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HPB : the Official Journal of the... Feb 2019Growing evidence has suggested that intrahepatic cholangiocarcinoma (iCCA) can be classified into small- and large-duct types. The present study aimed to elucidate how... (Comparative Study)
Comparative Study
BACKGROUND
Growing evidence has suggested that intrahepatic cholangiocarcinoma (iCCA) can be classified into small- and large-duct types. The present study aimed to elucidate how large-duct iCCA is similar and dissimilar to perihilar cholangiocarcinoma (pCCA).
METHODS
The study cohort consisted of iCCA (n = 58) and pCCA (n = 44). After iCCA tumors were separated into small- (n = 36) and large-duct (n = 22) types based on our histologic criteria, genetic statuses of the three types of neoplasms were compared. Locations of iCCA were plotted on a three-dimensional image and their distances from the portal bifurcation were measured.
RESULTS
Large-duct iCCA was distinct from small-duct iCCA in terms of frequency of bile duct reconstruction required, perineural infiltration, and survival, with these features more similar to pCCA. Large-duct iCCA and pCCA more frequently had the loss of SMAD4 expression and MDM2 amplifications than small-duct iCCA, whereas the loss of BAP1 expression and IDH1 mutations were mostly restricted to small-duct iCCA. From imaging analysis, most tumors of large-duct iCCA were present around the second branches of the portal vein.
CONCLUSION
Large-duct type iCCA shared the molecular features with pCCA, and it may be reasonable to expand the definition of pCCA to include cancers originating from the second bile duct branches.
Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Biomarkers, Tumor; Female; Gene Amplification; Gene Deletion; Genetic Predisposition to Disease; Humans; Klatskin Tumor; Male; Middle Aged; Mutation; Phenotype; Prognosis
PubMed: 30170977
DOI: 10.1016/j.hpb.2018.07.021 -
Medicine Feb 2018Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system. (Review)
Review
RATIONALE
Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system.
PATIENT CONCERNS
A 44-year-old woman presented with a history of continuous upper abdominal pain and vomiting.
DIAGNOSES
Magnetic resonance cholangiopancreatography (MRCP) disclosed diffuse dilatation of the intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) showed the presence of two extrahepatic bile ducts with calculus at the distal end of the CBD.
INTERVENTIONS
Laparoscopic cholecystectomy (LC) was performed after an ERCP. Choledochoscopy, performed during the operation, showed duplicated common bile duct and the cystic duct was seen opening at the right side of the extrahepatic duct.
OUTCOMES
The patient was doing well after 6 months of follow-up.
LESSONS
We reported a case of a double common duct with choledocholithiasis and gallstone. This rare anomaly may lead to cholangitis, common bile duct injury during surgery, malignancy occurrence, and should be treated with extreme care.
Topics: Adult; Bile Duct Diseases; Bile Ducts, Extrahepatic; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholecystectomy, Laparoscopic; Choledocholithiasis; Common Bile Duct; Female; Gallstones; Humans
PubMed: 29465584
DOI: 10.1097/MD.0000000000009953 -
International Journal of Surgery Case... 2018Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of...
INTRODUCTION
Multiple and large pancreatic duct stones concomitant with primary choledochal stones is a rare case. Patients usually present with recurrent jaundice and signs of pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is the leading method to manage the patients. But ERCP has difficulties when facing the multiple and large stones PRESENTATION OF CASE: Our first case was a 51-years-old man who was admitted to our surgery unit with a diagnosis of chronic pancreatitis. Plain abdominal radiogram, Abdominal MSCT and Magnetic Resonance Cholangiopancreatography (MRCP) showed opacity suspected as stone at the pancreatic duct and distal part of the common bile duct. The second case was a 48-years-old female with the clinical presentation of left upper quadrant pain and history of chronic pancreatitis and intermittent jaundice. Plain abdominal radiogram and MRCP revealed multiple stones in the main pancreatic duct and common bile duct stones. Our third case was female, 60-years-old, who was hospitalized with jaundice and recurrent upper abdominal pain with a history of open cholecystectomy one month previously. Radiologic examination showed multiple stones in the main pancreatic duct and common bile duct. Combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy were performed successfully in all cases. Postoperative follow-up showed good recovery of all patients.
DISCUSSION
Since ERCP is not proper to be used for multiple and large pancreatic duct stones, we performed a combination of longitudinal pancreatojejunostomy Roux-en-Y and choledoco-duodenostomy to treat the patients and prevent the recurrence.
