Patient: Hello doctor! My mother had a cholecystectomy ten years ago, and seven days after the surgery, she discovered necrosis of the common bile duct and had an emergency hepaticoenteric anastomosis. One year after the surgery, she had three more surgeries for recurrent infections and had a drainage tube for a year. In the following years, he was hospitalized once every few months with anti-inflammatory and liver-protective drugs. This year, I have been hospitalized four times since July, and I have not seen any improvement after each medication. The doctor said that I was resistant to the medication and that I was allergic to the painkiller “6542” and “Pingxin” that I used before. In previous years, the onset of the disease was resolved by a week of anti-inflammatory drugs (cephalosporins) and liver-protective drugs at the hospital. It is the same as normal people. Usually one to two to see strong. Is there any way to relieve and improve this situation. Thank you Hepatobiliary Hospital Hepatobiliary Surgery Department: There may be recurrent biliary tract infections, special attention should be paid to the presence of the original bile-intestinal anastomosis stenosis or intrahepatic bile duct stones, it is recommended to check MRCP (magnetic resonance cholangiopancreatic duct imaging). If these conditions exist, medication alone will not solve the problem. Patient: Dr. Zhang, my mother’s MRI was done in June 2000 after her third surgery, and at that time there was no stenosis of the anastomosis nor intrahepatic bile duct stones. So is it possible that it has changed over the years? I asked for an MRI last month, but the hospital doctor said it would be fine without a CT, which showed air bubbles in the intrahepatic bile ducts. I’ll ask her to do it again in a few days to see the results. If it’s really that kind of situation can there be any solution? If not, how do we treat it. Thank you. Hepatobiliary Surgery at Hepatobiliary Hospital: A lot can change in 9 years! CT findings of intrahepatic bile duct gas accumulation is often one of the manifestations of intrahepatic biliary tract infection (of course, it can also originate from intestinal reflux), and its most important cause is the original biliary-intestinal anastomotic stricture, which can be basically clarified by MRCP. If there is indeed an anastomotic stricture, another surgery is usually required to resolve it. Patient: Dr. Zhang, two surgeries have been done for this anastomosis, can we do it again? Is there anything else I can do if I don’t have surgery? I will arrange for her to be hospitalized tomorrow for a full examination. If the phenomenon you described really exists and the doctor in Dalian can’t do it, can you come over? Or we can come over. Thank you. Hepatobiliary Surgery Department, Hepatobiliary Hospital: If there is still a suitable bile duct above the original bile-intestinal anastomosis area, it is possible to make the anastomosis bigger again, which will be determined by the specific imaging results. If there is anastomotic stenosis and you don’t want to do surgery, you can try PTCD+balloon dilation, but whether it will work or not is affected by the specific condition of the bile duct and the details of the operation. Bring the material to us when you have the exact result. Patient: Hi Dr. Zhang, the MRI results are back. The film shows: partial signal loss of the superior choledochopancreatic segment, dilated proximal common bile duct, dilated intrahepatic bile duct and right and left hepatic ducts with a maximum diameter of about 1.1 cm, absence of the gallbladder, no dilatation of the pancreatic duct, and normal alignment and signal. Diagnosis: MRCP plain scan suggests: gallbladder agenesis, proximal common bile duct and intrahepatic bile duct dilatation, please combine with medical history. Now the hospital in Dalian no way, the patient has been also uncomfortable back always pain, fasting for four days playing glucose are nausea, how to do ah. Hepatobiliary Hospital Hepatobiliary Surgery: You can send me the picture to see. It is estimated that the possibility of needing another surgery Patient: Hello Dr. Zhang, my mother was discharged from the hospital today, she still has back pain and discomfort in the liver area. She only drinks thin rice every day, and today, after eating a bite of steamed bread, she felt uncomfortable in the liver area, back pain, nausea, burping, and rumbling in her stomach. I’ve uploaded the pictures, please give them a look. Hepatobiliary Surgery Department of Hepatobiliary Hospital: The pictures have been read, and it can be seen that the common hepatic duct is narrowed and the left hepatic duct is narrowed and the left intrahepatic bile duct is dilated, but the structure of the cystic mass in the right front of the bile duct is yet to be confirmed, so it is suggested to pass the cross-sectional images again, or re-check the enhanced CT of the liver, and the barium meal examination of the upper gastrointestinal tract should be done as well. We also need to know the results of liver function, blood and urine amylase, CEA and CA19-9. Patient: Hi Dr. Zhang, I have just one picture in my hand, I will ask the hospital again. In addition, the liver function, blood count and gastroscopy checked during the hospitalization were normal. Doctor, can there be a good solution for her condition without surgery. Hepatobiliary Surgery Department, Hepatobiliary Hospital: In this case, there are indications for reoperation. If you don’t operate, you can only use cholestatic treatment, pay attention to your diet, and use herbal medicine appropriately, and then use antimicrobial agents when there is an acute inflammation.