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Gang S, Kwon H, Song IH, Namgoong JM. Clinical implications of pediatric biliary intraepithelial neoplasia diagnosed from a choledochal cyst specimen. World J Surg Oncol 2024; 22:105. [PMID: 38643155 PMCID: PMC11031949 DOI: 10.1186/s12957-024-03384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Biliary intraepithelial neoplasia (BilIN), a noninvasive precursor of cholangiocarcinoma, can manifest malignant transformation. Since cholangiocarcinoma (CCA) may progress due to chronic inflammation in the bile ducts and gallbladder, choledochal cysts are considered a precursor to CCA. However, BilIN has rarely been reported in children, to date. METHODS We reviewed medical records of patients (< 18 years of age, n = 329) who underwent choledochal cyst excision at Asan Medical Center from 2008 to 2022. BilIN was diagnosed in 15 patients. Subsequent analyses were performed of the demographics, surgical procedures, clinical course, and outcomes in these patients. Subgroup analysis and multivariate logistic regression test were performed to identify factors influencing BilIN occurrence. RESULTS The mean age of the patients included in our study was 40.1 ± 47.6 months. In 15 patients, BilIN of various grades was diagnosed. Todani type I was prevalent in 80% of the patients. The median age at surgery was 17 months. During a mean follow-up of 63.3 ± 94.0 months, no adverse events such as stone formation in the remnant intrapancreatic common bile duct and intrahepatic duct or cholangiocarcinoma were observed, indicating a favorable outcome until now. CONCLUSIONS The potential progression of choledochal cysts to BilIN in children was demonstrated. These results could underscore the importance of early and comprehensive excision of choledochal cysts, including resection margins for associated lesions and more thorough postoperative surveillance in patients with or at risk of BilIN.
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Affiliation(s)
- Sujin Gang
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - Hyunhee Kwon
- Department of Pediatric Surgery, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea
| | - In Hye Song
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
| | - Jung-Man Namgoong
- Department of Pathology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea.
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Eiamkulbutr S, Tubjareon C, Sanpavat A, Phewplung T, Srisan N, Sintusek P. Diseases of bile duct in children. World J Gastroenterol 2024; 30:1043-1072. [PMID: 38577180 PMCID: PMC10989494 DOI: 10.3748/wjg.v30.i9.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/26/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024] Open
Abstract
Several diseases originate from bile duct pathology. Despite studies on these diseases, certain etiologies of some of them still cannot be concluded. The most common disease of the bile duct in newborns is biliary atresia, whose prognosis varies according to the age of surgical correction. Other diseases such as Alagille syndrome, inspissated bile duct syndrome, and choledochal cysts are also time-sensitive because they can cause severe liver damage due to obstruction. The majority of these diseases present with cholestatic jaundice in the newborn or infant period, which is quite difficult to differentiate regarding clinical acumen and initial investigations. Intraoperative cholangiography is potentially necessary to make an accurate diagnosis, and further treatment will be performed synchronously or planned as findings suggest. This article provides a concise review of bile duct diseases, with interesting cases.
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Affiliation(s)
- Sutha Eiamkulbutr
- Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Chomchanat Tubjareon
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Anapat Sanpavat
- Department of Pathology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Teerasak Phewplung
- Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nimmita Srisan
- Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
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Simmons CL, Harper LK, Patel MC, Katabathina VS, Southard RN, Goncalves L, Tran E, Biyyam DR. Biliary Disorders, Anomalies, and Malignancies in Children. Radiographics 2024; 44:e230109. [PMID: 38358937 DOI: 10.1148/rg.230109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Biliary abnormalities in children are uncommon, and the spectrum of biliary disorders is broader than in adult patients. Unlike in adults, biliary disorders in children are rarely neoplastic and are more commonly rhabdomyosarcoma rather than cholangiocarcinoma. Pediatric biliary disorders may be embryologic or congenital, such as anatomic gallbladder anomalies, anomalous pancreaticobiliary tracts, various cholestatic processes, congenital cystic lesions, or genetic conditions. They may also be benign, such as biliary filling anomalies, biliary motility disorders, and biliary inflammatory and infectious disorders. Distinguishing these entities with a single imaging modality is challenging. US is the primary imaging modality for initial evaluation of biliary abnormalities in children, due to its wide availability, lack of ionizing radiation, and low cost and because it requires no sedation. Other examinations such as MRI, CT, and nuclear medicine examinations may provide anatomic and functional information to narrow the diagnosis further. Hepatobiliary-specific contrast material with MRI can provide better assessment of biliary anatomy on delayed images than can traditional MRI contrast material. MR cholangiopancreatography (MRCP) allows visualization of the intra- and extrahepatic biliary ducts, which may not be possible with endoscopic retrograde cholangiopancreatography (ERCP). Suspected biliary atresia requires multiple modalities for diagnosis and timely treatment. Determining the type of choledochal cyst calls for a combination of initial US and MRCP. Many benign and malignant biliary masses require biopsy for definitive diagnosis. Knowledge of the imaging appearances of different pediatric biliary abnormalities is necessary for appropriate imaging workup, providing a diagnosis or differential diagnosis, and guiding appropriate management. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Curtis L Simmons
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Laura K Harper
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Mittun C Patel
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Venkat S Katabathina
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Richard N Southard
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Luis Goncalves
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Evelyn Tran
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
| | - Deepa R Biyyam
- From the Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Main Tower, Phoenix, AZ 85016 (C.L.S., M.C.P., R.N.S., L.G., D.R.B.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (L.K.H.); Department of Radiology, UT Health San Antonio, San Antonio, Tex (V.S.K.); and Baylor College of Medicine, Houston, Tex (E.T.)
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Bloomfield GC, Nigam A, Calvo IG, Dorris CS, Fishbein TM, Radkani P, Winslow ER. Characteristics and malignancy rates of adult patients diagnosed with choledochal cyst in the West: a systematic review. J Gastrointest Surg 2024; 28:77-87. [PMID: 38353080 DOI: 10.1016/j.gassur.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND The approach to patients with choledochal cysts (CCs) remains varied and subject to institutional practices. Owing to the rarity of the disease, the optimal treatment remains poorly defined, particularly in the adult population. This study aimed to review the literature on adult patients with CCs to evaluate trends of diagnosis and management in Western countries. METHODS A literature search of 3 electronic databases was performed on adult patients diagnosed with CCs in Western institutions. A review of published literature was completed with comprehensive screening by 2 independent reviewers. Studies were analyzed, and data on surgical approach, malignancies, and follow-up were collected. Findings are presented in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS Of the 3488 articles retrieved, 21 studies evaluated Western adults with CCs for a combined population of 1337 patients. The most common Todani subtypes included types I (64%) and IV (22%). Symptoms at presentation included abdominal pain and jaundice, although many were asymptomatic. Ultrasound was used most frequently for diagnosis, followed by computed tomography and endoscopic cholangiopancreatography. The combined malignancy rate was 10.9%, with cholangiocarcinoma being the most prevalent. Complete extrahepatic cyst resection was standard for type I and IV CCs. Among malignancies, 18.5% and 16.4% were observed in patients with prior resection and internal drainage, respectively. CONCLUSIONS A significant proportion of patients who undergo resection of CC disease harbor malignancy. Cancer risk seems reduced but not eliminated with complete resection, which remains the standard treatment. Additional studies are needed to standardize guidelines for the diagnosis and postoperative care of patients in Western countries.
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Affiliation(s)
- Grace C Bloomfield
- Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Inochi Gonzalez Calvo
- Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - C Scott Dorris
- Dahlgren Memorial Library, Georgetown University Medical Center, Washington, District of Columbia, United States
| | - Thomas M Fishbein
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Pejman Radkani
- MedStar Georgetown Transplant Institute, Medstar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Emily R Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Okazaki T, Nikai K, Koga H, Miyano G, Ochi T, Lane GJ, Fukumura Y, Yamataka A. Premalignant/malignant histology in excised choledochal cyst specimens from children. Experience and literature review. Pediatr Surg Int 2023; 40:5. [PMID: 37996760 DOI: 10.1007/s00383-023-05582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Dysplasia, carcinoma in situ, and other malignant transformation or premalignant/malignant histopathology (PMMH) seem uncommon in pediatric choledochal cyst (CC). A literature review and the authors' experience are presented. METHODS All reports about PMMH in CC patients 15 years old or younger published in English and all cases of PMMH in specimens excised from CC patients 15 years old or younger by the authors were reviewed. RESULTS Of 20 published reports, PMMH was adenocarcinoma (n = 4), sarcoma (n = 4), and dysplasia (n = 12). Treatment for malignancies was primary pancreaticoduodenectomy (PD; n = 2) or cyst excision/hepaticojejunostomy (Ex/HJ; n = 6). Outcomes at the time of writing for malignancies: 2 deaths, 4 survivors after follow-up of 2 years, and 2 lost to follow-up. No dysplasia case has undergone malignant transformation. The authors have experienced 7 cases of PMMH; adenocarcinoma in situ (AIS; n = 1) and dysplasia (n = 6). CONCLUSIONS The present study identified the youngest cases of AIS and dysplasia from specimens excised when they were 3 years old and 4 months old, respectively. Both are published for the first time as evidence that PMMH can complicate CC in young patients. Long-term protocolized postoperative follow-up is mandatory when PMMH is diagnosed in pediatric CC.
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Affiliation(s)
- Tadaharu Okazaki
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, Japan.
| | - Koki Nikai
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, Japan
- Department of Pediatric General and Urogenital Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Go Miyano
- Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, Japan
| | - Takanori Ochi
- Department of Pediatric General and Urogenital Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Geoffrey J Lane
- Department of Pediatric General and Urogenital Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Nguyen SH, Abella M, Gutierrez JV, Tabak B, Puapong D, Johnson S, Woo RK. Robotic Surgery for Pediatric Choledochal Cysts: An American Case Series and Literature Review. J Surg Res 2023; 291:473-479. [PMID: 37531675 DOI: 10.1016/j.jss.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Choledochal cysts are rare congenital biliary cystic dilations. The US incidence rate varies between 5 and 15 cases per 1,000,000 people. In contrast, Asians, which are a large subset of the population of Hawaii, have an incidence of approximately one in every 1000 births. We report our experience with robot-assisted laparoscopic surgical management with biliary reconstruction of choledochal cysts which to date is the largest American case series to be reported. MATERIALS AND METHODS From 2006 to 2021, patients diagnosed with a choledochal cyst(s) at a tertiary children's hospital were retrospectively reviewed. Perioperative analysis was performed. Complications were defined as immediate, early, or late. The data underwent simple descriptive statistics. RESULTS Nineteen patients underwent choledochal cystectomy and hepaticoduodenostomy. Thirteen underwent a robotic approach while the rest were planned laparoscopic. Eighteen of 19 were female with 15/19 of Asian descent. The ages ranged from 5 mo to 21 y. Presenting diagnoses included jaundice, primary abdominal pain, pancreatitis, and cholangitis. Sixty eight percent had type 1 fusiform cysts while the rest were type 4a. Operative time and length of stay for robotic versus laparoscopic were 321 versus 267 min and 8.2 versus 17.3 d, respectively. For the robotic group, there was one immediate complication due to peritonitis. One-year follow-up revealed two patients requiring endoscopic retrograde cholangiopancreatography with dilation/stenting for an anastomotic stricture. There were no anastomotic leaks. CONCLUSIONS Robot-assisted laparoscopic choledochal cystectomy with hepaticoduodenostomy is associated with overall good outcomes with the most common long-term complication being anastomotic stenosis.
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Affiliation(s)
- Scott H Nguyen
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii.
| | | | | | - Benjamin Tabak
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
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Chung PHY, Yeung F, Ma MKI, Wong KKY. The impact of pre-operative cholecystostomy on laparoscopic excision of choledochal cyst in paediatric patients. Pediatr Surg Int 2023; 39:282. [PMID: 37847409 DOI: 10.1007/s00383-023-05562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE This aim of this study was to identify the pre-operative risk factors for conversion during laparoscopic excision of choledochal cyst in paediatric patients. METHODS A retrospective single-centre study was carried out. All paediatric patients (< 18 years) who had undergone laparoscopic excision of choledochal cyst between 2004 and 2021 were reviewed. The outcome was conversion to open surgery and pre-operative factors that affected the conversion rate were analyzed. RESULTS Sixty-one patients were included. Conversion was required in 24 cases (39.3%). There was no difference in the conversion rate between the first (before 2012, n = 30) and second (after 2012, n = 31) half of the series (36.7% vs. 42.0%, p = 0.674). Majority was type 1 cyst (86.8%) and the median cyst size was 4.6 cm (IQR: 2.2-6.4 cm). Antenatal diagnosis was available in 18 patients (29.5%). The median age at operation was 23.0 months (IQR: 8.0-72.0 months). Pre-operatively, 19 patients (31.1%) suffered from cholangitis and 5 (8.2%) of them required cholecystostomy. Comparing patients with successful laparoscopic surgery (L) and converted cases (C), there were no differences in the age at operation (p = 0.74), cyst size (p = 0.35), availability of antenatal diagnosis (p = 0.23) and cholangitic episodes (p = 0.40). However, a higher percentage of patients required cholecystostomy in the converted group (L vs. C = 2.7% vs. 16.7%, p = 0.05). Using logistic regression analysis, it was also a risk factor for conversion (OR = 3.5 [1.37-5.21], p = 0.05). CONCLUSION Pre-operative cholecystostomy is a potential risk factor for conversion during laparoscopic excision of choledochal cyst in children.
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Affiliation(s)
- Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong S.A.R..
| | - Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong S.A.R
| | - Marco King In Ma
- Division of Paediatric Surgery, Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong S.A.R
| | - Kenneth Kak Yuen Wong
- Division of Paediatric Surgery, Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong S.A.R
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Singh RJ, Ali MM, Rashi R, Kumar A, Dudhani S, Sinha AK. Giant choledochal cyst in infant: A rare case report. Afr J Paediatr Surg 2023; 20:243-244. [PMID: 37470565 PMCID: PMC10450116 DOI: 10.4103/ajps.ajps_72_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/28/2022] [Indexed: 01/22/2023] Open
Abstract
The cystic dilatation of the common bile duct (CBD) is a rare pathology in an infant. It is the second-most common surgical cause of cholestatic jaundice in infants after biliary atresia. A 4-month-old female child was admitted to our department with complaints of abdominal distension. The physical examination revealed the presence of a huge palpable mass involving the right hypochondrium up to the right iliac fossa and umbilical region. Ultrasound abdomen revealed a large intra-abdominal cyst but unable to comment on the organ of origin of the cyst due to its huge size. Multidetector computed tomography of the abdomen was suggestive of possible origin of the cyst from CBD extending from porta hepatis to pelvis. At laparotomy, there was a huge choledochal cyst extending from porta hepatis to pelvis. The choledochal cyst was excised, followed by Roux-en-Y hepaticojejunostomy.
