MyMedR

Fulltext Ascaris in the common bile duct: diagnosis by ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) and extraction by balloon catheter

Murugiah M, Sakijan AS

Med J Malaysia, 1991 Sep;46(3):290-3.

PMID: 1839928

This is a case report of ascaris worm in the common bile duct in a 61 year old lady. Ultrasound diagnosis was initially made based on the presence of linear hyperreflective foci within the common bile duct. ERCP confirmed a single worm within the duct. Balloon extraction was then successfully carried out following papillotomy. This case illustrates the value of ultrasound in the definitive diagnosis of biliary ascariasis and the therapeutic role of ERCP.

Matched MeSH terms: Common Bile Duct Diseases/diagnosis*; Common Bile Duct Diseases/parasitology; Common Bile Duct Diseases/therapy; Common Bile Duct Diseases/ultrasonography

Fulltext Ascarid worms causing recurrent cholangitis in a patient with an obstructing ampullary tumour

Khan TF, Zahari A, Sherazi ZA, Visvanathan R

Singapore Med J, 1993 Oct;34(5):462-3.

PMID: 8153702

This is a report of a 57-year-old Malay lady who presented with recurrent episodes of cholangitis and septicaemia. A dilated biliary tree caused by a stenosing periampullary tumour was found to contain adult round worms. A pancreatico-duodenectomy was performed following biliary decompression. Ascarid worms are a rare cause of cholangitis in malignant biliary obstruction.

Matched MeSH terms: Common Bile Duct Diseases/etiology; Common Bile Duct Diseases/parasitology*; Common Bile Duct Neoplasms/complications*; Common Bile Duct Neoplasms/pathology

Fulltext Large type I choledochal cyst in adults: a case report

Krishnan MMS, Couper NTA

Med J Malaysia, 1984 Jun;39(2):163-6.

PMID: 6392840

Matched MeSH terms: Common Bile Duct Diseases/diagnosis*

An unusual cause of obstructive jaundice

Shahrudin MD

JUMMEC, 1996;1:41-43.

Compression of the common bile duct by a stone impacted in the cystic duct is an uncommon cause of obstructive jaundice. We present a case study and review of the literature pertaining to the presentation, diagnosis, and surgical treatment of Mirizzi syndrome.

Matched MeSH terms: Common Bile Duct

Fulltext Right posterior segmental hepatic duct: role of intraoperative cholangiogram to prevent extrahepatic biliary duct injuries

Ikhwan SM, Zamri Z, Hairol O, Razman J, Affirul C

International Medical Journal Malaysia, 2015;14(2):63-66.

MyJurnal

Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary
operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The
challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which
may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive
jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic
duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct
exploration. The operation was successful without incidence of biliary duct injury.

Matched MeSH terms: Common Bile Duct

Fulltext Bilio-enteric anastomoses: results in benign and malignant conditions

Toufeeq Khan TF, Lwin M, Ulah S, Zahari A, Mokti I

Singapore Med J, 1993 Dec;34(6):545-50.

PMID: 8153721

Twenty bilio-enteric anastomoses were performed or managed from May 1990 to December 1992. Recurrent pyogenic cholangitis (RPC) and pancreatic cancer were the commonest conditions which required drainage procedures. Roux-en-Y hepatico-jejunostomy (RHJ) was performed in 9 patients, 4 for RPC, one for pancreatic cancer, another for a cholangiocarcinoma, 2 following excision of choledochal cyst and one hepatico-jejunostomy was part of a Whipple reconstruction. Roux-en-Y side to side choledocho-jejunostomy (CDJ) was performed in one patient. Choledocho-duodenostomy (CDD) was performed in 6, 4 for obstructive jaundice due to choledocholithiasis, one for RPC and one in a choledochal cyst. One patient operated elsewhere presented with complications after a CDD. Palliative cholecysto-jejunostomy (CYJ) was carried out in 4 patients with pancreatic malignancy. All benign conditions were treated by hepatico-jejunostomy and choledocho-duodenostomy, while three patients with malignant conditions were treated by hepatico-jejunostomy. Permanent subcutaneous access loops were provided when recurrent problems were anticipated, 4 in RPC and one after subtotal resection of a cholangiocarcinoma. Based on this study, we found Roux-en-Y hepatico-jejunostomy a versatile drainage procedure, which was useful in both benign and malignant diseases.

