP) may only increase cost and delay time to intervention. In the absence of any variable, biliary evaluation by intraoperative cholangiogram may be sufficient. Decisions regarding patients with one to three variables should occur on a case-to-case basis. Initial biliary evaluation by MRCP is likely preferable, however, as no increased probability of CBD stone was identified, thus not warranting risks associated with intervention. Content Type Journal ArticleCategory 2009 SSAT Quick Shot PresentationDOI 10.1007/s11605-009-1041-1Auth...

Long-term outcome of endoscopic and/or percutaneous transhepatic therapy in patients with biliary stricture after orthotopic liver transplantation

Journal of Gastroenterology — Fri, 18 Sep 2009 06:42:51 +0100

Conclusions Endoscopic as well as percutaneous transhepatic approaches in combination or as monotherapy are effective in the management of anastomotic and non-anastomotic strictures after liver transplantation. Content Type Journal ArticleCategory Original Article—Liver, Pancreas, and Biliary TractDOI 10.1007/s00535-009-0123-xAuthors Andreas Weber, Technical University of Munich Department of Gastroenterology and Hepatology Munich GermanyChristian Prinz, Technical University of Munich Department of Gastroenterology and Hepatology Munich GermanyCarlos Gerngroß, Technical University of Munich Department of Gastroenterology and Hepatology Munich GermanyLeopold Ludwig, Technical University of Munich Department of Gastroenterology and Hepatology Munich GermanyWolfgang Hu...

Long-term follow-up evaluation for more than 10 years after endoscopic treatment for postoperative bile duct strictures

Surgical Endoscopy — Tue, 15 Sep 2009 20:43:50 +0100

Conclusions Endoscopic stent therapy is available for postoperative bile duct strictures. Long-term prognosis for more than 10 years is excellent. Repeat surgical interventions may be unavoidable in some cases, but endoscopic treatment should be proposed as the first-line treatment. Content Type Journal ArticleDOI 10.1007/s00464-009-0673-2Authors Yasuhisa Kuroda, Chiba University Department of Medicine and Clinical Oncology, Graduate School of Medicine 1-8-1 Inohana, Chuo-ku Chiba 260-0856 JapanToshio Tsuyuguchi, Chiba University Department of Medicine and Clinical Oncology, Graduate School of Medicine 1-8-1 Inohana, Chuo-ku Chiba 260-0856 JapanYuji Sakai, Chiba University Department of Medicine and Clinical Oncology, Graduate School of Medicine 1-8-1 Inohana, Ch...

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Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst

Digestive Endoscopy — Sun, 13 Sep 2009 23:00:00 +0100

We report feasibility and outcome of the endoscopic method for treatment of ruptured hepatic hydatid cyst into the biliary tract that also benefited from drainage of the whole cyst and membranes into the major biliary duct. (Source: Digestive Endoscopy)

An unusual presentation of biloma five years following cholecystectomy: a case report

Cases Journal — Wed, 09 Sep 2009 23:00:00 +0100

A 34-year-old female presented with right hypochondrial pain of 6 months following an uneventful open cholecystectomy about 5 years ago. A firm intra abdominal lump was felt in the right hypochondrium. Ultrasonography and computed tomography of the abdomen showed a large cystic lesion in relation to the porta hepatis. On exploration, a large cystic mass was found in relation to the undersurface of liver, adherent to the colon and duodenum. The cyst was excised leaving a cuff of cyst wall, densely adherent to the duodenum. A small opening with bile trickling through it was noted in the region of the confluence of hepatic ducts. Choledochotomy was done and T-tube placed. The bilious output from the sub-hepatic drain gradually decreased and the repeat T-tube cholangiogram on 14th day followin...

[Small cell carcinoma of extahepatic bile duct presenting with hemobilia.]

Korean J Gastroenter... — Mon, 31 Aug 2009 23:00:00 +0100

We report a case of small cell carcinoma of extrahepatic bile duct presenting with jaundice and hemobilia. A 59-year-old woman was admitted due to right upper quadrant pain and jaundice. An abdominal computed tomography revealed a 2 cm sized mass in the extrahepatic bile duct. Endoscopic retrograde cholangiopancreatography revealed bloody discharge coming out of the papillary orifice in endoscopic view and a dilated extrahepatic bile duct with multiple irregular filling defects in cholangiogram. A coronal T2-weighted image revealed a hyperintense mass at extrahepatic bile duct. Laparotomy was performed, and pathologic examination of resected specimen showed tumor cells having round to oval nuclei with coarsely granular chromatin and scanty cytoplasm, which were immunoreactive for synaptoph...

Intravenous Morphine for Augmentation of Postoperative T-tube Cholangiograms in Liver Transplant Recipients with Choledocho-choledochal Anastomoses

Journal of Vascular and Interventional Radiology : JVIR — Sun, 30 Aug 2009 23:00:00 +0100

Conclusions: In 92% of cases, intravenous morphine was successful in opacifying the biliary tract without complications. In well-positioned T-tubes, the use of morphine increased diagnostic yield from 85% to 93%. No predictors for inadequate filling were found. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Endoscopic transpapillary intraductal ultrasonography and biopsy in the diagnosis of IgG4-related sclerosing cholangitis

Journal of Gastroenterology — Mon, 27 Jul 2009 22:38:03 +0100

Conclusions The IDUS findings were useful for distinction of IgG4-SC from cholangiocarcinoma. Transpapillary biopsy was not useful for direct diagnosis of IgG4-SC even after IgG4 immunostaining, but it did allow distinction of IgG4-SC from cholangiocarcinoma in some cases. IDUS and transpapillary biopsy after endoscopic retrograde cholangiopancreatography can provide further information for precise diagnosis of IgG4-SC. Content Type Journal ArticleCategory Original Article—Liver, Pancreas, and Biliary TractDOI 10.1007/s00535-009-0108-9Authors Itaru Naitoh, Nagoya City University Graduate School of Medical Sciences Department of Gastroenterology and Metabolism 1 Kawasumi Mizuho-cho, Mizuho-ku Nagoya 467-8601 JapanTakahiro Nakazawa, Nagoya City University Graduate Sc...

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Prediction of Which Patients with an Abnormal Intraoperative Cholangiogram Will Have a Confirmed Stone at ERCP

Digestive Diseases and Sciences — Sat, 25 Jul 2009 04:29:59 +0100

Conclusions Approximately one-half of patients with an abnormal IOC have a normal postoperative ERCP. None of the parameters evaluated in this retrospective study helped identify patients who merit further evaluation by ERCP. The argument could be made that in patients with an abnormal IOC, less invasive methods such as endoscopic ultrasound or magnetic resonance cholangiopancreatography could be used postoperatively if symptoms arise to assess for possible retained stone. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10620-009-0894-1Authors Matthew P. Spinn, University of Texas Health Science Center, Medical School Houston Division of Gastroenterology 6431 Fannin Street, MSB 4.234 Houston TX 77030 USADavid S. Wolf, University of Texas Health Scie...

Should radiocontrast be diluted for operative cholangiography?

International Journal of Surgery — Wed, 15 Jul 2009 23:00:00 +0100

The role of operative cholangiography for detecting common bile duct stones and for delineating biliary anatomy is well established. The first operative cholangiogram was described by Mirizzi in 1937 and popularized in the United States by Hickens. Operative cholangiography has resulted in improved detection of common bile duct stones from 83% based on clinical findings alone to over 95%. The introduction of portable C-arm fluoroscopy in the 1970s by Berci and Steckell has even further improved the accuracy of operative cholangiography. (Source: International Journal of Surgery)

Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step?

Surgical Endoscopy — Thu, 09 Jul 2009 12:46:12 +0100

Conclusions The laparoscopic basket blind technique and choledochoscopy are safe and effective for CBD stone removal. However, the latter seems to be better in terms of a higher stone removal rate and fewer minor complications despite its longer operation time. In the authors’ opinion, it may be preferable to reserve ERCP for very high-risk patients, taking into account that in addition to the related complications, it results in an approximate 10% rate of recurrent or persistent stones. Content Type Journal ArticleDOI 10.1007/s00464-009-0599-8Authors R. Campagnacci, Università Politecnica delle Marche Clinica di Chirurgia Generale e Metodologia Chirurgica, Ospedali Riuniti via Conca 1 60121 Ancona ItalyA. Baldoni, Università Politecnica delle Marche Clinica di C...

[A case of early bile duct cancer arising from villous adenoma in choledochal cyst.]

Korean J Gastroenter... — Tue, 30 Jun 2009 23:00:00 +0100

Authors: Lee TS, Kim HK, Ahn HM, Lee UJ, Choi YC, John BM, Park TI, Koo JH Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed ch...

Liver injury from endoscopic insertion of self-expandable metallic stent to relieve biliary obstruction: a fatal complication

Gastrointestinal Endoscopy — Thu, 25 Jun 2009 23:00:00 +0100

A 75-year-old man was diagnosed with advanced hilar cholangiocarcinoma and underwent an ERCP. His cholangiogram revealed a hilar stricture and mild left intrahepatic duct dilatation (A). A guidewire could be passed through the stricture into the left intrahepatic duct, and a noncovered self-expandable metallic stent was inserted over the wire. After stent deployment, an abdominal film was taken (B). On the first postoperative day, the patient developed a high fever, abdominal pain, and distention. CT scan of the abdomen demonstrated a malpositioned stent (C). In the operating room, the stent was found to have penetrated segment III of the liver and was extending into the peritoneal cavity (D). The stent was removed, and a drainage tube was placed. Unfortunately, the patient expired from se...

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Long-Term Results of Percutaneous Bilioenteric Anastomotic Stricture Treatment in Liver-Transplanted Children

CardioVascular and Interventional Radiology — Sat, 20 Jun 2009 06:03:57 +0100

In conclusion, balloon dilation and percutaneous drainage placement is safe and effective, and it has long-term patency for children with BAS after liver transplantation. Because of prolonged treatment time, reintervention may be necessary, thereby increasing the complication rate. Balloon dilation and percutaneous drainage placement should be considered as the first treatment option because of its minimally invasive nature. Content Type Journal ArticleCategory Clinical InvestigationDOI 10.1007/s00270-009-9619-2Authors Airton Mota Moreira, São Paulo University Medical School Interventional Radiology Unit, Radiology Institute, Hospital das Clínicas Av. Dr. Enéas de Carvalho Aguiar, 255 Sao Paulo 05403-001 BrazilFrancisco César Carnevale, São Paulo University Medical School Int...

Endoscopic Resection of Distal Bile Duct Mass

The Digital Atlas of Video Education - Gastroenterology — Mon, 01 Jun 2009 06:06:56 +0100

1. This video demonstrated a case of endoscopic resection of a distal bile duct mass. 2. A 76-yr old patient with recurrent cholangitis under went EUS for evaluation of a dilated bile duct. 3. At EUS, a hyperechoic mass was seen in the distal CBD consistent with a polyp. 4. An ERCP was undertaken to evaluate the mass by intraductal ultrasound. 5. Cholangiogram confirmed the presence of a distal CBD mass. 6. At intraductal ultrasound, a dilated CBD was seen with a hyperechoic polypoid mass sparing the deep muscle layers. 7. A biliary sphincterotomy was undertaken and extended up to the duct-duodenal junction. 8. A stone retrieval balloon was then advanced into the bile duct and the inflated balloon was pulled. 9. The bile duct mass was then gently extracted by pulling the balloon. ...

Direct Peroral Cholangioscopy in the Management of Refractory Stone Disease

The Digital Atlas of Video Education - Gastroenterology — Mon, 01 Jun 2009 06:06:55 +0100

Direct, peroral cholangioscopy in the management of refractory stone disease, presented by Gregory Cote, Steven Edmundowicz, Sreenivasa Jonnalagadda and Riad Azar. Cholangioscopy allows direct visualization of the bile duct; this has been used to distinguish malignant from benign bile duct lesions, as wall as in the management of complicated choledocholithiasis by allowing direct visualization for electrohydraulic lithotripsy, or EHL. Traditional mother-daughter systems are limited by the need for two experienced endoscipists, poor visualization and the absence of a meaningful working channel. Single operator, fiberoptic cholangioscopy allows for four-way deflection and continuous irrigation, but the optical resolution remains inferior to standard endoscopic images. Direct, peroral chol...

Long-Term Effects of Iatrogenic Bile Duct Injury During Cholecystectomy

Clinical Gastroenterology and Hepatology — Sun, 24 May 2009 23:00:00 +0100

Conclusions: Patients with iatrogenic reconstructed bile duct injury have a decreased survival rate compared with noninjured cholecystectomy patients. Patients' younger age, absence of other diseases, and routine use of intraoperative cholangiogram seem to be positive prognostic survival factors. These patients also may be at increased risk of dying from liver diseases, although this issue requires further study. (Source: Clinical Gastroenterology and Hepatology)

Neonatal cholestasis: differentiation of biliary atresia from neonatal hepatitis in a developing country

Acta Paediatrica — Fri, 15 May 2009 04:00:00 +0100

Conclusions: One-third of all NCS in India is due to BA and among the intrahepatic causes acquired infection and galactosaemia are common. Liver biopsy is the best method to differentiate NH from BA. (Source: Acta Paediatrica)

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Electronic Clinical Challenges and Images in GI

Gastroenterology — Fri, 08 May 2009 04:00:00 +0100

Question: A 28-year-old Latin American woman presented with a 1-week history of right upper quadrant pain. Pain initially was severe along with vomiting, over the next few days pain subsided, and she was jaundiced on presentation to the hospital. Her past medical history was unremarkable. Pertinent laboratory data showed a normal white cell count, total bilirubin of 11.6 mg/dL (normal, 0.2–1.3), alkaline phosphatase 200 U/L(normal, 38–126), aspartate aminotransferase 157 U/L (normal, 13–40), alanine aminotransferase 471 U/L (normal, 10–40), and serum lipase 28 U/L (normal, 7–59). A right upper quadrant ultrasound showed common bile duct (CBD) of 7 mm along with intrahepatic ductal dilation and cholelithiasis. Murphy's sign was negative. On Endoscopic retrograde cholangiopancreato...

