scholarly journals Troubleshooting for severe acute cholangitis caused by proximally migrated metal stent into the intrahepatic bile duct: Stent shortening via a balloon catheter

2020 ◽  
Vol 32 (5) ◽  
Author(s):  
Kohei Yamakawa ◽  
Atsuhiro Masuda ◽  
Yuzo Kodama
Keyword(s):  
Bile Duct ◽  
Acute Cholangitis ◽  
Intrahepatic Bile Duct ◽  
Balloon Catheter ◽  
Metal Stent ◽  
Bile Duct Stent

scholarly journals Three Cases of Difficult Bile Duct Stone Removal by EUS-guided Choledochoduodenostomy

2020 ◽  
Vol 25 (2) ◽  
pp. 128-134
Author(s):  
Yeong Joo Jeong ◽  
Man Ki Choi ◽  
Seung Goun Hong
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Bile Duct Stone ◽  
Intrahepatic Bile Duct ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Metal Stent ◽  
Endoscopic Retrograde ◽  
Duration Of Hospital Stay

After failed removal of common bile duct or intrahepatic bile duct (IHD) stones by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous lithotripsy is well-known as an effective procedure. However, it is time-consuming because multiple sessions of transhepatic tract dilatation are required. Endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) has been recently used to approach IHD to remove difficult bile duct stones. We recently experienced EUS-guided CDS performed with metal stent. Common bile duct or IHD stones were removed by retrieval accessories after initial failed or inadequate ERCP in three patients. Serious complications including bleeding, infection, and perforation were not noted. The duration of hospital stay from EUS-guided procedure to discharge ranged from 10 to 14 days. Although this result is interim and ongoing, it suggests that EUS-guided CDS might be an effective and safe procedure after failed ERCP to remove difficult bile duct stones through the tract.

scholarly journals Common bile duct stone development due to a Hem-o-lok clip migration: a rare complication of laparoscopic cholecystectomy

2019 ◽  
Vol 12 (7) ◽  
pp. e230178
Author(s):  
Yong Jun Roh ◽  
Jong Whan Kim ◽  
Tae Joo Jeon ◽  
Ji Young Park
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Stone Formation ◽  
Rare Complication ◽  
Acute Cholangitis ◽  
Balloon Catheter ◽  
Wall Thickening ◽  
Surgical Clip ◽  
Upper Abdominal

Surgical clip migration is a rare complication of laparoscopic cholecystectomy (LC). Surgical clips migrating into the common bile duct (CBD) can lead to stone formation and obstruction. Here, we report a case of acute cholangitis caused by surgical Hem-o-lok clip migration into the bile duct with stone formation 13 months after LC. A 65-year-old man who underwent LC presented with upper abdominal pain and fever for 3 days. Abdominal CT scan showed a radiopaque material in the CBD, diffuse wall thickening and dilatation of intrahepatic and extrahepatic duct. Emergency percutaneous transhepatic biliary drainage was performed. Twodays later, an endoscopic retrograde cholangio-pancreatography was implemented, and muddy stones and one surgical clip were successfully removed by extraction balloon catheter.

Massive left lobe primary hepatolithiasis with extremely high CA 19.9

2013 ◽  
Vol 19 (S4) ◽  
pp. 37-38
Author(s):  
A. Murinello ◽  
P. Guedes ◽  
A.M. Carvalho ◽  
J.S. Coelho ◽  
B.B. Leite ◽  
...  
Keyword(s):  
Bile Duct ◽  
Epigastric Pain ◽  
Acute Cholangitis ◽  
Intrahepatic Bile Duct ◽  
Left Lobe ◽  
Left Hepatectomy ◽  
Caroli Disease ◽  
Acute Calculous Cholecystitis ◽  
Ultrasound Study ◽  
Calculous Cholecystitis

