Role Of Ultrasonography In Diagnosis Of Various Biliary System Pathologies

Background:Discuss the role of ultrasound in detecting various gallbladder and biliary tract pathologies in patients presenting as right upper quadrant/epigastric pain/obstructive jaundice especially in emergency situations and demonstrating the incidence of various gallbladder and biliary tract pathologies. Material And Methods:A retrospective observational study of 85 patients having upper abdominal/epigastric pain/obstructive jaundice was carried out at SVP Hospital, ahmedabad. Ultrasound was performed by using MINDRAY RESONA 6 machine. Both curvilinear and linear probes were used for the scanning.Result:The study included 85 patients with 50 female patients and 35 male patients.Most common pathology found was gallbladder calculus (47%). Female gender (72.5%) wasmore prone for having gallstones than male gender (27.5%). Gallstones were commonly associated with diffuse wall thickening and most common pathology associated with diffuse wall thickening was acute calculus and acalculous cholecystitis with both havinga frequency of 30 % each. Gallstones were found a common risk factor for gallbladder perforation as well as gallbladder malignancy. Common pathologies presenting with obstructive jaundice were CBD stones and CBD stricture in which distal CBD was the commonest site for the stones (39%) as well as stricture (50%).In paediatric age group presenting with jaundice common pathologies were choledochal cyst and biliary atresia.Conclusion:Ultrasound is a non-invasive, least expensive,highly sensitive imaging modality and free from radiation for the assessment of the gallbladder and biliary tree pathologies especially in emergency situations

Articulated percutaneous plastic biliary stents: How to do it

The use of articulated plastic biliary stents is not well known. This technique allows drainage of two or more biliary segments using a single percutaneous access in hilar lesions. In patients that need dilatation of benign biliary stenoses, articulated plastic biliary stent allows placing two or more plastic in the area of stenosis achieving a large internal temporal dilatation while using smaller external biliary drains.

Magnetic resonance imaging features of choledochal traumatic neuroma / 中华消化外科杂志

Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma,and investigate the key points of diagnosis and differentiation.Methods This was a retrospective descriptive study.The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August,2015 were collected.The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP).Observational indexes included:(1) imaging features:location,size,signal intensity and enhancement characteristics of the lesion;(2) treatment and prognosis:surgical treatment,pathological findings,results of immunohistochemical staining and clinical follow-up.After preoperative related examinations,the patient and relatives were willing to receive surgical therapy,and postoperative pathological examinations and immunohistochemical staining were conducted.The follow-up using outpatient examination was performed to detect the patient's recovery and clinical symptoms up to January 2016.Ultrasound and laboratory examinations [alanine transaminase (ALT),aspartate transaminase (AST),γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded.Results (1) Imaging features:pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct.The nodular was measured 1.2 cm × 0.9 cm at maximum cross-section.The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma,slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image.MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts.The width of common bile duct was 1.4 cm.After administration of contrast materials,the nodular showed avid enhancement and delay enhancement,which was mild enhancement at the artery phase,and gradual increase at the portal vein phase and the delay phase.The length of central stricture of the common bile duct was 1.3 cm.There was no abnormal enhancement in liver,spleen and pancreas.No retroperitoneal lymphadenopathy could be seen.The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts.(2) Treatment and prognosis:the patient received surgery for tumor resection and Roux-en-Y reconstruction.The removed gross specimen was a grey-white nodular measured 2.0 cm × 1.0 cm.The cute surface was grey-white and stiff.The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma.Normal biliary epithelial cells can be seen beside the nerve bundles.Immunohistochemical staining showed S-100 and Vimentin were positive.The index of Ki-67 was 5％.The patient was discharged at 14 days postoperatively with the good recovery.During postoperative 5-month follow-up,the patient had good recovery and jaundice seleras were disappeared.Ultrasound showed the bile ducts were not dilated.The results of laboratory examinations were normal.Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration.

