Percutaneous transhepatic intervention for removal of common bile duct stones is introduced as a secondary choice of treatment in the high-risk patient. Through a percutaneous transhepatic biliary drainage catheter, a Dormia basket was inserted and the stone was entraped. Then the stone was crushed and fragments were passed spontaneously to the duodenum through the Ampulla of Vater. We experienced one case of successful treatment of a common bile duct stone using percutaneous transhepatic insertion of the Dormia basket.
Ampulla of Vater ; Catheters ; Common Bile Duct* ; Drainage ; Duodenum ; Humans

The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature.
Adenocarcinoma ; Adult ; Ampulla of Vater* ; Chemistry ; Choledochal Cyst ; Cholelithiasis ; Common Bile Duct ; Constriction, Pathologic ; Cystic Duct* ; Humans ; Pancreatic Ducts ; Pancreatitis* ; Sphincter of Oddi Dysfunction

Of the various anomalies of the biliary system, a double common bile duct (DCBD) is extremely rare. According to a report by Boyden, the first case of DCBD was reported by Vesalius in 1543, with few additional case reports since 1986. Cancer and Anomalous pancreatobiliary ductal union (APBDU) are the two of the most serious concomitant conditions. A 69-year-old female was admitted to our hospital with the complaint of jaundice. An abdominal computed tomography and percutaneous transhepatic cholangiography revealed a mass lesion at the distal common bile duct. The patient underwent Whipple's operation, and the operative finding showed a septum in the common bile duct, with a DCBD opening as a single duct into the ampulla of Vater. A histological examination showed an adenocarcinoma in the ampulla of Vater. Herein, a case of the ampulla of Vater cancer in a patient with a double common bile duct is reported, with a review of the literature.
Adenocarcinoma ; Aged ; Ampulla of Vater* ; Biliary Tract ; Cholangiography ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Female ; Humans ; Jaundice

Ampulla of Vater (AoV) is a small dilated duct less than 1.5 cm long, formed by the union of pancreatic duct and common bile duct. AoV has also anatomic layer of mucosa, sphincter of Oddi, perisphincteric or duodenal submucosa, and duodenal proper muscle, which corresponds to mucosa, muscularis mucosa, submucosa, and proper muscle layer of other gastrointestinal tract organs, respectively. Because of its small compact size and variation of anatomic structure, it is sometimes difficult to identify layering architecture of AoV. This anatomic difficulty may cause some problem in T classification of ampullary carcinoma (AC). The most confusing point in T classification is the vague definition of T2, "Tumor invades duodenal wall". It seems that duodenal wall includes duodenal mucosa, submucosa, and proper muscle layer. However there is no precise description or definition about duodenal wall that might lead personal variation in T classification of AC staging. We found that clinical course of AC with perisphincteric and/or duodenal submucosal invasion is more close to AC with T2 than T1. Although it is described as T1b according to T classification scheme of ordinary gastrointestinal tract cancer, we thought AC with T1b may have more high-grade malignant potential than those of other gastrointestinal (GI) tract malignancy. AC showed various clinicopatholgic findings that represent heterogeneous tumor groups within category of AC. Recently site-specific classification of AC was introduced, and it showed relatively well-categorized clinical prognosis. It may be reasonable to understand site-specific tumorigenesis in AC. The standard gross protocol is needed to evaluate pathologic T classification of AC. In conclusion, ampullary neoplasm is composed of various subtypes, which require a separate approach according to anatomic epicenter of ampullary neoplasm. Although submucosal invasion in AC was classified into pT1b, its' biologic behavior is more close to pT2.
Ampulla of Vater ; Carcinogenesis ; Classification ; Common Bile Duct ; Duodenum ; Gastrointestinal Neoplasms ; Gastrointestinal Tract ; Humans ; Mucous Membrane ; Neoplasm Staging ; Pancreatic Ducts ; Prognosis ; Sphincter of Oddi

