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 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.

scholarly journals Surgical management of choledochal cysts in adults; Our experience

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.

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 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 A GIANT CHOLEDOCHAL CYST WITH CYSTIC DILATATION OF THE INTRAHEPATIC BILE DUCTS

1979 ◽  
Vol 40 (4) ◽  
pp. 672-678
Author(s):  
Keishoku CHO ◽  
Teizo TODO ◽  
Mitsugu NITTA ◽  
Myoshin RAI ◽  
Hiloyosi DOHI ◽  
...  
Keyword(s):  
Choledochal Cyst ◽  
Bile Ducts ◽  
Cystic Dilatation ◽  
Intrahepatic Bile Ducts

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 Preservation injury of the distal extrahepatic bile duct of donor livers is representative for injury of the intrahepatic bile ducts

2015 ◽  
Vol 63 (1) ◽  
pp. 284-287 ◽  
Author(s):  
Negin Karimian ◽  
Pepijn D. Weeder ◽  
Fernanda Bomfati ◽  
Annette S.H. Gouw ◽  
Robert J. Porte
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Extrahepatic Bile Duct ◽  
Intrahepatic Bile Ducts ◽  
Preservation Injury

scholarly journals Structure and Innervation of the Extrahepatic Biliary System in the Australian Possum, Trichosurus Vulpecula

HPB Surgery ◽  
1993 ◽  
Vol 7 (2) ◽  
pp. 125-140 ◽  
Author(s):  
R. T. A. Padbury ◽  
R. A. Baker ◽  
J. P. Messenger ◽  
J. Toouli ◽  
J. B. Furness
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Ducts ◽  
Internal Sphincter ◽  
External Sphincter ◽  
Duodenal Wall ◽  
Sphincter Muscle ◽  
Trichosurus Vulpecula ◽  
Nerve Fibres ◽  
The Common

The morphology, microanatomy and innervation of the biliary tree of the Australian possum, Trichosurus vulpecula, was examined. The gross morphology of the gallbladder, hepatic and cystic ducts, and the course of the common bile duct, conforms to those of other species. The sphincter of Oddi has an extraduodenal segment that extends 15mm from the duodenal wall; within this segment the pancreatic and common bile ducts are ensheathed together by sphincter muscle. Their lumens unite to form a common channel within the terminal intraduodenal segment.Nerve cell bodies of the gallbladder were found in an inter-connecting network of ganglia that were located in the serosa, muscularis and mucosa. Nerve fibres innervated the muscle, arterioles and the mucosa. Few ganglia were found along the supra sphincteric portion of the common bile duct. Nerve trunks followed the duct and a dense nerve fibre plexus was found in the mucosa. In the sphincter most ganglia were located in two plexuses, the first between the layers of the external sphincter muscle, which was continuous with the external muscle of the duodenum, and the second was associated with the internal sphincter muscle. Nerve fibres were numerous in the sphincter muscle, and were also found in the subepithelial and periglandular plexuses of both the pancreatic and common bile ducts.

scholarly journals Intrahepatic Transposition of Bile Ducts

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Jasmin Delić ◽  
Admedina Savković ◽  
Eldar Isaković ◽  
Sergije Marković ◽  
Alma Bajtarevic ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Anatomical Variation ◽  
Intrahepatic Bile Duct ◽  
Main Research ◽  
Intrahepatic Bile Ducts ◽  
Anatomical Terminology ◽  
Segment Viii ◽  
Safe Performance

Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications.

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