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Scandinavian Journal of Gastroenterology Jan 1993The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and...
The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and by gross intraoperative examinations in 468 surgical patients with biliary diseases. The cystic duct entered the hepatic duct at a very low position and was consequently long in 39 patients. The clinical significance of this abnormally low junction of the cystic duct was studied in comparison with 358 patients with gallstones with a normal cystic duct-hepatic duct junction. In the low-junction group with a short common bile duct several complications, including gallstone pancreatitis (7 patients), the Mirizzi syndrome (7), confluence stones (2), gallbladder cancer (3), and congenital dilation of the cystic duct (1), were demonstrated preoperatively. The anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct, producing a choledochopancreatic ductal junction and posing difficulties at surgery.
Topics: Adult; Aged; Aged, 80 and over; Cholangiography; Cholelithiasis; Cystic Duct; Female; Hepatic Duct, Common; Humans; Male; Middle Aged
PubMed: 8430277
DOI: 10.3109/00365529309096050 -
World Journal of Clinical Cases Feb 2014Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of...
Variations in the bile duct and pancreatic duct opening are related to the process of rotation and recanalization during embryologic development. Complete non-union of distal common bile duct and pancreatic duct gives rise to double papillae of Vater. The separation of the drainage of the main pancreatic duct and bile duct can be appreciated by careful assessment at the time of endoscopic retrograde cholangiopancreatograpy. The cranial orifice is a bile duct opening, whereas the caudal orifice is a pancreatic duct opening. The separate orifice finding can be confirmed by cholangiogram and pancreatogram with no communication between the two orifices. Endoscopists should be aware of this rare variant because late recognition can result in unnecessary manipulation and contrast injections of the main pancreatic duct and biliary cannulation failure.
PubMed: 24579069
DOI: 10.12998/wjcc.v2.i2.36 -
Canadian Journal of Surgery. Journal... Dec 1993To determine the nature of bile duct injuries during laparoscopic cholecystectomy, the treatment of these injuries and patient outcome.
OBJECTIVE
To determine the nature of bile duct injuries during laparoscopic cholecystectomy, the treatment of these injuries and patient outcome.
DESIGN
Case series review.
SETTING
Two tertiary care hospitals.
PATIENTS
Twenty-one patients (average age 37 years) who sustained bile duct injuries during laparoscopic cholecystectomy over a 2-year period. Two groups were analysed: patients whose injury was recognized intraoperatively (9 patients) and patients in whom it was diagnosed postoperatively (12 patients).
INTERVENTIONS
Laparoscopic cholecystectomy, duct-to-duct repair over a T tube, Roux-en-Y hepaticojejunostomy, endoscopic cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC).
RESULTS
Misidentification of the common duct during laparoscopic cholecystectomy, resulting in accidental division or resection of a portion of the duct, and obstruction of the duct by hemoclips were the most common types of injury. Pain, jaundice and bile collections were the typical presenting features of injuries that became evident after laparoscopic cholecystectomy. ERCP and PTC accurately defined the injuries. Immediate duct-to-duct repair over a T tube was associated with a high failure rate. Twenty of the 21 patients required Roux-en-Y hepaticojejunostomy for definitive treatment. There were no deaths.
CONCLUSIONS
Proper identification of the pertinent anatomy will prevent the majority of these injuries. Prompt radiographic visualization of the biliary tract is indicated in patients who have pain, jaundice and bile collections postoperatively. A hepaticojejunostomy is the procedure of choice for repair of these bile duct injuries.
Topics: Adult; Anastomosis, Roux-en-Y; Bile Duct Diseases; Bile Ducts; Bile Ducts, Intrahepatic; Cholecystectomy, Laparoscopic; Cholestasis; Cholestasis, Extrahepatic; Common Bile Duct; Common Bile Duct Diseases; Constriction, Pathologic; Elective Surgical Procedures; Female; Follow-Up Studies; Hepatic Duct, Common; Humans; Intraoperative Complications; Jejunum; Male; Middle Aged; Postoperative Complications
PubMed: 8258129
DOI: No ID Found -
Zentralblatt Fur Chirurgie Apr 2016
Topics: Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Common Bile Duct; Expert Testimony; Gallstones; Germany; Hepatectomy; Hepatic Duct, Common; Humans; Jejunostomy; Malpractice; Medical Errors; Reoperation
PubMed: 27088270
DOI: 10.1055/s-0036-1583227 -
Surgical Laparoscopy, Endoscopy &... Jun 1999Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare, with only six... (Review)
Review
Although an aberrant hepatic duct entering the cystic duct is not especially rare, the main right hepatic duct entering the cystic duct is extremely rare, with only six cases reported thus far. All of the reported patients underwent open cholecystectomy, during which one patient received a bile duct injury. The anomaly was unsuspected preoperatively in all of these cases. We report an additional patient with this anomaly, the first such case diagnosed before laparoscopic cholecystectomy using direct cholangiography. Cholangiography may be mandatory whenever biliary anomalies are suspected during laparoscopic cholecystectomy. As the right hepatic duct entering the cystic duct can lead to ductal injury, this anomaly should be kept in mind when performing laparoscopic cholecystectomy.
