1/4. Heterotopic gastric mucosa involving the gallbladder and biliary tree.A case of heterotopic gastric mucosa in the common bile duct, cystic duct and gallbladder is reported in a 3-year-old girl with abdominal pain and jaundice. Abdominal US and CT showed dilatation of the biliary tree and a well-defined mass in the common bile duct that narrowed its lumen. The gallbladder was contracted in both examinations. The common bile duct and the gallbladder were resected and a choledochojejunostomy was performed. Although gastric heterotopy has been described throughout the entire length of the gastrointestinal tract, it is a very uncommon finding in the gallbladder and extremely rare in the biliary tree. A firm diagnosis of gastric heterotopia is based on the presence of fundal mucosa replete with parietal and chief cells. To our knowledge, this is the fifth reported case of heterotopic gastric tissue within the common bile duct, and the first to describe the US and CT findings. A relevant literature review and brief outline of the histological and radiological features are included in the discussion.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/4. mirizzi syndrome and gallstone ileus: an unusual presentation of gallstone disease.We discuss the case of a man with an unusual complication of gallstone disease. An 85-year-old patient presented to the emergency department with a 3-week history of abdominal pain in the right upper abdominal quadrant. Thoracoabdominal radiography demonstrated that the whole extrahepatic biliary tree, including the common bile duct, common hepatic duct, gallbladder, and left and right hepatic ducts, were visibly delineated by air. The operative findings revealed a small shrunken gallbladder, a fistula between the gallbladder fundus and the gastric antrum, and a cholecystohepatic fistula, corresponding to mirizzi syndrome, type II. A large gallstone was found impacted in the jejunum. This patient seems to have developed initially a cholecystohepatic fistula. Due to the acute inflammatory process, the stone eroded through the gallbladder wall and into the gastric antrum, passing from the antrum into the small bowel, where it became impacted. We suggest that the natural history of mirizzi syndrome does not end with a cholecystobiliary fistula but that the continuous inflammation in the triangle of Calot may result in a complex fistula involving not only the biliary tract but also the adjacent viscera.- - - - - - - - - - ranking = 0.16666666666667keywords = tree (Clic here for more details about this article) |
3/4. Biliary peritonitis due to fistulous tract rupture following a T-tube removal.We present a patient with biliary peritonitis following a T-tube removal. The patient underwent laparotomy; a rupture of the fistulous tract around the T-tube was found. A Nelaton catheter was inserted through this opening and advanced toward the biliary tree and secured in place by a suture ligature. Postoperative course was uneventful.- - - - - - - - - - ranking = 0.16666666666667keywords = tree (Clic here for more details about this article) |
4/4. Pneumobilia: benign or life-threatening.Pneumobilia, or air within the biliary tree of the liver, suggests an abnormal communication between the biliary tract and the intestines, or infection by gas-forming bacteria. Pneumobilia usually can be distinguished from air in the portal venous system by its appearance on computed tomography (CT) scan. The most common conditions associated with pneumobilia include: 1) a biliary-enteric surgical anastamosis, 2) an incompetent sphincter of oddi, or 3) a spontaneous biliary-enteric fistula. Three cases of pneumobilia associated with its most common causes are presented and further differential diagnostic possibilities as well as the implications of this finding on patient management are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = tree (Clic here for more details about this article) |