Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
Cystic Duct ; Hepatic Duct, Common ; Mirizzi Syndrome*

Biliary adenoma is rarely found in the biliary tract, and there are currently few reported cases of tubular adenoma. Biliary adenoma most often occurs on the duodenal ampulla and the next most common site is on the common bile duct. Because the clinical signs, symptoms and the laboratory findings of these lesions may be similar to malignant biliary diseases, it is difficult to differentiate benign biliary adenoma from malignancy. Therefore, the diagnosis of these tumors tends to be delayed and physicians usually make the pathologic confirmation after a surgical operation. We experienced a case of the simultaneous occurrence of tubular adenoma of the common hepatic duct and gallbladder carcinoma, and all this was diagnosed and treated with common hepatic duct resection and a Roux-en-Y hepaticojejunostomy operation. To the best of our knowledge, this is the first report of biliary tubular adenoma accompanied with gallbladder carcinoma arising from tubulovillous adenoma.
Adenoma ; Biliary Tract ; Common Bile Duct ; Gallbladder ; Hepatic Duct, Common

We present two cases of compression of the common hepatic duct by overriding of the right hepatic artery. One case is gall bladder, common hepatic duct stone and one case is right intrahepatic duct stone. We observed the compression of the common hepatic duct caused by overriding of the right hepatic artery in the both cases. The final diagnosis was made at operative fields. These patient were successfully treated by dissection of adhesion, suture, fixation between gall bladder bed and right hepatic artery.
Diagnosis ; Hepatic Artery* ; Hepatic Duct, Common* ; Humans ; Sutures ; Urinary Bladder

A primary carcinoma of the cystic duct is extremely rare, accounting for 2.6% of all biliary carcinomas. However, the prognosis is better than other biliary carcinomas. The median survival is 20.4 months. In Korea, three cases have been reported and there is no case where a pre-operative MRI has been performed. We report a case of a primary carcinoma of the cystic duct with hepatic duct invasion, which presented as a painless right upper quadrant mass, that was diagnosed by MRCP in a pre-operative situation.
Cystic Duct* ; Hepatic Duct, Common* ; Korea ; Magnetic Resonance Imaging ; Prognosis

PURPOSE: To determine the incidence of flow artifact and vascular compression, phenomena that mimic biliary stone disease at magnetic resonance cholangio pancreatography (MRCP). MATERIALS AND METHODS: In 160 patients who underwent MRCP, the prescence and location of flow artifact were determined. The signal intensity of flow artifacts was chassifieded as either higher than renal cortical density (group I), the same as renal cortical density (group II), the same as hepatic density (group III), or the same as vascular density (group IV). Correlation between flow artifact and the largest diameter of the extrahepatic duct (EHD) was statistically evaluated, and the location of vascular compression in the biliary system and causative vessels was also determined. RESULTS: At MRCP, flow artifacts were observed in 81 patients (76.4%). Forty-five (42.5%) were classified as group I, 15 (14.2%) as group II, 18 (17.0%) as group III, and three (2.8%) as group IV. They were located in the common bile duct (78.3%), common hepatic duct (70.0%), or intrahepatic duct (29.2%) or at the cystic duct insertion site (7.5%). In patients in whom a flow artifact was not apparent, the diameter of the EHD was 7.1mm; in those with an artifact, this diameter was 11.3 mm. The mean diameter of the EHD was greater in groups II, III and IV (11.4 mm) than in group I (9.8 mm). Vascular compression was demonstrated in 21 patients (19.8%), occurring in the common hepatic duct in 8.5%, the left intrahepatic duct in 8.5%, the common bile duct in 1.9%, and the right intrahepatic duct in 0.9%. Causative vessels were the right hepatic artery (12.5%), left hepatic artery (5.7%), and branches of the gastroduodenal artery (1.9%). CONCLUSION: As the extrahepatic duct is wide, a flow artifact appears and signal intensity decreases. In particular, flow artifacts with a signal intensity of grade III or IV, occuring in 19.8% of patients, mimicked biliary stones at MRCP. The presence of a flow artifact and vascular compression, which mimic biliary stone, therefore be carefully interpreted.
Arteries ; Artifacts ; Biliary Tract ; Common Bile Duct ; Cystic Duct ; Diagnosis* ; Hepatic Artery ; Hepatic Duct, Common ; Humans ; Incidence

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder. It has been known a cause of cholecystitis. Churchman firtst reported a case of curious deposition of calcium salts within the gallbladder in 1911. The etiology of limy bile is unclear. Recently we experienced a 32-year-old woman who had a limy bile in the gallbladder, right hepatic duct, common hepatic duct with multiple gallbladder stones and common bile duct stone. We report this case with a review of literature.
Adult ; Bile* ; Calcium ; Calcium Carbonate ; Cholecystitis ; Common Bile Duct* ; Female ; Gallbladder* ; Hepatic Duct, Common ; Humans ; Salts

BACKGROUND/AIMS: Brush cytology during ERCP can provide a pathologic diagnosis in malignant biliary obstruction. K-ras and p53 mutations are commonly found in biliary and pancreatic cancers. We evaluated the diagnostic yield of brush cytology and the changes obtained by adding p53 and K-ras staining. METHODS: One hundred and forty patients with biliary obstruction who underwent ERCP with brush cytology during a 7-year period were included. The sensitivity and specificity of brush cytology only and with the addition of p53 and K-ras staining were obtained. RESULTS: Malignant biliary obstruction was confirmed in 119 patients. The sensitivity and specificity of brush cytology were 78.2% and 90.5%, respectively. The sensitivity of cytology was 77.3% at the ampulla-distal common bile duct (CBD), 92.6% at the mid common hepatic duct (CHD), and 94.7% at the proximal CBD-CHD (p<0.05); these values did not differ with the degree or the length of the obstruction. In the 97 patients who received additional p53 and K-ras staining, the sensitivity of cytology plus p53 was 88.2%, cytology plus K-ras was 84.0%, and cytology plus p53 and K-ras was 88.2%. The sensitivity of cytology plus p53 was higher than that of brush cytology only (95% confidence interval: 83.69-92.78 vs 72.65-83.65) but not that of cytology plus K-ras. CONCLUSIONS: Brush cytology for malignant biliary obstruction has a high diagnostic accuracy. Adding p53 staining can further improve the diagnostic yield, whereas K-ras staining does not.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Hepatic Duct, Common ; Humans ; Pancreatic Neoplasms ; Sensitivity and Specificity

For the purpose of the precise diagnosis and proper treatment planning of obstructive jaundice, various techniques to obtain tissues from biliary strictrue sites have been proposed. We performed perutaneous transcatheter biopsies of biliary strictrues with a biotome in six patients with obstructive jaundice. The sites of biliary stricture were distal common bile ducts (n=3), common hepatic duct (n=1), and confluence of both intrahepatic ducts (n=2). Their histologic diagnoses were adenocarcinoma (n=2), chronic choledochitis (n=3), and atypical cell suspicious of malignancy (n=1). False positive or false results were not documented by other means (including laparotomy),when regarding atypical cell suspicious of malignancy as true positive for malignancy. Percutaneous transcatheter biliary biopsy with biotome is easy to perform in conjunction with percutaneous transhepatic biliary drainage procedure, and can be able to obtain specific tissues for correct diagnosis.
Adenocarcinoma ; Biopsy* ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive

For the purpose of the precise diagnosis and proper treatment planning of obstructive jaundice, various techniques to obtain tissues from biliary strictrue sites have been proposed. We performed perutaneous transcatheter biopsies of biliary strictrues with a biotome in six patients with obstructive jaundice. The sites of biliary stricture were distal common bile ducts (n=3), common hepatic duct (n=1), and confluence of both intrahepatic ducts (n=2). Their histologic diagnoses were adenocarcinoma (n=2), chronic choledochitis (n=3), and atypical cell suspicious of malignancy (n=1). False positive or false results were not documented by other means (including laparotomy),when regarding atypical cell suspicious of malignancy as true positive for malignancy. Percutaneous transcatheter biliary biopsy with biotome is easy to perform in conjunction with percutaneous transhepatic biliary drainage procedure, and can be able to obtain specific tissues for correct diagnosis.
Adenocarcinoma ; Biopsy* ; Common Bile Duct ; Constriction, Pathologic ; Diagnosis ; Drainage ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive

Surgical clip migration and subsequent stone formation in the common bile duct is a rare, but well-established complication after laparoscopic cholecystectomy. There are some suggestions about the mechanisms of the migration process, but the details are still unclear. We report here on a case in which common bile duct stones were formed around surgical clips, and other clips were found to have penetrated into the common hepatic duct, which we believe were in the process of migration after laparoscopic cholecystectomy. The patient required a laparotomy to retrieve the bile duct stones due to the distal bile duct stricture, and another laparotomy was necessary to remove the penetrating clips, which were deeply embedded in the bile duct wall. Although a variety of endoscopic and percutaneous interventional procedures are available in this era of modern medical technology, it is sometimes impractical to apply these procedures in such cases as ours, and exploratory laparotomy is sometimes required to correctly treat the patient. This case shows that the metallic surgical clips can penetrate into the intact bile duct wall through serial maceration, and we believe that careful application of clips may be the only way to prevent their migration after laparoscopic cholecystectomy.
Bile Ducts ; Cholecystectomy, Laparoscopic* ; Common Bile Duct ; Constriction, Pathologic ; Hepatic Duct, Common* ; Humans ; Laparotomy ; Surgical Instruments*