Topics: Adult; Cholangiography; Cholecystectomy, Laparoscopic; Cystic Duct; Hepatic Duct, Common; Humans; Male; Preoperative Care
PubMed: 10804003
DOI: No ID Found -
Arab Journal of Gastroenterology : the... Jun 2020The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs....
The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.
Topics: Bile Duct Neoplasms; Biliary Tract Surgical Procedures; Diagnosis, Differential; Female; Hepatic Duct, Common; Humans; Ki-67 Antigen; Klatskin Tumor; Magnetic Resonance Imaging; Middle Aged; Neoplasm Grading; Neoplasm Staging; Neuroendocrine Tumors; Treatment Outcome
PubMed: 32423858
DOI: 10.1016/j.ajg.2020.04.003 -
African Journal of Paediatric Surgery :... 2018Spontaneous perforation of common bile duct is a rare phenomenon; few cases are reported in literature. Hence, there is a dilemma for the management of these cases, but...
Spontaneous perforation of common bile duct is a rare phenomenon; few cases are reported in literature. Hence, there is a dilemma for the management of these cases, but with modern radiological equipment and high degree of suspicion, it is possible to diagnose early. The overall prognosis of this condition is good, provided an early surgical intervention is instituted; we are reporting a case of a 6-year-old male with spontaneous perforation of common hepatic duct. Managed by repair of rent over T-tube, postoperative period was uneventful, T-tube was removed after 3 weeks, and the patient is doing well in follow-up.
Topics: Bile Duct Diseases; Biopsy; Child; Cholangiography; Hepatic Duct, Common; Humans; Laparotomy; Male; Postoperative Period; Spontaneous Perforation
PubMed: 30829311
DOI: 10.4103/ajps.AJPS_74_17 -
Hepatobiliary & Pancreatic Diseases... Oct 2019
Topics: Aged, 80 and over; Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct; Common Bile Duct Diseases; Dilatation, Pathologic; Endosonography; Female; Foreign Bodies; Humans; Sphincterotomy, Endoscopic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31378473
DOI: 10.1016/j.hbpd.2019.07.009 -
Journal of Hepato-biliary-pancreatic... 2008An 84-year-old woman was admitted to the hospital because of pyloric stenosis caused by gastric cancer. Abdominal computed tomography and magnetic resonance imaging...
An 84-year-old woman was admitted to the hospital because of pyloric stenosis caused by gastric cancer. Abdominal computed tomography and magnetic resonance imaging failed to demonstrate the gallbladder, but showed a gallstone in a duct-like structure parallel to the common bile duct. When laparotomy was performed, the gallbladder and the fossa were not observed, and a blind-end duct, similar to a cystic duct, was found beside the common bile duct. Incisional exploration of the common bile duct was done after distal gastrectomy; the gallstone was not found in the common bile duct, but in the duct parallel to it. By observing the duct beneath the common bile duct with a cholangioscope, we considered it to be a hypoplastic cystic duct. After the gallstone was removed, a T-tube was placed into the common bile duct. Agenesis of the gallbladder is a rare congenital anomaly and is often asymptomatic. As far as we know, this is the first report of gallbladder agenesis with a hypoplastic cystic duct impacted with a stone. Careful intraoperative examination using a cholangioscope is useful to confirm the structure of the common bile duct.
Topics: Aged, 80 and over; Cholelithiasis; Cystic Duct; Female; Gallbladder; Humans; Stomach Neoplasms
PubMed: 18392719
DOI: 10.1007/s00534-007-1236-3 -
Vestnik Khirurgii Imeni I. I. Grekova 1998
Review
Topics: Acute Disease; Adenoma; Aged; Bile Duct Neoplasms; Cholestasis, Intrahepatic; Hepatic Duct, Common; Humans; Hyperplasia; Male
PubMed: 9751990
DOI: No ID Found