Matched MeSH terms: Common Bile Duct/surgery*; Common Bile Duct Diseases/surgery*

Endoscopic sphincterotomy with balloon dilatation versus sphincterotomy alone for common bile duct stones removal: a randomised controlled trial

Ooi JS, Ikhwan SM, Azem Fathi MA, Leow VM, Syed Hassan AZ

Med J Malaysia, 2024 Mar;79(2):133-140.

PMID: 38553916

INTRODUCTION: Endoscopic sphincterotomy (EST) plus endoscopic papillary large balloon dilatation (EPLBD) has been reported as a valid alternative to EST alone in removing common bile duct (CBD) stone. The aim of this study is to compare efficacy, and safety of these two groups of patients in removing CBD stone in Hospital Universiti Sains Malaysia (HUSM).

MATERIALS AND METHODS: This is a prospective single centre randomised single blinded comparative study conducted in HUSM. The primary endpoints for this study are the overall complete stone clearance rate and complication rate, while the secondary outcome for this study are duration of procedure and rate of usage of adjunct methods. Objective data analysis is conducted using independent sample t-test and chi-squared test.

RESULTS: A total of 66 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis which is CBD stone. 34 patients were allocated to EST plus EPLBD arm (n=34), and 32 patients were in EST alone arm (n=32) using randomisation method. For intention to treat, patients from EST alone arm that unable to achieve complete stone clearance will be switched to EST plus EPLBD arm. The overall complete stone removal rate for both groups were comparable (EST plus EPLDB: 100% versus EST alone: 93.8%; p= 0.139). The two patients from EST alone group (6.2%) that unable to achieve complete stone clearance were converted to EST plus EPLBD group for intention to treat and able to achieve complete stone clearance by EST plus EPLBD. For procedural time, both arms are comparable as well (EST plus EPLDB: 15.8 minutes vs EST alone: 15.5 minutes; p= 0.860). Complications such as pancreatitis occurred in one patient in EST plus EPLBD arm (EST plus EPLDB: 2.9 % vs EST alone: 0 %; p= 0.328), and bleeding occurred in one patient in EST alone arm (EST plus EPLDB: 0 % vs EST alone: 3.1 %; p= 0.299) , but it is not statistically significant. No perforation or cholangitis complication occurred in both groups. No adjunct usage was observed in both groups.

CONCLUSION: In this study with limited sample size, both EST plus EPLBD and EST alone are effective and has comparable procedural time in removing CBD stone. Even though both methods are equally effective, EPLBD plus EST is an alternative solution if complete stone clearance is unable to achieve via EST alone.

Matched MeSH terms: Common Bile Duct

Fulltext Observational study on cannulation rate during ERCP at hospital alor setar

Sivasubramaniam M, Naidu RR

Malays J Med Sci, 2001 Jan;8(1):25-30.

PMID: 22973152 MyJurnal

ERCP (Endoscopic Retrograde Cholangiopancreaticography) was introduced in this hospital in late 1995. Since then, a lot of improvement have been achieved in the management of biliary tract diseases. Various general surgeons posted to this hospital have been trained in this procedure. A study was done to include all patients admitted for ERCP from August 1998 to July 1999. A total of 322 new patients with a mean of 26.9 cases a month had underwent this procedure. The duration of cannulation varied from 2 minutes to 45 minutes with a mean of 12 minutes. Cannulation rate by various surgeons differed. Overall success rate was 80%. Mortality was 0.6 % and morbidity was 0.9%. ERCP is safe and it takes at least 6 months of regular duodenoscopy before one can master the technique. Achieving 80% cannulation rate, has definitely reduced unnecessary common bile duct (CBD) explorations. During this study we have trained various surgeons in this procedure and at least 2 surgeons could be credentialled according to the guidelines provided by the Malaysian Society of Gastroenterology and Hepatology. During this study we have identified various reasons for the failure of cannulation which are useful for future training of endoscopists.

Matched MeSH terms: Common Bile Duct

Common bile duct perforation due to tuberculosis: a case report

Jarmin R, Alwi RI, Shaharuddin S, Salleh KM, Gunn A

Asian J Surg, 2004 Oct;27(4):342-4.

