1/39. A rare cause of biliary pain in belgium.ascaris lumbricoides is the most frequent human helminthic parasite. Usually human ascariasis is poorly symptomatic but complications can arise due to worm migration. Erratic worm migration into the biliary tree is a rare but threatening condition regarding the associated complications: cholecystitis, pancreatitis, obstruction of bile ducts, liver abcesses and recurrent pyogenic cholangitis. We describe a case of a young belgian women suffering from recurrent biliary colics over a period of eight months with repeated normal ultrasound findings. ERCP proved being the only effective diagnostic procedure for a living biliary worm, which was successfully removed with a balloon catheter.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/39. Bilo-pancreatic ascaris lumbricoides infestation. Endoscopic discovery and removal.ascaris lumbricoides infestation is relatively rare in industrialized countries, and it occurs mainly in conditions in which hygiene is lacking. We describe here a case of a 39-year-old female from ex-Jugoslavia affected by recurrent hepatic colic. At entry ultrasonography revealed microlithiasis in the gallbladder and widening of the pancreatic head. The subsequent ERCP showed slight filling defects in the choledochus and an inflammation-like stricture of the papilla of Vater, and after endoscopic sphincterotomy we saw an outflow of dense bile and microlitholits. Thus, a standard surgical cholecystectomy was carried out and the patient was dismissed on the 3rd postoperative day without any symptoms. However, the patient was admitted again after four days for a new coliky pain attack. An upper endoscopy showed a 23 cm long mobile parasite in the duodenum: it was caught with the polypectomy loap, extracted and identified as A. Lumbricoides. The patient's symptoms disappeared after the endoscopic removal of the worm and she was dismissed the day after the worm's removal. No recurrence of symptoms was noted during a 1-year follow-up. This case showed that A. Lumbricoides infestation of the biliary tree should be considered when biliary and/or pancreatic symptoms recur, especially in patients coming from undeveloped countries. At the same time we showed that endoscopic removal is a safe and effective treatment for this infestation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/39. coccidioides immitis in the gallbladder and biliary tree.Intraabdominal coccidioidomycosis is a very rare entity and usually responds to medical therapy. Operative intervention is reserved for diagnosis or drainage of localized collections. With biliary coccidioidomycosis, medical treatment appears to be ineffective, and biliary tract drainage is necessary for optimal management. A case of coccidioidomycosis in the gallbladder and biliary tree is described and the literature reviewed.- - - - - - - - - - ranking = 5keywords = tree (Clic here for more details about this article) |
4/39. Cystic dilatation of the intrahepatic bile ducts.Two cases of cystic dilatation of the intrahepatic biliary tree in Black patients are described. Both patients presented with extremely short histories of abdominal pain, and one patient had an associated jaundice. Biliary tree pathology was confirmed by physical examination and biochemical investigation in one patient while in the second patient cystic dilatation of the biliary tree was an incidental finding.- - - - - - - - - - ranking = 3keywords = tree (Clic here for more details about this article) |
5/39. 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 = 6keywords = tree (Clic here for more details about this article) |
6/39. Idiopathic cholangiopathy in a biliary cast syndrome necessitating liver transplantation following head trauma.The development of total biliary casts is very unusual, especially in patients who have not undergone liver transplantation. The aetiology of these casts is uncertain but several factors are believed to play a role, including periods of fasting, haemolysis, cholangitis and recent surgery. Resultant bile stasis and/or gallbladder hypocontractility promote sludge and subsequent stone formation. Here we present the case of a previously well 66-year-old woman who developed a total biliary cast several weeks after being involved in a road traffic accident during which she sustained head injuries but no obvious liver insult. This cast was removed at laparotomy but the patient had resultant diffuse biliary tree abnormalities and persistent cholestasis and subsequently required a liver transplant. The possible aetiologies of biliary cast formation and subsequently cholangiopathy necessitating transplantation in this patient are described.