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Recurrent pyogenic (Oriental) cholangiohepatitis with intrahepatic biliary stricture and stone formation.

Scism JTS - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Recurrent pyogenic (Oriental) cholangiohepatitis with intrahepatic biliary stricture and stone formation.

History: 46 year-old female with history of Oriental cholangiohepatitis who undergoes routine cholangiogram and biliary stone removal.

Findings: After accessing the Hutson-Russell cutaneous choledochojejunostomy loop, a glidewire and vascular sheath were passed into the biliary system allowing a cholangiogram to be performed which demonstrated numerous small filling defects consistent with stones within the left dorsal and ventral hepatic biliary system. The right biliary system was clear of stones. The entire biliary tract was diffusely mildly dilated. A short segment stenosis was noted within the left hepatic duct near the confluence of the right and left ducts. This was dilated with a 10 mm angioplasty balloon. A Fogarty balloon was advanced into the left biliary systems, inflated, and retracted pulling the stones into the common bile duct. Post procedure cholangiogram reveled significant improvement in the left-sided stone burden and reduction of the stricture of the left hepatic duct.

Ddx: Recurrent pyogenic (Oriental) cholangiohepatitis Hemobilia Caroli's Disease with stone formation hemolytic anemia with intrahepatic stone formation

Dxhow: liver biopsy, prior studies

Exam: none

No MeSH data available.


Note surgical clips projected over the right mid abdomen.  These clips identifiy the location of the Hutson-Russell loop, the blind end of the afferent limb of a hepatico-jejunostomy (also described as cutaneous choledochojejunostomy), surgically anastomosed to the abdominal wall for easier assess to the patient’s biliary system.
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MPX1466_synpic30279: Note surgical clips projected over the right mid abdomen. These clips identifiy the location of the Hutson-Russell loop, the blind end of the afferent limb of a hepatico-jejunostomy (also described as cutaneous choledochojejunostomy), surgically anastomosed to the abdominal wall for easier assess to the patient’s biliary system.


Recurrent pyogenic (Oriental) cholangiohepatitis with intrahepatic biliary stricture and stone formation.

Scism JTS - MedPix (2006)

Note surgical clips projected over the right mid abdomen.  These clips identifiy the location of the Hutson-Russell loop, the blind end of the afferent limb of a hepatico-jejunostomy (also described as cutaneous choledochojejunostomy), surgically anastomosed to the abdominal wall for easier assess to the patient’s biliary system.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1466&req=5

MPX1466_synpic30279: Note surgical clips projected over the right mid abdomen. These clips identifiy the location of the Hutson-Russell loop, the blind end of the afferent limb of a hepatico-jejunostomy (also described as cutaneous choledochojejunostomy), surgically anastomosed to the abdominal wall for easier assess to the patient’s biliary system.

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Recurrent pyogenic (Oriental) cholangiohepatitis with intrahepatic biliary stricture and stone formation.

History: 46 year-old female with history of Oriental cholangiohepatitis who undergoes routine cholangiogram and biliary stone removal.

Findings: After accessing the Hutson-Russell cutaneous choledochojejunostomy loop, a glidewire and vascular sheath were passed into the biliary system allowing a cholangiogram to be performed which demonstrated numerous small filling defects consistent with stones within the left dorsal and ventral hepatic biliary system. The right biliary system was clear of stones. The entire biliary tract was diffusely mildly dilated. A short segment stenosis was noted within the left hepatic duct near the confluence of the right and left ducts. This was dilated with a 10 mm angioplasty balloon. A Fogarty balloon was advanced into the left biliary systems, inflated, and retracted pulling the stones into the common bile duct. Post procedure cholangiogram reveled significant improvement in the left-sided stone burden and reduction of the stricture of the left hepatic duct.

Ddx: Recurrent pyogenic (Oriental) cholangiohepatitis Hemobilia Caroli's Disease with stone formation hemolytic anemia with intrahepatic stone formation

Dxhow: liver biopsy, prior studies

Exam: none

No MeSH data available.