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Article
The Role of Magnetic Resonance Imaging and Magnetic Resonance Cholangiopancreatography in Patients with Obstructive Jaundice
استخدام الرنين المغناطيسي وتلوين القنوات الصفراوية لدى مرضى اليرقان الانسدادي

Authors: Najeeb S. Jabbo د. نجيب صليوة جبو --- Ayad Mahmood Subhi د. اياد محمود صبحي --- Ra'ad H. AL-Kayat د. رعد حفظي الخياط
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2006 Volume: 19 Issue: 3 Pages: 253-258
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Abstract:Objectives: The aim of this study is to evaluate the sensitivity, specificity and diagnostic accuracy of magnetic resonance cholangio-pancreatography in patients with obstructive jaundice after comparing it with the final diagnosis after surgical exploration and histopathological study. Methods: This study was held at Al-Yarmouk Teaching Hospital where patients with obstructive jaundice were investigated with magnetic resonance cholangio-pancreatography followed by surgical exploration and confirmation of diagnosis. Comparison of both results was carried out.Results: There were 42 patients, 26 females and 16 males. Their mean age was 59 years. 17 patients had common bile duct stones, 17 had malignancy, 3 had hydatid cyst, 2 had benign stricture and one patient had Mirrizi`s syndrome, chronic liver disease and biloma for each. After comparison with the final diagnosis after surgical exploration, the sensitivity, specificity and diagnostic accuracy of magnetic resonance cholangio-pancreatography were 100%, 92% and 95.2% respectively for those with common bile duct stones, while they were 94.1%, 100% and 97.6% respectively for those with malignancy.Conclusion: Magnetic resonance cholangio-pancreatography is of high diagnostic accuracy when used for patients with obstructive jaundice of different causes. In addition to its characters of being a non-invasive technique that need neither specific preparation nor anesthesia. We recommend using it on a wider scale in our country.Keywords: Obstructive jaundice, diagnosis, MRCP

الملخص:الهدف: هدف هذه الدراسة هو تقييم حساسية ومدى الوثوق ودقة الشخيص لجهاز الرنين المغناطيسي في مستشفى اليرموك التعليمي في حالات اليرقان الأنسدادي وبعد المقارنة مع التشخيص النهائي بواسطة التداخل الجراحي مع أو بدون الفحص النسيجي.الطرق: اجريت هذه الدراسة التتبعية لحالات اليرقان الأنسدادي في مستشفى اليرموك التعليمي. أجري لجميع المرضى فحص الرنين المغناطيسي ثم تم متابعتهم بالأستكشاف الجراحي وتثبيت التشخيص بالتحليل النسيجي أو اعتمادا على الملاحظات الجراحية. النتائج: شملت الدراسة 42 مريضا ( 25 من الأناث و 16 من الذكور)0 معدل العمر كان 59 سنة0 عدد المرضى المصابين بالأورام الخبيثة وحصى قناة الصفراء 17 مريضا لكل منهم, 3 مصابين بالأكياس المائية ومريضين مصابين بتضيق قناة الصفراء0 بعد التحقق من التشخيص اعتمادا على نتائج الأجراء الجراحي كانت حساسية الفحص بجهاز الرنين المغناطيسي 100 % في حالات الحصى و9401 % في حالات الأورام0 أما دقة التشخيص فكانت95,2 % في حالات الحصى و97,6 % في حالات الأورام.الأستنتاج: أن الفحص بواسطة الرنين المغناطيسي لحالات اليرقان الأنسدادي ذو حساسية ودقة عالية وخالية من المضاعفات. بالأضافة الى أنها لا تحتاج الى التخدير ولا اجراء تحضيرات خاصة.


