1/105. Fibropolycystic disease of the hepatobiliary system and kidneys.This complicated case of fibropolycystic disease of the hepatobiliary system and kidneys was ably and incisively analyzed by Professor Sheila Sherlock. Her clinical acumen was revealed by her ability to differentiate congenital hepatic fibrosis, Caroli's disease, and adult polycystic disease of the liver and kidney. Interesting histologic features of this case included hepatic fibrosis with intact limiting plates anc central veins and the presence of bile plugs in the ducts, but the absence of bile statsis in the parenchyma. A percutaneous transhepatic cholangiogram demonstrated the dilated intrahepatic and extrahepatic ducts. Washing out the "gunk" from the biliary tract by T-tube drainage has great limitations in this type of case. Therefore, Dr. Adson suggested irrigation of the biliary ductal system using tubed placed transhepatically, plus a wide choledojejunostomy. Dr. Sherlock questioned this surgical approach. The use of chenodeoxycholic acid for this "gunk" was suggested. In spite of the dilated ducts and pathologic changes in the liver, the patient was not jandiced and did not have stones in her biliary tract. The genetics of this patient's problems was discussed.- - - - - - - - - - ranking = 1keywords = extrahepatic, duct (Clic here for more details about this article) |
2/105. Choledochoduodenal fistula at the anterior wall of the duodenal bulb: a rare complication of duodenal ulcer.A 38 year-old man was admitted to our hospital with the chief complaint of epigastralgia. His laboratory data revealed leukocytosis and increased serum amylase, and abdominal ultrasonography revealed diffuse swelling of the pancreas. Thus, he was diagnosed as having acute pancreatitis. Moreover, abdominal computed tomography showed pneumobilia in the gallbladder and the common bile duct. Gastroduodenal fiberscopy demonstrated peptic ulcer scars around a foramen with smooth margins at the anterior wall of the duodenal bulb. The bile juice flowed from the bottom of the foramen. Endoscopic retrograde cholangiopancreatography revealed the fistula between the common bile duct and the anterior wall of the duodenal bulb, but not the posterior wall. However, there was no pancreatico-biliary maljunction and no stones in the gallbladder or bile duct. This is a rare case of choledochoduodenal fistula at the anterior wall of the duodenal bulb caused by duodenal peptic ulcer disease.- - - - - - - - - - ranking = 0.3733265053937keywords = bile duct, duct (Clic here for more details about this article) |
3/105. Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.- - - - - - - - - - ranking = 0.016488014279875keywords = duct (Clic here for more details about this article) |
4/105. Aberrant pancreatic tissue accompanied by heterotopic gastric mucosa in the gall-bladder.A 5 mm pancreatic heterotopia was incidentally identified in the gall-bladder with small cholesterol polyps following cholecystectomy in an asymptomatic 49-year-old female. Microscopically, inflammatory changes in the wall were minimal. The aberrant tissue consisted of acini and ducts but did not have islet formation. Heterotopic gastric mucosal tissue with a mixture of foveolar cells and pyloric glands was seen at the orifice of the pancreatic heterotopia. Islet peptide-immunoreactive endocrine cells were scattered among the pancreatic parenchyma, and the gastric-type gland contained cells positive for gastrin, somatostatin and glucagon. A noteworthy finding was the immunohistochemical detection of a single insulin-containing cell in the pyloric gland.- - - - - - - - - - ranking = 0.016488014279875keywords = duct (Clic here for more details about this article) |
5/105. Floating gallbladder: a questionable prelude to torsion: a case report.A 55-year-old woman had recurrent bouts of low substernal and epigastric pain radiating into the interscapular region. A hepatobiliary scan initially showed what was believed to be a dilated common bile duct and nonvisualization of the gallbladder. A delayed image obtained after having the patient move about revealed the presence of a filled gallbladder and normal common bile duct. The combination of recurrent pain with this scintigraphic picture may be representative of a floating gallbladder or an incomplete torsion with spontaneous detorsion. This case is presented to describe the scintigraphic appearance of a mobile gallbladder that may be prone to volvulus and to emphasize the importance of obtaining decubitus or oblique views at the end of a hepatobiliary study in selected cases of unusual findings.- - - - - - - - - - ranking = 0.24888433692914keywords = bile duct, duct (Clic here for more details about this article) |
