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Prajapati R, Desai P, Patel C, Kabrawala M, Arora P. Choledochocele Type B. ACG Case Rep J 2024; 11:e01375. [PMID: 38854804 PMCID: PMC11161290 DOI: 10.14309/crj.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/23/2024] [Indexed: 06/11/2024] Open
Affiliation(s)
- Ritesh Prajapati
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Pankaj Desai
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Chintan Patel
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Mayank Kabrawala
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Surat, India
| | - Priya Arora
- Department of Pathology, Surat Institute of Digestive Sciences, Surat, India
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2
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Cao LP, Zhong X, Chen KJ, Yu J. Endoscopic retrograde cholangiopancreatography management for choledochocele in a young female. Hepatobiliary Pancreat Dis Int 2023; 22:658-660. [PMID: 36720661 DOI: 10.1016/j.hbpd.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Lin-Ping Cao
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xun Zhong
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Kang-Jie Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jun Yu
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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3
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Cui Y, Kozarek RA. Evolution of Pancreatic Endotherapy. Gastrointest Endosc Clin N Am 2023; 33:679-700. [PMID: 37709404 DOI: 10.1016/j.giec.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
In the last half century, endotherapy for pancreatic diseases has changed considerably. Although endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were introduced initially as diagnostic tools, they quickly evolved into therapeutic tools for preventing and managing complications of pancreatitis. More recently, therapeutic endoscopy has shown potential in palliation and cure of pancreatic neoplasms. This article discusses the changing landscape of pancreatic endotherapy as therapeutic ERCP and EUS were introduced and because they have evolved to treat different diseases.
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Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, Virginia Mason Medical Center
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4
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Novis E, Bull N, Di Sano S, Arnold C, Wong KS. Choledochocele with cholecystoduodenal fistula. ANZ J Surg 2023; 93:2508-2510. [PMID: 37170396 DOI: 10.1111/ans.18508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Elan Novis
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Nicholas Bull
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Suzanne Di Sano
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - Colin Arnold
- Department of Pathology, The Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - King-Sang Wong
- Department of General Surgery, The Tweed Hospital, Tweed Heads, New South Wales, Australia
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5
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Paņina A, Zviedre A, Laizāns P, Apine I. A Unique Type or Variation of Bile Duct Cyst in a 9-Year-Old Girl:A Remarkable Case Study. Acta Med Litu 2023; 30:117-123. [PMID: 38516514 PMCID: PMC10952425 DOI: 10.15388/amed.2023.30.2.3] [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: 07/16/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 03/23/2024] Open
Abstract
Patients with bile duct cysts require careful radiological assessment of the hepatobiliary system prior to surgical intervention. This clinical case is uncommon with an atypical clinical presentation and radiological findings. According to the most widely used classification of choledochal cysts, this case presents a combination of Type I and Type IV of choledochal cyst (CC) combining the form of extra, intrahepatic bile ducts and cystic duct dilations.
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Affiliation(s)
| | - Astra Zviedre
- Riga Stradiņš University, Department of Pediatric Surgery Children’s Clinical University Hospital, Department of Paediatric Surgery, Riga, Latvia
| | - Paulis Laizāns
- Children’s Clinical University Hospital, Department of Paediatric Surgery, Riga, Latvia University of Latvia, Department of Surgery
| | - Ilze Apine
- Children’s Clinical University Hospital, Department of Radiology, Riga, Latvia Riga Stradiņš University, Department of Radiology
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Shrateh ON, khader A, Musleh A, Abbadi K, Asbah M, Sawalha N, Jobran AW. Successful radiological detection and surgical management of type 3 choledochocele: A case report. Radiol Case Rep 2023; 18:1502-1506. [PMID: 36816336 PMCID: PMC9932293 DOI: 10.1016/j.radcr.2023.01.029] [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: 12/29/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 02/05/2023] Open
Abstract
According to Todani's classification, a choledochocele is a cystic dilatation of the distal section of the common bile duct that protrudes into the duodenal lumen. It is also known as a type III choledochal cyst. There are not many cases, and the cause is still unknown. Typically, it is misdiagnosed as a peptic ulcer, as was the case with the patient in this case study. For choledochocele diagnosis, multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be equivalent to endoscopic retrograde cholangiography. Both endoscopic therapy and open surgical care are risk-free possibilities, and the cyst's size influences which strategy should be used. A 35-year-old woman admitted to the hospital with upper abdominal pain caused by a large choledochocele was successfully treated by open surgical management. In this case study, we outline the specifics of her situation and talk about the most recent research on similar cases and how to treat them therapeutically. There is ongoing debate regarding the best course of action. However, to achieve a successful outcome, open surgical care for choledochocele of large size (ie, > 3 cm in diameter) is advised.
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Affiliation(s)
- Oadi N. Shrateh
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Corresponding author.
| | - Abdullatif khader
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- General Surgery Department, Palestinian Medical Complex, Ramallah, Palestine
| | - Asil Musleh
- Department of General Surgery, Palestinian Medical Complex, Ramallah, Palestine
| | - Khaled Abbadi
- Department of General Surgery, Palestinian Medical Complex, Ramallah, Palestine
| | - Malvina Asbah
- Department of General Surgery, Palestinian Medical Complex, Ramallah, Palestine
| | - Nihal Sawalha
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
- Department of General Surgery, Palestinian Medical Complex, Ramallah, Palestine
| | - Afnan W.M. Jobran
- Medical Research Club, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
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7
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Abstract
This article discusses current standard of care in neonatal biliary disease, particularly management of biliary atresia and choledochal cysts. It highlights surgical considerations, guidelines for adjuvant therapies, and promising therapeutic options that are under investigation.
