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Dong Il Gwon, Gi-Young Ko, Jong Woo Kim, Heung Kyu Ko, Hyun-Ki Yoon, Kyu-Bo Sung
Objective: To investigate the technical safety and clinical efficacy of a double-stent system with long duodenal extension in patients with malignant extrahepatic biliary obstruction. Materials and Methods: This prospective study enrolled 48 consecutive patients (31 men, 17 women; mean age, 61 years; age range, 31-77 years) with malignant extrahepatic biliary obstructions from May 2013 to December 2015. All patients were treated with a double-stent system with long duodenal covered extension (16 cm or 21 cm)...
March 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Hiroshi Kawakami, Yoshimasa Kubota, Tesshin Ban
Uncovered self-expandable metallic stents (USEMS) are superior to plastic stents in patients with unresectable malignant perihilar biliary obstruction (UMHBO)1 . The causes of SEMS occlusion include: tumor ingrowth/mucosal hyperplasia, tumor overgrowth, sludge with/without stone, hemobilia, food impaction, bile duct kinking, ulceration, perforation, and fibrin clots2-3 . We present a rare case of ultra-early occlusion of the normal bile duct after USEMS placement for UMHBO. This article is protected by copyright...
March 2, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Kotaro Miyazawa, Shigeru Yoshioka, Masayuki Shiobara, Kazuo Wakatsuki, Syuka Arai, Kosuke Suda, Toshiaki Aida, Tetsutaro Miyoshi, Hirofumi Saito, Kazuto Yamazaki
A 77-year-old men with abdominal pain suffered from gall bladder hemorrhage and liver abcess was admitted for intensive care of severe acute cholangitis. He had hemobilia which was treated by the endoscopic retrograde bile duct drainage. After 2 months treatment with rest for purulent myelitis, he had neoplastic change of liver abcess diagnosed as intrahepatic bile duct cancer by percutaneous core needle biopsy. He underwent surgery as central bisegmentectomy and left the hospital at home 3 months later after rehabilitation for surgical site infection...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Kazuhito Uemura, Hiroaki Takahashi, Kazuhiro Mino, Takuji Ota, Shunsuke Shichi
We report a case of combined hepatocellular and cholangiocarcinoma with hemobilia. A 65-year-old man was admitted to our hospital because of pain in the right hypochondralrigion. Abdominal ultrasonography revealed bile duct dilatation in the lateral segment of liver and blood test findings showed elevation of the hepatobiliary enzyme, so ERC was performed and hemorrhage from the duodenal papilla was observed. In cholangiography, dilation of the left hepatic bile duct and filling defect were observed, and in the peroral cholangioscopy, a hemorrhagic papillary elevated lesion was identified in the left hepatic bile duct and diagnosed as adenocarcinoma as a result of biopsy...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Masataka Kikuyama, Naofumi Shirane, Shinya Kawaguchi, Shuzou Terada, Tsuyoshi Mukai, Ken Sugimoto
AIM: To investigate whether an uncovered self-expandable metal stent (UCSEMS) with a large diameter could prevent recurrent biliary obstruction (RBO). METHODS: Thirty-eight patients with malignant biliary obstruction underwent treatment with an UCSEMS with a 14-mm diameter (Niti-S 14). Retrospectively, we evaluated technical and functional success rate, RBO rate, time to RBO, survival time, and adverse events in these patients. RESULTS: Stent placement success and functional success were achieved in all patients...
January 16, 2018: World Journal of Gastrointestinal Endoscopy
Praveer Rai, C R Lokesh, Amit Goel, Rakesh Aggarwal
Background and study aims : Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is an alternative to percutaneous transhepatic biliary drainage (PTBD) for patients with malignant distal biliary obstruction in whom ERCP has failed. We studied technical success, clinical success, stent patency rate and occurrence of adverse events in patients undergoing EUS-CDS with partially-covered self-expanding metal stent (PCSEMS). Patients and methods : Medical records of consecutive patients with unresectable malignant distal biliary obstruction requiring biliary drainage who underwent EUS-CDS because of failure of attempt at ERCP were reviewed...
