In order to assess the reliability of ultrasonographic criteria of clonorchiasis, a prospective study was performed in 14 patients who were diagnosed as clonorchiasis by ultrasonogram only, using the criteria of peripheral duct dilatation without dilatation of extrah epatic duct. Eleven out of 14 patients were turned out to be clonorchiasis, showing 93% accuracy. Authors in tend to stress these ultrasonographic signs are very well correlated with the CT and E RCP findings and are proved to be highly reliable for clonorchiasis, and thus clonorchiasis could be diagnosed by ultrasonogram only.
Clonorchiasis ; Diagnosis ; Dilatation ; Humans ; Prospective Studies ; Ultrasonography

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intrahepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.
Bile Ducts/parasitology/pathology ; *Cholangiography ; Clonorchiasis/*diagnosis/ultrasonography ; Humans

BACKGROUND/AIMS: Intrahepatic cholangiocarcinoma, which has been defined as a primary adenocarcinoma from the intrahepatic bile ducts distal to the second-order branch of the main hepatic ducts, has a poor prognosis against various treatment modalities. We analyzed the clinical characteristics of intrahepatic cholangiocarcinomas and evaluated the outcomes of surgical treatment. METHODS: Forty five cases of microscopically-proven intrahepatic cholangiocarcinoma during 8 and a half year period from January 1993 to june 2001 were reviewed. RESULTS: They comprised 29 men and 16 women with an average age of 54.3 years (range: 34 to 76 years). The overall incidence of intrahepatic cholangiocarcinoma in association with hepatolithiasis was 4~% and in this sutdy 17 out of 45 cases (37.8%) of intrahepatic cholangiocarcinoma was combined with intrahepatic stones. The incidence of accurate preoperative diagnosis was 56% due to low index of suspicion. The growth pattern of intrahepatic cholangiocarcinoma was mass-forming type in 32 cases, periductal infiltrative type in 9 cases, and intraductal growth type in 4 cases. CONCLUSION: Careful preoperative evaluation using computed tomography, ultrasonography, and angiography and a study of tumor markers for the possibility of a intrahepatic cholangiocarcinoma is necessary in risk groups with hepatolithiasis or clonorchiasis. Hepatric resection should be used in hepatolithiasis patients to improve the chance of survival.
Adenocarcinoma ; Angiography ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma* ; Clonorchiasis ; Diagnosis ; Female ; Hepatic Duct, Common ; Humans ; Incidence ; Male ; Prognosis ; Biomarkers, Tumor ; Ultrasonography

Although ultrasonography replaced many invasive studies in biliary tract diseases, direct cholangiography does still play an important role in the diagnosis and management of choledocholithiasis. Endoscopoic retrograde cholangiography (ERC) is regarded as the best method in evaluation of exact extent of the disease and its frequent complication, cholangitis. Authors analysed 56 cases of choledocolithiasis diagnosed by ERC and compared these with ERC in 18 cases of normal, 22 cases of cholecystitis, 15 cases of clonorchiasis and 9 cases of parenchymal diseases of liver. The results are as follows; 1. ERC findings of choledocholithiasis are filling defects by stoneor stones, dilation of common hepatic as well as common bile ducts and findings of cholangitis. 2. ERC findings of cholangitis are dilatation of larger intrahepatic biliary radicles and acute peripheral tapering, decrease of arborization, increased or right angle branching pattern, straightening and rigidity as well as irregular narrowing of intrahepatic biliary trees. This findings are observed in majority of choledocholithiasis. 3. Over9mm in diameter at intraprancreatic portion of common bile duct was regarded as abnormal, with 95% sensitivity,85% specificity and 91% diagnostic accuracy by decision matrix analysis. 4. In the presence of dilatation of CBD and findings of cholangitis in ERC, one should consider choledocholithiasis in spite of absence of stone defect.
Biliary Tract Diseases ; Cholangiography ; Cholangitis ; Cholecystitis ; Choledocholithiasis ; Clonorchiasis ; Common Bile Duct ; Diagnosis ; Dilatation ; Liver ; Methods ; Sensitivity and Specificity ; Trees ; Ultrasonography

Acalculous cholecystitis is an inflammation of the gallbladder in the absence of gallstones. Diagnosing this condition is often difficult because of the patient's debilitated medical condition and because of the limitation of biliary imaging technique. Nonetheless, its recognition and therapy are critically important, for if left untreated, many patients will die. During 10 years and 6 months from January 1986 to June 1996, 52 patients underwent assessment and treatment for acalculous cholecystitis at the Department of Surgery, Kyungpook National University Hospital. A clinical analysis of those patients was done and the following results were obtained: The incidence rate was 3.5%. The most prevalent age group was the seventh decade (13cases), and the male-to-female ratio was 1.4 : 1. Possible etiologic factors were found in 25 cases (48.1%). These factors were surgery in 5 cases (9.6%), trauma in 5 cases (9.6%), sepsis in 5 cases (9.6%), clonorchiasis in 5 cases (9.6%), and others in 5 cases(9.6%). Neither Ascariasis nor Salmonellosis was found as a predisposing factor in this study.The main cardinal symptoms and physical signs were similar to those of calculous cholecystitis. The sensitivities of diagnostic imaging by ultrasonography and computed tomography were 88.4% and 100%, respectively. Of the 52 patients, 46 cases underwent cholecystectomy, and 6 cases were initially treated by percutaneous transhepatic cholecystostomy. Of these 6 cases, two patients had cholecystostomies during subsequent abdominal operations for other conditions. Two patients had the cholecystostomy tube removed 2 months after an uneventful recovery and have had no further biliary problems. The other two patients died. The operative findings were cholecystitis only in 26 cases (56.5%), cholecystitis with localized peritonitis in 18 cases (39.1%), and cholecystitis with generalized peritonitis in 2 cases (4.3%). Postoperative complications occurred in 16 cases (34.8%), and wound infection was the most common complication (62.5% of all complications).The overall mortality was 9.6%. Conclusively, acalculous cholecystitis had high morbidity and mortality in this study. Once the diagnosis of acalculous cholecystitis is made, the gallbladder should be drained or removed. A decision as to the best approach depends on the specific situation and will require close cooperation between the internist, the surgeon, and the radiologist.
Acalculous Cholecystitis* ; Ascariasis ; Causality ; Cholecystectomy ; Cholecystitis ; Cholecystostomy ; Clonorchiasis ; Diagnosis ; Diagnostic Imaging ; Gallbladder ; Gallstones ; Gyeongsangbuk-do ; Humans ; Incidence ; Inflammation ; Mortality ; Peritonitis ; Postoperative Complications ; Salmonella Infections ; Sepsis ; Ultrasonography ; Wound Infection

