Cyst Drainage Research Articles

Percutaneous drainage of an infected hepatic cyst, responsible for obstructive jaundice by compression on the intrahepatic biliary tract

Hepatic cysts consist of a heterogeneous group of lesions that differ in etiology, prevalence, and clinical manifestations. Liver cystic lesions fall into two main categories: congenital and acquired. Congenital cystic lesions of the liver include polycystic liver disease, simple cysts, ciliated and duct-related liver cysts. Acquired liver cysts are further divided into infected and non-infected. There are two types of infected cysts, parasitic ones (hydatid cysts and amoebic abscesses) and non-parasitic ones, or pyogenic liver abscesses. Infection is a serious complication of cystic liver disease, which can lead to sepsis and death. A diagnosis of cystic infection is usually made by culturing pathogens from the fluid aspirated from the cyst. If an aspirate is not available for testing, the diagnosis of a liver cyst complicated by infection is made by correlating clinical, biochemical, and imaging findings. Infected liver cysts and liver abscesses can be caused by the portal spread of intra-abdominal infections (e.g., appendicitis, diverticulitis, colitis). The placement of a percutaneous drainage catheter allows controlled aspiration of large abscesses for a short-medium period with minimal hemodynamics and physiological stress for the patient. Furthermore, compared to surgical drainage, the results are comparable, while the morbidity is lower.

AN UNUSUAL CYSTIC PANCREATIC MASS

Hydatidosis is an endemicdisease in Morocco. Localization in the pancreas is very rare especially when isolated. We report the case of a patient admitted in the emergency room for a suppurated pancreatic collection, about 15 cm in diameter, resembling a fistulized Pseudo-pancreatic cyst, or a cystic pancreatic tumoror a pancreatic hydatid cyst. In spite of an initial empirical antibiotic therapy, the unfavorable evolution led us to perform an exploratory laparotomy which confirmed the diagnosis of an isolated pancreatic hydatid cyst. The classic surgical treatment by subcutaneous laparotomy is still effective in this situation, and consists of cyst drainage and a cysto-jejunal bypass on a Y loop to compensate for the pancreatic cyst-channel fistula. Because of the emergency context, large volume, lack of diagnosis certainty and the slow evolution of this cyst, we preferred surgical treatment to per cutaneous or endoscopic drainage.

Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients.

The most common presenting symptom in patients with both small and large Rathke cleft cysts (RCC) is headache (H/A). It is well established that patients with large RCC can have significant symptomatic improvement after cyst drainage. However, patients with small RCC (≤ 1cm) are rarely operated on, even if they present with debilitating H/A. It is not well understood whether resection of these smaller RCCs can lead to durable H/A resolution. A retrospective search of our institutional database for sub-centimeter RCCs presenting with intractable H/A and treated with an endoscopic endonasal approach was carried out. A detailed H/A questionnaire as well as patient chart review was conducted to assess the long-term outcome of these patients after surgical intervention. Ten consecutive patients with 11 endonasal surgeries met inclusion criteria. Eight responded to the questionnaire. The median cyst diameter was 6mm (IQR 3-9). Median preoperative H/A duration was 12months (range 2months-15years). H/As occurred on average for 20days per month and all required analgesics for symptomatic control for more than 15 of these 20days. Half of the patients also had to miss work because of H/A. Average preoperative H/A intensity was 8.7 (scale 0-10) compared with postoperative scores of 2.9 at one month, 1.6 at 3months, and 0.9 at 1year. There were no permanent endocrinological or other surgical complications. After a median follow-up of 2years, one patient had radiographic and symptomatic recurrence which resolved after re-operation. Endoscopic fenestration of sub-centimeter RCCs provides a safe and durable treatment for patients with intractable H/A.

