We studied the radiological anatomy of the bile ducts of the medial segment by performing computed tomography under cholangiography (Cholangio-CT) in 60 patients with obstructive jaundice. The medial segment was divided into three subsegments, so was defined as follows: S4a was ventral area of cul-de-sac of umbilical portion, S4b was dorsal area, and S4c was ventral area of the root of the middle hepatic vein.90 branches (65.2%) of 138 which run in S4a (B4a) joint the bile duct of the medial segment near cul-de-sac.75 branches (69.4%) of 108 which run in S4b (B4b)joint between cul-de-sac and horizontal portion. All 61 branches which run in S4c (B4c) joint near horizontal portion. In most cases, S4a is the distal area from the hepatic hilum. Therefore, S4a should be preserved when major hepatic resection will be performed for carcinoma of the hepatic duct confluence.

View full abstract

We study the relationship between the ultrasound image and the disintegration efficiency of gallbladder stones by shock wave in vitro. Ultrasound image was analyzed by profile curve along the central axis of stone image. Then, profile curve was classified and evaluated as following four type: Type A; it rises sharply and attenuates gently over the diameter, Type B; it rises sharply and attenuates sharply under diameter, shaped like triangle, Type C; it is subtype of Type B and it has another small peak in diameter, Type D; Its attenuation is weak and later echo level is 1/2-1/3 of peak, shaped like square. Type A is the best efficiency of fragmentation and is good indication of ESWL. Type B and C are indicated by stone volume. Type D is the worst and is not indication of ESWL. This classification is simpler than B-mode US, macroscopic and chemical classification. It is practical and effective classification for determining the indication of ESWL.

View full abstract

Hydroxyapatite [Ca₁₀(PO₄)₆(OH)₂, HAP] and whitlockite [Ca₉(PO₄)₆, TCP] were identified in black gallstones by X-ray powder defractometry. HAP was found in twenty gallstone specimens, TCP in eight, but the remaining six specimens contained HAP plus TCP.
There was a close correlation between the calcium contents (mg.g^-1, Y) and phosphorus contents (mg.g^-1, X) of both HAP containing specimens and TCP containing ones. For the specimens containing HAP, the following correlation was found: Y=2.154X+18.00, r=0.9943. For the specimens containing TCP, Y=1.964X+13.43, r=0.9994. The slope of each regression line was nearly equal to the idealized Ca/P weight ratio of 2.157 (HAP) or 1.941 (TCP).

View full abstract

In long-term obstructive jaundice, recovery of hepatic energy metabolism is very late even if biliary drainage is performed. We evaluated the effects of biliary drainage on hepatic energy metabolism between internal and external drainage for long-term obstructive jaundiced rats. Longterm (4 weeks) obstructive jaundiced rats, Male SPF SD, received either one of these two kinds of biliary decompression method, Group 1: internal biliary drainage (IBD) by choledocho-duodenal fistula, Group 2: external biliary drainage (EBD) by choledochobladdercystic fistula. Arterial ketone body ratio (AKBR) as index of hepatic energy metabolism and hepatic tissue blood flow (HTF) were determined. Level of total bilirubin increased after obstructive jaundiced, but promptly decreased in both groups. Level of AKBR became lower 4 weeks after obstructive jaundiced, level of HTF decreased 1 week after it. After IBD, level of AKBR and HTF recovered to normal range after 10 weeks and 6 weeks respectively. On the other hand, after EBD, HTF recovered to normal range after 10 weeks, however, the level of AKBR did not recoverd.

View full abstract

During December 1995 and November 1996, EPBD with direct infusion of isosorbide dinitrate in to the bile duct was performed in 13 patients. In 3 or 5 minutes after the direct infusion of isosorbide dinitrate, we smoothly could insert a ballon-tipped biliary catheter into the common bile duct with relaxation of the sphincter of Oddi. All stones were completely removed at first or second process.
As for the complications of papillary balloon dilation, pancreatitis was observed in 3 patients and cholangitis in 1 patient. However these complications were recoverd with conservative medication in short term.
This technique was useful for the extraction of common bile duct stones, the prevention of hemorrhage and preservation of Oddi′s function.

