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Bhattarai, Suraj, Abhisekh Bhattarai, and Kishor Kumar Tamrakar. "GIANT STAGHORN COMMON BILE DUCT CALCULUS: A CASE REPORT." Journal of Chitwan Medical College 9, no. 4 (2019): 72–74. http://dx.doi.org/10.54530/jcmc.37.
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A bile duct stone is defined as large if it is more than 15mm in size and giant when it is 5cm or more. Giant staghorn calculi are usually uncommon but can be found in oriental cholangio-hepatitis and usually pigment stones. Bile infection appears to be the initial event leading to stone formation. The primary bile duct stones form within the bile ducts and usually of brown pigment type while secondary bile duct stones arise from gall bladder or intra or extra hepatic ducts. There are very few published reports which describe a giant staghorn calculus in the common bile duct (CBD). The purpose of this case report is to report a new rare case of giant staghorn CBD calculus and discuss the diagnostic and surgical approach because staghorn calculi are very rare in the biliary tract.
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Bhattarai, Suraj Raj, Abhisekh Bhattarai, and Kishor Kumar Tamrakar. "Giant staghorn common bile duct calculus: a case report." Journal of Chitwan Medical College 9, no. 4 (2019): 72–74. http://dx.doi.org/10.3126/jcmc.v9i4.26907.
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A bile duct stone is defined as large if it is more than 15mm in size and giant when it is 5cm or more. Giant staghorn calculi are usually uncommon but can be found in oriental cholangio-hepatitis and usually pigment stones. Bile infection appears to be the initial event leading to stone formation. The primary bile duct stones form within the bile ducts and usually of brown pigment type while secondary bile duct stones arise from gall bladder and intra or extra hepatic ducts. There are very few published reports which describe a giant staghorn calculus in the common bile duct (CBD). The purpose of this case report is to report a new rare case of giant staghorn CBD calculus and discuss the diagnostic and surgical approach because staghorn calculi are very rare in the biliary tract.
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Mannan, Ambreen, Suhail Ahmed Soomro, Rizwanullah Junaid Bhanbhro, Amir Ghauri, Muhammad Hussain Laghari, and Shakir Shakir. "COMMON BILE DUCT INJURY." Professional Medical Journal 22, no. 06 (2015): 818–22. http://dx.doi.org/10.29309/tpmj/2015.22.06.1255.
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Objectives: To evaluate management and outcome of Iatrogenic Common BileDuct injury after cholecystectomy. Material and methods: Study Design: Descriptive study.Place and Duration of Study: Isra University Hospital Hyderabad during the period of April2013 to April 2014. Methodology: All patients presented with CBD injury after cholecystectomyincluded while CBD tumor and CBD stone and trauma were excluded from study. Total ofsixteen patients with CBD injury were admitted from outside the hospital in surgical ward in IsraUniversity hospital either through OPD or Emergency Room or Endoscopy Suite depending onthe mode of presentation and failure of ERCP if performed according to the need and clinicalpresentation. All patients were resuscitated and investigated thoroughly and the procedurewhether ERCP, or reconstructive surgery or conservative treatment performed based on patient’sclinical presentation and mode of injury and is recorded in the preset approved Performa fromrelative hospital’s ethical review committee and the data compiled in SPSS version 10. Results:All 16 patients; 4(25%) male and 12(75%) females admitted from outside the hospital in twoyear period. Presented in variable time interval12 (75%) patients admitted in 1 month, 3(18.8%)in 6 months& 1(6.3%) in 12 months. Jaundice was the main presenting symptom. Patientswere resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery.Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and1with some biliary drainage responded to simple conservative treatment. Operative successrate was 75% with 25% mortality which was related to the presence of peritonitis, developmentof multiorgan failure and late repair of bile duct injury. Conclusion: Although CBD injury is oneof the most devastating complication but its early diagnosis and prompt treatment can preventpatient’s life with subsequent few or no complication even after its reconstructive surgery.Training must be emphasized to find the all possible ways of recognizing biliary tract anatomyduring surgery and possess skills to overwhelm the primary and leading cause of bile ductinjury i.e. the visual misperception.
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Soltan, M., and M. Abd Ghaffar. "Sphincter of oddi dysfunction: sonographic examination in opiate addicts." European Psychiatry 26, S2 (2011): 107. http://dx.doi.org/10.1016/s0924-9338(11)71818-1.
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ObjectiveTo benefit from the usefulness of ultrasonography in measurement of common bile duct in opiate addicts and to correlate between the common bile duct (CBD) diameter and the duration of addiction.Materials and methodFifteen addicts, diagnosed according to DSM IV diagnostic criteria, were examined by abdominal ultrasound. The common bile duct is measured and the results were analyzed with other factors like age, the period of addiction, laboratory findings.ResultsAccording to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.01) and there was a positive significant correlation between the CBD diameter and the period of addiction (p < 0.05, r = 0.875); the multiple comparisons shows that the significant difference between the 3 age groups were due to a significance between group (1) & (2), and group (1) & (3) but no significance between group (2) & (3). So, with the increased length of the addiction period, the mean CBD diameter increases.ConclusionIn opiate addicts, the common bile duct is found to be dilated; however with normal serum bilirubin and alkaline phosphatase level and no obstructive causes by ultrasound examination, no need for any further assessment.
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Dixon, Jennifer A., Katherine A. Morgan, and David B. Adams. "Management of Common Bile Duct Injury during Partial Gastrectomy." American Surgeon 75, no. 8 (2009): 719–21. http://dx.doi.org/10.1177/000313480907500815.
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Injury to the common bile duct (CBD) during upper gastrointestinal surgery for peptic ulcer disease is a serious complication with an underestimated prevalence in light of the few cases reported in the surgical literature. Three cases of CBD injury were referred to a multidisciplinary specialized gastrointestinal unit for management over a 4-year period. Anomalous anatomy, adhesions, and potential duodenal shortening secondary to contracture all predispose the biliary ducts to intraoperative injury. The axial nature of the blood supply to the extrahepatic ducts and the tendency of bile itself to cause rapid collagen turnover and fibrosis, combined with the inflammation and subsequent fibrosis to the surrounding tissues caused by bile leakage, give the bile ducts a high propensity for stricture formation. Frequently presenting symptoms of CBD injury immediately after surgery include jaundice, elevated bilirubin values, elevated t-tube drainage, and symptoms of sepsis. The most common complaints noted in patients who present in a delayed manner are symptoms of cholangitis. Even when injuries are rapidly identified and corrected, the potential for lasting negative impact on quality of life is great in many cases. When CBD injury occurs, the pancreatic duodenal union can be concomitantly disrupted.
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Arias González, Camila, Paula María Jaramillo Gómez, David Alejandro González Ospina, Álvaro Andrés Duarte Garcés, and Sergio Iván Hoyos Duque. "Choledocholithiasis as a cause of spontaneous common bile duct perforation: From myths to reality. A case report." Journal of Case Reports and Images in Surgery 11, no. 1 (2025): 42–46. https://doi.org/10.5348/100156z12cg2025cr.
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Introduction: Spontaneous common bile duct (CBD) perforation is a rare complication of choledocholithiasis. Typically, it is diagnosed during surgery, particularly exploratory laparotomy, in patients experiencing acute abdomen. Case Report: We present a case of a 16-year-old female with no prior medical history except for a cesarean section two months prior, who presented to the emergency department with abdominal pain. During surgery, we diagnosed spontaneous common bile duct (CBD) perforation due to choledocholithiasis and described the treatment. Conclusion: Due to its low incidence, diagnosis of spontaneous CBD perforation is often delayed, leading to increased morbidity and mortality. Symptoms vary, and diagnostic imaging is nonspecific. Treatment choice between conservative and surgical approaches depends on patient hemodynamic stability, perforation characteristics, and CBD condition. Surgical options include bile duct repair or reconstruction. Spontaneous CBD perforation is rare and usually diagnosed during surgery. Treatment ranges from conservative measures to bile duct reconstruction.
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Kabrawala, Mayank, Pankaj Desai, Rajiv Mehta, et al. "Common Bile Duct Polyp—Rare But Not So Rare Cause Of Obstructive Jaundice." Journal of Digestive Endoscopy 11, no. 04 (2020): 283–86. http://dx.doi.org/10.1055/s-0040-1713711.
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AbstractPolyps are usually found in gastrointestinal tract as their primary site of occurrence. In contrast, polyps in common bile duct (CBD) are uncommon. Biliary polyps can manifest as obstructive jaundice, which is the usually a presentation of common bile duct stone or malignant tumor of bile duct and pancreas. In this case series, we present five patients who had clinical manifestations of obstructive jaundice. However, systematic diagnostic approach in these patients revealed presence of polyps in distal CBD. We have focused on diagnostic challenges encountered during the investigation of CBD polyps.
