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This page shows you the latest news and research items in this category.

Accuracy of magnetic resonance cholangiopancreatography for diagnosing stones in the common bile duct in patients with abnormal intraoperative cholangiograms
Conclusions: MRCP has a high rate of false normal results compared with IOC and is not as accurate as more invasive techniques. There is no need for preoperative MRCP in patients with suspected choledocholithiasis caused by stones. (Source: American Journal of Surgery)
Source: American Journal of Surgery - April 1, 2013 Category: Surgery Authors: Franchell Richard, Mark Boustany, L.D. Britt Tags: Society of Black Academic Surgeons Source Type: research

Complex spontaneous bile duct perforation: An alternative approach to standard porta hepatis drainage therapy
Conclusion: Complex spontaneous biliary perforation may require extensive interventions if the perforation fails to resolve with standard porta hepatis drainage. Access of the biliary tree via Interventional Radiology procedures for complex biliary disease of this type is novel and presents an alternative to traditional open surgical treatment and control of spontaneous biliary perforations. (Source: Journal of Pediatric Surgery)
Source: Journal of Pediatric Surgery - April 1, 2013 Category: Surgery Authors: Joseph T. Murphy, Korgun Koral, Tim Soeken, Steve Megison Tags: Operative Techniques Source Type: research

Ultrasound-Guided Biliary Intervention: Can Radiation Risk Be Reduced?
Cumulative ionizing radiation exposure has become a popular topic in the medical atmosphere and a source of public concern. Methods that can be used to reduce radiation to both patients and clinicians during interventional radiology biliary procedures are discussed in this article, including cholecystectomy tube placement and percutaneous transhepatic cholangiogram with biliary stent placement, while focusing on ultrasound as a key imaging modality for radiation reduction. Ultrasound offers real-time monitoring and direct visualization during these procedures. (Source: Ultrasound Clinics)
Source: Ultrasound Clinics - January 23, 2013 Category: Radiology Authors: Shirley Chan, Devang Butani Source Type: research

[Clinical Effects of Bile Aspiration Just before Contrast Injection during Endoscopic Retrograde Cholangiopancreatography].
Conclusions: Initially bile juice aspiration just before contrast injection into the bile duct rarely prevented post-ERCP cholangitis, liver function worsening, and pancreatitis in patients with the extrahepatic bile duct obstruction. (Korean J Gastroenterol 2012;60:368-372). PMID: 23242020 [PubMed - in process] (Source: Korean J Gastroenter...)
Source: Korean J Gastroenter... - December 25, 2012 Category: Gastroenterology Authors: Choi JS, Kang DH, Kim HD, Urm SH, Lee SH, Kim JH, Jee SR, Jung EU, Park SJ, Lee YJ, Seol SY Tags: Korean J Gastroenterol Source Type: research

Falciform ligament abscess from left sided portal pyaemia following malignant obstructive cholangitis
We present this patient's operative images and radiographic findings, which may explain the pathophysiology behind this rare complication. We hypothesize that cholangitis, with secondary portal pyaemia and tracking via the paraumbilical veins, can cause infectious seeding of the falciform ligament, with consequent abscess formation. (Source: World Journal of Surgical Oncology)
Source: World Journal of Surgical Oncology - December 22, 2012 Category: Cancer & Oncology Authors: Leigh WarrenManju ChandrasegaramDaniel MadiganPaul DolanEu NeoChristopher Worthley Source Type: research

Teaching Cholangiography in a Surgical Residency Program
Conclusions: Intraoperative cholangiogram can be safely performed by residents at every level during laparoscopic cholecystectomy without adding significant time to the operation. (Source: Journal of Surgical Education)
Source: Journal of Surgical Education - October 22, 2012 Category: Surgery Authors: William W. Hope, Lindsay Bools, W. Borden Hooks, Ashley Adams, Cyrus A. Kotwall, Thomas V. Clancy Tags: ORIGINAL REPORTS Source Type: research

Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration.
CONCLUSIONS: Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration. PMID: 23044315 [PubMed - in process] (Source: Chinese Medical Journal)
Source: Chinese Medical Journal - October 1, 2012 Category: Journals (General) Authors: Sun DL, Zhang F, Chen XM, Jiang HY, Yang C, Sun YP, Yang B, Yang Y, Cai HH, Wang CY, Wu XQ Tags: Chin Med J (Engl) Source Type: research