Diagnosis and Treatment of Acne Vulgaris: A Narrative Literature Review

Acne vulgaris usually occurs during puberty due to hormonal changes. However, acne can also occur in adulthood due to factors such as stress, genetics, and overuse of cosmetics. There are various types of treatments for acne, ranging from topical treatments to oral medications and cosmetic procedures. This literature review aimed to describe the diagnosis and treatment of acne vulgaris. Acne is a common skin condition, and the degree of acne can vary from mild to severe. Acne can be classified according to its severity, namely acne degrees I (mild), II (moderate), III (severe), and IV (very severe). Acne therapy that is appropriate to the degree can help reduce inflammation and speed up the healing of skin affected by acne. In grade I acne, therapy begins with topical treatments such as benzoyl peroxide, salicylic acid, or retinoids. In grade II acne, acne therapy involves topical and oral treatments. Oral antibiotics such as tetracycline or doxycycline can help reduce skin inflammation. In grade III acne, acne treatment usually requires stronger oral medications such as isotretinoin. In grade IV acne, acne therapy usually requires more aggressive interventions such as cyst drainage or laser treatment to remove acne scars. In conclusion, determining the right degree of acne vulgaris can improve the accuracy of therapy and cure.

Percutaneous management in hepatic alveolar echinococcosis: A sum of single center experiences and a brief overview of the literature.

Hepatic alveolar echinococcosis (HAE) is a serious zoonotic infection that affects humans. It may have a tumor-like appearance at times. Percutaneous treatment of HAE patients is extremely relaxing for them. HAE is a significant human zoonotic infection caused by the fox tapeworm Echinococcus Multilocularis larvae. It possesses the characteristics of an invasive tumor-like lesion due to its infiltrative growth pattern and protracted incubation period. The disease is endemic over central Europe, Asia, and North America. To characterize HAE patients who were treated percutaneously, their outcomes, and the major technical features of percutaneous treatment in HAE. Patients who were treated with percutaneous cyst drainage and/or percutaneous biliary drainage were included in the study. Uncorrected abnormal coagulation values and solid or non-infected HAE with minor necrotic change were excluded. Thirty-two patients underwent percutaneous cyst drainage, two patients underwent percutaneous biliary drainage, and four patients underwent percutaneous biliary drainage alone. Interventional radiology is utilized to drain echinococcal necrosis and abscesses within/without the liver, as well as diseased and clogged bile ducts. Percutaneous drainage of cyst contents and/or biliary channels using a minimally invasive technique is a very beneficial. Percutaneous cyst drainage with albendazole therapy improves quality of life in patients who are unable to undergo surgery, even when the mass resolves with long-term treatment.

ACUTE DESTRUCTIVE PANCREATITIS IN CHILDREN

Unlike adults, acute pancreatitis in children is a rare disease. The absence of unified standards for the diagnosis, treatment and rehabilitation of children with acute destructive pancreatitis, as well as high rates of complications and mortality, determined the relevance of our study.Materials and methods. Materials and methods. The results of treatment of 11 children with acute destructive pancreatitis were studied. The age of the patients ranged from 2 to 16 years. Laboratory examination in all patients included general and biochemical analyzes of blood, urine, peritoneal and thoracic exudate. All children underwent an ultrasound examination of the abdomen, chest cavity and mediastinum, and plain radiography of the chest and abdominal cavity. Computed tomography was performed in 6 patients (54.5%). Fibrogastroduodenoscopy (FGDS) was performed in 3 patients (27.3%). All patients underwent surgery. In 8 cases (72.7%), a median laparotomy was performed initially. In 3 observations (27.3%), surgical treatment began with video surgical revision of the abdominal organs, and then switched to conversion. Three patients (27.3%) subsequently underwent cystopancreatic jejunostomy. In one child, transcutaneous drainage of a false pancreatic cyst was performed under video surgical control. Synthetic somatostatin analogs and proteinase inhibitors were used as targeted therapy. All patients received long-term antibacterial therapy. Various methods of extracorporeal detoxification were used in 6 patients (54.5%).Statistical processing of the research results was carried out using standard methods with the calculation of relative values (absolute number of observations, % ratio).The approval of the scientific work was received from the Bioethical Commission of the Donetsk National Medical University (Ukraine).The work is a fragment of proactive research work of the Department of General and Children's Surgery of the Donetsk National Medical University (Ukraine). Results. Complications in the early postoperative period were noted in 8 children (72.7%). The group of the most severe complications included progressive enzymatic bacterial peritonitis, early adhesive intestinal obstruction, failure of cystopancreatic ileal anastomosis, profuse arrosive hemorrhage from the pancreas, cystopancreaticodigestive fistula and eventation. In the early postoperative period, 1 child aged 14 years (9.1%) died, and the rest of the patients were discharged in satisfactory condition. The average hospital stay for children was 23.1 days. In 7 patients (63.6%), complaints characterized by "enteric" discomfort occurred later.Conclusions. The principles of surgical and therapeutic tactics in children with acute destructive pancreatitis are based on a differentiated approach depending on the form of pancreatic necrosis and the development of purulent and destructive complications. Further study requires determination of situational surgical tactics, assessment of the effectiveness of combined therapy with somatostatin and proteinase inhibitors, selection of the optimal regimen of nutritional therapy and rehabilitation.

