1/14. 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) |
2/14. 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) |
3/14. Laparoscopic surgery in the treatment of Mirizzi's syndrome.Mirizzi's syndrome is an unusual complication of cholelithiasis which results when an impacted cystic duct stone causes edema and compression of the adjacent common hepatic duct. The authors report the successful treatment of a patient with this syndrome by laparoscopic means. A flexible 5.0 mm choledochoscope was inserted under laparoscopic guidance into the dilated proximal cystic duct and the impacted stone was extracted. Though still a technically demanding procedure, the authors feel that under certain conditions, laparoscopic surgery may represent the preferred initial approach to patients with Mirizzi's syndrome.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
4/14. common bile duct obstruction in cystic fibrosis: utility of hepatobiliary scintigraphy.abdominal pain occurs commonly in patients with cystic fibrosis, and is the result of a variety of causes, including hepatobiliary disorders. With the increasing duration of survival in these patients, diagnostic investigations for abdominal pain, including hepatobiliary scanning, may be utilized more frequently than in the past. Difficulties in the interpretation of scintigraphic studies may arise because of associated gallbladder anomalies that occur in more than 50% of patients with cystic fibrosis. Hypoplasia of the gallbladder (microgallbladder) occurs commonly. A case is presented in which Tc-99m disofenin hepatobiliary scanning proved diagnostic in a patient with cystic fibrosis and cholelithiasis leading to common bile duct obstruction. The hepatobiliary abnormalities and causes of common bile duct obstruction encountered in cystic fibrosis are reviewed.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
5/14. Biliobiliary fistula: preoperative diagnosis and management implications.Experience with cholecystohepaticodochal and cholecystocholedochal fistulas as a result of an erosion of gallstones from the gallbladder into the adjacent common duct in five patients is presented. The incidence was 1.4% in a population of 350 patients undergoing cholecystectomy. The condition was indicated clinically on the basis of a symptom triad of jaundice, fever, and pain with cholelithiasis in a small contracted gallbladder. In addition, proximal intra- and extrahepatic ductal dilatation, calculus in the common duct, and normal-caliber (or unprofiled) distal common duct on ultrasound scan were present in all the patients. Endoscopic retrograde cholangiopancreatography proved to be the most useful means of investigation, and it confirmed the diagnosis in four patients before surgery. A modified antegrade cholecystectomy was performed with the gallbladder opened inferiorly at the fundus, and the stones were evacuated. A partial cholecystectomy and choledochoplasty were accomplished with gallbladder flaps whenever feasible. Other useful operative procedures are side-to-side hepaticodochojejunostomy and hepaticodochoduodenostomy. In the presence of high benign bile duct stricture, an approach to the left hepatic duct is now preferred for biliary bypass.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
6/14. Treatment of biliary fistulas and cholelithiasis: is endoscopic sphincterotomy acceptable in the paediatric age group?Two children, both girls, aged 11 and 16 with a postoperative biliary fistula and cholelithiasis, choledochal cyst and common bile duct stones have undergone endoscopic sphincterotomy (EST), leading to a rapid recovery from their pathologies, thanks to cooperative work. In reviewing the literature we have not come across any cases of EST in our patients' age group. There were no complications during or immediately after endoscopic sphincterotomies. We believe that it has become an important and valuable rival to conventional surgical means with correct indications and in experienced hands.- - - - - - - - - - ranking = 5keywords = cholelithiasis (Clic here for more details about this article) |
7/14. biliary tract disease due to fasciola hepatica: report of a case.We report a case of a 23 year old woman who presented with symptoms of biliary tract disease to our University Hospital in Bayamon, puerto rico. A diagnosis of chronic cholelithiasis was made and the patient was taken to surgery. An adult fasciola hepatica was recovered from the common bile duct. We review the pathobiology of this uncommon zoonosis.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
8/14. A case of the pathogenesis of choledochocele in relation to dysfunction of the sphincter of oddi.A 47-year-old woman was admitted for evaluation of pain in the right upper quadrant of the abdomen. Seventeen years previously, she had undergone cholecystectomy for cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cystic dilatation of the terminal portion of the common bile duct (CBD) protruding into the duodenal lumen and delaying the drainage of contrast medium. In this patient the CBD and the pancreatic duct appeared to be unimportant in the formation of the cyst. Repeated changes in the radius of the cyst suggested dysfunction of the ampullary component of the sphincter of oddi, with maintenance of normal function of the common duct component. The pathogenesis of the choledochocele in this patient is discussed in relation to dysfunction of the sphincter of oddi. In addition, 2 criteria for the diagnosis of choledochocele by ERCP are proposed: [1] cystic dilatation of the terminal portion of the CBD protruding into the duodenal lumen, and [2] absence of the narrow segment of the CBD.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
9/14. Obstruction of the bile duct by a papillary adenoma of the gallbladder.A case of papillary adenoma of the gallbladder unassociated with cholelithiasis and showing detachment of part of the growth with obstruction of the common bile duct is described. One the basis of a search of the literature, it would appear that this is the first time such a case has been reported. The bibliography is discussed and a distinction drawn between this kind of adenoma and other benign tumors of the gallbladder.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
10/14. Congenital choledochal dilatation associated with carcinoma after choledochocystoduodenostomy--case report and a review of the literature.A 24-year old Japanese woman with congenital choledochal dilatation associated with carcinoma, cholelithiasis and pancreatolithiasis was treated. She had undergone choledochocystoduodenostomy at the age of 5 years. At the present admission, a dilated choledochus was excised and hepaticojejunostomy (Roux-en-Y anastomosis) and pancreatic ductojejunostomy were performed. adenocarcinoma involved the entire mucosal surface of the resected specimen. We also present a review of the literature on the treatment and prognosis of patients with congenital biliary dilatation associated with carcinoma after bypass operation in childhood. We emphasize that in patients with congenital choledochal dilatation, the dilated choledochus should be excised, even in young children.- - - - - - - - - - ranking = 1keywords = cholelithiasis (Clic here for more details about this article) |
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