Aberrant Duct Research Articles

Pancreaticoduodenectomy in Childhood for Rare Pancreatic Ductal Anomalies - Case Reports

In the past 9 years, 3 children suffering rare pancreatic disorders have undergone cephalic pancreaticoduodenectomy (Whipple procedure) required after the failure of initial conservative treatments. Ductal anomalies such as pancreas divisum or predominant Santorini duct can be managed conservatively (especially by papillotomy of the minor papilla), unless the extent of the fibrotic lesions of the pancreas jeopardizes the final evolution of the pancreatic disease. Intrapancreatic gastric duplications remain extremely rare. Even to-day, diagnosis was made only on pathologic specimens after radical surgery. Better knowledge of this rare pathology, with emphasis on its radiological features, may help better assessment. Hemoductal pancreatitis is evocative of the coexistence of gastric duplication and pancreatic aberrant duct. However, when fibrotic and necrotic changes in the duodenopancreatic region are considerable, assessment of this anomaly becomes difficult. Radical though it is, pancreaticoduodenectomy may be necessary to treat cephalic pancreatic lesions in childhood after the failure of reasonable attempts of conservative treatment.

Composition of fluids obtained from human epididymal cysts.

The fluid composition of five epididymal spermatocoeles, one epididymal cyst and a hydrocoele was examined. The fluid obtained from the spermatocoeles was a dilute suspension of mainly immotile spermatozoa. The sperm-free fluid contained less protein, phosphate, glucose, triglyceride and cholesterol than serum but more testosterone and chloride than peripheral blood. It contained no epididymal secretion products. Proteins in the fluid differed from those in serum. From the fluid composition these cysts appeared to be continuous with the rete testis, either dilatations of efferent ducts or Haller's superior aberrant duct (vas aberrans of the rete testis). Fluid from an epididymal cyst containing no spermatozoa was mainly of similar composition. In contrast, hydrocoele fluid resembles blood serum.

Intraoperative cholangiography: use of portable fluoroscopy and transmitted images.

Intraoperative cholangiograms were obtained with portable fluoroscopy in 53 patients during laparoscopic cholecystectomy, and the images were transmitted to the radiology department. Each image was assessed for diagnostic quality and bile duct abnormalities (eg, retained stones and duct aberrancies). The aberrancy rate was 5.7% with the aberrant duct in the region of surgical dissection. The fluoroscopic technique provided diagnostic images with the advantage of real-time visualization, immediate communication with the surgeon, and the potential to decrease the risk of bile duct injury.

Absence of common bile duct.

Anomalies of the biliary ducts are a constant source of concern to physicians performing surgery in that area. Numerous variations in the position and length of the cystic duct as well as the cystic artery have been described in detail. Mention has frequently been made of aberrant hepatocystic ducts; however, absence of the common bile duct, discussed in the following case report, has been reported briefly only once before, when it occurred in an infant who died because of this anomaly. The ducts were all atretic. 1 This anatomic variation, if it had not been recognized in the usual technical performance of cholecystectomy, would surely have led to death or unfortunate complications. The maneuver emphasized by Gatch 2 of tracing the biliary ducts from within after emptying the gallbladder was helpful in tracing the anomaly. This procedure is a sound, valuable aid in preventing surgical accidents in the biliary ducts.

Induction of Mammary Ducts

THE mammary gland of the pig has normally two primary ducts which open separately on the surface of the nipple. Embryologically, the two ducts proliferate from the base of a cone-shaped depression of the stratum germinativum known as the mammary pocket or mammary bud. A similar depression or epithelial ingrowth, variable in depth, surrounds the nipple at its juncture with the body wall. Among several f” tal glands sectioned, a few cases of aberrant ducts, similar histologically to the primary ducts, were noticed to have sprouted from the same relative position to the apex of the epithelial ingrowth at the base of the nipple as the primary ducts do to the apex of the mammary pocket (Fig. 1).