Conservative management of spontaneous bile duct perforation in infancy: case report and literature review
Abstract: Spontaneous bile duct perforation in infants is rare, with less than 150 cases having been reported worldwide. With a highly variable presentation, diagnosis and treatment can prove challenging, and outcomes are not without significant morbidity.We herewith report the case of an 8-week-old male infant with spontaneous bile duct perforation. He initially presented with abdominal sepsis and septated ascites on ultrasound, which was confirmed as bilious on ascitic tap and at diagnostic laparoscopy. Intraoperative cholangiogram demonstrated a localized leak at the junction of the cystic and common bile duct. Conversi...
Source: Journal of Pediatric Surgery - September 1, 2012 Category: Surgery Authors: Maria Virginia Pereira E Cotta, Jennifer Yan, Mina Asaid, Peter Ferguson, Thomas Clarnette Tags: Case Reports Source Type: research

Left‐sided hepatic resection for hepatolithiasis: a longitudinal study of 110 patients
Conclusions: This study highlights the impact of the presence or absence of bile duct stricture on the clinical and histological profile of patients as well as their operative and the post‐operative behaviour. It is concluded that hepatic resection is an appropriate treatment modality in localized left‐sided hepatolithiasis. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)
Source: HPB: official journal of the International Hepato Pancreat Biliary Association - August 17, 2012 Category: Gastroenterology Authors: Omar Javed Shah, Irfan Robbani, Parveen Shah, Showkat Ali Zargar, Gul Javaid, Ghulam N Yattoo, Altaf Shah, Farhat Mustafa Source Type: research

Hepatic Arteriovenous Fistulae: Role of Interventional Radiology
Conclusions Endovascular techniques currently form less invasive and first line treatment options in arterioportal/venous fistulae, surgery being reserved only for unsuccessful embolizations/complex fistulae. Content Type Journal ArticleCategory Original ArticlePages 1-10DOI 10.1007/s10620-012-2331-0Authors Ajay Kumar, Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 IndiaChirag Kamal Ahuja, Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012 Ind...
Source: Digestive Diseases and Sciences - August 9, 2012 Category: Gastroenterology Tags: Digestive Diseases and Sciences Source Type: research

Balloon-assisted enteroscopy in patients with surgically altered anatomy: a liver transplant center experience (with video)
Before the development of balloon-assisted enteroscopy (BAE), gaining endoscopic access to the Roux limb and biliary tree in surgically altered anatomy has been notoriously difficult to accomplish. This may be particularly the case in patients who have had a Whipple or Roux-en-Y procedure. Other instruments such as push enteroscopes and pediatric colonoscopes have been explored as potential options, but their failure rates have been high. Accordingly, percutaneous transhepatic cholangiograms, or even surgical approaches, have been required even for fairly basic diagnostic and therapeutic purposes. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - July 30, 2012 Category: Gastroenterology Authors: Tee Joo Chua, Arthur John Kaffes Tags: Case Studies Source Type: research

Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle
Conclusions: Preliminary data suggest that the flexible 19-G needle can be used for procuring cytologic aspirates and histologic specimens and to undertake therapeutic interventions even by the transduodenal route. Confirmatory studies are required in a larger cohort of patients with varied pathologic conditions to validate these findings. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - July 27, 2012 Category: Gastroenterology Authors: Shyam Varadarajulu, Ji Young Bang, Shantel Hebert-Magee Tags: Clinical Endoscopy Source Type: research

Endoscopic diagnosis of endovascular filter migration
A 41-year-old woman with metastatic ovarian cancer and obstructive jaundice was referred for ERCP. The patient had a history of multiple deep vein thromboses, for which an inferior vena cava filter had been placed 2 years earlier. At endoscopy a metal tine was seen protruding through the posteromedial wall of the descending duodenum near the major papilla (, arrow). At this point, given the concern for bowel perforation, air insufflation was switched to carbon dioxide. Deep biliary cannulation was accomplished without incident and a cholangiogram revealed a high-grade stenosis of the mid common bile duct. An uncovered meta...
Source: Gastrointestinal Endoscopy - July 9, 2012 Category: Gastroenterology Authors: Rabindra R. Watson, Daniel Pievsky, John R. Saltzman Tags: At the Focal Point Source Type: research

