Journal articles: 'Biliary duct obstruction'

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Tanaka, Toshiyuki, Hideo Akiyoshi, Keiichiro Mie, Hitoshi Shimazaki, and Fumihito Ohashi. "Drip infusion cholangiography with CT in cats." Journal of Feline Medicine and Surgery 20, no. 12 (December 1, 2017): 1173–76. http://dx.doi.org/10.1177/1098612x17738615.

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Objectives Ultrasonography can detect extrahepatic biliary obstructions. However, visualisation of part of the bile duct using ultrasonography can be technically difficult if there is overlying bowel gas. This study investigated the safety and value of drip infusion cholangiography with computed tomography (DIC-CT) in the visualisation of the bile duct in healthy cats and extrahepatic biliary obstruction in cats with cholelithiasis. Methods DIC-CT was performed in three healthy cats and two cats with cholelithiasis. Meglumine iotroxate was administered by intravenous drip infusion over 30 mins. The attenuation value was measured perpendicular to the lumen by a region of interest covering about 50% of the area of the lumen. Results The bile ducts were visualised successfully with DIC-CT in all healthy cats without any significant adverse events. The attenuation value of the contrast medium was 271 ± 37 HU. In the two cats with cholelithiasis, the presence or absence of extrahepatic biliary obstruction was determined using DIC-CT without any significant adverse events. The attenuation value of cholelithiasis in the cat with an extrahepatic biliary obstruction was 933 ± 119 HU. In the cat with no extrahepatic biliary obstruction, the attenuation value of the contrast medium was 249 ± 53 HU and the attenuation value of cholelithiasis was 167 ± 28 HU. Conclusions and relevance DIC-CT visualises bile ducts and detects obstructive biliary disease without significant adverse events. Therefore, it appears to be a safe procedure for visualisation of the bile duct in cats.

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K.S., Swasthik, Preetha Sundaresan, and Varun Vijayan. "Extra-Hepatic Biliary Obstruction - A Cross-Sectional Study to Assess the Various Benign and Malignant Causes for Obstructive Jaundice among Patients Attending Trivandrum Medical College." Journal of Evolution of Medical and Dental Sciences 10, no. 9 (March 1, 2021): 600–603. http://dx.doi.org/10.14260/jemds/2021/129.

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BACKGROUND Extra-hepatic biliary tract obstruction can be due to a number of conditions. Most causes are due to stones in the common biliary duct or due to malignant obstruction. Malignant causes include carcinoma head of pancreas, periampullary carcinoma and cholangiocarcinoma. Besides calculus and malignant obstruction, benign and malignant strictures can also cause obstruction of extra hepatic biliary ducts. The objectives of the study were to describe the clinical profile of patients presenting with extra-hepatic biliary obstruction and to assess the known aetiological factors. METHODS The research was designed as a hospital based cross-sectional study in the general surgery wards of our institution from 2016 to 2017. All individuals who were diagnosed to have extra-hepatic biliary obstruction by imaging were included in the study. RESULTS Among the 66 cases studied, majority were due to malignancies and gall stones. The malignancies included carcinoma head of pancreas, periampullary carcinoma, cholangiocarcinoma and Klatskin’s tumour. Miscellaneous causes were bile duct stricture, cholelithiasis with biliary sludge and annular pancreas. For the malignant cases, Whipple surgery and its pylorus-preserving variant were the most common surgical procedures carried out. Biliary bypass procedures were also carried out in some patients. For patients with common bile duct (CBD) stones, cholecystectomy, choledocholithotomy and choledochojejunostomy were done. CONCLUSIONS Malignant causes of jaundice are more common than benign causes. Secondary stones are the commonest cause of non-malignant biliary obstruction. Jaundice is more severe and associated with pruritis and more intolerable and persistent in malignancy. Surgical bypass procedures give good palliation for obstructive jaundice. KEY WORDS Bile Ducts, Choledocholithiasis, Cholestasis, Extra Hepatic, Pancreatic Cancer, Periampullary Cancer

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Camacho, Juan C., Lynn A. Brody, and Anne M. Covey. "Treatment of Malignant Bile Duct Obstruction: What the Interventional Radiologist Needs to Know." Seminars in Interventional Radiology 38, no. 03 (August 2021): 300–308. http://dx.doi.org/10.1055/s-0041-1731269.

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AbstractManagement of malignant bile duct obstruction is both a clinically important and technically challenging aspect of caring for patients with advanced malignancy. Bile duct obstruction can be caused by extrinsic compression, intrinsic tumor/stone/debris, or by biliary ischemia, inflammation, and sclerosis. Common indications for biliary intervention include lowering the serum bilirubin level for chemotherapy, ameliorating pruritus, treating cholangitis or bile leak, and providing access for bile duct biopsy or other adjuvant therapies. In some institutions, biliary drainage may also be considered prior to hepatic or pancreatic resection. Prior to undertaking biliary intervention, it is essential to have high-quality cross-sectional imaging to determine the level of obstruction, the presence of filling defects or atrophy, and status of the portal vein. High bile duct obstruction, which we consider to be obstruction above, at, or just below the confluence (Bismuth classifications IV, III, II, and some I), is optimally managed percutaneously rather than endoscopically because interventional radiologists can target specific ducts for drainage and can typically avoid introducing enteric contents into isolated undrained bile ducts. Options for biliary drainage include external or internal/external catheters and stents. In the setting of high obstruction, placement of a catheter or stent above the ampulla, preserving the function of the sphincter of Oddi, may lower the risk of future cholangitis by preventing enteric contamination of the biliary tree. Placement of a primary suprapapillary stent without a catheter, when possible, is the procedure most likely to keep the biliary tree sterile.

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Stojanovic, Dragos, Mirjana Stojanovic, Predrag Milojevic, Zorica Caparevic, Djordje Lalosevic, and Dragan Radovanovic. "Strategies for endoscopic and surgical management of common bile duct stones." Medical review 56, no. 1-2 (2003): 69–75. http://dx.doi.org/10.2298/mpns0302069s.

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Introduction Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitis. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. Classification From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs,2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Discussion Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Conclusion Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.

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Mamontov, I. N., T. I. Tamm, K. A. Kramarenko, S. G. Belov, A. Ya Bardiuk, V. V. Nepomniashchyi, A. P. Zakharchuk, O. M. Reshetniak, and E. A. Shakalova. "The risk factors for development of an acute biliary pancreatitis and its signs in obstruction of extrahepaic bilairy ducts." Klinicheskaia khirurgiia 86, no. 10 (October 21, 2019): 3–7. http://dx.doi.org/10.26779/2522-1396.2019.10.03.

