1/10. Mucin-producing carcinoma of the cystic duct that caused obstructive jaundice.We report a very rare case of what appeared to be mucin-producing carcinoma of the cystic duct, and this is the forth case recorded in the English-language and Japanese literature. The patient was a 67-year-old man with a chief complaint of dark urine and jaundice. cholangiography via an endoscopic nasobiliary drain showed dilatation of the common hepatic duct to 14 mm, with no visualization of the cystic duct or gallbladder, and an approximately 15-mm filling defect was observed at the junction of the common bile duct and the cystic duct. Based on these findings a diagnosis of cancer of the middle portion of the bile duct was made. cholecystectomy and resection of the bile duct with dissection of regional lymph nodes and choledochoduodenostomy were performed. About a 1-cm mass was palpable in the region of the cystic duct, and the gallbladder contained mucin some of which reached the common bile duct. Histological examination revealed well-differentiated ductal adenocarcinoma infiltrating the serosa, in which mucus production was observed. The patient was discharged on postoperative day 50. At the present time, 38 months postoperatively, there are no signs of recurrence, and he is attending the outpatient clinical in good health.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/10. Limy bile: a case of obstructive jaundice and review of 26 cases.BACKGROUND: A number of reports on limy bile have been published but obstructive jaundice due to limy bile is quite rare. We report a case of obstructive jaundice due to limy bile and review 26 cases of limy bile diagnosed in our institution. CASE OUTLINE: A 39-year-old woman was admitted to our hospital with epigastric pain and jaundice. Abdominal ultrasonography and computed tomography revealed limy bile in the common bile duct and a gallbladder stone with biliary obstruction. Percutaneous transhepatic biliary drainage was performed. The limy bile drained out through the catheter over a few weeks. cholecystectomy and choledochotomy with choledocholithotomy were subsequently performed. DISCUSSION: The strategy for managing patients with limy bile is individualized based on symptoms, the clinical conditions, and the location of the limy bile, and any associated biliary stones or lesions causing cystic duct obstruction.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
3/10. Combined percutaneous transhepatic biliary drainage with port implantation for management of patients with malignant biliary obstruction.BACKGROUND: Endoscopic biliary stent insertion has become a standard palliative treatment for patients with obstructive jaundice caused by malignancies of the hepatobiliary system or metastases of other tumors, such as pancreatic or gastric cancer. Unfortunately, bacterial colonization and encrustation frequently leads to occlusion of plastic stents and, consequently, recurrent cholangitis. methods: An external-internal Yamakawa-type endoprosthesis was modified and combined with a titanium, subcutaneously implanted port. This technique was evaluated as a new approach to prolongation of stent patency and prevention of cholangitis. Two patients with obstructive jaundice, one with recurrent gastric carcinoma and the other with invasive gallbladder cancer, underwent treatment with this new method. RESULTS: Effective biliary drainage was established and cholangitis was prevented in both patients for 6 and 2 months, respectively. CONCLUSIONS: A new method of percutaneous transhepatic drainage combined with port implantation was effective and safe in two patients. This technique may be a reasonable treatment option for selected patients, but further evaluation in a larger series is required to establish efficacy and safety.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
4/10. Gall-bladder agenesis presenting with obstructive jaundice and elevated CA 19-9.We report the case of an 81-year-old man with agenesis of the gall-bladder that presented with choledocholithiasis, obstructive jaundice, and very high CA 19-9 serum level (2765 U/ml). On ultrasound and CT scan, the gallbladder was not visualised and it was assumed shrunken and filled with gall-stones. After repeated unsuccessful endoscopic retrograde cholangiopancreatography, the patient was operated on for common bile duct (CBD) stones. At laparotomy the gall-bladder was not identified but a 3 cm long gall-stone was removed from the CBD. After decompression of the CBD all symptoms disappeared and the CA 19-9 returned to normal. We believe that this is the first report in the literature of gall-bladder agenesis presenting with high serum level of CA 19-9.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
5/10. Obstructive jaundice caused by enteropathy-associated t-cell lymphoma in a patient with celiac sprue.patients with celiac sprue carry a considerable risk of gastrointestinal malignancies; in particular, non-Hodgkin's lymphoma. These malignancies represent the most serious complications of celiac disease. Commonly, patients present with deteriorating symptoms of the underlying disease, which makes an early diagnosis difficult. We report a patient with a 13-year history of celiac sprue presenting with painless jaundice and a Courvoisier gallbladder. Abdominal computed tomography (CT) scan showed thickening of the duodenal wall, suggesting a neoplastic infiltration of the papilla of Vater, causing biliary obstruction. Biopsies taken on endoscopy revealed enteropathy-associated t-cell lymphoma of the duodenum. Biliary obstruction is a rare clinical finding in enteropathy-associated t-cell lymphoma. To our knowledge, this is the first reported case of this unusual manifestation in celiac disease.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
