1
|
Zhang T, Shi X, Li J, Zhang J, Li X, Ren G, Luo H, Kang X, Liang S, Wang X, Pan Y. Horizontal duodenal papilla is associated with a special spectrum of pancreaticobiliary diseases: a retrospective magnetic resonance cholangiopancreatography-based study. Gastroenterol Rep (Oxf) 2024; 12:goae059. [PMID: 38863808 PMCID: PMC11165313 DOI: 10.1093/gastro/goae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 06/13/2024] Open
Abstract
Background Horizontal duodenal papilla (HDP) is not an uncommon ectopic major papilla. The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear. Here, we explored the associations in patients who underwent magnetic resonance cholangiopancreatography (MRCP). Methods Consecutive patients who underwent MRCP at Xijing Hospital (Xi'an, China) between January 2020 and December 2021 were eligible. Patients were divided into HDP and regular papilla (RP) according to the position of the major papilla. The primary outcome was the proportion of congenital pancreaticobiliary diseases. Results A total of 2,194 patients were included, of whom 72 (3.3%) had HDP. Compared with the RP group (n = 2,122), the HDP group had a higher proportion of congenital pancreaticobiliary diseases, especially choledochal cyst (CC) or anomalous pancreaticobiliary junction (APBJ) (6.9% vs 1.4%, P = 0.001). More gallbladder cancer (6.9% vs 1.2%, P < 0.001) and pancreatic cysts (27.8% vs 16.3%, P = 0.01) were also identified in the HDP group. Morphologically, the HDP group had a longer extrahepatic bile duct (8.4 [7.6-9.3] cm vs 7.2 [6.5-8.1] cm, P < 0.001), and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum. Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. Conclusions This study confirmed that HDP was not rare in patients underwent MRCP. A higher prevalence of congenital pancreaticobiliary malformations (especially CC or APBJ), gallbladder cancer and pancreatic cysts was observed in patients with HDP, as well as distinctive morphologic features.
Collapse
Affiliation(s)
- Tiantian Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Gastroenterology, Xi’an Medical University, Xi’an, Shaanxi, P. R. China
| | - Xin Shi
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Pathology, Lanzhou Petrified Total Hospital, Lanzhou, Gansu, P. R. China
| | - Jing Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Jingsong Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xixian Li
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
- Department of Gastroenterology, Xi’an Medical University, Xi’an, Shaanxi, P. R. China
| | - Gui Ren
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Hui Luo
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xiaoyu Kang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Shuhui Liang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Xiangping Wang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| | - Yanglin Pan
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, P. R. China
| |
Collapse
|
2
|
AlSharit MA, Althwanay RM, AlQattan AS, AlTamimi AA, Mansi N. Ectopic ampulla of vater in D4 with adenosquamous carcinoma: case report and literature review. J Surg Case Rep 2024; 2024:rjae377. [PMID: 38832061 PMCID: PMC11146092 DOI: 10.1093/jscr/rjae377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Ampulla of Vater (AOV) is typically located in the second part of the duodenum. There are few reported cases of ectopic AOV over the line extending from the pylorus of the stomach down to the distal part of the duodenum. However, to the best of our knowledge, there are only five cases reported in the English literature of an ectopic AOV in the fourth part of the duodenum, with only one of them having adenocarcinoma of the ampulla. Hereby, we report the first case of ectopic AOV in the fourth part of the duodenum, presenting with obstructive due to adenocarcinoma with focal squamous differentiation. This is the case a 42-year-old lady who had a sleeve gastrectomy for morbid obesity in the past. She presented with right upper quadrant pain for one month associated with subjective fever, unintentional weight loss, pale stool, and dark urine. The physical examination revealed a deeply jaundiced lady with an unremarkable abdominal exam. A computed tomography scan of the abdomen revealed intrahepatic and extrahepatic biliary dilation with ectopic insertion of the distal CBD into the fourth part of the duodenum with no evidence of biliary stones. She underwent pancreaticoduodenectomy after difficult biliary decompression. Histopathological diagnosis was moderately differentiated adenocarcinoma, pancreaticobiliary type with focal squamous differentiation. Ectopic AOV is a very rare entity, especially when it is associated with adenosquamous carcinoma changes.
