CONTACT US
CONTACT US
CONTACT US

BILE DUCT PROBLEMS (OBSTRUCTION, HYDROPS, PERFORATION, FISTULA)

  • Home
  • Condition
  • BILE DUCT PROBLEMS (OBSTRUCTION, HYDROPS, PERFORATION, FISTULA)
UNDERSTANDING THE PROBLEM

A bile duct is any of a number of long tube-like structures that carry bile. Bile, required for the digestion of food, is secreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct (carrying bile to and from the gallbladder) to form the common bile duct, which opens into the intestine. The two types of bile ducts in the liver are intrahepatic and extrahepatic ducts.

A biliary obstruction is a blockage of the bile ducts. Bile is a dark-green or yellowish-brown fluid secreted by the liver to digest fats. Much of the bile is released directly into the small intestine, and what remains is stored in the gallbladder. After eating, the gallbladder releases bile to help in digestion and fat absorption. Bile also helps rid the liver of waste products.

Obstruction of any of these bile ducts is referred to as a biliary obstruction.

UNDERSTANDING WHO SUFFERS

Disorders of the biliary tract affect a significant portion of the worldwide population, and the overwhelming majority of cases are attributable to cholelithiasis (gallstones). Biliary obstruction refers to the blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine. This can occur at various levels within the biliary system. The major signs and symptoms of biliary obstruction result directly from the failure of bile to reach its proper destination.

In the United States, the incidence of biliary obstruction is approximately 5 cases per 1000 people.

POTENTIAL SIGNS AND SYMPTOMS

The symptoms of biliary obstruction can depend on the cause of the obstruction, some are outlined below:

  • Most common symptoms can include light or clay-colored stools, dark urine and Nausea and vomiting typically present in Choledocholithiasis (at least one gallstone in the common bile duct), although many times initially conditions can be asymptomatic.
  • Signs of jaundice (skin and icterus). Patients typically present with jaundice and pruritus can experience more generalized symptoms, such as weight loss, anorexia, and fatigue.
  • The gallbladder may be palpable (Courvoisier sign). This may be associated with underlying pancreatic malignancy.
  • Weight loss, adenopathies, and blood in the stool, suggesting a neoplastic lesion.
  • Presence or absence of ascites (abnormal accumulation fluid in the abdominal (peritoneal) cavity) and collateral blood circulation associated with cirrhosis.
  • High fever and chills suggest a coexisting cholangitis.
  • Abdominal pain in various areas dependent on cause. Pain can be intermittent, and may also spread to the back. Pains can be mild or intense, depending on the severity of the condition.
  • Malignancy is more commonly associated with the absence of pain and tenderness during the physical examination.
  • Irregular yellow patches or nodules on the skin (Xanthomata) associated with primary biliary cirrhosis (PBC).
EXAMINATIONS USUALLY REQUIRED

Various tests may be performed for suspicion of biliary obstruction:

  • Blood Test: A blood test can include a complete blood count (CBC) and liver function test. Blood tests can usually rule out certain conditions, such as:
  • Cholecystitis, which is an inflammation of the gallbladder
  • Cholangitis, which is an inflammation of the common bile duct
  • An increased level of conjugated bilirubin, which is a waste product of the liver
  • An increased level of liver enzymes
  • An increased level of alkaline phosphatase

Any of these may indicate a loss of bile flow.

  • Ultrasound is the preferred initial screening and is highly accurate in detecting gallbladder stones and bile duct dilation.
  • Once biliary dilation or the presence of a common duct stone is noted on an imaging study, or biliary obstruction is strongly suspected on clinical grounds despite negative imaging studies, endoscopic retrograde cholangiopancreatography (ERCP) is recommended. ERCP provides a means of visualizing the biliary tree and the opportunity for therapy.
  • Abdominal CT scanning can also be helpful in evaluating patients with obstructive jaundice. It is as accurate as ultrasound in detecting common duct stones and may help localize the level of obstruction in the biliary tree.
  • Cholangiography: A cholangiography is an X-ray of the bile ducts.
  • Magnetic resonance cholangiopancreatography (MRCP), a type of MRI scan is a noninvasive way to visualize the hepatobiliary tree.
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Gallbladder and Biliary Tract Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field including:

  • Cholelithiasis – Gallstones - Cholecystectomy (Gallbladder removal), Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholecystitis - Gallbladder Inflammation - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Gallbladder Problems (Obstruction, Hydrops, Perforation, Fitsula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Bile Duct Problems (Obstruction, Hydrops, Perforation, Fistula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholangitis -Inflammation/bacterial infection of the biliary tract - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

FURTHER INFO
TECHNOLOGIES
OUR SURGEONS
OUR FACILITIES
AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Miscellaneous Conditions Causing Biliary Tract Obstruction

  • Benign Tumors. Although most bile duct tumors are malignant, some benign biliary lesions result in biliary obstruction and cholestasis. These include papillomas, adenomas, and cystadenomas.
  • Ampullary Tumors. Tumors of the ampulla of Vater can be benign (adenomas) or malignant (ampullary carcinoma). Either can result in biliary obstruction and can be confused with cholangiocarcinoma and pancreatic adenocarcinoma. At presentation, patients are often jaundiced and may have a palpable gallbladder because of bile duct obstruction distal to the cystic duct. Laboratory findings typically show an elevation of alkaline phosphatase and bilirubin levels.
  • Pancreatic Disorders. Carcinoma of the head of the pancreas can manifest with painless jaundice caused by obstruction of the bile duct as it passes through the head of the pancreas. Weight loss, fatigue, and other constitutional symptoms often accompany the cholestasis. Cholestasis can also result from benign pancreatic disorders such as chronic pancreatitis resulting in pancreatic fibrosis leading to common duct narrowing and cholestasis or a pancreatic pseudocyst causing compression of the biliary tree.
  • Mirizzi's Syndrome. Mirizzi's syndrome is caused by an impacted cystic duct stone, leading to gallbladder distention and subsequent compression of the extrahepatic biliary tree. Occasionally, the gallstone erodes into the common hepatic duct, producing a cholecystocholedochal fistula. The original classification of Mirizzi's syndrome has been expanded to include hepatic duct stenosis caused by a stone at the junction of the cystic and hepatic ducts or as a result of cholecystitis, even in the absence of a obstructing cystic duct stone. Patients present with jaundice, right upper quadrant, pain and fever.
  • AIDS Cholangiopathy. Cholestasis can be seen in AIDS as a result of biliary ductal changes seen on a cholangiogram that resemble primary sclerosing cholangitis. The ductal strictures are believed to be caused by infections, including Cryptosporidium spp, cytomegalovirus, microsporidian, and Cyclospora spp. Patients present with right upper quadrant pain and laboratory tests suggesting cholestasis. A wide variety of other hepatobiliary abnormalities may also occur in those with HIV infection, including granulomatous liver disease from mycobacteria, fungi, or drugs, bacterial abscesses, neoplasms such as Kaposi's sarcoma or lymphoma, and drug toxicity.
  • Parasites. Extrahepatic biliary obstruction has been seen with various parasitic infections, such as Strongyloides and Ascaris spp, and liver flukes, such as Opisthorchis sinensisand Fasciola hepatica.
FURTHER INFORMATION ON INCREASED RISK GROUPS

The risk factors for biliary obstruction usually depend on the cause of the obstruction as previous outlined. The majority of the cases are a result of gallstones, making women more vulnerable to developing a biliary obstruction.

Other risk factors include:

  • A history of gallstones
  • Chronic pancreatitis
  • A history of tumors in the right part of the abdomen
  • An injury to the right part of the abdomen
  • Obesity
  • Rapid weight loss
  • Other diseases that can more likely cause biliary obstruction as outlined in the above section
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED
  • Initial diagnostic testing for cholangiocarcinoma is similar to that used for other causes of cholestasis.
  • Ultrasound examination, MRI, or CT scanning may reveal areas of focal biliary dilation. MRI is the optimal imaging study when cholangiocarcinoma is suspected.
  • Direct cholangiography with ERCP or PTHC cholangiography with brush cytology of the biliary tree can be useful for diagnosis, although the sensitivity for detecting malignancy with brush cytology is less than 75%.
  • Blood testing for cancer antigens, particularly CA19-9, has been shown to be useful in detecting cholangiocarcinoma, as has an index using CA19-9 and carcinoembryonic antigen (CEA). Neither method is highly sensitive or specific but can help confirm suspected cholangiocarcinoma.
  • Ampullary Tumors: Imaging studies of the biliary tree will often show dilation, suggesting a distal bile duct obstruction.
  • Pancreatic Disorders: CT scanning or ultrasound typically reveal biliary ductal dilation to the level of the pancreatic head and a pancreatic mass.
  • Mirizzi's Syndrome: Ultrasound or CT scanning reveals biliary dilation above the cystic duct. ERCP may reveal the obstructing stone, which can occasionally be removed, but the definitive treatment is usually surgical, consisting of cholecystectomy with surgical repair of the bile duct, if necessary.
  • AIDS Cholangiopathy: Initial evaluation should include ultrasound and ERCP if the ultrasound is abnormal. ERCP should also be carried out despite a normal ultrasound if there is evidence of severe abdominal pain.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field In contrast to other gallbladder-preserving minimally invasive or interventional methods, robotic is a one-session procedure avoiding the need for post-operative drainage of the gallbladder by a balloon catheter. Robotic cholecystectomy does not cause functional disturbances or severe bile duct injury, as is observed after cholecystectomy.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

Cholecystectomy through the belly button can be done using traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

FURTHER INFO
TECHNOLOGIES
OUR SURGEONS
OUR FACILITIES

© AIMIS 2017-2019 All Rights Reserved. | Site by GetNetty