[Bile duct lesions in liver trauma]

Injuries of the biliary tract remain an important concomitant lesion following liver trauma. Intra- and extrahepatic bile duct injuries differ substantially in etiology and choice of surgical procedure. Intrahepatic bile duct injuries gain clinical relevance postoperatively following primary surgical liver treatment. Characteristic consequences of intrahepatic bile duct injuries are: infected necrosis, abscess, bilious fistula, bilhemia, hemobilia and biliary duct stricture. In contrast, concomitant organ or vessel injury are of primary importance in extrahepatic biliary duct injury. Lesions of the distal biliary duct, always associated with duodenal or pancreatic injury, remains a particular thrill in general surgery. The approach to surgical treatment in case of biliary duct injury and its consequences are outlined and discussed in detail.

[Preoperative evaluation of resectability of hilar bile duct carcinoma by color Doppler flow imaging and duplex Doppler]

Color flow images of hilar bile duct carcinoma and the relationship between tumors and hilar important blood vessals were observed in 22 patients with hilar bile duct carcinoma by color Doppler flow imaging (CDFI) and Duplex Doppler. It was found that most of bile duct carcinoma were of oligovascularity. Accurate rate were 81.82% and 77.28% respectively by preoperative ultrasound evaluation of the relationship between the tumor and the portal vein, and the tumor and the hepatic artery. CDFI and Duplex Doppler are sensitive, convenient and noninvasive methods for preoperative evaluation of resectability of hilar bile duct carcinoma and provide important information for surgery.

[Assessment of tumor extent in extrahepatic bile duct cancers--utility of intraductal ultrasonography]

Intraductal ultrasonography (IDUS) were performed in patients with extrahepatic bile duct cancer and compared to other diagnostic modalities and to resected specimens. Endoscopic ultrasonography (EUS) is a non-invasive diagnostic method useful for screening patients with bile duct cancers and determining whether they are resectable or not. While, EUS was not useful for the differential diagnosis of advanced and early tumors, and less useful in case of bile duct tumors located at the hilus hepatitis. IDUS proved useful without blind spot even in case of bile duct cancers at the hilus hepatis. IDUS was especially useful for the differential diagnosis of advanced and early tumors. IDUS is the very accurate diagnostic modality which make up for EUS and essential to determine the appropriate operation plan.

Laparoscopic intracorporeal ultrasound. An alternative to cholangiography?

The purpose of this study was to compare laparoscopic intracorporeal ultrasound (LICU) examination of the biliary duct system with cholangiography for delineation of duct anatomy and determination of presence or absence of ductal calculi. Thirty-one patients had LICU examination of the extrahepatic bile ducts after exposure of the gallbladder but prior to dissection of the cystic duct. After LICU examination, cystic duct dissection and cholangiography were done. Evaluation of duct anatomy and decision for duct exploration were based on findings of both tests. All patients had successful LICU examination and 30 had successful cholangiography. Duct size as determined by LICU corresponded precisely with cholangiography. LICU provided useful anatomical information in two patients with aberrant anatomy and detected cholangiogram. LICU aids in delineation of biliary duct anatomy and accurately determines presence or absence of duct calculi.

[The clinical evaluation of a method for venous autoplasty of the extrahepatic bile ducts]

Based on previous experimental investigations, the authors have successfully performed autovenous plasty of defects of extrahepatic bile ducts for scarry strictures under clinical conditions. In 3 patients portions of conserved free autovein were used. In 3 other patients a preliminarily bougienaged dissected segment of the umbilical autovein was used. The authors consider that to use a polyethelene drainage-frame is necessary for performing the above mentioned operations during 7-8 weeks.

New technique using intraductal ultrasonography for the diagnosis of bile duct cancer

We investigated the extent to which BDca can be visualized and diagnosed via a percutaneous fistula using IDUS. IDUS was performed in 42 cases, including 15 of normal bile ducts; 12 of choledocholithiasis, and 15 of BDca. The depth of invasion of the BDca was diagnosed with a 93% accuracy rate by visualizing the EP or MA or both. The infiltration of BDca into the surrounding organs was clearly visualized and diagnosed with an accuracy of 100% in the RHA, 93% in the PV, and 93% in the pancreas. These accuracy rates were higher than those obtained by computed tomography or angiography. We believe, therefore, that IDUS should be further studied as a diagnostic modality for staging malignancy in the biliary field.

Two different manifestations of botryoid sarcoma (embryonal rhabdomyosarcoma) of the biliary tree

A 16-month-old girl and a 5-year-old boy with botryoid sarcoma of the biliary tree are presented. The girl's tumor infiltrated the liver, whereas the boy's tumor was confined to the extrahepatic biliary tree. Computed tomography not only enabled the evaluation of the tumor-surrounding structures, but also indicated the tumorous nature of the lesion following intravenous administration of a contrast agent. In cholangiograms, the exact extension of the intraluminal tumors could be differentiated by the typical bizarre filling defects.

Laparoscopic cholecystectomy: intraoperative ultrasound of the extrahepatic biliary tree and the natural history of postoperative transabdominal ultrasound findings

Laparoscopic cholecystectomy (LC) has been rapidly embraced as an alternative to conventional open cholecystectomy (OC). While LC is less invasive than OC, it is still a surgical procedure with potential complications such as retained bile duct stones, iatrogenic injury to the bile duct with or without bile leak, hemorrhage, intestinal injury, and abscess formation. This article discusses the feasibility of intraoperative transmural ultrasound of the extrahepatic biliary tree with a 6.2 French catheter-based ultrasound probe and reviews the natural history of postoperative changes in the liver and gallbladder bed with conventional transabdominal ultrasound.

A Small-Bowel Segment as a Total Extrahepatic Bile Duct Replacement

The effect of a small-bowel segment as a total extrahepatic bile duct replacement, with preservation of the bile passage through the papilla of Vater, was examined in 12 pigs followed up for 420 days. No complications during or after surgery were observed in any of the animals. The laboratory parameters were within normal range during the entire observation period. No anastomotic stenosis was evident on percutaneous transhepatic cholangiography in animals examined 2, 6, or 12 months after surgery. The intrahepatic biliary tract was not dilated. There was obvious peristalsis of the grafted small-bowel toward the papilla of Vater. Autopsies showed that the grafts had healed without any sign of irritation. Histologically, the structure of the graft remained undisturbed. There was a clear distinction between the mucosa of the bile duct and that of the small bowel, with no sign of chronic infection. In the graft as well as in the vascular pedicle, the nerve fibers were intact. Liver biopsy showed no pathologic changes. In light of the results of these experiments, the small-bowel segment appears to be a very promising substitute for the injured extrahepatic biliary duct.