1.Spontaneous Resolution of Vanishing Bile Duct Syndrome in Hodgkin's Lymphoma.
Woo Sik HAN ; Eun Suk JUNG ; Youn Ho KIM ; Chung Ho KIM ; Sung Chul PARK ; Ji Yeon LEE ; Yun Jung CHANG ; Jong Eun YEON ; Kwan Soo BYUN ; Chang Hong LEE
The Korean Journal of Hepatology 2005;11(2):164-168
Cholestasis in a patient with Hodgkin's disease is uncommon, and the causes of cholestasis are mainly direct tumor involvement of the liver, hepatotoxic effects of drugs, viral hepatitis, sepsis and opportunistic infections. Vanishing bile duct syndrome (VBDS) represents a very rare cause for cholestasis in this disease. We report here on a case of a 45-year-old man who developed VBDS during the complete remission stage of Hodgkin's lymphoma. There was no history of hepatitis or intravenous drug abuse, and the patient had negative results for hepatitis A virus, hepatitis B virus, hepatitis C virus, cytomegalovirus, and human immunodeficiency virus. The serological studies for antinuclear antibodies, anti-mitochondrial antibodies and anti-smooth muscle antibodies were also negative. Liver biopsy disclosed the absence of interlobular bile ducts in 9 of 10 portal tracts without any active lymphocyte infiltration and there were no Reed-Sternberg cell in the liver. The patient's cholestasis was in remission and the serum bililrubin level was normalized after two months without treatment, but tumor recurrence was noted at multiple sites of the abdominal lymph nodes on follow-up abdomino-pelvic computed tomogram.
Adult
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Bile Duct Diseases/*complications/diagnosis
;
*Bile Ducts, Intrahepatic
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Cholestasis/*complications
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English Abstract
;
Hodgkin Disease/*complications
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Humans
;
Male
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Remission, Spontaneous
2.Obstructive jaundice due to compression of the common hepatic duct by right hepatic artery: a case associated with the absence of the lateral segment of the left hepatic lobe.
Jun Pyo CHUNG ; Ki Whang KIM ; Hoon Sang CHI ; Sang In LEE ; Eun Tack SHIN ; Jae Hwa CHO ; Hong Woo LEE ; Jin Kyung KANG ; In Suh PARK
Yonsei Medical Journal 1994;35(2):231-238
Various benign and malignant conditions can cause biliary obstruction. We present a rare case of obstructive jaundice due to the compression of the common hepatic duct by the anteriorly overriding right hepatic artery. This case was also associated with the absence of the lateral segment of the left hepatic lobe. The patient was a 39 year-old housewife with a 4-day history of jaundice and occasional febrile sensation. An abdominal computed tomography showed absence of the lateral segment of the left hepatic lobe and a percutaneous transhepatic cholangiography showed a band-like filling defect of 2 mm width at the level of the upper common hepatic duct. The anteriorly overriding right hepatic artery compressing the common hepatic duct and the absence of the lateral segment of the left hepatic lobe were confirmed by operation.
Adult
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Bile Duct Diseases/complications
;
Case Report
;
Cholestasis/*etiology
;
Female
;
*Hepatic Artery
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*Hepatic Duct, Common
;
Human
;
Liver/*abnormalities
3.A Case of Duodenal Diverticulum Accompanied with Choledochoduodenal and Pancreaticoduodenal Fistulas.
Sang Ik WHANG ; Jin Bae KIM ; Hae Ri LEE ; Il Hyun BAEK ; Yun Jung CHANG ; Sung Won JUNG ; Myung Seok LEE
The Korean Journal of Gastroenterology 2006;47(5):386-388
Choledochoduodenal fistula (CDF) occurring simultaneously with pancreaticoduodenal fistula is extremely rare. CDF has known to be a chronic sequela of cholelithiasis, but it is unknown whether pancreaticoduodenal fistula results from chronic cholelithiasis as well. We report a case of cholelithiasis accompanied with choledochoduodenal and pancreaticoduodenal fistula opening into small suprapapillary diverticulum in a 80-year-old woman.
Aged, 80 and over
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Biliary Fistula/*complications
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Cholelithiasis/complications
;
Common Bile Duct Diseases/*complications
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Diverticulum/*complications
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Duodenal Diseases/*complications
;
Female
;
Humans
;
Intestinal Fistula/*complications
;
Pancreatic Fistula/*complications
4.Histochemical and ultrastructure study of bile cast in liver transplantation patients.
Qing-chuan ZHAO ; Ke-feng DOU ; Yong HE ; Hong-lin DONG ; Jia-ze AN ; Ya-lin KONG ; Peng ZHANG
Chinese Journal of Surgery 2006;44(5):306-309
OBJECTIVETo investigate the histological components and solubility of the bile-cast, and to study the pathological course of bile cast formation.
METHODSHE staining, bilirubin staining (Gmelin reaction), Masson's staining, alcian blue staining and fibrin staining (weigert's) were performed on the formalin-fixed paraffin-embedded section of the bile cast. Ultrastructure was examined under the scanning electron microscope. Solubility test was also conducted using chymotrypsin, heparin, trypsin solution, HCl and NaOH solution to dissolve the bile-cast.
RESULTSThe major components of the bile-cast were bilirubin crystals and collagen fibers. Between the mass of collagen fibers there was certain blood vessel structure. Necrosis bile duct structure was not found in the cast. Under the scanning electron microscope, four kinds of crystal morphologies were viewed. There were some mucoid mass and necrosis defluvium epithelial cells in the bile cast. Solubility test showed that the bile cast could be partial dissolved in NaOH solution (pH = 12.5). No dissolution was found in HCl solution (pH = 5.0), chymotrypsin solution, heparin and trypsin solution.
CONCLUSIONSCollagen fibers work as framework in the bile cast with bilirubin crystal filling between the framework. The emergence of fibroblast and blood vessels indicated the formation of bile cast might be the course of exudation and organization due to bile duct epithelium damage. Bile cast could be partially dissolved in alkaline solution, but could not be dissolved in acid solution, or in chymotrypsin, heparin and trypsin solutions.
Bile Duct Diseases ; etiology ; pathology ; Bile Ducts ; ultrastructure ; Humans ; Immunohistochemistry ; Liver Transplantation ; adverse effects ; Microscopy ; Postoperative Complications ; Staining and Labeling
5.A large common bile duct stone migrated from the gallbladder through a cholecystohepaticodochal fistula: an unusual complication of Mirizzi syndrome type II.
Jun Pyo CHUNG ; Hyeon Geun CHO ; Chae Yoon CHON ; Hyo Jin PARK ; Kwan Sik LEE ; Jin Kyung KANG ; In Suh PARK ; Ki Whang KIM
Yonsei Medical Journal 1995;36(2):206-213
Mirizzi syndrome with a biliobiliary fistula (Mirizzi syndrome type II) is a rare complication of a long-standing gallbladder stone disease. It is even rarer for a gallbladder stone to migrate through a biliobiliary fistula into the common duct. We encountered this interesting complication of Mirizzi syndrome type II in an 86 year-old female patient. A large gallbladder stone migrated into, and impacted into the distal common bile duct through a cholecystohepaticodochal fistula. The stone was resistant to mechanical lithotripsy and was treated with biliary endoprosthesis and oral bile acids.
Aged
;
Aged, 80 and over
;
Biliary Fistula/*complications
;
Case Report
;
Cholelithiasis/*complications
;
Common Bile Duct Calculi/*etiology
;
Common Bile Duct Diseases/*complications
;
Female
;
Fistula/*complications
;
Human
;
Liver Diseases/*complications
;
Syndrome
6.A Case of Infected Biloma due to Spontaneous Intrahepatic Biliary Rupture.
Joong Hyun LEE ; Jeong Ill SUH
The Korean Journal of Internal Medicine 2007;22(3):220-224
A "biloma" is a loculated collection of bile located outside of the biliary tree. It can be caused by traumatic, iatrogenic or spontaneous rupture of the biliary tree. Prior reports have documented an association of biloma with abdominal trauma, surgery and other primary causes, but spontaneous bile leakage has rarely been reported. A spontaneous infected biloma, without any underlying disease, is a very rare finding. We recently diagnosed a spontaneous infected biloma by abdominal computed tomography and sonographically guided percutaneous aspiration. The patient was successfully managed with percutaneous drainage and intravenous antibiotics. We report here a case of infected biloma caused by spontaneous rupture of the intrahepatic duct, and review the relevant medical literature.
