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Bile duct anatomy

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https://read.qxmd.com/read/30886133/a-new-approach-to-accomplish-intraoperative-cholangiography-in-left-lateral-segmentectomy-of-living-liver-donation
#1
Lin Wei, Zhong-Tao Zhang, Zhi-Jun Zhu, Li-Ying Sun, Zhi-Gui Zeng, Wei Qu, Liang Zhang, En-Hui He, Rui-Fang Xu, Guang-Peng Zhou
BACKGROUND There are 2 main methods of bile duct division in harvesting left lateral segment of a living donor: 1) by intraoperative cholangiography through cystic duct with cholecystectomy, or 2) by direct vision with preoperative magnetic resonance cholangiopancreatography. Here, we present a new approach to cholangiography by using the bile duct stump of the fourth liver segment (B4 stump) to achieve left lateral segmentectomy in pediatric living donor liver transplantation. MATERIAL AND METHODS This was a prospective study of 221 living donors who had undergone intraoperative cholangiography via the B4 stump in the course of left lateral segmentectomy...
March 19, 2019: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://read.qxmd.com/read/30866611/endoscopic-ultrasound-guided-biliary-drainage-for-benign-biliary-diseases
#2
Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike
Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy...
March 14, 2019: Clinical Endoscopy
https://read.qxmd.com/read/30859236/-passive-and-active-magnetic-resonance-cholangiopancreatography-technique-indications-and-typical-anatomy
#3
REVIEW
J Vosshenrich, D T Boll, C J Zech
CLINICAL/METHODICAL ISSUE: In daily routine, every radiologist is confronted with a variety of questions concerning the biliary tract and pancreatic system. STANDARD RADIOLOGICAL METHODS: Today, besides sonography, magnetic resonance cholangiopancreatography (MRCP) is considered the method of choice in the investigation of many disorders of the hepatobiliary and pancreatic system and is commonly preferred over invasive ERCP in a mere diagnostic setting. METHODICAL INNOVATIONS: Since its introduction in 1991, MRCP has constantly evolved...
March 11, 2019: Der Radiologe
https://read.qxmd.com/read/30851627/case-report-of-a-duplicated-cystic-duct-a-unique-challenge-for-the-laparoscopic-surgeon
#4
Semeret Munie, Hassan Nasser, Pauline H Go, Kelly Rosso, Ann Woodward
INTRODUCTION: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare. PRESENTATION OF CASE: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy...
February 28, 2019: International Journal of Surgery Case Reports
https://read.qxmd.com/read/30850016/gastric-adenocarcinoma-causing-biliary-obstruction-without-ductal-dilatation-a-case-report
#5
Karl Vaz, Raphael P Luber, Catriona McLean, Jan Frank Gerstenmaier, Stuart K Roberts
INTRODUCTION: Gastric adenocarcinoma is a known complication of partial gastrectomy. Jaundice from gastric adenocarcinoma usually occurs in the setting of hepatic nodal or parenchymal metastasis. This case demonstrates an unusual level of biliary obstruction from gastric adenocarcinoma. CASE PRESENTATION: An 84-year-old Caucasian man was diagnosed as having a new gastric adenocarcinoma at the level of the gastroenteric anastomosis of a prior Billroth II gastrectomy after presenting with painless jaundice...
March 9, 2019: Journal of Medical Case Reports
https://read.qxmd.com/read/30846035/an-update-on-iatrogenic-biliary-injuries-identification-classification-and-management
#6
REVIEW
Joshua T Cohen, Kevin P Charpentier, Rachel E Beard
Common bile duct injury is a feared complication of cholecystectomy, with an incidence of 0.1% to 0.6%. A majority of injuries go unnoticed at index operation, and postoperative diagnosis can be difficult. Patient presentation can vary from vague abdominal pain to uncontrolled sepsis and peritonitis. Diagnostic evaluation typically begins with ultrasound or CT scan in the acute setting, and source control is paramount at time of presentation. In a stable patient, hepatobiliary iminodiacetic acid scan can be useful in identifying an ongoing bile leak, which requires intervention...
April 2019: Surgical Clinics of North America
https://read.qxmd.com/read/30836441/left-sided-gallbladder-a-systematic-review-of-a-rare-biliary-anomaly
#7
REVIEW
Ryan Pereira, Talbir Singh, John Avramovic, Sam Baker, Guy D Eslick, Michael R Cox
BACKGROUND: A left-sided gallbladder (LSGB) is a rare anatomical anomaly that is often not discovered until surgery. Two cases of LSGB managed with laparoscopic cholecystectomy (LC) stimulated this systematic review. The aims of this study were in LSGB to define the rate of pre-operative detection, variations in biliary anatomy, laparoscopic techniques employed and outcomes of surgery for symptomatic gallstones. METHODS: A systematic review was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses principles...
