1.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
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Aged, 80 and over
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Biliary Fistula/*complications
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Case Report
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Cholelithiasis/*complications
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Common Bile Duct Calculi/*etiology
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Common Bile Duct Diseases/*complications
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Female
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Fistula/*complications
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Human
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Liver Diseases/*complications
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Syndrome
2.Tissue plasminogen activator and plasminogen activator inhibitor-1 in human choledochal bile.
Se Joon LEE ; Jun Sik CHO ; Jun Pyo CHUNG ; Kwan Sik LEE ; Jae Bock CHUNG ; Sang In LEE ; Young Myoung MOON ; Jin Kyung KANG ; Sung Won KWON ; Hoon Sang CHI ; Jong Rak CHOI ; Kyung Soon SONG
Yonsei Medical Journal 2000;41(1):119-122
Fibrinolytic properties have been detected in animal and human gallbladder (GB) bile. Plasminogen activator inhibitor-1 (PAI-1) has been reported in greater concentration in GB stone bile and may be a nucleating factor in the pathogenesis of GB stone formation. It is unknown whether or not human choledochal bile has similar properties, which could have a role in choledocholithiasis. The aims of this study were to determine the presence of fibrinolytic properties of human choledochal bile and to compare those properties among normal, acalculous, and calculous-infected choledochal bile. Tissue plasminogen activator (t-PA) and PAI-1 of choledochal bile were measured by enzyme linked immunosorbent assay in patients with cholangitis due to acalculous bile duct obstructions (n = 9), choledocholithiasis with cholangitis (n = 20), and normal bile (n = 7). The t-PA concentration of choledochal bile was no different among the three groups (acalculous-infected bile, median 4.61 ng/ml, and calculous-infected bile, 4.61 ng/ml, versus normal bile, 7.33 ng/ml). PAI-1 was detected in choledochal bile in significantly greater concentrations in patients with acalculous cholangitis due to bile duct obstructions and choledocholithiasis with cholangitis (acalculous-infected bile, median 0.36 ng/ml, and calculous-infected bile, 0.1 ng/ml, versus normal bile, 0.02 ng/ml, p < 0.05), but the bile concentration of PAI-1 was no different between the acalculous and calculous-infected choledochal bile. Human choledochal bile possesses t-PA and PAI-1. PAI-1 was present in greater concentrations in both acalculous and calculous-infected choledochal bile. Increased levels of PAI-1 may be an epiphenomenon of cholangitis rather than a factor in the pathogenesis of choledocholithiasis.
Aged
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Bile/microbiology
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Bile/chemistry*
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Cholangitis/microbiology
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Cholangitis/metabolism
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Cholangitis/etiology
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Cholangitis/chemically induced
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Cholestasis/metabolism
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Cholestasis/complications
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Common Bile Duct/metabolism*
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Common Bile Duct Calculi/metabolism
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Common Bile Duct Calculi/complications
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Female
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Human
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Male
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Middle Age
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Plasminogen Activator Inhibitor 1/analysis*
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Tissue Plasminogen Activator/analysis*