Collapse
Affiliation(s)
| | | | | | | | - Nabeel Mansi
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| |
Collapse
|
3
|
Chen S, Yin T, Li L, Diao M, Huang T. Correlation of ectopic distal location of papilla of Vater and clinical characteristics in pediatric choledochal cysts. Pediatr Surg Int 2023; 39:201. [PMID: 37191896 DOI: 10.1007/s00383-023-05486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Ectopic distal location of papilla of Vater (EDLPV) is an obvious pathological feature of choledochal cyst (CDC). This study aimed to investigate the correlation between EDLPV and clinical characteristics of CDCs. METHODS Three groups were studied: Group 1 (G1), papilla in the middle third of second part of duodenum (n = 38); Group 2 (G2), papilla from the distal third of second part to the beginning of third part of duodenum (n = 168); Group 3 (G3), papilla from the middle of third part to fourth part of duodenum (n = 121). Relative variables among three groups were compared. RESULTS Compared with G1 and G2, G3 patients had the largest cysts (relative diameter: 1.18 vs. 1.60 vs. 2.62, p < 0.001), the youngest age (20.52 vs. 19.47 vs. -3.40 months, p < 0.001), the highest rate of prenatal diagnosis (26.32% vs. 36.31% vs. 62.81%, p < 0.001), the lowest occurrence of protein plugs in common channel (44.74% vs. 38.69% vs. 16.53%, p < 0.001), and the most elevated total bilirubin level (7.35 vs. 9.95 vs. 28.70 μmol/L, p < 0.001). Prenatally diagnosed G3 patients had heavier liver fibrosis than G2 (13.16% vs. 1.67%, p = 0.015). CONCLUSION The more distal papilla location, the more severe clinical characteristics of CDCs, suggesting a crucial role in its pathogenesis.
Collapse
Affiliation(s)
- Suyun Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Tong Yin
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China.
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
- Department of Pediatric Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China.
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Ting Huang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Children's Hospital Capital Institute of Pediatrics, Graduate School of Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Alkarboly T, Gharib DT, Salih KM, Mustafa SM, Salih AM, Kakamad FH. Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review. Int J Surg Case Rep 2022; 93:106887. [PMID: 35305424 PMCID: PMC8928074 DOI: 10.1016/j.ijscr.2022.106887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 10/25/2022] Open
|
5
|
Ali SW, Kazmi S, Jabeen A, Ashraf MS, Mateen Khan MA. Choledochal cyst associated with anomalous biliary drainage. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Xu H, Li X, Zhu KX, Zhou WC. Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report. World J Clin Cases 2021; 9:5332-5338. [PMID: 34307586 PMCID: PMC8283612 DOI: 10.12998/wjcc.v9.i19.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.
CASE SUMMARY A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.
CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.
Collapse
Affiliation(s)
- Hao Xu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xin Li
- The First Clinical Medical School of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Xiang Zhu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Ce Zhou
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| |
Collapse
|
7
|
Pancreaticobiliary maljunction in Turkish patients: a multicenter case series. Surg Endosc 2021; 36:2042-2051. [PMID: 33844087 DOI: 10.1007/s00464-021-08490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Pancreaticobiliary maljunction (PBM) is a malformation in which the pancreatic and bile ducts join outside the duodenal wall. It is associated with various biliary and pancreatic diseases. In addition, patients with PBM carry a substantial lifetime risk of developing biliary or gallbladder carcinoma. We aimed to present a multicenter case series of PBM from Turkey. METHODS This study was conducted in adult and pediatric PBM patients who were referred to three tertiary reference centers of Turkey for endoscopic retrograde cholangiopancreatography (ERCP) between July 2007 and May 2020. The clinical presentations, types of PBM, ERCP findings, surgical histories, and the postoperative courses, including the development of biliary malignancies, were retrospectively reviewed. RESULTS The study group included 47 (31 adult and 16 children) patients. Type D PBM was more frequent (13/41: 27.7%) than that reported in Eastern studies. Type A PBM was more common in the adults (51.6% vs. 12.5%, p < 0.05), whereas type C was more common in pediatric patients (31.3% vs. 13.2%, p < 0.05). Although fusiform anatomy was predominant in both of the groups, cystic dilatation was more common (25.8% vs. 12.5%) in adults and the common bile duct diameter was greater [22 mm (range 11-58) vs. 12 mm (range 5-33)] in adult patients compared to pediatric patients. Resective surgeries were more frequently done in pediatric patients (73.3% vs. 53.6%), whereas cholecystectomy was more frequently performed in adult patients (21.4% vs. 6.7%). CONCLUSION Although our findings were compatible with Eastern studies, type D PBM (associated with pancreas divisum) was more frequent in our study population.