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Affiliation(s)
| | | | - Rashi Rashi
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
| | - Amit Kumar
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
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Asghar MS, Sabir Z, Zaman BS, Zafarullah S, Zaigham Ali Shah HS, Aslam I, Afzal A. Experience of surgical management of rare cases of choledochal cyst in last five years-tertiary care reflection. J PAK MED ASSOC 2023; 73:677-680. [PMID: 36932781 DOI: 10.47391/jpma.5245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Choledochal Cyst (CC), also known as the biliary cyst, is one of the rare inherited anomalies of intrahepatic and/or extrahepatic biliary system characterised by varying degrees of cystic dilatation of the biliary tract without acute obstruction. The prevalence ranges from 1 in 13,000 people to 1 in 2 million people with preponderance in Asia1, particularly in Japan. Moreover, the presentation also varies in children and adults, and is usually vaguer and non-specific in adults. The prevalence is even lower in males, with female to male ratio being 3:1-4:12. We present here three cases of adult choledochal cysts excised in our surgical unit in the last five years. We discuss the aetiopathogenesis, presentation, diagnosis, surgical treatment, and complications of choledochal cysts based on the available literature. It is crucial to establish a multidisciplinary group of professionals, that comprises paediatric surgeons, pathologists, paediatric gastroenterologists, physiotherapists, nutritionists, oncologists, and radiologists, to get acceptable outcomes in diagnosing and treating children with choledochal cysts.
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Affiliation(s)
| | - Zainab Sabir
- Department of Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Balakh Sher Zaman
- Department of General Surgery, King Edward Medical University Mayo Hospital Lahore, Pakistan
| | - Sadaf Zafarullah
- Department of Surgery, King Edward Medical University, Mayo Hospital, Lahore,Pakistan
| | | | - Imran Aslam
- Department of Surgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Ameer Afzal
- Department of Surgery, King Edward Medical University, Mayo Hospital,Lahore, Pakistan
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Zhang W, Wu Z, Chen S, Zuo T, Cheng Z, Fu J, Wang B. Expression profile of circRNA in biliary atresia and choledochal cyst. Chin Med J (Engl) 2023; 136:365-366. [PMID: 36228165 PMCID: PMC10106123 DOI: 10.1097/cm9.0000000000002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Wenjie Zhang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong 518000, China
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Rahamtalla D, Al Rawahi Y, Jawa ZM, Wali Y. Cystic biliary atresia in a neonate with antenatally detected abdominal cyst. BMJ Case Rep 2022; 15:e246081. [PMID: 35228221 PMCID: PMC8886371 DOI: 10.1136/bcr-2021-246081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Cystic biliary atresia (BA) is a rare but an important type of BA. An antenatally detected cystic lesion at the porta hepatis raises the suspicion of cystic BA. It is very important to differentiate this from choledochal cyst in infants with cholestasis and cystic lesions. This case report outlines the clinical presentation and radiological findings of an infant who had an antenatally detected intra-abdominal cystic mass, thought to be a choledochal cyst.
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Affiliation(s)
- Dafalla Rahamtalla
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yusriya Al Rawahi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Yasser Wali
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Tannuri ACA, Hara LADA, Paganoti GDF, Andrade WDC, Tannuri U. Choledochal cysts in children: How to Diagnose and Operate on. Clinics (Sao Paulo) 2020; 75:e1539. [PMID: 32215454 PMCID: PMC7074585 DOI: 10.6061/clinics/2020/e1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.
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Affiliation(s)
- Ana Cristina Aoun Tannuri
- Divisao de Cirurgia Pediatrica, Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica (LIM 30), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Lucas Arjona de Andrade Hara
- Divisao de Cirurgia Pediatrica, Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica (LIM 30), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Guilherme de Freitas Paganoti
- Divisao de Cirurgia Pediatrica, Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica (LIM 30), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Wagner de Castro Andrade
- Divisao de Cirurgia Pediatrica, Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica (LIM 30), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Uenis Tannuri
- Divisao de Cirurgia Pediatrica, Unidade Pediatrica de Transplante de Figado e Laboratorio de Pesquisa em Cirurgia Pediatrica (LIM 30), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Upadhyaya VD, Kumar B, Upadhyaya E, Neeyaz Z. Choledochal Cyst of Cystic Duct in Children a Rare Entity. Kathmandu Univ Med J (KUMJ) 2018; 16:354-358. [PMID: 31729354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Choledochal cyst of the cystic duct is an uncommon entity which may occur as isolated disease or may be associated with choledochal cyst of the other part of the biliary tree. In most of the reported series it was diagnosed at time of operation but now days to better investigation modality it can be diagnosed preoperatively if the index of suspicion is high. We are presenting a series of such case in pediatric age group (which includes an infant) where the diagnosis was made during operation with a light on means and ways for suspecting this entity before operation and how to differentiate other lesion with this entity with relevant review of literature.
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Affiliation(s)
- V D Upadhyaya
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical, Sciences (SGPGIMS), Lucknow, India
| | - B Kumar
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical, Sciences (SGPGIMS), Lucknow, India
| | - E Upadhyaya
- Department of Anatomy, ERAS, Lucknow Medical College, India
| | - Z Neeyaz
- Department of Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical, Sciences (SGPGIMS), Lucknow, India
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14
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ten Hove A, de Meijer VE, Hulscher JBF, de Kleine RHJ. Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg 2018; 105:482-490. [PMID: 29480528 PMCID: PMC5900735 DOI: 10.1002/bjs.10798] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Choledochal malformations comprise various congenital cystic dilatations of the extrahepatic and/or intrahepatic biliary tree. Choledochal malformation is generally considered a premalignant condition, but reliable data on the risk of malignancy and optimal surgical treatment are lacking. The objective of this systematic review was to assess the prevalence of malignancy in patients with choledochal malformation and to differentiate between subtypes. In addition, the risk of malignancy following cystic drainage versus complete cyst excision was assessed. METHODS A systematic review of PubMed and Embase databases was performed in accordance with the PRISMA statement. A meta-analysis of the risk of malignancy following cystic drainage versus complete cyst excision was undertaken in line with MOOSE guidelines. Prevalence of malignancy was defined as the rate of biliary cancer before resection, and malignant transformation as new-onset biliary cancer after surgery. RESULTS Eighteen observational studies were included, reporting a total of 2904 patients with a median age of 36 years. Of these, 312 in total developed a malignancy (10·7 per cent); the prevalence of malignancy was 7·3 per cent and the rate of malignant transformation was 3·4 per cent. Patients with types I and IV choledochal malformation had an increased risk of malignancy (P = 0·016). Patients who underwent cystic drainage had an increased risk of developing biliary malignancy compared with those who had complete cyst excision, with an odds ratio of 3·97 (95 per cent c.i. 2·40 to 6·55). CONCLUSION The risk of developing malignancy among patients with choledochal malformation was almost 11 per cent. The malignancy risk following cystic drainage surgery was four times higher than that after complete cyst excision. Complete surgical resection is recommended in patients with choledochal malformation.
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Affiliation(s)
- A. ten Hove
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - V. E. de Meijer
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - J. B. F. Hulscher
- Division of Paediatric Surgery, Department of SurgeryUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
| | - R. H. J. de Kleine
- Division of Hepato‐Pancreato‐Biliary Surgery and Liver TransplantationUniversity of Groningen and University Medical Centre GroningenGroningenThe Netherlands
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15
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Quintana A, Sathyanarayana SA. Type VI Choledochal Cyst: An Unusual Case of a Bile Duct Anomaly. Am Surg 2018; 84:462-465. [PMID: 29559068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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16
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Toumi O, Chaouch MA, Ghedira A, Korbi I, Nasr M, Noomene F, Zouari K, Salem R, Hamida B, Golli M. Adult's congenital bile duct cysts. Tunis Med 2017; 95:411-414. [PMID: 29512796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Congenital bile duct cysts (CBDC) is a rare congenital malformation. It results from an anomaly of the biliopancreatic junction (AJBP). This condition is often diagnosed at a young age. Although, it can be asymptomatic and discovered only at an advanced age. The aim of our work was to describe the diagnosis, therapeutic and evolutionary aspects of BVCD through a series of 11 cases diagnosed in adult cases. METHODS This is a descriptive, retrospective and monocentric study. It collects patients operated for CBDC between 01/08/1999 and 30/06/2009. RESULTS The mean age was 45.3 years. Two men and nine women. The right hypochondria pain has been reported by all patients. On physical examination, jaundice was noted in five cases and the rest of the examination was normal. Biology showed cholestasis in six cases and cytolysis in four cases. Only one patient had hyperamylasaemia (five times normal). The preoperative diagnosis of a VBCD was reported in eight cases. Peroperative cholangiography (OCP) allowed to make the diagnosis and classify the CBDC according to the classification of Todani. Microscopic examination demonstrated three cases of associated gallbladder adenocarcinoma. The operative follow-up was simple for ten cases. A case of surgical recovery was necessary due to infection of necrotic pancreatitis. The mean follow-up was 40.6 months with extremes from one month to seven years. Only one case of death has been reported. No patient has presented a later biliary tract degeneration. Only one case of secondary biliary cirrhosis due to repeated attacks of angiocholitis has been reported. CONCLUSION CBDC is rare. It must be suspected at any age. It is characterized by the increased risk of degeneration. Radiological examinations can suspect the diagnosis in younger and asymptomatic patients to ensure a well-conducted and timely surgical treatment.