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Affiliation(s)
- Sarah Mohamedaly
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1652, Campus Box 0570, San Francisco, CA 94143-0570, USA
| | - Amar Nijagal
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, HSW 1652, Campus Box 0570, San Francisco, CA 94143-0570, USA; The Liver Center, University of California, San Francisco, CA, USA; The Pediatric Liver Center at UCSF Benioff Childrens' Hospitals, San Francisco, CA, USA.
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8
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Wu GZ, Wu QY, Zhao ZH, Wang M. Diagnosis and minimally invasive treatment of type III choledochal cysts. BMC Surg 2022; 22:272. [PMID: 35836224 PMCID: PMC9284719 DOI: 10.1186/s12893-022-01713-w] [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: 10/02/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Type III choledochal cysts (CCs) are the rarest and least well-characterized of the five variants of biliary cysts. Only a few relevant studies have been conducted and a gold standard treatment for type III CCs is still lacking because of their scarcity. An unusual case of type III CC with choledochocele at the end of the distal common bile duct (CBD) with no bulging of the duodenum is presented here. Case presentation A 61-year-old woman presented to our department with repeated upper abdominal pain for one year. Laboratory examination revealed abnormal liver function and a slight increase in the white blood cell (WBC) count and proportion of neutrophils. In an MRCP of the patient, the distal CBD was found to have a cystic structure indicative of a type III CC. Endoscopic retrograde cholangiopancreatograpy (ERCP) revealed cystic findings compatible with Todani type III CCs. However, duodenoscopy did not show a bulge in the duodenum so laparoscopic cholecystectomy and Roux-en-Y hepaticojejunostomy were performed. In her 6-month follow-up, the patient reported that recovery from the operation was uneventful. Conclusions ERCP has become the gold standard for diagnosing type III CCs. Type III CCs can be treated minimally invasively with laparoscopic cholecystectomy and Roux-en-Y hepaticojejunostomy.
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Affiliation(s)
- Guang-Zhen Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun City, Jilin Province, China
| | - Qing-Yuan Wu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun City, Jilin Province, China
| | - Zhi-Hao Zhao
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun City, Jilin Province, China
| | - Meng Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun City, Jilin Province, China.
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9
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Islek A, Tumgor G. Biliary atresia and congenital disorders of the extrahepatic bile ducts. World J Gastrointest Pharmacol Ther 2022; 13:33-46. [PMID: 36051179 PMCID: PMC9297290 DOI: 10.4292/wjgpt.v13.i4.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Biliary atresia (BA) and choledochal cysts are diseases of the intrahepatic and extrahepatic biliary tree. While their exact etiopathogeneses are not known, they should be treated promptly due to the potential for irreversible parenchymal liver disease. A diagnosis of BA may be easy or complicated, but should not be delayed. BA is always treated surgically, and performing the surgery before the age of 2 mo greatly increases its effectiveness and extends the time until the need for liver transplantation arises. While the more common types of choledochal cysts require surgical treatment, some can be treated with endoscopic retrograde cholangiopancreatography. Choledochal cysts may cause recurrent cholangitis and the potential for malignancy should not be ignored.
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Affiliation(s)
- Ali Islek
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Cukurova University School of Medicine, Adana 01320, Turkey
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10
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Jang MJ, Kim HG, Oh CH, Kim S, You M. Unusual cause of gastric outlet obstruction mimicking superior mesenteric artery syndrome: A case of infiltrative duodenal cancer arising from a choledochocele. JGH Open 2021; 6:91-93. [PMID: 35071794 PMCID: PMC8762617 DOI: 10.1002/jgh3.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/28/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022]
Abstract
Choledochocele is a rare subtype of choledochal cyst and is associated with increased prevalence of periampullary cancers. Here, we report an unusual manifestation of infiltrative duodenal cancer arising from a choledochocele, involving superficial spreading (muscularis mucosae) of cancer cells along the duodenum causing gastric outlet obstruction, which clinically mimicked superior mesenteric artery syndrome. Histologically, wide spread of cancer cells was confirmed from periampullary region to duodenojejunal junction showing mismatch with radiologic findings, in which the cancer segment was mainly located in the distal duodenum. Clinical, radiologic, and pathologic findings are discussed with literature reviews.
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Affiliation(s)
- Min Jae Jang
- Department of Radiology Kyung Hee University Hospital Seoul Republic of Korea
| | - Hyun Gun Kim
- Department of Radiology Kyung Hee University Hospital Seoul Republic of Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine Kyung Hee University Hospital Seoul Republic of Korea
| | - So‐Woon Kim
- Department of Pathology Kyung Hee University Hospital Seoul Republic of Korea
| | - Myung‐Won You
- Department of Radiology Kyung Hee University Hospital Seoul Republic of Korea
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11
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Pastor P, Ocaña J, González A, Nuñez J, García A, García JC, Fernández-Cebrián JM, Nuño J. Choledochal cysts surgical management: Retrospective and historical comparative analysis. Cir Esp 2021; 100:39-45. [PMID: 34876365 DOI: 10.1016/j.cireng.2021.11.013] [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: 07/08/2020] [Accepted: 10/11/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Choledochal cysts are rare bile duct dilatations, which have higher prevalence in Asian population. The aim of the study was to analyze clinical and surgical results about biliary cysts management. In addition, a comparative historical analysis was performed. METHODS Patients who underwent surgery between January 1988 and December 2019 in a single tertiary level center were retrospectively included. Demographic and clinical patient data; cyst types; diagnostic methods and surgical technique were analyzed, as well as short and long-term follow-up complications. A comparative descriptive study focus on the main historical series was also carried out. RESULTS A total of seventeen patients were identified; 58.8% were men. The mean age at diagnosis was 39.9 years (SD: 20.54). The median follow-up was 5 years (IQR 1-15). The most frequent cysts were type I (41.2%). Abdominal pain was the most common presenting symptom (58.8%). Cystic excision with bilio-enteric anastomosis was the main procedure, it was underwent in 85, 7% type I cysts. 29.4% postoperative complications were recorded. Malignancy was not documented in any pathology specimen. CONCLUSIONS Choledochal cysts are an uncommon disorder whose diagnosis requires a high level of suspicion. Surgical treatment depends on type of cyst. In most patients with choledochal cysts disease, complete cyst excision with bilio-enteric anastomotic reconstruction is the treatment of choice.
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Affiliation(s)
- Paula Pastor
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Juan Ocaña
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alberto González
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jordi Nuñez
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alba García
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Carlos García
- Sección de Coloproctología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José María Fernández-Cebrián
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Javier Nuño
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
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12
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Mirante VG, Cecinato P, Grillo S, Sereni G, Lucarini M, Beltrami M, Sassatelli R. Endoscopic resection of a choledochocele. Endoscopy 2021; 53:E401-E402. [PMID: 33336334 DOI: 10.1055/a-1314-9054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Vincenzo Giorgio Mirante
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Cecinato
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simone Grillo
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuliana Sereni
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matteo Lucarini
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marina Beltrami
- Medicine and Gastroenterology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda USL - RCCS di Reggio Emilia, Reggio Emilia, Italy
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Sunnapwar A, Nagar A, Katre R, Khanna L, Sayana HP. Imaging of Ampullary and Periampullary Conditions. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1726663] [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: 10/21/2022] Open
Abstract
AbstractThe ampulla of Vater is formed by the union of the pancreatic duct and the common bile duct and is also known as hepatopancreatic ampulla or hepatopancreatic duct. The ampulla is surrounded by a muscular valve known as the sphincter of Oddi, which controls the flow of bile and pancreatic juices into the duodenum in response to food. The ampulla is also an important embryological landmark as it marks the anatomical transition from foregut to the midgut. Because of this, it is a watershed zone where the blood supply changes from the celiac axis to the superior mesenteric artery. Radiologic evaluation of the ampulla and the periampullary region is challenging because it requires an understanding of the embryology, the normal appearance, and different anatomic variants. Also, a wide variety of pathologies can occur in this region. The purpose of this review is to present the normal anatomy of the ampulla and the periampullary region on different imaging modalities and to summarize the imaging features of the common variants, and benign and malignant ampullary and periampullary conditions. Understanding of the normal anatomical appearance and variants along with the knowledge of common pathologic conditions affecting the ampulla and periampullary conditions can help radiologists in making accurate diagnosis resulting in optimum patient care.
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Affiliation(s)
- Abhijit Sunnapwar
- Department of Radiology, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Rashmi Katre
- Department of Radiology, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Lokesh Khanna
- Department of Radiology, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Hari Prasad Sayana
- Department of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, United States
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14
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Suda T, Yoshida R, Oishi N, Matsushita E. Biliary stones in the smooth hemispherical mass protruding into the duodenal lumen. Frontline Gastroenterol 2021; 13:91-92. [PMID: 34970433 PMCID: PMC8666857 DOI: 10.1136/flgastro-2021-101835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 03/26/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tsuyoshi Suda
- Gastroenterology, Kanazawa Shiritsu Byoin, Kanazawa, Ishikawa, Japan
| | - Ryota Yoshida
- Gastroenterology, Kanazawa Shiritsu Byoin, Kanazawa, Ishikawa, Japan
| | - Naoki Oishi
- Gastroenterology, Kanazawa Shiritsu Byoin, Kanazawa, Ishikawa, Japan
| | - Eiki Matsushita
- Gastroenterology, Kanazawa Shiritsu Byoin, Kanazawa, Ishikawa, Japan
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15
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Pastor P, Ocaña J, González A, Nuñez J, García A, García JC, Fernández-Cebrián JM, Nuño J. Choledochal cysts surgical management: Retrospective and historical comparative analysis. Cir Esp 2021; 100:S0009-739X(20)30318-3. [PMID: 33714555 DOI: 10.1016/j.ciresp.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Choledochal cysts are rare bile duct dilatations, which have higher prevalence in Asian population. The aim of the study was to analyze clinical and surgical results about biliary cysts management. In addition, a comparative historical analysis was performed. METHODS Patients who underwent surgery between January 1988 and December 2019 in a single tertiary level center were retrospectively included. Demographic and clinical patient data; cyst types; diagnostic methods and surgical technique were analyzed, as well as short and long-term follow-up complications. A comparative descriptive study focus on the main historical series was also carried out. RESULTS A total of seventeen patients were identified; 58.8% were men. The mean age at diagnosis was 39.9 years (SD: 20.54). The median follow-up was 5 years (IQR 1-15). The most frequent cysts were tipe I (41.2%). Abdominal pain was the most common presenting symptom (58.8%). Cystic excision with bilio-enteric anastomosis was the main procedure, it was underwent in 85, 7% type I cysts. 29.4% postoperative complications were recorded. Malignancy was not documented in any pathology specimen. CONCLUSIONS Choledochal cysts are an uncommon disorder whose diagnosis requires a high level of suspicion. Surgical treatment depends on type of cyst. In most patients with choledochal cysts disease, complete cyst excision with bilio-enteric anastomotic reconstruction is the treatment of choice.