Gs37pselective magnetic resonance cholangio-pancreatography (mrcp) in gallstone pancreatitis may miss choledocholithiasis

ANZ Journal of Surgery — Mon, 27 Apr 2009 04:00:00 +0100

Conclusion: Choledocholithiasis is common in GP. Selective MRCP is highly specific in GP but may not be sensitive enough to exclude choledocholithiasis in this context. (Source: ANZ Journal of Surgery)

Rs10plearning curve on intra-operative cholangiogram in the perspective of new surgeons

ANZ Journal of Surgery — Mon, 27 Apr 2009 04:00:00 +0100

Conclusion: For training purpose junior surgeons should be increasingly exposed to IOC. IOC can identify missed stones, biliary anatomy and complications of Laparoscopic Cholecystectomy immediately. (Source: ANZ Journal of Surgery)

Biliary - Type III Choledochal Cyst with Biliary Reflux through the Minor Papilla; Needle Knife Major Papillotomy

The Digital Atlas of Video Education - Gastroenterology — Thu, 23 Apr 2009 10:04:08 +0100

This 17 year old male was referred for unexplained acute pancreatitis. His initial episode of acute pancreatitis resulted in a 5 day hospitalization, with serum lipase 10 times normal, and CT showing mild interstitial pancreatitis. He has had intermittent mild abdominal pain since. Laparoscopic cholecystectomy was performed because of a dilated gallbladder; intraoperative cholangiogram showed dilation of the terminal bile duct. ERCP attempted locally resulted in inability to find any orifice or cannulate any duct in the major papilla. He was referred to us for further evaluation. MRCP with secretin was performed. With successive images after secretin injection, you can see cystic dilation of terminal bile duct and pancreatic duct, which appear to be separate and parallel, then fuse into o...

Mirizzi’s syndrome: a diagnostic dilemma

Irish Journal of Medical Science — Wed, 15 Apr 2009 08:00:00 +0100

Abstract A 62-year-old male presented with a history of upper abdominal discomfort. Past history included asymptomatic gallstones. Abdominal ultrasound and CT demonstrated gallstones within a thick-walled gallbladder, and intra and extrahepatic duct dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a stricture within the mid-portion of the common bile duct. At laparotomy, a single large stone was found causing external compression of the common bile duct causing a Mirizzi’s-type stricture. At repeat ERCP, cholangiogram showed no evidence of stricture. Clinicians should be aware that no definite clinical signs distinguish Mirizzi’s syndrome and surgical exploration is often required for diagnosis. Content Type Journal ArticleCategory Case Repo...

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Are there roles for intraductal US and saline solution irrigation in ensuring complete clearance of common bile duct stones?

Gastrointestinal Endoscopy — Fri, 27 Feb 2009 00:00:00 +0100

Conclusion: IDUS detected small residual CBD stones that persisted after EST and basket/balloon extraction. Saline solution irrigation appeared useful in clearing residual small stones. (Source: Gastrointestinal Endoscopy)

Long-term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy

Journal of Gastroenterology and Hepatology — Mon, 09 Feb 2009 05:00:00 +0100

Conclusions: Endoscopic treatment of bile duct lesions after cholecystectomy is effective, particularly in patients with peripheral bile duct leakages and bile duct strictures. Therefore, it should be the first-line therapy used in these patients. Although endoscopic management is less successful in patients with central bile duct leakages, an attempt is warranted. (Source: Journal of Gastroenterology and Hepatology)

An unusual variant of choledochal cyst: a case report

Journal of Medical Case Reports — Mon, 09 Feb 2009 05:00:00 +0100

Conclusion: The anatomy should be clearly defined before surgical excision as abnormal variants can occur, which usually do not fit into the known classification types and subtypes. (Source: Journal of Medical Case Reports)

Cholangiographic Features in the Diagnosis and Management of Obstructive Icteric Type Hepatocellular Carcinoma

HPB Surgery — Sun, 25 Jan 2009 11:29:25 +0100

In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encaseme...

Small-duct primary sclerosing cholangitis

Current Gastroenterology Reports — Sat, 17 Jan 2009 08:48:07 +0100

Abstract Patients with cholestatic liver tests and typical histologic features of primary sclerosing cholangitis (PSC) but a normal cholangiogram have been identified as having small-duct PSC. This subgroup of PSC has been less well characterized than the classic largeduct form. Some patients characterized as having small-duct PSC develop cholangiographic features of PSC during follow-up. Three papers published in 2002 on small-duct PSC patients suggested a better prognosis in patients with small-duct PSC than in those with large-duct PSC. However, these studies included a limited number of patients and had a short follow-up. A combined cohort of these patients with a prolonged follow-up recently confirmed these previous observations. However, some patients will suffer fro...

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Open common bile duct exploration — end of an epoch?

Irish Journal of Medical Science — Wed, 24 Dec 2008 08:53:19 +0100

Abstract With the advent of laparoscopic cholecystectomy and the impending replacement of open common bile duct exploration, we have reviewed our ten year experience of conventional common bile duct exploration. Open cholecystectomy was performed in 1681 patients and the common bile duct was explored in 325 (19%). Following initial duct exploration, rigid choledo identified residual choledocholithiasis in 58 and periampullary neoplasia in 2 patients. Unexpected retained stones were identified in 3 patients (0.9%). In a further 4 patients, stones which could not be dislodged from the hepatic ducts were confirmed on 10 day T-tube cholangiogram - transduodenal sphincteroplasty had been performed at the time of original surgery in all four. The mortality was 1.9% overall and...

Absence of glycochenodeoxycholic acid (GCDCA) in human bile is an indication of cholestasis: A 1H MRS study

NMR in Biomedicine — Tue, 09 Dec 2008 05:00:00 +0100

The utility of 1H MR spectroscopy in detecting chronic cholestasis has been investigated. The amide proton region of the 1H MR spectrum of human bile plays a major role in differentiating cholestatic (Ch) patterns from the normal ones. Bile obtained from normal bile ducts contains both taurine and glycine conjugates of bile acids - cholic acid (CA), chenodeoxycholic acid (CDCA), and deoxycholic acid (DCA). Absence of a glycine-conjugated bile acid glycochenodeoxycholic acid (GCDCA) has been observed in bile samples obtained from primary sclerosing cholangitis (PSC) patients. A total of 32 patients with various hepatobiliary diseases were included in the study. Twenty-one patients had PSC and 11 had normal cholangiograms. One PSC patient was excluded from the study because of a bad spectrum...

An unusual presentation of primary sclerosing cholangitis.

World Journal of Gastroenterology : WJG — Fri, 21 Nov 2008 05:00:00 +0100

Authors: Goldwire FW, Norris WE, Koff JM, Goodman ZD, Smith MT This case report describes the unusual presentation of a patient who had findings which were initially suggestive of a type IV choledochal cyst. Her liver biopsy demonstrated biliary cirrhosis. She was treated with endoscopic retrograde cholangiopancreatography and biliary stent exchanges over one year. Her cholangiogram one year later demonstrated resolution of the biliary cystic dilation which led to her initial diagnosis, with beading and stricturing of the hepatic ducts consistent with primary sclerosing cholangitis. Liver-associated enzymes and physical findings also improved. A liver biopsy one year later demonstrated a marked improvement in hepatic fibrosis with no evidence of cirrhosis. PMID: 19034983 [PubMed - ...

Urgent cholecystectomy for acute cholecystitis in a disctrict general hospital - is it feasible?