Pneumobilia almost always indicates an abnormal communication between the biliary and gastrointestinal systems. Air may occasionally enter the biliary tract in a retrograde fashion through the papilla. Transient incompetence of the sphincter of Oddi, which is produced by the passage of small biliary stones, is one rare mechanism that can explain pneumobilia. We present here a case of spontaneous pneumobilia after sphincter disruption that was presumably caused by the passage of biliary stone. A 37-year-old woman visited our hospital with the symptom of right upper quadrant pain. The pain subsided after she had an episode of severe vomiting. Plain abdominal radiography revealed that air filled the branches of the hepatic ducts, and the common bile duct had a large filling defect. We also include a review of the related literature.
Adult ; Biliary Tract ; Common Bile Duct ; Female ; Hepatic Duct, Common ; Humans ; Radiography, Abdominal ; Sphincter of Oddi ; Vomiting

Phytobezoar is a rare cause of gastro-intestinal tract obstruction. Common sites of phytobezoar are the stomach and small bowel. Naturally, extrahepatic duct phytobezoar is near impossible due to anatomical structure and location such as ampulla of vater, common bile duct and bifurcation of bile duct. Here, we present an extremely rare case of extrahepatic duct phytobezoar that resulted in abdominal pain. We successfully treated the case with extraoperative transenteral endoscopic removal of phytobezoar. For its great rarity and particular treatment approach, we report this case with review of literature.
Abdominal Pain ; Ampulla of Vater ; Bile Ducts ; Common Bile Duct ; Endoscopy* ; Stomach

If manometric profiles of sphincter of Oddi(SO) measured from the pancreatic duct and the bild duct are essentially equal, then measurement of manometric profiles from only one duct would be adequate in evaluating SO dysfunction. We report a series of 9 patients whom we evaluate with SO manometry. Cannulation of both the biliary sphincter segment and pancreatic sphincter segment was archived consecutively in one session and we compared the manometric parameters of choledochal sphincter from those of pancreatic sphincter. 1) In 7 out of 9 patients(78%), normal manometric finding of SO were seen in both choledochal and pancreatic sphincters. However, in 2 out of 9 cases(22%) abnormal manometric findings were noted in only one sphincter segment. Elevation of basal pressure(n = l) and increased retrograde propagation(n = 1) were found in the pancreatic sphincter segment alone. 2) Tbe mean intraductal pressure in the pancreatic duct was significantly greater(12.6+/- 5.8mmHg) than that of common bile duct(3.8+/- 3.3mmHg)(p<0.01). However, basal pressure, amplitude, frequency and propagation sequence in the phasic contraction of SO were not different significantly between choledochal and pancreatic sphincter segment. In conclusion, SO manometry of both the pancreatic and bile duct is needed if complete manometric information is desired. Selective cannulation of common bile duct and pancreatic duct during SO manometry is necessary in order to diagnose segmental 50 dysfunction.
Bile ; Bile Ducts ; Catheterization ; Common Bile Duct ; Humans ; Manometry ; Pancreatic Ducts ; Sphincter of Oddi

BACKGROUND/AIM: There is little data on whether plastic stents with a larger diameter are patent for longer than small stents in patients with bile duct cancer. The aim of this study was to compare the stent survival between 7-French (Fr) and 10-Fr plastic stents and evaluate the factors affecting stent survival. METHODS: Patients with biliary obstruction due to biliary tract cancer were enrolled at Yonsei University Wonju College of Medicine from January 2010 to October 2014. RESULTS: A total of 215 patients (7-Fr:10-Fr = 89:126 patients) were retrospectively enrolled. The primary tumor sites were common bile duct (n = 111), hilar (n = 45), and ampulla of Vater (n = 59). Rates of stent migration and stent obstruction were not different between the two groups. The median duration of stent survival was 3.3 months in the 7-Fr group and 5.9 months in the 10-Fr group (p = 0.543). The diameter of the stent did not have an effect on stent survival (hazard ratio 1.11, 95% confidence interval 0.71-1.73, p = 0.649). CONCLUSIONS: 7-Fr and 10-Fr stents have similar rates of stent migration and stent obstruction. The stent survival of 7-Fr was not inferior to 10-Fr stents in the management of biliary tract cancer.
Ampulla of Vater ; Bile Duct Neoplasms ; Biliary Tract Neoplasms* ; Biliary Tract* ; Common Bile Duct ; Gangwon-do ; Humans ; Plastics* ; Retrospective Studies ; Stents*

No abstract available.
Common Bile Duct*

No abstract available.
Adenoma* ; Common Bile Duct*