Chronic periaortitis presenting as common bile duct obstruction.

The case of a 67 year old woman is reported who presented with cholestatic jaundice and was found to have, in addition, an inflammatory abdominal aortic aneurysm. Only at necropsy did histopathology show chronic periaortitis as the aetiology of a pancreatic head mass which, during life, mimicked a pancreatic neoplasm obstructing the bile and pancreatic ducts.     

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.     

Gallbladder cystadenoma and common bile duct obstruction

Cystadenomas are usually found in the extra-hepatic bile ducts in conjunction with multilocular cysts in the liver. Cystadenoma of the gallbladder itself is a rare finding, cited only once in the literature as the cause of extrinsic obstruction of the common bile duct (5). In this report, we describe the endoscopic retrograde cholangiopancreaticographic (ERCP) detection of intrinsic obstruction of the cystic duct and common bile duct by such a tumor in a 47-yr-old woman.     

Fascioliasis of the common bile duct: endoscopic ultrasonographic diagnosis and endoscopic sphincterotomy]

Two cases of biliary fasciolasis are reported. The patients presented with biliary pain and/or acute pancreatitis. Pre-operative ultrasound endoscopy showed main bile duct dilation and linear elongated echogenic structures in the common bile duct lumen. Endoscopic retrograde cholangiography and endoscopic sphincterotomy were performed. Parasites were endoscopically removed resulting in disappearance of symptoms and biological abnormalities. Serological tests and pathological examination confirmed the presence of Fasciola hepatica. During follow-up, stool examination failed to show any Fasciola hepatica eggs, and in one case, serology became negative. This report emphasizes the value of ultrasound endoscopy in the diagnosis of unsuspected biliary fasciolasis. This report also confirms the therapeutic role of endoscopic sphincterotomy in patients with obstructive biliary fasciolasis.     

Sarcomatoid carcinoma of common bile duct: a case report

Sarcomatoid carcinomas (carcinosarcomas) are rare lesions in the hepatobiliary pancreatic system. We present an extremely rare case of sarcomatoid carcinoma of the common bile duct. The tumor showed a biphasic pattern of intermixed carcinomatous (adenocarcinoma) and sarcomatoid elements (spindle and giant cells). By immunohistochemical staining, cytokeratin and vimentin were demonstrated in the sarcomatoid component. The proliferative activity and the oncoproteins expressed by the tumor were investigated by the PCNA, Ki-67, p53 and Bcl-2 in different tumor fields. Overall, the intensities of PCNA and p53 were moderate in the sarcomatoid component, but mild in the carcinomatous component. However, Ki-67 and Bcl-2 were both negative in the carcinomatous and sarcomatoid components. The possible histogenensis of sarcomatoid carcinoma of the common bile duct is discussed. We report upon an additional extremely rare case of sarcomatoid carcinoma arising in the common bile duct together with its immunohistochemical characteristics, and give details of its proliferative activity and oncoprotein expression.     

Delayed common bile duct obstruction in acute pancreatitis

Summary Common bile duct obstruction during acute pancreatitis usually occurs in the early symptomatic phase of the illness, involves only the distal portion of the common bile duct, and subsides with clinical improvement. We present two cases of persistent common bile duct obstruction that developed 2–3 months after complete clinical subsidence of the initial episode of severe acute pancreatitis and involved a long segment of the common bile duct. After surgical decompression, there was no recurrence of common bile duct obstruction or pancreatitis.     

Delayed common bile duct obstruction in acute pancreatitis

Common bile duct obstruction during acute pancreatitis usually occurs in the early symptomatic phase of the illness, involves only the distal portion of the common bile duct, and subsides with clinical improvement. We present two cases of persistent common bile duct obstruction that developed 2-3 months after complete clinical subsidence of the initial episode of severe acute pancreatitis and involved a long segment of the common bile duct. After surgical decompression, there was no recurrence of common bile duct obstruction or pancreatitis.     

Adenomyoma of the common bile duct: report of a case

We report a case of adenomyoma in the common bile duct accompanied by obstructive jaundice. A 64-year-old woman presented with abdominal pain, fever, appetite loss and jaundice. Endoscopic retrograde cholangiopancreatography revealed possible stenosis in the distal common bile duct. We could not distinguish whether the tumor was benign or malignant based on the clinical presentation, or biochemical, radiographic, or endoscopic investigations. Pancreatoduodenectomy was performed. The histological diagnosis was adenomyoma. The natural history of and optimal treatment for, adenomyoma have not been established.     

Double-barrel common bile duct: a rare cause of extrahepatic biliary obstruction.

Double-barrel common bile duct is rare. We report a 50-year-old woman with defective canalization of the common bile duct, presenting with extrahepatic biliary obstruction due to stones in one compartment. CT scan highlighted this anomaly. After failed attempts at stone extraction at ERCP, she was successfully operated on.     

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。     

A common bile duct web in association with common bile duct stone]

Webs are diagnosed by their characteristic appearance on imaging studies, typically appearing as thin, radiolucent rings with or without dilatation of the organ proximal to it. Like in other organs, the etiology of webs in the common bile duct is controversial. Some webs are thought to be congenital, whereas others occur in the presence of chronic inflammation, suggesting a pathogenic relationship. We report a case of a common bile duct septum in association with numerous large black pigment stones in a 62-year-old woman. The patient was treated by cholecystectomy with T-tube insertion.     

Echinococcal cysts in the common bile duct: an uncommon cause of obstruction

Obstruction of the biliary system due to intraductal echinococcal cysts is a rare but serious presentation of hepatic echinococcal disease. Four cases are described. There was a 50% mortality rate and morbidity was high. The clinical presentation is difficult to differentiate from other disease processes. Careful preoperative sonograms should be taken to detect echogenic cyst material in the biliary system in all patients with hepatic echinococcal cysts. If biliary pigments are seen in the cyst during surgical removal, or if the patient has a recent history of jaundice or cholangitis, intraoperative cholangiography should be done to rule out intraductal cysts, which may cause obstruction.     

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.     

Heterotopic gastric mucosa in intrahepatic bile duct, presenting with hemobilia: a case report.

We present a 66-year-old man with unique heterotopic gastric mucosa in the intrahepatic bile duct causing hemobilia. Endoscopic retrograde cholangiography showed irregular stenosis of the left intrahepatic bile duct, and a provisional diagnosis of cholangiocarcinoma was made. Therefore, partial hepatic lobectomy and cholecystectomy were performed. Histological examination of the liver showed the presence of ectopic gastric mucosa in the intrahepatic bile duct containing mucous glands with parietal and chief cells and bile. Heterotopic gastric mucosa in the intrahepatic bile duct is a rare cause of hemobilia.