March 5, 2019: ANZ Journal of Surgery
https://read.qxmd.com/read/30820620/-biliary-system-what-does-the-surgeon-want-to-know-from-the-radiologist
#8
REVIEW
A Bauschke
CLINICAL/METHODICAL ISSUE: Exact diagnostic procedures are prerequisite for surgical treatment of bile duct diseases. STANDARD RADIOLOGICAL METHODS: Magnetic resonance cholangiopancreatography may be supplemented by computed tomography (CT) for planning surgical interventions, for staging diagnostics in malignancies and for imaging the vascular anatomy in the upper abdomen. METHODICAL INNOVATIONS: Statements from magnetic resonance cholangiopancreatography (MRCP) and CT may be supplemented via digital workup in selected cases of transplantation medicine and in liver surgery...
February 28, 2019: Der Radiologe
https://read.qxmd.com/read/30810329/endoscopic-papillary-large-balloon-dilatation-eplbd-for-the-extraction-of-common-bile-duct-stones-cbds
#9
Mohamed Alsenbesy, Khaled Shahat, Abdallah Nawara, Mohammad Sallam, Mohamed Fakhry, Mohamed Shazly, Mohamed Moussa, Mohammed Tag-Adeen, Hussein El-Amin, Mohammed Sobh
BACKGROUND AND AIM: endoscopic papillary large balloon dilatation (EPLBD) is increasingly accepted as an appropriate option for the management of difficult common bile duct stones (CBDS). This study aimed to evaluate the safety and efficacy of EPLBD with a relatively large balloon (15-20 mm) for the extraction of difficult CBDS. PATIENTS AND METHODS: a total of 40 patients were recruited with obstructive jaundice and dilated CBD (≥ 10 mm) subsequent to a single large CBDS of ≥ 10 mm or multiple stones (≥ 3)...
February 27, 2019: Revista Española de Enfermedades Digestivas
https://read.qxmd.com/read/30720694/the-feasibility-of-conventional-forward-viewing-endoscope-for-endoscopic-retrograde-cholangiopancreatography-in-patients-with-altered-gastrointestinal-anatomy
#10
Onur Bayraktar, Bariş Bayraktar
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has been commonly used for biliopancreatic diseases of patients with normal gastrointestinal (GI) anatomy with a success rate of >90%. However, this procedure may also be necessary in patients with altered GI anatomy such as Billroth II or Roux-en-Y reconstructions. Performing ERCP in these patients may pose extreme technical challenges, and increase the risk of complications. The aim of this study was to analyze the feasibility of ERCP using forward-viewing endoscopy in patients with altered GI anatomy...
February 1, 2019: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://read.qxmd.com/read/30656081/against-the-odds-a-novel-technique-to-perform-cholangiography-from-a-percutaneous-approach-through-the-cystic-duct
#11
Rebekah M Padilla, Paul C Hulsberg, Erik Soule, Taylor S Harmon, Erik Eadie, Preston Hood, Michael Shabandi, Jerry Matteo
Percutaneous cholangiography is typically performed via a transhepatic approach and is reserved for patients with contraindications to traditional cholangiogram imaging modalities. For those with suspected cholelithiasis or choledocholithiasis who cannot undergo magnetic resonance imaging for diagnosis, percutaneous cholecystostomy with cholangiogram is a viable option. Endoscopic retrograde cholangiopancreatography may also be precluded due to anatomic or obstructive limitations, in which case, percutaneous transhepatic cholangiography (PTC) may be indicated for diagnosis...
November 12, 2018: Curēus
https://read.qxmd.com/read/30620696/selective-chemoembolization-of-caudate-lobe-hepatocellular-carcinoma-anatomy-and-procedural-techniques
#12
Hyo-Cheol Kim, Shiro Miyayama, Jin Wook Chung
Transarterial chemoembolization is the most common treatment for unresectable hepatocellular carcinomas (HCCs). However, when an HCC is located in the caudate lobe, many interventional radiologists are reluctant to perform chemoembolization and percutaneous ablation owing to the tumor's complex vascular supply and deep location. With the advent of C-arm CT, rendering the three-dimensional display of the hepatic artery and detecting the tumor-feeding vessels are possible and can help guide interventional radiologists to the tumor...
January 2019: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://read.qxmd.com/read/30561406/fluorescence-guided-surgery-in-liver-tumors-applications-and-advantages
#13
Giorgio Rossi, Antonio Tarasconi, Gianluca Baiocchi, Gian Luigi De' Angelis, Federica Gaiani, Francesco Di Mario, Fausto Catena, Raffaele Dalla Valle
The use of fluorescence-guided surgery for benign and malignant hepatobiliary (HPB) neoplasms has significantly increased and improved imaging methods creating new interesting perspectives. A major challenge in HPB surgery is performing radical resection with maximal preservation of the liver parenchyma and obtaining a low rate of complications. Despite the developments, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today.  In laparoscopic and robotic HPB surgery palpation is not possible...
