Re: Inspisated Bile extending from Gall Bladder into both cystic and common bile ducts.

Richard Larkin — Wed, 07 Nov 2012 22:57:00 GMT

Thanks Rajat, That's pretty much how I see it. I am personally inclined to start treating medically initially , monitoring as described. I would not be confident in gall bladder stoma surgery or cholecystectomy, and not sure the latter would sort out the inspisated bile in the ducts unless I could Catherise the duodenal papilla to flush it out successfully. Considered doing a cystotomy and milking / flushing the ducts in which ever direction was possible; bit nervous that would not suffice if the gallbladder was was knackered and also of recurrence. Happier scanning gallbladders et al than operating on them! Work at the blue cross in Grimsby so referral within charity may be possible . Once again cheers, Richard

Re: Inspisated Bile extending from Gall Bladder into both cystic and common bile ducts.

Rajat — Wed, 07 Nov 2012 22:06:17 GMT

Hi Richard

While I am no expert, I would say what you describe is an emergency surgery waiting to happen. If it wasn't a mucocoele then great, but that bile is likely to be an issue sooner rather than later. The fact there is distension means there is stasis and expansion of the ducts via this bile and it is unlikely to move. Destolit is what I normally use in these types of cases where I am not concerned about total obstruction or where I feel there is a decent chance of things moving. The risk of rupture in the face of obstruction is probably overstated so I have no major issues using it, and if you choose to treat medically, like you I'd monitor closely with US prob once-twice weekly while checking T.bilirubin with a similar frequency.Any increase in CBD diameter would prompt a major rethink and likely surgery.

But on the other hand, for what you'll have to charge for medical monitoring in this case, over say 2 months, you could probably sort via cholecystectomy or choleduodenostomy - altho I am not sure the latter is a good procedure for a case where bile gets this inspissated and I would wager removing the offending organ is the way to go. I can't see the benefit of waiting if the surgery can be done.

I have this op on my to do list! I have done it on a cadaver-not to be taken lightly but if you are of strong surgical leanings and confident, and practise on a coupla cadavers before the op, and you are the dogs only option, then it may be worth considering..personally, I would suggest calling in a friendly surgeon, who will do it at charity prices or referring it to a charity hospital that does these kind of ops. I know there are a few around eg PDSA/blue cross type places. Where are you based?

Sorry if this is disjointed, I am knackered !

Cheers

Raj