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Sugita R, Furuta A, Yamazaki T, Ito K, Noda Y. Pancreaticobiliary Juice Reflux in Patients With a Morphologically Normal Ductal System: Assessment Using Unenhanced MRI With Spin Labeling. AJR Am J Roentgenol 2017; 208:322-327. [DOI: 10.2214/ajr.16.16601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Reiji Sugita
- Department of Radiology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi 983-0824, Japan
| | - Akemi Furuta
- Department of Radiology, Ishinomaki Red Cross Hospital, Ishinomaki, Miyagi, Japan
| | - Tetsuro Yamazaki
- Department of Radiology, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
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Alatise OI, Oke OA, Adesunkanmi AK, Olaofe OO, Asaleye CM. Management of Adult Choledochal Cyst Coexisting with Gallbladder Carcinoma: A Case Report and Review of Literature. Niger J Surg 2016; 22:43-7. [PMID: 27013859 PMCID: PMC4785692 DOI: 10.4103/1117-6806.169870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Choledochal cyst is a relatively rare condition. Even rarer is a choledochal cyst in association with a gallbladder carcinoma. This study reports a rare case of gallbladder carcinoma coexisting with a choledochal cyst in a Nigerian patient. Clinical records of the patient including preoperative evaluation, intraoperative findings, and postoperative care were reviewed. A 38-year-old woman presented with the recurrent right upper abdominal pain of 3 years duration associated with progressive weight loss, anorexia, recurrent vomiting, as well as, low-grade fever with chills and rigors. Physical examination revealed an anicteric woman with tenderness in the right hypochondrium and a positive Murphy's sign. A combination of abdominal ultrasound and computed tomography scan suggested a Type IV choledochal cyst and a distended gallbladder with thickened walls containing a heterogeneous hyperdense mass. Preoperative serum alkaline phosphatase was elevated while endoscopic retrograde cholangiopancreatography was inconclusive. At laparotomy, extrahepatic biliary dilatation and enlarged, the nodular gallbladder was found with a diffusely fibrotic pancreas. Intraoperative cholangiogram confirmed Type IV choledochal cyst. Excision of the common bile duct and radical cholecystectomy was performed, and a Roux-en-Y hepaticojejunostomy. Histopathology confirmed the diagnosis of gallbladder adenocarcinoma. She had adjuvant chemotherapy and is presently on follow-up. No evidence of recurrence after 5 years of follow-up. A high index of suspicion is required to detect a combination of these two rare entities. When detected, both conditions should be surgically addressed at the same sitting, and when combined with adjuvant chemotherapy, may increase the chances of achieving a cure.
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Affiliation(s)
- Olusegun Isaac Alatise
- Department of Surgery, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State, Nigeria
| | - Olatunbosun Ayokunle Oke
- Department of Surgery, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State, Nigeria
| | | | - Olaejinrin O Olaofe
- Department of Morbid Anatomy, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State, Nigeria
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Sallahu F, Hasani A, Limani D, Shabani S, Beka F, Zatriqi S, Murati S, Jashari H. Choledochal cyst - presentation and treatment in an adult. Acta Inform Med 2013; 21:138-9. [PMID: 24058256 PMCID: PMC3766534 DOI: 10.5455/aim.2013.21.138-139] [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: 01/25/2013] [Accepted: 03/28/2013] [Indexed: 12/18/2022] Open
Abstract
CONFLICT OF INTEREST NONE DECLARED Choledochal cyst is a congenital cystic dilation of a part of bile duct that occurs most commonly in the main part of common bile duct. Diagnosis of choledochal cyst is concluded upon disproportionate expansion of extrahepatic bile duct. Symptom trias are: abdominal pain, jaundice and abdominal mass represent clinical guideline signs of diagnosis. Furthermore, hepato-biliary diseases in adults can conceal the primary condition. In addition to this, ultrasound, CT, MRI, cholangiopancreatography (ERCP), transhepatic percutane cholangiography (PTC) guide us for a detailed examination in order to verify the diagnosis. Active endoscopic cholangiography represents an important technique that provides needed anatomic solution and details in diagnosis of choledochal cyst.