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Badebarin D, Aslanabadi S, Teimouri-Dereshki A, Jamshidi M, Tarverdizadeh T, Shad K, Ghabili K, Khajir G. Different clinical presentations of choledochal cyst among infants and older children: A 10-year retrospective study. Medicine (Baltimore) 2017; 96:e6679. [PMID: 28445267 PMCID: PMC5413232 DOI: 10.1097/md.0000000000006679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Choledochal cyst is a rare and often benign congenital cystic dilation throughout the biliary tree. Due to the benign nature of choledochal cyst among early-diagnosed patients, the clinical assumption and diagnosis seem to be of utmost significance. Therefore, we sought to assess different clinical manifestations of choledochal cyst and relevant laboratory findings in infants and older children.Retrospectively, medical records of all patients with the diagnosis of choledochal cyst between 2005 and 2015 were reviewed. Demographic data, initial clinical presentation, positive findings on physical examination, history of any remarkable behavior such as persistent and unexplained crying and poor feeding, and diagnostic imaging modalities were listed. In addition, laboratory values for total and direct bilirubin, alkaline phosphatase, alanine transaminase, aspartate transaminase, prothrombin time, and partial thromboplastin time (PTT) were recorded for each patient. Patients were divided into 2 groups; younger than 1-year-old (infants), and 1 year to 18 years old (older children). Demographic data, clinical data, and laboratory values were compared between the infants and older children.Thirty-two patients with a diagnosis of choledochal cyst were included in the study: 9 patients (28.12%) were infants and 23 patients (71.87%) were older children. Abdominal pain was the most common presenting symptom (62.5%), followed by nausea/vomiting (59.4%) and jaundice (28.1%). None of the patients presented with the classic triad of abdominal pain, jaundice, and right upper quadrant mass. Seventeen older children (73.91%) presented with nausea and vomiting, while 2 subjects (22.22%) in the infantile group presented with this feature (P = .01). Similarly, abdominal pain was found in 20 older children (86.95%); however, none of the infants presented with abdominal pain at diagnosis (P < .001). By contrast, the abdominal mass was more detected in infants than the older children (33.33% vs. 0%, P = .01). In terms of laboratory values, the median PTT was 44 and 36 s in infants and older children, respectively (P = .04).Infants were more likely to present with abdominal mass and older children were more likely to have nausea, vomiting, and abdominal pain. Furthermore, infants had more prolonged PTT than older children, implying a potential bleeding tendency.
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Affiliation(s)
- Davoud Badebarin
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Saeid Aslanabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | | | - Masoud Jamshidi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Tuba Tarverdizadeh
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kaveh Shad
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Ghabili
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ghazal Khajir
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Peribiliary cysts, otherwise known as cystic dilatation of the peribiliary glands, are uncommon, and are usually discovered incidentally at autopsy, or in explants following liver transplantation. Preoperative diagnosis is often difficult owing to their asymptomatic nature and small size. Exclusion of a premalignant or malignant cystic condition is mandatory. We report a case of peribiliary cysts, initially thought to represent Caroli’s disease, and briefly discuss the management of this condition.
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Affiliation(s)
- G Fusai
- Liver Transplant, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK
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Panebianco A, Carbotta G, Prestera A, Laforgia R, Volpi A, Sallustio P. Choledochal cysts in pregnancy A case report and literature review. Ann Ital Chir 2016; 87:S2239253X16025238. [PMID: 27215168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Aim is to demonstrate that surgery can be the best way to reduce the risk of malignancy in choledochal cysts (CC) and how hard can be the diagnosis and the treatment during pregnancy. CASE REPORT We report a case of a pregnant young woman (36 week) with a Todani's score II CC. After caesarean, due to increasing jaundice, she underwent magnetic resonance cholangiopancreatography (MRCP) and Endoscopic retrograde cholangiopancreatography (ERCP) that confirmed the diagnosis. Surgical operation consisted in "cholecystectomy, resection of the choledocal cyst and poli-jejunum anastomosis. drainage of the abscess in the iv hepatic segment". DISCUSSION This case report highlights the difficult diagnosis and consequently treatment of a CC, especially during pregnancy. A significant association of biliary duct cyst and hepato-bilio-pancreatic malignancy has been reported with an age-related incidence. CONCLUSION Surgery is considered as the best treatment with a close follow-up because of the risk of recurrent cholangitis and malignant degeneration. This case represents also a challenge because of physiological changes in pregnancy and also because of the risk of fetal mortality and maternal morbidity. KEY WORDS Choledochal cyst, Colangiocarcinoma, Pregnancy, Todani's score.
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20
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Diaz Ramos NM, Lugo-Vicente H. Choledochal Cyst: Hepaticoduodenostomy or hepaticojejunostomy? Bol Asoc Med P R 2016; 108:41-46. [PMID: 29193916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Choledochal cysts are cystic dilatation of the common bile duct managed by excision and hepatico-intestinal reconstruction. The gold standard after choledochal cyst excision is reconstruction using the jejunum. With the advent of laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction. We review the classification, diagnosis and recent management of choledochal cyst.
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Randle RW, Qasem SA, Shen P. Biliary Duplication Cyst. Am Surg 2015; 81:E291-E293. [PMID: 26140880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Reese W Randle
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shadi A Qasem
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Perry Shen
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Chang MY, Kim MJ, Han SJ, Kim HM, Lee MJ. Choledochal cyst rupture with an intrahepatic pseudocyst mimicking hepatic mesenchymal hamartoma in an infant. Clin Imaging 2015; 39:914-6. [PMID: 25986162 DOI: 10.1016/j.clinimag.2015.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/17/2015] [Accepted: 04/28/2015] [Indexed: 12/28/2022]
Abstract
Spontaneous choledochal cyst rupture and consequent biliary peritonitis are rare in children. Here, we report a unique case of intrahepatic bile duct rupture of choledochal cyst type IV that resulted in loculated biliary peritonitis with an intrahepatic pseudocyst mimicking a hepatic mesenchymal hamartoma in a 3-month-old boy. Magnetic resonance cholangiopancreatography can help differentiate these conditions. Regardless of the location, pseudocysts resulting from biliary peritonitis should be considered in cases of choledochal cysts with adjacent fluid collection or cystic lesions.
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Affiliation(s)
- Min-Yung Chang
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea 120-752
| | - Myung-Joon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea 120-752
| | - Seok Joo Han
- Department of Pediatric Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea 120-752
| | - Hye Min Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea 120-752
| | - Mi-Jung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea 120-752.
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Villa N, Raijman I. Transcystic access of the common bile duct in a patient with a type III choledochal cyst (choledochocele) and cystolithiasis. Gastrointest Endosc 2015; 81:1264. [PMID: 25264209 DOI: 10.1016/j.gie.2014.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 07/24/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Nicolas Villa
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Isaac Raijman
- Digestive Associates of Houston, Houston, Texas, USA
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Bedregal-Mendoza T, Matos-Rojas IA, Díaz Gonzales JE, Ramírez-De la Cruz R, Castro-Johanson R. [Acute pancreatitis in childhood by choledocal stone in a choledocal cyst. Case report]. Rev Gastroenterol Peru 2015; 35:173-178. [PMID: 26228985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute pancreatitis is a known complication of choledochal cysts. It is associated with changes in the biliopancreatic junction and with intra-cystic gallstones. We describe a case of pancreatitis and biliary obstruction caused by choledochal cyst type IVa complicated with obstruction by biliary stones in a 2 year old infant.
