CYST OF THE AMPULLA OF VATER: CASE REPORT

Intrapancreatic ciliated enteric duplication cyst presenting with biliary obstruction

A 46-yr-old man presenting with biliary obstruction from an intrapancreatic tumor underwent pancreaticoduodenectomy. The pathology report showed the tumor to be an enteric duplication cyst. Diagnostic imaging features and operative management are discussed.

Obstructing choledochocele: diagnosis by endoscopic ultrasound

This report demonstrates the use of endoscopic ultrasound in the diagnosis of choledochocele. The patient was an elderly female who presented with abdominal pain, weight loss, and biliary obstruction. At endoscopic ultrasound a 5 cm cystic lesion was found near the ampulla, which clearly communicated with the common bile duct.

Relapsing pancreatitis due to juxta-pancreatic duodenal duplication cyst with pancreatic ductal communication

A 21 year old patient first presented with acute pancreatitis in infancy, followed by subsequent episodes of relapsing pancreatitis in childhood. The cause of the pancreatitis defied diagnosis, despite two laparotomies in infancy and childhood, until twenty years later when a juxta-pancreatic duodenal duplication--a rare congenital lesion--was finally discovered. The duplication communicated with the main pancreatic duct via a long, aberrant duct, resulting in the relapsing pancreatitis. Abdominal ultrasonography and computerized tomography scan, and endoscopic retrograde cholangiopancreaticogram were useful in demonstrating the lesion. Surgical excision of part of the cyst, with marsupialization of the remaining structure to the stomach, abolished further symptoms and recurrence of pancreatitis.

Periampullary cyst: a surgically remediable cause of pancreatitis

We report two patients with periampullary cysts associated with recurrent attacks of acute pancreatitis. In both patients the diagnosis was made preoperatively by upper gastrointestinal endoscopy and ERCP, which was also useful in determining the relationship of the cysts to the biliary and pancreatic ductal systems. Simple marsupialisation of the cysts resulted in long term relief of symptoms. Congenital cystic anomalies in the second part of the duodenum should be diligently sought in patients with pancreatitis of unexplained cause, as surgical therapy is safe and effective.

Management of adult choledochal cysts

A review of the English literature reveals a total of 1,337 patients with choledochal cysts. Improved diagnostic techniques to visualize the biliary system are demonstrating an increasing number of unsuspected choledochal cysts in adult patients. Either choledochal cysts remain clinically silent until adulthood or may develop in later life. Experience is reported with adult patients having type I, II, III, and IV choledochal cysts. Type I cysts are preferably managed by excision but cyst anatomy may necessitate choledochoenteric drainage. Type II cysts are treated by excision except for those located within the pancreatic portion of the common bile duct. These are best managed by transduodenal cystoduodenostomy. The type III cyst (choledochocele) should be excised carefully, identifying and preserving the common bile and pancreatic ducts. Type IV cysts include a combination of any one of the first three types of cyst plus the presence of intrahepatic cyst or cysts. Treatment of these cysts is dictated by the type and location of the extrahepatic cyst. Since choledochal cysts are being recognized with increased frequency in adults, surgeons need to be aware of the diagnostic and treatment modalities available for each type of biliary cyst.

Choledochocele associated with acute hemorrhagic pancreatitis

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Choledochocele: report of a case and review of the literatures

A case of choledochocele seen in a 68-year-old male was reported. Analysis of fourteen cases reported under a variety of designations featuring cystic dilatation of the distal common bile duct protruding into the duodenal lumen and the case presented here disclosed that these cases could be classified into two types of pathology; both of the bile duct and the pancreatic duct opened into the cyst of the ampulla in 6 cases, whereas the bile duct and the pancreatic duct joined at the papilla of Vater and distal end of the bile duct formed a cystic dilatation protruding into the duodenal lumen in the remaining 9 cases.

Choledochocele demonstrated on percutaneous cholangiography: a patient with acute fulminant pancreatitis

A patient with a choledochocele associated with development of acute fulminant pancreatitis is presented. Treatment had been severely compromised by this rare anomaly before it was identified by percutaneous cholangiography. Because it is potentially curable with surgery, identification of the lesion by percutaneous or intravenous cholangiography has important clinical significance.

Choledochocele of the common bile duct

The eighth report case of choledochocele is described. This lesion is a cyst communicating with the terminal portion of the common bile duct. It is characteristically lined with duodenal mucosa and is probably a form of duplication of the duodenum. The surgical treatment is marsupialization of the cyst to the interior of the duodenum.

Intraluminal diverticulum of the duodenum and choledochocele

An example of intraluminal diverticulum and another of choledochocele are reported. They both presented as abdominal emergencies in adult life, and the conditions are readily shown on barium studies.

Surgical treatment of choledochal cyst

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Enterogenous cyst of the duodenum

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Post eclamptic anuria complicated by haemorrhage into a duodenal cyst

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