Type VI Choledochal Cysts—Case Report and Review of Literature

AbstractCholedochal cysts (CDC), are rare congenital dilations involving the extra hepatic biliary apparatus with or without dilation of the intrahepatic bile ducts. They are conventionally classified into five types. A new type, type VI, causing dilation of the cystic duct between the neck of the gall bladder and the common hepatic duct (CHD) has been described in medical literature which is the rarest of all these subtypes. They are commonly observed in middle aged females and are mostly symptomatic. Most of these cysts need magnetic resonance cholangiopancreatography (MRCP) for accurate diagnosis. Treatment options for these lesions are not well defined but range from simple cholecystectomy to complete excision of the entire bile duct and biliary reconstruction, as there is a concern of malignant transformation in these cysts. Hence, these rare cysts, though rare, must be borne in mind when dealing with suspicious cystic lesions in the biliary tract. Here, we present an interesting case of such a rare cyst and its management in a middle aged woman.

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The Value of Cholangiography through Jackson-Pratt Drains in the Management of Postoperative Biliary Injuries

The American Surgeon ◽

10.1177/000313481408000126 ◽

2014 ◽

Vol 80 (1) ◽

pp. 66-71 ◽

Cited By ~ 1

Author(s):

Francisco Igor B. Macedo ◽

Victor J. Casillas ◽

James S. Davis ◽

Joe U. Levi ◽

Danny Sleeman

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Common Hepatic Duct ◽

Biliary Reconstruction ◽

Biliary Injury ◽

Endoscopic Retrograde ◽

Distal Common Bile Duct ◽

Potential Benefits

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

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Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2018.v02.i01.p02 ◽

2018 ◽

Vol 2 (1) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Made Mahayasa ◽

Tommy Lesmana

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Gall Bladder ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Common Hepatic Duct ◽

Hepatic Bile ◽

Hepatic Bile Duct

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.

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Laparoscopic Treatment for Choledochal Cysts with Stenosis of the Common Hepatic Duct

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2012.03.001 ◽

2012 ◽

Vol 214 (6) ◽

pp. e47-e52 ◽

Cited By ~ 8

Author(s):

Jian Wang ◽

Wentong Zhang ◽

Daqing Sun ◽

Qiangye Zhang ◽

Hongzhen Liu ◽

...

Keyword(s):

Hepatic Duct ◽

Common Hepatic Duct ◽

Laparoscopic Treatment ◽

Choledochal Cysts ◽

The Common

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Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report

Journal of Pediatric and Adolescent Surgery ◽

10.46831/jpas.v1i1.7 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Allah Ditta ◽

Muhammad Bilal Mirza ◽

Muhammad Waqas-ur-Rehman ◽

Maria Fahim ◽

Farrakh Mehmood Satar ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Biliary Tree ◽

Postoperative Recovery ◽

Common Hepatic Duct ◽

Rare Entity ◽

Case Presentation ◽

Complete Obstruction ◽

The Common

Background: Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children. Case Presentation: We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful. Conclusion: We conclude that congenital biliary web is a rare entity and should be considered in the differential diagnosis of biliary atresia.

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Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report

Journal of International Medical Research ◽

10.1177/0300060518797246 ◽

2018 ◽

Vol 46 (11) ◽

pp. 4806-4812 ◽

Cited By ~ 1

Author(s):

Jiang Zhou ◽

Rui Xiao ◽

Jing-rui Yang ◽

Lu Wang ◽

Jia-xing Wang ◽

...

Keyword(s):

Abdominal Pain ◽

Hepatic Duct ◽

Rare Complication ◽

Magnetic Resonance Cholangiopancreatography ◽

Mirizzi Syndrome ◽

Fistula Formation ◽

Common Hepatic Duct ◽

Asian Woman ◽

Calot’S Triangle ◽

Hepatic Atrophy

Background Mirizzi syndrome is a rare complication of chronic cholecystitis, usually caused by gallstones impacted in the cystic duct or the neck of the gallbladder. Mirizzi syndrome results in compression of the hepatic duct or fistula formation between the gallbladder and common bile duct (or hepatic duct, right hepatic duct, or even mutative right posterior hepatic duct). Clinical features include abdominal pain, fever, and obstructive jaundice. Severe inflammation and adhesion at Calot’s triangle are potentially very dangerous for patients with Mirizzi syndrome undergoing cholecystectomy. Case presentation: We report the case of a 68-year-old Asian woman who presented with abdominal pain and jaundice. She had a medical history of gallstones, but no fever. Magnetic resonance cholangiopancreatography revealed cholecystitis, cholelithiasis, common hepatic duct stones, and ascites. Findings at surgery included a porcelainized, atrophic gallbladder that was full of gallstones, fistula formation between the gallbladder and common hepatic duct, and left hepatic atrophy. The prominent feature was the left hepatic atrophy, but stones were not visible pre-operatively in the left liver by radiologic examination. Conclusions This patient exhibited what can be considered a special type II of Mirizzi syndrome with a fistula of the common hepatic duct as well as left hepatic atrophy.

