BACKGROUND: Periampullary tumours (PAT) may cause obstruction of distal choledochus. The bile stasis is a risk factor for microbial colonisation of bile (bacteriobilia), cholangitis, hepatic insufficiency and coagulopathy. PAT obstruction can be managed surgically or non-operatively - by inserting a biliary drain or stent (BDS). Although BDS allows for adequate bile drainage, liver function restitution and coagulopathy, increased bacteriobilia has been reported and this is associated with an increased incidence of postoperative complications. METHODS: A monocentric, prospective, comparative study including 100 patients operated with PAT. The effects of bacteriobilia and the presence of a drain in the biliary tract on the development of postoperative complications were evaluated. RESULTS: Positive microbial findings in bile were found in 67% of patients. It was 98% in the biliary drain group vs. 36% in non-drained patients (p = 0.0001). In 68% 2 or more different bacterial strains were simultaneously present (p = 0.0001). Patients with a positive microbial finding in bile had more frequent incidence of infectious complications 40.2% (27) vs. 9.1% (3); p = 0.0011. The most frequent infectious complication was wound infection 29.8% (20) vs. 3.03% (1); p = 0.0014. Similarly, a higher incidence of postoperative infectious complications occurred in patients with BDS - 36% (18) vs. 24% (12); p = 0.2752. CONCLUSION: The presence of a drain or stent in the biliary tract significantly increases the microbial colonisation of bile. It is associated with a significant increase in infectious complications, especially infections in the wound.

• Klíčová slova
• Bacteriobilia, Complications, Periampullary tumor,
• MeSH
• cholangitida * epidemiologie   etiologie   chirurgie   MeSH
• cholestáza * MeSH
• lidé MeSH
• nádory * MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• prospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, which was subsequently treated endoscopically. Fish bones are one of the most commonly encountered swallowed foreign bodies. However, involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult, and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis, and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.

• Klíčová slova
• Biliary complications, Common bile duct, Endoscopy, Fish bone, Foreign body, Papilla of Vater,
• MeSH
• cholangiopankreatografie endoskopická retrográdní MeSH
• cholangitida * etiologie   MeSH
• jídla MeSH
• lidé MeSH
• žlučové kameny * MeSH
• žlučové ústrojí * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PRACTICAL RELEVANCE: Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES: Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE: The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.

• Klíčová slova
• IBD, Triaditis, cholangitis, inflammatory bowel disease, pancreatitis,
• MeSH
• cholangitida diagnóza   epidemiologie   etiologie   veterinární   MeSH
• idiopatické střevní záněty diagnóza   epidemiologie   etiologie   veterinární   MeSH
• kočky MeSH
• komorbidita MeSH
• nemoci koček diagnóza   epidemiologie   etiologie   MeSH
• pankreatitida diagnóza   epidemiologie   etiologie   veterinární   MeSH
• prevalence MeSH
• zvířata MeSH
• Check Tag
• kočky MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Surgical factors and direct cytotoxicity of bile salts on cholangiocytes may play a role in the development of ischemic cholangiopathy (IC) after liver transplantation (LTx). There is no validated consensus on how to protect the bile ducts during procurement, static preservation, and LTx. Meanwhile, IC remains the most troublesome complication after LTx. AIM: To characterize bile duct management techniques during the LTx process among European transplant centers in cases of donation after brain death (DBD) and circulatory death (DCD). METHOD: An European Liver and Intestine Transplant Association-European Liver Transplant Registry web survey designed to conceal respondents' personal information was sent to surgeons procuring and/or transplanting livers in Europe. RESULTS: Sixty-five percent of responses came from large transplant centers (>50 procurements/y). In 8% of DBDs and 14% of DCDs the bile duct is not rinsed. In 46% of DBDs and 52% of DCDs surgeons prefer to remove the gallbladder after graft reperfusion. Protocols concerning preservation solutions (nature, pressure, volume) are extremely heterogeneous. In 54% of DBDs and 61% of DCDs an arterial back table pressure perfusion is performed. Steroids (20%-10%), heparin (72%-60%), prostacyclin (3%-7%), and fibrinolytics (4%-11%) are used as donor-protective interventions in DBD and DCD cases, respectively. In 2% of DBD and 6% of DCD cases a hepatic artery reperfusion is performed first. In 4% of DBD and 6% of DCD cases, fibrinolytics are administered through the hepatic artery during the bench and/or implantation. CONCLUSION: This European web survey shows for the first time the heterogeneity in the management of bile ducts during procurement, preservation, and transplantation in Europe. In the context of sharing more marginal liver grafts, an expert meeting must be organized to formulate guidelines to be applied to protect liver grafts against IC.