6/10. Squamous cell carcinoma of the distal common bile duct.CONTEXT: Squamous cell carcinoma of the biliary tree is rare. Although few cases of squamous cell carcinoma of the intrahepatic bile-duct and gallbladder have been reported, until today, only four cases of squamous cell carcinoma of the extrahepatic bile duct have been reported in the literature. CASE REPORT: We present a case of squamous cell carcinoma of the distal common bile duct presenting with obstructive jaundice in a 60-year-old male which was successfully managed by a Whipple's pancreaticoduodenectomy. CONCLUSION: Squamous cell carcinoma of the distal bile duct without lymph node metastasis can be managed by pancreaticoduodenectomy alone.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
7/10. Stauffer's syndrome variant with cholestatic jaundice: a case report.cholestasis is a common feature of several malignant diseases, including pancreatic, hepatic, gallbladder, and ampullary carcinomas. It is usually secondary to main bile duct obstruction or widespread hepatic metastasis, but it can also be a paraneoplastic syndrome of other underlying malignancies. Stauffer's syndrome is a rare paraneoplastic manifestation of renal cell carcinoma (RCC) that is characterized by elevated alkaline phosphatase, erythrocyte sedimentation rate, alpha-2-globulin, and gamma-glutamyl transferase, thrombocytosis, prolongation of prothrombin time, and hepatosplenomegaly, in the absence of hepatic metastasis and jaundice. A rare variant of this syndrome with jaundice has recently been described in 3 cases in the literature. We report a patient who presented with abdominal pain and cholestatic jaundice in whom RCC was incidentally found during initial workup. jaundice and liver dysfunction resolved completely after surgical resection of the tumor. This case illustrates the protean manifestations of RCC, and the importance of considering Stauffer's syndrome and its variant in the differential diagnosis of anicteric and icteric cholestasis, which may allow early recognition and treatment of an underlying malignancy.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
8/10. mirizzi syndrome: laparoscopic management by subtotal cholecystectomy.BACKGROUND: The authors present their experience with laparoscopic subtotal cholecystectomy for the management of Mirizzi's syndrome and their review of the literature. methods: Over a period of 24 months, five cases of Mirizzi's syndrome were encountered, representing 1.5% of all the laparoscopic cholecystectomies performed in the authors' unit. The sex ratio was 4 females to 1 male, and the mean age of the patients was 66 years. All underwent a subtotal cholecystectomy. RESULTS: All procedures were completed laparoscopically. Morbidities involved one case of biliary peritonitis and a one case of biliary leak requiring endoscopic stenting. CONCLUSION: Mirizzi's syndrome cannot always be anticipated on the basis of preoperative staging, and often is encountered during the procedure. The "anatomic scenario" of this condition should be suspected for patients presenting with conditions such as empyema or mucocoele when there is a likelihood of stone impaction in the infundibulum of the gallbladder. Subtotal cholecystectomy with secure intraperitoneal biliary drainage appears to be a safe option for these patients.- - - - - - - - - - ranking = 0.5keywords = gallbladder (Clic here for more details about this article) |
9/10. Agenesis of the gallbladder with primary choledochal stones.OBJECTIVE: To report a case of true agenesis of the gallbladder (GB) with obstructive jaundice due to primary choledochal stone. CLINICAL PRESENTATION AND INTERVENTION: A 66-year-old woman presented with a full picture of obstructive jaundice, both clinically and biochemically. Ultrasound and endoscopic retrograde cholangiopancreatography failed to show the GB but showed dilatation of extrahepatic ducts with a stone in the common bile duct (CBD). Upon exploration, the GB was found to be absent and through a choledochotomy, the stone in the CBD was removed. CONCLUSION: This case shows that proper exploratory laparotomy and intraoperative cholangiography may be required to confirm absence of the GB.- - - - - - - - - - ranking = 2.5keywords = gallbladder (Clic here for more details about this article) |
10/10. An alternative surgical approach to a difficult case of mirizzi syndrome: a case report and review of the literature.mirizzi syndrome (MS) is an uncommon complication of gallstone disease and occurs in approximately 1% of all patients suffering from cholelithiasis. The syndrome is characterized by extrinsic compression of the common hepatic duct frequently resulting in clinical presentation of intermittent or constant jaundice. Most cases are not identified preoperatively. Surgery is the indicated treatment for patients with MS. We report here a 71-year-old male patient referred to the surgical outpatient department for diffuse upper abdominal pain and mild jaundice (bilirubin rate: 4.2 mg/dL). Ultrasound examination revealed a stone in the cystic duct compressing the common hepatic duct. The patient had a history of gastrectomy for gastric ulcer 30 years ago. MRCP revealed a stone impacted in the cystic duct causing obstruction of the common hepatic duct by extrinsic compression. With these findings the preoperative diagnosis was indicative of MS. At laparotomy a moderately shrunken gallbladder was found embedded in adhesions containing a large stone which was palpable in the common bile duct. The anterior wall of the body of the gallbladder was opened by an incision which extended longitudinally along the gallbladder towards the common bile duct. The stone measuring 3.0 cm in diameter, was then removed setting astride a large communication with the common bile duct. A Roux-en-Y cholecysto-choledocho-jejunostomy was performed. The subhepatic region was drained. The patient had an uneventful recovery. He was discharged eleven days after operation and remained well after a 30-mo follow-up.- - - - - - - - - - ranking = 1.5keywords = gallbladder (Clic here for more details about this article) |
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