• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제19권4호
• /
• pp.281-285
• /
• 2016

Laparoscopic cholecystectomy, though an uncommon surgical procedure in paediatric age group is still associated with a higher risk of post-operative bile duct injuries when compared with the open procedure. Small leaks from extra hepatic biliary apparatus usually lead to the formation of a localized sub-hepatic bile collection, also known as biloma. Such leaks are rare complication after laparoscopic cholecystectomy, especially in paediatric age group. Minor bile leaks can usually be managed non-surgically by percutaneous drainage combined with endoscopic retrograde cholangio-pancreatography (ERCP). However, surgical exploration is required in cases not responding to non-operative management. If not managed on time, such injuries can lead to severe hepatic damage. We describe a case of an eight-year-old girl who presented with biloma formation after laparoscopic cholecystectomy who was managed by ERCP.

• Clinical Endoscopy
• /
• 제56권2호
• /
• pp.143-154
• /
• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• 한국임상수의학회지
• /
• 제22권4호
• /
• pp.412-416
• /
• 2005

Three cases of extrahepatic bile duct disorder were presented. Two cases, a dog and a cat, were related to the obstruction of the extrhepatic bile duct, the other dog was affected with the gall bladder rupture. The clinical signs included anorexia, abdominal distension and vomiting. The laboratory test represented increased hepatic enzymes. On the radiography, hepatomegaly was seen in the obstructive cases, and ascites could be seen in the ruptured case. On the Ultrasonography, dilated gall bladder and extrahepatic bile duct were found in the obstructive cases, and there were ascites, indistinct gall bladder wall, dilation of gall bladder and extrabiliary tract, increased mesenteric echogenicity in the ruptured case. All presented were taken medication, surgical foreign material removal, or cholecystectomy showed complete recovery.

• 대한소아치과학회지
• /
• 제27권1호
• /
• pp.70-76
• /
• 2000

Intra- & extra-hepatic duct system의 경화를 야기하는 Biliary atresia는 출생시 1 : 10,000의 발생빈도를 보이며, 5년 이하의 생존율을 나타내는 예후가 좋지 않은 질환이다. 담도폐쇄증의 원인은 아직 명확하지 않으나, 유전적인 요소나 발육성 원인으로 믿고 있다. 임상적 특징으로 두드러진 황달, 간비증대, 가려움증, 지방변, 황색종, 성장지연, 문맥압항진증, 출혈, 골연하증, 복수 그리고 호흡기계 감염 등을 나타낸다. 구강내 소견으로 녹색을 띄는 변색치아, 유치의 확장된 치수강과 치근관, 치아맹출지연, 법랑질 형성부전, 그리고 심한 치아 우식 등이다. 담도폐쇄증은 조기진단과 수술에 의해 사망률이 감소되고, 성장과 발달이 정상으로 돌아오며 생존율도 향상되었으나 여전히 그 원인과 치료에 대한 연구가 계속되어야 할 것이다. 이에 저자는 전북대학교 치과병원에 내원한 2명의 담도폐쇄증환아에 대해 임상, 방사선학적 특징 및 적합한 처치에 대하여 보고하고자 한다.

• BMB Reports
• /
• 제53권6호
• /
• pp.311-316
• /
• 2020

Cholestasis is a condition in which the bile duct becomes narrowed or clogged by a variety of factors and bile acid is not released smoothly. Bile acid-induced liver injury is facilitated by necrotic cell death, neutrophil infiltration, and inflammation. Metformin, the first-line treatment for type 2 diabetes, is known to reduce not only blood glucose but also inflammatory responses. In this study, we investigated the effects of metformin on liver injury caused by cholestasis with bile acid-induced hepatocyte injury. Static bile acid-induced liver injury is thought to be related to endoplasmic reticulum (ER) stress, inflammatory response, and chemokine expression. Metformin treatment reduced liver injury caused by bile acid, and it suppressed ER stress, inflammation, chemokine expression, and neutrophil infiltration. Similar results were obtained in mouse primary hepatocytes exposed to bile acid. Hepatocytes treated with tauroursodeoxycholic acid, an ER stress inhibitor, showed inhibition of ER stress, as well as reduced levels of inflammation and cell death. These results suggest that metformin may protect against liver injury by suppressing ER stress and inflammation and reducing chemokine expression.

• Journal of Yeungnam Medical Science
• /
• 제35권1호
• /
• pp.109-113
• /
• 2018

A 75-year-old man with chronic cholangitis and a common bile duct stone that was not previously identified was admitted for right upper quadrant pain. Acute cholecystitis with cholangitis was suspected on abdominal computed tomography (CT); therefore, endoscopic retrograde cholangiopancreatography with endonasal biliary drainage was performed. On admission day 5, hemobilia with rupture of two intrahepatic artery pseudoaneurysms was observed on follow-up abdominal CT. Coil embolization of the pseudoaneurysms was conducted using percutaneous transhepatic biliary drainage. After several days, intrahepatic artery pseudoaneurysm rupture recurred and coil embolization through a percutaneous transhepatic biliary drainage tract was conducted after failure of embolization via the hepatic artery due to previous coiling. After the second coil embolization, a common bile duct stone was removed, and the patient presented no complications during 4 months of follow-up. We report a case of intrahepatic artery pseudoaneurysm rupture without prior history of intervention involving the hepatobiliary system that was successfully managed using coil embolization through percutaneous transhepatic biliary drainage.

• 대한핵의학회지
• /
• 제29권4호
• /
• pp.492-496
• /
• 1995

저자들은 신생아 황달에서 간담도 스캔의 결과를 판정하는데 있어서 간 섭취율의 차이가 담도폐쇄증과 신생아 간염 감별진단에 도움이 되는지 여부를 평가하고자 하였다. 1) 신생아 황달로 간담도 스캔을 시행한 38명의 환아중 24시간 지연 영상에서도 장내 방사능이 관찰되지 않은 14명중 확진된 결과를 얻을 수 있었던 13명의 환아를 대상으로 하였다. 2) 13명의 대상 환아중 담도폐쇄증이 4명, 신생아간염이 9명이었다. 3) 담도폐쇄증과 신생아 간염을 감별진단하는데 있어서 간 섭취율의 차이를 살펴본 결과 두 질환간의 통계적으로 의의있는 간 섭취율의 차이는 없었다. 4) 간담도 스캔은 장내 방사능의 유무로 두 질환을 감별시 민감도가 100%인 우수한 검사법이지만, 지연영상에서도 장내 방사능이 관찰이 안되는 경우에 대하여서는 Jaw등12)과 같이 십이지장액의 방사능을 측정하거나 또는 다른 보조적인 검사에 대한 연구가 필요하리라 생각된다.

• Journal of Pharmaceutical Investigation
• /
• 제7권1_4호
• /
• pp.13-21
• /
• 1977

This study on the biliary excretion of sulfadiazine has been established in the rats. 1. Sulfadiazine, administered intravenously to rats with ligated renal pedicles and a cannulated bile duct, rapidly appeared in the bile in high concentration. 2. Between 0-30min. and 30-60 min. after administration, the bile-to-plasma concentration ratios(B/P) of the sulfadiazine were 1. 02-2.67, 1.14-3.79 for 1mg/kg dose, 1.48-3.89, 1.30-3.81 for 10mg/kg, 1.97-4.27, 2.11-4.07 for 50mg/kg, and 1.70-4.21, 1.71-5.34 for 100mg/kg. Thus, B/P ratios at any doses of sulfadiazine greatly exceeded 1.0 at all experimental periods. 3. Furthermore, the biliary excretion of sulfadiazine was inhibited by probenecid significantly. 4. Hepatic clearance of sulfadiazine in the rats was increased from 0.515 to 1.780 ml/60 min. when the dose was raised from 1.0mg/kg to 50.0mg/kg of sulfadiazine, but at 100mg/kg, decreased to 1.250ml/60min. All these results indicate that sulfadiazine is excreted into the bile by active transport process in the rats with ligated renal pedicles and a cannulated bile duct.

• 한국응용약물학회:학술대회논문집
• /
• 한국응용약물학회 1994년도 춘계학술대회 and 제3회 신약개발 연구발표회
• /
• pp.202-202
• /
• 1994

G009의 hepatic cirrhosis animal model중 bile duct ligation/scission (BDL/S) rat에서의 항섬유화 효과를 조사하였다. BDL/S 수술 후 4주간 투약군에는 G009 saline soln.(5mg/rat/day)을, 대조군에는 saline을 경구투여하였다. fibrosis가 최고에 달하는 4주후 rat를 도살하여, 혈청중 N-terminal procollagen type III peptide(PIIINP) level, 간 조직중 hydroxy proline content, serum biochemical value(ALT, AST, choleterol, total bilirubin, creatinine) 측정 및 간조직검사를 실시하였다. 그 결과 1) 혈청중 PIIINP의 경우, 투약군 BDL/S group(10.3ng/ml$\pm$2.2)이 대조군 (20.5ng/m1$\pm$3.9)에 비해 약 50%정도 유의성 있게 감소하였다(p<0,01). 2) 간 조직중 hydroxy proline치 측정 결과, 투약군 BDL/S group(471$\pm$160$\mu\textrm{g}$/g liver)이 대조군(566$\pm$42.9$\mu\textrm{g}$/g liver)에 비하여 약 13%정도 유의성있게 감소하였다(p<0.05). 3) 간조직검사 결과 투약군의 BDL/S op. group이 대조군보다 necrosis, inflammetion, bile duct proliferation, connective tissue 침착 등이 약화되었다. 위 실험을 종합한 결과 G009는 biliary cirrhosis model에서 antifibrotic effect가 있음이 사료된다.

• Parasites, Hosts and Diseases
• /
• 제31권1호
• /
• pp.71-74
• /
• 1993

복통과 담석을 주소로 서울시립 보라매병원에 입원한 43세 여자 환자가 수술 후 담석증을 동반한 담도회충증으로 진단되었다. 환자는 어릴 때부터 '횟배'를 자주 앓아왔으며 입원 20일 전부터 식후 복통과 오심 및 구토 증세를 나타내었고 개인병원에서 시행한 초음파 검사에서 담석이 발견되어 수술을 받기 위해 입원하였다. 입원 당시 간기능 검사상 SGOT 및 SGPT는 다소 증가되어 있었고 대변검사에서 기생충의 충란은 검출되지 않았다. 환자는 담석증 진단 하에 담낭절제술을 시행받았다. 수술 전 담도조영 검사상 좌측 간내 담도는 막혀 있었으며 수술 후 어느 정도 호전되었으나 잔존 오니 (sludge)로 여전히 막혀있는 상태였다 광학현미경 검사상 담낭은 만성 담낭염의 소견을 보였고 오니에서는 심하게 변성된 회충의 충체와 비교적 잘 보존된 충란이 함께 관찰되었다. 이 환자의 경우 담석 형성은 담관 내로 기어 들어간 회충이 오랜 기간 경과하면서 변성되어 담석의 핵 (nidus)으로 작용하였을 것으로 추측되었다. 이 환자는 최근 5년 동안 국내 문헌상 매우 드물게 발견되는 담도 회충증의 증례이었다.