Caracterización de pacientes con lesiones quirúrgicas iatrogénicas de las vías biliares / Characterization of patients with surgical iatrogenic injuries of the biliary apparatus

Se realizó un estudio descriptivo de 35 pacientes intervenidos quirúrgicamente mediante las técnicas convencional y laparoscópica, quienes presentaron lesiones iatrogénicas de las vías biliares, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en un período de 8 años (2007-2014), con vistas a caracterizarles según algunas variables de interés y determinar la mortalidad asociada. Entre los resultados preponderantes figuraron el sexo femenino y las edades de 35 a 54 años, las lesiones producidas de la colecistectomía videolaparoscópica electiva por litiasis vesicular, las formas clínicas de presentación el absceso intraabdominal con signos de peritonitis e ictericia, cuyo diagnóstico fue confirmado mediante la ecografía. Asimismo, las lesiones de tipo A y C, según la clasificación de Strasberg, fueron las más reiteradas y el procedimiento técnico reparador más común fue el drenaje y lavado de la cavidad abdominal; 88,6 % de los pacientes egresaron vivos y 4 féminas fallecieron (11,4 %), cuya causa de muerte fue el choque séptico. Pudo concluirse que el momento del diagnóstico de estas lesiones se efectuaba tardíamente, y que a pesar de la complejidad de la reparación quirúrgica, existió baja mortalidad.

A descriptive study of 35 surgically treated patients by means of conventional and laparoscopic techniques who presented iatrogenic injuries of the biliary system, was carried out in the General Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in a 8 year period (2007-2014), with the aim of characterizing them according to some variables of interest and of determining the associated mortality. Among the predominant results there were the female sex and the ages from 35 to 54 years, the produced lesions of the elective videolaparoscopic cholecystectomy for vesicular lithiasis, the clinical forms of presentation the intraabdominal abscess with peritonitis signs and jaundice, diagnosis confirmed by means of the echography. Also, injuries A and C, according to the classification of Strasberg, were those most reiterated and the most common restorative technical procedure was drainage and washing of the abdominal cavity; 88.6% of the patients were discharged alive and 4 female patients died (11.4%) whose cause of death was the septic shock. It could be concluded that the moment of diagnosis for these lesions took place late, and that in spite of the complexity of the surgical repair, there was low mortality.

The value of ultrasound in the diagnosis of viral hepatitis complicated with bile duct injury / 中国医学装备

Objective: To investigate rules and affect factors in virus hepatitis complicated with biliary system damage. Methods: To observe 158 patients with various clinical types of viral hepatitis, gallbladder filling degree of gallbladder wall thickness, the gallbladder bile in the gallbladder situation, through sound situation by ultrasound, and the patients with intrahepatic, extrahepatic bile duct wall thickness were measured, the clarity of cavity were observed. Results:The 158 cases of patients with biliary ultrasonic testing results showed the gallbladder wall thickening, rough bilateral syndrome, sound transparent difference, stones, gallbladder enlargement or smaller, like solid. Severe hepatitis, biliary system in patients and liver cirrhosis was significantly higher than that of the abnormal in patients with acute hepatitis and chronic hepatitis (x2=17.96, x2=16.27; P<0.05). Conclusion: Viral hepatitis complicated with biliary system damage is related to clinical type, course of disease, liver function damage. Observe the change of ultrasonic dynamic biliary system, liver function testing timely, and provide the basis for guiding clinical treatment, to judge the severity and chronicity of hepatitis prediction.

Intraductal Papillary Mucinous Neoplasm with Associated Invasive Carcinoma Arising from Remnant Cystic Duct: A Case Report

Intraductal papillary mucinous neoplasm (IPMN) involving the biliary system is rare. To date, only a few cases of IPMN arising from the extrahepatic bile duct have been reported. In our case, extrahepatic IPMN arose in the remnant cystic duct after cholecystectomy, and to the best of our knowledge, this is the first report in the remnant cystic duct after cholecystectomy. A 74-year-old woman was referred for right upper quadrant pain lasting one day. Ultrasonography (US) showed a lobulated and hyperechoic mass with an outer linear hypoechoic lesion located adjacent to the dilated common bile duct. Contrast enhanced computed tomography showed a heterogeneously enhancing mass. Magnetic resonance imaging (MRI) showed a heterogenous mass with an outer semicircular high signal portion indicating remnant cystic duct.

