Ultrasonography in diagnosis of the common bile duct pathology and pathology of the major duodenal papilla, complicated by mechanical jaundice

2021 ◽  
pp. 5-17
Author(s):  
Vladimir Alexandrovich Ivanov ◽  
Roman Nikolaevich Malushenko ◽  
Alexander Evgenievich Denisov ◽  
Elena Nikolaevna Kondrashenko

Mechanical jaundice is a clinical syndrome that develops due to the bile flow impairment along the bile ducts to the duodenum, remains one of the urgent problems of medicine. Of great importance among the causes of mechanical jaundice are diseases of the common bile duct and the major duodenal papilla, the diagnosis of which to this day remains a rather difficult task. The use of MRCP, ERСP, endo-ultrasonography and other highly informative bile tract imaging methods, despite great diagnostic capabilities, is associated with a number of limitations. In this regard, an important place, especially in the primary examination of patients, is occupied by transabdominal ultrasound, the advantages of which are non-invasiveness, portability, accessibility, safety, the possibility of multiple reiteration. A review of the literature presents domestic and foreign data of researchers regarding the possibility of ultrasonography in diagnostics of the common bile duct pathology and the pathology of the major duodenal papilla that are complicated by mechanical jaundice, as well as the greatest difficulties in diagnosing this pathology.

2021 ◽  
Vol 25 (2) ◽  
pp. 48-54
Author(s):  
V. A. Lazarenko ◽  
Y. V. Kanishchev ◽  
P. M. Nazarenko ◽  
D. P. Nazarenko ◽  
T. A. Samgina ◽  
...  

Objective. The radical elimination of extrahepatic biliary tract pathology in choledocholithiasis and acute biliary pancreatitis (ABP) reduces the risk of infection and eliminates the source of endogenous intoxication; so, the search of safe and effective techniques for endoscopic papillosphincterotomy (EPT) is important.Purpose: to assess outcomes of laser-assisted endoscopic papillosphincterotomy.Material and methods. 288 patients with “wedged” (n = 111) and “valve” (n = 177) choledocholithiasis and acute biliary pancreatitis were divided into two groups depending on EPT technique: in the control group, a papillotome with electrocoagulation cord was used (n = 195); in the main group, laser scalpel was used (n = 93).Results. 87 patients with “wedged” choledocholithiasis were treated with EPT and an end electrode on the wedged stone. 16 patients out of them had mild bleeding which was stopped by irrigation with epinephrine solution (1 : 10 000) followed by the targeted coagulation. The average surgical time was 38 ± 16 min. In 24 patients with rigid and edematous medial wall of the duodenum due to acute biliary pancreatitis, the proposed device plus laser technique for papillosphincterotomy were used (patent of the Russian Federation No. 2614891). There was no bleeding, the average surgical time was 24 ± 12 min. In “valve” choledocholithiasis, laparoscopic cholecystectomy (LCE) was performed; calculi from the common bile duct were removed. In 108 patients during LCE, EPT was made via an antegrade catheter. In 69 patients with anatomical and physiological obstacles caused by the major duodenal papilla, we performed LCE and EPT with laser light via an antegrade guide light made of fluoroplastics (patent of the Russian Federation No. 41594). Concrements from the common bile duct were removed with the Dormia basket.Conclusions. Laser light causes less damage, reliably provides hemostasis along the incision line on the anterior wall of the major duodenal papilla; in addition, a wedged calculus in “wedged” choledocholithiasis and a fluoroplastic light guide in “valve” choledocholithiasis reliably protect the posterior wall of the major duodenal papilla from laser light damage. Laser techniques used in EPT make the treatment of choledocholithiasis in patients with ABP having anatomical and physiological problems due to the major duodenal papilla safe and effective.


2016 ◽  
Vol 21 (5) ◽  
pp. 244-249
Author(s):  
Yury S. Vinnik ◽  
E. V Serova ◽  
D. A Chernykh ◽  
A. V Kovalev ◽  
D. V Stratovich ◽  
...  

