1/9. pseudomonas aeruginosa liver abscesses after diagnostic endoscopic retrograde cholangiography in two patients with sphincter of oddi dysfunction type 2.patients with sphincter of oddi dysfunction have a significantly increased rate of pancreatitis after manometry or sphincterotomy, but septic complications after diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of oddi dysfunction type 2 have not been reported. We describe two patients with sphincter of oddi dysfunction type 2 in whom pseudomonas aeruginosa serotype 10 septicemia and multiple small hepatic abscesses developed, all within 48 h after they underwent diagnostic ERCP. The sepsis and hepatic abscesses resolved after successful intravenous antibiotic administration. Despite scrupulous examination of the duodenoscope washing machine and the bottle of water, the bacteria responsible for the sepsis could not be isolated. It is possible that despite disinfection, a nondetectable colony of P. aeruginosa remained in a part of duodenoscope and proliferated to reach a potentially hazardous level the following day. This report highlights the importance administering antibiotic prophylaxis to patients with sphincter Oddi dysfunction type 2 who undergo ERCP, despite the functional nature of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. Xanthogranulomatous choledochitis: a previously undescribed mass lesion of the hepatobiliary and ampullary region.Solid liver and pancreatic masses are commonly neoplastic in nature; however, inflammatory lesions mimicking carcinoma are at times encountered in these sites. We report two cases of previously undescribed inflammatory mass lesions of the liver and pancreas that originated in the biliary tract. Detailed clinical and histologic evaluations were performed in two patients who underwent right partial hepatic lobectomy and Whipple's resection for presumed hepatic and pancreatic neoplasms. In case 1, with a remote history of cholecystectomy and recent extraction of a stone from the common bile duct, a liver mass in segment 6 was discovered incidentally. In case 2, a periampullary pancreatic mass was diagnosed radiographically following papillotomy and stent insertion for stricture and biliary calculous disease. The histologic findings in both cases were similar, localized around a part of the biliary tract, and consisted of inspissated bile, acute and chronic inflammation, abundant lipid-laden macrophages, fibrosis, and giant cell reaction. No neoplasm was identified. On the basis of the close resemblance of these features to those seen in xanthogranulomatous cholecystitis, the lesions seen here were termed xanthogranulomatous choledochitis. In conclusion, xanthogranulomatous choledochitis is a benign inflammatory process involving the biliary tract that can form a mass lesion within the liver or pancreas and thus mimic a neoplasm. Extensive sampling of the lesion is required to rule out an underlying neoplastic process. In our patients a propensity to form lithogenic bile and a prior history of biliary tract operative procedure were present.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Inflammatory pseudotumor of the common bile duct.An exceptional cause of obstructive jaundice is reported in the present case. A 51-year-old woman progressively developed jaundice with pruritus, and abdominal ultrasonography revealed dilated intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiography and endoscopic ultrasonography showed a tumor in the distal common bile duct, but failed to determine the nature of the lesion, and the patient underwent a pancreaticoduodenectomy. The final diagnosis was an inflammatory pseudotumor of the common bile duct. Inflammatory pseudotumors are uncommon, without evident pathogenesis, and are described in many organs. The localization in the common bile duct is exceptional. The prognosis is good, and a more conservative approach is possible if the diagnosis is certain before surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. MR imaging of a choledochal cyst.The preoperative magnetic resonance (MR) appearance of a choledochal cyst using the saturation recovery-spin echo technique is presented along with the CT and ultrasound images. Although CT suggested the correct diagnosis of choledochal cyst, the "solid" characteristics depicted by sonography led to confusion. The MR image demonstrated a mass, similar to the CT image with both a long T1 and T2, thus substantiating the cystic nature of the mass. Hepatoscintigraphy confirmed the obstructive nature of the lesion.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
5/9. The importance of early ultrasonography in jaundice.The ultrasonographic findings in 3 patients with longstanding jaundice of clinically unsuspected obstructive nature are presented and discussed. attention is drawn to the importance of early ultrasonography, even when the clinical and biochemical picture is not necessarily in keeping with a diagnosis of obstructive jaundice.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. choledochal cyst: sonographic evaluation of an unusual case.The preeminence of sonography in the diagnosis of obstructive jaundice has already been established. Earlier reports have described a variety of radiologic modalities used to establish the diagnosis of choledochal cyst. Our case illustrates the usefulness of sonography in differential consideration, though either transhepatic or operative cholangiography is necessary to further define the point and nature of the obstructive process and to determine that the cyst communicates with the common bile duct.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Abrupt termination of the common bile duct: a sign of malignancy identified by high-resolution real-time sonography.Although contrast cholangiography has a greater accuracy than sonography in determining the precise nature of extrahepatic biliary obstruction, it is not without risk. High-resolution real-time sonography is frequently adequate to evaluate the extrahepatic biliary system in multiple planes without known risk to the patient. In a one-year period the authors prospectively observed eight instances of distal biliary obstruction with abrupt termination of the common bile duct, and all were associated with malignant obstruction. There was no instance of abrupt ductal termination secondary to benign disease in this series. Malignancy should be suspected when careful sonograms along the longitudinal axis of an obstructed distal common bile duct reveal an abrupt termination.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. Spontaneous gallstone migration followed by endoscopic retrograde cholangiography.A case in which a medium-sized common bile duct stone spontaneously passed through the papilla into the duodenum is presented. The naturel course of this patient was followed by repeated endoscopic retrograde cholangiography. Acute ulcerous changes caused by the passage of a gallstone and a surprisingly quick recovery are demonstrated by vivid illustrations. The clinical significance of the phenomenon with regard to the patulous sphincter of Oddi or, in contrast, papillary stenosis, is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. A case of inflammatory pseudotumour of the common bile duct.Inflammatory pseudotumour of the common bile duct (CBD) is extremely rare. A 58-year-old Japanese female without choledocolithiasis underwent pancreatico-duodenectomy for constriction of the middle lower region of the CBD. A submucosal tumour protruding into the CBD, was histologically inflammatory consisting of fibroblastic cells, collagen fibres and myxoid stroma with chronic inflammatory cells. This lesion was surrounded by an irregular fibrosclerosing lesion with obliterative phlebitis which involved the neighbouring pancreas and lymph nodes. Clonal analysis of the tumour by polymerase chain reaction analysis of x chromosome inactivation patterns, confirmed the polyclonal nature of the lesion. Immunohistochemically, the fibroblastic cells in both lesions had the same phenotype [vimentin ( ), desmin (-), muscle-specific actin (-) and CD34 ( )] suggesting that these lesions with different histological features represent zonation of the same inflammatory process. The outer lesion extended irregularly into adjacent pancreatic tissue and lymph nodes. This fact made it difficult to differentiate this from a malignant lesion, even if frozen sections contained no atypical cells.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |