Volume-reserving Surgery after Photodynamic Therapy for Biliary Papillomatosis: A Case Report / 대한소화기학회지

Biliary papillomatosis is rare, and its pathogenic mechanisms are not yet clear. Because of its high risk for malignancy transformation, surgical resection is regarded as a standard treatment. Photodynamic therapy (PDT) has been used by the intravenous administration of hematoporphyrin derivative followed by laser exposure. A photochemical process causes disturbance of the microvascular structure and degradation of membrane. Cholangitis is a major complication after PDT. A healthy 56-year-old man was diagnosed with biliary papillomatosis involving the common hepatic duct, both proximal intrahepatic bile ducts (IHD), and the right posterior IHD. After biliary decompression by endoscopic nasobiliary drainage, PDT was performed to avoid extensive liver resection and recurrence using endoscopic retrograde cholangiographic guidance. After portal vein embolization, the patient underwent extended right hemihepatectomy. Following administration of chemoradiation therapy with tegafur-uracil and 45 Gy due to local recurrence at postoperative 13 months, there was no local recurrence or distant metastases. This is the first case report on PDT for biliary papillomatosis in Korea. Preoperative PDT is beneficial for reducing the lesion in diffuse or multifocal biliary papillomatosis and may lead to curative and volume reserving surgery. Thus, PDT could improve the quality of life and prolong life expectation for biliary papillomatosis patients.

A Case of Small Cell Neuroendocrine Tumor Occurring at Hilar Bile Duct / 대한소화기학회지

Neuroendocrine tumors of the extrahepatic biliary tree are extremely rare malignancies accounting for 0.2-2.0% of all gastrointestinal carcinoid tumors. Neuroendocrine tumors obstructing the biliary tree are extremely difficult to diagnose preoperatively and nearly impossible to differentiate from cholangiocarcinoma. Statistically, the most common anatomic location in the biliary tree is the common bile duct, followed by the perihilar region. Herein, we present a case of a small cell neuroendocrine carcinoma of the hilum in a 79-year-old man following laparotomy. To our knowledge, this is the first case of small cell type neuroendocrine carcinoma of hilar bile duct reported in Korea.

Liver histological, portal flow and plasmatic nitric oxide alterations caused by biliary obstruction and drainage in rats / Alterações histológicas, do fluxo portal e do óxido nítrico plasmático em ratos submetidos à obstrução/desobstrução biliar

PURPOSE: To evaluate liver alterations caused by biliary obstruction and drainage. METHODS: Thirty-nine male Wistar rats were randomly distributed in 4 groups: BO (n=18) bile duct ligation for 20 days, with a periodic evaluation of liver histological alterations, Doppler echography portal flow and measurements of NO and malondialdehyde (MDA); BO/DB (n=13) bile duct occlusion for 20 days followed by biliary drainage by choledochoduodenal anastomosis, 5 days follow-up, same BO group parameters evaluations; group CED (n=4) sham operation and portal flow evaluation trough 20 days; CHB (n=4) sham operation, with hepatic biopsy on 25th day and followed-up trough 25 days, by the same parameters of group BO, with exception of portal flow. Direct bilirubin (DB) and alkaline phosphatase (AP) were evaluated in the group BO, BO/DB and CHB. RESULTS: The bile duct ligation led to an increase of DB and AP, development of liver histological alterations, reduction of portal flow and increase of plasmatic NO and of MDA levels. The bile duct clearing resulted in a reduction of DB, AP, NO, MDA histological alterations and increase of portal flow. CONCLUSION: The biliary occlusion resulted in cholestasis and portal flow reduction, besides the increase of plasmatic NO and of hepatic MDA levels, and histological liver alterations, with a tendency of normalization after the bile duct clearing.

OBJETIVO: Avaliar alterações hepáticas resultantes do processo de obstrução/desobstrução biliar. MÉTODOS: Trinta e nove ratos Wistar foram distribuídos aleatoriamente em 4 grupos: OB (n=18), oclusão biliar, seguimento de 20 dias, avaliação das alterações histológicas hepáticas, do fluxo portal e dosagens de NO e de malondialdeído (MDA); grupo OB/DB (n=13) oclusão biliar por 20 dias seguida de desobstrução biliar por anastomose colédoco-duodenal, seguimento por 5 dias e avaliação dos mesmos parâmetros do grupo BO; grupo CED (n=4) operação simulada, avaliação do fluxo portal e seguimento por 25 dias; grupo CHB (n=4) operação simulada com biópsia hepática no 25º dia, e seguido por 25 dias com avaliação periódica dos mesmos parâmetros do grupo BO, com exceção da ecografia Doppler. Nos grupos BO, OB/DB e CHB foram avaliadas também a bilirrubina direta (BD) e a fosfatase alcalina (FA). RESULTADOS: A oclusão do colédoco causou aumento da BD e da FA, desenvolvimento de alterações hepáticas, redução do fluxo portal, com aumentos do NO plasmático e do MDA. A desobstrução biliar resultou na redução da BD, da FA, das alterações hepáticas, aumento do fluxo portal e redução do NO e do MDA. CONCLUSÃO: A obstrução biliar resultou em colestase, alterações histológicas hepáticas, diminuição do fluxo portal, aumentos do NO plasmático e MDA hepático, com tendência à normalização após a desobstrução biliar.

