Biliary ductal and vascular anomalies associated with choledochal cyst (original) (raw)
Related papers
Medicina
Background and Objectives: Choledocal cyst is a rare congenital disease of the biliary tree defined by dilatation of the extrahepatic and/or intrahepatic biliary ducts. Untreated, it leads to complications such as cholangitis, stone formation and malignant degeneration. The standard treatment for choledocal cyst is complete excision and subsequent biliary reconstruction via hepaticojejunostomy or hepatiocoduodenostomy. Materials and Methods: We report our experience with 16 pediatric cases of choledocal cyst over a 10-year period. Results: The predominant symptoms were nausea and jaundice, both at 62.5% (n = 10), followed by abdominal pain at 56.3% (n = 9). Ultrasonography was the diagnostic method used in all patients. Computed tomography was used in 75% (n = 12) and magnetic resonance imaging in 25% (n = 4) of cases. Age at the time of intervention ranged from 2 months to 17 years with a mean of 4 years and 5 months. The open approach was used in nine patients and the laparoscopic...
Journal of the Pakistan Medical Association
Choledochal Cyst (CC), also known as the biliary cyst, is one of the rare inherited anomalies of intrahepatic and/or extrahepatic biliary system characterised by varying degrees of cystic dilatation of the biliary tract without acute obstruction. The prevalence ranges from 1 in 13,000 people to 1 in 2 million people with preponderance in Asia (1), particularly in Japan. Moreover, the presentation also varies in children and adults, and is usually vaguer and non-specific in adults. The prevalence is even lower in males, with female to male ratio being 3:1-4:1 (2). We present here three cases of adult choledochal cysts excised in our surgical unit in the last five years. We discuss the aetiopathogenesis, presentation, diagnosis, surgical treatment, and complications of choledochal cysts based on the available literature. ---Continue
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
Case reports in gastroenterology, 2011
Choledochal cysts (CCs) are rare congenital cystic or fusiform dilatations of the biliary tree that can involve the extrahepatic and/or intrahepatic biliary tree. We report a case of huge type I CC associated with an aberrant posterior hepatic duct. A 52-year-old man presented with a 3-week history of upper right abdominal pain and jaundice and serologic sign of obstructive jaundice. Ultrasonography (US), magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed with the diagnosis of CC type I according to the classification of Alonso-Lej and Todani-Watanabe. The indication for surgical resection was posed. The cyst was completely resected and the biliary tract was reconstructed with a double hepatico-jejunostomy using the same Roux limb, since during the surgical dissection a before unrecognized anatomical variation of the right biliary tree (aberrant posterior hepatic duct at VI-VII segment) was identified. The diagnosis of CC is...
Choledochal cyst: A review of 79 cases and the role of hepaticodochoduodenostomy
Journal of Indian Association of Pediatric Surgeons, 2011
been described in literature. Recently there are several reports of laparoscopic excision of choledochal cyst and hepaticoduodenostomy. [6-8] Complete excision of the cyst and bilioenteric anastomosis is the treatment of choice in choledochal cyst. [2-8] The purpose of this study is to analyze our experience of 79 patients with various types of choledochal cyst treated in our institution and to highlight the results of
Use of vascularized appendiceal graft for biliary tract replacement in a case of choledochal cyst
Journal of Indian Association of Pediatric Surgeons, 2007
A case of a choledochal cyst managed with cyst excision and an antiperistaltic hepaticoappendicoduodenostomy (HAD) is reported. Although the possibility of a postoperative evaluation using endoscopic retrograde cholangiopancreaticography has been considered previously, this is probably the first reported case where postoperative stenting of HAD has been successfully performed to treat postoperative biliary leak.
World Journal of Laparoscopic Surgery with DVD, 2019
Introduction: Choledochal cysts (CC) are rare congenital pathology in adult population. Since 1995, laparoscopic management has been described for this entity. Nevertheless, its management is considered to be a controversial matter due to the augmented risk of associated cholangiocarcinoma. Materials and methods: A retrospective, observational, and descriptive study was conducted considering patients diagnosed with CC who were operated at a hepatobiliary surgery referral center from January 2013 to June 2018. Patients were taken to simplified laparoscopic hepaticojejunostomy with a Roux-en-Y reconstruction. A retrospective analysis of the data obtained is presented. Results: Ten adult patients with CC underwent surgical biliary reconstruction at a mean age of 34.5 years; 75% had Todani type I CC and 25% Todani type IV-B CC. About 50% of the patients were diagnosed via endoscopic retrograde cholangiopancreatography (ERCP) and 50% of them via magnetic resonance cholangiopancreatography. None required re-intervention, no mortality was reported; and the mean hospital stay was 5 days, no patient had postoperative biliary leakage, none was converted to open surgery, and all patients had adequate oral feeding tolerance 2 days postoperative. Long-term follow-up showed no incidence of cholangiocarcinoma after 2-year follow-up. Conclusion: Choledochal cysts in adults is a rare pathology that has a high probability of developing malignancy when not adequately surgically managed and because of secondary bile reflux. These factors make surgical management a critical decision. The simplified laparoscopic approach presented in this paper seems to be an effective and safe alternative to biliary duct reconstructive surgery.
Malignant change in the biliary tract after excision of choledochal cyst
British Journal of Surgery, 1997
Background Choledochal cyst is a rare congenital condition with a high risk of malignant change if Methods Forty-eight patients with choledochal cysts managed over a 21-year period were reviewed, to untreated. The risk of malignancy after surgical excision of choledochal cyst is not known.