Article
The Role of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Obstructive Jaundice

Author: Safa Al-Obaidi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 1 Pages: 7-17
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Evaluation of jaundiced patients should include proper history and examination, laboratory investigation and imaging investigations (non invasive like US, CT and MRI or invasive like ERCP and PTC).AIM OF STUDY:The aim of this prospective study is to evaluate the role of US and MRI-MRCP in patients with obstructive jaundice in clinical practice.METHODS:This is a prospective study performed on 80 patients (42 female and 38 male) with an average age of 53 years presented with obstructive jaundice for whom abdominal ultrasound (US) and magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) performed in the departments of radiology in Al-Kadhemiyyah teaching hospital and Specialized surgical hospital and Baghdad teaching hospital from October 2003 to October 2005. The final diagnosis was found by endoscopic retrograde cholangiopancreatography (ERCP) and or surgery and confirmed by histopathology.RESULTS:The most common cause of obstructive jaundice in our study was tumors (41.25%) followed by common bile duct stones (36.25%) then benign strictures (13.75%), hydatid cyst (6.25%) & finally choledochal cyst (2.5%). In this study, MRI-MRCP could differentiate surgical from medical jaundice in all cases, while US could differentiate surgical from medical jaundice in 91.25% of cases. MRI-MRCP correctly defines the level of obstruction in all cases (100%).While US correctly define the level of obstruction in only 86.2 % of the total cases. MRI-MRCP correctly suggests the most possible cause of obstruction in 96.25% of cases. While US correctly suggests the most possible cause in only 36.2 %.CONCLUSION:So that US, as a screening modality is useful to confirm or exclude biliary dilatation & to choose patients for MRCP examination. MRI-MRCP is a useful non-invasive and essential method in the preoperative evaluation of patients with obstructive jaundice. In addition MRI-MRCP was superior to US or ERCP in studying the extent & staging of malignant lesions

Keywords

Ultrasound --- MRI --- MRCP --- Obstructive jaundice.


Article
Value of Magnetic Resonance Cholangiopancreatography Signs in the Detection of Choledocholithiasis

Author: Mohammed Abd Kadhim *, Farah Saad Ahmed**, Alaa Saud Sali***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2018 Volume: 17 Issue: 2 Pages: 157-163
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Common bile duct stones may be small or large, single or multiple, the incidence increases with age. Biliary stones present almost always as low signal intensity on MR images. Therefore, the stone is identified as a round or oval- shaped "signal void" within the common bile duct (CBD), surrounded by the high signal intensity bile, CBD stone can present as sharp cutoff of a CBD at the ampulla, often with a well-marginated “meniscus” configuration, CBD stone may be associated with CBD dilatation and/or dilated intrahepatic biliary tree.OBJECTIVE: To evaluate MRCP signs in detecting CBD stones in patients with obstructive jaundice. PATIENTS AND METHODS: The study included 50 patients with jaundice suspecting to have CBD stones as a cause of their complaint ,MRCP parameters include: CBD diameter, meniscus sign ,Status of intrahepatic and extrahepatic ducts, Gall bladder status, Pancreatic duct status Statistical analyses for the results were done. RESULTS: MRCP diagnose choledocholithiasis in 49(98%) out of 50 patients with a sensitivity of 98%, Accuracy =98%, the specificity of MRCP in diagnosing choledocholithiasis in our study was 95%, P value= 0.001. MRCP show filling defect in 31 patients (3 of them show multiple filling defects) giving Accuracy =62%, sensitivity rate 62%, specificity rate 90%, P value= 0.0001. MRCP show meniscus sign in 18 patients giving Accuracy =36%, sensitivity rate 36%, specificity rate 95%, P value= 0.0001. MRCP show CBD dilatation in 48 patients giving Accuracy =96%, sensitivity rate 96%, specificity rate 95%, P value= 0.001.CONCLUSION: MRCP is a non–invasive investigation with high sensitivity, specificity, positive and negative predictive values in detection of CBD stones. Gathering well-defined radiological signs of CBD stones in MRCP allows good diagnostic accuracy. CBD dilatation is the more sensitive sign of detecting CBD stone while meniscus sign is more specific sign for detecting CBD stone in MRCP..


