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Bile duct anatomy

Frédéric Borel, Julien Branche, Grégory Baud, Romain Gérard, François Pattou, Robert Caiazzo
BACKGROUND: The incidence of biliary lithiasis is increased after bariatric surgery due to rapid weight loss [1]. Trans-oral endoscopic management in cases of common bile duct gallstone complication is not possible in patients with Roux-en-Y gastric bypass (RYGB) due to the modified anatomy. Access to the biliary tree after RYGB with a classical direct surgical approach of common bile duct and choledocoscopy can be used, but may be complicated in situations of acute cholangitis because of the fragility of common duct, or in cases of previous cholecystectomy...
December 11, 2018: Obesity Surgery
Ryosuke Tonozuka, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Mitsuru Fujita, Yasutsugu Asai, Yukitoshi Mastunami, Takashi Kurosawa, Hiroyuki Kojima, Hirofumi Kogure, Yuichi Nagakawa
The efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy have been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique because of surgically altered anatomy, due to failed conventional stone extraction...
December 1, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Hiromi Edo, Ryuzo Sekiguchi, Naoki Edo, Akiko Kajiyama, Masashi Nagamoto, Tatsuya Gomi
PURPOSE: This study aimed to retrospectively evaluate the caudate branches (CBs), which are bile ducts originating from the caudate lobe (CL), using drip infusion cholangiography with computed tomography (DIC-CT). METHODS: The confluence patterns of CBs were evaluated in 185 adult patients undergoing DIC-CT. The following bile duct features were evaluated: (a) number of depicted CBs; (b) identification of the caudate portion from which the CBs were derived; (c) identification of the confluence site of a CB; and (d) whether there was a difference in the confluence site of the CBs depending on the position of the right posterior hepatic duct (RPHD) and the portal vein (PV)...
November 17, 2018: Abdominal Radiology
Gabriel Rodrigues, Shruti Rahul Pandit, Afroz Khan, Bharath Veerabharappa, Balaji Jayasankar, Rasagna Anaparti
The anatomy of the biliary tree is complex, and its variations of both intra- and extra-hepatic bile ducts can be found in approximately 30% of the general population. These variations are not picked up on routine pre-operative investigations of patients planned for a laparoscopic cholecystectomy (LC) and often present as an unusual 'surprise' and a challenge that can make dissection in the Calot's triangle difficult leading to iatrogenic injury. We present a case of a 53-year-old female with an undescribed anomaly encountered during an LC...
November 9, 2018: Journal of Minimal Access Surgery
Inés C Oría, Juan E Pizzala, Augusto M Villaverde, Juan C Spina, Analía V Pasqua, Julio C Lazarte, Oscar M Mazza, Mariano M Marcolongo
The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case...
November 9, 2018: Clinical Endoscopy
H Helmberger, B Kammer
Upper abdominal pain, icterus and cholestasis are the main symptoms leading to evaluation of the biliary tract. Since the advent of contrast-enhanced ultrasound techniques the accuracy of bile duct imaging has significantly improved. This is also true for computed tomography using isotropic secondary reconstructions as well as magnetic resonance imaging (MRI) including MR cholangiography (MRC), classically and after iv injection of hepatobiliary contrast agent. Diffusion-weighted imaging sequences have a recently proven ability for improving biliary tract imaging...
November 2018: Der Radiologe
Julien Garnon, Roberto Luigi Cazzato, Jean Caudrelier, Maud Nouri-Neuville, Pramod Rao, Emanuele Boatta, Nitin Ramamurthy, Guillaume Koch, Afshin Gangi
Although rare, unintended thermal injury to organs surrounding the ablation zone can lead to severe complications. Over the past 15 years, different protective methods have been developed to limit risk of complications, and expand indications to include more challenging lesions in various locations including liver, kidney, lung and bone. The most frequently used techniques include hydrodissection, carbodissection, balloon interposition and probe torqueing. In most cases, tumours can be physically separated from sensitive structures, reducing risk of thermal injury...
October 11, 2018: Cardiovascular and Interventional Radiology
Hyo-Jin Kang, Jeong Min Lee, Su Joa Ahn, Jae Seok Bae, Stephan Kannengiesser, Berthold Kiefer, Kyung-Suk Suh
OBJECTIVES: The aim of this study was to evaluate the clinical feasibility of gadoxetic acid-enhanced isotropic high-resolution (IHR) 3-dimensional (3D) T1-weighted (T1W) magnetic resonance cholangiography (MRC) using an iterative denoising (ID) algorithm for evaluation of the biliary anatomy of living liver donors in comparison with conventional 3D multislice T2-weighted (T2W) MRC. MATERIALS AND METHODS: In this institutional review board-approved retrospective study, a total of 75 living liver donors who underwent conventional 3D multislice T2W-MRC and IHR-3D-T1W-MRC on a 3 T scanner and subsequent right hepatectomy for liver donation were included...
October 2, 2018: Investigative Radiology
Mohammad Tayeb, Fozia Rauf, Nasir Bakhtiar
OBJECTIVE: To have an audit of the outcome of laparoscopic cholecystectomy for acute cholecystitis at a tertiary care centre. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Surgery, Prime Teaching Hospital, Peshawar Medical College, Peshawar, KPK, Pakistan, from January 2011 to December 2015. METHODOLOGY: Patients with acute cholecystitis undergoing laparoscopic cholecystectomy were evaluated for conversion rate, morbidity and hospital stay...
October 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Andrea Balla, Silvia Quaresima, Mario Corona, Pierleone Lucatelli, Fausto Fiocca, Massimo Rossi, Mario Bezzi, Carlo Catalano, Filippo M Salvatori, Abe Fingerhut, Alessandro M Paganini
PURPOSE: Bile duct injuries (BDIs) are more frequent during laparoscopic cholecystectomy (LC). Several BDI classifications are reported, but none encompasses anatomy of damage and vascular injury (A), timing of detection (To), and mechanism of damage (M). Aim was to apply the ATOM classification to a series of patients referred for BDI management after LC. METHODS: From 2008 to 2016, 26 patients (16 males and 10 females, median age 63 years, range 34-82 years) with BDIs were observed...
September 25, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Vasile Sandru, Mădălina Ilie, Oana Plotogea, Bogdan Silviu Ungureanu, Adina Stoica, Dan Ionut Gheonea, Gabriel Constantinescu
We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage...
July 2018: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
Christienne Shams, Michael Cannon, Jared Bortman, Seifeldin Hakim
A biliary enteric fistula (BEF) is a rare, abnormal communication between any segment of the biliary tree with any portion of the small or large intestine. BEF is more frequently diagnosed with the increasingly widespread use of endoscopic retrograde cholangiopancreatography. Different theories have been postulated regarding the etiology of this fistula formation, with the most likely cause being gallstones. Treatment modalities, ranging from conservative management to surgical reconstruction, show varying levels of success...
2018: ACG Case Reports Journal
Ying Luo, Tao Yang, Qiang Yu, Yu Zhang
BACKGROUND: There continues to be controversy regarding the optimal screening modality in patients with symptomatic cholelithiasis and suspected common bile duct (CBD) stones. The aim of this study was to assess the diagnostic accuracy of laparoscopic ultrasonography (LUS) compared to magnetic resonance cholangiopancreatography (MRCP). METHODS: Both LUS and MRCP were performed to evaluate the CBD stones and biliary anatomy in 200 patients undergoing laparoscopic surgery...
September 5, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Gennaro Clemente, Andrea Tringali, Agostino M De Rose, Elena Panettieri, Marino Murazio, Gennaro Nuzzo, Felice Giuliante
Background: Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular "challenge" for the biliary surgeon. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. The aim of this study is to point out some particular aspects of diagnosis and treatment of this condition. Methods: The clinical records of patients with Mirizzi syndrome, treated in the last five years, were reviewed...
2018: Canadian Journal of Gastroenterology & Hepatology
Tri Huu Nguyen, Tung Sanh Nguyen, Phu Doan Van Nguyen, Thanh Nhu Dang, Ernest F Talarico
INTRODUCTION: Left-sided gallbladder without situs viscerum inversus (LSG-woSVI) is defined as a gallbladder located under the left lobe of the liver; to the left of the round/falciform ligament, but with all other viscera maintaining normal anatomical relationships. This is a rare congenital anomaly with a reported prevalence that ranges from 0.04% to 1.1%. It is usually an incidental intraoperative finding, and can be associated with anatomic abnormalities of the biliary tree, portal system and vasculature...
2018: International Journal of Surgery Case Reports
Takeshi Tsujino, Jason B Samarasena, Kenneth J Chang
Clinical applications of EUS for the liver have been recently increasing. They include the screening and diagnosis of liver parenchymal disease and malignant tumors as well as EUS-guided interventions such as hepaticogastrostomy, tumor ablation therapy, and portal pressure gradient measurement. Although the segmental localization of the targeted tumor, bile duct, and vessel in the liver is important to complete these procedures, little information is available regarding hepatic segmental anatomy on EUS. The liver can be visualized with EUS by transgastric and transduodenal scanning, and the EUS determination of segmental location can be achieved using various anatomical landmarks...
July 2018: Endoscopic Ultrasound
Yuichi Nakaseko, Takeaki Ishizawa, Akio Saiura
In hepatobiliary surgery, fluorescence imaging enables identification of subcapsular liver tumors through accumulation of indocyanine green after preoperative intravenous injection in cancerous tissues of hepatocellular carcinoma and in noncancerous hepatic parenchyma around intrahepatic cholangiocarcinoma and liver metastases. Indocyanine green-fluorescence imaging can also be used for visualizing extrahepatic bile duct anatomy and hepatic segmental boundaries, enhancing the accuracy of open and laparoscopic hepatectomy...
August 2018: Journal of Surgical Oncology
Mamoru Takenaka, Kentaro Yamao, Masatoshi Kudo
No abstract text is available yet for this article.
November 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Shuntaro Mukai, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Mitsuru Fujita, Kenjiro Yamamoto, Yuichi Nagakawa
BACKGROUND AND AIMS: Although balloon enteroscopy-assisted ERCP (BE-ERCP) is effective and safe for benign biliary diseases in patients with surgically altered anatomy (SAA), BE-ERCP is not always successful. Recently, EUS-guided antegrade intervention (EUS-AI) by using a 1-stage or 2-stage procedure has been developed for BE-ERCP failure cases. The aim of the present study was to evaluate the outcome of EUS-AI for benign biliary diseases in patients with SAA. METHODS: Of 48 patients in whom BE-ERCP failed, percutaneous transhepatic intervention was performed in 11...
August 1, 2018: Gastrointestinal Endoscopy
Kiyokazu Hiwatashi, Hiroshi Okumura, Tetsuro Setoyama, Kei Ando, Yoshito Ogura, Kuniaki Aridome, Shigeho Maenohara, Shoji Natsugoe
Intraoperative cholangiography involving the excretion of fluorescent indocyanine green (ICG) into the bile is used to determine biliary anatomy in laparoscopic cholecystectomy (LC). This study aimed to evaluate the features of intraoperative ICG cholangiography, in LC with cholecystitis, and compared the delineation of the cystic duct (CD) between ICG cholangiography and magnetic resonance cholangiopancreatography (MRCP).Participants comprised 65 patients undergoing LC using ICG cholangiography.Fifty-eight patients (89...
July 2018: Medicine (Baltimore)
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