Congenital malformations of the gallbladder and cystic duct diagnosed by laparoscopy: high surgical risk.
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Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur. (+info)
Congenital hepatic fibrosis and cystic bile duct formation in Swiss Freiberger horses.
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Congenital hepatic fibrosis with autosomal recessive or dominant inheritance has been described in humans, cats, piglets, and dogs. In horses, only two cases of congenital hepatic fibrosis have been previously reported. This retrospective study of records from the Institute for Animal Pathology, University of Berne, identified 30 foals with liver lesions compatible with congenital hepatic fibrosis. Anamnestic data revealed clinical signs of severe liver injury in most affected animals. Pathologic examination showed severely enlarged, firm livers with thin-walled cysts. Histologically, the livers showed diffuse porto-portal bridging fibrosis with many small, irregularly formed and sometimes cystic bile ducts. All foals belonged to the Swiss Freiberger breed. Pedigree analysis revealed that the diseased animals could be traced back to one stallion. These results strongly suggest that congenital hepatic fibrosis in Swiss Freiberger horses is a recessively inherited autosomal genetic defect. (+info)
The effect of bile acid synthesis on cholesterol secretion into the bile.
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Cholesterol secretion into the bile has been shown to be related to the bile acid secretion rate. It has been suggested that the availability of bile acid micelles controls the entry of cholesterol into the bile. However, previous data could have been interpreted to indicate that bile acid synthesis controls cholesterol secretion into the bile. To discover whether bile acid synthesis has a significant influence on cholesterol secretion, Rhesus monkeys were studied during the period of increasing bile acid secretion and bile acid synthesis, which begins 6-10 hours following interruption of the enterohepatic circulation of bile acids. This is the only condition in which bile acid synthesis and bile acid secretion increase simultaneously. The cholesterol secretion rate fell signficantly during this period, and this effect was enhanced by phenobarbital administration. An increasing cholesterol secretion rate would have been expected if micellar attraction controlled cholesterol secretion under these conditions. Bile acid synthesis appears to have an important influence upon cholesterol secretion into the bile. (+info)
Role of intraoperative cholangiography in detecting rare bile duct anomalies.
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A case of an anomalous extrahepatic biliary system is reported in which the right hepatic duct was found to enter the infundibulum of the gallbladder. In this case, a selective intraoperative cholangiography has prevented a possible major iatrogenic injury. (+info)
Agenesis of the gallbladder and cystic duct.
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Agenesis of the gallbladder and cystic duct is a rare anomaly that is usually asymptomatic. The patient may present symptoms characteristic of cholelithiasis. Its surgical confirmation requires careful dissection of the common bile duct and intraoperative cholangiography or ultrasonography to be performed, to exclude the possibility of an ectopic gallbladder. The authors describe two cases of this unusual affection and comment on its clinical, pathophysiological and diagnostic aspects. (+info)
DIAGNOSTIC PROBLEMS IN BILIARY DUCT LYMPH NODES.
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Lymph nodes in the area of the cystic duct are sometimes included with surgically removed gall bladders for pathological examination. These nodes may show a range of histological changes, including sinus histiocytosis and panhyperplasia with, or without giant cell systems, granuloma and fibrosis. The nature and incidence of these changes were studied with appropriate lymph nodes collected routinely from 80 patients, mainly at necropsy. Awareness of these changes should obviate possible serious error in histological diagnosis. (+info)
Three-dimensional identification of the cystic infundibulum-cystic duct junction: a technique for identification of the cystic duct in laparoscopic cholecystectomy.
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OBJECTIVE: The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i.e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy. METHODS: The CI was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged. RESULTS: Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecystectomy, the technique for prevention of misidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted. CONCLUSIONS: Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI. (+info)
Safety of cystic duct clipping in healthy and cirrhotic livers: a cadaveric study.
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BACKGROUND AND OBJECTIVES: Biliary leakage through the cystic duct stump due to clip dislodgement has been a concern since the advent of the laparoscopic cholecystectomy. The authors proposed a cadaveric model to test the safety of cystic duct clipping in a hypertensive biliary tract in healthy and cirrhotic livers. METHODS: Twenty fresh cadavers were studied (5 cirrhotic, 15 healthy). Open cholecystectomy was performed and the cystic duct clipped with commercially available titanium clips. The distal common bile duct was catheterized to allow infusion of water and pressure measurement. RESULTS: Increased pressure in the bile duct resulted in back diffusion into the liver, preventing reaching high-pressure levels. Only 1 clip was dislodged in this situation, in a cirrhotic liver with a large cystic duct. As a second experiment, the hepatic hilum was clamped to allow higher pressures of the biliary tree (500 mm Hg). In this situation, no clip was dislodged. CONCLUSIONS: We have established the safety of cystic duct clipping in healthy and cirrhotic livers; however, bigger clips or alternative methods to seal the duct may be necessary in larger ducts. (+info)