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Affiliation(s)
- Paula Pastor
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - Juan Ocaña
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Alberto González
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Jordi Nuñez
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Alba García
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Juan Carlos García
- Sección de Coloproctología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - José María Fernández-Cebrián
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Javier Nuño
- Sección de Hepatología, Departamento de Cirugía General y Digestiva, Hospital Universitario Ramón y Cajal, Madrid, España
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16
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Boudou M, Jabi R, Kora C, Miry A, Kamaoui I, Bouziane M. [Squamous cell carcinoma of the gallbladder complicating a cystic dilation of the cystic duct and common bile duct: a case report]. Pan Afr Med J 2021; 38:144. [PMID: 33912314 PMCID: PMC8052619 DOI: 10.11604/pamj.2021.38.144.22684] [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: 04/06/2020] [Accepted: 01/20/2021] [Indexed: 11/11/2022] Open
Abstract
Congenital cystic disease of the biliary tree is a known risk factor for gallbladder cancer. We here report a case of squamous cell carcinoma of the bile duct (BD) complicating a cystic dilatation of the bile ducts in a 54-year-old woman hospitalized for biliary pancreatitis. Abdominal scanner showed nodular thickening of the fundus of the gallbladder and fusiform dilation of the cystic duct and the main bile duct (VBP) with lesion of the tail of the pancreas, initially suggesting mucinous cystadenoma. Extended cholecystectomy involving the gallbladder fossa with resection of the distal biliary tract, choledocoduodenal anastomosis with caudal splenopancreatectomy + drainage were performed. Histopathological examination of the gallbladder mass revealed moderately differentiated invasive squamous cell carcinoma without infiltration of the hepatic parenchyma. The patient underwent adjuvant chemotherapy. The patient did not have the common symptoms of gallbladder cancer. Then radiology was necessary to make a diagnosis. Surgery is the best therapeutic option for early-stage gallbladder cancer, but adjuvant chemo-radiation may also be useful in treating these patients. Cholecystectomy with resection of cystic dilatation of the bile duct in high-risk patients are the most effective means of prevention.
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Affiliation(s)
- Mohamed Boudou
- Service de Chirurgie Viscérale et Oncologie Digestive A, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Rachid Jabi
- Service de Chirurgie Viscérale et Oncologie Digestive A, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Christine Kora
- Service de Radiologie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Achraf Miry
- Service de l´Anatomopathologie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Imane Kamaoui
- Service de Radiologie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Mohammed Bouziane
- Service de Chirurgie Viscérale et Oncologie Digestive A, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
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17
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Han M, Yang N, Zhang H, Ran X. Endoscopic management of a type III choledochal cyst (choledochocele) using snare resection without balloon-catheter assistance. VideoGIE 2020; 6:134-135. [PMID: 33738364 PMCID: PMC7947370 DOI: 10.1016/j.vgie.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Min Han
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Nenghong Yang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Hao Zhang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Xun Ran
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
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18
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Ikarashi S, Hayashi K, Terai S. Choledochocele observed on direct peroral cholangioscopy using an ultra-slim endoscope. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:e49-e51. [PMID: 33320443 DOI: 10.1002/jhbp.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 11/06/2022]
Abstract
Highlight Ikarashi and colleagues report a case of choledococele treated by endoscopic sphincterotomy and observed on direct peroral cholangioscopy. Histological examination reveals duodenum-like mucosa without atypical changes in the choledochocele. Direct peroral cholangioscopy using an ultra-slim endoscope may be a useful technique for diagnosis and surveillance of choledochocele.
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Affiliation(s)
- Satoshi Ikarashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan
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19
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Sugawa C, Culver A, Sundaresan N, Lucas CE. Congenital pancreaticobiliary anomalies in an urban medical center in the United States. JGH OPEN 2020; 4:1176-1182. [PMID: 33319053 PMCID: PMC7731818 DOI: 10.1002/jgh3.12418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/06/2020] [Indexed: 11/17/2022]
Abstract
Background and Aim Pancreaticobiliary anomalies are rare and often present with cryptic signs and symptoms, thus delaying appropriate treatment. Methods Endoscopic retrograde cholangiopancreatography (ERCP) was used to define pancreaticobiliary anomalies. A retrospective review was performed of 5522 ERCPs conducted at a tertiary care center from 1972 to 2015. Results There were 249 (4.5%) patients with pancreaticobiliary anomalies, including 179 patients with pancreas divisum (PD), 44 patients with choledochal cyst (CC) (Todani's classification Type I: extrahepatic cyst 31, Type III; choledochocele 9, Type V: Caroli's disease 4), 20 patients with anomalous pancreaticobiliary ductal union (APDU), and 6 patients with other abnormalities. Of 179 patients with pancreas divisum, 8 (4.5%) required minor sphincterotomies for multiple unexplained acute pancreatitis. Of the 31, 15 (48%) Type I CC patients underwent an operation. In patients with Type III CC (choledochocele), seven of the nine were treated by endoscopic sphincterotomy, and two patients were treated by surgery. Four patients with Type V CC (Caroli's disease) were managed nonoperatively. Of the 20 patients with APDU, 8 (40%) required operative intervention. Six patients were found to have other anomalies: two with pancreas bifidum, one with a duplication of the gallbladder, one with a cystic duct diverticulum, one with an annular pancreas, and one with an abnormal cystic duct origin. These patients were treated based on their etiology. Conclusion Pancreaticobiliary anomalies are rare and can be defined using ERCP. The appreciation of these abnormalities is important for the proper diagnosis and treatment of these rare biliary and pancreatic disorders.
