BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present ...BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present a case of hepatic duct diverticulum,one of the variations,and discuss its diagnosis and treatment. METHODS:A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting.She was finally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT:The patient underwent resection of the hepatic duct diverticulum and cholecystectomy,and was asymptomatic 26 months after surgery. CONCLUSIONS:Hepatic duct diverticulum is a rare form of choledochal cyst,not included in Todani’s classification. Todani’s classification including this and other uncommon variations of choledochal cysts must be reviewed.The best diagnostic imaging methods and treatment for choledochal cysts must be defined.展开更多
Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair p...Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair plus drainage with supporting tube. In 7 cases, there were combined injuries of 2 or more than 2 organs. The combined injuries were respectively treated. Long-term complication of bile duct stenosis was managed with internal drainage. Results Five cases were found during operation. Of these 5 patients, 3 were with the traumatic split less than 50% diameter and 2 with that more than 50% diameter. After repair,1 of the former 3 died and 2 remained in good condition. However, 1 of the latter 2 died and 1 was reoperated on due to bile duct stricture after the repair. Other 3 cases were found due to postoperative bile leakage. They were treated with internal drainage and good results achieved. Conclusion It is difficult to make a definite diagnosis of traumatic injury of hepatic protal bile展开更多
Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 ...Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion.展开更多
BACKGROUND: Inflammatory pseudotumor of the biliary tract is a benign disease, and is extremely rare. Its diagnosis often depends on pathological examination after operation. The histopathological examination shows in...BACKGROUND: Inflammatory pseudotumor of the biliary tract is a benign disease, and is extremely rare. Its diagnosis often depends on pathological examination after operation. The histopathological examination shows inflammatory lesions with a polymorphous infiltration and variable amounts of fibrous tissue. This study was undertaken to elucidate that an inflammatory pseudotumor in the right hepatic duct is especially difficult to distinguish from hilar cholangiocarcinoma. METHOD: The clinical data of one patient with inflammatory pseudotumor of the right hepatic duct were analyzed. RESULTS: An occupying lesion of the right hepatic duct was revealed by abdominal ultrasound and magnetic resonance cholangiopancreatography. The right hepatic duct inflammatory pseudotumor was not identified during the operation but was confirmed by postoperative histopathological analysis. The patient recovered well without any serious complication. CONCLUSIONS: The preoperative evaluation for optimizing surgical management is important to the diagnosis of hepatobiliary occupying lesions. The evaluation involves clinical manifestations, imaging appearance and tumor markers. Malignant tumors and possible benign lesions should be considered to avoid aggressive surgical treatment. (Hepatobiliary Pancreat Dis Int 2010; 9: 219-221)展开更多
文摘BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present a case of hepatic duct diverticulum,one of the variations,and discuss its diagnosis and treatment. METHODS:A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting.She was finally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT:The patient underwent resection of the hepatic duct diverticulum and cholecystectomy,and was asymptomatic 26 months after surgery. CONCLUSIONS:Hepatic duct diverticulum is a rare form of choledochal cyst,not included in Todani’s classification. Todani’s classification including this and other uncommon variations of choledochal cysts must be reviewed.The best diagnostic imaging methods and treatment for choledochal cysts must be defined.
文摘Objective To investigate the diagnosis and treatment of trauma of hepatic portal bile duct. Methods Eight cases of trauma of the hepatic portal bile duct were reviewed. All short-term splits were treated with repair plus drainage with supporting tube. In 7 cases, there were combined injuries of 2 or more than 2 organs. The combined injuries were respectively treated. Long-term complication of bile duct stenosis was managed with internal drainage. Results Five cases were found during operation. Of these 5 patients, 3 were with the traumatic split less than 50% diameter and 2 with that more than 50% diameter. After repair,1 of the former 3 died and 2 remained in good condition. However, 1 of the latter 2 died and 1 was reoperated on due to bile duct stricture after the repair. Other 3 cases were found due to postoperative bile leakage. They were treated with internal drainage and good results achieved. Conclusion It is difficult to make a definite diagnosis of traumatic injury of hepatic protal bile
文摘Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion.
文摘BACKGROUND: Inflammatory pseudotumor of the biliary tract is a benign disease, and is extremely rare. Its diagnosis often depends on pathological examination after operation. The histopathological examination shows inflammatory lesions with a polymorphous infiltration and variable amounts of fibrous tissue. This study was undertaken to elucidate that an inflammatory pseudotumor in the right hepatic duct is especially difficult to distinguish from hilar cholangiocarcinoma. METHOD: The clinical data of one patient with inflammatory pseudotumor of the right hepatic duct were analyzed. RESULTS: An occupying lesion of the right hepatic duct was revealed by abdominal ultrasound and magnetic resonance cholangiopancreatography. The right hepatic duct inflammatory pseudotumor was not identified during the operation but was confirmed by postoperative histopathological analysis. The patient recovered well without any serious complication. CONCLUSIONS: The preoperative evaluation for optimizing surgical management is important to the diagnosis of hepatobiliary occupying lesions. The evaluation involves clinical manifestations, imaging appearance and tumor markers. Malignant tumors and possible benign lesions should be considered to avoid aggressive surgical treatment. (Hepatobiliary Pancreat Dis Int 2010; 9: 219-221)
