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Objective To evaluate the application efficacy of SpyGlass endoscopic direct visualization system in management of complex biliary complications after orthotopic liver transplantation. Methods Clinical data of 369 adult patients with biliary complications after orthotopic liver transplantation who received endoscopic retrograde cholangiopancreatography (ERCP) for the first time were retrospectively analyzed. Preoperative conditions, intraoperative manifestations, treatment outcomes and complications of patients treated with SpyGlass system were analyzed. Results Fifty-six patients were treated with SpyGlass system. The main preoperative symptoms included abdominal discomfort in 38 cases, fever in 8 cases, jaundice in 6 cases and skin itching in 4 cases. Ultrasound examination in 18 patients indicated common bile duct stenosis and significant intrahepatic bile duct dilatation. Preoperative magnetic resonance cholangiopancreatography (MRCP) of 56 patients revealed that 36 cases were diagnosed with common bile duct stenosis complicated with stones, 16 cases of common bile duct stenosis alone and 4 cases of suspected tumors. All patients had definite indications for SpyGlass system treatment. Among 56 patients treated with SpyGlass system, 34 cases were diagnosed with anastomotic stricture complicated with stones, 12 cases of anastomotic stricture alone, 1 case of biliary stone and 4 cases of tumors. Among 48 cases who were successfully treated, the levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, alkaline phosphatase and total bilirubin at postoperative 48 h were all significantly lower than preoperative levels (all P<0.05). No severe complications occurred in 56 patients treated with SpyGlass system. Conclusions Use of SpyGlass system may significantly increase success rate and guarantee surgical safety in the treatment of complex biliary complications after liver transplantation, which is worthy of promotion and application.
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Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented. Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.
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ABSTRACT Background: Abbreviated magnetic resonance imaging protocols have emerged to reduce the examination time of the long protocols eliminating unnecessary pulse sequences to answer a targeted clinical question, without compromising diagnostic information. Objective: The objective of this study was to evaluate the diagnostic accuracy of an abbreviated magnetic resonance cholangiopancreatography (A-MRCP) protocol in patients with suspected choledocholithiasis. Methods: This retrospective study evaluated patients (ages 10 + years) that performed consecutive MRCP examination from October 2019 to June 2020, with the clinical suspicion of choledocholithiasis. Readers first evaluated the biliary tree using a four-sequence A-MRCP protocol and later reviewed the entire conventional eleven-sequence MRCP. Presence of choledocholithiasis, stone size, common bile duct caliber, and additional findings were evaluated. Results: A total of 148 patients with MRCP were included (62.8% female, mean 50.9 years). The prevalence of choledocholithiasis was 32.2%. The accuracy of the abbreviated MRCP protocol for choledocholithiasis was 98.7%. There was no difference between the performance of the abbreviated and conventional MRCP image sets for detection of choledocholithiasis (kappa=0.970), with a sensitivity of 98% and a specificity of 99%. There was excellent inter-reader agreement evaluating for choledocholithiasis on both imaging sets of MRCP protocols (kappa values were 0.970). Conclusion: An abbreviated MRCP protocol to evaluate for choledocholithiasis provides similar diagnostic over the conventional MRCP protocol, offering potential for decreased scanning time and improved patient tolerability.
RESUMO Contexto: Protocolos abreviados de ressonância magnética (RM) surgiram a fim de reduzir o tempo de exame, eliminando sequências de pulso desnecessárias para responder a uma questão clínica específica, sem comprometer o diagnóstico. Objetivo: O objetivo do estudo foi avaliar a acurácia diagnóstica de um protocolo abreviado de colangiopancreatografia por ressonância magnética (colangioRM) em pacientes com suspeita de coledocolitíase. Métodos Estudo retrospectivo, com pacientes acima de 10 anos que realizaram exame de colangioRM, entre outubro de 2019 a junho de 2020, com suspeita clínica de coledocolitíase. Os observadores, radiologistas especialistas, primeiro avaliaram a árvore biliar usando um protocolo abreviado de colangioRM composto por quatro sequências de pulso e, posteriormente, revisaram o protocolo convencional de colangioRM de 11 sequências. A presença de coledocolitíase, o tamanho do cálculo, o calibre do ducto hepático comum e achados adicionais foram avaliados. Resultados Um total de 148 pacientes foram incluídos, sendo 62,8% do sexo feminino, com média de 50,9 anos de idade. A prevalência de coledocolitíase foi de 32,2%. A acurácia do protocolo abreviado de colangioRM para coledocolitíase foi de 98,7%. Não houve diferença entre o desempenho dos protocolos abreviado e convencional de colangioRM para a detecção de coledocolitíase (k=0,970), com uma sensibilidade de 98% e uma especificidade de 99%. Além disso, observou-se excelente concordância entre observadores na avaliação de coledocolitíase em ambos os protocolos de colangioRM (k=0,925). Conclusão O protocolo abreviado de colangioRM apresentou excelente acurácia para o diagnóstico de coledocolitíase quando comparado ao protocolo convencional.
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Objective To preliminarily evaluate the application value of SpyGlass direct visualization system in the diagnosis and treatment of biliary stricture after liver transplantation. Methods Clinical data of 4 patients presenting with biliary stricture after liver transplantation who underwent SpyGlass direct visualization system examination were collected. The examination, treatment and prognosis of biliary stricture were analyzed. Results The examination results of color Doppler ultrasound, magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in 4 patients suggested biliary anastomotic stricture with intrahepatic biliary dilatation, and 2 of them were complicated with intrahepatic biliary calculi. Repeated placement of biliary stent under ERCP yielded poor effect in 3 cases. SpyGlass direct visualization system examination hinted biliary anastomotic stricture in 4 patients, 3 cases of intrahepatic biliary dilatation, 3 cases of intrahepatic biliary calculi, 2 cases of purulent bile and 3 cases of floccules within the biliary tract, 1 case of congestion and edema of biliary tract wall and 2 cases of local epithelial necrosis and stiffness changes of intrahepatic biliary tract wall. The wire could not be inserted in 1 patient due to severe biliary anastomotic stricture. Four patients were treated with biliary stricture resection + biliary stone removal + biliary end-to-end anastomosis, biliary stricture resection + biliary-intestinal anastomosis, ERCP lithotomy + biliary metal stent implantation, and biliary metal stent implantation + percutaneous transhepatic bile duct lithotomy, respectively. Relevant symptoms were relieved without evident complications. All patients survived during the follow-up until the submission date. Conclusions Compared with traditional imaging examination, SpyGlass direct visualization system may more directly display the morphological characteristics of biliary tract wall and structural changes within biliary tract cavity, which is an effective examination tool for biliary stricture after liver transplantation. In addition, individualized treatment methods may be adopted for different biliary tract diseases, which is expected to improve clinical prognosis of patients.
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Liver transplantation has become an effective treatment for end-stage liver diseases. With rapid development of surgical techniques, donor selection, organ preservation and transportation, immunosuppressants and perioperative management, the overall incidence of complications after liver transplantation has been significantly decreased, whereas the incidence of biliary complications remains relatively high. At present, biliary complications after liver transplantation are still an important cause of graft failure. Nevertheless, the pathogenesis, diagnosis and treatment of biliary complications remain controversial, which are also research hotspots in the field of organ transplantation in recent years. In this article, new breakthrough and research progress upon biliary complications after orthotopic liver transplantation in adults were reviewed, aiming to provide theoretical basis for resolving biliary complications-related clinical issues.
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Background and Aim: There is limited data on imaging features of extra hepatic portal venous obstruction (EHPVO) induced portal biliopathy. We describe a decade long experience of imaging spectrum of EHPVO induced portal biliopathy using MR/CT in a referral centre for liver diseases. Methods: Retrospective data of patients with primary EHPVO on contrast magnetic resonance imaging MRI/ computed tomography (CT) (n=120) and portal biliopathy (PB) on subsequent magnetic resonance cholangiopancreatography (MRCP) (n=80/120) between June 2009 - 2019 was collected. Categorisation of portal biliopathy was as per the Sarin classification and the corresponding, relevant imaging parameters were studied and analysed. Results: Sarin Type 1 biliopathy was present in 16.3 %, Type 2 in 13.8%, Type 3a in 8.8% and Type 3b in 61.3%patients. The median total serum bilirubin was 1.6 (0.9-3.4) mg/dl with a mean CBD diameter of 6.7 ± 2.9 mm. Bilobar and unilobar IHBRD were observed in 87.5% and 6.3% patients respectively. The mean CBD angle was 138.9 ± 18.8º. CBD showed smooth wall contours (10%), extrinsic indentations (83.8%) and smooth strictures (6.3%). The median CBD stricture length was 26 mm (1.25- 45 mm). Pre-stenotic dilatation was observed in 66.3% with stricture length >16 mm (sensitivity 81.1 % specificity 78%) predisposing to it. Statistically significant associations were tabulated according to the classification of PB. Conclusion: This study provides the decade long experience of imaging findings in EHPVO induced portal biliopathy according to its classification and its clinical implications.
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Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.
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Background: Choledocholithiasis with cholelithiasis is a common problem in the middle and older age group people. Aim of this study is to assess the usefulness of ultrasonography in the diagnosis of choledocholithiasis in resource poor set up.Methods: After matching the inclusion and exclusion criteria, all cases of diagnosed choledocholithiasis were taken for this prospective, single center, observational study.Results: Out of total 130 subjects, 41 were male and 89 were female. Increased incidence of choledocholithiasis was found in females (M:F=1:2.08). The mean age of presentation was 49.27±10.60 years. Ultrasonography was able to diagnose common bile duct (CBD) stones in 57 patients (43.84%) and ductal dilatation in 89 (68.46%). Whereas, magnetic resonance cholangiopancreatography (MRCP) detected CBD stones in 112 (86.15%). Cholelithiasis was associated with choledocholithiasis in 108 patients (83.07%).Conclusions: In the evaluation of choledocholithiasis, in our study particularly trans-abdominal ultrasonography (USG) seemed to have a lower yield than expected for accuracy in determining choledocholithiasis when compared to MRCP and Intra-operative findings. So, a negative USG in a particular may not exclude choledocholithiasis. So, MRCP is the ‘investigation of choice’ among the suspicious patients for CBD stone disease. That is why prior to cholecystectomy in symptomatic patients with deranged liver function test, MRCP always to be done, to detect the missed stone in CBD.