Caroli's Syndrome with Autosomal Recessive Polycystic Kidney Disease in a Two Month Old Infant

Caroli's syndrome is a rare congenital disorder that involves intrahepatic bile duct ectasia and congenital hepatic fibrosis, frequently seen with concomitant autosomal recessive polycystic kidney disease (ARPKD). Literature on infants with ARPKD is rare. Here, we present a case of a two month old boy who was diagnosed with Caroli's syndrome and ARPKD.

Hilar biliary cystadenocarcinoma: an uncommon hepatic neoplasm.

Biliary cystadenocarcinoma (BCAC) is a rare cystic tumour of the liver; with its benign counterpart, it accounts for <5% of non-parasitic hepatic cysts. Preoperative diagnosis of BCAC is difficult; complete surgical excision is recommended to prevent recurrence or metastasis. We present the case of a 67-year-female with centrally located BCAC involving the right hepatic duct and distorting the hepatic hilum. This report highlights the difficulties in diagnosis, surgical resection, subsequent biliary reconstruction and its outcome.

Unilocular Extrahepatic Biliary Cystadenoma Mimicking Choledochal Cyst: A Case Report

We report here on a case of extrahepatic biliary cystadenoma arising from the common hepatic duct. A 42-year-old woman was evaluated by us to find the cause of her jaundice. Ultrasonography and CT showed a cystic dilatation of the common hepatic duct and also marked dilatation of the intrahepatic duct. Direct cholangiography demonstrated a large filling defect between the left hepatic duct and the common hepatic duct; dilatation of the intrahepatic duct was also demonstrated. Following excision of the cystic mass, it was pathologically confirmed as a unilocular biliary mucinous cystadenoma arising from the common hepatic duct.

Endoscopic and laparoscopic treatment of mirizzi syndrome

Endoscopic followed by laparoscopic treatment of Mirizzi syndrome has been shown to be safe and effective. This technique was applied in 15 patients with Mirizzi syndrome. Ten patients had a single large stone and five had multiple stones impacted in the cystic duct. Nasobiliary drainage tube [NBDT] or stent was applied in patients for preoperative drainage of biliary tree and to prevent acute cholangitis by endoscopic retrograde cholangiopancreatography [ERCP]. Laparoscopic cholecystectomy was tried in all patients within 3 days after endoscopic intervention. In 6 cases, conversion was done from laparoscopic to open cholecystectomy. Conversion was due to fistula in three cases, injury to common bile duct in two cases and bleeding from slipped cystic artery in one case. Mortality was zero. Preoperative endoscopic drainage has many advantages including abortion of endotoxaemia in acute cholangitis, lowering the elevated serum bilirubin, improving the clinical condition of the patient, allowing easy identification of the anatomy of the bile ducts intraoperatively and immediate detection of any injury to bile ducts. The presence of stented bile duct allows for primary closure of the injury

value of ultrasonography in the diagnosis of obstructive jaundice

88 cases of obstructive jaudice to whom ultrasound was carried out were studied prospectively during the past three years. All these cases were admitted to Baghdad Teaching Hospital where other investigations and/or operation were carried out on them. There were 42 male and 46 females, their age ranged between 7 years and 82 with a meanage of 64 years. Dilatation of the intrahepatic bile ducts was demonstrable in 85 cases, ie, 96.5%. Ultrasound was useful in defining localized lobar or segmental bile duct dilatation as in case of traumatic biliary stricture or Klaskin tumors U/S was quite sensitive in defining common hepatic duct dilatation and lesions, but not very accurate in defining lesions at the lower part of the common bile duct. In pancreatic and ampullary tumors, huge distention of the gall bladder was defined in 81% of cases and was a useful indirect sign

Spontaneous perforation of the left hepatic duct with acalculous cholecystitis.

Spontaneous rupture of the biliary tree leading to bile peritonitis is rare. We report a boy who developed spontaneous perforation of the left hepatic duct and had acalculous cholecystitis.

Adenomatosis del hepatocolédoco y ampulla / Adenomatosis of the hepatocholedocal duct ampulla

Se presentan 6 enfermos con obstrucción de la vía biliar extrahepática por adenomiosis. Esta patología se ubica en el grupo de los tumores epiteliais benignos, que obstruyen la vía biliar por la presencia intraparietal de cúmulos de conductos glandulares nodeados por un proceso inflamatorio crónico escleroso. Es una lesión de difícil diagnóstico clínico y operatorio donde la verdadera naturaleza la establece la anatomía patológica, que debe diferenciarlo del cáncer y páncreas aberrante