6/105. Heterotopic pancreas--an unusual cause of cholecystitis.A 47-year-old woman presented with signs and symptoms of acute cholecystitis. A routine cholecystectomy was performed. No gallstones were present. On histological examination of the gallbladder, a nodule impinging on the lumen was present in the region of the cystic duct. This nodule was composed of mature, uninflamed exocrine and endocrine pancreatic tissue. In the absence of gallstones, the heterotopic pancreas was the cause of obstruction, with subsequent cholecystitis.- - - - - - - - - - ranking = 0.022795469617049keywords = duct, obstruction (Clic here for more details about this article) |
7/105. Preoperative diagnosis of gallbladder torsion by magnetic resonance cholangiopancreatography.The patient was a 78-year-old woman who was diagnosed as having gallbladder torsion preoperatively. This is the first reported case diagnosed by magnetic resonance cholangiopancreatography (MRCP). signs and symptoms of this condition are often subtle. Radiologic evaluation by ultrasonography and computed tomography (CT) showed acute cholecystitis with stone. Drip-infusion cholangiography CT failed to outline the gallbladder, and distortion of the extrahepatic bile ducts and interruption of the cystic duct were observed. MRCP showed 1) a v-shaped distortion of the extrahepatic bile ducts due to traction by the cystic duct, 2) tapering and twisting interruption of the cystic duct, 3) a distended and enlarged gallbladder that was deviated to the midline of the abdomen, and 4) a difference in intensity between the gallbladder and the extrahepatic bile ducts and the cystic duct. A definitive diagnosis of gallbladder torsion (volvulus) was made by MRCP preoperatively. If treated surgically, gallbladder detorsion before cholecystectomy is a helpful technique to avoid bile duct injury. This condition should be suspected in elderly women with acute cholecystitis or acute abdominal pain of unknown origin, and MRCP may be very useful in making a definitive diagnosis.- - - - - - - - - - ranking = 3.3658645596193keywords = extrahepatic, bile duct, duct (Clic here for more details about this article) |
8/105. Gallstone ileus: CT findings.Gallstone ileus is a rare complication of recurrent gallstone cholecystitis. The classic radiographic triad of small bowel obstruction, pneumobilia and ectopic gallstone on abdominal plain radiograph is described with CT imaging. Because of the better resolution of CT compared with abdominal radiography and its recent accession to emergency use, radiologists should be aware of CT findings of gallstone ileus. We report a case in which gallstone ileus was initially diagnosed by CT.- - - - - - - - - - ranking = 0.0063074553371737keywords = obstruction (Clic here for more details about this article) |
9/105. Spontaneous neonatal gall bladder perforation.A full term neonate was operated for diaphragmatic eventration through the chest. Postoperatively the baby developed gastric outlet obstruction. ultrasonography and barium meal examination were suggestive of extrinsic compression in the region of the pylorus. At laparotomy a gall bladder perforation was found producing a biloma just abve the pylorus. drainage of the bilioma and temporary cholecystostomy cured the gastric outlet obstruction.- - - - - - - - - - ranking = 0.012614910674347keywords = obstruction (Clic here for more details about this article) |
10/105. Post-decompression gallbladder haemorrhage in obstructive jaundice. A report of 2 cases.Two cases of massive haemorrhage from the gallbladder in patients suffering from common bile duct obstruction are described. Sudden operative decompression of the massively distended gallbladder was the probable cause of the bleeding.- - - - - - - - - - ranking = 0.42306026880167keywords = duct obstruction, bile duct, duct, obstruction (Clic here for more details about this article) |
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