Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación de caso / Gall bladder agenesis associated with recurrent acute pancreatitis. Case presentation

Introducción: La Agenesia de la Vesícula Biliar es una anomalía congénita rara, entre 13 y 65 por ciento por cada 100 000 habitantes. Su asociación con pancreatitis aguda es extremadamente rara. Objetivo: Presentar un caso de Agenesia de la Vesícula Biliar asociada a pancreatitis aguda recurrente. Presentación del caso: Se presenta una mujer de 85 años, con antecedentes de litiasis vesicular por ultrasonido (US), y crisis de dolor abdominal, vómitos e hipotensión frecuentes, a quien remitían con tratamiento médico. Acudió al hospital con dolor abdominal, vómitos e hipotensión. Al examen físico se constató: dolor epigástrico, sin reacción peritoneal ni tumor palpable. El US informó vesícula no visible. En menos de 24 horas evolucionó con shock, disfunción múltiple de órganos y muerte. En la necropsia se encontró Agenesia de la Vesícula Biliar (AVB) y pancreatitis aguda necrotizante. Conclusiones: La AVB es una anomalía congénita rara, de difícil diagnóstico preoperatorio, por lo que casi siempre es un hallazgo de la cirugía abdominal o en la autopsia. Su asociación con pancreatitis aguda es rara. La pancreatitis puede ser debida a Disfunción del Esfínter de Oddi o de origen idiopático(AU)

Introduction: Gallbladder agenesis (GA) is a rare congenital anomaly, with a reported incidence ranging between 13-65 percent a 100 000 population. Its association with acute pancreatitis is extremely rare. Objective: To present a case of GA associated with recurrent acute pancreatitis. Case Presentation: We present an 85 years old woman whose clinical record reported a bladder stonediagnosis by US, that arrive to the hospital with frequent episodes of intermittent vomiting, abdominal pain and hypotension. She was admitted at hospital with upper abdominal pain, vomiting and hypotension. At the physical examination the abdomen was soft, with mild epigastric tenderness, without tenderness rebound or tumor. US report gallbladder not visible. In less than 24 hours the patient evolved with shock, multiple organ failure and death. Gallbladder agenesis and acute pancreatitis were found in autopsy. Conclusions: The GA is a rare congenital anomaly, difficult to establish a correct preoperative diagnosis, always found during the abdominal surgery or autopsy. Its association with acute pancreatitis is very uncommon. Pancreatitis may be due to of Oddi Sphincter's Dysfunction (SOD) or idiopathic origin(AU)

Controversy on the Oddi Sphincter Function in the Treatment of Hepatolithiasis：Preservation Versus Deprivation / 中国微创外科杂志

[Summary] The controversy remains on whether the Oddi sphincter function should be preserved or deprived in the treatment of hepatolithiasis .The surgical approaches achieving both hepatobiliary lesions clearance and Oddi sphincter preservation have been widely accepted .The biliary-enterostomy is suspected to increase the risk of reflux cholangitis and cholangiocarcinoma due to iatrogenic Oddi sphincter deprivation.Endoscopic sphincterotomy (EST) as a minimally invasive method still needs further research to determine its role in hepatolithiasis management .

Effect of Acupuncture on Motor Function of Extrahepatic Biliary System of Guinea Pig / 世界科学技术-中医药现代化

This study was aimed to compare the effects of acupuncture stimulation on different acupoints, which included LR14-Qimen, ST25-Tianshu, GB34-Yanglingquanand CO11-pancreas and gallbladder (auricular vagus nerve intensively distributed areas) on gallbladder pressure and Oddi sphincter function of guinea pig, in order to discuss acupuncture effect on different acupoints in the regulation of motor function of extrahepatic biliary system. A total of 20 adult guinea pigs of both sexes were randomly divided into two groups, with 10 in each group. The detection was made on changes of Oddi sphincter electromyography and gallbladder pressure before and after acupuncture. A double-hook electrode was implanted into the Oddi sphincter for the detection of Oddi sphincter electromyography. And one small artificial balloon was put into the gallbladder to measure the intrabiliary pressure. After the guinea pig was anesthetized, changes of gallbladder pressure as well as the electromyography frequency and amplitude index of Oddi sphincter of the normal guinea pig were recorded. When the guinea pig was stabilized, acupuncture was given on LR14, ST25, GB34 and CO11 for 1 min. Observations were made on acupuncture effects of gallbladder pressure and Oddi sphincter function of guinea pig. The results showed that after acupuncture on LR14 and ST25, the electromyography frequency of Oddi sphincter was obviously increased compared with before acupuncture (frequency:P < 0.01, amplitude:P < 0.05); the gallbladder pressure was obviously decreased (P < 0.05). After acupuncture on CO11 and GB34, the electromyography frequency and amplitude index of Oddi sphincter were obviously decreased compared with before acupuncture (P < 0.05); the gallbladder pressure was obviously increased (P < 0.01). It was concluded that acupuncture on LR14 and ST25 can obviously inhibit the movement of gallbladder and promote the myoelectricity release of Oddi sphincter. Acupuncturing on CO11 and GB34 can apparently promote the shrinking movement of gallbladder and inhibit the myoelectricity release of Oddi sphincter.

Clinical analysis of short- and long-term complications after endoscopic Oddi's sphincterotomy in 95 patients / 中华肝胆外科杂志

Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.

Effect of combined laparoscopic treatment of gallstone duodenoscope on common bile duct stones / 国际外科学杂志

Objective To study the effect of laparoscopic cholecystectomy endoscopic sphincterotomy combined with Oddi lithotomy (EST) treatment of gallbladder stone on common bile duct stones. Methods A retrospective analysis between May 2003 and June 2009 ,the combined treatment of LC and EST in 78 patients with common bile duct stones was retrospectivelly analyzed. First, bile duct stones were removed by EST, then laparoscopic cholecystectomy was performed within 5 days. Results EST was performed successfully in 76 cases (97%), failure in 2 cases, 1 case abdominal choledochojejunostomy due to the end of bile duct stenosis; one cases of common bile duct stone diameter of 1.6 cm, firm, failure of mechanical lithotripsy received common bile duct ploration T-tube drainage 76 cases of laparoscopic operation is successful, without obvious bleeding, bile leakage and other severe complications. Conclusions The advantages of EST + LC for the gallbladder stones and common bile duct stones with less trauma, faster recovery, fewer complications, and no T-tube drainage, etc; this is a safe and effective treatment.

Changes and significance of the contents of cholecystokinin acceptors and nitric oxide synthuse in Sphincter of Oddi and the contents of cholecystokinin and nitric oxide in the blood of patients with calculus of bile duct / 中国综合临床

Objective To investigate the changes and significance of the contents of cholecystokinin (CCK) acceptors and nitric oxide synthase (NOS) in sphincter of Oddi and the contents of CCK and nitric oxide (NO) in the blood of the patients with calculus of bile duct. Methods The contents of CCK acceptors and NOS in sphincter of Oddi and the contents of CCK and NO in the blood were determined in 41 patients with gallstone and 6 controls. Results The contents of CCK and NO in the blood of patients with gallstone were significantly higher than that in control [ ( 38.91±4.85 ) pmol/L vs ( 30.67±1.81 ) pmol/L; (40.84±4.74 ) pmol/L vs ( 32.81±1.11) pmol/L] ;The contents of CCK acceptors and NOS in sphincter of Oddi in the patients with gallstone were signifi-cantly lower than in the controls [ (67.59±5.87 ) ng/L vs ( 78.99±1.71 ) ng/L; ( 457.52±45.40 ) ng/L vs ( 519.61±11.38 ) ng/L] ;The contents of CCK and NO in the blood in the different groups with calculus of bile duct were significantly different from those in the controls. Conieusion The degree of the decrease of the contents CCK acceptors and NOS in sphincter of Oddi leads to the decrease of Oddi sphincter function,resuting in cholestasis and promoting the formation of bile duct stone.