Collapse
|
8
|
Hong J, Pan W, Zuo W, Wang A, Zhu L, Zhou X, Zhou X, Li G, Liu Z, Liu P, Zhen H, Zhu Y, Ma J, Yuan J, Shu X, Zhu Y, Lu N, Chen Y. Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater. Medicine (Baltimore) 2020; 99:e18536. [PMID: 31895789 PMCID: PMC6946525 DOI: 10.1097/md.0000000000018536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It remains challenging for endoscopists to manage pancreaticobiliary diseases in patients with ectopic papilla of Vater by endoscopic retrograde cholangiopancreatography (ERCP). The present study sought to evaluate the efficacy and safety of ERCP for this issue.Consecutive patients with ectopic papilla of Vater who underwent initial ERCP due to pancreaticobiliary diseases were retrospectively analyzed.One hundred seven patients with ectopic papilla of Vater were included. The success rate of cannulation was 83.2%. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and mechanical lithotripsy were performed in 12 (11.2%), 25 (23.4%), and 1 (0.9%) patients, respectively. The technical success rate was 83.2%; of these, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoscopic retrograde pancreatic drainage, and stone extraction was conducted in 61 (57.0%), 17 (15.9%), 5 (4.7%), and 45 (42.1%) patients, respectively. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis were risk factors for stone extraction inability. Adverse events occurred in 20 (18.7%) patients, including post-ERCP pancreatitis (3.7%), hyperamylasemia (12.1%), and infection of biliary tract (2.8%); all of the adverse events were mild and alleviated by conventional therapies.ERCP is an appropriate choice for pancreaticobiliary diseases in patients with ectopic papilla of Vater due to its high efficacy and safety. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis increase difficulties for stone extraction.
Collapse
Affiliation(s)
| | | | - Wei Zuo
- Department of Respiratory Medicine
| | | | | | | | | | | | | | - Pi Liu
- Department of Gastroenterology
| | | | | | | | - Jianhui Yuan
- Endoscopy Center
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology
| | - Yin Zhu
- Department of Gastroenterology
| | | | | |
Collapse
|
9
|
Abstract
The major papilla of Vater can be ectopically present in the stomach, pyloric canal, duodenal bulb, and third or fourth portion of the duodenum. In this study, we determined the clinical significance of ectopic papilla of Vater by endoscopic retrograde cholangiopancreatogram (ERCP).A retrospective study was conducted by reviewing the medical records of 6133 patients receiving ERCP from 1988 to 2011. The diagnosis was confirmed if both the common bile duct (CBD) and the main pancreatic duct (PD) drained into the same opening, either by ERCP or magnetic resonance cholangiopancreatography.Eight patients with major papilla of Vater in the duodenal bulb were identified among 6133 patients receiving ERCP from 1988 to 2011, with an incidence rate of 0.13%. The mean age was 67 years and patients were predominantly male. Duodenal bulb deformity was noted in all patients and three of them had shallow gastric and/or duodenal ulcers. Hook-shaped CBD configuration was seen only in half of our cases. Three patients with CBD stones were treated successfully after endoscopic sphincterotomy or papillary balloon dilation.Ectopic orifice of papilla is a rare finding of ERCP. Opacification of both the CBD and main PD from the same opening is an essential criterion for diagnosing an ectopic papilla of Vater in the duodenal bulb.