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Uchida, Yuichiro, Yusuke Ome, Keita Shimata, et al. "Inflammatory Polyp in the Common Bile Duct with Pancreaticobiliary Maljunction." Case Reports in Gastroenterology 9, no. 1 (2015): 88–92. http://dx.doi.org/10.1159/000381306.
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A 63-year-old woman was admitted because of epigastric pain and obstructive jaundice. Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography revealed a 25-mm papillary nodule in the middle to inferior portion of the common bile duct (CBD). Pancreaticobiliary maljunction (PBM) was also identified. Contrast-enhanced computed tomography also showed an enhanced nodule in the CBD, and we suspected intraductal papillary neoplasm of the bile duct. We performed pylorus-preserving pancreatoduodenectomy. Postoperative pathological examination revealed an inflammatory polyp in the middle CBD. Inflammatory polyp in the bile duct is rare and there are no previous reports accompanied by PBM. PBM is a major risk factor for biliary tract cancer. Preoperative diagnosis of a benign disorder was difficult in this case.
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Rawal, Krishn Kant. "Migration of Surgical Clips into the Common Bile Duct after Laparoscopic Cholecystectomy." Case Reports in Gastroenterology 10, no. 3 (2017): 787–92. http://dx.doi.org/10.1159/000453658.
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Laparoscopic cholecystectomy (LC) is currently the treatment of choice for symptomatic gallstones. Associated complications include bile duct injury, retained common bile duct (CBD) stones, and migration of surgical clips. Clip migration into the CBD can present with recurrent cholangitis over a period of time. Retained CBD stones can be another cause of recurrent cholangitis. A case of two surgical clips migrating into the common bile duct with few retained stones following LC is reported here. The patient had repeated episodes of fever, pain at epigastrium, jaundice, and pruritus 3 months after LC. Liver function tests revealed features of obstructive jaundice. Ultrasonography of the abdomen showed dilated CBD with few stones. In view of acute cholangitis, an urgent endoscopic retrograde cholangiopancreatography was done, which demonstrated few filling defects and 2 linear metallic densities in the CBD. A few retained stones along with 2 surgical clips were removed successfully from the CBD by endoscopic retrograde cholangiopancreatography after papillotomy using a Dormia basket. The patient improved dramatically following the procedure.
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Horwood, James, Fayaz Akbar, Katherine Davis, and Richard Morgan. "Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones." Annals of The Royal College of Surgeons of England 92, no. 3 (2010): 206–10. http://dx.doi.org/10.1308/003588410x12628812458293.
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INTRODUCTION Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis, and aimed to identify the factors most likely to predict the presence of CBD stones positively. PATIENTS AND METHODS Data from 501 consecutive patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gallstones, of whom 166 underwent IOC for suspected CBD stones, were prospectively collected. Suspicion of choledocholithiasis was based upon: (i) deranged liver function tests (past or present); (ii) history of jaundice (past or present) or acute pancreatitis; (iii) a dilated CBD or demonstration of CBD stones on imaging; or (iv) a combination of these factors. Patient demographics, intra-operative findings, complications and clinical outcomes were recorded. RESULTS Sixty-four cholangiograms were positive (39%). All indications for cholangiogram yielded positive results. Current jaundice yielded the highest positive predictive value (PPV; 86%). A dilated CBD on pre-operative imaging gave a PPV of 45% for CBD calculi; a history of pancreatitis produced a 26% PPV for CBD calculi. Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms. Of the 64 patients having a laparoscopic common bile duct exploration (LCBDE), four (6%) required endoscopic retrograde cholangiopancreatography (ERCP) for retained stones (94% successful surgical clearance of the common bile duct) and one (2%) for a bile leak. Of the 335 patients undergoing LC alone, three (0.9%) re-presented with a retained stone, requiring intervention. There were 12 (7%) requiring conversion to open operation. CONCLUSIONS A selective policy for intra-operative cholangiography yields acceptably high positive results. Pre-operatively, asymptomatic bile duct stones rarely present following LC; thus, routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore, a rationing approach to the use of intra-operative imaging based on the pre-operative indicators presented in this paper, successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration, performed by an experienced laparoscopic surgeon, is a safe and effective method of clearing the bile duct of calculi, with minimal complications, avoiding the necessity for an additional intervention and prolonged hospital stay.
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Cho, Eunae, Dong Kee Jang, Seong-Hun Kim, and Dong Uk Kim. "Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Endoscopic Management of Difficult Common Bile Duct Stones." Korean Journal of Pancreas and Biliary Tract 29, no. 4 (2024): 135–43. http://dx.doi.org/10.15279/kpba.2024.29.4.135.
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Difficult common bile duct (CBD) stones are difficult to remove using conventional stone clearance methods such as endoscopic papillary sphincterotomy. In this guideline, we present several recommendations and relevant information on the endoscopic treatment of difficult CBD stones. For the primary treatment of large CBD stones in patients without distal bile duct stricture, we recommend limited endoscopic sphincterotomy followed by endoscopic papillary large balloon dilation. For large CBD stones that are difficult to remove with conventional endoscopic treatment methods, we recommend electrohydraulic or laser lithotripsy under cholangioscopy. Short-term biliary stenting is recommended in patients with CBD stones that are difficult to remove by these methods. Finally, endoscopic treatment via small bowel enteroscopy or percutaneous transhepatic cholangioscopy may be an option in patients with surgically altered anatomy.
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Shen, Danfeng, Peng Chang, Haibin Xu, Hongxing Xu, and Yingchao Lu. "Is an 8 mm cutoff necessary when performing primary common bile duct closure after laparoscopic common bile duct exploration?" Pakistan Journal of Medical Sciences 40, no. 11 (2024): 2636–42. http://dx.doi.org/10.12669/pjms.40.11.9441.
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Objective: To evaluate whether the efficacy and safety of primary duct closure(PDC) was limited to patients with a wider common bile duct(CBD) (≥8 mm). Methods: A retrospective study of patients who underwent PDC after laparoscopic common bile duct exploration (LCBDE) at Taicang Affiliated Hospital of Soochow University from March 2012 to June 2019 was performed. Fifty-five patients were enrolled and classified into two groups according to the diameter of the CBD: the wider group (Group-W, CBD diameter≥8 mm, n=36) and the slender group (Group-S, CBD diameter<8 mm, n=19). The clinical data were compared and analysed. Results: No significant difference in the mean operative time, mean hospital stay or mean total charge was observed. Bile leakage occurred in 5.26%(1/19) of patients in Group-S, which accounted for only 1.81% (1/55) of total patients. There were no severe complications or mortality in either group. No significant differences in the rate of stone recurrence were observed. No biliary stricture occurred during follow-up. Conclusions: PDC may not be limited by the slender CBD (<8 mm), and the proper selection of patients and the standard surgical procedure are particularly important. doi: https://doi.org/10.12669/pjms.40.11.9441 How to cite this: Shen D, Chang P, Xu H, Xu H, Lu Y. Is an 8 mm cutoff necessary when performing primary common bile duct closure after laparoscopic common bile duct exploration?. Pak J Med Sci. 2024;40(11):2632-2642. doi: https://doi.org/10.12669/pjms.40.11.9441 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Patel, Ajay P., Jonathan S. Lokey, James B. Harris, et al. "Current Management of Common Bile Duct Stones in a Teaching Community Hospital." American Surgeon 69, no. 7 (2003): 555–61. http://dx.doi.org/10.1177/000313480306900702.
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The advent of laparoscopic cholecystectomy (LC) has complicated management of common bile duct (CBD) stones. While LC is routine, laparoscopic CBD exploration (LCBDE) is not, and an algorithm to manage suspected choledocholithiasis has not been uniformly accepted. We evaluated current management of choledocholithiasis. Patients suspected of having CBD stones over a 2-year period were evaluated, and 42 studies in the literature were reviewed. Thirty-two patients were identified. Fourteen patients (44%) had LC with intraoperative cholangiogram (IOC) with no preoperative studies. IOC revealed CBD stones in nine (64%). Seven had CBD exploration (CBDE) at cholecystectomy, and two had postoperative endoscopic retrograde cholangiopancreatography (ERCP). CBDE was successful in five cases, and ERCP was successful in one. Eighteen patients (56%) underwent preoperative ERCP. Five (28%) had no CBD stones. ERCP removed stones in nine patients, and four had open CBDE after failed ERCP. Current literature supports LC with IOC without any preoperative studies. Laparoscopic CBDE is highly successful but depends on surgeon experience. Removing CBD stones with ERCP is also very successful but is associated with increased cost, hospital stay, and complications. We conclude that LC with IOC should be performed without preoperative ERCP when choledocholithiasis is suspected. If found, stones should be removed laparoscopically if possible.