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Affiliation(s)
- Ferat Sallahu
- Clinic of Surgery, University Clinical Centre of Kosovo , Prishtina, Kosovo
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Nawara C, Wolkersdörfer G, Öfner-Velano D, Emmanuel K. Recent developments in the diagnosis and treatment of bile duct cysts: a review. Eur Surg 2011. [DOI: 10.1007/s10353-011-0006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim SJ, Choi BI, Kim SH, Lee JY. Three-dimensional imaging for hepatobiliary and pancreatic diseases: Emphasis on clinical utility. Indian J Radiol Imaging 2011; 19:7-15. [PMID: 19774130 PMCID: PMC2747398 DOI: 10.4103/0971-3026.45336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Three-dimensional (3D) imaging allows disease processes and anatomy to be better understood, both by radiologists as well as physicians and surgeons. 3D imaging can be performed with USG, CT scan and MRI, using different modes or rendering that include surface-shaded display, volume-based rendering, multiplanar imaging, etc. All these techniques are used variably depending on the indications.
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Comparative Study of the Diagnostic Ability of Magnetic Resonance Imaging and Multidetector Row Computed Tomography for Anomalous Pancreaticobiliary Ductal Junction. J Comput Assist Tomogr 2010; 34:725-31. [DOI: 10.1097/rct.0b013e3181e23ff2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee HK, Park SJ, Yi BH, Lee AL, Moon JH, Chang YW. Imaging features of adult choledochal cysts: a pictorial review. Korean J Radiol 2009; 10:71-80. [PMID: 19182506 PMCID: PMC2647175 DOI: 10.3348/kjr.2009.10.1.71] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Choledochal cysts are rare congenital anomalies which are principally diagnosed by disproportional dilatation of the extrahepatic bile ducts. In addition, choledochal cysts are believed to arise from the anomalous union of the common bile duct and pancreatic duct outside the duodenal wall which is also proximal to the sphincter of the Oddi mechanism. The various types of choledochal cysts have been classified on the basis of these anomalous unions (Komi classification) and their anatomical locations (Todani classification). The multidetector computed tomography with reformatted imaging, magnetic resonance cholangiopancreatography, and an endoscopic retrograde cholangiography represent the important techniques providing the anatomical resolution and detail required to properly diagnose and classify choledochal cysts and their associated abnormal features of the biliary tree, as well as their pancreaticobile duct union. This study describes the various imaging features of a choledochal cyst in adults according to the various types of anomalous unions of the pancreaticobile duct according to Komi's classification and anatomic location according to Todani's classification. Lastly, we also review and discuss the associated abnormal findings developed in biliary systems.
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Affiliation(s)
- Hae Kyung Lee
- Department of Radiology, College of Medicine, Soonchunhyang University Bucheon Hospital, Gyunggi-do, Korea.
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Anderson SW, Zajick D, Lucey BC, Soto JA. 64-Detector Row Computed Tomography: An Improved Tool for Evaluating the Biliary and Pancreatic Ducts? Curr Probl Diagn Radiol 2007; 36:258-71. [DOI: 10.1067/j.cpradiol.2007.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kim HC, Yang DM, Jin W, Ryu CW, Ryu JK, Park SI, Park SJ, Shin HC, Kim IY. Multiplanar reformations and minimum intensity projections using multi-detector row CT for assessing anomalies and disorders of the pancreaticobiliary tree. World J Gastroenterol 2007; 13:4177-84. [PMID: 17696245 PMCID: PMC4250615 DOI: 10.3748/wjg.v13.i31.4177] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
CT scan is regarded as the imaging modality of choice in patients with pancreaticobiliary ductal abnormalities. However, the axial orientation of the CT images provides only limited anatomical view of pancreaticobiliary ductal abnormalities. The technological advances of multi-detector row CT and three-dimensional image processing in workstations allows rapid image acquisition and a short postprocessing time. In particular, multiplanar reformations (MPR) and minimum intensity projections (MinIP) offer rapid and accurate images of the anatomy and abnormalities of the pancreaticobiliary tree. Moreover, MPR and MinIP help determine the relationship between the pancreaticobiliary ductal anatomy and the surrounding structures. This pictorial review illustrates the wide spectrum of images obtained by the MPR and MinIP of the anomalies and disorders of the pancreaticobiliary tree.
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Affiliation(s)
- Hyun Cheol Kim
- Department of Radiology, East-West Neo Medical Center, Kyung-Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea.
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Søreide K, Søreide JA. Bile duct cyst as precursor to biliary tract cancer. Ann Surg Oncol 2006; 14:1200-11. [PMID: 17187167 DOI: 10.1245/s10434-006-9294-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 09/24/2006] [Accepted: 09/25/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile duct cysts (BDC) are rare, of uncertain origin, and occur most often in young females of Asian descent. Increasingly, BDCs are reported in the Western population, often with coexistent biliary tract cancer. METHODS The PubMed and Medline literature databases were searched for pertinent publications regarding the clinical association and molecular biological development of cancerogenesis in BDC. Reports from the last two decades were emphasized. RESULTS Cancer is found in 10-30% of adults with BDC. The cancer-risk is low in childhood (<1% in the first decade), and shows a clear increase with age. Cholangiocarcinoma is the most common malignancy in BDC, and represents a 20- to 30-fold risk compared to the general population. The mean age of malignancy in BDC is 32 years (about two decades earlier than in the general population). Type I and type IV cysts show a higher cancer incidence, even after cyst excision. Pathological findings strongly suggest a hyperplasia-dysplasia-carcinoma sequence in carcinogenesis of pancreatico-biliary maljunction (PBM). Reflux of pancreatic enzymes, amylase, bile stasis, and an increased intraductal concentration of bile acids contribute to proliferative activity of bile acids in BDC. While microsatellite instability, k-ras mutations, expression of COX-2 and bcl-2, and increased telomerase activity seem to occur early; involvement of cyclin D1, beta-catenin, DPC-4/Smad4 and p53 appear later in carcinogenesis. CONCLUSION Increased molecular knowledge substantiates the clinically related cancer-risk in BDC. Surgery remains the golden standard for treatment, relieves patients from associated complications, and interrupts the cancerous potential in BDC.
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Affiliation(s)
- Kjetil Søreide
- Department of General and Gastroenterologic Surgery, Stavanger University Hospital, Stavanger, Norway.
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Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 2006; 26:715-31. [PMID: 16702450 DOI: 10.1148/rg.263055164] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A wide spectrum of anomalies of the pancreas, the pancreatic ductal system, and the biliary tree are commonly encountered at radiologic evaluation. These anomalies may simulate various neoplastic, inflammatory, and posttraumatic conditions and should be part of the differential diagnosis for a variety of abnormalities found at diagnostic imaging. Anatomic variants, developmental anomalies (eg, pancreas divisum, annular pancreas, ectopic pancreas, pancreatic agenesis and hypoplasia), and congenital diseases (congenital pancreatic cysts, von Hippel-Lindau disease, choledochal cysts), in addition to potential imaging pitfalls (uneven distribution of fat, "pseudomasses"), can all pose a diagnostic challenge for the radiologist. Familiarity with these anomalies, the imaging techniques available for their study, and their variable imaging manifestations is necessary for differentiating them from other biliary and pancreatic conditions. A basic understanding of the embryologic development and normal anatomy of the pancreas and biliary tree is also essential for identifying these anomalies.