Collapse
Affiliation(s)
- Yen-Chun Peng
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
- School of Medicine, National Yang-Ming University, Taipei
| | - Wai-Keung Chow
- Division of Gastroenterology, Department of Internal Medicine, Taichung Tzu-Chi Hospital, Taichung, Taiwan
| |
Collapse
|
10
|
Soares KC, Goldstein SD, Ghaseb MA, Kamel I, Hackam DJ, Pawlik TM. Pediatric choledochal cysts: diagnosis and current management. Pediatr Surg Int 2017; 33:637-650. [PMID: 28364277 DOI: 10.1007/s00383-017-4083-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 02/07/2023]
Abstract
Choledochal cysts are rare congenital disorders first described by Vater and Ezler in 1723. Their exact etiology remains incompletely understood; however, an anomalous pancreaticobiliary union (APBDU) and subsequent reflux of biliary contents into the biliary tree are thought to play a role. Accordingly, APBDU-associated choledochal cyst patients are significantly more likely to have evidence of hepatitis, cholangitis or pancreatitis and pathologically confirmed inflammation. In 1977, Todani and colleagues modified the original Alonso-Lej classification to include five types of CC. Type I and IV are the most common and most likely to be associated with malignancy. The majority of choledochal cysts are diagnosed in childhood. Clinical presentation varies and most often consists of nonspecific abdominal pain. Diagnosis is typically accomplished using multimodality imaging techniques including computed tomography, magnetic resonance imaging, ultrasound and MRCP. The use of diagnostic PTC and ERCP in CC has been largely replaced by MRCP. Appropriate management consists of prompt, complete cyst excision followed by restoration of biliary enteric continuity when necessary. Minimally invasive CC resection in the pediatric population has demonstrated acceptable outcomes. Prognosis is generally excellent; however, malignancy risk remains higher than the general population even after complete surgical excision.
Collapse
Affiliation(s)
- Kevin C Soares
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Blalock 688, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth D Goldstein
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes A Ghaseb
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David J Hackam
- Division of General Pediatric Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Department of Surgery, Wexner Medical Center, Ohio State University, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
| |
Collapse
|
11
|
Huang SG, Guo WL, Wang J, Sheng M, Lan XH, Fang L. Factors Interfering with Delineation on MRCP of Pancreaticobiliary Maljunction in Paediatric Patients. PLoS One 2016; 11:e0154178. [PMID: 27104956 PMCID: PMC4841599 DOI: 10.1371/journal.pone.0154178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/08/2016] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to assess factors for delineating the pancreaticobiliary junction in the presence of pediatric congenital choledochal cysts (CCC) using Magnetic resonance cholangiopancreatography (MRCP). Methods Retrospective review of medical records for 48 patients with CCC was conducted, including demographics, biliary amylase and MRCP findings if available. With univariate and multivariate logistic regression, we measured significant factors affecting pancreaticobiliary maljunction(PBM) diagnoses by MRCP. Results Of the subjects enrolled with CCC. Twenty-eight cases had PBM according to MRCP. Univariate analysis confirmed that age, cyst diameter > 30 mm and cysts that descended to the introitus pelvis affected junctional delineation and detection of PBM (P<0.05). Stepwise logistic regression analysis confirmed large cysts in the introitus pelvis predicted pancreaticobiliary junctional delineation in MRCP and these data agreed with the literature. A correlation between cyst diameter and the length of the common channel was found as was cyst diameter and biliary amylase although there were no significant differences between them. Conclusions Age, cyst diameter >30 mm and descending cysts into the introitus pelvis affected junctional delineation of the pancreatic and bile duct in PBM with MRCP. Large cyst descension into the introitus pelvis was an independent factors affecting PBM detection.
Collapse
Affiliation(s)
- Shun-gen Huang
- General surgery department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Wan-liang Guo
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
- * E-mail:
| | - Jian Wang
- General surgery department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Mao Sheng
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Xing-hao Lan
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| | - Lin Fang
- Radiology department, Children’s Hospital of Soochow University, Suzhou, China, 215003
| |
Collapse
|
12
|
Liang YX, Nong B, Liang LX. Endoscopic retrograde cholangiopancreatography for treatment of choledocholithiasis with ectopic duodenal papilla. Shijie Huaren Xiaohua Zazhi 2015; 23:4423-4427. [DOI: 10.11569/wcjd.v23.i27.4423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effects of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of choledocholithiasis with ectopic duodenal papilla.
METHODS: Clinical cases of choledocholithiasis were collected through the hospital's database to identify the cases with ectopic papilla of Vater. Based on the location of duodenal papilla, the safety and efficacy of ERCP were analyzed.
RESULTS: The total number of choledocholithiasis patients who had undergone ERCP was 968 cases, and the number of cases with ectopic duodenal papilla was 6 (0.62%). Of the 6 patients, 2 underwent surgery, 3 were treated by biliary stent placement, and 1 had successful stone removal.
CONCLUSION: Patients suffering from choledocholithiasis with ectopic duodenal papilla can be treated by ERCP, and surgery can be considered a useful alternative.
Collapse
|
13
|
Lee W, Park JH, Kim JY, Kwag SJ, Park T, Jeong SH, Ju YT, Jung EJ, Lee YJ, Choi SK, Hong SC, Jeong CY. A case of gallbladder cancer combined with ectopic individual opening of pancreatic and bile ducts to the duodenal bulb. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:121-4. [PMID: 26379734 PMCID: PMC4568595 DOI: 10.14701/kjhbps.2015.19.3.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 12/30/2022]
Abstract
Ectopic opening of the pancreatic and bile ducts (EOPBD) into the duodenal bulb is an extremely rare congenital anomaly with unknown clinical implications. We presented a case of gallbladder cancer with EOPBD into the duodenal bulb. A 57-year-old male was referred to our hospital with intermittent right upper abdominal pain. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed individual EOPBD into the duodenal bulb with no papillary structure, and a focal nodular lesion in the gallbladder. A follow-up abdominal computed tomography scan 9 months later revealed a slight increase in the size of the fundal nodule, which was suspected as gallbladder cancer. An intraoperative frozen biopsy identified the nodular lesion as adenocarcinoma involving the cystic duct, and the patient underwent radical cholecystectomy including bile duct resection with hepaticojejunostomy. EOPBD is an extremely rare condition that can be associated with gallbladder malignancy as well as benign disease. Clinicians should follow up carefully and consider surgical treatment for suspected malignant lesions.
Collapse
Affiliation(s)
- Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Sang-Kyung Choi
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, Jinju, Korea
| |
Collapse
|
14
|
Guo WL, Bai XJ, Huang SG, Fang L, Wang J. The role of 64-slice CT following perfusion with iohexol via the hepatopancreatic ampulla in assessing pancreaticobiliary junctions. Clin Anat 2015; 28:645-8. [PMID: 25752686 DOI: 10.1002/ca.22529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/22/2015] [Accepted: 02/02/2015] [Indexed: 12/16/2022]
Abstract
The aim of this study was to delineate the structure of the pancreatic and biliary ducts in premature infants using a novel imaging method. The duodenal papillae of 30 premature infant cadavers were dissected. The pancreatic and biliary ducts were visualized using 64-detector multislice spiral computed tomography (MSCT). Contrast agent was injected into the duodenal papilla via the hepatopancreatic ampulla of Vater. MSCT scanning revealed both the pancreatic and biliary ducts as well as the common channel in 18 cases. The bile duct was visualized in the remaining 12 cases. Four patterns of the pancreaticobiliary ductal junction were noted: Y-type (73.3%), U-type (13.3%), V-type (6.7%), and II-type (6.7%). The results showed that MSCT and three-dimensional reconstruction can be used to visualize the junction pattern and common channel of the pancreatic and biliary ducts, and the structure of the surrounding tissue, in premature infants.
