scholarly journals The role in the decision-making of the surgeon in choledochal cysts during pregnancy

2021 ◽  
Vol 8 (11) ◽  
pp. 3452
Author(s):  
Carlos F. Nicolás-Cruz ◽  
Paola I. Pech-Cervantes ◽  
Juan A. Loyo-Cosme ◽  
Omar M. Herrera-Ortiz De Ora ◽  
Jorge A. Ordoñez-García ◽  
...  
Keyword(s):  
Decision Making ◽  
Bile Duct ◽  
Choledochal Cyst ◽  
Medical Management ◽  
Surgical Intervention ◽  
Well Being ◽  
Choledochal Cysts ◽  
Bile Duct Diseases ◽  
Diagnosis And Management

The diagnosis and management of bile duct diseases during pregnancy are highly controversial because preserving both the fetus and pregnancy often required surgical intervention. In this manuscript we reported three cases of pregnant patients referred to our hospital with choledochal cyst. Medical management was implemented until fetal well-being was compromise with moderate cholangitis and oligohydramnios. A C-section prior induction with lung ripeness was performed, four weeks later cyst resection and biliodigestive derivation was performed prior preoperative parenteral total nutrition was implemented. All patients and products survived without complications.  

scholarly journals Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst and anomalous pancreaticobiliary junction: case report

2019 ◽  
Vol 5 (2) ◽  
pp. 20180079
Author(s):  
Marta Reis de Sousa ◽  
Inês Santiago ◽  
Maria J Barata ◽  
Mireia Castillo ◽  
Celso Matos
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Gastric Adenocarcinoma ◽  
Choledochal Cyst ◽  
Histopathological Analysis ◽  
Gallbladder Neoplasms ◽  
Choledochal Cysts ◽  
Bile Duct Dilatation ◽  
Duct Dilatation ◽  
Anomalous Pancreaticobiliary Junction

A 75-year-old female incidentally presented with an enhancing intraluminal gallbladder mass, main bile duct dilatation and anomalous pancreaticobiliary junction (APBJ) during the staging of gastric adenocarcinoma. Histopathological analysis confirmed the diagnosis of intracholecystic papillary-tubular neoplasm. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder are rare gallbladder neoplasms, defined as intramucosal, preinvasive, exophytic, mass forming lesions. An association between choledochal cysts and anomalous pancreaticobiliary junction with gallbladder neoplasms is well known, and this case potentially illustrates gallbladder carcinogenesis related to these biliary anomalies.

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

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.

scholarly journals Symptomatic intracranial arterial disease: incidence, natural history, diagnosis, and management

2011 ◽  
Vol 30 (6) ◽  
pp. E14 ◽  
Author(s):  
Ananth K. Vellimana ◽  
Andria L. Ford ◽  
Jin-Moo Lee ◽  
Colin P. Derdeyn ◽  
Gregory J. Zipfel
Keyword(s):  
Natural History ◽  
Medical Therapy ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Surgical Intervention ◽  
Disease Incidence ◽  
Arterial Disease ◽  
High Rate ◽  
Diagnosis And Management ◽  
Ischemic Events

Symptomatic intracranial arterial disease is associated with a high rate of recurrent ischemic events. The management of this condition is controversial, with some advocating medical therapy as a sole means of treatment and others recommending endovascular therapy in addition to best medical management. In rare cases, surgical intervention is considered. A thorough review of the available literature was performed, and treatment recommendations based on these data are provided.

scholarly journals Choledochal cyst of the proximal cystic duct: a taxonomical and therapeutic conundrum

2018 ◽  
Vol 100 (2) ◽  
pp. e34-e37 ◽  
Author(s):  
R Kilambi ◽  
AN Singh ◽  
KS Madhusudhan ◽  
P Das ◽  
S Pal
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Frozen Section ◽  
Type Ii ◽  
Choledochal Cysts ◽  
Duct Excision ◽  
Term Data

Isolated choledochal cysts involving the cystic duct are rare. We present a case of a choledochal cyst involving only the proximal cystic duct, and discuss the taxonomic and therapeutic challenges. There is a need for a clearly defined classification system for these cysts as they may be categorised as either type II or type VI cysts. The optimal treatment remains debatable, with some authors recommending a bilioenteric reconstruction owing to the wide cystic duct–bile duct junction. However, we suggest that a cholecystectomy should be performed with examination of the specimen and frozen section in case of any abnormality rather than upfront bile duct excision. In addition, given the rarity of this condition and the paucity of long-term data, we recommend meticulous follow-up for development of any malignancy.

