1/26. 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.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
2/26. Adenomyomatous hyperplasia of the papilla of Vater: A sequela of chronic papillitis?A case of adenomyomatous hyperplasia of the papilla of Vater is described. The lesion presented as a small polypoid tumor projecting into the duodenal lumen, causing obstruction and dilatation of the common bile duct. Serial cross-section of the ampulla showed diffuse thickening of the muscular layer corresponding to Oddi's sphincter, with resulting narrowing of the lumen. Many ductal or glandular components were dispersed within the mucosa and the muscular layer and were admixed with lymphocytes, a few lymphoid aggregates, and fibrosis. Based both on the absence of cellular atypia and the presence of inflammation, fibrosis, and preservation of the normal architecture of the ampulla, we favor the interpretation that this hyperplastic lesion represents a sequela of chronic papillitis. The different diagnoses for this lesion are presented along with a review of the literature.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
3/26. Peroral tunable-dye laser lithotripsy of intrahepatic stones in oriental cholangitis.This case report details the use of a pulsed tunable-dye laser lithotripter in the endoscopic management of recurrent intrahepatic stones in a patient with Oriental cholangitis. A 42-year-old Chinese man had a cholecystectomy and choledochoduodenostomy in 1980. Subsequently he had three episodes of recurrent cholangitis which responded to medical treatment. The patient presented in April 1989 with a fourth attack of cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound demonstrated a large mass of stones in the right intrahepatic ductal system. A flexible upper gastrointestinal endoscope was passed into the right hepatic duct via the choledochoduodenostomy. The stones were fragmented with a tunable-dye laser and the residual fragments were removed endoscopically.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
4/26. Traumatic neuroma of the bile duct causing cholangitis and atrophy of the right hepatic lobe.Intraluminal traumatic neuromas are an unusual cause of bile duct obstruction. These benign collections of disorganized nerve fibers arise from a bile duct injury during cholecystectomy. Symptoms associated with obstruction or cholangitis may develop decades after the operation. Our patient's neuroma imitated a malignant neoplasm, but the patient has been returned to good health by resection of the right hepatic duct and the atrophic right hepatic lobe.- - - - - - - - - - ranking = 0.014145098434582keywords = neoplasm (Clic here for more details about this article) |
5/26. Hamartomatous lesion of the liver in an adult patient with biliary dilatations: a variant of inflammatory pseudotumor of the liver?An unusual tumor-like lesion (1.2 cm in diameter) in the left lobe of the liver in a 67-year-old woman with dilatations of the common and hepatic bile ducts is reported. Histologically, this lesion was composed of hyalinized connective tissue, several dilated bile ducts with periductal fibrosis and biliary epithelial proliferation, lymphocytic and plasmacytic infiltrates, stenotic venous and arterial vasculature, and nerve bundles. Although these elements were found in a disordered pattern and appeared to have a hamartomatous etiology, each of these pathologic components seemed inflammatory in character. Besides, clinical data disclosed that this lesion was acquired in origin. Although such a hepatic tumor-like lesions has not previously been reported to the best of our knowledge, this tumorous lesion shared features of hepatobiliary lesions reported in intrahepatic calculi, a form of chronic cholangitis. It seems likely that this tumor-like lesion might have arisen from localized chronic cholangitis, possibly related to the dilatations of the common and hepatic ducts, and we suggest that this lesion be named "fibroductal variant" of inflammatory pseudotumor of the liver.- - - - - - - - - - ranking = 2keywords = ductal (Clic here for more details about this article) |
6/26. Somatostatin-producing pancreatic endocrine carcinoma presented as relapsing cholangitis -- a case report.Somatostatin-producing endocrine tumors are rare neoplasms usually arising in the pancreas and duodenum and they account for less than 1% of all gastrointestinal endocrine tumors. Besides somatostatinoma syndrome, which is characterized by diabetes mellitus, steatorrhea and cholelithiasis, patients with somatostatin-producing endocrine tumors commonly complain of nonspecific symptoms such as vague abdominal pain, weight loss or changes in bowel habits. Tumor behavior cannot be predicted by histological features alone, and malignancy is determined by the presence of metastases. We report here a case of malignant pancreatic endocrine tumor producing somatostatin presented as relapsing cholangitis who was treated with Whipple pancreatoduodenectomy.- - - - - - - - - - ranking = 0.014145098434582keywords = neoplasm (Clic here for more details about this article) |
7/26. Recurrent cholangitis as the first manifestation of an intraductal papillary mucinous tumor of the pancreas.Intraductal papillary mucinous tumor is a rare pancreatic tumor originating from the epithelium of the pancreatic duct and exhibiting papillary proliferation of tall columnar epithelial cells. The usual clinical presentation is recurrent episodes of pancreatitis due to hypersecretion of mucin and obstruction of a markedly dilated pancreatic duct. We describe a 74-year-old man who presented recurrent attacks of cholangitis, due to a common bile duct obstruction from thick pancreatic mucus reflux, as the first manifestation of intraductal papillary mucinous tumor.- - - - - - - - - - ranking = 6keywords = ductal (Clic here for more details about this article) |
8/26. Successful orthotopic liver transplantation in a patient with refractory biliary candidiasis.The authors present a nonimmunocompromised patient who developed refractory fungal (candida albicans) cholangitis and who subsequently underwent successful orthotopic liver transplantation for progressive destruction of intrahepatic and extrahepatic bile ducts. Liver biopsy specimens showed periductal abscesses, and cholangiograms showed rapidly progressive destruction of intrahepatic and extrahepatic bile ducts. Standard immunosuppressive therapy and perioperative amphotericin b were administered. At 6 months, the patient was clinically well with no evidence of recurrent biliary candidiasis. The authors suggest that orthotopic liver transplantation may be a reasonable therapeutic option for patients with refractory biliary candidiasis.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
9/26. Hepatobiliary alterations in massive biliary ascariasis. Histopathological aspects of an autopsy case.Hepatobiliary alterations found in an autopsy case of massive Biliary ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts. The authors discuss the similarity between such findings and Oriental Cholangio-hepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
10/26. Eosinophilic cholangitis: a self-limited cause of extrahepatic biliary obstruction.The first case of eosinophilic cholecystitis with radiographically documented biliary tract obstruction is presented. Differences between eosinophilic cholecystitis with and without obstruction in terms of gender predilection and the incidence of associated cholelithiasis suggest these may be two distinct disease processes. The dense eosinophilic infiltration of the porta hepatis seen in the present case has led us to believe that extrahepatic obstruction was due to "eosinophilic cholangitis." The self-limited nature of eosinophilic cholangitis makes it an essential consideration in the evaluation of presumed neoplasms of the porta hepatis.- - - - - - - - - - ranking = 0.014145098434582keywords = neoplasm (Clic here for more details about this article) |
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