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Objective. A search for factors, promoting development of an acute biliary pancreatitis, and peculiarities of its signs in patients, suffering obstruction of extrahepatic biliary ducts. Materials and methods. Retrospective analysis of treatment in 283 patients, suffering obstruction of extrahepaic biliary ducts, was conducted, together with various indices analysis in patients, suffering an acute biliary pancreatitis and without acute biliary pancreatitis. Results. An acute biliary pancreatitis was diagnosed in 30 (10.6%) patients. Trustworthy differences (p < 0.05) were revealed, concerning pronounced pain syndrome, hyperthermia, leukocytosis, young neutrophils, general bilirubin, amylase in the blood, the gallbladder volume, choledocholithiasis, the fixed calculus and stenosis of duodenal papilla magna, cholangitis. Big calculi of hepaticocholedochus did not associated with development of an acute biliary pancreatitis, and a sludge in common biliary duct and stenosis of duodenal papilla magna were characteristic for an acute biliary pancreatitis (p < 0.001). Conclusion. Sludge of common biliary duct, stenosis and fixed calculus of duodenal papilla magna, bilirubinemia 70 mcmol/l and higher constitute the risk factors for development of an acute biliary pancreatitis, and the pronounced abdominal pain syndrome, hyperthermia, hyperamylasemia, leucocytosis, increase of the young neutrophils content up to 7% and higher, the volume of a gallbladder 50 cm3 and more - served as the signs of an acute biliary pancreatitis in obstruction of extrahepatic biliary ducts. In obstruction of extrahepatic biliary ducts with an acute biliary pancreatitis, comparing with obstruction of extrahepatic biliary ducts without an acute biliary pancreatitis, cholangitis is revealed trustworthily: 16.7 and 5.1% accordingly (p < 0.05).

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Rousslang, Lee K., Omar Faruque, Kyler Kozacek, and J. Matthew Meadows. "Percutaneous Transhepatic Cholangioscopy and Stone Extraction in a Patient with Recurrent Cholangitis Following Liver Trauma." Journal of Clinical Imaging Science 11 (February 25, 2021): 11. http://dx.doi.org/10.25259/jcis_165_2020.

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Percutaneous transhepatic cholangioscopy (PTCS) is a safe and effective treatment for obstructive biliary stones, when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful or unavailable. Once percutaneous access is gained into the biliary tree by an interventional radiologist, the biliary ducts can be directly visualized and any biliary stones can be managed with lithotripsy, mechanical fragmentation, and/or percutaneous extraction. We report a case of a 45-year-old man who sustained a traumatic liver laceration and associated bile duct injury, complicated by bile duct ectasia and intrahepatic biliary stone formation. Despite undergoing a cholecystectomy, multiple ERCPs, and percutaneous transhepatic cholangiogram with drain placement, the underlying problem was not corrected leading to recurrent bouts of gallstone pancreatitis and cholangitis. He was ultimately referred to an interventional radiologist who extracted the impacted intrahepatic biliary stones that were thought to be causing his recurrent infections through cholangioscopy. This is the first case of PTCS with biliary stone extraction in the setting of recurrent biliary obstruction and cholangitis due to traumatic bile duct injury.

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Doi, Yasuhiro, Yasushi Takii, Hiroyuki Ito, Norihiko Jingu, Kentaro To, Sinichiro Kimura, Koichi Kimura, et al. "Usefulness of Endoscopic Managements in Patients with Ceftriaxone-Induced Pseudolithiasis Causing Biliary Obstruction." Case Reports in Medicine 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/3835825.

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Ceftriaxone (CTRX) is known to cause reversible biliary stones/sludge, which is called biliary pseudolithiasis. We report two rare cases of biliary obstruction by pseudolithiasis shortly after completing CTRX treatment. Stones and sludge, which had not been detected before CTRX administration, appeared in the gallbladder and common bile duct and led to biliary obstruction and acute cholangitis. The obstructions were successfully treated with endoscopic retrograde biliary drainage and endoscopic sphincterotomy. CTRX-induced biliary pseudolithiasis has been reported mainly in children and adolescents but is also seen in adults with similar incidence rate. Although CTRX-induced biliary pseudolithiasis is usually asymptomatic and disappears spontaneously after discontinuing the drug, some patients develop biliary obstruction. Endoscopic managements should be considered in such cases.

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Tanoue, Kazuo, Takashi Kanematsu, Takashi Matsumata, Ken Shirabe, Keizo Sugimachi, and Chikao Yasunaga. "Successful Surgical Treatment of Hepatocellular Carcinoma Invading Into Biliary Tree." HPB Surgery 4, no. 3 (January 1, 1991): 237–44. http://dx.doi.org/10.1155/1991/80824.

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A 41-year-old woman was admitted to hospital with obstructive jaundice. Computed tomography showed a large mass in the right hepatic lobe and marked dilatation of the biliary tree in the left lateral segment of the liver. Angiography showed evidence of neovascularity. Percutaneous transhepatic cholangiography revealed complete obstruction of the common bile duct just below the bifurcation. The serum level of alpha-fetoprotein on admission was 1,080,000 ng/ml. These findings suggested to us a primary hepatocellular carcinoma invading the intrahepatic bile duct. Extended right lobectomy and hepaticojejunostomy for bile drainage was carried out. The patient is doing well 3 years after surgery.Hepatocellular carcinoma (HCC) invading to the portal vein is not so rare, but invasion into the bile duct is much less common. In 1947, Mallory1 described a single case of HCC invading the gallbladder and obstructing extrahepatic bile ducts. In 1975, Lin2 termed this HCC “Icteric type hepatoma”. The incidence of such HCC in Japan was reported to be 1.9-9%2,3.Obstructive jaundice is a clinical manifestation of the terminal stage in HCC. We describe here our treatment of a woman with HCC invading the common bile duct. Right extended lobectomy and reconstruction of hepaticojejunostomy were effective.

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Zarubin, V. V., A. P. Kurazhov, V. D. Zavadovskaja, O. V. Rodionova, O. S. Tonkikh, I. Yu Klinovitskiy, M. A. Zorkaltsev, and V. I. Haritonkin. "CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC CHOLANGIOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF THE MALIGNANT AND BENIGN CAUSES OF BILIARY OBSTRUCTION." Siberian journal of oncology 20, no. 4 (August 30, 2021): 39–48. http://dx.doi.org/10.21294/1814-4861-2021-20-4-39-48.

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Introduction. Determination of the cause of cholestasis and treatment of patients with obstructive jaundice syndrome remains challenging owing to the steady rise in diseases of the hepatopancreatoduodenal zone and the high frequency of diagnostic errors. In the differential diagnosis of the causes of obstructive jaundice, diagnostic imaging techniques are of the greatest importance. In the world literature, there are few reports on the assessment of the diagnostic potential of multispiral computed tomography under conditions of direct contrasting of the biliary tree using endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or through pre-installed palliative drainage in the bile ducts. There is no generally accepted algorithm for determining the causes of biliary obstruction. It leads to ineffective use of various diagnostic imaging techniques, complicating the diagnostic process.The purpose of the study was to evaluate the diagnostic efficacy of contrast-enhanced ct cholangiography (ct-cg) in the differential diagnosis of causes of malignant and benign biliary obstruction in cases with obstructive jaundice syndrome.Material and methods. The study included 55 patients with obstructive jaundice, who were treated in a surgical hospital from july 2016 to july 2019.Results. It was found that contrast ct-cg in diagnosing the causes of biliary obstruction of both malignant and benign genesis is more informative than x-ray endoscopic retrograde cholangiopancreatography. The diagnostic efficacy of ct-cg in detecting causes of malignant biliary obstruction was: 93.3% sensitivity, 92.9% specificity, and 93.1% accuracy. The diagnostic efficacy of ct-cg in detecting causes of benign biliary obstruction was: 92.9%, 93.3% and 93.1%, respectively.Conclusion. Based on the high accuracy, contrast-enhanced ct-cg is a promising imaging technique in cases with bile duct obstruction.

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Volynets, G. V., A. I. Khavkin, and A. V. Nikitin. "Modern view of biliary atresia in children." Experimental and Clinical Gastroenterology, no. 1 (May 2, 2020): 40–55. http://dx.doi.org/10.31146/1682-8658-ecg-173-1-40-55.

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Atresia of the biliary tract, or biliary atresia (BA), is a destructive, inflammatory disease in which progressive biliary tree fibrosis in an infant leads to obstruction of the bile ducts and, as a result, to cirrhosis of the liver. If untreated, progressive cirrhosis leads to death by 2 years. Biliary atresia can be divided into 3 types, each of which depends on the level closest to biliary obstruction. Type I (obstruction of the common bile duct), type II (patency of the bile ducts to the level of the common hepatic duct), type III (obstruction at the level of the gates of the liver). It is very important to distinguish between types of BA and conduct differential diagnosis with other cholestatic diseases. There are nonsyndromic, syndromic, and BA, combined with other malformations. In diagnostics, in addition to clinical manifestations and specific changes in blood biochemical parameters characterizing cholestasis, an ultrasound examination of the abdominal cavity organs, gepatobiliscintigraphy, magnetic resonance cholecystopancreatocholangiography, according to indications, a puncture biopsy of the liver and histological examination are performed. The main method of treatment is hepatoportoenterostomy according to Kasai, which must be performed no later than 3 months, and with liver cirrhosis and hepatic insufficiency, liver transplantation. Additional methods of treatment include the use of ursodeoxycholic acid, fat-soluble vitamins.

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Colovic, Radoje, Nikica Grubor, Vladimir Radak, Marjan Micev, and Stojan Latincic. "Cholangiocellular carcinoma of the common hepatic duct causing obstructive jaundice in a patient with metastatic colonic carcinoma within liver." Srpski arhiv za celokupno lekarstvo 138, no. 1-2 (2010): 88–90. http://dx.doi.org/10.2298/sarh1002088c.

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Introduction. Colorectal carcinoma, one of the most frequent carcinomas, produces liver metastasis very frequently. Surprisingly, those secondaries rarely cause obstructive jaundice. If it appears, it is usually caused by compression or infiltration of the major bile ducts close to the hepatic hilus, less frequently with bile duct obstruction by gelatinous mucus produced by the tumour, much rarer by the tumour growth within the, otherwise intact, common bile duct and very rarely by metastasis into the biliary tree. Case Outline. We present a 67-year-old man who had been submitted to left colectomy for sygmoid colon carcinoma four years earlier, now, admitted with an obstructive jaundice, along with a number of liver and lung secondaries. Obstructive jaundice was caused by the vegetative tumour of the proximal part of the common hepatic duct which was resected and anastomosed with a Roux-en-Y jejunal limb. The postoperative recovery was uneventful. The patient died 7 months later without jaundice due to liver and lung secondaries. Histological findings showed cholangiocellular carcinoma of the common hepatic duct, while the histological findings of the liver tumour specimen confirmed metastatic colonic carcinoma. Conclusion. In case of obstructive jaundice in patients with metastatic colonic carcinoma within liver, other aethiological factors of biliary obstruction can not be excluded and have to be taken into differential diagnosis.

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Andreev, A. V., V. M. Durleshter, A. I. Leveshko, S. A. Gabriel, and E. V. Tokarenko. "Antegrade biliary stenting for obstructive jaundice." Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery 24, no. 2 (June 24, 2019): 25–35. http://dx.doi.org/10.16931/1995-5464.2019225-35.

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Objective. To determine the role bile duct stenting with self-expandable metallic stents in the treatment of malignant obstructive jaundice. Material and methods. Eight-year experience of palliative antegrade stenting with self-expandable metallic stents was analyzed. There were 218 patients with malignant obstructive jaundice. Distal and proximal obstruction was diagnosed in 118 (54%) and 100 (46%) patients, respectively. We have used self-expandable metallic covered, partially covered and bare-metal stents with diameter of 10, 8 and 6 mm and length of 40, 60 and 80 mm. Results. Technical success in antegrade two-stage installation of self-expandable stents have been achieved in 208 (99%) patients. There were 230 deployed self-expandable metallic stents. Seven (3%) patients underwent simultaneous stenting of right and left hepatic ducts and confluence area with bare-metal stents. Stenting of right or left hepatic ducts and confluence area with partially covered stents was carried out in 34 (16%) patients. Other 59 (27%) patients with proximal biliary obstruction and no separation of lobar bile ducts underwent stenting with 27 partially covered and 31 covered stents. Distal obstruction was managed by using of covered stents as a rule (63%). Complications after antegrade biliary stenting occurred in 29 (13%) patients. Conclusion. Antegrade biliary stenting with metallic self-expandable stents is effective and minimally invasive approach. Moreover, it is comparable with conventional palliative interventions aimed at bile outflow recovery.

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Dumonceau, Jean-Marc, Andrea Tringali, Ioannis Papanikolaou, Daniel Blero, Benedetto Mangiavillano, Arthur Schmidt, Geoffroy Vanbiervliet, et al. "Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017." Endoscopy 50, no. 09 (August 7, 2018): 910–30. http://dx.doi.org/10.1055/a-0659-9864.

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Main RecommendationsESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence.

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Menon, Shyam, and Andrew Holt. "Large-duct cholangiopathies: aetiology, diagnosis and treatment." Frontline Gastroenterology 10, no. 3 (January 4, 2019): 284–91. http://dx.doi.org/10.1136/flgastro-2018-101098.

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Cholangiopathies describe a group of conditions affecting the intrahepatic and extrahepatic biliary tree. Impairment to bile flow and chronic cholestasis cause biliary inflammation, which leads to more permanent damage such as destruction of the small bile ducts (ductopaenia) and biliary cirrhosis. Most cholangiopathies are progressive and cause end-stage liver disease unless the physical obstruction to biliary flow can be reversed. This review considers large-duct cholangiopathies, such as primary sclerosing cholangitis, ischaemic cholangiopathy, portal biliopathy, recurrent pyogenic cholangitis and Caroli disease.

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Brugge, William R. "Endoscopic Techniques to Diagnose and Manage Biliary Tumors." Journal of Clinical Oncology 23, no. 20 (July 10, 2005): 4561–65. http://dx.doi.org/10.1200/jco.2005.19.729.

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Malignancies of the bile duct are often suspected in patients with abnormal serum hepatic enzyme levels and obstruction of the biliary system. Although cross-sectional imaging can provide evidence for biliary obstruction and a malignancy arising from the bile duct, a definitive diagnosis is often obtained through the use of endoscopic procedures. Endoscopic retrograde cholangiopancreatography (ERCP), the most commonly performed procedure for cholangiocarcinoma, can provide a tissue diagnosis through brush cytology of the bile duct. Relief from biliary obstruction can be provided with temporary plastic stenting or permanent metal stenting. Photodynamic therapy guided by ERCP may provide improved palliation from biliary obstruction in the future. Endoscopic ultrasonography complements the role of ERCP and may provide a tissue diagnosis through fine-needle aspiration and staging through ultrasound imaging. High-resolution ultrasound images can provide detailed information regarding the relationship between a mass and the bile duct wall. Despite these advances in endoscopic techniques and imaging of the bile duct, a tissue diagnosis often remains elusive in many patients. In the future, molecular markers will be employed to improve the sensitivity for the detection of malignancy in bile duct samples obtained through brushing, aspiration, and biopsy.

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Dʼalmeida, Rosario, Coralie Barbe, Valérie Untereiner, Fidy Ramaholimihaso, Pascal Renard, Ganesh D. Sockalingum, Roselyne Garnotel, and Gérard Thiefin. "White bile in patients with malignant biliary obstruction is an independent factor of poor survival." Endoscopy International Open 09, no. 02 (February 2021): E203—E209. http://dx.doi.org/10.1055/a-1324-2721.

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Abstract Background and study aims White bile is defined as a colorless fluid occasionally found in the biliary tract of patients with bile duct obstruction. Its significance is not clearly established. Our objective was to analyze the prognostic value of white bile in a series of patients with biliary obstruction due to biliary or pancreatic cancer. Patients and methods The study was conducted on a series of consecutive patients with malignant obstructive jaundice. They all underwent endoscopic retrograde cholangiopancreatography with collection of bile and biliary stent insertion. White bile was defined as bile duct fluid with bilirubin level < 20 µmol/L. Univariate and multivariate analyses were performed to identify variables associated with overall survival (OS). Results Seventy-three patients were included (32 pancreatic cancers, 41 bile duct cancers). Thirty-nine (53.4 %) had white bile. The mean bile duct bilirubin level in this group was 4.2 ± 5.9 µmol/L vs 991 ± 1039 µmol/L in patients with colored bile (P < 0.0001). In the group of 54 patients not eligible for surgery, the multivariate analysis demonstrated an association between the presence of white bile and reduced OS (HR 2.3, 95 %CI 1.1–4.7; P = 0.02). Other factors independently associated with OS were metastatic extension (HR 2.8, 95 %CI 1.4–5.7) and serum total bilirubin (HR 1.003, 95 %CI 1.001–1.006). There was a significant inverse correlation between serum and bile duct bilirubin levels (r = –0.43, P = 0.0001). Conclusion White bile in patients with inoperable malignant biliary obstruction is an independent factor of poor survival.

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Guorong, Xu, C. J. C. Kirk, and A. W. Goode. "Changes in Biliary Lipid Concentrations in Bile Duct Obstruction: An Experimental Study." Journal of the Royal Society of Medicine 79, no. 9 (September 1986): 522–27. http://dx.doi.org/10.1177/014107688607900908.

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Changes in biliary concentrations of bile acids, phospholipids and cholesterol and biliary pressures were measured in dogs. These parameters were studied during 7-day periods of partial biliary obstruction, of varying degrees, and after 24-hour and 48-hour periods of complete obstruction. The samples were obtained via an exteriorized but intact enterohepatic circulation allowing the introduction of varying degrees of obstruction and bile sampling. Biliary obstruction reduced the concentration of all biliary lipids especially when the obstruction produced pressures in excess of 75% of the maximum biliary secretion pressure. Only immediately after the release of a 48-hour period of complete obstruction did the risk of cholesterol supersaturation of bile occur. However, at that time there was a greatly reduced concentration of lipids in the bile and the amount of cholesterol that could potentially have precipitated was very small. It is suggested that this supersaturation would not play a significant role in the formation of gallstones.

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Vij, Mukul, and Mohamed Rela. "Biliary atresia: pathology, etiology and pathogenesis." Future Science OA 6, no. 5 (June 1, 2020): FSO466. http://dx.doi.org/10.2144/fsoa-2019-0153.

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Biliary atresia is a progressive fibrosing obstructive cholangiopathy of the intrahepatic and extrahepatic biliary system, resulting in obstruction of bile flow and neonatal jaundice. Histopathological findings in liver biopsies include the expansion of the portal tracts, with edematous fibroplasia and bile ductular proliferation, with bile plugs in duct lumen. Lobular morphological features may include variable multinucleate giant cells, bilirubinostasis and hemopoiesis. The etiopathogenesis of biliary atresia is multifactorial and multiple pathomechanisms have been proposed. Experimental and clinical studies have suggested that viral infection initiates biliary epithelium destruction and release of antigens that trigger a Th1 immune response, which leads to further injury of the bile duct, resulting in inflammation and obstructive scarring of the biliary tree. It has also been postulated that biliary atresia is caused by a defect in the normal remodelling process. Genetic predisposition has also been proposed as a factor for the development of biliary atresia.

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Daneze, Edmilson Rodrigo, Guilherme Azevedo Terra, Júverson Alves Terra Júnior, Aline Gomes de Campos, Alex Augusto da Silva, and Sílvia Azevedo Terra. "Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines." Acta Cirurgica Brasileira 26, suppl 2 (2011): 31–37. http://dx.doi.org/10.1590/s0102-86502011000800007.

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PURPOSE: To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS: Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS: The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION: Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.

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Kapur, B. M. L., M. C. Mishra, P. S. V. Rao, and R. K. Tandon. "Gall Bladder And Common Bile Duct Stones – When Is Direct Cholangiography Indicated?" HPB Surgery 1, no. 3 (January 1, 1989): 201–5. http://dx.doi.org/10.1155/1989/51967.

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The medical records of 277 consecutive patients who underwent cholecystectomy for benign gall stone disease, were reviewed to determine the incidence and cause of biliary tract obstructuion.Obstructive jaundice (icteric obstructive biliopathy) was present in 38 cases. This was due to choledocholithiasis in 22, Mirizzi's Syndrome in two, biliobiliary fistula in eight and biliary stricture in five patients. Preoperative direct cholangiography (ERCP/PIC) was helpful.Anicteric patients were classified on the basis of a history of jaundice, serum alkaline phosphatase, sonography and operative findings. Anicteric patients with evidence of biliary tract pathology (anicteric obstructive biliopathy) had a significant incidence of choledocholithiasis (33.3% ). Biliary complications were uncommon in this group (4.3%). Peroperative cholangiography was carried out and was valuable in these patients but was normal in all 83 patients who had no evidence of biliary obstruction.

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Deipolyi, Amy, and Anne Covey. "Palliative Percutaneous Biliary Interventions in Malignant High Bile Duct Obstruction." Seminars in Interventional Radiology 34, no. 04 (December 2017): 361–68. http://dx.doi.org/10.1055/s-0037-1608827.

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AbstractThe optimal palliative intervention for malignant biliary obstruction is internal drainage by placement of a metallic stent. For patients with hilar biliary obstruction or low bile duct obstruction in whom endoscopy is not feasible, a percutaneous transhepatic approach in interventional radiology is preferred. This article reviews the rationale for this approach, periprocedural management, and techniques to optimize stent patency.

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Dronov, A. I., I. L. Nastashenko, Yu P. Bakunets, P. P. Bakunets, and L. V. Levchenko. "Problematic issues of endoscopic biliary stenting." Klinicheskaia khirurgiia 86, no. 7 (July 7, 2019): 13–17. http://dx.doi.org/10.26779/2522-1396.2019.07.13.

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Objective. To study the results of endoscopic biliary stenting (EBS) for biliary obstruction of various genesis to determine the problematic issues of the procedure and possibility of its efficacy raising. Materials and methods. Experience of conduction of 5748 endoscopic transpapillary interventions in 2010 - 2017 yrs was analyzed: endoscopic papillosphincterotomy was performed in 2919 (50.8%) observations, stenting of biliary ducts - in 379 (6.6%). In 296 (78.1%) observations plastic stents (PS) were introduced, while in 83 (21.9%) – the self-expanding metallic stents. Results. Of 208 patients, in whom primary temporary EBS was performed for tumoral biliary obstruction, using PS, in 153 (73.6%) the next stage of treatment have constituted elective operation in 10 - 14 days after elimination of hyperbilirubinemia, signs of cholangitis, additional examination and determination of the intervention volume. Among these patients in 56 (36.6%) radical operations were performed, and in 97 (63.4%) – palliative operations. In 47 patients PS for closure of external biliary fistula (EBS) PS was introduced: in 13 (27.7%) – for tubular stenosis of distal part of common biliary duct, in 7 (14.9%) – for insufficiency of sutures of common biliary duct (after choledocholithotomy), in 14 (29.8%) – for intraoperative damages of extrahepatic biliary ducts, in 5 (10.6%) – for presence of Luschka channels, in 8 (17.0%) – for a state after hepatic resection, echinococectomy. Presence of concrements, which due to some reasons were not removed endocopically, in environment of purulent cholangitis have constituted the indication for performance of EBS in 24 (8.1%) observations, chronic pancreatitis, complicated by obturation jaundice – in 9 (3.0%). Correction of iatrogenic damages of biliary ducts with development of their partial strictures, EBF, using EBS with introduction of PS, were performed in 8 (2.7%) patients. Conclusion. The necessity exists to study the treatment results in patients, suffering biliary obstruction of various genesis, to determine problematic issues of the main procedures and possibilities of their efficacy raising.

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Miranda-Díaz, A. G., H. Alonso-Martínez, J. Hernández-Ojeda, O. Arias-Carvajal, A. D. Rodríguez-Carrizalez, and L. M. Román-Pintos. "Toll-Like Receptors in Secondary Obstructive Cholangiopathy." Gastroenterology Research and Practice 2011 (2011): 1–10. http://dx.doi.org/10.1155/2011/265093.

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Secondary obstructive cholangiopathy is characterized by intra- or extrahepatic bile tract obstruction. Liver inflammation and structural alterations develop due to progressive bile stagnation. Most frequent etiologies are biliary atresia in children, and hepatolithiasis, postcholecystectomy bile duct injury, and biliary primary cirrhosis in adults, which causes chronic biliary cholangitis. Bile ectasia predisposes to multiple pathogens: viral infections in biliary atresia; Gram-positive and/or Gram-negative bacteria cholangitis found in hepatolithiasis and postcholecystectomy bile duct injury. Transmembrane toll-like receptors (TLRs) are activated by virus, bacteria, fungi, and parasite stimuli. Even though TLR-2 and TLR-4 are the most studied receptors related to liver infectious diseases, other TLRs play an important role in response to microorganism damage. Acquired immune response is not vertically transmitted and reflects the infectious diseases history of individuals; in contrast, innate immunity is based on antigen recognition by specific receptors designated as pattern recognition receptors and is transmitted vertically through the germ cells. Understanding the mechanisms for bile duct inflammation is essential for the future development of therapeutic alternatives in order to avoid immune-mediated destruction on secondary obstructive cholangiopathy. The role of TLRs in biliary atresia, hepatolithiasis, bile duct injury, and primary biliary cirrhosis is described in this paper.

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Goh, Mervin Feng Ji, Malcolm Han Wen Mak, Yee Low, and Caroline Choo Phaik Ong. "Congenital or acquired? Obstructive jaundice in reoperated duodenal atresia." BMJ Case Reports 12, no. 8 (August 2019): e231021. http://dx.doi.org/10.1136/bcr-2019-231021.

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A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.

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MALANGONI, MARK A., D. MARK McCOY, J. DAVID RICHARDSON, and LEWIS M. FLINT. "Effective Palliation of Malignant Biliary Duct Obstruction." Annals of Surgery 201, no. 5 (May 1985): 554–59. http://dx.doi.org/10.1097/00000658-198505000-00003.

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Blanton, Christie, John Kalarickal, and Virendra Joshi. "Biliary Obstruction From a Bile Duct Mass." Gastroenterology 141, no. 3 (September 2011): 812–1129. http://dx.doi.org/10.1053/j.gastro.2010.06.082.

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Jakhete, Neha R., David Victor, and Zhiping Li. "A Rare Case of Biliary Duct Obstruction." Clinical Gastroenterology and Hepatology 12, no. 12 (December 2014): e117-e118. http://dx.doi.org/10.1016/j.cgh.2014.05.016.

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KON, YOH-ICHI, TUGIO HIGUCHI, KEN IGARASHI, TOHRU KIMURA, NORIYUKI NAGAMATA, TAKASHI AOKI, HIROAKI HAGIWARA, et al. "ENDOSCOPIC BILIARY DRAINAGE FOR BILE DUCT OBSTRUCTION." KITAKANTO Medical Journal 36, no. 2 (1986): 193–201. http://dx.doi.org/10.2974/kmj1951.36.193.

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29

Jeyarajah, D. Rohan, Mariusz L. Kielar, Hoosein Saboorian, Prameela Karimi, Nicole Frantz, and Christopher Y. Lu. "Impact of bile duct obstruction on hepatic E. coli infection: role of IL-10." American Journal of Physiology-Gastrointestinal and Liver Physiology 291, no. 1 (July 2006): G91—G94. http://dx.doi.org/10.1152/ajpgi.00095.2004.

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Biliary obstruction in the setting of hepatic bacterial infection has great morbidity and mortality. We developed a novel murine model to examine the effect of biliary obstruction on the clearance of hepatic Escherichia coli infection. This model may allow us to test the hypothesis that biliary obstruction itself adversely affects clearance of hepatic infections even if the bacteria are introduced into the liver by a nonbiliary route. We ligated the bile ducts of C57BL/6 mice on days − 1, 0, or + 1, relative to a day 0 portal venous injection of E. coli. We monitored survival, hepatic bacterial growth, pathology, and IL-10 protein levels. The role of IL-10 in this model was further examined using IL-10 knockout mice. Mice with bile duct ligation at day +1 or 0, relative to portal venous infection at day 0, had decreased survival compared with mice with only portal venous infection. The impaired survival was associated with greater hepatic bacterial growth, hepatic necrosis, and increased production of IL-10. Interestingly, the transgenic knockout of IL-10 resulted in impaired survival in mice with bile duct ligation and portal venous infection. Biliary obstruction had a dramatic detrimental effect on hepatic clearance of portal venous E. coli infection. This impaired clearance is associated with increased IL-10 production. However, transgenic knockout of IL-10 increased mortality after hepatic infection.

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Martinez, Nichol S., Sumant Inamdar, Sheila N. Firoozan, Stephanie Izard, Calvin Lee, Petros C. Benias, Arvind J. Trindade, and Divyesh V. Sejpal. "Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions." Endoscopy International Open 09, no. 06 (May 27, 2021): E888—E894. http://dx.doi.org/10.1055/a-1388-6964.

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Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

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Shinozaki, Hiroharu, Yuuichi Sasakura, Satoshi Shinozaki, Toshiaki Terauchi, Junichi Matsui, Kenji Kobayashi, Alan Kawarai Lefor, and Yoshiro Ogata. "Cholangiocarcinoma Presenting after Eight Years of Treatment of IgG4-Related Autoimmune Pancreatitis with Steroids." Case Reports in Gastroenterology 15, no. 1 (February 5, 2021): 154–62. http://dx.doi.org/10.1159/000512402.

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Autoimmune pancreatitis (AIP) is characterized by pancreatic manifestations of IgG4-related disease. Malignancies in patients with AIP have been reported, but carcinoma of the bile duct is extremely rare. We report a patient with IgG4-related AIP who developed cholangiocarcinoma after 8 years of steroid treatment. A 76-year-old male presented with fever (37.8°C) due to biliary obstruction and cholangitis. He had been treated with steroids for 8 years to control inflammation due to IgG4-related AIP. During 8 years of treatment, hepatobiliary enzyme levels were well controlled within their normal range, but serum IgG4 levels remained elevated. A computed tomography scan showed intrahepatic bile duct dilatation. Magnetic resonance cholangiopancreatography showed obstructive changes at the junction of the cystic and common ducts. To relieve biliary obstruction, endoscopic bile duct drainage using a nasobiliary tube was performed, and cytology was Class IV. Aorto-caval lymph node enlargement was found at laparotomy, intraoperatively diagnosed as adenocarcinoma, and resection was abandoned. He died 4 months postoperatively. We report a patient with IgG4-related AIP complicated by cholangiocarcinoma which developed after 8 years of steroid treatment. Even if hepatobiliary markers are well controlled, periodic follow-up with imaging studies may facilitate detection of an early cholangiocarcinoma.

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32

Paiva Neto, Manoel Camelo de, Rosimara Eva Ferreira Almeida, Marcelo Magalhães Xavier, Gustavo Henrique Soares Takano, Orlando de Castro e. Silva Jr, Carlos Augusto Teixeira da Cruz, and João Batista de Sousa. "Influence of glutamine on morphological and functional changes of liver in the presence of extrahepatic biliary obstruction in rats." Acta Cirurgica Brasileira 25, no. 4 (August 2010): 375–80. http://dx.doi.org/10.1590/s0102-86502010000400014.

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PURPOSE: To study the influence of glutamine on functional and morphological changes of liver in the extrahepatic biliary obstruction through an experimental model in rats. METHODS: Seventy Wistar rats were divided into four groups: control (group C) fictitious operation, (group FO), submitted to laparotomy with handling of bile ducts, but without hepatic duct ligation, (group EBO) submitted to laparotomy and hepatic duct ligation, one of them submitted to supplementation with glutamine 2% (group G). The control group consisted of 6 animals. The animals from groups FO, EBO and G were divided into three groups consisting of 6 animals each, being sacrificed at 7, 14 and 21 days after operation, respectively. Blood samples were collected for biochemical analysis and a fragment of liver tissue was collected from the middle lobe for histological analysis. RESULTS: Both for biochemical analysis (BT, aspartate and alanine aminotransferase AST, ALT and alkaline phosphatase FAL) and for histopathological changes (fibrosis, portal inflammation, parenchymal inflammation, hepatocytic changes and duct proliferation), no statistical difference between groups submitted to extrahepatic biliary obstruction (EBO) with and without treatment with glutamine (G) was observed. CONCLUSION: Glutamine supplementation did not alter the prognosis of liver enzymes and histopathological changes in animals submitted to extrahepatic biliary obstruction.

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Matsushita, Kazuki, Ken Kageyama, Natsuhiko Kameda, Yurina Koizumi, and Akira Yamamoto. "Obstructive Jaundice Following Transarterial Chemoembolization for Hepatocellular Carcinoma with Bile Duct Invasion." Journal of Clinical Interventional Radiology ISVIR 5, no. 02 (June 30, 2021): 127–30. http://dx.doi.org/10.1055/s-0041-1730850.

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AbstractHepatocellular carcinoma (HCC) with bile duct invasion is considered rare. A case in which a fragment of intraductal tumor dropped into the common bile duct after transarterial chemoembolization (TACE) and caused abdominal pain, and obstructive jaundice secondary to biliary obstruction is presented. This case was successfully managed by emergent endoscopic sphincterotomy. Physicians should recognize one of the complications due to TACE for HCC with intraductal tumor invasion.

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Sharma, Ankush, Priyansh Jariwala, and Navneet Kaur. "Biliary ascariasis presenting with gangrenous perforation of the gall bladder: report of a case and brief review of literature." Tropical Doctor 48, no. 3 (April 13, 2018): 242–45. http://dx.doi.org/10.1177/0049475518768103.

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The most common cause of gallbladder perforation is calculous cholecystitis. Rarer causes include trauma, iatrogenic injuries, biliary stasis and gall bladder ischemia. We report a case of gall bladder gangrene with perforation, secondary to extensive ascariasis. A 45-year-old woman presented with acute intestinal obstruction and jaundice. She had abdominal distension and right hypochondrial tenderness. Abdominal radiography showed dilated bowel loops and ultrasonogram showed worms in the small intestine and biliary tree. On exploration, a bolus of worms 2 feet proximal to the ileocaecal junction was found causing obstruction. Worms were also present in the bile duct and gallbladder causing gangrene and perforation. She underwent cholecystectomy, bile-duct exploration and enterotomy. However, she died on the third postoperative day of overwhelming sepsis. Enteric complications of ascaris leading to bowel obstruction are well-known. Hepatobiliary complications such as cholangitis and obstructive jaundice are rare. However, such an extreme degree of infestation leading to gangrene and perforation of the gall bladder is extremely rare.

