1
|
Cushman CJ, Ibrahim AF, Rostas J, Montgomery J. Access and reattachment of biliary tree anomaly through Roux-en-Y hepaticojejunostomy: A case report. Radiol Case Rep 2024; 19:3358-3362. [PMID: 38832338 PMCID: PMC11145206 DOI: 10.1016/j.radcr.2024.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
The right posterior segmental duct (RPSD) draining into the cystic duct is exceedingly rare. Ligation of the cystic duct in proximity to the junction of an aberrant right hepatic duct after a cholecystectomy can lead to life threatening complications. The present case study reveals a severed anomalous RPSD and subsequent Roux-en-Y hepaticojejunostomy procedure employed to fix biliary anomaly.
Collapse
Affiliation(s)
- Caroline J. Cushman
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Andrew F. Ibrahim
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jack Rostas
- Department of Surgery, Covenant Medical Center, Lubbock, TX, USA
| | - James Montgomery
- Department of Interventional Radiology, Covenant Medical Center, Lubbock, TX, USA
| |
Collapse
|
2
|
Obadan-Udoh E, Howard R, Valmadrid LC, Walji M, Mertz E. Patients' Experiences of Dental Diagnostic Failures: A Qualitative Study Using Social Media. J Patient Saf 2024; 20:177-185. [PMID: 38345377 DOI: 10.1097/pts.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Despite the many advancements made in patient safety over the past decade, combating diagnostic errors (DEs) remains a crucial, yet understudied initiative toward improvement. This study sought to understand the perception of dental patients who have experienced a dental diagnostic failure (DDF) and to identify patient-centered strategies to help reduce future occurrences of DDF. METHODS Through social media recruitment, we conducted a screening survey, initial assessment, and 67 individual patient interviews to capture the effects of misdiagnosis, missed diagnosis, or delayed diagnosis on patient lives. Audio recordings of patient interviews were transcribed, and a hybrid thematic analysis approach was used to capture details about 4 main domains of interest: the patient's DDF experience, contributing factors, impact, and strategies to mitigate future occurrences. RESULTS Dental patients endured prolonged suffering, disease progression, unnecessary treatments, and the development of new symptoms as a result of experiencing DE. Poor provider communication, inadequate time with provider, and lack of patient self-advocacy and health literacy were among the top attributes patients believed contributed to the development of a DE. Patients suggested that improvements in provider chairside manners, more detailed patient diagnostic workups, and improving personal self-advocacy; along with enhanced reporting systems, could help mitigate future DE. CONCLUSIONS This study demonstrates the valuable insight the patient perspective provides in understanding DEs, therefore aiding the development of strategies to help reduce the occurrences of future DDF events. Given the challenges patients expressed, there is a significant need to create an accessible reporting system that fosters constructive clinician learning.
Collapse
Affiliation(s)
- Enihomo Obadan-Udoh
- From the UC San Francisco Department of Preventive and Restorative Dental Sciences, San Francisco
| | - Rachel Howard
- From the UC San Francisco Department of Preventive and Restorative Dental Sciences, San Francisco
| | | | | | | |
Collapse
|
3
|
Gupta R, Kumar A, Hariprasad CP, Kumar M. Anatomical variations of cystic artery, cystic duct, and gall bladder and their associated intraoperative and postoperative complications: an observational study. Ann Med Surg (Lond) 2023; 85:3880-3886. [PMID: 37554913 PMCID: PMC10406088 DOI: 10.1097/ms9.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Anatomical variations in the calots triangle encountered during laparoscopic cholecystectomy are not uncommon. Misidentification and misperception of these structures are the major cause of vasculobiliary injuries. This study was conducted to estimate the prevalence of anatomical variations of the cystic artery, cystic duct (CD), and gall bladder. This is the first study in India to access the rate of intraoperative and postoperative complications in anatomical variants compared to normal individuals. PATIENTS AND METHODS It was a prospective observational study on patients undergoing laparoscopic cholecystectomy in the department of General Surgery at the tertiary center of India. The calculated sample size was 298. Variations of the cystic artery, CD, and gall bladder along with intraoperative and postoperative complications were noted. The comparative analysis of intraoperative and postoperative complications and a subgroup analysis between anatomical variants and normal patients were performed. RESULTS The most common variations were found in cystic arteries (16.8%). CD anomalies were present in 11.4% of patients, and gall bladder anomalies were the least common of all (5.4%). Intraoperative and postoperative complications were compared between patients with anatomical variations and normal anatomy. Intraoperative complications in patients with anatomical variations were significantly higher. Bile leak (15.7% vs. 6.4%) (P=0.01), haemorrhage (16.8% vs. 1.9%) (P-value <0.001), conversion to open (3 vs. 0 patients) (P-value =0.03). Subgroup analysis revealed a strong association between intraoperative haemorrhage and bile leak with cystic artery and CD anomalies, respectively. CONCLUSION Cystic artery anomalies are the most common variations. Patients with anatomical variations had significant intraoperative and postoperative complications compared to patients with normal anatomy.
Collapse
Affiliation(s)
| | - Anil Kumar
- Department of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Patna, India
| | | | | |
Collapse
|
4
|
Muacevic A, Adler JR. Variant Biliary Anatomy in Biological Siblings. Cureus 2023; 15:e34199. [PMID: 36843766 PMCID: PMC9955506 DOI: 10.7759/cureus.34199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
Laparoscopic cholecystectomy is the standard of care for cholecystolithiasis but carries an increased risk of biliary injury compared to open cholecystectomy. Complications from laparoscopic cholecystectomy can be related to several factors. These include - (i) technical factors that depend on the skill of the surgeon, (ii) pathologic factors such as associated inflammation and adhesions, and (iii) anatomic factors such as biliary anatomy. Aberrant biliary anatomy is a major cause of bile duct injury during surgery. To the best of our knowledge familial aberrant biliary anatomy has not been previously reported in the literature. We report a case series of two biological sisters with isolated posterior right duct syndrome and present a brief literature review of this medical condition.
Collapse
Affiliation(s)
- Alexander Muacevic
- Department of Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
| | - John R Adler
- Department of Gastroenterology and Hepatology, University of Connecticut Health, Farmington, USA
| |
Collapse
|
5
|
Ali SW, Kazmi S, Jabeen A, Ashraf MS, Mateen Khan MA. Choledochal cyst associated with anomalous biliary drainage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Hirao H, Okabe H, Ogawa D, Kuroda D, Taki K, Tomiyasu S, Hirota M, Hibi T, Baba H, Sugita H. A case of right hepatic duct entering cystic duct successfully treated by laparoscopic subtotal cholecystectomy through preoperatively placed biliary stent. Surg Case Rep 2020; 6:221. [PMID: 32975684 PMCID: PMC7519020 DOI: 10.1186/s40792-020-00994-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy is a well-established surgical procedure and is one of the most commonly performed gastroenterological surgeries. Therefore, strategy for the management of rare anomalous cystic ducts should be determined. CASE PRESENTATION A 56-year-old woman was admitted to our hospital owing to upper abdominal pain and diagnosed with acute cholecystitis. Magnetic resonance cholangiopancreatography suspected that several small stones in gallbladder and the right hepatic duct drained into the cystic duct. Endoscopic retrograde cholangiopancreatography confirmed the cystic duct anomaly, and an endoscopic nasobiliary drainage catheter (ENBD) was placed at the right hepatic duct preoperatively. Intraoperative cholangiography with ENBD confirmed the place of division in the gallbladder, and laparoscopic subtotal cholecystectomy was safely performed. CONCLUSIONS The present case exhibited rare right hepatic duct anomaly draining into the cystic duct, which might have caused biliary tract disorientation and bile duct injury (BDI) intraoperatively. Any surgical technique without awareness of this anomaly preoperatively might insufficiently prevent BDI, and preoperative ENBD would facilitate safe and successful surgery.
Collapse
Affiliation(s)
- Hiroki Hirao
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan. .,Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - HiroHisa Okabe
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Daisuke Ogawa
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Katsunobu Taki
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Shinjiro Tomiyasu
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Masahiko Hirota
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-Ku, Kumamoto, 860-0811, Japan
| |
Collapse
|
7
|
Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
Collapse
Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| |
Collapse
|
8
|
Tringali A, Massinha P, Schepis T, Landi R, Boškoski I, Perri V, Bove V, Costamagna G. Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. Gastrointest Endosc 2020; 91:584-592. [PMID: 31629720 DOI: 10.1016/j.gie.2019.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. METHODS Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. RESULTS Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. CONCLUSIONS An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.
Collapse
Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paulo Massinha
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy; Gastroenterology Department, Garcia de Orta Hospital, E.P.E, Almada, Portugal
| | - Tommaso Schepis
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
9
|
Laparoscopic management for aberrant hepatic duct in children with choledochal cysts. Surg Endosc 2019; 33:2376-2380. [DOI: 10.1007/s00464-019-06807-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
|
10
|
Petrillo M, Ierardi AM, Tofanelli L, Maresca D, Angileri A, Patella F, Carrafiello G. Gd-EOB-DTP-enhanced MRC in the preoperative percutaneous management of intra and extrahepatic biliary leakages: does it matter? Gland Surg 2019; 8:174-183. [PMID: 31183327 DOI: 10.21037/gs.2019.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Postoperative bile leakage is a common complication of abdominal surgical procedures and a precise localization of is important to choose the best management. Many techniques are available to correctly identify bile leaks, including ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI), being the latter the best to clearly depict "active" bile leakages. This paper presents the state of the art algorithm in the detection of biliary leakages in order to plan a percutaneous biliary drainage focusing on widely available and safe contrast agent, the Gb-EOB-DPA. We consider its pharmacokinetic properties and impact in biliary imaging explain current debates to optimize image quality. We report common sites of leakage after surgery with special considerations in cirrhotic liver to show what interventional radiologists should look to easily detect bile leaks.
Collapse
Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Laura Tofanelli
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Duilia Maresca
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
11
|
Abe T, Ito S, Kaneda Y, Suto R, Noshima S. Main right hepatic duct entering the cystic duct: a case report. Surg Case Rep 2019; 5:46. [PMID: 30911867 PMCID: PMC6434006 DOI: 10.1186/s40792-019-0604-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot’s triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury. Case presentation A 65-year-old woman was admitted with right hypochondrial pain and high fever. A diagnosis of acute calculous cholecystitis was made by radiological imaging. Magnetic resonance cholangiopancreatography revealed that the confluence of the right and left hepatic duct was unclear. Intraoperatively, the procedure was converted from a laparoscopic cholecystectomy to laparotomy because of unclear anatomy of the cystic duct with severe inflammation at Calot’s triangle. Furthermore, intraoperative cholangiography from Hartmann’s pouch showed the main right hepatic duct entering the cystic duct. Subtotal cholecystectomy was performed to avoid injuring the right hepatic duct. Conclusion Although an aberrant hepatic duct entering the cystic duct is not uncommon, the main right hepatic duct infiltrating the cystic duct is extremely rare. Preoperative and intraoperative evaluation of the biliary duct and awareness of aberrant biliary duct variations is important in preventing bile duct injury.
Collapse
Affiliation(s)
- Toshiya Abe
- Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan.
| | - Shinichiro Ito
- Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan
| | - Yoshikazu Kaneda
- Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan
| | - Ryuichiro Suto
- Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan
| | - Shinji Noshima
- Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan
| |
Collapse
|
12
|
Magdy M, Spencer S, Graham S, Mekisic A. Absence of the common bile duct. ANZ J Surg 2018; 89:782-784. [PMID: 30203612 DOI: 10.1111/ans.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mark Magdy
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sascha Spencer
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Susannah Graham
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Allan Mekisic
- Department of Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| |
Collapse
|
13
|
Wang L, Zhou D, Hou H, Wu C, Geng X. Application of "three lines and one plane" as anatomic landmarks in laparoscopic surgery for bile duct stones. Medicine (Baltimore) 2018; 97:e0155. [PMID: 29668576 PMCID: PMC5916665 DOI: 10.1097/md.0000000000010155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022] Open
Abstract
To investigate the clinical application ofthe "three lines and one plane" concept as the anatomic landmarks during laparoscopic common bile duct exploration (LCBDE).From January 2014 to February 2017, 148 cases of LCBDE performed in the General Surgery Department of the 2nd affiliated Hospital of Anhui Medical University were recruited, and analyzed in this study. "Three lines and one plane" was applied as anatomical landmarks during LCBDE, and the perioperative clinical outcomes were analyzed.No serious operational complications occurred in all the patients in this study. Two cases (1.4%) was converted to open operation. Two other cases (1.4%) suffered post-operative bile leakage and were cured by conservative treatment. All patients recovered uneventfully.Anatomical landmarks of "three lines and one plane" is benefit in helping surgeons to build a three-dimensional (3D) anatomical construction, and avoiding the operative injury of the bile duct, and vessels.
Collapse
|
14
|
Tatsuaki S, Yasuo S, Takehiro O, Yasuhiro H, Yoshihiro N, Michihiko K, Kenta S, Yuji N, Taijiro S. Multidetector CT in detection of troublesome posterior sectoral hepatic duct communicating with cystic duct. Br J Radiol 2017; 90:20170260. [PMID: 28749170 DOI: 10.1259/bjr.20170260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate whether multiple detector CT (MDCT) could detect troublesome aberrant posterior sectoral hepatic duct (PHD) communicating with cystic duct (CD). METHODS The most troublesome bile duct anomaly during cholecystectomy is an aberrant PHD communicating with CD. It has been suggested that an unenhanced small duct between Rouviere's sulcus and CD on MDCT could be coincident to an aberrant PHD communicating with CD. A total of 224 patients who underwent laparotomy with complete lymph node dissection in the hepatoduodenal ligament for hepatobiliary or pancreatic tumour were enrolled. Retrospective review of preoperative MDCT images and surgical records was performed. RESULTS Preoperative MDCT detected 8 (3.6%) unenhanced ducts between Rouviere's sulcus and CD. Surgical records identified 7 (3.1%) cases of aberrant PHD communicating with CD, and all 7 cases showed an unenhanced duct between Rouviere's sulcus and CD on preoperative MDCT imaging. Among the 7 patients, 5 (71%) were without bile duct dilatation. CONCLUSION MDCT could detect troublesome aberrant PHD communicating with CD, regardless of the presence or absence of bile duct dilatation. Advances in knowledge: MDCT could detect most troublesome PHD communicating with CD, regardless of the presence or absence of bile duct dilatation.
Collapse
Affiliation(s)
- Sumiyoshi Tatsuaki
- 1 Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Shima Yasuo
- 1 Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Okabayashi Takehiro
- 1 Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Hata Yasuhiro
- 2 Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Noda Yoshihiro
- 2 Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Kouno Michihiko
- 2 Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Sui Kenta
- 1 Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Negoro Yuji
- 3 Department of Medical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Sueda Taijiro
- 4 Department of Surgery, Applied Life Sciences Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
15
|
Singh K, Singh R, Kaur M. Clinical reappraisal of vasculobiliary anatomy relevant to laparoscopic cholecystectomy. J Minim Access Surg 2017; 13:273-279. [PMID: 28872096 PMCID: PMC5607794 DOI: 10.4103/jmas.jmas_268_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) has many advantages as compared to open cholecystectomy. However, vasculobiliary injuries still continue to be a matter of concern despite advances in laparoscopic techniques. Misidentification and misperception of vasculobiliary structures is considered to be a pivotal factor leading to injuries. Although many studies since time immemorial have stressed on the importance of anatomy, an insight into laparoscopic anatomy is what essentially constitutes the need of the hour. OBJECTIVE To assess the frequency and the relevance of anatomical variations of extrahepatic biliary system in patients undergoing LC. MATERIALS AND METHODS The present study is an observational study performed for a period of 2 years from August 2014 to August 2016. It included all diagnosed patients of cholelithiasis undergoing routine LC performed by a single surgeon by achieving a critical view of safety. During dissection, vascular and ductal anomalies were noted and assessed for their relevance in LC. RESULTS Seven hundred forty cases of cholelithiasis, irrespective of pathology, comprising 280 (37.83%) men and 460 (62.16%) females with a mean age of 39.85 ± 18.82 years were included in the study. Photodocumentation and operative recordings were available in 93% of cases. Operative findings revealed 197 (26.62%) vascular anomalies and 90 (12.16%) ductal anomalies. A single cystic artery was seen in 340 cases, and a normal cystic duct was seen in 650 cases. Variations in ductal anatomy were fewer than variations in vascular anatomy. CONCLUSION Extra-biliary anatomy relevant to LC is unpredictable and varies from patient to patient. Vascular anomalies are more frequent than the ductal anomalies, and surgeon should be alert regarding their presence.
Collapse
Affiliation(s)
- Kuldip Singh
- Department of General Surgery, Adesh Institute of Medical Science and Research, Bathinda, Punjab, India
| | - Ranbir Singh
- Department of General Surgery, Adesh Institute of Medical Science and Research, Bathinda, Punjab, India
| | - Manjot Kaur
- Department of General Surgery, Adesh Institute of Medical Science and Research, Bathinda, Punjab, India
| |
Collapse
|
16
|
Mittal T, Pulle MV, Dey A, Malik VK. Congenital absence of the common bile duct: A rare anomaly of extrahepatic biliary tract. J Minim Access Surg 2016; 12:281-2. [PMID: 27279403 PMCID: PMC4916758 DOI: 10.4103/0972-9941.181292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Congenital absence of the common bile duct (CBD) is an extremely rare developmental anomaly with right and left hepatic ducts draining directly into the gallbladder (GB). Other synonyms for this clinical condition are "cholecystohepatic ducts", "transverse lie of the GB" or "interposition of the GB". The potential for iatrogenic injury is high, because of either inadvertent division or ligation of the ducts. Diagnosis is mostly made intraoperatively, and needs some form of biliary reconstruction. Herein, we are reporting a case of congenital absence of the CBD in a 36-year-old lady that was detected intraoperatively.
Collapse
Affiliation(s)
- Tarun Mittal
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan V Pulle
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Dey
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Vinod K Malik
- Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
17
|
Kurata M, Honda G, Okuda Y, Kobayashi S, Sakamoto K, Iwasaki S, Chiba K, Tabata T, Kuruma S, Kamisawa T. Preoperative detection and handling of aberrant right posterior sectoral hepatic duct during laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:558-62. [DOI: 10.1002/jhbp.252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 03/12/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Masanao Kurata
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 3-18-22 Honkomagome Bunkyo-ku Tokyo 113-8677 Japan
| | - Goro Honda
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 3-18-22 Honkomagome Bunkyo-ku Tokyo 113-8677 Japan
| | - Yukihiro Okuda
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 3-18-22 Honkomagome Bunkyo-ku Tokyo 113-8677 Japan
| | - Shin Kobayashi
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 3-18-22 Honkomagome Bunkyo-ku Tokyo 113-8677 Japan
| | - Katsunori Sakamoto
- Department of Surgery; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 3-18-22 Honkomagome Bunkyo-ku Tokyo 113-8677 Japan
| | - Susumu Iwasaki
- Department of Internal Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Kazuro Chiba
- Department of Internal Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Taku Tabata
- Department of Internal Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Sawako Kuruma
- Department of Internal Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| | - Terumi Kamisawa
- Department of Internal Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; Tokyo Japan
| |
Collapse
|
18
|
Hennedige T, Anil G, Madhavan K. Expectations from imaging for pre-transplant evaluation of living donor liver transplantation. World J Radiol 2014; 6:693-707. [PMID: 25276312 PMCID: PMC4176786 DOI: 10.4329/wjr.v6.i9.693] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/25/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Living donor liver transplant (LDLT) is a major surgical undertaking. Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in pre-operative evaluation. These cross-sectional imaging techniques can reveal the vascular and biliary anatomy, assess the hepatic parenchyma and perform volumetric analysis. Knowledge of the broad indications and contraindications to qualify as a recipient for LDLT is essential for the radiologist reporting scans in a pre-transplant patient. Similarly, awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations. CT and MRI have largely replaced invasive techniques such as catheter angiography, percutaneous cholangiography and endoscopic retrograde cholangiopancreatography. In order to generate a meaningful report based on these pre-operative imaging scans, it is also mandatory for the radiologist to be aware of the surgeon’s perspective. We intend to provide a brief overview of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans performed for LDLT related evaluation.
Collapse
|
19
|
Detection and localization of bile duct leaks after cholecystectomy using Gd-EOB-DTPA-enhanced MR cholangiography: retrospective study of 16 patients. J Comput Assist Tomogr 2014; 38:518-25. [PMID: 24651750 DOI: 10.1097/rct.0000000000000083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine if gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) cholangiography can detect and localize bile duct leaks in postcholecystectomy patients. MATERIAL AND METHODS Four blinded independent radiologists performed a retrospective review of 16 consecutive patients who underwent MR cholangiography with intravenous Gd-EOB-DTPA for the evaluation of possible biliary leak. Image quality, ductal opacification, and presence and location of any bile leak were evaluated. An independent observer determined the criterion standard using a consensus of all chart, clinical, and imaging findings. RESULTS All 6 bile leaks confirmed at endoscopic retrograde cholangiopancreatography were diagnosed by all reviewers (sensitivity, 100%). Of the 10 patients with no leak, only one reader incorrectly diagnosed a bile leak in a single case (specificity, 98%). The accuracy for detection of the site of leak with Gd-EOB-DTPA-enhanced MR cholangiography was 80%. CONCLUSION Gadolinium-EOB-DTPA-enhanced MR can detect bile leaks with a high sensitivity and specificity.
Collapse
|
20
|
Abstract
Although ultrasound, computed tomography, and cholescintigraphy play essential roles in the evaluation of suspected biliary abnormalities, magnetic resonance (MR) imaging and MR cholangiopancreatography can be used to evaluate inconclusive findings and provide a comprehensive noninvasive assessment of the biliary tract and gallbladder. This article reviews standard MR and MR cholangiopancreatography techniques, clinical applications, and pitfalls. Normal biliary anatomy and variants are discussed, particularly as they pertain to preoperative planning. A spectrum of benign and malignant biliary processes is reviewed, emphasizing MR findings that aid in characterization.
Collapse
|
21
|
Cholecystectomy-related aberrant bile duct injuries and their endoscopic treatment. Surg Laparosc Endosc Percutan Tech 2014; 23:e119-23. [PMID: 23752019 DOI: 10.1097/sle.0b013e3182751e6c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Both complete transection and accidental ligation of the main bile duct because of a cholecystectomy are the injuries that are not amenable to endoscopic treatment and require an additional surgery. Leaks resulting from the severance of an aberrant bile duct may be treated endoscopically, although such injuries are difficult to be identified, thus resulting in treatment delays. Presented here are the details and follow-up results of 7 cases of patients with postcholecystectomy aberrant bile duct injuries, which were treated by endoscopic treatment.
Collapse
|
22
|
Wigham A, Alexander Grant L. Preoperative hepatobiliary imaging: what does the radiologist need to know? Semin Ultrasound CT MR 2013; 34:2-17. [PMID: 23395314 DOI: 10.1053/j.sult.2012.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate preoperative reporting is essential in guiding the surgeon in deciding when and how to operate safely and effectively. Critically, this relies on an understanding of the operative issues faced by the surgeon, which is not always appreciated by the radiologist. This paper therefore aims to address this, first focusing on relevant anatomical variants, and then issues specific to laparoscopic cholecystectomy, hepatic transplantation, and finally hepatic resection (including cholangiocarcinoma resection). Throughout the paper, there is an emphasis on associated surgical techniques to add context to the discussion.
Collapse
Affiliation(s)
- Andrew Wigham
- Department of Radiology, Royal Free Hospital, London, UK
| | | |
Collapse
|
23
|
Timing and risk factors of hepatectomy in the management of complications following laparoscopic cholecystectomy. J Gastrointest Surg 2012; 16:815-20. [PMID: 22068969 DOI: 10.1007/s11605-011-1769-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/19/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Complex bile duct injury (BDI) is a serious condition requiring hepatectomy in some instances. The present study was to analyse the factors that led to hepatectomy for patients with BDI after laparoscopic cholecystectomy (LC). METHODS The medical records of patients referred to our department from April 1998 to September 2007 for management of BDI following LC were reviewed, and patients who underwent hepatectomy were identified. The type of BDI, indication for liver resection, interval between LC and liver surgery, histology of the liver specimen, postoperative morbidity and long-term results were analysed. RESULTS Hepatectomy was performed in 10 of 76 patients (13.2%), with BDI either as isolated damage or in combination with vascular injury (VI). Proximal BDI (defined as disruption of the biliary confluence) and injury to the right hepatic artery were found to be independent risk factors of hepatectomy, with odds ratios of 16 and 45, respectively. Five patients required early liver resection (within 5 weeks post-LC) to control sepsis caused by confluent liver necrosis or bile duct necrosis. In five patients, hepatectomy was indicated during long-term follow-up (over 4 months post-LC) to effectively manage recurrent cholangitis and liver atrophy. Despite of high postoperative morbidity (60%) and even mortality (10%), the long-term results (median follow-up of 34 months) were satisfactory, with either no or only transitory symptoms in 67% of the patients. CONCLUSION Hepatectomy may inevitably be necessary to manage early or late complications after LC. Proximal BDI and VI were the two independent risk factors of hepatectomy in this series.
Collapse
|
24
|
Hyodo T, Kumano S, Kushihata F, Okada M, Hirata M, Tsuda T, Takada Y, Mochizuki T, Murakami T. CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree. Br J Radiol 2012; 85:887-96. [PMID: 22422383 DOI: 10.1259/bjr/21209407] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Recent developments in imaging technology have enabled CT and MR cholangiopancreatography (MRCP) to provide minimally invasive alternatives to endoscopic retrograde cholangiopancreatography for the pre- and post-operative assessment of biliary disease. This article describes anatomical variants of the biliary tree with surgical significance, followed by comparison of CT and MR cholangiographies. Drip infusion cholangiography with CT (DIC-CT) enables high-resolution three-dimensional anatomical representation of very small bile ducts (e.g. aberrant branches, the caudate branch and the cystic duct), which are potential causes of surgical complications. The disadvantages of DIC-CT include the possibility of adverse reactions to biliary contrast media and insufficient depiction of bile ducts caused by liver dysfunction or obstructive jaundice. Conventional MRCP is a standard, non-invasive method for evaluating the biliary tree. MRCP provides useful information, especially regarding the extrahepatic bile ducts and dilated intrahepatic bile ducts. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRCP may facilitate the evaluation of biliary structure and excretory function. Understanding the characteristics of each type of cholangiography is important to ensure sufficient perioperative evaluation of the biliary system.
Collapse
Affiliation(s)
- T Hyodo
- Department of Radiology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Chung YH, Kim DJ, Kim IG, Kim HJ, Chon SE, Jeon JY, Jung JP, Jeong JC, Kim JS, Yun EJ. Relationship between the risk of bile duct injury during laparoscopic cholecystectomy and the types of preoperative magnetic resonance cholangiopancreatiocography (MRCP). KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:17-23. [PMID: 26388901 PMCID: PMC4575012 DOI: 10.14701/kjhbps.2012.16.1.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/10/2011] [Accepted: 02/05/2012] [Indexed: 02/07/2023]
Abstract
Backgrounds/Aims Bile duct injury is one of the potential severe complications that can occur during laparoscopic cholecystectomy, which can be cause by anatomic variations in the confluence of the bile duct. Recently magnetic resonance cholangiopancreatiocography (MRCP) has become a helpful tool to detect bile duct variation on a preoperative basis and to prevent bile duct injury during laparoscopic cholecystectomy, as well other hepatic surgeries. This study aimed to clarify the types of bile duct on MRCP and to search for a method of avoiding injury during laparoscopic cholecystectomy. Methods Between January 2009 and December 2010, 277 patients underwent laparoscopic cholecystectomy with preoperative MRCP in our institution. On a retrospective basis, the bile ducts were categorized into 5 types according to the Couinaud classification system. Results The proportion of types was revealed type A (70.4%), type B (8.7%), type C (19.5%), type D (0.7%), type E (0%), and type F (0.7%), respectively. Bile duct injury occurred in 4 cases (1.4%) during laparoscopic cholecystectomy. In particular, the possibility of aberrant extrahepatic confluence (Type C and F) represented the highest risk of duct injury (OR=11.89 [CI: 1.21-116.53]). Conclusions Preoperative evaluation of the bile duct anatomy is important to avoid injury of duct during laparoscopic cholecystectomy. Specific types of bile duct variation should be considered as a high risk group for bile duct injury.
Collapse
Affiliation(s)
- Yun Ho Chung
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Doo Jin Kim
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - In-Gyu Kim
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Han Jun Kim
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Seong Eun Chon
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Jang Yong Jeon
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Jae Pil Jung
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Jin Cheol Jeong
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Joo Seop Kim
- Department of Surgery, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Eun Joo Yun
- Department of Radiology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Sharmila A, Sumathilatha S, Jebakani CF. Anatomical Variations in the Extra Hepatic Biliary Ductal System. J ANAT SOC INDIA 2011. [DOI: 10.1016/s0003-2778(11)80011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
27
|
Ikeda T, Yonemura Y, Ueda N, Kabashima A, Mashino K, Yamashita K, Fujii K, Tashiro H, Sakata H. Intraoperative cholangiography using an endoscopic nasobiliary tube during a laparoscopic cholecystectomy. Surg Today 2011; 41:667-73. [PMID: 21533939 DOI: 10.1007/s00595-010-4334-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 01/04/2010] [Indexed: 01/07/2023]
Abstract
PURPOSE The goals of this report are to present the characteristics of biliary complications associated with laparoscopic cholecystectomies (LC) performed at a single center, and to evaluate the efficacy of intraoperative cholangiography (IOC) using an endoscopic nasobiliary tube (ENBT) during an LC in order to prevent biliary complications. METHODS A retrospective audit was conducted on a total of 657 patients who underwent either LC or open cholecystectomies (OC). There were 19 patients who developed bile duct injury (BDI; n = 9) or bile leakage (BL; n = 10) during an LC and were actively treated. After May of 1999, the patients with a higher risk of developing biliary complications were selected for preoperative placement of an ENBT, and IOC was performed. RESULTS Intraoperative cholangiography using ENBT was performed on 93 (27.1%) out of 343 patients who underwent either LC or OC after May of 1999. An LC was performed in 335 cases (97.7%), and a conversion from an LC to OC was necessary in only three cases. Even though BDI never occurred, BL from the cystic duct and gallbladder bed were recognized in five cases. CONCLUSIONS The selective use of IOC using ENBT may help to prevent BDI during LC, thereby expanding the indications for LC, while also reducing the rate of conversion to open procedures.
Collapse
Affiliation(s)
- Tetsuo Ikeda
- Department of Surgery, Oita Prefectural Hospital, 476 Oaza-Bunyou, Oita, 870-8511, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
An unusual anamoly of the extrahepatic bitiary system is reported in which the common hepatic duct was found to enter the gallbladder, whereas the cystic duct drained the entire biliarysystem into the duodenum. Excision of the gallbladder and cystic duct and a roux-en-Y hepaticojejunostomy was performed. Identification and treatment options of this rare anomaly are briefly discussed.
Collapse
Affiliation(s)
- Ravula Phani Krishna
- Sanjay gandhi postgraduate institute of medical sciences, Lucknow, Uttar Pradesh India
| | | |
Collapse
|
29
|
Aberrant right hepatic duct draining into the cystic duct: clinical outcomes and management. Gastroenterol Res Pract 2011; 2011:458915. [PMID: 21687615 PMCID: PMC3113254 DOI: 10.1155/2011/458915] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/27/2011] [Accepted: 02/19/2011] [Indexed: 11/21/2022] Open
Abstract
Background. Aberrant right hepatic duct (ARHD) draining into
cystic duct (CD) is relatively rare but clinically important
because of its susceptibility to injuries during cholecystectomy.
These injuries are often-times missed or diagnosed late and as a
result can develop serious complications. Methods. Four
consecutive patients diagnosed with ARHD draining into CD were
identified for inclusion. Results. The mean age of patients was
42.5 years. The diagnosis in one of the patient was incidental
during a routine endoscopic retrograde cholangiopancreatography
(ERCP). Other three patients were diagnosed post-cholecystectomy-
one presented with suspected intra-operative biliary injury, one
with persistent bile leak and another with recurrent cholangitis.
Inadequate filling of the segment of liver on ERCP with dilation
of intrahepatic ducts in the corresponding segment on imaging was
present in two patients with complete obstruction of ARHD which
was managed surgically. In another patient, the partially
obstructed ARHD was managed by endoscopic therapy. Conclusion.
ARHD draining into the CD can have varied clinical manifestations.
In appropriate clinical settings, it should be suspected in
patients with persistence of bile leak early after
cholecystectomy, segmental dilation of intrahepatic-bile ducts on
imaging and paucity of intrahepatic filling in a segment of liver
on ERCP.
Collapse
|
30
|
Choi G, Eun CK, Choi H. Acetic acid sclerotherapy for treatment of a bile leak from an isolated bile duct after laparoscopic cholecystectomy. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S303-6. [PMID: 21191591 DOI: 10.1007/s00270-010-0060-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 11/19/2010] [Indexed: 11/26/2022]
Abstract
Bile leak after laparoscopic cholecystectomy is not uncommon, and it mainly occurs from the cystic duct stump and can be easily treated by endoscopic techniques. However, treatment for leakage from an isolated bile duct can be troublesome. We report a successful case of acetic acid sclerotherapy for bile leak from an isolated bile duct after laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Gibok Choi
- Department of Radiology, Haeundae Paik Hospital, College of Medicine, Inje University, 1435 Jwa-dong, Haeundae-gu, Busan 612-030, Korea.
| | | | | |
Collapse
|
31
|
Magnetic Resonance Cholangiopancreatography of Benign Disorders of the Biliary System. Magn Reson Imaging Clin N Am 2010; 18:497-514, xi. [DOI: 10.1016/j.mric.2010.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
32
|
Intraoperative near-infrared fluorescent cholangiography (NIRFC) in mouse models of bile duct injury. World J Surg 2010; 34:336-43. [PMID: 20033407 DOI: 10.1007/s00268-009-0332-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accidental injury to the common bile duct is a rare but serious complication of laparoscopic cholecystectomy. Accurate visualization of the biliary ducts may prevent injury or allow its early detection. Conventional X-ray cholangiography is often used and can mitigate the severity of injury when correctly interpreted. However, it may be useful to have an imaging method that could provide real-time extrahepatic bile duct visualization without changing the field of view from the laparoscope. The purpose of the present study was to test a new near-infrared (NIR) fluorescent agent that is rapidly excreted via the biliary route in preclinical models to evaluate intraoperative real-time near infrared fluorescent cholangiography (NIRFC). METHODS To investigate probe function and excretion, a lipophilic near-infrared fluorescent agent with hepatobiliary excretion was injected intravenously into one group of C57/BL6 control mice and four groups of C57/BL6 mice under the following experimentally induced conditions: (1) chronic biliary obstruction, (2) acute biliary obstruction (3) bile duct perforation, and (4) choledocholithiasis, respectively. The biliary system was imaged intravitally for 1 h with near-infrared fluorescence (NIRF) with an intraoperative small animal imaging system (excitation 649 nm, emission 675 nm). RESULTS The extrahepatic ducts and extraluminal bile were clearly visible due to the robust fluorescence of the excreted fluorochrome. Twenty-five minutes after intravenous injection, the target-to-background ratio peaked at 6.40 +/- 0.83 but signal was clearly visible for ~60 min. The agent facilitated rapid identification of biliary obstruction and bile duct perforation. Implanted beads simulating choledocholithiasis were promptly identifiable within the common bile duct lumen. CONCLUSIONS Near-infrared fluorescent agents with hepatobiliary excretion may be used intraoperatively to visualize extrahepatic biliary anatomy and physiology. Used in conjunction with laparoscopic imaging technologies, the use of this technique should enhance hepatobiliary surgery.
Collapse
|
33
|
Surgical management of segmental and sectoral bile duct injury after laparoscopic cholecystectomy: a challenging situation. J Gastrointest Surg 2010; 14:344-51. [PMID: 19911237 DOI: 10.1007/s11605-009-1087-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 10/26/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injury to a segmental or sectoral bile duct is a rare event in laparoscopic cholecystectomy; its diagnosis and management may be difficult. PATIENTS AND METHODS Between April 1998 and December 2006, 73 patients referred to the author's tertiary center for management of postcholecystectomy biliary complications were studied. The patients with segmental/sectoral bile duct injury were divided into two groups: injury to a duct which drains at least one Couinaud segment (type 1) or injury to a minor biliary radical in the gallbladder fossa (type 2). Beside the management of concomitant vascular or other biliary injury, type 1 segmental/sectoral duct injury was repaired by biliary-enteric anastomosis and type 2 by oversewing. RESULTS Ten out of 73 referred patients had segmental/sectoral duct injuries (eight type 1, two type 2). Despite multiple radiological imaging and endoscopic procedures, in seven patients, the lesion was identified only by precise surgical dissection. The median length of hospital treatment was 26 (range 9-47) days. One patient died due to sepsis before any definitive treatment. During the mean follow-up of 43 (range 27-111) months, seven patients remained asymptomatic while two patients developed biliary anastomotic strictures requiring intervention. CONCLUSION Segmental/sectoral duct injury is difficult to be assessed by conventional radiological diagnostics and should be taken into consideration in every case of bile leakage. Surgical treatment, adapted to the type of lesion, generally results in a favorable outcome.
Collapse
|
34
|
Tamm EP, Balachandran A, Bhosale P, Szklaruk J. Update on 3D and multiplanar MDCT in the assessment of biliary and pancreatic pathology. ACTA ACUST UNITED AC 2009; 34:64-74. [PMID: 18483805 DOI: 10.1007/s00261-008-9416-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of multidetector row computed tomography (MDCT) has led to the acquisition of true isotropic voxels that can be postprocessed to yield images in any plane of the same resolution as the original axially acquired images. This, coupled with rapid MDCT imaging during peak target organ enhancement has led to a variety of means to review imaging information beyond that of the axial perspective. Postprocessing can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary-related surgery, determine the level and cause of biliary obstruction and assist in staging of biliary cancer. Postprocessing can also be used to identify pancreatic ductal variants, visualize diagnostic features of pancreatic cystic lesions, diagnose and stage pancreatic cancer, and differentiate pancreatic from peripancreatic disease.
Collapse
Affiliation(s)
- Eric P Tamm
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | |
Collapse
|
35
|
Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance. Radiol Med 2008; 113:841-59. [PMID: 18592141 DOI: 10.1007/s11547-008-0298-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 12/26/2007] [Indexed: 01/03/2023]
Abstract
PURPOSE The objective of this paper is to document the magnetic resonance cholangiopancreatography (MRCP) findings and the epidemiology of congenital anomalies and variations of the bile and pancreatic ducts and to discuss their clinical significance. MATERIALS AND METHODS Three-hundred and fifty patients of both sexes (150 females, 200 males, age range 0-76 years, average age 38 years) underwent MRCP for clinically suspected lithiasic, neoplastic or inflammatory disease of the bile and pancreatic ducts. Patients were imaged with a 1.5-T superconductive magnet (Magnetom Vision, Siemens, Erlangen, Germany), a four-channel phased-array body coil, breath-hold technique, with multislice T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), MIP reconstructions, and a single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) with different slice thicknesses. Studies in oncological patients were completed with fat saturation 3D T1 gradient-echo sequences during the intravenous injection of gadolinium diethylene triamine pentaacetate acid (DTPA) (0.2 ml/kg). RESULTS MRCP demonstrated recurrent and therefore normal bile and pancreatic ducts in 57% of patients. In the remaining 42.3%, it documented anatomical variants (41%) and congenital anomalies (1.3%). Variants of the intrahepatic bile duct were seen in 21% of cases: crossover anomaly (6.7%), anterior branch of the right hepatic duct draining the IV and VII segments that flow together with the left bile duct (3.1%) and anterior and posterior branches of the right hepatic duct that flow together with the common hepatic duct (3.3%). Variants of the extrahepatic bile ducts were present in 8.8% of patients: low insertion of the cystic duct into the common hepatic duct (4.5%), emptying of the cystic duct into the right hepatic duct (2.7%) and a second-order large branch draining into the cystic duct (1.6%). MRCP identified a double gall bladder in 3% of patients and anatomical variants of the biliopancreatic system in 8.2%: pancreas divisum (5.2%) and a long sphincter of Oddi (3%). Finally, congenital anomalies were diagnosed in 1.3% of cases: bile duct cysts (0.3%), atresia of the bile ducts (0.3%) and multiple biliary hamartomatosis (0.7%). CONCLUSIONS The congenital anomalies and anatomical variants of the bile and pancreatic ducts present a complex spectrum of frequent alterations, which are worthy of attention in both the clinical and surgical settings and are readily identified by MRCP.
Collapse
|
36
|
Abstract
Laparoscopic cholecystectomy is the present treatment of choice for patients with gallbladder stones, despite its being associated with a higher incidence of biliary injuries compared with the open procedure. Injuries occurring during the laparoscopic approach seem to be more complex. A complex biliary injury is a disease that is difficult to diagnose and treat. We considered complex injuries: 1) injuries that involve the confluence; 2) injuries in which repair attempts have failed; 3) any bile duct injury associated with a vascular injury; 4) or any biliary injury in association with portal hypertension or secondary biliary cirrhosis. The present review is an evaluation of our experience in the treatment of these complex biliary injuries and an analysis of the international literature on the management of patients.
Collapse
Affiliation(s)
- E. De Santibáñes
- Department of Surgery and Liver Transplant Unit, Hospital Italiano de Buenos AiresArgentina
| | - V. Ardiles
- Department of Surgery and Liver Transplant Unit, Hospital Italiano de Buenos AiresArgentina
| | - J. Pekolj
- Department of Surgery and Liver Transplant Unit, Hospital Italiano de Buenos AiresArgentina
| |
Collapse
|
37
|
Pottakkat B, Sikora SS. Aberrant right hepatic duct presenting as empyema of the gall bladder. ACTA ACUST UNITED AC 2007; 51 Suppl:B303-5. [DOI: 10.1111/j.1440-1673.2007.01826.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Yu J, Turner MA, Fulcher AS, Halvorsen RA. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 2, Pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187:1536-43. [PMID: 17114548 DOI: 10.2214/ajr.05.0772] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to highlight the imaging features of congenital anomalies and normal variants of the pancreatic duct and the pancreas using contemporary imaging techniques such as MR cholangiopancreatography (MRCP), MRI, and helical CT. CONCLUSION Congenital anomalies and normal variants of the pancreatic duct and the pancreas may be clinically significant and may create a diagnostic challenge. Recognition of the updated imaging features of these entities is important in clinical management and for avoiding misdiagnosis.
Collapse
Affiliation(s)
- Jinxing Yu
- Department of Radiology, VCU Health Systems, Virginia Commonwealth University, 1250 East Marshall St., Richmond, VA 23298, USA
| | | | | | | |
Collapse
|
39
|
Pérez G, Escárcega RO, Gargantua J, Fuentes-Alexandro S. Aberrant right hepatic duct originating from the right posterior duct with low insertion into the common bile duct. J Am Coll Surg 2006; 203:972. [PMID: 17116567 DOI: 10.1016/j.jamcollsurg.2006.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
40
|
Spanos CP, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): a review. Langenbecks Arch Surg 2006; 391:441-7. [PMID: 16927110 DOI: 10.1007/s00423-006-0078-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 05/17/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gallstone disease remains the most common disease of the digestive system in Western societies and laparoscopic cholecystectomy one of the most common surgical procedures performed. Bile leaks remain a significant cause of morbidity for patients undergoing this procedure. These occur in 0.2-2% of cases. The bile ducts of Luschka, or subvesical ducts, are small ducts which originate from the right hepatic lobe, course along the gallbladder fossa, and usually drain in the extrahepatic bile ducts. Injuries to these ducts are the second most frequent cause of postcholecystectomy bile leaks. METHODS A literature search using MEDLINE's Medical Subject Heading terms was used to identify recent articles. Cross-references from these articles were also used. RESULTS Subvesical bile duct leaks can be detected by drip-infusion cholangiography using computed tomography preoperatively, direct visualization or cholangiography intraoperatively, and fistulography, endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography with intravenous contrast postoperatively. ERCP is the most common diagnostic method used. Most patients with subvesical duct leaks are symptomatic, and most leaks will be detected postoperatively during the first postoperative week. Drainage of extravasated bile is mandatory in all cases. Reduction of intrabiliary pressure with endoscopic sphincterotomy and stent placement will lead to preferential flow of bile through the papilla, thus permitting subvesical duct injuries to heal. This is the most common treatment modality used. In a minority of patients, relaparoscopy is performed. In such cases, the leaking subvesical duct is visualized directly, and ligation usually is sufficient treatment. Simple drainage is adequate treatment for a small number of asymptomatic patients with low-volume leaks. CONCLUSIONS Subvesical duct leaks occur after cholecystectomy regardless of gallbladder pathology or urgency of operation. They have been encountered more frequently in the era of laparoscopic cholecystectomy. Intraoperative cholangiography does not detect all such leaks. Staying close to the gallbladder wall during its removal from the fossa is the only known prophylactic measure. ERCP and stent placement are the most common effective diagnostic and therapeutic methods used. Intraoperative and perioperative adjunctive measures, such as fibrin glue instillation and pharmacologic relaxation of the sphincter of Oddi, can potentially be used in lowering the incidence of subvesical bile leaks.
Collapse
|
41
|
Uchiyama K, Tani M, Kawai M, Ueno M, Hama T, Yamaue H. Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy. Surg Endosc 2006; 20:1119-23. [PMID: 16703426 DOI: 10.1007/s00464-005-0689-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 12/12/2005] [Indexed: 01/24/2023]
Abstract
BACKGROUND The incidence of aberrant bile duct injury associated with laparoscopic cholecystectomy (LC) has not yet been adequately examined. This study aimed to clarify the types of normal cystic ducts and the incidence of aberrant extrahepatic bile ducts, and to search for a method of avoiding injuries during LC. METHODS Aberrant hepatic ducts were retrospectively categorized into five types according to the pattern of the cystic ducts and the accessory hepatic ducts by preoperative endoscopic retrograde cholangiography or multidetector three-dimensional computed tomography using drip infusion cholangiography. The aberrant bile ducts were classified as type A (merging at the right side of the common bile duct), type B (merging at the anterior side), or type C (merging at the posterior left side). RESULTS The intrahepatic bile ducts and cystic duct were clearly shown for 1,044 of the 1,278 patients who underwent LC. Secondary branches of aberrant cystic ducts were observed in 37 cases (3.5%), and accessory hepatic ducts were observed in 30 cases (2.9%). A comparison of the difficulties encountered with LC for each type based on the merging patterns of cystic ducts showed that type C needed a much longer operation time for LC than the other types. CONCLUSIONS A preoperative evaluation of the bile duct tract and the accessory hepatic duct before LC is important. Patients with a cystic duct merging normally into the posterior left side of the common hepatic duct (type C) experienced difficulty when undergoing LC. The authors have safely performed LC with the use of an endoscopic nasobiliary drainage tube in type D cases (cystic duct merging with the right hepatic duct), in type IV cases (cystic duct merging with an accessory hepatic duct).
Collapse
Affiliation(s)
- K Uchiyama
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | | | | | | | | | | |
Collapse
|
42
|
Strasberg SM. Biliary injury in laparoscopic surgery: part 1. Processes used in determination of standard of care in misidentification injuries. J Am Coll Surg 2005; 201:598-603. [PMID: 16183500 DOI: 10.1016/j.jamcollsurg.2005.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 05/03/2005] [Accepted: 05/10/2005] [Indexed: 11/16/2022]
Affiliation(s)
- Steven M Strasberg
- Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
43
|
Izuishi K, Toyama Y, Nakano S, Goda F, Usuki H, Masaki T, Maeta H. Preoperative assessment of the aberrant bile duct using multislice computed tomography cholangiography. Am J Surg 2005; 189:53-5. [PMID: 15701492 DOI: 10.1016/j.amjsurg.2004.06.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2004] [Revised: 06/23/2004] [Accepted: 06/23/2004] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study aimed to determine the frequency of anatomic variations of bile ducts (aberrant bile ducts) using multislice helical computed tomography (MCT) cholangiography. METHODS MCT scanning was performed after slow infusion of 100 mL meglumine iotroxate. Overlapping axial images, taken at 0.5-mm intervals, were reconstructed to create a multiplanar reconstruction with volume rendering. We analyzed anatomical variations of the biliary tree by MCT cholangiography. RESULTS In a total of 113 patients, MCT cholangiography provided clear images of aberrant bile ducts in 18 patients. Major type (draining a particular segment of the liver) was found in 9 cases (8%) and minor type (draining a particular subsegment of the liver) in 9 cases (8%). CONCLUSIONS Preoperative MCT cholangiography provides important information about the precise biliary anatomy and can reveal unexpected aberrant bile ducts prior to biliary surgery, especially laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Kunihiko Izuishi
- First Department of Surgery, Faculty of Medicine, Kagawa University 1750-1 Miki, Kita, Kagawa 761-0793, Japan.
| | | | | | | | | | | | | |
Collapse
|
44
|
Sharif K, de Ville de Goyet J. Bile duct of Luschka leading to bile leak after cholecystectomy--revisiting the biliary anatomy. J Pediatr Surg 2003; 38:E21-3. [PMID: 14614740 DOI: 10.1016/j.jpedsurg.2003.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bile ducts of Luschka (also called supravesicular ducts) are small bile ducts in the gallbladder bed. Although they do not drain any liver parenchyma, they can be a source of bile leak or biliary peritonitis after cholecystectomy in both adults and children, as shown in this case report. As a reminder, variations of biliary anatomy in the gallbladder bed and cholecysto-hepatic triangle of Calot, are reviewed.
Collapse
Affiliation(s)
- K Sharif
- Liver Unit, Birmingham Children's Hospital, Birmingham, England, UK
| | | |
Collapse
|
45
|
Abstract
In summary, over the past decade, MRCP has evolved not only as a feasible means of noninvasively evaluating the pancreaticobiliary tract but also as a technique with documented clinical utility. With the evolution of MRCP, there has been, by necessity, an evolution of ERCP. In fact, at some institutions MRCP has replaced diagnostic ERCP such that ERCP is reserved primarily for therapeutic interventions. When MRCP is performed in conjunction with abdominal MR and MRA, a comprehensive examination results that permits evaluation of the solid organs and vessels of the abdomen as well as the ductal systems.
Collapse
Affiliation(s)
- Ann S Fulcher
- Department of Radiology, 401 North 12th Street, Room 3-407B, Post Office Box 980615, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298-0615, USA.
| | | |
Collapse
|
46
|
Vitellas KM, El-Dieb A, Vaswani KK, Bennett WF, Fromkes J, Ellison C, Bova JG. Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients. AJR Am J Roentgenol 2002; 179:409-16. [PMID: 12130442 DOI: 10.2214/ajr.179.2.1790409] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of our study was to determine whether contrast-enhanced MR cholangiography using IV mangafodipir trisodium can accurately detect the presence and location of bile duct leaks in patients who have undergone cholecystectomy. SUBJECTS AND METHODS Our study group included 11 patients with suspected bile duct leaks after cholecystectomy. Axial single-shot fast spin-echo and gradient-echo images were acquired in all patients before and 1-2 hr after IV administration of mangafodipir trisodium. The contrast-enhanced MR cholangiograms were evaluated for image quality, degree of ductal or small bowel opacification, and the presence and location of bile duct leaks, strictures, and stones. MR cholangiograms were correlated with conventional contrast-enhanced cholangiograms obtained in all patients, including endoscopic retrograde cholangiography (n = 10) and percutaneous transhepatic cholangiography (n = 1). RESULTS Excretion of mangafodipir trisodium was noted in the intrahepatic and extrahepatic bile ducts in all patients from 1 to 2 hr after IV administration. Bile ducts and fluid collections that contained excreted mangafodipir trisodium showed increased signal intensity on gradient-echo sequences and decreased signal intensity on single-shot fast spin-echo sequences. Conventional contrast-enhanced cholangiography showed the presence of bile duct leaks in six patients and the absence of bile duct leaks in five patients, with false-negative findings in one patient and false-positive findings in one patient for bile duct leak (sensitivity, 86%; specificity, 83%). CONCLUSION Contrast-enhanced MR cholangiography with IV mangafodipir trisodium can successfully detect the presence and location of bile duct leaks in patients suspected of having such leaks after undergoing cholecystectomy. More research is necessary before acceptance of this examination as routine in the workup of these patients.
Collapse
Affiliation(s)
- Kenneth M Vitellas
- Department of Radiology, The Ohio State University Medical Center, S-211 Rhodes Hall, 450 W. 10th Ave., Columbus, OH 43210, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
Conrad GR, Sinha P. Delayed postoperative stenosis of a right hepatic choledochojejunostomy. Clin Nucl Med 2002; 27:597-8. [PMID: 12170010 DOI: 10.1097/00003072-200208000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gary R Conrad
- Department of Radiology, The University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA.
| | | |
Collapse
|
48
|
Mutignani M, Shah SK, Tringali A, Perri V, Costamagna G. Endoscopic therapy for biliary leaks from aberrant right hepatic ducts severed during cholecystectomy. Gastrointest Endosc 2002; 55:932-6. [PMID: 12024159 DOI: 10.1067/mge.2002.124638] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
49
|
Hirao K, Miyazaki A, Fujimoto T, Isomoto I, Hayashi K. Evaluation of aberrant bile ducts before laparoscopic cholecystectomy: helical CT cholangiography versus MR cholangiography. AJR Am J Roentgenol 2000; 175:713-20. [PMID: 10954455 DOI: 10.2214/ajr.175.3.1750713] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of our study was to compare the accuracy of helical CT cholangiography and that of MR cholangiography in the diagnosis of aberrant bile ducts or cystic ducts before laparoscopic cholecystectomy. SUBJECTS AND METHODS A total of 120 consecutive patients, including 114 patients with cholecystolithiasis and six with gallbladder polyps, were treated using laparoscopic cholecystectomy between November 1996 and August 1998. Eighteen (15%) of the 120 patients were suspected of having aberrant bile ducts or cystic ducts on helical CT cholangiography, and 16 of these 18 patients were subsequently examined on MR cholangiography. For the 16 patients who underwent both imaging examinations, findings from helical CT cholangiography and MR cholangiography were compared with intraoperative cholangiography. RESULTS Aberrant bile ducts in 13 patients and aberrant cystic ducts in three patients were divided into six types on the basis of the results of intraoperative cholangiography. Although these types were clearly identified using helical CT cholangiography in all 16 patients, the anatomic variants were not correctly identified in seven (44%) of the 16 patients with MR cholangiography. False-negative findings were mainly a result of the insertion sites of the cystic ducts or aberrant bile ducts being obscured by aberrant bile ducts or duodenum. Two (2%) of the 120 patients developed mild adverse reactions to the contrast material, but neither required treatment. CONCLUSION Helical CT cholangiography clearly showed aberrant bile ducts and cystic ducts, but visualization of these structures on MR cholangiography was unsatisfactory because of overlapping duodenum and hepatic ducts.
Collapse
Affiliation(s)
- K Hirao
- Department of Radiology, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo City, Nagasaki 857-1195, Japan
| | | | | | | | | |
Collapse
|