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Surgical approach to a left-sided gallbladder

BMJ Case Reports ◽

10.1136/bcr-2019-230681 ◽

2019 ◽

Vol 12 (8) ◽

pp. e230681

Author(s):

Ryan Pereira ◽

Marlon Perera ◽

Matthew Roberts ◽

John Avramovic

Keyword(s):

Cystic Duct ◽

Imaging Modality ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Falciform Ligament ◽

Biliary Colic ◽

Common Hepatic Duct ◽

Critical View Of Safety ◽

Symptomatic Gallstones ◽

The Right

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

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Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

Radiology Research and Practice ◽

10.1155/2016/3021484 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Radha Sarawagi ◽

Shyam Sundar ◽

Sanjeev K. Gupta ◽

Sameer Raghuwanshi

Keyword(s):

Magnetic Resonance ◽

Cystic Duct ◽

Imaging Modality ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Anatomical Variations ◽

Common Hepatic Duct ◽

Clinical Implications ◽

Imaging Features ◽

Type Iv

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented.Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst.Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

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Isolated Avulsion of the Common Hepatic Duct from Blunt Abdominal Trauma

Case Reports in Surgery ◽

10.1155/2012/254563 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Victor W. Wong ◽

Arvin Gee ◽

Paul Hansen ◽

Andrew Michaels

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Hepatic Duct ◽

Treatment Options ◽

Common Hepatic Duct ◽

Concomitant Injuries ◽

Endoscopic Techniques ◽

The Common ◽

The Stability ◽

Delays In Diagnosis

Isolated extrahepatic biliary tract injury following blunt abdominal trauma is rare. The underlying pathogenic mechanisms remain obscure, but include shear and/or compression forces on the biliary system. Associated morbidity rates are high and largely the result of delays in diagnosis. Imaging modalities commonly employed for diagnosis include ultrasonography, computed tomography, nuclear medicine, and magnetic resonance imaging. Percutaneous and endoscopic techniques have been used both for diagnosis and treatment. Treatment options are dictated by the stability of the patient and the extent of bile duct and concomitant injuries. In this paper, we discuss a case of isolated avulsion of the hepatic duct confluence following blunt trauma that was successfully managed with Roux-en-Y hepaticojejunostomy. To our knowledge, this specific injury pattern has not been previously reported.

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Laparotomy-Assisted Direct Cholangioscopy for Bile Duct Stone Removal via an Incision of the Jejunum

Case Reports in Gastroenterology ◽

10.1159/000515371 ◽

2021 ◽

pp. 674-679

Author(s):

Shinya Sugimoto ◽

Toji Murabayashi ◽

Ayako Ichikawa ◽

Keita Sato ◽

Akira Kamei

Keyword(s):

Bile Duct ◽

Biliary Drainage ◽

Epigastric Pain ◽

Hepatic Duct ◽

Intrahepatic Bile Duct ◽

Balloon Catheter ◽

Magnetic Resonance Cholangiopancreatography ◽

Caudate Lobe ◽

Common Hepatic Duct ◽

Intrahepatic Stones

A 77-year-old man presented to our hospital with epigastric pain. He had previously undergone hepatic left lateral segmentectomy, cholangiojejunostomy, and Roux-en-Y reconstruction at 42 years of age for intrahepatic stones and liver abscesses. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed bile duct stones and intrahepatic bile duct dilation of the caudate lobe. Bile duct drainage for the caudate lobe was necessary; however, the volume of his caudate lobe was very small, making percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD) difficult. Therefore, we attempted laparotomy-assisted endoscopic biliary drainage. Under general anesthesia, an incision was made on the jejunum approximately 15 cm from the Y-leg anastomosis. An esophagogastroduodenoscope was directly inserted into the common hepatic duct anastomosed with the jejunum. The caudate lobe branch had severe stenosis, and the area upstream of the stenosis was filled with stones, sludge, and pus. The biliary stenosis was dilated using a balloon, and the stones were completely removed using a basket and a balloon catheter. There are various methods of biliary and pancreatic surgery and gastrointestinal reconstruction, and there are cases in which PTBD, EUS-BD, and endoscopic retrograde cholangiopancreatography (ERCP) with an enteroscope are difficult. In such cases, ERCP under laparotomy could be a good treatment option.

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ANATOMIC VARIANTS OF INTRAHEPATIC BILE DUCTS AND CYSTIC DUCTS IN SAUDI ARABIA: MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY ANALYSIS IN LIVER DONORS

10.36106/ijar/7018150 ◽

2021 ◽

pp. 30-32

Author(s):

Ayesha Nuzhat ◽

Maram AlGhamdi ◽

Abdullah AlAyed

Keyword(s):

Saudi Arabia ◽

Bile Duct ◽

Magnetic Resonance ◽

Cystic Duct ◽

Hepatic Duct ◽

Magnetic Resonance Cholangiopancreatography ◽

Radiology Department ◽

Common Hepatic Duct ◽

Left Hepatic Duct ◽

Liver Donors

Background: Data regarding the pattern of the anatomical variations of biliary tree from the Middle East is considerably decient when compared with the literature available elsewhere. To dete Objective: rmine anatomic variation in branching pattern of intra hepatic bile duct and cystic duct on Magnetic resonance Cholangiopancreatography in liver donors from Saudi Arabia. Methods: This descriptive study was done at Radiology Department Prince Sultan Military Medical City Riyadh, KSA between 2019-2020 after taking IRB approval (IRB No:1404) and collecting data of liver donors (n=92) using Magnetic resonance cholangiopancreatography. Result: Regarding the right hepatic duct, in our study Type A1(69.6%) was predominant followed by Type A2(16.3%). As for the left hepatic duct, typical pattern Type A was observed in 94.6% cases. Drainage of right posterior hepatic duct into left hepatic duct, A3(7.6%) and A4(5.4%) drainage of right posterior hepatic duct into the common hepatic duct were the most common variants in our study. Accessory bile duct with segment 5 draining into CHD with segment 5and 8 draining into CHD was found in 2.2% of cases, and an aberrant bile duct in 1.1% In our study, majority (97.8% )had lateral insertion of cystic duct and in 1.4% accessory cystic duct was noted. Because of growing trend found in Conclusion: number of liver transplant surgeries being performed, magnetic resonance cholangiopancreatography (MRCP) has become optimal for noninvasive evaluation of abnormalities of the biliary tract.

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