[Difficulty to cannulate papilla of Vater in the presence of periampullary duodenal diverticulum]. / Grado de dificultad para canular papila de Vater en presencia de divertículo duodenal periampular.

BACKGROUND: There are conflicting results in the literature regarding the impact of duodenal diverticula on the technical success and complications of endoscopic retrograde cholangiopancreatography (ERCP). AIM: To evaluate if the presence of periampullary duodenal diverticulum increases the risk of failure of ampulla cannulation. METHODS: Patients who underwent ERCP between January 2008 and December 2009 were evaluated. They were divided in group A (without duodenal diverticulum) or group B (with duodenal diverticulum). Gender, age, endoscopic and radiological diagnosis, difficulty to cannulate, endoscopic sphincterotomy, precut technique, therapeutic procedure and complications were documented. RESULTS: 1159 patients were included: 1100 in group A and 59 in group B. A successful cannulation was obtained in 1061 patients of group A and 53 of group B (96.46 vs. 89.83%, p < 0.0001, OR 0.03). The failure of cannulation was observed in 39 patients of group A and 6 of group B (3.54 vs. 10.17%, p= 0.021, OR 2.94). The presence of intradiverticular papilla was the cause of failure in all cases. The therapeutic procedures showed statistical differences in choledocholithiasis clearance as well as endoscopic sphincterotomy and biliary stents insertion, but there was no significant difference in complications. We found statistical significant differences in biliary lithiasis, malignant stenosis, mechanical lithotripsy and insertion of biliary stents. CONCLUSIONS: Periampullary duodenal diverticula increase the risk of failure for cannulation of ampulla. However, it should not be considered as contraindication for ERCP.

Endoscopic biliary large-balloon dilation after endoscopic sphincterotomy for the treatment of large common bile duct stones. Case report.

Common bile duct (CBD) stones extraction is usually performed by endoscopic sphincterotomy followed by removal by either a Dormia basket or extraction balloon catheter. However, some stones due to their size are not amenable to these procedures and extracorporeal or mechanical lithotripsy devices need to be used. Mechanical lithotripsy involves usage of a basket that will be inevitably destroyed which increases cost to the patient and endoscopy unit. The use of extracorporeal wave shock lithotripsy is an alternative; however it is not available widely. Reports about the use of hydrostatic large caliber balloon dilator (HLCBD) aiding in the extraction of large caliber CBD stones have concluded that is a safe and feasible therapeutic alternative. We present the case of a 25 mm x 30 mm CBD stone that could not be extracted using conventional methods. CBD dilation using HLCBD was performed after endoscopic sphincterotomy in an attempt to avoid mechanical lithotripsy.

Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction-an experimental study in growing animals.

BACKGROUND: Many chronic liver diseases lead to progressive hepatic fibrosis, a condition that can ultimately result in loss of organ function and severe portal hypertension necessitating hepatic transplantation. Within the last few decades, studies have been conducted to demonstrate the possibility of drug modulation of hepatic fibrogenesis. Regarding biliary obstruction, it has been suggested that administration of corticosteroids could promote better late outcomes for children with biliary atresia submitted to Kasai's portoenterostomy. Models used to test potential antifibrogenic drugs such as pentoxifylline (PTX) have not included growing animals. METHODS: In this experimental study, 119 young rats (21st or 22nd days) were submitted to laparotomy and common bile duct ligation (CBDL) or to sham surgery (SHAM). Animals were allocated into 5 groups, according to surgical procedure, and administered the following solutions: (1) CBDL + distilled water, (2) SHAM + distilled water, (3) CBDL + PTX, (4) CBDL + prednisolone (PRED), and (5) CBDL + PTX + PRED (PTX + PRED). Each group was further divided into 2 subgroups according to the length of the experiment (15 or 30 days). At the end of the defined period, animals were weighed, and a hepatic fragment was collected from each one for analyses. RESULTS: The PTX animals exhibited increased weight gain compared to animals in the PRED or PTX + PRED groups. Animals from the 3 therapeutic groups (PTX, PRED, and PTX + PRED) showed diminished collagen-filled area in portal spaces. Total portal space area was increased in the PTX group. CONCLUSIONS: Hepatic fibrosis induced by bile duct ligation in young rats could be modulated by pharmacologic interventions. Administration of PTX or PRED, or the combination of both, resulted in diminished collagen-filled areas in portal spaces.

Vanishing bile duct syndrome in Hodgkin's disease: case report.

CONTEXT: Liver damage is relatively common in patients affected by Hodgkin's disease. A smaller proportion of cases develops jaundice. Recently, the vanishing bile duct syndrome was described in Hodgkin's disease. The mechanisms of this severe complication have been poorly understood until now. OBJECTIVE: To describe a rare case of intra-hepatic cholestasis due to vanishing bile duct syndrome. DESIGN: Case report. CASE REPORT: A 38-year-old male patient affected by Hodgkin's disease. Liver biopsy showed no detectable Hodgkin's disease. Intra-hepatic cholestasis was found and none of the six portal tracts analyzed contained normal bile ducts. The treatment was based on conventional and high-dose escalation chemotherapy. The patient died from an irreversible liver failure while in complete remission from Hodgkin's disease.

Vanishing bile duct syndrome in Hodgkin's disease: case report

CONTEXT: Liver damage is relatively common in patients affected by Hodgkin's disease. A smaller proportion of cases develops jaundice. Recently, the vanishing bile duct syndrome was described in Hodgkin's disease. The mechanisms of this severe complication have been poorly understood until now. OBJECTIVE: To describe a rare case of intra-hepatic cholestasis due to vanishing bile duct syndrome. DESIGN: Case report. CASE REPORT: A 38-year-old male patient affected by Hodgkin's disease. Liver biopsy showed no detectable Hodgkin's disease. Intra-hepatic cholestasis was found and none of the six portal tracts analyzed contained normal bile ducts. The treatment was based on conventional and high-dose escalation chemotherapy. The patient died from an irreversible liver failure while in complete remission from Hodgkin's disease

Common biliary-pancreatic conduit stenosis induces pancreobiliary reflux.

A striking pancreatic juice reflux toward the biliary tree (PR) has frequently been found in subjects with common bile-pancreatic conduit (CBPC) and gallstone-induced acute pancreatitis (SAP). Our aim was to determine the role of the CBPC functional diameter as a potential trigger of PR. The CBPC was calibrated in three groups of patients: (A) patients with gallbladder stones using intraoperative direct cholangiometry (n = 24), (B) patients after surgical removal of common bile duct stones using postoperative cholangiometry via T-drain (n = 6), and (C) patients with SAP using the same procedures as in group B (n = 6). In all patients in groups B and C, aliquots of bile were collected and assayed for pancreatic amylase content. The mean functional diameter of the CBPC varied from 0.80 mm in patients in groups A and B to 0.47 mm in group C (p < 0.001). The bile samples of group B contained low concentrations of amylase, whereas high values could be found in all samples of group C. We conclude that PR is a frequent event occurring after bile duct revision concerning small amounts of pancreatic juice. However, CBPC functional stenosis as seen in patients with SAP obviously induces PR with high amounts of pancreatic juice.

[Congenital cystic dilatation of the common bile duct]. / Dilatación quística congénita del colédoco.

The congenital cystic dilatation of choledochal is a congenital malformation with little frequency in Mexico. It is of multifactorial etiology and it is known with different names. The work present its frequency, pathology, etiology, its clinic manifestations, the actual methods of cabinet and laboratory there are most frequently to be used in the preoperative diagnosis of the disease. It is proposed an algorithm for to study the icteric syndrome in infants and childhood who has suspicion of congenital cystic dilatation of choledochal. It is describe the surgical treatment and the mortality.

Ileo biblial yeyunal

Al tiempo que revisamos las características clínico-quirúrgicas que envuelven a la patología biliodigestiva que describieron Batholuis en 1854 y Bouveret, presentamos un caso tratado en el Centro Médico de la Universidad Central del Este (UCE), dada la baja incidencia universal de la patología. Bajo el diagnóstico de oclusión intestinal aaltas se interviene de emergencia una paciente de 74 años de edad. En el transoperatorio se evidenció una fístula vesicoduodenal, espontánea; un cálculo biliar único de 3.5 cms. de diámetro, obstruía el lúmen yeyunal a unos 90 cms., aproximadamente, del ángulo de Treitz. Se practicó una yeyunolitotomía sub-obstrutiva y yeyunorrafía transversa en uno solo plano, dejándose intacta la fístula biliodigestiva por razones evidentes en el orden táctico