View full abstract

A 14-year-old female was admitted to our hospital because of upper abdominal pain. Abdominal ultrasonography of the abdomen and endoscopic retrograde cholangiography revealed cylindrical dilatation of the common bile duct, cystic dilatation of the common hepatic bile duct associated with anomalous arrangement of the pancreatobiliary duct and multiple polypoid lesion of the gallbladder.
At operation, the gallbladder was shown to have diffuse multiple polypoid lesions on the mucosal surface and histologically many foamy cells in the lamina propria. From these findings, a diagnosis of diffuse papillomatous cholesterosis with congenital dilatation of the bile duct associated with anomalous arrangement of the pancreatobilliary duct was made.
The case is of particular interest in investigating the relation between mucosal change of the gallbladder and congenital dilatation of the bile duct or anomalous arrangement of the pancreatobilliary duct.

View full abstract

A case of benign inflammatory segmental stricture of the common bile duct with squamous metaplasia is reported. A 69-year-old woman was seen at the hospital because of epigastralgia and low grade fever. The blood chemical examinations revealed the liver dysfunction, and abdominal imagings (ultrasonography, computed tomography, cholangiography) revealed a stone in the dilated common hepatic duct and a segmental stricture of the middle common duct. Under the tentative diagnosis of the bile duct carcinoma with cholelithiasis, operation was done. Both the intraoperative histopathological findings and macroscopic findings revealed no malignant lesion. After cholecysto-choledochectomy, hepatico-duodenostomy was carried out. Histopathological findings of the resected specimen revealed squamous metaplasia and severe eosin ophilic infiltration in the hepatic duct, and fibrosis, peribiliary glands with hyperplastic change and lymphoid cells infiltration in the stenotic portion with no part of the malignant lesion.

View full abstract

A57-year-old male was admitted to another hospital by a complaint of jaundice. He underwent surgery under the diagnosis of common bile duct stone based on ERC and CT. Because a large amount of mucus was obtained from the common bile duct in cholecystectomy and choledochotomy, T-tube was inserted into the bile duct. The patient was then admitted to our hospital due to suspected mucus-producing bile duct tumor. Papillary lesions were diagnosed the upper bile duct by fiber scope examination. He was diagnosed with mucus-producing bile duct cancer based on biopsy result, so a bile duct resection and anastomosis of the hepatic duct and the jejunum was peformed. About 6 months postoperatively he suffered from a recurrence on the lymph nodes around the abdominal aorta, and he was treated by chemohyperthermia. This disease is sometimes diagnosed as intrahepatic stone or common bile duct stone because of mucus retention in the biliary tract. There have been some cases with long survival compared with common bile duct cancer if they had been diagnosed accurately diagnosed preoperatively, however, some reccurent case similar to ours have been reported based on intraoperative abdominal scatter of mucous into the abdomen. It is necessary to diagnose this disease carefully and adequately before surgery.

View full abstract

Two rare cases of the biliary disease with aberrant bile duct from the caudate lobe are reported.
Case 1: A 78-year-old woman was admitted to the hospital becouse of fever and abdominal pain. Under a diagnosis of calculus cholecystitis, laparotomy was performed after conservative treatment. Two aberrant bile ducts (the right hepatic duct and the duct of the right caudate lobe) opened into the cystic duct. A stone incarcerated into the cystic duct between two aberrant bile ducts. Cystic duct was divided on the gallbladder side of the aberrant right hepatic duct. The aberrant duct of the caudate lobe was divided from the cystic duct. End to side anastomosis was made between the stump of the duct of the caudate lobe and the right hepatic duct.
Case 2: A 38-year-old woman was admitted to the hospital because of upper abdominal pain. ERCP demonstrated anomalous arrangement of the pancreaticobiliary ductal system and the aberrant duct of the left caudate lobe, which opened into the common bile duct on the opposite side of the cystic duct. After cholecystectomy and resection of the extrahepatic bile duct, the hepatic duct and the aberrant hepatic duct of the left caudate lobe was anastomosed to a Roux-en-Y loop of jejunum.

View full abstract