Biliary pancreatitis

The major blood supply of extrahepatic biliary ductal system is by
cystic artery, which supplies to cystic duct, common hepatic duct
and the upper part of the common bile duct. The lower part of bile
duct  is  supplied  by  gastroduodenal  artery.  The  present  study  is
aimed at determining the anatomical variations of blood supply of
extrahepatic biliary ductal system and its clinicalimplications. The
present  study  of  the  blood  supply  of  extrahepatic  biliary  ductal
system  has  been  conducted  on  30  cadavers.  After  exposing  the
abdominal cavity and removing peritoneal fat, extrahepatic biliary
system and its blood supply was carefully dissectedand relevant
photographs  were  taken.  Special  attention  was  given to  the
relationship of the cystic artery to the Calot’s triangle. Along with
the arteries, the variations in the venous drainagewere also noted.
Major  importance  of  knowledge  of  blood  supply  of  extrahepatic
biliary  ductal  system  may  well  lie  in  the  understanding  of  the
etiology  of  postoperative  bile  duct  strictures  and  in  their
prevention. A clear understanding of the major arterial supply to
the  extrahepatic  bile  ducts  should  be  of  assistance in  biliary
reconstruction and treating hemobilia.

The treatment of acute biliary pancreatitis during pregnancy remains controversial. We present our experience of treating 7 pregnant women with acute biliary pancreatitis and verified or suspected choledocholithiasis, by using magnetic resonance chol-angiopancreatography (MRCP), endoscopic retrograde chol-angiopancreatography (ERCP), and sphincterotomy followed by laparoscopic cholecystectomy. MRCP was performed in all patients to confirm the presence of common bile duct stones, their size and number. ERCP and sphincterotomy were performed without the use of radiation. The procedure was terminated only when all stones (the number clarified at MRCP), were retrieved into the duodenum. All patients underwent laparoscopic cholecystectomy the following day. Neither post-ERCP nor postoperative major complications were noted. All but one patient reached a healthy natural-term labor. One patient had a planned cesarean section on 35th week. The combination of MRCP, nonradiation ERCP, and immediate laparoscopic cholecystectomy provides definite treatment and seems to put both mother and fetus at lower risk than presumed.

The practice of gastroenterology has undergone a sea change during last one decade. Gastrointestinal endoscopy has now evolved from purely diagnostic modalities to a powerful therapeutic tool. Many gastrointestinal ailments, which required major open surgical procedures only till recently, have now slipped into the hands of GE physicians. Arrest of life threatening gastrointestinal hemorrhage, removal of intestinal polyps, palliation of gastrointestinal and biliary strictures and extraction of. retained CBD stones with the help of endoscopes are some of the glaring examples of this recent revolution in the medical technology. These ailments can now be dealt through flexible endoscopes with unimaginable ease and success in expert hands. The interesting aspect of endotherapy i.e. therapeutic endoscopy is that usually no anesthesia is required and morbidity and hospitalization are drastically reduced as compared to conventional surgery for these disorders. In the following sections we will try to give, a brief account of scope of therapeutic endoscopy as it stands today.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a universally established modality in the evaluation and treatment of adults with suspected biliary and pancreatic disease. Experience with ERCP in children has been relatively limited especially in a developing country like Bangladesh. Objective: Aim of this study is to evaluate the diagnostic and therapeutic yields of ERCP for biliary and pancreatic diseases in Bangladeshi children. Design and settings: This retrospective study was conducted in the departments of Gastroenterology & Hepatology of Bangabandhu Memorial Hospital and Chattagram Metropolitan Hospital, Chittagong, Bangladesh between 2004 and 2013. Patients: Seventy-three patients (14 males and 59 females) aged 1 year 7 months to 18 years with the suspicion of biliary or pancreatic diseases were included in this study. Interventions: Seventy-six procedures of ERCPs were performed. Main outcome measures: Common indications for ERCP and its therapeutic outcomes were assessed. Results: The most common indications were biliary ascariasis (25), choledocholithiasis (17), biliary dilatation of unknown cause (11), chronic pancreatitis (3), choledochal cyst (1), and Mirizzi syndrome (1). Therapeutic procedures included sphincterotomy (41), worm extraction (25), stone extraction (12), and biliary stenting (2). Adverse events were uncommon and usually minor. Conclusion: ERCP is a highly effective and safe diagnostic and therapeutic modality with highest indication for biliary ascariasis in Bangladeshi children.

Background: Bile acid exposure causes pancreatic acinar cell injury through a sustained rise in cytosolic Ca 2ϩ . Results: Pharmacologic and genetic inhibition of the Ca 2ϩ -activated phosphatase calcineurin dramatically reduces acinar cell injury and in vivo pancreatitis resulting from bile acid exposure. Conclusion: Acinar cell calcineurin mediates acinar cell injury and pancreatitis resulting from bile acid exposure. Significance: Calcineurin inhibitors may provide an adjunctive therapy for biliary pancreatitis.

Paciente adulta se presentó en la sala de urgencias con un cuadro de pancreatitis aguda como complicación de un quiste del conducto biliar colédoco tipo IV, el cual fue diagnosticado por ultrasonograma abdominal durante su estancia intrahospitalaria.

El diagnóstico de quiste de colédoco es más difícil en la edad adulta ya que los pacientes raramente se presentan con la triada clásica de dolor abdominal, masa palpable e ictericia, presentándose principalmente con alguna manifestación de vías biliares o pancreática benigna. Existen pocas publicaciones en Occidente acerca de este tópico. La importancia en cuanto al diagnóstico temprano, la clasificación del mismo y al tratamiento quirúrgico con la resección total del quiste radica en su alta incidencia hacia el desarrollo de colangiocarcinoma