Arranjos configurados pelas vias bilíferas no fígado do avestruz (Struthio camelus) / Arrangement configured by bile duct in the liver of the ostrich (Struthio camelus)

A ave avestruz (Struchio camelus) é originária da África, pertencendo a família das Ratitas. Seu valor zootécnico vem crescendo especialmente na região noroeste do Estado de São Paulo. Para a realização deste trabalho, utilizamos 20 peças de avestruz (Struthio camelus), machos e fêmeas, jovens e adultos, oriundos de criatórios da região noroeste do Estado de São Paulo. Após a abertura do trato gastrintestinal, ao longo da sua margem livre, escoamos as vias bilíferas mediante suaves massagens, canalizamos o ducto excretor, utilizando para tanto uma sonda flexível de polietileno de calibre compatível com a mencionada estrutura e, em seguida, injetamos por esta via Neoprene-látex “450” corado. Estas glândulas foram, a seguir, distendidas em base rígida, fixadas em solução de formol a 10%, esquematizadas e fotografadas. O ramo principal direito resulta do ramo lateral direito, ramo lobo quadrado e do ramo processo caudado em sete fígados. Em 13 peças, o ramo lateral direito é formado pelos ramoslateral direito e do processo caudado.O ramo esquerdo recebe os componentes oriundos do lobo lateral esquerdo e ramo do lobo medial esquerdo em todas as sete peças. Para ele, também aflui componente oriundo do lobo quadrado em 13 preparações e do processo caudado em sete fígados. Conclui-se que ofígado no avestruz não apresenta vesícula biliar, fazendo com que o ducto colédoco seja a única via de excreção da bile, resultando sempre da convergência do ducto hepático direito com o ducto hepático esquerdo.

The aim of this study was evaluate the influence of physical exercise (marcha gait) on serum values of CK and AST The Ostrich (Struthio camelus) is originally from Africa and belongs to the ratite’s family. Since its zootechnic value has been increasing, especially in the northwest region of the state of São Paulo, we studied the biliary system in the liver of this animal. To carry through it were used 20 ostrich livers, males and females, young and adults from place to production ostrich in the northwest region of the State of São Paulo. After the opening of the gastrointestinal tract and disposal of the bile through gentle massage, we cannulated the hepatic excretory duct with a flexible probe, compatible in size with the duct, and injected colored Neoprene latex “450” in the biliary system. Following this procedure, the livers were fixed in aqueous solution of formaldehyde to 10% dissected, schematized and photographed. The right main branch is derived from the right lateral, square lobe and the caudate process branches in 7 livers. In 13 livers, the right side branch is forned by the right side and caudate process branches. The left branch receives the components from the left lateral lobe and branch of the medial left lobe in 7 livers. It also receives component from the square lobe and from the caudate process in 13 and 7 livers, respectively.In conclusion, the ostrich liver has no gallbladder, causing the duct is the only route of excretion of bile, always resulting from the convergence of the right hepatic duct with the left hepatic duct.

The T2-Shortening Effect of Gadolinium and the Optimal Conditions for Maximizing the CNR for Evaluating the Biliary System: a Phantom Study

OBJECTIVE: Clear depiction of the common bile duct is important when evaluating neonatal cholestasis in order to differentiate biliary atresia from other diseases. During MR cholangiopancreatography, the T2-shortening effect of gadolinium can increase the contrast-to-noise ratio (CNR) of the bile duct and enhance its depiction. The purpose of this study was to confirm, by performing a phantom study, the T2-shortening effect of gadolinium, to evaluate the effect of different gadolinium chelates with different gadolinium concentrations and different magnetic field strengths for investigating the optimal combination of these conditions, and for identifying the maximum CNR for the evaluation of the biliary system. MATERIALS AND METHODS: MR imaging using a T2-weighted single-shot fast spin echo sequence and T2 relaxometry was performed with a sponge phantom in a syringe tube. Two kinds of contrast agents (Gd-DTPA and Gd-EOB-DTPA) with different gadolinium concentrations were evaluated with 1.5T and 3T scanners. The signal intensities, the CNRs and the T2 relaxation time were analyzed. RESULTS: The signal intensities significantly decreased as the gadolinium concentrations increased (p < 0.001) with both contrast agents. These signal intensities were higher on a 3T (p < 0.001) scanner. The CNRs were higher on a 1.5T (p < 0.001) scanner and they showed no significant change with different gadolinium concentrations. The T2 relaxation time also showed a negative correlation with the gadolinium concentrations (p < 0.001) and the CNRs showed decrease more with Gd-EOB-DTPA (versus Gd-DTPA; p < 0.001) on a 3T scanner (versus 1.5T; p < 0.001). CONCLUSION: A T2-shortening effect of gadolinium exhibits a negative correlation with the gadolinium concentration for both the signal intensities and the T2 relaxation time. A higher CNR can be obtained with Gd-DTPA on a 1.5T MRI scanner.