Annals of the Royal College of Surgeons of England — Tue, 04 Nov 2008 05:00:00 +0100

CONCLUSIONS Urgent laparoscopic cholecystectomy for acute cholecystitis is a feasible treatment option in a district general hospital. A safe practice can be ensured by adherence to a care pathway and a multidisciplinary, consultant-delivered service. Urgent cholecystectomy service can be provided safely in a district general hospital without comes comparable to previously published literature. PMID: 18990272 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)

What technical barriers exist for real-time fluoroscopic and video image overlay in robotic surgery?

The International Journal of Medical Robotics and Computer Assisted Surgery — Fri, 31 Oct 2008 04:00:00 +0100

A hypothetical advantage of the da Vinci® console is its ability to integrate multiple visual data sources. Current platforms for augmented reality surgery fuse pre-operative radiographic studies but are limited with their ability to update with intra-operative imaging. The aim of our study was to evaluate the feasibility of real-time radiographic image overlay with current technology.S-video composite output from a fluoroscopic C-arm was superimposed onto the video output of the da Vinci device. Image superimposition disparity measurements were evaluated in a bench model. The feasibility of robotic dissection assisted by real-time cholangiogram and intravenous pyelogram was evaluated.Image alignment resulted in a radiographic blind spot and image disparity with severely limited applicati...

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Congenital Common Bile Duct Web in Association with Hepatobiliary Pancreatic Ductal Anomalies

European Journal of Pediatric Surgery — Wed, 08 Oct 2008 00:47:41 +0100

Eur J Pediatr SurgDOI: 10.1055/s-2008-1038444AbstractCongenital webs are extremely rare anomalies of the extrahepatic ductal system. As the vast majority of such cases are asymptomatic, detection is usually incidental during surgery for some other cause. In a young boy presenting with features of cholangitis, a congenital common bile duct web was discovered on T-tube cholangiogram. Further anomalies of the intrahepatic and pancreatic ductal systems were also detected. Since all known causes of acquired web formation were excluded, a congenital origin of the web was assumed and the patient is continuing to do well after a follow-up of 22 months.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: European Journal of ...

A case of common bile duct stones, failed ERCP and sensitivity to iodine contrast media: what contrast media should we use for an on-table cholangiogram?

Annals of the Royal College of Surgeons of England — Wed, 01 Oct 2008 04:00:00 +0100

A case of common bile duct stones, failed ERCP and sensitivity to iodine contrast media: what contrast media should we use for an on-table cholangiogram? Ann R Coll Surg Engl. 2008 Oct;90(7):615 Authors: Massey JC, Gokhale JA, Kay CL, Griffith JP PMID: 18837121 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)

A 56-Year-Old Man with Sudden Onset of Portosystemic Encephalopathy Years after Severe Electrocution Trauma

Seminars in Liver Disease — Thu, 25 Sep 2008 15:12:55 +0100

Semin Liver Dis 2008; 28: 328-336DOI: 10.1055/s-0028-1085100ABSTRACTA 56-year-old white male painter, with a history of major electrocution and deep thermal injury, developed mental status changes initially ascribed to an acute neurological event. Unexpectedly, magnetic resonance imaging (MRI) of the head showed areas of high signal intensity in the basal ganglia, which can be observed in advanced liver disease. An electroencephalogram (EEG) suggested metabolic encephalopathy and coexistent elevation of ammonia, indicative of significant liver disease. The patient had had a long history of right upper quadrant pain and fluctuation in liver tests following the electrocution trauma. For these symptoms, he underwent surgery 7 years prior to his current presentation of portosystemic encephalop...

[Vascular and Interventional Radiology] Thirty Years' Experience with Balloon Dilation of Benign Postoperative Biliary Strictures: Long-term Outcomes

Continuous Publishing articles — Tue, 23 Sep 2008 04:00:00 +0100

Conclusion: PBBD of benign strictures demonstrates long-term effectiveness. No significant difference was found in the rate of clinically significant restenosis after PBBD of biliary strictures at anastomotic and nonanastomotic sites. © RSNA, 2008 (Source: Continuous Publishing articles)

Management of Preoperatively Suspected Choledocholithiasis: A Decision Analysis

Journal of Gastrointestinal Surgery — Wed, 06 Aug 2008 05:51:53 +0100

Conclusion LCBDE has lower morbidity and mortality rates compared to preoperative ERCP/ES in the management of patients with suspected CBD stones even if the chance of CBD stones reaches 100%. Using a common duct double-lumen catheter may be considered if LCBDE is not feasible and the chance of CBD stone is less than 65%. Content Type Journal ArticleCategory ssat poster presentationDOI 10.1007/s11605-008-0624-6Authors Bilal Kharbutli, Henry Ford Hospital Division of General Surgery, K-8 2799 West Grand Blvd. Detroit MI 48202 USAVic Velanovich, Henry Ford Hospital Division of General Surgery, K-8 2799 West Grand Blvd. Detroit MI 48202 USA Journal Journal of Gastrointestinal SurgeryOnline ISSN 1873-4626Print ISSN 1091-255X (Source: Journal of Gastrointestinal Sur...

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Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration

Surgical Endoscopy — Sat, 12 Jul 2008 07:05:43 +0100

Conclusions To our knowledge, this is the first publication in the literature in which primary closure after laparoscopic common bile duct exploration in emergency setting was used. With no significant difference in operative time, hospital stay and complications, in experienced hands primary closure of CBD in emergency settings is safe and feasible. Content Type Journal ArticleDOI 10.1007/s00464-008-0021-yAuthors Ali Alhamdani, Wrexham Maelor Hospital General Surgery Wrexham UKSajid Mahmud, Wrexham Maelor Hospital General Surgery Wrexham UKM. Jameel, Wrexham Maelor Hospital General Surgery Wrexham UKAndrew Baker, Wrexham Maelor Hospital General Surgery Wrexham UK Journal Surgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

ORIGINAL ARTICLE: Liver Resection for Primary Intrahepatic Stones: A Single-Center Experience

Archives of Surgery — Mon, 16 Jun 2008 04:00:00 +0100

Conclusions Primary intrahepatic lithiasis more commonly involves 1 single liver segment or lobe. Partial hepatectomy is a safe and effective procedure, allowing definitive treatment of the disease and prevention of cancer. (Source: Archives of Surgery)

The Effects of Scolicidal Agent Propolis on Liver and Biliary Tree

Journal of Gastrointestinal Surgery — Fri, 30 May 2008 06:00:18 +0100

Conclusions Propolis may be used as a scolicidal agent even in the case of cystobiliary communication with no side effects on liver and biliary tree. Content Type Journal ArticleCategory original articleDOI 10.1007/s11605-008-0555-2Authors Kemal Kismet, Ankara Training and Research Hospital Ulucanlar Department of General Surgery Ankara TurkeySibel Serin Kilicoglu, Ufuk University Department of Histology-Embryology Ankara TurkeyBulent Kilicoglu, Ankara Training and Research Hospital Ulucanlar Department of General Surgery Ankara TurkeySerap Erel, Ankara Training and Research Hospital Ulucanlar Department of General Surgery Ankara TurkeyOmur Gencay, Hacettepe University Department of Biology, Faculty of Science Ankara TurkeyKadriye Sorkun, Hacettepe University Departmen...

Autoimmune Pancreatitis and Concurrent Small Lymphocytic Lymphoma: Not Just a Coincidence?