scholarly journals Minor Papillary Relief in a Type IA Choledochal Cyst: A Case Report and Review of the Literature

2020 ◽  
Vol 14 (1) ◽  
pp. 116-123
Author(s):  
Sindhura Kolli ◽  
Simcha Weissman ◽  
Emmanuel Ofori ◽  
Khoi Paul Dang-Ho ◽  
Praneeth Bandaru ◽  
...  
Keyword(s):  
Case Report ◽  
Choledochal Cyst ◽  
Classification System ◽  
Lag Time ◽  
Diagnosis And Treatment ◽  
Review Of The Literature ◽  
Choledochal Cysts ◽  
Diagnosis And Management ◽  
System Diagnosis ◽  
Type Ia

Choledochal cysts are an anatomical conundrum as they present with nonspecific symptoms generally delaying diagnosis and treatment. Its lag time remains critical, as cholangiocarcinoma, a fatal sequelae, contributes to its morbidity and mortality. Herein, we present a case of a type 1A choledochal cyst. We hope that its review on presentation, classification system, diagnosis, and management prevent complications and cataclysmic results.

Choledochal Cyst Originating from Primary Sclerosing Cholangitis in a Child

2011 ◽  
Vol 96 (4) ◽  
pp. 316-319
Author(s):  
Wei-Lung Tseng ◽  
Hao-Yu Lin ◽  
Wen-Hsi Lin ◽  
Hong-Shiee Lai
Keyword(s):  
Bile Duct ◽  
Primary Sclerosing Cholangitis ◽  
Choledochal Cyst ◽  
Sclerosing Cholangitis ◽  
Extrahepatic Bile Duct ◽  
Choledochal Cysts ◽  
Type Iv ◽  
Intrahepatic Duct ◽  
Computed Tomography Image ◽  
Distended Gallbladder

Abstract Choledochal cysts are common in Asian children. Primary sclerosing cholangitis (PSC), which is characterized by inflammation and fibrosis and may lead to bile duct stricture over the intrahepatic or extrahepatic bile duct, is rare in children. Here we report a case of a 10-year-old boy who presented with a choledochal cyst originating from PSC. He had suffered from repeated abdominal pain and cholangitis for 3 years. A type IV choledochal cyst was suspected from the ultrasound and computed tomography image showing a distended gallbladder and dilatation of the bilateral intrahepatic duct at the hepatic hilar area and common bile duct (CBD). During laparotomy, a markedly distended gallbladder was noted and was shown to have no communication with the CBD by intraoperative cholangiogram. Choledochal cysts with extrahepatic and intrahepatic duct dilatation at the hilar area and marked stenosis with nearly total obstruction of the distal CBD were noted. Hepaticojejunostomy was performed. The histopathologic findings demonstrated a typical PSC picture. The patient's postoperative course was uneventful for 8 months after surgery, and he received no medication during a regular follow-up.

scholarly journals Uncommon Mixed Type I and II Choledochal Cyst: An Indonesian Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Fransisca J. Siahaya ◽  
Toar J. M. Lalisang ◽  
Wifanto S. Jeo ◽  
Arnold B. H. Simanjuntak ◽  
Benny Philippi
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Mixed Type ◽  
Asian Population ◽  
Type I ◽  
Choledochal Cysts ◽  
Duct Cyst ◽  
Uncommon Disease ◽  
History Of ◽  
Upper Abdominal

Bile duct cyst is an uncommon disease worldwide; however, its incidence is remarkably high in Asian population, primarily in children. Nevertheless, the mixed type choledochal cysts are extremely rare especially in adults. A case report of a 20-year-old female with a history of upper abdominal pain that was diagnosed with cholecystitis with stone and who underwent laparoscopic cholecystectomy is discussed. Choledochal malformation was found intraoperatively. Magnetic resonance cholangiography (MRCP) and USG after first surgery revealed extrahepatic fusiform dilatation of the CBD; therefore, provisional diagnosis of type I choledochal cyst was made. Complete resection of the cyst was performed, and a mixed type I and II choledochal cyst was found intraoperatively. Bile duct reconstruction was carried out with Roux-en-Y hepaticojejunostomy. The mixed type I and II choledochal cysts are rare in adults, and this is the third adult case that has been reported. The mixed type can be missed on radiology imaging, and diagnosing the anomaly is only possible after a combination of imaging and intraoperative findings. Mixed type choledochal cyst classification should not be added to the existing classification since it does not affect the current operative techniques.