Clinical significance of preoperative magnetic resonance cholangiopancreatography in the evaluation of anatomic variants of the extrahepatic biliary tract / 中华消化外科杂志

Objective To evaluate the feasibility and clinical significance of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of anatomic variants of the extrahepatic biliary tract. Methods The MRCP images of 535 patients who were admitted to The Second Affiliated Hospital of Suzhou University from March 2008 to March 2009 were retrospectively analyzed by two reviewers independently. The anatomic variants of the extrahepatic biliary tract were evaluated by studying the T2-weighted magnetic resonance images. Results The consistency between the two reviewers in the diagnosis of low choledochal joint, medial cystic duct insertion, aberrant hepatic duct, accessory hepatic duct and other anatomic variants was 98% , 99% , 89% , 90% and 100%, respectively (K = 0.86, 0.93, 0.81, 0.82, 1.00). The extrahepatic biliary system was clearly displayed by MRCP in 500 patients, and anatomic variants were observed in 240 patients, including low choledochal joint in 85, parallel cystic duct in 37, medial cystic duct insertion in 82, aberrant hepatic duct in nine, accessory hepatic duct in 10, choledochal cyst in three and high cystic duct in seven. A total of 259 patients underwent operation, and 168 patients had anatomic variants of the extrahepatic biliary tract. Conclusion MRCP imaging enables the accurate assessment of anatomic variants of the extrahepatic biliary system and avoids bile duct injury.

Value of Gd-BOPTA in Diagnosis of Focal Liver Lesion and Biliary System Disease / 中国普外基础与临床杂志

Objective To investigate the diagnostic value of a double action MR contrast agent——gadobenate dimeglumine (Gd-BOPTA) for focal liver lesion and biliary system disease.Methods Articles about Gd-BOPTA in CNKI and PubMed for the past few years were searched and the value of Gd-BOPTA in the diagnosis of focal liver lesion and biliary system disease was summarized.Results For focal liver lesion,Gd-BOPTA not only can reveal blood supply of the lesion,but also reveal the hepatocellular functional status in the lesion.For biliary system,biliary excretion of Gd-BOPTA can be used to evaluate the anatomic structure of bile duct,function of gallbladder and biliary system disease.Conclusions Gd-BOPTA has an important value in the diagnosis of focal liver lesion and biliary system disease.Gd-BOPTA may have wider applications in the future.

The study on the application of rapid exchange biliary system for calculus of bile duct removed cases / 中国实用内科杂志

Objective To evaluate the application of RX rapid exchange biliary system in(endoscopic retrograde cholangiopancreatography,ERCP)treatment for patients with bile duct stone.Methods 154 patients were divided into traditional devices group(76 cases)or RX system group(78 cases)according to the size of bile duct stone and state of patients randomizly,then guide wire loss rates,catheter/guide wire exchange times and easy degree of buskets and ballons inserted to bile duct was recorded respectively during procedure,all parameters was analyized by Chi-square methods or t test.Results The guide wire loss rates(%) of RX group was obviously lower than that of traditional devices group(2.2?1.4 vs 9.5?2.8,P0.05).Conclusion RX system is shorten the time and convenience the operation in ERCP for treating patients with common bile duct stone,as well as improve the therapy efficiency.

Prospective study on the rapid exchange biliary system for therapeutic ERC / 中国实用内科杂志

Objective The study intends to evaluate the extent to which the rapid exchange biliary system(RX system)provides improved efficiency in comparison with conventional guide wire combinations during therapeutic endoscopic retrograde cholangiopancreatography(ERCP).Methods A prospective study was carried out in which 213 patients were randomized to undergo traditional devices(106 patients)or RX system(107 patients).The parameters were recorded in every case,including the wire loss rates,catheter/guide wire exchange times and fluoroscopy times.Results Wires accessing to the desired ductal/strictures were achieved in 97.1% of conventional devices group and 98.1% of RX system group.But in the conventional devices group,the wire loss rates(%)were significantly higher than the rates in RX system group(10.2?2.3 vs 2.4?1.2,P

Pretreatment with Ursodeoxycholic Acid (UDCA) as a Novel Pharmacological Intervention in Hepatobiliary Scintigraphy