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Abstract
Hepatobiliary cystadenoma complication with congenital choledochal cyst is extremely rare and has never been reported in literatures so far.The aim of the study was to investigate the disease arrangements by analyzing the case and performing a systematic review of the literature.This case report documents the details and clear patterns of the patient. A 65-year-old woman with fever (39.2°C), nausea, vomiting, and chronic hepatitis B imaging demonstrated a left hepatic multilocular cystic mass and cystic dilated common bile duct.A regular left hemihepatectomy was performed with resection of the entire tumor and choledochal cyst.The surgical margins were negative and a final diagnosis of hepatobiliary cystadenoma complicated with congenital choledochal cyst was established. The patient had an uneventful postoperative recovery and liver function returned to normal levels.Main lessons learned from this case are: the awareness should be raised about the disease to avoid misdiagnosis; preoperative ultrasonography, computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography play an important role in detecting the lesion; the scope and timing of the surgery should be determined, which provide the chance of cure to complete resection of the tumor.
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Affiliation(s)
- En-Liang Li
- From the Second Affiliated Hospital of Nanchang University, Department of Hepatobiliary Surgery, Nanchang, Jiangxi Province, China (EL,SD,XY, LW)
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Berger Y, Superina RA, Zbar A, Balint-Lahat N, Horesh N, Bilik R. A case series of congenital hepatic hilar cyst: recommendations for diagnosis and management. Isr Med Assoc J 2015; 17:32-36. [PMID: 25739174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Congenital hepatic hilar cysts are rare. Some are simple and do not require intervention, but some biliary cystic malformations impose the risk of morbidity and mortality. OBJECTIVES To assess a series of five patients presenting with congenital hepatic hilar cysts. METHODS We retrospectively reviewed all cases presenting to our pediatric surgical service between January 2010 and December 2012 and found to have a congenital hepatic hilar cyst. Data regarding clinical, radiological, operative and pathological features were analyzed. RESULTS Five children with congenital cyst of the hepatic hilum were identified; four of them were diagnosed prenatally. Four children had undergone surgical intervention: one with intrahepatic choledochal cyst, one with epidermoid cyst, and two with biliary atresia and an associated cyst of the common bile duct. In another case of choledochal cyst the treatment was conservative. All children except one had a good prognosis; one child with biliary atresia required liver transplantation. CONCLUSIONS The differential diagnosis of congenital hepatic hilar cyst includes a broad spectrum of pathologies. It is essential to diagnose biliary atresia as early as possible. Signs such as smaller cysts in association with a hypoplastic gallbladder and direct hyperbilirubinemia may be suggestive of biliary atresia.
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Mazo R, Ruiz-Elizalde AR, Chabot JA, Cowles RA. Pancreaticoduodenectomy for choledochal cyst. Hepatogastroenterology 2015; 62:175-177. [PMID: 25911891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Choledochal cyst (CDC) is a rare congenital cystic dilatation of the biliary system that can affect children and adults. Standard treatment for CDC includes surgical excision of the cystic bile duct with restoration of bilioenteric continuity by Roux-en-Y hepaticojejunostomy. In rare situations, however, surgical excision of a CDC may require pancreaticoduodenectomy (PD). The goal of this study was to identify instances where a PD may be deemed necessary. METHODOLOGY We retrospectively reviewed the medical records of all patients treated for CDC at our institution from January 1988 through December 2011. From this cohort, patients who underwent PD were reviewed in detail. Data on preoperative parameters, operative details, cyst type, pathologic diagnosis, and postoperative course were collected. RESULTS During the 24-year period, 59 patients with CDC were identified and four (7%) underwent formal PD. Final pathology revealed that none of the resected specimens harbored malignancy and all patients are well at follow-up. CONCLUSION While the standard surgical care for CDC remains complete cyst excision with Roux-en-Y hepaticojejunostomy, there may be particular instances where PD appears more appropriate. While the need for PD in cases of CDC is rare, it is important to consider this possibility when contemplating surgery for CDC.
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Ohtsuka H, Fukase K, Yoshida H, Motoi F, Hayashi H, Morikawa T, Okada T, Nakagawa K, Naitoh T, Katayose Y, Unno M. Long-term outcomes after extrahepatic excision of congenital choladocal cysts: 30 years of experience at a single center. Hepatogastroenterology 2015; 62:1-5. [PMID: 25911857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Congenital choladocal cysts are generally treated by resection of the dilated extrahepatic biliary duct followed by hepaticojejunostomy, but it is associated with postoperative complications, including postoperative cholangitis, intrahepatic calculi, pancreatitis, and carcinogenesis, in the remnant bile duct. We investigated the most common long-term complications and identified the factors implicated in their development. METHODOLOGY We conducted a retrospective review and analysis of the long-term complications of 65 patients surgically treated for congenital choledochal cysts between 1978 and 2008 at one institute. The risk factors for intrahepatic calculi were identified based on the odds ratios of the implicated variables. RESULTS Cholangitis with high fever or abdominal pain was reported in 14 patients (21.5%), intrahepatic calculi in 12 (18.5%), pancreatitis in 3 (4.6%), and cholangiocarcinoma in 3 (4.6%). Diagnosis with type IVa choledochal cysts was the most significant risk factor, followed by age ≥30 years at the time of treatment, and the presence of preoperative intrahepatic calculi. CONCLUSIONS While precise and thorough surgical treatment is necessary to prevent the long-term development of complications after surgical excision of congenital choledochal cysts, it must be accompanied by long-term postoperative follow-up, especially of elderly patients and those with type IVa cysts.
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29
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Yamataka A, Lane GJ, Koga H, Cazares J, Nakamura H. Role of laparoscopy during surgery at the porta hepatis. S Afr Med J 2014; 104:820-824. [PMID: 26038797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Minimally invasive surgery in children has evolved to the extent that complex procedures can be performed with safety, with comparable outcomes to open surgery and with the advantages of minimal scarring and less pain. In this article, we describe the latest laparoscopic techniques used at Juntendo University Hospital in Japan, for treating conditions affecting the porta hepatis, focusing on biliary atresia and choledochal cysts. We also summarise our postoperative management protocols and discuss preliminary outcomes.
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30
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Frattaroli FM, Coiro S, Nunziale A, De Lucia F, Frattaroli JM, Pappalardo G. Choledochal cyst mimicking Mirizzi's syndrome A case report. Ann Ital Chir 2014; 85:485-489. [PMID: 25600242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Choledochal cysts are cystic dilatations of the intra or extra-hepatic biliary tract with an incidence of 1 case per 150.000 live births. Cysts usually are diagnosed in childhood, but diagnosis can be delayed until adulthood in the 20-50% of cases. Clinical manifestations comprise abdominal pain with biliary or pancreatic features. Mirizzi's syndrome is a late and rare complication, that occurs in 1% of patients with cholelithiasis due to extrinsic compression of the common bile duct by stones impacted either in the gallbladder or in the cystic duct. Clinical symptoms include extrahepatic obstructive jaundice, ascending cholangitis, or, in the later course, cholecystocholedocal fistula. For both pathologies the Endoscopic Retrograde Cholangio Pancreatography and the Magnetic Resonance Cholangio Pancreatography should lead to the diagnosis with a sensibility and a specificity up to 100%. We report the case of a 66 year old patient admitted to the Emergency Department of our hospital for jaundice and abdominal pain, whom both the endoscopic and radiologic examination showed a Mirizzi's syndrome but surgery revealed a type I choledocal cyst.