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The aim of the study was to evaluate role of Magnetic Resonance Cholangiopancreatography in differentiating benign from malignant causes of biliary strictures in adults using surgical, ERCPor histo-pathological findings as gold standard.The objectives of the study were to confirm the diagnosis of the biliary strictures , to localize the level of obstruction, to characterize the morphological features of stricture to differentiate benign from malignant cause on MRCPimaging and correlate with the surgical/ ERCP/ histo-pathological findings whenever its applicable.Study was conducted in Gujarat Imaging centre Post graduate institute of Radiology and Imaging (GIC-PGIR), Samved hospital, Ahmedabad .Patients with clinical and laboratory finding suggestive of biliary obstruction were imaged . Aprospective study was performed evaluating 80 patients for a duration of 1 year with clinical and laboratory finding suggestive of biliary obstruction referred to the hospital for Magnetic resonance Cholangiopancreatography.MRI (3- Tesla, Philips achieva with 16 array channel coil) with high resolution specific serial sections. Diagnostic effectivity was calculated for MRCPwhich included sensitivity, specificity and accuracy by comparing with surgical, histopathological or ERCPfindings. Statistical analysis was done by using chi-square test and p-value was calculated.We observed high sensitivity and specificity of MRCPin differentiating benign from malignat biliary strictures. In this study, 20 cases of benign stricture were correctly diagnosed on MRCPbased on patient's clinical history and MR characteristic findings. Two cases which were coined as benign strictures of distal CBD on MRCP, turned out malignant on post interventional cytology result. 31 cases of malignant stricture were correctly diagnosed on MRCP.Overall diagnostic accuracy of MRCPin differentiating benign from malignant biliary strictures in correlation with ERCP, surgical and histo-pathological outcome was 94.44 % , sensitivity 93.94% , specificity was 95.24%. PPV96.87 % and NPV90.91%
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Introduction: Obstructive jaundice is a common clinicalproblem and most common presentation in patients withbiliary ductal obstruction. The role of imaging is crucialfor detection of site and cause of obstruction and also todifferentiation of benign and malignant pathology. MRCP isused in patients with history of obstructive jaundice to identifyand confirm the presence of obstruction, its location, extent,probable cause and also to obtain a map of the biliary treethat will help the surgeon or the interventionist to determinethe best approach to each individual case. The main aim andobjective of the study was to determine the accuracy of MRCPin the evaluation of patients with obstructive jaundice.Method and Materials: In the evaluation of patientswith obstructive jaundice, MRCP was conducted in theDepartment of Radio Diagnosis, Sree Balaji Medical collegeand Hospital. A total number of twenty five patients sufferingfrom obstructive jaundice of all age groups and either sexwere included in this study. Total of Twenty five patients withclinical diagnosis of obstructive jaundice were included in thestudy. MRCP was done in all the patients and results werecompiled and compared with Operative/ ERCP findings andhistopathological reports.Results: A total of twenty five patients suffering fromobstructive jaundice underwent MRCP. Out of the twentyfive patients, ten patients had benign causes of obstructivejaundice, while fifteen patients had malignant causes ofobstructive jaundice. MRCP had an accuracy of 97% indetecting the cause of obstructive jaundice. In diagnosing thesite of obstruction MRCP had an accuracy of 100%.Conclusion: In the diagnosis of obstructive jaundice and toknow the cause, site and extent of the lesion MRCP being anon invasive, non ionizing procedure seems to be a accurateand better choice.
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Magnetic resonance imaging (MRI) plays an important role in abdominal imaging. The high contrast resolution offered by MRI provides better lesion detection and its capacity to provide multiparametric images facilitates lesion characterization more effectively than computed tomography. However, the relatively long acquisition time of MRI often detrimentally affects the image quality and limits its accessibility. Recent developments have addressed these drawbacks. Specifically, multiphasic acquisition of contrast-enhanced MRI, free-breathing dynamic MRI using compressed sensing technique, simultaneous multi-slice acquisition for diffusion-weighted imaging, and breath-hold three-dimensional magnetic resonance cholangiopancreatography are recent notable advances in this field. This review explores the aforementioned state-of-the-art techniques by focusing on their clinical applications and potential benefits, as well as their likely future direction.
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Cholangiopancreatography, Magnetic Resonance , Hand Strength , Magnetic Resonance ImagingABSTRACT
Objective@#To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic.@*Methods@#The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared.@*Results@#The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P<0.05) in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction. The CBD/LHD ratio and CBD/RHD ratio were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), but the maximum diameters of LHD and RHD were not significantly different (both P>0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), the maximum diameter of LHD and RHD was also significantly larger (P<0.05), while the ratios of CBD/LHD and CBD/RHD were not significantly different (P>0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05).@*Conclusions@#For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.