Choledochal cyst with secondary cholangitis, choledochitis, duodenal papillitis, and pancreatitis in a young domestic shorthair cat

2021 ◽  
pp. 104063872110171
Author(s):  
Megan E. Schreeg ◽  
Sybille A. Miller ◽  
John M. Cullen
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Duodenal Papilla ◽  
Choledochal Cysts ◽  
Chronic Antigenic Stimulation ◽  
Bile Drainage ◽  
Biliary Ducts ◽  
The Common ◽  
Duodenal Papillitis

Choledochal cysts, congenital segmental dilations of the common bile duct, have been reported in few cats, and histologic characterization is lacking. A 20-mo-old spayed female domestic shorthair cat was presented because of vomiting and weight loss. There was progressive elevation of liver enzyme activity (ALT > ALP, GGT) and hyperbilirubinemia. Diagnostic imaging identified focal cystic dilation of the common bile duct, dilation and tortuosity of adjacent hepatic ducts, and a prominent duodenal papilla. A choledochal cyst was suspected, and the animal was euthanized. On postmortem examination, there was a 2-cm, firm, thickened, cystic dilation of the common bile duct, patent with adjacent ducts. Histologically, the cyst wall was expanded by fibroblasts, collagen, and lymphoplasmacytic inflammation. Adjacent bile ducts were markedly dilated and tortuous, with lymphoplasmacytic inflammation and papillary mucosal hyperplasia that extended to the major duodenal papilla. There was chronic neutrophilic cholangitis, suggesting bacterial infection and/or disturbed bile drainage, extrahepatic obstruction, and lymphoplasmacytic pancreatitis with ductular metaplasia. Prominent lymphoid follicles within biliary ducts and duodenum suggested chronic antigenic stimulation. Choledochal cysts can be associated with chronic neutrophilic cholangitis, extrahepatic obstruction, choledochitis, duodenal papillitis, and pancreatitis, and should be a differential for increased hepatic enzymes and hyperbilirubinemia in young cats.

scholarly journals Choledochal cysts – state of the art

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.

The Relationship Between Hearing Loss Self-Management and Hearing Aid Benefit and Satisfaction

2019 ◽  
Vol 28 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Louise Hickson ◽  
Carly Meyer
Keyword(s):  
Decision Making ◽  
Hearing Loss ◽  
Hearing Aids ◽  
Clinical Decision Making ◽  
Hearing Aid ◽  
Well Being ◽  
Self Report ◽  
Self Management ◽  
Hearing Aid Benefit ◽  
The Relationship

Purpose Hearing loss self-management refers to the knowledge and skills people use to manage the effects of hearing loss on all aspects of their daily lives. The purpose of this study was to investigate the relationship between self-reported hearing loss self-management and hearing aid benefit and satisfaction. Method Thirty-seven adults with hearing loss, all of whom were current users of bilateral hearing aids, participated in this observational study. The participants completed self-report inventories probing their hearing loss self-management and hearing aid benefit and satisfaction. Correlation analysis was used to investigate the relationship between individual domains of hearing loss self-management and hearing aid benefit and satisfaction. Results Participants who reported better self-management of the effects of their hearing loss on their emotional well-being and social participation were more likely to report less aided listening difficulty in noisy and reverberant environments and greater satisfaction with the effect of their hearing aids on their self-image. Participants who reported better self-management in the areas of adhering to treatment, participating in shared decision making, accessing services and resources, attending appointments, and monitoring for changes in their hearing and functional status were more likely to report greater satisfaction with the sound quality and performance of their hearing aids. Conclusion Study findings highlight the potential for using information about a patient's hearing loss self-management in different domains as part of clinical decision making and management planning.

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