Anomalous drainage of the common bile duct: demonstration by hepatobiliary imaging

El drenaje anómalo del ducto biliar común a la tercera porción del duodeno es un hallazgo raro que se había descrito previamente en autopsias y colangiografias operatorias. Aquí reportamos el primer caso de esta variante identificada por escintigrafía del sistema hepatobiliar utilizando técnicas de medicina nuclear

Doença de Caroli associada a fibrose hepática congênita: relato de um caso e revisäo de literatura / Caroli disease associated with congenital hepatic fibrosis: report of a case and review of the literature

Relata-se um caso de doença de Caroli associada a fibrose hepática congênita e hipertensäo porta em uma criança de um ano e três meses de idade, faz-se uma breve revisäo da literatura sobre o assunto. Salienta-se a baixa idade do diagnóstico neste paciente, o que provavelmente se deveu à associaçäo da doença com fibrose hepática congênita. Neste paciente o quadro de colangite recidivante existia desde os seis meses de idade. Durante a propedêutica, a ultra-sonografia foi fundamental na conduçäo diagnóstica. A cintilografia com Tc 99, que é apontada como excelente método propedêutico, näo foi eficaz no presente caso

Radiomanometría transoperatoria de vías biliares / Transoperative radiomanometry of the bile ducts

La radiomanometría (RM) puesta en boga por su autor Jean Caroli desde 1941 en Francia, ha sido poco utilizada fuera de Europa y en pocas ocasiones en México. En el Hospital de Especialidades del I.M.S.S. en Puebla se practica por el autor desde Enero de 1980 usando el aparato de Caroli-Fourés. Fueron documentados 98 resgistros operatorios hasta Julio de 1982, su análisis constituye el contenido de este trabajo. La presión inicial (PI) promdedio (X) fue de 3.58 con una desviación estándar (DE) de ñ 2.72,la presión de paso (PP) necesaria para franquear el esfínter de Oddi X 11.6 y DE ñ 3.97 y la presión residual (PR) resultante de la presión del líquido perfundido y la resistencia del mismo esfínter X 9.68 DE ñ 4.05, consitituyen la parte manométrica del estudio, que se efectua en 7 u 8 minutos. Simultáneamente tres placas radiográficas son impresas para correlacionar ambos procedimientos. Todos los pacientes fueron seguidos por espacio de un mes, mínimo de dos consultas. El estudio fue practicado en 11 pacientes en fase aguda, en quince litiasis de la vía biliar VB, 10 de los cuales no se habían sospechado en el preoperatorio. Se descubrieron tres alteraciones del esfínter del Oddi (Oddipatias) en dos de ellas la RM permitió decidir la esfinteroplastia. Los resultados obtenidos en las cifras, se aproximan bastante a lo informado en la literatura. El aumento de la PR se asoció siempre con alteraciones de la VB. La mortalidad operatoria y hospitalaria fue del 0% y solo hubo tres complicaciones no relacionadas con el procedimiento. Un modelo presonal es presentado, fácil de construir y posiblemente con la misma aplicación que el radiomanómetro francés. La RM es un procedimiento accesible en el transoperatorio para el diagnóstico de las lesiones asociadas de la VB principal en la colecistectomía y para la toma de decisión quirúrgica

Cisto dos colédoco como causa de dor abdominal e vômitos recorrentes na criança: relato de um caso / Common bile duct cyst as cause of abdominal pain and vomiting in children: report of a case

Os autores relatam caso de cisto do colédoco tipo IV, em criança do sexo feminino com sete anos e 10 meses de idade. A única manifestaçäo clínica foi dor abdominal e vômitos recorrentes. O diagnóstico foi feito pela colangiografia intravenosa pré-operatória. A ultra-sonografia suspeitou-se de dilataçäo do colédoco. O tratamento cirúrgico consistiu em ressecçäo do cisto coledociano, do canal cístico e da vesícula, com anastomose hepático-jejunal com alça em Y de Roux. A biópsia hepática demonstrou ausência de alteraçöes do fígado. O pós-operatório evoluiu sem anormalidades