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Tissue Engineering. Part A Sep 2022Although choledochojejunostomy is the standard technique for biliary reconstruction, there are various associated problems that need to be solved such as reflux...
Although choledochojejunostomy is the standard technique for biliary reconstruction, there are various associated problems that need to be solved such as reflux cholangitis. Interposition with an artificial bile duct (ABD) to replace the resected bile duct maintains a physiological conduit for bile and may solve this problem. This study investigated the usefulness of an ABD made of gelatin hydrogel nonwoven fabric (GHNF). GHNF was prepared by the solution blow spinning method. The migration and activity of murine fibroblast L929 cells were examined in GHNF sheets. L929 cells migrated into GHNF sheets, where they proliferated and synthesized collagen, suggesting GHNF is a promising scaffold for bile duct regeneration. ABDs made of GHNF were implanted in place of resected bile duct segments in rats. The rats were killed at 2, 6, and 12 weeks postimplantation. The implantation site was histologically evaluated for bile duct regeneration. At postoperative 2 weeks, migrating cells were observed in the ABD pores. The implanted ABD was mostly degraded and replaced by collagen fibers at 6 weeks. Ki67-positive bile duct epithelial cells appeared within the implanted ABD. These were most abundant within the central part of the ABD after 6 weeks. The percentages of Ki67-positive cells were 31.7 ± 9.1% in the experimental group and 0.8 ± 0.6% in the sham operation group at 6 weeks ( < 0.05), indicating that mature biliary epithelial cells at the stump proliferated to regenerate the biliary epithelium. Biliary epithelial cells had almost completely covered the bile duct lumen at 12 weeks (epithelialization ratios: 10.4 ± 6.9% at 2 weeks, 93.1 ± 5.1% at 6 weeks, 99.2 ± 1.6% at 12 weeks). The regenerated epithelium was positive for the bile duct epithelium marker cytokeratin 19. Bile duct regeneration was accompanied by angiogenesis, as evidenced by the appearance of CD31-positive vascular structures. Capillaries were induced 2 weeks after implantation. The number of capillaries reached a maximum at 6 weeks and decreased to the same level as that of normal bile ducts at 12 weeks. These results showed that an ABD of GHNF contributed to successful bile duct regeneration in rats by facilitating the cell migration required for extracellular matrix synthesis, angiogenesis, and epithelialization. Impact Statement Development of an artificial bile duct (ABD) enables physiological biliary reconstruction and may solve clinical problems associated with choledochojejunostomy. In this study, we created ABDs with gelatin hydrogel nonwoven fabric and implanted them in place of resected bile duct in rats. We evaluated the process of bile duct regeneration as well as decomposition of the ABD and demonstrated successful regeneration of resected bile duct, highlighting the possibility of this novel biliary reconstruction method to replace choledochojejunostomy.
Topics: Animals; Bile Ducts; Collagen; Gelatin; Hydrogels; Ki-67 Antigen; Mice; Rats; Regeneration
PubMed: 35383474
DOI: 10.1089/ten.TEA.2021.0209 -
Journal of Vascular Surgery. Venous and... Sep 2020An 11-year-old girl with kaposiform lymphangiomatosis presented with recurrent chylous pericardial effusions that were refractory to pericardial drainage and medical...
An 11-year-old girl with kaposiform lymphangiomatosis presented with recurrent chylous pericardial effusions that were refractory to pericardial drainage and medical therapy. Magnetic resonance imaging demonstrated a prominent lymphatic duct with anterior mediastinal extension into the left clavicular region and a region of high signal that was favored to represent a low-flow lymphatic malformation. The patient underwent direct access thoracic duct lymphangiography with thoracic duct embolization and sclerotherapy of the large left-sided neck and pericardial lymphatic malformation. After the procedure, her pericardial effusions resolved, and she has remained asymptomatic for 15 months.