Collapse
Affiliation(s)
- Wan-Liang Guo
- Radiology Department, The Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Xue-Jie Bai
- General Surgery, Traditional Chinese Medicine Hospital of Yulin, Yulin, China
| | - Shun-Gen Huang
- Pediatric General Surgery Department, The Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Lin Fang
- Radiology Department, The Children's Hospital Affiliated to Soochow University, Suzhou, China
| | - Jian Wang
- Pediatric General Surgery Department, The Children's Hospital Affiliated to Soochow University, Suzhou, China
| |
Collapse
|
15
|
Kim SK, Jeong YJ, Kim JC. Choledochal cyst with ectopic distal location of the papilla of Vater. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 81 Suppl 1:S85-8. [PMID: 22319748 PMCID: PMC3267075 DOI: 10.4174/jkss.2011.81.suppl1.s85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/21/2011] [Accepted: 05/06/2011] [Indexed: 11/30/2022]
Abstract
In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.
Collapse
Affiliation(s)
- Sung Kang Kim
- Division of Pediatric Surgery, Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | | | | |
Collapse
|
16
|
Kim SK, Jeong YJ, Kim JC. Choledochal cyst with ectopic distal location of the papilla of Vater. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011. [PMID: 22319748 DOI: 10.4174/jkss.2011.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.
Collapse
Affiliation(s)
- Sung Kang Kim
- Division of Pediatric Surgery, Department of Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | | | | |
Collapse
|
17
|
Diao M, Li L, Cheng W. Is it necessary to ligate distal common bile duct stumps after excising choledochal cysts? Pediatr Surg Int 2011; 27:829-32. [PMID: 21431961 DOI: 10.1007/s00383-011-2877-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE After excision of choledochal cysts (CDC), the distal common bile duct (CBD) stumps are conventionally ligated. Yet, the distal common bile duct stump mobilization and ligation carries certain risk of pancreatic duct injury. The current study investigates the feasibility of selectively leaving distal stump unligated in CDC children with stenotic distal CBD. METHODS Between 2001 and 2010, 270 CDC children successfully underwent laparoscopic cyst excision and Roux-en-Y hepatojejunostomy and were recruited into this study. The distal stump management was based on its radiological morphology. The patients were divided into two groups: (1) non-ligation group (n = 207), where the distal stump was stenotic and was left unligated; (2) ligation group (n = 63), where the distal stump was not stenotic and was ligated. The pancreatic juice leakage rates were compared. RESULTS The median follow-up periods in the non-ligation and ligation group were 36 and 33 months, respectively. There was no pancreatic juice leakage in either group. CONCLUSION Not ligating distal stump is a feasible approach for managing CDC with stenotic distal CBD. It simplifies the operative procedure and may minimize pancreatic duct injury.
Collapse
Affiliation(s)
- Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | | | | |
Collapse
|
18
|
Hac SA, Dobosz M, Nalecz A, Reszetow J, Dobrowolski S, Friess H, Michaljevic AL, Mroczkowski P, Studniarek M, Sledzinski Z. Surgical morphology of the pancreatic isthmus. Pancreatology 2010; 10:179-85. [PMID: 20484956 DOI: 10.1159/000231983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 07/14/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic isthmus method anastomosis following pancreatic resection is an important factor of postoperative fistula formation. While the anatomy and vascular supply of the pancreatic head have been studied in detail, little is known about the morphology of the pancreatic isthmus. The authors determine the anatomy and morphology of the pancreatic isthmus. METHODS 99 consecutive cadaveric pancreatic specimens were taken during standard autopsy. Organs were transected at the isthmus and pancreatograms and microscopic specimens of the transection plane were analyzed. RESULTS The mean size of the Wirsung duct at the isthmus was 2.89 mm (+/-0.87 mm, from 1.4 to 6 mm). The main pancreatic duct was located approximately in the middle of the pancreatic cross-section plane in almost all specimens. The total number of second-degree pancreatic ducts visible on pancreatograms within the isthmus was 1.77 (+/-1.00, from 0 to 4) and 1.83 (+/-1.4, from 0 to 5) on microscopic analysis. CONCLUSIONS The presence of second-degree pancreatic ducts at the transection site might favor the use of a pancreaticoenteric anastomosis with stump invagination to reduce the risk of anastomotic leakage. and IAP.
