Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature

2021 ◽  
Vol 14 (10) ◽  
pp. e244393
Author(s):  
G Revathi ◽  
Brijesh Kumar Singh ◽  
Yashwant Singh Rathore ◽  
Sunil Chumber
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Incidental Finding ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Type I ◽  
Laparoscopic Management ◽  
Cyst Excision

A young adult male presented with biliary colic and intermittent jaundice for 1 year. Abdomen findings were unremarkable. Routine investigations revealed a raised total bilirubin. On abdominal ultrasonography, common bile duct (CBD) dilatation with multiple stones was noted. On further imaging with magnetic resonance cholangiopancreatography, type I choledochal cyst (CDC) was suspected. A laparoscopic approach was planned. Intraoperatively, dilatation of cystic duct was noted which constitute type VI CDC. Partial malrotation of the gut and accessory right hepatic artery were also noted as incidental finding. Laparoscopic cholecystectomy with CBD exploration and removal of stones, biliary stent placement, cystic duct cyst excision and primary repair of CBD was done. Postoperatively, the patient improved symptomatically with a fall in bilirubin to normal range. We are describing the laparoscopic management of a rare case of type IV CDC which was diagnosed intraoperatively.

scholarly journals Case Report: Isolated Cystic Dilatation of the Cystic Duct: A Misdiagnosed Case Preoperatively

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiankang Zhang ◽  
Zeming Hu ◽  
Xuan Lin ◽  
Dongliang Zhang ◽  
Hao Wang ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Cystic Dilatation ◽  
Liver Transaminase ◽  
Caudal Portion ◽  
The Common

A 33-year-old female with a mild elevation of liver transaminase was sent to the general surgery department for medical services due to upper-right abdominal pain for 2 weeks. A liquid dark area ~4 × 3 × 3 cm in size in the theoretical location of the pancreatic segment of the common bile duct was detected by abdominal CT with no enhancement of the cystic wall found in the enhanced CT scan. The patient was then diagnosed with a choledochal cyst based on the results of the radiological images preoperatively. During the operation, the isolated cystic dilatation was found in the middle part of the cystic duct, and its caudal portion was found behind the head of the pancreas and converged into the common bile duct at an acute angle and low insertion. According to the intraoperative evaluation, the female was then diagnosed with a cystic duct cyst (CDC). The surgery was converted to a laparotomy for the unclear structure and the possibility of anatomic variation of the bile duct. The caudal portion of the cystic duct was found communicated with the common bile duct with a narrow base, and the extrahepatic bile duct was not cystic. The CDC was removed in the surgery. One week later, the patient was discharged from the hospital for the disappearance of abdominal pain and normal liver transaminase and did not report any discomfort in the 1-month-long follow-up. The lessons drawn from this case were as follows: (1) the distinction between the relatively frequent choledochal cyst and the isolated CDC should always be taken in mind; (2) a surgical strategy should be given priority for an intraoperatively confirmed CDC; (3) a common bile duct exploration is recommended for patients with choledocholithiasis or jaundice.

scholarly journals Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Arpit Amin ◽  
Yuriy Zhurov ◽  
George Ibrahim ◽  
Anthony Maffei ◽  
Jonathan Giannone ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Mirizzi Syndrome ◽  
Endoscopic Retrograde ◽  
Laparoscopic Management ◽  
Novel Strategy ◽  
Laparoscopic Techniques ◽  
Stage 1 ◽  
Bile Duct Stent

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann’s pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

scholarly journals Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

2009 ◽  
Vol 91 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Chinnusamy Palanivelu ◽  
Muthukumaran Rangarajan ◽  
Priyadarshan Anand Jategaonkar ◽  
Madhupalayam Velusamy Madankumar ◽  
Natesan Vijay Anand
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Operating Time ◽  
Laparoscopic Management ◽  
Subtotal Cholecystectomy ◽  
Laparoscopic Excision ◽  
The Common ◽  
The Mean

INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.

scholarly journals Post Cholecystectomy Syndrome in a Patient due to Multiple Biliary Pathologies.

2013 ◽  
Vol 11 (1) ◽  
pp. 52-54
Author(s):  
Bikash Bikram Thapa ◽  
Kunda Bikram Shah ◽  
Sushil Bahadur Rawal ◽  
Srijan Malla
Keyword(s):  
Medical Journal ◽  
Case Report ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Endoscopic Removal ◽  
Rare Presentation ◽  
Postcholecystectomy Syndrome ◽  
Bile Duct Calculi

Postcholecystectomy syndrome is the recurrence of symptoms after cholecystectomy. Postcholecystectomy syndrome due to a combination of cystic duct stump calculus and choledochal cyst with recurrent choledocholithiasis is a rare presentation. This is a case report of a patient who had developed recurrent common bile duct calculi despite endoscopic removal and eventully managed with Rou-en-Y Hepati cojejunostomy for having choledochal cyst 39 years postcholecstectomy. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/52-54 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7792

scholarly journals A variant of type VI choledochal cyst: combined dilatation of cystic duct and common bile duct

