ABSTRACT
Objective To investigate the short term efficacy and security of different diameters of ampulla balloon dilation in the treatment of choledocholithiasis. Methods 80 patients with extrahepatic bile duct stones treated by EPBD were included in this study. All the patients were divided into 8 mm group, 10 mm group, 12 mm group, 14 mm group, which were according to the diameter of common bile duct (CBD) and stones. CBD stones were removed with retrieved balloon, Dormia basket, and/or mechanical lithotripsy if necessary. The incidence of 24 h hemorrhage, acute pancreatitis, hyperamylasemia and intestinal perforation were observed, and the incidence of pneumobilia and duodenobiliary reflux two weeks after EPBD. Then analyzed the short-term efficacy of the four groups. Result The overall success of stone removal in all groups were 100.0%, there was no significant differences in bleeding, intestinal perforation, hyperamylasemia, pancreatitis between each group (P > 0.05) . There shows significant differences in pneumobilia and duodenobiliary reflux two weeks after EPBD (P < 0.05). The incidence of pneumobilia and duodenobiliary reflux increased with the size of the balloon. Conclusion The application of EPBD is effective and safe for bile duct stone removal, while with the increasing of balloon diameter, the function of Oddi sphincter has severely influenced.
ABSTRACT
Pneumobilia almost always indicates an abnormal communication between the biliary and gastrointestinal systems. Air may occasionally enter the biliary tract in a retrograde fashion through the papilla. Transient incompetence of the sphincter of Oddi, which is produced by the passage of small biliary stones, is one rare mechanism that can explain pneumobilia. We present here a case of spontaneous pneumobilia after sphincter disruption that was presumably caused by the passage of biliary stone. A 37-year-old woman visited our hospital with the symptom of right upper quadrant pain. The pain subsided after she had an episode of severe vomiting. Plain abdominal radiography revealed that air filled the branches of the hepatic ducts, and the common bile duct had a large filling defect. We also include a review of the related literature.
Subject(s)
Adult , Female , Humans , Biliary Tract , Common Bile Duct , Hepatic Duct, Common , Radiography, Abdominal , Sphincter of Oddi , VomitingABSTRACT
Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from 0% to 3.3%. Moreover, liver abscess formation in non-tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo-enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non-tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia.