Surgical Diseases of the Pancreas and Biliary Tree (original) (raw)
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Bile duct cyst type V (Caroli's disease): surgical strategy and results
HPB, 2007
Background. Caroli's disease (CD) is a benign congenital disorder characterized by segmental cystic dilatation of the intrahepatic biliary ducts. Therapeutic strategy includes medical treatment, percutaneous, endoscopic or surgical drainage of the affected bile ducts, liver resection or transplantation. The aim of this study was to analyse the results and long-term follow-up of a consecutive series of patients who underwent surgical treatment for CD. Patients and methods. Between 1995 and 2005, 10 patients were surgically treated for CD. Variables evaluated were: age, gender, clinical presentation, diagnostic procedures, percutaneous and surgical treatments, histopathological analysis and outcome. Results. The average age of the patients was 45.8 years. Recurrent cholangitis was the main clinical manifestation (70%). In unilateral CD a liver resection was performed in nine patients (left lateral sectionectomy in seven, left hepatectomy in one and right hepatectomy in one). In bilateral disease a cholecystectomy, duct exploration, hepaticojejunostomy and liver biopsy of both lobes were performed. Average follow-up was 60 months. All the patients are alive and free of symptoms without recurrence in the remnant liver. Discussion. Liver resection is the preferred therapeutic option for unilateral CD, demonstrating good results in long-term follow-up. In bilateral disease, hepaticojejunostomy could be considered as an alternative or a previous step to liver transplantation, which still remains the ultimate option.
Bile duct cysts: A changing spectrum of presentation
Journal of Hepato-Biliary-Pancreatic Surgery, 1996
Since the report of our early experience in 1984, the clinical management of 33 patients (23 adults, 10 children) with bile duct cysts has been reviewed. The mean age was 28 years, and female preponderance was observed. Complicated clinical presentations (namely, cholangitis) and coexistent hepato-biliary-pancreatic diseases (present in 45 % of the patients) were encountered more frequently in adult patients and those who had had previous cyst enteric drainage operations. Pancreatitis occurred in 27% and cyst-associated malignancy in 9%, with 2 patients alive 29 and 125 months, respectively, postoperatively after curative resection. Cyst type included type I, 58%; type II, 3%; and type VIA, 33%. Anomalous biliary-pancreatic junction (as a long common channel in 18 patients) was observed in 19 patients in whom the anatomy was documented. Eighteen patients (group I) underwent primary extrahepatic cyst excision, and 15 patients (group II) with previous cyst-related operations (35 previous surgical procedures) underwent secondary cyst excision. Mortality was nil, but postoperative morbidity was significantly higher in group II. During a mean follow-up of 51 months, satisfactory results were observed in 94% of the patients. In conclusion, primary complete cyst excision of extrahepatic component is recommended as the treatment of choice, achieving satisfactory clinical results in the majority of patients. The clinical spectrum of the disease has changed in our experience because of the routine use of early cyst excision in patients with bile duct cysts.
Choledochal cysts: presentation, clinical differentiation, and management
Journal of the American College of Surgeons, 2014
Choledochal cysts (CC) are a rare congenital cystic dilation of the biliary tract, first described by Vater and Ezler in 1723. 1 They present primarily in female infants and young children and are more prevalent in East Asian populations. Although benign, CC can be associated with serious complications including malignant transformation, cholangitis, pancreatitis, and cholelithiasis. 2 We herein provide a state-of-the-art, evidence-based review of CC with particular emphasis on clinical differentiation and approach to management. A search of the available electronic databases, including MEDLINE/ Pubmed, using the term choledochal cyst as well as under the MeSH database subheading choledochal cyst, was performed. Criteria for inclusion included English articles (Fig. 1). Incidence and epidemiology Approximately 80% of CC are diagnosed in infants and young children within the first decade of life. 3,4 The incidence of CC ranges from 1 in 100,000 to 1 in 150,000 individuals in Western countries 5 to 1 in 13,000 individuals in Japan. 6 Choledochal cysts are 4 times more common in females. 2,7,8 Although the exact etiology is unknown, anomalous pancreaticobiliary duct union (APBDU) is seen in 30% to 70% of all CC where the common bile duct (CBD) and pancreatic duct junction occurs outside the duodenum, allowing reflux of pancreatic fluid into the biliary tree. 9-13 The exposure of biliary epithelium to digestive and caustic pancreatic enzymes may contribute to CC formation. In 1969, Babbitt 14 initially described APBDU, and it is believed to be secondary to arrest in migration of the choledochopancreatic junction into the duodenal wall, leading to a long common channel
Choledochal cysts: diagnosis and treatment
2012
The aim of this study is to show the different diagnostic procedures and treatment in patients diagnosed with congenital choledochal cysts. Choledochal cysts are congenital anomalies of the bile ducts and include cystic dilatation of the extrahepatic and intrahepatic biliary ducts or both. The study shows ten patients diagnosed as having choledochal cysts. Diagnosis was established by clinical and radiographic findings including: ultrasound (US), magnetic resonance cholangiopancreatograpy (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and cytological examination of the bile juice. In the study choledochal cysts were classified according to the Todani classification. Most common cysts were type I (six cases); type III (one case), type IVa (one case) and two patients were type V cysts (Caroli disease). The most frequent symptoms were abdominal pain, jaundice and cholangitis. US findings were sensitive for the preliminary ...
Pediatric Gastroenterology, Hepatology & Nutrition, 2014
Purpose: Choledochal cyst is a cystic dilatation of common bile duct. Although the etiology is presently uncertain, anomalous pancreaticobiliary ductal union (APBDU) is thought to be a major etiology of choledochal cyst. In this study, we analyzed the clinical and anatomical characteristics and pathologies of patients diagnosed with choledochal cyst in a single institute for 25 years. Methods: A total of 113 patients, diagnosed with choledochal cyst and who received an operation in Severance Children's Hospital from January 1988 to May 2013, were included. Medical records were reviewed, including clinical and demographic data, surgical procedures. Abdominal ultrasonography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography were used as diagnostic tools for evaluation and classification of choledochal cyst and the presence of anomalous pancreaticobiliary ductal union. Todani's classification, and relationship between APBDU and surgical pathology. Results: Among 113 patients, 77 patients (68.1%) presented symptoms such as hepatitis, pancreatitis and/or cholecystitis. Eighty three patients (73.5%) had APBDU, and 94 patients (83.2%) showed inflammatory pathologic changes. APBDU, pathologic inflammation, and serological abnormalities such as hepatitis or pancreatitis showed a statistically significant correlation to one another. Conclusion: APBDU is thought to be one of the etiologic factors of choledochal cyst. It is related to the inflammatory changes in bile duct that can lead to the cystic dilatation.
Unusual Presentations of Choledochal Cyst: Case Series and Review of Literature
Indian Journal of Surgery, 2014
Congenital cystic dilation of the biliary duct is defined as choledochal cyst (CDC). CDC presenting with the classical triad of abdominal pain, lump, and jaundice is s e e n i n o n l y 6 % c a s e s. C y s t e x c i s i o n w i t h hepaticojejunostomy is the standard treatment worldwide. We hereby report five cases of CDC with unusual presentations (gastric outlet obstruction, cyst perforation, giant cystolithiasis, giant cyst, and mixed type) and discuss the challenges faced during the diagnosis and perioperative management of these cases. diagnosis and management. Herein, we report five cases of CDC who had unusual features on presentation. Case Series Of the 29 cases of CDC managed between January 2009 and December 2013, 5 (17.2 %) cases had unusual presentation. Case 1 A 12-year-old girl presented with history of pain in the abdomen for 2 years and recurrent bilious vomiting for 7-months duration. Upper gastrointestinal endoscopy showed dilated stomach with external compression at the antropyloric region. Subsequently, contrast-enhanced computed tomography (CECT) was done, which showed type I CDC with gastric outlet obstruction (Fig. 1a). On exploration, dilated stomach with a large CDC (10×7 cm) compressing the antropyloric region was present (Fig. 1b). CDC excision with Roux-en-Y hepaticojejunostomy (RYHJ) was performed. Postoperative course was uneventful and patient is doing well after a follow up of two and half years. Case 2 A 16-year-old female presented with complaints of abdominal pain for 2 months. Abdominal ultrasonography (USG) revealed a dilated common bile duct (CBD) suggesting CDC. Though surgery was advised on index admission, patient refused the same due to personal reasons. One month later, she presented with jaundice, fever, epigastric lump, and features of local peritonitis. Liver function test showed raised serum bilirubin, 17.25 mg/dl (normal range 0-1.4 mg/dl) and liver enzymes (serum aspartate transaminase, AST), 174 IU/L