0
ARTICLE |

Coexisting Sharp Ductal Angulation With Intrahepatic Biliary Strictures in Right Hepatolithiasis

Kuo-Shyang Jeng, MD; Ikuho Ohta, MD; Fi-Sh Yang, MD; Tsang-Pai Liu, MD; Shou-Chuan Shih, MD; Wen-Shiung Chang, MD; Horng-Yuan Wan, MD; Shih-Hung Huang, MD
Arch Surg. 1994;129(10):1097-1102. doi:10.1001/archsurg.1994.01420340111022.
Text Size: A A A
Published online

Objective:  To investigate the clinical characteristics of a coexisting sharp ductal angulation (<90°) with biliary stricture and to evaluate the difficulties it imposes in the management of retained or recurrent hepatolithiasis.

Design:  Case-controlled study.

Setting:  A referral center.

Patients:  Eighteen consecutive patients having right-sided hepatolithiasis and a coexisting sharp ductal angulation associated with biliary stricture (group 1) were compared with 84 patients matched with sex, age, and conditions of hepatolithiasis and intrahepatic biliary stricture(s) but no sharp angulated duct (group 2).

Intervention:  Postoperative cholangioscopic management (electrohydraulic lithotripsy or other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube tract or percutaneous transhepatic route).

Main Outcome Measures:  Sessions of manipulations, incidence of complications associated with interventions or disease, and mortality were compared.

Results:  Patients of group 1 needed more sessions of postoperative manipulation of stones and strictures (13.7±4.2 vs 8.0±2.3; P<.001). During management, there was a significantly increased vulnerability of severe and/or recurrent cholangitis (66.7% vs 9.5%; P<.001), septic shock (77.8% vs 11.9%; P<.001), liver abscess (55.6% vs 7.1%; P<.001), or massive hemobilia (33.3% vs 7.4%) in group 1 than in group 2. Their risks of coexisting secondary biliary cirrhosis (55.6% vs 9.5%; P<.001) and/or cholangiocarcinoma (16.6% vs 2.4%; P<.04) and mortality (27.8% vs 4.8%; P<.01) were also significantly higher in group 1.

Conclusion:  Our results suggest that the coexisting sharp ductal angulation with biliary strictures in right-sided hepatolithiasis is a distinct difficult clinical entity in the field of biliary tract calculi.(Arch Surg. 1994;129:1097-1102)

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();