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Affiliation(s)
- Choichi Sugawa
- Michael and Marian Ilitch Department of Surgery Wayne State University School of Medicine Detroit, Michigan USA
| | - Ashley Culver
- Michael and Marian Ilitch Department of Surgery Wayne State University School of Medicine Detroit, Michigan USA
| | - Naresh Sundaresan
- Michael and Marian Ilitch Department of Surgery Wayne State University School of Medicine Detroit, Michigan USA
| | - Charles E Lucas
- Michael and Marian Ilitch Department of Surgery Wayne State University School of Medicine Detroit, Michigan USA
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20
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Zimmer V. Small type A choledochocele presenting with a nonbulging “
stalactite papilla
”. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Vincent Zimmer
- Department of Medicine Marienhausklinik St. Josef Kohlhof Neunkirchen Germany
- Department of Medicine II Saarland University Medical Center, Saarland University Homburg Germany
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21
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Orr J, Alexopoulos S, Gamboa A. Needle-knife papillotomy of a choledochocele: a safe solution for a technically challenging dilemma. VideoGIE 2020; 5:362-363. [PMID: 32821867 PMCID: PMC7426654 DOI: 10.1016/j.vgie.2020.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jordan Orr
- Vanderbilt University Medical Center, Division of Gastroenterology, Hepatology & Nutrition, Nashville, Tennessee
| | - Sophoclis Alexopoulos
- Vanderbilt University Medical Center, Division of Gastroenterology, Hepatology & Nutrition, Nashville, Tennessee
| | - Anthony Gamboa
- Vanderbilt University Medical Center, Division of Gastroenterology, Hepatology & Nutrition, Nashville, Tennessee
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22
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Abstract
In contrast to gallstones, which are increasingly diagnosed in children and adolescents, congenital or perinatally acquired malformations of the biliary tree are rare entities. The surgical treatment of these diseases frequently represents a technical challenge. For children with biliary atresia Kasai portoenterostomy is a therapeutic option in the first weeks of life. Most affected children, however, require a liver transplantation before they enter adulthood. Segmental dilatations of the bile duct carry the risk of ascending infections and malignant transformation. This requires early resection of the biliary tree and reconstruction with a bilioenteric anastomosis. While laparoscopic cholecystectomy has become the standard approach also for children, the value of minimally invasive procedures for more complex surgical procedures of the biliary tract has not yet been defined.
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Affiliation(s)
- M Dübbers
- Schwerpunkt Kinderchirurgie, Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinik Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
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23
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Baison GN, Bonds MM, Helton WS, Kozarek RA. Choledochal cysts: Similarities and differences between Asian and Western countries. World J Gastroenterol 2019; 25:3334-3343. [PMID: 31341359 PMCID: PMC6639560 DOI: 10.3748/wjg.v25.i26.3334] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/05/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023] Open
Abstract
Choledochal cysts (CCs) are rare bile duct dilatations, intra-and/or extrahepatic, and have higher prevalence in the Asian population compared to Western populations. Most of the current literature on CC disease originates from Asia where these entities are most prevalent. They are thought to arise from an anomalous pancreaticobiliary junction, which are congenital anomalies between pancreatic and bile ducts. Some similarities in presentation between Eastern and Western patients exist such as female predominance, however, contemporary studies suggest that Asian patients may be more symptomatic on presentation. Even though CC disease presents with an increased malignant risk reported to be more than 10% after the second decade of life in Asian patients, this risk may be overstated in Western populations. Despite this difference in cancer risk, management guidelines for all patients with CC are based predominantly on observations reported from Asia where it is recommended that all CCs should be excised out of concern for the presence or development of biliary tract cancer.
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Affiliation(s)
- George N Baison
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Morgan M Bonds
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - William S Helton
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Richard A Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA 98101, United States
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24
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KarthiKeyan M, SoundaraRajan L, Karthi M, UmaMaheswaran M, Rajendran S. Type B choledochocele vs duodenal duplication cyst: a diagnostic dilemma and its management: a case report. J Med Case Rep 2019; 13:160. [PMID: 31122272 PMCID: PMC6533763 DOI: 10.1186/s13256-019-2010-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 02/06/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Duplication cyst of the alimentary tract is a rare congenital anomaly. Duodenal duplication cyst accounts for less than 5% overall. These entities rarely present in adults. They are often mistaken as choledochoceles. Management is most often complete excision, but it is individualized to the particular case. CASE PRESENTATION A 22-year-old woman was admitted to our hospital with a history of intermittent colicky right hypochondrial pain not relieved by any medications for the past 3 months. Initially, she was given proton pump inhibitors, but her pain was not relieved. Further evaluation was done, and preoperative imaging showed a cyst in the second part of the duodenum. Magnetic resonance imaging revealed it as a choledochocele, but duodenal duplication cyst was kept in the differential diagnosis. Further ultrasound identified it to be a duplication cyst. After failed endotreatment, the patient was successfully managed with partial excision and marsupialization. CONCLUSION Duodenal duplication cyst is uncommon and rarely diagnosed in adults. Duplications in the duodenum should always be a part of the differential diagnosis, especially in cystic lesions. Ultrasonogram of the cyst might lead to the proper diagnosis. Surgery is the treatment of choice if endotherapy is not successful.