Correlation between NO, CCK, VIP and Oddi sphincter on the CRUSe of bile duct calculus / 国际外科学杂志

Bile duct stone is the common and frequently-occurring disease, its incidence upwards trend. In recent years, people realize that Oddi sphincter movement disorders play an important role in the inci-dence of bile duct stones. NO, CCK, VIP and theie interactian have effects on sphincter function and dis-charged from the regulation of bile. These factors are necessary to conduct an in-depth study to investigate the cause of bile duct stone and its treatment.

Clinical significance of duodenoscopy combined with choledochoscopy in the test of the functions of Oddi's sphincter / 中国微创外科杂志

Objective To determine operation procedure according to Oddi's sphincter functions decteted by preoperative duodenoscopy combined with intraoperative choledochoscopy (IOC). Methods The duodenal papillae and Oddi's sphincter functions of 319 cases with hepatobiliary calculus were detected by preoperative duodenoscopy, ERCP and IOC. Results As for the functions of Oddi's sphincter, 79 cases were superior, 152 cases favorable and 88 cases poor. Conclusions For patients with hepatobiliary calculus whether Oddi's sphincter is reserved according to the Oddi's sphincter function.

Study on the primary closure of bile duct incision of laparoscopic bile duct exploration and balloon dilatation catheter dilatation / 中华消化内镜杂志

Objective To discuss the indications and complications of primary closure of bile duct incision in laparoscopic bile duct exploration and balloon dilatation catheter dilatation to treat the papillary stenosis and the intrahepatic bile duct stenosis. Methods A pospective study of 42 ptients of bile duct incision closure primary in laparoscopic bile duct exploration and balloon dilatation catheter dilatation, laparoscopic bile duct exploration and extraction of bile duct stones with choledochotomy was first adopted in order to clear the stones, then followed by the balloon dilatation catheter(explosive pressure reached 2020 kPa, used 505kPa) to dilate the papillary stenosis and the intrahepatic bile duct stenosis (CT-7542～ CT-75104) until the stenosis was released. Whether the primary closure of duct incision was selected or not, it was based on the situation of intraoperative choledochoscopic exploration, if it had been selected, the closure of bile duct incision would accepted by using absorbable suture 4-0 or 5-0, without placing bile duct drainage.It was routinely to place the drainage tube in the oriffice of the lesser omentum. Results 41 out of 42 patients had obtained successful duct clearance, the dilatation of the stenosis to reach the expected expansion and without bile leakage. One patient had bile leakage about 30-150 ml daily persisted for 4 days through cured conservatively. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilatation of the stenosis to reach the expected expansion with the balloon dilatation catheter. They were adopted to the primary closure of duct incision using absorbable suture and did not need to place bile duct drainage.

Effects of protease inhibitor gabexate mesilate on motility of human Oddi's sphincter / 中华消化杂志

0.05).②Gabexate mesilate significantly reduced the frequency of contraction (P0.05).③High dose gabexate mesilate could markedly reduce the motility index ( P

Endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome / 中华消化内镜杂志

Objective To approach the treatment value of endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome.Methods Endoscopic sphincterotomy was undergone in 28 cases with ultimate diagnosis of Oddi sphincter dysfunction after BUS, ERCP , basal sphincter pressure examination and ruled out the patients with retained or recurrent stones,stricture or carcinoma in the bile duct having postcholecystectomy syndrome.Results Symptoms disappeared completely after the treatment in 18 cases,alleviated apparently in 5 cases and other 2 cases after the second treatment,without alleviation in 3 cases,the effective rate is 89.3%(25/28).No severe complication happened.Conclusion It is assumed that endoscopic sphincterotomy is a micro-traumatic,safe and effective treatment for the dysfuction of Oddi sphincter in postcholecystectomy syndrome.