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Raj Joshi, B. "Sonographic variations in common bile duct dimensions." Journal of Institute of Medicine Nepal 31, no. 3 (2009): 27–29. http://dx.doi.org/10.59779/jiomnepal.404.
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Introduction: Biliary diseases such as cholelithiasis, cholecystitis, hepatitis, cirrhosis and pancreatitis are common in Nepal. Cholelithiasis was present in 8 percent of the emergency patients, second to acute appendicitis. Acute cholecysistitis was present in 25 percent of these patients. 1 The most common operation in a district hospital was cholecystectomy (31%]). 2 Ultrasound plays an integral part in evaluation of biliary system. The aim of the study was also to determine whether the size of the CBD increases with age. Methods: We prospectively collected data on 100 patients aged 15 years or older who underwent abdominal sonography. The subjects had no history of biliary and pancreatic disease or operation.The CBD was measured in porta hepatis, in the distal aspect of head of pancreas and midway between these points. Linear regression was used to correlate age with the dimension. Results: There were 30 males and 70 females in the study. The subjects ranged from 15 to 80 years.The mean diameters were as follows: 3.76mm in proximal, 4.26 mm in middle, 4.90mm in distal portionof CBD. The overall measurement was 4.23mm. Conclusions: There was a significant correlation between CBD size and age. Correlation with age was best observed for the distal segment
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Vinayaka, S. J. Haridarshan, and Venkatesh S. "ERCP stent as a nidus for CBD stone: post cholecystectomy status." International Surgery Journal 5, no. 1 (2017): 350. http://dx.doi.org/10.18203/2349-2902.isj20175927.
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Obstruction of common bile duct due to a ‘Forgotten stent’ causing stone formation is a rare entity, which is usually associated with cholangitis. A much rarer presentation is our case with an ERCP stent forming a nidus for stone formation in the common bile duct without any evidence of cholangitis or bile duct obstruction. A 66-year-old female patient with a previous history of laparoscopic cholecystectomy and common bile duct stenting done 2 years back presented with vague abdominal pain, nausea and vomiting without features of jaundice or cholangitis. She was diagnosed on imaging as a case of choledocholithiasis with two stents in the common bile duct. A failed ERCP to extract the stent and relieve obstruction necessitated open choledochotomy, stents removal, common bile duct clearance and choledochoduodenostomy. The rarity of this patient with an ERCP acting as a nidus for common bile duct stones without evidence of obstruction or cholangitis is something to be documented. Although rare, these complications must always be considered and considered a possibility due to which post-operative and post-endoscopic follow up, regular check-ups and timely removal of the stents is necessary to avoid unnecessary complications or a need for repeat procedures and surgery that results in greater morbidity.
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Lee, Jungnam, Hye Jung Jeong, Hanul Kim, and Jin-Seok Park. "The Role of the Bile Microbiome in Common Bile Duct Stone Development." Biomedicines 11, no. 8 (2023): 2124. http://dx.doi.org/10.3390/biomedicines11082124.
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Introduction: Common bile duct (CBD) stones are a health concern for 10–20% of individuals with symptomatic gallstones, leading to health complications and placing a burden on healthcare systems. This study was initiated to investigate the changes in microbiome compositions and the metabolic signature associated with CBD stones. The research approach integrated taxonomic and functional data with metabolomics data, complemented by in vivo experiments. Methods: In a single tertiary healthcare institution, a total of 25 patients were enrolled who had undergone endoscopic retrograde cholangiopancreatography (ERCP) between February 2019 and January 2021. We harvested DNA from bile samples acquired from these individuals. The amplification of the bacterial 16S rRNA gene V3-V4 region was conducted through polymerase chain reaction (PCR), followed by sequencing. We utilized QIIME2 for a comprehensive data analysis. Furthermore, we performed a metabolomic analysis of the bile samples using nuclear magnetic resonance (NMR) spectroscopy. For the assessment of functional gene enrichment, we employed MetaboAnalyst 5.0. Lastly, we executed in vivo experiments on C57BL/6 mice and undertook histological examinations of tissue samples. Results: Out of the 25 study subjects, 17 underwent ERCP due to CBD stones (the CBD stone group), while the remaining 8 had the procedure for different reasons (the non-CBD stone group). An alpha diversity analysis showed a significantly greater microbial diversity in the bile samples of the non-CBD stone group (p < 0.01), and a beta diversity analysis confirmed the greater microbial compositional abundance in the gut microbiomes in this group (p = 0.01). A taxonomic analysis revealed that the abundances of Enterococcaceae and Enterococcus were higher in the bile microbiomes of the CBD stone group. A metabolic profile analysis showed that the acetate, formate, and asparagine levels were higher in the CBD stone group. A pathway enrichment analysis showed the metabolic pathways (Arginine and Proline Metabolism, Aspartate Metabolism, Glycine, and Serine Metabolism, and Ammonia Recycling pathways) that were associated with these differences. Preclinical experiments demonstrated systemic inflammation and extracellular trap formation in the CBD stone group. Conclusions: Our study highlights the importance of biliary dysbiosis and bile metabolites, specifically acetate and formate, in CBD stone development and progression. These findings have implications for the development of diagnostic and therapeutic strategies using microbiomes for CBD stones.
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P, Debnath, Nair SP, Junare P, et al. "Rare Cause of Obstructive Jaundice in a Young Female." Journal of Gastroenterology, Pancreatology & Liver Disorders 7, no. 1 (2019): 1–3. http://dx.doi.org/10.15226/2374-815x/7/1/001138.
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Introduction: Congenital common bile duct (CBD) webs are extremely rare abnormalities of the extra hepatic ducts with approximately 10 cases reported in the literature. The age at presentation and the clinical symptomatology of these anomalies depend on the grade of the biliary obstruction. These webs usually exhibit early in life as obstructive jaundice, dilation of the proximal biliary tree or even spontaneous perforation of the extra hepatic duct. Some of these congenital webs are partially developed and remain asymptomatic until adulthood. Case Report: 28 year female patient presented with cholestatic pattern jaundice for 2 months. On evaluation found to have dilated CBD with IHBRD on USG. On further imaging studies, CT revealed horizontal web like projection from distal CBD suggestive of web with similar findings on MRCP. ERCP showed horizontal filling defect on cholangiogram with dilated CBD. Endoscopic Ultrasound examination revealed horizontal hyper echoic structure at distal CBD with proximally dilated CBD and IHBRD. Dilatation was performed using Soehendra Biliary Dilation Catheter with significant improvement in her symptomatology. Conclusion: Our case remains the first of its kind in which EUS characterisation of CBD web is described. Though rare congenital anomalies remain an important cause of young patients presenting with obstructive jaundice. Treatment for such cases remains Endoscopic dilatation or surgical by-pass in which endoscopic treatment fails. Keywords: Common bile duct web; Obstructive jaundice; Soehendra Biliary Dilation Catheter; Endoscopic Ultrasound. Abbreviations: HB-Haemoglobin; TLC-Total Leucocyte Count; AST-Aspartate Transaminase; ALT-Alanine Transaminase; ALPAlkaline Phosphatase; USG- Ultrasonography; IHBRD- Intra-hepatic biliary radicle, CBD- Common bile duct; GB- Gall bladder; MRCPMagnetic Resonance Cholangio-Pancreatography
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Shandilaya, Umang, and Abhijit S. Joshi. "Laparoscopic Common Bile Duct Exploration for Multiple Large Common Bile Duct Stones: A Case Report with Review of Literature." South Asian Research Journal of Medical Sciences 6, no. 01 (2024): 1–4. http://dx.doi.org/10.36346/sarjms.2024.v06i01.001.
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Endoscopic retrograde cholangio pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) in 2 different sessions, is the widely followed standard sequence of surgical procedures for concurrent gall bladder and common bile duct (CBD) stone disease, across the world. However, being highly technical, skillful and technology dependant, ERCP, sometimes, does not succeed even in the best of hands. This can happen due to abnormal local anatomy (eg. Previous Billroth II gastrectomy, previous surgical scars which distort the duodenum etc.) and unfriendly stone morphology such as a very large stone or a large number of stones. Failure to extract/retrieve bile duct stones at ERCP is an indication for CBD exploration (open or laparoscopic) at surgery. Herein, we present one such case of a 67 year old woman who had previously undergone surgery – laparoscopic cholecystectomy for gall stone disease 3 years back. She presented to us with a common bile duct loaded with multiple large stones. Inspite of undergoing ERCP (2 attempts over 48 hours), a common bile duct access could not be achieved endoscopically, thereby rendering endotherapy unsuccessful. She then underwent a successful totally laparoscopic CBD exploration, using standard laparoscopy instruments, some endoscopy accessories like endo-balloon & dormia basket and intraoperative fluoroscopy.