2015 ◽  
Vol 19 (1) ◽  
pp. 71-72 ◽  
Author(s):  
Rohit Bhoil ◽  
Shikha Sood ◽  
R. G. Sood ◽  
Gazal Singla ◽  
Shivani Bakshi
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct

OUTCOME OF THE LAPAROSCOPIC CHOLEDOCHAL CYST EXCISION

2017 ◽  
pp. 239-244
Author(s):  
Thanh Xuan Nguyen ◽  
Dinh khanh Le ◽  
Huu Thien Ho
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Postoperative Treatment ◽  
High Tech ◽  
Type I ◽  
Duct Cyst ◽  
Drain Pipe ◽  
Cyst Excision ◽  
Bile Duct Cyst ◽  
Laparoscopic Excision

Objectives: To study the clinical and subclinical characteristics, and the treatment results of the laparoscopic choledochal cyst excision. Subjects and Methods: patients with bile duct cyst were diagnosed and treated by laparoscopic excision at the Hue Central Hospital from 6/2013 to 9/2017. Result: The common bile duct cyst was type I with highest ratio (90.77%), in which type Ic occupied the rate was 53.84%. The most common clinical manifestation was abdominal pain which occupied 87.69% of cases. The average time of opreation was 197.58 ± 46.57. Drain pipe was removed within 1-4 days after surgery. The average time of postoperative treatment was 8.7 ± 3.8 days. The rate of early complications after surgery was 3.07%. The rate of postoperative complications was 1.54%. Conclusion: Laparoscopic treatment of choledochal cyst is safe, feasible and efficient in medical high-tech center Key words: laparoscopic, bile duct cyst

scholarly journals Cystic Dilatations of the Common Bile Duct in Adults

HPB Surgery ◽  
1996 ◽  
Vol 10 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Gr. Kouraklis ◽  
E. Misiakos ◽  
A. Glinavou ◽  
G. Karatzas ◽  
J. Gogas ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Good Health ◽  
Type I ◽  
Cyst Excision ◽  
Type Iii ◽  
Long Term Follow Up ◽  
Risk Of Malignancy ◽  
The Common ◽  
Age Range

Cystic dilatations of the common bile duct are believed to be of congenital etiology with most cases presenting in childhood. During the last 20 years, 10 patients with cystic dilatations of the bile duct were treated in our Department. There were 5 men and 5 women with an age range of 35–81 years. Clinical presentation consisted of right hypohondrial pain, nausea, vomiting and a history of obstructive jaundice. Diagnosis was established by ultrasound, cholangiography and ERCP in most cases. According to the Todani classification system, 5 patients had type I cysts, 4 had type II and one had type III. At the time of surgery, main associated diseases were choledocholithiasis in 3 cases and cholangitis in 2 cases. One patient (type III) underwent endoscopic sphincterotomy; 4 patients underwent internal drainage and 2 of them developed mild cholangitis postoperatively; 5 patients underwent excision of the cyst and a biliary-enteric bypass and developed no main complications. Patients remained in good health during long-term follow-up. We conclude that cyst excision is the treatment ofchoice for adults in order to reduce postoperative morbidity and the potential risk of malignancy.

scholarly journals Adenomyoma of common bile duct arising in a type I choledochal cyst

2011 ◽  
Vol 54 (2) ◽  
pp. 365 ◽  
Author(s):  
DeepakKumar Singh ◽  
Archana Rastogi ◽  
Puja Sakhuja ◽  
Ranjana Gondal
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Type I

scholarly journals Choledochal Cyst Associated With Polycystic Kidney Disease: Report of a Case

HPB Surgery ◽  
1999 ◽  
Vol 11 (3) ◽  
pp. 185-190 ◽  
Author(s):  
T. Hasegawa ◽  
M. Kim ◽  
Y. Kitayama ◽  
K. Kitamura ◽  
T. Hiranaka
Keyword(s):  
Bile Duct ◽  
Kidney Disease ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Polycystic Kidney Disease ◽  
Choledochal Cyst ◽  
Amylase Level ◽  
Type I ◽  
Polycystic Kidney ◽  
Endoscopic Retrograde

We report a very rare case of type I choledochal cyst associated with a polycystic kidney disease. A 48- year-old female had been dependent on hemodialysis for chronic renal failure due to polycystic kidney disease and was incidentally diagnosed to have a dilated common bile duct by an ultrasonography. An endoscopic retrograde cholangiopancreatography showed a spindle-shaped, dilated common bile duct (type I choledochal cyst) without visualization of the pancreatic duct. She underwent a resection of the choledochal cyst. Intraoperative cholangiography showed no reflux of contrast medium into the pancreatic duct. Amylase level of the aspirated bile from the bile duct was not elevated. In the case of choledochal cyst combined with renal fibropolycystic disease, pancreaticobiliary maljunction may not contribute to the etiology of choledochal cyst. In such cases, management of choledochal cyst is still controversial and requires further discussion.

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