Article
Bile Leak Management Following Laparoscopic Cholecystectomy

Author: Ali Abdulhaleem Kadhim Al-Eessa
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 3 Pages: 580 -587
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopy now is the gold standard technique for cholecystectomy. Post laparoscopic cholecystectomy (LC) bile leak may occur. This prospective studyincludes 38 patientsfrom a period of May 2014 to May 2016 in Hilla teaching general hospital to assess options of management of bile leakfollowing LC.Conservative supportive measures alone was successful in 20 patients.ERCP intervention applied in 9 patients with a stent application, papillatomy or CBD stone extractionwith subsequent resolution. Explorative laparotomy by expert surgical team was done for 9 patients with Roux-en-Y-hepaticojejunostomy as a result of iatrogenicmassive injury to main biliary duct. Mortality rate was zero.Male to female ratio was 2:1 for whole bile leaked patients, and 3:1 for patients treated with interventions. Post laparoscopic cholecystectomy bile leak can be managed conservatively with close monitoring in a start.MRCP is valuable noninvasive test to assess biliary duct system. ERCP as a diagnostic and therapeutic measure was effective minimal invasive approach to control leak. Laparoscopic cholecystectomy should be performed meticulously in order to avoid catastrophic biliary ductal injury with a wise conversion to open when indicated. Proper clipping technique of cystic duct is essential to avoid cystic duct leak.


Article
Management of Obstractive Jaundice Due to Common Bile Duct Stone in Baghdad Teaching Hospital
علاج اليرقان الانسدادي الناتج عن حصاة القناة الصفراوية المشتركة في مستشفى بغداد التعليمي

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Background: the most common cause of obstructive jaundice is CBD stones, and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution; several methods of investigations and treatment have been introduced, and each one has its own advantages and disadvantages.Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital.Patients and methods: a prospective study of 111 patients with clinical, laboratory, and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011; other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them, MRCP for 26 patients, and EUS for 9 patients. Four patients had primary stones, 95 patients had secondary stones, 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions, and they were excluded from the study, so the total number of the patients was 111; 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients, 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone (more than 15mm) Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries, because there is no intraoperative screening to avoid missing CBD stones in our hospital.Key wards: CBD stones, endoscopic management, surgical intervention

خلفيه الموضوع: اكثر اسباب اليرقان الانسدادي هو حصا القناه الصفراء,وهذا يمكن ان يولد مضاعفاه ووفياه مهمه.معالجه اليرقان الانسدادي الناتج من حصاه ه قناه الصفراء في تطور,عده طرق تشخيصيه وعلاجيه ادخلت في هذا الموضوع وكل منها له فوائده ومضاره.هدف الدراسه:لغرض دراسه وتقييم معالجه اليرقان الانسدادي الناتج عن حصاه القناه الصفراء في مستشفى بغداد التعليمي.المرضى والوسائط :دراسه مستقبليه مكونه من 111 مريض لديهم اعراض سريريه ونتائج مختبريه وصوريه تقترح وجود يرقان انسدادي ناتج عن حصاه القناه الصفراء عولجو في مستشفى بغداد التعليمي في الفتره من كانون الثاني 2011 الى تشرين الثاني 2011 14 مريض اخر ابعدو من الدراسه بسبب ثبوت ان سبب اليرقان الانسدادي لديهم كان باسباب اخرى.العمل المبذول لكل مريض كان اخذ تاريخ المرض والفحص السريري وفحوصات مختبريه فحص الامواج فوق الصوتيه (السونار) للبطن.نفس المرضى تعرضوا لعمليه تنظير القناه الصفراء لسببين لغرض التشخيص واستخراج حصاه قناه الصفراء .مريضين فقط ارسلوا مباشره الى العلاج الجراحي كان لديهم (متلازمه ميريزي).كذالك اجريت العمليات الجراحيه للمرضى الذين فشلت لديهم المعالجه الناظوريه.النتائج:من ال125 مريض الذين لديهم يرقان انسدادي والذين انضموا لهذه الدراسه ,14مريض لديهم اسباب غير حصاه القناه الصفراء ابعدوا من هذه الدراسه, فاصبح العدد الكلي للمرضى 111 مريض46 ذكر و65 انثى .جميع المرضى ليهم اعراض سريريه ولديهم نتائج تحاليل وظائف كبد غير طبيعيه , اجري الفحص السوناري لجميع المرضى ,وفحص الرنين المغناطيسي للقنوات الصفراء والبنكرياس اجري ل26 مريض وفحص السونار عن طريق ناظور المعده والاثني عشر ل9 مرضى ,4 مرضى كان لديهم حصاه القناه الصفراء الاوليه, 95 مريض كان لديهم حصاه القناه الصفراء الثانويه , 9 مرضى كان لديهم حصاه القناه الصفراء المحفوظه , و3 مرضى لديهم (متلازمه ميريزي ).المعالجه المنظاريه اجريت ل 108 مريض نجحت في 90% من المرضى.العلاج الجراحي اجري ل 13 مريض 10 منهم بعد فشل العلاج المنظاري و3 مرضى كان لديهم (متلازمه ميريزي) .الاستنتاجات:العلاج الناظوري لاستخراج حصاه القناه الصفراء المتبوع برفع المراره ما زال الطريقه الرشيده في علاج حصاه القناه الصفراء . حصاه القناه الصفراء الكبيره وتعددها ما زالا الاسباب الاكثر شيوعا لفشل العلاج المنظاري لاستخراج حصاه القناه الصفراء والعلاج الجراحي ,في هذه الدراسه كان هنالك نسبه حصاه محفوظه في القناه الصفراء اعلى من الدراسات المذكوره في الدول الغربيه,بسبب عدم وجود فحوصات خلال العمليه تجرى لغرض تشخيص حصاه القناه الصفراء لغرض تلافي ترك حصا في القناه الصفراء في مستشفانا مفتاح الكلمات: حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

Keywords

Background: the most common cause of obstructive jaundice is CBD stones --- and these can produce significant morbidity and mortality. The management of the obstructive jaundice due to CBD stones is in evolution --- several methods of investigations and treatment have been introduced --- and each one has its own advantages and disadvantages. Objective: to study and evaluate the management of obstructive jaundice due to CBD stones in Baghdad teaching hospital. Patients and methods: a prospective study of 111 patients with clinical --- laboratory --- and imaging features suggestive of obstructive jaundice due to CBD stones who were managed in Baghdad teaching hospital over the period from January 2011 to November 2011 --- other 14 patients with obstructive jaundice due to other causes were excluded. . All patients were symptomatic and had abnormal liver function tests. Transabdominal US was done for all of them --- MRCP for 26 patients --- and EUS for 9 patients. Four patients had primary stones --- 95 patients had secondary stones --- 9 patients had retained stones and 3 patients had Mirizzi syndrome.Those patients were subjected to ERCP both to prove the diagnosis and extract the CBD stones. Only three patients sent directly for surgical treatment because they were diagnosed as Mirizzi syndrome. Surgical treatment also was offered for those patients in whom endoscopic management failed. Results: from the 125 patients presented with obstructive jaundice included in this study 14 patients were found to have a periampullary lesions --- and they were excluded from the study --- so the total number of the patients was 111 --- 46 males and 65 females Endoscopic management was done for 108 patients with success rate of 90%. Surgical treatment was required in 13 patients --- 10 of them following failure of ERCP and the other 3 patients were those with Mirizzi syndrome. The most common complication of ERCP was acute pancreatitis and the most common cause of failure to extract the stones was the size of stone --- more than 15mm Conclusions: Endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy is still considered the orthodox treatment of CBD stones. Large and multiple CBD stones are the most common causes of failure of endoscopic extraction and indication for surgical treatment. There was higher incidence of retained CBD stones in our study than what was reported in western countries --- because there is no intraoperative screening to avoid missing CBD stones in our hospital. Key wards: CBD stones --- endoscopic management --- surgical intervention --- حصاة القناة الصفراوية المشتركة، العلاج الناظوري، التداخل الجراحي

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