Carcinoma of the cystic duct

Two patients with carcinoma of the cystic duct presented with obstructive jaundice due to extrinsic compression of the common hepatic duct by the tumor. Sonography and computed tomography showed dilatation of the intrahepatic bile ducts and gallbladder. In one patient, a calculus seen in the gallbladder neck suggested Mirizzi syndrome. In the other, a small soft tissue mass was indistinguishable from a common duct tumor or an enlarged lymph node. In both cases, direct cholangiography demonstrated extrinsic compression and displacement of the common duct with proximal biliary dilatation and nonvisualization of the gallbladder. Carcinoma of the cystic duct should be considered whenever there is evidence of cystic duct obstruction and/or when cholangiography shows extrinsic mass effect on the common duct.     

Anomalous pancreaticobiliary duct union associated with bile duct carcinoma

An abnormal high union of the common bile duct and the main pancreatic duct, without accompanying cystic dilatation of the bile ducts, is a rare occurrence. A case of obstructive jaundice due to bile duct carcinoma in connection with this anomaly is reported.     

Ultrasonic evaluation of the pancreatic duct

In a prospective ultrasound study of 253 patients, the lumen of the normal pancreatic duct of Wirsung could be demonstrated in 82% of the patients. The mean diameter of the normal pancreatic duct (of Wirsung) was 1.3 mm. The duct of Santorini occasionally could be demonstrated. A duct of Wirsung greater than 2 mm in diameter should be considered dilated. The pancreatic duct is dilated in most patients with acute pancreatitis, in some patients with chronic pancreatitis, and in some patients with pancreatic tumor.     

Three-dimensional sonographic evaluation of the common bile duct.

OBJECTIVE: To assess the accuracy of three-dimensional sonographic measurements of the common bile duct compared with standard two-dimensional anteroposterior measurement of the common duct. METHODS: Fifty-five consecutive patients referred for abdominal sonography underwent standard two-dimensional abdominal sonography followed by three-dimensional sonographic data acquisition of the right upper quadrant. A radiologist blinded to the results of the two-dimensional examination later measured the three-dimensional long axis anteroposterior common duct diameter and three-dimensional short axis anteroposterior and transverse common duct diameters. RESULTS: The mean average common duct diameter as measured by two-dimensional sonography (long axis anteroposterior) was 3.6 mm. The mean average common duct diameter as measured by long axis anteroposterior three-dimensional sonography was 4.1 mm. The mean average common duct diameter as measured by anteroposterior short axis three-dimensional sonography was 4.1 mm, and by transverse short axis three-dimensional sonography, it was 4.4 mm. The two-dimensional common duct measurement correlated with the long axis anteroposterior three-dimensional measurement (P < .001), the short axis anteroposterior three-dimensional measurement (P < .001), and the short axis transverse three-dimensional measurement (P < .005) by the Spearman rank order correlation coefficient test. CONCLUSIONS: Three-dimensional sonographic measurements of the common bile duct correlate highly with two-dimensional measurements, validating the use of three-dimensional sonography as a reliable method for evaluation of common bile duct size.     

Pancreatic duct diameter: Sonographic measurement in normal subjects

In a prospective ultrasonic study of the pancreatic duct, 233 sonograms were obtained from 49 normal subjects. The duct in the regions of the head-neck and body was measured in the transverse/oblique planes. The mean diameter of the duct in the area of the head-neck was 3 mm; in the body proximal and distal to the neck, duct diameters were 2.1 and 1.6 mm, respectively.     

Intersegmental connection with aberrant hepatic duct

A 66-year-old Japanese woman whose cystic duct drained into an aberrant bile duct was found to have an intersegmental connection bridging the right anterior and posterior ducts. The patient had cholelithiasis but no history of hepatic trauma, lending support to congenital etiology for the intersegmental duct. In the presence of aberrant bile ducts, a meticulous search may reveal such biliary communications.     

Interhepatic duct: A new biliary anomaly

True accessory bile ducts occur in only 1% of patients. An accessory bile duct connecting the right and left hepatic ducts at the porta hepatis is described. This anomaly has never been reported previously, and was clinically significant in the presence of partial obstruction of an anomalous right hepatic duct by stones. The embryologic origin of this duct, which we term an interhepatic duct, is uncertain.     

