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Choledochoduodenostomy (CDD) is a surgical procedure to create an anastomosis, a surgical connection, between the common bile duct (CBD) and an alternative portion of the duodenum. [1] In healthy individuals, the CBD meets the pancreatic duct at the ampulla of Vater , which drains via the major duodenal papilla to the second part of duodenum. [ 2 ]
Type I: Most common variety (80-90%) involving saccular or fusiform dilatation of a portion or entire common bile duct (CBD) with normal intrahepatic duct. Type II: These cysts are present as an isolated diverticulum protruding from the CBD. Type III or Choledochocele: Arise from dilatation of duodenal portion of CBD or where pancreatic duct meets.
The bile duct is some 6–8 cm long, and normally up to 8 mm in diameter. [4]Its proximal supraduodenal part is situated within the free edge of the lesser omentum.Its middle retroduodenal part is oriented inferiorly and right-ward, and is situated posterior to the first part of the duodenum, and anterior to the inferior vena cava.
Common bile duct 7. Ampulla of Vater 8. Major duodenal papilla 9. Gallbladder 10–11. Right and left lobes of liver 12. Spleen 13. Esophagus 14. Stomach 15. Pancreas: 16. Accessory pancreatic duct 17. Pancreatic duct 18. Small intestine: 19. Duodenum 20. Jejunum 21–22. Right and left kidneys
When the intrahepatic bile duct wall has protrusions, it is clearly seen as central dots or a linear streak. [10] Caroli disease is commonly diagnosed after this “central dot sign” is detected on a CT scan or ultrasound. [10] However, cholangiography is the best, and final, approach to show the enlarged bile ducts as a result of Caroli disease.
Insertion of a stent through the major duodenal papilla and ampulla of Vater into the common bile duct and/or the pancreatic duct; Dilation of strictures (e.g. primary sclerosing cholangitis, anastomotic strictures after liver transplantation) [5] Extraction of liver flukes from the biliary system (e.g., opisthorchiasis, clonorchiasis, fasciolosis)
Abnormal cannabidiol (Abn-CBD) is a synthetic regioisomer of cannabidiol, which unlike most other cannabinoids produces vasodilator effects, lowers blood pressure, and induces cell migration, cell proliferation and mitogen-activated protein kinase activation in microglia, but without producing any psychoactive or sedative effects.
Impacted gallstone in the cystic duct is obstructing the common hepatic duct. Mirizzi's syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common hepatic duct, resulting in obstruction and jaundice.