Hepatolithiasis (HL) or intrahepatic calculi is an uncommon condition in Western countries, with a prevalence under 1%. It is much more frequent in East Asia, reaching 20% in China and Taiwan, up to 50% of which show associated cholelithiasis. The authors report a European patient with primary HL of the left hepatic lobe, 12 years after cholecystectomy for acute calculous cholecystitis, now successfully treated after left lobe hepatectomy.A 63-year-old caucasian man with a past medical history of hypertension, coronary artery disease, dyslipidaemia and urgent cholecystectomy 12 years ago (due to an acute calculous cholecystitis without ultrasonographic or perioperative evidence of bile duct dilation or choledocholithiasis, and with no cholangitis ever since) was now admitted to our ward following a 2-day course of fever (39ºC), epigastric pain, nausea, vomiting and tender right upper abdominal quadrant.Bloodwork showed mild leukocytosis with neutrophilia and low platelets; elevated C-reactive protein, γGT, alkaline phosphatase and LDH; normal AST, ALT, bilirubin and amylase. Negative HBV, HCV and HIV serologies. CA19.9 was notably high (7500 U/mL), 200x above normal range (N≤37). A diagnosis of acute cholangitis was assumed on clinical and laboratory basis, despite the absence of jaundice. The patient began therapy with iv ceftriaxone and improved clearly over the next few days. Raised CA19.9 in the setting of acute cholangitis, however, forced us into further study directed at the possibility of underlying biliary or pancreatic malignancy.Abdominal ultrasound disclosed multiple calcifications in the left lobe. CT displayed several left lobe intrahepatic bile duct dilations but no calcifications, thus suggesting intrahepatic cholesterol stones and cholangitis due to an obstacle before the hilum. MR-cholangiography was performed, showing marked dilation of the left intrahepatic bile duct and moderate dilation in the extrahepatic portion of the common bile duct (CBD). Neither exam showed any sign of cancer. Surgery was the therapeutic approach, and the patient underwent a left hepatectomy.Intra-operative ultrasound study unveiled severe dilation of the left intrahepatic bile duct, which was filled with gallstones, but no choledocholithiasis and no tumour whatsoever. Both the surgical procedure and the post-operative period were uneventful.Macroscopic liver section showed multiple dilated bile ductules containing fragile yellowish-green gallstones (Fig.1). Microscopy revealed cystic dilations of the left intrahepatic biliary tree packed with intraluminal gallstones (Fig.2), fibrosis and moderate chronic inflammatory infiltrate with lymphoid aggregates (Fig.3). Some areas of the epithelium displayed erosion and reactive changes. No biliary neoplasm was found.Immunocytochemistry for angiogenesis or lymphocyte membrane markers are not available in our Hospital. Soon after surgery, CA19.9 values decreased abruptly and just 4 months after the left hepatectomy they were back within reference range.Our working hypotheses were primary hepatolithiasis (HL), secondary HL and Caroli disease.Secondary HL, due to stone migration from the CBD, was discarded because calculi in the CBD were absent in the cholecystectomy 12 years ago and in ultrasonographic studies both then and now. Caroli disease, a congenital condition characterised by intrahepatic bile duct dilation, was contradicted by the ultrasonography in 2000 showing normal bile duct dimension. Excluding these two entities made primary idiopathic HL our final diagnosis.The patient is now asymptomatic, having returned to his normal life with no limitations.This report showcases a rare entity known as primary hepatolithiasis, usually causing recurrent cholangitis in older patients of Asian descent but seldom seen in Europe. The steep increase in CA19.9 related to cholangitis, although previously reported, is also very uncommon. Another interesting aspect is the conspicuous inexistence, over 12 years, of recurrent episodes of acute cholangitis (a traditional finding in hepatolithiasis). These three features help to compose this most peculiar case.

EUS-guided intrahepatic bile duct stone extraction via choledochoduodenostomy created by a lumen-apposing metal stent

2016 ◽  
Vol 83 (4) ◽  
pp. 832-833 ◽  
Author(s):  
Shuntaro Mukai ◽  
Takao Itoi ◽  
Takayoshi Tsuchiya ◽  
Reina Tanaka ◽  
Ryosuke Tonozuka
Keyword(s):  
Bile Duct ◽  
Bile Duct Stone ◽  
Intrahepatic Bile Duct ◽  
Metal Stent ◽  
Stone Extraction

Diffuse Caroliʼs Disease: A Rare Form of Intrahepatic Bile Duct Dilatation Presenting with Acute Cholangitis

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S826-S827
Author(s):  
Juan F. Ricardo ◽  
Ahmed I. Salem ◽  
Talal Alkayali ◽  
Wilhelmine Wiese-Rometsch ◽  
Stephen Kucera
Keyword(s):  
Bile Duct ◽  
Acute Cholangitis ◽  
Intrahepatic Bile Duct ◽  
Rare Form ◽  
Bile Duct Dilatation ◽  
Duct Dilatation

scholarly journals Laparotomy-Assisted Direct Cholangioscopy for Bile Duct Stone Removal via an Incision of the Jejunum