• MeSH
• cholangitida etiologie   MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• odběr tkání a orgánů škodlivé účinky   metody   MeSH
• perfuze škodlivé účinky   metody   MeSH
• pooperační komplikace etiologie   MeSH
• přežívání štěpu MeSH
• průzkumy a dotazníky MeSH
• reperfuze škodlivé účinky   metody   MeSH
• transplantace jater škodlivé účinky   MeSH
• uchovávání orgánů škodlivé účinky   metody   MeSH
• žlučové cesty krevní zásobení   transplantace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in children. PATIENTS AND METHODS: Fourteen pediatric patients, with traumatic or postoperative bile duct injury, in which ERCP was performed, were retrospectively evaluated. RESULTS: We performed 46 ERCP and 12 endoscopic papillotomies in children with suspected bile duct injuries. A bile stent was primarily inserted in 13 patients and there were 20 replacements. Endoscopic treatment of bile leakage without need for bile duct sutures or reconstruction was successful in 85.7%. Post ERCP complications included cholangitis and recurrent bleeding, which occurred only in two patients each. CONCLUSIONS: ERCP and endoscopic bile stent insertion is a highly effective, minimally-invasive treatment for bile duct injury and should be included as part of the therapeutic procedures in pediatric patients with suspected bile duct injury.

• Klíčová slova
• Bile duct trauma, ERCP, bile duct stenting,
• MeSH
• cholangiopankreatografie endoskopická retrográdní * MeSH
• cholangitida etiologie   MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• nemoci žlučových cest chirurgie   MeSH
• pooperační komplikace chirurgie   MeSH
• pooperační krvácení etiologie   MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• sfinkterotomie endoskopická MeSH
• stenty MeSH
• výsledek terapie MeSH
• žlučové cesty zranění   chirurgie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

AIM: A retrospective assessment of the post-surgical and long-term results of the high biliodigestive anastomoses constructed using the authors' own technique modification. METHODOLOGY: This study evaluates 25 patient cases during an 8-year-period. The patients had high biliodigestive anastomosis affixed due to the clinically manifested obstructive icterus or due to repetitive attacks of cholangitides. The underlying causes of the attacks were malignancies of the ductus hepatocholedochus in 13 cases, a stricture of the ductus hepatocholedochus following the drainage according to Kehr in 1 case, an inflammative stenosis of the ductus hepatocholedochus during choledocholithiasis in 1 case, the Mirizzi syndrome in 2 cases, a cyst of the ductus hepatocholedochus in 2 cases, a stricture of the ductus hepatocholedochus following choledochoduodenoanastomosis in 4 cases, hepaticolithiasis in 1 case, a status after cholecystogastrostomy in 1 case, and a status after ductus hepatocholedochus contusion in 1 case. The immediate post-surgical progress and complications and the long-term survival rate, as well as any signs of the intrahepatic cholestasis, were assessed. RESULTS: Out of the 13 cases of the hepatochodochus malignancy, in 5 cases it was resected and only in 8 cases a paliative anastomosis was performed. A classical hepaticojejunoanastomosis was performed in 14 cases, anastomosis according to Hepp-Couinaud in three cases, the Smith telescopic anastomosis in 2 cases, the Hutson loop in 4 cases, an anastomosis to the biliary duct in the recess of Rex in 2 cases. In 2 cases a post-surgical biliary fistula, once multiple liver abscesses, in 3 cases exitus due to the malignancy progress during hospitalization and once a suppurative inflammatory process in the wound appeared. Two female patients who underwent resection of the ductus hepatocholedochus due to a malignancy have been surviving for 12 and 66 months. None of the 12 patients who underwent hepaticojejunoanastomoses due to benign strictures had signs of the post-surgical cholestasis. One female patient died after 13 months following the surgery due to the cardial causes. CONCLUSION: The paliative hepaticojejunoanastomosis without malignancy resection is followed by a short-term survival rate. Only following the simultaneous ductus hepatocholedochus resection, an exceptional case of a long-term patient survival may be expected, with a questionable curative effect. The hepatojejunoanastomosis construction according to our modification never caused a biliary fistula. The both cases of anastomoses to the biliary duct in the recess of Rex caused a transient biliary fistula. If in doubts about the long-term function of the anastomosis, the Hutson loop application appears to be of advantage.

• MeSH
• anastomóza chirurgická MeSH
• cholangitida etiologie   chirurgie   MeSH
• dospělí MeSH
• ductus hepaticus communis chirurgie   MeSH
• jejunum chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory žlučových cest komplikace   MeSH
• obstrukční žloutenka etiologie   chirurgie   MeSH
• paliativní péče MeSH
• pooperační komplikace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• MeSH
• absces etiologie   MeSH
• cholangitida etiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sfinkterotomie endoskopická škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• cholangitida etiologie   MeSH
• ductus choledochus chirurgie   MeSH
• duodenum chirurgie   MeSH
• kineradiografie MeSH
• lidé MeSH
• metody MeSH
• pankreatitida chirurgie   MeSH
• pooperační komplikace MeSH
• žlučové kameny chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• cholangitida etiologie   MeSH
• dospělí MeSH
• duodenum chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace * MeSH
• senioři MeSH
• žlučové cesty chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH