Biliary Leak after Pancreatoduodenectomy for Duodenal Neuroendocrine Tumors
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
Percutaneous transhepatic biliary drainage is the only endoluminal treatment option for biliary leakage post-pancreatoduodenectomy. It provides an opportunity to create a low-pressure system along the biliary tract, redirecting the bile flow from the defect into the bile ducts permitting time for the leak to heal. Percutaneous transhepatic biliary drainage therefore may avoid further surgery or serve as a bridging therapy while stabilizing the patient’s condition prior to surgery. Transhepatic biliary drainage should be considered in prolonged high-output fistulae associated with fluid and electrolyte derangements, especially with a significant anastomotic disruption. In the clinical scenario of non-dilated biliary ducts, percutaneous transhepatic biliary drainage can be challenging, but several reports have demonstrated feasibility of the procedure with good technical success, and rates comparable to percutaneous transhepatic biliary drainage in patients with dilated bile ducts. The average time from percutaneous transhepatic biliary drainage placement to resolution of bile leak varies from 9–150 days.
Normal and Abnormal Development of the Biliary Tree
Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso in The Pathophysiology of Biliary Epithelia, 2020
It is worth considering first the anatomy of the mature biliary tree. The extrahepatic biliary tract consists of the common bile duct, cystic duct and gallbladder, and the common hepatic duct. Approximately 60% to 70% of the time, the common hepatic duct bifurcates into the right and left hepatic ducts before entering the liver.5 The predominant anatomic variation is absence of the right hepatic duct. Instead, posterior and anterior branches of bile ducts supplying the right portion of the liver arise from a hilar confluence with the left hepatic bile duct. This occurs in the form of a three-way branch point with the left hepatic bile duct, or variations of two-way confluences of the anterior or posterior branches with the left hepatic duct.5 Finally, while the common hepatic duct and its branches lie ventral to the portal vein system, the right posterior bile duct may wrap in an inferior/ventral or a superior/dorsal fashion around the right portal vein. This last variation must be kept in mind when performing surgery in the region of the liver hilum, so as to avoid transecting the portal vasculature.
Enterocytozoon
Dongyou Liu in Handbook of Foodborne Diseases, 2018
Intestinal involvement is the most common presentation of E. bieneusi with diarrhea as the predominant feature. The spectrum of clinical features varies from overtly asymptomatic to those with severe wasting, and this is governed by the host's immune status. AIDS patients with a CD4+ T-cell count of less than 50/μL experience persistent diarrhea, abdominal pain, and weight loss. HIV-seropositive patients on HAART and HIV-seronegative patients may develop a mild form of diarrhea that subsequently resolves on its own.63,64 Organ transplant recipients on immunosuppressive therapy may present with fatigue, fever, nausea, and chronic diarrhea.54 Children from low socioeconomic countries also suffer from long-duration diarrhea due to relative immune compromise resulting from malnutrition.65 In a majority of cases, E. bieneusi infection remains localized to the small intestine of man, but on rare occasions, extraintestinal spread has also been documented. The biliary tract may get infected leading to cholangitis or acalculous cholecystitis.66 Reports of unusual E. bieneusi infection in the respiratory epithelium4,67 and hepatocytes68 are available in the literature. Nonetheless, such non-small-intestinal infection is rather uncommon, and the mechanism of spread is unknown.
Incidence and outcomes in patients with acute cholangitis: a population-based study
Published in Scandinavian Journal of Gastroenterology, 2023
H. F. Fridgeirsson, M. Konradsson, E. Vesteinsdottir, E. S. Bjornsson
The number of ERCPs performed in our Institution increased considerably during the study period. Although there was an increase in the population of Iceland, it is not enough to explain increase the number of patients undergoing ERCP. There are several other potential explanations. (1) It is conceivable that MRCP might have been utilized more frequently in the latter part of study period, sometimes identifying small gallstones, not always identified by ERCP and considered to have passed spontaneously. (2) The operational code for ERCP is only registered if the biliary tract was intubated and it is conceivable that successful ERCPs have increased, and PTC have decreased. (3) Previously, large impacted gallstones in the biliary tract were removed surgically but nowadays the technique has improved and ERCP is more often used than surgery. (4) Other indications have increased such as papillectomy in patients with papillary adenoma and also ERCP. (5) Spyglass technique has been introduced and unclear biliary strictures are investigated. (6) Other ERCP indications such as chronic pancreatitis have increased, if there is a pancreatic leakage and for biliary tract leakage after cholecystectomy and/or liver surgery. Our aims were not to study all these factors which we think are beyond the scope of the study.
Giant skull base mass need not be a tumor – a rare presentation of IgG4-related disease
Published in British Journal of Neurosurgery, 2021
Sushanta K Sahoo, Kavindra Singh, Debajyoti Chatterjee, Chirag Kamal Ahuja, Pinaki Dutta, Sivashanmugam Dhandapani
Intracranial masses often present with a significant neurological burden, necessitating aggressive resection.11,12 These may occasionally turn out to be pathologies not needing much resection. ‘IgG4-related’ disease is a multisystem disorder that commonly affects the pancreas, liver, kidney, respiratory tract, salivary glands, heart, prostate, and orbit. Most patients have multiple organ dysfunction with predominantly biliary tract involvement. Neurological manifestation is less common and reported in up to 4% of cases.13 Predominant central nervous system involvement is unusual. Focal hypertrophic pachymeningitis and hypophysitis are the common neurological manifestation of IgG4-related disease. These patients may present with visual disturbances, diplopia, multiple cranial nerve involvement, and motor deficit. Hypophysitis patients may present with panhypopituitarism.6,9 Usually, they do not invade the brain parenchyma, although adjacent parenchymal edema may be seen. Patients with orbit involvement may present with lid swelling or proptosis secondary to the retro-orbital mass lesion.4,13
The effect of cholecystectomy on the risk of acute myocardial infarction in patients with gallbladder stones
Published in Postgraduate Medicine, 2021
Chien-Hua Chen, Cheng-Li Lin, Chia-Hung Kao
Gallbladder stones (GBS) account for the most common disease of outpatient visits in gastrointestinal department globally, and it has been reported that about 85% of the patients with biliary tract stones harbor gallbladder stones (GBS) [6]. Moreover, the epidemiological studies have reported that prevalence of GBS for adult Taiwanese ranges between 5% and 10% [7,8]. Prophylactic cholecystectomy is not clinically indicated since approximately 80% of patients with GBS will remain asymptomatic in their lifetimes and only 1.5% of patients with symptomatic GBS will develop biliary complications, such as cholecystitis, cholangitis, and pancreatitis [9,10]. In addition to biliary complications, GBS has been reportedly related to the development of CAD through the pathogenesis of shared risk factors, common pathophysiology of cholesterol accumulation, dysbiosis with the resultants of lithogenic bile acid secretion and vascular inflammation, or the oxidative stress imposed by GBS [11,12]. However, debate remains to determine whether GBS is a causal factor or an epiphenomenon of CAD [13].