Cases reported "Bile Duct Diseases"

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1/230. Bile duct hamartomas (von Meyenburg complexes): value of MR imaging in diagnosis.

    We present a case of a patient initially believed to have multiple liver metastases based on ultrasound and computed tomography findings in whom a diagnosis of multiple bile duct hamartomas (von Meyenburg complexes) was indicated after ultrasound-guided liver biopsy. magnetic resonance imaging aided greatly in confirming the diagnosis of von Meyenburg complexes, thereby avoiding laparotomy and open liver biopsy.
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2/230. Mucin-producing biliary papillomatosis associated with gastrobiliary fistula.

    We report a case of mucin-producing biliary papillomatosis in a 78-year-old woman. Abdominal ultrasound (US) and computed tomography (CT) showed wall thickening and dilatation of the intrahepatic bile duct (IHBD), as well as a nodular lesion, 1.2 cm in diameter, in the left branch of the IHBD. Gastric endoscopy revealed excretion of bile-containing mucin on the anterior wall of the body of the stomach. Endoscopic ultrasonography (EUS) showed gastrobiliary fistula and discharge of mucin into the stomach. Needle biopsy of the biliary tumor revealed papillary proliferation, but no malignant cells were recognized histologically. Therefore this patient was diagnosed as having mucin-producing biliary papillomatosis forming gastrobiliary fistula. She did not present with obstructive jaundice, probably because of the fistula. She is alive, without obstructive jaundice, 16 months after the diagnosis without having had surgery. This is, to our knowledge, the first reported case of biliary papillomatosis forming gastrobiliary fistula and with the patient free of obstructive jaundice.
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3/230. Pancreatic arteriovenous malformation observed to bleed from the bile duct and a duodenal ulcer: report of a case.

    A 48-year-old man with recurrent episodes of biliary colic and subsequent pancreatitis was admitted to undergo a cholecystectomy. A gastroduodenal fiberscopic examination was performed because of massive melena on the seventh day after admission. It revealed a shallow ulcer on the posterior wall of a duodenal bulbus with rubor and an exposed vessel, which was clipped endoscopically to stop the bleeding. Further observations showed the papilla of Vater to be bleeding from the papilla. A contrast-enhanced abdominal computed tomography scan demonstrated a dilatation of the common bile duct and several dilated vasculatures around the portal vein, some of which drained into the portal vein. Based on the angiography findings, a diagnosis of arteriovenous malformation in the pancreas head was obtained and an embolization of the gastroduodenal artery was performed. Although the melena subsided, he underwent a pylorus-preserving pancreatoduodenectomy to prevent the recurrence of hemorrhaging. The histopathological findings of the bile duct revealed inflammatory cell infiltration and a detachment of the epithelium, except in a small part of the bile duct. A rupture of a damaged vessel inside the bile duct was observed, which was thought to be the cause of hemobilia. Sections of the pancreatic head demonstrated an inflammatory lesion with fibrosis and saponification as well as a large degree of arteriovenous anastomosis. The patient was discharged on the 35th day after the operation following an uneventful postoperative course.
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4/230. Management of bile duct stones in 1572 patients undergoing laparoscopic cholecystectomy.

    Evidence of bile duct stones (BDSs) was identified on routine cholangiogram in 136 (8.7%) of 1572 patients undergoing laparoscopic cholecystectomy from March 1989 through March 1997. Forty-two (30.9%) were unsuspected. All patients with evidence of BDSs underwent laparoscopic bile duct exploration (LBDE). Initially, a standard choledochotomy with T-tube drainage as in the open approach was used. Later, transcystic duct exploration was added to the algorithm. The algorithm evolved into an ongoing treatment protocol study that was initiated in March 1992. Through March 1997, 100 patients underwent LBDE based on the protocol. The study is divided into two groups. Group A comprises the total 136 patients undergoing LBDE, including those in the protocol study. A subgroup, Group B, comprises only the 100 patients in the protocol study. In Group A, LBDE was successful in 114 patients (83.8%). Stones were missed in seven patients and left behind for spontaneous passage or later retrieval in six patients. Eleven patients (8.1%) were converted to open. There were 13 major complications (9.6%), including the seven missed stones and two deaths. In Group B, LBDE was successful in 94 per cent. Stones were missed in one patient and intentionally left behind in four patients. One patient was converted to open. There were seven major complications (7%), including one of the missed stones and one death. Using the protocol algorithm and the techniques described, BDSs can be effectively managed laparoscopically at the time of cholecystectomy in approximately 94 per cent of cases.
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ranking = 1.4
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5/230. Acute hepatobiliary tuberculosis: a report of two cases and a review of the literature.

