Successful treatment of hepatic artery aneurysm with erosion into the common duct.
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A patient with an hepatic artery aneurysm is presented with preoperative angiographs, and intra-operative photographs demonstrating erosion and fistulazation into the common duct. The aneurysm was ligated and excised, and the erosion of the common duct was treated successfully with a Roux-en-Y choledochoduodenstomy. This is the fourth case with erosion into the common duct to be treated successfully by surgery. The other three cases are discussed. A review of the literature reveals that hepatic artery aneurysms are rare, and successful treatment is based on several different techniques. Ligation of the hepatic artery, with or without excision of the aneurysm, is discussed as a method that may in fact be the safest treatment in a group of patients who because of their disease are already in a high risk category. (+info)
A case report of disseminated recurrence of inferior bile duct carcinoma in PTCD fistula.
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We report a case of disseminated recurrence of inferior bile duct carcinoma growing in the fistula where the percutaneous transhepatic cholangiodrainage (PTCD) catheter was instituted. The recurrent tumor seemed to be implanted by dissemination of the original tumor during the first surgery. We could successfully remove this recurring tumor with lateral segmentectomy of the liver plus peritoneal dissection. This patient had been followed after the first surgery (pancreaticoduodenectomy) for inferior bile duct carcinoma causing obstructive jaundice. CEA and CA19-9 raised and CT scan confirmed the recurrent tumor in the lateral segment of the liver. This patient has been in good condition for 2 years following the second surgery. (+info)
Successful treatment of postoperative external biliary fistula by selective nasobiliary drainage.
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A 25-year old man presented with a high output external biliary fistula after an operation for a giant hydatid cyst of the liver. Endoscopic sphincterotomy was inadequate to close the fistula. A nasobiliary tube was selectively inserted into the leaking hepatic duct and bile was continuously aspirated. The fistula and the residual cavity healed completely. Details of the patients' management using this alternative technique, are discussed. (+info)
Postoperative bile leakage: endoscopic management.
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Bile leakage is an infrequent but serious complication after biliary tract surgery. This non-randomised single centre study evaluated the endoscopic management of this problem in 55 consecutive cases. Treatment consisted of standard sphincterotomy and, if needed, subsequent stone extraction with or without endoprosthesis placement. The aim of all treatments was to facilitate bile flow into the duodenum. The biliary tract and the site of the leakage were visualised during endoscopic retrograde cholangiopancreatography (ERCP) in 98%. There was distal obstruction in 33--caused by retained gall stones in 15 patients and concomitant strictures in 18. Overall, 48 of 55 patients were treated endoscopically. An excellent outcome (clinical and radiological resolution of the bile leak) was achieved in 43 patients (90%). Five patients (10%) had continuing sepsis from which they died. Postoperative bile leakage can be diagnosed safely and effectively by ERCP and subsequent endoscopic management is successful in most cases. (+info)
Enterohepatic circulation in hamsters with an extracorporeal bile duct.
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The present study describes a novel technique for investigations of the enterohepatic circulation in the hamster with an extracorporeal bile duct that allows long-term bile collection in the free-moving animal. The animals recovered for 7 days after the operation before the external loop was cut and bile was collected over a period of 78 h. Under these optimal conditions, initial bile flow (651 +/- 89 microliters per 100 g.h-1) and the secretion rates of biliary lipids were several-fold higher than reported in an earlier study using the acute fistula hamster. Biliary cholesterol secretion amounted to 369 +/- 32 nmol per 100 g.h-1, phospholipid secretion was 2.6 +/- 0.3 mumol per 100 g.h-1, and total bile acid secretion was 31.9 +/- 2.2 mumol per 100 g.h-1. A clearcut diurnal rhythm was demonstrated for bile flow and all biliary constituents. After 9 h the depletion of the bile acid pool was complete and cholic acid synthesis derepressed 1.4-fold from a basal rate of 818 nmol per 100 g.h-1, whereas the derepression of chenodeoxycholic acid synthesis was even less pronounced. Biliary cholesterol output increased 2.2-fold, but the phospholipid secretion was constant during the full experiment. It may be concluded that the technique of an extracorporeal bile duct in the free-moving animal allows studies of bile secretion under optimal conditions. Most likely the bile secretion rates given above approach the physiological rates in the hamster. (+info)
THE ABSORPTION OF OLEIC ACID IN THE BILE FISTULA RAT.
