A choledochocele is a benign cyst-like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. Cholangiography is essential to demonstrate a choledochocele. Because choledochoceles are often associated with characteristic structual alterations of the papilla of Vater and the peripapillary area, ERCP is helpful in demonstrating a choledochocele. We present the clinical, endoscopic and radiographic (ERCP) findings in a patient with choledochocele.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Humans

A choledochocele is a benign cyst-like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. Cholangiography is essential to demonstrate a choledochocele. Because choledochoceles are often associated with characteristic structual alterations of the papilla of Vater and the peripapillary area, ERCP is helpful in demonstrating a choledochocele. We present the clinical, endoscopic and radiographic (ERCP) findings in a patient with choledochocele.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Humans

A 41-year-old woman liked farm chemical-free (pesticid-free) vegetables. She was admitted for severe upper abdominal pain. Biliary ascariasis was suspected upon abdominal ultrasonographic examination. ERC (Endoscopic Retrograde Cholangiography) was performed and a linear filling defect was shown in the bile duct. We diagnosed her case as biliary ascariasis. And then, we removed a worm from the bile duct using stone extracer basket forceps. After this, she was given pyrantel pamoate.Abdominal ultrasonographic examination was helpful in diagnostic screening for biliary ascariasis. ERC and basket forceps were useful in removing the parasite.
Biliary ; Ascariasis ; success ; Manufactured aid ; Endoscopic retrograde cholangiography

Endoscopic retrograde cholangiopancreatography(ERCP) procedures are more difficult in patients who have undergone partial gastrectomy with Billroth II anastomosis. Because its altered anatomical relationship. the endoscopist is presented with additional problems: (i) Dfficulties in entering the afferent loop, depending on the surgical techiques used. (ii) The endoscope may be too sort to reach the papillary region unless the loops are suecessfully straightened out. (iii) Difficulties in passing the ligament of Treitz, especially in patients with Braun's anastomosis, (iv) Problems in cannulating the papilla and especially the common bile duct from a reversed position. (v) Problems in carrying out a papillotomy in a correct position. We attempted endoscopic sphincterotomy in 3 opatients previously subjected to gastrectomy with needle knife, and succeeded in 2 of them. In the two patients, successful billary drainage was achieved. And one patients with Billroth II gastrectomy, presented with CBD stone and cholangit, was successfully treated with endoscopic stone retriveial. The patient with a Billroth-II operation may unergo endscopic diagnostic as well as therapeutic procedures with a high rate of success, and can be suitable candidates for ERCP and endoscopic sphincterotomy
Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Drainage ; Endoscopes ; Gastrectomy* ; Gastroenterostomy* ; Humans ; Ligaments ; Needles ; Sphincterotomy, Endoscopic

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction. BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.
Biliary Tract ; Carcinoma, Hepatocellular ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Fatal Outcome ; Fistula* ; Hepatectomy ; Mortality

PURPOSE: In order to reduce the rate of conversion to an open cholecystectomy, and to avoid the retention of bile duct stones, it is important to detect a choledocholithiasis prior to a laparoscopic cholecystectomy. The aim of this study was to compare the diagnostic accuracy of endoscopic ultrasonography (EUS) with endoscopic retrograde cholangiopancreatography (ERCP) in 150 patients who had an intraoperative cholangiography and choledochotomy with a choledocholithiasis performed. METHODS: Between January 2001 and February 2002, 150 patients who underwent an ERCP or EUS performed preoperatively and a cholecystectomy with intraoperative cholangiography or choledochotomy consecutively performed at the Inha University Hospital were reviewed. RESULTS: An ERCP was performed in 119 patients, and an EUS was carried out in 67 patients. Thirty six patients had both performed. The ERCP failed in 17cases (14.3%). The EUS identified the bile duct in all cases. There were five ERCP related complications (3 pancreatitis, 2 cholangitis), but no complications were encountered when using EUS. In 62 patients (41.3%), a choledocholithiasis was found. ERCP had a sensitivity of 89.5%, a specificity of 84.4%, a positive predictive value of 87.8%, and a negative predictive value of 86.4%. EUS showed a sensitivity of 88.9%, a specificity of 84.7%, a positive predictive value of 66.7%, and a negative predictive value of 95.3%. Concordance of ERCP and EUS was obtained in 90% of cases. CONCLUSIONS: EUS appears to be safer, more comfortable, and, as accurate as an ERCP detecting a choledocholithiasis.
Bile Ducts ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Choledocholithiasis* ; Diagnosis* ; Endosonography* ; Humans ; Pancreatitis ; Sensitivity and Specificity

