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The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
For the lower ductal injuries (those injuries below the cystic duct), when the tissue loss is minimal, the lesion can be closed over a T-Tube (as with exploration of the CBD for stones). A choledochoduodenostomy can be performed if the duodenum has not been injured. If the duodenum has been injured, or there is tissue loss, since the common duct is invariably small, a modification of the Carrel patch can be utilized. From blunt trauma, the common bile duct can be transected at the superior border of the pancreas. This is best treated with Roux-en-Y hepatojejunostomy.
Tropical infections and infestations
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Praziquantel and albendazole are the drugs of choice. However, the surgeon faces a challenge when there are stones not only in the gallbladder but also in the common bile duct. Cholecystectomy with exploration of the common bile duct is performed when indicated. Repeated washouts are necessary during the exploration, as the common bile duct is dilated and contains stones, biliary debris, sludge and mud. This should be followed by choledochoduodenostomy. As this is a disease with a prolonged and relapsing course, some surgeons prefer to do a choledochojejunostomy to a Roux loop. The Roux loop is brought up to the abdominal wall, referred to as ‘an access loop’, which allows the interventional radiologist to deal with any future stones.
Intestinal Transplantation
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Sherilyn Gordon Burroughs, Douglas G. Farmer
The modified multivisceral graft proceeds exactly as described for the multivisceral graft except that the native liver is retained and the allograft consists of an en bloc stomach (optional), pancreas, duodenum, jejunoileum, and colon (optional). The celiac trunk with the hepatic artery is spared to maintain blood supply to the native liver. Allograft venous outflow is via the portal vein, and biliary reconstruction is usually accomplished with a choledochoduodenostomy.
Endoscopic ultrasound‑guided biliary drainage in patients with surgically altered anatomy: a systematic review and Meta‑analysis
Published in Scandinavian Journal of Gastroenterology, 2023
Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Rie Shiomi, Takahiro Shin, Dai Hirata, Rie Terada, Tomoaki Tashima, Yumi Mashimo, Shomei Ryozawa
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has recently been developed as an alternative procedure for difficult ERCP cases, such as duodenal obstruction due to malignant tumors, difficult selective cannulation and patients with SAA [10–14]. EUS-BD includes various EUS-guided techniques, such as drainage (e.g., EUS-guided choledochoduodenostomy or hepaticogastrostomy), antegrade stenting (EUS-AG) [15], and rendezvous technique [16]. EUS-BD provides a high technical success rate and short procedure time [17]. A recent systematic review and meta-analysis of EUS-BD procedures reported pooled technical and clinical success rates of 91.5% and 87%, respectively, with an adverse events rate of 17.9% [18]. However, the outcomes of EUS-BD for patients with SAA have not yet been reported. Endoscopists treating biliopancreatic disorders sometimes encounter patients with SAA for treatment. As mentioned above, the technical success rate of ERCP-related procedures in patients with SAA is unsatisfactory. Therefore, it is worth reporting the pooled technical, clinical success and adverse event proportions regarding EUS-BD in patients with SAA to see the advantages and disadvantages of EUS-BD compared with ERCP-related procedures and determine if EUS-BD can be the first choice for those patients. Accordingly, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-BD for patients with SAA.
Sump syndrome of the remnant common bile duct following a living donor liver transplant
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Gordon Robbins, Justin Brilliant, Yuting Huang, Jonah Rubin, Eric Goldberg, Zurabi Lominadze
Sump syndrome was initially described as digested food, debris, stones, bile, and/or bacteria accumulating in a poorly drained distal common bile duct (CBD) in patients undergoing choledochoduodenostomy[1]. The presenting symptoms of sump syndrome include indigestion, abdominal pain, nausea, vomiting, postprandial discomfort, and jaundice[1]. With the decline of choledochoduodenostomies in favor of endoscopic retrograde cholangiopancreatography (ERCP), sump syndrome is less prevalent and is now described mainly as a complication following Roux-en-Y hepaticojejunostomy for benign biliary disease[2]. Biliary complications following a living donor liver transplant are common, but sump syndrome has yet to be described in the literature. We present a case of sump syndrome in a patient with living donor liver transplantation for primary sclerosing cholangitis (PSC).
Efficacy of a dedicated plastic stent in endoscopic ultrasound-guided hepaticogastrostomy during the learning curve: cumulative multi-center experience
Published in Scandinavian Journal of Gastroenterology, 2023
Koh Kitagawa, Akira Mitoro, Ryuki Minami, Shinsaku Nagamatsu, Takahiro Ozutsumi, Yukihisa Fujinaga, Norihisa Nishimura, Yasuhiko Sawada, Tadashi Namisaki, Takemi Akahane, Kosuke Kaji, Fumimasa Tomooka, Shohei Asada, Miki Kaneko, Hitoshi Yoshiji
The treatment outcomes are shown in Table 2. The number of punctured bile duct branches was 3 for the biliary branch in segment 2 (B2) and 20 for B3. Simultaneous EUS-AS was performed in three (13.0%) patients. Successful placement of dedicated plastic stents via EUS-HGS was achieved in 22 patients, with a technical success rate of 95.7%. One patient in whom stenting was impossible had obstructive jaundice due to pancreatic cancer. In this failed case, although bile duct puncture and cholangiography were achieved, the guidewire could not be properly inserted into the common bile duct (Case 6). In this patient, EUS-BD was finally successful after conversion to EUS-guided choledochoduodenostomy using a fully covered SEMS.