Central hepatic resection and anastomosis for stricture or carcinoma at the hepatic bifurcation

Ten cases of central hepatic resection for benign and malignant strictures are reported. Reconstruction was by hepaticojejunostomy with placement of a transhepatic silastic stent across the anastomosis. Four patients had carcinomas at the hepatic bifurcation. Four had high biliary stricture and two had intrahepatic stones and strictures. Follow-up ranged from six to 30 months. Two patients died in the postoperative period at two months and 18 months, both with widely patent hepaticojejunostomies. Satisfactory results have been obtained in seven of the eight remaining patients. These seven are symptom-free and without jaundice.

Communication of intrahepatic cavities with bile ducts: demonstration with Tc-99m-diethyl-IDA imaging

Tc-99m-diethyl-IDA imaging demonstrated intrahepatic bile leaks in two patients. The first patient had an intrahepatic abscess associated with a common bile duct stone; he was successfully treated with common duct lithotomy and antibiotics, but without surgical drainage of the intrahepatic abscess. The second patient had bile leakage into an intrahepatic cavitary hematoma after abdominal trauma.

[Spontaneous perforation of the bile duct (author's transl)]

A report is given about the clinical picture, the course and therapy of spontaneous perforation of the bile duct. In adults perforations may be caused by necrotic lesions of the bile duct due to thrombosis of very small vessels supplying the wall. Increase of bile pressure due to various causes then may induce perforation.

Biliary tract dilatation in the nonjaundiced patient

The significance of intra- or extrahepatic biliary distension (or both) in 33 anicteric patients was investigated. The entire biliary tree and pancreas were sonographically evaluated. Correlation with the biochemical profile, cholangiography, endoscopy, and surgery were obtained when available. Fourteen patients had common bile duct stones, nine had partially obstructing masses, four had papillary stenosis, and three had common bile duct strictures. Two postcholecystectomy patients had dilatation without obstruction. Two patients had mild intrahepatic biliary tract distension without other evidence of biliary tract disease. Sonography is a more sensitive indicator of partial obstruction of the biliary tract than the serum bilirubin. If biliary distension exists, further investigation is warranted, unless an obstructing lesion is clearly defined by the sonogram.

[Sonography in the Diagnosis of Intrahepatic Cholangiectasis (author's transl)]

The sonographic pattern of signs associated with cholangiectasis is analysed in 25 patients. The extent of dilatation of the bile ducts correlates with the bilirubin level and the duration of the disease. Discrepancies occur in fibrose processes in the biliary tract region and in localised cholangiectases. Sonography is a basic radiologic examination method if there is any suspicion of obstruction to flow in the biliary tract. Findings obtained via sonography are the starting-point of further examinations.

[So-called cystic stump syndrome]

After outlining and discussing the etiology and pathophysiology of the postcholecystectomy syndrome, the authors describe their own series of 35 cases, therapeutic policies, and results obtained. In the discussion they suggest that the so-called cystic stump syndrome has probably been overplayed, since in the authors' own series of cases there was a high incidence of associated pathology.

[Hepato-biliary sequential scintigraphy for diagnosis of bile-passage after bilio-digestive anastomosis (author's transl)]

37 patients with bilio-digestive anastomosis--18 choledocho- and 19 hepatico-jejunostomies Roux-en-Y--had been followed up for 6--62 months. Hepato-biliary sequential scintigraphy showed in 26 patients both unimpeded bile passage and normal function of the jejunal loop. 6 patients had stenosis in the common bile duct or the anastomotic region with cholangitis and cholostasis. In 5 patients we observed an impaired function of the jejunal loop. Though all of these patients had clinical symptoms only one patient developed cholostasis.