ABSTRACT
Traumatic injury to extrahepatic bile duct system is a rare entity. Associated injuries are usually the indication of surgical exploration, and most of the common bile duct (CBD) injuries are diagnosed intraoperatively. Here, we present a case of a 23-year-old boy with a history of road traffic accident. Intraoperatively there was moderate hemoperitoneum with Grade 3 liver laceration, Grade 1 splenic laceration, laceration of anterior wall of stomach, common hepatic artery tear, and complete transaction of CBD. The principle of damage control surgery followed. Stomach laceration repaired and common hepatic artery ligated. Infant feeding tube placed in a proximal portion of transected CBD and distal portion ligated. The patient was discharged on the 45th day with infant feeding tube draining bile. In follow-up OPD tube cholangiogram followed by magnetic resonance cholangiopancreatography done which showed the formation of a choledochoduodenal fistula. Infant feeding tube removed. The patient did well for next 6 months but after that he presented with jaundice which on evaluation found to be due to stricture of choledochoduodenal fistula. The patient underwent elective cholecystojejunostomy. Miraculous spontaneous formation of choledochoduodenal fistula in traumatic CBD injury and management by cholecystojejunostomy is very less reported in the literature.
ABSTRACT
Objective To investigate the place reaction of support drainage tube in cholecystojejunostomy and its pathological changes.Methods Eight pigs were randomized into 2 groups.The tube-placing cholecystojeunostomy(n=2)or choledochocholedochostomy(n=2)and non-tube-placing cholecystojejunostomy(n=2)or choledochocholedochostomy(n=2)were performed respectively.All the 8 pigs were sarcrificed 3 months after the operation for pathological examination.Results Gross anatomy catheter group showed anastomotic inflammatory hyperplasia, wall hardening hyperplasia,luminal narrow contracture and stone formation.Microscopic biopsy showed bile duct mucosa in interstitial lymphocytes, plasma cells and other chronic inflammatory cell infiltration, a large number of fibrous tissue hyperplasia.However, these features were not found in pigs without placing the tube.Conclusion The tube can not prevent the stenosis.It might promote the formation of stricture since it can stimulate inflammatory hyperplasia and tissue hardening.
ABSTRACT
Objective To compare the prevent effect of biliary retrograde infection in the uncut and cut Roux-en-Y cholecystojejunostomy. Methods Sixteen Begle dogs were divided into two groups randomly. One group was performed with the uncut Roux-en-Y cholecystojejunostomy(the uncut group) and the other was performed with the cut Roux-en-Y cholecystojejunostomy (the cut group). The categories of bacterium in the the Roux limb before and twelve weeks after operation, and the biliary duct pressure of the anastomotic stoma were detected. The changes of the categories of bacterium before and after operation, the categories of bacterium and the biliary duct pressure after operation in two groups were analyzed. Results The isolating rate of G-aerobic bacteria and anaerobic bacteria was 37.50% and 6.25% before operation; in the uncut group, the isolating rate was 62.50%, 12.50%,with no significance difference comparing to preoperation(p＝0.390、1.000). In the uncut group the isolating rate was 87.50%, 75.00%after operation, with significance difference comparing to preoperation (p＝0.033、0.001).The isolating rate of anaerobic bacteria after operation in the cut group is higher than the uncut group,the difference is significance (p＝0.041). And the biliary duct pressure in the cut group is higher than the uncut group(p<0.001).Conclusion The uncut Roux-en-Y cholecystojejunostomy was more effective in prevent biliary retrograde infection.