1/8. Combined endoscopic and surgical management of mirizzi syndrome.mirizzi syndrome is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with or without a cholecystocholedochal fistula. This syndrome is a rare complication of cholelithiasis that accounts for 0.1% of all patients with gallstone disease. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with a preoperative diagnosis of type I mirizzi syndrome that was confirmed and drained by endoscopic retrograde cholangiography (ERC), followed by subtotal cholecystectomy. A review of the literature covering its clinical presentation, diagnosis, and surgical treatment is also presented.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
2/8. Obstruction of common bile duct caused by liver fluke--fasciola hepatica.Three cases of obstruction of the common bile duct by fasciola hepatica with two of the patients presenting jaundice are reported. The authors have reviewed several publications concerning common bile duct obstruction by liver fluke, a quite rare complication of fascioliasis. Only nineteen cases of common bile duct obstruction caused by fasciola hepatica have been reported in a review of medical publications during last ten years. Clinical presentation, diagnostic methods and considerations, types of surgery are fairly uniform in all of the reported cases. Almost all of patients reviewed, had the history, symptoms and signs characteristic for cholelithiasis including recurrent colic pain in right hypochondriac area, fever or subfebrile temperature, fluctuating or stabile jaundice, and palpable painful gallbladder. The laboratory findings in all cases reviewed had shown leucocytosis, eosinophilia, high or slight elevated serum bilirubin. Echographically commonly revealed dilated intra- and extrahepatic bile ducts containing one or more hyperechogenic elements with or without casting an acoustic shadow. All patients underwent open surgery, comprised with choledochotomy and if possible extraction of the fluke. Only two postoperative cases were of necessity followed by ERCP. In all of our cases the primary pre-operative diagnosis was choledocholithiasis, with diagnose of fascioliasis established at the operation. According to the literature this uncertainty in diagnosis is common because of difficulties in differentiation of fascioliasis versus choledocholithiasis. Considerations for making the differential diagnosis--a history of origin or visiting in endemic area of infection, history of eating of aquatic vegetables, laboratory findings including eosinophilia, fasciola eggs in stool, sonography and radiological imaging results and enzyme-linked immunosorbent essay (ELISA) which has been shown to be rapid, sensitive and quantitative. In all three cases we have observed intraoperative significant signs for liver fascioliasis to include surface scarring of the left lobe on the liver--tracks caused by subcapsular migration and location of the hepatic lesions (these findings were also seen by two authors in literature) with resemblance to Japanese letters. The most effective drug for treatment of fascioliasis according to our experience and literature reviewed is bithionol.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
3/8. Congenital web of the common bile duct in association with cholelithiasis.Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. We report a case of a common bile duct septum in association with cholelithiasis in a 30-year-old woman. The diagnosis was made on preoperative magnetic resonance cholangiopancreatography (MRCP) and confirmed with intraoperative cholangiography. Because all known causes of acquired web formation were excluded, a congenital origin of the web was assumed. The patient was treated with a hepaticoduodenostomy above the level of the septum. The embryological aspects of this rare anomaly are described.- - - - - - - - - - ranking = 5keywords = cholelithiasis (Clic here for more details about this article) |
4/8. 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 = 1keywords = cholelithiasis (Clic here for more details about this article) |
5/8. Hepatocellular carcinoma presenting extrahepatic obstructive jaundice due to bile duct invasion--clinicopathological study of two cases.Two rare cases of autopsy and surgery presenting extrahepatic biliary obstruction due to intrabile-duct growth of hepatocellular carcinoma were reported. Clinically obstructive jaundice was predominant in comparison with the other symptoms in both cases. In one autopsy case, hepatocellular carcinoma developed in the right lobe of the cirrhotic liver (posthepatitic). It involved the secondary branch of the right hepatic duct and grew into the common hepatic duct. In the other case of surgical operation, hepatocellular carcinoma, which developed in the posterior portion of the right lobe of the cirrhotic liver (posthepatitic), destroyed the posterior wall of the bifurcation of the bilateral hepatic duct and obstructed the common hepatic duct due to the intraductal cancer growth. From the site of the bile duct invasion or permeation by the tumor, two cases were classified into the peripheral (the former case) and proximal (the latter case) types, respectively. Furthermore, as far as obstructive jaundice is clinically concerned, the possibility should be kept in mind that hepatocellular carcinoma may proliferate into the large bile ducts, apart from that of cholangiocarcinoma or cholelithiasis.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
6/8. Evolution of mirizzi syndrome with biliobiliary fistula.The mechanisms of fistula formation were analyzed in eight patients with Mirizzi syndrome with biliobiliary fistula. The fistula was type 1 in three patients and type 2 in five, according to the Corlette-bismuth classification. The apparent mechanisms of fistula formation include inflammation of the gallbladder, its subsequent fusion to the bile duct, and increase in the internal pressure due to either contraction of the gallbladder or multiple stones. However, no predisposing conditions other than a longstanding history of cholelithiasis have been suggested. Differences in the type of fistula are considered to be due to the mode of fusion of the gallbladder to the bile duct, and the size of the perforation, which is apparently determined by the area in contact with the stone.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
7/8. choledocholithiasis in a premature neonate.choledocholithiasis in neonates and infants has been reported only rarely. Infants with complications of prematurity are more predisposed to development of biliary calculi. With the current widespread use of diagnostic ultrasonography, more neonates may be found to have gallstones and common bile duct stones. We describe a case of choledocholithiasis and cholelithiasis in a premature neonate successfully treated by surgical placement of a cholecystotomy tube and irrigation of the biliary system.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
8/8. Sonographic features of mucinous biliary papillomatosis: case report and review of imaging findings.Because of its indolent course, high recurrence rate, and risk of malignant transformation, mucinous biliary papillomatosis is an important consideration in the differential diagnosis of bile duct obstruction. We report a case of mucinous biliary papillomatosis and review the sonographic and other imaging findings previously reported in the literature. On sonography, these tumors appear as nonshadowing intrabiliary masses that are clearly defined and associated with proximal biliary dilatation. They may be multiple and associated with mucoid sludge. The imaging findings reflect the macroscopic appearance of a doughy papilliferous tumor of a bile duct. Associated findings include cholelithiasis, choledocholithiasis, and gallbladder dysplasia.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |