A case of septum formation of the common hepatic duct combined with an anomalous hepatic duct of the caudate lobe

A 66-year-old Japanese woman was admitted to our hospital with upper right quadrant pain and jaundice. Laboratory data indicated the presence of obstructive jaundice. A diagnosis of cholecystocholedocholithiasis was made by ultrasonography. Endoscopic retrograde cholangiography revealed choledochal stones with septum formation in a portion of the common hepatic duct up to where an anomalous bile duct drained from the caudate lobe of the liver. We performed a cholecystectomy, T-tube drainage, and partial resection of the septum when these findings were confirmed at surgery. Histological examination of the removed septum showed fibrous stroma under atrophic mucosa. To our knowledge, this is the eighteenth reported case in Japan of septum formation of the bile duct. However, no other such case to date has been seen combined with an anomalous hepatic duct of the caudate lobe of the liver. Selective cholangiography by choledochoscope and computed tomography with a thin guide-wire inserted to the bile duct were useful in confirming the origin of the anomalous bile duct. This case may serve as further evidence of the assumption that septum formation of the common (hepatic) bile duct is a malformation of congenital origin. An erratum to this article is available at .     

胆总管神经纤维瘤1例报告

1病例资料 患者女性,47岁,因发现＂皮肤、巩膜黄染8 d＂于2015年10月8日入本院。病程中无明显腹痛、腹胀,寒战高热等症状。既往：2015年4月30日于吉林市华侨医院诊断为胆囊结石,胆管结石行腹腔镜胆囊切除术、胆道探查取石、T管引流术。5年前因子宫肌瘤行子宫次全切术。20年前行阑尾切除术。体格检查：皮肤、巩膜黄染。     

Adenomyoma of the common hepatic duct

BackgroundAdenomyoma occurs most commonly in the fundus of the gallbladder, seldom in other parts of the gallbladder and rarely in the extrahepatic biliary tree, where most lesions are localised to the common bile duct or papilla of Vater. Adenomyoma of the common hepatic duct is extremely rare. To the best of our knowledge, only three cases have been reported so far.Case outlineA 51-year-old woman was admitted with a three month history of attacks of right upper abdominal pain, nausea, vomiting and fever. Laboratory data, ultrasonography, ERCP and CT confirmed slight cholestasis and proximal bile duct dilatation due to a tumour within the common hepatic duct. Cholecystectomy was performed with excision of the suprapancreatic common bile duct including the convergence of the hepatic ducts plus lymphadenectomy and Roux-en-Y hepaticojejunostomy. Frozen section histology showed the benign nature of the lesion and a tumour-free resection line. Final histology showed adenomyoma. The patient has remained symptomfree for more than 30 months.DiscussionAlthough adenomyoma is a benign lesion and the surgical strategy has not been established, complete excision with frozen section is recommended to exclude small malignant foci and local recurrence as well as to avoid surgical over-treatment.     

胆囊管癌伴右副肝管直接汇入胆囊管1例报告

正胆道变异的类型繁多,包括胆囊管与肝总管并行低位汇合,胆囊管汇入右肝管、副肝管等~([1])。其中副肝管又叫Luschka胆管或迷走胆管,是胚胎期肝十二指肠发育不全的常见畸形,直接连接胆囊和肝内胆管通道,常开口于胆总管,其次是右肝管和胆囊管~([2])。本文报道1例较大右副肝管直接汇入胆囊管,并伴有胆囊管癌的罕见病例。1病例资料患者男性,63岁,因"间断性上腹部胀痛不适2年,加重伴     

Double common bile duct： A case report

Double common bile duct （DCBD） is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct （ACBD） opens in different parts of upper gastrointestinal tract （stomach, duodenum, ductus pancreaticus or septum）. This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction （APBJ） and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APB3 with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography （ERCP） followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APB3 and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.     

The case for laparoscopic common bile duct exploration

The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.     

处置困难胆总管结石1例治疗体会

采用常规取石技术仍未能取出的结石,被认为是处置"困难"的胆总管结石。现将我院收治的1例处置困难的胆总管结石患者治疗经过和治疗体会报道如下。     

Benign giant-cell tumor of the common bile duct: A case report

Primary giant-cell tumors rarely arise in the common bile duct. We herein report a case of primary giant-cell tumor of the common bile duct. The patient was an 81-year-old male who was diagnosed with a well-defined 1.2-cm mass projecting into the lumen of the middle common bile duct. Excision of the gallbladder and extrahepatic bile duct and a Roux-en-Y cholangiojejunostomy were performed. Histologically, the tumor had no association with carcinomas of epithelial origin and was similar to giant-cell tumors of the bone. The tumor consisted of a mixture of mononuclear and multinucleated osteoclast-like giant cells. The mononuclear cells showed no atypical features, and their nuclei were similar to those of the multinucleated giant cells. CD68 was expressed on the mononuclear and multinucleated osteoclast-like giant cells, whereas CD163 immunoreactivity was restricted to the mononuclear cells. Six months after the operation, the patient was still alive and had no recurrence. The interest of this case lies in the rarity of this entity, the difficulty of preoperative diagnosis, and this tumor’s possible confusion with other malignant tumors.     

Diagnostic dilemma in an unusual case of common bile duct obstruction

Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze within the common bile duct. The patient had previously undergone an open cholecystectomy. Radiological investigations were inconclusive and suggestive of either a calculus or a cholangiocarcinoma. Surgical exploration revealed full length surgical gauze within the common bile duct. Because imaging modalities are often non-determinant, the possibility of biliary tract obstruction from a foreign body should be borne in mind for patients with unusual presentations, especially those who have previously undergone surgery.     

A case of septum formation of the common hepatic duct combined with an anomalous hepatic duct of the caudate lobe.

A 66-year-old Japanese woman was admitted to our hospital with upper right quadrant pain and jaundice. Laboratory data indicated the presence of obstructive jaundice. A diagnosis of cholecystocholedo-cholithiasis was made by ultrasonography. Endoscopic retrograde cholangiography revealed choledochal stones with septum formation in a portion of the common hepatic duct up to where an anomalous bile duct drained from the caudate lobe of the liver. We performed a cholecystectomy, T-tube drainage, and partial resection of the septum when these findings were confirmed at surgery. Histological examination of the removed septum showed fibrous stroma under atrophic mucosa. To our knowledge, this is the eighteenth reported case in Japan of septum formation of the bile duct. However, no other such case to date has been seen combined with an anomalous hepatic duct of the caudate lobe of the liver. Selective cholangiography by choledochoscope and computed tomography with a thin guide-wire inserted to the bile duct were useful in confirming the origin of the anomalous bile duct. This case may serve as further evidence of the assumption that septum formation of the common (hepatic) bile duct is a malformation of congenital origin.     

Granular cell tumor of the common bile duct: A Japanese case

Granular cell tumor (GCT) of the biliary system is rare. It is reported that it occurs more commonly in young black women. We report here our seldom experience of a Japanese case in whom icterus was found as a first symptom just after a caesarean operation. A 36-year-old Japanese woman developed icterus after delivery by the Caesarean operation. A surgical operation was performed without can deny that there was a tumor-related change in a bile duct as a result of examination for various images. As a result of pathological evaluation, GCT was diagnosed. By the preoperative organization biomicroscopy result, it was not able to be attachd a right diagnosis. It was thought that this tumor, although rare, should be considered as one of the causes of biliary stenosis in the younger population.     

Duplication of the common bile duct manifesting as recurrent pyogenic cholangitis: A case report

BACKGROUNDDuplication of the extrahepatic bile duct (DCBD) is an extremely rare congenital anomaly of the biliary system. There are five types of DCBD according to the latest classification. Among them, Type V is characterized by single drainage of the extrahepatic bile ducts. Reports on DCBD Type V are scarce.CASE SUMMARYA 77-year-old woman presented with recurrent epigastric pain but without fever or chills. Computed tomography revealed a dilated common bile duct (CBD) that harboured multiple choledocholithiasis. Endoscopic retrograde cholangio-pancreatography (ERCP) was performed, and the stones were extracted using a Dormia basket. She was discharged without any complications; however, she visited the emergency department a day after she was discharged due to epigastric pain and fever. Laboratory findings were suggestive of cholestasis. After urgent ERCP for stone removal, magnetic resonance cholangiopancrea-tography was performed to evaluate remnant choledocholithiasis. Magnetic resonance cholangiopancreatography revealed a DCBD Type Va and remnant choledocholithiasis in the right CBD. Both CBDs were accessed, and the stones were cleared successfully during a subsequent ERCP.CONCLUSIONIn this article, we report an extremely rare case of DCBD manifesting as recurrent pyogenic cholangitis. This case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.     

Management of bile duct injuries combined with accessory hepatic duct during laparoscopic cholecystectomy

Bile duct injuries (BDIs) are difficult to avoid absolutely when the biliary tract has a malformation, such as accessory hepatic duct. Here, we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.     

少年ERCP胆总管取石及鼻胆引流术后并发脓毒性休克1例

鼻胆引流管对于预防ERCP术后并发症非常重要。本文通过分析1例少年胆总管结石患者,取石术后置入鼻胆引流管并发化脓性胆管炎和脓毒性休克的原因,发现针对非扩张的胆总管,选择合适的鼻胆引流管及正确的引流位置更加重要。     

右副肝管直接汇入胆囊合并胆囊管与肝总管低位汇合1例报告

<正>胆道变异的类型繁多,包括胆囊管与肝总管并行低位汇合、胆囊管汇入右肝管、迷走胆管、副肝管等[1]。其中,副肝管是指肝脏的某一叶或某一段肝管低位与肝外胆管汇合,肝外部分的胆管称为副肝管,出现率约10%~20%[2]。副肝管在Calot三角发现,表现形式多样,例如副肝管汇入肝总管、汇入胆总管、汇入右肝管、汇入胆囊管,或者汇入胆囊颈部[3]。本文报道1例副肝管直接汇入胆囊且较粗大的病例。