Journal of Gastrointestinal Surgery — Wed, 28 May 2008 05:57:35 +0100

Discussion Autoimmune pancreatitis is the most common benign diagnosis after pancreatic resection for presumed malignancy. It has a well-documented association with autoimmune conditions, such as Sjögren’s syndrome, inflammatory bowel disease, and sclerosing cholangitis. Additionally, chronic lymphocytic leukemia–small lymphocytic lymphoma is often associated with autoimmune phenomena, most notably autoimmune hemolytic anemia. However, an association between autoimmune pancreatitis and small lymphocytic lymphoma has not been previously described. To our knowledge, this is the first reported case of a patient with concurrent autoimmune pancreatitis and small lymphocytic lymphoma. Content Type Journal ArticleCategory case reportDOI 10.1007/s11605-008-0543-6Authors...

Removal and Placement of Metallic Biliary Stent

The Digital Atlas of Video Education - Gastroenterology — Tue, 06 May 2008 06:05:08 +0100

This is the case of an 81 year old gentleman with unresectable adenocarcenoma of the pancreas. He's treated with metallic stenting and presents with recurrent jaundice and colongitis three moths after stent placement. ERCP reveals obstruction of metallic stent. A balloon is placed within the stent and the cholangiogram is performed. As you see on the right screen, there are failing defects within the main bile duct. Balloon extraction yields leafy material; a corn kernel and other food residue. We decide to remove the stent in order to place a newer stent. We ensnare the stent and then gently remove it. It comes easy within the scope channel, even folded over. We recannulate with a balloon in order to completely clear the bile duct with several sweeps. Another Viabil stent is placed. W...

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Improvement in accuracy of gamma-glutamyl transferase for differential diagnosis of biliary atresia by correlation with age.

The Turkish Journal of Pediatrics — Thu, 01 May 2008 04:00:00 +0100

Authors: Rendón-Macías ME, Villasís-Keever MA, Castañeda-Muciño G, Sandoval-Mex AM In order to determine the accuracy of serum gamma-glutamyl transferase (GGT) as a test for biliary atresia, we reviewed the charts of 29 infants with cholestatic jaundice less than one year of age. All patients underwent liver biopsy or laparotomy with cholangiogram to establish neonatal hepatitis (NH) or extrahepatic biliary atresia (EHBA). We also gathered information from 176 patients from published studies. Sensitivity, specificity, and likelihood ratios (LR) were calculated with 95% confidence interval (95% CI). GGT levels of the EHBA group were higher than those from the NH group. For diagnosis of EHBA at a cut-off level >250 U/L, sensitivity was 83.3% (95% CI, 55.2- 95....

Biliary - Balloon Sphincteroplasty in the Removal of Difficult Bile Duct Stones

The Digital Atlas of Video Education - Gastroenterology — Thu, 10 Apr 2008 09:04:11 +0100

Endoscopic sphincterotomy (ES) has been a useful method in the removal of common bile duct (CBD) stones for some time. However, in certain patients, stone removal by endoscopic sphincterotomy is unsuccessful due to challenging access to the bile duct, stone size exceeding the diameter of ampullary orifice or impacted stones in the bile duct. In the past, such difficult-to-remove stones were extracted by methods like mechanical lithotripsy, intraductal shock-wave lithotripsy, extracorporeal shock-wave lithotripsy, biliary stenting, and chemical dissolution. Biliary sphincterotomy involves making an incision along the ampullary orifice to make it larger. Another method used to enlarge the biliary sphincter opening is Balloon Sphincteroplasty, which in spite of being popular in the Orient, ...

Effects of honey as a scolicidal agent on the hepatobiliary system.

World Journal of Gastroenterology — Mon, 07 Apr 2008 04:00:00 +0100

CONCLUSION: According to these results, we concluded that 10% diluted honey could be used as scolicidal agent safely in the presence of biliary-cystic communication. PMID: 18395911 [PubMed - in process] (Source: World Journal of Gastroenterology)

Pancreas - Biopsy of IPMN Nodule by Direct Pancreatoscopy

The Digital Atlas of Video Education - Gastroenterology — Wed, 02 Apr 2008 15:04:03 +0100

A 36 year old woman was referred to the Massachusetts General Hospital for evaluation of an incidental pancreatic cystic lesion found on abdominal ultrasound. An abdominal CT confirmed the finding, demonstrating a 5 cm multi-cystic lesion in the pancreatic head, with diffuse dilation of the pancreatic duct in the body and tail. ERCP and EUS performed at an outside institution were non-diagnostic. However, the EUS at the outside hospital demonstrated an intramural nodule, raising concern for malignancy, and thus warranting further evaluation. The patient was subsequently seen at the MGH. Endoscopic evaluation demonstrated a patulous ampulla. A pancreatogram was obtained and demonstrated a large, cystic dilation of the pancreatic duct in the head. Aspiration of 10 cc of pancreatic duct fluid...

Anaphylactoid reaction to intraoperative cholangiogram

Surgical Endoscopy — Fri, 21 Mar 2008 19:41:16 +0100

We describe a case of a systemic anaphylactoid reaction caused by intraoperative cholangiogram during laparoscopic cholecystectomy. We then discuss the clinical presentation, suspected etiology, and treatment of these idiosyncratic reactions as well as established guidelines for prevention in patients at risk. Content Type Journal ArticleDOI 10.1007/s004640041033Authors A.H. Moskovitz, Department of Surgery, University of Washington, 1959 N.E. Pacific Street, P.O. Box 356410, Seattle, WA. 98195, USA USW.H. Bush, Department of Radiology, University of Washington, 1959 N.E. Pacific Street, Seattle, WA. 98195, USA USK.D. Horvath, Department of Surgery, University of Washington, 1959 N.E. Pacific Street, P.O. Box 356410, Seattle, WA. 98195, USA US Journal Surgical EndoscopyOnline...

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Evaluation of real-time infrared intraoperative cholangiography in a porcine model

Surgical Endoscopy — Tue, 18 Mar 2008 08:16:48 +0100

Conclusions The CBD anatomy, obstruction, and injury can be clearly visualized with an infrared camera. Intraoperative infrared imaging is an emerging method already being used in several surgical fields. Ultimately, the integration of infrared and laparoscopic technology will be necessary to make infrared technology important in laparoscopic cholecystectomy. Content Type Journal ArticleDOI 10.1007/s00464-008-9792-4Authors Jack J. Liu, National Cancer Institute Urologic Oncology Branch Bethesda MD USAMehrdad Alemozaffar, National Cancer Institute Urologic Oncology Branch Bethesda MD USABenjamin McHone, National Cancer Institute Urologic Oncology Branch Bethesda MD USANadeem Dhanani, National Cancer Institute Urologic Oncology Branch Bethesda MD USAFred Gage, Combat Ca...

Mirizzi syndrome

Current Treatment Options in Gastroenterology — Fri, 14 Mar 2008 07:23:08 +0100

Opinion statement Mirizzi syndrome is an important complication of gallstone disease. If not recognized preoperatively, it can result in significant morbidity and mortality. Preoperative diagnosis may be difficult despite the availability of multiple imaging modalities. Ul-trasonography (US), CT, and magnetic resonance cholangiopancreatography (MRCP) are common initial tests for suspected Mirizzi syndrome. Typical findings on US suggestive of Mirizzi syndrome are a shrunken gallbladder, impacted stone(s) in the cystic duct, a dilated intrahepatic tree, and common hepatic duct with a normal-sized common bile duct. The main role of CT is to differentiate Mirizzi syndrome from a malignancy in the area of porta hepatis or in the liver. MRI and MRCP are increasingly playing an ...

