Arterial Ring Encircling the Bile Duct with Coexisting Anomalous Liver Irrigation

Dušanović, Aleksandar M.; Ignjatović, Dejan; Knežević, Paja A.; Todorović, Milorad; Krgović, K; Filipović, Branislav

doi:10.1159/000018697

Cited by 4 publications

(2 citation statements)

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“…Son pocos los casos descritos de estenosis de vía biliar congénita. Existen 4 casos publicados de obstrucción de vía biliar por anillo vascular, todos en adultos: uno en que se describe el reemplazo de la arteria hepática derecha por 2 arterias segmentarias que forman un anillo vascular alrededor del conducto hepá-tico común pero sin ictericia 3 , el segundo de una mujer 68 años que se hospitaliza por un cuadro de colangitis, y dentro de su estudio se determina la presencia de una dilatación intra y extra hepática, secundaria a un anillo vascular de la arteria hepática común, proveniente de la arteria mesentérica superior 3 , otro de un hombre 63 años con ictericia colestásica causada por anillo vascular esclerótico de la arteria hepática derecha 9 y el cuarto es un caso descrito en una revista de anatomía patológica como hallazgo en un cadáver 10 . Tanto estos casos, como otros casos de estenosis idiopática de vía biliar se resolvieron con una derivación biliodigestiva en Y de Roux 4,11 .…”

Section: Discussionunclassified

Estenosis crítica de conducto hepático común por anillo vascular: reporte de un caso

Larraín¹,

Chaimovich²,

Villanueva³

2014

Rev. chil. pediatr.

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Common bile duct stricture caused by vascular ring: a case report introduction: The most common congenital malformations of the bile duct are biliary atresia and choledochal cyst. In addition, the most common liver anatomical variation is the right hepatic artery aberration. The goal of this study is to characterize a patient with this disease and propose the hepatoduodenal anastomosis as surgical treatment. Case report: One-month-old patient with suspected congenital biliary atresia due to progressive jaundice and acholia since birth. Liver tests consistent with a cholestatic pattern and brain MRI scan consistent with biliary atresia. Periods of decreased bilirubin and sporadic slight pigmentation of depositions were described. The surgical finding was a bile duct stricture due to a vascular ring caused by aberrant right hepatic artery. Resection of bile duct and hepatic-duodenal bypass were performed. The patient evolved satisfactorily from this condition. Conclusion: There are few reports of biliary obstruction due to vascular malformations. It is important to keep in mind that not all neonatal jaundice episodes are caused by biliary atresia or choledochal cyst. The clinical course, laboratory tests and imaging should be considered and in the case of suspicion, further exploration should take place. (Key words: Biliary stenosis, vascular ring, hepato-duodenal anastomosis, biliary atresia). Rev Chil Pediatr 2014; 85 (5): 594-598 resUmen introducción: Las malformaciones congénitas de la vía biliar más frecuentes son la atresia de vías biliares y quiste de colédoco. Por otro lado, la variante anatómica hepática más común es la aberración de la arteria hepática derecha. El objetivo es caracterizar un paciente portador de esta patología y plantear la hepato-duodeno anastomosis como tratamiento quirúrgico. Caso clínico: Paciente de 1 mes de edad, con sospecha de Atresia de Vía Biliar congénita por ictericia progresiva y acolia desde recién nacido. Pruebas hepáticas concordantes con un patrón colestásico y resonancia magnética compatible con atresia de vías biliares. Evolucionó con períodos de descenso de bilirrubina y leve pigmentación, esporádica, de deposiciones. El hallazgo quirúrgico fue una estenosis crítica de vía biliar a nivel del conducto hepático común debido a un anillo vascular por una arteria hepática derecha aberrante. Se realizó una sección de vía biliar y una derivación hepato-duodenal. Evolucionó con una resolución completa de su patología. Conclusión: Existen pocos reportes de obstrucción de vía biliar por malformaciones vasculares. Es importante tener presente que no todas las ictericias neonatales son por atresia de vías biliares o quiste de colédoco. Se debe considerar la evolución clínica, laboratorio e imágenes, y si existen sospechas, explorar. (palabras clave: Estenosis vía biliar, anillo vascular, hepático-duodeno anastomosis, atresia vía biliar). Rev Chil Pediatr 2014; 85 (5): 594-598 CASOS CLíNICOSRev

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Section: Discussionunclassified

Estenosis crítica de conducto hepático común por anillo vascular: reporte de un caso

Larraín¹,

Chaimovich²,

Villanueva³

2014

Rev. chil. pediatr.

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“…Aneurysm of the hepatic artery can also cause obstructive jaundice [9]. Dusanovic et al reported a missing right branch of the hepatic artery that was replaced by 2 segmental arteries, so that these segmental arteries formed an arterial ring around the common hepatic duct, thus completely encircling it, but without jaundice [10]. We are reporting a case complicated with symptoms of cholangitis, of a complete arterial ring around the CBD caused by the proper hepatic artery which originated from the superior mesenteric artery.…”

Section: Discusionmentioning

confidence: 99%

Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile duct

et al. 2011

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SummaryBackgroundMany different benign and malignant diseases can cause obstruction of the extrahepatic biliary duct. One of the more serious complications of biliary obstruction is cholangitis leading to emergency decompression. Anatomic variations are frequent in this region; however, it has rarely been reported that the extrahepatic bile duct is compressed by the arterial vessels.Case ReportWe present the case of a 68-year-old woman who was admitted through the emergency department of our hospital with jaundice, abdominal pain and fever. Biochemical analyses of liver function showed increased value of AST (113 IU/L) and AST (128 IU/L). Total bilirubin was 5.88 mg/dl, conjugated bilirubin was 3.00 mg/dl, and alkaline phosphatase was 393 IU/L. We performed abdominal ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), and computed tomography (CT) imaging. Multislice CT angiography showed that the arterial ring of the common hepatic artery around the common bile duct (CBD) originated from the superior mesenteric artery. Cholecystectomy and intraoperative cholangiography were performed, as well as decompression and lavage of the biliary tree. Escherichia coli was identified from bile. Dissection of the hepatoduodenal ligament confirmed that the proper hepatic artery made a vascular ring around the CBD. Finally, a T tube was placed into the CBD. During 5 years of follow-up the patient has been without recurrent episodes of jaundice. In such cases dissection of the proper hepatic artery from the common hepatic duct is the treatment of choice.ConclusionsIf there are signs of cholangitis decompression and lavage of the biliary tree with “T”, drainage should be performed. Vascular malformations should be considered as a possible cause of extrahepatic biliary obstruction. CT angiography may be helpful in identifying these malformations.

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Bile Duct Compression and Stenosis Due to Anomalies and Acquired Disorders of the Splanchnic Arterial Tree and the Portal Venous System

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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Arterial Ring Encircling the Bile Duct with Coexisting Anomalous Liver Irrigation

Cited by 4 publications

References 9 publications

Estenosis crítica de conducto hepático común por anillo vascular: reporte de un caso

Estenosis crítica de conducto hepático común por anillo vascular: reporte de un caso

Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile duct

Bile Duct Compression and Stenosis Due to Anomalies and Acquired Disorders of the Splanchnic Arterial Tree and the Portal Venous System

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