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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 -
The American Surgeon Jan 2021
Topics: Aged, 80 and over; Bile Duct Diseases; Cholecystectomy; Choledochal Cyst; Cystic Duct; Female; Humans
PubMed: 32870020
DOI: 10.1177/0003134820945235 -
Pediatric Surgery International 1999A rare hepatobiliary malformation in which the common hepatic duct drains directly into the gallbladder or the cystic duct (cholecystohepatic duct) is described in two... (Review)
Review
A rare hepatobiliary malformation in which the common hepatic duct drains directly into the gallbladder or the cystic duct (cholecystohepatic duct) is described in two children born with oesophageal atresia. Attention is drawn to the rarity of this combination. A brief review of the literature of cholecystohepatic and accessory hepatic ducts is also presented.
Topics: Abnormalities, Multiple; Cholestasis, Extrahepatic; Cystic Duct; Esophageal Atresia; Female; Hepatic Duct, Common; Humans; Infant, Newborn; Male; Tracheoesophageal Fistula
PubMed: 9914348
DOI: 10.1007/s003830050503 -
Nihon Rinsho. Japanese Journal of... Nov 1998The cystic duct are variable in length, course and site of termination. A knowledge of the variable anatomy of the cystic duct and cysticohepatic junction is important... (Review)
Review
The cystic duct are variable in length, course and site of termination. A knowledge of the variable anatomy of the cystic duct and cysticohepatic junction is important in biliary surgery, because failure to recognize anatomic variations may result in a significant ductal injury. Magnetic resonance cholangiography (MRC) is a recently developed technique that demonstrates the biliary tree noninvasively and without injection of contrast material. Anatomic variants of the cystic duct and cysticohepatic junction that may increase the risk of bile duct injury in biliary surgery are frequently identified with MRC. MRC will be a noninvasive and a useful technique in the diagnosis of anatomic variants of the cystic duct and cysticohepatic junction.
Topics: Cystic Duct; Hepatic Duct, Common; Humans; Magnetic Resonance Imaging
PubMed: 9847621
DOI: No ID Found -
Der Chirurg; Zeitschrift Fur Alle... Sep 1994Laparoscopic cholecystectomy is both resulting in a slightly higher incidence of biliary lesions and a change of prevalence of the type of lesions. Damage to the biliary... (Review)
Review
Laparoscopic cholecystectomy is both resulting in a slightly higher incidence of biliary lesions and a change of prevalence of the type of lesions. Damage to the biliary system occurs in 4 different types: The most severe case is the lesion with a structural defect of the hepatic or common bile duct with (IVa) or without (IVb) vascular injury. Tangential lesions without structural loss of the duct should be denominated as type III (IIIa with additional lesion to the vessels, type IIIb without). Type II comprehends late strictures without obvious intraoperative trauma to the duct. Type I includes immediate biliary fistulae of usually good prognosis. The increasing prevalence of structural defects of the bile ducts appears to be a peculiarity of laparoscopic cholecystectomy necessitating highly demanding operative repair. In the majority of cases, hepatico-jejunostomy or even intraparenchymatous anastomoses are required. Adaptation of well proven principles of open surgery is the best prevention of biliary lesions in laparoscopic cholecystectomy as well as the readiness to convert early to the open procedure.
Topics: Biliary Fistula; Cholecystectomy, Laparoscopic; Cholelithiasis; Cholestasis; Common Bile Duct; Hepatic Duct, Common; Humans; Intraoperative Complications; Postoperative Complications; Radiography; Reoperation; Risk Factors; Suture Techniques
PubMed: 7995083
DOI: No ID Found -
Journal of Pediatric Surgery Sep 2012Spontaneous bile duct perforation in infants is rare, with less than 150 cases having been reported worldwide. With a highly variable presentation, diagnosis and... (Review)
Review
Spontaneous bile duct perforation in infants is rare, with less than 150 cases having been reported worldwide. With a highly variable presentation, diagnosis and treatment can prove challenging, and outcomes are not without significant morbidity. We herewith report the case of an 8-week-old male infant with spontaneous bile duct perforation. He initially presented with abdominal sepsis and septated ascites on ultrasound, which was confirmed as bilious on ascitic tap and at diagnostic laparoscopy. Intraoperative cholangiogram demonstrated a localized leak at the junction of the cystic and common bile duct. Conversion to laparotomy was ultimately required with cholecystostomy, and 2 external intraabdominal drains were placed. He was subsequently managed conservatively with 4 weeks external drainage, with a repeat cholangiogram at 6 weeks, demonstrating successful resolution of the leak. The reported case supports the findings of changing practices in the existing literature. We suggest that, in cases of spontaneous bile duct perforation with no distal obstruction, dissection and surgery to the biliary tree are not always required. Conservative management with simple external drainage can have its complications but, as shown here, can be a successful treatment option in terms of healing of perforation.