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Affiliation(s)
- M KarthiKeyan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India.
| | - L SoundaraRajan
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | - M Karthi
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | - M UmaMaheswaran
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
| | - S Rajendran
- Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, India
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25
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The hepatoduodenal ligament revisited: cross-sectional imaging spectrum of non-neoplastic conditions. Abdom Radiol (NY) 2019; 44:1269-1294. [PMID: 30448917 DOI: 10.1007/s00261-018-1829-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The hepatoduodenal ligament is frequently involved by conditions affecting the portal triad and surrounding structures, including a vast array of non-neoplastic conditions. Due its unique location between the retroperitoneum and the peritoneal space, the hepatoduodenal ligament is also targeted by inflammatory conditions involving the retroperitoneum and the liver. Finally, the presence of lymphatics and of the biliary tracts makes the hepatoduodenal ligament a route of spread for a variety of infections. The purpose of this pictorial essay is twofold: to review the cross-sectional radiological anatomy and variants of the structures within the hepatoduodenal ligament, and to illustrate the non-neoplastic conditions that may arise within the hepatoduodenal ligament. CONCLUSION Familiarity with these specific entities and their cross-sectional imaging findings is fundamental for a more accurate diagnosis.
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26
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Yang J, Xiao GF, Li YX. Open surgical treatment of choledochocele: A case report and review of literature. World J Clin Cases 2018; 6:842-846. [PMID: 30510953 PMCID: PMC6264990 DOI: 10.12998/wjcc.v6.i14.842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 02/05/2023] Open
Abstract
Choledochocele (also known as type III choledochal cyst according to Todani’s classification) is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Cases are rare and the etiology remains unclear. It is usually misdiagnosed as peptic ulcer, as in the patient whose case is described here. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiography for diagnosis of choledochocele. Both endoscopic therapy and open surgical management are safe options, and size of the cyst plays a role in the decision-making for which approach to apply. A 50-year-old woman admitted to our hospital with upper abdominal pain caused by choledochocele with large size was successfully treated by open surgical management. We present the details of her case in this case report and discuss the recent literature on such cases and their therapeutic management.
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Affiliation(s)
- Jie Yang
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Guang-Fa Xiao
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yi-Xiong Li
- Department of Biliopancreatic Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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27
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Choledochal Malformations: Surgical Implications of Radiologic Findings. AJR Am J Roentgenol 2018; 210:748-760. [DOI: 10.2214/ajr.17.18402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Saraç M, Bahcecioglu IH, Tartar T, Bakal U, Kazez A. Endoscopic treatment of a pediatric case of choledochocele associated with choledocholithiasis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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29
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Lobeck IN, Dupree P, Falcone RA, Lin TK, Trout AT, Nathan JD, Tiao GM. The presentation and management of choledochocele (type III choledochal cyst): A 40-year systematic review of the literature. J Pediatr Surg 2017; 52:644-649. [PMID: 27829523 DOI: 10.1016/j.jpedsurg.2016.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/24/2016] [Accepted: 10/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Choledochoceles may cause biliary obstruction and harbor malignancy. We conducted a 40-year systematic review of the literature for this rare anomaly. METHODS PubMed and Cochrane databases were accessed 1975-2015 using terms "choledochocele" or "choledochal cyst". Studies reviewed that met the following criteria: English language, published 1975-2015 with human subjects. RESULTS 325 patients with a choledochocele were identified, including 71 case reports and 254 cases within institutional reviews. 13 pediatric case reports of choledochocele exist, with abdominal pain being the most common symptom (n=11). The most frequent diagnostic and treatment modalities were ultrasound (n=10), and endoscopic sphincterotomy (n=5). No malignancies were reported. 58 adult case reports exist, with the most common presenting symptom being abdominal pain (n=54). Ultrasound was the frequently employed diagnostic modality (n=32). Open procedures were performed more often (n=30). Malignant lesions were identified in 5. In 42 institutional reviews, the frequency of choledochocele was 0.7%. Of those for whom treatment was reported, 69% underwent endoscopic sphincterotomy. CONCLUSION Choledochocele is a rare malformation. Similarities exist between pediatric and adult patients, but malignancy has only been reported in adults. An algorithm based on patient age, cyst size, lining and amenability to endoscopic resection may be considered as a treatment strategy for this uncommon condition.
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Affiliation(s)
- Inna N Lobeck
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Phylicia Dupree
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Tom K Lin
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jaimie D Nathan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Greg M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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30
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Dogan MS, Doganay S, Koc G, Gorkem SB, Ciraci S, Coskun A. Imaging Findings of Intraluminal Duodenal Duplication Cyst in a Pediatric Patient. Pediatr Neonatol 2017; 58:194-195. [PMID: 27663362 DOI: 10.1016/j.pedneo.2016.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mehmet S Dogan
- Radiology Clinic, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey.
| | - Selim Doganay
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gonca Koc
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sureyya B Gorkem
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Saliha Ciraci
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abdulhakim Coskun
- Department of Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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32
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Ray-Offor E, Elenwo SN, Igwe PO, Ngeribara C. Ulcerated choledochocele: A case report. Int J Surg Case Rep 2016; 28:42-44. [PMID: 27677116 PMCID: PMC5037116 DOI: 10.1016/j.ijscr.2016.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023] Open
Abstract
Upper gastro-intestinal endoscopy is part of diagnostic work-up for massive bleeding per rectum. A positive ‘pillow sign’ in a mass in the region of the ampulla of Vater may be a choledochocele. Cyst excision and marsupialization is the definitive treatment for a choledochocele. Laparoscopic adhesiolysis is useful in adhesive small bowel obstruction.