Endoscopy after radiology: Two‐step combined therapy for biliary stricture after Roux‐en‐Y hepaticojejunostomy
Benign postoperative anastomotic strictures after hepaticojejunostomy are difficult to manage. Before interventional techniques were developed, surgical intervention was the only option for treatment. A 28‐year‐old man underwent Whipple procedure with Roux‐en‐Y hepaticojejunostomy for abdominal trauma. Two years later, a late anastomotic biliary stricture was diagnosed. A percutaneous cholangiography showed a severe stricture in the hepaticojejunostomy. Because of the severity and length of the stricture, and the failure of repeated percutaneous balloon‐dilations, we percutaneously placed a self‐expandable meta...
Source: Digestive Endoscopy - June 24, 2012 Category: Gastroenterology Authors: Gabriele Curcio, Mario Traina, Roberto Miraglia, Ilaria Tarantino, Luca Barresi, Antonino Granata, Angelo Luca, Bruno Gridelli Source Type: research

Cystic Biliary Atresia: Confounding and Intriguing
A 50-day-old girl was referred to our Institute for evaluation of progressive jaundice. She was noted to be icteric soon after birth but was not further evaluated by the local practitioner. Laboratory markers at the time of admission revealed total bilirubin of 11.3 mg% (direct 6 mg%), serum glutamic oxaloacetic transaminase of 226 IU, serum glutamic pyruvic transaminase of 103 IU, alkaline phosphatase of 686 IU, and gamma-glutamyl transpeptidase of 80 IU. Magnetic resonance cholangiopancreatography of abdomen revealed a collapsed gallbladder (GB) and a cystic structure near the porta hepatis misdiagnosed as a congenit...
Source: The Journal of Pediatrics - June 11, 2012 Category: Pediatrics Authors: Ankur Arora, Yashwant Patidar, Rajeev Khanna, Seema Alam, Archana Rastogi, Sanjay Singh Negi Tags: Insights Source Type: research

A survey of the accuracy of interpretation of intraoperative cholangiograms
Conclusions: The present study shows that the accuracy of detection of both normal and variants of normal anatomy was poor in all grades of surgeon irrespective of a policy of routine or selective IOC. Improving operators' understanding of biliary anatomy may help to increase the diagnostic accuracy of IOC interpretation. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)
Source: HPB: official journal of the International Hepato Pancreat Biliary Association - June 11, 2012 Category: Gastroenterology Authors: Pandanaboyana Sanjay, Sherry Tagolao, Ilse Dirkzwager, Adam Bartlett Source Type: research

Hepatic artery pseudoaneurysm caused by acute idiopathic pancreatitis.
We report a case of HAP caused by acute idiopathic pancreatitis which developed in a 61-year-old woman. The woman initially presented with acute pancreatitis due to unknown cause. After conservative management, her symptoms seemed to have improved. But eight days after admission, abdominal pain abruptly became worse again. Abdominal computed tomography (CT) was rechecked and it detected a new HAP that was not seen in a previous abdominal CT. Endoscopic retrograde cholangiopancreatography (ERCP) was performed because of a suspicion of hemobilia as a cause of aggravated abdominal pain. ERCP confirmed hemobilia by observing f...
Source: World Journal of Gastroenterology : WJG - May 14, 2012 Category: Gastroenterology Authors: Yu YH, Sohn JH, Kim TY, Jeong JY, Han DS, Jeon YC, Kim MY Tags: World J Gastroenterol Source Type: research

Gallbladder damage control: compromised procedure for compromised patients
Conclusion Various circumstances may require gallbladder damage control with PC and TC. Postoperative complications and common bile duct injury remain significantly high despite limited resection, and the teaching status of the hospital is associated with CBD injury. High morbidity and mortality of gallbladder damage control may reflect both the compromised nature of the procedures and multiple comorbidities. Content Type Journal ArticlePages 1-5DOI 10.1007/s00464-012-2278-4Authors Justin Lee, St. Elizabeth Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135,...
Source: Surgical Endoscopy - April 27, 2012 Category: Surgery Tags: Surgical Endoscopy Source Type: research

Upper GI Bleeding in a Post-Liver Transplant Patient
Question: A 45-year-old man presented to the emergency room with large-volume hematochezia and subsequent hematemesis. His medical history is notable for alpha-1 antitrypsin deficiency with eventual liver failure. He underwent orthotopic liver transplantation 9 months prior, which was complicated by ischemic cholangiopathy with recurrent cholangitis and need for serial percutaneous cholangiogram tube exchanges. He underwent retransplantation 2 months before presentation, this time with a relatively uncomplicated postoperative course. The patient was not on aspirin or any nonsteroidal anti-inflammatory drugs. On this presen...
Source: Gastroenterology - April 26, 2012 Category: Gastroenterology Authors: Anoop Prabhu, Narasimham L. Dasika, Pratima Sharma Tags: Clinical Challenges and Images in GI Source Type: research

Left-sided gallbladder: An incidental finding on laparoscopic cholecystectomy.
Abstract Transposition of the gallbladder to the left side without situs inversus viscerum is rare. These gallbladders are situated under the left lobe of the liver between Segment III and IV or on Segment III to the left of the falciform ligament. This is a report of a 50-year-old woman who was admitted to our department with a history of pain in her right upper abdomen. The physical examination showed tenderness in the right upper quadrant of the abdomen without a Murphy's sign. Abdominal ultrasonography showed gall bladder stones without dilatation of the bile ducts. The patient underwent a laparoscopic cholecys...
Source: Asian Journal of Surgery - April 1, 2012 Category: Surgery Authors: Makni A, Magherbi H, Ksantini R, Rebai W, Safta ZB Tags: Asian J Surg Source Type: research

Cobra‐head choledochocele: depiction with computed tomography and cholangiogram
(Source: HPB: official journal of the International Hepato Pancreat Biliary Association)
Source: HPB: official journal of the International Hepato Pancreat Biliary Association - March 31, 2012 Category: Gastroenterology Authors: Ankur AroraAbhay KapoorSunil Kumar Puri Source Type: research

Degree of bile-duct dilatation in liver-transplanted patients with biliary stricture: a magnetic resonance cholangiography-based study
Conclusions Biliary dilatation after liver transplantation is mild and develops slowly regardless of the underlying type of stricture, possibly in relation to graft properties. MRC has a potential role as first-line imaging modality for a reliable assessment of biliary dilatation and the presence of a stricture. Content Type Journal ArticleCategory Abdominal Radiology / Radiologia AddominalePages 1-15DOI 10.1007/s11547-012-0805-1Authors R. Girometti, Istituto di Radiologia Diagnostica, Dipartimento di Scienze Mediche Sperimentali e Cliniche, Università di Udine, Via Colugna 50, 33100 Udine, ItalyC....
Source: La Radiologia Medica - March 22, 2012 Category: Radiology Tags: La Radiologia Medica Source Type: research

Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures (with videos)
Conclusion: Temporary intraductal placement of a newly modified FCSEMS effectively improved strictures and prevented potential stent-induced complications in patients with benign biliary strictures. Controlled large-scale trials are needed to confirm the long-term efficacy. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - March 9, 2012 Category: Gastroenterology Authors: Jong Ho Moon, Hyun Jong Choi, Hyun Cheol Koo, Seung Hyo Han, Tae Hoon Lee, Young Deok Cho, Sang-Heum Park, Sun-Joo Kim Tags: Clinical Endoscopy Source Type: research

Endoscopic ultrasound-guided rendezvous for biliary access after failed cannulation
Conclusion: EUS – RV is safe and effective and should be considered as a primary salvage technique after failed cannulation. Immediate re-attempt at ERC after failed EUS – RV is warranted, as EUS-guided cholangiogram can facilitate biliary cannulation in some cases. Finally, prompt alternative biliary drainage should be available.[...]© Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals:Table of contents | Abstract | Full text (Source: Endoscopy)
Source: Endoscopy - November 29, 2011 Category: Gastroenterology Authors: Iwashita, T.Lee, J. G.Shinoura, S.Nakai, Y.Park, D. H.Muthusamy, V. R.Chang, K. J. Tags: Original article Source Type: research