Topics: Bile Duct Diseases; Common Bile Duct; Common Bile Duct Diseases; Cystic Duct; Drainage; Humans; Infant; Male; Radiography; Rupture, Spontaneous; Ultrasonography
PubMed: 22974619
DOI: 10.1016/j.jpedsurg.2012.06.023 -
Transplantation Proceedings 2021In right-lobe liver grafts, variations in the biliary tree anatomy can result in multiple bile duct orifices. We present our experience of 10 patients in which biliary...
BACKGROUND
In right-lobe liver grafts, variations in the biliary tree anatomy can result in multiple bile duct orifices. We present our experience of 10 patients in which biliary reconstruction was performed with the cystic duct for 1 of the anastomoses with 2 separated ducts. Also, we investigated whether the bile duct anastomosis technique, number of bile duct anastomoses, and use of biliary stents affect the rate of biliary complications.
METHODS
We evaluated patients who underwent right-lobe living donor liver transplantation (LDLT) at İstinye University Hospital and İstanbul Aydın University Hospital between December 2017 and June 2020. The patients were divided into 4 groups: duct-to-duct (D-D), duct-to-sheath, double duct-to-duct, and duct-to-duct plus cystic duct-to-duct. Biliary complication rates were compared among these 4 groups, between single- and double-duct groups, and between stent (+) and stent (-) groups.
RESULTS
Ninety-three patients who underwent right-lobe LDLT (60 men, 33 women) with a mean age of 51 ± 13 years were included. Mean follow-up time was 18.5 ± 8.3 months. The overall biliary complication rate was 17.2% for all patients, 12.1% for the D-D (single-duct) group (33 patients), 16.1% for the duct-to-sheath group (31 patients), 26.3% for the double duct-to-duct group (19 patients), 20% for the duct-to-duct plus cystic duct-to-duct group (10 patients), 20% for the double-duct group (60 patients), 14.5% for the stent (+) group (69 patients), and 25% for the stent (-) group (24 patients). There were no significant differences among these groups in terms of biliary complication rates. Bile stricture occurred in only 1 cystic duct anastomosis (10%), and no bile leakage was observed.
CONCLUSIONS
Multiple D-D biliary reconstruction using the cystic duct with external drainage tubes is feasible and safe for LDLT.
Topics: Adult; Anastomosis, Surgical; Bile Ducts; Cystic Duct; Female; Humans; Liver; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Complications
PubMed: 34233848
DOI: 10.1016/j.transproceed.2021.06.005 -
The Journal of Trauma Dec 1991A laceration-avulsion injury of the hepatic duct from blunt trauma is described. Operative findings rather than preoperative studies led to the correct diagnosis. A... (Review)
Review
A laceration-avulsion injury of the hepatic duct from blunt trauma is described. Operative findings rather than preoperative studies led to the correct diagnosis. A combination of suture repair, left hepatic duct ligation, and hepaticojejunostomy were used to primarily manage this complex injury. Postoperative hepatobiliary scintigraphy and clinical follow-up over 1 year demonstrate satisfactory biliary drainage. Principles of the management of hepatic duct injury are reviewed.
Topics: Abdominal Injuries; Adolescent; Hepatic Duct, Common; Humans; Male; Radiography; Wounds, Nonpenetrating
PubMed: 1749047
DOI: 10.1097/00005373-199112000-00024 -
Journal of Laparoendoscopic & Advanced... Oct 2003Laparoscopic cholecystectomy is associated with an increase in biliary injuries, particularly in acute inflammatory conditions. The cystic lymph node enlarges in most... (Review)
Review
Laparoscopic cholecystectomy is associated with an increase in biliary injuries, particularly in acute inflammatory conditions. The cystic lymph node enlarges in most cases of acute cholecystitis. Staying lateral to the node avoids major bile duct injury during dissection of the cystic duct and cystic artery. An enlarged cystic node can thus be used as an endpoint in the dissection of the Calot triangle.
Topics: Bile Duct Diseases; Cholecystectomy, Laparoscopic; Common Bile Duct; Gallbladder Diseases; Hepatic Duct, Common; Humans; Intraoperative Complications; Risk Factors; Video-Assisted Surgery
PubMed: 14617391
DOI: 10.1089/109264203769681718 -
HPB Surgery : a World Journal of... Aug 1993Granular [correction of Granulosa] cell tumors are rare benign tumors which may be found throughout the body. Rare cases are isolated within the biliary tree. If... (Review)
Review
Granular [correction of Granulosa] cell tumors are rare benign tumors which may be found throughout the body. Rare cases are isolated within the biliary tree. If completely resected, surgical excision is curative. A case of biliary duct granular [correction of granulosa] cell tumor is presented with review of the world's literature on this topic.
Topics: Adult; Bile Duct Neoplasms; Female; Follow-Up Studies; Granular Cell Tumor; Hepatic Duct, Common; Humans
PubMed: 8217927
DOI: 10.1155/1993/68037