Decompression drainage of jaw cysts as a method of providing emergency surgical care and treatment of the crew of ships and vessels

OBJECTIVE: Based on the data of domestic and foreign literature, as well as our own research, to evaluate the possibility of treating patients with extensive jaw cysts, including those undergoing military service in seafarers, using various surgical methods.MATERIALS AND METHODS: A review of the literature presented in domestic and foreign scientometric databases over the past 10 years was made. 15 domestic and 37 foreign scientific papers from the PubMed international medical library, the CyberLeninka electronic library and the elibrary medical electronic portal were analyzed. Publications were studied for the following keywords: odontogenic cysts of the jaws, cystectomy, cystotomy, marsupialization, decompression drainage, guided bone regeneration, keratocysts.RESULTS: During the study of specialized literature over the past 10 years, it was revealed that in the context of the treatment of extensive jaw cysts, the description of the cystectomy operation was most common: in 65.0% of domestic and 50.0% of foreign literature sources. Cystotomy was found in 25.0% and 33.3% among domestic and foreign sources. The method of marsupialization was used less often only in 10.0% in domestic literature and in 17.7% in foreign literature.DISCUSSION: Analysis of literature sources of domestic and foreign databases has demonstrated the most frequent use of cystotomy and cystectomy in the treatment of extensive jaw cysts and extremely rare use of decompression drainage, despite the significant advantages of using the marsupialization method, namely minimizing the likelihood of damage to neighboring anatomical structures, preventing subsequent possible deformation of the jaws, reducing the risk of recurrence of jaw cysts, as well as the development of postoperative and intraoperative complications compared with cystotomy and cystectomy.CONCLUSION: Based on the review of the literature and our own research, this article examines the main options for surgical treatment, and also assesses the possibility of using decompression drainage to provide emergency care in a campaign and treat military personnel with extensive cavity formations of the jaws.

Autosomal Dominant Polycystic Kidney Disease: Role of Imaging in Diagnosis and Management.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disorder with progressive renal function decline, and disease severity is determined based on the type of genetic mutation. The diagnosis is usually established at imaging, primarily at US, and is based on age-dependent criteria and the number of visible cysts. ADPKD is classified into class 1 (typical) and class 2 (atypical) according to the Mayo Clinic Imaging Classification (MCIC) system. Height-adjusted total kidney volume (TKV) has emerged as a predictor of future renal function decline and renal failure in ADPKD, and several methods can be used for estimation. MCIC class 1 ADPKD is further subdivided into five types based on height-adjusted TKV (A, B, C, D, and E). Patients with a larger height-adjusted TKV (ie, MCIC 1C-E) are at high risk for progression to end-stage renal disease and will potentially benefit from vasopressin receptor antagonists, which have been shown to reduce the rate of cyst growth and slow renal function decline. Other renal complications primarily relate to hemorrhage within cysts or cyst infections. Subtraction images are key for assessment of complex cysts when malignancy is suspected, as the presence of protein and blood can limit the assessment for an enhancing component. The radiologist has a central role in establishing a diagnosis, excluding mimics, identifying complications, assessing severity, and predicting future renal failure. Interventional radiologists play a therapeutic role in management of complications by cyst drainage, sclerotherapy, or embolization. © RSNA, 2022 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Simple drainage versus drainage with minocycline infusion for symptomatic hepatic cysts.

Percutaneous treatment of symptomatic hepatic cysts includes simple drainage and drainage with sclerosing agents. We compared the efficacy of simple drainage with that of drainage with minocycline infusion for treating symptomatic hepatic cysts. We retrospectively evaluated 11 patients who underwent percutaneous drainage of symptomatic hepatic cysts. In seven cases, minocycline infusion was added at the discretion of the clinician. Cyst volume was evaluated before drainage, immediately after drainage, and after long-term follow-up. Cyst volume was calculated before treatment by multiplying the orthogonal diameters using the ellipsoid formula. Relapse was defined as the regrowth of the cyst with symptoms. Cyst volume immediately after drainage and after long-term follow-up was significantly less than that before treatment for the drainage with minocycline infusion group (p<0.05) but not for the simple drainage group. The relapse rates were 25% (1/4) for the simple drainage group and 0% for the drainage with minocycline infusion group. Drainage with minocycline infusion could be a promising option for treating symptomatic hepatic cysts, although simple drainage was not reliable.

Drainage of the Hepatic Cyst by Laparoscopy: Clinical Case

Drainage of the Hepatic Cyst by Laparoscopy: Clinical Case

EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video).

Background and study aims Simple hepatic cysts (SHCs) are usually asymptomatic and detected incidentally. However, larger cysts may present with clinical signs and require treatment such as percutaneous aspiration or surgery with non negligeable rate of recurrence. We report a series of 13 consecutive patients who underwent EUS-guided lumen-apposing metal stent (LAMS) drainage of SHCs of the right and left liver. Patients and methods Nine men and four women, average age 71.9 years, underwent EUS-guided LAMS cyst drainage because of significant symptoms. At 1 month, LAMS was exchanged for a double pigtail stent (DPS), which was left in place for 3 months. Nine of the SHCs were located in the right liver and four in the left. The average diameter was 22.2 cm. Results Thirteen LAMS were successful delivered in all patients. However only 12 of 13 (92.3 %) remained in place. In one case, the LAMS slipped out immediately and was promptly removed and the cyst treated percutaneously. One of 12 patients experienced bleeding, which was treated conservatively. In seven patients, the LAMS was exchanged for a DPS; in the other five, it was successfully left in place until the patients died, given their comorbidities. At 10.5 months of follow-up, none of the SHCs had recurred. Conclusions EUS-guided LAMS drainage permits treatment of symptomatic SHCs without recurrence and with few adverse events. Comparative studies are needed to consider this approach as first intention.

Transient Ageusia and Dysgeusia Following Thalamic Cyst Drainage.

Taste consists of perception and sensation. Specific neural structures transmit a stimulus from the taste buds to the gustatory cortex to generate taste sensation. Any disruption of this pathway, whether it affects sensation or perception, can result in taste disorders. Stereotactic procedures involving the thalamus may result in gustatory complications. A 41-year-old female patient who underwent stereotactic drainage of a thalamic cyst suffered transient ageusia. Subsequently, she developed metallic taste perception. When her stereotactic plan was re-evaluated, it was noted that the posteromedial ventral thalamus nucleus was in the path of the needle tract and the needle had passed through it. Follow-up was recommended and her symptoms completely resolved within 2 months following surgery. Modern imaging techniques allow for the visualization of neural structures related to the sense of taste. Additionally, care must be taken when planning stereotactic procedures for such lesions.

Idiopathic thoracolumbar spinal epidural arachnoid cysts: A case report and systematic review.

Idiopathic spinal epidural arachnoid cysts (SEACs) are rare and may cause myelopathy and cord compression. They typically arise from a congenital defect in the dura that communicates with the intrathecal subarachnoid space. Although the ideal treatment of SEACs is direct dural repair and cyst excision, there is as yet no clear standard of care for the management of these lesions. A 47-year-old female presented with myelopathy attributed to an magnetic resonance imaging-documented posterior epidural T12-L2 cyst (i.e., 1.1 × 6 × 3.3 cm) lesion. The patient underwent a direct dural repair of the fistulous communication between the subarachnoid space and the cyst, along with cyst drainage/ excision through a right-sided laminotomy. Postoperatively, the patient was asymptomatic. We additionally reviewed the literature regarding the management of SEACs. Our review yielded 14 articles involving 18 patients with predominantly thoracolumbar (57%) SEACs that were either communicating (61%) or not communicating (39%) with the subarachnoid space. They averaged 35.5 years of age and exhibited a male preponderance (66%). Symptoms typically included pain (78%), followed by weakness/myelopathy (42%). Surgery frequently included bilateral laminectomies (57%) followed by unilateral laminectomies (50%) that typically resulted in symptom resolution. SEACs are rare typically thoracolumbar lesions that may cause myelopathy which resolves following direct dural closure/subarachnoid fistulous occlusion.

Arthroscopic Treatment of Lateral Meniscal Cyst Causing Peroneal Nerve Injury.

Compression of the common peroneal nerve by lateral meniscal cysts is rare. We report a 29-year male patient who complained of a gradually enlarging mass in the right popliteal fossa. He was diagnosed with a lateral meniscal cyst and a common peroneal nerve injury. The patient underwent arthroscopic surgery, including lateral partial meniscectomy and cyst drainage. When followed up at 3 months, the dorsal extensor strength of the right foot recovered to grade 5, and sensation of the distal right lower limb returned to normal. No recurrence of the cyst was found at the last follow-up at 18 months. This is a rare case of common peroneal nerve paralysis caused by a lateral meniscal cyst. Key Words: Meniscal cyst, Common peroneal nerve, Nerve injury.

An Effective Surgical Strategy for Anteromedial Osteoarthritis of the Knee with Simultaneous Popliteal Cysts Drainage

Unicompartmental knee arthroplasty (UKA) is an established treatment option for anteromedial osteoarthritis, and popliteal cysts are a common finding in the knee among patients with chronic osteoarthritis pain. The two are so closely related that popliteal cysts are commonly discovered during the unicompartmental knee arthroplasty preoperative examination. However, only a few reports exist on the management and outcome of popliteal cysts in the patients receiving UKA for knee osteoarthritis (OA) and popliteal cysts. As such, it is crucial to evaluate different treatment strategies and their management of popliteal cysts. In this paper, we evaluate a surgical strategy for patients with knee anteromedial osteoarthritis and symptomatic popliteal cysts. These patients were treated with UKA and internal drainage of the popliteal cyst. The results shown here, spanning 1-year post-operation follow-up, demonstrated that UKA and internal drainage is an effective surgical protocol for treating anteromedial osteoarthritis with symptomatic popliteal cysts.

Arthroscopic internal drainage of popliteal cysts with cyst wall resection in pediatric patients.

To evaluate the efficacy of arthroscopic internal drainage (AID) and cyst wall resection (CWR) in children with popliteal cysts. This study included 16 pediatric patients with popliteal cysts and received arthroscopy using the double posteromedial (PM) portal system during June 2020 and June 2021 at The General Hospital of Northern Theater Command. Among these pediatric patients, 14 were males and two were females, with the mean age of nine years (range: 7-12 years). The left knee was affected in 12 cases, while the right knee was involved in the rest four cases. All patients underwent MR imaging before the procedure to assess whether there was intra-articular trauma and whether the popliteal cyst communicated with the knee-joint cavity. The MRI results showed that each patient had a simple popliteal cyst that involved a single knee joint without intra-articular trauma, which was classified as Grade-1 (n=3), Grade-2 (n =10) or Grade-3 (n =3) according to the Rauschning and Lindgren grading of knee joint symptoms. Arthroscopy was performed through anterolateral (AL) and PM portals to the knee joint for AID plus CWR, and the surgical outcomes were evaluated based on the Rauschning and Lindgren criteria. No major vascular or nerve injury occurred during the operation. Postoperative complications such as wound infection and lower-extremity deep venous thrombosis were not recorded in these patients. Complications involving the saphenous nerve or the great saphenous vein or pseudocyst formation were not observed during the follow-up period. All patients completed the follow-up ranging from 3-12 months and were identified to have grade-0 (n=15) and grade-1 (n=1) popliteal cysts based on the Rauschning and Lindgren criteria, indicating significant improvement compared with the preoperative levels (all p<0.05). Moreover, no recurrence was recorded after operation. AID plus CWR is a minimally invasive and safe approach for pediatric patients with popliteal cysts to promote postoperative recovery and reduce the recurrence rate.

Clinical Effect of Flexible Ureteroscope and Laparoscope in the Treatment of Parapelvic Cyst.

