Gallstones and Biliary Tract Emergencies

2020 ◽  
Author(s):  
Luis F. Lobon ◽  
Michael Billington
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Gallbladder Disease ◽  
Diagnosis And Treatment ◽  
Hepatic Bile ◽  
Ascending Cholangitis

Patients with diseases of the biliary tract (which includes the hepatic bili canaliculi, hepatic bile ducts, common bile duct, and gallbladder) typically present with symptoms that include abdominal pain, nausea, vomiting, and jaundice. This review covers the pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for common biliary tract emergencies (cholelithiasis, acute cholecystitis, choledocholithiasis, and ascending cholangitis).  This review contains 5 figures, 11 tables, and 34 references. Keywords: Cholelithiasis, gallbladder disease, acute cholecystitis, gallstones, choledocholithiasis, ascending cholangitis

scholarly journals FIBROCHOLODOSCOPY IN DIAGNOSTICS AND TREATMENT OF COMPLEX FORMS OF CHOLEDOCHOLITHIASIS

2019 ◽  
Vol 21 (1) ◽  
pp. 43-46
Author(s):  
K V Pavelets ◽  
A K Ushkats ◽  
D V Gacko
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Surgical Procedures ◽  
Bile Ducts ◽  
Diagnosis And Treatment ◽  
The Common ◽  
Complex Forms

Relevance of the topic: endoscopic intraoperative choledochoscopy with traditional surgical procedures is a highly informative research in the diagnosis and treatment of choledocholithiasis. Objective: to evaluate the effectiveness of intraoperative use of fibrocholedochoscopy in the diagnosis and treatment of "complex" forms of choledocholithiasis. Materials and methods: Between 2011 and 2017, 88 patients underwent treatment for "complicated" forms of choledocholithiasis using intraoperative fibrocholedochoscopy. Results: after dissection of the choledochal wall and extraction of large concrements from the lumen, a fibrocholedochoscopy was performed. The fibrocholedochoscope was inserted into the lumen of the common bile duct through a formed opening with examination of the biliary tract. An obligatory condition for assessing the permeability of the distal sections of the bile ducts was the carrying out of an endoscope through the OBD zone. The remaining remaining calculi were recovered with the help of Dormia baskets (15 (17%) cases). In 86 (97.7%) patients, the operation is completed by the imposition of a hollow stitch of choledoch (priority reference No. 2018122530, 2018). Conclusion: fibrocholedochoscopy in the treatment of complex forms of choledocholithiasis allows to methodically evaluate the biliary tract, perform lithoextraction from the proximal and distal sections.

CHOLANGITIS AS A SYSTEMIC MANIFESTATION OF ACUTE BILIARY INFECTION

2020 ◽  
pp. 43-47
Author(s):  
A. O. Nekludov ◽  
M. O. Klosova ◽  
O. V. Volchenko ◽  
M. M. Goloborodko ◽  
A. Yu. Korolevska
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Water Column ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Inflammatory Process ◽  
Acute Cholangitis ◽  
Biliary Infection ◽  
The Common ◽  
Further Development

The main causes of cholangitis are hypertension in the biliary ducts and infection. In order to determine the place of the infectious factor in the acute cholangitis development, a retrospective and prospective analysis of case histories of 176 patients with choledocholithiasis and manifestations of acute and chronic cholangitis was performed. Bile from the common bile duct in the patients with obstruction of the biliary tract was studied. In the patients with mechanical jaundice without and with cholangitis, the intraductal pressure in the common bile duct averaged 227.3±26.1 mm of water column, in the patients without signs of cholangitis that was 97.5±8.3 mm of water column. With mechanical jaundice without acute cholangitis, it was slightly elevated if compared to normal. This suggests that the increase in pressure in the bile ducts in acute cholangitis is not influenced by the fact of obstruction of the biliary tract, and the development of the inflammatory process in them. In the patients with cholangitis, the initial values of the number of colonizing units were much higher than in "pure" choledocholithiasis. After endoscopic papillosphincterotomy in the patients with vivid clinical cholangitis, in whom decompression was achieved, in the control study, this value decreased by 100−500 times, which was accompanied by clinical improvement. According to the results of the study, it was noted that in the patients with a manifested clinic sign of cholangitis there is a significant decrease in the number of colonizing units on the third day after endoscopic papillosphincterotomy. At the stone stuck in a papilla the choledoch turns into so−called analog of an abscess. The opening of the papilla provides a free passage of the contents of the choledochus (i.e. pus) into the duodenum, so there is an almost instant therapeutic effect. The increase in pressure in the bile ducts in acute cholangitis is influenced by the development of an inflammatory process, which indicates the manifestations of biliary infection. The presented research has a prospective character and needs further development. Key words: cholangitis, biliary infection, intraductal pressure, bile.

scholarly journals Cholestatic hepatitis as a clinical mask of choledocholithiasis

2016 ◽  
Vol 97 (3) ◽  
pp. 439-442
Author(s):  
D V Pikulev ◽  
O N Vorob’eva
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Hiatal Hernia ◽  
Bile Ducts ◽  
Clinical Laboratory ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Cholestatic Hepatitis ◽  
The Common

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.

Ultrasonography in the Diagnosis of Acute Cholecystitis

1984 ◽  
Vol 25 (5) ◽  
pp. 379-383 ◽  
Author(s):  
M. Kurol ◽  
L. Forsberg
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Biliary Tract ◽  
Ultrasound Examination ◽  
Endoscopic Retrograde ◽  
Quadrant Pain ◽  
Biliary Calculi ◽  
Biliary Ducts ◽  
Normal Ultrasound

Eighty-two patients with right upper quadrant pain and a clinical suggestion of acute cholecystitis had their gallbladder and biliary ducts ultrasonographically examined in the period immediately following admission to the hospital. Biliary calculi or signs of cholecystitis, or both, were found in 65 per cent of the cases at ultrasound examination. An additional 10 per cent had pathologic changes unrelated to the biliary tract. In 44 of 48 cases the presence of calculi or inflammation could be confirmed at surgery, autopsy or endoscopic retrograde cholangiopan-creaticography. Only one patient with a normal ultrasound examination was later found to have a small calculus in a common bile duct of normal caliber.

scholarly journals THE ROLE OF THE INFECTIOUS FACTOR IN THE DEVELOPMENT OF CHOLANGITIS

2021 ◽  
pp. 32-37
Author(s):  
Oleksandr Maloshtan ◽  
Rostyslav Smachilo ◽  
Oleksandr Tishchenko ◽  
Аndrii Nekludov ◽  
Мariia Klosova ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Severe Form ◽  
Duct System ◽  
Histological Picture ◽  
Colony Forming Units ◽  
The Common

Introduction. The problems of the pathogenesis of cholangitis have not been finally clarified to date. Aim: to investigate the dynamics of microbial contamination of the biliary tract in obstructive jaundice before and after decompression. Materials and methods. To determine the significance of the infectious factor in the development of acute cholangitis, bile from the common bile duct was examined in 40 patients with the biliary tract obstruction, which were divided into three groups according to the clinical course of the disease. Results. The quantitative infection indicators of the common bile duct were studied in asymptomatic choledocholithiasis, in obstructive jaundice without clinical manifestations of cholangitis and in a developed clinic of cholangitis. It has been proven that endoscopic decompression of the biliary tree allows to obtain an almost instant therapeutic effect, the number of colony-forming units of the pathogen decreases by almost three orders of magnitude within 3 days. However, in phlegmonous inflammation of the bile duct wall patients, this period was significantly lengthened, and the course of the disease, according to the Tokyo Guidelines (2013), was assessed as severe. Conclusion. In the study of quantitative infection indicators in patients with a bright clinic of cholangitis, a significant decrease in the number of colony-forming units was observed already on the third day after endoscopic papilosphincterotomy due to an adequate drainage effect. When a stone is driven into the large papilla of the duodenum, the common bile duct turns into an analogue of an abscess. Opening the papilla not only frees the mouth of the duct from the stone, but also provides free passage of the contents of the common bile duct (pus) into the duodenum. This provides an almost instant healing effect. When comparing the severity of cholangitis with the histological picture of the wall of the bile ducts (common bile duct, intrahepatic ducts), data were obtained that it is in patients with a severe form of the disease that phlegmonous inflammation of the wall of the duct system takes place. When comparing the severity of cholangitis with the histological picture of the wall of the bile ducts (common bile duct, intrahepatic ducts), data were obtained that phlegmonous inflammation of the wall of the duct system is observed precisely in patients with a severe form of the disease. Keywords: cholangitis, endoscopic decompression

scholarly journals Short-Term Biliary Stent Placement Contributing Common Bile Duct Stone Disappearance with Preservation of Duodenal Papilla Function

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Tatsuki Ueda ◽  
Masataka Kikuyama ◽  
Yuzo Kodama ◽  
Takafumi Kurokami
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Stent Placement ◽  
Bile Ducts ◽  
Common Bile Duct Stones ◽  
Biliary Stent ◽  
Duodenal Papilla ◽  
Short Term ◽  
Endoscopic Retrograde ◽  
Obstructive Cholangitis