PMID: 15564193

A young man with HIV presented with biliary peritonitis secondary to spontaneous common bile duct perforation. Investigation revealed that the perforation was due to Mycobacterium tuberculosis. Tuberculosis of the bile duct is uncommon and usually presents with obstructive jaundice due to stricture. Bile duct perforation due to tuberculosis is extremely rare. Its management is discussed.

Matched MeSH terms: Common Bile Duct Diseases/etiology*

Gall bladder tumour, choledochal cyst and an anomalous pancreatico-biliary junction

Toufeeq Khan TF, Sherazi ZA, Tan YY

HPB Surg, 1995 Jun;8(3):185-6.

PMID: 7547622

This report highlights the association of a tumour in an acalculous gall bladder with an anomalous pancreatico-biliary junction (PBJ) and a type IVa choledochal cyst. Cholecystectomy and Rouxen-Y hepatico-jejunostomy (RHJ) was performed after division of the common bile duct (CBD) and excision of the dilated segment. The details of the case are presented and the role of an abnormal PBJ in gall bladder carcinogenesis is discussed.

Matched MeSH terms: Common Bile Duct/abnormalities*

Recurrent pyogenic cholangitis: 'sump syndrome' following choledochoduodenostomy

Khan TF, Sherazi ZA, Muniandy S, Mumtaz M

Trop Doct, 1997 Jan;27(1):51-2.

PMID: 9030026

An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the 'sump syndrome', developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.

Matched MeSH terms: Common Bile Duct/surgery

Fulltext Choledochal cyst and cholangiocarcinoma

Yeoh NT, Somasundaram K, Alhady SF, Paramsothy M

Med J Malaysia, 1986 Dec;41(4):365-9.

PMID: 2823084

Carcinoma of the biliary tract is a rare complication of choledochal cysts. Furthermore, the greater predisposition of the cyst wall to neoplastic change has been cited as additional justification for cyst excision rather than on-site internal drainage as the primary choice of operation. The report concerns a patient who developed cholangiocarcinoma despite excision of a choledochal cyst and presented with symptoms of biliary obstruction within one year of the operation. Although this is a rare complication, the need for careful long-term follow-up is supported by this observation.

Matched MeSH terms: Common Bile Duct Diseases/complications*

Fulltext Anomalous pancreatico-biliary junction--a non-dilated biliary system and gallbladder carcinoma

Toufeeq Khan TF, Hayat FZ, Muniandy S

Singapore Med J, 1998 Jan;39(1):25-6.

PMID: 9557100

Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.

Matched MeSH terms: Common Bile Duct/abnormalities*

Fulltext Biliary ascariasis and extrahepatic cholangiocarcinoma: a report of two cases

Lim KG, Sellaiah SP

Singapore Med J, 1994 Aug;35(4):400-2.

PMID: 7899902

We report two cases of rural Malay women in Perak, Malaysia, with extrahepatic cholangiocarcinoma and coexistent biliary ascariasis. In both cases, the narrowed bile duct may have resulted in inability of the migratory nematode to return to the gastrointestinal tract. It may be reasonable, also, to postulate that chronic biliary tract infestation by Ascaris lumbricoides may have contributed to the development of cholangiocarcinoma; a situation similar to that observed in liver fluke infestation.

Matched MeSH terms: Common Bile Duct Diseases/parasitology*

Fulltext Images in clinical medicine. Virchow's node (Troisier's sign)

Loh KY, Yushak AW

N Engl J Med, 2007 Jul 19;357(3):282.

PMID: 17634463 DOI: 10.1056/NEJMicm063871

Matched MeSH terms: Common Bile Duct Neoplasms/pathology*

Retrieval of an impacted Dormia basket and stone in situ using a novel method

Ranjeev P, Goh Kl

Gastrointest Endosc, 2000 Apr;51(4 Pt 1):504-6.

PMID: 10744838

Matched MeSH terms: Common Bile Duct*

Fulltext Dilated common bile duct in opium addicts with and without biliary symptoms --implication for research in AIDS cholangiopathy

Chuah SY, Leong CK, Pang CW

Singapore Med J, 2003 May;44(5):261-7.

PMID: 13677363

Opium addicts (OA) with no biliary symptoms have been shown to have dilated common bile duct (CBD). Endoscopic retrograde cholangio-pancreatography (ERCP) without biliary drainage in such asymptomatic OA is hazardous. Hence it is not indicated unless there are clear clinical and laboratory evidences of biliary stasis.