Objective Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst. Method A total of 82 patients with parapelvic cyst who underwent surgical treatment in our hospital from May 2019 to May 2020 were selected. Patients were randomly divided into a control group and an observation group; the control group underwent laparoscopic parapelvic cyst topical decompression; the observation group underwent transurethral flexible ureteroscope holmium laser incision and drainage of parapelvic cyst. The intraoperative (operative time, intraoperative blood loss, and ventilation time), postoperative (time of getting out of bed, pain score, and length of hospital stay), and recurrence were compared between the two groups. Results (1) The operative time and intraoperative blood loss in the observation group were significantly better than those in the control group (P < 0.05), while the ventilation time had no significant difference (P > 0.05). (2) The pain score and length of hospital stay in the observation group were better than those in the control group (P < 0.05). There was no significant difference in the time of getting out of bed (P > 0.05). (3) There was no serious infection or bleeding in either group. The observation group had no recurrence, and the postoperative recurrence rate was 0. There were 11 cases of recurrence in the control group, and the postoperative recurrence rate was 26.83%. The postoperative recurrence rate of the observation group was significantly lower than that of the control group, with statistical significance (χ2 = 4.604, P < 0.05). Conclusion Flexible ureteroscope for the treatment of parapelvic cyst could effectively reduce the operative time, intraoperative blood loss, and pain; in addition, the postoperative recovery was fast and the recurrence is rare, which was worth popularizing.

S1708 Combination of Pancreatic and Hepatic Pseudocyst in a Patient With Pancreatitis: A Case Report

Introduction: Pancreatic pseudocysts are common occurrences after episodes of acute pancreatitis. Up to 20% of pseudocysts are extra-pancreatic throughout the abdomen including intrahepatic. There are only a few cases of hepatic pseudocysts reported in the literature. We report this unique case with both pancreatic and intrahepatic pseudocysts occurring at the same time in a patient with pancreatitis. Case Description/Methods: A 56-year-old White woman with history of alcoholism and chronic pancreatitis, presented with epigastric and left upper quadrant abdominal pain radiating to the left shoulder. Examination revealed tenderness in the epigastric and left upper quadrant of the abdomen. Labs showed an elevated lipase of 217 IU/L (13-60), normal total bilirubin and transaminases, hemoglobin of 9.1 g/dL(11.5-15), and slight leukocytosis 12.6 K/uL (3.7-10.4). She was admitted 3 times in the last 4 months. Prior computerized tomography (CT) scan showed pseudocysts in the head and tail of the pancreas. CT scan this admission showed a decreased size of pseudocyst in the pancreatic head from 2.5 cm to 2.2 cm and pancreatic tail from 4.2 cm to 3.7 cm (Figure). It also showed 2 subcapsular fluid collections in the left lobe of the liver measuring 9X5X2cm and 9X7X3 cm. Percutaneous drainage of the hepatic cysts with the placement of a drainage catheter was performed by interventional radiology. 50 mL of bilious appearing fluid was drained with negative gram stain and cultures with an elevated fluid amylase level of 1,765 U/L. The patient’s pain improved and a subsequent CT a few weeks after discharge showed a decrease in the size of the hepatic cysts. Discussion: This is the first documented case of combined pancreatic and intrahepatic pseudocyst formation. Elevated amylase level in the hepatic fluid analysis confirmed the diagnosis of a hepatic pseudocyst. The interesting fact is that the size of the pancreatic pseudocyst decreased as the hepatic pseudocyst increased because of fluid tracking likely in the pre-renal space or along the hepato-gastric ligament. The diagnosis of hepatic pseudocyst needs to be considered in a patient with new hepatic fluid collection with a recent history of pancreatitis and pancreatic pseudocyst.Figure 1.: A – Axial CT showing previous pancreatic pseudocyst prior to admission B – Axial CT showing new hepatic pseudocyst adjacent to falciform ligament during admission C – Axial CT showing drain in hepatic pseudocyst.

Management Strategies for Choledochal Cysts in Infants and Children Our Experience at Department of Pediatric Surgery ,L.R.H, Peshawar

Objective: This study aims to understand more about choledochal cysts and how they are managed in children under 12 years old. Setting and Design: A Descriptive Study at Department of Pediatric surgery L.R.H. Hospital Peshawar. Method and Material: The most common kind of malformation of the biliary tree in Pakistan is choledochal cyst malformation (C.C.M.). Congenital choledochal anomalies range from asymptomatic to life-threatening cholangitis or pancreatitis. Surgeons now recommend total cyst ectomy and bilioentenric anastomosis. This five-year research examines. Clinical presentation, blood and laboratory testing, imaging, surgery, and predictive data were evaluated from case records. Twenty-three children with choledochal cysts were treated between January 2019 and December 2021, and their clinical presentation, diagnostic tests, and treatments were recorded. ERCP or a cholangiogram confirmed choledochal cysts after ultrasound diagnosis (P.O.C.). Before surgery, children with cholangitis received antibiotics and percutaneous transhepatic biliary drainage (excision of the cyst and jejunal loop interposition hepaticoduodenostomy) Results: Twenty-three patients were analyzed; eight presented with chronic abdominal pain, five with a history of cholangitis, two with acute cholangitis, four with biliary peritonitis, and one with a history of pancreatitis. Following cyst excision, Roux-en-Y hepaticojejunostomy (RYHJ) was performed in 13 patients, and hepaticoduodenostomy (H.D.) was performed in 4 patients. One example of congenital choledochal malformation type II was treated with cyst excision and drainage because cholangitis and jaundice threatened the patient's life. The median age was 3, and the gender distribution was about even. Of the patients who sought care, 18 presented with jaundice, 15 with abdominal discomfort, 12 with fever, and 9 with a mass in their stomach. Only four people had all three symptoms of characteristic jaundice, pain, and lump. Overall, the results of both ERCP in 7 patients and P.O.C. in 14 cases were favorable. There were two distinct clinical presentations: I infantile form (less than a year), which included nine infants with jaundice in all, acholic stool in 7, lump abdomen in 4, but only one with classical triad; and (ii) childhood form (more than a year), which included twelve patients with abdominal pain, jaundice, and cholangitis. Twenty patients had a type I cyst, and three had a type Iva cyst. Only two kids said no to surgery, while the rest went through with it. Only three newborns were lost during surgery, but the other 18 did well following their follow-up visits (median 25 months). Six had extrahepatic biliary atresia, two had congenital hepatic fibrosis, and one had congenital biliary cirrhosis. Practical implication: Our study will provide a new data to the health care providers about choledochal cysts and how they are managed in children under 12 years old Conclusions: However, total cyst removal and Roux en Y hepaticojejunostomy (RYHJ) anastomosis is the definitive treatment of Congenital Choledochal Malformation. However, several other temporary therapies are also necessary at various phases of the illness. Their criticality—evolutionary stages may differentiate two types of choledochal cysts from infancy through adulthood. The prognosis is favorable following surgery, but early identification and referral are critical for reducing the risk of complications and mortality. Keywords: Choledochal cyst, ERPC, H.D., RYHJ, and C.C.M. (Endoscopic retrograde cholangiopancreatography)

Clinical efficacy of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts

ObjectiveThis study aims to investigate the efficacy and safety of intraoperative real time ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts, and to review recently published relevant literature.MethodThis is a retrospective study in which the clinical data of 47 patients who underwent flexible ureteroscopic holmium laser incision and internal drainage of parapelvic cysts in our center from March 2017 to March 2021 were retrospectively analyzed. A literature search was conducted to review and summarize relevant reports on endoscopic treatment of parapelvic cysts published in the past 10 years.ResultsAmong 47 patients with parapelvic cysts who underwent flexible ureteroscopic holmium laser incision and internal drainage, 12 (25.53%) cases had a typical cyst wall bulging into the collecting system under flexible ureteroscope. As the cyst wall was thin and translucent in these cases, ultrasound was not used during the operation. The cysts of the remaining 35 patients were located with the aid of intraoperative real time ultrasound, and all underwent successful operation. No serious surgical complications occurred after surgery. The patients were followed up for 12–24 months after operation. The cyst in one case was observed larger than its original size before operation, so recurrence was considered. In another two cases, the diameters of the cysts were more than half of their original diameters before operation. Thus, the efficacy was poor in the three cases. For the remaining 44 cases, there was no obvious cyst observed or the diameter of the cysts was less than half their preoperative level.ConclusionThe approach of ultrasound-assisted flexible ureteroscopic holmium laser incision and internal drainage in the treatment of parapelvic cysts is safe and effective, which helps to solve the problem of localization of atypical parapelvic cysts on endoscopic findings.