Laparoscopic common bile duct exploration for extraction of a round worm.

A 35 years old lady presented with fever, biliary colic, mild jaundice, indigestion and flatulence. The upper abdominal ultrasonography revealed cholecystitis with sludge and a round worm in the common bile duct. Laparoscopic cholecystectomy and exploration of the bile duct for the removal of round worm was performed. The post-operative period was uneventful and the patient was discharged fit on the 4th post-operative day.

Acute myeloid leukemia presenting as obstructive jaundice.

We report a 32-year-old man with acute myeloid leukemia presenting as obstructive jaundice. Imaging revealed dilated common bile duct with abrupt narrowing at the lower end, distended gall bladder, and dilated intrahepatic biliary radicles. In addition he had a mass lesion in the urinary bladder. On evaluation he was found to have the eosinophilic variant of M4 subtype acute myeloid leukemia. He expired before chemotherapy could be instituted.

A Case of Duodenal Diverticulum Accompanied with Choledochoduodenal and Pancreaticoduodenal Fistulas / 대한소화기학회지

Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.

Vanishing bile duct syndrome in Hodgkin's disease: case report

CONTEXT: Liver damage is relatively common in patients affected by Hodgkin's disease. A smaller proportion of cases develops jaundice. Recently, the vanishing bile duct syndrome was described in Hodgkin's disease. The mechanisms of this severe complication have been poorly understood until now. OBJECTIVE: To describe a rare case of intra-hepatic cholestasis due to vanishing bile duct syndrome. DESIGN: Case report. CASE REPORT: A 38-year-old male patient affected by Hodgkin's disease. Liver biopsy showed no detectable Hodgkin's disease. Intra-hepatic cholestasis was found and none of the six portal tracts analyzed contained normal bile ducts. The treatment was based on conventional and high-dose escalation chemotherapy. The patient died from an irreversible liver failure while in complete remission from Hodgkin's disease

Obstructive jaundice and acute cholangitis due to papillary stenosis

Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.

Evaluation of various diagnostic signs on percutaneous transhepatic cholangiography in obstructive jaundice.

Twenty patients of obstructive jaundice were subjected to percutaneous transhepatic cholangiography (PTC) of which 17 were operated on. Patients were divided in 4 groups according to the site of obstruction. The diagnostic signs observed were: Complete block with interface having convexity downwards (4), convexity upwards (3), biconcave caudal cut off (6), smooth edged cut off (one), irregular edged cut off (one) and non-specific appearance (one); incomplete block with interface having convexity upwards (one); biconcave caudal cut off (2) and multiple smooth central filling defects (2). In one case there was incomplete obstruction at two sites giving rise to two different signs. PTC was 100% correct in accurately telling the site of lesion. As regards the nature of the lesion the diagnosis on PTC was found correct in 15 out of 17 cases (88.5%).

A large common bile duct stone migrated from the gallbladder through a cholecystohepaticodochal fistula: an unusual complication of Mirizzi syndrome type II

Mirizzi syndrome with a biliobiliary fistula (Mirizzi syndrome type II) is a rare complication of a long-standing gallbladder stone disease. It is even rarer for a gallbladder stone to migrate through a biliobiliary fistula into the common duct. We encountered this interesting complication of Mirizzi syndrome type II in an 86 year-old female patient. A large gallbladder stone migrated into, and impacted into the distal common bile duct through a cholecystohepaticodochal fistula. The stone was resistant to mechanical lithotripsy and was treated with biliary endoprosthesis and oral bile acids.

Ileo biblial yeyunal

Al tiempo que revisamos las características clínico-quirúrgicas que envuelven a la patología biliodigestiva que describieron Batholuis en 1854 y Bouveret, presentamos un caso tratado en el Centro Médico de la Universidad Central del Este (UCE), dada la baja incidencia universal de la patología. Bajo el diagnóstico de oclusión intestinal aaltas se interviene de emergencia una paciente de 74 años de edad. En el transoperatorio se evidenció una fístula vesicoduodenal, espontánea; un cálculo biliar único de 3.5 cms. de diámetro, obstruía el lúmen yeyunal a unos 90 cms., aproximadamente, del ángulo de Treitz. Se practicó una yeyunolitotomía sub-obstrutiva y yeyunorrafía transversa en uno solo plano, dejándose intacta la fístula biliodigestiva por razones evidentes en el orden táctico