CONCLUSION
The incidence of multiple pancreatic duct stones and large choledochal stones is infrequent. Surgical treatment with combined longitudinal pancreatojejunostomy Roux-en-Y and Choledoco-duodenostomy is safe and effective to resolve jaundice and recurrent pain caused by chronic pancreatitis.
PubMed: 30472627
DOI: 10.1016/j.ijscr.2018.10.051 -
Interventional Radiology... Mar 2024Hepatocellular carcinoma invading the bile duct (bile duct tumor thrombus) is an unfavorable condition. Although overall survival following surgical resection among... (Review)
Review
Hepatocellular carcinoma invading the bile duct (bile duct tumor thrombus) is an unfavorable condition. Although overall survival following surgical resection among patients with hepatocellular carcinoma with bile duct tumor thrombus is significantly better than that among those treated with transarterial chemoembolization or chemotherapy, surgical resection can be indicated for selected patients. Additionally, systemic therapy is indicated only for patients with Child-Pugh class A. Therefore, transarterial therapy plays an essential role in the treatment of bile duct tumor thrombus. Transarterial chemoembolization with iodized oil and gelatin sponge particles is an established first-line transarterial treatment that can necrotize most bile duct tumor thrombi. However, we should pay attention to symptoms caused by intraductal hemorrhage during transarterial chemoembolization and the sloughing of necrotized bile duct tumor thrombi.
PubMed: 38524999
DOI: 10.22575/interventionalradiology.2023-0019 -
Medicine International 2021Choledocholithiasis is a common disease of the biliary system. The traditional surgical method for this is to remove the gallbladder, open the common bile duct, remove...
Choledocholithiasis is a common disease of the biliary system. The traditional surgical method for this is to remove the gallbladder, open the common bile duct, remove the stones and place a T-tube in the common bile duct for drainage. Common bile duct exploration usually requires a T-tube. Without a T-tube, there is a risk of bile leakage due to pressure in the bile duct. After the T-tube is placed, patients experience some form of discomfort and inconveniences with daily life, and there is also a risk of accidental detachment, as well as a risk of bile leakage when the T-tube is removed. In severe cases, patients may need to be hospitalized again. With advancements being made in surgical instruments and technology, laparoscopic common bile duct exploration has been widely used. Due to the carbon dioxide pneumoperitoneum, laparoscopic common bile duct exploration requires a long period of time for T-tube sinus formation compared with open surgery. Therefore, the extubation time needs to be prolonged in laparoscopic common bile duct exploration. The use of an internal drainage tube may be used in order to avoid the aforementioned disadvantages. Since 2012, the authors have performed laparoscopic common bile duct exploration with the placement of an internal drainage tube for the treatment of common bile duct stones, and have completed >160 surgeries. The present study provides a summary of the data of these 160 cases. The 160 patients underwent laparoscopic cholecystectomy. Following the removal of the stones, an internal drainage tube was placed, and the common bile duct incision was primary sutured. All patients were discharged, and there were no complications, such as biliary leakage, biliary bleeding and biliary stricture. On the whole, the present study demonstrates that where possible, the placement of an internal drainage tube in laparoscopic common bile duct exploration is safe and reliable, and may be used to avoid the risk of bile leakage without a T-tube, any inconveniences for patients, and the risk of bile leakage following the removal of the T-tube.
PubMed: 36698429
DOI: 10.3892/mi.2021.14 -
Indian Journal of Otolaryngology and... Mar 2019Total dry eye is encountered less frequently, but it may lead to blindness. Transposition of parotid duct to the conjunctival cul-de-sac is a method of treatment for...
Total dry eye is encountered less frequently, but it may lead to blindness. Transposition of parotid duct to the conjunctival cul-de-sac is a method of treatment for advanced cases of xerophthalmia to prevent blindness. Tears and parotid secretions have similar composition; therefore saliva provides an excellent replacement for tears. Limitation of this procedure is that the length of the parotid duct may not be adequate to reach the conjunctival cul-de-sac. This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7 cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1-1.50 cm in length. Parotid duct can be transposed easily to the lower conjunctival cul-de-sac in majority of the cases. If the parotid duct is falling short than a cuff of the buccal mucosa can be taken in order to gain length.