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0bjective To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic.Methods The clinical data of 41 patients with choledochal cyst type Ic,47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital.PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed.The diameters of the common bile duct,the left and the fight hepatic ducts were measured and compared.Results The maximum diameter of the left hepatic duct(LHD),right hepatic duct(RHD)and common bile duct(CBD)were significantly different(all P＜0.05)in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction.The CBD/LHD ratio and CBD/RHD ratio were significantly larger(P＜0.05).For patients with choledochal cyst type Ic,when compared with patients with simple gallbladder stones or polyps,the maximum diameter of CBD was significantly larger(P＜0.05),but the maximum diameters of LHD and RHD were not significantly different(both P＞0.05),while the ratios of CBD/LHD and CBD/RHD were significantly larger(P＜0.05).For patients with choledochal cyst type Ic,when compared with patients with simple gallbladder stones or polyps,the maximum diameter of CBD was significantly larger(P＜0.05),the maximum diameter of LHD and RHD was also significantly larger(P＜0.05),while the ratios of CBD/LHD and CBD/RHD were not significantly different(P＞0.05).The proportion of pancreaticobiliary maljunction(PBM)in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruc-tion and simple gallstone or polyp(P＜0.05).Conclusions For patients with choledochal cyst type Ic,their CBD shows obvious dilation,while there is no obvious dilation in LHD and RHD,It is helpful to con-duct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.
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Background: Bronchiectasis is a disease in which patients spends morbid life having dyspnoea and productive, often foul-smelling sputum which produces social isolation and depressive states. The mortality rate in bronchiectasis patients 2, states the mortality rate of bronchiectasis in 12 years follow up period is 29.7% in the age group at 52 in 1years. 70% cause of death in bronchiectasis is due to respiratory tract infection leading to respiratory failure. Aim of the study: To evaluate the Bronchial inflammatory response and its relationship to bacterial colonization through radiological evaluation. Materials and methods: This study was done for a period of 7 months from February 2016 to August 2016 in the Department of Thoracic Medicine, Government Villupuram Medical College, Villupuram. The Bacterial flora from Lower Respiratory tract of Bronchiectasis patients who attended Thoracic Medicine Outpatient Department with diagnosis confirmed by a radiologist was studied. Bronchoalveolar lavage was done as an invasive procedure in 90 patients with bronchiectasis and from 6 patients admitted with chronic upper respiratory symptoms as laboratory control in Interleukin-8 estimation for all the patients radiological and pulmonary function test assessment done. Results: Among the 90 patients in this study Cylindrical types were 53%, Cystic types were 35%, Varicose types were 4.4 %, Traction bronchiectasis were 3% and 3% were mixed types i.e. Cystic A. Sundrarajaperumal, R. Nedunchezhian, D. Ranganathan, V Sundar. Radiological and pulmonary function test assessment in clinically stable bronchiectasis patients. IAIM, 2019; 6(6): 87-91. Page 88 plus cylindrical and Traction plus cylindrical. Spirometry pattern distribution showing Normal spirometer in 14% of patients, Obstructive pattern observed in 64% of patients, Restrictive pattern observed in 15% of patients and the mixed pattern was observed in 7% of patients. Conclusion: Increased incidence of bronchiectasis in females (58%). Cylindrical bronchiectasis was the commonest type followed by Cystic bronchiectasis. Regarding etiology of Bronchiectasis, 42% of bronchiectasis was Idiopathic followed by post infectious 21%. The pulmonary function FEV1< 70% was associated with microorganisms colonization of bronchiectasis airways.