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Younes, R. N., N. A. Vydelingum, P. Derooij, F. Scognamiglio, L. Andrade, M. C. Posner, and M. F. Brennan. "Metabolic Alterations in Obstructive Jaundice: Effect of Duration of Jaundice and Bile-Duct Decompression." HPB Surgery 5, no. 1 (January 1, 1991): 35–48. http://dx.doi.org/10.1155/1991/27457.

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We examined the effect of prolonged bile duct obstruction, and subsequent biliary decompression, on biochemical and metabolic parameters, using a reversible jaundice model in male Fischer 344 rats. The animals were studied after biliary obstruction for varying periods (4 days, one week, and two weeks) and following decompression. They were sacrificed one or two weeks following decompression. All the rats were compared to sham operated, pair-fed, controls. Obstructive jaundice rapidly increased bilirubin, liver enzymes, serum free fatty acid, and triglyceride levels. Glucose levels were significantly decreased in the jaundice rats compared to their pair-fed controls. Only after two weeks of jaundice was significant hypoalbuminemia observed. Following decompression, all biochemical and metabolic values gradually returned to normal levels, except for albumin. Hypoalbuminemia was not reversed within the two-week post-decompression period. The rats jaundiced for two weeks had significantly higher mortality, compared to the other groups. We conclude that prolonged jaundice adversely affects the metabolic capacity of the rats, with albumin concentration being markedly decreased, and that biliary decompression could not reverse completely all the alterations seen with cholestasis, especially following two weeks of bile duct obstruction.

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Sciarra, Amedeo, Roxane Hessler, Sébastien Godat, Montserrat Fraga, Clarisse Dromain, Rafael Duran, Nermin Halkic, and Christine Sempoux. "Heterotopic Gastric Mucosa in a Duplication Cyst of the Common Hepatic Duct Mimicking Cholangiocarcinoma." International Journal of Surgical Pathology 26, no. 1 (August 22, 2017): 84–88. http://dx.doi.org/10.1177/1066896917727101.

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Heterotopic gastric mucosa in biliary tract is a congenital anomaly that can prove significant clinical dilemmas. Here we report the case of a 28-year-old female patient presenting with jaundice, pruritus, and altered liver tests, with predominant cholestasis. Liver biopsy revealed histological changes suggesting large bile duct obstruction with advanced fibrosis. At imaging, common hepatic duct stricture due to an intraluminal enhancing mass was observed. Endoscopic retrograde cholangiopancreatography and upper echoendoscopy revealed a firm mass of the common hepatic duct with a complete obstruction, suspicious for cholangiocarcinoma. Fine-needle aspiration biopsy performed under echoendoscopic guidance revealed fundic type gastric mucosa. Despite histological result, radiological suspicion of malignancy together with advanced fibrosis prompted a segmental resection of biliary tract. At macroscopic examination, the common hepatic duct presented a focal pseudocystic appearance with a firm zone of subtotal stenosis. Histology revealed a duplication cyst lined by heterotopic fundic gastric mucosa. Heterotopic gastric mucosa of the biliary tract should be suspected in young patients without know risk factors for hepatobiliary malignancies. Imaging and careful histological examination are mandatory for optimal management. Liver fibrosis, secondary to chronic biliary obstruction may be a significant late complication.

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Lau, W. Y., C. K. Leow, K. L. Leung, Thomas W. T. Leung, Michael Chan, and Simon C. H. Yu. "Cholangiographic Features in the Diagnosis and Management of Obstructive Icteric Type Hepatocellular Carcinoma." HPB Surgery 11, no. 5 (January 1, 2000): 299–306. http://dx.doi.org/10.1155/2000/79241.

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In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable, 67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition.

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Suzuki, Yuko, Yusuke Hashimoto, Taro Shibuki, Motoyasu Kan, Gen Kimura, Kumiko Umemoto, Kazuo Watanabe, et al. "Endoscopic Ultrasound-Guided Gallbladder Drainage for Aberrant Right Posterior Duct Obstruction Developing after Placement of a Covered Self-Expandable Metallic Stent in a Patient with Distal Biliary Obstruction." Case Reports in Gastroenterology 12, no. 3 (November 28, 2018): 722–28. http://dx.doi.org/10.1159/000492215.

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Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been utilized as an alternative endoscopic technique for patients with acute cholecystitis. In addition to EUS-guided hepaticogastrostomy and EUS-guided cystogastrostomy, EUS-GBD has been reported as being useful for biliary drainage in cases with distal malignant biliary obstruction instead of conventional endoscopic retrograde cholangiopancreatography. We present a case of successful EUS-GBD for malignant obstruction of an aberrant hepatic duct draining directly into the cystic duct.

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Kuramoto, Tomomi, Hiroya Senzaki, Hiroyuki Koike, Kenji Yamagiwa, Shinobu Tamura, Tokuzou Fujimoto, and Takeshi Inagaki. "Cholestatic Jaundice as a Paraneoplastic Manifestation of Prostate Cancer." Case Reports in Urology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/303727.

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Paraneoplastic syndrome associated with prostate cancer is extremely rare. We report a patient who presented with cholestatic jaundice without biliary duct obstruction, hepatic involvement, or infection. After a few detailed examinations, prostate cancer was diagnosed. After treatment with bicalutamide and leuprolide, the patient’s symptoms and laboratory abnormalities were reversed. Cholestatic jaundice was regarded as a paraneoplastic manifestation in this patient. The patient remains symptom-free after 14-month followup. Paraneoplastic syndrome should be considered in case of cholestatic jaundice without biliary duct obstruction, hepatic involvement, or infection.

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Mygind, T., and V. Hennild. "Expandable Metallic Endoprostheses for Biliary Obstruction." Acta Radiologica 34, no. 3 (May 1993): 252–57. http://dx.doi.org/10.1177/028418519303400310.

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Expandable metal stents (20 Gianturco Z-stents and 1 Strecker stent deployed through 8.5 F sheaths) were used with initial success for palliating bile duct obstruction in 10 patients, 8 with malignant and 2 with benign strictures. Short-term failure occurred in one patient after 2 weeks, one died of unrelated causes after 10 days, and one remained jaundiced due to fulminant liver metastases. In the remaining 7 patients the obstruction was markedly palliated, with normalization of the serum bilirubin. Four have died without recurrent bile duct obstruction after a mean of 5.9 months, the 2 with benign strictures are well after 4 and 7 months, and one patient is presently palliated with a plastic endoprosthesis following reocclusion after 4 months. Expandable stents were easier to insert than conventional percutaneous endoprostheses of plastic polymers, and had longer patency in several patients, but reocclusion by tumor growth remains a constant threat in malignant disease. Metallic stents may be the therapy of choice in recurrent benign strictures, although the definitive conclusion needs longer observation and larger materials.

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Xuan, Jingjing, Lingxiang Che, and Yao Liu. "Ultrasonic Diagnosis of Intestinal Loop Obstruction After Introducing Loop Syndrome After Subtotal Gastrectomy." Journal of Medical Imaging and Health Informatics 11, no. 6 (June 1, 2021): 1695–703. http://dx.doi.org/10.1166/jmihi.2021.3686.