Incidence of residual choledocholithiasis detected by intraoperative cholangiography at the time of laparoscopic cholecystectomy in patients having undergone preoperative ERCP

Surgical Endoscopy — Thu, 06 Mar 2008 16:45:29 +0100

Conclusions The overall incidence of retained or newly passed CBD stones on IOC during LC after a preoperative ERCP is 12.9%. Although the natural history of residual CBD stones after preoperative ERCP is not known, the routine use of IOC should be considered in patients with CBD stones on preoperative ERCP undergoing an interval LC. Content Type Journal ArticleDOI 10.1007/s00464-008-9785-3Authors Richard A. Pierce, Washington University School of Medicine Department of Surgery and Institute for Minimally Invasive Surgery 660 South Euclid Avenue Campus Box #8109 Saint Louis MO 63110 USASreenivasa Jonnalagadda, Washington University School of Medicine Department of Internal Medicine, Division of Gastroenterology Saint Louis MO USAJennifer A. Spitler, Washington Univers...

Minor Duct Sphincterotomy

The Digital Atlas of Video Education - Gastroenterology — Thu, 06 Mar 2008 06:03:57 +0100

Pancreas divisum is a failure of the ventral and dorsal pancreatic ducts to fuse in utero resulting in the major portion of pancreatic secretions entering the duodenum by the minor papilla. Pancreas divisum is the most common congenital pancreatic anomaly occurring in approximately 7% of autopsy subjects. Approximately 95% of patients with pancreas divisum are asymptomatic. The diagram of the anatomy of the pancreas in the presentation illustrates pancreatic divisum showing the relationship of the dorsal duct (Santorini) to the minor ampulla and the ventral duct (Wirsung) to the major ampulla. The diagnosis of pancreas divisum is made by Computed tomography (CT) scan, Magnetic resonance cholangiopancreatography (MRCP), or Endoscopic retrograde cholangiopancreatography (ERCP). A CT scan c...

Cholecystostomy and transcholecystic biliary access.

Techniques in Vascular and Interventional Radiology — Sat, 01 Mar 2008 05:00:00 +0100

Authors: Ginat D, Saad WE Percutaneous cholecystostomy represents a minimally invasive procedure for providing gallbladder decompression, often in critically ill patient populations. Indications for this procedure include calculous and acalculous cholecystitis, gallbladder perforation, malignant obstruction, percutaneous biliary stone removal, biliary duct drainage, and diagnostic imaging of the gallbladder and biliary ductal system. In addition, gallbladder access provided by percutaneous cholecystostomy may serve to carry additional procedures, such as cholangiograms, gallstone dissolution, and lithotripsy. Review of prior imaging studies including ultrasound, CT, and hepatobiliary scans are essential to planning the procedure, by helping to determine the access route: transhepatic v...

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Bronchobiliary fistula

International Journal of Gastrointestinal Cancer — Thu, 10 Jan 2008 16:43:30 +0100

Conclusions Bronchobiliary fistula is an infrequent manifestation of common bile duct obstruction. The slowly progressive narrowing of the common duct by the fibrosis of chronic pancreatitis is an even more rare mechanism of such fistula formation with only two cases having been reported previously. A third case of bronchobiliary fistula caused by chronic pancreatitis is presented and its successful management is discussed. Background A 54-yr-old male with known chronic pancreatitis presented with a cough productive of copious amounts of bile and with pulmonary infiltrates. Methods Diagnosis of bronchobiliary fistula was made based on HIDA scan and confirmed by operative cholangiogram. Results Successful correction of thi...

Endoscopic retrograde cholangio-pancreatography in pancreatitis with persistent or recurrent pain

International Journal of Gastrointestinal Cancer — Thu, 03 Jan 2008 16:31:39 +0100

Summary We have reviewed the endoscopic retrograde cholangiopancreatograms (ERCPs) of 115 patients already known to have pancreatitis, who were referred because of persistent or recurrent pain, in order to determine the prevalence of those lesions that have been regarded as amenable to conservative surgery. Such lesions were seen on the pancreatograms of 35 patients and on the cholangiograms of 29 patients. In all, 53 patients (46.1%) had ‘treatable’ lesions demonstrated at ERCP. Preoperative ERCP is helpful in demonstrating operable features in both pancreatic and biliary systems, and should be part of any prospective long-term study of pain relief in pancreatitis. Content Type Journal ArticleCategory Practical ReportDOI 10.1007/BF02801873Authors Peter A. Winstanl...

Unusual presentation of recurrent hepatocellular carcinoma as obstructive jaundice 15 years after liver transplant.

Sat, 01 Dec 2007 05:00:00 +0100

We report a case of recurrent hepatocellular carcinoma 15 years after orthotopic liver transplant, presenting initially as obstructive bile duct compression as detected by cholangiogram. Laparotomy revealed hepatocellular carcinoma invading the common bile duct without any mass in the liver parenchyma. The main focus of the case is the endoscopic retrograde cholangiopancreatography image, which is unique in the setting of liver disease following liver transplant. PMID: 18194129 [PubMed - in process] (Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation)

Pablo luis mirizzi: the man behind the syndrome

ANZ Journal of Surgery — Mon, 29 Oct 2007 01:42:39 +0100

ANZ Journal of Surgery, Volume 77, Issue 12, Page 1062-1064, December 2007. Pablo Luis Mirizzi (1893–1964), who was born and died in the city of Cordoba in Argentina, dedicated his life to the service of surgery and the teaching of his students. Although known for the introduction of the intraoperative cholangiogram and for ... (Source: ANZ Journal of Surgery)

Pancreas - EUS Vascular Staging and FNA of a Pancreas Head Mass with ERCP and Metal Stent Placement

The Digital Atlas of Video Education - Gastroenterology — Wed, 10 Oct 2007 09:10:56 +0100

An 84 year old male presents with obstructive jaundice and a pancreas head mass seen on CT scan of the abdomen. EUS identifies a 2.5 cm hypoechoic mass in the head of the pancreas obstructing the bile duct. The proximal bile duct is markedly dilated to 2 cm. Some sludge is seen in the bile duct and the dilated cystic duct. The relationship between the tumor and the mesenteric vessels is defined by EUS with views from the duodenal bulb and second duodenum. Narrowing of the PV/SMV and loss of echoplane is identified. A branch of the SMA is encased by the tumor. EUS guided fine needle aspiration is performed. Cytology reveals adenocarcinoma. ERCP is performed to achieve biliary drainage. A cholangiogram reveals distal biliary obstruction from the mass with marked proximal dilation as...

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Treatment strategy for hilar cholangiocarcinoma, with special reference to the limits of ductal resection in right-sided hepatectomies

Journal of Hepato-Biliary-Pancreatic Surgery — Tue, 02 Oct 2007 16:10:12 +0100

Abstract The surgical anatomy of the hepatic hilar region is characterized by the three-dimensional formation of the branches of the bile duct, portal vein, and hepatic artery. The limit of ductal resection in hepatectomy for hilar cholangiocarcinoma is the most peripheral point where the hepatic ducts can be separated from the vasculature. The limit is different for each type of hepatectomy because the portal vein branches that should be preserved or divided vary with the extent of the hepatectomy, and therefore the limit of separation of the hepatic ducts differs. Surgeons are required to understand the surgical anatomy and to identify the precise area of cancer spread on a preoperative cholangiogram so as to choose the appropriate type of hepatectomy, and to ensure that...