Topics: Child; Embolization, Therapeutic; Female; Humans; Lymphangiectasis; Lymphatic Abnormalities; Pericardial Effusion; Sclerotherapy; Thoracic Duct; Treatment Outcome
PubMed: 32653407
DOI: 10.1016/j.jvsv.2020.03.013 -
Euroasian Journal of... 2022Disconnected pancreatic duct syndrome (DPDS) is a condition where there is a ductal disconnection between viable secreting distal pancreatic tissues and the...
UNLABELLED
Disconnected pancreatic duct syndrome (DPDS) is a condition where there is a ductal disconnection between viable secreting distal pancreatic tissues and the gastrointestinal tract. It may follow acute or chronic pancreatitis, abdominal trauma, and pancreatic surgery, leading to necrosis or structural disintegration of the pancreatic duct.
AIM
The aim of our study is to describe the imaging features of DPDS on ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) that helps in diagnosis.We present a case series of DPDS with their imaging features in two settings, one in the patient with acute necrotizing pancreatitis and the other with blunt abdominal trauma.
CONCLUSION
Imaging plays a significant role in preoperative diagnosis. Contrast-enhanced computed tomography provides a comprehensive assessment of pancreatic duct integrity, and it shows its type and site of ductal disruption. It is a simple, effective noninvasive imaging modality in diagnosing pancreatic duct disruption.
HOW TO CITE THIS ARTICLE
Satyam S, Singh S, Sah PK. Disconnected Pancreatic Duct Syndrome: A Case Series. Euroasian J Hepato-Gastroenterol 2022;12(1):60-63.
PubMed: 35990868
DOI: 10.5005/jp-journals-10018-1357 -
Cirugia Y Cirujanos 2022To determine the average value of the diameter of the common bile duct by age group in adult patients without bile duct pathology.
OBJECTIVE
To determine the average value of the diameter of the common bile duct by age group in adult patients without bile duct pathology.
METHOD
A cross-sectional, observational, descriptive and prospective study in adults without bile duct pathology who underwent abdominal ultrasound. The internal diameter of the common bile duct was measured after questioning. In the descriptive analysis, absolute frequencies, percentages, mean and standard deviation were used in the inferential Student's t test and Pearson's correlation.
RESULTS
608 patients without bile duct pathology were included, the mean diameter of the common bile duct was 4.04 ± 1.11 mm; with a minimum of 1.9 mm and a maximum of 8.8 mm. The mean for the population under 30 years was 3.8 ± 0.87, for the 30-39 years group it was 4.27 ± 0.89, for the 40-49 years group it was 4.39 ± 0.83, for the 50-59 years 4.86 ± 1, for the 60-69 years group it was 5.4 ± 0.95, and for those over 70 years it was 6.9 ± 0.8.
CONCLUSIONS
The diameter of the common bile duct in adult patients without biliary pathology is greater at older age.
Topics: Adult; Bile Ducts; Common Bile Duct; Cross-Sectional Studies; Humans; Prospective Studies; Ultrasonography
PubMed: 35944397
DOI: 10.24875/CIRU.20001391 -
Drug Discoveries & Therapeutics Dec 2022Cholestasis and obstructive jaundice can be extrahepatic or intrahepatic. Here we present one case with calculous cholecystitis who presenting with repeated obstructive...
Cholestasis and obstructive jaundice can be extrahepatic or intrahepatic. Here we present one case with calculous cholecystitis who presenting with repeated obstructive jaundice and without bile duct dilation. The patient received laparoscopic cholecystectomy, and cystohepatic duct was identified intraoperatively, there was no cholestasis or obstructive jaundice postoperatively. Cystohepatic duct is a rare biliary anomaly observed in 0.7% of all surgical cases and in 1.5% of all cadaveric dissections. The cystohepatic duct can be the bridge of calculous cholecystitis complicating cholangitis and obstructive jaundice, here we for the first time presented this entity.
Topics: Humans; Jaundice, Obstructive; Cholecystitis; Cholangitis; Cholecystectomy, Laparoscopic
PubMed: 36529506
DOI: 10.5582/ddt.2022.01078 -
World Journal of Gastroenterology Aug 2023Current abdominal surgery has several approaches for biliary reconstruction. However, the creation of functional and clinically applicable bile duct substitutes still...
Current abdominal surgery has several approaches for biliary reconstruction. However, the creation of functional and clinically applicable bile duct substitutes still represents an unmet need. In the paper by Miyazawa and colleagues, approaches to the creation of bile duct alternatives were summarized, and the reasons for the lack of development in this area were explained. The history of bile duct surgery since the nineteenth century was also traced, leading to the conclusion that the use of bioabsorbable materials holds promise for the creation of bile duct substitutes in the future. We suggest three ideas that may stimulate progress in the field of bile duct substitute creation. First, a systematic analysis of the causative factors leading to failure or success in the creation of bile duct substitutes may help to develop more effective approaches. Second, the regeneration of a bile duct is delicately balanced between epithelialization and subsequent submucosal maturation within limited time frames, which may be more apparent when using quantitative models to estimate outcomes. Third, the utilization of the organism's endogenous regeneration abilities may enhance the creation of bile duct substitutes. We are convinced that an interdisciplinary approach, including quantitative methods, machine learning, and deep retrospective analysis of the causes that led to success and failure in studies on the creation of bile duct substitutes, holds great value. Additionally, more attention should be directed towards the balance of epithelialization and submucosal maturation rates, as well as induced angiogenesis. These ideas deserve further investigation to pave the way for bile duct restoration with physiologically relevant outcomes.
Topics: Humans; Retrospective Studies; Bile Ducts; Biliary Tract Surgical Procedures; Machine Learning; Metaplasia
PubMed: 37662863
DOI: 10.3748/wjg.v29.i30.4701 -
Frontiers in Cardiovascular Medicine 2023Despite the advancements in the technique of duct stenting (DS) in patients with duct-dependent pulmonary circulation (DDPC) and the valuable role of DS in preventing... (Review)
Review
Despite the advancements in the technique of duct stenting (DS) in patients with duct-dependent pulmonary circulation (DDPC) and the valuable role of DS in preventing the risk of surgical creation of shunts and early repair, not all ducts are amenable to being stented, and not all interventions with DS are safe and can achieve positive outcomes. Very few studies focusing on tortuous ducts have been conducted until now. Their results showed that stenting of highly tortuous ducts has the same risk as surgical options. This type of stenting has greater possibility of complications, early in-stent thrombosis, and stent failure than do other duct types. In such cases, the surgical options could be superior to DS and have better outcomes. This report aims to review the very scarce available data about stenting of high-tortuous ducts and criticisms of performing DS in ducts associated with pulmonary stenosis and to highlight the essential points that must be considered before deciding on intervention.
PubMed: 38054094
DOI: 10.3389/fcvm.2023.1275545 -
Surgical Case Reports Mar 2019Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the...
BACKGROUND
Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury.
CASE PRESENTATION
A 65-year-old woman was admitted with right hypochondrial pain and high fever. A diagnosis of acute calculous cholecystitis was made by radiological imaging. Magnetic resonance cholangiopancreatography revealed that the confluence of the right and left hepatic duct was unclear. Intraoperatively, the procedure was converted from a laparoscopic cholecystectomy to laparotomy because of unclear anatomy of the cystic duct with severe inflammation at Calot's triangle. Furthermore, intraoperative cholangiography from Hartmann's pouch showed the main right hepatic duct entering the cystic duct. Subtotal cholecystectomy was performed to avoid injuring the right hepatic duct.
CONCLUSION
Although an aberrant hepatic duct entering the cystic duct is not uncommon, the main right hepatic duct infiltrating the cystic duct is extremely rare. Preoperative and intraoperative evaluation of the biliary duct and awareness of aberrant biliary duct variations is important in preventing bile duct injury.
PubMed: 30911867
DOI: 10.1186/s40792-019-0604-y -
Endoscopy Dec 2022
Topics: Humans; Cystic Duct; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Cholecystectomy, Laparoscopic
PubMed: 35863338
DOI: 10.1055/a-1882-5491