Cholangiocarcinoma Arising from a Type VI Biliary Cyst: A Case Report and Review of the Literature

Cystic dilatations of the cystic duct which are suggested as type VI biliary cysts are very rare and many of them go unrecognized or are confused with other cysts until the operation although they are obvious on imaging studies. They can present with fusiform or saccular dilatations and can be accompanied by common bile duct dilatations. It is important to identify these cysts as they share the same characteristics as the other biliary cyst types and can be complicated with malignancy. We herein present a very unusual case of a cholangiocarcinoma arising from a type VI biliary cyst in a 58-year-old female patient and review the literature. The patient presented with jaundice, weight loss, and abdominal pain. On imaging, the cystic duct and common bile duct were fusiformly dilated and had a wide communication. There was a mass filling the distal parts of both ducts. The patient was urgently operated on after perforation following ERCP. Histopathology was compatible with a type VI biliary cyst and an associated cholangiocarcinoma.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.686629 ◽

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.

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Fibrosing Pancreatitis—An Obscure Cause of Painless Obstructive Jaundice: A Case Report and Review of the Literature

PEDIATRICS ◽

10.1542/peds.67.1.136 ◽

1981 ◽

Vol 67 (1) ◽

pp. 136-139

Author(s):

Raymond L. Meneely ◽

James O'Neill ◽

Fayez K. Ghishan

Keyword(s):

Differential Diagnosis ◽

Abdominal Pain ◽

Case Report ◽

Bile Duct ◽

Common Bile Duct ◽

Obstructive Jaundice ◽

Asymptomatic Patient ◽

Review Of The Literature ◽

Distal Common Bile Duct

We report a 3-year-old asymptomatic patient who had obstructive jaundice. Percutaneous transhepatic cholangiogram showed total obstruction of the distal common bile duct. At laparotomy, fibrosing pancreatitis was found. Sphincteroplasty and choledochoduodenostomy relieved his symptoms. A review of the literature disclosed ten patients, nine of whom had abdominal pain. Fibrosing pancreatitis should be considered in the differential diagnosis of obstructive jaundice in children, even in the absence of abdominal pain.

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Dilated Pancreatic Duct and Common Bile Duct in a Patient with Abdominal Pain and Weight Loss

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2004.t01-3-40012.x ◽

2004 ◽

Vol 99 (8) ◽

pp. 1623-1625 ◽

Cited By ~ 1

Author(s):

Banke Agarwal ◽

Stephen Kuehn ◽

Brian T. Collins

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct

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Superior mesenteric artery syndrome caused by acute weight loss in a 16-year-old polytrauma patient: An unusual case report and review of the literature

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.102284 ◽

2021 ◽

pp. 102284

Author(s):

Habib Ahmad Esmat ◽

Din Mohammad Najah

Keyword(s):

Weight Loss ◽

Case Report ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Unusual Case ◽

Superior Mesenteric Artery Syndrome ◽

Review Of The Literature ◽

Polytrauma Patient ◽

Unusual Case Report

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

BMJ Case Reports ◽

10.1136/bcr-2021-244393 ◽

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.

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ROLE OF EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN PREVENTING COMPLICATIONS OF ACUTE CHOLECYSTITIS

10.36106/ijsr/4727478 ◽

2020 ◽

pp. 1-3

Author(s):

Mukesh Kumar ◽

Sanjay Kumar Suman ◽

Pawan Kumar Jha ◽

Debarshi Jana

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Conservative Treatment ◽

Common Bile Duct ◽

Acute Cholecystitis ◽

Common Bile Duct Stone ◽

Bile Duct Stone ◽

The Other ◽

Study Results ◽

Delayed Group

Background: Cholecystectomy is the standard and the only curative treatment for acutecholecystitis. The complications of acute cholecystitis are disastrous to the patients; on the other hand, conservative treatment is associated with recurrence of symptoms and other complications as common bile duct stone. The aim of this study is to weight out the complication of emergency surgery against the complications of conservative treatment in patients with acute cholecystitis. Materials andmethods: A total of 80 patients were included in the study. All Patients underwent early laparoscopiccholecystectomy or interval laparoscopic cholecystectomies for acute calcularcholecystitis from October 2017 to September 2019 were included in the study. Results: The overall complication rate was 15% (6 of 40 in early group and 10% (4 of 40) in the delayed group. One case of delayed group suffering recurrent acute attack and the other one suffering common bile duct stone, there was no major bile duct injury in the delayed group. Conclusion: Laparoscopic cholecystectomy is a safe and cost-eﬀective approach for the treatment of acute cholecystitis within 72 h after the onset of attack.

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Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

Journal of Clinical Imaging Science ◽

10.25259/jcis-17-2019 ◽

2019 ◽

Vol 9 ◽

pp. 23

Author(s):

Giulia Frauenfelder ◽

Annamaria Maraziti ◽

Vincenzo Ciccone ◽

Giuliano Maraziti ◽

Oliviero Caleo ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Bile Duct ◽

Common Bile Duct ◽

Acute Abdominal Pain ◽

Imaging Modality ◽

Biliary Duct ◽

History Of ◽

The Common ◽

Solid Lesions

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

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