Background The cystic dilatation of the biliary tract is an uncommon anomaly. Choledochocele, a cystic dilatation of the distal common bile duct, rarely presents clinically as massive gastrointestinal bleeding. Aim This is to report a very rare disease condition and highlight minimal access options in surgical care. Case summary A 13 year-old boy was referred with a day history of sudden onset of passage of bright red blood per rectum with a fainting episode. There was no anal protrusion, jaundice, recurrent epigastric pain nor bleeding from any other orifice. An initial endoscopic assessment of the upper digestive tract showed profuse bleeding from a sub-mucosal mass in the region of ampulla of Vater. Emergency laparotomy revealed small intestine filled with blood from duodenum to ileum. A duodenotomy showed a cystic mass with an ulcerated mucosa at the dome containing bilious fluid in the second part of the duodenum. The cyst was de-roofed and marsupialized. Post-operative recovery was complicated by features of adhesive small bowel obstruction on the 9th post op day and treated by laparoscopic adhesiolysis. He was discharged home in good clinical state. Conclusion Choledochocele is a differential diagnosis in the endoscopic finding of a submucosal mass in the second part of the duodenum. An initial oesophagogastroduodenoscopy endoscopy is necessary in the evaluation of massive lower gastrointestinal bleeding.
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Affiliation(s)
- E Ray-Offor
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Rivers State, Nigeria.
| | - S N Elenwo
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Rivers State, Nigeria
| | - P O Igwe
- Department of Surgery, University of Port-Harcourt Teaching Hospital, Rivers State, Nigeria
| | - C Ngeribara
- Total E & P Clinic, Port Harcourt, Rivers State, Nigeria
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33
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Moslim MA, Takahashi H, Seifarth FG, Walsh RM, Morris-Stiff G. Choledochal Cyst Disease in a Western Center: A 30-Year Experience. J Gastrointest Surg 2016; 20:1453-63. [PMID: 27260526 DOI: 10.1007/s11605-016-3181-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to report a Western experience in the diagnosis and management of choledochal cyst disease. RESULTS Sixty-seven patients were identified including 15 children and 52 adults; 76.1 % were females. The median age at diagnosis was 3 [inter-quartile range (IQR) = 6.0-0.7] years for children, and 46 [IQR = 55.6-34.3] years for adults. Forty-eight patients (72 %) were symptomatic. Types of choledochal cyst included: I (n = 49, 73.1 %), II (n = 1, 1.5 %), IV (n = 9, 13.4 %), and V (n = 8, 12 %). The median diameter of the type I choledochal cyst was 35 [IQR = 47-25] mm. All 48 patients underwent excision of cyst with Roux-en-Y hepaticojejunostomy, and eight underwent resection with hepaticoduodenostomy. Six patients underwent liver resection, and five patients underwent orthotopic liver transplantation. Malignancy was concomitant in five adult patients, being identified on preoperative imaging in three cases; and atypia was seen in three additional patients. Early morbidity included Clavien-Dindo classification grades III (n = 7) and II (n = 5), while long-term complications consisted of Clavien-Dindo grades V (n = 5), IV (n = 2), III (n = 18), and II (n = 1). CONCLUSIONS Presentation and management of choledochal cyst is varied. Malignant transformation is often detected incidentally, and so should be the driving source for resection when a choledochal cyst is diagnosed.
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Affiliation(s)
- Maitham A Moslim
- Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Hideo Takahashi
- Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Federico G Seifarth
- Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - R Matthew Walsh
- Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Gareth Morris-Stiff
- Department of HPB Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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34
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Orizu M, Robertson K. Incidental choledochocoele, imaging and endoscopic findings. BMJ Case Rep 2016; 2016:bcr-2016-215583. [PMID: 27151059 DOI: 10.1136/bcr-2016-215583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mavis Orizu
- University Hospital Crosshouse, Kilmarnock, UK
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35
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Takikawa T, Kanno A, Masamune A, Hongo S, Yoshida N, Nakano E, Miura S, Hamada S, Kume K, Kikuta K, Hirota M, Shimosegawa T. Ectopic Opening of the Common Bile Duct Accompanied by Choledochocele and Pancreas Divisum. Intern Med 2016; 55:1097-102. [PMID: 27150861 DOI: 10.2169/internalmedicine.55.6240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 32-year-old woman was referred due to abdominal pain and elevated liver enzymes. Computed tomography and magnetic resonance imaging showed ectopic opening of the common bile duct (CBD) into the duodenal bulb. Esophagogastroduodenoscopy showed a hemispheric bulge in the duodenal bulb. Endoscopic retrograde cholangiopancreatography (ERCP) revealed the bulge to be cystic dilatation of the CBD. ERCP also showed no communication between the ventral and dorsal pancreatic ducts. We diagnosed the patient with ectopic opening of the CBD accompanied by choledochocele and pancreas divisum. Endoscopic incision was performed for the treatment of the choledochocele. The patient's symptoms and elevated liver enzymes improved after treatment.