PubMed: 30906709
DOI: 10.1007/s12070-018-1559-1 -
Clinical Case Reports Jan 2019The anatomical variations of accessory biliary ducts account for up to 2% of the population. The two types of ducts are the: subvescical and hepaticocholecystic. The...
The anatomical variations of accessory biliary ducts account for up to 2% of the population. The two types of ducts are the: subvescical and hepaticocholecystic. The knowledge of such variations is extremely important during cholecystectomy in order to avoid possible postoperative complications such as biliary injury or choleperitoneum.
PubMed: 30656048
DOI: 10.1002/ccr3.1875 -
BMC Surgery Mar 2020Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with...
BACKGROUND
Many options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence.
METHODS
In this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient's own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.
RESULTS
Forty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot's triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later.
CONCLUSIONS
The current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.
Topics: Adolescent; Adult; Aged; Cholecystectomy; Cholecystectomy, Laparoscopic; Choledocholithiasis; Common Bile Duct; Cystic Duct; Dilatation; Female; Gallstones; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32183778
DOI: 10.1186/s12893-020-00705-y -
International Journal of Surgery Case... 2017Mixed adenoneuroendocrine carcinomas (MANECs) of the distal bile duct are extremely rare, and only a few cases have been reported in the English literature.
INTRODUCTION
Mixed adenoneuroendocrine carcinomas (MANECs) of the distal bile duct are extremely rare, and only a few cases have been reported in the English literature.
PRESENTATION OF CASE
An 82-year-old man was referred to our hospital for increasing biliary enzymes. Abdominal computed tomography (CT) showed enlargement of the intrahepatic bile ducts and stenosis of the distal bile duct. Endoscopic retrograde cholangiopancreatography showed stenosis of the distal bile duct and a high-density signal at the same site on diffusion weighted imaging. PET-CT showed increased FDG accumulation (SUVmax: 4.5) at the distal bile duct stenosis. Biopsy specimens obtained by endoscopic ultrasonography-guided fine-needle aspiration revealed adenocarcinoma. The patient was diagnosed with adenocarcinoma of the distal bile duct and underwent subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. The resected distal bile duct tumor was 18×14×12mm in diameter. Hematoxylin and eosin staining revealed a composite carcinoma with adenocarcinoma and non-adenocarcinoma elements. The non-adenocarcinoma component stained positive for synaptophysin and chromogranin A. The Ki-67 labeling index was 37%. The non-adenocarcinoma component was therefore diagnosed as a neuroendocrine carcinoma. The two composite carcinoma was diagnosed as MANEC of the distal bile duct. The patient was treated with surgery alone and he remained disease-free for 7 months after the surgery.
DISCUSSION
The treatment of MANECs of the bile duct remains controversial and the prognosis is poor.
CONCLUSIONS
There is no standard treatment for MANECs of the bile duct. Larger studies are required to establish standard treatment regimens.
PubMed: 28854410
DOI: 10.1016/j.ijscr.2017.08.031 -
JTCVS Techniques Oct 2022Clinically, recurrent chylothorax is challenging to solve, especially when chylothorax is still present after the thoracic duct is ligated. In this study we explored...
OBJECTIVES
Clinically, recurrent chylothorax is challenging to solve, especially when chylothorax is still present after the thoracic duct is ligated. In this study we explored alternative surgical options to treat complex cases of recurrent chylothorax.
METHODS
Clinical records, laboratory results, and magnetic resonance imaging scans were retrospectively reviewed for 3 patients with recurrent chylothorax who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from August 8, 2016, to October 30, 2019. Evidence from the surgical treatment of thoracic duct-venous anastomosis was assessed using pictures from the operation room, with follow-up until now.
RESULTS
Thoracic duct ligation had failed twice in patient 1, and the other 2 patients each had thoracic duct ligation that failed once again. After undergoing thoracic duct ligation, all 3 patients showed a significant reduction in chest fluid, but their condition soon returned to the same as that before ligation. All 3 patients finally underwent thoracic duct-venous anastomosis. The changes in lymphocyte and granulocyte numbers in the blood system of the patients before and after the operation were not substantial, and the operations had little effect on liver and kidney function. The patients achieved satisfactory treatment results, with follow-up until the present (23-60 months).
CONCLUSIONS
This research shows that thoracic duct-venous anastomosis is a safe and effective alternative surgical approach for complex recurrent chylothorax.
PubMed: 36276678
DOI: 10.1016/j.xjtc.2022.07.015