Mirizzi syndrome secondary to an adenoma of the cystic duct

Bile duct adenomas are uncommon lesions that can cause obstructive jaundice. We report the unusual case of a 54-year-old man who developed Mirizzi syndrome secondary to a bile duct papillary adenoma located in the cystic duct remnant. A case report is presented, together with a review of extrahepatic bile duct adenomas published in the English-language literature, with special attention directed toward the clinical manifestations, locations, and prognosis of these tumors. Bile duct adenomas are very rare tumors. Although cholangiography can detect many of these lesions, few cases were correctly diagnosed preoperatively. Most lesions were located in the distal common bile duct or at the ampulla of Vater. Pathologic examination often revealed foci of carcinoma in situ, dysplasia, or atypia. Local resection was performed in most cases. There were no previous case reports of extrinsic common bile duct obstruction caused by tumors within the cystic duct. We describe here a very rare, acalculous variant of Mirizzi syndrome secondary to a solitary papillary adenoma of the cystic duct. In general, bile duct adenomas are uncommon lesions that are difficult to diagnoses preoperatively. These tumors usually present with jaundice secondary to intraluminal biliary obstruction. These lesions are premalignant and should be managed by complete surgical resection.     

Cholestatic jaundice secondary to portal cavernoma: Case report

Portal biliopathy is due to compression of the common bile duct by varicose veins constituting portal cavernoma. Usually asymptomatic, it can occasionally be responsible for jaundice or cholangitis. We report a case of portal cavernoma secondary to pylephlebitis complicating acute appendicitis, followed eleven years later by occurrence of cholestatic jaundice. Diagnosis of portal biliopathy was done by imaging and confirmed by endoscopic retrograde cholangiography with insertion of a plastic stent into common bile duct. This stent was periodically changed and allowed regression of jaundice with a 3-year follow-up. Through a review of the literature, both clinical and therapeutic characteristics of portal biliopathy were studied.     

Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct

We report a case of double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct. A 73-year-old woman was admitted to the hospital complaining of upper abdominal pain. Endoscopic retrograde cholangiography showed a stenotic lesion in the lower common bile duct and no visualization of the cystic duct or gallbladder. Enhanced computed tomography revealed a heterogeneously enhanced tumorous lesion around the lower bile duct in the pancreatic head. A diagnosis of cancer arising from the cystic duct that entered the lower part of the common hepatic duct was made by intraductal ultrasonography, which showed an intraluminal protruding lesion in the cystic duct. Isolated gallbladder cancer was also diagnosed, by abdominal computed tomography. She underwent pancreaticoduodenectomy with dissection of regional lymph nodes. Histological examination revealed moderately differentiated adenocarcinoma of the cystic duct and well-differentiated adenocarcinoma of the gallbladder. Double cancer of the cystic duct and gallbladder is extremely rare, and this case also suggests a relationship between a low junction of the cystic duct and neoplasm in the biliary tract.     

Agenesia of the gallbladder and the cystic duct. Apropos of 2 personal cases]

After a survey of the literature on gall bladder and cystic duct agenesia, two personally observed cases are described. Stress is laid on the aetiopathogenesis, physiopathology and clinical aspects of the malformation.     

胆囊癌胆总管内种植转移致梗阻性黄疸三例

海南省人民医院1992至2003年共收治3例原发性胆囊癌胆管内种植转移引起梗阻性黄疸的病例,报告如下.临床资料患者均为女性,年龄分别为53、75、66岁,首发症状均为无痛性逐渐加重黄疸,病史10～15 d.     

Multiple carcinoid tumors of the gallbladder and cystic duct

A very rare case of multiple carcinoid tumors of the gallbladder and cystic duct is reported in a 77-year-old woman. Cholecystectomy and resection of the common bile duct, with regional lymph node dissection, were performed. The tumors consisted of a large mass (30×20×15mm) in the neck of the gallbladder and three small lesions in the cystic duct. Histologically, the tumor cells were arranged in solid nests, and showed many mitoses. Histochemical studies revealed argyrophilic and argentaffinic staining. Immunohistochemically, the tumor cells were positive for serotonin, chromogranin A, Leu 7, synaptophysin, and neuron-specific enolase. Thus, the present case was diagnosed as midguttype carcinoids.     

Unusual cases of jaundice secondary to non-neoplastic bile duct obstruction

Obstructive jaundice secondary to common bile duct stricture is most commonly attributed to malignancy. Here we present three unusual cases that mimicked carcinoma in presentation but were histologically diagnosed as benign inflammatory processes during operative care. The first case was attributed to obstruction-induced chronic pancreatitis secondary to Crohn's disease of the head of the pancreas, the second was due to sarcoidosis within periportal and extrahepatic biliary lymph nodes and distal common bile duct, and the third case was due to tuberculosis of biliary lymph nodes. All were successfully managed surgically, but potentially these patients may have been effectively treated pharmacologically, without the need for invasive surgical intervention, if an earlier diagnosis were available to the clinicians. A retrospective and comparative review of the data of each case demonstrated subtle clues such as multiple enlarged biliary lymph node involvement and only moderately elevated bilirubin levels that pointed toward possible nonmalignant processes.     

Delayed obstructive jaundice secondary to bullet in common hepatic duct

A young male presented with obstructive jaundice and recurrent attacks of acute cholangitis. He had sustained gunshot wound in abdomen 9 years back. Laparotomy was done at that time and the bullet was found left within right lobe of liver, as it was inaccessible and possible benefit to take it out was considered less than leaving it in-situ. The patient recovered and did well for 7 years. After 7 years of latency, he developed recurrent attacks of acute cholangitis. The reason of this delayed presentation was probably the migration of the bullet from its original place to the biliary tree i.e. common hepatic duct.     

胆总管继发结石病人胆囊管形态的变化

目的 分析胆囊结石继发胆道结石病例胆囊管结构的特点,为腹腔镜联合胆道镜胆道探查术提供术式判断的指证.方法 回顾性分析108例腹腔镜联合胆道镜胆囊切除加胆管探查术病例的术前影像检查结果,同时结合术中胆囊管形态、直径和扩张的情况,分析胆囊管结构变化特点.结果 术前B超检查显示108例病人均有胆囊结石,胆总管扩张75例,胆囊管扩张21例,胆总管结石76例.磁共振胰胆管造影(MRCP)检查发现胆总管扩张81例,有明显结石图像的52例,胆囊管扩张36例,发现9例胆囊管异位走行.CT检查显示胆总管扩张45例,有明显结石影的42例,胆囊管扩张19例.胆囊管有明显扩张的病例中,胆囊管和胆总管之间的夹角多呈钝角(22/24例);此夹角呈锐角的病例胆囊管扩张的少(2/28).胆囊管扩张明显的病例胆囊管形态常短粗(24/24),胆囊管细长的病例中胆囊管扩张的少.结论 MRCP对胆囊管的形态和走行有明显的判断和指导作用.胆囊管和胆总管之间的夹角呈钝角,胆囊管短粗的病例,其胆囊管扩张明显.