1/15. Pyloric gland-type tubular adenoma superimposed on intraductal papillary mucinous tumor of the pancreas. Pyloric gland adenoma of the pancreas.We report a rare case of pyloric gland-type tubular adenoma of the main pancreatic duct. It was a grossly visible polypoid nodule and was composed of closely packed pyloric-type glands. This adenoma was present within an intraductal papillary mucinous adenoma (IPMA). In this IPMA lesion, aggregations of pyloric-type glands were occasionally observed, and most of the cells including ductal lining cells expressed pyloric gland-type mucin. The IPMA of the present case showed more extensive pyloric gland metaplasia or differentiation than commonly noted in IPMAs. We consider this pyloric gland-type tubular adenoma to be derived from a selective growth of IPMA cells showing pyloric gland metaplasia.- - - - - - - - - - ranking = 1keywords = ductal (Clic here for more details about this article) |
2/15. Marked diffuse dilations of the biliary tree associated with intrahepatic calculi, biliary sludges and a mucinous cyst of the pancreatic head in a 99-year-old woman.A 99-year-old woman was admitted to Shizuoka Shimizu Municipal Hospital because of fever and anasarca. Imaging and laboratory tests showed pneumonia, urinary tract infection, and cardiac failure. The patient died 20 days after admission. An autopsy revealed marked diffuse dilations of the biliary tree ranging from the lower common bile duct to intrahepatic bile ducts. Intrahepatic calcium bilirubinate stones and biliary sludges were recognized within the dilated bile ducts. A unilocular cyst (2 cm in diameter) was present in the pancreatic head adjacent to the lower common bile duct, and it appeared to compress the common bile duct. Histologically, the walls of the dilated biliary tree showed proliferation of peribiliary glands, fibrosis, and infiltration of lymphocytes and neutrophils (cholangitis). The lumens of the dilated biliary ducts contained neutral and acidic mucins, fibrinous materials, bacteria, neutrophils, and aspergillus fungi, in addition to the calculi and sludges. The background liver showed atrophy (400 g). The pancreatic unilocular cyst was composed of mucous columnar cells with a few infoldings, and the pancreas also showed foci of mucinous duct hyperplasia and ectasia; the pathological diagnosis of the cyst was cystic dilations of a pancreatic duct branch (mucinous ductal ectasia or mucinous cyst). Other lesions included aspiration pneumonia, emaciation, atrophy of systemic organs, gastric leiomyoma, serous cystadenoma of the right ovary, and arteriosclerotic nephrosclerosis. The present case suggests that a mucinous cyst of the pancreas may compress the biliary tree and lead to marked diffuse dilations of the biliary tree. Alternatively, the dilations of the bile ducts may be associated with aging or may be of congenital origin. The dilated bile ducts may, in turn, give rise to bacterial and fungal cholangitis and formation of biliary sludges and intrahepatic calcium bilirubinate stones.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
3/15. A new technique for the rapid dissolution of retained ductal gallstones with monoctanoin in T-tube patients.Retained gallstones in the biliary ducts have been therapeutically managed with monoctanoin (Moctanin; Ethitek Pharmaceuticals Company, Skokie, IL) since food and Drug Administration approval in 1985. The clinical usefulness of monoctanoin therapy has previously been regarded by some investigators as limited because of the length of time required to achieve complete dissolution (2 to 10 days) and less than optimal results (50% to 86% efficacy). Here, the authors describe a safe technique for the rapid dissolution of retained stones that they have used successfully in four patients. This technique eliminates the need for pressure monitoring in the T-tube patient and is suitable for short-stay hospitalization. Representative case histories are presented.- - - - - - - - - - ranking = 0.66666666666667keywords = ductal (Clic here for more details about this article) |
4/15. Retained common bile duct stone as a consequence of a fundus-first laparoscopic cholecystectomy.The fundus-first technique for laparoscopic cholecystectomy provides an alternative to the conventional dissection technique in patients at high risk for conversion to open cholecystectomy or at risk for bile duct injury. We report the complication of a retained common bile duct (CBD) stone after utilizing this technique. Intraoperative cholangiography (IOC) was not performed due to the concern for causing CBD injury in a patient with significant periductal inflammation and no risk factors for CBD stones. Following discharge, the patient developed scleral icterus 3 days later and returned for evaluation. He required endoscopic retrograde cholangiopancreatography for removal of a CBD stone. None of the four series reporting on this technique have described this complication. It should now be recognized that there is a risk of displacing a gallstone into the CBD in utilizing this technique. This report highlights the importance of intraoperative imaging of the CBD when using this technique, even in patients considered to be at low risk for having CBD stones. If IOC is considered hazardous, then intraoperative ultrasound should be the modality of choice.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
5/15. Right hepatic duct opening into the cystic duct: the role of pre- and intraoperative cholangiography.Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare. A 69-year-old woman developed severe intermittent right upper quadrant pain and high fever. A diagnosis of acute calculus cholecystitis was made by radiographic examinations. Magnetic resonance cholangiopancreatography demonstrated dilatation of the right hepatic duct, but could not identify the junction of the right hepatic duct and the cystic duct. Endoscopic retrograde cholangiopancreatography established that the right hepatic duct joined the cystic duct and that cholecystolithiasis was present. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy. Pre- and intraoperative cholangiography contribute to the avoidance of iatrogenic bile duct injury. When the right hepatic duct drains into the cystic duct, the gallbladder should be removed distal to the junction of the hepatic and cystic ducts.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