December 17, 2018: Acta Bio-medica: Atenei Parmensis
https://read.qxmd.com/read/30539515/management-of-acute-gallstone-cholangitis-after-roux-en-y-gastric-bypass-with-laparoscopic-transgastric-endoscopic-retrograde-cholangiopancreatography
#14
Frédéric Borel, Julien Branche, Grégory Baud, Romain Gérard, François Pattou, Robert Caiazzo
BACKGROUND: The incidence of biliary lithiasis is increased after bariatric surgery due to rapid weight loss [1]. Trans-oral endoscopic management in cases of common bile duct gallstone complication is not possible in patients with Roux-en-Y gastric bypass (RYGB) due to the modified anatomy. Access to the biliary tree after RYGB with a classical direct surgical approach of common bile duct and choledocoscopy can be used, but may be complicated in situations of acute cholangitis because of the fragility of common duct, or in cases of previous cholecystectomy...
December 11, 2018: Obesity Surgery
https://read.qxmd.com/read/30506597/novel-peroral-direct-digital-cholangioscopy-assisted-lithotripsy-using-a-monorail-technique-through-the-overtube-in-patients-with-surgically-altered-anatomy-with-video
#15
Ryosuke Tonozuka, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Mitsuru Fujita, Yasutsugu Asai, Yukitoshi Mastunami, Takashi Kurosawa, Hiroyuki Kojima, Hirofumi Kogure, Yuichi Nagakawa
Efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons...
March 2019: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
https://read.qxmd.com/read/30448918/evaluation-of-biliary-anatomy-in-the-caudate-lobe-using-drip-infusion-cholangiography-computed-tomography
#16
Hiromi Edo, Ryuzo Sekiguchi, Naoki Edo, Akiko Kajiyama, Masashi Nagamoto, Tatsuya Gomi
PURPOSE: This study aimed to retrospectively evaluate the caudate branches (CBs), which are bile ducts originating from the caudate lobe (CL), using drip infusion cholangiography with computed tomography (DIC-CT). METHODS: The confluence patterns of CBs were evaluated in 185 adult patients undergoing DIC-CT. The following bile duct features were evaluated: (a) number of depicted CBs; (b) identification of the caudate portion from which the CBs were derived; (c) identification of the confluence site of a CB; and (d) whether there was a difference in the confluence site of the CBs depending on the position of the right posterior hepatic duct (RPHD) and the portal vein (PV)...
November 17, 2018: Abdominal Radiology
https://read.qxmd.com/read/30416140/high-insertion-of-cystic-duct-at-the-gallbladder-fundus-an-undescribed-anomaly
#17
Gabriel Rodrigues, Shruti Rahul Pandit, Afroz Khan, Bharath Veerabharappa, Balaji Jayasankar, Rasagna Anaparti
The anatomy of the biliary tree is complex, and its variations of both intra- and extra-hepatic bile ducts can be found in approximately 30% of the general population. These variations are not picked up on routine pre-operative investigations of patients planned for a laparoscopic cholecystectomy (LC) and often present as an unusual 'surprise' and a challenge that can make dissection in the Calot's triangle difficult leading to iatrogenic injury. We present a case of a 53-year-old female with an undescribed anomaly encountered during an LC...
November 9, 2018: Journal of Minimal Access Surgery
https://read.qxmd.com/read/30408946/endoscopic-ultrasound-in-the-diagnosis-of-pancreatoduodenal-groove-pathology-report-of-three-cases-and-brief-review-of-the-literature
#18
Inés C Oría, Juan E Pizzala, Augusto M Villaverde, Juan C Spina, Analía V Pasqua, Julio C Lazarte, Oscar M Mazza, Mariano M Marcolongo
The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case...
November 9, 2018: Clinical Endoscopy
https://read.qxmd.com/read/30353209/-radiologic-diagnostics-of-the-gall-bladder-and-bile-ducts-part-1-imaging-techniques-normal-variants-and-congenital-disorders-cholelithiasis
#19
H Helmberger, B Kammer
Upper abdominal pain, icterus and cholestasis are the main symptoms leading to evaluation of the biliary tract. Since the advent of contrast-enhanced ultrasound techniques the accuracy of bile duct imaging has significantly improved. This is also true for computed tomography using isotropic secondary reconstructions as well as magnetic resonance imaging (MRI) including MR cholangiography (MRC), classically and after iv injection of hepatobiliary contrast agent. Diffusion-weighted imaging sequences have a recently proven ability for improving biliary tract imaging...
November 2018: Der Radiologe
https://read.qxmd.com/read/30310986/adjunctive-thermoprotection-during-percutaneous-thermal-ablation-procedures-review-of-current-techniques
#20
Julien Garnon, Roberto Luigi Cazzato, Jean Caudrelier, Maud Nouri-Neuville, Pramod Rao, Emanuele Boatta, Nitin Ramamurthy, Guillaume Koch, Afshin Gangi
Although rare, unintended thermal injury to organs surrounding the ablation zone can lead to severe complications. Over the past 15 years, different protective methods have been developed to limit risk of complications, and expand indications to include more challenging lesions in various locations including liver, kidney, lung and bone. The most frequently used techniques include hydrodissection, carbodissection, balloon interposition and probe torqueing. In most cases, tumours can be physically separated from sensitive structures, reducing risk of thermal injury...
October 11, 2018: Cardiovascular and Interventional Radiology
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