Matched MeSH terms: Common Bile Duct/pathology*

Fulltext Benign teratoma of the liver: a rare cause of cholangitis

Rahmat K, Vijayananthan A, Abdullah B, Amin S

Biomed Imaging Interv J, 2006 Jul;2(3):e20.

PMID: 21614237 MyJurnal DOI: 10.2349/biij.2.3.e20

Teratomas are neoplasms characterised by an abnormal growth of tissues derived from the three germinal layers. The term 'teratoma' is derived from the Greek root 'teratos', meaning monster. Germ cells develop in the embryo and subsequently become the cells that make up the reproductive system. During fetal development, these cells follow a midline path and descend into the pelvis as ovarian cells or the scrotal sac as testicular cells. The presence of germ cells in extragonadal sites is because of the failure of these cells to migrate along the urogenital ridge. Therefore, teratomas occur in order of decreasing frequency in the ovaries, testes, anterior mediastinum, retroperitoneum, sacrococcygeal region and cranium.Liver teratomas are very rare; of the 25 hepatic teratomas described in the literature, only five have occurred in adults. The majority of the cases were in female children below the age of three, mostly arising in the right lobe of liver.We report a case of an adult male with benign mature teratoma arising in the left lobe of liver, compressing the common bile duct and causing obstructive jaundice.

Matched MeSH terms: Common Bile Duct

Fulltext Ultrasound Subcostal Approach Transversus Abdominis Plane Block in Morbidly Obese Patient

Nelbon Giloi, Liew, Constance Sat Lin, Payus, Alvin Oliver, Mac Guad, Rhanye, Murugaiah, Chandrika, Soe, May Zaw, et al.

Borneo Journal of Medical Sciences, 2019;13(3):43-47.

MyJurnal

As general population of obese patients in Malaysia rapidly increases, more obese patients are requiring anaesthesia for various operative procedures. Obesity is associated with anatomical and physiological differences and co-morbidities that influence on the choices of anaesthesia care. A surgical case with general anaesthesia is used as a basis of discussion. A 37-year-old female, history of untreated hypertension and gastrooesophageal reflux disease (GORD), BMI of 41 admitted for laparoscopic cholecystectomy for symptomatic cholelithiasis under general anaesthesia. She presented with pain at the upper right abdomen and associated with bloated abdomen, nausea and vomiting after intake of meals. General anaesthesia and right ultrasound-guided transversus abdominis plane (TAP) block for abdominal wall blocks via subcostal approach was performed. Operation was removal gallstones in the common bile duct via laparoscopic approach. Post-operation patient was extubated successfully. She was prescribed paracetamol 1g 4 hourly and started on fentanyl patient-controlled analgesia (PCA) for next 2 days. In this case report, there is the description of the application of TAP block which when used in obese abdominal surgical procedure, can provide excellent postoperative pain relief, early mobilization and recovery.

Matched MeSH terms: Common Bile Duct

Biliary ascariasis: a wandering worm

Lim, C.B., Munirah, A., Alias, M., Nandy, A.K., Thamby Dorai, C.R.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):68-71.

MyJurnal

Ascaris lumbricoides infection usually results in mild gastrointestinal symptoms. However, heavy worm load infections can cause major complications. In one-third of the latter cases, the worms enter the bile duct causing cholangitis, biliary colic and acute pancreatitis. We describe an eleven-year-old Indian boy who presented with high grade fever, vomiting of worms, jaundice and right hypochondria! pain. Examination revealed an ill, malnourished and jaundiced child. His abdomen was tender with positive Murphy's sign and hepatomegaly. Urgent ultrasound showed hepatomegaly with dilated intrahepatic and common bile ducts (CBD). There were tubular echogenic filling defects with central sonolucency along the long axis of the CBD. He was fasted, started on intravenous fluids and broad spectrum antibiotics. As there was no improvement after 24 hours, endoscopic retrograde cholangio-pancreaticography (ERCP) was performed: it showed worms in the CBD. A stent was inserted to decompress the bile ducts and to ensure biliary drainage. The patient improved, the fever settled, jaundice resolved, serum amylase and transaminase levels normalised. It was planned to remove the stent at a later date.

Matched MeSH terms: Common Bile Duct

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