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Sadiq, I., A. Malik, J. K. Lodhi, S. T. Bukhari, R. Maqbool, and M. Zubair. "Laparoscopic CBD Exploration (LCBDE) a better and safe option for large CBD stones." Pakistan Journal of Medical and Health Sciences 15, no. 6 (2021): 1321–23. http://dx.doi.org/10.53350/pjmhs211561321.
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Background: Conventionally, common bile duct stones (CBDS) are removed with help of ERCP. However, if CBDS are larger than 10 mm, then the ERCP failure rate to retrieve CBDS becomes high. In that case, open or laparoscopic common bile duct exploration (LCBDE) is other alternative. In this era of minimally invasive surgery, laparoscopic CBD exploration (LCBDE) seems to be a better option than open approach, but in our set up the safety of LCBDE is questioned. Aim: To see the conversion rate as well as complications associated with LCBDE. Material & Methods: Methods: This is a retrospective analysis of data of patients who underwent Laparoscopic Common Bile Duct Exploration (LCBDE) for large CBD stones at Fatima Memorial Hospital Lahore. Results: Since 2012, 29 patients of large (≥10 mm) CBD stones were included in this study. Among them 20(69.9%) were females and 9(31.01%) were males. The mean CBD stone size was 13 mm. Stones were extracted transcystically in 4 case and Transcholedochal stone extraction was done in 25 cases. The average duration of surgery was 130 minutes, but all cases were completed successfully without converting to open approach. There was minor bile leak in 3 patients which was managed successfully without any further intervention. No other complication was observed with LCBDE and even no retained stone was reported. Conclusion: Laparoscopic CBD exploration is safe and effective method of dealing CBD stones especially of large size when the chances of ERCP failure to retrieve stones are high. Keywords: Laparoscopy, ERCP, common bile duct,
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Deo, K. B., S. Adhikary, S. Khaniya, V. C. Shakya, and C. S. Agrawal. "Laparoscopic Choledochotomy in a Solitary Common Duct Stone: A Prospective Study." Minimally Invasive Surgery 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/8080625.
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Background. Laparoscopic common bile duct exploration has all the advantages of minimal access and is also the most cost effective compared to the other options. Objective. To study a profile on laparoscopic common bile duct exploration for a single common duct stone. Methods. A total of 30 consecutive patients with solitary common bile duct stone attending our hospital over a period of one year were enrolled in the study. Laparoscopic common bile duct exploration was done by transductal route in all the patients. Results. There were 18 females and 12 males with age ranging from 28 to 75 years. Jaundice was present in 12 (40%) patients. Twenty-four (80%) patients had raised alkaline phosphatase. The mean size of CBD on ultrasound was 11.55 mm. The mean size of calculus was 11.06 mm and was located in the distal CBD in 26 (86.7%) patients. The mean operative time was 158.4 ± 57.89 min. There were 8 (26.6%) conversions to open procedure. T-tube was used in 26 (86.7%) patients. The postoperative complications were hospital acquired chest infection in 3 (10%), surgical site infection in 3 (10%), acute coronary syndrome in one (3.3%), and bile leak after T-tube removal in one (3.3%) patient. Conclusions. Laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone.
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Tantia, Om, SamikKumar Bandyopadhyay, Shashi Khanna, and Bimalendu Sen. "Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration." Journal of Minimal Access Surgery 3, no. 1 (2007): 19. http://dx.doi.org/10.4103/0972-9941.30682.
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Tantia, Om. "Antegrade common bile duct (CBD) stenting after laparoscopic CBD exploration." Journal of Minimal Access Surgery 3, no. 3 (2007): 114. http://dx.doi.org/10.4103/0972-9941.37196.
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Kou, Kai, Xingkai Liu, Yuelei Hu, et al. "Hem-o-lok clip found in the common bile duct 3 years after laparoscopic cholecystectomy and surgical exploration." Journal of International Medical Research 47, no. 2 (2019): 1052–58. http://dx.doi.org/10.1177/0300060518817216.
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Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction is a common and preferred choice for gallstone disease. Laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) are being increasingly used for managing choledocholithiasis and cholecystolithiasis. We report a case of a Hem-o-lok clip that was dropped into the common bile duct (CBD) after LC and surgical common bile duct exploration (CBDE). An 84-year-old man presented with right upper quadrant pain and jaundice for 2 months, and chills and hyperpyrexia for 1 day. The patient had received ERCP and surgical CBDE at a local hospital 3 years previously. The patient first received ERCP and endoscopic nasobiliary drainage (ENBD). When laboratory tests were normal, the patient then received LCBDE. During exploration, stones and a Hem-o-lok clip in the CBD were removed. The patient made good progress after LCBDE + T-tube placement and was discharged from hospital. The findings from this case suggest the following: 1) an appropriate therapy method should be considered for certain gallstone diseases, especially for choledocholithiasis and cholecystolithiasis; and 2) a Hem-o-lok clip should be carefully used during laparoscopic or robot-assisted surgery and the Hem-o-lok clip should not be in close proximity to the incision on the CBD.
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Alam, Muhammad, Siddique Ahmad, Ali Gohar Khan, Sheema Amin, and Rizmi Tahir. "Post-Cholecystectomy Biliary Dilatation." Pakistan Journal of Medical and Health Sciences 17, no. 2 (2023): 249–50. http://dx.doi.org/10.53350/pjmhs2023172249.
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Introduction: Despite the fact that the common bile duct (CBD) is thought to dilate following surgery, post-cholecystectomy CBD dilatation still remains a source of debate. Intravenous cholangiography made it possible to measure the common duct directly. Although most patients did not have a substantial increase in duct diameter following cholecystectomy, there was a trend toward a modest degree of duct dilatation, according to prospective studies employing sonography to assess the common duct. Objective: To determine the frequency of common bile duct dilatation after cholecystectomy for chronic cholecystitis. Study Design: Descriptive study Place and Duration of Study: General Surgery Department, Hayatabad Medical Complex, Peshawar from 1st February 2020 to 31st January 2021. Methodology: Eighty seven patients and age range is 20-60 years booked for cholecystectomy in outpatient department were included and followed up to 6 month to determine the frequency of common bile duct dilatation. Results: The mean age was 38.6±10.3 years with 25 (28.7%) males and 62 (71.2%) females. Mean body mass index of the sample was 25±2.3kg/m2. Sixty (68.9%) underwent laparoscopic cholecystectomy while 17 (19.5%) underwent open cholecystectomy. Mean baseline common bile duct diameter on ultrasound was 1.3±0.1 mm while the mean follow up common bile duct diameter was 1.8±0.2 mm (p<0.001). Common bile duct dilatation was recorded in 20 (22.98%) patients. Conclusion: Common bile duct dilatation after cholecystectomy is controversial, but in asymptomatic patients, a dilation of up to 10mm should be accepted as normal. Keywords: Cholecystectomy, Cholecystitis, Common bile duct dilatation, Body mass index
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Govindan, Shankara, Nebiyu Elias Tamrat, and Zi Jun Liu. "Effect of Ageing on the Common Bile Duct Diameter." Digestive Surgery 38, no. 5-6 (2021): 368–76. http://dx.doi.org/10.1159/000519446.
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<b><i>Introduction:</i></b> The aim of the study was to determine if the common bile duct (CBD) diameter increases physiologically with age and investigate whether gallstones lead to changes in CBD diameter. <b><i>Method:</i></b> Our study is composed of 721 patients in 2 groups: 517 asymptomatic patients and 204 gallstones patients who underwent MRCP. Their CBD diameter was measured at its widest visible portion on MRCP. Simple linear regression of the average of these measurements was used to investigate the relationship between age and CBD diameter in both populations. Subjects were further divided into 8 subgroups age-wise, respectively, and their means compared decade-wise using ANOVA. Furthermore, each subgroup mean from both populations was compared with each other using a <i>t</i> test. <b><i>Results:</i></b> Among the 517 subjects, the mean CBD diameter was 5.3663 mm ± 1.43546 and correlated with age (<i>p</i> &#x3c; 0.01), dilating at 0.07 mm/year. The mean diameter of our oldest group was 7.9 mm, resulting in a plausible upper limit of 8 mm for the asymptomatic population. The mean CBD diameter of the cholelithiasis population was 5.6738 mm ± 1.40986 and also correlated with age (<i>p</i> &#x3c; 0.01). The mean CBD diameter of the age groups from the cholelithiasis population was larger than that from the asymptomatic population, but none were statistically significant. <b><i>Conclusion:</i></b> Although the CBD increases physiologically with age, there is no significant difference in CBD size between the general population and the cholelithiasis patients at any particular age. Gallstones do not independently dilate the CBD.