Laparoscopic Cholecystectomy Without Intraoperative Cholangiography

Journal of Laparoendoscopic — Tue, 02 Oct 2007 11:38:41 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques Oct 2007, Vol. 17, No. 5: 620-625. Background: The aim of this retrospective study was to evaluate the outcome of laparoscopic cholecystectomies (LCs) performed in our Academic Surgical Unit, and the impact of our policy not to perform intraoperative cholangiograms (IOCs) on the incidence ... (Source: Journal of Laparoendoscopic)

Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN) of the pancreas

World Journal of Surgical Oncology — Tue, 28 Aug 2007 04:00:00 +0100

Conclusions: It is only recently that the term "intraductal papillary mucinous neoplasm (IPMN)," which is accepted as a distinct disease entity of the pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to be intraductal papillary neoplasm with prominent cystic dilatation of the bile duct. (Source: World Journal of Surgical Oncology)

Review of 300 consecutive laparoscopic cholecystectomies: development, evolution, and results

Surgical Endoscopy — Fri, 13 Jul 2007 11:26:21 +0100

Summary The present paper reviews 300 laparoscopic cholecystectomies with intraoperative cholangiograms that were performed by the authors. The development and evolution of this procedure are described along with the results. The guidewire technique used for operative cholangiography and the maneuver applied to control bleeding of the cystic artery are detailed. Five cases were converted to open operations. No serious complications were encountered. One common bile duct injury occurred during endoscopic retrograde cholangiopancreaticography performed on postoperative day 8 for diagnostic purposes. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 Journal VolumeVolume 5 Journal IssueVolume 5, Number 3 / October, 199...

Endoscopic treatment of bile duct complications after orthotopic liver transplantation.

Transplantation Proceedings — Sun, 01 Jul 2007 04:00:00 +0100

CONCLUSION: ERCP is a safe and effective mode of management of bile duct complications after OLT. It should be attempted before a surgical approach. Better results are obtained for treatment of biliary stones than of anastomotic strictures. PMID: 17692660 [PubMed - in process] (Source: Transplantation Proceedings)

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Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

Pediatric Surgery International — Fri, 29 Jun 2007 08:27:03 +0100

This study is a 10 year retrospective review of all infants with persistent direct hyperbilirubinemia and inconclusive biliary nuclear scans who underwent further evaluation for suspected biliary atresia. A gallbladder ultrasound (US) was obtained in all patients. When the gallbladder was visualized, further imaging by PCC was done under intravenous sedation; otherwise, the standard operative cholangiogram (OCG) was performed, with liver biopsy as indicated. The primary outcome was the diagnostic accuracy of PCC, especially with respect to preventing a laparotomy. There were 35 infants with suspected biliary atresia, with a mean age of 8 weeks (range 1–14 weeks). Nine infants whose gallbladder was visualized by ultrasound underwent PCC that definitively excluded bili...

Laparoscopic primary choledochorrhaphy over endonasobiliary drainage tubes

Surgical Endoscopy — Sat, 19 May 2007 07:31:55 +0100

Conclusion Laparoscopic choledochotomy over ENBD tubes proved to be technically feasible and safe. The ENBD tube decompresses the biliary tree and allows for cholangiography after surgery. Its removal does not need to wait for tract maturation, which allows an earlier removal of the tube and a shorter postoperative hospital stay. Laparoscopic choledochotomy over ENBD tubes is an effective alternative to the T-tube in laparoscopic choledochotomy. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Foregut atresias and bile duct anomalies: rare, infrequent or common?!

Pediatric Surgery International — Thu, 17 May 2007 07:05:00 +0100

Abstract The association of foregut atresias and bile duct anomalies is reportedly rare. We encountered five referrals within 2 years where the secondary diagnosis was missed at operation. Four patients initially presented on antenatal scans as a foregut atresia whereas the fifth presented at nine years with abdominal pain due to a choledochal cyst. The biliary anomalies (cholecysto-hepatic duct, liver cyst and choledochal cysts) in the first four presented as postoperative jaundice during infancy whereas the fifth patient developed subacute intestinal obstruction due to congenital duodenal stenosis at fifteen years. In the patients with duodenal atresia neither did the preoperative X ray reveal any distal bowel gas nor did the subsequent intraoperative cholangiograms ...

Who should perform laparoscopic cholecystectomy? A 10-year audit

Surgical Endoscopy — Sat, 05 May 2007 08:20:17 +0100

Conclusion In their institution, the authors found evidence of improved outcomes when laparoscopic cholecystectomy was performed under the care of surgeons with a specialist interest in upper GI or hepatopancreaticobiliary surgery. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Recurrent bile duct stricture: causes and long-term results of surgical management

Journal of Hepato-Biliary-Pancreatic Surgery — Sat, 24 Mar 2007 11:27:16 +0100

Conclusions Patients referred with recurrent strictures had had their primary repair at peripheral settings; the failures were technical, presenting early (median, 1.5 months) with recurrent symptoms, compared to findings in patients with recurrent strictures following primary repair at our center. The long-term outcome following the repair of the primary and the recurrent strictures was no different in our experience. Content TypeJournal Article JournalJournal of Hepato-Biliary-Pancreatic SurgeryOnline ISSN 1436-0691Print ISSN 0944-1166 Journal VolumeVolume 14 Journal IssueVolume 14, Number 2 / March, 2007 (Source: Journal of Hepato-Biliary-Pancreatic Surgery)

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A reliable method for handling the “difficult” cystic duct to obtain a good cholangiogram during laparoscopic cholecystectomy

Surgical Endoscopy — Mon, 05 Mar 2007 16:08:07 +0100

Conclusions??This is a safe, reliable, less traumatic, readily available, and inexpensive method that provides a secure way of handling the ?difficult? cystic duct. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Endoscopic Therapy of Hepatic Hydatid Cyst Disease in Preoperative and Postoperative Settings

Digestive Diseases and Sciences — Fri, 02 Mar 2007 08:58:53 +0100

Abstract??The most common and serious complication of hepatic hydatid cyst disease is the communication between the cyst and the biliary tree. The diagnosis and treatment of this condition poses various difficulties. Data from patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for hydatid cysts communicating with the bile ducts either in the preoperative or postoperative setting over a 2-year period have been analyzed. In the preoperative group (n=41), jaundice (n=18), biliary colic (n=11), and cholangitis (n=10) were the most common presentations. On the other hand, the most common indication for ERCP in the postoperative group (n=69) was biliocutaneous leaks (n=60) and cholangitis (n=9). All but 2 patients in the preoperative group were treated by endoscopic sph...

Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration

Journal of Minimal Access Surgery — Fri, 23 Feb 2007 10:20:02 +0100

Conclusion: </b> In our experience, a single stage laparoscopic treatment of cholelithiasis with choledocholithiasis is a safe, viable and cost-effective option. Closure of the CBD over an antegrade stent is a feasible option but requires advanced skills in minimal access surgical techniques, especially endosuturing. The procedure may be performed safely in expert hands without mortality and with negligible morbidity. (Source: Journal of Minimal Access Surgery)

The role of intraoperative cholangiogram in the management of patients recovering from acute biliary pancreatitis

Surgical Endoscopy — Thu, 08 Feb 2007 10:56:17 +0100

Conclusion??In the setting of normal preoperative imaging and lab work, the incidence of CBD stones among patients recovering from acute mild to moderate gallstone pancreatitis is not significantly higher than among patients with no history of pancreatitis. Therefore, an IOC for post-gallstone pancreatitis does not alter management. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery

Surgical Endoscopy — Wed, 07 Feb 2007 07:54:34 +0100

Conclusion??In this series, 10% of the abnormal cholangiograms occurred in patients without preoperative risk factors for bile duct stones. Altogether, 88 IOCs (31%) were cleared after either simple flushing or trawling with a Dormia basket. Formal LBDE was not required for 40% of abnormal cholangiograms. Simple transcystic manipulations to clear the bile ducts justify the use of routine IOC in units without laparoscopic biliary expertise. Content TypeJournal Article JournalSurgical EndoscopyOnline ISSN 1432-2218Print ISSN 0930-2794 (Source: Surgical Endoscopy)

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[A case of primary small cell carcinoma arising from the common bile duct]

Korean J Gastroenter... — Sat, 20 Jan 2007 12:35:02 +0100

We report a case of extrapulmonary small cell carcinoma arising from the common bile duct. PMID: 17189930 [PubMed - in process] (Source: Korean J Gastroenter...)

ORIGINAL ARTICLE: Optimizing Choledocholithiasis Management: A Cost-effectiveness Analysis

Archives of Surgery — Mon, 15 Jan 2007 07:00:00 +0100

Conclusions Endoscopic retrograde cholangiopancreatography was both less costly and more effective than LCBDE. Factors important to choosing the best strategy for CDL management included the cost of a potential case lost due to LCBDE performance and the cost of ERCP hospitalization. (Source: Archives of Surgery)

[A case of primary small cell carcinoma arising from the common bile duct.]

Korean J Gastroenter... — Fri, 29 Dec 2006 00:41:02 +0100

We report a case of extrapulmonary small cell carcinoma arising from the common bile duct. PMID: 17189930 [PubMed - in process] (Source: Korean J Gastroenter...)

Causes and consequences of ischemic-type biliary lesions after liver transplantation

Journal of Hepato-Biliary-Pancreatic Surgery — Fri, 01 Dec 2006 07:52:58 +0100

Abstract??Biliary complications are a major source of morbidity, graft loss, and even mortality after liver transplantation. The most troublesome are the so-called ischemic-type biliary lesions (ITBL), with an incidence varying between 5% and 15%. ITBL is a radiological diagnosis, characterized by intrahepatic strictures and dilatations on a cholangiogram, in the absence of hepatic artery thrombosis. Several risk factors for ITBL have been identified, strongly suggesting a multifactorial origin. The main categories of risk factors for ITBL include ischemia-related injury; immunologically induced injury; and cytotoxic injury, induced by bile salts. However, in many cases no specific risk factor can be identified. Ischemia-related injury comprises prolonged ischemic times and disturbance in ...

Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy

Surgical Endoscopy — Tue, 26 Sep 2006 12:41:37 +0100

Abstract The incidence of bile duct injury in laparoscopic cholecystectomy is 0.3% to 1.0%. This is higher than the incidence reported for open cholecystectomy (i.e., 0.1–0.2%), and the surgeons all over the world are relentlessly trying to find the ways and means to lower this incidence. Various operating strategies, techniques, and instrumentations such as the 0° telescope, intraoperative cholangiogram, hydrodissection, and peanut gauze dissection have been claimed by various authors to minimize the risk of bile duct injury during cholecystectomy. However, the surgical fraternity agrees that there has been no substitute for meticulous dissection and display of various vital structures near the common bile duct. The authors describe seven anatomic landmarks encountered during ...

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Cholangiography of mucin-hypersecreting intrahepatic biliary neoplasms

Journal of Hepato-Biliary-Pancreatic Surgery — Thu, 21 Sep 2006 18:27:30 +0100

Abstract Bile duct obstruction caused by profuse mucin secretion in a major bile duct is rare. Such cases are often incorrectly identified as choledocholithiasis before being histologically proven. The goal of this study was to analyze the cholangiograms of mucin-hypersecreting intrahepatic biliary neoplasms and to try to identify the characteristic cholangiographic features of this rare disease. A retrospective analysis of 20 cholangiograms (from 6 men and 14 women) of mucin-hypersecreting intrahepatic biliary neoplasms over a 13-year period was carried out. Sixty percent of the patients had associated biliary tract stones. A mucinous substance drained out during biliary catheterization (endoscopic retrograde cholangiography [ERC]; percutaneous transhepatic cholangiography [PTC] ...

Duplicate gallbladder: an unusual case report

Surgical and Radiologic Anatomy — Thu, 21 Sep 2006 10:02:22 +0100

In this report we present a case of duplicated gallbladder diagnosed serendipitously in a 63-year-old male patient who had previously undergone successful laparoscopic cholecystectomy (confirmed histologically) approximately a year before for gallstones. The patient was re-admitted with obstructive jaundice. An abdominal computed tomography scan and magnetic resonance cholangiogram both revealed the presence of a gallbladder, which was thereafter removed at surgery undertaken to palliate the jaundice. Content TypeJournal Article JournalSurgical and Radiologic AnatomyOnline ISSN 1279-8517Print ISSN 0930-1038 (Source: Surgical and Radiologic Anatomy)

Experience with choledochal cysts in infants

Pediatric Surgery International — Fri, 01 Sep 2006 08:29:47 +0100

Abstract The purpose of this analysis is to study the clinical features, liver histology and the outcome after surgery in infants with choledochal cysts (CDCs), and to draw conclusions on the management strategy accordingly. The clinical features, liver histology and the outcome after surgery in 14 cases of CDCs treated before 1 year of age (the “infantile group”) were compared with 52 cases that were diagnosed and treated between 1 and 12 years of age (the “classical pediatric group”). The differentiation of the “infantile choledochal cysts” from “biliary atresia with cystic dilatation” was based on the configuration of intrahepatic bile ducts on cholangiogram. Jaundice was the universal presenting feature in 14 patients in the “infantile group”, the clinical pres...

Natural history of asymptomatic bile duct stones at time of cholecystectomy.

The Ulster Medical Journal — Thu, 01 Sep 2005 04:00:00 +0100

CONCLUSIONS: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed. PMID: 16235763 [PubMed - indexed for MEDLINE] (Source: The Ulster Medical Journal)

Fish bone as a nidus for stone formation in the common bile duct: report of two cases.

Korean J Radiol — Wed, 14 Jul 2004 06:00:00 +0100

We report two cases of common bile duct stone formed around a fish bone which migrated from the intestinal tract, along with their characteristic imaging findings. Two patients who had no history of previous operation were admitted because of cholangitis. Percutaneous transhepatic biliary drainage (PTBD) was performed and the cholangiogram showed filling defects with an unusually elongated shape in the common bile duct. After improvement of the cholangitic symptoms, the stones were removed through the PTBD tract under fluoroscopic guidance. A nidus consisting of a 1.5 cm sized fish bone was found in each stone removed. PMID: 15467418 [PubMed - indexed for MEDLINE] (Source: Korean J Radiol)

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