The purpose of this volunteer study was to investigate whether pretreatment with UDCA before the administration of 99mTc DISIDA affects the biliary excretion of the DISIDA, and whether it can shorten the total imaging time. Ten young, healthy volunteers (eight males, two females, mean age: 26.3 +/- 2.1 years) participated in the study. Hepatobiliary scintigraphies were performed twice per volunteer within three days, for the control and the UDCA-pretreated studies. In the control study, the gallbladder (GB) was observed first in four cases and the intestine was observed first in another four cases; in contrast, in the UDCA challenge study, the GB was observed first in eight cases. The quantitative results for the factors related to the GB differed significantly between the control and challenge studies. When the subjects were pretreated with UDCA, the time duration until visualization of the GB was shortened, and the maximum activity of the GB became more intense. In conclusion, UDCA pretreatment before hepatobiliary scintigraphy can shorten the total imaging time for evaluating functional obstructions of the cystic duct and increase the specificity of the process.

Using pig biliary system, in vivo propagation of Enterocytozoon bieneusi, an AIDS-related zoonotic pathogen

A microsporidian parasite Enterocytozoon bieneusi is the most common microorganism recognized in AIDS patients, and slow scientific progress is attributed to our inability to propagate the parasite. We report upon the development of a system of propagation using the pig biliary system. The parasite spores were continuously detected in the bile samples post onset of spore shedding in the gall bladder, which suggests that this organism maintain persistent infection in the biliary system and that the hepatobiliary tree may represent a reservoir of infection. In conclusion the biliary tree is an adequate niche for the propagation of E. bieneusi. This work has also resulted in the development of a procedure of ultrasound-guided cholecystocentesis for aspirating biles. This is a simple and non-surgical procedure, and creates no signs of clinical complications in the livers and the gall bladders after dozens of separate attempts. Thus, this is a very useful and safe technique for the aspiration of bile from live animals.

Atresia of the extrahepatic biliary system (a report and review)

A case report of a complete atresia of the extra hepatic biliary system is made and a brief review of the many aspects involved in the management of the case is given. An early diagnosis should be the objective as early as possible during the first six months of life, if we are to offer a chance of salvage to the newborn. Unfortunately, it is not always so attained. A dilemma in the diagnosis arises such that an early diagnostic laparotomy is indicated. (Summary)

Clinical Observation of Bile Culture and Chronological Change of Bacteriology

BACKGROUND: Intraoperative collection of bile and a bile culture are of use in predicting bacterial infection in the biliary system. The aim of this study was to identify chronological changes in the bacteriology of the bile in the age and sex distributions for biliary tract disease of the patients. METHODS: We retrospectively reviewed the clinical records of 722 patients who had been operated on for biliary tract disease at the Department of Surgery Ewha Womans University Hospital, from Jan. 1979 to July 1998 and on whom intraoperative bile culture had been performed. We divided the 722 patients into two group based on the time of their treatment, period A being 1979-1988 and period B being 1989-1998. The statistical analysis was done by using the Mantel-Haenszel Chi-Square test. RESULTS: The overall bile culture positive rate was 56% (404 cases), and the male-to-female ratio was 1:1.64. There was no significant statistical difference in the sex ratio between the two periods (period A: 1:1.78, period B: 1:1.55) (p>0.05). Overall, the most commonly isolated organism in the bile was Escherichia coli (137 cases, 30%). Comparing the two periods, we found that the Enterococcus species was an organism found increasingly in biliary tract infections (period A: 0%; period B: 17%) whereas infection by Escherichia coli was significantly decreased in the latter period (period A: 43%; period B: 28%) (p<0.05). The sixth decade (29.1%) was the most prevalent age overall. The age distribution for period A showed no statistical difference between the 5th (21.58%) and the 7th decades (21.94%), but there was significant difference between the 7th (29.95%) and the 5th decades (16.89%) in the age distribution for period B (p<0.05). CONCLUSIONS: According to the above results, we concluded that there were significant chronological changes in the bacteriology of the bile & in the age distributions between the two periods, but no such difference was observed between the sex distribution.

