Spontaneous Rupture of the Common Bile Duct

Spontaneous rupture of the common bile duct is rare, but may result from increased intraductal pressure with associated calculous erosion and necrosis of the bile duct wall secondary to thrombosis. Two cases are reported; one clearly related to calculous erosion and the other unexplained. Survival depends on early diagnosis. Aggressive supportive therapy, including Swan-Ganz catheter, intensive care unit monitoring, and appropriate antibiotics, are mandatory. Only with early operation to alleviate sepsis and decompression of the biliary system can better survival be expected.     

Large Gallstones Stacked Together in the Common Bile Duct after Choledochojejunostomy

A 65-year-old man had a history of cholecystectomy and treatment for cholelithiasis with a common bile duct incision. Owing to frequent cholangitis, he underwent choledochojejunostomy. Twenty years after the surgery, he was hospitalized for cholangitis and was suspected of having hilar cholangiocarcinoma based on imaging findings. Percutaneous transhepatic cholangioscopy using a SpyGlass™ DS (Boston Scientific, Marlborough, USA) showed gallstones and bile sludge in the bile ducts, but no tumors were noted. Electrohydraulic shockwave lithotripsy with double-balloon enteroscopy enabled complete stone removal; a direct visual biopsy with peroral cholangioscopy showed no malignancy in the bile duct.     

Angioleiomyoma of the Common Bile Duct

ABSTRACT An 80-year-old woman with angioleiomyoma in the common bile duct is described. Apart from weakness and jaundice, the patient had no signs or symptoms until after endoscopic retrograde cholangiopancreatography, when cholangitis and septicaemia due to Pseudomonas aeruginosa developed. X-ray during endoscopy revealed a tumour obstructing the common bile duct and was assumed to be malignant. Because the patient was so old and her general condition had deteriorated, no treatment was given. Autopsy revealed a benign angioleiomyoma of the common bile duct and suppurative cholangitis, the latter obviously caused by the endoscopy.     

Adenomyoma of the Common Bile Duct

We report an unusual case of biliary obstruction secondary to adenomyoma of the common bile duct. Adenomyomas are benign tumors, found infrequently in the biliary tree. Clinical presentation, biochemical, radiographic, and endoscopic investigations do not distinguish adenomyomas from malignant or other lesions; diagnosis requires histological examination. The natural history and optimal treatment of these tumors have not been established.     

Spontaneous Neuroma of the Bile Duct: A Case Report

We report on a 65-year-old man with a stenosis of the bile duct which was caused by spontaneous neuroma, with no history of laparotomy. Although he had a gallstone and slightly abnormal parameters on liver function tests, he had no known history of abdominal pain or jaundice. This is a very rare case of a benign stenosis of the common bile duct.     

Carcinoid Tumor of the Common Bile Duct

The fifth case of a common bile duct carcinoid tumor is reported. The importance of endoscopic retrograde cholangiography on the one hand and specialized staining on the other for diagnosis is emphasized. The slow growing nature of these tumors favors extensive surgery whenever possible.     

Endoscopic Removal of Ascaris lumbricoides from the Common Bile Duct

The management of biliary obstruction caused by Ascaris lumbricoides bas usually been surgical. This report describes the endoscopic removal of a roundworm located in the common bile duct.     

Hyperplastic Polyp of the Common Bile Duct

We describe a hyperplastic polyp of the common bile duct, found in a 45-yr-old Japanese woman. Endoscopic retrograde sphincterotomy and intraductal biopsy yielded a histological diagnosis of adenocarcinoma, preoperatively. However, final diagnosis after pancreatoduodenectomy proved to be hyperplasia. The wrong diagnosis seemed attributable to tortuosity of the specimens caused by the biopsy procedure and/or a lack of experience of pathologists due to the rarity of this condition. One should be aware of this entity in diagnosing polypoid lesions in the biliary tract.     

Preventive Saline Irrigation of the Bile Duct After the Endoscopic Removal of Common Bile Duct Stones

Background

Small stone fragments after an endoscopic stone extraction for choledocholithiasis may act as the nidus for recurrent choledocholithiasis. Therefore, efforts to eliminate the nidus might reduce the recurrence of choledocholithiasis and cholangitis related to choledocholithiasis.

Aims

The purpose of this study was to determine whether an additional preventive saline irrigation of the bile duct after the endoscopic removal of common bile duct stones would decrease residual stones and the recurrence of cholangitis.

Methods

A retrospective analysis was performed for the consecutively collected data about the patients who underwent the complete endoscopic treatment for common bile duct stone.

Results

Among 99 patients, 45 patients underwent saline irrigation. Residual stones were detected in 18 patients (18.2 %). The incidences of residual stones were 8.9 % (4 of 45 patients) in the irrigation group and 25.9 % (14 of 54 patients) in the non-irrigation group (P = 0.037). In multivariate analysis, preventive saline irrigation was found to be the only significant factor for the decrease of residual stones (HR = 0.258, P = 0.039). When analyzing the occurrence of recurrent cholangitis and the procedure related to complications, there were no significant differences according to the performance of preventive saline irrigation of the bile duct.

Conclusions

Preventive saline irrigation could reduce the residual common bile duct stones without complications.     

Idiopathic Benign Stricture of the Common Bile Duct

An unusual case of idiopathic benign stricture of the intrapancreatic portion of the common bile duct is described. Because of the absence of a history of pancreatitis or an operation upon the biliary tract, the obstruction was thought to be due to malignancy. However, histologic studies of tissues removed by pancreaticoduodenectomy established that the lesion was a benign stricture.     

Gallstone-linked Tubular Stenosis of the Common Bile Duct

The transpancreatic segment of the distal common bile duct can be extrinsically stenosed by a pure gallstone-linked pancreatic disorder. It has a specific roentgen configuration--long, tubular and smooth. In two instances it was associated with severe suppurative complications. Precholedochotomy cholangiography is required to identify such long segment benign tubular stenosis of the distal common bile duct as an indication for management alternatives and as a guide to judicious common bile duct exploration.     

Granular Cell Tumor of the Common Bile Duct

A case of granular cell tumor is reported and the main features of the previously reported cases are summarized. This lesion usually presents in a black woman as a small tumor obstructing the common bile duct and resulting in cholecystitis and/or obstructive jaundice. The cell of origin is still disputed. Local resection with cholecystectomy and choledochoduodenostomy appears to be the treatment of choice.     

Common Bile Duct Stones: A Cause of Chronic Salmonellosis

A chronic carrier state of Salmonella spp is present in 0.15% of the population, and is believed to be related to the presence of a diseased gallbladder. We present a patient with common bile duct (CBD) stones, whose bile cultures repeatedly indicated Salmonella typhi, despite an adequate course of antibiotic treatment. The carrier state was abolished after removal of the CBD stones 4 months later. The chronic carrier state may be related to biofilm formation on the surface of the CBD stones. The removal of the biliary stones, which are the most likely reservoir for Salmonella spp, may be a crucial step in eradication of the carrier state.     

Common Bile Duct Obstruction Due to Candidiasis

Biliary obstruction with its wide range of potential causes (e.g. neoplastic lesions, gallstones and inflammatory processes) is a common disease in gastroenterology. Although infections with Candida and other fungal species have increasingly been recognized in patients with certain predispositions, fungal involvement of the biliary tract is extremely rare. We report the case of a male patient with a past history of long-time mechanical ventilation and who was referred to our department with cholangitis. Endoscopic retrograde cholangio-pancreatography (ERCP) of the septic patient revealed a high-degree stenosis of the distal common bile duct with a prestenotic dilation which was strongly suspicious of an underlying malignancy. Control ERCP revealed a beads-like deformation of the intra- and extrahepatic bile duct system which was compatible with chronic secondary sclerosing cholangitis. Examining the bile duct system with a balloon catheter, a long tubular, filamentous structure with several branches at its sides could be extracted and was assessed histologically to be a Candida conglomerate. Candida colonization of the bile duct was confirmed by microbiological analysis of aspirated bile.