    Two cases of hepatobiliary tuberculosis are described. Case one, the macronodular type of hepatic tuberculosis, presented as pyrexia of unknown origin and was eventually diagnosed by sectional imaging when a mass lesion developed in the liver and aspiration revealed acid-fast bacilli. Case two presented with jaundice due to a hilar bile duct stricture. The patient was successfully treated by repeated bile duct stenting and later chemotherapy for tuberculosis. In both cases previous positive histology or culture would have expedited diagnosis and treatment. Acute hepatobiliary tuberculosis remains a rare disease. Suspicion of the disease and adequate biopsy are important to allow prompt appropriate treatment.
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6/230. Clinical evaluation of three-dimensional MR-cholangiopancreatography using three-dimensional Fourier transform fast asymmetric spin echo method (3DFT-FASE): usefulness of observation by multi-planar reconstruction.

    MR-cholangiopancreatography (MRCP) is a new method that is non-invasive and permits volume data collection and three-dimensional expression. With the three-dimensional Fourier transform fast asymmetric spin echo (3DFT-FASE) method, a higher spatial resolution can be obtained both in-pain and in slice selecting direction. In this paper, the usefulness of this new technique is investigated in the clinical diagnosis of MIP images and MPR. The study was performed in 10 normal volunteers and 21 patients with abnormalities in the pancreas or bile-duct sustem. The study was done using a 1.5 Tesla super-conductive machine. The MRCP images were interpreted by three radiologists. In most cases good images were obtained. The additional clinical information provided by MPR was remarkably useful in cystic lesions, especially in mucinous cystic neoplasm of the pancreas. Even when the intestine overlapped the pancreas, it was possible to evaluate the pancreatic duct by MPR. Three-dimensional observation and clinically useful diagnosis were possible by utilizing the advantageds of the 3DFT-FASE method appears quite useful in clinical application.
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ranking = 0.6
keywords = duct
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7/230. Spontaneous biliary perforation and necrotizing enterocolitis.

    A case of spontaneous bile-duct perforation in a 5-month-old boy with a history of necrotizing enterocolitis in his 1st week of life is reported. To our knowledge, this is the second case reported with such an antecedent, supporting a vascular etiology for some cases of spontaneous biliary perforation.
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8/230. Interventional radiology in percutaneous management of bile duct obstruction: biliary drainage through a spontaneous common hepatic duct-duodenal fistula.

    Bile duct injuries are a serious complication of biliary surgery. We report a case of benign obstruction of the common hepatic duct associated with common hepatic duct-duodenal spontaneous fistula following complex surgical intervention. We managed percutaneously the fistula with balloon dilatation and long-term stenting, as the fistula allowed biliary flow in the duodenum. We avoided reintervention preserving biliary flow, with good clinical results after a follow-up of a 3 years. We emphasize the role of a clinically focused approach to percutaneous management of complications following biliary surgery.
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ranking = 2.2
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9/230. Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

    A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.
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ranking = 0.2
keywords = duct
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10/230. An unusual bile duct injury in a child after blunt abdominal trauma.

    Bile duct injuries are rare in children after blunt trauma. This report describes a 3-year-old child who sustained a blunt abdominal trauma resulting in bile duct, liver, and small bowel injuries. The initial management at another hospital included recognition and repair of a small bowel perforation. However, the postoperative course was complicated by a large biliary leak. The child was transferred to our institution where radioisotope scanning and endoscopic retrograde cholangiography confirmed the extent of the ductal injury. At laparotomy there were injuries of both right and left hepatic ducts, and an anomaly of bile duct course was noted. The right hepatic duct was repaired primarily and the left one was repaired with Roux-en-Y hepaticojejunostomy. Postoperatively, normal bile drainage was documented by radioisotope scan and the patient remains symptom free at 1 year follow-up.
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