Primary common bile duct carcinoid

Endoscopic retrograde cholangiography was performed in a 32-year-old man with recurrent episodes of painless jaundice. There was demonstration of a large intraluminal mass causing partial obstruction of the common bile duct. The lesion proved to be a primary carcinoid tumor of the bile duct.     

Bile duct involvement in hepatocellular carcinoma: MR demonstration

Background: To determine the magnetic resonance (MR) features of hepatocellular carcinoma (HCC) with associated bile duct involvement. Methods: MR examinations of six patients (mean age, 62 years) demonstrating bile duct involvement due to HCC were retrospectively reviewed and compared to surgical and pathologic findings. Results: Three of the tumors were solitary, and three were multifocal. In two patients, MR showed direct biliary duct invasion by tumor. On T1-weighted MR images, four tumors were hypointense compared to the liver and two were isointense. On T2-weighted MR images, four tumors were hyperintense, and two were isointense. The two tumors studied with dynamic T1-weighted MR images obtained after intravenous administration of a gadolinium chelate, displayed enhancement similar to that of the liver. There was no evidence of a tumor capsule on either unenhanced or enhanced MR images. Intrahepatic bile duct dilatation was seen in five patients. The extrahepatic bile duct was normal in all cases. Conclusion: Although rare, HCC should be included when considering the etiology of intrahepatic bile duct obstruction. Imaging features suggestive of the diagnosis by MR include intrabiliary tumor or bile duct obstruction with an associated hepatic mass.     

Accessory bile duct draining into the stomach: Case report and review

Accessory bile duct with ectopic drainage into the gastrointestinal tract is an extremely rare congenital anomaly, and only 55 cases have been reported in the literature. We present another case of accessory bile duct draining into the stomach. Barium meal study of the stomach first revealed the accessory bile duct, and the diagnosis was confirmed by gastrofiberscopy, ultrasonography, hepatobiliary scintigraphy, computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP).     

Ultrasound of the common bile duct in patients undergoing cholecystectomy

One hundred patients undergoing cholecystectomy underwent ultrasonography of the biliary tree on the day prior to surgery. At operation a per-operative cholangiogram was performed unless stones were palpable in the duct. Pre-operative biliary ultrasonography accurately identified dilatation of the common bile duct (sensitivity 96%, specificity 95%) but was less accurate at detecting common duct stones (sensitivity 36%, specificity 98%). Thirty three percent of patients with dilated ducts on ultrasound did not have stones in the duct, while 20% of patients with common duct stones had normal sized ducts. We conclude that ultrasonography alone cannot reliably select patients who require exploration of the common bile duct, or select patients for operative cholangiography. Although pre-operative demonstration of common bile duct dilation is an absolute indication for operative cholangiography, by itself it does not indicate the need for exploration.     

Bile duct measurements after ceruletide as an aid to the ultrasound diagnosis of choledocholithiasis

Despite good results in gallbladder imaging, ultrasound (US) diagnosis of choledocholithiasis remains a challenge. The value of US before and after a provocative injection of the decapeptide ceruletide was examined in 25 patients with suspected common duct stones immediately prior to diagnostic retrograde cholangiography. An abnormal response (increase in US duct diameter) was seen in 4 of 6 patients with an obstructed duct, giving a sensitivity of 67% and predictive value of 80% for the procedure. There was a normal response (decrease in US diameter of a dilated duct or decrease/no change in a normal duct) in 14 of 19 with an unobstructed duct (specificity 79%, predictive value 93%) and an equivocal response (no change in diameter of a dilated duct) in 5 patients. In 1 patient a calculus not seen on the initial US became visible as the duct distended by ceruletide administration. Symptoms after ceruletide were few and not discriminatory. Although it added to the time and difficulty of performing biliary US, ceruletide administration proved a useful adjunct to the diagnosis of choledocholithiasis.     

Carcinoid tumor of the bile duct: Case report

Carcinoid tumor of the bile duct is extremely rare. Ten cases have been reported in the literature. This report describes the eleventh case. A 55-year-old woman was hospitalized with biliary stenosis. Sonography (US) and computed tomography (CT) demonstrated a tumor in the upper common hepatic duct (CHD). Percutaneous transhepatic cholangiography showed extraluminal growth of the tumor. The tumor was resected and histologic examination showed carcinoid tumor of the common hepatic duct.     

