Surgical management of choledochal cysts in adults; Our experience

Journal of Surgical Arts ◽

10.14717/jsurgarts-210103 ◽

2021 ◽

pp. 11-16

Keyword(s):

Choledochal Cyst ◽

Bile Ducts ◽

Precancerous Lesions ◽

Demographic Data ◽

Biliary Fistula ◽

Biliary Colic ◽

Choledochal Cysts ◽

Extrahepatic Bile Ducts ◽

Male Patients ◽

And Gender

Choledochal cysts are the name given to the congenital cystic dilatation of the intrahepatic and/or extrahepatic bile ducts. It is most commonly observed in childhood ages but there are cases diagnosed in adult-hood. They are precancerous lesions and should be resected when diagnosed. The aim of this study is to present the results of the patients who underwent surgical therapy due to choledochal cyst. This study retrospectively included adult patients who were diagnosed with choledochal cyst between January 2015 and December 2019. In addition to demographic data such as age and gender, the operative and postoperative morbidity and mortality rates were documented. The study included nine patients who underwent surgery due to a choledochal cyst. Of nine patients, three (33%) were male and six (66%) were female. The general mean age of the patients was 42.4 while the mean age of male patients was 56.5 and female patients was 35.5. The complaints were jaundice in three pati-ents (33%), acute pancreatitis in two patients (22%), biliary colic abdominal pain in two patients (22%), sepsis in one patient (11%), and suspected malignity in one patient (11%). Type 1 choledochal cyst was detected in all cases. In all patients included in the study, the external bile ducts including the intrapancreatic part were resected by incising the choledochal dilatation from the endpoint. The surgical procedure was performed laparoscopi-cally in two cases (22%). A biliary fistula that regressed with medical treatment was detected in postoperative one patient (11%). A postoperative pancreas fistula was not detected in any patient. Margin positive adenocar-cinoma was observed in the choledochal incisions of one patient who underwent laparoscopic surgery. The pati-ent was taken to re-exploration and conventional pancreaticoduodenectomy was performed. Choledochal cysts detected in older ages and male patients have a greater risk of malignity. Therefore, complete resection of bile ducts is necessary. The intraoperative frozen examination should be kept in mind as it protects patients from the second operation.

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Anomalous choledocho-pancretic ductal junction in a choledochal cyst: A case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0406179j ◽

2004 ◽

Vol 132 (5-6) ◽

pp. 179-181

Author(s):

Miodrag Jovanovic ◽

Dragoljub Bilanovic ◽

Radoje Colovic ◽

Nikica Grubor ◽

Milenko Ugljesic

Keyword(s):

Bile Duct ◽

Choledochal Cyst ◽

Bile Ducts ◽

Postoperative Recovery ◽

Biliary Colic ◽

Duodenal Wall ◽

Choledochal Cysts ◽

Bile Duct Wall ◽

Intrahepatic Bile Ducts ◽

Inflammatory Changes

Choledochal cysts are rare congenital anomalies, mostly detected in adults. Pathogenesis of these cysts seems to be in anomalous junction between pancreatic and common bile duct, above the papillary sphincterand outside of the duodenal wall. The absence of the sphincter above the junction is followed by reflux of the pancreatic juice into the bile duct leading to dilatation and fibrous changes of bile duct wall. A 38-year-old female is presented in whom a choledochal cyst was found 11 years earlier, during the operation performed for obstructive jaundice, when cystojejunostomy with Roux-en Y jejunal limb was carried out. In February 1990, she was admitted to our Institution for jaundice and biliary colic. The patient was reoperated. Operative cholangiography showed an anomalous pancreatobiliary junction, choledochal cyst, dilated cystic duct and moderate dilatation of intrahepatic bile ducts. Cholecystectomy, desanastomosis with partial excision of choledochal cyst, and retrocolic choledochojejunostomy with the same Roux-en-Y jejunal limb were performed. Total excision of choledochal cyst was too risky due to chronic inflammatory changes in the hepatoduodenal ligament. Postoperative recovery was uneventful and the patient remained symptom-free so far.

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Choledochal cysts – state of the art

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2021-25-1-37-43 ◽

2021 ◽

Vol 25 (1) ◽

pp. 37-43

Author(s):

Thanh Liem Nguyen ◽

V. S. Cheremnov ◽

Yu. A. Kozlov

Keyword(s):

