Congenital cystic dilatation of the common bile duct: relationship to anomalous pancreaticobiliary ductal union.

Thirty patients from 15 to 69 years of age with congenital cystic dilatation of the common bile duct were studied. The diagnosis was made by intravenous cholangiography in 70% of the patients and by percutaneous transhepatic cholangiography and/or endoscopic retrograde cholangiopancreatiography in the entire group. Cystic dilatation was also noted in the intraphepatic bile ducts in 12 patients. A union between the common bile and main pancreatic ducts occurred at a high position in 17 of 18 patients in whom both ducts were adequately opacified, forming an abnormally long common channel. One patient with choledochodele had a normal union. The anomalous unions were of two types: the pancreatic duct entering the common duct and the common duct entering the pancreatic duct. The mode of union was correlated with the degree of extrahepatic bile duct dilatation, age of onset, and frequency and severity of symptoms. It is postulated that the congenital anomaly in the union of the two duct systems is the cause of the disease and the congenital choledochocele has a different etiology.     

Bile duct carcinoma in a focal dilatation of the intrahepatic bile duct

A 40 year old male with bile duct carcinoma arising in a localised dilatation of the intrahepatic bile duct is presented. The patient presented with recurrent upper abdominal pain, fever and jaundice. Computed tomography showed a localised duct dilatation and ultrasound clearly demonstrated a tumor mass arising within the bile duct. At surgery, papillary adenocarcinoma was confirmed. This case suggests that the tumour arose from the pre-existing cyst. A localised dilatation of the bile duct on computed tomography and ultrasound may harbour a bile duct carcinoma.     

Congenital cystic dilatation of the common bile duct in adults. Apropos of a case diagnosed ultrasonically

The authors report the observation of a thirty years old woman presenting a choledochal cyst demonstrated by echography. This rare condition is characterized by a segmentary dilatation of the distal portion of the commun bile duct needing surgical treatment. The described case is distinguishable from usual forms by a few own particularities.     

Patterns of intrahepatic bile duct dilatation at CT: correlation with obstructive disease processes.

The authors performed a blinded, retrospective analysis of 100 computed tomographic (CT) scans of patients with proved extrahepatic bile duct obstruction, including primary sclerosing cholangitis (PSC), to determine whether certain patterns of intrahepatic bile duct dilatation are suggestive of specific disease processes. Among 30 patients with benign obstructive disease, CT showed pruning of the intrahepatic ducts in four patients (13%), beading in four (13%), and skip dilatations in one (3%). Among 54 patients with malignant obstructive disease, CT illustrated pruning in eight (15%) patients, beading in 11 (20%), and skip dilatations in two (4%). Among 16 patients with PSC, CT demonstrated pruning in four (25%), beading in two (13%), and skip dilatations in five (31%). The majority of patients with malignant or benign obstructive disease or PSC had intrahepatic duct dilatation in both lobes of the liver. It extended into the periphery in 46 of 54 patients (85%) with malignant obstructive disease, in 20 of 30 (67%) with benign obstructive disease, and in 10 of 16 (63%) with PSC. The CT finding of skip dilatations is strongly suggestive of PSC. The CT findings of pruning and beading are nonspecific and may be observed at CT in patients with bile duct obstruction due to a wide variety of causes. The distribution and extent of intrahepatic duct dilatation at CT do not differ among biliary disease processes.     

Animal model of bile duct dilatation created with minimally invasive surgery

RATIONALE AND OBJECTIVES: The purpose of the study was to evaluate a method of producing obstruction of the common bile duct and concomitant biliary duct dilatation in an animal model. MATERIALS AND METHODS: Laparoscopic placement of a double-balloon occlusion device was used to produce common bile duct obstruction and bile duct dilatation in pigs. RESULTS: One week after the procedure, common bile duct obstruction and dilatation of the biliary tree were demonstrated with either percutaneous transhepatic cholangiography or percutaneous cholecystography. CONCLUSION: The use of this method is technically feasible and provides a useful subacute and chronic animal model of common bile duct obstruction and dilatation of the biliary tree for percutaneous interventional training and research purposes.     

两种途径球囊扩张术治疗胆总管结石的临床效果比较

目的：比较经皮经肝球囊扩张和内镜下球囊扩张术治疗胆总管结石的临床效果。 方法：自2013年1月—2015年1月,25例胆总管结石患者采用经皮经肝途径取石,纳入A组。选取同期经内镜途径球囊扩张术治疗的60例胆总管结石患者,纳入B组。 结果：A组胆总管结石取净率为100%,B组为96.7%,差异无统计学意义（P=1.000）;A组近期并发症发生率12%（3/25）,B组10%（6/60）,两组差异无统计学意义（校正χ²=0.073,P>0.05）,B组发生2例胰腺炎,A组发生1例肝脓肿。A组平均手术时间(50±8) min,长于B组(39±6) min。随访1年,A组有1例患者胆总管结石复发,B组发生1例返流性胆管炎。 结论：经皮经肝胆途径取石具有与内镜下球囊扩张术取石相同的手术成功率以及较低的并发症发生率,可以作为不适合内镜治疗或者内镜治疗失败的胆总管结石患者的治疗措施。     

Medial indentation of the duodenal sweep by common bile duct dilatation.

The dilated common bile duct has long been recognized as a cause for a smooth, tubular impression across the duodenal bulb or immediate postbulbar duodenum. Only scattered references suggest that a smooth indentation on the medial aspect of the descending duodenum might also be due to an enlarged, tortuous common duct. Three cases of this condition are reported. The dilated common duct impression can mimic a pancreatic mass. While computed tomography, ultrasonography, or transhepatic cholangiography readily suggest the true diagnosis, potential pitfalls in patient management are possible when the first radiographic procedure is an upper gastrointestinal series.     

Congenital cystic dilatation of biliary tract (author's transl)

The congenital cystic dilatation of biliary tract is un frequent affection and there are many types described (classification of Alonso Lej). The authors present the observation of a little girl of 12 years who presented a complete cystic dilatation ob biliary tract, diagnosed before the operation by intravenous biligraphy. This association of intra and extra hepatic cystic dilatation has been described in 1964 by Arthur and Stuart, and the diagnosis is to be done by intraveinous biligraphy in 30% of cases.