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Affiliation(s)
- Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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36
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[Bile duct cysts; an unusual cause of jaundice in paediatrics. Presentation of a case series]. ACTA ACUST UNITED AC 2015; 87:137-42. [PMID: 26471312 DOI: 10.1016/j.rchipe.2015.08.009] [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: 01/31/2015] [Revised: 08/12/2015] [Accepted: 08/30/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. OBJECTIVE To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. METHOD A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. CASE REPORTS A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. CONCLUSIONS Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.
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Zhu L, Lv Z, Liu J, Xu W. Choledochocele: A Case Report and Discussion of Diagnosis Criteria. European J Pediatr Surg Rep 2015; 3:85-9. [PMID: 26788455 PMCID: PMC4712052 DOI: 10.1055/s-0035-1563601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
A 6-year-old girl presented with intermittent abdominal pain, without jaundice and a palpable mass in the epigastrium. Preoperative imaging and upper endoscopy suggested duodenal duplication. During surgery, the patient was diagnosed with a rare type of choledochal cyst—choledochocele (type 3b). The authors emphasize that, in children, choledochocele should be included in the differential diagnosis of cystic lesions located in the duodenal area and the head of the pancreas area, regardless of jaundice or abnormal liver function. Since mucosal histology showing duodenal mucosa did not match the final diagnosis, we suggest that three criteria should be met for the diagnosis of a choledochocele to be diagnosed: (1) a cyst protruding into the duodenal lumen; (2) filling with contrast during cholangiography and (3) a filling defect on X-ray barium meal.
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Affiliation(s)
- Linlin Zhu
- Department of Surgery, Children's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Zhibao Lv
- Department of Surgery, Children's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Jiangbin Liu
- Department of Surgery, Children's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Weijue Xu
- Department of Surgery, Children's Hospital of Shanghai Jiaotong University, Shanghai, China
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Alessandrino F, Souza D, Ivanovic AM, Radulovic D, Yee EU, Mortele KJ. MDCT and MRI of the ampulla of Vater (part II): non-epithelial neoplasms, benign ampullary disorders, and pitfalls. ACTA ACUST UNITED AC 2015; 40:3292-312. [DOI: 10.1007/s00261-015-0529-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Beştaş R, Ekin N, Uçmak F, Kaya M. An Adult Choledochocele Case Presented with Acute Pancreatitis: Treatment by Endoscopic Sphincterotomy and Cyst Unroofing. Clin Endosc 2015; 48:348-9. [PMID: 26240813 PMCID: PMC4522431 DOI: 10.5946/ce.2015.48.4.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/03/2015] [Accepted: 03/19/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Remzi Beştaş
- Department of Gastroenterology, Diyarbakir Education and Research Hospital, Diyarbakır, Turkey
| | - Nazım Ekin
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Feyzullah Uçmak
- Department of Gastroenterology, Diyarbakir Education and Research Hospital, Diyarbakır, Turkey
| | - Muhsin Kaya
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey
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Angelis CD, Marietti M, Bruno M, Pellicano R, Rizzetto M. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World J Gastrointest Endosc 2015; 7:799-805. [PMID: 26191344 PMCID: PMC4501970 DOI: 10.4253/wjge.v7.i8.799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/23/2014] [Accepted: 05/27/2015] [Indexed: 02/05/2023] Open
Abstract
In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among non-jaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects.
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Katabathina VS, Kapalczynski W, Dasyam AK, Anaya-Baez V, Menias CO. Adult choledochal cysts: current update on classification, pathogenesis, and cross-sectional imaging findings. ACTA ACUST UNITED AC 2015; 40:1971-81. [DOI: 10.1007/s00261-014-0344-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kwak TY, Park CH, Eom SH, Hwang HS, Chung DW, Seo JY, Kim YS, Kwak DH. Choledochocele containing a stone mistaken as a distal common bile duct stone. Yeungnam Univ J Med 2015. [DOI: 10.12701/yujm.2015.32.1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tae Young Kwak
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Seok Hyeon Eom
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Hong Suk Hwang
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Duk Won Chung
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Ji Young Seo
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Yeong Sung Kim
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
| | - Dong Hyup Kwak
- Department of Internal Medicine, Kwak's Hospital, Daegu, Korea
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Zhu L, Lv Z, Liu J, Xu W. WITHDRAWN: Choledochocele: A Case Report and Discussion of Diagnosis Criterias. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Soufi M, Lahlou MK, Chad B. [Cancer developed in cystic dilatation of the bile duct: report of a case]. Pan Afr Med J 2014; 19:346. [PMID: 25922635 PMCID: PMC4406382 DOI: 10.11604/pamj.2014.19.346.5110] [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: 07/21/2014] [Accepted: 09/27/2014] [Indexed: 11/25/2022] Open
Abstract
Les auteurs rapportent un cas de dilatation kystique du cholédoque intra- pancréatique découvert chez une femme de 46 ans et compliqué d'un carcinome tubulo-papillaire n'envahissant pas le pancréas. Le traitement a consisté en une duodénopancréatectomie céphalique avec un curage ganglionnaire et anastomose hépatico-jéjunale; la survie était de 30 mois; les auteurs abordent les aspects radiologiques, anatomopathologiques, thérapeutiques et pronostiques de ces cancers développé sur dilatation kystique de la voie biliaire et discutent la place d'une radiothérapie complémentaire de la chirurgie susceptible d'améliorer la survie.
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Affiliation(s)
- Mehdi Soufi
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Mohammed Khalid Lahlou
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
| | - Bouziane Chad
- Division of Digestive Surgery, Oujda CHU, Faculty of Medicine, University Mohammed First, Oujda, Maroc
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