2021 ◽  
pp. 674-679
Author(s):  
Shinya Sugimoto ◽  
Toji Murabayashi ◽  
Ayako Ichikawa ◽  
Keita Sato ◽  
Akira Kamei
Keyword(s):  
Bile Duct ◽  
Biliary Drainage ◽  
Epigastric Pain ◽  
Hepatic Duct ◽  
Intrahepatic Bile Duct ◽  
Balloon Catheter ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Caudate Lobe ◽  
Common Hepatic Duct ◽  
Intrahepatic Stones

A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y reconstruction at 42 years of age for intrahepatic stones and liver abscesses. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed bile duct stones and intrahepatic bile duct dilation of the caudate lobe. Bile duct drainage for the caudate lobe was necessary; however, the volume of his caudate lobe was very small, making percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD) difficult. Therefore, we attempted laparotomy-assisted endoscopic biliary drainage. Under general anesthesia, an incision was made on the jejunum approximately 15 cm from the Y-leg anastomosis. An esophagogastroduodenoscope was directly inserted into the common hepatic duct anastomosed with the jejunum. The caudate lobe branch had severe stenosis, and the area upstream of the stenosis was filled with stones, sludge, and pus. The biliary stenosis was dilated using a balloon, and the stones were completely removed using a basket and a balloon catheter. There are various methods of biliary and pancreatic surgery and gastrointestinal reconstruction, and there are cases in which PTBD, EUS-BD, and endoscopic retrograde cholangiopancreatography (ERCP) with an enteroscope are difficult. In such cases, ERCP under laparotomy could be a good treatment option.

Use of a Fogarty Balloon Catheter to Create Backwall Support and Facilitate Intrahepatic Bile Duct Access During Antegrade Stone Extraction

2018 ◽  
Author(s):  
George Carberry ◽  
Orhan Ozkan
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Balloon Catheter ◽  
Stone Extraction ◽  
Biliary Calculi ◽  
Stone Removal ◽  
The Wire ◽  
Upper Gastrointestinal

Percutaneous transhepatic stone removal may be indicated in patients with altered upper gastrointestinal anatomy precluding use of endoscopic stone extraction. When biliary calculi are located in a duct adjacent to the duct cannulated percutaneously, obtaining wire and catheter access into the target duct may be difficult due to the acute angles required of the wire and catheter to access the stone-containing duct. One useful method described and illustrated in this chapter to address this issue involves inflating a balloon catheter downstream from the origin of the target duct to deflect a wire into the target duct and to provide backwall support at the apex of the wire for advancement of the stiff balloon catheter. Once the duct containing the biliary calculi is accessed, sweeps of the calculi can be performed.

Pyogenic Liver Abscess of Biliary Origin: The Existing Problems and Their Strategies

2018 ◽  
Vol 38 (03) ◽  
pp. 270-283 ◽  
Author(s):  
Shao-hua Shi ◽  
Zheng-long Zhai ◽  
Shu-sen Zheng
Keyword(s):  
Bile Duct ◽  
Southeast Asia ◽  
Liver Abscess ◽  
Bile Duct Stone ◽  
Extrahepatic Bile Duct ◽  
Acute Cholangitis ◽  
Intrahepatic Bile Duct ◽  
Pyogenic Liver Abscess ◽  
Bilioenteric Anastomosis ◽  
Existing Problems

AbstractPyogenic liver abscess (PLA) of biliary origin in Southeast Asia mainly occurs in patients with intrahepatic bile duct stone (IBDS) and extrahepatic bile duct stone (EBDS), bilioenteric anastomosis, or biliary stent. IBDS, as an endemic to Southeast Asia, remains a frequent etiology of acute cholangitis and PLA. PLA related to IBDS is characterized by high incidences of PLA recurrence and death related to infection, and difficulties in diagnosis of concomitant cholangicarcinoma. PLA of biliary origin is more likely caused by Escherichia coli, more often presented as polymicrobial infections, and more associated with extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae isolates. In this review, the authors summarize the differences on the presumed causes, pathogens, multidrug resistance, treatment, and prognosis of PLA between biliary origin and cryptogenic origin, the latter serving as a first and foremost presumed etiology of PLA. The authors also discuss the existing problems on early diagnosis of concomitant cholangicarcinoma related to IBDS.

Localized Intrahepatic Bile Duct Dilatation without a Visible Mass or Stone as depicted on CT Images: Findings of Malignancy Prediction

2008 ◽  
Vol 59 (3) ◽  
pp. 163
Author(s):  
Ju Wan Choi ◽  
Gab Chul Kim ◽  
Han Young Jeong ◽  
Hui Joong Lee ◽  
Jae Hyuck Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
Ct Images ◽  
Bile Duct Dilatation ◽  
Duct Dilatation
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