Unique Case of Congenital Duodenal Atresia and a Choledochal Cyst and the Hypothesis of Their Embryological Evolution

The concomitant occurrence of duodenal atresia (DA) and a choledochal cyst (CC) has rarely been reported. Knowledge of both the presentation and management of this rare co-occurrence is imperative in avoiding potential complications and sequelae, such as biliary metaplasia. Herein we describe a female infant born at 32 weeks gestational age who was diagnosed with duodenal atresia and annular pancreas postnatally, who had subsequent findings of malrotation and a choledochal cyst, as seen from contrast imaging. Uncomplicated repair of the DA and obstruction was performed at 4 days of life. She re-presented 2 years later with non-bloody, nonbilious emesis and was found to have elevated amylase, lipase and liver enzymes. Imaging revealed dilated intra-hepatic ducts, a distended gallbladder and a large choledochal cyst. She underwent a cholecystostomy tube placement followed by a definitive choledochal cyst excision with immediate improvement following surgery and full resolution of symptoms before discharge.

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First case report of acute cholangitis secondary to Cronobacter sakazakii

BMC Infectious Diseases ◽

10.1186/s12879-021-06195-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Syeda Sahra ◽

Abdullah Jahangir ◽

Neville Mobarakai ◽

Allison Glaser ◽

Ahmad Jahangir ◽

...

Keyword(s):

Acute Cholangitis ◽

Tube Placement ◽

Cronobacter Sakazakii ◽

First Case ◽

Shunt Procedure ◽

Intrahepatic Portosystemic Shunt ◽

History Of ◽

Cholecystostomy Tube ◽

Percutaneous Cholecystostomy Tube ◽

First Time

Abstract Introduction Cronobacter sakazakii is an opportunistic Gram-negative, rod-shaped bacterium which may be a causative agent of meningitis in premature infants and enterocolitis and bacteremia in neonates and adults. While there have been multiple cases of C. sakazakii infections, there have been no acute cholangitis cases reported in humans. Case presentation An 81-year-old male with a past medical history of basal cell carcinoma, alcoholic liver cirrhosis, transjugular intrahepatic portosystemic shunt procedure, complicated by staphylococcus bacteremia, pituitary tumor, glaucoma, and hypothyroidism presented to the emergency room with the complaint of diffuse and generalized 10/10 abdominal pain of 1 day’s duration. There was a concern for pancreatitis, acute cholangitis, and possible cholecystitis, and the patient underwent a percutaneous cholecystostomy tube placement. Blood cultures from admission and biliary fluid cultures both grew C. sakazakii. The patient was treated with a carbapenem and clinically improved. Conclusions The case study described a patient with multiple medical comorbidities that presented with C. sakazakii bacteremia and cholangitis. While this bacterium has been implicated in other infections, we believe this is the first time the bacteria is being documented to have caused acute cholangitis.

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Abstract No. 520 Clinical characteristics, imaging manifestations, and outcomes of patients undergoing percutaneous cholecystostomy tube placement for acute cholecystitis in the setting of COVID-19 infection

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2021.03.329 ◽

2021 ◽

Vol 32 (5) ◽

pp. S138-S139

Author(s):

K. Chen ◽

E. Gandras ◽

C. Greben ◽

J. Weinstein

Keyword(s):

Acute Cholecystitis ◽

Clinical Characteristics ◽

Tube Placement ◽

Percutaneous Cholecystostomy ◽

Cholecystostomy Tube ◽

Percutaneous Cholecystostomy Tube

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Thinking ahead: gallbladder intussusception following transperitoneal percutaneous cholecystostomy tube placement

BMJ Case Reports ◽

10.1136/bcr-2020-238885 ◽

2021 ◽

Vol 14 (2) ◽

pp. e238885

Author(s):

Ryan William England ◽

Caleb Heiberger ◽

Harjit Singh

Keyword(s):

Tube Placement ◽

Pigtail Catheter ◽

Percutaneous Cholecystostomy ◽

Transperitoneal Approach ◽

Proper Position ◽

Image Guided ◽

Risk Patients ◽

Procedural Complications ◽

Cholecystostomy Tube ◽

Percutaneous Cholecystostomy Tube

Percutaneous cholecystostomy (PC) is a common minimally invasive, image-guided procedure performed primarily on high-risk patients with acute cholecystitis for gallbladder decompression. Herein, we present a case of a patient undergoing PC placement using a transperitoneal approach. On subsequent upsizing attempts, the gallbladder fundus was found to invaginate during advancement of replacement drains, causing gallbladder intussusception. The use of a balloon and locked pigtail catheter were required to reposition the gallbladder to proper position. The patient’s planned percutaneous cholecystoscopy was delayed by 4 weeks until intended upsizing could be performed. This case demonstrates the advantage of achieving transhepatic gallbladder access to support tract formation and limit procedural complications.

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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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Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2016.125 ◽

2016 ◽

Vol 38 (2) ◽

Cited By ~ 2

Author(s):

Mario Lima ◽

Tommaso Gargano ◽

Giovanni Ruggeri ◽

Francesca Destro ◽

Michela Maffi

Keyword(s):

Choledochal Cyst ◽

Laparoscopic Approach ◽

Rare Condition ◽

Early Experience ◽

Cyst Excision ◽

Intrahepatic Bile Ducts ◽

First Case ◽

Laparoscopic Excision ◽

Extracorporeal Anastomosis ◽

Laparoscopic Removal

Choledochal cyst (CDC) is a congenital dilatation of the extra and/or intrahepatic bile ducts and it is a rare condition in western countries. Classical treatment consists of cyst excision and hepaticojejunostomy. The first case of a laparoscopic CDC excision was described in 1995 and since that time an increasing number of institutions have adopted this technique, with good success. We describe our early experience of 3 cases of CDC treated with laparoscopic approach. We used a 10 mm umbilical port for the camera, and four 3-5 mm operative ports. We performed the laparoscopic removal of the cyst and gallbladder, videoassisted preparation of the Roux-en-Y loop and laparoscopic hepaticjejunostomy. No post-operative complications occurred. Laparoscopic excision of CDCs has been supposed to give better observation, a better cosmetic result, potentially less postoperative pain, and a shorter recovery. The main argument for performing an extracorporeal anastomosis is that it decreases the operative time. We recommend caution to prevent injury to the pancreatic duct and biliary structures during dissection and anastomosis. Lifelong surveillance is mandatory, even after resection of the choledochal cyst.

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