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A technique is described for collecting thoracic duct lymph in a portable glass saddle from an unrestrained rat. Uniformly labelled oleic acid in various physical states was given to rats with thoracic duct and bile fistulae to study the influence of bile salts on the amount absorbed and on the route of transport and esterification after absorption. It is suggested that in addition to their emulsifying action bile salts may stimulate the esterification of absorbed oleic acid by the intestinal mucosa. (+info)
Thyroid hormone differentially augments biliary sterol secretion in the rat. II. The chronic bile fistula model.
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To further define thyroid hormone effects on bile acid synthesis and biliary lipid secretion, studies were done in chronic bile fistula rats. Euthyroid and methimazole-hypothyroid rats, with and without triiodothyronine (T3) injection, had total bile diversion for timed bile collections. With interrupted enterohepatic circulation, cholesterol absorption is negligible and bile acid secretion equals bile acid synthesis rate. Hypothyroid rats had diminished levels of bile acid synthesis and biliary secretion of cholesterol and phospholipid. Single dose T3 injection produced a 13-fold increase in bile cholesterol secretion and a 3-fold increase in phospholipid secretion, both initiated 12 h after T3. Bile acid synthesis increased by 50%, but the increase did not begin until 24 h after T3. Neither hypothyroidism nor T3 treatment abolished diurnal rhythms of bile acid synthesis and biliary lipid secretion. Inhibition of cholesterol synthesis with lovastatin resulted in a persistent 33% decrease in bile acid synthesis in euthyroid and hypothyroid rats, while bile cholesterol secretion only transiently decreased. Inhibition of cholesterol synthesis did not alter T3-induced bile cholesterol secretion, with a 10-fold increase seen. However, bile acid synthesis was not stimulated by T3 in the presence of lovastatin. We conclude that facilitated bile acid synthesis and biliary cholesterol secretion are early effects of T3 and may account for the hypocholesterolemia of T3. Cholesterol synthesis does not appear to be required for the T3-induced bile cholesterol secretion. (+info)
THE FATE OF 2,4,6-TRI-(3',5'-DI-TERT.-BUTYL-4'-HYDROXYBENZYL)MESITYLENE (IONOX 330) IN THE DOG AND RAT.
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1. Unchanged Ionox 330 is quantitatively eliminated in the faeces of dogs, rats and man after oral administration, and (14)C is absent from the urine and expired gases of rats intubated with [(14)C]Ionox 330. Dogs and rats do not show a sex difference in this pattern of elimination. 2. Quantitative elimination of [(14)C]Ionox 330 and the absence of (14)C in the carcass and viscera of rats 72hr. after dosage show that this substance does not accumulate in the body. 3. No metabolites are formed in consequence of the ingestion of Ionox 330. 4. Rats eliminate three-quarters or more of a dose (285.7mg./kg. body wt.) of Ionox 330 in 24hr. and the remainder during 24-48hr., and dogs eliminate the whole dose (90mg./kg. body wt.) within 48hr. and a variable proportion within 24hr. These rates of elimination are consistent with the passage of unabsorbed material through the alimentary canal. 5. After removal of the alimentary canal, radioactivity is absent from the carcass and remaining viscera of rats 8, 16 and 24hr. after ingestion of [(14)C]Ionox 330, and this strongly suggests the absence of alimentary absorption. 6. The absence of (14)C in the 24hr. bile of animals with biliary fistulae establishes that [(14)C]Ionox 330 is not absorbed from the gastro-intestinal tract. (+info)