EUS-Guided Antegrade Transhepatic Placement of a Self-Expandable Metal Stent in Hepatico-Jejunal Anastomosis.
CONCLUSION: The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. EUS-guided biliary drainage is feasible when performed by professionals with expertise in biliopancreatic endoscopy and advanced echo-endoscopy and should be performed currently under rigorous protocol in educational institutions. PMID: 22072253 [PubMed - in process] (Source: JOP)
Source: JOP - November 20, 2011 Category: Gastroenterology Authors: Artifon EL, Safatle-Ribeiro AV, Ferreira FC, Poli-de-Figueiredo L, Rasslan S, Carnevale F, Otoch JP, Sakai P, Kahaleh M Tags: JOP Source Type: research

Duplication of the extrahepatic bile duct
AbstractDuplication of the extrahepatic bile duct is an extremely rare anomaly. There are five types of this anomaly with type V is the least common variant. Only two cases of type V (one each of type Va and type Vb) have been reported in the literature. Here we report the second case of type Vb duplication of the common bile duct presenting with choledocholithiasis. Patient underwent open choledocholithotomy and T tube choledochostomy after failed endoscopic stone clearance. Duplication of the bile duct was detected on the T tube cholangiogram which was confirmed by magnetic resonance cholangiopancreaticography (MRCP). No...
Source: Congenital Anomalies - October 13, 2011 Category: Genetics & Stem Cells Authors: Vishal GuptaAbhijit Chandra Source Type: research

To ‘gram or not’? Indications for intraopertive cholangiogram
Conclusion: Our data reveals that the selective use of IOC is helpful in diagnosing and clearing CBD calculi, that the use of preoperative CBD size aids in selecting patients for IOC, and that choledocholithiasis identified with IOC or after discharge can be managed successfully with ERCP. (Source: Surgery)
Source: Surgery - October 1, 2011 Category: Surgery Authors: Lawrence E. Tabone, Sharfi Sarker, Piero M. Fisichella, Molly Conlon, Emil Fernando, Sophia Yi, Fred A. Luchette Tags: Central Surgical Association Source Type: research

Diagnostic criteria for IgG4-related sclerosing cholangitis based on cholangiographic classification
Conclusions Diagnostic criteria for IgG4-SC based on cholangiographic classification are useful for distinguishing it from PCa, PSC, and CC. Content Type Journal ArticleCategory Original Article—Liver, Pancreas, and Biliary TractPages 1-9DOI 10.1007/s00535-011-0465-zAuthors Takahiro Nakazawa, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601 JapanItaru Naitoh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mi...
Source: Journal of Gastroenterology - September 23, 2011 Category: Gastroenterology Tags: Journal of Gastroenterology Source Type: research

Breaking the barrier: using extractable fully covered metal stents to treat benign biliary hilar strictures
Conclusions: Treatment of benign hilar strictures with an fcSEMS deployed across the liver hilum in conjunction with a contralateral plastic stent placement is feasible without ensuing cholangitis caused by bile duct occlusion. (Source: Gastrointestinal Endoscopy)
Source: Gastrointestinal Endoscopy - August 8, 2011 Category: Gastroenterology Authors: Jan-Werner Poley, Antonie J.P. van Tilburg, Ernst J. Kuipers, Marco J. Bruno Tags: New Methods Source Type: research

HIDA, percutaneous transhepatic cholecysto-cholangiography and liver biopsy in infants with persistent jaundice: can a combination of PTCC and liver biopsy reduce unnecessary laparotomy?
Conclusion PTCC, particularly when performed in combination with simultaneous liver biopsy, effectively excludes BA in cholestatic infants with acceptable morbidity. PTCC can frequently be performed when a contracted gallbladder is seen on initial US exam. Negative laparotomy rate is lowest when PTCC is coupled with simultaneous liver biopsy. Content Type Journal ArticlePages 1-8DOI 10.1007/s00247-011-2202-4Authors M. Kyle Jensen, Department of Pediatrics, Division of Pediatric Gastroenterology, Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, WI, USAVincent F. Biank, Dep...
Source: Pediatric Radiology - July 23, 2011 Category: Radiology Tags: Pediatric Radiology Source Type: research

Successful endoscopic removal of metal vascular coils from the biliary tree
A 65 year-old male was diagnosed with B-cell lymphoma in the head of the pancreas in 2001. Also in 2001, he underwent Tornado coil embolization of a right hepatic lobe pseudoaneurysm. In 2002, he received CHOP, Rituxan, and radiation, with complete response. In July 2010, he presented with one week of abdominal pain and jaundice. On admission, bilirubin was 11.4mg/dL (9.4mg/dL direct), and alkaline phosphatase 632U/L. Computed tomography scan of the abdomen was negative for recurrent lymphoma, but revealed migration of previously placed Tornado coils into the common bile duct. During ERCP, purulent bile consistent with cho...
Source: Digestive and Liver Disease - July 6, 2011 Category: Gastroenterology Authors: Darcie R. Gorman, William R. Hutson Tags: Image of the Month e-pages Source Type: research

Novel reconstruction of the extrahepatic biliary tree with a biosynthetic absorbable graft
Conclusions: Biliary reconstruction using a synthetic bioabsorbable prosthetic as an interposition tube graft is feasible based on initial results. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)
Source: HPB: official journal of the International Hepato Pancreat Biliary Association - June 29, 2011 Category: Gastroenterology Authors: Peter NauJames LiuE. Christopher EllisonJeffrey W. HazeyMatthew HennPeter MuscarellaVimal K. NarulaW. Scott Melvin Source Type: research

Biliary Complications Postlaparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review
This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach. (Source: Anesthesiology Research and Practice)
Source: Anesthesiology Research and Practice - June 13, 2011 Category: Anesthesiology Source Type: research

[A Case of Primary Mucoepidermoid Carcinoma Arising from the Common Bile Duct.]
Mucoepidermoid carcinoma of the bile duct is an extremely rare tumor. Seventeen cases originating from intrahepatic bile duct and 2 cases from common hepatic duct have been reported in the English literature. Mucoepidermoid carcinoma arising from the common bile duct has not been previously reported. A 68 year-old man was admitted due to obstructive jaundice. Computed tomography showed a malignant tumor of the common bile duct located in the intrapancreatic segment. Filling defects of the distal common bile duct was seen on endoscopic retrograde cholangiogram. Under the impression of bile duct cancer, pylorus-preservin...
Source: Korean J Gastroenter... - May 24, 2011 Category: Gastroenterology Authors: Song BJ, Kwon JH, Kim JJ, Lee JW, Min SY, Lee KB, Jang JY, Ryu JK Tags: Korean J Gastroenterol Source Type: research

Biliary leiomyoma diagnosed by Spyglass cholangioscopy (with video)
A previously healthy, 51-year-old woman was referred to the outpatient clinic because of intermittent right upper quadrant abdominal pain associated with intermittently raised liver biochemical test result levels (maximum alkaline phosphatase 2 × the upper limit of normal, alanine aminotransferase 3 × the upper limit of normal, bilirubin normal). In between pain attacks, results of her liver tests, complete blood counts, and renal profile were normal. A US scan and EGD showed normal results. Subsequently, the patient was admitted for abdominal pain associated with sepsis. An abdominal CT scan showed dilated intrahepatic ...
Source: Gastrointestinal Endoscopy - May 8, 2011 Category: Gastroenterology Authors: Evangelos Kalaitzakis, Richard Sturgess Tags: At the Focal Point Source Type: research

Aberrant right hepatic duct with patent ducts of Luschka
Severe necrotizing pancreatitis caused by gallstones developed in a 73-year-old man. His hospital course was complicated by multiorgan system failure, prolonged difficulty weaning him from mechanical ventilation, and profound debilitation. Six months after initial presentation, while undergoing physical therapy, he was noted on routine laboratory evaluation to have a serum alkaline phosphatase of 892 IU/L, bilirubin of 2.6 mg/dL, and aminotransferase levels in the range of 100 IU/L. A CT scan revealed a 14-cm area of walled-off pancreatic necrosis compressing the intrapancreatic portion of the common bile duct (CBD) and re...
Source: Gastrointestinal Endoscopy - May 1, 2011 Category: Gastroenterology Authors: B. Joseph Elmunzer, Jason R. Taylor Tags: At the Focal Point Source Type: research

Ulcerative colitis and an abnormal cholangiogram
(Source: Cleveland Clinic Journal of Medicine)
Source: Cleveland Clinic Journal of Medicine - May 1, 2011 Category: Journals (General) Authors: NGUYEN, D. L., LAZARIDIS, K. N. Tags: IM Board Review Source Type: research

Hepatobiliary anomalies in conjoined twins
Conclusion: In our experience, we did not find hepatobiliary anomalies to be the sole reason for inseparability in any of the conjoined sets. Hepatobiliary anomalies seem to be more frequent in the nonseparable group. (Source: Journal of Pediatric Surgery)
Source: Journal of Pediatric Surgery - April 30, 2011 Category: Surgery Authors: Abdullah Al-Rabeeah, Mohammed Zamakhshary, Mohammed Al-Namshan, Saud Al-Jadaan, Hesham Alshaalan, Aayed Al-Qahtani, Ibraheem Alassiri, Kingdom of Humanity team for conjoined twins separation Tags: CAPS Papers Source Type: research

Improving Performance in Single-Incision Laparoscopy
I read with great interest the study by Rieder and colleagues concerning the use of a triangulating surgical platform in single-incision laparoscopy. As an “average Joe” general surgeon practicing in a medium-sized suburban community, I decided to become an early adopter of single-incision laparoscopic surgery (SILS) in 2009 because I thought it would add a challenging and aesthetically enhancing aspect to laparoscopic procedures that I have been performing for almost 20 years. Since 2010, I have performed more than 20 SILS inguinal hernias, more than 25 SILS cholecystectomies (5 with cholangiograms), more than 20 SILS...
Source: Journal of the American College of Surgeons - April 28, 2011 Category: Surgery Authors: Atul N. Jani Tags: Letters Source Type: research

AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya
AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbum...
Source: Anesthesiology Research and Practice - April 5, 2011 Category: Anesthesiology Source Type: research

Choledochal cyst: A review of 79 cases and the role of hepaticodochoduodenostomy
Conclusions : In choledochal cyst, complete excision of cyst and good bilioenteric anastomosis with wide stoma should be done. Hepaticodochoduodenostomy with wide stoma is a simple, quick procedure with preservation of normal anatomy and physiology and minimum complications. It also avoids multiple intestinal anastomoses and so should be the preferred approach. (Source: Journal of Indian Association of Pediatric Surgeons)
Source: Journal of Indian Association of Pediatric Surgeons - March 17, 2011 Category: Surgery Authors: Biswanath MukhopadhyayRam Mohan ShuklaMadhumita MukhopadhyayKartik Chandra MandalPartha Pratik MukherjeeDipankar RoySumitra Kumar BiswasKalyani Saha Basu Source Type: research

Laparoscopic posterior sectoral bile duct injury: the emerging role of nonoperative management with improved long-term results after delayed diagnosis
Conclusion Bile leak in the presence of an intact common duct shown on cholangiogram should raise the suspicion of an RPSD injury. Expertise is needed to interpret the absence of RPSD in these cases. Drain tube cholangiogram is an important adjunctive investigation. In selected cases, the results of nonoperative management alone is comparable with the results of reconstruction. Content Type Journal ArticlePages 1-8DOI 10.1007/s00464-011-1630-4Authors M. T. P. R. Perera, The Liver Unit, University Hospital Birmingham, Queen Elizabeth NHS Trust, Edgbaston, Birmingham B15 2TH, UKA. Monaco, The Liver Un...
Source: Surgical Endoscopy - March 17, 2011 Category: Surgery Tags: Surgical Endoscopy Source Type: research