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Objective To analyze the clinical value of repeat ultrasonography and MRCP in patients who presented with acute abdomen caused by a single common bile duct stone after the pain had subsided.Methods The clinical data of 46 patients who were diagnosed to have a single common bile duct stone and presented with acute abdomen admitted to the Department of Hepatobiliary and Pancreatic Surgery and Minimally Invasive Surgery in Zhejiang Provincial People's Hospital were retrospectively studied.The patients were treated with anti-infection,antispasmodic and choleretic drugs with other conservative symptomatic and supportive therapy.Ultrasound and MRCP examinations were carried out before and after conservative treatment of the acute abdominal pain.Results 26 (56.5％) patients with a single stone in the common bile duct passed the stone spontaneously.Of these patients,11 patients were discharged home and were treated conservatively,15 patients underwent LC,and 20 (43.5％) patients still had choledocholithiasis.Of these 20 patients,12 underwent ERCP + EST,followed by LC;while the remaining 8 patients had a history of cholecystectomy,6 and 2 patients underwent ERCP + EST and LCBDE,respectively.Conclusion A single common bile duct stone in patients who presented with acute abdomen may pass the stone spontaneously as shown in this study using ultrasound and MRCP examinations.
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Objective To study the pattern of cystic duct (CD) drainage into hepatic ducts (CDIHD) by using three dimensional magnetic resonance cholangiopancreatography (3D M RCP) combined with conventional MRI sequences.Methods Thirty-eight patients with CDIHD were studied retrospectively and they served as the observation group.Another 38 patients who had no CDIHD were selected randomly and they served as the control group.The hepatic bile duct where the CD drained in the observation group,the site where the common hepatic duct (CCHD) started,and the types of the intrahepatic bile duct (IHBD) in the two groups were analyzed.The types of the IHBD were classified according to the modified Couinaud's criteria.Results There were 26 patients who had their CD draining into the right liver bile ducts,9 into the incomplete common hepatic duct,and 3 into the left hepatic duct in the observation group.For the types of IHBD in the observation/control groups,type A was observed in 15/19 patients,type B in 0/6,type C in 22/1,type D in 0/9,type E in 0/2,and type F in 1/1,respectively.The differences were significant (P ＜ 0.05).The number of patients who had their CCHD starting in the porta hepatis,superior duodenal bulb,posterior duodenal bulb,and pancreatic head in the observation/control groups,were 1/36,19/2,17/0,1/0,respectively.The differences were also significant (P ＜ 0.05).Conclusion In patients with CDIHD,CD most commonly drained into the right hepatic duct.Patients with CDIHD had a different IHBD type,and the IHBD confluence was lower.
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Objective To study the pattern of cystic duct (CD) drainage into hepatic ducts (CDIHD) by using three dimensional magnetic resonance cholangiopancreatography (3D M RCP) combined with conventional MRI sequences.Methods Thirty-eight patients with CDIHD were studied retrospectively and they served as the observation group.Another 38 patients who had no CDIHD were selected randomly and they served as the control group.The hepatic bile duct where the CD drained in the observation group,the site where the common hepatic duct (CCHD) started,and the types of the intrahepatic bile duct (IHBD) in the two groups were analyzed.The types of the IHBD were classified according to the modified Couinaud's criteria.Results There were 26 patients who had their CD draining into the right liver bile ducts,9 into the incomplete common hepatic duct,and 3 into the left hepatic duct in the observation group.For the types of IHBD in the observation/control groups,type A was observed in 15/19 patients,type B in 0/6,type C in 22/1,type D in 0/9,type E in 0/2,and type F in 1/1,respectively.The differences were significant (P ＜ 0.05).The number of patients who had their CCHD starting in the porta hepatis,superior duodenal bulb,posterior duodenal bulb,and pancreatic head in the observation/control groups,were 1/36,19/2,17/0,1/0,respectively.The differences were also significant (P ＜ 0.05).Conclusion In patients with CDIHD,CD most commonly drained into the right hepatic duct.Patients with CDIHD had a different IHBD type,and the IHBD confluence was lower.