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Arioğul, O., B. H. Güvenç, A. Emre, K. Acarli, A. Alper, and A. Ökten. "Papillary Adenocarcinoma of the Common Bile Duct." HPB Surgery 8, no. 4 (1995): 245–48. http://dx.doi.org/10.1155/1995/86293.
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Five patients with papillary adenocarcinoma of the common bile duct (CBD) are described. These are rare tumors and make up 5% of all malignant tumors of the biliary tract. The symptoms and signs at the time of initial diagnosis resemble benign obstructive lesions of the bile ducts. The tumor is soft, less invasive to adjacent tissues and tends to grow into the lumen. The early onset of the symptoms results in early intervention, with a better prognosis. Two of our patients are doing well after two and four years, where as three others were readmitted with recurrent disease.
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Sanjay, Kumar Sah1 *. Himal Panth2 and Ying Xiong Wang3. "Morphometric Analysis of Common Bile Duct: A Cadaveric Study." Journal of Biomedical Research & Environmental Sciences 2, no. 2 (2021): 064–68. https://doi.org/10.37871/jbres1190.
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Introduction: Though human beings look similar in their general anatomical appearances but during the investigation of a particular structure in detail, it is surprising how frequently we meet one sort or another type of variation. Literature reports that accurate dimensions of CBD are debatable. Therefore, determination of a spontaneous abnormality or atypical variation is important and reference range plays a significant role to classify the normal or abnormal duct. Materials and Methods: A total of thirty (30) cadavers were dissected at MGM Medical College Mumbai, India from Jan 2012 to March 2013 for anatomical features of the common bile duct-like their size, variations in the course and termination. Results: The length of the common bile duct varies 35.19 mm to 62.43 mm with Mean ± SD 46.92 ± 7.91 mm and diameter varied between 3.65 mm to 10.31 mm with mean value 6.50 ± 1.77. The correlation between length and diameter of common bile duct is statistically insignificant (p = 0.243) Conclusion: We established a reference range for the CBD length and diameter. Thus, the exact knowledge of the anatomy of the common bile duct is significant for successful hepato-biliary surgery and biliary pathology
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Ahirwar, Sovat Lal. "Study on 60 cases of common bile duct stone, there different modality of management and its inference." International Surgery Journal 7, no. 9 (2020): 2960. http://dx.doi.org/10.18203/2349-2902.isj20203776.
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Background: The aim of the study was to determine the best treatment modality for common bile duct stone become more challenging as large number of options available such as endoscopic, laparoscopic or open surgical methods, we need to choose specific therapy according to patient’s clinical conditions, and individual expertise.Methods: It is prospective study including 60 patient having common bile duct stone along with gall bladder stone, its different modality of management and its inference, conducted in Bhopal Memorial Hospital and Research Centre, Bhopal, during period of January 2017 to January 2020.Results: In 60 cases 41 patients undergoes to endoscopic retrograde cholangio pancreatography (ERCP) first, stone successfully removed in 34 patients and stent placed, one patients developed pancreatitis after ERCP, managed conservatively, In 6 patients retained stone after ERCP procedure, one patients developed surgical emphysema after procedure, managed with ICD and conservatively, and one patient had bleeding during sphincterotomy so its procedure abandoned and one of the patient failed to cannulate common bile duct (CBD). 21 patients undergo laparoscopic common bile duct explorations, 2 lap CBD exploration converted to open CBD exploration with cholecystectomy, due to adhesion at hepatocystic triangle. Five patients undergoes open CBD exploration, in one patient hepaticojejunostomy was done as patient was having CBD stone with stricture. No mortality during and after procedure.Conclusions: Management of CBD stone is depends upon individual expertise and available modality. If surgeons are expertise then lap CBD exploration with cholecystectomy without attempting to ERCP guide stone removal is best approach in majority of patients.
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Sah, SK, H. Pant, and YX Wang. "Morphometric Analysis of Common Bile Duct: A Cadaveric Study." Journal of Biomedical Research & Environmental Sciences 2, no. 2 (2021): 064–68. http://dx.doi.org/10.37871/jbres1190.
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Introduction: Though human beings look similar in their general anatomical appearances but during the investigation of a particular structure in detail, it is surprising how frequently we meet one sort or another type of variation. Literature reports that accurate dimensions of CBD are debatable. Therefore, determination of a spontaneous abnormality or atypical variation is important and reference range plays a significant role to classify the normal or abnormal duct. Materials and Methods: A total of thirty (30) cadavers were dissected at MGM Medical College Mumbai, India from Jan 2012 to March 2013 for anatomical features of the common bile duct-like their size, variations in the course and termination. Results: The length of the common bile duct varies 35.19 mm to 62.43 mm with Mean ± SD 46.92 ± 7.91 mm and diameter varied between 3.65 mm to 10.31 mm with mean value 6.50 ± 1.77. The correlation between length and diameter of common bile duct is statistically insignificant (p = 0.243) Conclusion: We established a reference range for the CBD length and diameter. Thus, the exact knowledge of the anatomy of the common bile duct is significant for successful hepato-biliary surgery and biliary pathology.
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Khan, Mushtaq Ahmad, Zaffar Ali Wani, Hilal Ahmad Dar, Altaf H. Shah, Bhagat Singh, and Gul Javid. "Extracorporeal Shock Wave Lithotripsy for Large Common Bile Duct and Pancreatic Duct Stones: Efficacy, Safety and Analysis of Factors That Favor Stone Fragmentation." Journal of Digestive Endoscopy 10, no. 02 (2019): 118–23. http://dx.doi.org/10.1055/s-0039-1693275.
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Abstract Background: Extracorporeal shockwave lithotripsy (ESWL) with subsequent endoscopic extraction of residual fragments is an established treatment option in technically challenging situations for extraction of pancreatic and common bile duct calculi. Common bile duct (CBD) stone fragmentation rates of 71 to 95% have been reported with ESWL, leading to final duct clearance rates of 70 to 90%. While complete clearance of 76% and partial clearance of 17% of pancreatic duct calculi have been documented with ESWL, our study was undertaken to investigate the efficacy and safety of ESWL in clearance of difficult bile duct and large pancreatic duct calculi. Methods: The study population consisted of 61 patients who had either large or difficult bile duct calculi or large pancreatic duct calculi documented on ultrasonography abdomen or magnetic resonance cholangiopancreatography (MRCP). All patients were subjected to ESWL sessions with endoscopic nasobiliary drainage (ENBD) placement till stones got fragmented. Results: A total of 1,284 patients underwent ERCP for either choledocholithiasis or pancreatic duct calculi during the study period (June 2015 to December 2016). Out of them 61 patients had either large or difficult CBD calculi or large pancreatic duct calculi. Forty (65.57%) had choledocholithiasis (Group-A) and 21 (34.42%) had chronic calcific pancreatitis (Group-B). CBD was cleared in 37 patients (92.5%) and 3 patients (7.5%) underwent surgical intervention. Main pancreatic duct (MPD) was cleared in all patients with clearance rate of 100%. Conclusions: ESWL is an effective and safe method for clearance of difficult CBD and pancreatic duct calculi. Combined efficacy of duct clearance is >90%. Complications are minimal and managed conservatively.
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Lee, C. G., G. L. Zimmerman, and J. R. Duimstra. "Light and scanning electron microscopic studies of the extrahepatic bile duct of sheep with experimentally induced Fasciola hepatica infection." American Journal of Veterinary Research 53, no. 5 (1992): 796–800. http://dx.doi.org/10.2460/ajvr.1992.53.05.796.
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Summary Changes in the common bile duct that contained adult Fasciola hepatica of sheep were evaluated by light (lm) and scanning electron microscopy (sem). Nine ewes were inoculated with F hepatica metacercariae and necropsied 18 weeks after inoculation. The proximal portion of the common bile duct (cbd) that contained adult flukes was recovered and examined by lm and sem. The cbd from 2 noninoculated ewes were used for control. On gross examination, cbd were markedly large because of the adult flukes, which were free in the lumen of the ducts. Extensive hemorrhage was not found either in intrahepatic or in extrahepatic bile ducts of any sheep. Histologic examination revealed changes, such as villous hyperplasia and hypertrophy of the epithelium; cell infiltration, predominately with eosinophils or macrophages; and arterial intimal proliferation. By sem, the epithelial surface of the cbd appeared intact. Villous hyperplasia and hypertrophy of the epithelium observed by lm was clearly seen by sem. Epithelial damage, seen as small areas of denuded surface by lm and sem, was confined to a few areas of the mucosa. Lack of extensive hemorrhage and confined epithelial damage were evaluated relative to the mode of feeding of adult flukes.
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Lee, Sang Hoon. "Papillary Cholangiocarcinoma Located in the Distal Common Bile Duct." Clinical Ultrasound 7, no. 1 (2022): 49–53. http://dx.doi.org/10.18525/cu.2022.7.1.49.
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Papillary tumors are the rarest form of cholangiocarcinoma, usually present as intraductal masses in the common bile duct (CBD), which cause obstructive jaundice early in the course of the disease. A 66-year-old female had jaundice for one month. Abdominal ultrasonography revealed a 2-cm-sized hypoechoic mass located in the distal CBD with upstream biliary tree dilatation. Computed tomography and magnetic resonance imaging suggested the possibility of extrahepatic cholangiocarcinoma. We performed endoscopic retrograde cholangiopancreatography with intraductal ultrasonography, revealing a papillary mass without definitive bile duct invasion located in the distal CBD. The patient underwent successful surgery and was diagnosed with stage T1N0M0 papillary adenocarcinoma. The patient is currently, one year after the surgery, under follow-up without recurrence.
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Lin, Shun-Feng, Hung-Chang Lee, Chun-Yan Yeung, Chuen-Bin Jiang, and Wai-Tao Chan. "Common Bile Duct Dilatations in Asymptomatic Neonates: Incidence and Prognosis." Gastroenterology Research and Practice 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/392562.
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Background. This retrospective study reviewed 213 asymptomatic neonates with common bile duct (CBD) dilatations diagnosed via ultrasound to evaluate their incidence and outcomes.Materials and Methods. From August 2001 to July 2010, 18,230 abdominal ultrasound scans were performed as newborn screening. There were 213 (1.17%) cases of CBD dilatation. Dilatation of neonatal CBD was defined when its diameter was ≥2 mm. The neonates’ birth history, CBD size, and follow-up results were analyzed.Results. In the 213 infants, four cystic dilatations (1.88%, 4/213) that were eventually diagnosed as choledochal cysts (CC). Among 209 neonates with fusiform dilatations (size 2.0–6.7 mm), 77 had ultrasound follow-up and 87% of them resolved spontaneously which were diagnosed as transient CBD dilatation (TCBDD). Eighty percent of TCBDDs resolved within 6 months. Patients with initial CBD size ≥3 mm had significantly lower resolution rate and neonates whose mothers are older than 35 years took longer time to resolve.Conclusion. The incidence of CBD dilatation in asymptomatic neonates was 1.17%. Eighty percent of TCBDDs resolved within 6 months. Regular ultrasound follow-up every 6 months may be appropriate for asymptomatic neonates with fusiform CBD dilatations to ensure resolution or progression.
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Liu, Wen-Song, Yan Zou, Bo Yang, Yong Jiang, and Dong-lin sun. "Laparoscopic Exploration Can Salvage Recurrent Common Bile Duct Stone after Cholecystectomy." American Surgeon 83, no. 12 (2017): 1343–46. http://dx.doi.org/10.1177/000313481708301215.
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Conventionally, patients suffered from recurrent common bile duct (CBD) stone after cholecystectomy are suggested to be treated with endoscopic retrograde cholangiopancreaticography. This study was designed to explore the feasibility of laparoscopic common bile duct exploration (LCBDE) as a salvage procedure for recurrent CBD calculi after cholecystectomy. A retrospective review was conducted of data from 65 patients who underwent LCBDE for recurrent CBD calculi after cholecystectomy from January 2011 to July 2015. LCBDE was successfully carried out in 61 cases, with a successful rate of 93.8 per cent. Three cases required open conversion because of serious abdominal adhesion, and one case for intraoperative bleeding. Postoperative bile leakage occurred in two cases, and bile peritonitis developed in one case; all these three patients with complications were fully cured by conservative treatment. A postoperative retained CBD stone was found in one patient, which was extracted with endoscopic sphincterotomy. Furthermore, it was found that the mean operative time and length of postoperative hospital stay were much shorter in primary closure group (n = 49) than in T-tube drainage group (n = 12), and the hospital expense was also lower in primary closure group. We suggest that LCBDE could be a novel approach as a salvage procedure for the recurrent CBD stone after cholecystectomy, and we prefer to intraoperative primary closure of CBD if possible.
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Dabbas, N., M. Abdelaziz, K. Hamdan, B. Stedman, and M. Abu Hilal. "Gallstone-Induced Perforation of the Common Bile Duct in Pregnancy." HPB Surgery 2008 (June 30, 2008): 1–3. http://dx.doi.org/10.1155/2008/174202.
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Spontaneous perforation of the extrahepatic biliary system is a rare presentation of ductal stones. We report the case of a twenty-year-old woman presenting at term with biliary peritonitis caused by common bile duct (CBD) perforation due to an impacted stone in the distal common bile duct. The patient had suffered a single herald episode of acute gallstone pancreatitis during the third trimester. The patient underwent an emergency laparotomy, bile duct exploration, and removal of the ductal stone. The postoperative course was uneventful.
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Lee, Hee Seung, Dong Wook Lee, Joon Seong Park, and Seong-Hun Kim. "Revised Clinical Practice Guideline of Korean Pancreatobiliary Association for Common Bile Duct Stones: Endoscopic Management of Common Bile Duct Stones." Korean Journal of Pancreas and Biliary Tract 29, no. 4 (2024): 128–34. http://dx.doi.org/10.15279/kpba.2024.29.4.128.
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For the optimal treatment of common bile duct (CBD) stones, several facts should be considered before or during endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic antibiotics is necessary for the patients with high risk of post ERCP cholangitis and cessation of anticoagulant should be considered for prevention of complications associated with post ERCP bleeding. Furthermore, endoscopic papillary balloon dilatation can be replaced with endoscopic sphincterotomy in patients with bleeding tendency such as chronic kidney disease, liver cirrhosis, thrombocytopenia etc. Prophylactic pancreatic duct stent can be helpful in reducing post ERCP pancreatitis (PEP) but caution is required as excessive attempts for selective cannulation into pancreatic duct for stent insertion can cause PEP. If gallbladder stone is present and treatment for CBD stones has been completed, prophylactic cholecystectomy should be performed selectively after consideration of patient’s condition.
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Čólović, Radoje, and Mirjana Perišić-Savić. "Retroperitoneal Biloma Secondary to Operative Common Bile Duct Injury." HPB Surgery 3, no. 3 (1991): 193–97. http://dx.doi.org/10.1155/1991/39181.
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Encapsulated collections of bile (“biloma”) may be a sequela of liver trauma, operative injury or disease. Such collections may be intrahepatic or extrahepatic and usually in the supramesocolic compartment of the abdomen. This is a report of a retroperitoneal biloma, an entity that has been reported only twice to date but this is the first secondary to an operative common bile duct lesion.Evacuation of the biloma and reconstruction of the associated biliary stricture were successfully carried out. The patient remains sympton free with normal clinical and laboratory data more than 14 months after surgery.Operative common bile duct (CBD) injury may be followed by a number of complications. To our knowledge retroperitoneal biloma secondary to a CBD lesion has not been previously reported.
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Pirah, Sarika, Anila Ahmed, et al. "Frequency of Common Bile Duct Injury in Open Cholecystectomy versus Laparoscopic Cholecystectomy." Indus Journal of Bioscience Research 3, no. 3 (2025): 707–12. https://doi.org/10.70749/ijbr.v3i3.1075.
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Background: Laparoscopic cholecystectomy has replaced open cholecystectomy as the standard treatment for cholelithiasis. However, it is associated with a higher incidence of common bile duct (CBD) injury. (LC) has become the preferred treatment for cholelithiasis; however, it carries a higher risk of common bile duct (CBD) injury compared to open cholecystectomy. It is a largely replaced open cholecystectomy (OC) but is associated with higher rates of common bile duct (CBD) injury. This study compares the frequency of CBD injury between the two techniques. To compare the frequency of CBD injury in open cholecystectomy versus laparoscopic cholecystectomy. Methodology: A randomized controlled trial was conducted at the Department of Surgery, People Medical College Hospital Nawabshah, from July 1 to December 31, 2020. A total of 320 patients aged 20–50 years with cholelithiasis were randomly divided into two groups: 160 underwent open cholecystectomy and 160 laparoscopic cholecystectomy CBD injuries were diagnosed clinically (jaundice) and confirmed via MRCP. Frequency of CBD injury was observed and analyzed statistically using SPSS 22.0, with significance at p ≤ 0.05. Results: Out of 320 patients (160 in each group) Mean age was 33.5±8.7 years; 54.7% were female, CBD injury was observed in 3.8% of patients in the open cholecystectomy group compared 9.4% of the laparoscopic group. The difference was statistically significant (p = 0.042). Indicating a significantly higher rate in laparoscopic procedures and those with diabetes had higher injury rates in the LC group. Conclusion: Laparoscopic cholecystectomy is associated with a higher frequency of CBD injury compared to open cholecystectomy. Enhanced surgical training and safety protocols are essential.
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Vidit, Manish Jangra, Hansraj Ranga, and Bhavinder K. Arora. "Spontaneous common bile duct perforation: a rare case report." International Surgery Journal 11, no. 3 (2024): 542–44. http://dx.doi.org/10.18203/2349-2902.isj20240592.
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Spontaneous common bile duct (CBD) perforation is a rare and life threatening clinical condition. The course of management and choice of surgical intervention depends on clinical presentation; site, size, nature of defect. It is usually reported in infants and adults due to congenital anomalies and following invasive procedure respectively but spontaneous CBD perforation in older age groups is rare without underlying cause presenting as acute abdomen. In this case report, an 82-year-old female presented to the emergency room with an acute abdomen diagnosed as spontaneous CBD perforation and its prompt management and its successful outcome.
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Wen, Tzu-Cheng, Kuo-Hua Lin, and Yang-Yuan Chen. "Migration of a Retained Surgical Suture Needle in the Common Bile Duct." Diagnostics 12, no. 10 (2022): 2276. http://dx.doi.org/10.3390/diagnostics12102276.
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Retained surgical foreign bodies have been a cause of concern since physicians began operating on patients. Retained surgical foreign bodies in the common bile duct (CBD) are rare and may cause cholangitis and jaundice. We report the case of a patient who initially presented with fever and right upper-quadrant abdominal pain. He had received cholecystectomy and choledochojejunostomy 28 years ago and had been well since then. Abdominal computed tomography (CT) revealed left-lobe liver abscess and a linear curve of high-density material. Endoscopic retrograde cholangiopancreatography (ERCP) displayed mild dilatation of the common bile duct (CBD) and choledojejunostomic fistula of the middle CBD. A curved, linear, rusty, metallic surgical suture needle was detected and successfully removed under ERCP.
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Gupta, Ankit, Saurabh Agrawal, Namrata Sharma, and Nakum Parth. "Extra hepatic bile duct injury after laparoscopic cholecystectomy: a retrospective study." International Surgery Journal 7, no. 8 (2020): 2517. http://dx.doi.org/10.18203/2349-2902.isj20203084.
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Background: Laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedure among the basic surgeries. Incidence of common bile duct (CBD) injury as high as 1.4-3% has been reported in some studies. The aim of this study was to estimate the incidence and predictors of CBD injury who underwent elective laparoscopic cholecystectomy.Methods: A retrospective observational study conducted at Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh India. Data was collected for a period of 1 year between March 2019 till 2020.Results: In majority of laparoscopic cholecystectomy we encountered moderate degree of difficulty. Extra hepatic bile duct injuries occurred in 1.4% of cases and were classified according to Strasberg classification. Type A injury was most common followed by type E2. Most major bile duct injuries were recognized intraoperatively. No mortality was noted in our study.Conclusions: Bile duct injuries is a major complication of laparoscopic cholecystectomy with significant morbidity and mortality, reduced survival impaired quality of life and subsequent litigations. Majority of bile duct injuries, results mainly from the surgeon’s inexperience, misinterpretation of anatomy and poor surgical techniques.
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Jang, Ji Woong, Jae Hyuck Jun, Dong-kyu Lee, et al. "Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography." Korean Journal of Pancreas and Biliary Tract 26, no. 3 (2021): 195–99. http://dx.doi.org/10.15279/kpba.2021.26.3.195.
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Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.
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Aldardeer, Ahmed Abdel Kahaar, and Alaa A. Redwaan. "Two-stages using endoscopic retrograde cholangio-pancreatography procedures versus single stage laparoscopic management for concomitant gallstones and common bile duct stones." International Surgery Journal 6, no. 12 (2019): 4244. http://dx.doi.org/10.18203/2349-2902.isj20195381.
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Background: Laparoscopic common bile duct exploration (LECBD) has been proven to be a safe, reliable, and effective treatment for common bile duct (CBD) stones and has gained wider acceptance. Endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is safe and efficient method that has been usually used for the treatment of bile duct stones. The aim of this study is to compare the outcome of management of concomitant gallstones and common bile duct by two stage (ERCP+LC) versus one stage (LECBD+LC).Methods: This study included 150 patients with concomitant gallstones and CBD stones who were treated at sohag university hospital from July 2017 to December 2018. Results were statistically analysed.Results: The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (Group A 96% vs. Group B 97.3%). The mean operative time was significantly longer in-group A (125.7±36.6 min) vs. in-group B (82.4±27.6 min), Group A as regard intraoperative complications (one patient had hemorrhage) vs. group B (2 patients hemorrhage during lap. cholecystectomy). As for conversion to other procedure 2 patients for group A vs. 3 patients for group B (conversion of LC to open).Conclusions: Single and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single stage strategy was better in terms of shorter hospital stay, need for fewer procedures, less morbidity, and allows earlier recovery with a reduced period of short-term disability.
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Rivai, Muhammad Iqbal, Arnetta Naomi Louise Lalisang, Adianto Nugroho, et al. "Konsensus Perhimpunan Dokter Spesialis Bedah Digestif Indonesia tentang Pedoman Diagnosis dan Tatalaksana Batu Saluran Empedu." Journal Of The Indonesian Medical Association 74, no. 2 (2024): 51–63. http://dx.doi.org/10.47830/jinma-vol.74.2-2024-1188.
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Pendahuluan: Koledokolitiasis, adanya batu pada common bile duct (CBD), merupakan tantangan dalam bidang bedah digestif karena ragam kasus yang sangat bervariasi dengan tingkat kesulitan yang berbeda-beda. Hingga saat ini, pilihan modalitas diagnosis dan terapi semakin berkembang, baik dari prosedur noninvasif hingga invasif. Oleh sebab itu, Perhimpunan Spesialis Bedah Digestif Indonesia (IKABDI) memberikan rekomendasi terhadap pengelolaan kasus batu CBD di Indonesia.Metode: Konsensus disusun menggunakan survei Delphi yang melibatkan para pakar bedah digestif dari berbagai kota di Indonesia. Berbagai isu terkait diagnosis dan tatalaksana batu CBD disusun dan dijawab sesuai dengan penelitian terkini, namun juga mempertimbangkan pendapat dari para pakar.Hasil: Konsensus ini terdiri dari dua bagian, yaitu 15 rekomendasi terkait pemilihan modalitas diagnosis dan 10 rekomendasi terkait pilihan tatalaksana. Rekomendasi terkait diagnosis mencakup penggunaan ultrasonografi, CT-scan abdomen, dan magnetic resonance cholangiopancreatography (MRCP). Selain prosedur terapeutik standar, konsensus ini juga memberikan rekomendasi mengenai prosedur terkini, seperti endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic common bile duct exploration (LCBDE), hingga open common bile duct exploration (OCBDE).Kesimpulan: Rekomendasi ini diharapkan dapat membantu para ahli bedah digestif dalam memberikan tatalaksana terbaik pada kasus batu CBD.
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Chevallier, Olivier, Hélène Escande, Khalid Ambarki, et al. "Single-Breath-Hold MRI-SPACE Cholangiopancreatography with Compressed Sensing versus Conventional Respiratory-Triggered MRI-SPACE Cholangiopancreatography at 3Tesla: Comparison of Image Quality and Diagnostic Confidence." Diagnostics 11, no. 10 (2021): 1886. http://dx.doi.org/10.3390/diagnostics11101886.
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To compare two magnetic resonance cholangiopancreatography (MRCP) sequences at 3 Tesla (3T): the conventional 3D Respiratory-Triggered SPACE sequence (RT-MRCP) and a prototype 3D Compressed-Sensing Breath-Hold SPACE sequence (CS-BH-MRCP), in terms of qualitative and quantitative image quality and radiologist’s diagnostic confidence for detecting common bile duct (CBD) lithiasis, biliary anastomosis stenosis in liver-transplant recipients, and communication of pancreatic cyst with the main pancreatic duct (MPD). Sixty-eight patients with suspicion of choledocholithiasis or biliary anastomosis stenosis after liver transplant, or branch-duct intraductal papillary mucinous neoplasm of the pancreas (BD-IPMN), were included. The relative CBD to peri-biliary tissues (PBT) contrast ratio (CR) was assessed. Overall image quality, presence of artefacts, background noise suppression and the visualization of 12 separated segments of the pancreatic and bile ducts were evaluated by two observers working independently on a five-point scale. Diagnostic confidence was scored on a 1–3 scale. The CS-BH-MRCP presented significantly better CRs (p < 0.0001), image quality (p = 0.004), background noise suppression (p = 0.011), fewer artefacts (p = 0.004) and better visualization of pancreatic and bile ducts segments with the exception of the proximal CBD (p = 0.054), cystic duct confluence (p = 0.459), the four secondary intrahepatic bile ducts, and central part of the MPD (p = 0.885) for which no significant differences were found. Overall, diagnostic confidence was significantly better with the CS-BH-MRCP sequence for both readers (p = 0.038 and p = 0.038, respectively). This study shows that the CS-BH-MRCP sequence presents overall better image quality and bile and pancreatic ducts visualization compared to the conventional RT-MRCP sequence at 3T.
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Chevallier, Olivier, Hélène Escande, Khalid Ambarki, et al. "Single-Breath-Hold MRI-SPACE Cholangiopancreatography with Compressed Sensing versus Conventional Respiratory-Triggered MRI-SPACE Cholangiopancreatography at 3Tesla: Comparison of Image Quality and Diagnostic Confidence." Diagnostics 11, no. 10 (2021): 1886. http://dx.doi.org/10.3390/diagnostics11101886.
Full textAbstract:
To compare two magnetic resonance cholangiopancreatography (MRCP) sequences at 3 Tesla (3T): the conventional 3D Respiratory-Triggered SPACE sequence (RT-MRCP) and a prototype 3D Compressed-Sensing Breath-Hold SPACE sequence (CS-BH-MRCP), in terms of qualitative and quantitative image quality and radiologist’s diagnostic confidence for detecting common bile duct (CBD) lithiasis, biliary anastomosis stenosis in liver-transplant recipients, and communication of pancreatic cyst with the main pancreatic duct (MPD). Sixty-eight patients with suspicion of choledocholithiasis or biliary anastomosis stenosis after liver transplant, or branch-duct intraductal papillary mucinous neoplasm of the pancreas (BD-IPMN), were included. The relative CBD to peri-biliary tissues (PBT) contrast ratio (CR) was assessed. Overall image quality, presence of artefacts, background noise suppression and the visualization of 12 separated segments of the pancreatic and bile ducts were evaluated by two observers working independently on a five-point scale. Diagnostic confidence was scored on a 1–3 scale. The CS-BH-MRCP presented significantly better CRs (p < 0.0001), image quality (p = 0.004), background noise suppression (p = 0.011), fewer artefacts (p = 0.004) and better visualization of pancreatic and bile ducts segments with the exception of the proximal CBD (p = 0.054), cystic duct confluence (p = 0.459), the four secondary intrahepatic bile ducts, and central part of the MPD (p = 0.885) for which no significant differences were found. Overall, diagnostic confidence was significantly better with the CS-BH-MRCP sequence for both readers (p = 0.038 and p = 0.038, respectively). This study shows that the CS-BH-MRCP sequence presents overall better image quality and bile and pancreatic ducts visualization compared to the conventional RT-MRCP sequence at 3T.
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Elghamry, Elghamry E., Mohamed M. Elsheikh, and Hamdy A. Mohamed. "Evaluation of different methods of laparoscopic treatment of common bile duct stones." International Surgery Journal 6, no. 8 (2019): 2670. http://dx.doi.org/10.18203/2349-2902.isj20193306.
Full textAbstract:
Background: Common bile duct (CBD) stones are the second most common complication of gall bladder stones. The best management of patients with CBD stones remains controversial. The aim of this study was to evaluate the methods of laparoscopic CBD exploration (LCBDE).Methods: This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. Authors used transcystic and transcholedochotomy approaches for LCBDE either with or without choledoschope. Primary repair of the choledochotomy incision was done. Results: The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients. The transcystic approach for CBD exploration was used in 16 cases without conversion, 11 cases were completed without choledochoscope, while 5 cases with choledochoscopic guided extraction. Choledochotomy approach had been used in 13 cases, 6 cases were completed with choledochoscope and 7 cases without it, two cases of them failed. One case failed from the beginning and was converted to open exploration. 5 ERCP previously inserted stents were removed. The mean operative time was 162.33±74.67 min. Bile leakage occurred in 2 cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days.Conclusion: LCBDE is a feasible, effective and safe approach to bile duct stones. Depending on proper training and gaining experience.
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Sonal, Susanne, and Hatem Kaseb. "An Unusual Case of Diffuse Large B-Cell Lymphoma of the Common Bile Duct." ACG Case Reports Journal 12, no. 6 (2025): e01734. https://doi.org/10.14309/crj.0000000000001734.
Full textAbstract:
ABSTRACT Diffuse large B-cell lymphoma (DLBCL) of the common bile duct (CBD) is extremely rare. A 77-year-old male patient presented with obstructive jaundice, weight loss, and abdominal pain. An endoscopic retrograde cholangiography revealed a stricture in the common hepatic duct. Biopsy and cytology specimens performed were inconclusive. A pancreaticoduodenectomy revealed a final diagnosis of DLBCL of the CBD. DLBCL of the CBD usually presents with vague symptoms. The definitive diagnosis of DLBCL-CBD can only be rendered by immunomorphological assessment and based on careful exclusion of other nodal and extranodal sites.
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Aggarwal, Amulya, Alok V. Mathur, and Manmeet Kaur. "Choledochodudenostomy for bile duct injuries: a less demanding option, in a demanding surgical situation." International Surgery Journal 6, no. 5 (2019): 1817. http://dx.doi.org/10.18203/2349-2902.isj20191918.
Full textAbstract:
Cholecystectomy is one of the most common surgical procedure performed worldwide and therefore a common cause for iatrogenic biliary tract injury. Bile duct injuries are associated with significant morbidity and are a potentially fatal complication. Choledochodudenostomy in patients of post cholecystectomy bile duct injury can be done safely by experienced surgeons in CBD injuries distal to the confluence of the cystic and common hepatic duct after eradication of sepsis. Choledochoduodenostomy has its own technical advantages and it maintains the normal anatomy. As compared with a routine Roux-en-Y hepaticojejunostomy, CDD is technically easier, faster, requires less manipulation of the CBD, and is more physiological. We present a case report of a patient of laparoscopic cholecystectomy with CBD injury managed with choledochoduodenostomy who did extremely well after procedure with no immediate and delayed postoperative complication.
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Valarmathi, M., and Anandi Andappan. "Analysis of the management of choledocholithiasis and it’s outcome with the role of preoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography." International Surgery Journal 6, no. 6 (2019): 2002. http://dx.doi.org/10.18203/2349-2902.isj20192146.
Full textAbstract:
Background: Choledocholithiasis implies stones in the common bile duct (CBD). Most of the common bile duct stones are those that have passed into the bile duct from the gall bladder. About 20 to 25% of patients above the age of 60 with symptomatic gall stones are likely to have stones in the CBD. To analyse the role of ERCP and MRCP in the management of choledocholithiasis.Methods: About 60 patients who are attending the General Surgery OPD of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India from the October 2017-March 2018 were included in the study with confirmed common bile duct stones with or without gall stones were chosen. patients were categorized into group A- who has undergone a successful ERCP followed by laparoscopic cholecystectomy and group B- who underwent open cholecystectomy with CBD exploration.Results: Ultrasonography was done in 57 patients, of which 41 patients showed CBD stones (71.93%), 12 patients showed dilated CBD in the presence of cholelithiasis (21.05%) and in the remaining 4 patients (7.01%) this investigation showed only cholelithiasis. Since clinical condition warranted, authors proceeded with further hepatobiliary imaging, which revealed choledocholithiasis.Conclusions: Magnetic resonance cholangio pancreatography can also be used for follow up of the patients with choledocholithiasis after therapy, to look for the presence of retained stones, since it can detect stones even in the size as small as 2 mm. Selective use of intraoperative choledochoscopy in suspected cases helps in reducing the incidence of retained stones.