Effects of cholecystokinin on canine Oddi sphincter function after pancreas transplantation with bladder drainage / 中国普通外科杂志

Objective To study the effects of cholecystokinin (CCK) on canine Oddi sphincter(SO)function after pancreas transplantation with bladder drainage. Methods Normal canine and transplant canine SO manometry before and after CCK administration was carried out. Results SO basal pressure in control group was(18 5?2 8) mm Hg, frequency was(9 7?1 5)per min, amplitude was (47?6) mm Hg, motility index was(236?56). After CCK administration, basal pressure, frequency, amplitude and motility index decreased significantly to(10 2?2 2) mm Hg ,(5 0?1 2)per minute,(19?5) mm Hg and(50?17), all P

Oddi sphincter lesions:a clinical and histological study / 中国普通外科杂志

Objective To explore the relationship between the histological alterations of Oddi sphincter lesions and clinical manifestations. MethodsFrom October 1995 to May 2003, biopsies of Oddi sphincter were undertaken during transduodenal sphincteroplasty (TSP) in 32 cases. Specimens were stained with Van Gieson Mason staining. ResultsThirty one out of 32 specimens were found with histological alterations in Oddi sphincter including diffuse fibrosis in 87 1% (27/31) , adenomyosis in 2 cases and chronic inflammatory infiltration in 2 cases. Impacted stone in the terminal common bile duct, benign papillary stenosis and visible postpancreatitis parenchymal changes were all found accompanying severe fibrosis of Oddi sphincter. ConclusionIn patients with impacted stones in the ampulla, intracholedochal sludge with recurrent cholangitis, and relapsing pancreatitis, endoscopic sphincterotomy is recommended.

Effect of Cyclovirobuxine D(CVB-D) on Oddi's sphincter contraction / 中成药

AIM: To study the effect of CVB-D on contraction of guinea pig Oddi's sphincter in vitro. METHODS: Within the range from 1?10 -7 M to 3?10 -6 M, CVB-D's effects on the smooth muscle under the following conditions were observed: 1) the two phases of the Oddi's sphincter contractive curve caused by 80 mM K+ and 5?10 -6 M Ach; 2)together with verapamil, the contraction of Oddi's sphincter induced by 80 mM K+ and 5?10 -6 M Ach respectively. RESULTS: The relation between the amount of CVB-D and rapid contraction of desived inihibitory response was possessed of a dose-effect one, as well as ratio of plateau and peak of contractions, and slightly elevated contraction in continuous phase. CVB-D kept rapid phase peak value and plateau/peak value decreased markedly that expressed a dose-effect relationship. Contrary to CVB-D. Ach caused rapid, continuous phase and plateau/peak value to fall according as CVB-D decreased. Combination of verapamin and CVB-D led rapid phase peak value induced by KCl to lessen, but do not influence verapamin plateau used only and vanish plateau of rapid phase induced by Ach. CONCLUSION: CVB-D's effects on the contraction of Oddi's sphincter are related to the agonists and contractive phases, which reflect its effects on Ca 2+ channels.

An experimental study of hypercholesterolemia-induced disorder of Oddi's sphincter / 中国病理生理杂志

AIM:To investigate the functional changes and histopathological basis of Oddi's sphincter under hypercholesterolemia. METHODS:Twenty - four New Zealand rabbits were equally divided into be groups ran- domly. Experimental groups Ⅰ and Ⅱ fed with cholesterol - added forage for 4 and 8 weeks respectively before sacri- ficed. Images, functions and histopathological characteristics of Oddi's sphincters of experimental groups were studied and compared with control group by cholangiography, catheter manometry, and quantitative analysis of nitric oxide synthase. RESULTS: The hasal pressures of proximal low - pressure segment of Oddi's sphincter of hath experimen- tal groups Ⅰand Ⅱ (20.9?6.1 mmHg, 25 .6?9.1 mmHg, respectively) were higher than those of control group sig- nificantly (11 .7?2. 8 mmHg, P