In the structure of malignant tumors, accompanied by obstructive jaundice, there are most occurred such as the lesion of the pancreas (47%), bile duct cancer (20%) also papillary carcinoma (MDP) and gall bladder cancer (about 15%). In the case of inoperable tumor, in elderly and senile patients with severe concomitant somatic pathology, there are indicated palliative interventions as follows: percutaneous transhepatic external or external-internal drainage of the biliary tract with possible subsequent percutaneous transhepatic stenting of the common bile duct. Under our observation there was a patient of 75 years with verified major duodenal papilla cancer, complicated by obstructive jaundice, to whom as the first step there was performed percutaneous transhepatic external-internal drainage of the biliary tract, and as the second one - percutaneous transhepatic stenting of the common bile duct.


2018 ◽  
Vol Volume 11 ◽  
pp. 2295-2301 ◽  
Author(s):  
Zhong Liu ◽  
Deng-Yong Zhang ◽  
Zheng Lu ◽  
Pei Zhang ◽  
Wan-Liang Sun ◽  
...  

1999 ◽  
Vol 31 (1) ◽  
pp. 156-159 ◽  
Author(s):  
Clemens Dejaco ◽  
Peter Ferenci ◽  
Ewald Schober ◽  
Klaus Kaserer ◽  
Reinhold Függer ◽  
...  

1976 ◽  
Vol 231 (1) ◽  
pp. 40-43 ◽  
Author(s):  
RS Jones

Mongrel dogs were prepared by cholecystectomy, ligation of the lesser pancreatic duct, and insertion of gastric and duodenal cannulas. The common bile duct was cannulated through the duodenal fistula. After bile flow had been stabilized by intravenous infusion of sodium taurocholate the dogs were given an intravenous injection of insulin or 0.9% NaCl (control). Insulin caused marked increases in bile flow, chloride output, and biliary clearance of erythritol and small increases in bicarbonate output and bile salt output. The increased erythritol clearance indicates that canalicular secretion contributes to insulin choleresis in dogs.


2014 ◽  
Vol 53 (23) ◽  
pp. 2679-2682 ◽  
Author(s):  
Tatsuaki Sumiyoshi ◽  
Yasuo Shima ◽  
Takehiro Okabayashi ◽  
Takuhiro Kohsaki ◽  
Atsushi Kigi ◽  
...  

2017 ◽  
Vol 8 (4) ◽  
pp. 132-136
Author(s):  
Anastasios Katsourakis ◽  
Ioannis Dimitriou ◽  
Efthimios Chatzitheoklitos ◽  
Danai Chourmouzi ◽  
George Noussios

1981 ◽  
Vol 62 (5) ◽  
pp. 41-42
Author(s):  
O. S. Kochnev ◽  
V. N. Biryaltsev

Determination of the state of the biliary tract and the terminal part of the common bile duct is one of the most difficult issues of intraoperative diagnosis in complicated cholecystitis. Currently, none of the surgeons doubts the need for intraoperative cholangiography and its value. It is she who allows to identify in many patients the presence of calculi in the biliary tract, to determine the degree of expansion of the common bile duct and bile hypertension, the state of the terminal part of the common bile duct. However, the analysis of radiographs performed during 170 surgical interventions for various degrees of stenosis of the large duodenal papilla showed that even this most reliable method of intraoperative diagnosis has a significant drawback.


2019 ◽  
pp. 26-29
Author(s):  
I. N. Mamontov

Abstract. Aim: to determine the factors influencing on bacteribilia in patients with benign obstruction of the extrahepatic biliary tract (BOEBT). Materials and Methods. A study of 30 cases of BOEBT with bacteriologic bile assessment was performed. A comparison of the incidence of different factors in patients with or without bacteriobilia was done. Results. Positive bile culture was in 22 (73.3%) patients. The most common were E. coli and Klebsiella (68.2%). There was no difference (p<0.05) in sex, age, bilirubin level, gallbladder condition, common bile duct size, major duodenal papilla (MDP) size, common bile duct stones, sludge, Mirizzi syndrome, impacted stone in MDP. Significant differences were found in number of common bile duct stones: 1-2 stones (p<0,001) and multiple stones (p<0,05). Conclusions. Risk factors for bacteriobilia is 1-2 stones in the common bile duct (p<0,001). Multiple stones (≥3) are not associated with bacteriobilia (p<0,05).


Sign in / Sign up

Export Citation Format

Share Document