Bile Duct ◽

Choledochal Cyst ◽

Bile Ducts ◽

Proteolytic Enzymes ◽

Common Hepatic Duct ◽

Malignant Degeneration ◽

Biliary Cirrhosis ◽

Choledochal Cysts ◽

Invasive Approach ◽

The Common

Introduction. Choledochal cyst is enlargement of the external bile duct system that can lead to liver dysfunction and biliary cirrhosis in childhood and malignant degeneration of the liver and bile ducts in adulthood. There are many theories explaining the origin of the common bile duct cyst. However, none of them can explain the formation of all five different types. Most of them are congenital. However, some of them may be aquired. The theory of a long common biliopancreatic canal has become widespread and is still used to explain the formation of this type of cystic anomalies. If the common canal is long and its part is not surrounded by the sphincter of Oddi, the secret of the pancreas begins to be thrown into the choledochus. Proteolytic enzymes from the pancreas are quite active and can damage the epithelium and the wall of the bile ducts, which leads to their weakness and, as a result, dilatation of the choledochus. Ultrasound examination is the initial and main method for diagnosing choledochal cysts. In some cases, there is a need for endoscopic or magnetic resonance retrograde cholangiopancreatography, intraoperative cholangiography. Removal of the cyst and anastomosis of the common hepatic duct with the lumen of the jejunum or duodenum, performed through the subcostal approach, are standard procedures for the treatment of patients with a choledochal cyst. The advent of laparoscopy and the accumulation of experience in performing complex surgical interventions introduced a minimally invasive approach for the production of laparoscopic biliodigestive anastomoses. Intra- and postoperative complications include damage to the structures of the hepatic hilum, torsion of the abduction loop, incompetence and stricture of biliodigestive anastomosis, cholangitis, stone formation, adhesive intestinal obstruction, and malignancy of the cyst remnants.Conclusion. This literature review has demonstrated modern views on the origin, etiology, diagnosis and treatment of choledochal cysts. The scientific work discussed the versatile technical aspects of the surgical treatment of choledochal cysts in children and assessed its safety and effectiveness.

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Pathogenesis of Biliary Atresia

PEDIATRICS ◽

10.1542/peds.78.1.183 ◽

1986 ◽

Vol 78 (1) ◽

pp. 183-183

Author(s):

THOMAS C. MOORE

Keyword(s):

Biliary Atresia ◽

Bile Ducts ◽

Early Operation ◽

Spontaneous Perforation ◽

Round Cell ◽

Choledochal Cysts ◽

Viral Etiology ◽

Round Cell Infiltration ◽

Extrahepatic Bile Ducts ◽

Inflammatory Component

In Reply.— The letter of Esterly is an important one with some significant observations regarding a potential acquired inflammatory and viral etiology of biliary atresia. A marked and progressive inflammatory component of biliary atresia with extensive early round cell infiltration and progressive fibrosis was reported by one of the authors in 1953.1 This observation led to strong recommendations for early operation in biliary atresia.2,3 It has been suggested that biliary atresia, neonatal spontaneous perforation of the extrahepatic bile ducts, and choledochal cysts may be variants of an acquired infalmmatory process, possibly viral, such as cytomegalovirus, and possibly oncogenic.4

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Animal Welfare Attitudes: Effects of Gender and Diet in University Samples from 22 Countries

Animals ◽

10.3390/ani11071893 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1893

Author(s):

Christoph Randler ◽

Ana Adan ◽

Maria-Mihaela Antofie ◽

Arturo Arrona-Palacios ◽

Manecas Candido ◽

...

Keyword(s):

Gender Differences ◽

Animal Welfare ◽

Demographic Data ◽

Vegetarian Diet ◽

Vegan Diet ◽

Short Version ◽

Convenience Sample ◽

Gender Empowerment ◽

Welfare Attitudes ◽

And Gender

Animal Welfare Attitudes (AWA) are defined as human attitudes towards the welfare of animals in different dimensions and settings. Demographic factors, such as age and gender are associated with AWA. The aim of this study was to assess gender differences among university students in a large convenience sample from twenty-two nations in AWA. A total of 7914 people participated in the study (5155 women, 2711 men, 48 diverse). Participants completed a questionnaire that collected demographic data, typical diet and responses to the Composite Respect for Animals Scale Short version (CRAS-S). In addition, we used a measure of gender empowerment from the Human Development Report. The largest variance in AWA was explained by diet, followed by country and gender. In terms of diet, 6385 participants reported to be omnivores, 296 as pescatarian, 637 ate a vegetarian diet and 434 were vegans (n = 162 without answer). Diet was related with CRAS-S scores; people with a vegan diet scored higher in AWA than omnivores. Women scored significantly higher on AWA than men. Furthermore, gender differences in AWA increased as gender inequality decreased.

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TWO TUMOURS OF THE EXTRAHEPATIC BILE DUCTS

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1940.tb53815.x ◽

1940 ◽

Vol 1 (8) ◽

pp. 268-269 ◽

Cited By ~ 3

Author(s):

A. M. McIntosh ◽

A. D. Gillies

Keyword(s):

Bile Ducts ◽

Extrahepatic Bile Ducts

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Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Journal of Clinical Medicine ◽

10.3390/jcm10071346 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1346

Author(s):

Talida Georgiana Cut ◽

Cristina Tudoran ◽

Voichita Elena Lazureanu ◽

Adelina Raluca Marinescu ◽

Raluca Dumache ◽

...

Keyword(s):

Mechanical Ventilation ◽

Subcutaneous Emphysema ◽

Diffuse Alveolar Damage ◽

Demographic Data ◽

Pathophysiological Mechanism ◽

Spontaneous Pneumomediastinum ◽

Intensive Care Stay ◽

Laboratory Investigations ◽

Male Patients ◽

Pulmonary Pathology

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

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