Cystic Dilatation Of Bile Duct Research Articles

DILATATION KYSTIQUE DU CHOLEDOQUE A PROPOS D’UN CAS.

Summary Introduction: Cystic dilatation of the bile ducts is a rare birth defect. Its incidence is of the order of 1/100,000 to 1/150,000 births. Surgery is indicated to avoid liver damage secondary to stasis and infection (hepatic cirrhosis). Observation: This was a 16-year-old patient seen in a surgical consultation for pain in the right hypochondrium, nausea, vomiting, subjaundice, and intermittent fever. The clinical history of the disease found a history of 2 poorly documented surgeries for the same pathology in 2016 and 2020. On examination, she was in good general condition, a subicterus, the abdomen is supple with no palpable mass. An abdominal CT scan concluded to a cystic dilation of the common bile duct. A total surgical resection of the cystic wall was performed followed by a hepatico-jejunal anastomosis in Y. The postoperative course is simple. Conclusion: Cystic dilation of the common bile duct is often difficult to diagnose. Its main progressive risks are lithiasis, cancerization and infection. These complications can be fatal and are prevented by early resection of the cyst, the only valid treatment. Keywords: Common bile duct cyst, Malignant degeneration, Children

CHOLEDOCAL CYST Pada DEWASA: PERAN ULTRASONOGRAFI

Choledocal cyst (CC) is a rare congenital cystic dilatation of bile duct. The etiology is unknown, and likely multifactorial and it is uncertain whether they are congenital or acquired. Ultrasonography is initial imaging which can be used to evaluate biliary system. We report 43 year old female presented with icteric for 3 months. She had dark-color urine and white stool. She didn’t complain about abdominal pain or palpable mass in her abdomen.We performed ultrasonography and found dilatation of common bile duct for ± 7.4 cm. Gall bladder and another intrahepatic structures were normal. The patient was referred to digestive surgeon in adequate facility. Conclusion: Ultrasonography is initial and non-invasive imaging for viewing biliary system. Early detection and management can prevent morbidity and improve patient’s quality of life.

Cystic Dilatation of Main Bile Duct: About A Case

Cystic dilatation of the bile ducts is a rare congenital malformation. It’s due to an abnormality of the bilio-pancreatic junction which may involve the extra and/or intrahepatic bile ducts. According to Todani, there are several types depending on the site, shape and distribution of the malformation. It’s evoked in front of the inconstant clinical triad: pain, jaundice and mass. Ultrasound and better sectional imaging confirm the diagnosis. Surgical excision is the treatment of choice to prevent malignant degeneration of the cyst wall and bile ducts.

Unusual case of acute cholangitis in adults: congenital cystic dilatation of the bile ducts

We report 20 year old woman who was admitted with an acute cholangitis with a history of abdominal pain since 12 month. Clinical examination found the Charcot’s cholangitis triad: jaundice, fever and right upper quadrant abdominal pain. Laboratory studies revealed an elevated leukocyte (14 000/mm3), cholestasis with elevated total bilirubin value 139 mg/l and direct bilirubin 85 mg/l. An abdominal ultrasound demonstrated a cystic dilatation of the extra and intra hepatic biliary tree. An MRI showed a malformed cystic dilatation of the intrahepatic bile ducts and the common bile duct (Todani type IVa). We performed a laparotomy by subcostal incision, a cholecystectomy with side-to-side anastomosis between the choledochal cyst and the second portion of the duodenum were made. The patient suffered of an early biliary fistula treated spontaneously with any medical or surgical intervention. She was discharged 7 days after the surgery. The outcome until 10 months after still uneventful.

Undiscribed Intra and Extrahepatic Congenital Choledochal Cysts

Background: Choledochal cysts are congenital anomalies involving cystic dilatation of bile ducts. They usually lead to obstruction of the bile ducts and retention of bile. If the obstruction is not relieved, permanent damage may occur to the liver. We report an undiscribed case of an intra and extrahepatic choledochal cystic dilatation. Methods: A 5 years old female girl was referred to our center from Syria with C/C of abdominal pain and jaundice of few months duration. She was left untreated for few months because she couldnt seak medical attention because she was living in a war zone area. Results: She was investigated and her blood tests revealed: serum bilirubin (total) 589 μmol/L, serum aspartate aminotransferase (AST) median 191.5 IU/L, gamma-glutamyl transferase 627.25 IU/L, alkaline phosphatase median 537 IU/L. MRCP revealed dilatation of the right, left, common hepatic, commone bile duct and cystic duct Conclusion: Choledochal cysts are rare entities. The imaging modality of choice for diagnosing and characterizing choledochal cysts is MRCP. Our case has not been described before as it involves the intra and extra biliary system.

Undiscribed intra and extrahepatic congenital choledochal cysts

Background: Choledochal cysts are congenital anomalies involving cystic dilatation of bile ducts. They usually lead to obstruction of the bile ducts and retention of bile. If the obstruction is not relieved, permanent damage may occur to the liver. We report an undiscribed case of an intra and extrahepatic choledochal cystic dilatation. Methods: A 5 years old female girl was referred to our center from Syria with C/C of abdominal pain and jaundice of few months duration. She was left untreated for few months because she couldnt seak medical attention because she was living in a war zone area. Results: She was investigated and her blood tests revealed: serum bilirubin (total) 589 μmol/L, serum aspartate aminotransferase (AST) median 191.5 IU/L, gamma-glutamyl transferase 627.25 IU/L, alkaline phosphatase median 537 IU/L. MRCP revealed dilatation of the right, left, common hepatic, commone bile duct and cystic duct. Conclusion: Choledochal cysts are rare entities. The imaging modality of choice for diagnosing and characterizing choledochal cysts is MRCP. Our case has not been described before as it involves the intra and extra biliary system.

Planned hepatectomy for the"central type"intrahepatic and extrahepatic choledochal cysts

Objective To retrospectively study the clinical value and the advantages inplanned hepatectomyfor thecentral typeintrahepatic and extrahepatic choledochal cysts. Methods The clinical data of 7 patients with thecentral typeof intrahepatic and extrahepatic choledochal cysts which were treated withplanned hepatectomyfrom January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University were retrospectively analyzed. Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with theplanned hepatectomy. The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision. Combined right liver resection was performed in 6 patients, and combined left liver resection in one patient. All the 7 patients had a history of chronic cholangitis. Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE, whereas the hemilivers to be persevered were remarkably enlarged. No complication associated with PTCD and PVE occurred. The mean postoperative hospitalization was 12 days. Liver function tests suggested all the patients recovered well. No postoperative complication of bleeding, infection or liver function failure was observed, except in one patient who experienced pleural and abdominal effusion. Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with thecentral typeintrahepatic and extrahepatic choledochal cysts. The surgical strategy in planned hepatectomy can be used effectively to treat thecentral typeof intrahepatic and extrahepatic choledochal cysts, with improved surgical safety, decrease in incidences of postoperative liver function failure and residual choledochal cysts. Key words: Intrahepatic and extrahepatic bile duct cysts; Congenital cystic dilatation of bile duct; Planned hepatectomy; Percutaneous transhepatic cholangial drainage (PTCD); Portal vein embolization (PVE)

Polycystic kidney disease in Sprague-Dawley rats

Polycystic kidney disease (PKD) is a cystic genetic disorder of the kidneys which is typically associated with cystic bile duct dilatation in the liver in humans, and domestic and laboratory animals. In humans, there are two types of PKD, autosomal dominant polycystic kidney disease (ADPKD) and autosomal recessive polycystic kidney disease (ARPKD). ADPKD is caused by mutations in PKD1 or PKD2 gene while ARPKD is caused by mutation or loss of the PKHD1 (polycystic kidney and hepatic disease 1) gene. Here we report a morphologically confirmed case of spontaneous PKD in a Sprague-Dawley rat in which anatomic pathology examination revealed numerous cystic changes in the kidney and liver. Lesions consisted of marked cystic dilatations of renal tubules, and moderate cystic dilatations of intrahepatic bile ducts with portal fibrosis. We present detailed histologic features of the spontaneous PKD and compare them with disease model rats carrying an autosomal recessive PKHD 1 gene mutation.

Common Bile Duct Cysts Leading to Cholestasis and Jaundice: A Rare Case Report

Cystic dilatation of the common bile duct constitutes a rare congenital malformation prevalent in people of Asian origin with a female predominance. Its classification follows that of Todani. The commonest form, found in 80% of cases, is type I. Common bile duct cysts are often diagnosed in 2 out of 3 cases, during childhood with adult forms often rare. We hereby report the case of a cystic dilatation of the bile duct in a 75-year-old patient without significant history of disease.

A Case Report of an Unusual Type of Choledochal Cyst with Choledocholithiasis: Saccular Dilatation of the Confluent Portion of Both Intrahepatic Ducts

A choledochal cyst is a rare congenital anomaly of the biliary system, manifested as the cystic dilatation of bile ducts, usually occurring in the common bile duct (1-4). The Todani classification system is widely used to classify choledochal cysts; however, not all cases fit into this classification system. Here, we present a case of a choledochal cyst that did not fit into this Todani classification system: saccular cystic dilatation of the confluent portion of both intrahepatic ducts (IHDs).

345. Cystic bile duct dilatation and malignant transformation risk (a west Algerian series)

Introduction: Cystic dilatation of the biliary tract is a rare disease usually discovered in the pediatric age, with female predominance in Asian people, however 20–23% of patients have their disease diagnosed in adulthood. Its incidence is 1/200,000 inhabitants, it is often associated with an abnormality of the biliopancreatic junction and its evolution can be characterized by many serious complications essentially risk of malignant transformation in bile duct tracts.

Aggressive Hepatectomy for the Curative Treatment of Bilobar Involvement of Type IV-A Bile Duct Cyst

To analyze the risk and benefit of aggressive hepatectomy for the curative treatment of bilobar bile duct cysts (BDCs) of type IV-A. Conventional surgical treatment of bilobar BDCs of type IV-A is extrahepatic cyst excision, followed by biliodigestive anastomosis. The role of hepatectomy in the treatment of bilobar BDCs remains unclear. Between January 2006 and December 2011, a total of 28 patients with bilobar BDCs who underwent an aggressive hepatectomy were identified from a prospective database. Perioperative and long-term outcomes in these patients were compared with 18 patients with bilobar BDCs who received conventional surgical treatment. Patient characteristics such as age, sex, and clinical presentation were similar in both groups. Cystic dilatation of bile ducts was curatively resected in all 28 patients undergoing aggressive hepatectomy. Postoperative morbidity (57.1% vs 22.2%, P = 0.020), but not mortality (3.6% vs 0%, P = 1.000), in patients who underwent aggressive hepatectomy was significantly increased when compared with those who received conventional surgical treatment. Clearance rate of intrahepatic stones was significantly higher after aggressive hepatectomy than that after conventional surgical treatment (100.0% vs 45.5%, P < 0.001). Twenty-seven of 28 patients (96.4%), except 1 patient who met in-hospital death, achieved a symptom-free status after aggressive hepatectomy during a mean follow-up of 31 months. In contrast, during a mean follow-up of 37 months, 7 patients (38.9%, 7/18) remained free of biliary symptoms after conventional surgical treatment. The long-term outcomes between aggressive hepatectomy and conventional surgical treatment were significantly different (P < 0.001). In addition, no malignant transformation occurred after aggressive hepatectomy. However, intrahepatic cholangiocarcinoma has developed in the remnant BDC in 2 of 18 patients (11.1%) receiving conventional surgical treatment during follow-up. Aggressive hepatectomy, a challenging procedure, provides an efficient treatment option for some selected patients with bilobar BDCs of type IV-A. The role of aggressive hepatectomy in the curative treatment of bilobar BDCs of type IV-A should be paid particular attention in the future.

A Case of Gallbladder Cancer Associated with a Choledochocele

Choledochal cysts are congenital lesions involving cystic dilatation of the bile ducts. The choledochocele, the rarest type of choledochal cyst, is a cystic dilatation of the distal common bile duct that protrudes into the duodenum. There have been few reports concerning malignancy in the biliary tree associated with choledochoceles. We recently experienced a case of a choledochocele with gallbladder cancer. (Korean J Med 2013;85:73-76)

A Case of Biliary Papillomatosis with Cystic Dilatation of Bile Duct

A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis (BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.

IS-012 Cystic dilatation of bile duct in infants : an entity closer to biliary atresia than choledochal cyst in older children?(International Session III,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

IS-012 Cystic dilatation of bile duct in infants : an entity closer to biliary atresia than choledochal cyst in older children?(International Session III,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Intrahepatic Biliary Cysts Presenting before Hepatic Portoenterostomy in Biliary Atresia

Intrahepatic Biliary Cysts Presenting before Hepatic Portoenterostomy in Biliary Atresia

Les dilatations kystiques congénitales des voies biliaires

Congenital cystic dilatation of bile ducts is a rare condition. We report a retrospective study about 18 patients having congenital bile duct cysts. According to Todani's classification, 11 cases were type I and 7 were type V. Six patients from the first group had a pancreatobiliary maljunction. A total resection of the cyst was conducted in the type I cysts. Anatomopathologic examination showed an adenocarcinoma of a common bile duct cyst. In one case, a cancer of the gall bladder associated to a common bile duct cyst in another case. Three patients with segmental dilatation of intrahepatic bile ducts (type V) underwent liver resection. Four patients had a diffuse form, one of them was treated by percutaneous drainage, and in the other cases a hepatojejunostomy was performed. Postoperative course was complicated with acute cholangitis in these four cases. Percutaneous drainage and antibiotics allowed a positive outcome in most of the cases. In one case, secondary biliary cirrhosis occurred as a long-term complication. Congenital cystic dilatation of bile ducts is considered to be a precancer state. Enterocystic anastomosis is proscribed and the resection has to be as complete as possible.

Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study

Anomalous pancreaticobiliary ductal junction, a rare congenital anomaly, is associated with various biliary and pancreatic diseases. The aim of this study was to determine the frequency of anomalous pancreaticobiliary ductal junction in Chinese patients with gallbladder cancer. One thousand eight hundred seventy-six patients underwent ERCP between April 2000 and September 2001 with biliary and pancreatic duct opacification in 1082. Among the latter patients, those with proven gallbladder carcinoma were identified. Anomalous pancreaticobiliary ductal junction was defined as a common channel greater than 15 mm in length or a contractile segment totally distal to the union of the biliary and pancreatic ducts. When the common bile duct appeared to join the main pancreatic duct, the anomalous pancreaticobiliary ductal junction was denoted as B-P subtype; if the main pancreatic duct appeared to join the common bile duct, it was denoted P-B subtype. Fifty-four patients had gallbladder carcinoma, 7 of whom (3 men, 4 women) had anomalous pancreaticobiliary ductal junction (P-B subtype 6, B-P subtype 1). The mean (SD) length of the common channel was 21.0 mm (11.2 mm) with a range of 12 to 45 mm. One patient had early cystic dilation of bile duct. Three other patients had anomalous pancreaticobiliary ductal junction; 1 had an associated choledochal cyst and 2 a normal biliary tree. The overall frequency of anomalous pancreaticobiliary ductal junction was 0.9% (10/1082 cases). The frequency of anomalous pancreaticobiliary ductal junction was significantly higher in patients with gallbladder carcinoma (p < 0.001; OR, 50.7; 95% CI [12.7, 202.3]). Anomalous pancreaticobiliary ductal junction is strongly associated with gallbladder cancer among Chinese patients.

Colangiocarcinoma primario asociado a enfermedad de Caroli

A 68 years old male presented with right hypochondrium abdominal pain and jaundice with no other clinical finding. CAT Scan and Ultrasonography showed right lobe bile duct dilatation. Magnetic Resonance Cholangiopancreatography gave an outstanding vision of a restricted right lobe bile duct dilatation associated to choledocholithiasis. A right hepatectomy and bile duct exploration were performed. The histopathological study disclosed a Caroli disease associated to a primary cholangiocarcinoma. Caroli disease is a congenital disorder characterized by intrahepatic cystic bile duct dilatation with a high risk association with cholangiocarcinoma.

Cholangiocarcinoma in patients with hepatolithiasis and cystic dilatation of bile ducts

Cholangiocarcinoma in patients with hepatolithiasis and cystic dilatation of bile ducts