No abstract available.
Aged, 80 and over ; Animals ; Anthelmintics/therapeutic use ; Bile Duct Neoplasms/diagnosis/surgery/ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis/*diagnosis/drug therapy/surgery ; Clonorchis sinensis/isolation & purification ; Common Bile Duct/ultrasonography ; Humans ; Male ; Praziquantel/therapeutic use ; Tomography, X-Ray Computed

BACKGROUND: Hepatolithiasis is rarely associated with a cholangiocarcinoma and the etiologic relationship between them has not been proved. Hepatolithiasis is a risk factor for cholangiocarcinoma. Accurate preoperative diagnosis remains low, and the survival outcome is still dismal, despite improvements in imaging studies. METHODS: Eighteen cases of intrahepatic cholangiocarcinomas among the 522 cases undergoing treatments from Jan. 1984 to May 1998 for hepatolithiasis at the Department of Surgery, Kyung Hee University Hospital were reviewed. RESULTS: The patients had a significantly long duration of symptoms, a high incidence of previous biliary surgery, and a lower rate of preoperative diagnosis. The eighteen cases accounted for 3.4% of the hepatolithiasis cases and 8.5% of the cholangiocarcinomas. There were 17 women and 1 man, and the most prevalent age group was in the 5th and the 6th decades. HBsAg was positive in one case who had chronic hepatitis, 3 patients had clonorchiasis, and 2 patients had liver cirrhosis. CEA and CA19-9 were elevated in 42.9% (3/7) and 27.3% (3/11) of the patients. Various imaging studies, including ultrasonography, CT, choangiography, angiography, and ERCP were performed for diagnosis. The malignant lesions could not be detected preoperatively in 9 patients, and the presence of a coexisting malignant tumor was confirmed by frozen section or by permanent tissue pathology. The operative methods were as follows; a lobectomy in 4 patients, a segmentectomy in 4 patients, and a CBD resection for palliation or explo-laparotomy only in 4 patients because of multiple hepatic metastases. During the operation, the exact location of the stones and the gross pathology of the tumor were recorded in each case. The left side was more prevalent than the right. The mean survival was 15 months for resection group and 9 months for non resection group. CONCLUSIONS: The lower survival rates may be attributed to delayed diagnosis, lower diagnostic accuracy, and relatively fewer curative resections in the patients with stone-containing cholangiocarcinomas. Hepatolithiasis is one of the risk factors of a cholangiocarcinoma. During the diagnostic and operative procedures, we should not overlook a cholangiocarcinoma which can coexist with hepatolithiasis, and we should examine tumor markers, the results of imaging studies and tissue examinations, and the operative findings.
Angiography ; Biomarkers, Tumor ; Cholangiocarcinoma* ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchiasis ; Delayed Diagnosis ; Diagnosis ; Female ; Frozen Sections ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Humans ; Incidence ; Liver Cirrhosis ; Mastectomy, Segmental ; Neoplasm Metastasis ; Pathology ; Risk Factors ; Surgical Procedures, Operative ; Survival Rate ; Ultrasonography

Functional dyspepsia is a very common disease and there are two types of dyspepsia. One is functional dyspepsia in the gastrointestinal tract and the other is pancreatobiliary dyspepsia. Biliary dyspepsia is caused by biliary tract disease and can even cause biliary pain. Acalculous biliary pain (ABP) is biliary colic without gallstones, it is caused by functional biliary disorder or structural disorders such as microlithiasis, sludges or parasitic infestation like Clonorchiasis. The endoscopic ultrasonography is helpful tool for differential diagnosis of ABP. Although sphincter of Oddi manometry (SOM) is performed for the confirmative diagnosis of sphincter of Oddi dysfunction (SOD), several non-invasive tests have been studied because of some practical limitations and invasiveness of SOM itself. In fact, the most clinically used easy test to diagnose functional biliary disorder is quantitative hepatobiliary scintigraphy and it can distinguish gallbladder dyskinesia, SOD, or combined type. Initial treatment of functional biliary disorder is adequate dietary control and medication, but if the symptoms worsened or recurred frequently, laparoscopic cholecystectomy could be performed with gallbladder dyskinesia. If SOD is suspected, additional SOM should be considered and endoscopic sphincterotomy (EST) can be done according to the outcome. If the SOM is not available, the patient could be diagnosed by stimulated ultrasound.
Biliary Dyskinesia ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Clonorchiasis ; Colic ; Diagnosis ; Diagnosis, Differential ; Dyspepsia* ; Endosonography ; Gallstones ; Gastrointestinal Tract ; Humans ; Manometry ; Radionuclide Imaging ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic ; Ultrasonography