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Affiliation(s)
- Koenraad J Mortelé
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Itoh S, Fukushima H, Takada A, Suzuki K, Satake H, Ishigaki T. Assessment of Anomalous Pancreaticobiliary Ductal Junction with High-Resolution Multiplanar Reformatted Images in MDCT. AJR Am J Roentgenol 2006; 187:668-75. [PMID: 16928928 DOI: 10.2214/ajr.05.0824] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of our study was to assess the capabilities of MDCT for the diagnosis of an anomalous pancreaticobiliary ductal junction using high-resolution multiplanar reformatted (multiplanar reconstruction) images. MATERIALS AND METHODS This study included nine patients with and 54 without an anomalous pancreaticobiliary ductal junction confirmed on direct cholangiopancreatography. Multiplanar reconstruction images with 0.5-mm continuous slices were generated from isotropic or nearly isotropic pancreatic phase images. By mainly interpreting the multiplanar reconstruction images using the Scrolling mode, two blinded reviewers independently determined whether the confluence of the pancreatic and biliary ducts joined in the pancreatic parenchyma (in other words, outside the duodenal wall). The results were correlated with the findings of direct cholangiopancreatography. The diagnostic capabilities of CT for revealing associated pancreatobiliary diseases were assessed in patients with this anomaly. RESULTS Interobserver agreement in the classification of the duct confluence was high (kappa = 0.804). The duct confluence was identified in all patients except four without an anomalous pancreaticobiliary ductal junction. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT for diagnosing an anomalous pancreaticobiliary ductal junction were 100% (9 of 9 patients), 87% (47 of 54 patients), 89% (56 of 63 patients), 75% (9 of 12 patients), and 100% (47 of 47 patients) in the final decisions, respectively. CT showed all associated pancreatobiliary diseases except bile duct stones in two patients. CONCLUSION MDCT enabled the diagnosis of an anomalous pancreaticobiliary ductal junction by showing whether the pancreatic and biliary ducts join within the pancreatic parenchyma on high-resolution multiplanar reconstruction images.
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Affiliation(s)
- Shigeki Itoh
- Department of Technical Radiology, Nagoya University School of Health Sciences, Nagoya, Aichi 461-8673, Japan.
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Pilleul F. [Asymptomatic or paucisymptomatic CBD dilatation on US after cholecystectomy: management]. ACTA ACUST UNITED AC 2006; 87:494-9. [PMID: 16691178 DOI: 10.1016/s0221-0363(06)74029-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In western countries, 10-15% of the population has gallbladder stones with 46,000 cholecystectomies performed in France in 2003. So, daily ultrasonography of the abdomen performed in patients without gallbladder is a routine exam. However, identification of an enlarged common bile duct is frequent and the normal nature of this finding remains uncertain. The purpose of this article is to perform a literature review of the impact of cholecystectomy on the diameter of the common bile duct. Furthermore, it is important not to dismiss common bile duct dilatation after cholecystectomy because it may be the result of post operative complication or secondary to a congenital disease of bile duct.
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Affiliation(s)
- F Pilleul
- Service de Radiologie Digestive du Pr. PJ Valette, Hôpital Edouard Herriot, Place d'Arsonval, 69437 Lyon cedex 03.
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Abstract
BACKGROUND Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian descent, but an increasing number have occurred in Western adults. METHODS A Medline literature search was performed to locate articles on the pathophysiological concepts, clinical behaviour and management controversies pertaining to bile duct cysts in adults. Emphasis was placed on reports from the past two decades. RESULTS AND CONCLUSION An increasing rate of occurrence of bile duct cyst is reported in adults. Type IV cysts are more frequent in adults than children. Presentation tends to be non-specific abdominal discomfort. Related hepatobiliary or pancreatic disease frequently precedes recognition, and may complicate the postoperative course. Surgical treatment aims to relieve complications deriving from the cysts and to reduce the significant risk of malignant change within the biliary tree. Complete cyst resection, cholecystectomy and Roux-en-Y hepaticojejunostomy reconstruction is standard. Controversy exists about the role of hepatic resection in type IV and V cysts, and the role of minimally invasive and laparoscopic treatment. In general, the outcome is good and a near-zero mortality rate has been reported in institutional series over the past decade.
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Affiliation(s)
- K Söreide
- Department of Surgery, University of Bergen, Stavanger, Norway
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Abstract
Cystic diseases of the biliary tract encompass a complex group of congenital disorders. Some of the disorders, such as Caroli disease and the hepatobiliary cysts of autosomal-dominant polycystic kidney disease, share common embryologic origins, whereas others, such as choledochal cysts, biliary diverticula, and choledochoceles, have unclear origins. This article reviews the embryologic, clinical, pathologic, and imaging features of biliary cystic disease.
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Affiliation(s)
- Angela D Levy
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.
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