6/15. Solitary main pancreatic ductal calculus of possible biliary origin causing acute pancreatitis.CONTEXT: Pancreatic ductal calculi are most often associated with chronic pancreatitis. Radiological features of chronic pancreatitis are readily evident in the presence of these calculi. However, acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. CASE REPORT: A 59-year-old man presented with a first episode of acute pancreatitis. Contrast enhanced computerized tomography (CT) scan and endoscopic retrograde cholangiopancreatography (ERCP) revealed a calculus in the main pancreatic duct in the head of the pancreas causing acute pancreatitis. There were no features suggestive of chronic pancreatitis on CT scanning. The episode acute pancreatitis was managed conservatively. ERCP extraction of the calculus failed as the stone was impacted in the main pancreatic duct resulting in severe acute pancreatitis. Once this resolved, a transduodenal exploration and extraction of the pancreatic ductal calculus was performed successfully. Crystallographic analysis revealed the composition of the calculus was different to that seen in chronic pancreatitis, but more in keeping with a calculus of biliary origin. This could be explained by migration of the biliary calculus via the common channel into the main pancreatic duct. Following the operation the patient made an uneventful recovery and was well at two-year follow up. CONCLUSION: Acute pancreatitis due to a solitary main pancreatic ductal calculus of biliary origin is rare. Failing endoscopic extraction, transduodenal exploration and extraction is a safe option after resolution of acute pancreatitis.- - - - - - - - - - ranking = 1.3333333333333keywords = ductal (Clic here for more details about this article) |
7/15. Acute cholangitis after endoscopic sphincterotomy: complications of expectant treatment.Two elderly patients who had endoscopic sphincterotomy (EST) for their common duct stones developed acute cholangitis and, one of them also developed acute pancreatitis after the procedure. Despite the presence of an adequate sphincterotomy which allows subsequent spontaneous stone elimination, transient ductal obstruction during stone migration through the sectioned papilla is probably accountable for their complications. From the present reported experience, it is clear that expectant treatment of common duct stone after EST can be associated with definite hazards. Immediate biliary decompression with either active instrumental extraction or, when not feasible, insertion of nasobiliary catheter, should be performed to prevent these complications in selected patients.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
8/15. Problems in the diagnosis of pancreatic carcinoma by endoscopic retrograde cholangiopancreatography.Diagnostic problems occurred in five out of 55 patients undergoing endoscopic retrograde cholangiopancreatography who subsequently proved to have carcinoma of the pancreas. In one patient the pancreatic duct was normal, two had non-specific ductal abnormalities, one had pancreas divisum, and one had ductal ectasia. Two patients with non-specific changes on retrograde pancreatography had evidence of tumor on their retrograde cholangiogram. Two patients had ductal obstruction simulating pancreatic cancer, in one due to compression by the thoracic spine, in the other by inflammatory changes.- - - - - - - - - - ranking = 0.5keywords = ductal (Clic here for more details about this article) |
9/15. Mechanical lithotripsy through the intact papilla of vater.The indications for endoscopic papillotomy are clearly defined. When only the normal risk presents, our working group favours an age limit of 50 years, below which the papilla should, as far as possible, be preserved. In the present case report, a possibility is described for effecting an endoscopic extraction of bile duct concrements through a completely intact papilla. It is thus apparent that, in certain cases, mechanical lithotripsy can also be employed to smash ductal stones through the intact papilla.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
10/15. common bile duct stones and biliary-intestinal anastomoses.Six patients with symptoms referable to residual or recurrent common bile duct calculi following biliary tract operations, including a biliary-intestinal diversion, were studied by endoscopic retrograde cholangiography. Two patients were treated by endoscopic papillotomy and the remainder, by surgical procedures which included choledocholithotomy, transduodenal sphincteroplasty and revision of the biliary-intestinal anastomosis. Analysis of this experience suggests that one cannot assume that choledochoduodenostomy or choledochojejunostomy will always mitigate the consequences of retained or recurrent common duct stones. The segment of common bile duct between the biliary-intestinal anastomosis and the papilla of Vater may serve as a blind pouch or sump in a small number of patients undergoing these procedures. In patients with choledocholithiasis, efforts to remove all stones from the ductal system are the principal consideration; and choledochoduodenostomy should be reserved for specific indications, such as obstruction of the distal part of the bile duct.- - - - - - - - - - ranking = 0.16666666666667keywords = ductal (Clic here for more details about this article) |
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