January 2018: Endoscopy International Open
Pietro Achilli, Angelo Guttadauro, Paolo Bonfanti, Sabina Terragni, Luca Fumagalli, Ugo Cioffi, Francesco Gabrielli, Matilde De Simone, Marco Chiarelli
BACKGROUND: The burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis. CASE PRESENTATION: We present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis...
December 29, 2017: BMC Gastroenterology
K Ozturk, O F Nas, E Soylu, K Hacikurt, C Erdogan
PURPOSE: The purpose of this study was to retrospectively assess the potential of percutaneous transhepatic biliary drainage (PTBD) in patients with nondilated bile ducts (NDBD) using a transgallbladder opacification of the bile ducts. PATIENTS AND METHODS: Eight patients with NDBD (7 men, 1 women; median age, 65 years; Q1-Q3, 35-69 years; range, 22-77 years) who underwent PTBD after opacification of the bile ducts through the gallbladder were evaluated. Opacification of NDBD was performed using a retrograde injection of contrast material through the gallbladder...
December 8, 2017: Diagnostic and Interventional Imaging
Mahir Gachabayov, Kubach Kubachev, Sergey Mityushin, Nonna Zarkua
Hemobilia is a potentially life-threatening clinical issue in the etiology of which iatrogenesis is playing increasingly more immense role. Nowadays the most frequent etiology of hemobilia has shifted toward iatrogenesis owing to increasingly more frequent performance of liver procedures, either open or minimally invasive. Here we report a rare case of recurrent hemobilia after transarterial embolization. A 57-year-old male patient after cholecystectomy presented with Quincke's triad. CT revealed a pseudoaneurysm of the right hepatic artery...
December 1, 2017: Clinical Medicine & Research
Ludomir Stefańczyk, Michał Polguj, Wojciech Szubert, Jarosław Chrząstek, Piotr Jurałowicz, Jerzy Garcarek
Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision...
January 1, 2017: Vascular
Aijaz Ahmed Sofi, Muhammad Ali Khan, Ananya Das, Mankanwal Sachdev, Sadik Khuder, Ali Nawras, Wade Lee
BACKGROUND AND AIMS: Unresectable malignant biliary strictures are generally managed by palliative stent placement for drainage of biliary tree. Recently, radiofrequency ablation (RFA) has been used to improve the patency of biliary stents in these patients. Several studies have evaluated the effectiveness of biliary stent placement with RFA on stent patency and patient survival with variable results. We performed this meta-analysis to evaluate the efficacy and safety of biliary stent placement with RFA compared with stent placement alone in patients with malignant biliary strictures...
November 3, 2017: Gastrointestinal Endoscopy
Maiko Nishi, Issei Saeki, Takahiro Yamasaki, Masaki Maeda, Takuro Hisanaga, Takuya Iwamoto, Toshihiko Matsumoto, Isao Hidaka, Tsuyoshi Ishikawa, Taro Takami, Isao Sakaida
Transcatheter arterial chemoembolization (TACE) is used as a palliative treatment for unresectable hepatocellular carcinoma (HCC) worldwide. Recently, a novel drug delivery-embolic agent, the drug-eluting bead (DEB), was introduced for TACE. There are a few reports of tumor hemorrhage after TACE using DEB (DEB-TACE) for HCC. However, there have not been any reports of hemobilia immediately after DEB-TACE for an HCC with intrahepatic bile duct invasion. Here, the first such case is reported. A 71-year-old woman was admitted to our hospital to undergo DEB-TACE for multiple HCCs with worsening left intrahepatic bile duct dilatation...
November 2, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
Abhinav Tiwari, Tariq Hammad, Himani Sharma, Khola Qamar, Mohammad Saud Khan, Zubair Khan, Ali Nawras, Thomas Sodeman
Hemobilia is caused by the abnormal connection between a blood vessel and the bile duct, which is usually iatrogenic and caused by hepatobiliary procedures. The classic triad of hemobilia includes biliary colic, obstructive jaundice, and gastrointestinal bleeding. We present the case of an 80-year-old man who had laparoscopic cholecystectomy complicated by hemobilia. He had an unusual presentation of hemobilia in the form of transient vasovagal episodes in addition to abdominal pain and hematochezia.
September 2017: Case Reports in Gastroenterology
Kenji Yamauchi, Daisuke Uchida, Hironari Kato, Hiroyuki Okada
A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed...
October 16, 2017: Internal Medicine
Demosthenes D Cokkinos, Eleni G Antypa, Sofia Tsolaki, Maria Skylakaki, Alkmini Skoura, Vassiliki Mellou, Ioannis Kalogeropoulos
The gallbladder and bile ducts are usually assessed initially with conventional gray-scale ultrasound (US). Contrast enhanced US (CEUS) is used when a diagnosis cannot be reached with conventional US. CEUS is easy to learn and perform. US contrast agents can be safely administered in patients with renal function impairment. In this pictorial essay the physics, examination technique and indications of CEUS for examining the gallbladder and bile ducts are reviewed. Gallbladder indications include elucidating normal variants, differentiating sludge from neoplastic lesions, benign and malignant pathology, infection, wall rupture and hemobilia...
October 6, 2017: Journal of Clinical Ultrasound: JCU
Ihab I El Hajj, Stuart Sherman, Maximilian Pyko, Glen A Lehman
Arterial vascular complication from endoscopic retrograde cholangiopancreatography (ERCP) is exceedingly rare. This report describes a life threatening hemobilia, from a pseudoaneurysm of the right hepatic artery (RHA), which occurred post ERCP. The pseudoaneurysm and the active bleed were diagnosed by selective angiography of the RHA, and successfully treated with stenting.
December 2017: Digestive and Liver Disease
Nicolae Bacalbasa, Iulian Brezean, Claudiu Anghel, Ion Barbu, Mihai Pautov, Irina Balescu, Vladislav Brasoveanu
Right hepatic artery aneurysms are rare events that might remain asymptomatic for a long period of time. However, in cases presenting large lesions, symptoms might develop especially due to the association of compression of the surrounding elements. Most often these symptoms and signs include diffuse abdominal pain, jaundice or portal vein compression signs. In rare cases life-threatening complications might develop due to the aneurysmal erosion of the biliary duct, portal vein or due to the aneurysmal rupture in the peritoneal cavity...
September 2017: In Vivo
Victoria de Lara Bendahán, Encarna García DomÍnguez, Marta Rivas Rivas, Jesús García Serrano
The present paper describes a case of hemobilia in a woman with a cystic artery pseudoaneurysm. The pseudoaneurysm could be seen with ultrasound, Doppler sonography and CT angiography. In our case, Doppler sonography was the most useful technique for diagnosis, revealing the turbulent forward and backwards flow within the gallbladder, representing the focally dilated artery. This was later confirmed by CT angiography. A recent bleeding site was found on the cholecystectomy specimen.
September 7, 2017: Revista Española de Enfermedades Digestivas
Richard H Tapnio, Marcin K Kolber, Pratik A Shukla, Eric Berkowitz
Cystic artery pseudoaneurysm is a rare entity most closely associated with trauma to the biliary vasculature (usually iatrogenic) or inflammation from adjacent cholecystitis. Most cases are treated intraoperatively during cholecystectomy. We describe 3 cases of cystic artery pseudoaneurysms secondary to acute cholecystitis, 2 with active hemobilia, treated with transcatheter embolization at our institution.
October 2017: Vascular and Endovascular Surgery
Victoria de Lara Bendahán, Encarna García DomÍnguez, Marta Rivas Rivas, Jesús García Serrano
The present paper describes a case of hemobilia in a woman with a cystic artery pseudoaneurysm. The pseudoaneurysm could be seen with ultrasound, Doppler sonography and CT angiography. In our case, Doppler sonography was the most useful technique for diagnosis, revealing the turbulent forward and backwards flow within the gallbladder, representing the focally dilated artery. This was later confirmed by CT angiography. A recent bleeding site was found on the cholecystectomy specimen.
August 2017: Revista Española de Enfermedades Digestivas
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