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Tamura M, Ohta H, Hasegawa N, Hosoya K, Takiguchi M. Case Report: Usefulness of Drip Infusion Cholangiography With Computed Tomography for the Diagnosis of Biloma in a Dog. Front Vet Sci 2022; 9:854042. [PMID: 35321057 PMCID: PMC8936172 DOI: 10.3389/fvets.2022.854042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Bilomas are encapsulated collections of bile outside or inside the biliary tract within the abdominal cavity. For diagnostic and therapeutic approaches, it is important to identify the origin of bile leaks from the biliary tract. This case report describes the usefulness of drip infusion cholangiography with computed tomography (DIC-CT) for detecting the site of bile leakage in a dog with biloma. A 10-year-old, castrated male Pomeranian dog was referred to our department for gastrointestinal signs. Abdominal ultrasonography detected gallbladder mucocele without evidence of defect on the wall and well-defined anechoic localized fluid accumulation around the right division of the liver. On the other hand, there was only a small amount of ascites in the abdominal cavity. The accumulated fluid collected through abdominocentesis had a bilirubin concentration of 11.4 mg/dl, which was more than twice as high as that in serum (0.4 mg/dl), but had absence of pyogenic bacteria. The DIC-CT with meglumine iotroxate showed two well-defined large fluid collections: one between right medial and lateral lobe and the other between the right lateral lobe and caudate process of caudate lobe. Three-dimensional DIC-CT views that the former was enhanced by the contrast agent and that it communicated with an intrahepatic bile duct of the right lateral lobe. Moreover, the DIC-CT images confirmed communication with each fluid collections. After 6 days of hospitalization, a decrease in the amount of accumulated fluid was confirmed, after which cholecystectomy was performed. The dog was discharged from the hospital without complications. No signs of bile leakage were observed on follow-up imaging on postoperative day 10. According to authors knowledge, this has been the first report to show that DIC-CT can be useful for determining the origin of bile leakage in dogs with bilomas.
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Affiliation(s)
- Masahiro Tamura
- Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
- Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Ohta
- Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Nene Hasegawa
- Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
- Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Hosoya
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
| | - Mitsuyoshi Takiguchi
- Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo, Japan
- *Correspondence: Mitsuyoshi Takiguchi
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Acquafresca PA. Minimal invasive treatment of biliary leak after laparoscopic cholecystectomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii180041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Adler DG, Papachristou GI, Taylor LJ, McVay T, Birch M, Francis G, Zabolotsky A, Laique SN, Hayat U, Zhan T, Das R, Slivka A, Rabinovitz M, Munigala S, Siddiqui AA. Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. Gastrointest Endosc 2017; 85:766-772. [PMID: 27569859 DOI: 10.1016/j.gie.2016.08.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/17/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Postsurgical or traumatic bile duct leaks (BDLs) can be safely and effectively managed by endoscopic therapy via ERCP. The early diagnosis of BDL is important because unrecognized leaks can lead to serious adverse events (AEs). Our aim was to evaluate the relationship between timing of endotherapy after BDL and the clinical outcomes, AEs, and long-term results of endoscopic therapy. METHODS We conducted a multicenter, retrospective study on patients with BDLs who underwent ERCP between 2006 and 2014. Data were assembled on patient demographics, etiology of BDL, and procedural details. Endotherapy for BDLs were classified a priori into 3 groups based on timing of ERCP from time of biliary injury: within 1 day of BDL, on day 2 or 3 after BDL, and greater than 3 days after BDL. The relationship among timing of ERCP after BDL injury and outcomes, procedure-related AEs, and patient AEs and mortality were evaluated. RESULTS From February 2006 to June 2014, 518 patients (50% male; mean age, 51.7 years) underwent ERCP for therapy of BDLs. The etiology of the BDL was laparoscopic cholecystectomy (70.7%), post-liver transplantation (11.2%), liver resection (14.1%), trauma (2.5%), and other causes (1.5%). Endotherapy was performed by placing a transpapillary stent alone (73.5%) or with a sphincterotomy (26.5%). The timing of ERCPs was as follows: ≤1 day = 57 patients, day 2 or 3 = 140 patients, and >3 days = 321 patients. There was no statistical difference in patient demographics, etiology/site of BDL, or type of endotherapy performed among the 3 groups. On multivariate analysis there was no statistically significant difference in BDL success rate for ERCPs performed within 1 day compared with those performed on day 2 or 3 or after 3 days of bile duct injury (91.2%, 90%, and 88.5%, respectively; P = .77). Similarly, there was no significant difference in the overall patient AE rate among the 3 groups (21.1%, 22.9%, and 24.6%, respectively; P = .81). AEs in men occurred significantly more frequently when compared with women, even after adjusting for age, BDL etiology, and location of leak (27.6% vs 19.9%; OR, 1.53; P = .04). Patients whose BDL was due to a cholecystectomy had a lower AE and mortality rate compared with those who had biliary injury from other etiologies (OR, .42; P < .001). CONCLUSIONS The overall success rates and AEs after ERCP were not dependent on the timing of the procedure relative to the discovery of the bile leak. This suggests that ERCP in these patients can usually be performed in an elective, rather than an urgent, manner.
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Affiliation(s)
- Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Georgios I Papachristou
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Linda Jo Taylor
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tyler McVay
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madeleine Birch
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Gloria Francis
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew Zabolotsky
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sobia N Laique
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Umar Hayat
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rohit Das
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam Slivka
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mordechai Rabinovitz
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Satish Munigala
- Division of Biostatistics, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
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Nikpour AM, Knebel RJ, Cheng D. Diagnosis and Management of Postoperative Biliary Leaks. Semin Intervent Radiol 2016; 33:307-312. [PMID: 27904250 DOI: 10.1055/s-0036-1592324] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Postoperative biliary leaks have become more common in the past three decades since the development of laparoscopic biliary surgery. The role of the radiologist and interventional radiologist is important in the diagnosis and treatment of such complications, and can play an adjunctive role in the definitive surgical repair. Ultrasound, computed tomography, magnetic resonance cholangiopancreatography, nuclear medicine cholescintigraphy studies, and percutaneous transhepatic cholangiograms (PTC) are the various imaging modalities used for diagnosis. Interventional radiology treatment involves percutaneous drainage of bilomas, characterization of the biliary tree and assessment of the site of ductal injury with PTC, and biliary diversion with external biliary drainage.
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Affiliation(s)
- Arian M Nikpour
- Division of Interventional Radiology, Department of Radiology, UC Davis Medical Center, UC Davis School of Medicine, Sacramento, California
| | - R Justin Knebel
- Division of Interventional Radiology, Department of Radiology, UC Davis Medical Center, UC Davis School of Medicine, Sacramento, California
| | - Danny Cheng
- Division of Interventional Radiology, Department of Radiology, UC Davis Medical Center, UC Davis School of Medicine, Sacramento, California
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Yousefian R, Jones P, Kia MA, Zadeh MH. LigLAP: Encirclement and Ligation of Vessels in Laparoscopic Surgery: A Double-Layer Suture Sealing Approach. Surg Innov 2015; 22:606-14. [PMID: 25918125 DOI: 10.1177/1553350615579728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article proposes a potential automatic ligation (LigLAP) method to occlude vessels and ducts in several laparoscopic surgical procedures. Currently, stapling devices are widely used for this purpose. However, there are some complications associated with stapling devices, including biliary leak and tissue damage. In this article, we examine the feasibility of an alternative method that uses a double-layer suture to encircle and occlude a vessel. A heating element melts the outer layer of the suture at the cross-point of the suture to create a seal. Several electromechanical mechanisms have been proposed to carry out this ligation process. In addition, some parts have been prototyped for experimental verification and visualization. Several double-layered sutures have been created, and their tensile strength and sealing capabilities have been measured. Moreover, a simple leakage experiment has been performed to verify experimentally the idea of using the double-layer suture. The results show that the new suture and the thermal sealing method provide the required strength to occlude balloons filled with water. Although the results suggest that the proposed method and the double-layer suture may be used in surgical ligation processes, much more rigorous testing of leakage is required.
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Affiliation(s)
| | | | - Michael A Kia
- Department of Surgery, Michigan State University (McLaren Regional medical center), Flint, MI, USA
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Optimum cystic duct closure: a comparative study using metallic clips, ENSEAL, and ENDOLOOP in swine. Am J Surg 2013; 205:547-50; discussion 550-1. [PMID: 23592161 DOI: 10.1016/j.amjsurg.2013.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 01/07/2013] [Accepted: 01/15/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Metal clips are commonly used to secure the cystic duct during cholecystectomy, although use of an ENDOLOOP (Ethicon Endo-Surgery, Blue Ash, OH) is often touted as a more secure closure when postoperative endoscopic retrograde cholangiopancreatography (ERCP) is anticipated. The objective of this study was to test the strength of 3 different cystic duct closure methods in a model simulating postoperative biliary insufflation. METHODS The extrahepatic biliary system, including common bile duct, gallbladder, and cystic duct, was harvested en bloc from 22 swine postmortem. A cholecystectomy was performed and the cystic duct was secured using 1 of 3 randomly assigned methods: metallic clips (Ethicon Endo-Surgery), an ENDOLOOP (Ethicon Endo-Surgery), or an ENSEAL tissue sealing device (Ethicon Endo-Surgery). The common bile duct was cannulated with a pressure-monitoring system and insufflated with air. The burst pressures, location of rupture, and size of the common bile duct and cystic duct were recorded and compared. RESULTS There were 7 pigs each in the ENDOLOOP and ENSEAL groups and 8 in the metallic clip group, with no statistical significance between cystic and common bile duct size. Mean burst pressure was 432 mm Hg for metallic clips, 371 mm Hg for the ENDOLOOP, and 238 mm Hg for the ENSEAL device (P = .02). Post hoc analysis revealed clips to be statistically superior when compared with the ENSEAL (P= .01). There was no statistical difference between the ENDOLOOP and metal clips or between the ENDOLOOP and the ENSEAL. CONCLUSIONS All 3 closure methods successfully secured the cystic duct, with mean burst pressures exceeding 195 mm Hg. Metallic clips demonstrated the highest burst pressures and no cystic duct stump leaks. This study challenges the traditional dogma of additionally securing the cystic duct with an ENDOLOOP when postoperative biliary instrumentation is expected and also suggests that an adequately secure closure may be obtained with thermal sealing devices.
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Soultani C, Patsikas M, Mylonakis M, Papazoglou L, Papadopoulou PL, Papakonstantinou PE, Tziris N. Evaluation and treatment of a posttraumatic intrahepatic biloma in a dog. J Am Anim Hosp Assoc 2010; 47:64-6. [PMID: 21164162 DOI: 10.5326/jaaha-ms-5710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 9 mo old male mixed-breed dog was presented with a history of chronic vomiting and fever after undergoing a cholecystectomy for the management of traumatic cystic duct rupture associated with biliary effusion 10 days before referral. A 6 cm × 6 cm intrahepatic bile collection, a biloma, was diagnosed on abdominal ultrasound and fine-needle aspiration. The biloma was treated with percutaneous catheter drainage under ultrasonographic guidance. Two years after aspiration, the dog continued to do well.
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Affiliation(s)
- Christina Soultani
- Section of Diagnostic Imaging, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hatzidakis A, Krokidis M, Gourtsoyiannis N. Percutaneous removal of biliary calculi. Cardiovasc Intervent Radiol 2009; 32:1130-8. [PMID: 19629589 DOI: 10.1007/s00270-009-9652-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 05/23/2009] [Accepted: 06/22/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Adam Hatzidakis
- Department of Radiology, Medical School of Heraklion, Em. Kastrinaki 7, 71306, Heraklion, Crete, Greece.
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Alibrahim E, Gibson RN, Vincent J, Speer T, Collier N, Jardine C. Spiral computed tomography-intravenous cholangiography with three-dimensional reconstructions for imaging the biliary tree. ACTA ACUST UNITED AC 2006; 50:136-42. [PMID: 16635032 DOI: 10.1111/j.1440-1673.2006.01557.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study aimed to assess the ability of CT-i.v. cholangiography to show the perihilar biliary and cystic duct anatomy and to assess the relative performance of axial, maximum intensity projection and surface rendered displays. We also assessed the correlation between serum bilirubin levels and adequacy of biliary opacification. Spiral CT was carried out following infusion of 100 mL of Biliscopin in 181 patients with suspected biliary disease. The display of biliary anatomy was of high quality, with 91% of patients having good opacification of at least first-order bile ducts and 84% having good opacification of at least third-order right and left hepatic ducts. The quality of biliary opacification correlated inversely to serum bilirubin levels, with levels above two to three times the normal value being associated with lower rates of good opacification. Maximum intensity projection and surface rendered reformats aided anatomical interpretation to a similar degree. The relative frequency of types of perihilar branching patterns and cystic duct junctional anatomy correlated closely to those reported from previous anatomical studies.
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Affiliation(s)
- E Alibrahim
- Department of Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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Coleman J. Bile duct injuries in laparoscopic cholecystectomy: nursing perspective. AACN CLINICAL ISSUES 1999; 10:442-54. [PMID: 10865529 DOI: 10.1097/00044067-199911000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
The advent of laparoscopic cholecystectomy brought a new approach with many advantages to patients for the treatment of symptomatic gallstones. What was not anticipated was an increase in bile duct injuries as a major complication of this new technique. The advanced practice nurse (APN) must understand the technical aspects of a laparoscopic cholecystectomy and routine perioperative care, because this knowledge provides a basis to recognize signs and symptoms of potential postoperative problems characteristic of a bile duct injury. The APN may be the initial healthcare provider who examines a patient or who is contacted by the patient with reports of symptoms that must be heeded and acted on. The APN responds to the patient by providing symptom management, initiating and coordinating care, and alerting the healthcare team. The APN at a specialty center may also be the consistent member of the healthcare team caring for a patient through nonoperative management and operative repair of the bile duct injury. Knowledge of the spectrum of bile duct injuries, their various manifestations, diagnostic tests, nonoperative management, and complex surgical repair is necessary for the APN to educate patients, coordinate care along the continuum, and support a patient with a bile duct injury. The medicolegal aspect of bile duct injury during laparoscopic cholecystectomy is also a topic the APN may encounter that requires thoughtful consideration and response. The recognition of subtle postoperative symptoms of a laparoscopic cholecystectomy may mean the difference between early diagnosis of and intervention in a minor injury or a major complication.
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Affiliation(s)
- J Coleman
- Department of Surgical Nursing, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Nascimento S, Murray W, Wilson P. Computed tomography intravenous cholangiography. AUSTRALASIAN RADIOLOGY 1997; 41:253-61. [PMID: 9293676 DOI: 10.1111/j.1440-1673.1997.tb00669.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Indications for direct visualization of the bile ducts include bile duct dilatation demonstrated by ultrasound or CT scanning, where the cause of the bile duct dilatation is uncertain or where the anatomy of bile duct obstruction needs further clarification. Another indication is right upper quadrant pain, particularly in a post-cholecystectomy patient, where choledocholithiasis is suspected. A possible new indication is pre-operative evaluation prior to laparoscopic cholecystectomy. The bile ducts are usually studied by endoscopic retrograde cholangiopancreatography (ERCP), or, less commonly, trans-hepatic cholangiography. The old technique of intravenous cholangiography has fallen into disrepute because of inconsistent bile-duct opacification. The advent of spiral CT scanning has renewed interest in intravenous cholangiography. The CT technique is very sensitive to the contrast agent in the bile ducts, and angiographic and three-dimensional reconstructions of the biliary tree can readily be obtained using the CT intravenous cholangiogram technique (CT IVC). Seven patients have been studied using this CT IVC technique, between February 1995 and June 1996, and are the subject of the present report. Eight further studies have since been performed. The results suggest that CT IVC could replace ERCP as the primary means of direct cholangiography, where pancreatic duct visualization is not required.
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Affiliation(s)
- S Nascimento
- Pittwater Radiology, Dee Why, New South Wales, Australia
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Oliva VL, Nicolet V, Soulez G, Falardeau M, Daloze P, Abou Jaoude M, Carignan L. Bilomas developing after laparoscopic biliary surgery: percutaneous management with embolization of biliary leaks. J Vasc Interv Radiol 1997; 8:469-73. [PMID: 9152924 DOI: 10.1016/s1051-0443(97)70591-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- V L Oliva
- Department of Radiology, Hôpital Notre-Dame, Montréal (Québec), Canada
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