1/5. 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 = calculus (Clic here for more details about this article) |
2/5. Percutaneous choledochoscopic choledocholithotomy in Caroli's disease.Communicating cavernous ectasia of the intrahepatic bile ducts (Caroli's disease) is frequently accompanied by calculus formation. Percutaneous choledocholithotomy was successfully performed using a choledochoscope in a young adult with multiple calculi. To our knowledge this is the first reported case of choledocholithotomy using this technique in Caroli's disease.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
3/5. cystic duct entry--another cause of pseudocalculus.Certain pitfalls face the endoscopist during ERC in the diagnosis of common bile duct stones. False-positive filling defects for calculi may be caused by air bubbles, blood clot, tumor, and the pseudocalculus sign of the lower common bile duct (CBD) due to sphincter spasm. Another false positive may be encountered by the presence of a filling defect at the confluence of the cystic duct and common bile duct, and we report on three such cases. The cause of this pseudocalculus sign of the mid-CBD is not clear. We speculate that it may arise as a result of an unopacified jet of bile flowing from the cystic duct displacing contrast in the CBD.- - - - - - - - - - ranking = 6keywords = calculus (Clic here for more details about this article) |
4/5. Surgical management of spontaneous hepatic duct perforations.Spontaneous rupture of the hepatic ducts is an exceedingly rare and unusually unrecognized cause of peritonitis in adults. In the last four years we have operated on three patients with bile peritonitis from hepatic duct perforation caused by calculus erosion. All were elderly, had a prolonged period of symptoms prior to presentation, and were gravely ill at the time of operation. Each perforation was managed differently: one by fine suture closure, one by insertion of a T-tube in the perforation, and the third by T-tube drainage of the common duct when the perforation was inaccessible to repair. Two of the three patients survived and remain healthy without evidence of bile duct stricture three and three and a half years later, respectively.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |
5/5. Video-laparoscopic treatment of a sizeable cyst of the cystic duct: a case report.A case of cystic dilation isolated from the cystic duct is described. The patient showed symptoms of chronic calculous cholecystitis; the ultrasonographic examination confirmed the clinical hypothesis and showed a 1.3-cm calculus impacted in the infundibulum of the gallbladder. The hepatic and biliary functions were normal. During surgery, the routine cholangiographic study showed a sizable cyst in the cystic canal, as well as an anomalous duct uniting the cyst to the right hepatic duct. As for the rest of the extrahepatic biliary canal, as well as the intrahepatic canal, nothing abnormal was noticed. The videolaparoscopic treatment consisted of a ligature with a clip of the cystic duct and the anomalous duct plus en bloc resection of the cyst and the gallbladder. Histopathologic study showed it to be a benign cyst and chronic calculous cholecystitis. It is important to establish the site of the cyst precisely before surgery, as the procedure should include its resection, since it could be the source of infection or development of lithiasis and even malignant degeneration. There are two hypotheses for the appearance of cysts in the biliary tract: congenital, due to a flaw in the multiplication of the cells that will form the biliary tract during the fetal life, and by aggression by pancreatic juice flowing back to the main biliary canal. The congenital origin seems to be the hypothesis that better explains the appearance of the cyst in the case described here, considering that the backflow of the pancreatic juice could hardly have occurred because of the anatomy as observed: the nonexistence of the common biliary-pancreatic canal and the valvular mechanism, present in the cystic canal, between the cyst itself and the confluence of the cystic canal into the main biliary canal, in addition to the anomalous biliary canal communicating the cyst to the right intrahepatic canal.- - - - - - - - - - ranking = 1keywords = calculus (Clic here for more details about this article) |