Analysis of the arterial supply of the extrahepatic bile ducts and its clinical significance

Acute acalculous cholecystitis in children

Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.

Changing patterns of traumatic bile duct injuries: a review of forty years experience

AIM: To summarize the experiences of treating bile duct injuries in 40 years of clinical practice.

MATHODS: Based on the experience of more than 40 years of clinical work, 122 cases including a series of 61 bile duct injuries of the Southwest Hospital, Chongqing, and 42 cases (1989-1997) and 19 cases (1998-2001) of the General Hospital of PLA, Beijing, were reviewed with special reference to the pattern of injury. A series of cases of the liver and the biliary tract injuries following interventional therapy for hepatic tumors, most often hemangioma of the liver, were collected. Chinese medical literature from 1995 to 1999 dealing with 2742 traumatic bile duct strictures were reviewed.

RESULTS: There was a changing pattern of the bile duct injury. Although most of the cases of bile duct injuries resulted from open cholecystectomy. Other types of trauma such as laparoscopic cholecystectomy (LC) and hepatic surgery were increased in recent years. Moreover, serious hepato-biliary injuries following HAE using sclerotic agents such as sodium morrhuate and absolute ethanol for the treatment of hepatic hemangiomas were encountered in recent years. Experiences in how to avoid bile duct injury and to treat traumatic biliary strictures were presented.

CONCLUSION: Traumatic bile duct stricture is one of the serious complications of hepato-biliary surgery, its prevalence seemed to be increased in recent years. The pattern of bile duct injury was also changed and has become more complicated. Interventional therapy with sclerosing agents may cause serious hepatobiliary complications and should be avoided.

Severe biliary complications after hepatic artery embolization

AIM

To study the mechanism and treatment of severe biliary complications arising from hepatic artery embolization(HAE).

METHODS

Of seven cases of intra- and extrahepatic biliary damage resulting from hepatic artery embolization reported since 1987, 6 patients suffered from hepatic haemangioma, the other case was due to injection of TH compound into the hepatic artery during operation. The hepatic artery was injected with ethanol so as to evaluate the liver damage in experimental rats.

RESULTS

All the cases were found to have destructive damage of intra- and extrahepatic bile duct at the hilum with biliary hepatocirrhosis. Experimental results revealed necrosis of the liver parenchyma, especially around the portal tract and obliteration of intrahepatic bile duct.

CONCLUSIONS

To prevent the severe biliary complications of HAE, the use of HAE for hepatic haemangioma which was widely practiced in China, should be re-evaluated. Hepatic arterial embolization of hepatic haemangioma may resulte in severe destructive biliary damages and its indiscriminate use should be prohibited.