Anomalous drainage of the common bile duct: demonstration by hepatobiliary imaging

El drenaje anómalo del ducto biliar común a la tercera porción del duodeno es un hallazgo raro que se había descrito previamente en autopsias y colangiografias operatorias. Aquí reportamos el primer caso de esta variante identificada por escintigrafía del sistema hepatobiliar utilizando técnicas de medicina nuclear

Doença de Caroli associada a fibrose hepática congênita: relato de um caso e revisäo de literatura / Caroli disease associated with congenital hepatic fibrosis: report of a case and review of the literature

Relata-se um caso de doença de Caroli associada a fibrose hepática congênita e hipertensäo porta em uma criança de um ano e três meses de idade, faz-se uma breve revisäo da literatura sobre o assunto. Salienta-se a baixa idade do diagnóstico neste paciente, o que provavelmente se deveu à associaçäo da doença com fibrose hepática congênita. Neste paciente o quadro de colangite recidivante existia desde os seis meses de idade. Durante a propedêutica, a ultra-sonografia foi fundamental na conduçäo diagnóstica. A cintilografia com Tc 99, que é apontada como excelente método propedêutico, näo foi eficaz no presente caso

Radiomanometría transoperatoria de vías biliares / Transoperative radiomanometry of the bile ducts

La radiomanometría (RM) puesta en boga por su autor Jean Caroli desde 1941 en Francia, ha sido poco utilizada fuera de Europa y en pocas ocasiones en México. En el Hospital de Especialidades del I.M.S.S. en Puebla se practica por el autor desde Enero de 1980 usando el aparato de Caroli-Fourés. Fueron documentados 98 resgistros operatorios hasta Julio de 1982, su análisis constituye el contenido de este trabajo. La presión inicial (PI) promdedio (X) fue de 3.58 con una desviación estándar (DE) de ñ 2.72,la presión de paso (PP) necesaria para franquear el esfínter de Oddi X 11.6 y DE ñ 3.97 y la presión residual (PR) resultante de la presión del líquido perfundido y la resistencia del mismo esfínter X 9.68 DE ñ 4.05, consitituyen la parte manométrica del estudio, que se efectua en 7 u 8 minutos. Simultáneamente tres placas radiográficas son impresas para correlacionar ambos procedimientos. Todos los pacientes fueron seguidos por espacio de un mes, mínimo de dos consultas. El estudio fue practicado en 11 pacientes en fase aguda, en quince litiasis de la vía biliar VB, 10 de los cuales no se habían sospechado en el preoperatorio. Se descubrieron tres alteraciones del esfínter del Oddi (Oddipatias) en dos de ellas la RM permitió decidir la esfinteroplastia. Los resultados obtenidos en las cifras, se aproximan bastante a lo informado en la literatura. El aumento de la PR se asoció siempre con alteraciones de la VB. La mortalidad operatoria y hospitalaria fue del 0% y solo hubo tres complicaciones no relacionadas con el procedimiento. Un modelo presonal es presentado, fácil de construir y posiblemente con la misma aplicación que el radiomanómetro francés. La RM es un procedimiento accesible en el transoperatorio para el diagnóstico de las lesiones asociadas de la VB principal en la colecistectomía y para la toma de decisión quirúrgica

Cisto dos colédoco como causa de dor abdominal e vômitos recorrentes na criança: relato de um caso / Common bile duct cyst as cause of abdominal pain and vomiting in children: report of a case

Os autores relatam caso de cisto do colédoco tipo IV, em criança do sexo feminino com sete anos e 10 meses de idade. A única manifestaçäo clínica foi dor abdominal e vômitos recorrentes. O diagnóstico foi feito pela colangiografia intravenosa pré-operatória. A ultra-sonografia suspeitou-se de dilataçäo do colédoco. O tratamento cirúrgico consistiu em ressecçäo do cisto coledociano, do canal cístico e da vesícula, com anastomose hepático-jejunal com alça em Y de Roux. A biópsia hepática demonstrou ausência de alteraçöes do fígado. O pós-operatório evoluiu sem anormalidades