01 August 2011
Obstructive jaundice and cholangitis caused by an arterial ring of the proper hepatic artery around the common bile ductDragoljub BilanovicABD, Darko ZdravkovicABDF, Borislav ToskovicBDF, Tomislav RandjelovicAD, Srdjan DikicDF, Blagoje DjukanovicDF, Marija ZdravkovicEF
Med Sci Monit 2011; 17(8): CS91-93
Background: Many 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 Report: We 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.
Conclusions: If 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.
Keywords: Common Bile Duct - surgery, Cholangitis - surgery, Angiography - methods, Hepatic Artery - surgery, Jaundice, Obstructive - surgery
01 June 2023 : EditorialEditorial: Infectious Disease Surveillance Using Artificial Intelligence (AI) and its Role in Epidemic and Pandemic Preparedness
Med Sci Monit 2023; 29:e941209
08 Jun 2023 : Clinical ResearchRisk Factors for New Vertebral Compression Fracture After Percutaneous Vertebral Augmentation: A Retrospect...
Med Sci Monit In Press; DOI: 10.12659/MSM.940134
08 Jun 2023 : Clinical ResearchA Nomogram for Identifying HR+/Her2- Breast Cancer Patients with Positive Sentinel Lymph Nodes and Omitted ...
Med Sci Monit In Press; DOI: 10.12659/MSM.940124
08 Jun 2023 : Clinical ResearchBurden of COVID-19 on Mental Health of Resident Doctors in Poland
Med Sci Monit In Press; DOI: 10.12659/MSM.940208
08 Jun 2023 : Clinical ResearchRisk Prediction for Rapidly Progressive Interstitial Lung Disease in Anti-MDA5-Positive Dermatomyositis: Th...
Med Sci Monit In Press; DOI: 10.12659/MSM.940251
Most Viewed Current Articles
13 Nov 2021 : Clinical ResearchAcceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical ResearchRetrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...
Med Sci Monit 2021; 27:e935379
08 Mar 2022 : Review articleA Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...
Med Sci Monit 2022; 28:e936292
01 Jan 2022 : EditorialEditorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...
Med Sci Monit 2022; 28:e935952