Asymptomatic T-tube remnant in common bile duct.

A 46-year-old lady presented with itching, five years after a primary common bile duct repair following cholecystectomy. Prior to this she underwent an interno-external biliary drainage. At laparotomy the horizontal limb of a T-tube was found in the common hepatic duct. Eleven months after a Roux loop hepatico-jejunostomy she is asymptomatic.

Segment IV liver cyst with biliary communication following laparoscopic deroofing.

Simple cysts of the liver rarely have a biliary communication. We record the development of a biliary communication following laparoscopic deroofing of a segment IV simple cyst of liver and document its successful sclerosis with tetracycline.

Superior mesenteric artery syndrome following ileo-anal pouch procedure.

A rare complication following ileo-anal pouch procedure is the occurrence of superior mesenteric artery syndrome. We report a patient with ulcerative colitis who developed vascular compression of the duodenum following J-pouch construction.

Choledochoduodenostomy: influence of risk factors in post-operative morbidity.

BACKGROUND: Choledochoduodenostomy is performed for a variety of lower common bile duct lesions. AIMS: To analyse the influence of risk factors on the post-operative morbidity following choledochoduodenostomy. METHODS: Relation of risk factors including age more than 60 years, medical Illness, hemoglobin less than 10 g/dL, albumin less than 3 g/dL, bilirubin more than 10m/dL, presence of cholangitis at admission (treated pre-operatively), use of pre-operative endoscopic sphincterotomy and common bile duct diameter at surgery were related to the occurrence of post-operative morbidity was studied using univariate analysis. RESULTS: Fifty patients underwent choledochoduodenostomy. One patient (2%) died; major post-operative morbidity occurred in 12 patients (24%). Presence of cholangitis at admission was the only factor related (p = 0.00012) to the occurrence of post-operative morbidity. No long-term complications were encountered in 35 patients (70%) mean with followup period of 28 (range 8-60) months. CONCLUSIONS: Choledochoduodenostomy is a safe permanent drainage procedure for benign lower biliary obstruction.

Transcholedochal cholecystolithotomy for a variant of Mirizzi's syndrome.

Obstruction of the common bile duct by impaction of a gallstone in the neck or the cystic duct of the gallbladder results into repeated attacks of cholangitis (Mirizzi's syndrome). In suspected cases preoperative diagnosis can be made by ultrasonography and cholangiography. We report two patients of a variant of Mirizzi's syndrome. The common bile duct was obstructed by a stone impacted in the neck and causing extrinsic compression from behind. Ultrasonography and endoscopic retrograde cholangiography diagnosed the condition as common bile duct stone in both the cases. The anomaly could be diagnosed only after choledochotomy. Stones were retrieved by transcholedochal cholecystolithotomy--an innovative surgical procedure for this variant of Mirizzi's syndrome.