Clinical Significance of Low Junction of the Cystic Duct / 대한소화기내시경학회지

BACKGROUND AND AIMS: Recently, similar to the anomalous union of the pancreatobiliary duct (AUPBD), a low junction of the cystic duct (LJCD) was reported to be associated with the carcinogenesis of the gall bladder (GB) and other pancreatobiliary diseases. This study was designed to evaluate the clinical significance of the LJCD. METHODS: In this study all cases were performed ERCP. Three hundred and twenty two cases were selected due to their clear identification of the union area between the bile duct and the pancreatic duct, inserted area of the cystic duct, and the duodenal opening of the bile duct. The LJCD was defined that the cystic duct joins the distal bile duct between the upper margin of the pancreas and the duodenal opening of the bile duct. AUPBD was defined as a common channel greater than 15 mm in length. The clinical data was divided into four groups-normal biliary anatomy (Group 1), AUPBD (Group 2), LJCD (Group 3), and combined with AUPBD and LJCD (Group 4), and then analyzed. RESULTS: The mean age of the subjects was 56.6 with 183 male and 139 female cases. Among 322 cases, there were 7.1% (23 of 322) of AUPBD, 11.2% (36 of 322) of LJCD and 0.6% (2 of 322) of combined with AUPBD and LJCD. The clinical symptoms and the laboratory findings of the subjects were no statistical significance among the groups. The incidence of CBD stones was 27.3% (88 of 322) of the patients; 25.3% (66 of 261) of Group 1, 21.7% (5 of 23) of Group 2, 47.2% (17 of 36) of Group 3, and were significantly higher in Group 3 than Group 1 & Group 3 (p=0.038). However, the incidence of GB stones and cystic duct stones was no statistical significance among the groups. Malignant diseases of the biliary trees were 9.65% (31 of 322) of the patients; 6.8% (18 of 261) of Group 1, 26% (6 of 23) of Group 2, 13.8% (5 of 36) of Group 3, and were closely correlated with AUPBD (p<0.001) and LJCD (p=0.017). CONCLUSIONS: LJCD is relatively common in patients undergoing ERCP and closely correlated with the CBD stones and the malignacies of the biliary system. However its role in these condition is uncertain and needs to be further investigated.

Excretory system of the liver in deers (Manzana americana, Blastocerus bezoarticus e Manzana simplicicornis). I. ramus principalis dexter / Sistema excretor do fígado de veados f Manzana americana, Blastocerus bezoarticus e Manzana simplicicornis). I. sistematização do ramus principalis dexter

The ramus principalis dexter of the excretory system of the liver in 6 specimens of Manzana americana, 1 ofManzana simplieieornis and 1 of Blastocerus bezoartieus was injected with colored latex-Neoprene, fixed in10% formaldehyde solution and dissected. In the 3 species, which do not have a vesica tellea, the ductuschotedocus results from the junction of the ramus principalis dexter and the sinister. The ramus principalisdexter is formed, under several dispositions, by the ramus medialis lobi dextri, the ramus dorsalis lobidextri, the ramus processi caudati and the ramus lateralis lobi dextri.

A sistematização do ramus principalis dexter do sistema excretor do fígado foi estudada em 06 veados mateiros (Manzana americana), 01 veado catingueiro (Manzana simplicicornis) e 01 veado do rabo branco (Blastocerus bezoarticus). Foi utilizado látex Neoprene corado para o preenchimento das vias biliares, e o método empregado para a evidenciação dos coletores foi o da dissecação, realizada após a fixação das peças com solução aquosa de formol a 10%. Nas três espécies estudadas o ductus choledocus resulta da reunião do ramus p rin cipa lis dexter e do ramus prin cipa lis sinister, sem a participação do ductus cysticus, pois estes animais não possuem vesíbula biliar. Nas três espécies, participam do sistema do ramus principalis dexter, sob diversos arranjos, o ramus medialis lobi dextri, o ramus dorsalis lobi dextri, o ramus processi caudati e o ramus lateralis lobi dextri.

Blood supply and clinical significance of extra hepatic duct / 中华器官移植杂志

Objective To observe the blood supply of the extra hepatic duct and prevent the ischemia of extra hepatic duct after liver transplantation. Methods Microdissection for the main arteries of extra hepatic duct in 15 samples was performed. Results The main arteries supplying extra hepatic duct included cystic artery’s branches and posterior superior pancreaticoduodenal artery’s branches. There were 1~3 cystic artery’s branches and 3~5 posterior superior pancreaticoduodenal artery’s branches to supply extra hepatic duct. Conclusion The posterior superior pancreaticoduodenal artery is one of the main arteries supplying extra hepatic duct. In orthotopic liver transplantation, this artery is considered to preserve.