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/39. Unexplained biliary tract dilatation in lung cancer patients.Three patients, two men and one woman, diagnosed as having adenocarcinoma of the lung were found to have changes in cholestatic biochemical values, and CT scan of the abdomen demonstrated dilation of the biliary tree. Upon further evaluation using ERCP marked dilation of the biliary tree was confirmed. There was no anatomic obstruction to bile flow, no neoplastic involvement of the liver or bile ducts and no evidence of any infiltrative process or disease to explain the dilation. A paraneoplastic syndrome is proposed as the etiology of the biliary tract abnormality. Along with other more common causes, this newly described paraneoplastic syndrome should be considered in the differential diagnosis of lung cancer in patients presenting with cholestasis and biliary tract dilation.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
8/39. Motility and dysmotility of the biliary tract.Muscle fibers in the biliary tree, and therefore the potential for dysmotility, are located in the gallbladder and the sphincter of Oddi. Dysmotility at either site is a potential cause of biliary pain in the absence of stones, although significant controversy persists. Diminished gallbladder emptying measured by biliary scintigraphy is an indication for cholecystectomy, although studies are contradictory regarding clinical benefit. It is likely that careful selection of patients for cholescintigraphic testing, many of whom have had missed stones or sludge, will identify patients who benefit from cholecystectomy. However, given the increased incidence of gallbladder stasis in functional gastrointestinal disorders, wide use of this study in patients with abdominal symptoms leads to a frequent failure to respond to cholecystectomy. sphincter of oddi dysfunction (SOD) has been best studied in patients with biliary type pain who have had prior cholecystectomy. Much less understood is the association of SOD with idiopathic recurrent acute pancreatitis and chronic pancreatitis. The least-studied clinical association for SOD is in patients with biliary pain and intact gallbladders. Elevated basal sphincter of Oddi pressure is predictive of clinical response to sphincterotomy in patients with postcholecystectomy pain in two randomized sham-controlled studies. However, patients with suspected SOD have the highest complication rate from endoscopic retrograde cholangiogram and sphincterotomy, and, therefore, careful patient selection is mandatory.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/39. 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 = 1keywords = tree (Clic here for more details about this article) |
10/39. Late choledochal pathology after cholecystectomy for cholelithiasis.After "simple" cholecystectomy for lithiasis, biliary disorders can appear, with the onset more than 3 years postoperative, like cholangitis or transitory jaundice. Meantime, a whole range of congenital abnormalities initially ignored can become manifest: biliary tract congenital dilatations, duodenal para-Vater diverticulum, Oddi stenosis. Aim: to establish the pathological circumstances that determine late choledochal syndrome, including an analysis concerning the therapeutical approach in these cases. patients with cholecystectomy complains of late biliary disorders (least 3 years symptom-free) between 1997-2005, were retrospectively studied. Exclusion criteria were intraoperative incidents or accidents, recognised incomplete surgical procedure, early difficult postoperative course. Therapeutical approach was endoscopical, surgical or conservative. 46 patients entered the study group; 38 underwent open cholecystectomy. Mean interval between operation and disturbances onset was 10 years. Following etiopathologic causes of late choledochal pathology were recorded: incomplete cholecystectomy, retained or primary common bile duct (CBD) stones, choledochal cyst or stenosis, Oddi stenosis, duodenal para-Vater diverticulum, anomaly biliary tree. Thirty patients undergone successful endoscopic treatment; in 8 cases endoscopy failed, in 2 cases open surgery was the first choice; 5 diagnostic endoscopic cholangiography with conservative treatment were performed; 1 patient refused any procedure. cholecystectomy indication is regularly based on clinical and ultrasound examination criteria. Even a simple cholecystectomy can be followed after first 3 years by cholangitis, obstructive jaundice, caused by initially ignored biliary tract pathology. To avoid such omissions, routine intraoperative cholangiography and duodenal endoscopy should precede cholecystectomy. On the other side, cholecystectomy itself can cause late complaints: retained CBD stones, gallbladder stump, and iatrogenic stenosis. The duodenal para-Vater diverticulum seems to have a more important role in biliary disturbances, before and after cholecystectomy.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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