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Abstract
AIM: To evaluated our management algorithm of the coagulopathy. We evaluated our management algorithm of the coagulopathy.
METHODS: Between October 2001 and January 2013, 160 CDC children with coagulopathy (fibrinogen, FIB < 2 g/L) were recruited. FIB ≥ 1 g/L is generally required for safe elective surgery. We used FIB level as an indicator when: (1) patients with FIB levels between 1-2 g/L underwent one-stage definitive operation; and (2) patients with FIB < 1 g/L underwent 3 d of medical treatment. Thereafter, those with FIB ≥ 1 g/L underwent one-stage definitive operation whereas those with FIB < 1 g/L underwent external biliary drainage to allow liver function improvement. Those patients with liver function improvements underwent definitive operation after 7 d of drainage.
RESULTS: After preoperative optimization, 92.5% of CDC children with coagulopathy underwent successful one-stage definitive operation. The remaining 7.5% of CDC children required initial external bile drainage, and underwent definitive operation 11 d after the admission. The mean operative time and postoperative recovery duration were comparable to those with normal coagulations. The median follow-up period was 57 mo. No blood transfusion or other postoperative complications were encountered.
CONCLUSION: Following our management protocol, the majority of CDC children with coagulopathy can be managed with one-stage definitive operation.
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Gadelhak N, Shehta A, Hamed H. Diagnosis and management of choledochal cyst: 20 years of single center experience. World J Gastroenterol 2014; 20:7061-7066. [PMID: 24944503 PMCID: PMC4051952 DOI: 10.3748/wjg.v20.i22.7061] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/11/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
We report the first case series from Africa and the Middle East on choledochal cyst, a disease which shows significant geographical distribution with high incidence in the Asian population. In this study, the epidemiological data of the patients are presented and analyzed. Attention was paid to diagnostic imaging and its accuracy in the diagnosis and classification of choledochal cyst. Most cases of choledochal cyst disease have type I and IV-A cysts according to the Todani classification system, which support the etiological theories of choledochal cyst, especially Babbitt’s theory of the anomalous pancreaticobiliary duct junction, which are clearly stated. The difficulties and hazards of surgical management and methods used to avoid operative complications are clarified. Early and late postoperative complications are also included. This study should be followed by multicenter studies throughout Egypt to help assess the incidence of choledochal cysts in one of the largest populations in Africa and the Middle East.
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Frattaroli FM, Coiro S, Nunziale A, De Lucia F, Frattaroli JM, Pappalardo G. Choledochal cyst mimicking Mirizzi's syndrome: a case report. Ann Ital Chir 2014; 85:S2239253X14022312. [PMID: 25336283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Choledochal cysts are cystic dilatations of the intra or extra-hepatic biliary tract with an incidence of 1 case per 150.000 live births. Cysts usually are diagnosed in childhood, but diagnosis can be delayed until adulthood in the 20-50% of cases. Clinical manifestations comprise abdominal pain with biliary or pancreatic features. Mirizzi's syndrome is a late and rare complication, that occurs in 1% of patients with cholelithiasis due to extrinsic compression of the common bile duct by stones impacted either in the gallbladder or in the cystic duct. Clinical symptoms include extrahepatic obstructive jaundice, ascending cholangitis, or, in the later course, cholecystocholedocal fistula. For both pathologies the Endoscopic Retrograde Cholangio Pancreatography and the Magnetic Resonance Cholangio Pancreatography should lead to the diagnosis with a sensibility and a specificity up to 100%. We report the case of a 66 year old patient admitted to the Emergency Department of our hospital for jaundice and abdominal pain, whom both the endoscopic and radiologic examination showed a Mirizzi's syndrome but surgery revealed a type I choledocal cyst.
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Abstract
Choledochoceles are cystic dilatations of the intraduodenal portion of the common bile duct. Although often classified as Type III biliary cysts, choledochoceles have distinctive demographic and anatomic features and a lower risk of malignancy than other types of choledochal cysts. Type A choledochoceles are cystic dilatations of a segment of the intra-ampullary bile duct and are located proximal to the ampullary orifice. Type B choledochoceles are diverticula of the intra-ampullary common channel and are located distal to the ampullary orifice; they can be distinguished from duodenal duplication cysts both anatomically and histologically. Both types of choledochocele may present with pancreatitis, biliary obstruction, or nonspecific gastrointestinal symptoms. Cross-sectional imaging, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are useful for diagnosis. Choledochoceles may be drained or resected endoscopically. Surveillance for dysplasia should be considered for lesions that are not resected.
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Affiliation(s)
- Ryan Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
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Dumitrascu T, Ionescu M. An unclassified congenital bile duct cyst. Acta Chir Belg 2014; 114:82-83. [PMID: 24720146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Congenital bile duct cysts are rare in adulthood. The most frequently used classification was proposed by Todani in 1977. However, in rare cases, not all the bile duct cysts are suitable to this classification. Hereby, we describe the case of an unclassified and very rare form of congenital bile duct cyst--isolated cystic duct cyst. En-block resection of the cyst, along with gallbladder, is the treatment of choice. Although exceptional, cystic duct cysts should be included in Todani classification so that the surgeons to be aware for this variation.
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Razumovskiĭ AI, Degtiareva AV, Uskova NG, Kulikova NV, Feoktistova EV, Rachkov VE. [Endosurgical treatment of the bile duct lesions in children]. Eksp Klin Gastroenterol 2014:59-65. [PMID: 25518459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Question of feasibility of laparoscopic Kasai procedure and laparoscopic hepaticojejunostomy for biliary atresia (the BA) and choledochal cysts (the CC) in children has been a subject of discussion for a long time and still remains unsolved. AIM To improve the results of surgery for biliary tract malformations (the BTM) in children using laparoscopic technique. MATERIALS AND METHODS The are 55 patients with BA and CC, who were performed endosurgical operations, and 37 patients, who were performed traditional open surgical procedures. During this study we worked out and put into laparoscopic practice some new methods. We've made an analysis of technical features of liver transplantation after laparoscopic and traditional Kasai's operation in BA. RESULTS The duration of laparoscopic Kasai procedure was significantly longer than open surgery (p < 0.05). In CC the duration was the similar (p > 0.05). There was no any urgent surgical complication after laparoscopic Kasai procedure in contrast to open surgery. We observed significantly fewer complications (40%) after laparoscopic hepaticojejunostomy than after traditional hepaticojejunoduodenostomy (84.6%, p < 0.05). The average length of stay in ICU and duration of analgesia after laparoscopy was significantly lower than after open surgery (p < 0.05). Comparing the efficiency of endosurgery and traditional operations using coloration of stool, decreasing of bilirubin level and the presence of indications to liver transplantation criteria we didn't find any significant difference (p > 0.05). CONCLUSION At the same efficiency of laparoscopic and open reconstructive surgery for BA and CC the first has a number of incontrovertible advantages. Our experience allows us to recommend laparoscopic procedures to perform for the correction of BTM in children.
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Abstract
PURPOSE Although most patients with choledochal cyst (CC) have a favorable prognosis with prompt treatment, some of them are complicated with liver fibrosis, resulting in prolonged liver dysfunction even after definitive surgery. The aim of this study was to distinguish the high-risk group of liver fibrosis in patients with CC. METHODS Fifteen patients who underwent liver biopsy during surgery for CC from 1981 to 2012 were enrolled in this study. Liver histology with H&E staining was graded according to Ohkuma's classification, and the correlation with the clinical characteristics was retrospectively assessed. RESULTS Their median age at biopsy was 13.4 months (range 1-42 months), and there were 7 in Ia, 2 in Ic, and 6 in IVa of the Todani classification. There were no significant differences in serum liver function test among those cyst types. The histological grades of liver fibrosis were as follows: grade 0 (no fibrosis) in 7 patients, grade 1 (mild) in 2, grade 2 (moderate) in 3, grade 3 (severe) in 2, grade 4 (cirrhosis) in 1. All 3 patients with grade 3 and 4 had CC with IVa and were under 18-month old. A 3-month-old girl with cirrhosis presented with severe jaundice resulting in living-donor liver transplantation despite bile drainage. A 16-month-old girl with grade 3 suffered from prolonged liver dysfunction and intractable ascites after surgery. CONCLUSIONS The progression of liver fibrosis is likely to be correlated with IVa, and the postoperative course might be unsatisfactory in advanced cases. The prompt surgical intervention is recommended especially for neonatal and infantile cases with type IVa cyst because irreversible liver cirrhosis could occur as early as in the infantile period.
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Affiliation(s)
- Shigehisa Fumino
- Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
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Cerwenka H. Bile duct cyst in adults: Interventional treatment, resection, or transplantation? World J Gastroenterol 2013; 19:5207-5211. [PMID: 23983423 PMCID: PMC3752554 DOI: 10.3748/wjg.v19.i32.5207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/02/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree, within the liver, or in both of these locations simultaneously. Presentation in adults is often associated with complications. The therapeutic possibilities have changed considerably over the last few decades. If possible, complete resection of the cyst(s) can cure the symptoms and avoid the risk of malignancy. According to the type of bile duct cyst, surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection. However, the diffuse forms of Todani type V cysts (Caroli disease and Caroli syndrome) in particular remain a therapeutic problem, and liver transplantation has become an important option. The mainstay of interventional treatment for Todani type III bile duct cysts is via endoscopic retrograde cholangiopancreatography. The diagnostic term “bile duct cyst” comprises quite different pathological and clinical entities. Interventional therapy, hepatic resection, and liver transplantation all have their place in the treatment of this heterogeneous disease group. They should not be seen as competitive treatment modalities, but as complementary options. Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team.
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Lipton A, Carlan SJ, Teixeira A, Locksmith G. Biliary cyst in pregnancy managed by percutaneous drainage: a case report. J Reprod Med 2013; 58:357-360. [PMID: 23947090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND A maternal biliary cyst diagnosed in pregnancy is extremely rare. The condition can be asymptomatic or can present with chronic and intermittent abdominal pain, rupture of the cyst, and liver function test abnormalities. Management depends on the gestational age and the patient's condition when it is diagnosed. CASE We present a case of a symptomatic type IV biliary cyst with abnormal liver function tests diagnosed in the second trimester of pregnancy and treated with a percutaneous drainage. The patient delivered vaginally at term and developed obstruction of the percutaneous drain with superimposed bacterial infection postpartum. She was lost to follow-up intermittently throughout her treatment. CONCLUSION Symptomatic biliary cyst in pregnancy may require palliative invasive intervention until delivery.
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Affiliation(s)
- Alexis Lipton
- Department of Obstetrics and Gynecology, Winnie Palmer Hospital, Orlando Regional Healthcare, 105 West Miller Street, Orlando, FL 32806, USA
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40
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Mishra PK, Ramaswamy D, Saluja SS, Patil N, Chandrashekhar S. Unusual variants of choledochal cyst: how to classify. Am Surg 2013; 79:E162-E164. [PMID: 23574833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital & Maulana Azad Medical College, New Delhi, India
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41
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Sood V, Bhatnagar S. Choledochal cyst and crossed fused ectopic kidney--a hitherto unknown association. Acta Gastroenterol Belg 2012; 75:467-468. [PMID: 23402098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Tahara K, Ishimaru Y, Fujino J, Suzuki M, Hatanaka M, Igarashi A, Ikeda H. Association of extrahepatic bile duct duplication with pancreaticobiliary maljunction and congenital biliary dilatation in children: a case report and literature review. Surg Today 2012; 43:800-5. [PMID: 22825653 DOI: 10.1007/s00595-012-0262-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/22/2012] [Indexed: 11/25/2022]
Abstract
We herein report a case of cystic-type congenital biliary dilatation (CBD) in whom an extremely rare anomalous duplication of the common bile duct and pancreaticobiliary maljunction were diagnosed intraoperatively by meticulous surgical manipulations via conventional open surgery. By performing a dissection at the outer epicholedochal layer of the cyst, a thin cord-like structure shown to be the distal part of the common bile duct was identified. A further exploration revealed that the most distal (extra- and intrapancreatic) part of the common bile duct was duplicated, and each branch of the duct was connected to the main and accessory pancreatic ducts. The experience with our case and a literature review showed that extrahepatic bile duct duplication is generally associated with pancreaticobiliary maljunction and CBD. We conclude that an extremely careful exploration with delicate and meticulous surgical manipulation is essential to identify these morphological anomalies and prevent intraoperative and postoperative complications of CBD, such as pancreatic duct injury or pancreatitis.
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Affiliation(s)
- Kazunori Tahara
- Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50, Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Murphy AJ, Axt JR, Crapp SJ, Martin CA, Crane GL, Lovvorn HN. Concordance of imaging modalities and cost minimization in the diagnosis of pediatric choledochal cysts. Pediatr Surg Int 2012; 28:615-21. [PMID: 22526551 PMCID: PMC4158915 DOI: 10.1007/s00383-012-3089-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Given evolving imaging technologies, we noted significant variation in the diagnostic evaluation of pediatric choledochal cysts (CDC). To streamline the diagnostic approach to CDC, and minimize associated expenses, we compared typing accuracy and costs of ultrasound (US), intraoperative cholangiography (IOC), and magnetic resonance cholangiopancreatography (MRCP). METHODS Records of 30 consecutive pediatric CDC patients were reviewed. Blinded to all clinical data, two pediatric radiologists reviewed all US, MRCPs, and IOCs to type CDCs according to the Todani classification. When compared with pathologic findings, the concordance between and accuracy of each diagnostic test were determined. Inflation-adjusted procedure charges and collections for imaging modalities were analyzed. RESULTS Mean typing accuracy overlapped for US, IOC, and MRCP. Inter-rater reliability was 87 % for US (κ = 0.77), 80 % for IOC (κ = 0.62), and 60 % for MRCP (κ = 0.37). MRCP procedure charges ($1204.69) and collections ($420.85) exceeded IOC and US combined ($264.80 charges, p = 0.0002; $93.40 collections, p = 0.0021). CONCLUSION Our data support the use of US alone in the diagnosis of pediatric CDC when no intrahepatic biliary ductal dilatation is visualized. However, when dilated intrahepatic ducts are encountered on US, MRCP should be utilized to distinguish a type I from a type IV CDC, which may alter the operative approach.
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Affiliation(s)
- Andrew J Murphy
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232-9780, USA.
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Al-Sinani S, Al Naamani K, Lutfi W, Al Hajri A. Choledochal cysts in Omani children: a case series. Arab J Gastroenterol 2012; 13:89-92. [PMID: 22980599 DOI: 10.1016/j.ajg.2012.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 12/22/2011] [Accepted: 03/08/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Choledochal cysts (CCs) are rare congenital anomalies of the biliary tract with a low incidence in the western countries and a higher incidence in the eastern part of the world. CCs have female to male preponderance. CCs type distribution is known in certain parts of the world but very little is published about the common types of CCs and gender distribution in the Arab countries. We aim to describe the CC types and gender distribution in Omani children in one centre. PATIENTS AND METHODS A retrospective review of all children diagnosed to have choledochal cysts over a 2 year period at a tertiary hospital in Oman. RESULTS We diagnosed six children with CCs. The type distribution of CCs and gender preponderance in Omani children are not similar to what is described internationally. Type IV A was the most common type (50%) and less of type I (16.7%), unlike worldwide distribution. Female to male preponderance described in the literature is not seen in our case series. Fifty percent of our patients were boys. In this case series, we compare our results to the described case reports of CCs from Arab countries and Africa and bring up the difference. CONCLUSIONS We demonstrate the unusual types of CCs and gender distribution in Omani children compared to the literature. To our best knowledge, this is the first case series of CCs in Omani children and the largest reported study in the literature in the Arab countries so far.