Aged
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*Bile
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Bile Duct Diseases/*diagnosis/microbiology/*therapy
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Bile Ducts, Intrahepatic/*radiography
;
Cholangiography
;
Drainage
;
Escherichia coli Infections/*complications
;
Female
;
Humans
;
Rupture, Spontaneous
;
Tomography, X-Ray Computed
7.Radiologic findings of Mirizzi syndrome with emphasis on MRI.
Byoung Wook CHOI ; Myeong Jin KIM ; Jae Joon CHUNG ; Jae Bok CHUNG ; Hyung Sik YOO ; Jong Tae LEE
Yonsei Medical Journal 2000;41(1):144-146
We have reported a case of Mirizzi syndrome preoperatively diagnosed using MR cholangiopancreatography. MRCP and T2-weighted image using a single-shot fast spin-echo sequence accurately depicted all components of Mirizzi syndrome, including impacted stone in the neck of the gallbladder compressing the common hepatic duct and wall-thickening of the gallbladder without any evidence of malignancy. The combination of MRCP and T2-weighted image can be counted on to replace conventional modalities of diagnosing Mirizzi syndrome without any loss of diagnostic accuracy.
Bile Duct Diseases/etiology*
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Bile Duct Diseases/diagnosis
;
Case Report
;
Cholangiopancreatography, Endoscopic Retrograde
;
Cholelithiasis/diagnosis
;
Cholelithiasis/complications*
;
Constriction, Pathologic/etiology
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Gallbladder/pathology
;
Hepatic Duct, Common*
;
Human
;
Magnetic Resonance Imaging*
;
Male
;
Middle Age
;
Syndrome
9.A Case of Spontaneous Perforation of the Common Bile Duct Associated with Cholangitis.
Byoung Kwan YOO ; Jong Hyeok KIM ; Hong Ju MOON ; Won Seok CHEON ; Ji Youn YOO ; Jong Pyo KIM ; Kyoung Oh KIM ; Cheol Hee PARK ; Tae Ho HAHN ; Kyo Sang YOO ; Sang Hoon PARK ; In Jae LEE ; Choong Kee PARK
The Korean Journal of Gastroenterology 2005;45(5):361-364
Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.
Aged, 80 and over
;
Cholangiopancreatography, Endoscopic Retrograde
;
Cholangitis/*complications
;
Choledocholithiasis
;
Common Bile Duct Diseases/*etiology
;
Female
;
Humans
;
Rupture, Spontaneous
10.Experimental study of relationship of bile composition imbalance with bile duct injury.
Geng CHEN ; Yu-Jun ZHANG ; Cheng YANG ; Kun LI ; Xiao-Wu LI ; Shu-Guang WANG ; Jia-Hong DONG
Chinese Journal of Surgery 2008;46(3):179-182
OBJECTIVETo investigate the change of bile composition and its role in bile duct injury after orthotopic liver transplantation (OLT).
METHODSRats were randomly divided into 3 groups: group A (sham surgery), group B (OLT with 1 h cold preservation), group C (OLT with 12 h cold preservation). The arterialized rat liver transplantation model with biliary extra-drainage was used in group B and C. Animals were sacrificed at posttransplant 1, 3, 5, 7, 10 and 14 day. Routine bile chemistry and pathological assays were performed.
RESULTSCold preservation/reperfusion injury (CPRI) could repress the secretion of bile salts and phospholipid. However, in contrast with a rapid increase of bile salt secretion, the biliary secretion of phospholipid recovered more slowly, leading to an abnormal high bile salts/phospholipid ratio early after transplantation. Further analysis suggested that the secretion of bile salts correlated strongly with biochemical and histopathological signs of bile duct injury.
CONCLUSIONSCPRI can lead to great changes of graft bile composition, which plays a role in the pathogenesis of bile duct injury following liver transplantation.
Animals ; Bile ; metabolism ; Bile Acids and Salts ; metabolism ; Bile Duct Diseases ; etiology ; Bile Ducts, Intrahepatic ; pathology ; Cold Ischemia ; Disease Models, Animal ; Liver Transplantation ; Male ; Postoperative Complications ; etiology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; complications ; metabolism ; pathology