• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.21 no.3
• /
• pp.203-208
• /
• 2018

Purpose: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. Methods: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. Results: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was $6.4{\pm}4.9$ (range, 0.8-17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. Conclusion: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

• Parasites, Hosts and Diseases
• /
• v.45 no.4
• /
• pp.301-306
• /
• 2007

We attempted to identify parasite DNA in the biliary stones of humans via PCR and DNA sequencing. Genomic DNA was isolated from each of 15 common bile duct (CBD) stones and 5 gallbladder (GB) stones. The patients who had the CBD stones suffered from cholangitis, and the patients with GB stones showed acute cholecystitis, respectively. The 28S and 18S rDNA genes were amplified successfully from 3 and/or 1 common bile duct stone samples, and then cloned and sequenced. The 28S and 18S rDNA sequences were highly conserved among isolates. Identity of the obtained 28S D1 rDNA with that of Clonorchis sinensis was higher than 97.6%, and identity of the 18S rDNA with that of other Ascarididae was 97.9%. Almost no intra-specific variations were detected in the 28S and 18S rDNA with the exception of a few nucleotide variations, i.e., substitution and deletion. These findings suggest that C. sinensis and Ascaris lumbricoides may be related with the biliary stoneformation and development.

• Journal of radiological science and technology
• /
• v.28 no.2
• /
• pp.105-110
• /
• 2005

Background/Aim : Common bile duct (CBD) stones may cause jaundice, cholangitis, or pancreatitis. Extracorporeal shock wave lithotripsy (ESWL) may be needed whenever endoscopic procedure are failed to extract common bile duct stones. The aim of this study is to provide the standard for patient's best choice on ESWL for treatment of CBD stones resistant to endoscopic extraction. Materials and Methods : Fourty-six patients failed in endoscopic stone extraction including mechanical lithotripsy were treated by ESWL. In all patients, endoscopic sphincterotomy and nasobiliary drainage tube was done before ESWL using the ultrasonography for stone localization with a spark-gap type lithotriptor. Patients were sedated with an intravenous injection of 50 mg of Demerol. None were treated under general anesthesia. Results : Overall complete clearance rate of CBD stone was 89.1% (41/46). In 82.6% of the patients, the stones were extracted endoscopically after ESWL, and spontaneous passage was observed in 6.5%. In the clearance rate after ESWL, there were no noticeable differences with regard to number (single: 82.8%, two or three: 100%, more than three: 100%) and size of the stone (less than 33mm: 92.9%, 33 mm or larger: 83.3%), whereas there were significant differences with regard to the ratio of sum of long-axis length of the all stones to sum of long-axis length of the CBD excluding stone (1:2.4, 1:2.1) and diameter of the largest stone to diameter of CBD excluding stone (1:0.9, 1:0.4) for patients with complete clearance compared with those without. Conclusion : We propose that stones without the fragments are travelable sufficient space in CBD or extractable sufficient diameter of CBD regardless of stone size and number should be treated by other technique to prevent time and cost consuming, such as percutaneous transhepatic cholangioscopylithotomy.

• Clinical Endoscopy
• /
• v.56 no.1
• /
• pp.92-99
• /
• 2023

Background/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. Methods: We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. Results: A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. Conclusions: Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

• Clinical Endoscopy
• /
• v.55 no.2
• /
• pp.297-301
• /
• 2022

Common bile duct (CBD) stones are prevalent in 11% to 21% of patients with gallstones and can cause various clinical manifestations, from biliary colic to biliary sepsis. The treatment of choice is endoscopic retrograde cholangiopancreatography, but approximately 5% to 10% of CBD stones are difficult to remove using these conventional endoscopic methods. Although percutaneous transhepatic cholangioscopy and lithotripsy can be used as an alternative, it can be technically demanding and risky if the intrahepatic duct is not dilated. We report a case of a large CBD stone that was successfully removed using percutaneous transcholecystic cholangioscopy.

• Annals of Hepato-Biliary-Pancreatic Surgery
• /
• v.27 no.2
• /
• pp.166-171
• /
• 2023

Backgrounds/Aims: Routine execution of intraoperative cholangiography (IOC) in laparoscopic cholecystectomy (LC) is considered a good practice to help early identification of biliary duct injuries (BDIs) or common bile duct (CBD) stones. This study aimed to determine the impact of IOC during LC. Methods: This is a retrospective, monocentric study, including patients with a LC performed from January 2020 to December 2021. Results: Of 303 patients, 215 (71.0%) were in the IOC group and 88 (29.0%) in the no-IOC group. IOC was incomplete or unclear in 10.7% of patients, with a failure rate of 14.7%. Operating time was 15 minutes longer in the IOC group (p = 0.01), and postoperative complications were higher (5.1% vs. 0.0%, p = 0.03). There were three BDIs (0.99%), all included in the IOC group; only one was diagnosed intraoperatively, and the other two were identified during the postoperative course. Regarding identifying CBD stones, IOC showed a sensitivity of 77%, a specificity of 98%, an accuracy of 97.2%, a positive predictive value of 63% and a negative predictive value of 99%. Conclusions: Systematic IOC has shown no specific benefits and prolonged operative duration. IOC should be performed on selected patients or in situations of uncertainty on the anatomy.

• The Korean Journal of Nuclear Medicine
• /
• v.26 no.1
• /
• pp.82-85
• /
• 1992

To evaluate the role of hepatobiliary (DISIDA) scan in the diagnosis of biliary obstruction, we studied the clinical characteristics of 9 cases with biliary obstructuon, whose hepatobiliary scans and ultrasonography were not concordant (normal ultrasonography and abnormal hepatobiliary scan). The results were as follows; 1) The main chief complaints (89%) were abdominal pain, especially in RUQ area. The levels of serum bilirubin were elevated in 67% of patients $(normal\sim5.9mg/dl)$ and those of alkaline phosphatase were elevated in 78% of patients $(normal\sim724U/L)$. 2) The final diagnoses were CBD stones (67%), tumor (22%) and 3 cases were associated with C. sinensis. 3) The major obstruction sites were in distal CBD (89%). From the above results we concluded that hepatobiliary scan is a useful diagnostic method of biliary obstruction, especially in distal CBD lesion and early stage, in spite of normal ultrasonography.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.15 no.1
• /
• pp.57-61
• /
• 2012

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.

• Journal of the Korean Society of Radiology
• /
• v.85 no.3
• /
• pp.581-595
• /
• 2024

Purpose The present study aimed to investigate the frequency and extent of compensatory common bile duct (CBD) dilatation after cholecystectomy, assess the time between cholecystectomy and CBD dilatation, and identify potentially useful CT findings suggestive of obstructive CBD dilatation. Materials and Methods This retrospective study included 121 patients without biliary obstruction who underwent multiple CT scans before and after cholecystectomy at a single center between 2009 and 2011. The maximum short-axis diameters of the CBD and intrahepatic duct (IHD) were measured on each CT scan. In addition, the clinical and CT findings of 11 patients who were initially excluded from the study because of CBD stones or periampullary tumors were examined to identify distinguishing features between obstructive and non-obstructive CBD dilatation after cholecystectomy. Results The mean (standard deviation) short-axis maximum CBD diameter of 121 patients was 5.6 (± 1.9) mm in the axial plane before cholecystectomy but increased to 7.9 (± 2.6) mm after cholecystectomy (p < 0.001). Of the 106 patients with a pre-cholecystectomy axial CBD diameter of < 8 mm, 39 (36.8%) showed CBD dilatation of ≥ 8 mm after cholecystectomy. Six of the 17 patients with long-term (> 2 years) serial follow-up CT scans (35.3%) eventually showed a significant (> 1.5-fold) increase in the axial CBD diameter, all within two years after cholecystectomy. Of the 121 patients without obstruction or related symptoms, only one patient (0.1%) showed IHD dilatation > 3 mm after cholecystectomy. In contrast, all 11 patients with CBD obstruction had abdominal pain and abnormal laboratory indices, and 81.8% (9/11) had significant dilatation of the IHD and CBD. Conclusion Compensatory non-obstructive CBD dilatation commonly occurs after cholecystectomy to a similar extent as obstructive dilatation. However, the presence of relevant symptoms, significant IHD dilatation, or further CBD dilatation 2-3 years after cholecystectomy should raise suspicion of CBD obstruction.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.2
• /
• pp.131-136
• /
• 2008

Cholethorax (bilious pleural effusion) is an extravasation of bile into the thoracic cavity via a pleurobiliary fistula (and also a bronchobiliary fistula). It is an extremely rare complication of thoraco-abdominal injuries. It can be caused by congenital anomaly and also by hepatobiliary trauma, severe infection or iatrogenic procedures. The definitive diagnosis is made with aspiration of bilious fluid from the pleural space during thoracentesis, by finding a fistulous tract during endoscopic retrograde cholangiopancreatography (ERCP) or cholagioscopy, or with finding an abnormal pleural accumulation of radioisotope during hepatobiliary nuclear imaging. Its symptoms include coughing, fever, dyspnea and pleuritc chest pain. Herein we report on a case of cholethorax following performance of percutaneous transhepatic cholangioscopy (PTCS) to remove incidentally discovered common bile duct (CBD) stones.