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Affiliation(s)
- Siham Al-Sinani
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
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45
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Gong L, Qu Q, Xiang X, Wang J. Clinical analysis of 221 cases of adult choledochal cysts. Am Surg 2012; 78:414-418. [PMID: 22472397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Choledochal cyst, usually recognized as a problem in infants, is increasingly reported in adult patients. The aim of this study was to share our experience in treating adult patients with choledochal cysts. Two hundred twenty-one adult patients with choledochal cysts who were treated in our hospital from January 2002 to December 2010 were enrolled. The clinical data were retrospectively collected and analyzed. There were 168 Type I, three Type II, three Type III, 26 Type IV, and 21 Type V cysts. The presentations were nonspecific with 177 patients having abdominal pain and a few patients having other rare symptoms including back pain, cirrhosis, occupying lesions, or spontaneous rupture. The cysts were completely removed in 169 patients, and 36 patients required liver resection. There was one death resulting from abdominal bleeding. Morbidity was limited to 27 patients, 11 of whom underwent invasive interventions. Choledochal cysts remain an interesting clinical problem. In some adult cases, the diagnosis is very difficult. Treatment is type-dependent, complete removal of the cysts is widely accepted, and lifelong follow-up for these patients is recommended.
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Affiliation(s)
- Lei Gong
- Department of General Surgery, Beijing Tsinghua Hospital, Tsinghua University, Beijing, China
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46
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Popova-Jovanovska R, Genadieva-Dimitrova M, Trajkovska M, Serafimoski V. Choledochal cysts: diagnosis and treatment. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2012; 33:49-63. [PMID: 22952094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The aim of this study is to show the different diagnostic procedures and treatment in patients diagnosed with congenital choledochal cysts. Choledochal cysts are congenital anomalies of the bile ducts and include cystic dilatation of the extrahepatic and intrahepatic biliary ducts or both. The study shows ten patients diagnosed as having choledochal cysts. Diagnosis was established by clinical and radiographic findings including: ultrasound (US), magnetic resonance cholangiopancreatograpy (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and cytological examination of the bile juice. In the study choledochal cysts were classified according to the Todani classification. Most common cysts were type I (six cases); type III (one case), type IVa (one case) and two patients were type V cysts (Caroli disease). The most frequent symptoms were abdominal pain, jaundice and cholangitis. US findings were sensitive for the preliminary diagnosis of choledochal cysts in all the patients. MRCP accurately defined the cyst anatomy and the site of the biliary origin in all the cases with extrahepatic cysts. In three cases ERCP clearly demonstrated the cyst and by PTC smaller cysts were well defined. Cytological examination of the bile juice obtained during the PTC procedure showed malignant cells in one case. Therefore pancreaticoduodenectomy was performed and pathological examination showed associated cholangiocarcinoma. Five years after the operation the patient was well and free of the disease. Five patients underwent surgical treatment with a total cyst excision and Roux-en-Y hepaticojejunostomy while the surgical approach in two patients was partial cyst excision and cystojejunostomy. Patients with Caroli disease were conservatively treated and 3 with interventional endoscopic procedures. Despite US evidence suggesting choledochal cyst diagnosis, other supportive radiographic imaging modalities such as MRCP, ERCP and PTC are required to define the precise cyst anatomy and are essential for the preoperative assessment. Total cyst excision is recommended for reducing cyst-related complications and risk of cholangiocarcinoma.
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Affiliation(s)
- R Popova-Jovanovska
- University Gastroenterohepatology Clinic, Medical Faculty, Skopje, R. Macedonia
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47
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Tarasenko SV, Natal'skiĭ AA, Zaĭtsev OV, Peskov OD, Aftaev VB, Shchekotikhin MA. [The choledochal cyst as a rare reason of the obstructive jaundice]. Khirurgiia (Mosk) 2012:59-60. [PMID: 23235383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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48
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Germani M, Liberto D, Elmo G, Lobos P, Ruiz E. Choledochal cyst in pediatric patients: a 10-year single institution experience. Acta Gastroenterol Latinoam 2011; 41:302-307. [PMID: 22292226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Choledochal cysts (CCs) are rare congenital dilatations of the biliar tree. The incidence is 1:150,000. A correct diagnosis and surgical treatment are important because of the long term risks of infection and neoplasia. We report our experience with CCs in children. PATIENTS AND METHODS Patients with CC disease, who were seen at the Hospital Italiano de Buenos Aires between 1999 and 2009, were identified retrospectively from our prospectively acquired hepato-pancreatico-biliary database. Prenatal, clinical, surgical and pathological records were analysed. RESULTS We included 12 children (10 girls and 2 boys), all of them affected by a cystic dilatation type I of Todani classification. Between the 4 patients with antenatal diagnosis only one presented symptoms before surgery, expressed in acolic feces. Between the 8 patients with postnatal diagnosis, the most common clinical presentation was abdominal pain, occurring in all patients. Ultrasound was used for the diagnosis of all patients. Mean age at surgery was 74 months. All patients had intraoperative cholangiograms to definitively confirm the diagnosis. Five patients underwent open surgery and 7 laparoscopic approach. From patients with a laparoscopic approach, 1 had to be converted to open surgery due to intraoperative complications and 2 underwent an initial surgery for a cholecystectomy and a CC cyst excision. The complications observed were: anastomotic biliary fistula 1, residual lithiasis in the pancreatic portion of the duct 1 and anastomotic stenosis 1. The last 2 cases required reoperation. CONCLUSIONS Once CCs are diagnosed, careful treatment decisions need to be taken because both intra hepatic and extra hepatic CCs, if untreated, have an increased risk of cancer. After a careful study of the cyst's characteristics, we recommend a laparoscopic approach when possible, as the best choice, after 3 months of life to increase the success of the treatment according to the size of the anatomic structure. We recommend early treatment, before 3 months of life, only in case of severe symptoms.
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Affiliation(s)
- Micaela Germani
- Department of Pediatric Surgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
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Abstract
The classification of choledochoceles as a type of choledochal cyst stems from the 1959 article by Alonso-Lej and colleagues describing 94 choledochal cysts, only 4 of which were choledochoceles. Even then, Alonso-Lej questioned the propriety of including the choledochocele, stating it was unclear "as to whether or not it originates from the same etiologic factors [as other choledochal cysts]". In 1971, Trout and Longmire also questioned the validity of classifying choledochoceles as choledochal cysts, noting the anatomic position article and variant mucosa of the choledochocele. Wearn and Wiot, in an article titled "Choledochocele: not a form of choledochal cyst", cite the differences in clinical presentation, demographics, and histology as reasons why choledochoceles represent separate entities from choledochal cysts. Over the ensuing decades, numerous investigators have questioned the legitimacy of classifying choledochoceles as choledochal cysts. In our recent series (the only one to our knowledge directly comparing patients with choledochocele and other [type I, II, IV, and V] choledochal cysts), patients with choledochoceles differed from patients with choledochal cysts in their age, gender, presenting symptoms, history of previous cholecystectomy, pancreatobiliary ductal anatomy, management, and most importantly, propensity to developing biliary malignancy. Based on the available cases of choledochoceles found in the literature, combined with the recent series from our institution, we conclude that choledochoceles seem to be distinct entities from choledochal cysts.
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Affiliation(s)
- Kathryn M Ziegler
- Department of Surgery, Indiana University, 545 Barnhill Drive, EH 202, Indianapolis, IN 46202, USA
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Machairas A, Petropoulos K, Machairas N, Charalabopoulos A, Misiakos EP. Image of the month. Choledochocele. Arch Surg 2011; 146:1213-1214. [PMID: 22006883 DOI: 10.1001/archsurg.2011.263-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Anastasios Machairas
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Athens, Greece
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