After cholecystectomy complications can occur in 15%. Identification and management of bile duct injuries is very important. This question and subsequent discussion has been routinely asked in many exams
Q) Supraduodenal CBD is supplied by all except (AIIMS NOV 18) a Cystic art b RHA c LHA d Anterosuperior pancreaticoduodenal artery
Ans c
The blood supply to the right and left hepatic ducts and upper portion of the CHD is from the CA and the right and left hepatic arteries.
The supraduodenal bile duct is supplied by arterial branches from the right hepatic, cystic, posterior superior pancreaticoduodenal, and retroduodenal arteries.
arteries to the supraduodenal bile duct run parallel to the duct at the 3 and 9 o’clock positions.
Approximately 60% of the blood supply to the supraduodenal bile duct originates inferiorly from the pancreaticoduodenal and retroduodenal arteries
whereas 38% of the blood supply originates superiorly from the right hepatic artery and CD artery
Q) Which statement is not true about recurrent pyogenic cholangitis :
a) Mostly there are intrahepatic strictures with involvement of the left side duct
b) It can present as choledocho duodenal fistula
c) There is complete biliary obstruction which leads to marked jaundice and pruritis
d) MRCP and other other cholangiography can be diagnostic
Answer c
In recurrent pyogenic cholangitis (RPC) complete obstruction does not occur and jaundice and pruritis is not marked.
RPC is a disease commonly seen in young Asians (also known as oriental cholangiohepatitis) which leads to multiple strictures in extra or intrahepatic ducts.
Men and women are equally affected, and, historically, the disease strikes at an early age (20–40 years) in patients from lower socioeconomic classes.
Cause for recurrent pyogenic cholangitis
Association with Ascaris lumbricoides and Clonorchis sinensis has been noted.
Stones and strictures
Clinical Presentation of Recurrent pyogenic Cholangitis
It can present as choledocholithiasis with stricture, choledochoduodenal fistula, acute pancreatitis, secondary biliary cirrhosis and can lead to cholangiocarcinoma.
Radiology for Recurrent Pyogenic Cholangitis
MRCP can be diagnostic and is preferred because of its non invasive nature.
Surgical treatment
Goal is to clear the biliary tree and to bypass or resect the strictures