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Background: Choledocolithiasis may be classified into primary and secondary forms. Primary choledocolithiasis denotes de novo formation of stones, often made of calcium bilirubinate within the ducts. Materials and Methods: The present prospective comparative study was conducted in the Department of Radio Diagnosis and Imaging, SMHS hospital, Government medical college srinagar. Patients admitted or attending OPD in SMHS hospital with suspected obstructive jaundice or who were known case of obstructive jaundice were included in the study. The study was performed on all patients after written informed consent was acquired from them. The study was carried out over a period of 24 months from August 2014 to July 2016. Results: Total 70 patients were selected for this comparative study after taking informed consent. Among 70 patients 50 patients were found to have choledocolithiasis. Rest 20 patients were found to Khan NA, Dar SA, Khan S, Yassar S. Comparative study of diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) with ultrasonography in choledocolithiasis with post endoscopic retrograde cholangiopancreatography (ERCP) correlation. IAIM, 2017; 4(2): 35-41. Page 36 have obstructive jaundice due to causes other than choledocolithiasis. Out of 70 patients 40 (57%) patients were female and 30 (43%) patients were male. Conclusion: USG is inexpensive, non-invasive modality for choledocolithiasis, however has low sensitivity for detecting distal CBD calculi.
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Dorsal pancreatic agenesis is an extremely rare congenital entity. Very few cases have been published in the literature about this congenital anomaly. Agenesis of the dorsal pancreas is associated with various anomalies, such as polysplenia syndrome, wandering spleen, interruption of the inferior vena cava, hemiazygos and azygos continuation, symmetrical liver, anomalous hepatic fissure or lobe, leftsided inferior vena cava, median gall bladder, inverted gallbladder and stomach, and intestinal malrotation. We have reported here an asymptomatic 31 year old male with incidental findings of hypoplasia of pancreatic body and absence of pancreatic tail on contrast enhanced abdominal computed tomography (CT) and similar findings were seen on Magnetic resonance imaging (MRI). Further Magnetic resonance cholangiopancreatography (MRCP) was done on which hypoplastic proximal MPD at body of pancreas with complete absent of MPD at tail region noted. The final diagnosis was dorsal pancreatic agenesis.
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El ultrasonido endoscópico (EUS) ha revolucionado el diagnóstico y el manejo de muchas patologías de la vía digestiva, particularmente la patología pancreática, convirtiéndose en un examen prácticamente imprescindible en el abordaje diagnóstico y terapéutico de un paciente con un problema de páncreas. Es necesario dejar en claro que el método no es único y que para lograr una sensibilidad alta y cumplir el objetivo de realizar lo más adecuado, debe sumarse a otros métodos de acuerdo a cada caso, como la ecografía, la tomografía axial computarizada (TAC), la resonancia magnética (MRI) en sus diferentes modalidades, y las pruebas del laboratorio clínico microbiológico y patología. En este artículo se revisarán algunos casos de enfermedades evaluadas con este método, que muestran por qué el EUS, es una herramienta clave para el médico de urgencias y de consulta externa, el internista, el cirujano, el médico del servicio hospitalario y el personal de salud en general, al momento de definir, clasificar y orientar el manejo de determinadas patologías en el tubo digestivo. El EUS es una importante ayuda y no debe ser extraña al personal médico, debe tenerla presente junto a las demás pruebas diagnósticas en patología pancreática. Se señalarán los aspectos más relevantes en cada caso y las indicaciones del EUS.
Endoscopic ultrasound (EUS) has revolutionized the diagnosis and management of many diseases of the digestive tract, particularly the pancreatic ones, becoming a practically essential test in the diagnosis and therapeutic management of a patient with a pancreatic problem. It's necessary to establish the final diagnosis are necesary many tests to achive high sensitivity. It should join with other methods according to each case, such as ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) in its various forms, and chemical, microbiological and pathology tests. In this article we reviewed some cases of pathologies evaluated by this diagnosis test, which demonstrate why the EUS, is a key for the emergency and outpatient physician, internist, surgeon, doctor of the hospital service and staff health in general, when defining, classifying and guide the management of certain diseases in the digestive tract. The EUS is an important tool and should not be foreign to the medical staff, who must consider it, with other diagnostic tests for pancreatic disease. This article point out the most important aspects in each case and indications of EUS.