Natural history of small duct primary sclerosing cholangitis: a case series with review of the literature
Conclusions SDPSC, a mild disease at presentation typically runs a benign course and likely is not an early stage of classic PSC. Further studies with a control group of classic PSC and longer follow-up are needed to study the natural history of SDPSC. Content Type Journal ArticlePages 1-6DOI 10.1007/s12072-011-9260-4Authors A. K. Singal, Department of Gastroenterology, University of Texas Medical Branch, Galveston, TX USAC. M. Stanca, Department of Liver Diseases, Mount Sinai Medical Center, New York, NY USAV. Clark, Department of Gastroenterology, Hepatology, Nutrition, University of Florida, Gaine...
Source: Hepatology International - March 10, 2011 Category: Infectious Diseases Tags: Hepatology International Source Type: research

Microlithiasis, endoscopic ultrasound, and children: not just little gallstones in little adults
Conclusion: Children with biliary microlithiasis and associated clinical symptoms can be successfully treated with laparoscopic cholecystectomy. Endoscopic ultrasound should be considered in the evaluation of the child with clinical biliary symptoms and a negative transabdominal ultrasound result. (Source: Journal of Pediatric Surgery)
Source: Journal of Pediatric Surgery - February 28, 2011 Category: Surgery Authors: Lucas P. Neff, Girish Mishra, John E. Fortunato, Jennifer Laudadio, John K. Petty Tags: Original Articles Source Type: research

[Biliary atresia: A condition requiring urgent diagnosis and treatment.]
Every neonatal jaundice lasting more than 2 weeks needs urgent investigations, beginning with examination of stools colour, and blood tests with total and conjugated serum bilirubin. If neonatal cholestasis (NC) is confirmed, vitamin K should be immediately injected, and the child should be referred to a specialised centre for investigations and treatment. Biliary atresia (BA) is the first cause of NC. Its diagnosis is urgent, since the chance of success of the conservative surgical treatment (Kasai operation or variants) decreases rapidly as the age at surgery increases. Normal ultrasound scans cannot rule out BA. A...
Source: Archives de Pediatrie - February 28, 2011 Category: Pediatrics Authors: Chardot C, Debray D Tags: Arch Pediatr Source Type: research

Cholecystectomy in the Next Decade: Is LESS Really Better?
In a recently published paper in the Journal of Surgical Research, Aprea et al. present a randomized study comparing traditional laparoscopic cholecystectomy to the new approach of laparoendoscopic single site (LESS) cholecystectomy. The study population consists of the first 50 patients of an ongoing larger clinical trial. Patients were randomized to either traditional or LESS cholecystectomy and were routinely admitted for overnight observation to the hospital. The authors performed LESS procedures without any major complications, although in two patients, additional ports had to be placed to help manage bleeding and pl...
Source: Journal of Surgical Research - February 24, 2011 Category: Surgery Authors: Ali Tavakkolizadeh Tags: Commentary Source Type: research

A Delayed Surgical Complication
Question: An 82-year-old man presented with intermittent colicky upper abdominal pain, anorexia, vomiting, and jaundice. Four years previously, he had undergone cholecystectomy for symptomatic gallstones. Liver blood tests showed a cholestatic pattern and an abdominal ultrasound demonstrated choledocholithiasis and dilatation of the common bile duct (CBD). A cholangiogram performed during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) demonstrated the findings seen in . What is the diagnosis? (Source: Gastroenterology)
Source: Gastroenterology - February 23, 2011 Category: Gastroenterology Authors: David Prichard, Nasir Mahmud Tags: Electronic Clinical Challenges and Images in GI Source Type: research

Pediatric single incision laparoscopic cholecystectomy: lessons learned in the first 25 cases
Conclusion Single incision laparoscopic cholecystectomy is safe and feasible to perform in pediatrics, even in the setting of acute disease. Content Type Journal ArticlePages 1-4DOI 10.1007/s00383-011-2865-9Authors Claudia N. Emami, Department of Pediatric Surgery, USC-Keck School of medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS#100, Los Angeles, CA 90027, USADeiadra Garrett, Department of Pediatric Surgery, USC-Keck School of medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS#100, Los Angeles, CA 90027, USADean Anselmo, Department of Pediatric Surgery, USC-Keck School of me...
Source: Pediatric Surgery International - February 19, 2011 Category: Surgery Tags: Pediatric Surgery International Source Type: research