Value of MR Cholangiography in Patients with Iatrogenic Bile Duct Injury After Cholecystectomy

Ragozzino, Alfonso; Ritis, Rosaria De; Mosca, Alessandro; Iaccarino, Vittorio; Imbriaco, Massimo

doi:10.2214/ajr.183.6.01831567

Cited by 56 publications

(37 citation statements)

References 28 publications

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“…The cystic duct may have a posterior or anterior spiral insertion in up to 75% of cases in some series [2], as compared with only up to 30% of cases in other series [16]. A long parallel course of the cystic duct (10-25%) [2,16] can be confused with a vessel and ligated as such during laparoscopic surgery [1,15,20]. These differences between series can be explained partly by the fact that data have been created and retrieved from different imaging sources: by direct cholangiography (percutaneous transhepatic catheterization, T-cholangiography, ERCP), autopsy series, or MRC images.…”

Section: Discussionmentioning

confidence: 99%

Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones?

et al. 2006

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Section: Discussionmentioning

confidence: 99%

Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones?

et al. 2006

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“…Therefore, preoperative evaluation of the biliary tree and comprehensive intraoperative exploration are important prerequisites for a successful operation. 8,9,21,22 It is essential to choose an appropriate surgical modality based on meticulous assessment of the biliary structure by an experienced biliary surgeon.…”

Section: Liu H Et Al Int Surg J 2015 May;2(2):179-186mentioning

confidence: 99%

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

et al. 2015

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INTRODUCTIONBile Duct Injury (BDI) remains to be a serious complication of biliary surgery. The reported incidence of major BDI is about 0.5% [1][2][3][4][5] and is still on the rise with the advent of laparoscopic techniques, seriously affecting the patient's quality of life. 6,7 There are controversies over optimal strategy for surgical management of BDI, especially for biliary strictures after BDI. Biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) are believed to be the choice of treatment in most cases, 3,[8][9][10][11][12] but few reports have specifically analyzed the outcomes. The purpose of this study was to determine the ABSTRACT Background: There are controversies over the optimal surgical strategy for the management of complicated biliary strictures after Bile Duct Injury (BDI). The purpose of this study is to investigate the efficacy of biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) for this condition. Methods: Included in this single-center retrospective clinical study were 10 patients with the diagnosis of BDIassociated biliary strictures between July 2010 and July 2013. Results: The 10 patients included 6 women (60%) ranging in age from 26 to 64 years with a mean of 48.6 years. They were patients who failed in repeated conservative, interventional, endoscopic therapies in other hospitals. The interval between the initial operation causing BDI and this operation in our hospital was less than 3 months in 2 patients, less than 6 months in 2 patients, and more than a year in 3 patients. According to the Strasberg classification of BDI, there were 3 cases of type E2, 1 case of type E3, 6 cases of type E4, one patient with type E2 also had right hepatic duct injury besides common bile duct injury. All the 10 patients received biliary reconstruction and RYHJ based on their bile duct conditions. The non-traumatic technique was used in all cases, knowing that the diameter of the bile duct reconstructed was about 1.5 to 3cm. Two patients received segment I hepatectomy; 3 patients received biliary supporting tube placement during operation, which was removed 6 months after operation; and 3 patients received reconstruction of the hepaticojejunostomy anastomosis. All patients recovered well after a mean length of postoperative hospital stay of 9.2 days (range 7 to 13 days). By July 2013, the patients has been followed up for a mean of 19.9 months (range 4 to 36 months), during which no incisional complication, hemorrhage, bile leak, biliary re-stricture, acute pancreatitis, acute cholangitis, or cystic artery pseudoaneurysm occurred in any patients. The level of serum total bilirubin and conjugated bilirubin remained within the normal range. Conclusions: According to the Strasberg classification and the bile duct condition, appropriate biliary reconstruction and RYHJ for BDI-related biliary strictures can bring good outcomes.

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“…Magnetic resonance cholangiography (MRC) is one popular noninvasive alternative that has been shown to be both sensitive and specific for various hepatobiliary pathologies [3][4][5][6][7]. Limitations of MRC include high cost and unsuitability for patients with claustrophobia or cardiac pacemakers, or for those with multiple, artifact-producing metallic clips at the level of the porta hepatis.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the optimal temporal window for intravenous CT cholangiography

et al. 2007

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The optimal temporal window of intravenous (IV) computed tomography (CT) cholangiography was prospectively determined. Fifteen volunteers (eight women, seven men; mean age, 38 years) underwent dynamic CT cholangiography. Two unenhanced images were acquired at the porta hepatis. Starting 5 min after initiation of IV contrast infusion (20 ml iodipamide meglumine 52%), 15 pairs of images at 5-min intervals were obtained. Attenuation of the extrahepatic bile duct (EBD) and the liver parenchyma was measured. Two readers graded visualization of the higher-order biliary branches. The first biliary opacification in the EBD occurred between 15 and 25 min (mean, 22.3 min +/- 3.2) after initiation of the contrast agent. Biliary attenuation plateaued between the 35- and the 75-min time points. Maximum hepatic parenchymal enhancement was 18.5 HU +/- 2.7. Twelve subjects demonstrated poor or non-visualization of higher-order biliary branches; three showed good or excellent visualization. Body weight and both biliary attenuation and visualization of the higher-order biliary branches correlated significantly (P<0.05). For peak enhancement of the biliary tree, CT cholangiography should be performed no earlier than 35 min after initiation of IV infusion. For a fixed contrast dose, superior visualization of the biliary system is achieved in subjects with lower body weight.

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Value of MR Cholangiography in Patients with Iatrogenic Bile Duct Injury After Cholecystectomy

Cited by 56 publications

References 28 publications

Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones?

Low conjunction of the cystic duct with the common bile duct: does it correlate with the formation of common bile duct stones?

Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

Assessment of the optimal temporal window for intravenous CT cholangiography

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