Aims. To investigate the effect of biliary stent placement without endoscopic sphincterotomy (EST) on common bile duct stones (CBDS) disappearance and the contribution of preserving the duodenal papilla function to reduce recurrence of CBDS.Methods. Sixty-six patients admitted for acute obstructive cholangitis due to CBDS who underwent biliary stent placement without EST for 2 years from March 2011 were evaluated retrospectively. The second endoscopic retrograde cholangiopancreatography (ERCP) was performed for treatment of CBDS 3 to 4 months after the first ERCP. We estimated the rate of stone disappearance at the time of second ERCP.Results. CBDS disappearance was observed in 32 (48.5%) of 66 patients. The diameter of the bile ducts and the diameter of CBDS in patients with CBDS disappearance were significantly smaller than in those with CBDS requiring extraction (p=0.007andp<0.001, resp.). Stone disappearance was evident when the diameter of bile ducts and that of CBDS were <10 and 7 mm, respectively (p=0.002).Conclusions. Short-term stent placement without EST eliminates CBDS while preserving duodenal papilla function and may be suitable for treating CBDS in patients with nondilated bile ducts and small CBDS.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY IN THE DIAGNOSTICS OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE*

2021 ◽  
Vol 8 (2) ◽  
pp. 62-67
Author(s):  
Valeriy V. Boyko ◽  
Yuriy V. Avdosyev ◽  
Anastasiia L. Sochnieva ◽  
Denys O. Yevtushenko ◽  
Dmitro V. Minukhin
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Percutaneous Transhepatic Cholangiography ◽  
Biliary Decompression ◽  
Biliodigestive Anastomosis ◽  
Bile Duct Diseases

Aim: Evaluation of the effectiveness of percutaneous transhepatic cholangiography in the diagnostics of bile duct diseases complicated by obstructive jaundice. Material and methods: This article presents the experience of using percutaneous transhepatic cholangiography in 88 patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Results: Methods of direct contrasting of the biliary tract make it possible to visualize choledocholithiasis with 86.5% accuracy, with 84.1% common bile duct strictures, with 87.8% stricture of biliodigestive anastomosis and with 97.5% accuracy of cholangiocarcinomas. Conclusions: Direct antegrade bile duct enhancement should be used if ERCPG has low explanatory value. PTCG in case of “endoscopically complicated forms” of choledocholithiasis, CBD and BDA strictures and cholangiocarcinomas enhances all bile duct sections and helps assess the level and completeness of biliary blockade. Following PTCG, measures can be taken to achieve biliary decompression regardless of OJ genesis.

scholarly journals LAPAROSCOPIC CHOLEDOCH REVISION FOR THE TREATMENT OF CHOLEDOCHOLITHIASIS IN AN INFANT

2019 ◽  
Vol 23 (4) ◽  
pp. 220-223
Author(s):  
M. Yu. Kozlov ◽  
Anton S. Malashenko ◽  
A. A. Shchebeteev
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Ducts ◽  
Open Abdomen ◽  
Unified Approach ◽  
Endoscopic Retrograde ◽  
Surgical Practice ◽  
Percutaneous Puncture ◽  
The Common

Choledocholithiasis is a rare pathology in children. Various techniques have been proposed for removing calculi from the common bile duct: percutaneous puncture drainage of bile ducts, endoscopic retrograde cholangiopancreatography with papillosphincterotomy as well as revision of the common bile duct which can be done laparoscopically or in the open abdomen. However at present, there is no any unified approach to managing this pahtology in children. The article describes authors’ experience of laparoscopic revision of the common bile duct in an infant with choledocholithiasis. The authors consider that this technique can be applied in pediatric surgical practice.

scholarly journals Rhabdomyosarcoma of the biliary tract: a case report

2017 ◽  
Vol 4 (3) ◽  
pp. 1093 ◽  
Author(s):  
Asmaa Kouadir ◽  
Abderrahmane El Mazghi ◽  
Khalid Hassouni
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Biliary Tract ◽  
Clinical Symptoms ◽  
Treatment Approach ◽  
Imaging Techniques ◽  
Multidisciplinary Treatment ◽  
Rare Tumor ◽  
The Common

Rhabdomyosarcoma (RMS) of the biliary tract is a rare tumor that commonly arises from the common bile duct. The most common clinical symptoms are obstructive jaundice and abdominal pain. Although diagnosis is often difficult and is frequently made during surgery, diagnostic imaging techniques including ultrasound, computerized tomography scan, and magnetic resonance cholangiopancreatography remain useful in the diagnosis and evaluation of biliary tree anatomy. In order to improve prognosis, different rhabdomyosarcoma study groups have adopted multidisciplinary treatment approach. Herein we describe a case of three-year-old child with Embryonal rhabdomyosarcoma originating in the common bile duct who was treated with surgery, chemotherapy according to European soft tissue sarcoma group (EpSSG) protocol and adjuvant postoperative intensity modulated radiotherapy to surgical bed with 6 MV photons to a dose of 41, 4Gy in 23 fractions. One year and a half after the end of therapy, the patient is still disease free. Although Rhabdomyosarcoma of the biliary tract is a rare tumor, it should be considered in the differential diagnosis of patients who have obstructive jaundice and a cystic mass within the common bile duct. Once believed to be an incurable disease, the prognosis of patients with biliary rhabdomyosarcoma has improved with a multidisciplinary treatment approach.

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