Changes of Bile Duct Mucosa after Choledochoduodenostomy in Rats

Kuo, Kung‐Kai; Ker, Chen‐Guo; Sheen, Pai‐Ching; Wang, H.-J.

doi:10.1159/000129441

Cited by 5 publications

(2 citation statements)

References 9 publications

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“…The frequent isolation of β g l u c u r o n i d a s eproducing bacteria such as Clostridium spp., B a c t e roides fragilis, Escherichia coli and P e p t o c o c c u s spp. from the bile of aff e c t e d patients supports this (Tabata and Nakayama 1981;Vitetta and Sabi 1992;Kuo et al 1996). Although liver biopsy material was processed for both aerobic and anaerobic culture in all the cases within this report, positive culture results were obtained from only 2.…”

Section: Discussionsupporting

confidence: 65%

Medical treatment of cholangiohepatitis and cholelithiasis in mature horses: 9 cases (1991–1998)

Peek

2000

Equine Veterinary Journal

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The medical approach to treatment of cholangiohepatitis and cholelithiasis in 9 horses is described. Seven horses were treated successfully and returned to normal use, with a minimum follow-up period of 12 months. Long-term antimicrobial therapy was believed to be critical in those cases that survived, with a median treatment duration of 51 days (range 17-124 days). Treatment failure was associated with severe periportal and bridging hepatic fibrosis from biopsy material obtained at admission in 2 horses, one of whom also presented with hyperammonaemic hepatic encephalopathy. Transabdominal ultrasound was used diagnostically in each case to obtain hepatic biopsy material for histopathology and bacterial culture, to evaluate hepatic size and echogenicity and to identify and monitor the dissolution of hepatoliths. Histologically, all horses had evidence of suppurative cholangiohepatitis with varying degrees of periportal and bridging fibrosis. Discrete hyperechoic calculi were identified in 4 cases, but all horses had ultrasonographic evidence of biliary obstruction with numerous dilated bile ducts. Aerobic and anaerobic cultures of liver biopsy material were negative from 7 horses, but 2 different species of Escherichia coli were obtained from one horse, and Bacteroides vulgatus and Escherichia coli were isolated from another. In all 7 horses that survived, clinical recovery was seen before normalisation of biochemical indices of hepatobiliary function including gammaglutamyl transaminopeptidase (GGT), alkaline phosphatase (AP), bile acids and serum bilirubin. Serum GGT levels were monitored extensively as a marker of hepatobiliary disease and actually increased during the initial period of clinical improvement in horses that recovered. Supportive medical therapy with i.v. fluids was also a critical part of the therapy of several cases in this report, both acutely and in the management of chronic cases that deteriorated clinically during treatment. Previous therapeutic failures may well be related to treatment periods of inadequate duration, and the authors recommend that antimicrobial therapy should be continued until GGT values are normal.

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Section: Discussionsupporting

confidence: 65%

Medical treatment of cholangiohepatitis and cholelithiasis in mature horses: 9 cases (1991–1998)

Peek

2000

Equine Veterinary Journal

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“…The long-term sequel of choledochoduodenostomy may further be complicated by induction of biliary malignancy. In an experimental setting, choledochoduodenostomy resulted in reflux cholangitis, bacterial infection, mucin overproduction, and bile deconjugation; stone formation was found in 42 % and severe dysplasia of the mucosa in 50 % of the rats at the end of the study [7]. Clinically, the late development of bile duct cancer in patients who had bilioenteric drainage for benign disease was 5.8 % in transduodenal sphincteroplasty patients, 7.6 % in choledochoduodenostomy patients, and 1.9 % in hepaticojejunostomy patients out of 1003 patients who underwent a long-term follow-up of 130 months on average [8].…”

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confidence: 99%

Endoscopic Treatment of the “Sump Syndrome” after Choledochoduodenostomy: A New Technique using an Amplatzer Septal Occluder

Ell

Boosfeld²,

Henrich³

et al. 2006

Z Gastroenterol

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A 58-year-old male patient had been suffering for 35 years from recurrent cholangitis, biliary sludge and infection-induced stone formation after open cholecystectomy because of empyema of the gallbladder and severe acute and delayed postoperative complications. The pathophysiological origin of this chronic "sump syndrome" was a choledochoduodenostomy which had been performed prophylactically at the time of the initial operation. The patient agreed to an experimental treatment option with use of an Amplatzer atrial-septal defect (ASD) occluder for closure of the symptomatic choledochoduodenal fistula. The double-disc occluder was introduced through a 9 French diameter and 90 cm long sheath side to side with a duodenoscope. Under endoscopic and fluoroscopic guidance the distal disc was opened in the common bile duct, then retracted against the fistula's orifice. Subsequently, the proximal disc was unfolded in the duodenum, while the 9 mm waist between the two discs filled and shut the fistula. No side effects or complications were detected. The day after the procedure, endoscopic evaluation demonstrated the correct position of the occluder and closure of the fistula. Over a period of 12 months, repeated assessments did not reveal any major problems. The patient felt a significant subjective improvement. The use of a self-expanding occluder system for closure of a choledochoduoenotomy complicated by chronic and symptomatic duodenocholedochal reflux might therefore represent an enrichment of the equipment of interventional endoscopists.

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