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The purpose of biliary endoscopic sphincterotomy in the treatment of a bile leak is to reduce or eliminate the pressure gradient between the bile duct and the duodenum, encouraging transpapillary bile flow and allowing the leak to heal. [7] Others: Palliation of malignant biliary strictures; Gallbladder drainage; Biliary parasite removal; Sump ...
Cholecystostomy or (cholecystotomy) is a medical procedure used to drain the gallbladder through either a percutaneous or endoscopic approach. The procedure involves creating a stoma in the gallbladder, which can facilitate placement of a tube or stent for drainage, first performed by American surgeon, Dr. John Stough Bobbs, in 1867.
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.
Although they may not drain any liver parenchyma, they can be a source of a bile leak or biliary peritonitis after cholecystectomy in both adults and children. If an accessory bile duct goes unrecognized at the time of the gallbladder removal, 5–7 days post-operative the patient will develop bile peritonitis, [10] an easily treatable complication with a morbidity rate of 44% if left untreated.
Some uses for this procedure includes: drainage of bile/infected bile to relieve obstructive jaundice, to place a stent to dilate a stricture in the biliary system, stone removal, and rendezvous technique [4] where guidewire from the common bile duct (CBD) meets with duodenoscope (coming from the oesophagus into the stomach and then duodenum) at the major duodenal papilla.
There are other causes such as abdominal surgery, endoscopic surgery and percutaneous catheter drainage. [6] Injury and abdominal trauma can cause damage to the biliary tree. The biliary tree is a system of vessels that direct secreations from the liver, gallbladder, and pancreas through a series of ducts into the duodenum.
The cystic lymph node is situated at the neck of the gallbladder. [2] [4] It is invariably situated lateral to the biliary tree. [9] The node receives lymphatic drainage from the gallbladder, cystic duct, hepatic duct, and the superior portion of the common bile duct. [10] It in turn drains lymph into the hepatic lymph nodes. [2] [4]
The major duodenal papilla (papilla of Vater) is a rounded projection in the duodenum into which the common bile duct and pancreatic duct drain. The major duodenal papilla is, in most people, the primary mechanism for the secretion of bile and other enzymes that facilitate digestion.