A double gallbladder is a condition that arises during the fetal period due to the abnormal differentiation of presumptive gallbladder cells, which causes two separate gallbladders, each with their own cystic duct. Most cases are diagnosed incidentally during surgery. Detailed preoperative investigations (ultrasound, oral cholecystography, intravenous cholangiography, CT, ERCP and MRCP) are required for an accurate preoperative diagnosis before considering a cholecystectomy to avoid inadvertent damage to the biliary ductal system and to overlook the second gallbladder during surgery. A total cholecystectomy, with removal of both gallbladders, should be the appropriate treatment for a double gallbladder to avoid complications and a reoperation. We report a patient with an accessory gallbladder, originating from right hepatic duct, and also discuss the characeristics of this rare anomaly.
Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystography ; Cystic Duct ; Diagnosis ; Gallbladder* ; Hepatic Duct, Common* ; Humans ; Reoperation

E.S.T. is performed not only for the treatment but also for the diagnosis of biliary tract diseases. E.S.T. serves as a diagnostic aid for some of biliary tract diseases which require such procedures as a peroral cholangioscopy or biopsy of the biliary duct for precise diagnosis and further differential diagnosis. The diseases of our patients were diagnosed by clinical findings and such diagnostic maneuvers as abdominal ultrasonography, intravenous cholangiography, percutaneous transhepatic chorangiography(P.T.C.), endoscopic retrograde chorangiopancreatography(E.R.C.P.), In all the two cases, abdominal ultrasonography revealed dilated extrahepatic duct, but biliary trees were not visualized at E.R.C.P. In one of the two cases, P.T.C. revealed a filling defect with dilated common bile ducts(CBD) but we could not make a differential diagnosis of CBD stone from CBD cancer. In another of the two cases, on which intravenous cholangiography was done, we could not see CBD. For the purpuse of precise diagnosis and further differential diagnosis, we performed EST and then ERCP thraugh widened papillae. With those procedures, CBD stones were shown.
Bile ; Biliary Tract Diseases ; Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Humans ; Ultrasonography

Cystic dilatation of bile duct, so called choledochal cysts are a well documented abnormalities. Although choledochal cyst is a relatively rare disease, the number of reports have been increasing especially in tht Orient. It may be easily overlooked by the conventional diagnostic methods, such as upper gastrointestinal series, intravenous cholangiography and abdominal ultrasonogrsphy. Recent advances on diagnostic methods, such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography had been helpful in demonstrating choledochal cysts. 29 patients with choledochal cysts who had been admitted in Hanyang Universty Hospital between September l981 and August 1991 were reviewed and the clinical endoseopic and rediographic findings were discussed comparing with that from foreign literatures. (continue...)
Bile Ducts ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Dilatation ; Humans ; Rare Diseases

BACKGROUND/AIMS: The aim of this study was to evaluate the diagnostic accuracy of 64-multidetector CT (MDCT) cholangiography for determining the causes of distal common bile duct (CBD) obstruction. METHODS: Two hundred fifty consecutive patients underwent 64-MDCT for diagnosing the clinical and biochemical signs of bile duct obstruction. The causes of bile duct obstruction were assessed by the pre- and post-enhanced axial and coronal multiplanar reformation images of 64-MDCT. The results were compared with ERCP, biopsy and surgery. RESULTS: The sensitivity and specificity of MDCT for CBD stones were 96.1% and 84.9%, respectively. In seven patients, The CBD stones in 7 patients could not be detected on MDCT. Eleven patients with stones in the distal CBD, as detected on MDCT, had no stones seen on ERCP. For malignant obstruction, the sensitivity and specificity of MDCT were 97.0% and 98.6%, respectively. Three patients who were diagnosed with periampullary cancers on MDCT were disclosed to have severe papillitis on ERCP. One patient who was diagnosed with CBD stone by MDCT was disclosed to have ampullary cancer. The overall accuracy of MDCT for determining the causes of biliary obstruction was 90.5%. CONCLUSIONS: MDCT cholangiography is a non-invasive method with relatively high sensitivity and high specificity for diagnosing the causes of distal CBD obstruction.
Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Common Bile Duct ; Humans ; Papilledema ; Sensitivity and Specificity