Angiographic demonstration of gastrointestinal bleeding through the pancreatic duct

This article describes the angiographic findings in the case of a bleeding stump of the left gastric artery, following subtotal gastrectomy, into a pancreatic pseudocyst with instantaneous opacification of the pancreatic duct and duodenum. This is the first reported case to demonstrate a frank bleed with total opacification of the pancreatic duct. Based on our experience and previously reported cases, we conclude that subselective catheterization of the bleeding vessel is necessary to demonstrate total opacification of the pancreatic duct in such cases.     

多层螺旋CT显示管壁局限增厚探测肝外胆管结石

目的 探讨多层螺旋CT显示管壁局限性增厚对诊断肝外胆管结石的价值.方法 66例肝外胆管结石病例接受多层螺旋CT平扫和增强扫描.观察平扫时的结石密度、大小、部位和数目.根据静脉期增强扫描,以肝外胆管壁≥2 mm为增厚标准,分别评价结石密度、大小、数目及部位的构成比及其与管壁增厚的关系.结果 CT共发现不同密度结石57例,9例等密度结石未能识别.66例胆管结石患者中出现管壁增厚的构成比为84.85%(56/66),平均增厚(2.88±0.56)mm.其中等密度结石、非等密度结石出现管壁增厚构成比差异无统计学意义(P＞0.05).管壁增厚与结石密度、部位和数目无相关性(P均＞0.05),但与结石大小有相关性(P=0.001).56例管壁增厚者中,呈同心圆者87.50%(49/56),偏心圆者12.50%(7/56).管壁增厚出现在结石下方占62.50%(35/56);位于结石平面或上下方占17.86%(10/56),位于结石上方为8.93%(5/56),6例(6/56,10.71%)呈广泛管壁增厚,均为多枚结石所致.结论 肝外胆管结石时,多数在结石平面或其下方出现局限性同心圆样管壁增厚.CT平扫未见明确胆管结石而增强扫描门静脉期出现此征象时,应考虑到有结石存在的可能.     

Villous adenoma of the common bile duct

A villous adenoma of the common bile duct (CBD) causing obstructive jaundice was demonstrated by sonography and ERCP in a 34-year-old man. The radiological and clinical features of this rare tumor are herein presented.     

Migration of Hem‐o‐lok clip into the common hepatic duct after laparoscopic bile duct exploration: A case report

Hem‐o‐lok clip migration into the bile duct can lead to stone formation and granulation tissue hyperplasia. This report discusses a case wherein four clips migrated into the bile duct after laparoscopic bile duct exploration.     

Percutaneous dislodgement of an impacted cystic duct stone

An obstructing cystic duct stone was dislodged with an angiographic catheter and guidewire via a percutaneous cholecystostomy tract in a mildly sedated patient. After brief stenting of the cystic duct, the patient remained asymptomatic with internal bile drainage. When endoscopic negotiation of the cystic duct is difficult, an impacted cystic duct stone can sometimes be dislodged with standard angiographic techniques.     

Extracorporeal shockwave lithotripsy of pancreatic duct stones

Encouraging results with extracorporeal shockwave lithotripsy (ESWL) for pancreatic duct stones have been reported from Europe. We present our experience with the first two North American patients, treated with excellent results in one and limited clinical improvement in the other patient at 1 year follow-up. Targeting of pancreatic duct stones was achieved with either fluoroscopy or ultrasound.     

Distal common bile duct obstruction: An experimental study in monkeys

Biliary obstruction was accomplished by surgically occluding the distal common bile duct in seven rhesus monkeys. Ultrasound scanning at 24-hour intervals showed that dilation of the common bile duct and gallbladder occurred before elevation of bilirubin or development of jaundice. The bile ducts expanded centrifugally from the obstructing point, with dilation of the intrahepatic ducts occurring several days after the onset of obstruction. After surgical release of the obstruction, the biliary ducts contracted centripetally, with the common bile duct requiring 30–50 days to return to normal size.