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In this paper, a graphical diagnosis of intestinal loop obstruction input into the loop syndrome after subtotal gastrectomy based on ultrasound diagnosis is more fluid accumulating in the bridge loop. The pressure in the intestinal loop is constantly rising, causing bile and pancreatic juice excretion disorder, and dilation of intrahepatic and external bile ducts or dilation of pancreatic ducts, which is similar to the anatomical features of low biliary obstruction. For dilated bowel, the expansion of the upstream drainage pipe organ changes in physiological and pathological anatomy pathological bridge loop obstruction. The ultrasound can show good and on the ming stomach ultrasound pictures of patients with loop syndrome after major resection were analyzed. Most patients with hepatic shape changed the left hepatic duct dilatation, and the inner diameter is 4.8 cm and the length is 18.0 cm. The wall of the tube is a multi-layer structure, and fold-like echoes can be seen. The lumen does not pass through the angle between the superior mesenteric artery and the abdominal aorta. Patients with a history of pancreas Whillp or Child type surgery or a history of Roux-en-Y type biliary jejunum have clinical manifestations of bowel obstruction. The ultrasound of their bridge loop obstruction showed a long tubular anechoic dark area in the upper abdomen and dilation of the upstream drainage organ duct.

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Knap, Daniel, Natalia Orlecka, Renata Judka, Aleksandra Juza, Michał Drabek, Maciej Honkowicz, Tomasz Kirmes, Bartosz Kadłubicki, Dominik Sieroń, and Jan Baron. "Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage." Alexandria Journal of Medicine 52, no. 2 (June 1, 2016): 185–91. http://dx.doi.org/10.1016/j.ajme.2015.07.003.

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Walker, David. "Clinical Forum: canine pancreatitis and biliary duct obstruction." Companion Animal 18, no. 2 (April 2013): 40–44. http://dx.doi.org/10.12968/coan.2013.18.2.40.

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Schaafsma, Irene, Kate Bradley, Andrew Denning, and Esther Barett. "Clinical Forum: canine pancreatitis and biliary duct obstruction." Companion Animal 18, no. 4 (June 2013): 147–50. http://dx.doi.org/10.12968/coan.2013.18.4.147.

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Anderson, Davina, Pieter Nelissen, Rosangela Ragni, and Kelly Bowlt. "Clinical forum: canine pancreatitis and biliary duct obstruction." Companion Animal 18, no. 6 (August 2013): 284–87. http://dx.doi.org/10.12968/coan.2013.18.6.284.

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Lichtman, Steven N., and R. Balfour Sartor. "Duct proliferation following biliary obstruction in the rat." Gastroenterology 100, no. 6 (June 1991): 1785–86. http://dx.doi.org/10.1016/0016-5085(91)90698-k.

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Schweiger, F., J. Radhi, FW Coop, and RW Murphy. "Granular Cell Tumour of the Bile Duct in Association with Intrahepatic Bile Duct Adenomas." Canadian Journal of Gastroenterology 8, no. 2 (1994): 92–96. http://dx.doi.org/10.1155/1994/271012.

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Granular cell tumour of the extrahepatic biliary tract is a rare benign lesion likely of neurogenic origin. Review of the previously reported cases indicates that almost all patients are female, and the majority is Black. Symptoms usually are those of biliary obstruction or cholecystitis. Surgical resection of the tumour is curative. Intrahepatic bile duct adenoma is another rare benign biliary neoplasm that does not manifest clinically but can be confused with metastatic carcinoma, cholangiocarcinoma or other focal liver lesions at laparotomy or autopsy. The authors report the case of an asymptomatic Caucasian woman with biochemical evidence of liver disease who had a granular cell tumour of the bile duct as well as several intrahepatic bile duct adenomas.

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Maloshtan, Oleksandr, Rostyslav Smachilo, Oleksandr Tishchenko, Аndrii Nekludov, Мariia Klosova, and Оleg Volchenko. "THE ROLE OF THE INFECTIOUS FACTOR IN THE DEVELOPMENT OF CHOLANGITIS." JOURNAL OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, Issue 1; 2021 (May 26, 2021): 32–37. http://dx.doi.org/10.37621/jnamsu-2021-1-4.

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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

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Ball, C. S., J. Mck Manson, Fiona Reid, and D. E. F. Tweedle. "The Pharmacokinetics of The Biliary Excretion of Ciprofloxacin." HPB Surgery 1, no. 4 (January 1, 1989): 319–27. http://dx.doi.org/10.1155/1989/41415.

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The pharmacokinetics of ciprofloxacin excretion have been studied in 54 patients undergoing biliary and pancreatic operations with and without obstruction of the common bile duct. High concentrations were achieved in common duct bile within 20 minutes of intravenous injection and persisted for over 3 hours after 100 mg and for over 8 hours after 200 mg. The concentration of ciprofloxacin in the bile of functioning gall bladders was much greater than that in the common duct bile. Remarkably, it was identified in therapeutic concentrations in the bile of obstructed ducts. This and the rapid fall from initially high venous concentrations probably reflect diffusion from the circulation as a result of the exceptional tissue penetration. A unique feature of this study was the finding of clinically significant concentrations in the bile of obstructed ducts.Two patients developed wound infection and no side effects were observed. The broad spectrum antibiotic ciprofloxacin has potential as a useful agent for prophylaxis in biliary surgery maintaining biliary and venous concentrations in excess of the MIC90 for most biliary pathogens for more than 8 hours.

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Venier, Francesca, Krizia Compagnone, Annette Kerins, and Chantal Rosa. "Common bile duct obstruction caused by a helminth in a cat in the UK: ultrasonographic findings, histopathology and outcome." Journal of Feline Medicine and Surgery Open Reports 7, no. 1 (January 2021): 205511692098439. http://dx.doi.org/10.1177/2055116920984391.

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Case summary An 11-year-old neutered female domestic shorthair cat presented to our hospital with a 5-day history of vomiting, lethargy, anorexia and hyperbilirubinaemia, despite intravenous fluid therapy, gastroprotectants and antibiotic treatment. An abdominal ultrasound revealed a markedly distended common bile duct (diameter 6.2 mm). The cystic duct and intrahepatic bile ducts were also dilated. A linear structure formed by two parallel hyperechoic lines was identified in the common bile duct and could be traced to the duodenal papilla. The cat underwent laparotomy for surgical decompression of the biliary tree. A tubular, brown-coloured structure was retrieved from the common bile duct. Histological examination was consistent with a degenerate helminth. The cat recovered uneventfully from the surgery and its demeanour and appetite improved rapidly over the following days. Liver and gallbladder wall histopathology was consistent with bacterial cholangitis and cholecystitis. Escherichia coli was cultured from both bile and liver parenchyma. Relevance and novel information To our knowledge, this is the first reported case of extrahepatic biliary duct obstruction caused by a helminth in a cat in the UK. We hypothesised that the obstruction had been caused by the aberrant migration of an intestinal nematode that became lodged in the duodenal papilla. Ultrasound allowed prompt diagnosis and guided the treatment decision.

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Journal articles on the topic 'Biliary duct obstruction'

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