Collapse
Affiliation(s)
- Stanisław A Hac
- Department of General Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Saritas U, Senol A, Ustundag Y. The clinical presentations of ectopic biliary drainage into duodenal bulbus and stomach with a thorough review of the current literature. BMC Gastroenterol 2010; 10:2. [PMID: 20064279 PMCID: PMC2881112 DOI: 10.1186/1471-230x-10-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 01/12/2010] [Indexed: 02/06/2023] Open
Abstract
Background Ectopic biliary drainage is a rare congenital anomaly on which we have scarce data in the current literature. Methods The data were collected from the records of 400 endoscopic retrograde cholangio-pancreatography (ERCP). In this report, we present 10 cases (male/female: 9/1, mean age 54 years, range 38-74) with ectopic biliary openings into the duodenum and/or stomach diagnosed by endoscopic retrograde cholangio-pancreatography (ERCP). Results In our series, the frequency of ectopic biliary drainage is 2% (10 out of 400 ERCPs). Recurrent attacks of cholangitis and complicated ulcer formation in the distal stomach and bulbar duodenum were the most common signs in the present series. The sites of ectopic biliary drainage were the stomach in 1 case, the duodenum bulbus in 7 cases and the postbulbar duodenum in 2 cases. Bulbar ulcer, deformed pylorus and bulbus were present in 7 cases, apical bulbar stricture in 2, gastric ulcer in 1, pyloroplasty and/or gastroenterostomy in 3 cases. One case had had previous bleeding episode. Some of them had undergone previous surgeries for gall-stone disease (cholecystectomy in 5 cases, bile duct operation in 3 cases) and ulcer complications (pyloroplasty/gastroenterostomy in 3 cases). ERCP revealed dilatation of the biliary tree and hook shaped distal choledochus in all cases, choledocholithiasis in 7 and Mirizzi syndrome in 1. Endoscopic balloon dilatations for gastric outlet obstruction, extraction of bile stones after balloon dilating the ectopic site, surgery for difficult cases with large bile duct stones or with gastric outlet obstruction were preferred methods in this series of patients. Conclusion With this report, we have to remind that ectopic biliary drainage must be considered in the differential diagnosis when the clinician faces cases with gastric outlet obstruction due to peptic ulcer formation accompanied by cholangitis/cholestasis.
Collapse
Affiliation(s)
- Ulku Saritas
- Department of Internal Medicine, Süleyman Demirel University School of Medicine, Isparta, 32040 Turkey
| | | | | |
Collapse
|
20
|
Pancreatic duct diversity. Pancreas 2009; 38:318-21. [PMID: 19066495 DOI: 10.1097/mpa.0b013e31819081ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The formation of the pancreatic duct system is the result of the fusion of 2 embryonic buds, the ventral and dorsal primordia. Frequently, this fusion process is localized in the pancreatic head; variations, however, may account for the structural diversity of the duct system. Pancreatic duct anomalies and diversity of body and tail are thought to be casuistic. METHODS Ninety-nine consecutive adult autopsies with reference to macroscopic anomalies in the distal part of the gland were evaluated. Pancreatograms were performed after large duodenal papilla cannulation. Ducts parallel to gland axis with a diameter of at least one third of the main pancreatic duct at the junction point and aberrant duct with different shapes and/or abnormal third-degree ductuli architecture were noted. RESULTS Our study revealed a 9.9% frequency of main pancreatic duct diversity in the pancreatic corpus and tail. Eleven atypical ducts were visible, 9 cranially and 2 caudally from the main pancreatic duct. CONCLUSIONS The pancreatic duct system in the body and the tail presents abnormal configuration not described in the past.
Collapse
|