ABSTRACT
Se presenta una variante anatómica de la vía biliar extrahepática, como lo es la verdadera duplicación vesicular. Las malformaciones congénitas vesiculares se categorizan en anormalidades posicionales y morfológicas, la duplicación vesicular está incluida en este último. La clasificación aceptada es la de Boyden. Basado en la relación del conducto cístico con el cuerpo vesicular describió la "vesica fellea divisa" (vesícula bilobulada que drena a un solo conducto cístico y comparte origen embriológico común) y "vesica fellea duplex" (verdadera duplicación vesicular, dos vesículas separadas con conductos císticos independientes, origen embriológico doble).
Subject(s)
Humans , Bile Ducts, Extrahepatic/abnormalities , Cholangiography , Bile Ducts, Extrahepatic/diagnostic imagingABSTRACT
OBJECTIVES: To explore the clinical value of preferred ultrasound endoscopic guided biliary drainage in patients with extrahepatic biliary obstruction with intrahepatic biliary ectasis. METHODS: A total of 58 patients with malignant obstruction and intrahepatic bile duct expansion, including 32 males, 26 females and median age 65 (58â81) were selected. A prospective randomized controlled study was randomized into EUS-AG and ERCP-BD, with 28 patients in EUS-AG and 30 in ERCP-BD. The efficacy of the two treatments, operation success rate, operation time, the incidence of complications, hospitalization days, cost, unimpeded stent duration, and survival time were compared. RESULTS: 1) The surgical success rate in group EUS-AG was 100%, and in group, ERCP-BD was 96.67%. There was no statistical difference in surgical success rate in the two groups (p>0.05). 2) Average operating time in EUS-AG was (23.69±11.57) min, and in ERCP-BD was (36.75±17.69) min. The difference between the two groups has statistical significance (p<0.05). 3) The clinical symptoms of successful patients were significantly relieved. Compared with the preoperative procedure, the differences in group levels had statistical significance (p<0.05); TBIL, ALP, WBC and CRP levels, no statistical significance difference in groups (p>0.05). CONCLUSION: EUS-AG operation has short time, low incidence of complications, safe, effective, and can be used as the preferred treatment plan for patients with extrahepatic biliary duct malignant obstruction associated with intrahepatic biliary duct expansion; EUS-AG operation has more unique clinical advantages for patients with altered gastrointestinal anatomy or upper gastrointestinal obstruction.
Subject(s)
Bile Ducts, Extrahepatic , Cholestasis , Aged , Bile Ducts, Extrahepatic/diagnostic imaging , Bile Ducts, Extrahepatic/surgery , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholestasis/diagnostic imaging , Cholestasis/etiology , Cholestasis/surgery , Drainage/adverse effects , Drainage/methods , Endosonography/methods , Female , Humans , Male , Prospective Studies , Stents/adverse effects , Ultrasonography, InterventionalABSTRACT
Carcinosarcoma is a malignant neoplasm characterized for intermingled epithelial and mesenchymal components. CASE REPORT: A preoperative suspected diagnosis will allow a radical therapy avoiding a very bad prognosis. We report on a male patient who was operated in our Service with diagnosis of synchronous carcinosarcoma of gallbladder and extrahepatic bile duct and a review of the Medical Literature. DISCUSSION: A gallblader carcinosarcoma showing extension into common bile duct is very rare, a carcinosarcoma of the bile duct is exceptional, and a synchronous carcinosarcoma ofthe bile duct and gallbladder has not been reported previously.
Subject(s)
Bile Duct Neoplasms , Bile Ducts, Extrahepatic , Carcinosarcoma , Gallbladder Neoplasms , Neoplasms, Multiple Primary , Aged , Bile Duct Neoplasms/diagnostic imaging , Bile Duct Neoplasms/pathology , Bile Duct Neoplasms/surgery , Bile Ducts, Extrahepatic/diagnostic imaging , Bile Ducts, Extrahepatic/surgery , Carcinosarcoma/diagnostic imaging , Carcinosarcoma/pathology , Carcinosarcoma/surgery , Cholelithiasis/diagnostic imaging , Cholelithiasis/surgery , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/pathology , Gallbladder Neoplasms/surgery , Humans , Male , Neoplasms, Multiple Primary/diagnostic imaging , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgeryABSTRACT
PURPOSE: To report the authors' experience with percutaneous papillary balloon dilation for extrahepatic bile duct stone clearance to the duodenum in 300 patients. MATERIALS AND METHODS: During a 16-year period, 300 patients with extrahepatic bile duct stones who underwent papillary balloon dilation were retrospectively evaluated. Two hundred eighty-six patients with retained extrahepatic bile duct stones were treated through a postoperative drain placed during cholecystectomy; 245 patients were treated through a T-tube route and 41 through a transcystic approach. In the remaining 14 patients, the procedure was performed through a newly created percutaneous transhepatic route. Success rates, technical features, reasons for failure, and complications were evaluated. RESULTS: Biliary duct stone removal after papillary dilation was successful in 288 patients (96%). In 244 patients, the procedure was successfully completed on the first attempt. Forty-three patients needed two sessions, and in one patient it took three sessions. Stone diameters ranged from 4 mm to 18 mm (mean, 8 mm). Two hundred fourteen patients had four or fewer stones (mean, 2.3), and 86 patients had more than four (mean, 8.8; range, 5-25). Two patients required surgical intervention after loss of transcystic drainage, with subsequent development of peritonitis. During the follow-up period (mean, 26.6 months), no clinical or laboratory abnormalities were observed. CONCLUSIONS: Percutaneous antegrade papillary balloon dilation and stone clearance is a safe and effective tool in removing common bile duct stones. Some technical issues should be considered to achieve complete stone removal while minimizing the incidence of complications.
Subject(s)
Bile Ducts, Extrahepatic/surgery , Catheterization , Cholecystectomy , Cholelithiasis/therapy , Drainage/methods , Adolescent , Adult , Aged , Aged, 80 and over , Argentina , Bile Ducts, Extrahepatic/diagnostic imaging , Catheterization/adverse effects , Cholecystectomy/methods , Cholecystectomy, Laparoscopic , Cholelithiasis/diagnostic imaging , Cholelithiasis/surgery , Female , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
We evaluated the efficacy of wide 14F endoprostheses endoscopically placed in en patients with malignant extrahepatic bile duct stenosis. Large-bore stents were successfully placed in all patients. There were no early complications. Stent clogging occurred in two patients after one month and after three months in another patient. Seven patients remained free of symptoms after a mean follow-up period of 4.5 months (Au)
Subject(s)
Humans , Cholestasis, Extrahepatic/therapy , Palliative Care/instrumentation , Pancreatic Neoplasms/therapy , Stents , Aged , Cholestasis, Extrahepatic/etiology , Cholestasis, Extrahepatic/diagnostic imaging , Bile Ducts, Extrahepatic/diagnostic imaging , Duodenoscopy , Equipment Failure , Palliative Care/adverse effects , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnostic imaging , Radiography, Interventional , Stents/adverse effectsABSTRACT
We evaluated the efficacy of wide 14F endoprostheses endoscopically placed in en patients with malignant extrahepatic bile duct stenosis. Large-bore stents were successfully placed in all patients. There were no early complications. Stent clogging occurred in two patients after one month and after three months in another patient. Seven patients remained free of symptoms after a mean follow-up period of 4.5 months.